Implementation of esophageal endoscopic submucosal dissection in Spain: Results from the nationwide registry. / Implementación de la disección endoscópica submucosa esofágica en España: resultados del registro nacional.

INTRODUCTION AND AIMS: The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique. MATERIAL AND METHODS: Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection. RESULTS: A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%). CONCLUSIONS: In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events.

Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs.

Background and study aims Conventional endoscopic mucosal resection (C-EMR) is limited by low en-bloc resection rates, especially for large (> 20 mm) lesions. Underwater EMR (U-EMR) has emerged as an alternative for colorectal polyps and is being shown to improve en-bloc resection rates. We conducted a systematic review and meta-analysis comparing the two techniques. Methods Multiple databases were searched through November 2022 for randomized controlled trials (RCTs) comparing outcomes of U-EMR and C-EMR for colorectal polyps. Meta-analysis was performed to determine pooled proportions and relative risks (RRs) of R0 and en-bloc resection, polyp recurrence, resection time, and adverse events. Results Seven RCTs with 1458 patients (U-EMR: 739, C-EMR: 719) were included. The pooled rate of en-bloc resection was significantly higher with U-EMR vs C-EMR, 70.17% (confidence interval [CI] 46.68-86.34) vs 58.14% (CI 31.59-80.68), respectively, RR 1.21 (CI 1.01-1.44). R0 resection rates were higher with U-EMR vs C-EMR, 58.1% (CI 29.75-81.9) vs 44.6% (CI 17.4-75.4), RR 1.25 (CI 0.99-1.6). For large polyps (> 20 mm), en-bloc resection rates were comparable between the two techniques, RR 1.24 (CI 0.83-1.84). Resection times were comparable between U-EMR and C-EMR, standardized mean difference -1.21 min (CI -2.57 to -0.16). Overall pooled rates of perforation, and immediate and delayed bleeding were comparable between U-EMR and C-EMR. Pooled rate of polyp recurrence at surveillance colonoscopy was significantly lower with U-EMR than with C-EMR, RR 0.62 (CI 0.41-0.94). Conclusions Colorectal U-EMR results in higher en-bloc resection and lower recurrence rates when compared to C-EMR. Both techniques have comparable resection times and safety profiles.

Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial.

BACKGROUND AND AIMS: Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs. METHODS: We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others. RESULTS: There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe. CONCLUSIONS: UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).

Prevalence of Mycobacterium avium Subsp. paratuberculosis in Feral Pigeons (Columba livia) Associated with Difficulties Controlling Paratuberculosis in a Bovine Herd (Fighting Bull Breed).

A bovine herd with a high prevalence of paratuberculosis (PTB) cohabiting with a population of pigeons was studied (2011−2020). After finding the disease in 2011, annual monitoring was performed in 2012−2014 by obtaining blood samples for ELISA and intradermal tuberculinization (IT) tests for Mycobacterium avium subsp. paratuberculosis (MAP). Positive animals were eliminated. PTB prevalence dropped from 10% to 0% but returned to similar values (9.5%) after 6 years without tests. In all animals, Ac values according to the optical density (OD) determined by ELISA increased each year and could be used to isolate herds close to the cutoff point to improve PTB control. Possible reservoirs were considered after evaluating the little success of the PTB control program, and the population of feral pigeons was studied. Specifically, 10% of the pigeon population (n = 13) was necropsied. Samples of intestine, feces, and foot skin for PCR study for MAP and samples of terminal intestine for histopathological analysis were taken. Eleven pigeons were PCR-positive against MAP, in the intestine (10/11), foot skin (3/11), and feces (1/11). The presence of MAP in pigeon feet could demonstrate its role as a mechanical disseminator of PTB, while the presence in pigeon intestine and feces could also suggest its role as a reservoir.

No Evidence that CD33 rs12459419 Polymorphism Predicts Gemtuzumab Ozogamicin Response in Consolidation Treatment of Acute Myeloid Leukemia Patients: Experience of the PETHEMA Group.

