RESUMEN
INTRODUCTION: Lower blood levels of the omega-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) are correlated with worse cognitive functions, particularly among APOE ε4 carriers. Whether DHA supplementation in APOE ε4 carriers with limited DHA consumption and dementia risk factors can delay or slow down disease progression when started before the onset of clinical dementia is not known. METHODS: PreventE4 is a double-blind, single site, randomized, placebo-controlled trial in cognitively unimpaired individuals with limited omega-3 consumption and dementia risk factors (n=368). Its objectives are to determine (1) whether carrying the APOE ε4 allele is associated with lower delivery of DHA to the brain; and (2) whether high dose DHA supplementation affects brain imaging biomarkers of AD and cognitive function. RESULTS: 365 cognitively unimpaired individuals between 55 and 80 (mean age 66) were randomized to 2 grams of DHA per day or identically appearing placebo for a period of 2 years. Half the participants were asked to complete lumbar punctures at baseline and 6-month visits to obtain cerebrospinal fluid (CSF). The primary trial outcome measure is the change in CSF DHA to arachidonic acid ratio after 6 months of the intervention (n=181). Secondary trial outcomes include the change in functional and structural connectivity using resting state functional MRI at 24 months (n=365). Exploratory outcomes include the change in Repeatable Battery of the Assessment of Neuropsychological Status at 24 months (n=365). CONCLUSIONS: Findings from PreventE4 will clarify the brain delivery of DHA in individuals carrying the APOE ε4 allele with implications for dementia prevention strategies. Trial was registered as NCT03613844.
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Enfermedad de Alzheimer , Ácidos Grasos Omega-3 , Humanos , Enfermedad de Alzheimer/tratamiento farmacológico , Apolipoproteína E4/genética , Encéfalo/diagnóstico por imagen , Ácidos Docosahexaenoicos/uso terapéutico , Ácidos Grasos Omega-3/uso terapéutico , Persona de Mediana Edad , Anciano , Anciano de 80 o más AñosRESUMEN
At "Instituto de Alergias y Autoinmunidad Dr. Maximiliano Ruiz Castañeda, A.C." in Mexico City, a non-traditional health care center focused on the treatment of autoimmune and allergic diseases using personalized medicine, an alternative treatment referred to as an "immune-modulator" has been developed. In this study, we will refer to this treatment substance as the "immune-modulator." In brief, a urine sample is collected from the patient and processed to obtain the peptide fraction, which is conditioned and then administered sublingually to the patient. Sample processing involves multiple steps aimed at the removal of toxic compounds and enrichment for cytokines, growth factors, and other immune peptides that may contribute to the function of the immune-modulator. This treatment has been administered for many years, and patients testify that it is useful and reliable. Despite the benefits of this treatment, the molecular mechanisms underlying its effects have not been thoroughly investigated. Therefore, this study aims to identify immunoregulatory peptides, such as cytokines and growth factors, in the immune-modulator. Urine and immune-modulator concentrations of cytokines and growth factors were assessed using a Luminex assay. Twenty-one cytokines and growth factors were identified in immune-modulator samples. MCP-1 was identified in 100% of the samples; MIP-1ß, IL-8, RANTES, INF-γ, and IP-10 were identified in approximately 65-70% of samples; IL5, IL-1B, and IL-17 in 50-60%; eotaxin, VEGF, IL-6, and FGF in about 40%; MIP-1α, IL-9, GM-CSF, G-CSF, IL-12, and IL-15 in about 20-30%; and IL-13 and PDGF-bb were identified in <6% of samples. Additionally, patients exhibited significant changes in IL-1ß, IFN-γ, and MCP-1 concentrations after treatment with the immune-modulator, whereas healthy individuals showed no significant change in response to the treatment. The immune-modulator is an alternative treatment based on the administration of cytokines and growth factors obtained from the urine of patients. In this study, its composition was characterized. The isolated products could be responsible for the effects of the immune-modulator. Further trials are required to evaluate the effective delivery of these molecules by the administration route described.
