Tumor-secreted extracellular vesicles(EVs)participate in the metastasis process through different mechanisms,including the preparation of the pre-metastatic niche to grant circulating tumor cells(CTCs)implantation and...Tumor-secreted extracellular vesicles(EVs)participate in the metastasis process through different mechanisms,including the preparation of the pre-metastatic niche to grant circulating tumor cells(CTCs)implantation and growth.The study of the metastasis process through the analysis of CTCs and tumor-derived EVs is difficult because of the dilution grade of these elements in peripheral blood.In early-stage lung cancer patients,the tumor-secreted products are even more diluted.An attractive strategy in surgical lung cancer patients is to purify them from a pulmonary tumor-draining vein where they are enriched.The information obtained from the analysis of EVs and CTCs purified from this source could give more accurate information about tumor biology and could be an important source of biomarkers to identify patients at high risk of relapse after curative surgery.展开更多
Background: Bladder and lung cancer are among the ten most common cancers in both genders. The NKG2D receptor and one of its ligands, MICA, are associated with smoking and susceptibility to both chronic obstructive pu...Background: Bladder and lung cancer are among the ten most common cancers in both genders. The NKG2D receptor and one of its ligands, MICA, are associated with smoking and susceptibility to both chronic obstructive pulmonary disease and lung cancer. Objective: We hypothesized that NKG2D-MICA system was associated with other smoking-related epithelial cancers such as bladder cancer. Design, Setting, and Participants: 70 cases of primary non-muscle invasive bladder cancer were screened for the MICA expression and CD8+, CD4+ and NK cell infiltration. Most patients (n = 55, 78.6%) were current or former smokers. Measurements: Tissue microarray (TMA) technology was chosen to evaluate MICA and tumor infiltrating lymphocytes in samples with confirmed bladder cancer. Kaplan-Meier curves and univariate Cox analysis was used to assess relapse, all-cancer mortality and specific bladder cancer mortality. Results and Limitations: MICA was expressed in most cancer specimens examined (i.e., 70%). Relapse of bladder cancer was not associated with the status of MICA expression (log rank p = 0.1123). Nevertheless, a significant association existed between high MICA expression and bladder cancer mortality (HR = 0.25;CI95% = 0.06 - 0.97). Tumor infiltrating CD4+ and CD8+ lymphocytes were found in the majority (64%) of samples. Cells expressing the NKG2D receptor were found in only 3% of the samples. There was no linear function between NKG2D+ cells and number or ratio of CD4+ and CD8+ TIL. Conclusions: MICA is expressed in a significant proportion of bladder carcinomas. MICA expression associates with significant survival advantages in the face of both all-cancer and bladder cancer. The NKG2D-MICA system could represent a common mechanism involved in the immunopathology and natural history of bladder neoplasms.展开更多
Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated patients.We summarized evidence concerning ventilator care bundles to prevent VAP.Methods A ...Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated patients.We summarized evidence concerning ventilator care bundles to prevent VAP.Methods A systematic review and meta-analysis were performed.Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation(MV)for at least 48 h were considered for inclusion.Outcomes of interest were the number of VAP episodes,duration of MV,hospital and intensive care unit(ICU)length of stay,and mortality.A systematic search was conducted in the MEDLINE,the Cochrane Library,and the Web of Science between 1985 and 2022.Results are reported as odds ratio(OR)or mean difference(MD)with 95%confidence intervals(CI).The PROSPERO registration number is CRD42022341780.Results Thirty-six studies including 116,873 MV participants met the inclusion criteria.A total of 84,031 participants underwent care bundles for VAP prevention.The most reported component of the ventilator bundle was head-of-bed elevation(n=83,146),followed by oral care(n=80,787).A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles,compared with the non-care bundle group(OR=0.42,95%CI:0.33,0.54).Additionally,the implementation of care bundles decreased the duration of MV(MD=−0.59,95%CI:−1.03,−0.15)and hospital length of stay(MD=−1.24,95%CI:−2.30,−0.18)in studies where educational activities were part of the bundle.Data regarding mortality were inconclusive.Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs.Their application in combination with educational activities seemed to improve clinical outcomes.展开更多
基金Ministry of Economy and Competition(MINECO)Co-Financed with the European Union FEDER Funds(SAF2017-88606-P,2017)SEPAR-AstraZeneca Ayudas Investigación PII Oncología 2021Becas SEPAR 2022(Proyecto 1326).
