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Acceso a medicamentos huérfanos para el tratamiento de la atrofia muscular espinal en España
(Viguera Editores SL, 2022) García Parra, Beliu; Guiu Segura, Josep Maria; Modamio Charles, Pilar; Martínez Yélamos, Antonio; Mariño Hernández, Eduardo L.; Povedano Panades, Mónica
Introducción. La atrofia muscular espinal (AME) es una enfermedad rara cuyo diagnóstico y tratamiento es complejo. En
España hay dos medicamentos huérfanos financiados por el Sistema Nacional de Salud, nusinersén y onasemnogén abeparvovec,
y un tercero, risdiplam, pendiente. El objetivo fue analizar el acceso a los fármacos modificadores de la AME y
detectar posibles causas de inequidad.
Materiales y método. Estudio descriptivo realizado en dos fases: revisión bibliográfica y entrevistas semiestructuradas a
expertos clínicos en AME de las comunidades autónomas (CC. AA.) de Andalucía, Castilla-La Mancha, Cataluña y Murcia.
Resultados. El número de centros, servicios o unidades de referencia, la disponibilidad de planes autonómicos para enfermedades
raras y los programas piloto de cribado neonatal pueden modular el acceso a los nuevos tratamientos farmacológicos.
El número de nuevos pacientes diagnosticados al año se estimó entre uno y seis en cada una de las CC. AA. estudiadas.
Dos de las cuatro CC. AA. estaban participando en ensayos clínicos. El tiempo desde la prescripción a la
administración de nusinersén estaba entre siete y 60 días. Sólo Cataluña comunicó experiencia con onasemnogén abeparvovec
a 30 de junio de 2022. Dos CC. AA. de las cuatro estudiadas disponen de plan autonómico para enfermedades
raras; no obstante, se identificó como relevante para el tratamiento de la AME sólo en una de ellas.
Conclusiones. No se identificaron diferencias importantes en el acceso al nusinersén en las CC. AA. estudiadas. El diagnóstico
de la AME requiere personal clínico experto y centros especializados para iniciar precozmente los tratamientos modificadores
de la enfermedad.
OP01.09: Perinatal outcomes in gestations with intrauterine growth restriction and small for gestational age foetuses, admitted to neonatal unit
(John Wiley & Sons, 2010-12-14) Gómez Roig, Ma. Dolores; Mazarico Gallego, Edurne; Sabrià Bach, Joan; Martín Ancel, Ana; Vela, A.; Lailla Vicens, José Ma. (José María), 1948-
To compare perinatal outcomes between those gestations with intrauterine growth restriction or with small for gestational age foetuses.
Ecological validity of maximal exercise tests to simulate competitive demands in amateur female handball
(Association of Physical Education and Health Educators Ljubuški, 2026-01-14) Batalla Gavaldà, Abraham; Beltrán Garrido, José Vicente; Montoliu-Colás, Raúl; Reina-Gómez, Álvaro; Corbi, Francisco; Daza Sobrino, Gabriel
Purpose: Laboratory tests are fundamental for assessing handball performance, but their ecological validity for amateurfemale players is unclear. This exploratory study compared physiological and perceptual responses between commonmaximal exercise tests and official match play to determine if they replicate competitive demands. Methods: Sixteen amateur female handball players completed three laboratory tests (Wingate, cycle ergometer, treadmill) and were monitored during ten official matches. The data collection included both physiological and psychological indicators: heart rate (HR), blood lactate concentration, rating of perceived exertion (RPE), perceived stress, and mood states. Results: Peak HR values recorded in the Wingate and Cycle ergometer were lower than those reached during actualcompetition (d = -.77 to -.75, P< .05). In addition, compared with the Wingate and cycle ergometer tests, competitive matchesrequired players to spend a significantly larger proportion of time with their HR exceeding 90% of its maximum. This contrast was less evident when compared with the treadmill test. A clear mismatch was observed between physiological andperceptual measures. Despite showing stronger physiological strain during matches -such as greater weight loss and higherpre-exercise lactate levels- players reported significantly lower RPE values than in the laboratory conditions (d = .27 to .36,P< .05). Conclusions: None of the laboratory-based tests accurately reproduced the full demands of a handball match. Although the treadmill test elicited similar peak HR values, it failed to reflect the sport’s intermittent nature. The Wingate and cycletests showed even greater discrepancies in cardiovascular intensity. These findings underline the importance of developingsport-specific or hybrid assessment protocols that integrate intermittent workloads and cognitive demands for a more validevaluation of performance.
