Efectos de la almitrina durante la ventilación unipulmonar en pacientes anestesiados con sevoflurano en cirugia torácica

La ventilación de un solo pulmón (VUP) durante la resección pulmonar es un requisito necesario en este tipo de intervenciones ya que facilita la cirugía. Sin embargo, el pulmón no ventilado queda colapsado produciéndose una alteración severa del cociente ventilación/perfusión (V/Q) y consecuentemente la aparición de un shunt intrapulmonar que disminuye la oxigenación del paciente. Para compensar esta alteración se produce una vasoconstricción pulmonar hipóxica (VPH) que deriva parte del flujo sanguíneo del pulmón no ventilado al pulmón ventilado disminuyendo el shunt intrapulmonar. La VPH puede ser deficiente en un porcentaje alto de pacientes persistiendo la hipoxemia, o bien puede que los tratamientos convencionales durante esta situación no sean efectivos para mejorar el intercambio gaseoso. En estos casos podrían ser útiles tratamientos farmacológicos basados en la redistribución del flujo sanguíneo pulmonar. La almitrina es un vasoconstrictor pulmonar selectivo que potencia la VPH en las zonas no ventiladas pudiendo mejorar el cociente V/Q y por tanto la oxigenación arterial durante la VUP. Los estudios previos a este trabajo que emplearon almitrina se llevaron a cabo sin anestésicos halogenados, ya que estos son vasodilatadores generales e inhiben la VPH pudiendo contrarrestar el efecto de almitrina. Hasta el momento no existía ningún ensayo estudio clínico o experimental que evaluara la asociación de almitrina y anestésicos halogenados, lo que reforzaba el interés de este tema. Para ello se diseñó un ensayo clínico prospectivo, aleatorizado, a doble ciego y controlado con placebo y se seleccionaron pacientes programados para cirugía torácica que precisaban toracotomía y ventilación unipulmonar. Los pacientes fueron asignados aleatoriamente para recibir almitrina 16 micg/kg/min i.v. o placebo (suero salino 0,9% i.v.) durante la VUP. El anestésico general empleado fue el sevoflurano inhalado a dosis acorde con la edad del paciente. Se registraron de forma continua variables respiratorias y hemodinámicas durante todo el estudio y mediante la inserción de un catéter de arteria pulmonar. Se reclutaron 40 pacientes de los cuales 30 fueron analizados (15 pacientes por grupo). Durante la VUP, la PaO2 y el shunt intrapulmonar empeoraron en todos los pacientes, sin diferencias significativas entre los grupos. A los 30 min de la VUP, la PaO2 fue 184 ± 67 mmHg en el grupo almitrina y 145 ± 56 mmHg en el grupo de placebo, mientras que la fracción de shunt fue 31 ± 6 y 36 ± 13%, respectivamente. Ni la PaO2 ni el shunt fueron diferentes entre los grupos. En cambio, la presión arterial pulmonar media fue mayor en el grupo almitrina (31 ± 5 vs 24 ± 5 mmHg, p 0,001). La conclusión principal del estudio fue que durante la anestesia con sevoflurano a tórax abierto y en ventilación unipulmonar, la almitrina no mejoró la oxigenación arterial y aumentó de la presión de la arteria pulmonar. Por tanto, la combinación de ambos fármacos debe ser evitada.Almitrine enhances hypoxic pulmonary vasoconstriction (HPV) and can improve hypoxemia related to one-lung ventilation (OLV). Studies using almitrine have been conducted without inhaled anesthetics because they could inhibit HPV, counteracting the effect of almitrine. This hypothesis, however, has not been confirmed. Our aim was to evaluate whether almitrine could improve oxygenation when administered during OLV with sevoflurane anesthesia. We conducted a prospective, randomized, double-blind, placebo-controlled trial in patients undergoing elective open-chest thoracic surgery. Patients were randomly assigned to receive almitrine 16 micg/kg/min or placebo during OLV. Respiratory and hemodynamic variables were measured during two-lung ventilation and during open-chest OLV by a pulmonary artery catheter. Forty adult patients were elected and thirty of that completed the study and were analyzed (fifteen patients per group). During OLV, PaO2 and shunt fraction worsened in all patients without significant differences between groups. At 30-min OLV, PaO2 was 184 ± 67 mmHg in the almitrine group and 145 ± 56 mmHg in the placebo group, while shunt fraction were 31 ± 6 and 36 ± 13%, respectively. PaO2 and shunt fraction were not difference between the groups. Mean pulmonary artery pressure was higher in the almitrine group (31 ± 5 v 24 ± 5 mmHg, p 0.001). During anesthesia with sevoflurane for open-chest OLV, almitrine failed to improve oxygenation and increased pulmonary artery pressure. The combination of sevoflurane and almitrine should, therefore, be avoided

