SEOM clinical guideline for the diagnosis and treatment of gastric cancer (GC) and gastroesophageal junction adenocarcinoma (GEJA) (2019)

Gastric cancer (GC) is the fifth most common cancer worldwide with a varied geographic distribution and an aggressive behavior. In Spain, it represents the sixth cause of cancer death. In Western countries, the incidence is decreasing slightly, with an increase in gastroesophageal junction adenocarcinoma (GEJA), a different entity that we separate specifically in the guideline. Molecular biology advances have been done recently, but do not yet lead to the choice in treatment approach except in advanced disease with overexpression of HER2. Endoscopic resection in very early stage, perioperative chemotherapy in locally advanced tumors and preliminary immune therapy resulting in advanced disease are the main treatment innovations in the GC/GEJA treatment. We describe the different evidences and recommendations following the statements of the American College of Physicians

Spatial and temporal variation of fish assemblage associated with aquatic macrophyte patches in the littoral zone of the Ayapel Swamp Complex, Colombia

ABSTRACT: Aim: The purpose of the present study was to examine spatial and temporal variation in fish assemblage structure associated with aquatic macrophytes in the littoral zone of the ASC. Methods: Specimens were caught between January 2008 and February 2009, over four limnimetric moments, using both cast net and seine net. Data on the temperature, electrical conductivity, pH and dissolved oxygen was recorded for the characterization of the water mass in the sites. Results: A total of 34,151 specimens from 44 species were collected. The most abundant species were Eigenmannia virescens, Astyanax caucanus, Astyanax fasciatus, Roeboides dayi and Cyphocharax magdalenae, which together accounted for more than 75% of the sample. Temporal and spatial comparisons showed variation in the environmental conditions and highlighted the existence of heterogeneous abiotic conditions (p0.05) regarding the fish assemblage structure. The multivariate analysis showed no significant relationship between existing environmental conditions and the fish assemblage (p=0.04). The analysis also showed the absence of a relationship between the fish assemblage and environmental variables with respect to the flood pulse and sampling sites (p>0.05). Conclusion: The uniformity of the fish communities that inhabit aquatic macrophyte patches in the littoral region of the ASC may be related to the availability of suitable habitat in structural terms, that probably supports a more abundant and varied wildlife

Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease

Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with noncardiovascular death in CKD populations are lacking. The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n ¼ 2185 CKD patients). After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG þ rs2283368 CC/CT þ rs2320762 GG). Among the patients with the three SNPs genotyped (n ¼ 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA þ rs2283368 TT þ rs2320762 GT/TT). All the other combinations [n ¼ 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher fhazard ratio [HR] 3.28 [confidence interval (CI) 1.51-7.12]g and lower [HR 6 × 10- (95% CI 3.3 × 10--1.1 × 10-)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD

Association of candidate gene polymorphisms with chronic kidney disease : Results of a case-control analysis in the NEFRONA cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2,445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionization-time of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

