The overlap with metabolic dysfunction-associated steatotic liver disease negatively affects outcomes of primary biliary cholangitis.

BACKGROUND AND AIMS: The relationship between primary biliary cholangitis (PBC) and metabolic dysfunction-associated steatotic liver disease, and its impact on treatment response and prognosis, remains underexplored. METHODS: Patient cohort from two centres comprising long-term follow-up data. All patients had histologically confirmed PBC. Biopsies were classified according to Non-Alcoholic Steatohepatitis Clinical Research Network. Diagnosis of metabolic dysfunction-associated steatotic liver disease was established when steatosis exceeded 5%, along with at least one metabolic risk factor. Patients with specific aetiologies of steatosis, other liver diseases, incomplete results and inadequate treatment with ursodeoxycholic acid were excluded. Data from patients initiating second-line treatment were censored. Treatment response was assessed using the Toronto, Paris II and AST-to-platelet at 12-month criteria. The UK PBC and Globe scores, and liver events were utilized as outcome measures. RESULTS: The study included 129 patients, 36 showing histologically confirmed overlap between PBC and steatosis. Patients with overlap showed worse prognosis according to Paris II (61.1% vs. 33.3%, p = 0.004), Toronto (52.5% vs. 24.7%, p = 0.002), AST-to-platelet 12-month >0.54 (36.1% vs. 17.2%, p = 0.021), Globe >0.30 (49.2% vs. 29.2%, p = 0.033) and UK PBC at 5, 10 and 15 years (p ≤ 0.001). Liver-related mortality and liver transplant were more prevalent in the overlap group (p = 0.001). In the multivariate analysis, steatosis, dyslipidaemia and advanced fibrosis were independently associated to worse outcomes. CONCLUSIONS: Our findings suggest that metabolic dysfunction-associated steatotic liver disease worsens the prognosis of PBC.

The loss of crude oil droplets by filter feeders and the role of surfactants.

Various methods of oil spill remediation exist, e.g., floating booms, controlled burning and the release of chemical surfactants. These surfactants facilitate the breakup of the slick into micron-sized droplets. Here, we studied the impact such a surfactant has on the size distribution of oil droplets in the water column and in the gut of the filter feeder Daphnia magna. We also studied the effect of surfactants on detachment conditions of chemically and mechanically dispersed oil (respectively MDO and CDO) droplets from capture fibers. Our results show that including solubilized dioctyl sulfosuccinate sodium salt in the mixing of the emulsion produces smaller droplets and a narrower size distribution in the water. In the gut, the size of ingested droplets does not change whether the oil is mixed mechanically or chemically. Also, surfactant coated droplets detach at a lower velocity than mechanically dispersed droplet because of their lower oil/water interfacial tension.

Cervical and oral human papillomavirus infection in women living with human immunodeficiency virus (HIV) and matched HIV-negative controls in Brazil.

BACKGROUND: Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil. MATERIAL AND METHODS: Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients' medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12. RESULTS: HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa. CONCLUSION: Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.

Factores asociados a la Emoción Expresada familiar en la Esquizofrenia: implicaciones terapéuticas / Factors associated with Family Expressed Emotion in Schizophrenia: therapeutic implications

Desde las primeras descripciones de la esquizofrenia se sospechó acerca de la contribución de la familia al establecimiento y curso de la enfermedad. En la segunda mitad del siglo XX surge el concepto de emoción expresada para referirse al estilo de comunicación prevalente dentro de una familia. La alta emoción expresada, determinada por altos niveles de criticismo, hostilidad o sobreimplicación emocional hacia el paciente, está reconocida como uno de los mejores predictores ambientales de recaída en esquizofrenia. Se han investigado posibles variables asociadas a la emoción expresada, incluidas características del paciente, familiares, de la enfermedad, cultura, etc. Las intervenciones familiares disminuyen el número de recaídas mediante la reducción de la expresión emocional, el estrés y la carga familiar. El modelo de atención comunitaria en el trastorno mental grave debe implicar el compromiso de dotar a la familia del paciente de las herramientas suficientes para afrontar la enfermedad de forma digna (AU)

