Cigarrillos electrónicos

Dispositius electrònics; Cigarretes electròniques; Productes de tabac per escalfamentDispositivos electrónicos; Cigarrillos electrónicos; Productos de tabaco por calentamientoElectronic devices; Electronic cigarettes; Tobacco products for heatingEls dispositius electrònics (DE) són sistemes que proporcionen nicotina i altres substàncies en forma d’aerosol inhalable. Van ser introduïts en el mercat l’any 2003 sense estudis preclínics, proves toxicològiques ni assajos de seguretat a llarg termini, tal com requereixen els productes farmacèutics o els productes sanitaris, i no han estat autoritzats com a productes terapèutics. Hi ha dos tipus principals de DE: les cigarretes electròniques (CE) i els productes de tabac per escalfament (PTE). Els seus efectes sobre la salut a llarg termini són desconeguts i, per tant, no hi ha proves que els DE siguin més segurs que el tabac convencional. A curt termini, poden tenir efectes respiratoris similars als de les cigarretes convencionals. L’any 2019, es va descriure una entitat pròpia de lesions pulmonars associades al vapeig (EVALI, de l’anglès E-cigarette or Vaping Product Use-Associated Lung Injury). També s’han notificat diverses afectacions relacionades dels sistemes respiratori, cardiovascular o immunitari, entre d’altres. Els assaigs clínics publicats fins avui no han aclarit si les CE són efectives per deixar de fumar, bàsicament perquè presenten dèficits metodològics importants. Hi ha una gran evidència (OR 4,59) entre l’ús de CE i la posterior conversió d’aquestes persones en fumadors habituals. L’estratègia més efectiva per ajudar les persones fumadores es basa en el suport psicològic o conductual i la utilització de fàrmacs (teràpia substitutiva de nicotina, bupropió i vareniclina). Els professionals sanitaris haurien de desaconsellar les cigarretes electròniques.Los dispositivos electrónicos (DE) son sistemas que proporcionan nicotina y otras sustancias en forma de aerosol inhalable. Se introdujeron en el mercado el año 2003, sin estudios preclínicos, pruebas toxicológicas, ni ensayos clínicos de seguridad a largo plazo, tal como requieren los medicamentos o los productos sanitarios, y no han sido autorizados como producto terapéutico. Hay dos tipos principales de DE, los cigarrillos electrónicos (CE) y los productos de tabaco por calentamiento (PTC). Los efectos a largo plazo sobre la salud de estos productos son desconocidos y, por tanto, no se dispone de pruebas que permitan afirmar que los DE son más seguros que el tabaco convencional. A corto plazo, pueden tener efectos respiratorios similares a los de los cigarrillos convencionales. En el año 2019, se describió una entidad propia de lesiones pulmonares asociadas al vapeo (EVALI: “E-cigarette Vaping product uso Associated Lung Injury”). También se han notificado varias afectaciones en los sistemas respiratorio, cardiovascular e inmunitario entre otros. Los ensayos clínicos publicados hasta el momento no aclaran si los CE son eficaces para dejar de fumar, básicamente, a causa de que presentan déficits metodológicos importantes. Se dispone de fuerte evidencia (ORO 4,59) entre el uso de CE y la posterior conversión a fumadores habituales. La estrategia más efectiva para ayudar a las personas fumadoras se basa en el apoyo psicológico/conductual y la utilización de fármacos (Terapia sustitutiva de nicotina, bupropión y vareniclina). Los profesionales sanitarios deben desaconsejar el uso de cigarrillos electrónicos

mHealth technology as a help tool during breast cancer treatment: A content focus group

Purpose: To assess the usability and preferences of the contents of mHealth software developed for breast cancer patients as a tool to obtain patient-reported outcomes (PROMs), improve the patient’s knowledge about the disease and its side effects, increase adherence to treatment, and facilitate communication with the doctor. Intervention: an mHealth tool called the Xemio app provides side effect tracking, social calendars, and a personalized and trusted disease information platform to deliver evidence-based advice and education for breast cancer patients. Method: A qualitative research study using semi-structured focus groups was conducted and evaluated. This involved a group interview and a cognitive walking test using Android devices, with the participation of breast cancer survivors. Results: The ability to track side effects and the availability of reliable content were the main benefits of using the application. The ease of use and the method of interaction were the primary concerns; however, all participants agreed that the application would be beneficial to users. Finally, participants expressed their expectations of being informed by their healthcare providers about the launch of the Xemio app. Conclusion: Participants perceived the need for reliable health information and its benefits through an mHealth app. Therefore, applications for breast cancer patients must be designed with accessibility as a key consideration.Postprint (published version

The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever

Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. The incidence of NF among the groups was reduced (64%, 44%, and 24%; P2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age �60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05. G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial

Ecomobilitat a Sitges : anàlisi de la situació actual i propostes de millora

La mobilitat urbana és una de les temàtiques més importants a les ciutats ja que convergeixen diversos aspectes a nivell social i ambiental. El present article es centra en el sistema de mobilitat de la ciutat de Sitges tot avaluant l'estat de la xarxa viària, el parc de vehicles, els sistemes de transport i els serveis bàsics actuals. En l'anàlisi socioambiental de les variables d'aquest àmbit, s'han detectat una sèrie de problemes com ara una distribució no equitativa dels serveis bàsics, desigualtat en la distribució de carrers vianalitzats i carrils bici i manca d'homogeneïtat en la distribució de pàrquings. Els resultats obtinguts permeten proposar una sèrie de millores en busca d'una mobilitat més sostenible. Millorar les parades de bus que no tenen sistema de marquesina per a protegir-les del fred i el sol, augmentar potencialment el carril bici desplegant-lo per carrers que no en tenen, desenvolupar campanyes per a fomentar l'ús de la bici i augmentar la presència de carrers d'exclusiu ús per a vianants.La movilidad urbana es una de las temáticas más importantes en las ciudades ya que convergen varios aspectos a nivel social y ambiental. El presente artículo se centra en el sistema de movilidad de la ciudad de Sitges evaluando el estado de la red viaria, el parque de vehículos, los sistemas de transporte y los servicios básicos actuales. En el análisis socioambiental de las variables de este ámbito, se han detectado una serie de problemas como una distribución no equitativa de los servicios básicos, desigualdad en la distribución de calles peatonales y carriles bici y falta de homogeneidad en la distribución de parkings. Los resultados obtenidos permiten proponer una serie de mejoras en busca de una movilidad más sostenible. Mejorar las paradas de bus que no tienen sistema de marquesina para protegerlas del frío y el Sol, aumentar potencialmente el carril bici desplegándose el por calles que no tienen, desarrollar campañas para fomentar el uso de la bici y aumentar la presencia de calles de exclusivo uso peatonal.Urban mobility is one of the most important issues in cities and converge at various aspects of social and environmental. This article focuses on the mobility system of the city of Sitges assessing the status of the road network, vehicle fleet, transportation systems and basic services today. In the socio-environmental analysis in this field variables, we have detected a number of problems such as inequitable distribution of basic services, inequality in the distribution of pedestrian streets and cycle paths and lack of homogeneity in the distribution of parking. The results obtained suggest a number of improvements in search of a more sustainable mobility. Improve bus stops with no marquee system to protect them from cold and the sun, potentially increasing the unfolding cycle lanes on streets that have not, develop campaigns to promote the use of the bike and increase the presence of street use only crosswalk

T cells isolated from G-CSF-treated multiple myeloma patients are suitable for the generation of BCMA-directed CAR-T cells

Autologous cell immunotherapy using B cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR)-T cells is an effective novel treatment for multiple myeloma (MM). This therapy has only been used for relapsed and refractory patients, at which stage the endogenous T cells used to produce the CAR-T cells are affected by the immunosuppressive nature of advanced MM and/or side effects of previous therapies. An alternative pool of fitter T cells is found in leukocytoapheresis products that are routinely collected to obtain hematopoietic progenitor cells for autologous stem cell transplantation (ASCT) early in the treatment of MM. However, to mobilize the progenitor cells, patients are dosed with granulocyte colony-stimulating factor (G-CSF), which is reported to adversely affect T cell proliferation, function, and differentiation. Here, we aimed to first establish whether G-CSF treatment negatively influences T cell phenotype and to ascertain whether previous exposure of T cells to G-CSF is deleterious for anti-BCMA CAR-T cells. We observed that G-CSF had a minimal impact on T cell phenotype when added in vitro or administered to patients. Moreover, we found that CAR-T cell fitness and anti-tumor activity were unaffected when generated from G-CSF-exposed T cells. Overall, we showed that ASCT apheresis products are a suitable source of T cells for anti-BCMA CAR-T cell manufacture

Mitochondrial dysfunction governs immunometabolism in leukocytes of patients with acute-on-chronic liver failure.

