Sant Pau Hospital Research Articles

Cannabinoid syndrome in cannabis dependence: a case report

IntroductionA 36-year-old man with a history of cannabis use disorder since age 16, consuming 8-10 units/day, experienced irritability and tremors upon reducing consumption. His psychiatric issues emerged in 2020, marked by anxiety, abdominal pain, and severe vomiting, leading to a dyspepsia diagnosis. Subsequently, he received psychiatric care at CAS Hospitalet, diagnosed with severe cannabis use disorder. No prior inpatient admissions occurred.Objectives Our project aims to show a case report and summarize the available evidence on cannabinoid hyperemesis syndrome (CHS).MethodsIn May 2023, he voluntarily sought admission to Barcelona’s “Hospital Sant Pau,” aiming for cannabis detox and treatment of cannabinoid hyperemesis. He’d endured years of intense abdominal pain, nausea, and vomiting, worsening over the last two years, with uncontrollable vomiting hindering daily life. Admission saw reduced cannabis use to 3-4 units/day. Inpatient care revealed anticipatory anxiety, rumination, and somatic anxiety, accompanied by distal tremors and internal restlessness due to abdominal discomfort, partially alleviated by 5-10 mg of diazepam.ResultsTreatment included domperidone 10mg/8h, haloperidol drops (5-10 drops/8h), capsaicin ointment, hot showers, and cryotherapy, resulting in gradual relief from abdominal pain. Moderate cravings for tobacco and cannabis led to acetylcysteine 600mg/12h and gabapentin up to 1200mg/8h. Gastric discomfort with SSRIs led to vortioxetine 10 mg/day, well-tolerated with a positive response. Consultation with the GI department confirmed the treatment’s efficacy, emphasizing cannabis abstinence. Upon discharge, cannabinoid hyperemesis symptoms markedly improved, and the patient was referred to “Hospital de Dia.”Conclusions CHS is a cyclic vomiting syndrome, preceded by daily to weekly chronic longstanding use of cannabis that can be difficult to diagnose and treat(1,3,4). It is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing (2). The major characteristics are as follows: history of regular cannabis for any duration of time (100%), cyclic nausea and vomiting (100%), resolution of symptoms after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%)(1). Treatments such as topical capsaicin, haloperidol, benzodiazepines, and propranolol have shown symptom relief (3) whereas opioids should be avoided (4). Cannabis cessation appears to be the best treatment (1,3).

M-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study

Background In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS. Objective The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention. Methods A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured. Results This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients’ acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients’ satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied. Conclusions The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS. Trial Registration ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2017-021346

Plasma and cerebrospinal fluid glial fibrillary acidic protein levels in adults with Down syndrome: a longitudinal cohort study.

The diagnosis of symptomatic Alzheimer's disease is a clinical challenge in adults with Down syndrome. Blood biomarkers would be of particular clinical importance in this population. The astrocytic Glial Fibrillary Acidic Protein (GFAP) is a marker of astrogliosis associated with amyloid pathology, but its longitudinal changes, association with other biomarkers and cognitive performance have not been studied in individuals with Down syndrome. We performed a three-centre study of adults with Down syndrome, autosomal dominant Alzheimer's disease and euploid individuals enrolled in Hospital Sant Pau, Barcelona (Spain), Hospital Clinic, Barcelona (Spain) and Ludwig-Maximilians-Universität, Munich (Germany). Cerebrospinal fluid (CSF) and plasma GFAP concentrations were quantified using Simoa. A subset of participants had PET 18F-fluorodeoxyglucose, amyloid tracers and MRI measurements. This study included 997 individuals, 585 participants with Down syndrome, 61 Familial Alzheimer's disease mutation carriers and 351 euploid individuals along the Alzheimer's disease continuum, recruited between November 2008 and May 2022. Participants with Down syndrome were clinically classified at baseline as asymptomatic, prodromal Alzheimer's disease and Alzheimer's disease dementia. Plasma GFAP levels were significantly increased in prodromal and Alzheimer's disease dementia compared to asymptomatic individuals and increased in parallel to CSF Aβ changes, ten years prior to amyloid PET positivity. Plasma GFAP presented the highest diagnostic performance to discriminate symptomatic from asymptomatic groups (AUC=0.93, 95% CI 0.9-0.95) and its concentrations were significantly higher in progressors vs non-progressors (p<0.001), showing an increase of 19.8% (11.8-33.0) per year in participants with dementia. Finally, plasma GFAP levels were highly correlated with cortical thinning and brain amyloid pathology. Our findings support the utility of plasma GFAP as a biomarker of Alzheimer's disease in adults with Down syndrome, with possible applications in clinical practice and clinical trials. AC Immune, La Caixa Foundation, Instituto de Salud Carlos III, National Institute on Aging, Wellcome Trust, Jérôme Lejeune Foundation, Medical Research Council, Alzheimer's Association, National Institute for Health Research, EU Joint Programme-Neurodegenerative Disease Research, Alzheimer's Society, Deutsche Forschungsgemeinschaft, Stiftung für die Erforschung von Verhaltens, Fundación Tatiana Pérez de Guzmán el Bueno & European Union's Horizon 2020 und Umwelteinflüssen auf die menschliche Gesundheit.

Editorial introductions.

