HMGA1 regulates trabectedin sensitivity in advanced soft-tissue sarcoma (STS): A Spanish Group for Research on Sarcomas (GEIS) study.

HMGA1 is a structural epigenetic chromatin factor that has been associated with tumor progression and drug resistance. Here, we reported the prognostic/predictive value of HMGA1 for trabectedin in advanced soft-tissue sarcoma (STS) and the effect of inhibiting HMGA1 or the mTOR downstream pathway in trabectedin activity. The prognostic/predictive value of HMGA1 expression was assessed in a cohort of 301 STS patients at mRNA (n = 133) and protein level (n = 272), by HTG EdgeSeq transcriptomics and immunohistochemistry, respectively. The effect of HMGA1 silencing on trabectedin activity and gene expression profiling was measured in leiomyosarcoma cells. The effect of combining mTOR inhibitors with trabectedin was assessed on cell viability in vitro studies, whereas in vivo studies tested the activity of this combination. HMGA1 mRNA and protein expression were significantly associated with worse progression-free survival of trabectedin and worse overall survival in STS. HMGA1 silencing sensitized leiomyosarcoma cells for trabectedin treatment, reducing the spheroid area and increasing cell death. The downregulation of HGMA1 significantly decreased the enrichment of some specific gene sets, including the PI3K/AKT/mTOR pathway. The inhibition of mTOR, sensitized leiomyosarcoma cultures for trabectedin treatment, increasing cell death. In in vivo studies, the combination of rapamycin with trabectedin downregulated HMGA1 expression and stabilized tumor growth of 3-methylcholantrene-induced sarcoma-like models. HMGA1 is an adverse prognostic factor for trabectedin treatment in advanced STS. HMGA1 silencing increases trabectedin efficacy, in part by modulating the mTOR signaling pathway. Trabectedin plus mTOR inhibitors are active in preclinical models of sarcoma, downregulating HMGA1 expression levels and stabilizing tumor growth.

Analysis and Prediction of Vehicle Kilometers Traveled: A Case Study in Spain.

Knowledge of the kilometers traveled by vehicles is essential in transport and road safety studies as an indicator of exposure and mobility. Its application in the determination of user risk indices in a disaggregated manner is of great interest to the scientific community and the authorities in charge of ensuring road safety on highways. This study used a sample of the data recorded during passenger vehicle inspections at Vehicle Technical Inspection stations and housed in a data warehouse managed by the General Directorate for Traffic of Spain. This study has three notable characteristics: (1) a novel data source is explored, (2) the methodology developed applies to other types of vehicles, with the level of disaggregation the data allows, and (3) pattern extraction and the estimate of mobility contribute to the continuous and necessary improvement of road safety indicators and are aligned with goal 3 (Good Health and Well-Being: Target 3.6) of The United Nations Sustainable Development Goals of the 2030 Agenda. An Operational Data Warehouse was created from the sample received, which helped in obtaining inference values for the kilometers traveled by Spanish fleet vehicles with a level of disaggregation that, to the knowledge of the authors, was unreachable with advanced statistical models. Three machine learning methods, CART, random forest, and gradient boosting, were optimized and compared based on the performance metrics of the models. The three methods identified the age, engine size, and tare weight of passenger vehicles as the factors with greatest influence on their travel patterns.

A DNA damage repair gene-associated signature predicts responses of patients with advanced soft-tissue sarcoma to treatment with trabectedin.

Predictive biomarkers of trabectedin represent an unmet need in advanced soft-tissue sarcomas (STS). DNA damage repair (DDR) genes, involved in homologous recombination or nucleotide excision repair, had been previously described as biomarkers of trabectedin resistance or sensitivity, respectively. The majority of these studies only focused on specific factors (ERCC1, ERCC5, and BRCA1) and did not evaluate several other DDR-related genes that could have a relevant role for trabectedin efficacy. In this retrospective translational study, 118 genes involved in DDR were evaluated to determine, by transcriptomics, a predictive gene signature of trabectedin efficacy. A six-gene predictive signature of trabectedin efficacy was built in a series of 139 tumor samples from patients with advanced STS. Patients in the high-risk gene signature group showed a significantly worse progression-free survival compared with patients in the low-risk group (2.1 vs 6.0 months, respectively). Differential gene expression analysis defined new potential predictive biomarkers of trabectedin sensitivity (PARP3 and CCNH) or resistance (DNAJB11 and PARP1). Our study identified a new gene signature that significantly predicts patients with higher probability to respond to treatment with trabectedin. Targeting some genes of this signature emerges as a potential strategy to enhance trabectedin efficacy.

Road Safety Perception Questionnaire (RSPQ) in Latin America: A Development and Validation Study.

