The Effect of Oral Simethicone in a Bowel Preparation in a Colorectal Cancer Screening Colonoscopy Setting: A Randomized Controlled Trial.

Introduction: Current guidelines suggest adding oral simethicone to bowel preparation for colonoscopy. However, its effect on key quality indicators for screening colonoscopy remains unclear. The primary aim was to assess the rate of adequate bowel preparation in split-dose high-volume polyethylene glycol (PEG), with or without simethicone. Methods: This is an endoscopist-blinded, randomized controlled trial, including patients scheduled for colonoscopy after a positive faecal immunochemical test. Patients were randomly assigned to 4 L of PEG split dose (PEG) or 4 L of PEG split dose plus 500 mg oral simethicone (PEG + simethicone). The Boston Bowel Preparation Scale (BBPS) score, the preparation quality regarding bubbles using the Colon Endoscopic Bubble Scale (CEBuS), ADR, CIR, and the intraprocedural use of simethicone were recorded. Results: We included 191 and 197 patients in the PEG + simethicone group and the PEG group, respectively. When comparing the PEG + simethicone group versus the PEG group, no significant differences in adequate bowel preparation rates (97% vs. 93%; p = 0.11) were found. However, the bubble scale score was significantly lower in the PEG + simethicone group (0 [0] versus 2 [5], p < 0.01), as well as intraprocedural use of simethicone (7% vs. 37%; p < 0.01). ADR (62% vs. 61%; p = 0.86) and CIR (98% vs. 96%, p = 0.14) did not differ between both groups. Conclusion: Adding oral simethicone to a split-bowel preparation resulted in a lower incidence of bubbles and a lower intraprocedural use of simethicone but no further improvement on the preparation quality or ADR.

Introdução: As normas de orientação atuais sugerem a adição de simeticone oral à preparação intestinal para colonoscopia. Contudo, o seu efeito nos indicadores de qualidade no âmbito da colonoscopia de rastreio não está comprovado. O objetivo principal foi avaliar a taxa de preparação adequada usando polietilenoglicol (PEG) em dose dividida com e sem simeticone oral. Métodos: Estudo randomizado controlado, cego para o endoscopista, incluindo doentes admitidos para colonoscopia após teste fecal imunoquímico positivo. Os doentes foram aleatoriamente alocados para 4 litros de PEG em dose dividida (PEG) ou 4 litros de PEG em dose divida + simeticone oral (PEG + simeticone). Foram avaliados: Boston Bowel Preparation Scale (BBPS), qualidade da preparação relativa às bolhas através da Colon Endoscopic Bubble Scale (CEBuS) scale, ADR, CIR e uso de simeticone durante o procedimento. Resultados: Foram incluídos 191 e 197 doentes nos grupos PEG + simeticone e PEG, respetivamente. Comparando os grupos PEG + simeticone versus PEG, não se registaram diferenças de significado estatístico relativamente à taxa de preparação intestinal adequada (97% vs. 93%; p = 0,01) mas o score da escala de bolhas foi significativamente inferior no grupo PEG + simeticone [0 (0) versus 2 (5), p < 0.01], assim como o uso de simeticone durante o procedimento (7% vs. 37%; p < 0,01). A ADR (62% vs. 61%; p = 0,86) e a CIR (98% vs. 96%, p = 0,14) não diferiram significativamente entre os dois grupos, respetivamente. Discussão/Conclusão: Adicionar simeticone oral à preparação intestinal em dose dividida permitiu menor incidência de bolhas e menor utilização de simeticone durante o procedimento, mas não se associa a melhor preparação intestinal ou melhor ADR.

Differentiated thyroid carcinoma: what the nonspecialists needs to know.

Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents.