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Luis QuerolLuis QuerolLuis Querol (Valencia, 1980) graduated in Medicine at the University of Oviedo, Spain, and completed his residency in Neurology at the Santa Creu i Sant Pau Hospital in Barcelona. In 2009, he joined the group of Prof. Isabel Illa where he developed his doctoral thesis on the role of autoantibodies in immune-mediated neuropathies. In 2012, he worked as an associate researcher in the group of Dr Kevin O’Connor, Department of Neurology, Yale University (USA), where he developed projects related to autoantibodies in multiple sclerosis and myasthenia gravis. He completed his PhD in Medicine at the Universidad Autónoma de Barcelona, Spain, in 2013 thanks to studies that identified anti-contactin antibodies in a specific subgroup of patients with CIDP, in what is the first clinically useful marker detected in CIDP. Since then, he has led the auoimmune neurology clinics at Hospital Sant Pau in Barcelona and has continued a fruitful scientific production in the field of autoantibodies and biomarkers in autoimmune neurological disorders. Ichizo NishinoIchizo NishinoDr Ichizo Nishino, FAAN, FANA, is Director of Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP). He obtained his M.D. in 1989 and Ph.D. in 1998 from Kyoto University, Japan. After five years of training in clinical neurology and six years of research fellowship, including two years at Columbia University, he was appointed to his current position in 2001. By now, he has published more than 600 PubMed-listed papers in the field, including the reports of gene discoveries for MNGIE and Danon disease, and the report of a new muscle disease – megaconial congenital muscular dystrophy (OMIM: 602541) whose causative was also later identified by his own group. His laboratory functions as a nationwide referral center for muscle disease, providing diagnostic analyses for muscle pathology and genetic diagnosis. His lab receives around 80% of muscle biopsies performed in Japan (1103 cases in 2021) and he signs out all cases. As a result, more than 22,000 frozen muscle biopsy samples have been accumulated in his muscle repository, which is one of the largest collections of the patient's muscles. Currently, Dr Nishino is a Visiting Professor at six universities: University of Yamanashi (Japan), Shinshu University (Japan), Kaohsiung Medical University (Taiwan), Fu Jen Catholic University (Taiwan), Peking University First Hospital (China), and Siriraj Hospital Mahidol University (Thailand). He is also serving as President of Asian-Oceanian Myology Center and Executive Board member in several societies including World Muscle Society. Albert LudolphAlbert LudolphAlbert Ludolph is currently Professor of Neurology, Chair and Director of the Department of Neurology, University of Ulm, Ulm, Germany and Speaker of the Site Ulm of the German Center for Neurodegenerative diseses (DZNE, Helmholtz Society). He obtained his M.D. from the University of Mainz, Germany, in 1981 and is a boarded neurologist and psychiatrist (education from University of Münster, Germany). His research focusses on translational work in neurodegenerative diseases; his work is mirrored by more than 600 PubMed-listed papers. His specific focus of interests are motor neuron diseases, Huntington's disease and frontotemporal dementias. The Department of Neurology in Ulm is an international referral center in particular for patients with ALS/MND. In the past his research focused on neurotoxicological and neuropharmacological research in humans, but also non-human primates. He was involved and initiated studies of neurogenetics of ALS, of the epidemiology of the disease (established registers in Southern Germany, Egypt and Mongolia), of the definition of the neuroanatomical sequence of events describing ALS and FTD, the development of biomarkers in ALS and FTD and beyond, and several drug trials, including investigator-initiated interventions. In recent years he tried to define the preclinical period of ALS including the role of the hypothalamus and its metabolic consequences.

Defining Minor Intracerebral Hemorrhage

Background and Purpose: The minor stroke concept has not been analyzed in intracerebral hemorrhage (ICH) patients. Our purpose was to determine the optimal cut point on the NIH Stroke Scale (NIHSS) for defining a minor ICH (mICH) in patients with primary ICH. Methods: An ICH was considered minor if associated with a favorable 3-month outcome (modified Rankin Scale score ≤2). For supratentorial ICH, the discovery cohort consisted of 478 patients prospectively admitted at University Hospital del Mar. Association between NIHSS at admission and 3-month outcome was evaluated with area under the curve-receiver operating characteristics (AUC-ROC) and Youden’s index to identify the optimal NIHSS cutoff point to define mICH. External validation was performed in a cohort of 242 supratentorial ICH patients from University Hospital Sant Pau. For infratentorial location, patients from both hospitals (n = 85) were analyzed together. Results: The best ­NIHSS cutoff point defining supratentorial-mICH was 6 (AUC-ROC = 0.815 [0.774–0.857] in the discovery cohort and AUC-ROC = 0.819 [0.756–0.882] in the external validation cohort). For infratentorial ICH, the best cutoff point was 4 (AUC-ROC = 0.771 [0.664–0.877]). Using these cutoff points, 40.5% of all primary ICH cases were mICH. Of these, 70.2% were living independently at 3-month follow-up (72% for supratentorial ICH and 56.1% for infratentorial ICH) and 6.5% had died (5.3% for supratentorial ICH, and 14.6% for infratentorial ICH). For patients identified as non-mICH, good 3-month outcome was observed in 11.3% of cases; mortality was 51%. Conclusions: The definition of mICH using the NIHSS cutoff point of 6 for supratentorial ICH and 4 for infratentorial ICH is useful to identify good outcome in ICH patients.

