Predictive model of resection in endoscopic endonasal approach for pituitary adenomas based on anatomical limits / Modelo predictivo de resección en abordaje endoscópico endonasal de adenomas hipofisarios basado en límites anatómicos

Introduction The aim of this project is to study several anatomical-radiological features of pituitary adenomas obtained from preoperative radiological images and to analyze their relationship with the extent of resection achieved through the endoscopic endonasal approach. The second objective was to create a prediction model of the extent of resection. Material and methods We retrospectively evaluated 105 patients. Tumor volume, Knosp grade, suprasellar-diaphragm coefficient and invasion of the posterior compartment have been analyzed. The extent of resection was assessed by analyzing the postoperative magnetic resonance. We created the predictive scale using statistically independent variables. Results When each of the variables has been studied individually, a statistically significant value of all of them is appreciated to obtain a complete resection. However, only the Knosp grade and the suprasellar-diaphragm coefficient had a statistically significant value as independent variables. The sum of the Odds Ratio obtained from the Knosp scale, and the suprasellar-diaphragm coefficient gives the probability of complete resection. A new set of cases was employed to validate the scale. Conclusions The cavernous sinus invasion and the newly designed suprasellar diaphragm coefficient are directly related to the extent of resection in pituitary adenoma surgery performed by a transellar endoscopic approach. Moreover, based on both radiologic factors, a predictive scale may predict the probability of complete resection in a series of patients (AU)

Introducción El objetivo principal de este proyecto es estudiar diversas variables anatomo-radiológicas de los adenomas hipofisarios obtenidas a partir de imágenes radiológicas preoperatorias y analizar su relación con el grado de resección logrado mediante el abordaje endoscopio endonasal. El segundo objetivo ha sido crear un modelo de predicción del grado de resección tumoral. Material y métodos Se ha evaluado retrospectivamente a 105 pacientes, analizando el volumen tumoral, el grado de Knosp, el coeficiente supraselar-diafragma y la invasión del compartimento posterior. El grado de resección se ha evaluado mediante el análisis de la resonancia magnética postoperatoria. Se ha creado la escala predictiva empleando variables estadísticamente independientes. Resultados Al estudiar cada una de las variables de forma individual, se aprecia un valor estadísticamente significativo en cada una de ellas para obtener una resección completa. Sin embargo, tan solo el grado de Knosp y el coeficiente supraselar-diafragma tuvieron un valor estadísticamente significativo como variables independientes. Empleando la suma de la odds ratio obtenida de la escala Knosp y el coeficiente supraselar-diafragma, se ha obtenido la probabilidad de resección completa. Se ha empleado un nuevo conjunto de casos para validar la escala. Conclusiones La invasión del seno cavernoso y el coeficiente supraselar-diafragma son variables que están directamente relacionadas con el grado de resección en la cirugía de adenoma hipofisario realizada mediante un abordaje endoscópico transellar. Además, basándose en ambos factores radiológicos, se ha creado una escala predictiva que permite predecir la probabilidad de resección completa en una serie de pacientes (AU)

Predictive model of resection in endoscopic endonasal approach for pituitary adenomas based on anatomical limits.

INTRODUCTION: The aim of this project is to study several anatomical-radiological features of pituitary adenomas obtained from preoperative radiological images and to analyze their relationship with the extent of resection achieved through the endoscopic endonasal approach. The second objective was to create a prediction model of the extent of resection. MATERIAL AND METHODS: We retrospectively evaluated 105 patients. Tumor volume, Knosp grade, suprasellar-diaphragm coefficient and invasion of the posterior compartment have been analyzed. The extent of resection was assessed by analyzing the postoperative magnetic resonance. We created the predictive scale using statistically independent variables. RESULTS: When each of the variables has been studied individually, a statistically significant value of all of them is appreciated to obtain a complete resection. However, only the Knosp grade and the suprasellar-diaphragm coefficient had a statistically significant value as independent variables. The sum of the Odds Ratio obtained from the Knosp scale, and the suprasellar-diaphragm coefficient gives the probability of complete resection. A new set of cases was employed to validate the scale. CONCLUSIONS: The cavernous sinus invasion and the newly designed suprasellar diaphragm coefficient are directly related to the extent of resection in pituitary adenoma surgery performed by a transellar endoscopic approach. Moreover, based on both radiologic factors, a predictive scale may predict the probability of complete resection in a series of patients.

