Hospital Royo Villanova

ABSTRACTBackgroundLimited data are available on the management and outcomes of postoperative Crohn's disease (CD) in older patients. We aimed to describe the management of CD in the postoperative setting and assess surgical postoperative recurrence (POR) in this population.MethodsThis was a case‐control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo‐colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).ResultsA total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo‐colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.ConclusionsAlthough postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.

This study presents the design and validation process of a new Bebras-based instrument to assess computational thinking (CT) in 7th-grade students. An initial version of the test, composed of 18 multiple-choice items, was piloted with 80 students and revised based on their performance and classroom feedback. The final version, composed of 17 tasks balanced across CT components and difficulty levels, was administered to 1513 students from 86 Spanish schools. No significant gender differences were found in overall performance, supporting the potential of Bebras tasks to provide equitable assessment. An exploratory factor analysis revealed a dominant factor explaining 20% of the variance, and additional evidence (Lord’s index = 10.61) supported the use of a one-dimensional model despite the ambiguous dimensionality of the domain. BBACT offers a balanced and theoretically grounded tool for assessing CT in compulsory education and lays the foundation for future work exploring its validity and application across diverse contexts.

Introduction: The prognosis of PMBCL has improved in the modern era; however, there is no a standard frontline treatment and when to associate radiotherapy remains controversial. Refractory/relapsed (R/R) disease traditionally had a dismal prognosis, but nowadays new therapeutic alternatives are available that could be effective. Methods: We conducted a retrospective multicenter study within GELTAMO group. Each participating center included patients with histological diagnosis of PMBCL from 2007 to 2023. In the present analysis, we evaluated the influence on prognosis of several clinical characteristics by uni and multivariate analysis and the efficacy of frontline and subsequent treatments by Kapplan Meier method. Results: 329 patients from 41 Spanish centers were included. Patient characteristics are summarized in table 1. All patients received chemoimmunotherapy as first-line, mainly DA-EPOCH-R or R-CHOP-21, often combined with consolidative radiotherapy (RT). A significantly higher rate of patients treated with R-CHOP-21 versus DA-EPOCH-R received RT (51% vs. 17%, p < 0.01). The overall and complete response (OR, CR) rates after first-line were 86% and 79%, respectively. Among patients treated with DA-EPOCH-R +/− RT, 83% achieved CR versus 73% of patients treated with R-CHOP-21 +/− RT (p = 0.04). With a median follow-up (mFU) in alive patients of 54 months (4–214), 4-year progression free survival (PFS) and overall survival (OS) were 72% and 90%, respectively. Patients treated with DA-EPOCH-R had better PFS (78% vs. 61%, p < 0.01) and a trend to better OS (91% vs. 84%, p = 0.08) than patients treated with R-CHOP-21. In addition, first-line chemoimmunotherapy regimen had independent influence on PFS (HR 2.3, 95% CI: 1.4–3.7, p < 0.01) in a Cox regression model adjusted by other prognostic factors highligted in table 1. 85 patients (26%) had R/R disease after a median of 6 months (0–30) with a higher relapse rate in patients treated with R-CHOP-21 versus DA-EPOCH-R (36% vs. 21%, p < 0.01). With a mFU of 52 months (5–178) from relapse, 4-year PFS and OS were 37% and 66%, respectively. At first relapse, 30 patients (35%) received autologous stem cell transplantation (ASCT) as consolidation therapy, with a 4-year PFS from ASCT of 76%. 36 patients (42%) received CAR-T cell therapy in second or subsequent treatment lines. Of them, 20 patients (56%) achieved prolonged CR, after a mFU from CAR-T infusion of 25 months (5–72) in CR patients. In 24 patients (28%) a checkpoint inhibitor (50% monotherapy) was used as salvage treatment in second or subsequent treatment lines. Five (29%) patients reached sustained CR (mFU of 11 months) without CAR-T or transplant consolidation. Conclusions: Our results indicate that DA-EPOCH-R has significantly higher efficacy than R-CHOP-21 with lower use of RT. The prognosis is good for most patients, even R/R patients seem to have better prognosis than reported in historical series, probably related to new treatment approaches. Research funding declaration: No disclosure Keywords: aggressive B-cell non-Hodgkin lymphoma No potential sources of conflict of interest.

Backgrounds: Despite the significant global health impact of cardiometabolic multimorbidity (CMM), our understanding of potential predictors associated with its development in smokers, remains limited. Objective: This study aimed to investigate whether a new COPD diagnosis and the rate of lung function decline serve as predictors for incident CMM (defined as having at least two of the following comorbidities: cerebro-cardiovascular diseases, hypertension, dyslipidemia, and diabetes mellitus) in smokers. Methods: An observational longitudinal analysis of prospectively collected data was conducted, including smokers without a previous COPD diagnosis and any cardiometabolic conditions. Sociodemographic and clinical data (body mass index, smoking history, respiratory symptoms, and hospital admissions) were collected at baseline. Lung function tests were performed at baseline and at the end of the follow-up period. The incidence of CMM, a new positive diagnosis of COPD, and the forced expiratory volume in 1 s (FEV1) annual rate of decline were prospectively registered. Adjusted Cox proportional hazard models were adopted to explore risk factors associated with the incidence of CMM. Results: From the 391 smokers included in the study, 207 (53%) were newly diagnosed with COPD, and 184 had a preserved spirometry at baseline (non-COPD group). After nearly a decade of follow-up, 34% (n = 133) of smokers developed CMM. This group was characterized by male predominance, older age, higher BMI and pack-years of smoking, lower post-FEV1, baseline COPD diagnosis, and a history of hospital admission. A positive diagnosis of COPD at baseline and a greater rate of lung function decline (ΔFEV1 ≥ 40 mL/year) were independent predictors for developing CMM. Conclusions: A new COPD diagnosis and an accelerated decline in lung function are significantly associated with the development of CMM in smokers.