Bibliometric analysis in paediatric dental journals listed in journal citation reports. Current trends

AIM

The aim of this study was to analyse articles published in paediatric dental journals included in Journal Citation Reports (JCR), to determine current trends in paediatric publishing.

METHODS

Articles included in paediatric dentistry journals in 2020 JCR were selected, published during the period 2008-2020. After applying inclusion criteria, author-based parameters (article title, first author's name, institution, sex and number of authors, number of affiliations, first/last author's origin and geographic origin), and article-based parameters (article type, main topic, research design) were registered for each article.

CONCLUSION

International Journal of Paediatric Dentistry, Journal of Clinical Pediatric Dentistry, European Journal of Paediatric Dentistry and Pediatric Dentistry were the four main journals in terms of production volume, USA being the most productive country. The most recurrent topic was dental surgery, and the most common design was observational studies. Study design, geographic origin of the articles, article type and main subject of the article might predict citation.

Trauma: Harmful effect of diagnostic labeling and iatrogenic intervention for the recovery process

Introduction

We know the coexistence of traumatic factors (loss of affective relationships, experiences of abuse, extreme risk situations, etc.) is common in psychiatric pathologies in which level of stress experienced exceeds normal capacity of the person, favoring the appearance of dissociative or excision mechanisms. A common mistake is to pathologize them and try to eliminate them.

Objectives

The objective of this paper is to study trauma and defense mechanisms involved, in order to carry out a better approach.

Methods

A bibliographic search was performed from different database (Pubmed, TripDatabase) about trauma, mechanisms involved and the construction of identity.

Results

We know neural pathways mature asymmetrically in evolutionary development (functions related to attention, concentration and executive function having special importance) and thus, traumas occurred in moments of greatest vulnerability such as early childhood, can damage and interfere with the correct integration of neural processes, producing disproportionate and unnecessarily maintained alert responses (common basis for many pathologies such as borderline personality disorder or traumatic psychosis). In response to this, reactive mechanisms are produced (such as dissociation or cleavage) that are not necessarily pathological and therefore, we should not always intervene by eliminating them because they often function as a protective factor, allowing to preserve functioning and favoring recovery.

Conclusions

In conclusion, we need a better understanding of mechanisms involved in trauma, executive function and the alarm system beyond anxiety reactions, trying to understand the function of symptom without eliminating it, but evaluating whether there are healthier alternatives can be promoted for the complete recovery of the patient.

Disclosure

No significant relationships.

Iatrogenesis as a possible cause of chronification of mental disorders

Introduction

Most mental disorders tend to relapse (severe or mild pathologies such as anxiety or dystima disorders), which are potentially recoverable and yet, tend to evolve poorly, persisting residual symptoms without achieving a complete recovery.

Objectives

The objective of this paper is to analyze the factors that influence process of recurrence and chronification, among which are our own therapeutic interventions.

Methods

A bibliographic search was performed from different database (Pubmed, TripDatabase) about the iatrogenic potential of our intervention (psychopharmacological or psychotherapeutic), analyzing influence and mechanisms involved, and the way to prevent them.

Results

Anxiety is a necessary element for the development of people, both from a biological perspective (natural and adaptive psychological response that allows us to respond adequately to possible threats); as an evolutionary psychological (element involved in conflict resolution, in turn necessary for personal development). It would be a mistake to consider it as pathological and try to eliminate it through medication or psychotherapy, since we could interfere with the natural recovery processes, contributing to its chronification and preventing possibility of change. At times, anxiety can be pathological when it occurs disproportionately and exceeds ability to adapt, but we must not eliminate it but to study origin and factors involved, to achieve complete resolution.

Conclusions

In conclusion, we must consider possible iatrogenesis of our therapeutic interventions in process of chronification of mental disorders and try to avoid them by adequately studying individual factors and characteristics, before intervening.

P–398 Decidualization inhibits the expression of CXCR3-binding chemokines by human decidual stromal cells. Role in maternal-fetal immune tolerance

Study question

We aimed to analyze the effects of decidualization on the expression of chemokines that attract abortogenic T cells by human DSCs.

Summary answer

Decidualization inhibits the expression of chemokines that attract Th1 and Tc1 cells by DSCs, thereby preventing the arrival of abortogenic T cells into the decidua.

What is known already

Decidual stromal cells (DSCs) are the most abundant cells in the human decidua, the tissue that constitutes the maternal component of the placenta. Numerous evidences confirm that DSCs play a key role in maternal-fetal immune tolerance. In normal pregnancy, DSCs undergo a process of differentiation (decidualization) under the effect of progesterone and other pregnancy hormones. Decidualized DSCs become rounded and secrete prolactin, IL–15 and other factors. In the mouse, it has been observed that during pregnancy, DSCs inhibit the expression of chemokines that attract abortogenic Th1 and Tc1 cells from blood to the decidua.

Study design, size, duration

We compared the expression of CXCR3-binding chemokines by undifferentiated and decidualized human DSCs. We also compared the capacity of these cells to attract activated Th1 and Tc1 cells in vitro. Ten DSC lines were obtained from elective vaginal terminations of first-trimester pregnancies (6–11 weeks). Donors were healthy women aged 20–30 years. Informed consent was obtained from each donor. This study was approved by the Research and Ethics Committee of the University of Granada.

Participants/materials, setting, methods

Decidual stromal cell lines were established as previously described. These lines were decidualized with progesterone and cAMP in vitro. The expression of chemokines by these cells was studied by RT-PCR. Peripheral blood lymphocytes were activated with PHA, anti-CD28 and IL–2. As a consequence of this activation, CXCR3+ Th1 and Tc1 cells were produced. We used a migration assay in Transwell chambers to study the capacity of DSCs to attract these activated T cells.

