Rearrangements involving 11q23.3/KMT2A in adult AML: mutational landscape and prognostic implications - a HARMONY study.

Balanced rearrangements involving the KMT2A gene (KMT2Ar) are recurrent genetic abnormalities in acute myeloid leukemia (AML), but there is lack of consensus regarding the prognostic impact of different fusion partners. Moreover, prognostic implications of gene mutations co-occurring with KMT2Ar are not established. From the HARMONY AML database 205 KMT2Ar adult patients were selected, 185 of whom had mutational information by a panel-based next-generation sequencing analysis. Overall survival (OS) was similar across the different translocations, including t(9;11)(p21.3;q23.3)/KMT2A::MLLT3 (p = 0.756). However, independent prognostic factors for OS in intensively treated patients were age >60 years (HR 2.1, p = 0.001), secondary AML (HR 2.2, p = 0.043), DNMT3A-mut (HR 2.1, p = 0.047) and KRAS-mut (HR 2.0, p = 0.005). In the subset of patients with de novo AML < 60 years, KRAS and TP53 were the prognostically most relevant mutated genes, as patients with a mutation of any of those two genes had a lower complete remission rate (50% vs 86%, p < 0.001) and inferior OS (median 7 vs 30 months, p < 0.001). Allogeneic hematopoietic stem cell transplantation in first complete remission was able to improve OS (p = 0.003). Our study highlights the importance of the mutational patterns in adult KMT2Ar AML and provides new insights into more accurate prognostic stratification of these patients.

Quality of Life of Colorectal Cancer Survivors: Mapping the Key Indicators by Expert Consensus and Measures for Their Assessment.

Quality of life (QoL) assessments are integral to cancer care, yet their effectiveness in providing essential information for supporting survivors varies. This study aimed to elucidate key indicators of QoL among colorectal cancer survivors from the perspective of healthcare professionals, and to evaluate existing QoL questionnaires in relation to these indicators. Two studies were conducted: a Delphi study to identify key QoL indicators and a scoping review of questionnaires suitable for colorectal cancer survivors. Fifty-four healthcare professionals participated in the Delphi study's first round, with 25 in the second. The study identified two primary QoL domains (physical and psychological) and 17 subdomains deemed most critical. Additionally, a review of 12 questionnaires revealed two instruments assessing the most important general domains. The findings underscored a misalignment between existing assessment tools and healthcare professionals' clinical priorities in working with colorectal cancer survivors. To enhance support for survivors' QoL, efforts are needed to develop instruments that better align with the demands of routine QoL assessment in clinical practice.

LSD1 drives intestinal epithelial maturation and controls small intestinal immune cell composition independent of microbiota in a murine model.

Postnatal development of the gastrointestinal tract involves the establishment of the commensal microbiota, the acquisition of immune tolerance via a balanced immune cell composition, and maturation of the intestinal epithelium. While studies have uncovered an interplay between the first two, less is known about the role of the maturing epithelium. Here we show that intestinal-epithelial intrinsic expression of lysine-specific demethylase 1A (LSD1) is necessary for the postnatal maturation of intestinal epithelium and maintenance of this developed state during adulthood. Using microbiota-depleted mice, we find plasma cells, innate lymphoid cells (ILCs), and a specific myeloid population to depend on LSD1-controlled epithelial maturation. We propose that LSD1 controls the expression of epithelial-derived chemokines, such as Cxcl16, and that this is a mode of action for this epithelial-immune cell interplay in local ILC2s but not ILC3s. Together, our findings suggest that the maturing epithelium plays a dominant role in regulating the local immune cell composition, thereby contributing to gut homeostasis.

Development of Flame-Retardant Polylactic Acid Formulations for Additive Manufacturing.

