Microwave-sustained inductively coupled atmospheric-pressure plasma (MICAP) for the elemental analysis of complex matrix samples.

Microwave induced plasma optical emission spectrometry (MIP-OES) has gained widespread attention in the last few years for trace elemental analysis. Among the new generation of MIPs it is worth to mention the microwave-sustained inductively coupled atmospheric-pressure plasma (MICAP) for which previous works have shown similar detection capabilities to those afforded by ICP-OES. Nevertheless, this instrument has not been applied yet to complex matrix sample analysis. Therefore, the goal of this work is to evaluate MICAP-OES performance (e.g., analytical figures of merit, matrix effects, etc.) for elemental analysis of samples of different nature (e.g., environmental, food and polymers). To this end, both spectral and non-spectral interferences were investigated for 19 elements (Ag, Al, As, B, Ca, Cd, Co, Cr, Cu, Fe, Ga, In, Mg, Mn, Ni, Pb, Sr, Tl, Zn) in the presence of inorganic acid, organic and saline solutions and compared to a 5 % w w-1 HNO3 solution. Unlike previous MIPs, experimental data showed that the optimum nebulizer gas flow rate for a given emission wavelength was mostly independent of matrix characteristics. Regarding matrix effects, this device was highly robust operating both inorganic acid and organic matrices. Interestingly, when operating saline matrices, changes on emission signal by easily ionizable elements were less significant than those early reported by alternative MIP cavities. Moreover, due to MICAP spectrometer design employed allows real-time simultaneous analysis, Rh, Pd, Sc and Y were suitable internal standards to minimize non-spectral interferences. Finally, MICAP-OES can be successfully applied to the elemental analysis of different complex matrix samples (i.e., CRM-DW1 Drinking water; BCR-146 Sewage sludge industrial; BCR-185 Bovine liver; BCR-278R Mussel tissue; NIST-1549 Non-fat milk powder; ERM-EC681k Polyethylene (high level) and BCR-483 Sewage sludge amended soil).

Longitudinal study of patients with discrepant results in CLIFT and a solid-phase dsDNA antibody assay: does a gold standard dsDNA assay exist?

OBJECTIVE: Antidouble-stranded DNA (dsDNA) antibodies are essential for diagnosis and follow-up of systemic lupus erythematous (SLE). To ensure the best diagnostic approach, most healthcare laboratories opt for a combination of highly sensitive methods, such as solid-phase immunoassays, and highly specific methods, such as the Crithidia luciliae indirect immunofluorescence test (CLIFT). Even so, discordant results are common, thus hindering the diagnostic process. Therefore, this study aimed to characterise a cohort of patients with discrepant results for a dsDNA fluorescence enzyme immunoassay (FEIA) and CLIFT during 2016-2018 and to follow patients up until December 2021. METHODS: We performed an observational, longitudinal and retrospective study on 417 samples from 257 patients who had been referred for suspected connective tissue diseases or followed up after diagnosis. All of them were positive for antinuclear antibodies (ANAs) using an indirect immunofluorescence assay (IFA) on Hep-2 cells, the entry criterion in our laboratory, and positive for FEIA dsDNA. Samples were then tested with CLIFT according to our routine protocol, which includes CLIFT testing after FEIA dsDNA results ≥10 UI/ml. After the assessment of data quality, the final analysis was based on 222 patients. RESULTS: Eighty-three patients (37.4%) had positive results in both tests and met the diagnostic criteria for SLE. However, 139 patients (62.6%) had discrepant results (FEIA+, CLIFT-). Of these, 58 patients (41.7%) had a diagnosis of SLE, with 47 (33.8%) having been previously diagnosed and under treatment. The remaining 11 patients (7.9%) had a new diagnosis of SLE, which was made up within 4 years of the initial screening. A total of 81 of the 139 patients (57.5%) with discrepant results did not meet lupus criteria during the follow-up period. CONCLUSIONS: The study showed that CLIFT could be negative in both treated and newly diagnosed SLE, thus underlining the importance of follow-up of dsDNA-positive results using solid-phase tests. Therefore, quantitative tests such as FEIA could add value to the diagnosis and management of patients with suspected SLE.

Recruiting Socially Disconnected Latinos Caring for a Person with Alzheimer's Disease and Related Dementias During the COVID-19 Pandemic: Lessons Learned.

