Effect of Pleurotus agaves mushroom addition on the physicochemical and sensory properties of blue maize tortillas produced with traditional and ecological nixtamalization.

The physicochemical, nutritional and sensory properties of flours, doughs and tortillas made with traditional nixtamalization (TN) and ecological nixtamalization (EN) and enriched (9%) with the traditional maguey mushroom (Pleurotus agaves) were analysed. EN resulted in flours and tortillas having a greater content of bioactive compounds than that of TN flours, which represents a production process of maize tortillas containing high amounts of antioxidants. The addition of mushrooms to EN flours improved their sensory properties, whereas the addition of mushrooms to TN flours decreased them. The amount of P. agaves added to tortillas was equivalent to 3% enrichment with ß-glucans. The edible mushroom P. agaves, highly appreciated in many Mexican regions, improved the nutritional and sensory quality of blue maize tortillas when added to flours prepared by EN. A new product was developed using local traditional foods of complementary nutritional value.

Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador.

BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

Administration of vitamin D and high dose of omega 3 to sustain remission of type 1 diabetes.

OBJECTIVE: Two cases of Type 1 Diabetes (T1D) in pediatric subjects treated with supplementation with high dose vitamin D and omega 3 are reported. A similar pattern of remission of the disease was observed, resulting in restoration and subsequent persistence of optimal metabolic control, one and two years after T1D onset. Minimal basal insulin administration (0.1 IU/kg/die) in a single evening injection was required. The immunomodulatory and anti-inflammatory properties of the supplements were likely contributing to the observed effect. Similarities in genotyping and autoantibody patterns in these two cases could be of assistance to identify which subjects with T1D could benefit from this supplemental therapy. High dose vitamin D and omega 3 could be of assistance in childhood T1D therapy, to prolong preservation of endogenous insulin secretion in the absence of side effects. We do not know how long the state of remission can last, but these initial results are promising and represented a significant benefit for the two pediatric subjects treated. Larger controlled studies will determine the long-term effect of this proposed supplementation and its possible cost-benefits, including reduction of hypoglycemic episodes and complications.

Utilidad de la técnica ROLL en la exéresis de lesiones no palpables de mama / Use of the ROLL technique for lumpectomy in non-palpable breast lesions

Objetivo: Evaluar la eficacia de la localización radioguiada de lesiones no palpables de mama (LNPM) respecto al arpón quirúrgico. Método: Se han estudiado prospectivamente 161 mujeres con LNPM, 80 marcadas con arpón (grupo 1) y 81 con inyección intratumoral de 99mTc nanocoloide (grupo 2). Las lesiones se localizaron por ecografía o estereotaxia. Las tumorectomías se realizaron, en el grupo 1 siguiendo la dirección del arpón y en el grupo 2 con la ayuda de una sonda gammadetectora. Posteriormente se comprobaron los márgenes quirúrgicos, determinando la necesidad de ampliación si el margen era menor a 5 mm en el estudio intraoperatorio y menor a 2mm en el estudio diferido. Se recogieron datos de porcentaje de detección quirúrgica, afectación de márgenes quirúrgicos, número de ampliaciones, presencia de lesión residual en la ampliación, número de reintervenciones, volumen de la tumorectomía y volumen total extraído, ratio volumen/tumor y complicaciones. Resultados: No hubo diferencias significativas entre ambos grupos en porcentaje de detección, afectación de márgenes, número de ampliaciones, presencia de lesión residual en la ampliación, reintervenciones, volumen de la tumorectomía, volumen total extraído, ratio volumen/tumor y complicaciones. El análisis multivariante mostró que los factores condicionantes del volumen extraído son la técnica de marcaje radiológico y el cirujano. Conclusiones: La técnica de localización radioguiada de lesiones ocultas permite la detección y exeresis de las LNPM con la misma eficacia que el arpón y añade la posibilidad de detección simultánea del ganglio centinela. Los condicionantes del volumen extraído son la técnica de marcaje radiológico y el cirujano (AU)

