Lusory dysphagia: Unusual cause of intermittent dysphagia.

INTRODUCTION AND IMPORTANCE: Lusory dysphagia (LD) is a rare disorder resulting from extrinsic vascular compression of the esophagus, is often associated with an aberrant right subclavian artery (ARSA). LD is characterized by abnormal development of the right fourth aortic arch during embryonic stages, leading to posterior coursing of the artery in 80 % of cases. Predominantly presenting as dysphagia, LD can occasionally manifest with laryngeal stridor or dyspnea, yet it often remains asymptomatic and incidentally discovered. CASE PRESENTATION: We present a case of LD in a 24-year-old male with Down syndrome, experiencing prolonged dysphagia and recurrent aspiration episodes. Emergency upper gastrointestinal endoscopy revealed food impactation beyond the upper esophageal sphincter, and subsequent imaging studies confirmed an aberrant right subclavian artery causing extrinsic compression. DISCUSSION: LD is a rare condition. It is a challenging diagnosis often necessitating a combination of endoscopy, contrasted imaging and angiography. Treatment strategies vary, with conservative approaches for mild symptoms involving dietary modifications, and surgical intervention considered for persistent or severe cases. CONCLUSION: Recognizing LD in the context of long-standing dysphagia is crucial for accurate diagnosis and appropriate management. Further research is needed to establish standardized diagnostic and therapeutic guidelines for this uncommon condition.

Cell-type and subcellular compartment-specific APEX2 proximity labeling reveals activity-dependent nuclear proteome dynamics in the striatum.

The vertebrate brain consists of diverse neuronal types, classified by distinct anatomy and function, along with divergent transcriptomes and proteomes. Defining the cell-type specific neuroproteomes is important for understanding the development and functional organization of neural circuits. This task remains challenging in complex tissue, due to suboptimal protein isolation techniques that often result in loss of cell-type specific information and incomplete capture of subcellular compartments. Here, we develop a genetically targeted proximity labeling approach to identify cell-type specific subcellular proteomes in the mouse brain, confirmed by imaging, electron microscopy, and mass spectrometry. We virally express subcellular-localized APEX2 to map the proteome of direct and indirect pathway spiny projection neurons in the striatum. The workflow provides sufficient depth to uncover changes in the proteome of striatal neurons following chemogenetic activation of Gαq-coupled signaling cascades. This method enables flexible, cell-type specific quantitative profiling of subcellular proteome snapshots in the mouse brain.

Resultados del primer registro nacional de fibrosis pulmonar idiopática en Chile / Results of the first national register of idiopathic pulmonary fibrosis in Chile

INTRODUCCIÓN: La FPI es la neumonía intersticial idiopática más común, con cifras de incidencia y prevalencia que varían en el mundo por la poco uniforme manera de recolectar casos en los diferentes estudios. No hay cifras publicadas sobre la epidemiología de la FPI en Chile ni Latinoamérica. Se hace relevante conocerlas por la carga sanitaria que representan los pacientes con FPI y por la aprobación reciente de drogas antifibróticas de alto costo. El objetivo de este estudio fue realizar un registro de pacientes con FPI atendidos por neumólogos chilenos de diversos regiones del país, con los medios diagnósticos que habitualmente utilizan en la vida real. PACIENTES Y MÉTODOS: Se utilizó una encuesta electrónica en línea diseñada por el grupo de enfermedades pulmonares difusas del Instituto Nacional del Tórax para registro de pacientes con diagnóstico de FPI según criterios ATS/ERS/JRS/ALAT desde junio de 2015 a junio de 2017. RESULTADOS: 40 de los 200 neumólogos invitados enviaron casos de FPI de las 13 regiones del país, completando un total de 700 pacientes. 2/3 eran casos antiguos, un número similar de hombres y mujeres, 73% tienen patrón definitivo de UIP (Usual Interstitial Pneumonia) en tomografía axial computarizada, la mayoría eran pacientes sobre 60 años y en solo 16% se solicitó biopsia para diagnóstico. CONCLUSIONES: Un registro de 700 casos representa un número muy importante de pacientes con FPI en Chile que nos permite acercarnos a la caracterización de la cohorte y a fortalecer una red de especialistas dedicados al cuidado de estos pacientes y sus familias.