Differentiated thyroid carcinoma: what the nonspecialists needs to know

ABSTRACT Differentiated thyroid carcinoma (DTC) accounts for most cases of thyroid cancer, and the heterogeneity of DTC requires that management decisions be taken by a multidisciplinary team involving endocrinologists, head and neck surgeons, nuclear medicine physicians, pathologists, radiologists, radiation oncologists, and medical oncologists. It is important for nonspecialists to recognize and refer patients with DTC who will benefit from a specialized approach. Recent advances in knowledge and changes in management of DTC call for the need to raise awareness on the part of these nonspecialist physicians, including general endocrinologists and medical oncologists at large. We provide an overview of diagnostic and therapeutic principles in DTC, especially those that bear direct implication on day-to-day management of these patients by generalists. Patients with DTC may be broadly categorized as having localized, locally persistent/recurrent, or metastatic disease. Current recommendations for DTC include a three-tiered system that classifies patients with localized disease into low, intermediate, or high risk of persistent or recurrent disease. Risk stratification should be performed at baseline and repeated on an ongoing basis, depending on clinical evolution. One of the overarching goals in the management of DTC is the need to personalize treatment by tailoring its modality and intensity according to ongoing prognostic stratification, evolving knowledge about the disease, and patient characteristics and preference. In metastatic disease that is refractory to radioactive iodine, thyroid tumors are being reclassified into molecular subtypes that better reflect their biological properties and for which molecular alterations can be targeted with specific agents.

Raynaud Phenomenon of the Nipple: A Clinical Case Report.

Objective: In Raynaud's phenomenon of the nipple there is a change in color, accompanied by pain or discomfort during breastfeeding. Case report: A 29-years old female patient, breastfeeding, develops a severe bilateral nipple pain during and after breastfeeding and biphasic change in nipple color, with difficulties in the breastfeeding technique. She was medicated with nifedipine and recommended application of warm compresses to the nipples and use of electric breast pump, showing complete resolution after four weeks of treatment. Conclusion: Raynaud's phenomenon of the nipple should be considered in breastfeeding women who report nipple pain or discomfort. In clinical practice, nipple pain is a very frequent complaint, and responsible for many cases of early abandonment of breastfeeding. It is therefore essential to make an early diagnosis and implement a correct and immediate treatment.

Antimony Selenide Solar Cells Fabricated by Hybrid Reactive Magnetron Sputtering.

The fabrication of Sb2Se3 thin-film solar cells deposited by a pulsed hybrid reactive magnetron sputtering (PHRMS) was proposed and examined for different growth conditions. The influence of growth temperature and Se pulse period were studied in terms of morphology, crystal structure, and composition. The Sb2Se3 growth showed to be dependent on the growth temperature, with a larger crystal size for growth at 270 °C. By controlling the Se pulse period, the crystal structure and crystal size could be modified as a function of the supplied Se amount. The solar cell performance for Sb2Se3 absorbers deposited at various temperatures, Se pulse periods and thicknesses were assessed through current-voltage characteristics. A power conversion efficiency (PCE) of 3.7% was achieved for a Sb2Se3 solar cell with 900 nm thickness, Sb2Se3 deposited at 270 °C and Se pulses with 0.1 s duration and period of 0.5 s. Finally, annealing the complete solar cell at 100 °C led to a further improvement of the Voc, leading to a PCE of 3.8%, slightly higher than the best reported Sb2Se3 solar cell prepared by sputtering without post-selenization.

Cap-Assisted Endoscopic Mucosal Resection for Rectal Neuroendocrine Tumors: An Effective Option.

Introduction: The incidence of rectal neuroendocrine tumors (r-NETs) is increasing, and most small r-NETs can be treated endoscopically. The optimal endoscopic approach is still debatable. Conventional endoscopic mucosal resection (EMR) leads to frequent incomplete resection. Endoscopic submucosal dissection (ESD) allows higher complete resection rates but is also associated with higher complication rates. According to some studies, cap-assisted EMR (EMR-C) is an effective and safe alternative for endoscopic resection of r-NETs. Aims: This study aimed to evaluate the efficacy and safety of EMR-C for r-NETs ≤10 mm without muscularis propria invasion or lymphovascular infiltration. Methods: Single-center prospective study including consecutive patients with r-NETs ≤10 mm without muscularis propria invasion or lymphovascular invasion confirmed by endoscopic ultrasound (EUS), submitted to EMR-C between January 2017 and September 2021. Demographic, endoscopic, histopathologic, and follow-up data were retrieved from medical records. Results: A total of 13 patients (male: 54%; n = 7) with a median age of 64 (interquartile range: 54-76) years were included. Most lesions were located at the lower rectum (69.2%, n = 9), and median lesion size was 6 (interquartile range: 4.5-7.5) mm. On EUS evaluation, 69.2% (n = 9) of tumors were limited to muscularis mucosa. EUS accuracy for the depth of invasion was 84.6%. We found a strong correlation between size measurements by histology and EUS (r = 0.83, p < 0.01). Overall, 15.4% (n = 2) were recurrent r-NETs and had been pretreated by conventional EMR. Resection was histologically complete in 92% (n = 12) of cases. Histologic analysis revealed grade 1 tumor in 76.9% (n = 10) of cases. Ki-67 index was inferior to 3% in 84.6% (n = 11) of cases. The median procedure time was 5 (interquartile range: 4-8) min. Only 1 case of intraprocedural bleeding was reported and was successfully controlled endoscopically. Follow-up was available in 92% (n = 12) of cases with a median follow-up of 6 (interquartile range: 12-24) months with no evidence of residual or recurrent lesion on endoscopic or EUS evaluation. Conclusion: EMR-C is fast, safe, and effective for resection of small r-NETs without high-risk features. EUS accurately assesses risk factors. Prospective comparative trials are needed to define the best endoscopic approach.

