Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists.

BACKGROUND: Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function. METHODS: It is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were used. RESULTS: Up to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05). CONCLUSION: The incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively registered.

Computational capabilities at the edge of chaos for one dimensional systems undergoing continuous transitions.

While there has been a keen interest in studying computation at the edge of chaos for dynamical systems undergoing a phase transition, this has come under question for cellular automata. We show that for continuously deformed cellular automata, there is an enhancement of computation capabilities as the system moves towards cellular automata with chaotic spatiotemporal behavior. The computation capabilities are followed by looking into the Shannon entropy rate and the excess entropy, which allow identifying the balance between unpredictability and complexity. Enhanced computation power shows an increase of excess entropy, while the system entropy density has a sudden jump to values near one. The analysis is extended to a system of non-linear locally coupled oscillators that have been reported to exhibit spatiotemporal diagrams similar to cellular automata.

Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain.

OBJECTIVE: Patients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model. METHODS: One hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1 week, 3 months, and 12 months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty. RESULTS: A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value = .87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results. CONCLUSIONS: Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.

Health-related quality of life in well-differentiated metastatic gastroenteropancreatic neuroendocrine tumors.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare neoplasms capable of producing hormones. The development of new treatments has improved progression-free survival, albeit with increased toxicity. Health-related quality of life (HRQoL) has become an important endpoint in clinical research to evaluate patients' well-being in such a contradictory scenario. In this review, we examine key reported outcomes across clinical studies exploring HRQoL in patients with GEP-NETs. We have conducted a review of the literature using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Selection criteria for articles were (1) publication in English between 1995 and 2014, (2) patients with GEP-NET, and (3) analysis of HRQoL, including mental health and psychological symptoms. Forty-nine studies met the inclusion criteria (31 clinical trials, 14 observational studies, and 4 developments of NET-specific HRQoL instruments). The scope and nature of the literature was diverse with 27 instruments used to measure aspects of HRQoL. EORTC QLQ-C30 was the most frequently used, in 38 of the 49 studies. Standardized measures revealed that in spite of generally good HRQoL, GEP-NET patients have specific psychological and physical complaints. The clinical benefit of somatostatin analogs and sunitinib has been clearly supported by HRQoL assessment. Improvement in HRQoL scores or symptom relief over time was also reported in 14 trials of peptide receptor radionuclide therapy, however the absence of randomized studies obviate definitive conclusions. We have also identified several unanswered questions that should be addressed in further research concerning chemotherapy, everolimus, surgery, local ablative therapies, and chemoembolization. Future research should incorporate GEP-NET-specific HRQoL instruments into phase III trials. This review may help both clinicians and researchers to select the most appropriate tools to assess changes in HRQoL in this population.

The effects of a topical gel containing chitosan, 0,2% chlorhexidine, allantoin and despanthenol on the wound healing process subsequent to impacted lower third molar extraction.

BACKGROUND: Despite efforts to prevent postoperative discomfort, there are still many immediate side effects associated with the surgical extraction of impacted lower third molars. Cicatrization is a physiological process through which the loss of integrity of oral mucosa is recovered and damaged tissues are repaired. Bexident Post (ISDIN, Spain) is a topical gel that contains chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol. While this gel has many clinical indications, there are no published clinical trials evaluating its use in impacted mandibular third molar surgery. This study aims to clinically evaluate the efficacy of a gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on wound healing and reduction of postoperative side effects and complications after extraction of an impacted mandibular third molar. MATERIAL AND METHODS: A split-mouth design study was carried out on a total of 50 bilaterally and symmetrically impacted third molar extractions, which were randomly placed into either a control group (CG=25) or an experimental group (EG=25). Patients were all informed of the purpose of the study and provided written consent. All procedures were carried out by the same dental practitioner, in accordance with standard surgical protocol. A different dental practitioner, unaware of which treatment had been applied, provided follow-up care. The EG applied 10 ml of topical gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol to the surgical wound three times a day for 10 days, patients in the CG did not apply any gel. RESULTS: The groups were homogeneous insofar as potentially confounding variables. No significant findings were found regarding postoperative swelling and pain. Neither of the groups displayed poor healing or infectious complications of the wound during the postoperative period. In all the recorded follow-ups (Day 7 p=0.001, and Day 14 p=0.01), the wound's aesthetic appearance was better in the EG. Overall treatment tolerance was satisfactory and similar in both groups. CONCLUSIONS: The gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol did not aid in patients' postoperative comfort; however, improved wound healing was observed.

Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients.

OBJECTIVES: To assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later. METHODS: In 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10 years. RESULTS: 53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10 years was 90.7%. CONCLUSIONS: Patients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications.

Lempel-Ziv complexity analysis of one dimensional cellular automata.

Lempel-Ziv complexity measure has been used to estimate the entropy density of a string. It is defined as the number of factors in a production factorization of a string. In this contribution, we show that its use can be extended, by using the normalized information distance, to study the spatiotemporal evolution of random initial configurations under cellular automata rules. In particular, the transfer information from time consecutive configurations is studied, as well as the sensitivity to perturbed initial conditions. The behavior of the cellular automata rules can be grouped in different classes, but no single grouping captures the whole nature of the involved rules. The analysis carried out is particularly appropriate for studying the computational processing capabilities of cellular automata rules.

[Bibliometric study and analysis of citation networks of visual screening in primary care]. / Estudio bibliométrico y análisis de redes de citación de los screening visuales en atención primaria.

AIM: Screenings make it possible to detect anomalies that can be treated and identify patients who require referral to a specialist. The objective is to identify the different areas of research and determine the most cited publications on screening in primary care. METHODS: An analysis of publications and visualization of citation networks has been carried out using the Citation Network Explorer software. The bibliographic search was carried out with the Web of Science (WOS) database using the search term: "screening AND (vision OR eye OR ocular OR visual)". RESULTS: We analyzed 16707 publications in all fields, 23919 citation networks have been found. The number of publications has increased, with 2021 being the year with the highest number. The majority are scientific articles and the predominant language is English. The most cited article is a global meta-analysis on the prevalence of glaucoma, showing the importance of screening for its early detection since it is essential to avoid blindness. Using the clustering function we found 8 groups with a significant number of publications where we have bibliography on certain eye diseases: glaucoma, diabetic retinopathy, pediatric amblyopia, keratoconus and dry eye. CONCLUSIONS: The main areas of study in relation to screening are the detection of diseases such as glaucoma, retinopathy of prematurity, keratoconus and dry eye. As well as the detection through visual analysis of childhood amblyopia and vision loss in elderly patients. It also gives importance to performing ocular motility tests in problems of acquired brain damage.

On the non-randomness of maximum Lempel Ziv complexity sequences of finite size.

Random sequences attain the highest entropy rate. The estimation of entropy rate for an ergodic source can be done using the Lempel Ziv complexity measure yet, the exact entropy rate value is only reached in the infinite limit. We prove that typical random sequences of finite length fall short of the maximum Lempel-Ziv complexity, contrary to common belief. We discuss that, for a finite length, maximum Lempel-Ziv sequences can be built from a well defined generating algorithm, which makes them of low Kolmogorov-Chaitin complexity, quite the opposite to randomness. It will be discussed that Lempel-Ziv measure is, in this sense, less general than Kolmogorov-Chaitin complexity, as it can be fooled by an intelligent enough agent. The latter will be shown to be the case for the binary expansion of certain irrational numbers. Maximum Lempel-Ziv sequences induce a normalization that gives good estimates of entropy rate for several sources, while keeping bounded values for all sequence length, making it an alternative to other normalization schemes in use.

Characterization of heavy-metal contamination in surface sediments of the Minho river estuary by way of factor analysis.

