Cáncer de mama metaplásico: a propósito de un caso / Metaplastic breast cancer: A case report

Introducción: El carcinoma metaplásico de mama (CMM) es un tipo raro y agresivo de cáncer de mama que suele diagnosticarse en etapas avanzadas, con tumores de gran tamaño y grado histológico elevado. En este estudio, presentamos un caso de CMM, y realizamos una revisión y discusión de la literatura relacionada. Principales síntomas o hallazgos clínicos: Paciente de 35 años, sin antecedentes personales ni familiares relevantes, que consulta por tumoración mamaria de 2cm, de crecimiento progresivo, que agrega en la evolución umbilicación del pezón y dolor mamario. Se realiza ecografía mamaria que evidencia masa sólida polilobulada con características sospechosas. En suma: masa en mama izquierda BI-RADS 5. Diagnósticos principales, intervenciones terapéuticas y resultados: Se realiza core biopsia y la anatomía patológica evidencia un carcinoma ductal infiltrante, variedad metaplásico, triple negativo y con expresión PDL1>1%. Se realiza mastectomía radical modificada. En la evolución se diagnostica un secundarismo pulmonar, y la paciente recibió tratamiento sistémico de primera y segunda línea. Conclusiones: Dada la naturaleza agresiva de este tipo de tumor, y las limitadas opciones de tratamiento disponibles, la participación en ensayos clínicos puede considerarse para mejorar los resultados en estas pacientes. Un enfoque multidisciplinario, y la revisión en un comité de tumores son fundamentales para guiar las decisiones terapéuticas y proporcionar la mejor atención posible a estas pacientes(AU)

Introduction: Metaplastic breast carcinoma (MBC) is a rare and aggressive type of breast cancer that is often diagnosed in advanced stages, with large tumors and a high histological grade. In this study, we present a case of MBC, and conduct a review and discussion of the related literature. Main symptoms or clinical findings: A 35-year-old patient with no relevant personal or family history presents with a progressively growing 2 cm breast mass, which, over time, develops into nipple retraction and breast pain. A breast ultrasound reveals a suspicious-looking polilobulated solid mass. In summary: a BI-RADS 5 mass in the left breast. Main diagnoses, therapeutic interventions, and outcomes: A core biopsy is performed, and the pathology report reveals an infiltrating ductal carcinoma, metaplastic variety, triple-negative with PDL1 expression > 1%. A modified radical mastectomy is performed. During follow-up, pulmonary metastasis is diagnosed, and the patient receives first and second-line systemic treatment. Conclusions: Given the aggressive nature of this type of tumor and the limited treatment options available, participation in clinical trials may be considered to improve outcomes in these patients. A multidisciplinary approach, and review in a tumor committee are essential to guide therapeutic decisions and provide the best possible care for these patients.(AU)

3D muscle networks based on vibrational mechanomyography.

Objective. Muscle network modeling maps synergistic control during complex motor tasks. Intermuscular coherence (IMC) is key to isolate synchronization underlying coupling in such neuromuscular control. Model inputs, however, rely on electromyography, which can limit the depth of muscle and spatial information acquisition across muscle fibers.Approach. We introduce three-dimensional (3D) muscle networks based on vibrational mechanomyography (vMMG) and IMC analysis to evaluate the functional co-modulation of muscles across frequency bands in concert with the longitudinal, lateral, and transverse directions of muscle fibers. vMMG is collected from twenty subjects using a bespoke armband of accelerometers while participants perform four hand gestures. IMC from four superficial muscles (flexor carpi radialis, brachioradialis, extensor digitorum communis, and flexor carpi ulnaris) is decomposed using matrix factorization into three frequency bands. We further evaluate the practical utility of the proposed technique by analyzing the network responses to various sensor-skin contact force levels, studying changes in quality, and discriminative power of vMMG.Main results. Results show distinct topological differences, with coherent coupling as high as 57% between specific muscle pairs, depending on the frequency band, gesture, and direction. No statistical decrease in signal strength was observed with higher contact force.Significance. Results support the usability vMMG as a tool for muscle connectivity analyses and demonstrate the use of IMC as a new feature space for hand gesture classification. Comparison of spectrotemporal and muscle network properties between levels of force support the robustness of vMMG-based network models to variations in tissue compression. We argue 3D models of vMMG-based muscle networks provide a new foundation for studying synergistic muscle activation, particularly in out-of-clinic scenarios where electrical recording is impractical.