INTRODUCTION: Idiopathic pulmonary fibrosis is the most common idiopathic interstitial pneumonia, with incidence and prevalence figures varying worldwide because of the inconsistent way of collecting cases in different studies. There are no published figures on the epidemiology of IPF in Chile or Latin America. It is relevant to know them because of the health burden of patients with IPF and the recent approval for treatment purposes of high cost antifibrotic drugs. The objective of this study was to develop a clinical registry of patients with IPF treated by Chilean pulmonologists from different regions of the country, using the diagnostic means they usually use in real life. PATIENTS AND METHODS: An online electronic survey was designed by the group of diffuse pulmonary diseases of the "Instituto Nacional del Tórax" to register patients with diagnosis of IPF from June 2015 to June 2017 according to ATS/ERS/JRS/ALAT criteria. RESULTS: 40 of the 200 invited pulmonologists sent IPF cases from the country's 13 regions, completing a total of 700 patients. 2/3 were old cases, a similar number of men and women, 73% had definitive UIP pattern in CT, the majority were patients over 60 years old and in only 16% biopsy was requested for diagnosis. CONCLUSIONS: A register of 700 cases represents a very important number of patients with IPF in Chile that allows us to approach the characterization of the cohort and to strengthen a network of specialists dedicated to the care of these patients and their families.

Fibroblast growth factor-21 potentiates glucose transport in skeletal muscle fibers.

Fibroblast growth factor 21 (FGF21) is a pleiotropic peptide hormone that is considered a myokine playing a role in a variety of endocrine functions, including regulation of glucose transport and lipid metabolism. Although FGF21 has been associated with glucose metabolism in skeletal muscle cells, its cellular mechanism in adult skeletal muscle fibers glucose uptake is poorly understood. In the present study, we found that FGF21 induced a dose-response effect, increasing glucose uptake in skeletal muscle fibers from flexor digitorum brevis muscle of mice, evaluated using the fluorescent glucose analog 2-NBDG (300 µM) in single living fibers. This effect was prevented by the use of either Cytochalasin B (5 µM) or Indinavir (100 µM), both antagonists of GLUT4 activity. The use of PI3K inhibitors such as Wortmannin (100 nM) and LY294002 (50 µM) completely prevented the FGF21-dependent glucose uptake. In fibers electroporated with the construct encoding GLUT4myc-eGFP chimera and stimulated with FGF21 (100 ng/mL), a strong sarcolemmal GLUT4 label was detected. This effect promoted by FGF21 was demonstrated to be dependent on atypical PKC-ζ, by using selective PKC inhibitors. FGF21 at low concentrations potentiated the effect of insulin on glucose uptake but at high concentrations, completely inhibited the uptake in the presence of insulin. These results suggest that FGF21 regulates glucose uptake by a mechanism mediated by GLUT4 and dependent on atypical PKC-ζ- in skeletal muscle.

Association of neurologic manifestations and CEA levels with the diagnosis of brain metastases in lung cancer patients.