Polymeric materials, renowned for their lightweight attributes and design adaptability, play a pivotal role in augmenting fuel efficiency and cost-effectiveness in railway vehicle development. The tailored formulation of compounds, specifically designed for additive manufacturing, holds significant promise in expanding the use of these materials. This study centers on poly(lactic acid) (PLA), a natural-based biodegradable polymeric material incorporating diverse halogen-free flame retardants (FRs). Our investigation scrutinizes the printability and fire performance of these formulations, aligning with the European railway standard EN 45545-2. The findings underscore that FR in the condensed phase, including ammonium polyphosphate (APP), expandable graphite (EG), and intumescent systems, exhibit superior fire performance. Notably, FR-inducing hydrolytic degradation, such as aluminum hydroxide (ATH) or EG, reduces polymer molecular weight, significantly impacting PLA's mechanical performance. Achieving a delicate balance between fire resistance and mechanical properties, formulations with APP as the flame retardant emerge as optimal. This research contributes to understanding the fire performance and printability of 3D-printed PLA compounds, offering vital insights for the rail industry's adoption of polymeric materials.

Variability of the trophic state in a coastal reef system associated with submarine groundwater discharge in the Mexican Caribbean.

Submarine groundwater discharges (SGD) have been associated with important sources of nutrients between the land and oceans that can generate eutrophication conditions. This study aims to analyze the behavior of nitrogen and phosphorus using the mixing curve method, to examine the variation of the trophic state using the Karydis Index, and to evaluate the δ15N in benthic organisms to trace the origin of nitrogen in neap tide (November) and spring tide (January) in the Manatí Cenote, and Nohoch-Teek reef lagoon in the Mexican Caribbean. Nitrogen and phosphate enrichment was in the Manatí Cenote during neap and spring tides. This enrichment was particularly noticeable in the reef lagoon during low tides in the areas influenced by SGD. In the Cenote, differences in the nitrate trophic state were observed, indicating an eu-mesotrophic condition during neap tide and a mesotrophic condition during spring tide. However, no significant differences were observed for ammonium (oligo-mesotrophic), nitrites, or phosphate compounds (oligotrophic). The trophic state reef lagoon exhibited a similar pattern but with different spatial variations. In both systems, phosphorus was a limiting nutrient, while δ15N suggested anthropogenic nitrogen uptake by several benthic organisms.

Effects of Aerobic Exercise Therapy through Nordic Walking Program in Lactate Concentrations, Fatigue and Quality-of-Life in Patients with Long-COVID Syndrome: A Non-Randomized Parallel Controlled Trial.

BACKGROUND: Long-COVID syndrome comprises a variety of signs and symptoms that develop during or after infection with COVID-19 which may affect the physical capabilities. However, there is a lack of studies investigating the effects of Long-COVID syndrome in sport capabilities after suffering from COVID-19 infection. The purpose of the study was to evaluate and compare lactate concentration and quality of life (QoL) in patients with Long-COVID with those who have not developed non-Long-COVID during Nordic walking exercise therapy. METHODS: Twenty-nine patients (25.5 ± 7.1 years) took part in a non-randomized controlled trial, divided into two groups: a Long-COVID group (n = 16) and a non-Long-COVID control (n = 13). Patients were confirmed as having Long-COVID syndrome if they experienced fatigue or tiredness when performing daily activities and worsening of symptoms after vigorous physical or mental activity. All participants underwent a 12-week Nordic Walking program. Lactate concentration after exercise and distance covered during all sessions were measured. Pre- and Long-Nordic Walking program, the Modified Fatigue Impact Scale (MFIS), the Short Form 36 Health Survey (SF-36), and EURO QoL-5D (EQ-ED) were administered to assess fatigue and quality of life, respectively. RESULTS: There was a lactate concentration effect between groups (F = 5.604; p = 0.024). However, there was no significant effect as a result of the session (F = 3.521; p = 0.121) with no interaction of group × session (F = 1.345; p = 0.414). The group main effect (F = 23.088; p < 0.001), time effect (F = 6.625; p = 0.026), and group × time (F = 4.632; p = 0.002) interaction on the SF-36 scale were noted. Also, there were a significant group main effect (F = 38.372; p < 0.001), time effect (F = 12.424; p = 0.005), and group × time interaction (F = 4.340; p = 0.014) on EQ-5D. However, there was only a significant group main effect (F = 26.235; p < 0.001) with no effect on time (F = 2.265; p = 0.160) and group × time (F = 1.584; p = 0.234) interaction on the MFIS scale. CONCLUSIONS: The Long-COVID group showed higher lactate concentration compared with the control group during the 12 weeks of the Nordic Walking program. The Long-COVID group presented a decrease in fatigue with respect to the control group according to the MFIS scale, as well as improvement in quality of life after aerobic exercise therapy.