Main results and the role of chance

We observed that those chemokines that bind to CXCR3, a chemokine receptor detected in activated Th1 and Tc1 cells, were not expressed by either undifferentiated and decidualized DSCs (CXCL9) or their expression was inhibited in decidualized DSCs (CXCL10 P < 0.01, CXCL11 P < 0.05). We found that conditioned media of undifferentiated DSCs decreased the migration of CXCR3+ activated T cells (Th1 and Tc1 cells) (P < 0.05), and this effect was even stronger with conditioned media of decidialized DSCs P < 0.001). These results demonstrated that decidualization of DSCs during pregnancy inhibits the expression of chemokines that attract Th1 and Tc1 cells by DSCs, thereby preventing the arrival of abortogenic T cells into the decidua.

Limitations, reasons for caution

This is an in vitro study due to the impossibility of performing an in vivo study in humans for ethical reasons.

Wider implications of the findings: Several publications have shown that DSCs have a therapeutic effect in various Th1-associated diseases. Our results explain this effect and suggest the extension of the use of these cells in the treatment of this type of diseases.

Trial registration number

Not applicable

Saving time in the radiotherapy procedures for COVID-19 pneumonia treatment. A single-institution experience

Background

The use of low dose radiotherapy (LD-RT) for the treatment of COVID-19 pneumonia is supported by biological rationale for its immunomodulatory effect. Some institutions have started to treat these patients showing encouraging results. To shorten procedure times is crucial for the comfort of symptomatic patients receiving respiratory support and to optimize institutional facilities.

Patients and methods

At our institution, LD-RT is offered to hospitalized patients with COVID-19 pneumonia and signs of early cytokine-released syndrome on behalf of a multicenter study. We designed a coordinated process flow starting from the patient transfer to the simulation CT-scan (first-step), to the end of the LD-RT treatment (last step). The times spent on each step of the process flow were evaluated.

Results

Mean age of treated patients was 83 (72–91) years-old. The timing parameters of the first 10 consecutive patients were analyzed. Except for the first (dummy run), patients were managed from the first to the last step in a median of 38 min (25–58, SD 10.67). The most time-consuming sub-process was the contouring of the treatment volumes and dosimetry.

Conclusions

LD-RT is not only an encouraging option for COVID-19 pneumonia patients, but a convenient and feasible procedure if performed in a coordinated way by reducing procedure times.

Limitation of therapeutic effort in pychiatric patients. about a case

Introduction

Thanks to advances in medicine, more diseases are being cured, but this benefit can become a problem when it causes a worsening of quality of life.

Objectives

The objective of this paper is to analyze, regarding the following case, the convenience of treating or to limit the therapeutic effort (LTE) in psychiatric patients who are in situations at the end of life.

Methods

62-year-old woman begins with depressive symptoms from financial problems. In 4 months ago she makes four suicide attempts (drug overdose, cuts, self-stabbing, and precipitation), being hospitalized in ICU after latter because of multiple trauma and shock. During that time, she had a bad evolution with several complications that made LTE be evaluated. A bibliographic search was performed from different database (Pubmed, TripDatabase) about LTE and ethical implications.

Results

Trying to prolong life by disproportionate means in a patient with a poor prognosis or poor quality of life is bad practice. We must assess the severity, quality of life, capacity and preferences of the patient to decide to treat or not, thus guaranteeing the principle of beneficence. It is also important to respect the principle of autonomy, accepting patients can refuse treatment. All this is equally applicable to psychiatric patients, whom we should not stigmatize but rather evaluate their ability to decide, as in any person.

Conclusions

In conclusion, in situations of high suffering and near death, it is necessary a complete evaluation of the patient (psychiatric or not) is carried out in order to act in the most ethical way.

Obsessive symptoms as first alert of psychosis: Two cases report

Introduction

Concomitant presence of obsessive-compulsive symptoms(OCS)is relatively frequent in psychotic patients and there are different hypotheses trying to explain the origin of them as pathology evolution,comorbid disorder,defence mechanism,or even a medication side-effect,but it is difficult to make a precise evaluation of these symptoms and the mechanisms involved.SometimesOCS are the first manifestation toappear without any other areas affected,and psychotic disorder comes later with initial symptoms in that domain.

Objectives

Evaluate the association between OCS and psychosis to document pathogenia of both entities.

Methods

A bibliographic search was performed about this topic.We present two cases of patients that have been referred to our unit: A34year old man, a usual consumer of cannabis,who shows checking and organizing compulsions that interfere significantly with their life.Consumptions grew progressively until they became daily,trying to decrease partly this behaviour. He comes to an addiction unit where he achieves abstinence,but immediately shows an important functional-impairment, adding to the previous compulsions new ones,and also thought blocking,social retraction and personality change. He starts taking antidepressant and benzodiazepines to reduceOCS, and weeks later begins a manic episode with delusions as a bipolar-disorder debut. A29year old man, with a history of familiar obsessive personality,that begins to worry about physical appearance and starts compulsive behaviour focused on exercise preventing him from daily activities.No response to antidepressants, he started antipsychotics and develop referential-symptoms.

Results

Both are atypical presentations of bipolar and schizophreniform disorders withOCS,where the beginning of treatment causes psychosis-symptoms not previously developed.

Conclusions

Frequent doubts are what factors determine the eclosion.The triggers are not clear and neither the related-pathology.

Disclosure

No significant relationships.

Mental illness pathogenia: Anxiety disorders, an evolutive vision

Introduction

There are many authors that follow and develop Pinel-hypotheses about unitary psychosis, joining recent discoveries in neuropathology and neurochemistry, supporting the vision of mental illness as neurodevelop disorders. The classification they suggest, distinguishes early, late neurodevelop disorders, and those related to traumatic factors, what determine an evolutive vision of this pathology. In terms of anxiety symptoms/disorders, they have been usually associated with categorical pathology, and treated focus on symptoms,unfortunately relapses are very frequent.

Objectives

Proving that the evolutive vision may ease a change on the intervention of anxiety disorders, that would propound different therapeutic alternatives.

Methods

A bibliographic search was performed from different databases, showing throw aspects related to main etiopathogenic theories about anxiety disorders from an evolutive vision.

