Artículos (Anatomía y Embriología Humana)

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Assessment of home exercise adherence in patients with non-surgical post-traumatic neck pain: a study protocol using the exercise adherence rating scale
(MDPI, 2026-06-16) Martínez Fernández, José Antonio; Socarrás-Alonso, Luis; Pabón-Carrasco, Daniel; Fisioterapia; Anatomía y Embriología Humana
Background/Objectives: Whiplash-associated disorders (WADs) and non-surgical post-traumatic neck pain often require active rehabilitation, including prescribed home exercise, where poor adherence can limit treatment effectiveness. This protocol describes a standardised observational method to assess home exercise adherence using the Exercise Adherence Rating Scale (EARS). Methods: This prospective protocol outlines eligibility criteria, recruitment settings, core variables, and a structured EARS administration procedure four weeks post-prescription. The primary outcome is the six-item EARS adherence section score. A target sample of approximately 75 participants will be recruited to ensure at least 62 analyzable participants. Outputs: The protocol will generate descriptive data on adherence levels, questionnaire completion rates, and missing data to evaluate implementation feasibility. Planned analyses testing potential associations between adherence and clinical variables will be strictly exploratory and hypothesis-generating. Conclusions: This study operationalizes a standardised method for tracking self-reported adherence in cervical trauma rehabilitation, enhancing methodological transparency and reproducibility.
A role for the transducer of the Hippo pathway, TAZ, in the development of aggressive types of endometrial cancer
(Elsevier, 2015) Romero Pérez, Laura; García Sanz, Pablo; Mota, Alba; Leskela, Susanna; Hergueta Redondo, Marta; Díaz Martín, Juan; Palacios, José; Anatomía y Embriología Humana; Asociación Española Contra el Cáncer; Comunidad Autónoma de Madrid; Junta de Andalucía; European Development Regional Fund; Gobierno de España; ISM; PFIS fellowship; Instituto de Salud Carlos III; TV3; CTS1035: Patología Molecular del Cáncer Sólido
Although TAZ, the final effector of the Hippo pathway that modulates epithelial to mesenchymal transition and stemness, has been implicated in the development of different types of cancer, its role in endometrial cancer has not yet been studied. Thus, we evaluated the expression of TAZ in different types of endometrial cancer by immunohistochemistry. TAZ expression was detected in 76% of undifferentiated endometrial carcinomas, 54% of endometrial carcinosarcomas, 46% of endometrial serous carcinomas, 36% of grade 3 endometrioid carcinomas, and 18% of grade 1-2 endometrioid carcinomas, with statistically significant differences. We analyzed the WWTR1 gene that encodes TAZ by FISH and MassARRAY spectrometry, ruling out gene amplification and differential promoter methylation as the main mechanisms that modulate TAZ expression in endometrial tumors. However, we did detect a significant association between Scribble hypoexpression and delocalization with TAZ expression. Moreover, we demonstrated that TAZ promoted invasiveness, and it favored cell motility and tumor growth, in endometrial cancer cell lines. In addition, TAZ expression was associated with the transition from an epithelial to mesenchymal phenotype, both in vitro and in human tumors. Together, these data reveal a previously unknown role for TAZ and the Hippo pathway in the progression of aggressive subtypes of endometrial cancer.
Nuclear TAZ expression associates with the triple-negative phenotype in breast cancer
(Society for Neuroscience, 2015-06) Díaz Martín, Juan; López García, María Ángeles; Romero Pérez, Laura; Atienza Amores, María Reina; Pecero, María Luisa; Castilla, María Ángeles; Biscuola, Michele; Santón, Almudena; Palacios, José; Anatomía y Embriología Humana; Instituto de Salud Carlos III; European Development Regional Fund.; CTS1035: Patología Molecular del Cáncer Sólido
The Hippo signaling pathway, a conserved regulator of organ size, has emerged as an important regulatory pathway in cancer. The final transducer effectors of this pathway in mammals are the oncoproteins TAZ and YAP1, which are transcriptional coactivators of target genes involved in cell proliferation and survival. TAZ has been previously reported to play a role in tumorigenesis in breast cancer, but detailed analyses of the different breast cancer phenotypes have not been conducted thus far. We analyzed TAZ expression by immunohistochemistry in a retrospective series of 640 invasive breast carcinomas, comprising estrogen/progesterone receptor-positive (ER+/PR+), HER2-positive, and triple-negative (TN) tumors. We found a strong association of TAZ nuclear expression with the TN phenotype (60.5% TAZ-positive, P<0.001), which was strengthened when stratified into the basal-like subtype (70.8% TAZ-positive, P<0.001). Moreover, 90% of metaplastic breast carcinomas with morphological epithelial–mesenchymal transition features were TAZ-positive. We also investigated whether amplification or differential DNA methylation of the TAZ-encoding locus could account for the observed enhanced TAZ protein expression in the TN/basal phenotype. Amplification of the TAZ locus was analyzed by fluorescence in situ hybridization in 30 TN tumors, and we found gene amplification in some cases (6.45%). DNA methylation analysis was performed using the Sequenom MassArray MALDI-TOF platform, and we observed similar low methylation levels both in TN (n=25) and ER+/PR+ (n=26) tumors. These results were further confirmed using a panel of breast cancer cell lines and using the TCGA dataset. Finally, patients with strong TAZ expression showed poorer clinical outcomes with respect to both recurrence and overall survival.