文摘Tumor-secreted extracellular vesicles(EVs)participate in the metastasis process through different mechanisms,including the preparation of the pre-metastatic niche to grant circulating tumor cells(CTCs)implantation and growth.The study of the metastasis process through the analysis of CTCs and tumor-derived EVs is difficult because of the dilution grade of these elements in peripheral blood.In early-stage lung cancer patients,the tumor-secreted products are even more diluted.An attractive strategy in surgical lung cancer patients is to purify them from a pulmonary tumor-draining vein where they are enriched.The information obtained from the analysis of EVs and CTCs purified from this source could give more accurate information about tumor biology and could be an important source of biomarkers to identify patients at high risk of relapse after curative surgery.
文摘Background: Bladder and lung cancer are among the ten most common cancers in both genders. The NKG2D receptor and one of its ligands, MICA, are associated with smoking and susceptibility to both chronic obstructive pulmonary disease and lung cancer. Objective: We hypothesized that NKG2D-MICA system was associated with other smoking-related epithelial cancers such as bladder cancer. Design, Setting, and Participants: 70 cases of primary non-muscle invasive bladder cancer were screened for the MICA expression and CD8+, CD4+ and NK cell infiltration. Most patients (n = 55, 78.6%) were current or former smokers. Measurements: Tissue microarray (TMA) technology was chosen to evaluate MICA and tumor infiltrating lymphocytes in samples with confirmed bladder cancer. Kaplan-Meier curves and univariate Cox analysis was used to assess relapse, all-cancer mortality and specific bladder cancer mortality. Results and Limitations: MICA was expressed in most cancer specimens examined (i.e., 70%). Relapse of bladder cancer was not associated with the status of MICA expression (log rank p = 0.1123). Nevertheless, a significant association existed between high MICA expression and bladder cancer mortality (HR = 0.25;CI95% = 0.06 - 0.97). Tumor infiltrating CD4+ and CD8+ lymphocytes were found in the majority (64%) of samples. Cells expressing the NKG2D receptor were found in only 3% of the samples. There was no linear function between NKG2D+ cells and number or ratio of CD4+ and CD8+ TIL. Conclusions: MICA is expressed in a significant proportion of bladder carcinomas. MICA expression associates with significant survival advantages in the face of both all-cancer and bladder cancer. The NKG2D-MICA system could represent a common mechanism involved in the immunopathology and natural history of bladder neoplasms.
基金supported by CIBERES,Instituto de Salud Carlos III,Madrid,Spain (grant number:Fondos FEDER:CB06-06-036).
文摘Background Ventilator-associated pneumonia(VAP)represents a common hospital-acquired infection among mechanically ventilated patients.We summarized evidence concerning ventilator care bundles to prevent VAP.Methods A systematic review and meta-analysis were performed.Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation(MV)for at least 48 h were considered for inclusion.Outcomes of interest were the number of VAP episodes,duration of MV,hospital and intensive care unit(ICU)length of stay,and mortality.A systematic search was conducted in the MEDLINE,the Cochrane Library,and the Web of Science between 1985 and 2022.Results are reported as odds ratio(OR)or mean difference(MD)with 95%confidence intervals(CI).The PROSPERO registration number is CRD42022341780.Results Thirty-six studies including 116,873 MV participants met the inclusion criteria.A total of 84,031 participants underwent care bundles for VAP prevention.The most reported component of the ventilator bundle was head-of-bed elevation(n=83,146),followed by oral care(n=80,787).A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles,compared with the non-care bundle group(OR=0.42,95%CI:0.33,0.54).Additionally,the implementation of care bundles decreased the duration of MV(MD=−0.59,95%CI:−1.03,−0.15)and hospital length of stay(MD=−1.24,95%CI:−2.30,−0.18)in studies where educational activities were part of the bundle.Data regarding mortality were inconclusive.Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs.Their application in combination with educational activities seemed to improve clinical outcomes.
