Depósito Académico
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845 results
Results
- Prospective multicenter study to identify optimal target population for motorized spiral enteroscopy(2024) Carretero, C. (Cristina); Giordano, A. (Antonio); Gonzalez-Suarez, B. (Begoña); Compañy, L. (Luis); Urpi-Ferreruela, M. (Miguel); Fernández-Gil, P. L. (Pedro Luis); Aicart-Ramos, M. (Marta); Alonso-Lázaro, N. (Noelia); Parejo-Carbonell, S. (Sofía); Bógalo-Romero, C. (Cintia); Egea-Valenzuela, J. (Juan); Pons-Beltran, V. (Vicente); Ruiz-Gómez, F. (Francisco); Sola-Vera, J. (Javier); Dedeu-Cuscó, J. M. (Josep María); Alajarin-Cervera, M. (Miriam); Prieto-de-Frias, C. (César)Motorized spiral enteroscopy (MSE) enhances small bowel exploration, but the optimal target population for this technique is unknown. We aimed to identify the target population for MSE by evaluating its efficacy and safety, as well as detecting predictors of efficacy. A prospective multicenter observational study was conducted at 9 tertiary hospitals in Spain, enrolling patients between June 2020–2022. Analyzed data included demographics, indications for the procedure, exploration time, depth of maximum insertion (DMI), technical success, diagnostic yield, interventional yield, and adverse events (AE) up to 14 days from enteroscopy. Patients with prior gastrointestinal surgery, unsuccessful balloon enteroscopy and small bowel strictures were analyzed. A total of 326 enteroscopies (66.6% oral route) were performed in 294 patients (55.1% males, 65 years ± 21). Prior abdominal surgery was present in 50% of procedures (13.5% gastrointestinal surgery). Lower DMI (162 vs 275 cm, p = 0.037) and diagnostic yield (47.7 vs 67.5%, p = 0.016) were observed in patients with prior gastrointestinal surgery. MSE showed 92.2% technical success and 56.9% diagnostic yield after unsuccessful balloon enteroscopy (n = 51). In suspected small bowel strictures (n = 49), the finding was confirmed in 23 procedures (46.9%). The total AE rate was 10.7% (1.8% classified as major events) with no differences related to prior gastrointestinal/abdominal surgery, unsuccessful enteroscopy, or suspected small bowel strictures. The study demonstrates that MSE has a lower diagnostic yield and DMI in patients with prior gastrointestinal surgery but is feasible after unsuccessful balloon-enteroscopy and in suspected small bowel strictures without safety concerns.
- Neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: reconstructed patient-level meta-analysis of randomized clinical trials(Oxford University Press, 2024) Chopitea, A. (Ana); Rotellar, F. (Fernando); Rodriguez, J. (Javier); Pardo, F. (Fernando); Zozaya-Larequi, G. (Gabriel); Castañon, E. (Eduardo); Ponz-Sarvise, M. (Mariano); Blanco, N. (Nuria); Marti-Cruchaga, P. (Pablo); Aliseda, D. (Daniel)Background: Neoadjuvant treatment has shown promising results in patients with borderline resectable pancreatic ductal adenocarcinoma. The potential benefits of neoadjuvant treatment on long-term overall survival in patients with resectable pancreatic ductal adenocarcinoma have not yet been established. The aim of this study was to compare long-term overall survival of patients with resectable pancreatic ductal adenocarcinoma based on whether they received neoadjuvant treatment or underwent upfront surgery. Methods: A systematic review including randomized clinical trials on the overall survival outcomes between neoadjuvant treatment and upfront surgery in patients with resectable pancreatic ductal adenocarcinoma was conducted up to 1 August 2023 from PubMed, MEDLINE and Web of Science databases. Patient-level survival data was extracted and reconstructed from available Kaplan–Meier curves. A frequentist one-stage meta-analysis was employed, using Cox-based models and a non-parametric method (restricted mean survival time), to assess the difference in overall survival between groups. A Bayesian meta-analysis was also conducted. Results: Five randomized clinical trials comprising 625 patients were included. Among patients with resectable pancreatic ductal adenocarcinoma, neoadjuvant treatment was not significantly associated with a reduction in the hazard of death compared with upfront surgery (shared frailty HR 0.88, 95% c.i. 0.72 to 1.08, P = 0.223); this result was consistent in the non-parametric restricted mean survival time model (+2.41 months, 95% c.i. −1.22 to 6.04, P < 0.194), in the sensitivity analysis that excluded randomized clinical trials with a high risk of bias (shared frailty HR 0.91 (95% c.i. 0.72 to 1.15; P = 0.424)) and in the Bayesian analysis with a posterior shared frailty HR of 0.86 (95% c.i. 0.70 to 1.05). Conclusion: Neoadjuvant treatment does not demonstrate a survival advantage over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma.
