Evidence and research perspectives for surgeons in the European Rectal Cancer Consensus Conference (EURECA-CC2)

PURPOSE: Although surgery remains the most important treatment of rectal cancer, the management of this disease has evolved to become more multidisciplinary to offer the best clinical outcome. The International Conference on Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) had the due to identify the degree of consensus that could be achieved across a wide range of topics relating to the management of rectal cancer helping shape future programs, investigational protocols and guidelines for staging and treatment throughout Europe. MATERIALS AND METHODS: Consensus was achieved using the Delphi method. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by topic, and a series of statements were developed. Each committee member commented and voted, sentence by sentence three times. Sentences which did not reach agreement after voting round # 2 were openly debated during the Conference in Perugia (Italy) December 2008. The Executive Committee scored percentage consensus based on three categories: 'large consensus', 'moderate consensus', 'minimum consensus'. RESULTS: The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only 3 (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of members. All chapters were voted on by at least 75% of the members, and the majority was voted on by 85%. CONCLUSIONS: This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe. In spite of substantial progress, many research challenges remain

Contribution to ehtno-genetic chatacterisation of anandalusian canine dog racial group

We are analysing a sample of 53 animals (16 males and 37 females) of Andalusian mouse hunter dogs or caves dog, with a view to obtain their ethnogenetic characterisation. From our results we have concluded that this population is a racial group presenting a great homogeneity in the variables and zoometric indexes studied, as in the phaneroptical aspects. Their morphology is as a small format, probably elipometrics, with proportional leg length, brevilineous cephalic and body proportions. This population present a three-coloured coat, generally white colour on the body and “black and tan” on the head; the hair is short and smooth, the mucosae is black and the iris brown. With respect the bite, the most frequent are the tweezers form and the scissors, also in few animals we have found the absence of premolars.Se analiza una muestra de perros ratoneros o bodegueros compuesta por 53 ejemplares de los cuales 16 eran machos y 37 hembras, con objeto de lograr una caracterización etnogenética. De los resultados obtenidos concluimos que se trata de una agrupación racial que presenta gran homogeneidad tanto en las variables e índices zoométricos estudiados como en los aspectos fanerópticos. Morfológicamente se trata de animales de formato pequeño, posiblemente elipométricos, ni lejos ni cerca de tierra, y de proporciones braquicéfalas y brevilíneas en cuanto a sus proporciones cefálicas y corporales respectivamente. Fanerópticamente esta población presenta una capa tricolor, generalmente blanco en el cuerpo y negro-fuego en la cabeza, el pelo corto y liso, la pigmentación de las mucosas negras y el iris castaño. En cuanto a la mordida los tipos más frecuentes son en tijera y pinza, y en un escaso número de ejemplares existe ausencia de premolares

Patient-reported outcomes in type 2 diabetes mellitus: Patients’ and primary care physicians’ perspectives in the Spanish health care system

Objective: Understanding patients’ and physicians’ perceptions of type 2 diabetes mellitus (T2DM) management and treatment has important implications for diabetes care, allowing the identification of clinical practice issues that could be improved, leading to patients’ better understanding of the illness and, consequently, healthier self-management behaviors. The objective of this study was to identify differences between physicians’ and T2DM patients’ perceptions related to health status, patient-reported outcomes assessments, and T2DM management and treatment, in routine clinical practice in Spain. Methods: This was an observational, cross-sectional study including 1, 012 T2DM patients and 974 physicians from 47 and 52 Spanish provinces, respectively. An electronic structured self-administered questionnaire containing 17 questions was designed aiming to address both physicians’ and patient’s perceptions on overall T2DM health status and patient-reported outcomes. Results: T2DM patients perceived a worse health status (40% reported having a “good” and 38% a “neither good nor bad” health status) compared with physicians’ perceptions (77% thought patients had a “good” health status). Most patients answered being “satisfied” or “neither satisfied nor unsatisfied” with the given information, while physicians considered that patients were “satisfied” or “very satisfied” with the information for self-monitoring blood glucose and treatment administration. Fifty-seven percent of patients reported that medical recommendations were “important”, while 58% of physicians considered it as “very important”. Fifty-three percent of patients perceived that their current T2DM treatment suited their preferences “quite a lot”, and this was lower than the proportion of physicians (69%) that believed this for their patients. Additionally, a lower percentage of patients (53%) than physicians (79%) believed that their treatment improved their health-related quality of life “quite a lot”. All differences between patients and physicians were statistically significant (P<0.001). Conclusion: Patients and physicians demonstrate different views concerning all questions related to T2DM health status and diabetes management and treatment (information, recommendations, satisfaction, and preferences)

