[Predictive pre-treatment value of the Prognostic Nutritional Index on survival in gastric carcinoma]

BACKGROUND

The Prognostic Nutritional Index (PNI) combines the values of circulating lymphocytes and serum albumin and, in the Asian literature; it has been related with the prognosis following R0 resection of gastric cancer. No results are available in Western countries. We study the possible independent prognostic value, at the moment of the tumour's diagnosis, of PNI on survival.

PATIENTS AND METHODS

We review 234 consecutive gastric carcinomas, calculating global survival and tumour-specific survival. We considered pre-treatment PNI values of < 40 to be pathological. We carried out a univariate and multivariate analysis of cases of survival according to PNI, including the following adjustment variables: age > 70 years, ASA anaesthetic at the time of diagnosis, size of the neoplasia > 5cm, macroscopic type, undifferentiated degree and TNM clinical stage through echoendoscopy and/or CAT.

RESULTS

The univariate analysis registered greater global and specific survival in cases with PNI ≥ 40 versus PNI < 40: [HR = 2.28; CI 95% = (1.60-3.26); p< 0.001] and [HR = 2.35; CI 95% = (1.63-3.39); p< 0.001], respectively. The multivariate analysis confirmed a better independent prognosis in cases with OI ≥ 40: global survival: [HR = 1.48; CI 95% = (1.02-2.16); p = 0.040], specific survival: [HR = 1.51; CI 95% = (1.03-2.23); p = 0.036].

CONCLUSIONS

At the moment of diagnosis of gastric cancer and including all registered cases, a PNI ≥ 40 is accompanied by a signifi-cantly greater global and tumour-specific survival. In our series, this better prognosis is independent of the patient's age group, his/her ASA classification, the size and degree of differentiation of the neoplasia and its TNM clinical stage.

Imaging assessment of portal venous system: pictorial essay of normal anatomy, anatomic variants and congenital anomalies

The purpose of this pictorial essay is to describe anatomic variants and congenital anomalies of portal venous system and related liver parenchymal alterations. The imaging findings of some of these entities have been previously described in other articles, however this work encompasses all congenital anomalies of portal venous system with attention to their features on various imaging modalities; in particular we illustrated with detailed pictures all the main portal vein variants, congenital extra- and intra-hepatic porto-systemic venous shunts and portal vein aneurysm. Variants of portal branches and intrahepatic portosystemic shunts are quite uncommon, however, when present, they should be recognized before performing surgery or interventional procedures. Congenital absence of the portal vein is an important finding as the complete loss of portal perfusion predisposes the liver to focal or diffuse hyperplastic or dysplastic changes. Portal vein aneurysm is a rare clinical entity that can affect intra- and extra-hepatic portal branches; although usually asymptomatic, thrombosis can occur. Awareness of congenital variants of portal venous system among radiologists should allow a more confident diagnosis and permit an accurate planning of surgical procedures and percutaneous interventions; identification of portal system anomalies also suggest an accurate evaluation of associated hepatic parenchymal anomalies such as nodular regenerative hyperplasia, focal nodular hyperplasia (FNH), and adenomas with high risk of malignant transformation.

Screening for Atrial Fibrillation

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

[Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma resection]

BACKGROUND

It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection.

PATIENTS AND METHODS

In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI =45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined.

RESULTS

We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12.7% [odds ratio (OR) = 4.17; CI95% = (1.71 - 10.20 p = 0.001)], confirmed by multivariate analysis: [OR = 4.17; CI95% = (1.54 - 11.30); p = 0.005]. Patients with OI <45 had more severe complication-exitus: 20.8% versus 5.6% [OR = 4.39; CI95% = (1.31 - 14.68); p = 0.011].

CONCLUSIONS

We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade.

