Ingesta de polifenoles y riesgo cardiovascular en el ensayo PREDIMED-Plus. Una comparación de diferentes ecuaciones de riesgo / Polyphenol intake and cardiovascular risk in the PREDIMED-Plus trial. A comparison of different risk equations

Introducción y objetivos: La cuantificación del riesgo cardiovascular se basa en puntuaciones como las de Framingham, Framingham-REGICOR, SCORE o Life's Simple 7 (LS7). Los polifenoles pueden proporcionar beneficios al sistema vascular y reducir la respuesta inflamatoria; sin embargo, los estudios clínico-epidemiológicos muestran resultados discordantes. Nuestro objetivo es evaluar la posible asociación entre la ingesta de diferentes clases de polifenoles y las puntuaciones cardiovasculares. Métodos: Estudio transversal sobre 6.633 participantes del estudio PREDIMED-Plus. El contenido de polifenoles se estimó mediante un cuestionario semicuantitativo de frecuencia alimentaria y se ajustó por la ingesta energética total según el método de residuales. La asociación entre la ingesta de polifenoles y el riesgo cardiovascular se evaluó mediante análisis de regresión lineal. Resultados: La ingesta total de polifenoles y flavonoides se asoció directa y significativamente con la escala LS7. Igualmente, los lignanos se asociaron directa y significativamente con las escalas SCORE y LS7; los estilbenos, con la SCORE y los ácidos fenólicos, con las de Framingham y Framingham-REGICOR. La clase «otros polifenoles» se asoció de manera significativa con las escalas de Framingham, SCORE y LS7. En las mujeres, la ingesta de todas las clases de polifenoles, excepto los ácidos fenólicos, mostró una tendencia directa en los resultados de Framingham y Framingham-REGICOR e indirecta con la escala LS7. Conclusiones: Se encontraron asociaciones inversas entre el consumo de la clase «otros polifenoles» y, especialmente en las mujeres, el riesgo cardiovascular estimado. Los resultados fueron similares con las de Framingham, Framingham-REGICOR y LS7 (después de eliminar el componente de dieta) y diferentes con la SCORE, pero los predictores que se incluyen en este son escasos (AU)

Introduction and objectives: Quantification of cardiovascular risk has been based on scores such as Framingham, Framingham-REGICOR, SCORE or Life's Simple 7 (LS7). In vitro, animal, and randomized clinical studies have shown that polyphenols may provide benefits to the vascular system and reduce the inflammatory response. However, some clinical-epidemiological studies have yielded inconsistent results. Our aim was to assess the possible association between intake of the various polyphenol classes and established cardiovascular scores. Methods: This cross-sectional analysis involved 6633 PREDIMED-Plus study participants. Food polyphenol content was estimated by a semiquantitative food frequency questionnaire, adjusted for total energy intake according to the residual method. The association between polyphenol intake and cardiovascular risk was tested using linear regression analyses. Results: Total polyphenol and flavonoid intake were directly and significantly associated only with the LS7 scale. Intake of lignans was directly and significantly associated with SCORE and LS7 scales, stilbene intake with SCORE, and phenolic acid intake with Framingham and Framingham-REGICOR scores. Other polyphenol classes were associated in a protective and significant manner in Framingham, SCORE and LS7 scores. In women, intake of all the polyphenol classes, except phenolic acids, showed a protective trend in the results of the Framingham, Framingham-REGICOR scores and LS7 scale. Conclusions: An inverse association was found between consumption of the ‘other polyphenols’ class and, especially among women, with estimated cardiovascular risk. The results were similar to those of Framingham, Framingham-REGICOR and LS7 (after eliminating the diet component) and differed from those of SCORE, but the predictors included were limited in the latter case (AU)

Hepatocarcinoma fibrolamelar. Revisión de sus características diferenciales a partir de nuestra serie / Fibrolamellar hepatocellular carcinoma. Differencial characteristics based on our own case series

