Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP) / Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

La vía clínica de recuperación intensificada en cirugía cardiaca (RICC) pretende identificar, difundir y favorecer la implementación de las mejores actuaciones basadas en la evidencia científica para disminuir la variabilidad en la práctica clínica. La puesta en marcha de estas prácticas en el proceso clínico global favorecerá la obtención de mejores resultados, acortamiento de estancias hospitalarias y en la Unidad de Cuidados Críticos, lo que permitirá una reducción de costes y una mayor eficiencia. Tras realizar una revisión sistemática en cada uno de los puntos del proceso perioperatorio en cirugía cardiaca, se han redactado recomendaciones basadas en la mejor evidencia científica disponible en la actualidad con el consenso de las sociedades científicas implicadas.(AU)

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.(AU)

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). / Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP).

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Pediatric chest x-ray in covid-19 infection.

BACKGROUND: The outbreak of COVID-19 has become pandemic. Pediatric population has been less studied than adult population and prompt diagnosis is challenging due to asymptomatic or mild episodes. Radiology is an important complement to clinical and epidemiological features. OBJECTIVE: To establish the most common CXR patterns in children with COVID-19, evaluate interobserver correlation and to discuss the role of imaging techniques in the management of children. MATERIALS AND METHODS: Forty-four patients between 0 and 16 years of age with confirmed SARS-Cov-2 infection and CXR were selected. Two paediatric radiologists independently evaluated the images and assessed the type of abnormality, distribution and evolution when available. RESULTS: Median age was 79.8 months (ranging from 2 weeks to 16 years of age). Fever was the most common symptom (43.5 %). 90 % of CXR showed abnormalities. Peribronchial cuffing was the most common finding (86.3 %) followed by GGOs (50 %). In both cases central distribution was more common than peripheral. Consolidations accounted for 18.1 %. Normal CXR, pleural effusion, and altered cardiomediastinal contour were the least common. CONCLUSION: The vast majority of CXR showed abnormalities in children with COVID-19. However, findings are nonspecific. Interobserver correlation was good in describing consolidations, normal x-rays and GGOs. Imaging techniques have a role in the management of children with known or suspected COVID-19, especially in those with moderate or severe symptoms or with underlying risk factors.

Osteomielitis pélvica y piomiositis del músculo obturador interno. Revisión del tratamiento a propósito de un caso / Pelvic osteomyelitis and obturator internus muscle pyomyositis. Revision of the treatment with regard to a case

La osteomielitis pélvica asociada a infección del músculo obturador interno es una infección poco difundida en la literatura científica. Presentamos el caso de un adolescente con ambas infecciones y una revisión del abordaje terapéutico de ambas patologías

Pelvic osteomyelitis associated with pyomyositis of the obturador internus muscle is rarely reported. We present the case of a teenager with both infections and a review of the therapeutic approach of both pathologies

Demora diagnóstica como principal factor contribuyente a un importante brote de tuberculosis en una universidad / Diagnostic delay as main contributing factor to a large outbreak of tuberculosis in a university

OBJETIVO: Describir las características epidemiológicas de un importante brote de tuberculosis en el ámbito universitario y los principales factores de riesgo asociados. MÉTODO: Se realizó un análisis descriptivo de los datos recogidos de las personas enfermas y de los contactos. Para el estudio de contactos se siguieron las pautas establecidas en el Programa de Tuberculosis de la Comunidad Autónoma del País Vasco. Seis de las cepas del brote fueron enviadas al Centro Nacional de Microbiología para su tipado molecular. RESULTADOS: El número total de casos del brote fue de 11. La tasa de infección tuberculosa en el aula del caso índice, incluidas las personas enfermas, fue del 88,1% (59 infectados y solo 8 no infectados). La demora diagnóstica del caso índice fue de 260 días, y en los otros 8 casos sintomáticos osciló entre 10 y 70 días. El patrón obtenido por las 2 técnicas de genotipado fue idéntico en las 6 cepas estudiadas. CONCLUSIONES: La gran demora diagnóstica del caso índice auténtico, que se diagnosticó en el estudio de contactos, y las malas condiciones de ventilación del aula determinaron el alto número de casos secundarios asociados a este brote