- Ablative radioembolization of hepatocellular carcinoma with total arterial supply originating from the superior adrenal artery achieved complete pathologic necrosis(Elsevier, 2022) Lewis, A.R. (Andrew R.); Arotzarena, G. (Gonzalo); Paz-Fumagalli, R. (Ricardo); Toskich, B.B. (Beau B.)Exclusively extrahepatic arterial perfusion to previously untreated, early-stage, hepatocellular carcinoma (HCC) is uncommon. We present a case of right superior adrenal artery completely supplying a subcapsular HCC in a 68-year-old male. The extrahepatic arterial territory targeted excluded structures potentially vulnerable to radiation, which allowed safe ablative Y-90 radioembolization that achieved complete pathological necrosis.
- The profile of social communication in Dravet syndrome(Elsevier, 2024) Laña, B. (Borja); Sanchez-Carpintero, R. (Rocío); Crespo-Eguilaz, N. (Nerea)Dravet syndrome (DS) presents a multifaceted clinical picture marked by epilepsy, cognitive impairments and behavioral disorders that progresses throughout development. Behavioral disorders include impairments in social relationships and communication, with frequent diagnosis of autism spectrum disorder. This study focused on comprehensively evaluating and comparing social communication profiles among a group of 43 children with Dravet syndrome, 30 children with level 1 autism spectrum disorder, 36 with social (pragmatic) communication disorder, and 18 with intellectual disability. Using validated tools like the Childhood Autism Spectrum Test and Children’s Communication Checklist, distinct patterns of social communication deficits were delineated. Our findings indicate that children with Dravet syndrome experience challenges in social relationships, primarily due to difficulties in use of pragmatic language. Areas such as range of interests and social interaction are less affected compared to those with ASD, emphasizing differing profiles between the conditions. While children with DS and ID may have similar intellectual functioning, the different social communication deficits in DS indicate their role in the DS phenotype beyond ID. These results underscore the unique social communication profile of DS and emphasizes the importance of tailored interventions and deep phenotyping efforts for effective DS management.
- Colaboración interprofesional en las sesiones clínicas de una unidad de cuidados intensivos: percepción de enfermeras y médicos. Una revisión sistemática de la literatura(Elsevier, 2024) Calderón-Breñosa, B. (B.); Alzate-Moreno, M. (M.); Sarasa-Monreal, M.M. (Mari Mar); Rodríguez-San Miguel, K. (K.)Introducción: Las Unidades de Cuidados Intensivos son unidades dinámicas y complejas que requieren del trabajo conjunto de varios profesionales. Esto se consigue mediante la práctica colaborativa interprofesional, que es el proceso en el que interactúan diferentes profesionales con metas y objetivos comunes en la toma de decisiones, proporcionando una atención segura y de calidad. Las sesiones clínicas conjuntas brindan a los profesionales la posibilidad de interactuar, mejorando la comunicación y los resultados en la práctica clínica. Objetivos: Explorar las percepciones de enfermeras y médicos sobre la práctica colaborativa en las sesiones clínicas conjuntas en una Unidad de Cuidados Intensivos. Metodología: Se realizó una revisión sistemática de la literatura en las bases de datos Medline, Pubmed, Cinahl, Web of Science y Psycinfo, incluyendo artículos publicados en los últimos diez años. Resultados: El análisis de las publicaciones detectó cinco categorías principales: 1) Concepto: definición de colaboración interprofesional según enfermeras y médicos; 2) Repercusión en la práctica clínica: valor otorgado a las sesiones clínicas por enfermeras y médicos; 3) Barreras: aspectos influyentes en las sesiones clínicas según la percepción de enfermeras y médicos; 4) Rol: papel percibido por cada profesional, y 5) Estrategias de mejora: propuestas planteadas por profesionales de enfermería y medicina. Conclusiones: A pesar de que médicos y enfermeras son conscientes de la importancia y repercusión de la práctica colaborativa interprofesional en la atención al paciente crítico, no resulta una práctica habitual en la asistencia.