Intermittent parathyroid hormone enhances the healing of medication-related osteonecrosis of the jaw lesions in rice rats.

Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event in patients treated with antiresorptives. Management of MRONJ is challenging, and no non-antibiotic, established medical treatment exists. Intermittent parathyroid hormone (iPTH) has been used off-label to treat MRONJ with favorable results. However, its medical efficacy has rarely been substantiated in clinical or preclinical experiments. Using a validated rice rat, infection-based model of MRONJ, we evaluated the effects of iPTH on established MRONJ. We hypothesize that iPTH contributes to MRONJ resolution by enhancing alveolar bone turnover and healing oral soft tissues. Eighty-four rice rats began a standard rodent chow diet at age 4 weeks to induce localized periodontitis. Rats were simultaneously randomized to receive saline (vehicle, VEH) or zoledronic acid (ZOL, 80 µg/kg IV) every 4 weeks. Oral exams were conducted bi-weekly to assign a gross quadrant grade (GQG, 0-4) to evaluate any lesion at the lingual aspect of the interdental space between maxillary molar (M2) and M3. 14 of 20 VEH-treated rice rats (70%) developed maxillary localized periodontitis with GQG 2-3 after 30 ± 10 weeks of saline. Additionally, 40 of 64 ZOL-treated rice rats with periodontitis developed MRONJ-like lesions after 30 ± 10 weeks of ZOL treatment. Rice rats with localized periodontitis or MRONJ-like lesions were treated with saline or iPTH (40 µg/kg) subcutaneously (SC) 3 times/week For 6 weeks until euthanasia. We found that iPTH -treated ZOL rats had a lower prevalence of MRONJ (p < 0.001), with lower severity extent of oral lesions (p = 0.003) and percentage of empty osteocyte lacunae (p < 0.001). ZOL rats treated with iPTH displayed a higher osteoblast surface (p < 0.001), more osteoblasts (p < 0.001), higher osteoclast surface (p < 0.001) and more osteoclasts (p = 0.002) at alveolar bone surfaces than ZOL/VEH rats. Greater gingival epithelial thickness and epithelial cell proliferation rate was found in the oral mucosa and gingiva of ZOL/PTH rats than in ZOL/VEH rats (p < 0.001). Our data suggest that iPTH is an efficacious non-operative medicinal therapy that accelerates oral healing and enhances the resolution of MRONJ lesions in ZOL-treated rice rats.

Conocimiento de las puérperas sobre los efectos perinatales del tabaquismo materno y factores sociodemográficos asociados al consumo / Knowledge of puerperal women about the effects rates of maternal smoking and factors sociodemographics associated with consumption

Objetivo. El tabaquismo materno es un factor de riesgo conductual, evitable y cuyos efectos perjudiciales alcanzan todo el ciclo vital del niño. El objetivo es valorar el conocimiento de una población de puérperas atendidas en el Hospital de la Línea de la Concepción, sobre los efectos perinatales del tabaquismo materno. Material y métodos. Estudio exploratorio, transversal (septiembre a noviembre de 2022). Muestreo consecutivo y aplicación de encuesta a 151 puérperas/ expedientes de neonatos, para recolectar información sociodemográfica, clínica obstétrica y del neonato, de consumo de tabaco y de conocimiento sobre efectos perinatales del tabaquismo materno con preguntas cerradas. Estadísticas descriptivas y comparación de grupos independientes con las pruebas t de Student y chi-cuadrado. Resultados. El consumo de tabaco previo al embarazo distinguió un 32% (48/151) de fumadoras. Se obtuvo un nivel global de aciertos entre el 45% y el 76,8%; mayor proporción de aciertos entre no fumadoras (rango 45,6-79,6%) que entre fumadoras (rango 37,5-72,9%). Para cada enunciado, el nivel de aciertos resultó sin diferencias (p>0,05) entre ambos grupos. Conclusiones. El nivel de conocimientos registrado no mostró diferencias entre fumadoras y no fumadoras. Se discuten alternativas para profundizar en la investigación y acciones integrales orientadas a reducir y eliminar el consumo de tabaco por la población femenina general y las mujeres embarazadas. (AU)