VGLL1 expression is associated with a triple-negative basal-like phenotype in breast cancer
(Society for Endocrinology, 2014-08) Castilla, María Ángeles; López García, María Ángeles; Reina Atienza, María; Rosa Rosa, Juan Manuel; Díaz Martín, Juan; Pecero, María Luisa; Vieites Pérez-Quintela, Begoña; Romero Pérez, Laura; Benítez, Javier; Calcabrini, Annarica; Palacios, José; Anatomía y Embriología Humana; Junta de Andalucía; European Development Regional Fund; Instituto de Salud Carlos III; PFIS fellowship; CTS1035: Patología Molecular del Cáncer Sólido
Vestigial-like 1 (VGLL1) is a poorly characterized gene encoding a transcriptional co-activator structurally homologous to TAZ and YAP that modulates the Hippo pathway in Drosophila. In this study, we examined the expression of VGLL1 and its intronic miRNA, miR-934, in breast cancer. VGLL1 and miR-934 expression miRNA profiling was carried out on frozen samples of grade 3 invasive ductal carcinomas. VGLL1 protein was also examined in 433 sporadic and BRCA1-associated breast carcinomas on tissue microarrays. RNA-seq data from The Cancer Genome Atlas (TCGA) was used to confirm differences in VGLL1 and miR-934 expression in different breast cancer subtypes, and to correlate their expression with that of other genes and miRNAs. Of 28 miRNAs differentially expressed in estrogen receptor (ER)-positive and ER-negative grade 3 breast carcinomas, miR-934 was most strongly upregulated in ER-negative carcinomas, and its expression was correlated with that of VGLL1. Nuclear VGLL1 expression was observed in 13% of sporadic breast carcinomas, and while VGLL1 was only occasionally found in luminal A (0.70%) and B (5.60%) carcinomas, it was often expressed in HER2-positive (17%), triple-negative (TN) breast carcinomas (>40%) and BRCA1-associated TN carcinomas (>50%). These findings were confirmed in the TCGA dataset, which revealed positive associations with luminal progenitor genes (GABRP, SLC6A14, FOXC1, PROM1, and BBOX1) and strong negative correlations with ER-associated genes (ESR1, C6ORF211, GATA3, and FOXA1). Moreover, VGLL1 expression was associated with reduced overall survival. In conclusion, VGLL1 and miR-934 are mainly expressed in sporadic and BRCA1-associated TN basal-like breast carcinomas, and their coordinated expression, at least partially mediated by the direct modulation of ESR1, might be involved in the maintenance of a luminal progenitor phenotype.
ZEB1 overexpression associated with E-cadherin and microRNA-200 downregulation is characteristic of undifferentiated endometrial carcinoma
(Elsevier, 2013) Romero Pérez, Laura; López García, María de los Ángeles; Díaz Martín, Juan; Biscuola, Michele; Castilla Moro, Mª Ángeles; Tafe, Laura J.; Garg, Karuna; Oliva, Esther; Matías-Guiu, Xavier; Soslow, Robert A.; Palacios, José; Anatomía y Embriología Humana; Asociación Española Contra el Cáncer; Junta de Andalucía; CTS1035: Patología Molecular del Cáncer Sólido
Undifferentiated endometrial carcinomas are very aggressive high-grade endometrial carcinomas that are frequently under-recognized. This study aimed to analyze the molecular alterations underlying the development of these endometrial carcinomas, focusing on those related to dedifferentiation. We assessed a series of 120 tumors: 57 grade 1 and 2 endometrioid endometrial carcinomas, 15 grade 3 endometrioid endometrial carcinomas, 27 endometrial serous carcinomas, and 21 undifferentiated endometrial carcinomas. We found a high frequency of DNA mismatch repair deficiency (38%) and moderate rate of p53 overexpression (∼33%) in undifferentiated carcinomas. In contrast to the characteristic endometrioid phenotype, there was a dramatic downregulation of E-cadherin expression in the undifferentiated subtype. Quantitative methylation studies dismissed CDH1 promoter hypermethylation as the mechanism responsible for this change in gene expression, while immunohistochemistry revealed that the E-cadherin repressor ZEB1 was frequently overexpressed (62%) in undifferentiated endometrial carcinomas. This finding was accompanied by a sharp downregulation in the expression of the miR-200 family of microRNAs, well-known targets of ZEB1. Furthermore, there was enhanced expression of epithelial-to-mesenchymal transition markers in undifferentiated endometrial carcinomas, such as N-cadherin, cytoplasmic p120, and osteonectin. In addition, HMGA2, a regulator of epithelial-to-mesenchymal transition that is expressed in aggressive endometrial tumors, such as endometrial serous carcinomas and carcinosarcomas, was expressed in >20% of undifferentiated carcinomas. These results suggest that ZEB1 overexpression, associated with E-cadherin and miR-200s downregulation, and the expression of mesenchymal markers might enhance the metastatic potential of undifferentiated endometrial carcinomas, leading to a poor prognosis. In addition, our observations suggest that the immnohistochemical analysis of E-cadherin and ZEB1 can aid in the differential diagnosis of the more agressive undifferentiated endometrial carcinomas from grade 3 endometrioid carcinomas.
