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Objective Laryngopharyngeal reflux (LPR) is a common illness of otolaryngology visits. Over the past few years, pepsin has become a promising marker of LPR. The objective of the present research is to analyze the existing literature using pepsin as a diagnostic tool of LPR through a systematic review. Data Sources PubMed (Medline), Trip Database, Cochrane Library, EMBASE, SUMsearch, and Web of Science. Review Methods The outcome assessed was the presence of pepsin in LPR patients. We included articles in which pepsin was studied in LPR patients (clinically suspected or with confirmed diagnosis). Studies with no control group, comparison group, and/or a sample size lower than 20 patients were excluded. Results Twelve studies were included. All included studies, with the exception of 2, found statistically significant differences for pepsin in cases compared with healthy controls. Conclusion Pepsin might be a reliable marker in LPR patients, although questions remain about optimal timing, location, nature, and threshold values for pepsin testing. Future investigations are necessary to clarify the best method to use pepsin in the diagnostic process of LPR.

Purpose The mechanisms of lung carcinogenesis are not fully understood. Not all smokers develop lung cancer, indicating that genetic variations and other environmental factors may play an important role in its development. The human glutathione S-transferases (GSTs) have been associated with an increased risk of lung cancer. Glutathione S-transferases are phase II biotransformation enzymes that play a role in detoxifying a wide range of exogenous agents including carcinogens but also anticarcinogenic drugs. Methods We assessed the effect of allelic deletions in the GSTM1 and GSTT1 genotypes on lung cancer overall survival through a systematic review of the scientific literature after applying predefined inclusion and exclusion criteria. Results Most of the included studies found no effect or a tendency to worse survival for individuals with deletion of GSTs. Conclusions Further studies are necessary to understand the magnitude of the effect of the deletion of both genes on lung cancer survival.

Background. Vertical facial growth has a high prevalence. Nonspecialized professionals have shown low sensitivity to identify patients at risk. In the face of this difficulty, we designed and validated a screening checklist for vertical facial growth. Methods. A multidisciplinary team of 5 members developed the Vertical Facial Growth Screening Test. A sample of 160 evaluations was obtained. We consider as the gold standard the evaluation of 2 specialists in dentofacial orthopedics. Results. Consistency measured with Cronbach α was .675 for 10 items. Test-retest reliability was .956. The interobserver concordance was .886. The receiver operating characteristic curve has .987 area under the curve. Conclusion. This is the first study to design and validate a screening checklist for vertical facial growth for nonexpert evaluators. We think that given its good performance, ease of use, inexpensiveness, and availability, the test could be useful for nontrained professionals dealing with children.

Background The aim of this study was to assess the relationship between do-it-yourself activities entailing the exposure to carcinogenic substances and the risk of lung cancer. Methods We pooled individual data from different case-control studies conducted in Northwestern Spain which investigated residential radon and lung cancer. Cases had an anatomopathologically confirmed primary lung cancer and controls were selected at the pre-surgery unit with uncomplicated surgeries. Both cases and controls were older than 30 years with no previous cancer history. All participants were interviewed face-to-face using a specific questionnaire. Painting, model building, furniture refinishing and woodworking or home carpentry were the do-it-yourself activities considered risky due to exposure to carcinogenic agents. Results We included 1528 cases and 1457 controls. Practicing do-it-yourself risk activities was more frequent among cases: 16.0% were exposed to carcinogenic exposures during leisure time, compared to 11.8% for controls. The overall adjusted OR for lung cancer risk among individuals who practiced do-it-yourself risk activities, was 1.77 (95% CI: 1.36–2.31); this was 2.17 (95% CI: 1.51–3.11) when the analysis was restricted to individuals who performed these activities for at least 10 years. These risks were greater when the analyses were carried out exclusively among never-smokers, with the respective ORs being 2.04 (95% CI: 1.38–3.01) and 3.10 (95% CI: 1.78–5.40). Conclusion These results support the hypothesis that do-it-yourself activities involving exposure to certain carcinogens are associated with an increased risk of lung cancer, both in ever and never-smokers.

To assess the association between exposure to radon and genitourinary cancer in a mining population through a systematic review of the scientific literature.A systematic review of the scientific literature was carried out in MEDLINE (PubMed), combining MeSH (Medical Subject Heading) terms and free terms. We applied a specific scale to assess the quality of the included studies.We included 17 studies; all were cohort studies with the exception of one which was a pooling of data. All studies included analysed the relationship between exposure to radon and genitourinary cancer. While some studies point towards an association between radon exposure and genitourinary cancer, especially kidney cancer, others do not find such association.The included studies showed great heterogeneity. It cannot be concluded that there is an association between exposure to radon and genitourinary cancer. More research is needed on this topic, designing studies with higher statistical power, better control of confounders, and preferably prospective.

