Capecitabine and bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer.

BACKGROUND: The efficacy and safety of capecitabine and bevacizumab in elderly patients with metastatic colorectal cancer (mCRC) considered unsuitable for receiving first-line chemotherapy with an irinotecan or oxaliplatin-based combination were assessed in a phase II, open, multicentre, uncontrolled study. METHODS: Treatment consisted of capecitabine 1250 mg m(-2) (or 950 mg m(-2) for patients with a creatinine clearance of 30-50 ml min(-1)) twice daily on days 1-14 and bevacizumab (7.5 mg kg(-1)) on day 1 every 3 weeks. RESULTS: A total of 59 patients aged >or=70 years with mCRC were enrolled. In an intention-to-treat analysis, the overall response rate was 34%, with 71% of patients achieving disease control. Median progression-free survival and overall survival were 10.8 months and 18 months, respectively. In all, 32 patients (54%) had grade 3/4 adverse events (AEs), the most common being hand-foot syndrome (19%), diarrhoea (9%) and deep venous thrombosis (7%). Four patients died because of treatment-related AEs. A relationship was detected between creatinine clearance

SEOM clinical guidelines to primary prevention of cancer (2018).

Cancer is the leading social and healthcare problem of the twenty-first century. The aim of primary prevention is to decrease the incidence of cancer by avoiding the known causes and risk factors. Nevertheless, it has been estimated that cancer diagnoses could be halved through primary prevention measures. A comprehensive review of the scientific evidence regarding the main carcinogens and risk factors and primary prevention recommendations have been put forth based on this evidence. The GRADE scale has been used to classify the grade of evidence. We present the scientific evidence and recommendations for primary prevention of the major modifiable risk factors: smoking, alcohol, diet, obesity, physical activity, occupational and environmental factors, ultraviolet radiation, infections, and socioeconomic factors. Primary prevention is a simple, effective means to lower the incidence of cancer. Preventive measures must be circulated in the fight against cancer.

Recurrent non-functioning pituitary adenomas: a review on the new pathological classification, management guidelines and treatment options.

At least 50% of surgically resected non-functioning pituitary adenomas (NFPA) recur. Either early or late adjuvant radiotherapy is highly efficacious in controlling recurrent NFPA but associates potentially burdensome complications like hypopituitarism, vascular complications or secondary neoplasm. Reoperation is indicated in bulky tumor rests compressing the optic pathway. To date, no standardized medical therapy is available for recurrent NFPA although cabergoline and temozolomide show promising results. Guidelines on the management of recurrent NFPAs are now available. The new 2017 WHO pituitary tumor classification, based on immunohistochemistry and transcription factor assessment, identifies a group of aggressive NFPA variants that may benefit from earlier adjuvant therapy. Nevertheless, NFPA patients exhibit a reduced overall life expectancy largely due to hypopituitarism and treatment-related morbidity. The management of recurrent NFPA benefits from a multidisciplinary teamwork of surgeons, endocrinologists, radiation oncologists, ophthalmologists, pathologists and neuro-radiologists in order to provide individualized therapy and anticipate deterioration.

Desarrollo de ecuaciones antropométricas para predecir el porcentaje de grasa corporal total en niños y adolescentes chilenos / Development of anthropometric equations for predicting total body fat percentage in Chilean children and adolescents