Long-term cardiac rehabilitation program favorably influences fibrinolysis and lipid concentrations in acute myocardial infarction

BACKGROUND AND OBJECTIVE: The control of well-known atherosclerotic risk factors represents the optimal strategy in the prevention of acute coronary syndromes. It was the aim of this work to analyze the effects of a long-term cardiac rehabilitation program on the changes of fibrinolysis parameters and plasma lipid profile in coronary patients. DESIGN AND METHODS: The study was carried out in 30 (M/F:22/8, mean age 47 years) survivors of a first acute myocardial infarction (AMI) and in 30 healthy controls who underwent a cardiac rehabilitation program (9 months duration). Samples were taken before, at 3 and 9 months after the beginning of the program to measure: tissue-type plasminogen activator (t-PA) antigen and plasminogen activator inhibitor (PAI-1) activity and antigen. A lipid profile including cholesterol (both HDL and LDL) and lipoprotein(a) was also assessed. The Wilcoxon and Mann-Whitney tests were used for statistical comparisons. RESULTS: There was a marked decrease of functional PAI-1 after 3 and 9 months as compared with baseline in AMI patients (p < 0.01). Results showed a significant increase of HDL-cholesterol (p < 0.01) and decrease of lipoprotein(a) levels after the exercise program (p < 0.01). INTERPRETATION AND CONCLUSIONS: The cardiac rehabilitation program improved fibrinolysis, by reducing the functional levels of PAI-1, and ameliorated the lipid profile by decreasing lipoprotein(a) and increasing HDL-cholesterol in patients with AMI. A long-term cardiac rehabilitation has positive effects on some risk factors for coronary disease

Molecular and functional characterization of calvarial stem cells in nonsyndromic craniosynostosis: role of the primary cilium-related signaling in the abnormal osteogenic niche

Nonsyndromic craniosynostosis (NSC) is a congenital malformation due to the premature ossification of calvarial sutures, representing a paradigm of aberrant osteogenesis, with an unclear multifactorial etiopathogenesis. Through comparative analyses of fused-versus-patent sutures of affected patients, we demonstrated that calvarial stem cells (CSCs) display a constitutively overactive osteogenic potential at the site of premature synostosis, driven by the activation of intracellular osteogenic pathways. Microarray profiling allowed evidencing the significant differential expression of genes involved in the structure and function of the primary cilium, a key sensing organelle involved in cell differentiation and development. Indeed, the Bardet Biedl Syndrome-associated gene 9 (BBS9), encoding a structural component of the primary cilium, has been associated to the NSC phenotype in a recent GWAS. The expression of BBS9 appeared to be increased in CSCs from fused- versus unfused-sutures; moreover, confocal microscopy indicated that BBS9 expression in fused suture-CSCs tended to be scattered within the cytoplasm rather than localized at the transition zone of the primary cilium, as in control cells, indicating a reduced cell polarization. We performed in vitro gene silencing, co-culture assays and in vivo expression analysis in the rat calvarium, to confirm the role of BBS9 and related signaling in the osteogenic differentiation of CSCs and in the ossification of calvarial sutures. Overall our original data point towards the identification of the primary cilium as a key player involved in the abnormal communication of calvarial stem cells with surrounding cells and extracellular matrix within the abnormal osteogenic niche orchestrating the NSC phenotype

Synergistic effect of Si-hydroxyapatite coating and VEGF adsorption on Ti6Al4V-ELI scaffolds for bone regeneration in an osteoporotic bone environment.

