Hilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts.Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma.However...Hilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts.Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma.However,radical resection requires aggressive surgical strategies that should be tailored optimally according to the location,size and vascular invasion of the tumors.Accurate diagnosis and staging of these tumors is therefore critical for optimal treatment planning and for determining a prognosis.Multidetector computed tomography(MDCT),magnetic resonance imaging(MRI) and MR cholangiography are useful tools,both to diagnose and stage hilar cholangiocarcinoma.Modern imaging techniques allow accurate detection of the level of obstruction and the longitudinal and radial spread of the tumor.In addition,high-resolution MDCT and MR provide specific radiographic features to determine vascular involvement of anatomic structures,such as the hepatic artery or the portal vein,which are critical to decide the surgical strategy.Finally,radiological staging allows detection of patients with distant metastasis in the liver or peritoneum who will not benefit from a surgical approach.展开更多
Diabetes mellitus and its complications are becoming one of the most important health problems in the world. Diabetic nephropathy is now the main cause of end-stage renal disease. The mechanisms leading tothe developm...Diabetes mellitus and its complications are becoming one of the most important health problems in the world. Diabetic nephropathy is now the main cause of end-stage renal disease. The mechanisms leading tothe development and progression of renal injury are not well known. Therefore, it is very important to f ind new pathogenic pathways to provide opportunities for early diagnosis and targets for novel treatments. At the present time, we know that activation of innate immunity with development of a chronic low grade inflammatory response is a recognized factor in the pathogenesis of diabetic nephropathy. Numerous experimental and clinical studies have shown the participation of different inflammatory molecules and pathways in the pathophysiology of this complication.展开更多
The progressive ageing of the population and the high incidence of acute coronary syndromes(ACS)in the elderly is leading to an important increase in the number of elderly patients admitted for ACS.[1]Nevertheless,the...The progressive ageing of the population and the high incidence of acute coronary syndromes(ACS)in the elderly is leading to an important increase in the number of elderly patients admitted for ACS.[1]Nevertheless,the information about the optimal clinical management in this age group is scarce due to the exclusion of older patients from clinical trials.[2]Higher comorbidity and frailty are common in this clinical setting and they are associated with higher rates of complications and consumption of healthcare resources.[3]These are the main reasons for launching this special issue about management of ACS in the elderly,in which several experts in the field address some of the most important questions about how to deal with ACS in patients at older ages.展开更多
BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Imp...BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.展开更多
AIM To identify short-term and oncologic outcomes of pelvic exenterations(PE) for locally advanced primary rectal cancer(LAPRC) in patients included in a national prospective database.METHODS Few studies report on PE ...AIM To identify short-term and oncologic outcomes of pelvic exenterations(PE) for locally advanced primary rectal cancer(LAPRC) in patients included in a national prospective database.METHODS Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Espa?ola de Cirujanos(AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence(LR), disease-free survival(DFS) and overall survival(OS). A propensitymatched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint.RESULTS Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication(abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio(HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival(HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS.CONCLUSION PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.展开更多
The incidence of cardiogenic shock(CS)complicating acute myocardial infarction(AMI-CS)remains between 3%and 10%and in-hospital mortality is hardly less than 30%.[1-3]In addition,the economic cost of caring for these p...The incidence of cardiogenic shock(CS)complicating acute myocardial infarction(AMI-CS)remains between 3%and 10%and in-hospital mortality is hardly less than 30%.[1-3]In addition,the economic cost of caring for these patients is high.[4]Revascularization in the acute phase is the only measure that has demonstrated to modify the prognosis of AMI-CS.展开更多
Cardiogenic shock(CS)is a severe clinical condition characterized initially by reduced cardiac output with abnormal organ perfusion which commonly leads to a multiorgan failure.Despite expansion of cardiac critical ca...Cardiogenic shock(CS)is a severe clinical condition characterized initially by reduced cardiac output with abnormal organ perfusion which commonly leads to a multiorgan failure.Despite expansion of cardiac critical care units,development of reperfusion networks and progress of mechanical circulatory support(MCS),mortality of CS due to acute myocardial infarction(AMI)remains as high as 40%−50%.[1]Clinical outcomes in non-AMI patients are less established but remains similarly disappointing.展开更多
To the Editor:Peribiliary cysts are cystic dilatations of the extramural peribiliary glands that appears in the connective tissue around the hepatic hilum.They can affect up to the fourth order intrahepatic bile ducts...To the Editor:Peribiliary cysts are cystic dilatations of the extramural peribiliary glands that appears in the connective tissue around the hepatic hilum.They can affect up to the fourth order intrahepatic bile ducts and do not communicate with the bile lumen.It is a rare entity first described in 1984 by Nakanuma et al.[1].Its diagnosis is usually an incidental discovery in patients with advanced liver disease,portal thrombosis,and portal hypertension [2].展开更多