Integrative clinical, molecular, and computational analysis identify novel biomarkers and differential profiles of anti-tnf response in rheumatoid arthritis
(Frontiers media SA, 2021-03-23) Luque-Tevar, Maria; Carlos Pérez-Sánchez; Patino-Trives, Alejandra Mª; Barbarroja, Nuria; Arias de la Rosa, Iván; Abalos-Aguilera, M. Carmen; Ruiz Montesino, Mª Dolores; López-Pedrera, Chary; Anatomía y Embriología Humana; Sistema Regional de Salud de Andalucía; Instituto de Salud Carlos III; Red Española de Enfermedades Inflamatorias y Reumáticas (RIER), Instituto de Salud Carlos III
Background: This prospective multicenter study developed an integrative clinical and molecular longitudinal study in Rheumatoid Arthritis (RA) patients to explore changes in serologic parameters following anti-TNF therapy (TNF inhibitors, TNFi) and built on machine-learning algorithms aimed at the prediction of TNFi response, based on clinical and molecular profiles of RA patients. Methods: A total of 104 RA patients from two independent cohorts undergoing TNFi and 29 healthy donors (HD) were enrolled for the discovery and validation of prediction biomarkers. Serum samples were obtained at baseline and 6 months after treatment, and therapeutic efficacy was evaluated. Serum inflammatory profile, oxidative stress markers and NETosis-derived bioproducts were quantified and miRNomes were recognized by next-generation sequencing. Then, clinical and molecular changes induced by TNFi were delineated. Clinical and molecular signatures predictors of clinical response were assessed with supervised machine learning methods, using regularized logistic regressions. Results: Altered inflammatory, oxidative and NETosis-derived biomolecules were found in RA patients vs. HD, closely interconnected and associated with specific miRNA profiles. This altered molecular profile allowed the unsupervised division of three clusters of RA patients, showing distinctive clinical phenotypes, further linked to the TNFi effectiveness. Moreover, TNFi treatment reversed the molecular alterations in parallel to the clinical outcome. Machine-learning algorithms in the discovery cohort identified both, clinical and molecular signatures as potential predictors of response to TNFi treatment with high accuracy, which was further increased when both features were integrated in a mixed model (AUC: 0.91). These results were confirmed in the validation cohort. Conclusions: Our overall data suggest that: 1. RA patients undergoing anti-TNF-therapy conform distinctive clusters based on altered molecular profiles, which are directly linked to their clinical status at baseline. 2. Clinical effectiveness of anti-TNF therapy was divergent among these molecular clusters and associated with a specific modulation of the inflammatory response, the reestablishment of the altered oxidative status, the reduction of NETosis, and the reversion of related altered miRNAs. 3. The integrative analysis of the clinical and molecular profiles using machine learning allows the identification of novel signatures as potential predictors of therapeutic response to TNFi therapy.
