The TEOGIC study project: a comprehensive characterization of early onset gastrointestinal cancer in the Northern area of Spain.

BACKGROUND: Gastrointestinal cancers represent one of the most prevalent diseases worldwide. Strikingly, the incidence of Early Onset Gastrointestinal Cancer (EOGIC) has been rising during the last decades and changes in lifestyle and environmental exposure seem to play a role. EOGIC has been defined as a different entity compared to on-average gastrointestinal cancer, with distinct clinical and molecular characteristics. Inherent to the particularities of younger age, there is an unmet need for a tailored approach for the management of these patients. The TEOGIC proposes a comprehensive study to characterize EOGIC patients in the northern of Spain. METHODS: Patients with histologically confirmed new diagnosis of colorectal, gastroesophageal and pancreatic adenocarcinoma will be considered for two cohorts: EOGIC (≤ 50 years old) and non-EOGIC (60-75 years old), with a ratio of 1:2. Two hundred and forty patients will be recruited in 4 Public Hospitals from northern Spain. After receiving unified informed consent, demographic and clinical data of the patients will be collected in a REDCap database. Lifestyle related data will be obtained in questionnaires assessing diet, physical activity and the general quality of life of the patients before diagnosis. Biological samples prior to any onco-specific treatment will be obtained for the analyses of circulating inflammatory proteins, gut microbiota, and the proteome of the tumor microenvironment. Histologic characteristics and routine biomarkers will be also collected. Thereafter, data will be integrated and analyzed to assess tumor specific, pan-tumor and sex-associated differential characteristics of EOGIC. DISCUSSION: The underlying risk factors and differential characteristics of EOGIC remain poorly studied, particularly in our geographical area. Although limited by the exploratory nature and the small sample size estimated to be recruited, TEOGIC represents the first attempt to comprehensively characterize these young patients, and thus attend to their special needs. Findings derived from this study could contribute to raise awareness and preventive behaviors in the population. In parallel, molecular studies could lead to the identification of potential novel non-invasive biomarkers and therapeutic targets that would help in the development of the tailored clinical management of these patients, focusing on screening programs for early diagnosis and precision medicine.

[Body weight- independent variations in HDL-cholesterol following gastric bypass]. / Las variaciones en cholesterol-HDL tras bypass gástrico proximal son independientes de la evolución ponderal.

BACKGROUND: Bariatric surgery has multiple beneficial effects on lipid profile in patients with morbid obesity. However, these changes can be attenuated by weight regain. This retrospective study was designed to assess the effects of gastric bypass(GBP) on different lipid fractions over a 6 year follow-up. PATIENTS AND METHODS: We studied 177 patients (135 women)with morbid obesity (BMI 44.2+0.4 kg/m2) aged 42.4+0.9 years before and 3, 6, 9, 12, 24, 36, 48, 60 and 72 months after laparoscopic proximal GBP. Anthropometry, body composition measurement (Bod-Pod) and fasting blood samples were taken in all evaluations to measure total cholesterol (TC),LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides(TG), glucose and insulin. RESULTS: GPB was followed by a significant BMI reduction (nadir BMI at 18 m 28.3+0.4 kg/m2 p<0,001) and fat mass decrease(p<0,001). Maximal percentage of excess BMI lost was 84.1%and that of body fat was 87% 18 months after GBP. These numbers decreased to 65.6% and 38.3% (p<0,005 vs nadir) respectively 72 months after the operation, indicating both weight and fat mass regain. TG and LDL-C values decreased 30% with respect to preoperative levels, while HDL-C increased 97%over initial values. This HDL-C increase was progressive even over the weight regain phase. Both TC/HDL-C and TG/HDL-Cratios normalized after GBP and values were sustained over the weight regain period until the end of the study. CONCLUSIONS: These results confirm the beneficial effects of GBP on all lipid fractions, which are maintained over 6 years of follow-up. Globally, the rise in HDL-C seems to be independent of weight or fat mass changes, since it increases even over the weight regain phase, so contributing to a reduction in the prevalence of dyslipidaemia and to cardiovascular risk reduction.

