Dynamism, Sensitivity, and Consequences of Mesenchymal and Stem-Like Phenotype of Cancer Cells.

There are remarkable similarities in the description of cancer stem cells (CSCs) and cancer cells with mesenchymal phenotype. Both cell types are highly tumorigenic, resistant against common anticancer treatment, and thought to cause metastatic growth. Moreover, cancer cells are able to switch between CSC and non-CSC phenotypes and vice versa, to ensure the necessary balance within the tumor. Likewise, cancer cells can switch between epithelial and mesenchymal phenotypes via well-described transition (EMT/MET) that is thought to be crucial for tumor propagation. In this review, we discuss whether, and to which extend, the CSCs and mesenchymal cancer cells are overlapping phenomena in terms of mechanisms, origin, and implication for cancer treatment. As well, we describe the dynamism of both phenotypes and involvement of the tumor microenvironment in CSC reversion and in EMT.

Integrated assessment of air pollution using observations and modelling in Santa Cruz de Tenerife (Canary Islands).

The present study aims to analyse the atmospheric dynamics of the Santa Cruz de Tenerife region (Tenerife, Canary Islands). This area is defined by the presence of anthropogenic emissions (from a refinery, a port and road traffic) and by very specific meteorological and orographic conditions-it is a coastal area with a complex topography in which there is an interaction of regional atmospheric dynamics and a low thermal inversion layer. These factors lead to specific atmospheric pollution episodes, particularly in relation to SO2 and PM10. We applied a methodology to study these dynamics based on two complementary approaches: 1) the analysis of the observations from the air quality network stations and 2) simulation of atmospheric dynamics using the WRF-ARW/HERMESv2/CMAQ/BSC-DREAM8b and WRF-ARW/HYSPLIT modelling systems with a high spatial resolution (1×1 km(2)). The results of our study show that the refinery plume plays an important role in the maximum SO2 observed levels. The area of maximum impact of the refinery is confined to a radius of 3 km around this installation. A cluster analysis performed for the period: 1998-2011 identified six synoptic situations as predominant in the area. The episodes of air pollution by SO2 occur mainly in those with more limited dispersive conditions, such as the northeastern recirculation, the northwestern recirculation and the western advection, which represent 33.70%, 11.23% and 18.63% of the meteorological situations affecting the study area in the year 2011, respectively. In the case of particulate matter, Saharan dust intrusions result in episodes with high levels of PM10 that may exceed the daily limit value in all measurement station; these episodes occur when the synoptic situation is from the east (3.29% of the situations during the year 2011).

[Impact of a clinical self-evaluation intervention on the appropriateness of hospital stays]. / Impacto de una intervención de autoevaluación clínica sobre la adecuación de la estancia hospitalaria.

AIM: To assess the impact of an intervention on inappropriate hospital stays (IHS) in acute-care hospitals in Catalonia (Spain) with the aim of testing the hypothesis that a simple intervention (adeQhos) reduces the proportion of IHS. METHODS: A pre-test/post-test study was performed through the <> questionnaire. Two intervention groups (internal medicine and general surgery) and 2 control groups (other medical specialities, orthopedics) were compared in 10 acute-care hospitals in Catalonia. The same evaluators assessed appropriateness of hospital stays before and after the intervention, using the Appropriateness Evaluation Protocol. RESULTS: A total of 1,594 pre-test stays and 1,495 post-test stays were reviewed. Of all the stays reviewed (day before discharge), 41.1% were inappropriate. The intervention was applied to 4,613 stays. There was a significant increase of IHS in the medicine control group (from 39.7 to 48.6%), and no decrease in the intervention groups (internal medicine [from 46.7 to 50.6%] or general surgery [from 27.2 to 31.2%]). The correlation between the intensity of the intervention and the difference in IHS before and after the intervention was r = -0.373 (p = 0.106). The intensity of intervention differed among the hospitals. In hospitals with an intensity of intervention > 60%, the proportion of IHS decreased by 10.7 points in internal medicine and by 4.8 points in general surgery, while the proportion of IHS increased in the control groups. CONCLUSIONS: The prevalanece of IHS the day before discharge in the hospitals studied was high (41.1%). No significant decrease in IHS was observed after a low-intensity intervention.

Impacto de una intervención de autoevaluación clínica sobre la adecuación de la estancia hospitalaria / Impact of a clinical self-evaluation intervention on the appropriateness of hospital stays

Objetivo: Evaluar el impacto de una intervención sobre la proporción de estancias inapropiadas (EI), para contrastar la hipótesis de que una intervención sencilla de información y participación (adeQhos®) permite reducir la proporción de EI. Método: Estudio pre/postintervención mediante el cuestionario «adeQhos®», que compara 2 grupos experimentales (medicina, cirugía) y 2 grupos control (otras especialidades médicas, cirugía ortopédica y traumatología), en 10 hospitales de agudos de Cataluña. Los mismos revisores evaluaron la adecuación mediante el Appropriateness Evaluation Protocol, antes y después de la intervención. Resultados: Se revisaron 1.594 estancias antes de la intervención y 1.495 después. El 41,1% de todas las estancias revisadas (día previo al alta) resultaron inapropiadas. La intervención se realizó sobre 4.613 estancias. Hubo un incremento significativo de EI en el grupo control de medicina (del 39,7 al 48,6%), mientras que en los grupos de intervención no se observó ninguna disminución (en medicina del 46,7 al 50,6%, y en cirugía del 27,2 al 31,2%). Sin embargo, la correlación entre la intensidad de la intervención y las diferencias de EI antes y después fue de r = -0,373 (p = 0,106). La intensidad de la intervención fue desigual en los diferentes hospitales; en los que presentaban una intensidad de intervención > 60% el porcentaje de EI disminuyó 10,7 puntos en medicina y 4,8 en cirugía, mientras que en los grupos control aumentó. Conclusiones: La prevalencia de EI en el día previo al alta en los hospitales estudiados fue considerablemente alta (del 41,1%). No se observó ninguna reducción significativa de la inadecuación hospitalaria tras una intervención de baja intensidad

