First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy.

INTRODUCTION: Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS: We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS: We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION: Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.

Derivación y validación de una puntuación de riesgo de ingreso en la Unidad de Cuidados Intensivos para pacientes con COVID-19 / Derivation and validation of a risk score for admission to the Intensive Care Unit in patients with COVID-19

Fundamento: Identificar y validar una escala de riesgo de ingreso en las unidades de cuidados intensivos (UCI) en pacientes hospitalizados con enfermedad por coronavirus 2019 (COVID-19). Métodos: Realizamos una regla de derivación y otra de validación para ingreso en UCI, utilizando los datos de un registro nacional de cohortes de pacientes con infección confirmada por SARS-CoV-2 ingresados entre marzo y agosto del año 2020 (n = 16.298). Analizamos variables demográficas, clínicas, radiológicas y de laboratorio disponibles en el ingreso hospitalario. Evaluamos el rendimiento de la escala de riesgo mediante estimación del área bajo la curva de característica operativa del receptor (AROC). Utilizamos los coeficientes β del modelo de regresión para elaborar una puntuación (0 a 100 puntos) asociada con ingreso en UCI. Resultados: La edad media de los pacientes fue de 67 años; 57% varones. Un total de 1.420 (8,7%) pacientes ingresaron en la UCI. Las variables independientes asociadas con el ingreso en UCI fueron: edad, disnea, índice de comorbilidad de Charlson, cociente neutrófilos-linfocitos, lactato deshidrogenasa e infiltrados difusos en la radiografía de tórax. El modelo mostró un AROC de 0,780 (IC: 0,763-0,797) en la cohorte de derivación y un AROC de 0,734 (IC: 0,708-0,761) en la cohorte de validación. Una puntuación > 75 se asoció con una probabilidad de ingreso en UCI superior a un 30%, mientras que una puntuación < 50 redujo la probabilidad de ingreso en UCI al 15%. Conclusiós: Una puntuación de predicción simple proporcionó una herramienta útil para predecir la probabilidad de ingreso en la UCI con un alto grado de precisión (AU)

Background: This work aims to identify and validate a risk scale for admission to intensive care units (ICU) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods: We created a derivation rule and a validation rule for ICU admission using data from a national registry of a cohort of patients with confirmed SARS-CoV-2 infection who were admitted between March and August 2020 (n = 16,298). We analyzed the available demographic, clinical, radiological, and laboratory variables recorded at hospital admission. We evaluated the performance of the risk score by estimating the area under the receiver operating characteristic curve (AUROC). Using the β coefficients of the regression model, we developed a score (0 to 100 points) associated with ICU admission. Results: The mean age of the patients was 67 years; 57% were men. A total of 1,420 (8.7%) patients were admitted to the ICU. The variables independently associated with ICU admission were age, dyspnea, Charlson Comorbidity Index score, neutrophil-to-lymphocyte ratio, lactate dehydrogenase levels, and presence of diffuse infiltrates on a chest X-ray. The model showed an AUROC of 0.780 (CI: 0.763-0.797) in the derivation cohort and an AUROC of 0.734 (CI: 0.708-0.761) in the validation cohort. A score of greater than 75 points was associated with a more than 30% probability of ICU admission while a score of less than 50 points reduced the likelihood of ICU admission to 15%. Conclusion: A simple prediction score was a useful tool for forecasting the probability of ICU admission with a high degree of precision (AU)

Derivation and validation of a risk score for admission to the Intensive Care Unit in patients with COVID-19.

