We investigated whether pre-treatment with statins is associated with surrogate markers of amyloid and hypertensive angiopathies in patients who need to start long-term oral anticoagulation therapy. ...A prospective multicenter study of patients naive for oral anticoagulants, who had an acute cardioembolic stroke. MRI was performed at admission to evaluate microbleeds, leukoaraiosis and superficial siderosis. We collected data on the specific statin compound, the dose and the statin intensity. We performed bivariate analyses and a logistic regression to investigate variables associated with microbleeds. We studied 470 patients (age 77.5 ± 6.4 years, 43.7% were men), and 193 (41.1%) of them received prior treatment with a statin. Microbleeds were detected in 140 (29.8%), leukoaraiosis in 388 (82.5%) and superficial siderosis in 20 (4.3%) patients. The presence of microbleeds, leukoaraiosis or superficial siderosis was not related to pre-treatment with statins. Microbleeds were more frequent in patients with prior intracerebral hemorrhage (OR 9.7, 95% CI 1.06-90.9) and in those pre-treated antiplatelets (OR 1.66, 95% CI 1.09-2.53). Prior treatment with statins was not associated with markers of bleeding-prone cerebral angiopathies in patients with cardioembolic stroke. Therefore, previous statin treatment should not influence the decision to initiate or withhold oral anticoagulation if these neuroimaging markers are detected.
Highlights * Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of ...SARS-CoV-19 still remain to be defined. * We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. * We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation. Author Affiliation: (a) Hospital Clinic, Barcelona, Spain (b) Hospital Clinico San Carlos, Madrid, Spain (c) Hospital General de Alicante, Spain (d) Hospital Universitario de Canarias, Tenerife, Spain (e) Hospital Universitario Severo Ochoa de Leganes, Madrid, Spain (f) Hospital General Universitario Reina Sofia, Murcia, Spain (g) Complejo Asistencial de Soria, Spain (h) Hospital Universitario Rey Juan Carlos, Madrid, Spain (i) Hospital San Pedro, Logrono, Spain (j) Hospital de Leon, Spain (k) Hospital de la Princesa, Madrid, Spain (l) Hospital Clinico San Carlos, Madrid, Spain (m) Hospital de Fuenlabrada, Madrid, Spain (n) Hospital Clinico Universitario Lozano Blesa, Spain (o) Hospital Clinico Universitario de Salamanca, Spain (p) Complejo Hospitalario Universitario de A Coruna, Spain (q) Hospital Universitario de Bellvitge de l'Hospitalet de Llobregat, Barcelona, Spain (r) Hospital de la Vega Baja de Orihuela, Alicante, Spain (s) Hospital Virgen de los Lirios de Alcoy, Alicante, Spain (t) Hospital Francesc de Borja de Gandia, Valencia, Spain (u) Hospital Doctor Peset, Valencia, Spain (v) Hospital la Fe, Valencia, Spain (w) Hospital Reina Sofia, Murcia, Spain (x) Hospital General de Albacete, Spain (y) Hospital del Vinalopo de Elche, Alicante, Spain (z) Hospital de Torrevieja, Alicante, Spain (aa) Hospital Universitari de Vic, Barcelona, Spain (ab) Hospital General de Alicante, Spain (ac) Hospital Marina Baixa de Villajoyosa, Alicante, Spain (ad) Hospital Arnau de Vilanova, Valencia, Spain (ae) Hospital Clinic de Barcelona, Spain (af) Hospital Universitario LucusAugusti, Lugo, Spain (ag) Hospital de Henares, Madrid, Spain (ah) Hospital Comarcal El Escorial, Madrid, Spain (ai) Hospital Universitario de Burgos, Spain (aj) Hospital Costa del Sol de Marbella, Malaga, Spain (ak) Hospital de Lliria, Valencia, Spain (al) Hospital de Requena, Valencia, Spain (am) Hospital Clinico de Valencia, Spain (an) Hospital Universitario La Ribera, Valencia, Spain (ao) Hospital del Mar, Barcelona, Spain (ap) Hospital Universitario La Paz, Madrid, Spain (aq) Hospital Santa Tecla, Tarragona, Spain (ar) Hospital Rio Hortega, Valladolid, Spain (as) Hospital General de Elche, Alicante, Spain (at) Hospital Universitario Central Asturias, Oviedo, Spain (au) Hospital de Parla, Madrid, Spain (av) Hospital Virgen de la Luz, Cuenca, Spain (aw) Hospital Joan XXIII, Tarragona, Spain (ax) Hospital Universitario de Canarias, Tenerife, Spain (ay) Clinica Universidad Navarra, Madrid, Spain (az) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (ba) Hospital Juan Ramon Jimenez, Huelva, Spain (bb) Hospital Doctor Josep Trueta, Girona, Spain (bc) Clinica Sagrada Familia, Barcelona, Spain (bd) Hospital Severo Ochoa de Leganes, Madrid, Spain (be) Hospital GermansTrias i Pujol de Badalona, Barcelona, Spain (bf) Hospital Universitario Sant Joan, Alicante, Spain (bg) Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain (bh) Hospital Nuestra Senora del Prado de Talavera de la Reina, Toledo, Spain (bi) Hospital Valle de los Pedroches de Pozoblanco, Jaen, Spain (bj) Hospital Regional Universitario de Malaga, Spain (bk) Hospital Lluis Alcanyis de Xativa, Valencia, Spain (bl) Hospital Alvaro Cunqueiro de Vigo, Pontevedra, Spain (bm) Consorci Hospitalari de Terrassa, Barcelona, Spain (bn) Hospital de Denia, Alicante, Spain (bo) Hospital de Gijon, Asturias, Spain (bp) Hospital Virgen de la Arrixaca, Murcia, Spain (a) Emergency Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain (b) Emergency Department, Hospital General de Alicante, University Miguel Hernandez, Elche, Alicante, Spain (c) Emergency Department, Hospital General UniversitarioReina Sofia, Murcia, Spain (d) Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain (e) Emergency Department, Hospital UniversitarioSevero Ochoa, Universidad Alfonso X, Madrid, Spain (f) Emergency Department, Hospital Clinico San Carlos, IDISSC, Univesdad Complutense, Madrid, Spain * Corresponding author at: Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. Article History: Received 27 August 2020; Revised 18 December 2020; Accepted 24 January 2021 Byline: Oscar Miro omiro@clinic.cat (a,*), Pere Llorens (b), Sonia Jimenez (a), Pascual Pinera (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Francisco Javier Martin-Sanchez (f), Juan Gonzalez del Castillo (f), Oscar Miro (a), Sonia Jimenez (a), Juan Gonzalez del Castillo (b), Francisco Javier Martin-Sanchez (b), Pere Llorens (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Pascual Pinera Salmeron (f), Fahd Beddar Chaib (g), Enrique del Hoyo Pelaez (g), Belen Rodriguez Miranda (h), Alejandra Sanchez Arias (h), Noemi Ruiz de Lobera (i), Marta Iglesias Vela (j), Laura Hernando Lopez (j), Carmen del Arco Galan (k), Guillermo Fernandez Jimenez (k), E. Jorge Garcia Lamberechts (l), Marcos Fragiel (l), Maria Jesus Dominguez (m), Maria Eugenia Barrero Ramos (m), Jose Maria Ferreras Amez (n), Belen Arribas Entrala (n), Angel Garcia Garcia (o), Marta Fuentes de Frutos (o), Ricardo Calvo Lopez (p), Javier Jacob-Rodriguez (q), Ferran Llopis-Roca (q), Maria Carmen Ponce (r), Napoleon Melendez (s), Maria Jose Fortuny Bayarri (t), Francisco Jose Salvador Suarez (t), Maria Luisa Lopez Grima (u), M*. Angeles Juan Gomez (u), Javier Millan (v), Jose A. Sanchez Nicolas (w), Paula Lazaro Aragues (w), Francisco Javier Lucas-Imbernon (x), Francisco Javier Lucas-Galan (x), Blas Jimenez (y), Blas Jimenez (z), Rigoberto del Rio (z), Lluis LLauger Garcia (aa), Begona Espinosa (ab), Ana Belen Paya (ab), Juan Miguel Porrino (ac), Maria Rosales Maestre (ac), Maria Jose Cano Cano (ad), Rosa Sorando Serra (ad), Carlos Cardozo (ae), Juan Jose Lopez Diaz (af), Martin Ruiz Grinspan (ag), Cristobal M. Rodriguez Leal (ag), Sara Gayoso Martin (ah), Silvia Ortiz Zamorano (ah), Maria Pilar Lopez Diaz (ai), Carmen Aguera Urbano (aj), Elisa Delgado Padial (aj), Ana Peiro Gomez (ak), Elena Gonzalo Bellver (ak), Laura Ejarque Martinez (al), Maribel Marzo Lambies (al), Jose Noceda (am), Jose Vicente Braso Aznar (an), Jose Luis Ruiz Lopez (an), Alfons Aguirre Tejedo (ao), Isabel Cirera Lorenzo (ao), Alejandro Martin Quiros (ap), Elena Munoz del Val (ap), Enrique Martin Mojarro (aq), Brigitte Silvana Alarcon Jimenez (aq), Virginia Carbajosa (ar), Susana Sanchez Ramon (ar), Matilde Gonzalez Tejera (as), Pablo Herrero Puente (at), Desire Maria Velarde Herrera (at), Francisco Javier Teigell Munoz (au), Juan Carlos Reparaz Gonzalez (au), Felix Gonzalez Martinez (av), Diana Moya Olmeda (av), Anna Palau (aw), Patricia Eiroa Hernandez (ax), Marcos Exposito Rodriguez (ax), Nieves Lopez Laguna (ay), Maria Garcia-Uria (ay), Josep Guardiola (az), Polo Higa Sansome (az), Maria Jose Marchena Gonzalez (ba), EissaJaloud Saavedra (ba), Maria Adroher (bb), Ester Soy Ferrer (bb), Arturo Huertas (bc), Raquel Torres Garate (bd), Beatriz Valle Borrego (bd), Josep Maria ModolDeltell (be), Samuel Olmos Soto (be), Elena Diaz Fernandez (bf), Jose Pavon Monzo (bg), Nayra Cabrera Gonzalez (bg), Ricardo Juarez (bh), Jorge Pedraza Garcia (bi), Manuel Salido (bi), Miguel Moreno Fernandez (bj), Carles Perez (bk), Maria Teresa Maza Vera (bl), Raquel Rodriguez Calveiro (bl), Josep Tost (bm), Antonio Barcelo (bn), Rosario Carrio (bo), Eva Quero Moto (bp)
Aging is defined as the functional loss of tissues and organs over time. This is a biological, irreversible, progressive, and universal process that results from genetic and environmental factors, ...such as diet, physical activity, smoking, harmful alcohol consumption, and exposure to toxins, among others. Aging is a consequence of molecular and cellular damage built up over time. This damage begins with a gradual decrease in physical and mental capacity, thus increasing the risk of neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Neuronal, functional, and structural damage can be explained by an imbalance among free radicals, reactive oxygen species, reactive nitrogen species, and antioxidants, which finally lead to oxidative stress. Due to the key role of free radicals, reactive oxygen species, and reactive nitrogen species, antioxidant therapy may reduce the oxidative damage associated with neurodegeneration. Exogenous antioxidants are molecules that may help maintain the balance between the formation and elimination of free radicals, thus protecting the cell from their toxicity. Among them, polyphenols are a broad group of secondary plant metabolites with potent antioxidant properties. Here, we review several studies that show the potential role of polyphenol consumption to prevent, or slow down, harmful oxidative processes linked to neurodegenerative disorders.
Background
Biologicals, in combination with chemotherapy, are recommended as first-line treatment of metastatic colorectal cancer (mCRC); however, evidence guiding the appropriate management of older ...patients with mCRC is limited.
Objective
This study was undertaken to compare the efficacy and safety outcomes in older versus younger patients with mCRC who received first-line biological therapy.
Methods
This retrospective analysis used pooled data from five trials undertaken by the Spanish Cooperative Group for the Treatment of Digestive Tumours. All were studies of adults with advanced CRC who received first-line treatment with chemotherapy plus bevacizumab, cetuximab or panitumumab, stratified by age (≥ 65 vs. < 65 years). Endpoints included progression-free survival (PFS), overall survival (OS), overall response rate (ORR) and safety.
Results
In total, 999 patients from five studies were included in the analysis: 480 (48%) were aged ≥ 65 years, and 519 (52%) were aged < 65 years. Median PFS did not differ significantly between patients aged ≥ 65 and < 65 years (9.9 vs. 9.4 months; hazard ratio HR 1.01; 95% confidence interval CI 0.88–1.17). Median OS was significantly shorter in older than in younger patients (21.3 vs. 25.0 months; HR 1.21; 95% CI 1.04–1.41). There was no significant difference between older and younger patients in ORR (59 vs. 62%). Patients aged ≥ 65 years experienced significantly more treatment-related grade 3 or higher adverse events (61.67%) than did patients aged < 65 years (45.86%).
Conclusions
Biologicals plus chemotherapy is an effective first-line treatment option for selected patients aged ≥ 65 years with mCRC and has a manageable safety profile and efficacy comparable to that observed in younger patients.
