Search

Psychomotricity in school contexts can be applied according to two currents: normative psychomotricity and dynamic psychomotricity. Although there has been research into the benefits of each one of these psychomotricity currents separately, there are no studies that compares the two types with one another . The aim of the present study was to establish if there were any significant differences between the two currents of psychomotricity at the level of general and psychomotor development in children at preschool age. At the same time, the study aimed to determine any emotional differences among 5-year-old children. Seventy-five pre-school children (aged between 3 and 5 years) were evaluated through standardised tests in two public schools, where 50.7% of the sample were girls. The results indicated that, in general, psychomotor development was significantly better in the group that had followed the dynamic methodology than in the group that had been taught using the normative methodology.

In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It is often managed suboptimally, which results in a negative outcome for patients, healthcare providers, and healthcare systems. Several barriers to the appropriate management of BTcP have been identified. These include, among others, an incomplete definition of BTcP, poor training of healthcare providers and patients alike, a lack of a multidisciplinary approach and the absence of specific protocols and tools. We provide some actions to help physicians and patients improve their approach to BTcP, including specific training, the design of easy-to-use tools for BTcP identification and assessment (such as checklists and pocket-sized cards), individualized treatment, and the use of multidisciplinary teams.

Accelerating maturation of greenhouse tomatoes at the end of the growing season permits to save energy and to reduce the quantity of unripe tomatoes. Indeed, at the end of the cropping season, several kg m-2 of tomatoes do not reach a degree of maturity permitting them to be sold. In Switzerland, it was possible to accelerate the ripening of tomatoes by applying ethephon, a product which releases ethylene. Since August 2014, this product is no longer authorized, in Switzerland. An alternative is the application of ethylene, a naturally occurring hormone, directly in the greenhouse. In collaboration with the company Carbagas, Agroscope tested the effect of ethylene application on tomato ripening. The trials were conducted in 2012 and 2013 in two identical compartments of a Venlo greenhouse. In one compartment, ethylene was injected at a concentration of 10 ppm during nine or ten nights. The other compartment served as control. In 2012, tomatoes 'Levanzo', 'Komeett' and 'Endeavour' were planted and in 2013 'Endeavour'. In average over the two years, the application of ethylene enabled to harvest 1.5 truss m-2 or 0.75 kg m-2 (1.5% of the total yield) more compared to the control compartment. The quality of tomatoes at harvest (acidity, firmness and total soluble substances) was only slightly influenced by the addition of ethylene. Economically, such an application seems profitable. Registration for the application of ethylene in greenhouse is in progress in Switzerland.

Management of malunion of the distal radius remains difficult. Planning of the correction of the articular displacement requires a comprehensive analysis by CT arthrography to analyze bone, cartilage and ligaments. Arthroscopy is a valuable tool in the context of joint trauma. In the absence of osteoarthritis, the correction can be carried out as early as possible in the weeks or months following the initial fracture. The use of locking plates allows early mobilization after surgery. This correction aims to prevent the development of secondary osteoarthritis.

The wrist's function is at stake in young active adults with partial intra-articular fractures of the distal radius. The high energy nature of these injuries, displaced fractures with risk of malunion in case of insufficient treatment, and associated ligament or cartilage damage all hinder the prognosis of these fractures. Many classification systems exist to help us analyze and in some cases, select a treatment. Optimal management requires a high-quality preoperative assessment and a precise surgical technique coupled with the use of arthroscopy to deal with joint and ligament injuries in the same operation. Devices that address the fragmented nature of these fractures provide the best fixation. The primary treatment goal is reduction with less 1mm intra-articular step-off in order to reduce the risk of secondary osteoarthritis and to treat associated ligament damage, which is very common and often under-estimated. Treating the fracture and any associated lesions during the same operation is the best way to ensure a good functional outcome.

