In which service should a patient be hospitalized? Montero Muñoz, J; Martínez Carrasco, S M; Montero Ruiz, E
Journal of healthcare quality research,
2022 Jan-Feb, Letnik:
37, Številka:
1
Journal Article
Resumen Introducción y objetivo. La fractura nasal es la lesión facial más común y más del 50 % de todas las fracturas faciales en adultos. Debido a que en muchas ocasiones no es diagnosticada y ...tratada oportunamente, puede generar diferentes grados de limitación funcional y resultados estéticos indeseables. Pocos estudios evalúan la satisfacción de los pacientes tratados con técnica cerrada de reducción de fractura nasal. Nuestro objetivo es valorar la satisfacción funcional y estética posterior a reducción cerrada de fractura de huesos nasales en un hospital de Colombia, mediante la escala de evaluación de síntomas de obstrucción nasal (NOSE, por sus siglas en inglés - nasal obstruction symptom evaluation) y la escala estética subjetiva. Material y método. Estudio observacional analítico prospectivo de pacientes con fractura nasal llevados a reducción cerrada en el Hospital Universitario de Santander, Colombia. Se registraron las puntuaciones de las escalas NOSE y estética subjetiva, antes y 2 meses después de la cirugía. Resultados. Evaluamos 55 pacientes, 90.9% hombres. La mediana de edad fue de 31 años (RIC 24-48). El contexto de lesión principal fue violencia física (40%), seguido de accidente de tránsito (32.7%). Tras el procedimiento, los pacientes presentaron mejoría de obstrucción nasal medida con la escala NOSE (p<0.001); antes de la cirugía el 89% presentaba obstrucción nasal moderada-severa, posteriormente descendió a 14.5%. La escala NOSE mostró fabilidad por consistencia interna con alfa de Cronbach de 0.8317. Tras la cirugía hubo aumento de la satisfacción respecto al aspecto nasal (p<0.001). Conclusiones. En nuestro estudio, el cuestionario NOSE permitió cuantificar la mejora de síntomas de obstrucción nasal en pacientes con reducción cerrada por fractura de huesos nasales. Observamos mejoría de síntomas obstructivos nasales y aumento de satisfacción estética. Nivel de evidencia científica 4c Terapéutico
Radiotherapy has been used for more than a hundred years as a local tumor treatment. The occurrence of systemic antitumor effects manifesting as regression of tumors outside of the irradiated field ...(abscopal effect) was occasionally observed but deemed too rare and unpredictable to be a therapeutic goal. This has changed with the advent of immunotherapy. Remarkable systemic effects have been observed in patients receiving radiotherapy to control tumors that were progressing during immune checkpoint blockade, stimulating interest in using radiation to overcome primary and acquired cancer resistance to immunotherapy. Here, we review the immunological mechanisms that are responsible for the ability of focal radiation to promote antitumor T cell responses that mediate tumor rejection and, in some cases, result in systemic effects.
Tumor-targeted radiation occasionally elicits immune-mediated systemic tumor regression.
Evidence of synergy between radiotherapy and immune checkpoint blockade (ICB) supports the concept of in situ vaccination by radiation, and ICB combinations together with an optimization of the radiation dose and fractionation offer paths to improved responses.
Radiation alters the balance between immune-activating and -suppressive signals in the tumor microenvironment.
Pathways involved in autoimmunity and microbial immunity are responsible for regulating the induction of type I interferon via cGAS/STING in irradiated tumors and are stimulated upon tumor cell irradiation and activation of the DNA damage response.
There currently are no internationally recognised treatment guidelines for patients with advanced gastric cancer/gastro-oesophageal junction cancer (GC/GEJC) in whom two prior lines of therapy have ...failed. The randomised, phase III JAVELIN Gastric 300 trial compared avelumab versus physician’s choice of chemotherapy as third-line therapy in patients with advanced GC/GEJC.
Patients with unresectable, recurrent, locally advanced, or metastatic GC/GEJC were recruited at 147 sites globally. All patients were randomised to receive either avelumab 10mg/kg by intravenous infusion every 2weeks or physician’s choice of chemotherapy (paclitaxel 80mg/m2 on days 1, 8, and 15 or irinotecan 150mg/m2 on days 1 and 15, each of a 4-week treatment cycle); patients ineligible for chemotherapy received best supportive care. The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety.
A total of 371 patients were randomised. The trial did not meet its primary end point of improving OS {median, 4.6 versus 5.0months; hazard ratio (HR)=1.1 95% confidence interval (CI) 0.9–1.4; P=0.81} or the secondary end points of PFS median, 1.4 versus 2.7months; HR=1.73 (95% CI 1.4–2.2); P>0.99 or ORR (2.2% versus 4.3%) in the avelumab versus chemotherapy arms, respectively. Treatment-related adverse events (TRAEs) of any grade occurred in 90 patients (48.9%) and 131 patients (74.0%) in the avelumab and chemotherapy arms, respectively. Grade ≥3 TRAEs occurred in 17 patients (9.2%) in the avelumab arm and in 56 patients (31.6%) in the chemotherapy arm.
Treatment of patients with GC/GEJC with single-agent avelumab in the third-line setting did not result in an improvement in OS or PFS compared with chemotherapy. Avelumab showed a more manageable safety profile than chemotherapy.
ClinicalTrials.gov: NCT02625623.
White-to-brown adipose tissue remodeling (browning) in response to different stimuli constitutes an active research area for obesity treatment. The emergence in traditional white adipose tissue (WAT) ...depots of multilocular adipocytes that express uncoupling protein 1 (UCP1) and resemble brown adipocytes, the so called 'brite' adipocytes, could contribute to increased energy expenditure. In rodents, obesogenic stimuli such as the intake of hyperlipidic diets can increase brown adipose tissue (BAT) thermogenic capacity and contribute to maintaining body weight. The aim of this study was to investigate the potential of two different hyperlipidic diets, a commercial high-fat (HF) diet and a highly palatable cafeteria (CAF) diet, to induce WAT browning.
We analyzed gene expression of a wide number of brown/brite adipocyte markers in different WAT depots, in BAT and in peripheral blood mononuclear cells (PBMCs) increasingly being used in nutrition studies as a potential source of biomarkers of physiological effects. We also performed morphological analysis of adipose tissue.
Both HF diets studied were able to increase the expression of the markers studied in WAT in a depot-specific manner, as well as in BAT; some of these changes were also reflected in PBMCs. This increased browning capacity was translated into the appearance of UCP1- and CIDE-A (cell death-inducing DFFA-like effector A)-positive brite adipocytes in retroperitoneal WAT. Administration of the CAF diet, associated with higher adiposity, produced the strongest impact on the parameters studied while its withdrawal restored basal conditions.
Acquisition of brown adipocyte features in WAT could evidence an adaptation to try to counteract increased adiposity due to the intake of HF diets. Additionally, PBMCs could constitute an interesting easily obtainable material to assess the effect of nutritional interventions on browning capacity.
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