Lumbalgia durante la práctica del windsurfing

El windsurfing es, posiblemente, el deporte náutico más practicado hoy en el mundo. Pero tiene un aspecto negativo: las lesiones que provoca. Existe poca experiencia al respecto y la información no es abundante. Por estas razones, los autores realizaron una encuesta clínica a 55 personas que pratican este deporte para comprobar la incidencia de tales afecciones, especialmente de la lumbalgia, así como las razones de su presentación, muy frecuente entre ellos. Hallaron que el 66 % habían padecido dolor lumbar después de su práctica. Concluyen que la adopción de una postura incorrecta, motivada por el poco dominio de la técnica, el no poseer una buena preparación física previa y no efectuar un calentamiento muscular antes de cada sesión, constituyen las principales causas de las lesiones y molestias musculares causadas por la sobrecarga que debe enfrentar el sistema muscular, especialmente la región lumba

Validation of Backtable Graft Arterial Anastomosis Between Splenic Artery and Superior Mesenteric Artery: A 21-year Single-center Experience of Pancreas Transplantation

Resumen del trabajo presentado en el IPITA 2021 VIRTUAL CONGRESS, celebrado de forma virtual del 20 al 23 de octubre de 2021Aim: To determine the role of the arterial spleno-mesenteric anastomosis reconstruction technique compared to other types of backtable arterial anastomosis, in terms of vascular complications and long-term patient and graft survival in a single institution. Methods: Retrospective analysis including all pancreas transplants performed over 21 years (1999–2019). For the bench reconstruction: (1) the distal superior mesenteric artery (SMA) was distally dissected and sewn to the splenic artery (SA), or (2) the arteries were reconstructed with an iliac arterial “Y” graft. Results: A total of 412 pancreas transplantations were done. At the bench procedure SMA/SA anastomosis was performed in 376 of patients, arterial iliac “Y” graft in 32 of patients, and no arterial reconstruction was required in 4 of patients. A total of 90 patients presented vascular complications within the 30 days following transplant: (venous (n=64), arterial (n=11), both (n=15), without statistically significant differences between the SMA/SA anastomosis group and others. Regarding acute arterial events:(1) for the SMA/SA anastomosis group, a total of 24 patients presented with thrombosis (n=16), stenosis (n=5), pseudoaneurysm (n=2); (2) for the iliac “Y” graft group, there were 3 patients with thrombosis. Focusing on chronic arterial events:(1)for the SMA/SA anastomosis group, a total of 2 patients presented with chronic thrombosis, 2 with pseudoaneurysm, 2 with arterioenteral fistula and one with arteriovenous fistula;(2)for the iliac “Y” graft group, and one patient with arterioenteral fistula. After a median follow-up of 129.2 [77.2–182] months, no statically differences were found between SMA/SA anastomosis and iliac “Y” graft arterial reconstruction groups at 1, 3, 5 and 10 years in terms of patient and graft survival. Conclusions: The back table procedure used in our institution (SMA/SA) is an easy, effective and safe surgical technique that can be used as the first option for arterial reconstruction or as a good alternative for surgeons to the widely used arterial “Y” graft.Peer reviewe