Surface sediments were collected in August 2009 from 49 sites along the Minho estuary (between Tui and Caminha) and analyzed for grain size, organic carbon (Corg) and total nitrogen (Ntot) contents, and major (silicon [Si], aluminum [Al], iron [Fe], calcium [Ca], magnesium [Mg], sodium [Na], potassium [K], titanium [Ti], and mangesese [Mn]) and trace element (arsenic [As], chromium [Cr], copper [Cu], mercury [Hg], lithium [Li], lead [Pb], rubidium [Rb], tin [Sn], and zinc [Zn]) concentrations. Factor analysis was used to decrease 22 selected variables into 4 factors accounting for 85.9 % of the total variance explained, suggesting distinct elemental sources or sediment components affecting their spatial distributions. Although factors 1 (detrital component; elements strongly associated with fine- [Na, Mg, Ti, Li, Cr, Cu, Fe, Al, Zn, Ca, and As] and coarse-grained sediments [Si, K, Rb; mean grain-size [MGS]) and 3 (Fe-Mn oxyhydroxide sediment component; Fe, Mn, As, fine fraction) are interpreted as reflecting predominance of natural contributions, factors 2 (urban and industrial contamination: sediment components [Pb, Hg, organic carbon [Corg], total nitrogen [Ntot] and 4 (components associated with contamination by nautical activities; the association of tin [Sn] and calcium [Ca]) seem to indicate anthropogenic contributions). Nevertheless, the influence of elemental contributions derived from tungsten (W)-Sn mineralizations and those resulting from mining activities can also contribute to the obtained geochemical associations and should be considered. Spatial distribution of dominant factor scores shows the dominance of factors 2 and 4 between Tui and Vila Nova de Cerveira, whereas samples dominated by factors 3 and 1 are found between Ilha da Boega and Seixas and in the Caminha areas, respectively. Despite the dominance of factor score 1 in the Caminha area, the distribution pattern of dominant factor scores shows samples dominated by other factor scores that can be explained by dredging activities in this river sector that restore ancient sedimentary characteristics or expose contaminated sediments. Through the identification of sample locations dominated by factors associated with contamination, it will be possible to select them as priority areas where new environmental (e.g., toxicity tests, organic Sn compounds, tracers of sewage contamination) studies should be implemented in the future.

Natural heavy metal and metalloid concentrations in sediments of the Minho River estuary (Portugal): baseline values for environmental studies.

Forty-nine surface sediment samples from the Minho estuary sector between Tui and Caminha were analyzed for grain-size contents, Al, As, Cr, Cu, Hg, Li, Pb, Sn, and Zn concentrations. Selected heavy metal (Cu, Cr, Hg, and Zn) and metalloid (As and Sn) distributions were normalized against Al and Li with the main goal of compensating for natural grain-size variability and to separate natural from anthropogenic contributions, by using a combination of normalization techniques (definition of regional geochemical baselines (RGB) and determination of enrichment factors (EF)). Lead did not reveal a significant relationship with Al and Li. Aluminum explained more variance than Li for As, Cu, Hg, and Zn. Assuming the general non-impacted metal character of the Minho River estuary sediments, RGBs are defined for differentiating between natural and anthropogenic contributions. Based on RGB defined for each heavy metal/metalloid, the degree of enrichment is estimated through the determination of EF. Despite the relatively low total heavy metal and metalloid concentrations, the defined RGB identifies a set of samples characterized by presenting As, Cu, Cr, Hg, and Zn enrichments relatively to expected natural levels. Mercury is the element showing the highest level of enrichment relative to the baseline values being spread through all the study area. Tin present enrichments relatively to Al and or Li always lower than 1.5 suggesting natural contributions.

Matrix metalloproteinase-10 effectively reduces infarct size in experimental stroke by enhancing fibrinolysis via a thrombin-activatable fibrinolysis inhibitor-mediated mechanism.

BACKGROUND: The fibrinolytic and matrix metalloproteinase (MMP) systems cooperate in thrombus dissolution and extracellular matrix proteolysis. The plasminogen/plasmin system activates MMPs, and some MMPs have been involved in the dissolution of fibrin by targeting fibrin(ogen) directly or by collaborating with plasmin. MMP-10 has been implicated in inflammatory/thrombotic processes and vascular integrity, but whether MMP-10 could have a profibrinolytic effect and represent a promising thrombolytic agent is unknown. METHODS AND RESULTS: The effect of MMP-10 on fibrinolysis was studied in vitro and in vivo, in MMP-10-null mice (Mmp10(-/-)), with the use of 2 different murine models of arterial thrombosis: laser-induced carotid injury and ischemic stroke. In vitro, we showed that MMP-10 was capable of enhancing tissue plasminogen activator-induced fibrinolysis via a thrombin-activatable fibrinolysis inhibitor inactivation-mediated mechanism. In vivo, delayed fibrinolysis observed after photochemical carotid injury in Mmp10(-/-) mice was reversed by active recombinant human MMP-10. In a thrombin-induced stroke model, the reperfusion and the infarct size in sham or tissue plasminogen activator-treated animals were severely impaired in Mmp10(-/-) mice. In this model, administration of active MMP-10 to wild-type animals significantly reduced blood reperfusion time and infarct size to the same extent as tissue plasminogen activator and was associated with shorter bleeding time and no intracranial hemorrhage. This effect was not observed in thrombin-activatable fibrinolysis inhibitor-deficient mice, suggesting thrombin-activatable fibrinolysis inhibitor inactivation as one of the mechanisms involved in the MMP-10 profibrinolytic effect. CONCLUSIONS: A novel profibrinolytic role for MMP-10 in experimental ischemic stroke is described, opening new pathways for innovative fibrinolytic strategies in arterial thrombosis.

