Clinical guideline SEOM: hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents the second leading cause of cancer-related death worldwide. Surveillance with abdominal ultrasound every 6 months should be offered to patients with a high risk of developing HCC: Child-Pugh A-B cirrhotic patients, all cirrhotic patients on the waiting list for liver transplantation, high-risk HBV chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and patients with chronic hepatitis C and bridging fibrosis. Accurate diagnosis, staging and functional hepatic reserve are crucial for the optimal therapeutic approach. Characteristic findings on dynamic CT/MR of arterial hyperenhancement with "washout" in the portal venous or delayed phase are highly specific and sensitive for a diagnosis of HCC in patients with previous cirrhosis, but a confirmed histopathologic diagnosis should be done in patients without previous evidence of chronic hepatic disease. BCLC classification is the most common staging system used in Western countries. Surgical procedures, local therapies and systemic treatments should be discussed and planned for each patient by a multidisciplinary team according to the stage, performance status, liver function and comorbidities. Surgical interventions remain as the only curative procedures but both local and systemic approaches may increase survival and should be offered to patients without contraindications.

[Self-regulation systems to control tobacco advertising. An empirical analysis]

OBJECTIVE

Against the background of the debate aroused by the tobacco advertising ban as a result of Directive 98/43/EC and of the Proposed Directive of 5/9/2001, we aimed to evaluate how self-regulation of tobacco advertising systems has worked in the last 5 years and to evaluate its effectiveness and relevance as a potential tool in public health prevention.

METHODS

We performed a content and discourse analysis of all advertisements appearing in the Sunday supplements of the three weekly newspapers with the widest circulation in Spain (El Pais, El Mundo, and ABC) between January 1995 and January 2000 to detect infractions of the norms of the self-regulation code of the Spanish Tobacco Association (Asociacion Espanola de Tabaco [AET]) regarding: a) the identity of models used in advertising; b) direct or indirect claims for the therapeutic properties of smoking; c) depiction of cigarettes in advertisements, and d) printed warnings on advertisements.

RESULTS

We examined 910 banners and 369 advertisements. Very few advertisements displayed rational arguments on elements such as price (13%) or product components (7%). Although the AET's code was generally respected, the advertisements displayed a series of subtleties that allowed the industry to get around the code: 10 of the 369 advertisements reviewed depicted famous people (mainly pilots and artists) and one third of them used iconic personages (Joe Camel or Marlboro Man); one advertisement suggested the therapeutic properties of tobacco and almost all linked smoking with social success and leisure. Although cigarettes were not depicted, 18% of the advertisements showed substitutes for cigarettes in various places (12%) and a large percentage infringed the code's recommendations on printed warnings.

CONCLUSIONS

The industry's use of creative subtleties infringing its self-imposed norms begs the question of how far self-regulation is viable when a failure in the system can have serious consequences for public health.

Phase II study of first-line biweekly docetaxel and cisplatin combination chemotherapy in advanced gastric cancer

PURPOSE

Previous studies have shown that docetaxel and cisplatin, as single agents, are effective and relatively well tolerated in patients with advanced gastric cancer. The aim of this study was to assess efficacy and toxicity of a biweekly regimen of docetaxel plus cisplatin in patients with advanced gastric cancer.

PATIENTS/METHODS

Fifty-five patients with histologically proven advanced gastric cancer with at least 1 measurable lesion and ECOG PS ≤ 2 were enrolled. Patients received docetaxel 50 mg/m(2) and cisplatin 50 mg/m(2) every 2 weeks until progression disease, unbearable toxicity or a maximum of 12 cycles.

RESULTS

In total, 426 cycles were administered (median 8.5 cycles) to 52 evaluable patients. One patient (1.9 %) showed a complete response, while 21 (40.4 %) had partial responses. The objective response rate was 42.3 % (95 % CI 28.9-55.7), the median time to progression was 5.5 months (95 % CI 4.0-7.0), and the median overall survival was 8.9 months (95 % CI 6.0-11.9). The most common grade 3-4 toxicities per cycle were haematological [neutropenia (5.9 %)].

CONCLUSIONS

Biweekly administration of docetaxel and cisplatin in advanced gastric cancer has a manageable toxicity profile and shows a promising antitumour activity as a first-line therapy.