Prospective evaluation of copy number alterations validates chromosome 1q gain as an independent marker of poor prognosis in localized Ewing sarcoma
(Academic press inc elsevier science, 2025-11-17) Díaz-Martín, Juan; Ranft, Andreas; Blanquer-Maceiras, Maite; Noguera, Rosa; Salguero Aranda, Carmen; Delgado-Bellido, Daniel; Romero Pérez, Laura; Álava Casado, Enrique de; Anatomía y Embriología Humana; Instituto de Biomedicina de Sevilla (IBIS); Citología e Histología Normal y Patológica; CIBERONC; CRIS Foundation against Cancer; ISCIII-FEDER; NEN Association (Nico against Childhood Cancer); University Hospital Muenster; CTS1035: Patología Molecular del Cáncer Sólido
Background Ewing sarcoma is a rare and aggressive tumor affecting mainly adolescents and young adults. Accurate risk stratification is critical for treatment tailoring, yet traditional clinical parameters lack sufficient predictive accuracy. While retrospective studies have identified potential molecular biomarkers, prospective validation is required for clinical implementation. Methods The international PROVABES consortium (PROspective Validation of Biomarkers in Ewing Sarcoma) aims to evaluate molecular prognostic markers in European patients treated under international phase III trials. This study focuses on copy number alterations (CNAs), in 305 primary tumors. Tissue microarrays were analyzed by FISH for chromosome 1q gain (n = 297) and 16q loss (n = 266). Genome-wide CNAs were further assessed using SNP arrays in 139 samples. Associations with clinical outcomes were evaluated via Kaplan-Meier and multivariate Cox regression, with event-free survival (EFS) and overall survival (OS) as endpoints. Results Chromosome 1q gain was significantly associated with shorter OS in both localized cases and the overall cohort, and with inferior EFS specifically in localized patients. In contrast, 16q loss showed no significant prognostic impact. Multivariate analysis confirmed 1q gain as an independent predictor of poor EFS in localized disease. Notably, a higher fraction of genome altered was associated with inferior OS and EFS not only in localized patients but also in the entire cohort, and remained an independent predictor of outcome despite the smaller subset analyzed. Conclusions This prospective study validates chromosome 1q gain as an independent marker of poor prognosis in localized Ewing sarcoma. Furthermore, the extent of genomic alteration emerges as a promising predictor of both OS and EFS. Incorporating these biomarkers may improve individualized risk stratification and ultimately enhance patient outcomes.
High 4E-BP1 expression associates with chromosome 8 gain and CDK4/6 sensitivity in Ewing sarcoma
(Amer soc clinical investigation inc, 2025-10-16) Funk, Cornelius M.; Ehlers, Anna C.; Orth, Martin F.; Aljakouch, Karim; Li, Jing; Hölting, Tilman Lb; Romero Pérez, Laura; Musa, Julian; Anatomía y Embriología Humana; Instituto de Biomedicina de Sevilla (IBIS); Asociación Candela Riera al laboratorio de JA; Asociación Todos somos Ivn al laboratorio de JA; Subvenciones de la Ayuda Alemana contra el Cáncer; Beca de ayuda alemana contra el cánce; Beca de la Fundación Heinrich F.C. Behr; Instituto de Salud Carlos III; CTS1035: Patología Molecular del Cáncer Sólido
Chromosome 8 (chr8) gains are common in cancer, but their contribution to tumor heterogeneity is largely unexplored. Ewing sarcoma (EwS) is defined by FET::ETS fusions with few other recurrent mutations to explain clinical diversity. In EwS, chr8 gains are the second most frequent alteration, making it an ideal model to study the relevance of chr8 gains in an otherwise silent genomic context. We report that chr8 gain-driven expression patterns correlate with poor overall survival of patients with EwS. This effect is mainly mediated by increased expression of the translation initiation factor binding protein 4E-BP1, encoded by EIF4EBP1 on chr8. Among all chr8-encoded genes, EIF4EBP1 expression showed the strongest association with poor survival and correlated with chr8 gains in EwS tumors. Similar findings emerged across multiple cancer entities in The Cancer Genome Atlas. Multiomics profiling revealed that 4E-BP1 orchestrates a pro-proliferative proteomic network. Silencing 4E-BP1 reduced proliferation, clonogenicity, spheroidal growth in vitro, and tumor growth in vivo. Drug screens demonstrated that high 4E-BP1 expression sensitizes EwS to pharmacological CDK4/6-inhibition. Chr8 gains and elevated 4E-BP1 emerge as prognostic biomarkers in EwS, with poor outcomes driven by 4E-BP1-mediated pro-proliferative networks that sensitize tumors to CDK4/6 inhibitors. Testing for chr8 gains may enhance risk stratification and therapy in EwS and other cancers.
