The value of sentinel lymph-node biopsy in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy: a systematic review.

PURPOSE: To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. METHODS: The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. RESULTS: Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11-0.17), the pooled SLNIR was 0.89 (95% CI 0.86-0.92), NPV was 0.83 (95% CI 0.79-0.87), and summary accuracy was 0.92 (95% CI 0.90-0.94). SLNB performed better when more than one node was removed and double mapping was used. CONCLUSIONS: SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer.

Clinical Features and Natural History of Preadolescent Nonsyndromic Hypertrophic Cardiomyopathy.

BACKGROUND: Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. OBJECTIVES: The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. METHODS: Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. RESULTS: At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. CONCLUSIONS: Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages.

Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy.

BACKGROUND: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. METHODS: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). RESULTS: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. CONCLUSIONS: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.

Atypical course of long-term colon cancer.

BACKGROUND: Thyroid metastases are extremely rare, with an incidence of 1-3% according to different data. Colon cancer is the second most common tumor that metastasizes to this organ. CASE REPORT: We report a case of a long-standing colon cancer with an atypical metastatic pattern and the appearance of a thyroid metastases. In addition, we highlight the importance of multidisciplinary management of this pathology and the emerging need to establish next generation sequencing panels for better molecular characterization.

ANTECEDENTES: Las metástasis tiroideas son tremendamente infrecuentes, situándose su incidencia en torno al 1-3% según los diferentes datos. El cáncer de colon es el segundo tumor que con más frecuencia produce metástasis en este órgano. CASO CLÍNICO: Se expone un caso de cáncer de colon de larga evolución con patrón metastásico atípico y aparición de metástasis tiroidea. Además, se señala la importancia del manejo multidisciplinario de esta patología y la necesidad emergente de establecer paneles de secuenciación masiva para una mejor caracterización molecular.

Clinical and therapeutic management of a pleural fibrous tumor with ALK translocation.

We present a clinical case of a solitary fibrous pleural tumor (TFSP) with abnormal behavior due to its high aggressiveness and poor short-term prognosis, where an ALK translocation was identified. TFSP is an infrequent tumor, with an estimated incidence of around 8 per 100,000 inhabitants and with few cases reported in the literature. The most common is that it is a neoplasm of benign behavior, with debut as a localized mass and whose The treatment of choice is surgical resection. All the data in the literature contrast with our experience, which we report below.

Presentamos un caso clínico de un tumor fibroso solitario pleural (TFSP) de comportamiento anómalo por su alta agresividad y mal pronóstico a corto plazo, en el que se identificó una translocación de ALK. El TFSP es un tumor infrecuente, con una incidencia estimada en torno a 8 casos por 100,000 habitantes y con pocos reportes en la literatura. Lo más habitual es que se trate de una neoplasia de comportamiento benigno, con debut como una masa localizada y cuyo tratamiento de elección es la resección quirúrgica. Todos los datos de la literatura contrastan con nuestra experiencia, que presentamos a continuación.

Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids).

Importance: Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM), but there is no validated algorithm to identify those at highest risk. Objective: To develop and validate an SCD risk prediction model that provides individualized risk estimates. Design, Setting, and Participants: A prognostic model was developed from a retrospective, multicenter, longitudinal cohort study of 1024 consecutively evaluated patients aged 16 years or younger with HCM. The study was conducted from January 1, 1970, to December 31, 2017. Exposures: The model was developed using preselected predictor variables (unexplained syncope, maximal left-ventricular wall thickness, left atrial diameter, left-ventricular outflow tract gradient, and nonsustained ventricular tachycardia) identified from the literature and internally validated using bootstrapping. Main Outcomes and Measures: A composite outcome of SCD or an equivalent event (aborted cardiac arrest, appropriate implantable cardioverter defibrillator therapy, or sustained ventricular tachycardia associated with hemodynamic compromise). Results: Of the 1024 patients included in the study, 699 were boys (68.3%); mean (interquartile range [IQR]) age was 11 (7-14) years. Over a median follow-up of 5.3 years (IQR, 2.6-8.3; total patient years, 5984), 89 patients (8.7%) died suddenly or had an equivalent event (annual event rate, 1.49; 95% CI, 1.15-1.92). The pediatric model was developed using preselected variables to predict the risk of SCD. The model's ability to predict risk at 5 years was validated; the C statistic was 0.69 (95% CI, 0.66-0.72), and the calibration slope was 0.98 (95% CI, 0.59-1.38). For every 10 implantable cardioverter defibrillators implanted in patients with 6% or more of a 5-year SCD risk, 1 patient may potentially be saved from SCD at 5 years. Conclusions and Relevance: This new, validated risk stratification model for SCD in childhood HCM may provide individualized estimates of risk at 5 years using readily obtained clinical risk factors. External validation studies are required to demonstrate the accuracy of this model's predictions in diverse patient populations.