Evaluation of the anti-inflammatory effects of two platelet-rich gel supernatants in an in vitro system of cartilage inflammation

OBJECTIVES

To study, in normal cartilage explants (CEs) challenged with lipopolysaccharide (LPS), the temporal effects (at 48 and 96h) of leukocyte- and platelet-rich gel (L-PRG) and pure platelet-rich gel (P-PRG) supernatants on the production and degradation of platelet-associated growth factors (GFs) (platelet-derived GF isoform BB [PDGF-BB] and transforming growth factor beta-1 [TGF-β1]), pro-inflammatory (tumour necrosis factor alpha [TNF-α]) and anti-inflammatory cytokines (interleukin 4 [IL-4] and IL-1 receptor antagonist [IL-1ra]).

METHODS

CEs from six horses were challenged with LPS and cultured for 96h with L-PRG and P-PRG supernatants at concentrations of 25% and 50%, respectively. The CE culture medium was changed every 48h and used for determination, by ELISA, of PDGF-BB, TGF-β1, TNF-α, IL-4 and IL-1ra.

RESULTS

Both the 25% and 50% PRG supernatants produced a different molecular profile in the culture media, unlike that of the CE challenged with LPS only. 50% L-PRG produced the most sustained release of growth factors and anti-inflammatory cytokines, although it produced the highest TNF-α release. PDGF-BB was significantly correlated with IL-1ra and TNF-α concentrations, whereas TNF-α was correlated with IL-4.

CONCLUSIONS

50% L-PRG supernatant produced a more sustained concentration of growth factors and anti-inflammatory cytokines than the other hemoderivatives evaluated. This substance could be evaluated in animal models of arthritis or in patients with arthropathies.

Jump percentile: a proposal for evaluation of high level sportsmen

AIM

The goal of this study was to determine reference values of explosive strength for Spanish professional athletes using a force platform. Reference values are displayed as a sports-independent percentile distribution.

METHODS

A total of 323 elite male athletes (age: 20.38 ± 4.65 years, body mass: 75.04 ± 14.30 kg, height: 178.62 ± 14.18 cm) from different disciplines performed the following test: squat jump (SJ), countermovement jump (CMJ), Abalakov test (AB), drop jump (DJ) and repeated jumps (RJ). We calculated: relative peak power, relative peak force, maximal height, symmetry index, explosive index of strength, relative effective impulse, duration of jump, elastic capacity, eccentric time, action of arm, jump number, average height, intensity and fatigue index of force.

RESULTS

Significant differences were found among sports disciplines (P<0.05) in relative peak power, maximal height and relative effective impulse during the SJ, CMJ and AB tests. No significant differences were found among disciplines in DJ variables. In RJ, the main variable characterizing the disciplines analyzed was average height, which showed a significant negative association with athletics, soccer, volleyball and gymnastics.

CONCLUSION

The results obtained suggest that a percentile table may be useful in assessing explosive strength in athletes, regardless of there being any reference values available for their sports discipline.

[Patients treated with micafungin during their stay in intensive care unit]

OBJECTIVES

To determine the reasons of prescription, the characteristics of patients and factors that affected the outcome of critically ill patients treated with micafungin (MCF) during their stay in Spanish ICUs.

MATERIAL AND METHODS

Observational, retrospective and multicenter study. Patients admitted to the ICU between March 2011 and October 2012 (20-month period) treated with MCF for any reason were included in the study. Severity of patients at the beginning of treatment was measured with the APACHE II, SOFA, Child-Pugh and MELD scores. Reasons for the use of MCF were classified as prophylaxis, preemptive treatment, empirical treatment and directed treatment. Continuous variables are expressed as mean and standard deviation or median, and categorical variables as percentages. A multivariate analysis was performed to identify variables related to intra-ICU mortality.

