Cytokines and Lymphoid Populations as Potential Biomarkers in Locally and Borderline Pancreatic Adenocarcinoma

Despite its relative low incidence, PDAC is one of the most aggressive and lethal types of cancer, being currently the seventh leading cause of cancer death worldwide, with a 5-year survival rate of 10.8%. Taking into consideration the necessity to improve the prognosis of these patients, this research has been focused on the discovery of new biomarkers. For this purpose, patients with BL and resectable disease were recruited. Serum cytokines and growth factors were monitored at different time points using protein arrays. Immune cell populations were determined by flow cytometry in peripheral blood as well as by immunohistochemistry (IHC) in tumor tissues. Several cytokines were found to be differentially expressed between the study subgroups. In the BL disease setting, two different scores were proven to be independent prognostic factors for progression-free survival (PFS) (based on IL-10, MDC, MIF, and eotaxin-3) and OS (based on eotaxin-3, NT-3, FGF-9, and IP10). In the same context, CA19-9 was found to play a role as independent prognostic factor for OS. Eotaxin-3 and MDC cytokines for PFS, and eotaxin-3, NT-3, and CKβ8-1 for OS, were shown to be predictive biomarkers for nab-paclitaxel and gemcitabine regimen. Similarly, oncostatin, BDNF, and IP10 cytokines were proven to act as predictive biomarkers regarding PFS, for FOLFIRINOX regimen. In the resectable cohort, RANTES, TIMP-1, FGF-4, and IL-10 individually differentiated patients according to their cancer-associated survival. Regarding immune cell populations, baseline high levels of circulating B lymphocytes were related to a significantly longer OS, while these levels significantly decreased as progression occurred. Similarly, baseline high levels of helper lymphocytes (CD4+), low levels of cytotoxic lymphocytes (CD8+), and a high CD4/CD8 ratio, were related to a significantly longer PFS. Finally, high levels of CD4+ and CD8+ intratumoural infiltration was associated with significantly longer PFS. In conclusion, in this study we were able to identify several prognostic and predictive biomarker candidates in patients diagnosed of resectable or BL PDAC.

Deciphering CHFR Role in Pancreatic Ductal Adenocarcinoma

Checkpoint with forkhead-associated and ring finger domains (CHFR) has been proposed as a predictive and prognosis biomarker for different tumor types, but its role in pancreatic ductal adenocarcinoma (PDAC) remains unknown. The aim of this study was two-pronged: to review the role of CHFR in PDAC and evaluating CHFR as a potential predictive biomarker in this disease. For this purpose, we first explored the CHFR messenger (m)RNA expression and promoter methylation through the TCGA database. Secondly, the CHFR expression and promoter methylation were prospectively evaluated in a cohort of patients diagnosed with borderline (n = 19) or resectable (n = 16) PDAC by immunohistochemistry (IHC), methylation specific-PCR (MSP), and pyrosequencing. The results from the TCGA database showed significant differences in terms of progression-free survival (PFS) and overall survival (OS) based on the CHFR mRNA expression, which was likely independent from the promoter methylation. Importantly, our results showed that in primarily resected patients and also the entire cohort, a higher CHFR expression as indicated by the higher IHC staining intensity might identify patients with longer disease-free survival (DFS) and OS, respectively. Similarly, in the same cohorts, patients with lower methylation levels by pyrosequencing showed significantly longer OS than patients without this pattern. Both, the CHFR expression intensity and its promoter methylation were established as independent prognostic factors for PFS and OS in the entire cohort. In contrast, no significant differences were found between different methylation patterns for CHFR and the response to taxane-based neoadjuvant treatment. These results suggest the potential role of the higher expression of CHFR and the methylation pattern of its promoter as potential prognostic biomarkers in PDAC, thus warranting further comprehensive studies to extend and confirm our preliminary findings.