Expression patterns and genetic variation of the ovine skeletal muscle transcriptome of sheep from five Spanish meat breeds

The goal of the current study is to analyse the gene expression profile of the ovine skeletal muscle as well as to characterize the genetic variation of transcripts expressed in such tissue. This aim has been achieved by sequencing the longissimus dorsi transcriptomes of 50 sheep distributed in five pools representing the Canaria de Pelo, Roja Mallorquina, Gallega, Xisqueta and Ripollesa Spanish autochthonous breeds. Approximately, 363 million reads per pool have been produced and 71.9-82.9% have been successfully mapped to the ovine genome in a paired-end mode (2 X 75 bp). The 200 most expressed muscle transcripts (-1% of the total transcript count) account for 51% (Canaria de Pelo) to 67% (Gallega) of the total ovine skeletal muscle mRNA expression. These highly expressed genes play key roles in pathways related with striated muscle contraction, gluconeogenesis, glycolysis, citric acid cycle and respiratory electron transport. RNA-Sequencing of muscle transcripts has also revealed that -72% of the SNPs detected with this approach are shared by at least two pools, and 10% of them segregate in the five pools under analysis. Most of the substitutions detected by RNA-Seq are synonymous or missense and only a minority are predicted to have consequences on protein function

Quality of Life and Autonomy in Patients with Intermittent Bladder Catheterization Trained by Specialized Nurses

Intermittent bladder catheterization (IBC) involves regular urine draining using a catheter, which is removed immediately after urinary elimination. It allows for the patient's urological health to be managed and their renal function to be preserved, and it promotes autonomy. Compliance with the prescribed number of daily catheterizations, which must be conducted by the patient, and infection prevention measures are crucial. To identify the patients requiring IBC, and to determine their adherence (whether they followed the prescribed guidelines and their difficulty in carrying out the procedure, as well as to assess how the IBC influences their quality of life and state of mind after receiving self-care training from a specialized nurse), we carried out a prospective, multicenter observational study in 24 Spanish hospitals with one month of monitoring and a sample of 99 patients. The sources of information were the patients' clinical records, the King's Health Questionnaire, the Mini-Mental State Examination (MMSE), and the hospital anxiety and depression scale (HADS). Descriptive and bivariate statistics were used to analyses the paired data. After recruitment (n = 99), 79 patients completed the questionnaire at a mean age of 35.2 years (SD = 20.5 years). In total, 53.5% (53) of the sample consisted of men and 32.3% (32) had neurological damage as the reason for prescription; 67% (67.7) performed self-catheterization and 86.7% adhered to the IBC. After one month of monitoring, a statistically significant improvement in quality of life was observed in all criteria, with the exception of personal relationships (p < 0.005), as well as an improvement in anxiety and depression levels (p < 0.001). Patients who require IBC show good adherence to the IBC with a significant percentage of self-catheterization. After one month of IBC, a significant improvement in the patients' quality of life and mood was observed. These results could be attributed to adequate patient training and adequate personalization of the IBC materials by the specialized nurses

