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Colorectal Cancer Surgery in Extreme Elderly Population

Journal of Cancer Therapy 2015年第1期6卷 12-20页

作者： Javier Gallego Plazas Elena Asensio Juan C. Navalon Inmaculada Lozano Jose M. Navarro Guillermo Ricote Montse Olcina Almudena Cotes Henry M. Ore Alejandra Magdaleno Maria C. Ors Maria J. Escudero Miguel A. Morcillo Servicio de Oncología Médica Hospital General Universitario de Elche-Hospital Vega Baja Alicante Espana Servicio de Cirugía General Hospital Vega Baja Alicante Espana

Background: Colorectal cancer surgery in extreme elderly population (380 years) is a growing problem and a subject in question. Experiences and results in this scenario are limited. Methods: Medical records of patients?380 years old hospitalized in General Surgery Department in vega baja hospital between January 1st 2008 and December 31st 2012 were retrospectively reviewed. Patients diagnosed with colorectal cancer (CRC) were selected. Data regarding comorbidities, treatment performed, complications and survival were collected. Results: 95 patients (74 colon, 21 rectum) were identified: median age 83.0 years (80 - 93), 64.2% males. 93.7% of patients were operated on: median hospital and post-operative stay of 11 and 9 days, respectively;curative intention surgery 82.1%. 4.2% of patients were treated with interventionist procedures, and 2.1% of patients in a conservative way. 17.9% and 4.2% of patients came up with early and late complications, respectively. Early and late mortality occurred in 9.5% and 3.2% of patients, respectively. By March 2014, with a median follow up of 43.8 months, median overall survival for colorectal cancer patients was 2.7 years (95%IC, 2.0 - 3.2). Univariaye Cox Regresion analysis revealed the presence of cardiomyopathy (p = 0.024), the presence of chornic kidney disease (p = 0.025), the presence of comorbidities (vs absence) (0.026), the number of comorbidities (0.034), type of admission (p = 0.001), treatment with surgery (p = 0.001) and the incidence of early (p = 0.004) or late complications (p = 0.023) associated to overall survival with statically significance. Multivariate Cox Regression analysis showed number of comorbidities (HR = 1.104;95%CI: 0.851 - 1.431;p = 0.456), treatment with surgery (HR = 4.928;95%CI: 1.815 - 13.385;p = 0.002), programmed admission into hospital (HR = 2.316;95%CI: 1.298 - 4.133;p = 0.004), and the incidence of late complications (HR = 4.629;95%CI: 1.279 - 16.750;p = 0.020) independently associated with o

关键词： Colorectal Cancer Surgery Elderly

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Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation

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Journal of Geriatric Cardiology 2020年第3期17卷 141-148,I0005-I0007页

作者： Gines Elvira-Ruiz Cesar Caro-Martinez Pedro JoseFlores-Blanco Juan JoseCerezo-Manchado Helena Albendin-Iglesias Alejandro Lova-Navarro Francisco Arregui-Montoya Francisca Maria Munoz-Franco Natalia Garcia-Iniesta Arcadio Garcia-Alberola JoseLuis Bailen-Lorenzo Domingo Andres Pascual-Figal Sergio Manzano-Fernández Department of Cardiology University Hospital Virgen de la ArrixacaMurciaSpain Instituto Murciano de Investigación en Biomedicina(IMIB) MurciaSpain Department of Cardiology University Hospital Morales MeseguerMurciaSpain Department of Hematology University Hospital Virgen de la ArrixacaMurciaSpain Department of Internal Medicine University Hospital Virgen de la ArrixacaMurciaSpain School of Medicine University of MurciaMurciaSpain Department of Cardiology Hospital Vega BajaAlicanteSpain

