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Summary Background Watch and wait is a novel management strategy in patients with rectal cancer who have a clinical complete response after neoadjuvant chemoradiotherapy. Surveillance of these patients is generally intensive, because local regrowth (with the potential for salvage) occurs in 25% of patients, and distant metastases occur in 10% of patients. It is unclear for how long these patients should be followed up. To address this issue, we did conditional survival modelling using the International Watch & Wait Database (IWWD), which is a large-scale registry of patients with a clinical complete response after neoadjuvant chemotherapy who have been managed by a watch-and-wait strategy. Methods We did a retrospective, multicentre registry study using a dataset from the IWWD, which includes data from 47 clinics across 15 countries. We selected patients (aged ≥18 years) with rectal cancer who had a clinical complete response after neoadjuvant chemotherapy, and who were subsequently managed by a watch-and-wait strategy between Nov 25, 1991, and Dec 31, 2015. Patients who had not achieved a clinical complete response or who had undergone any surgical procedure were excluded. The criteria used for defining a clinical complete response and the specific surveillance strategies were at the discretion of each participating centre. We used conditional survival modelling to estimate the probability of patients remaining free of local regrowth or distant metastasis for an additional 2 years after sustaining a clinical complete response or being distant metastasis-free for 1, 3, and 5 years from the date of the decision to commence watch and wait. The primary outcomes were conditional local regrowth-free survival at 3 years, and conditional distant metastasis-free survival at 5 years. Findings We identified 793 patients in the IWWD with clinical complete response who had been managed by a watch-and-wait strategy. Median follow-up was 55·2 months (IQR 36·0–75·6). The probability of remaining free from local regrowth for an additional 2 years if a patient had a sustained clinical complete response for 1 year was 88·1% (95% CI 85·8–90·9), for 3 years was 97·3% (95·2–98·6), and for 5 years was 98·6% (97·6–100·0). The probably of remaining free from distant metastasis for a further 2 years in patients who had a clinical complete response without distant metastasis for 1 year was 93·8% (92·3–95·9), for 3 years was 97·8% (96·6–99·3), and for 5 years was 96·6% (94·0–98·9). Interpretation These results suggest that the intensity of active surveillance in patients with rectal cancer managed by a watch-and-wait approach could be reduced if they achieve and maintain a clinical complete response within the first 3 years of starting this approach. Funding European Registration of Cancer Care, financed by the European Society of Surgical Oncology, the Champalimaud Foundation Lisbon, the Bas Mulder Award, granted by the Alpe d’HuZes Foundation and the Dutch Cancer Society, the European Research Council Advanced Grant, and the National Institute of Health and Research Manchester Biomedical Research Centre.

Native to southeast Asia, the spotted-wing drosophila (Drosophila suzukii (Matsumura); Diptera: Drosophilidae) has become a major pest of small fruits in the Americas and Europe. Field studies were conducted over a two-year period (2015–2016) in cultivated highbush blueberry (Vaccinium corymbosum Linnaeus; Ericaceae) fields and adjacent non-crop habitats containing wild blueberries in New Jersey (United States of America). We tracked seasonal changes in D. suzukii adult abundance and fruit infestation throughout the ripening period (June–August). In both years, D. suzukii adult counts post-harvest were generally higher in traps located in non-crop habitats compared with those located in highbush blueberry fields. Wild and cultivated fruits synchronised in maturation, and the numbers of eggs laid and of emerged adults in both fruit types were comparable for most of the season, although sometimes these numbers were higher in wild fruits post-harvest. Overall, immature success (measured as the per cent egg-to-adult survival) was also mostly higher in wild than in cultivated fruits. Altogether, these studies document that non-crop habitats, and wild hosts therein, are used by D. suzukii during fruit ripening and may serve as potential sources of infestation to nearby highbush blueberry fields. Hence, methods that reduce D. suzukii populations in non-crop habitats may help manage this pest in neighbouring highbush blueberries.