- Experiencia de una enfermera de práctica avanzada en una unidad de cuidados intensivos(Elsevier, 2024) Goñi-Viguria, R. (Rosana)La estructura de las unidades de cuidados intensivos, el perfeccionamiento tecnológico y la gravedad de los pacientes, exigen que exista armonía entre todos los actores participantes del asistir al paciente crítico. A este contexto se añade que el rol actual de la supervisora pasa por asumir cada vez más competencias en gestión, sin perder de vista la necesidad de enmarcar la práctica profesional en el marco de una filosofía de cuidados. Ante este reto para la supervisora, la aparición en nuestro entorno de la figura de la enfermera de práctica avanzada (EPA) es una oportunidad. La EPA es fundamental para mejorar la atención al paciente, el desarrollo del personal y la implantación de la práctica basada en la evidencia. En este artículo se describe cómo trabaja la EPA con los diferentes miembros del equipo de salud y cuáles han sido los resultados desde su incorporación. La EPA lidera los esfuerzos para mantener la calidad del cuidado. Utiliza su conocimiento para evaluar las brechas dentro de la práctica y entre los entornos de práctica, y diseñar y liderar cambios en la práctica basados en la evidencia, para que los puntos de referencia puedan cumplirse de la manera más eficiente y oportuna. Además, apoya a la organización para responder a un entorno sanitario en constante cambio y es un instrumento para alcanzar sus metas.
- Wearable voice dosimetry system.(MDPI, 2024) Fernández-González, S. (Secundino); Llorente-Ortega, M. (Marcos); Podhorski, A. (Adam)The objective quantification of voice acoustic parameters is used for the diagnosis, monitoring, and treatment of voice disorders. Such assessments are carried out with specialised equipment within the doctor's office. The controlled conditions employed are usually not those of the real environment of the patient. The results, although very informative, are specific to those measurement conditions and to the time when they were performed. A wearable voice monitoring system, based on an accelerometer to ensure the message, can overcome these limitations. We present a miniaturised, low-power, and low-cost wearable system to estimate and record voice fundamental frequency (F0), intensity and phonation time for long intervals in the everyday environment of the patient. It was tested on two subjects for up to two weeks of recording time. It was possible to identify distinct periods in vocal activity, such as normal, professional, demanding or hyperfunctional. It provided information on the workload that the vocal cords needed to cope with over time and when and to what extent that workload was concentrated. The proposed voice dosimetry system enables the extraction and recording of voice parameters for long periods of time in the everyday environment of the patient, allowing the objectification of vocal risk situations and personalised treatment and monitoring.
- FNDC4 reduces hepatocyte inflammatory cell death via AMPKa in metabolic dysfunction-associated steatotic liver disease(Elsevier Ltd., 2024) Neira, G. (Gabriela); Valenti, V. (Víctor); Colina, I. (Inmaculada); Catalan, V. (Victoria); Becerril, S. (Sara); Frühbeck, G. (Gema); Moncada, R. (Rafael); Silva, C. (Camilo); Gomez-Ambrosi, J. (Javier); Rodriguez, A. (Amaia); Escalada, J. (Javier)Background: The molecular mediators responsible for the progression of metabolic dysfunction- associated steatotic liver disease (MASLD) to steatohepatitis (MASH) have not yet been completely disentangled. We sought to analyze whether FNDC4, an hepatokine and adipokine with anti-inflammatory properties, is involved in TNF-a-induced inflammatory cell death in patients with MASLD. Methods: Plasma FNDC4 (n 1⁄4 168) and hepatic FNDC4 and inflammatory cell death (n 1⁄4 65) were measured in samples from patients with severe obesity with available liver biopsy-proven MASLD diagnosis. The effect of FNDC4 on TNF-a-induced pyroptosis, apoptosis and necroptosis (PANoptosis) and mitochondrial dysfunction was studied in vitro using human HepG2 hepatocytes. Results: Compared with individuals with normal liver, patients with type 2 diabetes and MASLD exhibited decreased hepatic FNDC4 mRNA and protein levels, which were related to liver inflammation. An overexpression of TNF-a, its receptor TNF-R1 and factors involved in inflammatory cell death was also found in the liver of these patients. FNDC4-knockdown in HepG2 hepatocytes increased apoptotic cell death, while FNDC4 treatment blunted NLRP3 inflammasome-induced pyroptosis, apoptosis and necroptosis in TNF-a-stimulated hepatocytes. Moreover, FNDC4 improved TNF-a-induced hepatocyte mitochondrial dysfunction by enhancing mitochondrial DNA (mtDNA) copy number and OXPHOS complex subunits I, II, III and V protein expression. Mechanistically, AMP-activated protein kinase a (AMPKa) was required for the FNDC4-mediated inhibition of cell death and increase in mtDNA content. Conclusions: FNDC4 acts as a hepatocyte survival factor favouring mitochondrial homeostasis and decreasing inflammatory cell death via AMPKa. Collectively, our study identifies FNDC4 as an attractive target to prevent hepatocellular damage in patients with MASLD.
