Influencia de los congresos en la difusión de la especialidad. #CirugíaPlástica por redes sociales / Influence of meetings on dissemination of the specialty. #PlasticSurgery in social media

INTRODUCCIÓN Y OBJETIVO: La utilidad de las redes sociales como medio de difusión de la Cirugía Plástica, y específicamente en cuestiones académicas, es un área en desarrollo. Estudios recientes han demostrado el uso de la etiqueta (hashtag) #CirugiaPlastica. Sin embargo, no se ha estudiado la influencia de los congresos nacionales e internacionales en la difusión del conocimiento a través de las redes sociales, tema que nos proponemos estudiar en el presente artículo. MATERIAL Y MÉTODO: Realizamos un análisis retrospectivo de los tuits publicados en español con las palabras "CirugiaPlastica" o la etiqueta #CirugiaPlastica, comparando 5 grupos en relación a los congresos más importantes de la especialidad en español: 1. Grupo control días laborables (no coincidente con congresos de Cirugía Plástica); 2. Grupo control fin de semana (no coincidente con congresos de Cirugía Plástica); 3. Grupo Congreso Iberolatinoamericano; 4. Grupo Jornada Monográfica SECPRE (Sociedad Española de Cirugía Plástica, Reparadora y Estética); 5. Grupo Congreso AECEP (Asociación Española de Cirugía Estética Plástica). Analizamos, entre otras, las siguientes variables: identidad del autor, tema del tuit, uso de la etiqueta #CirugiaPlastica, finalidad educativa o promocional y disponibilidad de enlace a un artículo científico. RESULTADOS: Revisamos 1165 tuits. Los realizados por cirujanos plásticos, instituciones académicas y sociedades científicas supusieron un 13.44% en los grupos control frente a un 18.52% en los grupos congreso (p-valor = 0.02). La presencia de un congreso nacional o internacional no aumentó de manera significativa el número de tuits educacionales, ni el número de enlaces a artículos científicos (p-valor > 0.05). CONCLUSIONES: En el ámbito de la Cirugía Plástica, los congresos analizados no han demostrado una repercusión estadísticamente significativa en el contenido educacional de los tuits. Las redes sociales deberían ser potenciadas durante estos congresos para aumentar la difusión y conocimiento de nuestra especialidad

BACKGROUND AND OBJECTIVE: The use of social media to spread knowledge about Plastic Surgery, especially regarding academic issues, is still in its infancy. Recent studies have shown that the hashtag #PlasticSurgery has been used to spread knowledge and leadership in our specialty. However, the influence of national and international meetings in this regard has not been studied, a topic that we propose to study in this article. METHODS: A retrospective analysis of tweets published in Spanish containing the words "CirugiaPlastica" or the hashtag #CirugiaPlastica was performed, comparing 5 groups: 1. Working days control group (non-coincident with Plastic Surgery meetings); 2. Weekend control group (non-coincident with Plastic Surgery meetings); 3. Iberolatinoamericano Meeting Group; 4. SECPRE (Spanish Plastic, Reconstructive and Aesthetic Surgery Association) Monographic Meeting Group; 5. AECEP (Spanish Aesthetic Plastic Surgery Association) meeting group. The following variables were analyzed, among several others: author identity, tweet topic, hashtag #CirugiaPlastica use, educative or promotional finality and the availability of the digital link to a journal article. RESULTS: A total of 1165 tweets were analyzed. Tweets written by plastic surgeons, academic institutions and scientific societies were 13.44% in the control groups compared to 18.52% in the meeting groups (p-value = 0.02). The presence of a national or international meeting did not increase significantly the number of educational tweets nor the links to scientific articles (p-value > 0.05). CONCLUSIONS: Analyzed meetings did not show a statistically significant repercussion on the educational content of tweets. Social media should be encouraged during these meetings to spread knowledge and to increase the repercussion of our specialty

