Recomendaciones para la nomenclatura de compuestos radiomarcados / Recommendations for the nomenclature of radiolabeled compounds

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A Mediterranean Diet Rich in Extra-Virgin Olive Oil Is Associated with a Reduced Prevalence of Nonalcoholic Fatty Liver Disease in Older Individuals at High Cardiovascular Risk.

BACKGROUND: Adherence to a Mediterranean diet (MedDiet) is thought to reduce liver steatosis. OBJECTIVES: To explore the associations with liver steatosis of 3 different diets: a MedDiet + extra-virgin olive oil (EVOO), MedDiet + nuts, or a control diet. METHODS: This was a subgroup analysis nested within a multicenter, randomized, parallel-group clinical trial, PREvención con DIeta MEDiterránea (PREDIMED trial: ISRCTN35739639), aimed at assessing the effect of a MedDiet on the primary prevention of cardiovascular disease. One hundred men and women (mean age: 64 ± 6 y), at high cardiovascular risk (62% with type 2 diabetes) from the Bellvitge-PREDIMED center were randomly assigned to a MedDiet supplemented with EVOO, a MedDiet supplemented with mixed nuts, or a control diet (advice to reduce all dietary fat). No recommendations to lose weight or increase physical activity were given. Main measurements were the percentage of liver fat and the diagnosis of steatosis, which were determined by NMR imaging. The association of diet with liver fat content was analyzed by bivariate analysis after a median follow-up of 3 y. RESULTS: Baseline adiposity and cardiometabolic risk factors were similar among the 3 treatment arms. At 3 y after the intervention hepatic steatosis was present in 3 (8.8%), 12 (33.3%), and 10 (33.3%) of the participants in the MedDiet + EVOO, MedDiet + nuts, and control diet groups, respectively (P = 0.027). Respective mean values of liver fat content were 1.2%, 2.7%, and 4.1% (P = 0.07). A tendency toward significance was observed for the MedDiet + EVOO group compared with the control group. Median values of urinary 12(S)-hydroxyeicosatetraenoic acid/creatinine concentrations were significantly (P = 0.001) lower in the MedDiet + EVOO (2.3 ng/mg) than in the MedDiet + nuts (5.0 ng/mg) and control (3.9 ng/mg) groups. No differences in adiposity or glycemic control changes were seen between groups. CONCLUSIONS: An energy-unrestricted MedDiet supplemented with EVOO, a food with potent antioxidant and anti-inflammatory properties, is associated with a reduced prevalence of hepatic steatosis in older individuals at high cardiovascular risk.

Tratamiento del cáncer diferenciado de tiroides con radioyodo a la luz de las guías y de la literatura científica / Radioiodine treatment of differentiated thyroid cancer related to guidelines and scientific literature

En el cáncer diferenciado de tiroides (CDT), el tratamiento con 131I se administra para eliminar tejido tiroideo residual sano postiroidectomía (tratamiento ablativo), para tratar enfermedad residual microscópica (tratamiento adyuvante) y para tratar enfermedad macroscópica o metastásica. A día de hoy, el tratamiento con 131I del CDT es todavía un tema de controversia debido a la ausencia de ensayos clínicos prospectivos que evalúen su beneficio en cuanto a supervivencia global e intervalo libre de recurrencia. Las recomendaciones actuales de los expertos se basan en datos retrospectivos observacionales y en su interpretación de la literatura. A la espera de los resultados de los ensayos prospectivos actualmente en marcha, la utilización del 131I parece estar justificada no solamente en los pacientes de alto riesgo, sino también en los de riesgo intermedio y bajo. Para la realización del presente documento de formación continuada se han considerado las guías de la Sociedad Americana y Británica de Tiroides, de las Sociedades Europea y Americana de Medicina Nuclear, el consenso del Grupo Europeo y la última edición del National Comprehensive Cancer Network (NCCN), así como se ha revisado la literatura científica relacionada

In differentiated thyroid cancer (DTC), radioiodine is administered to eliminate residual normal thyroid tissue after thyroidectomy (ablative treatment), to treat residual microscopic disease (adjuvant treatment), and to treat macroscopic or metastatic disease. Currently, treatment of DTC with 131I is still a matter of controversy due to the absence of prospective clinical trials assessing its benefit in terms of overall survival and recurrence-free interval. The current recommendations of the experts are based on observational retrospective data and on their interpretation of the literature. Pending the results of the prospective trials that are currently underway, the use of 131I seems to be justified not only in high-risk patients, but also in intermediate-risk and low-risk patients. The guidelines of The American and British Thyroid Association, European and American Societies of Nuclear Medicine, The European Consensus Group and the latest edition of National Comprehensive Cancer Network (NCCN) were considered in drawing up this continuing education document, we also undertook a review of the related scientific literature

Radioiodine treatment of differentiated thyroid cancer related to guidelines and scientific literature. / Tratamiento del cáncer diferenciado de tiroides con radioyodo a la luz de las guías y de la literatura científica.

