Meta-analysis of genome-wide association studies for cancer therapy-related cardiovascular dysfunction and functional mapping highlight an intergenic region close to TP63.

Cancer therapy-related cardiac dysfunction (CTRCD), which commonly includes left ventricular dysfunction and heart failure, is the main adverse effect of anticancer therapy. In recent years several candidate genes studies and genome-wide association studies have identified common genetic variants associated with CTRCD, but evidence remains limited and few genetic variants are robust. A genome-wide meta-analysis of CTRCD was performed with 852 oncology patients receiving cancer therapy. DNA samples were genotyped and imputed to perform a GWAS meta-analysis for case-control (N = 852 (380 cases and 472 controls) and extreme phenotypes (N = 618 (78 cases and 472 controls) looking for genetic variants that predispose to CTRCD. The results were validated in a replicate cohort of 1,191 oncology patients (245 cases and 946 controls). Functional mapping of the replicated loci was then performed. The meta-analysis showed 9 and 17 loci suggestively associated (P-value < 1 × 10-5) with CTRCD in case-control and extreme phenotypes analyses, respectively. The 3q28 locus (rs rs7652759, P = 5.64 × 10-6) in the case-control analysis was the strongest signal, with up to 64 SNPs above the suggestive significance threshold. The rs7652759, an intergenic variant between TPRG1 and TP63 genes, was the only variant validated in the replication cohort (P-value = 0.01). Functional mapping of this significant locus revealed up to 5 new genes potentially involved in the CTRCD. We identified the intergenic region near TP63 as a novel CTRCD susceptibility locus. In the future, the genotyping of these markers could be considered in new CTRCD risk scores to improve preventive strategies in cardio-oncology.

Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study. / Guías impresas en 3D: ¿mejoran el control local y la supervivencia global en el tratamiento de los sarcomas pélvicos? Estudio de validación clínica.

BACKGROUND AND OBJECTIVES: 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients. MATERIAL AND METHODS: A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed. RESULTS: The 3D group achieved a higher rate of free margins (80% vs 66.7%, p = 0.345). Local recurrence (50% vs 60%, P=.244) and distant disease relapse (20% vs 47%, p = 0.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs 40%, p = 0.327). The complication rate was similar in both groups, with a deep infection rate of 40%. CONCLUSIONS: The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.

Impact of diabetes, malnutrition and sarcopenia on the prognosis of patients admitted to internal medicine.

OBJECTIVE: To describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. METHODS: Cross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48 h are excluded. RESULTS: 511 patients were analyzed, 49.1% male, mean age 75.2 +/- 15 years, 210 (41.1%) DM2. 6 groups (2 × 3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12-14 points, without risk; MNA-SF 8-12 points, high risk; MNA-SF 0-7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95%CI 1.06-1.54, p = 0.01), comorbidity (OR 1.27, 95%CI 1,08-1,49, p = 0.003) and inflammation (OR 1.01, 95%CI 1.00-1.02, p = 0.02). The 120-day prognosis was worse among malnourished patients (p = 0.042). CONCLUSION: Patients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients.

Usefulness of thermography in the diagnosis and classification of complex regional pain syndrome.

INTRODUCTION: We propose a protocol for study of complex regional pain syndrome (CRPS) based on a battery of quantitative measures (skin thermography, electrochemical skin conductance and sensory thresholds) and apply such protocol to 5 representative cases of CRPS. PATIENTS AND METHODS: 5 CPRS cases (2 women/3 men) that met the Budapest criteria for the diagnosis of CRPS. RESULTS: All patients showed spontaneous pain and allodynia. Two cases correspond to a stage I, in both the resting basal temperature was increased in the affected limb. Three cases reflect more advanced stages with a decrease in resting temperature and a delay in the recovery of the temperature when compared to contralateral limb. DISCUSSION: These non-invasive quantitative functional tests not only improve the diagnostic accuracy of CRPS but also, they help us to stratify and understand the pathological processes of the disease.

[Translated article] Evaluation of factors related to the occurrence of new fragility fractures: A case-control study.

INTRODUCTION: Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. MATERIAL AND METHOD: A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). RESULTS: Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥-2.5 (OR: 0.642). CONCLUSIONS: Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥-2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.

Evaluation of factors related to the occurrence of new fragility fractures: A case-control study. / Evaluación de los factores relacionados con la aparición de nuevas fracturas por fragilidad: un estudio de casos y controles.

INTRODUCTION: Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. MATERIAL AND METHOD: A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). RESULTS: Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥-2.5 (OR: 0.642). CONCLUSIONS: Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥-2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.

Brain fog of post-COVID-19 condition and Chronic Fatigue Syndrome, same medical disorder?

