Factores pronósticos biológicos y clínicos en el linfoma de células del manto

[spa] El linfoma de células del manto (LCM) es una entidad heterogénea tanto en sus aspectos biológicos como en su comportamiento clínico. La existencia de pacientes con mala respuesta al tratamiento sugiere que, de manera análoga a otros síndromes linfoproliferativos crónicos, existen alteraciones en los mecanismos de citotoxicidad inducida por fármacos. La heterogeneidad clínica del LCM queda reflejada, entre otros, por la variabilidad en la presentación de expresión hemoperiférica e infiltración del sistema nervioso central (SNC), dos complicaciones controvertidas y no suficientemente estudiadas. La hipótesis planteada en la presente tesis fue que la heterogeneidad observada en el LCM podría ser debida a la existencia de alteraciones en los mecanismos de apoptosis en un subgrupo de pacientes y se relacionaría con el pronóstico de éstos. Por otro lado, el análisis exhaustivo de los pacientes con expresión hemoperiférica o infiltración del SNC permitiría establecer cuáles son las características clínicas y biológicas que determinan la aparición de estas complicaciones en determinados enfermos. Para confirmar esta hipótesis nos planteamos los siguientes objetivos: 1) estudiar las bases moleculares de la regulación de la apoptosis en el LCM, tanto en líneas celulares como en células primarias de pacientes afectos; 2) analizar la incidencia y el impacto pronóstico de la expresión hemoperiférica en los enfermos con LCM mediante citología y citometría de flujo y 3) estudiar la incidencia y los factores determinantes de la infiltración del SNC en pacientes afectos de esta hemopatía.Para el estudio de las bases moleculares de la apoptosis en el LCM se analizaron cuatro líneas celulares portadoras de la t(11;14)(q13;q32), característica de esta entidad, y células primarias de 10 pacientes con LCM. El análisis de la viabilidad celular mediante marcaje con anexina V y yoduro de propidio, la detección de la pérdida de potencial de membrana y la producción de ROS, la determinación de caspasa 3 activa y de los cambios de conformación de BAX y BAK se llevaron a cabo mediante citometría de flujo (CMF). El análisis de diversas proteínas de la familia de BCL-2 se realizó mediante "Western blot". El estudio del ciclo celular se efectuó asimismo mediante CMF. El análisis de las alteraciones cromosómicas existentes en los LCM leucemizados se realizó mediante hibridación genómica comparada (CGH). Las diferencias entre subgrupos de pacientes se analizaron mediante la prueba exacta de Fisher y la t de Student. El análisis de supervivencia se llevó a cabo mediante el método de Kaplan y Meier y las diferencias observadas en términos de supervivencia se analizaron con el "log-rank test". El análisis de variables dependientes del tiempo se efectuó mediante el método de Mantel y Byar. Los resultados obtenidos en el primer trabajo demuestran que la citotoxicidad inducida por mitoxantrona en las células del LCM fue debida a la activación de la vía mitocondrial de apoptosis, y tiene lugar, probablemente, de manera dependiente de la integridad de los sensores de daño al ADN. Los resultados del segundo trabajo permiten concluir que la expresión hemoperiférica detectada mediante CMF se observa en la mayoría de los pacientes con LCM, incluso en aquellos con recuentos linfocitarios normales. Aunque la leucemización morfológica no se asoció en nuestro estudio con ninguna alteración citogenética específica detectable mediante CGH, los casos con linfocitosis >/5 x 10(9)/L presentaron anomalías citogenéticas diferenciales y un peor pronóstico. Los resultados del tercer trabajo demuestran que la infiltración del SNC se presenta fundamentalmente en pacientes con LCM blastoide, índice proliferativo elevado, niveles de LDH sérica elevados e IPI de riesgo intermedio/alto o alto, en general en el contexto de recidivas o progresiones sistémicas.[eng] "BIOLOGICAL AND CLINICAL PROGNOSTIC FACTORS IN MANTLE CELL LYMPHOMA"TEXT:Mantle cell lymphoma (MCL) is characterized by the presence of translocation t(11;14)(q13;q32), an aggressive clinical course and poor response to chemotherapy. Few data concerning drug-induced apoptosis in MCL have been reported. The aim of the first study that constitutes the present thesis was to analyze the mechanisms of drug-induced apoptosis in MCL. Four cell lines carrying the t(11;14) and primary cells of 10 patients with MCL were incubated in vitro with several drugs currently used in the treatment of lymphoproliferative disorders and drug-induced cell death was characterized. Our results support that MCL cells have functional apoptotic machinery but require the integrity of functional DNA-damage response genes for its activation. From a clinical standpoint, extranodal involvement is a well-known feature in patients with MCL. Relatively few studies to date have focused on the peripheral blood (PB) involvement and the incidence of leukemic expression in MCL varies highly in different studies. The objective of our second study was to analyze the incidence, and the biological and clinical significance of leukemic involvement in patients with MCL. We investigated the incidence of PB involvement by both morphologic and flow cytometry (FC) analyses. Clinical features, genetic abnormalities detected by comparative genomic hybridization (CGH) and patient outcome were also determined. Leukemic expression at diagnosis detected by FC was a highly common feature, even in patients with a normal lymphocyte count. Although morphologically apparent leukemic expression was not associated with specific chromosomal alterations detected by CGH, a lymphocyte count >/ 5 x 10(9)/L was correlated with particular genetic abnormalities and a poor outcome.The incidence of central nervous system (CNS) involvement in patients with MCL is also highly variable in different studies, and predicting factors and outcome of CNS infiltration in these patients have not been thoroughly investigated. The aim of our study was to assess the incidence and factors for CNS involvement in MCL. In addition, we analyzed the clinical features, therapy and outcome of patients with MCL once CNS infiltration was detected. Our results suggest that, in most cases, CNS involvement occur late in the course of the disease, as part of a generalized relapse or progression. Blastoid histology, high proliferative index, high serum LDH and high-risk IPI are the variables associated with a higher risk to develop this complication

