1,384 research outputs found
Use of colonoscopy as a primary screening test for colorectal cancer in average risk people
The use of colonoscopy as a primary screening test for colorectal
cancer (CRC) in average risk adults is a subject of controversy. Our primary
objective was to build a predictive model based on a few simple variables that
could be used as a guide for identifying average risk adults more suitable for
examination with colonoscopy as a primary screening test. METHODS: The prevalence
of advanced adenomas was assessed by primary screening colonoscopy in 2210
consecutive adults at least 40 yr old, without known risk factors for CRC. Age,
gender, and clinical and biochemical data were compared among people without
adenomas, those with non-advanced adenomas, and those with any advanced neoplasm.
A combined score to assess the risk of advanced adenomas was built with the
variables selected by multiple logistic regression analysis. RESULTS: Neoplastic
lesions were found in 617 subjects (27.9%), including 259 with at least one
neoplasm that was 10 mm or larger, villous, or with moderate-to-severe dysplasia,
and 11 with invasive cancers. Advanced lesions were more frequent among men,
older people, and those with a higher body mass index (BMI). These three
variables were independent predictors of advanced adenomas in multivariate
analysis. A score combining age, sex, and BMI was developed as a guide for
identifying individuals more suitable for screening colonoscopy. CONCLUSIONS:
Age, gender, and BMI can be used to build a simple score to select those average
risk adults who might be candidates for primary screening colonoscop
Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy
For colorectal cancer screening, the predictive value of distal
findings in the ascertainment of proximal lesions is not fully established. The
aims of this study were to assess distal findings as predictors of advanced
proximal neoplasia and to compare the predictive value of endoscopy alone vs.
combined endoscopic and histopathologic data. METHODS: Primary colonoscopy
screening was performed in 2210 consecutive, average-risk adults. Age, gender,
endoscopic (size, number of polyps), and histopathologic distal findings were
used as potential predictors of advanced proximal neoplasms (i.e., any adenoma >
or =1 cm in size, and/or with villous histology, and/or with severe dysplasia or
invasive cancer). Polyps were defined as distal if located in the descending
colon, the sigmoid colon, or the rectum. Those in other locations were designated
proximal. RESULTS: Neoplastic lesions, including 11 invasive cancers, were found
in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma
were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not
associated with any distal polyp. Older age, male gender, and distal adenoma were
independent predictors of advanced proximal neoplasms. The predictive ability of
a model with endoscopic data alone did not improve after inclusion of
histopathologic data. In multivariate logistic regression analysis, the
predictive ability of models that use age, gender, and any combination of distal
findings was relatively low. The proportion of advanced proximal neoplasms
identified if any distal polyp was an indication for colonoscopy was only 62%.
CONCLUSIONS: A strategy in which colonoscopy is performed solely in patients with
distal colonic findings is not effective screening for the detection of advanced
proximal neoplasms in an average-risk populatio
Goats as Valuable Animal Model to Test the Targeted Glutamate Supplementation upon Antral Follicle Number, Ovulation Rate, and LH-Pulsatility
The potential effect of intravenous administration of glutamate on the ovarian activity and the LH secretion pattern, considering the anestrous yearling goat as an animal model, were assessed. In late April, yearling goats (n = 20) were randomly assigned to either (1) Glutamate supplemented (GLUT; n = 10, Live Weight (LW) = 29.6 ± 1.02 kg, Body Condition (BCS) = 3.4 ± 0.2 units; i.v. supplemented with 7 mg GLUT kg−1 LW) or (2) Non-supplemented (CONT; n = 10; LW = 29.2 ± 1.07 kg, BCS = 3.5 ± 0.2 units; i.v. saline). The oats were estrus-synchronized; blood sampling (6 h × 15 min) was carried out for LH quantification. Response variables included pulsatility (PULSE), time to first pulse (TTFP), amplitude (AMPL), nadir (NAD), and area under the curve (AUC) of LH. Ovaries were ultra-sonographically scanned to assess ovulation rate (OR), number of antral follicles (AF), and total ovarian activity (TOA = OR + AF). LH-PULSE was quantified with the Munro algorithm; significant treatment x time interactions were evaluated across time. The variables LW and BCS did not differ (p > 0.05) between the experimental groups. Nevertheless, OR (1.77 vs. 0.87 ± 0.20 units), TOA (4.11 vs. 1.87 ± 0.47 units) and LH-PULSE (5.0 vs. 2.2 pulses 6 h-1) favored (p < 0.05) to the GLUT group. Our results reveal that targeted glutamate supplementation, the main central nervous system neurotransmitter, arose as an interesting strategy to enhance the hypothalamic–hypophyseal–ovarian response considering the anestrous-yearling goat as an animal model, with thought-provoking while promising translational applications
Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study
Purpose: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. Materials and Methods: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. Results: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. Conclusions: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to “conventional” ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure
Late gadolinium enhancement distribution patterns in non-ischemic dilated cardiomyopathy: Genotype-phenotype correlation.
