RESUMO

PURPOSE: The primary aim of this retrospective study was to describe the treatment patterns according to the type of treatment received by patients with metastatic colorectal cancer (mCRC) in Spain. METHODS: This was a retrospective, observational, multicenter study performed by 33 sites throughout Spain that included consecutive patients aged 18 years or older who had received or were receiving treatment for mCRC. RESULTS: At the time of inclusion, of the 873 evaluable patients, 507 (58%) had received two lines, 235 (27%) had received three lines, 106 (12%) had received four lines, and the remaining patients had received up to ten lines. The most frequent chemotherapy schemes were the FOLFOX or CAPOX regimens (66%) for first-line treatment, FOLFOX, CAPOX or FOLFIRI (70%) for second-line treatment, and FOLFOX, FOLFIRI or other fluoropyrimidine-based regimens for third- and fourth-line (over 60%) treatment. Sixty percent of patients received targeted therapy as part of their first-line treatment, and this proportion increased up to approximately 70% of patients as part of the second-line of treatment. A relevant proportion of patients were treated with unknown KRAS, and especially the BRAF, mutation statuses. CONCLUSIONS: This study reveals inconsistencies regarding adherence to the recommendations of the ESMO guidelines for the management of mCRC in Spain. Improved adherence to the standard practice described in such guidelines for the determination of RAS and BRAF mutation statuses and the use of targeted therapies in first-line treatment should be considered to guarantee that patients can benefit from the best therapeutic approaches available.

Assuntos

RESUMO

A viromics study on the intestinal contents of migratory wild ducks of the genera Anas, Mareca, Spatula, and Oxyura during their winter stay in Mexico showed the presence of the virus family Alloherpesviridae. The genus Cyprinivirus is part of this family and includes cyprinid herpesvirus 3 (CyHV3). This is the etiological agent of the lethal disease known as koi herpesvirosis, which affects different strains of Common Carp Cyrprinus carpio. In this study, samples of the contents of 87 wild duck intestines were analyzed by endpoint PCR, of which 7 samples were positive for the amplification of the TK gene fragment corresponding to CyHV3. These results contribute to the knowledge about the spread of this virus to other species of aquatic animals in areas where fish and ducks coexist.

Assuntos

RESUMO

INTRODUCTION: Cancer imposes a huge financial burden in all developed countries. This study estimates the burden of cancer in Spain in 2015. METHODS: The most recent available epidemiological data on prevalence, incidence and mortality, and the economic data on direct (hospital, drugs, and primary care) and indirect (productivity) costs was used from the social perspective. RESULTS: Prevalence, incidence, and mortality were, respectively, 1240, 478, and 218 per 100,000 inhabitants. Mortality was higher for men, while disability rates were higher for women. Direct costs accounted for 4818 million euros and indirect costs were 640 million euros in 2015. Direct costs were almost completely borne by the hospital (94%). Total burden of cancer in Spain was 5458 million euros in 2015. CONCLUSIONS: In Spain, the costs of cancer were mainly borne by the hospital and these costs might increase in the future due to the expected increase in longevity. Further research would be needed to investigate whether it is possible to redistribute the economic burden of cancer.

Assuntos

RESUMO

PURPOSE: Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. METHODS: Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline. RESULTS: A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines. CONCLUSION: Despite oncologist's clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.

