Late metastases: a rare cause of diarrhea.

We present the case of a 64-year-old female with personal history of breast carcinoma diagnosed in 2011, treated and discharged from the Oncology service after 10 years disease-free who, 21 years after the diagnosis, undergoes a colonoscopy with biopsy sampling due to a 2-year period of diarrhea and weight loss, which histological study show infiltration of the large intestine's by breast carcinoma. Due to the usual lymphatic widespread, metastases of breast cancer in the gastrointestinal tract are extremely rare with nonspecific symptoms, long latency periods and poor prognosis.

Intracranial thrombus composition is associated with occlusion location and endovascular treatment outcomes: results from ITACAT multicenter study.

BACKGROUND: The impact of thrombolytics directed towards different thrombus components regarding site of occlusion in combination with mechanical thrombectomy (MT) to achieve endovascular complete recanalization is unclear. METHODS: Retrospective analysis of a prospective database in two stroke centers. Intracranial thrombi retrieved by MT were analyzed using hematoxylin-eosin staining for fibrin and red blood cell proportions, and CD61 immunostaining for platelets proportion in thrombus (PLTPT) assessment. Thrombi composition, baseline variables, etiology, treatment features and occlusion location were analyzed. RESULTS: Overall, 221 patients completed the per protocol analysis and 110 cases achieved a final expanded Thrombolysis in Cerebral Infarction (eTICI) 3 (49%) of which 70 were MT (32%) by first pass effect (FPE). Thrombi from medium distal vessel occlusions had higher PLTPT compared with thrombi from proximal large vessel occlusions (68% vs 61%, P=0.026). In particular, middle cerebral artery M2-M3 segment thrombi had the highest PLTPT (70%), and basilar artery thrombi the lowest PLTPT (41%). After logistic regression analysis adjusted for occlusion location and intravenous fibrinolysis, lower baseline National Institutes of Health Stroke Scale score (adjusted OR (aOR) 0.95, 95% CI 0.913 to 0.998) and PLTPT (aOR 0.97, 95% CI 0.963 to 0.993) were independently associated with FPE. Fewer MT passes (aOR 0.67, 95% CI 0.538 to 0.842) and platelet poor thrombus (<62% PLTPT; aOR 2.39, 95% CI 1.288 to 4.440) were independently associated with final eTICI 3. CONCLUSIONS: Occlusion location might be a surrogate parameter for thrombus composition. Platelet poor clots and fewer MT passes were independently associated with complete endovascular recanalization. Clinical trials testing the benefits of combining selective intra-arterial platelet antagonists with MT to improve endovascular outcomes are warranted.

Safety and Efficacy of ApTOLL in Patients With Ischemic Stroke Undergoing Endovascular Treatment: A Phase 1/2 Randomized Clinical Trial.

Importance: ApTOLL is a TLR4 antagonist with proven preclinical neuroprotective effect and a safe profile in healthy volunteers. Objective: To assess the safety and efficacy of ApTOLL in combination with endovascular treatment (EVT) for patients with ischemic stroke. Design, Setting, and Participants: This phase 1b/2a, double-blind, randomized, placebo-controlled study was conducted at 15 sites in Spain and France from 2020 to 2022. Participants included patients aged 18 to 90 years who had ischemic stroke due to large vessel occlusion and were seen within 6 hours after stroke onset; other criteria were an Alberta Stroke Program Early CT Score of 6 to 10, estimated infarct core volume on baseline computed tomography perfusion of 5 to 70 mL, and the intention to undergo EVT. During the study period, 4174 patients underwent EVT. Interventions: In phase 1b, 0.025, 0.05, 0.1, or 0.2 mg/kg of ApTOLL or placebo; in phase 2a, 0.05 or 0.2 mg/kg of ApTOLL or placebo; and in both phases, treatment with EVT and intravenous thrombolysis if indicated. Main Outcomes and Measures: The primary end point was the safety of ApTOLL based on death, symptomatic intracranial hemorrhage (sICH), malignant stroke, and recurrent stroke. Secondary efficacy end points included final infarct volume (via MRI at 72 hours), NIHSS score at 72 hours, and disability at 90 days (modified Rankin Scale [mRS] score). Results: In phase Ib, 32 patients were allocated evenly to the 4 dose groups. After phase 1b was completed with no safety concerns, 2 doses were selected for phase 2a; these 119 patients were randomized to receive ApTOLL, 0.05 mg/kg (n = 36); ApTOLL, 0.2 mg/kg (n = 36), or placebo (n = 47) in a 1:1:√2 ratio. The pooled population of 139 patients had a mean (SD) age of 70 (12) years, 81 patients (58%) were male, and 58 (42%) were female. The primary end point occurred in 16 of 55 patients (29%) receiving placebo (10 deaths [18.2%], 4 sICH [7.3%], 4 malignant strokes [7.3%], and 2 recurrent strokes [3.6%]); in 15 of 42 patients (36%) receiving ApTOLL, 0.05 mg/kg (11 deaths [26.2%], 3 sICH [7.2%], 2 malignant strokes [4.8%], and 2 recurrent strokes [4.8%]); and in 6 of 42 patients (14%) receiving ApTOLL, 0.2 mg/kg (2 deaths [4.8%], 2 sICH [4.8%], and 3 recurrent strokes [7.1%]). ApTOLL, 0.2 mg/kg, was associated with lower NIHSS score at 72 hours (mean difference log-transformed vs placebo, -45%; 95% CI, -67% to -10%), smaller final infarct volume (mean difference log-transformed vs placebo, -42%; 95% CI, -66% to 1%), and lower degrees of disability at 90 days (common odds ratio for a better outcome vs placebo, 2.44; 95% CI, 1.76 to 5.00). Conclusions and Relevance: In acute ischemic stroke, 0.2 mg/kg of ApTOLL administered within 6 hours of onset in combination with EVT was safe and associated with a potential meaningful clinical effect, reducing mortality and disability at 90 days compared with placebo. These preliminary findings await confirmation from larger pivotal trials. Trial Registration: ClinicalTrials.gov Identifier: NCT04734548.