A peculiar case of diffuse hemangiomatosis of the left hepatic lobe in an asymptomatic adult patient: case report and literature review

We report a rare case of diffuse hepatic hemangiomatosis (DHH) of the left hepatic lobe coexistent with giant hepatic hemangioma and without extra-hepatic involvement in an asymptomatic adult patient. Liver hemangiomas are the most common benign liver tumors. However, DHH without extra-hepatic involvement has rarely been reported in adults. Furthermore, giant hepatic hemangioma coexistent with DHH is even uncommon, although an association between hemangiomatosis and giant hepatic hemangiomas may be supposed. In this peculiar case, we observed an exclusive and widespread involvement of the left hepatic lobe with a sharp boundary between normal and altered liver parenchyma running along Cantlie's line.

Channel interpolation in TMS-EEG: a quantitative study towards an accurate topographical representation

The co-registration of transcranial magnetic stimulation and electroencephalography (TMS-EEG) is emerging as a successful technique for causally exploring cortical mechanisms and connections. However, various artefacts could affect TMS-EEG signals. Correct artefacted channels reconstruction is crucial to obtain accurate topographical representation and consequently accurate inverse problem solution, in order to map in a proper way the global brain responses after the stimulation of one particular brain region of interest. In this paper, we discuss the problem of artefacted channels interpolation in TMS-EEG signals. Aim of the study was to investigate two different interpolation methods evaluating their performance in two datasets: one constituted by 19 EEG channels montage (low-density spatial resolution) and the other one by 60 EEG channels montage (high-density spatial resolution). In addition, these evaluations took place in two different contexts of application: after the averaging of TMS Evoked Potentials (TEPs) in a time interval to obtain a global information in the considered range, and at fixed latencies 100 ms and 300 ms after the TMS stimulus. The results showed that the global reconstruction error was lower at fixed latencies for the high-density electrodes spatial resolution montage.

European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

Abstract

Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence.

Key Points

• This report provides guidelines for MRI in endometriosis.

• Minimal and optimal MRI acquisition protocols are provided.

• Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria.

Electronic supplementary material

The online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.

EL PROMISORIO CAMINO DE LA TECNOLOGÍA CRISPR-CAS9 EN LA EDICIÓN GENÓMICA

CRISPR, grupo de repeticiones cortas palindrómicas regularmente espaciadas (clustered regularly interspaced short palindromicrepeat), es un sistema de defensa viral encontrado en el genoma de bacterias y arqueas. La transcripción de estas secuencias CRISPR, que portan ADN viral asimilado previamente (espaciadores), produce crARNs que, en complejo con complejos  multiproteicos asociados a CRISPR, Cas (CRISPR associated), catalizan la degradación de material genético invasor que porte secuencias complementarias a los crARNs (protoespaciadores). En Streptococcus pyogenes, Cas9 en la única proteína encargada de efectuar los cortes de doble hebra en el ADN extraño, proporcionando un sistema in vitro e in vivo rápido, simple y barato para introducir cortes y mutaciones en cualquier región deseada, en tanto Cas9 sea programada con un crARN específico, llamado específicamente gARN, sgARN o chiARN. La tecnología CRISPR-Cas9 puede aplicarse eficientemente a una gran variedad de organismos procariotas y eucariotas, es decir, constituye una herramienta de inestimable poder en la edición genómica y estudio de la función de los genes. 