OBJECTIVE: To describe the epidemiological characteristics of a large tuberculosis outbreak in the university environment and the main risk factors associated with it. METHOD: A descriptive analysis of the data collected from sick individuals and their contacts was made. For the contact tracing, the guidelines established in the Tuberculosis Programme of the Autonomous Community of the Basque Country were followed. Six of the outbreak strains were sent to the National Centre of Microbiology for molecular typing. RESULTS: The total number of cases of the outbreak was 11. The rate of tuberculosis infection in the classroom of the index case, including the sick individuals, was 88.1% (59 infected and only 8 uninfected). The diagnostic delay of the index case was 260 days, and in the other 8 symptomatic cases it ranged between 10 and 70 days. The pattern obtained by the 2 genotyping techniques was identical in the 6 strains studied. CONCLUSIONS: The long diagnostic delay of the authentic index case, which was diagnosed in the contact tracing, and the poor ventilation conditions of the classroom, determined the high number of secondary cases associated with this outbreak

[Inferior vena cava compression in children with pectus excavatum]. / Compresión de la vena cava inferior en niños con pectus excavatum.

INTRODUCTION: In severe cases of pectus excavatum (PE) the sternal depression may cause distortion of the cardiac chambers and great vessels. The aim of our study was to determine if the sternal impingement causes significant inferior vena cava (IVC) compression. METHODS: Retrospective study of patients with severe PE assessed between 2015-2017. The antero-posterior (AP) and transverse diameters of the suprahepatic IVC were measured on a cardiac-MRI at the level of the diaphragmatic hiatus. Results were compared with patients that had a thoracic image study performed for other causes, adjusting for age and sex. RESULTS: Among the 81 patients, 28 cases and 53 controls, 63% were males and had a mean age of 12.9±0.5 yrs. Significant differences were found between groups in both AP and transverse diameter of the IVC: 13.3±0.75 mm vs. 15.8±0.76 mm (p=0.001) and 28.8±1.34 mm vs. 27.1±0.89mm (p=0.045) respectively. After adjusting for age and sex, these differences were only statistically significant for AP IVC diameter in males 12.7±0.5 mm (95% CI 11.66-13.79 mm) vs. 16.6±0.5 mm (95% CI 15.69-17.56 mm) (p=0.000). The Pearson correlation coefficient for the Haller index was r=0.471 (p=0.01). CONCLUSION: Male patients with severe sternal depression show changes in the IVC diameter that may correspond to compression. These changes are correlated with the severity of the deformity and can justify certain clinical symptoms and cardiac function abnormalities in patients with severe PE.

INTRODUCCION: En casos graves de pectus excavatum (PE), el hundimiento esternal ocasiona distorsión del corazón y grandes vasos. Nuestro propósito fue determinar si existe compresión de la vena cava inferior (VCI) en estos pacientes. METODOS: Estudio retrospectivo de pacientes con PE grave valorados entre 2015 y 2017. Se efectuaron mediciones del diámetro anteroposterior (AP) y transverso de la VCI suprahepática a su paso por el hiato diafragmático en imágenes de RM-cardiaca. Estas se compararon con las medidas de pacientes a los que se les realizó una RM o TC por otro motivo, ajustando los datos para edad y sexo. RESULTADOS: De los 81 pacientes, 28 casos y 53 controles, el 63% fueron varones con una edad media de 12,9±0,5 años. Se identificaron diferencias significativas entre los grupos, tanto del diámetro AP como del transverso: 13,3±0,75 mm vs. 15,8±0,76 mm (p=0,001) y 28,8±1,34 mm vs. 27,1±0,89 mm (p=0,045), respectivamente. Tras ajustar los datos para edad y sexo, estas diferencias solo fueron significativas para el diámetro AP de la VCI en hombres: 12,7±0,5 mm (IC95% 11,66-13,79 mm) vs. 16,6±0,5 mm (IC95% 15,69-17,56 mm) (p=0,000). El coeficiente de correlación de Pearson del diámetro transverso de la VCI con el índice de Haller fue r=0,471 (p=0,01). CONCLUSION: Los varones con un hundimiento esternal grave asocian alteraciones en el diámetro de la VCI que pueden indicar compresión de la misma. Estos cambios se correlacionan con la gravedad del PE y podrían justificar algunos síntomas y alteraciones cardiovasculares encontradas en estos pacientes.

