Circulating microRNAs as Promising Biomarkers in Colorectal Cancer.

Colorectal cancer (CRC) is one of the most common cancers and a leading cause of cancer-related deaths worldwide. Despite numerous advances in therapeutic approaches, this cancer has a poor prognosis when it is diagnosed at late stages. Therefore, the scientific effort is nowadays directed towards the development of new non-invasive and dynamic biomarkers to improve the survival expectancy of CRC patients. In this sense, deregulated expression of many miRNAs has been shown to play an important role for CRC carcinogenesis and dissemination. Noticeably, an increasing number of studies highlight that circulating miRNAs, including those traveling inside exosomes or those released by tumor cells into circulation, constitute a promising tool for early detection, prognosis and therapy selection of CRC. Therefore, in this review we focus on the clinical potential of blood circulating miRNAs as emerging biomarkers with high value to improve the clinical management of CRC patients, providing a deep and complete perspective of the realities and challenges to translate these biomarkers to the clinical context.

Instauración ambulatoria y manejo inicial del tratamiento con infusión intraduodenal de levodopa-carbidopa en la enfermedad de Parkinson avanzada / Outpatient establishment and initial management of treatment with intraduodenal levodopa-carbidopa infusion in advanced Parkinson's disease

Introducción. El tratamiento con infusión intraduodenal de levodopa-carbidopa es una de las tres terapias de que disponemos en la actualidad en la enfermedad de Parkinson avanzada. Optimiza el beneficio del tratamiento antiparkinsoniano al contrarrestar el efecto negativo que provoca el vaciado gástrico errático sobre la absorción de la levodopa oral. El objetivo es describir nuestro protocolo de instauración del tratamiento de modo ambulatorio. Pacientes y métodos. En nuestra unidad hemos implementado un protocolo de instauración del tratamiento con infusión continua de levodopa-carbidopa intestinal sin necesidad de ingreso hospitalario gracias al desarrollo de un circuito multidisciplinar entre el propio servicio de neurología, la unidad de endoscopia digestiva y la unidad de hospitalización a domicilio. Resultados. En año y medio se trató a cinco pacientes con enfermedad de Parkinson avanzada. Todos ellos continúan con el tratamiento y no han tenido complicaciones significativas. Conclusión. La instauración ambulatoria del tratamiento ahorra costes y evita el impacto negativo del ingreso en el paciente con enfermedad de Parkinson avanzada, de la misma manera que favorece su adaptación y tolerancia a aquél

Introduction. Treatment with intraduodenal levodopa-carbidopa infusion is one of the three therapies currently available for advanced Parkinson's disease. It optimizes the benefit of antiparkinsonian treatment by counteracting the negative effect of erratic gastric emptying on the absorption of oral levodopa. The purpose is to describe our outpatient protocol of treatment establishment. Patients and methods. In our unit we have implemented a protocol for the treatment with intradoudenal levodopacarbidopa infusion without admission based on the development of a multidisciplinary circuit among the Neurology Service, the Digestive Endoscopy Unit and the Home Hospitalization Unit. Results. Over one and a half year, we treated five patients with advanced Parkinson's disease. All of them remain on the medication and no significant side effect has taken place. Conclusion. The outpatient onset install of this treatment saves costs and avoids the negative impact of admission on the patient with advanced Parkinson's disease, in the same way that favors their adaptation and tolerability to it

Citrobacter freundii infection after acute necrotizing pancreatitis in a patient with a pancreatic pseudocyst: a case report.

INTRODUCTION: Infections are the most frequent and severe complications of acute necrotizing pancreatitis with a mortality rate of up to 80 percent. Although experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is controversial. CASE PRESENTATION: We describe a Citrobacter freundii isolation by endoscopy ultrasound fine needle aspiration in a 80-year-old Caucasian man with pancreatic pseudocyst after acute necrotizing pancreatitis. CONCLUSION: Our case report confirms that this organism can be recovered in patients with a pancreatic pseudocyst. On-site cytology feedback was crucial to the successful outcome of this case as immediate interpretation of the fine needle aspiration sample directed the appropriate cultures and, ultimately, the curative therapy. To the best of our knowledge, this is the first reported case of isolated pancreatic C. freundii diagnosed by endoscopy ultrasound fine needle aspiration.

Accuracy of plasma levels of polymorphonuclear elastase as early prognostic marker of acute pancreatitis in routine clinical conditions.

OBJECTIVES: The early prognostic evaluation of acute pancreatitis (AP) is a key step in the appropriate management of the disease. Plasma levels of polymorphonuclear elastase have proved to be an accurate early prognostic marker of AP in research conditions. Whether the test remains sufficiently accurate in routine clinical conditions has been questioned. The aim of our study was to evaluate the accuracy of plasma polymorphonuclear-elastase levels for the early prognostic evaluation of AP in the clinical setting. METHODS: A total of 224 consecutive patients with AP admitted to our Gastroenterology Department were included. A blood sample for polymorphonuclear-elastase quantification was obtained from all of them in the first morning of hospital stay, together with samples for routine haematological and biochemical analysis. Blood samples for polymorphonuclear-elastase evaluation were sent to the laboratory and managed there according to routine protocols. AP was classified as mild or severe according to the Atlanta classification, whereas polymorphonuclear-elastase results were kept blind. Results were shown as mean+/-SD and compared using Student's t-test for unrelated samples. The accuracy of the test for the prognostic evaluation of AP was calculated after drawing the corresponding receiver operator curve. RESULTS: Fifty patients (23%) suffered from severe AP. The plasma levels of polymorphonuclear elastase were 217.8+/-93.5 microg/l in patients with severe AP and 68.1+/-32.7 microg/l in those with mild disease (P<0.001). The sensitivity and specificity of the test for the detection of severe AP were 92 and 91%, respectively, for an optimal cut-off value of 110 microg/l. The positive and negative predictive values for a prevalence of severe disease of 20% were 78 and 96%, respectively. The area under the receiver operator curve was 0.956. CONCLUSION: Quantification of plasma polymorphonuclear-elastase levels is a very accurate method for the early prognostic evaluation of AP, and is easily applicable in the clinical setting.