Análisis del riesgo de sufrir trastornos alimentarios en jóvenes universitarios de Extremadura (España) / Analysis of the risk of suffering eating disorders in young student university of Extremadura (Spain)

Los Trastornos de la Alimentación (TA), la Anorexia Nerviosa (AN), Bulimia nerviosa (BN) y trastorno por atracón son trastornos de gran preocupación en el mundo occidental. Sus tendencias crecientes han llevado a los investigadores a tratar de explicar los factores implicados, sus causas y sus efectos, como una forma de contribuir a los esfuerzos para detener las tendencias de crecimiento.Nuestro proyecto de investigación se centra en el estudio del riesgo de padecer TA entre una muestra de 600 estudiantes de la Universidad de Extremadura (España). Dichos estudiantes están matriculados en doce de los grados ofertados por dicha Universidad.Los instrumentos de evaluación utilizados para los fines de esta investigación están el inventario-3 trastorno del RF (RF de EDI-3) y el cuestionario en español, IMAGEN (evaluación de la insatisfacción con la imagen corporal).Los resultados más significativos demuestran la existencia de un alto porcentaje de estudiantes en riesgo de sufrir TA. En las jóvenes alumnas se evidencia mayores tasas de insatisfacción corporal y de delgadez que sus compañeros masculinos que, por el contrario, demuestran más características de bulimia. Además quienes estudian grados de educación presentan tasas más altas de los factores de riesgo para sufrir tales como TC, la unidad de la delgadez y la insatisfacción de su propio cuerpo, en la situación opuesta se encuentran los grados de ciencias de la salud en particular los estudiantes de enfermería, probablemente como consecuencia de un mayor conocimiento biosanitario

Eating disorders (ED), anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder are disorders of great concern in western world countries. Their rising tendencies have led researchers to try to explain the factors involved, their causes, and their effects, as a way of contributing to the efforts to stop the growing trends. Our research project focuses on the study of the risk of suffering ED amongst a sample of 600 students from the University of Extremadura (Spain). Said students are enrolled in twelve of the degrees offered by the University. The assessment tools used for the purposes of this research are the Eating Disorder Inventory-3 RF (EDI-3 RF) and the Spanish questionnaire, IMAGEN (Evaluation of Dissatisfaction with Body Image). The most significant results show the existence of a high percentage of students at risk of suffering ED. Young female students evidence higher rates of body dissatisfaction and drive for thinness than their male classmates who, conversely, demonstrate more characteristics of bulimia. Those studying education present higher rates of risk factors for suffering ED, such as the drive for thinness and their own body dissatisfaction, in the opposite situation are the health degrees in particular the nursing students, as a result of a greater bio health knowledge caused

Resultados de un programa educativo con refuerzo audiovisual durante la sesión, en pacientes en hemodiálisis / Results of an educational program with audio-visual reinforcement during the session in hemodialysis patients

Los medios audiovisuales son imprescindibles para reforzar la información del paciente. El objetivo del trabajo es describir la utilidad del uso de presentaciones educativas para los pacientes en hemodiálisis y los medios audiovisuales disponibles en la unidad. Se elaboraron tres presentaciones educativas en Microsoft Office Power Point y se pasaron una serie de cuestionarios con 13 preguntas que hacían referencia a aspectos fundamentales del cuidado tratados en las presentaciones, antes y después de éstas. Se realizó un análisis estadístico descriptivo con la distribución de frecuencias y porcentajes de las variables categóricas y con la media y la desviación típica de las variables cuantitativas. Para comprobar los resultados de las respuestas antes y después de las presentaciones/micropíldoras se ha utilizado la prueba de McNemar para dos muestras relacionadas con un nivel de significación estadística de p<0,05. El estudio consta de 45 pacientes, 73,3% varones con una edad media de 63,82 años. Se encontraron resultados estadísticamente significativos con p=0,031 y p=0,004, referentes a cuestiones sobre la desinfección de la fístula y el aporte proteico. El presente estudio ha servido para demostrar que la herramienta ha abierto nuevas posibilidades de formación a los pacientes (AU)