Objective. Maternal smoking is an avoidable behavioral risk factor whose harmful effects reach the entire life cycle of the child. The objective is to evaluate the knowledge of a population of puerperal women treated at the Hospital de la Linea de la Concepción (Cádiz, Spain), about the perinatal effects of maternal smoking. Material and methods. Exploratory, cross-sectional study –September to November 2022. Consecutive sampling and survey application to 151 puerperal women/newborn records, to collect sociodemographic, obstetric, and neonatal clinic information on tobacco use and knowledge about the perinatal effects of maternal smoking with closed questions. Descriptive statistics and comparison of independent groups with Student’s t and chi-square tests. Results . Tobacco use prior to pregnancy distinguished 32% (48/151) smokers. A level global of hits between45% and 76.8% was obtained; higher proportion of correct answers among non-smokers (range 45.6%-79.6%) than among smokers (range 37.5%-72.9%). For each statement, the level of correct answers was not different between both groups (p>0.05). Conclusions. The level of knowledge registered did not show differences between smokers and non-smokers. Alternatives are discussed to deepen the research and integral actions aimed at reducing and eliminating tobacco use by the general female population and pregnant women. (AU)

The removal of dissolved organic matter by marine sponges is a function of its composition and concentration: An in situ seasonal study of four Mediterranean species.

Sponges are unique among metazoans in their ability to use dissolved organic matter (DOM), the largest pool of organic matter in the ocean, as a major food source. The effect of variations in DOM abundance and composition on its uptake by sponges has rarely been studied. We examined, in situ, the seasonal uptake of DOM by four sponges [2 species with high microbial abundance (HMA) and 2 with low microbial abundance (LMA)] in the northwestern Mediterranean. Dissolved organic carbon (DOC) showed a strong seasonality with 3-fold higher concentrations in fall-winter (256 ± 16 µmol L-1, mean ± SE) than in spring-summer (88 ± 3 µmol L-1). Dissolved organic nitrogen (DON) showed the opposite trend, with higher summer concentrations (8.9 ± 0.4 µmol L-1) and mean concentrations of 2.5-3.4 µmol L-1 in the other seasons. DOC removal by all sponge species increased linearly with its ambient concentration, but only above a DOC removal threshold that was threefold higher in fall-winter (198 µmol L-1) than in spring-summer (74 µmol L-1). All species showed a concentration-dependent DON removal, but LMA sponges removed more DON than HMA sponges. The DOC removal rate (normalized to sponge volume) was 2-3 times higher in fall-winter, when ambient DOC levels were high, than in spring-summer. Sponges efficiently removed clusters of the fluorescent DOM (FDOM) associated with protein-rich DOM, but not those associated with humic material. The clear threshold for DOC removal and the protein-like FDOM uptake pattern suggest that the quality and quantity of DOM control its removal and transformation by marine sponges. Our results indicate that marine sponges transform the composition of the coastal DOM pool, thereby affecting its fate. It is postulated that the DOM excreted by the sponges is more recalcitrant; consequently, sponge activity enhances carbon sequestration in benthic habitats in a similar fashion to that of the oceanic 'microbial pump'.

Compromiso sensitivo y polineuropatía periférica como manifestación inicial de enfermedad de Creutzfeldt-Jakob. A propósito de un caso

La enfermedad de Creutzfeldt-Jakob (ECJ) es una rara enfermedad neurodegenerativa con una alta incidencia en Chile respecto del resto del mundo. El cuadro se caracteriza principalmente por desarrollo de demencia rápidamente progresiva y diversos signos neurológicos inespecíficos, siendo el más frecuente la mioclonía. El caso que se describirá a continuación destaca por las manifestaciones iniciales atípicas que presentó el paciente, tales como compromiso sensitivo en región cráneo-cérvico-dorsal y polineuropatía periférica de extremidades inferiores (EEII), lo que significó un retraso en el diagnóstico clínico de la ECJ. Es importante conocer los diferentes síntomas y signos que pueden presentarse en el cuadro clínico de ECJ, tanto típicos como aquellos menos frecuentes, para así poder dar con el diagnóstico de la enfermedad en etapas más tempranas. De igual manera, es fundamental contar con herramientas diagnósticas como la detección de proteína 14-3-3 o proteína Tau en los centros de salud de nuestro país. Esto permitiría al equipo de salud, brindar un manejo de soporte adecuado y oportuno a estos pacientes.

