Hospital Virgen del Puerto

Y sin embargo, te leo nació para revitalizar la biblioteca del Centro de Educación de Personas Adultas de Extremadura. En este artículo, se hace un recorrido por su historia y las principales actividades que se han llevado a cabo desde 2019.

The low incidence of non-iatrogenic extremity vascular injuries in children, combined with the anatomical and physiological characteristics of children, poses challenges for diagnosis, operative treatment, and recovery. No national guidelines are available to inform the care of children with vascular injuries to the extremities. The objective of this concise report is to describe the incidence and contributing mechanisms of injury resulting in pediatric extremity vascular trauma and summarize currently cited approaches for management. English-language publications in PubMed and CINAHL that focus on extremity vascular injuries in children aged 0-17years were reviewed. Publications from 2014 to the present were prioritized; however, as relevant research remains sparse, sentinel papers published before 2014 were also reviewed. Bibliographies from retrieved articles were also scanned. Retrospective studies, case studies, and single institution studies were included in the analysis. Data were manually extracted from journal publications using established inclusion and exclusion criteria. A panel of pediatric trauma experts reviewed a total of 29 papers, seeking evidence-based methodology and brief summaries of the available literature. These injuries are rare, and the anatomical and physiological characteristics of pediatric vascular injuries mandate a multidisciplinary approach. To minimize the consequences of extremity vascular injuries, successful treatment requires a high index of suspicion that allows for early diagnosis and prompt management. Clear recommendations regarding diagnosis and treatment are needed.

BackgroundPosturography is a diagnostic technique that quantifies postural control through Centre of Pressure (CoP) displacement analysis on a force platform. Footwear characteristics, particularly heel-to-toe drop, may influence balance by modifying plantar pressure distribution and proprioceptive feedback. The aim of this study was to evaluate the impact of different footwear drops (0 mm, 5 mm, 10 mm) on postural control in healthy young adults, considering sex, BMI, and shoe size.MethodsA cross-sectional study was conducted in 117 participants (56 men, 61 women) using the Dinascan/IBV® platform and the Romberg test. CoP displacement and velocity were analyzed.ResultsSignificant differences were observed in CoP total displacement (p < 0.001), mean velocity (p < 0.001), and medio-lateral dispersion (p = 0.024) when comparing 0 mm to 5 mm and 10 mm drops. Sex differences were significant at 0 mm drop for maximum medio-lateral force (p < 0.001) and mean velocity (p = 0.042), with men exhibiting greater values. At 5 mm drop, men showed significantly higher swept area (p = 0.029) and anteroposterior displacement (p = 0.007) than women.ConclusionsSmall variations in footwear drop can affect postural control, particularly in the medio-lateral plane. Sex and BMI significantly influence CoP behavior, suggesting the need to consider these factors in footwear design and clinical balance assessments.

Sports footwear is widely used across a range of physical activities. A key factor distinguishing running shoes from other types of footwear is the “drop,” the millimeter difference between the heel and the forefoot. This study aimed to analyze the influence of different drops (0, 5, and 10 mm) on ground reaction forces during walking and to examine the effects of sex and body mass index (BMI) under these conditions. An observational, descriptive, and cross-sectional study was conducted with 117 participants (56 men and 61 women). The Dinascan/IBV® dynamometric platform (Instituto de Biomecánica de Valencia, Valencia, Spain) was used to measure ground reaction forces during walking (braking, take-off, propulsion, and swing forces), walking speed, and stance time. The descriptive analysis revealed comparable values for the left and right limbs, with slightly higher values observed in the right limb. Statistically significant differences were found in stance time, braking force, and swing force between the 0 mm and 10 mm drop conditions. Take-off force showed highly significant differences when comparing the 0–5 mm and 0–10 mm drop conditions. Sex-based differences were observed in all variables at the initial proposed drop condition of 0 mm, except for walking speed, possibly due to anatomical and physiological differences. Significant differences were found in stance time at 0 mm drop, braking force, and propulsion force. Highly significant values were obtained for take-off force and during the swing phase. A strong correlation was found between ground reaction forces and BMI with the different proposed drops in all forces studied, except for the support force, where a moderate correlation was obtained. Although shoe drop was found to influence ground reaction forces in this study, it is one of several factors that affect gait biomechanics. Other footwear characteristics, such as sole stiffness, material composition, weight, and elasticity, also play important roles in walking performance. Therefore, shoe drop should be considered an important but not exclusive parameter when selecting footwear. However, these results are limited to healthy young adults and may not be generalizable to other age groups or populations.