Gemtuzumab ozogamicin (GO) is a conjugate of a monoclonal antibody and calicheamicin, which has been reapproved for the treatment of acute myeloid leukemia (AML). AML patients with the CD33 rs12459419 CC genotype might benefit from the addition of GO to intensive treatment in contrast to patients with CT/TT genotypes. Nevertheless, contradictory results have been reported. We sought to shed light on the prediction of GO response in AML patients with rs12459419 polymorphism who were treated with GO in the consolidation (n = 70) or reinduction (n = 20) phase. The frequency distribution of the rs12459419 polymorphism in the complete cohort of patients was 44.4% (n = 40), 50% (n = 45), and 5.6% (n = 5) for CC, CT, and TT genotypes, respectively. Regarding the patients treated with GO for consolidation, we performed a Kaplan-Meier analysis of overall survival and relapse-free survival according to the rs12459419 polymorphism (CC vs. CT/TT patients) and genetic risk using the European Leukemia Net (ELN) 2010 risk score. We also carried out a Cox regression analysis for the prediction of overall survival, with age and ELN 2010 as covariates. We found no statistical significance in the univariate or multivariate analysis. Additionally, we performed a global Kaplan-Meier analysis for the patients treated with GO for reinduction and did not find significant differences; however, our cohort was too small to draw any conclusion from this analysis. The use of GO in consolidation treatment is included in the approval of the compound; however, evidence regarding its efficacy in this setting is lacking. Rs12459419 polymorphism could help in the selection of patients who might benefit from GO. Regrettably, in our cohort, the rs12459419 polymorphism does not seem to be an adequate tool for the selection of patients who might benefit from the addition of GO in consolidation cycles.

Potencial antioxidante del extracto de hojas de Spondias mombin L. en etanol al 70 % / Antioxidant potential of Spondias mombin L. leaf extract in 70% ethanol / Potencial antioxidante do extrato da folha de Spondias mombin L. em etanol 70%

RESUMEN Introducción: La especie Spondias mombin L. es una planta que crece en Cuba y a la que se le reporta un número considerables de aplicaciones etnofarmacológicas y elevado poder antioxidante. Sin embargo, la mayor parte de estos reportes está orientada al fruto, el cual resalta por su valor nutricional. Objetivo: Evaluar la actividad antioxidante de un extracto de hojas de Spondias mombin L. en etanol al 70 %. Método: La actividad antioxidante fue evaluada por seis métodos diferentes: determinación del índice de oxidación, poder reductor, inhibición de los radicales DPPH y ABTS, capacidad reductora del peróxido de hidrógeno y capacidad de neutralización del radical oxígeno. Se evaluaron concentraciones desde los 1 000 hasta los 62,5 µg/mL preparadas a partir del valor de sólidos totales determinados. Resultados: Para el índice de oxidación, concentraciones de 250 µg/mL resultaron suficientes para decolorar la solución de permanganato en igual período de tiempo que el patrón de quercetina. Sin embargo, los IC50 calculados para el poder reductor, la inhibición del radical DPPH y del ABTS resultaron mayores que el estándar de ácido ascórbico con valores de 362,33; 190,34 y 241,88 µg/mL, respectivamente. Conclusiones: El extracto de hojas de Spondias mombin L. en etanol al 70 % presenta una elevada acción antioxidante en los seis modelos experimentales ensayados, aun cuando en la mayor parte de casos, con valores inferiores al de la sustancia de referencia empleada. Estos resultados conjuntamente con la diversidad estructural de metabolitos presentes en el mismo resaltan su valor como potencial antioxidante natural.

ABSTRACT Introduction: The species Spondias mombin L. is a plant that grows in Cuba, and to which a considerable number of ethnopharmacological applications and high antioxidant power are reported. However, most of these reports are oriented to the fruit, which stands out for its nutritional value. Objective: To evaluate the antioxidant activity of an extract of Spondias mombin L. leaves in 70% ethanol. Method: The antioxidant activity was evaluated by six different methods: determination of the oxidation index, reducing power, inhibition of DPPH and ABTS radicals, hydrogen peroxide reducing capacity and oxygen radical neutralization capacity. Concentrations from 1000 to 62.5 µg/mL were evaluated, prepared from the value of total solids determined. Results: For the oxidation index, concentrations of 250 µg/mL were sufficient to decolorize the permanganate solution in the same period of time as the quercetin standard. However, the IC50 calculated for the reducing power, the inhibition of the DPPH radical and ABTS were higher than the ascorbic acid standard with values of 362.33; 190.34 and 241.88 µg/mL, respectively. Conclusions: The extract of leaves of Spondias mombin L. in 70% ethanol presents a high antioxidant action in the six experimental models tested, even though in most cases, with lower values than the reference substance used. These results, together with the structural diversity of metabolites present in it, highlight its value as a potential natural antioxidant.

