Cuantificación absoluta de la captación miocárdica de 99mTc-DPD en pacientes con amiloidosis cardiaca por depósitos de transtiretina (ATTR) / Absolute quantification of myocardial uptake of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR)

Objetivo Determinar la contribución diagnóstica de la cuantificación absoluta del depósito miocárdico de 99mTc-DPD en pacientes con amiloidosis cardiaca por depósitos de transtiretina (ATTR). Materiales y métodos Se realizó SPECT/TC a 41 pacientes con resultado gammagráfico positivo para amiloidosis cardiaca ATTR. Se dividió a los pacientes en dos grupos (grados2 y3 de Perugini) y se calcularon los SUVmax a nivel del hueso y de ambos ventrículos y el porcentaje de dosis calculado en estas áreas. Se empleó la prueba t de Student para comparar resultados y se calculó el área bajo la curva (AUC) para evaluar la eficacia diferencial y establecer unos puntos de corte discriminatorios entre ambos grupos de pacientes. Resultados Se observaron diferencias estadísticamente significativas en todas las variables a estudio, a excepción del SUVmax hueso. Las diferencias con mayor potencia estadística se observaron en las variables SUVmaxVD y el porcentaje de dosis en ambos ventrículos (p<0,001). El punto de corte obtenido para la variable SUVmaxVI fue de 8,620 (sensibilidad del 87,9% y especificidad del 100%; AUC: 0,966), mientras que el de la variable SUVmaxVD fue de 6,195 (sensibilidad del 81,8% y especificidad del 100%; AUC: 0,955). Conclusiones La cuantificación absoluta de la captación miocárdica de 99mTc-DPD en las imágenes SPECT/TC de pacientes con sospecha de amiloidosis cardiaca por depósitos de transtiretina supone una nueva herramienta diagnóstica que permite una adecuada clasificación de los pacientes, acorde a la escala de gradación visual de Perugini (AU)

Purpose To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR). Materials and methods SPECT/CT was performed on 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades2 and3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. Student's t-test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients. Results Statistically significant differences were observed in all the study variables, with the exception of SUVmax bone. The differences with the greatest statistical power were observed in the variables SUVmaxRV and the percentage of dose in both ventricles (P<.001). The cut-off point obtained for the variable SUVmaxLV was 8.620 (sensitivity 87.9% and specificity 100%; AUC: 0.966), while that of the variable SUVmaxRV was 6.195 (sensitivity 81.8% and specificity 100%; AUC: 0.955). Conclusions The absolute quantification of myocardial uptake of 99mTc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows an adequate classification of patients, according to the visual grading scale of Perugini (AU)

Prevalence and clinical significance in our setting of incidental uptake in the thyroid gland found on 18F-fluordeoxyglucose positron emission tomography-computed tomography (PET-CT).

INTRODUCTION: The expanding use of 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) has resulted in an increased frequency of incidentally discovered areas of FDG uptake within the thyroid gland. In these incidentalomas, high malignancy rates are reported. The study aimed, on the one hand, to determine the prevalence in our setting of thyroid incidentalomas in patients with no previous history of thyroid cancer undergoing an FDG PET-CT as well as the risk of malignancy and, on the other hand, to evaluate the usefulness of the maximum standard uptake value (SUVmax) for detecting thyroid cancer. MATERIAL AND METHODS: The FDG PET-CT scans performed at our hospital between June 2013 and December 2020 were retrospectively reviewed. In those incidentalomas with sufficient additional investigation, a diagnosis of benign or malignant was established based on the complementary tests. RESULTS: From the 21,594 PET-CT scans performed, 398 (1.8%) patients had an incidental FDG uptake, either focal (n=324) or diffuse (n=74). Among incidentalomas with further investigation, the rate of malignancy was higher in patients with focal FDG uptake than in those with diffuse uptake (26.5% versus 4%, respectively, p<0.05). The SUVmax value was significantly lower in benign focal lesions (5.7 [range: 2.3-66] than in malignant ones 10.6 [range: 3.1-51.2]; p<0.05). Nearly a quarter of malignant diagnoses (23.3%) were related to potentially aggressive tumours. CONCLUSION: The high rate of malignant tumours found among PET-CT incidentalomas and the high proportion of aggressive tumours demonstrate the need for a standardised approach in the investigation of incidental focal FDG uptake in the thyroid gland.

Absolute quantification of myocardial uptake of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR).

PURPOSE: To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99mTc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR). MATERIALS AND METHODS: SPECT/CT was performed in 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades 2 and 3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. The Student's t-test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients. RESULTS: Statistically significant differences were observed in all the study variables, with the exception of bone SUVmax. The differences with the greatest statistical power were observed in the variables SUVmaxRV and the percentage of dose in both ventricles (p < 0.001). The cut-off point obtained for the variable SUVmaxLV was 8.620 (sensitivity 87.9% and specificity 100%; AUC 0.966), while that of the variable SUVmaxRV was 6.195 (sensitivity 81.8% and specificity 100%; AUC 0.955). CONCLUSIONS: The absolute quantification of myocardial uptake of 99mTc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows adequate classification of patients according to the Perugini visual grading scale.

