Peripherally inserted central catheter in haematopoietic stem cell transplantation. Infusion of haematopoietic cells and complications. / Catéter central de inserción periférica en trasplante de progenitores hematopoyéticos. Infusión de células hematopoyéticas y complicaciones.

AIMS: To analyze the incidence of complications related to the central peripheral insertion catheter and the viability of the infusion of haematopoietic stem cells through volumetric perfusion pumps. METHOD: Prospective descriptive study that includes all patients who received a haematopoietic transplant in the Haematology Service of the Hospital Clínico de Valencia between January and December 2016 (n=73). All of them received a central peripheral insertion catheter. SPSS™ v22 was used to perform the descriptive analysis of the main variables using a confidence interval of 95%. The student's t-test was used to compare the means of two independent samples assuming unequal variances. RESULTS: The 63% (n=73) of the catheters remained without problems throughout the procedure. Fever of unknown origin (28.8%) was the main cause of catheter removal. The median number of days for haematological recovery was 12.5 for the autologous transplants and 15 for the allogeneic transplants. CONCLUSIONS: The central peripheral insertion catheter presents few complications related to insertion. The administration of haematopoietic cells through these catheters with volumetric perfusion pumps does not imply a delay in haematological recovery. Good acceptance by the patient is confirmed.

Cardiovascular risk reduction over time in patients with diabetes or pre-diabetes undergoing bariatric surgery: data from a single-center retrospective observational study.

BACKGROUND: Bariatric surgery is effective in remission of obesity comorbidities. This study was aimed at comparing CVD risk between morbidly obese patients with type 2 diabetes and pre-diabetes before and after bariatric surgery as well as assessing comorbidities. METHODS: This is a retrospective observational study with 105 patients with type 2 diabetes (DMbaseline) and prediabetes (preDMbaseline) who underwent Roux-en-Y gastric bypass. Data were collected preoperative and then at 3,6,12,18,24,36,48, and 60 months after surgery. Anthropometric, cardiovascular and glycemic parameters were assessed. CVD risk was calculated using the Framingham Risk Score. RESULTS: Prior to surgery, 48 patients had type 2 diabetes, while 57 had pre-diabetes. Mean age was 48 (9.2) and mean BMI was 52 (7.4). 26.1% of patients had a high CVD risk. CVD risk decreased in patients with type 2 diabetes and prediabetes at month 12 after surgery compared to the baseline risk (p < 0.001). BMI, body fat percentage, fasting plasma glucose, HbA1c, c-peptide, HOMA-IR, LDL-c, systolic blood pressure, and diastolic blood pressure decreased during the first year after surgery. From the 12th month until the 60th, they showed a flat trend, or a very mild increase in some cases. 3.2% of patients maintained high CVD risk at 60 months. Type 2 diabetes remission was 92%. No patient of the preDMbaseline group developed type 2 diabetes. CONCLUSION: Bariatric surgery reduces CVD risk in type 2 diabetes and pre-diabetes. Given that patients with type 2 diabetes benefit the most, more studies are necessary to consider pre-diabetes as a criterion for metabolic surgery in patients with BMI ≥ 35 kg/m2.

PF9601N [N-(2-propynyl)-2-(5-benzyloxy-indolyl) methylamine] confers MAO-B independent neuroprotection in ER stress-induced cell death.

Endoplasmic reticulum (ER) stress has recently been proposed as one of the factors contributing to apoptotic cell death in Parkinson's disease (PD). Although MAO-B inhibitors have been suggested to exert neuroprotective effects in several experimental models of PD, their effectiveness against ER stress has not been fully determined. Therefore, we have studied the potential usefulness of PF9601N, a non-amphetamine-like MAO-B inhibitor, in preventing cell death in a cell culture model of ER stress. Exposure of human dopaminergic cell line SH-SY5Y to the ER stressor brefeldin A led to Golgi disassembly, activation of the unfolded protein response (UPR), and subsequent expression of the proapoptotic mediator GADD153/CHOP. In this context, PF9601N pretreatment prevented brefeldin A-induced UPR responses, thus blocking the expression of GADD153/CHOP and resulting apoptotic features. In summary, our data suggests that PF9601N is able to block the responses elicited by ER stress, thus preventing apoptotic cell death in brefeldin A-treated cells.

Anti-apoptotic effect of Mao-B inhibitor PF9601N [N-(2-propynyl)-2-(5-benzyloxy-indolyl) methylamine] is mediated by p53 pathway inhibition in MPP+-treated SH-SY5Y human dopaminergic cells.

PF9601N [N-(2-propynyl) 2-(5-benzyloxyindol) methylamine] is a non-amphetamine type MAO-B inhibitor that has shown neuroprotective properties in vivo using different experimental models of Parkinson's disease. The mechanisms underlying its neuroprotective effects are poorly understood, but appear to be independent of MAO-B inhibition. We have studied its neuroprotective properties using the human SH-SY5Y dopaminergic cell line exposed to 1-methyl-4-phenylpyridinium (MPP(+)), a cellular model of Parkinson's disease. PF9601N pre-treatment significantly reduced MPP(+)-induced cell death and decreased the activation of one of the main executioner caspases, caspase-3. MPP(+) induced stabilization of transcription factor p53, which led to increased levels of this transcription factor, its nuclear translocation and transactivation of p53 response elements. PF9601N prevented this increase, thus reducing its transcriptional activity. Additional results showed that p53 may mediate its pro-apoptotic actions through caspase-2 under our experimental conditions. PUMA-alpha may also contribute to the p53-induced cell death. Since PF9601N significantly reduced MPP(+)-induced caspase-2 activity and PUMA-alpha levels, this reduction may lead to increased cell survival. Thus, PF9601N is a novel molecule with an apparently novel mechanism of action which has a promising potential as a therapeutic agent in the treatment of neurodegenerative diseases.

Severe protein-calorie malnutrition after gastric bypass.

Bariatric surgery achieves lasting weight loss and improves the comorbidities associated with morbid obesity. After surgery, patients can develop complications, mainly mild nutritional alterations. However, in some patients, complications can be serious and lifethreatening. We present the case of a 50-year-old woman who developed severe protein-calorie malnutrition after bariatric surgery, which required surgical reversion. The factors leading to malnutrition in this patient and the treatment options are discussed.

Hypogonadotropic hypogonadism in a patient with morbid obesity.

Obesity has recently become one of the most important public health problems. It is associated with a high rate of mortality, mainly because of cardiovascular disease, and can cause hormonal abnormalities such as hypogonadotropic hypogonadism. Weight loss is very beneficial for obese patients, because it results in improvement or even normalization of these conditions. In this report, we describe a morbidly obese patient with hypogonadotropic hypogonadism, which was probably caused by hyperprolactinemia and exacerbated by obesity-induced hormonal imbalances. After medical treatment for hyperprolactinemia and bariatric surgery, the patient's hormonal status became normal. Although morbid obesity can cause hypogonadotropic hypogonadism in men, the differential diagnosis should include other potential causes of hypogonadism if free testosterone levels are below normal.