Las pruebas diagnósticas desde la perspéctiva poblacional: epidemiología de la enfermedad renal crónica y la resistencia a la insulina

La definición de estados patológicos a partir de puntos de corte en la distribución de marcadores biológicos continuos está sujeta a importantes fuentes de variabilidad y de sesgo. Un adecuado estudio de fiabilidad y precisión del método utilizado en la estimación del biomarcador es imprescindible para la correcta clasificación diagnóstica de los individuos. En la presente Tesis Doctoral se analiza el comportamiento poblacional de biomarcadores utilizados en el diagnostico de dos trastornos prevalentes de base inflamatoria como son la Enfermedad Renal Crónica, ERC, y la Resistencia a la Insulina, RI en una muestra aleatoria (n 2746) de la población española mayor de 20 años, estratificada por edad y sexo. Existe una importante variabilidad en los criterios utilizados para clasificación diagnóstica tanto de deterioro de la función renal como de resistencia a la insulina. La prevalencia poblacional en España de ERC es 9.16%. Se propone un instrumento de clasificación de riesgo de deterioro de ERC para su empleo en practica clínica. Se establece la distribución percentil de HOMA-I, proponiéndose el valor de 2 como punto de corte para identificar individuos con mayor riesgo cardiometabólico. Previamente a la realización del proyecto objeto de esta Tesis Doctoral, no se conocía la prevalencia de ERC ni la distribución de valores de HOMA-IR en población general en España, por lo que los resultados pueden contribuir a un precoz diagnóstico y correcta clasificación del riesgo de eventos clínicamente relevantes en la población general. Además contribuyen a una utilización más segura y eficiente de los dispositivos sanitarios

Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors

BACKGROUND: The aim of this study was to ascertain the incidence of and the risk factors associated with morbidity in laparoscopy performed on patients with cervical cancer and endometrial cancer. METHODS: This was an observational study of a cohort of 128 women, 89 with endometrial cancer and 39 with cervical cancer from January 2000 to December 2011. We used the Student's t-test or the Mann-Whitney U test for continuous variables, and the Chi-square or Fisher's exact test for categorical variables. RESULTS: Complications were found in 44 patients (34.4%). After a multivariate analysis, among the risk factors associated with the presence of complications as the only type of surgery was found to be statistically significant (p = 0.043), more frequent in the most complex procedures such as Wertheim operation, trachelectomy, and para-aortic lymphadenectomy. Type of surgery (p = 0.003) and tumour type (p = 0.003) were risk factors associated with conversion to laparotomy. It was more frequent among the most complex procedures and cervical cancer cases. Regarding the need for transfusion, significant differences were observed in terms of surgery duration (p < 0.001), more frequent in longer surgery. CONCLUSION: Morbidity in laparoscopic surgical oncology is related to the surgery complexity, where the basal characteristics of the patient are not a factor of influence in the development of complications

The role of p21Waf 1/CIP1 as a Cip/Kip type cell-cycle regulator in oral squamous cell carcinoma: review

Oral Squamous Cell Carcinoma (OSCC) is biologically characterized by the accumulation of multiple genetic and molecular alterations that end up clinically characterized as a malignant neoplasm through a phenomenon known as multistep. The members of the Cip/Kip family, specifically p21 Waf 1/CIP1 , are responsible for cell cycle control, blocking the transition from phase G1 to phase S. We made a search of articles of peer-reviewed Journals in PubMed/ Medline, crossing the keywords. The goal of this paper is to determine the relationship between p21 Waf 1/ CIP1 expression and several clinical and pathological aspects of OSCC, their relationship with p53 and HPV, as well as genetic alterations in their expression pattern, their use as a prognosis market in the evolution of precancer - ous lesions and their roles in anticancer treatments. The results of p21 WA F1/C I P1 expression in OSCC showed mixed results in terms of positivity/negativity throughout different studies. It seems that, although p21 Waf 1/CIP1 expression is controlled in a p53-dependent manner, coexpression of both in OSCC is not intrinsically related. Although the presence of HPV viral oncoproteins increases p21 Waf 1/CIP1 levels, the small number of studies, have forced us to disregard the hypothesis that HPV infected lesions that present better prognosis are due to a p21 Waf 1/CIP1 -dependent control. The role of p21 WA F1/C I P1 as cell-cycle regulator has been well described; however, its relationship to OSCC, the clinical and pathological variables of tumors, HPV and different treatments are not entirely clear. Thus, it would be very interesting to pursue further study of this protein, which may have a significant value for the diagnosis, prog nosis and therapy of this type of tumors

Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study

Background: Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. Methods: It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. Results: In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. Conclusions: The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women

Obesity and renal function. Data from the epidemiological study: Prevalence of chronic renal disease in Spain. EPIRCE Study.

También en inglésCon ocasión del Día Mundial del Riñón 2017 bajo el lema «Obesidad y enfermedad renal», quisiéramos aprovechar esta ocasión para mostrar los datos epidemiológicos del estudio sobre la epidemiología de la enfermedad renal crónica en España (EPIRCE)S

Quantitative determination of c-myc facilitates the assessment of prognosis of OSCC patients

Myc genes are a family of proto-oncogenes whose proteins are implicated in the regulation of cell proliferation, differentiation and apoptosis, and in regulating the activity of genes involved in cell division. The aim of the present study was to establish a quantitative description of the expression of c-myc and evaluate its relationship with other clinical and prognostic factors, as well as to establish a multivariate survival prediction model. This is a retrospective study of 68 patients diagnosed with oral squamous cell carcinoma (OSCC). We constructed a tissue microarray for investigating the expression of c-myc by immunohistochemistry. Statistical analyses were carried out, and a multivariate model that predicts survival was established. The average expression of c-myc was 50.32 (SD, 26.05) with a range from 6.60 to 99.48; similar for initial and advanced tumor stages. Non-smoking patients had higher levels of c-myc, showing statistically significant differences (Kruskal-Wallis chi2=5.975; p=0.05). We found no statistically significant relationship between the quantitative expression of c-myc and any other clinical or pathological parameters. For each unit of increase of c-myc, the risk increased by 1.15 (p<0.001; HR, 1.150; 95% CI, 1062-1245). Further study of this protein, which may have a significant diagnostic, prognostic and therapeutic value is warranted. Its determination can be valuable when used together with other markers to assess the prognosis of OSCC patients

Moderación de la Mesa redonda: Cómo abordar los retos del RRI en los IIS. Encuentro RRI en España y su modelo de incorporación en los institutos de investigación sanitaria. Universidad Internacional Menéndez Pelayo del 1 al 3 de julio de 2019

IIS acreditados. Modelo de iis y dimensiones de la guia de evaluacion: para cumplir la misión de producir un impacto de mejora en el paciente y la sociedad, con la estrategia de asegurar los recursos, capacidades y rendimiento científico. El IIS tiene una gobernanza eficaz. Programa de institutos de investigación sanitaria. PEASIIS. ¿Dónde estamos? ¿Cuales son las dificultades en este proceso? Propuestas para avanzarN

Ciencia Abierta: implementación desde la visión del Instituto de Salud Carlos III

La subdirectora, Pilar Gayoso, nos habla de la Ciencia Abierta, qué es y en qué contribuye. La Ciencia Abierta aumenta a transparencia y fomenta la participación y la cooperación, favore la democratiación y sostenibilidad de los sitemas de I+D+i, promueve la incorporación de actores no académicos al proceso investigador. Se exponen las 6 dimensiones de la Ciencia Abierta y cómo se están implementando desde la acción intramural y extramural en el Instituto de Salud Carlos III (ISCIII).N

Conclusiones y cierre de jornadas

Conclusiones y cierre de las Jornada de RIs en Ciencias Biomédicas “El papel de las RIs en medicina personalizada” por parte de Pilar Gayoso (Subdirectora General de Terapia Celular y Medicina Regenerativa del ISCIII).N