Background Antibodies to the aquaporin-4 (AQP4) water channel in neuromyelitis optica spectrum disorder (NMOSD) are reported to trigger the complement cascade, which is implicated in astrocyte damage and subsequent neuronal injury. The PREVENT study demonstrated that the terminal complement inhibitor eculizumab reduces adjudicated relapse risk in patients with anti-AQP4 immunoglobulin G-positive (AQP4+) NMOSD. The objective of this analysis was to evaluate the efficacy of eculizumab in reducing relapse risk and its safety in AQP4+ NMOSD across clinically relevant subgroups in PREVENT. Methods In the randomized, double-blind, time-to-event, phase 3 PREVENT trial, 143 adults received eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo (2:1), with stable-dose concomitant immunosuppressive therapy (IST) permitted (except rituximab and mitoxantrone). Post hoc analyses of relapses and adverse events were performed for prespecified and post hoc subgroups based on concomitant IST and prior rituximab use, demographic and disease characteristics, and autoimmune comorbidity. Results The significant reduction in relapse risk observed for eculizumab versus placebo in the overall PREVENT population was consistently maintained across subgroups based on concomitant IST and previous rituximab use, age, sex, region, race, time since clinical onset of NMOSD, historical annualized relapse rate, baseline Expanded Disability Status Scale score, and history of another autoimmune disorder. The serious infection rate was lower with eculizumab than placebo regardless of rituximab use in the previous year, concomitant IST use, or history of another autoimmune disorder. Conclusion Across a wide range of clinically relevant AQP4+ NMOSD patient subgroups in PREVENT, eculizumab therapy was consistently effective versus placebo in reducing relapse risk, with no apparent increase in serious infection rate. Trial registration NCT01892345 (ClinicalTrials.gov).

BACKGROUND: The strategy of watch and wait (W&W) in patients with rectal cancer who achieve a complete clinical response (cCR) after neoadjuvant therapy is new and offers an opportunity for patients to avoid major resection surgery. However, evidence is based on small-to-moderate sized series from specialist centres. The International Watch & Wait Database (IWWD) aims to describe the outcome of the W&W strategy in a large-scale registry of pooled individual patient data. We report the results of a descriptive analysis after inclusion of more than 1000 patients in the registry.METHODS: Participating centres entered data in the registry through an online, highly secured, and encrypted research data server. Data included baseline characteristics, neoadjuvant therapy, imaging protocols, incidence of local regrowth and distant metastasis, and survival status. All patients with rectal cancer in whom the standard of care (total mesorectal excision surgery) was omitted after neoadjuvant therapy were eligible to be included in the IWWD. For the present analysis, we only selected patients with no signs of residual tumour at reassessment (a cCR). We analysed the proportion of patients with local regrowth, proportion of patients with distant metastases, 5-year overall survival, and 5-year disease-specific survival.FINDINGS: Between April 14, 2015, and June 30, 2017, we identified 1009 patients who received neoadjuvant treatment and were managed by W&W in the database from 47 participating institutes (15 countries). We included 880 (87%) patients with a cCR. Median follow-up time was 3·3 years (95% CI 3·1-3·6). The 2-year cumulative incidence of local regrowth was 25·2% (95% CI 22·2-28·5%), 88% of all local regrowth was diagnosed in the first 2 years, and 97% of local regrowth was located in the bowel wall. Distant metastasis were diagnosed in 71 (8%) of 880 patients. 5-year overall survival was 85% (95% CI 80·9-87·7%), and 5-year disease-specific survival was 94% (91-96%).INTERPRETATION: This dataset has the largest series of patients with rectal cancer treated with a W&W approach, consisting of approximately 50% data from previous cohort series and 50% unpublished data. Local regrowth occurs mostly in the first 2 years and in the bowel wall, emphasising the importance of endoscopic surveillance to ensure the option of deferred curative surgery. Local unsalvageable disease after W&W was rare.FUNDING: European Registration of Cancer Care financed by European Society of Surgical Oncology, Champalimaud Foundation Lisbon, Bas Mulder Award granted by the Alpe d'Huzes Foundation and Dutch Cancer Society, and European Research Council Advanced Grant.

Performance at the elite level in running-based team sports requires outlining the cyclical nature in which physiological and biomechanical loads lead to adaptation of the biological system as a whole (Vanrenterghem et al., 2017). Very commonly, there are congested fixture periods that seem to have no effect on physical activity, technical performance, and injury incidence (Dellal et al., 2015) injury rates or patterns (Carling et al., 2016), but do seem to decrease tactical performance, as measured by levels of movement synchronization (Folgado et al., 2015). A very high traveling frequency is required to compete in elite professional sport. For example, the National Basketball Association’s regular season consists of 82 games (41 home, 41 away) played over a 6-month period (Sampaio et al., 2015). This can have consequences for both physiological and psychological status and has the potential to impair performance

Aim: To determine the impact of KRAS mutation status on survival in patients undergoing surgery for colorectal liver metastases (CLM). Patients & methods: Patients with resected CLM and KRAS mutations. Survival was compared between mt-KRAS and wt-KRAS. Results: Of 662 patients, 174 (26.3%) were mt-KRAS and 488 (73.7%) wt-KRAS. mt-KRAS patients had significantly lower recurrence-free survival (HR: 1.42; 95% CI: 1.10–1.84). There were no differences between the groups for sidedness. Poorer survival was associated with mt-KRAS with positive lymph nodes, >1 metastases, tumors >5 cm, synchronous tumors and R1–R2. Conclusion: KRAS mutation status can help predict recurrence-free survival. Primary tumor location was not a prognostic factor after resection. KRAS mutation status can help design a multidisciplinary approach after curative resection of CLM.