Introdução: Os tumores neuroendócrinos do reto (r-NETs) apresentam incidência crescente. A maioria dos tumores de pequenas dimensões pode ser excisada endoscopicamente, no entanto, a abordagem ótima é controversa. A mucosectomia convencional associa-se, frequentemente, a resseção endoscópica incompleta. A disseção endoscópica submucosa (ESD) permite elevadas taxas de resseção completa, mas é tecnicamente complexa e associa-se a maior número de complicações. Alguns estudos sugerem a mucosectomia assistida por cap (EMR-C) como uma alternativa eficaz e segura. Objetivo: Este estudo pretendeu avaliar a eficácia e segurança da mucosectomia com cap na resseção de r-NETs com dimensões ≤10 mm, sem invasão da muscularis própria nem infiltração linfovascular. Material e Métodos: Estudo prospetivo unicêntrico incluindo consecutivamente r-NETs com ≤10 mm, sem invasão da muscularis própria ou linfovascular confirmada em ultrassonografia endoscópica (EUS), submetidos a mucosectomia assistida cap entre janeiro de 2017 e setembro de 2021. Colheita de dados demográficos, clínicos e histopatológicos através de registos médicos eletrónicos. Resultados: Incluídos 13 doentes (género masculino: 54%; n = 7) com idade mediana de 64 (intervalo interquartil [IIQ]: 54­76) anos. A maioria das lesões localizava-se no reto inferior (69.2%; n = 9) e apresentava tamanho mediano de 6 (IIQ: 4.5­7.5) mm. Na avaliação por EUS, 69.2% (n = 9) encontravam-se limitados à muscularis mucosa. A acuidade da EUS na avaliação do envolvimento das camadas da parede retal foi de 84.6% e o tamanho avaliado por EUS correlacionou-se fortemente com o medido na histologia (r = 0.83, p < 0.01). Dois casos (15.4%) corresponderam a recorrências de mucosectomias convencionais prévias. A resseção foi macroscópica e histologicamente completa em 92% (n = 12) dos casos. A análise histológica revelou 76.9% (n = 10) tumores de grau 1. O índice Ki-67 foi inferior a 3% em 84.6% (n = 11) dos casos. O tempo mediano de procedimento foi 5 (IIQ: 4­8) minutos. Verificou-se apenas um caso de hemorragia intraprocedimento resolvida endoscopicamente. O seguimento de 92% dos casos (n = 12) com mediana de 6 (IIQ:12­24) meses não revelou lesão residual ou recorrência em avaliações endoscópica e ultrassonográfica. Discussão/Conclusão: A EMR-C é uma técnica endoscópica segura, rápida e efetiva para a resseção de r-TNEs pequenos sem fatores de alto risco. A EUS apresenta elevada acuidade na avaliação dos fatores de risco. Estudos comparativos prospetivos são necessários para estabelecimento da abordagem endoscópica mais profícua.

Can white-light endoscopy or narrow-band imaging avoid biopsy of colorectal endoscopic mucosal resection scars? A multicenter randomized single-blind crossover trial.