Valor pronóstico de los criterios PERCIST y los parámetros metabólicos de la PET/TC en pacientes con cáncer de esófago tras tratamiento neoadyuvante / Prognostic value of PERCIST and PET/CT metabolic parameters in patients with esophageal cancer after neoadjuvant treatment

Objetivo Valorar la utilidad clínica de los criterios PERCIST y de los cambios en los parámetros cuantitativos de la PET/TC con [18F]FDG como factores pronósticos para la supervivencia libre de progresión y la supervivencia cáncer-específica en pacientes con cáncer de esófago tratados mediante quimiorradioterapia. Material y métodos Se valoraron retrospectivamente 50 pacientes (48 hombres) diagnosticados de cáncer de esófago durante un intervalo de 7,5 años. Se utilizaron los criterios PERCIST para valorar la respuesta a la neoadyuvancia. Asimismo, se determinaron las variaciones del SUV máximo, volumen metabólico tumoral y glucólisis tumoral total entre los estudios PET/TC pre- y postratamiento. Las curvas ROC, el método de Kaplan-Meier y el modelo de regresión de Cox se aplicaron para el análisis de factores pronósticos y curvas de supervivencia. Resultados El seguimiento medio fue de 26,8 meses, produciéndose 40 recurrencias-progresiones y 41 muertes. El análisis de supervivencia mostró curvas de supervivencia cáncer-específica con diferencias estadísticamente significativas en relación con los criterios PERCIST y la variación del volumen metabólico tumoral y la glucólisis tumoral total. Los criterios PERCIST fueron el único factor predictivo independiente en el análisis multivariante. Ni el SUV máximo ni el tamaño tumoral fueron predictores para ninguno de los criterios de evaluación. Conclusión La aplicación de los criterios PERCIST, así como el cambio de volumen metabólico tumoral y glucólisis tumoral total de los estudios PET/TC demostraron ser factores pronósticos para la supervivencia cáncer-específica en pacientes de nuestro entorno tratados por cáncer de esófago. Los resultados podrían ayudar a personalizar el tratamiento (AU)

Aim To assess the clinical utility of PERCIST criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival and cancer-specific survival in patients with esophageal cancer treated by chemoradiotherapy. Material and methods Fifty patients (48 men) diagnosed with esophageal cancer were retrospectively evaluated over a 7.5-year interval. PERCIST criteria were used to assess response to neoadjuvant therapy. Variations in the metabolic parameters maximum SUV, metabolic tumor volume and total lesion glycolysis between pre- and post-treatment PET/CT studies were also determined. ROC curves, Kaplan-Meier method and Cox regression model were used for the analysis of prognostic factors and survival curves. Results The average follow-up was 26.8 months, with 40 recurrences-progressions and 41 deaths. Survival analysis showed statistically significant differences in cancer-specific survival curves for PERCIST criteria and variation of metabolic tumor volume and total lesion glycolysis. PERCIST criteria were the only independent predictor in the multivariate analysis. Neither maximum SUV nor tumor size were predictors for any of the assessment criteria Conclusion Application of PERCIST criteria as well as change in metabolic tumor volume and total lesion glycolysis from PET/CT studies proved to be prognostic factors for cancer-specific survival in patients in our setting treated for esophageal cancer. The results could help to personalize treatment (AU)

Estrategia de captación para vacunación en una zona de transformacion social / Recruitment strategy for vaccination in a social transformation area

En zona de transformación social del sur de España, se realiza una estrategia de captación para vacunación COVID-19 de personas que cumplen con los requisitos establecidos. Se realiza captación en zona de 360 personas de etnia gitana, mediante un equipo de asistencia social apoyado por Protección Civil. Se reparten mascarillas como reclamo para entablar contacto y dar información del proceso de vacunación. Posteriormente, se procede a la vacunación. Se consiguió vacunar al 40% de la población. Un 14% correspondían a aquellos con enfermedad reciente o vacunados; el resto eran menores. Se recogió, el argumento que tenían para rechazar vacunarse. La organización, y buena integración de los servicios sociales en programas de Salud Pública, ha tenido un importante papel en la creación y aceptación de programas específicos con, resultados evaluables. Tanto la estrategia de captación como la respuesta obtenida se consideraron buenas. Encontramos necesarias este tipo de intervenciones en determinados colectivos.(AU)

In an area of social transformation in southern Spain, a recruitment strategy for COVID-19 vaccination of people who meet the established requirements. A social assistance team, supported by Civil Protection, is recruiting 360 gypsy people in the area. Masks are distributed as a lure to establish contact and provide information on the vaccination process. Subsequently, vaccination is carried out. We managed to vaccinate 40% of the population. Some 14% corresponded to those with recent disease or vaccinated; the rest were minors. The argument they had for refusing to be vaccinated was collected. The organization and good integration of social services in Public Health programs has played an important role in the creation and acceptance of specific programs with evaluable results. Both the recruitment strategy and the response obtained were considered good. We found this type of intervention necessary in certain groups.(AU)