Aim: To assess the impact of an intervention on inappropriate hospital stays (IHS) in acute-care hospitals in Catalonia (Spain) with the aim of testing the hypothesis that a simple intervention (adeQhos®) reduces the proportion of IHS. Methods: A pre-test/post-test study was performed through the «adeQhos®» questionnaire. Two intervention groups (internal medicine and general surgery) and 2 control groups (other medical specialities, orthopedics) were compared in 10 acute-care hospitals in Catalonia. The same evaluators assessed appropriateness of hospital stays before and after the intervention, using the Appropriateness Evaluation Protocol. Results: A total of 1,594 pre-test stays and 1,495 post-test stays were reviewed. Of all the stays reviewed (day before discharge), 41.1% were inappropriate. The intervention was applied to 4,613 stays. There was a significant increase of IHS in the medicine control group (from 39.7 to 48.6%), and no decrease in the intervention groups (internal medicine [from 46.7 to 50.6%] or general surgery [from 27.2 to 31.2%]). The correlation between the intensity of the intervention and the difference in IHS before and after the intervention was r = -0.373 (p = 0.106). The intensity of intervention differed among the hospitals. In hospitals with an intensity of intervention > 60%, the proportion of IHS decreased by 10.7 points in internal medicine and by 4.8 points in general surgery, while the proportion of IHS increased in the control groups. Conclusions: The prevalanece of IHS the day before discharge in the hospitals studied was high (41.1%). No significant decrease in IHS was observed after a low-intensity intervention

[Quick and early diagnostic outpatient unit: an effective and efficient assistential model. Five years experience]. / Unidad de diagnóstico rápido: un modelo asistencial eficaz y eficiente. Experiencia de 5 años.

BACKGROUND AND OBJECTIVE: To analyze the applicability of an out-patient Quick and Early Diagnostic Unit (QEDU) to evaluate patients with a potential life-threatening disorder on an out-patient basis. PATIENTS AND METHOD: We analyzed prospectively all patients attended in the unit for five years (1997-2001). We compared patients with lung cancer and colorectal cancer admitted to hospital for conventional study versus patients studied at the unit. RESULTS: We attended 2,748 patients in total Main reasons for consultation were abdominal pain, asthenia-anorexia, neurologic symptoms, anemia and palpable tumors. The most frequent diagnostic category corresponded to gastroenterological diseases and neoplastic diseases. The mean interval (standard error) for the first visit was 4.9 (3.4) days and for diagnosis it was 5.7 (6.5) days. Some 95% patients displayed a high degree of satisfaction by the questionnaire. In patients with cancer of the colon studied at the QEDU, we observed a reduction in the average interval for diagnosis which was highly significant (p = 0.03). The overall costs of final diagnosis were also lower for the QEDU model. CONCLUSIONS: The QEDU unit represents an alternative to in hospital admission for diagnostic workouts, which is fully feasible in our setting. It can result in the same efficacy and a higher efficiency than hospital admission.

Unidad de diagnóstico rápido: un modelo asistencial eficaz y eficiente. Experiencia de 5 años / Quick and early diagnostic outpatient unit: an effective and efficient assistential model. Five years experience

FUNDAMENTO Y OBJETIVO: Valorar la aplicabilidad de una unidad de diagnóstico rápido (UDR) dirigida al estudio ambulatorio de pacientes con sospecha de enfermedad grave. PACIENTES Y MÉTODO: Se analiza de forma prospectiva a los pacientes atendidos en una UDR durante 5 años (1997-2001) y se compara a los pacientes con cáncer de pulmón y los de cáncer de colon atendidos en la UDR y hospitalizados. RESULTADOS: Los principales motivos de consulta fueron dolor abdominal, síntomas constitucionales y neurológicos, anemia y tumoraciones palpables. Las enfermedades digestivas y neoplásicas fueron las más frecuentes. El intervalo medio (desviación estándar) para la primera visita fue de 4,9 (3,4) días y el de diagnóstico, de 5,7 (6,5) días. Un 95 por ciento de los pacientes mostró un elevado grado de satisfacción con este modelo asistencial. En pacientes con cáncer de colon estudiados en la UDR se observó una reducción del intervalo diagnóstico (p = 0,03) respecto a los hospitalizados. El coste económico del estudio diagnóstico fue inferior en la UDR. CONCLUSIONES: La UDR representa una forma asistencial aplicable en nuestro medio que consigue la misma eficacia y una mayor eficiencia que el ingreso hospitalario (AU)