PURPOSE: Lung cancer (LC) is the most common source of brain metastases (BM). Because of the difficulty in predicting LC patients who will develop BM, we aimed to identify the clinical and serologic markers that could predict the presence of BM in LC patients. METHODS: We analyzed a cohort of LC patients sent for neurooncological consultation for any neurologic symptom at a cancer center from June 2013 to July 2017. INCLUSION CRITERIA: histologically confirmed LC, age ≥ 18 years and complete clinical records. EXCLUSION CRITERIA: BM diagnosis before our consultation and absence of MRI. Oncologic history, clinical symptoms and comorbidities were analyzed. RESULTS: From 199 patients, most (70%) had > 1 neurological symptom. The most common was headache (n = 46, 21%), followed by seizures (17%), altered mental status (16%) and focal motor weakness (13%). BM was found in 74% of the patients during follow-up. Multivariate logistic regression analysis showed factors associated with a higher frequency of BM: age < 65 years [OR 3.15, 95% CI 1.3-7.5], headache (OR 3.8, 95% CI 1.2-11.8), seizures (OR 3.2, 95% CI 1.1-9.3) and CEA ≥ 15 ng/mL (OR 5.5, 95% CI 2.2-13.8). Focal sensory deficit was associated with a lower frequency of BM (OR 0.2, 95% CI 0.06-0.92). The presence of certain clinical neurologic symptoms, together with CEA level, was associated with a higher risk of BM in LC patients. CONCLUSION: The clinical manifestations of patients with LC should not be overlooked because some may have a substantial correlation with BM.

Perfusión de lidocaína intravenosa / Intravenous lidocaine infusion

La perfusión perioperatoria de lidocaína intravenosa tiene propiedades analgésicas, antihiperalgésicas y antiinflamatorias, disminuyendo el consumo de opioides y agentes volátiles, brindando una rápida recuperación de la función intestinal y alta hospitalaria. Esta revisión narrativa tiene como objetivo exponer su farmacología e indicaciones para su aplicación en la clínica anestésica. Recientes revisiones sistemáticas y metaanálisis confirman su empleo en cirugía abdominal videolaparoscópica y abierta, como también en otros tipos de cirugía, destacándose su uso en protocolos de pronta recuperación. Potenciales beneficios en dolor crónico posoperatorio, disfunción cognitiva posoperatoria y recurrencia de cáncer están siendo investigados. La evidencia actual avala su administración en el contexto de analgesia multimodal debido a sus propiedades inmunomoduladoras sobre el estrés quirúrgico, considerándose un fármaco necesario en la clínica perioperatoria moderna

Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery. Peri-operative lidocaine infusion may be a useful analgesic adjunct in enhanced recovery protocols. Potential benefits of intravenous lidocaine in chronic post-surgical pain, post-operative cognitive dysfunction, and cancer recurrence are under investigation. Due to its immunomodulation properties over surgical stress, current evidence suggests that intravenous lidocaine could be used in the context of multimodal analgesia

Intravenous lidocaine infusion. / Perfusión de lidocaína intravenosa.

Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery. Peri-operative lidocaine infusion may be a useful analgesic adjunct in enhanced recovery protocols. Potential benefits of intravenous lidocaine in chronic post-surgical pain, post-operative cognitive dysfunction, and cancer recurrence are under investigation. Due to its immunomodulation properties over surgical stress, current evidence suggests that intravenous lidocaine could be used in the context of multimodal analgesia.

¿Constituyen los cannabinoides una alternativa terapéutica para insomnio? / Do cannabinoids constitute a therapeutic alternative for insomnia?

INTRODUCCIÓN: Se ha planteado que la estimulación del sueño con cannabinoides podría constituir una alternativa terapéutica en pacientes con insomnio. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen tres estudios primarios, de los cuales dos corresponden a ensayos aleatorizados. Concluimos que no está claro si los cannabinoides tienen un efecto en la severidad del insomnio o en la calidad del sueño; que podrían no tener efecto en la conciliación del sueño, despertar del sueño ni comportamiento durante vigilia, y probablemente se asocian a efectos adversos frecuentes.

INTRODUCTION: It has been suggested that cannabinoids would constitute a therapeutic alternative for patients with insomnia. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including three studies overall, of which two were randomized trials. We concluded it is not clear whether cannabinoids have an effect on insomnia severity or on sleep quality; that they might have no effect on sleep conciliation, sleep awakening or behavior during wakefulness, and are probably associated with frequent adverse effects.

¿Es útil el ejercicio en la prevención de infecciones respiratorias altas? / Is the exercise effective for the prevention of upper respiratory tract infections?