Barriers and facilitators to performing benign paroxysmal positional vertigo manoeuvres among primary care physicians in Barcelona: a qualitative study
(BMJ Publishing Group, 2025-12-08) Rullan-Rabassa, Alicia; Abiétar, Daniel G.; Rando-Matos, Yolanda; Ballvé Moreno, José Luis; Daryanani-Nawalrai, Sheena; Hernández-Méndez, Patricia; Rozenek, Malgorzata Anna; Santolalla-De Pedro, Anna; Torrecilla-Sánchez, Raquel; Peguero Rodríguez, Eva
Objective: To explore the barriers and facilitators in adherence to the guidelines in the management of benign paroxysmal positional vertigo from the perspective of primary care physicians. Design: Qualitative study using focus groups. Setting: L'Hospitalet del Llobregat (Barcelona), Spain. Study design: Qualitative study using focus groups. Structured 90 min focus groups were conducted until data saturation was reached. Each session included a moderator and an observer from the research team. Sessions were transcribed and thematically analysed by three independent researchers. Participants: Purposeful sampling was used to form four groups of 4-10 participants, selected by sex, age, years of experience and primary care team (PCT). Participants were recruited between January and February 2023. Results: A total of 34 family physicians belonging to four PCTs participated in the study. The main barriers identified were a lack of time, negative initial experiences, a fear of harming patients (especially older adults), difficulty in nystagmus visualisation and challenges in managing patient expectations, as many preferred medication over physical manoeuvres. Facilitators included potential time savings from effective early management, the value of initial practical training with periodic refreshers, access to expert consultants for case discussions and the availability of digital tools, such as tutorials, videos and aids for nystagmus interpretation. Conclusion: Health systems should invest in protected time for history-taking and physical examination, and in regular, updated training for primary care professionals. This could improve vertigo management and reduce unnecessary investigations and medications, ultimately benefiting both patients and the healthcare system.
6-Year Risk of Developing Lung Cancer in Spain: Analysis by Autonomous Communities
(Elsevier, 2020-05-11) Travier, Noémie; Fu Balboa, Marcela; Romaguera, Amparo; Martín-Cantera, Carlos; Fernández Muñoz, Esteve; Vidal, Carmen; García Martínez, Montserrat; LUCAPREV research group
Introduction: Lung cancer screening with low-dose computed tomography (LDCT) has been proposed as a strategy to reduce lung cancer mortality. Since LDCT has side effects there is a need to carefully select the target population for screening programmes. Because in Spain health competences are transferred to the seventeen Autonomous Communities (ACs), the present paper aims to identify individuals at high risk of developing lung cancer in the different ACs. Methods: We used the 2011-2012 data of the Spanish National Interview Health Survey (n=21,006) to estimate the proportion of individuals at high risk of developing lung cancer using a 6-year prediction model (PLCOm2012). This proportion was then extrapolated into absolute figures for the Spanish population, using the population census data of 2018 from the National Institute of Statistics. Results: The proportion of individuals aged 50-74 with a risk of lung cancer ≥2% was 9.5% (15.9% in men, 3.5% in women). This proportion ranged from 6.6% in Región de Murcia to 12.7% in Andalucía and 13.0% in Extremadura. When extrapolated to the Spanish population, it was estimated that a total of 1,341,483 individuals may have a 6-year risk of lung cancer ≥2%. Conclusions: The present study is the first one that evaluated the number of individuals at high risk of developing lung cancer in the different Spanish ACs using a prediction model and selecting people with a 6-year risk ≥2%. Further studies should assess the cost and effectiveness associated to the implementation of a lung cancer screening programme to such population.
