BRAF mutational status is associated with survival outcomes in locally advanced resectable and metastatic NSCLC.

BACKGROUND: Immunotherapy-based treatments have demonstrated high efficacy in patients with advanced and locally advanced non-small-cell lung cancer (NSCLC). BRAF mutations affect a small but significant fraction of NSCLC. The efficacy of these therapies in this subgroup of patients is unknown. MATERIALS AND METHODS: Plasma and tissue samples from 116 resectable stage IIIA/B NSCLC patients, included in NADIM and NADIM II clinical trials (NADIM cohort), and from a prospective academic cohort with 84 stage IV NSCLC patients (BLI-O cohort), were analyzed by next-generation sequencing. RESULTS: The p.G464E, p.G466R, p.G466V, p.G469V, p.L597Q, p.T599I, p.V600E (n = 2) BRAF mutations, were identified in four (3.45 %) samples from the NADIM cohort, all of which were cases treated with neoadjuvant chemoimmunotherapy (CH-IO), and four (4.76 %) samples from the BLI-O cohort, corresponding to cases treated with first-line immunotherapy (n = 2) or CH-IO (n = 2). All these patients were alive and had no evidence of disease at data cut-off. Conversely, patients with BRAF wild-type (wt) tumors in the BLI-O cohort had a median progression-free survival (PFS) of 5.49 months and a median overall survival (OS) of 12.00 months (P-LogRank = 0.013 and 0.046, respectively). Likewise, PFS and OS probabilities at 36 months were 60.5 % and 76.1 % for patients with BRAF-wt tumors in the NADIM cohort. The pathological complete response (pCR) rate after neoadjuvant CH-IO in patients with BRAF-positive tumors (n = 4) was 100 %, whereas the pCR rate in the BRAF-wt population was 44.3 % (RR: 2.26; 95 % CI: 1.78-2.85; P < 0.001). CONCLUSION: BRAF mutations may be a good prognostic factor for advanced and locally advanced NSCLC patients undergoing immunotherapy-based treatments.

The S-REAL study: Spanish real-world data on unresectable stage III NSCLC patients treated with durvalumab after chemoradiotherapy.

OBJECTIVES: The S-REAL study aimed to assess the effectiveness of durvalumab as consolidation therapy after definitive chemoradiotherapy (CRT) in a real-world cohort of patients with locally advanced, unresectable stage III non-small cell lung cancer (LA-NSCLC) included in a Spanish early access program (EAP). METHODS: In this multicentre, observational, retrospective study we analysed data from patients treated in 39 Spanish hospitals, who started intravenous durvalumab (10 mg/kg every 2 weeks) between September 2017 and December 2018. The primary endpoint was progression-free survival (PFS). Secondary endpoints included patient characterization and adverse events of special interest (AESI). RESULTS: A total of 244 patients were followed up for a median of 21.9 months [range 1.2-34.7]. Median duration of durvalumab was 45.5 weeks (11.4 months) [0-145]. Median PFS was 16.7 months (95% CI 12.2-25). No remarkable differences in PFS were observed between patients with programmed cell death-ligand 1 (PD-L1) expression ≥ 1% or < 1% (16.7 versus 15.6 months, respectively). However, PFS was higher in patients who had received prior concurrent CRT (cCRT) versus sequential CRT (sCRT) (20.6 versus 9.4 months). AESIs leading to durvalumab discontinuation were registered in 11.1% of patients. CONCLUSIONS: These results are in line with prior published evidence and confirm the benefits of durvalumab in the treatment of LA-NSCLC patients in a real-world setting. We also observed a lower incidence of important treatment-associated toxicities, such as pneumonitis, compared with the pivotal phase III PACIFIC clinical study.

Addressing lung cancer screening eligibility in Spain using 2013 and 2021 US Preventive Service Task Force criteria: cross-sectional study.

Objectives: The aim of the study was to ascertain the percentage of Spanish lung cancer cases that would fulfil the lung cancer screening inclusion criteria recommended by the United States Preventive Service Task Force (USPSTF) in 2013 and 2021. Methods: A cross-sectional study was carried out. All lung cancer cases registered in the Thoracic Tumor Registry with data on date of birth, date of diagnosis, smoking habit, number of pack-years and time elapsed since smoking cessation were included. Results: The study included 15 006 patients diagnosed with lung cancer in Spain between 2016 and 2022. Eligibility to participate in screening increased from 53.7% to 63.5% (an increase of 9.8%) according to the 2013 and 2021 recommendations, respectively. The percentage of eligible men rose by 9.2 percentage points with the 2021 versus 2013 recommendations, whereas this rise was 11.5 percentage points in women. Under the 2021 recommendations, 36.6% of women and 5.3% of men would not have fulfilled the screening inclusion criteria due to being never-smokers; 14.9% of women and 11.0% of men would not have fulfilled the age criterion; and 27.0% of ex-smokers among women compared to 35.6% among men would not have been eligible due to >15 years having elapsed since smoking cessation. Conclusions: In Spain, over one-third of lung cancer cases could not be detected through screening, by virtue of not meeting the most recent inclusion criteria stated by the USPSTF. The degree of fulfilment in a potential nationwide screening programme should be analysed, with the aim of establishing inclusion criteria in line with each country's context.

Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass.

PURPOSE: Obesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery. MATERIALS AND METHODS: We conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12-18 months after surgery in 11 of them. RESULTS: We observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium. CONCLUSION: Weight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.

Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain.

Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.

Mental imagery rotation and graph comprehension of IS-LM macroeconomic models.

The aim of this study was to determine if the ability to rotate mental imagery influenced the comprehension of graphs in economics. A sample of 140 Business Administration undergraduates familiar with economic analysis using graphs were administered the Measure of the Ability to Rotate Mental Images (MARMI). Moreover, participants completed an ad hoc graph comprehension test consisting of six exercises of increasing difficulty with graphs developing the IS-LM model described in conventional macroeconomic textbooks. Both the ability to rotate mental imagery and graph complexity (the number of quadrants in each graph) were found to significantly influence the number of correct graph comprehension responses.

Colangitis bacteriana complicada con sangrado por pseudoaneurisma hepático / No disponible

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Active bleeding due to a hepatic arterial pseudoaneurysm that occurred after acute cholangitis.

We read with interest the article by Guido Villa-Gómez, Manuel Alejandro Mahler and Dante Manazzoni "A new case of pseudoaneurysm of the right hepatic artery secondary to laparoscopic cholecystectomy". A 57-year-old cholecystectomized female was admitted due to abdominal pain with an analytical pattern of cholestasis and liver enzyme alterations, with cholangitis that progressed to septic shock of a biliary origin with gradual anemia and hypotension.

Aneurisma de arteria hepática secundario a síndrome de ligamento arcuato medio (SLAM) del diafragma / No disponible

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Aneurysm of the hepatic artery caused by median arcuate ligament syndrome (MALS).

We present the case of a 74-year-old man, with a history of residual schizophrenia, who underwent abdominal-pelvic CT with intravenous contrast, due to abdominal acute pain, that showed a stenosis at the origin of the celiac trunk and a large aneurysm of the hepatic artery, secondary to a mediam arcuate ligament syndrome, of the diaphragm was observed.

Changes in lung cancer survival by TNM stage in the Basque country from 2003 to 2014 according to period of diagnosis.

INTRODUCTION: The objective of this study was to analyze the survival of patients with lung cancer by TNM stage in the 4-year periods 2003-2006, 2007-2010 and 2011-2014, treated in the Basque Health Service, and to compare this with survival in an equivalent sample of the general population. METHODS: A retrospective observational design was applied to cases from the Hospital Cancer Registry of Euskadi. A cohort of 11,635 patients had complete data for the following variables: TNM stage, age, sex, histology, date of diagnosis, vital status and date of death. Relative survival and Cox and parametric regression models were used to assess changes in survival. RESULTS: The lung cancer 5-year survival probability decreased with increasing stage, from 50-65% in patients with stage I disease to 2-3% in those with stage IV disease. Comparing patients diagnosed from 2011-2014 and 2003-2006, we found that survival improved: (a) the risk of death (hazard ratio) in 2003-2006 was 1.66 for stage I, 1.51 for stage II, 1.21 for stage III, and 1.10 for stage IV; (b) the 5-year relative survival increased from 11.0% to 17.8% in the period 2011-2014; and (c) the years of life lost decreased significantly from 2003-2006 to 2011-2014, varying between 6.16 (stage I) and 16.21 (stage IV). CONCLUSIONS: Survival from lung cancer by stage in the Basque Country has lengthened significantly across all disease stages. Nonetheless, since we estimated that lung cancer patients still have significantly lower mean survival times than the general population, there is a need for more research to improve these outcomes.

Angiomiolipoma hepático epitelioide primario. Aporte de un caso / No disponible

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Hepatic epithelioid angiomyolipoma: contribution of a new case.

In relation to the article published by Ortiz S et al. (1), we have recently seen a 37-year-old female who presented to the Emergency Department with pain in right hypochondrium and a mild increase in transaminase levels. An ultrasound was performed that showed a large 13-cm tumor in the right hepatic lobe, which was heterogeneous with hyperechogenic and anechoic areas.

