Efectos cognitivos de la radioterapia en gliomas de bajo grado

The increased survival of patients with low grade gliomas generated increased interest in the neurotoxic effects associated with treatment, especially radiotherapy. Currently, the radiotherapy is associated with visual memory failures in this population. On the contrary, some authors postulate that radiotherapy, as well as other treatments, helps control the disease and preserves the neuropsychological performance. However, methodological limitations of these studies and the difficulty in monitoring these patients could be causing this divergence in the results found in this research field. Therefore, we note the need for studies that use radiation therapy treatment techniques current, which increase safety and reduce neurological side effects, and apply appropriate questionnaires with a sensitivity to the neurotoxic effects of adjuvant treatments.El aumento en las tasas de supervivencia de los pacientes con gliomas de bajo grado está suscitando un elevado interés en los efectos neurotóxicos asociados a los tratamientos, en especial a la radioterapia. En la actualidad, se señala la presencia de alteraciones principalmente en memoria visual asociada a dicha técnica de tratamiento, aunque existen datos contrarios que postulan que la radioterapia, al igual que otros tratamientos, favorece el control de la enfermedad y preserva el rendimiento neuropsicológico de esta población. No obstante, las limitaciones metodológicas de estos estudios y la dificultad en el seguimiento de estos pacientes podrían estar provocando esta divergencia en los resultados hallados en este campo de investigación. Por ello, se reitera la necesidad de realizar estudios que utilicen las técnicas de tratamiento de radioterapia actuales,que aumentan la seguridad y disminuyen los efectos secundarios neurológicos, así como que apliquen cuestionarios con una adecuada sensibilidad a los efectos neurotóxicos de los tratamientos adyuvantes

Osteocondroma lumbar sintomático

Se presenta un caso de osteocondroma solitario espinal localizado en la zona para-articular de la lámina izquierda de L4 y que producía una lumbociática secundaria a la estenosis del receso lateral. El osteocondroma espinal sintomático es una lesión neoplásica benigna poco frecuente y cuyo tratamiento de elección es la extirpación quirúrgica.A case of solitary spinal osteochondroma growing from the left L4 lamina, close to the facet joint, is presented. The tumor produced a stenosis of the left lateral recess and the patient suffered from low-back and sciatic pain. Symptomatic spinal osteochondroma is a rare beningn tumor, surgical removal being the most useful treatment

Cognitive effects of radiotherapy in low grade gliomas

The increased survival of patients with low grade gliomas generated increased interest in the neurotoxic effects associated with treatment, especially radiotherapy. Currently, the radiotherapy is associated with visual memory failures in this population. On the contrary, some authors postulate that radiotherapy, as well as other treatments, helps control the disease and preserves the neuropsychological performance. However, methodological limitations of these studies and the difficulty in monitoring these patients could be causing this divergence in the results found in this research field. Therefore, we note the need for studies that use radiation therapy treatment techniques current, which increase safety and reduce neurological side effects, and apply appropriate questionnaires with a sensitivity to the neurotoxic effects of adjuvant treatments

Are We Ready for Cell Therapy to Treat Stroke?

Clinical trials of cell therapies that target stroke started at the beginning of this century and they have experienced a significant boost in recent years as a result of promising data from basic research studies. The increase in the information available has paved the way to carry out more innovative and varied human studies. Efforts have focused on the search for a safe and effective treatment to stimulate neuro-regeneration in the brain and to reduce the sequelae of stroke in patients. Therefore, this review aims to evaluate the clinical trials using cell therapy to treat stroke published to date and assess their limitations. From 2000 to date, most of the published clinical trials have focused on phases I or II, and the vast majority of them demonstrate that stem cells are essentially safe to use when administered by different routes, with transient and mild adverse events that do not generally have severe consequences for health. In general, there is considerable variation in the trials in terms of statistical design, sample size, the cells used, the routes of administration, and the functional assessments (both at baseline and follow-up), making it difficult to compare the studies. From this general description, possibly the experimental protocol is the main element to improve in future studies. Establishing an adequate experimental and statistical design will be essential to obtain favorable and reliable results when conducting phase III clinical trials. Thus, it is necessary to standardize the criteria used in these clinical trials in order to aid comparison. Shortly, cell therapy will be a key approach in the treatment of stroke if adequate and comprehensive levels of recovery are to be achieved

Conspiración de silencio y malestar emocional en pacientes diagnósticados de glioblastoma multiforme