Difusión de la hipnosis en prensa online escrita en español / Dissemination of hypnosis in the online press written in Spanish

Las creencias y expectativas sobre hipnosis de pacientes/clientes y de profesionales cualificados influyen en la decisión de usar este procedimiento, así́ como en sus efectos. Por otro lado, en Internet hay mucha información sobre hipnosis, que configura la opinión del público y de los profesionales. Por ello, el objetivo de este estudio es analizar la calidad de la información difundida por la prensa online no especializada. Se han analizado 334 (de 2011 a 2012) y 200 artículos (de 2018 a 2019) publicados en español en prensa online no especializada. Los resultados muestran que, aunque un elevado número de artículos desmitifica la hipnosis, muchos de ellos difunden mitos al mismo tiempo. El mayor porcentaje de artículos que desmitifican la hipnosis está asociado al tema “Ciencia y Cultura”. Los resultados indican que los mitos están ampliamente presentes en la cultura popular y se mantienen con el apoyo de su continua difusión en los artículos de prensa online. Esto reafirma la importancia de fomentar la difusión de evidencia científica disponible sobre la investigación aplicada y básica sobre hipnosis. (AU)

The patients/clients and the skilled professionals’ beliefs and expectations about hypnosis, influence the decision to use this procedure as well as its effects. On the other hand, in the Internet there is plenty of information about hypnosis, which shapes opinions of public and professionals. Therefore, the aim of this study is to analyze the quality of the information disseminated by non-specialized online press. 334 articles (from 2011 to 2012) and 200 articles (from 2018-2019) written in Spanish and published online in non-specialized publications press have been analyzed. Results show that, although a high number of articles demystify hypnosis, many of them disseminate myths as well. The highest percentage ofarticles that demystify hypnosis is associated with the press topic “Science and Culture”. Results indicate that myths are broadly present in the popular culture and are maintained with the support of their ongoing dissemination in the newspapers online articles. This supports the importance of fostering the dissemination of scientific available evidence about applied and basic research on hypnosis. (AU)

Utilidad de la neuromonitorización vagal continua en cirugía tiroidea: experiencia y resultados en un hospital de tercer nivel / The role of continuous vagal intraoperative nerve monitoring in thyroid surgery: experience and results in a third-level hospital

Resumen Objetivo: La lesión del nervio laríngeo recurrente es una grave complicación en cirugía tiroidea. El propósito del presente estudio es analizar la utilidad de la neuromonitorización vagal continua intraoperatoria en un hospital terciario. Materiales y Método: Estudio observacional, analítico y retrospectivo que recoge pacientes intervenidos de cirugía tiroidea con neuromonitorización en un período de 14 meses. La pérdida de señal se define como amplitud final nerviosa < 100 ^V, realizándose laringoscopia postquirúrgica ante la sospecha de lesión nerviosa. El análisis estadístico se realizó con el programa SPSS® V25,0, con p < 0,05. Resultados: Se incluyeron 120 pacientes intervenidos, registrándose en el 24,2% pérdida de señal. Factores de riesgo para lesión fueron bocio intratorácico (OR 5,31; IC 95% 1,56-17,99; p = 0,007), cirugía cervical previa (OR 5,76; IC 95% 0,64-51,97; p = 0,119) y patología maligna (OR 1,44; IC 95% 0,16-12,79; p = 0,743). Fue posible el cambio de estrategia quirúrgica en 7 casos. En el seguimiento posterior se cuantificó parálisis recurrencial transitoria en 27 pacientes y permanente en 4. Discusión: La neuromonitorización parece reducir la incidencia de parálisis laríngea porque aumenta la seguridad en la identificación del nervio recurrente y reduce su manipulación durante la cirugía. Conclusiones: La neuromonitorización intraoperatoria es útil para identificar el nervio laríngeo recurrente y advierte del riesgo potencial de lesión, permitiendo cambiar la estrategia quirúrgica para evitar la parálisis bilateral de cuerdas vocales.

Aim: Recurrent laryngeal nerve injury is a serious complication in thyroid surgery. The purpose of the present study is to analyze the use of intraoperative continuous vagal neuromonitoring in a tertiary hospital. Materials and Method: Observational, analytical and retrospective study that includes patients who underwent thyroid surgery with neuromonitoring in a period of 14 months. Loss of signal is defined as final nerve amplitude < 100 ^V, and postsurgical laryngoscopy is performed due to suspicion of nerve injury. Statistical analysis was performed with the SPSS® V25.0 program, with p < 0.05. Results: 120 operated patients were included, registering loss of signal in 24.2%. Risk factors for injury were intrathoracic goiter (OR 5.31; 95% CI 1.56-17.99; p = 0.007), previous cervical surgery (OR 5.76; 95% CI 0.64-51.97; p = 0.119) and malignant pathology (OR 1.44; 95% CI 0.16-12.79; p = 0.743). A change in surgical strategy was possible in 7 cases. In the subsequent follow-up, transient recurrent paralysis was quantified in 27 patients and permanent in 4. Discussion: Neuromonitoring seems to reduce the incidence of laryngeal paralysis because it increases the security in the identification of the recurrent nerve and reduces its manipulation during surgery. Conclusions: Intraoperative neuromonitoring is useful to identify the recurrent laryngeal nerve and warns of the potential risk of injury, allowing to change the surgical strategy to avoid bilateral vocal cord paralysis.

