Interdisciplinar teragnosis and radiosomics

Autores: Calvo Manuel, Felipe (Autor de correspondencia); Ayestarán Aldaz, Adriana; Serrano Andreu, Francisco Javier; et al.

Título: Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect (VOL 12, 1037262, 2022)

Revista: FRONTIERS IN ONCOLOGY

ISSN: 2234-943X Vol.12 2023 págs. 1116433
Autores: Calvo Manuel, Felipe (Autor de correspondencia); Serrano Andreu, Francisco Javier; Sole, C.; et al.

Título: Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

Revista: CLINICAL AND TRANSLATIONAL ONCOLOGY

ISSN: 1699-048X Vol.25 N° 2 2023 págs. 429 - 439

Resumen

Background: Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. Methods: Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results: In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions: Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.
Autores: Azcona Armendáriz, Juan Diego (Autor de correspondencia); Aguilar Redondo, Pedro Borja; Perales Molina, Alvaro; et al.

Título: Commissioning of a synchrotron-based proton beam therapy system for use with a Monte Carlo treatment planning system

Revista: RADIATION PHYSICS AND CHEMISTRY

ISSN: 0969-806X Vol.204 2023 págs. 110708

Resumen

This work tackles the commissioning and validation of a novel combination of a synchrotron-based proton beam therapy system (Hitachi, Ltd.) for use with a Monte Carlo treatment planning system (TPS). Four crucial aspects in this configuration have been investigated: (1) Monte Carlo-based correction performed by the TPS to the measured integrated depth-dose curves (IDD), (2) circular spot modelling with a single Gaussian function to characterize the synchrotron physical spot, which is elliptical, (3) the modelling of the range shifter that enables using only one set of measurements in open beams, and (4) the Monte Carlo dose calculation model in small fields.Integrated depth-dose curves were measured with a PTW Bragg peak chamber and corrected, with a Monte Carlo model, to account for energy absorbed outside the detector. The elliptical spot was measured by IBA Lynx scintillator, EBT3 films and PTW microDiamond. The accuracy of the TPS (RayStation, RaySearch Laboratories) at spot modelling with a circular Gaussian function was assessed.The beam model was validated using spread-out Bragg peak (SOBP) fields. We took single-point doses at several depths through the central axis using a PTW Farmer chamber, for fields between 2 x 2cm and 30 x 30cm. We checked the range-shifter modelling from open-beam data. We tested clinical cases with film and an ioni-zation chamber array (IBA Matrix).Sigma differences for spots fitted using 2D images and 1D profiles to elliptical and circular Gaussian models were below 0.22 mm. Differences between SOBP measurements at single points and TPS calculations for all fields between 5 x 5 and 30 x 30cm were below 2.3%. Smaller fields had larger differences: up to 3.8% in the 2 x 2cm field. Mean differences at several depths along the central axis were generally below 1%. Differences in range -shifter doses were below 2.4%. Gamma test (3%, 3 mm) results for clinical cases were generally above 95% for Matrix and film.Approaches for modelling synchrotron proton beams have been validated. Dose values for open and range -shifter fields demonstrate accurate Monte Carlo correction for IDDs. Elliptical spots can be successfully modelled using a circular Gaussian, which is accurate for patient calculations and can be used for small fields. A double-Gaussian spot can improve small-field calculations. The range-shifter modelling approach, which reduces clinical commissioning time, is adequate.
Autores: Calvo Manuel, Felipe (Autor de correspondencia); Serrano Andreu, Francisco Javier; Cambeiro Vázquez, Felix Mauricio; et al.

Título: Intra-operative electron radiation therapy: an update of the evidence collected in 40 years to search for models for electron-FLASH studies

Revista: CANCERS

ISSN: 2072-6694 Vol.14 N° 15 2022 págs. 3693

Resumen

Simple Summary Four decades ago, intraoperative electron radiation therapy (IOeRT) was developed to improve precision in local cancer treatment by combining real-time surgical exploration and resection with high-energy electron irradiation. The technology of ultra-high dose rate electron and other radiation beams known as FLASH irradiation sharply increases its interests, as data from preclinical experiments have proven a marked favorable effect on the therapeutic index: similar cancer control with a clearly improved tolerance of many normal tissues to high doses of irradiation. The knowledge and tools regarding technology, physics, biology, and preclinical results in heterogeneous cancers opens great opportunities towards the path of developing the first clinical applications of the emerging FLASH technology via clinical trials based on state-of-the-art medical practice with IOeRT. Introduction: The clinical practice and outcome results of intraoperative electron radiation therapy (IOeRT) in cancer patients have been extensively reported over 4 decades. Electron beams can be delivered in the promising FLASH dose rate. Methods and Materials: Several cancer models were approached by two alternative radiobiological strategies to optimize local cancer control: boost versus exclusive IOeRT. Clinical outcomes are revisited via a bibliometric search performed for the elaboration of ESTRO/ACROP IORT guidelines. Results: In the period 1982 to 2020, a total of 19,148 patients were registered in 116 publications concerning soft tissue sarcomas (9% of patients), unresected and borderline-resected pancreatic cancer (22%), locally recurrent and locally advanced rectal cancer (22%), and breast cancer (45%). Clinical outcomes following IOeRT doses in the range of 10 to 25 Gy (with or without external beam fractionated radiation therapy) show a wide range of local control from 40 to 100% depending upon cancer site, histology, stage, and treatment intensity. Constraints for normal tissue tolerance are important to maintain tumor control combined with acceptable levels of side effects. Conclusions: IOeRT represents an evidence-based approach for several tumor types. A specific risk analysis for local recurrences supports the identification of cancer models that are candidates for FLASH studies.
Autores: Zapatero, A. (Autor de correspondencia); Calvo Manuel, Felipe; González San-Segundo, C.; et al.

Título: Reply to Leonard P. Bokhorst and Berdine L. Heesterman's Words of Wisdom re: High-dose Radiotherapy and Risk-adapted Androgen Deprivation in Localised Prostate Cancer (DART 01/05): 10-Year Results of a Phase 3Randomised, Controlled Trial. Eur Urol. 2022;82:441

Revista: EUROPEAN UROLOGY

ISSN: 0302-2838 Vol.82 N° 6 2022 págs. E177 - E178
Autores: Leal Lorenzo, José ignacio (Autor de correspondencia); Gallardo Madueño, Guillermo; Alcazar Peral, Andrés; et al.

Título: Bilateral ovarian vein embolisation from a unilateral basilic approach with n-2-Butyl cyanoacrylate and crossover technique for pelvic congestion syndrome

Revista: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

ISSN: 1078-5884 Vol.63 N° 1 2022 págs. 163 - 164
Autores: Rodríguez Pérez, María (Autor de correspondencia); Milla, L.

Título: What is the real value of predictive models?

Revista: TRANSLATIONAL LUNG CANCER RESEARCH

ISSN: 2218-6751 Vol.11 N° 11 2022 págs. 2178-2180
Autores: Rodríguez Garijo, Nuria; Tomás Velázquez, Alejandra; Estenaga Pérez de Albéniz, Ángela; et al.

Título: Granuloma annulare subtypes: sonographic features and clinicopathological correlation

Revista: JOURNAL OF ULTRASOUND

ISSN: 1971-3495 Vol.25 N° 2 2022 págs. 289 - 295

Resumen

Purpose Diagnosis of granuloma annulare (GA) is based on the clinical and histopathological findings. However, only sporadic case reports of subcutaneous GA sonography have been published to date. The objective of this study was to evaluate the ultrasonographic patterns of the different clinical variants of GA: localized, generalized, subcutaneous, and perforating. Methods In this retrospective observational study, we analyzed and correlated the clinical, histopathological, and sonographic features of 15 patients diagnosed with GA. Results We included 8 women and 7 men with a mean age of 48.4 years (8-77 years). We found three different sonographic patterns depending on the clinical variant of GA: poorly defined hypoechoic band including the dermis (dermal pattern), irregularly shaped hypoechoic hypodermal lumps (hypodermal pattern), and ill-defined hypoechoic dermal and subcutaneous lesions (mixed pattern). Five cases showed increased blood flow signal on Doppler interrogation. Conclusion Although our findings are broadly consistent with the previous reports of subcutaneous GA, the sonographic features in localized, generalized, and perforating GA have not been previously reported.
Autores: Ornilla Laraudogoitia, Enrique Tomás (Autor de correspondencia); Sancho Rodriguez, Lidia; Beorlegui, C.; et al.

Título: Diagnostic value of quantitative SPECT/CT in assessing active sacroiliitis in patients with axial spondylarthritis and/or inflammatory low back pain

Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA

ISSN: 1137-6627 Vol.45 N° 1 2022 págs. e0953

Resumen

Background. The diagnostic accuracy of bone scintigraphy (BS) increases with SPECT/CT imaging. It would therefore be appropriate to reassess the diagnostic utility of scintigraphy in sacroiliitis with axial spondyloarthritis (SpA). The aim of this study was to compare the diagnostic performance of MRI, SPECT/CT and a combination of both techniques in sacroiliitis, and to evaluate the correlation between quantitative SPECT/CT indices and quantitative MRI inflammatory lesion scores. Methods. Thirty-one patients with active SpA and 22 patients with inflammatory low back pain underwent MRI and SPECT/ CT of the sacroiliac joints. The diagnostic accuracy of both techniques was calculated using clinical diagnosis as the gold standard. The correlation between MRI and SPECT/CT was calculated by comparing the SPECT/CT activity indices and the Berlin/ SPARCC scoring systems for MRI. Results. The sensitivity and specificity values in quantitative SPECT/CT, taking the sacroiliac/promontory ratio of >1.36 as the cut-off value, were close to those from MRI published in the literature. The combination of both techniques increased sensitivity while maintaining high specificity. There was a moderate correlation between SPECT/CT and MRI total scores. This correlation was improved by using solely the MRI inflammation scores. Conclusion. Quantitative SPECT/CT showed better diagnostic accuracy than planar scintigraphy and showed a moderate correlation with MRI scores in active sacroiliitis. The combination of both tests increased the diagnostic accuracy. Quantitative SPECT/CT could play a relevant role in the diagnosis of active sacroiliitis in patients with high a suspicion of SpA and a negative/inconclusive MRI test or in patients with whom MRI studies cannot be carried out. Keywords. Diagnoses. Sacroiliitis. Spondyloarthritis. Bone scintigraphy. Magnetic resonance imaging.
Autores: Bertoglio, P. (Autor de correspondencia); Ventura, L.; Aprile, V.; et al.

Título: Prognostic role of standard uptake value according to pathologic features of lung adenocarcinoma

Revista: TUMORI

ISSN: 0300-8916 Vol.108 N° 5 2022 págs. 461 - 469

Resumen

Objective: To evaluate the influence of lung adenocarcinoma second predominant pattern on the maximal standard uptake value (SUVmax) and its prognostic effect in different histologic groups. Methods: We retrospectively collected surgically resected pathologic stage I and II lung adenocarcinoma from nine European institutions. Only patients who underwent preoperative PET-CT and with available information regarding SUVmax of T (SUVmaxT) and N1 (SUVmaxN1) component were included. Results: We enrolled 344 patients with lung adenocarcinoma. SUVmaxT did not show any significant relation according to the second predominant pattern (p = 0.139); this relationship remained nonsignificant in patients with similar predominant pattern. SUVmaxT influenced the disease-free survival in the whole cohort (p = 0.002) and in low- and intermediate-grade predominant pattern groups (p = 0.040 and p = 0.008, respectively). In the high-grade predominant pattern cohort and in the pathologic N1 cases, SUVmaxT lost its prognostic power. SUVmaxN1 did not show any significant correlation with predominant and second predominant patterns and did not have any prognostic impact on DFS. Conclusions: SUVmaxT is influenced only by the adenocarcinoma predominant pattern, but not by second predominant pattern. Concurrently, in high-grade predominant pattern and pN1 group the prognostic power of SUVmaxT becomes nonsignificant.
Autores: Lazcanoiturburu, N.; García-Sáez, J.; González-Corralejo, C.; et al.

Título: Lack of EGFR catalytic activity in hepatocytes improves liver regeneration following DDC-induced cholestatic injury by promoting a pro-restorative inflammatory response

Revista: JOURNAL OF PATHOLOGY

ISSN: 0022-3417 Vol.258 N° 3 2022 págs. 312 - 324

Resumen

Despite the well-known hepatoprotective role of the epidermal growth factor receptor (EGFR) pathway upon acute damage, its specific actions during chronic liver disease, particularly cholestatic injury, remain ambiguous and unresolved. Here, we analyzed the consequences of inactivating EGFR signaling in the liver on the regenerative response following cholestatic injury. For that, transgenic mice overexpressing a dominant negative mutant human EGFR lacking tyrosine kinase activity (Delta EGFR) in albumin-positive cells were submitted to liver damage induced by 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC), an experimental model resembling human primary sclerosing cholangitis. Our results show an early activation of EGFR after 1-2 days of a DDC-supplemented diet, followed by a signaling switch-off. Furthermore, Delta EGFR mice showed less liver damage and a more efficient regeneration following DDC injury. Analysis of the mechanisms driving this effect revealed an enhanced activation of mitogenic/survival signals, AKT and ERK1/2-MAPKs, and changes in cell turnover consistent with a quicker resolution of damage in response to DDC. These changes were concomitant with profound differences in the profile of intrahepatic immune cells, consisting of a shift in the M1/M2 balance towards M2 polarity, and the Cd4/Cd8 ratio in favor of Cd4 lymphocytes, overall supporting an immune cell switch into a pro-restorative phenotype. Interestingly, Delta EGFR livers also displayed an amplified ductular reaction, with increased expression of EPCAM and an increased number of CK19-positive ductular structures in portal areas, demonstrating an overexpansion of ductular progenitor cells. In summary, our work supports the notion that hepatocyte-specific EGFR activity acts as a key player in the crosstalk between parenchymal and non-parenchymal hepatic cells, promoting the pro-inflammatory response activated during cholestatic injury and therefore contributing to the pathogenesis of cholestatic liver disease. (c) 2022 The Pathological Society of Great Britain and Ireland.
Autores: Baldini, C. (Autor de correspondencia); Younan, N.; Castañón Álvarez, Eduardo; et al.

Título: Genome-driven medicine for patients with recurrent glioma enrolled in early phase trials

Revista: EUROPEAN JOURNAL OF CANCER

ISSN: 0959-8049 Vol.163 2022 págs. 98 - 107

Resumen

Background: Recent studies showed that patients with glioma can safely participate in early phase clinical trials; however, clinical benefits in this population were limited. We aimed to evaluate the benefit of molecular profiling to guide enrolment in early phase trials for patients with recurrent glioma.Methods: Records of patients enrolled in early phase trials of cytotoxic therapies, small molecule inhibitors or monoclonal antibodies from 2008 to 2018 were reviewed for clinicopathological characteristics, toxicity, response, progression-free survival and overall survival (OS). The primary objective was to evaluate response rates in molecularly-oriented versus non-molecularly-oriented patients.Results: Eighty-eight patients were enrolled, of whom 45 (51.1%) patients were molecularly oriented. Targets included IDH1/2 (n = 15), BRAF (n = 11), and FGFR1 (n = 3) mutations, FGFR2-3 fusions (n = 9), and mismatch repair deficiency (n = 7). Among patients with highgrade glioma (n = 74), the rate of stable disease >= 6 months and partial or complete response was 25.7% in molecularly-oriented versus 5.1% in non-molecularly-oriented patients (p = 0.02). Upon multivariable adjustment, baseline steroid use >= 20 mg prednisone equivalent per day was associated with shorter OS (OR 3.15 [95% CI 1.62-6.13], p = 0.0008), while molecular enrichment strategy was associated with longer OS (OR 0.40 [95% CI 0.22-0.73], p = 0.003). Nine (10.2%) patients experienced grade 3-4 toxicity and no dose limiting toxicity (DLT) occurred in both cohorts.Conclusion: The use of molecular profiling to guide enrolment in early phase trials is feasible and might provide benefits to selected patients with glioma. Further studies are warranted to confirm these results in larger randomised settings and identify the patients most likely to benefit from this approach.
Autores: Bermejo-Peláez, D.; San José Estépar, R.; Fernández-Velilla, M.; et al.

Título: Deep learning-based lesion subtyping and prediction of clinical outcomes in COVID-19 pneumonia using chest CT

Revista: SCIENTIFIC REPORTS

ISSN: 2045-2322 Vol.12 N° 1 2022 págs. 9387

Resumen

The main objective of this work is to develop and evaluate an artificial intelligence system based on deep learning capable of automatically identifying, quantifying, and characterizing COVID-19 pneumonia patterns in order to assess disease severity and predict clinical outcomes, and to compare the prediction performance with respect to human reader severity assessment and whole lung radiomics. We propose a deep learning based scheme to automatically segment the different lesion subtypes in nonenhanced CT scans. The automatic lesion quantification was used to predict clinical outcomes. The proposed technique has been independently tested in a multicentric cohort of 103 patients, retrospectively collected between March and July of 2020. Segmentation of lesion subtypes was evaluated using both overlapping (Dice) and distance-based (Hausdorff and average surface) metrics, while the proposed system to predict clinically relevant outcomes was assessed using the area under the curve (AUC). Additionally, other metrics including sensitivity, specificity, positive predictive value and negative predictive value were estimated. 95% confidence intervals were properly calculated. The agreement between the automatic estimate of parenchymal damage (%) and the radiologists' severity scoring was strong, with a Spearman correlation coefficient (R) of 0.83. The automatic quantification of lesion subtypes was able to predict patient mortality, admission to the Intensive Care Units (ICU) and need for mechanical ventilation with an AUC of 0.87, 0.73 and 0.68 respectively. The proposed artificial intelligence system enabled a better prediction of those clinically relevant outcomes when compared to the radiologists' interpretation and to whole lung radiomics. In conclusion, deep learning lesion subtyping in COVID-19 pneumonia from noncontrast chest CT enables quantitative assessment of disease severity and better prediction of clinical outcomes with respect to whole lung radiomics or radiologists' severity score.
Autores: Li, Y.; Zheng, X. X.; Xie, F. F.; et al.

Título: Development and validation of the artificial intelligence (AI)-based diagnostic model for bronchial lumen identification

Revista: TRANSLATIONAL LUNG CANCER RESEARCH

ISSN: 2218-6751 Vol.11 N° 11 2022 págs. 2261 - 2274

Resumen

Background: Bronchoscopy is a key step in the diagnosis and treatment of respiratory diseases. However, the level of expertise varies among different bronchoscopists. Artificial intelligence (AI) may help them identify bronchial lumens. Thus, a bronchoscopy quality-control system based on AI was built to improve the performance of bronchoscopists.Methods: This single-center observational study consecutively collected bronchoscopy videos from Shanghai Chest Hospital and segmented each video into 31 different anatomical locations to develop an AI-assisted system based on a convolutional neural network (CNN) model. We then designed a single-center trial to compare the accuracy of lumen recognition by bronchoscopists with and without the assistance of the AI system.Results: A total of 28,441 qualified images of bronchial lumen were used to train the CNNs. In the cross-validation set, the optimal accuracy of the six models was between 91.83% and 96.62%. In the test set, the visual geometry group 16 (VGG-16) achieved optimal performance with an accuracy of 91.88%, and an area under the curve of 0.995. In the clinical evaluation, the accuracy rate of the AI system alone was 54.30% (202/372). For the identification of bronchi except for segmental bronchi, the accuracy was 82.69% (129/156). In group 1, the recognition accuracy rates of doctors A, B, a and b alone were 42.47%, 34.68%, 28.76%, and 29.57%, respectively, but increased to 57.53%, 54.57%, 54.57%, and 46.24% respectively when combined with the AI system. Similarly, in group 2, the recognition accuracy rates of doctors C, D, c, and d were 37.90%, 41.40%, 30.91%, and 33.60% respectively, but increased to 51.61%, 47.85%, 53.49%, and 54.30% respectively, when combined with the AI system. Except for doctor D, the accuracy of doctors in recognizing lumen was significantly higher with AI assistance than without AI assistance, regardless of their experience (P<0.001).Conclusions: Our AI system could better recognize bronchial lumen and reduce differences in the operation levels of different bronchoscopists. It could be used to improve the quality of everyday bronchoscopies.
Autores: de Jong, C.M.M.; Blondon, M.; Ay, C.; et al.

Título: Incidence and impact of anticoagulation-associated abnormal menstrual bleeding in women after venous thromboembolism

Revista: BLOOD

ISSN: 0006-4971 Vol.140 N° 16 2022 págs. 1764 - 1773

Resumen

Preliminary data and clinical experience have suggested an increased risk of abnormal uterine bleeding (AUB) in women of reproductive age treated with anticoagulants, but solid data are lacking. The TEAM-VTE study was an international multicenter prospective cohort study in women aged 18 to 50 years diagnosed with acute venous thromboembolism (VTE). Menstrual blood loss was measured by pictorial blood loss assessment charts at baseline for the last menstrual cycle before VTE diagnosis and prospectively for each cycle during 3 to 6 months of follow-up. AUB was defined as an increased score on the pictorial blood loss assessment chart (>100 or >150) or self-reported AUB. AUB-related quality of life (QoL) was assessed at baseline and the end of follow-up using the Menstrual Bleeding Questionnaire. The study was terminated early because of slow recruitment attributable to the COVID-19 pandemic. Of the 98 women, 65 (66%) met at least one of the 3 definitions of AUB during follow-up (95% confidence interval [CI], 57%-75%). AUB occurred in 60% of women (36 of 60) without AUB before VTE diagnosis (new-onset AUB; 95% CI, 47%-71%). Overall, QoL decreased over time, with a mean Menstrual Bleeding Questionnaire score increase of 5.1 points (95% CI, 2.2-7.9), but this decrease in QoL was observed only among women with new-onset AUB. To conclude, 2 of every 3 women who start anticoagulation for acute VTE experience AUB, with a considerable negative impact on QoL. These findings should be a call to action to increase awareness and provide evidence-based strategies to prevent and treat AUB in this setting.
Autores: Belda-Hofheinz, S.; Núñez-Ramos, R. (Autor de correspondencia); Germán-Díaz, M.; et al.

Título: Which is the best route to achieve nutritional goals in pediatric ECMO patients?