Audiovisual media are essential to reinforce patient information. The objective of this study is to describe the usefulness of educational presentations for hemodialysis patients and available audiovisual media in the unit. Three educational presentations were developed in Microsoft Office Power Point and questionnaires were used with 13 questions regarding fundamental aspects of care approached in the presentations, before and after these presentations. A descriptive statistical analysis was performed with the distribution of frequencies and percentages of the categorical variables and with the mean and standard deviation of the quantitative variables. To test the results of the responses before and after the presentations, the McNemar’s test was used for two related samples, with a statistical significance level of p<0.05. The study included 45 patients, 73.3% males with a mean age of 63.82 years. Statistically significant results were found with p=0.031 and p=0.004, concerning questions about fistula disinfection and protein intake (AU)

Split-dose sodium picosulfate-magnesium citrate colonoscopy preparation achieves lower residual gastric volume with higher cleansing effectiveness than a previous-day regimen.

BACKGROUND AND AIMS: It is known that sodium picosulfate-magnesium citrate (SPMC) bowel preparations are effective, well tolerated and safe, and that split-dosing is more effective for colon cleansing than previous-day regimens. Anesthetic guidelines consider that residual gastric fluid is independent of clear liquid fasting times. However, reluctance to use split-dosing persists. This may be due to limited data on residual gastric fluid volumes (RGFVs) and split-dosing bowel preparations, and that these may not be perceived as standard clear liquids. Furthermore, no studies are available on RGFV/residual gastric fluid pH (RGFpH) and SPMC. We aimed to evaluate the cleansing effectiveness and the RGFV/RGFpH achieved after an SPMC split-dosing regimen compared with a SPMC previous-day regimen. METHODS: This was a single-center observational study. A total of 328 outpatients scheduled for simultaneous EGD and colonoscopy and following a split-dosing or previous-day regimen of SPMC were included. We prospectively measured colon cleanliness by using the Ottawa Bowel Preparation Scale, RGFV, and RGFpH. RESULTS: Ottawa Bowel Preparation Scale scores for overall, right, mid-colon, and colon fluid were significantly better in the split-dosing group. In the split-dosing group, the 3- to 4-hour fasting time consistently achieved the best cleansing quality. RGFV was significantly lower in the split-dosing group (11.09 vs 18.62, P < .001). No significant differences in RGFpH were detected. CONCLUSIONS: Split-dosing SPMC provides higher colon cleansing quality with lower RGFVs than previous-day SPMC regimens. SPMC in split-dosing acts exactly as a standard clear liquid acts, and thus anesthetic guidelines on this issue may be applied with no concerns.

Spinal cord toxoplasmosis in human immunodeficiency virus infection/acquired immunodeficiency syndrome.

Neurological complications in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) are still common, even in the era of highly active antiretroviral therapy. Opportunistic infections, immune reconstitution, the virus itself, antiretroviral drugs and neurocognitive disorders have to be considered when establishing the differential diagnosis. Toxoplasmic encephalitis remains the major cause of space-occupying lesions in the brain of patients with HIV/AIDS; however, spinal cord involvement has been reported infrequently. Here, we review spinal cord toxoplasmosis in HIV infection and illustrate the condition with a recent case from our hospital. We suggest that most patients with HIV/AIDS and myelitis with enhanced spine lesions, multiple brain lesions and positive serology for Toxoplasma gondii should receive immediate empirical treatment for toxoplasmosis, and a biopsy should be performed in those cases without clinical improvement or with deterioration.

Amino acid deprivation decreases intracellular levels of reactive oxygen species in hepatic stellate cells.