RESULTS

The study population included 139 patients admitted to 19 Spanish ICUs, with a mean age of 57.3 (17.1) years, 89 (64%) men, with surgical (53.2%) and/or medical (44.6%) conditions, APACHE II score of 20.6 (7.7) and SOFA score of 8.4 (4.3), with 84.2% of patients requiring mechanical ventilation, 59% parenteral nutrition, 37.4% extrarenal depuration procedures and 37.4% treatment with steroids. MCF was indicated as empirical treatment of a proven infection in 51 (36.7%) cases, pre-emptive treatment in 50 (36%) especially as a result of the application of the Candida score (32 cases), directed treatment of fungal infection in 23 (16.5%) and as prophylactic treatment in 15 (10.8%) cases. In 108 (77%) cases, a daily dose of 100mg was administered, with a loading dose in only 9 cases (6.5%). The mean duration of treatment was 13.1 (13) days. A total of 59 (42.4%) patients died during their stay in the ICU and 16 after ICU discharge (hospital mortality 53.9%). Independent risk factors for intra-ICU mortality were the Child-Pugh score (OR 1.45, 95% CI 1.162-1.813; P=.001) and the MELD score (OR 1.05, 95% CI 1.011-1.099; P=.014).

CONCLUSIONS

MCF is usually administered at a dose of 100mg/day, without loading dose and in 72.7% of cases as pre-emptive or empirical treatment. Factors that better predicted mortality were indicators of liver insufficiency at the time of starting treatment.

Marteilia sp. and other parasites and pathological conditions in Solen marginatus populations along the Galician coast (NW Spain)

This paper reports the results of the survey developed after the first detection of protozoan Marteilia sp. infection of the grooved razor shell Solen marginatus (Pulteney, 1799) from Galicia (NW Spain) in 2006. Furthermore, we analysed other parasites and pathological conditions found in grooved razor shell populations throughout this survey, such as metacercariae of trematodes, prokaryotic infections and disseminated neoplasms, some of which could cause moderate or severe damage to the host depending on the intensity of infection. A total of 17 natural beds distributed along the Galician coast were analysed, and Marteilia sp. was detected in 6 of them with low prevalence, moderate intensity and no negative effects over the populations.

Magnetic Cross-Linked Enzyme Aggregates (mCLEAs) of Candida antarctica lipase: an efficient and stable biocatalyst for biodiesel synthesis

Enzyme-catalyzed production of biodiesel is the object of extensive research due to the global shortage of fossil fuels and increased environmental concerns. Herein we report the preparation and main characteristics of a novel biocatalyst consisting of Cross-Linked Enzyme Aggregates (CLEAs) of Candida antarctica lipase B (CALB) which are covalently bound to magnetic nanoparticles, and tackle its use for the synthesis of biodiesel from non-edible vegetable and waste frying oils. For this purpose, insolubilized CALB was covalently cross-linked to magnetic nanoparticles of magnetite which the surface was functionalized with -NH2 groups. The resulting biocatalyst combines the relevant catalytic properties of CLEAs (as great stability and feasibility for their reutilization) and the magnetic character, and thus the final product (mCLEAs) are superparamagnetic particles of a robust catalyst which is more stable than the free enzyme, easily recoverable from the reaction medium and reusable for new catalytic cycles. We have studied the main properties of this biocatalyst and we have assessed its utility to catalyze transesterification reactions to obtain biodiesel from non-edible vegetable oils including unrefined soybean, jatropha and cameline, as well as waste frying oil. Using 1% mCLEAs (w/w of oil) conversions near 80% were routinely obtained at 30°C after 24 h of reaction, this value rising to 92% after 72 h. Moreover, the magnetic biocatalyst can be easily recovered from the reaction mixture and reused for at least ten consecutive cycles of 24 h without apparent loss of activity. The obtained results suggest that mCLEAs prepared from CALB can become a powerful biocatalyst for application at industrial scale with better performance than those currently available.