Assuntos

RESUMO

Phylogenetic analysis of the rabies virus in molecular epidemiology has been traditionally performed on partial sequences of the genome, such as the N, G, and P genes; however, that approach raises concerns about the discriminatory power compared to whole genome sequencing. In this study we characterized four strains of the rabies virus isolated from cattle in Querétaro, Mexico by comparing the whole genome sequence to that of strains from the American, European and Asian continents. Four cattle brain samples positive to rabies and characterized as AgV11, genotype 1, were used in the study. A cDNA sequence was generated by reverse transcription PCR (RT-PCR) using oligo dT. cDNA samples were sequenced in an Illumina NextSeq 500 platform. The phylogenetic analysis was performed with MEGA 6.0. Minimum evolution phylogenetic trees were constructed with the Neighbor-Joining method and bootstrapped with 1000 replicates. Three large and seven small clusters were formed with the 26 sequences used. The largest cluster grouped strains from different species in South America: Brazil, and the French Guyana. The second cluster grouped five strains from Mexico. A Mexican strain reported in a different study was highly related to our four strains, suggesting common source of infection. The phylogenetic analysis shows that the type of host is different for the different regions in the American Continent; rabies is more related to bats. It was concluded that the rabies virus in central Mexico is genetically stable and that it is transmitted by the vampire bat Desmodus rotundus.

Assuntos

RESUMO

INTRODUCTION: The clinical use of magnetic resonance (MR) in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Several groups around the world have developed consensus guidelines about the role of MR in MS at diagnosis and during follow up. However, in some regions is difficult to extrapolate the recommendations. AIM: To provide recommendations for the implementation of MR in MS patients at diagnosis and follow up in Venezuela. DEVELOPMENT: A group of experts from Venezuela that included neurologists and radiologists, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MR during the diagnosis and follow up of MS patients in Venezuela. Seventeen recommendations were established based on published evidence and the expert opinion. Recommendations focused on the role of conventional MR techniques and brain atrophy measurement in MS patients both at diagnosis and during follow-up. CONCLUSIONS: The recommendations of this consensus guidelines attempts to optimize the health care and management of patients with MS in Venezuela.

TITLE: Consenso venezolano para el uso de la resonancia magnetica en el diagnostico y seguimiento de pacientes con esclerosis multiple.Introduccion. El uso de la resonancia magnetica (RM) en el diagnostico y seguimiento de pacientes con esclerosis multiple (EM) se ha incrementado considerablemente durante los ultimos años. Diversos grupos de trabajo internacionales han intentado clarificar y normativizar el uso de la RM tanto en el momento del diagnostico como durante el seguimiento de los pacientes. Sin embargo, en muchas ocasiones se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son dificiles de implementar. Objetivo. Elaborar un consenso venezolano para el uso de la RM en el diagnostico y seguimiento de pacientes con EM. Desarrollo. Un grupo de expertos de Venezuela, conformado por neurologos y radiologos, mediante metodologia de ronda de encuestas a distancia y reuniones presenciales, llevo adelante la elaboracion del consenso pretendido para el uso de la RM en el diagnostico y seguimiento de pacientes con EM en Venezuela. Se establecieron 17 recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el papel de las tecnicas convencionales de RM, asi como en el de la medicion de la atrofia cerebral en pacientes con EM, tanto en el momento del diagnostico como durante el seguimiento. Conclusion. Las recomendaciones establecidas en el presente consenso permitiran optimizar el cuidado y el seguimiento de los pacientes con EM en Venezuela.

Assuntos

RESUMO

The NCCN-evidence-based oncology guidelines are consensus-based management documents, to ensure that all patients receive the most appropriate diagnosis, treatment and support services to achieve the best results. However, the use of these guidelines for decision-making by physicians in Spain is sometimes controversial, as treatments or diagnostic procedures are recommended which might not be authorised in our country, or other management options may exist. In March 2015, the ECO Foundation reached an agreement to translate and adapt the NCCN's clinical practice guidelines in oncology for the Spanish sector. Consequently, ECO is the first European organization to reach an agreement of this type with the NCCN. This agreement will allow all agents involved in managing the cancer patients to have available guidelines that are adapted to the specific needs of Spain.

