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Epidemiological, clinical and histological characteristics of melanoma in young adults: a 30-year retrospective study (1993-2022).
No full text20.500.12530/87858Melanoma in young adults significantly impacts the survival of individuals in this age group. There are few studies that analyse melanoma characteristics in young patients. To describe the epidemiological, clinical and histological characteristics of melanoma in young adults and the temporal trends in these characteristics in recent decades. A retrospective observational study was conducted, involving 399 patients with melanoma aged 18-44 years, over a 30-year period (1993-2022). Patients were divided into two groups based on their date of diagnosis (period 1, 1993-2007; period 2, 2008-2022). Age at diagnosis was higher in period 2 than period 1 (34.3 vs. 36.7 years; P Melanoma diagnoses in young adults are occurring at progressively advanced ages, with a rise in melanomas situated on the head and extremities and in histological types linked to prolonged sun exposure. Strategies such as minimizing sun exposure from a young age and encouraging self-examination could lead to improved survival rates
Enhancing interventional imaging: the role of computed tomography and intraprocedural echocardiography in the diagnosis and management of acquired pulmonary vein stenosis.
No full text20.500.12530/8785
Cost-effectiveness of a machine learning risk prediction model (LungFlag) in the selection of high-risk individuals for non-small cell lung cancer screening in Spain.
No full text20.500.12530/87908The LungFlag risk prediction model uses individualized clinical variables to identify individuals at high-risk of non-small cell lung cancer (NSCLC) for screening with low-dose computed tomography (LDCT). This study evaluates the cost-effectiveness of LungFlag implementation in the Spanish setting for the identification of individuals at high-risk of NSCLC. A model combining a decision-tree with a Markov model was adapted to the Spanish setting to calculate health outcomes and costs over a lifetime horizon, comparing two hypothetical scenarios: screening with LungFlag versus non-screening, and screening with LungFlag versus screening the entire population meeting 2013 US Preventive Services Task Force (USPSTF) criteria. Model inputs were obtained from the literature and the clinical practice of a multidisciplinary expert panel. Only direct costs (€of 2023), obtained from local sources, were considered. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results. A cohort of 3,835,128 individuals meeting 2013 USPSTF criteria would require 2,147,672 LDCTs scans. However, using LungFlag would only require 232,120 LDCTs scans. Cost-effectiveness results showed that LungFlag was dominant versus non-screening scenario, and outperformed the scenario where the entire population were screened since the observed loss of effectiveness (-224,031 life years [LYs] and -97,612 quality-adjusted life years [QALYs]) was largely offset by the significant cost savings provided (€7,053 million). The resulting incremental cost-effectiveness ratio (ICER) for this strategy of screening the whole population versus using LungFlag was €72,000/QALY, showing that LungFlag is cost-effective. Various were described, such as the source of the efficacy or adherence rates, and other limitations inherent to cost-effectiveness analyses. Using LungFlag for the selection of high-risk individuals for NSCLC screening in Spain would be a cost-effective strategy over screening the entire population meeting USPSTF 2013 criteria and is dominant over non-screening
(R)-Mandelonitrile Lyase, a Homolog of Pru du 10, Is a Major Peach Allergen
No full text20.500.12530/87913Background: Peach allergy is a prevalent cause of food allergy. Despite the repertoire of allergens available for molecular diagnosis, IgE to individual peach allergens may still be undetectable in some patients who present symptoms after ingestion. The objective of this study was to investigate the allergen profile of patients with symptoms induced by peach. Materials and Methods: We performed an exploratory retrospective study of 42 patients presenting symptoms after ingestion of peach. The allergen profile of individual patients was investigated using immunoblot. A serum pool was prepared with sera that recognized a 70-kDa band. The pool was used to detect this protein in peach peel and pulp and to identify the 70-kDa protein in 2D immunoblot. Spots recognized in the 2D immunoblot were sequenced using LC-MS/MS. Inhibition studies were performed with peach peel and almond. Results: The immunoblot revealed that 22 patients (52.4%) recognized the 70-kDa protein in peach peel and pulp. Two spots were observed in 2D-PAGE, and both were identified as (R)-mandelonitrile lyases (RMLs) showing high amino acid similarity with Pru du 10. The RMLs were partially inhibited with an almond extract. No association was found between symptoms and sensitization to RML. RMLsensitized patients were older and reported pollen-associated respiratory symptoms more frequently than patients whose results were negative for this protein. Conclusions: We identified a new peach allergen, an RML, which was a homolog of Pru du 10 and was recognized by 52% of the population
Updated document on the management of functional dyspepsia by the Asociación Española de Neurogastroenterologia y Motilidad (ASENEM) and Sociedad Española de Medicina Familiar y Comunitaria (semFYC).