Results

Evolutive-Psychology raises that anxiety is a concomitant process to development, that grows progressively and is necessary to induce changes in it. However a high level of anxiety might block that process or causes alterations. In that sense, anxiety-disorders may be related to an excess of anxiety that provoke a fault in present handling mechanisms. According to classic dynamic-theories, these mechanisms are associated with defence concept, but now we can link them to neurobiological development. From this point, there exists an asymmetric neurological maturation through childhood-adolescence that translates different manifestations of anxiety along development, initially more related with external contemption and relationship with caregiver, but later with hormonal pulses, physical changes and separation from family.

Conclusions

The evolutive vision allows to understand development fluctuation of anxiety symptoms along the growth process, more accurately than categorical classic tendency.

Disclosure

No significant relationships.

Steroid-induced psychosis in context a SARS-CoV-2 pandemic. about a case

Introduction

SARS-CoV-2 is having an important direct impact, and also due to treatments used such as corticosteroids. Among its effects, we have focused on psychosis.

Objectives

The objective of this paper is to study, from following case, incidence of steroid-induced psychosis in context of COVID-19.

Methods

A bibliographic search was performed from different database (Pubmed, TripDatabase) about psychiatric symptoms associated with use of corticosteroids during pandemic. 64-year-old woman with no psychiatric history, who is hospitalized for pneumonia secondary to SARS-Cov2 and treated with antibiotics, bronchodilators, and corticosteroids. At 4 days she began with injury and nihilistic delusions. The corticosteroids were progressively reduced, adding 2.5 mg Risperidone, resolving after ten days.

Results

Corticosteroids are currently being used to treat the systemic inflammatory response associated with COVID-19, but they can produce other effects such as psychiatric symptoms (3-6%): 75% affective (mainly hypomanic symptoms); and 25% psychotic. Steroid-induced psychosis are characterized by confusion, delusions, and hallucinations, and they usually begin 3-4 days after onset, and resolve within a week. They are associated especially with oral systemic steroids and high doses: 1.3% with 40mg of prednisone, and 18% with 80mg; increased this incidence due to the greater use that is being made to treat COVID-19 and the higher doses used in severe cases (up to 120 mg).

Conclusions

To conclude, we need to know characteristics of these episodes in order to be able to prevent and treat them properly (minimum effective dose and less time), since they will probably occur more frequently at this time.

The requirement of an early detection of vulnerability base patterns in childhood to reduce relapse tendency in psychiatric pathology

Introduction

In order to understand etiopathogeny of any mental illness, it is important to be aware of the sequential emergence of symptoms, having presentations, that appear before, after or simultaneously. We could understand mental pathology as the sumatory of different factors and vulnerable cerebral substrates. Adverse external factors influence over them, causing relapses, that would lead to the evolution of diagnosis through time. However,patients usually come when pathology is already developed. Interventions are delayed, what is insufficient to modify the course of the illness.

Objectives

Proving that replacing classic clinical evaluation by an open access/multiintervention model, would determine a better prevention and reduction of relapse tendency.

Methods

We have arranged a prospective descriptive study of 124 users along 2 years. The idea was to test a first sample which let us check the viability of our project. We adopted a qualitative approach, linking practice and research, which have implied to perform a structured clinical process based on a dynamic reevaluation performed for different professionals in various stages using Rodman’s model.

Results

MultiIntervention model reduces the prognosis factor of delayed treatment thanks to reaching a high risk group in the early stages. That model allows us to determine the way each factor relates to each other, what facilitates multiple-intervention that tries to eliminate the symptom and also the relapse.

Conclusions

Late adolescence and early adulthood are stages in which many mental disorders start, however treatment delays some years. Rothman’s model may be a useful tool, what means a multiintervention treatment that mixes biological and psychosocial interventions.

[Renal transplantation during COVID-19 period in Spain.]

The COVID-19 pandemic poses significant challenges in the area of kidney donation and transplantation. The objective of this article is to establish general recommendations for surgical teams to manage the kidney transplant program duringthe COVID-19 era. MATERIAL AND METHODS: This document is based on the scientific evidence available on the infection caused by SARS-CoV-2 and the experience of authors during the COVID-19 pandemic. A web and Pubmed search was performed using the keywords "SARS-CoV-2"," COVID-19", "COVID Urology", "COVID-19 surgery", and "kidney transplantation." A modified nominal group technique was used. RESULTS: When health system saturation occurs, kidney transplants should be deferred, except in patients with low transplant possibilities and an optimal kidney available, combined transplants or life-threatening situations. Screening for the SARS-CoV-2 virus should be done in all those donors and recipients with clinical symptoms consistent with COVID-19, who have visited or live inhigh-risk areas, or who have been in close contact with confirmed cases of COVID-19. Donation and transplantation will not proceed in confirmed cases of COVID-19. Surgeries should be based on general recommendations in the COVID-19 era and will be efficient, short, and focused on those with the shortest hospital stay. In emergencies, protective measures will be taken with persona lprotection equipment. Surgical staff will be only the strictly necessary, and permanence in the OR should be minimized. Transplant urology consultations will be conducted by teleconsultation when possible. CONCLUSION: The safety of potential donors and recipients must be guaranteed, adopting individual protection measures and screening for SARS-CoV-2. Kidney transplant surgery must be efficient in terms of health, human resources, and clinical benefit. All non-urgent transplant activities should be delayed until the improvement of the local condition of each center.

