Análisis de supervivencia e identificación de factores pronósticos de metástasis hepáticas de cáncer colorrectal tras resección hepática / Survival analysis and identification of prognostic factors in colorectal liver metastasis after liver resection

Introducción: El único tratamiento curativo para las metástasis hepáticas de cáncer colorrectal es la cirugía. La identificación de factores pronósticos nos permite individualizar el tratamiento de estos pacientes, mejorando sus resultados oncológicos a largo plazo. El objetivo de nuestro estudio es identificar la supervivencia y los factores pronósticos de pacientes sometidos a tratamiento quirúrgico de metástasis hepáticas de cáncer colorrectal. Métodos: Se trata de un estudio retrospectivo de todos los casos de hepatectomías por metástasis hepáticas de cáncer colorrectal, operadas en un hospital de tercer nivel en España, entre los años 2010 y 2018. Se realizó análisis de supervivencia univariante con las curvas de supervivencia Kaplan-Meier. Mediante el modelo multivariante regresión de Cox se determinaron los factores pronósticos asociados a la supervivencia global. Resultados: La supervivencia global y supervivencia libre de enfermedad de nuestra serie, a los 5 años fue del 43% y del 33%, respectivamente. En el análisis de supervivencia, las características de las metástasis hepáticas (números, tamaño mayor, distribución bilobar y enfermedad extrahepática) y postoperatorias (transfusión sanguínea, complicaciones graves y margen afecto), así como el KRAS no mutado resultaron estadísticamente significativos. No obstante, después de aplicar la regresión de Cox, solo se identificaron 5 factores de riesgo independientes: mutación del KRAS, metástasis hepáticas >4cm, transfusión intraoperatoria, complicaciones graves y margen afecto. Conclusiones: En nuestro grupo de pacientes hemos observado que el tamaño>4cm de la metástasis hepáticas, la transfusión intraoperatoria, las complicaciones posquirúrgicas graves y el margen afecto se mantienen como factores pronósticos tradicionales vigentes. Mientras que el biomarcador KRAS cobra un valor predictivo importante como factor pronóstico de supervivencia. (AU)

Introduction: Liver resection is the only curative treatment for colorectal liver metastasis. The identification of predictive factors leads to personalize patient management to enhance their long-term outcomes. This population-based study aimed to characterize factors associated with, and survival impact of patients who received hepatectomy for colorectal liver metastasis. Methods: A retrospective cohort study of all the hepatectomies for colorectal liver metastasis performed at third-level hospital of Spain (2010–2018) was conducted. The Kaplan–Meier method was used for survival analyses. Multivariable Cox and regression models were used to determine prognostic factors associated with overall survival. Results: The 5-year overall survival and disease-free survival were 42 and 33%, respectively. Survival analysis showed that metastasis features (number, largest size, distribution, and extrahepatic disease) and postsurgical factors (transfusion, major complications, and positive margin resection), as well as non-mutated KRAS, showed a significant association with survival. Otherwise, on multivariate analysis, only 5 independent risk factors were identified: major size metastasis>4cm, RAS mutation, positive margin resection, intraoperative transfusion, and major complications. Conclusions: According to our findings, major size metastasis>4cm, intraoperative transfusion, and major postoperative complications continue to be traditional prognostic factors. Meanwhile, the KRAS biomarker has a powerful impact as a survival prognostic factor. (AU)

Survival analysis and identification of prognostic factors in colorectal liver metastasis after liver resection.