Revista: NUTRITION

ISSN: 0899-9007 Vol.93 2022 págs. 111497

Resumen

Objectives: Estimating caloric intake and choosing route of administration are fundamental in the nutritional support of patients being supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to review the nutritional intervention carried out in a pediatric cohort in a third-level hospital. Methods: This was a prospective descriptive study. Age, sex, underlying pathology, Pediatric Risk of Mortality score, ECMO indication, type of care, duration of ECMO support, and prognosis were collected. Type of nutritional support, route of administration, kcal/kg achieved, estimated energy requirements, and percentage of caloric objective (%CO) reached on days 3 and 5 after cannulation were recorded. Results: Twenty-four venoarterial ECMO runs in 23 patients over a period of 2 y were recorded. Of the 23 patients, 15 were <1 y of age. The underlying pathology in 56.5% was cardiac disease. Three groups were identified: parenteral nutrition (group 0, n = 7), enteral nutrition (group 1, n = 8), and mixed nutrition (group 2, n = 7). The median of the %CO was 33.34 (0-84) on day 3 and 87.75% (78.4-100) on day 5 of ECMO, respectively for group 0; 75.5 (42.25-98.5) and 85% (24.4-107.7) in group 1 and 68.7 (44.4-82.2) and 91.2% (35.5-92) in group 2 (P > 0.05). Children <12 mo of age and cardiac patients represented 85.71% and 71.43% of total patients in group 0. Among the eight episodes of exclusive enteral nutrition, no complications were identified. Conclusion: Enteral nutrition appears to be safe in the setting of hemodynamic stability and absence of contraindications and is equivalent to other nutritional interventions in terms of compliance with estimated energy requirements. (c) 2021 Elsevier Inc. All rights reserved.
Autores: de Winter, M. A.; Dorresteijn, J. A. N.; Ageno, W.; et al.

Título: Estimating Bleeding Risk in Patients with Cancer-Associated Thrombosis: Evaluation of Existing Risk Scores and Development of a New Risk Score

Revista: THROMBOSIS AND HAEMOSTASIS

ISSN: 0340-6245 Vol.122 N° 5 2022 págs. 818 - 829

Resumen

Background Bleeding risk is highly relevant for treatment decisions in cancer-associated thrombosis (CAT). Several risk scores exist, but have never been validated in patients with CAT and are not recommended for practice. Objectives To compare methods of estimating clinically relevant (major and clinically relevant nonmajor) bleeding risk in patients with CAT: (1) existing risk scores for bleeding in venous thromboembolism, (2) pragmatic classification based on cancer type, and (3) new prediction model. Methods In a posthoc analysis of the Hokusai VTE Cancer study, a randomized trial comparing edoxaban with dalteparin for treatment of CAT, seven bleeding risk scores were externally validated (ACCP-VTE, HAS-BLED, Hokusai, Kuijer, Martinez, RIETE, and VTE-BLEED). The predictive performance of these scores was compared with a pragmatic classification based on cancer type (gastrointestinal; genitourinary; other) and a newly derived competing risk-adjusted prediction model based on clinical predictors for clinically relevant bleeding within 6 months after CAT diagnosis with nonbleeding-related mortality as the competing event (CAT-BLEED). Results Data of 1,046 patients (149 events) were analyzed. Predictive performance of existing risk scores was poor to moderate (C-statistics: 0.50-0.57; poor calibration). Internal validation of the pragmatic classification and CAT-BLEED showed moderate performance (respective C-statistics: 0.61; 95% confidence interval [CI]: 0.56-0.66, and 0.63; 95% CI 0.58-0.68; good calibration). Conclusion Existing risk scores for bleeding perform poorly after CAT. Pragmatic classification based on cancer type provides marginally better estimates of clinically relevant bleeding risk. Further improvement may be achieved with CAT-BLEED, but this requires external validation in practice-based settings and with other DOACs and its clinical usefulness is yet to be demonstrated.
Autores: Ruiz Artacho, Pedro Celso (Autor de correspondencia); Lecumberri Villamediana, Ramón; Trujillo-Santos, J.; et al.

Título: Cancer histology and natural history of patients with lung cancer and venous thromboembolism

Revista: CANCERS

ISSN: 2072-6694 Vol.14 N° 17 2022 págs. 4127

Resumen

Simple Summary Cancer is a widely heterogeneous disease, and the natural history of patients with cancer-associated thrombosis may differ according to the cancer site. Lung cancer is the most common malignancy, and a leading cause of death. A number of studies in the literature suggest that patients with adenocarcinoma may have a worse outcome than those with squamous or other types of lung cancer. The aim of the current study was to assess the potential impact of lung cancer histology on the incidence rates of VTE recurrences, major bleeding, or death appearing during the course of anticoagulation, in patients with lung cancer and VTE. Our findings, obtained from a large series of consecutive patients with lung cancer and VTE (482 patients), reveal important differences between patients with adenocarcinoma vs. other histologies in their outcomes during anticoagulation. This might likely help to design better therapeutic strategies for patients with lung cancer. Background: In patients with lung cancer and venous thromboembolism (VTE), the influence of cancer histology on outcome has not been consistently evaluated. Methods: We used the RIETE registry (Registro Informatizado Enfermedad TromboEmbolica) to compare the clinical characteristics and outcomes during anticoagulation in patients with lung cancer and VTE, according to the histology of lung cancer. Results: As of April 2022, there were 482 patients with lung cancer and VTE: adenocarcinoma 293 (61%), squamous 98 (20%), small-cell 44 (9.1%), other 47 (9.8%). The index VTE was diagnosed later in patients with squamous cancer than in those with adenocarcinoma (median, 5 vs. 2 months). In 50% of patients with adenocarcinoma, the VTE appeared within the first 90 days since cancer diagnosis. During anticoagulation (median 106 days, IQR: 45-214), 14 patients developed VTE recurrences, 15 suffered major bleeding, and 218 died: fatal pulmonary embolism 10, fatal bleeding 2. The rate of VTE recurrences was higher than the rate of major bleeding in patients with adenocarcinoma (11 vs. 6 events), and lower in those with other cancer types (3 vs. 9 events). On multivariable analysis, patients with adenocarcinoma had a non-significantly higher risk for VTE recurrences (hazard ratio [HR]: 3.79; 95%CI: 0.76-18.8), a lower risk of major bleeding (HR: 0.29; 95%CI: 0.09-0.95), and a similar risk of mortality (HR: 1.02; 95%CI: 0.76-1.36) than patients with other types of lung cancer. Conclusions: In patients with lung adenocarcinoma, the rate of VTE recurrences outweighed the rate of major bleeding. In patients with other lung cancers, it was the opposite.
Autores: Tambas, M. (Autor de correspondencia); van der Laan, H. P.; Steenbakkers, R. J. H. M.; et al.

Título: Current practice in proton therapy delivery in adult cancer patients across Europe

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.167 2022 págs. 7 - 13

Resumen

Background and purpose: Major differences exist among proton therapy (PT) centres regarding PT delivery in adult cancer patient. To obtain insight into current practice in Europe, we performed a survey among European PT centres. Materials and methods: We designed electronic questionnaires for eight tumour sites, focusing on four main topics: 1) indications and patient selection methods; 2) reimbursement; 3) on-going or planned studies, 4) annual number of patients treated with PT. Results: Of 22 centres, 19 (86%) responded. In total, 4233 adult patients are currently treated across Europe annually, of which 46% consists of patients with central nervous system tumours (CNS), 15% head and neck cancer (HNC), 15% prostate, 9% breast, 5% lung, 5% gastrointestinal, 4% lymphoma, 0.3% gynaecological cancers. CNS are treated in all participating centres (n = 19) using PT, HNC in 16 centres, lymphoma in 10 centres, gastrointestinal in 10 centres, breast in 7 centres, prostate in 6 centres, lung in 6 centres, and gynaecological cancers in 3 centres. Reimbursement is provided by national health care systems for the majority of commonly treated tumour sites. Approximately 74% of centres enrol patients for prospective data registration programs. Phase II-III trials are less frequent, due to reimbursement and funding problems. Reasons for not treating certain tumour types with PT are lack of evidence (30%), reimbursement issues (29%) and/or technical limitations (20%). Conclusion: Across European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Lack of evidence for PT and reimbursement issues are the most reported reasons for not treating specific tumour types with PT.
Autores: Dezube, A. R. (Autor de correspondencia); Hirji, S.; Shah, R.; et al.

Título: Pre-COVID-19 national mortality trends in open and video-assisted lobectomy for non-small cell lung cancer

Revista: JOURNAL OF SURGICAL RESEARCH

ISSN: 0022-4804 Vol.274 2022 págs. 213 - 223

Resumen

Introduction: In the current era of episode-based hospital reimbursements, it is important to determine the impact of hospital size on contemporary national trends in surgical technique and outcomes of lobectomy. Methods: Patients aged >18 y undergoing open and video-assisted thoracoscopic surgery (VATS) lobectomy from 2008 to 2014 were identified using insurance claims data from the National Inpatient Sample. The impact of hospital size on surgical approach and outcomes for both open and VATS lobectomy were analyzed. Results: Over the 7-y period, 202,668 lobectomies were performed nationally, including 71,638 VATS and 131,030 open. Although the overall number of lobectomies decreased (30,058 in 2008 versus 27,340 in 2014, P < 0.01), the proportion of VATS lobectomies increased (24.0% versus 46.9%), and open lobectomies decreased (76.0% versus 53.0%, all P < 0.01). When stratified by hospital size, small hospitals had a significant increase in the proportion of open lobectomies (6.4%-12.2%; P 1/4 0.01) and trend toward increased number of VATS lobectomies (2.7%-12.2%). Annual mortality rates for VATS (range: 1.0%-1.9%) and open (range: 1.9%-2.4%) lobectomy did not significantly differ over time (all P > 0.05) but did decrease among small hospitals (4.1%-1.3% and 5.1%-1.1% for VATS and open, respectively; both P < 0.05). After adjusting for confounders, hospital bed size was not a predictor of in-hospital mortality. Conclusions: Utilization of VATS lobectomies has increased over time, more so among small hospitals. Mortality rates for open lobectomy remain consistently higher than VATS lo bectomy (range 0.4%-1.4%) but did not significantly differ over time. This data can help benchmark hospital performance in the future.
Autores: Kashyap, V. S. (Autor de correspondencia); So, K. L.; Schneider, P. A.; et al.

Título: One-year outcomes after transcarotid artery revascularization (TCAR) in the ROADSTER 2 trial

Revista: JOURNAL OF VASCULAR SURGERY

ISSN: 0741-5214 Vol.76 N° 2 2022 págs. 466 - 473.e1

Resumen

Objectives: Transcarotid artery revascularization (TCAR) is a carotid stenting technique that utilizes reversal of cerebral arterial flow to confer cerebral protection. Although carotid endarterectomy (CEA) remains the standard for treatment of symptomatic and asymptomatic carotid stenosis, the search for the optimal minimally invasive option for the high-risk surgical patient continues. The goal of the current study is to evaluate the 1-year safety and efficacy of TCAR in a prospective clinical trial. Methods: ROADSTER 2 is a prospective, open-label, single-arm, multicenter, post-approval registry for patients undergoing TCAR. All patients were considered high risk for CEA and underwent independent neurological assessments preoperatively, postoperatively, and had long-term clinical follow-up. The primary end point was incidence of ipsilateral stroke after treatment with the ENROUTE Transcarotid Stent System. Secondary end points included individual/composite rates of stroke, death, and perioperative myocardial infarction. Results: Between June 2016 and November 2018, 155 patients at 21 centers in the United States and one in the European Union were enrolled and represented a subset of the overall trial. Asymptomatic (n = 119; 77%) and symptomatic patients (n = 36; 23%) with high-risk anatomic (ie, high lesion, restenosis, radiation injury; 43%), physiologic (32%), or combined factors (25%) were enrolled. No patient suffered a perioperative myocardial infarction or stroke. Over the year, no patient had an ipsilateral stroke, but four patients died (2.6%), all from non-neurological causes. Additionally, a technical success rate of 98.7% with a low cranial nerve deficit rate of 1.3% was achieved. Conclusions: In patients with high risk factors, TCAR yields high technical success with a low stroke and death rate at 1 year. Further comparative studies with CEA are warranted.
Autores: del Olmo-García, M. D.; Moreno Villares, José Manuel; Álvarez-Hernández, J.; et al.

Título: Nutrición en cuidados paliativos: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.39 N° 4 2022 págs. 936 - 944

Resumen

Resumen Los cuidados paliativos proporcionan una atención integral que tiene en cuenta los aspectos físicos, emocionales, sociales y espirituales del paciente con enfermedad terminal y su entorno familiar. El tratamiento nutricional debe formar parte activa de los equipos de cuidados paliativos. La necesidad de iniciar o no un tratamiento nutricional sigue siendo, desde hace décadas, uno de los principales problemas éticos a los que se enfrentan los profesionales dedicados a la nutrición clínica. El origen de tal controversia radica, fundamentalmente, en cómo se consideran la nutrición y la hidratación: cuidado/soporte o tratamiento médico. Los objetivos fundamentales del tratamiento nutricional en los pacientes en cuidados paliativos deben ser otros: la mejoría de la calidad de vida, de la supervivencia o de ambas. La decisión de indicar o no el tratamiento nutricional en cuidados paliativos debe tomarse tras considerar el pronóstico, la calidad de vida y la relación ¿riesgo/beneficio¿. En relación a la alimentación por vía oral (con o sin suplementos orales), prevalece la idea de la ¿alimentación de confort¿, que se basa en intentos de alimentación oral hasta que se produzcan la incomodidad y/o el rechazo del paciente. No existen evidencias que justifiquen el uso de nutrientes específicos, aunque desde hace años se señala la posibilidad de lograr beneficios cuando se utilizan ácidos grasos omega-3 en los pacientes con cáncer. En cuanto al tratamiento nutricional (enteral o parenteral), en ausencia de evidencia, las decisiones sobre si iniciar una nutrición artificial en un paciente paliativo deben tomarse teniendo en cuenta los deseos y creencias del paciente y sus familiares, y basarse en el consenso del equipo interdisciplinar sobre los objetivos que se persiguen al iniciarla.
Autores: Castañón Álvarez, Eduardo; Sánchez-Arráez, A.; Jiménez-Fonseca, P.; et al.

Título: Bayesian interpretation of immunotherapy trials with dynamic treatment effects

Revista: EUROPEAN JOURNAL OF CANCER

ISSN: 0959-8049 Vol.161 2022 págs. 79 - 89

Resumen

Introduction: The mechanism of action of immune checkpoints inhibitors hinders the writing of rational statistical analysis plans for phase III randomised clinical trials (RCTs) because of their unpredictable dynamic effects. The purpose is to illustrate the advan-tages of Bayesian reporting of treatment efficacy analysis in immunotherapy RCTs, in contrast to frequentist reporting. Method: Fourteen RCTs (one with two pairwise comparisons) that failed to achieve their pri-mar y objective (overall survival, OS) were selected. These RCTs were reanalysed using Bayesian Cox models with dynamic covariate coefficients and time-invariant models. Results: The RCTs that met inclusion criteria were 7 lung cancer trials, various other tumours, with antiPD1, antiPDL1 or antiCTLA4 therapies. The minimum detectable effect (dS) was su-perior to the true benefit observed in all cases, in conditions of non-proportional hazards. Schoenfeld tests indicated the existence of PH assumption violations (p < 0.05) in 6/15 cases. The Bayesian Cox models revealed a probability of benefit > 79% in all the RCTs, with the therapeutic equivalence hypothesis unlikely. The OS curves diverged after a median of 9.1 months. Since the divergency, no non-proportionality was evinced in 13/15, while the Wald tests achieved p < 0.05 in 12/15 datasets. In all cases, the Bayesian Cox models with dynamic coefficients detected fluctuations of the hazard ratio, and increased 2-year OS was the most likely hypothesis. Conclusion: We recommend progressively implementing Bayesian and dynamic analyses in all RCTs of immunotherapy to interpret and assess the credibility of frequentist results.
Autores: Gimeno Morales, Marta; Martínez Monge, Rafael; Martínez Regueira, Fernando; et al.

Título: Four-fraction ultra-accelerated minimal breast irradiation in early breast cancer: the initial feasibility results of an institutional experience

Revista: BRACHYTHERAPY

ISSN: 1538-4721 Vol.21 N° 4 2022 págs. 475 - 486

Resumen

Purpose: To evaluate the feasibility, early toxicity, and clinical outcomes of early-breast cancer patients in a single-arm, phase I/II study of an ultra-accelerated, four-fraction schedule of minimal breast irradiation (4f-AMBI) using a multicatheter, minimally-invasive, intraoperative tumor bed implant (MITBI) during breast-conserving surgery (BCS). Methods and materials: Eligible women aged >40 years with clinically and radiologically confirmed, unifocal invasive or in situ ¿3 cm tumors were considered as potential candidates for MITBI during BCS. After the pathology report, patients who met APBI criteria received ultra-accelerated four-fractions irradiation (6.2 Gy BID x 4fx over 2 days) with perioperative HDR-brachytherapy (PHDRBT). Early complications, toxicity, clinical outcomes, and cosmetic results were analyzed. Results: Of 89 patients initially implanted, 60(67.4%) were definitively included in the 4f-AMBI-protocol. The median age was 64.4 years; the median CTV was 32.1 cc (6.9-75.4 cc), and the external-V100 was 43.1 cc (12.87-107 cc), representing 5% of the breast tissue irradiated with a median CTV D90 of 6.2 Gy (5.6-6.28 Gy). The entire local treatment (BCS&MITBI-4f-AMBI) was completed at a median of 8 days (4-10 days). The rate of early complications was 11%. There were no major complications. Acute skin-subcutaneous G1 toxicity was reported in 11.7%, and late G1 toxicity on 36.7%. After a median follow-up of 27 months (11-51 months), the local, elsewhere, locoregional and distant-control rates were 100%, 98.3%, 100%, and 100% respectively. The early-cosmetic evaluation was excellent-good in 94.5% of patients evaluated. Conclusions: Ultra-accelerated, four-fraction, minimal breast irradiation (4f-AMBI) using a minimally-invasive tumor bed implant procedure is safe, dosimetrically feasible, and shows small irradiated volumes. This program provides low toxicity rates and excellent short-term clinical and cosmesis outcomes.
Autores: Zapatero, A. (Autor de correspondencia); Guerrero, A.; Maldonado, X.; et al.

Título: High-dose radiotherapy and risk-adapted androgen deprivation in localised prostate cancer (DART 01/05): 10-year results of a phase 3 randomised, controlled trial

Revista: LANCET ONCOLOGY

ISSN: 1470-2045 Vol.23 N° 5 2022 págs. 671 - 681

Resumen

Background The optimal duration of androgen deprivation combined with high-dose radiotherapy in prostate cancer remains controversial. The DART 01/05 trial was designed to determine whether long-term androgen deprivation is superior to short-term androgen deprivation when combined with high-dose radiotherapy. The 5-year results showed that 2 years of adjuvant androgen deprivation combined with high-dose radiotherapy significantly improved biochemical control, metastasis, and overall survival, especially in patients with high-risk disease. In this report, we present the 10-year final results of the trial. Methods This open-label, phase 3, randomised, controlled trial was done in ten hospitals in Spain. The eligibility criteria included patients aged 18 years or older with histologically confirmed T1c to T3, N0, and M0 adenocarcinoma of the prostate, according to the 2002 classification of the American Joint Committee on Cancer, with intermediaterisk and high-risk factors, prostate-specific antigen (PSA) less than 100 ng/mL, and a Karnofsky performance score of at least 70%. Patients were randomly assigned (1:1) to receive 4 months of neoadjuvant and concomitant short-term androgen deprivation (STAD) plus high-dose radiotherapy (minimum dose 76 Gy; median dose 78 Gy) or to receive the same treatment followed by 24 months of adjuvant long-term androgen deprivation (LTAD), via a randomisation scheduled generated by Statistical Analysis Software programme (version 9.1) and an interactive web response system. Patients assigned to the STAD group received 4 months of neoadjuvant and concomitant androgen deprivation (oral flutamide 750 mg per day or oral bicalutamide 50 mg per day) with subcutaneous goserelin (2 months before and 2 months combined with high-dose radiotherapy). Anti-androgen therapy was added during the first 2 months of treatment. Patients assigned to LTAD continued with goserelin every 3 months for another 24 months. The primary endpoint was biochemical disease-free survival at 5 years. For this 10-year study we analysed overall survival, metastasis-free survival, biochemical disease-free survival, and cause-specific survival. Analysis was by intention to treat. This trial is closed and is registered at ClinicalTrials.gov (NCT02175212) and in the EU Clinical Trials Register (EudraCT 2005-000417-36). Findings Between Nov 7, 2005, and Dec 20, 2010, 355 patients were enrolled. One patient in the STAD group withdrew from the trial, hence 354 participants were randomly assigned to STAD (n=177) or LTAD (n=177). The median follow-up was 119,4 months (IQR 100, 6-124,3). The 10-year biochemical disease-free survival for LTAD was 70,2% (95% CI 63,1-77,3) and for STAD was 62,3% (54, 9-69,7; hazard ratio [ HR] 0,84; 95% CI 0 ,50- 1,43; p=0,52). At 10 years, overall survival was 78,4% (72,1-84 ,8) for LTAD and 73,3% (66,6-80,0) for STAD (HR 0 ,84; 95% CI 0,55-1,27; p=0,40), and metastasis- free survival was 76,0% (69,4- 82,7) for LTAD and 70, 9% (64,0-77 ,8) for STAD (HR 0,90; 95% CI, 0,37-2,19; p=0,81). For the subgroup of high-risk patients, the 10-year biochemical disease-free survival was 67,2% (57,2-77,2) for LTAD and 53,7% (43,3-64,1) for STAD (HR 0,90; 95% CI 0,49-1,64; p=0,73), the 10-year overall survival was 78,5% (69,6-87 ,3) for LTAD and 67,0% (57,3- 76,7) for STAD (HR 0,58; 95% CI 0,33-1,01; p=0,054), and the 10-year metastasis-free survival was 76,6% (95% CI 67,6-85 ,6) for LTAD and 65,0% (55,1-74,8) for STAD (HR 0,89; 95% CI 0,33-2,43; p=0, 82). Only 11 (3%) of 354 patients died from prostate cancer, all of them in the high-risk subgroup (five in the LTAD group and six in the STAD group). 76 (21%) patients died from other causes (mainly second malignancies in 31 [9%] and cardiovascular disease in 21 [6%]). No treatment-related deaths were observed. Interpretation After an extended 10-year follow-up, we were unable to support the significant benefit of LTAD reported at 5 years. However, the magnitude of the benefit was clinically relevant in high-risk patients. Intermediate-risk patients treated with high-dose radiotherapy do not benefit from LTAD. A biological characterisation with the inclusion of genomic testing is needed in the decision-making process.
Autores: Rodríguez Pérez, María; Sholl, L. M.; Wee, J. O. (Autor de correspondencia)

Título: Diffuse tracheobronchial neurofibromatosis and papillomatosis: key diagnostic aspects and treatment

Revista: ANNALS OF THORACIC SURGERY

ISSN: 0003-4975 Vol.113 N° 3 2022 págs. E192 - E195

Resumen

Diffuse tracheobronchial neurofibromatosis is a rare condition, and its clinical manifestations include obstruction, cough, wheezing, and dyspnea. Furthermore limited data make treatment decisions challenging. In addition airway papillomatosis tends to affect the upper airway and the larynx in the form of well-delimited lesions leading to obstruction, predominantly in children. Diffuse involvement of the trachea and the bronchial tree and its association with neurofibromatosis have been rarely reported in adults. We present a patient diagnosed with neurofibromatosis of the trachea complicated by papillomatosis.
Autores: Calvo Manuel, Felipe (Autor de correspondencia); Ayestarán Aldaz, Adriana; Serrano Andreu, Francisco Javier; et al.