Impact of a clinical pathway on cardiovascular risk in patients with diabetes.

OBJECTIVES: Clinical pathways (CPs) are interventions that target the way clinical practice guidelines are applied. They can be implemented in different diseases, including diabetes. In this study we evaluated the impact of the implementation of a CP in the control of cardiovascular risk factors and the occurrence of new events in patients with type 2 diabetes. METHODS: A pre- and post-intervention population-based study in a Spanish region, conducted in 2014-2016. Variables before and after the intervention were: screening; good control of diabetes, dyslipidemia and hypertension; hypoglycemia and hyperglycemic decompensation; obesity; cardiovascular events; diabetic ketoacidosis; hyperglycemic and hypoglycemic coma. Proportional differences and parameters of clinical relevance (absolute and relative risk reduction, relative risk and number needed to treat) were calculated. RESULTS: The CP achieved an improvement in all outcomes, reducing events and increasing control of different cardiovascular parameters. The greatest improvement was in metabolic control (HbA1c) (37.1% in younger patients and 34.0% in older patients) and screening (5.4%). Indicators of clinical relevance showed that the CP was able to improve metabolic control of diabetes with little effort and great benefit. CONCLUSION: The CP was of considerable benefit to metabolic control as well as control of dyslipidemia and obesity. Screening for diabetes also benefitted. The CP decreased the incidence of events, especially of angina pectoris.

When animals cry: The effect of adding tears to animal expressions on human judgment.

At a time of growing interest in and awareness about the relationships between humans and animals, it is of relevance to scientifically analyse the intrinsic nature of these interactions. Reactions to emotional tears show our extraordinary capacity for detecting micro-nuances when judging another human's face. Regarding such behaviour, previous studies carried out in our laboratory have pointed to an adaptive function of emotional tears: i.e. their inhibitory influence on perceived aggressiveness. In the present work we aimed to further explore that hypothesis by extending our investigation from humans to animals, using pictures of five different animal faces (cat, dog, horse, chimpanzee, hamster) to which tears were added digitally. To this end, we conducted an online study of 403 participants recruited from different social networks and academic institutions. We questioned the participants about their perceptions of emotional intensity, aggressiveness and friendliness in the animal faces and analysed the comparisons they made between faces with and without tears. In addition, a latent variable referred to as "passion for animals" was measured using different indicators. By adding the results obtained in each species and breaking them down into different basic emotions, we found that the presence of tears was related to a higher absolute frequency of participants who perceived sadness, which endorsed our previous results obtained using images of humans. Regarding aggressiveness, the presence of tears favoured the perception of less aggressiveness. A structural equation model was also conducted to explore the relations among all the measured variables. The model confirmed that the presence of tears in the animal faces had a significant influence on the perception of higher emotional intensity and friendliness, and of lower aggressiveness.

Proposal of a clinically relevant working classification of pituitary neuroendocrine tumors based on pituitary transcription factors.

The immunohistochemistry (IHC) characterization of pituitary transcription factors (PTFs) PIT1, TPIT, and SF1, which enable the identification of three different adenohypophyseal cell lines, has been incorporated into the latest classification system of the World Health Organization (WHO) for pituitary adenomas. This change overturns the concept of the adenoma as solely a hormone producer and classifies these tumors based on their cell lineage. The aim of the study was to provide a diagnostic algorithm, based on IHC expression of hypophyseal hormones with potential use in diagnostic practice, contributing to an improved classification of pituitary adenomas. Our sample included 146 pituitary adenomas previously classified based on hormonal subtypes by IHC (former 2004 WHO criteria) and re-evaluated after the IHC quantification of PIT1, TPIT, and SF1 expression, under WHO 2017 recommendations. We assessed the correlation between expression of PTFs and the classification as per hormonal IHC and correlated clinicopathological profiles based on PTFs. The IHC study of PTFs allowed reclassification of 82% of tumors that were negative for all pituitary hormones, with 21 positive cases for SF1 (reclassified as gonadotroph tumors), 1 positive case for TPIT (reclassified as a corticotroph tumor), and 4 positive cases for PIT1. Using SF1 enabled detection of a substantial portion of gonadotroph tumors, reducing the estimated prevalence of null cell tumors to less than 5%, and identification of plurihormonal pituitary neuroendocrine tumors with PIT1-SF1 coexpression and hormone-negative PIT1s, a group in which we did not observe differences in the clinical behavior compared with the rest of the tumors of the same cell lineage.Our results suggest that applying a diagnostic algorithm based on the study of PTFs could contribute to improving the classification of pituitary adenomas. By adding TPIT assessment, we propose a two-step algorithm, with hypophyseal hormones being used in a selective modality, depending on initial results.