Objectives To analyze the relationship of GSTT1, GSTM1, XRCC1 (rs25487), ERCC1 (rs11615, rs3212986), ERCC2 (rs13181), XRCC3 (rs861539), OGG1 (rs1052133), and Alpha-1-Antitrypsin mutations (AAT) with the risk of lung cancer in never-smokers, and ascertain if there is an effect modification between these polymorphisms and residential radon exposure. Material and methods We designed a multicenter hospital-based case-control study in a radon-prone area. 322 cases and 338 controls, all never-smokers, were included. They were selected using a frequency sampling based on sex and age distribution of the cases. Participants donated 3 ml. of whole blood used to determine genotype for polymorphisms. They placed a radon detector to measure residential radon exposure in their dwelling. Results The OR for deleted GSTM1 patients was 3.46 (95% CI = 1.52–7.89) at residential radon exposures above 200 Bq/m3. The ERCC1 rs3212986 polymorphism was the most associated with the risk of developing lung cancer, both for low and high radon exposures. The ERCC1 rs321986 GT and TT genotypes (at radon concentrations >200 Bq/m3) were more significantly associated with higher lung cancer risk (OR = 2.40, 95% CI = 1.29–4.45; OR = 4.45, 95% CI = 1.26–15.7, respectively). Conclusions These findings support the hypothesis that certain polymorphisms in genes involved in DNA-repair and carriers of GSTM1 deletion have an increased risk of lung cancer in never-smokers exposed to residential radon.

The presence of radon in buildings is a matter of growing concern in the industry. A further layer of complexity is present in heritage buildings, where sources of exhalation other than those observed in more modern conventional buildings may render diagnosis and intervention even more difficult. This study explored the high exhalation rates originating in the inner fillers in thick elements such as bearing walls and structural floors and vaults characterising historic construction. They were found to be close to the values observed in soils and one to two orders of magnitude greater (range: 32.5 mBq/m2·s to 149.7 mBq/m2·s) than found in the construction materials themselves, such as granite. The radon emitted into building interiors by those members exhibited more or less uniform concentration profiles on all storeys, irrespective of elevation and consequently distance form the soil. Further to the results delivered by an accumulative model, the only explanation for the empirical findings is that the inner filler in structural members sources a substantial fraction of the high exhalation rates. That would open a new exploratory pathway for remedies that should necessarily address all emissions, rather than deeming the soil as the sole or primary source of radon gas. The issue is broached in this article on the grounds of a case study of the Tower of Hercules at Corunna, Spain, a building dating from Roman times and presently used as a museum and monument open to the public.

Lung cancer has the highest cancer mortality rate in developed countries. The principal risk factor for lung cancer is tobacco use, with residential radon being the leading risk factor among never smokers and the second among ever smokers. We sought to estimate mortality attributable to residential radon exposure in Spain and its Autonomous Regions, with correction for dwelling height and differentiation by tobacco use. We applied a prevalence-based method for estimating attributable mortality. For estimations, we considered exposure to radon in the different Autonomous Regions corrected for dwelling height, using the National Statistics Institute Housing Census and prevalence of tobacco use (never smokers, smokers and ex-smokers). The results showed that 3.8% (838 deaths) of lung cancer mortality was attributable to radon exposure of over 100 Bq/m3, a figure that rises to 6.9% (1,533 deaths) when correction for dwelling height is not performed. By Autonomous Region, the highest population attributable fractions, corrected for dwelling height, were obtained for Galicia, Extremadura, and the Canary Islands, where 7.0, 6.9, and 5.5% of lung cancer mortality was respectively attributable to radon exposure. The greatest part of the attributable mortality occurred in men and among smokers and ex-smokers. Residential radon exposure is a major contributor to lung cancer mortality, though this contribution is highly variable among the different territories, indicating the need for targeted prevention policies. Correction of estimates for dwelling height is fundamental for providing reliable estimates of radon-attributable mortality Carlos III Institute of Health (Instituto de Salud Carlos III) Project FIS PI19/00288 SI

Introduction: There is debate as to whether lung-ultrasound (LUS) can replace lung-auscultation (LA) in the assessment of respiratory diseases. Methodology: The diagnostic validity, safety, and reliability of LA and LUS were analyzed in patients admitted in a pulmonary ward due to decompensated obstructive airway diseases, decompensated interstitial diseases, and pulmonary infections, in a prospective study. Standard formulas were used to calculate the diagnostic sensitivity, specificity, and accuracy. The interobserver agreement with respect to the LA and LUS findings was evaluated based on the Kappa coefficient (ᴋ). Results: A total of 115 patients were studied. LUS was more sensitive than the LA in evaluating pulmonary infections (93.59% vs. 77.02%, p = 0.001) and more specifically in the case of decompensated obstructive airway diseases (95.6% vs. 19.10%, p = 0.001). The diagnostic accuracy of LUS was also greater in the case of pulmonary infections (75.65% vs. 60.90%, p = 0.02). The sensitivity and specificity of the combination of LA and LUS was 95.95%, 50% in pulmonary infections, 76.19%, 100% in case of decompensated obstructive airway diseases, and (100%, 88.54%) in case of interstitial diseases. (ᴋ) was 0.71 for an A-pattern, 0.73 for pathological B‑lines, 0.94 for condensations, 0.89 for pleural-effusion, 0.63 for wheezes, 0.38 for rhonchi, 0.68 for fine crackles, 0.18 for coarse crackles, and 0.29 for a normal LA. Conclusions: There is a greater interobserver agreement in the interpretation of LUS-findings compared to that of LA-noises, their combined use improves diagnostic performance in all diseases examined.