Endothelial glycocalyx shedding in patients undergoing pancreas transplantation

Trabajo presentado en el 12th EPITA Symposium - 41st AIDPIT Workshop, celebrado en Austria, del 22 al 24 de enero de 2023Background: The vascular endothelium is critically involved in many steps of tissue damage originating during ischemia-reperfusion (IR) in human transplantation. An endothelial surface layer, the glycocalyx, forms the primary interface between the blood and the healthy endothelium and its shedding is recognized as a cornerstone in IR-related endothelial dysfunction. We investigated the role of endothelial glycocalyx breakdown products in patients undergoing pancreas transplantation. Methods: Endothelial integrity and remodelling products were measured in plasma from 26 simultaneous reno-pancreas transplants and 2 re-transplants recipients. The levels of syndecan-1, hyaluronan, heparan sulfate and Vascular Endothelial Growth Factor (VEGF) were determined using enzyme-linked immunosorbent assay at different time points: before surgery, 10 minutes and 24 hours after reperfusion, and at patient discharge. Results: Transplant recipients had greater evidence of glycocalyx damage 10 min. after reperfusion of the graft as compared before surgery, measured by plasma levels of syndecan-1 (66.54 vs 155ng/mL; p<0.0001) and heparan sulfate (4.96 vs 6.07 ng/mL, p=0.0435) components. However, plasma hyaluronan levels remained unchanged throughout. The levels of VEGF significantly decreased in plasma 10 min. after graft reperfusion (117 vs 18 pg/mL; p<0.0001). No correlation existed between endothelial markers except for syndecan-1 with VEGF and heparan sulfate at this time point, respectively (r=0.395, p=0.0371; r=0.572, p=0.001). Regression analysis showed that the higher levels of syndecan-1 were more frequent in patients with acute rejection (p=0.011), intestinal complications (p=0.045) and those who developed kidney surgical complications (p=0.026) or needed for a urological reintervention (p=0.024). Graft pancreatitis and pancreatic fistulas were associated with the levels of hyaluronan at 24h post-reperfusion (p=0.04; p=0.04, respectively) and at patient discharge (p=0.012; p=0.012, respectively). Conclusions: This study provides the first evidence for endothelial glycocalyx damage in pancreas transplantation. Further studies are needed to validate these findings in a larger sample size

Degradación del glicocáliz endotelial en pacientes sometidos a trasplante de páncreas

Trabajo presentado en el 17º Congreso de la Societat Catalana de Transplantament, celebrado en Barcelona, del 22 al 24 de marzo de 2023Objetivos: El glicocálix es una estructura que recubre la capa luminal del endotelio vascular cuya degradación se reconoce como una piedra angular en la disfunción endotelial relacionada con el proceso de isquemia-reperfusión. En este sentido, investigamos el papel de los productos de degradación del glicocálix endotelial en pacientes trasplantados de páncreas. Material y métodos: Los niveles de los principales componentes del glicocálix: sindecan-1, ácido hialurónico y heparán sulfato, y el factor de crecimiento endotelial vascular (VEGF) se determinaron en el plasma de 28 pacientes trasplantados mediante ensayos ELISA antes de la cirugía, 10 minutos y 24 horas después de la reperfusión, y al alta del paciente. Resultados: Los pacientes trasplantados presentaron mayor evidencia de daño endotelial 10 minutos después de la reperfusión del injerto versus antes de la cirugía, determinado por los niveles plasmáticos de sindecan-1 (66,54 frente a 155 ng/ml; p<0,0001) y heparán sulfato (4,96 frente a 6,07 ng/ml, p=0,0435). Sin embargo, los niveles de ácido hialurónico se mantuvieron sin cambios significativos durante todo el proceso. Los niveles de VEGF disminuyeron drásticamente en plasma 10 minutos después de la reperfusión del injerto (117 vs 18 pg/ml; p<0,0001). El análisis de regresión mostró una asociación entre los pacientes con niveles elevados de sindecan-1 a los 10 minutos post-reperfusión y el desarrollo de rechazo agudo del páncreas (p=0,011), aparición de complicaciones intestinales (p=0,045), complicaciones quirúrgicas renales (p=0,026) o requerimiento de reintervención urológica (p=0,024). Por otro lado, los niveles de VEGF antes de la cirugía se asociaron negativamente con el desarrollo de infección (p=0,016) y complicaciones quirúrgicas del páncreas como la pancreatitis del injerto (p=0,045) o hemorragia abdominal (p=0,040). Conclusiones: Este estudio proporciona la primera evidencia de daño en el glicocálix endotelial durante el trasplante de páncreas. Aun así, son necesarios más estudios para validar estos hallazgos en un tamaño muestral más grande

Utilización del maniquí de alta afinidad SinMan3G para adquisición de habilidades en el Grado en Medicina

Memoria ID-0185. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016

Patient Experience in Pancreas-Kidney Transplantation-A Methodological Approach Towards Innovation in an Established Program