BACKGROUND: This work aims to identify and validate a risk scale for admission to intensive care units (ICU) in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: We created a derivation rule and a validation rule for ICU admission using data from a national registry of a cohort of patients with confirmed SARS-CoV-2 infection who were admitted between March and August 2020 (N = 16,298). We analyzed the available demographic, clinical, radiological, and laboratory variables recorded at hospital admission. We evaluated the performance of the risk score by estimating the area under the receiver operating characteristic curve (AUROC). Using the ß coefficients of the regression model, we developed a score (0-100 points) associated with ICU admission. RESULTS: The mean age of the patients was 67 years; 57% were men. A total of 1420 (8.7%) patients were admitted to the ICU. The variables independently associated with ICU admission were age, dyspnea, Charlson Comorbidity Index score, neutrophil-to-lymphocyte ratio, lactate dehydrogenase levels, and presence of diffuse infiltrates on a chest X-ray. The model showed an AUROC of 0.780 (CI: 0.763-0.797) in the derivation cohort and an AUROC of 0.734 (CI: 0.708-0.761) in the validation cohort. A score of greater than 75 points was associated with a more than 30% probability of ICU admission while a score of less than 50 points reduced the likelihood of ICU admission to 15%. CONCLUSION: A simple prediction score was a useful tool for forecasting the probability of ICU admission with a high degree of precision.

[Derivation and validation of a risk score for admission to the Intensive Care Unit in patients with COVID-19]. / Derivación y validación de una puntuación de riesgo de ingreso en la Unidad de Cuidados Intensivos para pacientes con COVID-19.

BACKGROUND: This work aims to identify and validate a risk scale for admission to intensive care units (ICU) in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS: We created a derivation rule and a validation rule for ICU admission using data from a national registry of a cohort of patients with confirmed SARS-CoV-2 infection who were admitted between March and August 2020 (n = 16,298). We analyzed the available demographic, clinical, radiological, and laboratory variables recorded at hospital admission. We evaluated the performance of the risk score by estimating the area under the receiver operating characteristic curve (AUROC). Using the ß coefficients of the regression model, we developed a score (0 to 100 points) associated with ICU admission. RESULTS: The mean age of the patients was 67 years; 57% were men. A total of 1,420 (8.7%) patients were admitted to the ICU. The variables independently associated with ICU admission were age, dyspnea, Charlson Comorbidity Index score, neutrophil-to-lymphocyte ratio, lactate dehydrogenase levels, and presence of diffuse infiltrates on a chest X-ray. The model showed an AUROC of 0.780 (CI: 0.763-0.797) in the derivation cohort and an AUROC of 0.734 (CI: 0.708-0.761) in the validation cohort. A score of greater than 75 points was associated with a more than 30% probability of ICU admission while a score of less than 50 points reduced the likelihood of ICU admission to 15%. CONCLUSION: A simple prediction score was a useful tool for forecasting the probability of ICU admission with a high degree of precision.

Clinical factors associated with discontinuation of ts/bDMARDs in rheumatic patients from the BIOBADASER III registry.

Biologic and targeted synthetic disease-modifying antirheumatic drugs (ts/bDMARDs) play a pivotal role in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Persistence of therapy provides an index of a drug's overall effectiveness. The objective of the study was to identify factors associated with discontinuation of ts/bDMARDs in a real-world dataset. The study population comprised patients diagnosed with RA, PsA, and AS included in the BIOBADASER registry for whom follow-up data were available until November 2019. Patient features and treatment data were included in the analysis. The Kaplan-Meier method was used to study survival of the different drugs according to the reason for discontinuation. Factors associated with discontinuation were studied using Cox regression models and bivariate and multivariate analyses. P values of less than 0.05 were regarded as statistically significant. The study population comprised 4,752 patients who received a total of 8,377 drugs, of which 4,411 (52.65%) were discontinued. The Kaplan-Meier curves showed that survival for first-line treatment was greater in all 3 groups (p < 0.001). Patients with RA had a greater risk of discontinuation if they were younger (HR, 0.99; 95% CI 0.99-1.00), if they were receiving anti-TNFα agents (HR, 0.61; 95% CI 0.54-0.70), and if they had more comorbid conditions (HR, 1.09; 95% CI 1.00-1.17). Patients with PsA had a higher risk if they were women (HR, 1.36; 95% CI 1.15-1.62) and if they were receiving other ts/bDMARDs (HR, 1.29; 95% CI 1.05-1.59). In patients with AS, risk increased with age (HR, 1.01; 95% CI 1.00-1.02), as did the number of comorbid conditions (HR, 1.27; 95% CI 1.12-1.45). The factors that most affected discontinuation of ts/bDMARDs were line of treatment, age, type of drug, sex, comorbidity and the year of initiation of treatment. The association with these factors differed with each disease, except for first-line treatment, which was associated with a lower risk of discontinuation in all 3 diseases.