Comparación del rendimiento cognitivo entre pacientes con patrones circadianos anómalos y fisiológicos de presión arterial sistémica en una comunidad rural / Comparison of cognitive performance among patients with abnormal and physiological circadian patterns of systemic blood pressure in a rural community

Resumen: ANTECEDENTES La hipertensión arterial es un proceso crónico degenerativo ampliamente estudiado y relacionado con daños a órganos blanco, entre ellos el cerebro y su función cognitiva. Actualmente se cuenta con dispositivos que realizan mediciones ambulatorias por 24 horas, lo que abre una ventana para el estudio de los patrones circadianos y sus posibles afectaciones orgánicas. OBJETIVO Comparar los resultados del rendimiento cognitivo entre pacientes con patrones circadianos anómalos y fisiológicos de presión arterial sistémica de una comunidad rural en Yucatán. MATERIAL Y MÉTODO Estudio clínico epidemiológico con diseño observacional, analítico, transversal, efectuado de enero a diciembre de 2016. Se realizaron registros de presión arterial de 24 horas a sujetos mayores de 50 años de edad sin diagnóstico previo de hipertensión arterial. Posteriormente se les aplicó una batería de pruebas neurológicas del RBANS (Repeatable Battery for the Assessment of Neuropsychological Status). RESULTADOS Se realizaron 30 registros de presión arterial; al comparar entre el rendimiento cognitivo en los grupos de patrones circadianos anómalos y fisiológicos se encontró diferencia significativa (p = 0.028) con el análisis de X2 de Pearson, mostrando mayor frecuencia de rendimiento cognitivo alto en los que tenían patrones circadianos patológicos. CONCLUSIONES Se obtuvo una relación de mejor rendimiento cognitivo a mayor descenso de la presión arterial nocturna. Esto puede explicarse por la falta de un límite establecido para diferenciar el descenso de la presión arterial media nocturna fisiológica de la patológica en la población adulta media.

Abstract: BACKGROUND Hypertension is a chronic disease widely approached and related with several organic dysfunctions, brain damage and its cognitive performance among them. Nowadays we count with dispositives that can do arterial measures in an ambulatory form for 24 hours, which opens a path to study the circadian patterns and their possible consequences. OBJECTIVE To compare the cognitive performance between patients with physiologic and pathologic arterial circadian patterns in the inhabitants of a rural community in Yucatan. MATERIAL AND METHOD A clinical epidemiologic study, with observational analytic transversal and prospective design was done from January to December 2016. There were performed ambulatory arterial records of 24 hours in patients older than 50 years without previous diagnosis of hypertension. Then the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) battery was applied to them. RESULTS There were performed 30 ambulatory arterial records. We found a significant difference (p = 0.028) with the Pearson's X2 when contrasting the cognitive performance amount the circadian physiologic and pathologic patterns. It showed a bigger frequency of higher cognitive performance amount the patients with pathologic circadian patterns. CONCLUSIONS Patients seem to have a higher cognitive performance with a higher decline in their night arterial pressure. This could be explainef by the lack of an established limit to differentiate a physiologic arterial pressure decline with the pathologic one among adults in the middle age.