From the first descriptions of schizophrenia has been suspected the contribution of the family to the establishment and course of the disease. In the second half of the 20th century the concept of Expressed emotion emerged as referring the prevalent style of family communication. High expressed emotion, determined by high levels of criticism, hostility or emotional over-involvement towards the patient, is recognized as one of the best environmental predictors of relapse in schizophrenia. It has been investigated potential factors associated with expressed emotion, including characteristics of the patient, family, of the disease, culture, etc. Family interventions decrease the number of relapses by the reduction of emotional expression, stress and family burden. The model of community- based healthcare in severe mental disorder must involve commitment to provide the family of the patient of the necessary tools to deal with the disease in a dignified manner (AU)

Déficit de cognición social en el trastorno bipolar: relevancia y estrategias de rehabilitación / Social cognition deficit in bipolar disorder: relevance and rehabilitation strategies

Introducción: El trastorno afectivo bipolar (TAP) está asociado con un significativo deterioro en el funcionamiento social, laboral y familiar, incluso en períodos de estabilidad clínica, y ello podría explicarse por un déficit de la cognición social. Objetivo: Revisar los principales hallazgos sobre la cognición social de los pacientes bipolares, a través de sus principales dimensiones y a través de las distintas fases de la enfermedad. Método: Búsqueda en la literatura biomédica en Medline, OVID, Proquest y EMBASE, cruzando los términos MeSH cognición social, teoría de la mente, reconocimiento de emociones, empatía y procesamiento emocional con trastorno bipolar, delimitando los resultados a los estudios clínicos con calidad metodológica media/alta, en español o inglés, y publicados en los últimos 20 años en la población infantil y adulta. Resultados: Se seleccionaron 83 artículos que se referían al tema, aunque sólo 16 evalúan específicamente la cognición social en población bipolar. La mayoría de estudios muestran un déficit tanto en las fases de descompensación como en estado de eutimia. Discusión: Desde una perspectiva neurocognitiva se plantean diversas explicaciones a estas alteraciones cognitivas, asociadas con la existencia de sintomatología subsindrómica afectiva. Finalmente, se revisan las estrategias rehabilitadoras que podrían ser de utilidad para revertir este déficit que conlleva importantes repercusiones funcionales...

Introduction: Bipolar disorder (BD) is associated with significant impairment in social, work, and family functioning, even in euthymic state. This could be explained by a social cognition deficit. Objective: To review the findings on social cognition in bipolar patients through its main dimensions, and through the various stages of the illness. Method: We searched the biomedical literature on Medline, OVID, Proquest, and EMBASE for articles matching the MeSH terms “social cognition”, “theory of mind”, “emotion recognition”, “empathy”, and “emotional processing” to “bipolar disorder”, limiting the results to clinical studies with medium/high methodological quality, in Spanish or English and published in the last 20 years, in children and adults. Results: We selected 83 items referring to this topic but only 24 specifically assessed social cognition in bipolar population. Most studies showed a deficit in both the phases of relapse as well as in euthymic state. Discussion: From a neurocognitive perspective a number of explanations arise for this cognitive impairment, associated with the existence of subsyndromal affective symptoms. Finally, we review the rehabilitation strategies that could be useful to reverse this deficit that carries important functional implications...

Subcutaneous atypical fibrous histiocytoma.