Compresión de la vena cava inferior en niños con pectus excavatum / Inferior vena cava compression in children with pectus excavatum

Introducción: En casos graves de pectus excavatum (PE), el hundimiento esternal ocasiona distorsión del corazón y grandes vasos. Nuestro propósito fue determinar si existe compresión de la vena cava inferior (VCI) en estos pacientes. Métodos: Estudio retrospectivo de pacientes con PE grave valorados entre 2015 y 2017. Se efectuaron mediciones del diámetro anteroposterior (AP) y transverso de la VCI suprahepática a su paso por el hiato diafragmático en imágenes de RM-cardiaca. Estas se compararon con las medidas de pacientes a los que se les realizó una RM o TC por otro motivo, ajustando los datos para edad y sexo. Resultados: De los 81 pacientes, 28 casos y 53 controles, el 63% fueron varones con una edad media de 12,9±0,5 años. Se identificaron diferencias significativas entre los grupos, tanto del diámetro AP como del transverso: 13,3±0,75 mm vs. 15,8±0,76 mm (p=0,001) y 28,8±1,34 mm vs. 27,1±0,89 mm (p=0,045), respectivamente. Tras ajustar los datos para edad y sexo, estas diferencias solo fueron significativas para el diámetro AP de la VCI en hombres: 12,7±0,5 mm (IC95% 11,66-13,79 mm) vs. 16,6±0,5 mm (IC95% 15,69-17,56 mm) (p=0,000). El coeficiente de correlación de Pearson del diámetro transverso de la VCI con el índice de Haller fue r=0,471 (p=0,01). Conclusión: Los varones con un hundimiento esternal grave asocian alteraciones en el diámetro de la VCI que pueden indicar compresión de la misma. Estos cambios se correlacionan con la gravedad del PE y podrían justificar algunos síntomas y alteraciones cardiovasculares encontradas en estos pacientes

Introduction: In severe cases of pectus excavatum (PE) the sternal depression may cause distortion of the cardiac chambers and great vessels. The aim of our study was to determine if the sternal impingement causes significant inferior vena cava (IVC) compression. Methods: Retrospective study of patients with severe PE assessed between 2015-2017. The antero-posterior (AP) and transverse diameters of the suprahepatic IVC were measured on a cardiac-MRI at the level of the diaphragmatic hiatus. Results were compared with patients that had a thoracic image study performed for other causes, adjusting for age and sex. Results: Among the 81 patients, 28 cases and 53 controls, 63% were males and had a mean age of 12.9±0.5 yrs. Significant differences were found between groups in both AP and transverse diameter of the IVC: 13.3±0.75 mm vs. 15.8±0.76 mm (p=0.001) and 28.8±1.34 mm vs. 27.1±0.89mm (p=0.045) respectively. After adjusting for age and sex, these differences were only statistically significant for AP IVC diameter in males 12.7±0.5 mm (95% CI 11.66-13.79 mm) vs. 16.6±0.5 mm (95% CI 15.69-17.56 mm) (p=0.000). The Pearson correlation coefficient for the Haller index was r=0.471 (p=0.01). Conclusion: Male patients with severe sternal depression show changes in the IVC diameter that may correspond to compression. These changes are correlated with the severity of the deformity and can justify certain clinical symptoms and cardiac function abnormalities in patients with severe PE

Diagnostic delay as main contributing factor to a large outbreak of tuberculosis in a university. / Demora diagnóstica como principal factor contribuyente a un importante brote de tuberculosis en una universidad.

OBJECTIVE: To describe the epidemiological characteristics of a large tuberculosis outbreak in the university environment and the main risk factors associated with it. METHOD: A descriptive analysis of the data collected from sick individuals and their contacts was made. For the contact tracing, the guidelines established in the Tuberculosis Programme of the Autonomous Community of the Basque Country were followed. Six of the outbreak strains were sent to the National Centre of Microbiology for molecular typing. RESULTS: The total number of cases of the outbreak was 11. The rate of tuberculosis infection in the classroom of the index case, including the sick individuals, was 88.1% (59 infected and only 8 uninfected). The diagnostic delay of the index case was 260 days, and in the other 8 symptomatic cases it ranged between 10 and 70 days. The pattern obtained by the 2genotyping techniques was identical in the 6 strains studied. CONCLUSIONS: The long diagnostic delay of the authentic index case, which was diagnosed in the contact tracing, and the poor ventilation conditions of the classroom, determined the high number of secondary cases associated with this outbreak.

