Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study

Purpose Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain. Methods Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence). Results Ninety-four patients were analyzed. During a mean follow-up of 73.3 +/- 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 +/- 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001). Conclusion FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA

Modifiable risk factors associated with prediabetes in men and women: A cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes

Background: Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods: Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results: Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions: Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population

Oceanic and terrestrial sources of continental precipitation

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Reviews of Geophysics 50 (2012): RG4003, doi:10.1029/2012RG000389.The most important sources of atmospheric moisture at the global scale are herein identified, both oceanic and terrestrial, and a characterization is made of how continental regions are influenced by water from different moisture source regions. The methods used to establish source-sink relationships of atmospheric water vapor are reviewed, and the advantages and caveats associated with each technique are discussed. The methods described include analytical and box models, numerical water vapor tracers, and physical water vapor tracers (isotopes). In particular, consideration is given to the wide range of recently developed Lagrangian techniques suitable both for evaluating the origin of water that falls during extreme precipitation events and for establishing climatologies of moisture source-sink relationships. As far as oceanic sources are concerned, the important role of the subtropical northern Atlantic Ocean provides moisture for precipitation to the largest continental area, extending from Mexico to parts of Eurasia, and even to the South American continent during the Northern Hemisphere winter. In contrast, the influence of the southern Indian Ocean and North Pacific Ocean sources extends only over smaller continental areas. The South Pacific and the Indian Ocean represent the principal source of moisture for both Australia and Indonesia. Some landmasses only receive moisture from the evaporation that occurs in the same hemisphere (e.g., northern Europe and eastern North America), while others receive moisture from both hemispheres with large seasonal variations (e.g., northern South America). The monsoonal regimes in India, tropical Africa, and North America are provided with moisture from a large number of regions, highlighting the complexities of the global patterns of precipitation. Some very important contributions are also seen from relatively small areas of ocean, such as the Mediterranean Basin (important for Europe and North Africa) and the Red Sea, which provides water for a large area between the Gulf of Guinea and Indochina (summer) and between the African Great Lakes and Asia (winter). The geographical regions of Eurasia, North and South America, and Africa, and also the internationally important basins of the Mississippi, Amazon, Congo, and Yangtze Rivers, are also considered, as is the importance of terrestrial sources in monsoonal regimes. The role of atmospheric rivers, and particularly their relationship with extreme events, is discussed. Droughts can be caused by the reduced supply of water vapor from oceanic moisture source regions. Some of the implications of climate change for the hydrological cycle are also reviewed, including changes in water vapor concentrations, precipitation, soil moisture, and aridity. It is important to achieve a combined diagnosis of moisture sources using all available information, including stable water isotope measurements. A summary is given of the major research questions that remain unanswered, including (1) the lack of a full understanding of how moisture sources influence precipitation isotopes; (2) the stationarity of moisture sources over long periods; (3) the way in which possible changes in intensity (where evaporation exceeds precipitation to a greater of lesser degree), and the locations of the sources, (could) affect the distribution of continental precipitation in a changing climate; and (4) the role played by the main modes of climate variability, such as the North Atlantic Oscillation or the El Niño–Southern Oscillation, in the variability of the moisture source regions, as well as a full evaluation of the moisture transported by low-level jets and atmospheric rivers.Luis Gimeno would like to thank the Spanish Ministry of Science and FEDER for their partial funding of this research through the project MSM. A. Stohl was supported by the Norwegian Research Council within the framework of the WATER‐SIP project. The work of Ricardo Trigo was partially supported by the FCT (Portugal) through the ENAC project (PTDC/AAC-CLI/103567/2008).2013-05-0

Intrapancreatic Lesion of Biliary Duct Following a Blunt Trauma: A Rare Entity Difficult to Identify with Conservative Management

Lesions of the biliary duct following a blunt abdominal trauma occurs infrequently, and even more so when it occurs in the intrapancreatic biliary duct. With the increase of conservative treatment in blunt abdominal trauma, the diagnosis of this entity can be difficult and delayed. We present the case of a lesion of the intrapancreatic biliary duct following a blunt trauma. A 51-year-old male patient was treated following a&nbsp; bicycle accident. Initial CT scan showed multiple bilateral rib fractures and grade 2 liver injury in segment VII. On the basis of these findings and the stability of the patient, a conservative treatment was adopted. On the 9th day following admission he developed a progressive jaundice. This prompted a Doppler ultrasonography of the liver, showing no abnormalities in the pedicle or hepatic vessels, as well as an MR-cholangiography, which only revealed an increased amount of abdominal fl uid without dilatation of the bile duct and without apparent injury of the duct.Upon the onset of fever and general worsening of the patient’s condition, an exploratory laparotomy was performed on the 16th day following admission, revealing plenty of intraperitoneal bile fl uid, but a visual examination of the bile duct failed to determine the site of injury. An intraoperative ERCP was performed, revealing a lesion of the intrapancreatic bile duct, after which a biliary stent was inserted.In the early postoperative period the patient developed a leak through the external biliary drains placed during laparotomy. A new ERCP was therefore performed, together with the insertion of a coated metal prosthesis, after which the patient progressed satisfactorily. Damage to the intrapancreatic bile duct by blunt abdominal trauma is a rare entity, diffi cult to diagnose&nbsp; especially with the increase of conservative treatment of associated injury such as liver damage. MR&nbsp; cholangiography and ERCP play a fundamental role in the diagnosis and actual endoscopic treatment of these injuries (with or without a surgical cavity wash) and, when feasible, this constitutes the best option for treatment.</p