Association of in utero exposure to phthalate and DINCH metabolites with placental DNA methylation
(Elsevier Ltd., 2025-11-19) Dadvand, Payam; Bustamante Pineda, Mariona; Vrijheid, Martine; Vespalcova, Hana; Knox, Bethany; Sakhi, Amrit K.; Thomsen, Cathrine; Aguilar Lacasaña, Sofía; Cosín Tomàs, Marta; Gómez-Herrera, Laura; Sánchez García, Olga; Llurba Olivé, Elisa; Gómez Roig, Ma. Dolores; Sunyer, Jordi
Phthalates and DINCH are non-persistent chemicals widely used in consumer products. In utero exposure to these compounds has been linked to adverse reproductive and long-term health outcomes, potentially through epigenetic changes in the placenta. This study investigated associations between maternal phthalate and DINCH metabolite levels and placental DNA methylation in 469 mother–child pairs from the Barcelona Life Study Cohort (BiSC). Fifteen phthalate and two DINCH metabolites were measured in pooled maternal urine samples collected at 19 and 35 weeks of gestation using liquid chromatography–tandem mass spectrometry (LC-MS/MS. Placental DNA methylation was assessed using the Illumina EPIC array. We applied robust linear regression models to test associations between single exposures at 19 weeks, 35 weeks, and whole pregnancy (average of the two time points), with each CpG site. In secondary analyses, quantile g-computation was used to test associations between exposure mixtures and suggestive CpGs (p-value < 1E-05). We identified 38 Bonferroni significant associations in the single exposure models (p-value < 1E-07)— 24 at 19 weeks, 8 at 35 weeks and 6 for the whole pregnancy period. Suggestive CpGs (p-value < 1E-05) were annotated to genes involved in metabolic, immune and vascular pathways, steroid biosynthesis, and sex hormone signaling. Sex-stratified analyses revealed 49 female-specific and 42 male-specific associations, most of which were identified at a single time point. Mixture analyses revealed 20 significant associations, all consistent in direction with the single-metabolite models. These results suggest that prenatal exposure to phthalates and DINCH may contribute to placental epigenetic alterations supporting a role for endocrine disruption, metabolism, and vascular and immune modulation in mediating their effects.
Exploring the relationship between maternal carbohydrate quality and quantity during pregnancy and early childhood neurodevelopment: a prospective cohort study within the BiSC cohort
(Springer Verlag, 2025-12-01) Panisello, Laura; Mateu-Fabregat, Javier; Novau-Ferré, Nil; Ayala-Aldana, Nicolas; Bernardo-Castro, Sara; Ferrer, Muriel; Jiménez-Arenas, Pol; Llurba Olivé, Elisa; Lassale, Camille; Gómez Roig, Ma. Dolores; Vioque, Jesús; González Palacios, Sandra; Contreras Rodríguez, Oren; Foraster, Maria; Gascón, Mireia; Sunyer, Jordi; Awad, Camila; Júlvez, Jordi; Bulló, Mònica
Purpose: Maternal nutrition during pregnancy is key for offspring neurodevelopment. Given the role of glucose in brain function, assessing carbohydrate quantity and quality, including glycemic index (GI), glycemic load (GL) and carbohydrate quality index (CQI), may provide insights into early brain development. This study examined the associations between maternal dietary carbohydrate intake and neurodevelopmental outcomes in early childhood. Methods: The prospective cohort study included 1080 mother-child pairs from the Barcelona Life Study Cohort. Maternal dietary carbohydrate intake, GI, GL and CQI were assessed during mid-pregnancy using a food frequency questionnaire. Child neurodevelopment was evaluated at 8 and 28 months using the Developmental Profile 3 (DP-3) and at 18 months using the Bayley Scales of Infant and Toddler Development (BSID-III). Associations were analyzed using multivariable linear regression models adjusted for relevant maternal and child covariates. Results: Increased maternal carbohydrate intake, GI, and GL were inversely associated with language development (β (95% CI): - 2.67 (- 5.13, - 0.21), - 2.73 (- 5.21, - 0.26), - 3.51 (- 5.96, - 1.07) respectively) and receptive language (β (95% CI): - 0.58 (- 1.07, - 0.08), - 0.54 (- 1.04, - 0.04), - 0.70 (- 1.20, - 0.21) respectively) at 18 months, as measured by the BSID-III, although these associations were attenuated after adjustment for maternal and child covariates. Increased GI and lower CQI were associated with lower gross motor scores (β (95% CI): - 0.49 (- 0.84, - 0.15), 0.39 (0.06, 0.71) respectively) at 18 months (BSID-III), as well as reduced motor development (β (95% CI): - 3.2 (- 5.50, - 0.76), 2.22 (- 0.1, 4.54) respectively) at 8 and 28 months (DP-3). Conclusions: Maternal carbohydrate quality during pregnancy may influence early neurodevelopment, particularly motor outcomes. Emphasizing low-GI, low-GL and high-CQI carbohydrate sources during pregnancy could support favorable developmental trajectories in offspring.