Digital Microscopy Augmented by Artificial Intelligence to Interpret Bone Marrow Samples for Hematological Diseases.

Analysis of bone marrow aspirates (BMAs) is an essential step in the diagnosis of hematological disorders. This analysis is usually performed based on a visual examination of samples under a conventional optical microscope, which involves a labor-intensive process, limited by clinical experience and subject to high observer variability. In this work, we present a comprehensive digital microscopy system that enables BMA analysis for cell type counting and differentiation in an efficient and objective manner. This system not only provides an accessible and simple method to digitize, store, and analyze BMA samples remotely but is also supported by an Artificial Intelligence (AI) pipeline that accelerates the differential cell counting process and reduces interobserver variability. It has been designed to integrate AI algorithms with the daily clinical routine and can be used in any regular hospital workflow.

Academic Procrastination of Spanish Pre-service Teachers during the COVID-19 Pandemic / La procrastinación académica de los estudiantes españoles de formación inicial del profesorado durante la pandemia de COVID-19

The present study seeks to ascertain whether the academic procrastination of university pre-service teachers varied during the COVID-19 pandemic when compared to data collected from another sample (n = 794) taken before the pandemic, and the reasons that might explain this. 910 pre-service teachers responded to the PASS scale, Academic Procrastination Scale, Unintentional Procrastination Scale, Active Procrastination Scale, and the New General Self-Efficacy Scale during the pandemic. The results reflect greater procrastination than for the pre-pandemic sample; 37.8% felt that their procrastination had increased due to the pandemic, which was more evident amongst women, whereas 8.7% reported having procrastinated less, displaying the highest level of self-efficacy. In both instances, the most commonly alleged reasons were greater time management, together with changes they were forced to make in their study habits. We discuss the implications that might need to be considered when planning and organizing teaching, should a similar situation occur again. (AU)

El objetivo de este trabajo es conocer si la procrastinación académica de los estudiantes universitarios de formación del profesorado varió durante la pandemia de COVID-19 en comparación con datos recogidos de otra muestra (n = 794) antes de la pandemia y los motivos que lo justifican. Han participado 910 estudiantes, que respondieron a la escala PASS, la Escala de Procrastinación Académica, la Escala de Procrastinación Involuntaria, la Escala de Procrastinación Activa y la Nueva Escala de Autoeficacia General durante la pandemia. Los resultados indican una mayor procrastinación que la muestra prepandemia. Un 37.8% cree haber aumentado su procrastinación por la pandemia, sobre todo las mujeres, mientras el 8.7% afirman procrastinar menos, siendo los que mayor autoeficacia tienen. En ambos casos, los motivos más frecuentes han sido el disponer de más tiempo, junto a cambios en sus hábitos de estudio. Se comentan las implicaciones para la organización docente en caso de repetirse una situación similar. (AU)

The prognostic impact of non-driver gene mutations and variant allele frequency in primary myelofibrosis.

Prognostic impact of non-MPN driver gene mutations in primary myelofibrosis. MIPSS70: Mutation-Enhanced International Prognostic Score System.

Sequential-contingent strategy for fallopian tube evaluation using hysterosalpingo foam sonography: a cost analysis.