In differentiated thyroid cancer (DTC), radioiodine is administered to eliminate residual normal thyroid tissue after thyroidectomy (ablative treatment), to treat residual microscopic disease (adjuvant treatment), and to treat macroscopic or metastatic disease. Currently, treatment of DTC with 131I is still a matter of controversy due to the absence of prospective clinical trials assessing its benefit in terms of overall survival and recurrence-free interval. The current recommendations of the experts are based on observational retrospective data and on their interpretation of the literature. Pending the results of the prospective trials that are currently underway, the use of 131I seems to be justified not only in high-risk patients, but also in intermediate-risk and low-risk patients. The guidelines of The American and British Thyroid Association, European and American Societies of Nuclear Medicine, The European Consensus Group and the latest edition of National Comprehensive Cancer Network (NCCN) were considered in drawing up this continuing education document, we also undertook a review of the related scientific literature.

Results of a nationwide survey on multidisciplinary teams on thyroid cancer in Spain.

AIM: There is an important lack of knowledge as to the functioning of multidisciplinary teams on thyroid cancer in current clinical practice. We aimed to retrieve data on the composition, structure, and procedures developed by the multidisciplinary units of thyroid cancer in Spain. METHODS: A nationwide survey consisting of questions about composition, structure, and functioning of multidisciplinary teams was designed. It was available online from November 15, 2017 to February 15, 2018. RESULTS: Seventy-two multidisciplinary units responded to our survey. Of these, 15 (20.8%) focused only in thyroid cancer, while 57 (79.2%) included other endocrine disorders or non-endocrine tumors. The median (interquartile range) of members of the teams was 11 (9-14). The most frequent medical specialties in the units were endocrinology (100%), surgery (94.4%), pathology (80.6%), radiology (75.0%), nuclear medicine (73.6%), and medical oncology (55.6%). The annual number of patients reviewed by the teams was 40 (20-74). 56.9% of the multidisciplinary teams have elaborated clinical protocols for local use. Apart from clinical case discussions in the meetings, 45.8% of the units included educational activities and 36.1% research subjects. Quality indicators were developed by 22% of the teams. CONCLUSIONS: These results suggest that there are some hopeful signs that international recommendations of having multidisciplinary approach to patients with thyroid cancer are being followed in Spain. This gives us the opportunity to proceed with further studies to analyze the real impact of this high standard of care on patient outcomes.

Parámetros de cuantificación metabólica en la práctica clínica. ¿Es el momento de incluirlos en los informes? / Parameters of metabolic quantification in clinical practice. Is it now time to include them in reports?

Las técnicas de valoración cualitativa han sido el estándar tradicional de valoración diagnóstica en los estudios PET con 18F-FDG. Desde los inicios de la técnica se han buscado parámetros cuantitativos, más exactos y con mejor precisión diagnóstica, que puedan ofrecer información relevante en cuanto al comportamiento, agresividad o pronóstico de los tumores. Cada vez hay más estudios con evidencia de alta calidad sobre la utilidad de diferentes parámetros metabólicos distintos al SUV máximo, cuyo uso es controvertido, a pesar de ser ampliamente utilizado en la práctica clínica, y del que muchos médicos desconocen todavía su significado real. El objetivo de este trabajo ha sido revisar los conceptos clave de estos parámetros metabólicos que pueden ser relevantes en la práctica habitual durante los próximos años. Se ha visto que existe mayor evidencia en la valoración del metabolismo de una lesión de forma completa a través de parámetros volumétricos que reflejan de forma más adecuada la carga tumoral que presenta un paciente. Básicamente, estos parámetros calculan el volumen de tumor que cumple unas características determinadas. Para ello se ha utilizado un software, disponible en la mayor parte de las estaciones de trabajo y procesado de estudios PET, que ha permitido calcular estos volúmenes utilizando criterios más o menos complejos. Los métodos de segmentación más simples, basados en umbrales, están disponibles en la mayor parte de los equipos, son fáciles de calcular y han demostrado en muchos trabajos tener un importante significado pronóstico