Creutzfeldt-Jakob disease is a rare neurodegenerative disease with a high incidence in Chile compared to the rest of the world. The condition is mainly characterized by the development of rapidly progressive dementia and various nonspecific neurological signs, the most common being myoclonus. The case that will be described below stands out for the atypical initial manifestations that the patient presented, such as sensory compromise in the cranio-cervico-dorsal region and peripheral polyneuropathy of the lower extremities, which meant a delay in the clinical diagnosis of the disease. It is important to know the different symptoms and signs that can be present in the clinical picture of CJD, both typical and those less frequent, in order to be able to diagnose the disease in earlier stages. Similarly, it is essential to have diagnostic tools such as the detection of 14-3-3 protein or Tau protein in health centers in our country. This would allow the health team to provide adequate and timely support management to these patients.

Carbon metabolism and bioavailability of dissolved organic carbon (DOC) fluxes in seagrass communities are altered under the presence of the tropical invasive alga Halimeda incrassata.

Seagrass beds act as blue carbon sinks globally as they enhance the trapping of recalcitrant (i.e., low biodegradability) organic carbon in their sediments. Recent studies also show that the recalcitrant fraction of the dissolved organic carbon (DOC) pool in seawater has an important role as long-term carbon sequestration in oceans. Although seagrasses are known for the large amount of DOC they export, little attention has been given to its biodegradability, which ultimately determinates its fate in the coastal carbon cycle. In turn, invasive algae are a major global concern in seagrass ecosystems since they can deeply modify their structure and functions, which may affect carbon metabolism and DOC release. This work assesses how the presence of Halimeda incrassata, an invasive tropical calcareous macroalga, modifies carbon metabolism and DOC fluxes in invaded areas dominated by the seagrass Cymodocea nodosa. Our results show that stands with the presence of this seagrass (i.e., both monospecific and mixed meadow) had the highest production values, acting as high DOC producers in both winter (mainly of labile DOC; DOCL) and summer (mainly as recalcitrant DOC; DOCR). In contrast, monospecific H. incrassata beds exhibited low production values, and the presence of this macroalga (either as monospecific beds or mixed with C. nodosa) triggered the shift from a net DOC-producing-system in summer (mainly DOCL) to a net DOC-consuming-system in winter. This work thus suggests that C. nodosa meadows have the potential to export a significant fraction of both labile and recalcitrant DOC, and that the spread of this invasive alga might decrease the C export capacity of seagrass meadows. Such shift would imply the reduction of a quick and efficient transfer of carbon and energy to higher trophic levels, and might reduce the blue carbon potential of seagrasses as dissolved form in the water column.

COVID-19 lockdown as an opportunity to rethink urban freight distribution: Lessons from the Barcelona metropolitan area.

The COVID-19 health crisis has had a strong impact on societies around the world, affecting both the health of populations and countries' economies. While lockdowns imposed to stop the spread of infection reduced urban mobility and had a positive impact on air quality, lowering the emission of polluting particles and greenhouse gases, they had the opposite effect on urban freight distribution (UFD). With the population remaining at home, ecommerce-driven shipments surged, and total freight traffic increased. In order to have a better understanding of this phenomenon, the aim of this study was to identify the impact of COVID-19 lockdowns on the daily operation of the region's main logistics agents. Lessons learned from this cyclical scenario could be used to define more sustainable public policies regarding UFD in the post-COVID era. To meet the above objectives, semi-structured interviews were conducted with public administrations and private operators, before being transcribed and encoded for later analysis. The results of our study show that common problems in UFD, such as traffic congestion or problems finding parking in the loading and unloading (L/U) zones, temporarily disappeared during the lockdown phase. Delivery times were consequently reduced, despite an increase in operations due to ecommerce. In addition, the public administrations took advantage of this situation to adapt the urban space and force a transition towards new delivery systems, such as cargo-bikes, to guarantee sustainable last-mile operations in specific zones.

Synergistic Upper-Limb Functional Muscle Connectivity Using Acoustic Mechanomyography.