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Enfermedades Autoinmunes/orina , Citocinas/orina , Hipersensibilidad/orina , Adulto , Anciano , Enfermedades Autoinmunes/terapia , Enfermedad Crónica , Femenino , Humanos , Hipersensibilidad/terapia , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Male breast cancer (MBC) management is extrapolated from female BC. Mastectomy remains the most frequently used surgical procedure for male breast cancer (MBC). We performed a literature review to assess the use of breast-conservation (BCS) in MBC as well as outcomes following BCS. METHODS: A systematic literature was performed, and articles screened to identify studies that measured overall survival (OS), disease-free survival (DFS), or local recurrence (LR) in patients undergoing BCS. Weighted averages based on study size were performed for LR, DFS, and 5-year OS. RESULTS: Eight studies met the inclusion criteria with male breast surgery cases, and 859 (14.7%) underwent BCS. The mean follow-up time was 53 months, and mean age was 62.6 years, with stage II as the most common presentation. Two studies reported that 50-71.4% of patients underwent sentinel lymph node biopsy, and four studies reported axillary lymph node dissection in 14.3-100%. Five studies reported on adjuvant radiation therapy in 12.0-100% of total patients undergoing BCS. Four studies reported use of hormonal therapy in 73.8-100% of patients. Four studies reported use of chemotherapy in 25-66.7% of patients. Seven studies reported LR among 116 patients, with a weighted average of 9.9%. Three studies reported on DFS in 14 patients, with a weighted average 85.6%. Two studies report OS in 143 patients with a weighted average of 84.4%. CONCLUSIONS: Breast conservation may be considered a safe alternative in the surgical treatment of MBC. Future research should focus on better standardization of local therapy for MBC and improved reporting of outcomes.
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Neoplasias de la Mama Masculina/cirugía , Mastectomía Segmentaria/métodos , Humanos , Masculino , PronósticoRESUMEN
This study examines trends in antidepressant drug dispensations among young people aged 0-24 years in Sweden during the period 2006-2013, as well as prescription patterns and central nervous system (CNS) polypharmacy with antidepressants. Using linkage of Swedish national registers, we identified all Swedish residents aged 0-24 years that collected at least one antidepressant prescription (here defined as antidepressant users) between 1 January 2006 and 31 December 2013 (n = 174,237), and categorized them as children (0-11 years), adolescents (12-17 years), and young adults (18-24 years). Prevalence of antidepressant dispensation rose from 1.4 to 2.1% between 2006 and 2013, with the greatest relative increase in adolescents [by 97.8% in males (from 0.6 to 1.3%) and by 86.3% in females (from 1.1 to 2.1%)]. Most individuals across age categories were prescribed selective serotonin reuptake inhibitors, received their prescriptions from psychiatric specialist care, and had treatment periods of over 12 months. Prevalence of CNS polypharmacy (dispensation of other CNS drug classes in addition to antidepressants) increased across age categories, with an overall increase in prevalence from 52.4% in 2006 to 62.1% in 2013. Children experienced the largest increase in polypharmacy of three or more psychotropic drug classes (4.4-10.1%). Anxiolytics, hypnotics, and sedatives comprised the most common additional CNS drug class among persons who were prescribed antidepressants. These findings show that the dispensation of antidepressants among the young is prevalent and growing in Sweden. The substantial degree of CNS polypharmacy in young patients receiving antidepressants requires careful monitoring and further research into potential benefits and harms.
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Antidepresivos/uso terapéutico , Polifarmacia , Psicotrópicos/uso terapéutico , Adolescente , Adulto , Antidepresivos/farmacología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Psicotrópicos/farmacología , Suecia , Adulto JovenRESUMEN
Adverse perinatal events may increase the risk of Tourette's and chronic tic disorders (TD/CTD), but previous studies have been unable to control for unmeasured environmental and genetic confounding. We aimed to prospectively investigate potential perinatal risk factors for TD/CTD, taking unmeasured factors shared between full siblings into account. A population-based birth cohort, consisting of all singletons born in Sweden in 1973-2003, was followed until December 2013. A total of 3 026 861 individuals were identified, 5597 of which had a registered TD/CTD diagnosis. We then studied differentially exposed full siblings from 947 942 families; of these, 3563 families included siblings that were discordant for TD/CTD. Perinatal data were collected from the Medical Birth Register and TD/CTD diagnoses were collected from the National Patient Register, using a previously validated algorithm. In the fully adjusted models, impaired fetal growth, preterm birth, breech presentation and cesarean section were associated with a higher risk of TD/CTD, largely independent from shared family confounders and measured covariates. Maternal smoking during pregnancy was associated with risk of TD/CTD in a dose-response manner but the association was no longer statistically significant in the sibling comparison models or after the exclusion of comorbid attention-deficit/hyperactivity disorder. A dose-response relationship between the number of adverse perinatal events and increased risk for TD/CTD was also observed, with hazard ratios ranging from 1.41 (95% confidence interval (CI): 1.33-1.50) for one event to 2.42 (95% CI: 1.65-3.53) for five or more events. These results pave the way for future gene by environment interaction and epigenetic studies in TD/CTD.