Las variaciones en colesterol-HDL tras bypass gástrico proximal son independientes de la evolución ponderal / Body weight- independent variations in HDL-cholesterol following gastric bypass

Fundamento: La cirugía bariátrica posee efectos beneficiosos sobre el perfil lipídico en pacientes con obesidad mórbida que pueden atenuarse con la recuperación ponderal. El presente estudio se ha llevado a cabo para evaluar el perfil lipídico antes y a lo largo de los seis años consiguientes a la realización de bypass gástrico proximal (BPG). Material y métodos: Se han estudiado 177 pacientes (135 mujeres) con obesidad mórbida (IMC 44,2+0,4 kg/m2) de 42,4+0,9 años de edad antes, 3,6,9, 12,24,36,48,60 y 72 meses después de realizar BPG. En todas las revisiones se evaluó el tratamiento hipolipemiante, antropometría (IMC, cintura), composición corporal (Bod-Pod) y determinaciones de colesterol total (CT), colesterol-LDL (LDL-C), colesterol-HDL (HDL-C), triglicéridos (TG), glucosa e insulina. Resultados: El BPG indujo marcada reducción de IMC (nadir IMC a 18 meses 28,3+0,4 kg/m2 p<0,001) y grasa corporal consiguiendo una pérdida de exceso IMC del 84,1% y del exceso de porcentaje de grasa del 87% que disminuyó al 65,6 y 38,3% (ambos p<0,005 respecto a nadir) respectivamente a los 6 años del BPG, indicando recuperación de peso y grasa corporal. Los valores de TG alcanzaron el 70% a los 60 meses, los de LDL-C el 70,6% a los 18 meses y los de HDL-C el 197% del valor pre-intervención a los 48 meses. La elevación de HDL-C aumentó durante la fase de recuperación ponderal de forma continuada (p<0,001). Tanto los cocientes CT/HDL-C como TG/HDL-C se normalizaron de forma mantenida durante los 6 años de seguimiento. Conclusiones: Estos resultados confirman la mejoría de todas las fracciones lipídicas 6 años después del BPG, con especial mención a HDL-C, que mantuvo progresión creciente incluso durante la recuperación ponderal, reduciendo la tasa de dislipemia a los 6 años del BPG (AU)

Background: Bariatric surgery has multiple beneficial effects on lipid profile in patients with morbid obesity. However, these changes can be attenuated by weight regain. This retrospective study was designed to assess the effects of gastric bypass (GBP) on different lipid fractions over a 6 year follow-up. Patients and Methods: We studied 177 patients (135 women) with morbid obesity (BMI 44.2+0.4 kg/m2) aged 42.4+0.9 years before and 3, 6, 9, 12, 24, 36, 48, 60 and 72 months after laparoscopic proximal GBP. Anthropometry, body composition measurement (Bod-Pod) and fasting blood samples were taken in all evaluations to measure total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), glucose and insulin. Results: GPB was followed by a significant BMI reduction (nadir BMI at 18 m 28.3+0.4 kg/m2 p<0,001) and fat mass decrease (p<0,001). Maximal percentage of excess BMI lost was 84.1% and that of body fat was 87% 18 months after GBP. These numbers decreased to 65.6% and 38.3% (p<0,005 vs nadir) respectively 72 months after the operation, indicating both weight and fat mass regain. TG and LDL-C values decreased 30% with respect to preoperative levels, while HDL-C increased 97% over initial values. This HDL-C increase was progressive even over the weight regain phase. Both TC/HDL-C and TG/HDL-C ratios normalized after GBP and values were sustained over the weight regain period until the end of the study. Conclusions: These results confirm the beneficial effects of GBP on all lipid fractions, which are maintained over 6 years of follow-up. Globally, the rise in HDL-C seems to be independent of weight or fat mass changes, since it increases even over the weight regain phase, so contributing to a reduction in the prevalence of dyslipidaemia and to cardiovascular risk reduction (AU)

El índice de masa corporal y la circunferencia abdominal infraestiman el diagnóstico de obesidad en pacientes con diabetes mellitus tipo 2 / The diagnosis of obesity is infraestimated by body mass index and abdominal circumference in patients with type 2 diabetes mellitus

