Scientia, Dipòsit d’Informació Digital del Departament de Salut
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Repensar la evaluación de la investigación: sesgos cognitivos & sistémicos involutarios
No full textAvaluació de la recerca; Biaixos en els criteris; Presa de decisionsEvaluación de la investigación; Sesgos en los criterios; Toma de decisionesResearch evaluation; Biases in criteria; Decision makingInfografia que identifica set biaixos cognitius personals que poden influir en decisions d’avaluació acadèmica. També exposa quatre implicacions institucionals i proposa estratègies per reduir aquests biaixos mitjançant canvis estructuralsInfografía que identifica siete sesgos cognitivos personales que pueden influir en decisiones académicas. También presenta cuatro implicaciones institucionales y ofrece estrategias para reducir estos sesgos mediante cambios estructurales.Infographic that identifies seven personal cognitive biases affecting academic evaluation decisions. It outlines four institutional implications and suggests strategies to reduce bias through structural change
Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer: safety analysis of FRESCO-2
Full text linkAdverse event management; Metastatic colorectal cancerGestió d'esdeveniments adversos; Càncer colorectal metastàticGestión de eventos adversos; Cáncer colorrectal metastásicoBackground
Fruquintinib is a highly selective, oral inhibitor of all 3 VEGF receptors. The global, randomized, double-blind phase 3 FRESCO-2 trial (NCT04322539) met its primary endpoint demonstrating significantly improved overall survival in patients with refractory metastatic colorectal cancer (mCRC) who received fruquintinib plus best supportive care (BSC) versus placebo plus BSC. Here we report detailed safety data from FRESCO-2 including an analysis of treatment-related adverse events of special interest (AESIs).
Patients and methods
Patients with mCRC eligible for FRESCO-2 had received all standard chemotherapies and prior anti-VEGF and anti-EGFR therapies if indicated, and displayed progression on, or intolerance to, TAS-102 and/or regorafenib. Prespecified AESIs based on VEGFR tyrosine kinase inhibitor drug classes were evaluated.
Results
Incidences of treatment-related AESIs were 64.9% with fruquintinib + BSC versus 23.0% with placebo + BSC. The most frequent all-grade treatment-related AESIs for fruquintinib were hypertension (28.9%; grade ≥3 10.7%), palmar-plantar erythrodysesthesia syndrome/hand-foot skin reaction (PPE 18.6%; grade ≥3 6.1%), and hypothyroidism (15.6%; grade ≥3 0.4%). Dose reductions due to treatment-related AESIs were reported in 10.3% of patients who received fruquintinib + BSC versus 0.4% with placebo + BSC. The most common treatment-related AESIs resulting in dose reduction for fruquintinib were PPE syndrome (5.0%), hypertension (2.9%), and proteinuria (1.3%). Overall, 5.9% versus 0.9% had treatment-related AESIs resulting in study drug discontinuation.
Conclusion
Fruquintinib + BSC demonstrated a predictable and manageable safety profile in pretreated patients with mCRC and is a novel oral treatment option that prolongs survival and enriches the continuum of care in this population.This study was funded by HUTCHMED
Longitudinal recovery trajectories and ventilatory modalities in COVID-19 acute respiratory distress syndrome survivors
Full text linkVentilatory support; COVID-19 acute respiratory distress syndromeSuport ventilatori; Síndrome de dificultat respiratòria aguda per COVID-19Soporte ventilatorio; Síndrome de dificultad respiratoria aguda por COVID-19Background: The impact of different ventilatory support modalities and timing of intubation on longitudinal lung recovery trajectories in patients with severe coronavirus disease 2019 (COVID-19) is unknown.
Methods: This was a multicentre, prospective observational study conducted in 52 Spanish intensive care units (ICUs) involving critically ill COVID-19 patients admitted between 25 February 2020 and 8 February 2021. 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with diffusing capacity of the lung for carbon monoxide (D LCO) measurements and chest imaging. Patients were classified regarding the ventilatory support received during the ICU stay: noninvasive mechanical ventilation (NIMV), high-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV), divided into early IMV (intubation within 24 h) and late IMV (intubation after 24 h). The primary objective was to evaluate the impact of the different respiratory support modalities during the ICU stay and the time of intubation on D LCO measurements and their recovery trajectories over a 1-year follow-up. Secondary outcomes included other pulmonary function parameters and chest imaging findings.
