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Resting-state brain connectivity following extra virgin olive oil intake in healthy adults: a randomised crossover pilot neuroimaging substudy
(Royal Society of Chemistry, 2026-04-08) Estruch Riba, Ramon; Lamuela Raventós, Rosa Ma.; Gutiérrez-Romero, Rocío M.; Donat Vargas, Carolina; Muñoz-Moreno, Emma; Hinojosa-Moscoso, Alejandro; Galkina, Polina; Arancibia Riveros, Camila; Domínguez-López, Inés; Hurtado Barroso, Sara; Pérez Bosch, Maria; Vallverdú i Queralt, Anna; Casas Rodríguez, Rosa M.
This pilot randomised crossover neuroimaging substudy (n = 9) identified increased resting-state occipital functional connectivityfollowing daily consumption of (poly)phenol-rich extra virgin olive oil compared with regular olive oil. Urinary hydroxytyrosol-glucuronideexcretion increased significantly, and a significant interaction between intervention and metabolite levels was observed on occipitalconnectivity. These preliminary findings require replication in larger, adequately powered studies.
CAR-T cell therapy for cancer: current challenges and future directions
(Springer Nature, 2025-07-04) Zugasti, Inés; Espinosa-Aroca, Lady; Fidyt, Klaudyna; Mulens-Arias, Vladimir; Díaz Beyà, Marina; Juan, Manel; Urbano Ispizua, Álvaro; Esteve, Jordi; Velasco-Hernandez, Talia; Menéndez Buján, Pablo
Chimeric antigen receptor T (CAR-T) cell therapies have transformed the treatment of relapsed/refractory (R/R) B-cell malignancies and multiple myeloma by redirecting activated T cells to CD19- or BCMA-expressing tumor cells. However, this approach has yet to be approved for acute myeloid leukemia (AML), the most common acute leukemia in adults and the elderly. Simultaneously, CAR-T cell therapies continue to face significant challenges in the treatment of solid tumors. The primary challenge in developing CAR-T cell therapies for AML is the absence of an ideal target antigen that is both effective and safe, as AML cells share most surface antigens with healthy hematopoietic stem and progenitor cells (HSPCs). Simultaneously targeting antigen expression on both AML cells and HSPCs may result in life-threatening on-target/off-tumor toxicities such as prolonged myeloablation. In addition, the immunosuppressive nature of the AML tumor microenvironment has a detrimental effect on the immune response. This review begins with a comprehensive overview of CAR-T cell therapy for cancer, covering the structure of CAR-T cells and the history of their clinical application. It then explores the current landscape of CAR-T cell therapy in both hematologic malignancies and solid tumors. Finally, the review delves into the specific challenges of applying CAR-T cell therapy to AML, highlights ongoing global clinical trials, and outlines potential future directions for developing effective CAR-T cell-based treatments for relapsed/refractory AML.
Efficacy, acceptability, and related outcomes of pharmacological interventions for acute bipolar depression: A systematic review and dose-related network meta-analysis across different age groups
(Elsevier B.V., 2026-06-23) Fornaro, Michele; Di Lorenzo, Chiara; Oliva, Vincenzo; De Prisco, Michele; Vieta i Pascual, Eduard, 1963-
Background: Acute bipolar depression poses a significant burden and socioeconomic costs. We investigated the comparative efficacy/response/acceptability of pharmacological interventions for acute bipolar depression, considering dose effects across different age groups. Methods: We conducted a network meta-analysis (NMA), searching for randomized controlled trials (RCTs) comparing pharmacological interventions against each other/or placebo in patients with acute bipolar depression (Type-I/Type-II/other), indexed in PubMed/MEDLINE, Embase, Web-of-Science/and Scopus (database inception up to 2025.11.25). Co-primary outcomes were change in depressive symptoms/response/and acceptability. Tolerability/remission/change in anxious symptoms/and risk-of-manic/hypomanic switches were secondary outcomes. Confidence-In-Network-Meta-Analysis was likewise appraised. Results: 103 RCTs, encompassing 71 distinct treatment combinations, included 20,941 participants. Sensitivity analysis including low-risk-of-bias studies only and excluding outliers for possible effect modifiers indicated that lamotrigine 50 mg/day or 200 mg/day, quetiapine extended-release 150 mg/day and 300 mg/day, and lumateperone 42 mg/day outperformed placebo for depressive symptoms, with estimates ranging from -1.53(95%C.I. = -2.13;-0.93) for lamotrigine 50 mg/day, to -0.36(95%C.I. = -0.68;-0.04) for lumateperone 42 mg/day. Several additional drugs might be efficacious, although they emerged as outliers for either mean age of participants/proportion of females/BD-II participants/psychotic features/rapid cycling/baseline severity of depression/and trial duration. No treatment outperformed placebo for response/remission/acceptability/tolerability/and manic/hypomanic switches. Conclusions: Our findings are consistent with previous NMAs and current guidelines, thereby expanding knowledge by concurrently appraising different drugs, doses, and age groups.
