Tocilizumab en pacientes con artritis reumatoide activa y respuesta inadecuada a fármacos antirreumáticos modificadores de la enfermedad o antagonistas del factor de necrosis tumoral: subanálisis de los datos españoles de un estudio abierto cercano a la práctica clínica habitual / Tocilizumab in patients with active rheumatoid arthritis and inadequate response to disease-modifying antirheumatic drugs or tumor necrosis factor inhibitors: Subanalysis of Spanish results of an open-label study close to clinical practice

Objetivos: Analizar la experiencia española en un estudio internacional para evaluar tocilizumab en pacientes con artritis reumatoide (AR) con respuesta insuficiente al tratamiento con fármacos antirreumáticos modificadores de la enfermedad convencionales (FAME) o anti-TNF en condiciones cercanas a la práctica clínica habitual. Material y métodos: Subanálisis de 170 pacientes con AR que participaron en España en un ensayo clínico, internacional abierto de fase iiib, que presentaban una respuesta inadecuada al tratamiento con FAME o anti-TNF. Los pacientes recibieron 8 mg/kg de tocilizumab cada 4 semanas en combinación con FAME o en monoterapia durante un periodo de 20 semanas. Se evaluaron la seguridad y la eficacia de tocilizumab distinguiendo entre pacientes con fallo a FAME o anti-TNF y, dentro de estos, entre los que habían hecho o no periodo de lavado del anti-TNF. Resultados: Los acontecimientos adversos más frecuentes fueron infecciones (25%) y elevación de colesterol total (38%) y transaminasas (15%). Cinco pacientes abandonaron el estudio por un acontecimiento adverso. El 71/50/30% de los pacientes cumplía criterios de respuesta ACR 20/50/70 a los 6 meses del inicio del tratamiento con tocilizumab. Los pacientes naïve para anti-TNF presentaron una mayor respuesta ACR20: el 76% frente a un 64% en el grupo anti-TNF con lavado previo y el 66% en el grupo anti-TNF sin lavado previo. Conclusiones: Se confirma el perfil de seguridad de tocilizumab en pacientes con AR y fallo a FAME o anti-TNF. Tocilizumab es más eficaz en pacientes que no responden de forma satisfactoria al tratamiento con FAME convencionales que con anti-TNF (AU)

Objectives: To analyze the Spanish experience in an international study which evaluated tocilizumab in patients with rheumatoid arthritis (RA) and an inadequate response to conventional disease-modifying antirheumatic drugs (DMARDs) or tumor necrosis factor inhibitors (TNFis) in a clinical practice setting. Material and methods: Subanalysis of 170 patients with RA from Spain who participated in a phase IIIb, open-label, international clinical trial. Patients presented inadequate response to DMARDs or TNFis. They received 8 mg/kg of tocilizumab every 4 weeks in combination with a DMARD or as monotherapy during 20 weeks. Safety and efficacy of tocilizumab were analyzed. Special emphasis was placed on differences between failure to a DMARD or to a TNFi and the need to switch to tocilizumab with or without a washout period in patients who had previously received TNFi. Results: The most common adverse events were infections (25%), increased total cholesterol (38%) and transaminases (15%). Five patients discontinued the study due to an adverse event. After six months of tocilizumab treatment, 71/50/30% of patients had ACR 20/50/70 responses, respectively. A higher proportion of TNFi-naive patients presented an ACR20 response: 76% compared to 64% in the TNFi group with previous washout and 66% in the TNFi group without previous washout. Conclusions: Safety results were consistent with previous results in patients with RA and an inadequate response to DMARDs or TNFis. Tocilizumab is more effective in patients who did not respond to conventional DMARDs than in patients who did not respond to TNFis (AU)

Tocilizumab in patients with active rheumatoid arthritis and inadequate response to disease-modifying antirheumatic drugs or tumor necrosis factor inhibitors: subanalysis of Spanish results of an open-label study close to clinical practice.

OBJECTIVES: To analyze the Spanish experience in an international study which evaluated tocilizumab in patients with rheumatoid arthritis (RA) and an inadequate response to conventional disease-modifying antirheumatic drugs (DMARDs) or tumor necrosis factor inhibitors (TNFis) in a clinical practice setting. MATERIAL AND METHODS: Subanalysis of 170 patients with RA from Spain who participated in a phase IIIb, open-label, international clinical trial. Patients presented inadequate response to DMARDs or TNFis. They received 8mg/kg of tocilizumab every 4 weeks in combination with a DMARD or as monotherapy during 20 weeks. Safety and efficacy of tocilizumab were analyzed. Special emphasis was placed on differences between failure to a DMARD or to a TNFi and the need to switch to tocilizumab with or without a washout period in patients who had previously received TNFi. RESULTS: The most common adverse events were infections (25%), increased total cholesterol (38%) and transaminases (15%). Five patients discontinued the study due to an adverse event. After six months of tocilizumab treatment, 71/50/30% of patients had ACR 20/50/70 responses, respectively. A higher proportion of TNFi-naive patients presented an ACR20 response: 76% compared to 64% in the TNFi group with previous washout and 66% in the TNFi group without previous washout. CONCLUSIONS: Safety results were consistent with previous results in patients with RA and an inadequate response to DMARDs or TNFis. Tocilizumab is more effective in patients who did not respond to conventional DMARDs than in patients who did not respond to TNFis.

