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1.
Phys Rev Lett ; 133(7): 076302, 2024 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-39213570

RESUMEN

We demonstrate an efficient and continuous microwave photon-to-electron converter with large quantum efficiency (83%) and low dark current. These unique properties are enabled by the use of a high kinetic inductance disordered superconductor, granular aluminium, to enhance light-matter interaction and the coupling of microwave photons to electron tunneling processes. As a consequence of strong coupling, we observe both linear and nonlinear photon-assisted processes where two, three, and four photons are converted into a single electron at unprecedentedly low light intensities. Theoretical predictions, which require quantization of the photonic field within a quantum master equation framework, reproduce well the experimental data. This experimental advancement brings the foundation for high-efficiency detection of individual microwave photons using charge-based detection techniques.

2.
Actas Dermosifiliogr ; 2024 Jun 07.
Artículo en Inglés, Español | MEDLINE | ID: mdl-38852841

RESUMEN

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematodermic neoplasm usually involving the skin. In this retrospective case series, 10 cases of BPDCN were identified, 90% of which had skin involvement and exhibited predominantly violaceous nodules and/or bruise-like plaques. Skin lesions showed diffuse or nodular dermal-based infiltrates of intermediate sized blasts with a grenz zone. Tumor immunophenotyping was CD4(+), CD56(+), CD123(+) and CD303(+). The most frequently mutated genes according to targeted next-generation sequencing were TET2 (3/7) and NRAS (2/7). Multiagent chemotherapy (CT) was administered as first-line therapy, and a total of 5 patients underwent allogenic hematopoietic stem cell transplantation (allo-HSCT). Better outcomes were observed in younger patients and those treated with acute lymphoblastic leukemia (ALL)-like CT followed by allo-HSCT. This study shows the clinical range of cutaneous lesions of BPDCN. Despite the absence of a gold standard therapy, patients treated with myeloablative intensive regimens and allo-HSCT seems to have a more favorable prognosis.

3.
Ann Hematol ; 99(4): 765-772, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32062741

RESUMEN

Bone marrow WT1 mRNA levels assessed by the ELN method are useful to establish prognostic correlations in myeloid malignancies treated with chemotherapy or hematopoietic stem cell transplantation (HCT). Those patients with WT1 levels below ten copies have a good outcome. However, some of these patients relapse. To further characterize this group of cases, we applied a new and sensitive digital (ddPCR) WT1 method. A consecutive series of 49 patients with treated myeloid malignancies and with an ELN WT1 quantitation of < 10 copies were included in the study. All cases (47 AML and 2 MDS) have received intensive chemotherapy or HCT. One to four micrograms of total RNA were retrotranscribed to obtain ≥ 10,000 ABL1 copies using the ELN protocol. Only those cases with a good quality cDNA were used in the ddPCR WT1 test. The ddPCR Gene Expression WT1 Assay of Bio-Rad© was used to perform the PCR amplification, and the microdroplets were quantified in the Bio-Rad's QX200 droplet reader. Eighteen patients showed a negative WT1 ddPCR assay (0 copies/µl), whereas 31 cases were positive (results ranged from 1 to 15.2 copies/µl). Survival analysis showed statistically significant differences in terms of OS between both groups, 83 ± 8% vs. 46 ± 9% (p = 0.024). A statistically significant correlation was also found between ddPCRWT1 results and CD123+ cell number detected by flow cytometry (p = 0.024). Larger series of patients tested with the current ddPCRWT1 method will solve whether it could be used to stratify patients with myeloid malignancies achieving deep WT1 molecular response (< 10 copies).


Asunto(s)
Genes del Tumor de Wilms , Leucemia Mieloide Aguda/genética , Síndromes Mielodisplásicos/genética , Reacción en Cadena de la Polimerasa/métodos , Adulto , Anciano , ADN Complementario/genética , Femenino , Citometría de Flujo , Dosificación de Gen , Humanos , Inmunofenotipificación , Lactante , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , ARN Neoplásico/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Adulto Joven
4.
Phys Rev Lett ; 116(24): 247402, 2016 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-27367407

RESUMEN

The narrow emission of a single carbon nanotube at low temperature is coupled to the optical mode of a fiber microcavity using the built-in spatial and spectral matching brought by this flexible geometry. A thorough cw and time-resolved investigation of the very same emitter both in free space and in cavity shows an efficient funneling of the emission into the cavity mode together with a strong emission enhancement corresponding to a Purcell factor of up to 5. At the same time, the emitted photons retain a strong sub-Poissonian statistics. By exploiting the cavity feeding effect on the phonon wings, we locked the emission of the nanotube at the cavity resonance frequency, which allowed us to tune the frequency over a 4 THz band while keeping an almost perfect antibunching. By choosing the nanotube diameter appropriately, this study paves the way to the development of carbon-based tunable single-photon sources in the telecom bands.