In eukaryotic cells amino acid deprivation triggers a response aimed to ensure cell survival in stress conditions. In the present work we analyzed the effects of amino acid deprivation on intracellular levels of reactive oxygen species (ROS) of hepatic stellate cells (HSC), a key cell type in the development of liver fibrosis. Histidine deprivation caused in the human immortalized HSC cell line LX-2 a fast decrease of intracellular ROS levels that was also observed in HSC incubated either with leucine-free or amino acid-free medium, but not with glucose-free medium. Phosphorylation of GCN2 kinase and its substrate eIF2alpha was induced by histidine deprivation. Reversion studies and activation of GCN2 by tRNA and the proteasome inhibitor MG-132 showed a correlation between GCN2 phosphorylation and diminished ROS levels. However, a lack of correlation between eIF2alpha phosphorylation and ROS levels was found using salubrinal, an inhibitor of eIF2alpha phosphorylation, suggesting a role for GCN2 unrelated to its activity as eIF2alpha kinase. LX-2 cells treated with histidine-free medium presented reduced SOD activity that could account for the decrease on ROS levels. Histidine deprivation as well as activation of GCN2 by treatment with tRNA, caused an increase in LX-2 cell viability, suggesting amino acid restriction to present a protective effect in HSC which is mediated by GCN2 activation.

Safety and efficacy assessment of flow redistribution by occlusion of intrahepatic vessels prior to radioembolization in the treatment of liver tumors.

We evaluated the feasibility, safety, and efficacy of radioembolization (administered from one or two vascular points) after the redistribution of arterial blood flow in the liver in patients with hepatic neoplasms and arterial anatomic peculiarities (AAP). Twenty-four patients with liver neoplasms and AAP (graded according to Michel's classification) were included in the study. During pretreatment angiographic planning, all extrahepatic vessels that could feed the tumor were embolized and the intrahepatic vessels occluded in order to redistribute blood flow. The distribution of microspheres was initially assessed by using technetium-99m-labeled macroaggregated albumin ((99m)Tc-MAA) from one of two vascular points before the administration of yttrium-90 ((90)Y)-radiolabeled resin microspheres. Perfusion of lesions situated in the redistributed segments (L-RS) and nonredistributed segments (L-NRS) were compared by assessing the distribution of (99m)Tc-MAA by SPECT/CT. Perfusion was graded as normal, reduced, or absent. (90)Y resin microspheres were then injected from the same arterial sites as (99m)Tc-MAA and the tumor response recorded 3 months later. The tumor response in L-RS was compared with that in L-NRS and graded as better, similar, or worse. Among 11 patients with type I AAP in whom mainly vessels in segments I-III or IV were occluded, perfusion of L-RS was graded as similar (n = 7) or reduced (n = 4). Among the remaining 13 patients with AAP types III (n = 3), V (n = 4), VIII (n = 3), and others (n = 3) in which aberrant arteries were occluded, perfusion of L-RS was graded as similar (n = 9), reduced (n = 3), or absent (n = 1). Overall, (99m)Tc-MAA was present in the L-RS of 95.8% patients and the distribution of (99m)Tc-MAA in L-RS and L-NRS were graded as similar in 66.6% of patients. Compared with lesions in the L-NRS, tumor response in L-RS was similar in 23 cases and worse in 1 case. No complications were recorded after the administration of (90)Y resin microspheres. Redistribution of flow in L-RS is feasible and enables a safe and effective delivery of (90)Y resin microspheres that are able to be distributed via intrahepatic collaterals and access the microvasculature of L-RS.

Epithelial to mesenchymal transition is impaired in colon cancer cells with microsatellite instability.

