SEOM clinical guidelines for pancreatic and biliary tract cancer (2020)

Pancreatic cancer (PC) and biliary tract cancer (BTC) are both aggressive and highly fatal malignancies. Nowadays we have a profound knowledge about the molecular landscape of these neoplasms and this has allowed new therapeutic options. Surgery is the only potentially curative therapy in both cancers, but disease recurrence is frequent. In PC, adjuvant treatment with mFOLFIRINOX has improved overall survival (OS) and in BTC adjuvant treatment with capecitabine seems to improve OS and relapse-free survival. Concomitant radio-chemotherapy could also be considered following R1 surgery in both neoplasms. Neoadjuvant treatment represents the best option for achieving an R0 resection in borderline PC. Upfront systemic chemotherapy is the treatment of choice in unresectable locally advanced PC and BTC; then locoregional therapy could be considered after an initial period of at least 3-4 months of systemic chemotherapy. In metastatic PC, FOLFIRINOX or Gemcitabine plus nab-paclitaxel have improved OS compared with gemcitabine alone. In metastatic BTC, cisplatin plus gemcitabine constitute the standard treatment. Progress in the knowledge of molecular biology has enabled the identification of new targets for therapy with encouraging results that could in the future improve the survival and quality of life of patients with PC and BTC.

Bond strength and micro morphology of a self-etching primer versus a standard adhesive system with varying etching times in primary teeth

AIMS

These were to firstly evaluate the shear bond strength of a composite resin to primary dental enamel treated with a standard adhesive system but with varying phosphoric acid etching times along with a self-etching prime, secondly to analyse the etching patterns using SEM.

METHODS

Forty primary molars were used. In the first three groups, following acid etching, a layer of Prime & Bond NT adhesive was employed, and in group 4 the self-etching adhesive system (Prompt-L-Pop) was used. A composite cylinder (Spectrum, Denstply, Germany) was then applied. After processing of the samples, the teeth were subjected to shear stress using an Instrom universal machine. The study of primary enamel morphology after etching for different time periods and using different etching systems was carried out with a scanning electron microscope.

STATISTICS

Data were analysed using one way ANOVA, followed by Scheffé, test to determine differences between groups.

RESULTS

In the groups subjected to acid etching for 5 and 15 seconds significant differences were recorded versus the self-etching group (p<0.0001). Regarding the SEM study of primary enamel morphology, there was predominately a clear and marked type 2 etching pattern.

CONCLUSIONS

Longer acid etching times for primary enamel do not appear necessary, as 15 seconds suffice to obtain retentive etching patterns, and the bonding strengths obtained with the traditional etching technique followed by two-step adhesive application are sufficient to ensure good composite resin bonding to the enamel surface. However, the self-etching adhesive system employed yields less than optimum bonding strength to primary enamel surfaces.

[Seroepidemiological study of hepatitis A in Gran Canaria (Spain)]

BACKGROUND

The aim of this study was to assess the seroprevalence and the risk factors of hepatitis A virus (HAV) infection in the population from Gran Canaria (Spain) and to determine at which age pre-vaccination testing would be useful.

METHODS

A transversal observational study of the presence of HAV antibodies (IgG) on serum samples obtained from a population ranging from 8 months to 63 years old was performed between January 1995 and December 1996. IgG anti-HAV were detected by a commercial immunoenzyme assay. The study included 547 persons resident in Gran Canaria. Epidemiological data (age, sex, number of family members, educational level, urban/rural residence and previous history of hepatitis) were gathered through a personal interview. Confusing variables were excluded by mean a multiple logistic regression analysis.

RESULTS

Global prevalence of anti-HAV (IgG) was 36.0% (CI 95% 32.0-40.0). The prevalence of anti-HAV increased significantly with age from 2.3% in children under 4 years until 98.9% in older than 40 years (OR 3956.0; CI 95% 241.7-64,753.5). Only three independent data (age, sex and educational level) were significantly associated with HAV seroprevalence. A previous history of hepatitis A was present only in 4.8% of HAV-positive subjects.

CONCLUSIONS

The low prevalence of anti-HAV (IgG) in persons under 25 years old suggest that in the adolescent population the implementation of universal vaccination programs is recommended even without previous serologic screening. Otherwise, the results suggest that HAV prevaccination screening in our geographical were must be limited to subjects older than 25 years.

[Corynebacterium amycolatum: sepsis in hematologic patients]

BACKGROUND

To evaluate clinical and microbiological characteristics of sepsis due to Corynebacterium amycolatum, because few cases have been reported in human infections by this bacteria.

METHODS

We report two cases of sepsis due to Corynebacterium amycolatum, the patients were diagnosed as having leukaemia. The identification procedures are discussed.