Knowledge, attitudes, and behavior regarding antibiotics, antibiotic use, and antibiotic resistance in students and health care professionals of the district of Barranquilla (Colombia): A cross-sectional survey.

Objective: To evaluate the knowledge, attitudes and behavior regarding antibiotics, use of antibiotics, and antibiotic resistance in students and health care professionals of the district of Barranquilla, Colombia. Study design: Descriptive, cross-sectional. Methods: A sample of 399 respondents was selected, that included health professionals and medical students from 12 health institutions in the district of Barranquilla (Colombia), using an established stratified sampling method. Each of the respondent professionals completed a survey that included 43 items in the Likert scale. A descriptive analysis of the study variables was performed using the software SPSS version 25. Results: Most of the respondents were women (64.4%), aged between 26 and 35 years (47.6%); 28.8% were nurses and 26.1% general practitioners, with ≤10 years of professional experience (63.4%). Overall, the survey revealed that the participants had considerable knowledge about antibiotic use (89.5%-98% correct answers) and the spread of antibiotic resistance (67.4%-89% correct answers). Approximately 74% of the respondents agreed or fully agreed with the questions related to the management of infections and the provision of advice. Conclusions: The present study revealed that most of the health care professionals surveyed had a good knowledge about antibiotic use, although strategies must be developed to strengthen knowledge regarding the spread of antibiotic resistance. Likewise, it is important to identify opportunities for improvement related with access to the guidelines and/or materials necessary to treat infections and to provide advice on antibiotic use and antibiotic resistance.

Ion homeostasis during salt stress in plants.

Recent progress has been made in the characterization of cation transporters that maintain ion homeostasis during salt stress in plants. Sodium-proton antiporters at the vacuolar (NHX1) and plasma membrane (SOS1) have been identified in Arabidopsis. SOS1 is regulated by the calcium-activated protein kinase complex SOS2-SOS3. In yeast, a transcription repressor, Sko1, mediates regulation of the sodium-pump ENA1 gene by the Hog1 MAP kinase. The recent visualization at the atomic level of the inhibitory site of sodium in the known target Hal2 has helped identify the interactions determining Na(+) toxicity.

[Leptomeningeal spread of an intramedullary cervical pilocytic astrocytoma: case report and literature review]. / Diseminación leptomeníngea de un astrocitoma pilocítico cervical en el adulto:publicación de un caso y revisión de la literatura.

BACKGROUND. The rarest location of pilocytic astrocytoma is intramedullary. Gliomas represent up to 24 - 30% of intramedullary tumors in adulthood and are second only after ependymomas. Leptomeningeal dissemination through cerebrospinal fluid is unusual and occurs predominantly in medulloblastomas, ependymoblastomas, central neuroblastomas, ependymomas, germ cell tumors and high-grade gliomas. The majority of spinal cord gliomas reporting metastasis were anaplastic astrocytomas or glioblastomas multiforme and relatively few were low-grade gliomas. The incidence of leptomeningeal spread of low-grade tumors is rare. A rare cranial extension of brain leptomeningeal dissemination in an intramedullary pilocytic astrocytoma during adulthood is reported. CASE REPORT. A 51 year-old-man with a recurrent intramedullary mass at C5-C7 level operated 4 times with all pathological anatomy reports describing the lesion as Pilocytic Astrocytoma developed, after 15 years from the diagnosis, visual hallucinations and his level of consciousness worsened to Glasgow coma score 13/15. The MRI showed highly enhanced cranial and spinal leptomeninges and paquimeninges with a micro nodular-granulomatous aspect associated with intense affectation of basal cisterns, subarachnoid spaces and convexity of both cerebral hemispheres suggestive of leptomeningeal spread of the spinal mass. The patient expired after three days. CONCLUSION. Leptomeningeal spread is a rare phenomenon and when it happens usually doesn't change the primary tumor's behavior. In our case the aggressiveness could be explained by a potential malignization of the primary tumor that it was not documented because of the partial resections from the lasts surgeries or instead the tumor was actually a monomorphous pilomyxoid tumor.