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Trastornos de Tic/genética , Síndrome de Tourette/genética , Adolescente , Adulto , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Preescolar , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Atención Perinatal , Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Estudios Prospectivos , Factores de Riesgo , Hermanos , Fumar/epidemiología , Suecia/epidemiología , Trastornos de Tic/metabolismo , Síndrome de Tourette/metabolismoRESUMEN
The association between obsessive-compulsive disorder (OCD) and Tourette's/chronic tic disorders (TD/CTD) with autoimmune diseases (ADs) is uncertain. In this nationwide study, we sought to clarify the patterns of comorbidity and familial clustering of a broad range of ADs in individuals with OCD, individuals with TD/CTD and their biological relatives. From a birth cohort of 7 465 455 individuals born in Sweden between 1940 and 2007, we identified 30 082 OCD and 7279 TD/CTD cases in the National Patient Register and followed them up to 31 December 2013. The risk of 40 ADs was evaluated in individuals with OCD, individuals with TD/CTD and their first- (siblings, mothers, fathers), second- (half siblings) and third-degree (cousins) relatives, compared with population controls. Individuals with OCD and TD/CTD had increased comorbidity with any AD (43% and 36%, respectively) and many individual ADs. The risk of any AD and several individual ADs was consistently higher among first-degree relatives than among second- and third-degree relatives of OCD and TD/CTD probands. The risk of ADs was very similar in mothers, fathers and siblings of OCD probands, whereas it tended to be higher in mothers and fathers of TD/CTD probands (compared with siblings). The results suggest a familial link between ADs in general (that is, not limited to Streptococcus-related conditions) and both OCD and TD/CTD. Additional mother-specific factors, such as the placental transmission of antibodies, cannot be fully ruled out, particularly in TD/CTD.
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Enfermedades Autoinmunes/epidemiología , Trastorno Obsesivo Compulsivo/inmunología , Síndrome de Tourette/inmunología , Adolescente , Adulto , Anciano , Enfermedades Autoinmunes/fisiopatología , Estudios de Casos y Controles , Niño , Análisis por Conglomerados , Comorbilidad , Familia , Femenino , Humanos , Masculino , Trastorno Obsesivo Compulsivo/complicaciones , Trastorno Obsesivo Compulsivo/genética , Linaje , Factores de Riesgo , Hermanos , Suecia/epidemiología , Trastornos de Tic/epidemiología , Síndrome de Tourette/complicaciones , Síndrome de Tourette/genéticaRESUMEN
All melanoma suspected patients must be confirmed histologically and resected. Sentinel node biopsy must be done when tumor is over 1 mm or if less with high-risk factors. Adjuvant therapy with interferon could be offered for patients with high-risk melanoma and in selected cases radiotherapy can be added. Metastatic melanoma treatment is guided by mutational BRAF status. BRAF wild type patients must receive anti-PD1 containing therapy and BRAF mutated patients BRAF/MEK inhibitors or anti-PD1 containing therapy. Up to 10 years follow up is reasonable for melanoma patients with dermatologic examinations and physical exams.
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Melanoma/terapia , Terapia Combinada/métodos , HumanosRESUMEN
The risk of death by suicide in individuals with obsessive-compulsive disorder (OCD) is largely unknown. Previous studies have been small and methodologically flawed. We analyzed data from the Swedish national registers to estimate the risk of suicide in OCD and identify the risk and protective factors associated with suicidal behavior in this group. We used a matched case-cohort design to estimate the risk of deaths by suicide and attempted suicide in individuals diagnosed with OCD, compared with matched general population controls (1:10). Cox regression models were used to study predictors of suicidal behavior. We identified 36 788 OCD patients in the Swedish National Patient Register between 1969 and 2013. Of these, 545 had died by suicide and 4297 had attempted suicide. In unadjusted models, individuals with OCD had an increased risk of both dying by suicide (odds ratio (OR)=9.83 (95% confidence interval (CI), 8.72-11.08)) and attempting suicide (OR=5.45 (95% CI, 5.24-5.67)), compared with matched controls. After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial for both death by suicide and attempted suicide. Within the OCD cohort, a previous suicide attempt was the strongest predictor of death by suicide. Having a comorbid personality or substance use disorder also increased the risk of suicide. Being a woman, higher parental education and having a comorbid anxiety disorder were protective factors. We conclude that patients with OCD are at a substantial risk of suicide. Importantly, this risk remains substantial after adjusting for psychiatric comorbidities. Suicide risk should be carefully monitored in patients with OCD.