Background Exosomes are small membranous vesicles (around 40-130 nm), that have been detected in different biological samples, that play a key role in NSCLC and being relevant in stem cell differentiation as well. The main objective of this study was to analyze the exosomes cargo from NSCLC cell cultures growth in monolayer (2D) and suspension conditions (3D, lung tumorespheres). Methods Cultures were established from NSCLC resected patients and cell lines. Exosomes isolation was performed by ultracentrifugation. Characterization was carried out by NTA, electron microscopy, immunoblot and flow cytometry. Mutational status of EGFR and RAS genes was analyzed by BEAMing dPCR. Transcriptomic analysis has been carried out from exosomal RNA with microarrays, (p ≤ 0.01). Consequently, XAGE1B (significantly expressed gene in exosomes) was analyzed by RTqPCR in 189 paired fresh-frozen tumor and normal tissue samples of resected NSCLC. Prognostic value was assessed by Kaplan‐Meier curves (log rank‐test), considering significant p Results Exosomal characterization through NTA and electron microscopy showed an exosomes size from 108-125 nm. Specific markers were detected by IB and FC. Mutational analysis of EGFR and RAS genes in exosomes shown the same pattern displayed by the origin cells. Transcriptomic analysis showed that the expression of mRNAs, miRNAs and precursors were significantly different between 3D and 2D-derived exosomes. A pathway enrichment was carried out to know in which processes (cancer-related) are involved. Significant differential expression was also found between ADC vs SCC–derived exosomes. Concretely, XAGE1B is overexpressed in ADC-derived exosomes (p = 0.00003). This overexpression in ADC was validated in NSCLC cohort (p = 0.002). Furthermore, it has revealed a significant association with patient prognosis for overall survival in the ADC group (n = 74)(OS 49.8 vs. NR months, p = 0.043). Conclusions Differences in exosomal cargo have been observed between: i) 3D vs. 2D cultures and ii) ADC vs. SCC. In addition, the same mutational pattern was detected in exosomes as compared with parental cells. Therefore, exosomes can be a useful source of biomarkers in NSCLC analysis. Supported by grant GV/2018/026, PI18/00266, & AECC Valencia. Legal entity responsible for the study Fundacion de Investigacion del Hospital General Universitario de Valencia. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Aims To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists’ prior perception. Design Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled. Participants and study period A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July–December 2016). Results The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain. Conclusions Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists. pre-print 339 KB

Background Target therapy guide by biomarkers have become the standard of care for patients with lung cancer (LC). So, identify those molecular alterations is one of the most important care needs nowdays. Our objective was to know the implementation degree of these tests in a large cohort of patients in Spain using the Thoracic Tumor Registry (TTR) of the Grupo Espanol de Cancer de Pulmon (Spanish Lung Cancer Group). Methods The TTR is an observational cohort multicenter study of LC in Spain. The study is conducted according to the Declaration of Helsinki and approved by the institutional review board of each participating institute. The registry was approved by the Spanish Drug Agency as a non-post-authorization, non-interventional study. We analyzed the molecular biomarkers considering all stages of LC. Results A total of 7,872 patients from 58 Spanish centers were enrolled between August 2016 to December 2018. The most frequent screened molecular test was the EGFR mutations, it was performed in 4,456 patients (67.5%). The proportion of biomarker evaluation has varied over time, ranging from 57.9% prior to 2012 up to 73.7% in 2017. The molecular assessment of some biomarkers reached 81.4% of these patients, with some differences between Regional Communities, regarding the molecular tests performed. Three thousand four hundred forty-six (3,446) patients (52.2%) had a stage IV at diagnosis. There was performed some biomarker test in 92% of the 2570 patients with stage IV and non-squamous histology. In those stage IV non-squamous patients, the EGFR and ALK test were performed in 92% and 79% respectively but 2 years ago ALK test was done only in 40% of the patients. ROS1 was studied in 20% of the cases. Conclusions Although no national plan exists for molecular biomarker analysis in Spain, the implementation of biomarkers tests in all the hospitals that contribute to the TTR is high. The increase in the ALK analysis in the last period is relevant. As we have some regional differences, it is important to understand the causes to improve them. Clinical trial identification NCT02941458. Legal entity responsible for the study Spanish Lung Cancer Group. Funding Novartis, Merck Sharp and Dohme, Lilly. Disclosure All authors have declared no conflicts of interest.