OBJECTIVES: The purpose of this article is to present conceptual and methodological challenges to recruitment strategies in enrolling socially disconnected middle-aged and older Latino caregivers of a loved one with Alzheimer's disease and related dementias (ADRD). METHODS: Middle-aged and older Latino ADRD caregivers were recruited into two early stage, intervention development studies during the COVID-19 pandemic via online or in-person methods. Recruitment criteria included Latino ADRD caregivers over the age of 40 reporting elevated loneliness on the UCLA 3-item Loneliness Scale (LS) during screening. RESULTS: Middle-aged, Latino caregivers were recruited predominantly from online methods whereas older caregivers were mostly recruited from in-person methods. We report challenges identifying socially disconnected Latino caregivers using the UCLA 3-item LS. CONCLUSIONS: Our findings support previously reported disparities in recruitment by age and language and suggest further methodological considerations to assess social disconnection among Latino caregivers. We discuss recommendations to overcome these challenges in future research. CLINICAL IMPLICATIONS: Socially disconnected Latino ADRD caregivers have an elevated risk for poor mental health outcomes. Successful recruitment of this population in clinical research will ensure the development of targeted and culturally sensitive interventions to improve the mental health and overall well-being of this marginalized group.

Ultrasensitive determination of ß-conglutin food allergen by means an aptamer assay based on inductively coupled plasma mass spectrometry detection.

The overall objective of this work is the evaluation of different competitive aptamer assays based on inductively coupled plasma mass spectrometry (ICP-MS) detection for the determination of ß-conglutin (food protein allergen from lupin) in flour samples. To this end, two competitive aptamer assay schemes were developed using either thiolated aptamers chemisorbed onto gold nanoparticles (AuNPs) or biotinylated aptamers linked to streptavidin-AuNPs. The influence of ICP-MS detection mode (i.e., conventional vs single particle) on assay performance was explored. In the case of the thiolated aptamer, the limit of detection (LoD) obtained using the single particle mode was improved 2-fold as compared to the LoD provided by the conventional mode. With regards to the biotinylated aptamer, the use of the conventional mode provided a 5-fold improvement of LoD as compared to that obtained for the single particle one. Using the optimized conditions, the best LoD of 2 pM was obtained with the biotinylated aptamer operating with conventional ICP-MS detection. When compared to previous reports using the same aptamer in a competitive assay, the developed method significantly improved the LoD by at least an order of magnitude. Different flour samples containing lupin were successfully analyzed according to European Conformity guidelines for the analysis of food contaminants.

Determination of elemental bioavailability in soils and sediments by microwave induced plasma optical emission spectrometry (MIP-OES): Matrix effects and calibration strategies.

In the past few years, microwave induced plasma optical emission spectrometry (MIP-OES) has generated great interest as an alternative technique to inductively coupled plasma-based techniques due to its lower operational cost. Since MIP-OES suffers from severe matrix effects due to easily ionizable elements (EIEs) (Na, Ca, etc.), it is unclear whether this technique could be employed for elemental bioavailability studies in soils and sediments since the main extractant solutions employed in such works may contain high levels of these elements. Thus, the aim of this work was to evaluate the feasibility of MIP-OES as a detector for such applications. To this end, the influence of different extractant solutions (0.25 mol L-1 MgCl2, 0.25 mol L-1 CaCl2, 0.10 mol L-1 acetic acid, 0.05 mol L-1 Na2EDTA, 0.25 mol L-1 NaNO3, 0.25 mol L-1 NaOAc/HOAc and 0.10 mol L-1 NH2OH·HCl) on the analyte emission of several elements (As, Cd, Co, Cr, Cu, Fe, Mg, Mn, Mo, Ni, Pb, Rh, Se, Sr and Zn) was investigated. Results were compared to those obtained using a reference solution made of 5% w w-1 HNO3 solution. For saline extractant solutions, both the optimum nebulizer gas flow rate (Qg) and analyte emission were modified with regard to the reference solution. In general, the optimum Qg was reduced by between 0.1 and 0.2 L min-1 for both ionic and atomic lines. Under optimum Qg conditions, analyte emission was supressed by saline solutions except for atomic lines with an upper electronic state below 4 eV, which were enhanced. The magnitude of matrix effects was strongly dependent on EIE ionization energy. The lower the ionization energy, the greater the matrix effects were registered. No measurable matrix effects were registered on both Qg and analyte emission within experimental uncertainties for NH2OH·HCl and acetic acid extractant solutions. Experimental data suggest that matrix effects were related to changes in plasma characteristics and the analyte excitation/ionization mechanism. To mitigate matrix effects and improve long-term MIP-OES performance, internal standardization using either Rh (343.489 nm and 369.236 nm) or OH molecular emission band (308.958 nm) was required. This calibration methodology was successfully applied to the study of the elemental bioavailability in soil samples from a vineyard affected by copper-based fungicides and sediment samples from an area affected by mining waste.