BACKGROUND : Current guidelines suggest that routine biopsy of post-endoscopic mucosal resection (EMR) scars can be abandoned, provided that a standardized imaging protocol with virtual chromoendoscopy is used. However, few studies have examined the accuracy of advanced endoscopic imaging, such as narrow-band imaging (NBI) vs. white-light endoscopy (WLE) for prediction of histological recurrence. We aimed to assess whether NBI accuracy is superior to that of WLE and whether one or both techniques can replace biopsies. METHODS : The study was a multicenter, randomized, pathologist-blind, crossover trial, with consecutive patients undergoing first colonoscopy after EMR of lesions ≥ 20 mm. Computer-generated randomization and opaque envelope concealed allocation. Patients were randomly assigned to scar examination with NBI followed by WLE (NBI + WLE), or WLE followed by NBI (WLE + NBI). Histology was the reference method, with biopsies being performed for all tissues. RESULTS : The study included 203 scars (103 in the NBI + WLE group, 100 in the WLE + NBI group). Recurrence was confirmed histologically in 29.6 % of the scars. The diagnostic accuracy of NBI was not statistically different from that of WLE (95 % [95 %CI 92 %-98 %] vs. 94 % [95 %CI 90 %-97 %]; P = 0.48). The negative predictive values (NPVs) were 96 % (95 %CI 93 %-99 %) for NBI and 93 % (95 %CI 89 %-97 %) for WLE (P = 0.06). CONCLUSIONS : The accuracy of NBI for the diagnosis of recurrence was not superior to that of WLE. Endoscopic assessment of EMR scars with WLE and NBI achieved an NPV that would allow routine biopsy to be avoided in cases of negative optical diagnosis.

Características clínico-epidemiológicas del síndrome coronario agudo

RESUMEN Fundamento: las enfermedades cardiovasculares se consideran un problema de salud a nivel mundial, entre ellas, el infarto agudo de miocardio ocupa un lugar relevante y representa una de las primeras causas de muerte en la mayoría de los países. Objetivo: describir las características clínico-epidemiológicas de los pacientes ingresados por síndrome coronario agudo con elevación del segmento ST en el Servicio de Cardiología y Unidad de Cuidados Coronarios del Hospital General Docente Enrique Cabrera de La Habana. Método: se realizó un estudio descriptivo y transversal en pacientes con diagnóstico de síndrome coronario agudo con elevación del segmento ST ingresados en la unidad de cuidados coronarios desde septiembre de 2018 hasta septiembre 2021. Se estudiaron 423 pacientes y se analizaron las variables sociodemográficas y clínicas. En el análisis estadístico las variables se expresaron como media para las variables continuas y frecuencia y proporción para las variables categóricas utilizando el porcentaje como medida de resumen. Para cuantificar un posible riesgo se utilizó la prueba de Productos Cruzados u Odd Ratio con un intervalo de confianza del 95 % calculado por el método de Woolf. Resultados: se observó predominio del sexo masculino (71,2 %) y la edad promedio fue de 62,31 años. El 74,2 % de los pacientes presentaron hipertensión arterial y 62,2 % fueron fumadores. Se presentó la insuficiencia cardiaca, la hipotensión y la pericarditis como complicaciones más frecuentes. El tratamiento con la terapia trombolítica se administró en la mayoría de los pacientes y la mortalidad se presentó en un 5,6 %. Conclusiones: la hipertensión arterial y el tabaquismo predominaron dentro de los factores de riesgo. La insuficiencia cardiaca fue la complicación más frecuente. Los pacientes con infarto anterior extenso y diabetes mellitus presentaron una probabilidad mayor de complicaciones.

ABSTRACT Background: cardiovascular diseases are considered a health problem worldwide, among them, acute myocardial infarction occupies a relevant place and represents one of the leading causes of death in most countries. Objective: to describe the clinical-epidemiological characteristics of patients admitted for ST-segment elevation acute coronary syndrome in the Cardiology Service and Coronary Care Unit of the Enrique Cabrera General Teaching Hospital in Havana. Method: a descriptive and cross-sectional study was carried out in patients diagnosed with ST-segment elevation acute coronary syndrome admitted to the coronary care unit from September 2018 to September 2021. 423 patients were studied and sociodemographic and clinical variables were analyzed. In the statistical analysis, the variables were expressed as mean for continuous variables and frequency and proportion for categorical variables, using the percentage as a summary measure. To quantify a possible risk, the Cross Products or Odd Ratio test was used with a 95 % confidence interval calculated by the Woolf method. Results: there was a predominance of males (71.2 %) and the average age was 62.31 years. 74.2 % of the patients had high blood pressure and 62.2 % were smokers. Heart failure, hypotension and pericarditis were presented as the most frequent complications. Treatment with thrombolytic therapy was administered in the majority of patients and mortality was 5.6 %. Conclusions: arterial hypertension and smoking predominated within the risk factors. Heart failure was the most frequent complication. Patients with extensive anterior infarction and diabetes mellitus had a higher probability of complications.