INTRODUCTION: Liver resection is the only curative treatment for colorectal liver metastasis. The identification of predictive factors leads to personalize patient management to enhance their long-term outcomes. This population-based study aimed to characterize factors associated with, and survival impact of patients who received hepatectomy for colorectal liver metastasis. METHODS: A retrospective cohort study of all the hepatectomies for colorectal liver metastasis performed at third-level hospital of Spain (2010-2018) was conducted. The Kaplan-Meier method was used for survival analyses. Multivariable Cox and regression models were used to determine prognostic factors associated with overall survival. RESULTS: The 5-year overall survival and disease-free survival were 42 and 33%, respectively. Survival analysis showed that metastasis features (number, largest size, distribution, and extrahepatic disease) and postsurgical factors (transfusion, major complications, and positive margin resection), as well as non-mutated KRAS, showed a significant association with survival. Otherwise, on multivariate analysis, only 5 independent risk factors were identified: major size metastasis >4 cm, RAS mutation, positive margin resection, intraoperative transfusion, and major complications. CONCLUSIONS: According to our findings, major size metastasis >4 cm, intraoperative transfusion, and major postoperative complications continue to be traditional prognostic factors. Meanwhile, the KRAS biomarker has a powerful impact as a survival prognostic factor.

Resultados a largo plazo de la devascularización esofagogástrica, según técnica de Han, en el tratamiento de la hemorragia digestiva secundaria a varices esofagogástricas y trombosis portal / Long term results of periesophagogastric devascularization (Han technique) for esophagogastric variceal bleeding and portal thrombosis

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BDNF concentrations and daily fluctuations differ among ADHD children and respond differently to methylphenidate with no relationship with depressive symptomatology.

RATIONALE: Brain-derived neurotrophic factor (BDNF) enhances the growth and maintenance of several monoamine neuronal systems, serves as a neurotransmitter modulator and participates in the mechanisms of neuronal plasticity. Therefore, BDNF is a good candidate for interventions in the pathogenesis and/or treatment response of attention deficit hyperactivity disorder (ADHD). OBJECTIVE: We quantified the basal concentration and daily fluctuation of serum BDNF, as well as changes after methylphenidate treatment. METHOD: A total of 148 children, 4-5 years old, were classified into groups as follows: ADHD group (n = 107, DSM-IV-TR criteria) and a control group (CG, n = 41). Blood samples were drawn at 2000 and 0900 hours from both groups, and after 4.63 ± 2.3 months of treatment, blood was drawn only from the ADHD group for BDNF measurements. Factorial analysis was performed (Stata software, version 12.0). RESULTS: Morning BDNF (36.36 ± 11.62 ng/ml) in the CG was very similar to that in the predominantly inattentive children (PAD), although the evening concentration in the CG was higher (CG 31.78 ± 11.92 vs PAD 26.41 ± 11.55 ng/ml). The hyperactive-impulsive group, including patients with comorbid conduct disorder (PHI/CD), had lower concentrations. Methylphenidate (MPH) did not modify the concentration or the absence of daily BDNF fluctuations in the PHI/CD children; however, MPH induced a significant decrease in BDNF in PAD and basal day/night fluctuations disappeared in this ADHD subtype. This profile was not altered by the presence of depressive symptoms. CONCLUSIONS: Our data support a reduction in BDNF in untreated ADHD due to the lower concentrations in PHI/CD children, which is similar to other psychopathologic and cognitive disorders. MPH decreased BDNF only in the PAD group, which might indicate that BDNF is not directly implicated in the methylphenidate-induced amelioration of the neuropsychological and organic immaturity of ADHD patients.

Tuberculosis intestinal y peritoneal en paciente no inmunodeprimido / Intestinal and peritoneal tuberculosis in a non-immunocompromised patient

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Methylphenidate ameliorates depressive comorbidity in ADHD children without any modification on differences in serum melatonin concentration between ADHD subtypes.

