First-line maintenance treatment in metastatic colorectal cancer (mCRC) : Quality and clinical benefit overview

Different strategies of maintenance therapy (sequential CT, intermittent CT, intermittent CT and MAbs, or de-escalation MAbs monotherapy) after first-line treatment are undertaken. Many randomized clinical trials (RCT), which evaluated these approaches, suffer from incorrect design, heterogenous primary endpoints, inadequate size, and other methodology flaws. Drawing any conclusions becomes challenging and recommendations are mainly vague. We evaluated those studies from another perspective, focusing on the design quality and the clinical benefit measure with a more objective and accurate methodology. These data allowed a clearer and more exact overview of the statement in maintenance treatment

PRACTICUM II de Psicologia Mèdica en els Centres d'Atenció Primària sobre la comunicació no verbal en la relació metge-pacient

La Unitat de Psicologia Mèdica de la Facultat de Medicina de la UAB va posar en marxa durant el curs 2005/2006 el Practicum II de Psicologia Mèdica en els Centres d'Atenció Primària amb l'objectiu que els estudiants comencin a copsar la importància de les conductes i dels estats psicològics de les persones en els processos de salut-malaltia que es veuen en els Centres d'Atenció Primària (CAP). El Practicum està dedicat específicament als aspectes no verbals de la comunicació entre el professional de la salut i el pacient. L'experiència forma part de l'assignatura "Bases Psicològiques dels Estats de Salut i de Malaltia", impartida a segon curs de Medicina; s'inscriu en el paradigma de l'aprenentatge des de la pràctica que protagonitzen els professionals del sistema sanitari; i s'emmarca en el context d'un procés impulsat pels equips deganals de la Facultat de Medicina de la UAB des del curs 2004/2005 per tal d'apropar l'estudiant a la pràctica clínica des del primer curs de carrera i avançar cap a la consecució dels objectius que marquen les directrius europees. Cada alumne realitza dues visites programades a un CAP i participa en quatre sessions de tutoria a la Facultat en grups reduïts. En les visites al CAP, ha d'assistir a sessions de consulta amb diversos professionals de l'àmbit de la salut. Ha d'observar, identificar i enregistrar els elements no verbals que es descriuen en els objectius del Practicum i el context en què ocorren. A les sessions de tutories s'entrena els alumnes per a fer les observacions mitjançant material audiovisual i es discuteixen les observacions realitzades en els CAP. A més, també s'utilitza com a material una monografia específica sobre el tema. L'experiència es valora favorablement. tant des del punt de vista dels resultats obtinguts pels alumnes com per la seva satisfacció.The Medical Psychology Unit of the UAB School of Medicine initiated during the academic year 2005/2006 the Medical Psychology Practicum II in primary care centers with the goal that students realize the importance of human behaviors and psychological states in health-illness processes in primary care centers. The Practicum is specifically oriented to non verbal communication between the health professional and the patient. The experience is part of the subject "Psychological Bases of Health and Illness", taught in second course of Medicine; it is registered "learning from the practice" paradigm that professionals from the health system lead; and it is framed in the context of a process promoted by the UAB School of Medicine Deanship since the academic year 2004/2005 with the goal of bringing the clinical practice to the student from the first academic year and advancing towards the achievement of the goals that the European guidelines mark. Each student does two programmed visits to primary health center and participates in four tutorials of reduced groups in the Faculty. During the visits to the primary health center, he has to attend sessions of consultation with professionals from several health areas. He has to observe, to identify and to record the non verbal elements that are described in the Practicum goals and the context in which they occur. At the tutorials, students are trained to observe through audiovisual didactic material and the observations carried out at the primary health center are argued. Moreover, a specific monograph is also used as a specific material about the subject. The experience of these last two years has been satisfactory so for the professionals of the primary care centres as for the tutors and the students. The experience is valued favorably considering students' academic results and their satisfaction

Large-scale movements of common bottlenose dolphins in the Atlantic : dolphins with an international courtyard