Estrés académico en universitarios durante la pandemia de COVID-19

RESUMEN Introducción: durante el último año, la población ha sufrido las consecuencias emocionales y psicológicas de la pandemia de COVID-19. Por su parte, los universitarios tuvieron que modificar sus rutinas y adaptarse a una nueva modalidad de enseñanza. Objetivo: identificar la incidencia de la pandemia de COVID-19 en la manifestación de estrés académico en estudiantes universitarios. Materiales y métodos: se realizó un estudio descriptivo transversal en un universo conformado por 359 estudiantes de universidades ecuatorianas. Para la recolección de datos se utilizó la ficha sociodemográfica y el Inventario SISCO del estrés académico. Resultados: en la investigación predominaron el sexo femenino y el grupo de edad de 18 a 20 años de varias universidades de la República del Ecuador. El 66,01 % de los universitarios reportaron estrés académico en indicadores de Casi siempre y Siempre; el estresor más frecuente fue la sobrecarga de tareas (x = 4,08); el síntoma más padecido fue problemas de concentración (x = 3,55), y la estrategia más usada fue escuchar música o distraerse viendo televisión (x = 4,00). Conclusión: un alto porcentaje de universitarios presentaron estrés académico, identificándose una relación con la pandemia de COVID-19 en esta población.

ABSTRACT Introduction: throughout the last year, the population has suffered the emotional and psychological consequences of COVID-19 pandemic. University students, as well, had to modify their routines and to adapt themselves to a new teaching modality. Objective: to identify the incidence of COVID-19 pandemic on the manifestation of academic stress in university students. Materials and methods: a cross-sectional, descriptive study was carried out in a universe composed by 359 students from Ecuadorian universities. The socio-demographic card and SISCO Academic Stress Inventory were used for data collection. Results: Female sex and the age group from 18 to 20 years predominated in students from several universities of Republic of Ecuador. 66.01 % of the university students reported academic stress with indicators of Almost always and Always; the most frequent stressor was task overload (x = 4.08); the most suffered symptom was concentration troubles (x = 3.55); and the most used strategy was listening to music and distracting watching television (x = 4.00). Conclusion: a high percent of university students showed academic stress, being identified its relationship to COVID-19 pandemic in this population.

Trastorno de ansiedad generalizada y estrés académico en estudiantes universitarios ecuatorianos durante la pandemia COVID-19 / Generalized anxiety disorder and academic stress in university students during the COVID-19 pandemic

RESUMEN La crisis sanitaria causada por el Coronavirus SARS-COV2 o COVID-19 incrementa sus niveles de contagio y deja millones de muertes, así como secuelas en la esfera psíquica de las personas afectadas. El confinamiento, la cuarentena obligatoria y las medidas usadas para reducir el número de contagios conllevan consecuencias negativas en la salud mental de los estudiantes universitarios. Objetivo: Identificar la relación entre estrés académico y el trastorno de ansiedad generalizada ocasionado por la pandemia COVID-2019. Material y Métodos : Estudio descriptivo-correlacional, empleando el Inventario Sistémico Cognoscitivo de Estrés Académico (SISCO) y la Escala para el Trastorno de Ansiedad Generalizada (GAD-7), aplicados a 359 estudiantes universitarios del Ecuador en el periodo Mayo-Junio 2020. Resultados: La muestra estudiada contó con 64,9% de mujeres y 35,1% hombres, con un 43,7% en el intervalo de edad 21 a 23 años. En SISCO, la media de estrés fue mayor en mujeres (X = 3,4313) vs. varones (X = 3,2142), ambos grupos mostrando niveles altos de estrés académico. Un 51.5% de mujeres y un 34,5% de hombres presentan además síntomas de ansiedad severa según GAD-7. La moderada correlación positiva entre estrés académico y ansiedad generalizada se reflejó en un rho = 0,68. Conclusiones: Existen niveles elevados de estrés académico en estudiantes universitarios, con mujeres como el grupo más afectado. Probandos de ambos sexos mostraron, en su mayoría, síntomas severos de ansiedad.