Neuroprogression in bipolar disorder: why right is wrong
(Cambridge University Press (CUP), 2024-07-01) Vieta i Pascual, Eduard, 1963-
The controversy on whether bipolar disorder is a neurodevelopmental versus a neuroprogressive illness is still around, despite some reductionistic claims that only one model is right. The current diagnostic classifications are not helpful to address this issue, and there is conflicting evidence in favor and against either model. In practice, though, understanding that many patients may show a progressive cognitive and functional decline which may be correlated with the number and severity of episodes may lead to better outcomes through early intervention strategies.
Neuroprogression happens
(Cambridge University Press (CUP), 2024-10-01) Vieta i Pascual, Eduard, 1963-
I read with interest the contribution by Samamé on neuroprogression in bipolar disorder (Samamé, in press) in response to a commentary on the same topic (Vieta, 2024), and appreciate the opportunity to further discuss the nuances around the origin and course of cognitive impairment in patients with bipolar disorder from a scientific perspective. The neuroprogression model fits well in some patients, but not all. When addressing cognition and functioning in conditions such as bipolar disorder, heterogeneity is the rule.
Predicting the past: The risks and rewards of post-hoc findings
(Elsevier B.V., 2025-03-01) Oliva, Vincenzo; Vieta i Pascual, Eduard, 1963-
Given the age of this sophism, one could say that it is human nature to connect existing elements—events, outcomes, or data—and link them in a way that feels coherent. However, there is the risk that this coherence is artificial
Bipolar disorder
(Elsevier B.V., 2016-04-09) Grande, Iria; Berk, Michael; Birmaher, Boris; Vieta i Pascual, Eduard, 1963-
Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression. Moreover, there are currently no valid biomarkers for the disorder. Therefore, the role of clinical assessment remains key. Detection of hypomanic periods and longitudinal assessment are crucial to differentiate bipolar disorder from other conditions. Current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder is of utmost importance.
Discovery of Donor-Derived Exosomal DNA as an Exploratory Biomarker of Kidney Graft Rejection: A Cross-Sectional Study
(Frontiers Media, 2026-03-18) Cuadrado Payán, Elena; Ramírez Bajo, María José; Bañón Maneus, Elisenda; Rovira Juárez, Jordi; Hierro García, Natalia; Serrano Jorcano, Daniel; Argudo, María; Montagud Marrahi, Enrique; Rodríguez Espinosa, Diana; Arana, Carolt; Molina Andújar, Alícia; Gonzalez Rojas, Ángela; Esforzado Armengol, Núria; Torregrosa, Vicens; Ventura Aguiar, Pedro; Broseta, José Jesús; González Roca, Eva; Palou Rivera, Eduard; Diekmann, Fritz; Cucchiari, David; Revuelta, Ignacio
Circulating donor DNA has emerged as a valuable tool for clinical decision-making in kidney transplantation. While most studies focus on cell-free DNA, the role of donor DNA associated with extracellular vesicles (EVs) remains unexplored. To address this, we analyzed donor-derived exosomal DNA (dd-exoDNA) in 100 kidney transplant recipients (KTR) undergoing surveillance or indicated biopsies. Serum exosomes were isolated using precipitation-based technology, and dd-exoDNA was analyzed via digital PCR targeting donor/recipient HLA-DRB1 mismatches. Dd-exoDNA levels were higher in rejection versus non-rejection (2.66 [0.56-7.10] ×10-3 vs. 0.69 [0.28-1.71] ×10-3, p = 0.004) and were associated with Banff score items: glomerulitis ≥1 (p = 0.037), peritubular capillaritis ≥1 (p = 0.040), and tubulitis ≥2 (p = 0.043). In multivariate analysis, dd-exoDNA remained independently associated with rejection, although with wide confidence intervals (OR [95%CI] 3.68 [1.32-10.26], P = 0.013). Exploratory threshold analyses suggested moderate discriminative performance. These findings indicate that donor DNA associated with circulating EVs may offer complementary information to existing biomarkers, warranting validation in external cohorts and comparison with established assays.