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Trastorno Obsesivo Compulsivo/complicaciones , Trastorno Obsesivo Compulsivo/psicología , Suicidio/psicología , Adulto , Ansiedad/epidemiología , Trastornos de Ansiedad/epidemiología , Estudios de Cohortes , Comorbilidad , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , Ideación Suicida , Intento de Suicidio/psicología , SueciaRESUMEN
BACKGROUND: Sleep disorders in schoolchildren are a common problem worldwide, and when are not adequately diagnosed and treated, their negative impact on daytime functioning may be significant. The aim of this study was to evaluate the psychometric properties of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ). METHODS: Participants were 286 school-aged children from a community-based sample, aged 4 to 7 years. The sleep behaviour was evaluated using the CSHQ and actigraphy (ActiSleep monitor). The CSHQ was adapted to the Spanish language. The internal consistency of the questionnaire and the test-retest reliability between scores at baseline and three-weeks-later were estimated. Associations between CSHQ items and accelerometer sleep quality indicators were used as indicators of concurrent validity. RESULTS: Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.81, and 0.81 for the full scale; the intraclass correlation coefficients ranged from 0.56 to 0.81. A moderate correlation was observed in sleep latency and awakenings measurements using both parents' reported sleep habits (CSHQ-SP) and sleep quality indicators (ActiSleep). CONCLUSIONS: The CSHQ-SP has demonstrated adequate psychometric properties, and it serves as a useful instrument for clinical and research setting.
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Higiene del Sueño , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Actigrafía/métodos , Niño , Conducta Infantil , Preescolar , Femenino , Humanos , Masculino , Psicometría , Reproducibilidad de los Resultados , España , Encuestas y CuestionariosRESUMEN
Corn is a major crop and various herbicides are used to maximize its production, which include a dicamba-atrazine mixture. This has great advantages, but can also induce DNA damage. Genotoxic activity was assessed by comet assay following application of two concentrations of dicamba-atrazine: 1000-2000 and 2000-4000 ppm. Apical meristem leaf nuclei from 119 varieties of sweetcorn plants from Mexico and South America, and from five commercial sweetcorn hybrids were used. Each accession comprised two individuals per concentration and two controls. Significant genotoxic activity (P < 0.001) was observed following treatment with 1000-2000 and 2000-4000 ppm compared to the negative control. There was no difference in the genotoxic activity induced by both 1000-2000 and 2000-4000 ppm concentrations in plants from Mexico and South America (P > 0.05) except (P < 0.05) in the 2000-4000 ppm treated plants from Mexico and the 1000-2000 ppm treated plants from South America. Sweetcorn hybrids showed significant genetic damage (P < 0.01) at all concentrations compared to the negative controls. Thus, the dicamba-atrazine mixture caused genetic damage to corn plants, and it suggested that Mexican sweetcorn is more sensitive to dicamba-atrazine than the maize varieties from South America. Neither hybrid status nor the origin avoids DNA damage caused by Marvel. Thus, maize can be useful as a biomonitor of genetic damage induced by chemicals and to identify possible phenotypes based upon the amount of genetic damage induced by herbicides and selection of resistant genotypes.