UNLABELLED: The vast majority of Attention-deficit/hyperactivity disorder (ADHD) patients have other associated pathologies, with depressive symptoms as one of the most prevalent. Among the mediators that may participate in ADHD, melatonin is thought to regulate circadian rhythms, neurological function and stress response. To determine (1) the serum baseline daily variations and nocturnal excretion of melatonin in ADHD subtypes and (2) the effect of chronic administration of methylphenidate, as well as the effects on symptomatology, 136 children with ADHD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: DSM-IV-TR criteria) were divided into subgroups using the "Children's Depression Inventory" (CDI). Blood samples were drawn at 20:00 and 09:00 h, and urine was collected between 21:00 and 09:00 h, at inclusion and after 4.61 ± 2.29 months of treatment. Melatonin and its urine metabolite were measured by radioimmunoassay RIA. Factorial analysis was performed using STATA 12.0. Melatonin was higher predominantly in hyperactive-impulsive/conduct disordered children (PHI/CD) of the ADHD subtype, without the influence of comorbid depressive symptoms. Methylphenidate ameliorated this comorbidity without induction of any changes in the serum melatonin profile, but treatment with it was associated with a decrease in 6-s-melatonin excretion in both ADHD subtypes. CONCLUSIONS: In untreated children, partial homeostatic restoration of disrupted neuroendocrine equilibrium most likely led to an increased serum melatonin in PHI/CD children. A differential cerebral melatonin metabolization after methylphenidate may underlie some of the clinical benefit.

Eficacia del valproato de sodio en el tratamiento profiláctico de la migraña / Efficacy of sodium valproate in the prophylactic treatment of migraine

Introducción: La migraña es un síndrome doloroso recurrente crónico acompañado de características neurológicas, objetivos: evaluar la eficacia del valproato de sodio en la profilaxis de la migraña a través de cambios en intensidad, dolor y frecuencia. Materiales y Métodos: Estudio prospectivo, longitudinal,experimental y aleatorio en 30 pacientes que recibieron en la 1ra semana 1 tableta/dia de valproato de sodio 500 mg vía oral y 2 tabletas/dia de 500 mg por 7 semanas más. Resultados: 97% refirió disminución de la intensidad del dolor. 97% estuvieron en la categoría 3 de frecuencia de crisis de migraña al mes 0; durante el 1er mes de tratamiento, se redujo al 0% y se mantuvo durante el 2do mes. Conclusiones: El tratamiento profiláctico de la migraña con valproato de sodio produce una disminución de la frecuencia e intensidad del dolor

Introduction: migraine is a chronic recurrent pain syndrome accompanied by neurological features. Objectives: evaluate the efficacy of sodium valproate in the migraine prophylactic, measuring pain intensity and frequency.Material and Methods: prospective, longitudinal, experiemental and randomized in 30 patients, each patient received in the 1st week 1 table/day of 500 mg for the next 7 weeks. Results: 97% reported decreased pain intensity. 97% were in category 3 of frequency of migraine attacks per month 0. during the 1 st month of treatment, it was reduced to 0% and remained during the 2nd month. Conclusions: prophylactic treatment of migraine with sodiumvalproate causes a decrease in pain intensity and frequency.

Entrenamiento de equipos interdisciplinares en urgencias obstétricas mediante simulación clínica / Training of interdisciplinary teams in obstetric emergencies through clinical simulation

Objetivo. Describir el programa de entrenamiento de equipos sanitarios en urgencias obstétricas graves mediante simulación clínica con un abordaje interdisciplinar, desarrollado en el Hospital virtual Valdecilla. Material y métodos. El programa fue dirigido a los profesionales implicados en la atención de la urgencia obstétrica (obstetras y ginecólogos, anestesiólogos, intensivistas y matronas). Se constituyó un equipo de trabajo para definir los objetivos, diseñar los escenarios y coordinar la realización de cada curso. Se dispuso dos salas de simulación con simuladores de pacientes, salas de control y sistemas de grabación audiovisual, un aula de análisis, un aula polivalente, y diverso material médico-quirúrgico. Para analizar los resultados de la actividad los participantes completaron una encuesta de evaluación. Resultados. Un total de 30 miembros de los equipos clínicos realizaron el entrenamiento en las entidades clínicas más frecuentemente implicadas en los casos de mortalidad materna (hemorragia postparto, embolismo de líquido amniótico y eclampsia), seleccionadas de los resultados de una encuesta de muerte materna enviada por correo a 69 hospitales españoles. Cada curso consistió en 3 casos clínicos realizados en quirófano, sala de puerperio y paritorio, seguidos de una sesión de análisis de la experiencia vivida. Los resultados valoraron como muy útil la experiencia vivida, destacaron la oportunidad que la simulación clínica brinda para practicar sin riesgo y entrenar el trabajo en equipo, y recomendarían su realización a otros compañeros. Conclusiones. El entrenamiento de profesionales sanitarios en urgencias obstétricas mediante simulación clínica con un abordaje interdisciplinar permite una práctica segura y efectiva de los algoritmos de diagnóstico y tratamiento, y de las habilidades de comunicación y trabajo en equipo, antes de enfrentarse a estas situaciones en la práctica diaria (AU)