Introducción. El hepatocarcinoma fibrolamelar (CHCFL) es un tumor infrecuente, de aparición en adultos jóvenes y sobre hígado sano. Clásicamente considerado una variante del carcinoma hepatocelular (CHC), difieren en tantos aspectos, que debieranconceptuarse como entidades diferentes. El objetivo de este trabajo es refrescar sus características, haciendo hincapié en las diferenciales, para ser tenido en consideración ante lesiones hepáticas sólidas ocupantes de espacio en pacientes jóvenes. Material ymétodo.Estudio descriptivo retrospectivo de las características de 5 casos de CHCFL intervenidos en la unidad de cirugía hepatobiliopancreática un hospital de tercer nivel. Resultados. Cinco casos, edad media 31.8 años, mujer/hombre 4/1. Todos ellos sobrehígado sano, con clínica inespecífica. Radiológicamente e histopatológicamente cumplen las características típicas de este tumor.Sometidos en todos los casos a resecciones quirúrgicas amplias, y reintervenidos, por recidiva, 2 casos, uno de ellos en forma detrasplante hepático. La tabla 1 recoge todas las características epidemiológicas y clínicas, datos operatorios y supervivencia globaly libre de enfermedad de los pacientes incluidos en el estudio. Discusión. De curso clínico insidioso y silente en muchas ocasiones,el diagnóstico suele ser tardío, con grandes masas tumorales en las pruebas de imagen. Actualmente el tratamiento quirúrgico esel único potencialmente curativo. Pese a una supervivencia prolongada, la tasa de recidiva es muy elevada, precisando en muchoscasos intervenciones reiteradas. Los resultados en nuestra serie son acordes con la literatura y podrían calificarse como paradigmade las características anatomoclínicas, terapéuticas y pronósticas de este tipo de tumor. (AU)

Introduction. Fibrolamellar hepatocellular carcinoma is an infrequent tumour, which appears in young adults and on healthy liver.It has been classically considered a subtype of hepatocellular carcinoma, but they differ in such many aspects they could be considered separately. The objective of this review is to refresh its differential characteristics in order to take into account in the differentialdiagnosis of hepatic solid lessions in young adults. Material and methods. Descriptive retrospective study of the principles characteristics of the five fibrolamellar hepatocellular carcinoma operated patients by the hepatobilliary surgery team of our hospital.Results. Five cases, medium age 31.8 years, women/men 4/1. All of them in healthy liver with inespecific symptoms and radiollogicaland hystopathological typical characteristics. All of them having enlarged hepatic ressections and reoperated two of them becauseof recurrence, in one case in form of hepatic transplantation. Table 1 collect all the epidemiological and clinical characteristics, operation reports, global and recurrence free survival of all patientes included in the study. Discussion. Having insidious and silentdevelopment in many cases, diagnosis can be delayed, appearing big tumoral masses on the imaging tests. Nowadays, surgery is the only curative treatment. Despite long survival periods, the recurrence rate is very high, needing sometimes being reoperated. Our results are in the line of the literature results and could be classified as the paradigm of anatomoclinic, therapeutic and prognostic characteristics of this type of tumour. (AU)

Gangrena de fournier con extensión retroperitoneal. claves para una evolución favorable / Fournier's gangrene with retroperitoneal extension. Key points for a satisfactory evolution

INTRODUCCIÓN: La fascitis necrotizante, Gangrena de Fournier cuando su origen es perianal, es una infección severa de los tejidos blandos, músculos y fascias, asociada a elevada mortalidad. CASO CLÍNICO: Presentamos un caso tratado con éxito en nuestro centro. Paciente de 63 años con dolor abdominal y perianal, exploración clínica y radiografía simple altamente sugestivas, diagnosticado de Gangrena de Fournier con extensión retroperitoneal. La actuación terapéutica sin demora (desbridamiento quirúrgico agresivo, medidas de resucitación intensivas y antibioterapia de amplio espectro) permitieron salvar la vida del paciente. DISCUSIÓN: La Gangrena de Fournier se asocia mayoritariamente a factores de riesgo y su evolución es rápida y fulminante hacia una sepsis polimicrobiana. La exploración física es suficiente para su diagnóstico y no debemos perder tiempo en la realización de pruebas complementarias. En caso de extensión retroperitoneal, con menor expresión clínica, el TAC es sensible. La actuación terapéutica debe aplicarse sin demora y de forma agresiva de inicio. Un elevado índice de sospecha y una actuación rápida, agresiva y multidisciplinar, siguen siendo las claves en el manejo de esta patología, reduciendo así su alta mortalidad

