Craniopharyngioma in the elderly: a multicenter and nationwide study in Spain

[Abstract] Background: Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. Aim: To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. Patients and Methods: This was a retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated. Results: From a total of 384 adult CP patients, we selected 53 (13.8%) patients (27 women [50.9%], mean age 72.3 ± 5.1 years [range 65–83 years]) diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). The maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%), and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP and papillary CP were present in 51 and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9 to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs. 53.6%, p = 0.008). Patients were followed for 46.7 ± 40.8 months. The mortality rate was 39.6% with a median survival time of 88 (95% CI: 57–118) months. DI at last visit was associated with a lower survival. Conclusion: CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation, visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population

Data mining analyses for precision medicine in acromegaly: a proof of concept

Predicting which acromegaly patients could benefit from somatostatin receptor ligands (SRL) is a must for personalized medicine. Although many biomarkers linked to SRL response have been identified, there is no consensus criterion on how to assign this pharmacologic treatment according to biomarker levels. Our aim is to provide better predictive tools for an accurate acromegaly patient stratification regarding the ability to respond to SRL. We took advantage of a multicenter study of 71 acromegaly patients and we used advanced mathematical modelling to predict SRL response combining molecular and clinical information. Different models of patient stratification were obtained, with a much higher accuracy when the studied cohort is fragmented according to relevant clinical characteristics. Considering all the models, a patient stratification based on the extrasellar growth of the tumor, sex, age and the expression of E-cadherin, GHRL, IN1-GHRL, DRD2, SSTR5 and PEBP1 is proposed, with accuracies that stand between 71 to 95%. In conclusion, the use of data mining could be very useful for implementation of personalized medicine in acromegaly through an interdisciplinary work between computer science, mathematics, biology and medicine. This new methodology opens a door to more precise and personalized medicine for acromegaly patients

Comportamiento tributario de los responsables del impuesto de industria y comercio del sector educativo para el año gravable 2018

The investigation established an analysis of the tax behavior of those responsible for the industry and commerce tax of the education sector and the factors that influence the timely conduct of compliance with this responsibility of the Municipality of San José de Cúcuta for the taxable year 2018, within the aspect Theoretical highlights the theory of equivalence, the theory of Eheberg or tax duty and the theory of public spending, with reference to the methodology the approach that was approached is quantitative, the type of research was descriptive, the population was composed of 300 private education establishments, the sample was represented by 62 educational establishments, the data collection instrument was the survey, according to the descriptive statistical analysis it was observed that more than half of the respondents presented the declaration in a timely manner of the industry and commerce tax, the fourth part was presented externally temporary or without payment and with a low percentage are those who did not file it, the analysis concludes that there is a tax culture but not efficient, although most of the taxpayers were aware of the tax calendar and submitted the industry tax return in a timely manner and trade of the taxable year 2018, a certain percentage of taxpayers were not aware of the deadline for filing, being one of the reasons for not being up to date with the tax obligation, Likewise, in the opinion of the respondents it is considered that the Secretary The Municipal Treasury must use new strategies to collect the industry and commerce tax. Finally, recommendations were made.La investigación estableció un análisis del comportamiento tributario de los responsables del impuesto de industria y comercio del sector educativo y los factores que inciden en la conducta oportuna del cumplimiento de esta responsabilidad del Municipio de San José de Cúcuta para el año gravable 2018, dentro del aspecto teórico se resalta la teoría de la equivalencia, la teoría de Eheberg o del deber tributario y la teoría del gasto público, con referencia a la metodología el enfoque que se abordó es el cuantitativo, el tipo de investigación fue descriptiva, la población estuvo compuesta por 300 establecimientos de educación de carácter privado, la muestra estuvo representada por 62 establecimientos de educación, el instrumento de recolección de datos fue la encuesta, de acuerdo al análisis estadístico descriptivo se observó que más de la mitad de los encuestados presentaron de forma oportuna la declaración del impuesto de industria y comercio, la cuarta parte la presento de forma extemporánea o sin pago y con un porcentaje bajo están quienes no la presentaron, del análisis se concluye que existe una cultura tributaria pero no eficiente, aunque la mayoría de los contribuyentes conocieron el calendario tributario y presentaron de forma oportuna la declaración del impuesto de industria y comercio del año gravable 2018, cierto porcentaje de contribuyentes no tenían conocimiento de la fecha límite para la presentación, siendo una de las razones para no estar al día con la obligación tributaria, Así mismo, en la opinión de los encuestados se consideran que la Secretaria de Hacienda Municipal debe utilizar nuevas estrategias para el recaudo del impuesto de industria y comercio, por último se realizaron recomendaciones

Geografía : BUP : segundo curso

Este material complementa a cualquier libro de texto de los aprobados por el MInisterio de Educación y Ciencia para la asignatura de geografíaMaterial de trabajo destinado al alumnado de bachillerato para la asignatura de geografía en la modalidad a distancia. Consta de un total de 30 unidades distribuidas en tres documentos en los que se abordan los contenidos teóricos relativos a la geografía de la población, sectores primario, secundario y terciario de la economía, geografía urbana, formas políticas y económicas del mundo actual. Los contenidos de las distintas unidades están relacionados entre sí, de ahí que la evaluación abarque tanto los contenidos del documento correspondiente como los aprendidos en el anterior.MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

Dynamic study of NI (II) adsorption onto Musa aab simmonds residue.