The Influence Of A 12-week Home-exercise Program On Physical Fitness And Physical Functioning In Childhood Survivors Of Acute Lymphoblastic Leukaemia: Results Of A Randomised Clinical Trial

PURPOSE: Positive effects of home-exercise programmes on physical fitness have been reported in studies with childhood malignancy. However, conclusive evidence on the impact of home-exercise programmes for physical fitness indicators or functional capacity during daily life activities outcomes in leukaemia is yet to be established. Therefore, the research question for this randomised controlled trial was: Does home-exercise programme improve the physical fitness and physical functioning outcomes more than usual care among children survivors of ALL? METHODS: A parallel-group, assessor-blinded, pilot randomised controlled trial was conducted at the Santa Creu i Sant Pau Hospital in Spain (NCT03005392). Twenty-four survivors of ALL were assigned to usual care (control group, n=12, 11.0±3.7 years) or to a home-exercise programme (intervention group, n=12, 11.8±4.3 years). Peak oxygen uptake (VO2peak ml/kg/min), minute ventilation (VE L/min), output of carbon dioxide (VCO2 L/min), respiratory exchange ratio (RER), peak heart rate (beats/min), maximal load (W), VO2 at anaerobic threshold (VO2 at AT, mL/kg/min), pulse oxygen (PO2 ml/beat), heart rate at anaerobic threshold (beats/min), handgrip test (pounds), flexibility (cm), Timed Up & Go test TUG (s), and Timed Up and Down Stairs test (TUDS s) were measured at baseline and over 16 weeks of intervention. RESULTS: Adjusted mixed linear models revealed a significant group-time interaction +6.7 (95% CI = 0.6-12.8 ml/kg/min; η2 partial = 0.046, P=0.035) for VO2peak. Similarly changes in mean values was observed after the home-exercise programme compared to baseline for VE (L/min) −8.8 (3.0) (P=0.035), VCO2 −0.23 (0.08), (P=0.041), maximal load (W) −35.5 (12.8) (P=0.024), TUDS (s) 0.8 (2.6) (P=0.010), and TUG (s) 0.60 (0.1) (P=0.001), however the group-time interaction were not significant. CONCLUSIONS: The home-exercise program resulted in changes in measures of VO2peak, VE, VCO2 and functional capacity during daily life activities (TUDS and TUG test). This is an interesting and important study that surely adds to the current body of knowledge/ literature on the safety of exercise interventions, especially in children with haematological cancer.

A Conversation Between Ignasi Carrió and Ken Herrmann.

Ken Herrmann, MD, MBA, a professor of nuclear medicine at the Universitatsklinikum Essen (Germany), talked with Ignasi Carrio, MD, a professor of Radiology and Nuclear Medicine at the Autonomous University of Barcelona (Spain) and director of the Department of Nuclear Medicine at Hospital Sant Pau

Observational Study of Complexity in a Psychiatric Hospital Unit

ABSTRACT&#x0D; Objectives: 1. Describe the possible variables that may be related to a psychiatric complex patient at the Acute Psychiatric Unit of Santa Creu i Sant Pau Hospital. 2. Determine the usefulness of the standard concept of chronic complex patient in a psychiatric patient.&#x0D; Methods: Cross sectional, observational, and quantitative study were conducted in Hospital Santa Creu i Sant Pau, Barcelona. 46 patients admitted at the Acute Psychiatric Ward from March to May 2018 were included in the study. The scales used were: PANSS, HDRS, YMRS, EEAG, FAST, CGI, EQ-VAS and Zarit Burden. The number of extended stays in health institutions, need for social assistance, previous admissions and duration of hospital stay were also evaluated.&#x0D; &#x0D; Results: There is no difference in the need for social assistance between chronic complex patient (11%) and non-chronic complex patient (18.9%). Also, no difference was noted among the scales FAST, CGI, EEAG, EQ-VAS and Zarit Burden. Upon analysis of the variables, the result of the quality of life is correlated with: 1. PANSS_N (p&lt;0.0044) 2. FAST finances (p&lt;0.0027) 3. FAST cognitive (p&lt;0.0018).&#x0D; &#x0D; Conclusion: The standard definition of a Chronic Complex Patient does not fit the needs of complexity in a psychiatric patient.&#x0D; &#x0D; DeCS: quality of life, multimorbidity, caregiver, psychiatric

566P - Validation of GAME score risk groups in resected colorectal cancer liver metastases and the prognostic relevance of KRAS, NRAS and BRAF mutation analysis

BackgroundHepatic resection of liver metastases is considered the optimal potentially curative treatment for colorectal liver metastases. Numerous clinical and pathological factors have been proved to be prognostic. The Genetic And Morphological Evaluation (GAME) has been proposed as a preoperative prognostic tool to select patients candidates for liver resection. This study aimed to validate the utility of GAME score risk groups in patients with colorectal liver metastases that underwent hepatic resection. MethodsClinical and pathological data were collected from 142 metastatic colorectal cancer patients undergoing liver resection (48% after neoadjuvant chemotherapy) between August 1999 and February 2018 at Sant Pau Hospital. The GAME score was calculated allocating points for KRAS mutation, CEA levels, lymph node metastasis, Tumour Burden score (TBS) and extrahepatic disease. We analysed the progression free survival (PFS) and overall survival (OS) according to the GAME score risk groups. Additionally, we considered other KRAS, NRAS and BRAF mutations not included in the original GAME score. Histopathological changes in malignant tissue and liver parenchyma were documented to identify potential prognostic factors for tumor recurrence. ResultsThe high-risk group (GAME score ≥ 4 points) had a median PFS of 15.8 months compared with 24.2 months for the low-risk group (GAME score 0–1 point; p=0.019). The high-risk group had a medium OS of 38.6 months compared with 68.8 months for the low-risk group (p=0.05). When all RAS and BRAF status was considered regardless of the GAME score a median OS of 66.2 months was observed in wild type tumours compared to 44.5 months for mutated tumours (p=0.005). Histological examination showed that a mixed and infiltrative growth pattern and the absence of a fibrotic pseudocapsule or liver cell rosettes were associated with a worse outcome. ConclusionsThe GAME score was validated as a useful preoperative prognostic tool in our cohort of patients. However, in our series, molecular profile was a prognostic factor regardless of the GAME score. Some pathologic characteristics may help on further clinical decisions after liver resection. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Cannabis users show increased susceptibility to false memories

