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Konstantinos Koutsoukos,1,2 Aristotelis Bamias,1,2 Kimon Tzannis,1 Marta Espinosa Montaño,3 Vasiliki Bozionelou,4 Christos Christodoulou,5 Dimitra Stefanou,6 Haralabos Kalofonos,7 Ignacio Duran,3 Konstantinos Papazisis1,8 1Hellenic Genito-Urinary Cancer Group, 2Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece; 3Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 4Department of Medical Oncology, University Hospital of Heraklion, Heraklion, 52nd Oncology Clinic, Metropolitan Hospital, Piraeus, 61st Department of Medical Oncology, Saint Savvas Anticancer Hospital, Athens, 7Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, 8Euromedica General Clinic, Thessaloniki, Greece Aim: We aimed to provide real-life data on the outcomes of metastatic renal cell carcinoma (mRCC) patients treated with everolimus as second-line treatment after failure of first-line pazopanib.Patients and methods: Data from the medical charts of mRCC patients from 8 centers in Greece and Spain were reviewed. All patients had received or were continuing to receive second-line everolimus treatment after failure of first-line treatment with pazopanib. No other previous therapies were allowed. The primary end point was the determination of progression-free survival (PFS).Results: In total, 31 patients were enrolled. Of these, 26% had performance status (PS) >0, 88% were of intermediate/poor Memorial Sloan-Kettering Cancer Center (MSKCC) risk group, and only 61% had undergone prior nephrectomy. Median PFS was 3.48months (95%CI: 2.37–5.06months). Median overall survival (OS) from everolimus initiation was 8.9months (95%CI: 6.47–13.14 months). Median OS from pazopanib initiation was 14.78months (95%CI: 10.54–19.08months). Furthermore, 32% of patients temporarily discontinued everolimus due to adverse events (AEs), and 22% of patients discontinued everolimus permanently due to toxicity. Most common toxicities were anemia (29%), stomatitis (26%), pneumonitis (19%), and fatigue (10%). Moreover, 14 AEs (27%) were graded as 3 or 4 and were reported by 13patients (42%).Conclusion: This study provides data exclusively on the sequence pazopanib–everolimus in mRCC. Everolimus has a favorable safety profile and is active. The short PFS and OS could be attributed to the fact that the pazopanib–everolimus sequence was mainly offered to patients with adverse prognostic features, resulting in a modest increase in the combined OS of our population. Keywords: pazopanib, everolimus, renal cell carcinoma

En Ciénaga municipio importante del departamento del Magdalena, la movilidad y el transporte se ha visto afectado hace muchos años, debido a la carencia de un terminal de transporte terrestre que facilite la operación logística del transporte desde y hacia el casco urbano del municipio, el cual se considera necesario debido a problemas evidentes como las malas condiciones y peligrosidad en que los usuarios se ven obligados a tomar el servicio, la afectación en la movilidad tanto del municipio como de la troncal del caribe (carretera nacional) y la contaminación ambiental y auditiva que supone el paso de estos automotores. Se prevé entonces que la construcción de un terminal de transporte terrestre debidamente organizado supondría una mejora en la calidad de vida de vida de las personas que utilizan el servicio de transporte intermunicipal en esta población colombiana. El diseño desde la parte física del proyecto contempla 51000 m^2 dentro de los cuales 8000 m^2 son de área construida, el edificio principal consta de 3 niveles y un sótano, seguido del diseño arquitectónico y urbanístico; adicionalmente los estudios pertinentes como lo son: la topografía del terreno, el estudio de suelos en el cual se encontró una limitante importante durante el proceso constructivo del proyecto debido a que el nivel freático se encontraba a 1 metro, luego el estudio hidrológico y ambiental. Además, el diseño de las estructuras que comprenden el proyecto (resaltando que se utilizó sistema de estructuras metálicas) y sus redes hidrosanitarias, en las cuales se implementó drenajes no convencionales o SUDS, lo que permitirá un ahorro en el manejo de recursos hídricos, de igual forma, el diseño de los 800 metros lineales de vías que abarcara este y una programación de obra para asegurar la culminación del proyecto en el tiempo que se estableció. In Ciénaga important municipality of the department of Magdalena, mobility and transport has been affected many years ago, due to the lack of a land transport terminal that facilitates the logistics operation of transport to and from the urban area of ​​the municipality, which It is considered necessary due to obvious problems such as poor conditions and danger in which users are forced to take the service, the impact on mobility of both the municipality and the trunk of the Caribbean (national highway) and environmental and auditory pollution that It is the passage of these cars. It is anticipated that the construction of a properly organized land transport terminal would mean an improvement in the quality of life of people who use the intermunicipal transport service in this Colombian population. The design from the physical part of the project includes 51,000 m ^ 2 within which 8,000 m ^ 2 are of built area, the main building consists of 3 levels and a basement, followed by the architectural and urban design; additionally the pertinent studies such as: the topography of the land, the study of soils in which an important limitation was found during the construction process of the project because the water table was 1 meter, then the hydrological and environmental study. In addition, the design of the structures that comprise the project (highlighting that a system of metal structures was used) and its hydrosanitary networks, in which unconventional drainage or SUDS was implemented, which will allow savings in the management of water resources, of Likewise, the design of the 800 linear meters of roads that this will cover and a work schedule to ensure the completion of the project in the time it was established.

This publication provides practical guidance for performing strategic environmental assessments (SEAs) for nuclear power programmes. It incorporates the latest knowledge and draws on best practices in conducting SEAs. Based on inputs from SEA experts from across the world, it lays down an effective SEA process that contributes to: strengthening decision making for nuclear power programmes ; achieving environmentally sound and sustainable development ; and improving good governance and building public trust and confidence in decision-making. Importantly, SEA for nuclear power programmes can ensure effective communication with the public and other stakeholders. Consequently, significant emphasis is placed on stakeholder engagement and public participation. Further, appropriate tools for assessment and quality review are presented for all stages of the SEA process.

INTRODUCTION:Since 2011, the training of nurses in the echoguided insertion of the central venous catheter with the Shelinger technique (PICC) has begun.Until 2016 the nurses placed PICC in hematology patients and some specialties.In 2017, the Vascular Access Nursing Unit of the Virgen del Rocu00edo University Hospital was created in Seville, Spain for the insertion of the PICC with the Sherlock methodology, training in primary care and advice on vascular access.MATERIALS AND METHODS:The use of the Sherlock 3CGTM tip confirmation system (TCS) as a guide for the placement of the PICC and to confirm the location of the catheter tip.Collection of data from patient recordsDevelopment of databases of patients with implanted PICCData analysisRESULTS:In 2017, 312 PICC were inserted in the Virgen del Rocu00edo University Hospital (HUVR) in Seville, Spain, Hematology 137, Oncology 144, other specialties 30.The success in insertion was 98.71% with only 4 unsuccessful in relation to greater difficulty in patients who previously had a central venous catheter (CVC).Of the 312 inserted, 159 were eliminated and 153 remain, with an average of more than 120 days inserted.The motive for remove: Exitus / End of treatment 109: suspected infection 25, catheter tip confirmed + 4; Thrombosis 6; Other reasons (obstruction, accidental exit, change through another central route, migration, voluntary refusal to treatment) 19.For the attention of the PICC in Primary Care, 61 health centers have been attended and 25 clinical nursing sessions have been carried out during 2017CONCLUSION:The start-up of the vascular access nurse unit has revealed:- an increase in the quality of life of the patient from the placement of the PICC until its removethe need for continuing education of health professionals.