[Iatrogenic cervical epidural hematoma: case report and review of the literature]. / Heamtoma epidural ccervical yatrogenico. Presentacion de un caso clinico y revision de la literatura.

BACKGROUND: Around 600 spinal epidural hematoma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous malformations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its incidence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. CASE REPORT: 80 year-old-man that developed intense cervicalgia with lower limbs weakness showing complete paraplegia and arreflexia 2 hours after analgesic treatment with epidural cervical infiltration for cervicoartrosis. Cervical MRI showed epidural cervical hematoma between C4 and T1 levels. The patient is transferred to our facilities in order to perform surgery. But after showing fast recovery, medical conservative management was elected. After one month, the patient's condition has improved showing no neurological deficits and complete resorption is seen in MRI. CONCLUSIONS: Nowadays, trend is to perform surgery in patients with spinal hematoma and significant neurological deterioration during the first hours. However, good neurological outcomes can be achieved with conservative management, in well selected patients with non progressive, incomplete and partial deficits. Presently, we can not predict which is the best treatment for each case.

Subsoil TPH contamination in two oil pipeline pumping stations and one pipeline right-of-way in north Mexico.

This investigation deals with the characterization carried out in zones around two pipeline pumping stations and one pipeline right-of-way in the north of Mexico. In particular those areas where contamination was evaluated: (a) south area of the separation ditch in the Avalos station, (b) the area between the separation ditch at the Avalos station, (c) km 194+420 of the Moctuzma station, and (d) km 286+900 in the Candelaria station. Results of this investigation showed that only four samples showed TPH values higher than the Mexican limit for 2004: AVA 1B, with 21,191 mg kg(-1); AVA 1C, with 9348 mg kg(-1); AVA 2B, with 13,970 mg kg(-1); and MOC 2A, with 4108 mg kg(-1).None of the sampled points showed the presence of PAHs at values higher than those found in the Mexican or American legislations. PAH were detected in the range of 0.0004 and 13.05 mg kg(-1).It is suggested to implement surfactant soil washing as a remediation technique for the approximately 600 m(3) that need to be treated.

SEOM clinical guideline on hereditary colorectal cancer (2019).

In the last 2 decades, clinical genetics on hereditary colorectal syndromes has shifted from just a molecular characterization of the different syndromes to the estimation of the individual risk of cancer and appropriate risk reduction strategies. In the last years, new specific therapies for some subgroups of patients have emerged as very effective alternatives. At the same time, germline multigene panel testing by next-generation sequencing (NGS) technology has become the new gold standard for molecular genetics.

New viral biogeochemical roles revealed through metagenomic analysis of Lake Baikal.

BACKGROUND: Lake Baikal is the largest body of liquid freshwater on Earth. Previous studies have described the microbial composition of this habitat, but the viral communities from this ecosystem have not been characterized in detail. RESULTS: Here, we describe the viral diversity of this habitat across depth and seasonal gradients. We discovered 19,475 bona fide viral sequences, which are derived from viruses predicted to infect abundant and ecologically important taxa that reside in Lake Baikal, such as Nitrospirota, Methylophilaceae, and Crenarchaeota. Diversity analysis revealed significant changes in viral community composition between epipelagic and bathypelagic zones. Analysis of the gene content of individual viral populations allowed us to describe one of the first bacteriophages that infect Nitrospirota, and their extensive repertoire of auxiliary metabolic genes that might enhance carbon fixation through the reductive TCA cycle. We also described bacteriophages of methylotrophic bacteria with the potential to enhance methanol oxidation and the S-adenosyl-L-methionine cycle. CONCLUSIONS: These findings unraveled new ways by which viruses influence the carbon cycle in freshwater ecosystems, namely, by using auxiliary metabolic genes that act upon metabolisms of dark carbon fixation and methylotrophy. Therefore, our results shed light on the processes through which viruses can impact biogeochemical cycles of major ecological relevance. Video Abstract.

Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry.

BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.