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

75 años como referente de la investigación agraria y medioambiental española en condiciones de clima mediterráneo [Sitio Web]

1 .pdf con imagen de acceso al “website”, su url y los créditos relacionados con su creación y diseño.-- Créditos: Organización, Estación Experimental de Aula Dei (EEAD-CSIC); Dirección, Jesús Val Falcón; Coordinación, Ana Álvarez-Fernandez, Jorge Álvaro-Fuentes, Ernesto Igartua; Contenido, Anunciación Abadía, Javier Abadía, Carlos Albiñana, Miguel Alfonso, Arancha Arbeloa, Raúl Arbués, Isabel Armillas, Manuel Becana, Santiago Beguería, Carmen Castañeda, Ana Castillo, José Cavero, Bruno Contreras, Azahara Díaz, Edgar García, Elena García, Juan Manuel Gascuñana, Leticia Gaspar, Yolanda Gogorcena, Juan Herrero, Victoria Lafuente, María Victoria López, Juan Antonio Marín, José Martínez, José Carlos Martínez-Giménez, Ana Pilar Mata, Manuel Matamoros, Pierre Mignard, María Ángeles Moreno, Paula Murillo, Ana Navas, Antonio Pérez, Rafael Picorel, María Pilar Vallés, Irene Villar, Inmaculada Yruela, Nery Zapata, Isabel Zarazaga; Diseño y programación: DigitalWorks (Juanjo Ascaso y Asun Dieste); Vídeo, Delegación del CSIC en Aragón (Sara Gutiérrez y Yolanda Hernáiz); Fotografía, Archivo EEAD-CSIC, Anunciación Abadía, Jorge Álvaro-Fuentes, Arancha Arbeloa, Juanjo Ascaso, Santiago Beguería, Elena García, Ernesto Igartua, Ignasi Iglesias, José Manuel Lasa, José Carlos Martínez-Giménez, Pierre Mignard, María Ángeles Moreno, Rubén Sancho, Kosana Suvocarev, María Pilar Vallés, Nery Zapata."Sitio web" de nueva creación y conmemorativo del 75 Aniversario de la EEAD-CSIC que contiene: 1) Foto esférica de su personal en activo; 2) Recopilación de sus hitos históricos más destacados, en orden cronológico; 3) Un vídeo con participación de su personal y muestra de algunas de sus instalaciones; 4) Un mapa con la distribución geográfica de los egresado del Instituto; 5) Algunas fotos, destacando las tomadas a su personal en las celebraciones del 25 y 50 Aniversarios de la EEAD-CSIC.Presentado durante la "Jornada. 75 Aniversario EEAD-CSIC (Zaragoza, Patio de la Infanta. 30 octubre 2019)".Financiación: CSIC, Vicepresidencia Adjunta de Organización y Cultura Científica.N