Background: Tubal pathology is the etiological factor in 20% of couples with female infertility. Historically, diagnostic evaluation of the fallopian tubes has been performed by means of hysterosalpingography (HSG). Hysterosonosalpingography with EXEM® foam is a recent technique with supposedly comparable effectiveness to HSG, but with better tolerability for patients. Methods: Tubal patency was assessed in patients who were candidates for intrauterine insemination (IUI) between January 2020 and July 2021. (I) Hysterosonosalpingography with EXEM® foam. (II) If the patient had both tubes patent, IUI was proposed. In case of inconclusive or pathological results, HSG was performed. (III) If the HSG concludes tubal patency, IUI is proposed. On the other hand, if it results in tubal obstruction, in vitro fertilization (IVF) is proposed. Results: Assessment of tubal patency by HSG showed concordance with previous Hysterosonosalpingography with EXEM® foam results in 45.5% (n=15) of cases of unilateral obstruction and 66.7% (n=6) of cases of bilateral obstruction. When we compare the total cost of HSG (€54,899.46) with the sum of patients who only required Hysterosonosalpingography with EXEM® foam together with those who underwent both tests (€45,575.96), it shows that the latter represents a cost benefit strategy (cost difference €9,323.50). Conclusions: Our results suggest a benefit of €9,323.50 when performing the contingent sequential strategy, in case of pathological or inconclusive results, compared to performing a systematic HSG in all patients. Patients with an obstructive hysterosalpingogram with EXEM® and a patent hysterosalpingogram will be the subgroup that will benefit the most, as IUI can be proposed instead of IVF. In addition, there is a benefit in terms of optimizing the medical procedure, hospital visits and speeding up the time to start assisted reproductive technology (ART).

Azoic sediments and benthic foraminifera: Environmental quality in a subtropical coastal lagoon in the gulf of California.

Marine transitional environments play an important role in human sustainability. Around these ecosystems, coastal lagoons are subject to high anthropogenic pressure from population growth. The increased demand for goods and services is associated with the elevated discharge of untreated and treated wastewater into lagoon systems. The absence of benthic organisms in lagoon environments has been linked to extreme natural conditions and severe anthropogenic impact at both spatial and temporal scales. However, the mechanisms that lead to the presence of azoic sediments in lagoon environments have yet to be studied. This study aimed to determine the vertical variability of textural groups, geochemistry, and benthic foraminiferal fauna to understand how natural and anthropogenic components generate a vertical sediment sequence with low or absent benthic foraminifera in a subtropical coastal lagoon in the southwestern end of the Gulf of California. A 41 cm-long sediment core was collected from La Paz Lagoon at a 1-m depth. The core was sectioned every centimeter, and sediment subsamples were dried and homogenized for grain size, calcium carbonate, elemental and isotopic carbon and nitrogen analyses, and benthic foraminifera quantification. Muds with fine sands towards the core's base characterized the sedimentary sequence. Organic carbon and total nitrogen increased from the base (1.4% and 0.06%, respectively) to the core-top (CT, 3.0% and 0.14%, respectively), significant from the 27 cm interval. Calcium carbonate content was very low (<0.8%). The relationship of δ13C vs. C:N ratio indicated that sedimentary organic carbon was derived from the marine and sewage source mixture. The δ15N of organic matter increased by 3.7‰, starting from the 27 cm interval towards the CT. The nitrogen sewage input source was relatively more significant than nitrogen fixation. The few individuals (<18 ind. in 10 g) and genera (Ammonia and Elphidium), as well as the absence of foraminifera in 19 of 41 intervals in the core, indicated that environmental conditions were unfavorable, even for colonization of environmentally stress-tolerant genera. The frequency of azoic sediments was higher from the 25 cm interval to the CT vs. from the base to the 25 cm interval. Moreover, the AEI revealed severe to moderate hypoxia in the study area. The limited presence of benthic foraminifera and calcium carbonate preservation corroborated that the quality of the lagoon's environment has deteriorated along with population growth, which requires strategic programs to sustain this transitional ecosystem.