Drug and Alcohol Dependence 156 (2015) e183–e245 e189 areas of sexual risk reduction, prevention and treatment for substanceabuseandmental health. Publichealthprogramsprioritizing the different populations are necessary. Financial support: Fogarty International Center; Grant 1R03TW007612; Fundo de Incentivo e Auxilio a Pesquisa (FIPE) from Hospital de Clinicas de Porto Alegre, Brazil (GPPGHCPA – No. 07-391). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.507 Crack, powdered cocaine, both or neither: A generalized logit analysis of a community-based sample Grace L. Reynolds1,2,∗, Dennis G. Fisher1, Erlyana Erlyana2 1 Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, United States 2 Health Care Administration, California State University, Long Beach, Long Beach, CA, United States Aims: To understand factors associated with use of both crack cocaine and non-injected powered cocaine. Methods: The Risk Behavior Assessment (RBA; 1993) was used to elicit information on past month, past 48-hours and drugs used before/during sex drug use in a sample of out-of-treatment drug users (N=8538). Past 30 day, past 48h, and before/during sex drug use were coded into (1) use of crack (smokable cocaine) only, (2) powdered cocaine use only, (3) both drugs used during the timeframe and (4) neither drug used. Generalized logit analysis was used to develop models for each timeframe (48-hour and 30-day). For all models the reference group was using neither drug. Results: Respondents who reported use of both crack and powdered cocaine (N=306) included both men (n=207) and women (n=99). The 48-hour, 30-day, and before/during sex models were almost identical. Those who reported using both crack and cocaine were more likely to: be Black (OR=1.65, CI 1.27, 2.14); bisexual (OR=1.85, CI 1.39, 2.47); trade sex fordrugs (OR=4.88CI 3.73, 6.39); tobehomeless (OR=3.50, CI 2.66, 4.62), havehighernumberof days used alcohol in the pastmonth (OR=1.09, CI 1.08, 1.10); and to have had gonorrhea (OR=1.42, CI 1.07, 1.88). Conclusions: The general logit model highlights factors associated with use of both crack and powdered cocaine within the same timeframe, includinghomelessness, andbeingamemberof anethic or sexual minority, and sex trading. Financial support: Funding was provided in part by grant R01 DA030234 from the National Institute on Drug Abuse, P20MD003942 from the National Institute of Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, the National Institute ofMinority Health and Health Disparities or the National Institutes of Health. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.508 Cannabis users show increased susceptibility to false memories Jordi Riba1,∗, Frederic Sampedro2, Aina Rodriguez-Pujadas2, Saul Martinez-Horta1, Jaime Kulisevsky1, Jose-Carlos Perez-de-los-Cobos1, Antoni Rodriguez-Fornells1, Marta Valle1 1 Hospital Sant Pau, Barcelona, Spain 2 University of Barcelona, Barcelona, Spain Aims: Previous studies on the neurocognitive impact of cannabis use have found working and declarative memory deficits that tend to normalize with abstinence. An unexplored aspect of cognitive function in chronic cannabis users is the ability to distinguish between veridical and illusory events; a crucial aspect of reality monitoring that relies on adequate memory function and cognitive control. Methods: Sixteen heavy cannabis users not seeking treatment for their cannabis consumptionwerematched to a group of healthy controls taking into account sex, age, years of education, verbal intelligence and fluid intelligence. All participants performed a modified version of the Deese–Roediger–McDermott paradigm in an MRI scanner. Following a study phase, subjects were presented with 75 old words, 40 semantically unrelated new words and 40 semantically related new words or lures. They were required to judge whether a word had been presented in the study phase and make an old vs. new decision by button press. Results: Cannabis users showed an increased susceptibility to false memories, failing to identify lure stimuli as events that never occurred. In addition to impaired performance, they displayed reduced activation in areas associated with memory processing within the medial temporal lobe (MTL), and in parietal and frontal brain regions involved in attention and performance monitoring. Reduced activity in the MTL was associated with greater cannabis consumption. Conclusions: These findings indicate that cannabis users have an increased susceptibility to memory distortions even when abstinent and drug-free, suggesting a long-lasting compromise of memory and cognitive control mechanisms involved in reality monitoring. Financial support: This research was supported by the “Plan Nacional Sobre Drogas” of the Spanish Government. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.509 CaMKII inhibition affects cocaine-cue memory processes to attenuate reinstatement Matthew T. Rich1,∗, Mary M. Torregrossa2 1 University of Pittsburgh, Pittsburgh, PA, United States 2 Psychiatry, University of Pittsburgh, Pittsburgh, PA,

Correlates between Brazilian club drug users men who have sex with men, psychiatric vulnerabilities and multiple sexual partners