5.
Nature ; 464(7292): 1165-9, 2010 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-20357767

RESUMEN

Interference is fundamental to wave dynamics and quantum mechanics. The quantum wave properties of particles are exploited in metrology using atom interferometers, allowing for high-precision inertia measurements. Furthermore, the state-of-the-art time standard is based on an interferometric technique known as Ramsey spectroscopy. However, the precision of an interferometer is limited by classical statistics owing to the finite number of atoms used to deduce the quantity of interest. Here we show experimentally that the classical precision limit can be surpassed using nonlinear atom interferometry with a Bose-Einstein condensate. Controlled interactions between the atoms lead to non-classical entangled states within the interferometer; this represents an alternative approach to the use of non-classical input states. Extending quantum interferometry to the regime of large atom number, we find that phase sensitivity is enhanced by 15 per cent relative to that in an ideal classical measurement. Our nonlinear atomic beam splitter follows the 'one-axis-twisting' scheme and implements interaction control using a narrow Feshbach resonance. We perform noise tomography of the quantum state within the interferometer and detect coherent spin squeezing with a squeezing factor of -8.2 dB (refs 11-15). The results provide information on the many-particle quantum state, and imply the entanglement of 170 atoms.

6.
Epidemiol Infect ; 143(4): 734-40, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24977667

RESUMEN

This study was part of a bloodstream infection surveillance programme that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2012. We included 2092 bacteraemias in neutropenic patients. Shock and mortality accounted for 299 and 349 cases, respectively (14% and 17%). The main microorganisms isolated were coagulase-negative staphylococci (CoNS, 634, 30%), Escherichia coli (468, 22%) and Pseudomonas aeruginosa (235, 11%). During 2006-2012, there were 155 (27%) E. coli isolates; of these, 73% were fluoroquinolone resistant and 26% cefotaxime resistant. The independent risk factors for mortality were shock on presentation, rapidly fatal prognosis of underlying disease, corticosteroid use, and polymicrobial bacteraemia. Factors associated with lower mortality were the isolation of CoNS [odds ratio (OR) 0·38, 95% confidence interval (CI) 0·20-0·73, P = 0·004] and empirical therapy with amikacin (OR 0·50, 95% CI 0·29-0·88, P = 0·016). The progressive increase of Gram-negative microorganisms resistant to antibiotics influences the choice of empirical treatment in febrile neutropenia and in our experience, the addition of amikacin could be beneficial for such patients.


Asunto(s)
Bacteriemia/epidemiología , Infección Hospitalaria/epidemiología , Neutropenia/complicaciones , Antibacterianos/uso terapéutico , Bacteriemia/etiología , Bacteriemia/microbiología , Bacteriemia/mortalidad , Infección Hospitalaria/etiología , Infección Hospitalaria/mortalidad , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neutropenia/epidemiología , Estudios Prospectivos , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/etiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Resultado del Tratamiento
7.
BJOG ; 121(6): 706-13, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24423186