Background Kawasaki Disease (KD) is the second most common vasculitis in the pediatric population and the leading cause for pediatric acquired heart disease in developed countries. It is commonly diagnosed in the Mexican pediatric population, epidemiology in this country is not established, since cases are not usually reported to the healthcare system. The clinical features are quite variable, but diagnosis and prompt treatment will decrease morbidity and mortality. Coronary artery aneurysms are the most common complication, which represent the leading cause of acute coronary syndrome before 40 years of age. Recurrence of KD is estimated to be around 3% in Japanese patients and 1% in the United States, nevertheless, this data in Latin-American children is unknown. It usually affects patients before reaching 3 years old and within 2 years of the initial attack, presenting with an abrupt onset and higher complication rates, requiring aggressive workup, treatment and follow-up. Objectives To review an atypical presentation of KD and early recurrence in a 7-month-old female. Methods We present a 7-month-old female diagnosed with KD at 48 days old. She presented to the emergency unit with irritability, high and persistent fever and acholia. During workup, she was found with cholestasis and gallbladder hydrops. Negative CSF, blood and urine cultures were documented during hospitalization, and fulfilled the KD criteria. The cardiac ultrasound revealed coronary abnormalities: a RCA of 2.8mm (Z-Score +4.79), LCA of 3.3mm (Z-Score +5.69) and LAD of 2.4mm (Z-SCORE +4.25), which fit into classification 3 and 4, as small and medium aneurysms, according to AHA 2017. Immunoglobulin (2g/kg) and aspirin (80mg/kg) were administered and she was discharged 36 hours after the IVIg infusion, afebrile and with ambulatory follow-up, 30 days later the coronary abnormalities showed RCA of 2.0mm (Z-Score +2.3), LCA of 3.0mm (Z-Score +6), LAD 2.3mm (Z-Score +2.9). Six months later, she presented fever for 6 days, irritability and polymorphous rash. On physical exam BCGitis, non-suppurative conjunctivitis and pallor in hands and feet, elevated CRP and ESR, leukocytosis, thrombocytosis and sterile leukocyturia. Echocardiography reported RCA od 2.4mm (Z-Score +4.8), LCA of 3.1 (Z-Score +4.2) and LAD of 2.3mm (Z-Score +3.2), diagnosing KD recurrence, admitting the patient for IVIg and aspirin administration. Results The patient was treated with IVIg and aspirin. Follow-up by Cardiology determined improvement of Z-Scores. Recurrence occurred with worsening of the cardiac abnormalities. Cardiac prognosis is importantly affected due to the atypical age, vascular abnormalities and repeated vasculitic process. Rheumatologic consult should be considered since disease like Takayasu Arteritis, Polyarteritis Nosa and ADA2 deficiency need to be ruled out. Conclusion KD needs prompt diagnosis and treatment due to the potential consequences when delayed. Clinical suspicion is important due to the possible atypical presentation. As with this patient, age, gender and presentation are not exclusive. Despite adequate treatment, recurrence and worsening of the cardiac abnormalities occurred. Both KD events before 1 year old and with atypical presentations. Rheumatologic and cardiac follow-up need to be stringent through lifetime, to determine pharmacologic treatment, as ell as physical activity and reproductive counseling. References [1] McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, Treatment and Long-term Management of Kawasaki Disease: A scientific Statement for Health Professionals From the American Heart Association. Circulation2017;135(17):e927-e99. Disclosure of Interests None declared

Background The non-surgical management in a selected group of rectal cancer patients has shown promising results with adequate follow up. Aims describing the results of the non-surgical management in patients with complete clinical response, with a close follow up. Methods Between 2006 and 2015, patients with rectal cancer, stages I-III, without metastasis, treated with neoadjuvant CRT/CT, who had clinical complete response were included. CCR was defined through digital palpation, endoscopy-based criteria and MRI. Follow up was set according to institutional guidelines. Results 68 patients were included. Initial stage was assessed with MRI in 55/68 pts and EUS 11/68. Considering the recurrence risk factors 57.6% (29/68) were T2-3ab N0, 3.3% (2/68) were T4N0, 29% (20/68) were T3-4 N1-2, with 39.7% with positive MRC. Mean distance to the anal margin was 3 cm. Chemoradiation included radiotherapy at 50.4 cGy, and concurrent capecitabine. In 22% a fluoropirimidine and oxaliplatin-based schema was used as induction therapy. Median follow up was 37.5 months and response assessment time 9 weeks (5–19). Eleven patients recurred, 6 endoluminally, 3 developed mesorectal recurrence, and two distant failure. Five years DFS and OS were 76.3% and 93.8%. Conclusions conservative management was feasible with close follow up in leading cancer centres. In this series, DFS and OS were comparable to the data already reported in the literature.