SUMMARY The health crisis caused by the Coronavirus Disease 2019 o COVID-19 pandemic, increases its contagiousness, and leaves millions of deaths, as well as significant consequences in the psychic sphere of affected people. Lockdown, mandatory quarantine, and the actions taken to reduce the number of infections lead to negative consequences for the mental health of university students. Objective: To identify the relationship between academic stress and generalized anxiety disorder caused by the COVID-2019 pandemic. Material and Methods: Descriptive-correlational study, using the Cognitive Systemic Inventory of Academic Stress (CSIAS) and the Scale for Generalized Anxiety Disorder (GAD-7), applied to 359 university students of Ecuador during the period May-June 2020. Results: From the total sample, 64.9% were women and 35.1%, men, with 43.7% in the 21-23 years-old group. In the CSIAS, the mean stress was higher in women (X = 3.4313) than in men (X = 3.2142), both groups presenting high levels of academic stress. On GAD-7, 51.5% of women presented symptoms of severe anxiety vs. 34.5% of men. A moderate positive correlation between academic stress and generalized anxiety was shown by a rho = 0.638. Conclusions: There are elevated levels of academic stress among university students, with women as the most affected group. A majority of probands of both genders showed symptoms of severe anxiety.

An unexpected location for a metastasis from esophageal squamous carcinoma.

We report the case of a 69-year-old male with a relevant alcohol consumption and a history of prostate cancer who underwent screening upper gastrointestinal endoscopy and colonoscopy. The upper gastrointestinal endoscopy revealed an ulcerated mass in the middle esophagus occupying half the circumference. Histologic examination was compatible with a squamous cell carcinoma. Staging with endoscopic ultrasound and computed tomography of the neck, chest and abdomen was consistent with a T3N1M0.

Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis.

AIMS: Sex-specific thresholds of aortic valve calcification (AVC) have been proposed and validated in Caucasians. Thus, we aimed to validate their accuracy in Asians. METHODS AND RESULTS: Patients with calcific aortic stenosis (AS) from seven international centres were included. Exclusion criteria were ≥moderate aortic/mitral regurgitation and bicuspid valve. Optimal AVC and AVC-density sex-specific thresholds for severe AS were obtained in concordant grading and normal flow patients (CG/NF). We included 1263 patients [728 (57%) Asians, 573 (45%) women, 837 (66%) with CG/NF]. Mean gradient was 48 (26-64) mmHg and peak aortic velocity 4.5 (3.4-5.1) m/s. Optimal AVC thresholds were: 2145 Agatston Units (AU) in men and 1301 AU in women for Asians; and 1885 AU in men and 1129 AU in women for Caucasians. Overall, accuracy (% correctly classified) was high and comparable either using optimal or guidelines' thresholds (2000 AU in men, 1200 AU in women). However, accuracy was lower in Asian women vs. Caucasian women (76-78% vs. 94-95%; P < 0.001). Accuracy of AVC-density (476 AU/cm2 in men and 292 AU/cm2 in women) was comparable to absolute AVC in Caucasians (91% vs. 91%, respectively, P = 0.74), but higher than absolute AVC in Asians (87% vs. 81%, P < 0.001). There was no interaction between AVC/AVC-density and ethnicity (all P > 0.41) with regards to AS haemodynamic severity. CONCLUSION: AVC thresholds defining severe AS are comparable in Asian and Caucasian populations, and similar to those proposed in the guidelines. However, accuracy of AVC to identify severe AS in Asians (especially women) is sub-optimal. Therefore, the use of AVC-density is preferable in Asians.

Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis.