Assuntos

RESUMO

West Nile virus (WNV) is a mosquito-borne neurotropic viral pathogen maintained in an enzootic cycle between mosquitoes (vectors) and birds (natural hosts) with equids, humans, and other vertebrates acting as dead-end hosts. WNV activity in Mexico has been reported in several domestic and wild fauna and in humans, and the virus has been isolated from birds, mosquitoes, and humans. However, no serological studies have been conducted in monkeys, and only two in a limited number of crocodiles (Crocodylus moreletii). Here we present data on the prevalence of neutralizing antibodies against WNV in 53 healthy wild monkeys (49 Ateles geoffroyi and four Alouatta pigra), and 80 semi-captive healthy crocodiles (60 C. acutus and 20 C. acutus-C. moreletti hybrids) sampled during 2012. None of the monkey sera neutralized WNV, whereas 55% of the crocodile sera presented neutralizing antibodies against WNV. These results can contribute to the design of surveillance programmes in Mexico.

Assuntos

RESUMO

Los sistemas Doppler ultrasónicos han sido utilizados ampliamente en el diagnóstico médico, en general en el estudio de flujo sanguíneo y en particular en el diagnóstico de padecimientos vasculares. Esto se debe principalmente a su carácter no invasivo y su relativo bajo costo. Una característica importante de los sistemas Doppler ultrasónicos es la de poder detectar la señal asociada con el flujo sanguíneo y discriminar la dirección del mismo. La señal Doppler ultrasónica contiene información asociada con la velocidad de los componentes de la sangre, y su espectro en frecuencia representa el perfil de velocidad del flujo sanguíneo, que puede ser de sentido directo o inverso. Típicamente los sistemas Doppler ultrasónicos que detectan el sentido de la dirección de flujo sanguíneo de la señal, se basan en métodos de demodulación homodina en cuadratura. Sin embargo las señales producidas por este tipo de detectores requieren de un proceso adicional de separación. Este trabajo aborda la implementación de un demodulador heterodino que forma parte de un detector Doppler ultrasónico para la medición de flujo sanguíneo bi-direccional. Se describe el principio de la detección de la señal Doppler ultrasónica de flujo sanguíneo y su representación en la forma de un espectrograma de dos dimensiones, así como también los dispositivos detectores Doppler de flujo sanguíneo, su clasificación de acuerdo a su modo de operación y tipo de demodulación. Finalmente se presentan pruebas de funcionalidad y se analizan los resultados obtenidos contrastándolos con los resultados teóricos.

Doppler ultrasound systems have been widely used in medical diagnosis, in the study of blood flow, in particular, in the diagnosis of vascular disorders. This is mainly due to its non-invasive method and its relatively low cost. An important feature of the ultrasonic Doppler system is the capability to detect the signal associated with the blood flow and discriminate its direction. The Doppler ultrasound signal contains information associated with the velocity of the blood components, and its frequency spectrum represents the velocity profile of blood flow, which may be direct or reverse. Typically Doppler ultrasound systems which detect the sense of the direction of blood flow signal, are based on methods of homodyne demodulation in quadrature. However the signals produced by these detectors require an additional separation process. This paper addresses the implementation of a heterodyne demodulator as a part of a Doppler ultrasound detector for measuring bi-directional blood flow. We describe the detection process of the Doppler ultrasound blood flow signal and its representation in the form of a two-dimensional spectrogram. Doppler blood flow sensing devices and their classification according to their operation mode and type of demodulation are also described. Finally, functionality tests are presented and results are analyzed.