Título: Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect

Revista: FRONTIERS IN ONCOLOGY

ISSN: 2234-943X Vol.12 N° 1037262 2022 págs. 1037262 -*

Resumen

Background: Oligo-recurrent disease has a consolidated evidence of long-term surviving patients due to the use of intense local cancer therapy. The latter combines real-time surgical exploration/resection with high-energy electron beam single dose of irradiation. This results in a very precise radiation dose deposit, which is an essential element of contemporary multidisciplinary individualized oncology. Methods: Patient candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based on the institutional resources and expertise. Proton therapy was delivered by a synchrotron-based pencil beam scanning technology with energy levels from 70.2 to 228.7 MeV, whereas intraoperative electrons were generated in a miniaturized linear accelerator with dose rates ranging from 22 to 36 Gy/min (at Dmax) and energies from 6 to 12 MeV. Results: In a period of 24 months, 327 patients were treated with proton therapy: 218 were adults, 97 had recurrent cancer, and 54 required re-irradiation. The specific radiation modalities selected in five cases included an integral strategy to optimize the local disease management by the combination of surgery, intraoperative electron boost, and external pencil beam proton therapy as components of the radiotherapy management. Recurrent cancer was present in four cases (cervix, sarcoma, melanoma, and rectum), and one patient had a primary unresectable locally advanced pancreatic adenocarcinoma. In re-irradiated patients (cervix and rectum), a tentative radical total dose was achieved by integrating beams of electrons (ranging from 10- to 20-Gy single dose) and protons (30 to 54-Gy Relative Biological Effectiveness (RBE), in 10-25 fractions). Conclusions: Individual case solution strategies combining intraoperative electron radiation therapy and proton therapy for patients with oligo-recurrent or unresectable localized cancer are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams.
Autores: Bertoglio, P.; Aprile, V. (Autor de correspondencia); Ventura, L.; et al.

Título: Impact of High-Grade Patterns in Early-Stage Lung Adenocarcinoma: A Multicentric Analysis

Revista: LUNG

ISSN: 0341-2040 Vol.200 N° 5 2022 págs. 649 - 660

Resumen

Objective The presence of micropapillary and solid adenocarcinoma patterns leads to a worse survival and a significantly higher tendency to recur. This study aims to assess the impact of pT descriptor combined with the presence of high-grade components on long-term outcomes in early-stage lung adenocarcinomas. Methods We retrospectively collected data of consecutive resected pT1-T3N0 lung adenocarcinoma from nine European Thoracic Centers. All patients who underwent a radical resection with lymph-node dissection between 2014 and 2017 were included. Differences in Overall Survival (OS) and Disease-Free Survival (DFS) and possible prognostic factors associated with outcomes were evaluated also after performing a propensity score matching to compare tumors containing non-high-grade and high-grade patterns. Results Among 607 patients, the majority were male and received a lobectomy. At least one high-grade histological pattern was seen in 230 cases (37.9%), of which 169 solid and 75 micropapillary. T1a-b-c without high-grade pattern had a significant better prognosis compared to T1a-b-c with high-grade pattern (p = 0.020), but the latter had similar OS compared to T2a (p = 0.277). Concurrently, T1a-b-c without micropapillary or solid patterns had a significantly better DFS compared to those with high-grade patterns (p = 0.034), and it was similar to T2a (p = 0.839). Multivariable analysis confirms the role of T descriptor according to high-grade pattern both for OS (p = 0.024; HR 1.285 95% CI 1.033-1.599) and DFS (p = 0.003; HR 1.196, 95% CI 1.054-1.344, respectively). These results were confirmed after the propensity score matching analysis. Conclusions pT1 lung adenocarcinomas with a high-grade component have similar prognosis of pT2a tumors.
Autores: Jaureguizar, A.; Jiménez, D. (Autor de correspondencia); Bikdeli, B.; et al.

Título: Heart rate and mortality in patients with acute symptomatic pulmonary embolism

Revista: CHEST

ISSN: 0012-3692 Vol.161 N° 2 2022 págs. 524 - 534

Resumen

BACKGROUND: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. RESEARCH QUESTION: Does an association exist between baseline HR and PE outcome across the continuum of HR values? STUDY DESIGN AND METHODS: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad Trom-boEmbolica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. RESULTS: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of >= 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/ min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. INTERPRETATION: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.
Autores: Bertoglio, P. (Autor de correspondencia); Ventura, L.; Aprile, V.; et al.

Título: Pathological and clinical features of multiple cancers and lung adenocarcinoma: a multicentre study

Revista: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY

ISSN: 1569-9293 Vol.35 N° 1 2022 págs. ivac047

Resumen

OBJECTIVES: Lung cancer is increasingly diagnosed as a second cancer. Our goal was to analyse the characteristics and outcomes of early-stage resected lung adenocarcinomas in patients with previous cancers (PC) and correlations with adenocarcinoma subtypes. METHODS: We retrospectively reviewed data of patients radically operated on for stage I-II lung adenocarcinoma in 9 thoracic surgery departments between 2014 and 2017. Overall survival (OS) and time to disease relapse were evaluated between subgroups. RESULTS: We included 700 consecutive patients. PC were present in 260 (37.1%). Breast adenocarcinoma, lung cancer and prostate cancer were the most frequent (21.5%, 11.5% and 11.2%, respectively). No significant differences in OS were observed between the PC and non-PC groups (P = 0.378), with 31 and 75 deaths, respectively. Patients with PC had smaller tumours and were more likely to receive sublobar resection and to be operated on with a minimally invasive approach. Previous gastric cancer (P = 0.042) and synchronous PC (when diagnosed up to 6 months before lung adenocarcinoma; P = 0.044) were related, with a worse OS. Colon and breast adenocarcinomas and melanomas were significantly related to a lower incidence of high grade (solid or micropapillary, P = 0.0039, P = 0.005 and P = 0.028 respectively), whereas patients affected by a previous lymphoma had a higher incidence of a micropapillary pattern (P = 0.008). CONCLUSIONS: In patients with PC, we found smaller tumours more frequently treated with minimally invasive techniques and sublobar resection, probably due to a more careful follow-up. The impact on survival is not uniform and predictable; however, breast and colon cancers and melanoma showed a lower incidence of solid or micropapillary patterns whereas patients with lymphomas had a higher incidence of a micropapillary pattern.
Autores: Jiménez, D. (Autor de correspondencia); Rodríguez, C.; León, F.; et al.

Título: Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism

Revista: EUROPEAN RESPIRATORY JOURNAL

ISSN: 0903-1936 Vol.59 N° 2 2022 págs. 2100412

Resumen

Background The length of hospital stay (LOS) for acute pulmonary embolism (PE) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown. Methods We conducted a randomised controlled trial of adults hospitalised for acute PE: patients were assigned either to a prognostic assessment and management pathway involving risk stratification followed by predefined criteria for mobilisation and discharge (intervention group) or to usual care (control group). The primary end-point was LOS. The secondary end-points were the cost of prognostic tests and of hospitalisation, and 30-day clinical outcomes. Results Of 500 patients who underwent randomisation, 498 were included in the modified intention-to-treat analysis. The median LOS was 4.0 days (interquartile range (IQR) 3.7-4.2 days) in the intervention group and 6.1 days (IQR 5.7-6.5 days) in the control group (p<0.001). The mean total cost of prognostic tests was EUR 174.76 in the intervention group, compared with EUR 233.12 in the control group (mean difference EUR -58.37, 95% CI EUR -84.34 to -32.40). The mean total hospitalisation cost per patient was EUR 2085.66 in the intervention group, compared with EUR 3232.97 in the control group (mean difference EUR -1147.31, 95% CI EUR -1414.97 to -879.65). No significant differences were observed in 30-day readmission (4.0% versus 4.8%), all-cause mortality (2.4% versus 2.0%) or PE-related mortality (0.8% versus 1.2%) rates. Conclusions The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE.
Autores: Duan, J.; Tan, F.; Bi, N.; et al.

Título: Expert consensus on perioperative treatment for non-small cell lung cancer

Revista: TRANSLATIONAL LUNG CANCER RESEARCH

ISSN: 2218-6751 Vol.11 N° 7 2022 págs. 1247 - 1267
Autores: Jiménez, D. (Autor de correspondencia); Rodríguez, C.; Pintado, B.; et al.

Título: Effect of prognostic guided management of patients with acute pulmonary embolism according to the European Society of Cardiology risk stratification model

Revista: FRONTIERS IN CARDIOVASCULAR MEDICINE

ISSN: 2297-055X Vol.9 2022 págs. 872115

Resumen

Background: A recent trial showed that management driven by prognostic assessment was effective in reducing the length of stay (LOS) for acute stable pulmonary embolism (PE). The efficacy and safety of this strategy in each subgroup of risk stratification remains unknown. Methods: We conducted a post-hoc analysis of the randomized IPEP study to evaluate the effect of a management strategy guided by early use of a prognostic pathway in the low- and intermediate-high risk subgroups defined by the European Society of Cardiology (ESC) model. These subgroups were retrospectively identified in the control arm. The primary outcome was LOS. The secondary outcomes were 30-day clinical outcomes. Results: Of 249 patients assigned to the intervention group, 60 (24%) were classified as low-, and 30 (12%) as intermediate-high risk. Among 249 patients assigned to the control group, 66 (27%) were low-, and 13 (5%) intermediate-high risk. In the low-risk group, the mean LOS was 2.1 +/- 0.9) days in the intervention group and 5.3 (+/- 2.9) days in the control group (P < 0.001). In this group, no significant differences were observed in 30-day readmissions (0% vs. 3.0%, respectively), all-cause (0% vs. 0%) and PE-related mortality rates (0% vs. 0%), or severe adverse events (0% vs. 1.5%). In the intermediate-high risk group, the mean LOS was 5.3 (+/- 1.8) days in the intervention group and 6.5 (+/- 2.5) days in the control group (P = 0.08). In this group, no significant differences were observed in 30-day readmissions (3.3% vs. 3.0%, respectively), all-cause (6.7% vs. 7.7%) and PE-related mortality rates (6.7% vs. 7.7%), or severe adverse events (16.7% vs. 15.4%). Conclusion: The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE without comprising safety across subgroups of risk stratification.
Autores: Cubero, L.; Serrano Andreu, Francisco Javier; Calvo Manuel, Felipe; et al.

Título: DL-based OAR delineation for head and neck radiotherapy: accuracy versus computational resources

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.170 N° Suppl. 1 2022 págs. S1425 - S1426
Autores: Andre, T.; De Braud, F. G.; Jiménez-Rodríguez, B.; et al.

Título: Antitumor activity and safety of dostarlimab monotherapy in patients with mismatch repair deficient non-endometrial solid tumors: a post-hoc subgroup analysis of patients with colorectal cancer

Revista: JOURNAL OF CLINICAL ONCOLOGY

ISSN: 0732-183X Vol.40 N° 4 suppl. 2022 págs. 201
Autores: Meiriño Seoane, Rosa María; Calvo Manuel, Felipe; Burguete Mas, Javier; et al.

Título: Analysis of vascular and circular blood in radiation treatment planning: technological options

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.170 N° Supl. 1 2022 págs. S1670 - S1671
Autores: Toussaint, L.; Matysiak, W.; Muren, L. P.; et al.

Título: Proton pencil beam scanning and the brainstem in pediatric posterior fossa tumors: a European survey

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.170 N° Suppl. 1 2022 págs. S672 - S672
Autores: Jimenez, D.; Garcia-Sanchez, A.; Rali, P.; et al.

Título: Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019 A Systematic Review and Meta-analysis

Revista: CHEST

ISSN: 0012-3692 Vol.159 N° 3 2021 págs. 1182 - 1196

Resumen

BACKGROUND: Individual studies have reported widely variable rates for VTE and bleeding among hospitalized patients with coronavirus disease 2019 (COVID-19). RESEARCH QUESTION: What is the incidence of VTE and bleeding among hospitalized patients with COVID-19? METHODS: In this systematic review and meta-analysis, 15 standard sources and COVID-19-specific sources were searched between January 1, 2020, and July 31, 2020, with no restriction according to language. Incidence estimates were pooled by using random effects meta-analyses. Heterogeneity was evaluated by using the I-2 statistic, and publication bias was assessed by using the Begg and Egger tests. RESULTS: The pooled incidence was 17.0% (95% CI, 13.4-20.9) for VTE, 12.1% (95% CI, 8.4-16.4) for DVT, 7.1% (95% CI, 5.3-9.1) for pulmonary embolism (PE), 7.8% (95% CI, 2.6-15.3) for bleeding, and 3.9% (95% CI, 1.2-7.9) for major bleeding. In subgroup meta-analyses, the incidence of VTE was higher when assessed according to screening (33.1% vs 9.8% by clinical diagnosis), among patients in the ICU (27.9% vs 7.1% in the ward), in prospective studies (25.5% vs 12.4% in retrospective studies), and with the inclusion of catheter-associated thrombosis/isolated distal DVTs and isolated subsegmental PEs. The highest pooled incidence estimate of bleeding was reported for patients receiving intermediate- or full-dose anticoagulation (21.4%) and the lowest in the only prospective study that assessed bleeding events (2.7%). INTERPRETATION: Among hospitalized patients with COVID-19, the overall estimated pooled incidence of VTE was 17.0%, with higher rates with routine screening, inclusion of distal DVT, and subsegmental PE, in critically ill patients and in prospective studies. Bleeding events were observed in 7.8% of patients and were sensitive to use of escalated doses of anticoagulants and nature of data collection. Additional studies are required to ascertain the significance of various thrombotic events and to identify strategies to improve patient outcomes.
Autores: Moreno Aznar, L. A.; Vidal Carou, M. C.; López Sobaler, A. M.; et al.

Título: Papel del desayuno y su calidad en la salud de los niños y adolescentes en España

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.38 N° 2 2021 págs. 396 - 409

Resumen

Eating breakfast is a healthy habit that should be encouraged since childhood. When it provides nutritional quality, it is an important daily meal. The consumption of dairy products, cereals, and fruits at breakfast is associated with healthier dietary patterns, with a beneficial impact on the overall quality of the diet. In Spain, as in many other countries, the proportion of children who eat breakfast daily is very high, decreasing somewhat in adolescence. However, the quality of breakfast leaves room for improvement, with a low proportion of children/adolescents with high nutritional quality breakfasts. Children/adolescents who eat breakfast regularly have a higher intake of various nutrients (especially vitamins and minerals) than those who do not eat breakfast. Although the evidence is not entirely conclusive, numerous studies have shown various benefits when comparing the population that eats breakfast regularly versus those who do not, such as cardiometabolic risk parameters (obesity, diabetes, blood pressure and lipid profile) and cognitive functions. Breakfast should be included in healthy eating plans, since it allows incorporating foods that are difficult to consume in other meals and may contribute to reducing the risk of developing cardiometabolic diseases. In order to promote the intake of a healthy breakfast, it is essential to act on the sociodemographic and cultural factors that influence compliance and quality, such as age, nutritional education (mainly parents and children/adolescents, but also other family members, school mates, friends...), carrying it out as a family, adapting it to the tastes of each population and balancing quality and costs.
Autores: Serrano Andreu, Francisco Javier (Autor de correspondencia); Calvo Crespo, P.; Taboada, B.; et al.

Título: Postoperative radiotherapy in resected non-small cell lung cancer: The never-ending story

Revista: WORLD JOURNAL OF CLINICAL ONCOLOGY

ISSN: 2218-4333 Vol.12 N° 10 2021 págs. 833 - 844

Resumen

This manuscript collects in a joint and orderly manner the existing evidence at the present time about postoperative treatment with radiotherapy in non-small cell lung cancer. It also systematically reviews the current evidence, the international recommendations in the most relevant guidelines, the most controversial aspects in clinical and pathological staging, the specific technical aspects of radiotherapy treatment, and also collects all the potential risk factors that have been postulated as significant in the prognosis of these patients, evaluating the possibility of segmenting a particularly sensitive subpopulation with a high risk of relapse on which an adjuvant treatment with radiotherapy could have an impact on their clinical evolution. Finally, currently active trials that aspire to provide more evidence on this topic are reviewed.
Autores: Soriano, V.; Meiriño Seoane, Rosa María; Corral, O.; et al.

Título: Severe Acute Respiratory Syndrome Coronavirus 2 Antibodies in Adults in Madrid, Spain

Revista: CLINICAL INFECTIOUS DISEASES

ISSN: 1058-4838 Vol.72 N° 6 2021 págs. 1101 - 1102
Autores: García Martinez, Francisco Javier (Autor de correspondencia); Duat-Rodríguez, A.; Torrelo, A.; et al.

Título: Hypopigmented macules in neurofibromatosis type 1: A case control study

Revista: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

ISSN: 0190-9622 Vol.84 N° 4 2021 págs. 1128 - 1130
Autores: Roeder, F.; Calvo Manuel, Felipe; Asencio, J. M.; et al.

Título: Patterns of use of palliative radiotherapy fractionation for bone metastases and 30-day mortality response

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.154 2021 págs. 306 - 307
Autores: Lopez Martin, I.; Andres Esteban, E.; García Martinez, Francisco Javier (Autor de correspondencia)

Título: Relación entre la gravedad de la infección Covid-19 y el estado vacunal. Resultados de una encuesta anónima entre médicos de atención primaria

Revista: MEDICINA CLINICA

ISSN: 0025-7753 Vol.156 N° 3 2021 págs. 140 - 141
Autores: Castañón Álvarez, Eduardo; Sanchez Arraez, A.; Alvarez Mancenido, F.; et al.

Título: Erratum to "Critical reappraisal of phase III trials with immune checkpoint inhibitors in non-proportional hazards settings"

Revista: EUROPEAN JOURNAL OF CANCER

ISSN: 0959-8049 Vol.142 2021 págs. 152 - 153
Autores: Iscar Galan, Teresa (Autor de correspondencia); Arean Cuns, Carolina; Chiva de Agustín, Luis; et al.

Título: Ovarian yolk sac tumor

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 5 2021 págs. 797 - 798
Autores: Alonso Burgos, Alberto (Autor de correspondencia)

Título: Bariatric Embolization: A Procedure Dead or Alive?

Revista: CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY

ISSN: 0174-1551 Vol.44 N° 4 2021 págs. 607-609
Autores: Alonso Burgos, Alberto (Autor de correspondencia)

Título: Interventional Radiology Should be Competitive-If Haemorrhoids are Arteriovenous Connections, It is Now the Time for Liquids? Commentary on "Superior Rectal Artery Embolisation for Haemorrhoids: What do We Know so Far?"

Revista: CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY

ISSN: 0174-1551 Vol.44 N° 5 2021 págs. 686-688
Autores: Bertoglio, P. (Autor de correspondencia); Querzoli, G.; Ventura, L.; et al.

Título: Prognostic impact of lung adenocarcinoma second predominant pattern from a large European database

Revista: JOURNAL OF SURGICAL ONCOLOGY

ISSN: 1096-9098 Vol.123 N° 2 2021 págs. 560-569

Resumen

Background and objectives: Adenocarcinoma patterns could be grouped based on clinical behaviors: low- (lepidic), intermediate- (papillary or acinar), and high-grade (micropapillary and solid). We analyzed the impact of the second predominant pattern (SPP) on disease-free survival (DFS). Methods: We retrospectively collected data of surgically resected stage I and II adenocarcinoma. Selection criteria: anatomical resection with lymphadenectomy and pathological N0. Pure adenocarcinomas and mucinous subtypes were excluded. Recurrence rate and factors affecting DFS were analyzed according to the SPP focusing on intermediate-grade predominant pattern adenocarcinomas. Results: Among 270 patients, 55% were male. The mean age was 68.3 years. SPP pattern appeared as follows: lepidic 43.0%, papillary 23.0%, solid 14.4%, acinar 11.9%, and micropapillary 7.8%. The recurrence rate was 21.5% and 5-year DFS was 71.1%. No difference in DFS was found according to SPP (p = .522). In patients with high-grade SPP, the percentage of SPP, age, and tumor size significantly influenced DFS (p = .016). In patients with lepidic SPP, size, male gender, and lymph-node sampling (p = .005; p = .014; p = .038, respectively) significantly influenced DFS. Conclusions: The impact of SPP on DFS is not homogeneous in a subset of patients with the intermediate-grade predominant patterns. The influence of high-grade SPP on DFS is related to its proportion in the tumor.
Autores: Carriel Mancilla, J. (Autor de correspondencia); Jiménez Hernández, S.; Martín-Sánchez, F. J.; et al.

Título: Registro ESPHERIA: perfiles de pacientes con enfermedad tromboembólica venosa en urgencias y su asociación con el pronóstico a medio plazo

Revista: EMERGENCIAS

ISSN: 1137-6821 Vol.33 N° 2 2021 págs. 107 - 114

Resumen

Objetivos. Evaluar el pronóstico a 180 días de los pacientes diagnosticados de enfermedad tromboembólica venosa (ETV) en urgencias, en función de una clasificación por perfiles clínicos. Los objetivos secundarios fueron evaluar la mortalidad y el reingreso por todas las causas de manera individual, y describir las características clínicas y formas de presentación de trombosis venosa profunda (TVP) y tromboembolismo pulmonar (TEP), según dichos perfiles. Método. Análisis secundario del registro ESPHERIA que incluye pacientes consecutivos con ETV sintomática de 53 servicios de urgencias (SU). Se dividió la muestra en 4 perfiles: ETV no provocada (perfil 1), ETV provocada por factores de riesgo transitorios (perfil 2), cáncer (perfil 3) y baja reserva cardiopulmonar (perfil 4). La variable de resultado primaria fue la compuesta mortalidad o reingreso por cualquier causa a 180 días. Resultados. Se incluyeron 773 pacientes de los cuales 450 (58,2%) fueron clasificados en el perfil 1, 128 (16,6%) en el perfil 2, 115 pacientes (14,9%) en el perfil 3 y 80 (10,3%) en el perfil 4. Se documetaron diferencias demográficas, de comorbilidad, presentación clínica, tipo de ETV, manejo, ubicación y resultados entre los perfiles clínicos. Ciento noventa y cinco pacientes (25,2%) presentaron un resultado adverso compuesto a los 180 días, de los cuales 69 (8,9%) fallecieron y 179 (23,2%) sufrieron un nuevo ingreso por cualquier causa. La ETV asociada a baja reserva cardiopulmonar (HR 1,73; IC 95% 1,12-2,68; p = 0,01) y la ETV asociada a cáncer (HR 3,10; IC 95% 2,22-4,34; p < 0,001) se asociaron de forma independiente con sufrir un resultado adverso en los primeros 180 días. Conclusiones. Clasificar a los pacientes con ETV según factores de riesgo y comorbilidades en 4 perfiles (no provocada, provocada por factores transitorios, asociada a cáncer y asociada a baja reserva cardiopulmonar) resulta útil al momento del diagnóstico de la ETV para estimar el pronóstico en términos de mortalidad y reingreso a 180 días. Esta clasificación podría ayudar a establecer un plan de cuidados y seguimiento al alta en la ETV diagnosticada en urgencias.
Autores: Rodríguez Pérez, María; Dezube, A. R. (Autor de correspondencia); Bravo-Iñiguez, C. E.; et al.