BACKGROUND Treatment of children with medulloblastoma (MB) can lead survivors to lidiate with long term sequelae and affect their quality of life (QoL). This study evaluates QoL in long term MB survivors. DESIGN/ METHODS Clinical files of MB survivors from 1997 to 2016 were retrospectively analyzed. QoL was defined by Schipper Criteria in a five dimensional evaluation: clinical data, physic effects of treatment, academic develop, functional state and self welfare report. RESULTS Clinical data: Twenty eight survivors were identified, mean age at review was 18 years, median follow up was 106 months. Functional state: Last visit Karfnosky/lansky were 90 to 80% in 25% of patients. Physic effects of treatment: Cerebellar Mutism or ataxia were present in 25% of cases. Two patients required external dispositives. Audiometry detected an auditive tonal decrease in 25% of cases. An endocrine disfunction was present in 46% of cases, 32% required hormone replacement and 28% having short size. Renal damage without dialysis was detected in 7% and 10% had a transient tubulopaty. One case had bilateral amaurosis and 14% uses glasses. Three patients had a life partner. One female has offspring and two males had azoospermia. Academic development: While 90% attends to school, 35.7% complained of learning difficulties and 18% needed special education. Self welfare report: Difficulties in social environment were described in 21% and 14% still feeling sick during years. CONCLUSIONS Survivors of MB had adverse physical effects, followed by academic development, functional state and self welfare report and all this has a negative impact in their QoL.

BACKGROUND Rubinstein–Taybi syndrome (RTS) is characterized by multiple congenital anomalies and associated with mutations in CREBBP (70%) and EP300 (5–10%). Previous reports have suggested an increased incidence of benign and possibly also malignant tumors, but the correlation remains unclear. Here we present a case of a patient with RTS and medulloblastoma. CLINICAL CASE: A 5-year-old male presented with increased intracranial pressure. An MRI revealed a 4.2 x 4.7 cm mass in the midline of cerebellum arising from the floor of 4th ventricle. The patient underwent a complete resection and pathology revealed medulloblastoma, classic histology. Staging established no disseminated disease. At diagnosis, a peculiar phenotype consisting in mild mental retardation, microcephaly, down-slanting palpebral fissures, broad nasal bridge, highly arched palate, mild micrognathia, screwdriver incisors and wide thumbs and toes was noted. Clinical genetics evaluation was consistent with RTS. Karyotype was performed and normal. Further genetics testing was not done. Treatment consisted in 8 cycles of chemotherapy and craniospinal radiation (2300 cGy to spine, 5500 cGy Total). At the end of treatment, there was no evidence of disease. He was under surveillance for 33 months free of disease, but relapsed with a supratentorial meningeal disease that ultimately resulted in death. CONCLUSION This report highlights the fact that pediatric medulloblastoma can be associated to RTS, in this case associated to classical histology and recurrent disease.

BACKGROUND Brain tumors are the most common solid tumors in childhood, 35% of them being low-grade gliomas (LGGs). Few data is available regard LGGs in low-and-middle-income countries. This study evaluates LGGs in a tertiary center in Mexico. DESIGN: A retrospective review of clinical files of 105 children diagnosed with LGG other than optic nerve glioma from 2007 to 2019 was done. RESULTS Median age at diagnosis was 7.2 years (from 5 months to 18 years). Male to female ratio was 0.75:1. WHO Grade I represented 68% of the cases. Anatomic sites were: posterior fossa (41%), supratentorial (43.5 %), spinal (8.5%), subependymal (6 %) and pineal (1%). Ten percent of patients had a diagnosed phacomatosis. Treatment was observation without surgery in 3.8%, surgery followed by observation in 49.5%, only chemotherapy in 2.8%, only radiotherapy in 6.7%, and surgery combined with chemotherapy or radiotherapy in 37.2% of cases. Among patients who had surgical intervention, 40% achieved gross total resection, 44% subtotal resection and 16% only biopsy. One or more recurrences were found in 20 % of patients. The 5 and 10-year overall survival (OS) was 83% and 73% respectively. The 5 and 10-year progression-free survival (PFS) was 66 % and 44 % respectively. CONCLUSIONS In this series the OS were lower compared with countries with high income, reflecting the need to improve surgery, since only 40% achieved complete resection that is a determining factor for the prognosis. We observed a decrease in OS until 10-year follow and the PFS was even lower due to recurrence/progression.