Assessment of the main factors affecting the dynamics of nutrients in two rainfed cereal watersheds

Nutrient dynamics and factors that control nutrient exports were observed in two watersheds, namely Latxaga and La Tejería, with similar climatic and management characteristics throughout 10 years (2007-2016). Similar patterns were observed in intra-annual and inter-annual dynamics with higher NO₃^- concentration and NO₃^--N yield during the humid seasons (i.e., winters and hydrological year 2013). Regarding concentration, Latxaga showed a higher decrease of nitrate due to a higher development of vegetated areas. High discharge events produced nitrate dilution due to the presence of tile-drainage at La Tejeria. At Latxaga, where tile-drainage was not observed, an increase in concentration occurred as a response to high discharge events. Comparing both watersheds, La Tejería presented ca. 73 ± 25 mg NO₃^- L^-1 while at Latxaga, the concentration observed was almost three times lower, with ca. 21 ± 15 mg NO₃^- L^-1 throughout the study period. Similar patterns were observed for the NO₃^--N yield, with 32 kg NO₃^--N ha^-1 year^-1 and 17 kg NO₃^--N ha^-1 year^-1 at La Tejería and Latxaga, respectively. Regarding phosphorous, the observed concentrations were 0.20 ± 0.72 mg PO₄^3- L^-1 and 0.06 ± 0.38 mg PO₄^3- L^-1 at La Tejería and Latxaga, respectively, with PO₄^3--P yields being 71 kg PO₄^3--P ha^-1 year^-1 and 33 kg PO₄^3--P ha^-1 year^-1. Annual phosphate-P yield distribution in both watersheds followed similar patterns to those observed for the nitrate-N yield, with higher yields in the humid season. Regarding concentration, highly erosive rainfall that occurred in summer, mobilizing sediments and probably generating desorption of phosphorous in the stream channel, increased phosphate concentration. This research adds to the knowledge base regarding the dynamics of nutrients and the controlling factors in complex agricultural systems with Mediterranean characteristics.

[Characteristics of YouTube videos in Spanish about the influenza vaccine]

BACKGROUND

To analyze the characteristics of YouTube videos in Spanish about the influenza vaccine.

METHODS

In April 2019, a search was conducted on YouTube with the term vacuna gripe. We studied the association between the type of author, and country of publication, and the rest of the variables (tone of the message, type of publication, and vaccination recommendations according to the Spanish Ministry of Health, among others) with univariate analysis and a multiple logistic regression model.

RESULTS

In total, 208 videos were assessed; 51.0% had been published from Spain and Mexico, and 79.8% of the videos supported the use of influenza vaccines. The main topics discussed in the videos were whether the vaccine should be considered the most effective method to prevent influenza (64.4%) and recommendations concerning the vaccination of people over 65 years old (43.3%). The variables type of authorship (healthcare professionals) and country of publication (Spain) were associated with a positive attitude towards vaccination (OR: 2.91; 95%CI: 1.12-7.53 and OR: 0.31; 95%CI: 0.15-0.65, respectively).

CONCLUSIONS

The existing information on YouTube about the influenza vaccine is not generally very complete, and it varies depending on the authorship of the videos and the country of publication. It would be advisable for healthcare professionals to publish videos promoting vaccination based on the guidelines from the Spanish Ministry of Health, and it is necessary to promote those videos for Spanish users who search for reliable information about this vaccine on YouTube.

Irrigation implementation promotes increases in salinity and nitrate concentration in the lower reaches of the Cidacos River (Navarre, Spain)