Background: Although public bodies need to know drivers' perception of road safety, in Latin America there are no valid and reliable instruments that propose an integral dimensionality. The objective of this study was to design and validate a Road Safety Perception Questionnaire (RSPQ). Methodology: The design included a review of the available evidence and expert knowledge to select the dimensional items for the instrument. A pilot test was carried out to determine possible corrections and adjustments to the questionnaire, after which a Confirmatory Factor Analysis was performed on a stratified sample of 736 Ecuadorian drivers to determine its reliability and construct validity. Results: The results suggest that the RSPQ has a clear factorial structure with high factorial weight items and good internal consistency. The results of the 41-item model grouped into six dimensions (human, vehicle, road infrastructure, regulatory framework and intervention measures, socioeconomic and driving precautions) obtained the best adjustment indexes at the absolute, incremental and parsimonious levels. Conclusions: The preliminary RSPQ evidence can be considered a valid and reliable instrument to assess drivers' perception of road safety.

Driver Liability Assessment in Vehicle Collisions in Spain.

An accurate estimation of exposure is essential for road collision rate estimation, which is key when evaluating the impact of road safety measures. The quasi-induced exposure method was developed to estimate relative exposure for different driver groups based on its main hypothesis: the not-at-fault drivers involved in two-vehicle collisions are taken as a random sample of driver populations. Liability assignment is thus crucial in this method to identify not-at-fault drivers, but often no liability labels are given in collision records, so unsupervised analysis tools are required. To date, most researchers consider only driver and speed offences in liability assignment, but an open question is if more information could be added. To this end, in this paper, the visual clustering technique of self-organizing maps (SOM) has been applied to better understand the multivariate structure in the data, to find out the most important variables for driver liability, analyzing their influence, and to identify relevant liability patterns. The results show that alcohol/drug use could be influential on liability and further analysis is required for disability and sudden illness. More information has been used, given that a larger proportion of the data was considered. SOM thus appears as a promising tool for liability assessment.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Technical considerations and the learning curve.

Over the past decade, there has been a considerable increase in the utilization of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of patients with peritoneal metastases. This is due to improved safety and favorable oncologic outcomes, including curative potential. CRS/HIPEC has a steep learning curve and requires familiarity with peritonectomy procedures. This review will outline the technical aspects and learning curve of CRS/HIPEC.

Análisis de la cultura de seguridad del paciente en unidades extra-hospitalarias de hemodiálisis. Evolución tras la implantación de medidas / Analysis of the safety culture of the patient in out-of-hospital hemodialysis units. Evolution after the implementation of measures

INTRODUCCIÓN: El fomento de la cultura de seguridad del paciente es recomendado para una atención más segura. OBJETIVOS:· Conocer la frecuencia de percepciones y actitudes de los profesionales de los centros de hemodiálisis en relación con la seguridad del paciente.·Identificar puntos fuertes y oportunidades de mejora en el ámbito de la seguridad del paciente.·Comparar los resultados obtenidos, tras la implantación de medidas, con los del estudio de 2014. Material y MÉTODO: Estudio cuantitativo, descriptivo, transversal y comparativo, para medir la cultura de seguridad del paciente en seis centros periféricos de hemodiálisis mediante un cuestionario anónimo autoapli-ado (Cuestionario sobre la seguridad de los pacientes, versión española del Hospital Survey on Patient Safe-ty) en agosto-2014 y marzo-2017. En ese trascurso de tiempo se puso en marcha un sistema de notificación de eventos dversos y se realizó formación en seguridad del paciente. RESULTADOS: La media de la valoración del grado de seguridad percibido por todos los profesionales, fue de 8.02 (±1.42). Se ha incrementado notablemente el grado de notificación manifestada por los profesionales (62.5%). Se identificaron como fortalezas: el trabajo en equipo (86.2%), el feed back sobre errores (75.5%) y las expectativas en la dirección/supervisión (75.1%). Siete de las doce dimensiones presentaron mejoría significativa con respecto a los resultados del 2014. CONCLUSIONES: Podría atribuirse el incremento significativo de los porcentajes de respuesta positiva a la formación realizada en los centros y a la implantación del sistema de notificación y los informes publicados

INTRODUCTION: Developing patient safety culture is recommended for safer care. OBJECTIVES: • Knowing the frequency of staff perceptions and attitudes of health-care workers in hemodialysis centers concerning patient safety.• Identifying strengths and improvement areas in relation to patient safety.• Contrasting the results obtained, after the implementation of measures, with those of the 2014 study. Material and METHOD: A quantitative, descriptive, cross sectional and comparative study to evaluate patient safety culture in six hemodialysis centers through an anonymous self-administered questionnaire (Patient Safety Questionnaire, Spanish version of the Hospital Survey on Patient Safety) in August 2014 and March 2017. An adverse event notification system was implemented during this period, as well as a patient safety training. RESULTS: The average rating of staff security perception was 8.02 (± 1.42). The notification expressed by professionals has increased significantly (62.5%). Teamwork (86.2%), error feedback (75.5%) and management/supervision expectations (75.1%) were identified as strengths. Seven out of the twelve dimensions studied showed a significant improvement in relation to the 2014 results. CONCLUSIONS: A significant increase in positive response ratio could be attributed to the training programs carried out in the centers and to the implementation of the notification system, as well as to the reports already published

Melanoma maligno primario atípico de esófago y su manejo quirúrgico: a propósito de un caso clínico / Atypical primary malignant melanoma of esophagus and the surgical management: Case report

Resumen Introducción El melanoma maligno primario de esófago es un tumor raro y muy agresivo. De manejo controversial, el tratamiento quirúrgico es el que predomina en enfermedad localizada. Caso clínico Presentamos el caso de una mujer joven con melanoma maligno primario de esófago de presentación atípica y su manejo quirúrgico utilizando la técnica de Akiyama.