Short-term Safety of one Anastomosis Gastric Bypass (OAGB) Versus Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): 30-day Results from the OASIS trial.
(Springer Verlag, 2026-04-01) Lopez Gonzalez, Ruth; Sanchez Cordero, Sergi; Hermoza, Rodrigo; Pujol Gebelli, Jordi
BACKGROUND: Metabolic and bariatric surgery (MBS) is an effective treatment for obesity, but selecting the optimal technique remains challenging. One Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Duodeno-Ileal with Sleeve Gastrectomy (SADI-S) are increasingly used, yet direct comparisons are scarce. OBJECTIVES: To compare 30-day outcomes of OAGB and SADI-S in patients with a BMI of 45–50 kg/m², focusing on safety and short-term efficacy within the OASIS trial. METHODS: In this randomized, single-blind trial, 89 patients underwent laparoscopic OAGB (n = 48) or SADI-S (n = 41). The primary endpoint is 5-year weight loss; this manuscript reports a planned 30-day safety analysis. Complications were graded using the Clavien-Dindo scale. Secondary outcomes included operative time, hospital stay, and early weight loss. RESULTS: Severe complications (Clavien-Dindo ≥ IIIb) occurred in 7.3% of SADI-S and 2.1% of OAGB patients (p = 0.33). Reoperations were also more common in SADI-S (7.3% vs. 2.1%; p = 0.33). Operative time was significantly longer for SADI-S (103.8 ± 18.4 vs. 82.2 ± 23.9 min; p < 0.001). No significant differences were found in early weight loss or comorbidity resolution. No 30-day mortality was recorded. CONCLUSIONS: OAGB was associated with fewer complications and shorter operative times compared to SADI-S, although differences in severe complications and reoperations were not statistically significant. Long-term data are needed to fully evaluate outcomes.
Operational performance of a programmatic mass drug administration campaign for malaria in southern Mozambique: a comprehensive mixed-methods evaluation of implementation outcomes
(BioMed Central, 2026-04-07) Fuente Soro, Laura; Tusell Rabassa, Maria; Vecchio, Jacopo; Nhangave, Amancio; Bapu, Khalid; Riley, Christina; Materrula, Felisbela; Dimene, Mércia; Sibindy, Samira; Candrinho, Baltazar; Aide, Pedro Carlos Paulino; Guinovart, Caterina
BACKGROUND: The World Health Organization (WHO) recommends Mass Drug Administration (MDA) to reduce malaria transmission in low-transmission settings, with a target coverage of at least 80%. To maximize impact, the development of effective and sustainable programmatic implementation strategies is essential. Between December 2022 and February 2023, two rounds of programmatic MDA (pMDA) were implemented in Chidenguele, in Gaza province, Mozambique. The target population was approximately 59,271 individuals. Door-to-door drug distribution, using dihydroartemisinin-piperaquine, was guided by satellite imagery-based mapping. METHODS: A mixed-methods evaluation was conducted to assess operational performance —including acceptability, appropriateness, coverage, feasibility, fidelity, and adoption— using a community household survey (n = 770), a health staff survey (n = 28), and field observations (n = 149). RESULTS: Among household survey participants eligible for medication during round 2, 96,2% (607/631) accepted to participate in the pMDA. All health staff survey participants and 91,3% (703/770) of household survey participants considered taking antimalarials while asymptomatic to be an acceptable preventive measure. All health staff survey participants (28/28) and 84,1% (648/770) of household survey participants felt the intervention was appropriate for reducing malaria transmission in the community. Programmatic or contact coverage (proportion of survey participants that received pMDA treatment) reached 73,9% (569/770), while operational coverage (proportion of those present at the time of the intervention that received pMDA treatment) was 90,2% (569/631). All