Functional muscle network is a critical concept in describing functional synergistic muscle synchronization and functional connectivity needed for the execution of complex motor tasks. Muscle network is typically derived from decomposition of intermuscular coherence (IMC) at different frequency bands of multichannel electromyography (EMG) measurements, which potentially limits out-of-clinic applications. In this investigation, we introduce muscle network analysis to assess the functional coordination and functional connectivity of muscles based on mechanomyography (MMG). We focus on a targeted group of muscles vital for activities of daily living (ADLs) in the upper-limb. Functional muscle networks are evaluated for ten able-bodied participants and three upper-limb amputees. Muscle activity was acquired from a custom-made wearable armband of MMG sensors placed over four superficial muscles around the forearm (flexor carpi radialis (FCR), brachioradialis (BR), extensor digitorum communis (EDC), and flexor carpi ulnaris (FCU)) while participants performed four different hand gestures. Muscle connectivity analysis at multiple frequency bands shows significant topographical differences across gestures for low (i.e., 5 Hz) and high (i.e., 12 Hz) activation frequencies as well as observable network differences between amputee and non-amputee subjects. Results demonstrate MMG can be used for the analysis of functional muscle connectivity and mapping of synergistic functional synchronization of upper-limb muscles in complex movement tasks. The new physiological modality provides key insights into neural circuitry of motor coordination. Findings further offer the concomitant outcomes of demonstrating feasibility of MMG to map muscle coherence from a neurophysiological perspective and providing a mechanistic basis for its translation in human-robot interface.

EVIPNet Americas: Overcoming barriers to integrate scientific evidence and health policies in the Americas

In response to the challenges created by the COVID-19 pandemic to the role of evidence in policymaking, the World Health Organization (WHO) in collaboration with the Pan American Health Organization (PAHO) convened the first Global Evidence-to-Policy (E2P) Summit.This summit brought together different stakeholders from all WHO Regions to identify common challenges, share lessons learned, and provide recommendations to support evidence-informed decisionmaking as a catalyst for policy and societal changes

Assessing the effects of common topical exposures on skin bacteria associated with atopic dermatitis.

BACKGROUND: While patients and families struggling with atopic dermatitis (AD) have documented concerns for a contributory role of skin care products in AD pathology, nearly all the skin microbiome studies to date have asked participants to avoid topical products (such as soaps or select medications) for the preceding days to weeks prior to sample collection. Thus, given the established role of the microbiome in AD, the interactions between topical exposures, dysbiosis and AD remains underrepresented in the academic literature. OBJECTIVES: To address this knowledge gap, we expanded our previous evaluations to test the toxicological effects of a broader range of common chemicals, AD treatment lotions, creams and ointments using both health- and AD-associated strains of Roseomonas mucosa and Staphylococcus spp. METHODS: Use of in vitro culture techniques and mouse models were deployed to identify chemicals with dysbiotic or pre-biotic potential. A proof-of-concept study was subsequently performed in healthy volunteers to assess global microbiome shifts after exposure to select chemicals using dermatologic patch testing. RESULTS: Numerous chemicals possessed antibiotic properties, including many not marketed as anti-microbials. Through targeted combination of potentially beneficial chemicals, we identified combinations which promoted the growth of health-associated isolates over disease-associated strains in bacterial culture and enhanced microbe-specific outcomes in an established mouse model of AD; the most promising of which was the combination of citral and colophonium (often sold as lemon myrtle oil and pine tar). Additional studies would likely further optimize the combination of ingredients use. Similar results were seen in the proof-of-concept human studies. CONCLUSIONS: Our results could offer a systematic, multiplex approach to identify which products carry dysbiotic potential and thus may guide formulation of new topicals to benefit patients with AD.

Ecological Drawbacks of Nanomaterials Produced on an Industrial Scale: Collateral Effect on Human and Environmental Health.

