Alejandro Jiménez

Compensatory reading strategies in test anxiety

Abstract The effects of test anxiety and evaluative stress on reading speed, articulatory rehearsal, reading regressions, and comprehension were examined. High- and low-test-anxiety subjects read texts under conditions of stress (Studies 1, 2 and 3) or non-stress (Study 4). Texts were presented either with concurrent irrelevant speech (heard), an articulatory suppression task, or no concurrent task. Measures of working memory span and prior vacabulary knowledge were collected under non-stress conditions (Study 5). There were no differences in comprehension performance as a function of anxiety, but high anxious subjects were less efficient than low-anxious subjects, as the former employed more reading time and regressions, though not more articulation, than the latter to obtain an equivalent comprehension score. Reading regressions emerged as the most discriminating compensatory strategy associated with anxiety. This reduced efficiency is partly dependent on a basic deficit in vocabulary knowledge—but not ...

Usefulness of an intensive bowel cleansing strategy for repeat colonoscopy after preparation failure.

BACKGROUND: No consensus exists regarding the optimal bowel preparation regimen for patients with poor bowel cleansing at a previous colonoscopy. OBJECTIVE: We investigated the usefulness of an intensive cleansing regimen for repeat colonoscopy after previous failure of bowel preparation. DESIGN AND SETTING: A prospective observational study was performed in patients undergoing colonoscopy at a university-based, tertiary referral hospital. PATIENTS AND INTERVENTION: Outpatients with inadequate preparation at an index colonoscopy were offered a repeat colonoscopy and instructed to follow an intensive preparation regimen consisting of a low-fiber diet for 72 hours, liquid diet for 24 hours, bisacodyl (10 mg) in the evening of the day before the colonoscopy, and a split dose of polyethylene glycol (1.5 L in the evening before and 1.5 L in the morning on the day of the colonoscopy). MAIN OUTCOME MEASURES: The adequacy of bowel cleansing was assessed according to the Boston Bowel Preparation Scale (0 or 1 on any colon segment = inadequate bowel preparation). Procedural variables, detection rates for polyps and adenomas, compliance, and tolerability of the regimen were assessed. Satisfaction with the regimen was assessed with a 10-point visual analog scale. RESULTS: Of 83 patients with inadequate bowel preparation at colonoscopy, 51 underwent a second colonoscopy and were analyzed; 46 patients (90.2%) had adequate bowel cleansing at the second colonoscopy, with a mean (SD) total Boston Bowel Preparation Scale score of 7.43 (1.5) and scores of 2.31 (0.6) for the right colon, 2.49 (0.6) for the transverse colon, and 2.63 (0.6) for the left colon. Polyps, flat lesions, or flat lesions proximal to the splenic flexure were found in significantly more patients at the second colonoscopy than at the index colonoscopy. The global satisfaction score was 6.6 (2.7). LIMITATIONS: The study was limited because of its open observational design, possible patient learning effect for bowel preparation at the repeat colonoscopy, and the inclusion of only outpatients. CONCLUSIONS: An intensive regimen consisting of a low-fiber diet, bisacodyl, and a split dose of polyethylene glycol can achieve good colon preparation with an improved detection rate for polyps and adenomas in most patients who have had poor bowel cleansing at a previous colonoscopy.

Risk for high-grade dysplasia or invasive carcinoma in colorectal flat adenomas in a Spanish population.