External validity of clinical trials with diverse trastuzumab-based chemotherapy regimens in advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry.

BACKGROUND: Trastuzumab combined with cisplatin and fluoropyrimidines, either capecitabine or 5-fluorouracile (XP/FP), is the standard first-line treatment for advanced, HER2-positive, gastric cancer patients based on the ToGA trial. Despite the lack of phase III trials, many clinicians administer trastuzumab with alternative regimens. One meta-analysis suggests that substituting cisplatin for oxaliplatin might lead to greater efficacy and less toxicity. METHODS: 594 patients with HER2-positive gastroesophageal adenocarcinoma were recruited from the AGAMENON-SEOM registry. The objective was to evaluate the external validity of clinical trials with chemotherapy and trastuzumab. RESULTS: The regimens used in at least 5% of the patients were XP (27%), oxaliplatin and capecitabine (CAPOX) (26%), oxaliplatin and 5-fluorouracil (FOLFOX) (14%), FP (14%), triplet with anthracycline/docetaxel (7%), and carboplatin-FU (5%). Median exposure to trastuzumab was longer with FOLFOX (11.4 months, 95% CI, 9.1-21.0) versus ToGA regimens (7.5, 6.4-8.5), p < 0.001. Patients with HER2-IHC 3+ cancers had higher response rates than those with IHC 2+/FISH+, odds-ratio 1.97 (95% CI, 1.25-3.09). The results achieved with CAPOX-trastuzumab were comparable to those attained with ToGA regimens. FOLFOX-trastuzumab was superior to ToGA schemes in terms of overall survival (OS), with a greater magnitude of effect in IHC 2+/FISH+ tumors (HR 0.47, 0.24-0.92) compared with IHC 3+ (HR 0.69, 0.49-0.96), and in diffuse (HR 0.37, 0.20-0.69) versus intestinal-type tumors (HR 0.76, 0.54-1.06). CONCLUSION: We have updated the external validity of clinical trials with trastuzumab in first-line treatment of gastric cancer. Our data confirm the comparable outcomes of ToGA regimens and CAPOX-trastuzumab in clinical practice and point toward a possible benefit of FOLFOX-trastuzumab, contingent on the subtypes typically less sensitive to trastuzumab, to be confirmed in clinical trials.

Intervención integral en el ictus / Comprehensive intervention in stroke

Introducción: se mantiene el debate sobre qué tipos de intervenciones para la recuperación del ictus ofrecen mejores resultados para el paciente. Objetivo: evaluar el efecto de una intervención integral durante seis meses sobre la recuperación funcional en pacientes con ictus. Métodos: la muestra estuvo compuesta por 42 participantes con ictus: un grupo experimental (N = 22) con una media de edad de 52,68 años (DE = 14,39) que recibió una intervención integral, intensiva y multidisciplinar, y un grupo control (N = 20) con una media de edad de 56,20 años (DE = 14,82) que no recibió este tipo de intervención. Se valoraron los siguiente índices de severidad del ictus: Escala de Coma de Glasgow, Escala Canadiense, estancia en Unidad de Cuidados Intensivos, signos de enclavamiento uncal, signos de hipertensión endocraneal, volumen del hematoma/área isquémica, desplazamiento de línea media, necesidad de cirugía y tiempo total de hospitalización. Ambos grupos eran equivalentes en estos índices de gravedad. El grado de funcionalidad fue medido con la aplicación de la escala Functional Independence Measure and Functional Assessment Measure. Esta prueba se aplicó al inicio de la intervención y 6 meses después. Resultados: se observó una evolución positiva en ambos grupos en todas las áreas de la escala. La intervención integral y un menor tiempo total de hospitalización se relacionaron con una mejor recuperación funcional en el ictus. Conclusiones: se sugiere la necesidad de realizar estrategias de rehabilitación integral en los pacientes con ictus(AU)

