The Medtronic 780G advanced hybrid closed-loop system achieves and maintains good glycaemic control in type 1 diabetes adults despite previous treatment.

INTRODUCTION: Improvements in continuous glucose monitoring (CGM) in recent years have changed the treatment of type 1 diabetes (T1D) by permitting the automation of glucose control. The Minimed 780G advanced hybrid closed-loop (ACHL) system adapts basal infusion rates and delivers auto-correction boluses in order to achieve a user-decided glucose target (100, 110 or 120mg/dL). This study set out to evaluate the effectiveness of the Medtronic 780G system in real-life conditions over 6 months. MATERIALS AND METHODS: Prospective study that included T1D subjects previously treated with insulin pump without CGM (pump group) or with sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS group) who started with the Minimed 780G system. Sensor and pump data from baseline, and at 1, 3 and 6 months were downloaded and HbA1c was recorded at baseline and at 6 months. RESULTS: Fifty T1D subjects were included; 25 were previous SAP-PLGS 640G users and 25 used 640G without CGM. 66% were female, 48.6 (40-57) years of age with 20 (12-31.5) years of diabetes duration. Time in range (TIR) improved in the total cohort from baseline to 6 months (69% (57.7-76) vs. 74% (70-82); p=0.01 as did HbA1c (7.6% (7.1-7.8) vs. 7.0% (6.8-7.5); p<0.001), with improvement in times <54, >180 and >250mg/dL. Outcomes at 6 months did not differ between groups, although the SAP-PLGS subjects were prone to hypoglycaemia and the pump group mainly presented suboptimal metabolic control. CONCLUSION: The AHCL Medtronic Minimed 780G system achieves and maintains good glycaemic control over 6 months in real-life conditions in different profiles of T1D subjects.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

[Identification and review of health promotion at work programs in Spain.] / Identificación y revisión de los programas de promoción de la salud en el trabajo en España.

OBJECTIVE: Health promotion at work (HPW) is an essential component of social and economic policies. Objectives: 1) To determine which regions in Spain have a HPW program and 2) To review these programs according to health promotion and equity models. METHODS: Regional HPW programs were identified through occupational health committee. Their webs were reviewed, and we interviewed by videoconference the persons in charge of each program. We used a data collection notebook to collect descriptive as well as quality variables, according to health promotion and equity models. RESULTS: 6 regions have a HPW program: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura and Galicia, developed by health administration or work administration, but only in 1 case by both. 4 programs have regulations and 3 have created a network. The participation of occupational risk prevention services is key, while participation of workers and management teams is variable. Only 2 regions have incorporated information and materials related to COVID-19. Measures to promote equality and work-life balance, but not to promote equity. CONCLUSIONS: HPW in Spain is a reality in 6 regions, with differences between them related to the requisites and what the administration offers to them.

OBJETIVO: La promoción de la salud en el trabajo (PSLT) es un componente esencial de la política social y económica. Los objetivos fueron: 1) Determinar en qué comunidades autónomas (CCAA) existe un programa de PSLT y 2) Revisar dichos programas de acuerdo con los modelos de promoción de la salud y equidad en salud. METODOS: Los programas se han identificado a través de la Ponencia de salud laboral. Se han revisado sus webs y se han entrevistado por videoconferencia las personas responsables de cada programa. Se ha utilizado un cuaderno de recogida de datos para recoger variables descriptivas y de calidad según los marcos de promoción de la salud y equidad. RESULTADOS: 6 CCAA tienen programa de PSLT: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura y Galicia, desarrollados por la administración sanitaria, por la de trabajo o conjuntamente. 4 CCAA han desarrollado normativa para el programa y 3 han creado una red. La participación de los servicios de prevención de riesgos laborales es clave, mientras que la de las personas trabajadoras y equipos directivos es variable. Sólo 2 CCAA han incorporado información y materiales relacionados con la COVID-19. Se observan medidas para el fomento de la igualdad y conciliación laboral, pero no para fomentar la equidad. CONCLUSIONES: La PSLT en España es una realidad en 6 CCAA, con diferencias entre los programas, tanto en relación con los requisitos, como respecto a lo que les ofrece la administración.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. / Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didnt find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Prognostic significance of histopathological factors in survival and recurrence of atypical carcinoid tumours.