RESUMO Introdução: A espécie Spondias mombin L. é uma planta que cresce em Cuba e à qual são relatados um número considerável de aplicações etnofarmacológicas e alto poder antioxidante. No entanto, a maioria desses relatos é voltada para o fruto, que se destaca pelo seu valor nutricional. Objetivo: Avaliar a atividade antioxidante de um extrato de folhas de Spondias mombin L. em etanol 70%. Método: A atividade antioxidante foi avaliada por seis diferentes métodos: determinação do índice de oxidação, poder redutor, inibição dos radicais DPPH e ABTS, capacidade redutora do peróxido de hidrogênio e capacidade de neutralização do radical oxigênio. Foram avaliadas concentrações de 1000 a 62,5 µg/mL, preparadas a partir do valor de sólidos totais determinado. Resultados: Para o índice de oxidação, concentrações de 250 µg/mL foram suficientes para descolorir a solução de permanganato no mesmo período de tempo do padrão de quercetina. No entanto, o IC50 calculado para o poder redutor, a inibição do radical DPPH e ABTS foram superiores ao padrão de ácido ascórbico com valores de 362,33; 190,34 e 241,88 µg/mL, respectivamente. Conclusões: O extrato de folhas de Spondias mombin L. em etanol 70% apresenta alta ação antioxidante nos seis modelos experimentais testados, embora na maioria dos casos com valores inferiores à substância de referência utilizada. Esses resultados, juntamente com a diversidade estrutural de metabólitos presentes nele, destacam seu valor como potencial antioxidante natural.

Location, morphology and invasiveness of lateral spreading tumors in the colorectum differ between two large cohorts from an eastern and western country.

BACKGROUND AND STUDY AIMS: Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. PATIENTS AND METHODS: Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. RESULTS: We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. CONCLUSION: This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.

Individual Tree Segmentation Method Based on Mobile Backpack LiDAR Point Clouds.

Individual tree (IT) segmentation is crucial for forest management, supporting forest inventory, biomass monitoring or tree competition analysis. Light detection and ranging (LiDAR) is a prominent technology in this context, outperforming competing technologies. Aerial laser scanning (ALS) is frequently used for forest documentation, showing good point densities at the tree-top surface. Even though under-canopy data collection is possible with multi-echo ALS, the number of points for regions near the ground in leafy forests drops drastically, and, as a result, terrestrial laser scanners (TLS) may be required to obtain reliable information about tree trunks or under-growth features. In this work, an IT extraction method for terrestrial backpack LiDAR data is presented. The method is based on DBSCAN clustering and cylinder voxelization of the volume, showing a high detection rate (∼90%) for tree locations obtained from point clouds, and low commission and submission errors (accuracy over 93%). The method includes a sensibility assessment to calculate the optimal input parameters and adapt the workflow to real-world data. This approach shows that forest management can benefit from IT segmentation, using a handheld TLS to improve data collection productivity.

When will taxonomic saturation be achieved? A case study in Nunduva and Kyrtuthrix (Rivulariaceae, Cyanobacteria).

A number of heterocytous, mat-forming, tapering cyanobacteria in Rivulariaceae have recently been observed in both the Atlantic and Pacific coasts in the rocky intertidal and supratidal zones. These belong to the genera Nunduva, Kyrtuthrix, and Phyllonema and have been the subject of several recent studies. Herein, two new species of Nunduva (N. komarkovae and N. sanagustinensis) and two new species of Kyrtuthrix (K. munecosensis and K. totonaca) are characterized and described from the coasts of Mexico. Genetic separation based on the 16S-23S ITS region was pronounced (>10% in all comparisons). Morphological differences between all existing species in these two genera were also observed, but the group is morphologically complex, and these taxa are considered pseudocryptic. Nunduva and Kyrtuthrix remain morphologically and phylogenetically separate even with the addition of new species. However, how long will this remain the case? Many new genera and species of cyanobacteria have recently been described. Will the taxonomy of cyanobacteria eventually become saturated? Will we start to see multiple populations for the same cryptic species, or will future taxonomists collapse multiple species into fewer species, or multiple genera into single genera. The description of even more Nunduva and Kyrtuthrix species causes us to pause and evaluate the future of cyanobacterial taxonomy. These same questions are faced by algal taxonomists studying other phyla, and the resolution may ultimately be similar.