Point-Of-Care CAR T-Cell Production (ARI-0001) Using a Closed Semi-automatic Bioreactor: Experience From an Academic Phase I Clinical Trial

Development of semi-automated devices that can reduce the hands-on time and standardize the production of clinical-grade CAR T-cells, such as CliniMACS Prodigy from Miltenyi, is key to facilitate the development of CAR T-cell therapies, especially in academic institutions. However, the feasibility of manufacturing CAR T-cell products from heavily pre-treated patients with this system has not been demonstrated yet. Here we report and characterize the production of 28 CAR T-cell products in the context of a phase I clinical trial for CD19+ B-cell malignancies (NCT03144583). The system includes CD4-CD8 cell selection, lentiviral transduction and T-cell expansion using IL-7/IL-15. Twenty-seven out of 28 CAR T-cell products manufactured met the full list of specifications and were considered valid products. Ex vivo cell expansion lasted an average of 8.5 days and had a mean transduction rate of 30.6 ± 13.44%. All products obtained presented cytotoxic activity against CD19+ cells and were proficient in the secretion of pro-inflammatory cytokines. Expansion kinetics was slower in patient's cells compared to healthy donor's cells. However, product potency was comparable. CAR T-cell subset phenotype was highly variable among patients and largely determined by the initial product. T_CM and T_EM were the predominant T-cell phenotypes obtained. 38.7% of CAR T-cells obtained presented a T_N or T_CM phenotype, in average, which are the subsets capable of establishing a long-lasting T-cell memory in patients. An in-depth analysis to identify individual factors contributing to the optimal T-cell phenotype revealed that ex vivo cell expansion leads to reduced numbers of T_N, T_SCM, and T_EFF cells, while T_CM cells increase, both due to cell expansion and CAR-expression. Overall, our results show for the first time that clinical-grade production of CAR T-cells for heavily pre-treated patients using CliniMACS Prodigy system is feasible, and that the obtained products meet the current quality standards of the field. Reduced ex vivo expansion may yield CAR T-cell products with increased persistence in vivo.

FDTD Modeling of double ultrashort pulse propagation in nonlinear absorbing media

An approach based on the finite-difference time-domain (FDTD) method is developed for simulating the dynamics of two ultrashort laser pulses inside a saturable absorbing media. This work discusses the results obtained using this numerical model for the prediction of the nonlinear absorbing media behaviour as well as how it affects the final double pulse combination. These results can be used to improve contrast cleaning conditions for high power laser chains and for synchronization studies, this last application was checked in the VEGA facility lab as a code validation.

Post-mortem toxicology in the diagnosis of sudden death in young and middle-aged victims

OBJECTIVE

We aimed to investigate the impact of the toxicological results found in cases of sudden death (SD) and to correlate the clinical, autopsy and genetic findings with the toxicology results.

MATERIALS AND METHODS

Consecutive SD in people aged between 16 and 50 years with medico-legal autopsies and toxicology studies were included over a 3-year period. The comparison between the toxicological data and demographic characteristics, clinical circumstances, autopsy, and genetic results were taken into account.

RESULTS

101 cases were finally included. They were predominately males (84%) and the mean age was 39.8 years. 52 (51.5%) cases had positive toxicological findings and in 25 cases (24.8%), toxic compounds were considered the first cause of death. Ethanol was the most frequently identified agent (69%), following by licit drugs (56%) and drugs of abuse (39%). Cases with positive toxicology were younger than those with negative results (37.9±9.1 vs. 41.9±7.8; p=0.02). Patients with more than 3 comorbidities showed an association with positive toxicological results (n=14 vs. n=3; p=0.017). The genetic study was performed in 70 (69.3%) SD cases. We identified pathogenic or likely pathogenic variants in 17.1% cases and uncertain significance variants in 42.8% cases. 58% of these variants were probably related to the cause of death.

CONCLUSIONS

A large fraction of SD victims had positive toxicological findings and a quarter of deaths were directly caused by toxic substances. The identification of the factors that trigger SD provides a good approach to contribute in avoiding future episodes.

Epidemiology of tumors in dogs in the capital of the state of Mexico from 2002-2016

ABSTRACT A retrospective and cross-sectional study of canine tumors was performed in the capital of State of Mexico from 2002-2016. Since then, 393 tumors were remitted. Descriptive epidemiology was made from all data: breed, age, sex, and tumor features. Then the risk association between cutaneous and non-cutaneous tumors with variables such as sex, breed, and age were analyzed through an exact Fisher test and Odds ratio. In addition, some characteristics of the canine population were studied under a survey. Of all tumors, skin tumors were the most frequent (59.0%). The group of tumors related to ultraviolet radiation was the most common (15.1%). The frequency of tumors in females was 53%, nevertheless, males had more risk to develop cutaneous tumors (OR=1.88, 1.24-2.84) (0.003). The Pure breeds were the most common (82.5%) and the most frequent age range was > 7 years (54.7%). The survey showed that males (53%) and the age range 1-7 years (62.1%) were the most frequent. Conclusions, age, breed, and sex were identified as the major risk factors for tumorigenesis. Likewise, skin tumors were associated with exposure to ultraviolet radiation, probably to the height of the locality (2667mamls).

First Results on Dark Matter Annual Modulation from the ANAIS-112 Experiment

ANAIS is a direct detection dark matter experiment aiming at the testing of the DAMA/LIBRA annual modulation result, which, for about two decades, has neither been confirmed nor ruled out by any other experiment in a model independent way. ANAIS-112, consisting of 112.5 kg of sodium iodide crystals, has been taking data at the Canfranc Underground Laboratory, Spain, since August 2017. This Letter presents the annual modulation analysis of 1.5 years of data, amounting to 157.55 kg yr. We focus on the model independent analysis searching for modulation and the validation of our sensitivity prospects. ANAIS-112 data are consistent with the null hypothesis (p values of 0.67 and 0.18 for [2-6] and [1-6] keV energy regions, respectively). The best fits for the modulation hypothesis are consistent with the absence of modulation (S_{m}=-0.0044±0.0058  cpd/kg/keV and -0.0015±0.0063  cpd/kg/keV, respectively). They are in agreement with our estimated sensitivity for the accumulated exposure, which supports our projected goal of reaching a 3σ sensitivity to the DAMA/LIBRA result in five years of data taking.