health staff survey participants (28/28) considered the pMDA implementation strategy feasible to implement. In terms of fidelity, direct observations of pMDA household visits showed that pMDA distribution teams correctly explained the purpose of the visit in 74,5% (111/149) of interactions, requested verbal consent in 86,6% (129/149), and emphasized the importance of completing the treatment in 60,4% (90/149). Health staff survey participants showed strong willingness to adopt the procedures, with 86.0% (24/28) and 96.0% (27/28) expressing high commitment in rounds 1 and 2, respectively. CONCLUSIONS: Despite the pMDA delivery strategy being implemented with good operational performance and being well accepted by the community and health staff, reaching the 80% coverage target remains challenging. Sustained collaboration and active engagement from communities, partners, and policymakers, and enhancement of some key outcomes, such as the fidelity of the implementation, are critical to improving coverage and ensuring the success of pMDA campaigns.
Cognition Assessment in Virtual Reality (CAVIR)-Spanish Version: Validation of a Novel Virtual Reality Test for Daily-Life Cognitive Skills in Bipolar Disorder
(John Wiley & Sons, 2026-06-01) Fares Otero, Natalia Elena; Solé Cabezuelo, Brisa; Elleby Jespersen, Andreas; Roberto, Natalia; Martín Parra, Sara; López Escribano, Ricardo; Pérez Ramos, Anaid; Piazza, Flavia; Ruiz Muñoz, Andrea; Varo, Cristina; Lumbye, Anders; Vieta i Pascual, Eduard, 1963-; Martínez-Arán, Anabel, 1971-; Woznica Miskowiak, Kamilla
Objectives: There is a need for ecologically valid measures of real-life cognitive functioning. We investigated: (I) the sensitivity of the Cognition Assessment in Virtual Reality (CAVIR) test, which assesses daily-life cognitive skills in an immersive virtual reality kitchen scenario, to capture cognitive impairments in a Spanish sample of patients with bipolar disorder (BD) compared to healthy controls (HCs); (II) the convergent validity of CAVIR against standard neuropsychological tests and functional measures. Methods: Patients with BD in full/partial remission (n = 40) and HCs (n = 40) completed the CAVIR–Spanish version and standard neuropsychological tests; the Hamilton Depression Rating Scale (HRDS-17), the Young Mania Rating Scale (YMRS), the Functioning Assessment Short-Test (FAST) and the Brief University of California Performance-based Skills Assessment (UPSA-B). Between-group comparisons of CAVIR global and subtask scores were conducted, together with correlation and linear regression analyses adjusting for age and mood symptoms. Results: CAVIR was sensitive to cognitive impairments in BD, with patients showing poorer performance than HCs on CAVIR global composite (BD = −1.09, 95% CI [−1.44, 0.74] vs. HCs = −0.19, 95% CI [−0.53, 0.15]) (F(1,72) = 9.52, p = 0.003, 2 = 0.12) and subtasks of sustained attention (BD = −1.25, 95% CI [−1.83, −0.70] vs. HCs = −0.14, 95% CI [−0.66, 0.37]) (F(1,69) = 6.12, p = 0.016, 2 = 0.08), processing speed (BD = −1.64, 95% CI [−2.11, −1.18] vs. HCs = −0.20, 95% CI [−0.66, 0.25]) (F(1,68) = 13.67, p < 0.001, 2 = 0.17) and working memory (BD = −0.91, 95% CI [−1.42, −0.41] vs. HCs = 0.05, 95% CI [−0.42, 0.52]) (F(1,71) = 5.50, p = 0.022, 2 = 0.07). The global CAVIR composite and subtasks scores were associated with standard global neurocognitive composite and domains, respectively (σ = 0.50–0.74, p < 0.001). The global CAVIR and all subtasks scores were associated with both observed/interview-based (FAST; σ = −0.29 to −0.55, p < 0.001) and performance-based (UPSA-B; σ = 0.29–0.49, p < 0.05) functional outcomes. Conclusions: The CAVIR-Spanish version is a sensitive and valid instrument for measuring real-life cognitive skills in BD and may be implemented in clinical settings and treatment trials targeting cognition following further studies.