Background Inflammatory Bowel Disease (IBD) is a multifactorial pathology with an increasing incidence. There are environmental factors, many unknown, that participate in its development. There is no study having assessed a possible relationship with residential radon exposure, which is very high in the study area. The aim of this study was to analyze if residential radon concentration measured at a municipal level is associated with a higher incidence of IBD and its characteristics (clinical or demographic). Methods We performed an ecological study where we included all incident cases of IBD in the area of Santiago de Compostela between January and December 2017 in order to estimate municipal incidence rates. Radon levels at a municipal level were obtained from the Galician Radon Map and correlated with demographic factors and type of IBD. We used the Spearman’s correlation coefficient to test the existence of any association. Results 96 patients were included, 63 (65.6%) with Ulcerative Colitis, 29 (30.25) with Crohn’s Disease and 4 (4.2%) with indeterminate colitis. Median age was 41 (IQR: 33.5 to 56 years), and 50.0% were women. The incidence rate per 100.000 inhabitants-year in the study area was 21.6 cases. The median radon concentration was 104.9Bq/m3 (IQR: 91.0 to 154.6), without statistically significant differences in function of the location of the house (rural vs. urban) nor the type of edification (flat vs house), p >0.05. There were no statistically significant differences on the type of IBD developed (ulcerative colitis, Crohn’s disease or indeterminate colitis) regarding radon levels either (p>0.05). There were no statistically significant differences (p>0.05) between radon and sex of IBD cases. No correlation between radon levels and age of the individuals was observed (Spearman’s rho = -0.13, p-value 0.2), nor radon levels variation by age groups (p>0.05). There was no correlation between radon concentration and cumulative incidence of IBD at municipal level (Spearman’s rho = 0.13, p-value 0.5), as it is shown in figure 1. Conclusion In the area of Santiago de Compostela there is a higher incidence of IBD in comparison with previous studies taking western countries as reference. It is possible that some environmental risk factors, could be responsible of this difference. In this study we have not found any correlation with municipal average radon concentration and incidence of IBD or any of its types.

Background: Lung cancer is a public health problem worldwide. Small-cell lung cancer (SCLC) is the most aggressive histologic type, with a 5-year survival, This work was supported by the Instituto de Salud Carlos III (ISCIII)/PI15/01211/Cofinanciado FEDER, Spanish Society of Neumology and Thoracic Surgery (Project number 848. 2019 call)

Objective To review the existing literature on when and how to treat patients with asymptomatic bacteriuria (AB) who undergo urological surgery, as uncertainty about this issue persists. Methods A systematic review was conducted to compare the different timing of administration of antibiotic prophylaxis in patients with AB undergoing urological surgery. We used predefined inclusion and exclusion criteria, and we also developed a specific quality scale to assess the quality of the papers included. Results Nine studies met the inclusion criteria. Of the nine studies included, eight evaluated antibiotic prophylaxis regardless of the presence of AB, as their purpose was to evaluate the effectiveness of antibiotic prophylaxis for urological procedures. Of these, four studies showed a significant reduction in the rate of infections in the intervention group compared with placebo, or with the same antibiotic therapy but using different durations of therapy. Four studies found no significant differences in infectious complications between the intervention and comparison arms. Only one study assessed the duration of antibiotic prophylaxis in patients with AB. Conclusions With the available evidence, antibiotic therapy should be considered only for procedures in which studies have shown a clinical benefit in the prevention of infection. It is important to establish the duration and type of treatment for antimicrobial therapy for surgical prophylaxis in patients with AB who are going to receive urological invasive procedures. Open Access funded by Arab Association of Urology SI

Background: Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude. Purpose: The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard. Materials and Methods: An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests. Results: As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97). Conclusions: The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging.

Emphysema and lung cancer (LC) are two diseases which share common risk factors, e.g., smoking. In recent years, many studies have sought to analyse this association. By way of illustration, we conducted a review of the scientific literature of the studies published to date, whose main designated aim was to demonstrate the relationship between emphysema and LC, and this association’s influence on the histology, prognosis and molecular mechanisms responsible. We included over 40 studies (ranging from case-control and cohort studies to systematic reviews and meta-analyses), which highlight the association between emphysema and LC, independently of smoking habit. These studies also report a possible influence on histology, with adenocarcinoma being the most frequent lineage, and an association with poor prognosis, which affects both survival and post-operative complications. Oxidative stress, which generates chronic inflammatory status as well as the presence of certain polymorphisms in various genes (CYP1A1, TERT, CLPTM1L, ERK), gives rise—in the case of patients with emphysema—to alteration of cellular repair mechanisms, which in turn favours the proliferation of neoplastic epithelial cells responsible for the origin of LC.

The authors regret not having included the following funding in the paper “Spanish Society of Neumology and Thoracic Surgery”. Project number 848. 2019 call. The authors would like to apologise for any inconvenience caused.

Radon gas is a pulmonary carcinogen and the second leading cause of lung cancer after smoking. There are many countries that have not implemented measures to reduce the risk it poses to the general population. The aim of this study was to locate available evidence on exposure to residential radon and the regulations to monitor and control this across Central and South America, by conducting a review of the scientific literature and government documents in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included 31 studies which had taken measurements of radon in these countries. While Brazil, Argentina, and Peru have undertaken most research, no country in Central and South America has a national map of exposure to residential radon. The prevalence of exposure to radon was uneven, both among the different countries and within individual countries. No country has regulations to prevent the entry of radon into homes, and nine countries have not set maximum permissible concentrations for residential radon. There is a limited number of studies in South and Central America, with a limited spatial coverage, and there is a need to improve knowledge on exposure to residential radon and its effects, and for governments to take the necessary actions to introduce preventive measures in their statutory regulations.