RESUMO

OBJETIVO: Evaluar la concordancia en el diagnóstico pulpar mediante la evaluación del sangrado pulpar y los niveles de oxi-metría de pulso, en molares primarios.METODOLOGÍA: La muestra estuvo constituida por 20 molares primarias de pacientes que requirieron terapia pulpar. Se confeccionó un sensor adecuado para molares primarias obteniendo un valor de saturación de oxígeno que se comparó con el examen clínico; condición, color, tipo y tiempo de sangrado pulpar. El análisis de datos, se realizó con ayuda del programa estadístico SPSS 20.0. Se aplicaron las pruebas de Kruskal-Wallis y U de Mann Whitney bajo un nivel de significancia de 0.05.RESULTADOS: La saturación en la pulpitis reversible fue 85.3% +/- 2.43%, irreversible 83.2% +/- 2.3% y necrosis 85% +/- 6. (p=0.421). La saturación para la condición de sangrado pulpar; presente fue 84.69% +/- 3.40, y ausente 85% +/- (0.933). La saturación para el sangrado pulpar leve fue 83.75% +/-2.5%, moderado 85% +/-4.35% y severo 85.5% +/-0.70%.(p=0.575). La saturación para el color del sangrado pulpar rojo fuerte fue 83.60% +/-2.63% y rojo vinoso de 88.33% +/-3.51%.(p=0.077). La saturación de oxígeno para la hemostasia a los 5 minutos fue 85.20% +/- 4.43%, luego de 5 minutos 84.40% +/-2.51% no cesa 84.33% +/- 4.04%. (p=0.995). (AU)

OBJECTIVE: To evaluate the concordance in the pulpal diagnostic thru the evaluation of pulpal bleed and the pulse oximetry levels in primary molars.METHODOLOGY: Sample conducted at 20 primary molars of different patients who required pulpal therapy. A sensor was made in order to obtain the oxygen saturation value for each primary molars; information later compared with the data from the clinical exam- molar condition, color, type and pulpal bleeding duration. The data analysis was conducted thru SPSS 20.0, a statistical pro-gram which also helped us to apply the Kruskall Wallis and the U Mann Whitney test under a significant level of 0.05.RESULTS: The oxygen saturation in the reversible pulpitis was of 85.3% +/- 2.43%, at the irreversible of 83.2% +/- 2.3% and at the necrosis of 85% +/- 6. (p=0.421). The saturation for the condition of pulpal bleeding was: present of 84.69% +/- 3.40, and absent of 85% +/- (0.933). The oxygen saturation for the mild pulpal bleeding was of 83.75% +/-2.5%, for the moderate bleeding of 85% +/-4.35% and for the severe bleeding of 85.5% +/-0.70%.(p=0.575). The oxygen saturation for the color of the pulpal bleeding was: 83.60% +/-2.63% for the strong red and 88.33% +/-3.51%.(p=0.077) for the wine colored. The oxygen saturation for the hemostasis at 5 minutes was of 85.20% +/- 4.43%, after 5 minutes of 84.40% +/-2.51%, and at nonstop of 84.33% +/- 4.04%. (p=0.995). (AU)

Assuntos

RESUMO

PURPOSE: To identify a novel system for scoring intratumoral immune response that can improve prognosis and therapy decisions in early stage non-small cell lung cancer (NSCLC). METHODS/PATIENTS: Eighty-four completely resected stage I/II NSCLC without adjuvant therapy were classified by expression profiling using whole genome microarrays. An external cohort of 162 tumors was used to validate the results. Immune cells present in tumor microenvironment were evaluated semiquantitatively by CD20, CD79, CD3, CD8, CD4 and CD57 immunostaining. Univariate and multivariate analyses of variables associated with recurrence-free survival were performed. RESULTS: Initial molecular classification identified three clusters, one with significantly better RFS. A reduced two-subgroup classification and a 50-gene predictor were built and validated in an external dataset: high and low risk of recurrence patients (HR = 3.44; p = 0.001). Analysis of the predictor´s genes showed that the vast majority were related to a B/plasma cell immune response overexpressed in the low-risk subgroup. The predictor includes genes coding for unique B lineage-specific genes, functional elements or other genes that, although non-restricted to this lineage, have strong influence on B-cell homeostasis. Immunostains confirmed increased B-cells in the low-risk subgroup. Gene signature (p < 0.0001) and CD20 (p < 0.05) were predictors for RFS, while CD79 and K-RAS mutations showed a tendency. CONCLUSIONS: Favorable prognosis in completely resected NSCLC is determined by a B-cell-mediated immune response. It can be differently scored by a 50-gene expression profile or by CD20 immunostaining. That prognosis information not reflected by traditional classifications may become a new tool for determining individualized adjuvant therapies.