Título: Impact of neoadjuvant chemoradiation on adverse events after bronchial sleeve resection

Revista: ANNALS OF THORACIC SURGERY

ISSN: 0003-4975 Vol.112 N° 3 2021 págs. 890 - 896

Resumen

Background. We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications. Methods. After instructional review board approval we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, and pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15. Results. We analyzed 136 patients (18 underwent neoadjuvant chemoradiation), 77 (57%) of whom had non-small cell lung cancer. Postoperative pulmonary complications were observed in 44 of 136 patients (32%). Incidences of pulmonary complications were higher in the neoadjuvant chemoradiation group compared with the non-neoadjuvant radiation group (15/18 patients [83%] vs 29/118 patients [25%], respectively; P < .001). Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, bronchopleural fistula, and completion pneumonectomy (2/18 [11%]) were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all cases except bronchial stenosis and prolonged air leak. Only neoadjuvant chemoradiation therapy remained significant for postoperative pulmonary and airway complications on logistic regression (both P < .05). Conclusions. Patients who undergo neoadjuvant chemoradiation before sleeve resection are at an increased risk of pulmonary and airway complications. (C) 2021 by The Society of Thoracic Surgeons
Autores: Jiménez, D. (Autor de correspondencia); Agustí, A.; Tabernero, E.; et al.

Título: Effect of a pulmonary embolism diagnostic strategy on clinical outcomes in patients hospitalized for COPD exacerbation: a randomized clinical trial

Revista: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

ISSN: 0098-7484 Vol.326 N° 13 2021 págs. 1277 - 1285

Resumen

Question Does an active search for pulmonary embolism (PE) improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD)? Findings This multicenter randomized clinical trial included 746 patients who required hospitalization for exacerbation of COPD and were randomized to receive usual care plus an active strategy for diagnosing PE or usual care alone. The primary outcome (a composite of nonfatal symptomatic venous thromboembolism, readmission for COPD, or death within 90 days after randomization) occurred in 29.7% of patients in the intervention group vs 29.2% in the control group, a difference that was not statistically significant. Meaning Among patients hospitalized for an exacerbation of COPD, addition of an active diagnostic strategy for PE to usual care compared with usual care alone did not improve a composite set of health outcomes. Importance Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). Objective To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation. Design, Setting, and Participants Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020). Interventions Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367). Main Outcomes and Measures The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected. Results Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, -6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, -2.0% [95% CI, -4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, -3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, -1.7% [95% CI, -5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, -1.9% to 1.8%]; P = .99). Conclusions and Relevance Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome. This randomized clinical trial examines the effect of an active strategy for the diagnosis of pulmonary embolism in addition to usual care on clinical outcomes, including nonfatal symptomatic venous thromboembolism, readmission for chronic obstructive pulmonary disorder (COPD), or death within 90 days after randomization, among individuals hospitalized for an exacerbation of COPD.
Autores: Barco, S.; Schmidtmann, I.; Ageno, W.; et al.

Título: Survival and quality of life after early discharge in low-risk pulmonary embolism

Revista: EUROPEAN RESPIRATORY JOURNAL

ISSN: 0903-1936 Vol.57 N° 2 2021 págs. 2002368

Resumen

Introduction: Early discharge of patients with acute low-risk pulmonary embolism requires validation by prospective trials with clinical and quality-of-life outcomes. Methods: The multinational Home Treatment of Patients with Low-Risk Pulmonary Embolism with the Oral Factor Xa Inhibitor Rivaroxaban (HoT-PE) single-arm management trial investigated early discharge followed by ambulatory treatment with rivaroxaban. The study was stopped for efficacy after the positive results of the predefined interim analysis at 50% of the planned population. The present analysis includes the entire trial population (576 patients). In addition to 3-month recurrence (primary outcome) and 1-year overall mortality, we analysed self-reported disease-specific (Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire) and generic (five-level five-dimension EuroQoL (EQ-5D-5L) scale) quality of life as well as treatment satisfaction (Anti-Clot Treatment Scale (ACTS)) after pulmonary embolism. Results: The primary efficacy outcome occurred in three (0.5%, one-sided upper 95% CI 1.3%) patients. The 1-year mortality was 2.4%. The mean +/- sD PEmb-QoL decreased from 28.9 +/- 20.6% at 3 weeks to 19.9 +/- 15.4% at 3 months, a mean change (improvement) of -9.1% ( p<0.0001). Improvement was consistent across all PFmb-Qol, dimensions. The EQ-5D-5L was 0.89 +/- 0.12 at 3 weeks after enrolment and improved to 0.91 +/- 0.12 at 3 months (p<0.0001). Female sex and cardiopulmonary disease were associated with poorer disease-specific and generic quality of life; older age was associated with faster worsening of generic quality of life. The ACTS burden score improved from 40.5 +/- 6.6 points at 3 weeks to 425 +/- 5.9 points at 3 months (p<0.0001). Conclusions: Our results further support early discharge and ambulatory oral anticoagulation for selected patients with low-risk pulmonary embolism. Targeted strategies may be necessary to further improve quality of life in specific patient subgroups.
Autores: Beddar Chaib, F.; Jiménez Hernández, S.; Pedrajas Navas, J. M.; et al.

Título: Characteristics of isolated superficial vein thrombosis and diagnostic-therapeutic management in Spanish hospital emergency departments: the ALTAMIRA study

Revista: EMERGENCIAS

ISSN: 1137-6821 Vol.33 N° 6 2021 págs. 433 - 440

Resumen

Objectives. To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy). Methods. Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy. ...
Autores: Garrido Martínez Salazar, Felipe (Autor de correspondencia); García Fernández, Pilar Montserrat; Gambra Arzoz, Marta Inmaculada; et al.

Título: Preferencias de los alumnos del grado de Medicina sobre el uso de redes sociales como herramienta docente

Revista: EDUCACION MEDICA

ISSN: 1575-1813 Vol.22 N° 5 2021 págs. 251 - 255

Resumen

Introducción Las redes sociales tienen un creciente potencial como herramienta educativa universitaria, pero existe poca evidencia sobre cuáles son las preferencias de los alumnos, y en qué condiciones prefieren utilizarlas. El objetivo de nuestro estudio ha sido identificar esas preferencias para favorecer un uso dirigido por el profesorado de Ciencias de la Salud. Métodos Hemos investigado las redes sociales preferidas de los alumnos del último curso del Grado de Medicina a través de un cuestionario online. Se ha realizado un análisis descriptivo de sus respuestas, y de relación estadística entre las mismas a través del cálculo de la chi-cuadrado. Resultados Han participado en el estudio un total de 147 alumnos, de una muestra de 220. Más del 80% consideraban que las redes sociales son una herramienta docente útil, y mostraban un interés moderado-máximo hacia el aprendizaje vehiculado a través de las mismas. De entre las redes sociales, las preferidas fueron Instagram y YouTube. Una mayoría desean recibir las «píldoras educativas» con una frecuencia moderada, y con contenido mixto (texto, imágenes, cuestionarios¿). Conclusión El uso de las redes sociales como herramienta docente suscita interés entre los alumnos, que se decantan por redes de contenido visual. Esta conectividad profesor-alumno podría favorecer el refuerzo de conceptos docentes y la comunicación bidireccional.
Autores: Fernandez Martinez, A. M. (Autor de correspondencia); Alonso Burgos, Alberto; Lopez, R.; et al.

Título: Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder

Revista: JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY

ISSN: 1051-0443 Vol.32 N° 4 2021 págs. 489 - 496

Resumen

Purpose: To assess the clinical outcomes of transcatheter arterial embolization (TAE) for secondary stiff shoulder (SSS). Materials and Methods: This is a retrospective analysis of prospectively collected data performed between January 2017 and December 2019. This study comprised 25 patients (20 women and 5 men; median age, 49 years; range 27-59) with SSS resistant to conservative management during at least 3 months. The median time of stiffness was 12 months. The etiology of SSS was postoperative in 14 patients (56%) and posttraumatic in the remaining 11 patients (44%). Periods of immobilization in all patients were associated. TAE was performed, and technical aspects, adverse events, changes for pain, and physical examination before and 6 months after TAE were assessed. Results: Abnormal vessels were observed in 20 of 25 (80%) of the procedures. Transitory cutaneous erythema was noted in 4 patients treated after TAE. Significant differences were observed in the median pain visual analog scale reduction between before and 6 months after TAE (8 vs 2, P <.001). Shoulder mobility significantly improved in both flexion and abduction degrees between before and at 6 months after TAE in (70 degrees vs 150 degrees; P <.001). No symptoms of recurrence appeared. Conclusions: TAE can result in pain reduction and mobility improvement in patients with SSS refractory to conservative therapy.
Autores: Madrigal, C.; Soto-Méndez, M. J.; Hernández-Ruiz, A.; et al.

Título: Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study

Revista: NUTRIENTS

ISSN: 2072-6643 Vol.13 N° 4 2021 págs. 1062

Resumen

Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler's milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.
Autores: Silberberg, A.; Paladino, M. S.; Moreno Villares, José Manuel

Título: An Ethical Pathway to Quality of Life in Critically Ill Newborns

Revista: THE NEW BIOETHICS

ISSN: 2050-2877 Vol.27 N° 2 2021 págs. 148 - 158

Resumen

Advances in perinatology have permitted the survival of fragile neonates. Quality of life (QoL) has been considered a key element in medical decision-making. In this review we analyse the role of QoL regarding the decision of withholding or withdrawing of life-sustaining treatment (LST). The role of QoL is debated because of the conceptual difficulties it raises. The lack of consensus on its definition and the difficulties in measuring it objectively, mean that basing clinical decisions solely on QoL has some risks. To avoid a purely subjective assessment, the principle of totality, and the principle of therapeutic adequacy should be considered. In case of uncertain prognosis, some therapeutic persistence seems reasonable. If this does not benefit the clinical condition of the child, then it may be no longer appropriate to continue the LST in case of severe disabilities. QoL is essential in medical decision-making, but is insufficient as the only criterion.
Autores: Rico, M.; Flamarique, S.; Casares, C.; et al.

Título: GOECP/SEOR radiotherapy guidelines for thymic epithelial tumours

Revista: WORLD JOURNAL OF CLINICAL ONCOLOGY

ISSN: 2218-4333 Vol.12 N° 4 2021 págs. 195 - 216

Resumen

Thymic epithelial tumours (TET) are rare, heterogeneous neoplasms that range from resectable indolent tumours to aggressive thymic carcinomas with a strong tendency to metastasize. The pathological diagnosis is complex, in part due to the existence of several different classification systems. The evidence base for the management of TETs is scant and mainly based on non-randomised studies and retrospective series. Consequently, the clinical management of TETs tends to be highly heterogenous, which makes it difficult to improve the evidence level. The role of technological advances in the field of radiotherapy and new systemic therapies in the treatment of TETs has received little attention to date. In the present clinical guidelines, developed by the GOECP/SEOR, we review recent developments in the diagnosis and classification of TETs. We also present a consensus-based therapeutic strategy for each disease stage that takes into consideration the best available evidence. These guidelines focus primarily on the role of radiotherapy, including recent advances, in the management of TETs. The main aim of this document is to promote the standardisation of clinical practice and lay the foundations for future studies to clarify the main unresolved questions related to the optimal management of TET.
Autores: Altali Alhames, K.; Martin-Sánchez, F. J. (Autor de correspondencia); Ruiz Artacho, Pedro Celso; et al.

Título: Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

Revista: REVISTA ESPAÑOLA DE QUIMIOTERAPIA

ISSN: 0214-3429 Vol.34 N° 3 2021 págs. 220 - 227

Resumen

Objective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.
Autores: Martinez, A. M. F. (Autor de correspondencia); Baldi, S. ; Alonso Burgos, Alberto; et al.

Título: Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment

Revista: CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY

ISSN: 0174-1551 Vol.44 N° 3 2021 págs. 443 - 451

Resumen

Purpose To evaluate the mid-term clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis (AC) resistant to medical treatments. Materials and Methods This is a prospective analysis performed between February 2016 and February 2020. Inclusion criteria for TAE were shoulder pain, restriction of movement and no response to conservative treatment for at least 3 months. Demographic variables, risk factors, technical aspects, adverse events, changes by visual analogue scale (VAS) for pain and physical examination before and after TAE were assessed. Results This study included 40 patients with AC (35 women and 5 men; mean age 50 +/- 9 years old). Abnormal vessels were observed in 31/40 (77.5%) procedures. As embolic agent, imipenem/cilastatin was used. The mean follow-up was 21.2 +/- 10.5 months. Significant differences were obtained in terms of pain reduction before and 6 months after TAE with the median visual analogue scale (VAS) of 8 vs. 0.5, P = 0.0001. Substantial differences were found regarding mobility in flexion and abduction before and 6 months after embolization, respectively (79.5 degrees +/- 18.5 degrees vs. 133 degrees +/- 24.5 degrees, P = 0.0001; 72.4 degrees +/- 18.8 degrees vs. 129.7 degrees +/- 27.9 degrees, P = 0.0001). No complications occurred. Complete recovery was obtained in 37/40 (92.5%) patients and partial recovery in 2/40 (5%). No clinical recurrence appeared. Conclusions Clinical results of transcatheter arterial embolization with imipenem/cilastatin are effective and stable in the mid-term follow-up for patients presenting with AC resistant to conservative treatments.
Autores: Moreno Ajona, David; Álvarez Gómez, Laura; Manrique Huarte, Raquel; et al.

Título: VEMPs and dysautonomia assessment in definite cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS): a case series study

Revista: CEREBELLUM

ISSN: 1473-4222 Vol.20 N° 5 2021 págs. 717 - 723

Resumen

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a recently described slowly progressive ataxia with severe imbalance due to the compromise of three of the four sensory inputs for balance, leaving only vision unaffected. Bilateral vestibulopathy is present but saccular and utricular function, measured by vestibular evoked myogenic potentials (VEMPs), has not been widely studied in these patients. Dysautonomia has been reported but is not among the diagnostic criteria. We performed a database analysis to identify patients evaluated between 2003 and 2019 with probable diagnosis of CANVAS by using key words "bilateral vestibulopathy and/or cerebellar ataxia and/or sensory polyneuropathy." Five out of 842 met all conditions. Patients underwent neurological/neurootological exam, brain MRI, visually enhanced vestibulo-ocular reflex (VVOR) exam by high-speed video-oculography using video-Head Impulse Test (vHIT), VEMPs, neurophysiological studies, and genetic tests to exclude other causes of ataxia. Dysautonomia was addressed by the standardized survey of autonomic symptoms. All patients had clinically definite CANVAS as brain MRI showed vermal cerebellar atrophy, neurophysiological studies showed a sensory neuronopathy pattern (absent sensory action potentials), VVOR was abnormal bilaterally, and genetic tests ruled out other causes of ataxia including SCA 3 and Friedreich ataxia. Patients had at least 3 dysautonomic symptoms, including xerostomia/xerophthalmia (5/5). VEMP results varied among patients, ranging from normal to completely abnormal. We found inconsistent results with VEMPs. The utilization of VEMPs in more CANVAS cases will determine its utility in this syndrome. Dysautonomia may be included in the diagnostic criteria.
Autores: San José González, M. A.; Blesa Baviera, L. C.; Moreno Villares, José Manuel (Autor de correspondencia)

Título: Comedores preescolares y escolares: Guías, recomendaciones y normativa en España

Revista: ANALES DE PEDIATRIA

ISSN: 1695-4033 Vol.95 N° 1 2021 págs. 55.e1-55.e9

Resumen

Introduction: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community. Material and methods: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered. Results: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules. Conclusions: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations. (C) 2021 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.
Autores: Chaib, F. B.; Jiménez Hernández, S.; Pedrajas Navas, J. M.; et al.

Título: Características y manejo diagnóstico-terapéutico de los pacientes con trombosis venosa superficial aislada en los servicios de urgencias hospitalarios españoles: Estudio ALTAMIRA

Revista: EMERGENCIAS

ISSN: 1137-6821 Vol.33 N° 6 2021 págs. 433 - 440

Resumen

Objectives. To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy). Methods. Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy. Results. A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). ...
Autores: Chung, H. C.; Saada Bouzid, E.; Longo Munoz, F.; et al.

Título: Lenvatinib plus pembrolizumab for previously treated, advanced triple-negative breast cancer: Early results from the multicohort phase 2 LEAP-005 study

Revista: CANCER RESEARCH

ISSN: 0008-5472 Vol.81 N° 4 2021
Autores: Martín Pastor, Santiago Mariano; Calvo Manuel, Felipe; García-Consuegra López-Picazo, Alejandro; et al.

Título: 11C-methionine-PET scan for target delineation in patients treated with IMPT for CNS tumors

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.161 N° Supl. 1 2021 págs. S874 - S875
Autores: Bertoglio, P.; Aprile, V.; Ventura, L.; et al.

Título: High-Grade Patterns Cause the Upstaging of Lung Adenocarcinomas From T1 to T2a: A Multicentric Analysis

Revista: JOURNAL OF THORACIC ONCOLOGY

ISSN: 1556-0864 Vol.16 N° 10 (Supplement) 2021 págs. S856 - S856
Autores: Márquez-Rodas, I.; Dalle, S.; Castañón Álvarez, Eduardo; et al.

Título: Combination of radiomic and biomarker signatures as exploratory objective in a phase II trial with intratumoral BO-112 plus pembrolizumab for advanced melanoma

Revista: JOURNAL OF CLINICAL ONCOLOGY

ISSN: 0732-183X Vol.39 N° 15 2021
Autores: Márquez-Rodas, I. ; Fernández de Sanmamed Gutiérrez, Miguel; González-Cao, M.; et al.

Título: Phase 2 clinical study to evaluate the efficacy and safety of intratumoral BO-112 in combination with pembrolizumab in patients with advanced melanoma that have progressive disease on anti-PD-1-based therapy

Revista: CANCER RESEARCH

ISSN: 0008-5472 Vol.81 N° 13 Supl. S 2021
Autores: Márquez Rodas, I.; Saiag, P.; de la Cruz Merino, L.; et al.

Título: Preliminary results of a phase 2 study of intratumoral administration of BO-112 with pembrolizumab in patients with advanced melanoma that have progressive disease on anti-PD-1-based therapy

Revista: JOURNAL FOR IMMUNOTHERAPY OF CANCER

ISSN: 2051-1426 Vol.9 N° Supl. 2 2021 págs. A1011 - A1012
Autores: Tambas, M.; van der Laan, H. P.; Steenbakkers, R.; et al.

Título: Current practice for selection of adult patients for proton therapy across Europe

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.161 N° Supplement 1 2021 págs. S240 - S241
Autores: Bertoglio, P.; Ventura, L.; Aprile, V.; et al.

Título: Prognostic Impact of Second Predominant Pattern in Lung Adenocarcinoma: Analysis From a Large Multicentric European Database

Revista: JOURNAL OF THORACIC ONCOLOGY

ISSN: 1556-0864 Vol.16 N° 3 2021 págs. S281 - S281
Autores: Chung, H. C.; Lwin, Z.; Gómez-Roca, C.; et al.

Título: LEAP-005: A phase II multicohort study of lenvatinib plus pembrolizumab in patients with previously treated selected solid tumors-Results from the gastric cancer cohort.

Revista: JOURNAL OF CLINICAL ONCOLOGY

ISSN: 0732-183X Vol.39 N° 3 Supl. 2021 págs. 230 - 230
Autores: Gómez-Roca, C.; Yanez, E.; Im, S. A.; et al.

Título: LEAP-005: A phase II multicohort study of lenvatinib plus pembrolizumab in patients with previously treated selected solid tumors-Results from the colorectal cancer cohort

Revista: JOURNAL OF CLINICAL ONCOLOGY

ISSN: 0732-183X Vol.39 N° 3 Supl. 2021 págs. 94 - 94
Autores: Calvo Manuel, Felipe (Autor de correspondencia); Chera, B. S.; Zubizarreta, E. ; et al.

Título: The role of the radiation oncologist in quality and patient safety: A proposal of indicators and metrics

Revista: CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY

ISSN: 1040-8428 Vol.154 N° 103045 2020 págs. 1-8

Resumen

This manuscript represents a collaboration from an international group of quality and safety expert radiation oncologists. It is a position/review paper with the specific aim of defining the role of the radiation oncologist in quality and safety management. This manuscript is unique in that we recommend specific quality assurance/control tasks and correlated quality and indicators and safety measures that are the responsibility of the radiation oncologist. The article addresses the role of the radiation oncologist in quality and safety from a strong perspective of multidisciplinarity and teamwork. Our manuscript is "cross-cuffing" and applicable to radiation oncologist in any practice setting (i.e. low middle-income countries).
Autores: Moreno Villares, José Manuel (Autor de correspondencia)

Título: (Reseña) 101 alimentos saludables para tener en tu casa

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.37 N° 4 2020 págs. 886 - 886
Autores: Guillan, M. (Autor de correspondencia); Villacieros-Alvarez, J.; Bellido, S. ; et al.

Título: Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient

Revista: THROMBOSIS RESEARCH

ISSN: 0049-3848 Vol.193 2020 págs. 107 - 109
Autores: Carmona-Bayonas, A.; Jiménez-Fonseca, P.; Castañón Álvarez, Eduardo (Autor de correspondencia)

Título: A trial of lopinavir-ritonavir in Covid-19

Revista: NEW ENGLAND JOURNAL OF MEDICINE

ISSN: 0028-4793 Vol.382 N° 21 2020 págs. e68
Autores: García Martinez, Francisco Javier (Autor de correspondencia); Moreno Artero, Ester; Jahnke, Sandra

Título: SARS-CoV-2 and EBV coinfection

Revista: MEDICINA CLINICA

ISSN: 0025-7753 Vol.155 N° 7 2020 págs. 319 - 320
Autores: Rodríguez Pérez, María (Autor de correspondencia); Ferrari-Light, D. ; Wee, J. O.; et al.

Título: The need for structured thoracic robotic training: the perspective of an American Association for Thoracic Surgery surgical robotic fellow

Revista: ANNALS OF TRANSLATIONAL MEDICINE

ISSN: 2305-5839 Vol.8 N° 8 2020 págs. 557
Autores: Valle, H. A. (Autor de correspondencia); Ezquerra, P. G. ; Gonzalez, I. S. ; et al.

Título: Nonsuspected pulmonary embolism in the emergency department

Revista: EUROPEAN JOURNAL OF EMERGENCY MEDICINE

ISSN: 0969-9546 Vol.27 N° 5 2020 págs. 379 - 380
Autores: Schreiber, K.; Sciascia, S.; Bruce, I. N.; et al.

Título: Hydroxychloroquine in patients with rheumatic diseases during the COVID-19 pandemic: a letter to clinicians

Revista: THE LANCET. RHEUMATOLOGY

ISSN: 2665-9913 Vol.2 N° 12 2020 págs. E735-E736
Autores: Marijnen, C. A. M.; Peters, F. P.; Rodel, C. ; et al.