Wide-ranging connectivity patterns of common bottlenose dolphins (Tursiops truncatus) are generally poorly known worldwide and more so within the oceanic archipelagos of Macaronesia in the North East (NE) Atlantic. This study aimed to identify long-range movements between the archipelagos of Macaronesia that lie between 500 and 1,500 km apart, and between Madeira archipelago and the Portuguese continental shelf, through the compilation and comparison of bottlenose dolphin's photo-identification catalogues from different regions: one from Madeira (n = 363 individuals), two from different areas in the Azores (n = 495 and 176), and four from different islands of the Canary Islands (n = 182, 110, 142 and 281), summing up 1791 photographs. An additional comparison was made between the Madeira catalogue and one catalogue from Sagres, on the southwest tip of the Iberian Peninsula (n = 359). Results showed 26 individual matches, mostly between Madeira and the Canary Islands (n = 23), and between Azores and Madeira (n = 3). No matches were found between the Canary Islands and the Azores, nor between Madeira and Sagres. There were no individuals identified in all three archipelagos. The minimum time recorded between sightings in two different archipelagos (≈ 460 km apart) was 62 days. Association patterns revealed that the individuals moving between archipelagos were connected to resident, migrant and transient individuals in Madeira. The higher number of individuals that were re-sighted between Madeira and the Canary Islands can be explained by the relative proximity of these two archipelagos. This study shows the first inter-archipelago movements of bottlenose dolphins in the Macaronesia region, emphasizing the high mobility of this species and supporting the high gene flow described for oceanic dolphins inhabiting the North Atlantic. The dynamics of these long-range movements strongly denotes the need to review marine protected areas established for this species in each archipelago, calling for joint resolutions from three autonomous regions belonging to two EU countries.Partnership Program (US) and project ‘‘Cetáceos, Oceanografía y Biodiversidad de las Aguas Profundas de La Palma y El Hierro’’ funded by ‘‘Ministerio de Ciencia e Innovación’’ of the Spanish Government, grant number CETOBAPH-CGL2009-1311218 supported the work in the Canary Island. In Madeira, this study was supported by the Oceanic Observatory of Madeira through the project M1420-01-0142-FEDER-000001 and by the Portuguese Foundation for Science and Technology through the strategic project UID/MAR/04292/2020. Ana Dinis and Filipe Alves have grants funded by ARDITI— Madeira’s Regional Agency for the Development of Research, Technology and Innovation, throughout the project M1420-09- 5369- FSE- 000002, and Annalisa Sambolino is supported by the Portuguese Foundation for Science and Technology through the PhD grant number SFRH/BD/1416092018. In Azores, the MONICET platform is supported by project MEEMO (ACORES-01-0145-FEDER-000079) and Marta Tobena is supported by a PhD grant (M31a/F/0722015). There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio

Ansietats normals i anormals : de la neurofarmacologia a la neurogenètica

Hem revisat els sistemes neuroreguladors centrals implicats en 1'ansietat, fent un èmfasi especial en aquell que tradicionalment s'hi ha considerat més relacionat, el sistema GABAèrgic. Es descriuen els principals moduladors de 1'acció GABAèrgica i es discuteix la importància de la composició molecular del complex GABAA/Bz/Cl- en determinar la seva resposta a les manipulations farmacolbgiques. A mes, es fa un resum dels diversos intents realitzats des de línies de recerca diferents per trobar possibles substàncies endògenes que actuïn als receptors benzodiazepinics. Pel que fa a altres sistemes de neuroregulació implicats en 1'ansietat, es revisen les evidencies a favor del paper de la serotonina, la colecistocinina, el factor d'alliberament de la corticotropina, el glutamat i el neuropèptid Y. Finalment es parla de 1'existència de diferències individuals en la susceptibilitat ansiosa i dels intents d'abordar-les mitjançant 1'estudi de la possible contribució genètica en soques de rosegadors que difereixen en la reactivitat emocional

A randomised phase 2 study comparing different dose approaches of induction treatment of regorafenib in previously treated metastatic colorectal cancer patients (REARRANGE trial)