Aim: For those patients suffering serious illnesses with a poor prognosis, there continues to be a significant percentage of well-meaning family members who, out of a desire to protect the patient, decide to hide the truth, even if the patient wishes to know what the real situation is. Methods: To measure the incidence of conspiracies of silence within families and their repercussions on levels of anxiety and depression of patients diagnosed Glioblastoma Multiforme (GBM). Findings: 19.3 % of the families taking part thought that it would not be appropriate to give the patient information about their disease, despite the patient stating that he or she would like to know more about their disease. This conspiracy had an impact on the anxiety levels of the patient even a month after the discharge from hospital. At this point in the disease process, those patients where there was a conspiracy of silence demonstrated psychopathological levels of anxiety (12.71±2.28), whereas the levels of anxiety for those patients who were allowed more open communication showed levels which were below clinical significance (7.00±3.27). Conclusions: The needs for information of family members and patients with GBM are different and their repercussions on emotional distress in patients can continue during a prolonged period of time.Objetivo: En el ámbito de enfermedades muy graves y de mal pronóstico, continúa existiendo un importante porcentaje de familiares que, por motivos beneficentes y de protección, deciden ocultar la verdad a los enfermos que desean conocer lo que les ocurre. El objetivo es identificar la incidencia de conspiración de silencio familiar y su repercusión en los niveles de ansiedad y depresión del paciente diagnosticado de glioblastoma multiforme (GBM). Método: Los niveles de ansiedad y depresión fueron recogidos en cinco momentos del proceso de enfermedad: ingreso, después de la comunicación del diagnóstico, en el alta hospitalaria, un mes después del alta y seis meses después del alta. Las necesidades de información fueron recogidas en el momento del ingreso. Resultados: El 19,3 % de las familias, consideró que no sería conveniente comunicar al paciente lo que le ocurría a pesar de que éste quería conocer aspectos relacionados con su enfermedad. Esta conspiración repercute en los niveles de ansiedad del paciente hasta incluso un mes después del alta hospitalaria. En este momento de la enfermedad, en los pacientes donde existía pacto de silencio presentaban unos niveles psicopatológicos de ansiedad (12,71±2,28), mientras que los niveles de ansiedad de los pacientes a los que se les permitió una comunicación abierta estaban por debajo de la significación clínica (7,00±3,27). Conclusiones: Existe una alta incidencia de pacto de silencio en pacientes con GBM y su repercusión sobre el malestar emocional de los enfermos se mantiene durante un largo periodo de tiempo

Dynamic modeling of the solar field in parabolic trough solar power plants

Parabolic trough solar power plants use a thermal fluid to transfer thermal energy from solar radiation to a water-steam Rankine cycle in order to drive a turbine that, coupled to an electrical generator, produces electricity. These plants have a heat transfer fluid (HTF) system with the necessary elements to transform solar radiation into heat and to transfer that thermal energy to the water-steam exchangers. In order to get the best possible performance in the Rankine cycle and, hence, in the thermal plant, it is necessary that the thermal fluid reach its maximum temperature when leaving the solar field (SF). Also, it is mandatory that the thermal fluid does not exceed the maximum operating temperature of the HTF, above which it degrades. It must be noted that the optimal temperature of the thermal fluid is difficult to obtain, since solar radiation can change abruptly from one moment to another. The aim of this document is to provide a model of an HTF system that can be used to optimize the control of the temperature of the fluid without interfering with the normal operation of the plant. The results obtained with this model will be contrasted with those obtained in a real plant

Toma de decisiones en el paciente diagnosticado de tumor cerebral. A propósito de un caso clínico

[email protected]ón: La decisión sobre la alternativa terapéutica más conveniente, que corresponde al paciente asesorado por el equipo sanitario, se hace especialmente difícil en casos del mal pronóstico. Pacientes: Paciente joven con tumor cerebral, reintervenido en diversas ocasiones, al que se detecta una recidiva. Resultados: En contra de la opinión del equipo multidisciplinar, el paciente decide someterse a una reintervención, falleciendo a los cuatro meses presentando una calidad de vida aceptable. Conclusiones: Se plantea la necesidad, a través de un counselling adecuado, de permitir que el paciente escoja el resultado clínico preferido tras la transmisión clara de las distintas consecuencias de cada decisión y de la probabilidad de que cada una de ellas ocurra, evitando el uso de términos confusos, como la descripción técnica de procedimientos y las sugerencias globales sobre las decisiones. Se enfatiza el respeto a la autonomía del paciente, bajo condiciones de no maleficencia.The patient´s decision regarding the most advisable therapeutic alternative is difficult, speccially in patients with poor prognosis. Patients: Young patient who was operated on several times by brain tumour and he was admitted again by tumour recurrence. Results: The patient preferred to be reoperated against the multidisciplinary team decision. His quality of life was acceptable but the patient died four months later. Conclusion: We think that the patient could be able to choose the preferred therapeutic option after adequate counselling. Confusing terms such as technical description should be avoided. We emphasize the respect to the patient´s autonomy under non-maleficent conditions