BACKGROUND Ependymomas occur in the brain or spinal cord and rarely as an extraspinal variety at the sacrococcygeal region, separated from the spinal cord. This rare presentation is thought to originate from a group of heterotopic ependymal cells called the coccygeal medullary vestige. There are few reports of this occurrence in children. CLINICAL CASE: A 7-year-old male presented with a history of a soft mass arising in the sacrococcygeal area 3 years earlier, diagnosed as pilonidal cyst at primary level and treated with surgery twice, as this mass recurred the boy was sent to our hospital, a 3rd surgery was performed, all tumoral tissue was removed, no attachment with dural space was founded, pathology revealed myxopapilar ependymoma with positivity for PS100, EMA and Vimentin. After surgery a Follow up MRI of cranium and spine showed absence of disease, no radiotherapy neither chemotherapy was implemented. He has been on surveillance from 3 years now without recurrence. CONCLUSION This report highlights the fact that pediatric ependymoma can have an extradural presentation and can be confounded with pilonidal cyst, total resection is needed to control the disease. Potential for recurrence or metastatic disease can continue 20 years from the time of primary tumor, so prolonged surveillance is important.

The gingival injures have a multifactorial etiology as hormonal influences, trauma, bacterial plaque, and rests derived from odontogenic epithelium that can cause different developmental or odontogenic anomalies. Objective: To show an unusual case with presence of ectopic glandular tissue in gingiva. Medical description: A 72-year-old woman with a medical history of mastectomy 6 years ago, presents with a swelling above the alveolar ridge at the level of the right lower premolar, translucent, fluctuating, asymptomatic, of 2 months’ duration. Radiography description: Root tip with endodontic treatment; diffuse radiolucent cervical area extending 3 mm on each side. Histopathology description: Cuts of 5 µm, from excisional biopsy, stained with hematoxylin and eosin (H & E) observed in magnitude 10 x and 40 x; a bilayer epithelium, eosinophilic cuboidal cells with a sometimes-ciliated glandular appearance, band of fibrous tissue and chronic inflammatory infiltrate. Other histochemical stains: The Alcian blue–stained epithelial structures with mucinous content, and the periodic acid-Schiff (PAS) was not observed. Conclusion: Ectopic glandular tissue in the gingiva is rare and might be related to glandular odontogenic cyst (found more often intraosseous, this case is in the alveolar ridge) or gingival salivary gland choristoma, a mature tissue in ectopic location. Therefore, pluripotential embryonic epithelial cells can develop into glandular tissue. Collaboration: Pathology Institute Mejia Jimenez (Cali, Colombia).

We communicate the first reported application of video-assisted thoracic surgery for early repair of a postintubation tracheal laceration. The patient was a 60-year-old man. After an initial unsuccessful approach with conservative measures, surgical repair was indicated. The patient underwent 2-port video-assisted thoracic surgery for direct tracheal repair using a 3-0 resorbable monofilament running suture and two reinforcing X-stitches. Bronchoscopic control after 2 and 4 weeks showed complete restoration of the airway, with no complication.

Background: In this paper, we report our experience in the resection and immediate reconstruction of chest wall tumors, using oncoplastic surgery criteria. Methods: This is a prospective study including 27 patients with malignant tumors of the chest wall (primary and metastatic) who underwent oncoplastic surgery with curative intent. Results: In 15 cases, it was a sternal defect and in 12, the ribs were involved. Immediate closure, in collaboration with teams of plastic surgeons, was conducted with different prostheses to provide wall stability and then be able to cover the defect with musculocutaneous flaps at different levels, depending on the need. Conclusions: Extended resection of the chest wall is the best treatment for most tumors affecting this region. Reconstruction with mesh and musculocutaneous flap is an effective technique for repairing such defects, although not without morbidity. J Curr Surg. 2015;5(1):133-136 doi: http://dx.doi.org/10.14740/jcs262w

Vascular injuries in the oral cavity cause anesthetic and functional problems, and a high risk of severe hemorrhages in simple surgical treatments; therapy with copper wires and corticosteroids generates local coagulation and fibrosis and are effective for an uncomplicated resection. Through a series of cases, clinical and anatomopathologic characteristics of the combined sclerotherapy effects are described, as an alternative for the treatment of vascular malformations performed on 7 patients, using intralesional corticoid (0.2 mL/cm2) for 2 or 3 weeks, followed by a cerclage with copper wires, for 1 week, until color change from red or purple to lighter color and a fibrous consistency was observed. Continued resection of the lesion occurred in the absence of bleeding. Histologic studies were performed, which revealed neoformation of fibrous tissue, hyalinization of blood vessels, and loss of endothelial continuity. The result was favorable in 100% of the cases.

Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells throughout the body. The objective of this clinical investigation of retrospectively and prospectively collected data was to describe the prevalence, demographic data, clinical symptoms and methods of diagnosis of NET and the treatment and long-term follow-up of patients with NET. Data were provided by the participating centers and assessed for consistency by internal reviewers. All the cases were centrally evaluated (when necessary) by the pathologists in our group. The tissue samples were reviewed by hematoxylin and eosin and immunohistochemical staining techniques to confirm the diagnosis of NET. In total, 532 cases were documented: 461 gastroenteropancreatic-NET (GEP-NET) and 71 bronchial NET (BNET). All the tumors were immunohistochemically defined according to the World Health Organization (WHO) and European Neuroendocrine Tumor Society criteria. The most common initial symptoms in GEP-NET were abdominal pain, diarrhea, bowel obstruction, flushing, gastrointestinal bleeding and weight loss. The most common tumor types were carcinoid (58.0%), non-functional pancreatic tumor (23.0%), metastatic NET of unknown primary (16.0%) and functional pancreatic tumor (3.0%). Of the BNET, 89.0% were typical and 11.0% atypical carcinoids. Of the patients with GEP-NET, 59.2% had distant metastasis at diagnosis. The locations of the primary tumors in GEP-NET were the small bowel (26.9%), pancreas (25.2%), colon-rectum (12.4%), appendix (7.6%), stomach (6.9%), esophagus (2.8%), duodenum (2.0%) and unknown primary (16.3%). The histological subtypes based on the WHO classification were well-differentiated NET (20.1%), well-differentiated neuroendocrine carcinomas (66.5%) and poorly differentiated neuroendocrine carcinomas (10.3%). Overall, 67.3% of the patients underwent surgery, 41.2% with curative intent and 26.1% for palliative purposes. The 5-year survival rates were 65.1% (95% confidence interval, 58.0-71.4%) in GEP-NET and 100.0% in typical carcinoid of the lung. This observational, non-interventional, longitudinal study aimed to accumulate relevant information regarding the epidemiology, clinical presentation and current practices in the treatment of NET patients in Argentina, providing insight into regional differences and patterns of care in this heterogeneous disease.

The impact of apathy on health-related quality of life (HRQOL) in recently diagnosed Parkinson's disease (PD) has not been systematically investigated. The objective of this cross-sectional survey (ANIMO study) was to examine the contribution of apathy to HRQOL in a Spanish sample of recently diagnosed PD patients. PD patients, diagnosed within 2 years of inclusion, were recruited at 102 outpatient clinics in 82 communities throughout Spain. Apathy was quantified using the Lille Apathy Rating Scale and HRQOL with the EuroQol-5D questionnaire. A mean EuroQol-5D index score of 0.89 obtained from population references in Spain was used as the cutoff for this study. The relationship between apathy and the dichotomized EuroQol-5D index score (

e15533Background: In pts. with advanced CRC, KRAS mutations predicts response to treatment with EGFR inhibitor. The Liver metastases selection criteria include anatomic and biological variables. Re...

We calculated ranges for the cost per disability adjusted life year (DALY) averted for cutaneous leishmaniasis (CL) treatment during an ongoing epidemic of CL in Chaparral, Colombia. Using operational clinical and cost data, we calculated that the cost of treating leishmaniasis patients with standard pentavalent antimony was US$345 (95% CI 277-488) per patient treated and cured. The cost per DALY averted per patient cured with antimony was estimated to be approximately US$15 000 (95% CI 12 226-21 532).