INTRODUCCIÓN: Las infecciones respiratorias altas son una de las principales causas de consulta médica en el mundo. Dado que no hay tratamiento específico, la prevención es fundamental. Se ha postulado que el ejercicio tendría un rol preventivo, pero su real efectividad sigue siendo motivo de controversia. MÉTODOS: Para responder a esta pregunta, utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas, que en conjunto incluyeron 14 estudios primarios, de los cuales seis corresponden a ensayos aleatorizados. Concluimos que aún no está claro si el ejercicio físico de moderada intensidad previene o no las infecciones respiratorias altas, porque la certeza de la evidencia existente es muy baja.

INTRODUCTION: Upper respiratory tract infections are one of the main causes of medical consultation in the world. Considering the lack of specific treatment, prevention becomes essential. It has been postulated that exercise could have a preventive role, but its clinical effectiveness remains a topic of discussion. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including fourteen studies overall, of which six were randomized trials. We concluded it is not clear whether exercise of moderate intensity prevents or not upper respiratory infections, because the certainty of the evidence is very low.

¿Son efectivos los antibióticos profilácticos postoperatorios en fractura de órbita? / Are postoperative prophylactic antibiotics effective for orbital fracture?

INTRODUCCIÓN Una de las principales complicaciones de la fractura de órbita son las infecciones, ya sea por la comunicación con los senos paranasales o como complicación postoperatoria de su tratamiento. Pese a los avances en esta patología, aún existe controversia sobre el rol de los antibióticos profilácticos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos sólo una revisión sistemática que incluyó cuatro estudios primarios, de los cuales tan solo uno corresponde a un ensayo aleatorizado. Concluimos que la profilaxis antibiótica postoperatoria podría no disminuir el riesgo de infección en fractura de órbita, y probablemente aumenta el riesgo de diarrea.

INTRODUCTION Infection is one of the main complications of orbital fracture, either because of the connection to the paranasal sinuses or as a postoperative complication. Despite the advances made in this condition, there is still controversy regarding the role of prophylactic antibiotics. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified only one systematic review including four studies overall, of which only one was a randomized trial. We concluded that postoperative antibiotic prophylaxis might not decrease the risk of infection in orbital fracture, and probably increases the risk of diarrhea.

¿Previene la vitamina C el resfrío común? / Does vitamin C prevent the common cold?

INTRODUCCIÓN: El resfrío común es una enfermedad muy frecuente. Existe la creencia que el consumo de vitamina C previene su aparición, pero la real eficacia de esta medida es controvertida. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos ocho revisiones sistemáticas que en conjunto incluyen 45 estudios primarios, de los cuales 31 corresponden a ensayos aleatorizados. Concluimos que el consumo de vitamina C no previene la aparición del resfrío común.

INTRODUCTION: The common cold is one of the most common diseases. It is generally believed that the consumption of vitamin C prevents its appearance, but the actual efficacy of this measure is controversial. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 45 studies overall, of which 31 were randomized trials. We concluded the consumption of vitamin C does not prevent the incidence of common cold.

¿Cuál es el efecto del tratamiento con vitamina C en la duración y severidad del resfrío común? / What are the effects of vitamin C on the duration and severity of the common cold?

Resumen INTRODUCCIÓN: El resfrío común causa una gran morbilidad en todo el mundo y no se cuenta con agentes terapéuticos eficaces contra éste. Existe la creencia de que ingerir vitamina C durante un episodio de resfrío ayuda a disminuir la duración y severidad de los síntomas, sin embargo existe controversia respecto a esta afirmación. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales siete son ensayos aleatorizados. Concluimos que la vitamina C tiene un impacto mínimo o nulo en la duración del resfrío y en los días en casa o sin trabajar.

Abstract INTRODUCTION: The common cold causes great morbidity throughout the world and there are no effective therapeutic agents against it. There is a belief that consuming vitamin C during a cold episode would help reduce duration and severity of symptoms. However, there is controversy about this claim. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews that included eight primary studies overall, of which seven were randomized trials. We concluded vitamin C has minimal or no impact on the duration of common cold or in the number of days at home or out of work.

