The presence of the messenger RNA for GLP-1 receptor (GLP-1R), GLUT-2 (isoform 2 of glucose transporter ) and GK (glucokinase) in brain areas might be related to the glucose sensing process that was ...recently described in pancreatic β cells. GLUT-2, GK and the regulatory protein of GK (GKRP) were identified in both human and rat brains. The GK gene expression generates a 52 kDa protein, identified by biochemical and immunochemical methods; it shows a high Km for glucose and a high capacity to phosphorylate glucose in the hypothalamus and in the brain cortex. Its physiological importance is related to its activation secondary to an increase in glycaemia related to food ingestion. GK and GKRP modulate the enzymatic activity according to the metabolic needs of the cells. This is necessary for the sensing process that is controlled by GK and GKRP, and could also contribute to a sensation of satiety. It would be interesting to know if mutations in the genes codifying the mentioned proteins can produce pathological alterations, or whether changes in the feeding behavior are related to the brain glucose sensing process. Until now, our work has focused on the role of hypothalamic glucokinase as a glucose sensor related to food behavior, but we cannot forget that this enzyme is widely expressed in the brain cortex, where it could also carry out other important functions. These observations, together with the anorexigenic activity of GLP-1 (glucagon-like peptide-1), suggest a combined role of these peptides on food intake control.
Objective
To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type ...of components of ERAS play a key role on the decrease of surgical morbidity.
Materials and methods
We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate.
Results
Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (
p
< 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%,
p
= 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively,
p
= 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted RR = 0.815; 95% confidence interval (CI) 0.667–0.996;
p
= 0.045. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications.
Conclusions
Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS
Clinical data suggest that cardiosphere-derived cells (CDCs) could modify post-infarction scar and ventricular remodeling and reduce the incidence of ventricular tachycardia (VT). This paper assesses ...the effect of CDCs on VT substrate in a pig model of postinfarction monomorphic VT. We studied the effect of CDCs on the electrophysiological properties and histological structure of dense scar and heterogeneous tissue (HT). Optical mapping and histological evaluation were performed 16 weeks after the induction of a myocardial infarction by transient occlusion of the left anterior descending (LAD) artery in 21 pigs. Four weeks after LAD occlusion, pigs were randomized to receive intracoronary plus trans-myocardial CDCs (IC+TM group, n: 10) or to a control group. Optical mapping (OM) showed an action potential duration (APD) gradient between HT and normal tissue in both groups. CDCs increased conduction velocity (53 ± 5 vs. 45 ± 6 cm/s, p < 0.01), prolonged APD (280 ± 30 ms vs. 220 ± 40 ms, p < 0.01) and decreased APD dispersion in the HT. During OM, a VT was induced in one and seven of the IC+TM and control hearts (p = 0.03), respectively; five of these VTs had their critical isthmus located in intra-scar HT found adjacent to the coronary arteries. Histological evaluation of HT revealed less fibrosis (p < 0.01), lower density of myofibroblasts (p = 0.001), and higher density of connexin-43 in the IC+TM group. Scar and left ventricular volumes did not show differences between groups. Allogeneic CDCs early after myocardial infarction can modify the structure and electrophysiology of post-infarction scar. These findings pave the way for novel therapeutic properties of CDCs.
Neuroanatomy is always a challenging topic for veterinary students. It is widely accepted that understanding the anatomy of the central nervous system (CNS) is essential to explain many of the ...pathological processes that affect the brain. Although its study has varied over time to achieve this goal, in human and veterinary medicine it is difficult to find a teaching method that associates normal anatomy with pathological alterations of the brain. For the first time, we have created an educational tool that combines neuroanatomy and neuropathology, using different magnetic resonance (MR) images as a basis and EspINA software as analyzer, to obtain segmented structures and 3D reconstructions of the dog brain. We demonstrate that this combination is an optimal tool to help anatomists to understand the encephalon, and additionally to help clinicians to recognize illness including a multitude of neurological problems. In addition, we have tried to see whether photogrammetry, which is a common technique in other sciences, for example geology, could be useful to teach veterinary neuroanatomy. Although we still need further investigations, we have been able to generate 3D reconstructions of the whole brain, with very promising results to date.