Background: There is a relationship between Chronic Obstructive Pulmonary Disease (COPD) and the development of lung cancer (LC). The aim of this study is to analyse several blood markers and compare their concentrations in patients with only COPD and LC + COPD. Methods: Case-control study with cases presenting combined LC and COPD and two control groups (patients presenting only COPD and patients presenting only LC). We also included LC patients with descriptive purposes. In both groups, peripheral blood analyses of TNF-α, IL-6, IL-8, total leukocyte, lymphocyte and neutrophil counts, neutrophil-to-lymphocyte ratio, total platelet count, mean platelet volume, platelet-to-lymphocyte ratio, alpha 1-antitripsin (A1AT), IgE, C-reactive protein, fibrinogen, cholesterol and bilirubin were performed. We developed univariate and multivariate analyses of these markers, as well as a risk score variable, and we evaluated its performance through ROC curves. Results: We included 280 patients, 109 cases (LC + COPD), 83 controls (COPD) and 88 LC without COPD. No differences were observed in the distribution by sex, age, BMI, smoking, occupational exposure, lung function, GOLD stage or comorbidity. Patients with LC + COPD had significantly higher levels of neutrophils [OR 1.00 (95%CI 1.00–1.00), p = 0.03] and A1AT [OR 1.02 (95%CI 1.01–1.03), p = 0.003] and lower cholesterol levels [OR 0.98 (95%CI 0.97–0.99), p = 0.009] than COPD controls. We developed a risk score variable combining neutrophils, A1AT and cholesterol, achieving a sensitivity of 80%, a negative predictive value of 90.7% and an area under the curve of 0.78 (95%CI 0.71–0.86). Conclusions: COPD patients who also have LC have higher levels of neutrophils and A1AT and lower of cholesterol. These parameters could be potentially predicting biomarkers of LC in COPD patients. This work was supported by the project 110/2016 of the Spanish Society of Respiratory Pathology (SEPAR) SI

Introduction: Inherited susceptibility to lung cancer risk in never-smokers is poorly understood. The major reason for this gap in knowledge is that this disease is relatively uncommon (except in Asians), making it difficult to assemble an adequate study sample. In this study we conducted a genome-wide association study on the largest, to date, set of European-descent never-smokers with lung cancer. Methods: We conducted a two-phase (discovery and replication) genome-wide association study in never-smokers of European descent. We further augmented the sample by performing a meta-analysis with never-smokers from the recent OncoArray study, which resulted in a total of 3636 cases and 6295 controls. We also compare our findings with those in smokers with lung cancer. Results: We detected three genome-wide statistically significant single nucleotide polymorphisms rs31490 (odds ratio [OR]: 0.769, 95% confidence interval [CI]: 0.722-0.820; p value 5.31 x 10(-16)), rs380286 (OR: 0.770, 95% CI: 0.723-0.820; p value 4.32 x 10(-16)), and rs4975616 OR: 0.778, 95% CI: 0.730-0.829; p value 1.04 x 10(-14)). All three mapped to Chromosome 5 CLPTM1L-TERT region, previously shown to be associated with lung cancer risk in smokers and in never-smoker Asian women, and risk of other cancers including breast, ovarian, colorectal, and prostate. Conclusions: We found that genetic susceptibility to lung cancer in never-smokers is associated to genetic variants with pan-cancer risk effects. The comparison with smokers shows that top variants previously shown to be associated with lung cancer risk only confer risk in the presence of tobacco exposure, underscoring the importance of gene-environment interactions in the etiology of this disease. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective : To explore whether there is a possible problem regarding indoor radon concentration surpassing the new European Directive 2013/59/Euratom threshold in Spanish workplaces. We also aim to find out whether radon concentration might be associated with certain characteristics of workplaces. Method : We performed a cross-sectional study to measure indoor radon concentrations in Spanish workplaces including five different sectors (education, public administration, the health sector, the tourist sector and the private sector). To be measured, the workplace should be occupied permanently by at least one worker. Alpha-track type radon detectors were placed for at least three months and read at the Galician Radon Laboratory at the University of Santiago de Compostela. A descriptive analysis was performed on radon distribution by sector, building characteristics and number of workers affected. Results : We faced enormous difficulties in finding volunteers for this study. Galicia and Madrid had the highest number of measurements. Of a total of 248 measurements, 27% had concentrations above 300 Bq/m3. Median radon concentration was 251 Bq/m3 in Galicia, followed by Madrid, with 61.5 Bq/m3. Forty-six percent of the workplaces measured in Galicia had radon concentrations higher than 300 Bq/m3 followed by 10.6% in Madrid. Nineteen percent of all workers were exposed to more than 300 Bq/m3 and 6.3% were exposed to radon concentrations higher than 500 Bq/m3. Conclusion : Indoor radon exposure might be a relevant problem in Spanish workplaces and the number of affected workers could be high. The prevalence of workers exposed to high radon concentrations probably depends on the geographical area. Objetivo: Explorar si podría existir un problema en cuanto a la concentración de radón en los puestos de trabajo en España por superación del umbral propuesto por la nueva Directiva Europea 2013/59/Euratom. También se pretende conocer si la concentración de radón puede estar asociada a las características de los puestos de trabajo. Método: Estudio transversal en seis regiones y diferentes sectores (educación, administración pública, sanitario, turístico y privado). El puesto de trabajo medido debía ser ocupado de manera permanente por al menos un trabajador. Los detectores de radón de tipo alfa-track estuvieron colocados al menos 3 meses y fueron revelados en el Laboratorio de Radón de Galicia, de la Universidad de Santiago de Compostela. Se realizó un análisis descriptivo de la concentración de radón por sector, por características de los edificios y por número de trabajadores afectados. Resultados: Hubo dificultades para encontrar voluntarios para este estudio. Galicia y Madrid tuvieron el mayor número de mediciones. Se midieron 248 lugares de trabajo, con el 27% por encima de los 300 Bq/m3. La concentración mediana fue de 251 Bq/m3 en Galicia, seguida de Madrid con 61,5 Bq/m3. El 46% de los puestos de trabajo en Galicia tenían concentraciones mayores de 300 Bq/m3, y el 10,6% en Madrid. El 19% de los trabajadores estuvieron expuestos a más de 300 Bq/m3 y el 6,3% a más de 500 Bq/m3. Conclusión: La exposición a radón podría ser un problema de salud relevante en los lugares de trabajo en España. El número de trabajadores expuestos parece elevado. La prevalencia de trabajadores afectados depende del área geográfica. This paper has been funded by a competitive research grant of the Fundación Prevent (2015) entitled Exposición laboral a radón interior en España – Estudio piloto. Instituto Sindical de Trabajo, Ambiente y Salud. SI