How reactant polarization can be used to change the effect of interference on reactive collisions

It is common knowledge that integral and differential cross sections (DCSs) are strongly dependent on the spatial distribution of the molecular axis of the reactants. Hence, by controlling the axis distribution, it is possible to either promote or hinder the yield of products into specific final states or scattering angles. This idea has been successfully implemented in experiments by polarizing the internuclear axis before the reaction takes place, either by manipulating the rotational angular distribution or by the Stark effect in the presence of an orienting field. When there is a dominant reaction mechanism, characterized by a set of impact parameters and angles of attack, it is expected that a preparation that helps the system to reach the transition state associated with that mechanism will promote the reaction, whilst a different preparation would generally impair the reaction. However, when two or more competing mechanisms via interference contribute to the reaction into specific scattering angles and final states, it is not evident which would be the effect of changing the axis preparation. To address this problem, throughout this article we have simulated the effect that different experimental preparations have on the DCSs for the H + D2 reaction at relatively high energies, for which it has been shown that several competing mechanisms give rise to interference that shapes the DCS. To this aim, we have extended the formulation of the polarization dependent DCS to calculate polarization dependent generalized deflection functions of ranks greater than zero. Our results show that interference is very sensitive to changes in the internuclear axis preparation, and that the shape of the DCS can be controlled exquisitely.

Abstract GS2-04: Efficacy results from CIBOMA/2004-01_GEICAM/2003-11 study: A randomized phase III trial assessing adjuvant capecitabine after standard chemotherapy for patients with early triple negative breast cancer

Background: Triple negative breast cancers (TNBC) have a greater risk of relapse than non-TNBC. New therapeutic approaches are needed for these patients (pts). CIBOMA/2004-01_GEICAM/2003-11 is a multinational, randomized phase III trial exploring adjuvant capecitabine (X) after completion of standard treatment in early TNBC pts.

Materials and Methods: Patients with operable, node-positive (or node-negative with tumor size ≥ 1 cm), centrally confirmed hormone receptor-negative, HER2-negative early BC, who had received 6–8 cycles (cy) of standard anthracycline and/or taxane-containing chemotherapy or 4 cy of doxorubicin-cyclophosphamide (for node-negative disease) in the (neo)adjuvant setting, were eligible. Patients were randomized to either 8 cy of X (1,000 mg/m2 bid, days 1–14, every 3 weeks) or observation. Stratification factors included center, prior taxane-based therapy, number of involved axillary lymph nodes and phenotype (basal vs non-basal, according to cytokeratins 5/6 and/or EGFR positivity). The primary objective was to compare the disease-free survival (DFS) between both treatment arms, and secondary objectives included the comparison in terms of 5-year DFS, overall survival (OS) and safety. Assuming a 30% risk reduction in DFS rate at 5 years (from 64.7% to 73.7%, hazard ratio 0.70) with 80% power and a two-tailed log-rank test at 0.05, 834 evaluable pts were needed. 876 pts had to be finally enrolled considering a drop-out rate of 5%.

Results: Recruitment of 876 pts from 8 countries was completed in September 2011. Median age was 49 years; 68.5% of pts were postmenopausal, 55.5% were lymph node negative, 71.7% had a basal phenotype, 67.5% received chemotherapy based on anthracyclines and taxanes. Median follow-up was 7.3 years (range 0.0 to 11.1). DFS was not significantly prolonged with X vs observation (hazard ratio (HR) 0.82; 95% confidence interval (CI), 0.63 to 1.06; P=0.1353). Five-year DFS was 79.6% (95% CI, 75.8% to 83.4%) with X and 76.8% (95% CI, 72.7% to 80.9%) with observation. OS was not statistically different between treatment arms (HR 0.92; 95% CI, 0.66 to 1.28; P=0.6228). In subgroup analysis for DFS, we found no statistically significant interaction between X treatment and different subgroups, with the exception of basal vs non-basal phenotypes (basal HR 0.97, 95% CI 0.72 to 1.32, P=0.8620; non-basal HR 0.51, 95% CI, 0.31 to 0.86, P=0.0101; interaction P=0.0357). Similar results were found for OS (basal HR 1.20, 95% CI 0.81 to 1.77, P=0.3684; non-basal HR 0.48, 95% CI, 0.26 to 0.91, P=0.0205; interaction P=0.0155). 75.2% of pts completed 8 cy of X, with a median relative dose intensity of 86.3%. Grade (G) 3 or higher adverse events (AEs) were observed in 40.4% of pts in X arm. In 9.6% of pts the AEs were related with X. Hand-foot syndrome was the most common AE in X arm (G3 on 18.8% of pts).

Conclusions: In our study, the addition of adjuvant X after standard (neo) adjuvant anthracycline and/or taxane-containing chemotherapy was not associated with a statistically significant improvement of DFS or OS compared to observation in pts with early TNBC. However, in a subgroup analysis a significant DFS and OS improvement was observed with X in pts with non-basal phenotype.

Sponsor: CIBOMA.

Citation Format: Martín M, Barrios CH, Torrecillas L, Ruiz-Borrego M, Bines J, Segalla J, Ruiz A, García-Sáenz JA, Torres R, de la Haba J, García E, Gómez HL, Llombart A, Rodríguez de la Borbolla M, Baena JM, Barnadas A, Calvo L, Pérez-Michel L, Ramos M, Castellanos J, Rodríguez-Lescure A, Cárdenas J, Vinholes J, Martínez de Dueñas E, Godes MJ, Seguí MA, Antón A, López-Álvarez P, Moncayo J, Amorim G, Villar E, Reyes S, Sampaio C, Cardemil B, Escudero MJ, Bezares S, Carrasco E, Lluch A. Efficacy results from CIBOMA/2004-01_GEICAM/2003-11 study: A randomized phase III trial assessing adjuvant capecitabine after standard chemotherapy for patients with early triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS2-04.

Structural, chemical and mechanical study of TiAlV film on UHMWPE produced by DC magnetron sputtering

Ultra High Molecular Weight Polyethylene (UHMWPE), with a semi-trapezoidal topography, and glass samples were coated with a TiAlV film using magnetron sputtering in order to study its structure, chemical composition and the adhesion film properties on the polymer surfaces. The magnetron sputtering is a PVD technique that depending on the deposited parameter produces a coating with structural, chemical and specific topographic characteristics that increase the electrical, mechanical, optical and biological surface properties of the organic compounds. The quantities of Vanadium (V) and Aluminum (Al) were similar to that of Ti64 alloy. The metallic film obtained presents α-Ti phase structure with a (200) preferential orientation. The TiAlV film on polymeric surfaces with semi-trapezoidal topography exhibit irregularities and uncoated zones but on the glass, the metallic coating was smooth and continuous. The scratch tests were carried out using an incremental load configuration with a Tribotechnic scratch tester equipment. The metallic film decreased the viscoelastic recovering of the polymeric surface but increased the load capacity. The metallic film did not present complete delamination but fractures and small zones of coating detachment were observed on all the scratch tracks.