AIMnto determine the frequency and malignancy risk of colonic flat adenomas among patients with colorectal polyps in a Spanish population.nnnMETHODSn1300 consecutive colonoscopic examinations were reviewed; 640 polyps were detected and removed endoscopically in 298 patients. Chromoendoscopy with 0.2% indigo carmine was applied to clarify the macroscopical appearance of flat lesions. The following data was collected for flat and protruding polyps: size, location (proximal or distal to splenic flexure), histology (neoplastic or non neoplastic), high grade dysplasia (HGD) and submucosal invasive carcinoma (SIC) or beyond.nnnRESULTSn490 polyps (76.6%) were adenomas and 150 (23.4%) hyperplastic; 114 (23.3%) adenomas were flat (3 flat-depressed) whereas 376 (76.7%) were protruding. The diameter of flat and protruding adenomas was 9.2 +/- 7.9. mm and 7.0 +/- 5.9 mm, respectively (p < 0.001). A proximal location was more frequent for flat (63.1%) than for protruding adenomas (48.7%) (p = 0.003). The rate of HGD or SIC was significantly higher in flat than in protruding adenomas (7.0 vs 2.6%; p < 0.04). Two of the 3 flat-depressed lesions (both <or= 10 mm in diameter) were carcinomas (T1 and T2, respectively). Flat adenomas had an increased risk for HGD or SIC (OR = 2,7; CI, 1,04-7,04; p < 0.05).nnnCONCLUSIONSnIn a Spanish population, flat adenomas represent nearly one quarter of all colorectal neoplastic polyps, their most frequent location being the right colon and they bear a higher risk of malignancy than protruding adenomas, especially for the flat depressed type.

Serum malondialdehyde levels in patients with malignant middle cerebral artery infarction are associated with mortality.

Objective Malondialdehyde (MDA) is an end-product formed during lipid peroxidation, due to degradation of cellular membrane phospholipids. MDA is released into extracellular space and finally into the blood; it has been used as an effective biomarker of lipid oxidation. High circulating levels of MDA have been previously described in patients with ischemic stoke than in controls, and an association between circulating MDA levels and neurological functional outcome in patients with ischemic stoke. However, an association between serum MDA levels and mortality in patients with ischemic stroke has not been previously reported, and that was the objective of this study. Methods Observational, prospective and multicenter study performed in six Intensive Care Units. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as Glasgow Coma Scale (GCS) lower than 9. We measured serum MDA levels in 50 patients with severe MMCAI at the time of diagnosis and in 100 healthy subjects. Mortality at 30 days was the end point of the study. Results We found that patients with severe MMCAI showed higher serum MDA levels than healthy subjects (p<0.001). We found higher serum MDA levels (p<0.001) in non-surviving MMCAI patients (n=26) than in survivors (n=24). The area under the curve for prediction of 30-day mortality for serum MDA levels was 0.77 (95% CI = 0.63-0.88; p<0.001). Serum MDA levels >2.27 nmol/mL were associated with 30-day mortality (OR=7.23; 95% CI=1.84-28.73; p=0.005) controlling for GCS and age on multiple binomial logistic regression analysis. Conclusions To our knowledge, this is the first study showing that serum malondialdehyde levels in patients with MMCAI are associated with early mortality.

Efecto del sulfato de magnesio intravenoso en la exacerbación de la EPOC que precisa hospitalización: estudio aleatorizado controlado con placebo

Objetivo: El sulfato de magnesio (SM) ha demostrado tener en el asma bronquial un efecto broncodilatador, que resulta dudoso en el caso de la enfermedad pulmonar obstructiva cronica (EPOC). Por ello hemos llevado a cabo un estudio con el objetivo de investigar el posible efecto broncodilatador del SM intravenoso en la EPOC agudizada. nnPacientes y metodos: Se estudio a 24 pacientes diagnosticados de EPOC agudizada que requirieron ingreso en la Unidad de Hospitalizacion de Neumologia. A cada uno se le realizo una espirometria basal. Posteriormente, se efectuo una aleatorizacion a doble ciego y cruzada de los pacientes para recibir 1,5 g de SM o placebo en solucion intravenosa (20 min). A quienes el primer dia recibieron SM se les administro placebo el segundo dia, y al reves. Se realizaron espirometrias a los 15, 30 y 45 min de la administracion de SM o placebo. Por ultimo, se administraron 400 µg de salbutamol inhalados mediante camara espaciadora y a los 15 min se realizo una ultima espirometria. Todos los enfermos recibieron ademas tratamiento con esteroides, antibioticos intravenosos, oxigeno y broncodilatadores pautados (salbutamol y bromuro de ipratropio cada 6 h). nnResultados: Cuando se compararon los incrementos absolutos (en ml) y porcentuales del volumen espiratorio forzado en el primer segundo (FEV1) obtenidos con SM y placebo a los 15, 30 y 45 min, no se encontraron diferencias significativas. Al comparar los incrementos absolutos y porcentuales del FEV1 tras la administracion de salbutamol se observaron incrementos significativos con el SM (incrementos absolutos FEV1 SM/placebo: 0,185 ± 0,42 frente a 0,081 ± 0,01 l; p = 0,004. Incrementos porcentuales FEV1 SM/placebo: 17,11 ± 3,7% frente al 7,06 ± 1,8%; p = 0,008). nnConclusiones: La administracion de SM intravenoso carece de efecto broncodilatador en pacientes con EPOC agudizada; sin embargo, si potencia dicho efecto de los betamimeticos inhalados.