Safe and successful treatment of refractory polyarteritis nodosa with tocilizumab in a patient with past hepatitis B virus infection: a case-based review.

Polyarteritis nodosa is a primary systemic necrotizing vasculitis whose evolution follows, in many cases, a chronic remitting-recurrent course with refractoriness to conventional immunosuppressants. We report here the clinical case of a 75-year-old patient with serologies suggestive of past hepatitis B virus infection who presented a flare of polyarteritis nodosa with great secondary functional impairment. She had not responded to several previous immunosuppressants and required high doses of glucocorticoids to control the flare. After the initiation of biological therapy with tocilizumab, the patient experienced a rapid and marked clinical and analytical improvement, going into clinical remission and being able to remarkably lower the corticosteroid dose and stop the rest of the immunosuppressants. There was no evidence of hepatitis B virus reactivation or changes in the titers of any of the parameters related to the aforementioned infection. This clinical case represents the first case reported in the literature about the successful and safe treatment of polyarteritis nodosa with tocilizumab in a patient with serologies suggestive of past hepatitis B virus infection.

Use of intracranial stent as rescue therapy after mechanical thrombectomy failure-9-year experience in a comprehensive stroke centre.

PURPOSE: There is no established rescue treatment in patients with mechanical thrombectomy (MT) failure. Our aim is to analyse whether the use of an intracranial stent improves prognosis in these patients. METHODS: Retrospective analysis of a prospective cohort of patients with ischemic stroke due to middle cerebral artery occlusion (MCA) or distal intracranial carotid artery (ICA) occlusion, from September 2009 to April 2019 in our comprehensive stroke care centre. Patients with MT failure were identified and dichotomized into two groups according to whether or not an intracranial stent was implanted. We analysed clinical outcomes in both groups. RESULTS: There was MT failure in 60 patients (14%) of the 433 with large vessel occlusion in distal ICA and proximal MCA. A stent was placed in 20 of them (33.3%). Compared to patients without rescue stenting, they showed better rates of independence at 3 months (mRS ≤ 2) 45% vs 2.5% (p < 0.001) and lower mortality 15% vs 50% (p = 0.009), maintaining statistical significance after multivariate analysis, without a significant increase of the rate of symptomatic intracranial haemorrhage (p = 0.209). CONCLUSION: Placement of an intracranial stent as rescue therapy after MT failure was associated with better clinical outcome without significant increase in haemorrhagic complications. We believe that this procedure should be appraised in these patients.

Dual SAVE technique for mechanical thrombectomy rescue on MCA bifurcation clots.

The Stent retriever Assisted Vacuum-locked Extraction (SAVE) technique in mechanical thrombectomy consists of the simultaneous use of a stent retriever and a distal aspiration catheter, with the removal of both as a unit when performing the thrombectomy pass. This is a safe procedure that provides a high rate of first-pass reperfusion.1 In the distal M1 segment of the middle cerebral artery (MCA) occlusions, with the distal portion of the clot extending to the upper and lower MCA branches, mechanical thrombectomy can be challenging since the thrombus is not fully trapped, with risk of distal clot migration to the branch in which the retriever is not placed. In these cases the double stent-retriever technique has been described as a rescue strategy.2-4 We describe a case of the combined use of SAVE and double stent-retriever techniques as a rescue strategy in a patient with tandem occlusion of the proximal internal carotid artery and distal MCA-the D-SAVE technique. (video 1).

Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos / Aortic dissection class 3: a little-known entity. Presentation of 4 cases

La disección aórtica es la patología aguda más frecuente de la aorta y presenta una elevada mortalidad, por lo que constituye una urgencia radiológica de vital importancia. Actualmente se diferencian cinco subtipos, siendo la clase 3, también conocida como disección aórtica limitada o sutil, la variante más desconocida. Este tipo de disección es infrecuente y exige un conocimiento claro de su semiología radiológica para que no pase desapercibida. Desde el punto de vista de la imagen, esta entidad se caracteriza por un pequeño abultamiento focal del contorno aórtico y/o dilatación circunferencial localizada del segmento aórtico afectado por el desgarro intimal. Recientemente se ha destacado la baja familiaridad del radiólogo con esta patología. Con la finalidad de ilustrar los principales hallazgos de imagen y revisar los aspectos más relevantes de esta entidad, presentamos cuatro casos de disección aórtica de clase 3 diagnosticados en nuestro hospital

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital

Aortic dissection class 3: a little-known entity. Presentation of 4 cases. / Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos.

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital.

Profilaxis antibiótica "dirigida" por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria / Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs

Introducción: La biopsia prostática transrectal ecográficamente dirigida (BPTE) se asocia a complicaciones infecciosas (CI). Las CI están relacionadas con un incremento de la prevalencia de bacterias ciprofloxacino-resistentes (BCR) en la flora rectal. Estudiamos las CI ocurridas en 2 grupos. Grupo de profilaxis antibiótica «dirigida» (GPD) vs. grupo de profilaxis empírica (GPE). Evaluamos el impacto económico que supone la profilaxis antibiótica «dirigida» (PD). Material y métodos: El GPD se estudió prospectivamente (junio 2013-julio 2014). Se recogieron cultivos rectales (CR) antes de BPTE y se sembraron en medios selectivos con ciprofloxacino para determinar la presencia de BCR. Los pacientes con bacterias sensibles recibieron ciprofloxacino. Pacientes con bacterias resistentes recibieron PD según antibiograma del CR. El GPE se estudió retrospectivamente (enero 2011-junio 2009). El CR no se realizó y todos los pacientes recibieron ciprofloxacino como profilaxis. Las CI ocurridas en ambos grupos se registraron en un periodo no superior a 30 días después de BPTE (historia clínica electrónica). Resultados: Trescientos pacientes fueron sometidos a BPTE, 145 recibieron PD y 155 PE. En el GPD, 23 pacientes (15,86%) presentaron BCR en CR. Solo un paciente (0,7%) experimentó ITU. En el GPE, 26 pacientes (16,8%) experimentaron múltiples CI (incluidas 2 sepsis) (p < 0,005). El coste total estimado, incluido el manejo de las CI, fue de 57.076 € con PE vs. 4.802,33 € con PD. El coste promedio/paciente con PE fue de 368,23 € vs. 33,11 € con PD. La PD logró un ahorro total estimado de 52.273,67 €. Es necesario que 6 pacientes se sometan a PD para prevenir una CI. Conclusiones: La PD se asoció a un notable descenso de la incidencia de CI causadas por BCR y redujo los costos de atención sanitaria

Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP.: Material and methods: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Results: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P < .005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was € 368.23 versus €33.11 with GP. GP achieved an estimated total savings of € 52,273.67. Six patients had to undergo GP to prevent an IC. Conclusions: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs

Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs. / Profilaxis antibiótica «dirigida¼ por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. MATERIAL AND METHODS: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). RESULTS: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. CONCLUSIONS: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs.

[Benign tumors that cause fractures in children]. / Tumores benignos que producen fracturas en niños.

