[Commentary on the original 'Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents']. / Comentario al original 'Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.

TITLE: Comentario al original 'Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.

Comentario al original ‘Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares / Commentary on the original 'Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents'

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Toxicidad inmuno-relacionada asociada al uso de pembrolizumab en la práctica asistencial / Inmune-related toxicity with pembrolizumab in health care practice

Introducción: Los inhibidores del checkpoint inmunológico (ICIs) han conseguido buenos resultados en salud, pero pueden presentar eventos adversos inmunorelacionados (EAir), en ocasiones, graves y poco predecibles.Objetivo principal: Identificar los EAir asociados al uso de pembrolizumab y conocer su incidencia, características y tratamiento, en nuestro centro.Material y métodos: Estudio observacional y retrospectivo que incluye pacientes con cáncer oncohematológico tratados con pembrolizumab, excluyendo los que participaron en ensayos clínicos. Se recogen variables sociodemográficas, clínicas, y las relacionadas con el tratamiento, incluyendo EAir. El tratamiento estadístico se realizó mediante el paquete estadístico STATA/IC 12.1.Resultados: Se incluyeron 31 pacientes, 81% varones, con una mediana de edad de 67 años (rango 26-88), siendo los diagnósticos mayoritarios: cáncer de pulmón (55%) y melanoma (16%). 81% de los pacientes presentaban estadio IV y el 71%, PDL-1 positivo. La mediana de duración fue de 3,4 meses (rango 0,7-26). El 77% de los pacientes experimentaron EAir y las más frecuentes fueron: astenia, linfopenia e hipotiroidismo. Respecto a la gravedad, el 91% fueron leves o moderadas y en el 9% grado 3. Las reacciones adversas más graves fueron encefalitis, nefritis, anemia grado 3, liquen plano y polineuropatía motora desmielinizante. 11 de los pacientes suspendieron pembrolizumab, de los cuales el 36% fue de forma definitiva. Conclusión: La mayoría de los EAir que aparecen son leves, aunque los casos graves observados y el tiempo de aparición variable hacen que sea importante realizar una monitorización continua de la toxicidad de estos fármacos durante tratamiento, incluso después de suspenderlo. (AU)

Background: Immune checkpoint inhibitors (ICIs) have achieved good health outcomes but it presents immunorelated adverse events (AEsir), sometimes serious and not very predictable.Main objective: To identify the immune-mediated adverse effects (irAE) associated with the use of pembrolizumab and to know its incidence, characteristics and treatment in our center.Material and methods: Observational and retrospective study including oncohematological cancer patients treated with pembrolizumab, excluding those who participated in clinical trials. Sociodemographic, clinical, and treatment-related variables were collected, including EAir. Statistical treatment was performed using the STATA/IC 12.1 statistical package.Results: 31 patients, 81% male, with a median age of 67 years (range 26-88), the main diagnoses being lung cancer (55%) and melanoma (16%). Eighty-one percent of the patients had stage IV and PDL-1 positive in 71%. The median duration was 3.4 months (range 0.7-26). Seventy-seven percent of patients experienced AEir and the most frequent were: asthenia, lymphopenia and hypothyroidism. Regarding severity, 91% were mild or moderate and 9% were grade 3. The most serious adverse reactions were encephalitis, nephritis, grade 3 anemia, lichen planus and demyelinating motor polyneuropathy. Eleven of the patients discontinued pembrolizumab, 36% of whom discontinued permanently. Conclusions: Most of the AEs that appeared were mild, although the severe cases observed and the variable time of onset make it important to continuously monitor the toxicity of these drugs during treatment, even after discontinuation. (AU)

Enhancement of interfacial adhesion between starch and grafted poly(ε-caprolactone).

The use of a modified poly(ε-caprolactone) (gPCL) to enhance polymer miscibility in films based on thermoplastic starch (S) and poly(ε-caprolactone) is reported. PCL was functionalized by grafting with maleic anyhdride (MA) and/or glycidyl methacrylate (GMA) by reactive blending in a batch mixer. gPCL based materials were analysed in terms of their grafting degree, structural and thermal properties. Blends based on starch and PCL (wt. ratio 80:20) with including gPCL (0, 2.5 and 5wt.%), as a compatibilizer, were obtained by extrusion and compression moulding, and their structural, thermal, mechanical and barrier properties were investigated. Blends containing gPCL evidenced better interfacial adhesion between starch and PCL domains, as deduced from both structural (XRD, FTIR, SEM) and bulk properties (DSC, TGA). Moreover, grafted PCL-based compatibilizers greatly improved functional properties of S-PCL blend films, as pointed out from mechanical performance and higher barrier properties, valuable to meet the food packaging requirements.

Rhabdomyolysis after initial session of indoor cycling: analysis of 11 patients.