Aim: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisat ion (CNV) secondary to age related macular degeneration (A...Aim: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisat ion (CNV) secondary to age related macular degeneration (AMD). Methods: Accordin g to greatest linear dimension (GLD) of the entire lesion determined with fluore scein angiography (FA) patients were divided into two groups. In the first group GLD was < 3000 μm and in the second one GLD was 3000-5000 μm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA). Resul ts: 64 patients (mean (SD) age, 76.7 (7.7) years; range 58-95 years) were recru ited to participate in the study. All participants in the study completed the fo llow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesi ons (n=32) compared with 15 patients (46.8%) in the group of larger lesions (n= 32) did not show significant leakage in FA at the end of follow up (p=0.02). A G LD increase >1000 μm was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p=0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the g roup of larger lesions lost less than three lines of vision (p=0.06). Relevant s ide effects related to verteporfin therapy were not recorded, except for four pa tients (6.2%) with infusion related back pain. Conclusions: These results sugge st that lesion size at baseline may be a prognosis factor in PDT in patients wit h subfoveal predominantly classic CNV secondary to AMD. There are no relevant si de effects or safety concerns derived from verteporfin therapy.展开更多
Background:New fuid biomarkers for Alzheimer’s disease(AD)that reveal synaptic and neural network dysfunc‑tions are needed for clinical practice and therapeutic trial design.Dense core vesicle(DCV)cargos are promisin...Background:New fuid biomarkers for Alzheimer’s disease(AD)that reveal synaptic and neural network dysfunc‑tions are needed for clinical practice and therapeutic trial design.Dense core vesicle(DCV)cargos are promising cerebrospinal fuid(CSF)indicators of synaptic failure in AD patients.However,their value as biomarkers has not yet been determined.Methods:Immunoassays were performed to analyze the secretory proteins prohormone convertases PC1/3 and PC2,carboxypeptidase E(CPE),secretogranins SgIII and SgII,and Cystatin C in the cerebral cortex(n=45,provided by Bellvitge University Hospital)and CSF samples(n=66,provided by The Sant Pau Initiative on Neurodegeneration cohort)from AD patients(n=56)and age-matched controls(n=55).Results:In AD tissues,most DCV proteins were aberrantly accumulated in dystrophic neurites and activated astro‑cytes,whereas PC1/3,PC2 and CPE were also specifcally accumulated in hippocampal granulovacuolar degeneration bodies.AD individuals displayed an overall decline of secretory proteins in the CSF.Interestingly,in AD patients,the CSF levels of prohormone convertases strongly correlated inversely with those of neurodegeneration markers and directly with cognitive impairment status.Conclusions:These results demonstrate marked alterations of neuronal-specifc prohormone convertases in CSF and cortical tissues of AD patients.The neuronal DCV cargos are biomarker candidates for synaptic dysfunction and neurodegeneration in AD.展开更多
文摘Hilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts.Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma.However,radical resection requires aggressive surgical strategies that should be tailored optimally according to the location,size and vascular invasion of the tumors.Accurate diagnosis and staging of these tumors is therefore critical for optimal treatment planning and for determining a prognosis.Multidetector computed tomography(MDCT),magnetic resonance imaging(MRI) and MR cholangiography are useful tools,both to diagnose and stage hilar cholangiocarcinoma.Modern imaging techniques allow accurate detection of the level of obstruction and the longitudinal and radial spread of the tumor.In addition,high-resolution MDCT and MR provide specific radiographic features to determine vascular involvement of anatomic structures,such as the hepatic artery or the portal vein,which are critical to decide the surgical strategy.Finally,radiological staging allows detection of patients with distant metastasis in the liver or peritoneum who will not benefit from a surgical approach.
基金Supported by Ministerio de Ciencia e Innovación(Instituto de Salud Carlos Ⅲ-Fondo de Investigación Sanitaria:PI07/0870and PI10/576)Ministerio de Sanidad y Política Social(Dirección General de Terapias Avanzadas y Trasplante:TRA-182)Sociedad Espaola de Nefrología y ACINEF
文摘Diabetes mellitus and its complications are becoming one of the most important health problems in the world. Diabetic nephropathy is now the main cause of end-stage renal disease. The mechanisms leading tothe development and progression of renal injury are not well known. Therefore, it is very important to f ind new pathogenic pathways to provide opportunities for early diagnosis and targets for novel treatments. At the present time, we know that activation of innate immunity with development of a chronic low grade inflammatory response is a recognized factor in the pathogenesis of diabetic nephropathy. Numerous experimental and clinical studies have shown the participation of different inflammatory molecules and pathways in the pathophysiology of this complication.
文摘The progressive ageing of the population and the high incidence of acute coronary syndromes(ACS)in the elderly is leading to an important increase in the number of elderly patients admitted for ACS.[1]Nevertheless,the information about the optimal clinical management in this age group is scarce due to the exclusion of older patients from clinical trials.[2]Higher comorbidity and frailty are common in this clinical setting and they are associated with higher rates of complications and consumption of healthcare resources.[3]These are the main reasons for launching this special issue about management of ACS in the elderly,in which several experts in the field address some of the most important questions about how to deal with ACS in patients at older ages.
文摘BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.
