Clinical guideline SEOM: cancer of unknown primary site

Cancer of unknown primary site is a histologically confirmed cancer which is manifested in advanced stage, with no identifiable primary site after the use of standard diagnostic procedures. Patients are initially placed into one of categories based upon the examination of the initial biopsy: adenocarcinoma, squamous cell carcinoma, neuroendocrine carcinoma and poorly differentiated carcinoma. Appropriate patient management requires an understanding of several clinicopathologic features that help to identify several subsets of patients with more responsive tumors

Implementación de una estructura neuronal celular en hardware reconfigurable

El siguiente artículo presenta el diseño e implementación de una red neuronal celular (CNN) desarrollado en dispositivos reconfigurables FPGA con aplicaciones para procesamiento digital de imágenes en escala de grises a ocho bits y dimensión M x N.La CNN es capaz de hacer el procesamiento mediante una exploración sobre todo el patrón de entrada, desplazando por bloques la matriz para procesar la imagen. La red propuesta consiste en una matriz de 24 elementos de procesamiento, constituidos por unidades aritméticas independientes que determinan su valor, colocados en una malla rectangular de cuatro filas por seis columnas. Se describe un conjunto de enlaces programables que permiten modificar la salida mediante el tipo de conectividad definido.El diseño fue desarrollado utilizando lenguaje de descripción de hardware VHDL. La implementación se realizó en un dispositivo FPGA Xilinx® de la familia Virtex-6. Se muestra la simulación, así como los resultados en área de ocupación y latencia.Palabra(s) Clave(s): CNN, FPGA, procesamiento digital de imágenes

A Speed Bump: SN 2021aefx Shows that Doppler Shift Alone Can Explain Early Excess Blue Flux in Some Type Ia Supernovae

We present early-time photometric and spectroscopic observations of the Type Ia supernova (SN Ia) 2021aefx. The early-time u-band light curve shows an excess flux when compared to normal SNe Ia. We suggest that the early excess blue flux may be due to a rapid change in spectral velocity in the first few days post explosion, produced by the emission of the Ca ii H&K feature passing from the u to the B bands on the timescale of a few days. This effect could be dominant for all SNe Ia that have broad absorption features and early-time velocities over 25,000 km s. It is likely to be one of the main causes of early excess u-band flux in SNe Ia that have early-time high velocities. This effect may also be dominant in the UV filters, as well as in places where the SN spectral energy distribution is quickly rising to longer wavelengths. The rapid change in velocity can only produce a monotonic change (in flux-space) in the u band. For objects that explode at lower velocities, and have a more structured shape in the early excess emission, there must also be an additional parameter producing the early-time diversity. More early-time observations, in particular early spectra, are required to determine how prominent this effect is within SNe Ia.C.A. and B.J.S. are supported by NSF grants AST-1907570, AST-1908952, AST-1920392, and AST-1911074. M.D.S. is funded in part by an Experiment grant (No. 28021) from the Villum FONDEN, and by a project 1 grant (No. 8021-00170B) from the Independent Research Fund Denmark (IRFD). P.H. acknowledges support by National Science Foundation (NSF) grant AST- 1715133. E.B. and J.D. are supported in part by NASA grant 80NSSC20K0538. This work has been generously supported by the National Science Foundation under grants AST-1008343, AST-1613426, AST-1613455, and AST1613472. This paper includes data gathered with the 6.5 meter Magellan Telescopes located at the Las Campanas Observatory, Chile. We would like to thank the technical staff for constant support for observations on the Swope telescope. The early-time spectrum that was critical for this analysis came from SALT through Rutgers University time via program 2021-1-MLT-007 (PI: Jha). L.G. acknowledges financial support from the Spanish Ministerio de Ciencia e Innovación (MCIN), the Agencia Estatal de Investigación (AEI) 10.13039/501100011033, and the European Social Fund (ESF) "Investing in your future" under the 2019 Ramón y Cajal program RYC2019-027683-I and the PID2020-115253GA-I00 HOSTFLOWS project, from Centro Superior de Investigaciones Científicas (CSIC) under the PIE project 20215AT016, and the program Unidad de Excelencia María de Maeztu CEX2020-001058-M

Apex scavengers from different European populations converge at threatened savannah landscapes