How Our Gaze Reacts to Another Person's Tears? Experimental Insights Into Eye Tracking Technology.

Crying is an ubiquitous human behavior through which an emotion is expressed on the face together with visible tears and constitutes a slippery riddle for researchers. To provide an answer to the question "How our gaze reacts to another person's tears?," we made use of eye tracking technology to study a series of visual stimuli. By presenting an illustrative example through an experimental setting specifically designed to study the "tearing effect," the present work aims to offer methodological insight on how to use eye-tracking technology to study non-verbal cues. A sample of 30 healthy young women with normal visual acuity performed a within-subjects task in which they evaluated images of real faces with and without tears while their eye movements were tracked. Tears were found to be a magnet for visual attention in the task of facial attribution, facilitating a greater perception of emotional intensity. Moreover, the inspection pattern changed qualitatively and quantitatively, with our participants becoming fully focused on the tears when they were visible. The mere presence of a single tear running down a cheek was associated with an increased emotional inference and greater perception of sincerity. Using normalized and validated tools (Reading the Eyes in the Mind Test and the SALAMANCA screening test for personality disorders), we measured the influence of certain characteristics of the participants on their performance of the experimental task. On the one hand, a higher level of cognitive empathy helped to classify tearful faces with higher emotional intensity and tearless faces with less emotional intensity. On the other hand, we observed that less sincerity was attributed to the tearful faces as the SALAMANCA test scores rose in clusters A (strange and extravagant) and B (immature and emotionally unstable) of our sample. The present findings highlight the advantages of using eye tracking technology to study non-verbal cues and draw attention to methodological issues that should be taken into account. Further exploration of the relationship between empathy and tear perception could be a fruitful avenue of future research using eye tracking.

ACROSTART: A retrospective study of the time to achieve hormonal control with lanreotide Autogel treatment in Spanish patients with acromegaly / ACROSTART: Estudio retrospectivo del período de tiempo para lograr el control hormonal con lanreótida Autogel en pacientes con acromegalia en la práctica clínica española

Objectives: The ACROSTART study was intended to determine the time to achieve normalization of GH and IGF-I levels in responding patients with acromegaly administered different dosage regimens of lanreotide Autogel (Somatuline(R) Autogel(R)). Methods: From March 2013 to October 2013, clinical data from 57 patients from 17 Spanish hospitals with active acromegaly treated with lanreotide for ≥4 months who achieved hormonal control (GH levels <2.5ng/ml and/or normalized IGF-I levels in ≥2 measurements) were analyzed. The primary objective was to determine the time from start of lanreotide treatment to hormonal normalization. Results: Median patient age was 64 years, 21 patients were male, 39 patients had undergone surgery, and 14 patients had received radiotherapy. Median hormonal values at start of lanreotide treatment were: GH, 2.6ng/ml; IGF-I, 1.6×ULN. The most common starting dose of lanreotide was 120mg (29 patients). The main initial regimens were 60mg/4 weeks (n=13), 90mg/4 weeks (n=6), 120mg/4 weeks (n=13), 120mg/6 weeks (n=6), and 120mg/8 weeks (n=9). An initial treatment regimen with a long interval (≥6 weeks) was administered in 25 patients. Mean duration of lanreotide treatment was 68 months (7-205). Median time to achieve hormonal control was 4.9 months. Injections were managed without healthcare assistance in 13 patients. Median number of visits to endocrinologists until hormonal control was achieved was 3. Fifty-one patients were "satisfied"/"very satisfied" with treatment and 49 patients did not miss any dose. Conclusions: Real-life treatment with lanreotide Autogel resulted in early hormonal control in responding patients, with high treatment adherence and satisfaction despite disparity in starting doses and dosing intervals