Caracterización del Banco de La Concepción

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación del Banco de La ConcepciónEl proyecto INDEMARES ha permitido utilizar amplios medios económicos y personales para estudiar en detalle y desde múltiples perspectivas la zona del Banco de La Concepción. Se han aplicado metodologías para el estudio de la hidrografía, caracterizando la región, describiendo sus principales masas de agua y la hidrodinámica de las corrientes. También se ha abordado la geología de la zona, incluyendo levantamientos batimétricos, perfiles sísmicos, muestreos de sedimento y petrológicos, obteniendo modelos digitales del terreno, mapas de tipos de fondo, geomorfológicos. Se han caracterizado las comunidades bentopelágicas, demersales, epibentónicas y endobentónicas, prestando especial atención a aquellas que conforman o estructuran los hábitats sensibles cuyo inventariado y cartografía era objeto principal del proyecto. Los trabajos de identificación de hábitats se han realizado con muestreadores directos, pero también con muestreadores visuales, que han permitido hacer un mayor esfuerzo de muestreo sin aumentar el impacto sobre los fondos de la zona. Por otro lado se ha estudiado la huella pesquera de la zona por medio del análisis de los datos VMS y los cuadernos de pesca proporcionados por la SGP, además de una ardua labor a pie de puerto de entrevistas y encuestas. Toda la información ha sido gestionada y analizada por diferentes grupos de investigación de diferentes centros (Universidad de La Laguna, Instituto Universitario de Ciencias Políticas y Sociales, Universidad de Las Palmas de Gran Canaria, Instituto de Ciencias del Mar de Barcelona, Universidad de Barcelona, Centro de Investigaciones Medioambientales del Atlántico, Centro Oceanográfico de Santander y Centro Oceanográfico de Málaga del Instituto Español de Oceanografía, …), aunque el grueso de esta labor, además de la coordinación, se ha llevado a cabo en el Centro Oceanográfico de Canarias del Instituto Español de Oceanografía. Los resultados permiten tener un conocimiento profundo y multidisciplinar de la zona de estudio comparable a pocos proyectos de investigación marina en la macaronesia. El estudio oceanográfico, el geológico, y el de las comunidades biológicas, ha permitido la caracterización de los hábitats de la zona, y su cartografiado mediante el intenso muestreo y la aplicación de análisis de idoneidad de hábitats.INDEMARES Project made possible to bring together economic and staff resources to study in detail, and from multiple perspectives, the area of Banco de La Concepción. Methodologies have been applied to study hydrography, making a regional characterization, depicting main water masses, and current hydrodynamics. Geology has been tackled including bathymetric uplifting, seismic profiles, sediment and petrological sampling, obtaining digital terrain models, type of bottom maps, geomorphological maps, as an output. Benthopelagic, demersal, epibenthic and endobenthic communities have been characterized, paying special attention to sensitive habitats which inventory and mapping was the project’s main aim. Habitat identification has been made with direct and visual samplers, the latter making a major sampling effort possible without an increase of bottom impact. Moreover, fisheries footprint has been identified by Vessel Monitoring System data, together with logbooks from Secretaría General de Pesca (Fisheries Ministry), as well as a hard interviewing and surveying task at landing points. Information has been managed and analysed by different research groups from different Centres (Universidad de La Laguna, Instituto Universitario de Ciencias Políticas y Sociales, Universidad de Las Palmas de Gran Canaria, Instituto de Ciencias del Mar de Barcelona, Universidad de Barcelona, Centro de Investigaciones Medioambientales del Atlántico, Centro Oceanográfico de Santander y Centro Oceanográfico de Málaga del Instituto Español de Oceanografía), although the main body of the work, plus coordination, has been made by the Canary Islands Oceanographic Centre, from the Spanish Institute of Oceanography. Results let us have a multidisciplinary profound knowledge of the study zone, comparable to few other marine research projects off Macaronesia. The study about oceanography, geology and biologic communities has allowed the habitats characterization and mapping by means of intensive sampling and habitat suitability analysis.Instituto Español de Oceanografía, Comisión Europea Programa LIFE+, Fundación Biodiversida

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Volume I. Introduction to DUNE

The preponderance of matter over antimatter in the early universe, the dynamics of the supernovae that produced the heavy elements necessary for life, and whether protons eventually decay—these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our universe, its current state, and its eventual fate. The Deep Underground Neutrino Experiment (DUNE) is an international world-class experiment dedicated to addressing these questions as it searches for leptonic charge-parity symmetry violation, stands ready to capture supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector technical design report (TDR) describes the DUNE physics program and the technical designs of the single- and dual-phase DUNE liquid argon TPC far detector modules. This TDR is intended to justify the technical choices for the far detector that flow down from the high-level physics goals through requirements at all levels of the Project. Volume I contains an executive summary that introduces the DUNE science program, the far detector and the strategy for its modular designs, and the organization and management of the Project. The remainder of Volume I provides more detail on the science program that drives the choice of detector technologies and on the technologies themselves. It also introduces the designs for the DUNE near detector and the DUNE computing model, for which DUNE is planning design reports. Volume II of this TDR describes DUNE\u27s physics program in detail. Volume III describes the technical coordination required for the far detector design, construction, installation, and integration, and its organizational structure. Volume IV describes the single-phase far detector technology. A planned Volume V will describe the dual-phase technology

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Searches for lepton-flavour-violating decays of the Higgs boson in s=13\sqrt{s}=13 TeV pp\mathit{pp} collisions with the ATLAS detector

This Letter presents direct searches for lepton flavour violation in Higgs boson decays, H → eτ and H → μτ , performed with the ATLAS detector at the LHC. The searches are based on a data sample of proton–proton collisions at a centre-of-mass energy √s = 13 TeV, corresponding to an integrated luminosity of 36.1 fb−1. No significant excess is observed above the expected background from Standard Model processes. The observed (median expected) 95% confidence-level upper limits on the leptonflavour-violating branching ratios are 0.47% (0.34+0.13−0.10%) and 0.28% (0.37+0.14−0.10%) for H → eτ and H → μτ , respectively.publishedVersio