Accelerating single molecule localization microscopy through parallel processing on a high-performance computing cluster

Super‐resolved microscopy techniques have revolutionized the ability to study biological structures below the diffraction limit. Single molecule localization microscopy (SMLM) techniques are widely used because they are relatively straightforward to implement and can be realized at relatively low cost, e.g. compared to laser scanning microscopy techniques. However, while the data analysis can be readily undertaken using open source or other software tools, large SMLM data volumes and the complexity of the algorithms used often lead to long image data processing times that can hinder the iterative optimization of experiments. There is increasing interest in high throughput SMLM, but its further development and application is inhibited by the data processing challenges. We present here a widely applicable approach to accelerating SMLM data processing via a parallelized implementation of ThunderSTORM on a high‐performance computing (HPC) cluster and quantify the speed advantage for a four‐node cluster (with 24 cores and 128 GB RAM per node) compared to a high specification (28 cores, 128 GB RAM, SSD‐enabled) desktop workstation. This data processing speed can be readily scaled by accessing more HPC resources. Our approach is not specific to ThunderSTORM and can be adapted for a wide range of SMLM software.

Lay Description

Optical microscopy is now able to provide images with a resolution far beyond the diffraction limit thanks to relatively new super‐resolved microscopy (SRM) techniques, which have revolutionized the ability to study biological structures. One approach to SRM is to randomly switch on and off the emission of fluorescent molecules in an otherwise conventional fluorescence microscope. If only a sparse subset of the fluorescent molecules labelling a sample can be switched on at a time, then each emitter will be, on average, spaced further apart than the diffraction‐limited resolution of the conventional microscope and the separate bright spots in the image corresponding to each emitter can be localised to high precision by finding the centre of each feature using a computer program. Thus, a precise map of the emitter positions can be recorded by sequentially mapping the localisation of different subsets of emitters as they are switched on and others switched off.

Typically, this approach, described as single molecule localisation microscopy (SMLM), results in large image data sets that can take many minutes to hours to process, depending on the size of the field of view and whether the SMLM analysis employs a computationally‐intensive iterative algorithm. Such a slow workflow makes it difficult to optimise experiments and to analyse large numbers of samples. Faster SMLM experiments would be generally useful and automated high throughput SMLM studies of arrays of samples, such as cells, could be applied to drug discovery and other applications. However, the time required to process the resulting data would be prohibitive on a normal computer.

To address this, we have developed a method to run standard SMLM data analysis software tools in parallel on a high‐performance computing cluster (HPC). This can be used to accelerate the analysis of individual SMLM experiments or it can be scaled to analyse high throughput SMLM data by extending it to run on an arbitrary number of HPC processors in parallel. In this paper we outline the design of our parallelised SMLM software for HPC and quantify the speed advantage when implementing it on four HPC nodes compared to a powerful desktop computer.

Risk factors for clinical ketosis and association with milk production and reproduction variables in dairy cows in a hot environment

The aims of the present study were to investigate (1) the risk factors that influence the occurrence of clinical ketosis (CK; blood β-hydroxybutyrate > 3.0 mmol/L) and (2) to determine the influence of subclinical ketosis (SCK; 1.2 ≤ β-hydroxybutyrate ≤ 2.9 mmol/L) and CK on reproductive performance and milk yield in high-yielding Holstein cows in a hot environment. Cows (n = 345) were blood sampled from 6 to 15 days postpartum for β-hydroxybutyrate (BHB) determination with a hand-held meter. Cows calving in spring had 3.7 increased odds of having CK (20.7% incidence) than cows calving in summer (3.9% incidence) and autumn (9.4% incidence). Temperature-humidity index < 83 was associated with 1.6 times higher risk for CK compared with cows calving in warmer days. First-service conception rate was 12 and 16 percentage point higher (P < 0.05) in nonketotic cows compared with cows with SCK and CK, respectively. Actual 305-day milk yields for healthy, SCK, and CK cows were 9991 ± 1411, 10,123 ± 1442, and 10,386 ± 1435 kg (mean ± SD), respectively, with no difference (P > 0.05) between groups. In conclusion, this study documented that ketosis was seasonal with lower incidence of this metabolic disease during hot seasons and with increased ambient temperature at calving. Also, 305-day milk yield of Holstein cows was not related to blood BHB content early in lactation in this hot environment. However, elevated circulating BHB was negatively associated with conception rate at first service and fetal losses.

Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy

A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery.

Design and Testing of a New Diatom-Based Index for Heavy Metal Pollution

The Tinto and Odiel river basins (SW Spain) are known worldwide for their unique water characteristics. Such uniqueness is a consequence of their flow through the Iberian Pyrite Belt (an area rich in metal sulphides) and the mining activities in the basins. A process of sulphide oxidation occurs in this region, which acidifies the water and increases the amount of heavy metals in it. As a result, the rivers suffer the so-called "acid mine drainage" (AMD). Traditional biotic diatom-based indexes (IPS, IBD, EPI-D, etc.) do not take into account the pollution caused by AMD. The purpose of this paper is to develop a new diatom-based index which can serve as a useful and quick monitoring tool. Such tool must reflect the level of AMD while being user friendly. We present the development and validation of the ICM (Índice de Contaminación por Metales or Metal Pollution Index). ICM demonstrated to meet successfully the above criteria and, therefore, can assess water quality in the Tinto and Odiel Rivers. In addition, ICM was applied with satisfactory results in the Guadiamar River (SW Spain), which was subjected to AMD too. Thus, we propose to make use of it in any other basin with the same type of pollution.