Background: Sex-specific thresholds of computed tomography (CT)-derived aortic valve calcification (AVC) or AVC density (AVCd) to identify severe aortic stenosis (AS) have been established in populations that consisted mainly of Caucasians with a tricuspid aortic valve. The objective of this study was to evaluate the accuracy (i.e., sensitivity and specificity) of previously established thresholds to identify severe AS in patients with bicuspid aortic valve (BAV) and according to ethnicity: Caucasian vs. Asian. Methods: We built a multicenter registry of echocardiographic and CT data collected in BAV patients with at least mild AS and preserved left ventricular ejection fraction from 7 different centers. Anatomic severity of AS obtained by CT-derived AVC and AVCd was compared to hemodynamic severity of AS obtained by echocardiography. Results: Among 485 BAV patients (60% men, 73% Asians), the best thresholds of AVC and AVCd to identify severe AS in BAV patients were 2315 arbitrary units (AU) (sensitivity [Se]/specificity [Spe] = 82/78%) in men, 1103 AU (Se/Spe = 80/82%) in women, and 561 AU/cm2 (Se/Spe = 86/91%) in men, and 301 AU/cm2 (Se/Spe = 83/82%) in women, respectively. According to ethnicity, thresholds for severe AS in Caucasian patients were, respectively, in men and women: 2208 AU (Se/Spe = 83/83%) and 1230 AU (Se/Spe = 87/82%) for AVC and 474 AU/cm2 (Se/Spe = 88/83%) and 358 AU/cm2 (Se/Spe = 80/82%) for AVCd. In Asian patients, they were 2582 AU (Se/Spe = 76/78%) and 924 AU (Se/Spe = 84/80%) for AVC and 640 AU/cm2 (Se/Spe = 82/89%) and 255 AU/cm2 (Se/Spe = 86/80%) for AVCd. Conclusions: The optimal thresholds to identify hemodynamically severe AS in BAV patients are similar in Caucasians but appear to be higher in Asian men, compared with thresholds previously reported in tricuspid aortic valve patients. Nonetheless, the thresholds currently proposed in the guidelines have good accuracy and can be applied in BAV patients to confirm AS severity.

Temporal changes in the potential geographic distribution of Histiotus velatus (Chiroptera, Vespertilionidae), the "decade effect".

We investigated how the potential distribution of Histiotus velatus is affected by the addition of new records over decades (decade effect). Assuming that (1: hypothesis of the effect of the decade) the addition of new occurrence records over time increases the potential size of the species distribution; and (2: Wallacean distance hypothesis) over the years, the new points added are increasingly distant from the research centers. Considering the geographic knowledge gap of this species, our objective is to report a new record of this species and estimate its potential distribution in South America through environment niche models (ENMs). For this, we compiled records of occurrence of species, selected from 1900 to 2015. We used 19 bioclimatic variables available in the WorldClim database to estimate the potential distribution of the species, and we used three modeling algorithms: Maximum Entropy (MXT), Random Forest (RDF), and Support Vector Machine. To test the Wallacean distance hypothesis, we calculated the Euclidian distance from occurrences to bat research centers in Brazil, located using a national researchers' information dataset ("Plataforma Lattes"). To test the hypothesis of the decade effect, we used the beta regression analysis, taking conservative and non-conservative approaches. The results showed that the predicted area expanded and retracted with the addition of new occurrences over the decades, with an improvement in the accuracy of models. Most records are located in the southeastern region of Brazil, but algorithms predicted areas in regions where there are no records. Only the conservative approach has had a positive relationship over the decades. The distance from new points does not increase over the years of research centers.

Gastric Hyperplastic Polyps: A Benign Entity? Analysis of Recurrence and Neoplastic Transformation in a Cohort Study.

INTRODUCTION: Hyperplastic polyps represent 30-93% of all gastric epithelial polyps. They are generally detected as innocuous incidental findings; however, they have a risk of neoplastic transformation and recurrence. Frequency and risk factors for neoplastic transformation and recurrence are not well established and are fields of ongoing interest. This study aims to evaluate the frequency of and identify the risk factors for recurrence and neoplastic change of gastric hyperplastic polyps (GHP). METHODS: A single-centre retrospective cohort study including consecutive patients who underwent endoscopic resection of GHP from January 2009 to June 2020. Demographic, endoscopic, and histopathologic data was retrieved from the electronic medical records. RESULTS: A total of 195 patients were included (56% women; median age 67 [35-87] years). The median size of GHP was 10 (3-50) mm, 62% (n = 120) were sessile, 61% (n = 119) were located in the antrum, and 36% (n = 71) had synchronous lesions. Recurrence rate after endoscopic resection was 23% (n = 26). In multivariate analysis, antrum location was the only risk factor for recurrence (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1-8.1). Overall, 5.1% (n = 10) GHP showed neoplastic transformation, with low-grade dysplasia in 5, high-grade dysplasia in 4, and adenocarcinoma in 1. In multivariate analysis, a size >25 mm (OR 84; 95% CI 7.4-954) and the presence of intestinal metaplasia (OR 7.6; 95% CI 1.0-55) and dysplasia (OR 86; 95% CI 10-741) in adjacent mucosa were associated with an increased risk of neoplastic transformation. Recurrence was not associated with neoplastic transformation (OR 1.1; 95% CI 0.2-5.9). DISCUSSION: Our results confirmed the risk of recurrence and neoplastic transformation of GHP. Antrum location was a predictor of recurrence. The risk of neoplastic change was increased in large lesions and with intestinal metaplasia and dysplasia in adjacent mucosa. More frequent endoscopic surveillance may be required in these subgroups of GHP.

