Increased Th17-Related Cytokine Serum Levels in Patients With Multiple Polyps of Unexplained Origin

OBJECTIVES: Most patients with multiple colonic polyps do not have a known genetic or hereditary origin. Our aim was to analyze the presence of inflammatory cytokines and levels of glucose, insulin, and C-reactive protein (CRP) in patients with multiple colonic polyps. METHODS: Eighty-three patients with 10 or more adenomatous or serrated polyps and 53 control people with normal colonoscopy were included. Smoking habits were registered, and glucose, CRP, and basal insulin in the serum/blood were measured. Quantification of IL-2, IL-4, IL-6, IL-10, IL-11, IL-17A, and IL-23 cytokine levels in the serum was performed by a high-sensitivity enzyme-linked immunosorbent assay. RESULTS: Smoking and diabetes were more prevalent in those with colonic polyps than in the control people (67% vs 16%, P = 0.001; 11% vs 2%, P = 0.048). In addition, the cytokine serum levels were higher, i.e., IL-2 (P = 0.001), IL-4 (P = 0.001), IL-6 (P = 0.001), IL-17A (P = 0.001), IL-23 (P = 0.014), and CRP (P = 0.003). Adjusting for sex, smoking, and diabetes in a multivariate analysis, IL-2, IL-4, IL-6, IL-17A, and IL-23 remained independently elevated in cases with multiple polyps. DISCUSSION: These results indicate that immune responses mediated by Th17 cells may be involved in the pathogenesis of multiple colonic polyps

How the Emotional Content of Discourse Affects Language Comprehension

Emotion effects on cognition have often been reported. However, only few studies investigated emotional effects on subsequent language processing, and in most cases these effects were induced by non-linguistic stimuli such as films, faces, or pictures. Here, we investigated how a paragraph of positive, negative, or neutral emotional valence affects the processing of a subsequent emotionally neutral sentence, which contained either semantic, syntactic, or no violation, respectively, by means of event-related brain potentials (ERPs). Behavioral data revealed strong effects of emotion; error rates and reaction times increased significantly in sentences preceded by a positive paragraph relative to negative and neutral ones. In ERPs, the N400 to semantic violations was not affected by emotion. In the syntactic experiment, however, clear emotion effects were observed on ERPs. The left anterior negativity (LAN) to syntactic violations, which was not visible in the neutral condition, was present in the negative and positive conditions. This is interpreted as reflecting modulatory effects of prior emotions on syntactic processing, which is discussed in the light of three alternative or complementary explanations based on emotion-induced cognitive styles, working memory, and arousal models. The present effects of emotion on the LAN are especially remarkable considering that syntactic processing has often been regarded as encapsulated and autonomous

Incidence, clinical characteristics and management of inflammatory bowel disease in Spain: large-scale epidemiological study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100, 000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Maximum permisible temperature deviations for thermolabile medicines

Los medicamentos termolábiles constituyen un grupo especialmente susceptible, a que se produzcan errores en su conservación durante su transporte y su almacenaje en el Servicio de Farmacia y en los botiquines de las distintas Unidades Clínicas. El objetivo de este estudio ha sido elaborar una tabla de consulta rápida donde se incluyen los tiempos de estabilidad a temperatura ambiente y las actuaciones en caso de congelación, de los medicamentos incluidos en la Guía Farmacoterapéutica del Hospital. Su confección se hizo a partir de los datos solicitados y proporcionados por los Laboratorios fabricantes.Thermolabile medicines are especially susceptible to storage errors in both transportation and storage at pharmacies and dispensing units in different clinical centres. The objective of this study was to produce a quick consultative table that gives information on stability times at room temperature and procedures when freezing of medicines occur, for drugs included in hospital pharmacotherapeutic guides. The table was produced from information provided by manufacturing laboratories

Meta-evaluación del programa DOCENTIA de la UCM

En este proyecto nos hemos planteado el análisis de las propiedades psicométricas de los instrumentos del Programa DOCENTIA aplicado por la UCM para determinar si es adecuado para conseguir los objetivos que se pretenden con su aplicació

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding Hallazgos digestivos altos de la cápsula endoscópica en la hemorragia digestiva de origen oscuro

Objective: we analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. Methods: we retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. Results: capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. Conclusions: the performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.<br>Objetivo: hemos analizado los hallazgos que la cápsula endoscópica aportó de las zonas accesibles a una gastroscopia que podrían justificar un sangrado digestivo oscuro, así como la evolución de estos enfermos tras la nueva gastroscopia recomendada para determinar si una segunda gastroscopia previa a la cápsula podría añadir beneficios en el manejo de esta patología. Métodos: estudiamos de forma retrospectiva 82 pacientes a los que se efectuó cápsula endoscópica como estudio de hemorragia oscura que contaban con una única gastroscopia. Los hallazgos que la cápsula apreció en tramos altos se dividieron en normales, leves/conocidos y severos-desconocidos que recomendaron una segunda gastroscopia. Estos últimos casos fueron seguidos. Resultados: la cápsula endoscópica no objetivó hallazgos esofágicos desconocidos. En un 63% no evidenció lesiones gastroduodenales, en un 20% estas eran leves o conocidas y en un 17% se recomendó una nueva gastroscopia al encontrar patología desconocida y que podría motivar la hemorragia digestiva a este nivel. La información motivó cambios en el tratamiento en un 85% de este grupo, con mejoría en el 78%. La cápsula endoscópica encontró alteraciones intercurrentes llamativas en el intestino delgado en sólo un 14%. Conclusiones: una segunda gastroscopia previa a una cápsula endoscópica en el estudio de la hemorragia oscura ofrecería beneficios en términos diagnósticos y a la hora de introducir cambios terapéuticos que consiguen buenos resultados clínicos. El análisis detallado de los fotogramas del tracto digestivo alto es obligado, ya que puede aportar información relevante y con importancia en el manejo de estos pacientes