Prenatal phenol exposure and child behaviour: insights into the hypothalamic-pituitary-adrenal axis from two prospective mother-child cohorts
(2025-12-09) Rolland, Matthieu; Bustamante Pineda, Mariona; Jedynak, Paulina; Thomsen, Cathrine; Sakhi, Amrit K.; Foraster, Maria; Gascón, Mireia; Gómez Roig, Ma. Dolores; Llurba Olivé, Elisa; Rivas, Ioar; Ouellet-Morin, Isabelle; Ferrer, Muriel; Morillas, Alex; Carras, Sylvain; Bayat, Sam; Lyon-Caen, Sarah; Pozo, Oscar J.; Vrijheid, Martine; Sunyer, Jordi; Slama, Rémy; Dadvand, Payam; Philippat, Claire
Background: Synthetic phenols are widely used chemicals with potential neurodevelopmental toxicity. Human studies are often limited by small sample sizes and exposure misclassification. Identifying the biological pathways affected by these substances is crucial for understanding key drivers of toxicity. We aimed to study associations between prenatal exposure to synthetic phenols and child behaviour, exploring the potential mediating role of maternal steroid hormones. Methods: We pooled data from two European cohorts: the Barcelona Life Study Cohort (BiSC; Barcelona, Spain, 2018-21, N=1080) and Suivi de l'Exposition à la Pollution Atmosphérique durant la Grossesse et Effets sur la Santé (SEPAGES; Grenoble, France, 2014-17, N=484). Mothers older than 18 years having a singleton pregnancy of less than 19 weeks gestational age were eligible for inclusion in the cohorts; those having multiple pregnancies were excluded. Repeated urine samples (up to 24 in BiSC; up to 42 in SEPAGES) collected in the second and third trimesters were pooled and analysed for 12 synthetic phenols. Child behavioural outcomes were assessed at 18 months in BiSC and 24 months in SEPAGES using the Child Behavior Checklist for Ages 1·5-5 (CBCL). Concentrations of total cortisol, total cortisone, and 11-dehydrocorticosterone-steroid hormones involved in the hypothalamic-pituitary-adrenal axis-were measured from maternal hair samples. Associations between phenol exposure and behavioural outcomes were estimated by adjusted linear regression analysis, and mediation by steroid hormones was assessed with regression-based causal mediation analysis within the counterfactual framework. Findings: 1024 mother-child pairs were included in the study: 607 from BiSC and 417 from SEPAGES. Maternal exposure to methylparaben in the third trimester of pregnancy was associated with higher internalising scores (change in score of 0·44 [95% CI 0·10-0·79] points) and externalising scores (0·67 [0·12-1·24]) in the CBCL. In boys, maternal exposure to bisphenol S in the third trimester was linked to increased internalising scores (0·92 [0·15 to 1·75]; p=0·019) and could be linked to increased externalising scores (1·14 [-0·09 to 2·44]; p=0·070). In girls, second-trimester butylparaben and propylparaben exposure were associated with lower internalising (-1·03 [-1·84 to -0·09], p=0·033) and externalising (-0·68 [-1·23 to -0·12]; p=0·019) scores. No mediation by steroid hormones was observed. Interpretation: Prenatal exposure to phenols might influence early behavioural development, with sex-specific patterns. There was no strong evidence of mediation by maternal steroid hormones, suggesting the involvement of alternative pathways in the biological effects of phenols. Together with previous findings, these results highlight the need for stricter regulation of these compounds to reduce prenatal exposure.
Impact on delay times and characteristics of patients undergoing primary percutaneous coronary intervention in the southern metropolitan area of Barcelona after implementation of the infarction code program
(Elsevier España, 2012-10) Gómez Hospital, Joan Antoni; Cequier Fillat, Àngel R.; Dallaglio, Paolo D.; Sánchez Salado, Jose Carlos; Ariza Solé, Albert; Homs, Silvia; Lorente, Victòria; Ferreiro Gutiérrez, José Luis; Gómez Lara, Josep; Romaguera, Rafael; Salazar Mendiguchía, Joel; Teruel Gila, Luis Miguel
[eng] A standardized protocol of emergent transfer for primary percutaneous coronary intervention for patients with ST elevation myocardial infarction, defined as the Infarction Code, was implemented in June 2009 in the Catalan regional health system. The objective of this study was to evaluate the impact of the new protocol on delay times, number of procedures and clinical characteristics compared with the previous period in the population of patients referred to our hospital. Methods All consecutive patients undergoing primary percutaneous coronary intervention in our hospital were prospectively registered. The clinical characteristics, delay times and mortality in the follow-up of the protocol implementation period (June 2009-May 2010) were analyzed and compared with the previous year (June 2008-May 2009). Results During the protocol period, 514 patients were included, compared with 241 in the previous year. Age, cardiovascular risk factors, anterior myocardial infarction and procedure characteristics were similar in the 2 groups. The first medical contact to balloon time was lower in the protocol period (median time 120 min vs 88 min; P<.001). Patients in the protocol period showed a trend toward less severe disease (Killip III, rescue angioplasty). The multivariate regression analysis showed a significant association between 1-year mortality and age, Killip class≥III at admission, anterior infarction and 3-vessel disease. Conclusions The introduction of the Infarction Code program increased the number of patients treated by primary percutaneous coronary intervention with a reduction in delay times and better clinical characteristics at presentation.