Captación tiroidea de yodo radioactivo 131 en 24 horas en adultos jóvenes eutiroideos residentes de gran altitud / Thyroid uptake of radioactive iodine 131 in 24 hours in eutiroid young adults residents at high altitude

INTRODUCCIÓN: el tiroides exhibe una gran avidez por el yodo radioactivo (I131) que al ser fijado por ésta glándula puede determinarse, desde afuera, aprovechando el hecho de que las radiaciones gamma atraviesan los tejidos blandos del cuello y pueden registrarse (Gammagrafía) a distancias apreciables. Desde 1962 Bolivia cuenta con esta tecnología, sin embargo, no cuenta con trabajos similares desde la declaración de país libre de enfermedades secundarias a la deficiencia de Yodo en 1997. El objetivo fue determinar valores de la captación tiroidea de I131 a las 24 horas en adultos jóvenes eutiroideos, residentes de gran altitud. MÉTODO: se realizó un estudio descriptivo transversal, en 76 sujetos obtenidos por intención y seleccionados mediante una entrevista clínica, examen físico dirigido y un consentimiento informado. El procedimiento fue ejecutado por personal calificado en el INAMEN siguiendo las recomendaciones de la OIEA. RESULTADOS: el valor de la captación tiroidea de I131 en 24 horas fue de 18,23 + 5,79% (rango 7,70 ­ 39,70). DISCUSIÓN: los expertos recomiendan establecer valores de referencia actualizados en cada región. Se han descrito variaciones de los valores normales influenciados por el sexo y edad; esta última, aparentemente por una hipofunción tiroidea inversamente proporcional con la edad. CONCLUSIÓN: el valor referencial encontrado en nuestro estudio es concordante con los establecidos en el extranjero, sin embargo, con una tendencia incrementada. Podría deberse a la secuencia cronológica de los estudios comparados en países que ya habían establecido políticas de yodación más tempranamente.

INTRODUCTION: the thyroid exhibits a great avidity for radioactive iodine (I131) which, when fixed by this gland, can be determined from the outside, taking advantage of the fact that gamma radiation passes through the soft tissues of the neck and can be registered (scintigraphy) at appreciable distances. Since 1962, Bolivia has had this technology, however, it does not have similar studies since the declaration of a country free of diseases secondary to iodine deficiency in 1997. The objective was to determine values of the thyroid uptake of I131 at 24 hours in euthyroid young adults, high altitude residents. METHOD: a descriptive cross-sectional study was carried out in 76 subjects obtained by intention and selected by means of a clinical interview, directed physical examination and informed consent. The procedure was carried out by qualified personnel at INAMEN, following IAEA recommendations. RESULTS: the value of the thyroid uptake of I131 in 24 hours was 18.23 + 5.79% (range 7.70 - 39.70). DISCUSSION: experts recommend establishing up-to-date reference values in each region. Variations in normal values influenced by sex and age have been described; the latter, apparently due to a thyroid hypofunction inversely proportional to age. CONCLUSION: the reference value found in our study is consistent with those established abroad, however, with an increased trend. It could be due to the chronological sequence of comparative studies in countries that had already established iodination policies earlier.

Adrenal glands uptake patterns in 18F-Fluoroethylcholine PET/CT. / Patrones de captación en las glándulas suprarrenales de la PET/TC con 18F-Fluoroetilcolina.

PURPOSE: To find reasons of different radioactive choline adrenal uptake in prostate or renal cancer patients who underwent 18F-fluoroethylcholine positron emission tomography/computed tomography. METHODS: Forty-nine positron emission tomography/computed tomography studies with radioactive choline (96 adrenal glands) were analysed with respect to the adrenal glands shape, uptake pattern and maximum standardised uptake value. Fifteen other parameters were recorded, assessed or counted, ratios of chosen parameters were calculated, and checked for correlation with adrenal glands uptake. RESULTS: Adrenal glands presented a wide range of radioactive choline uptake intensities (range 2-7.9) and different uptake patterns (diffuse, focal or mixed). Maximum uptake in the right (4.3±1.2) adrenal gland positively correlated with the thickness of the parenchyma at the point of maximal uptake (5.3mm±1.5) (p=0.000). Maximum uptake in the right and left adrenal gland, as well as mean adrenal gland uptake, correlated with maximum uptake in the pituitary gland (p=0.000, p=0.000 and p=0.001, respectively) and with maximum uptake in liver (p=0.008, p=0.000 and p=0.011, respectively). Neither hormonal treatment nor patients' age significantly correlated with standardised uptake values of adrenal glands in the studied group. CONCLUSIONS: The variability of radiocholine uptake in adrenal glands depends probably on overall body metabolism and hypophyseal function expressed by statistically significant correlation with liver and pituitary gland uptake. Predominant focal or mixed with focal areas uptake patterns on positron emission tomography in normal in computed tomography adrenal glands should be assessed with caution to avoid a diagnostic mistake.