Changes in Volatile Compounds during Ripening in Grapes of Airén, Macabeo and Chardonnay White Varieties Grown in La Mancha Region (Spain)

Changes in volatile compounds in musts and skins of grapes of Airén, Macabeo and Chardonnay white varieties were determined during ripening. The musts of the Airén variety contained higher concentrations of c-3-hexenol; musts of the Macabeo variety were the richest in t-3-hexenol and 2,4-hexadienal, while the Chardonnay musts stood out for having higher concentrations of benzaldehyde, phenylacetaldehyde and benzyl alcohol. The skins of the three varieties were both qualitatively and quantitatively richer in volatiles than were the musts. The skins of the Airén grapes had the highest levels of nerol. Airén grapes were the only variety in which citronellol was present in the skins. Low concentrations of eugenol were detected in the skins of the Chardonnay grape variety but were not present in the other two varieties. Changes in the concentration of the volatile compounds during ripening were not uniform; this made difficult the determination of the optimum level of ripening for each variety on the basis of the volatile compound content. Nevertheless, results indicated that C6 compounds and terpene concentrations reached a maximum at 6-8 ° Baumé in the Airén grapes and at around 11 ° Baumé in the Chardonnay and Macabeo grapes.

Neutrophil gelatinase-associated lipocalin is a biomarker of acute-on-chronic liver failure and prognosis in cirrhosis

BACKGROUND & AIMS

Acute-on-chronic liver failure (ACLF) is a syndrome that occurs in cirrhosis characterized by organ failure(s) and high mortality rate. There are no biomarkers of ACLF. The LCN2 gene and its product, neutrophil gelatinase-associated lipocalin (NGAL), are upregulated in experimental models of liver injury and cultured hepatocytes as a result of injury by toxins or proinflammatory cytokines, particularly Interleukin-6. The aim of this study was to investigate whether NGAL could be a biomarker of ACLF and whether LCN2 gene may be upregulated in the liver in ACLF.

METHODS

We analyzed urine and plasma NGAL levels in 716 patients hospitalized for complications of cirrhosis, 148 with ACLF. LCN2 expression was assessed in liver biopsies from 29 additional patients with decompensated cirrhosis with and without ACLF.

RESULTS

Urine NGAL was markedly increased in ACLF vs. no ACLF patients (108(35-400) vs. 29(12-73)μg/g creatinine; p<0.001) and was an independent predictive factor of ACLF; the independent association persisted after adjustment for kidney function or exclusion of variables present in ACLF definition. Urine NGAL was also an independent predictive factor of 28day transplant-free mortality together with MELD score and leukocyte count (AUROC 0.88(0.83-0.92)). Urine NGAL improved significantly the accuracy of MELD in predicting prognosis. The LCN2 gene was markedly upregulated in the liver of patients with ACLF. Gene expression correlated directly with serum bilirubin and INR (r=0.79; p<0.001 and r=0.67; p<0.001), MELD (r=0.68; p<0.001) and Interleukin-6 (r=0.65; p<0.001).

CONCLUSIONS

NGAL is a biomarker of ACLF and prognosis and correlates with liver failure and systemic inflammation. There is remarkable overexpression of LCN2 gene in the liver in ACLF syndrome.

LAY SUMMARY

Urine NGAL is a biomarker of acute-on-chronic liver failure (ACLF). NGAL is a protein that may be expressed in several tissues in response to injury. The protein is filtered by the kidneys due to its small size and can be measured in the urine. Ariza, Graupera and colleagues found in a series of 716 patients with cirrhosis that urine NGAL was markedly increased in patients with ACLF and correlated with prognosis. Moreover, gene coding NGAL was markedly overexpressed in the liver tissue in ACLF.

Serum Levels of Osteocalcin and Insulin Resistance in Patients with Impaired Glucose Tolerance or New-Onset Diabetes Mellitus After Liver Transplantation

Liver transplantation (LT) patients are at high risk of developing new-onset diabetes after transplantation (NODAT). Osteocalcin has been proposed as a mediator between bone tissue and glucose metabolism, but its role in the pathogenesis of diabetes is not defined yet. Our objective was to assess the relationship between serum osteocalcin and glucose metabolism parameters in liver transplantation recipients. A total of 187 liver transplantation patients were cross-sectionally studied, 54 of them developed NODAT. None had been diagnosed of diabetes mellitus prior to transplant. In 133 nondiabetic patients, a 75 g oral glucose tolerance test (OGTT) was performed to assess blood glucose, insulin, and C-peptide levels at baseline and 120 min. Serum total osteocalcin was measured at baseline in all patients.After OGTT, 10.5% of LT patients had NODAT criteria, 51.9% showed impaired glucose tolerance, and 37.6% had normal glucose tolerance. Overall, NODAT prevalence was 36.3%. HOMA-IR was significantly higher in NODAT compared with impaired glucose tolerance and normal glucose tolerance groups (p<0.001). Osteocalcin was inversely correlated to HOMA-IR (r=- 0.16, p=0.05), BMI (r=- 0.27, p=0.000) and waist circumference (r=- 0.21, p=0.005). Patients in the lowest osteocalcin tertile (< 16.5 ng/ml) had significantly higher fasting plasma glucose and HOMA-IR index (p=0.029 and 0.037, respectively) than those in medium or highest tertiles. In multiple linear regression analysis, osteocalcin was negatively associated with fasting plasma glucose (standardized β coefficient-0.16; p=0.041) and 2-h insulin (standardized β coefficient-0.21; p=0.028). Prevalence of NODAT/impaired glucose tolerance is high in liver transplantation patients and is associated with insulin resistance. In these patients total osteocalcin is inversely associated with plasma glucose level and insulin resistance indexes.

IgE responses to Ascaris and mite tropomyosins are risk factors for asthma

BACKGROUND

The relationship between helminthiases and allergy is a matter of considerable interest and research. In the tropics, house dust mite exposure, a known risk factor for asthma, is frequently concurrent with helminth infections. It remains to be defined whether infection with the common roundworm Ascaris or its bystander immunological effects influence the prevalence and pathogenesis of asthma independently of mite sensitization.

OBJECTIVE

To investigate the relationship between the IgE responses to Ascaris and its purified allergens and the risk of asthma in a tropical country.