Introduction The Primary Malignant Melanoma of Esophagus is an uncommon and very agressive tumor. With controversial management, it predominates the surgical treatment in localized disease. Clinical case We present the case of a young women with Primary Malignant Melanoma of Esophagus with atypical presentation and its surgical management using the Akiyama technique.

Valoración enfermera del estado emocional del paciente en hemodiálisis mediante la herramienta para la detección del estado emocional de pacientes en diálisis (EE-D) / Nurse evaluation of the patient’s emotional state on hemodialysis using the tool for the detection of the emotional state of patients on dialysis (EE-D)

Introducción: Las alteraciones psicológicas y emocionales influyen en el estado bio-psico-social del paciente en hemodiálisis. Un mejor conocimiento de estos aspectos nos ayuda a la comprensión y al manejo de las situaciones difíciles en su día a día. Objetivos: Con este estudio se describe el estado emocional de los pacientes en hemodiálisis por medio del cuestionario EE-D, aplicado por profesionales de enfermería y analizaremos si existe relación entre éste y otras variables individuales. Metodología: Se realizó un estudio descriptivo de corte trasversal, a 84 pacientes en hemodiálisis. Se utilizó el cuestionario EE-D, donde se valora la tristeza y el nerviosismo percibido por el paciente en la última semana, sus preocupaciones en diferentes ámbitos y que motivaciones encuentra para sentirse mejor o ilusionarse. Se recopilaron en un cuestionario ad hoc, datos demográficos, laborales, de adhesión al tratamiento farmacológico, etc. Resultados: En el parámetro tristeza obtuvimos una media de 3.8 (0 nada y 10 máxima), la moda fue 0 y un 73.8% obtuvo un nivel igual o inferior a 5. En cuanto al nerviosismo, la media fue 3, la moda 0 y el 79.8% manifestaron un nivel igual o inferior a 5. En cuanto a las preocupaciones casi la mitad de los pacientes refirió tener preocupaciones relacionadas con el ámbito familiar y con su enfermedad o tratamiento, seguido por el ámbito emocional, laboral y religioso respectivamente. Conclusiones: Nuestros pacientes presentan niveles bajos de tristeza, medios en cuanto a sus preocupaciones relacionadas con su enfermedad, mostrando en su mayoría facilidad para ilusionarse al encontrar motivaciones para ello (AU)

Introduction: Psychological and emotional alterations influence the bio-psycho-social state of the patient on hemodialysis. A better understanding of these aspects helps to understand and manage difficult daily situations. Objectives: This study describes the emotional state of patients on hemodialysis using the EE-D questionnaire, applied by nursing professionals and we will analyze if there is a relationship between this and other individual variables. Methodology: A cross-sectional descriptive study was carried out in 84 patients on hemodialysis. The EE-D questionnaire was used, which evaluates the sadness and nervousness perceived by the patient in the last week, their concerns in different areas and what motivations they find to feel better or to be excited. Demographic, labor, adherence to pharmacological data, etc. were collected in an ad hoc questionnaire. Results: In the sadness parameter, we obtained a mean of 3.8 (0 nothing and 10 maximum), the mode was 0 and 73.8% obtained a level equal to or less than 5. Regarding the concerns, almost half of the patients reported having concerns related to the family environment and their illness or treatment, followed by the emotional, occupational and religious environment, respectively. Conclusions: Our patients present low levels of sadness and middle ones in the concerns related to their illness, showing in the majority, facilities to be excited, when finding motivations for it (AU)

Methodological development for selection of significant predictors explaining fatal road accidents.

Identification of the most relevant factors for explaining road accident occurrence is an important issue in road safety research, particularly for future decision-making processes in transport policy. However model selection for this particular purpose is still an ongoing research. In this paper we propose a methodological development for model selection which addresses both explanatory variable and adequate model selection issues. A variable selection procedure, TIM (two-input model) method is carried out by combining neural network design and statistical approaches. The error structure of the fitted model is assumed to follow an autoregressive process. All models are estimated using Markov Chain Monte Carlo method where the model parameters are assigned non-informative prior distributions. The final model is built using the results of the variable selection. For the application of the proposed methodology the number of fatal accidents in Spain during 2000-2011 was used. This indicator has experienced the maximum reduction internationally during the indicated years thus making it an interesting time series from a road safety policy perspective. Hence the identification of the variables that have affected this reduction is of particular interest for future decision making. The results of the variable selection process show that the selected variables are main subjects of road safety policy measures.