Metástasis cerebrales en pacientes con cáncer de tiroides / Brain metastases in patients with thyroid cancer

Resumen: ANTECEDENTES: el cáncer es una de las primeras causas de morbilidad y mortalidad en el mundo; la neoplasia endocrinológica más frecuente es el cáncer de tiroides. A pesar que la mayoría de los pacientes con cáncer de tiroides tienen buen pronóstico, 10 a 15% de los pacientes muestra recurrencia de la enfermedad e incluso 5% padece metástasis a distancia. Las metástasis cerebrales del cáncer de tiroides son raras y habitualmente conllevan mal pronóstico. OBJETIVO: describir las características demográficas y radiológicas, así como el pronóstico clínico de pacientes con cáncer de tiroides que requirieron consulta neurológica. MATERIAL Y MÉTODO: estudio prospectivo observacional en el que se incluyeron pacientes atendidos en un centro de referencia de tercer nivel con cáncer de tiroides que requirieron consulta neurológica entre enero de 2010 y enero de 2016. Se estudiaron las concentraciones séricas de tiroglobulina, TSH y anticuerpos anti-tiroglobulina, como se ha sugerido previamente. RESULTADOS: encontramos siete pacientes con metástasis cerebrales por cáncer de tiroides y las comparamos con registros encontrados en la bibliografía. El género masculino, la edad avanzada y las concentraciones elevadas de tiroglobulina se asociaron con mayor frecuencia de metástasis a distancia de cáncer de tiroides. CONCLUSIONES: las metástasis cerebrales de cáncer de tiroides son complicaciones poco frecuentes con pronóstico adverso. La tiroglobulina es un marcador tumoral muy útil para el seguimiento de pacientes con cáncer de tiroides ya que está elevada en pacientes con actividad sistémica y muy elevada en sujetos con metástasis cerebrales.

Abstract: BACKGROUND: Cancer is one of the first causes of both mortality and morbidity in the world. Thyroid cancer is the most common endocrine neoplasm. Although most TC patients have a good prognosis, 10 to 15% present recurrent disease and up to 5% show distant metastases. Brain metastases are unusual and are associated with a worse prognosis. OBJECTIVE: To describe the demographic and radiological characteristics, as well as clinical prognosis of patients with thyroid cancer who required neurological consultation. MATERIAL AND METHOD: A prospective observational study in which patients with thyroid cancer who required neurological consultation, attended in a tertiary referral cancer center, was done from January 2010 to January 2016. Serum levels of thyroglobulin, TSH and anti-thyroglobulin antibodies were studied, as suggested previously. RESULTS: We followed around 400 patients with TC and we found seven patients with brain metastases by thyroid cancer and compared them with records found in literature. Male gender, older age and high levels of thyroglobulin were associated with higher incidence of distant metastases of thyroid cancer. CONCLUSIONS: Brain metastases of thyroid cancer are little frequent complications with adverse prognosis. Thyroglobulin is a very useful tumoral marker for the following of patients with thyroid cancer, because it is high in patients with systemic activity and very high in patients with brain metastases.

Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters / Aportación del SPECT/TC precoz a la gammagrafía de doble fase con 99mTc-MIBI en pacientes con hiperparatiroidismo primario: valor diagnóstico y correlación de la captación con parámetros biológicos