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by persistent physical and mental fatigue. The post-COVID-19 condition patients refer physical fatigue and cognitive impairment sequelae. Given the similarity between both conditions, could it be the same pathology with a different precipitating factor? OBJECTIVE: To describe the cognitive impairment, neuropsychiatric symptoms, and general symptomatology in both groups, to find out if it is the same pathology. As well as verify if the affectation of smell is related to cognitive deterioration in patients with post-COVID-19 condition. METHODS: The sample included 42 ME/CFS and 73 post-COVID-19 condition patients. Fatigue, sleep quality, anxiety and depressive symptoms, the frequency and severity of different symptoms, olfactory function and a wide range of cognitive domains were evaluated. RESULTS: Both syndromes are characterized by excessive physical fatigue, sleep problems and myalgia. Sustained attention and processing speed were impaired in 83.3% and 52.4% of ME/CFS patients while in post-COVID-19 condition were impaired in 56.2% and 41.4% of patients, respectively. Statistically significant differences were found in sustained attention and visuospatial ability, being the ME/CFS group who presented the worst performance. Physical problems and mood issues were the main variables correlating with cognitive performance in post-COVID-19 patients, while in ME/CFS it was anxiety symptoms and physical fatigue. CONCLUSIONS: The symptomatology and cognitive patterns were similar in both groups, with greater impairment in ME/CFS. This disease is characterized by greater physical and neuropsychiatric problems compared to post-COVID-19 condition. Likewise, we also propose the relevance of prolonged hyposmia as a possible marker of cognitive deterioration in patients with post-COVID-19.

European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

Sintonizando con otro: la teoría polivagal y el proceso de psicoterapia / Tuning into another: the polivagal theory and the psychotherapy process

RESUMEN: El presente trabajo tiene como principal objetivo presentar la teoría polivagal como un modelo bio-comportamental del comportamiento emocional e interpersonal, con la finalidad de identificar ámbitos de contribución de la teoría al estudio de la psicoterapia en torno al estatus clínico de los consultantes, el proceso terapéutico y el cambio. La revisión del modelo neurofisiológico muestra una reconceptualización las relaciones recíprocas entre sistema nervioso autónomo y la emocionalidad en el contexto interpersonal, lo cual permite distinguir condiciones de activación normal y patológica de las estrategias comportamentales defensivas (lucha/huida e inmovilización), así como su inhibición a través del sistema de enganche prosocial. Las investigaciones revisadas muestran evidencia a favor de las hipótesis derivadas del modelo tanto en población normal como clínica. De particular interés clínico resulta el sistema de enganche prosocial, pues habilita la emergencia del comportamiento interpersonal confiable, lo cual resulta ser un elemento pivotal para la psicoterapia por su potencial valor diagnóstico, así como sus efectos sobre el desarrollo y consolidación de la relación terapéutica y los resultados benéficos en el consultante. Finalmente, es posible identificar un cuerpo emergente de estudios de psicoterapia que evalúan la actividad del sistema de enganche prosocial mediante la variabilidad de la frecuencia cardiaca de alta frecuencia, vinculándolo tanto al proceso (p. ej., alianza de trabajo) como al resultado (p. ej., nivel de síntomas), evidenciando el valor de profundizar en esta línea interdisciplinaria de investigación y, eventualmente, incorporar estas mediciones al arsenal clínico de evaluación.

ABSTRACT The present work presents the polivagal theory as a bio-behavioral model of emotional and interpersonal behavior, aiming to identify its theoretical contributions to the study of psychotherapy regarding client's clinical status, therapeutic process as well as change. A review of the model shows a reconceptualization of interactions among autononomic nervous system and emotionality within interpersonal context, allowing for identifying normal and pathological activation of defensive behavioral strategies (figh-or-flight and immobilization), as well as their inhibition through the social engagement system. Empirical research shows evidence in favor of hypotheses derived from the model in normal and clinical populations. In clinical contexts, the social engagement system is of particular interest as it allows the emergence of interpersonal trustworthy behavior, being a cornerstone in psychotherapy due to its potential diagnostic value for clients, the development of the therapeutic relationships, as well as beneficial outcomes. Lastly, a nascent body of psychotherapy studies assessing the social engagement system (through high frequency heart rate variability-) and its relation with the therapeutic process (i.e. working alliance) and outcomes (i.e. symptom level) are identified. The evidence supports the value of further developing this interdisciplinary line of research and, eventually, incorporating these measurements into the clinical assessment arsenal.

The role of seagrass meadows in the coastal trapping of litter.

The accelerated discard and mismanagement of human-made products are resulting in the continued input of litter into the oceans. Models and field observations show how floating litter can accumulate in remote areas throughout the global ocean, but far less is known about the non-floating litter fraction. Seagrass meadows play an important role in the sediment and natural-debris dynamics, and likely also in the storage and processing of non-floating litter. In this work, non-floating litter was studied across six Posidonia oceanica meadows. Litter accumulated mainly around the landside edge of the meadow. The outer margin of the edge predominantly trapped macro-litter, whilst microplastics accumulated mainly along the inner margin. On average, macro-litter concentrations increased 3-fold after heavy rainfall. Retention of non-floating litter by coastal meadows facilitates the recurrent landward-seaward conveyance of the easily-transportable litter (mainly plastic items) and its fragmentation before it is buried or transferred to deeper areas.

