Response to Novel Drugs before and after Allogeneic Stem Cell Transplantation in Patients with Relapsed Multiple Myeloma

Multiple myeloma (MM) remains as an incurable disease and, although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative approach, most patients ultimately relapse, and their treatment remains challenging. Because allo-HSCT can modify not only the biology of the disease, but also the immune system and the microenvironment, it can potentially enhance the response to rescue therapies. Information on the efficacy and safety of novel drugs in patients relapsing after allo-HSCT is lacking, however. The objectives of this study were to evaluate the efficacy and toxicity of rescue therapies in patients with MM who relapsed after allo-HSCT, as well as to compare their efficacy before and after allo-HSCT. This retrospective multicenter study included 126 consecutive patients with MM who underwent allo-HSCT between 2000 and 2013 at 8 Spanish centers. All patients engrafted. The incidence of grade II-IV acute graft-versus-host disease (GVHD) was 47%, and nonrelapse mortality within the first 100 days post-transplantation was 13%. After a median follow-up of 92 months, overall survival (OS) was 51% at 2 years and 43% at 5 years. The median progression-free survival after allo-HSCT was 7 months, whereas the median OS after relapse was 33 months. Patients relapsing in the first 6 months after transplantation had a dismal prognosis compared with those who relapsed later (median OS, 11 months versus 120 months; P <.001). The absence of chronic GVHD was associated with reduced OS after relapse (hazard ratio, 3.44; P <.001). Most patients responded to rescue therapies, including proteasome inhibitors (PIs; 62%) and immunomodulatory drugs (IMiDs; 77%), with a good toxicity profile. An in-depth evaluation, including the type and intensity of PI- and IMiD-based combinations used before and after allo-HSCT, showed that the overall response rate and duration of response after allo-HSCT were similar to those seen in the pretransplantation period. Patients with MM who relapse after allo-HSCT should be considered candidates for therapy with new drugs, which can achieve similar response rates with similar durability as seen in the pretransplantation period. This pattern does not follow the usual course of the disease outside the transplantation setting, where response rates and time to progression decreases with each consecutive line of treatment

Desarrollo de una aplicación informática para aprender clínica y producción equina jugando al Trivial

Introducción/objetivos: esta iniciativa surge de la puesta en común de experiencias docentes en las I Jornadas de Innovación Docente en Medicina y Cirugía Animal (Córdoba, 2011). Allí se presentaron algunas actividades que utilizan el éxito de metodologías basadas en concursos y competiciones, que consiguen que los alumnos las adopten fácilmente como métodos de aprendizaje.La actividad propuesta se basa en el popular juego TRIVIAL™ en el que equipos de alumnos contestan cuestiones de una batería de preguntas sobre veterinaria equina. Las preguntas están agrupadas por sistemas/especialidades.Se persigue crear un sistema de aprendizaje y autoevaluación formativa, que permita la evaluación de conocimientos adaptados al nivel de los alumnos de S~ del Grado en Veterinaria. Además de autoevaluar sus propios conocimientos sin la presión de un examen formal, el alumno practica la dinámica de grupo. La competitividad generada entre equipos estimula el trabajo individual y de grupo (...