Introduction: debate is currently underway about what types of stroke recovery interventions are more beneficial for patients. Objective: evaluate the effect of a six-month comprehensive intervention on the functional recovery of stroke patients. Methods: the study sample was 42 stroke patients: an experimental group (N = 22), mean age 52.68 years (SD = 14.39), who received a comprehensive intensive multidisciplinary intervention, and a control group (N = 20), mean age 56.20 years (SD = 14.82), who did not receive this type of intervention. The following stroke severity indices were applied: Glasgow Coma Scale, Canadian Scale, intensive care unit stay, uncal latching signs, endocranial hypertension signs, hematoma volume / ischemic area, midline displacement, need for surgery and total hospital stay time. These severity indices were similar in the two groups. Degree of functionality was gauged with the scales Functional Independence Measure and Functional Assessment Measure. This test was applied at the start of the intervention and 6 months later. Results: both groups had a positive evolution in all the areas of the scale. The comprehensive intervention and a shorter total hospital stay were associated to better functional recovery from stroke. Conclusions: the need is suggested to implement comprehensive rehabilitation strategies in stroke patients(AU)

Wernicke-Korsakoff Syndrome: A Case Series in Liaison Psychiatry.

Wernicke-Korsakoff syndrome (WKS) is a life-threatening and underdiagnosed neuropsychiatric condition caused by thiamine deficiency that comprises Wernicke encephalopathy and Korsakoff syndrome. Although mainly associated with chronic alcoholism, WKS can arise from other circumstances. This report describes a series of cases of WKS that were clinically evaluated by liaison psychiatrists on a nonpsychiatric inpatient unit. The cases illustrate a deficit in the recognition and adequate treatment of WKS, demonstrating its clinical complexity and the need to improve physicians' knowledge.

¿Cómo diseñar, aplicar y evaluar un programa de Mentoring en enfermedad renal crónica? evaluación narrativa del impacto en 6 centros asistenciales / How to design, apply and assess a Mentoring programme in chronic kidney disease: Narrative impact assessment in six health care centres

ANTECEDENTES Y OBJETIVO: La enfermedad renal crónica (ERC) requiere de un proceso de adaptación en el paciente, que se puede facilitar con el apoyo de los profesionales sanitarios, así como por iguales capacitados. El objetivo de este estudio es presentar la puesta en marcha de un programa piloto de paciente mentor para promover la adaptación de los pacientes con ERC. MATERIALES Y MÉTODO: Diseño mixto (cuantitativo y cualitativo) pre-post. El estudio se llevó a cabo en 6 hospitales de España. Los instrumentos utilizados para medir el impacto fueron escalas elaboradas ad-hoc (formato de respuesta escala de Likert de 10 puntos) de satisfacción y adquisición de competencias, así como la creación de grupos focales con 8 pacientes mentores y 10 profesionales sanitarios. Se dividió el programa en 4 fases: 1) Diseño y validación de contenidos del programa manualizado y selección de pacientes mentores; 2) Formación a mentores, satisfacción con la formación y competencias adquiridas por los mentores; 3) Implementación de los grupos de apoyo mutuo y perfil de los asistentes a los grupos de apoyo mutuo, y 4) Evaluación y resultados del programa de Mentoring. RESULTADOS: Se han formado a un total de 39 mentores en habilidades para conducción de grupos, así como para facilitar apoyo emocional. Se han conducido 22 grupos de apoyo con 121 participantes (22% cuidadores). El 65% de los pacientes estaban en consulta de ERC. Un 65% de los pacientes participantes consideraron hacer algún cambio en su estilo de vida tras la asistencia al programa. Todos los ítems que evalúan satisfacción y utilidad han mostrado una puntuación muy elevada, por encima del valor 8,5 sobre 10. CONCLUSIONES: Este es el primer programa manualizado de Mentoring en ERC llevado a cabo de manera simultánea en 6 hospitales españoles. La naturaleza del programa, manualizado y altamente estructurado, permite su replicabilidad minimizando el riesgo de error