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Atrazina/toxicidad , Daño del ADN , Dicamba/toxicidad , Herbicidas/toxicidad , Zea mays/efectos de los fármacos , Atrazina/efectos adversos , Dicamba/efectos adversos , Herbicidas/efectos adversos , Zea mays/genéticaRESUMEN
BACKGROUND: A new diagnostic category, hoarding disorder (HD), has been proposed for inclusion in DSM-5. This study field-tested the validity, reliability and perceived acceptability of the proposed diagnostic criteria for HD. Method Fifty unselected individuals with prominent hoarding behavior and 20 unselected, self-defined 'collectors' participated in thorough psychiatric assessments, involving home visits whenever possible. A semi-structured interview based on the proposed diagnostic criteria for HD was administered and scored by two independent raters. 'True' diagnoses were made by consensus according to the best-estimate diagnosis procedure. The percentage of true positive HD cases (sensitivity) and true negative HD cases (specificity) was calculated, along with inter-rater reliability for the diagnosis and each criterion. Participants were asked about their perceptions of the acceptability, utility and stigma associated with the new diagnosis. RESULTS: Twenty-nine (58%) of the hoarding individuals and none of the collectors fulfilled diagnostic criteria for HD. The sensitivity, specificity and inter-rater reliability of the diagnosis, and of each individual criterion and the specifiers, were excellent. Most participants with HD (96%) felt that creating a new disorder would be very or somewhat acceptable, useful (96%) and not too stigmatizing (59%). CONCLUSIONS: The proposed HD criteria are valid, reliable and perceived as acceptable and useful by the sufferers. Crucially, they seem to be sufficiently conservative and unlikely to overpathologize normative behavior. Minor changes in the wording of the criteria are suggested.
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Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastorno de Acumulación/diagnóstico , Pasatiempos/psicología , Diagnóstico Diferencial , Femenino , Trastorno de Acumulación/psicología , Humanos , Entrevista Psicológica , Londres , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Estigma SocialRESUMEN
BACKGROUND: Neurological soft signs (NSS) have been inconsistently reported in obsessive-compulsive disorder (OCD) but may make an impact on treatment response. Method The current study examined the presence of NSS in two independent European samples of OCD patients (combined 85 patients and 88 matched healthy controls) using a standardized instrument and conducted a meta-analysis of all published studies identified in the literature with the aim to provide a more definitive answer to the question of whether OCD patients are characterized by increased NSS. RESULTS: Both empirical studies found elevated NSS scores in patients compared with matched controls. The results of the meta-analysis, which included 15 studies (combined 498 patients and 520 controls) showed large effect sizes (Hedges' g=1.27, 95% confidence interval 0.80-1.75), indicating that OCD patients have significantly higher rates of NSS than matched controls on both sides of the body and in multiple domains (motor coordination, sensory integration and primitive reflexes). The results were robust and remained largely unchanged in our reliability analyses, which controlled for possible outliers. Meta-regression was employed to examine the role of potential variables of interest including sociodemographic variables, symptom severity, medication effects and the use of different instruments, but none of these variables was clearly associated with NSS. CONCLUSIONS: As a group, OCD patients are characterized by increased rates of NSS, compared with healthy controls. However, their origins and potential clinical importance remain to be clarified. Future directions for research are discussed.
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Enfermedades del Sistema Nervioso/epidemiología , Pruebas Neuropsicológicas/estadística & datos numéricos , Trastorno Obsesivo Compulsivo/epidemiología , Adulto , Estudios de Casos y Controles , Modificador del Efecto Epidemiológico , Femenino , Humanos , Masculino , Enfermedades del Sistema Nervioso/complicaciones , Examen Neurológico , Trastorno Obsesivo Compulsivo/complicaciones , Desempeño Psicomotor/fisiología , Reflejo/fisiología , Análisis de Regresión , Reproducibilidad de los Resultados , Sensación/fisiología , España , Reino UnidoRESUMEN
INTRODUCTION: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition characterized by a few consistent, temporally stable symptom dimensions. The dimensional Yale-Brown obsessive-compulsive scale (DY-BOCS) is a recently developed instrument that allows patient and clinician ratings of dimension-specific symptom severity, as well as estimates of global symptom severity in patients with OCD. METHODS: We examined the psychometric properties of the DY-BOCS in a sample of 128 European adult patients with OCD. RESULTS: The results of the psychometric analyses were overall excellent. The internal consistency across the domains of time, distress and interference for each dimension was high. The subscales of the DY-BOCS were largely independent from one another. The convergent and discriminant validity of the DY-BOCS subscales were adequate. The Global Severity and Interference scales were largely intercorrelated, suggesting that they may be redundant. The level of agreement between self-report and expert ratings was adequate although somewhat lower than in the original validation study. CONCLUSION: The results of the present study confirm the excellent psychometric properties of the DY-BOCS reported in the original validation study.