Intervención grupal desde un enfoque sensoriomotriz para reducir la intensidad del dolor crónico / Group intervention from a sensorimotor approach to reduce the intensity of chronic pain

Objetivo: Determinar la eficacia de una intervención (Time In) para reducir el dolor y mejorar los síntomas psicológicos en personas con dolor crónico. Diseño: Ensayo clínico aleatorizado con grupo control y con 3 mediciones realizadas a lo largo de 3 meses. Emplazamiento: Granada. Participantes: Un total de 40 mujeres mayores de 18 años con una historia de dolor crónico (más de 6 meses de duración). La captación fue en la Asociación de Fibromialgia de Granada (AGRAFIM). Intervenciones: Time In es un trabajo sensoriomotriz que combina procedimientos biomecánicos fisioterapéuticos y estrategias psicológicas. Se planificó una sesión semanal de 3h de duración y el total del programa se desarrolló durante 5 semanas seguidas. Mediciones principals: Variables dependientes: puntuaciones de las escalas Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) y Clinical Outcome in Routine Evaluation (CORE-OM). Variables independientes: información sociodemográfica, historial clínico y grupo de intervención o control. Resultados: Se observaron diferencias significativas entre grupo control y grupo intervención de gran parte de las escalas utilizadas en las mediciones postintervención y seguimiento. Así pues, se obtuvieron puntuaciones medias significativamente inferiores en la intensidad, interferencia y zonas de dolor, calidad de vida, síntomas psicológicos y cambio de comportamiento. Se observaron resultados similares en las puntuaciones de d Cohen "muy importantes" en la intensidad del dolor (d = -1,01, d = -0,97) y la interferencia del dolor (d = -0,85, d = 0,74), con un porcentaje de mejoría del 21 al 30%. Conclusiones. La intervención Time In reduce el dolor y mejora los síntomas psicológicos en pacientes con fibromialgia, lo que redunda en una mejor calidad de vida

Objective: To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms. Design: A randomized clinical trial with a control group, taking three measurements over three months. Setting: Granada, Spain. Participants: A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM). Interventions: Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks. Main measurements: Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM). Results: Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were 'very important' on intensity of pain (d = -1.01, d = -0.97) and interference of pain (d = -0.85, d = -0.74), with an improvement percentage from 21% to 30%. Conclusions: Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life

[Group intervention from a sensorimotor approach to reduce the intensity of chronic pain]. / Intervención grupal desde un enfoque sensoriomotriz para reducir la intensidad del dolor crónico.

OBJECTIVE: To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms. DESIGN: A randomized clinical trial with a control group, taking three measurements over three months. SETTING: Granada, Spain. PARTICIPANTS: A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM). INTERVENTIONS: Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks. MAIN MEASUREMENTS: Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM). RESULTS: Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were 'very important' on intensity of pain (d=-1.01, d=-0.97) and interference of pain (d=-0.85, d=-0.74), with an improvement percentage from 21% to 30%. CONCLUSIONS: Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life.

The effect of methotrexate versus other disease-modifying anti-rheumatic drugs on serum drug levels and clinical response in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors.

To investigate the effect of concomitant conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) with adalimumab or infliximab on maintaining serum drug and clinical outcomes after the first year of treatment in patients with rheumatoid arthritis (RA). Second, to assess the influence of methotrexate (MTX) dose on these outcomes. Ninety-two patients with RA starting infliximab (n = 67) or adalimumab (n = 25) tumor necrosis factor inhibitor (TNFi) with available drug levels and clinical improvement assessment (European League Against Rheumatism [EULAR] response) after 12 months were included. Patients were grouped according to concomitant csDMARD use: (i) TNFi monotherapy; (ii) TNFi+MTX; (iii) TNFi with csDMARDs other than MTX (TNFi+OD). Patients receiving MTX were also classified by dose as < 15 mg/week (TNFi+MTX<15) and ≥ 15 mg/week (TNFi+MTX≥15). Logistic regression analyses were employed. More TNFi+MTX patients had circulating serum TNFi at 12 months (71% TNFi+MTX vs. 20% TNFi+OD vs. 9% TNFi monotherapy). Of these, the probability of maintaining serum TNFi levels was twice (OR 2.3; p = 0.06) than that of patients without MTX. However, statistically significant results were observed only for the highest MTX dose (OR 4.9; p = 0.02). Most patients achieving good EULAR response were treated with TNFi+MTX (81%). The probability of achieving this response was three times higher in patients within the TNFi+MTX group (OR 3.4; p = 0.03); however, no differences were found with regard to MTX dose. The persistence of serum TNFi and the probability of achieving clinical response are influenced by MTX but not by OD in patients with RA treated with infliximab or adalimumab.

Gastric invagination in adults as a rare cause of constitutional syndrome.

This article describes and illustrates the case of an adult patient with clinical symptoms of constitutional syndrome, postprandial discomfort and a mass in the left lateral abdominal region caused by a gastric intussusception with a fundal adenoma as the head of the invagination. The intussusception was diagnosed by MRI (magnetic resonance imaging).

Invaginación gástrica en el adulto como causa poco frecuente de síndrome constitucional / Gastric invagination in adults as a rare cause of constitutional syndrome

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