Hypochromicity in red blood cells: an experimental and theoretical investigation.

Multiwavelength UV-visible transmission spectrophotometry is a useful tool for the examination of micron-size particle suspensions in the context of particle size and chemical composition. This paper reports the reliability of this method to characterize the spectra of purified red blood cells both in their physiological state and with modified hemoglobin content. Previous studies have suggested the contribution of hypochromism on the particle spectra caused by the close electronic interaction of the encapsulated chromophores. Our research shows, however, that this perceived hypochromism can be accounted for by considering two important issues: the acceptance angle of the instrument and the combined scattering and absorption effect of light on the particles. In order to establish these ideas, spectral analysis was performed on purified and modified red cells where the latter was accomplished with a modified hypotonic shock protocol that altered the hemoglobin concentration within the cells. Moreover, the Mie theory was used to successfully simulate the spectral features and trends of the red cells. With this combination of experimental and theoretical exploration, definition of hypochromism has been extended to two subcategories.

Rayleigh-Debye-Gans as a model for continuous monitoring of biological particles: Part II, development of a hybrid model.

Rayleigh-Debye-Gans and Mie theory were previously shown to disagree for spherical particles under ideal conditions4. A Hybrid model for spheres was developed by the authors combining Mie theory and Rayleigh- Debye-Gans. The hybrid model was tested against Mie and Rayleigh- Debye-Gans for different refractive indices and diameter sizes across the UV-Vis spectrum. The results of this study show that the hybrid model represents a considerable improvement over Rayleigh-Debye-Gans for submicron particles and is computationally more effective compared to Mie model. The development of the spherical hybrid model establishes a platform for the analysis of non-spherical particles.

Light scattering and microarchitectural differences between tumorigenic and non-tumorigenic cell models of tissue.

Differences in light scattering properties of a tumorigenic and a non-tumorigenic model for tissue were demonstrated using a variety of light scattering techniques, the majority of which are in vivo compatible. In addition to determining that light scattering differences exist, models for the microarchitectural changes responsible for the light scattering differences were developed.

Análisis del perfil lipídico en pacientes con artritis reumatoide de inicio reciente / Lipid profile analysis in patients with early rheumatoid arthritis

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Trasplante de progenitores hematopoyéticos en enfermedades autoinmunitarias sistémicas. Situación actual / Hematopoietic stem cell transplantation in systemic autoimmune diseases. State of the art

La prática del trasplante de células progenitoras para las enfermedades autoinmunitarias severas refractarias a terapia convencional parte de dos descubrimientos: los excelentes resultados de los experimentos animales, y las observaciones descubiertas en humanos con enfermedades coincidentes. Los datos de los estudios experimentales y en fase temprana I-II en algunos pacientes altamente seleccionados sugieren que la quimioterapia a dosis elevadas seguidas por trasplante autólogo de progenitores hematopoyéticos (TPH) puede detener la progresión de enfermedades autoinmunitarias (EAI) severas con un aceptable riesgo/beneficio. En este artículo revisamos los ensayos en fase II-III prospectivos, multicéntricos, aleatorizados en diferentes EAI. Por otra parte, el trasplante alogénico de células progenitoras para EAI está siendo cautelosamente explorado en protocolos actuales(AU)

The use of stem cell transplantation for severe autoimmune diseases refractory to conventional therapy arose from two discoveries: the excellent results of animal experiments, and serendipitous observations in human coincidental diseases. Experimental data and early phase I-II trials in highly selected patients suggest that highdose chemotherapy followed by autologous hematopoietic stem cell transplantation can arrest progression of severe autoimmune diseases with an acceptable risk/benefit ratio. The present article reviews the phase II-III prospective, multicenter, randomized trials that have been performed in distinct autoimmune diseases. In addition, allogeneic stem cell transplantation for autoimmune diseases is being cautiously explored in current protocols(AU)

[Hematopoietic stem cell transplantation in systemic autoimmune diseases. State of the art]. / Trasplante de progenitores hematopoyéticos en enfermedades autoinmunitarias sistémicas. Situación actual.