BACKGROUND AND OBJECTIVE: Chronic kidney disease (CKD) requires patients to participate in an adaptation process, which may be facilitated with the support of healthcare professionals and trained peers. The objective of this study is to present the implementation of a pilot patient mentoring programme to promote adaptation in patients with CKD. MATERIALS AND METHOD: Pre-test-post-test design (quantitative and qualitative). The study was carried out in six hospitals in Spain. The instruments used to measure impact were ad-hoc scales (10-point Likert scale response format) on satisfaction and skill acquisition, as well as the creation of focus groups with eight patient mentors and 10 healthcare professionals. The programme was split into four phases: 1. Design and validation of the manualised programme's content, and selection of patient mentors; 2. Mentor training, satisfaction with training and skills acquired by the mentors; 3. Implementation of mutual support groups and profile of those attending these mutual support groups; 4. Assessment and results of the Mentoring programme. RESULTS: In total, 39 mentors were trained on group management skills, as well as how to provide emotional support. 22 support groups were held, with 121 participants (22% carers). The 65% of the patients were attending the CKD clinic. 65% of the participating patients considered making some form of lifestyle change after taking part in the programme. All the items assessing satisfaction and usefulness scored very highly, achieving 8.5 out of 10 or above. CONCLUSIONS: This is the first manualised mentoring programme in CKD to be undertaken simultaneously in six Spanish hospitals. The manualised and highly structured nature of the programme make it easy to replicate, minimising the risk of error

Multistate Models: Accurate and Dynamic Methods to Improve Predictions of Thrombotic Risk in Patients with Cancer.

Research into cancer-associated thrombosis (CAT) entails managing dynamic data that pose an analytical challenge. Thus, methods that assume proportional hazards to investigate prognosis entail a risk of misinterpreting or overlooking key traits or time-varying effects. We examined the AGAMENON registry, which collects data from 2,129 patients with advanced gastric cancer. An accelerated failure time (AFT) multistate model and flexible competing risks regression were used to scrutinize the time-varying effect of CAT, as well as to estimate how covariates dynamically predict cumulative incidence. The AFT model revealed that thrombosis shortened progression-free survival and overall survival with adjusted time ratios of 0.72 and 0.56, respectively. Nevertheless, its prognostic effect was nonproportional and disappeared over time if the subject managed to survive long enough. CAT that occurred later had a more pronounced prognostic effect. In the flexible competing risks model, multiple covariates were seen to have significant time-varying effects on the cumulative incidence of CAT (Khorana score, secondary thromboprophylaxis, high tumor burden, and cisplatin-containing regimen), whereas other predictors exerted a constant effect (signet ring cells and primary thromboprophylaxis). The model that assumes proportional hazards was incapable of capturing the effect of these covariates and predicted the cumulative incidence in a biased way. This study evinces that flexible and multistate models are a useful and innovative method to describe the dynamic effect of variables associated with CAT and should be more widely used.

How to design, apply and assess a Mentoring programme in chronic kidney disease: Narrative impact assessment in six health care centres. / ¿Cómo diseñar, aplicar y evaluar un programa de Mentoring en enfermedad renal crónica? evaluación narrativa del impacto en 6 centros asistenciales.

BACKGROUND AND OBJECTIVE: Chronic kidney disease (CKD) requires patients to participate in an adaptation process, which may be facilitated with the support of healthcare professionals and trained peers. The objective of this study is to present the implementation of a pilot patient mentoring programme to promote adaptation in patients with CKD. MATERIALS AND METHOD: Pre-test-post-test design (quantitative and qualitative). The study was carried out in six hospitals in Spain. The instruments used to measure impact were ad-hoc scales (10-point Likert scale response format) on satisfaction and skill acquisition, as well as the creation of focus groups with eight patient mentors and 10 healthcare professionals. The programme was split into four phases: 1. Design and validation of the manualised programme's content, and selection of patient mentors; 2. Mentor training, satisfaction with training and skills acquired by the mentors; 3. Implementation of mutual support groups and profile of those attending these mutual support groups; 4. Assessment and results of the Mentoring programme. RESULTS: In total, 39 mentors were trained on group management skills, as well as how to provide emotional support. 22 support groups were held, with 121 participants (22% carers). The 65% of the patients were attending the CKD clinic. 65% of the participating patients considered making some form of lifestyle change after taking part in the programme. All the items assessing satisfaction and usefulness scored very highly, achieving 8.5 out of 10 or above. CONCLUSIONS: This is the first manualised mentoring programme in CKD to be undertaken simultaneously in six Spanish hospitals. The manualised and highly structured nature of the programme make it easy to replicate, minimising the risk of error.

The role of Cymodocea nodosa on the dynamics of trace elements in different marine environmental compartments at the Mar Menor Lagoon (Spain).