Background The identification of modifiable bleeding risk factors may be of *** aim is to evaluate if aortic stenosis(AS)provides additional information to bleeding risk scores for predicting major bleeding(MB)in non-valvular atrial fibrillation(AF).Methods We designed a retrospective multi-center study including 2880 consecutive non-valvular AF patients initiating oral anticoagulation between January 2013 and December *** was defined as moderate or severe according to European echocardiography guidelines ***,ATRIA and ORBIT scores were used to evaluate the bleeding *** was defined according to the International Society on Thrombosis and Haemostasia criteria and registered at 18 months of *** 168(5.8%)patients had *** with AS had higher risk for MB compared to those without AS(HR=2.13,95%CI:1.40-3.23,P<0.001).Patients without AS and low-intermediate bleeding risk(0 points)showed the lowest MB rate,whereas the MB rate observed among patients with AS and high bleeding risk(2 points)was the highest *** and reclassification analyses showed that AS provided additional information to bleeding risk scores for predicting MB at 18 months of *** In this population,AS was associated with an increased risk for MB at midterm *** three scoring systems showed a moderate discriminatory ability for ***,the addition of AS was associated with a significant improvement in their predictive *** suggest that the presence of this valvulopathy should be taken into account for bleeding risk assessment.

关键词： Anticoagulants Aortic stenosis Atrial fibrillation Major bleeding Valvular disease

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Real-World Evidence in Localized Pancreatic: Coping with Uncertainty in Unselected Populations

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Journal of Cancer Therapy 2024年第4期15卷 164-178页

作者： María I. Pamies Ramón Diana Ibarra Anguita Paula Rodríguez Payá Alvaro Muñoz Abad David Sánchez García María Valero Revert Beatriz Grau Mirete Mariano Martínez Marín Alicia Calero Amaro Lorena Rodríguez Cazalla Javier Gallego Plazas Medical Oncology Department Elche University Hospital Elche (Alicante) Spain General Surgery Department Elche University Hospital Elche (Alicante) Spain General Surgery Department Vega Baja Hospital Orihuela (Alicante) Spain

Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based on clinical trials in selected populations. Hence, exploring with real world evidence (RWE) clinicians’ preferences for treatment options and their results seems pertinent. Methods: In a set of consecutive patients with localized pancreatic cancer assisted in a third level hospital from January 2013 to December 2022, medical records, symptoms, diagnostic process, distribution between subtypes, and treatment plans, with safety and efficacy results, were assessed. Results: A total of 152 patients with localized disease were included (43.4% R, 21.0% BR, 33.6% LAU). The population characteristics exemplified differences between daily practice and clinical trials. Tumor location and symptoms were as expected. Treatment plan was conditioned by PS or comorbidities in 23.0% of patients. In patients with R disease, surgery followed by different adjuvant chemotherapy (CT) regimes was the antineoplastic treatment of choice (64.8%) with efficacy results (OS 37.5 months;95% CI 18.4 - 56.7), in the range of contemporary standards. The common use of neoadjuvant CT for BR disease (94.4%), with surgery in 50% of them, and its results (OS 30.8 months;95% CI 10.5 - 51.2) reflected current controversies of treatment recommendations and evolution in this scenario. Paliative CT with or without radiotherapy was the standard specific treatment in LAU disease (95.1%) with survival results (PFS: 10.8 months;95% CI 8.8 - 12.7. OS: 20.3 months;95% CI 13.5 - 27.2) that justify the distinct character and the specific study of this entity. Conclusion: RWE for localized pancreatic cancer aroused from the analysis of this population confirms the distinct nature of patients assisted in daily practice, as well as mirrors the complexity of decision making in clinical assumptions in which a

关键词： Real-World Evidence Localized Pancreatic Cancer

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Comparison between type-2 and type-1 myocardial infarction：clinical features, treatment strategies and outcomes

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Journal of Geriatric Cardiology 2016年第1期13卷 15-22页

作者： Angel Lopez-Cuenca Miriam Gomez-Molina Pedro J Flores-Blanco Marianela Sanchez-Martinez Andrea Garcia-Narbon Ignacio De Las Heras-Gomez Maria J Sainchez-Galian Esther Guerrero-Perez Mariano Valdes Sergio Manzano-Femandez Department of Internal Medicine Hospital de la Vega Lorenzo Guirao Cieza Spain Division of Cardiology University Hospital Virgen de la Arrixaca School of Medicine IMIB Murcia Spain Department of Biochemistry University Hospital Virgen de la Arrixaca School of Medicine IMIB Murcia Spain Department of lnternal Medicine University of Murcia Murcia Spain