Qualitative techniques have traditionally been the standard for the diagnostic assessment with 18F-FDG PET studies. Since the introduction of the technique, quantitative parameters have been sought, more accurate and with better diagnostic precision, that may offer relevant information of the behavior, aggressiveness or prognosis of tumors. Nowadays, more and more studies with high quality evidence show the utility of other metabolic parameters different from the SUV maximum, which despite being widely used in clinical practice is controversial and many physicians still do not know its real meaning. The objective of this paper has been to review the key concepts of these metabolic parameters that could be relevant in normal practice in the future. It has been seen that there is more evidence in the complete evaluation of the metabolism of a lesion, through volumetric parameters that more adequately reflect the patient's tumor burden. Basically, these parameters calculate the volume of tumor that fulfills certain characteristics. A software available in the majority of the workstations has been used for this purpose and it has allowed to calculate these volumes using more or less complex criteria. The simplest threshold-based segmentation methods are available in most equipments, they are easy to calculate and they have been shown in many studies to have an important prognostic significance

Parameters of metabolic quantification in clinical practice. Is it now time to include them in reports? / Parámetros de cuantificación metabólica en la práctica clínica. ¿Es el momento de incluirlos en los informes?

Qualitative techniques have traditionally been the standard for the diagnostic assessment with 18F-FDG PET studies. Since the introduction of the technique, quantitative parameters have been sought, more accurate and with better diagnostic precision, that may offer relevant information of the behavior, aggressiveness or prognosis of tumors. Nowadays, more and more studies with high quality evidence show the utility of other metabolic parameters different from the SUV maximum, which despite being widely used in clinical practice is controversial and many physicians still do not know its real meaning. The objective of this paper has been to review the key concepts of these metabolic parameters that could be relevant in normal practice in the future. It has been seen that there is more evidence in the complete evaluation of the metabolism of a lesion, through volumetric parameters that more adequately reflect the patient's tumor burden. Basically, these parameters calculate the volume of tumor that fulfills certain characteristics. A software available in the majority of the workstations has been used for this purpose and it has allowed to calculate these volumes using more or less complex criteria. The simplest threshold-based segmentation methods are available in most equipments, they are easy to calculate and they have been shown in many studies to have an important prognostic significance.

A Mediterranean diet supplemented with extra virgin olive oil or nuts improves endothelial markers involved in blood pressure control in hypertensive women.

PURPOSE: Serum nitric oxide (NO) reduction and increased endothelin-1 (ET-1) play a pivotal role in endothelial dysfunction and hypertension. Considering that traditional Mediterranean diet (TMD) reduces blood pressure (BP), the aim of this study was to analyze whether TMD induced changes on endothelial physiology elements such as NO, ET-1 and ET-1 receptors which are involved in BP control. METHODS: Non-smoking women with moderate hypertension were submitted for 1 year to interventions promoting adherence to the TMD, one supplemented with extra virgin olive oil (EVOO) and the other with nuts versus a control low-fat diet (30 participants/group). BP, NO, ET-1 and related gene expression as well as oxidative stress biomarkers were measured. RESULTS: Serum NO and systolic BP (SBP) or diastolic BP (DBP) were negatively associated at baseline, as well as between NO and ET-1. Our findings also showed a DBP reduction with both interventions. A negative correlation was observed between changes in NO metabolites concentration and SBP or DBP after the intervention with TMD + EVOO (p = 0.033 and p = 0.044, respectively). SBP reduction was related to an impairment of serum ET-1 concentrations after the intervention with TMD + nuts (p = 0.008). We also observed changes in eNOS, caveolin 2 and ET-1 receptors gene expression which are related to NO metabolites levels and BP. CONCLUSIONS: The changes in NO and ET-1 as well as ET-1 receptors gene expression explain, at least partially, the effect of EVOO or nuts on lowering BP among hypertensive women.

El nomenclátor y unidades relativas de valor como herramientas de gestión / The nomenclature and the relative value units as a management tools

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Neuroimagen funcional en el diagnóstico de pacientes con síndrome parkinsoniano: actualización y recomendaciones para el uso clínico / Functional neuroimaging in the diagnosis of patients with Parkinsonism: Update and recommendations for clinical use

