Radioterapia en cáncer de recto localmente avanzado: situación actual y desarrollo terapéutico

La radioterapia es uno de los elementos integrantes del tratamiento radical del cáncer de recto localmente avanzado. La radioterapia preoperatoria y la radioterapia postoperatoria en combinación con quimioterapia han demostrado aumento del control local y la supervivencia. La tendencia actual es el uso de quimioirradiación preoperatoria por su mejor tolerancia y porque a los beneficios en control local y supervivencia se le podrían añadir los de mayor tasa de respuesta (downstaging) y un aumento de cirugía preservadora del esfínter anal. El desarrollo terapéutico en cáncer de recto localmente avanzado se sitúa en conseguir una mayor intensificación terapéutica sobre el tumor y las regiones de riesgo de recidiva sin aumentar la toxicidad sobre los tejidos sanos: esquemas de radioterapia con fraccionamientos modificados, radioterapia intraoperatoria, radioterapia con intensidad modulada de dosis, nuevos agentes quimioterápicos en combinación con radioterapia. En el presente artículo se revisan los datos más relevantes de esta modalidad terapéutica.Radiotherapy is one of the integral elements of the radical treatment of locally advanced rectal cancer. Combined chemotherapy and postoperative radiotherapy or preoperative radiotherapy has demonstrated an increase in local control and survival. The present trend is the use of preoperative chemoradiotherapy: this scheme seems to have a better tolerance and downstaging with an increase in sphincter-preserving surgery rates. Current therapeutic development in locally advanced rectal cancer focuses on obtaining a greater therapeutic ratio: with modified fractionation, intraoperative radiation therapy, intensity modulated radiation therapy, new chemoradiation regimens. The present work reviews the state of the art and the most significant advances in radiation in rectal cancer

The plant traits that drive ecosystems: Evidence from three continents.

Question: A set of easily‐measured (‘soft’) plant traits has been identified as potentially useful predictors of ecosystem functioning in previous studies. Here we aimed to discover whether the screening techniques remain operational in widely contrasted circumstances, to test for the existence of axes of variation in the particular sets of traits, and to test for their links with ‘harder’ traits of proven importance to ecosystem functioning. Location: central‐western Argentina, central England, northern upland Iran, and north‐eastern Spain. Recurrent patterns of ecological specialization: Through ordination of a matrix of 640 vascular plant taxa by 12 standardized traits, we detected similar patterns of specialization in the four floras. The first PCA axis was identified as an axis of resource capture, usage and release. PCA axis 2 appeared to be a size‐related axis. Individual PCA for each country showed that the same traits remained valuable as predictors of resource capture and utilization in all of them, despite their major differences in climate, biogeography and land‐use. The results were not significantly driven by particular taxa: the main traits determining PCA axis 1 were very similar in eudicotyledons and monocotyledons and Asteraceae, Fabaceae and Poaceae. Links between recurrent suites of ‘soft’ traits and ‘hard’ traits: The validity of PCA axis 1 as a key predictor of resource capture and utilization was tested by comparisons between this axis and values of more rigorously established predictors (‘hard’ traits) for the floras of Argentina and England. PCA axis 1 was correlated with variation in relative growth rate, leaf nitrogen content, and litter decomposition rate. It also coincided with palatability to model generalist herbivores. Therefore, location on PCA axis 1 can be linked to major ecosystem processes in those habitats where the plants are dominant. Conclusion: We confirm the existence at the global scale of a major axis of evolutionary specialization, previously recognised in several local floras. This axis reflects a fundamental trade‐off between rapid acquisition of resources and conservation of resources within well‐protected tissues. These major trends of specialization were maintained across different environmental situations (including differences in the proximate causes of low productivity, i.e. drought or mineral nutrient deficiency). The trends were also consistent across floras and major phylogenetic groups, and were linked with traits directly relevant to ecosystem processes.Fil: Díaz, Sandra Myrna. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Hodgson, J.G.. The University. Department of Animal and Plant Sciences. Unit of Comparative Plant Ecology; Reino UnidoFil: Thompson, K.. The University. Department of Animal and Plant Sciences. Unit of Comparative Plant Ecology; Reino UnidoFil: Cabido, Marcelo Ruben. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Cornelissen, Johannes H. C.. Free University. Faculty Earth and Life Sciences. Department of Systems Ecology; Países BajosFil: Funes, Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Pérez Harguindeguy, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Vendramini, Fernanda. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Falczuk, Valeria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Zak, Marcelo Román. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Khoshnevi, M.. Research Institute of Forests and Rangelands; IránFil: Pérez Rontomé, M. C.. Instituto Pirenaico de Ecología; EspañaFil: Shirvani, F. A.. Research Institute of Forests and Rangelands; IránFil: Yazdani, S.. Research Institute of Forests and Rangelands; IránFil: Abbas Azimi, R. Research Institute of Forests and Rangelands; IránFil: Bogaard, A. The University. Department of Archaeology and Prehistory; Reino UnidoFil: Boustani, S.. Research Institute of Forests and Rangelands; IránFil: Charles, M.. The University. Department of Archaeology and Prehistory; Reino UnidoFil: Dehghan, M.. Research Institute of Forests and Rangelands; IránFil: de Torres Espuny, L.. Instituto Pirenaico de Ecología; EspañaFil: Guerrero Campo, J.. Instituto Pirenaico de Ecología; EspañaFil: Hynd, A.. The University. Department of Archaeology and Prehistory; Reino UnidoFil: Jones, G.. The University. Department of Archaeology and Prehistory; Reino UnidoFil: Kowsary, E.. Research Institute of Forests and Rangelands; Irán. Instituto Pirenaico de Ecología; EspañaFil: Kazemi Saeed, F.. Research Institute of Forests and Rangelands; IránFil: Maestro Martínez, M.. Instituto Pirenaico de Ecología; EspañaFil: Romo Diez, A.. Instituto Botanico de Barcelona; EspañaFil: Shaw, S.. Research Institute of Forests and Rangelands; Irán. The University. Department of Animal and Plant Sciences; Reino UnidoFil: Siavash, B.. Research Institute of Forests and Rangelands; IránFil: Villar Salvador, P.. Instituto Pirenaico de Ecología; Españ

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Preoperative medical treatment in Cushing's syndrome : frequency of use and its impact on postoperative assessment : data from ERCUSYN

Background: Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. Objective: (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). Patients and methods: 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS). Results: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (P < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (P < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (P < 0.01) and a lower remission rate (P < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results

Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

Search for resonances decaying into photon pairs in 139 fb−1 of pp collisions at √s = 13 TeV with the ATLAS detector

Searches for new resonances in the diphoton final state, with spin 0 as predicted by theories with an extended Higgs sector and with spin 2 using a warped extra-dimension benchmark model, are presented using 139 fb−1 of √s = 13 TeV pp collision data collected by the ATLAS experiment at the LHC. No significant deviation from the Standard Model is observed and upper limits are placed on the production cross-section times branching ratio to two photons as a function of the resonance mass