SEOM clinical guideline in ovarian cancer (2020)

Despite remarkable advances in the knowledge of molecular biology and treatment, ovarian cancer remains the leading cause of death from gynecologic cancer. In the last decade, there have been important advances both in systemic and surgical treatment. However, there is no doubt that the incorporation of PARP inhibitors as maintenance after the response to platinum-based chemotherapy, first in recurrent disease and recently also in first line, will change the natural history of the disease. The objective of this guide is to summarize the current evidence for the diagnosis, treatment, and follow-up of ovarian cancer, and to provide evidence-based recommendations for clinical practice (AU)

SEOM clinical guideline in ovarian cancer (2020).

Despite remarkable advances in the knowledge of molecular biology and treatment, ovarian cancer remains the leading cause of death from gynecologic cancer. In the last decade, there have been important advances both in systemic and surgical treatment. However, there is no doubt that the incorporation of PARP inhibitors as maintenance after the response to platinum-based chemotherapy, first in recurrent disease and recently also in first line, will change the natural history of the disease.The objective of this guide is to summarize the current evidence for the diagnosis, treatment, and follow-up of ovarian cancer, and to provide evidence-based recommendations for clinical practice.

Urinary and fecal incontinence in patients with advanced ovarian cancer treated with CRS + HIPEC.

PURPOSE: The objective of this work was to analyze the long-term prevalence of urinary and fecal incontinence and their impact on quality of life in patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (CRS + HIPEC). METHODS: This cross-sectional study included a series of patients with advanced and recurrent ovarian cancer treated by CRS + HIPEC, with a disease-free period of at least 12 months after the procedure. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), fecal incontinence using the Wexner test and the Fecal Incontinence Quality of Life (FIQL) questionnaire and global quality of life using the Short Form 36 (SF-36) survey. RESULTS: A total of 64 patients were included in the study, with a median age of 55 years (range 28-78). The urinary incontinence rate was 45% and the fecal incontinence rate was 20%. Up to 14% of the patients presented both types of incontinence. The presence of urinary or fecal incontinence generated a significant negative impact on quality of life in relation to patients without incontinence. DISCUSSION: Urinary and fecal incontinence is frequent in the follow-up of ovarian cancer patients treated with CRS + HIPEC. Reconsidering the approach to the pelvis without peritoneal metastases in the peritoneum could modify the incidence of these pelvic floor dysfunctions.

Improved magnetic lateral flow assays with optimized nanotags for point-of-use inductive biosensing.

Lateral flow assays may be used by minimally trained personnel for fast and inexpensive bioanalyses in decentralized non-exigent environments. Their extension to a broader catalog of applications depends on improvements in their quantification and their sensitivity. We report a strategy that combines nanomagnetic tagging of the analyte of interest with radiofrequency inductive sensing, easy to achieve in friendly and portable format. To optimize nanotag performance, we investigated the influences of their magnetic core size and agglomeration. Iron oxide nanoparticles, with sizes from 5 to 23 nm, were synthesized by thermal decomposition and then coated with dimercaptosuccinic acid and functionalized with neutravidin protein. We tested the system by immobilizing biotin in lateral flow membrane strips. When a sample containing the particles flows along the membrane, the biotin captures the neutravidin together with the magnetic nanotags, which are detected by the inductive sensor. The optimal nanotag core size is the critical threshold for superparamagnetic behavior, which maximizes both the initial magnetic permeability and the saturation magnetization. Controlled agglomeration of the nanotags increases the magnetic mass captured in the test line and further amplifies the signal.

Risk factors and management of incisional hernia after cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal surface malignancies.

BACKGROUND: The incidence of incisional hernia in patients with peritoneal surface malignancies treated by cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) remains unclear, and the criteria commonly used to indicate their repair cannot be applied in these patients. The objective of this work was to analyze the incidence of incisional hernias in these patients, identify the risk factors associated with their appearance, and propose an algorithm for their management. METHODS: We analyzed a series of patients with malignant pathologies of the peritoneal surface treated by cytoreduction with peritonectomy and HIPEC procedures between January 2008 and June 2017. Only patients with a minimum postoperative follow-up period of 12 months were included. RESULTS: Our series included 282 patients, 28 (10%) of whom developed an incisional hernia during the follow-up period. Fifty-one patients, all with ovarian cancer with peritoneal dissemination, did not receive HIPEC after cytoreduction as they were part of the control arm of the CARCINOHIPEC clinical trial (NCT02328716) or because they did not provide specific informed consent. In the multivariate analysis, treatment with HIPEC (OR 2.56, 95% CI [1.57, 4.31], p = 0.032) and the administration of preoperative systemic chemotherapy (OR = 1.59, 95% CI [1.26, 3.58], p = 0.041) were found to be independent factors related to the appearance of an incisional hernia. CONCLUSIONS: The incidence of incisional hernia after cytoreduction and HIPEC is within the ranges described in the literature for other abdominal surgery procedures. The use of systemic chemotherapy and treatment with HIPEC, in particular, were identified as factors related to their occurrence.

Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors

Purpose. The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. Methods. We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. Results. 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. Conclusion. Despite FN’s clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN (AU)

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Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors.

PURPOSE: The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. METHODS: We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. RESULTS: 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. CONCLUSION: Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.

A lock-in-based method to examine the thermal signatures of magnetic nanoparticles in the liquid, solid and aggregated states.

We propose a new methodology based on lock-in thermography to study and quantify the heating power of magnetic nanoparticles. Superparamagnetic iron oxide nanoparticles exposed to a modulated alternating magnetic field were used as model materials to demonstrate the potency of the system. Both quantitative and qualitative information on their respective heating power was extracted at high thermal resolutions under increasingly complex conditions, including nanoparticles in the liquid, solid and aggregated states. Compared to conventional techniques, this approach offers a fast, sensitive and non-intrusive alternative to investigate multiple and dilute specimens simultaneously, which is essential for optimizing and accelerating screening procedures and comparative studies.

Dynamic network modelling to understand flowering transition and floral patterning.

Differentiation and morphogenetic processes during plant development are particularly robust. At the cellular level, however, plants also show great plasticity in response to environmental conditions, and can even reverse apparently terminal differentiated states with remarkable ease. Can we understand and predict both robust and plastic systemic responses as a general consequence of the non-trivial interplay between intracellular regulatory networks, extrinsic environmental signalling, and tissue-level mechanical constraints? Flower development has become an ideal model system to study these general questions of developmental biology, which are especially relevant to understanding stem cell patterning in plants, animals, and human disease. Decades of detailed study of molecular developmental genetics, as well as novel experimental techniques for in vivo assays in both wild-type and mutant plants, enable the postulation and testing of experimentally grounded mathematical and computational network dynamical models. Research in our group aims to explain the emergence of robust transitions that occur at the shoot apical meristem, as well as flower development, as the result of the collective action of key molecular components in regulatory networks subjected to intra-organismal signalling and extracellular constraints. Here we present a brief overview of recent work from our group, and that of others, focusing on the use of simple dynamical models to address cell-fate specification and cell-state stochastic dynamics during flowering transition and cell-state transitions at the shoot apical meristem of Arabidopsis thaliana. We also focus on how our work fits within the general field of plant developmental modelling, which is being developed by many others.

A pandemic Vibrio parahaemolyticus O3:K6 clone causing most associated diarrhea cases in the Pacific Northwest coast of Mexico.

Between September and October of 2004, more than 1230 cases of gastroenteritis due to pandemic O3:K6 strains of Vibrio parahaemolyticus (V. parahaemolyticus) were reported in the relatively small geographical area of Southern Sinaloa, a state located in Northwest Mexico. Since then, V. parahaemolyticus-associated gastroenteritis cases have gradually increased in prevalence spreading from south to north. The present study conducted an epidemiological surveillance of V. parahaemolyticus strains in both environmental and clinical samples along the Pacific coast of Sinaloa from 2011 to 2013. The genetic relatedness, serotype dominance and antibiotic resistance of isolates were investigated. A total of 46 strains were isolated from environmental samples (e.g., sediment, seawater and shrimp), whereas 249 strains were obtained from stools of patients with gastroenteritis. Nine different O serogroups and 16 serovars were identified. Serovars O3:K6 and O6:K46 were identified in both environmental and clinical strains. Whereas most environmental isolates carried the tdh gene (71.74%, 33/46), only three (6.52%) belonged to pandemic clones (O3:K6, O3:KUT and OUT:KUT). In contrast, 81.1% (202/249) of clinical isolates belonged to pandemic serotypes, with O3:K6 (tdh, toxRS/new, and/or orf8) representing the predominant serovar (97%, 196/202). This prevalence of pathogenic (tdh and/or trh positive) and O3:K6 pandemic V. parahaemolyticus isolates in this study were similar to those found from 2004 to 2010. As investigated by REP-PCR, genetic lineages of selected O3:K6 strains isolated in this study and some isolated earlier were nearly identical. Antimicrobial susceptibility testing showed that most strains (93.8%) were resistant to ampicillin but sensitive to chloramphenicol (98.8%). Multidrug resistance significantly increased from 8.6% (2004-2010) to 22.93% (2011-2013; p < 0.05). Our data indicate that pandemic O3:K6 clone has endemically established in the Pacific Coast of Mexico.

