Ganglio centinela en la metástasis ganglionar por cáncer papilar de tiroides: validez diagnóstica y aplicación en la práctica clínica / Sentinel lymph node biopsy in papillary thyroid cancer: Accuracy and application in clinical practice

Introducción La biopsia selectiva del ganglio centinela (BSGC) puede completar el estudio preoperatorio detectando adenopatías no visibles ecográficamente. De este modo, se puede estadificar a los pacientes y estratificar el riesgo de recidiva de forma más precisa y, por tanto, ayudar a definir el tipo de tratamiento tanto quirúrgico como con 131I que debemos realizar. El objetivo fue validar la BSGC para su utilización en el diagnóstico de la metástasis ganglionar por cáncer papilar de tiroides. Métodos Estudio observacional prospectivo de cohortes que incluye a 55 pacientes intervenidos por cáncer papilar de tiroides sin sospecha de afectación ganglionar clínica o radiológica, desde febrero de 2012 hasta febrero de 2015, con un seguimiento de entre 6 y 8 años. Se utilizó 99Tc con nanocoloide intratumoral y una sonda portátil de la gammacámara para la detección de los ganglios centinelas. Variables: edad, género, histológicas, analíticas y estadificación preoperatoria y postoperatoria. Se calculó la sensibilidad, la especificidad y los valores predictivos de la técnica. La validación se determinó calculando la detectabilidad y los falsos negativos de la prueba. Resultados En 53 de los 55 (96,36%) pacientes hubo detección del ganglio centinela. Los falsos negativos fueron 4 (7,5%) pacientes. Del resto, tras aplicar la BSGC, 24 (48,9%) se mantuvieron como N0, 14 (28,5%) pasaron a ser N1a y 11 (22,4%) se clasificaron como N1b. Las diferencias observadas en el estudio fueron significativas (p<0,05). La sensibilidad fue del 86,21%, la especificidad del 100%, el VPP del 100% y el VPN del 85,71%. La precisión diagnóstica fue del 92,45%. Conclusiones La BSGC es una técnica válida para su utilización en los pacientes afectos de cáncer papilar de tiroides, con una alta precisión diagnóstica (AU)

Introduction The presence of lymph nodes metastasis in papillary thyroid cancer modifies the type of surgical resection as well as the indication of the treatment with 131I in the postoperative period. This therapeutic approach is based on the results of the diagnostic tests, like the cervical ultrasonography. Currently other methods of diagnostic are tested as selective sentinel lymph node biopsy (SLNB). It can complement to the ultrasound results. The aim was to validate the SLNB for use in the diagnosis of lymph node metastasis by papillary thyroid cancer. Methods Observational prospective cohort study of 55 patients who underwent papillary thyroid cancer without suspicion of lymph node involvement clinical or radiological, since February 2012 through February 2015, with a follow-up between 6 and 8 years. It was used 99Tc with intratumoral nanocoloid and a portable tube of the gamma camera for the detection of the sentinel node. Variables: age, gender, histological, analytical and preoperative and postoperative staging. The sensitivity, specificity and predictive values of technique was calculated. The validation was determined by calculating the detectability and the false negative results of the test. Results In 53 of the 55 patients (96.36%) there was the sentinel node detection. The false negative were 4 patients (7.5%). Of the rest, after applying the SLNB, 24 (48.9%) were kept as N0, 14 (28.5%) became N1a and 11 (22.4%) were classified as N1b. The differences observed in the study were significant (P<.05). The sensitivity was 86.21%, the specificity of 100%, the PPV was 100% and the NPV of 85.71%. The diagnostic accuracy was 92.45%. Conclusions The SLNB is a valid technique for use in patients suffering from papillary thyroid cancer with a high diagnostic accuracy (AU)

Frequencies of the precision ID ancestry panel markers in Basques using the Ion Torrent PGMTM platform.