Objectives. To describe the healthcare team training in obstetric emergencies using clinical simulation with an interdisciplinary approach, developed at the Hospital virtual Valdecilla. Material and methods. The program was aimed at health professionals involved in emergency obstetric care (obstetricians and gynecologists, anesthesiologists, intensivists and midwives). A working team was established to define the objectives, design the scenarios, and coordinate the completion of each course. Two simulation rooms were available with patient simulators, control rooms and audiovisual recording systems, an analysis room, a multipurpose classroom, and diverse medical and surgical equipment. To analyze the results of the program, the participants completed an evaluation survey. Results. A total of 30 members of clinical teams underwent training in the clinical entities most frequently involved in cases of maternal mortality (postpartum hemorrhage, amniotic fluid embolism and eclampsia), selected from the results of a survey of maternal death mailed to 69 Spanish hospitals. Each course consisted of three clinical cases performed in the operating room, postpartum and birthing room, followed by a debriefing session. Participants rated the courses as highly useful, highlighted the opportunity provided by clinical simulation to practice without risk and to train teamwork skills, and would recommend their peers to undergo the same training. Conclusions. Training of healthcare teams in obstetric emergencies using simulation with an interdisciplinary approach provides safe and effective practice of diagnostic and treatment algorithms, as well as of communication and teamwork skills, before these situations are met in daily practice (AU)

48,XXYY in a General Adult Psychiatry Department.

The 48,XXYY syndrome is a distinct clinical and genetic entity, with an incidence of 1:17,000 to 1:50,000 newborns. Patients often access mental healthcare services due to behavior problems, such as aggressiveness and impulsiveness, and are frequently intellectually disabled. We report a case of a patient with 48,XXYY syndrome treated in a general adult psychiatry department.A 23-year-old man was frequently admitted to our inpatient psychiatric unit (14 admissions in five years) due to disruptive behavior, including self harm, aggression to objects and animals, and fire-setting behavior, in a context of dysphoric mood and marked impulsivity. Upon observation, the patient had mild intellectual disability, with prominent impulsive and aggressive features and very low tolerance to frustration. His physical examination revealed hypertelorism, increased thickness of neck, acne, sparse body hair, triangular pubic hair distribution, fifth digit clinodactyly, small testicles and penis, and gynecoid pelvis. Laboratory analysis revealed endocrine abnormalities (low plasma testosterone and subclinical hypothyroidism). Cardiac Doppler sonogram was normal. Electroencephalogram revealed only a diffuse slowing electrogenesis, with no etiological specificity. Clinical suspicion of a chromosomal disorder was confirmed by a 48,XXYY karyotype. Subsequent magnetic resonance imaging detected discrete bilateral reduction of the hippocampal formations, possibly related to temporal dysgenesia. Psychopharmacological treatment options met moderate success, with lack of adherence. Other psychosocial treatment interventions ensued, including family therapy and psychoeducation. We underscore the need to be alert for chromosomal disorders, even in a general adult psychiatry department, as a minority of patients may reach adult care without proper diagnosis.