Resilience in Bipolar Disorder Compared to Clinical and Non-Clinical Populations: A Systematic Review and Meta-Analysis
(John Wiley & Sons, 2026-01-01) Clougher, Derek; De Prisco, Michele; Solé Cabezuelo, Brisa; Montejo Egido, Laura; Serra Navarro, Maria; Forte, Maria Florencia; Camprodon Boadas, Patricia; Serna, Elena de la, 1978-; Oliva, Vincenzo; Martín Parra, Sara; Sánchez-Moreno, José; Amann, Benedikt L.; Garriga, Marina; Verdolini, Norma; Ribasés Haro, Marta; Miskowiak, Kamilla W.; Martínez-Arán, Anabel, 1971-; Vieta i Pascual, Eduard, 1963-; Amoretti Guadall, Silvia; Torrent Font, Carla
Introduction: Resilience is present in both clinical and non-clinical populations; yet, there is a paucity of literature examining its role in bipolar disorder (BD). The goal of the present systematic review and meta-analysis was to substantiate the extant literature investigating resilience in BD in comparison to clinical and non-clinical populations. Method: PubMed/MEDLINE, PsycINFO, and Scopus were systematically searched from inception to August 8th, 2024. Results: Twenty-eight studies using a validated resilience scale with a total of 3094 people with BD, 4100 healthy controls, and 1768 with other mental diagnoses were included in the systematic review, and 21 were analyzed in a random effects meta-analysis. A statistically significant result with a medium effect (SMD = −0.787, p < 0.001) indicated that people with BD reported lower levels of resilience than healthy controls. Similarly, patients with BD showed higher levels of resilience than patients with schizophrenia (SCZ) (SMD = 0.336, p = 0.013). No significant differences were found between BD and major depressive disorder (MDD). Conclusion: Findings should be interpreted with caution due to the high heterogeneity observed and methodological challenges in the definition and measurement of resilience. Future research should aim to better characterize resilience in BD by improving its assessment as a standardized element of clinical evaluation. This will provide a basis for strategies to reduce the burden of this chronic condition.
Prothrombotic platelet phenotype in major depression: downregulation by antidepressant treatment
(Elsevier B.V., 2014-04) López Vilchez, Irene; Serra Millàs, Montserrat; Navarro, Valentín; Hernández, Maria Rosa; Villalta Blanch, Jaume; Diaz Ricart, M. Isabel; Gastó Ferrer, Cristóbal; Escolar Albaladejo, Ginés; Galán, Ana María
Background: Serotonergic mechanisms have been suggested as a link between major depression and cardiovascular risk. We investigated the existence of a prothrombotic condition in depressed patients and its possible modulation during treatment with a selective serotonin-reuptake inhibitor (SSRI). Methods: Modifications in a series of biomarkers of platelet and coagulation activation were evaluated in blood from 19 patients with a major depression disorder (MDD) at the time of diagnosis, and at 8 and 24 weeks of treatment with escitalopram. Response of blood aliquots recirculated through a thrombogenic surface was assessed in a thrombosis model. Results were compared with those of 20 healthy-matched controls. Results: In comparison with controls, platelets from MDD patients showed elevated volumes (p<0.01), significantly enhanced aggregating response to arachidonic acid and augmented expression of GPIb, fibrinogen, factor V, and anionic phospholipids by flow cytometry (p<0.05). Clot firmness and procoagulant activity of platelet-associated tissue factor were also significantly elevated (p<0.05). Studies with circulating blood revealed increased fibrin formation in early diagnosed patients (71.1±9.5% vs. 45.8±5.3%; p<0.05 vs. controls). After 24 weeks of treatment with escitalopram, the majority of the alterations observed were normalized, except for a residual increased expression of GPIIbIIIa (p<0.05) and persistent alterations in thromboelatometic parameters. Limitations: Despite the reduced number of followed-up patients our findings were consistent reaching statistical significance. Conclusions: Our results reveal a prothrombotic phenotype in MDD patients. While continuous treatment with an SSRI downregulated the majority of the biomarkers analyzed, alterations in viscoelastic parameters of clot formation remained unaffected by the antidepressant treatment.
