Rate of non-invasive follicular thyroid neoplasms with papillary-like nuclear features depends on pathologist's criteria: a multicentre retrospective Southern European study with prolonged follow-up.

PURPOSE: To determine the rate of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in a multi-institutional series from the Iberian Peninsula and describing this NIFTP cohort. METHODS: Retrospective study of papillary thyroid carcinoma (PTC) or well-differentiated tumours of uncertain malignant potential (WDT-UMP) diagnosed between 2005 and 2015 and measuring ≥5 mm in adult patients from 17 hospitals. Pathological reports were reviewed to determine the cases that fulfil the original criteria of NIFTP and histology was reassessed. Rates were correlated with the number of PTC and its follicular variant (FVPTC) of each institution. Demographic data, histology, management, and follow-up of the reclassified NIFTP cohort were recorded. RESULTS: A total of 182 cases with NIFTP criteria were identified: 174/3372 PTC (rate: 5.2%; range: 0-12.1%) and 8/19 WDT-UMP (42.1%). NIFTP rate showed linear correlation with total PTC (p: 0.03) and FVPTC (p: 0.007) identified at each centre. Ultrasound findings were non-suspicious in 60.1%. Fine-needle cytology or core biopsy diagnoses were undetermined in 49.7%. Most patients were treated with total thyroidectomy. No case had nodal disease. Among patients with total thyroidectomy, 89.7% had an excellent response evaluated 1 year after surgery. There were no structural persistence or relapses. Five patients showed residual thyroglobulin after 90 months of mean follow-up. CONCLUSIONS: NIFTP rate is low but highly variable in neighbouring institutions of the Iberian Peninsula. This study suggests pathologist's interpretation of nuclear alterations as the main cause of these differences. Patients disclosed an excellent outcome, even without using the strictest criteria.

On the Use of Dance as a Rehabilitation Approach for Children with Cerebral Palsy: A Single Case Study.

Cerebral Palsy (CP) is the most common motor disability in childhood. It is a group of permanent disorders that affect child development causing disorders of movement and posture and activity limitations. The impairment of psychomotor skills of children with Cerebral Palsy is attributed to a permanent alteration occurred in non-progressive brain development of the fetus or nursing infant. Some motor related symptoms can be treated using proper physical therapy. However, one of the biggest problems of the usual physical therapy is adherence to therapy. Ballet can be an alternative or a complement to physiotherapy, with the added attraction of not being part of a to therapy, but a fun activity with the extra reward associated with the realization of an artistic activity. For some years the ballet is used as therapeutically valuable for both children with cerebral palsy: Intensive ballet training can generate changes in the sensorimotor cortex. Ballet is characterized by a complex process of movements that have to be in a musical rhythm (hence have to be precise), in which there is an overall coordination of the muscles. It is also a highly motivating and rewarding activity that allows many children with CP sharing the activities of their peers without special needs. Objective measurements of the Full Port de Bras movement has been chosen as an index of improvement. The results shows progressive improvements of the execution in a single case.

Tratamiento con ribavirina de la infección crónica por el virus de la hepatitis E en pacientes trasplantados / Treatment with ribavirin of hepatitis E virus chronic infection in transplanted patients

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Circulating biomarkers of collagen metabolism in arterial hypertension: relevance of target organ damage.

OBJECTIVE: Increasing experimental evidence indicates that alterations in the extracellular matrix are implicated in hypertension and its chronic complications. Selected markers of extracellular matrix metabolism were investigated as potential biomarkers for hypertensive remodelling and correlated with the severity and extent of target organ damage (TOD) in patients with essential hypertension. METHODS: We studied 159 consecutive patients being treated for essential hypertension. An exhaustive evaluation of the heart, kidney and blood vessel damage was performed, and plasma levels of plasma procollagen type I (PICP), matrix metalloproteinase-1 (MMP-1) and its inhibitor (tissue inhibitor metalloproteinase-1, TIMP-1) were determined. Patients were categorized into four groups: no TOD (33 patients), level 1 TOD (52 patients), level 2 TOD (44 patients) and level 3 TOD (30 patients). RESULTS: The serum levels of MMP-1 and TIMP-1 were higher in patients with TOD than in hypertensive patients without TOD. Increasing levels of these molecules were progressively associated with an increase in the number of organs damaged, with highest levels of markers in patients with level 3 TOD (heart, kidney and blood vessels). There were no differences in PICP levels between groups. We found a slight but significant correlation between TIMP-1 and all hypertensive organ damage. Logistic regression analysis showed that age, smoking, diabetes mellitus, abdominal perimeter, MMP-1 and TIMP-1 were independently related to the level of TOD. CONCLUSION: Circulating concentration of MMP-1 and TIMP-1 is associated with an extended hypertensive disease, with more TOD. TIMP-1 may have a role as a biomarker of total remodelling burden in hypertensive patients.