Descriptive vs. mechanistic network models in plant development in the post-genomic era.

Network modeling is now a widespread practice in systems biology, as well as in integrative genomics, and it constitutes a rich and diverse scientific research field. A conceptually clear understanding of the reasoning behind the main existing modeling approaches, and their associated technical terminologies, is required to avoid confusions and accelerate the transition towards an undeniable necessary more quantitative, multidisciplinary approach to biology. Herein, we focus on two main network-based modeling approaches that are commonly used depending on the information available and the intended goals: inference-based methods and system dynamics approaches. As far as data-based network inference methods are concerned, they enable the discovery of potential functional influences among molecular components. On the other hand, experimentally grounded network dynamical models have been shown to be perfectly suited for the mechanistic study of developmental processes. How do these two perspectives relate to each other? In this chapter, we describe and compare both approaches and then apply them to a given specific developmental module. Along with the step-by-step practical implementation of each approach, we also focus on discussing their respective goals, utility, assumptions, and associated limitations. We use the gene regulatory network (GRN) involved in Arabidopsis thaliana Root Stem Cell Niche patterning as our illustrative example. We show that descriptive models based on functional genomics data can provide important background information consistent with experimentally supported functional relationships integrated in mechanistic GRN models. The rationale of analysis and modeling can be applied to any other well-characterized functional developmental module in multicellular organisms, like plants and animals.

Cu impedance-based detection of superparamagnetic nanoparticles.

A novel method for superparamagnetic nanoparticle detection using copper impedance as the sensing property is presented. The increase of impedance produced by the proximity of the nanoparticles in the copper is comparable to that of classical magnetoimpeditive materials. A physical interpretation of the detection in terms of the induction of eddy currents in the copper element by the oscillating magnetic moments of the particles is proposed. Experimental research has been done to support this hypothesis, namely, analyses of the influence of the driving current frequency and amplitude, and of the geometry and size of the sensing conductor. The ability of copper to quantify the number of nanoparticles was successfully verified, evidencing the great potential of this new method.

Disentangling molecular motions involved in the glass transition of a twist-bend nematic liquid crystal through dielectric studies.

Broadband dielectric spectroscopy spanning frequencies from 10(-2) to 1.9 × 10(9) Hz has been used to study the molecular orientational dynamics of the glass-forming liquid crystal 1",7"-bis (4-cyanobiphenyl-4'-yl)heptane (CB7CB) over a wide temperature range of the twist-bend nematic phase. In such a mesophase two different relaxation processes have been observed, as expected theoretically, to contribute to the imaginary part of the complex dielectric permittivity. For measurements on aligned samples, the processes contribute to the dielectric response to different extents depending on the orientation of the alignment axis (parallel or perpendicular) with respect to the probing electric field direction. The low-frequency relaxation mode (denoted by µ(1)) is attributed to a flip-flop motion of the dipolar groups parallel to the director. The high-frequency relaxation mode (denoted by µ(2)) is associated with precessional motions of the dipolar groups about the director. The µ(1)-and µ(2)-modes are predominant in the parallel and perpendicular alignments, respectively. Relaxation times for both modes in the different alignments have been obtained over a wide temperature range down to near the glass transition temperature. Different analytic functions used to characterize the temperature dependence of the relaxation times of the two modes are considered. Among them, the critical-like description via the dynamic scaling model seems to give not only quite good numerical fittings, but also provides a consistent physical picture of the orientational dynamics on approaching the glass transition.

Prevalence for the universal distribution of relaxation times near the glass transitions in experimental model systems: rodlike liquid crystals and orientationally disordered crystals.

Recently, Nielsen et al. [J. Chem. Phys. 130, 154508 (2009); Philos. Mag. 88, 4101 (2008)] demonstrated a universal pattern for the high frequency wing of the loss curve for primary relaxation time on approaching the glass transition for organic liquids. In this contribution it is presented that a similar universality occurs for glass-forming liquid crystals and orientationally disordered crystals (plastic crystals). Empirical correlations of the found behavior are also briefly discussed.

Enthalpy space analysis of the evolution of the primary relaxation time in ultraslowing systems.