BACKGROUND & AIMS: Colorectal cancers (CRCs) displaying DNA microsatellite instability (MSI) are associated with a favorable natural history, but the molecular basis for this observation has not been defined. We sought to determine whether the epithelial to mesenchymal transition (EMT) is impaired in MSI-positive CRCs that characteristically have a mutant transforming growth factor-beta receptor type II (TGFBR2) gene. METHODS: The induction of EMT by transforming growth factor-beta1 (TGF-beta1) was analyzed by phase contrast microscopy, immunofluorescence, quantitative reverse transcription polymerase chain reaction, immunoblotting, and cellular migration, and invasion assays. Expression of EMT markers was evaluated by immunohistochemistry and quantitative reverse transcription polymerase chain reaction in a series of human colorectal tumors. RESULTS: TGF-beta1 induced changes in cellular morphology, gene expression, motility, and invasion consistent with EMT in microsatellite stable (MSS) colon cancer cells, whereas cells with MSI and mutant TGFBR2 were unresponsive to TGF-beta1. These effects did not require Smad4, but depended on the recruitment of extracellular signal-regulated kinase. Tumor cells with MSI but wild-type TGFBR2 underwent EMT in response to TGF-beta1, indicating that TGFBR2 genotype is a key determinant of the EMT response in tumors with MSI. In human colorectal tumors, expression of EMT markers was significantly associated with adverse clinicopathologic features and the absence of MSI. CONCLUSIONS: These findings define a unique genotype-phenotype relationship between TGFBR2 and EMT that may contribute to the improved prognosis consistently observed in colon cancers with MSI.

Computed tomographic appearance of chest ports and catheters: a pictorial review for noninterventional radiologists.

Medical practice has expanded the need for long-term central venous catheterization. Chest ports play an important role in the management of oncology patients who need frequent blood products, chemotherapy, and other intravenous drugs. Imaging-guided placement of chest ports and catheters (CR) is a safe and efficacious procedure. Moreover, many cases of catheter-induced central thrombosis go unrecognized, but the incidence of pulmonary embolism in this group may be as high as 12%. Multi-detector computed tomography represents the main imaging method in the follow-up of oncologic patients. We review the radiologic features, mainly on multi-detector computed tomography, of CR commonly used for chemotherapy administration and describe the radiological findings of the complications associated with these devices. Examples of complications include the following: pneumothorax, inversion of the reservoir and malpositioned catheter, great vessel perforation, fibrin sheath formation and catheter-related venous thrombosis, infection, Pinch-off syndrome, and extravasation. When interpreting computed tomography (CT) in oncologic patients, radiologists should be familiar with CR and comment on catheter's position, and the presence or absence of complications. General radiologists should keep in mind the medical history of the patient with regards to the CR and the specific CT findings when they read radiological studies in oncologic patients. Appropriate window values and multi-plane CT reconstructions are useful in the diagnosis of CR-related complications.

HIF-1alpha and HIF-2alpha have divergent roles in colon cancer.

Hypoxia-inducible factor (HIF)-1 and HIF-2 are heterodimeric transcription factors that mediate the cellular response to hypoxia. Their key regulatory subunits, HIF-1alpha and HIF-2alpha, are induced similarly by hypoxia, but their functional roles in cancer may be distinct and isoform-specific. SW480 colon cancer cells with stable expression of siRNA to HIF-1alpha or HIF-2alpha or both were established. HIF-1alpha-deficient cells displayed lower rates of proliferation and migration, but HIF-2alpha-deficient cells exhibited enhanced anchorage independent growth in a soft agar assay. Xenograft studies revealed that HIF-1alpha deficiency inhibited overall tumor growth, whereas deficiency of HIF-2alpha stimulated tumor growth. In human colon cancer tissues, expression of HIF-1alpha and to a lesser extent, HIF-2alpha, was linked to upregulation of VEGF and tumor angiogenesis. However, loss of expression of HIF-2alpha but not HIF-1alpha was strongly correlated with advanced tumor stage. DNA microarray analysis identified distinct sets of HIF-1alpha and HIF-2alpha target genes that may explain these phenotypic differences. Collectively, these findings suggest that HIF isoforms may have differing cellular functions in colon cancer. In particular, HIF-1alpha promoted the growth of SW480 colon cancer cells but HIF-2alpha appeared to restrain growth. Consequently, therapeutic approaches that target HIF may need to consider these isoform-specific properties.

Quantification of left ventricular function and mass in cardiac Dual-Source CT (DSCT) exams: comparison of manual and semiautomatic segmentation algorithms.