Interference of Dermatophagoides pteronyssinus sensitization in grass pollen allergy.

Summary: Background. Climate conditions in the northwest of Spain are from the rest of the country, and the pollen sensitisation rates and allergens involved are different. The present study aimed to investigate the sensitisation profile of patients with grass pollen allergy and the interference of other sensitisations in respiratory symptoms. Methods. A total of 959 Spanish patients with seasonal respiratory symptoms and a positive skin prick test (SPT) to Phleum pratense pollen were studied. Patients were classified as having rhinitis and/or bronchial asthma. A battery of SPTs, including common weeds and tree pollens, profilin, polcalcin, moulds, Dermatophagoides pteronyssinus, Lepidoglyphus destructor, and cat and dog dander were performed. Serum specific IgE (sIgE) to Phl p 1 and Phl p 5, adding sIgE to Phl p 7, Phl p 12 and house dust mites (HDMs) or other pollens in selected cases were measured. Results.The majority (89.8%) of the patients were polysensitised according to SPT. HDM co-sensitisation was the most prevalent (62.3%). Profilin and polcalcin rendered a positive result in 25.9% and 18.7% of the patients, respectively. A higher proportion of patients recognized sIgE to Phl p 1 (88.7%) with respect to Phl p 5 (59%). Phl p 1-sIgE levels were higher than Phl p 5-sIgE levels, and no differences were found in patients with rhinitis and/or asthma. However, total serum IgE was higher in patients with asthma. Multivariate regression analyses revealed that only sIgE to Dermatophagoides pteronyssinus (after adjusting by sIgE to Phl p 1, Phl p 5 and Lepidoglyphus destructor) was associated with a greater risk of asthma. Conclusions. Phl p 1 is the most relevant allergen in patients with grass pollen allergy in the northwest of Spain. Sensitisation rates against panallergens are low. Even in patients with grass pollen allergy, HDM sensitisation plays a relevant role in asthma.

Usefulness of thermography in the diagnosis and classification of complex regional pain syndrome.

INTRODUCTION: We propose a protocol for study of complex regional pain syndrome (CRPS) based on a battery of quantitative measures (skin thermography, electrochemical skin conductance and sensory thresholds) and apply such protocol to 5 representative cases of CRPS. PATIENTS AND METHODS: 5 CPRS cases (2 women/3 men) that met the Budapest criteria for the diagnosis of CRPS. RESULTS: All patients showed spontaneous pain and allodynia. Two cases correspond to a stage I, in both the resting basal temperature was increased in the affected limb. Three cases reflect more advanced stages with a decrease in resting temperature and a delay in the recovery of the temperature when compared to contralateral limb. DISCUSSION: These non-invasive quantitative functional tests not only improve the diagnostic accuracy of CRPS but also, they help us to stratify and understand the pathological processes of the disease.

Sistemática en el Tratamiento Quirúrgico de las Fracturas Panfaciales Aplicado a un Caso Clínico De Alta Complejidad / Systematic in the Surgical Treatment of Panfacial Fractures Applied to a Highly Complex Clinical Case

RESUMEN: Las fracturas panfaciales son aquellas que afectan de forma simultánea al tejido óseo de dos o más tercios del rostro. El manejo inicial de estos pacientes es resolver o estabilizar las urgencias médico - quirúrgicas que puedan presentar, debido a que la gran mayoría de estas fracturas están asociadas a traumatismos de alta energía cinética, las que determinan la presencia de lesiones concomitantes que pueden comprometer la vida del paciente. El tratamiento quirúrgico de las fracturas panfaciales puede abarcar desde la intervención quirúrgica inicial de control de daños, estabilización, reducción y fijación quirúrgica de los segmentos fracturados mediante osteosíntesis hasta intervenciones mediatas para la reconstrucción de los tejidos afectados por el traumatismo. Para el tratamiento de las fracturas panfaciales existe una sistemática quirúrgica que tiene por objeto contener y/o minimizar daños agudos y permitir una reducción morfológica y funcional. Reportamos un caso clínico de fractura panfacial cuyo tratamiento siguió esta sistemática terapeútica.

ABSTRACT: Panfacial fractures affect bone tissue in two or more thirds of the face simultaneously. The initial management of these patients is to resolve or stabilize the medical-surgical emergencies that they may present. Most of these fractures are associated to trauma of high kinetic energy, which determine the presence of concomitant inju- ries that can compromise the life of the patient. The surgical treatment of panfacial fractures may include from the initial surgical intervention of damage control, stabilization, reduction and surgical fixation of fractured segments through osteosynthesis, to mediate the reconstruction of tissues affected by the trauma. For the treatment of panfacial fractures there is a surgical approach that aims to contain and/or minimize acute damage and allow for morphological and functional reduction. We report a clinical case of panfacial fracture whose treatment followed this therapeutic approach.