Introduction. Influenza A H1N1 community-acquired pneumonia (CAP) is a quite frequent respiratory disease. Despite being considered more serious than other CAPs, there are very few studies comparing its characteristics with noninfluenza CAP. We aim to establish the differences between pneumonia due to H1N1 virus and pneumonia not caused by H1N1 influenza virus and to determine the probability that a pneumonia is due to an H1N1 virus infection based on the most relevant variables. Methods. We used a case-control study where cases were H1N1 CAP patients with confirmed microbiological diagnosis and controls were patients with CAP admitted to hospital. H1N1 and other influenza types were discarded among controls. We calculated the probability of being a case or control using multivariate logistic regression. Results. We included 99 cases and 270 controls. Cases were younger than controls (53 vs 71 years, respectively). Mortality was much higher for H1N1 patients (13% vs 0.3%), and admission to intensive care unit was more frequent for H1N1 cases. The variables most associated with presenting H1N1 CAP were bilateral affectation on chest X-rays (OR: 5.70; 95% CI 2.69–10.40), followed by presence of arthromyalgias, with cases presenting close to three times more arthromyalgias compared to controls. Low leukocytes count and high AST values were also significantly associated with H1N1 CAP. H1N1 CAPs are characterized by bilateral affectation, low leukocyte count, presence of arthromyalgias, and high AST. Conclusions. A few and easy to obtain clinical parameters might be extremely useful to distinguish H1N1 CAP from CAPs of other origin.

Background Using a pooled case-control study design, including only never-smokers, we have assessed the association of residential radon exposure with the subsequent occurrence of lung cancer. We also investigated whether residential radon poses a different risk specifically for adenocarcinoma. Methods We pooled individual data from different case-control studies conducted in recent years in Northwestern Spain which investigated residential radon and lung cancer. All participants were never-smokers. Cases had a confirmed biopsy of primary lung cancer. Hospital controls were selected at pre-surgery units, presenting for non-complex surgical procedures. They were interviewed using a standardized instrument. Residential radon was measured using alpha track detectors at the Galician Radon Laboratory at the University of Santiago de Compostela. Results A total of 1415 individuals, 523 cases and 892 controls were included. We observed an odds ratio of 1.73 (95%CI: 1.27–2.35) for individuals exposed to ≥ 200 Bq/m3 compared with those exposed to ≤100 Bq/m3. Lung cancer risk for adenocarcinoma was 1.52 (95%CI: 1.14–2.02) using the same categories for radon exposure. Conclusions Residential radon is a clear risk factor for lung cancer in never-smokers. Our data suggest that radon exposure is associated with all histological types of lung cancer and also with adenocarcinoma, which is currently the most frequent histological type for this disease.

Background The prevalence of vertical facial growth is very high in the developed world. Most authors agree that mouth breathing is its main cause. Even though care is mainly conducted by odontologists, the professionals who first see these patients are pediatricians and otolaryngologists. The objective of this study is to analyze the ability of pediatricians and otolaryngologists to identify early signs of vertical facial growth among children. Methods 60 participant aged 4.1–13.7 years were analyzed subjectively by 9 otolaryngologists, 9 pediatricians and two specialists in dentofacial orthopedics. They were also assessed objectively with cephalometric analysis. Results Otolaryngologists showed 34.78% sensitivity, 92.86% specificity and 48.33% efficiency. Pediatricians showed 13.04% sensitivity, 100% specificity and 33.33% efficiency. Using a linear regression model compared against the objective measurements we found a weak positive correlation both for otolaryngologists and pediatricians. Conclusion The sensitivity was very low for both groups. We believe it is of paramount importance to increase the awareness and the ability of otolaryngologists and pediatricians to recognize signs of disrupt facial growth.

Lung cancer incidence among never smokers has increased in recent decades with 10-30% of all lung cancers occurring in never smokers, where exposure to residential radon is the leading cause of this disease. Lung cancer survival is low, ranging from 12% to 16% at 5 years of diagnosis. There is scant evidence to date on survival from this disease in never smokers. We aim to evaluate lung cancer survival in never smokers and ascertain whether there might be differences regarding smokers, through a systematic review applying predefined inclusion and exclusion criteria. 17 Studies were included. Never-smoker lung cancer patients seem to experience longer survival times than do smokers or ex-smokers. Lung cancer in never smokers displays distinctive clinical characteristics, is more frequent among women, is diagnosed at more advanced stages, and the predominant histologic type is adenocarcinoma. Further studies are necessary to ascertain lung cancer survival among never smokers.