No full text20.500.12530/87885Functional dyspepsia (FD) is a gut-brain axis disorder characterized by postprandial fullness, early satiety, bloating and/or epigastric pain, which are presumed to originate in the gastroduodenal tract. While the international recommendations in the Rome IV consensus require endoscopy to rule out an organic condition before establishing a diagnosis of FD, international guidelines recommend that, in the absence of risk factors, patient management be initiated at the primary care level by establishing Helicobacter pylori infection status, with eradication when positive, followed by empiric therapy with proton pump inhibitors and/or prokinetics, and that endoscopy be reserved for patients refractory to said measures. Second-line therapy includes neuromodulating agents, among which tricyclic antidepressants and atypical antipsychotics such as levosulpiride stand out. The latter has a predominant prokinetic effect, hence it is also used as first-line therapy for patients where early satiety and postprandial fullness predominate. Other therapy alternatives include phytotherapy using STW5 or peppermint/caraway oil, which have shown their superiority over placebo in controlled studies. Concurrently, dietary and lifestyle counseling, as well as psychological interventions such as cognitive-behavioral therapy, when available, may represent a therapeutic alternative worth considering for some patients
ECM1: a novel matricellular protein with promising antifibrotic potential.
No full text20.500.12530/8785
Placing the balloon-guide catheter in the high cervical segment of the internal carotid artery is associated with improved recanalization.
No full textMechanical thrombectomy (MT) is part of the standard of care for stroke treatment, and improving its efficacy is one of the main objectives of clinical investigation. Of importance is placement of the distal end of balloon-guided catheters (BGC). We aim to determine if this influences outcomes. We analyzed data from the ASSIST Registry, an international, multicenter prospective study of 1492 patients. We divided patients treated with BGC according to the placement of the BGC: low cervical (LCG (the lower 2/3 of cervical internal carotid artery (ICA)) or high cervical (HCG (upper 1/3 of cervical ICA, petro-lacerum or higher)). We analyzed characteristics and outcomes overall and stratified on the primary MT technique: Stent-Retriever only (SR Classic), Combined use of aspiration catheter and SR (Combined), and Direct Aspiration (ADAPT). Our study included 704 subjects -323 in the low cervical and 381 in the high cervical groups. Statistical differences were seen in the proportion of females and tandem lesions (both higher for LCG). Placing the BGC in the high cervical segment is associated with better recanalization rates (expanded treatment in cerebral infarction (eTICI) score of 2c-3) at the end of the procedure (P Placing the distal end of the BGC at the high cervical segment or higher is associated with better recanalization
Osteopontin as a diagnostic and NTZ-response biomarker of multiple sclerosis: a systematic review and meta-analysis.
No full textINTRODUCTION: Multiple sclerosis (MS) is a neuroinflammatory complex disease of the central nervous system (CNS). Diagnosing MS remains challenging due to its nonspecific signs, highlighting the need for reliable biomarkers. One potential biomarker is osteopontin (OPN), found in cerebrospinal fluid (CSF) and peripheral blood. This article presents a systematic review and meta-analysis of the association between OPN levels in CSF and blood and the presence of MS.
METHODS: We searched PubMed, Embase, and Cochrane databases for articles measuring OPN concentrations in peripheral blood and CSF samples from MS patients, published before July 12, 2024. A total of 605 articles were identified, and 29 were included in the analysis. Risk of bias was assessed with the NOS scale. The study protocol was officially registered in the PROSPERO website (registration number: CRD42023473406). We extracted standardized mean differences, 95% confidence intervals, and two-sided p values from each study and conducted a meta-analysis using a random-effects model. The heterogeneity among studies was evaluated by I-squared (I2), with values greater than 40% indicating high heterogeneity.