Objective To assess the differences in incidence, clinical features, current treatment strategies and outcome in patients with type-2vs. type-1 acute myocardial infarction （AMI）.Methods We included 824 consecutive patients with a diagnosis of type-1 or type-2 AMI. Dur-ing index hospitalization, clinical features and treatment strategies were collected in detail. At 1-year follow-up, mortality, stroke, non-fatal myocardial infarction and major bleeding were ***-1 AMI was present in 707 （86%） of the cases while 117 （14%） were classified as type-2. Patients with type-2 AMI were more frequently female and had higher co-morbidities such as diabetes, previous non-ST segment elevation acute coronary syndromes, impaired renal function, anaemia, atrial fibrillation and malignancy. However, preserved left ventricular ejection fraction and normal coronary arteries were more frequently seen, an invasive treatment was less common, and anti-platelet medications, statins and beta-blockers were less prescribed in patients with type-2 AMI. At 1-year follow-up, type-2 AMI was associated with a higher crude mortality risk （HR： 1.75, 95% CI： 1.14-2.68;P = 0.001）, but this association did not remain significant after multivariable adjustment （P = 0.785）. Furthermore, we did not find type-2 AMI to be associated with other clinical *** In this real-life population, compared with type-1, type-2 AMI were predominantly women and had more co-morbidities. Invasive treatment strategies and cardioprotective medications were less used in type-2, while the 1-year clinical outcomes were similar.

关键词： Coronary vessels Follow-up studies Myocardial infarction

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Heparan sulfate proteoglycans and heparanases in Alzheimer's disease:current outlook and potential therapeutic targets

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Neural Regeneration Research 2017年第6期12卷 914-915页

作者： Laura Lorente-Gea Beatriz García Carla Martín Luis M.Quirós Iván Fernández-vega Department of Pathology Hospital Universitario de Araba-Txagorritxu Department of Functional Biology University of Oviedo Instituto Universitario Fernández-vega Department of Pathology Hospital Universitario Central de Asturias Biobanco Vasco para la Investigación (O+e Hun) Brain Bank Hospital Universitario Araba

Relevance of Alzheimer’s disease（AD）：AD is one of the greatest health-care challenges of the 21^st *** is known to be the most common neurodegenerative disease and,in the United States,the sixth most common cause ... 详细信息

关键词： outlook amyloid pathogenesis prion greatest sixth gression challenges neuronal brains

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Mediastinal node staging by positron emission tomographycomputed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer:Results from a regional centre

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World Journal of Gastrointestinal Endoscopy 2018年第1期10卷 37-44页

作者： Chris Harrington Lyn Smith Jennifer Bisland Elisabet López González Neil Jamieson Stuart Paterson Adrian John Stanley Glasgow Royal Infirmary Glasgow G4 0ETUnited Kingdom Forth Valley Royal hospital Larbert FK5 4WRUnited Kingdom Raigmore hospital Inverness IV2 3UJUnited Kingdom hospital vega baja Orihuela 03314Spain

AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral *** We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values(PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was *** One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients(10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen(51.9%) experienced clinical remission of a median of nine months(range three to forty two months). CONCLUSION EUS-FNA leads to altered sta

关键词： Endoscopic ultrasound Oesophago-gastric cancer staging Oesophageal cancer Positron emission tomography-computed tomography Mediastinal nodes

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Heparan sulfate proteoglycans as possible diagnostic molecular tools with therapeutic potential in Alzheimer′s disease

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Neural Regeneration Research 2021年第7期16卷 1404-1405页

作者： Iván Fernández-vega Laura Lorente-Gea Carla Martín Luis M.Quirós Department of Pathology Hospital Universitario Central de Asturias/Biobank of Principality of AsturiasHealth Research Institute of the Principality of AsturiasOviedoSpain Department of Pathology Hospital Universitario de Araba-Txagorritxu/Biobanco Vasco para la Investigación(O+eHun)Brain BankHospital UniversitarioVitoriaSpain Instituto Universitario Fernández-vega OviedoSpain Department of Functional Biology University of OviedoSpain

Importance of dementia and Alzheimer's disease(AD): On Earth, there is a "country" that we call Dementia with around 50 million inhabitants and an estimated global economic cost of US $1 trillion(Wimo et al., 2017).AD may contribute to 60–70% of cases, with other major forms of dementia being vascular dementia, dementia with Lewy bodies and a group of diseases that contribute to frontotemporal ***, the boundaries between different forms of dementia are indistinct and mixed forms often co-exist, which are only confirmed after postmortem neuropathological studies(Fernandez-vega et al., 2015).