Currently, hundreds of different nanomaterials with a broad application in products that make daily lives a little bit easier, in every aspect, are being produced on an industrial scale at thousands of tons per year. However, several scientists, researchers, politics, and ordinary citizens have stated their concern regarding the life cycle, collateral effects, and final disposal of these cutting-edge materials. This review summarizes, describes, and discusses all manuscripts published in the Journal Citation Reports during the last 10 years, which studied the toxicity or the effects of nanomaterials on human and environmental health. It was observed that 23.62% of the manuscripts analyzed found no ecological or human risks; 54.39% showed that several nanomaterials have toxicological effects on the ecosystems, human, or environmental health. In comparison, only 21.97% stated the nanomaterials had a beneficial impact on those. Although only 54.39% of the manuscripts reported unfavorable effects of nanomaterials on ecosystems, human, or environmental health, it is relevant because the potential damage is invaluable. Therefore, it is imperative to make toxicological studies of nanomaterials with holistic focus under strictly controlled real conditions before their commercialization, to deliver to the market only innocuous and environmentally friendly products.

"ST-elevation myocardial infarction associated with air pollution levels in Mexico City".

Background Coronary heart disease has multiple risk factors, including air pollution. Numerous pathophysiological mechanisms have been identified with increasing levels of air pollution, mainly with ozone (O3), nitrogen dioxide (NO2), sulphur dioxide (SO2), particulate matter (PM10), fine particulate matter (PM2.5) and carbon monoxide (CO). In Mexico, the pollution level is reported using an air quality index called IMECA. Methods All patients with STEMI admitted at Hospital Español were collected between 2012 and 2019 (N = 348). We conducted a retrospective analysis using the air pollution exposure at the time of each event (lag0), the previous 24 h (lag1), 48 h (lag2), 72 h (lag3) and 5-day cumulative lag. The level of air pollution was analyzed independently using IMECA and particle concentrations. The data was divided in two groups: days with one of more STEMI's (MI group) and days free of events (Control group), using ANCOVA to evaluate the difference between means of both groups taking into account confounders. Results: For days with one or more cardiovascular event, a significant increase in SO2 was observed at lag1; similar increase was found in CO, PM2.5, SO2 at lag2. For the 5-day cumulative lag, SO2 and PM2.5 showed a significant increase. No differences were found using the IMECA levels in both groups. Conclusions: The elevated concentrations levels of CO, SO2 and PM2.5 showed significant association with STEMI at different time points before the event. Ozone, PM10 and NO2 showed no difference between groups. IMECA levels showed no association with STEMI in our study.

Cervical Spinal Cord Degeneration in Spinocerebellar Ataxia Type 7.

BACKGROUND AND PURPOSE: Spinocerebellar ataxia type 7 is an autosomal dominant neurodegenerative disease caused by a cytosine-adenine-guanine (CAG) repeat expansion. Clinically, spinocerebellar ataxia type 7 is characterized by progressive cerebellar ataxia, pyramidal signs, and macular degeneration. In vivo MR imaging studies have shown extensive gray matter degeneration in the cerebellum and, to a lesser extent, in a range of cortical cerebral areas. The purpose of this study was to evaluate the impact of the disease in the spinal cord and its relationship with the patient's impairment. MATERIALS AND METHODS: Using a semiautomated procedure applied to MR imaging data, we analyzed spinal cord area and eccentricity in a cohort of 48 patients with spinocerebellar ataxia type 7 and compared them with matched healthy controls. The motor impairment in the patient group was evaluated using the Scale for Assessment and Rating of Ataxia. RESULTS: Our analysis showed a significantly smaller cord area (t = 9.04, P < .001, d = 1.31) and greater eccentricity (t = -2.25, P =. 02, d = 0.32) in the patient group. Similarly, smaller cord area was significantly correlated with a greater Scale for Assessment and Rating of Ataxia score (r = -0.44, P = .001). A multiple regression model showed that the spinal cord area was strongly associated with longer CAG repetition expansions (P = .002) and greater disease duration (P = .020). CONCLUSIONS: Our findings indicate that cervical spinal cord changes are progressive and clinically relevant features of spinocerebellar ataxia type 7, and future investigation of these measures as candidate biomarkers is warranted.

Influence of Klebsiella pneumoniae and quinolone treatment on prognosis in patients with pancreatic cancer.