Objective: To evaluate the efficiency of radioguided occult lesion localising in non-palpable breast lesions (NPBL) compared to the surgical wire technique. Method: A prospective study was conducted on 161 women with NPBL, of whom 80 marked with the wire (group 1), whereas 81 women were marked with an intratumour injection of 99mTc-nanocoloid (group 2). The NPBL were located by ultrasound or stereotactic guidance. The lumpectomies were performed following the wire direction in group 1, and with the aid of a gamma-probe in group 2. Surgical margins were then checked, determining the need of extension if the margin was less than 5mm in the intra-surgical study, and less than 2mm in the deferred study. Data were collected on the mean number detected by surgery, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, as well as total resected volume, volume/tumour ratio, and complications. Results: No significant differences were observed between the two groups in the mean number detected, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, total resected volume, volume/tumour ratio or complications. The multivariate analysis showed the determining factors of the resected volume were the radiological guidance technique, as well as the surgeon. Conclusions: The radioguided occult lesion localising technique helps in the detection and resection of NPBL with the same efficiency as the surgical wire, and adds the possibility of sentinel node detection in the same surgery. The determining factors of the resected volume were the radiological guidance technique and the surgeon (AU)

Can Type 1 diabetes progression be halted? Possible role of high dose vitamin D and omega 3 fatty acids.

In Type 1 Diabetes (T1D) in children, close to the onset the requirements of insulin are often reduced. This represents a transient recovery of endogenous insulin secretion named "honeymoon" because transient and followed by a progressive decline in C-peptide secretion. This case report describes the effect of administration of high dose vitamin D and Ω-3 fatty acids on T1D progression in a 8-year-old child. At today after one year and a half from the onset of T1D, the subject shows a near-normal blood glucose with the administration of 1.5-2 UI of insulin once a day. Thus this report may be of assistance to design additional studies to determine and validate the effect of administration of vitamin D and Ω-3 fatty acids on the progression of T1D.

Use of the ROLL technique for lumpectomy in non-palpable breast lesions. / Utilidad de la técnica ROLL en la exéresis de lesiones no palpables de mama.

OBJECTIVE: To evaluate the efficiency of radioguided occult lesion localising in non-palpable breast lesions (NPBL) compared to the surgical wire technique. METHOD: A prospective study was conducted on 161 women with NPBL, of whom 80 marked with the wire (group 1), whereas 81 women were marked with an intratumour injection of 99mTc-nanocoloid (group 2). The NPBL were located by ultrasound or stereotactic guidance. The lumpectomies were performed following the wire direction in group 1, and with the aid of a gamma-probe in group 2. Surgical margins were then checked, determining the need of extension if the margin was less than 5mm in the intra-surgical study, and less than 2mm in the deferred study. Data were collected on the mean number detected by surgery, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, as well as total resected volume, volume/tumour ratio, and complications. RESULTS: No significant differences were observed between the two groups in the mean number detected, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, total resected volume, volume/tumour ratio or complications. The multivariate analysis showed the determining factors of the resected volume were the radiological guidance technique, as well as the surgeon. CONCLUSIONS: The radioguided occult lesion localising technique helps in the detection and resection of NPBL with the same efficiency as the surgical wire, and adds the possibility of sentinel node detection in the same surgery. The determining factors of the resected volume were the radiological guidance technique and the surgeon.

Captación leptomeníngea focal, un nuevo hallazgo radiológico en la seudomigraña con pleocitosis / Focal leptomeningeal uptake, a new radiological finding in pseudomigraine with pleocytosis

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Validación de la biopsia selectiva del ganglio centinela en mujeres con cáncer de mama N1-2 con respuesta axilar completa tras la neoadyuvancia. Estudio multicéntrico en la provincia de Tarragona / Validation of sentinel lymph node biopsy in breast cancer women N1-N2 with complete axillary response after neoadjuvant chemotherapy. Multicentre study in Tarragona