Comprehensive DSRCT multi-omics analyses unveil CACNA2D2 as a diagnostic hallmark and super-enhancer-driven WSR1::WT1signature gene
(WILEY, 2025-03-15) Geyer, FH; Ritter, A; Kinn-Gurzo, S; Faehling, T; Li, J; Jarosch, A; Romero Pérez, Laura; Álava Casado, Enrique de; Cidre-Aranaz, F; Anatomía y Embriología Humana; Citología e Histología Normal y Patológica; Instituto de Biomedicina de Sevilla (IBIS); Equipo del Centro Alemán de Investigación del Cáncer (DKFZ); CTS1035: Patología Molecular del Cáncer Sólido
Luxación peritalar lateral en un jugador de baloncesto. Reporte de caso
(Elsevier, 2025-09) Úbeda Pérez de Heredia, Íñigo; Anatomía y Embriología Humana
La luxación periastragalina es una lesión de baja incidencia que puede desembocar en secuelas que impiden el retorno a la actividad laboral o deportiva. El tratamiento suele ser conservador salvo en las luxaciones abiertas, irreductibles, compromiso neurovascular o ante lesiones asociadas que indiquen la cirugía. Se presenta el caso de un jugador de baloncesto que sufrió una luxación periastragalina lateral, la cual se trató de forma conservadora mediante reducción cerrada bajo sedación, inmovilización con férula de yeso durante 6 semanas y posterior rehabilitación funcional. Cuatro meses después del accidente el paciente fue dado de alta médica con un déficit de dorsiflexión de 25º, sin dolor ni inestabilidad, aunque tuvo que abandonar la competición deportiva.
Retorno a la competición tras rotura de ligamento cruzado anterior en deportes de alto contacto
(Nexus Medica Editores, 2025) Úbeda Pérez de Heredia, Íñigo; Julio Barrera Torres; Anatomía y Embriología Humana
Introducción: Conocer el tiempo de reincorporación a la competición y el abandono de la vida profesional de jugadores profesionales de deportes de alto contacto, intervenidos mediante plastia del cruzado anterior. Material y método: Se realizó una revisión sistemática de las publicaciones accesibles en las bases de datos científicas entre los años 2013 y 2023. Tras establecer criterios de inclusión y exclusión, se diseñaron dos bloques en función de la modalidad deportiva, resultando un primer grupo donde se incluyeron a jugadores de fútbol americano y canadiense, y un segundo grupo formado por jugadores de rugby y fútbol australiano. Se obtuvo una muestra de 3.395 deportistas, de los cuales 2.337 pertenecían al primer grupo y 1.058 al segundo. Para la evaluación de resultados se tuvo en cuenta la edad, el sexo, la modalidad deportiva y el tiempo de reincorporación a la competición. Resultados: El grupo 1 lo conforman 2.337 jugadores, de los cuales 1.541 (65,94%) retornaron a la competición, con un tiempo promedio de 11,37 meses. En el grupo 2 se incluyeron 1.058 jugadores, de los cuales 855 (80,81%) se incorporaron a la actividad deportiva previa a la lesión con un promedio de 9,21 meses. Conclusiones: Los jugadores profesionales de fútbol americano y canadiense tienen una mayor tasa de abandono de su actividad deportiva y, en los casos en que se produce la reincorporación a la competición, el tiempo es superior al de los jugadores profesionales de rugby y fútbol australiano.
Serie de casos sobre el diagnóstico diferencial del síndrome pronator teres
(Ciencias Médicas ECIMED, 2025-05-31) Úbeda Pérez de Heredia, Íñigo; Anatomía y Embriología Humana
Introducción: La compresión del nervio mediano entre los vientres del músculo pronator teresse denominasíndrome del pronator teres. Resulta una patología infrecuente, que puede acompañarse de otras neuropatías compresivas; por tanto, debe establecerse undiagnóstico diferencial.Objetivo: Reportar tres casos de síndrome del pronator teresen pacientes de mediana edad, tratados con medidas conservadoras.Presentación de casos: El primer casofue un guitarrista con parestesias en extremidad superior derecha. La electrofisiología confirmó el atrapamiento del nervio mediano en la muñeca y el cubital en el codo. La ultrasonografía evidenció una compresión del nervio mediano entre las cabezas del pronador redondo. El segundo paciente era un mozo repartidor que, a los tres meses de una cirugía de rotura distal del bíceps braquial derecho, presentó dolor, y perdió la fuerza en la muñeca y la mano derecha. La ultrasonografía mostró compresión del nervio cubital en el canal epitrócleo-olecraniano; mientras que la electromiografía objetivó la retención del nervio mediano en el codo y la muñeca, y del cubital en el codo. El tercer caso, un trabajador del metal, asistió a consulta por dolor en la epitróclea, con parestesias y pérdida de fuerza en la mano derecha. En la electromiografía se observaron atrapados los nervios mediano y cubital en el codo, y el nervio mediano en la muñeca. Las pruebas de imagen resultaron normales. Conclusiones:El síndrome del pronator teresdebe sospecharse en pacientes con alteraciones sensitivas en el miembro superior. Diferenciarlo de otras neuropatías compresivas se considera fundamental porque la detección precoz permite aplicar medidas terapéuticas conservadoras efectivas