Drug and Alcohol Dependence 156 (2015) e183–e245 e189 areas of sexual risk reduction, prevention and treatment for substanceabuseandmental health. Publichealthprogramsprioritizing the different populations are necessary. Financial support: Fogarty International Center; Grant 1R03TW007612; Fundo de Incentivo e Auxilio a Pesquisa (FIPE) from Hospital de Clinicas de Porto Alegre, Brazil (GPPGHCPA – No. 07-391). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.507 Crack, powdered cocaine, both or neither: A generalized logit analysis of a community-based sample Grace L. Reynolds1,2,∗, Dennis G. Fisher1, Erlyana Erlyana2 1 Center for Behavioral Research and Services, California State University, Long Beach, Long Beach, CA, United States 2 Health Care Administration, California State University, Long Beach, Long Beach, CA, United States Aims: To understand factors associated with use of both crack cocaine and non-injected powered cocaine. Methods: The Risk Behavior Assessment (RBA; 1993) was used to elicit information on past month, past 48-hours and drugs used before/during sex drug use in a sample of out-of-treatment drug users (N=8538). Past 30 day, past 48h, and before/during sex drug use were coded into (1) use of crack (smokable cocaine) only, (2) powdered cocaine use only, (3) both drugs used during the timeframe and (4) neither drug used. Generalized logit analysis was used to develop models for each timeframe (48-hour and 30-day). For all models the reference group was using neither drug. Results: Respondents who reported use of both crack and powdered cocaine (N=306) included both men (n=207) and women (n=99). The 48-hour, 30-day, and before/during sex models were almost identical. Those who reported using both crack and cocaine were more likely to: be Black (OR=1.65, CI 1.27, 2.14); bisexual (OR=1.85, CI 1.39, 2.47); trade sex fordrugs (OR=4.88CI 3.73, 6.39); tobehomeless (OR=3.50, CI 2.66, 4.62), havehighernumberof days used alcohol in the pastmonth (OR=1.09, CI 1.08, 1.10); and to have had gonorrhea (OR=1.42, CI 1.07, 1.88). Conclusions: The general logit model highlights factors associated with use of both crack and powdered cocaine within the same timeframe, includinghomelessness, andbeingamemberof anethic or sexual minority, and sex trading. Financial support: Funding was provided in part by grant R01 DA030234 from the National Institute on Drug Abuse, P20MD003942 from the National Institute of Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, the National Institute ofMinority Health and Health Disparities or the National Institutes of Health. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.508 Cannabis users show increased susceptibility to false memories Jordi Riba1,∗, Frederic Sampedro2, Aina Rodriguez-Pujadas2, Saul Martinez-Horta1, Jaime Kulisevsky1, Jose-Carlos Perez-de-los-Cobos1, Antoni Rodriguez-Fornells1, Marta Valle1 1 Hospital Sant Pau, Barcelona, Spain 2 University of Barcelona, Barcelona, Spain Aims: Previous studies on the neurocognitive impact of cannabis use have found working and declarative memory deficits that tend to normalize with abstinence. An unexplored aspect of cognitive function in chronic cannabis users is the ability to distinguish between veridical and illusory events; a crucial aspect of reality monitoring that relies on adequate memory function and cognitive control. Methods: Sixteen heavy cannabis users not seeking treatment for their cannabis consumptionwerematched to a group of healthy controls taking into account sex, age, years of education, verbal intelligence and fluid intelligence. All participants performed a modified version of the Deese–Roediger–McDermott paradigm in an MRI scanner. Following a study phase, subjects were presented with 75 old words, 40 semantically unrelated new words and 40 semantically related new words or lures. They were required to judge whether a word had been presented in the study phase and make an old vs. new decision by button press. Results: Cannabis users showed an increased susceptibility to false memories, failing to identify lure stimuli as events that never occurred. In addition to impaired performance, they displayed reduced activation in areas associated with memory processing within the medial temporal lobe (MTL), and in parietal and frontal brain regions involved in attention and performance monitoring. Reduced activity in the MTL was associated with greater cannabis consumption. Conclusions: These findings indicate that cannabis users have an increased susceptibility to memory distortions even when abstinent and drug-free, suggesting a long-lasting compromise of memory and cognitive control mechanisms involved in reality monitoring. Financial support: This research was supported by the “Plan Nacional Sobre Drogas” of the Spanish Government. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.509 CaMKII inhibition affects cocaine-cue memory processes to attenuate reinstatement Matthew T. Rich1,∗, Mary M. Torregrossa2 1 University of Pittsburgh, Pittsburgh, PA, United States 2 Psychiatry, University of Pittsburgh, Pittsburgh, PA,