Benign fibrous histiocytoma is one of the most frequent benign neoplasms mainly composed of a mixture of fibroblastic and histiocytic cells, especially found in the skin (dermatofibroma), particularly in the limbs. The diagnosis of cutaneous benign fibrous histiocytoma is generally easy; however, rare variants may be difficult to identify, and the diagnosis only confirmed after exhaustive histopathological examination. Thus, deep subcutaneous dermatofibroma may be difficult to distinguish from dermatofibrosarcoma protuberans and dermatofibroma with monster giant cells from malignant fibrous histiocytoma and atypical fibroxanthoma. We report a case of a 38-year-old woman with a painless swelling on the abdominal wall, which was totally excised and histopathologically diagnosed as subcutaneous atypical fibrous histiocytoma. The lesion was deeply located within the subcutaneous tissue and consisted of interlacing fascicles of predominant histiocyte-like spindle cells intermingled with pleomorphic giant cells with bizarre large nuclei (bilobed and multilobed) and prominent eosinophilic nucleoli. Only 1 mitotic figure was found in the whole lesion. Prominent hyaline collagen bundles surrounded by tumor cells were observed, predominantly at the periphery of the lesion. Immunohistochemical study showed positivity only for vimentin and factor XIIIa, whereas pan-keratins, actin, desmin, CD34, CD10, and S-100 protein were negative. Recognition of dermatofibroma is important, allowing sequential excision and optimal results. Definitive diagnosis, although especially difficult in our case, is established by characteristic histological and immunohistochemical criteria. To the best of our knowledge, we report the first case of subcutaneous fibrous histiocytoma with monster cells.

Variación del valor pronóstico de la proteína p53 en relación con el estadio tumoral en pacientes con adenocarcinoma colorrectal / Variation in the prognostic value of p53 protein in relation to tumoral stage in patients with colorectal adenocarcinoma

Objetivo. Analizar el valor pronóstico que posee la proteína p53 en cada estadio tumoral, como indicador de riesgo de recidiva. Pacientes y método. Estudio prospectivo de una cohorte de 288 pacientes intervenidos por adenocarcinoma colorrectal. Cuarenta y dos pacientes (14,6%) se encontraban en estadio I de la clasificación TNM (tu-mor-nodo-metástasis); 144 (50%), en estadio II, y 102 (35,4%), en estadio III. Se analizaron, en muestras tu-morales fijadas en formol y parafinadas, variables histopatológicas y se determinaron mediante inmunohistoquímica las proteínas p53 (anticuerpo DO7) y PCNA (proliferative cell nuclear antigen) (anticuerpo PC10). Se analizaron los resultados de p53 en cada una de las categorías de las variables clínicas e histopatológicas. Se calculó la supervivencia sin recidiva mediante el método de Kaplan-Meier. Se analizó el valor de cada variable como indicador predictivo de aparición de recidiva tumoral mediante análisis de regresión de Cox. Se calcularon las hazard ratio y los intervalos de confianza (IC) del 95%, como indicadores del riesgo relativo. El análisis se aplicó en toda la cohorte de pacientes y, posteriormente, fue repetido en cada estadio tumoral TNM por separado. Resultados. Los tumores con sobreexpresión de proteína p53 desarrollaron con mayor frecuencia recidiva tumoral y presentaron menor supervivencia sin recurrencia a los 5 años de seguimiento. Sin embargo, únicamente en los tumores en estadio III la asociación entre expresión de p53 y evolución postoperatoria alcanzó significación estadística. En este subgrupo de pacientes, la supervivencia sin recidiva a los 60 meses de seguimiento fue del 60% en los tumores con p53 negativo y del 26% en aquellos con p53 positivo (p = 0,010). En el análisis multivariante, p53 se mostró como un factor pronóstico independiente asociado a un riesgo elevado de recidiva en tumores en estadio III (hazard ratio = 2,76; IC del 95%, 1,29-5,9; p = 0,009). La sobreexpresión de p53 aportó valor pronóstico como indicador de riesgo elevado de recidiva en forma de metástasis (hazard ratio = 2,23; IC del 95%, 1,04-4,75) y no como factor pronóstico de recidiva locorregional. No se observó relación entre el estado de la proteína p53 y el efecto de la quimioterapia adyuvante postoperatoria. Conclusión. La proteína p53 no posee el mismo valor como factor pronóstico en todos los estadios tu-morales. Esta proteína únicamente posee valor predictivo indicativo de riesgo elevado de recidiva en el subgrupo de pacientes con tumores en estadio III (AU)