Magnetic biocatalysts and their uses to obtain biodiesel and biosurfactants

Nanobiocatalysis, as the synergistic combination of nanotechnology and biocatalysis, is rapidly emerging as a new frontier of biotechnology. The use of immobilized enzymes in industrial applications often presents advantages over their soluble counterparts, mainly in view of stability, reusability and simpler operational processing. Because of their singular properties, such as biocompatibility, large and modifiable surface and easy recovery, iron oxide magnetic nanoparticles (MNPs) are attractive super-paramagnetic materials that serve as a support for enzyme immobilization and facilitate separations by applying an external magnetic field. Cross-linked enzyme aggregates (CLEAs) have several benefits in the context of industrial applications since they can be cheaply and easily prepared from unpurified enzyme extracts and show improved storage and operational stability against denaturation by heat and organic solvents. In this work, by using the aforementioned advantages of MNPs of magnetite and CLEAs, we prepared two robust magnetically-separable types of nanobiocatalysts by binding either soluble enzyme onto the surface of MNPs functionalized with amino groups or by cross-linking aggregates of enzyme among them and to MNPs to obtain magnetic CLEAs. For this purpose the lipase B of Candida antarctica (CALB) was used. The hydrolytic and biosynthetic activities of the resulting magnetic nanobiocatalysts were assessed in aqueous and organic media. Thus, the hydrolysis of triglycerides and the transesterification reactions to synthesize biodiesel and biosurfactants were studied using magnetic CLEAs of CALB. The efficiency and easy performance of this magnetic biocatalysis validates this proof of concept and sets the basis for the application of magnetic CLEAs at industrial scale.

Pasteurella multocida bacterial meningitis caused by contact with pigs

Pasteurella multocida belongs to the normal flora of the respiratory and digestive tract of many animals. Animal exposure is a considerable risk factor for Pasteurella infection. P. multocida is the most common cause of local infection after an animal bite but is an unusual cause of meningitis. We present a case of bacterial meningitis by P. multocida in a 37-year-old man who worked in a pig farm and was bitten by a pig. The patient had a defect located in the lamina cribosa and this lesion could be the gateway of the infection, although in this case the infection could also be acquired through the pig bite. The bacteria was identified as P. multocida with the biochemical test API 20E (bioMérieux). In agreement with findings in the literature, the strain was susceptible in vitro to penicillin, ampicillin, cefotaxime, ceftriaxone ciprofloxacin, levofloxacin, imipenem and tetracycline.

Prevalence and identity of Sarcocystis spp. in roe deer (Capreolus capreolus) in Spain: a morphological study

Muscular samples from the oesophagus, diaphragm and heart of 101 roe deer (Capreolus capreolus) hunted in Galicia (Northwestern Spain) were examined, by the compression method, for the presence of Sarcocystis spp. infection. The structure of the cyst wall was examined by light (LM) and transmission electron microscopy (TEM). The overall prevalence of infection was very high (99%), with a density of 404 cysts/sample (SD 812). The prevalence was very similar in the different examined muscle types (99% heart and diaphragm, and 98.9% oesophagus). A significantly higher intensity of infection was found in the heart (831; SD 1281), followed by the diaphragm (197; SD 190) and the oesophagus (180; SD 205). Macrocysts (>1500 μm long) were only detected in the oesophagus of 48.5% of the examined roe deer; their mean size was 2055.4 μm (SD 632.46). Cysts localised in the myocardium were significantly shorter (371.5 μm; SD 160.47) than those found in the diaphragm (678.2; SD 546) and the oesophagus (973.4 μm; SD 667.87). By LM, most of the cysts (98.8%) displayed a thin wall, which was consistent with those of Sarcocystis sp., S. gracilis and S. capreolicanis; only 1.2% of the cysts had a thick striated wall, consistent with Sarcocystis silva. Three morphological distinct sarcocysts were observed by TEM: the unnamed species Sarcocystis sp., S. capreolicanis and S. gracilis. The wall ultrastructure of the examined macrocysts was consistent with S. gracilis. This study has revealed that Spanish roe deer harbours 4 morphologically distinct types of sarcocysts; being the first record of S. gracilis in roe deer from Spain.

Self-assembly structures of 1H-indazoles in the solution and solid phases: a vibrational (IR, FIR, Raman, and VCD) spectroscopy and computational study

1H-indazoles are good candidates for studying the phenomena of molecular association and spontaneous resolution of chiral compounds. Thus, because the 1H-indazoles can crystallize as dimers, trimers, or catemers, depending on their structure and the phase that they are in, the difficulty in the experimental analysis of the structure of the family of 1H-indazoles becomes clear. This difficulty leads us to contemplate several questions: How can we determine the presence of different structures of a given molecular species if they change according to the phase? Could these different structures be present in the same phase simultaneously? How can they be determined? To shed light on these questions, we outline a very complete strategy by using various vibrational spectroscopic techniques that are sensitive (VCD) and insensitive (IR, FIR, and Raman) towards the chirality, together with quantum chemical calculations.