BACKGROUND: An increasing body of evidence suggests that microbiota may promote progression of pancreatic ductal adenocarcinoma (PDAC). It was hypothesized that gammaproteobacteria (such as Klebsiella pneumoniae) influence survival in PDAC, and that quinolone treatment may attenuate this effect. METHODS: This was a retrospective study of patients from the Massachusetts General Hospital (USA) and Ludwig-Maximilians-University (Germany) who underwent preoperative treatment and pancreatoduodenectomy for locally advanced or borderline resectable PDAC between January 2007 and December 2017, and for whom a bile culture was available. Associations between tumour characteristics, survival data, antibiotic use and results of intraoperative bile cultures were investigated. Survival was analysed using Kaplan-Meier curves and Cox regression analysis. RESULTS: Analysis of a total of 211 patients revealed that an increasing number of pathogen species found in intraoperative bile cultures was associated with a decrease in progression-free survival (PFS) (-1·9 (95 per cent c.i. -3·3 to -0·5) months per species; P = 0·009). Adjuvant treatment with gemcitabine improved PFS in patients who were negative for K. pneumoniae (26·2 versus 15·3 months; P = 0·039), but not in those who tested positive (19·5 versus 13·2 months; P = 0·137). Quinolone treatment was associated with improved median overall survival (OS) independent of K. pneumoniae status (48·8 versus 26·2 months; P = 0·006) and among those who tested positive for K. pneumoniae (median not reached versus 18·8 months; P = 0·028). Patients with quinolone-resistant K. pneumoniae had shorter PFS than those with quinolone-sensitive K. pneumoniae (9·1 versus 18·8 months; P = 0·001). CONCLUSION: K. pneumoniae may promote chemoresistance to adjuvant gemcitabine, and quinolone treatment is associated with improved survival.

Linkages between greenhouse gases (CO2, CH4, and N2O) and dissolved organic matter composition in a shallow estuary.

Estuarine systems receive large amounts of organic matter that enhance the production of greenhouse gases (GHGs), such as carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O). Despite considerable research on GHGs and dissolved organic matter (DOM) distribution in estuaries, little is known about the linkage between these gases and DOM composition. Here we evaluated the relationship between three GHGs (CO2, CH4, and N2O) and DOM composition, determined through optical properties, in Guadalete estuary (Bay of Cadiz, Spain). The partial pressure of CO2, and CH4 and N2O concentrations ranged between 332.8 and 6807.1 µatm, 19.9-6440.1 nM, and 6.8-283.9 nM, respectively. Thus, the Guadalete estuary was a source of CO2, CH4 and N2O to the atmosphere. We validated three PARAFAC components related to humic-like fluorescence from terrestrial, microbial and effluent sources, and one with protein-like material. Humic-like components accounted for 86% ± 6% of the total FDOM pool, indicating a predominantly allochthonous DOM origin. The three GHGs were significantly linked to DOC concentration and DOM composition, exhibiting different patterns in these linkages. Terrestrial and microbial humic-like substances with increasing aromaticity might enhance pCO2 in Guadalete estuary. Dissolved CH4 concentrations showed the strongest relationship with DOM composition, indicating that humic and protein-like material are linked with their distribution. In contrast, dissolved N2O was only related with the protein-like fraction and with humic-like material derived from anthropogenic activities (sewage and agriculture). Our results further indicate that a possible coupling between benthic fluxes of GHGs and DOM might be occurring in this shallow estuary. We conclude that it is important to account for DOM composition when studying GHGs distribution in estuarine systems to understand their roles and potential responses associated with climate change.

Decoupling of biotic and abiotic patterns in a coastal area affected by chronic metal micronutrients disturbances.

Coastal systems are highly productive areas for primary productivity and ecosystem services and host a large number of human activities. Since industrialization, metal micronutrients in these regions have increased. Phytoplankton use metals as micronutrients in metabolic processes, but in excess, had deleterious effects. In coastal systems, picoeukaryotes represent a diverse and abundant group with widespread distribution and fundamental roles in biogeochemical cycling. We combined different approaches to explore picoeukaryotes seasonal variability in a chronically metal polluted coastal area at the south-eastern Pacific Ocean. Through remote and field measurements to monitor environmental conditions and 18S rRNA gene sequencing for taxonomic profiling, we determined metal chronic effect on picoeukaryote community's structure. Our results revealed a stable richness and a variable distribution of the relative abundance, despite the physicochemical seasonal variations. These results suggest that chronic metal contamination influences temporal heterogeneity of picoeukaryote communities, with a decoupling between abiotic and biotic patterns.