Surveillance for pancreatic cancer in high-risk individuals

Background: Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes. Methods: A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter. Results: Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality. Conclusion: A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC

Changes in wood anatomy in tree rings of Pinus pinaster Ait. following wounding by flash floods

This paper analyzes the anatomical response of Pinus pinaster Ait. following wounding by flash floods. A total of 14 wood samples were taken from 14 different scarred trees located on the river banks of the Arroyo Cabrera torrent (Spanish Central System). In addition, 20 increment cores were collected from undisturbed and healthy P. pinaster trees to build a local reference chronology. For the injured trees, analysis focused on growth changes in early earlywood (EE) tracheids, namely on differences in (i) lumen size; (ii) cell-wall percentage and cell-wall thickness; (iii) radial length and tangential width of tracheids; as well as (iv) in the abundance of resin ducts in earlywood (EW) and latewood (LW) following wounding. Results indicate that tissues bordering flash-flood wounds are characterized by reduced growth rates and a decrease of EE tracheid lumen area by 51%. In addition, cell-wall percentage increases by 34% in the increment rings formed after the event and significant changes are observed in the radial length and tangential width of EE tracheids. Observations on resin ducts do not yield any significant results. Based on these anatomical parameters, detecting and dating past flash-flood events in growth rings is now possible for Mediterranean species, specifically P. pinaster

Calibration of floodplain roughness and estimation of palaeoflood discharge based on tree-ring evidence and hydraulic modeling

The roughness calibration of floodplain and channels represents an important issue for flood studies. This paper discusses the genesis of scars on trees and their use as benchmarks in roughness calibration. In addition, it presents a methodology to reconstruct unrecorded flood discharge in the Alberche basin of the Spanish Central System. The study is based on the combined use of dendrogeomorphic evidence (i.e. scars on trees), data from the Navaluenga flow gauge (Avila Province) as well as a 1D/2D coupled numerical hydraulic model. A total of 49 scars have been analyzed with dendrogeomorphic techniques. Scar dates are in concert with seven flood events documented in the systematic record (i.e. 1989, 1993, 1996, 2000, 2002, 2003, and 2005). We were also able to identify an additional event dated to 1970, which is before the flow gauge was installed at Navaluenga. Based on the rating curve obtained from the flow gauge, cross-sectional area and data from hydraulic modelling, we cannot find a statistically significant difference between water depths registered at the flow gauge and scar heights on trees (p-value > 0.05), indicating that scars would have been generated through the impact of floating wood and that scars on trees would represent a valuable and accurate proxy for water depth reconstruction. Under this premise, we have estimated the peak discharge of the 1970 flood event to 1684.3 ± 519.2 m3 s−1; which renders this event the largest documented flood for the Alberche River at Navaluenga. In a last analytical step, we discuss the use of scars on trees as benchmark for roughness calibration in ungauged or shortly recorded basins and address the added value of dendrogeomorphic data in flood frequency analysis

Precision of estimating equations for GFR in children with a solitary functioning kidney: the KIMONO study.

Item does not contain fulltextBACKGROUND AND OBJECTIVE: Children with a solitary functioning kidney may develop CKD. Although widely used, equations to estimate GFR are not validated in these patients. This study sought to determine the precision of common estimating equations in the KIMONO (KIdney of MONofunctional Origin) cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Two creatinine-based (estimated GFR [eGFR]-Schwartz, urinary creatinine clearance), two cystatin C-based (eGFR-Zappitelli1, eGFR-CKiD [Chronic Kidney Disease in Children] 1), and two cystatin C/creatinine-based (eGFR-Zappitelli2, eGFR-CKiD2) estimates were compared with the gold standard GFR measured by inulin single injection (GFR-inulin) in 77 children with a solitary functioning kidney (time span of assembly, 2005-2012). Included patients were 1.5-19.8 years of age. Kidney Disease Outcomes Quality Initiative (K/DOQI) classification was compared between GFR-inulin and eGFR methods to analyze misclassification by estimating equations. RESULTS: The eGFR-CKiD2 equation performed best in children with a solitary functioning kidney (mean bias, -0.9 ml/min per 1.73 m(2); 95% and 54% of values within +/-30% and +/-10% of GFR-inulin, respectively). Mean bias for eGFR-Schwartz was 0.4 ml/min per 1.73 m(2), with 90% and 33% of values within +/-30% and +/-10% of GFR-inulin, respectively. For all estimates, misclassification in K/DOQI stage ranged from 22% (eGFR-Zappitelli1) to 44% (urinary creatinine clearance) of children. CONCLUSIONS: Use of a combined serum cystatin C/creatinine-based equation (eGFR-CKiD2) is recommended to monitor renal function in children with a solitary functioning kidney. When cystatin C is not routinely available, eGFR-Schwartz should be used. Misclassification in K/DOQI-stage remains a caveat for all equations.1 mei 201

Gully evolution and geomorphic adjustments of badlands to reforestation

International audienceBadlands and gullied areas are among those geomorphic environments with the highest erosion rates worldwide. Nevertheless, records of their evolution and their relations with anthropogenic land transformation are scarcer. Here we combine historical data with aerial photographs and tree-ring records to reconstruct the evolution of a badland in a Mediterranean environment of Central Spain. Historical sources suggest an anthropogenic origin of this badland landscape, caused by intense quarrying activities during the 18th century. Aerial photographs allowed detection of dramatic geomorphic changes and the evolution of an emerging vegetation cover since the 1960s, due to widespread reforestation. Finally, tree-ring analyses of exposed roots allowed quantification of recent channel incision of the main gully, and sheet erosion processes. Our results suggest that reforestation practices have influenced the initiation of an episode of incision in the main channel in the 1980s, through the hypothesized creation of disequilibrium in water-sediment balance following decoupling of hillslopes from channel processes. These findings imply an asymmetry in the geomorphic response of badlands to erosion such that in the early evolution stages, vegetation removal results in gullying, but that reforestation alone does not necessarily stabilize the landforms and may even promote renewed incision