The use of lymphocyte-depleting antibodies in specific populations of kidney transplant recipients: A systematic review and meta-analysis
(Elsevier, 2023-09-27) Montero Pérez, Núria; Rodrigo, Emilio; Crespo Barrio, Marta; Cruzado, Josep Ma.; Gutierrez Dalmau, Alex; Mazuecos Blanca, María Auxiliadora; Sancho Calabuig, Maria Asuncion; Belmar Vega, Lara; Calatayud Aristoy, Emma; Mora Lopez, Paula; Oliveras Pagès, Laia; Solà, Eulàlia; Villanego, Florentino; Pascual, Julio (Pascual Santos)
Background: Recommendations of the use of antibody induction treatments in kidney transplant recipients (KTR) are based on moderate quality and historical studies. This systematic review aims to reevaluate, based on actual studies, the effects of different antibody preparations when used in specific KTR subgroups. Methods: We searched MEDLINE and CENTRAL and selected randomized controlled trials (RCT) and observational studies looking at different antibody preparations used as induction in KTR. Comparisons were categorized into different KTR subgroups: standard, high risk of rejection, high risk of delayed graft function (DGF), living donor, and elderly KTR. Two authors independently assessed the risk of bias. Results: Thirty-seven RCT and 99 observational studies were finally included. Compared to anti-interleukin-2-receptor antibodies (IL2RA), anti-thymocyte globulin (ATG) reduced the risk of acute rejection at two years in standard KTR (RR 0.74, 95%CI 0.61-0.89) and high risk of rejection KTR (RR 0.55, 95%CI 0.43-0.72), but without decreasing the risk of graft loss. We did not find significant differences comparing ATG vs. alemtuzumab or different ATG dosages in any KTR group. Conclusions: Despite many studies carried out on induction treatment in KTR, their heterogeneity and short follow-up preclude definitive conclusions to determine the optimal induction therapy. Compared with IL2RA, ATG reduced rejection in standard-risk, highly sensitized, and living donor graft recipients, but not in high DGF risk or elderly recipients. More studies are needed to demonstrate beneficial effects in other KTR subgroups and overall patient and graft survival.
Participant selection for lung cancer screening using primary care electronic medical records: The Catalan scenario
(Elsevier España, 2025-11-18) Marzo Castillejo, Mercè; Mascort Roca, Juanjo; Brau Tarrida, Albert; Carrasco Ribelles, Lucía A.; Monteagudo Zaragoza, Mònica; Guiriguet Capdevila, Carolina; Espinàs Piñol, Josep Alfons; Cabrera Godoy, Olivia; Borràs Andrés, Josep Maria
Objective: To assess the feasibility of using primary care electronic health records (EHRs) and the PLCOm2012noRace lung cancer (LC) risk prediction model to identify high-risk individuals in the Catalan population. Design: Population-based cohort study. SITE: Catalonia, using data from the Information System for the Improvement of Research in Primary Care (SIDIAP), which covers approximately 80% of the population. Participants: A total of 1,998,282 individuals aged 55-79 years were initially considered, with data spanning from 2012 to 2023. After applying inclusion and exclusion criteria based on smoking status, 24,294 individuals with complete smoking history were included. Interventions: Estimation of LC risk using the PLCOm2012noRace model. Main measurements: Variables: age, smoking history, body mass index, educational level, chronic obstructive pulmonary disease, personal history of cancer, and family history of LC. A 6-year risk threshold of ≥2.6% was used to define eligibility for LC screening. Results: Overall, 18.6% of individuals exceeded the risk threshold, with higher prevalence in men (21.4%) and those aged 60-79 years (23.8%). Current smokers had the highest risk (25.7%), which decreased with time since quitting. On average, high-risk individuals could have been identified 4.29 years before. Conclusions: The use of EHRs and the PLCOm2012noRace model is a feasible approach to identify individuals at high risk of LC in the Catalan population. However, missing or outdated data, especially regarding smoking intensity, may limit the predictive performance. These findings highlight the need for systematic and timely data collection to support effective risk-based screening strategies.
Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact
(Elsevier B.V., 2024-06-10) Cano Ibáñez, Naomi; Álvarez-Álvarez, Laura; Rubín García, María; Vitelli Storelli, Facundo; García, Sílvia; Bouzas, Cristina; Martínez González, Miguel Ángel, 1957-; Corella Piquer, Dolores; Salas Salvadó, Jordi; Malcampo, Mireia; Martínez, J. Alfredo; Alonso Gómez, Ángel M.; Wärnberg, Julia; Vioque, Jesús; Romaguera, Dora; López Miranda, José; Estruch Riba, Ramon; Tinahones, Francisco J.; Lapetra, José; Serra Majem, Lluís; Bueno Cavanillas, Aurora; García Fernández, Camino; Pintó Sala, Xavier; Delgado Rodríguez, Miguel; Matía Martín, Pilar; Vidal i Cortada, Josep; Vázquez, Clotilde; Daimiel, Lidia; Ros Rahola, Emilio; Garcia-Arellano, Ana; Martínez Rodríguez, María Ángeles; Sorlí, José V.; Zomeño Fajardo, María Dolores; García Rios, Antonio; González Palacios, Sandra; Monserrat Mesquida, Margalida; Abete, Itziar; Colom Fernández, Antoni; Casas Rodríguez, Rosa M.; Ugarriza, Lucía; Bernal López, M. Rosa; Bes Rastrollo, Maira; Paz Graniel, Indira; Asensio, Eva M.; Fitó Colomer, Montserrat; Arenas Larriva, Antonio P.; Oncina Cánovas, Alejandro; Vázquez Ruiz, Zenaida; Fernández de la Puente, María; Pérez Vega, Karla Alejandra; Tur Marí, Josep A. (Josep Antoni); Martín Sánchez, Vicente
Objective: To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up. Methods: Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact. Results: We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %. Conclusions: A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.
Ibrutinib followed by ofatumumab consolidation in previously untreated patients with chronic lymphocytic leukemia (CLL): GELLC-7 trial from the Spanish group of CLL (GELLC)
(Elsevier, 2024-05-25) Abrisqueta Costa, Pau; González Barca, Eva; Ferrà, Christelle; Rios-Herranz, Eduardo; Fernández de la Mata, Margarita; Delgado, Julio (Delgado González); Andreu, Rafael; Hernandez Rivas, Jose Angel; Terol, María José; Navarro-Bailón, Almudena; Vidriales, Belén; Baltasar, Patricia; De la Serna, Javier; Ramírez, Ángel; Ballester, Carmen; Moreno, Carol; García-Marco, José Antonio; Córdoba, Raúl; Yáñez, Lucrecia; Casado, Luís Felipe; González, Marcos; Bosch Albareda, Francesc
Background: BTK inhibitors have been concurrently administered with anti-CD20 monoclonal antibodies (mAbs) in chronic lymphocytic leukemia (CLL). However, the optimal regimen for combining these two drugs remains pending. Methods: This multi-center phase 2 study aimed to analyze whether consolidation with ofatumumab improved the response in patients with CLL receiving front-line treatment with ibrutinib. Patients received 12 cycles of ibrutinib monotherapy. Those who achieved CR after this induction were maintained on ibrutinib. Conversely, those who did not attain CR continued with ibrutinib in addition to a consolidation, which involved 7 doses of ofatumumab. The primary objective was the complete response (CR) rate at cycle 20. This study is registered within the EU Clinical Trials Register (EudraCT 2016-004937-26). Findings: Between September 8, 2017, and May 21, 2018, 84 patients (median age, 69 years) were included. After completion of 12 cycles of ibrutinib (n = 80), 4 patients (5%) were in CR, 67 (84%) in partial response (PR), and 6 patients (7%) had a PR with lymphocytosis (PRL). After consolidation with ofatumumab, 20 patients improved the response from PR to CR and 6 patients with PRL obtained a PR. Seventy-one patients (85%) completed 20 cycles of treatment, with a CR rate of 24/71 (34%). According to the intention-to-treat analysis at cycle 20, the ORR was 69/84 (82.2%), with a CRR of 24/84 (28.6%). Progression-free survival and overall survival at 48-months were 89.9% (CI: 82.4-95.5) and 92.2% (CI: 85.3-97.1), respectively. Interpretation: These findings underscore the potential for a consolidation strategy in CLL, wherein the addition of a mAb in patients with low tumor burden might enhance the quality of the response.