Assuntos

RESUMO

La flujometría Doppler ultrasónica ha sido ampliamente utilizada en el diagnóstico de enfermedades vasculares. Aquellos sistemas que detectan el sentido de la dirección de la señal de flujo, pueden utilizar durante su operación señales producto de la demodulación homodina en cuadratura con el inconveniente de tener que procesar los dos canales (fase y cuadratura) para igualar sus amplitudes y mantener estas características en todo el ancho de banda de las señales. En este artículo se propone un método alternativo para separar el sentido de la dirección de la señal de flujo usando demodulación heterodina, el cual consiste en trasladar la banda de frecuencias de la señal de información Doppler a un origen desplazado al menos el ancho de banda de la señal. Este método tiene la ventaja de simplificar la etapa analógica de la adquisición de la señal Doppler, al utilizar una demodulación en un solo canal. Los resultados de las simulaciones llevadas a cabo en este trabajo muestran la efectividad del método al separar el sentido de la dirección del flujo de forma eficiente en el dominio de la frecuencia, evitando la generación de artefactos en la banda de interés.

Doppler ultrasound blood flow measurement techniques have been widely used for the diagnosis of vascular diseases. In particular, some Doppler systems which may be able to determine the blood flow direction use signals produced by the homodyne quadrature demodulation technique. This approach has a major disadvantage, since it has to process two channels (phase and quadrature), to equalize them (in amplitude) and to maintain these characteristics throughout the complete signal bandwidth. The work presented here, proposes an alternative method to determine the blood flow direction using heterodyne demodulation. The technique involves shifting the complete band of frequencies (where information of interest lies), at least a frequency equal to the bandwidth of the Doppler signal. This method simplifies the analog stage for the acquisition of the Doppler signal since it only needs to process one channel. Results of simulations show the effectiveness of the approach by determining the blood flow direction efficiently, in the frequency domain. It also reduces the generation of artifacts, in the band of interest, caused by differences in the phase and quadrature channels.

RESUMO

PURPOSE: The economic situation showed that the resources devoted to health spending are limited, making rationalisation of their consumption necessary. The relevance of pharmacoeconomic analyses is becoming crucial. The ECO Foundation, promoting the quality of oncology care, set out to analyse the consensus on the new therapeutic targets inclusion and the integration of pharmacoeconomics when evaluating their effectiveness. METHODS: Study about pharmacoeconomic estimations was performed during the first ECO-Seminar (2010). It was developed using a modified Delphi method, in four stages: (1) committee coordinator establishment, (2) expert-panel selection, (3) preparation and submission of survey (1 question) by email, and (4) analysis of the degree of consensus reached. RESULTS: Results were obtained from surveys completed by 35 experts. Regarding the tolerable annual cost for the approval of new drugs, 68.8 % of the respondents considered a cost per quality-adjusted life year (QALY) gained between €30,000 and 100,000 acceptable (34.4 % €30,000-60,000; 34.4 % €60,000-100,000), 21.9 % of the respondents found costs between €100,000-150,000/QALY and 9.3 % of the respondents found costs above €150,000/QALY acceptable. CONCLUSIONS: The costs of new drugs are higher than traditional treatments, making it a priority to identify subgroups of patients with specific molecular profiles as candidates for higher-efficiency-targeted therapies. The allocation of the available resources to the most effective interventions, to achieve the best clinical outcomes with lower costs and best subjective profile possible, allows expenditure to be rationalised. Pharmacoeconomic studies are a basic tool for obtaining better health outcomes according to the available resources, while also considering the other needs of the population.