Results: A total of 360 (19.4%) and 290 (15.6%) patients received HFNC and NIMV, respectively. 1204 (64.9%) patients underwent IMV; 966 received early IMV and 238 received late IMV. The latter exhibited a significantly worse percentage predicted D LCO during the 1-year follow-up with adjusted differences of 6.9 (95% CI 3.9-10; p<0.001), 4.2 (95% CI 1.1-7.2; p=0.007) and 4.9 (95% CI 1.7-8.2; p=0.003) at 3, 6 and 12 months compared with early IMV. NIMV patients exhibited greater lung damage at follow-up than those under HFNC with an adjusted difference of percentage predicted D LCO of 5.2 (95% CI 1.7-8.7; p=0.003) at 6 months and greater presence of radiological abnormalities during follow-up. Matched and sensitivity analysis showed results consistent with those reported.
Conclusions: Delay in intubation implies the worst outcomes; however, patients with NIMV exhibited a slower lung recovery in terms of D LCO measurements and more radiological abnormalities compared with HFNC patients. These results should be used to optimise follow-up protocols for COVID-19 acute respiratory distress syndrome (ARDS) survivors.Financial support was provided by Instituto de Salud Carlos III (ISCIII) (CIBERESUCICOVID, COV20/00110), with co-funding from: Fondo Europeo de Desarrollo Regional, “Una manera de hacer Europa”; Centro de Investigación Biomédica en Red – Enfermedades Respiratorias; Donation Programme “Estar preparados”, UNESPA, Madrid, Spain; and Fundación Francisco Soria Melguizo, Madrid, Spain. J. de Batlle acknowledges receiving financial support from ISCIII (Miguel Servet 2019: CP19/00108), co-funded by Fondo Social Europeo Plus (FSE+). D. de Gonzalo-Calvo has received financial support from ISCIII (Miguel Servet 2020: CP20/00041), co-funded by FSE+. F. Barbé acknowledges receiving financial support from the ICREA Academia programme. A. Ceccato acknowledges receiving financial support from ISCIII (Sara Borrell 2021: CD21/00087)
Infarct-like myocarditis in adolescents: Exploring genetic insights from diagnosis through follow-up
Full text linkAdolescents; Cardiac magnetic resonance; MyocarditisAdolescents; Ressonància magnètica cardíaca; MiocarditisAdolescentes; Resonancia magnética cardíaca; MiocarditisBackground
Myocarditis has traditionally been considered an acquired condition, but recent evidence suggests a genetic contribution, primarily in complicated cases. Data on pediatric uncomplicated or infarct-like myocarditis remain scarce. This study aimed to assess the prevalence of pathogenic or likely pathogenic (P/LP) variants in adolescents with infarct-like myocarditis and their association with clinical and imaging findings.
Methods
This prospective, multicenter study included 30 adolescents diagnosed with infarct-like myocarditis across five hospitals in Catalunya, Spain (2016–2024). Diagnosis was confirmed using the 2018 Lake Louise Criteria on cardiac magnetic resonance imaging (CMR). Follow-up CMR was performed at 12 months, and genetic testing was conducted using a next-generation sequencing panel targeting 174 genes associated with inherited cardiac diseases.
Results
P/LP variants in cardiomyopathy-associated genes were identified in 22.2 % of patients. Baseline CMR showed no significant differences in ventricular function or LGE extent, but a ring-like LGE pattern was significantly associated with genetic findings (p = 0.025), while septal involvement showed a p-value of 0.056. Over a median follow-up of 3 years (IQR 2–7), 9 patients (30 %) experienced recurrent myocarditis, more frequently in genetic-positive patients (66.7 % vs. 23.8 %). At 12 months, genetic-positive patients exhibited a greater LGE burden (p = 0.047) and persistent myocardial edema on T2-STIR (p = 0.009), suggesting ongoing myocardial remodeling.
