Intervención desde Terapia Ocupacional en un caso clínico de adulto con Síndrome de Down para la mejora del desempeño y autonomía a través de la gimnasia rítmica adaptada

El síndrome de Down se considera una alteración congénita ligada a latriplicación total o parcial del cromosoma 21, que origina discapacidadintelectual, retraso de crecimiento y produce determinadas anomalías físicas.Esto repercute en el funcionamiento ocupacional, social y personal,ocasionando problemas de desempeño en la vida cotidiana.La finalidad de este trabajo es identificar las limitaciones del desempeño quese producen en un adulto con síndrome de Down, con el objetivo de elaboraruna intervención de Terapia Ocupacional. Esta se llevará a cabo a través deentrenamientos pautados de gimnasia rítmica adaptada, la cual permita eldesarrollo de las habilidades necesarias para el incremento de su desempeñoy autonomía.El deporte adaptado es una actividad físico-deportiva con una serie decaracterísticas, entre ellas la adaptación de las reglas deportivas, y cuyoobjetivo principal es mejorar la calidad de vida, además de la inclusión en lasociedad. Por ello se ha decido usarlo como método de intervención.El trabajo se enmarca dentro del Modelo de Ocupación Humana, que aparecereflejado en su transcurso a través de los métodos de evaluación ytratamiento, enfocándose en las necesidades específicas que tiene la personapara el incremento de la participación y autonomía en las actividades de lavida diaria.Para ello se plantean cinco evaluaciones y una intervención la cual consta deseis sesiones a través de las que se obtienen unos resultados hipotéticos quecumplimentan los objetivos específicos del caso clínico.<br /

First evidence of microplastics isolated in European citizens’ lower airway

Microplastics (MPs) have been detected in all environmental locations, including the atmosphere. However, few studies have investigated the presence of airborne MPs in the human respiratory system. Our research purpose was to investigate these pollutants in the lower human airways of 44 adult European citizens, using bronchoalveolar lavage fluid (BALF) collection as a minimally invasive method, that enables the detection of these pollutants in living patients. We studied the relationship between the patients’ life habits and physiological parameters, based on background information and medical and occupational history, and the concentration of MPs isolated from their respiratory systems. Our results indicate that most MPs were in the form of microfibers (MFs) (97.06%), with an average concentration of 9.18 ± 2.45 items/100 mL BALF, and only 5.88% (0.57 ± 0.27 items/100 mL BALF) were particulate MPs, without a significant relationship with environmental, physiological, or clinical factors. The average size was 1.73 ± 0.15 mm, with the longest dimension (9.96 mm) corresponding to a polyacrylic fiber. Taken together, the results demonstrated the occurrence of MPs in the lower human airway, although more studies are necessary to elucidate the negative effects these pollutants could induce in the human respiratory system and its associated diseases.We wish to express our sincere appreciation to José V. Navarro for safe BALF samples transportation form HGUE to UPCT and back, as well as to the HGUE Pneumology Service, particularly to Sandra Ruiz, Lucía Zamora, Maria José Soler, Asunción Guillén, and Carmen María Vidal for their help in BALF samples collection and investigation support. This work was finacially supported by grant 20268/FPI/17 from Fundación Séneca assigned to Dra. Sonia Olmos, as well as by Project Number 6627/21IQA signed between FISABIO and Technical University of Cartagena, with financial help from Sociedad Valenciana de Neumología

Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?

Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2.70, 95% CI 2.26-3.23), age >70 years (OR 1.15, 95% CI 1.06-1.24), immobility (OR 2.06, 95% CI 1.93-2.19), renal insufficiency (OR 2.42, 95% CI 2.15-2.71) and anemia (OR 1.75, 95% CI 1.65-1.87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1.83, 95% CI 1.64-2.06), immobility (OR 1.51, 95% CI 1.30-1.76) and metastases (OR 3.22, 95% CI 2.87-3.61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision

Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever

Background: Large-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices. Methods: We retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. Results: We included 52 patients (median age, 75 y IQR: 64-83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13-22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0-2). Conclusion: This preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices

Comparisons between Upper and Lower Extremity Deep Vein Thrombosis : A Review of the RIETE Registry

Publisher Copyright: © SAGE Publications.Background: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). Methods: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. Results: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. Conclusion: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.publishersversionPeer reviewe

Therapeutic targeting of tumor growth and angiogenesis with a novel anti-S100A4 monoclonal antibody

S100A4, a member of the S100 calcium-binding protein family secreted by tumor and stromal cells, supports tumorigenesis by stimulating angiogenesis. We demonstrated that S100A4 synergizes with vascular endothelial growth factor (VEGF), via the RAGE receptor, in promoting endothelial cell migration by increasing KDR expression and MMP-9 activity. In vivo overexpression of S100A4 led to a significant increase in tumor growth and vascularization in a human melanoma xenograft M21 model. Conversely, when silencing S100A4 by shRNA technology, a dramatic decrease in tumor development of the pancreatic MiaPACA-2 cell line was observed. Based on these results we developed 5C3, a neutralizing monoclonal antibody against S100A4. This antibody abolished endothelial cell migration, tumor growth and angiogenesis in immunodeficient mouse xenograft models of MiaPACA-2 and M21-S100A4 cells. It is concluded that extracellular S100A4 inhibition is an attractive approach for the treatment of human cancer