Background In 2017, the ECO Foundation (Excellence and Quality in Oncology) completed the EIO-50 project to learn about the diagnostic and treatment criteria of opioid-induced constipation (OIC) in cancer patients. The EIO-Praxis project was designed as a continuation of EIO-50, to learn about the current clinical practice of oncology professionals for the management of patients with OIC (process, follow-up and results). Methods 77 health care professionals (HCP) from oncology units participated in the study. Each investigator collected information from 10 medical records of cancer patients who received OIC treatment, with a total of 770 records. In each center, 6 indicators of its structure were collected and the completion of a questionnaire with 15 questions regarding patient’s follow-up and treatment process was conducted. Results According to healthcare professionals (HCP), an average proportion of 47.5% of cancer patients received treatment with opioids. From these, an average of 44.9% developed OIC. 51.9% of the investigators didn’t follow any guidelines for the management of patients with OIC. The mean age of the patients of the study was 61.6 years old. The mean duration of opioid treatment was 4.9 months, with an average time of 16.5 days from the start of opioid treatment to the appearance of the first symptoms of OIC. Only in 55.1% of the patients, the presence of functional constipation before starting opioid treatment was assessed. Patients of the study presented the following Rome IV criteria symptoms: 82.6% reduced bowel frequency, 52.9% fewer than three spontaneous bowel movements per week, 54.4% development or worsening of straining and stool consistency (54.2%). The majority of the patients were treated with laxatives (76.0%). Oral Peripherally Active µ-Opioid Receptor Antagonist (PAMORA) was also used in 54.8% of the patients. Conclusions Despite new guidelines for the management of constipation in cancer patients were published in 2018, the management of OIC is still insufficient. After laxative failures, the use of PAMORA drugs should be taken into consideration for the management of OIC. Legal entity responsible for the study ECO Foundation. Funding Kyowa Kirin. Disclosure E. Aranda Aguilar: Advisory / Consultancy: Amgen; Advisory / Consultancy: Bayer; Advisory / Consultancy: Celgene; Advisory / Consultancy: Merck; Advisory / Consultancy: Roche; Advisory / Consultancy: Sanofi. J. Garcia Foncillas: Advisory / Consultancy, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: Bayer; Advisory / Consultancy, Travel / Accommodation / Expenses: Sanofi; Research grant / Funding (institution): Merck. E. Diaz Rubio: Advisory / Consultancy, Research grant / Funding (institution): Amgen; Advisory / Consultancy: Bayer; Advisory / Consultancy: Genomica; Advisory / Consultancy, Speaker Bureau / Expert testimony: Servier; Advisory / Consultancy, Research grant / Funding (institution): Merck Serono; Speaker Bureau / Expert testimony: MSD; Research grant / Funding (institution): Roche; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Sysmex. R. Lopez: Shareholder / Stockholder / Stock options, Licensing / Royalties: Nasasbiotech; Shareholder / Stockholder / Stock options: Mtrap Inc; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution): Merck; Advisory / Consultancy: MSD; Advisory / Consultancy: Bayer; Advisory / Consultancy, Travel / Accommodation / Expenses: BMS; Advisory / Consultancy: Novartis; Advisory / Consultancy: Janssen; Advisory / Consultancy: Lilly; Advisory / Consultancy: Pfizer; Travel / Accommodation / Expenses: PharmaMar; Travel / Accommodation / Expenses: Pierre Fabre. All other authors have declared no conflicts of interest.