Introducción: estudiar el porcentaje de grasa corporal (%GC) en niños y adolescentes es muy relevante, puesto que un elevado nivel de grasa corporal en la infancia y la adolescencia representa sobrepeso y obesidad. Objetivo: identificar los indicadores antropométricos que se relacionan con el %GC y validar ecuaciones de regresión para predecir el %GC de niños y adolescentes a partir del uso de la absorciometría de rayos X de doble energía (DXA) como método de referencia. Métodos: se diseñó un estudio descriptivo (transversal) en 1126 escolares (588 hombres y 538 mujeres) de la región del Maule (Chile). El rango de edad oscila desde los 6,0 hasta los 17,9 años. Se evaluaron el peso, la estatura, dos pliegues cutáneos (tricipital y subescapular) y la circunferencia de la cintura (CC). Se calcularon el índice de masa corporal (IMC), el índice ponderal (IP) y el índice cintura-estatura (ICE). Se evaluó el porcentaje de grasa corporal (%GC) por medio del escaneo DXA. Resultados: las relaciones entre Σ (Tricipital + Subescapular), IP e ICE con el %GC (DXA) fueron de R2 = 52-54 % en hombres y R2 = 41-49 % en mujeres. Las ecuaciones generadas para los hombres fueron: %GC = 9,775 + [(0,415 * (Tr + SE)] + (35,084 * ICE) - (0,828 * edad), R2 = 70 %, y %GC = 20,720 + [(0,492 * (Tr + SE)] + (0,354 * IP) - (0,923 * edad), R2 = 68 %; y para mujeres: %GC = 8,608 + [(0,291 * (Tr + SE)] + (38,893 * ICE) - (0,176 * edad), R2 = 60 %, y %GC = 16,087 + [(0,306 * (Tr + SE)] + (0,818 * IP) - (0,300 * edad), R2 = 59 %. Conclusión: este estudio demostró que la sumatoria de los pliegues cutáneos tricipital y subescapular, el IP y el ICE son adecuados predictores del %GC. Estos indicadores permitieron desarrollar dos ecuaciones de regresión aceptables en términos de precisión y exactitud para predecir el %GC en niños y adolescentes de ambos sexos (AU)

Introduction: studying the percentage of body fat (%BF) in children and adolescents is very relevant, since a high level of body fat in childhood and adolescence represents overweight and obesity. Objective: to identify the anthropometric indicators related to %BF and to validate regression equations to predict %BF in children and adolescents using dual-energy X-ray absorptiometry (DXA) as a reference method. Methods: a descriptive study (cross-sectional) was designed in 1126 schoolchildren (588 males and 538 females) from the Maule region (Chile). The age range ranged from 6.0 to 17.9 years. Weight, height, two skinfolds (tricipital and subscapular and waist circumference (WC) were evaluated. Body mass index (BMI), triponderal mass index (TMI), waist height index (WHtR) were calculated. Body fat percentage (%BF) was assessed by DXA scanning. Results: the relationships between Σ (Tricipital + Subscapular), TMI and WHtR with %BF (DXA) ranged from R2 = 52 % to 54 % in men, and from R2 = 41 % to 49 % in women. The equations generated for men were: %BF = 9.775 + [(0.415 * (Tr + SE)] + (35.084 * WHtR) - (0.828 * age), R2 = 70 %, and %BF = 20.720 + [(0.492 * (Tr + SE)] + (0.354 * TMI) - (0.923 * age), R2 = 68 %], and for women: %BF = 8.608 + [(0.291 * (Tr + SE)] + (38.893 * WHtR) - (0.176 * age), R2 = 60 %, and %BF = 16.087 + [(0.306 * (Tr + SE)] + (0.818 * TMI) - (0.300 * age), R2 = 59 %. Conclusion: this study showed that the sum of tricipital and subscapular skinfolds, IP and WHtR are adequate predictors of %BF. These indicators allowed the development of two regression equations acceptable in terms of precision and accuracy to predict %BF in children and adolescents of both sexes (AU)

Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: Initiation criteria in real life.

INTRODUCTION: Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit. MATERIAL AND METHODS: Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period. RESULTS: Seventy-six patients were started on CPAP (n = 64) or NIV (n = 12). CPAP/NIV was initiated because of CPAP/NIV weaning failure (Acute group) in 15 patients. None of these patients had an overnight gas exchange or sleep study before CPAP/NIV initiation. In 18 patients, CPAP/NIV was initiated on abnormal nocturnal gas exchange alone (Subacute group). These patients had a median of three of the following five overnight gas exchange abnormalities: minimal pulse oximetry (SpO2 ) <90%, maximal transcutaneous carbon dioxide (PtcCO2 ) >50 mmHg, time spent with SpO2 <90% or PtcCO2 >50 mmHg ≥2% of recording time, oxygen desaturation index >1.4/hr. In the last 43 patients, CPAP/NIV was initiated after an abnormal sleep study (Chronic group) on a mean of four of the aforementioned criteria and an apnea-hypopnea index >10/hr. CONCLUSION: In clinical practice, CPAP/NIV was initiated in an acute, subacute and chronic setting with most patients having an association of several abnormal gas exchange or sleep study parameters. Future studies should evaluate the effectiveness and benefits of CPAP/NIV according to the clinical situation and initiation criteria. Pediatr Pulmonol. 2016; 51:968-974. © 2016 Wiley Periodicals, Inc.