Impact of multimorbidity on the first ts/bDMARD effectiveness and retention rate after two years of follow-up in patients with rheumatoid arthritis from the BIOBADASER registry
(Springer Science and Business Media LLC, 2024-02-23) Calvo-Gutiérrez J.; López-Medina C.; Otero-Varela L.; Escudero-Contreras A.; Ortega-Castro R.; Ladehesa-Pineda L.; Campos C.; Ruiz Montesino, Mª Dolores; Castrejón I.; Anatomía y Embriología Humana
Background Patients with Rheumatoid Arthritis (RA) have a higher prevalence of comorbidities compared to the general population. However, the implications of multimorbidity on therapeutic response and treatment retention remain unexplored. Objectives: (a) To evaluate the impact of multimorbidity on the effectiveness of the first targeted synthetic or biologic disease-modifying antirheumatic drug (ts/bDMARD), in patients with RA after 2-year follow-up; (b) to investigate the influence of multimorbidity on treatment retention rate. Methods Patients with RA from the BIOBADASER registry exposed to a first ts/bDMARDs were included. Patients were categorized based on multimorbidity status at baseline, defined as a Charlson Comorbidity index (CCI) score ≥ 3. A linear regression model, adjusted for sex and age, was employed to compare the absolute DAS28 score over time after ts/bDMARD initiation between the two groups. The Log-Rank test and Kaplan-Meier curve were used to compare the retention rates of the first ts/bDMARD between the groups. Results A total of 1128 patients initiating ts/bDMARD were included, with 107 (9.3%) exhibiting multimorbidity. The linear regression model showed significantly higher DAS28 (beta coefficient 0.33, 95%CI:0.07–0.58) over a two-year period in patients with multimorbidity, even after adjusting for age and sex. Finally, no differences in the ts/bDMARD retention rate were found between groups (median 6.94–6.96 years in CCI < 3 vs. 5.68–5.62 in CCI ≥ 3; p = 0.610). Conclusions Multimorbidity in patients with RA was associated with greater DAS28 scores within the first two years after ts/bDMARD initiation, in comparison with patients without multimorbidity. A slightly shorter retention rate was found in patients with multimorbidity, although the difference was non-significant.
Real-world persistence of initial targeted therapy strategy in monotherapy versus combination therapy in patients with chronic inflammatory arthritis
(Wiley, 2023-09-16) Exposito L.; Sánchez-Piedra C.; Vela-Casasempere P.; Moreno-Ramos M.J.; Campos C.; Bohorquez C.; Manero J.; Ruiz Montesino, Mª Dolores; Díaz-González F.; Anatomía y Embriología Humana
Objective The persistence of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs(DMARDs) in monotherapy versus in combination with conventional synthetic (cs) DMARDs is still a controversial topic in rheumatic diseases. To clarify this issue, the retention of the initial treatment strategy of b/tsDMARD in combination with csDMARD versus monotherapy in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients under real-life conditions was evaluated. Factors associated with maintenance of the initial strategy were analysed. Methods Nested cohort study within the Spanish BIOBADASER III registry. Bivariate comparisons and multivariate Cox proportional hazards models were used for the analyses. Results A total of 2521 patients were included in the study. In the multivariate model, the initial strategy of combination therapy was associated with shorter persistence in patients with RA (hazard ratio [HR] 1.58;95% confidence interval [CI] 1.00–2.50; p = .049), PsA (HR 2.48; 95% CI 1.65–3.72) and AS (HR 16.77; 95% CI 7.37–38.16; p < .001), regardless of sex, time of disease progression, baseline disease activity, glucocorticoid use or type of b/tsDMARD. Overall, the combination strategy was associated with an increased incidence of adverse events (incidence rate ratio [IRR] 1.13; 95% CI 1.05–1.21). Conclusions In this real-life study, the strategy of combining a b/tsDMARD with a csDMARD is associated with lower persistence and worse safety profile compared to monotherapy in RA and especially in PsA and AS, suggesting that combination therapy should be rethought as first choice in RA patients, but especially in PsA and AS patients.