The Role of Free Radicals in Autophagy Regulation: Implications for Ageing.

Reactive oxygen and nitrogen species (ROS and RNS, resp.) have been traditionally perceived solely as detrimental, leading to oxidative damage of biological macromolecules and organelles, cellular demise, and ageing. However, recent data suggest that ROS/RNS also plays an integral role in intracellular signalling and redox homeostasis (redoxtasis), which are necessary for the maintenance of cellular functions. There is a complex relationship between cellular ROS/RNS content and autophagy, which represents one of the major quality control systems in the cell. In this review, we focus on redox signalling and autophagy regulation with a special interest on ageing-associated changes. In the last section, we describe the role of autophagy and redox signalling in the context of Alzheimer's disease as an example of a prevalent age-related disorder.

[Benefits of magnetic resonance for the study of pectus excavatum in children: initial experience]. / Beneficios de la resonancia magnética para el estudio del pectus excavatum en niños: experiencia inicial.

INTRODUCTION/AIM OF THE STUDY: In patients with PE, cardiovascular alterations ensue as a result of the mediastinum compression caused by sternum impingement and is responsible of many of the symptoms. Anatomical and functional assessment is of the utmost importance for a comprehensive understanding of the disease and an adequate treatment plan. Our aim was to describe the use of magnetic resonance image (MRI) in the study of PE and whether it is comparable to imaging techniques. PATIENTS AND METHODS: A retrospective study of the first 10 patients in which an MRI was performed as part of PE assessment within august 2015-2016. PE indexes were evaluated: Haller, correction, asymmetry, as well as sternal rotation. An analysis of right ventricular function was carried out comparing echocardiogram and MRI. RESULTS: MRI scan on 10 patients showed the following findings: Haller index: inspiration: 3.75 (3.5-7.3) and expiration 4,9 (3.9-10.8), correction index of 24% (5-37%) and a sternal rotation of 12º (0-31º). The cardiovascular study showed a median ejection fraction of the right ventricle (EFRV) of 50% (38-64%), with 9 of the 10 patients under the normal value of 61% (54-71%). Echocardiographic findings underestimated functional alterations in all of the patients. CONCLUSION: This initial study suggests that the use of MRI as a test of choice in the evaluation of PE subject to surgical correction is feasible. Absence of radiation offers the capacity of a complete and dynamic anatomical as well as cardiovascular study.

INTRODUCCION/OBJETIVOS: Las alteraciones cardiovasculares provocadas por la impronta del esternón en el mediastino causan muchos de los síntomas que presentan los pacientes con pectus excavatum (PE). Su estudio anatómico y funcional es fundamental para el entendimiento de la enfermedad y para la elección del tratamiento adecuado. Nuestro objetivo es describir el uso de la resonancia magnética (RM) en el estudio de los pacientes con PE, y si esta prueba es equiparable o superior a otras técnicas de imagen. PACIENTES Y METODOS: Evaluación retrospectiva de los resultados de las primeras 10 RM indicadas en pacientes con PE en el período de octubre 2015-2016. Se analizaron los índices de PE: Haller, corrección, asimetría, así como el grado de rotación esternal. Además se realizó un análisis de la función ventricular derecha mediante ecocardiografía y RM. RESULTADOS: Los 10 pacientes evaluados con RM presentaron: índice de Haller en inspiración de 3,75 (3,5-7,3) y en espiración de 4,9 (3,9-10,8), índice de corrección 24% (5-37%) y rotación esternal 12º (0º-31º). Del estudio cardiovascular destaca una fracción de eyección del ventrículo derecho (FEVD) del 50% (38-64%), con 9 de los pacientes por debajo del valor normal 61% (54-71%). La ecocardiografía infraestimó la alteración funcional en la mayoría de casos, al calificarla de normal en el 100%. CONCLUSION: Este estudio inicial sugiere que el uso de la RM como prueba de elección en la evaluación del PE susceptible de corrección quirúrgica es factible. La ausencia de radicación ofrece la capacidad de un estudio tanto anatómico como cardiovascular completo y dinámico.