Inflamación y apoptosis en la hipertensión arterial. Importancia de la extensión de la lesión de órgano diana / Inflammation and apoptosis in hypertension. Relevance of the extent of target organ damage

Introducción y objetivos. Analizar la relación entre parámetros inflamatorios y marcadores de apoptosis con la gravedad y la extensión de la lesión de órgano diana en pacientes con hipertensión arterial esencial. Métodos. Se ha reclutado, de manera consecutiva, a 159 pacientes hipertensos tratados, a los que se realizó un estudio exhaustivo de daño orgánico cardiaco, renal y vascular, y se determinaron las concentraciones plasmáticas de diferentes moléculas relacionadas con la inflamación (interleucina 6 y receptor soluble tipo 2 del factor de necrosis tumoral alfa) y apoptosis (receptor soluble tipo 1 del factor de necrosis tumoral alfa y receptor soluble Fas). Se dividió a los pacientes en cuatro grupos: a) sin lesión de órgano diana (33 pacientes); b) lesión a un nivel (52 pacientes); c) lesión a dos niveles (44 pacientes) y d) lesión a tres niveles (30 pacientes). Resultados. Los pacientes con lesión de órgano diana presentaban valores plasmáticos significativamente más elevados de interleucina 6, receptor soluble tipo 1 del factor de necrosis tumoral alfa y receptor soluble tipo 2 del factor de necrosis tumoral alfa que los pacientes hipertensos sin lesión orgánica. Además se objetivó un incremento progresivo de estos marcadores a medida que aumentaba el número de lesiones con las cifras plasmáticas más elevadas en los pacientes con lesión de órgano diana a tres niveles (cardiaco, renal y vascular). No hubo diferencias en el receptor soluble Fas entre las diferentes poblaciones. El análisis de regresión logística mostró que los valores plasmáticos de interleucina 6 y receptor soluble tipo 1 del factor de necrosis tumoral alfa, junto con edad, diabetes, tabaquismo y perímetro abdominal, se asociaban de manera independiente con el número de lesiones de órgano diana. Conclusiones. Una enfermedad hipertensiva más generalizada y con mayor número de órganos diana afectados se asocia a mayor activación inflamatoria y apoptótica en pacientes hipertensos (AU)

Introduction and objectives. To investigate the relationship between inflammatory and apoptotic parameters and the severity and extent of target organ damage in patients with essential hypertension. Methods. We studied 159 consecutive patients with treated essential hypertension. An exhaustive evaluation of damage to heart, kidney, and blood vessels was performed and plasma levels of inflammatory (interleukin 6 and soluble receptor of tumor necrosis factor-alpha type 2) and apoptotic markers (soluble receptor of tumor necrosis factor-alpha type 1 and soluble Fas receptor) were determined. Patients were categorized into four groups: a) no organ damage (33 patients); b) 1 organ damaged (52 patients); c) 2 organs damaged (44 patients), and d) 3 organs damaged (30 patients). Results. Serum levels of interleukin 6, soluble receptor of tumor necrosis factor-alpha type 1 and soluble receptor of tumor necrosis factor-alpha type 2 were higher in patients with target organ damage than in hypertensive patients without organ damage. Increasing levels of these molecules were progressively associated with an increase in the number of organs damaged, and the highest levels were observed in the group with damage to 3 organs (heart, kidney, and blood vessels). There were no differences in soluble Fas receptor levels between groups. Logistic regression analysis showed that age, smoking, diabetes mellitus, abdominal circumference, interleukin 6, and soluble receptor of tumor necrosis factor-alpha type 1 were independently related to the number of target organs damaged. Conclusions. Extensive hypertensive disease with involvement of more target organs was associated with greater inflammatory and apoptotic activation in these hypertensive patients (AU)

Inflammation and apoptosis in hypertension. Relevance of the extent of target organ damage.