INTRODUCTION: A pathological fracture is defined as that which occurs through an abnormal bone. Approximately 20,000 benign neoplasms of the musculoskeletal system are diagnosed each year. Often the pain of the fracture is the first symptom of a pathological process in the bone. The site, age and radiographic appearance create a differential diagnosis for pathological fractures that remains broad. The clinical examination evaluates the condition of the skin, palpating any tissue mass and determining if there are local inflammatory signs such as erythema, heat or edema. The biopsy is highly recommended to confirm the diagnosis of a pathological fracture. OBJECTIVE: To determine which benign bone tumors and pseudotumoral lesions produce fractures in childrens bones more frequently in our institution. MATERIAL AND METHODS: Cross-sectional retrospective study, review of records of patients with diagnosis of pathological fracture, attended in the period from March 2013 to March 2017, were reviewed. Results: The benign tumors that caused fractures in previously damaged areas were: aneurysmal bone cyst 13, enchondroma 5, osteoid osteoma 3, giant cell tumor 2. CONCLUSION: At our institution, aneurysmal bone cysts were the benign tumors that most frequently produce pathological fractures in children, with predominance in males.

INTRODUCCIÓN: Se define fractura patológica a la que se produce a través de un hueso anormal. Cada año se diagnostican aproximadamente 20,000 neoplasias benignas del sistema musculoesquelético. A menudo, el dolor de la fractura es el primer síntoma de un proceso patológico en el hueso. El sitio, la edad y la apariencia radiográfica crean un diagnóstico diferencial para las fracturas patológicas que sigue siendo amplio. El examen clínico evalúa la condición de la piel, palpar cualquier masa de tejido y determinar si hay signos inflamatorios locales como eritema, calor o edema. La toma de biopsia es muy recomendable para confirmar el diagnóstico de una fractura patológica. OBJETIVO: Determinar qué tumores óseos benignos y qué lesiones seudotumorales producen fracturas en huesos de niños con mayor frecuencia en nuestro hospital. MATERIAL Y MÉTODOS: Estudio retrospectivo transversal, se revisaron expedientes de pacientes con diagnóstico de fractura en terreno patológico, atendidos en el período de Marzo de 2013 a Marzo de 2017. RESULTADOS: Los tumores benignos que ocasionaron fracturas en terreno previamente dañado fueron: quiste óseo aneurismático 13, encondroma cinco, osteoma osteoide tres, tumor de células gigantes dos. CONCLUSIÓN: En nuestra institución, los quistes óseos aneurismáticos fueron los tumores benignos que con mayor frecuencia producen fracturas patológicas en niños, con predominio en el sexo masculino.

Revisión de 2 casos de pseudoaneurismas de carótida común, micótico y secundario a radioterapia, tratados con stent recubiertos / Review of two common carotid pseudoaneurysms, radiotherapy-induced and mycotic, treated with coated stents

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Fibrosis retroperitoneal relacionada con IgG4 / IgG4-Related Retroperitoneal fibrosis

OBJETIVO: Reportar dos nuevos casos de fibrosis retroperitoneal relacionada con IgG4, patología recientemente descrita. MÉTODO: Analizamos dos casos diagnosticados en nuestro centro y revisión de la literatura.RESULTADO: La enfermedad relacionada con IgG4 es una nueva entidad que agrupa diversas patologías fibroinflamatorias hasta ahora no relacionadas entre sí. Las manifestaciones clínicas son muy variables y la presentación suele ser subaguda. El tratamiento de elección son los corticoides. En el primer caso la evolución fue favorable con corticoides y azatioprina. En cambio, el segundo caso precisó cirugía en 2 ocasiones con nefrectomía radical. El diagnostico del segundo caso se realizó 9 años desde el inicio de los síntomas tras revisión de la biopsia; en ese momento no se inicio tratamiento inmunosupresor. CONCLUSIONES: Es muy importante conocerla y diagnosticarla dada la buena respuesta al tratamiento que evita complicaciones