Aneurisma de la vena porta. A propósito de un caso / Portal vein aneurysm. A case presentation

RESUMEN Fundamento: los aneurismas de la vena porta son entidades poco frecuentes, representan aproximadamente el 3% de los aneurismas del sistema venoso. La mayoría de los aneurismas de la vena porta se detectan en pacientes con hígado sano, aunque en algunas ocasiones la hipertensión portal podría favorecer el desarrollo de la patología. Los lugares más comunes son la confluencia venosa esplenomesentérica, la vena porta principal y las ramas de la vena porta intrahepática en los sitios de bifurcación. Objetivo: presentar el caso de un paciente portador de una aneurisma de la vena porta. Presentación del Caso: Paciente femenina, blanca de 49 años de edad con antecedentes de trastornos dispépticos, y en ocasiones, dolor a nivel del hipocondrio derecho. Su examen físico era negativo y la impresión diagnóstica de su médico de asistencia era litiasis vesicular. Durante la realización del examen ultrasonográfico se encuentra como dato positivo una dilatación de tipo aneurismático de la vena porta en el inicio de su trayecto intrahepático de 18 mm de diámetro, y el resto del examen resultó negativo. Conclusiones: Por lo inusual de este caso se decide hacer su presentación.

ABSTRACT: portal vein aneurysms are uncommon, representing approximately the 3% of venous system aneurysms. Most portal vein aneurysms are detected in patients with healthy liver, although on some occasions portal hypertension could favor their development. The most common sites are the splenomesenteric venous confluence, the main portal vein and the branches of the intrahepatic portal vein at bifurcation sites. Objective: to present the case of a patient with a portal vein aneurysm. Case Presentation: A 49-years-old white female patient with a history of dyspeptic disorders, and sometimes pain in the right upper quadrant. Her physical examination was negative and the diagnostic impression from her attending physician was gallstones. During the ultrasound examination, an aneurysmal dilatation of the portal vein at the beginning of its intrahepatic path of 18 mm in diameter was found as a positive finding, being the rest of the examination negative Conclusions: Due to the unusual nature of this case, it was decided to present it.

Impact of Mediterranean Diet prior to Stroke on the Prognosis of Patients Undergoing Endovascular Treatment.

INTRODUCTION: Mediterranean diet (MeDiet) has been associated with lower risk of stroke. Additionally, animal models suggested that some components of MeDiet are associated with better outcomes after ischemic stroke (IS). We aimed to evaluate the association between global adherence to the MeDiet and the consumption of particular components of the MeDiet with stroke outcomes. MATERIAL AND METHODS: Multicenter observational study of consecutive IS patients treated with endovascular therapy. Inclusion criteria were large anterior circulation vessel occlusion and pre-stroke modified Rankin scale (mRS) <2. Adherence to MeDiet prior to stroke was evaluated using MEDAS 14-item scale. We evaluated the total score and also individual components of the scale. Clinical, radiological, and prognostic variables were collected. Good functional prognosis was considered as mRS ≤2 and complete recanalization as thrombolysis in cerebral infarction 3. RESULTS: From January 1 to October 30, 2018, 239 patients were included (mean age 71 years, 48% women, median baseline NIHSS 16). Median MEDAS scale was 8 points (7-10). Patients with a higher adherence to MeDiet had significantly lower total and LDL-cholesterol levels. Total adherence score was not associated with stroke outcomes. In multivariate analyses, consumption of olive oil as the principal source of fat was independently associated with good functional outcome at 3 months, OR 3.2 (1.1-10.1) and daily consumption of wine was independently associated with complete recanalization, OR 2.0 (1.1-3.8). CONCLUSIONS: Our study suggests that some components of MeDiet, such as olive oil and wine consumption, are related to better prognosis after stroke. More studies are needed to confirm these findings.

Impact of measurable residual disease by decentralized flow cytometry: a PETHEMA real-world study in 1076 patients with acute myeloid leukemia.