Objective: Analyze the interaction between GSTM1/GSTT1 polymorphsms (wild type, hemizygous deletion, homozygous deletion) and residential radon (RR) exposure in the lung cancer risk in never smokers Material and Methods: Multicentric, case-control study. Consecutive cases of lung cancer diagnosed in never smokers in 10 Spanish hospitals were included. Controls were never smokers undergoing minor, non-oncologic surgery at the same hospitals. Participants were interviewed through a questionnaire, focusing on risk factors for lung cancer. A blood sample was obtained for genetic analysis. Radon at dwellings was measured using alpha-track detectors Results: We included 322 cases (80,4%women) and 338 controls (78% women), median age:70. The most frequent histologic type was adenocarcinoma (78.5%). RR concentration was >200 Bq/m3 in 45.3% of cases and in 30.2% of controls. GSTM1 and GSTT1 status was analyzed in 207 and 197 cases and in 299 and 302 controls, respectively. Table 1 shows that lung cancer risk increases for the same radon exposure when the gene is absent compared to non-deleted gene. This effect is more evident when only adenocarcinoma patients are analyzed Conclusions: Homozigous deletion of GSTM1 is associated with an increased risk of lung cancer in never smokers exposed to residential radon concentrations above 200 Bq/m3, suggesting that this gene could modulate the effect of residential radon

A pneumatized middle turbinate is called concha bullosa. Bolger classified it in bulbous, lamellar, and extensive. Lamellar cells could have a variable extension. We propose the first radiologic classification of lamellar cells. 195 CT sinonasal scans were included in the study. Lamellar cells were classified into four categories according to their degree of aeration. Lamellar cells were found in 47.7% of patients: unilateral in 14.9% of cases and bilateral in the remaining 32.8%. The most common lamellar cell is type 1, followed by types 3, 2, and 4; there were no statistically significant differences regarding side. A subgroup analysis was performed in 106 patients with no inflammatory diseases of the nasal cavity; there were no significant differences. Cell types 3 and 4 are a complete pneumatization of the insertion of the middle turbinate; these cells are rare and could be associated with middle turbinate instability.

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions. This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined. The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.

Purpose: The purpose of the study was to analyze the determinants of citations such as publication year, article type, article topic, article selected for a press release, number of articles previously published by the corresponding author, and publication language in a Spanish journal of public health. Methods: Observational study including all articles published in Gaceta Sanitaria during 2007-2011. We retrieved the number of citations from the ISI Web of Knowledge database in June 2013 and also information on other variables such as number of articles published by the corresponding author in the previous 5 years (searched through PubMed), selection for a press release, publication language, article type and topic, and others. Results: We included 542 articles. Of these, 62.5% were cited in the period considered. We observed an increased odds ratio of citations for articles selected for a press release and also with the number of articles published previously by the corresponding author. Articles published in English do not seem to increase their citations. Conclusions: Certain externalities such as number of articles published by the corresponding author and being selected for a press release seem to influence the number of citations in national journals. (C) 2016 Elsevier Inc. All rights reserved.

Oropharyngeal cancer is a multifactorial disease. Alcohol and tobacco are the main risk factors. Radon is a human carcinogen linked to lung cancer risk, but its influence in other cancers is not well known. We aim to assess the effect of radon exposure on the risk of oral and pharyngeal cancer through a systematic review of the scientific literature. This review performs a qualitative analysis of the available studies. 13 cohort studies were included, most of them mortality studies, which analysed the relationship between occupational or residential radon exposure with oropharyngeal cancer mortality or incidence. Most of the included studies found no association between radon exposure and oral and pharyngeal cancer. This lack of effect was observed in miners studies and in general population studies. Further research is necessary to quantify if this association really exists and its magnitude, specially performing studies in general population, preferably living in areas with high radon levels.

Resumen Fundamento y objetivo El radon residencial es la segunda causa de cancer de pulmon y la primera en sujetos que nunca han fumado. Galicia es un area de alta emision de radon. El objetivo de este estudio es analizar la correlacion entre mortalidad por cancer de pulmon y exposicion a radon residencial en los municipios gallegos. Material y metodo Se realizo un estudio ecologico en el que se incluyeron 192 municipios con al menos 3 mediciones de radon residencial cada uno. El numero de muertes observadas se obtuvo del Registro de Mortalidad de Galicia, calculandose posteriormente las razones de mortalidad estandarizadas (RME) de cancer de pulmon para ambos sexos durante el periodo 1980-2009. Las concentraciones medianas de radon residencial para cada municipio se correlacionaron con las RME por cancer pulmonar. Resultados La concentracion mediana de radon residencial en los municipios analizados fue de 75 Bq/m 3 , con un rango intercuartilico de 40,7 a 154 Bq/m 3 . La correlacion entre las RME por cancer de pulmon y la concentracion de radon es significativa para los varones (p = 0,023), mientras que para las mujeres la asociacion no alcanza la significacion estadistica (p = 0,087.) Conclusion Existe asociacion entre el radon residencial y la mortalidad municipal por cancer de pulmon en Galicia en varones, aunque en las mujeres esta asociacion no es estadisticamente significativa. Estos datos evidencian que el radon residencial puede aumentar el riesgo de cancer de pulmon en varones, aunque en las mujeres no se puede establecer ninguna conclusion.