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background and ImportanceInflammation plays a major role in the progression of neoplasms such as non-small-cell lung cancer (NSCLC), so it is vitally important to find biomarkers that are easily ...applicable and reproducible in routine clinical practice that allow us to classify patients according to their forecast.Aim and ObjectivesTo analyse the inflammatory marker platelet/lymphocyte ratio (PLR) as a predictor of efficacy in immunotherapy treatments; to assess whether there is a relationship between PLR value and response to treatment.Material and MethodsRetrospective and observational study of patients diagnosed with NSCLC and treated with pembrolizumab in a tertiary hospital, from January 2018 to December 2021. We collected demographic variables (sex and age), ECOG, histology, presence of metastases, PD-L1 expression and previous treatments. Progression-free survival (PFS) and overall survival (OS) were calculated by the Kaplan-Meier method and log-rank as hypothesis testing.; PLR (absolute platelet count/absolute lymphocyte count) was calculated and PLR=200 was considered the cut-off point. Cox regression test was used to assess the influence of PLR on treatment efficacy.ResultsSeventy-three patients treated with pembrolizumab (80.8% male, n=59) and median age 65 83-37 years. Adenocarcinoma histology was 90% (n=66); 40 patients ECOG=0, 31 patients ECOG=1 and 2 patients ECOG=2; 26 patients PD-L1<50%, 19 patients PD-L1>50% and for 28 patients it was unknown; 12 patients CNS metastases and 22 patients had liver/bone metastases. Significant differences were obtained in the group of patients with liver/bone metastases in PFS with median of 6.3 (2.9-9.6) CI 95% vs 17.3 (11.4-23.2) CI 95% months (p=0.03), and in the group of patients with CNS metastases in OS with a median of 9.6 (1.2-17.9) CI 95% vs at 24.9 (18.6-31.2) 95% CI months (p=0.003). Median PFS was 15.6 10.15-21.1 95% CI for PLR <200 vs 9.97 2.86-17.1 95% CI months for PLR >200 (p=0.04); median OS was 26.25 19.87-32.64 95% CI for PLR <200 vs 11.31 3.86-18.79 95% CI months for PLR >200 (p=0.001). Cox regression test: HR=1.001 (p=0.017) for PFS and HR=1.002 (p=0.003) for OS.Conclusion and RelevancePLR and the presence of metastases correlates with PFS and OS. PLR, with a cut-off point =200, appears useful as a prognostic biomarker for patients with NSCLC treated with pembrolizumab; higher PLR values, result in lower PFS and OS (HR>1 in PFS and OS).References and/or AcknowledgementsConflict of InterestNo conflict of interest
Little is known about the strategies used by olive trees to overcome the long dry periods typical of the areas where they are cropped. This makes it difficult to optimize the water supply in ...orchards. To study the control of water consumption by olive trees, measurements of leaf water potential (Ψ) and stomatal conductance to H₂O (g) were made on 26-year-old Manzanillo olive trees under three irrigation treatments. The first treatment provided enough water to cover the crop water demand, the next treatment supplied one third of that rate, and the final treatment was no irrigation at all, typical of dry-farming conditions. Under conditions of high vapour pressure deficit of the air (Da), the olive trees prevented excessive water loss by closing their stornata. Leaves of the current year showed better stomatal control than did the 1-year-old leaves. The upper-bound functional relationships between g and Da and photon flux density (IP) were obtained by boundary-line analysis, based on a technique of non-linear least squares. Maximum values of g were observed at relatively low levels of IP, from about 500 µmol m⁻² s⁻¹, and a proportional decrease in g with increasing Da was also found, at least for values of up to approximately 3.5 kPa. Higher values of g were observed in the morning than in the afternoon, for similar levels of IP and Da. Unirrigated olive trees recovered quickly after the dry season, showing values of Ψ and g similar to those of irrigated trees after just two days.
Abstract Objectives To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients ...with low-risk prostate cancer. Materials and methods Prospective study of patients enrolled in an active surveillance program at our center between 2004 and 2012. The inclusion criteria were PSA < 10 ng/ml, Gleason score ≤ 6, clinical stage T1c/T2a, ≤2 positive cores, and no more than 50% of the core being affected. Curative treatment was proposed when faced with pathological progression over the course of the monitoring. Results In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance program and were treated actively. We analyzed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2–7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8–99.8%) and 70.9% (95% CI: 59.3–85.5%), respectively. Thirty-four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3). Conclusions Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community.
To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients with low-risk prostate ...cancer.
Prospective study of patients enrolled in an active surveillance programme at our centre between 2004 and 2012. The inclusion criteria were PSA <10 ng/ml, Gleason score ≤6, clinical stage T1c/T2a, ≤2 positive cores, and no more than 50% of the core being affected. Curative treatment was proposed when faced with pathological progression over the course of the monitoring.
In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance programme and were treated actively. We analysed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2-7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8%-99.8%) and 70.9% (95% CI: 59.3%-85.5%), respectively. Thirty four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3).
Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community.
4CPS-204 Medicine reconciliation at hospital discharge Martinez Aguirre, I; Revuelta Amallo, A; Domínguez Menéndez, JA ...