Background & aims: Patients with acute-on-chronic liver failure (ACLF) present a systemic hyperinflammatory response associated with increased circulating levels of small-molecule metabolites. To investigate whether these alterations reflect inadequate cell energy output, we assessed mitochondrial morphology and central metabolic pathways with emphasis on the tricarboxylic acid (TCA) cycle in peripheral leukocytes from patients with acutely decompensated (AD) cirrhosis, with and without ACLF. Methods: The study included samples from patients with AD cirrhosis (108 without and 128 with ACLF) and 41 healthy individuals. Leukocyte mitochondrial ultrastructure was visualized by transmission electron microscopy and cytosolic and mitochondrial metabolic fluxes were determined by assessing NADH/FADH2 production from various substrates. Plasma GDF15 and FGF21 were determined by Luminex and acylcarnitines by LC-MS/MS. Gene expression was analyzed by RNA-sequencing and PCR-based glucose metabolism profiler array. Results: Mitochondrial ultrastructure in patients with advanced cirrhosis was distinguished by cristae rarefication and swelling. The number of mitochondria per leukocyte was higher in patients, accompanied by a reduction in their size. Increased FGF21 and C6:0- and C8:0-carnitine predicted mortality whereas GDF15 strongly correlated with a gene set signature related to leukocyte activation. Metabolic flux analyses revealed increased energy production in mononuclear leukocytes from patients with preferential involvement of extra-mitochondrial pathways, supported by upregulated expression of genes encoding enzymes of the glycolytic and pentose phosphate pathways. In patients with ACLF, mitochondrial function analysis uncovered break-points in the TCA cycle at the isocitrate dehydrogenase and succinate dehydrogenase level, which were bridged by anaplerotic reactions involving glutaminolysis and nucleoside metabolism. Conclusions: Our findings provide evidence at the cellular, organelle and biochemical levels that severe mitochondrial dysfunction governs immunometabolism in leukocytes from patients with AD cirrhosis and ACLF. Lay summary: Patients at advanced stages of liver disease have dismal prognosis due to vital organ failures and the lack of treatment options. In this study, we report that the functioning of mitochondria, which are known as the cell powerhouse, is severely impaired in leukocytes of these patients, probably as a consequence of intense inflammation. Mitochondrial dysfunction is therefore a hallmark of advanced liver disease

A Phase I-II multicenter trial with Avelumab plus autologous dendritic cell vaccine in pre-treated mismatch repair-proficient (MSS) metastatic colorectal cancer patients; GEMCAD 1602 study

[Background]: Immune check-point blockade (ICB) has shown clinical beneft in mismatch repair-defcient/microsatellite instability high metastatic colorectal cancer (mCRC) but not in mismatch repair-profcient/microsatellite stable patients. Cancer vaccines with autologous dendritic cells (ADC) could be a complementary therapeutic approach to ICB as this combination has the potential to achieve synergistic efects. [Methods]: This was a Phase I/II multicentric study with translational sub-studies, to evaluate the safety, pharmacodynamics and anti-tumor efects of Avelumab plus ADC vaccine in heavily pre-treated MSS mCRC patients. Primary objective was to determine the maximum tolerated dose and the efcacy of the combination. The primary end-point was 40% progressionfree survival at 6 months with a 2 Simon Stage. [Results]: A total of 28 patients were screened and 19 pts were included. Combined therapy was safe and well tolerated. An interim analysis (Simon design frst-stage) recommended early termination because only 2/19 (11%) patients were disease free at 6 months. Median PFS was 3.1 months [2.1–5.3 months] and overall survival was 12.2 months [3.2–23.2 months]. Stimulation of immune system was observed in vitro but not clinically. The evaluation of basal RNA-seq noted signifcant changes between pre and post-therapy liver biopsies related to lipid metabolism and transport, infammation and oxidative stress pathways. [Conclusions]: The combination of Avelumab plus ADC vaccine is safe and well tolerated but exhibited modest clinical activity. Our study describes, for the frst-time, a de novo post-therapy metabolic rewiring, that could represent novel immunotherapyinduced tumor vulnerabilities.The study was funded by grants from the FIS PI17/00732 from Instituto de Salud Carlos III, Premi Fi de Residència Emili Letang from Hospital Clínic Barcelona, Plan Nacional de I + D (PID-107139RB-C21 to DB-R and PID2020-115051RB-I00 to MC) and Grupo Español Multidisciplinar en Cáncer Digestivo (GEMCAD). The study was funded with Grants from Catalan Agency for Management of University and Research Grants (AGAUR) (2014-SGR-474, 2017-SGR-1174 and 2017-SGR-1033), Fundació la Marató de TV3 (201330.10), Instituto de Salud Carlos III (PI13/01728 and PI19/00740) and Fundacion Olga Torres (Modalitat A. 2019/2020) to JM. IMMETCOLS signature is under patent protection (EP21382772.8.) This research was financially supported by GEMCAD and (OR Avelumab was provided) by Merck, S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Darmstadt, Germany, as part of an alliance between the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: https://doi.org/10.13039/100009945) and Pfizer

Long-term Responders after autologous stem cell transplantation in multiple myeloma