Accidente cerebro vascular visualizado en gammagrafía conTc-99m MDP, un hallazgo extraóseo inusual / Stroke in scintigraphy with Tc-99m MDP, an unusual extraosseous finding / Acidente vascular cerebral visualizado na cintilografia com Tc-99m MDP, um achado extra-sensorial incomum

Se presenta el caso de un paciente con antecedente de adenocarcinoma de próstata y diagnóstico de ACV isquémico con transformación hemorrágica. La gammagrafía ósea con Tc-99m MDP complementada con SPECT e imágenes de fusión con TC cerebral simple, realizada a los 15 días, muestra hipercaptación en la región temporal izquierda, correspondiente al ACV en etapa subaguda.

We present the case of a patient with a history of prostate adenocarcinoma with a diagnosis of ischemic stroke with hemorrhagic transformation. Bone scintigraphy with Tc-99m MDP supplemented with SPECT and fusion images with simple cerebral CT, performed at 15 days, shows uptake in the left temporal region, corresponding to stroke in subacute stage

Apresentamos o caso de um paciente com história de adenocarcinoma de próstata com diagnóstico de acidente vascular cerebral isquêmico com transformação hemorrágica. A cintilografia óssea com Tc-99m MDP suplementada com SPECT e imagens de fusão com TC cerebral simple, realizadas aos 15 dias, mostra captação na região temporal esquerda, correspondente ao ACV na fase subaguda

99mTc-pertechnetate thyroid scintigraphy predicts clinical outcomes in personalized radioiodine treatment for Graves' disease. / Predicción de los resultados clínicos en el tratamiento personalizado con yodo radiactivo de la enfermedad de Graves, mediante gammagrafía tiroidea con 99mTc-pertecnetato.

OBJECTIVE: The aim of this study was, first, to ascertain the efficacy of radioiodine therapy (RIT) for Graves' disease (GD) based on a calculated-dose regime and, second, to determine the value of 99mTc-pertechnetate thyroid scintigraphy in predicting the clinical outcomes of RIT. METHODS: One hundred and thirty 9consecutive GD patients who underwent RIT using a calculated-dose method in our hospital from January 2015 to September 2015 were retrospectively evaluated. Radioiodine dose was calculated based on the Marinelli's formula. 99mTc-pertechnetate uptake, age, gender, thyroid mass, duration of the disease, previous antithyroid drugs treatment, serum levels of TSH, FT3 and FT4, a positive rate of TPOAb and Anti-TRAb, radioiodine dose and follow-up were evaluated as potential interference factors for RIT success. RESULTS: One hundred and 8(77.7%) GD patients including 71 (51.1%) euthyroid and 37 (26.6%) hypothyroid were successful, but 31 (22.3%) remained hyperthyroid (treatment failure). Significant differences were found between the treatment success group and the failure group in 99mTc-pertechnetate uptake (p<0.0001), the duration of disease (P=.0140) and positive rate of Anti-TRAb (P=.0103). 99mTc-pertechnetate uptake is an independent risk factor for predicting treatment failure (P=.0394). Using a cut-off value of 18.4%, 99mTc-pertechnetate uptake could predict treatment failure with a sensitivity of 84.3%, and a specificity of 80.6%. CONCLUSION: Our study has shown that a calculated radioiodine dose is effective in treating GD patients with a consequent low rate of hypothyroid. A 99mTc-pertechnetate uptake above 18.4% is a significant predictor of treatment failure and these patients should receive a higher radioiodine dose in this scenario.

Captación de ácido siálico por larvas musculares de Trichinella spiralis durante incubación in vitro / Sialic acid capture by Trichinella spiralis muscle larvae during incubation in vitro / Captação de ácido siálico por larvas musculares de Trichinella spiralis durante a incubação in vitro

Se ha comunicado que los eritrocitos (GR) incubados in vitro con larvas infectantes (LM) de T. spiralis presentan mayor agregación que los GR Controles incubados con solución salina, lo que indica que el parásito capta el ácido siálico globular. El objetivo del trabajo fue estudiar la captación de ácido siálico por LM durante incubación in vitro. Se incubaron 30, 60, 90 y 180 larvas con 30 mL del sedimento de GR en 1 mL de solución salina durante 24 y 48 h (37 °C). Se aplicó el Método de Agregación por Polibrene y se calculó Tïtulo, Score Total y CexpCASP. Los resultados mostraron una disminución significativa de estos 3 valores en relación al Control, excepto en el cultivo con 30 LM donde solo se observó un descenso moderado del Score Total y CexpCASP. La captación fue máxima a las 24 h, sin diferencias con los valores obtenidos a las 48 h. Posteriormente se incubaron 60 LM durante 1, 2 y 3 h. Se observó que no hubo captación de ácido siálico en la primera hora de incubación y que fue moderada a las 3 h. La experiencia demostró la captación de ácido siálico globular por las LM in vitro, lo que sugiere que podrían secuestrarlo del miocito con el objeto de evadir y/o interferir la respuesta inmune a los fines de asegurar su permanencia en el hospedador.