Association between symptomatic profile and remission following antidepressant treatment in unipolar major depression
(Elsevier B.V., 2013) Navarro, Valentín; González, Alejandro; Guarch, Joana; Penadés Rubio, Rafael; Torra, Mercè; Fañanás Saura, Lourdes; Arias Sampériz, Bárbara; Serra, Maria; Pintor Pérez, Luis; Gastó Ferrer, Cristóbal
Background: To evaluate, in patients affected by an acute major depressive episode, what predictive value certain baseline psychopathological characteristics have with regard to expected therapeutic remission following biological antidepressant treatment (pharmacological/electroconvulsive; non-psychological). Methods: Six predefined psychopathological characteristics in acute major depressive episode were evaluated using a logistic regression model through a protocolised antidepressant treatment to assess their predictive value with regard to expected remission rate. Results: The final study sample consisted of 129 subjects affected by an acute major depressive episode. From the baseline evaluation of the anguish/restlessness, reduced emotional reactivity, reduced attention, reduced motor response, feeling of worthlessness, and mood characteristics items, it was possible to correctly classify 88.1% of the sample as remitter/non-remitter with sensitivity of 0.77 and specificity of 0.96. Addition of the 17-item HRSD baseline variable to the regression model increased the capacity for correct classification of the baseline sample by only 0.09%. Limitations: Protocolised antidepressant treatment was used. The results of this study may not be generalisable to pharmacological treatments not included in this protocol. Conclusions: The results of this study suggest that certain baseline psychopathological characteristics (and perhaps other clinical variables too) of the acute major depressive episode may be of great use in establishing patient subgroups according to expected clinical remission to the administration of biological antidepressant treatment. This could have considerable consequences for individualised therapeutic decision-making and for future researches (clinical trials included).
Changes in plasma and platelet BDNF levels induced by S-citalopram in major depression
(Elsevier B.V., 2011) Serra-Millàs, Montserrat; López Vilchez, Irene; Navarro, Valentín; Galán, Ana María; Escolar Albaladejo, Ginés; Penadés Rubio, Rafael; Catalán Campos, Rosa; Fañanás Saura, Lourdes; Arias Sampériz, Bárbara; Gastó Ferrer, Cristóbal
OBJECTIVES: Compare BDNF levels in depressed patients and healthy controls in platelet poor plasma and in washed platelets. Observe the effects of 8 and 24 week treatment with S-citalopram on these levels. METHODS: We assessed the levels of BDNF in platelet poor plasma and in washed platelets from 18 major depression patients, and compared them with 14 healthy controls. Blood samples were obtained from patients before and during treatment (8 and 24 weeks) with a selective serotonin reuptake inhibitor, S-citalopram. RESULTS: A significant decrease in severity of depressive symptoms was observed from the first month of treatment with S-citalopram, and symptoms continued decreasing until the 6th month. Plasma BDNF levels in untreated patients appeared significantly increased (p<0.01), but reached values similar to those of controls at the 24th week. In contrast, levels of platelet BDNF appeared significantly decreased (p<0.05), but treatment also normalized levels so that values obtained were equivalent to those of controls. CONCLUSIONS: Untreated depressed patients showed increased plasma BDNF levels and decreased platelet BDNF levels, as compared with control subjects, and tend to normalize during treatment with S-citalopram for 24 weeks, with BDNF reaching levels similar to those in healthy controls at the 24th week in both samples. We observed that improvement in depressive symptoms was accompanied by normalization of plasma and platelet BDNF levels.