Objetivos: El objetivo del estudio ACROSTART era determinar el período de tiempo para lograr la normalización hormonal (GH e IGF-I) en pacientes con acromegalia respondedores al tratamiento considerando los regímenes de lanreótida Autogel (Somatuline(R) Autogel(R)) utilizados en la práctica clínica. Métodos: Desde marzo de 2013 hasta octubre de 2013, en 17 hospitales españoles se analizaron los datos clínicos de 57 pacientes con acromegalia activa tratados con lanreótida durante ≥4 meses que lograron control hormonal (niveles de GH <2,5ng/ml y/o IGF-I normalizado en ≥2 evaluaciones). El objetivo principal fue determinar el período de tiempo desde el inicio del tratamiento con lanreótida hasta la normalización hormonal. Resultados: La mediana de edad de los pacientes fue 64 años, 21 pacientes eran hombres, 39 pacientes habían recibido cirugía, 14 pacientes habían recibido radioterapia. Los valores hormonales medianos al inicio del tratamiento con lanreótida fueron GH: 2,6ng/ml, IGF-I: 1,6×LSN. La dosis inicial más frecuente de lanreótida fue de 120mg (29 pacientes). Los principales regímenes iniciales fueron 60mg/4 semanas (n=13), 90mg/4 semanas (n=6), 120mg/4 semanas (n=13), 120mg/6 semanas (n=6), 120mg/8 semanas (n=9). Se administró un régimen de intervalo prolongado (≥6 semanas) en 25 pacientes. La duración media del tratamiento con lanreótida fue de 68 meses (7-205). El tiempo medio hasta lograr el control hormonal fue de 4,9 meses. Las inyecciones se manejaron sin asistencia médica en 13 pacientes. La mediana del número de visitas al endocrinólogo hasta el control hormonal fue 3. Cincuenta y un pacientes estaban "satisfechos"/"muy satisfechos" con el tratamiento y 49 pacientes no olvidaron ninguna dosis. Conclusiones: El tratamiento en la vida real con lanreótida Autogel condujo a un control hormonal temprano en pacientes que respondieron, con una alta adherencia al tratamiento y satisfacción con el tratamiento, a pesar de la disparidad de las dosis iniciales y los intervalos de dosificación

El regreso de los estadísticos. Sobre el valor de la estadística en neuropsicología clínica / The return of the statisticians. On the value of statistics in clinical neuropsychology

Hubo un tiempo en que los clínicos despreciaban cualquier toma de decisiones que no dependiera de su propio juicio. Los estadísticos se reían de tal ingenuidad, conociendo lo falible de los heurísticos que guían las decisiones humanas, incluso en los individuos más entrenados. Tras más de 60 años del inicio del enfrentamiento, ambas posturas aún no se han asimilado en psicología clínica ni en neuropsicología. El presente trabajo respalda la aplicación práctica de la estadística en la toma de decisiones clínica y muestra que incluso el juicio de tipo intuitivo descansa de algún modo en la aplicación del uso básico de conceptos estadísticos, sin obviar que en ocasiones se ha hecho mal uso de las herramientas estadísticas. Para ello contrasta las opiniones ofrecidas por algunos clínicos en forma de frase con la bibliografía consultada, que se extiende desde los primeros trabajos del psicólogo clínico Paul Meehl hasta la actualidad. Lejos de querer imponer una opinión, se comenta la ventaja de asumir un enfoque que aproveche los conocimientos matemáticos como apoyo a la toma de decisiones clínica. Finalmente se comenta la necesidad de equipos multidisciplinares en las unidades especiales de nuestros centros hospitalarios

There was a time when clinicians looked down on any decision-making that did not depend on their own judgement. Statisticians laughed at such naivety, as they were fully aware of the extent to which the heuristics that guide human decisions are capable of error, even in the most highly trained individuals. More than 60 years after the beginning of this conflict, the two standpoints have still not been adopted in clinical psychology or in neuropsychology. This work defends the practical application of statistics in clinical decision-making and shows that even intuitive-type judgement is somehow based on applying the basic use of statistical concepts, without neglecting the fact that statistical instruments have sometimes been misused. To this end, this study compares the opinions offered by some clinicians in sentence form with the bibliography consulted, which spans the period from the earliest works by the clinical psychologist Paul Meehl to the present day. We have no intention whatsoever of imposing an opinion, but instead of discussing the advantage of adopting an approach that uses mathematical knowledge to support clinical decision-making. Attention is also drawn to the need for multidisciplinary teams in the special units of our hospitals

ACROSTART: A retrospective study of the time to achieve hormonal control with lanreotide Autogel treatment in Spanish patients with acromegaly.

OBJECTIVES: The ACROSTART study was intended to determine the time to achieve normalization of GH and IGF-I levels in responding patients with acromegaly administered different dosage regimens of lanreotide Autogel (Somatuline® Autogel®). METHODS: From March 2013 to October 2013, clinical data from 57 patients from 17 Spanish hospitals with active acromegaly treated with lanreotide for ≥4 months who achieved hormonal control (GH levels <2.5ng/ml and/or normalized IGF-I levels in ≥2 measurements) were analyzed. The primary objective was to determine the time from start of lanreotide treatment to hormonal normalization. RESULTS: Median patient age was 64 years, 21 patients were male, 39 patients had undergone surgery, and 14 patients had received radiotherapy. Median hormonal values at start of lanreotide treatment were: GH, 2.6ng/ml; IGF-I, 1.6×ULN. The most common starting dose of lanreotide was 120mg (29 patients). The main initial regimens were 60mg/4 weeks (n=13), 90mg/4 weeks (n=6), 120mg/4 weeks (n=13), 120mg/6 weeks (n=6), and 120mg/8 weeks (n=9). An initial treatment regimen with a long interval (≥6 weeks) was administered in 25 patients. Mean duration of lanreotide treatment was 68 months (7-205). Median time to achieve hormonal control was 4.9 months. Injections were managed without healthcare assistance in 13 patients. Median number of visits to endocrinologists until hormonal control was achieved was 3. Fifty-one patients were "satisfied"/"very satisfied" with treatment and 49 patients did not miss any dose. CONCLUSIONS: Real-life treatment with lanreotide Autogel resulted in early hormonal control in responding patients, with high treatment adherence and satisfaction despite disparity in starting doses and dosing intervals.