Fiabilidad y validez para un cuestionario de satisfacción con la formación continuada en salud: el cuestionario de satisfacción del discente / Reliability and validity of a continuous training satisfaction questionnaire in health: the Learning Satisfaction Questionnaire

Introducción: La formación continuada es el proceso de enseñanza y aprendizaje activo que tiene lugar a lo largo de toda la vida profesional. Valorar el grado de satisfacción con dicho proceso se presenta como una tarea necesaria. Si bien la mayoría de cuestionarios que evalúan la satisfacción del alumnado contemplan las diferentes dimensiones del proceso formativo como la metodología empleada, la adecuación de los contenidos o la calidad de los docentes, no todos han comprobado la fiabilidad y validez de los mismos. El objetivo del estudio es observar las características psicométricas del cuestionario de satisfacción del discente (CSD) enmarcado en la herramienta 'eValúa' de la línea de proyectos para el desarrollo profesional continuo de la Agencia de Calidad Sanitaria de Andalucía, España. Sujetos y métodos: Análisis estadísticos de las puntuaciones del CSD (n = 1.628), usando análisis de fiabilidad, análisis de componentes principales y correlaciones de los factores. Resultados: El CSD fue muy fiable, con un α de Cronbach global de 0,979. Las dimensiones del cuestionario mostraron cargas factoriales elevadas (Utilidad: R = 85,9; α = 0,91. Metodología: R = 77,4; α = 0,95. Organización y recursos: R = 73,25; α = 0,92. Capacidad docente: R = 90; α = 0,97. Valoración global: R = 96,6; α = 0,96). Las dimensiones 'utilidad' y 'metodología' fueron las que presentaron niveles de correlación más altas con la totalidad del cuestionario y con las dos preguntas de valoración global con la formación. Conclusiones: El CSD se presenta como una herramienta fiable y válida para la medición de la satisfacción con la formación continuada en salud. Dadas las altas correlaciones ítem-total que presentaron algunos ítems, se propone repasar su diseño para evitar concurrencias entre preguntas

Introduction: Continuing training is conceived as the learning and permanent asset process to which all health professionals are entitled and obliged. Although most questionnaires that assess participants satisfaction look at the different dimensions of the learning process, such as methodology used, content appropriateness or teachers performance quality, not all have proven its reliability and validity. The aim of the study is to observe the psychometric characteristics of Teaching Satisfaction Questionnaire (CSD) framed in the evaluation tool ‘eValúa’, designed by the Continuing Professional Development Project of the Andalusian Agency for Healthcare Quality (Spain). Subjects and methods: Statistical analysis of the scores of CSD with a sample of 1628 cases using reliability analysis, principal component analysis, and correlation of the factors that are derived from the five dimensions that make up the questionnaire. Results: The CSD was highly reliable with an overall Cronbach’s α of 0.979. The dimensions of the questionnaire showed high factor loadings (Utility: R = 85.9; α = 0.91. Methodology: R = 77.4; α = 0.95. Organization and resources: R = 73.25; α = 0.92. Teaching capacity: R = 90; α = 0.97. Global satisfaction: R = 96.6; α = 0.96). The 'utility' and 'methodology' dimensions were those that showed the highest levels of correlation with both the entire questionnaire and the two global satisfaction questions. Conclusions: The CSD is presented as a reliable and valid tool for measuring satisfaction with continuing education in health. Given the high item-total correlations some items showed, a review of the questionnaire design is proposed to avoid concurrency between questions. Future analysis of the differences in satisfaction with training according to different socio-professional characteristics was raised

Photoelectrocatalytic oxidation of remazol turquoise blue and toxicological assessment of its oxidation products.

The ability of photoelectrocatalytic oxidation to degrade the commercially important copper-phtalocyanine dye, remazol turquoise blue 15 (RTB) was investigated. The best experimental condition was optimized, evaluating the performance of Ti/TiO2 thin-film electrodes prepared by sol-gel method in the decolourization of 32 mg L(-1) RTB dye in 0.5 mol L(-1) Na2SO4 pH 8 and applied potential of +1.5 V versus SCE under UV irradiation. Spectrophotometric measurements, high performance liquid chromatography, dissolved organic carbon (TOC) evaluation and stripping analysis of yielding solution obtained after 3 h of photoelectrolysis leads to 100% of absorbance removal from wavelength of 250-800 nm, 79.6% of TOC reduction and the releasing of up to 54.6% dye-bound copper (0.85 mg L(-1)) into the solution. Both, original and oxidized dye solution did not presented mutagenic activity with the strains TA98 and TA100 of Salmonella in the presence and absence of S9 mix at the tested doses. Nevertheless, the yielding photoelectrocatalytic oxidized solution showed an increase in the acute toxicity for Vibrio fischeri bacteria, explained by copper liberation during treatment.