http://hdl.handle.net/10498/28208 Thu, 05 Nov 2026 11:38:37 GMT 2026-11-05T11:38:37Z http://hdl.handle.net/10498/40549 Sentinel lymph node detection in gastric cancer using a dual tracer (Superparamagnetic iron oxide and methylene blue): a prospective study with histological and OSNA validation Escalera Pérez, Raquel; Medina-Achirica, C.; García-Molina, F.J.; Del Rio-Ignacio, J.J.; Lagares Franco, Carolina María; Estella García, Ángel; Mateo Vallejo, Francisco de Asís Gastric cancer (GC) remains an oncological challenge, with lymph node involvement being a major prognostic factor. Sentinel lymph node (SLN) mapping may improve staging and reduce morbidity. This study evaluated a dual-tracer technique (superparamagnetic iron oxide: SPIO and methylene blue) for ex vivo detection; assessed one-step nucleic acid amplification (OSNA) versus conventional histology; and applied OSNA-pooling analysis in non-SLN. Prospective study of patients undergoing curative gastrectomy with lymphadenectomy (2017–2022). SLNs were identified in fresh specimens by Sentimag® and/or macroscopic staining. Each lymph node was bisected, with one half analyzed by hematoxylin–eosin (H&E) and the other by OSNA. Non-SLN were assessed using pooled OSNA to enhance diagnostic performance. Diagnostic performance metrics and agreement (Cohen’s κ) were calculated. Survival was estimated by Kaplan–Meier. Thirty-eight patients were included (mean age 64.3 years; 58% male); 71.1% received neoadjuvant therapy. SLN detection rate was 84.2% (32/38), with 80 SLNs identified. The dual-tracer approach demonstrated high sensitivity (93.1%) and moderate specificity (44.4%), resulting in an accuracy of 81.6%. Tracer concordance was moderate (κ = 0.42; p < 0.007). OSNA showed good agreement with H&E (sensitivity 80%, specificity 87%), and better performance for micrometastases. The pooling analysis evaluated 1155 non-SLN simultaneously; this novel strategy showed good concordance with conventional histology. After a median follow-up of 53 months, OSNA and H&E status were associated with overall survival in exploratory analyses; however, these findings should be interpreted with caution given the limited sample size and ex vivo proof-of-concept design. Combining SPIO and methylene blue is technically feasible for ex vivo SLN mapping. OSNA complements histology, and its pooled use represents an innovative methodological approach. These results are preliminary and hypothesis-generating; larger prospective in vivo studies are required before clinical applicability can be evaluated. Dual-tracer sentinel node mapping in gastric cancer proved feasible and accurate. OSNA complemented histology, pooled analysis improved detection efficiency, and neoadjuvant therapy did not affect diagnostic performance. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10498/40549 2026-01-01T00:00:00Z http://hdl.handle.net/10498/40543 Efficacy and Safety of Guselkumab in Real-World Evidence: A Systematic Review and Meta-Analysis Dodero-Anillo, Jose Manuel; Fernandez-Pujol-Marzo, Marta; Pedrosa Martínez, María José; Ruiz-Villaverde, Ricardo; Armario Hita, José Carlos Background: Guselkumab, a selective anti-IL-23p19 monoclonal antibody, has shown high efficacy in randomized trials for moderate-to-severe psoriasis and active psoriatic arthritis (PsA). Real-world evidence is essential to assess treatment performance in broader and more heterogeneous patient populations. Objectives: To synthesize the available real-world evidence on the effectiveness and safety of guselkumab in psoriasis and PsA, and to quantify pooled clinical responses across clinically relevant follow-up windows. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020. PubMed/MEDLINE, MEDLINE, and Web of Science were searched for observational real-world studies of guselkumab in adults with psoriasis and/or PsA. Primary pooled outcomes were PASI 90 and PASI 100 in psoriasis and DAPSA < 14 in PsA. Random-effects meta-analysis of proportions was performed using a logit transformation. Cohort overlap was explicitly assessed and overlapping publications were not allowed to contribute concurrently to the same pooled estimate. Results: Thirty-four studies were included (29 psoriasis, 5 PsA). In psoriasis, pooled PASI 90 response rates were 50.8% (95% CI 46.8–54.8) at 12–16 weeks, 68.4% (95% CI 66.3–70.4) at 20–28 weeks, 71.2% (95% CI 64.9–76.8) at 36–60 weeks, and 77.1% (95% CI 74.9–79.3) at ≥96 weeks. Pooled PASI 100 response rates were 49.8% (95% CI 47.5–52.2) at 20–28 weeks and 49.7% (95% CI 47.1–52.3) at 36–60 weeks. In PsA, pooled DAPSA < 14 response rates were 56.9% (95% CI 23.0–85.3) at 20–28 weeks and 69.5% (95% CI 62.5–75.7) at 