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Trastorno Obsesivo Compulsivo/diagnóstico , Escalas de Valoración Psiquiátrica/normas , Psicometría/instrumentación , Adulto , Humanos , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/fisiopatología , Reproducibilidad de los Resultados , Autoinforme , Índice de Severidad de la Enfermedad , España , Reino Unido , Adulto JovenRESUMEN
PREMISE OF THE STUDY: Teosinte species are the closest relatives of maize and represent an important but increasingly rare genetic resource for maize improvement and the study of evolution by domestication. Three morphologically and ecologically distinct teosinte populations were recently discovered in México. The taxonomic status of these rare and endangered populations was investigated by detailed comparisons to previously characterized wild Zea species. ⢠METHODS: Three new teosinte populations were compared to known teosinte taxa on the basis of morphological, ecogeographic, cytological, and molecular characteristics. Phenetic and phylogenetic analyses were performed using morphological and molecular data, respectively. ⢠KEY RESULTS: The newly discovered populations are distinct from each other and from other Zea species to represent three new entities based on their unique combinations of morphological, ecological, ploidy, and DNA markers. A perennial diploid population from Nayarit is distinguished by early maturing plants, and having male inflorescences with few tassel branches and long spikelets. A perennial tetraploid population from Michoacán is characterized by tall and late maturing plants, and having male inflorescences with many branches. An annual diploid population from Oaxaca is characterized by having male inflorescences with fewer branches and longer spikelets than those found in the sister taxa Z. luxurians and Z. nicaraguensis, plants with high thermal requirements, and very long seed dormancy. ⢠CONCLUSIONS: Evidence from multiple independent sources suggests placement of the three new populations of teosinte as distinct entities within section Luxuriantes of the genus Zea. However, more extensive DNA marker or sequence data are required to resolve the taxonomy of this genus.
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Zea mays/clasificación , Cromosomas de las Plantas , Marcadores Genéticos , México , Filogenia , Zea mays/genéticaRESUMEN
BACKGROUND: The DSM-5 Obsessive-Compulsive Spectrum Sub-Workgroup is recommending the creation of a new diagnostic category named Hoarding Disorder (HD). The validity and acceptability of the proposed diagnostic criteria have yet to be formally tested. METHOD: Obsessive-compulsive disorder/hoarding experts and random members of the American Psychiatric Association (APA) were shown eight brief clinical vignettes (four cases meeting criteria for HD, three with hoarding behaviour secondary to other mental disorders, and one with subclinical hoarding behaviour) and asked to decide the most appropriate diagnosis in each case. Participants were also asked about the perceived acceptability of the criteria and whether they supported the inclusion of HD in the main manual. RESULTS: Altogether, 211 experts and 48 APA members completed the survey (30% and 10% response rates, respectively). The sensitivity and specificity of the HD diagnosis and the individual criteria were high (80-90%) across various types of professionals, irrespective of their experience with hoarding cases. About 90% of participants in both samples thought the criteria would be very/somewhat acceptable for professionals and sufferers. Most experts (70%) supported the inclusion of HD in the main manual, whereas only 50% of the APA members did. CONCLUSIONS: The proposed criteria for HD have high sensitivity and specificity. The criteria are also deemed acceptable for professionals and sufferers alike. Training of professionals and the development and validation of semi-structured diagnostic instruments should improve diagnostic accuracy even further. A field trial is now needed to confirm these encouraging findings with real patients in real clinical settings.
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Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastorno de Acumulación/diagnóstico , Trastorno de Acumulación/psicología , Humanos , Psiquiatría/métodos , Psiquiatría/normas , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Locally advanced melanoma is characterized clinically by the appearance of in-transit or satellite metastases, and is considered stage IIIB or IIIC according to the 2002 classification of the American Joint Committee on Cancer. Despite the absence of distant metastases, the management of locally advanced melanoma is complicated and the disease is associated with a reduction in overall survival. The initial step in the approach to the patient with locally advanced melanoma involves the restaging in order to exclude the presence of distant metastases. Positron emission tomography-computed tomography is currently accepted as the most accurate restaging technique. Surgical excision of the metastases continues to be the treatment of choice for locally advanced melanoma. In the case of unresectable metastases, hyperthermic isolated limb perfusion with melphalan with or without tumor necrosis factor has achieved complete responses in up to 60% of patients treated, with very rare severe locoregional and systemic toxic effects. Radiation therapy, chemotherapy, and biochemotherapy are options that, even though they have not been tested in patients with only in-transit metastases, may have a role in unresectable, locally advanced melanoma without distant metastases.In any case, therapeutic options for locally advanced melanoma should be individualized, and should take into consideration the availability of each of these techniques as well as the experience of the health care team.