OBJECTIVES: Atypical carcinoids are neuroendocrine neoplasms of intermediate degree and low frequency. The aim of this study is to analyse their clinical characteristics and the importance of different histopathological factors in their prognosis. METHODS: Multicentre cooperative group EMETNE prospectively reviewed 153 patients operated on between 1998 and 2016 with diagnosis of atypical carcinoids. Clinical variables and histopathological features were assessed. RESULTS: Mean age was 54.36 years, similar for both genders. Concerning pathological study, mean tumour size was 31.7 mm. Rosettes were presented in 17% of the cases and tumoural necrosis in 23.3%. The cell proliferation factor Ki-67 index was 10.7%. The 2- and 5-year overall survival rates were 95.8% and 88.9%, respectively. In the univariate study, statistically significant differences in survival were found for each of the categories of T, N and M factors. Mitotic index and quantification of expression of Ki-67 showed influence in overall survival, although without statistical significance. In the multivariate analysis, factors N, M and mitotic index behaved as independent prognostic factors related to survival. Median disease-free interval in the series was 163.35 months. In cases with loco-regional recurrence, 53% had positive hiliar or mediastinal nodal involvement at the time of the surgery. In the univariate analysis, we observed statistically significant differences in disease-free interval in patients with nodal involvement (P = 0.024) and non-anatomical resections (P = 0.04). Histological characteristics showed no statistically significant differences in disease-free interval. CONCLUSIONS: Lymph node involvement, the development of distant metastasis and mitotic index, more than Ki-67 determination, were shown as independent prognostic factors related to survival of these patients.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: Report of two cases / Hiperplasia neuroendocrina difusa pulmonar idiopática: estudio de dos casos

Introduction: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder characterized by a proliferation of neuroendocrine cells within the lung. It is classically described as a disease with persistent cough, dyspnea and wheezing in non-smoker middle aged females. CT of the chest reveals diffuse air trapping with mosaic pattern. Patients and methods: We present two cases of DIPNECH that were sent to our department to perform a lung biopsy with the diagnostic suspicion of diffuse interstitial disease. Both cases were women with a history of chronic cough and moderate effort dyspnea. Results and discussion: The aim of this paper is that physicians take into account this diagnostic entity before treating as an asthmatic a patient with these characteristics, not forgetting that they are prenoplastic lesions

Introducción: La hiperplasia neuroendocrina difusa pulmonar idiopática (HNDPI) es una patología poco frecuente que se caracteriza por la proliferación de células neuroendocrinas en el parénquima pulmonar. Se describe clásicamente como una enfermedad que afecta a mujeres de mediana edad no fumadoras y que presentan tos persistente, disnea y sibilancias. La TC muestra una imagen de patrón en mosaico como resultado del atrapamiento aéreo. Pacientes y métodos: Presentamos dos casos de HNDPI que fueron enviados a nuestro servicio para realizar una biopsia pulmonar con la sospecha diagnóstica de enfermedad intersticial difusa. Ambos casos fueron mujeres con antecedentes de tos crónica y disnea de esfuerzo moderado. Resultados y discusión: El objetivo de este documento es que los facultativos tengan en cuenta este diagnóstico antes de tratar como asmática a una paciente con estas características, no olvidando además que son lesiones preneoplásicas

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: Report of two cases.

INTRODUCTION: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder characterized by a proliferation of neuroendocrine cells within the lung. It is classically described as a disease with persistent cough, dyspnea and wheezing in non-smoker middle aged females. CT of the chest reveals diffuse air trapping with mosaic pattern. PATIENTS AND METHODS: We present two cases of DIPNECH that were sent to our department to perform a lung biopsy with the diagnostic suspicion of diffuse interstitial disease. Both cases were women with a history of chronic cough and moderate effort dyspnea. RESULTS AND DISCUSSION: The aim of this paper is that physicians take into account this diagnostic entity before treating as an asthmatic a patient with these characteristics, not forgetting that they are prenoplastic lesions.

Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms? / ¿Es la edad un factor predisponente de complicaciones postoperatorias en las resecciones pulmonares por neoplasias pulmonares primarias?

INTRODUCTION: Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS: A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS: The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION: Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications.

Es la edad un factor predisponente de complicaciones postoperatorias en las resecciones pulmonares por neoplasias pulmonares primarias / Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms?

