Implicaciones de iniciar fármacos antiepilépticos previo a la realización de EEG en primeras crisis epilépticas / Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures

Introducción: Determinar si la administración de fármacos antiepilépticos (FAE) puede alterar la probabilidad de encontrar anomalías epileptiformes en EEG realizados de forma precoz tras una primera crisis epiléptica (CE). Método: Estudio observacional retrospectivo en el que se incluyó a los pacientes atendidos en urgencias de nuestro centro por una primera CE entre julio del 2014 y noviembre del 2019. Se recogieron los datos clínicos, las características técnicas de adquisición e interpretación de los EEG efectuados durante las primeras 72 h tras la CE y los factores relacionados con la recurrencia. Resultados: Se recogieron 155 pacientes; edad media 48,6 ±22,5 años; 61,3% hombres. El 51% presentó crisis tónico-clónicas de inicio desconocido y el 12% focales con progresión a tónico-clónica bilateral. El 25,2% (39/155) recibió tratamiento con FAE antes de la realización del EEG; en 33 pacientes se administró un FAE no benzodiacepínico y en 6 una benzodiacepina. Se observaron anomalías epileptiformes en 29,7% de los pacientes. La administración previa de FAE no se asoció de forma significativa ni con la probabilidad de detectar anomalías epileptiformes (p = 0,25) ni con el riesgo de recurrencia a los 6 meses (p = 0,63). Conclusiones: La administración de un FAE previo a la realización del EEG precoz tras una primera CE no disminuye la probabilidad de detectar anomalías epileptiformes. Estos hallazgos sugieren que iniciar un FAE de forma inmediata en aquellos pacientes con alto riesgo de recurrencia precoz no implica un menor rendimiento diagnóstico de dicha prueba.(AU)

Introduction: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. Method: We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. Results: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). Conclusions: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.(AU)

Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures.

INTRODUCTION: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS: We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.

ABS-SMART (Aortic Balloon Supporting for Superior Mesenteric Artery Recanalization Technique): A New Technical Option for Recanalization of Complete Superior Mesenteric Artery Occlusion in Chronic Mesenteric Ischemia.

OBJECTIVE: To report our experience with a new technique for recanalization of the superior mesenteric artery (SMA)/celiac trunk (CT) with complete occlusion at the origin. TECHNIQUE: We describe our ABS-SMART (Aortic Balloon Supporting for Superior Mesenteric Artery Recanalization Technique) for recanalization of the CT and SMA in cases of complete occlusion of these arteries with a short or inexistent stump, which usually corresponds to chronic lesions with important calcification of the ostium. CONCLUSION: The ABS-SMART is an alternative for the recanalization of visceral arteries in cases where other conventional techniques have failed. It is particularly useful in scenarios characterized by a short occlusion at the origin of the target vessel, with no entry stump or severe calcification at the origin. CLINICAL IMPACT: Catheterization and recanalization of visceral stenoses may pose a challenge in some cases, as for example in the presence of a very narrow angle between the root or origin of the vessel and the aorta, as well as in the case of long and calcified stenoses, or when arteriography is unable to visualize the origin of the vessel. The present study describes our experience with the endovascular revascularization of visceral vessels using an aortic balloon-supported recanalization technique not previously described in the literature, that may be an effective alternative for the treatment of lesions of difficult access, such as total occlusion at the origin of the target vessel, with no entry stump or severe calcification at the origin of the SMA and CT, by improving the chances for technical success.

Management of acute stroke. Specific nursing care and treatments in the stroke unit.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Incidence and Severity of Community- and Hospital-Acquired Hyponatremia in Pediatrics.

Hyponatremia is the most common electrolyte disturbance in hospitalized children, with a reported incidence of 15-30%, but its overall incidence and severity are not well known. The objective of our study was to determine the incidence, severity, and associated risk factors of community- and hospital-acquired hyponatremia on a general pediatric ward. Data of 5550 children admitted from June 2012 to December 2019 on plasma sodium and discharge diagnosis were analyzed by logistic regression model. Clinically relevant diagnostic groups were created. Hyponatremia was classified as mild, moderate, and severe. The incidence of community- and hospital-acquired hyponatremia was 15.8% and 1.4%, respectively. Most of the cases were mild (90.8%) to moderate (8.6%), with only two cases of severe community-acquired hyponatremia. There were no clinical complications in any of the hyponatremic children. Age and diagnosis at discharge were principal factors significantly correlated with hyponatremia. Community-acquired hyponatremia is more common than hospital-acquired hyponatremia in clinical practice. Severe cases of both types are rare. Children from 2 to 11 years of age presenting with infections, cardiovascular disorders, and gastrointestinal disorders are at risk of developing hyponatremia.

Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures. / Implicaciones de iniciar fármacos antiepilépticos previo a la realización de EEG en primeras crisis epilépticas.

INTRODUCTION: This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHOD: We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence. RESULTS: We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). CONCLUSIONS: Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.

Management of acute stroke. Specific nursing care and treatments in the stroke unit. / Manejo del ictus agudo. Tratamientos y cuidados específicos de enfermería en la Unidad de Ictus.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

How soon should urgent EEG be performed following a first epileptic seizure?

PURPOSE: Patients with a first unprovoked epileptic seizure are often seen in emergency services. Electroencephalography (EEG) is indicated for diagnosing epilepsy, but the optimal time to perform this test has not been defined. This study aimed to determine the time interval following a seizure within which EEG has the greatest diagnostic yield. METHODS: We conducted a retrospective study of all adult patients with a first unprovoked seizure who had undergone emergency EEG (July 2014-December 2019). Data collection included demographics, seizure type, time interval to EEG study, EEG pattern identified, and the prescription after emergency assessment. An optimal cut-off point for time to EEG was obtained, and an adjusted regression model was performed to establish associations with the presence of epileptiform abnormalities. RESULTS: A total of 170 patients were included (mean age: 50.7 years, 40.6% women). Epileptiform discharges were identified in 34.1% of recordings, nonepileptiform abnormalities in 46.5%, and normal findings in 19.4%. A lower latency from seizure to EEG was associated with a higher probability of finding epileptiform discharges (median: 12.7 in the epileptiform EEGs vs. 20 h in the nonepileptiform EEGs, p < 0.001). The time interval associated with the highest probability of detecting an epileptiform EEG pattern was within the first 16 h after seizure onset: 52.1% of recordings performed before the 16-h cut-off showed these abnormal patterns compared with 20.2% performed after (p < 0.001). These findings were not related to the presence of an epileptogenic lesion in neuroimaging or to other clinical variables. The finding of epileptiform abnormalities was followed by a greater prescription of antiseizure drugs (96.4% vs. 66% in nonepileptiform patterns, p < 0.001). CONCLUSION: The diagnostic yield of EEG following a first unprovoked epileptic seizure is highest when this test is performed within the first 16 h after onset of the event.

Mechanical thrombectomy with a novel stent retriever with multifunctional zones: Initial clinical experience with the NeVa™ thrombectomy device.

BACKGROUND AND PURPOSE: The NeVa™ (Vesalio, Nashville, Tennessee) thrombectomy device is a CE-approved novel hybrid-cell stent retriever with offset enlarged openings coupled with functional zones and a closed distal end. The device was designed to incorporate and trap resistant emboli. The purpose was to determine the safety and efficacy of the NeVa™ stent. METHODS: Prospective data was collected on the first thirty consecutive patients treated at four stroke centers with NeVa™ as first line treatment between December 2017 and May 2018. Clinical outcome measures included re-perfusion scores after each pass, complications (per-procedural complications, device related adverse events, all intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) on follow up imaging), 24 hour NIHSS, mRS at discharge and 90 days. Baseline data as well as treatment parameters were documented. RESULTS: Mean presenting NIHSS was 16. Sites of primary occlusion were 10 ICA, 16 M1-MCA, 3 M2-MCA and one basilar. There were five tandem occlusions. Reperfusion outcomes after each NeVa pass; TICI ≥ 2b after first pass 63%, after 1 or 2 passes 83%, after 1 to 3 passes 90%. TICI 2c-3 after first pass 47%, after 1-2 passes 57%, after 1-3 passes 60%. TICI ≥ 2b after final pass 93%; TICI 2c-3, 63%. There were no device related serious averse events and no sICH. Clot material was partially or completely incorporated into the device after 70% passes. The mean 24 hour NIHSS was 7 and the 90 day mRS was 0-2 in 53%. CONCLUSIONS: The NeVa™ device demonstrated a high rate of first pass complete reperfusion effect, a good safety profile and favorable 90 day clinical outcomes in this initial clinical experience.