Síndrome del pronator teres asociado a otras neuropatías compresivas en la extremidad superior. Serie de casos y revisión bibliográfica
(Elsevier, 2025-10) Úbeda Pérez de Heredia, Íñigo; Anatomía y Embriología Humana
Introducción: El síndrome del pronator teres (SPT) consiste en una compresión del nervio mediano entre los vientres del músculo pronador redondo. Es una efermedad poco común que suele confundirse con otras neuropatías compresivas de la extremidad superior. Presentamos 3 casos infrecuentes de SPT asociados a compresiones nerviosas en codo y muñeca. Caso 1: Varón de 53 años, músico, consultó por parestesias en el miembro superior derecho. La electrofisiología objetivó atrapamiento del nervio mediano en muñeca y del cubital en codo. La ultrasonografía evidenció una compresión del mediano entre las cabezas del pronador redondo. El paciente mejoró con tratamiento conservador. Caso 2: Varón de 41 años, repartidor, que 3 meses después de ser intervenido de rotura distal del bíceps braquial derecho presentó dolor y pérdida de fuerza en muñeca y mano. La ultrasonografía mostró compresión del nervio cubital en el canal epitrócleo-olecraniano. La electromiografía objetivó atrapamiento del nervio mediano en codo y muñeca, y del nervio cubital en codo. Mejoró con AINE y fisioterapia. Caso 3: Varón de 52 años, carpintero metálico, que presentó dolor en epitróclea, parestesias y pérdida de fuerza en mano derecha. La electromiografía mostró atrapamiento de los nervios mediano y cubital en codo y del nervio mediano en la muñeca. Las pruebas de imagen fueron normales. Se trató conservadoramente, sin remisión completa de los síntomas. Conclusión: El SPT debe sospecharse en los pacientes con alteraciones sensitivas en el miembro superior. Diferenciarlo de otras neuropatías compresivas es fundamental puesto que la detección precoz permite aplicar medidas terapéuticas conservadoras efectivas.
Introducción de la cirugía artroscópica en Camboya en tres fases en el seno de un proyecto de cooperación al desarrollo
(Asociación Española de Artroscopia, 2012) Úbeda Pérez de Heredia, Íñigo; García Medina, J.R.; López-Vidriero Tejedor, E.; Paulín Seijas, J.L.; Sánchez González, A.D.; Díaz Álvarez, M.; Anatomía y Embriología Humana
Introducción: se diseña un programa de formación en cirugía artroscópica para los cirujanos camboyanos, buscando fortalecer el sistema sanitario y ofrecer los beneficios de esta técnica a la población. Material y método: se configuran tres equipos quirúrgicos que viajan a Camboya en tres fases, a intervalos de 6-8 meses. El trabajo de campo tiene una duración de tres semanas para cada equipo e incluye ponencias, talleres con modelos de plástico, semiología y exploración, cirugía y consultas. En las interfases se seleccionan nuevos casos. La actividad se centraliza en la capital (Phnom Penh), invitando a participar a cirujanos de otras provincias. El reclutamiento y traslado de los pacientes es competencia de organizaciones no gubernamentales involucradas en el proyecto. Discusión: se comprueba la viabilidad del proyecto. Las actividades se desarrollan en un hospital público con la participación de profesionales del propio centro y de otros hospitales. Se provee del material necesario y se da continuidad a los programas a través de sesiones clínicas virtuales. En un futuro se prevé la aplicación progresiva de la artroscopia en otras articulaciones. Resultados: se han realizado más de 300 consultas y 90 cirugías artroscópicas, y se han consolidado los conocimientos básicos de 20 profesionales camboyanos.
A Retrospective Study on tDCS Treatment in Patients with Drug-Resistant Chronic Pain
(MDPI, 2024-01-05) Pérez Borrego, Yolanda A.; Soto León, Vanesa; Brocalero Camacho, Ángela; Oliviero, Antonio; Carrasco López, María del Carmen; Anatomía y Embriología Humana; European Commission (EC)
Background. Transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) has an analgesic effect superior to a placebo in chronic pain. Some years ago, tDCS was implemented at the Hospital Nacional of Paraplegics (Toledo, Spain) to treat patients with pharmacological resistance to chronic pain. Objective. The main objectives of this study with tDCS were (1) to confirm the safety of one-year treatment; (2) to estimate the number of patients after one year in treatment; (3) to describe the effects of tDCS on the pain intensity during one-year treatment; and (4) to identify factors related to treatment success. Methods. This was a retrospective study conducted at the National Hospital for Paraplegics with 155 patients with pharmacologically resistant chronic pain. Anodal tDCS was applied over the M1 for 20 min at 1.5 mA for 10 treatment sessions from Monday to Friday (Induction phase), followed by 2–3 sessions per month (Maintenance phase). Pain intensity was assessed using a Visual Analogue Scale (VAS). Results. Anodal tDCS on M1 confirmed the reduction in the pain intensity. Moreover, 58% of outpatients completed one year of treatment. Only the VAS values obtained during the baseline influenced the response to treatment. Patients with a very high VAS at the baseline were more likely to not respond adequately to tDCS treatment. Conclusions. Anodal tDCS over M1 is an adequate therapy (safe and efficient) to treat drug-resistant chronic pain. Moreover, pain intensity at the start of treatment could be a predictor of patients’ continuity with tDCS for at least one year.
