Tumor-Agnostic Circulating Tumor DNA Testing for Monitoring Muscle-Invasive Bladder Cancer.

Circulating tumor DNA (ctDNA) has recently emerged as a real-time prognostic and predictive biomarker for monitoring cancer patients. Here, we aimed to ascertain whether tumor-agnostic ctDNA testing would be a feasible strategy to monitor disease progression and therapeutic response in muscle-invasive bladder cancer (MIBC) patients after radical cystectomy (RC). Forty-two MIBC patients who underwent RC were prospectively included. Blood samples from these patients were collected at different follow-up time points. Two specific mutations (TERT c.1-124C>T and ATM c.1236-2A>T) were analyzed in the patients' plasma samples by droplet digital PCR to determine their ctDNA status. During a median follow-up of 21 months, 24% of patients progressed in a median of six months. ctDNA status was identified as a prognostic biomarker of tumor progression before RC and 4 and 12 months later (HR 6.774, HR 3.673, and HR 30.865, respectively; p < 0.05). Lastly, dynamic changes in ctDNA status between baseline and four months later were significantly associated with patient outcomes (p = 0.045). In conclusion, longitudinal ctDNA analysis using a tumor-agnostic approach is a potential tool for monitoring MIBC patients after RC. The implementation of this testing in a clinical setting could improve disease management and patients' outcomes.

The Effect of Adverse Surgical Margins on the Risk of Biochemical Recurrence after Robotic-Assisted Radical Prostatectomy.

Positive surgical margins (PSM) after radical prostatectomy are associated with a greater risk of biochemical recurrence (BCR). However, not all PSM harbour the same prognosis for recurrence. We aim to determine the impact of different PSM characteristics and their coexistence on the risk of BCR. This retrospective study included 333 patients that underwent robotic-assisted radical prostatectomy for prostate cancer between 2015−2020 at a single institution. The effect of PSM and their adverse characteristics on the risk of BCR was assessed using Cox proportional hazard models. Kaplan−Meier was used to represent BCR-free survival stratified by margin status. With a median follow-up of 34.5 months, patients with PSM had a higher incidence of BCR, higher risk of relapse and lower BCR-free survival than negative margins (p < 0.001). We established as adverse characteristics: PSM length ≥ 3 mm, multifocality and Gleason at margin > 3. PSM ≥ 3 mm or multifocal PSM were associated with an increased risk for BCR compared to favourable margins (HR 3.50; 95% CI 2.05−5.95, p < 0.001 and HR 2.18; 95% CI 1.09−4.37, p = 0.028, respectively). The coexistence of these two adverse features in the PSM also conferred a higher risk for biochemical relapse and lower BCR-free survival. Adverse Gleason in the margin did not confer a higher risk for BCR than non-adverse margins in our models. We concluded that PSM are an independent predictor for BCR and that the presence of adverse characteristics, such as length and focality, and their coexistence in the PSM are associated with a greater risk of recurrence. Nevertheless, subclassifying PSM with adverse features did not enhance the model's predictive performance in our cohort.

[Orthotopic renal allograft transplant. State of the art.] / Trasplante renal ortotópico. Estado actual.

Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESRD)as it has shown a better quality of life and longer survival compared to dialysis. Patients with ESRD have associated vascular pathology in a significant percentage, with abundant calcifications at the level of the aorto-iliac axis.The survival of transplanted patients has also increased so an important number of patients have multiple transplants,patients with an indication for a third, fourth and even fifth transplant.In these cases, in which the iliac fossa is no longer practicable(atheromatosis, vascular abnormalities, occupied iliac fossae for previous kidney transplant…), orthotopic kidney transplantation offers a viable option with good results.

El trasplante renal es el tratamiento de elección para pacientes con insuficiencia renal crónica terminal (IRCT) ya que ha demostrado una mejor calidadd e vida y mayor supervivencia en comparación ala diálisis. Los pacientes con IRCT tienen asociada patología vascular en un importante porcentaje, con abundantes calcificaciones a nivel del eje aorto-ilíaco. La supervivencia de los pacientes trasplantados también se ha incrementado por lo que cada vez más nos encontramos con pluritrasplantados, pacientes con indicación de tercer, cuarto e incluso quinto trasplante.En estos casos en los que la fosa ilíaca ya no es practicable (ateromatosis, malformaciones vasculares, ocupación de fosas ilíacas por trasplantes renales previos…),el trasplante renal ortotópico ofrece una opción viable con buenos resultados.

Trasplante renal ortotópico. Estado actual / Trapianto renale ortotopico. Stato attuale

El trasplante renal es el tratamiento deelección para pacientes con insuficiencia renal crónicaterminal (IRCT) ya que ha demostrado una mejor calidad de vida y mayor supervivencia en comparación ala diálisis. Los pacientes con IRCT tienen asociada patología vascular en un importante porcentaje, con abundantes calcificaciones a nivel del eje aorto-ilíaco. Lasupervivencia de los pacientes trasplantados también seha incrementado por lo que cada vez más nos encontramos con pluritrasplantados, pacientes con indicaciónde tercer, cuarto e incluso quinto trasplante.En estos casos en los que la fosa ilíaca ya no es practicable (ateromatosis, malformaciones vasculares, ocupación de fosas ilíacas por trasplantes renales previos...),el trasplante renal ortotópico ofrece una opción viablecon buenos resultados.(AU)

