Geriatric Assessment Scale for Optimal Management of Gastric Cancer in Older Adults Who Underwent Gastrectomy: A Systematic Review.

INTRODUCTION: Stomach cancer is one of the most common causes of cancer worldwide, especially in the population over 65 years. The survival rate of the elderly is lower in comparison with young people, and they are underrepresented in clinical trials and research in general. The evaluation of Multidimensional Geriatric Assessment (MGA) would be key for assessing the prognosis of these patients and therefore having a more informed decision-making process when considering one of the most vulnerable populations. METHODS: A search was performed in the OVID, Embase, and PubBMed databases. There was no restriction on publication time, language, or study design. Eligible studies were those that included geriatric patients with a diagnosis of nonmetastatic stomach cancer who receive oncospecific and surgical management, used Multidimensional/Comprehensive Geriatric Assessment (MGA), and which outcomes included at least overall survival, morbidity, and mortality. RESULTS: Four studies were included, and the MGA battery was not implemented, but rather easily measurable scales such as nutritional status, functional status, cognitive and behavioral disorders, comorbidities, and polypharmacy. Some authors proposed that the assessment of overall survival is not explicit among the included studies; patients with gastric cancer and mild, moderate, severe, and total dependence had higher mortality than independent patients (39% [HR 1.39; 95% CI: 1.09-1.7], 68% [95% CI: 1.46-1.93], 187% [HR 2.87 95% CI: 2.47-3.34], and 234% [95% CI: 2.81-3.97]), respectively. The Zhou study showed an association between sarcopenia, assessed by imaging studies, and a longer hospital stay in days (16 [9] vs. 13 [6], p 0.004). The study by Pujara found that polypharmacy (OR 2.36 CI: 1.08-5.17) and weight loss greater than 10% in the past 6 months were associated with greater postoperative morbidity at 90 days (OR 2.36 CI: 1.08-5.17, OR 11.21 CI: 2.16-58.24). CONCLUSION: MGA was not broadly implemented. Geriatric assessment dependency appears to be a prognostic marker of survival in patients with gastric cancer. Sarcopenia appears to be an important prognostic marker for short- and long-term outcomes. Higher quality studies in this specific population are required to support the systematic use of this assessment for the choice of appropriate therapy according to the patient.

Myeloid/lymphoid neoplasm with eosinophilia and BCR/FGFR1 rearrangement with transformation to cortical T-lymphoblastic lymphoma and erythroid precursors: a case report.

BACKGROUND: Myeloproliferative neoplasms are a group of diseases with diverse biological and clinical characteristics. As a provisional separate entity, myeloid/lymphoid neoplasms with eosinophilia and genetic rearrangement have been described, which may present an initial clinical behavior of myeloproliferation and be characterized by varied genetic rearrangements. One of these entities is associated with FGFR1 rearrangements, characterized by its low prevalence and few treatment options. CASE PRESENTATION: We present the case of a 53-year-old Mestizo male patient of Hispanic origin who initially presented weight loss and fatigue, with a complete blood count showing leukocytosis and eosinophilia, with an initial diagnosis of nonspecific myeloproliferative disorder. In a next-generation sequencing study, BCR::FGFR1 rearrangement was documented, a diagnosis of myeloid/lymphoid neoplasia with eosinophilia and BCR::FGFR1 rearrangement was made, and hydroxyurea therapy was initiated. Subsequently, transformation to cortical T-lymphoblastic leukemia/lymphoma and erythroid precursors was documented, requiring management with chemotherapy. CONCLUSIONS: Myeloid/lymphoid neoplasms with eosinophilia and genetic rearrangements constitute a group of deeply heterogeneous diseases with variable clinical and diagnostic characteristics and whose treatment is not clearly defined.

Combination immunotherapy in a patient with hemodialysis therapy and metachronous bilateral clear cell renal cell carcinoma: Case report and literature review.