Higher serum caspase-cleaved cytokeratin-18 levels during the first week of sepsis diagnosis in non-survivor patients.

Abstract Background: Caspase-cleaved cytokeratin (CCCK)-18 is a protein released into the blood during apoptosis. Higher circulating CCCK-18 concentrations have been found in non-survivor than in survivor septic patients at moment of sepsis diagnosis. The following questions arise now: (1) How are serum CCCK-18 levels during the first week of sepsis? (2) Is there an association between sepsis severity and mortality and serum CCCK-18 levels during the first week? The aims of this study were to answer these questions. Methods: Multicenter study with 321 severe septic patients from eight Spanish intensive care units. We determined serum concentration of CCCK-18, tumor necrosis factor (TNF)-α, and interleukin (IL)-10 during the first week. Our end-point study was 30-day mortality. Results: Non-survivor (n=108) compared to survivor patients (n=213) showed higher serum CCCK-18 levels at days 1, 4 and 8 (p<0.001). ROC curve analyses showed that serum CCCK-18 levels at days 1 (AUC=0.77; 95% CI=0.72–0.82), 4 (AUC=0.81; 95% CI=0.76–0.85) and 8 (AUC=0.83; 95% CI=0.78–0.88) could predict mortality at 30 days (p<0.001). Logistic regression analyses showed that serum CCCK-18 levels at days 1 (OR=4.367; 95% CI=2.491–7.659), 4 (OR=10.137; 95% CI=4.741–21.678) and 8 (OR=8.781; 95% CI=3.626–21.268) were associated with 30-day mortality (p<0.001). We found a positive correlation between CCCK-18, SOFA, and lactic acid at days 1, 4 and 8. Conclusions: Non-survivor septic patients showed persistently during the first week higher serum CCCK-18 levels than survivor patients, and there is an association between sepsis severity and mortality and serum CCCK-18 levels during the first week.

Association between Pre-Transplant Serum Malondialdehyde Levels and Survival One Year after Liver Transplantation for Hepatocellular Carcinoma

Previous studies have found higher levels of serum malondialdehyde (MDA) in hepatocellular carcinoma (HCC) patients compared to healthy controls and higher MDA concentrations in tumoral tissue of HCC patients than in non-tumoral tissue. However, the association between pre-transplant serum levels of MDA and survival in HCC patients after liver transplantation (LT) has not been described, and the aim of the present study was to determine whether such an association exists. In this observational study we measured serum MDA levels in 127 patients before LT. We found higher pre-LT serum MDA levels in 15 non-surviving than in 112 surviving patients one year after LT (p = 0.02). Exact binary logistic regression analysis revealed that pre-LT serum levels of MDA over 3.37 nmol/mL were associated with mortality after one year of LT (Odds ratio = 5.38; 95% confidence interval (CI) = from 1.580 to infinite; p = 0.007) adjusting for age of the deceased donor. The main finding of our study was that there is an association between serum MDA levels before LT for HCC and 1-year survival after LT.

Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study

Objectives:Inadequate bowel cleansing is a major burden for endoscopy units. The aim of this study was to compare two intensive bowel cleansing regimens in patients with previous colonoscopy with inadequate bowel preparation.Methods:Patients with inadequate cleansing at index colonoscopy were randomized to 4-L split-dose polyethylene-glycol (PEG) regimen vs. 2-L split-dose PEG plus ascorbic acid (PEG+Asc) regimen. All individuals underwent a 3-day low-residue diet and received 10u2009mg of bisacodyl, the day before colonoscopy. Cleansing was considered to be adequate if the Boston Bowel Preparation Scale scored ≥2 at each colonic segment. A non-inferiority analysis was performed to demonstrate that colonic cleansing with 2-L PEG+Asc was not inferior to 4-l PEG, considering a non-inferiority margin of 10%.Results:Adequate bowel cleansing was significantly higher in patients assigned to 4-L PEG regimen (n=127) vs. those randomized to 2-L PEG+Asc regimen (n=129) by intention-to-treat analysis (81.1 vs. 67.4%, odds ratio (OR) 2.07, 95% confidence interval (CI) (1.163–3.689)) and by per-protocol analysis (86.6 vs. 71.7%, OR: 2.55, 95% CI: (1.316–4.922)). The study was terminated for futility after the interim analysis, because the 95% CI of the difference of proportions was 3.13–24.27% in the intention-to-treat analysis and 3.33–26.47% in the per-protocol analysis, confirming the superiority of 4-L PEG preparation.Conclusions:After 3-day low-residue diet and oral bisacodyl before colonoscopy, colon cleansing with 4-L split-dose PEG was superior to 2-L split-dose PEG+Asc in patients with previous inadequate cleansing. (EUDRACT: 2013-002506-31, NCT02073552).

Prognostic Value of Serum Caspase-Cleaved Cytokeratin-18 Levels before Liver Transplantation for One-Year Survival of Patients with Hepatocellular Carcinoma.

Cytokeratin (CK)-18 is the major intermediate filament protein in the liver and during hepatocyte apoptosis is cleaved by the action of caspases; the resulting fragments are released into the blood as caspase-cleaved cytokeratin (CCCK)-18. Higher circulating levels of CCCK-18 have been found in patients with hepatocellular carcinoma (HCC) than in healthy controls and than in cirrhotic patients. However, it is unknown whether serum CCCK-18 levels before liver transplantation (LT) in patients with HCC could be used as a prognostic biomarker of one-year survival, and this was the objective of our study with 135 patients. At one year after LT, non-survivors showed higher serum CCCK-18 levels than survivors (p = 0.001). On binary logistic regression analysis, serum CCCK-18 levels >384 U/L were associated with death at one year (odds ratio = 19.801; 95% confidence interval = 5.301–73.972; p < 0.001) after controlling for deceased donor age. The area under the receiver operating characteristic (ROC) curve of serum CCCK-18 levels to predict death at one year was 77% (95% CI = 69%–84%; p < 0.001). The new finding of our study was that serum levels of CCCK-18 before LT in patients with HCC could be used as prognostic biomarker of survival.

Risk factors for inadequate bowel preparation: a validated predictive score

Background and study aimu2002Inadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness. Patients and methodsu2002The model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014.u200aThe validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014.u200aCleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination. Resultsu2002In the development cohort, BBPS was adequate in 541 patients (81.1u200a%). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95u200a% confidence interval [CI] 1.91u200a-u200a9.47), co-morbidity (OR 3.35, 95u200a%CI 2.16u200a-u200a5.18), constipation (OR 2.09, 95u200a%CI 1.29u200a-u200a3.40), and abdominal/pelvic surgery (OR 1.60, 95u200a%CI 1.03u200a-u200a2.47) were independent predictors for inadequate cleansing. The model built with these variables showed an area under the curve of 0.72 in the development cohort and 0.70 in the validation cohort. A cutoff of 1.225 predicted inadequate bowel preparation with a sensitivity, specificity, positive predictive value, and negative predictive value of 60.3u200a% (95u200a%CI 51.6u200a-u200a68.4), 75.4u200a% (95u200a%CI 71.6u200a-u200a78.9), 36.4u200a% (95u200a%CI 30.1u200a-u200a43.1), and 89.1u200a% (95u200a%CI 85.9u200a-u200a91.6) in the development cohort, and 50.0u200a% (95u200a%CI 38.1u200a-u200a61.9), 80.0u200a% (95u200a%CI 75.3u200a-u200a84.2), 35.7u200a% (95u200a%CI 26.4u200a-u200a45.6), and 87.9u200a% (95u200a%CI 83.7u200a-u200a91.3) in the validation cohort. Conclusionu2002A simple score may assist the clinician in predicting which patients are at high risk of inadequate bowel cleanliness. This may guide changes in bowel preparation strategy accordingly.