Estudio clínico del linfoma no Hodgkin con 18F-FDG PET

Introducción: La Tomografía por Emisión de Positrones (PET) registra la radiación electromagnética procedente de la aniquilación en la misma línea de respuesta de los positrones con los electrones. Deben alcanzar el detector en un tiempo determinado (ventana de coincidencia) del orden de los nanosegundos. El trazador a utilizar en la fluorodesoxiglucosa que se introduce en la célula tumoral, gracias al aumento de sus procesos glicolíticos, donde sufre atrapamiento celular. Hipótesis: Establecemos como hipótesis de trabajo el que no existe una optimización de la técnica PET en el estudio del Linfoma No Hodgkin (LNH) y por tanto se está dando un manejo insatisfactorio del paciente afecto de esta enfermedad. Una hipótesis que avalamos con tres supuestos: - Por el extenso proceso por el que ha pasado la técnica hasta su competa instauración en la práctica clínica diaria. Por parte de la AETS (Agencia Evaluadora de Tecnologías Sanitarias) hasta haber quedado abierta para toda la oncología sin ningún tipo de restricciones, proceso necesario pero que por otro lado ha limitado la realización de los estudios. - Por la complejidad del linfoma no Hodgkin, la variabilidad de su histología y los distintos comportamientos con respecto a la PET todavía en vías de conocimiento. - Y en tercer lugar por la falta de accesibilidad a la técnica. En el estudio de extensión de la enfermedad pensamos que no es correcto un estadiaje guiado por criterios morfológicos (que podrían estar infra o supraestadificando la enfermedad con los supuestos cambios de manejo que esto supondría) incluyendo aquí que estos mismos criterios no son suficientes para la determinación de enfermedad esplénica y ósea; en la valoración de respuesta precoz y completa la valoración guiada por criterios funcionales que aporta la PET podría condicionar la actuación clínica en el campo de la terapia y serviría como factor pronóstico de la enfermedad. Y en el seguimiento la PET podría aportar datos relevantes en lo que al seguimiento de estos pacientes supone y pensamos podría determinar recaídas de forma precoz dado que los cambios funcionales preceden a los morfológicos. Objetivo: Se plantea como objetivo la valoración de la PET con respecto a las técnicas morfológicas y la identificación de aspectos funcionales como factores pronósticos y para el seguimiento de los mismos. Material y métodos: Se obtiene una muestra de 145 pacientes y se les realiza PET de extensión, de valoración de respuesta precoz y completa y de seguimiento. Resultados: Obtenemos valores de sensibilidad de la PET superior a la TAC en los distintos estadios, con mayor discordancia en los estudio de extensión en estadio I (la PET detecta más enfermedad) y IV (la PET es más sensible en la detección de afectación ósea). Valoramos la PET de respuesta precoz y el SUV máximo calculado en el mismo obteniendo menores cifras de SUV en los que responderán al tratamiento, con respecto a los que no lo harán. Se establece la posible correlación del SUV con otras variables (glucemia, LDH, dosis e IPI) no obteniendo resultados significativos. Se propone un algoritmo con el fin de incluirlo en las guías de manejo de esta enfermedad. Conclusiones: La PET todavía no está completamente implantada en el campo de la actuación clínica del manejo del paciente con LNH. Establecemos un algoritmo para su correcto manejo. La PET es superior a la TAC para el estadiaje y el seguimiento posterior del mismo. Descartamos el uso del galio para la valoración de esta enfermedad. La PET de valoración de respuesta precoz tras dos-tres ciclos podría tener un valor pronóstico de la enfermedad.Our hypothesis is that there isn’t an optimization in the use of PET in patient with non-Hodgkin’s lymphoma, so the management is not as good as should be. Morphological staging isn’t the best method, so we need functional factors that may change clinic and therapeutic decisions. Splenic and bone disease may be evaluated better with PET than CT. Follow up guided by these functional findings may identify early relapse. Aim: to evaluate the use of PET in patient with non-Hodgkin’s lymphoma and to compare this technique with other morphological techniques. To evaluate some functional findings in order to use them as prognostic factors. Material and methods: We evaluate 145 patients (80 male, 65 female). All patients have PET scan studies performed at diagnosis, during treatment (after two or three cycles), at the end of therapy and after six-twelve months. SUVs interim were calculated to compare patients that will achieve complete response with those that will not. Results: PET sensibility was superior to CT in different stages with more disagreement in the first stage where PET shows more disease than CT, and in the fourth stage due to PET is more sensible than CT in detecting bone infiltration. SUVs interim were lower in patients that will achieve complete response after finishing treatment than those that will not. We assess a possible correlation between SUV and other variables (glucose, LDH, IPI) without any significance. We proposed an algorithm for management of these patients to include it in LNH´s guidelines. Conclusions: PET is not yet well established in LNH´s management. We establish an algorithm to perform it. PET is superior to CT to stage and follow these patients. Gallium is ruled out to evaluate this disease. PET interim after two or three cycles may be a good outcome predictor; PET may improve patient management by signalling the need for early therapy change in non-responders to avoid ineffective therapies

Genistein effect on cognition in prodromal Alzheimer's disease patients : the GENIAL clinical trial

Delaying the transition from minimal cognitive impairment to Alzheimer's dementia is a major concern in Alzheimer's disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet effective substances are recommended. There is a need to develop new drugs to delay Alzheimer's dementia. We have taken a nutritional supplement approach with genistein, a chemically defined polyphenol that acts by multimodal specific mechanisms. Our group previously showed that genistein supplementation is effective to treat the double transgenic (APP/PS1) AD animal model

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine