Basic Family Relations, Parental Bonding, and Dyadic Adjustment in Families with a Member with Psychosis.

The aim of the current study is to describe and explore basic family relations, parental bonding, and dyadic adjustment in families with offspring diagnosed with a psychotic disorder. The sample was made up of 120 participants, 60 in the clinical group (GCL) and 60 in the comparison group (GCP). All participants were assessed using the basic family relations evaluation questionnaire (CERFB), the parental bonding instrument (PBI), and the dyadic adjustment scale (DAS). The results showed differences between the clinical and comparison groups in terms of perceptions of basic family relations, dyadic adjustment and parental bonding. The clinical group recorded less favorable results for all of these variables. More specifically, the study observed significant differences between the groups in parental function, overprotection and caring. This study deepens our understanding of how family assessment and relational diagnoses can serve as prevention and intervention tools for families affected by a psychotic disorder.

Evidence and decision algorithm for the withdrawal of antipsychotic treatment in the elderly with dementia and neuropsychiatric symptoms.

PURPOSE: Antipsychotics (APs) are commonly used to manage neuropsychiatric symptoms (NPS) in elderly patients with dementia, even though several large studies have demonstrated an association between AP treatment and increased morbidity and mortality in people with dementia. The aim of this study is to review the scientific literature of the use of AP in the elderly with dementia and to propose an algorithm to assist in decision-making regarding the withdrawal of APs. METHODS: A computerized literature search (MEDLINE: 1966 to December 2016, EMBASE: 1982 to December 2016) was used to locate relevant literature. Keywords in the search included terms from Medical Subject Headings (MESH) and EMBASE thesaurus (EMTREE). The following terms were used in the MESH database and EMTREE thesaurus: Aged, Antipsychotic Agents, Behavioral Symptoms and Dementia. RESULTS: Earlier studies of APs used in elderly patients with dementia suggest that, in most elderly demented patients, APs can be withdrawn with no effect on behaviour. These patients are likely to benefit from the algorithm we propose to assist clinicians in the withdrawal of APs. CONCLUSIONS: In this paper, we review the potential risks and benefits of discontinuing AP treatment in elderly demented patients with NPS and propose an algorithm to assist in decision-making regarding AP withdrawal.

Methylphenidate in the management of asthenia in breast cancer patients treated with docetaxel: results of a pilot study.

BACKGROUND: The objectives of this pilot study were to evaluate the safety and efficacy of the central nervous system stimulant methylphenidate in the management of asthenia in breast cancer patients treated with docetaxel. PATIENTS AND METHODS: Patients with early breast cancer who presented asthenia >3 on the Visual Analogue Scale (VAS) after the first cycle of docetaxel-based chemotherapy were included. Patients received two additional cycles of chemotherapy, one with methylphenidate (10 mg bid) and the other without methylphenidate. Asthenia was evaluated using VAS and the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale. Distress was assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life using FACT-F. RESULTS: Ten patients were included and evaluated for efficacy and safety. Overall, cycles with methylphenidate were better tolerated than those without methylphenidate in terms of asthenia (VAS, p = 0.004; FACT-F, p = 0.027) and quality of life (FACT-F, p = 0.047). No significant differences were observed in terms of distress (HADS, p = 0.297). Six (60%) patients continued with methylphenidate after study end. Main adverse events during study were palpitations and insomnia (30% of patients each). CONCLUSIONS: This pilot study suggests that methylphenidate may reduce asthenia and improve quality of life in breast cancer patients treated with docetaxel.

[Informed consent in shared processes]. / Consentimiento informado en procesos compartidos.

Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must performed by another specialist. In this scenario that involves different professionals, it is reasonable a certain debate about which of them should obtain the informed consent of the patient. The first error would be to pose this process as a confrontation between professionals who derive or delegate their own responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. On the one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a procedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And, since everything is understood as a shared process, it would also be advisable that the physician in charge of the care and follow-up of the patient, and who has taken the initiative to request this technique, had already provided basic information, more focused on the reason for the indication, and that a pre-consent had been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection. And it would be convenient to record this information in the medical record as well.

School teachers' vocal use, risk factors, and voice disorder prevalence: guidelines to detect teachers with current voice problems.

UNLABELLED: Teachers' voice problems are widely recognized as a consequence of their work. The measurement of vocal demands and risk factors is essential for adjusting occupational safety and health services to this population's needs. OBJECTIVES: To correlate vocal behavior and symptomatology with risk factors and voice disorders, and to further analyze gender influence on these variables. SUBJECTS AND METHODS: 282 kindergarten and elementary education teachers were surveyed in a cross-sectional study using a self-administered questionnaire. For the purpose of this study, voice disorder prevalence was estimated based on the presence of a vocal effort plus 2 frequent symptoms. RESULTS: 81.5% of teachers reported some degree of vocal effort; more than 60% of subjects evidenced frequent throat paresthesias or vocal fatigue at the end of a working day, and about 55% reported hoarseness. Voice disorder prevalence was 59%. Multivariate logistic regression analysis revealed that female gender, time required to alleviate vocal symptoms, perceived general state of health, prolonged use of the voice, and pupils' indiscipline significantly increased the odds of having vocal problems. CONCLUSIONS: Voice disorders affected most teachers and had a multifactorial nature. Vocal health care is particularly necessary for those subjects reporting vocal effort and more than 2 frequent symptoms.

[Care and support: children of a lesser god?] / Cuidar y asistir: ¿hijos de un dios menor?

Our health system runs the risk of ruling out or neglecting a significant proportion of patients who require less technological but closer and humane care, those who require more support and attention. In this scenario, it is easy that both the assistance and close care and the patients who need this care and who would not benefit from aggressive or interventionist treatments may be considered as secondary: as children of a lesser god. It would be necessary to change the paradigm to understand that the quality of care is not limited to technology. And it would also be necessary to promote the dignity of care so that it is not seen as secondary and passive. On the contrary, care should be understood not only as active but also as intense without losing its close and human profile. Promoting the dignity of care also means promoting the dignity of all patients who may have been marginalized or excluded from this health system that is marked by technology and complexity and whose goal is efficiency.

Additive effects of LPL, APOA5 and APOE variant combinations on triglyceride levels and hypertriglyceridemia: results of the ICARIA genetic sub-study.

BACKGROUND: Hypertriglyceridemia (HTG) is a well-established independent risk factor for cardiovascular disease and the influence of several genetic variants in genes related with triglyceride (TG) metabolism has been described, including LPL, APOA5 and APOE. The combined analysis of these polymorphisms could produce clinically meaningful complementary information. METHODS: A subgroup of the ICARIA study comprising 1825 Spanish subjects (80% men, mean age 36 years) was genotyped for the LPL-HindIII (rs320), S447X (rs328), D9N (rs1801177) and N291S (rs268) polymorphisms, the APOA5-S19W (rs3135506) and -1131T/C (rs662799) variants, and the APOE polymorphism (rs429358; rs7412) using PCR and restriction analysis and TaqMan assays. We used regression analyses to examine their combined effects on TG levels (with the log-transformed variable) and the association of variant combinations with TG levels and hypertriglyceridemia (TG > or = 1.69 mmol/L), including the covariates: gender, age, waist circumference, blood glucose, blood pressure, smoking and alcohol consumption. RESULTS: We found a significant lowering effect of the LPL-HindIII and S447X polymorphisms (p < 0.0001). In addition, the D9N, N291S, S19W and -1131T/C variants and the APOE-epsilon4 allele were significantly associated with an independent additive TG-raising effect (p < 0.05, p < 0.01, p < 0.001, p < 0.0001 and p < 0.001, respectively). Grouping individuals according to the presence of TG-lowering or TG-raising polymorphisms showed significant differences in TG levels (p < 0.0001), with the lowest levels exhibited by carriers of two lowering variants (10.2% reduction in TG geometric mean with respect to individuals who were homozygous for the frequent alleles of all the variants), and the highest levels in carriers of raising combinations (25.1% mean TG increase). Thus, carrying two lowering variants was protective against HTG (OR = 0.62; 95% CI, 0.39-0.98; p = 0.042) and having one single raising polymorphism (OR = 1.20; 95% CI, 1.39-2.87; p < 0.001) or more (2 or 3 raising variants; OR = 2.90; 95% CI, 1.56-5.41; p < 0.001) were associated with HTG. CONCLUSION: Our results showed a significant independent additive effect on TG levels of the LPL polymorphisms HindIII, S447X, D9N and N291S; the S19W and -1131T/C variants of APOA5, and the epsilon4 allele of APOE in our study population. Moreover, some of the variant combinations studied were significantly associated with the absence or the presence of hypertriglyceridemia.

The Effects of Parenteral K1 Administration in Pseudoxanthoma Elasticum Patients Versus Controls. A Pilot Study.

INTRODUCTION: Pseudoxanthoma elasticum (PXE) is a rare disease caused by mutations in the ABCC6 gene. Vitamin K1 is involved in the posttranslational carboxylation of some proteins related to inhibition of the calcification process. Our aim was to investigate, in patients affected by PXE, baseline levels of vitamin K1-dependent proteins and -metabolites and whether parenteral administration of phytomenadione was effective in modulating their levels. METHODS: We included eight PXE patients with typical clinical symptoms (skin, retina, and vascular calcification) and two ABCC6 causative mutations; 13 clinically unaffected first-degree patients' relatives (9 carrying one ABCC6 mutation and 4 non-carriers). We assessed urinary vitamin K1 metabolites and serum Glu- and Gla-OC, Gas6 and undercaboxylated prothrombin (PIVKA-II), at baseline and after 1 and 6 weeks after a single intramuscular injection of 10 mg vitamin K1. RESULTS: Comparison of PXE patients, heterozygous, and non-carriers revealed differences in baseline levels of serum MK-4 and of urinary vitamin K metabolites. The response to phytomenadione administration on vitamin K-dependent proteins was similar in all groups. CONCLUSION: The physiological axis between vitamin K1 and vitamin K-dependent proteins is preserved; however, differences in the concentration of vitamin K metabolites and of MK-4 suggest that vitamin K1 metabolism/catabolism could be altered in PXE patients.

Biomarkers and polymorphisms in pancreatic neuroendocrine tumors treated with sunitinib.

Several circulating biomarkers and single nucleotide polymorphisms (SNPs) have been correlated with efficacy and tolerability to antiangiogenic agents. These associations remain unexplored in well-differentiated, metastatic pancreatic neuroendocrine tumors treated with the multitargeted tyrosine kinase inhibitor sunitinib. We have assessed the effect on tumor response at 6 months, overall survival, progression-free survival and safety of 14 SNPs, and 6 soluble proteins. Forty-three patients were recruited. Two SNPs in the vascular endothelial growth factor receptor 3 (VEGFR-3) gene predicted lower overall survival: rs307826 with hazard ratio (HR) 3.67 (confidence interval [CI] 95%, 1.35-10.00) and rs307821 with HR 3.84 (CI 95%, 1.47-10.0). Interleukin-6 was associated with increased mortality: HR 1.06 (CI 95%, 1.01-1.12), and osteopontin was associated with shorter PFS: HR 1.087 (1.01-1.16), independently of Ki-67. Furthermore, levels of osteopontin remained higher at the end of the study in patients considered non-responders: 38.5 ng/mL vs. responders: 18.7 ng/mL, p-value=0.039. Dynamic upward variations were also observed with respect to IL-8 levels in sunitinib-refractory individuals: 28.5 pg/mL at baseline vs. 38.3 pg/mL at 3 months, p-value=0.024. In conclusion, two VEGFR-3 SNPs as well as various serum biomarkers were associated with diverse clinical outcomes in patients with well-differentiated pancreatic neuroendocrine tumors treated with sunitinib.

Adipose-derived mesenchymal stem cells (AdMSC) for the treatment of secondary-progressive multiple sclerosis: A triple blinded, placebo controlled, randomized phase I/II safety and feasibility study.

BACKGROUND: Currently available treatments for secondary progressive multiple sclerosis(SPMS) have limited efficacy and/or safety concerns. Adipose-mesenchymal derived stem cells(AdMSCs) represent a promising option and can be readily obtained using minimally invasive procedures. PATIENTS AND METHODS: In this triple-blind, placebo-controlled study, cell samples were obtained from consenting patients by lipectomy and subsequently expanded. Patients were randomized to a single infusion of placebo, low-dose(1x106cells/kg) or high-dose(4x106cells/kg) autologous AdMSC product and followed for 12 months. Safety was monitored recording adverse events, laboratory parameters, vital signs and spirometry. Expanded disability status score (EDSS), magnetic-resonance-imaging, and other measures of possible treatment effects were also recorded. RESULTS: Thirty-four patients underwent lipectomy for AdMSCs collection, were randomized and thirty were infused (11 placebo, 10 low-dose and 9 high-dose); 4 randomized patients were not infused because of karyotype abnormalities in the cell product. Only one serious adverse event was observed in the treatment arms (urinary infection, considered not related to study treatment). No other safety parameters showed changes. Measures of treatment effect showed an inconclusive trend of efficacy. CONCLUSION: Infusion of autologous AdMSCs is safe and feasible in patients with SPMS. Larger studies and probably treatment at earlier phases would be needed to investigate the potential therapeutic benefit of this technique.