RESUMEN

OBJECTIVE: The aim of the study was to evaluate the effectiveness of intravenous iron versus placebo added to standard oral iron therapy in the treatment of severe postpartum anaemia. DESIGN: A randomised, double-blind, parallel-group, placebo-controlled clinical trial was performed in a single centre. SETTING: Hospital Clinic of Barcelona, Barcelona, Spain. POPULATION: A cohort of 72 women with severe postpartum anaemia (6.0-8.0 g/dl) treated with oral ferrous sulphate (two tablets of 525 mg). METHODS: Women were randomised to receive either intravenous ferrous sucrose (200 mg/24 hours for two consecutive days) or intravenous placebo, in addition to standard iron therapy. Clinical and laboratory data were obtained at 1, 2, and 6 weeks. MAIN OUTCOME MEASURES: Haemoglobin and haematocrit at 1, 2, and 6 weeks. Other haematological and clinical parameters, psychological status, and adverse side effects were also evaluated. RESULTS: Haemoglobin and haematocrit values were comparable in women receiving intravenous iron or placebo in addition to oral iron therapy at any of the time points. At 6 weeks, haemoglobin level (mean ± SD) was 12.2 ± 1.0 versus 12.2 ± 0.9 g/dl, with a mean difference of -0.03 (95% CI -0.6 to 0.6), in the placebo and in the intravenous iron groups, respectively. No differences were found between clinical symptoms of anaemia, psychological status, and adverse side effects between groups. CONCLUSIONS: Intravenous iron added to oral iron therapy did not show significant benefits over placebo, neither in haemoglobin rise nor in symptoms or adverse side effects.


Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Suplementos Dietéticos , Compuestos Férricos/administración & dosificación , Ácido Glucárico/administración & dosificación , Hematínicos/administración & dosificación , Hemoglobinas/metabolismo , Hierro de la Dieta/administración & dosificación , Trastornos Puerperales/tratamiento farmacológico , Administración Oral , Adulto , Anemia Ferropénica/sangre , Anemia Ferropénica/epidemiología , Método Doble Ciego , Quimioterapia Combinada , Femenino , Sacarato de Óxido Férrico , Hematócrito , Humanos , Infusiones Intravenosas , Trastornos Puerperales/sangre , Trastornos Puerperales/epidemiología , Índice de Severidad de la Enfermedad , España/epidemiología , Resultado del Tratamiento
8.
Nature ; 455(7217): 1216-9, 2008 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-18830245

RESUMEN

Entanglement, a key feature of quantum mechanics, is a resource that allows the improvement of precision measurements beyond the conventional bound attainable by classical means. This results in the standard quantum limit, which is reached in today's best available sensors of various quantities such as time and position. Many of these sensors are interferometers in which the standard quantum limit can be overcome by using quantum-entangled states (in particular spin squeezed states) at the two input ports. Bose-Einstein condensates of ultracold atoms are considered good candidates to provide such states involving a large number of particles. Here we demonstrate spin squeezed states suitable for atomic interferometry by splitting a condensate into a few parts using a lattice potential. Site-resolved detection of the atoms allows the measurement of the atom number difference and relative phase, which are conjugate variables. The observed fluctuations imply entanglement between the particles, a resource that would allow a precision gain of 3.8 dB over the standard quantum limit for interferometric measurements.

9.
Langmuir ; 27(13): 8302-8, 2011 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-21661741

RESUMEN

In this work, two types of polycrystalline silicon (polysilicon) microparticles were modified with specific ligands in order to be selectively attached to chemical residues located at the plasma membrane and thus to be applied to study individual cells in culture. Two different functionalization approaches based on adsorption and covalent attachment were assayed. A comparative study of the efficiency of the ligand immobilization and stability of the modified particle in the culture medium was carried out using the selected ligands labeled with a fluorophore. Cylindrical microparticles (nonencoded microparticles) and shape-encoded microparticles (bar codes) were used with the aim of demonstrating the nondependence of the particle size and shape on the efficiency of the immobilization protocol. Fluorescence imaging and statistical analysis of the recorded fluorescence intensity showed that the covalent attachment of the ligand to the surface of the microparticle, previously modified with an aldehyde-terminated silane, gave the best results. As a proof of concept, Vero cells in culture were labeled with the covalently modified bar codes and successfully tracked for up to 1 week without observing any alteration in the viability of the cells. Bar code numbers could be easily read by eye using a bright-field optical microscope. It is anticipated that such modified microparticles could be feasible platforms for the introduction of other analytical functions of interest in single-cell monitoring and cell sorting in automatic analysis systems.