- Cortical activation in REM behavior disorder mimics voluntary movement. An electroencephalography study(Elsevier B.V., 2024) Alegre, M. (Manuel); Horrillo-Maysonnial, A. (Alejandro); Valencia, M. (Miguel); Manzanilla-Zapata, Ó. (Óscar); Urrestarazu, E. (Elena)Objectives: Motor symptoms of Parkinson’s disease improve during REM sleep behavior disorder movement episodes. Our aim was to study cortical activity during these movement episodes, in patients with and without Parkinson’s disease, in order to investigate the cortical involvement in the generation of its electromyographic activity and its potential relationship with Parkinson’s disease. Methods: We looked retrospectively in our polysomnography database for patients with REM sleep behavior disorder, analyzing fifteen patients in total, seven with idiopathic REM sleep behavior disorder and eight associated with Parkinson’s disease. We selected segments of REM sleep with the presence of movements (evidenced by electromyographic activation), and studied movement-related changes in cortical activity by averaging the electroencephalographic signal (premotor potential) and by means of time/ frequency transforms. Results: We found a premotor potential and an energy decrease of alpha–beta oscillatory activity preceding the onset of electromyographic activity, together with an increase of gamma activity for the duration of the movement. All these changes were similarly present in REM sleep behavior disorder patients with and without Parkinson’s disease. Conclusions: Movement-related changes in electroencephalographic activity observed in REM sleep behavior disorder are similar to those observed during voluntary movements, regardless of the presence of Parkinson’s disease motor symptoms. Significance: These results suggest a main involvement of the cortex in the generation of the movements during REM sleep.
- Ácido úrico y daño renal agudo en pacientes con alto riesgo de desarrollar daño renal agudo sometidos a cirugía cardiaca: cohorte prospectiva multicéntrica(Elsevier, 2024) Tamayo-Gómez, E. (Eduardo); Gómez, L. (L.); Esteva, C. (Carlos); Pereira, M.A. (Miguel Ángel); Sánchez, J. (J.); Aparicio, R. (Rosa); Vives, M. (Marc); Candela, A. (A.); Pita-Romero, R. (Rafael); Monedero, P. (Pablo); Murie-Fernández, M. (Manuel); Medina, A. (A.); Mon, T. (T.); Nagore-Setién, D. (David); Matilla, A. (Ana); Gragera, I. (Isabel); Calderón, E. (Enrique); Varela-Durán, M. (Marina); Mendez, E. (Elena); Rodríguez, J.M. (J.M.); Álvarez-Escudero, J. (Julián); Pasqualetto, A. (Alberto); García, A. (A.); Rodríguez, M.A. (M.A.); Vicente, R. (Rosario); López, M. (Marta); Marcos, J.M. (J. M.); Bürge, M. (M.); Carmona, P. (Paula); Pajares, A. (Azuzena)Objetivo: No está claro si la elevación de ácido úrico sérico (AUS) preoperatorio puede desempeñar un papel en el desarrollo de daño renal agudo (DRA) asociado a cirugía cardiaca (DRA-CS). Se realizó un estudio de cohortes para evaluar la influencia de la hiperuricemia en el DRA en pacientes de alto riesgo para desarrollar DRA-CS. Diseño: Estudio de cohortes prospectivo multicéntrico. Entorno: Catorce hospitales universitarios en España y en Reino Unido. Participantes: Se estudiaron a 261 pacientes consecutivos con alto riesgo de desarrollar DRA-CS, según una puntuación de Cleveland ≥ 4 puntos, de julio a diciembre de 2017. Intervenciones: Ninguna. Mediciones y resultados principales: Se utilizaron los criterios AKIN para la definición de DRA. Para determinar la asociación ajustada entre hiperuricemia (> = 7 mg/dL) e DRA se utilizaron modelos de regresión logística multivariable y análisis de pares emparejados por puntuaje de propensión. El AUS preoperatorio elevado (> = 7 mg/dL) estaba presente en 190 pacientes (72,8%), mientras que la DRA-CS se produjo en 145 pacientes (55,5%). En los modelos de regresión logística multivariable, la hiperuricemia no se asoció con un aumento significativo del riesgo de DRA (Odds Ratio [OR] ajustado: 1,58; intervalo de confianza [IC] 95%: 0,81-3; p = 0,17). En el análisis de emparejamiento por puntaje de propensión de 140 pacientes, el grupo de hiperuricemia experimentó probabilidades ajustadas similares de DRA (OR 1,05; IC 95%: 0,93-1,19; p = 0,37). Conclusiones: La hiperuricemia no se asoció con un mayor riesgo de DRA en esta cohorte de pacientes con alto riesgo de desarrollar DRA-CS.