DETERMINACIÓN DE GÉNEROS BACTERIANOS EN EL MAR DE LA PLAYA CANTOLAO – LA PUNTA – CALLAO

Los océanos albergan una gran diversidad biológica, hasta el momento relativamente poco explorada por el humano. Con el objetivo de ampliar los conocimientos en la biodiversidad bacteriana del mar peruano, se realizaron muestreos aleatorios en el mar de Playa Cantolao-La Punta-Callao (12º04´06´´ S 77º10´10´´O), en total se tomaron 5 muestras en frascos estériles a una profundidad de 3 m utilizando una vara de madera acondicionada a una jeringa de 20 ml. Para el aislamiento se utilizó el método de dispersión en placa en Agar Marino, se trabajó con diluciones sucesivas para obtener colonias aisladas. Para la identificación se realizaron pruebas bioquímicas que incluían determinación de citocromo oxidasa, motilidad, producción de H2S, producción de indol, metabolismo de glucosa, producción de pigmento, luminiscencia, catalasa y desarrollo en anaerobiosis; además de las coloraciones Gram y de espora. Los esquemas propuestos por Das S et al. (2007), Oliver J (1982) y el Bergey´s Manual 2da y 7ma edición fueron utilizados para la determinación de géneros. Se logró el aislamiento de 20 cepas bacterianas. Los géneros encontrados fueron: Moraxella, Bacillus, Acinetobacter, Vibrio, Aeromonas, Photobacterium, Alteromonas, Alcaligenes, Streptococcus y Chromobacterium. 

Stroop Color-Word Interference Test: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Stroop Test across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the Stroop Test, as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 14-36% of the variance in Stroop Word scores, 12-41% of the variance in the Stoop Color, 14-36% of the variance in the Stroop Word-Color scores, and 4-15% of variance in Stroop Interference scores. Although t-tests showed significant differences between men and women on the Stroop test, none of the countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

This is the first normative multicenter study conducted in Latin America to create norms for the Stoop Test in a Spanish-Speaking sample. This study will therefore have important implications for the future of neuropsychology research and practice throughout the region.

Acute and chronic malnutrition and their predictors in children aged 0-5 years in São Tomé: a cross-sectional, population-based study

OBJECTIVE

Undernutrition is an important cause of morbidity and mortality in infants and children worldwide. The aim of this study was to evaluate the nutritional status and their predictors in children from 0 to 5 years of age in São Tomé.

STUDY DESIGN

A cross-sectional study was conducted in São Tomé Island.

METHODS

A total of 1285 individuals were enrolled between January and May 2011. Children were measured, and height for age (HAZ), weight for height (WHZ) and body mass index (BAZ) Z-score were computed. Global acute undernutrition is defined as weight for height <-1 Z-score (wasting < -2 Z-scores) and global chronic undernutrition as length/height for age <-1 Z-score (stunting < -2 Z-scores). Relevant information was collected from individual health bulletins, namely gestational age and birth weight, as well as weight at 6, 12, 18 and 24 months for all individual above these ages. Mothers were invited to answer a specific questionnaire.

RESULTS

A high percentage of global acute undernutrition (30.9% in <24 months and 21.9% in ≥24 months) and global chronic undernutrition (32.5% in <24 months and 41.1% in ≥24 months) was observed. Appropriate birth weight for gestational age (AGA) is significantly associated with lower odds for both acute (OR 0.485 [95% CI 0.299-0.785]) and chronic undernutrition (OR 0.427 [95% CI 0.270-0.675]) in children >12 months. Weight gain above 0.67 Z-score in the first semester of life was strongly related to lower odds for both acute (OR 0.109 [95% CI 0.040-0.291]) and chronic undernutrition (OR 0.379 [95% CI 0.187-0.770]) in children >12 months of age. Similarly, mother's education seems to protect against acute (>12 months: OR 0.448 [95% CI 0.244-0.825]; >24 months: OR 0.186 [95% CI 0.064-0.540]) and chronic undernutrition (>12 months: OR 0.389 [95% CI 0.232-0.653]; >24 months: OR 0.324 [95% CI 0.171-0.625]). All logistic regressions were adjusted for all children (gender, age, gestational age, birth weight, breastfeeding, begin consumption alcohol), mothers (age, height, body mass index, educational level, number of previous pregnancies, smoking during pregnancy, alcohol consumption during pregnancy) and household (number of siblings and persons at home) variables included in the protocol.