Clinical and Sociodemographic Determinants of Adherence to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Recommendations in Breast Cancer Survivors-Health-EpiGEICAM Study

Breast cancer (BC) survivors are advised to follow the WCRF/AICR cancer prevention recommendations, given their high risk of developing a second tumour. We aimed to explore compliance with these recommendations in BC survivors and to identify potentially associated clinical and sociodemographic factors. A total of 420 BC survivors, aged 31-80, was recruited from 16 Spanish hospitals. Epidemiological, dietary and physical activity information was collected through questionnaires. A 7-item score to measure compliance with the recommendations was built according to the 2018 WCRF/AICR scoring criteria. Standardized prevalences and standardized prevalence ratios of moderate and high compliance across participant characteristics were estimated using multinomial and binary logistic regression models. The mean score was 3.9 (SD: 1.0) out of 7 points. Recommendations with the worst adherence were those of limiting consumption of red/processed meats (12% of compliance, 95% CI: 8.2-15.0) and high fibre intake (22% of compliance, 95% CI: 17.6-27.0), while the best compliance was observed for the consumption of fruits and vegetables (73% of compliance, 95% CI: 69.2-77.7). Overall, adherence was worse in women with university education and in those with first-degree relatives with BC. This information may be of interest to design and implement personalized preventive measures adapted to the characteristics of these patients.This research was funded by the Fundación Científica Asociación Española Contra el Cancer (AECC) (Scientific Foundation of the Spanish Association against Cancer 2016). This article presents independent research. The views expressed are those of the authors and not necessarily those of the Carlos III Institute of Health.S

Competencias cívico-sociales, inclusión y calidad de vida de las personas mayores. Una colaboración europea en innovación

Depto. de Estudios EducativosFac. de EducaciónFALSEsubmitte

Evolution of Quality of Life and Treatment Adherence after One Year of Intermittent Bladder Catheterisation in Functional Urology Unit Patients

Objective: To determine patient difficulties and concerns when performing IBC (Intermittent Bladder Catheterisation), as well as the evolution of adherence, quality of life, and emotional state of patients one year after starting IBC. Method: A prospective, observational, multicentre study conducted in 20 Spanish hospitals with a one-year follow-up. Data sources were patient records and the King's Health Questionnaire on quality of life, the Mini-Mental State Examination (MMSE), and the Hospital Anxiety and Depression Scale (HADS). Perceived adherence was measured using the ICAS (Intermittent Catheterization Adherence Scale) and perceived difficulties with IBC were assessed using the ICDQ (Intermittent Catheterization Difficulty Questionnaire). For data analysis, descriptive and bivariate statistics were performed for paired data at three points in time (T1: one month, T2: three months, T3: one year). Results: A total of 134 subjects initially participated in the study (T0), becoming 104 subjects at T1, 91 at T2, and 88 at T3, with a mean age of 39 years (standard deviation = 22.16 years). Actual IBC adherence ranged from 84.8% at T1 to 84.1% at T3. After one year of follow-up, a statistically significant improvement in quality of life (p <= 0.05) was observed in all dimensions with the exception of personal relationships. However, there were no changes in the levels of anxiety (p = 0.190) or depression (p = 0.682) at T3 compared to T0. Conclusions: Patients requiring IBC exhibit good treatment adherence, with a significant proportion of them performing self-catheterisation. After one year of IBC, a significant improvement in quality of life was noted, albeit with a significant impact on their daily lives and their personal and social relationships. Patient support programmes could be implemented to improve their ability to cope with difficulties and thus enhance both their quality of life and the maintenance of their adherence

Competencias cívico-sociales, inclusión y calidad de vida de las personas mayores. Una colaboración europea en innovación (II)

Este proyecto se centra en el desarrollo de competencias cívico-sociales y el fomento de la educación para la salud en situaciones de crisis sanitaria como la provocada por la COVID-19. Participa estudiantes de grado, de máster y personas mayores

