Un reto multidisciplinar: tratamiento con fósforo-32 en el carcinoma de páncreas localmente avanzado / A multidisciplinary challenge: Therapy with phosphorus-32 for locally advanced pancreatic cancer

El cáncer de páncreas es una enfermedad de pronóstico precario, siendo su supervivencia global la que menos ha mejorado en los últimos 40 años entre todos los cánceres. El adenocarcinoma de páncreas localmente avanzado, sin metástasis a distancia, pero con una afectación vascular limitante, constituye casi un tercio de estos pacientes. En este grupo se concentran gran parte de los esfuerzos investigadores para introducir tratamientos que permitan un aumento de las tasas de rescate quirúrgico y/o de la supervivencia, con 2 objetivos fundamentales: el del control local y el de la prevención de la progresión sistémica. El tratamiento intratumoral con micropartículas de fósforo-32, guiado por ecoendoscopia y combinado con quimioterapia estándar puede tener beneficios significativos y clínicamente relevantes en estos pacientes y, por tanto, una opción valiosa de tratamiento en una enfermedad en la que existe una necesidad urgente de desarrollar nuevas terapias que nos ayuden a mejorar los resultados (AU)

Pancreatic cancer is a disease with a poor prognosis, and overall survival has improved the least in the last 40 years of all cancers. Locally advanced pancreatic adenocarcinoma, without distant metastasis but with limiting vascular involvement, constitutes almost one third of these patients. This group is the focus of most research efforts to introduce treatments to increase surgical salvage rates and/or survival, with two main objectives: local control and prevention of systemic progression. Intratumoural treatment with phosphorus-32 microparticles, guided by echoendoscopy and combined with standard chemotherapy may have significant and clinically relevant benefits in these patients, and therefore a valuable treatment option in a disease where there is an urgent need to develop new therapies to help improve outcomes (AU)

A multidisciplinary challenge: Therapy with phosphorus-32 for locally advanced pancreatic cancer.

Pancreatic cancer is a disease with a poor prognosis, and overall survival has improved the least in the last 40 years of all cancers. Locally advanced pancreatic adenocarcinoma, without distant metastasis but with limiting vascular involvement, constitutes almost one third of these patients. This group is the focus of most research efforts to introduce treatments to increase surgical salvage rates and/or survival, with two main objectives: local control and prevention of systemic progression. Intratumoural treatment with phosphorus-32 microparticles, guided by echoendoscopy and combined with standard chemotherapy may have significant and clinically relevant benefits in these patients, and therefore a valuable treatment option in a disease where there is an urgent need to develop new therapies to help improve outcomes.

A narrative overview of the patients' outcomes after multigene cancer panel testing, and a thorough evaluation of its implications for genetic counselling.

Massively parallel sequencing is being implemented in clinical practice through the use of multigene panel testing, whole exome sequencing and whole genome sequencing. In this manuscript we explore how the use of massively parallel sequencing, and in particular multigene cancer panel testing, is potentially changing the process of genetic counselling and how patients cope with pre-test genetic counselling and results. We found that the main challenges are around uncertainty, hopes and expectations and the amount and complexity of information that needs to be discussed. This may impact the process of genetic counselling, although genetic counsellors can still use their core skills and enhance some of them in order to evolve and meet patients' needs in the genomics era. Available data suggests that patients can cope with multigene cancer panels although more research is needed to fully understand the psychosocial implications of multigene cancer panels for patients, especially for those who have variants of unknown significance or moderate penetrance variants. Research is also needed to explore and develop communication models that maximize patients' understanding and empower them to make informed decisions.

Fin whales as bioindicators of multi-decadal change in carbon and oxygen stable isotope shifts in the North Atlantic.

Global changes, and particularly the massive release of CO2 to the atmosphere and subsequent global warming, have altered the baselines of carbon and oxygen stable isotopic ratios. Temporal shifts in these baselines can be advantageously monitored through cetacean skin samples because these animals are highly mobile and therefore integrate in their tissues the heterogeneity of local environmental signals. In this study, we examine variation of δ13C and δ18O values in the skin of fin whales sampled over three decades in two different North Atlantic feeding grounds: west Iceland and northwest Spain. These locations are situated about 2700 km apart and thus represent a wide latitudinal range within the North Atlantic Ocean. The δ13C decrease in both areas is attributed to the burning of fossil fuels and increased deforestation worldwide, the so-called Suess effect. The dissimilarity in the magnitude of the shift between the two areas is coincidental with previous information on local shifts and lies within the ranges of variation observed. δ18O values experienced a minimal, yet significant change in fin whales from W Iceland (a decline of -0.44‰ between 1986 and 2013) but not in those from NW Spain. This is in concordance with a higher rise in temperatures in the former area than in the latter. The study validates the use of cetacean skin to monitor temporal and geographical shifts in stable isotopic values and alerts that, when applying this tool to ecological research, comparisons between sample sets should take into account temporal and latitudinal scales.

Influence of the reformulation of ingredients in bakery products on healthy characteristics and acceptability of consumers.