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial.

BACKGROUND: In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors. METHODS: The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay. RESULTS: We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses. CONCLUSION: In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.

Long-term antibiotic therapy in patients with surgery-indicated not undergoing surgery infective endocarditis.

BACKGROUND: To date, there is little information regarding management of patients with infective endocarditis (IE) that did not undergo an indicated surgery. Therefore, we aimed to evaluate prognosis of these patients treated with a long-term antibiotic treatment strategy, including oral long term suppressive antibiotic treatment in five referral centres with a multidisciplinary endocarditis team. METHODS: This retrospective, multicenter study retrieved individual patient-level data from five referral centres in Spain. Among a total of 1797, 32 consecutive patients with IE were examined (median age 72 years; 78% males) who had not undergone an indicated surgery, but received long-term antibiotic treatment (LTAT) and were followed by a multidisciplinary endocarditis team, between 2011 and 2019. Primary outcomes were infection relapse and mortality during follow-up. RESULTS: Among 32 patients, 21 had IE associated with prostheses. Of the latter, 8 had an ascending aorta prosthetic graft. In 24 patients, a switch to long-term oral suppressive antibiotic treatment (LOSAT) was considered. The median duration of LOSAT was 277 days. Four patients experienced a relapse during follow-up. One patient died within 60 days, and 12 patients died between 60 days and 3 years. However, only 4 deaths were related to IE. CONCLUSIONS: The present study results suggest that a LTAT strategy, including LOSAT, might be considered for patients with IE that cannot undergo an indicated surgery. After hospitalization, they should be followed by a multidisciplinary endocarditis team.

Blood Biomarkers to Predict Long-Term Mortality after Ischemic Stroke.

Stroke is a major cause of disability and death globally, and prediction of mortality represents a crucial challenge. We aimed to identify blood biomarkers measured during acute ischemic stroke that could predict long-term mortality. Nine hundred and forty-one ischemic stroke patients were prospectively recruited in the Stroke-Chip study. Post-stroke mortality was evaluated during a median 4.8-year follow-up. A 14-biomarker panel was analyzed by immunoassays in blood samples obtained at hospital admission. Biomarkers were normalized and standardized using Z-scores. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with long-term mortality and mortality due to stroke. In the multivariate analysis, the independent predictors of long-term mortality were age, female sex, hypertension, glycemia, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Independent blood biomarkers predictive of long-term mortality were endostatin > quartile 2, tumor necrosis factor receptor-1 (TNF-R1) > quartile 2, and interleukin (IL)-6 > quartile 2. The risk of mortality when these three biomarkers were combined increased up to 69%. The addition of the biomarkers to clinical predictors improved the discrimination (integrative discriminative improvement (IDI) 0.022 (0.007-0.048), p < 0.001). Moreover, endostatin > quartile 3 was an independent predictor of mortality due to stroke. Altogether, endostatin, TNF-R1, and IL-6 circulating levels may aid in long-term mortality prediction after stroke.