Aim. To evaluate the value of 99mTc-MIBI double-phase scintigraphy (DPS) and early SPECT/CT in the pre-surgical assessment of patients with primary hyperparathyroidism (PHPT). Also, to calculate the correlation between uptake and some biological parameters. Material and methods. Forty patients with PHPT were included: 37 solitary adenomas, 1 hyperplasia, and 2 double adenomas. Fifteen patients had ectopic glands. DPS and early SPECT/CT were acquired in all patients. Ultrasound was performed in 31/40. All patients underwent surgery, intra-operative iPTH measurements, and histopathological examinations. Qualitative DPS uptake was assessed and correlated to pre-surgical calcium, iPTH levels, gland weight, and maximum diameter. Results. In the planar study, there were 23 positive cases, 8 doubtful, and 9 negatives. With the SPECT/CT, 8/9 negatives cases were located. All doubtful cases were confirmed as positives. Gland location improved in 16 cases (12 ectopic). DPS+SPECT/CT failed to detect a solitary adenoma and at least one gland in three cases of multiglandular disease (MGD). The sensitivity by patient was: DPS 72.5%, DPS+SPECT/CT 90%, and ultrasound 42%. Ultrasound and scintigraphy (DPS+SPECT/CT) were concordant in 16/31 patients. For the rest of them, scintigraphy proved correct in 14/15, and both techniques failed in one case. There was a significant correlation between level of uptake and iPTH level, gland weight, and maximum diameter. Conclusion. Early SPECT/CT improves sensitivity and the locating of parathyroid pathological glands and increases diagnostic confidence. iPTH level, glandular size, and weight are related to the qualitative assessment of 99mTc-MIBI uptake in early DPS (AU)

Objetivo. Evaluar la gammagrafía de doble fase con 99mTc-MIBI (GDF) y el SPECT/TC precoz, en la valoración prequirúrgica del hiperparatiroidismo primario (HPTP), calculando la correlación entre grado de captación y algunos parámetros biológicos. Material y métodos. Se incluyeron 40 pacientes: 37 adenomas solitarios, dos adenomas dobles, una hiperplasia. Quince tenían glándulas ectópicas. En 40 pacientes se realizaron GDF y SPECT/TC; en 31/40, ecografía. Todos los pacientes fueron intervenidos, realizando determinación de PTHi intraoperatoria y examen histopatológico. Se evaluó cualitativamente la captación en la GDF, correlacionándose con calcio y PTHi prequirúrgicos, peso y diámetro máximo glandulares. Resultados. En el estudio planar se obtuvieron 23 casos positivos, 8 dudosos, y 9 negativos. Con SPECT/TC se localizaron 8/9 de los negativos. Todos los dudosos se confirmaron como positivos. La localización glandular mejoró en 16 casos (12 ectópicos). La GDF+SPECT/TC fallaron en la detección de un adenoma solitario y en la visualización de alguna de las glándulas en tres casos de enfermedad multiglandular (EMG). La sensibilidad por pacientes fue: GDF 72,5%, GDF+SPECT/TC 90%, ecografía 42%. Ecografía y gammagrafía (GDF+SPECT/TC) concordaron en 16/31 pacientes. De los no concordantes, la gammagrafía acertó en 14/15 y ambas técnicas fallaron en uno. Hubo correlación significativa entre captación y PTHi, peso y diámetro máximo glandulares. Conclusion. El SPECT/TC precoz mejora la sensibilidad y la localización de las paratiroides patológicas y aumenta la confianza diagnóstica. PTHi, tamaño y peso glandulares se correlacionan con la valoración cualitativa de la captación precoz de 99mTc-MIBI en la GDF (AU)

Respuesta del balance simpático-parasimpático de la variabilidad de la frecuencia cardíaca durante una semana de entrenamiento aeróbico en ciclistas de ruta / Resposta do balanço simpático-parassimpático da variabilidade de frequencia cardíaca durante uma semana de treino aeróbico em ciclistas de estrada / Response of the sympathetic-parasympathetic balance of the heart rate variability during a week of aerobic training in road cyclists