The shift from rainfed to irrigated agriculture is associated with a change in the fertilization rates due to increases in expected production and the fact of growing more N demanding crops. In addition, the circulation of irrigation return flows (IRF) mobilizes soluble salts stored in soils or geological materials. As a consequence, it implies severe modifications in the dynamics and total amount of soluble salts and nitrogen exported, especially in semi-arid watersheds. In this study, long-term data collected by the regional authorities was used to assess the effects of irrigation implementation on salinity (using electrical conductivity, EC, as a proxy) and nitrate concentration (NO₃^-) after the transformation of ca. 77 km² from rainfed to irrigated agriculture in the Cidacos River (CR) watershed. The results indicate that water quality in the lower reaches of the CR was significantly modified after the diffuse incorporation of IRF. In contrast, neither EC nor NO₃^- were different in those monitoring stations whose contributing watersheds did not include transformed area. In addition, the temporal dynamics in the analysed variables shifted from a rainfed land signal typical in the region to an irrigated land signal, and the hydrochemical type of the CR shifted from mixed-to-Na⁺-mixed-to-HCO₃^- to mostly Na⁺-mixed type, typical of waters affected by IRF in the region. Groundwater EC and NO₃^- also increased in those wells located within the irrigated area. Although there are great uncertainties in the actual amount of salt and N reaching the CR via IRF, the expected contribution of waste water spilled into the CR is minor in comparison to other sources, mostly agricultural sources in the case of N. The observed changes have promoted the designation of the lower reaches of the CR as "affected" by NO₃^- pollution, and the whole CR watershed as a Nitrate Vulnerable Zone, with the emergent question about whether irrigation implementation as carried out currently in Spain is against the environmental objectives of the Water Framework Directive.

Omics Approaches in Pancreatic Adenocarcinoma

Pancreatic ductal adenocarcinoma, which represents 80% of pancreatic cancers, is mainly diagnosed when treatment with curative intent is not possible. Consequently, the overall five-year survival rate is extremely dismal—around 5% to 7%. In addition, pancreatic cancer is expected to become the second leading cause of cancer-related death by 2030. Therefore, advances in screening, prevention and treatment are urgently needed. Fortunately, a wide range of approaches could help shed light in this area. Beyond the use of cytological or histological samples focusing in diagnosis, a plethora of new approaches are currently being used for a deeper characterization of pancreatic ductal adenocarcinoma, including genetic, epigenetic, and/or proteo-transcriptomic techniques. Accordingly, the development of new analytical technologies using body fluids (blood, bile, urine, etc.) to analyze tumor derived molecules has become a priority in pancreatic ductal adenocarcinoma due to the hard accessibility to tumor samples. These types of technologies will lead us to improve the outcome of pancreatic ductal adenocarcinoma patients.

[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]

BACKGROUND

Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department.

PATIENTS AND METHODS

The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found.

RESULTS

Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19).

CONCLUSIONS

The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

[Impact of short-stay units on the quality of medical care in Spain]

OBJECTIVE

Short-stay units (SSUs) have been developed as an alternative to conventional hospitalisation. The aim of this study is to analyse the impact of short-stay units on the quality of medical care in Spain.

MATERIAL AND METHODS

A systematic review was performed by retrieving studies that analysed the results of SSUs in Spain, in terms of clinical effectiveness, efficiency and satisfaction among patients, using an electronic database search (Pubmed/Medline and Spanish Medical Index) and a review of selected references. The data collected included, mortality, length of stay and re-admission rates, as well as other variables.

RESULTS

Twenty-seven articles were found, with a great heterogeneity in both study design and type of SSU analysed. After analysing results, it was observed that SSUs in Spain provided effective clinical care. Low-quality evidence was also found supporting the hypothesis that SSUs are able to reduce overall length of stay in the whole hospital or department where they were created. There are not enough data to support any other advantages or benefits of SSUs, when compared with other hospitalisation units.

CONCLUSIONS

SSUs may be able to effectively improve clinical care in selected patients, and may help to shorten overall length of stay. Further research is needed in order to define their exact role and to establish their optimal model.