RESULTS AND DISCUSSION: The present analysis revealed that individuals who suffered a first episode suggestive of MS, Clinically Isolated Syndrome (CIS), exhibited higher OPN levels in CSF than controls and patients with other neurological disorders (OND), emerging as an additional diagnosis tool. Furthermore, the observed decrease of OPN levels after Natalizumab (NTZ) treatment evidenced its potential as a biomarker of its efficacy. Higher OPN levels were found in CSF of individuals with MS compared to healthy controls (HC) and subjects with no other neurological diseases (NOND), result corroborated in relapsing remitting (RRMS) and secondary progressive (SPMS) patients. Similar OPN levels were observed when comparing MS patients to OND patients, suggesting that elevated OPN levels may be a common feature across various neurological conditions.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42023473406
Real-world evaluation of the effectiveness and safety of dupilumab in bullous pemphigoid: an ambispective multicentre case series.
No full text20.500.12530/87909Bullous pemphigoid (BP) affects elderly individuals with multiple comorbidities, making conventional treatments unsuitable. Evaluate the effectiveness and safety of dupilumab in the treatment of BP. A multicentre ambispective cohort study was conducted across 34 hospitals. Patients with BP treated with dupilumab were included. Most of the patients (97.1%) received an initial 600-mg dose followed by 300 mg every 2 weeks. The primary outcome was the proportion of patients achieving complete remission (CR) within 4 weeks, defined as an Investigator's Global Assessment score of 0 or 1. CR at weeks 16, 24 and 52, adverse events (AEs), reductions in Peak Pruritus Numerical Rating Scale (PP-NRS) and systemic glucocorticoid use were also assessed. The study included 103 patients with a median age of 77.3 years; 58.3% were male. CR was achieved by 53.4% within 4 weeks and 95.7% by week 52. The PP-NRS score reduced by 70.0% by week 4 and was completely controlled by week 24. Thirteen patients presented with AEs, most of which were mild. Systemic glucocorticoid use reduced by 82.1% by week 52. Shorter disease duration and exclusive cutaneous involvement predicted better response at 16 weeks. No differences in response rates to dupilumab were observed between drug-associated BP and idiopathic cases. No significant difference in response rates was observed between patients treated with dupilumab in monotherapy and those receiving dupilumab with concomitant treatments. Dupilumab is effective, rapid and safe in managing BP, reducing the need for corticosteroids and other treatments. Early initiation and exclusive skin involvement predict better outcomes
Early Detection of Cancer and Precancerous Lesions in Persons With HIV Through a Comprehensive Cancer Screening Protocol.
No full text20.500.12530/87910Non-AIDS defining malignancies present a growing challenge for persons with human immunodeficiency virus (HIV, PWH), yet tailored interventions for timely cancer diagnosis are lacking. The Spanish IMPAC-Neo protocol was designed to compare two comprehensive cancer screening strategies integrated into routine HIV care. This study reports baseline data on the prevalence and types of precancerous lesions and early-stage cancer among participants at enrolment. Acceptability of the procedure was additionally assessed. Cross-sectional analysis of a comprehensive screening protocol to detect precancer and cancer. The readiness of healthcare providers to implement the protocol was evaluated using a validated 4-item survey. Among the 1430 enrolled PWH, 1172 underwent 3181 screening tests, with positive findings in 29.4% of cases, leading to further investigation in 20.7%. Adherence to the protocol was 84%, with HIV providers expressing high acceptability (97.1%), appropriateness (91.4%), and feasibility (77.1%). A total of 145 lesions were identified in 109 participants, including 60 precancerous lesions in 35 patients (3.0%), 9 early-stage cancers in 9 patients (0.8%), and 76 low-risk lesions in 65 subjects (5.5%). Adverse events related to screening occurred in 0.8% of participants, all mild. The overall prevalence of cancer precursors or early-stage cancer was 3.8% (95% confidence interval [CI], 2.74%-5.01%), with highest rates observed in individuals screened for anal and colorectal cancers. The baseline comprehensive cancer screening protocol of the IMPAC-Neo study successfully identified a significant proportion of PWH with precancerous lesions and early-stage cancer. High adherence rates and positive feedback from providers suggest effective implementation potential in real-world healthcare settings