Objetivo. Describir la respuesta del balance simpático-parasimpático después una semana de entrenamiento de volumen aeróbico en ciclistas de ruta. Métodos. El estudio fue basado en un diseño transversal no experimental. Una muestra no aleatoria de cinco ciclistas hombres. Todos participan en la categoría «Todo Competidor» del circuito nacional (27.0±1.9 años, 170.0±6.6cm, 66.0±4.3kg). Los sujetos fueron evaluados durante seis días con un entrenamiento aeróbico (108.4±49.5km por día). Cada día se les midió el balance autonómico a través del cociente baja frecuencia/alta frecuencia, en reposo e inmediatamente posterior al entrenamiento. Resultados. Los valores del intervalo RR (1205.9 ± 35.2-993.7 ± 61.2 basal y postentrenamiento respectivamente) muestran diferencia significativa (p<0.05). Los valores del cociente baja frecuencia/alta frecuencia (0.861±0.090-3.067±0.590 basal y postentrenamiento respectivamente) reflejan que existe una activación del balance autonómico inmediatamente terminado el entrenamiento (p<0.05). La potencia de la HF del balance autonómico (2567±697-926±367 basal y postentrenamiento respectivamente) refleja una disminución significativa apenas termina el entrenamiento y comienza la recuperación (p<0.05). Conclusiones. Los resultados de este estudio muestran un aumento significativo en la respuesta del balance autonómico del cociente baja frecuencia/alta frecuencia posterior al entrenamiento. Además, una disminución significativa de la potencia de la banda de alta frecuencia durante la recuperación que puede implicar aumento de la actividad de la respuesta parasimpática. Estos cambios podrían ayudar al control y diseño de programas de entrenamiento de forma individualizada para el ciclismo en ruta, además de ser una herramienta barata y no invasiva (AU)

Objetivo. Descrever a resposta do balanço simpático-parassimpático após uma semana de treino de volume aeróbico em ciclistas de estrada. Métodos. O estudo foi baseado num design não experimental. Amostra não-aleatória de cinco homens ciclistas. Todos participam na categoria «Todos os competidores» do circuito nacional (27±1.9 anos, 170±6.6cm, 66±4.3kg). Os indivíduos foram avaliados por seis dias com o treino de resistencia (108.4±49.5 km por dia). Cada dia era medido o balanço autonómico através da razão baixa frequencia/alta frequencia, em repouso e imediatamente após o treino. Resultados. Os valores do intervalo RR (1205.9±35.2 para 993.7±61.2 para o início do estudo e o pós-treino, respetivamente) mostram diferença significativa (p<0.05). Os valores da razão baixa frequencia/alta frequencia (0.861 ± 0.09-3.067 ± 0.59 para o início do estudo e 0 pós-treino, respetivamente) mostram que existe uma ativação do balanço autonómico imediatamente após o treino (p<0.05). A potencia alta frequencia do balanço autonómico (2.567±697-926±367 no início do estudo e pós-treino, respetivamente), reflete uma diminuição significativa logo após o treinamento e o início da recuperação (p<0.05). Conclusões. Os resultados deste estudo mostraram um aumento significativo na resposta do balanço autonómico da relação baixa frequencia/alta frequencia após o treino. Por outro lado, uma diminuição significativa na potencia banda de alta frequencia durante a recuperação pode envolver o aumento da atividade da resposta parassimpática. Essas mudanças poderiam ajudar a controlar e desenhar os programas de treino individualmente para ciclismo de estrada, além de ser uma ferramenta barata e não invasiva (AU)

Objective. To describe the response of the sympathetic-parasympathetic balance after a week of aerobic training volume in road cyclists. Methods. The study was based on a non experimental transectional design. A non-random sample of five cyclists men. All participates in category «All competitors» of the national circuit (27.0±1.9 years, 170.0±6.6cm, 66.0±4.3kg). Subjects were evaluated for six days with aerobic training (108.4±49.5km per day). Each day the autonomic balance through the ratio LF/HF was measured, at rest and immediately after training. Results. Mean values of RR (1205.9±35.2 to 993.7±61.2 at baseline and post-training respectively) interval show significant difference (p<0.05). The values of the ratio Low Frequency/High Frequency (0.861±0.090 to 3.067±0.59 at baseline and post-training respectively) show that there is an activation of the autonomic balance immediately completed the training (p<0.05). The High Frequency power of autonomic balance (2567±697 to 926±367 at baseline and post-training respectively), shows a significant decline straight after training and start recovery (p<0.05). Conclusions. The results of this study show a significant increase in the response of the autonomic balance of the ratio Low Frequency/High Frequency after training. Furthermore, a significant decrease in power of the High Frequency band during recovery may involve and increased activity of the parasympathetic response. These changes can help to the control and design of individual training programs for road cycling as well as being an inexpensive and non-invasive tool (AU)

Parathyroid Hormone Polymorphism RS6254 is Associated with the Development and Severity of Osteoporosis in Asymptomatic but not Normocalcemic Hyperthyroidism.