INTRODUCCIÓN: La edad del paciente ha sido clásicamente interpretada como un factor condicionante de la aparición de complicaciones postoperatorias en cirugía de resección pulmonar por carcinoma broncogénico. El Grupo de Estudio de Complicaciones Postoperatorias de la Sociedad Española de Cirugía Torácica promovió un registro que permitiera analizar este hecho. MÉTODOS: Se recogieron de forma consecutiva, sistemática y prospectiva los datos de un total de 3.307 pacientes tratados con algún tipo de resección quirúrgica por carcinoma broncogénico en las 24 unidades que forman parte del grupo. Fueron analizadas variables relativas a la comorbilidad y la edad del paciente, así como a las complicaciones postoperatorias acaecidas. RESULTADOS: La edad media de los pacientes intervenidos fue de 65,44 años. La población masculina en la serie era significativamente mayor que la femenina. La complicación más frecuente fue la fuga aérea prolongada, que ocurrió en más de un tercio de los pacientes. En el estudio univariante, la aparición de fugas aéreas y de atelectasias posquirúrgicas mostraron asociación estadística con la edad de los enfermos, analizada por grupos etarios. En el análisis multivariante, la edad se presentó como un factor pronóstico independiente en relación con la aparición de fugas aéreas posquirúrgicas, no así en cuanto a las atelectasias posresección. CONCLUSIÓN: La edad es un factor predisponente para el desarrollo de complicaciones postoperatorias tras resección pulmonar en nuestro medio, si bien otros factores asociados condicionan también la aparición de estas complicaciones

INTRODUCTION: Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS: A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS: The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION: Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications

Primary pulmonary synovial sarcoma: a rare neoplasm.

Primary pulmonary synovial sarcoma is an extremely rare tumor with an unknown cause. The diagnosis is established after other primary lung malignancies or metastatic extrathoracic sarcoma have been excluded. We report the case of a 69-year-old man who presented with a well-defined mass in the right upper lobe on a chest X-ray. A video-assisted thoracoscopic surgery (VATS) right upper lobectomy was performed. Immunohistochemically, neoplastic cells were positive for vimentin, CD56 and Bcl-2, and focally positive for CD99, epithelial membrane antigen and cytokeratin 7 and 19. The cytogenetic study revealed a SYT genetic reassortment. So, the final pathological diagnosis was primary pulmonary synovial sarcoma.

Update in the extraction of airway foreign bodies in adults.

Foreign body (FB) aspiration into the airway is lees common in adults than children. Nevertheless its incidence does not decrease through time. We present clinical relevant aspects of airway FBs on the basis of a selective review of pertinent literature retrieved by a search in the PubMed database. The most common aspirated FBs by adults are organics, especially fragments of bones and seeds. Symptoms usually are cough, chocking and dyspnea. Right localization, especially bronchus intermedius and right lower lobe, is more frequent. Chest radiography can be normal in up to 20% of the cases and FBs can be detected in 26% of the patients. FBs can safely remove in the majority of patients under flexible bronchoscopy. Surgical treatment must be reserved for cases in which bronchoscope fails or there are irreversible bronchial or lung complications.

Design and development of a nutritional assessment application for smartphones and tablets with Android® OS / Diseño y desarrollo de una aplicación de valoración nutricional para smartphones y tablets Android®

Background & Aims: To design and develop a nutritional application for smartphones and tablets with Android® operating system for using to in- and outpatients that need a nutritional assessment. To check the validity of the results of such software. Methods: The application was compiled for version 2.1 of the Android® operating system from Google®. A cohort of 30 patients was included for evaluating the reliability of the application. The calculations were performed by staff of the Nutrition Unit of the Complexo Hospitalario Universitario de Vigo, manually and through e-Nutrimet© software on a smartphone and a tablet. Results: Concordance was absolute between results of different methods obtained using e-Nutrimet© on a smartphone and a tablet (Fleiss index κ = 1). The same level of concordance was obtained by comparing handmade and e-Nutrimet© made results. Conclusions: The degree of correlation is good, and it would be extended to all healthcare staff who wants to determine whether a patient has malnutrition, or not. The nutritional assessment software e-Nutrimet© does not replace healthcare staff in any case, but could be an important aid in assessing patients who may be in risk of malnutrition, saving time of evaluation (AU)