Increased CXCR3+ T Cells Impairs Recruitment of T-Helper Type 17 Cells via Interferon γ and Interleukin 18 in the Small Intestine Mucosa During Treated HIV-1 Infection.

The restoration of CD4+ T cells, especially T-helper type 17 (Th17) cells, remains incomplete in the gut mucosa of most human immunodeficiency virus type 1 (HIV-1)-infected individuals despite sustained antiretroviral therapy (ART). Herein, we report an increase in the absolute number of CXCR3+ T cells in the duodenal mucosa during ART. The frequencies of Th1 and CXCR3+ CD8+ T cells were increased and negatively correlated with CCL20 and CCL25 expression in the mucosa. In ex vivo analyses, we showed that interferon γ, the main cytokine produced by Th1 and effector CD8+ T cells, downregulates the expression of CCL20 and CCL25 by small intestine enterocytes, while it increases the expression of CXCL9/10/11, the ligands of CXCR3. Interleukin 18, a pro-Th1 cytokine produced by enterocytes, also contributes to the downregulation of CCL20 expression and increases interferon γ production by Th1 cells. This could perpetuate an amplification loop for CXCR3-driven Th1 and effector CD8+ T cells recruitment to the gut, while impairing Th17 cells homing through the CCR6-CCL20 axis in treated HIV-1-infected individuals.

The ADAN scale: a proposed scale for pre-hospital use to identify status epilepticus.

BACKGROUND AND PURPOSE: The prognosis of status epilepticus (SE) depends on the time between onset and the diagnosis and start of treatment. Our aim was to design a scale with predictive value for pre-hospital diagnosis of SE. METHODS: This was a retrospective study of 292 patients who attended the emergency department for an epileptic seizure. A total of 49 patients fulfilled the criteria for SE. We recorded the patients' history and clinical features. Variables independently associated with SE were combined to design a clinical scale. The performance of the scale was evaluated in a validation dataset of 197 patients. RESULTS: A total of 50.3% of the patients were male and the mean age was 55.9 years. The following features were more prevalent in patients with SE: abnormal speech (79.6% vs. 18.9%, P < 0.001), eye deviation (69.4% vs. 14.0%, P < 0.001), automatism (22.4% vs. 6.3%, P < 0.001), hemiparesis (24.5% vs. 10.9%, P = 0.011), state of stupor/coma (46.9% vs. 4.2%, P < 0.001) and number of pre-hospital seizures, i.e. two (34.7% vs. 4.5%, P < 0.001) or more than two (51.0% vs. 0.4%, P < 0.001). Based on these findings, we designed a scale that scored 1 point each for presence of abnormal speech, eye deviation, automatism and two seizures, and 2 points for more than two seizures. The predictive capacity of the scale for identifying SE in the validation dataset was 98.7% (95% confidence interval, 97.3%-100%) and 85.4% of patients with a score >1 had SE. CONCLUSIONS: A score >1 on the ADAN scale is a robust predictor of the diagnosis of SE in patients who experience an epileptic seizure. This scale may be a useful tool for clinical use and warrants further investigation.

Disfunción eréctil, litiasis renal y test de ADAM: estudio observacional mediante encuesta telefónica / Renal lithiasis, erectile dysfunction and ADAM test: observational study using telephone survey