The role of decentralized assessment of measurable residual disease (MRD) for risk stratification in acute myeloid leukemia (AML) remains largely unknown, and so it does which methodological aspects are critical to empower the evaluation of MRD with prognostic significance, particularly if using multiparameter flow cytometry (MFC). We analyzed 1076 AML patients in first remission after induction chemotherapy, in whom MRD was evaluated by MFC in local laboratories of 60 Hospitals participating in the PETHEMA registry. We also conducted a survey on technical aspects of MRD testing to determine the impact of methodological heterogeneity in the prognostic value of MFC. Our results confirmed the recommended cutoff of 0.1% to discriminate patients with significantly different cumulative-incidence of relapse (-CIR- HR:0.71, P < 0.001) and overall survival (HR: 0.73, P = 0.001), but uncovered the limited prognostic value of MFC based MRD in multivariate and recursive partitioning models including other clinical, genetic and treatment related factors. Virtually all aspects related with methodological, interpretation, and reporting of MFC based MRD testing impacted in its ability to discriminate patients with different CIR. Thus, this study demonstrated that "real-world" assessment of MRD using MFC is prognostic in patients at first remission, and urges greater standardization for improved risk-stratification toward clinical decisions in AML.

Indoor Path-Planning Algorithm for UAV-Based Contact Inspection.

Nowadays, unmanned aerial vehicles (UAVs) are extensively used for multiple purposes, such as infrastructure inspections or surveillance. This paper presents a real-time path planning algorithm in indoor environments designed to perform contact inspection tasks using UAVs. The only input used by this algorithm is the point cloud of the building where the UAV is going to navigate. The algorithm is divided into two main parts. The first one is the pre-processing algorithm that processes the point cloud, segmenting it into rooms and discretizing each room. The second part is the path planning algorithm that has to be executed in real time. In this way, all the computational load is in the first step, which is pre-processed, making the path calculation algorithm faster. The method has been tested in different buildings, measuring the execution time for different paths calculations. As can be seen in the results section, the developed algorithm is able to calculate a new path in 8-9 milliseconds. The developed algorithm fulfils the execution time restrictions, and it has proven to be reliable for route calculation.

Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations.

BACKGROUND AND AIMS: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. METHODS: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. RESULTS: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). CONCLUSIONS: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.

Clinical and pathological characteristics of peripheral T-cell lymphomas in a Spanish population: a retrospective study.

We investigated the clinicopathological features and prognostic factors of patients with peripheral T-cell lymphoma (PTCL) in 13 sites across Spain. Relevant clinical antecedents, CD30 expression and staining pattern, prognostic indices using the International Prognostic Index and the Intergruppo Italiano Linfomi system, treatments, and clinical outcomes were examined. A sizeable proportion of 175 patients had a history of immune-related disorders (autoimmune 16%, viral infections 17%, chemo/radiotherapy-treated carcinomas 19%). The median progression-free survival (PFS) and overall survival (OS) were 7·9 and 15·8 months, respectively. Prognostic indices influenced PFS and OS, with a higher number of adverse factors resulting in shorter survival (P < 0·001). Complete response (CR) to treatment was associated with better PFS (62·6 vs. 4 months; P < 0·001) and longer OS (67·0 vs. 7·3 months; P < 0·001) compared to no CR. CD30 was expressed across all subtypes; >15% of cells were positive in anaplastic lymphoma kinase-positive and -negative anaplastic large-cell lymphoma and extranodal natural killer PTCL groups. We observed PTCL distribution across subtypes based on haematopathological re-evaluation. Poor prognosis, effect of specific prognostic indices, relevance of histopathological sub-classification, and response level to first-line treatment on outcomes were confirmed. Immune disorders amongst patients require further examination involving genetic studies and identification of associated immunosuppressive factors.

The Answer to "When to Clip" After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis.