Introducción. El objetivo de nuestro estudio fue evaluar los resultados de los ganglios obtenidos mediante biopsia selectiva del ganglio centinela en mujeres T1-T3/N1-N2 que después de la neoadyuvancia presentaron una axila N0. Material y métodos. Se realizó un estudio multicéntrico de validación diagnóstica en la provincia de Tarragona. Incluimos a mujeres afectadas por cáncer de mama en estadio T1-T3, N1-N2, que presentaron una respuesta axilar completa después de la quimioterapia neoadyuvante. El procedimiento consistió en la realización de la biopsia selectiva del ganglio centinela seguida de la linfadenectomía. El análisis estadístico consistió en la evaluación de la validez de la biopsia selectiva del ganglio centinela mediante la linfadenectomía como gold standard. Resultados. Se incluyeron 53 mujeres. La tasa de detección quirúrgica fue del 90,5% (en 5 pacientes no se encontró el ganglio centinela). El análisis histopatológico de la linfadenectomía mostró remisión completa de los ganglios axilares en el 35,4% (17/48) de las pacientes y enfermedad residual en los ganglios axilares en el 64,6% (31/48) de ellas. En 28 pacientes existía afectación residual en el ganglio centinela, en el 20% (10/48) de las cuales esta se localizaba únicamente en el ganglio centinela, estando el resto de la linfadenectomía libre de enfermedad. En 3 pacientes el ganglio centinela era negativo pero existía enfermedad en la linfadenectomía, resultando falsos negativos. Así, obtenemos una sensibilidad del 93,5%, una tasa de falsos negativos del 9,7% y una eficiencia de prueba global del 93,7%. Conclusiones. La biopsia selectiva del ganglio centinela, después de la quimioterapia en las pacientes que han presentado una respuesta axilar completa, proporciona información válida y confiable sobre el estado axilar después del tratamiento neoadyuvante, y podría evitar la linfadenectomía en casos con ganglio centinela negativo (AU)

Introduction. The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients. Material and methods. A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy. Results. A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%. Conclusions. Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy (AU)

Validation of sentinel lymph node biopsy in breast cancer women N1-N2 with complete axillary response after neoadjuvant chemotherapy. Multicentre study in Tarragona. / Validación de la biopsia selectiva del ganglio centinela en mujeres con cáncer de mama N1-2 con respuesta axilar completa tras la neoadyuvancia. Estudio multicéntrico en la provincia de Tarragona.

INTRODUCTION: The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients. MATERIAL AND METHODS: A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy. RESULTS: A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%. CONCLUSIONS: Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy.

Visualización de ganglio centinela axilar contralateral por linfogammagrafía en cáncer de mama: implicaciones pronósticas / Detection of contralateral axillary sentinel lymph node by lymphoscintigraphy in breast cancer: prognostic implications

La medicina nuclear, aplicada a la detección de ganglios centinela en los tumores primarios mamarios, es de gran utilidad para conocer el drenaje linfático regional de la mama afecta, principalmente su variabilidad individual anatómica y/o tumoral, para determinar el estadio tumoral inicial.Presentamos el caso de un carcinoma ductal infiltrante mamario (T2), en la unión de cuadrantes internos de mama derecha estudiado por linfogammagrafía y sonda gammadetectora. Se reconocieron 3 ganglios centinelas, 2 axilares homolaterales, y uno axilar contralateral, no metastásicos.El hallazgo linfogammagráfico del ganglio centinela axilar, contralateral a la mama afecta, demuestra la variabilidad anatómica individual en el drenaje mamario, remarca la importancia de la medicina nuclear en su detección, generando nuevos planteamientos pronósticos con repercusión en las medidas terapéuticas y en el seguimiento de los pacientes(AU)

The role of nuclear medicine in the detection of sentinel lymph nodes (SLNs) in primary breast cancer is very useful to determine regional lymphatic drainage from the affected breast, mainly its anatomical and/or tumoral individual variability and to determine the initial tumor stage.We present the case of an infiltrating ductal carcinoma of the breast (T2) in the junction of the inner quadrants of the right breast studied by lymphoscintigraphy and gamma probe detection. Three non-metastatic sentinel lymph nodes were found with the selective lymphadenectomy: two in the ipsilateral axilla and one in the contralateral axilla.The lymphoscintigraphic finding of the axillary sentinel lymph node contralateral to the affected breast demonstrates the individual anatomical variability in mammary drainage. It emphasizes the importance of nuclear medicine imaging techniques in its detection and generates new prognostic approaches with impact on therapeutic measuresand patient follow-up(AU)

[Detection of contralateral axillary sentinel lymph node by lymphoscintigraphy in breast cancer: prognostic implications]. / Visualización de ganglio centinela axilar contralateral por linfogammagrafía en cáncer de mama: implicaciones pronósticas.