Large-scale clustering of Lyman α emission intensity from SDSS/BOSS

We present a tentative detection of the large-scale structure of Ly α emission in the Universe at redshifts z = 2-3.5 by measuring the cross-correlation of Ly α surface brightness with quasars in Sloan Digital Sky Survey/Baryon Oscillation Spectroscopic Survey. We use a million spectra targeting luminous red galaxies at z < 0.8, after subtracting a best-fitting model galaxy spectrum from each one, as an estimate of the high-redshift Ly α surface brightness. The quasar-Ly α emission cross-correlation is detected on scales 1 ∼ 15 h−1 Mpc, with shape consistent with a ΛCDM model with Ωm=0.30+0.10−0.07 Ωm=0.30−0.07+0.10. The predicted amplitude of this cross-correlation is proportional to the product of the mean Ly α surface brightness, 〈μα〉, the amplitude of mass fluctuations and the quasar and Ly α emission bias factors. We infer 〈μα〉 (bα/3) = (3.9 ± 0.9) × 10−21 erg s−1 cm−2 Å−1 arcsec−2, where bα is the Ly α emission bias. If star-forming galaxies dominate this emission, we find ρSFR = (0.28 ± 0.07)(3/bα) yr−1 Mpc−3. For bα = 3, this value is ∼30 times larger than previous estimates from individually detected Ly α emitters, but consistent with the total ρSFR derived from dust-corrected, continuum UV galaxy surveys, if most of the Ly α photons from these galaxies avoid dust absorption and are reemitted after diffusing in large gas haloes. Heating of intergalactic gas by He II photoionization from quasar radiation or jets may alternatively explain the detected correlation, and cooling radiation from gas in galactic haloes may also contribute. We also detect redshift space anisotropy of the quasar-Ly α emission cross-correlation, finding evidence at the 3.0σ level that it is radially elongated, which may be explained by radiative-transfer effects. Our measurements represent the first application of the intensity mapping technique to optical observations

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Pharmaceutical expenditure derived from antibiotic prescription to the pediatric population in Castilla y León in the last ten years

Producción CientíficaIntroducción: la crisis económica y sus consecuencias están suponiendo dificultades para la soste-nibilidad de la prestación farmacéutica y del propio sistema sanitario. Entre los grupos terapéuticos de mayor consumo en población infantil se encuentran los antibióticos. Objetivo: descripción y análisis del coste del tratamiento en antibióticos prescritos a la población pediátrica de Castilla y León en la última década, en el ámbito extrahospitalario. Material y métodos: las bases de datos de gasto de antimicrobianos con cargo al Sistema Nacional de Salud provienen de Concylia. Indicadores de consumo: Euros (€)/dosis definida/día y €/1000 ha-bitantes/día. Resultados: se ha registrado un gasto en antibióticos de 15 750 829,26 €. Las penicilinas asocia-das a inhibidores de la betalactamasa (amoxicilina con clavulánico) son responsables del 32,62% del gasto, seguidas de las cefalosporinas y los macrólidos. En último lugar se encontrarían las penicilinas de amplio espectro (amoxicilina), pese a ser las más prescritas. La evolución interanual refleja un lla-mativo descenso en el precio de la mayoría de los antibióticos, principalmente durante los últimos cinco años. El análisis del gasto disgregado por áreas de salud muestra también importantes diferen-cias.Conclusión:las variaciones en el gasto están motivadas principalmente por la frecuencia de uso y por modificaciones en los precios de venta al público. La amoxicilina-clavulánico es el antibiótico que supone más gasto. Los macrólidos son los antibióticos de mayor precio y la amoxicilina el de menor. Se observa una tendencia descendente del gasto en la mayoría de los antibióticos a lo largo del dece-nio.Introduction:the economic crisis and its consequences are posing difficulties for the sustainability of providing a pharmaceutical and health care system. Antibiotics are the therapeutic groups with the highest consumption in children.Objective:description and analysis of the cost of prescribed antibiotics in the paediatric popula-tion of Castilla and Leon in the last decade, in the community setting. Methods:the databases of antimicrobials’ expenditure financed by the NHS come from Concylia. Consume indicators: Euro (€)/DDD and €/1000 inhabitants/day. Results:there has been an antibiotic cost of € 15,750,829.26. Penicillins associated with beta lactamase inhibitors (amoxicillin with clavulanic acid) are responsible for 32.62% of spending, fo-llowed by cephalosporins and macrolides. In the last place are the broad-spectrum penicillins (amoxi-cillin), although they are the most prescribed antibiotics. The annual evolution reflects a sharp drop in the price of most antibiotics mainly during the last five years. Disaggregated analysis of spending by Health Areas also shows important differences.Conclusions:variations in spending are driven primarily by the frequency of use and changes in retail prices. Amoxicillin clavulanate is the antibiotic responsible for the highest expense. Macrolides are the most expensive antibiotics and amoxicillin the lowest ones. There is a downward trend in spending in most antibiotics along the decadeGerencia Regional de Salud de Castilla y León. Incluido en los Proyectos en Biomedicina, Biotec-nología y Ciencias de la Salud (GRS587/B/10