INTRODUCTION AND OBJECTIVES: To investigate the relationship between inflammatory and apoptotic parameters and the severity and extent of target organ damage in patients with essential hypertension. METHODS: We studied 159 consecutive patients with treated essential hypertension. An exhaustive evaluation of damage to heart, kidney, and blood vessels was performed and plasma levels of inflammatory (interleukin 6 and soluble receptor of tumor necrosis factor-alpha type 2) and apoptotic markers (soluble receptor of tumor necrosis factor-alpha type 1 and soluble Fas receptor) were determined. Patients were categorized into four groups: a) no organ damage (33 patients); b) 1 organ damaged (52 patients); c) 2 organs damaged (44 patients), and d) 3 organs damaged (30 patients). RESULTS: Serum levels of interleukin 6, soluble receptor of tumor necrosis factor-alpha type 1 and soluble receptor of tumor necrosis factor-alpha type 2 were higher in patients with target organ damage than in hypertensive patients without organ damage. Increasing levels of these molecules were progressively associated with an increase in the number of organs damaged, and the highest levels were observed in the group with damage to 3 organs (heart, kidney, and blood vessels). There were no differences in soluble Fas receptor levels between groups. Logistic regression analysis showed that age, smoking, diabetes mellitus, abdominal circumference, interleukin 6, and soluble receptor of tumor necrosis factor-alpha type 1 were independently related to the number of target organs damaged. CONCLUSIONS: Extensive hypertensive disease with involvement of more target organs was associated with greater inflammatory and apoptotic activation in these hypertensive patients.

[Myocardial remodeling and immunologic activation in patients with heart failure]. / Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: Immune response-mediated regulation of myocardial collagen remains poorly understood. Our objective was to investigate the relationship between ventricular remodeling and immunologic activation in patients with heart failure (HF) by comparing dilated and ischemic cardiomyopathy. METHODS: We studied 94 patients with HF and dilated cardiomyopathy (n=46) or ischemic cardiomyopathy (n=48). We recorded left ventricular (LV) volumes, E/A ratio, and ejection fraction. Plasma concentrations of tumor necrosis factor alpha (TNFalpha), soluble TNFa receptor I (sTNF-RI), sTNF-RII, interleukin-6 (IL-6) and IL-10 were measured. The serum procollagen type-III amino-terminal propeptide (PIIINP) level was also obtained. RESULTS: Ventricular volumes were greater in the dilated cardiomyopathy than in the ischemic cardiomyopathy group (P< .05). However, sTNF-RI, sTNF-RII and PIIINP levels were higher in the ischemic group (P< .05). In this group, there were significant correlations between ventricular volumes and IL-10 and sTNF-RII levels. There was also a significant correlation between PIIINP and sTNF-RII levels (r=0.30; P< .05). In the dilated cardiomyopathy group, there was a significant correlation between ventricular volumes and IL-10 level, and between PIIINP level and IL-6 (r=0.32; P< .05) and sTNF-RII levels (r=0.32; P< .05). Multiple linear regression analysis, which included cytokine levels, age, sex and ventricular function, showed that the sTNF-RII level was an independent predictor of the PIIINP level (adjusted r(2)=0.16; P< .0001) and of ventricular volumes (LV end-systolic volume index, adjusted r(2)=0.034; P< .05; and LV end-diastolic volume index, adjusted r(2)=.048; P< .05) in both groups. CONCLUSIONS: In HF, there is an interaction between proinflammatory cytokines and the extracellular matrix. Immunologic implications vary according to disease etiology. The elevation in proinflammatory cytokine and PIIINP levels is greater in patients with ischemic cardiomyopathy. Multiple regression analysis showed that the sTNF-RII level was an independent predictor of ventricular remodeling.

Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca / Myocardial remodeling and immunologic activation in patients with heart failure

Introducción y objetivos. No se comprende bien la regulación del colágeno miocárdico mediada por la respuesta inmunitaria. Nuestro objetivo fue determinar las relaciones entre remodelado ventricular y activación inmunitaria en pacientes con insuficiencia cardiaca comparando miocardiopatía isquémica y dilatada. Métodos. Estudiamos a 94 pacientes con insuficiencia cardiaca: miocardiopatía dilatada (n = 46) e isquémica (n = 48). Determinamos volúmenes ventriculares, E/A y FE. Medimos las concentraciones de TNFα, sTNF-RI, sTNF-RII, IL-6 e IL-10 y calculamos los valores de PIIINP. Resultados. Los volúmenes ventriculares en la miocardiopatía dilatada fueron superiores a los del grupo isquémico (p < 0,05). Sin embargo, los valores de sTNF-RI, sTNF-RII y PIIINP fueron más elevados en el grupo isquémico (p < 0,05). En éste, los volúmenes ventriculares se correlacionaron significativamente con IL-10 y sTNF-RII. El PIIINP se correlacionó significativamente con sTNF-RII (r = 0,30; p < 0,05). En el grupo de miocardiopatía dilatada, los volúmenes ventriculares se correlacionaron significativamente con IL-10 y el PIIINP se correlacionó con IL-6 (r = 0,32; p < 0,05) y sTNF-RII (r = 0,32; p < 0,05). La regresión lineal múltiple, que incluyó citocinas, edad, sexo y función ventricular, demuestra que el sTNF-RII es un factor pronóstico independiente del PIIINP (r² ajustada = 0,16; p < 0,0001) y de los volúmenes ventriculares (IVTSVI, r² ajustada = 0,034; p < 0,05; IVTDVI, r² ajustada = 0,048; p < 0,05) en ambos grupos. Conclusiones. En la insuficiencia cardiaca hay una interacción de citocinas proinflamatorias con la matriz extracelular. La implicación inmunitaria es diferente dependiendo de la etiología. Las citocinas proinflamatorias y los valores de PIIINP son más elevados en los pacientes con miocardiopatía isquémica. La regresión múltiple demostró que el sTNF-RII es un factor pronóstico independiente de remodelado ventricular (AU)

Introduction and objectives. Immune response-mediated regulation of myocardial collagen remains poorly understood. Our objective was to investigate the relationship between ventricular remodeling and immunologic activation in patients with heart failure (HF) by comparing dilated and ischemic cardiomyopathy. Methods. We studied 94 patients with HF and dilated cardiomyopathy (n=46) or ischemic cardiomyopathy (n=48). We recorded left ventricular (LV) volumes, E/A ratio, and ejection fraction. Plasma concentrations of tumor necrosis factor α (TNFα), soluble TNFa receptor I (sTNF-RI), sTNF-RII, interleukin-6 (IL-6) and IL-10 were measured. The serum procollagen type-III amino-terminal propeptide (PIIINP) level was also obtained. Results. Ventricular volumes were greater in the dilated cardiomyopathy than in the ischemic cardiomyopathy group (P<.05). However, sTNF-RI, sTNF-RII and PIIINP levels were higher in the ischemic group (P<.05). In this group, there were significant correlations between ventricular volumes and IL-10 and sTNF-RII levels. There was also a significant correlation between PIIINP and sTNF-RII levels (r=0.30; P<.05). In the dilated cardiomyopathy group, there was a significant correlation between ventricular volumes and IL-10 level, and between PIIINP level and IL-6 (r=0.32; P<.05) and sTNF-RII levels (r=0.32; P<.05). Multiple linear regression analysis, which included cytokine levels, age, sex and ventricular function, showed that the sTNF-RII level was an independent predictor of the PIIINP level (adjusted r²=0.16; P<.0001) and of ventricular volumes (LV end-systolic volume index, adjusted r²=0.034; P<.05; and LV end-diastolic volume index, adjusted r²=.048; P<.05) in both groups. Conclusions. In HF, there is an interaction between proinflammatory cytokines and the extracellular matrix. Immunologic implications vary according to disease etiology. The elevation in proinflammatory cytokine and PIIINP levels is greater in patients with ischemic cardiomyopathy. Multiple regression analysis showed that the sTNF-RII level was an independent predictor of ventricular remodeling (AU)