Adaptación de la asignatura “Clínica Jurídica de Acción Social” a un modelo de Aprendizaje-servicio con docencia semipresencial u online

Memoria ID-102. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Análisis cuantitativo del colágeno para la detección del carcinoma basocelular mediante microscopía multifotón ex vivo

El carcinoma basocelular (CB) es el cáncer más frecuente del ser humano y su incidencia está en aumento. La microscopía multifotón (MMF) es una técnica de imagen que puede ayudar al diagnóstico de este tumor in vivo (eliminando biopsias innecesarias) y ex vivo (agilizando procesos laboriosos como la cirugía de Mohs). Además, la señal de generación de segundo armónico (GSA) en MMF puede clasificar y dar información pronóstica de los tumores en atención a los cambios en la matriz extracelular, a través del colágeno tipo I. En este trabajo se ha explorado el potencial de la MMF para diferenciar cambios en el colágeno asociados a diferentes subtipos histológicos de CB en relación con estructuras cutáneas normales y lesiones benignas. Sobre 418 imágenes de GSA de 52 CB y 12 lesiones cutáneas benignas se realizaron ex vivo análisis cuantitativos sobre el colágeno, como el análisis de energía en una banda de frecuencias en el dominio de Fourier, la densidad óptica integrada o el análisis mediante los softwares CurveAlign y CT-FIRE. Los resultados mostraron que el colágeno se dispone más alineado alrededor de los CB en comparación a las estructuras normales de la piel (p<0,001) y a los tumores benignos (p<0,001). Además, el colágeno se orienta más paralelo circundante a los CB de subtipo histológico indolente (superficial y nodular) en comparación a los de subtipo agresivo (infiltrante y micronodular) (p=0,021), hallazgo que muestra el potencial de la MMF para proporcionar información pronóstica cuantificable sobre el CB. Este trabajo sienta las bases iniciales para una futura cuantificación del colágeno in vivo, que permita obtener información pronóstica del CB directamente en la consulta

Terapia fotodinámica con luz de día en el tratamiento de la queilitis actínica

La queilitis actínica (QA) es una patología crónica premaligna que afecta generalmente al labio inferior y que se considera el equivalente de las queratosis actínicas en la piel1, 2, 3. Se han postulado múltiples tratamientos para la QA, no siendo ninguno de ellos definitivo. La terapia fotodinámica (TFD) con luz de día es una terapia ampliamente empleada en el tratamiento de las queratosis actínicas que ha demostrado unas tasas de efectividad similares a la TFD convencional, ocasionando un dolor nulo o mínimo4, 5. El objetivo de nuestro estudio fue describir nuestra experiencia en cuanto a la eficacia y la seguridad del tratamiento con TFD con luz de día de la QA. Entre mayo y octubre de 2018 se trataron seis pacientes. Tras un curetaje suave se les colocó un rollo de algodón en la mucosa labial interna para exponer el labio inferior y se les aplicó una cantidad suficiente de crema de aminolevulinato de metilo y, sin oclusión, se recomendó exposición a la luz del día ambiental durante dos horas. El resto de la piel se protegió con un protector solar FPS 50 +. Tras las dos horas de exposición, se lavó la zona tratada y se aplicó FPS 50 + en el labio. Se realizó otra sesión a las dos semanas y se revisó a los pacientes a los dos meses (Figura 1, Figura 2). Se evaluó a los pacientes mediante una escala clínica (superficie afecta y respuesta completa/parcial/no respuesta) y una escala EVA para el dolor. Las características de los pacientes tratados y los resultados del tratamiento están recogidos en la tabla 1. Cuatro de los pacientes (67%) mostraron una respuesta completa y dos una respuesta parcial con una reducción media de la superficie afecta de un 58,3%. El resultado medio en la escala de dolor fue de 0,5 sobre 10

Microscopía confocal de fluorescencia ex vivo en escala de tres colores (mcf-3cs): una nueva técnica de imagen

La microscopía confocal (MC) es una técnica de imagen que permite la visualización en tiempo real de estructuras de la piel, con una resolución comparable a la histología convencional1. Es una técnica que se ha aplicado sobre múltiples patologías dermatológicas, fundamentalmente sobre patología tumoral como el carcinoma basocelular (CB) o espinocelular. Esta tecnología puede aplicarse directamente sobre la piel (in vivo), o sobre piezas que se hayan extirpado quirúrgicamente (ex vivo). En este último caso, el uso de fluoróforos ha conseguido mejorar la calidad de las imágenes obtenidas, en lo que se conoce como MC de fluorescencia (MCF)