Assuntos

RESUMO

Exocrine pancreatic cancer (PC) is a very aggressive and heterogeneous tumor with several cellular signaling pathways implicated in its pathogenesis and maintenance. Several risk factors increase the risk of developing PC. Therapeutic strategies used are dictated by the extent of disease. Supportive treatment is critical because of the high frequency of symptoms. For localized disease, surgery followed by adjuvant gemcitabine is the standard. Neoadjuvant and new adjuvant chemotherapy regimens are being evaluated. Locally advanced disease should respond best guided by a multidisciplinary team. Various treatment options are appropriate such as chemotherapy alone or chemoradiotherapy with integration of rescue surgery if the tumor becomes resectable. In metastatic disease, chemotherapy should be reserved for patients with ECOG 0-1 using Folfirinox or gemcitabine plus nab-paclitaxel as the most recommended options. Several therapeutic strategies targeting unregulated pathways are under evaluation with an unmet need for biomarkers to guide management.

Assuntos

RESUMO

BACKGROUND: Breast cancer subtypes can be identified by genomic testing or pathology-based approximations. However, these classifications are not equivalent and the clinical relevance of both classifications needs to be fully explored. METHODS: Ninety-four patients were randomized to neoadjuvant single agent doxorubicin or docetaxel. Tumor subtype was assessed by pathology-based classification and by gene expression using the PAM50 plus the claudin-low predictor (CLP). Kappa Cohen's coefficient (κ) was used to test the agreement between methods. Multivariate Cox proportional hazards analyses were used to determine the significance of each methodology in the prediction of prognosis. Likelihood ratio statistics of both classifications were evaluated. RESULTS: The agreement between pathology-based classification and PAM50 was moderate [κ = 0.551, 95 % confidence interval (95 % CI) 0.467-0.641]. Tumor subtype assessed by both classifications were prognostic for overall survival (OS) and relapse-free survival (P < 0.05). However, PAM50 + CLP provided more prognostic information, in terms of OS, than the pathology-based classification (P < 0.05). Patients with triple negative tumors as well as basal-like tumors had worse OS when first treated with doxorubicin (HR = 5.98, 95 % CI 1.25-28.67, and HR = 5.02, 95 % CI 0.96-26.38, respectively). However, claudin-low tumors did not show significant differences in OS according to neoadjuvant treatment branch. Indeed, we found that claudin-low tumors treated with pre-operative doxorubicin had significantly better OS than basal-like tumors treated with neoadjuvant doxorubicin (adjusted HR = 0.16, 95 % CI 0.04-0.69, P = 0.014). CONCLUSIONS: The assignment of tumor subtype can differ depending on the methodology, which might have implications on patient's management and therapy selection.

Assuntos

RESUMO

OBJECTIVES: Under the auspices of the Foundation for Excellence and Quality in Oncology (ECO), the Translational Research in Oncology Medical Services Study (INTRO) was conducted with the aim of describing the current state of, and future expectations for translational cancer research in Spanish medical centres. The first step in the investigation was intended to analyse the current condition of the national Medical Oncology Services network by examining different aspects of the oncology research field. METHODS: A descriptive and observational multicentre study was performed at a statewide level; information was collected by surveying a cross-section of all those responsible for Medical Oncology Services in Spain. RESULTS: The survey was completed by key informants, who were selected independently by each service, between September 2010 and April 2011. We were able to gather comprehensive data from a total of 27 Spanish hospitals. These data enabled us to describe the allocation of human and material resources devoted to clinical and translational research across the Medical Oncology Services and to describe the organisational and functional components of these services and units. These data included information pertaining to the activities developed, their funding sources, and their functional dependence on other internal or external bodies. Finally, we explored the degree of dissemination and use of some specific techniques used for the genetic diagnosis of cancer, which have recently been introduced in Medical Oncology within the Spanish healthcare system. CONCLUSIONS: A wide range of variability exists between different oncology services in Spanish hospitals. Time should be spent reflecting on the need and opportunities for improvement in the development of translational research within the field of oncology.