The role of nuclear medicine in the detection of sentinel lymph nodes (SLNs) in primary breast cancer is very useful to determine regional lymphatic drainage from the affected breast, mainly its anatomical and/or tumoral individual variability and to determine the initial tumor stage. We present the case of an infiltrating ductal carcinoma of the breast (T2) in the junction of the inner quadrants of the right breast studied by lymphoscintigraphy and gamma probe detection. Three non-metastatic sentinel lymph nodes were found with the selective lymphadenectomy: two in the ipsilateral axilla and one in the contralateral axilla. The lymphoscintigraphic finding of the axillary sentinel lymph node contralateral to the affected breast demonstrates the individual anatomical variability in mammary drainage. It emphasizes the importance of nuclear medicine imaging techniques in its detection and generates new prognostic approaches with impact on therapeutic measures and patient follow-up.

Prognostic and biological implications of genetic abnormalities in multiple myeloma undergoing autologous stem cell transplantation: t(4;14) is the most relevant adverse prognostic factor, whereas RB deletion as a unique abnormality is not associated with adverse prognosis.

Fluorescence in situ hybridization (FISH) has become a powerful technique for prognostic assessment in multiple myeloma (MM). However, the existence of associations between cytogenetic abnormalities compels us to re-assess the value of each abnormality. A total of 260 patients with MM at the time of diagnosis, enrolled in the GEM-2000 Spanish transplant protocol, have been analyzed by FISH in order to ascertain the independent influence on myeloma prognosis of IGH translocations, as well as RB and P53 deletions. Survival analyses showed that patients with t(4;14), RB or P53 deletions had a significantly shorter survival than patients without these abnormalities. However, patients with RB deletions without other abnormalities in FISH analysis, displayed a similar outcome to those patients without genetic changes by FISH (46 vs 54 months, P=0.3). In the multivariate analysis the presence of t(4;14), RB deletion associated with other abnormalities, age >60 years, high proportion of S-phase cells and advanced stage of the disease according to the International Staging System retained their independent prognostic influence. In summary, RB deletion as a sole abnormality does not lead to a shortening in the survival of MM patients, whereas t(4;14) confers the worst prognosis in MM patients treated with high-dose chemotherapy.

[Prognostic utility of scintigraphy with 99mTc-HMPAO labelled leukocytes in inflammatory bowel disease]. / Utilidad pronóstica de la gammagrafía con leucocitos marcados 99mTc-HMPAO en la enfermedad inflamatoria intestinal.

OBJECTIVE: The inflammatory bowel disease (EII) has a chronic evolution with a frequent relapses. There is no specific diagnosis method to detect the patients with a high risk to relapse. The aim of the work was to analyse the prognostic value of 99mTc-HMPAO leukocyte scintigraphy (LS) performed during an acute attack of EII. MATERIAL AND METHODS: 18 patients (mean age 32 +/- 10 years) admitted for an acute attack of EII has been prospectively studied (5 ulcerative colitis [UC] and 13 Cronh's disease [CD]), excluding patient with prior steroids or immunosuppressive therapy during the last year. LS were obtained in basal conditions and following 3 weeks of steroid treatment and the scintigraphic activity index (SAI) has been calculated. Colonoscopy has been done in all patients, and CDAI in CD and Truelove index in UC have been calculated. Patients were followed up for 1 year. In the evolution the therapy requirements as well as the good response to initial treatment have been evaluated. RESULTS: All patients with UC and 4 patients with CD showed a SAI decrease > 50 % and all had a good clinical evolution. Only 2 out of the 9 patients with CD showing a IAG decrease < 50 % and had a good clinical evolution, the 7 remaining required additional medical treatment (immunosuppressors or surgery). CONCLUSION: LS may be of prognostic value in the management of EII. A SAI decrease > 50 % at 3 weeks of steroid treatment indicates a good clinical evolution.