It has been reported that erythrocytes (RBC) incubated with infective larvae of T. spiralis (ML) exhibit higher aggregation than Control RBC incubated with saline solution, indicating that the parasite captures erythrocyte sialic acid. The objective of this work was to study sialic acid capture by ML during in vitro incubation. A total of 30, 60, 90 and 180 larvae were incubated with 30 mL of GR sediment in 1 mL of saline solution for 24 to 48 hours (37 °C). Aggregation by Polybrene Method was used, and Titre, Total Score and CexpCASP were calculated. The results showed a significant decrease of these three values compared to Control except in the culture with 30 ML where only a moderate decrease of Total Score and CexpCASP were observed. The capture was maximal at 24 hours, with no difference with the values obtained at 48 hours. Then, 60 ML were incubated for 1, 2 and 3 hours. It was noted that ML did no capture sialic acid in the first hour of incubation and the capture was moderate at 3 hours. The experience showed globular sialic acid capture by ML in vitro, suggesting that they could sequester it from the myocyte in order to evade and/or interfere with the immune response for the purposes of assuring their permanence in the host.

Foi informado que os eritrócitos (GV) incubados in vitro com larvas infetantes (LM) da T. spiralis apresentam maior agregação que os GV Controles incubados com solução salina, indicando que o parasita capta o ácido siálico globular. O objetivo do trabalho foi estudar a captação de ácido siálico por LM durante a incubação in vitro. Foram incubadas 30 , 60 , 90 e 180 larvas com 30 μL do sedimento de GV em 1 mL de solução salina durante 24 a 48 horas (37 °C). Foi aplicado o Método de Agregação por Polibrene e se calculou o Título, Pontuação Total e CexpCASP. Os resultados mostraram uma diminuição significativa desses três valores em relação ao Controle, exceto na cultura com 30 LM, onde foi observada apenas uma redução moderada da Pontuação Total e CexpCASP. A captação foi máxima às 24 horas, sem diferença com os valores obtidos às 48 horas. Posteriormente 60 LM foram incubadas durante 1, 2 e 3 horas. Observou-se que não houve captação alguma de ácido siálico na primeira hora de incubação e que foi moderada às 3 horas. A experiência mostrou captação de ácido siálico globular pelas LM in vitro, sugerindo que poderiam sequestrá-lo do miócito visando a evadir e/ou interferir a resposta imune, para garantir sua permanência no hospedeiro.

Diagnóstico del sistema de aprovechamiento del agua lluvia en el consejo comunitario de la comunidad negra de los lagos, buenaventura / Diagnostic system rain water harvesting in the black community council community of lagos, buenaventura

Este trabajo presenta los resultados de la investigación realizada en el Consejo Comunitario de la Comunidad Negra Los Lagos (CCCN Los Lagos); la cual consistió en diagnosticar las condiciones de aprovechamiento del agua lluvia, por lo que se pudo determinar el potencial de aprovechamiento del agua lluvia en la comunidad, los tipos de techos que utilizan las viviendas, el sistema de recolección y conducción del agua lluvia, los tipos de recipientes para realizar el almacenamiento del agua lluvia. Para la identificación de los aspectos anteriores, se realizaron visitas al lugar, así como también la realización de entrevistas semiestructuradas y encuestas (anexo 1). Luego de conocer el sistema de abastecimiento del agua lluvia, se realizó análisis fisicoquímicos y microbiológicos al agua lluvia recolectada, permitiendo conocer con ello el cumplimiento o no de la normativa ambiental; además, se aplicaron análisis estadísticos para determinar correlaciones y varianzas en los resultados.

This paper presents the results of research conducted at the Community Council of the black community of Los Lagos, which was to diagnose the conditions of use of rain water, so they could determine the potential use of rain water in the community, the types of roofs used housing, the system of collection and conveyance of rain water, types of containers for storage of rain water; for the identification of the above aspects, site visits were conducted, as well as semi-structured interviews and surveys. After meeting the supply system of rain water, chemical and microbiological to rain water collected analyzes were performed, thus allowing to know or not compliance with environmental regulations; Additional statistical analyzes were applied to determine correlations and variances in the results.

The utility of 18F-FDG PET/CT in solitary fibrous tumors of the pleura.

OBJECTIVE: To demonstrate the utility of (18)F-FDG PET/CT in the differentiation of benign and malignant solitary fibrous tumors of the pleura (SFTP). MATERIALS AND METHODS: A retrospective review was performed on the (18)F-FDG PET/CT data from 17 patients with histopathologically diagnosed benign or malignant SFTP. The size, side of SFTP, presence of necrosis, calcification, pleural effusion, hilar lymphadenopathy (LAP), density on CT images (Hounsfield unit-HU), and (18)F-FDG uptake (SUVmax) were recorded and compared in order to detect malignant SFTP. Statistical significance was set as p<0.05. RESULTS: The difference in size, presence of necrosis, and hilar LAP on CT images were statistically significant (p=0.004, p<0.001, p=0.015, respectively) in a comparison of benign and malignant SFTPs. The mean HU of benign SFTP was 46.16±5.52HU, and for malignant SFTP it was 35.03±4.61HU (p=0.003). The mean SUVmax was 3.02±1.02 for benign SFTP and 4.89±2.12 for malignant SFTP (p=0.021). A cut-off value of ≥7cm for size, ≤39.81HU for density, and ≥3.47 for SUVmax was obtained by ROC analysis for detecting malignant SFTP. CONCLUSIONS: (18)F-FDG PET/CT may have a limited role in diagnosing malignant SFTP in suspected patients.