Sex-associated differences in genomic profile of chronic myelomonocytic leukemia involving differential representation of SRSF2 gene mutation

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Biodegradación de la lignocelulosa: aspectos microbiológicos, químicos y enzimáticos del ataque fúngico a la lignina

Wood is the main renewable material on Earth and is largely used as building material and in paper-pulp manufacturing. This review describes the composition of lignocellulosic materials, the different processes by which fungi are able to alter wood, including decay patterns caused by white, brown, and soft-rot fungi, and fungal staining of wood. The chemical, enzymatic, and molecular aspects of the fungal attack of lignin, which represents the key step in wood decay, are also discussed. Modern analytical techniques to investigate fungal degradation and modification of the lignin polymer are reviewed, as are the different oxidative enzymes (oxidoreductases) involved in lignin degradation. These include laccases, high redox potential ligninolytic peroxidases (lignin peroxidase, manganese peroxidase, and versatile peroxidase), and oxidases. Special emphasis is given to the reactions catalyzed, their synergistic action on lignin, and the structural bases for their unique catalytic properties. Broadening our knowledge of lignocellulose biodegradation processes should contribute to better control of wood-decaying fungi, as well as to the development of new biocatalysts of industrial interest based on these organisms and their enzymes.These studies have been partially supported by ENCE (Spain), by Spanish projects AGL2002-393 and BIO2002-1166, by EU projects QLK5-99-1357 and QLK3-99-590, and by an EUFORES(ENCE)-PDT/MEC(Uruguay) grant. Carmen Ascaso (CCMA, CSIC, Madrid) is acknowledged for low-temperature scanning-electron microscopy facilities. Klaus Piontek (ETH, Zurich) is acknowledged for solving the VP crystal structure. Lina Bettucci (Universidad de la República, Montevideo) is acknowledged for an Inocutis jamaicensis strain. M.S acknowledges MEC for a Postdoctoral Fellowship. F.J.R.-D. thanks CSIC for an I3P contract. A.G. and S.C. thank MEC for their “Ramón y Cajal” contracts.Peer reviewe

Cardiac troponin and COVID-19 severity: Results from BIOCOVID study.

Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P  In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day mortality, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury. Hence, the early measurement of cardiac troponin may be useful for risk stratification in COVID-19

Characteristics and laboratory findings on admission to the emergency department among 2873 hospitalized patients with COVID-19: the impact of adjusted laboratory tests in multicenter studies. A multicenter study in Spain (BIOCOVID-Spain study).

Identification of predictors for severe disease progression is key for risk stratification in COVID-19 patients. We aimed to describe the main characteristics and identify the early predictors for severe outcomes among hospitalized patients with COVID-19 in Spain. This was an observational, retrospective cohort study (BIOCOVID-Spain study) including COVID-19 patients admitted to 32 Spanish hospitals. Demographics, comorbidities and laboratory tests were collected. Outcome was in-hospital mortality. For analysis, laboratory tests values were previously adjusted to assure the comparability of results among participants. Cox regression was performed to identify predictors. Study population included 2873 hospitalized COVID-19 patients. Nine variables were independent predictors for in-hospital mortality, including creatinine (Hazard ratio [HR]:1.327; 95% Confidence Interval [CI]: 1.040-1.695, p = .023), troponin (HR: 2.150; 95% CI: 1.155-4.001; p = .016), platelet count (HR: 0.994; 95% CI: 0.989-0.998; p = .004) and C-reactive protein (HR: 1.037; 95% CI: 1.006-1.068; p = .019). This is the first multicenter study in which an effort was carried out to adjust the results of laboratory tests measured with different methodologies to guarantee their comparability. We reported a comprehensive information about characteristics in a large cohort of hospitalized COVID-19 patients, focusing on the analytical features. Our findings may help to identify patients early at a higher risk for an adverse outcome