Título: International expert consensus statement regarding radiotherapy treatment options for rectal cancer during the COVID 19 pandemic

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.148 2020 págs. 213 - 215
Autores: Carmona-Bayonas, A.; Jiménez-Fonseca, P.; Arráez, A. S.; et al.

Título: Does active smoking worsen Covid-19?

Revista: EUROPEAN JOURNAL OF INTERNAL MEDICINE

ISSN: 0953-6205 Vol.77 2020 págs. 129 - 131

Resumen

Probably it does.
Autores: Chahuan, B. (Autor de correspondencia); Soza-Ried, C. ; Farina, A.; et al.

Título: Management plan for breast cancer during the COVID-19 pandemic. A single-institution alternative to treat early breast cancer patients in a short time

Revista: BREAST JOURNAL

ISSN: 1075-122X Vol.26 N° 8 2020 págs. 1603-1605
Autores: Refoyo Salicio, Elena (Autor de correspondencia); Artaiz Urdaci, Miguel; Hernández Hernández, Felipe

Título: Imagen TrueVue de dispositivos implantados en el tabique interauricular

Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA

ISSN: 0300-8932 Vol.73 N° 8 2020 págs. 662 - 662
Autores: Rodríguez Pérez, María (Autor de correspondencia)

Título: Stair-climbing test: beyond the height

Revista: THORAX

ISSN: 0040-6376 Vol.75 N° 9 2020 págs. 716 - 716
Autores: Cuadrado-Soto, E. ; Lopez-Sobaler, A. M. (Autor de correspondencia); Jimenez-Ortega, A. I. ; et al.

Título: Usual Dietary Intake, Nutritional Adequacy and Food Sources of Calcium, Phosphorus, Magnesium and Vitamin D of Spanish Children Aged One to dagger

Revista: NUTRIENTS

ISSN: 2072-6643 Vol.12 N° 6 2020 págs. 1787

Resumen

Bone problems in the population begin to be establish in childhood. The present study aims to assess the usual calcium, phosphorus, magnesium, and vitamin D intakes, along with the food sources of these nutrients, in Spanish children participating in the EsNuPI (Estudio Nutricional en Poblacion Infantil Espanola) study. Two 24 h dietary recalls were applied to 1448 children (1 to <10 years) divided into two sub-samples: one reference sample (RS) of the general population [n= 707] and another sample which exclusively included children consuming enriched or fortified milks, here called "adapted milks" (AMS) [n= 741]. Estimation of the usual intake shows that nutrient intake increased with age for all nutrients except vitamin D. Using as reference the Dietary Reference Values from the European Food Safety Authority (EFSA), calcium and magnesium intakes were found to be below the average requirement (AR) and adequate intake (AI), respectively, in a considerable percentage of children. Furthermore, phosphorus exceeded the AI in 100% of individuals and vitamin D was lower than the AI in almost all children studied. The results were very similar when considering only plausible reporters. When analyzing the food sources of the nutrients studied, milk and dairy products contributed the most to calcium, phosphorus, magnesium, and vitamin D. Other sources of calcium were cereals and vegetables; for phosphorus: meat, meat products, and cereals; for magnesium: cereals and fruits; and, for vitamin D: fish and eggs. These results highlight the desirability of improving the intake concerning these nutrients, which are involved in bone and metabolic health in children. The AMS group appeared to contribute better to the adequacy of those nutrients than the RS group, but both still need further improvement. Of special interest are the results of vitamin D intakes, which were significantly higher in the AMS group (although still below the AI), independent of age.
Autores: Martín Romano, Patricia; Castañón Álvarez, Eduardo; Ammari, Samy; et al.

Título: Evidence of pseudoprogression in patients treated with PD1/PDL1 antibodies across tumor types.

Revista: CANCER MEDICINE

ISSN: 2045-7634 Vol.9 N° 8 2020 págs. 2643 - 2652
Autores: Madrigal, C.; Soto-Mendez, M. J. ; Leis, R. (Autor de correspondencia); et al.

Título: Dietary Intake, Nutritional Adequacy and Food Sources of Total Fat and Fatty Acids, and Relationships with Personal and Family Factors in Spanish Children Aged One to dagger

Revista: NUTRIENTS

ISSN: 2072-6643 Vol.12 N° 8 2020

Resumen

We aimed to determine the usual intake of total fat, fatty acids (FAs), and their main food sources in a representative cohort of the Spanish pediatric population aged 1 to <10 years (n= 707) who consumed all types of milk and an age-matched cohort who consumed adapted milk over the last year (including follow-on formula, toddler's milk, growing-up milk, and fortified and enriched milks) (n= 741) who were participants in the EsNuPI study (in English, Nutritional Study in the Spanish Pediatric Population). Dietary intake, measured through two 24 h dietary recalls, was compared to the European Food Safety Authority (EFSA) and the Food and Agriculture Organization of the United Nations (UN-FAO) recommendations. Both cohorts showed a high intake of saturated fatty acids (SFAs), according to FAO recommendations, as there are no numerical recommendations for SFAs at EFSA. Also, low intake of essential fatty acids (EFAs; linoleic acid (LA) and alpha-linolenic acid (ALA)) and long-chain polyunsaturated fatty acids (LC-PUFA) of the n-3 series, mainly docosahexaenoic acid (DHA) were observed according to EFSA and FAO recommendations. The three main sources of total fat and different FAs were milk and dairy products, oils and fats, and meat and meat products. The consumption of adapted milk was one of the main factors associated with better adherence to the nutritional recommendations of total fat, SFAs, EFAs, PUFAs; and resulted as the main factor associated with better adherence to n-3 fatty acids intake recommendations. Knowledge of the dietary intake and food sources of total fat and FAs in children could help in designing and promoting effective and practical age-targeted guidelines to promote the consumption of EFA- and n-3 PUFA-rich foods in this stage of life.
Autores: Boluda, E. R. ; Ferreiro, S. R.; Moral, O. M.; et al.

Título: Experience With Teduglutide in Pediatric Short Bowel Syndrome: First Real-life Data

Revista: JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION

ISSN: 0277-2116 Vol.71 N° 6 2020 págs. 734 - 739

Resumen

Objectives: The aim of the study was to describe the experience with teduglutide of several Spanish hospitals in pediatric patients with SBS (SBS). Methods: Seventeen pediatric patients with intestinal failure associated with SBS were treated with teduglutide. Patients received 0.05 mg center dot kg(-1) center dot day(-1) of subcutaneous teduglutide. Patients' demographics and changes in parenteral nutrition (PN) needs, fecal losses, and citrulline level initially and at 3, 6, and 12 months were collected, as well as any adverse events. Results: Patients were receiving 55 ml center dot kg(-1) center dot day(-1) and 33 kcal center dot kg(-1) center dot day(-1) of parenteral supplementation on average at baseline (2 patients received only hydroelectrolytic solution). A total of 12/17 patients achieved parenteral independence: 3 patients after 3 months of treatment, 4 patients at 6 months, and 5 after 12 months. One patient discontinued treatment 1 year after the beginning as no changes in parenteral support or fecal losses were obtained. All others decreased their intravenous requirements by 50%. One patient suffered an episode of cholecystitis, and another one with a pre-existing cardiac disease, developed a cardiac decompensation. Conclusions: Teduglutide seems to be a safe and effective treatment in the pediatric SBS population with better results than in the pivotal study as well as in the adult population.
Autores: Calvo Manuel, Felipe; Sole, C.; Rutten, H.; et al.

Título: ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in primary locally advanced rectal cancer

Revista: CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY

ISSN: 2405-6308 Vol.25 2020 págs. 29-36
Autores: Rodríguez Pérez, María; Dezube, A. R. (Autor de correspondencia); Bravo-Iniguez, C. E.; et al.

Título: Impact of neoadjuvant chemoradiation on adverse events following bronchial sleeve resection

Revista: THE ANNALS OF THORACIC SURGERY

ISSN: 1552-6259 Vol.112 N° 3 2020 págs. 890-896

Resumen

BACKGROUND: We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with incidence of postoperative pulmonary and airway complications. METHODS: After IRB approval, we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15. RESULTS: We analyzed 136 patients (18 underwent neoadjuvant chemoradiation). 77 of the 136 patients (57%) had Non-Small-Cell Lung Cancer. Postoperative pulmonary complications were observed in 44/136 patients (32%). Incidence of pulmonary complications were higher in the neoadjuvant chemoradiation group compared to those without neoadjuvant radiation [15/18 patients (83%) vs. 29/118 patients (25%), p=0.000]. Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, broncho-pleural fistula and completion pneumonectomy [2/18 (11%)] were higher in the neoadjuvant chemoradiation group, reaching statistical significance in...
Autores: Batuecas-Caletrío, A.; Martínez-Carranza, R.; Núñez, G. M. G.; et al.

Título: Skull vibration-induced nystagmus in vestibular neuritis

Revista: ACTA OTO-LARYNGOLOGICA

ISSN: 0001-6489 Vol.140 N° 12 2020 págs. 995 - 1000

Resumen

Background As described by Dumas, an 80-100 Hz vibration applied to the mastoid produces a horizontal nystagmus, with quick phases beating away from the affected side in patients with unilateral vestibular loss (UVL). Aim/objectives To elucidate the characteristics of skull vibration-induced nystagmus (SVIN) in patients suffering from vestibular neuritis and how these characteristics are related to information provided by the video head impulse test (vHIT). Material and methods Sixty-three patients were enrolled to perform a vHIT to measure the gain in both ears. SVIN was induced with stimulation at 30 Hz, 60 Hz, and 100 Hz. The slow phase velocity (SPV) of the SVIN was measured. Results The SVIN test was positive in 25/63 patients at 30 Hz, 36/63 at 60 Hz and 46/63 at 100 Hz. Mean gain difference between both ears to obtain a positive SVIN at 30 Hz was observed to be 0.38 +/- 0.25, decreasing to 0.35 +/- 0.23 at 60 Hz, and 0.31 +/- 0.24 at 100 Hz (p = .025). We found a significant positive linear correlation between the gain asymmetry measured using horizontal vHIT and SPV in SVIN at 100 Hz. Conclusions and significance There is a close relationship between the difference in the gains of both ears as measured using VHIT and the SPV of the nystagmus induced by SVIN at 100 Hz.
Autores: Madrigal, C.; Soto-Mendez, M. J.; Hernández-Ruiz, A. ; et al.

Título: Energy intake, macronutrient profile and food sources of Spanish children aged one to < 10 years-Results from the EsNuPI study

Revista: NUTRIENTS

ISSN: 2072-6643 Vol.12 N° 4 2020 págs. 893

Resumen

The present study aimed to assess energy intake, nutrient profile and food sources in Spanish children participating in the EsNuPI ("Estudio Nutricional en Poblacion Infantil Espanola") study. Plausibility of energy intake and adequacy of nutrient intakes to international recommendations were analyzed in a final sample of 1448 subjects (728 boys and 720 girls) and one group representative of the 1 to <10 years old urban Spanish children (reference sample (n = 707)) who consumed milk and one of the same age who consumed adapted milk over the last year (adapted milk consumers sample (n = 741)) were compared. Both groups completed data of a face-to-face and a telephone 24-h dietary recalls. Both the reference and the adapted milk consumers samples reported an adequate daily energy intake (1503 kcal/day and 1404 kcal/day); and a high contribution to total energy from protein (16.5% and 15.6%) and fat (36.5% and 35.9%). Also, a high percentage of children from both samples were below the lower limit of the recommendations for carbohydrates (47.8% and 39.3%). As the percentage of plausible energy reporters was high for both groups (84.7% and 83.5%, respectively), data for the whole sample were analyzed. Milk and dairy, cereals, meat and derived products, fats and oils, bakery and pastry, fruits and vegetables contributed to about 80% of the total energy intake in both groups. However, the reference sample reported significantly more contribution to energy from cereals, meat and meat products, bakery and pastry and ready to cook/eat foods; meanwhile, the adapted milk consumers sample reported significantly more energy from milk and dairy products, fruits and eggs. Those results suggest that adapted milk consumers have better adherence to the food-based dietary guidelines. Further analyses are warranted to characterize food patterns and the quality of the diet in the EsNuPI study population.
Autores: Calvo Manuel, Felipe (Autor de correspondencia); Asencio, J. M. ; Roeder, F. ; et al.

Título: ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer

Revista: CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY

ISSN: 2405-6308 Vol.23 2020 págs. 91 - 99

Resumen

Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoradiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer. (C) 2020 The Author(s). Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.
Autores: Fastner, G. (Autor de correspondencia); Gaisberger, C. ; Kaiser, J.; et al.

Título: ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.149 2020 págs. 150 - 157

Resumen

The aim of this review is to provide a comprehensive overview of the role of intraoperative radiation therapy with electrons (IOERT) in breast conserving therapy (BCT), both as partial breast irradiation (PBI) as well as anticipated boost ("IOERT-Boost"). For both applications, the criteria for patient selection, technical details/requirements, physical aspects and outcome data are presented. IOERT as PBI: The largest evidence comes from Italian studies, especially the ELIOT randomized trial. Investigators showed that the rate of in-breast relapses (IBR) in the IOERT group was significantly greater than with whole breast irradiation (WBI), even when within the pre-specified equivalence margin. Tumour sizes >2 cm, involved axillary nodes, Grade 3 and triple negative molecular subtypes emerged as statistically significant predictors of IBR. For patients at low risk for in-breast recurrence (ASTRO/ESTRO recommendations), full dose IOERT was isoeffective with standard WBI. Hence, several national guidelines now include this treatment strategy as one of the standard techniques for PBI in carefully selected patients. IOERT Boost: The largest evidence for boost IOERT preceding WBI comes from pooled analyses performed by the European Group of the International Society of Intraoperative Radiation Therapy (ISIORT Europe), where single boost doses (mostly around 10 Gy) preceded whole-breast irradiation (WBI) with 50 Gy (conventional fractionation). At median follow-up periods up to ten years, local recurrence rates around 1% were observed for low risk tumours. Higher local relapse rates were described for grade 3 tumours, triple negative breast cancer as well as for patients treated after primary systemic therapy for locally advanced tumours. Even in this settings, long-term (>5y) local tumour control rates beyond 95% were achieved. These encouraging results are interpreted as being attributable to utmost precision in dose delivery (by avoiding a "geographic and/or temporal miss"), and the possible radiobiological superiority of a single high dose fraction, compared to the conventionally fractionated boost. IOERT also showed favourable results in terms of cosmetic outcome, assumedly thanks to the small treated volumes combined with complete skin sparing. (C) 2020 Elsevier B.V. All rights reserved.
Autores: Caliz, R. C. (Autor de correspondencia); Fontecha, P. D. D. ; Izquierdo, M. G. ; et al.

Título: Recommendations of the Spanish Rheumatology Society for Primary Antiphospholipid Syndrome. Part II: Obstetric Antiphospholipid Syndrome and Special Situations

Revista: REUMATOLOGIA CLINICA

ISSN: 1699-258X Vol.16 N° 2 2020 págs. 133 - 148

Resumen

Objective: The difficulty in diagnosis and the spectrum of clinical manifestations that can determine the choice of treatment for antiphospholipid syndrome (APS) has fostered the development of recommendations by the Spanish Society of Rheumatology (SER), based on the best possible evidence. These recommendations can serve as a reference for rheumatologists and other specialists involved in the management of APS. Methods: A panel of 4 rheumatologists, a gynaecologist and a haematologist with expertise in APS was created, previously selected by the SER through an open call or based on professional merits. The stages of the work were: identification of the key areas for the document elaboration, analysis and synthesis of the scientific evidence (using the Scottish Intercollegiate Guidelines Network, SIGN levels of evidence) and formulation of recommendations based on this evidence and formal assessment or reasoned judgement techniques (consensus techniques). Results: Forty-six recommendations were drawn up, addressing 5 main areas: diagnosis and evaluation, measurement of primary thromboprophylaxis, treatment for APS or secondary thromboprophylaxis, treatment for obstetric APS and special situations. These recommendations also include the role of novel oral anticoagulants, the problem of recurrences or the key risk factors identified in these subjects. This document reflects the last 25, referring to the areas of: obstetric APS and special situations. The document provides a table of recommendations and treatment algorithms. Conclusions: Update of SER recommendations on APS is presented. This document corresponds to part II, related to obstetric SAF and special situations. These recommendations are considered tools for decisionmaking for clinicians, taking into consideration both the decision of the physician experienced in APS and the patient. A part I has also been prepared, which addresses aspects related to diagnosis, evaluation and treatment. Published by Elsevier Espalia, S.L.U.
Autores: Calvo Manuel, Felipe; Sole, C.; Rutten, H,; et al.

Título: ESTRO/ACROP IORT recommendations for intraoperative radiation therapy in locally recurrent rectal cancer

Revista: CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY

ISSN: 2405-6308 Vol.24 2020 págs. 41-48
Autores: Barco, S.; Schmidtmann, I.; Ageno, W.; et al.

Título: Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial

Revista: EUROPEAN HEART JOURNAL

ISSN: 0195-668X Vol.41 N° 4 2020 págs. 509 - 518

Resumen

Aims To investigate the efficacy and safety of early transition from hospital to ambulatory treatment in low-risk acute PE, using the oral factor Xa inhibitor rivaroxaban. Methods and results We conducted a prospective multicentre single-arm investigator initiated and academically sponsored management trial in patients with acute low-risk PE (EudraCT Identifier 2013-001657-28). Eligibility criteria included absence of (i) haemodynamic instability, (ii) right ventricular dysfunction or intracardiac thrombi, and (iii) serious comorbidities. Up to two nights of hospital stay were permitted. Rivaroxaban was given at the approved dose for PE for >= 3 months. The primary outcome was symptomatic recurrent venous thromboembolism (VTE) or PE-related death within 3 months of enrolment. An interim analysis was planned after the first 525 patients, with prespecified early termination of the study if the null hypothesis could be rejected at the level of alpha = 0.004 (<6 primary outcome events). From May 2014 through June 2018, consecutive patients were enrolled in seven countries. Of the 525 patients included in the interim analysis, three (0.6%; one-sided upper 99.6% confidence interval 2.1%) suffered symptomatic non-fatal VTE recurrence, a number sufficiently low to fulfil the condition for early termination of the trial. Major bleeding occurred in 6 (1.2%) of the 519 patients comprising the safety population. There were two cancer-related deaths (0.4%). Conclusion Early discharge and home treatment with rivaroxaban is effective and safe in carefully selected patients with acute low-risk PE. The results of the present trial support the selection of appropriate patients for ambulatory treatment of PE.
Autores: Irazola Rosales, Leticia; Perales Molina, Alvaro; Aguilar Redondo, Pedro Borja; et al.

Título: Evaluación de la constancia de la energía empleando el sistema de imagen portal

Revista: REVISTA DE FÍSICA MÉDICA

ISSN: 1576-6632 Vol.21 N° 1 2020 págs. 33 - 40

Resumen

Objetivo: Presentar una metodología para el control diario de la calidad energética del haz en rutina clínica, alternativa al uso de sistemas comerciales, empleando el sistema de imagen portal en combinación con un par de piezas cilíndricas de aluminio.Método: Degradando externamente el haz de fotones, se consiguió una desviación en el parámetro representativo de la energía (PDD20,10: cociente de porcentaje de dosis a las profundidades de 20 y 10 cm, respectivamente) de en torno al 2%, considerada como clínicamente relevante. La metodología propuesta se validó para la detección de esta perturbación del haz. Resultados: Se observó que, de manera reproducible, el método era capaz de distinguir las desviaciones efectuadas en la energía del haz, y se establecieron unos valores umbral de alarma. Conclusiones: La metodología propuesta permite detectar desviaciones clínicamente relevantes de la energía, mediante el uso del sistema de imagen portal y dos piezas cilíndricas de aluminio. El sistema ha demostrado ser fiable y sencillo de implementar, sin requerir equipamiento adicional.
Autores: Castañón Álvarez, Eduardo; Sanchez-Arraez, A. ; Alvarez-Mancenido, F. ; et al.

Título: Critical reappraisal of phase III trials with immune checkpoint inhibitors in non-proportional hazards settings

Revista: EUROPEAN JOURNAL OF CANCER

ISSN: 0959-8049 Vol.136 2020 págs. 159 - 168

Resumen

Background: The dynamic effects of immune checkpoint inhibitors (ICIs) are a challenge when designing and analysing data in non-proportional hazards (PH) scenarios. Herein, we present the risk of making type II errors, affecting pharmacotherapeutic development when methods that assume constant effects are applied. Patients and methods: Individual patient data from six clinical trials (KEYNOTE-062/061, IMvigor211, CA184-143 y CheckMate-057/037) were extracted. The most relevant time-varying effects were examined using the Royston-Parmar spline model (RPSM), time-driven analyses and weighted log-rank and Renyi tests. Results: The RPSM yields an appropriate fit in non-PH contexts, enabling dynamic descriptions of the hazard rate, and time-varying differences of overall survival (OS)/progression-free survival. In the KEYNOTE-061, CheckMate-057 and 037 trials, 12-, 18-, and 24-month OS rates were higher with immunotherapy (differences of some 10%) (P-value <0.05). In KEYNOTE-062, CA184-043 and IMvigor-211 trials, OS rate differences were significant for past 20 months. Flemming-Harrington and Renyi tests with late weighting (e.g. with ¿-value = 0 and ¿-value = 1) captured the existence of significant differences on all curves. The Cox models and log-rank tests were inefficient at detecting the effect. Conclusion: This analysis highlights the risk of declaring studies with ICIs negative, despite associating substantial OS benefits. Effort and consensus are needed with respect to methodology to design and evaluate trials with ICIs in non-PH settings.
Autores: Counago, F. (Autor de correspondencia); Navarro-Martin, A. ; Luna, J. ; et al.

Título: GOECP/SEOR clinical recommendations for lung cancer radiotherapy during the COVID-19 pandemic

Revista: WORLD JOURNAL OF CLINICAL ONCOLOGY

ISSN: 2218-4333 Vol.11 N° 8 2020 págs. 510 - 527

Resumen

The coronavirus disease 2019 crisis has had a major and highly complex impact on the clinical practice of radiation oncology worldwide. Spain is one of the countries hardest hit by the virus, with devastating consequences. There is an urgent need to share experiences and offer guidance on decision-making with regard to the indications and standards for radiation therapy in the treatment of lung cancer. In the present article, the Oncological Group for the Study of Lung Cancer of the Spanish Society of Radiation Oncology reviews the literature and establishes a series of consensus-based recommendations for the treatment of patients with lung cancer in different clinical scenarios during the present pandemic.
Autores: Garcia-Vazquez, V. (Autor de correspondencia); Calvo Manuel, Felipe; Ledesma-Carbayo, M. J.; et al.