Conclusions
The high prevalence of P/LP variants in infarct-like myocarditis highlights the need for genetic testing, particularly in patients with a ring-like LGE pattern or septal involvement. Persistent CMR abnormalities and symptomatic recurrences in genetic-positive cases support long-term monitoring, even in seemingly uncomplicated presentations
The importance of online presence and best practices for the orthopedic surgeon in social media
No full textXarxes socials; Relació metge-pacient; Bones pràctiquesRedes sociales; Relación médico-paciente; Buenas prácticasSocial media; Physician-patient relations; Best practicesInternet se ha posicionado en los últimos años como el primer canal de información y consulta sobre salud para nuestros pacientes. Los beneficios tanto directos como indirectos de una adecuada presencia en redes sociales (RRSS), convergen fundamentalmente en los siguientes cinco puntos: aumento de la visibilidad, networking profesional, acercamiento de la comunidad médica al paciente y educación sanitaria.In recent years, the Internet has positioned itself as the primary channel for healthcare information and consultation for our patients. The direct and indirect benefits of a strong social media presence converge primarily around the following five points: increased visibility, professional networking, bringing the medical community closer to patients, and health education
Association of the Timing and Type of Acute Symptomatic Seizures With Poststroke Epilepsy and Mortality
Full text linkEpilepsy; Seizures; StrokeEpilepsia; Convulsiones; IctusEpilèpsia; Convulsions; IctusBACKGROUND:
Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear.
METHODS:
This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within 7 days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS.
RESULTS:
The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3–4.0]; P=0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5–26.7]; P<0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9–6.3]; P<0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4–5.6]; P=0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5–58.8]; P<0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58; P=0.02) and in the validation cohort (0.70 versus 0.50; P=0.18).
CONCLUSIONS:
ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling
Neuromelanin and selective neuronal vulnerability to Parkinson’s disease
Full text linkAging; Neurodegeneration; Substantia nigraEnvelliment; Neurodegeneració; Substància negraEnvejecimiento; Neurodegeneración; Sustancia negraNeuromelanin is a unique pigment made by some human catecholamine neurons. These neurons survive with their neuromelanin content for a lifetime but can also be affected by age-related neurodegenerative conditions, as observed using new neuromelanin imaging techniques. The limited quantities of neuromelanin has made understanding its normal biology difficult, but recent rodent and primate models, as well as omics studies, have confirmed its importance for selective neuronal loss in Parkinson’s disease (PD). We review the development of neuromelanin in dopamine versus noradrenaline neurons and focus on previously overlooked cellular organelles in neuromelanin formation and function. We discuss the role of neuromelanin in stimulating endogenous α-synuclein misfolding in PD which renders neuromelanin granules vulnerable, and can exacerbates other pathogenic processes.This work was supported in part by Aligning Science Across Parkinson’s [020505] through the Michael J. Fox Foundation for Parkinson’s Research (MJFF) and also by funding to GH from the National Health and Medical Research Council of Australia [Investigator Grant 1176607]. For open access, the authors have applied a CC BY public copyright license to all Author Accepted Manuscripts arising from this submission. We would like to thank Heidi Cartwright for assistance with the figures
Mediastinal staging lymph node probability map in non-small cell lung cancer
Full text linkLung cancer; Lymph node; Mediastinal stagingCáncer de pulmón; Ganglio linfático; Estadificación mediastínicaCàncer de pulmó; Gangli limfàtic; Escenificació mediastínicaBackground: Mediastinal lymph node (LN) staging is routinely performed using PET/CT and EBUS-TBNA. Promising predictive algorithms for lymph nodes have been reported for each technique, both individually and in combination. This study aims to develop a predictive algorithm that combines EBUS, PET/CT and clinical data to provide a probability of malignancy.