Calcium as a nutrient involved in the synthesis and localization of proteins that facilitate iron uptake and efflux in enterocytes / El calcio como nutriente implicado en la síntesis y localización de proteínas que participan en la captación y eflujo del hierro en los enterocitos

Iron deficiency is the most common type of nutritional deficiency in the world, and calcium intake is low in many populations. Developing a supplement that contains both micronutrients would be an excellent method to prevent iron deficiency and increase calcium intake. Human and cellular studies have shown that calcium inhibits iron absorption. Currently, the mechanisms underlying this inhibitory effect have not been elucidated. Because calcium is involved in cell signaling pathways, it may affect the regulation of the expression or localization of proteins involved in iron uptake and efflux in enterocytes. The aim of this review was to describe the processes involved in the absorption of dietary iron and the regulation of the expression and activity of proteins involved in this absorption. Additionally, the potential mechanisms by which calcium affects the expression and localization of these proteins are also discussed.

La deficiencia de hierro es la deficiencia nutricional más común en el mundo y la ingesta de calcio es baja en la mayoría de poblaciones. El desarrollo de un suplemento que contenga ambos micronutrientes sería una excelente estrategia para prevenir la deficiencia de hierro y aumentar la ingesta de calcio. Estudios en humanos y en células han demostrado que el calcio inhibe la absorción del hierro. Actualmente los mecanismos que explican este efecto inhibitorio no están claramente dilucidados. Dado que el calcio está implicado en la señalización celular, podría afectar la regulación de la expresión y localización de proteínas implicadas en la captación y eflujo de hierro en los enterocitos. El objetivo de esta revisión es describir los procesos implicados en la absorción del hierro dietario y la regulación de la expresión y actividad de las proteínas implicadas en esta absorción. Además, se discutirán los posibles mecanismos por los cuales el calcio afecta la expresión y localización de esas proteínas.

Estudio de la cinética de captación de ácido siálico por larvas musculares de Trichinella spiralis / Study of kinetics of sialic acid capture by muscle larvae of Trichinella spiralis / Estudo da cinética de captaþao de ácido siálico por larvas musculares da Trichinella spiralis

Se ha comunicado que los eritrocitos (GR) incubados con larvas infectantes de Trichinella spiralis presentan mayor agregación que los GR Controles incubados con solución salina, lo cual indica que el parásito capta el ácido siálico globular. El objetivo fue estudiar la cinética de captación de ácido siálico por larvas musculares de T. spiralis aplicando Análisis Digital de Imágenes. Se trabajó con concentrados larvales de T. spiralis incubados en partes iguales con GR Grupo O, en medio salino y enzimático (GR Tratados), durante 120 minutos a intervalos de 15 minutos. Los Controles fueron incubados con igual volumen de solución salina. Se aplicó Análisis Digital de Imágenes y se calculó el valor del Coeficiente de células aisladas (CCA). Para analizar el efecto del tiempo de incubación en los valores de CCA, se utilizó un análisis de la variancia para un diseño en bloques completos aleatorizados. Los resultados mostraron que el valor promedio de CCA, en ambos medios, varió significativamente con el tiempo de incubación, lo que evidencia que el aumento del contacto de las larvas con los GR produce una disminución del ácido siálico que se refleja en mayores valores de CCA. La experiencia realizada sugeriría que durante su permanencia y viabilidad en el quiste, las larvas de T. spiralis podrían ir captando ácido siálico de la célula muscular con el objeto de interferir y/o evadir la respuesta inmune del hospedador.(AU)

It has been reported that erythrocytes (RBC) which were incubated with infective larvae of T. spiralis exhibit higher aggregation than RBC Controls incubated with saline solution, indicating that the parasite captures erythrocyte sialic acid. The objective of this work was to study the kinetics of sialic acid capture by muscle larvae of T. spiralis using Digital Image Analysis. The work was performed with larvae concentrates of T. spiralis, which were incubated with an equal volume of O Group RBC in saline and enzymatic mediums (Treated RBC), for 120 minutes at 15 minute intervals. Digital Image Analysis was applied and the value of Isolated Cells Coefficient (ICC) was calculated. To analyze the effect of incubation time on the ICC values, an analysis of variance was used to design randomized complete blocks. The results showed that the average value of ICC, both saline and enzymatic mediums, varied significantly with incubation time. It was shown that the increase in the contact of the larvae with erythrocytes produces the decrease of globular sialic acid, which is reflected in higher ICC values. The experience would suggest that during their stay and viability in the trichina cysts, the larvae could be capturing muscle sialic acid in order to interfere and/or evade the host immune response.(AU)