The use of stem cell transplantation for severe autoimmune diseases refractory to conventional therapy arose from two discoveries: the excellent results of animal experiments, and serendipitous observations in human coincidental diseases. Experimental data and early phase I-II trials in highly selected patients suggest that highdose chemotherapy followed by autologous hematopoietic stem cell transplantation can arrest progression of severe autoimmune diseases with an acceptable risk/benefit ratio. The present article reviews the phase II-III prospective, multicenter, randomized trials that have been performed in distinct autoimmunediseases. In addition, allogeneic stem cell transplantation for autoimmune diseases is being cautiously explored in current protocols.

Rayleigh-Debye-Gans as a model for continuous monitoring of biological particles: Part I, assessment of theoretical limits and approximations.

A rapid tool for the characterization of submicron particles is light spectroscopy. Rayleigh-Debye-Gans and Mie theories provide light scattering solutions that can be evaluated within the time constants required for continuous real time monitoring applications, as in characterization of biological particles. A multiwavelength assessment of Rayleigh-Debye-Gans theory for spheres was conducted over the UV-Vis wavelength range where strict adherence to the limits of the theory at a single wavelength could not be met. Reported corrections to the refractive indices were developed to extend the range of application of the Rayleigh-Debye-Gans approximation. The results of this study show that there is considerable disagreement between Rayleigh-Debye-Gans and Mie theory across the UV-Vis spectrum.

The sagittal mandibular osteotomy under local anesthesia and intravenous sedation: four years of multicenter experience.

Today many surgical procedures involving head and neck areas can be performed under local anesthesia and intravenous sedation. The authors add to this list the sagittal osteotomies of the mandibular rami, thereby avoiding the need for general anesthesia and a hospital stay. The authors designed a protocol to be followed in a multicenter study (Milan and Barcelona) and applied it in 35 clinical cases with Class II malocclusion. The surgical procedure was performed with the Monitored Anesthesia Care technique, a combination of regional anesthesia and intravenous sedation. The results were good in all the clinical cases; skeletal correction of Class II was achieved in all patients and there were no intraoperative or postoperative complications. The major advantage of this technique is the functional control of the temporomandibular joint, which avoids displacements caused by gravity and the muscular relaxation commonly seen under general anesthesia. Furthermore, this protocol allows a reduction in costs, duration of surgery, and patient morbidity and convalescence. When this technique is accepted without hesitation, all Class II patients with only mandibular deficiency deformity may be treated in the most suitable way, thus providing the most satisfactory outcomes for the patient, orthodontist, and surgeon.

Autotrasplante de progenitores hematopoyéticos en una paciente con artritis reumatoide / Autologous stem cell transplantation in a patient with rheumatoid arthritis

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Rabdomioma adulto del espacio masticatorio. Presentación de un nuevo caso y revisión de la literatura / Adult rhabdomyoma in the masticatory area. New case presentation and review of the literature

El rabdomioma adulto es una neoplasia infrecuente de origen mesenquimal que representa el 2 por ciento de los tumores con diferenciación de músculo esquelético. Solamente se han descrito en la literatura alrededor de 100 casos. Se trata de un tumor benigno que aparece con más frecuencia en cabeza y cuello, con una incidencia mayor en el sexo masculino y con una edad media de presentación de 54 a 60 años.El propósito de este artículo es presentar un nuevo caso de rabdomioma adulto localizado en el espacio masticador, que se presentó como una masa de crecimiento lento que abomba la mucosa yugal y la región temporal izquierda.La localización más frecuente del rabdomioma adulto es la cavidad faríngea. Estos tumores se presentan como una masa única, aunque de forma ocasional lo hacen de forma multifocal. Al tratarse de un tumor de baja incidencia, el diagnóstico correcto puede evitar intervenciones quirúrgicas agresivas (AU)

Impacto socioeconómico de la fibromialgia / The socioeconomic impact of fibromyalgia

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Características clínicas y criterios diagnósticos de la fibromialgia / The clinical characteristics and diagnostic criteria of fibromyalgia

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Trasplante autólogo de progenitores hematopoyéticos en las enfermedades autoinmunes / Autologous hematopoietic progenitor transplantation in autoimmune diseases

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Uno de los elementos de la calidad de vida: el contrato médico / One of the components of quality of life: the medical contract

A partir del análisis de sentimientos en médicos y pacientes con respecto a la atención de salud, se intenta una explicación del fenómeno del malestar observado en esta área. Para ello se aborda el concepto de calidad de vida y sus componentes, mostrándose las áreas que conforman la calidad de vida del paciente y la interacción de estas con las áreas de calidad de vida del médico. Se estudia cómo el médico influye en la calidad de vida del paciente y viceversa; sobre todo la influencia del paciente en el ejercicio profesional y situación laboral del médico. Finalmente se elucida el concepto de contrato entre el médico y el paciente. Su análisis detallado, el intento de aproximación a satisfacer las expectativas ideales de las partes concernientes, la comprensión de los requisitos, su fundamentación y su explicitación, serían los elementos clave para un buen diseño y desempeño del contrato