Bakery products are highly consumed by children and adults and as cereal-derived foods are considered a fundamental part of a balanced diet, but they are usually high in sugar and saturated and trans fat and low in fibre. This study aimed to develop four different bakery products (cookies, croissants, Spanish muffins and Spanish sponge cake) with healthier properties, such as lower fat and sugar content, healthy fatty acid profile and higher fibre content. Margarine and sunflower oil were replaced with high oleic sunflower oil, and inulin was also added. After the modifications, a significant reduction of fat content and kilocalories in all cases, an increment of monounsaturated fat and a decrease in saturated fatty acids in three products were observed. The sensory analysis resulted similar results in both recipes for cookies and lower acceptability in sponge cake, croissants and muffins. Purchase intention only decreased in sponge cake.

[Kidney angiomyolipoma as aetiology of haemorragic shock]. / Angimiolipoma renal como causa de shock hemorrágico agudo.

This is a case of retroperitoneal hematoma and hypovolemic shock as a presentation of renal angiomyolipoma, a rarely benign and asymptomatic tumor. The massive and spontaneous bleeding of the tumor was diagnosed by an abdominal ecography and confirmed by an abdominal computer tomography in the emergency room. Although that kind of tumor needs non-aggressive treatment, as a general rule, because of the size and severity of the following symptoms, the patient has been submitted to a selective embolization of the renal mass when he was hemodinamically stabilized. The evolution was favorable; it was not necessary to do more aggressive surgical handling neither to urgently remove the angiomyolipoma.

Angimiolipoma renal como causa de shock hemorrágico agudo / Kidney angiomyolipoma as aetiology of haemorragic shock

Presentamos un caso de hematoma retroperitoneal y shock hipovolémico como forma de presentación de angiomiolipoma renal, tumor benigno poco frecuente y generalmente asintomático. El sangrado masivo y espontáneo del tumor, fue diagnosticado mediante la realización de ecografía abdominal y confirmado por TAC abdominal de urgencia. Pese a que el tratamiento de este tipo de tumores, en general, es conservador, el tamaño y la severidad de la clínica acompañante obligó a trasladar a la paciente, una vez estabilizada hemodinámicamente, a hospital de tercer nivel para realizar embolización selectiva de la masa renal. La evolución fue favorable sin necesidad de realizar maniobras quirúrgicas más agresivas ni extirpación del angiomiolipoma de forma urgente (AU)

This is a case of retroperitoneal hematoma and hypovolemic shock as a presentation of renal angiomyolipoma, a rarely benign and asymptomatic tumor. The massive and spontaneous bleeding of the tumor was diagnosed by an abdominal ecography and confirmed by an abdominal computer tomography in the emergency room. Although that kind of tumor needs non-aggressive treatment, as a general rule, because of the size and severity of the following symptoms, the patient has been submitted to a selective embolization of the renal mass when he was hemodinamically stabilized. The evolution was favorable; it was not necessary to do more aggressive surgical handling neither to urgently remove the angiomyolipoma (AU)

An insight into the epidemiology of dolphin morbillivirus worldwide.

Serum samples from 288 cetaceans representing 25 species and originating from 11 different countries were collected between 1995 and 1999 and examined for the presence of dolphin morbillivirus (DMV)-specific antibodies by an indirect ELISA (iELISA) (N = 267) or a plaque reduction assay (N = 21). A total of 35 odontocetes were seropositive: three harbour porpoises (Phocoena phocoena) and a common dolphin (Delphinus delphis) from the Northeastern (NE) Atlantic, a bottlenose dolphin (Tursiops truncatus) from Kent (England), three striped dolphins (Stenella coeruleoalba), two Risso's dolphins (Grampus griseus) and a bottlenose dolphin from the Mediterranean Sea, one common dolphin from the Southwest (SW) Indian Ocean, three Fraser's dolphins (Lagenodelphis hosei) from the SW Atlantic, 18 long-finned pilot whales (Globicephala melas) and a bottlenose dolphin from the SW Pacific as well as a captive bottlenose dolphin (Tursiops aduncus) originally from Taiwan. The presence of morbillivirus antibodies in 17 of these animals was further examined in other iELISAs and virus neutralization tests. Our results indicate that DMV infects cetaceans worldwide. This is the first report of DMV-seropositive animals from the SW Indian, SW Atlantic and West Pacific Oceans. Prevalence of DMV-seropositives was 85.7% in 21 pilot whales from the SW Pacific and both sexually mature and immature individuals were infected. This indicates that DMV is endemic in these animals. The same situation may occur among Fraser's dolphins from the SW Atlantic. The prevalence of DMV-seropositives was 5.26% and 5.36% in 19 common dolphins and 56 harbour porpoise from the NE Atlantic, respectively, and 18.75% in 16 striped dolphins from the Mediterranean. Prevalence varied significantly with sexual maturity in harbour porpoises and striped dolphins; all DMV-seropositives being mature animals. The prevalence of seropositive harbour porpoise and striped dolphins appeared to have decreased since previous studies. These data suggest that DMV is not endemic within these populations, that they are losing their humoral immunity against the virus and that they may be vulnerable to new epidemics.

Urinary N-acetyl-beta-N-glucosaminidase in patients with urinary tract infection.

N-acetyl-beta-glucosaminidase (NAG, EC 3.2.1.30) is a lysosomal enzyme present in the proximal convoluted tubule. Increased urinary excretion of NAG has been shown in urinary tract infections. Our results have confirmed that urinary excretion of NAG is significantly higher (33.70 +/- 8.75 U/g Cr) in patients with upper urinary tract infection than in patients with lower urinary tract infection (14.10 +/- 6.80 U/g Cr) and healthy adults.