Objective. To analyze the prognostic value of p53 protein as a marker of recurrence risk in each tumoral stage. Patients and method. A prospective study of a cohort of 288 patients who underwent surgery for colo-rectal adenocarcinoma was performed. Stage 1 of the tumor-node-metastasis (TNM) classification was found in 42 patients (14.6%), stage II in 144 (50%) and stage III in 102 (35.4%). Histopathological variables were examined in tumor samples fixed in formol and embedded in paraffin and p53 (DO7 antibody) and proliferative cell nuclear antigen (PC-10 antibody) proteins were determined using immunohistochemistry. The results of p53 were analyzed in each of the categories of clinical and histopathological variables. Recurrence-free survival was calculated using the Kaplan-Meier method. The value of each variable as a predictive marker for tumoral recurrence was analyzed using Cox regression analysis. Hazard ratios and 95% confidence intervals were calculated as indicators of relative risk. The analysis was applied to the whole cohort and was subsequently repeated in each TNM tumoral stage separately. Results. Tumors with p53 protein overexpression more frequently recurred and showed lower recurren-ce-free survival at 5 years. However, the association between p53 expression and postoperative outcome was statistically significant in stage III tumors only. In this subgroup of patients, recurrence-free survival at 60 months was 60% in p53-negative tumors and was 26% in p53-positive tumors (p = 0.010). In the multivariate analysis, p53 was an independent prognostic factor associated with a high risk of recurrence in stage III tumors (hazard ratio = 2.76; 95% CI, 1.29-5.9; p = 0.009). Overexpression of p53 showed prognostic value as a marker of high risk of recurrence in the form of metastases (hazard ratio = 2.23; 95% CI, 1.04-4.75), but not as a prognostic marker of locoregional recurrence. No relationship was found between the state of p53 protein and the effect of postoperative adjuvant therapy. Conclusion. The p53 protein does not have the same prognostic value in all tumoral stages. This protein is only predictive of high recurrence risk in the subgroup of patients with stage III tumors (AU)

[Variation in the prognostic value of p53 protein in relation to tumoral stage in patients with colorectal adenocarcinoma]. / Variación del valor pronóstico de la proteína p53 en relación con el estadio tumoral en pacientes con adenocarcinoma colorrectal.

OBJECTIVE: To analyze the prognostic value of p53 protein as a marker of recurrence risk in each tumoral stage. PATIENTS AND METHOD: A prospective study of a cohort of 288 patients who underwent surgery for colorectal adenocarcinoma was performed. Stage 1 of the tumor-node-metastasis (TNM) classification was found in 42 patients (14.6%), stage II in 144 (50%) and stage III in 102 (35.4%). Histopathological variables were examined in tumor samples fixed in formol and embedded in paraffin and p53 (DO7 antibody) and proliferative cell nuclear antigen (PC-10 antibody) proteins were determined using immunohistochemistry. The results of p53 were analyzed in each of the categories of clinical and histopathological variables. Recurrence-free survival was calculated using the Kaplan-Meier method. The value of each variable as a predictive marker for tumoral recurrence was analyzed using Cox regression analysis. Hazard ratios and 95% confidence intervals were calculated as indicators of relative risk. The analysis was applied to the whole cohort and was subsequently repeated in each TNM tumoral stage separately. RESULTS: Tumors with p53 protein overexpression more frequently recurred and showed lower recurrence-free survival at 5 years. However, the association between p53 expression and postoperative outcome was statistically significant in stage III tumors only. In this subgroup of patients, recurrence-free survival at 60 months was 60% in p53-negative tumors and was 26% in p53-positive tumors (p=0.010). In the multivariate analysis, p53 was an independent prognostic factor associated with a high risk of recurrence in stage III tumors (hazard ratio=2.76; 95% CI, 1.29-5.9; p=0.009). Overexpression of p53 showed prognostic value as a marker of high risk of recurrence in the form of metastases (hazard ratio=2.23; 95% CI, 1.04-4.75), but not as a prognostic marker of locoregional recurrence. No relationship was found between the state of p53 protein and the effect of postoperative adjuvant therapy. CONCLUSION: The p53 protein does not have the same prognostic value in all tumoral stages. This protein is only predictive of high recurrence risk in the subgroup of patients with stage III tumors.