Personalized cardiovascular risk assessment in Rheumatoid Arthritis patients using circulating molecular profiles and their modulation by TNFi, IL6Ri, and JAKinibs
(Elsevier, 2024-03-12) Muñoz Barrera, Laura; Pérez Sánchez, Carlos; Ortega Castro, Rafaela; Corrales, Sagrario; Luque Tevar, Maria; Cerdó, Tomás; Ruiz Montesino, Mª Dolores; López Pedrera, Chary; Anatomía y Embriología Humana
Background & objectives This study aimed to: 1) analyze the inflammatory profile of Rheumatoid Arthritis (RA) patients, identifying clinical phenotypes associated with cardiovascular (CV) risk; 2) evaluate biologic and targeted-synthetic disease-modifying antirheumatic drugs (b-DMARDs and ts-DMARDs’: TNFi, IL6Ri, JAKinibs) effects; and 3) characterize molecular mechanisms in immune-cell activation and endothelial dysfunction. Patients & methods A total of 387 RA patients and 45 healthy donors were recruited, forming three cohorts: i) 208 RA patients with established disease but without previous CV events; ii) RA-CVD: 96 RA patients with CV events, and iii) 83 RA patients treated with b-DMARDs/ts-DMARDs for 6 months. Serum inflammatory profiles (cytokines/chemokines/growth factors) and NETosis/oxidative stress-linked biomolecules were evaluated. Mechanistic in vitro studies were performed on monocytes, neutrophils and endothelial cells (EC). Results In the first RA-cohort, unsupervised clustering unveiled three distinct groups: cluster 3 (C3) displayed the highest inflammatory profile, significant CV-risk score, and greater atheroma plaques prevalence. In contrast, cluster 1 (C1) exhibited the lowest inflammatory profile and CV risk score, while cluster 2 (C2) displayed an intermediate phenotype. Notably, 2nd cohort RA-CVD patients mirrored C3's inflammation. Treatment with b-DMARDs or ts-DMARDs effectively reduced disease-activity scores (DAS28) and restored normal biomolecules levels, controlling CV risk. In vitro, serum from C3-RA or RA-CVD patients increased neutrophils activity and CV-related protein levels in cultured monocytes and EC, which were partially prevented by pre-incubation with TNFi, IL6Ri, and JAKinibs. Conclusions Overall, analyzing circulating molecular profiles in RA patients holds potential for personalized clinical management, addressing CV risk and assisting healthcare professionals in tailoring treatment, ultimately improving outcomes.
Perspectivas de la moderna, ilusionante e innovadora docencia universitaria de la medicina
(Universidad de Sevilla, 2023-05-01) Dorado-Ocaña, Manuel E.; Anatomía y Embriología Humana
Decía A.W. Tony Bates, experto en educación en línea y tecnología educativa, “La tecnología ha sido utilizada principalmente para apoyar la enseñanza en el aula tradicional, sin embargo, en los últimos años la tecnología está influyendo de manera creciente en la actividad docente de las universidades. Hay un movimiento en la periferia hacia el centro de la educación”. (extracto)
Síndrome del pronador redondo en el contexto de otras neuropatías compresivas del miembro superior. Presentación de un caso
(Asociación Argentina de Ortopedia y Traumatología, 2024-12-26) Úbeda Pérez de Heredia, Íñigo; Anatomía y Embriología Humana
El síndrome del pronador redondo consiste en un atrapamiento del nervio mediano en su recorrido entre los vientres musculares del músculo pronador redondo. Es un cuadro poco común que habitualmente se confunde con otras neuropatías compresivas del miembro superior. Se presenta un caso infrecuente de síndrome del pronador redondo asociado a la compresión del nervio cubital en el codo y del nervio mediano en la muñeca. El estudio electrofisiológico detectó un atrapamiento del nervio mediano en la muñeca y una neuropatía cubital a nivel del codo. La ecografía dinámica del antebrazo constató una afectación morfológica del nervio mediano a su paso por el músculo pronador redondo. El paciente mejoró con la administración de corticoides y técnicas de rehabilitación y readaptación. Conclusiones: Se debe sospechar un síndrome del pronador redondo en pacientes que consultan por alteraciones sensitivas en el antebrazo y la muñeca. El diagnóstico diferencial con otras neuropatías compresivas es fundamental, porque la detección precoz permite indicar medidas terapéuticas conservadoras que eviten una progresión hacia la lesión estructural del nervio.

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