D. Alonso Castronuño, S. Romero Rodríguez, M. J. Terol Castera, and N. C. Gutiérrez equally contributing author. Background: Central nervous system (CNS) infiltration by diffuse large B-cell lymphoma (DLBCL), whether primary (PCNSL) or secondary (SCNSL), is associated with poor prognosis. Bruton’s tyrosine kinase inhibitors (BTKi) have demonstrated efficacy in lymphomas with B-cell receptor and Toll-like receptor signaling alterations pathways, such as lymphomas of immune-privileged sites, including PCNSL. Aims: To assess the real-world efficacy and safety of BTKi in patients with PCNSL and SCNSL. Desing: We conducted a retrospective, observational, multicenter study within the Spanish Lymphoma Group (GELTAMO). Patients diagnosed with PCNSL or SCNSL with DLBCL histology who received BTKi for the treatment of CNS infiltration were included. Prognostic factors and survival were analyzed using Chi-square and Kaplan-Meier models. Results: A total of 65 patients were analyzed. The median age was 60 (range 27–81) years. The diagnosis of PCNSL was more frequent (43/65, 66%) than that of SCNSL (22/65, 34%). Most cases (86%) exhibited a non-germinal center B-cell phenotype (non-GC-Ph). All GC-Ph were SCNSL. Population characteristics are summarized in Table 1. The overall and complete response rates were 54% and 24%, respectively. The diagnosis of PCNSL, a non-GC-Ph, MYD88 mutations and ECOG < 2 were associated with higher response rates (p < 0.05). After a median follow-up for surviving patients of 30 (3 to 93) months, the median progression-free survival (PFS) after BTKi was 3 months and PFS at 2-years was 26%. Median PFS was significantly longer for patients diagnosed with PCNSL compared to those diagnosed with SCNSL (7 vs. 2 months, p = 0.003), and for non-GC-Ph compared to CG-Ph (3 vs. 1 months (p = 0.001). At the time of the last follow-up, 66% of patients had died, 84% due to disease progression. The median overall survival (OS) was 6 months, and OS at 2-years was 36%. Median OS was higher in patients with PCNSL compared to those with SCNSL diagnosis (8 vs. 5 months, p = 0.017), and in patients with non-GC-Ph (6 vs. 1 month, p < 0.001), with normal LDH at the onset of BTKi (8 vs. 2 months, p = 0.009) and with ECOG < 2 at the onset of BTKi (not-reached vs. 6 months, p = 0.002) compared to the opposite alternative. Consolidation therapy (Table 1) after BTKi was associated with longer OS at 5-years with respect to patients without consolidation therapy (90% vs. 16%, p < 0.001). Half of the patients experienced BTKi-related toxicity (Table 1), requiring discontinuation in 22% of cases. The rate of febrile neutropenia was 9% and 12% of patients died due to infection. No fungal infections were reported. Less than 10% of patients presented cardiovascular toxicity. Conclusions: BTKi were effective in treating DLBCL involving CNS, particularly in PCNSL. Ibrutinib yielded a significant response in many patients; however, these responses were not durable. Consolidation treatment following ibrutinib significantly improved outcomes. Safety profile was as expected for this population. Keywords: aggressive B-cell non-Hodgkin lymphoma; molecular targeted therapies; extranodal non-Hodgkin lymphoma No potential sources of conflict of interest.

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.