Insulin and disorders of behavioural flexibility
(Elsevier, 2023-04-27) Scholtz, Samantha; Glennon, Jeffrey C.; Sullivan, Mairead; Fernández Aranda, Fernando; Camacho Barcia, Lucía; Harkin, Andrew; Macrì, Simone; Mora Maltas, Bernat; Jiménez-Murcia, Susana; O'Leary, Aet; Ottomana, Angela Maria; Presta, Martina; Slattery, David
Behavioural inflexibility is a symptom of neuropsychiatric and neurodegenerative disorders such as Obsessive-Compulsive Disorder, Autism Spectrum Disorder and Alzheimer's Disease, encompassing the maintenance of a behaviour even when no longer appropriate. Recent evidence suggests that insulin signalling has roles apart from its regulation of peripheral metabolism and mediates behaviourally-relevant central nervous system (CNS) functions including behavioural flexibility. Indeed, insulin resistance is reported to generate anxious, perseverative phenotypes in animal models, with the Type 2 diabetes medication metformin proving to be beneficial for disorders including Alzheimer's Disease. Structural and functional neuroimaging studies of Type 2 diabetes patients have highlighted aberrant connectivity in regions governing salience detection, attention, inhibition and memory. As currently available therapeutic strategies feature high rates of resistance, there is an urgent need to better understand the complex aetiology of behaviour and develop improved therapeutics. In this review, we explore the circuitry underlying behavioural flexibility, changes in Type 2 diabetes, the role of insulin in CNS outcomes and mechanisms of insulin involvement across disorders of behavioural inflexibility.
Prognostic impact of chronic total occlusion in a nonculprit artery in patients with acute myocardial infarction undergoing primary angioplasty.
(Elsevier España, 2014-05-01) Ariza Solé, Albert; Teruel Gila, Luis Miguel; Marco, Andrea di; Lorente, Victòria; Sánchez Salado, Jose Carlos; Sánchez Elvira, Guillermo; Romaguera, Rafael; Gómez Lara, Josep; Gómez Hospital, Joan Antoni; Cequier Fillat, Àngel R.
[eng] Introduction and objectives: The prognostic value of chronic total occlusion in nonculprit coronary arteries in patients with myocardial infarction undergoing primary angioplasty remains controversial. Several publications have described different methodologies and conflicting findings. In addition, causes of death were not reported. Our aim is to analyze the prognostic impact of chronic total occlusion in nonculprit coronary arteries and the role of left ventricular ejection fraction in this analysis. Methods: Prospective inclusion of consecutive patients with ST-segment elevation myocardial infarction who underwent primary angioplasty. We recorded baseline characteristics, in-hospital clinical course, and mortality and its causes during follow-up. We assessed the impact of chronic total occlusion on mortality using Cox regression analysis. Results: Chronic total occlusion in nonculprit arteries was present in 125 of 1176 patients (10.6%); in 79 of these 125 patients, chronic total occlusion was present in the proximal segments. The mean follow-up was 339 days; 64 (5.8%) patients died during the first 6 months. Patients with chronic total occlusions had more comorbidities, poorer ventricular function, and higher mortality (hazard ratio=2.79; 95% confidence interval, 1.71-4.56). Chronic total occlusion was also associated with noncardiac death (hazard ratio=3.83; 95% confidence interval, 2.10-7.01). Chronic total occlusion in proximal segments was associated with both cardiac (hazard ratio=3.22; 95% confidence interval, 1.42-7.30) and noncardiac deaths (hazard ratio=3.43; 95% confidence interval, 1.67-7.06). The multivariate analysis performed without including left ventricular ejection fraction showed a significant association between chronic total occlusion and mortality. However, when left ventricular ejection fraction was included in the analysis, this association was nonsignificant (hazard ratio=1.76; 95% confidence interval, 0.85-3.65; P=.166). Conclusions: Chronic total occlusion in this clinical setting identified patients at higher risk with more comorbidities and higher mortality, but did not behave as an independent predictor of mortality when left ventricular ejection fraction was included in the analysis.
Is it possible to separate ischemic and bleeding risk in patients with non-ST segment elevation acute coronary syndromes?