During mining activities historically developed at Sierra Minera (Cartagena-La Unión, Spain), high amounts of trace elements were discharged to the Mar Menor coastal lagoon mainly through El Beal Wadi. The objective of this study is to establish the role played by the Cymodocea nodosa in the coastal marine dynamics of trace elements at the mouth of the wadi. To this end, the content of nine trace elements (As, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn) in different marine environmental compartments (i.e. marine and coastal sediments, C. nodosa tissues collected from live seagrass and C. nodosa beach cast litter) at two different locations were determined by inductively coupled plasma atomic emission spectrometry. The results showed that the seagrass C. nodosa could mobilise part of the elements present in marine sediments and water, thereby causing their re-accumulation in the coastal sediments through the C. nodosa beach cast litter.

Evaluación del impacto de un programa de formación en Entrevista Motivacional a enfermería nefrológica / Assessing the impact of a training program in motivational interviewing to nephrology nursing

Introducción: Los profesionales de enfermería de cinco servicios de nefrología recibieron entrenamiento en Entrevista Motivacional mediante un taller de ocho horas centrado en como promover la adhesión al tratamiento en el paciente renal y su familia. El objetivo fue evaluar cambios en: competencia percibida en habilidades comunicativas especificas, respuesta empática espontanea e implantación de las habilidades in vivo medido a través de una rejilla observacional. Material y Método: Diseño pretest-postest sin grupo control. La muestra estaba formada por 46 profesionales del ámbito de la enfermería nefrológica. Resultados: Los resultados muestran cambios en la capacidad percibida de validar al paciente (p<0,031), así como en autorregulación emocional (p<0,014). La respuesta empática espontánea aumentó en los cuatro casos clínicos presentados, pero no llegó a alcanzar significancia estadística (p>0,05). La rejilla observacional, implementada durante el entrenamiento, informó acerca de indicadores de éxito tales como: reducir el tono paternalista, mostrar calma, generar confianza y escuchar de manera activa. Conclusiones: Los resultados son consistentes con otros estudios que evalúan el impacto de los programas de entrenamiento en habilidades de comunicación en nefrología

Introduction: Nursing professionals from five nephrology departments received training in Motivational Interviewing through an eight-hour workshop focused on how to promote adherence to treatment in renal patients and their families. The objective of the present study was to assess changes in: perceived competence in specific communication skills, spontaneous empathic response and readiness to apply in vivo communicative skills measured through an observation grid. Material and Method: Pretest-posttest design without control group. The sample consisted of 46 nephrology nurses. Results: The results show changes in the perceived competence to validate the patient (p<0.031), as well as emotional self-regulation (p<0.014). The empathic spontaneous response increased in the four clinical cases presented, but no statistical significance was reached (p>0.05). The observation grid, implemented during the training, reported on indicators of success such as: reducing the paternalistic tone, showing calm, generating trust and active listening. Conclusions: The results are consistent with other studies that evaluate the impact of communication training programs in nephrology

Efficacy and safety of chemotherapy in older versus non-older patients with advanced gastric cancer: A real-world data, non-inferiority analysis.

OBJECTIVE: Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC. MATERIALS AND METHODS: We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008-2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥70 vs.<70years. The fixed-margin method was used (hazard ratio [HR]<1.176) that corresponds to conserving at least 85% efficacy. RESULTS: 33% (n=489) of the cases analyzed were ≥70 years. Two-agent chemotherapies and combinations with oxaliplatin (48% vs. 29%) were used more often in the older patients, as were modified schedules and/or lower doses. Toxicity grade 3-4 was comparable in both groups, although when looking at any grade, there were more episodes of enteritis, renal toxicity, and fatigue in older patients. In addition, toxicity was a frequent cause for discontinuing treatment in older patients. The response rate was similar in both groups. After adjusting for confounding factors, the non-inferiority of OS associated with schedules administered to the older vs. younger subjects was confirmed: HR 1.02 (90% CI, 0.91-1.14), P (non inferiority)=0.018, as well as progression-free survival: HR 0.97 (90% CI, 0.87-1.08), P(non-inferiority)=0.001. CONCLUSION: In this AGC registry, the use of chemotherapy with schedules adapted to patients ≥70 years provided efficacy that was not inferior to that seen in younger cases, with comparable adverse effects.

Biomarkers and polymorphisms in pancreatic neuroendocrine tumors treated with sunitinib.