Objetivos: Cuantifi car la prevalencia de obesidad en pacientes con diabetes mellitustipo 2 (DM2), comparando criterios por índice de masa corporal (IMC), circunferenciaabdominal (CA) y pletismografía por desplazamiento de aire. Métodos:Estudio transversal de 80 pacientes con DM2, mediante valoración antropométricay pletismografía, estudiando la correlación entre IMC, CA y porcentaje de grasa corporal.Se defi ne obesidad según el IMC mediante criterios estándar (>30 kg/m2),por una CA mayor de 102 cm y de 88 cm en varones y mujeres, respectivamente,y por un porcentaje de grasa por encima del 25% en varones y del 35% en mujeres.Se analizó también la correlación existente con distintos parámetros del síndromemetabólico, la edad, el sexo, el tabaco, el tratamiento insulínico, los años deevolución de la diabetes y la hemoglobina glucosilada. Resultados: La prevalenciade obesidad según IMC, CA y pletismografía fue la siguiente: por IMC, 38 pacientes(47,5%); por CA, 50 (62,5%), y por pletismografía, 74 (92,5%); se encontrarondiferencias estadísticamente signifi cativas entre el IMC y la pletismografía (p <0,05)y entre la CA y la pletismografía (p <0,01). El tener un IMC >30 kg/m2 presentóuna especifi cidad del 100% para el diagnóstico de obesidad, pero la sensibilidadfue del 51%. El presentar una CA por encima del rango de normalidad mostró unaespecifi cidad del 100% pero una sensibilidad del 66%. El IMC presentó buenacorrelación con el porcentaje de grasa (R= 0,65; p <0,01). Otras variables asociadascon presentar mayor porcentaje de grasa fueron el sexo (mujer, p <0,01), lacircunferencia abdominal (p <0,01) y la circunferencia de la cadera (p <0,01).Conclusiones: En pacientes con DM2, el IMC y la CA infraestiman el diagnósticode obesidad. Por ello consideramos necesario el uso de técnicas de composicióncorporal en pacientes con DM2, especialmente en los diabéticos con criterios antropométricosdentro de la normalidad(AU)

Objective: The purpose of this study was to quantify obesity prevalence intype 2 diabetes (T2D) comparing criteria based on body mass index (BMI),abdominal circumference (AC) and air displacement pletismography (BODPOD®). Methods: A cross sectional study of 80 patients with T2D, studyingthe correlation among BMI, AC and body fat percentage after anthropometricassessment and BOD POD®. Obesity was defined using standard criteria asIMC >30 kg/m2, AC >102 cm in men or IMC >88 cm in women, or fat percentage>25% or >35% in women. The correlation with several parametersof metabolic syndrome, age, gender, tobacco, insulin treatment, diabetes durationand glycosylated hemoglobin has been also analyzed. Results: 38 patientswere classified as obese (47.5%) according to BMI, 50 (62.5%) by AC,and 74 (92.5%) by BOD POD®. Statistically significant differences were foundbetween BMI and BOD POD® (p <0.05), and between AC and BOD POD®(p <0.01). Having a BMI >30 kg/m2 has a specificity of 100% in the diagnosisof obesity, and a sensitivity of 51%. An AC superior to normality has a 66%of sensitivity and a 100% of specificity. BMI has a good correlation with bodyfat percentage (R= 0.65; p<0.01). Other variables associated with higher fatpercentage were: gender (female, p <0.01); AC (p <0.01) and hip circumference(p <0.01). Conclusions: In patients with T2D, both BMI and AC infraestimatethe diagnosis of obesity. Therefore we believe that corporal compositiontechniques should be used in the diagnosis of obesity in patients with T2D,specially in those with normal anthropometric criteria(AU)

Hipoglucemia reactiva posprandial: ¿mito o realidad? / Postprandial reactive hypoglycemia: myth or reality?

La hipoglucemia reactiva posprandial se caracteriza por síntomascompatibles con hipoglucemia en situación posprandial, habitualmentedurante las 4 horas postingesta, coincidiendo con glucemiasmenores de 60 mg/dL. Esta entidad ha sido muy cuestionada, fundamentalmentedebido a los diferentes criterios utilizados para ladefinición de hipoglucemia, a la inespecificidad de la clínica y al usoinapropiado de la sobrecarga oral de glucosa. Gran parte de la confusiónse debe al procedimiento diagnóstico utilizado. Lo fundamentales la interpretación de la clínica que refiere el paciente junto conla concentración glucémica en el momento de los síntomas. La clínicareferida por los pacientes se puede poner de manifiesto condiferentes test diagnósticos. Los principales son la sobrecarga oralde glucosa, el test de desayuno hiperglucídico, la monitorizaciónambulatoria de glucemia capilar y la monitorización continua de glucosaintersticial. Inicialmente estos pacientes son tratados con unaalimentación baja en hidratos de carbono, con ingestas repartidas alo largo del día. Sin embargo, algunos de ellos necesitarán tratamientofarmacológico. Los fármacos más utilizados son los inhibidoresde las alfaglucosidasas, aunque se han utilizado otros muchos(AU)