The Precision ID Ancestry Panel for the Ion Torrent PGM™ platform is able to genotype 165 autosomal SNPs by massively parallel sequencing (MPS). In the present study, we evaluated the depth of coverage, the locus strand balance and the heterozygote balance of the above panel. The SNPs rs1569175, rs2306040, rs9845457, rs1407434, and rs10007810 showed a low performance, due either to a low coverage, locus strand imbalance or heterozygote imbalance. To further to assess this panel, we analyzed 108 Basques. All loci proved to be in Hardy-Weinberg equilibrium and we did not detect any association between them with the exception of the pair rs3916235-rs4891825 in chromosome 18. The forensic parameters combined match probability and combined power of exclusion were estimated to be 3.13×10-35 and 99.9972%, respectively. In conclusion, the Precision ID Ancestry panel along with this new MPS technology constitute a very promising tool for human identification and biogeographical ancestry inference in routine casework in the forensic field.

The use of velodrome tests to evaluate aerodynamic drag in professional cyclists.

The purpose of this study was to analyse the validity, reliability and sensitivity of velodrome tests to detect small changes in aerodynamic drag in cycling. 12 professional cyclists were assessed to obtain the drag area (SCx) during wind tunnel and velodrome tests. Incremental and steady-state protocols were performed in the velodrome with a portable power meter, and 6 bicycle positions were analysed and compared that involved lowering the handlebars and advancing the pads between 2-5 cm. A significant relationship (r=0.88, p<0.001) between the SCx in the wind tunnel and velodrome tests was found (0.240 ± 0.007 and 0.237 ± 0.008 m2, respectively). The velodrome tests underestimated the SCx (0.0035 ± 0.0038 m2 and p<0.01), which decreased (p<0.001) when the bicycle speed increased (0.0013 m2 each 1 km · h(-1)). The SCx values showed high reliability during the steady-state (r=0.99, p<0.001) and incremental protocols (r=0.94, p<0.001). Small changes in the aerodynamic position affected the SCx (p<0.001), which decreased by 0.011 ± 0.007 m2 (4.6 ± 2.9%, 95% CI=2.7-6.4%). In conclusion, the validity, reliability and sensitivity of velodrome tests to detect small changes in aerodynamic drag in cycling were demonstrated. Although SCx values were not interchangeable between different studies, the velodrome tests presented advantages with respect to the wind tunnel tests.

Biomodelo para la docencia de grado y postgrado en pediatría / Biomodel for teaching undergraduate and graduate in pediatrics

Introducción: La incorporación de la Clínica y la Imagenología permiten una mejor comprensión de la Anatomía. El objetivo de este trabajo es desarrollar un prototipo rápido en material sintético que replique detalles anatómicos para ser utilizado en la docencia de grado y postgrado en Pediatría. Material y Método: Caso 1: Niña de 1 año de edad con síndrome de dificultad respiratoria a causa de una malformación vascular. Caso 2: recién nacido con malformación torácica. Con la finalidad de analizar una conducta adecuada, se solicitó la confección de un prototipo rápido a escala 1:1 que simulara una condición idéntica a la topografía torácica del paciente, utilizando imágenes virtuales 3D almacenadas en formato DICOM.Técnica de generación de prototipo rápido: Se obtuvouna malla digital tridimensional y se generó el código “g”que se utilizó para controlar el hardware de producción. Se efectuó simulación digital y producción en material plástico (ABS) con técnica de deposición y fusión (MDF).Se validó el prototipo comparándo lo con las mediciones testigos del modelo virtual en 3 D.Resultados y Discusión: El modelo replicó exactamente los defectos hallados en la tomografía y endoscopía, confirmando la presencia de la malformación vascular y su repercusión sobre el aparato respiratorio. El prototipo rápido muestra las estructuras internas y externas del cuerpo humano con máxima precisión permitiendo una visión topográfica de situaciones “normales o patológicas” que facilitaría la docencia y el entrenamiento del equipo quirúrgico para proponer un plan de tratamiento adecuado. Hay numerosas áreas de la medicina que sebeneficiarían con este modelo que podría ser construído con diversos tipos de materiales de diferente flexibilidad y consistencia. Conclusiones: El prototipo rápido le da estado físico a las imágenes virtuales 3D, permitiendo la docencia y entrenamiento del equipo quirúrgico.