Psychobiological response to an anger induction task in schizophrenia: The key role of anxiety.

In this study an anger induction laboratory task was applied to men with schizophrenia, and resulted in significant changes in different psychophysiological parameters that were measured in a pre-post design. We observed a significantly greater self-reported anger mood and negative affection, lower self-reported positive affection, an increase in cardiovascular reactivity (with blood pressure in deeper affection compared to controls), higher salivary testosterone levels, lower salivary cortisol levels, and an increase in right ear items reported in dichotic listening. Furthermore, clinical risk factors related to anger in our patients were analyzed by Stepwise Regression analyses. Trait anger was significantly associated with a higher level of delusional pathology and impulsivity. Regarding the resulted state of anger as an output of the induction, the most relevant finding was that anxiety consistently and significantly predicted the increasing in anger feelings, and, remarkably, it predicted also the increasing in T levels and the cardiovascular reactivity of the patients.

Cirugía endoscópica endonasal en adenomas hipofisarios: resultados quirúrgicos en una serie de 86 pacientes consecutivos / Endonasal endoscopic surgery in pituitary adenomas: Surgical results in a series of 86 consecutive patients

Introducción: El abordaje endoscópico endonasal se ha convertido en la técnica quirúrgica de elección para el tratamiento de los adenomas hipofisarios. Objetivos: El objetivo de este trabajo es presentar los resultados obtenidos en nuestro hospital en cirugía puramente endoscópica de los adenomas hipofisarios. Métodos: Hemos realizado un estudio prospectivo, recogiendo a los pacientes intervenidos de adenoma hipofisario mediante un abordaje endonasal puramente endoscópico, desde febrero de 2011 hasta agosto de 2016, obteniendo una muestra total de 86 pacientes. Todos los pacientes fueron intervenidos conjuntamente por un ORL y un neurocirujano con la técnica de four hands-two nostrils. El seguimiento medio postoperatorio fue de 32 meses. Todos los pacientes fueron evaluados según criterios clínicos, radiológicos y endocrinológicos. Resultados: En nuestra serie un 53% eran mujeres y un 47% hombres; el rango de edad variaba desde los 14 hasta los 84 años, siendo la media de 54 años. El síntoma inicial más habitual fue el déficit visual (42%), seguido por la hiperfunción hormonal (21%), siendo la acromegalia el síndrome clínico observado con más frecuencia. Los tumores más frecuentes fueron los no funcionantes (73%), y de entre los adenomas funcionantes el más frecuente fue el productor de GH (65%). En cuanto a tamaño tumoral, un 76% eran macroadenomas, un 11% microadenomas y un 13% gigantes. Un 63% presentaban extensión supraselar y un 37% invasión de seno cavernoso (grado de Knosp ≥3). Se consiguió una exéresis total en un 77% de los casos. Tras la intervención se consiguió en un 91% mejoría visual y hasta en un 73% remisión de la hiperfunción endocrina. En cuanto a las complicaciones, la más frecuente fue la insuficiencia de al menos un eje de la hipófisis anterior (9%), sin presentar casos de fístula de LCR posquirúrgica. Conclusiones: Nuestros resultados, en términos de calidad quirúrgica, se asemejan a las series publicadas y avalan la eficacia y seguridad del abordaje endoscópico endonasal como técnica de elección en el manejo quirúrgico de la glándula hipofisaria. Sin embargo, es necesario un estudio con mayor número de casos para obtener resultados con significación clínica

Introduction: The endoscopic endonasal approach has become the gold standard for the surgical treatment of pituitary adenomas. Objectives: The aim of this study is to present the results obtained in our hospital in purely endoscopic surgery of pituitary adenomas. Methods: From February 2011 to August 2016, we conducted a prospective study on a series of 86 patients with pituitary adenoma, all of whom underwent surgery with a purely endoscopic endonasal approach. The ‘four hands-two nostrils’ technique was performed in all cases by a surgical team composed of an ENT surgeon and a neurosurgeon. Mean follow-up was 32 months. All patients were evaluated according to clinical, radiological and endocrinological criteria. Results: In our series, 53% were women and 47% men. The age ranged from 14 to 84 years of age, with a mean of 54 years of age. The most common initial symptom was visual deficit (42%), followed by hormonal hyperfunction (21%), with acromegaly being the most common clinical syndrome. The most common tumours were non-functioning tumours (73%), while GH-secreting tumours (65%) were the most common functioning adenoma. Regarding tumour size, 76% were macroadenomas, 11% microadenomas and 13% giant adenomas. Approximately 63% of the adenomas exhibited suprasellar extension and 37% involved invasion of the cavernous sinus (Knosp grade ≥3). Total excision was achieved in 77% of the cases. After the intervention, visual improvement was achieved in 91% and remission of endocrine hyperfunction in up to a 73% of cases. The most common complication was anterior pituitary insufficiency of at least one axis (9%). There were no cases of postoperative cerebrospinal fluid fistula. Conclusions: In terms of surgical quality, our results are similar to those of published series, and demonstrate the efficacy and safety of the endoscopic endonasal approach as the surgical treatment of choice for pituitary adenomas. However, further studies with a higher sample size are necessary to obtain clinically significant results