Objetivo. La litiasis renal se asocia con trastornos hormonales y metabólicos, factores comunes a la disfunción eréctil. Algunos trabajos han estudiado la asociación entre la disfunción eréctil y la urolitiasis; sin embargo, los datos son todavía escasos. El objetivo del presente estudio fue estudiar la asociación entre la disfunción eréctil y la litiasis renal, así como las relaciones entre disfunción eréctil y síntomas asociados con el envejecimiento sugestivos de síndrome de déficit de testosterona con factores de riesgo cardiovascular. Material y métodos. Se realizó un estudio observacional transversal mediante encuesta telefónica. Por muestreo polietápico aleatorio, se seleccionó una muestra de 1.193 varones de edades comprendidas de 40 a 65años residentes en España. Se recogieron variables sociodemográficas y clínicas. Se usó el cuestionario del ADAM para evaluar los síntomas sugestivos de síndrome de deficiencia de testosterona. Resultados. La litiasis renal fue más frecuente en los pacientes con disfunción eréctil. La hipertensión arterial, la diabetes y la hipercolesterolemia se asociaron significativamente con la disfunción eréctil. La diabetes, la edad, la clase social media-alta basada en la ocupación laboral (claseii), la hipertensión arterial y la hipercolesterolemia fueron factores predictores independientes de un cuestionario ADAM positivo. Conclusiones. Nuestros datos indican una posible relación entre la disfunción eréctil y la litiasis renal. La relación entre la disfunción eréctil y un cuestionario de ADAM positivo con los factores de riesgo cardiovascular ponen de manifiesto la importancia de evaluar el riesgo cardiovascular de los pacientes que presentan dichas condiciones (AU)

Objective. Renal lithiasis is associated with hormonal and metabolic disorders, common factors to erectile dysfunction. A number of studies have analyzed the association between erectile dysfunction and urolithiasis, however data are still scarce. We aimed to study the association between erectile dysfunction and renal lithiasis, as well as the relations between erectile dysfunction and symptoms associated with aging suggestive of testosterone deficiency syndrome, and cardiovascular risk factors. Material and methods. A cross-sectional observational study of population level by telephone survey was conducted. By sampling random multistage, we selected a sample of 1,193 males aged 40 to 65 living in Spain. Socio-demographic and clinical variables were recorded. Suggestive symptoms of testosterone deficiency syndrome were screened by the ADAM questionnaire. Results. Renal lithiasis was more frequent in patients with erectile dysfunction. High blood pressure, diabetes and hypercholesterolemia were significantly associated with erectile dysfunction. Age, upper middle based on occupation (social classii), high blood pressure, diabetes and hypercholesterolemia were independent predictors of a positive ADAM questionnaire. Conclusions. Our results point out a possible relationship between erectile dysfunction and renal lithiasis. The connection between erectile dysfunction, symptoms associated with aging suggestive of testosterone deficiency syndrome, and cardiovascular risk factors remarks the importance of assessing the cardiovascular risk of patients presenting these conditions (AU)

CCR6(-) regulatory T cells blunt the restoration of gut Th17 cells along the CCR6-CCL20 axis in treated HIV-1-infected individuals.

The gut CD4(+) T cells, particularly the T helper type 17 (Th17) subset, are not completely restored in most HIV-1-infected individuals despite combined antiretroviral therapy, when initiated at the chronic phase of infection. We show here that the CCR6-CCL20 chemotactic axis is altered, with reduced CCL20 production by small intestine epithelial cells in treated HIV-1-infected individuals. This leads to impaired CCR6(+)CD4(+) T-cell homing, particularly Th17 cells, to the small intestine mucosa. In contrast, the frequency of gut FoxP3(+) T regulatory (Treg) cells, specifically the CCR6(-) subset, was increased. The resulting imbalance in the Th17/CCR6(-) Treg ratio and the associated shift from interleukin (IL)-17 to IL-10 and transforming growth factor-ß (TGF-ß) blunts CCL20 production by enterocytes, perpetuating a negative feedback for the recruitment of CCR6(+)CD4(+) T cells to the small intestine in treated HIV-1-infected individuals.

Unprocessed red meat and processed meat consumption and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC).