Postprandial reactive hypoglycemia is characterized by symptomsthat are compatible with hypoglycemia in a postprandial situation,usually within 4 hours of eating, coinciding with blood sugar levelsbelow 60 mg/dl. This entity has been widely questioned, mainly dueto the different criteria used to define hypoglycemia, to the lack ofspecificity concerning its clinical manifestations and to the inappropriateuse of the glucose tolerance test. A large part of the confusionis due to the diagnostic procedure used. Most fundamental are theinterpretation of the clinical manifestations reported by the patienttogether with the blood sugar concentration at the time when thesymptoms occur. The clinical manifestations reported by the patientscan be made evident through different diagnostic tests. The maintests are the glucose tolerance test, the hyperglucidic breakfast test,ambulatory capillary blood glucose monitoring and continuous interstitialglucose monitoring. At first these patients are treated with a lowcarbohydratediet, with meals spread throughout the day. However,some of those patients will require a pharmacological treatment. Themost commonly used drugs are the a-glucosidase inhibitors, althoughmany others have been used(AU)

A comparison of information on motor vehicle crashes as reported by written or telephone interviews.

OBJECTIVE: To compare information about traffic crash injuries and kilometers driven reported in a written questionnaire with information reported in a telephone interview. DESIGN: Telephone and paper surveys. SETTING: The Seguimiento Universidad de Navarra (SUN, University of Navarra Follow-up) study, in Spain. The SUN study is an open enrollment cohort study with 17 000 enrolled graduates followed through biennial mailed questionnaires. SUBJECTS: A sample of 542 individuals from the SUN study participants. MAIN OUTCOME MEASURE: Agreement on information about traffic crash injuries and mileage driven in a mailed questionnaire and a telephone survey. RESULTS: Participation was 90.4%. Considering the phone survey as the gold standard, data on traffic crash injuries in the mailed questionnaire had 83% sensitivity (95% CI 77% to 89%), 77% specificity (95% CI 71% to 82%), 74% positive predictive value (95% CI 67% to 80%), and 89% negative predictive value (95% CI 83% to 93%). Agreement beyond chance, measured by the kappa statistic, was 0.63 (95% CI 0.56 to 0.70). Correlation between questionnaire and telephone surveys and kilometers driven on average during a year assessed by the intraclass correlation coefficient was 0.64 (95% CI 0.57 to 0.70), p<0.001. CONCLUSIONS: Information on sustained traffic crash injuries and traveled mileage over the previous two years as reported through mailed questionnaires in a highly educated population could be used in the study of associations between traffic crash injuries and a variety of risk factors.

Further delineation of pseudotrisomy 13 syndrome: a case without polydactyly.

We report on a baby with holoprosencephaly, median cleft lip, cardiac and genital anomalies, normal upper limbs, and a 46,XX karyotype. We also reviewed 22 karyotypically normal cases whose clinical features resembled trisomy 13 syndrome and compared them with the case we present. The problem of variable expression of the pseudotrisomy 13 syndrome versus genetic heterogeneity is illustrated.

[Alterations in osmoregulation in the elderly]. / Alteraciones en la osmorregulación en el anciano.

In the present work we study the modifications in hydrosaline metabolism which occurred in two groups of healthy male individuals, one consisting of 15 young men (mean age of 20 years) and the other of 30 elderly subjects (mean age of 75 years) when the thirst test was performed for 48 hours. After performing the thirst test we observed that the elderly were less thirsty than the young group and that the former presented more marked alterations in the hydrosaline metabolisms. Thus, the elderly presented at the end of the test higher serum and urine sodium levels, a greater serum osmolarity and higher plasmatic ADH levels both basal and at the end of the test. However, inspite of all this, the elderly scarcely reduced their diuresis and urinary osmotic values were much lower (almost half) than the young subjects. The mechanism for which these alterations occur is probably multifactorial, in which the decrease in glomerular filtrate, the increase in filtration fraction, the proportional increase in medullar flux together with some tubular resistance to ADH action could intervene.

Quality analysis of the root canal filling employing gutta-percha thermoplasticized at a low temperature (Ultrafil system).

The objective of this study was the investigation of the sealing properties of gutta-percha thermoplasticized at a low temperature by either employing or not N-Rickert cement and vertical condensation. Methylene blue at 0.5% was used to demonstrate the apical leakage. Results demonstrated that minor penetration indexes were attained when cement was not employed and vertical condensation was accomplished.

Late embolization of disc occluder of a Beall mitral prosthesis with survival.

A case of arterial embolization of a Beall mitral prosthesis disc (model 104) 5 1/2 years after implantation is presented. The patient was referred to use 3 days after the onset of acute symptoms and was immediately operated upon in pulmonary edema and cardiogenic shock. The migrated disc was removed from the abdominal aorta 26 days later, showing marked signs of wear. The postoperative course was complicated and the patient made a slow recovery. It is suggested that patients with models 103 and 104 Beall mitral prostheses be followed very closely and that electric valve substitution should be considered when first signs of prosthetic attrition are noted.