Diagnostic Interval in Extranodal Non-Hodgkin Head and Neck Lymphomas.

The aim of this study is to measure the diagnostic interval (DI) of primary extranodal non-Hodgkin lymphomas (PE-NHL) affecting the head and neck and to discover any associated factors. With this aim, we performed a retrospective observational study in northwestern Spain on patients diagnosed between 1 January 2005 and 1 January 2016. A search was made across the electronic health records of the public health system of this region (SERGAS). DI was used as the dependent variable, and different clinicopathological data of the corresponding patients and tumors were analyzed as exposure variables. PE-NHLs were mostly located in Waldeyer's ring, and they presented a B phenotype and had a median DI of 65 days. Shorter diagnostic intervals were observed in (1) PE-NHL patients who had comorbidities (p = 0.02), (2) PE-NHL that caused symptoms of dysphagia (p = 0.04), (3) tumors with the highest proliferative activity (Ki67 > 80%) (p = 0.04), and (4) tumors diagnosed in the advanced stages of the disease (p = 0.004). Univariate analysis revealed a significant association between dysphagia and a shorter DI. We conclude that raising awareness about these neoplasms and warning about the presenting symptoms can contribute to earlier diagnoses of these tumors and to better outcomes.

Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy (OMT). However, many patients may not be under OMT when the CRT device is implanted. Here, we evaluate the long-term benefits of CRT in symptomatic HF patients receiving or not OMT. METHODS: We investigated the effect of OMT on HF developing or death in 328 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. After the CRT implant, we categorized the patients into three groups: no OMT, OMT at baseline and after 1 year of follow-up, and OMT only at the 1-year follow-up but not at baseline. We used multivariate Cox proportional hazards model to determine the effect of OMT on clinical outcomes. RESULTS: One hundred and twenty-two patients (37.2%) received OMT prior to CRT. OMT at baseline was not associated with a reduced risk of death or HF (HR 0.72; 95% CI 0.50-1.02; P = 0.067) compared with no-basal-OMT patients. After CRT, patients without OMT had a higher risk of death or HF than patients who received OMT in follow-up (HR 1.72, 95% CI 1.07-2.78, P = 0.025), and the risk of the patients who received OMT at baseline and at the 1-year follow-up was similar to that of the patients who achieved OMT at the 1-year follow-up (HR 0.90, 95% CI 0.54-1.50, P = 0.682). CONCLUSION: Basal OMT prior to CRT is not associated with better outcomes in terms of HF/death compared with no basal OMT. The subgroup of patients who achieved OMT at the 1-year follow-up exhibited a reduced risk of HF and death compared with patients who did not.

Biocompatibility of agarose gel as a dermal filler: histologic evaluation of subcutaneous implants.

BACKGROUND: The search for safe and effective tissue fillers has been an ongoing effort in plastic and cosmetic surgery over recent decades. Biocompatibility is a prerequisite for any substance to be used as an implant material, and potential biomaterials need to be characterized by histologic evaluation of tissue responses. Collagen is a well-known tissue filler. Agarose gel is widely used in bioengineering. Both products are considered biocompatible. The purpose of this study was to evaluate the bioactivity of agarose gel as a dermal filler compared with collagen. METHODS: Tissue responses to agarose gel and collagen were evaluated in a rat in vivo model (n = 96). Four groups were evaluated: group 1 (n = 24), rats with agarose gel implants; group 2 (n = 24), rats with collagen implants; group 3, a placebo group (n = 24); and group 4, a control group (n = 24). Responses and biocompatibility were assessed by histopathologic and histomorphometric evaluation at 1 week to 8 months after implantation. RESULTS: Agarose gel showed marked bioactivity and biodegradation, although the implants integrated well into tissues: newly formed collagen bands were observed inside the implants and no granulomas were detected. Collagen implants showed low cell infiltration and a significant loss of product over time. CONCLUSIONS: Agarose gel is a biocompatible product that can be considered for use as a tissue filler. Further investigation is required to assess its long-term efficacy and safety.