Hospital Universitario Infanta Cristina

Antecedentes y objetivos: La obesidad es uno de los problemas de la actualidad con una tendencia creciente y su vinculación a patologías como la diabetes mellitus tipo 2 (DM2) o la dislipemia (DL). El papel de la grasa o tejido adiposo visceral (TV) y, como subtipo de este, el tejido adiposo preperitoneal (TP), parece determinante en la obesidad visceral y el desarrollo de las complicaciones relacionadas. Los objetivos principales fueron relacionar la proporción de TV medida por BIA y el grosor de TP medido por ecografía con los niveles a analíticos de HbA1c y de CT, y su aplicación en el diagnóstico de DM2 y DL. Material y métodos: Se realizó un estudio observacional, descriptivo y retrospectivo con 72 pacientes que acudieron a la consulta de prehabilitación quirúrgica del Hospital Universitario Infanta Cristina a los cuales se les evaluó el grado de TV y TP y se correlacionó con los niveles analíticos de HbA1c y de CT Resultados: La acumulación tanto de TV como de TP se correlaciona con valores elevados de HbA1c (p<0,001 y p=0,001 respectivamente) y, por lo tanto, a la presencia de DM2. Además, comprobamos que exceso aislado de TV también se relaciona con la DL (p=0,041) debido a su asociación con niveles elevados de CT Conclusiones: La existencia de una patogénesis entre obesidad visceral, definida por acúmulo de TV y TP, con la DM2 y la DL, y su determinación mediante BIA y ecografía de composición corporal puede sugerir el diagnóstico de ambas patologías de forma precisa.

Introduction and Objective: Bipolar disorder affects approximately 2-4% of the global population, with acute mania representing a significant clinical challenge. While pharmacological interventions remain first-line treatments, 20-30% of patients experience inadequate response or intolerable side effects. This review evaluates the efficacy, safety, and clinical implementation of electroconvulsive therapy (ECT) as a second-line intervention for treatment-resistant bipolar mania. Material and Methods: A comprehensive analysis of contemporary literature was conducted, examining controlled trials, meta-analyses, systematic reviews, and clinical guidelines published between 1988 and 2024. The review focused on clinical response rates, comparative efficacy studies, adverse effect profiles, technical parameters, and integration with pharmacotherapy. Results: Evidence consistently demonstrates high efficacy rates (80-90%) for ECT in treatment-resistant mania, with rapid symptom resolution often occurring within the first week of treatment. Modern ECT techniques have substantially mitigated historical concerns regarding cognitive side effects. Bilateral electrode placement traditionally yields faster response in acute mania, though high-dose right unilateral placement may offer comparable efficacy with reduced cognitive impact. Integration with appropriate pharmacotherapy enhances long-term outcomes. Special populations, including pregnant women, elderly patients, and those with medical comorbidities, may particularly benefit from ECT when properly administered with population-specific modifications. Conclusions: ECT represents an effective, relatively safe, and rapid-acting intervention for treatment-resistant bipolar mania that should be considered earlier in treatment algorithms rather than as a last resort. Individualized approaches to electrode placement, stimulus dosing, and maintenance strategies optimize outcomes while minimizing adverse effects. Future research directions include parameter optimization, identification of predictive biomarkers, and development of cognitive remediation strategies.

ABSTRACT Blockade of the PD-1/PD-L1 pathway is part of the standard treatment for advanced urothelial cancer, but reliable predictive biomarkers have not been identified. Here, we analyze with Multiplexed Quantitative Immunofluorescence the pretreatment tumor microenvironment (TME) of urothelial cancer samples from patients treated with atezolizumab to identify correlations with treatment efficacy in a Real-World-Evidence (RWE) study. We assessed with Multiplexed Quantitative Immunofluorescence the expression of CD8, PD-1, TIM-3 and LAG-3 on T-cells in the different compartments of the TME (tumor, stroma and whole tissue) in pre-treatment tissue microarrays. We studied associations between the expression of the markers and clinical efficacy. One hundred-nine patients received atezolizumab, showing an overall response rate of 23.8%. Safety was comparable to previous studies with atezolizumab. Pre-treatment tumor samples were available from 45 patients. CD8+ T-cell density was significantly increased in the tumor compartment, but not in the stromal compartment, of patients experiencing complete and partial responses, as compared with patients presenting stable disease or progression. Similar results were observed for co-expression of CD8/PD-1, CD8/TIM-3 and CD8/PD-1/TIM-3/LAG-3. Our findings support the relevance of the density and spatial distribution of CD8+ T-cells and its co-receptors for the clinical efficacy of single-agent PD-L1 blockade in patients with advanced urothelial cancer. RWE studies are a valuable tool for identifying predictive biomarkers.