Consentimiento informado en procesos compartidos / Informed consent in shared processes

La medicina actual tiende a la especialización. Pero también cada vez son más frecuentes los procesoscompartidos o interdisciplinares en que un profesional solicita algún tipo de técnica o un procedimientodiagnóstico o terapéutico que debe realizar otro especialista. En un escenario así, que implica a profesio-nales diferentes, es razonable que surja cierto debate sobre a cuál de ellos le correspondería obtener elconsentimiento informado por parte del paciente. El primer error sería plantear este proceso como un en-frentamiento entre profesionales que derivan o delegan en otro sus propias responsabilidades. Al contra-rio, es preciso entenderlo como de un trabajo en equipo y no como una mera delegación de compromisos.Por una parte, sigue siendo el médico que lleva a cabo la técnica y que, por tanto, mejor la conoce comoprocedimiento y que es experto en la detección precoz y en el manejo de los efectos secundarios, el que de-bería asumir el compromiso de informar sobre este procedimiento y sus perfiles específicos. Y, por ello, esa él a quien le corresponde obtener el oportuno consentimiento informado. Por otra, al entenderlo comoun proceso compartido, lo adecuado sería que el médico responsable del seguimiento del paciente y quees quien ha tomado la iniciativa de solicitar esta técnica hubiese aportado una información elemental, máscentrada en el motivo de la indicación, y que con ello se hubiese obtenido un preconsentimiento, es deciruna aceptación básica o, al menos, un no-rechazo previo a la técnica. Y sería conveniente dejar registro deesta información en la historia clínica.(AU)

Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinaryprocesses in which professionals request some type of technique or a diagnostic or therapeutic procedurethat must performed by another specialist. In this scenario that involves different professionals, it is reaso-nable a certain debate about which of them should obtain the informed consent of the patient. The firsterror would be to pose this process as a confrontation between professionals who derive or delegate theirown responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. Onthe one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a pro-cedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And,since everything is understood as a shared process, it would also be advisable that the physician in chargeof the care and follow-up of the patient, and who has taken the initiative to request this technique, hadalready provided basic information, more focused on the reason for the indication, and that a pre-consenthad been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection.And it would be convenient to record this information in the medical record as well.(AU)

Changes in fatty liver index after consuming a Mediterranean diet: 6-year follow-up of the PREDIMED-Malaga trial. / Cambios en el Índice de Hígado Graso con una intervención con dieta mediterránea: seguimiento de 6 años del ensayo PREDIMED-Málaga.

OBJECTIVE: To analyze the effect of an intervention with a Mediterranean diet supplemented with either extra virgin olive oil or nuts, on the fatty liver index (FLI), compared to a low-fat control diet. METHODS: Participants of the PREDIMED-Malaga trial, free from cardiovascular disease at baseline, but with a high risk to develop it, were included in this study. Anthropometric measurements were assessed and blood samples were taken to calculate participants' FLI at study baseline and after one, 3, 5 and 6 years. Mixed linear models were used to explore the fixed effects of the 3 intervention groups on the FLI as well as their interaction with time. RESULTS: A total of 276 participants were included in the study. Average participant age was 67 years, with 66% of participants being women. The baseline prevalence of NAFL was 57%. The change in the FLI of the control group increased significantly over time (1.13±0.41; P=.006). In the MedDiet+EVOO group, the time trend of the change in the FLI was similar to that of the control group, although it was seen to be lower (-3.90±1.9; P=.038). In the MedDiet+Nuts group, the trend was significantly lower than that of the control group (-1.63±0.62; P=.009). In the MedDiet+Nuts group, the trend of changes in participants' BMI was 0.100 points lower per year compared to the control group (P=.004). In the control group, the change in waist circumference increased significantly over time (0.61±0.16cm/year; P<.001) in contrast to the MedDiet+EVOO group, in which this variable remained stable (-0.51±0.22; P=.019). CONCLUSIONS: A dietary intervention consisting of a Mediterranean diet could delay or slow down the natural progression of NAFL, thus, being beneficial for its prevention and treatment. However, further studies supporting these conclusions have yet to be carried out.

Equity, barriers and cancer disparities: study of the Spanish Society of Medical Oncology on the access to oncologic drugs in the Spanish Regions.

PURPOSE: The Spanish Society of Medical Oncology (SEOM) has conducted a study on the access to oncologic drugs across the 17 Spanish Regions with the aim of identifying potential heterogeneities and making proposals for eliminating the barriers identified at the different levels. METHODS: An Expert Panel made up of medical oncologists designed a survey on certain indications approved for 11 drugs in the approach of breast cancer, melanoma, lung cancer, prostate cancer and support treatment. This survey was sent to 144 National Health System (NHS) hospitals. RESULTS: 77 hospitals answered the survey. The information modules analysed were: scope of the Commission that establishes binding decisions related to drug access; conditions, stages and periods of drug application, approval and administration processes; barriers to accessing drugs. CONCLUSIONS: The study shows variability in drug access. The SEOM makes proposals addressed to reducing the differences identified and homogenizing drug access conditions.

Analysis of STR loci in Cartagena, a Caribbean city of Colombia.

Allele frequencies, together with some parameters of forensic interest were estimated for nine STRs included in the AmpF/STR Profiler kit (CSF1PO, D3S1358, D5S818, D7S820, D13S317, FGA, TH01, TPOX and vWA) in a sample of 215 unrelated individuals from Cartagena (Colombia). For all loci, no significant deviations from Hardy-Weinberg equilibrium were observed. Comparative analysis results between our data and those from other Colombian and African population samples revealed significant differences, except with two Colombian Caribbean Coast sub-regions.

Cuidar y asistir: ¿hijos de un dios menor? / Care and support: children of a lesser god?

El sistema sanitario occidental corre el riesgo de descartar o dejar de lado una proporción importantede pacientes que requieren una atención menos tecnológica y más cercana y humana, que precisan mássoporte y cuidados. En un escenario así, tanto la asistencia cercana y los cuidados como los pacientes quenecesitan estos cuidados –y que no se beneficiarían de tratamientos agresivos o intervencionistas– puedenverse como algo secundario, como hijos de un dios menor. Sería preciso cambiar el paradigma para enten-der que la calidad de la atención no se limita a la tecnología. Y sería necesario también promover la digni-dad de los cuidados de modo que no se contemplen como algo secundario y pasivo, sino que se entiendaque estos cuidados deben ser no solo activos sino también intensos sin perder perfil humano y cercano.Favorecer la dignidad de los cuidados supone también promover la dignidad de todos los pacientes quehan podido quedar marginados o excluidos por parte de un sistema sanitario marcado por la tecnología,la complejidad y que tiene como objetivo la eficiencia.(AU)

Our health system runs the risk of ruling out or neglecting a significant proportion of patients whorequire less technological but closer and humane care, those who require more support and attention.In this scenario, it is easy that both the assistance and close care and the patients who need this care andwho would not benefit from aggressive or interventionist treatments may be considered as secondary: aschildren of a lesser god. It would be necessary to change the paradigm to understand that the quality ofcare is not limited to technology. And it would also be necessary to promote the dignity of care so that it isnot seen as secondary and passive. On the contrary, care should be understood not only as active but alsoas intense without losing its close and human profile. Promoting the dignity of care also means promotingthe dignity of all patients who may have been marginalized or excluded from this health system that ismarked by technology and complexity and whose goal is efficiency.(AU)

EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10).

PURPOSE: This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancer (NSCLC) patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. PATIENTS AND METHODS: All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens) and serum samples. RESULTS: Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6%) had EGFR mutations (84% sensitizing mutations). EGFR mutation was found in serum in 14 (8.1%) patients (of 174 evaluable). Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52%, respectively. All but two patients received gefitinib. Median progression-free survival and overall survival were 10 (95% confidence interval: 4.8-15.3) months and 17.8 (95% confidence interval: 13.9-21.6) months, respectively, in patients carrying sensitizing mutations. CONCLUSION: The incidence of EGFR mutations in Galicia is consistent with previous data in Spain. Our results also support the feasibility of EGFR testing to guide treatment decision making using tumor tissue or cytology samples, or serum samples if tumor specimens are unavailable. These findings also confirm that first-line gefitinib is an active treatment option in Caucasians with EGFR mutation-positive NSCLC.

Molecular Profiling of Circulating Tumour Cells Identifies Notch1 as a Principal Regulator in Advanced Non-Small Cell Lung Cancer.