Simultaneous pancreas-kidney transplantation (SPKT) leads to increased survival and quality of life, and is an alternative treatment for insulin-dependent diabetes mellitus and end-stage kidney disease. Due to the particularities of this population (often with multiple comorbidities) and of the surgery (only performed in a few centers), a comprehensive analysis of patients' experience along the SPKT process is crucial to improve patient care and add value to this procedure. Therefore, we applied a systematic and iterative methodology with the participation of both patients and professional teams working together to explore and identify unmet needs and value-adding steps along the transplant patient journey at an established pancreas transplant program. Four main steps (to comprehend, to explore, to experiment and to assess) led to several interventions around three major areas: Administration and logistics, information and communication, and perceived quality of assistance. As a result, both displacements to the hospital for diagnostic purposes and the time delay involved in joining the patient waiting list for transplantation were reduced in parallel to the administrative procedures. In conclusion, the methodological implementation of key organizational changes has great impact on overall patient experience. Further quantitative analysis from the patient's perspective will consolidate our program and may add new prototype service design components

A Phase I-II multicenter trial with Avelumab plus autologous dendritic cell vaccine in pre-treated mismatch repair-proficient (MSS) metastatic colorectal cancer patients; GEMCAD 1602 study

[Background]: Immune check-point blockade (ICB) has shown clinical beneft in mismatch repair-defcient/microsatellite instability high metastatic colorectal cancer (mCRC) but not in mismatch repair-profcient/microsatellite stable patients. Cancer vaccines with autologous dendritic cells (ADC) could be a complementary therapeutic approach to ICB as this combination has the potential to achieve synergistic efects. [Methods]: This was a Phase I/II multicentric study with translational sub-studies, to evaluate the safety, pharmacodynamics and anti-tumor efects of Avelumab plus ADC vaccine in heavily pre-treated MSS mCRC patients. Primary objective was to determine the maximum tolerated dose and the efcacy of the combination. The primary end-point was 40% progressionfree survival at 6 months with a 2 Simon Stage. [Results]: A total of 28 patients were screened and 19 pts were included. Combined therapy was safe and well tolerated. An interim analysis (Simon design frst-stage) recommended early termination because only 2/19 (11%) patients were disease free at 6 months. Median PFS was 3.1 months [2.1–5.3 months] and overall survival was 12.2 months [3.2–23.2 months]. Stimulation of immune system was observed in vitro but not clinically. The evaluation of basal RNA-seq noted signifcant changes between pre and post-therapy liver biopsies related to lipid metabolism and transport, infammation and oxidative stress pathways. [Conclusions]: The combination of Avelumab plus ADC vaccine is safe and well tolerated but exhibited modest clinical activity. Our study describes, for the frst-time, a de novo post-therapy metabolic rewiring, that could represent novel immunotherapyinduced tumor vulnerabilities.The study was funded by grants from the FIS PI17/00732 from Instituto de Salud Carlos III, Premi Fi de Residència Emili Letang from Hospital Clínic Barcelona, Plan Nacional de I + D (PID-107139RB-C21 to DB-R and PID2020-115051RB-I00 to MC) and Grupo Español Multidisciplinar en Cáncer Digestivo (GEMCAD). The study was funded with Grants from Catalan Agency for Management of University and Research Grants (AGAUR) (2014-SGR-474, 2017-SGR-1174 and 2017-SGR-1033), Fundació la Marató de TV3 (201330.10), Instituto de Salud Carlos III (PI13/01728 and PI19/00740) and Fundacion Olga Torres (Modalitat A. 2019/2020) to JM. IMMETCOLS signature is under patent protection (EP21382772.8.) This research was financially supported by GEMCAD and (OR Avelumab was provided) by Merck, S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Darmstadt, Germany, as part of an alliance between the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: https://doi.org/10.13039/100009945) and Pfizer

What remains of the future: sustainability through heritage

Coordinators : Felipe Criado Boado (INCIPIT, CSIC), Blanca Ramírez Barat (CENIM, CSIC).Heritage is increasingly being recognized as a key element for social cohesion, sustainable socioeconomic development and people’s welfare. Resources dedicated to heritage conservation have gone from being considered an expense to being regarded as an investment, with a high revenue. The heritage industry has been an active part of this transformations in recent decades, it has generated employment, contributed to the worldwide expansion of tourism and has become a coveted sign of identity for political communities. Today there is no social or political process that does not use heritage in some way. Hence the actuality of the subject, and the importance of an organization such as the CSIC having research capabilities in this field