BACKGROUND: Air traffic controllers (ATC) work shifts and their work schedules vary according to the characteristics of each airport. The human body adapts to shiftwork differently. These adjustments affect the health-disease process, predisposing ATC to risk conditions associated with sleep deprivation and lack of night sleep, which can lead to conditions such as cardiovascular diseases, mood disorders, anxiety, and obesity. This study investigated the characteristics of health, sleep, and quality of life of ATC exposed to 8-h alternate work shifts and 6-h rotational work shifts. METHODS: The study was cross-sectional with convenience samples consisting of 84 ATC from two international airports in Brazil. We applied questionnaires to collect data about socioeconomic conditions, quality of life, sleep, and physical activity levels. We also collected health data regarding nutritional status, body composition, and blood pressure. We analyzed the differences between ATC from the two airports considering the variables of sleep, quality of life, and health. RESULTS: Differences were found between the groups in terms of body fat percentage (30.7% and 27.8%), scores of overall quality of life (56.2 and 68), concentration (3.37 and 3.96), energy (3.12 and 3.62), and sleep time on working days (5:20 h and 6:15 h). CONCLUSION: ATC under 8-h alternate shifts showed lower scores for quality of life, higher body fat, and less sleep time on working days, which characterizes inadequate shiftwork for this population. Sonati J, De Martino M, Vilarta R, Maciel E, Moreira E, Sanchez F, De Martino G, Sonati R. Quality of life, health, and sleep of air traffic controllers with different shift systems. Aerosp Med Hum Perform. 2015; 86(10):895-900. Language: en

Introduction: In a Spanish cohort of uncontrolled patients(pts) who initiated omalizumab(OMA) in the clinical practice, symptoms and exacerbations were significantly improved. Here, we describe the concomitant change in asthma-related healthcare resource utilization(HRU) and on absences from work or school. Methods: Analysis of HRU by the Spanish pts of a prospective, 2-years, international registry of subjects with uncontrolled severe allergic asthma who started OMA in the previous 15 weeks. Results: Among 96 subjects with a mean age (SD, range) of 45 (15;16-75) years, 69% females, the percentages of pts without clinically significant exacerbations and no severe exacerbations increased from 9% (mean 3.7/pt) and 45%, respectively, in the pre-OMA year, up to 65% (mean 1.0/pt) and 84% during the 1st year with OMA (p

Background: Asthmatic subjects have an exaggerated airway response to inhaled acetaldehyde, but no information is available on airway responsiveness to this bronchoconstrictor agent in subjects with allergic rhinitis. Objective: The aim of this study was to determine the effect of inhaled acetaldehyde on lung function in nonasthmatic subjects with allergic rhinitis. Methods: A total of 78 adults (43 subjects with allergic rhinitis, 16 asthmatics and 19 healthy subjects) were challenged with increased concentrations of acetaldehyde and methacholine. The response to each bronchoconstrictor agent was measured by the provocative concentration required to produce a 20% fall in FEV1 (PC20). Results: The geometric mean PC20 acetaldehyde value for asthmatics was 35.5 mg/ml compared with 67.6 mg/ml in subjects with allergic rhinitis and with 80.0 mg/ml in healthy subjects (p 20 acetaldehyde values in the allergic rhinitis group were also significantly lower than in the healthy control group (p = 0.04). All of the subjects with allergic rhinitis and increased responsiveness to acetaldehyde showed airway hyperresponsiveness to methacholine, but 9 patients with hyperresponsiveness to methacholine failed to respond to acetaldehyde. Conclusions: We conclude that subjects with allergic rhinitis are less responsive to inhaled acetaldehyde than asthmatic subjects, but more than healthy controls. Furthermore, only approximately half the patients with allergic rhinitis and airway hyperresponsiveness to methacholine exhibit bronchoconstriction with inhaled acetaldehyde, thus suggesting that airway hyperresponsiveness to methacholine may not be the sole factor leading to bronchoconstriction in response to acetaldehyde.

In order to evaluate the clinical and functional effectiveness of uvulopalatopharyngoplasty (UPPP) in chronic roncopathy, we studied the subjective improvement of operated patients and compared to pulsioximetry findings before and after surgery. A follow-up was made on 72 patients entitled of chronic roncopathy--51 with obstructive sleep apnea syndrome (OSAS) and 21 with simple snoring-, for a mean period of time of 41 months. Preoperatory study included on ENT exploration, fibre optic endoscopy, Muller maneuver, pharyngeal CT, value of daytime sleepiness with Epworth's scale, espirometry and pulsioximetry, and the postoperatory study included of pulsioximetry and a health questionnaire over snoring and daytime sleepiness. Snoring improved or disappeared in 13 of 21 patients (61.8%), and daytime sleepiness did it in 26 of 39 (66.6%). Therapeutic failure in snoring was mainly due to an increase in the body mass index. After UPPP in OSAS, only 21 patients (41.1%) showed all positive response criteria (decrease into ODI > or = 50% or in absolute values or = 85%). UPPP failed in long term evaluation in the rest of individuals. Patient selection is mandatory to optimize clinical response of UPPP for snoring, without OSAS success depends on body mass index, respiratory disturbances ratios and the eventual presence of another upper airways collapses below velopharyngeal segment.