Assuntos

RESUMO

Anaerobic ammonium oxidizers contribute to the removal of fixed nitrogen in oxygen-deficient marine ecosystems such as oxygen minimum zones (OMZ). Here we surveyed for the first time the occurrence and diversity of anammox bacteria in the Colombian Pacific, a transition area between the prominent South and North Pacific OMZs. Anammox bacteria were detected in the coastal and oceanic areas of the Colombian Pacific in low oxygen (< 22 µM), high nitrate (25­35 µM) and low nitrite (< 0.07 µM), and ammonium (< 1 µM) waters. In these waters, anammox bacteria were rich [∼ 7 operational taxonomic units (OTUs), 98% cut-off) and microdiverse (Shannon index H' < 1.24), in comparison with the observed at the prominent OMZ of the Eastern Tropical South Pacific, Arabian Sea and Black Sea. Anammox bacteria-like sequences from the Colombian Pacific were grouped together with sequences retrieved from the distinct OMZ's marine subclusters (Peru, Northern Chile and Arabian Sea) within Candidatus 'Scalindua spp'. Moreover, some anammox bacteria OTUs shared a low similarity with environmental phylotypes (86­94%). Our results indicated that a microdiverse anammox community inhabits the Colombian Pacific, generating new questions about the ecological and biogeochemical differences influencing its community structure.

Assuntos

RESUMO

Anomalous pulmonary venous connection is a rare pathology, both partial and total forms, according to the number of pulmonary veins draining into the left atrium, respectively. Total forms are classified into four groups, depending upon the anomalous connections to the systemic veins: supra, intracardiac or below, and finally a mixed form, the less frequent. Prenatal, even postnatal diagnose is difficult, especially in partial isolated forms. The association with chromosomal abnormalities is low, however is highly associated with complex heart malformations, especially total forms, often in the context of heterotaxy syndromes. We present a case of infracardiac APVC, in the context of complex heart disease, associated with complete atrioventricular canal and conotruncal anomaly, that came to surgery at 48 hours of life with poor outcome. We described the ultrasound and magnetic resonance angiography of this anomaly and its perinatal prognosis and management.

Assuntos

RESUMO

Sexual, ontogenic and temporal effects in the diet of Dasyatis longa were evaluated to determine feeding habits and trophic ecology. Numeric indices and the index of relative importance were applied to establish the feeding strategy of the species. Independence of the diet with respect to sex, dry or rainy season and size was evaluated with contingency tables, correspondence analysis and multivariate analysis (MANOVA). The trophic relationships of D. longa (by sex and size intervals) were determined using Levin's niche breadth index and the Pianka's diet overlap index and their significance was determined by null models. The trophic level for each size interval and the species was also calculated. Dasyatis longa showed a narrow niche breadth feeding mainly on shrimps and fishes and its diet was dependent on size, but not on sex or season. Juvenile individuals (class I) fed on shrimps, sub-adults (class II) on fishes and adults (class III) on stomatopods. Significant overlaps between size classes I and II and classes II and III were found. The trophic level shows D. longa to be a secondary or tertiary consumer. Due to considerable fishing pressures on shrimps, the principal prey of D. longa, it will be important to determine their ability to adapt to changes in prey populations.

Assuntos

RESUMO

In Spain 22,000 new cases of colorectal cancer are diagnosed each year, with 13,075 deaths resulting from this disease. Around 70% of colorectal cancers are localised in the colon and 30% in the rectum. A group of Spanish experts established recommendations on what would be the best strategy in the treatment of locally advanced rectal cancer (LARC). Adequate assessment of local tumour extension, including high-resolution magnetic resonance imaging and endorectal ultrasound, is essential for successful treatment. The three cornerstones in the treatment of LARC are surgery, radiotherapy and chemotherapy. Most patients will need a total mesorectal excision (TME). Preoperative chemo-radiotherapy (CRT) is preferred for the majority of patients with T3/T4 disease and/or regional node involvement, and adjuvant chemotherapy is recommended after a patient-sharing decision. Capecitabine, after showing a trend in improved downstaging in neoadjuvant stratum and the convenience of its oral administration, represents an alternative to 5-FU as perioperative treatment of LARC.

Assuntos