Validation of the Back-table Graft Arterial Anastomosis between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications after a 21-year Single-center Experience of Pancreas Transplantation

Objective: To determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplant (PT) recipients. Summary Background Data: The ASMA technique was first described in 1992 by Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature. Methods: Descriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The endpoints were the management of arterial complications and long-term patient and graft survival. Results: ASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%) they comprised: 15 acute thrombosis; 4 stenosis; 1 pseudoaneurysm and 10 diverse chronic arterial complications while in the Y-graft group (n=4, 12.9%) 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2 –182) months the overall graft and patient survival for the whole cohort at 1, 5, and 10 years was 86.7%, 79.5%, 70.5%, and 98.5%, 95.3%, 92.5%, respectively. Conclusions: The ASMA proves to be a safe and more easily reproducible technique and should therefore be considered for first-line back-table reconstruction in the PT population.Peer reviewe

Intermediate Molecular Phenotypes to Identify Genetic Markers of Anthracycline-Induced Cardiotoxicity Risk.

Cardiotoxicity due to anthracyclines (CDA) affects cancer patients, but we cannot predict who may suffer from this complication. CDA is a complex trait with a polygenic component that is mainly unidentified. We propose that levels of intermediate molecular phenotypes (IMPs) in the myocardium associated with histopathological damage could explain CDA susceptibility, so variants of genes encoding these IMPs could identify patients susceptible to this complication. Thus, a genetically heterogeneous cohort of mice (n = 165) generated by backcrossing were treated with doxorubicin and docetaxel. We quantified heart fibrosis using an Ariol slide scanner and intramyocardial levels of IMPs using multiplex bead arrays and QPCR. We identified quantitative trait loci linked to IMPs (ipQTLs) and cdaQTLs via linkage analysis. In three cancer patient cohorts, CDA was quantified using echocardiography or Cardiac Magnetic Resonance. CDA behaves as a complex trait in the mouse cohort. IMP levels in the myocardium were associated with CDA. ipQTLs integrated into genetic models with cdaQTLs account for more CDA phenotypic variation than that explained by cda-QTLs alone. Allelic forms of genes encoding IMPs associated with CDA in mice, including AKT1, MAPK14, MAPK8, STAT3, CAS3, and TP53, are genetic determinants of CDA in patients. Two genetic risk scores for pediatric patients (n = 71) and women with breast cancer (n = 420) were generated using machine-learning Least Absolute Shrinkage and Selection Operator (LASSO) regression. Thus, IMPs associated with heart damage identify genetic markers of CDA risk, thereby allowing more personalized patient management.J.P.L.’s lab is sponsored by Grant PID2020-118527RB-I00 funded by MCIN/AEI/10.13039/ 501100011039; Grant PDC2021-121735-I00 funded by MCIN/AEI/10.13039/501100011039 and by the “European Union Next Generation EU/PRTR”, the Regional Government of Castile and León (CSI144P20). J.P.L. and P.L.S. are supported by the Carlos III Health Institute (PIE14/00066). AGN laboratory and human patients’ studies are supported by an ISCIII project grant (PI18/01242). The Human Genotyping unit is a member of CeGen, PRB3, and is supported by grant PT17/0019 of the PE I + D + i 2013–2016, funded by ISCIII and ERDF. SCLl is supported by MINECO/FEDER research grants (RTI2018-094130-B-100). CH was supported by the Department of Defense (DoD) BCRP, No. BC190820; and the National Cancer Institute (NCI) at the National Institutes of Health (NIH), No. R01CA184476. Lawrence Berkeley National Laboratory (LBNL) is a multi-program national laboratory operated by the University of California for the DOE under contract DE AC02-05CH11231. The Proteomics Unit belongs to ProteoRed, PRB3-ISCIII, supported by grant PT17/0019/0023 of the PE I + D +i, 2017–2020, funded by ISCIII and FEDER. RCC is funded by fellowships from the Spanish Regional Government of Castile and León. NGS is a recipient of an FPU fellowship (MINECO/FEDER). hiPSC-CM studies were funded in part by the “la Caixa” Banking Foundation under the project code HR18-00304 and a Severo Ochoa CNIC Intramural Project (Exp. 12-2016 IGP) to J.J.S