BACKGROUND/OBJECTIVES: High intakes of unprocessed red or processed meat may increase the risk of stroke. We aimed to examine the association between unprocessed red meat, processed meat and total red meat consumption and risk of total stroke and ischaemic stroke. SUBJECTS/METHODS: Cox proportional hazards regression analyses were conducted based on the data for 41,020 men and women aged 29-69 years at baseline. RESULTS: During a mean follow-up of 13.8 years, 674 incident cases of stroke (531 ischaemic strokes, 79 haemorrhagic strokes, 42 subarachnoid haemorrhages and 22 mixed or unspecified events) were identified. After multiple adjustment, unprocessed red meat, processed meat and total red meat consumption were not correlated with incidence of total stroke or ischaemic stroke in either men or women. The hazard ratios (HRs) for unprocessed red meat and processed meat and risk of total stroke comparing the highest with the lowest quintiles were, respectively, 0.81 (95% confidence interval (CI) 0.54-1.21; P-trend=0.15) and 0.92 (95% CI 0.64-1.32; P-trend=0.82) in men and 1.21 (95% CI 0.79-1.85; P-trend=0.10) and 0.81 (95% CI 0.51-1.27; P-trend=0.17) in women. The HRs for unprocessed red meat and processed meat and risk of ischaemic stroke were, respectively, 0.80 (95% CI 0.51-1.25; P-trend=0.51) and 0.86 (95% CI 0.57-1.29; P-trend=0.77) in men and 1.24 (95% CI 0.74-2.05; P-trend=0.13) and 0.82 (95% CI 0.47-1.42; P-trend=0.31) in women. CONCLUSIONS: In the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, unprocessed red meat and processed meat consumption were not associated with risk of stroke in men or women.

Association between changes in soft and hard tissue after early chin cup treatment.

OBJECTIVE: To assess the soft tissue and to determine the potential association between changes in soft and hard tissue after early chin cup treatment in prognathic children. MATERIALS AND METHODS: A total of 42 children (21 boys, 21 girls) with skeletal Class III malocclusion due to mandibular prognathism were examined before (mean age, 8.5 ± 0.5 years) and after (mean age, 11.4 ± 0.6 years) chin cup treatment. Data were compared with 25 untreated matched controls (12 boys, 13 girls) with mean ages of 8.5 ± 0.5 years at the first and 11.7 ± 0.5 years at the second observation. Lateral cephalograms were taken before and after 36 months of treatment/observation. We evaluated the changes in hard and soft tissue and the correlations between these changes in both groups. RESULTS: The skeletal and soft-tissue facial profiles improved significantly in the treated patients, mainly due to changes in the mandible. The chin cup group revealed significant reductions in the facial-convexity angle and lower-lip inclination, leading to a remarkable improvement in the soft-tissue facial profile. We noted similar correlations between changes in the hard and soft tissue in both groups, except for a significant correlation between a pogonion retrusion and reduction in the facial-convexity angle detected only in the chin cup group. Various correlations were observed between corresponding soft and dentoalveolar changes between groups. CONCLUSION: Soft-tissue changes accompanied the underlying skeletal and dentoalveolar tissue changes after chin cup treatment.

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

Efecto del alprostadil en los cultivos de músculo esquelético isquémico. Estudio proteómico comparativo frente a músculo sano / The effect of alprostadil on ischemic skeletal muscle cultures. Comparative proteomic study with healthy muscle

INTRODUCCIÓN: El alprostadil tiene efecto vasodilatador y antiagregante. Es bien conocido su efecto endotelial, pero se desconocen sus posibles efectos pleiotrópicos sobre el músculo esquelético y si estos difieren en el músculo isquémico. OBJETIVO: Determinar el efecto del alprostadil sobre el metabolismo del músculo esquelético y valorar diferencias en su acción sobre el músculo isquémico frente al sano. MATERIAL Y MÉTODOS: Se obtuvieron muestras de tejido de 10 pacientes con isquemia irreversible intervenidos de amputación supracondílea, tanto de músculo isquémico (extensor corto de los dedos del pie, grupo I) como de músculo sano (músculo cuádriceps del borde de amputación, grupo S). Ambos grupos se cultivaron basalmente y con 5 ng de alprostadil. Se analizó la expresión proteómica de las siguientes enzimas: triosa-fosfato-isomerasa (TPI), malato deshidrogenasa (MDH), lactato deshidrogenasa (LDH) y piruvato carboxilasa (PC). Se determinaron también sus productos, lactato y piruvato. RESULTADOS: La MDH presentó una disminución en el grupo I en las muestras basales (2.196 ± 348 grupo S vs 644 ± 192 grupo I, p < 0,05). La PC estaba aumentada en el grupo I en ambos tipos de muestras (basal: 1,80 ± 1,27 vs 3,16 ± 2,25; alprostadil: 6,72 ± 2,13 vs 8,16 ± 3,63, grupo S vs grupo I, respectivamente, p < 0,05). No hubo diferencias significativas en la concentración de lactato ni en la de piruvato. CONCLUSIONES: La reducción de MDH en el músculo isquémico sugiere una reducción del ciclo de Krebs. El alprostadil estimula la expresión de PC, que induce la formación de oxalacetato; este se introduce en el ciclo de Krebs, permitiéndole funcionar parcialmente en el músculo isquémico y mejorando la obtención de energía