Purpose: The purpose of this article is to evaluate the safety of two regorafenib dose-escalation approaches in refractory metastatic colorectal cancer (mCRC) patients.Patients and methods: Patients with mCRC and progression during or within 3 months following their last standard chemotherapy regimen were randomised to receive the approved dose of regorafenib of 160 mg QD (arm A) or 120 mg QD (arm B) administered as 3 weeks of treatment followed by 1 week off, or 160 mg QD 1 week on/1 week off (arm C). The primary end-point was the percentage of patients with G3/G4 treatment-related adverse events (AEs) in each arm.Results: There were 299 patients randomly assigned to arm A (n = 101), arm B (n = 99), or arm C (n = 99); 297 initiated treatments (arm A n = 100, arm B n = 98, arm C n = 99: pop-ulation for safety analyses). G3/4 treatment-related AEs occurred in 60%, 55%, and 54% of patients in arms A, B, and C, respectively. The most common G3/4 AEs were hypertension (19, 12, and 20 patients), fatigue (20, 14, and 15 patients), hypokalemia (11, 7, and 10 pa-tients), and hand-foot skin reaction (8, 7, and 3 patients). Median overall survival was 7.4 (IQR 4.0-13.7) months in arm A, 8.6 (IQR 3.8-13.4) in arm B, and 7.1 (IQR 4.4-12.4) in arm C.Conclusions: The alternative regorafenib dosing schedules were feasible and safe in patients with mCRC who had been previously treated with standard therapy. There was a higher nu-merical improvement on the most clinically relevant AEs in the intermittent dosing arm, particularly during the relevant first two cycles

Adherence to capecitabine in preoperative treatment of stage II and III rectal cancer: do we need to worry?

Background: Preoperative oral capecitabine plus radiotherapy has been progressively adopted in oncology units to provide more convenient care to patients with rectal cancer, but little is known about adherence to this therapy. Patients and methods: Prospective, multicentre observational study in six hospitals in metropolitan Barcelona (Spain), in patients with stage II and III rectal cancer. Assessment of adherence was based on the medical report in the clinical history, a patient questionnaire and a pill count in the pharmacy service upon finalization of treatment. Patients were considered adherent if they had taken 80%-110% of the prescribed treatment. We evaluated clinical variables, adverse effects, anxiety and depression (using the hospital anxiety depression scale [HADS]), and quality of life (EORTC QLQ-30). We analysed adherence-associated variables using a logistic regression model and concordance between adherence measures by means of the modified Kappa index. Results: We included 119 participants. Adherence measures showed little concordance between the assessment methods used: adherence was 100% according to the clinical history, 83.2% according to self-report and 67.9% according to the pill count. In the multivariable analysis, the most relevant variable associated with non-adherence was anxiety prior to treatment (adjusted odds ratio [ORa] 6.96, 95% confidence interval [CI] 1.48-32.7). We did not observe any relevant association between adherence and clinical variables and baseline quality of life parameters. Conclusions: Adherence to short-term oral neoadjuvant treatment in rectal cancer may be a clinical problem, and it should be acknowledged and systematically evaluated by clinicians during treatment. The limited concordance between different measures of adherence highlights the challenges in monitoring it and the need to use different approaches to assess its impact in clinical practice

A randomised phase 2 study comparing different dose approaches of induction treatment of regorafenib in previously treated metastatic colorectal cancer patients (REARRANGE trial)