Knowledge on the molecular mechanisms underlying metastasis colonization in Non-Small Cell Lung Cancer (NSCLC) remains incomplete. A complete overview integrating driver mutations, primary tumour heterogeneity and overt metastasis lacks the dynamic contribution of disseminating metastatic cells due to the inaccessibility to the molecular profiling of Circulating Tumour Cells (CTCs). By combining immunoisolation and whole genome amplification, we performed a global gene expression analysis of EpCAM positive CTCs from advanced NSCLC patients. We identified an EpCAM+ CTC-specific expression profile in NSCLC patients mostly associated with cellular movement, cell adhesion and cell-to-cell signalling mediated by PI3K/AKT, ERK1/2 and NF-kB pathways. NOTCH1 emerged as a driver connecting active signalling pathways, with a reduced number of related candidate genes (NOTCH1, PTP4A3, LGALS3 and ITGB3) being further validated by RT-qPCR on an independent cohort of NSCLC patients. In addition, these markers demonstrated high prognostic value for Progression-Free Survival (PFS). In conclusion, molecular characterization of EpCAM+ CTCs from advanced NSCLC patients provided with highly specific biomarkers with potential applicability as a "liquid biopsy" for monitoring of NSCLC patients and confirmed NOTCH1 as a potential therapeutic target to block lung cancer dissemination.

Evaluation of Circulating Tumor Cells and Related Events as Prognostic Factors and Surrogate Biomarkers in Advanced NSCLC Patients Receiving First-Line Systemic Treatment.

In the present study we investigated the prognostic value of Circulating Tumour Cells (CTC) and their utility for therapy monitoring in non-small cell lung cancer (NSCLC). A total of 43 patients newly diagnosed with NSCLC were prospectively enrolled. Blood samples were obtained before the 1st, 2nd and 5th cycles of chemotherapy and analyzed using CellSearch technology. Both CTC and CTC-related objects (not morphological standard or broken epithelial cells) were counted. At baseline 18 (41.9%) patients were positive for intact CTC count and 10 (23.2%) of them had ≥5 CTC, while CK positive events were found in 79.1% of patients. The group of patients with CTC ³5 at baseline presented worse PFS and OS than those with <5 CTC (p = 0.034 and p = 0.008, respectively). Additionally, high levels of total CK positive events were associated with poor prognosis in the group of patients with <5 CTC. Regarding therapy monitoring, patients presenting increased levels of CTC during the treatment demonstrated lower OS and PFS rates. All these data supported the value of CTC as a prognostic biomarker and as a surrogate indicator of chemotherapy effectiveness in advanced NSCLC patients, with the additional value of analyzing other "objects" such as apoptotic CTC or CK fragments to guide the clinical management of these patients.

La Intervención Familiar Domiciliaria en Psicosis: Análisis Cualitativo de los Cambios Observados tras la Psicoterapia / Domiciliary family intervention in psychosis: Qualitative analysis of changes noticed after psychotherapy

El objetivo del estudio actual es evaluar los cambios en la estructura, la dinámica familiar y la comunicación durante una intervención familiar domiciliaria con pacientes diagnosticados de trastornos del espectro psicótico que muestran resistencia al tratamiento. Se incluyeron en el estudio un total de 12 familias (36 participantes) con descendencia diagnosticada de trastorno psicótico. Para la recopilación de datos se utilizaron diferentes técnicas cualitativas con el fin de triangular la información que proviene de cada una de ellas: un cuestionario de preguntas abiertas y un cuestionario más profundo para los observadores. Los dos ejes que explican la dinámica relacional más estrechamente ligada a la resistencia al tratamiento de estos pacientes fueron el "clima de confianza-desconfianza" y la "ambiguedad claridad-comunicación". Estos indicadores pueden cambiar dinámicamente e interactuar entre sí con el fin de mejorar el clima familiar y la comunicación

The aim of the current study is to assess the changes in the structure, family dynamics, and communication during a domiciliary family intervention with patients diagnosed with psychotic spectrum disorders showing resistance to treatment. A total of 12 families (36 participants) with offspring diagnosed with psychotic disorder were included. For data collection, different qualitative techniques were used in order to triangulate information coming from each of them: a questionnaire of open questions and a deepening questionnaire for the observers. The two axes that explain the relational dynamics most closely linked to the treatment resistance of these patients were "trust-distrust climate" and "clarity-communicational ambiguity". These indicators can dynamically change and interact with each other for the benefit of improving family climate and communication