[PCNA and Ki-67 expression in locally confined renal adenocarcinoma. Relationship with various histopathologic variables and prognostic significance]. / Expresión de PCNA y Ki-67 en el adenocarcinoma renal localmente confinado. Relación con diferentes variables histopatológicas y significación pronóstica.

OBJECTIVE: PCNA and Ki-67 expression are used as markers of cellular proliferation and different studies have investigated their value as prognostic indicators for renal adenocarcinoma. The aim of this study was to determine PCNA and Ki-67 expression in locally confined renal adenocarcinoma, their relationship with other histopathological variables and prognostic significance. METHODS: 58 cases of renal adenocarcinoma stages pT1-T3a N0 M0 (TNM 1997), treated by curative radical or partial nephrectomy were reviewed. The clinical and histopathological variables were analyzed. PCNA and Ki-67 expression in tissue embedded in paraffin were studied by immunohistochemical techniques. RESULTS: The mean percentage of nuclei that stained for PCNA was 7.03% (range 0-50%). Analysis of the correlation between PCNA and histopathological variables (size, grade and stage), showed a statistically significant correlation of PCNA only for the nuclear grade (p = 0.009). The mean percentage of nuclei that stained for Ki-67 expression was 2.96% (range 0-30%) and a relationship was found for size (p < 0.001), nuclear grade (p < 0.001) and stage (p < 0.001). The incidental clinical presentation, tumor size, stage, nuclear grade, PCNA and Ki-67 expression showed a relationship with survival. However, only perirenal fat infiltration, tumor size, nuclear grade and PCNA expression were found to be independent factors by multivariate analysis. CONCLUSIONS: PCNA expression correlated with nuclear grade, while Ki-67 demonstrated a significant correlation with tumor size, grade and stage. Survival analysis showed a relationship of both markers with prognosis. However, only PCNA was found to be an independent factor by multivariate analysis.

Expresión de PCNA y Ki-67 en el adenocarcinoma renal localmente confinado. Relación con diferentes variables histopatológicas y significación pronóstica / PCNA and Ki-67 expression in locally confined renal adenocarcicoma: Correlation with different histopathological variables and prognostic significance

OBJETIVO: La expresión de PCNA y Ki-67 se utilizan como indicadores de proliferación celular, habiéndose relacionado en diferentes estudios con el pronóstico del adenocarcinoma renal. El objetivo de este estudio es determinar la expresión de PCNA y Ki-67 en el adenocarcinoma renal localmente confinado, así como sus relaciones con diferentes variables histopatológicas y sus implicaciones pronósticas.MÉTODO: 58 adenocarcinomas renales, estadios pT1T3a N0 M0 (TNM 1997), tratados mediante nefrectomía radical o parcial con intención curativa. Analizamos variables clínicas e histopatológicas, así como la expresión de PCNA y Ki-67 en tejido parafinado mediante técnicas de inmunohistoquímica.RESULTADOS: El porcentaje medio de núcleos teñidos fue de 7,03 por ciento para PCNA, con un rango comprendido entre 0 y 50 por ciento. Cuando analizamos la relación de PCNA con variables histopatológicas (tamaño, grado y estadio), sólo encontramos asociación estadísticamente significativa de este marcador con el grado nuclear (p=0,009). En cuanto a la expresión de Ki-67, el porcentaje medio de núcleos teñidos fue del 2,96 por ciento, con un intervalo comprendido entre 0 y 30 por ciento, relacionándose ésta con el tamaño (p<0,001), el grado nuclear (p<0,001) y el estadio (p<0,001). La presentación clínica incidental, el tamaño tumoral, el estadio, el grado nuclear y la expresión de PCNA y Ki-67 demostraron relación con la supervivencia, pero en el análisis multivariante sólo la invasión de la grasa perirrenal, el tamaño, el grado nuclear y la expresión de PCNA se comportaron como factores independientes.CONCLUSIONES: La expresión de PCNA sólo se relacionó con el grado nuclear, mientras que el Ki-67 se asoció de forma muy significativa con el tamaño, el grado y el estadio. En el análisis de supervivencia ambos marcadores se relacionaron con el pronóstico, aunque sólo el PCNA se comportó como factor independiente en el análisis multivariante (AU)