Asunto(s)
Polímeros/química , Silicio/química , Animales , Membrana Celular/química , Células Cultivadas , Chlorocebus aethiops , Ligandos , Estructura Molecular , Tamaño de la Partícula , Propiedades de Superficie , Células Vero
10.
Nanotechnology ; 22(50): 505301, 2011 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-22107927

RESUMEN

We report on a new approach for magnetic imaging, highly sensitive even in the presence of external, strong magnetic fields. Based on FIB-assisted fabricated high-aspect-ratio rare-earth nanomagnets, we produce groundbreaking magnetic force tips with hard magnetic character where we combine a high aspect ratio (shape anisotropy) together with strong crystalline anisotropy (rare-earth-based alloys). Rare-earth hard nanomagnets are then FIB-integrated to silicon microcantilevers as highly sharpened tips for high-field magnetic imaging applications. Force resolution and domain reversing and recovery capabilities are at least one order of magnitude better than for conventional magnetic tips. This work opens new, pioneering research fields on the surface magnetization process of nanostructures based either on relatively hard magnetic materials-used in magnetic storage media-or on materials like superparamagnetic particles, ferro/antiferromagnetic structures or paramagnetic materials.


Asunto(s)
Campos Electromagnéticos , Imanes/química , Microscopía/métodos , Nanoestructuras/química , Anisotropía , Compuestos Férricos/química
11.
Leukemia ; 35(3): 835-849, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-32595214

RESUMEN

In the current World Health Organization (WHO)-classification, therapy-related myelodysplastic syndromes (t-MDS) are categorized together with therapy-related acute myeloid leukemia (AML) and t-myelodysplastic/myeloproliferative neoplasms into one subgroup independent of morphologic or prognostic features. Analyzing data of 2087 t-MDS patients from different international MDS groups to evaluate classification and prognostication tools we found that applying the WHO classification for p-MDS successfully predicts time to transformation and survival (both p < 0.001). The results regarding carefully reviewed cytogenetic data, classifications, and prognostic scores confirmed that t-MDS are similarly heterogeneous as p-MDS and therefore deserve the same careful differentiation regarding risk. As reference, these results were compared with 4593 primary MDS (p-MDS) patients represented in the International Working Group for Prognosis in MDS database (IWG-PM). Although a less favorable clinical outcome occurred in each t-MDS subset compared with p-MDS subgroups, FAB and WHO-classification, IPSS-R, and WPSS-R separated t-MDS patients into differing risk groups effectively, indicating that all established risk factors for p-MDS maintained relevance in t-MDS, with cytogenetic features having enhanced predictive power. These data strongly argue to classify t-MDS as a separate entity distinct from other WHO-classified t-myeloid neoplasms, which would enhance treatment decisions and facilitate the inclusion of t-MDS patients into clinical studies.


Asunto(s)
Biomarcadores de Tumor/análisis , Síndromes Mielodisplásicos/clasificación , Síndromes Mielodisplásicos/diagnóstico , Neoplasias Primarias Secundarias/clasificación , Neoplasias Primarias Secundarias/diagnóstico , Medición de Riesgo/métodos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/terapia , Neoplasias Primarias Secundarias/terapia , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
12.
Ann Oncol ; 21(6): 1211-1216, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19889622

RESUMEN

BACKGROUND: High-dose chemotherapy (HDT) followed by autologous stem-cell transplantation (ASCT) is considered the gold standard in the treatment of patients with relapsed or refractory Hodgkin's lymphoma (HL). However, the optimal salvage regimen has not yet been established. PATIENTS AND METHODS: We retrospectively analyzed the efficacy and toxicity of MINE (mesna, ifosfamide, mitoxantrone, and etoposide) alternated with ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin) in the treatment of 61 relapsed or refractory HL patients after ABVD-based chemotherapy. RESULTS: Overall, 25 patients (41%) achieved a complete response (CR), 23 (38%) a partial response (PR), 4 (7%) a stable disease, and 8 (13%) progressed for an overall response rate of 79%. Response to first-line chemotherapy was the most important prognostic factor for response to MINE-ESHAP (P = 0.041). No grade 4 extrahematologic toxic effects or toxic deaths were observed. Adequate peripheral blood stem-cell collection was achieved in 56 of 59 (95%) mobilized patients. Overall survival and event-free survival after HDT and ASCT were significantly higher for patients achieving CR/PR in comparison with those refractory to MINE-ESHAP (46% and 35% versus 74% and 69%, respectively). CONCLUSION: MINE-ESHAP results in a high response rate with acceptable toxicity in patients with HL having failed ABVD-based treatment.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Enfermedad de Hodgkin/terapia , Trasplante de Células Madre/métodos , Adolescente , Adulto , Cisplatino/administración & dosificación , Terapia Combinada , Citarabina/administración & dosificación , Esquema de Medicación , Etopósido/administración & dosificación , Femenino , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Ifosfamida/administración & dosificación , Masculino , Persona de Mediana Edad , Mitoguazona/administración & dosificación , Periodicidad , Prednisona/administración & dosificación , Recurrencia , Estudios Retrospectivos , Terapia Recuperativa , Trasplante Autólogo , Insuficiencia del Tratamiento , Vinblastina/administración & dosificación , Vinblastina/análogos & derivados , Adulto Joven
13.
Br J Surg ; 97(2): 235-9, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20069605