Título: Intraoperative computed tomography imaging for dose calculation in intraoperative electron radiation therapy: Initial clinical observations

Revista: PLOS ONE

ISSN: 1932-6203 Vol.15 N° 1 2020

Resumen

In intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown that intraoperative CT studies are not recommended when the procedure includes the use of shielding discs or surgical retractors unless metal artefacts are removed. IOERT dose distributions calculated under the conventional assumption or from preoperative CT studies may be inaccurate unless the air gap (which depends on the surface irregularities of the irradiated volume and on the applicator pose) is included in the calculations.
Autores: Roeder, F. (Autor de correspondencia); Morillo, V.; Saleh-Ebrahimi, L. ; et al.

Título: Intraoperative radiation therapy (IORT) for soft tissue sarcoma - ESTRO IORT Task Force/ACROP recommendations

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.150 2020 págs. 293 - 302

Resumen

Purpose: To describe guidelines for the use of intraoperative radiation therapy (IORT) in the treatment of soft-tissue sarcomas (STS). Methods: A panel of experts in the field performed a systematic literature review, supplemented their clinical experience and developed recommendations for the use of IORT in the treatment of STS. Results: Based on the evidence from the systematic literature review and the clinical experience of the panel members, recommendations regarding patient selection, incorporation into multimodal treatment concepts and the IORT procedure itself are made. The rationale for IORT in extremity and retroperitoneal STS is summarized and results of the major series in terms of patient and treatment characteristics, oncological outcome and toxicity are presented. We define surgical factors, volumes for irradiation, technical requirements, dose prescription, recording and reporting, treatment delivery and care during the course of IORT covering the main IORT techniques used for the treatment of STS. In extremity STS, evidence originates from a few small prospective and mainly from retrospective single centre studies. Based on those reports, IORT containing-approaches result in very high local control rates with low rates of acute and late toxicity. In retroperitoneal sarcomas, evidence is derived from one prospective randomized trial, a few prospective and a large number of retrospective studies. The randomized trial compared IORT combined with moderate doses of postoperative external-beam radiation therapy (EBRT) to high-dose postoperative EBRT alone after gross total resection, clearly favouring the IORT-containing approach. These results have been confirmed by the prospective and retrospective studies, which similarly showed high local control rates with acceptable toxicity, mainly favouring combinations of preoperative EBRT and IORT. Conclusions: IORT-containing approaches result in high rates of local control with low to acceptable toxicity rates. Based on the available evidence, we made recommendations for the use of IORT in STS. Clinicians and researchers are encouraged to use these guidelines in clinical routine as well as in the design of future trials. (c) 2020 Elsevier B.V. All rights reserved.
Autores: Leis, R. (Autor de correspondencia); Moreno Villares, José Manuel; Varela-Moreiras, G.; et al.

Título: Estudio Nutricional en Población Infantil de España (EsNuPI)

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.37 2020 págs. 3 - 7

Resumen

Introduction: promoting healthy lifestyles already from the pediatric age for prevention of diseases at a short, mid and long-term is compulsory worldwide. Objectives: to know eating patterns and dietary habits, physical activity and sedentary behaviours in urban Spanish children aged one to nine years old, no vegan, by evaluating the differences between standard milk consumers (RS) and milk formula (AMS). Methods: prospective, observational, cross-sectional study with 1,514 children. A food frequency questionnaire, a physical activity and sedentary behaviour questionnaire, and two 24-hour dietary recalls (one face-to-face and one by phone) were used. Results: the daily energy intake was significantly higher in the RS group (1,503 kcal vs 1,404 kcal). The contribution of protein and fat to the total caloric value of the diet is high, being for the first one significantly higher in RS (16.5 % vs 15.6 %). However, for carbohydrate is low and significantly higher in AMS (46.7 % vs 45.5 %). The contribution of the food groups to the energy intake present significant differences between the groups. Conclusions: Spanish children between 1-9 years old have an adequate, but slightly elevated energy intake than the recommendations. There is a high contribution of protein and fat, and low of carbohydrate to the total caloric value. AMS children have a higher adherence to dietary guidelines and nutritional recommendations and, therefore, a suggested higher diet quality.
Autores: Izquierdo-Garcia, E. (Autor de correspondencia); Escobar-Rodriguez, I. ; Moreno Villares, José Manuel; et al.

Título: Necesidades sociosanitarias en pacientes con intolerancia hereditaria a la fructosa en España

Revista: ENDOCRINOLOGIA DIABETES Y NUTRICION

ISSN: 2530-0180 Vol.67 N° 4 2020 págs. 253 - 262

Resumen

Introduction: Hereditary fructose intolerance is a metabolic disease due to an aldolase B deficiency. Our objective was to ascertain the social and health care needs of those with this deficiency. Material and methods: A prospective, observational study was performed. A survey of social and health care needs was conducted to hereditary fructose intolerance patients living in Spain. Results: Most patients had been diagnosed, mainly by genetic analysis in children and based on fructose overload in adults. Population surveyed had no sequelae (72.34%) or disability (64%), and 83.33% of children and 52.38% of adults were taking drugs (p < .05) (2.06 drugs on average). Most patients had attended medical visits in the past two years, mainly in metabolic disease units (42.5%) and/or nutrition units (42.5%), but less than a half attended reference centers (mostly children [p < 0.05]). Although 48% were satisfied with health care, they felt discriminated in recreational activities, school, health and/or daily activities. The most reliable sources of information were the specialized care physician (69.39%) and patients' association (59.18%). Fifty-five percent reported no problem in any quality of life dimension, although some had problems in daily activities, pain, and anxiety. Conclusions: Although hereditary fructose intolerance is less disabling than other rare diseases, it is important to know the needs of those who suffer from it. Although time to diagnosis has shortened, the poorer health care and satisfaction with it perceived in adults makes it necessary to emphasize the needs of this population, and the critical need of training and information of health care professionals. (C) 2019 SEEN y SEQ. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores: Samaniego-Vaesken, M. D.; Partearroyo, T. ; Valero, T. ; et al.

Título: Carbohydrates, Starch, Total Sugar, Fiber Intakes and Food Sources in Spanish Children Aged One to <10 Years-Results from the EsNuPI Study dagger

Revista: NUTRIENTS

ISSN: 2072-6643 Vol.12 N° 10 2020

Resumen

Diet quality is a modifiable factor that may contribute to the onset of diet-related chronic diseases. Currently, in Spain there are no studies that examine the intakes and sources for total carbohydrates, starch, total sugar, and fiber by both children consuming all kind of milks and children regularly consuming adapted milk formulas. Our goal was to evaluate the contribution of different food groups to total carbohydrates, starch, total sugar, and fiber consumption within the EsNuPI study participants by assessing their usual intakes by applying two 24 h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707) and another cohort which included children consuming adapted milks including follow-on milk, toddler's or growing up milk, fortified and enriched milks, here called Adapted Milk Consumers Cohort" (AMS) (n = 741). Estimation of the usual intake showed that nutrient intake increased with age for all nutrients except for fiber. The percentage of children by age and gender who met the reference intake (RI) range for total carbohydrates, was in all groups more than 50% of individuals, except for girls aged 6 to <10 years from the reference cohort in which only 46.9% complied the RI. Median fiber intake, both in the SRS and the AMS, was well below the adequate intake (AI) for children between 3 and 10 years. Main total carbohydrates sources were cereals, followed by milk and dairy products, fruits, bakery and pastry, vegetables and sugars and sweets. The highest contributors to starch intakes were cereals, bakery and pastry, vegetables, and fruits. Major sources of total sugar intakes were milk and dairy products, fruits, bakery and pastry, sugars and sweets, vegetables, and cereals. Nonetheless, milk and dairy products, and fruits, mainly provided lactose and fructose, respectively, which are not considered free sugars. Higher contribution to fiber intakes was provided by fruits, cereals, vegetables and bakery and pastry. There were no significant differences in relation with the total sugar intake according to the body mass index (BMI) between SRS and AMS. The present study suggests a high proportion of children had total carbohydrates intakes in line with recommendations by public health authorities, but still a significant number presented insufficient total carbohydrate and fiber intakes, while total sugar consumption was high, with no major differences between SRS and AMS cohorts.
Autores: Guajardo-Vergara, C. (Autor de correspondencia); Pérez Fernández, Nicolás

Título: A New and Faster Method to Assess Vestibular Compensation: A Cross-Sectional Study

Revista: LARYNGOSCOPE

ISSN: 0023-852X Vol.130 N° 12 2020 págs. E911 - E917

Resumen

Objectives/Hypothesis Characterize the state of vestibular compensation of subjects diagnosed with acute unilateral vestibulopathy (AUV) of peripheral origin according to the temporal organization pattern of the refixation saccades (Perez and Rey (PR) score). Study Design Retrospective cross-sectional study using previously collected clinical data from a tertiary referral center. Methods Following the vestibular compensation criteria defined by Eisenman, we used the video head impulse test as the main vestibular function test and compared the results with other traditional tests: rotatory chair test (ROT), caloric test, videonystagmography, clinical situation (CLIN), and the Dizziness Handicap Inventory (DHI) questionnaire from 28 subjects (17 men, 11 women), average age 60.21 years, who were in a compensated and noncompensated vestibular situation. We used the PR score to measure the differences between the study groups. A cluster was developed to define a cutoff point that objectively distinguishes the vestibular compensation status. Results Significant differences in the PR score were found in the state of vestibular compensation in the ROT test (P = .01), DHI (P = .04), and CLIN (P = .023). The vestibular compensation criteria that groups the original variables (PR-CLUSTER) cutoff point was 55 (P = .019). Conclusions The PR score is a measure of temporal organization of the refixation saccades that enables us to distinguish clearly and objectively the vestibular situation of subjects with AUV. We suggest its clinical application. Level of Evidence NA Laryngoscope, 2020
Autores: Suárez Vega, Victor Manuel (Autor de correspondencia); Domínguez Echávarri, Pablo Daniel; Caballeros Lam, Fanny Meylin; et al.

Título: Comparison between high-resolution 3D-IR with real reconstruction and 3D-flair sequences in the assessment of endolymphatic hydrops in 3 tesla

Revista: ACTA OTO-LARYNGOLOGICA

ISSN: 0001-6489 Vol.140 N° 11 2020 págs. 883-888

Resumen

Background The main sequences used to assess degree of endolymphatic hydrops (EH) are the 3D- inversion-recovery (IR) with real reconstruction and the 3D- fluid-attenuated inversion recovery (FLAIR). Objectives The purpose of this study is to describe and compare both sequences. Material and methods Forty-two consecutive patients diagnosed with probable or definite Menier ' s disease were referred for hydrops MR examination. Vestibular and cochlear EH in both sequences were read by two independent radiologists, unaware of the patient's clinical status. The primary study endpoint was the concordance in the hydrops detection and severity with both imaging sequences. This was assessed using the Cohen's kappa Kappa statistic for disease grading and Pearson X(2)test to test the difference in detection rates of hydrops. Statistical significance was defined as two-sidedp < .05. Results We obtained an excellent overall concordance, with a kappa of 0.821, (p < .001) when comparing hydrops detection. The degree of concordance is higher in vestibular hydrops than in cochlear hydrops. The 3D-IR sequence detected more hydrops than the 3D FLAIR, (62 vs. 39.5%,p < .03). Conclusion The 3D-IR sequence seems to be superior to the 3D-FLAIR for the assessment of EH. Significance:The 3D-IR sequence should be considered as a standalone parameter for a shorter and optimized EH magnetic resonance imaging protocol.
Autores: Calvo Manuel, Felipe (Autor de correspondencia); Krengli, M.; Asencio, J. M.; et al.

Título: ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in unresected pancreatic cancer

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.148 2020 págs. 57 - 64

Resumen

Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise sub-component of RT that can intensify the irradiation effect for cancer involving an anatomically well-defined volume, generally delivered with electrons (IOERT). Unresectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Long-term survivors were observed among unresected patients treated with external beam RT and an IOERT boost (OS 6% at 3 years; 3% >5 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted asset in the clinical scenario (maturity and reproducibility of results, albeit of low official level of evidence) and extremely accurate in terms of dose-deposit characteristics and normal tissue sparing. It is a technique that can be integrated with systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend the use of IOERT in cases of close surgical margins and residual disease. We report the ESTRO/ACROP recommendations for performing IOERT in unresected pancreatic cancer. (C) 2020 Elsevier B.V. All rights reserved.
Autores: Caliz Caliz, R. (Autor de correspondencia); Diaz del Campo Fontecha, P.; Galindo Izquierdou, M.; et al.

Título: Recomendaciones de la Sociedad Española de Reumatología sobre síndrome antifosfolípido primario. Parte I: Diagnóstico, evaluación y tratamiento

Revista: REUMATOLOGIA CLINICA

ISSN: 1699-258X Vol.16 N° 2 2020 págs. 71 - 86

Resumen

Objective: The difficulty in diagnosis and the spectrum of clinical manifestations that can determine the choice of treatment for primary antiphospholipid syndrome (APS) has fostered the development of recommendations by the Spanish Society of Rheumatology (SER), based on the best possible evidence. These recommendations can serve as a reference for rheumatologists and other specialists involved in the management of APS. Methods: A panel of four rheumatologists, a gynaecologist and a haematologist with expertise in APS was created, previously selected by the SER through an open call or based on professional merits. The stages of the work were: identification of the key areas for drafting the document, analysis and synthesis of the scientific evidence (using the Scottish Intercollegiate Guidelines Network [ SIGN] levels of evidence) and formulation of recommendations based on this evidence and formal assessment or reasoned judgement techniques (consensus techniques). Results: 46 recommendations were drawn up, addressing five main areas: diagnosis and evaluation, measurement of primary thromboprophylaxis, treatment for APS or secondary thromboprophylaxis, treatment for obstetric APS and special situations. These recommendations also include the role of novel oral anticoagulants, the problem of recurrences or the key risk factors identified in these subjects. This document reflects the first 21, referring to the areas of: diagnosis, evaluation and treatment of primary APS. The document provides a table of recommendations and treatment algorithms. Conclusions: An update of the SER recommendations on APS is presented. This document corresponds to part I, related to diagnosis, evaluation and treatment. These recommendations are considered tools for decision-making for clinicians, taking into consideration both the decision of the physician experienced in APS and the patient. A part II has also been prepared, which addresses aspects related to obstetric SAF and special situations. Published by Elsevier Espalia, S.L.U.
Autores: Nayahangan, L. J. (Autor de correspondencia); Vila, R.; Lawaetz, J.; et al.

Título: European Society for Vascular Surgery (ESVS) Certification of Theoretical and Practical Competences in Basic Vascular Ultrasound: Validity Investigation of the Assessment Tools

Revista: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

ISSN: 1078-5884 Vol.60 N° 6 2020 págs. 933 - 941

Resumen

Objective: The aim of this study was to gather validity evidence for the Assessment of basic Vascular Ultrasound Expertise (AVAUSE) tool, and to establish a pass/fail score for each component, to support decisions for certification. Methods: A cross sectional validation study performed during the European Society for Vascular Surgery's annual meeting. Validity evidence was sought for the theoretical test and two practical tests based on Messick's framework. The participants were vascular surgeons, vascular surgical trainees, sonographers, and nurses with varying experience levels. Five vascular ultrasound experts developed the theoretical and two practical test components of the AVAUSE tool for each test component. Two stations were set up for carotid examinations and two for superficial venous incompetence (SVI) examinations. Eight raters were assigned in pairs to each station. Three methods were used to set pass/fail scores: contrasting groups' method; rater consensus; and extended Angoff. Results: Nineteen participants were enrolled. Acceptable internal consistency reliability (Cronbach's alpha) for the AVAUSE theoretical (0.93), carotid (0.84), and SVI (0.65) practical test were shown. In the carotid examination, inter-rater reliability (IRR) for the two rater pairs was good: 0.68 and 0.78, respectively. The carotid scores correlated significantly with years of experience (Pearson's r = 0.56, p = .013) but not with number of examinations in the last five years. For SVI, IRR was excellent at 0.81 and 0.87. SVI performance scores did not correlate with years of experience and number of examinations. The pass/fail score set by the contrasting groups' method was 29 points out of 50. The rater set pass/fail scores were 3.0 points for both carotid and SVI examinations and were used to determine successful participants. Ten of 19 participants passed the tests and were certified. Conclusion: Validity evidence was sought and established for the AVAUSE comprehensive tool, including pass/fail standards. AVAUSE can be used to assess competences in basic vascular ultrasound, allowing operators to progress towards independent practice.
Autores: Cohen, H. (Autor de correspondencia); Cuadrado Lozano, María José; Erkan, D.; et al.

Título: 16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends

Revista: LUPUS

ISSN: 0961-2033 Vol.29 N° 12 2020 págs. 1571 - 1593

Resumen

Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.
Autores: Goswami, S. S.; Ortuno, J. E.; Santos, A. ; et al.

Título: A New Workflow for Image-Guided Intraoperative Electron Radiotherapy Using Projection-Based Pose Tracking

Revista: IEEE ACCESS

ISSN: 2169-3536 Vol.8 2020 págs. 137501 - 137516

Resumen

A new workflow is proposed to update the intraoperative electron radiotherapy (IOERT) planning refreshing the position and orientation (pose) of a virtual applicator with respect to the preoperative computed tomography (CT) with the actual pose during surgery. The workflow proposed relies on a robust registration of the preoperative CT and intraoperative projection radiographs acquired with a C-arm system. The workflow initially performs a geometric calibration of the C-arm using fiducials placed on the applicator. In the next step, a point-based 2D-3D registration based on fiducials positioned on the patient's skin is performed, followed by an intensity-based registration that refines the point-based registration result. The performance of the workflow has been evaluated using a realistic physical phantom consisting of a pig lower limb and its corresponding CT and 7 C-arm projections at different poses. The accuracy has been measured with respect to the applicator origin and axis before and after the registration refinement process. A feasibility study with human data is also included. Error analysis revealed angular accuracy of 0.9 +/- 0.7 degrees and translational accuracy of 1.9 +/- 1 mm. Our experiments demonstrated that the proposed workflow can achieve subdegree angular accuracy in locating the applicator with respect to the preoperative CT to update and supervise the IOERT planning right before radiation delivery. The proposed workflow could be easily implementable in a routine, corresponding to a significant improvement in quality assurance during IOERT procedures.
Autores: Silberberg, A. (Autor de correspondencia); Robetto, J.; Grimaux, G.; et al.

Título: Ethical issues about the paradigm shift in the treatment of children with trisomy 18

Revista: EUROPEAN JOURNAL OF PEDIATRICS

ISSN: 0340-6199 Vol.179 N° 3 2020 págs. 493 - 497

Resumen

Until recently, trisomy 18 was considered a disease incompatible with life, with a high percentage of electively terminated pregnancies. The usual behavior was denial of treatment. But some medical interventions have changed the survival of children. A search for articles published in the PubMed database on the latest medical decisions in newborns with trisomy 18 was done. Two main subjects were examined: (1) the chances of survival and (2) the perception of quality of life. Trisomy 18 is no longer considered a disease incompatible with life, and the discussion has shifted towards the type of treatment that is appropriate to initiate at birth. There are two medical attitudes towards these children: either palliative care or life-prolonging interventions. With medical intervention, the survival is as high as 23% at 5 years of age. Regarding the quality of life, all decision-makers emphasize the possibility of taking the child home. The physicians' perception is more pessimistic than that of the parents. Only a few children benefit from medical interventions. Conclusion: There is a rethinking of treatment behavior in children with trisomy 18. The possible quality of life achieved should be further investigated. It seems inappropriate to simply dismiss medical interventions.What is Known center dot Until recently, trisomy 18 was considered a disease incompatible with life. The most common behavior was abortion and denial of treatment.What is New center dot It is no longer considered a lethal disease. The type of medical intervention that is appropriate to perform is now being discussed. Selected children benefit from an interventionist approach.
Autores: Radin, M. ; Cecchi, I. ; Schreiber, K. ; et al.

Título: Pregnancy success rate and response to heparins and/or aspirin differ in women with antiphospholipid antibodies according to their Global AntiphosPholipid Syndrome Score

Revista: SEMINARS IN ARTHRITIS AND RHEUMATISM

ISSN: 0049-0172 Vol.50 N° 3 2020 págs. 553 - 556

Resumen

Background: The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global antiphospholipid syndrome (APS) score (GAPSS) is a tool to quantify the risk for the aPL-related clinical manifestations. In this study, we investigated the individual clinical response to SoC in women with aPL after stratifying them according to their GAPSS. Methods: One-hundred-fourty-three women (352 pregnancies) with aPL ever pregnant treated with SoC therapy were included. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (< 6), medium risk (6-11), and high risk (>= 12). Results: The live birth rate was 70.5% (248 out of the 352 pregnancies), 45 patients (31%) experienced at least one event of PM, defined as early or late. Patients were stratified according to GAPSS values, in order to identify a low risk group (GAPSS <6, n = 72), a medium risk group (GAPSS 6-11, n = 66) and a high risk group (GAPSS >= 12, n = 5). When considering patients who ever experienced any PM while treated with SoC, all patients in the high risk group experienced PM, while patients in the medium group had a significant higher rate of PM when compared to the low risk group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p < 0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11 (40.7%) live births vs. 100 (62.1%) and 137 (82.5%), respectively; p < 0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p < 0.001). Conclusions: GAPSS might be a valuable tool for to identify patients with a higher likelihood of response to SoC. (C) 2020 Elsevier Inc. All rights reserved.
Autores: Refoyo Salicio, Elena (Autor de correspondencia); Troya, J.; Trigo, E.; et al.

Título: Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone

Revista: AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE

ISSN: 0002-9637 Vol.103 N° 4 2020 págs. 1480 - 1486

Resumen

Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 +/- 0.9 years, and 66% were women. Mean time living in Spain was 9.7 +/- 0.5 years. The ECG revealed >= 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.
Autores: Mancilla, J. C. (Autor de correspondencia); Hernandez, S. J.; Martin-Sanchez, F. J.; et al.

Título: Características y evolución de los pacientes con enfermedad pulmonar obstructiva crónica y enfermedad tromboembólica venosa aguda sintomática en urgencias: subanálisis del registro ESPHERIA

Revista: EMERGENCIAS

ISSN: 1137-6821 Vol.32 N° 1 2020 págs. 40 - 44

Resumen

Objective. To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments. Methods. Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry. Results. A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD. Conclusions. COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality.
Autores: Auclin, E.; Vuagnat, P.; Smolenschi, C.; et al.

Título: Lung immune prognostic index (LIPI) can identify the fast-progressor to immune checkpoints inhibitors (ICI) in microsatellite instability (MSI) or mismatch repair deficient (dMMR) tumours

Revista: ANNALS OF ONCOLOGY

ISSN: 0923-7534 Vol.31 N° Suppl.7 2020 págs. S1418 - S1418
Autores: Lwin, Z.; Gomez-Roca, C.; Saada-Bouzid, E. ; et al.

Título: LEAP-005: phase II study of lenvatinib (len) plus pembrolizumab (pembro) in patients (pts) with previously treated advanced solid tumours

Revista: ANNALS OF ONCOLOGY

ISSN: 0923-7534 Vol.31 N° Supl. 4 2020 págs. S1170
Autores: Castañón Álvarez, Eduardo; Resano Eraul, Leyre; Barba, Luis; et al.