Managing Enterococcus faecium bloodstream infection: a Delphi document on clinical recommendations and research agenda
(Elsevier, 2026-05-02) Rinaldi, Matteo; Bartoletti, Michele; Cojutti, Piergiorgio; Escolà Vergé, Laura; Fernández Hidalgo, Nuria; Hornuss, Daniel; Gatti, Milo; Gudiol González, Carlota; Gutiérrez-Gutiérrez, Belén; López Cortés, Luis E.; Kern, Winfried V.; Los-Arcos, Ibai; Muñoz, Patricia; Oliva, Alessandra; Papadimitriou-Olivgeris, Matthaios; Pai, Manjunath; Pea, Federico; Pericàs, Juan M.; Rieg, Siegbert; Russo, Alessandro; Soriano Viladomiu, Alex; Thursky, Karin; Udy, Andrew; Venditti, Mario; Yahav, Dafna; Mo, Yin; Viale, Pierluigi; Giannella, Maddalena
Background: Management of E faecium bloodstream infections (BSIs) remains debated, particularly the clinical impact of vancomycin resistance, the role of follow-up cultures, and optimal therapeutic regimens. This study aimed to reach expert consensus on these unresolved clinical domains and identify priorities for future research. Methods: We first conducted a systematic review and meta-analysis in January 20, 204 focusing on four predefined areas: mortality in E faecium BSIs compared with other BSIs, mortality in vancomycin-resistant enterococci (VRE)-BSIs compared with vancomycin-susceptible enterococci-BSIs, management of catheter-related E faecium BSIs, and 4) optimal antibiotic therapy for VRE-BSIs. These results informed a three-round Delphi process involving a panel of experts. An iterative approach was adopted: 16 initial questions developed from the systematic review (6-point Likert scale) were refined across rounds based on expert feedback. Consensus was defined as at least 80% agreement or disagreement. Findings: 13 statements were generated across three broader domains. Regarding clinical outcomes and diagnostics, experts agreed that mortality is heavily influenced by comorbidities; thus, therapeutic assessment should rely on clinical trends and inflammatory markers, with follow-up blood cultures used to confirm eradication. Catheter-related BSI should be managed with device removal and short-course (<7 days) antibiotics in selected uncomplicated cases. For therapeutic management, teicoplanin is preferred for vanB VRE-BSI. For vanA VRE-BSI, both linezolid and high-dose daptomycin (>9 mg/kg per day) are effective, reserving daptomycin-based combinations for challenging cases (deep-seated infections and/or high Minimum Inhibitory Concentrations). Finally, future trials evaluating the impact of antimicrobial therapy should use Desirability-of-Outcome-Ranking analysis; the in-vitro potential of oritavancin justifies targeted randomized trials to define its clinical efficacy in VRE-BSI. Interpretation: This paper delineates current evidence and expert consensus on management of E faecium BSI while identifying crucial knowledge gaps to guide future clinical research.
Inequities in Waiting Times for Major Elective Surgery Before and After the COVID-19 Pandemic: Socioeconomic and Sex Differences in the Southern Barcelona Metropolitan Area
(MDPI, 2026-03-01) Pericas Escale, Carles; Vilaplana Carnerero, Carles; Poltorak, Violeta; Redondo, Ana; Masuet Aumatell, Cristina; Tor Roca, Alba; Pagès Fernández, Constança; Grau, María
Background: Waiting times for elective surgery are widely used as indicators of health system performance, particularly following the disruption caused by COVID-19. The objective of this study is to compare the waiting times for major elective surgeries in the Southern Barcelona Metropolitan Area before (2018–2019) and after (2022–2023) the pandemic, examining differences according to sociodemographic characteristics. Methods: A retrospective comparative study was conducted using data from the Southern Barcelona Metropolitan Area between 2018 and 2023. Adults registered on the waiting list for major elective surgical procedures were included. All analyses were stratified by sex. A stratified pre–post pandemic analysis was conducted to examine differences in waiting times by Socioeconomic Index. Waiting times were modelled using generalized linear models with a Gamma distribution and log link, adjusting for age and Socioeconomic Index quartiles. Interaction between period and Socioeconomic Index was tested. Results: The analysis included 73,055 individuals (50.5% women). Median waiting time decreased after the COVID-19 pandemic for both sexes (women: 128 to 121 days; men: 99 to 94 days). This reduction showed an inverse socioeconomic gradient. Adjusted analyses showed longer waits in the lowest versus highest Socioeconomic Index quartile after the pandemic (women: RR = 1.23; men: RR = 1.30). Conclusions: Waiting times for major elective surgery decreased after COVID-19. An exclusive focus on waiting time indicators may conceal structural barriers to access and contribute to inequalities. Equity-sensitive monitoring of elective care is essential to ensure a fair recovery of surgical services.