Background Tobacco use, mainly as cigarette smoking, is the leading cause of lung cancer. Eighty-five percent of LC occur in smokers. Understanding the Spanish smoking habits allows the government to design health care policies against this consumption. To do so, the Grupo Espanol de Cancer de Pulmon (Spanish Lung Cancer Group) made this analysis within the context of the Thoracic Tumor Registry (TTR). Methods The TTR is an observational cohort multicenter study in Spain. The study is conducted according to the Declaration of Helsinki and approved by the institutional review board of each participating site. The registry was approved by the Spanish Drug Agency, as a non-post-authorization, non-interventional study. Results Data have been collected from 6,600 LC from 58 different hospital sites across Spain. 12% (866 p) were non-smokers, 46% (3,039 p) were former smokers and 39% (2,611 p) were smokers. There were significant differences by gender, more women were non-smokers (37 % vs. 45% in males), meanwhile more former smokers were male (53.4% vs. 27.9% in women) (p-valor Conclusions Tobacco use is the leading cause of LC in Spain accounting 85% of the cases. Consumption has increased in both genders, but specially in women, in our country among lung cancer patients. Tobacco cessation campaigns, especially in women, should be a priority in western countries, like Spain, and it has to be adapted to regional differences in tobacco use. Clinical trial identification NCT02941458. Legal entity responsible for the study Spanish Lung Cancer Group. Funding Novartis, MSD, Lilly. Disclosure M. Provencio: Advisory / Consultancy: BMS; Advisory / Consultancy, Travel / Accommodation / Expenses: MSD; Advisory / Consultancy, Travel / Accommodation / Expenses: AstraZeneca; Advisory / Consultancy: Boehringer Ingelheim. All other authors have declared no conflicts of interest.

Purpose To evaluate the outcome of a silicone implant used after failure of primary trapeziometacarpal (TMC) surgery. Methods We retrospectively reviewed 22 Tie-in silicone implants performed between January 2005 and December 2015. All silicone implants were used for revision after failure of TMC surgery. We determined the time between implantation and the date of diagnosis of the failed revision procedure (rupture, major wear, dislocation, or poor clinical tolerance). Results Median survival was 2.15 years. Only 3 patients did not show wear, but one was lost after 1 year of follow-up. We found 10 cases with rupture of the implant, 5 with implant instability (subluxation or dislocation), 3 implants with abnormal wear, and 1 patient who reported residual pain. A total of 42% of failures were associated with silicone synovitis Conclusions Survival of the Tie-in silicone implant in TMC revision surgery is poor; nearly half of implants failed at 2 years. The rate of silicone synovitis is also important because future revision might be more complex owing to bone loss. Type of study/level of evidence Therapeutic IV.

OBJECTIVES: Caregivers of terminal patients often report a higher prevalence of unmet needs than cancer survivors. However, very few interventions have been carried out to support caregivers of patients in advanced stages, and, in most cases, they have not been rigorously designed and evaluated. The ultimate aim of this research was to obtain specific information about the sociodemographic characteristics, the different types of care provided, the symptoms due to burdens, the impact of caring on the quality of life, and the unmet needs of informal caregivers of dependent patients with cancer. This is to design effective intervention programs that can be implemented from the hospital setting itself and therefore, to improve their quality of life and prevent the deterioration of their health. STUDY DESIGN: A cross-sectional design and survey methodology were used for descriptive purposes. METHODS: The sample was composed of 132 informal caregivers of dependent patients with cancer, from a public hospital in Valencia, Spain, who were identified through the patient database of the oncology service, over the 4-month data collection period. Self-administered questionnaires were combined with personal interviews: Interview Protocol for the main caregiver, Questionnaire ICUB97, and survey of hospital quality. RESULTS: The most frequently provided types of care included the following: keeping the patient company, acting as an intermediary between them and healthcare workers, and helping them to do basic daily life activities. The main negative consequences caregivers reported were the following: feeling more tired, having less free time, changing their daily routines, and having fewer social relationships/interactions and various emotional and physical symptoms. Many of the needs of informal caregivers were not being met: resolution of doubts about illness, training in the care they should provide to the patient, and psychological help. CONCLUSIONS: Recommendations for the development of effective intervention programs are offered: increasing the psychological services provided in oncology units, training medical staff in communication skills, facilitating access to information about the disease through different means, training for informal caregivers in care techniques, coping and communication skills, self-care, and organization of time. On the one hand, implementing effective intervention programs for informal caregivers will reduce the amount withdrawing from their care duties and on the other hand, the proliferation of what are known as secondary patients.

[Purpose]: Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP., [Methods]: Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline., [Results]: A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines., [Conclusion]: Despite oncologist’s clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation., This study was funded by Kyowa Kirin Farmacéutica S. L.U. through Fundación ECO.

