Analytical parameters for the detection of post-surgical complications in the elderly patient

RESUMEN: Introducción: Las complicaciones sépticas tras la cirugía colorrectal puede afectar seriamente a la salud de los pacientes, por lo que su detección temprana es uno de los puntos clave para su tratamiento. La menor capacidad de respuesta del sistema inmunológico de los pacientes de mayor edad empeora el pronóstico, a la vez que hace que sea más complicado detectarlas a tiempo. Este problema plantea la duda de si podemos emplear los marcadores de infección clásicos como método de detección precoz. Pacientes y métodos: Estudio observacional retrospectivo en el que se evalúa la respuesta de leucocitos, proteína C reactiva ( PCR), procalcitonina ( PCT) y lactato en pacientes sometidos a cirugía colorrectal programada, comparando la respuesta entre los que presenten complicaciones sépticas y aquellos que no. Resultados: Se evalúan 302 pacientes mayores de 75 años. La elevación de PCR y leucocitos en sangre en el tercer día postoperatorio muestran mayor sensibilidad y especificidad para su detección precoz de complicaciones infecciosas. Conclusión: La proteína C reactiva seguida del recuento leucocitario es un marcador biológico que resulta más sensible y especifico en la detección de complicaciones infecciosas en el postoperatorio inmediato de cirugía colorrectal programada en el paciente anciano. Pese a esta relación, no pueden ser utilizados por sí solos para determinar qué pacientes van a complicarse con total seguridad. La edad de los pacientes no altera los resultados sobre PCR y leucocitos.ABSTRACT: Introduction: Septic complications after colorectal surgery can seriously affect the health of patients, so their early detection is one of the key points for their treatment. The lower response capacity of the immune system of older patients worsens the prognosis, while making it more difficult to detect them in time. This problem raises the question of whether we can use classical infection markers as an early detection method. Patients and methods: Retrospective observational study in which the response of leukocytes, C-reactive protein (CRP), procalcitonin (PCT) and lactate in patients undergoing scheduled colorectal surgery is evaluated, comparing the response between those presenting septic complications and those who do not. Results: 302 patients older than 75 years were evaluated. Elevation of CRP and leukocytes in the blood on the third postoperative day show greater sensitivity and specificity for early detection of infectious complications. Conclusion: C-reactive protein followed by leukocyte count is a biological marker that is more sensitive and specific in the detection of infectious complications in the immediate postoperative period of programmed colorectal surgery in the elderly patient. Despite this relationship, they can not be used alone to determine which patients are going to be completely safe. The age of the patients does not alter the results on CRP and leukocytes.Grado en Medicin

Identification and validation of circulating miRNAs as endogenous controls in obstructive sleep apnea

microRNAs (miRNAs) are non-coding RNAs highly relevant as biomarkers for disease. A seminal study that explored the role of miRNAs in obstructive sleep apnea syndrome (OSA) demonstrated their usefulness in clinical management. Nevertheless, the miRNAs that may act as endogenous controls (ECs) have not yet been established. The identification of ECs would contribute to the standardization of these biomarkers in OSA. The objective of the study is to identify miRNAs that can be used as ECs in OSA. We evaluated 100 patients divided into two different cohorts: a learning cohort of 10 non-OSA and 30 OSA patients, and a validation cohort (20 non-OSA and 40 OSA patients). In the learning cohort, a profile of 188 miRNAs was determined in plasma by TaqMan Low Density Array. The best EC candidates were identified by mean center+SD normalization and concordance correlation restricted normalization. The results were validated using NormFinder and geNorm to assess the stability of those ECs. Eight miRNAs were identified as EC candidates. The combination miRNA-106a/miRNA-186 was identified as the most stable among all candidates. We identified a set of ECs to be used in the determination of circulating miRNA in OSA that may contribute to the homogeneity of results.The project is supported by PI 14/01266 and PI 18/00449 from the Instituto de Salud Carlos III (ISCIII), Fondo Europeo de Desarrollo Regional (FEDER), Sociedad Española de Neumología y Cirugía Torácica (SEPAR) and Societat Catalana de Pneumologia (SOCAP). The work is supported by IRBLleida Biobank (B.0000682) and PLATAFORMA BIOBANCOS PT17/0015/0027”. We thank all the investigators of Sleep Unit of Santa Maria Hospital. F.S.-M. is the recipient of a predoctoral fellowship from “AGAUR-University of Lleida” and Convocatòria d’Ajuts 2018 de Promoció a la Recerca en Salut. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Soluble RAGE in COPD, with or without coexisting obstructive sleep apnoea

Background: Hypoxia can reduce the levels of soluble receptor for advanced glycation end-products (sRAGE), a new anti-infammatory biomarker of COPD. We assessed sRAGE in patients with hypoxia-related diseases such as COPD, OSA and OSA-COPD overlap. Methods: Plasma levels of sRAGE were measured in 317 subjects at baseline (57 heathy nonsmokers [HNS], 84 healthy smokers [HS], 79 OSA, 62 COPD and 35 OSA-COPD overlap patients) and in 294 subjects after one year of follow-up (50 HNS, 74 HS, 77 OSA, 60 COPD and 33 overlap). Results: After adjusting for age, sex, smoking status and body mass index, sRAGE levels showed a reduction in OSA (− 12.5%, p=0.005), COPD (− 14.8%, p<0.001) and OSA-COPD overlap (− 12.3%, p=0.02) compared with HNS. There were no diferences when comparing sRAGE plasma levels between overlap patients and those with OSA or COPD alone. At follow-up, sRAGE levels did not change signifcantly in healthy subjects, COPD and OSA or OSA-COPD overlap nontreated with continuous positive airway pressure (CPAP). Moreover, in patients with OSA and OSA-COPD overlap who were treated with CPAP, sRAGE increased signifcantly. Conclusions: The levels of sRAGE are reduced in COPD and OSA. Treatment with CPAP appears to improve sRAGE levels in patients with OSA who also had COPD.The EPIOSA study (NCT02131610) was supported by Grants Number PI12/02175, PI15/01940 and PI18/01524 from the Instituto Salud Carlos III, Spanish Ministry of Health, Madrid, Spain and the European Regional Development Fund (FEDER) and by a Grant Number 01/2010 from the SADAR-Pneumo Aragón, Zaragoza, Spain

Trabajo colaborativo basado en embodied learning y experiencias reales para mejorar la adquisición de competencias clínicas en geriatría

Memoria de proyectos de innovación y buenas prácticas docente

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

Nuevas tendencias en investigación e innovación en didáctica de la historia, patrimonio cultural y memoria. Proyección educativa.

Reflexión y debate sobre las nuevas tendencias en investigación e innovación en didáctica de la historia, patrimonio cultural y memoria. Su proyección educativa en los diversas etapas del sistema educativo. New trends in research and innovation in the teaching of history, cultural heritage and memory. Educational projectionGrupo de investigación UNES y Departamento de Didáctica de las CCSS de la UGR