The osteogenic and angiogenic responses to metal macroporous scaffolds coated with silicon substituted hydroxyapatite (SiHA) and decorated with vascular endothelial growth factor (VEGF) have been evaluated in vitro and in vivo. Ti6Al4V-ELI scaffolds were prepared by electron beam melting and subsequently coated with Ca10(PO4)5.6(SiO4)0.4(OH)1.6 following a dip coating method. In vitro studies demonstrated that SiHA stimulates the proliferation of MC3T3-E1 pre-osteoblastic cells, whereas the adsorption of VEGF stimulates the proliferation of EC2 mature endothelial cells. In vivo studies were carried out in an osteoporotic sheep model, evidencing that only the simultaneous presence of both components led to a significant increase of new tissue formation in osteoporotic bone. STATEMENT OF SIGNIFICANCE Reconstruction of bones after severe trauma or tumors extirpation is one of the most challenging tasks in the field of orthopedic surgery. This scenario is even more complicated in the case of osteoporotic patients, since their bone regeneration capability is decreased. In this work we present a porous implant that promotes bone regeneration even in osteoporotic bone. By coating the implant with an osteogenic bioceramics such as silicon substituted hydroxyapatite and subsequent adsorption of vascular endothelial growth factor, these implants stimulate the bone ingrowth when they are implanted in osteoporotic sheep

Connecting the data landscape of long-term ecological studies: The SPI-Birds data hub

The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long-term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad-scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long-term studies of birds, we have created the SPI-Birds Network and Database (www.spibirds.org)\u2014a large-scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI-Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI-Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community-derived data and meta-data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta-data language). The encouraging community involvement stems from SPI-Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI-Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community-specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much-needed large-scale ecological data integration

Techno-economic assessment of membrane assisted fluidized bed reactors for pure H2 production with CO2 capture

This paper addresses the techno-economic assessment of two membrane-based technologies for H2 production from natural gas, fully integrated with CO2 capture. In the first configuration, a fluidized bed membrane reactor (FBMR) is integrated in the H2 plant: the natural gas reacts with steam in the catalytic bed and H2 is simultaneously separated using Pd-based membranes, and the heat of reaction is provided to the system by feeding air as reactive sweep gas in part of the membranes and by burning part of the permeated H2 (in order to avoid CO2 emissions for heat supply). In the second system, named membrane assisted chemical looping reforming (MA-CLR), natural gas is converted in the fuel rector by reaction with steam and an oxygen carrier (chemical looping reforming), and the produced H2 permeates through the membranes. The oxygen carrier is re-oxidized in a separate air reactor with air, which also provides the heat required for the endothermic reactions in the fuel reactor. The plants are optimized by varying the operating conditions of the reactors such as temperature, pressures (both at feed and permeate side), steam-to-carbon ratio and the heat recovery configuration. The plant design is carried out using Aspen Simulation, while the novel reactor concepts have been designed and their performance have been studied with a dedicated phenomenological model in Matlab. Both configurations have been designed and compared with reference technologies for H2 production based on conventional fired tubular reforming (FTR) with and without CO2 capture. The results of the analysis show that both new concepts can achieve higher H2 yields than conventional plants (12-20% higher). The high electricity consumptions of membrane-based plants are associated with the required low pressure at the retentate side. However, the low energy cost for the CO2 separation and compression makes the overall reforming efficiency from 4% to 20% higher than conventional FTR with CO2 scrubbing. FBMR and MA-CLR show better performance than FTR with CO2 capture technology in terms of costs mainly because of lower associated CAPEX. The cost of H2 production reduces from 0.28 €/NmH23 to 0.22 €/NmH23 (FBMR) and 0.19 €/NmH23 (MA-CLR)