RESULTS

We describe 2 patients with sepsis in neutropenic phase. Antibiotic treatment was successful in both cases. Clinical isolates were classified as Corynebacterium xerosis by the Api Coryne system Version 1.0. The chemotaxonomic characteristics of the isolates were determined by thin-layer chromatographic analysis. Isolates did not contain mycolic acids, they were identified as Corynebacterium amycolatum.

CONCLUSIONS

Sepsis due to Corynebacterium amycolatum is a rare disorder. A test for mycolic acid could be sufficient to make a distinction between Corynebacterium amycolatum and other diphteroid bacteria. Such a test involves thin-layer chromatography.

The chemokine monocyte chemotactic protein 1 triggers Janus kinase 2 activation and tyrosine phosphorylation of the CCR2B receptor

The chemokines are a growing family of low m.w., 70- to 80-residue proinflammatory cytokines that operate by interacting with G protein-coupled receptors. Chemokines are involved in cell migration and in the activation of specific leukocyte subsets. Using the Mono Mac 1 monocytic cell line, we show that monocyte chemotactic protein 1 (MCP-1) triggers activation of the Janus kinase 2 (JAK2)/STAT3 pathway and CCR2 receptor tyrosine phosphorylation. Both Ca2+ mobilization and cell migration are blocked in Mono Mac 1 cells by tyrphostin B42, a specific JAK2 kinase inhibitor. Within seconds of MCP-1 activation, JAK2 phosphorylates CCR2 at the Tyr139 position and promotes JAK2/STAT3 complex association to the receptor. This MCP-1-initiated phosphorylation and association to JAK2 is also observed in CCR2B-transfected HEK293 cells. In contrast, when a CCR2B Tyr139Phe mutant is expressed in HEK293 cells, it is not phosphorylated in tyrosine and triggers neither JAK2/STAT3 activation nor Ca2+ mobilization in response to MCP-1. These results implicate the tyrosine kinase pathway in early chemokine signaling, suggesting a key role for this kinase in later events.

Epidemiology of human T-lymphotropic virus type II (HTLV-II) infection in Spain. HTLV Spanish Study Group

The human T-lymphotropic virus type II (HTLV-II) has recently been associated with the genesis of some subacute neurological syndromes and, rarely, with atypical T-lymphoid malignancies. The virus is endemic in some Amerindian and African tribes, and among intravenous drug users (IDUs) in North America and Europe. Given that HTLV-II is transmitted by the same routes as other human retroviruses, the screening of antibodies to HTLV-II in blood donors has became a matter of controversy in some countries. Herein, we describe the clinical, epidemiological and virological features of 113 individuals with HTLV-II infection identified in Spain up to September 1995. Most of them (94/113; 83%) were male, and all but seven were natives. Four were African immigrants living in Madrid and 3 had been born in other European countries. All but six subjects were IDUs, and sexual transmission of HTLV-II and transfusion were involved in five and one individual, respectively. Eighty-four percent of the IDUs infected with HTLV-II were co-infected by HIV-I (93/107). Clinical manifestations potentially linked to HTLV-II were absent, although an IDU male co-infected by HIV-1 and HTLV-II developed a severe non-inflammatory proximal myopathy. In conclusion, HTLV-II infection is present in Spain, mainly among IDUs, with a growing incidence and a current overall prevalence of 2.0 percent.

Epidemiology of HIV-2 infection in Spain. The HIV-2 Spanish Study Group

Human immunodeficiency virus type 2 (HIV-2) infection is endemic in West Africa, where it is responsible for many cases of AIDS. HIV-2-infected subjects have been described in other countries, mainly African immigrants, although infection in native individuals has been reported as well. The first cases of HIV-2 infection in Spain were identified in 1988. Through December 1995, 56 HIV-2 infected individuals have been diagnosed, primarily in large urban areas (23 cases in Madrid and 18 in Barcelona). All are African immigrants, except for 12 natives (21.4%), six of whom acquired the infection in endemic areas; the remaining six (2 women with numerous sexual partners and 4 homo/bisexual men) acquired the infection in Spain. Heterosexual transmission was probable in all but seven cases: five homo/bisexual males, a subject who likely acquired infection through parenteral exposure, and a child born to an HIV-2-infected mother. Nine patients (all Spanish born) have developed AIDS (16%), six of whom have died. In conclusion, HIV-2 infection is present in Spain at a low rate, and there is little evidence supporting an emerging ongoing transmission outside the population of African immigrants.