Introducción y objetivos: Diseñar y desarrollar una aplicación nutricional para smartphones y tablets con Sistema operativo Android® para realizar las valoraciones nutricionales de pacientes ambulatorios y hospitalizados. Verificar y comprobar la validez de los resultados de la aplicación. Métodos: La aplicación se compile para la versión 2.1del Sistema operativo Android® de Google®. Para evaluarla fiabilidad de la aplicación se incluyeron a 30 pacientes, a los que se le realizó una valoración nutricional. Todos los cálculos fueron efectuados por personal de la Unidad de Nutrición del Complexo Hospitalario Universitario de Vigo, de forma manual y a través del software e-Nutrimet©,tanto usando un Smartphone como una tablet. Resultados: Se obtuvo una concordancia absoluta entre los resultados de los diferentes métodos obtenidos utilizando la aplicación e-Nutrimet© en smartphones y en tablets (Fleiss index κ = 1). El mismo nivel de concordancia se obtuvo comparando el método manual como el automatizado mediante el software e-Nutrimet©. Conclusiones: El grado de correlación es muy bueno, permitiendo extender la valoración nutricional usando e-Nutrimet© a todo el personal sanitario que quiera determinar si un paciente presenta malnutrición o no. La aplicación de valoración nutricional e-Nutrimet© no sustituye al personal sanitario en ningún caso, pero podría ser de gran ayuda a la hora de valorar pacientes que pudieran estar en riesgo de malnutrición, ahorrando tiempo en estas valoraciones (AU)

Thoracic liposarcoma: resection and chest wall reconstruction.

Liposarcoma is a malignant neoplasm of mesodermal origin derived from adipose tissue. It most often originates in the extremities and retroperitoneum, and less frequently in the head and neck. Liposarcoma involving the chest wall is extremely rare with few reported cases. Surgery is the mainstay of treatment, and complete resection is the major factor influencing survival. We describe the case of a 65-year-old man diagnosed with a dedifferentiated liposarcoma of the chest wall, who underwent radical resection and chest wall reconstruction with a latissimus dorsi musculocutaneous flap.

Design and development of a nutritional assessment application for smartphones and tablets with Android OS.

BACKGROUND & AIMS: To design and develop a nutritional application for smartphones and tablets with Android operating system for using to in- and outpatients that need a nutritional assessment. To check the validity of the results of such software. METHODS: The application was compiled for version 2.1 of the Android operating system from Google. A cohort of 30 patients was included for evaluating the reliability of the application. The calculations were performed by staff of the Nutrition Unit of the Complexo Hospitalario Universitario de Vigo, manually and through e-Nutrimet software on a smartphone and a tablet. RESULTS: Concordance was absolute between results of different methods obtained using e-Nutrimet on a smartphone and a tablet (Fleiss index κ= 1). The same level of concordance was obtained by comparing handmade and e-Nutrimet made results. CONCLUSIONS: The degree of correlation is good, and it would be extended to all healthcare staff who wants to determine whether a patient has malnutrition, or not. The nutritional assessment software e-Nutrimet does not replace healthcare staff in any case, but could be an important aid in assessing patients who may be in risk of malnutrition, saving time of evaluation.

Introducción y objetivos: Diseñar y desarrollar una aplicación nutricional para smartphones y tablets con Sistema operativo Android® para realizar las valoraciones nutricionales de pacientes ambulatorios y hospitalizados. Verificar y comprobar la validez de los resultados de la aplicación. Métodos: La aplicación se compile para la versión 2.1 del Sistema operativo Android® de Google®. Para evaluar la fiabilidad de la aplicación se incluyeron a 30 pacientes, a los que se le realizó una valoración nutricional. Todos los cálculos fueron efectuados por personal de la Unidad de Nutrición del Complexo Hospitalario Universitario de Vigo, de forma manual y a través del software e-Nutrimet ©, tanto usando un Smartphone como una tablet. Resultados: Se obtuvo una concordancia absoluta entre los resultados de los diferentes métodos obtenidos utilizando la aplicación e-Nutrimet© en smartphones y en tablets (Fleiss index = 1). El mismo nivel de concordancia se obtuvo comparando el método manual como el automatizado mediante el software e-Nutrimet©. Conclusiones: El grado de correlación es muy bueno, permitiendo extender la valoración nutricional usando e-Nutrimet© a todo el personal sanitario que quiera determinar si un paciente presenta malnutrición o no. La aplicación de valoración nutricional e-Nutrimet© no sustituye al personal sanitario en ningún caso, pero podría ser de gran ayuda a la hora de valorar pacientes que pudieran estar en riesgo de malnutrición, ahorrando tiempo en estas valoraciones.

Epithelioid angiosarcoma of the lung with pleural metastases: a rare cause of haemoptysis clinicopathological conference.

Angiosarcomas are a rare type of malignant vascular tumour characterised by proliferation of tumour cells with vascular endothelial features. These tumours are usually very aggressive and overall mortality is very high. Pulmonary angiosarcomas are usually secondary tumours, and only a few primary cases have been reported. We present a case of a 56 year-old male with persistent haemoptysis secondary to lung epithelioid angiosarcoma with pleural metastases.