Several circulating biomarkers and single nucleotide polymorphisms (SNPs) have been correlated with efficacy and tolerability to antiangiogenic agents. These associations remain unexplored in well-differentiated, metastatic pancreatic neuroendocrine tumors treated with the multitargeted tyrosine kinase inhibitor sunitinib. We have assessed the effect on tumor response at 6 months, overall survival, progression-free survival and safety of 14 SNPs, and 6 soluble proteins. Forty-three patients were recruited. Two SNPs in the vascular endothelial growth factor receptor 3 (VEGFR-3) gene predicted lower overall survival: rs307826 with hazard ratio (HR) 3.67 (confidence interval [CI] 95%, 1.35-10.00) and rs307821 with HR 3.84 (CI 95%, 1.47-10.0). Interleukin-6 was associated with increased mortality: HR 1.06 (CI 95%, 1.01-1.12), and osteopontin was associated with shorter PFS: HR 1.087 (1.01-1.16), independently of Ki-67. Furthermore, levels of osteopontin remained higher at the end of the study in patients considered non-responders: 38.5 ng/mL vs. responders: 18.7 ng/mL, p-value=0.039. Dynamic upward variations were also observed with respect to IL-8 levels in sunitinib-refractory individuals: 28.5 pg/mL at baseline vs. 38.3 pg/mL at 3 months, p-value=0.024. In conclusion, two VEGFR-3 SNPs as well as various serum biomarkers were associated with diverse clinical outcomes in patients with well-differentiated pancreatic neuroendocrine tumors treated with sunitinib.

Prognostic significance of performing universal HER2 testing in cases of advanced gastric cancer.

BACKGROUND: Trastuzumab significantly improves overall survival (OS) when added to cisplatin and fluoropyrimidine as a treatment for HER2-positive advanced gastric cancers (AGC). The aim of this study was to evaluate the impact of the gradual implementation of HER2 testing on patient prognosis in a national registry of AGC. METHODS: This Spanish National Cancer Registry includes cases who were consecutively recruited at 28 centers from January 2008 to January 2016. The effect of missing HER2 status was assessed using stratified Cox proportional hazards (PH) regression. RESULTS: The rate of HER2 testing increased steadily over time, from 58.3 % in 2008 to 92.9 % in 2016. HER2 was positive in 194 tumors (21.3 %). In the stratified Cox PH regression, each 1 % increase in patients who were not tested for HER2 at the institutions was associated with an approximately 0.3 % increase in the risk of death: hazard ratio, 1.0035 (CI 95 %, 1.001-1.005), P = 0.0019. Median OS was significantly lower at institutions with the highest proportions of patients who were not tested for HER2. CONCLUSION: Patients treated at centers that took longer to implement HER2 testing exhibited worse clinical outcomes. The speed of implementation behaves as a quality-of-care indicator. Reviewed guidelines on HER2 testing should be used to achieve this goal in a timely manner.

The impact of specialty practice nursing care on health-related quality of life in persons with ostomies.

PURPOSE: Ostomy patients suffer significant physiological challenges that can affect psychological variables and health-related quality of life (HRQOL). The purpose of this study was to compare HRQOL in a group of patients cared for in hospitals that employed nurses specializing in ostomy care versus patients who were cared for at hospitals that did not employ nurses specializing in ostomy care. DESIGN: Multicenter, quasi-experimental, prospective, longitudinal study. SUBJECTS AND SETTING: This is a national study set in Spain. We collected data from 402 ostomy patients in health centers among 16 Spanish regions from March 2012 to June 2013. The average age of the patients was 61.3 ± 13.71 years (mean ± SD). METHODS: Questionnaires were administered by the investigators prior to and 3 months after the ostomy surgery. Two groups of patients were compared: patients in group 1 were treated by nurses specializing in ostomies; patients in group 2 were not treated by an ostomy nurse specialist. Two validated scales were used to determine HRQOL: EQ-5 D (Spanish version) and the Montreux questionnaire. RESULTS: Patients in group 1 adapted better to their ostomies than group 2. They exhibited less concern with appearance; increased comfort with cleaning, changing, and throwing away ostomy bags; and decreased pain and pain frequency. They reported less fearfulness; improvements in sleep, weight concerns, and strength; and better overall health, leading to a greater percentage of patients able to lead a normal life (P < .05). Sexual activity was the only variable that worsened in both groups, but it was more satisfactory at postoperation stage in group 1 (P = .015). CONCLUSIONS: Patients who received specialized ostomy care experienced significant improvements in HRQOL compared to patients who were not cared for by specialist nurses. Our findings strongly suggest that patients undergoing ostomy surgery should be provided access to a nurse specialist in ostomy care since our results highlight the potential benefit promoting the HRQOL of patients.