Utilidad pronóstica de la gammagrafía con leucocitos marcados 99mTc-HMPAO en la enfermedad inflamatoria intestinal / Prognostic utility of scintigraphy with 99mTc-HMPAO labelled leukocytes in inflammatory bowel disease

Objetivo. La enfermedad inflamatoria intestinal (EII) tiene una evolución crónica recidivante. No existe ningún método específico para detectar a los pacientes con riesgo elevado de recaída. El objetivo del trabajo ha sido analizar el valor pronóstico de la gammagrafía con leucocitos- 99mTc-HMPAO (GLM) realizada durante un ataque agudo de EII. Material y métodos. Se han estudiado 18 pacientes (32 ± 10 años) con sospecha de un ataque agudo de EII (5 colitis ulcerosa [CU] y 13 enfermedad de Crohn [EC]). Se excluyeron los que habían recibido tratamiento con esteroides o con immunosupresores durante el año anterior. Se obtuvo una GLM en condiciones basales y otra a las 3 semanas de tratamiento esteroideo y se calculó el índice de actividad gammagráfica (IAG). Se practicó una colonoscopia y se calcularon los índices clínico-analíticos, índice de actividad de la EC (Crohn's disease activity index [CDAI]) en la EC y Truelove en la CU. Los pacientes fueron evaluados clínicamente durante un año. En la evolución se valoraron la respuesta o no al tratamiento inicial y la necesidad de nuevas terapias. Resultados. Todos los pacientes con CU y 4 pacientes con EC mostraron una disminución de IAG > 50 %, presentando una buena evolución clínica. Sólo 2 de los otros 9 pacientes con EC mostraron una disminución de IAG 50 % a las 3 semanas de tratamiento esteroideo indica una buena evolución clínica y hace poco probable la aparición de nuevos brotes

Objective. The inflammatory bowel disease (EII) has a chronic evolution with a frequent relapses. There is no specific diagnosis method to detect the patients with a high risk to relapse. The aim of the work was to analyse the prognostic value of 99mTc-HMPAO leukocyte scintigraphy (LS) performed during an acute attack of EII. Material and methods. 18 patients (mean age 32 ± 10 years) admitted for an acute attack of EII has been prospectively studied (5 ulcerative colitis [UC] and 13 Cronh's disease [CD]), excluding patient with prior steroids or immunosuppressive therapy during the last year. LS were obtained in basal conditions and following 3 weeks of steroid treatment and the scintigraphic activity index (SAI) has been calculated. Colonoscopy has been done in all patients, and CDAI in CD and Truelove index in UC have been calculated. Patients were followed up for 1 year. In the evolution the therapy requirements as well as the good response to initial treatment have been evaluated. Results. All patients with UC and 4 patients with CD showed a SAI decrease > 50 % and all had a good clinical evolution. Only 2 out of the 9 patients with CD showing a IAG decrease 50 % at 3 weeks of steroid treatment indicates a good clinical evolution

[Influence of tumor location in patients with breast cancer on the sentinel node detection]. / Influencia de la localización del cáncer de mama en la detección del ganglio centinela.

OBJECTIVE: To evaluate the influence of tumour quadrant localization on the sentinel node (SN) detection and the visualisation of internal mammary chain (IM) drainage by radioisotopic techniques. 316 patients with breast cancer were studied. Mean age 57 years (range 29-88). All patients received 37-74 MBq of 99mTc-albumin nanocolloid in 2 ml by peritumoral injection. The breast cancer was located in the upper outer quadrant in 189 patients, in the upper inner in 57, in the lower outer in 57, in the lower inner in 55 and in the subareolar area in 18 patients. At two hours p.i., anterior and lateral chest lymphographies were obtained. The SN location was marked on the patient skin with permanent ink. SN was identified intraoperatively by the gamma probe. Histopatological analysis included imprints, delayed hematoxilin-eosin, inmunohistochemistry CAM 19-2 and PCR. RESULTS: The scintigraphy and surgical detection was in the upper outer quadrant of 90 % and 93 % respectively; in the lower outer quadrant of 91 % and 95 %, in the upper inner quadrant of 93 % and 95 %, in the lower inner quadrant 87 % and 95 % and in the subareolar area in 94 % and 83 %. The IM chain drainage was of 6 % in the UO, in the LO of 5 %, in the UI of 12 %, in the LI of 20 % and none in subareolar. CONCLUSIONS: Our data suggest that sentinel node location (quadrant) is not a influential factor in the scintigraphy and surgical detection. Tumours localised in internal quadrant show a higher rate of IM chain drainage.