AIM: The aim of this paper was to highlight the special frequency of cases of rhabdomyolysis related to the practice of indoor cycling and to define the characteristics, course, and outcome of this disease. METHODS: Retrospective review of clinical histories of patients diagnosed with rhabdomyolysis after indoor cycling in our unit from January 2012 to April 2013. RESULTS: Eleven patients were analyzed. All patients, regardless of the degree of previous physical training, were diagnosed after a first session of indoor cycling. Mean age was 27.63 years (SD=5.74). Fifty-four percent were women. Creatine kinase (CK) levels gradually decreased in response to rest and intensive intravenous hydration. Only in two cases was renal failure observed, and in none were electrolyte disorders, disseminated intravascular coagulation (DIC) or compartmental syndrome detected. CONCLUSION: A first session of indoor cycling has become a common cause of rhabdomyolysis secondary to the physical exercise in recent years, which should alert those responsible for teaching this sport of the need for a gradual start under adequate hydration and environmental conditions, because although the condition has a benign course with adequate treatment and the complication rate is low, there are patients with increased susceptibility to very high CK blood levels requiring hospitalization for treatment and follow-up of possible complications.

Autoradiographic localization of beta-adrenergic receptors in rabbit eye.

Using an in vitro autoradiography, beta-adrenergic receptors were localized in the rabbit eye. Autoradiograms were generated by apposition of isotope-sensitive film to slide-mounted eye sections, labelled with [125I](-)Iodocyanopindolol. A high density of silver grains was obtained in conjunctival, corneal and ciliary process epithelium. Binding sites were also present in corneal endothelium, iris epithelium, lens epithelium, choroid and extraocular muscles. In some areas, retina was also labelled. Studies with beta-adrenergic compounds showed that the majority of beta-adrenergic receptors, detectable by autoradiography, were of the beta2 type in the rabbit eye.

Dopamine receptors in rabbit and rat eye: characterization and localization of DA1 and DA2 binding sites.

In vitro autoradiography is used to characterize and localize DA1 and DA2 receptors in rabbit and rat eyes. The bindings of 125I-SCH 23982 (DA1 antagonist) and of 125I-Iodosulpride (DA2 antagonist) to slide mounted tissue sections take place with characteristics expected of substances that recognize DA1 and DA2 receptors respectively. They are saturable, have high affinity and exhibit an appropriate pharmacology. The regional distribution of these receptors indicates that they are mainly present in retina. Precise cellular localizations are visualized in retinal structures by means of histoautoradiography: DA1 receptors are found in inner plexiform layer, outer plexiform layer and inner nuclear layer and DA2 binding sites are present in the two plexiform layers.

[Parinaud's oculo-glandular syndrome secondary to cat-scratch disease]. / Síndrome oculo-glandular de Parinaud secundario a enfermedad por arañazo de gato.

A 56 year old patient with an oculo-glandular syndrome of Parinaud, secondary to a cat scratch disease, is presented. The biopsy of the palpebral conjunctiva and parotid gland showed a non-caseous granulomatosis. The patient met the diagnosis criteria for cat scratch disease and, after treatment with a low dosage of steroids, showed a good evolution.

[Arthritis, endophthalmitis and endocarditis caused by Escherichia coli]. / Artritis, endoftalmitis y endocarditis por Escherichia coli.

A female diabetic patient of 66 years old with acute pyelonephritis, caused by escherichia coli, was further complicated by bacteremia and a rare septic metastasis such as arthritis of the knee and coxa-femoral, unilateral purulent endophthalmitis with a loss of sight and aortic endocarditis which required a surgical change of valves, the posterior evolution being favourable.

[Thoracic and retroperitoneal dissemination of multiple myeloma. 2 cases]. / Diseminación torácica y retroperitoneal del mieloma múltiple. Dos observaciones.

The dissemination of multiple myeloma out of the bone marrow is very rare, even though the observation of plasmacytosis in the bodies of patients having died of this disease is not rare. We present 2 patients affected by multiple myeloma and with extra-bone marrow plasmacytomas at the diagnosis, localized at posterior mediastinum and retroperitoneum, discovered by tomography.

[Usefulness of captopril as monotherapy and combination therapy in the treatment of arterial hypertension]. / Utilidad del captopril como monoterapia y en terapia de combinación en el tratamiento de la hipertensión arterial.

The efficacy and tolerance of captopril was prospectively studied as monotherapy for blood hypertension (BH), as well as combined modality with thiazides diuretic and nifedipine as a third drug. 95 cases of BH were followed up for a period of 6 months. 43.15% of the patients who received monotherapy with captopril were controlled (diastolic BP less than 95 mmHg). Those patients who had a diuretic added showed a response of 71.75% and those administered 3 drugs showed a response of 81.25%. The decrease of BH was significant in all groups (p less than 0.01). There was a significant correlation (p less than 0.01) between the response to monotherapy and severity of BH (mild BH 67.50% and severe BH 35.20%). 6.5% of patients abandoned the treatment because of secondary effects. No alterations were noted in the blood test. Monotherapy with captopril is effective in control of mild and moderate BH. In resistant patients, the addition of a diuretic and nifedipine retard as a third drug is useful and well-tolerated in any type of BH severity.