Combination immunotherapy is a treatment strategy in patients with renal cell carcinoma that has proved to be effective in phase III randomized clinical trials. These studies do not include patients with end stage kidney disease on hemodialysis. We discuss this case about a patient with metachronous bilateral clear cell renal cell carcinoma, managed with bilateral nephrectomy and ulterior requirement of hemodialysis, with lung and intestinal progression, managed with combination immunotherapy, with a partial response and absence of adverse effects related to treatment.

SNAP23 is essential for platelet and mast cell development and required in connective tissue mast cells for anaphylaxis.

Degranulation, a fundamental effector response from mast cells (MCs) and platelets, is an example of regulated exocytosis. This process is mediated by SNARE proteins and their regulators. We have previously shown that several of these proteins are essential for exocytosis in MCs and platelets. Here, we assessed the role of the SNARE protein SNAP23 using conditional knockout mice, in which SNAP23 was selectively deleted from either the megakaryocyte/platelet or connective tissue MC lineages. We found that removal of SNAP23 in platelets results in severe defects in degranulation of all three platelet secretory granule types, i.e., alpha, dense, and lysosomal granules. The mutation also induces thrombocytopenia, abnormal platelet morphology and activation, and reduction in the number of alpha granules. Therefore, the degranulation defect might not be secondary to an intrinsic failure of the machinery mediating regulated exocytosis in platelets. When we removed SNAP23 expression in MCs, there was a complete developmental failure in vitro and in vivo. The developmental defects in platelets and MCs and the abnormal translocation of membrane proteins to the surface of platelets indicate that SNAP23 is also involved in constitutive exocytosis in these cells. The MC conditional deletant animals lacked connective tissue MCs, but their mucosal MCs were normal and expanded in response to an antigenic stimulus. We used this mouse to show that connective tissue MCs are required and mucosal MCs are not sufficient for an anaphylactic response.

Síndrome coronario agudo en el anciano: evaluación, diagnóstico y tratamiento / Acute coronary syndrome in the elderly: assessment, diagnosis and treatment

Introducción: la enfermedad coronaria, y en especial los síndromes coronarios agudos, son un grupo de entidades que generan alta mortalidad en la población anciana, que a su vez, representa un grupo poblacional importante en las diversas series epidemiológicas, caracterizándose por sus dificultades diagnósticas y terapéuticas, caracterizadas por una pobre cantidad de estudios y una baja representatividad en los ensayos clínicos, generando grandes dudas en la práctica clínica diaria. Objetivo: describir los aspectos más actualizados y relevantes en síndrome coronario agudo en el anciano, haciendo énfasis en el proceso diagnóstico y sus variaciones, y las consideraciones terapéuticas basadas en la última evidencia científica disponible. Metodología: se realizó una revisión sistemática de la literatura sobre síndrome coronario agudo en el anciano publicado en los últimos 20 años, desde 1996 hasta 2016, en las bases de datos PubMed, y Embase durante los meses de diciembre de 2015 y enero de 2016.Se incluyeron artículos en idioma inglés y español. La exclusión de los estudios se hizo con base a la evaluación de los resúmenes. Conclusión: los ancianos son un grupo poblacional altamente heterogéneo, presentando múltiples cambios fisiológicos carviovasculares, generando grandes variaciones en la clínica del síndrome coronario agudo. Su representación en los diferentes ensayos clínicos sigue siendo pobre, loque dificulta la toma de decisiones en la práctica clínica. Se requieren más estudios para precisar el manejo más óptimo en el anciano...(AU)