Foi relatado que os eritrócitos (GV) incubados com larvas infectantes da Trichinella spiralis apresentam maior agregaþÒo que os GV Controles incubados com soro fisiológico, indicando que o parasita capta o ácido siálico globular. O objetivo do trabalho foi estudar a cinética de captaþÒo de ácido siálico por larvas musculares da T. spiralis por Análise Digital de Imagens. O trabalho foi feito com concentrados de larvas de T. spiralis incubados em partes iguais com GV Grupo O, em meio salino e enzimático (GV Tratados), durante 120 minutos a intervalos de 15 minutos. Os controles foram incubados com igual volume de soluþÒo salina. Foi aplicada a Análise Digital de Imagens e calculado o Coeficiente de Células Isoladas (CCI). Para analisar o efeito do tempo de incubaþÒo sobre os valores do CCI foi usada uma análise da variÔncia para um desenho em blocos completos casualizados. Os resultados mostraram que o valor médio de CCI, em ambos os meios, variou significativamente com o tempo de incubaþÒo, evidenciando que o aumento do contato das larvas com os GV produz uma diminuiþÒo do acido siálico, que se reflete em valores de CCI mais elevados. A experiÛncia realizada sugeriria que as larvas T. spiralis durante sua permanÛncia e viabilidade no cisto, poderiam ir captando ácido siálico da célula muscular, com o fim de interferir e /ou evitar a resposta imune do hospedeiro.(AU)

Incidental pathologic extracardiac uptake of (99m)Tc-tetrofosmin in myocardial perfusion imaging: Importance of patient background evaluation.

(99m)Tc-tetrofosmin single photon emission computed tomography ((99m)Tc-tetrofosmin SPECT) has an important role in the assessment of coronary artery disease. Despite being its main indication, this study does not only evaluate myocardial perfusion, but much more. Moreover, during the SPECT acquisition, the field area covered includes many important organs of the thorax and abdomen, so extracardiac abnormalities can be observed. The correct etiologic diagnosis of them is only possible if we understand how (99m)Tc-tetrofosmin works and make a comprehensive investigation of the clinical history of the patient.

[Cervical cancer screening: Is active recruitment worth the effort?]. / Cribado de cáncer de cérvix: ¿merece la pena la búsqueda activa?

OBJECTIVES: To determine the percentage of women who have had a Pap smear in the last 5 years, and the place where it was carried out. To detect cytological abnormalities and precursors of cervical cancer in un-screened or inadequately screened women and the prevalence of HPV-positive determinations. DESIGN: Cross sectional study. SETTING: Natahoyo Health Centre, Gijón (Spain). PARTICIPANTS: Women aged 40-50 years living in the area and assigned to the Health Centre. METHODS: The information was collected from databases, telephone and home surveys. There was active recruitment of unscreened women or inadequately screened in Primary Care as well as offering to perform cytology and HPV determination. RESULTS: Of the 1420 women aged 40 to 50 years, 1236 (87%) had cytology in the last 5 years, and 184 women (13%) had no screening or it was inadequate. Of these 184 women, 108 (58.7%) agreed to have cytology and HPV test performed. No high-grade cervical dysplasia was diagnosed. The prevalence of HPV-positive was 8.3%. CONCLUSIONS: In our population there is a high coverage of opportunistic screening for cervical cancer. The active recruitment of women who were not in the screening program was not useful.

Thymic uptake after high-dose I-131 treatment in patients with differentiated thyroid carcinoma: a brief review of possible causes and management.

PURPOSE: To report five cases of patients diagnosed with differentiated thyroid carcinoma (DTC) with uptake in the thymic area after high-dose treatment with I-131 and to evaluate the potential causes and therapeutic management. METHODS: Five cases of young female patients with a mean age of 36.6 years (24-43) who had been treated with a mean dose of 106 mCi of I-131 (100-150 mCi) showing tracer uptake in the thymic area are reported. An I-131 whole-body scan (131I-WBS) was performed 7 days after therapeutic dose administration to each patient. Anterior and posterior planar images, followed by SPECT/CT of the head, neck and superior mediastinum were acquired in all patients. Thyroglobulin levels were measured with and without hormone replacement therapy in all cases. Samples taken from the superior mediastinum were sent to pathology for analysis, which confirmed the presence of thymic tissue. RESULTS: Two patients underwent elective total thymectomy due to the gross characteristics of the gland, local 131-I uptake, and high thyroglobulin levels. The remaining three patients had already undergone thymectomy as part of neck dissection during initial surgery, and no further invasive interventions were therefore performed. Pathological examination revealed no metastases in these five patients. CONCLUSIONS: Thymus visualization in young patients after administration of therapeutic doses of I-131 seems to be a more common finding than usually thought. Absence of metastasis in the thymus despite high thyroglobulin levels was confirmed in all cases. Based on these results, we suggest that a more expectant and less aggressive therapeutic approach could be used. We also suggest that I-131 therapy for DTC should be considered in classification of the potential causes of true thymic hyperplasia in the subgroup of patients recovering from a stressor.

A novel, fully automated, observer-independent program for semiquantifying striatal ¹²³I-FP-CIT uptake.