For decades the Vogel-Fulcher-Tammann equation has dominated the description of dynamics of the non-Arrhenius behavior in glass forming systems. Recently, this dominance has been questioned. Hecksher et al. [Nat. Phys. 4, 737 (2008)], Elmatad et al. [J. Phys. Chem. B 113, 5563 (2009)], and Mauro et al. [Proc. Natl. Acad. Sci. U.S.A. 106, 19780 (2009)] indicated superiority of several equations showing no divergence at a finite (nonzero) temperature. This paper shows distortion-sensitive and derivative based empirical analysis of the validity of leading equations for portraying the previtreous evolution of primary relaxation time.

Alpha-relaxation dynamics of orientanionally disordered mixed crystals composed of Cl-adamantane and CN-adamantane.

The alpha-relaxation dynamics of 1-cyano-adamantane (CNA) and its mixtures with 1-chloro-adamantane (ClA) has been studied by means of broadband dielectric spectroscopy. The existence of orientationally disordered (OD) face centered cubic mixed crystals (ClA(1-X)CNA(X)) for 0.5 < or = X < or = 1 has been put in evidence by thermodynamics and structural analyses. In addition to the OD phase of CNA, mixed crystals with compositions higher than the equimolar one exhibit a freezing of the orientational degrees of freedom into a glassy state, which involves also a strong increase of the antiferroelectric order at temperatures higher than the dielectric glass transition temperature. This experimental evidence is revealed by a stairlike effect in the variation of the Kirkwood factor with the temperature as a consequence of a twin effect in the dielectric strength without any anomaly in the temperature-density curves. The characteristic relaxation times are analyzed as a function of temperature and mole fraction. By setting a common temporal origin ("isochronal origin") at tau(T(g)) = 100 s for each mole fraction, it emerges that the substitution of ClA molecules by those of CNA (diminution of X) gives rise to a slow down in the dynamics, despite that the molecular volume of ClA molecules are smaller than those of CNA. This fact goes along and is accompanied by a diminution of the lattice packing with the decrease of composition. It is also shown that the heterogeneities produced by the concentration fluctuations due to the chemical disorder are the main contribution to the non-exponential character of the alpha-relaxation peaks.

Scaling the dynamics of orientationally disordered mixed crystals.

The evolution of the primary relaxation time of orientationally disordered (OD) mixed crystals [(CH(3))(2)C(CH(2)OH)(2)](1-X)[(CH(3))C(CH(2)OH)(3)](X), with 0 < X < or = 0.5, on approaching the glass temperature (T(g)) is discussed. The application of the distortion-sensitive, derivative-based procedure revealed a limited adequacy of the Vogel-Fulcher-Tammann parametrization and a superiority of the critical-like description tau proportional to (T - T(C))(-phi(') ), phi(') = 9-11.5, and T(C) approximately T(g) - 10 K. Basing on these results as well as that of Drozd-Rzoska et al. [J. Chem. Phys. 129, 184509 (2008)] the question arises whether such behavior may be suggested as the optimal universal pattern for dynamics in vitrifying OD crystals (plastic crystals). The obtained behavior is in fair agreement with the dynamic scaling model (DSM) [R. H. Colby, Phys. Rev. E 61, 1783 (2000)], originally proposed for vitrifying molecular liquids and polymers. The application of DSM made it possible to estimate the size of the cooperatively rearranging regions ("heterogeneities") in OD phases near T(g).

[How should the response to osteoporosis treatment be evaluated?]. / Cómo valorar la respuesta al tratamiento de la osteoporosis.

Osteoporosis is a disease with high morbidity-mortality that is important because it predisposes to fractures. Thus, treatment of this disease is aimed at preventing them. However, and in spite of the fact that the fracture is the truly important consequence of therapeutic failure, it should not be considered to be an exponent of it given that it may be due to factors not related with lack of response such as intrinsic predisposition of the disease to development of fractures or being prone to falls. Thus, as occurs in other diseases such as cardiovascular ones, we must use other variables to evaluate the therapeutic response (surrogated variables), which, in the case of osteoporosis, are bone mineral density (BMD) and bone remodeling markers (BRM). BMD is the closest surrogated markers we have. The current drugs not only decrease the risk of fractures but increase bone mass. However, it must be remembered that changes in BMD are generally late (1-2 years) and that there is controversy about which criterion should be used to define what variation of it can be considered significant (loss of bone mass regarding baseline value?, loss of bone mass greater than the minimum significant change?). Finally, some of the drugs used in the treatment of osteoporosis, specifically anti-resorptive ones, reduce the remodeling markers intensely and early so that they could be useful as complement of BMD, although the variability of the results obtained in the daily clinical practice limit their utility.

Fractura de la diáfisis del radio en un varón de 31 años / Radius shaft fracture in a 31-year old man

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