SEOM-GEMCAD-TTD clinical guidelines for localized rectal cancer (2021)

The management of localized rectal cancer requires a multidisciplinary approach to optimize outcomes, reduce morbidity and prevent under or overtreatments. While early stages may obtain benefit of local resections without any additional therapies, locally advanced rectal cancer becomes a challenge defining the better sequential strategy of surgery, radiotherapy and chemotherapy. The latest results of international phase III studies have positioned the total neoadjuvant therapy as a potential new standard of care in high risk rectal cancers, however, the best schedule is still not well defined

Predicting language learners' grades in the L1, L2, L3 and L4: the effect of some psychological and sociocognitive variables

This study of 89 Flemish high-school students' grades for L1 (Dutch), L2 (French), L3 (English) and L4 (German) investigates the effects of three higher-level personality dimensions (psychoticism, extraversion, neuroticism), one lower-level personality dimension (foreign language anxiety) and sociobiographical variables (gender, social class) on the participants' language grades. Analyses of variance revealed no significant effects of the higher-level personality dimensions on grades. Participants with high levels of foreign language anxiety obtained significantly lower grades in the L2 and L3. Gender and social class had no effect. Strong positive correlations between grades in the different languages could point to an underlying sociocognitive dimension. The implications of these findings are discussed

Removal efficiency for emerging contaminants in a WWTP from Madrid (Spain) after secondary and tertiary treatment and environmental impact on the Manzanares River

The effluents from wastewater treatment plants (WWTPs) can be an important contamination source for receiving waters. In this work, a comprehensive study on the impact of a WWTP from Madrid on the aquatic environment has been performed, including a wide number of pharmaceuticals and pesticides, among them those included in the European Watch List. 24-h composite samples of influent (IWW) and effluent wastewater after secondary (EWW2) and after secondary + tertiary treatment (EWW3) were monitored along two campaigns. Average weekly concentrations in IWW and EWW2 and EWW3 allowed estimating the removal efficiency of the WWTP for pharmaceutical active substances (PhACs). In addition, the impact of EWW3 on the water quality of the Manzanares River was assessed, in terms of PhAC and pesticide concentrations, through analysis of the river water collected upstream and downstream of the discharge point. After a preliminary risk assessment, a detailed evaluation of the impact on the aquatic environment, including a toxicological study and screening of pharmaceutical metabolites, was made for the seven most relevant PhACs: sulfamethoxazole, azithromycin and clarithromycin (antibiotics), metoprolol (antihypertensive), diclofenac (anti-inflammatory/analgesic), irbesartan (antihypertensive), and the antidepressant venlafaxine. Among selected PhACs, irbesartan, clarithromycin and venlafaxine presented moderate or high risk in the river water downstream of the discharge. Albeit no acute toxicity was detected, more detailed studies should be carried out for these substances, including additional toxicological studies, to set up potential sublethal and chronic effects on aquatic organisms.This work was developed under the financial support of DRACE INFRAESTRUCTURAS S.A. as a part of the project Estudio de contaminantes emergentes en aguas residuales y superficiales de Madrid. The authors acknowledge the support of Jose Ramon Rodriguez from DRACE INFRAESTRUCTURAS S.A., for collection of wastewater and surface water samples, as well as the discussion and useful suggestions from Jesus Angel López, Pedro Miguel Catalinas and Maria Elvira Benito, from Sub-Direccion General de Aguas, Ayuntamiento de Madrid. The University Jaume I of Castellón, Spain (project UJI-B2018-55), the Ministry of Science, Innovation and University, Spain (Ref RTI2018-097417-B-I00) and Generalitat Valenciana, Spain (research group of excellence PROMETEO 2019/040) are also acknowledged. The authors are very grateful to the Serveis Centrals d'Instrumentació Científica (SCIC) of University Jaume I for the use of LC-MS/MS instrumentation

Consensus of experts from the Spanish pharmacogenetics and pharmacogenomics society and the Spanish society of medical oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidinesThis project has been financed with SEOM and SEFF resource