RESUMEN

BACKGROUND: : Little is known at a population level about operative mortality after surgery for gastric cancer and whether differences between countries can explain differences in long-term survival. This study compared operative mortality recorded by ten cancer registries in seven European countries. METHODS: : Non-conditional logistic regression analysis was performed to estimate the independent effect of the studied factors on mortality within 30 days of surgery. A multivariable survival model was employed with and without operative mortality. RESULTS: : The overall operative mortality rate in 1611 patients studied was 8.9 (range 5.2-16) per cent. Country of residence was a significant prognostic factor in the multivariable analysis. The likelihood of operative mortality was lower in Italy, France and the UK than in the Netherlands, Spain, Slovenia and Poland. Age, type of gastrectomy and stage at diagnosis were also significant factors. Cancer site was not found to be significant in the multivariable analysis. The overall 5-year relative survival rate varied between 42.0 per cent (Italy) and 24 per cent (Poland); after excluding operative mortality, the 5-year survival rate was 44.3 and 28 per cent respectively. CONCLUSION: : Within Europe, the substantial differences in operative mortality after gastrectomy only partly explain marked differences in survival after gastric cancer resection.


Asunto(s)
Gastrectomía/mortalidad , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Supervivencia
14.
Clin Microbiol Infect ; 26(3): 345-350, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31295551

RESUMEN

OBJECTIVES: To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients. METHODS: Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS: Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and ß-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS: A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Neutropenia/complicaciones , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/etiología , Pseudomonas aeruginosa/efectos de los fármacos , Adulto , Anciano , Área Bajo la Curva , Biomarcadores , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Neutropenia/diagnóstico , Neutropenia/epidemiología , Oportunidad Relativa , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/epidemiología , Factores de Riesgo , Sensibilidad y Especificidad , España/epidemiología
15.
Rev Enferm ; 32(7-8): 36-44, 2009.
Artículo en Español | MEDLINE | ID: mdl-19711701

RESUMEN

The authors describe the profile corresponding to students enrolled in first, second and third year courses to become registered nurses in Catalonia, along with their professional and job expectations; the authors examine students' perceptions of the university environment. This information will be a great aid to, on the one hand, update the performances and initiatives taken by those responsible for nursing schools, and on the other hand, to obtain a preliminary view on future nursing professionals. At the same time, this information will provide useful elements for students themselves to reflect on their studies and their future as professionals.


Asunto(s)
Estudiantes de Enfermería/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Adulto Joven
16.
Clin Microbiol Infect ; 25(4): 447-453, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30096417