PurposeAfter surgical resection, an ample prognosis variability among stages is observed. Multiple prognostic factors are individually studied and some CRC classifiers have been proposed. Not one have been implemented into clinical practice.Methods/patientsWe classified 105 patients with resected CRC (stage I-III) into five molecular subtypes using BRAF(V600E) and RAS (KRAS; NRAS) status, and the expression of DNA mismatch repair (MMR) proteins (MLH1 and MSH2). Clinicopathological features and DFS) of distincts groups were evaluated.Results and conclusionsRAS and BRAF(V600E) mutations were detected in 43.8 and 11.4% of patients, respectively. 19% of tumours had lack of expression of any MMR proteins reflecting a system deficiency (dMMR). Patients with any RAS mutation had lower DFS that patients with RAS wild type (wt) (40.23 vs 45.26months; p value=0.035). Of a total of five molecular subtypes, three were MMR proficient (pMMR): RAS mutated (39%), BRAF(V600E) mutated (6.7%) and RAS/BRAF(V600E) wt (35.2%); and two were dMMR: BRAF(V600E) mutated (4.8%) and BRAF(V600E) wt (14.3%). Left side tumours were more frequently observed in pMMR/RAS and BRAF(V600E) wt subtype, and right side tumours in dMMR subtypes. Among the three pMMR subtypes, a benefit survival was observed for patients without any mutation in BRAF(v600E) or RAS oncogenes (median of DFS=45.5 vs 40.98months in RAS mutated group; p=0.084 and vs 34.13 in BRAF(v600E) mutated group; p=0.031). Molecular classification using these biomarkers can be useful to identify groups with differences in prognosis.

L’utilisation du lambeau homodactyle en ilot sur l’artere digitale necessite la mise en flexion de l’articulation interphalangienne proximale lorsqu’il est en limite de rayon d’action, avec un risque de flessum. La dissection au travers du pli de l’IPP peut entrainer une bride cicatricielle et une greffe peut etre necessaire sur la zone donneuse. Nous avons conduit une etude anatomique pour evaluer une technique modifiee et optimisee analogue a celle du lambeau Gigogne. Nous avons conduit une etude anatomique sur 4 membres superieurs (16 doigts longs soit 32 lambeaux). Un defect pulpaire a ete simule, puis 5 etapes chirurgicales sequentielles sur chaque hemipulpe ont ete pratiquees, avec mesures de l’avancement et de la surface couverte. La dissection commencait par un lambeau en ilot homodactyle classique a dissection limitee au pli IPP (groupe 1), suivi d’un avancement en V dans la palette du lambeau (groupe 2), d’un second V (groupe 3), d’une dissection proximale du pedicule (groupe 4), et enfin d’une suture des avancements en V mimant un lambeau homodactyle classique (groupe 5). L’avancement des lambeaux dans les groupes 1 a 5 etait respectivement de 9,7 mm, 15,8 mm, 18,6 mm, 20,5 mm et 11,7 mm. Les groupes 2, 3 et 4 presentaient un avantage significatif quand au gain d’avancement, par rapport au groupe 5. L’ajout d’un V simple et d’un double V faisaient gagner respectivement 30 % et 44 % de surface. Le lambeau gigogne par expansion d’un lambeau homodactyle d’avancement etait presente par une serie clinique. Notre etude anatomique permet de mesurer sur le meme pedicule la couverture fournie par les differentes options. L’avancement du lambeau homodactyle est principalement obtenu lors de la dissection jusqu’a l’IPP. L’ajout d’une plastie en V puis d’une 2e est plus performante que le lambeau classique, sans avoir a traverser le pli de flexion IPP, avec une dissection simplifiee. Notre etude anatomique nous permet de proposer une technique optimisee et simple de couverture pour les pertes de substances pulpaires distales des doigts longs, a partir du lambeau homodactyle en ilot sur l’artere collaterale. Traverser le pli IPP semble inutile dans la majorite des cas. Cette technique simple doit etre encore etudiee dans la pratique clinique pour en definir les benefices exacts.