Approaches to chronological age assessment based on dental calcification.

The aim of the present study was to find an accurate estimation of chronological age using a small number of selected teeth. For this purpose, the method devised by Nolla [C. Nolla, The development of the permanent teeth, J. Dent. Child. 27 (1960) 254-266.] was used: the development of each of the teeth was determined according to this method on 374 radiographs, 195 of boys (mean age 8.59) and 179 of girls (mean age 8.75). The 28 variables representing the calcification stages were analyzed using cluster analysis followed by multivariate analysis (multiple linear regression model). Patient age was considered to be a dependent variable. Our study showed that antimere teeth are the most homogeneous as regards stages of development. The prediction was more accurate for boys and girls below 10 years of age, using teeth 21, 43 and 46 from boys and teeth 21, 46 and 47 from girls. These teeth accounted for 80% total variance of chronological age for dental calcification. Standard error was +/-1.4 years for boys and +/-1.2 years for girls. When the age of the children remained completely unknown, the best estimates were provided by teeth 43, 47, 46 and 44 from boys and teeth 44, 47 and 43 from girls.

Haemodynamic and endocrine effects of digitoxin in healthy volunteers.

A study was conducted to evaluate the effects of a single oral dose of digitoxin on the circulatory function and the renin-angiotensin-aldosterone system. Seven doses of digitoxin and 6 of a placebo were given at random to 13 healthy volunteers, all of whom remained at rest, without smoking, throughout the study. Blood samples were taken initially after 1 h at rest, and at 1, 2 and 24 h after receiving the dose. Concentrations of serum digitoxin, aldosterone, angiotensin II (A II) as well as plasma renin activity (PRA) were determined by radioimmunoassay (RIA). In all subjects the blood pressure did not change throughout the study. Digitoxin decreased the heart rate significantly during the first and second hours, while in the placebo group the heart rate remained unchanged during the same period. The placebo had no detectable effect on PRA, A II and aldosterone. Digitoxin decreased PRA and A II levels, reaching its maximum effect 2 h after the administration. There was no correlation between the serum digitoxin concentration and PRA, A II or the aldosterone values. Digitoxin reached its maximum effect upon these parameters faster than what is generally accepted.

Second primary malignancies in patients with neuroendocrine tumors.

PURPOSE: An association between neuroendocrine tumors (NETs) and second primary malignancies (SPMs) has been reported. We have examined the incidence and etiology of SPMs in patients with NETs included in the Neuroendocrine Tumor Association of Andalusia (ATNEA) Registry. METHODS: Data on 111 patients were collected. Sex, age, NET site, chromogranin A levels, neuropeptide secretion and disease stage were compared between NETs with and without SPMs. RESULTS: SPMs were present in 21 patients (18.9 %): five colorectal tumors, four non-small-cell lung cancers, three gastric cancers, two tumors in the small intestine, one hepatocarcinoma, two ovarian tumors, one breast adenocarcinoma, one hypernephroma, one bladder cancer, and one neuroblastoma. SPMs were present in 18 % of patients with a gastrointestinal NET and 22 % of those with a non-gastrointestinal NET. SPMs were found in 23 % of patients with elevated levels of serum chromogranin A, compared to 17 % of patients with normal levels, and in 22 % of patients with functional tumors, compared to 11 % of those with non-functional tumors. Finally, SPMs were observed in 24 % of patients with a local or locoregional tumor but in only 13 % of those with a metastatic tumor. No other differences between patients with and without SPMs were observed. CONCLUSIONS: The percentage of patients with SPMs in the ATNEA Registry is similar to those reported in other series. In our registry, patients with functional NETs and local/locoregional tumors have higher probability of SPMs. The low number of patients, selection bias and other etiologic factors of SPMs may have influenced our results.