Predictive Factors and ACE-2 Gene Polymorphisms in Susceptibility to Long COVID-19 Syndrome.

Long COVID-19 syndrome is present in 5-10% of patients infected with SARS-CoV-2, and there is still little information on the predisposing factors that lead to its development. The purpose of the study was to evaluate the predictive factors in early symptoms, clinical features and the role of Angiotensin-Converting Enzyme-2 (ACE-2) c.513-1451G>A (rs2106806) and c.15643279T>C (rs6629110) polymorphisms in the susceptibility to developing Long COVID-19 syndrome subsequent to COVID-19 infectionA total of 29 patients who suffered COVID-19 were recruited in a descriptive longitudinal study of two groups: Long COVID-19 (n = 16) and non-Long COVID-19 (n = 13). Early symptoms and clinical features during COVID-19 were classified by a medical service. ACE-2 polymorphisms were genotyped by using a Single Nucleotide Primer Extension (SNPE). Of the early symptoms, fatigue, myalgia and headache showed a high risk of increasing Long COVID-19 susceptibility. Clinical features such as emergency care, SARS-CoV-2 reinfection, previous diseases, respiratory disease and brain fog also had a high risk of increasing Long COVID-19 susceptibility. The A allele in the rs2106806 variant was associated with an odds ratio (OR) of 4.214 (95% CI 2.521-8.853; p < 0.001), and the T allele in the rs6629110 variant was associated with an OR of 3.754 (95% CI 1.785-6.105; p = 0.002) of increasing Long COVID-19 susceptibility. This study shows the risk of ACE-2 polymorphisms, different early symptoms and clinical features during SARS-CoV-2 infection in susceptibility to Long COVID-19.

Impacto de la pandemia por COVID-19 en la formación de los cirujanos torácicos en España / Impact of the COVID-19 pandemic on thoracic surgery training in Spain

Tras más de dos años desde su aparición, la pandemia por SARS-CoV-2 ha generado importantes cambios en la sanidad y su organización. El presente trabajo trata de dilucidar las implicaciones de estos en la formación especializada de la cirugía torácica y sus repercusiones en los profesionales. Para ello, desde la Sociedad Española de Cirugía Torácica (SECT) se distribuye una encuesta entre los residentes en activo y aquellos que han terminado su formación en los últimos tres años. Esta consta de 24 preguntas cerradas de respuesta múltiple sobre el impacto de la pandemia en sus servicios, su formación y su vivencia. La tasa de respuesta (TR) de la encuesta fue de 42% (52 de una población objetivo de 120). El efecto de la pandemia en el funcionamiento de los servicios de cirugía torácica fue considerado alto o extremo según 78,8% de los participantes. Las actividades académicas fueron completamente suspendidas en 42,3% de los casos, mientras que 57,7% de los participantes tuvieron que prestar atención asistencial a pacientes ingresados por COVID, de los cuales 25% fue a tiempo parcial y 32,7% a tiempo completo. De los encuestados, 80% consideró que los cambios sufridos durante la pandemia afectaron su formación como residente y 36,5% opinó que debería ofrecerse una prolongación del periodo de formación para quienes se hayan visto afectados. Así pues, observamos cómo la pandemia ha afectado profundamente de forma negativa la formación especializada en cirugía torácica en España. (AU)