Título: Comparison of the predictive power of survival of the Royal Marsden Score (RMS), the Gustave Rousy Immunescore (GRIM score), the MDACC score (MDAS) and the LIPI score in phase I trials patients.

Revista: JOURNAL OF CLINICAL ONCOLOGY

ISSN: 0732-183X Vol.38 N° 15 2020
Autores: Powderly, J. ; Bendell, J. C.; Carneiro, B. A.; et al.

Título: A phase I, first-in-human, multicenter, open-label, dose-escalation study of IPH5201 as monotherapy or in combination with durvalumab +/- oleclumab in advanced solid tumours

Revista: ANNALS OF ONCOLOGY

ISSN: 0923-7534 Vol.31 N° Supl. 4 2020 págs. S728 - S729
Autores: Tektonidou, M. G. (Autor de correspondencia); Andreoli, L.; Limper, M. ; et al.

Título: EULAR recommendations for the management of antiphospholipid syndrome in adults

Revista: ANNALS OF THE RHEUMATIC DISEASES

ISSN: 0003-4967 Vol.78 N° 10 2019 págs. 1296 - 1304

Resumen

The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patient education about treatment adherence, and lifestyle counselling. Low-dose aspirin (LDA) is recommended for asymptomatic aPL carriers, patients with systemic lupus erythematosus without prior thrombotic or obstetric APS, and nonpregnant women with a history of obstetric APS only, all with high-risk aPL profiles. Patients with APS and first unprovoked venous thrombosis should receive long-term treatment with vitamin K antagonists (VKA) with a target international normalised ratio (INR) of 2-3. In patients with APS with first arterial thrombosis, treatment with VKA with INR 2-3 or INR 3-4 is recommended, considering the individual's bleeding/thrombosis risk. Rivaroxaban should not be used in patients with APS with triple aPL positivity. For patients with recurrent arterial or venous thrombosis despite adequate treatment, addition of LDA, increase of INR target to 3-4 or switch to low molecular weight heparin may be considered. In women with prior obstetric APS, combination treatment with LDA and prophylactic dosage heparin during pregnancy is recommended. In patients with recurrent pregnancy complications, increase of heparin to therapeutic dose, addition of hydroxychloroquine or addition of low-dose prednisolone in the first trimester may be considered. These recommendations aim to guide treatment in adults with APS. High-quality evidence is limited, indicating a need for more research.
Autores: Hernandez, S. J. (Autor de correspondencia); Linares, R. C.; Ruiz Artacho, Pedro Celso

Título: Comentario acerca de la precisión, seguridad y eficiencia de la ecografía realizada por urgenciólogos en el diagnóstico de la trombosis venosa profunda en servicios de urgencias hospitalarios

Revista: EMERGENCIAS

ISSN: 1137-6821 Vol.31 N° 4 2019 págs. 295 - 295
Autores: Moreno Villares, José Manuel (Autor de correspondencia)

Título: Una llamada de atención

Revista: ANALES DE PEDIATRIA

ISSN: 1695-4033 Vol.90 N° 1 2019 págs. 65 - 65
Autores: Moreno Villares, José Manuel (Autor de correspondencia); Galiano-Segovia, M. J.

Título: Screen-time: a new stakeholder in children and adolescent health

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.36 N° 6 2019 págs. 1235 - 1236
Autores: Rodríguez Pérez, María (Autor de correspondencia); Aymerich de Franceschi, María

Título: Enhanced recovery after surgery pathways in thoracic surgery, do they end at discharge?

Revista: ANNALS OF TRANSLATIONAL MEDICINE

ISSN: 2305-5839 Vol.7 N° Supl. 8 2019 págs. S357
Autores: Jimenez, D. (Autor de correspondencia); Bikdeli, B.; Quezada, A.; et al.

Título: Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study

Revista: BMJ (ONLINE)

ISSN: 1756-1833 Vol.366 2019 págs. l4416

Resumen

OBJECTIVES To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. DESIGN Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbolica (RIETE) registry between 1 January 2001 and 31 August 2018. SETTING 353 hospitals in 16 countries. PARTICIPANTS 39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. MAIN OUTCOME MEASURE Pulmonary embolism related mortality within 30 days after diagnosis of the condition. RESULTS Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. CONCLUSIONS In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.
Autores: Perales Molina, Alvaro; Baratto Roldan, Anna; Kimstrand, Peter; et al.

Título: Parameterising microdosimetric distributions of mono-energetic proton beams for fast estimates of yd and y*

Revista: BIOMEDICAL PHYSICS AND ENGINEERING EXPRESS

ISSN: 2057-1976 Vol.5 N° 4 2019 págs. 045014
Autores: Madrigal, C. ; Soto-Mendez, M. J.; Hernandez-Ruiz, A. ; et al.

Título: Dietary and Lifestyle Patterns in the Spanish Pediatric Population (One to < 10 Years Old): Design, Protocol, and Methodology of the EsNuPI Study

Revista: NUTRIENTS

ISSN: 2072-6643 Vol.11 N° 12 2019 págs. 3050

Resumen

The interest in a healthy diet and lifestyle during the early stages of life increased, pointing out its role in the development of noncommunicable chronic diseases throughout adult life. Dietary habits and dietary patterns begin to be established in early childhood and persist during adulthood. Therefore, the EsNuPI ("Nutritional Study in Spanish Pediatric Population") study aims to depict the dietary patterns, physical activity, and sedentary behaviors in Spanish children aged from one to <10 years old. This prospective, cross-sectional, observational study recruited a total of 1514 children from Spanish cities with >50,000 inhabitants, stratified by Nielsen areas. Participants were involved in one face-to-face survey, followed by a telephone survey after at least one week. Information about dietary intake and habits was obtained using a quantitative food frequency questionnaire and two 24-h dietary recalls. Physical activity and sedentary behaviors were registered using a specific questionnaire based on a seven-day record. Data were processed and stratified by categorical variables to be statistically analyzed in order to meet the study objectives. This study is the first of its kind in a Spanish reference population of this age range and the first to evaluate whether the consumption of adapted milk formulas and dairy products is associated with healthier dietary patterns and better diet quality and lifestyles in this group.
Autores: Martin-Sanchez, F. J. (Autor de correspondencia); Triana, F. C.; Bossello, X. ; et al.

Título: Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments

Revista: EUROPEAN JOURNAL OF INTERNAL MEDICINE

ISSN: 0953-6205 Vol.65 2019 págs. 69 - 77

Resumen

Background: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. Material and methods: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients >= 65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. Results: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95% CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95% CI 1.1-9.0; p = .033) compared to normal nutritional status. Conclusions: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
Autores: Blanco, A. C. (Autor de correspondencia); Fuster, F. M. L. ; Garcia, M. D. D. ; et al.

Título: Manejo nutricional de la demencia avanzada: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.36 N° 4 2019 págs. 988 - 995
Autores: Mattiucci, G. C.; Morganti, A. G.; Cellini, F. (Autor de correspondencia); et al.

Título: Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis

Revista: TRANSLATIONAL ONCOLOGY

ISSN: 1936-5233 Vol.12 N° 1 2019 págs. 1 - 7

Resumen

BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection +/- adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 >= 353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level.
Autores: Malas, M.B.; Leal Lorenzo, José ignacio; Nejim, B. ; et al.

Título: Analysis of the ROADSTER pivotal and extended-access cohorts shows excellent 1-year durability of transcarotid stenting with dynamic flow reversal

Revista: JOURNAL OF VASCULAR SURGERY

ISSN: 0741-5214 Vol.69 N° 6 2019 págs. 1786-1796
Autores: Sallabanda, K.; Yáñez, L.; Sallabanda, M.; et al.

Título: Stereotactic Radiosurgery for the Treatment of Recurrent High-grade Gliomas: Long-term Follow-up

Revista: CUREUS

ISSN: 2168-8184 Vol.11 N° 12 2019 págs. e6527

Resumen

High-grade gliomas (HGG) are the most frequent primary central nervous system tumors; treatment of HCGs includes surgery and post-operative conformal radiotherapy associated with temozolomide (TMZ or procarbazine/lomustine/vincristine [PCV], specifically in patients with anaplastic oligodendrogliomas or anaplastic oligoastrocytomas). However, recurrence is common. Re-irradiation has been utilized in this setting for years and remains a feasible option, although there is always a concern regarding toxicity. Modern high-precision conformal techniques, including stereotactic radiosurgery (SRS), could improve the therapeutic ratio by delivering high biologically equivalent doses while reducing high-dose radiotherapy (RT) to normal brain tissue. In this paper, we present the results obtained after prolonged follow-up in patients who underwent SRS as a treatment for recurrent high-grade gliomas at San Francisco Hospital in Madrid, Spain.
Autores: Moreno Villares, José Manuel (Autor de correspondencia); Collado, M. C.; Larque, E.; et al.

Título: Los primeros 1000 días: una oportunidad para reducir la carga de las enfermedades no transmisibles

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.36 N° 1 2019 págs. 218 - 232

Resumen

Growth and development are determined by genetic and environmental factors since the very early embryonic life. Long-term health risks, as obesity and other non-communicable diseases (NCD), could be programmed since these early stages. Early life, characterized by plasticity, is the ideal time to intervene and to prevent the risk of suffering a NCD (window of opportunity). Optimal nutrition during the first 1,000 days, since conception to the end of the second year of life, has a determinant role for long-term health. Pregnancy, infancy and toddler periods have specific nutritional requirements. Intestinal microbiota enhances maturation and functioning of the immune system. The interactions between host and intestinal microbiota are potential factors influencing early programming of the intestinal function. Alterations in intestinal colonization are associated to a higher risk of allergic diseases in childhood. Scientific evidence supports the fact that the first 1,000 days are crucial to achieve a better long-term health and represents a strategic period to intervene under the perspective of prevention and public health.
Autores: Armentia, E. S. (Autor de correspondencia); Noguerol, T. M.; Suárez Vega, Victor Manuel

Título: Técnicas avanzadas de resonancia magnética en patología tumoral de cabeza y cuello

Revista: RADIOLOGIA

ISSN: 0033-8338 Vol.61 N° 3 2019 págs. 191 - 203

Resumen

Magnetic resonance imaging has become a fundamental tool for the evaluation of head and neck tumors. The anatomic details that magnetic resonance images provide are fundamental for diagnosing, characterizing, and staging both primary tumors and lymph node metastases. In addition to technical improvements in anatomic sequences, such as Dixon techniques to improve fat suppression, other sequences being developed, such as diffusion and perfusion, provide molecular, biological, and physiological information about the tumor and are yielding imaging biomarkers that can help in determining the tumor's biology at the time of diagnosis and in the follow-up of the disease. Magnetic resonance imaging also provides very useful information about the response to treatment. (C) 2019 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores: Martorell Calatayud, Antonio; Alfageme Roldán, Fernando; Vilarrasa Rull, Eva; et al.

Título: Ultrasound as a Diagnostic and Management Tool in Hidradenitis Suppurativa Patients: A Multicenter Study

Revista: EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY. JOURNAL

ISSN: 1468-3083 Vol.33 N° 11 2019 págs. 2137-2142

Resumen

Background: It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS). Objective: To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management. Methods: Cross-sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared. Results: Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P < 0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P < 0.01). Concordance between clinical and ultrasound intra-rater examination was 22.8% (P < 0.01); intra-rater and inter-rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P < 0.01). Limitations: The inability to detect lesions that measure ¿0.1 mm or with only epidermal location. Conclusion: Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.
Autores: Radin, M.; Schreiber, K. ; Sciascia, S. (Autor de correspondencia); et al.

Título: Prevalence of Antiphospholipid Antibodies Negativisation in Patients with Antiphospholipid Syndrome: A Long-Term Follow-Up Multicentre Study

Revista: THROMBOSIS AND HAEMOSTASIS

ISSN: 0340-6245 Vol.119 N° 12 2019 págs. 1920 - 1926

Resumen

Objective This article aims to analyse the rate of antiphospholipid antibodies (aPL) negativisation in patients with antiphospholipid syndrome (APS), and to evaluate potential new clinical manifestations after negativisation and/or aPL fluctuations in a long-term follow-up. Methods Inclusion criteria are (1) any patients with an APS diagnosis according to the current Sydney criteria and (2) patients in whom aPL negativisation occurred. aPL negativisation was defined as repeated aPL measurements on at least two consecutive occasions at least 12 weeks apart, with a follow-up of at least 1 year since aPL first turned negative. Results Out of 259 APS patients, a total of 23 patients (8.9%) met the inclusion criteria for persistent aPL negativisation. Patients were followed-up for 14.4 +/- 8.1 years, experienced aPL negativisation after a mean of 5.3 +/- 3.5 years and were followed-up after experiencing the aPL negativisation for a mean of 7.6 +/- 5.8 years. Seventeen patients (73.9%) presented with thrombotic APS, 2 with pregnancy morbidity (8.7%) and 4 (17.4%) with both. Most of the patients (18; 78.3%) had a single aPL positivity, 5 (21.7%) double, while no triple aPL positivity was observed. At the time of data collection, after aPL negativisation, anticoagulation was stopped in 8 patients with previous thrombotic venous event (8/21, 38%) according to the treating physicians' judgements. None of the patients experienced any recurrent thrombotic event during the follow-up period after their aPL negativisation. Conclusion In our patient cohort consisting of 259 patients with definitive APS, we observed over a mean observation period of > 5 years, that aPL negativisation occurred in approximately 9% of patients. Negativisation occurred most often in patients who were previously found to be positive for only one aPL.
Autores: Radin, M.; Schreiber, K.; Sciascia, S.; et al.

Título: Prevalence of Antiphospholipid Antibodies Negativisation in patients with Antiphospholipid Syndrome: a long-term follow-up Multicentre study

Revista: LUPUS

ISSN: 0961-2033 Vol.28 N° Suppl.1 2019 págs. 21 - 22
Autores: Baldini, C. ; Younan, N.; Castañón Álvarez, Eduardo; et al.

Título: Feasibility and benefit of molecular profiling to guide enrollment of patients with recurrent gliomas in early phase trials

Revista: NEURO-ONCOLOGY

ISSN: 1522-8517 Vol.21 2019 págs. 10 - 10
Autores: Bertoglio, P. ; Cattoni, M.; Nachira, D.; et al.

Título: Impact of second predominant pattern on recurrence in early stage resected lung adenocarcinoma: a multicentric study

Revista: JOURNAL OF THORACIC ONCOLOGY

ISSN: 1556-0864 Vol.14 N° 10 2019 págs. S895 - S896
Autores: D'Angelo, E. ; Espinosa Mariscal, Íñigo; Cipriani, V.; et al.

Título: Atypical endometrial hyperplasia, low-grade: 'much ado about nothing'

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 2019 págs. A109 - A109
Autores: Caballeros Lam, Fanny Meylin; García de Yébenes Castro, Manuel; Suárez Vega, Victor Manuel; et al.

Título: Not all pericardial thickening is effusion: usefulness of CMR in the characterization of epicardial lipomatous hypertrophy

Revista: EUROPEAN HEART JOURNAL CARDIOVASCULAR IMAGING

ISSN: 2047-2404 Vol.20 2019 págs. 306 - 306
Autores: García de Yébenes Castro, Manuel; Caballeros Lam, Fanny Meylin; Huerta, A.; et al.

Título: Idiopathic recurrent myopericarditis: can we keep on talking about idiopathic disease or should we look further?

Revista: EUROPEAN HEART JOURNAL CARDIOVASCULAR IMAGING

ISSN: 2047-2404 Vol.20 N° Suppl.2 2019 págs. 396 - 396
Autores: Carmona-Bayonas, A. (Autor de correspondencia); Jimenez-Fonseca, P.; Fernandez-Somoano, A.; et al.

Título: Top ten errors of statistical analysis in observational studies for cancer research

Revista: CLINICAL AND TRANSLATIONAL ONCOLOGY

ISSN: 1699-048X Vol.20 N° 8 2018 págs. 954 - 965

Resumen

Observational studies using registry data make it possible to compile quality information and can surpass clinical trials in some contexts. However, data heterogeneity, analytical complexity, and the diversity of aspects to be taken into account when interpreting results makes it easy for mistakes to be made and calls for mastery of statistical methodology. Some questionable research practices that include poor analytical data management are responsible for the low reproducibility of some results; yet, there is a paucity of information in the literature regarding specific statistical pitfalls of cancer studies. In addition to proposing how to avoid or solve them, this article seeks to expose ten common problematic situations in the analysis of cancer registries: convenience, dichotomization, stratification, regression to the mean, impact of sample size, competing risks, immortal time and survivor bias, management of missing values, and data dredging.
Autores: Moreno Villares, José Manuel (Autor de correspondencia); Olveira, G.

Título: Editor's corner: Nutricion Hospitalaria 2017

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.35 N° 1 2018 págs. 1 - 3
Autores: Enríquez Merayo, Eugenia; Sciascia, S.; Roccatello, D.; et al.

Título: Can we treat systemic lupus erythematosus and other autoimmune diseases without oral steroids?

Revista: EXPERT REVIEW OF CLINICAL IMMUNOLOGY

ISSN: 1744-666X Vol.14 N° 11 2018 págs. 877-879
Autores: Moreno Villares, José Manuel (Autor de correspondencia)

Título: Veintiséis años del registro nadya de senpe. Una nueva etapa

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.35 N° 6 2018 págs. 1255 - 1256
Autores: Rodríguez Pérez, María (Autor de correspondencia); Mallidi, H. R.; da Silva, A.; et al.

Título: Recurrence of pericardial mesothelioma affecting the myocardium after pericardial resection, a case report of successful treatment

Revista: ANNALS OF THORACIC SURGERY

ISSN: 0003-4975 Vol.106 N° 5 2018 págs. e243 - e245

Resumen

Primary pericardial mesothelioma represents less than 1% of all malignant mesotheliomas. These tumors are very rare, difficult to diagnose, and have a poor response to established treatments. Common clinical presentations include constrictive symptoms, cardiac tamponade, and cardiac failure. Surgical resection can be curative in early stages and for localized tumors, and pericardiectomy and chemotherapy are often used as palliative approaches. We present the case of a 54-year-old woman who has so far survived 4 years after a primary resection of a pericardial mesothelioma and was referred with myocardial and aortopulmonary window recurrences for further treatment.
Autores: Cambeiro Vázquez, Felix Mauricio (Autor de correspondencia); Calvo Manuel, Felipe

Título: Tratamiento de la enfermedad local con radioterapia en cáncer de próstata metastásico.

Revista: ARCHIVOS ESPAÑOLES DE UROLOGIA

ISSN: 0004-0614 Vol.71 N° 3 2018 págs. 298 - 305

Resumen

OBJECTIVES: We elaborate the bases and rationale for the application of multimodal extended treatment including local radiotherapy in patients with oligometastatic prostate cancer (omPCa). We performed a bibliographic review on the state of the art in this field and propose a therapeutic strategy that incorporates ablative radiotherapy of the primary tumor +/- oligometastatic lesions. METHODS: We performed a comprehensive literature review consulting different sources that include data bases (Pubmed/Medline), and international treatment guidelines ((NCCN, NCI, EUA). Search criteria: Locally advanced prostate cancer, oligometastatic, disseminated and radiotherapy, ablative or stereotactic radiotherapy (SBRT). RESULTS: The most accepted definition for oligometastatic prostate cancer or oligotopic prostatic neoplasia is when we recognize at least 3 non-visceral metastatic lesions in an extrapelvic location. Whole body MRI and PET scan (Choline/PSMA) are non conventional useful tests for staging in the workup for oligometastatic disease. From a clinical point of view, omPCa behaves as an intermediate entity between locally advanced and disseminated or multimetastatic prostate cancer. Androgen deprivation therapy (ADT) represents the base of treatment for castration sensitive PCs. To date there is no biological marker/genetic sign identified that differentiate aggressiveness profiles in omPca. Most evidence on the use of radiotherapy for this entity comes from retrospective studies, showing a benefit in control and prevention of local symptoms. To date, the survival benefit derived from the application of local treatment to the primary tumor with demonstrable metastatic disease is uncertain, and it has not been shown in the available randomized prospective clinical trials. CONCLUSIONS: Primary tumor radiotherapy in omPca positively influences local control and prevention of local symptoms progression. The level of evidence to recommend prostatic radiotherapy as a therapeutic variable with impact on survival on omPca is limited (Level 2B-3 Category). Research lines in omPca deserve the inclusion of a multimodal systemic treatment including ADT, ablative radiotherapy for the tumor and consolidation radiotherapy in metastatic distant lesions.
Autores: Miras, Hector; Jimenez, Ruben; Perales Molina, Alvaro; et al.

Título: Monte Carlo verification of radiotherapy treatments with CloudMC

Revista: RADIATION ONCOLOGY

ISSN: 1748-717X Vol.13 2018 págs. 99-107
Autores: Arenas, M. (Autor de correspondencia); Sabater, S.; Biete, A.; et al.

Título: Radiation Oncology Teaching Programmes as Part of the Undergraduate Degree in Medicine in Spanish Universities: the Need for an Update of the Contents and Structure

Revista: JOURNAL OF CANCER EDUCATION

ISSN: 0885-8195 Vol.33 N° 2 2018 págs. 352 - 358

Resumen

The relevance of radiation oncology (RO) teaching in the Faculty of Medicine Degree Plan is justified by the high number of cancer patients who will require it at some point in their evolution of radiotherapy (RT). About 40 % of the population who will suffer cancer will be cured by RT alone or other related treatment modalities. Therefore, cancer education and RT teaching needs to have an in depth impact in the undergraduate medicine programmes. This education component is highly variable, not only among countries but also within each country, in terms of content (theory and practical training), number of credits and departmental affiliation of the teachers. Our aim is to take a snapshot of the situation of the teaching of RO in undergraduate university education in Spain. We have analysed 40 Spanish universities about specific aspects related to the teaching of RT. Information was obtained by mail or telephone contact throughout 2015. We have analysed the elements involved in teaching performance. In universities with various instructional units, we have taken the average of them. Among the Universities consulted in Spain, during the period of the medical degree, the average time allocated to RT lectures is 12 h (range, 0-36), the mean time allocated to seminars is 4 h (range, 0-22), and the mean time assigned to practices is 11 h (range, 0-38). The subject is mainly taught by a radiation oncologist and 80 % of Spanish universities have at least one radiation oncologist on staff. Undergraduate radiation oncology teaching in Spain shows structural heterogeneity. The Spanish Society of Radiation Oncology (SEOR) University Forum has identified new opportunities and elaborated a proposal to improve undergraduate education in oncology.
Autores: Garcia-Vazquez, V. (Autor de correspondencia); Sese-Lucio, B.; Calvo Manuel, Felipe; et al.