Perception of health and cognitive dysfunction in acromegaly patients

As therapeutic options improve for pituitary adenomas, we like to think we are capable of ‘curing’ patients with these diseases. However, in parallel to the availability of instruments to evaluate the patient’s subjective perception of outcome of the disease, evidence is accumulating on residual morbidity despite endocrine control of hormonal dysfunction. Over the last few years, cognitive dysfunction has been identified as one of the most common co-morbidities of pituitary tumours. Why this occurs is still unclear and could be related to neurovascular decline, ageing, suffering a chronic disease, apart from hormone imbalance, either chronic hormone excess or deficiency (mainly GH or cortisol). Evaluation of cognitive dysfunction in acromegaly has revealed contradictory findings. While Tiemensma et al. [1] reported normal cognitive function in patients with long-term cured acromegaly, several other studies showed deficits in attention, executive functions and memory [2– 4]. In their paper, Yedinak and Fleseriu [5] show cognitive dysfunction in 10 patients with active acromegaly, 17 with controlled acromegaly (defined as normal IGF-I and GH after an oral glucose tolerance test of \1 ng/mL) and 14 non-functioning pituitary microadenoma (NFPA), which were prospectively enrolled over a 3 year period in a tertiary referral centre in the US. They evaluated selfperception of cognitive deficits and quality of life/health by selecting and modifying relevant questions of questionnaires, originally designed for other diseases. Certain questions (16 of the original 37) from the Functional Assessment of Cancer Therapy Cognitive Scale (FACTCog) were selected, which reflected subsets of cognition, like ability to learn, concentration and distractibility, mental agility, memory and recall and verbal recall. Additionally, patients were asked to rate on a 1–5 scale how their health compared today with their desired health and to 12 months before. These questions are focused on patient perception, not objective cognitive measures, and this self-perception of cognitive function is influenced by the patient’s goals, expectations, standards, concerns, personality, as well as life events. For example, increased psychopathology (mainly anxiety and depression), maladaptive personality traits or less effective coping strategies, all previously described in patients with controlled acromegaly, may determine how these questions are answered [1, 6, 7]. The main findings of Yedinak and Fleseriu were that prevalence of cognitive dysfunction, in parallel to severity score for each of the 5 subsets of questions, was higher in NFPA (69 %) than in both groups of acromegalic patients, with no difference in prevalence between the latter (54 % in controlled vs. 57 % in active acromegaly). When the five specific cognitive areas were analysed, significant differences were observed for each subset; NFPA expressed greater cognitive dysfunction for mental agility, memory/ recall and verbal recall, but for ability to learn and concentration/distractibility, the group with active acromegaly expressed more problems and more severe dysfunction. This result is in line with previous studies that have reported attention and memory problems, and attenuation of electrophysiological brain activity in naive acromegaly I. Crespo S. M. Webb Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Pare Claret 167, 08025 Barcelona, Spain

Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Exacerbation of Chronic Heart Failure

Study Objective: To determine whether a new emergency department short-stay unit (EDSSU) was an effective alternative to conventional hospital units (HU) for acute exacerbation of chronic heart failure patients. Methods: Design: A comparative analysis was used to identify differences among patients admitted to EDSSU (n = 1546) and those admitted to the internal medicine (n = 552) or cardiology wards (n = 336) during the period of the study (January 1, 2008 to December 31, 2012). Setting: The study was performed at Sant Pau Hospital, a 500-bed teaching tertiary care referral center in Barcelona, Spain. The ED attends about 144,000 emergency visits per year. Participants: We studied retrospectively the characteristics of patients hospitalized with an acute exacerbation of chronic heart failure between January 1, 2008 and December 31, 2012 (n = 2434). We chose charts of patients from the hospital discharge database and selected according to the 9th revision of the International Classification of Diseases Codes. We used the computerized database to obtain outcome data on all patients. Results: Statistically significant differences were found in terms of mean age (HU: 77.38 (14.44) years versus EDSSU: 82.43 (8.72) years; p < 0.001), mean length of stay (HU: 11.57 (10.42) days versus EDSSU: 4.75 (3.18) days; p < 0.001), mortality (HU: 14.0% versus EDSSU: 4.0%; p < 0.001), but not for urgent readmission rate of 30 days or less (HU: 18.30% versus EDSSU: 18.30%; p = 0.998). There were statistically significant differences regarding sex (HU women = 60.6%; EDDSU women = 67.7%; p < 0.001) and number of associated conditions (Charlson index HU = 1.25, EDDSU = 0.90; p < 0.001). Conclusion: The EDSSU proved to be an effective and safe measure in emergency care of patients with acute heart failure (AHF).

Comparison of Far and near Contrast Sensitivity in Patients Symmetrically Implanted with Multifocal and Monofocal Iols

A prospective, randomized, double-masked, clinical trial was designed to evaluate distance and near contrast sensitivity (CS) in patients symmetrically, and randomly, implanted with 4 different multifocal intraocular lens (MIOL) designs (ReSTOR SN6AD1, ReSTOR SN60D3, ReZoom NXG, and Tecnis ZMA00) and a monofocal control group (Tecnis ZA9003), 6 months after cataract intervention. Photopic, mesopic, and mesopic with glare distance CS, as well as photopic near CS, was evaluated with the CSV-1000 CS test and the Vistech VCTS 6000 system, respectively, in a group of 180 patients attending the ophthalmology department of Sant Pau Hospital, Barcelona, for cataract intervention and lens implantation. Statistically and clinically significant differences were found between the monofocal and multifocal lens groups at all spatial frequencies and illumination conditions, both during distance and near CS evaluation (all p<0.05), with the monofocal lens offering the best performance in all cases. Contrast sensitivity was similarly compromised in all MIOL models at distance, although MIOLs with diffractive optics and aspheric profiles showed a non-statistically significant trend to perform better in mesopic conditions. Near CS was lower for refractive, distance dominant lens designs, particularly at medium to high spatial frequencies. The present results, which reflect intraocular lens (IOL) characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient by taking into consideration the individual needs for critical distance and near vision, both in terms of visual acuity and contrast sensitivity.

Blood transfusion for upper gastrointestinal bleeding: is less more again?