Introduction: The incorporation of the clinic and the imaging allow a better understanding of anatomy. Theaim of this work is to develop a rapid prototype in synthetic material that replicates anatomical details to be used inteaching and surgical training in Pediatrics. Material and method: Case 1: one year old female with respiratory distress syndrome because of vascular malformation. Case 2: newborn patient with thoracic malformation. In order to discuss appropriate conduct, the making of rapid prototyping in scale 1:1 was requested to simulate an identical condition of the thoracic topography of the patients, using virtual 3D images stored in the DICOM format. Rapid prototype technique: code "g" was generated, which was used to control the hardware of production and a three-dimensional digital grid was obtained. Digital simulation and production in plastic (ABS) with deposition and fusion technique (MDF) was performed. The prototype was validated by comparing measurements with witnesses of the virtual model in 3 D. Results and discussion: the model replied exactly the defects found in the scan and endoscopy, confirming the presence of vascular malformation and its impact on the respiratory system. Rapid prototype shows the internal and external structures of the human body with maximum precision allowing a topographic view of "normal or pathological" situations that would facilitate the teaching and training of the surgical team to propose an appropriate treatment plan. There are many areas of medicine that would benefit from this model that couldbe built with different types of materials with different flexibility and consistency. Conclusions: Rapid prototype gives form to virtual 3D images, allowing teaching and training of the surgical team.

Ginecomastia e hipertiroidismo: estudio hormonal a propósito de un caso / Gynecomastia and hyperthyroidism : hormonal study of one case

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Coma prolongado con daño neurológico por un insulinoma oculto / Prolonged coma with severe neurological damage due to an unsuspected benign insulinoma

Una mujer de 30 años ingresó en el hospital en coma profundo sin causa aparente ni duración conocida. Los estudios posteriores revelaron un hiperinsulinismo endógeno con hipoglucemia como origen del cuadro. La cateterización selectiva arterial de las ramas del tronco celíaco con inyección de calcio y recogida de muestras en vena hepática permitió localizar un insulinoma en la cabeza pancreática, no evidente en ninguna de las otras exploraciones practicadas. La cirugía subsiguiente fue curativa, pero quedaron secuelas neurológicas con lesiones groseras evidentes en la RMN. Aunque infrecuente, la posibilidad de una hipoglucemia debida a un insulinoma debe tenerse presente en el diagnóstico diferencial de un paciente en coma sin etiología evidente. El debut de un insulinoma con un único episodio de coma puede tener un efecto devastador a nivel cerebral, con importantes secuelas neurológicas (AU)

A single blind comparative study between Itraconazole and Fluconazole in the one-day treatment of vulvo-vaginal candidiasis.

PIP: This single-blind comparative study compares the efficacy and safety of oral itraconazole and fluconazole in the 1-day treatment of vulvo-vaginal candidosis. A total of 27 nonpregnant, symptomatic patients with microscopically proven vaginal candidiasis were included in the study. Patients assigned to the fluconazole group received a single oral dose of 150 mg, while those assigned to the itracozanole group received 200 mg twice a day, after breakfast and after dinner. In the analysis of comparative mycological effectiveness of the drugs, fluconazole shows a 55.6% cure rate, 33.3% failure rate, and 11% relapse/reinfection, while itraconazole has a 76.9% cure rate, 73.1% failure rate, and no relapse/reinfection. Researchers could not draw any conclusions regarding the efficacy of the two drugs because of the small sample size. However, it was found that neither drug showed any significant adverse effect. Both appear to be safe, convenient, and well tolerated at the recommended doses.^ieng