Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia

Background: Although insight in schizophrenia spectrum disorders (SSD) has been associated with positive outcomes, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight suggests that metacognitive training (MCT) may improve insight and clinical outcomes in SSD, although this remains to be established. Methods: This single-center, assessor-blind, parallel-group, randomised clinical trial (RCT) aims to investigate the efficacy of MCT for improving insight (primary outcome), including clinical and cognitive insight, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) and the Beck Cognitive Scale (BCIS), respectively, in (at least) n = 126 outpatients with SSD at three points in time: i) at baseline (T0); ii) after treatment (T1) and iii) at 1-year follow-up (T2). SSD patients receiving MCT and controls attending a non-intervention support group will be compared on insight level changes and several clinical and cognitive secondary outcomes at T1 and T2, whilst adjusting for baseline data. Ecological momentary assessment (EMA) will be piloted to assess functioning in a subsample of participants. Discussion: To the best of our knowledge, this will be the first RCT testing the effect of group MCT on multiple insight dimensions (as primary outcome) in a sample of unselected patients with SSD, including several secondary outcomes of clinical relevance, namely symptom severity, functioning, which will also be evaluated with EMA, hospitalizations and suicidal behaviour.This study was supported by the Universidad Autónoma de Madrid and European Union via the Intertalentum Project Grant-Marie Skłodowska Curie Actions (GA 713366) to JDLM who is the Princiapl Investigator. This grant therefore funds both JDLM’s salary and the consumable expenses related to the study. JDLM, VGRR, ASEM, MLBE, LMI, LML, SSA, AAR and EBG’s salaries come from the Hospital Universitario Fundación Jiménez Díaz, where this study is currently being carried out, which therefore provides the necessary institutional/departmental support for its development. Additional departmental support concerning the use of Ecological Momentary Assessment (see Methods section, page 11 -last paragraph- and page 12 –first paragraph-, for details) is provided by the Instituto de Salud Carlos III (Madrid, Spain) (ISCIII PI16/01852) and the Madrid Regional Government (Madrid, Spain) (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM). ASD acknowledges funding supports from University College London, which covers his salar

Analysis of the mutational landscape of classic Hodgkin lymphoma identifies disease heterogeneity and potential therapeutic targets

Defining the mutational landscape of classic Hodgkin lymphoma is still a major research goal. New targeted next-generation sequencing (NGS) techniques may identify pathogenic mechanisms and new therapeutic opportunities related to this disease. We describe the mutational profile of a series of 57 cHL cases, enriched in Hodgkin and Reed-Sternberg (HRS) cells. Overall, the results confirm the presence of strong genomic heterogeneity. However, several variants were consistently detected in genes related to relevant signaling pathways, such as GM-CSF/IL-3, CBP/EP300, JAK/STAT, NF-kappaB, and numerous variants of genes affecting the B-cell receptor (BCR) pathway, such as BTK, CARD11, BCL10, among others. This unexpectedly high prevalence of mutations affecting the BCR pathway suggests some requirement for active BCR signaling for cHL cell viability. Additionally, incubation of a panel of cHL cellular models with selective BTK inhibitors in vitro constrains cell proliferation and causes cell death. Our results indicate new pathogenic mechanisms and therapeutic opportunities in this disease

Innovaemprende

El proyecto INNOVAEMPRENDE se ha desarrollado en el contexto del Máster en Biotecnología Industrial y Ambiental, dentro de la asignatura del módulo fundamental “Organización y Seguridad Industrial” con el objetivo general de contribuir a la formación de los alumnos del Máster en la cultura del emprendimiento, favoreciendo la conciencia del valor del conocimiento dentro del ámbito de la biotecnología, sector en crecimiento que, en el contexto global de una economía cada vez más fundamentada en la I+D+i, ha demostrado su importancia e impacto económico, siendo uno de los nuevos yacimientos de riqueza económica y de empleo

Evolución del tratamiento del dolor en la última década, 2008-2018

This article summarizes the advances made in the Treatment of Color, the last decade, the perspective of the specialists in Anesthesiology and Resuscitation of the efforts in the Color Treatment Units. The characteristics of the treatment are described, the characteristics of each type of process and its viability are described, real, therapeutic. Emphasis is placed on the concepts of color training for health personnel as a measure of the decrease in the prevalence of pain in the population.En este artículo se resumen los avances realizados en el Tratamiento del Dolor, durante la última década, desde la perspectiva de los especialistas en Anestesiología y Reanimación que trabajan en Unidades de Tratamiento del Dolor. Se describen las distintas modalidades de tratamiento enfocadas a las distintas causas del fenómeno dolor, describiendo las características clínicas de cada tipo de proceso y su viabilidad, real, terapéutica. Se enfatiza en conceptos de formación en Dolor al personal Sanitario como medida de disminución de la prevalencia del fenómeno dolor en la población