Título: Surface scanning for 3D dose calculation in intraoperative electron radiation therapy

Revista: RADIATION ONCOLOGY

ISSN: 1748-717X Vol.13 2018

Resumen

BackgroundDose calculations in intraoperative electron radiation therapy (IOERT) rely on the conventional assumption of water-equivalent tissues at the applicator end, which defines a flat irradiation surface. However, the shape of the irradiation surface modifies the dose distribution. Our study explores, for the first time, the use of surface scanning methods for three-dimensional dose calculation of IOERT.MethodsTwo different three-dimensional scanning technologies were evaluated in a simulated IOERT scenario: a tracked conoscopic holography sensor (ConoProbe) and a structured-light three-dimensional scanner (Artec). Dose distributions obtained from computed tomography studies of the surgical field (gold standard) were compared with those calculated under the conventional assumption or from pseudo-computed tomography studies based on surfaces.ResultsIn the simulated IOERT scenario, the conventional assumption led to an average gamma pass rate of 39.9% for dose values greater than 10% (two configurations, with and without blood in the surgical field). Results improved when considering surfaces in the dose calculation (88.5% for ConoProbe and 92.9% for Artec).ConclusionsMore accurate three-dimensional dose distributions were obtained when considering surfaces in the dose calculation of the simulated surgical field. The structured-light three-dimensional scanner provided the best results in terms of dose distributions. The findings obtained in this specific experimental setup warrant further research on surface scanning in the IOERT context owing to the clinical interest of improving the documentation of the actual IOERT scenario.
Autores: Martin-Aragon, T. (Autor de correspondencia); Serrano, J. ; Benedi, J.; et al.

Título: The value of oxaliplatin in the systemic treatment of locally advanced rectal cancer

Revista: JOURNAL OF GASTROINTESTINAL ONCOLOGY

ISSN: 2078-6891 Vol.9 N° 4 2018 págs. 631 - 640

Resumen

Background: To evaluate, in a context of innovative multidisciplinary clinical practice, the efficacy of oxaliplatin in adjuvant administration (chemotherapy, CT) in relation to the total administered dose, in terms of prognosis with other clinical and therapeutic factors, in the heterogeneous model of locally advanced rectal cancer (LARC), which is characterized by a risk pattern of dominant systemic progression. Methods: Observational-analytical, retrospective, unicentric, non-randomized study of two cohorts of patients receiving FOLFOX-4 induction CT in neoadjuvancy, radiochemotherapy and surgery, differing in that one cohort did not receive any adjuvant post-surgical treatment and the other one received adjuvant CT with FOLFOX-4 cycles. A total of 212 patients from the Radiotherapy Oncology Service at the University Hospital Gregorio Maranon were studied: the neoadjuvant CT treatment group with oxaliplatin consisted of 110 patients and adjuvant CT treatment group with oxaliplatin consisted of 102 patients. The median follow-up time for the whole study population was 72 months (6 years). Results: The sociodemographic, clinical and diagnostic characteristics were very similar in both cohorts of patients, but with a pattern of therapeutic selection towards elements of adversity in pathological post-neoadjuvant staging. The dose of oxaliplatin in adjuvance (postoperative) superior to 6 cycles was positively associated with the locoregional control (LRC) at 5 years (P=0.012) and with the overall survival (OS) (P=0.048) at 5 years. In the responders to neoadjuvance with oxaliplatin [patients with tumor regression grade (TRG 3-4)], the dose of oxaliplatin greater than 5 cycles in adjuvance (postoperative) was positively associated with OS (P=0.06). And the dose of oxaliplatin in the range of 4-5 cycles in adjuvance (postoperative) was positively associated with distant metastasis-free survival (DMFS) and disease-free survival (DFS) in the cohort of responding patients (P=0.015 and 0.004, respectively). Conclusions: The contribution of adjuvant oxaliplatin in the oncological evolution shows a favorable effect of LRC, DMFS, DFS and OS in the subgroups of patients that exhibit elements of response to neoadjuvant oxaliplatin (categories TRG 3-4, and pN0, downstaging T, downstaging N). Therefore, this neoadjuvant response profile with oxaliplatin, measured with highly reliable methodology (validated microscopic pathological response scales), defines a population of oxaliplatin-sensitive patients who benefits significantly from the administration of adjuvant oxaliplatin in sufficient cumulative doses (more of 5 cycles).
Autores: Garcia, M. D. D.; Casas, N. V. ; Blanco, A. C. (Autor de correspondencia); et al.

Título: Manejo nutricional de la esclerosis lateral amiotrófica: resumen de recomendaciones

Revista: NUTRICION HOSPITALARIA

ISSN: 0212-1611 Vol.35 N° 5 2018 págs. 1243 - 1251
Autores: Herin, H.; Aspeslagh, S.; Castañón Álvarez, Eduardo; et al.

Título: Immunotherapy phase I trials in patients Older than 70 years with advanced solid tumours

Revista: EUROPEAN JOURNAL OF CANCER

ISSN: 18790852 Vol.95 2018 págs. 68-74
Autores: Bastarrika Alemañ, Gorka; González de la Huebra Rodríguez, Ignacio Javier; Calvo Imirizaldu, Marta; et al.

Título: Kinematic reconstruction in cardiovascular imaging

Revista: RADIOLOGIA

ISSN: 0033-8338 Vol.60 N° 5 2018 págs. 387-393
Autores: Roeder, F. (Autor de correspondencia); de Paoli, A.; Saleh-Ebrahimi, L.; et al.

Título: Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.25 N° 13 2018 págs. 3833 - 3842

Resumen

IntroductionWe report a pooled analysis evaluating the combination of gross complete limb-sparing surgery, intraoperative electron radiation therapy (IOERT), and external beam radiation therapy (EBRT) in patients with extremity soft tissue sarcoma (STS).MethodsIndividual data of 259 patients (median follow-up 63months) with extremity STS from three European expert centers were pooled. Median age was 55years and median tumor size was 8cm. Eighty percent of patients presented with primary disease, mainly located in the lower limb (81%). Union for International Cancer Control 7th edition stage at presentation was as follows: stage I: 9%; stage II: 47%; stage III: 39%; stage IV: 5%. Most patients showed high-grade lesions (91%), predominantly liposarcoma (31%). Median IOERT dose was 12Gy, preceeded (17%) or followed (83%) by EBRT, with a median dose of 45Gy.ResultsSurgery resulted in R0 resections in 71% of patients and R1 resections in 29% of patients. The 5-year local control (LC) rate was 86%, and significant factors in univariate analysis were disease status and resection margin. Only margin remained significant in multivariate analysis. The 5-year distant control rate was 69%, and significant factors in univariate analysis were histology, grading, resection margin, and metastases prior to/at IOERT. Only grading and metastases remained significant in multivariate analysis. Actuarial 5-year rates of freedom from treatment failure and OS were 61% and 78%, respectively. Significant factors for OS were grading and metastases prior to/at IOERT (univariate, multivariate). Limb preservation and good functional outcome were achieved in 95% and 81% of patients.ConclusionsOur pooled analysis confirmed prior reports of encouraging LC and survival, with excellent rates of preserved limb function with this treatment approach. Resection margin remained the most important factor for LC, while grading and metastases prior to/at IOERT mainly predicted survival.
Autores: Prat, J. (Autor de correspondencia); D'Angelo, E.; Espinosa Mariscal, Íñigo

Título: Ovarian carcinomas: at least five different diseases with distinct histological features and molecular genetics

Revista: HUMAN PATHOLOGY

ISSN: 0046-8177 Vol.80 2018 págs. 11 - 27

Resumen

Based on histopathology and molecular genetics, ovarian carcinomas are divided into five main types: high-grade serous (70%), endometrioid (10%), clear cell (10%), mutinous (3%), and low-grade serous (<5%) carcinomas. These tumors, which account for over 95% of cases, represent distinct diseases with different prognoses and treatments. TP53 mutations are identified in almost all (96%) high-grade serous carcinomas (HGSCs). Early p53 loss followed by BRCA loss leads to deficiency in homologous recombination (DHR) repair, which in turn triggers chromosomal instability and widespread somatic copy number changes. An undetermined number of cases of HGSCs originate in the tubal fimbria; however, an origin from the ovarian surface epithelium cannot be totally excluded. Low-grade serous carcinomas (LGSCs) most likely represent progression of SBTs. BRAF or KRAS mutations occur in one-third to one-half of cases. Mucinous carcinomas (MCs) typically show benign-appearing, borderline, non-invasive and invasive components indicating tumor progression. KRAS mutations occur in 43.6% of cases and overexpression/amplification of HER2 in 18.8%. Endometrioid and clear cell carcinomas (EC and CCC) originate from ovarian endometriosis. Compared with their uterine counterparts, ECs have a similar frequency of beta-catenin abnormalities but lower rate of microsatellite instability (MI) and PTEN alterations. ARID1A mutations occur in both ECs (30%) and CCCs (50%) and may be encountered in adjacent endometriosis. CCCs carry inactivating PTEN mutations and activating mutations in PIK3CA in 8% and 33% of cases, respectively. This review summarizes recent advances in the molecular pathology, which have greatly improved our understanding of the biology of ovarian carcinomas and are also relevant to patient management. (C) 2018 Elsevier Inc. All rights reserved.
Autores: Jaff, M. R.; Kokkosis, A. A.; Leal Lorenzo, José ignacio; et al.

Título: Periprocedural Hemodynamic Managemente for Transcarotid Artery Revascularization

Revista: ENDOVASCULAR TODAY

ISSN: 1551-1944 Vol.17 N° 8 2018 págs. 11-13
Autores: Poveda, Inés; Vilarrasa Rull, Eva; Martorell Calatayud, Antonio; et al.

Título: Serum Zinc Levels in Hidradenitis Suppurativa: A Case-Control Study

Revista: AMERICAN JOURNAL OF CLINICAL DERMATOLOGY

ISSN: 1175-0561 Vol.19 N° 5 2018 págs. 771-777

Resumen

Background: Serum zinc levels in patients with hidradenitis suppurativa (HS) have not been previously studied. Objective: The aim was to investigate the association between HS and serum zinc levels. Methods: A multicenter, prospective clinical and analytical case-control study was designed to assess the possible association between HS and serum zinc levels. Consecutive patients with moderate or severe HS (Hurley II or III exclusively) were enrolled. A control population was recruited from primary care clinics. Fasting blood samples were extracted from each patient and serum zinc levels determined. Candidate predictors for low serum zinc levels were determined using logistic regression models. Results: In total, 122 patients with HS and 122 control subjects were studied. Of the 122 HS patients, 79 (64.8%) were Hurley II and 43 (35.2%) were Hurley III. Low serum zinc levels (¿ 83.3 µg/dL) were more prevalent in HS (adjusted odds ratio [ORa] 6.7, P < 0.001). After logistic regression analysis, low serum zinc levels were associated with Hurley III (ORa 4.4, P < 0.001), Dermatology Life Quality Index ¿ 9 (ORa 3.1, P = 0.005), number of affected sites ¿ 3 (ORa 2.4, P = 0.042), genital location (ORa 2.9, P = 0.009), and perineal location (ORa 2.5, P = 0.025). Conclusion: Low serum zinc levels are more prevalent in HS than in a healthy population, an indicator that may also be associated with disease severity.
Autores: Jullien-Petrelli, A. C. ; Garcia-Sabrido, J. L.; Orue-Echebarria, M. I.; et al.

Título: Role of intraoperative radiotherapy in the treatment of sacral chordoma

Revista: SPINE JOURNAL

ISSN: 1529-9430 Vol.18 N° 4 2018 págs. 632 - 638

Resumen

BACKGROUND CONTEXT: Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. To date, there are no series available in literature combining surgery and intraoperative radiotherapy (IORT). PURPOSE: The objective of this study was to report the experience of our center in the management of sacral chordoma combining radical resection with both external radiotherapy and IORT. STUDY DESIGN: This is a retrospective case series. PATIENT SAMPLE: The patient sample included 15 patients with sacral chordoma resected in our center from 1998 to 2015. OUTCOME MEASURES: The outcome measures were overall survival (OS), disease-free survival (DFS), and rates of local and distant recurrences. METHODS: We retrospectively reviewed the records of all the patients with sacral chordoma resected in our center from 1998 to December 2015. Overall survival, DFS, and rates of local and distant recurrences were calculated. Results between patients treated with or without IORT were compared. RESULTS: A total of 15 patients were identified: 8 men and 7 women. The median age was 59 years (range 28-77). Intraoperative radiotherapy was applied in nine patients and six were treated with surgical resection without IORT. In 13 patients, we performed the treatment of the primary tumor, and in two patients, we performed the treatment of recurrence disease. A posterior approach was used in four patients. Wide surgical margins (zero residue) were achieved in six patients, marginal margins (microscopic residue) were achieved in seven patients, and there were no patients with intralesional (R2) margins. At a median follow-up of 38 months (range 11-209 months), the 5-year OS in the IORT group was 100% versus 53% in the group of non-IORT (p=.05). The median DFS in the IORT group was 85 months, and that in the non-IORT group was 41 months. In the group without IORT, two patients died and nobody died during the follow-up in the group treated with IORT. High-sacrectomy treated patients had a median survival of 41 months, and low-sacrectomy treated patients had a median survival of 90 months. Disease-free survival in patients without gluteal involvement was 100% at 5 years, and that in patients with gluteal involvement was 40%. All patients with a recurrence in our study had gluteal involvement. CONCLUSIONS: Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in OS and DFS. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed to confirm the utility of IORT. (C) 2017 Elsevier Inc. All rights reserved.
Autores: Jimenez-Fonseca, P. (Autor de correspondencia); Carmona-Bayonas, A.; Font, C.; et al.

Título: The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism

Revista: CLINICAL AND TRANSLATIONAL ONCOLOGY

ISSN: 1699-048X Vol.20 N° 2 2018 págs. 230 - 242

Resumen

To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.
Autores: Sun, R. ; Koubaa, I. ; Limkin, E. J. ; et al.

Título: Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae.

Revista: ONCOTARGET

ISSN: 1949-2553 (Electronic) Vol.9 N° 10 2018 págs. 9299-9310
Autores: Melero Bermejo, Ignacio; Castañón Álvarez, Eduardo; Mau-Sorensen, M.; et al.

Título: Clinical activity, safety, and PK/PD from a phase I study of RO6874281, a fibroblast activation protein (FAP) targeted interleukin-2 variant (IL-2v)

Revista: ANNALS OF ONCOLOGY

ISSN: 0923-7534 Vol.29 N° Supl. 8 2018
Autores: Perez-Sanchez, C. ; Sanchez, L. P. ; Patino-Trives, A. M.; et al.

Título: Integrated mRNA and microRNA Transcriptomes of Monocytes from Antiphospholipid Syndrome Patients Identifies Molecular Networks Related to Their Atherothrombotic Status. Modulatory Effects of In Vivo Ubiquinol Supplementation

Revista: ARTHRITIS & RHEUMATOLOGY

ISSN: 2326-5191 Vol.70 N° Suppl. 9 2018
Autores: Terlizzi, M.; Rapeaud, E.; Le Pechoux, C.; et al.

Título: Radiation Therapy in Extracranial Chondrosarcomas: A Multicenter French Sarcoma Group and Rare Cancer Network Study

Revista: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS

ISSN: 0360-3016 Vol.102 N° 3 2018 págs. E369 - E370
Autores: Radin, M. ; Schreiher, K.; Cuadrado Lozano, María José; et al.

Título: Pregnancy Outcomes in Mixed Connective Tissue Disease: Results from a Multicentre Cohort Study

Revista: ARTHRITIS & RHEUMATOLOGY

ISSN: 2326-5191 Vol.70 N° Suppl. 9 2018 págs. 1-3
Autores: Lopez-Pedrera, C. ; Cecchi, I.; Barbarroja, N.; et al.

Título: Rituximab Induces an Early Re-Assessment of the Immune and Vascular Systems in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis

Revista: ARTHRITIS & RHEUMATOLOGY

ISSN: 2326-5191 Vol.70 N° Suppl. 9 2018
Autores: Sciascia, S.; Yazdany, J.; Cuadrado Lozano, María José; et al.

Título: Clinical Outcomes and Response to Anti-Thrombotic Treatment Among Patients with Concomitant Lupus Nephritis and Thrombotic Microangiopathy: A Multicenter Cohort Study

Revista: ARTHRITIS & RHEUMATOLOGY

ISSN: 2326-5191 Vol.70 N° Suppl. 9 2018
Autores: Schreiber, K.; Radin, M.; Cecchi, I. ; et al.

Título: The Global Antiphospholipid Syndrome Score in Women with Systemic Lupus Erythematosus and Adverse Pregnancy Outcomes

Revista: ARTHRITIS & RHEUMATOLOGY

ISSN: 2326-5191 Vol.70 2018

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Autores: González Hernández, Álvaro; García del Barrio, María Ángeles; Arbea Moreno, Leire; et al.

Título: Alteraciones analíticas

Libro: Guía inmunotoxicidad: diagnóstico y manejo de los efectos secundarios asociados a inmunoterapia en oncología

ISSN: 9788431333003 2019 págs. 204 - 210
Autores: Ezponda Casajús, Ana; González de la Huebra Rodríguez, Ignacio Javier; Alonso Burgos, Alberto; et al.

Título: Radiología intervencionista en la patología de la vesícula, vías biliares y páncreas

Libro: Guía de Cirugía Biliopancreática

ISSN: 978-84-17554-11-8 N° 2ª edición 2018 págs. 83-98

Resumen

Durante los últimos años, la Cirugía Biliopancreática ha sufrido importantes cambios, entre los que la vía de abordaje ha podido ser uno de los más relevantes, junto a los avances en el tratamiento oncológico, la mínima invasión y los modernos métodos diagnósticos disponibles en los últimos años; todos ellos quedan reflejados en este documento, lo que le convierte en una guía actualizada, de fácil manejo y muy útil para cirujanos en formación en esta área de superespecialización de la cirugía digestiva, con el claro objetivo de resolver los retos que nuestra profesión nos pone en el camino. Cada día son más frecuentes los hallazgos incidentales en el páncreas y en las vías biliares, que requieren la aplicación de algoritmos diagnósticos y de decisiones terapéuticas que, en muchas ocasiones, precisan de un conocimiento profundo de la enfermedad, tecnología diagnóstica específica y experiencia quirúrgica en esta área; de ahí que el desarrollo de unidades de referencia en Cirugía Hepatobiliopancreática, donde se manejan un elevado número de casos, haya llevado a la baja morbimortalidad relacionada con procedimientos complejos. Estos hechos, añadidos al aumento de la prevalencia epidemiológica de la patología biliopancreática, constituyen una verdadera atracción para los cirujanos generales, a los que estos documentos sirven de guía para poner en práctica algunos de los procedimientos en función de su complejidad y del hospital en el que desempeñan su actividad.

Autores: Soriano-Colomé, T.; Martínez-Alés, G.; Leal Lorenzo, José ignacio; et al.

Título: Planificación y Gestión

ISSN: 978-84-17095-05-5 2018

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Otros (PIUNA, fundaciones, contratos…)

Título: Desarrollo de un test para el diagnóstico precoz no invasivo de cáncer de pulmón basado en marcadores moleculares, imágenes y herramientas de Big Data-oncoLung Dx

Código de expediente: CPP2021-008336

Investigador principal: LUIS MIGUEL SEIJO MACEIRAS.

Financiador: AGENCIA ESTATAL DE INVESTIGACION

Convocatoria: 2021 AEI Proyectos en Colaboración Público Privada

Fecha de inicio: 01-06-2022

Fecha fin: 31-05-2025

Importe concedido: 174.754,00€

Otros fondos: Fondos MRR
Título: Registro prospectivo de hipofraccionamiento con fotonterapia y protonterapia con sobreimpresion en zona GaPSMA positiva en el rescate tras prostatectomia

Código de expediente: pi20/01598

Investigador principal: FELIX MAURICIO CAMBEIRO VAZQUEZ.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: 2020 AES Proyectos de investigación

Fecha de inicio: 01-01-2021

Fecha fin: 31-12-2023

Importe concedido: 68.970,00€

Otros fondos: Fondos FEDER
Título: Marcadores de hipoxia en la confluencia de la EPOC, el SAHS y el cáncer de pulmón (proyecto ECCO)

Código de expediente: PI20/01689

Investigador principal: LUIS MIGUEL SEIJO MACEIRAS.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: 2020 AES Proyectos de investigación

Fecha de inicio: 01-01-2021

Fecha fin: 31-12-2023

Importe concedido: 87.604,00€

Otros fondos: Fondos FEDER
Título: Nuevas combinaciones inmunomoduladoras frente al adenocarcinoma de pulmón según el estado mutacional del oncogen KRAS. Estudio de nuevos biomarcadores de respuesta a terapia anti-PD-1

Código de expediente: PI19/00678

Investigador principal: IGNACIO GIL BAZO.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: 2019 AES Proyectos de investigación

Fecha de inicio: 01-01-2020

Fecha fin: 31-12-2022

Importe concedido: 111.320,00€

Otros fondos: Fondos FEDER
Título: Descifrando la disociación de resultados en pruebas vestibulares de pacientes con enfermedad de Méniere unilateral

Código de expediente: PI19/00414

Investigador principal: NICOLAS PEREZ FERNANDEZ.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: 2019 AES Proyectos de investigación

Fecha de inicio: 01-01-2020

Fecha fin: 31-12-2022

Importe concedido: 68.970,00€

Otros fondos: Fondos FEDER
Título: Neurodegeneración en epilepsia: ¿Una nueva Taupatía no descrita? Estudio in-vivo del depósito de proteina Tau en epilepsia temporal

Código de expediente: PI19/00610

Investigador principal: MARIA CENTENO SOLADANA, ASIER GOMEZ IBAÑEZ.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: 2019 AES Proyectos de investigación

Fecha de inicio: 01-01-2020

Fecha fin: 31-12-2022

Importe concedido: 75.020,00€

Otros fondos: Fondos FEDER
Título: Papel de los neutrófilos en la invasión miometrial del carcinoma endometrioide de endometrio

Código de expediente: PI16/00902

Investigador principal: IÑIGO ESPINOSA MARISCAL, JAIME PRAT DIAZ DE LOSADA, JULIAN SANZ ORTEGA.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: 2016 AES PROYECTOS DE INVESTIGACIÓN

Fecha de inicio: 01-01-2019

Fecha fin: 30-06-2021

Importe concedido: 19.360,00€

Otros fondos: Fondos FEDER

Título: Personalized Planning in RadioTherapy Through Integrative Modeling of Local Dose Effect and New Dosimetric Constraints

Código de expediente: AC20/00123

Investigador principal: FELIPE ANGEL CALVO MANUEL

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: FIMA 2020 AES Proyectos de Programación Conjunta Internacional

Fecha de inicio: 01-01-2021

Fecha fin: 31-12-2023

Importe concedido: 18.150,00€

Otros fondos: -

Título: Análisis de mecanismos moleculares e impacto pronóstico de la hiperferritinemia en la enfermedad hepática por grasa no-alcohólica

Investigador principal: MANUEL ANTONIO DE LA TORRE ALAEZ

Financiador: UNIVERSIDAD DE NAVARRA

Convocatoria: 2020 Convocatoria PIUNA

Fecha de inicio: 01-09-2020

Fecha fin: 31-08-2021

Importe concedido: 4.000,00€

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