BackgroundThe hemoglobin threshold for transfusion of red blood cells in patients with acute gastrointestinal (GI) bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.MethodsObjective: The objective was to prove that the restrictive threshold for red blood cell transfusion in patients with acute upper GI bleeding (UGIB) was safer and more effective than a liberal transfusion strategy.Design: A single-center, randomized controlled trial was conducted.Setting: Patients with GI bleeding were admitted to the de la Santa Creu i Sant Pau hospital in Barcelona, Spain.Subjects: The subjects were adult intensive care unit patients admitted with high clinical suspicion of UGIB (hematomemesis, melena, or both). Patients were excluded if they had massive exsanguinating bleeding, acute coronary syndrome, symptomatic peripheral vascular disease, stroke/transient ischemic attack, transfusion within the previous 90 days, recent trauma or surgery, lower GI bleeding, or a clinical Rockall score of 0 with hemoglobin higher than 12 g/dL.Intervention: A total of 921 patients with severe acute UGIB were enrolled. Of these, 461 were randomly assigned to a restrictive strategy (transfusion when the hemoglobin level fell to below 7 g/dL) and 460 to a liberal strategy (transfusion when the hemoglobin fell to below 9 g/dL). Random assignment was stratified according to the presence or absence of liver cirrhosis.Outcomes: The primary outcome was rate of death from any cause within the first 45 days. Secondary outcomes were further bleeding, defined as hematemesis or melena with hemodynamic instability or hemoglobin decrease of 2 g/dL or more, and in-hospital complications.ResultsIn total, 225 patients assigned to the restrictive strategy (51%) and 65 assigned to the liberal strategy (15%) did not receive transfusions (P <0.001). The probability of survival at 6 weeks was higher in the restrictive-strategy group than in the liberal-strategy group (95% versus 91%; hazard ratio (HR) for death with restrictive strategy, 0.55; 95% confidence interval (CI) 0.33 to 0.92; P = 0.02). Further bleeding occurred in 10% of the patients in the restrictive-strategy group and in 16% of the patients in the liberal-strategy group (P = 0.01), and adverse events occurred in 40% and 48%, respectively (P = 0.02). The probability of survival was slightly higher with the restrictive strategy than with the liberal strategy in the subgroup of patients who had bleeding associated with a peptic ulcer (HR 0.70, 95% CI 0.26 to 1.25) and was significantly higher in the subgroup of patients with cirrhosis and Child-Pugh class A or B disease (HR 0.30, 95% CI 0.11 to 0.85) but not in those with cirrhosis and Child-Pugh class C disease (HR 1.04, 95% CI 0.45 to 2.37). Within the first 5 days, the portal-pressure gradient increased significantly in patients assigned to the liberal strategy (P = 0.03) but not in those assigned to the restrictive strategy.ConclusionsCompared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute UGIB.

Analytic comments of the initial results of the VISION (Vascular events In noncardiac Surgery patIents cOhort evaluatioN): Association between troponin T and mortality at 30 days in noncardiac surgery patients

The initial results of the VISION study (Vascular events In noncardiac Surgery patIents cOhort evaluatioN) have recently been published in JAMA. VISION was proposed, designed, and directed by the team of Dr. Devereaux (McMaster University, Ontario, Canada), a cardiologist--epidemiologist who runs a perioperative ischemia research program. VISION is a prospective international multicenter cohort study, with more than 20,000 patients recruited to date. The two participating centers in Spain, with over 3700 patients included, are, respectively, Hospital Sant Pau in Barcelona, and Hospital Gregorio Maranon, in Madrid. The study initially intended

Unusual upper gastrointestinal diseases associated with achalasia: laparoscopic approach

As a result of the high success rate associated with the laparoscopic approach for achalasia, surgery for the disease has become the treatment of choice in recent years. With the greater number of patients undergoing surgery, surgeons may encounter other upper gastroesophageal illnesses associated with achalasia, and these may require evaluation for simultaneous surgical treatment. This study aimed to evaluate the incidence of gastroesophageal diseases associated with achalasia, and to determine the possibility for simultaneous management using the laparoscopic approach. From January 1999 to May 2006, 81 patients were referred from the Service of Gastroenterology to the Service of General and Digestive Surgery as candidates for the surgical management of achalasia. Data for this group were recorded prospectively in laparoscopic surgery databases at the Hospital Sant Pau and the Hospital de Igualada. A total of 78 patients underwent laparoscopic Heller myotomy with gastric fundoplication. In 8 of 81 patients, nine additional gastroesophageal diseases (11.1%) were found: three cases of pseudoachalasia (3.7%), three cases of paraesophageal hiatal hernia (3.7%), two cases of esophageal diverticulum (2.5%), and one case of gastric volvulus (1.2%). Pseudoachalasia was diagnosed for three patients. The diagnosis was made preoperatively for one of these patients. For the other two patients, an adenocarcinoma arising from the gastroesophageal junction was diagnosed during the laparoscopy. In three cases, a paraesophageal hiatal hernia was found and treated by laparoscopic Heller myotomy, sac excision, hiatal closure, and posterior fundoplication. Esophageal diverticulectomy was performed for one patient. Another patient presented with an organoaxial gastric volvulus associated with achalasia, for which laparoscopic Heller myotomy, posterior fundoplication, and anterior gastropexy were performed. The median follow-up period was 39 months, with no recurrence. Despite their infrequency, several gastroesophageal diseases may be found in association with achalasia. Laparoscopic surgery may be useful for the diagnosis and/or treatment of both diseases.