Negative Pressure Therapy with Intraperitoneal Saline Instillation in the Open Septic Abdomen

Introduction: Open abdomen has become a common technique in the management of abdominal sepsis. We present a series of cases of 12 open septic abdomen treated by using intermittent therapy with intra-abdominal irrigation with a modified VAC- Ulta® associated with ABThera® dressing, comparing with ABThera® dressing suction therapy alone. Methods: Pilot prospective study of 12 consecutive patients with temporary abdominal closure for abdominal sepsis. During the initial laparotomy washing of the peritoneal cavity was performed with warm saline. Six patients (Goup 1) were treated by KCI ABThera® dressing, and keeping constant suction pressure -125 mmHg. For the second group (Group 2) the mentioned dressing was used, and we performed also intermittent intra-abdominal instillation with modified VAC-Ulta®. Results: Primary fascial closure was achieved in 100% of patients with instillation therapy, 4 of them in the first change after 3 days, and the other 2 patients in the second change (6th day). In the group 1, only 3 of them were closed (at 3th, 6th and 11th day). Two of them remained with the open abdomen and the other one died. In patients with instillation therapy, there were no intra-abdominal complications after closure. Conclusions: The results obtained by combining the intra-abdominal instillation therapy with suction seem to be promising, regarding the rate of abdominal closure, reducing the time to primary fascial closure and consequently in fewer complications associated with open abdome

Full shape crystalline lens quantification from 3-D OCT images and its application to predict the post-operative IOL position.

ARVO 2017, Baltimore, MD, May 7-11, 20173-D OCT measurements with dedicated algorithms allow full quantification of the crystalline lens in-vivo. The estimated parameters (EPP in particular) provide valuable information for improving the estimation of the post-operative IOL position and thus the IOL selection. Improvements by 0.25 D in IOL power calculations resulting from accurate ELP accumulate to those arising from patient-specific measurements of posterior corneal surface, 3-D biometry and 3-D ray tracing analysis.Peer Reviewe

Negative Pressure Therapy with Intraperitoneal Saline Instillation in the Open Septic Abdomen

Introduction: Open abdomen has become a common technique in the management of abdominal sepsis. We present a series of cases of 12 open septic abdomen treated by using intermittent therapy with intra-abdominal irrigation with a modified VAC- Ulta® associated with ABThera® dressing, comparing with ABThera® dressing suction therapy alone. Methods: Pilot prospective study of 12 consecutive patients with temporary abdominal closure for abdominal sepsis. During the initial laparotomy washing of the peritoneal cavity was performed with warm saline. Six patients (Goup 1) were treated by KCI ABThera® dressing, and keeping constant suction pressure -125 mmHg. For the second group (Group 2) the mentioned dressing was used, and we performed also intermittent intra-abdominal instillation with modified VAC-Ulta®. Results: Primary fascial closure was achieved in 100% of patients with instillation therapy, 4 of them in the first change after 3 days, and the other 2 patients in the second change (6th day). In the group 1, only 3 of them were closed (at 3th, 6th and 11th day). Two of them remained with the open abdomen and the other one died. In patients with instillation therapy, there were no intra-abdominal complications after closure. Conclusions: The results obtained by combining the intra-abdominal instillation therapy with suction seem to be promising, regarding the rate of abdominal closure, reducing the time to primary fascial closure and consequently in fewer complications associated with open abdomen

Non-T cell activation linker (NTAL) proteolytic cleavage as a terminator of activatory intracellular signals.

Non-T cell activation linker is an adaptor protein that is tyrosine phosphorylated upon cross-linking of immune receptors expressed on B lymphocytes, NK cells, macrophages, basophils, or mast cells, allowing the recruitment of cytosolic mediators for downstream signaling pathways. Fas receptor acts mainly as a death receptor, and when cross-linked with Fas ligand, many proteins are proteolytically cleaved, including several signaling molecules in T and B cells. Fas receptor triggering also interferes with TCR intracellular signals, probably by means of proteolytic cleavage of several adaptor proteins. We have previously found that the adaptor linker for activation of T cells, evolutionarily related to non-T cell activation linker, is cleaved upon proapoptotic stimuli in T lymphocytes and thymocytes, in a tyrosine phosphorylation-dependent fashion. Here, we describe non-T cell activation linker proteolytic cleavage triggered in human B cells and monocytes by Fas cross-linking and staurosporine treatment. Non-T cell activation linker is cleaved, producing an N-terminal fragment of ∼22 kDa, and such cleavage is abrogated in the presence of caspase 8/granzyme B and caspase 3 inhibitors. Moreover, we have identified an aspartic acid residue at which non-T cell activation linker is cleaved, which similar to linker for activation of T cells, this aspartic acid residue is located close to tyrosine and serine residues, suggesting an interdependence of phosphorylation and proteolytic cleavage. Consistently, induction of non-T cell activation linker phosphorylation by pervanadate inhibits its cleavage. Interestingly, the truncated isoform of non-T cell activation linker, generated after cleavage, has a decreased signaling ability when compared with the full-length molecule. Altogether, our results suggest that cleavage of transmembrane adaptors constitutes a general mechanism for signal termination of immune receptors