Cecal volvulus secondary to iatrogenic postoperative intestinal obstruction
(Elsevier, 2021-11-01) Domínguez Garijo, Paula; Guzmán, Yoelimar
A 61-year-old woman with medical records of endometrioid carcinoma that required open cytoreductive surgery in 2018 and recent laparoscopic right partial nephrectomy consulted in the emergency room in the seventh postoperative day due to abdominal pain, distension, and constipation. Upon evaluation of the physical examination, the patient presented abdominal distension, with pain on palpation of the left hemiabdomen, without signs of peritoneal irritation
Incidence of Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-analysis, and Meta-regression
(Elsevier, 2022-02-01) Orci, Lorenzo A.; Sanduzzi Zamparelli, Marco; Caballol, Berta; Sapena, Víctor; Colucci, Nicola; Torres, Ferran; Bruix, J.; Reig, María; Toso, Christian
Background & Aims Nonalcoholic fatty liver disease (NAFLD) may be a risk factor for hepatocellular carcinoma (HCC), but the extent of this association still needs to be addressed. Pooled incidence rates of HCC across the disease spectrum of NAFLD have never been estimated by meta-analysis. Methods In this systematic review, we searched Web of Science, Embase, PubMed, and the Cochrane Library from January 1, 1950 through July 30, 2020. We included studies reporting on HCC incidence in patients with NAFLD. The main outcomes were pooled HCC incidences in patients with NAFLD at distinct severity stages. Summary estimates were calculated with random-effects models. Sensitivity analyses and meta-regression analyses were carried out to address heterogeneity. Results We included 18 studies involving 470,404 patients. In patients with NAFLD at a stage earlier than cirrhosis, the incidence rate of HCC was 0.03 per 100 person-years (95% confidence interval [CI], 0.01–0.07; I2 = 98%). In patients with cirrhosis, the incidence rate was 3.78 per 100 person-years (95% CI, 2.47–5.78; I2 = 93%). Patients with cirrhosis undergoing regular screening for HCC had an incidence rate of 4.62 per 100 person-years (95% CI, 2.77–7.72; I2 = 77%).
Factors associated with late presentation to the emergency department in patients complaining of chest pain.
(Elsevier, 2021-06-29) Miró i Andreu, Òscar; Troester, Valentina; García Martínez, Ana; Martínez Nadal, Gemma; Coll-Vinent i Puig, Blanca; Lopez-Ayala, Pedro; Gil Espinosa, Victor; Aguiló, Sira; Galicia, Miguel; Jiménez, Sònia; López Barbeito, Beatriz; Moll, Conxi; Sánchez Marcos, Carolina; Cardozo, Carol; López Sobrino, Teresa; Strebel, Ivo; Boeddinghaus, Jasper; Nestelberger, Thomas; Bragulat Baur, Ernesto; Sánchez Sánchez, Miguel; Müller, Christian
Objective We investigated which factors predict late presentation (LP) to the emergency department (ED) in patients with non-traumatic chest pain (CP). Methods All CP cases attended at a single ED (2008–2017) were included. LP was considered if time from CP onset to ED arrival was>6 h. We analyzed associations between 42 patient/CP-related characteristics and LP in the whole cohort and in patients with CP due to acute coronary syndrome (ACS). Results The cohort included 25,693 cases (LP=50.6%; ACS=19.0%). Twenty factors were associated with LP, and 8 were also found in patients with ACS: CP of short-duration, aggravated by exertion or breathing/movement, undulating or recurrent CP increased the risk of LP, whereas CP accompanied by diaphoresis, irradiated to the throat, and chronic treatment with nitrates decreased the risk of LP. Exertional and recurrent CP were associated with both, LP and ACS.

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