Methods: A retrospective study was conducted on consecutive patients with non-small cell lung carcinoma staged using PET/CT and EBUS-TBNA. Lymph nodes were identified by level (N1, N2, and N3) and anatomical region (AR) (subcarinal, paratracheal, and hilar). A Standardized Uptake Value (SUV) was determined for each sampled LN. The ultrasound features collected included diameter in the short axis (DSA), morphology, border, echogenicity and the presence of the vascular hilum. A robust logistic regression model was used to construct an algorithm to estimate the probability of malignancy of the lymph node. Results: A total of 116 patients with a mean age of 66, 93% of whom were men, were included. 358 lymph nodes were evaluated, 51% of which exhibited adenocarcinoma and 35% were squamous, while 14% were classified as non-small-cell lung carcinoma. The model estimated the probability of malignancy for each lymph node using age, DSA, SUVmax, and AR. The Area Under the ROC curve, was 0.89. A user-friendly application was also developed ( https://ubidi.shinyapps.io/lymma/ .) CONCLUSIONS: The integration of patient clinical characteristics, EBUS features, and PET/CT findings may generate a pre-sampling malignancy probability map for each lymph node. The model requires prospective and external validation
Venta de alimentos por internet
Full text linkComerç; Aliments; InternetComercio; Alimentos; InternetCommerce; Food; InternetEl comerç d’aliments per internet és una modalitat de venda. El responsable del producte n’ha de
garantir la seguretat i s’ha d’assegurar que el consumidor tingui la mateixa informació que quan
va a la botiga a comprar-lo.
Si vols vendre aliments per internet, assegura’t que es compleixen tots els requisits de seguretat alimentària.El comercio de alimentos por internet es una modalidad de venta. El responsable del producto debe garantizar su seguridad y asegurarse de que el consumidor disponga de la misma información que cuando lo compra en una tienda.
Si quieres vender alimentos por internet, asegúrate de que se cumplen todos los requisitos de seguridad alimentaria.The online food trade is a form of sales. The person responsible for the product must guarantee its safety and ensure that the consumer has the same information as when buying it in a physical store.
If you want to sell food online, make sure all food safety requirements are met
Taletrectinib in ROS1+ Non–Small Cell Lung Cancer: TRUST
Full text linkTaletrectinib; Non-small cell lung cancerTaletrectinib Cáncer de pulmón de células no pequeñasTaletrectinib; Càncer de pulmó de cèl·lules no petitesPurpose
Taletrectinib is an oral, potent, CNS-active, selective, next-generation ROS1 tyrosine kinase inhibitor (TKI). We report integrated efficacy and safety from registrational taletrectinib studies in ROS1+ non–small cell lung cancer.
Methods
TRUST-I and TRUST-II were phase II, single-arm, open-label, nonrandomized, multicenter trials. Efficacy outcomes were pooled from TRUST-I and TRUST-II pivotal cohorts. The safety population comprised all patients treated with once-daily oral taletrectinib 600 mg pooled across the taletrectinib clinical program. The primary end point was independent review committee–assessed confirmed objective response rate (cORR). Secondary outcomes included intracranial (IC)-ORR, progression-free survival (PFS), duration of response (DOR), and safety.
Results
As of June 7, 2024, the efficacy-evaluable population included 273 patients in TRUST-I and TRUST-II. Among TKI-naïve patients (n = 160), the cORR was 88.8% and the IC-cORR was 76.5%; in TKI-pretreated patients (n = 113), the cORR was 55.8% and the IC-cORR was 65.6%. In TKI-naïve patients, the median DOR and median PFS were 44.2 and 45.6 months, respectively. In TKI-pretreated patients, the median DOR and median PFS were 16.6 and 9.7 months. The cORR in patients with G2032R mutation was 61.5% (8 of 13). Among 352 patients treated with taletrectinib 600 mg once daily, the most frequent treatment-emergent adverse events (TEAEs) were GI events (88%) and elevated AST (72%) and ALT (68%); most were grade 1. Neurologic TEAEs were infrequent (dizziness, 21%; dysgeusia, 15%) and mostly grade 1. TEAEs leading to discontinuations (6.5%) were low.
Conclusion
Taletrectinib showed a high response rate with durable responses, robust IC activity, prolonged PFS, favorable safety, and low rates of neurologic adverse events in TKI-naïve and pretreated patients