OBJECTIVE: To report two new cases of IgG4-related retroperitoneal fibrosis, a recently described pathology. METHODS: We analyze two cases diagnosed in our center and performed a literature review. RESULT: IgG4 related disease is a recently described entity that includes previously not related pathologies. The clinical manifestations are highly variable and its presentation is usually subacute. The treatment of choice is glucocorticoids. In our first case the outcome was favorable with corticosteroids and azathioprine. However, the second case required surgery on 2 occasions with radical nephrectomy. The diagnosis of the latter was made nine years after the onset of symptoms when the biopsy was reviewed; at that moment immunosuppressive therapy was not started. CONCLUSIONS: It is very important to know and diagnose this disease because of the good response to treatment that prevents complications

Development of a comet-FISH assay for the detection of DNA damage in hemocytes of Crassostrea gigas.

In this work, the DNA-damaging effect of hydrogen peroxide on the structural integrity of nucleolar organizer regions (NORs) was studied for the first time by comet-FISH in the Pacific oyster Crassostrea gigas. Global DNA damage was assessed in hemocytes using an alkaline version of the comet assay. Next, NOR sensitivity was analyzed by mapping major rDNA repeat unit by fluorescence in situ hybridization (FISH) on the same comet slides. Exposure of hemocytes to 100 µM of hydrogen peroxide induced a significant increase in both DNA damage and number of FISH-signals of major ribosomal genes versus the control. Moreover, a significant positive correlation was shown between DNA damage as measured by the comet assay (percentage of DNA in comet tail) and the number of signals present in comet tails. This study demonstrates the potential value of the comet-FISH assay for the study of DNA damage induced by genotoxicant exposure of target genes. It offers a perspective for better understanding the impact of genotoxicity on animal physiology and fitness.

Targeting midkine and pleiotrophin signalling pathways in addiction and neurodegenerative disorders: recent progress and perspectives.

UNLABELLED: Midkine (MK) and pleiotrophin (PTN) are two neurotrophic factors that are highly up-regulated in different brain regions after the administration of various drugs of abuse and in degenerative areas of the brain. A deficiency in both MK and PTN has been suggested to be an important genetic factor, which confers vulnerability to the development of the neurodegenerative disorders associated with drugs of abuse in humans. In this review, evidence demonstrating that MK and PTN limit the rewarding effects of drugs of abuse and, potentially, prevent drug relapse is compiled. There is also convincing evidence that MK and PTN have neuroprotective effects against the neurotoxicity and development of neurodegenerative disorders induced by drugs of abuse. Exogenous administration of MK and/or PTN into the CNS by means of non-invasive methods is proposed as a novel therapeutic strategy for addictive and neurodegenerative diseases. Identification of new molecular targets downstream of the MK and PTN signalling pathways or pharmacological modulation of those already known may also provide a more traditional, but probably effective, therapeutic strategy for treating addictive and neurodegenerative disorders. LINKED ARTICLES: This article is part of a themed section on Midkine. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-4.

Implantación de un plan de calidad en un servicio de urgencias y su impacto en la satisfacción del paciente / Implementation of an emergency department health care quality plan and its impact on patient satisfaction