Background and objective Residential radon is the second cause of lung cancer and the first in never smokers. Galicia is a high radon emission area. The objective of this study is to analyse the relationship between municipal lung cancer mortality and residential radon in Galician municipalities. Material and method We performed an ecologic study including 192 municipalities with at least 3 residential radon measurements. The observed number of lung cancer deaths was obtained from the Galician Mortality Registry. Afterwards, we calculated the standardised mortality ratios (SMRs) of lung cancer for males and females for the period comprising 1980–2009. Median municipal residential radon concentrations were correlated with lung cancer SMRs. Results Median residential radon concentration for the included municipalities was 75 Bq/m3, with an interquartile range of 40.7–154 Bq/m3. The correlation between lung cancer SMRs and municipal radon concentration was statistically significant for males (p = .023) whereas it did not reach statistical significance for females (p = .087). Conclusion There exists an association between municipal residential radon and lung cancer mortality in Galicia for males, though for women the association is not statistically significant. These results suggest that residential radon could raise the risk of lung cancer in males, though for females no association is evident.

There are some published scores to estimate lung cancer risk of mortality or incidence. Nevertheless, no score has included residential radon as a variable to be considered when estimating lung cancer risk. In this commentary we discuss the importance of including residential radon as a factor to be taken into account when calculating lung cancer risk.

Summary Objective In this study, we have created and validated the Spanish translation of the Reflux Symptom Index (Sp-RSI). Materials and Methods RSI was translated according to the World Health Organization recommendation for the translation and adaptation of instruments. The final version of the Sp-RSI was administered twice (day 0 and day 7) to 150 participants with and without laryngopharyngeal reflux symptoms. Reliability was measured with Cronbach α, and temporal stability was measured with intraclass correlation coefficient. Results One hundred fifty participants were included. Internal consistency of the Sp-RSI measured with Cronbach α was 0.872. A subgroup analysis was performed according to age ( 55 years) and sex (female, male), with Cronbach α values of 0.854, 0.869, 0.852, and 0.897, respectively. The intraclass correlation coefficient was 0.987. According to age ( 55 years) and sex (female, male), the intraclass correlation coefficients were 0.990, 0.984, 0.987, and 0.987, respectively. Conclusions The Sp-RSI reported a very high internal consistency and reliability. It is, therefore, a valid, inexpensive, and reliable tool for assessing laryngopharyngeal reflux symptoms and may be used for screening among the Spanish-speaking medical community.

Objective: To analyze the causes of retracted publications and the main characteristics of their authors. Method: A descriptive cross-sectional study was designed including all retracted publications from January 1st, 2013-December 31st, 2016 indexed in PubMed. The causes of retraction were classified as: data management, authorship issues, plagiarism, unethical research, journal issues, review process, conflict of interest, other causes, and unknown reasons. Then, misbehaviour was classified as misconduct, suspicion of misconduct or no misconduct suspicion. Results: 1,082 retracted publications were identified. The retraction rate for the period was 2.5 per 10,000 publications. The main cause of retraction was misconduct (65.3%), and the leading reasons were plagiarism, data management and compromise of the review process. The highest proportion of retracted publications corresponded to Iran (15.52 per 10,000), followed by Egypt and China (11.75 and 8.26 per 10,000). Conclusions: Currently, misconduct is the main cause of retraction. Specific strategies to limit this phenomenon must be implemented. It would be useful to standardize reasons and procedures for retraction. The development of a standard retraction form to be permanently indexed in a database might be relevant. Resumen: Objetivo: Analizar las causas de las retractaciones y las características fundamentales de sus autores. Método: Se diseñó un estudio descriptivo, transversal, que incluyó todas las publicaciones con retractación entre el 1 de enero de 2013 y el 31 de diciembre de 2016 indexadas en PubMed. Las causas de la retractación fueron clasificadas como manejo de datos, asuntos de autoría, plagio, investigación no ética, asuntos de las revistas, proceso de revisión, conflictos de intereses, otras causas y razones desconocidas. Tras esto, la conducta indebida fue clasificada como mala conducta, sospecha de mala conducta y sin sospecha de mala conducta. Resultados: Se identificaron 1.082 publicaciones retractadas. La proporción de publicaciones retractadas fue de 2,5 por cada 10.000 publicaciones para el periodo evaluado. La principal causa de retractación fue la mala conducta (65,3%), y las causas principales fueron plagio, manejo de los datos y compromiso del proceso de revisión. La mayor proporción de publicaciones retractadas correspondió a Irán (15,52 por 10.000), seguido de Egipto y China (11,75 y 8,26 por 10.000, respectivamente). Conclusiones: Actualmente, la mala conducta es la principal causa de retractación. Deberían implementarse estrategias específicas para limitar este fenómeno. Sería de utilidad uniformar los motivos y procedimientos para la retractación. Podría ser apropiado el desarrollo de un formulario estándar de retractación que sea indexado permanentemente en una base de datos. Keywords: Plagiarism, Peer review, Authorship, Fraud, Scientific misconduct, Palabras clave: Plagio, Revisión por pares, Autoría, Fraude, Mala conducta científica

Peer review in the scientific publication is widely used as a method to identify valuable knowledge. Editors have the task of selecting appropriate reviewers. We assessed the reasons given by potential reviewers for declining a request to review, and the factors associated with acceptance, taking into account the difference in the sex of the reviewer. This is a descriptive study of the review requests from a public health journal (Gaceta Sanitaria) with an enforced gender policy. The dependent variables were requests, response to requests, reasons potential reviewers gave for declining requests and time to review. We carried out a descriptive analysis of these indicators and applied logistic regression to analyze factors (professional and research/review experience) associated with having done at least one review in 2014-2015. Results were stratified by sex. Journal editors sent 1,775 requests to 773 potential reviewers; 52.3% of whom reviewed at least one manuscript. Of the 396 declined requests (22.3%), the most common reasons were lack of time and of experience (88.1%). No differences were observed by sex. In the multivariate analysis, having reviewed for the journal in previous years showed the strongest association with acceptance. Specific analyses of data on requests reviewers may be useful for improving the acceptance rates to review. This study did not show gender differences in several indicators of the reviewing process.