Cutaneous malignant melanoma mortality in Spain from 1979 to 2018. Trends and new perspectives in the immunotherapy era

Background Recent studies suggest that cutaneous melanoma mortality rates in Spain are stabilizing and even decreasing in younger cohorts. Objectives To analyse mortality rates of melanoma from the last 40 years, focusing on changes related with the development of new therapeutic approaches. Methods Death records and mid‐year population data were collected from the National Statistics Institute. By using the direct method, age‐standardized mortality rates were calculated for overall population and for each sex and age group. Significant changes in mortality trends were identified by Joinpoint regressions. The independent effects of age, period and cohort (APC) and potential years of life lost (PYLL) due to melanoma were also analysed. Results Age‐standardized melanoma mortality rates rose in Spain from 0.78 to 2.13 deaths per 100 000 from the first to the last quinquennium of the study (1979–1983 to 2014–2018) for the overall population. After a marked increase until 1995, mortality rates levelled off. Following this stabilization, from 2015 to 2018 there was a decrease in mortality rates for the overall population (average annual per cent change (AAPC): −4.3, not significant), more accused in males over 64 years old (yo). A period effect was observed from the beginning of 21st century, with mortality rates dropping to date. Conclusions There is a decrease in melanoma mortality rates from 2015 in all age groups that confirms previous trends in mortality in younger cohorts. Improvement in diagnosis and development of new therapies for advanced melanoma may have a crucial role in this event. Close monitoring of melanoma mortality rates is necessary to confirm these trends

Patterns and trends in melanoma mortality in Spain (1999–2022)

Aim To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. Methods Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. Results Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: − 1.3%). A national trend reversal occurred in 2014 (AAPC: − 1.3%). For individuals aged 45–74 years, Catalonia saw a significant decrease (AAPC: − 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: − 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. Conclusion Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide

Expression patterns of aquaporin 1 in vascular tumours

[Background] Aquaporins (AQPs) are a family of water channels expressed in various body tissues. Beyond osmotic balance, AQPs have recently been confirmed to be involved in processes related to cancer (tumour proliferation, angiogenesis, etc.).[Objectives] To analyse the presence of these proteins in the endothelium of several vascular tumours, both benign and malignant, in order to establish whether AQPs may be used as a marker or future therapeutic target. Materials and Methods: We studied AQP1 expression in 39 patients with vascular tumours, classified into six groups according to ISSVA classification: haemangiomas, benign vascular tumours different from infantile haemangiomas, angiosarcomas, classic Kaposi's sarcoma (KS), and epidemic KS.[Results] AQP1 expression was present in 28 of 39 patients, representing 92.9% benign lesions, whereas no expression was found in 72% of malignant lesions. AQP1 expression was associated with benign lesions with an OR of 34.5 (95% CI: 5-250); p<0.0005, and was most frequently identified with a focal endothelial pattern (38%). A kappa index of 0.823 (95% CI: 0.678-0.971) was determined regarding the patterns of expression overall.[Conclusion] The expression of AQP1 was greater in benign lesions than malignant lesions and this difference was statistically significant, thus AQP1 expression could serve as a marker for benignity of vascular tumours. In addition, the expression pattern of AQP1 was different according to the type of vascular tumour.Peer reviewe

Cutaneous malignant melanoma mortality in Andalusia from 1979 to 2018. Toward new perspectives?

Malignant melanoma accounts for 80% of deaths due to skin cancer. Its incidence is globally increasing. However, melanoma mortality seems to be decreasing. The aim of this study was to analyze mortality rates due to melanoma in Andalusia between 1979 and 2018. Deaths due to melanoma and mid-year population in Andalusia were collected from the National Institute of Statistics. Age-adjusted mortality rates were calculated for overall population and for each sex and age group. Regression models were used to calculate significant points of change. Sex ratio and the independent effects of age, period, and cohort were also analyzed. Age-adjusted mortality due to melanoma rose from 0.61 to 1.94 deaths per 100.000 from 1979 to 2018 for the overall population. A significant change of trends was detected around 1994 when, after a steady rise from 1979, mortality rates stabilized up to the end of the period studied. The cited increase was more pronounced in >64 year males. From the end of the 2000s, there was a decrease in mortality rates to date in all population groups, producing a period effect. A stabilization in melanoma mortality rates was observed in Andalusia from 1994 with a decrease in some groups at the beginning of the 21st century. Trends observed in Andalusia do not differ substantially from those in Spain. The development of new therapies and an earlier diagnosis may have an influence in those changes. Studies that compare differences between Spanish regions are needed to define better prevention strategies