METHODS

A nested case-control study was performed in 356 subjects who reported current and past asthma symptoms (asthmatics) and 435 controls that had never experienced such symptoms. They were tested for serum levels of total IgE and specific IgE to Ascaris extract, Asc s 1 (ABA-1), Asc l 3 (tropomyosin) and GST (glutathione transferase). In addition, specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis and their tropomyosins Der p 10 and Blo t 10 was measured. Sensitization was defined as a positive specific IgE result to any extract or recombinant allergen.

RESULTS

Sensitization to Ascaris and D. pteronyssinus was independently associated with asthma after adjustment for age, gender, socio-economic stratum, city and other IgE levels (adjusted ORs: 2.17; 95% CI 1.37-3.42 and 2.46; 95% CI 1.54-3.92), respectively. There was also a significant association with sensitization to the highly allergenic and cross-reactive tropomyosins Asc l 3, Blo t 10 and Der p10 (aORs: 1.76; 95% CI 1.21-2.57, 1.64; 95% CI 1.14-2.35 and 1.51; 95% CI 1.02-2.24), respectively.

CONCLUSION AND CLINICAL RELEVANCE

IgE responses to Ascaris are associated with asthma symptoms in a population living in the tropics. Sensitization to the cross-reactive Ascaris and mite tropomyosins partially underlies this finding. These results have potential relevance in asthma diagnosis and management.

Inhibiting the PI3K signaling pathway: buparlisib as a new targeted option in breast carcinoma

Aberrations in the PI3K signaling pathway are frequently observed in patients with breast cancer. Because of that, PI3K inhibitors are attractive options for the treatment of breast cancer because PI3K is the most proximal component of the pathway other than receptor tyrosine kinases. Buparlisib is a potent and highly specific oral pan-class I PI3K inhibitor, which is currently under investigation in patients with breast cancer. In this article, we describe the PI3K signaling pathway, the prognostic value of PI3K pathway mutations, as well as the mechanism of action of buparlisib. Lastly, we discuss preliminary results of preclinical and clinical studies showing the efficacy and safety profile of this agent in breast cancer patients.

[Anaesthetic management in left ventricular assist device implantation as destination therapy: Our first experience]

Left ventricular assist devices have emerged as one of the main therapies of advanced cardiac failure due the increase of this disease and lack of organ supply for cardiac transplantation. The anaesthetic management is described on a patient without cardiac transplantation criteria. The device was successfully implanted as a destination therapy.

Flora of Bolivia - where do we stand?

Abstract The botanical exploration of Bolivia during the last two centuries did not leave a botanical legacy in the country. Only towards the end of the 20th century Bolivia saw the start of the biology careers at its universities and the development of its own herbaria. Nowadays there are important herbaria in La Paz, Santa Cruz, Cochabamba and Sucre with collections ranging between 40,000 and 350,000 specimens. In 2014 a catalogue of the vascular flora of Bolivia was published under the auspices of the Missouri Botanical Garden, recording 15,345 species, of which 12,165 are native and 2,343 are endemic, while 694 are cultivated, 267 adventitious and 221 are naturalized. Endemic species of vascular plants add up to 2,343 species. The 286 families listed follow the APG III classification system. There are about 150 botanists in Bolivia interested in studying the country's rich flora. During a workshop organized in 2013 to promote a Flora of Bolivia, the participants established jointly a preliminary format for the taxonomic treatments. The Flora of Bolivia is planned to be an electronic, open access publication with international participation. The World Flora represents a challenge that must be tackled by circumscribing, verifying and recording all species known within our territory, and it is expected that it will have positive repercussions from and towards the ongoing Flora of Bolivia, in a similar way as the long running series of the Flora Neotropica has provided a wider picture that can be adapted and modified to fit our particular country.

Curcumin prevents maleate-induced nephrotoxicity: relation to hemodynamic alterations, oxidative stress, mitochondrial oxygen consumption and activity of respiratory complex I

The potential protective effect of the dietary antioxidant curcumin (120 mg/Kg/day for 6 days) against the renal injury induced by maleate was evaluated. Tubular proteinuria and oxidative stress were induced by a single injection of maleate (400 mg/kg) in rats. Maleate-induced renal injury included increase in renal vascular resistance and in the urinary excretion of total protein, glucose, sodium, neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl β-D-glucosaminidase (NAG), upregulation of kidney injury molecule (KIM)-1, decrease in renal blood flow and claudin-2 expression besides of necrosis and apoptosis of tubular cells on 24 h. Oxidative stress was determined by measuring the oxidation of lipids and proteins and diminution in renal Nrf2 levels. Studies were also conducted in renal epithelial LLC-PK1 cells and in mitochondria isolated from kidneys of all the experimental groups. Maleate induced cell damage and reactive oxygen species (ROS) production in LLC-PK1 cells in culture. In addition, maleate treatment reduced oxygen consumption in ADP-stimulated mitochondria and diminished respiratory control index when using malate/glutamate as substrate. The activities of both complex I and aconitase were also diminished. All the above-described alterations were prevented by curcumin. It is concluded that curcumin is able to attenuate in vivo maleate-induced nephropathy and in vitro cell damage. The in vivo protection was associated to the prevention of oxidative stress and preservation of mitochondrial oxygen consumption and activity of respiratory complex I, and the in vitro protection was associated to the prevention of ROS production.

[Intramuscular myxoma. Report of three cases]

Intramuscular myxoma is a rare soft tissue benign tumor, arising from the mesenchyma; it presents as a slow-growing painless mass located usually in the thigh. Histologic diagnosis is necessary before resection and treatment consists of exeresis. There are no cases of malignization and recurrence results from incomplete resection. We report herein three cases of intramuscular myxoma treated at our center from 2004 to 2011. At the same time, we conducted a review of the clinical presentation, diagnosis, treatment and functional results. The same diagnostic and therapeutic protocol was used in all cases. It began with the patient's physical exam, and ultrasound and MRI as complementary tests. An incisional biopsy of the tumor was taken for anatomopathological studies and, finally, complete exeresis was performed.