Se estudió la dinámica de adsorción de Ni (II) a partir de la torta residual del proceso de extracción de almidón de plátano en columna de lecho fijo variando la temperatura y altura de lecho. La biomasa se caracterizó por análisis elemental y FTIR. La concentración final del ion en solución se determinó por espectrofotometría de absorción atómica. Se encontró que los grupos funcionales hidroxilos y carboxilos son los de mayor protagonismo en la retención del ion. Del análisis ANOVA se determinó que las variables estudiadas en la remoción del Ni (II) no presentan efectos significativos sobre el mismo. De la curva de ruptura se encontró que la capacidad de adsorción máxima de la columna fue de 18.72 mg/g. El modelo de Dosis de Respuesta es el que mejor describe el proceso de adsorción, concluyendo que la torta residual utilizada es una alternativa de bajo costo muy eficiente en la remoción de Ni (II) a condiciones ambientales.The Ni (II) adsorption dynamics was studied from the residual cake of the starch extraction process of plantain in a fixed bed column varying the temperature and bed height. The biomass was characterized by elemental analysis and FTIR. The final concentration of the ion was determined by atomic absorption spectrophotometry. It was found that the hydroxyl and carboxyl groups present in the biomass are the main protagonists in the adsorption of the heavy metal ion. From ANOVA it was determined that the studied variables do not have significant effects on the process. The breakthrough curve a maximum capacity achieved was 18.72 mg/g. The response-dose model fitted better the whole dynamic behavior of the continuous adsorption of Ni (II) rather than the others, concluding that the residual cake used is a low cost alternative very efficient in the removal of Ni (II) at room temperature

Optimization of the Effect of Temperature and Bed Height on Cr (VI) Bioadsorption in Continuous System

In the present paper, the residues of the plantain starch extraction process are proposed as an adsorbent to remove Cr (VI) in a continuous fixed bed-system, varying the temperature in 33, 40, 55, 70 y 76 °C and bed height in the range of 15.5, 30, 65, 100, 114.5 mm. The adsorbent material was characterized by Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM) and X-ray Diffraction Analysis (XRD). The Cr (VI) solution at 100 ppm had contact with the column by gravity, with a flow rate of 0.75 mL/s at the different working conditions. At the end of the process, the residual concentration of the metal was measured by UV-Vis spectroscopy using the standard method for the determination of Cr (VI) in water ASTM D1687-17. From the results, it was established that the bioadsorbent has the presence of hydroxyl, carboxyl and methyl functional groups and that the adsorption process is controlled by electrostatic interactions; the variables evaluated had a significant influence on the process because applying the RSM methodology it was observed that the optimal operating conditions are 81.49 mm of bed height and temperature of 68 ºC. Based on the behavior of the rupture curve, it was found that the bio-material has the potential to be used as a filler in an adsorption column with the purpose of remove Cr (VI).En el presente artículo se propone como adsorbentes residuos del proceso de extracción de almidón de plátano para remover Cr (VI) en un sistema continuo de lecho fijo, variando la temperatura 33, 40, 55, 70 y 76 °C y altura de lecho en el rango de 15.5, 30, 65, 100, 114.5 mm. El material adsorbente fue caracterizado mediante espectroscopia infrarroja por transformada de Fourier (FTIR), Microscopia Electrónica de Barrido (SEM) y análisis por difracción de rayos X (DRX). La solución de Cr (VI) a 100 ppm tuvo contacto con la columna por gravedad, con un caudal de 0.75 mL/s a las diferentes condiciones trabajadas. Al final del proceso la concentración residual del metal fue medida mediante espectroscopia UV-Vis usando el método estándar para la determinación de Cr (VI) en agua ASTM D1687-17. De los resultados, se estableció que el bioadsorbente cuenta con la presencia de grupos funcionales hidroxilo, carboxilo y metilo, y que el proceso de adsorción está controlado por interacciones electrostáticas; las variables evaluadas incidieron de forma significativa en el proceso, estableciendo al aplicar la metodología RSM que las condiciones óptimas de operación son 81.49 mm de altura de lecho y temperatura de 68 ºC. Del comportamiento de la curva de ruptura se encontró que el bio-material tiene potencial para ser usado como relleno en una columna de adsorción con el fin de remover Cr (VI)