Objetivo: Analizar el impacto de la implantación de un plan de calidad para mejorarla gestión de la demanda de atención urgente, en la evolución de las reclamaciones de los usuarios y su grado de satisfacción. Método: Estudio longitudinal observacional descriptivo prospectivo. Periodo de estudio: enero 2007 a diciembre 2010. Líneas del plan de calidad: desarrollo del plan funcional, un plan dirigido a la información y seguridad clínica, un sistema de gestión por procesos, un plan de actuación en formación y docencia con el desarrollo de un cuadro de mandos y un sistema de autoevaluación para el análisis de resultados. Análisis estadístico: test t de Student para variables continuas y la ji al cuadrado para dicotómicas o el Test exacto de Fisher y la corrección de Yates como test no paramétricos. Variables: urgencias atendidas/mes, número de reclamaciones y sus motivos, tiempos de estancia media en urgencias y demora admisión-1ª atención médica, y encuestas de opinión. Resultados: Se han incluido 210 reclamaciones: 81 en 2007, 59 en 2008, 48 en2009 y 22 en 2010. El 76,2% de ellas han sido por demora asistencial, seguidas por aquellas relacionadas con la disconformidad con las normas de organización (7,1%).Hay una reducción progresiva del porcentaje de reclamaciones respecto al total de urgencias atendidas con un valor de la ji al cuadrado de tendencia lineal de 28,28(p < 0,01). Tras la implantación del programa de calidad en 2008, disminuyeron un73,5% las reclamaciones por demora y dejaron de producirse reclamaciones por falta de intimidad y por accidentes en el centro. Conclusiones: El análisis de las reclamaciones es una herramienta útil de monitorización de la calidad asistencial. La implantación de un sistema de gestión de la calidad, se convierte en esencial en la mejora de la atención urgente del paciente sin costes adicionales (AU)

Objective: To analyze the effect of a quality control plan for improving emergency deparment case management interms of complaints received and patient level of satisfaction. Methods: Longitudinal, descriptive, prospective observational study. Time frame: January 2007 to December 2010.The health care quality plan involved the development of a viable plan; a campaign to impart information on patient and staff safety; a management system based on processes; and procedures for training and education, including a balanced scorecard and a system for self assessment of results. Outcome measures: emergencies attended monthly, number of claims and reasons for them, mean stay in the emergency department, delay from admission to first physician visit, and a user satisfaction survey. Results: A total of 210 claims were studied; 81 were filed in 2007, 59 in 2008, 48 in 2009, and 22 in 2010. Delays motivated 76.19% of the claims; disagreements about organizational procedures motivated 7.14%. More claims are received during summer months. After the program was implemented in 2008, complaints about delays decreased by73.53% and no further complaints about lack of privacy and accidents within the hospital were received. Conclusions: Claims analysis is a useful tool for monitoring health care quality. A health care quality management program is essential for improving emergency care without generating additional costs (AU)

Midkine regulates amphetamine-induced astrocytosis in striatum but has no effects on amphetamine-induced striatal dopaminergic denervation and addictive effects: functional differences between pleiotrophin and midkine.

Midkine (MK), a neurotrophic factor with important roles in survival and differentiation of dopaminergic neurons, is upregulated in different brain areas after administration of different drugs of abuse suggesting MK could modulate drugs of abuse-induced pharmacological or neuroadaptative effects. To test this hypothesis, we have studied the effects of amphetamine administration in MK genetically deficient (MK-/-) and wild-type (MK+/+) mice. In conditioning studies, we found that amphetamine induces conditioned place preference (CPP) similarly in both MK-/- and MK+/+ mice. In immunohistochemistry studies, we found that amphetamine (10 mg/kg, four times, every 2 h) causes a similar striatal dopaminergic denervation in both MK-/- and MK+/+ mice. However, we detected a significant increase of glial fibrillary acidic protein (GFAP)-positive cells in the striatum of amphetamine-treated MK-/- mice compared to MK+/+ mice, suggesting an enhanced amphetamine-induced astrocytosis in absence of endogenous MK. Interestingly, the levels of expression of the MK receptor, receptor protein tyrosine phosphatase (RPTP) ß/ζ, in the striatum were not found to be changed by the drug administration or the mouse genotype. In a similar manner the phosphorylation levels of RPTP ß/ζ substrates with important roles in survival of dopaminergic neurons, Fyn kinase and TrkA, and of the MAP kinases ERK1/2, were unaffected by the drug or the genotype. The data clearly suggest that endogenous MK limits amphetamine-induced astrocytosis through Fyn-, TrkA- and ERK1/2-independent mechanisms and identify previously unexpected functional differences between MK and pleiotrophin, the only other member of the MK family of growth factors, in the modulation of effects of drugs of abuse.