Beneficios de la resonancia magnética para el estudio del pectus excavatum en niños: experiencia inicial / Benefits of magnetic resonance for the study of pectus excavatum in children: initial experience

Introducción/Objetivos. Las alteraciones cardiovasculares provocadas por la impronta del esternón en el mediastino causan muchos de los síntomas que presentan los pacientes con pectus excavatum (PE). Su estudio anatómico y funcional es fundamental para el entendimiento de la enfermedad y para la elección del tratamiento adecuado. Nuestro objetivo es describir el uso de la resonancia magnética (RM) en el estudio de los pacientes con PE, y si esta prueba es equiparable o superior a otras técnicas de imagen. Pacientes y métodos. Evaluación retrospectiva de los resultados de las primeras 10 RM indicadas en pacientes con PE en el período de octubre 2015-2016. Se analizaron los índices de PE: Haller, corrección, asimetría, así como el grado de rotación esternal. Además se realizó un análisis de la función ventricular derecha mediante ecocardiografía y RM. Resultados. Los 10 pacientes evaluados con RM presentaron: índice de Haller en inspiración de 3,75 (3,5-7,3) y en espiración de 4,9 (3,9-10,8), índice de corrección 24% (5-37%) y rotación esternal 12º (0º-31º). Del estudio cardiovascular destaca una fracción de eyección del ventrículo derecho (FEVD) del 50% (38-64%), con 9 de los pacientes por debajo del valor normal 61% (54-71%). La ecocardiografía infraestimó la alteración funcional en la mayoría de casos, al calificarla de normal en el 100%. Conclusión. Este estudio inicial sugiere que el uso de la RM como prueba de elección en la evaluación del PE susceptible de corrección quirúrgica es factible. La ausencia de radicación ofrece la capacidad de un estudio tanto anatómico como cardiovascular completo y dinámico (AU)

Introduction/Aim of the study. In patients with PE, cardiovascular alterations ensue as a result of the mediastinum compression caused by sternum impingement and is responsible of many of the symptoms. Anatomical and functional assessment is of the utmost importance for a comprehensive understanding of the disease and an adequate treatment plan. Our aim was to describe the use of magnetic resonance image (MRI) in the study of PE and whether it is comparable to imaging techniques. Patients and methods. A retrospective study of the first 10 patients in which an MRI was performed as part of PE assessment within august 2015-2016. PE indexes were evaluated: Haller, correction, asymmetry, as well as sternal rotation. An analysis of right ventricular function was carried out comparing echocardiogram and MRI. Results. MRI scan on 10 patients showed the following findings: Haller index: inspiration: 3.75 (3.5-7.3) and expiration 4,9 (3.9-10.8), correction index of 24% (5-37%) and a sternal rotation of 12º (0-31º). The cardiovascular study showed a median ejection fraction of the right ventricle (EFRV) of 50% (38-64%), with 9 of the 10 patients under the normal value of 61% (54-71%). Echocardiographic findings underestimated functional alterations in all of the patients. Conclusion. This initial study suggests that the use of MRI as a test of choice in the evaluation of PE subject to surgical correction is feasible. Absence of radiation offers the capacity of a complete and dynamic anatomical as well as cardiovascular study (AU)

Total and mutated EGFR quantification in cell-free DNA from non-small cell lung cancer patients detects tumor heterogeneity and presents prognostic value.