Una mirada a las raíces, evolución y desarrollo de la Facultad de Cultura Física «Nancy Uranga Romagoza¼ de la Universidad de Pinar del Río «Hermanos Saíz Montes de Oca¼ / A view to the origin, evolution and development of the Faculty of Physical Culture «Nancy Uranga Romagoza at the University of Pinar del Rio «Hermanos Saíz Montes de Oca¼

RESUMEN Esta obra es el resultado del trabajo sistemático de quienes acumulan una larga trayectoria en el quehacer de la Facultad de Cultura Física "Nancy Uranga Romagoza" y en el ejercicio de la labor universitaria. En ella, se puede encontrar el proceso histórico de gestación, consolidación y afirmación de la Facultad de Cultura Física de Pinar del Río, expresado por los propios hacedores fundamentales. La investigación tiene como objetivo fundamental preservar la historia de la institución docente, así como también mostrar a las presentes y futuras generaciones el origen y decursar de la Facultad de Cultura Física "Nancy Uranga Romagoza" de la Universidad de Pinar del Río "Hermanos Saíz Montes de Oca", para así contribuir con la elevación del sentido de pertenencia hacia la carrera y el plantel. Para llevar a cabo este estudio, se realizó una revisión documental que incluyó una consulta a las resoluciones sobre la constitución de la Facultad de Cultura Física "Nancy Uranga Romagoza" en sus diferentes etapas, así como entrevistas a personalidades del deporte que han mantenido relación con las escuelas deportivas y, principalmente, con la Facultad de Cultura Física "Nancy Uranga Romagoza" en estudio.

ABSTRACT This work is the outcome of a systematic work coming from people who have saved deep and experienced records about the Faculty of Physical Culture"Nancy Uranga Romagoza", University of Pinar del Río "Hermanos Saíz Montes de Oca", Cuba. Throughout this article you can find the process of establishment and evolution of the Sport Faculty of Physical Culture "Nancy Uranga Romagoza" in Pinar del Río, taking in to consideration the critics and opinions of experts. The objective of the research is to preserve the historical background of the Faculty of Physical Culture "Nancy Uranga Romagoza" and the show the compiled work to the present and future generations. In this way it can be reinforced the sense of identity and positive moral values in the institution. To carry out this study it was necessary to apply some interviews and to consult some documents about the constitution of the Faculty of Physical Culture "Nancy Uranga Romagoza" attending to the different stages of evolution.

Blood Biomarkers for the Early Diagnosis of Stroke: The Stroke-Chip Study.

BACKGROUND AND PURPOSE: Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase. METHODS: The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves. RESULTS: From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55-3.71; P<0.0001) and endostatin >4.7 (odds ratio, 2.02; 95% confidence interval, 1.19-3.45; P=0.010), together with age, sex, blood pressure, stroke severity, atrial fibrillation, and hypertension, were included in the model. Predictive accuracy was 80.6%. CONCLUSIONS: The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.

Reported Prestroke Physical Activity Is Associated with Vascular Endothelial Growth Factor Expression and Good Outcomes after Stroke.

INTRODUCTION: Physical activity (PhA) prior to stroke has been associated with good outcomes after the ischemic insult, but there is scarce data on the involved molecular mechanisms. METHODS: We studied consecutive acute ischemic stroke patients admitted to a single tertiary stroke center. Prestroke PhA was evaluated with the International Physical Activity Questionnaire (metabolic equivalent of minutes/week). We studied several circulating angiogenic and neurogenic factors at different time points: vascular endothelial growth factor (VEGF), granulocyte colony-stimulating factor (G-CSF), and brain-derived neurotrophic factor (BDNF) at admission, day 7, and at 3 months. We considered good functional outcome at 3 months (modified Rankin scale ≤ 2) as primary end point, and final infarct volume as secondary outcome. RESULTS: We studied 83 patients with at least 2 time point serum determinations (mean age 69.6 years, median National Institutes of Health Stroke Scale 17 at admission). Patients more physically active before stroke had a significantly higher increment of serum VEGF on the seventh day when compared to less active patients. This increment was an independent predictor of good functional outcome at 3 months and was associated with smaller infarct volume in multivariate analyses adjusted for relevant covariates. We did not find independent associations of G-CSF or BDNF levels neither with level of prestroke PhA nor with stroke outcomes. CONCLUSIONS: Although there are probably more molecular mechanisms by which PhA exerts its beneficial effects in stroke outcomes, our observation regarding the potential role of VEGF is plausible and in line with previous experimental studies. Further research in this field is needed.