INTRODUCTION: Alprostadil has vasodilator properties and inhibits platelet aggregation. Its effects on endothelial wall have been widely studied, but there is no knowledge about possible skeletal muscle effects, and differences with ischemic muscle. OBJECTIVE: To determine the effects of alprostadil on skeletal muscle metabolism, and to investigate possible differences with ischemic muscle. METHODS: Samples were obtained in 10 patients with leg above-knee amputation due to severe irreversible ischemia, of ischemic muscle (extensor digitorum brevis, group I), and healthy muscle (quadriceps femoris, amputation edge, group S). Muscle segments were incubated with alprostadil 5 ng, or without it (baseline). Proteomic analysis of metabolic enzymes was performed: Triose-phosphate isomerase (TPI), malate dehydrogenase (MDH), lactate dehydrogenase (LDH) and pyruvate carboxylase (PC). Lactate and pyruvate was also determined. RESULTS: A decrease in malate dehydrogenase was observed in group I in the baseline samples (2196 ± 348 group S vs 644 ± 192 group I, P < 0.05). PC was increased in both samples in group I (baseline: 1.80 ± 1.27 vs 3.16 ± 2.25; alprostadil: 6.72 ± 2.13 vs 8.16 ± 3.63, group S vs group I, respectively, P < 0.05). No changes were observed in pyruvate and lactate. DISCUSSION: Decreased MDH in ischemic muscle suggests a Krebs cycle reduction. Alprostadil stimulates the expression of PC, which leads to oxaloacetate production. This product is inserted in Krebs cycle, improving energy obtaining. In this manner, Krebs cycle can work partially in ischemic muscle

[Analysis of efficacy in diaphragmatic plication with minimally invasive surgery]. / Análisis de efectividad de la plicatura diafragmática mínimamente invasiva.

OBJECTIVE: Diaphragmatic paralysis may result difficulty for respiratory compromise and extubation. We study the effectiveness of diaphragmatic plication held in its two modalities: videothoracoscopy assisted surgery (VATS) and percutaneous with needle. MATERIAL AND METHODS: Retrospective study of diaphragmatic plication performed in our center in the past three years. Review of clinical histories, analyzing the variables: sex and age, etiology and laterality, surgical indications, technique, ventilation support, complications and outcome. Data Analysis with SPSS 18.0. RESULTS: From 2009-2012, 24 diaphragmatic plication were realized (7 left, 13 right, 2 bilateral) in 22 children (15 males). The mean age was 10.4 months (2 to 23.1). In 68.1% paralysis was secondary to thoracic surgery. In 12 patients was performed VATS and in 5 percutaneous with needle. Surgical indications were: respiratory distress (69.1%) with intercurrent processes (pneumonia, bronchiolitis, and atelectasis) and failure of extubation in 27.3%. After diaphragmatic plication in 90.9% respiratory symptoms remitted. Extubation was accomplished in all patients, requiring ventilator support for 12-96 hours. Mean hospital stay was 7.5 days (3 to 13.5). There were no complications derived from surgery. There were two recurrences (9.2%) and only one was reoperated (4.6%). The percutaneous technique decreased the required postoperative analgesia and improved cosmetic outcome in 90.9%. CONCLUSIONS: The diaphragmatic plication by minimally invasive surgery reduces operative morbidity and facilitates extubation of ventilator-dependent patients with diaphragmatic paralysis. The percutaneous technique improves the cosmetic results and reduces pain after surgery, without finding differences with VATS.