Over millennia, human intervention has transformed European habitats mainly through extensive livestock grazing. “Dehesas/Montados” are an Iberian savannah-like ecosystem dominated by oak-trees, bushes and grass species that are subject to agricultural and extensive livestock uses. They are a good example of how large-scale, low intensive transformations can maintain high biodiversity levels as well as socio-economic and cultural values. However, the role that these human-modified habitats can play for individuals or species living beyond their borders is unknown. Here, using a dataset of 106 adult GPS-tagged Eurasian griffon vultures (Gyps fulvus) monitored over seven years, we show how individuals breeding in western European populations from Northern, Central, and Southern Spain, and Southern France made long-range forays (LRFs) of up to 800 km to converge in the threatened Iberian “dehesas” to forage. There, extensive livestock and wild ungulates provide large amounts of carcasses, which are available to scavengers from traditional exploitations and rewilding processes. Our results highlight that maintaining Iberian “dehesas” is critical not only for local biodiversity but also for long-term conservation and the ecosystem services provided by avian scavengers across the continent

A randomized study of nutritional supplementation in patients with unilateral wet age-related macular degeneration

The purpose of this study is evaluate the efficacy and safety of medicinal products con-taining the original Age-Related Eye Disease group (AREDS) formulation at doses approved in Europe (EU, control group; n = 59) with a product that adds DHA, lutein, zeaxanthin, resveratrol and hydroxytyrosol to the formula (intervention group; n = 50). This was a multicenter, random-ized, observer-blinded trial conducted in patients aged 50 years or older diagnosed with unilateral exudative Age related Macular Degeneration AMD. At month 12, the intervention did not have a significant differential effect on visual acuity compared with the control group, with an estimated treatment difference in Early Treatment Diabetic Retinopathy Study (ETDRS) of -1.63 (95% CI -0.83 to 4.09; p = 0.192). The intervention exhibited a significant and, in most cases, relevant effect in terms of a reduction in some inflammatory cytokines and a greater improvement in the fatty acid profile and serum lutein and zeaxantin concentration. In patients with unilateral wet AMD, the addition of lutein, zeaxanthin, resveratrol, hydroxytyrosol and DHA to the AREDS EU recommended doses in the short-term did not have a differential effect on visual acuity compared to a standard AREDS EU formula but, in addition to improving the fatty acid profile and increasing carotenoid serum levels, may provide a beneficial effect in improving the proinflammatory and proangiogenic profile of patients with AMD. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Options for agriculture at Marrakech climate talks: messages for SBSTA 45 agriculture negotiators

SBSTA 45 in Marrakech represents a unique opportunity for Parties to decide on the future of agriculture within the UNFCCC. The process of discussions on issues related to agriculture initiated at COP17 in Durban 2011 culminates at COP22 in Marrakech 2016. The explicit reference to food security in the preamble of the Paris Agreement and the Intended Nationally Determined Contributions which prioritize agriculture as a sector for adaptation and mitigation actions, provide a foundation for Parties to develop appropriate frameworks to support actions within the agricultural sector. SBSTA workshops on agriculture in 2015 and 2016 allowed Parties to share experiences, identify priorities, and propose ways of taking action within the agricultural sector and so provide the core knowledge base to work from. As Parties reach a decision on issues related to agriculture at SBSTA 45, a number of options are available. This report presents ten such options that might contribute to a decision, taking into consideration political priorities, implementation arrangements, timelines and level of ambition. Options outlined in this report are not mutually exclusive and can be combined in many different ways

