Study objective: To assess the feasibility of a colorectal cancer population-based screening programme in Catalonia (Spain).
Design and setting: A pilot colorectal cancer screening programme based on ...faecal occult blood (FOB) test was introduced in February 2000 in Hospitalet de Llobregat (Barcelona, Spain), a city of 239,000 inhabitants.
Participants: All the residents from the selected area, aged 50–69 years old, were invited by mail to participate in the screening programme. Overall, 63,880 persons were invited to the first screening round and 66,534, to the second round. Colonoscopy was the first choice of procedure for the positive FOB test.
Results: The participation rate was 17.2% in the first screening round and 22.3% in the second round. The overall rate of positive FOBT was 3.4% in the first round and 0.8% in the second round. In the first round, the prevalence of screen-detected cancer was 2.1 per 1000 screened people, 7.2 for high-risk adenomas (HRA) and 11.3 for neoplasm (cancer and/or adenoma). The positive predictive value (PPV) was 6.2% for cancer, 21.2% for HRA and 33.3% for advanced neoplasm. In the second round, the prevalence of screen-detected cancer was 0.9 per 1000 people screened, 2.8 per 1000 for HRA and 4.2 per 1000 for neoplasm. The PPV was 10.6% for cancer, 34.1% for HRA and 50.4% for any neoplasm.
Conclusions: Regardless of the moderate participation rate, population-based colorectal cancer screening would be feasible in Catalonia, with good results in terms of prevalence of screen-detected neoplasms.
To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things “not to do” for a paediatric patient who has been ...exposed to a potentially toxic substance.
The preparation process of the list was carried out in three phases. First: “Brainstorming” that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done.
A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven “not to do” recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes.
The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child.
Mostrar el proceso de elaboración, dentro del Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias de Pediatría (GTI-SEUP), de la lista de recomendaciones de “no hacer” ante un paciente pediátrico que ha contactado con una sustancia potencialmente tóxica.
El proceso de elaboración de la lista se realizó en 3 fases. Primera: “Lluvia de ideas” abierta a todos los miembros del GTI-SEUP. Segunda: Selección de las recomendaciones, siguiendo una metodología Delphi-modificada. Se solicitó a todos los participantes que puntuasen las propuestas (del 1 = totalmente en desacuerdo al 9 = totalmente de acuerdo). Se aceptaron aquellas con una puntuación media superior a 8 (siempre que al menos 2/3 de los participantes le hubieran otorgado una puntuación ≥ 7) y se realizó una segunda consulta para las recomendaciones con una puntuación media entre 6 y 8. Tercera: Redacción y consenso del documento final.
Inicialmente se obtuvieron 11 propuestas. Treinta y dos de los 57 participantes del GTI-SEUP respondieron al cuestionario de puntuación. En la primera consulta, fueron aceptadas 7 recomendaciones de “no hacer” y 4 obtuvieron una puntuación media dudosa (entre 6 y 8). Tras la segunda consulta, la lista quedó formada por 8 recomendaciones. Dos hacen referencia al manejo general, 4 a técnicas de descontaminación digestiva y 2 a la administración de antídotos.
La lista de acciones que no hay que hacer ante un niño que ha contactado con un posible tóxico es una herramienta consensuada, dentro del GTI-SEUP, para promover una mejora de la calidad asistencial ofrecida a estos pacientes. Dicha mejora se basa en evitar medidas innecesarias, que en ocasiones pueden resultar nocivas para el niño.
Objective: To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things “not to do” for a paediatric patient who ...has been exposed to a potentially toxic substance. Method: The preparation process of the list was carried out in three phases. First: “Brainstorming” that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done. Result: A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven “not to do” recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes. Conclusion: The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child. Resumen: Objetivo: Mostrar el proceso de elaboración, dentro del Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias de Pediatría (GTI-SEUP), de la lista de recomendaciones de “no hacer” ante un paciente pediátrico que ha contactado con una sustancia potencialmente tóxica. Método: El proceso de elaboración de la lista se realizó en 3 fases. Primera: “Lluvia de ideas” abierta a todos los miembros del GTI-SEUP. Segunda: Selección de las recomendaciones, siguiendo una metodología Delphi-modificada. Se solicitó a todos los participantes que puntuasen las propuestas (del 1 = totalmente en desacuerdo al 9 = totalmente de acuerdo). Se aceptaron aquellas con una puntuación media superior a 8 (siempre que al menos 2/3 de los participantes le hubieran otorgado una puntuación ≥ 7) y se realizó una segunda consulta para las recomendaciones con una puntuación media entre 6 y 8. Tercera: Redacción y consenso del documento final. Resultado: Inicialmente se obtuvieron 11 propuestas. Treinta y dos de los 57 participantes del GTI-SEUP respondieron al cuestionario de puntuación. En la primera consulta, fueron aceptadas 7 recomendaciones de “no hacer” y 4 obtuvieron una puntuación media dudosa (entre 6 y 8). Tras la segunda consulta, la lista quedó formada por 8 recomendaciones. Dos hacen referencia al manejo general, 4 a técnicas de descontaminación digestiva y 2 a la administración de antídotos. Conclusión: La lista de acciones que no hay que hacer ante un niño que ha contactado con un posible tóxico es una herramienta consensuada, dentro del GTI-SEUP, para promover una mejora de la calidad asistencial ofrecida a estos pacientes. Dicha mejora se basa en evitar medidas innecesarias, que en ocasiones pueden resultar nocivas para el niño.