Consensus of experts from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines

Dynamic soluble changes in sVEGFR1, HGF, and VEGF promote chemotherapy and bevacizumab resistance: A prospective translational study in the BECOX (GEMCAD 09-01) trial

Despite initial responsiveness, acquired resistance to both bevacizumab and chemotherapy in metastatic colorectal cancer is universal. We have recently published that in vitro, chronically oxaliplatin resistance upregulates soluble vascular endothelial growth factor receptor 1, downregulates vascular endothelial growth factor, and also promotes c-MET, b-ca catenin/transcription factor 4, and AKT activation. We tested whether variation in three serum biomarkers such as the natural c-MET ligand (hepatocyte growth factor), soluble vascular endothelial growth factor receptor 1, and vascular endothelial growth factor-A was associated with efficacy in metastatic colorectal cancer patients treated in the prospective BECOX study. Serum levels of vascular endothelial growth factor-A165, soluble vascular endothelial growth factor receptor 1, and hepatocyte growth factor were assessed by enzyme-linked immunosorbent assay method basally and every 3 cycles (at the time of computed tomography evaluation) in a preplanned translational study in the first-line BECOX trial in metastatic colorectal cancer patients treated with CAPOX plus bevacizumab. Response was evaluated by routine contrast-enhanced computed tomography by RECIST 1.1 by investigator assessment and by three blinded independent radiologists. Ratios between soluble vascular endothelial growth factor receptor 1/vascular endothelial growth factor-A and hepatocyte growth factor/vascular endothelial growth factor-A were established and variations through time were related to RECIST 1.1 by investigator assessment and independent radiologist. The BECOX trial included 68 patients, and 27 patients were analyzed in the translational trial. A total of 80 RECIST 1.1 evaluations were done by investigator assessment and 56 by independent radiologist. We found that a 3.22-fold increase in soluble vascular endothelial growth factor receptor 1/vascular endothelial growth factor-A by investigator assessment and a 3.06-fold increase in soluble vascular endothelial growth factor receptor 1/vascular endothelial growth factor-A by independent radiologist from previous determination were associated with responses compared with 1.38-fold increase by investigator assessment and 1.59 by independent radiologist in non-responders (p= 0.0009 and p = 0.03, respectively). Responders had a 3.36-fold increase in hepatocyte growth factor/vascular endothelial growth factor-A from previous determination by investigator assessment and 3.66-fold increase in hepatocyte growth factor/vascular endothelial growth factor-A by independent radiologist compared with 1.43-fold increase by investigator assessment and 1.53 by independent radiologist for non-responders (p = 0.002 and 0.003, respectively). In conclusion, a decrease in vascular endothelial growth factor-A and an increase in soluble vascular endothelial growth factor receptor 1 during chemotherapy and bevacizumab exposure can contribute to both chemotherapy (due to c- MET/b-catenin activation) and bevacizumab (due to low vascular endothelial growth factor requirements) resistance. Because hepatocyte growth factor levels decrease also during acquired resistance, alternative strategies to hepatocyte growth factor–ligand inhibition should be investigatedThis work was supported by “beca SEOM a Jóvenes Investigadores 2009” and by the Emili Letang fellowship to Estela Pineda

1st international experts' meeting on agitation. Conclusions regarding the current and ideal management paradigm of agitation

Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients' care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts' Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes

Data fusion of ultrasound and GPR signals for analysis of historic walls

[EN] This paper presents an application of ultrasounds and ground-penetrating radar (GPR) for analysis of historic walls. The objectives are to characterize the deformation of a historic wall under different levels of load weights and to obtain an enhanced image of the wall. A new method that fuses data from ultrasound and GPR traces is proposed which is based on order statistics digital filters. Application results are presented for non destructive testing (NDT) of two replicates of historic ashlars' masonry walls: the first one homogeneous and the second one containing controlled defects such as cracks and nooks. The walls are measured separately using ultrasounds and GPR at different load steps. Time and frequency parameters extracted from the signals and different B-Scans for each of the NDT techniques are obtained. After this, a new fused representation is obtained, which results demonstrate the improvement of characterization and defect detection in historic walls using data fusion.This work has been supported by Generalitat Valenciana under grant PROMETEO/2010/040, and Spanish Administration and European Union FEDER Prog. under grant TEC2011-23403 01/01/2012.Salazar Afanador, A.; Gosálbez Castillo, J.; Safont Armero, G.; Vergara Domínguez, L. (2012). Data fusion of ultrasound and GPR signals for analysis of historic walls. IOP Conference Series: Materials Science and Engineering. 42:1-4. https://doi.org/10.1088/1757-899X/42/1/012008S144

Transformación de los roles de las mujeres colonas y cambio socioambiental : el caso de la penetración de la minería transnacional en un agroecosistema de la comunidad de Junín, Ecuador

Este artículo trata de analizar el rol de las mujeres en una comunidad campesina de la Sierra norte del Ecuador, en función de las transformaciones socioambientales sufridas en base a dos procesos que se están dando hoy en día en el panorama local de Junín. Se trata por un lado de la tendencia de la comunidad hacia un modelo agroindustrial, y por el otro del conflicto socioambiental minero, latente desde hace poco más de una década en la realidad de la comunidad. Ambos procesos se encuentran fuertemente vinculados e influyen de manera directa sobre las estrategias de vida de la comunidad, puesto que ambos acaban transformando, debido a la aparición de nuevas actividades productivas, el uso que se hace de los recursos, de esta manera se observa una evolución del agroecosistema que conforma la comunidad de Junín. La discusión del presente estudio gira entorno a las repercusiones que estos dos procesos han tenido entorno al rol de la mujer, es decir se pretende estudiar un cambio social relacionado con el rol de la mujer en la comunidad, mediante un cambio ambiental que se ha dado entorno a estos dos procesos. De esta manera se ha observado que el conflicto minero ha sido el punto de partida que ha hecho salir a la mujer a la esfera pública, sobretodo por las alternativas productivas que ha creado, concretamente el ecoturismo por medio del cual la mujer ha pasado a realizar actividades productivas. Por otra parte, la modernización agrícola ha dejado patente la relación existente entre la mujer y la unidad doméstica. Esta tendencia hacia el modelo agroindustrial ha hecho desplazar a los hombres de la comunidad a realizar actividades agrícolas relacionadas con la comercialización, mientras que la mujer se ha mantenido en el sector de la agricultura de subsistencia

Correlation of recist, computed tomography morphological response, and pathological regression in hepatic metastasis secondary to colorectal cancer : The avamet study

The prospective phase IV AVAMET study was undertaken to correlate response evaluation criteria in solid tumors (RECIST)-defined response rates with computed tomography-based morphological criteria (CTMC) and pathological response after liver resection of colorectal cancer metastases. Eligible patients were aged ≥18 years, with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and histologically-confirmed colon or rectal adenocarcinoma with measurable liver metastases. Preoperative treatment was bevacizumab (7.5 mg on day 1) + XELOX (oxaliplatin 130 mg/m, capecitabine 1000 mg/m bid on days 1-14 q3w). After three cycles, response was evaluated by a multidisciplinary team. Patients who were progression-free and metastasectomy candidates received one cycle of XELOX before undergoing surgery 3-5 weeks later, followed by four cycles of bevacizumab + XELOX. A total of 83 patients entered the study; 68 were eligible for RECIST, 67 for CTMC, and 51 for pathological response evaluation. Of these patients, 49% had a complete or partial RECIST response, 91% had an optimal or incomplete CTMC response, and 81% had a complete or major pathological response. CTMC response predicted 37 of 41 pathological responses versus 23 of 41 responses predicted using RECIST (p = 0.008). Kappa coefficients indicated a lack of correlation between the results of RECIST and morphological responses and between morphological and pathological response rates. CTMC may represent a better marker of pathological response to bevacizumab + XELOX than RECIST in patients with potentially-resectable CRC liver metastases