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Introduction Despite the controversy concerning sentinel lymph node biopsy (SLNB) in papillary thyroid carcinoma (PTC), successful detection rates can be achieved by radioguidance and vital dyeing. However, the drawbacks in both techniques are notable. Magnetic-guided SLNB (mSLNB) using superparamagnetic iron oxide (SPIO) nanoparticles is appealing as an alternative procedure. Materials and Methods mSLNB using the Sentimag-Sienna System®, total thyroidectomy and central compartment dissection (CCD) were performed on all PTC patients. Lymph node involvement was assessed by postoperative pathological examination. Results From 2014 to 2016, 33 consecutive patients with PTC were enrolled in the study. A total of 20 patients met the eligibility. mSLNB succeeded in 16 patients, with a detection rate of 80%. A median of two SLN per patient were detected. A median of 10.5 non-sentinel lymph nodes (NSLN) from CCD were examined. Among the patients, 56.25% (9/16) had no metastatic nodes, while 12.5% (2/16) had exclusively SLN involvement. No false negative cases were found. The agreement between SLN and NSLN status was 87.5%. The prediction of NSLN involvement by SLN status showed 100% sensitivity, 81.8% specificity, 71.4% PPV and 100% NPV. Subsequently, mSLNB and the final pathological analysis would discriminate 43.75% (7/16) of patients who would certainly benefit from CCD whilst 56.25% of the total would confirm an unnecessary lymphadenectomy and avoid morbidity. Conclusion mSLNB showed satisfactory performance in PTC with clinical-negative nodes. We have shown mSLNB to be a good predictor of central compartment status that can improve the staging and management of PTC patients.

Objective: Type 2 diabetes mellitus (DM-2) is an important cardiovascular risk factor, although hardly any data are available in our country. Therefore, we decided to study the incidence of cardiovascular disease (CVD) and the related variables with its appearance in a group of patients with DM-2. Research design and methods: 176 DM-2 patients without CVD at baseline (63.6% women, mean age 54±8.9), mean follow-up 6.3 years. We collected data at 6-month intervals concerning new micro- and macrovascular complications, glucose, HbA 1C , lipid profile, and renal function. We analyzed values at baseline and at the end of follow-up. For numeric variables, the mean value during follow-up was calculated. In renal function variables, we also worked out the difference between baseline and final values, considering the time until the first episode of CVD as the independent variable. Kaplan–Meier analysis was used in categorical variables and Cox regression tests for numeric data and also for multivariate analysis. In multivariate analysis, we included significant data in the univariate analysis, excluding those from the end of the follow-up with the aim of having some predictive meaning in our results. Results: New episodes of CVD were detected in 28 patients (15.9%). These events were statistically related with baseline diagnosed hypertension, presence of diabetic nephropathy and retinopathy, HbA 1C , and total cholesterol. Among mean values during follow-up, the association was with HbA 1C , cholesterol, urinary albumin excretion rate (UAER), glomerular filtration rate (GFR), and systolic arterial pressure. There was also a relationship of CVD events with the new appearance or worsening of diabetic retinopathy or nephropathy, creatinine and UAER increase and the decrease of GFR and effective renal plasma flow (ERPF), during follow-up. In the multivariate analysis, we found an independent association with the appearance of CVD and mean HbA 1C , mean UAER and the presence of proliferative diabetic retinopathy at baseline. Conclusions: We have a rather low incidence of CVD in our patients with DM-2. The appearance of CVD is independently related with HbA 1C , the level of UAER, and the presence at baseline of diabetic retinopathy.

La publicacion reciente de las recomendaciones del comite de expertos para el diagnostico de la diabetes mellitus (DM) ha provocado un debate considerable. Por supuesto, la trascendencia que tiene un cambio en los criterios diagnosticos de una enfermedad como la DM justifica de sobras la polemica suscitada, aunque la postura que finalmente ha adoptado la Asociacion Americana de Diabetes (ADA) es probable que tranquilice, por lo menos en parte, los animos. Vamos a analizar aqui algunas de las consecuencias, ventajas e inconvenientes que puede tener la utilizacion de la hemoglobina glucosilada (HbA1C) para el diagnostico de la DM, de acuerdo con la informacion disponible hasta la fecha, fundamentalmente desde el punto de vista clinico. La DM esta causada por la incapacidad del organismo de mantener unas concentraciones de glucosa plasmaticas dentro de la normalidad, debido a un deficit de insulina, una falta de accion de esta o una combinacion de ambos defectos. Como en la mayoria de los parametros biologicos, la glucemia tiene una distribucion normal en la mayor parte de las poblaciones humanas; esto conlleva que la definicion de DM tenga que basarse en criterios arbitrarios. El establecimiento de un valor determinado se puede fundamentar en diversos criterios, pero parece logico esperar que el diagnostico de DM tenga relacion con las consecuencias de la enfermedad y que este diagnostico conlleve intervenciones efectivas para evitarlas. A pesar de ser una enfermedad conocida desde la antiguedad, no fue hasta 1979 que el National Diabetes Data Group propuso los primeros criterios diagnosticos aceptados de forma general, adoptados tambien por la