Fragilidad en pacientes con Enfermedad renal crónica avanzada en tratamiento renal conservador

Antecedentes: La prevalencia de Enfermedad Renal Crónica es superior al 20% en mayores 64 an~os y se asocia con importante morbimortalidad. En ellos el Tratamiento Renal Conservador es una opción legítima de tratamiento. En los últimos an~os la fragilidad se ha convertido en un campo de investigación en mayores y debe ser tenida en cuenta en pacientes ancianos con Enfermedad Renal. Objetivos: Determinar número de pacientes frágiles en Tratamiento Renal Conservador según Escala FRAIL. Determinar si la fragilidad se relaciona con la comorbilidad y la situación funcional. Material y Método: Seleccionamos en consulta de Enfermedad Renal Crónica Avanzada a pacientes mayores de 75 an~os orientados a Tratamiento Renal Conservador. Recogemos Criterios de Fragilidad de Fraid, índice de Comorbilidad de Charlson, Escala de Lawton y Brody, Evaluación para la capacidad de la marcha de FAC e índice de Barthel. Resultados: Se incluyen 80 pacientes 51,2% varones con edad media 84,7 ± 4 an~os y eFG 16,5 ml/min/1,73m2. El 51,2% cumplen criterios de fragilidad. No encontramos diferencias significativas en la escala Charlson entre los pacientes frágiles (8,61 ± 1,28) y no frágiles (8,39 ± 1,36) p= 0,55. La escala de Lawton y Brody y la escala FAC de la marcha se relacionaron con fragilidad (p = 0.001, p = 0.018 respectivamente). Conclusiones: El 51,2% de los pacientes Tratamiento Renal Conservador cumplen criterios de fragilidad por lo que consideramos esta escala válida como herramienta en la toma de decisiones. La fragilidad no se correlaciona con el índice de Charlson: la patología valorada por este test puede no ser sensible a la hora de estudiar esta situación clínica. Encontramos buena correlación con los test que valoran la situación funcional, tanto en la escala de actividades instrumentales de Lawton Brody (útil para detectar primeros grados de deterioro) y para la escala FAC de la marcha

Adipose-derived mesenchymal stromal cells for the treatment of patients with severe SARS-CoV-2 pneumonia requiring mechanical ventilation. A proof of concept study

Background: Identification of effective treatments in severe cases of COVID-19 requiring mechanical ventilation represents an unmet medical need. Our aim was to determine whether the administration of adipose-tissue derived mesenchymal stromal cells (AT-MSC) is safe and potentially useful in these patients. Methods: Thirteen COVID-19 adult patients under invasive mechanical ventilation who had received previous antiviral and/or anti-inflammatory treatments (including steroids, lopinavir/ritonavir, hydroxychloroquine and/or tocilizumab, among others) were treated with allogeneic AT-MSC. Ten patients received two doses, with the second dose administered a median of 3 days (interquartile range-IQR- 1 day) after the first one. Two patients received a single dose and another patient received 3 doses. Median number of cells per dose was 0.98 × 106 (IQR 0.50 × 106) AT-MSC/kg of recipient's body weight. Potential adverse effects related to cell infusion and clinical outcome were assessed. Additional parameters analyzed included changes in imaging, analytical and inflammatory parameters. Findings: First dose of AT-MSC was administered at a median of 7 days (IQR 12 days) after mechanical ventilation. No adverse events were related to cell therapy. With a median follow-up of 16 days (IQR 9 days) after the first dose, clinical improvement was observed in nine patients (70%). Seven patients were extubated and discharged from ICU while four patients remained intubated (two with an improvement in their ventilatory and radiological parameters and two in stable condition). Two patients died (one due to massive gastrointestinal bleeding unrelated to MSC therapy). Treatment with AT-MSC was followed by a decrease in inflammatory parameters (reduction in C-reactive protein, IL-6, ferritin, LDH and d-dimer) as well as an increase in lymphocytes, particularly in those patients with clinical improvement. Interpretation: Treatment with intravenous administration of AT-MSC in 13 severe COVID-19 pneumonia under mechanical ventilation in a small case series did not induce significant adverse events and was followed by clinical and biological improvement in most subjects. Funding: None.We would like to acknowledge the Instituto de Salud Carlos III (ISCIII) through the project “RD16/0011: Red de Terapia Celular”, from the sub-program RETICS, integrated in the “Plan Estatal de I+D+I 2013-2016” and co-financed by the European Regional Development Fund “A way to make Europe”, groups RD16/0011/0001, -/0002, -/005, -/0013, -/0015, -/0029), the Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Spain and AvanCell-CM (Red de Investigación de Terapia Celular de la Comunidad de Madrid, Spain), for supporting some personnel and networking activities

Therapeutic targeting of HER2–CB2R heteromers in HER2-positive breast cancer

There is a subtype of breast cancer characterized by the overexpression of the oncogene HER2. Although most patients with this diagnosis benefit from HER2-targeted treatments, some do not respond to these therapies and others develop resistance with time. New tools are therefore warranted for the treatment of this patient population, and for early identification of those individuals at a higher risk of developing innate or acquired resistance to current treatments. Here, we show that HER2 forms heteromer complexes with the cannabinoid receptor CB2R, the expression of these structures correlates with poor patient prognosis, and their disruption promotes antitumor responses. Collectively, our results support HER2–CB2R heteromers as new therapeutic targets and prognostic tools in HER2+ breast cancer