Current management of gastric cancer

Gastric cancer is a disease with high incidence and mortality in our population. The prognosis of patients with this disease is closely related to the neoplasm stage at diagnosis, including the following characteristics of the tumor: extension into the gastric wall thickness, spread to locoregional lymph nodes and the ability to generate distant metastases, as described by the TNM classification. For localized tumors characterized only by invasion of mucosa or submucosa at diagnosis, survival at 5 years is between 70 and 95% with exclusive surgical management; however, when extension into the gastric wall is higher and/or there is locoregional nodal involvement, survival decreases to 20-30% at 5 years. Currently, at high-volume centers, the extent of gastrectomy is individualized based on several parameters, which in an increasing number of cases allows a total gastrectomy with D2 lymphadenectomy and preservation of the spleen and pancreas. This improved procedure increases the chance of R0 surgery and improves the relationship between resected and affected lymph nodes, resulting in a decreased risk of the long-term locoregional recurrence. To improve these results, different therapeutic strategies combining chemotherapy or chemoradiotherapy with surgery have been tested. Previously, the Intergroup 0116 clinical trial, published in 2001, which changed clinical practice in the United States, showed that adjuvant chemoradiotherapy improved survival (from 26 to 37 months overall survival) of these patients. In Europe, perioperative chemotherapy has been considered the standard treatment, since the publication of two randomized phase III trials showed an increase at 5 years survival in the group treated with chemotherapy.

[Mortality attributable to smoking in Spain in 2006]

BACKGROUND

Tobacco consumption is a worldwide public health problem. Our aim was to estimate the mortality attributable to smoking and its impact on premature mortality in Spain in the year 2006.

METHODS

Descriptive, cross-sectional study, carried out on the Spanish population aged > or = 35 years in 2006. The number of deaths by age, sex and cause was obtained from the vital statistics of the National Institute of Statistics. The prevalence of smoking by age and sex was obtained from the national health survey. The relative risks of death employed were adjusted by age, sex, educational level, civil status, type of work, consumption of fruit/vegetables and other confounding factors specific to certain diseases. The proportion and number of deaths attributable to tobacco, by sex and age group, were estimated on the basis of the etiological fraction of the study population. Similarly, potential years of life lost (PYLL) were calculated.

RESULTS

In 2006, smoking caused 58,573 deaths (45,028 men; 13,545 women), which accounted for 16.15% of all deaths (23.94% in men; 7.76% in women). By cause, the attributable deaths were distributed in 25,500 malign tumours, 19,117 cardiovascular diseases and 13,956 respiratory diseases. Trachea-bronchial-lung cancer in men and other cardiopathies in women were those that most contributed to that mortality (33.9% and 30.9%). The PYLL were 211,251.8 (176,765.3 in men; 34,486.5 in women).

CONCLUSIONS

Tobacco consumption makes a very notable contribution to mortality in Spain. The impact that this habit has on our society is an unacceptable burden.

[Satisfaction among patients attending outpatient preventive medicine clinic]

INTRODUCTION

To evaluate satisfaction among patients attending the outpatient clinics of a Preventive Medicine Department and to identify any problems with the care they receive.

MATERIAL AND METHODS

We performed a cross-sectional study in outpatient clinics of the Preventive Medicine Department, at Hospital General Universitario in Alicante, during January 2009. A questionnaire was given to all patients after their visit. Patients were satisfied if the final score was > or = 8. Socio-demographic variables were: age, sex, educational level, marital status and type of user (external or internal). chi(2) were used to study the association between these variables and satisfaction.

RESULTS

The response rate was 84.4% (119/141), 94.1% were correctly completed (112/119), and 82.1% had a final score of > or = 8. The worst aspects were: comfort of waiting room, signs and wait time (percentage dissatisfied: 54.5%, 46.4% and 30.4%, respectively). The rest of the items obtained the following satisfaction percentages: medical treatment (97.3%), privacy of care (95.5%), information received (93.7%), easy next appointment (93.7%), visit length (92.9%), clarity of information (92.9%), to arrange the first appointment (90.2%), nursing treatment (87.5%), time to date of appointment (81.2%). Educational level was the only variable significantly associated with satisfaction.

CONCLUSIONS

General satisfaction was good, although aspects like waiting time and signs could be better, if changes were made to management of appointments and the signs in the Hospital Department were increased.