关键词： al. diseases Alzheimer

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Sudden Death in Sports: Case Report and Review of an Ongoing Problem

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Health 2019年第1期11卷 67-80页

作者： María Elena Caparrós-Hernández Mónica García-Fernández Carla Miró-Vicedo María del Mar Ponce-Abellán Andrea Ruso-Ruso María Dolores Jover-Ríos Juan Méndez-Mora Francisco Caparrós-Hernández Carmen Seguí-Pérez Marc Seguí-Pérez Pedro Esteve-Atiénzar Jorge Peris-García David Bonet-Tur Pablo Roig-Rico Asunción Pérez-Fullana José Miguel Seguí-Ripoll School of Medicine Miguel Hernández University Elche (Alicante) Spain Department of Internal Medicine Hospital La Vega Baja of Orihuela (Alicante) Spain Secondary School Marist Brothers High School Alicante Spain Department of Internal Medicine University Hospital of San Juan Alicante Spain Department of Clinical Medicine Miguel Hernández University Elche (Alicante) Spain

Background: Both competitive and recreational sports are considered a positive practice that is good for human health and quality of life, so it is difficult to understand how young, energetic and apparently healthy people can die while playing their usual sports. When these events occur in elite athletes during monitored events, they normally receive considerable media attention. Objective: To describe the case of sudden death in a young professional athlete who was successfully aided and resuscitated outside our hospital, and to review the literature about sudden death in sports. Materials and Method: We searched for Sudden Death (according to the International Classification of Diseases (ICD-9 and ICD-10)) in our hospital but found no other relevant cases. We performed a literature search on the state of the art in sudden death (Google Scholar, PubMed, LILACS, Scielo and the Revista Española de Cardiología). Results: Although we observed that the prevalence of sudden death is not very high, it still represents a potentially avoidable event. An adequate medical examination prior to regular sporting practice can decrease the incidence of sudden death in athletes under the age of 35. Data available in the literature support medical check-ups that include history-taking, physical examination and electrocardiogram. The findings of this evaluation may also prompt further assessment (electrocardiograph, ergometry). Conclusions: We could not identify standard, obligatory guidelines for screening possible heart diseases causing cardiorespiratory failure and sudden death. As a measure for primary prevention, we propose a protocol for reducing the risk of sudden death in athletes.

关键词： Sudden Death Sports Athletes Cardiopulmonary Resuscitation Implantable Automatic Defibrillator

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Caregiver Burden in the Management of Frail Elderly Patients with Diabetes in Internal Medicine

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Health 2018年第10期10卷 1383-1391页

作者： Jose Miguel Segui Ripoll Vicente Jesús Segui Llinares Miguel J.Reig Pérez Carles García Cervera Juan Manuel Núnez Cruz Pedro Esteve Atiénzar Sara Banón Escandell Alberto López Serrano María Dolores Jover Ríos Juan Méndez Mora Carmen Segui Pérez María Josefa Navarro Navarro Pablo Roig Rico Department of Internal Medicine University Hospital of San JuanAlicanteSpain Department of Clinical Medicine Miguel Hernández UniversityElcheSpain Institute of Design and Manufacturing Polytechnic University of ValenciaCampus of AlcoyAlicanteSpain Department of Internal Medicine Hospital La Vega Baja of OrihuelaAlicanteSpain Secondary School Marist Brothers High SchoolAlicanteSpain Primary Medicine BenillobaSpain