[Endonasal endoscopic surgery in pituitary adenomas: Surgical results in a series of 86 consecutive patients]. / Cirugía endoscópica endonasal en adenomas hipofisarios: resultados quirúrgicos en una serie de 86 pacientes consecutivos.

INTRODUCTION: The endoscopic endonasal approach has become the gold standard for the surgical treatment of pituitary adenomas. OBJECTIVES: The aim of this study is to present the results obtained in our hospital in purely endoscopic surgery of pituitary adenomas. METHODS: From February 2011 to August 2016, we conducted a prospective study on a series of 86 patients with pituitary adenoma, all of whom underwent surgery with a purely endoscopic endonasal approach. The 'four hands-two nostrils' technique was performed in all cases by a surgical team composed of an ENT surgeon and a neurosurgeon. Mean follow-up was 32 months. All patients were evaluated according to clinical, radiological and endocrinological criteria. RESULTS: In our series, 53% were women and 47% men. The age ranged from 14 to 84 years of age, with a mean of 54 years of age. The most common initial symptom was visual deficit (42%), followed by hormonal hyperfunction (21%), with acromegaly being the most common clinical syndrome. The most common tumours were non-functioning tumours (73%), while GH-secreting tumours (65%) were the most common functioning adenoma. Regarding tumour size, 76% were macroadenomas, 11% microadenomas and 13% giant adenomas. Approximately 63% of the adenomas exhibited suprasellar extension and 37% involved invasion of the cavernous sinus (Knosp grade ≥3). Total excision was achieved in 77% of the cases. After the intervention, visual improvement was achieved in 91% and remission of endocrine hyperfunction in up to a 73% of cases. The most common complication was anterior pituitary insufficiency of at least one axis (9%). There were no cases of postoperative cerebrospinal fluid fistula. CONCLUSIONS: In terms of surgical quality, our results are similar to those of published series, and demonstrate the efficacy and safety of the endoscopic endonasal approach as the surgical treatment of choice for pituitary adenomas. However, further studies with a higher sample size are necessary to obtain clinically significant results.

Claves para avanzar hacia un rol más activo por parte del paciente con diabetes mellitus tipo 2 en España / Key aspects to moving towards a more active role for the patient with diabetes mellitus type 2 in Spain

OBJETIVOS: La diabetes mellitus tipo 2 (DM2) es un problema de salud pública de primer orden que preocupa a gestores, a profesionales sanitarios y a la sociedad en su conjunto. Contar con un paciente con DM2 más activo y responsable con su salud se perfila como una de las soluciones. Por ello la importancia de impulsar un debate multidisciplinar que aporte ideas y soluciones que contribuyan a conseguir un paciente con DM2 involucrado en su salud. En este artículo se presentan una serie de recomendaciones consensuadas por el Grupo Paciente Activo y Diabetes (PAyDInet). MATERIAL Y MÉTODOS: Se constituyó el grupo de trabajo PAyDInet, en el que participaron diferentes agentes del sistema. Siguiendo la técnica de grupo nominal, se identificaron y priorizaron las barreras, los elementos facilitadores así como iniciativas concretas que fomenten una actitud preventiva y de autocuidado en el paciente con DM2. RESULTADOS: El grupo llegó a un consenso sobre las 3 barreras, 3 elementos facilitadores y 3 iniciativas clave en la consecución de un paciente con DM2 más activo en el manejo de su enfermedad. La configuración actual del sistema sanitario, la necesidad de mejorar la coordinación interprofesional y el desarrollo de la educación diabetológica estructurada constituyen los puntos esenciales identificados por el grupo. CONCLUSIÓN: Es una necesidad ineludible seguir avanzando para situar al paciente como centro del sistema. Un paciente formado e informado en DM2 es una tarea compleja que solo se logrará con nuevas alianzas y la colaboración de todos los agentes. En cualquier caso, el debate y las recomendaciones del grupo PAyDInet aportan una buena aproximación al tema y un excelente punto de partida