Actualización sobre calidad de vida para formadores de recursos humanos en Tecnología de la Salud / Updating about quality of life for trainers of human resources in Health Technology

Fundamento: es importante disponer de recursos humanos altamente calificados y actualizados sobre el tema Calidad de Vida a partir de acciones que transformen el modo y estilos de vida de los profesionales de la salud, tanto para favorecer el bienestar propio como para fortalecer la promoción y prevención de salud. Objetivo: diseñar una estrategia de actualización sobre Calidad de Vida para los formadores de los recursos humanos de la Facultad de Tecnología de la Salud. Métodos: se utilizó una metodología con enfoque cualitativo y se aplicaron métodos y técnicas de los niveles teórico, empírico y matemático, que permitieron la recogida y procesamiento de la información. La muestra estuvo constituida por 30 formadores (docentes y no docentes) seleccionados por muestreo aleatorio. Resultados: se identificaron las necesidades de aprendizaje, y se diseñó una estrategia que contiene acciones de diagnóstico sobre los determinantes del comportamiento que afectan su calidad de vida y de superación y/o capacitación, concebidas con enfoque sistémico, utilizando fundamentalmente talleres vivenciales con la participación de profesionales de las diferentes carreras de la facultad objeto de estudio, la cual fue valorada en su efectividad por diversos especialistas. Conclusiones: la estrategia respondió al diagnóstico realizado y permitió una actualización sobre el tema, modificación de concepciones y reconocimiento de las características personales necesarias, para mejorar la calidad de vida de los formadores de recursos humanos, lo que repercute en el accionar educativo de los estudiantes de la referida facultad.

Background: it is important to have human resources highly qualified and updated about the topic Quality of Life, as of actions that transform the way and styles of life of the health professionals, both to favor their own well-being as to strengthen the promotion and prevention of health. Objective: to design a strategy of updating on the Quality of Life for the trainers of human resources in the Faculty of Health Technology. Methods: a methodology with qualitative approach was used, and methods and techniques of the theoretical, empirical and mathematical levels were applied, that allowed to collect and process the information. The sample was composed of 30 trainers (teachers and non-teachers), selected by stratified sampling. Results: the learning needs were identified, and a strategy was designed that contains diagnostic actions on the behavioral factors that affect their quality of life and their training and upgrading, conceived with a systemic approach, by mainly using workshops with the participation of professionals from the different departments of the faculty. The effectiveness of this study was assessed by several specialists. Conclusions: the strategy responded to the diagnosis made, and allowed an updating on the theme, modification of conceptions and recognition of the necessary personal characteristics, in order to improve the quality of life of the trainers of human resources, which has repercussion in the educational behavior of the students of the faculty.

Hacia una concepción desarrolladora en la calidad de la evaluación del aprendizaje. Propuesta de Manual / Towards a developing conception in the quality of learning assessment. A booklet proposal

Las actuales demandas de la educación superior precisan de enseñar a pensar a los estudiantes, lo que transforma la toma de decisiones pedagógicas en los profesores. Se realizó una investigación en el Politécnico de la Salud villaclareño, donde se caracterizó el acontecer de las prácticas evaluativas de los docentes y su influencia en el aprendizaje y desarrollo personal de los estudiantes, lo que sirvió de base en la elaboración de un manual para transformar las prácticas evaluativas de los profesores, con un contenido teórico actualizado y didáctico que incluye actividades prácticas que permiten la reflexión, el autodidactismo, autoevaluación y su utilización en actividades metodológicas en diferentes carreras y departamentos de la Facultad, motivándolos a modificar sus prácticas evaluativas. Este documento ha sido socializado en actividades metodológicas y eventos a diferentes niveles y escenarios de la educación superior.

The current demands of the higher education need to teach the students to think, which make transformations in the pedagogical decision taking on the part of the professors. A research work was carried out in the health Technology faculty in Villa Clara, where the professor's assessment activities were characterized and the learning and personal development of the students as well. On these bases a booklet was elaborated to transform the assessment practices of the professors, having updated theoretical and didactic contents which allow a reflexive knowledge, self-learning, self-evaluation and its usage in methodological activities in different departments and careers of the faculty, motivating them to modify their assessment practices. This document has been discussed in methodological activities and events at different levels and scenarios of the higher education.