Despite NK cells being originally identified because of their ability to kill tumor cells in vitro, only limited information is available on NK cells infiltration of malignant tumors, especially in humans. NK cells infiltrating human colorectal carcinomas (CRCs) were analyzed to identify their potential protective role in an antitumor immune response. The expression and function of relevant molecules were analyzed from different sources, comparing tumor-associated NK cells (TANKs) with autologous peripheral blood NK cells (PB-NKs) from CRC patients-the latter in comparison with PB-NKs from normal donors. TANKs displayed a profound alteration of their phenotype with a drastic reduction of NK cell receptor expression. Co-culture experiments showed that CRC cells produce modulation in NK phenotype and functionality. Moreover, PB-NKs from CRC patients also exhibited an altered phenotype and profound defects in the ability to activate degranulation and IFN-γ production. For the first time, TANK and PB-NK cells from CRC patients have been characterized. It is shown that they are not capable of producing relevant cytokines and degranulate. Taken together, our results suggest that NK cells from CRC patients present alterations of phenotype and function therefore supporting the progression of cancer. Fil: Rocca, Yamila Sol. Fundacion Cancer. Centro de Investigaciones Oncologicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquimicas de Buenos Aires; Argentina Fil: Roberti, Maria Paula. Fundacion Cancer. Centro de Investigaciones Oncologicas; Argentina Fil: Arriaga, Juan Martín. Fundacion Cancer. Centro de Investigaciones Oncologicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquimicas de Buenos Aires; Argentina Fil: Amat, Mora. Instituto MÉdico Especializado Alexander Fleming; Fil: Bruno, Luisina. Instituto MÉdico Especializado Alexander Fleming; Fil: Pampena, María Betina. Fundacion Cancer. Centro de Investigaciones Oncologicas; Argentina Fil: Huertas, Eduardo. Instituto Médico Especializado Alexander Fleming; Fil: Sánchez Loria, Fernando. Instituto Médico Especializado Alexander Fleming; Fil: Pairola, Alejandro. Instituto Médico Especializado Alexander Fleming; Fil: Bianchini, Michele. Fundacion Cancer. Centro de Investigaciones Oncologicas; Argentina Fil: Mordoh, Jose. Fundación Instituto Leloir; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquimicas de Buenos Aires; Argentina Fil: Levy, Estrella Mariel. Fundacion Cancer. Centro de Investigaciones Oncologicas; Argentina

An open label, comparative study to compare the efficacy of thermotherapy to meglumine antimoniate in treating cutaneous leishmaniasis patients in an operational context was carried out in Chaparral, Colombia. After enrollment patients were followed-up for up to 100 days. Per protocol and intention-to-treat cure rates for 47 patients treated using thermotherapy (one-time 50 degrees C applications for 30s) were 100 and 19%, respectively. Per protocol and intention-to-treat cure rates for meglumine antimoniate (20 mg/kg body weight administered intramuscularly for 21 d) were 78 and 23%, respectively.

The oral phosphodiesterase-4 (PDE4) inhibitor, roflumilast, can improve lung function in moderate chronic obstructive pulmonary disease (COPD). Whether treatment is effective in more severe COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) over a longer period is unknown.To determine whether roflumilast improves lung function and decreases exacerbation frequency over 1 year in patients with stable COPD.We conducted a randomized, placebo-controlled, double-blind, parallel-group trial for 1 year. We recruited 1,513 patients (mean post-bronchodilator FEV1 41% predicted), 760 receiving oral 500 microg roflumilast and 753 receiving placebo once daily.We recorded post-bronchodilator FEV1, exacerbation rate, St. George's Respiratory Questionnaire total score at the study end point, and number and type of reported adverse events during treatment. Post-bronchodilator FEV1 increased by 39 ml with roflumilast compared with placebo by 52 weeks (p=0.001). The mean exacerbation rate was low and comparable in both treatment groups (0.86 vs. 0.92 exacerbations/patient/yr for roflumilast and placebo, respectively). In a retrospective analysis, the exacerbation rate in patients in GOLD stage IV disease was 36% lower in patients treated with roflumilast than in those treated with placebo (1.01 vs. 1.59 exacerbations/patient/year, respectively; p=0.024). The St. George's Respiratory Questionnaire total score did not differ between treatments. The commonest adverse events related to roflumilast treatment were diarrhea, nausea, and headache, which usually subsided during continued treatment. However, roflumilast resulted in more withdrawals within the first 3 to 4 weeks of administration.In severe, stable COPD, PDE4 inhibition with roflumilast produced a modest but significant improvement in lung function without changing the exacerbation rate or health status. However, patients with very severe disease experienced fewer exacerbations with roflumilast.