Complicaciones tempranas en pacientes portadores de ostomías con y sin atención de Enfermería especializada en ostomía / Early complications in ostomized patients receiving or not receiving ostomy-specialized nursing care

OBJETIVO: comparar las complicaciones inmediatas de los pacientes portadores de ostomía entre enfermos que reciben atención especializada en ostomía (AEO) y entre los que no disponen de esta atención (sin AEO).MÉTODO: se realizó un estudio multicéntrico nacional, cuasi experimental y prospectivo, registrando las complicaciones por laostomía y sus implicaciones en 402 pacientes. RESULTADOS: la intervención con AEO reduce el porcentaje de enfermos con complicaciones, siendo menos graves y de menor duración, necesitando menos ingresos hospitalarios, de menos duración y necesidad de otra intervención quirúrgica. También se desenvuelven cada vez mejor con el manejo del estoma, necesitando menos ayuda para realizar las actividades de la vida diaria (AVD). Asimismo, el sentimiento de ansiedad y/o depresión causado por el estoma fue menor en los pacientes con AEO. Por último, el número de bolsas usadas cada 24 horas por los enfermos con AEO es uniforme, en cambio los pacientes sin AEO van aumentando. CONCLUSIONES: la valoración global de los resultados hallados permite apoyar la hipótesis de la importancia del papel de los profesionales enfermeros especializados encontrada en la literatura. La AEO se convierte en la referencia de atención sanitaria del paciente para preguntarle dudas, consultar sus problemas y prevenir y/o tratar las complicaciones

PURPOSE: to compare immediate complications in ostomized patients receiving ostomy-specialized nursing care (OSC) or not receiving OSC (no OSC).METHODS: a multicenter, national, prospective, quasi-experimental study was carried out to assess ostomy complications and their impact in 402 patients. RESULTS: use of OSC resulted in a reduced proportion of patients with complications. Complications were less severe and had a shorter duration; hospital admissions were also less common and shorter; and less surgical procedures were needed. Furthermore, patients are more able to manage ostomies and require less help for their activities of daily living (ADL). Moreover, anxiety and/or depression feelings resulting from ostomie swere lower in patients receiving OSC. Finally, the number of ostomy bags per 24 hours remained constant in patients receiving OSC, whereas an increasing number of bags was used by patients not receiving OSC.C onclusions: an overall assessment of our findings supports the hypothesis on the importance of professional nursing specialists as reported in literature. Patients' doubts and problems can be solved and complications can be prevented and/or treated. Thus, OSC becomes a healthcare reference for the ostomized patient

Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica / From the vegetative state to unresponsive wakefulness: a historical review

Introducción. A lo largo de estas últimas décadas, la terminología, las técnicas diagnósticas y el tratamiento de los pacientescon niveles alterados de la conciencia han variado de forma considerable. A su vez, el porcentaje de pacientes en estasituación clínica se ha incrementado notablemente. Objetivo. Se presenta una revisión histórica de los diferentes términos que la literatura médica ha utilizado para la descripción de los pacientes con estados alterados de conciencia. El artículo incluye además los diferentes criterios diagnósticosempleados por los grupos de estudio que han centrado su interés en esta población. Desarrollo. Semiológicamente, el concepto de ‘estado vegetativo’ acuñado en los años setenta se ha transformado y se ha sustituido por términos con una connotación menos negativa, como el de ‘síndrome de vigilia sin respuesta’. Paralelamente, han surgido nuevas categorías clínicas (estado de mínima conciencia o de mínima conciencia plus) al reconocerse la existencia de pacientes con bajo nivel de conciencia pero con signos congruentes de interacción con el entorno a través de conductas inequívocamente voluntarias ante órdenes o gestos. Conclusión. El espectro semiológico de los pacientes con niveles alterados de conciencia refleja la heterogeneidad clínica y neuropatológica de estos estados. La tendencia actual es la de hacer una descripción clínica del estado, añadiendo la etiología y la fecha del evento que causó el cuadro clínico. Este artículo se centra en el contexto de un esfuerzo de la comunidad científica por hacer presente las necesidades de esta creciente población (AU)

Introduction. Over the last few decades, the terminology, diagnostic techniques and treatment of patients with alteredlevels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase. Aims. The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population. Development. The concept of ‘vegetative state’, a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as ‘unresponsive wakefulness syndrome’. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledgedthat there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures. Conclusions. The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects theclinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population (AU)