Mutation analysis of epidermal growth factor receptor (EGFR) gene is essential for treatment selection in non-small cell lung cancer (NSCLC). Analysis is usually performed in tumor samples. We evaluated the clinical utility of EGFR analysis in plasma cell-free DNA (cfDNA) from patients under treatment with EGFR inhibitors. We selected 36 patients with NSCLC and EGFR-activating mutations. Blood samples were collected at baseline and during treatment with EGFR inhibitors. Wild-type EGFR, L858R, delE746-A750, and T790M mutations were quantified in cfDNA by droplet digital PCR. Stage IV patients had higher total circulating EGFR copy levels than stage I (3523 vs. 1003 copies/mL; p < 0.01). There was high agreement for activating mutations between baseline cfDNA and tumor samples, especially for L858R mutation (kappa index = 0.679; p = 0.001). In 34 % of advanced NSCLC patients, we detected mutations in cfDNA not previously detected in tumor samples and double mutations in 17 %. Patients with baseline total EGFR copy levels above the median presented decreased overall survival (OS) (341 vs. 870 days, p < 0.05) and progression-free survival (PFS) (238 vs. 783 days; p < 0.05) compared with those with total EGFR copy levels below the median. Patients with baseline concentrations of activating mutations above the median (94 copies/mL) had lower OS (317 vs. 805 days; p < 0.05) and PFS (195 vs. 724 days; p < 0.05). During follow-up, T790M resistance mutation was detected in 53 % of patients. Total and mutated EGFR analysis in cfDNA seems a relevant tool to characterize the molecular profile and prognosis of NSCLC patients harboring EGFR mutations.

Complement activation product C4d in oral and oropharyngeal squamous cell carcinoma.

OBJECTIVE: Complement C4d-containing fragments have been proposed as diagnostic markers for lung cancer. The purpose of this study was to evaluate the presence of C4d in oropharyngeal (OPSCC) and oral (OSCC) squamous cell carcinomas. SUBJECTS AND METHODS: C4d staining was analyzed by immunohistochemistry in 244 OPSCC surgical specimens. C4d levels were quantified by ELISA in resting saliva samples from 48 patients with oral leukoplakia and 62 with OSCC. Plasma samples from 21 patients with leukoplakia and 30 with oral carcinoma were also studied. RESULTS: C4d staining in OPSCC specimens was associated with nodal invasion (P = 0.001), histopathologic grade (P = 0.014), disease stage (P = 0.040), and focal-adhesion kinase expression (P < 0.001). No association was found between C4d and prognosis. Saliva C4d levels were higher in patients with oral cancer than in subjects with leukoplakia (0.07 ± 0.07 vs 0.04 ± 0.03 µg ml(-1) , P = 0.003). The area under the ROC curve was 0.63 (95%CI: 0.55-0.71). Salivary C4d levels in stage IV patients were higher than in patients with earlier stages (P = 0.028) and correlated with tumor size (P = 0.045). Plasma C4d levels also correlated with salivary C4d levels (P = 0.041), but differences between patients with oral cancer and subjects with leukoplakia were not significant (1.26 ± 0.59 vs 1.09 ± 0.39 µg ml(-1) , P = 0.232). CONCLUSION: C4d-containing fragments are detected in oral primary tumors and are increased in saliva from patients with OSCC.

Sistemas de ventilación no invasiva de alto flujo en neonatología: revisión y aproximación a su utilización en hospitales de la Comunidad de Madrid / High flow non-invasive ventilation systems: review and approximation to its use in hospitals throughout Madrid

El uso de sistemas de ventilación de alto flujo ha ido creciendo en el ámbito de la neonatología en los últimos años. Estos dispositivos difieren de los sistemas de ventilación de presión continua (CPAP), por ejemplo, en la necesidad de que exista una fuga pericánula variable, y no deben emplearse como sustitutos de la CPAP. Es fundamental garantizar un adecuado calentamiento y humidificación del flujo para su correcta utilización. Sin embargo, a pesar de los numerosos estudios que intentan demostrar su eficacia y seguridad, y de la impresión subjetiva de ser un buen método de oxigenoterapia no invasiva, tanto en niños nacidos a término como en prematuros, aún desconocemos la presión espiratoria final exacta que generan en la orofaringe, y en qué patologías deben emplearse; por tanto, de momento no se pueden establecer protocolos de uso estandarizados (AU)

There is an increasing use of heated and humidified high flow ventilation systems in neonatology. There are some clear differences with continued airway pressure ventilation systems, such as the need for a variable nose leak. Heated and humidified airflow is imperative for its correct use. Despite a wide number of studies attempting to demonstrate its safety and effectiveness, and the general impression that it is a valid mode of oxygen therapy, both in preterm and term babies, we still do not know precisely what end expiratory pressure is being generated or in what scenarios to use it, therefore no standardized protocols for its use have currently been established (AU)

TGFBI expression is an independent predictor of survival in adjuvant-treated lung squamous cell carcinoma patients.