AIMS
Late gadolinium enhancement (LGE) is frequently found in patients with dilated cardiomyopathy (DCM), there is little information about its frequency and distribution pattern according to underlying genetic substrate. We sought to describe LGE patterns according to genotype and to analyze the risk of major ventricular arrhythmias (MVA) according to patterns.
METHODS AND RESULTS
Cardiac magnetic resonance findings and LGE distribution according to genetics was performed in a cohort of 600 DCM patients followed at 20 Spanish centers. After exclusion of individuals with multiple causative gene variants or with variants in infrequent DCM-causing genes, 577 patients (34% females, mean age 53.5 years, LVEF 36.9 ± 13.9%) conformed the final cohort. A causative genetic variant was identified in 219 (38%) patients and 147 (25.5%) had LGE. Significant differences were found comparing LGE patterns between genes (P < 0.001). LGE was absent or rare in patients with variants in TNNT2, RBM20 and MYH7 (0%, 5% and 20%, respectively). Patients with variants in DMD, DSP and FLNC showed predominance of LGE subepicardial pattern (50%, 41% and 18%, respectively) whereas patients with variants in TTN, BAG3, LMNA and MYBPC3 showed unspecific LGE patterns. Genetic yield differed according to LGE pattern. Patients with subepicardial, lineal midwall, transmural, right ventricular insertion points or with combination of LGE patterns showed increased risk of MVA compared with patients without LGE.
CONCLUSION
LGE patterns in DCM has a specific distribution according to the affected gene. Certain LGE patterns are associated with increased risk of MVA and with increased yield of genetic testing.This study has been funded by Instituto Salud Carlos III (ISCIII) through the
projects ‘PI18/0004, PI19/01283, and PI20/0320’ (co-funded by the
European Regional Development Fund/European Social Fund ‘A way to
make Europe’/‘Investing in your future’). The Hospital Universitario
Puerta de Hierro, the Hospital Universitario Vall Hebrón, the Hospital
General Universitario Gregorio Marañón, and the Hospital Universitario
Virgen de la Arrixaca are members of the European Reference Network
for Rare, Low Prevalence, and Complex Diseases of the Heart (ERN
GUARD-Heart). F.d.F. receives grant support from ISCIII (CM20/00101).
R.B. receives funding from the Obra Social la Caixa Foundation. M.B. receives funding from ISCIII (PI19/01283). The CNIC is supported by the
ISCIII, Ministerio de Ciencia e Innovación of the Spanish Government
(MCIN), and Pro CNIC Foundation.S
Método epidemiológico
Tomado de la cubierta : "Manual de Método Epidemiológico"El presente volumen incluye trece temas elaborados por diferentes autores, todos ellos expertos en salud pública y profesores de la Escuela Nacional de Sanidad, con la orientación fundamental de servir de apoyo a la docencia del método epidemiológico. Así, partiendo de la definición de epidemiología y de la descripción de sus usos potenciales, se describen los conceptos básicos de este método científico, sus principales diseños de investigación, los métodos básicos de análisis de datos, las técnicas de control de sesgos y factores de confusión, las bases de la inferencia causal y los aspectos fundamentales de la epidemiología clínica en el escenario actual
Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV
The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8 TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum
Long daytime napping is associated with increased adiposity and type 2 diabetes in an elderly population with metabolic syndrome
Research examining associations between objectively-measured napping time and type
2 diabetes (T2D) is lacking. This study aimed to evaluate daytime napping in relation to T2D and
adiposity measures in elderly individuals from the Mediterranean region. A cross-sectional analysis of
baseline data from 2190 elderly participants with overweight/obesity and metabolic syndrome, in the
PREDIMED-Plus trial, was carried out. Accelerometer-derived napping was measured. Prevalence
ratios (PR) and 95% confidence intervals (CI) for T2D were obtained using multivariable-adjusted
Cox regression with constant time. Linear regression models were fitted to examine associations of
napping with body mass index (BMI) and waist circumference (WC). Participants napping ≥90 min
had a higher prevalence of T2D (PR 1.37 (1.06, 1.78)) compared with those napping 5 to <30 min per
day. Significant positive associations with BMI and WC were found in those participants napping
≥30 min as compared to those napping 5 to <30 min per day. The findings of this study suggest that
longer daytime napping is associated with higher T2D prevalence and greater adiposity measures in
an elderly Spanish population at high cardiovascular risk
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Curso de especialidad en la carrera de Administración y Negocios Internacionales, de carácter teórico-práctico,
dirigido a los estudiantes del 1er ciclo, que aborda los principios básicos de la teoría administrativa global y su
evolución, naturaleza y funcionamiento, desde una perspectiva del libre comercio en el contexto de la
globalización del Siglo XXI. Los contenidos teóricos, además, están asociados al estudio de factores internos y
externos para la definición de la estrategia de negocios, midiendo y analizando variables vinculadas a la cultura,
las relaciones laborales, los entornos empresariales, el mercado y las actividades de los competidores nacionales
e internacionales.
1La globalización de los negocios significa que los decisores y el personal gerencial administrativo de una
organización trabajen e interactúen con miembros de otras culturas, valorando los distintos entornos y siendo
capaces de gestionarlo de manera eficiente para lograr los resultados de una organización empresarial
Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2
The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality
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