Introduction: Multiple myeloma (MM) is considered an incurable hematological neoplasm. For transplant-eligible patients, initial treatment includes an induction phase followed by an autologous stem cell transplantation (ASCT). Despite the introduction of several drugs in the past years, relapses still occur. Nevertheless, some patients achieve sustained responses after successful induction treatment and ASCT. Methods: We retrospectively evaluated all patients diagnosed with MM in our institution who underwent induction treatment and ASCT between 1990 and 2015. The subset of patients who achieved a sustained response (any degree) for 5 or more years after ASCT without further treatment or signs of progression were distinguished as 'long-term responders' (LTRs). In the non-LTR group, a cohort referred to as 'prolonged responders' (PLRs) showed sustained response of at least 5 years after ASCT but eventually relapsed. We collected and analyzed clinical and laboratory data. Results: Two hundred and fifty patients were diagnosed with MM and received induction treatment and ASCT at our institution in the study period. Among them, 54 (21.6%) patients met the criteria for LTR. Some diagnostic features such as a younger age, female gender, ECOG performance status of 0, lower International Staging System (ISS) stage, lower bone marrow plasma cell infiltration, and lower serum levels of calcium, C-reactive protein, and lactate dehydrogenase (LDH) were found to be more prevalent in LTR. Female gender, an ECOG performance status of 0, a localized Durie-Salmon stage, an ISS of I-II, the absence of bone disease, and an LDH within normal range were also predictive of longer progression-free survival (PFS) and overall survival (OS) in the whole cohort. The depth of the response achieved after induction and ASCT as well as the administration of an IMID-based maintenance regimen may play a role in the differences observed on PFS between cohorts. A detectable M-protein with a monoclonal gammopathy of undetermined significance (MGUS)-like behavior was detected in one-third of LTR after ASCT. Although relapses continue to occur in patients who achieve a 5-year treatment-free period after ASCT, a plateau is observed in the survival curves at approximately 21 years of follow-up

Document de consens sobre la malaltia celíaca a Catalunya

Malaltia celíaca; Diagnòstic precoç; AlimentsEnfermedad celíaca; Diagnóstico precoz; AlimentosCeliac Disease; Early Diagnosis; FoodDocumento que revisa las distintas formas clínicas de presentación de la enfermedad celíaca, establece los criterios y el proceso diagnóstico de esta des de la sospecha clínica hasta el diagnóstico definitivo; ofrece recomendaciones específicas sobre el tratamiento de la enfermedad celíaca, promueve el seguimiento adecuado del paciente que la sufre y define los criterios de derivación a la atención especializada. Su objetivo principal es incrementar el diagnóstico precoz de la enfermedad celíaca en niños y adultos.Document que revisa les diverses formes clíniques de presentació de la malaltia celíaca, estableix els criteris i el procés diagnóstic d’aquesta des de la sospita clínica fins al diagnòstic definitiu; ofereix recomanacions específiques sobre el tractament de la malaltia celíaca, promou el seguiment adequat del pacient que la pateix i defineix criteris de derivació a l’atenció especialitzada. El seu objectiu principal és incrementar el diagnòstic precoç de la malaltia celíaca en infants i en adults

Good practice regarding smoking cessation management in Spain: Challenges and opportunities for primary care physicians and nurses

INTRODUCTION We analyze the activities carried out by primary care (PC) physicians and nurses with respect to smoking cessation and evaluate their self-reported training, knowledge, and behavior. METHODS A cross-sectional study was conducted including 1514 PC physicians and nurses from June 2016 to March 2017, in Spain. The main variable was Good Practice (GP) in attention to smokers. To identify associated factors, a multilevel logistic regression model was used adjusted for sex, age, type of center, contract, years of employment, tobacco consumption, and self-reported training/knowledge. RESULTS Of the 792 physicians and 722 nurses, 48.6% referred to GP in smoking cessation management. The finding related to: being a non-smoker (OR=1.8; 95% CI: 1.2-2.5) or ex-smoker (OR= 1.4; 95% CI: 1.02-2.1), having a good level of knowledge (OR=1.8; 95% CI: 1.3-2.4) and training (OR=2.4; 95% CI: 1.8-3.2), and, to a lesser extent, being female (OR=1.3; 95% CI: 1.03-1.7), and work experience >10 years (OR=1.4; 95% CI: 1.03-1.9). The main GP barriers were: lack of time (45.5%), organizational problems (48.4%), and 35.4% lack of training. CONCLUSIONS The GP of PC physicians and nurses regarding smoking cessation management is related to being non-smokers or ex-smokers, and having sufficient training and knowledge. Lack of time and organizational problems were considered to be the main barriers. The promotion of training activities in the Spanish National Health Service with the support of scientific societies is required