In the more than 2 years since its emergence, the SARS-CoV-2 pandemic has prompted important changes in healthcare systems and their organization. The aim of this study is to determine the implications in specialized thoracic surgery training as well as the repercussions on thoracic surgery residents. With this objective, the Spanish Society of Thoracic Surgery has conducted a survey among all its trainees and those who had finished their residency during the last 3 years. It consisted of 24 multiple-answer closed questions about the impact of the pandemic on their services, their training, and their personal experience. The response rate was 42% (52 out of a target population of 120). The effect of the pandemic on thoracic surgery services was high or extreme according to 78.8% of the participants. Academic activities were completely cancelled in 42.3% of the cases, and 57.7% of the respondents were required to treat hospitalized COVID patients (25% part-time, and 32.7% full-time). More than 80% of the survey participants believed that changes during the pandemic negatively affected their training, and 36.5% would prefer to extend their training period. In sum, we observe how the pandemic has had deep negative effects on specialized training in thoracic surgery in Spain. (AU)

The Family Context in Cybervictimization: A Systematic Review and Meta-Analysis.

The use of Information and Communication Technologies is clearly widespread among adolescents from a young age. Although it poses a significant contribution at the academic, social, and emotional levels, it can also involve a set of important risks, including cyberbullying and, therefore, cybervictimization. Previous studies have pointed out the importance of family context since parental control and family communication emerge as contributors to this phenomenon. Therefore, the aim of the present study was to analyze the influence of family communication on cybervictims and the moderating role of different sociodemographic variables (age, gender, nationality, and culture), as well as social, emotional, and personality variables. In this context, a meta-analysis was performed with a random effects model, using a total meta-sample of 29,093 adolescents (mean age: 14.50 years) distributed in k = 20 samples belonging to nine studies on cybervictimization published in English in Q1 journals between 2015 and 2020. The results showed that family offensive communication is related to cybervictimization. This could be because the affected individuals often use social media to compensate for the deficiencies they perceive within their families, as well as to obtain support, which increases their time spent on the Internet and their exposure to this phenomenon. These findings highlight the need for family and community interventions, not only school-based or individual interventions.

Phylogenetic classification of natural product biosynthetic gene clusters based on regulatory mechanisms.

The natural products (NPs) biosynthetic gene clusters (BGCs) represent the adapting biochemical toolkit for microorganisms to thrive different microenvironments. Despite their high diversity, particularly at the genomic level, detecting them in a shake-flask is challenging and remains the primary obstacle limiting our access to valuable chemicals. Studying the molecular mechanisms that regulate BGC expression is crucial to design of artificial conditions that derive on their expression. Here, we propose a phylogenetic analysis of regulatory elements linked to biosynthesis gene clusters, to classify BGCs to regulatory mechanisms based on protein domain information. We utilized Hidden Markov Models from the Pfam database to retrieve regulatory elements, such as histidine kinases and transcription factors, from BGCs in the MIBiG database, focusing on actinobacterial strains from three distinct environments: oligotrophic basins, rainforests, and marine environments. Despite the environmental variations, our isolated microorganisms share similar regulatory mechanisms, suggesting the potential to activate new BGCs using activators known to affect previously characterized BGCs.

Postoperative morbidity after anatomical lung resections by VATS vs thoracotomy: Treatment and intention-to-treat analysis of the Spanish Video-Assisted Thoracic Surgery Group / Morbilidad postoperatoria después de una resección pulmonar anatómica mediante cirugía toracoscópica frente a cirugía abierta: análisis por tratamiento y por intención de tratar del Grupo Español de Cirugía Torácica Videoasistida