Aim: Advanced age and fragility often lead to dependence, making caregiver assistance necessary for performing the activities of daily living. Patients with diabetes are characterized by an elevated presence of comorbidities and subsequent frailty—a relevant consideration when making decisions regarding treatment goals. Health professionals may overlook the caregiver experience when assessing the circumstances surrounding frail elderly patients with diabetes, but this factor can have a large impact on relevant caregiver and patient outcomes. Methods: An observational, retrospective study was carried out to assess the impact of improved management in diabetes on caregiver burden. We assessed patients’ performance of activities of daily living using the Barthel scale. Our primary outcome was caregiver burden, as assessed using the Zarit scale. Results: At baseline, 81.4% of the caregivers reported severe overburden (>55 points on the Zarit scale). At three months, the proportion of caregivers reporting this level of burden had dropped to 76.7% and remained stable at six months (77.1%). In contrast, 8.5% of the caregivers reported moderate overburden (47 to 55 points) at baseline, compared to 13.3% at three months and 12.5% at six. The proportion of caregivers reporting no overburden (Conclusions: Caregiver burden remained persistently high, decreasing only slightly after six months.

关键词： Elderly Diabetes Frail Patient Overload Caregiver

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Post-hospital Syndrome and Hyponatremia

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Health 2021年第8期13卷 846-856页

作者： José Bellod-Tonda Julio Blázquez-Encinar María Dolores Jover-Ríos Carmen Seguí-Pérez Juan Méndez-Mora Francisco Caparrós-Hernández Álex Méndez-Jover Marc Seguí-Pérez David Baláž Leticia Espinosa del Barrio Jesús Corbacho-Redondo Carles García-Cervera Juan Manuel Núñez-Cruz Isidro Hernández-Isasi Javier Guzmán-Martínez Angie Gómez-Uranga Pedro Esteve-Atiénzar Jorge Peris-García Veronica Martínez-Sempere Eliana Damonte-White Óscar Hernando Ruiz-Ariza Juan Carlos López-Corbalán Lourdes Lajara-Villar Andrea Riaño-Pérez Paloma Chazarra-Pérez María Escamilla-Espínola Maria Luisa Asensio-Tomás Miguel Ángel Auladell-Alemany Laura Serna-Torres Asunción Pérez-Fullana Amparo Gómez-Siurana Sergio Menargues-Irles José Miguel Seguí-Ripoll Internal Medicine Department University Hospital of San Juan Alicante Spain Internal Medicine Department Torrevieja University Hospital Alicante Spain Internal Medicine Department Hospital La Vega Baja of Orihuela Alicante Spain CEU Cardinal Herrera University Veterinary Hospital Valencia Spain Secondary School Marist Brothers High School Alicante Spain Department of Clinical Medicine Miguel Hernández University Elche Spain Primary Care Medicine Benilloba Spain Sub-Delegation of the Government Alicante Spain Chemical Engineering Department University of Alicante Alicante Spain

Introduction: Post-hospital syndrome (PHS) is defined as a period of vulnerability during the first 30 days after a patient is discharged from hospital, in which multiple factors come into play. Hyponatremia is the most frequent hydroelectrolytic disorder in hospitalized patients and may be related to the appearance of PHS. Objective: The objective is to estimate the prevalence of PHS that is assessed as the rate of readmissions in the first 30 days after discharge, in patients with hyponatremia. Material and Methods: It is a descriptive observational study of patients with hyponatremia who were discharged from 1 September 2010 to 2 February 2020 at the Internal Medicine Service of the hospital University of San Juan (Alicante, Spain). Results: Of the 25 included patients, 5 (20%) were readmitted within a month of discharge, after a mean of 11.4 days (standard deviation [SD] 5.1). The overall mortality of the study was 20% (n = 5), with one case of death in the first 30 days post-hospitalization (4%). In 12 patients (48%) the origin of the hyponatremia was undetermined. The most frequently recorded etiology for the condition was pharmacological (n = 7, 28%), and there was pronounced variability in its clinical and laboratory study. The most widely used corrective measure was drug withdrawal, in 16 patients (64%). Water intake restriction was the most common treatment after discharge (5 patients, 20%), followed by urea (2 patients, 8%), while tolvaptan was not used. Conclusion: Hyponatremia may be the cause of PHS, which could increase the rate of early readmission. Hyponatremia is an underdiagnosed and undertreated entity, so it is necessary to apply an appropriate system to optimize its management and, in future studies, to assess its impact on PHS.

关键词： hospitalization Hyponatremia Patient Readmission Inappropriate ADH Syndrome

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