Purpose To analyse the prognostic role of the immunohistochemical expression of pKDR in patients with advanced colorectal cancer treated with oxaliplatin and fluoropyrimidines combination chemotherapy with or without bevacizumab. Methods Retrospective multicentre study, carried out at four hospitals in the Valencian Community (Spain). Patients evolution was compared based on the immunohistochemical expression of pKDR, classified using 4 categories: 0 (undetectable), 1 (mild), 2 (moderate) and 3 (high intensity). Patients were divided into two groups for the analysis: group 1 with low expression (0–1) vs. group 2 with high expression (2–3). Results Histological samples for the pKDR analysis were available for 84 of the 112 patients selected. Seven (8.3 %) had undetectable or mild expression of pKDR (Group 1) and 77 (91.7 %) showed moderate or high expression of pKDR (Group 2). Response rate in Group 1 was 100 % compared to 54.2 % in Group 2 (p = 0.019). Progression-free survival (PFS) (15 vs. 12 months, p = 0.4) and overall survival (OS) (28 vs. 22 months, p = 0.09) were numerically but not significantly higher in patients from Group 1 vs. Group 2. Patients from Group 2 who received bevacizumab presented a significantly higher PFS (13 vs. 11, p = 0.015) and a numerically higher OS (23 vs. 17 months, p = 0.27) than those treated exclusively with chemotherapy. Conclusions Our results suggest that the absence or low expression of pKDR is associated with a better prognostic profile in patients with advanced colorectal cancer treated with chemotherapy and bevacizumab. Patients with a high pKDR expression benefit from the combination of chemotherapy with bevacizumab.

The present study aimed at to follow the tomato fruit development and quality by hand-held near-infrared spectroscopy. Tomato quality were followed from few days after fruit setting until harvest at commercial maturity during two seasons (spring and summer). Results showed that in both seasons, fruit can be classified from fruit setting to harvest at maturity by using qualitative models (factorial discriminant analyses). Quantitatives models based on PLS regressions allowed the prediction of soluble solids content (R=0.9, RMSE=0.1%Brix), titrable acidity (R=0.9, RMSE=0.6meq.100g-1) and color (a*, R=0.9, RMSE=5) of fruit. The accuracy of the predictions depend on the season and also on the maturity stage. the results are promising in the context of developing a tool to assist in fruit phenotyping on site. Other experiment are now necessary to improve the accuracy and the robustness of the models with including additional varieties growing under variable climatic conditions in our greenhouses.

The economic situation showed that the resources devoted to health spending are limited, making rationalisation of their consumption necessary. The relevance of pharmacoeconomic analyses is becoming crucial. The ECO Foundation, promoting the quality of oncology care, set out to analyse the consensus on the new therapeutic targets inclusion and the integration of pharmacoeconomics when evaluating their effectiveness. Study about pharmacoeconomic estimations was performed during the first ECO-Seminar (2010). It was developed using a modified Delphi method, in four stages: (1) committee coordinator establishment, (2) expert-panel selection, (3) preparation and submission of survey (1 question) by email, and (4) analysis of the degree of consensus reached. Results were obtained from surveys completed by 35 experts. Regarding the tolerable annual cost for the approval of new drugs, 68.8 % of the respondents considered a cost per quality-adjusted life year (QALY) gained between €30,000 and 100,000 acceptable (34.4 % €30,000–60,000; 34.4 % €60,000–100,000), 21.9 % of the respondents found costs between €100,000–150,000/QALY and 9.3 % of the respondents found costs above €150,000/QALY acceptable. The costs of new drugs are higher than traditional treatments, making it a priority to identify subgroups of patients with specific molecular profiles as candidates for higher-efficiency-targeted therapies. The allocation of the available resources to the most effective interventions, to achieve the best clinical outcomes with lower costs and best subjective profile possible, allows expenditure to be rationalised. Pharmacoeconomic studies are a basic tool for obtaining better health outcomes according to the available resources, while also considering the other needs of the population.

Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. To evaluate the results of multidisciplinary management of malignant insulinoma. Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.