SEOM clinical guidelines to primary prevention of cancer (2018)

Cancer is the leading social and healthcare problem of the twenty-first century. The aim of primary prevention is to decrease the incidence of cancer by avoiding the known causes and risk factors. Nevertheless, it has been estimated that cancer diagnoses could be halved through primary prevention measures. A comprehensive review of the scientific evidence regarding the main carcinogens and risk factors and primary prevention recommendations have been put forth based on this evidence. The GRADE scale has been used to classify the grade of evidence. We present the scientific evidence and recommendations for primary prevention of the major modifiable risk factors: smoking, alcohol, diet, obesity, physical activity, occupational and environmental factors, ultraviolet radiation, infections, and socioeconomic factors. Primary prevention is a simple, effective means to lower the incidence of cancer. Preventive measures must be circulated in the fight against cancer

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Aplicación de un árbol de decisión difusa con clasificación de ambigüedad para determinar el exceso de peso en escolares / Application of a fuzzy decision tree with ambiguity classification to determine excess weight in schoolchildren

RESUMEN La técnica del árbol de decisiones en las ciencias de la salud sirve para comprender las correlaciones entre las descripciones de los pacientes y para clasificar de forma precisa en diversas categorías. El objetivo del estudio fue analizar la exactitud de la clasificación del exceso de peso de escolares mediante la aplicación de un árbol de decisión difusa, utilizando una base de datos de Itaupú, Paraná (Brasil). Se utilizó la base de datos de una muestra conformada por 5962 estudiantes (3024 del sexo femenino y 2938 del sexo masculino), con un rango de edad entre los 6 a 17 años de edad. Las variables consideradas fueron peso, estatura y el Índice de Masa Corporal (IMC). Para clasificar los datos antropométricos de los escolares se utilizó un árbol de decisión difusa. Los resultados del aprendizaje mostraron una clasificación correcta en el sexo femenino de 2688 y en el sexo masculino de 2471 registros respectivamente. En relación a la exactitud, se determinó 84% en el sexo masculino y 89% en el sexo femenino. El Área Bajo la curva mostró valores más altos en el método Difuso y en ambos sexos (0.965-0.983), mientras que en el método clásico, fueron inferiores (0.804-0.895). De acuerdo a los resultados calculados es posible aplicar el árbol de decisión difusa para la clasificación de escolares con exceso de peso con una exactitud aceptable, además se presenta como una técnica alternativa que puede ahorrar tiempo a la hora de analizar el estado nutricional, sin embargo, no se realizó otros cálculos estadísticos que tengan que ver con la precisión y exactitud a través de métodos estadísticos convencionales y comparar con la técnica de árboles difusos.

ABSTRACT The decision tree technique in the health sciences serves to understand the correlations between the descriptions of patients and to classify accurately in various categories. The aim of the study was to analyze the accuracy of the classification of excess weight of schoolchildren through the application of a fuzzy decision tree, using a database of Itaupú, Paraná (Brazil). We used the database of a sample consisting of 5962 students (3024 female and 2938 male), with an age range between 6 to 17 years of age. The variables considered were weight, height and the Body Mass Index (BMI). To classify the anthropometric data of the students, a diffuse decision tree was used. The learning results showed a correct classification in the female sex of 2688 and in the male sex of 2471 records respectively. In relation to accuracy, 84% was determined in the male sex and 89% in the female sex. The Area under the curve showed higher values in the Fuzzy method and in both sexes (0.965-0.983), while in the classical method, they were lower (0.804-0.895). According to the calculated results it is possible to apply the fuzzy decision tree for the classification of overweight students with an acceptable accuracy, and it is presented as an alternative technique that can save time when analyzing the nutritional status, however, no other statistical calculations were made that have to do with the precision and accuracy through conventional statistical methods and compare with the technique of fuzzy trees.

New species of Tetramorium Mayr (Hymenoptera: Formicidae) from Puebla State, Mexico.