The Cordillera Blanca, located in the central zone of the Andes Mountains in Peru, has shown a retreat in its glaciers. This paper presents a trend analysis of the glacier area over the groups of ...Nevados Caullaraju-Pastoruri from 1975 to 2010 using Landsat-5 Thematic Mapper (TM) imagery. In the case of the Nevados Pastoruri/Tuco, the study period was extended back to 1957 by using an aerial photograph taken that year. The extent of clean glacier ice was estimated using Normalized Difference Snow Index (NDSI) thresholds. Moreover, the estimation of debris-covered glacier ice was retrieved by means of a decision tree classification method using NDSI, Normalized Difference Vegetation Index (NDVI) and Land Surface Temperature (LST). Area estimations derived from Landsat imagery were compared to the glacier ground-truth data in 1975 and 2010. Results show a statistically significant (p < 0.05) decreasing trend over the whole study area. Total glacier area decreased at a rate of 4.5 km2 per decade from 1975 to 2010, with a total loss of 22.5 km2 (58%). Lower decreasing rates were found for the period 1987–2010: 3.5 km2 per decade with a total loss of 7.7 km2 (32.5%). In the case of the Nevados Pastoruri/Tuco, decreasing rates of clean ice extent were constant for the periods 1957–2010, 1975–2010 and 1987–2010, with values close to 1.4 km2 per decade and a total loss between 1957 and 2010 estimated at about 5 km2 (54%). This work shows an evident area decrease in the Caullaraju-Pastoruri tropical glaciers, which needs to be included in a future hydrological scenario of local adaptability and water management.
•Atmospherically corrected Land surface temperature and emissivity have been used to semi-automatic glacier delineation.•Glacier area in Nevados Pastoruri/Caullaraju decreased 58% between 1975 and 2010.•Aerophotograph image and long term Landsat TM imagery were used between 1957 and 2010.
In Duchenne muscular dystrophy (DMD), a persistently altered and reorganizing extracellular matrix (ECM) within inflamed muscle promotes damage and dysfunction. However, the molecular determinants of ...the ECM that mediate inflammatory changes and faulty tissue reorganization remain poorly defined. Here, we show that fibrin deposition is a conspicuous consequence of muscle-vascular damage in dystrophic muscles of DMD patients and mdx mice and that elimination of fibrin(ogen) attenuated dystrophy progression in mdx mice. These benefits appear to be tied to: (i) a decrease in leukocyte integrin α(M)β(2)-mediated proinflammatory programs, thereby attenuating counterproductive inflammation and muscle degeneration; and (ii) a release of satellite cells from persistent inhibitory signals, thereby promoting regeneration. Remarkably, Fib-gamma(390-396A) (Fibγ(390-396A)) mice expressing a mutant form of fibrinogen with normal clotting function, but lacking the α(M)β(2) binding motif, ameliorated dystrophic pathology. Delivery of a fibrinogen/α(M)β(2) blocking peptide was similarly beneficial. Conversely, intramuscular fibrinogen delivery sufficed to induce inflammation and degeneration in fibrinogen-null mice. Thus, local fibrin(ogen) deposition drives dystrophic muscle inflammation and dysfunction, and disruption of fibrin(ogen)-α(M)β(2) interactions may provide a novel strategy for DMD treatment.
Interleukin-7 receptor subunit alpha (IL7RA) rs6897932 polymorphism is related to CD4
recovery after combination antiretroviral therapy (cART), but no studies so far have analyzed its potential ...impact in patients with very low CD4
T-cells count. We aimed to analyze the association between
rs6897932 polymorphism and CD4
T-cells count restoration in HIV-infected patients starting combination antiretroviral therapy (cART) with CD4
T-cells count <200 cells/mm
. We performed a retrospective study in 411 patients followed for 24 months with a DNA sample available for genotyping. The change in CD4
T-cells count during the follow-up was considered as the primary outcome. The rs6897932 polymorphism had a minimum allele frequency (MAF) >20% and was in Hardy-Weinberg equilibrium (
= 0.550). Of 411 patients, 256 carried the CC genotype, while 155 had the CT/TT genotype. The CT/TT genotype was associated with a higher slope of CD4
T-cells recovery (arithmetic mean ratio; AMR = 1.16;
= 0.016), higher CD4
T-cells increase (AMR = 1.19;
= 0.004), and higher CD4
T-cells count at the end of follow-up (AMR = 1.13;
= 0.006). Besides, rs6897932 CT/TT was related to a higher odds of having a value of CD4
T-cells at the end of follow-up ≥500 CD4
cells/mm
(OR = 2.44;
= 0.006). After multiple testing correction (Benjamini-Hochberg), only the increase of ≥ 400 CD4
cells/mm
lost statistical significance (
= 0.052).
rs6897932 CT/TT genotype was related to a better CD4
T-cells recovery and it could be used to improve the management of HIV-infected patients starting cART with CD4
T-cells count <200 cells/mm
.
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