OBJECTIVE: To describe and validate a novel, fully automated program specifically designed for the semiquantification of striatal (123)I-FP-CIT uptake using volumes of interest (VOI) analysis. MATERIAL AND METHODS: The proposed algorithm is based on a template that mimics the striatal (123)I-FP-CIT uptake in a healthy subjects, derived from defined anatomical VOIs available from WFU PickAtlas. Four SPECT studies of the anthropomorphic Alderson phantom filled with variable radioactive concentrations were acquired for the experimental validation. Experimental SPECT images were spatially normalized with respect to the previously created template. The binary VOIs corresponding to left caudate and putamen and right caudate and putamen, which were used to construct the template, were projected onto the experimental images to obtain the counts for these regions. To minimize the partial volume effect, a percentage of the voxels in these regions (threshold), rather than all of them, was used. A binary occipital VOI was used to quantify the non-specific uptake. Experimental binding potentials (BPs) were calculated from the counts in these regions. True BPs were calculated from aliquots taken from the solutions used to fill the phantom. RESULTS: There were statistically significant differences in the experimental BP values (p<0.002) according to the percentage of voxels used. A highly significant correlation was achieved between true and experimental BP values, regardless of the percentage of voxels included for quantification. CONCLUSIONS: Our novel, observer-independent program automatically performs the semiquantification of striatal (123)I-FP-CIT uptake in experimental studies.

[Nuclear medicine and radiopharmaceuticals]. / Medicina nuclear y radiofármacos.

Nuclear Medicine is a medical specialty that allows modern diagnostics and treatments using radiopharmaceuticals original radiotracers (drugs linked to a radioactive isotope). In Europe, radiopharmaceuticals are considered a special group of drugs and thus their preparation and use are regulated by a set of policies that have been adopted by individual member countries. The radiopharmaceuticals used in diagnostic examinations are administered in very small doses. So, in general, they have no pharmacological action, side effects or serious adverse reactions. The biggest problem associated with their use are the alterations in their biodistribution that may cause diagnostic errors. Nuclear Medicine is growing considerably influenced by the appearance and development of new radiopharmaceuticals in both the diagnostic and therapeutic fields and primarily to the impact of new multimodality imaging techniques (SPECT-CT, PET-CT, PET-MRI, etc.). It's mandatory to know the limitations of these techniques, distribution and eventual physiological alterations of radiopharmaceuticals, contraindications and adverse reactions of radiological contrasts, and the possible interference of both.

Uso de las emulsiones lipídicas en intoxicaciones por anestésicos locales y otras intoxicaciones: evidencia actual / Use of lipid emulsions in poisoning by local anesthetics and other poisonings: current evidence

Objetivo: realizar una revisión narrativa con la evidencia de la composición, mecanismo de acción e indicaciones para el uso de emulsiones lipídicas como antídoto, en la toxicidad por anestésicos locales y otras intoxicaciones. Métodos: se realizó una búsqueda bibliográfica en PubMed, Scielo y Lilacs usando las palabras claves "lipid emulsion", "therapy toxicology", "lipid therapy toxicology", "intravenous lipid therapy toxicology", "fat emulsion toxicology" "local anesthetic toxicity" y "lipid sink", identificando información relevante relacionada con su fisiopatología y su uso publicada entre 1960 y 2013. Resultados: las emulsiones lipídicas usualmente se han utilizado como suplemento nutricional, su uso también se aprobó para el tratamiento de la intoxicación por anestésicos locales como bupivacaína gracias a diferentes mecanismos de acción como: el efecto de inmersión lipídica, lipid flux y los efectos en el transporte de ácidos grasos en la mitocondria, entre otros. Aunque los resultados en intoxicaciones con beta-bloqueadores, bloqueadores de canales de calcio y antidepresivos tricíclicos han sido controversiales y no deben anteponerse al manejo tradicional, registros como el LIPAEMIC evidencian mejoría en resultados como escalas de coma Glasgow, algunas variables hemodinámicas y mayor sobrevida. Conclusiones: no existe una forma de predecir la respuesta a la terapia lipídica ni las consecuencias y hasta la fecha no deben reemplazar tratamientos que el médico considere apropiados para el manejo del paciente.

Objective: To perform a narrative review with evidence of the composition mechanism of action and indications for the use of lipid emulsions as an antidote in local anesthetic toxicity and other poisonings. Methods: We performed a bibliographic research by using PubMed, Scielo and Lilacs using the keywords "lipid emulsion therapy toxicology", "lipid therapy toxicology", "intravenous lipid therapy toxicology", "fat emulsion toxicology" and "lipid sink", identifying relevant information related to, published between 1960 and 2013. Results: Lipid emulsions have been used as a nutritional supplement, its use is also approved for the treatment of poisoning by local anesthetics such as bupivacaine through different mechanisms of action such as: the effect of lipid sink, lipid flux and effects on transport fatty acids in mitochondria, among others. Although the results in other poisonings as beta-blockers, calcium channel blockers and tricyclics have been controversial and should not take precedence over traditional management. LIPAEMIC record show improved results as Glasgow coma scale, hemodynamic variables and survival. Conclusion: There is no way to predict the response to lipid therapy nor the consequences, and that's why until this day it should not replace any treatment that the physician considers appropriate for the management of his patient.