Tetramorium notomelanum sp. n. is described from the Tehuacán Valley, state of Puebla, México. Its distribution and relation with other species of the tortuosum-group is discussed. The new species of Tetramonium is described from workers, and distinguished from others of the group by several characters: i) black coloration of the body; ii) size: T. notomelanum sp. n. is smaller than T. hispidum (Wheeler), T. mexicanum Bolton and T.spinosum (Pergande), but larger than T. bicolorum Vásquez-Bolaños and T. placidum Bolton; iii) length of the hairs of the dorsal of the head are equal to the diameter of eye; iv) the length of the hairs on the scape and tibiae less than the width of the appendage where they are located. This is the second species of the tortuosum group of Tetramorium found in the State of Puebla, and the fourth recorded in Mexico.

Seroprevalence of Coxiella burnetii in domestic ruminants in Gran Canaria Island, Spain.

Coxiella burnetii is the causative agent of Q fever, a zoonosis with worldwide occurrence. In the Canary Islands, the overall seroprevalence in humans has been estimated to be 21.5%. Gran Canaria island concentrates the highest ruminant population in the archipelago and the prevalence of the human infection is 23.5%. To evaluate the seroprevalence in livestock and the affected areas in Gran Canaria island, a total of 1249 ruminants were randomly selected for this study (733 goats, 369 sheep and 147 cattle). The samples were evaluated using an indirect ELISA Kit. The results showed seroprevalences of 60.4%, 31.7% and 12.2% in goats, sheep and cattle, respectively. Based on these results, Q fever could be considered as endemic in Gran Canaria island. Sanitary measures should be taken at the farm level to minimize the risk of exposure of C. burnetii to humans.

Valoración de la maduración biológica: usos y aplicaciones en el ámbito escolar / Assessment of biological maturation: uses and applications in schools

Los indicadores de la valoración de la maduración biológica son ampliamente utilizados en diversas áreas. Proporcionan información relevante que permite determinar el ritmo o tiempo de maduración individual. El uso y la aplicación varía entre las técnicas, sin embargo, todos tienen un objetivo común, la clasificación de los niños y adolescentes en estadios de maduración. En este sentido, el objetivo de la presente revisión fue describir los indicadores de maduración biológica e indagar los posibles usos y aplicaciones dentro del ámbito escolar. Se concluye que a) la mayoría de los estudios coinciden en especificar que la maduración esquelética o edad ósea es el indicador más útil, aunque la predicción del pico de velocidad de crecimiento propuesta por Mirwald et al. (2002) es un indicador que permite valorar a poblaciones escolares de forma transversal y b) la valoración de la maduración, independientemente del tipo de metodología puede ser aplicada en el área clínica, la escuela, en el deporte y en la calidad de vida, como un medio de clasificación de grupos de trabajo para homogeneizar a los niños y adolescentes en circunstancias deportivas y no deportiva (AU)

The indicators for the assessment of biological maturation are widely used in various fields. Provide relevant information for determining the rate or time of individual maturation. The use and application varies between techniques, however, all have a common goal, the classification of children and adolescents in maturation stages. In this sense, the objective of this review was to describe indicators of biological maturation and investigate the possible uses and applications within the school. We conclude that a) most studies agree that specify skeletal maturity or bone age is the most useful indicator, although predicting the peak growth rate given by Mirwald et al. (2002) is an indicator for assessing school populations transversely, and b) the assessment of maturation, regardless of the methodology can be applied in the clinic, school, sports and quality of life as a means of classifying groups working to unify children and adolescents in circunstances competition and non-sports (AU)

Comparison of heart rate variability signal features derived from electrocardiography and photoplethysmography in healthy individuals.

The heart rate variability (HRV) signal is indicative of autonomic regulation of the heart rate (HR). It could be used as a noninvasive marker in monitoring the physiological state of an individual. Currently, the primary method of deriving the HRV signal is to acquire the electrocardiogram (ECG) signal, apply appropriate QRS detection algorithms to locate the R wave and its peak, find the RR intervals, and perform suitable interpolation and resampling to produce a uniformly sampled tachogram. This process could sometimes result in errors in the HRV signal due to drift, electromagnetic and biologic interference, and the complex morphology of the ECG signal. The photoplethysmographic (PPG) signal has the potential to eliminate the problems with the ECG signal to derive the HRV signal. To investigate this point, a PDA-based system was developed to simultaneously record ECG and PPG signals to facilitate accurately controlled sampling and recording durations. Two healthy young volunteers participated in this pilot study to evaluate the applicability of our approach. To improve data quality, ECG and PPG recordings were acquired three times/subject. A comparison between different features of the HRV signals derived from both methods was performed to test the validity of using PPG signals in HRV analysis. We used autoregressive (AR) modeling, Poincare' plots, cross correlation, standard deviation, arithmetic mean, skewness, kurtosis, and approximate entropy (ApEn) to derive and compare different measures from both ECG and PPG signals. This study demonstrated that our PDA-based system was a convenient and reliable means for acquisition of PPG-derived and ECG-derived HRV signals. The excellent agreement between different measures of HRV signals acquired from both methods provides potential support for the idea of using PPGs instead of ECGs in HRV signal derivation and analysis in ambulatory cardiac monitoring of healthy individuals.