The purpose of our study was to evaluate reliability of left ventricular (LV) function and mass quantification in cardiac DSCT exams comparing manual contour tracing and a region-growing-based semiautomatic segmentation analysis software. Thirty-three consecutive patients who underwent cardiac DSCT exams were included. Axial 1-mm slices were used for the semiautomated technique, and short-axis 8-mm slice thickness multiphase image reconstructions were the basis for manual contour tracing. Left ventricular volumes, ejection fraction and myocardial mass were assessed by both segmentation methods. Length of time needed for both techniques was also recorded. Left ventricular functional parameters derived from semiautomatic contour detection algorithm were not statistically different from manual tracing and showed an excellent correlation (p<0.001). The semiautomatic contour detection algorithm overestimated LV mass (180.30+/-44.74 g) compared with manual contour tracing (156.07+/-46.29 g) (p<0.001). This software allowed a significant reduction of the time needed for global LV assessment (mean 174.16+/-71.53 s, p<0.001). Objective quantification of LV function using the evaluated region-growing-based semiautomatic segmentation analysis software is feasible, accurate, reliable and time-effective. However, further improvements are needed to equal results achieved by manual contour tracing, especially with regard to LV mass quantification.

Reactive oxygen species (ROS) mediate the effects of leucine on translation regulation and type I collagen production in hepatic stellate cells.

The amino acid leucine causes an increase of collagen alpha1(I) synthesis in hepatic stellate cells through the activation of translational regulatory mechanisms and PI3K/Akt/mTOR and ERK signaling pathways. The aim of the present study was to evaluate the role played by reactive oxygen species on these effects. Intracellular reactive oxygen species levels were increased in hepatic stellate cells incubated with leucine 5 mM at early time points, and this effect was abolished by pretreatment with the antioxidant glutathione. Preincubation with glutathione also prevented 4E-BP1, eIF4E and Mnk-1 phosphorylation induced by leucine, as well as enhancement of procollagen alpha1(I) protein levels. Inhibitors for MEK-1 (PD98059), PI3K (wortmannin) or mTOR (rapamycin) did not affect leucine-induced reactive oxygen species production. However, preincubation with glutathione prevented ERK, Akt and mTOR phosphorylation caused by treatment with leucine. The mitochondrial electron chain inhibitor rotenone and the NADPH oxidase inhibitor apocynin prevented reactive oxygen species production caused by leucine. Leucine also induced an increased phosphorylation of IR/IGF-R that was abolished by pretreatment with either rotenone or apocynin. Therefore, leucine exerts on hepatic stellate cells a prooxidant action through NADPH oxidase and mitochondrial Reactive oxygen species production and these effects mediate the activation of IR/IGF-IR and signaling pathways, finally leading to changes in translational regulation of collagen synthesis.

Leucine stimulates procollagen alpha1(I) translation on hepatic stellate cells through ERK and PI3K/Akt/mTOR activation.

The essential amino acid leucine has been described to specifically activate signaling pathways leading to the activation of the translational machinery and the increase of total protein synthesis. Regulation of type I collagen production by hepatic stellate cells (HSC) is a multistep process involving transcriptional and post-transcriptional mechanisms. In the present work we studied the effect of leucine on translation regulation of collagen alpha1(I) production in HSC and the signaling pathways involved. Treatment of HSC with 5 mM leucine did not alter half-life or steady state levels of procollagen alpha1(I) mRNA, but caused an increase in procollagen alpha1(I) protein that correlated with changes of components involved in translational regulation, like enhanced 4E-BP1, Mnk-1, and eIF4E phosphorylation. Leucine also induced mTOR, ERK, and Akt phosphorylation in HSC, without affecting p38 and JNK activation. Pre-treatment of HSC with PD098059, wortmannin, or rapamycin prevented the profibrogenic action of leucine due to the inhibition of different molecular mechanisms. These results suggest leucine is a profibrogenic agent for HSC, activating signaling pathways that lead to an enhancement of collagen alpha1(I) production through translational regulation.