Altres ajuts: Bayer HealthCare Pharmaceuticals Inc.Purpose: The purpose of this article is to evaluate the safety of two regorafenib dose-escalation approaches in refractory metastatic colorectal cancer (mCRC) patients. Patients and methods: Patients with mCRC and progression during or within 3 months following their last standard chemotherapy regimen were randomised to receive the approved dose of regorafenib of 160 mg QD (arm A) or 120 mg QD (arm B) administered as 3 weeks of treatment followed by 1 week off, or 160 mg QD 1 week on/1 week off (arm C). The primary end-point was the percentage of patients with G3/G4 treatment-related adverse events (AEs) in each arm. Results: There were 299 patients randomly assigned to arm A (n = 101), arm B (n = 99), or arm C (n = 99); 297 initiated treatments (arm A n = 100, arm B n = 98, arm C n = 99: population for safety analyses). G3/4 treatment-related AEs occurred in 60%, 55%, and 54% of patients in arms A, B, and C, respectively. The most common G3/4 AEs were hypertension (19, 12, and 20 patients), fatigue (20, 14, and 15 patients), hypokalemia (11, 7, and 10 patients), and hand-foot skin reaction (8, 7, and 3 patients). Median overall survival was 7.4 (IQR 4.0-13.7) months in arm A, 8.6 (IQR 3.8-13.4) in arm B, and 7.1 (IQR 4.4-12.4) in arm C. Conclusions: The alternative regorafenib dosing schedules were feasible and safe in patients with mCRC who had been previously treated with standard therapy. There was a higher numerical improvement on the most clinically relevant AEs in the intermittent dosing arm, particularly during the relevant first two cycles. Clinicaltrials.gov identifier: NCT02835924

Marine mammals and Good Environmental Status: Science, Policy and Society; Challenges and Opportunities

The Marine Strategy Framework Directive has become the key instrument for marine conservation in European seas. We review its implementation, focusing on cetacean biodiversity, using the examples of Spain and the Regional Seas Convention, OSPAR. The MSFD has been widely criticised for legal vagueness, lack of coordination, uncertainty about funding, and poor governance; its future role within EU Integrated Maritime Policy remains unclear. Nevertheless, the first stages of the process have run broadly to schedule: current status, environmental objectives and indicators have been described and the design of monitoring programmes is in progress, drawing on experience with other environmental legislation. The MSFD is now entering its critical phase, with lack of funding for monitoring, limited scope for management interventions, and uncertainty about how conservation objectives will be reconciled with the needs of other marine and maritime sectors, being among the main concerns. Clarity in governance, about the roles of the EU, Member States, Regional Seas Conventions and stakeholders, is needed to ensure success. However, even if (as seems likely) good environmental status cannot be achieved by 2020, significant steps will have been taken to place environmental sustainability centre-stage in the development of Integrated Maritime Policy for EU seas.Postprin

Hibernation of Secession Tensions in Catalonia: Attenuation Trends on Antagonistic Alignments

The secession campaign in Catalonia created a political fracture into two sizeable and opposing citizenry segments, those who favored secession from Spain and those who were against it. In a series of longitudinal studies covering the entire period of regular surveys made by the official polling agency of the Regional Government (2006–2019), we showed that this fissure operated mainly through an ethnolinguistic cleavage based on family language and ascendancy origins. Media outlets linked to successive pro-secession Regional Governments accentuated the division. Here we extend these analyses till 2022, to capture potential variations in such a division across the five years following the failed secession attempt of October 2017. Present findings confirm the persistence of the fissure along similar lines: family language interacts with the influence of regional partisan media to keep the fracture alive, though with trends denoting an attenuation of antagonistic identity alignments. We detected, as well, a turning point for the attenuation of both political confrontation and social division, within a conflict that has not been solved, albeit it appears mitigated. We discuss how elapsed time after secession failure and the effects of several political and non-political events might have helped to dampen down divisive tensions and repair a serious fracture produced by the secession push

Inter-island movements of common bottlenose dolphins Tursiops truncatus among the Canary Islands: online catalogues and implications for conservation and management

A total of 313 individual common bottlenose dolphins Tursiops truncatus was photo-identified in four Special Areas of Conservation (SACs) in the western Canary Islands, Spain (El Hierro, La Palma, La Gomera and Tenerife), over a 10-year period (2001–2011). Of these, 36 individuals were resighted subsequently off two or more different islands, determined using online and conventional photo-identification catalogues. This study provides the first evidence of regular, long-distance movements undertaken by common bottlenose dolphins in the Canary Islands. Distances travelled ranged from 30 to 130 km between islands, demonstrating that the species is highly mobile within the archipelago. These results have important implications for the conservation and management of this species in this region and highlight the need to evaluate the efficiency of existing SACs and to further explore residency patterns.Keywords: marine protected area, photo-identification, SAC, site fidelityAfrican Journal of Marine Science 2014, 36(1): 137–14