INTRODUCTION: Necrotizing fasciitis, Fournier's gangrene when its origin is perianal, is a severe infection of the soft tissues, muscles and fascia, associated with high mortality. Clinical case. We present a case treated successfully in our center. 63-year-old patient with abdominal and perianal pain, highly suggestive clinical examination and plain X-ray, diagnosed with Fournier's gangrene with retroperitoneal extension. Therapeutic action without delay (aggressive surgical debridement, intensive resuscitation measures and broad-spectrum antibiotic therapy) saved the life of the patient. DISCUSSION: Fournier's gangrene is mainly associated with risk factors and its evolution is rapid and fulminant towards polymicrobial sepsis. The physical examination is sufficient for its diagnosis and we should not waste time in carrying out complementary tests. In the case of retroperitoneal extension, with less clinical expression, the CT scan is sensitive. Therapeutic action must be applied without delay and aggressively from the beginning. A high index of suspicion and rapid, aggressive and multidisciplinary action remain the keys to managing this pathology, thus reducing its high mortality

Histopathological and Ultrastructural Changes after Electroporation in Pig Liver Using Parallel-Plate Electrodes and High-Performance Generator.

Irreversible electroporation (IRE) has gained attention as a new non-thermal therapy for ablation with important benefits in terms of homogeneous treatment and fast recovery. In this study, a new concept of high voltage generator is used, enabling irreversible electroporation treatment in large tissue volume using parallel plates. Unlike currently available generators, the proposed versatile structure enables delivering high-voltage high-current pulses. To obtain homogeneous results, 3-cm parallel-plates electrodes have also been designed and implemented. IRE ablation was performed on six female pigs at 2000 V/cm electric field, and the results were analysed after sacrifice three hours, three days and seven days after ablation. Histopathological and ultrastructural studies, including transmission and scanning electron microscopy, were carried out. The developed high-voltage generator has proved to be effective for homogeneous IRE treatment using parallel plates. The destruction of the membrane of the hepatocytes and the alterations of the membranes of the cellular organelles seem incompatible with cell death by apoptosis. Although endothelial cells also die with electroporation, the maintenance of vascular scaffold allows repairing processes to begin from the third day after IRE as long as the blood flow has not been interrupted. This study has opened new direction for IRE using high performance generators and highlighted the importance of taking into account ultrastructural changes after IRE by using electron microscopy analysis.

Prevalencia e incidencia de hiperpotasemia en población española con insuficiencia cardiaca con fracción de eyección deprimida: revisión sistemática y relevancia poblacional / Prevalence and incidence of hyperkalaemia in the Spanish population with heart failure with reduced ejection fraction: a systematic review and populational relevance

Antecedentes y objetivo: La hiperpotasemia (K+≥5,5mmol/l) es un desequilibrio iónico grave cuando aparece en pacientes que padecen insuficiencia cardiaca con fracción de eyección deprimida (ICFED), ya que incrementa el riesgo de fibrilación ventricular. No existen estimaciones del número de pacientes que sufren esta complicación. El objetivo de este estudio fue estimar la prevalencia e incidencia de hiperpotasemia en pacientes con ICFED en España. Materiales y métodos: A partir de una búsqueda bibliográfica sistemática se calculó mediante un metaanálisis la prevalencia de ICFED<40% en población europea y norteamericana. A partir de otra búsqueda bibliográfica sistemática se calculó la prevalencia de hiperpotasemia en individuos con insuficiencia cardiaca, así como su incidencia anual. Considerando los anteriores valores y la pirámide de población española en 2016 se estimó el número de individuos con ICFED que presentan actualmente y que desarrollan cada año hiperpotasemia en España. Resultados: Alrededor de 17.100 individuos (10.000 hombres y 7.100 mujeres) de los 508.000 pacientes con ICFED presentan hiperpotasemia en España. Asimismo, unos 14.900 pacientes con ICFED (9.500 hombres y 5.400 mujeres) la desarrollan cada año. Conclusiones: Aproximadamente uno de cada 30 pacientes con ICFED presenta valores plasmáticos de potasio por encima de 5,5mmol/l

