Open Access
Prognostic relevance of preoperative immune, inflammatory, and nutritional biomarkers in patients undergoing gastrectomy for resectable gastric adenocarcinoma: an observational multicentre study
(MDPI, 2024-06-11) Tur-Martínez, Jaume ; Rodríguez-Santiago, Joaquín; Osorio, Javier ; Miró, Mònica; Yárnoz Irazábal, María Concepción; Jofra, Mariona; Ferret, Georgina; Salvador-Roses, Helena; Fernández-Ananín, Sonia ; Clavell, Arantxa ; Luna, Alexis; Aldeano, Aurora; Olona, Carles; Hermoso, Judith; Güell-Farré, Mercè; Dal Cero, Mariagiulia; Gimeno, Marta; Pallarès, Natàlia; Pera, Manuel; Ciencias de la Salud; Osasun Zientziak
Background: The aim of this study was to evaluate different preoperative immune, inflammatory, and nutritional scores and their best cut-off values as predictors of poorer overall survival (OS) and disease-free survival (DFS) in patients who underwent curative gastric cancer resection. Methods: This was a retrospective observational multicentre study based on data of the Spanish EURECCA Esophagogastric Cancer Registry. Time-dependent Youden index and log-rank test were used to obtain the best cut-offs of 18 preoperative biomarkers for OS and DFS. An adjusted Cox model with variables selected by bootstrapping was used to identify the best preoperative biomarkers, which were also analysed for every TNM stage. Results: High neutrophil-to-lymphocyte ratio (NLR), high monocyte systemic inflammation index (moSII), and low prognostic nutritional index (PNI) were identified as independent predictors of poor outcome: NLR > 5.91 (HR:1.73; 95%CI [1.23–2.43]), moSII >2027.12 (HR:2.26; 95%CI [1.36–3.78]), and PNI >40.31 (HR:0.75; 95%CI [0.58–0.96]) for 5-year OS and NLR > 6.81 (HR:1.75; 95%CI [1.24–2.45]), moSII > 2027.12 (HR:2.46; 95%CI [1.49–4.04]), and PNI > 40.31 (HR:0.77; 95%CI [0.60,0.97]) for 5-year DFS. These outcomes were maintained in the whole cohort for NLR and moSII (p < 0.05) but not in stage II and for PNI in all tumoral stages. The associations of NLR-PNI and moSII-PNI were also a relevant prognostic factor for OS. Conclusions: High NLR, high moSII (for stages I and III), and low PNI (regardless of tumour stage) were the most promising preoperative biomarkers to predict poor OS and DFS in gastric cancer patients treated with curative intent.
Open Access
Postoperative physical rehabilitation in the elderly patient after emergency surgery: influence on functional, cognitive and quality of live recovery: study protocol for a randomized clinical trial
(BMC, 2024) Esquiroz Lizaur, Irene; Zambom Ferraresi, Fabrício; Zambom Ferraresi, Fabíola; Ollo Martínez, Iranzu; Casa Marín, Antón de la; Martínez Velilla, Nicolás; Recreo Baquedano, Ana; Galbete Jiménez, Arkaitz; González Álvarez, Gregorio; Yárnoz Irazábal, María Concepción; Eguaras Córdoba, Inés; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: the progressive aging of the population has meant the increase in elderly patients requiring an urgent surgery. Older adults, especially those with frailty, have a higher risk for complications, functional and cognitive decline after urgent surgery. These patients have their functional and physiological reserve reduced which makes them more vulnerable to the effects of being bedridden. The consequences are at multiple levels emphasizing the functional loss or cognitive impairment, longer stays, mortality and institutionalization, delirium, poor quality of life and increased use of resources related to health. We aim to determine whether postoperative physical rehabilitation can prevent functional and cognitive decline and modify the posterior trajectory. Methods/design: this study is a randomized clinical trial, simple blinded, conducted in the Department of Surgery of a tertiary public hospital in Navarra (Hospital Universitario de Navarra), Spain. Patients > = 70 years old undergoing urgent abdominal surgery who meet inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent physical training programme, which will include progressive and supervised endurance, resistance and balance training for 4 weeks, twice weekly sessions with a total of 8 sessions, and the group control will receive the usual care. The primary outcome measure is the change in functional (SPPB) and cognitive status (Mini-Mental State Examination) and the change of quality of life (EuroQol-5D-VAS) during the study period. The secondary outcomes are postoperative complications, length of stay, delirium, mortality, use of health resources, functional status (Barthel Index and handgrip strength tests), cost per quality-adjusted life year and mininutritional assessment. The data for both the intervention group and the control group will be obtained at four different times: the initial visit during hospital admission and at months 1, 3 and 6 months after hospital discharge. Discussion: If our hypothesis is correct, this project could show that individualized and progressive exercise programme provides effective therapy for improving the functional capacity and achieve a better functional, cognitive and quality of life recovery. This measure, without entailing a significant expense for the administration, probably has an important repercussion both in the short- and long-term recovery, improving care and functional parameters and could determine a lower subsequent need for health resources. To verify this, we will carry out a cost-effectiveness study. The clinical impact of this trial can be significant if we help to modify the traditional management of the elderly patients from an illness model to a more person-centred and functionally oriented perspective. Moreover, the prescription of individualized exercise can be routinely included in the clinical practice of these patients. Trial registration: ClinicalTrials.gov Identifier: NCT05290532. Version 1. Registered on March 13, 2022.
Open Access
Exploración del papel de los índices celulares de eosinófilos en el diagnóstico de la esofagitis eosinofílica
(Elsevier, 2025-06-01) Moreno Alfonso, Julio César; Barbosa-Velásquez, Sharom; Molina Caballero, Ada; Pérez Martínez, Alberto; Yárnoz Irazábal, María Concepción; Ciencias de la Salud; Osasun Zientziak
La esofagitis eosinofílica (EEo) es un trastorno inmunológico del esófago con una respuesta inflamatoria predominantemente eosinofílica. La endoscopia con biopsias es el método de elección para su diagnóstico y seguimiento, pero su naturaleza invasiva, considerable coste y potenciales complicaciones representan una preocupación vigente. Aunque se ha estudiado la utilidad diagnóstica y pronóstica de parámetros no invasivos, como la eosinofilia periférica, los resultados son diversos y la evidencia, insuficiente. Investigaciones recientes han demostrado la aplicabilidad de los índices celulares en diferentes enfermedades gastrointestinales. Estos índices se obtienen fácilmente del hemograma, tienen bajo coste, y, hasta donde sabemos, su papel no ha sido estudiado en la EEo. Se explora la utilidad de los índices celulares derivados de eosinófilos en la EEo mediante un estudio diagnóstico de los pacientes de menos de 15 años tratados con esofagogastroscopia por sospecha de EEo entre 2015 y 2022 en un hospital pediátrico, incluyéndose los pacientes con histopatología normal y aquellos con diagnóstico anatomopatológico de EEo (No. Reg. 3318-0000206).

Yárnoz Irazábal, María Concepción

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