(Elsevier B.V., 2014-02-15) Ariza Solé, Albert; Sánchez Salado, Jose Carlos; Lorente, Victòria; Sánchez Elvira, Guillermo; Muntané, Guillem; Salazar Mendiguchía, Joel; Cequier Fillat, Àngel R.
Both intensive antithrombotic therapy and an early invasive strategy reduce the incidence of ischemic events in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), at the expense of increasing the rate of bleeding complications. Current recommendations [1] emphasize the use of an early invasive strategy in patients at higher risk. However, most registries show a more conservative management in these patients
Efficacy of Bleeding Risk Scores in Elderly Patients With Acute Coronary Syndromes
(Elsevier España, 2014-06) Ariza Solé, Albert; Formiga Pérez, Francesc; Lorente, Victòria; Sánchez Salado, Jose Carlos; Sánchez Elvira, Guillermo; Roura Ferrer, Gerard; Sánchez Prieto, Remedios; Vila Sala, Maria; Moliner Borja, Pedro; Cequier Fillat, Àngel R.
[eng] The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting. The available bleeding risk scores have not been validated specifically in the elderly. Our aim was to assess predictive ability of the most important bleeding risk scores in patients with acute coronary syndrome aged >= 75 years. Methods: We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves. Results: We included 2036 patients, with mean age of 62.1 years; 369 patients (18.1%) were >= 75 years. Older patients had higher bleeding risk (CRUSADE, 42 vs 22; Mehran, 25 vs 15; ACTION, 36 vs 28; P<.001) and a slightly higher incidence of major bleeding events (CRUSADE bleeding, 5.1% vs 3.8%; P=.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; P = .027; Mehran: 0.67 in older patients, 0.73 in younger patients; P = .340; ACTION: 0.58 in older patients, 0.75 in younger patients; P = .041). Conclusions: Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.
CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention
(Elsevier Ltd., 2013-10-10) Ariza Solé, Albert; Sánchez Elvira, Guillermo; Sánchez Salado, Jose Carlos; Lorente-Tordera, Victoria; Salazar Mendiguchía, Joel; Sánchez Prieto, Remedios; Romaguera-Torres, Rafael; Ferreiro Gutiérrez, José Luis; Gómez Hospital, Joan Antoni; Cequier Fillat, Àngel R.
Introduction: The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Materials and methods: We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC). Results: We included 1064 patients (mean age 63years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n=621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001). Conclusions: Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.
Early anticoagulation may improve preprocedural patency of the infarct-related artery in primary percutaneous coronary intervention.
(Elsevier España, 2013-02-01) Ariza Solé, Albert; Ferreiro Gutiérrez, José Luis; Sánchez Salado, Jose Carlos; Lorente, Victòria; Gómez Hospital, Joan Antoni; Cequier Fillat, Àngel R.
The aim of this study was to evaluate the impact of early administration of anticoagulation therapy (at diagnosis) compared with its application in the cardiac catheterization laboratory at the start of the procedure on the initial patency of the infarct-related artery (IRA) in patients undergoing pPCI as a reperfusion strategy.
Geriatric assessment for predicting outcomes among patients with aortic stenosis undergoing transcatheter aortic valve implantation
(Tsinghua University Press, 2025-12-01) Calvo, Elena; Castillo, P.; Romaguera, Rafael; Llaó, Isaac; Zafrilla Nieto, Raquel; Domene, Gerard; Alegre Canals, Oriol; Lorente, Victòria; Muntané Carol, Guillem; Formiga Pérez, Francesc; Cuerda Llorente, Francisco Javier de la; Gómez Hospital, Joan Antoni; Ariza Solé, Albert
Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis (AS). We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation (TAVI) and to analyze the ability of different tools for predicting clinical outcomes in this context. Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge. The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI. Results A total of 377 patients were included (mean age of 80.4 years). Most patients were independent or mildly dependent, with an optimal cognitive status. The proportion of frailty ranged from 17.6% to 49.8%. A total of 20 patients (5.3%) died and 110/377 patients (29.2%) died or were readmitted during follow up. Overall, most components of the geriatric assessment showed an association with clinical outcomes. Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission. The association between frailty and clinical outcomes was higher for short physical performance battery (SPPB), essential frailty toolset (EFT) and the frailty index based on comprehensive geriatric assessment (IF-VIG) and lower for Fried criteria and FRAIL scale. Conclusions AS patients from this series presented a good physical performance, optimal cognitive status and a reasonably low prevalence of frailty. The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT, SPPB and the IF-VIG.

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