Background and objectives: Hyperkalaemia (K+ levels≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalaemia in patients with HFrEF in Spain. Material and methods: Based on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S. population. Based on another systematic literature search, we calculated the prevalence of hyperkalaemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalaemia and those who develop it each year in Spain. Results: Approximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalaemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalaemia each year. Conclusions: Approximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5 mmol/L

Prevalence and incidence of hyperkalaemia in the Spanish population with heart failure with reduced ejection fraction: a systematic review and populational relevance. / Prevalencia e incidencia de hiperpotasemia en población española con insuficiencia cardiaca con fracción de eyección deprimida: revisión sistemática y relevancia poblacional.

BACKGROUND AND OBJECTIVES: Hyperkalaemia (K+ levels≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalaemia in patients with HFrEF in Spain. MATERIAL AND METHODS: Based on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S. POPULATION: Based on another systematic literature search, we calculated the prevalence of hyperkalaemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalaemia and those who develop it each year in Spain. RESULTS: Approximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalaemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalaemia each year. CONCLUSIONS: Approximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5 mmol/L.

Real-world treatment patterns and outcomes among metastatic cutaneous melanoma patients treated with ipilimumab.

BACKGROUND: There is a scarcity of real-world data on treatment patterns and outcomes among advanced melanoma patients treated with immunotherapies including ipilimumab, an anti-CTLA-4 antibody approved since 2011. OBJECTIVE: To evaluate ipilimumab and postipilimumab treatment patterns and outcomes among patients with advanced melanoma in Australia, Germany, Italy and Spain, following regulatory approval. METHODS: Retrospective multicentre, multinational, observational chart review study. Data were extracted from the start of ipilimumab therapy until the end of at least 40 weeks of follow-up, or death. RESULTS: Data from 371 patients (Australia, 103; Germany, 152; Italy, 76; Spain, 40) were analysed. Mean age was 65 years; 62% were male. Eastern Cooperative Oncology Group performance status (ECOG PS) was 0 or 1 for 94%. In 67%, ipilimumab was initially received as second-line or later therapy. Patients received on average 3.4 ipilimumab doses. The ipilimumab-refractory cohort comprised of 226 patients. Of these, 17% in Australia, 47% in Germany, 29% in Italy and 14% in Spain received another antimelanoma treatment after ipilimumab including chemotherapy in 26% and BRAF/other kinase inhibitors in 11%. Ipilimumab-refractory patients who received postipilimumab treatment showed a 40% reduced hazard of dying than those not receiving treatment after ipilimumab (HR 0.60; 95% CI 0.43-0.83), after adjustment for potential confounders. CONCLUSION: During the time observed, ipilimumab was mainly used as second-line or later therapy. A significant proportion of patients received postipilimumab therapy, most of which was chemotherapy. Nevertheless, overall survival following progression on ipilimumab treatment remained poor, highlighting the need for research to develop more effective end-of-life treatment options.

The dilemmas of chronicity: the transition of care policies from the authoritarian state to the welfare state in Spain.

In this article, the constitution of the population of chronic mental patients is examined for the period 1885 to 1975 as well as its influence on the design of reform programmes in the crisis of the Franco-ist state. Then follows an assessment of state reforms and regional policies with effect from 1980. Reference is made to the theoretical models utilised in this last period and to the tension and contradictions between professionals of bio-medical orientation and sectors sympathetic to community models sustained from the perspective of social psychiatry.