Although normocalcemic and asymptomatic hyperparathyroidism (HPT) are becoming more common, they remain only partially understood. Parathyroid hormone (PTH) polymorphisms have been associated with disease severity in classical HPT. The aim of the present study was to evaluate the clinical effect of PTH polymorphism (rs6254) in normocalcemic and asymptomatic HPT. A prospective study of 61 consecutive patients with normocalcemic or asymptomatic HPT was carried out. Secondary causes of HPT were ruled out. All patients were followed for≥1 year. Calcium and phosphorus metabolism parameters were assessed at least twice during the follow-up period to classify as normocalcemic or asymptomatic HPT. Bone mineral density (BMD) and the rs6254 polymorphism genotype were also assessed. Genotype rs6254GG was observed in 23 patients (37.7%) whereas GA and AA genotypes were presented in 29 (47.5%) and 9 (14.8%) patients, respectively. Age, sex and genotype distributions were comparable in both groups. In asymptomatic but not normocalcemic HPT patients, the GG genotype was associated with a significantly higher level of intact PTH [200.2 (SD 76.5) vs. 113.3 (SD 25.9) pg/ml; p<0.01], and significantly lower Z-score densitometry at the femoral neck, proximal femur, and lumbar spine. Both remained significant after adjusting for major confounding factors by multiple linear regression. The present study supports the independent pathogenic effect of rs6254GA polymorphism on the development and severity of BMD complications in patients with asymptomatic but not normocalcemic HPT. Further studies are needed to confirm this finding and to assess the effect of other polymorphisms in normocalcemic and asymptomatic HPT.

The Calcium-Sensing Receptor in Health and Disease.

The extracellular calcium-sensing receptor (CaSR) is a unique G protein-coupled receptor (GPCR) activated by extracellular Ca2+ and by other physiological cations including Mg2+, amino acids, and polyamines. CaSR is the most important master controller of the extracellular Ca2+ homeostatic system being expressed at high levels in the parathyroid gland, kidney, gut and bone, where it regulates parathyroid hormone (PTH) secretion, vitamin D synthesis, and Ca2+ absorption and resorption, respectively. Gain and loss of function mutations in the CaSR are responsible for severe disturbances in extracellular Ca2+ metabolism. CaSR agonists (calcimimetics) and antagonists (calcilytics) are in use or under intense research for treatment of hyperparathyroidism secondary to kidney failure and hypocalcemia with hypercalciuria, respectively. Expression of the CaSR extends to other tissues and systems beyond the extracellular Ca2+ homeostatic system including the cardiovascular system, the airways, and the nervous system where it may play physiological functions yet to be fully understood. As a consequence, CaSR has been recently involved in different pathologies including uncontrolled blood pressure, vascular calcification, asthma, and Alzheimer's disease. Finally, the CaSR has been shown to play a critical role in cancer either contributing to bone metastasis and/or acting as a tumor suppressor in some forms of cancer (parathyroid cancer, colon cancer, and neuroblastoma) and as oncogene in others (breast and prostate cancers). Here we review the role of CaSR in health and disease in calciotropic tissues and others beyond the extracellular calcium homeostatic system.

Ventilación mecánica: una breve historia / Mechanical ventilation: a short history

This review is a short history of mechanical ventilation, from its origins to the present day. This changing history provides the basis for speculation on the future innovations in the ventilatory support.

Se revisa la historia de la ventilación mecánica desde sus orígenes hasta el presente, una historia cambiante que permite especular sobre las futuras innovaciones en el soporte ventilatorio.