RESUMEN

OBJECTIVES: We aimed to describe the current time-to-positivity (TTP) of blood cultures in individuals with onco-haematological diseases with febrile neutropenia. We assessed the probability of having a multidrug-resistant Gram-negative bacilli (MDR-GNB) bloodstream infection (BSI) 24 h after cultures were taken, to use this information for antibiotic de-escalation strategies. METHODS: BSI episodes were prospectively collected (2003-2017). When a patient experienced more than one BSI, only one episode was randomly chosen. Time elapsed from the beginning of incubation to a positive reading was observed; TTP was recorded when the first bottle had a positive result. RESULTS: Of the 850 patient-unique episodes, 323 (38%) occurred in acute leukaemia, 185 (21.8%) in non-Hodgkin's lymphoma and 144 (16.9%) in solid neoplasms. Coagulase-negative staphylococci (225; 26.5%), Escherichia coli (207; 26.1%), Pseudomonas aeruginosa (136; 16%), Enterococcus spp. (81; 9.5%) and Klebsiella pneumoniae (67; 7.9%), were the most frequent microorganisms isolated. MDR-GNB were documented in 126 (14.8%) episodes. Median TTP was 12 h (interquartile range 9-16.5 h). Within the first 24 h, 92.1% of blood cultures were positive (783/850). No MDR-GNB was positive over 24 h. Of the 67 (7.9%) episodes with a TTP ≥24 h, 25 (37.3%) occurred in patients who were already receiving active antibiotics against the isolated pathogen. Most common isolations with TTP ≥24 h were coagulase-negative staphylococci, candidaemia and a group of anaerobic GNB. CONCLUSIONS: Currently, the vast majority of BSI in individuals with onco-haematological diseases with febrile neutropenia have a TTP <24 h, including all episodes caused by MDR-GNB. Our results support reassessing empiric antibiotic treatment in neutropenic patients at 24 h, to apply antibiotic stewardship de-escalation strategies.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Bacteriemia/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple/fisiología , Neutropenia Febril/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Neoplasias/complicaciones , Anciano , Bacteriemia/sangre , Bacteriemia/diagnóstico , Bacteriemia/microbiología , Cultivo de Sangre , Neutropenia Febril/sangre , Neutropenia Febril/microbiología , Femenino , Infecciones por Bacterias Gramnegativas/sangre , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
17.
Br J Cancer ; 99 Suppl 1: S2-10, 2008 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-18813248

RESUMEN

Survival has risen steadily since the 1970s for most cancers in adults in England and Wales, but persistent inequalities exist between those living in affluent and deprived areas. These differences are not seen for children. For many of the common adult cancers, these inequalities in survival (the 'deprivation gap') became more marked in the 1990s. This volume presents extended analyses of survival for adults diagnosed during the 14 years 1986-1999 and followed up to 2001, including trends in overall survival in England and Wales and trends in the deprivation gap in survival. The analyses include individual tumour data for 2.2 million cancer patients. This article outlines the structure of the supplement - an article for each of the 20 most common cancers in adults, followed by an expert commentary from one of the leading UK clinicians specialising in malignancies of that organ or system. The available data, quality control and methods of analysis are described here, rather than repeated in each of the 20 articles. We open the discussion between clinicians and epidemiologists on how to interpret the observed trends and inequalities in cancer survival, and we highlight some of the most important contrasts in these very different points of view. Survival improved substantially for adult cancer patients in England and Wales up to the end of the 20th century. Although socioeconomic inequalities in survival are remarkably persistent, the overall patterns suggest that these inequalities are largely avoidable.


Asunto(s)
Neoplasias/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra/epidemiología , Femenino , Predicción , Historia del Siglo XX , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/historia , Sistema de Registros , Clase Social , Análisis de Supervivencia , Gales/epidemiología
18.
Leukemia ; 21(7): 1413-22, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17476281

RESUMEN

Therapy-related myelodysplasia and acute myeloid leukemia (t-MDS/AML) is a malignancy occurring after exposure to chemotherapy and/or radiotherapy. Polymorphisms involved in chemotherapy/radiotherapy response genes could be related to an increased risk of developing this neoplasia. We have studied 11 polymorphisms in genes of drug detoxification pathways (NQO1, glutathione S-transferase pi) and DNA repair xeroderma pigmentosum, complementation group (3) (XPC(3), X-ray repair cross complementing protein (1)), Nijmegen breakage syndrome (1), excision repair cross-complementing rodent repair deficiency, complementation group (5) and X-ray repair cross complementing protein (3) and in the methylene tetrahydrofolate reductase gene (MTHFR(2), 677C>T, 1298A>C), involved in DNA synthesis. The analyzed groups were a t-MDS/AML patients group (n=81) and a matched control group (n=64) treated similarly, and they did not develop t-MDS/AML. We found no significant differences when the groups were compared globally. However, when analysis was carried out according to the primary neoplasia involved, a significant association was observed between the MTHFR haplotype (single nucleotide polymorphisms 677 and 1298) and the risk of developing t-MDS/AML in the breast cancer patients group (P=0.016) and cyclophosphamide-treated hematological disease group (P=0.005). Risk haplotype was different for each case, corresponding to the 677T1298A haplotype after breast cancer treatment and the 677C1298C haplotype after hematological malignancy treatment. We postulate that such differences are related to variations in chemotherapy schemes between hematological and breast cancers and their differential interaction with the MTHFR route.


Asunto(s)
Haplotipos , Leucemia/genética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Antineoplásicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Estudios de Casos y Controles , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/patología , Humanos , Leucemia/inducido químicamente , Leucemia/etiología , Persona de Mediana Edad , Neoplasias Primarias Secundarias/etiología , Neoplasias Primarias Secundarias/genética , Polimorfismo de Nucleótido Simple , Factores de Riesgo
19.
Leukemia ; 21(3): 446-52, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17205057

RESUMEN

To determine prognosis of acute promyelocytic leukemia (APL) failing to front-line therapy with all-trans retinoic acid (ATRA) and anthracyclines, outcome of 52 patients (32 M/20 F; age: 37, 3-72) included in PETHEMA trials LPA96 and LPA99 who presented with either molecular failure (MOLrel, n=16) or hematological relapse (HEMrel, n=36) was analyzed. Salvage therapy consisted of ATRA and high-dose ara-C-based chemotherapy (HDAC) in most cases (83%), followed by stem-cell transplantation (autologous, 18; allogeneic, 10; syngeneic, 1). Fourteen patients with MOLrel (88%) achieved second molecular complete response (molCR), whereas 81% HEMrel patients responded to second-line treatment, with 58% molCR. After median follow-up of 45 months, four MOLrel and 18 HEMrel patients, respectively, experienced a second relapse. Outcome after MOLrel compared favorably to HEMrel, with longer survival (5-year survival: 64+/-14 vs 24+/-8%, P=0.01) and lower relapse risk (5-year relapse risk: 30+/-13 vs 64+/-9%; P=0.044). Additionally, age

Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia Promielocítica Aguda/tratamiento farmacológico , Terapia Recuperativa , Adolescente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biomarcadores de Tumor/sangre , Niño , Preescolar , Terapia Combinada , Citarabina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Trasplante de Células Madre Hematopoyéticas , Humanos , Idarrubicina/administración & dosificación , Estimación de Kaplan-Meier , Leucemia Promielocítica Aguda/sangre , Leucemia Promielocítica Aguda/mortalidad , Leucemia Promielocítica Aguda/patología , Leucemia Promielocítica Aguda/cirugía , Liposomas/administración & dosificación , Masculino , Persona de Mediana Edad , Mitoxantrona/administración & dosificación , Neoplasia Residual , Proteínas de Fusión Oncogénica/sangre , Pronóstico , Recurrencia , Inducción de Remisión , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Tretinoina/administración & dosificación
20.
Leukemia ; 21(1): 129-35, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17128198

RESUMEN

We conducted a retrospective registry-based analysis to compare the outcome of 361 allogeneic human leukocyte antigen (HLA)-identical peripheral blood stem cell transplants (PBSCT) with reduced intensity conditioning (RIC) to that of 1369 autologous (auto) PBSCT in patients aged 50 years or older with de novo acute myeloid leukemia (AML), performed from 1997 until 2003 and reported to the European Group for Blood and Marrow Transplantation. Median age was 58 and 57 years in the RIC and auto groups, respectively. RIC patients had more advanced disease at the time of transplant. At a median follow-up of 24 months for RIC and 16 months for auto, multivariate analysis showed a lower risk for relapse (RR 0.77, P=0.013) without increased non-relapse mortality (NRM) in RIC patients (RR 1.26, P=0.28). Moreover, leukemia-free survival (RR 1.22, P=0.02) and overall survival (OS) (RR 1.32, P=0.005) were superior in the RIC group. In patients in 1st (CR), fewer relapses were counterbalanced by significantly increased NRM. Therefore, there was no survival advantage in this subgroup. In patients in 2nd or subsequent CR, LFS and OS were superior in the RIC group. RIC transplants show encouraging results in this older patient population with de novo AML.


Asunto(s)
Leucemia Mieloide Aguda/terapia , Trasplante de Células Madre de Sangre Periférica , Anciano , Femenino , Antígenos HLA/genética , Antígenos HLA/inmunología , Prueba de Histocompatibilidad , Humanos , Leucemia Mieloide Aguda/inmunología , Leucemia Mieloide Aguda/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Hermanos , Análisis de Supervivencia , Acondicionamiento Pretrasplante , Trasplante Autólogo , Trasplante Homólogo
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