[Treatment of arterial hypertension with captopril in lupus nephropathy]. / Tratamiento con captopril de la hipertensión arterial en la nefropatía lúpica.

We present a non-controlled prospective study of 10 hypertensive patients with systemic erythematous lupus and nephropathy, treated with captopril exclusively or combined with other drugs, in order to assess its effectivity and potential side effects. Four of these 10 patients had mild hypertension; 3, moderate hypertension and 3, severe hypertension. In 5 of them, arterial pressures was controlled with just captopril; in other 3, we added furosemide and in one patient, we added furosemide and nifedipine. In one case, hypertension was not controlled. Renal function remained stable and proteinuria improved in six patients. Three patients presented reversible agranulocytosis, during or immediately after treatment. One of them was treated two years after with enalapril, without observing hematologic recurrence. We conclude that captopril is useful in treating arterial hypertension associated to lupous nephropathy, but frequent leukocyte counting controls must be done during the first months.

[Evaluation of a combination of a diuretic and nifedipine retard for the treatment of hypertensive patients refractory to nifedipine retard]. / Evaluación de la asociación de un diurético a nifedipina retard como terapia en pacientes hipertensos refractarios a nifedipina retard.

This study assessed the effectivity of the association between a diuretic, chlorthalidone, and retard nifedipine in the treatment of patients above 50 years of age with Arterial Hypertension refractory to retard nifedipine. A prospective study of a 3-month controlled intervention was designed, in which the patients were treated with retard nifedipine for 2 months and, if they did not respond to the treatment, chlorthalidone was associated for 1 month. Out of 235 patients selected at the beginning of the study, 28 dropped out voluntarily, 24 were excluded because they did not adhere to the protocol and 30 dropped out due to side effects. After the first two months of therapy, hypertension was controlled in 60.2% of the 181 patients, whereas in the third month, only in 20% of the 44 patients considered could be controlled. Significant differences were observed between the two treatments (p < 0.001) with a 95% CI in the percentage differences of 54% versus 26.4%. These results suggest that the association of chlorthalidone and retard nifedipine does not improve the treatment of Arterial Hypertension refractory to retard nifedipine.

[Cauda equina syndrome caused by paraganglioma of the filum terminale]. / Paraganglioma del filum terminal como causa de síndrome de cauda equina.

Paragangliomas are neuroendocrine tumors that originate from cells migrating from the neural crest. They have a diverse localizations, and are common in the head, neck, mediastinum or retroperitoneum. Their growth in the filum terminale region is very infrequent. We report the case of a patient who suffered an acute cauda equina syndrome. We give a detailed description of the diagnostic process, radiological characteristics, treatment and the macro and microscopic properties of this tumor.

Flexible sensor based on carbon nanofibers with multifunctional sensing features.

Herein, we present the fabrication and characterization of a flexible gas sensor based on carbon nanofibers. The sensing device is composed of interdigitated silver electrodes deposited by inkjet printing on Kapton substrates, subsequently coated with carbon nanofibers as sensing element. Gas sensing response to CO, NH3 and humidity has been characterized in detail. Thermal, mechanical and electromagnetic radiation effects have also been studied and discussed from the point of view of the cross-sensitivity. The obtained results open the door for a new generation of flexible sensors with multifunctional sensing features, which are producible with scalable techniques based on low cost nanomaterials.

Patient age and biological aggressiveness of endometrial carcinoma.

BACKGROUND: Advanced age is associated with a significantly worse prognosis of endometrial carcinoma patients. The aim of this study was to test whether age is a poor-risk factor in endometrial carcinoma because tumors arising in older patients are biologically different from those diagnosed in patients of an earlier age. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded samples from 136 previously untreated patients with endometrial carcinoma were studied by means of immunohistochemistry. The expression of molecular markers associated with hormone responsiveness (estrogen and progesterone receptors), proliferation (Ki67, C-ERB-B2, p53), invasiveness (E-cadherin) and apoptosis (BCL2 and p53) was analyzed. The obtained expression levels, together with all available clinical and pathological features were tested for correlations with the patients age and survival. RESULTS: Advanced patient age showed a direct correlation with tumor stage (r=0.29, p=0.0008) and mutant p53 expression (r=0.25, p=0.004), and an inverse correlation with E-cadherin expression (r=-0.28, p=0.001). Patient age above the 25th percentile (57 years) of the age distribution was significantly associated with a worse prognosis (p=0.018). CONCLUSION: It appears that with advancing age, endometrial carcinoma exhibits a more aggressive tumor phenotype, characterized by mutant p53 expression and down-regulation of E-cadherin expression, and that this, in its turn, results in tumors being diagnosed at a more advanced stage in older patients.