Objectives In recent years, video-assisted thoracoscopic lung resections (VATS) have been associated with lower morbidity than open surgery. The aim of our study is to compare postoperative morbidity among patients from the national database of the Spanish Group of Video-Assisted Thoracic Surgery (GE-VATS) after open and video-assisted anatomic lung resections using a propensity score analysis.MethodsFrom December 2016 to March 2018, a total of 3533 patients underwent anatomical lung resection at 33 centers. Pneumonectomies and extended resections were excluded. A propensity score analysis was performed to compare the morbidity of the thoracotomy group (TG) vs the VATS group (VATSG). Treatment and intention-to-treat (ITT) analyses were conducted.ResultsIn total, 2981 patients were finally included in the study: 1092 (37%) in the TG and 1889 (63%) in the VATSG for the treatment analysis; and 816 (27.4%) in the TG and 2165 patients (72.6%) in the VATSG for the ITT analysis. After propensity score matching, in the treatment analysis, the VATSG was significantly associated with fewer overall complications than the TG OR 0.680 [95%CI 0.616, 0.750]), fewer respiratory (OR 0.571 [0.529, 0.616]) cardiovascular (OR 0.529 [0.478, 0.609]) and surgical (OR 0.875 [0.802, 0.955]) complications, lower readmission rate (OR 0.669 [0.578, 0.775]) and a reduction of hospital length of stay (−1.741 ([−2.073, −1.410]). Intention-to-treat analysis showed only statistically significant differences in overall complications (OR 0.76 [0.54–0.99]) in favor of the VATSG.ConclusionIn this multicenter population, VATS anatomical lung resections have been associated with lower morbidity than those performed by thoracotomy. However, when an intention-to-treat analysis was performed, the benefits of the VATS approach were less prominent. (AU)

Introducción El objetivo de nuestro estudio es comparar la morbilidad postoperatoria entre los pacientes de la base de datos nacional del Grupo Español de Cirugia Torácica Videoasistida (GE-VATS) después de resecciones pulmonares anatómicas abiertas y videoasistidas mediante un análisis de emparejamiento por índice de propensión.MétodosDesde Diciembre de 2016 hasta Marzo de 2018, un total 3533 pacientes fueron intervenidos de resección pulmonar anatómica en 33 centros. Se excluyeron las neumonectomías y las resecciones extendidas. Se realizó un análisis de índice de propensión para comparar la morbilidad de cirugía abierta (TG) frente a VATS (VATSG). Se realizó un análisis por tratamiento y por intención de tratar (ITT).ResultadosEn el estudio se incluyeron finalmente 2981 pacientes: 1092 (37%) en TG y 1889 (63%) en VATSG. En el análisis por tratamiento, la VATS se asoció significativamente con menor tasa de complicaciones que la cirugía abierta (OR 0.680 [95%CI 0.616, 0.750]), de complicaciones respiratorias (OR 0.571 [0.529, 0.616]), cardiovasculares (OR 0.529 [0.478, 0.609]) y quirúrgicas (OR 0.875 [0.802, 0.955]), menor tasa de reingresos (OR 0.669 [0.578, 0.775]) y menor estancia (−1.741 ([−2.073, −1.410]). En el de intención de tratar, se observaron diferencias estadísticamente significativas a favor de la VATS solo en las complicaciones en general (OR 0.76 [0.54–0.99]).ConclusionesEn esta población multicéntrica, las lobectomías y segmentectomias anatómicas por VATS se han asociado con menor tasa de complicaciones que las realizadas por toracotomía. Sin embargo, en el análisis por intención de tratar, los beneficios de la VATS no fueron tan evidentes. (AU)

The Five "Ws" of Frailty Assessment and Chronic Lymphocytic Leukemia: Who, What, Where, Why, and When.

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, but chronological age does not accurately discriminate frailty status at the inter-individual level. Frailty describes a person's overall resilience. Since CLL is a stressful situation, it is relevant to assess the patient´s degree of frailty, especially before starting antineoplastic treatment. We are in the era of targeted therapies, which have helped to control the disease more effectively and avoid the toxicity of chemo (immuno) therapy. However, these drugs are not free of side effects and other aspects arise that should not be neglected, such as interactions, previous comorbidities, or adherence to treatment, since most of these medications are taken continuously. The challenge we face is to balance the risk of toxicity and efficacy in a personalized way and without forgetting that the most frequent cause of death in CLL is related to the disease. For this purpose, comprehensive geriatric assessment (GA) provides us with the opportunity to evaluate multiple domains that may affect tolerance to treatment and that could be improved with appropriate interventions. In this review, we will analyze the state of the art of GA in CLL through the five Ws.