BACKGROUND: Transforming growth factor ß-induced protein (TGFBI) is a secreted protein that mediates cell anchoring to the extracellular matrix. This protein is downregulated in lung cancer, and when overexpressed, contributes to apoptotic cell death. Using a small series of stage IV non-small cell lung cancer (NSCLC) patients, we previously suggested the usefulness of TGFBI as a prognostic and predictive factor in chemotherapy-treated late-stage NSCLC. In order to validate and extend these results, we broaden the analysis and studied TGFBI expression in a large series of samples obtained from stage I-IV NSCLC patients. METHODS: TGFBI expression was assessed by immunohistochemistry in 364 completely resected primary NSCLC samples: 242 adenocarcinomas (ADCs) and 122 squamous cell carcinomas (SCCs). Kaplan-Meier curves, log-rank tests and the Cox proportional hazards model were used to analyse the association between TGFBI expression and survival. RESULTS: High TGFBI levels were associated with longer overall survival (OS, P<0.001) and progression-free survival (PFS, P<0.001) in SCC patients who received adjuvant platinium-based chemotherapy. Moreover, multivariate analysis demonstrated that high TGFBI expression is an independent predictor of better survival in patients (OS: P=0.030 and PFS: P=0.026). CONCLUSIONS: TGFBI may be useful for the identification of a subset of NSCLC who may benefit from adjuvant therapy.

Overexpression of TMPRSS4 in non-small cell lung cancer is associated with poor prognosis in patients with squamous histology.

BACKGROUND: Mortality rates in lung cancer patients have not decreased significantly in recent years, even with the implementation of new therapeutic regimens. One of the main problems is that a large proportion of patients present local or distant metastasis at the time of diagnosis. The need for identification of novel biomarkers and therapeutic targets for a more effective management of lung cancer led us to investigate TMPRSS4, a protease reported to promote tumour growth and metastasis. MATERIAL AND METHODS: In all, 34 lung cancer cell lines were used to evaluate the TMPRSS4 expression. Cell migration and clonogenic assays, and an in-vivo lung metastasis model were used for functional analysis of the TMPRSS4 downregulation in H358, H441 and H2170 cell lines. The TMPRSS4 expression analysis in normal and malignant lung tissue samples was performed by qPCR. Five different microarray-based publicly available expression databases were used to validate our results and to study prognosis. RESULTS: The TMPRSS4 knock down in H358, H441 and H2170 cells resulted in a significant reduction in proliferation, clonogenic capacity and invasion. A significant (P<0.05) decrease in the lung colonisation and growth was found when mice were injected with TMPRSS4-depleated H358-derived clones, as compared with controls. Expression of TMPRSS4 showed a >30-fold increase (P<0.001) in tumours in comparison with non-malignant samples. Levels in tumours with squamous cell carcinoma (SCC) histology were found to be significantly higher (P<0.001) than those with adenocarcinoma (AC) histology, which was confirmed in data retrieved from the microarrays. Kaplan-Meier curves demonstrated that high levels of TMPRSS4 were significantly associated (P=0.017) with reduced overall survival in the patients with SCC histology, whereas no correlation was found for the AC histology. CONCLUSION: Our results demonstrate that TMPRSS4 has a role in the lung cancer development. The potential use of TMPRSS4 as a biomarker for lung cancer detection or as a predictor of patient's outcome warrants further investigation.

Cutaneous, mediastinal and hepatic hemangiomas in a girl followed during 12 years.

We present in this paper the case of a 12-year-old girl who had the clinical features of 2 different disorders: neurofibromatosis 1 (NF1) and 3 hemangiomas located in the skin, liver and mediastinum. The patient did not receive any specific treatment and showed a normal progressive evolution that lasted 1 / to 2 years and a very slow regression that lasted for a more prolonged time than expected (the 3 hemangiomas have not completely disappeared yet), although all 3 have been asymptomatic. MRI of the brain did not disclose a hemangioblastoma of the cerebellum or any other vascular lesion of the brain. Mental development of this girl was in the borderline range, as is commonly seen in Pascual-Castroviejo II syndrome (P-CIIS)/PHACE syndrome and in NF1, 2 syndromes which have not been reported to be associated in the same patient previously.