Dolor en hematología clínica

Objective: The present review aims to provide an update on the pain management and/ or palliative care provided to patients with hematological disease, whether malignant or not. In hematology, several entities may require alleviation of pain or other distressing symptoms. It is generally acknowledged that only 5% of patients with malignant hematological disease experience pain, while this percentage ranges from 70 to 80% in other types of cancer (lung, prostate and breast, which frequently lead to bone metastases). Pain may be caused by the disease itself, due to leukemic or myelomatoid infiltration, bone destruction (75-80%), the therapies administered (15-19%), mucositis in neutropenic patients, methotrexate, thalidomide (paresthesias), bortezomib (Velcade®), imatinib (Glivec®), bone marrow transplantation, neurotoxicity of cytostatic agents (vincristine, cisplatin) and radiotherapy. Pain is unrelated to malignant disease in 3-5% of patients (muscular weakness and myalgia, decubitus ulcers, postherpetic neuralgia, diagnostic procedures). Classically, sickle cell disease, which is not a prevalent disease in Spain, is included among the benign hematological diseases that produce pain exacerbations. According to our experience, 10 years after our previous review on the topic, the percentage of hematological patients requiring specific management of "pain" (understood as "global pain" = physical, emotional, spiritual, social, occupational, familial...) can increase if, in addition to patients with pain, we also include those with unpleasant symptoms of varying severity throughout the course of their disease. The World health Organization (WHO) estimates that 9 million new cases of cancer occur each year, that there are 6.7 million annual deaths from cancer and that almost 25 million persons are still alive 3 years after diagnosis. Pain is moderate to intense in 40-50% of patients and very intense or intolerable in 25-30%. The WHO predicts that there will be 15 million new cases of cancer by 2020. Hematological cancer (leukemia, lymphoma and myeloma) is the fifth most frequent form of cancer and the second most frequent cause of death from cancer. Pain management and palliative care are based on symptom control (including pain) and the provision of appropriate emotional support to patients and their families. Material, methodology and results: We provide an update of the literature and summarize our experience in pain management and palliative care. The general features of symptoms in these patients are described, and the definition and classification of pain and the terms used in pain management are discussed. Next we focus on oncohematological pain, methods to measure this pain, and the therapeutic strategy still recommended by the WHO for its control. This strategy includes the "analgesic elevator", which increases the speed in moving up the steps of the analgesic ladder when required by the situation. The concept of opioid rotation is also discussed, as well as treatment of the most common adverse effects of opioids: constipation, nausea-vomiting, drowsiness and sedation, especially in older patients. The key to successful analgesia and symptom control lies in individually tailored analgesic regimens and the use of the oral route whenever possible (leading to greater patient comfort). In particular, we describe pain related to mucositis and sickle cell disease, as well as the methodological principles in which symptom control is based and the pharmacological therapies used to relieve pain. The distinct routes of administration of these drugs are described, with their benefits and drawbacks. Conclusions: Only 5% of patients with hematological disease experience severe pain. Oral opioid administration, according to the analgesic scale of the WHO, is the most effective, simple and efficient (cost/effectiveness) method for the management of pain in hematological disease. Conversion tables for use in opioid rotation are available. With this approach, pain can be controlled in approximately 85% of patients. Analgesic techniques with subcutaneous infusion or catheters are also excellent methods for the management of pain in these patients, but are more expensive and complex. Such techniques are generally only necessary in the remaining 15% of patients and require a normal platelet count and, in order to prevent the risk of infection, a normal granulocyte count, as well as a rigorous clinical follow-up.Objetivo: El objetivo de esta revisión es una puesta al día acerca del tratamiento del dolor así como los cuidados paliativos aplicables a pacientes con patología hematológica, oncológica o no. En hematología hay diversas entidades nosológicas y causas que pueden requerir alivio del dolor u otros síntomas molestos para el paciente. Generalmente, se admite que sólo un 5% de los pacientes afectados de enfermedad hematológica maligna presenta cuadros de dolor, mientras que en otros tipos de cáncer (pulmón, próstata y mama que cursan, con frecuencia, con metástasis ósea) el porcentaje llega al 70-80% de los pacientes. El dolor puede venir motivado por la propia enfermedad, por infiltración leucémica o mielomatosa, destrucción ósea (75-80%), por los tratamientos empleados (15-19%), mucositis en neutropénicos, posmetotrexato, talidomida (parestesias), bortezomib (Velcade®), imatinib (Glivec®), trasplante de médula ósea, neurotoxicidad de citostáticos (vincristina, cisplatino) y radioterapia. El dolor no tiene relación con el cáncer en un 3-5% de casos (debilidad muscular y mialgia, úlceras por decúbito, neuralgia postherpética, procedimientos diagnósticos, etc.). Clásicamente la drepanocitosis, que no es una enfermedad prevalente en España, se encuentra entre las enfermedades hematológicas benignas que producen crisis de dolor. En nuestra experiencia, 10 años después de nuestra primera revisión sobre el tema, el porcentaje de enfermos hematológicos que requieren atención específica al problema del "dolor" (entendido como "dolor total" la afectación de tipo físico, emocional, espiritual, social, laboral, familiar, etc.) se puede incrementar si englobamos no sólo a los pacientes con dolor, sino también a aquellos con síntomas más o menos desagradables durante el curso de su enfermedad. La Organización Mundial de la Salud (OMS) estima que se producen 9 millones de casos nuevos de cáncer cada año, 6,7 millones de muertes anuales por esta causa y casi 25 millones de personas vivas con la enfermedad a los 3 años del diagnóstico. El dolor es de moderado a intenso en un 40-50% de casos, y muy intenso o insoportable en un 25-30%; la OMS prevé 15 millones de casos nuevos de cáncer para el año 2020. El cáncer hematológico (leucemia, linfoma y mieloma) es el quinto en frecuencia de presentación y el segundo en mortalidad por cáncer. El tratamiento del dolor y la medicina paliativa se basan en el control de los síntomas (entre éstos, en especial, el dolor) y en dar un soporte emocional correcto a los pacientes y a sus familias. Material y métodos, y resultados: Se revisa y se hace una puesta al día de la bibliografía así como de nuestra experiencia en la prestación mencionada. Se describen las características generales de los síntomas de estos pacientes, la definición y clasificación de su dolor, y la terminología empleada en clínica del dolor. Posteriormente, nos centramos en el dolor oncohematológico, sus métodos de medida y la estrategia terapéutica recomendada por la OMS, aún vigente, para su control, incluyendo el concepto de "ascensor analgésico", que sugiere mayor rapidez en subir la escalera analgésica cuando la situación lo requiere. También se incluye el concepto de rotación de opiáceos, así como el tratamiento de sus efectos secundarios más comunes: constipación, náuseas-vómitos, mareos, sedación, sobre todo en los pacientes de edad avanzada. La clave del éxito en analgesia y control de síntomas es una terapia analgésica pautada o tratamiento del síntoma, tratamiento analgésico individualizado y utilización de la vía oral siempre que sea posible (por su mayor comodidad para el paciente). Se comentan específicamente el dolor en la mucositis y en la drepanocitosis, así como los principios metodológicos del control de síntomas y del tratamiento farmacológico del dolor. Se explican las diferentes vías de administración de fármacos con sus ventajas e inconvenientes. Conclusiones: Sólo el 5% de los pacientes afectados de hemopatías presenta cuadros de dolor intenso. La administración oral de opiáceos, según la escala analgésica de la OMS, es el método más eficaz, simple y eficiente (efectividad/coste) para el control del dolor en la enfermedad hematológica. Hay tablas de conversión equianalgésica entre ellos en caso de necesidad de rotación de opiáceos. Con ello, se consigue controlar el dolor del 85% de los pacientes. Las técnicas analgésicas con perfusión subcutánea o catéter son un método excelente, pero más caro y complejo, para el control del dolor en estos pacientes. Sólo suelen ser necesarias en el 15% restante. Para su instauración se requiere un recuento normal de plaquetas y para evitar el riesgo de infección un recuento normal de granulocitos así como un control clínico riguroso

Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study

Although two main methods of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) are currently accepted, the superiority of one over the other has not yet been demonstrated. The purpose of this study was to determine whether there are hemodynamic and temperature differences between patients who received HIPEC in two different techniques, open versus closed abdomen.Ye

Use of ecological momentary assessment through a passive smartphone-based app (eB2) by patients with schizophrenia: Acceptability study

Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on being user versus nonuser (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment.This study was supported by the Universidad Autónoma de Madrid and European Union via the Intertalentum Project Grant-Marie Skodowska Curie Actions (GA 713366) to JDLM who is the principal investigator. This grant, therefore, funds both JDLM's salary and the consumable expenses related to the study. MLB, VGRR, ASEM, PJEA, SSA, LMI, LML, and EBG's salaries come from the Hospital Universitario Fundación Jiménez Díaz, where this study is currently being carried out, which therefore provides the necessary institutional/departmental support for its development. Additional departmental support concerning the use of EMA is provided by the Instituto de Salud Carlos III (Madrid, Spain) (ISCIII PI16/01852), the Madrid Regional Government (Madrid, Spain) (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM), and the Spanish Ministerio de Ciencia, Innovación y Universidades (TEC2017-92552-EXP). ASD acknowledges funding support from University College London, which covers his salary. The funders had no role in hypothesis generation, study design, decision to publish, or the manuscript writing. No funder has a conflict of interest in relation to the study's results and findings. The funding bodies supported the peer review for this manuscript

Laboratorio virtual en Biotecnología: aplicación y evaluación

La implementación de prácticas virtuales mediante plataformas de simulación experimental en los estudios de máster en el área de la Biotecnología y otras áreas afines de grado, con el fin de avanzar en la digitalización e internacionalización de las asignaturas, evaluando diferentes recursos de varias plataformas comerciales y abierta

BioEmprende: Biología para el empleo

El proyecto pretende fomentar acciones encaminadas a la inserción en el mercado laboral, dar visibilidad a los convenios firmados y prácticas en empresas, acceso directo a redes de empleo internacionales y potenciar a bioemprendedores