Kidney transplantation is the treatment ofchoice for patients with end-stage renal disease (ESRD)as it has shown a better quality of life and longer survivalcompared to dialysis. Patients with ESRD have associated vascular pathology in a significant percentage, withabundant calcifications at the level of the aorto-iliac axis.The survival of transplanted patients has also increasedso an important number of patients have multiple transplants, patients with an indication for a third, fourth andeven fifth transplant.In these cases, in which the iliac fossa is no longer practicable (atheromatosis, vascular abnormalities, occupiediliac fossae for previous kidney transplant...) , orthotopickidney transplantation offers a viable option with goodresults.(AU)

Burnout y trabajo en equipo en los profesionales de Atención Primaria / Burnout and Teamwork in Primary Care Teams

OBJETIVO: Estimar la prevalencia de burnout y percepción de trabajo en equipo en los equipos de Atención Primaria (EAP) de Barcelona ciudad. DISEÑO: Transversal multicéntrico. Emplazamiento: EAP del Institut Català de la Salut (ICS) en Barcelona. PARTICIPANTES: Trabajadores fijos e interinos, de todas las categorías profesionales de 51 EAP (N = 2398). Respondieron 879 (36,7%). Mediciones: Se envió por correo electrónico el cuestionario «Maslach Burnout Inventory», con las dimensiones agotamiento emocional, despersonalización y realización personal. Se consideró burnout la afectación en grado alto de 2 o más dimensiones. La percepción del trabajo en equipo y la valoración de jefaturas se midió con un cuestionario diseñado ad hoc. RESULTADOS: La prevalencia de burnout fue del 17,2%. El 46,2% presentaron una o más subescalas alteradas. Presentan alto grado de agotamiento emocional 38,2%, 23,8% despersonalización y 7,7% baja realización personal. Un 49,2% consideran que se fomenta bastante o mucho el trabajo en equipo. Globalmente, trabajadores sociales presentan mayor media de dimensiones afectadas en grado alto, seguidas de administrativos, odontólogos, médicos y enfermeras (p < 0,001). El personal fijo presenta mayor grado de agotamiento emocional (p < 0,002). Los que peor valoraron a sus jefaturas y los que menos consideraban trabajar en equipo presentaron más agotamiento emocional, más despersonalización y mayor nivel de burnout en general (p < 0,001). CONCLUSIONES: El nivel de burnout entre los profesionales es considerable, existiendo diferencias entre categorías profesionales. El trabajo en equipo y una buena valoración de sus jefaturas protegen del burnout

OBJECTIVE: To estimate the prevalence of burnout and the perception of teamwork in Primary Care teams from Barcelona. DESIGN: Multicenter cross-sectional. LOCATION: Primary Health Care Teams from Barcelona. Institut Català de la Salut. PARTICIPANTS: All permanent employees or temporary professionals of all categories from 51 teams (N = 2398). A total of 879 responses (36.7%) were obtained. Measurements: The Maslach Burnout Inventory questionnaire, with 3 dimensions, was sent by emotional exhaustion (AE), depersonalization (DP), and personal accomplishment (RP). Burnout is considered present when two or more dimensions scored high marks. Perception of teamwork and evaluation of leaders was evaluated using an ad hoc questionnaire. RESULTS: The prevalence of burnout was17.2% (two or more dimensions affected), and 46.2% had at least one of the three dimensions with a high level. A high level of AE was found in 38.2%, of DP in 23.8%, and 7.7% had low RP. Almost half (49.2%) believe that teamwork is encouraged in their workplace. Social workers overall, have a higher average of dimensions affected at a high level, followed by administrative personnel, dentists, doctors and nurses (p < 0 .001). Permanent staff have a greater degree of emotional exhaustion (p < 0 .002). Those who rated their leaders worst and least rated teamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (p < 0 .001). CONCLUSIONS: The level of burnout among professionals is considerable, with differences existing between occupational categories. Teamwork and appreciating their leaders protect from burnout

[Burnout and teamwork in primary care teams]. / Burnout y trabajo en equipo en los profesionales de Atención Primaria.

OBJECTIVE: To estimate the prevalence of burnout and the perception of teamwork in Primary Care teams from Barcelona. DESIGN: Multicenter cross-sectional. LOCATION: Primary Health Care Teams from Barcelona. Institut Català de la Salut. PARTICIPANTS: All permanent employees or temporary professionals of all categories from 51 teams (N=2398). A total of 879 responses (36.7%) were obtained. MEASUREMENTS: The Maslach Burnout Inventory questionnaire, with 3 dimensions, was sent by emotional exhaustion (AE), depersonalization (DP), and personal accomplishment (RP). Burnout is considered present when two or more dimensions scored high marks. Perception of teamwork and evaluation of leaders was evaluated using an ad hoc questionnaire. RESULTS: The prevalence of burnout was17.2% (two or more dimensions affected), and 46.2% had at least one of the three dimensions with a high level. A high level of AE was found in 38.2%, of DP in 23.8%, and 7.7% had low RP. Almost half (49.2%) believe that teamwork is encouraged in their workplace. Social workers overall, have a higher average of dimensions affected at a high level, followed by administrative personnel, dentists, doctors and nurses (p<0.001). Permanent staff have a greater degree of emotional exhaustion (p<0.002). Those who rated their leaders worst and least rated teamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (p<0.001). CONCLUSIONS: The level of burnout among professionals is considerable, with differences existing between occupational categories. Teamwork and appreciating their leaders protect from burnout.