48–60 weeks. Safety reporting was heterogeneous, but serious adverse events and discontinuations due to adverse events were uncommon. Conclusions: Real-world evidence supports guselkumab as an effective treatment for psoriasis and a clinically useful option for PsA, with a safety profile broadly consistent with the known trial experience. Interpretation remains limited by observational designs, heterogeneous denominators, and inconsistent safety reporting. Mon, 11 May 2026 00:00:00 GMT http://hdl.handle.net/10498/40543 2026-05-11T00:00:00Z http://hdl.handle.net/10498/40542 Percutaneous Electrolysis for Patellar Tendinopathy: A Systematic Review and Meta-Analysis Góngora Rodríguez, Jorge Manuel; Rosety Rodríguez, Miguel Ángel; Fernández Santos, Jorge del Rosario; Ayala Martínez, Carmen María; Góngora Rodríguez, Jorge Manuel Patellar tendinopathy is a chronic musculoskeletal condition characterized by localized pain and functional impairment. This systematic review and exploratory meta-analysis aimed to synthesize current evidence on the effectiveness of percutaneous electrolysis (PE), combined with eccentric exercise, for improving functional performance in individuals with patellar tendinopathy. Following PRISMA guidelines and registration in PROSPERO (CRD420251233971), comprehensive searches were performed in Cochrane Library, PEDro, PubMed, ScienceDirect, Scopus, and Web of Science databases. Only two randomized controlled trials, published between 2016 and 2021, met the eligibility criteria and were included in the quantitative synthesis. Functional capacity recorded using the Victorian Institute of Sport Assessment-Patella (VISA-P) scale was the primary outcome. Both included studies presented some concerns regarding risk of bias. The pooled random-effects meta-analysis (REML estimation with Hartung–Knapp–Sidik–Jonkman adjustment) revealed no statistically significant difference favoring PE over control interventions (Hedges’ g = –0.10; 95% CI: –2.69 to 2.50; p = 0.72). Statistical heterogeneity was nominally low (I2 = 0%), although this metric is uninformative with only two studies. Between-group differences in both studies were below the minimal clinically important difference for the VISA-P scale. The certainty of evidence according to the GRADE framework was rated as very low. Given the extremely limited evidence base, these findings should be considered strictly exploratory. The very low certainty of evidence precludes definitive conclusions regarding the comparative effectiveness of PE. Larger, adequately powered randomized trials with standardized protocols and long-term follow-up are needed. Tue, 19 May 2026 00:00:00 GMT http://hdl.handle.net/10498/40542 2026-05-19T00:00:00Z http://hdl.handle.net/10498/40529 Optimising Therapeutic Intervals for Anti-TNF Biologics in Rheumatoid Arthritis: A Retrospective Real-World Study Dodero-Anillo, Jose Manuel; Rosety Rodríguez, Manuel; Pedrosa Martínez, María José Background: Therapeutic drug monitoring (TDM) of anti-TNF biologics may help optimise treatment in rheumatoid arthritis (RA), but current therapeutic ranges do not always reflect clinical response in routine practice. Methods: We conducted a retrospective observational study including 224 adults with RA treated with infliximab (IFX), adalimumab (ADL), or etanercept (ETN) during the maintenance phase at Hospital Universitario Puerto Real between May 2016 and May 2023. Drug and anti-drug antibody levels were measured by sandwich ELISA and analysed against clinical response using DAS28. Demographic and clinical variables, associations between drug levels and response, the effect of antibodies, correlations between serum concentrations and DAS28, and the performance of current and proposed therapeutic ranges were evaluated. Results: The cohort was mainly female (62.1%), with a mean age of 57.7 years, BMI of 28.5 kg/m2, and mean DAS28 of 3.33. ETN was most frequently used (62.5%), followed by ADL (21.9%) and IFX (15.6%). Drug levels were significantly associated with response (p < 0.001). Anti-drug antibodies were strongly linked to non-response, especially with IFX and ADL. Serum drug levels correlated inversely with disease activity for IFX and ADL, but not for ETN. Current therapeutic ranges showed low sensitivity, while lower proposed ranges improved sensitivity considerably. Conclusions: Current anti-TNF therapeutic ranges have limited ability to identify responders in real-world RA. Lowering the lower bound improves sensitivity and supports more individualised TDM, particularly for IFX and ADL, pending prospective validation. Fri, 24 Apr 2026 00:00:00 GMT http://hdl.handle.net/10498/40529 2026-04-24T00:00:00Z