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Melanoma/patología , Melanoma/terapia , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional , Terapia Combinada , Árboles de Decisión , Diagnóstico por Imagen/métodos , Humanos , Hipertermia Inducida , Factores Inmunológicos/uso terapéutico , Inmunoterapia , Incidencia , Melanoma/diagnóstico , Melanoma/tratamiento farmacológico , Melanoma/epidemiología , Melanoma/radioterapia , Melanoma/cirugía , Estadificación de Neoplasias , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/radioterapia , Neoplasias Cutáneas/cirugíaRESUMEN
Milk mineral content has received little attention in studies focusing on milk nutrient effects on offspring growth. This study examines calf growth in Iberian deer and compares the influence of milk minerals, other nutrients, and lactation variables relevant for growth to discern the relative weight of each factor. In addition, because Iberian deer hinds are the first mammal found to produce different milk for sons and daughters, the present study examines whether there are also sex differences in milk mineral composition. Concentrations and yields of Ca, P, Mg, Na, K, Fe, and Zn in milk of 46 red deer hinds were monitored through 18 weeks of lactation. Calf growth was influenced by Ca and P percent, and total Fe production. Milk for males had a lower content in Ca and P, a greater content of K, and Mg, whereas no sex effects were found in Na, Fe, or Zn percentages. Higher percentages in Ca and P for daughters might constitute a compensatory response, as daily production was not biased towards females in Ca or P, whereas in the latter and all the other minerals daily production was greater for heavier calves, which are usually males. In conclusion, milk mineral content and production influence calf growth even after controlling for other important lactation variables and nutrients, and they show effects and interactions more complicated than expected.
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Animales Lactantes , Ciervos , Leche/química , Minerales/farmacología , Caracteres Sexuales , Aumento de Peso/efectos de los fármacos , Animales , Animales Recién Nacidos/crecimiento & desarrollo , Animales Lactantes/crecimiento & desarrollo , Animales Lactantes/metabolismo , Ciervos/metabolismo , Ciervos/fisiología , Femenino , Lactancia/metabolismo , Lactancia/fisiología , Masculino , Leche/metabolismo , Leche/fisiología , Minerales/metabolismo , Diferenciación Sexual/efectos de los fármacos , Diferenciación Sexual/fisiología , Factores de Tiempo , Aumento de Peso/fisiologíaRESUMEN
The aim of this study is to describe the leptin cycle in male Iberian red deer (Cervus elaphus hispanicus) and relate it to antler and testosterone cycles. An additional aim is to assess the relationship between the plasma leptin concentration during antlers' growth and their final size. Therefore, blood from 21 Iberian red deer males was sampled monthly to analyse leptin and testosterone. At the same time the deer were weighed and their body condition was assessed. The length of antlers was measured every 2 weeks and, after casting, their final length and perimeters were taken. Leptin showed a seasonal cycle, with a peak in June that decreased as testosterone increased. Low values were observed in autumn, winter and early spring. The relationship observed between leptin and body mass or body condition score was different in spring, when plasma testosterone concentration is low, than in autumn, when testosterone increases. Leptin peak amplitude was positively related to final antler size. In conclusion, the relationship between leptin and body mass and body condition score changes through the year, possibly due to the influence of androgens and photoperiod. There was a positive relationship between plasma concentration of leptin during antler growth and final antler length.