INTRODUÇÃO E OBJETIVOS: Os pólipos hiperplásicos constituem 30­93% das lesões gástricas epiteliais benignas. Apresentam-se frequentemente como achados endoscópicos incidentais inocuos, no entanto, apresentam risco de recorrência e transformação neoplásica. A frequência e fatores associados à recorrência e transformação neoplásica não estão bem estabelecidos e são áreas de interesse crescente. Este estudo pretende avaliar a frequência e identificar fatores associados à recorrência e transformado maligna dos pólipos gástricos hiperplásicos (PGH). MÉTODOS: Estudo de coorte retrospectivo unicèntrico incluindo consecutivamente doentes com PGH submetidos a ressedo endoscópica entre janeiro de 2009 e junho de 2020. Efetuada análise das características demográficas, endoscópicas e anatomopatológicas através dos registos clínicos eletrónicos. SUMARIOS DOS RESULTADOS: Incluídos 195 doentes género feminino: 56%, idade mediana: 67 (35­87) anos. Os pólipos apresentavam tamanho mediano de 10 (3­50) mm, 61.5% (n = 120) eram sésseis, 61% (n = 119) apresentavam localização antral e 36% (n = 71) tinham lesões síncronas. A frequência de recorrência foi 23% (n = 26). Na análise multivariada, apenas a localização no antro se associou significativamente a recorrência odds ratio (OR): 3.0; intervalo de confiança (IC) 95%: 1.1­8.1). Em 5.1% (n = 10) dos casos verificou-se transformação neoplásica, correspondendo a 5 casos de displasia de baixo grau, 4 casos de displasia de alto grau e 1 caso de carcinoma. Na análise multivariada, dimensão superior a 25 mm (OR: 84; IC95%: 7.4­954), presença de metaplasia (OR: 7.6; IC95%: 1.0­55) e displasia (OR: 86; IC95%: 10­741) na mucosa adjacente associaram-se a transformação neoplásica. A recorrência não se associou a transformação neoplásica (OR: 1.1; IC95%: 0.2­5.9). DISCUSSÃO/CONCLUSÃO: Estes resultados corroboraram os riscos de recorrência e transformado neoplásica associados aos PGH. A localização antral foi preditor de recorrência. O risco de transformado neoplásica foi superior em lesões maiores e coexistência de metaplasia e displasia na mucosa adjacente. Poderá justificar-se uma estratégia de vigilancia mais frequente nestes subgrupos.

Duodenal lymphangiectasias - The first sign of pancreatic adenocarcinoma.

A 41-year-old caucasian female, with past medical history of pituitary adenoma medicated with cabergoline, presented with worsening dyspepsia and unintentional weight loss of 5%. Physical exam and laboratory results were unremarkable for pathological findings. Esophagogastroduodenoscopy revealed an oedematous and exuberant lymphangiectasia appearance in the duodenum, with no ulceration or suspected infiltration component. However, duodenal biopsies revealed infiltration by poorly differentiated carcinoma. In the meantime, infection and inflammatory/autoimmune causes were ruled out. A CT scan was performed revealing a thickened and enlarged pancreas with ill-defined limits and several intra-abdominal adenopathies, raising suspicion of pancreatic lymphoproliferative disease. EUS with FNB was performed with biopsy of the pancreas and one of the larger adenopathy. EUS also revealed an enlarged, non-nodular pancreas and a thickened duodenal wall. Mild ascites was detected. Both EUS-biopsies were concordant on the diagnosis of carcinoma with gastric or pancreatic-biliary origin, highly aggressive (Ki67 > 80 %). Therefore, the diagnosis of pancreatic adenocarcinoma was assumed (cT4N1Mx). The patient is currently on palliative chemotherapy and remains paucisymptomatic.