Introduction: the coronary diseases, especially the acute coronary syndromes, gather a group of entities that lead to high mortality rates among older patients, who represent a very important population in epidemiological terms, given their characteristic diagnostic and therapeutic difficulties, which can be explained by the poor amount of studies and a low representation at clinical trials, thus generating great doubts in daily clinical practice. Objective: to describe the most updated and relevant aspects in acute coronary syndrome in the old patient, emphasizing in the diagnostic process and its variations, and therapeutic considerations based on last available scientific evidence. Methodology: a systematic review of literature about acute coronary syndrome in the old patient published in last 20 years, from 1996 to 2016 was performed, in data bases Pubmed and Embase during December 2015 and January 2016. Articles in English and Spanish were included. The studies were excluded based on abstracts assessment.Conclusion: the old patients represent a very highly heterogeneous group which presents multiple physiological cardiovascular changes, generating important variations in symptomatology of acute coronary syndrome. Their representation among different clinical trials remains being poor, which turns very difficult making decisions in clinical practice. More studies are required in order to achieve the most optimal management in the old patient...(AU)

Depresión de aparición tardía y su relación con la demencia vascular en el anciano / Late-life depression and its relationship to vascular dementia in the elderly

Introducción: la demencia vascular es un síndrome de naturaleza crónica y progresiva, caracterizado por una perturbación de diversas funciones mentales superiores, la cual conlleva a un deterioro global en las esferas comportamental, social, emocional y biológica del individuo. Objetivo: describir los aspectos más actualizados y relevantes en demencia, específicamente la demencia vascular, su asociación con depresión de aparición tardía, mecanismos fisiopatológicos, el impacto en la funcionalidad del anciano y los puntos más destacados en el tamizaje y diagnóstico de ambas entidades. Metodología: se realizó una revisión sistemática de la literatura sobre demencia vascular y su asociación con la depresión de aparición tardía en las bases de datos PubMed, ScienceDirect y Ovid durante los meses de mayo a agosto de 2013. Resultados: se encontraron 62 artículos con información actualizada. Destaca la clara asociación entre ambas patologías, con una prevalencia global de trastornos depresivos de 27,41%, de los cuales 44,41% corresponden a sujetos con demencia de tipo vascular, 32,48% a otros tipos de demencia no especificada y 18,53% a Enfermedad de Alzheimer. Conclusión: la demencia vascular es una entidad que ha incrementado la morbilidad de la población geriátrica, por lo cual se hace cada vez más necesaria la aplicación sistemática de métodos de tamizaje reproducibles, económicos y confiables, con el objetivo de favorecer el diagnóstico y la detección precoz. En nuestro concepto dichos métodos de tamizaje deberían incluir dentro de sus criterios diagnósticos a los trastornos depresivos, dada la relación de su aparición en etapas tardías de la vida con el posterior desarrollo de deterioro cognitivo y demencia de tipo vascular. (MÉD.UIS. 2014;27(2):51-58).

Background: Vascular dementia is a syndrome of chronic progressive nature, characterized by a disturbance of various higher mental functions, which leads to an overall deterioration in the behavioral, social, emotional and biological areas of the individual. Objective: explain and describe the most current and relevant issues in dementia, vascular type specifically, and its association with late-onset depression, pathophysiological mechanisms, the impact they represent on the functionality of the elderly patient and the most prominent points in the screening and diagnosis of both entities. Methods: A systematic review of the literature on vascular dementia and its association with late-onset depression in PubMed and ScienceDirect data was performed. Results: 64 updated articles with information about the subject to develop were found. Highlights the clear association between the two conditions described, with an overall prevalence of depressive disorders of 27.41%, of which 44.41% were subjects with vascular dementia, 32.48% correspond to other types of non-specified dementia and 18.53% to Alzheimer s disease. Conclusion: Vascular dementia is an entity that has increased morbidity in the geriatric population, because of this, the systematic application of reproducible, economical and reliable screening methods becomes more necessary, with the aim of favoring early diagnosis and detection, in our opinion such screening methods should include depressive disorders as part of their diagnostic criteria, due to the relationship between its aparittion in the later stages of life and the subsequent development of cognitive impairment and vascular dementia. (MÉD.UIS. 2014;27(2):51-58).