Asunto(s)
Cuernos de Venado/crecimiento & desarrollo , Ciervos/sangre , Leptina/sangre , Animales , Peso Corporal/fisiología , Ciervos/crecimiento & desarrollo , Masculino , Fotoperiodo , Estaciones del Año , Testosterona/sangreRESUMEN
La maca crece en los departamentos alto andinos, de la Cordillera de los Andes del Perú, entre 3500 y 4700 m.s.n.m. Objetivos: Evaluar el efecto antioxidante de las hojas de Lepidium peruvianum Chacon, ôMacaõ. Materiales y Método: Se utilizaron hojas de maca, molidas, de la zona de Junín, a partir de las cuales se prepararon, por maceración, 3 extractos : 1) en éter etílico (EEE), 2) en agua destilada (EAD) y 3) en alcohol etílico (EAE). Posteriormente fueron filtrados y evaporados en un Rotavapor Laborota 4003, Heidolph. La evaluación del efecto antioxidante, se realizó por el método de DPPH, comparando el coeficiente de inhibición-50 (IC50) con la Vitamina C. Resultados: La captación de radicales libres (%) a 100 ug/m fue: EEE=99.63 , EAE=94.87, EAD= 99.37 , VIT C=, 94.72, a 50 ug/ml : EEE=96.83 , EAE=89.93, EAD= 86.57, VIT C= 93.69 , a 25ug/ml : EEE= 95.24, EAE=90.84, EAD= 78.02, VIT C=84.63, a 1 ug/ml: EEE=92.31, EAE=94.87, EAD= 35.53, VIT C=84.01. Asimismo, encontramos que el IC-50 (ug/ml) fue: EEE= 63.78, EAE=249, EAD= 75.29, VIT C= 1.76. Conclusión: Los resultados demuestran la capacidad antioxidante de Lepidium peruvianum Chacón, la que podría estar relacionada con la presencia de flavonoides (quercetina) y de antocianinas, entre otros compuestos.
Maca grows in the Andean regions of Peru between 3500 and 4700 meters above sea level. Objectives: To evaluate the antioxidant effect of Lepidium peruvianum Chacon, ôMacaõ leaves. Materials and Method: In the present study, we used ground leaves of maca from the Junìn region from where three types of extracts were prepared by maceration: 1) ethel ether extract (EEE), 2) water extract (EAD) and 3) ethyl alcohol extract (EAE). Evaluation of the antioxidant effect was performed by the DPPH method, comparing the coefficient of inhibition-50 (IC50) with Vitamin C. Results: Capture of free radicals (%) at 100 ug/ml was: EEE=99.63, EAE=94.87, EAD = 99,37, VIT C =, 94,72, at 50 ug/ml: EEE=96.83, EAE=89.93, EAD = 86,57, VIT C = 93,69, at 2üg/ml: EEE = 95,24, EAE=90.84, EAD = 78,02, VIT C=84.63, at 1 ug/ml: EEE=92.31, EAE=94.87, EAD = 35,53, VIT C=84.01. Also, we found that the IC- 50 (ug/ml) was: EEE = 63,78, EAE=249, EAD = 75,29, VIT C = 1.76. Conclusion: These results demonstrate the antioxidant capacity of Lepidium peruvianum Chacón, that could be related to the presence of flavonoids (quercetin) and anthocyanins, among other compounds.
Asunto(s)
Antioxidantes , Flavonoides , Hojas de la Planta , Lepidium , Quercetina , Ácido Ascórbico , Compuestos QuímicosRESUMEN
An alteration in the expression of E-cadherin has been observed in many epithelial neoplasms. No data exist, however, for the expression of this protein in an animal model for urinary bladder cancer. The present study investigated the expression of E-cadherin in rat urothelial preneoplastic lesions and tumours induced by oral administration of N-butyl-N-(4-hydroxybutyl) nitrosamine, during 10, 15 and 20 weeks. Simple hyperplasia and squamous metaplasia showed a similar E-cadherin pattern when compared with normal urothelium, with its expression confined to cell membrane. Thirty eight percent of the nodular hyperplasia, 41.4% of the dysplasia and 100% of the papillomas showed a weak E-cadherin expression. All papillary neoplasm of low malignant potential, low-and high-grade papillary carcinoma, and invasive carcinoma revealed an abnormal staining pattern with an increase in cytoplasm reactivity and discontinuous cell membrane positivity. The loss of expression for low-grade papillary carcinoma versus simple hyperplasia, nodular hyperplasia and dysplasia was statistically significant (p = 0.0001, p = 0.007 and p=0.008, respectively). There was a similar decrease in E-cadherin expression for papillary neoplasm of low malignant potential versus simple hyperplasia, nodular hyperplasia and dysplasia (p = 0.0001; p = 0.001 and p=0.0001, respectively). These results suggest that alteration in the expression of this adhesion molecule in rat may be indicative of tumour progression in N-butyl-N-(4-hydroxybutyl) nitrosamine-induced bladder cancer.