Las técnicas de neuroimagen funcional se han utilizado tradicionalmente en la investigación de los pacientes que presentan un síndrome parkinsoniano. Sin embargo, la aparición de radiofármacos comerciales junto a la disponibilidad de equipos de tomografía por emisión de fotón único (SPECT) y más recientemente de la tomografía por emisión de positrones (PET), han permitido su empleo rutinario en la práctica clínica. Precisamente el desarrollo y grado de evidencia clínica alcanzado por los biomarcadores de neuroimagen durante las 2 últimas décadas ha conllevado que progresivamente se estén incluyendo en los criterios clínicos de diagnóstico de enfermedades neurodegenerativas que cursan con un síndrome parkinsoniano. No obstante, la diversidad de radiofármacos que permiten evaluar la funcionalidad de las vías anatómicas involucradas en la neurodegeneración presente en los diferentes síndromes parkinsonianos (vía nigroestriatal dopaminérgica, actividad neuronal de los ganglios basales y la corteza, inervación simpática miocárdica), junto a las técnicas de neuroimagen (gammagrafía, SPECT y PET) han originado cierta controversia con respecto a la indicación de las pruebas de neuroimagen como exploración complementaria. En esta revisión realizada por un panel de expertos en medicina nuclear y neurología se analizan las técnicas de neuroimagen funcional disponibles haciendo especial énfasis en las consideraciones prácticas del diagnóstico de pacientes con un síndrome parkinsoniano de origen incierto y la valoración de la progresión de la enfermedad de Parkinson (AU)

Functional Neuroimaging has been traditionally used in research for patients with different Parkinsonian syndromes. However, the emergence of commercial radiotracers together with the availability of single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET) have made them available for clinical practice. Particularly, the development of clinical evidence achieved by functional neuroimaging techniques over the past two decades have motivated a progressive inclusion of several biomarkers in the clinical diagnostic criteria for neurodegenerative diseases that occur with Parkinsonism. However, the wide range of radiotracers designed to assess the involvement of different pathways in the neurodegenerative process underlying Parkinsonian syndromes (dopaminergic nigrostriatal pathway integrity, basal ganglia and cortical neuronal activity, myocardial sympathetic innervation), and the different neuroimaging techniques currently available (scintigraphy, SPECT and PET), have generated some controversy concerning the best neuroimaging test that should be indicated for the differential diagnosis of Parkinsonism. In this article, a panel of nuclear medicine and neurology experts has evaluated the functional neuroimaging techniques emphazising practical considerations related to the diagnosis of patients with uncertain origin parkinsonism and the assessment Parkinson’s disease progression (AU)

[Functional neuroimaging in the diagnosis of patients with Parkinsonism: Update and recommendations for clinical use]. / Neuroimagen funcional en el diagnóstico de pacientes con síndrome parkinsoniano: actualización y recomendaciones para el uso clínico.

Functional Neuroimaging has been traditionally used in research for patients with different Parkinsonian syndromes. However, the emergence of commercial radiotracers together with the availability of single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET) have made them available for clinical practice. Particularly, the development of clinical evidence achieved by functional neuroimaging techniques over the past two decades have motivated a progressive inclusion of several biomarkers in the clinical diagnostic criteria for neurodegenerative diseases that occur with Parkinsonism. However, the wide range of radiotracers designed to assess the involvement of different pathways in the neurodegenerative process underlying Parkinsonian syndromes (dopaminergic nigrostriatal pathway integrity, basal ganglia and cortical neuronal activity, myocardial sympathetic innervation), and the different neuroimaging techniques currently available (scintigraphy, SPECT and PET), have generated some controversy concerning the best neuroimaging test that should be indicated for the differential diagnosis of Parkinsonism. In this article, a panel of nuclear medicine and neurology experts has evaluated the functional neuroimaging techniques emphazising practical considerations related to the diagnosis of patients with uncertain origin parkinsonism and the assessment Parkinson's disease progression.

The effects of polyphenols on oxidative stress and the arachidonic acid cascade. Implications for the prevention/treatment of high prevalence diseases.

Redox state unbalance and the activation of the arachidonic acid (AA) cascade, contribute to the pathogenesis of cardiovascular disease (CVD) and cancer. Inflammatory cells that infiltrate the atheroma plaque or tumor are a major source of reactive oxygen species and eicosanoids. The human antioxidant defense network is complex and interlocking and there is controversy surrounding the beneficial effects of diet-derived antioxidants in vivo. However, epidemiological studies indicate that populations that consume high levels of plant-derived foods containing phenolic compounds have low rates of CVD and cancer. The molecular mechanisms for these effects are multi-faceted. They include the regulation of transcription factors and consequently the modulation of genes (cytokines, growth factors and adhesion molecules), and growth factor-receptor interactions and cell signaling cascades, which determine the expression of genes involved in cell cycle, cell survival and apoptosis, as well as adhesiveness/invasiveness and angiogenesis. The present paper also focuses on the effects of phenolic compounds on AA cascade enzymes (cyclooxygenases and lipoxygenases) and the subsequent synthesis of eicosanoids, which are involved in CVD and cancer. A better understanding of these processes could explain the beneficial effects of polyphenols on the most prevalent diseases in Western societies. This commentary shows that antioxidants under evaluation include structural modifications of low-molecular-mass polyphenols, which could lead to a valuable strategy for modulating the generation of inflammatory mediators involved in these chronic diseases.