Nutrición parenteral domiciliaria en niños en un hospital terciario entre los años 1993 y 2009 Home parenteral nutrition in infants and children in a tertiary level hospital between 1993 and 2009

La nutrición parenteral domiciliaria (NPD) constituye la piedra angular en el tratamiento del fracaso intestinal permanente o transitorio en pediatría. Su empleo no está exento de complicaciones. Revisamos la experiencia de nuestro programa desde su inicio en 1993. Pacientes y métodos: Estudio longitudinal retrospectivo de las historias clínicas de los 25 niños (11 niños, y 14 niñas) que recibieron NPD en ese periodo. Cuando un paciente recibió NPD en periodos separados más de 3 meses del anterior se consideró un episodio diferente, por lo que el número total de episodios fue de 32. Los datos cuantitativos se recogieron como media o mediana y los cualitativos como frecuencia. Se recogieron las tasas de complicaciones por cada 1.000 días de NPD. Resultados: 16 pacientes comenzaron NPD antes del año de edad. La duración total de la NPD fue de 9.986 días, con una mediana de duración de 174 días con un rango de 7 a 2.444 días. La indicación principal fue síndrome de intestino corto en 6 casos, trastornos de la motilidad en otros 6, diarrea crónica en 5 casos, malnutrición en 3 casos y 5 de los casos respondían a otras causas. Se utilizaron un total de 47 catéteres, con una duración media de 212,5 días, mediana de 120 días (rango: 7 a 930). Mayoritariamente el catéter venoso empleado fue un catéter tunelizado (n = 42), seguido de un reservorio en 3 casos y en 2 casos un catéter venoso central de abordaje periférico (PICC). La tasa de complicaciones para 1000 días de NPD fue la siguiente: 3,4 para las infecciones relacionadas con el catéter; de 0,1 para las obstrucciones; 0,9 para las roturas y 0,1 extracciones accidentales. Los gérmenes más frecuentes en las infecciones relacionadas con el catéter fueron los Staphylococcus coagulasa negativo (47%), seguido de las bacterias Gram negativas (21%), Staphylococcus aureus (15%), hongos (9%) y otros en un 9%. Presentaron afectación hepática importante 4 pacientes. En cuanto a la evolución: 21 pacientes pudieron prescindir de la NP por conseguir adaptación intestinal, 3 pacientes fallecieron mientras estaban en el programa a causa de su enfermedad de base, 2 recibieron un trasplante intestinal y 5 continúan actualmente con NPD. Conclusiones: Cada año se incorporan dos pacientes nuevos al programa de NPD. En el 65% de los casos se pudo suspender la NPD por adaptación intestinal. Las complicaciones infecciosas relacionadas con el catéter fueron las más frecuentes (3,4 infecciones por cada 1.000 días de NPD). La duración mediana de la NPD fue de 174 días, y algo menor para los catéteres (120 días).Home parenteral nutrition (HPN) has a key role in the management of permanent or transient intestinal failure in the pediatric patient. Although its use is not without complications. We review our experience since the beginning of the program in 1993. Patients and methods: Longitudinal and retrospective study of the clinical records from 25 infants and children (11 boys, 14 girls) who received HPN in this period. If a patient received HPN in periods separated more than 3 months we consider a different episode. In this way, 32 episodes were described. Quantitative data are presented as mean or median and qualitative as frequency. Complications are presented as complication rate per 1,000 days of HPN. Results: 16 patients started HPN younger than 1 year. Total length of HPN was 9,986 days, median 174 days (range 7 to 2,444 days). Main indication was short bowel syndrome (n = 6); motility disorders (n = 6); chronic diarrhea (n = 5), malnutrition (n = 3) and other causes (n = 5). 47 catheters were used; mean length 212.5 days, median 120 days (range: 7 to 930). Most of central venous catheters were tunnelled catheters (n = 42); subcutaneous ports (n=3) and in two cases periferically inserted central catheters (PICCS). Complication rate per 1,000 days of HPN was: 3.4 for catheter-related infections, 0.1 for obstruction; 0.9 for leakage, and 0.1 for accidental removal. Most common microorganisms were Staphylococcus coagulase negative (47%), Gram negative bacteria (21%), Staphylococcus aureus (15%), fungi (9%) and others in 9%. Parenteral nutrition-associated liver disease was present in 4 patients. 21 patients were weaned off HPN, 3 patients deceased because of underlying disease, 2 patients underwent intestinal transplantation, while 5 patients continue in the program. Conclusions: Every year two new patients enter in the program. 65% of patients were weaned off HPN. Infectious complications were the most frequent (rate 3.4 infections per 1,000 days of HPN). Mean length of HPN was 174 days, and 120 days for catheters