Trasplante alogénico de células progenitoras hematopoyéticas de sangre periférica con acondicionamiento de baja intensidad como tratamiento del carcinoma de células claras metastásico: Resultados preliminares con dos años de seguimiento mínimo

To evaluate the toxicity and outcomes of the allogeneic transplantation of peripheral blood hematopoietic stem-cells with low intensity conditioning (mini-alo Bone Marrow transplantation-BMT) in metastatic renal cell carcinoma refractory to at least one line of systemic treatment. From 30 patients submitted to the Sant Pau's Hospital for immunotherapy between 1/2001 and 1/2003, six patients finally underwent mini-alo BMT within a clinical trial. Conditioning: Fludarabine: 30 minute i.v. infusion of 13 mg/m2 on days -9, -8, -7, -6 and -5. Busulfan: 1 mg/kg (real weight) q 6 hours, PO on days -6, -5, and -4 (4 doses per day on days -6 and -5, and 2 doses only on day -4, total number of doses 10). Two patients achieved partial response, one patient stabilized disease, and two patients had progression on days +30 and +60. Therefore, 2/3 patients surviving more than six months achieved partial response. One patient died on day +30 after acute hepatic graft-versus-host disease. Complete chimerism was demonstrated in all patients. The mimni-alo BMT is feasible in patients with metastatic renal cell carcinoma and provides objective responses, although its efficacy should be confirmed by phase III clinical trials.

¿Qué ha cambiado en la adrenalectomía? De la cirugía abierta a la laparoscópica

After the introduction of the laparoscopic approach in adrenal surgery, this technique has become the gold standard in surgical adrenal diseases. Nevertheless, comparative studies with open surgery are scarce and the impact of laparoscopic techniques on these diseases is unknown. To evaluate our experience of adrenal surgery over a 14-year period, before and after the introduction of laparoscopic adrenalectomy, and to analyze the influence of this technique on the surgical management of adrenal diseases. From January 1990 to June 2004, 78 patients underwent adrenalectomy. Between 1990 and 1998, open adrenalectomy was performed in 24 patients, while between 1999 and 2004, 54 patients underwent the laparoscopic approach and 1 underwent open surgery. Data for the open group were retrospectively reviewed while those for the laparoscopic group were prospectively registered in the advanced laparoscopic surgery database of Hospital Sant Pau (HSP). The mean age was 47 years (16-75) in the open group and was 49 years (17-77) (p = NS) in the laparoscopic group. Distribution by surgical indication was similar in both periods concerning primary hyperaldosteronism, hypercortisolism, and pheochromocytoma, with a significant increase in surgical cases indicated by malignancy (1 vs 4) or incidentaloma (2 vs 13) (p<.001). Operating time was reduced from 150 min (65-210) in the open group to 90 min (30-300) in the laparoscopic group (p<.01). Morbidity was also reduced (20% vs 6%, p<.01). The size of lesions resected by open or laparoscopic surgery (4 cm [0.4-16] vs 3.5 cm [1.2-14]) was similar. The mean length of hospital stay was reduced from 8 days (3-13) to 3 days (2-12) (p<.01). The number of adrenalectomies performed in HSP was 24 in the first period (1990-1997) vs 40 in the second (1998-2004). This represented an increase from 3/year to 6.6/year mainly due to the increase in the number of incidentalomas. The laparoscopic approach has improved immediate surgical results (operating time, morbidity, and length of hospital stay). There was a clear increase in the number of adrenalectomies, and especially of incidentalomas, due to improved diagnostic techniques and the availability of a less aggressive approach.

The EJNM, an integrative vehicle for information transfer in nuclear medicine and molecular imaging

The European Journal of Nuclear Medicine (EJNM) was established in 1975 as a core publication for the promotion of nuclear medicine in Europe. Since that time, the EJNM has shown steady development in advancing science and facilitating the exchange of ideas in nuclear medicine and molecular imaging. Over the years, the EJNM has matured into a major medical journal of global importance. This has been an extraordinary accomplishment. However, the EJNM now needs to develop still further, on an international basis, as a leading vehicle for the delivery of knowledge and information in the field of nuclear medicine and molecular imaging. The journal must be the European investigative and clinical voice of the field, with boundaries established not by geography or professional subject but by intellectual content, scientific quality and clinical significance. Many opportunities are associated with this formidable task. In our multicultural world, the nuclear medicine community is extraordinarily vibrant and active. Multiple interactions constantly take place among creative scientists and clinicians, giving rise to innumerable advances. Given the vibrancy of our fertile field, I anticipate that the many scientists and professionals involved in nuclear medicine and molecular imaging will respond generously in helping to achieve our goals for the EJNM. The result will be rewarding, with published scientific material of growing interest and originality that will have a significant impact on research and clinical practice. The EJNM is also the official organ of the EANM. The Association takes advantage of the journal to inform members of its services and activities, and the journal thereby helps the Association to accomplish its mission and goals. The journal assists in advancing science and education in nuclear medicine. It promotes discussion and exchange of ideas on the role of nuclear medicine and molecular imaging in tackling problems associated with the diagnosis, treatment, research and prevention of diseases, and provides a medium for the dissemination of the latest results in the field. As new Editor-in-Chief, my responsibility is to ensure that the reports on medical research in nuclear medicine and molecular imaging that are published in the journal provide researchers and physicians with valid and readily accessible information. The journal must also serve as a suitable forum for discussion of issues relevant to research in the field. It is my responsibility to inform and educate readers, and to protect and strengthen the integrity and quality of the journal and its processes. On the Ignasi Carrio (✉) Department of Nuclear Medicine, Hospital Sant Pau, Autonomous University of Barcelona, Padre Claret 167, 08025 Barcelona, Spain e-mail: icarrio@hsp.santpau.es Tel.: +34-93-2919403, Fax: +34-93-2919409 Editorial