Biomarkers Associated with Regorafenib First-Line Treatment Benefits in Metastatic Colorectal Cancer Patients: REFRAME Molecular Study

© 2021 by the authors.First-line treatment with regorafenib in frail metastatic colorectal cancer (mCRC) patients has shown some benefit. To accurately identify such patients before treatment, we studied blood biomarkers and primary tumor molecules. We unveiled serum microRNAs (miRNAs), single-nucleotide polymorphisms (SNPs) in angiogenic-related genes, and Notch 1 expression as biomarkers associated with response or toxicity. MicroRNA array profiling and genotyping of selected SNPs were performed in the blood of fragile mCRC patients treated with regorafenib. Notch 1 and CRC-associated miRNA expression was also analyzed in tumors. High levels of miR-185-5p in serum, rs7993418 in the vascular endothelial growth factor receptor 1 (VEGFR1) gene, and Notch 1 expression in biopsies were associated with a favorable response to treatment. Serum levels of miR-126-3p and miR-152-3p and tumor expression of miR-92a-1-5p were associated with treatment toxicity, particularly interesting in patients exhibiting comorbidities, and high levels of miR-362-3p were associated with asthenia. Additionally, several miRNAs were associated with the presence of metastasis, local recurrence, and peritoneal metastasis. Besides, miRNAs determined in primary tumors were associated with tumor-node-metastasis (TNM) staging. The rs2305948 and rs699947 SNPs in VEGFR2 and VEGFA, respectively, were markers of poor prognosis correlating with locoregional relapse, a higher N stage, and metastatic shedding. In conclusion, VEGF and VEGFR SNPs, miRNAs, and Notch 1 levels are potential useful biomarkers for the management of advanced CRC under regorafenib treatment.Financial support for this research was provided by Bayer Hispania, which had no role in the design of the study; the collection, analysis, and interpretation of data; and the writing of the manuscript.Peer reviewe

Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol

Introduction In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson's disease patients (Parkinson's Holter). The effectiveness of these monitoring devices for improving clinical control is not known. Methods and analysis This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson?s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months. The primary outcome is the efficiency of the Parkinson?s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor?patient contacts will be analysed. The noninferiority of the Parkinson's Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective. Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson's Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.Funding This work is supported by AbbVie S.L.U, the Instituto de Salud Carlos III [DTS17/00195] and the European Fund for Regional Development, 'A way to make Europe'

Safety and preliminary efficacy on cognitive performance and adaptive functionality of epigallocatechin gallate (EGCG) in children with Down syndrome. A randomized phase Ib clinical trial (PERSEUS study)

Purpose: Although some caregivers are using epigallocatechin gallate (EGCG) off label in hopes of improving cognition in young adults with Down syndrome (DS), nothing is known about its safety, tolerability, and efficacy in the DS pediatric population. We aimed to evaluate safety and tolerability of a dietary supplement containing EGCG and if EGCG improves cognitive and functional performance. Methods: A total of 73 children with DS (aged 6-12 years) were randomized. Participants received 0.5% EGCG (10 mg/kg daily dose) or placebo for 6 months with 3 months follow up after treatment discontinuation. Results: In total, 72 children were treated and 66 completed the study. A total of 38 participants were included in the EGCG group and 35 in the placebo group. Of 72 treated participants, 62 (86%) had 229 treatment-emergent adverse events (AEs). Of 37 participants in the EGCG group, 13 (35%) had 18 drug-related treatment-emergent AEs and 12 of 35 (34%) from the placebo group had 22 events. In the EGCG group, neither severe AEs nor increase in the incidence of AEs related to safety biomarkers were observed. Cognition and functionality were not improved compared with placebo. Secondary efficacy outcomes in girls point to a need for future work. Conclusion: The use of EGCG is safe and well-tolerated in children with DS, but efficacy results do not support its use in this population. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of American College of Medical Genetics and Genomics