Role of oxidative stress and adenosine nucleotides in the liver of aging rats.

We studied the response of several parameters related to oxidative stress in the liver of aging rats. Male Wistar rats aged 1.5, 3, 18 and 24 months were used. Livers showed an increase in superoxide anion (O(2)(-)) concentration at 1.5 and 18 months of age compared to the 3-month-old group; a decrease in superoxide dismutase (SOD) was seen at 1.5 months and catalase concentrations remained unaltered throughout the aging process. Nitric oxide (NO) progressively declined with age; a significant decrease was particularly apparent at 18 and 24 months of age. Thiobarbituric acid reactive substances (TBARS) decreased significantly at 1.5 months, whereas it increased at 18 and 24 months of age. Concentrations of prostaglandin E(2) (PGE(2)), and adenine nucleotides, and their metabolites, remained unchanged throughout the aging process. Although the mitochondrial damage caused by oxidative stress can result in reduced ATP production and compromised cell function, our results on adenosine nucleotides and their metabolites support the notion that the integrity of mitochondria and enzymatic activity remain mostly unchanged with aging. In conclusion, we observed a significant decrease in the levels of NO in the older groups of rats and hence in its antioxidant activity. This could explain the observed increase in lipid peroxides which suggests an important role for NO in oxidative stress in the liver of older rats.

Line and birth season effects on plasma testosterone and oxidative stress parameters in testis of maturing rabbits.

Oxidative stress plays a key role in the male reproductive function. Differences between rabbit breeds have been found for testis size, seminiferous tubule diameter, number and size of interstitial and germ cells, etc. Traits related to the redox system could also be affected by genetic factors. It is likely that differences between breeds for these traits would lead to differences in reproductive maturation and fertility. We have investigated in the present paper the age-related changes of the plasma testosterone (TST) concentration, superoxide anion (O(2)(-)) radical formation, superoxide dismutase (SOD) activity, catalase (CAT) activity and thiobarbituric acid-reactive substances (TBARs) level in testis of rabbits in two breeds selected for different aptitudes (Caldes for growth rate and Prat for litter size). The effect of birth season for these traits was also assessed. Major changes in parameters related to oxidative stress were observed at an early age and most probably can be explained by the concomitant changes in testicular structure and function. Both lines showed similar developmental profiles and levels for all the variables studied. There was no interaction between line and birth season, consequently environmental conditions affected both lines in the same manner. Significant differences between males born in different seasons were found for O(2)(-) (4.84+/-0.19RLU/mg tissuemin versus 5.67+/-0.19RLU/mg tissuemin), SOD (6.12+/-0.11U/mg protein versus 7.09+/-0.11U/mg protein) and CAT (0.058+/-0.002K/mg protein versus 0.040+/-0.002K/mg protein). Future studies should take into account differences between seasons for a more precise analysis.

A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain.

BACKGROUND/OBJECTIVES: The aim of this study was to analyze the influence of a Mediterranean dietary pattern on plasma total antioxidant capacity (TAC) after 3 years of intervention and the associations with adiposity indexes in a randomized dietary trial (PREDIMED trial) with high cardiovascular risk patients. SUBJECTS/METHODS: 187 subjects were randomly selected from the PREDIMED-UNAV center after they completed 3-year intervention program. Participants were following a Mediterranean-style diet with high intake of virgin olive oil or high intake of nuts, or a conventional low-fat diet. Adiposity indexes were measured at baseline and at year 3. Plasma TAC was evaluated using a commercially available colorimetric assay kit. RESULTS: Plasma TAC in the control, olive oil and nuts groups was 2.01+/-0.15, 3.51+/-0.14 and 3.02+/-0.14 mM Trolox, respectively after adjusting for age and sex. The differences between the Mediterranean diet and control groups were statistically significant (P<0.001). Moreover higher levels of TAC were significantly associated with a reduction in body weight after 3 years of intervention among subjects allocated to the virgin olive oil group (B=-1.306; 95% CI=-2.439 to -0.173; P=0.025, after adjusting for age, sex and baseline body mass index). CONCLUSIONS: Mediterranean diet, especially rich in virgin olive oil, is associated with higher levels of plasma antioxidant capacity. Plasma TAC is related to a reduction in body weight after 3 years of intervention in a high cardiovascular risk population with a Mediterranean-style diet rich in virgin olive oil.