European journal of hospital pharmacy. Science and practice,
03/2020, Letnik:
27, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Background and importanceIt has been proven that an updated pharmacotherapeutic report means improvements in patient safety and system efficiency.Aim and objectivesTo describe and analyse medicine ...reconciliation errors (MRE) and to determine awareness of prescribers of keeping the treatment report updated at medical discharge.Material and methodsThis was a prospective study over a period of 17 weeks, involving all inpatients from the internal medicine ward (IM), cardiology ward (CAR) and oncology ward (ONC), for 8 weeks, 6 weeks and 3 weeks, respectively. Variables collected were age, sex, number of new medications, number of discrepancies not justified requiring clarification, type of MRE, communicated MRE and number of acceptances, and number of patients that received pharmaceutical care at discharge. On admission, data were collected by the pharmacist from an interview with the patient. All detected discrepancies were communicated to the physician to modify and update the treatment before discharge. The pharmacist conducted a final interview, where all modifications and new drugs were explained. Updated treatment and discharge reports were given after resolving patient doubts.ResultsA total of 151 patients were analysed with a mean age of 75±13 and 46.3% were women. The number of not justified discrepancies identified were 116, corresponding to IM 58.6% (68), CAR 27.6% (32) and ONC 13.8% (16). Classification of the discrepancies: dosage error 30.2% (35); not indicated or contraindicated for current clinical situation 24.1% (28); omission error 22.4% (26); commission error 16.4% (19); mistaken drug 1.7% (2); incomplete prescription 1.7% (2); and duplicity 3.4% (4). A total of 104 discrepancies were communicated and discussed with the physicians: 49% (51) of the discrepancies were accepted and 31.1% (47) of the discharge reports were incomplete, which means the dosage or duration of treatment and changes established were not included. New drugs were started in 74.8% of inpatients and pharmaceutical care was offered to 80.5% (91) before discharge.Conclusion and relevanceThe pharmacist integration has facilitated the acceptance of pharmaceutical interventions and has prevented MRE on discharge, where the most prevalent one was dosage discrepancy. This has raised awareness among all professionals about the importance of updating the medical history. All concerns about discharge medication were resolved in almost 80% of discharges.References and/or acknowledgementsNo conflict of interest.
Background and ImportanceThe prognostic value of biomarkers such as neutrophil/lymphocyte ratio (NLR), derived neutrophil/lymphocyte ratio (dNLR) and platelet/lymphocyte ratio (PLR) is increasingly ...studied, showing their usefulness in patients with different anti-PDL1 treatments in the context of oncological pathologies.Aim and ObjectivesTo analyse whether there is a statistical relationship between these three parameters and to analyse the biomarkers and to analyse their effect on survival.Material and MethodsObservational and retrospective study in patients treated with pembrolizumab and diagnosed with non-small-cell lung cancer (NSCLC) in a tertiary level hospital. Demographic variables (sex and age) were collected, NLR as neutrophil/lymphocyte count, dNLR as neutrophil/leukocyte/neutrophil count and PLR as platelet/lymphocyte count were calculated. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method and log-rank test as a hypothesis test. The cut-off points were NLR=5, dNLR=3 and PLR=200. Spearman’s correlation test was used to check the correlation between the three biomarkers (previously the non-normality of the samples was checked by Kolmogorov-Smirnov test).ResultsA total of 74 patients treated with pembrolizumab were registered, 59 men (80,8%) and 14 women, with a median age of 65 83-37 years. Median neutrophil count was 5.45 6.1-1.5 x109neut/L, lymphocyte count was 1.45 3.9-0.2 x109linf/L and platelet count was 174.7 56.92-1345 x109 platelets/L. Table 1 shows the survival results obtained.Abstract 4CPS-092 Table 1Results of Kaplan-Meier survival method and log-rank test Progression-free survival Overwal survival Median IC95% (months) p LR-t Median IC95% (months) p LR-t NLR<5 (n=41) 16,1 (10,5-21,6) 0,05 24,9 (18,5-31,3) 0,01 NLR>5 (n=29) 12,5 (5,1-19,9) 17,4 (9,1-25,6) dNLR<3 (n=42) 14,65 (9-20) 0,09 23 (17,1-30,6) 0,04 dNRL>3 (n=26) 11,5 (13,7-19,3) 17,09 (8,2-25) PLR<200 (n=42) 15,6 (10,15-21,1) 0,04 26,25 (19,87-32,64) 0,001 PLR>200 (n=26) 9,97 (2,86-17,1) 11,31 (3,86-18,79) Spearman’s correlation test showed statistical significance in the relationship between the three biomarkers showing a strong association between them, Spearman’s coefficients obtained are shown: NLR-dNLR 0.934 (p=0), NLR-PLR 0.697 (p=0) dNLR-PLR 0.616 (p=0).Conclusion and RelevanceFor the three biomarkers there are significant differences in survival outcomes for the selected cut-off points, offering prognostic value for our patients. Spearman’s test indicates that there is a correlation between the biomarkers.References and/or AcknowledgementsConflict of InterestNo conflict of interest
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