Determination of tin in canned fruits and vegetables by atomic absorption spectrometry and liquid-liquid extraction

A method was developed for the determination of tin based on the extraction of its 5,5'-methylenedisalicylohydroxamic acid complex with 1.09M isobutyl methyl ketone in tributyl phosphate. After the samples were treated with nitric and hydrochloric acid, the aqueous phase was made to 0.05M in perchloric acid. When the ratio of aqueous phase to organic phase was 4:1 (v/v), the detection limit and the relative standard deviation (n = 7, 50 micrograms tin) were 0.20 microgram/mL and 0.9%, respectively. The proposed method was applied to the analysis of tin in canned fruits and vegetables. The results were in good agreement with those obtained by the phenylfluorone method.

[Evaluation of an immunoenzyme technique for the detection in feces of the Giardia intestinalis antigen]

An evaluation is made of the utility for the diagnosis of giardiasis of an enzyme immunoassay (EIA) that detects the GSA65 specific antigen in feces, as compared with the formalin-ether sedimentation test. Within the context of a longitudinal study on intestinal parasitization, 147 fecal samples from children attending 7 day care centres in the city of Salamanca were studied. The feces were examined a few hours after collection by the sedimentation technique and conserved in 10% formol. They were later studied by the EIA method. G. intestinalis was detected by microscopy and/or EIA in 26 of the 147 fecal samples (17.7%). Both assays were positive in 22 of the 26 cases detected (84.6%) and the remaining 4 cases were positive only by EIA (4/26; 15.4%). The EIA assay, using visual reading and very simple to implement, showed sensitivity, specificity, positive predictive and negative predictive values of 100, 96.9, 84.6 and 100%, respectively.

[Antibodies against hepatitis C virus in hemophiliacs: correlation with peripheral blood lymphocyte populations]

The presence of antibodies (Abs) against hepatitis C virus (HCV) was analyzed in 26 haemophiliac patients; a prevalence of 38% was found in the total series and 56% in the treated patients. There were no cases with a positive serology among the three patients who had only received pasteurized factor. The frequency of detection of anti-HCV was higher in the patients who had a positive serology for HIV (67%) and hepatitis B virus (56%) than in the seronegative patients (24 and 29%, respectively). The patients with HCV Abs showed a decrease in the helper (CD4+) lymphocytic population, mainly due to the decrease in the helper inducer (CD4+/Leu8-) cells, such alterations being more evident in the patients who also were HIV+ who showed as well an increase in the T-cell activated lymphocytes (CD3+/la+) and a decrease in CD16+ natural killer cells. These results suggest that the lymphocytic alterations found in the patients with anti-HCV Abs are not specific and would rather be related to the presence or not of HIV infection.

Liver growth factor purified from human plasma is an albumin-bilirubin complex

We have reported that a liver growth factor isolated from plasma of partially hepatectomized rats is an albumin-bilirubin complex. In this paper, we characterize the liver growth factor purified from subjects with hepatitis (h-LGF). This factor increases synthesis of DNA in a dose-dependent manner both in vivo in mouse hepatocytes, with a dose of maximal stimulation of 150 ng of h-LGF/mouse, and in vitro in rat liver cell culture, with maximal effect at 7.5 to 10 ng of h-LGF/ml. In vivo, h-LGF increases the mitotic index of mouse hepatocytes, its action being organ-specific, acting on liver, but not on spleen, kidney, lung or brain. In vitro, h-LGF stimulates the uptake of 22Na+ by hepatocytes. In addition, we carried out a study comparing it with human serum albumin in terms of absorbance, fluorescence, circular dichroism spectra, amino acid composition, tryptic maps and antigenic determinants (Ouchterlony immunodiffusion). All these tests suggested that human serum albumin is a constituent of h-LGF. Moreover, when albumin isolated from humans without hepatic pathology is incubated with bilirubin, the albumin-bilirubin complex formed mimics the activity of the human liver growth factor with respect to stimulation of DNA synthesis and the effects on the mitotic index of mouse hepatocytes in vivo. We propose that this human liver growth factor is an albumin-bilirubin complex.

[Otomycosis: presentation of 15 cases]

Fifteen cases of otomycosis in 11 women and 4 men attending the Clinic Hospital in Salamanca during the period from 1984 to 1988 are discussed. A. niger was the species isolated on the majority of occasions (73.3%). The commonest form of presentation of otomycosis was simple chronic (73.3%). The clinical pictures was characterized by serous secretion and pruritus. Otomycosis with associated bacterial infection (20.0%) was the cause of the most intense symptoms, featuring suppuration and hypoacusia. In 5 patients, local antecedents of interest were observed: three cases of chronic cholesteatomatose otitis in which surgery had been performed; retroauricular eczema, and perichondritis of the ear. Despite topical treatment with clotrimazole, 4 cases of relapse occurred (26.7%) and in none of these was associated bacterial infection observed.