Objective: To review the published evidence of links between radon exposure and central nervous system tumors through a systematic review of the scientific literature. Methods: We performed a thorough bibliographic search in Medline (PubMed) and EMBASE. We combined MeSH (Medical Subject Heading) terms and free text. We developed a purpose-designed scale to assess the quality of the included manuscripts. Results: We have included 18 studies, 8 performed on miners, 3 on the general population and 7 on children, and the results have been structured using this classification. The results are inconclusive. An association between radon exposure and central nervous system tumors has been observed in some studies on miners, but not in others. The results observed in the general adult population and in children are also mixed, with some research evincing a statistically significant association and others showing no effect. Conclusions: We cannot conclude that there is a relationship between radon exposure and central nervous system tumors. The available studies are extremely heterogeneous in terms of design and populations studied. Further research is needed in this topic, particularly in the general population residing in areas with high levels of radon. Resumen: Objetivo: Revisar la evidencia publicada entre la exposición al radón y los tumores del sistema nervioso central a través de una revisión sistemática de la literatura científica. Método: Se realiza una revisión sistemática exhaustiva de la literatura científica en Medline (PubMed) y EMBASE, combinando términos MeSH (Medical Subject Heading) y texto libre. Se desarrolla una escala específica para valorar la calidad de los estudios incluidos. Resultados: Se incluyeron 18 estudios (8 realizados en mineros, 3 en población general y 7 en niños) y los resultados se estructuraron siguiendo esa clasificación. Los resultados son inciertos. Algunos estudios en mineros han observado una asociación entre la exposición a radón y tumores del sistema nervioso central, pero otros no. Los resultados en población general adulta y en niños también son diversos, con algunas investigaciones que encuentran una asociación estadísticamente significativa y otras que no encuentran ningún efecto. Conclusiones: No puede concluirse que exista una asociación entre la exposición al radón y los tumores del sistema nervioso central. Los estudios disponibles son muy heterogéneos en cuanto al diseño y los sujetos incluidos. Es necesaria más investigación sobre este tema, en particular en población general residente en áreas con elevados niveles de radón. Keywords: Central nervous system neoplasms, Radon, Systematic review, Palabras clave: Sistema nervioso central, Radón, Revisión sistemática

KPC carbapenemase-producing Klebsiella pneumoniae (KPC-KP) has become a major public health challenge. Accordingly, this study sought to use a systematic review of the scientific literature to ascertain the mortality of KPC-KP infection, and analyze such mortality by country, year of publication, hospital ward, and type of interpretation used to define carbapenem resistance.A search without language restrictions was made of the MEDLINE, CENTRAL, EBSCO, LILACS and EMBASE databases from 1996 through June 2017, to locate all studies which had determined the existence of KPC-KP infection. We then performed a meta-analysis of all studies that reported KPC-KP infection-related mortality, and analyzed mortality by subgroup in accordance with standard methodology.A total of 51 papers were included in the systematic review. From 2005 through 2017, data on KPC-KP infection were reported in 5124 patients, with an average of 465 patients per year. The most widely studied type of infection was bacteremia (28∙0%). The meta-analysis showed that overall mortality for the 37 studies was 41.0% (95%CI 37.0-44.0), with the highest mortality rates being observed in oncology patients, 56.0% (95%CI 38.1-73.0), and Brazil, 51.3% (95%CI 43.0-60.0).KPC-KP infection-related mortality is high, is manifested differently in some countries, and is highest among oncology patients.

Molecular characterization of non-small-cell lung cancer is becoming increasingly important with the appearance of molecular testing. Tumors with somatic mutations in the gene that encodes for the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) or in the gene that encodes for the anaplastic lymphoma kinase (ALK) preclude favorable responses to tyrosine kinase and ALK inhibitors, respectively. Semirigid thoracoscopy is a minimally invasive technique for pleural effusion management. However, there is scarce evidence assessing the role of semirigid thoracoscopy for molecular testing, with only one study including EGFR mutation status but no study analyzing ALK translocation. The aim of this prospective study was to evaluate the adequacy of samples obtained using semirigid thoracoscopy for EGFR mutation and ALK translocation analyses in confirmed primary lung cancers. We conducted a prospective analysis of 26 consecutive patients referred for semirigid thoracoscopy between November 2009 and July 2015. Twenty-two cases were adenocarcinomas. Fourteen samples were sent for molecular analysis. Semirigid thoracoscopy had a diagnostic yield of 95.45%for malignancy. EGFR mutation testing was possible in all (100%) cases. EGFR mutations were detected in 2/14 (14.2%) samples. ALK translocation testing was possible in all but one (90%), although negative in all of them. This study confirms the high clinical utility of samples obtained through semirigid thoracoscopy for EGFR and ALK genotyping in primary lung cancers.

Radon is the second most important risk factor for lung cancer but recommended exposure differs in many countries http://ow.ly/VZ8y30fDdYz