Small shorebird-like footprints have been discovered in Cenicero (La Rioja, Spain). They are preserved in a sandstone block of the transition unit between the Nájera and Haro Formations from the Ebro ...Basin. This level is positioned in the Y2 local zone (MN2), of Agenian age (early Miocene). The footprints are small, tridactyl or tetradactyl, with slender and proximally unconnected digit impressions. They have phalangeal pads and claw marks, and there is no evidence of a web or metatarsal pad. The footprints are compared with other shorebird-like ichnotaxa and assigned to the Cretaceous ichnotaxon Koreanaornis isp., which is herein identified for the first time in the Cenozoic. Other shorebird-like footprints from the late Eocene to early Miocene in the Ebro Basin and the early Miocene ichnotaxa Aviadactyla media and Aviadactyla vialovi are also related to this ichnotaxon. In addition to the shorebird-like footprints, the Cenicero tracksite has invertebrate traces and sedimentary and organic structures typical of the Scoyenia ichnofacies, suggesting a mud-dominated floodplain in a central-distal alluvial fringe as the paleoenvironment. The morphology, habitat, and behavior inferred from the shorebird-like footprints in the Cenicero tracksite are similar to other fossil footprints found in the Mesozoic and Cenozoic as well as to modern shorebird tracks. This is likely due to morphological, ecological, and behavioral convergences among different avian clades from the Early Cretaceous to the present.
We studied the photopic spectral sensitivity in the green-backed firecrown, Sephanoides sephaniodes, a South American hummingbird, and its possible ecological relationship with preferred flowers and ...body colouration. Avian colour vision is in general tetrachromatic with at least four types of cones, which vary in sensitivity from the near ultraviolet (UV) to the red wavelength range. Hummingbirds represent an important family of birds, yet little is known about their eye sensitivity, especially about the role of photoreceptors and their oil droplet complements. The photopic electroretinogram shows a main sensitivity peak at 560 nm and a secondary peak in the UV, and may be explained by the presence of four single cones (λ max at ~370, 440, 508 and 560 nm), and a double cone (λ max at 560 nm) screened by oil droplets. The flowers preferred by the firecrown are those in which the red-green wavelength region predominates and have higher contrast than other flowers. The crown plumage of males is highly iridescent in the red wavelength range (peak at 650 nm) and UV; when plotted in a high-dimensional tetrachromatic space, it falls in a “red + UV” purple hue line, suggesting a potential significant communication signal for sexual differentiation.
Summary
REFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent ...fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures.
Purpose
Fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to monitor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identified by these centers.
Methods
We conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Participants were individuals 50 years or above who suffered a low energy fragility fracture identified by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed.
Results
A total of 2965 patients and 3067 fragility fractures were identified, and the most frequent locations were hip (
n
= 1709, 55.7%) and spine (
n
= 492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky–Green test.
Conclusion
Our results provide a comprehensive picture of fragility fractures identified in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight.
The safety and efficacy of low-molecular-weight heparin (LMWH) treatment in patients with cancer-associated thrombosis (CAT) beyond 6months are unknown. Our aim was to determine the safety of ...long-term tinzaparin use in patients with CAT.
We performed a prospective, open, single arm, multicentre study in patients with CAT receiving treatment with tinzaparin. We evaluated the rate of clinically relevant bleeding events (major and non-major clinically relevant bleeding) and venous thromboembolism (VTE) recurrence.
A total of 247 patients were recruited, with a crude incidence of major bleeding of 4.9% (12/247). The rate of clinically relevant bleeding during months 1–6 and 7–12, was 0.9% 95% confidence interval (95% CI) 0.5 to 1.6% and 0.6% (95% CI 0.2 to 1.4%) (p=0.5) per patient and month, respectively. Male gender showed greater risk for clinically relevant bleeding with a hazard ratio (HR) of 2.97 (95% CI 1.01 to 8.1; p=0.02). The incidence of VTE recurrence at months 1–6 and 7–12 was 4.5% (95% CI 2.2 to 7.8%) and 1.1% (95% CI 0.1 to 3.9%), respectively. One patient died due to VTE recurrence and two because of severe bleeding.
Treatment with tinzaparin beyond 6months is safe in patients with CAT.
•In cancer-associated thrombosis, the safety of LMWH beyond 6months is unknown.•This work considers, from a clinical point of view, clinically relevant bleeding events as a safety outcome.•This single arm study shows that tinzaparin beyond 6months is safe.•Clinically relevant bleedings were lower in months 7–12 vs. 1–6.
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