INTRODUCTION: Delayed bleeding (DB) is the most common major complication of endoscopic mucosal resection (EMR). Two randomized clinical trials recently demonstrated that clip closure after EMR of large nonpedunculated colorectal polyps (LNPCPs) reduces the risk of DB. We analyzed the cost-effectiveness of this prophylactic measure. METHODS: EMRs of LNCPCPs were consecutively registered in the ongoing prospective multicenter database of the Spanish EMR Group from May 2013 until July 2017. Patients were classified according to the Spanish Endoscopy Society EMR group (GSEED-RE2) DB risk score. Cost-effectiveness analysis was performed for both Spanish and US economic contexts. The average incremental cost-effectiveness ratio (ICER) thresholds were set at 54,000 € or $100,000 per quality-adjusted life year, respectively. RESULTS: We registered 2,263 EMRs in 2,130 patients. Applying their respective DB relative risk reductions after clip closure (51% and 59%), the DB rate decreased from 4.5% to 2.2% in the total cohort and from 13.7% to 5.7% in the high risk of the DB GSEED-RE2 subgroup. The ICERs for the universal clipping strategy in Spain and the United States, 469,706 € and $1,258,641, respectively, were not cost effective. By contrast, selective clipping in the high-risk of DB GSEED-RE2 subgroup was cost saving, with a negative ICER of -2,194 € in the Spanish context and cost effective with an ICER of $87,796 in the United States. DISCUSSION: Clip closure after EMR of large colorectal lesions is cost effective in patients with a high risk of bleeding. The GSEED-RE2 DB risk score may be a useful tool to identify that high-risk population.

Helpful Criteria When Implementing NGS Panels in Childhood Lymphoblastic Leukemia.

The development of Next-Generation Sequencing (NGS) has provided useful diagnostic, prognostic, and therapeutic strategies for individualized management of B-cell precursor acute lymphoblastic leukemia (BCP-ALL) patients. Consequently, NGS is rapidly being established in clinical practice. However, the technology's complexity, bioinformatics analysis, and the different available options difficult a broad consensus between different laboratories in its daily routine introduction. This collaborative study among Spanish centers was aimed to assess the feasibility, pros, and cons of our customized panel and other commercial alternatives of NGS-targeted approaches. The custom panel was tested in three different sequencing centers. We used the same samples to assess other commercial panels (OncomineTM Childhood Cancer Research Assay; Archer®FusionPlex® ALL, and Human Comprehensive Cancer Panel GeneRead Panel v2®). Overall, the panels showed a good performance in different centers and platforms, but each NGS approach presented some issues, as well as pros and cons. Moreover, a previous consensus on the analysis and reporting following international guidelines would be preferable to improve the concordance in results among centers. Our study shows the challenges posed by NGS methodology and the need to consider several aspects of the chosen NGS-targeted approach and reach a consensus before implementing it in daily practice.

Enfermedad de Crohn perianal fistulizante / Fistulizing perianal Crohns disease

RESUMEN Fundamento: la enfermedad de Crohn se caracteriza por inflamación granulomatosa segmentaria del tracto intestinal y suele afectar los tejidos cutáneos. Su desarrollo incluye la compleja interacción entre la predisposición genética, la exposición al medio ambiente, la disfunción de la barrera epitelial y la respuesta inmunitaria anormal a bacterias patógenas y comensales. Las lesiones específicas de la enfermedad son manifestaciones extraintestinales, las más comunes: aftas orales y las fístulas perianales. Objetivo: exponer un caso con enfermedad de Crohn perianal fistulizante. Presentación del caso: paciente de 42 años masculino, blanco con antecedentes de haber sido atendido desde el año 2006 por estomatitis aftosa recurrente. Llega al Hospital Universitario Manuel Ascunce Domenech por primera vez en el 2013, donde fue valorado y seguido por el servicio de Coloproctología. Conclusiones: se realizó colonoscopia evolutiva y toma de biopsia, se sospechó por el cuadro en la enfermedad de Crohn con localización perianal.

ABSTRACT Background: Crohn's disease is characterized by segmental granulomatous inflammation of the intestinal tract and usually affects the cutaneous tissues. Its development includes the complex interaction between genetic predisposition, exposure to the environment, dysfunction of the epithelial barrier and the abnormal immune response to pathogenic and commensal bacteria. The specific lesions of the disease are extra-intestinal manifestations, the most common: oral aphthae and perianal fistulas. Objective: to report a case with fistulizing perianal Crohn's disease. Case report: 42-year-old male patient, white; with a history of having been treated since 2006 for recurrent aphthous stomatitis. He arrives at the Manuel Ascunce Domenech University Hospital for the first time in 2013, where he was evaluated and followed by the Coloproctology service. Conclusions: an evolutionary colonoscopy and biopsy was performed, it was suspected by the symptoms in Crohn's disease with perianal localization.