Neurorestoration approach by biomaterials in ischemic stroke

Ischemic stroke (IS) is the leading cause of disability in the western world, assuming a high socio-economic cost. One of the most used strategies in the last decade has been biomaterials, which have been initially used with a structural support function. They have been perfected, different compounds have been combined, and they have been used together with cell therapy or controlled release chemical compounds. This double function has driven them as potential candidates for the chronic treatment of IS. In fact, the most developed are in different phases of clinical trial. In this review, we will show the ischemic scenario and address the most important criteria to achieve a successful neuroreparation from the point of view of biomaterials. The spontaneous processes that are activated and how to enhance them is one of the keys that contribute to the success of the therapeutic approach. In addition, the different routes of administration and how they affect the design of biomaterials are analyzed. Future perspectives show where this broad scientific field is heading, which advances every day with the help of technology and advanced therapies.We gratefully acknowledge funding from Institute Carlos III (EC11-121) which support our research using biohybrids in the treatment of ischemic stroke. NE-G is funded by a contract from the European Social Fund through the Operational Youth Guarantee Program of the Ministry of Science, Universities and Innovation of the Community of Madrid (PEJD-2019- PRE/BMD-15396). CN was funded by Boston Scientifi

Decision making process in patients with brain tumor. Concerning a case report

Justificación: La decisión sobre la alternativa terapéutica más conveniente, que corresponde al paciente asesorado por el equipo sanitario, se hace especialmente difícil en casos del mal pronóstico. Pacientes: Paciente joven con tumor cerebral, reintervenido en diversas ocasiones, al que se detecta una recidiva. Re¬sultados: En contra de la opinión del equipo multidisciplinar, el paciente decide someterse a una reintervención, falleciendo a los cuatro meses presentando una calidad de vida aceptable. Conclusiones: Se plantea la necesidad, a través de un counselling adecuado, de permitir que el paciente escoja el resultado clínico preferido tras la transmisión clara de las distintas consecuencias de cada decisión y de la probabilidad de que cada una de ellas ocurra, evitando el uso de términos confusos, como la descripción técnica de procedimientos y las sugerencias globales sobre las decisiones. Se enfatiza el respeto a la autonomía del paciente, bajo condiciones de no maleficencia.The patient´s decision regarding the most advisable therapeutic alternative is difficult, speccially in patients with poor prognosis. Patients: Young patient who was operated on several times by brain tumour and he was admitted again by tumour recurrence. Results: The patient preferred to be reoperated against the multidisciplinary team decision. His quality of life was acceptable but the patient died four months later. Conclusion: We think that the patient could be able to choose the preferred therapeutic option after adequate counselling. Confusing terms such as technical description should be avoided. We emphasize the respect to the patient´s autonomy under non-maleficent conditions

Conspiracy of silence and emotional distress in patients diagnosed with glioblastoma multiforme

Aim: For those patients suffering serious illnesses with a poor prognosis, there continues to be a significant percentage of well-meaning family members who, out of a desire to protect the patient, decide to hide the truth, even if the patient wishes to know what the real situation is. Methods: To measure the incidence of conspiracies of silence within families and their repercussions on levels of anxiety and depression of patients diagnosed Glioblastoma Multiforme (GBM). Findings: 19.3 % of the families taking part thought that it would not be appropriate to give the patient information about their disease, despite the patient stating that he or she would like to know more about their disease. This conspiracy had an impact on the anxiety levels of the patient even a month after the discharge from hospital. At this point in the disease process, those patients where there was a conspiracy of silence demonstrated psychopathological levels of anxiety (12.71±2.28), whereas the levels of anxiety for those patients who were allowed more open communication showed levels which were below clinical significance (7.00±3.27). Conclusions: The needs for information of family members and patients with GBM are different and their repercussions on emotional distress in patients can continue during a prolonged period of time