In vitro activities of DX-619 and four comparator agents against 376 anaerobic bacterial isolates.

The activity of DX-619 was evaluated against 376 anaerobic isolates using the reference CLSI agar dilution method. Overall, 90% of the strains were susceptible to DX-619 at < or =1 microg/ml. It was more active than the other four compounds tested except for meropenem, which showed virtually identical overall activity.

New species of Tetramorium Mayr (Hymenoptera: Formicidae) from Puebla State, Mexico

Tetramorium notomelanum sp. n. is described from the Tehuacán Valley, state of Puebla, México. Its distribution and relation with other species of the tortuosum-group is discussed. The new species of Tetramonium is described from workers, and distinguished from others of the group by several characters: i) black coloration of the body; ii) size: T. notomelanum sp. n. is smaller than T. hispidum (Wheeler), T. mexicanum Bolton and T.spinosum (Pergande), but larger than T. bicolorum Vásquez-Bolaños and T. placidum Bolton; iii) length of the hairs of the dorsal of the head are equal to the diameter of eye; iv) the length of the hairs on the scape and tibiae less than the width of the appendage where they are located. This is the second species of the tortuosum group of Tetramorium found in the State of Puebla, and the fourth recorded in Mexico.

XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer.

The purpose of this phase II trial was to determine the efficacy and safety of the XELOX (capecitabine/oxaliplatin) regimen as first-line therapy in the elderly patients with metastatic colorectal cancer (MCRC). A total of 50 patients with MCRC aged > or = 70 years received oxaliplatin 130 mg m(-2) on day 1 followed by oral capecitabine 1000 mg m(-2) twice daily on days 1-14 every 3 weeks. Patients with creatinine clearance 30-50 ml min(-1) received a reduced dose of capecitabine (750 mg m(-2) twice daily). By intent-to-treat analysis, the overall response rate was 36% (95% CI, 28-49%), with three (6%) complete and 15 (30%) partial responses. In total, 18 patients (36%) had stable disease and 14 (28%) progressed. The median times to disease progression and overall survival were 5.8 months (95% CI, 3.9-7.8 months) and 13.2 months (95% CI, 7.6-16.9 months), respectively. Capecitabine was well tolerated: grade 3/4 adverse events were observed in 14 (28%) patients: 11 (22%) diarrhoea, eight (16%) asthenia, seven (14%) nausea/vomiting, three (6%) neutropenia, three (6%) thrombocytopenia, and two (4%) hand-foot syndrome. There was one treatment-related death from diarrhoea and sepsis. In conclusion, XELOX is well tolerated in elderly patients, with respectable efficacy and a meaningful clinical benefit response. Given its ease of administration compared with combinations of oxaliplatin with 5-FU/LV, it represents a good therapeutic option in the elderly.

Candida glabrata fungemia cured by antibiotic-lock therapy: case report and short review.

Catheter removal is now the standard recommendation of catheter-related fungemia even when tunneled devices are used. However, in the clinical practice, this procedure is not always without risks. Antibiotic-lock technique can resolve many cases of catheter-related bacteraemia, but cure of catheter-related candidemia by this method has been attempted in very few instances, reviewed in this article. Herein, we report a case of non-complicated Candida glabrata fungemia related to a Hickman catheter used for parenteral nutrition, cured with intraluminal amphotericin B in addition to systemic therapy. This case demonstrates that 'antifungal-lock therapy' can be effectively used in selected cases of catheter-related candidemia.