OBJECTIVES: Diabetes mellitus type 2 (DM2) is a public health problem of the first order of concern to managers, health professionals and society as a whole. Having a more active and responsible patient with DM2 is emerging as one of the solutions. Hence the importance of promoting a multidisciplinary discussion that provides ideas and solutions that contribute to an active and involved patient with DM2. In this article some consensual recommendations are provided by the working group called Active Patient and Diabetes(PAyDInet by its Spanish initials). METHODS: PAyDInet team was established by gathering agents from different fields of the system. Following the nominal group technique, barriers, facilitators and specific initiatives to promote a preventive attitude and self-care in patients with DM2, were identified and prioritized. RESULTS: The team reached a final consensus on 3 key barriers, 3 enablers and 3 key initiatives to achieve patients with DM2 more active in managing their disease. The configuration of the healthcare system, the need to improve interprofessional coordination, and development of structured diabetes education, are the key points identified by the group. CONCLUSION: It is an inescapable need to move forward to put the patient at the centre of the system. Training and informing a patient on DM2 is a complex task that can only be achieved with new partnerships and collaboration of all stakeholders. In any case, the discussion and recommendations of the group PAyDInet give us a good approach to the subject and an excellent starting point

Pituitary tumor transforming gene and insulin-like growth factor 1receptor expression and immunohistochemical measurement ofKi-67 as potential prognostic markers of pituitary tumorsaggressiveness

Introducción y objetivo La capacidad de predecir recurrencia en los adenomas hipofisarios (AH) tras la cirugía puede ser útil para determinar la frecuencia de seguimiento y la necesidad de tratamientos adyuvantes. El objetivo del presente estudio fue valorar la capacidad pronóstica de gen transformador de tumores hipofisarios (pituitary tumor transforming gene [PTTG]), del receptor del factor de crecimiento insulinoide 1 (insulin-like growth factor 1 receptor [IGF1R]) y de Ki-67. Material y métodos En este estudio retrospectivo determinamos el número de copias normalizadas de ARNm (Cnn) de PTTG e IGF1R mediante RT-PCR y el índice Ki-67 mediante inmunohistoquímica en 46 muestras de AH. Los datos clínicos, el subtipo histológico y las características radiológicas se recogieron para determinar asociaciones entre las variables y el comportamiento tumoral. Además, estudiamos la progresión de los restos tumorales y su asociación con los marcadores en 14 pacientes sin tratamiento adyuvante posquirúrgico seguidos durante 46 ± 36 meses. Resultados Los tumores extraselares mostraron una expresión de PTTG menor que los intraselares (0,065 [1.er-3.er cuartil: 0,000-0,089] Cnn frente a 0,135 [0,105–0,159] Cnn, p = 0,04). La expresión de IGF1R varió en función del subtipo histológico (p = 0,014), siendo mayor en los tumores que presentaron crecimiento de los restos mayor del 20% durante el seguimiento (10,69 ± 3,84 Cnn frente a 5,44 ± 3,55 Cnn, p = 0,014). Conclusiones Nuestros resultados indican que IGF1R, en mayor medida que PTTG, es un marcador molecular útil en el manejo de los AH. Ki-67 no mostró asociación con el comportamiento tumoral. Sin embargo, el potencial de estos marcadores debe ser establecido en futuros estudios con una metodología estandarizada y una muestra mayor (AU)

Introduction and objective The ability to predict recurrence of pituitary adenoma (PA) after surgery may be helpful to determine follow-up frequency and the need for adjuvant treatment. The purpose of this study was to assess the prognostic capacity of pituitary tumor transforming gene (PTTG), insulin-like growth factor 1 receptor (IGF1R), and Ki-67. Materials and methods In this retrospective study, the normalized copy number (NCN) of PTIG and IGF1R mRNA was measured using RT-PCR, and the Ki-67 index was measured by immunohistochemistry in 46 PA samples. Clinical data, histological subtype, and radiographic characteristics were collected to assess associations between variables and tumor behavior. Progression of tumor remnants and its association to markers was also studied in 14 patients with no adjuvant treatment after surgery followed up for 46 ± 36 months. Results Extrasellar tumors had a lower PTTG expression as compared to sellar tumors (0.065 [1st–3rd quartile: 0.000–0.089] NCN vs. 0.135 [0.105–0.159] NCN, p = 0.04). IGF1R expression changed depending on histological subtype (p = 0.014), and was greater in tumor with remnant growth greater than 20% during follow-up (10.69 ± 3.84 NCN vs. 5.44 ± 3.55 NCN, p = 0.014). Conclusions Our results suggest that the IGF1R is a more helpful molecular marker than PTTG in PA management. Ki-67 showed no association to tumor behavior. However, the potential of these markers should be established in future studies with standardized methods and on larger samples(AU)