文摘AIM To identify short-term and oncologic outcomes of pelvic exenterations(PE) for locally advanced primary rectal cancer(LAPRC) in patients included in a national prospective database.METHODS Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Espa?ola de Cirujanos(AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence(LR), disease-free survival(DFS) and overall survival(OS). A propensitymatched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint.RESULTS Eight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication(abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio(HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival(HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS.CONCLUSION PE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.
文摘The incidence of cardiogenic shock(CS)complicating acute myocardial infarction(AMI-CS)remains between 3%and 10%and in-hospital mortality is hardly less than 30%.[1-3]In addition,the economic cost of caring for these patients is high.[4]Revascularization in the acute phase is the only measure that has demonstrated to modify the prognosis of AMI-CS.
文摘Cardiogenic shock(CS)is a severe clinical condition characterized initially by reduced cardiac output with abnormal organ perfusion which commonly leads to a multiorgan failure.Despite expansion of cardiac critical care units,development of reperfusion networks and progress of mechanical circulatory support(MCS),mortality of CS due to acute myocardial infarction(AMI)remains as high as 40%−50%.[1]Clinical outcomes in non-AMI patients are less established but remains similarly disappointing.
文摘To the Editor:Peribiliary cysts are cystic dilatations of the extramural peribiliary glands that appears in the connective tissue around the hepatic hilum.They can affect up to the fourth order intrahepatic bile ducts and do not communicate with the bile lumen.It is a rare entity first described in 1984 by Nakanuma et al.[1].Its diagnosis is usually an incidental discovery in patients with advanced liver disease,portal thrombosis,and portal hypertension [2].
文摘Aim: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisat ion (CNV) secondary to age related macular degeneration (AMD). Methods: Accordin g to greatest linear dimension (GLD) of the entire lesion determined with fluore scein angiography (FA) patients were divided into two groups. In the first group GLD was < 3000 μm and in the second one GLD was 3000-5000 μm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA). Resul ts: 64 patients (mean (SD) age, 76.7 (7.7) years; range 58-95 years) were recru ited to participate in the study. All participants in the study completed the fo llow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesi ons (n=32) compared with 15 patients (46.8%) in the group of larger lesions (n= 32) did not show significant leakage in FA at the end of follow up (p=0.02). A G LD increase >1000 μm was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p=0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the g roup of larger lesions lost less than three lines of vision (p=0.06). Relevant s ide effects related to verteporfin therapy were not recorded, except for four pa tients (6.2%) with infusion related back pain. Conclusions: These results sugge st that lesion size at baseline may be a prognosis factor in PDT in patients wit h subfoveal predominantly classic CNV secondary to AMD. There are no relevant si de effects or safety concerns derived from verteporfin therapy.
基金This work was supported by grants from the Spanish Ministry of Economy and Competitiveness(BFU2016-80868-R,MINECO/FEDER,to FA)the Spanish Ministry of Science and Innovation(PID2019-107738RB-I00,MICINN/FEDER,to FA)+2 种基金the Catalonian Government(2017SGR1255 to FA,2014SGR-0235 to AL,PERIS SLT006/17/125 to DA)the Carlos III Institute of Health,Spain(PI18/00435 to DA,PI14/1561 and PI17/01896 to AL)and the CIBERNED program(Program 1,Alzheimer Disease to AL and IF),partly funded by Fondo Europeo de Desar‑rollo Regional(FEDER),Unión Europea,“Una manera de hacer Europa”,and BBVA Foundation(to AL)We are grateful to the Generalitat de Catalunya(NB),the Ministry of Education and Vocational Training(NB)and the Universitat de Barcelona(VP)for fnancial support.
文摘Background:New fuid biomarkers for Alzheimer’s disease(AD)that reveal synaptic and neural network dysfunc‑tions are needed for clinical practice and therapeutic trial design.Dense core vesicle(DCV)cargos are promising cerebrospinal fuid(CSF)indicators of synaptic failure in AD patients.However,their value as biomarkers has not yet been determined.Methods:Immunoassays were performed to analyze the secretory proteins prohormone convertases PC1/3 and PC2,carboxypeptidase E(CPE),secretogranins SgIII and SgII,and Cystatin C in the cerebral cortex(n=45,provided by Bellvitge University Hospital)and CSF samples(n=66,provided by The Sant Pau Initiative on Neurodegeneration cohort)from AD patients(n=56)and age-matched controls(n=55).Results:In AD tissues,most DCV proteins were aberrantly accumulated in dystrophic neurites and activated astro‑cytes,whereas PC1/3,PC2 and CPE were also specifcally accumulated in hippocampal granulovacuolar degeneration bodies.AD individuals displayed an overall decline of secretory proteins in the CSF.Interestingly,in AD patients,the CSF levels of prohormone convertases strongly correlated inversely with those of neurodegeneration markers and directly with cognitive impairment status.Conclusions:These results demonstrate marked alterations of neuronal-specifc prohormone convertases in CSF and cortical tissues of AD patients.The neuronal DCV cargos are biomarker candidates for synaptic dysfunction and neurodegeneration in AD.