CONCLUSIONS

Birth weight, nutritional status, and the mother's education and weight gain particularly in the first year of life were important factors protecting against undernutrition during infancy and childhood. These results emphasize the importance of women's nutrition and of adequate birth weight and particularly weight gain during the first year of life in order to prevent wasting and stunting in childhood.

A pilot study of nurse-led, home monitoring for patients with chronic respiratory failure and with mechanical ventilation assistance

We assessed the feasibility of telemedicine for home monitoring of 45 patients with chronic respiratory failure (CRF) discharged from hospital. The patients transmitted pulsed arterial saturation (pSat) data via a telephone modem to a receiving station where a nurse was available for a teleconsultation. A respiratory physician was also available. Scheduled and ad hoc appointments were conducted. Thirty-five patients were on home mechanical ventilation, 13 with invasive and 22 with non-invasive devices. The main diagnosis was chronic obstructive pulmonary disease (COPD). The follow-up period was 176 days (SD 69). In all, 376 calls for scheduled consultations were received and 83 ad hoc consultations were requested by the patients. The actions taken were: 55 therapy modifications, 19 hospitalizations in a respiratory department for decompensated CRF, three hospitalizations in an intensive care unit (ICU), 22 requests for further investigations, 25 contacts with the general practitioner (GP), 66 demands for respiratory consultations and 10 calls for the emergency department. The mean time recorded for the 459 calls was 16 min/patient/week. In 82% of calls, a pSat recording was received successfully. The nurse time required to train the users in the operation of the pSat instrument was high (mean time 30 min). However, the results showed that home monitoring was feasible, and useful for titration of oxygen, mechanical ventilation setting and stabilization of relapses.

An update on clinical applications of hepatospecific contrast media in magnetic resonance imaging of liver parenchyma

Hepatobiliary-specific contrast agents are now widely used in magnetic resonance imaging (MRI) of liver parenchyma. As extracellular fluid agents, they provide informations regarding lesion vascularity and their use in the hepatobiliary or delayed phase (DPI), and give additional data regarding hepatocyte presence and function. The aim of this article is to review the recent literature about MRI using hepatobiliary-specific contrast agents and to discuss benefits and limits of their clinical applications. Since November 2008, hepatobiliary contrast agents were routinely employed in our Institution for the characterization of equivocal liver lesions detected by other imaging modalities, and for the evaluation of hepatic nodules in liver cirrhosis. The informations provided are particularly relevant for the detection of metastases, for the differentiation between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), and for the detection and differentiation between dysplastic nodules (DNs) and hepatocellular carcinoma (HCC) in the cirrhotic liver. The role in the cirrhosis grading and the quantification of liver function is still controversial. Finally, their biliary excretion allows evaluation of anatomy and function of the biliary tree. According to our and reported data, hepatobiliary contrast agents are able to improve liver lesions detection and characterization; their introduction in clinical practice has improved MRI diagnostic efficacy/accuracy, allowing to decrease the number of invasive diagnostic procedures.

Pertinent parameters in photo-generation of electrons: Comparative study of anatase-based nano-TiO2 suspensions

In the field of solar fuel cells, the development of efficient photo-converting semiconductors remains a major challenge. A rational analysis of experimental photocatalytic results obtained with material in colloïdal suspensions is needed to access fundamental knowledge required to improve the design and properties of new materials. In this study, a simple system electron donor/nano-TiO2 is considered and examined via spin scavenging electron paramagnetic resonance as well as a panel of analytical techniques (composition, optical spectroscopy and dynamic light scattering) for selected type of nano-TiO2. Independent variables (pH, electron donor concentration and TiO2 amount) have been varied and interdependent variables (aggregate size, aggregate surface vs. volume and acid/base groups distribution) are discussed. This work shows that reliable understanding involves thoughtful combination of interdependent parameters, whereas the specific surface area seems not a pertinent parameter. The conclusion emphasizes the difficulty to identify the key features of the mechanisms governing photocatalytic properties in nano-TiO2.