Capecitabine and bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer

BACKGROUND: The efficacy and safety of capecitabine and bevacizumab in elderly patients with metastatic colorectal cancer (mCRC) considered unsuitable for receiving first-line chemotherapy with an irinotecan or oxaliplatin-based combination were assessed in a phase II, open, multicentre, uncontrolled study. METHODS: Treatment consisted of capecitabine 1250 mgm 2 (or 950 mgm 2 for patients with a creatinine clearance of 30–50ml min 1) twice daily on days 1–14 and bevacizumab (7.5 mg kg 1) on day 1 every 3 weeks. RESULTS: A total of 59 patients aged X70 years with mCRC were enrolled. In an intention-to-treat analysis, the overall response rate was 34%, with 71% of patients achieving disease control. Median progression-free survival and overall survival were 10.8 months and 18 months, respectively. In all, 32 patients (54%) had grade 3/4 adverse events (AEs), the most common being hand–foot syndrome (19%), diarrhoea (9%) and deep venous thrombosis (7%). Four patients died because of treatment-related AEs. A relationship was detected between creatinine clearance p50 ml min 1 and the development of non-bevacizumab-related grade 3/4 AEs. The incidence of bevacizumab-associated AEs (hypertension, thromboembolic events and proteinuria) was consistent with that of previous reports in elderly patients. CONCLUSION: Bevacizumab combined with capecitabine represents a valid therapeutic alternative in elderly patients considered to be unsuitable for receiving polychemotherapy.This study was supported by Hoffmann-La Roche, Nutley, NJ, USA

Towards a better characterisation of deep-diving whales’ distributions by using prey distribution model outputs?

In habitat modelling, environmental variables are assumed to be proxies of lower trophic levels distribution and by extension, of marine top predator distributions. More proximal variables, such as potential prey fields, could refine relationships between top predator distributions and their environment. In situ data on prey distributions are not available over large spatial scales but, a numerical model, the Spatial Ecosystem And POpulation DYnamics Model (SEAPODYM), provides simulations of the biomass and production of zooplankton and six functional groups of micronekton at the global scale. Here, we explored whether generalised additive models fitted to simulated prey distribution data better predicted deepdiver densities (here beaked whales Ziphiidae and sperm whales Physeter macrocephalus) than models fitted to environmental variables. We assessed whether the combination of environmental and prey distribution data would further improve model fit by comparing their explanatory power. For both taxa, results were suggestive of a preference for habitats associated with topographic features and thermal fronts but also for habitats with an extended euphotic zone and with large prey of the lower mesopelagic layer. For beaked whales, no SEAPODYM variable was selected in the best model that combined the two types of variables, possibly because SEAPODYM does not accurately simulate the organisms on which beaked whales feed on. For sperm whales, the increase model performance was only marginal. SEAPODYM outputs were at best weakly correlated with sightings of deep-diving cetaceans, suggesting SEAPODYM may not accurately predict the prey fields of these taxa. This study was a first investigation and mostly highlighted the importance of the physiographic variables to understand mechanisms that influence the distribution of deep-diving cetaceans. A more systematic use of SEAPODYM could allow to better define the limits of its use and a development of the model that would simulate larger prey beyond 1,000 m would probably better characterise the prey of deep-diving cetaceans.En prens

Correcting non cephalic presentation with moxibustion: study protocol for a multi-centre randomised controlled trial in general practice

<p>Abstract</p> <p>Background</p> <p>Non cephalic presentation in childbirth involves various risks to both the mother and the foetus. The incidence in Spain is 3.8% of all full-term pregnancies. The most common technique used to end the gestation in cases of non cephalic presentation is that of caesarian section, and although it provokes a lower rate of morbi-mortality than does vaginal delivery in such situations, there remains the possibility of traumatic injury to the foetal head and neck, while maternal morbidity is also increased. The application of heat (moxibustion) to an acupuncture point, in order to correct non cephalic presentation, has been practised in China since ancient times, but as yet there is insufficient evidence of its real effectiveness.</p> <p>Methods/Design</p> <p>The experimental design consists of a multi-centre randomised controlled trial with three parallel arms, used to compare real moxibustion, sham moxibustion and the natural course of events, among pregnant women with a non cephalic presentation and a gestational duration of 33–35 weeks (estimated by echography). The participants in the trial will be blinded to both interventions. The results obtained will be analyzed by professionals, blinded with respect to the allocation to the different types of intervention. In addition, we intend to carry out a economic analysis.</p> <p>Discussion</p> <p>This trial will contribute to the development of evidence concerning moxibustion in the correction of non cephalic presentations. The primary outcome variable is the proportion of cephalic presentations at term. As secondary outcomes, we will evaluate the proportion of cephalic presentations at week 38 of gestation, determined by echography, together with the safety of the technique, the specificity of moxibustion and the control of the blinding process.</p> <p>This study has been funded by the Health Ministry of the Andalusian Regional Government.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN10634508.</p