Incompletely resected rectum, recto-sigmoid, or sigmoid carcinoma: results of postoperative radiotherapy and prognostic factors

Postoperative radiotherapy was given in 40 patients with gross or microscopic pathologically proven residual disease after surgical resection of rectum, recto-sigmoid, or sigmoid carcinoma. The radiotherapy target volume included the pelvis with (9 patients) or without (31 patients) the perineum. Median total dose of radiation was 50 Gy (range 30-60). One patient received 30 Gy, 10 received greater than 30 to 40 Gy, 13 received greater than 40 to 50 Gy, and 16 patients received greater than 50 to 60 Gy. The median follow-up in the survivors (16 patients) was 53 months (range: 16-85). Probability of survival with censoring for death due to intercurrent disease was 36% at 5 years. Survival for patients with microscopic residual disease (21 patients) was 40% at 5 years compared to 12% for those with gross residual disease (19 patients) (p = 0.09). Twenty-five patients relapsed. All but one relapse occurred earlier than 50 months after radiotherapy. Approximately half (12/25) of the relapses were observed within 6 months after radiotherapy. Local relapse inside the radiotherapy portals was observed in 9/40 (22%) patients. Therapy-related urogenital complications occurred in no patient and gastro-intestinal complications in three patients (7%). In one patient they were scored WHO grade 4 and in two patients WHO grade 3. Prognostic factors were analyzed using the Cox proportional hazards model. For survival differentiation, grade (p less than 0.001), stage (p = 0.04), and perineal irradiation (p = 0.03) were independent prognostic factors. With relapse-free survival as the endpoint, only stage (p = 0.003) was a statistically significant prognostic factor. There was a trend toward a better relapse-free survival when the perineum was included in the radiation portals (p = 0.09).     

Measurement of femoral bone density using dual photon absorptiometry. Values in osteoporosis]

X-ray absorptiometry allows measuring the density of bone in the upper end of the femur in 3 mains areas: the neck, Ward's triangle and the greater trochanter. Failin prospective data, it is not possible at present to know whether one of these areas has better performances than the others for the assessment of fracture risks. The interpretation of the measurement is based on the idea that bone demineralization is the main risk factor of osteoporotic fracture. It is carried out on the basis of reference normal values, which must be determined in the French population. More sophisticated predictive models of fracture risks are being developed. In young adults, the reproducibility of the measurements is lower than 2% for the neck and the trochanter, and around 2.5 to 3% for Ward's triangle. The density of femoral bone is not well correlated to that of the other bony sites (os calcis, ulna, vertebrae: r = 0.3 to 0.7). On the other hand, the correlation between the right and left femur is good, as well as that of the three femoral measurement areas between them. A fracture of the upper end of the femur is often associated with a decrease in femoral bone density (-12 to -15%, according to the site of measurement), while the measurement in the ulna or the spine is normal or just slightly lowered. Femoral bone rarefaction is also noted in vertebral osteoporosis. Dual photon absorptiometry allows, in most cases, an accurate and reproducible measurement of the femoral bone density. This measurement is indicated to assess the risk of osteoporosis on menopause and in elderly subjects and/or those with lumbar osteoarthritis.     

PulseNet USA standardized pulsed-field gel electrophoresis protocol for subtyping of Vibrio parahaemolyticus

PulseNet is a national molecular subtyping network for foodborne disease surveillance composed of public health and food regulatory agencies. Participants employ molecular subtyping of foodborne pathogens using a standardized method of pulsed-field gel electrophoresis (PFGE) for conducting laboratory-based surveillance of foodborne pathogens. The PulseNet standardized PFGE protocols are developed through a comprehensive testing process. The reproducibility of the protocol undergoes an internal evaluation at the Centers for Disease Control and Prevention and an external evaluation in multiple PulseNet laboratories. Here we describe the development and evaluation of a rapid PFGE protocol for subtyping Vibrio parahaemolyticus for use in PulseNet activities. The protocol was derived from the existing standardized PulseNet protocols for Escherichia coli O157:H7 and Vibrio cholerae. An external evaluation of this protocol was undertaken in collaboration with three PulseNet USA participating public health laboratories. Comparative analysis of the PFGE fingerprints generated by each of these laboratories demonstrated that the protocol is both reliable and reproducible in the hands of multiple users.     

Right heart complications of dual lumen tunneled venous catheters in hemodialysis patients

Seven hemodialysis patients with infected right atrial thrombi and/or tricuspid valve endocarditis are reported. All cases were attributed to use of tunneled venous catheters. Staphylococcus aureus was the preponderant organism isolated on blood culture. Therapeutic measures included antibiotics, catheter exchange, and surgery. One patient died with pulmonary embolism, and the remainder survived the infectious episodes. Experimental evidence further confirms the relationship of venous catheters placed in or proximate to the right atrium as the cause for the reported infected thrombotic and tricuspid valve complications. Measures to reduce the incidence of right heart complications must begin with recognition of the need for a surgically created arterial venous dialysis access placed early in the course of kidney disease. There is no entirely satisfactory method for prevention of venous catheter--induced endocarditis.     

Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The DENERVHTA (Denervación en Hipertensión Arterial) study

Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty‐four patients with 24‐hour systolic blood pressure ≥140 mm Hg despite receiving three or more full‐dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24‐hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima‐media thickness, and left ventricular mass index were evaluated at 6 months. Mean baseline‐adjusted difference between the two groups (spironolactone vs renal denervation) at 6 months in 24‐hour systolic blood pressure was −17.9 mm Hg (95% confidence interval [CI], −30.9 to −4.9; P = .01). Mean baseline‐adjusted change in urine albumin excretion was −87.2 (95% CI, −164.5 to −9.9) and −23.8 (95% CI, −104.5 to 56.9), respectively (P = .028). Mean baseline‐adjusted variation of 24‐hour pulse pressure was −13.5 (95% CI, −18.8 to −8.2) and −2.1 (95% CI, −7.9 to 3.7), respectively (P = .006). The correlation of change in 24‐hour systolic blood pressure with change in log‐transformed urine albumin excretion was r = .713 (P < .001). At 6 months there was a reduction in albuminuria in patients with resistant hypertension treated with spironolactone as compared with renal denervation.     

Study of Fresh and Hardening Process Properties of Gypsum with Three Different PCM Inclusion Methods

Gypsum has two important states (fresh and hardened states), and the addition of phase change materials (PCM) can vary the properties of the material. Many authors have extensively studied properties in the hardened state; however, the variation of fresh state properties due to the addition of Micronal® DS 5001 X PCM into gypsum has been the object of few investigations. Properties in fresh state define the workability, setting time, adherence and shrinkage, and, therefore the possibility of implementing the material in building walls. The aim of the study is to analyze, compare and evaluate the variability of fresh state properties after the inclusion of 10% PCM. PCM are added into a common gypsum matrix by three different methods: adding microencapsulated PCM, making a suspension of PCM/water, and incorporating PCM through a vacuum impregnation method. Results demonstrate that the inclusion of PCM change completely the water required by the gypsum to achieve good workability, especially the formulation containing Micronal® DS 5001 X: the water required is higher, the retraction is lower (50% less) due to the organic nature of the PCM with high elasticity and, the adherence is reduced (up to 45%) due to the difference between the porosity of the different surfaces as well as the surface tension difference.     

Microbiological diagnosis and antimicrobial sensitivity profiles in diseased free-living raptors

Free-living raptors (birds of prey) can act as reservoirs of potentially zoonotic agents, but they also can be affected by microorganisms as target hosts. In this retrospective study, microbiological results (n?=?663) and antibiotic sensitivity profiles (n?=?108) of bacterial isolates were analysed from diseased free-living raptors. Sixty-nine percent of cases (n?=?457) yielded bacteria: 58% were in pure culture and 42% were of different species. Remarkably, samples from necropsies (47%) had higher percentage of pure isolations than those obtained from clinical (31%) samples (P?Escherichia coli was the most common agent (35%), principally recovered from necropsied birds with clinical signs of septicaemia or respiratory disorders. Pseudomonas aeruginosa (7%) was isolated from birds with systemic infection and from oral lesions, especially in nocturnal raptors (P?Staphylococcus spp. (5%), mainly Staphylococcus aureus, was found to be the most prevalent cause of pododermatitis (35%) and Staphylococcus hyicus was isolated from conjunctivitis (18.2%). Interestingly, 8% of samples with lesions compatible with avian tuberculosis were positive to the Mycobacterium avium complex. The most frequent fungi associated with pneumonic lesions and ingluvitis were Aspergillus spp. and Candida spp., respectively. More than 50% of the 108 isolates (34 different bacterial spp.) demonstrated resistance to clindamycin, ampicillin, tetracycline, cefuroxime, enrofloxacin and trimethoprim/sulphamethoxazole. Among the E. coli strains, 71% (27/38) presented a multidrug-resistance pattern to >3 antimicrobials. Detection in wildlife of antimicrobial-resistant pathogens that might be significant at the animal–human–ecosystem interface is of great relevance under the ‘One Health’ approach.     

FN14 and GRP94 expression are prognostic/predictive biomarkers of brain metastasis outcome that open up new therapeutic strategies

Brain metastasis is a devastating problem in patients with breast, lung and melanoma tumors. GRP94 and FN14 are predictive biomarkers over-expressed in primary breast carcinomas that metastasized in brain. To further validate these brain metastasis biomarkers, we performed a multicenter study including 318 patients with breast carcinomas. Among these patients, there were 138 patients with metastasis, of whom 84 had brain metastasis. The likelihood of developing brain metastasis increased by 5.24-fold (95%CI 2.83–9.71) and 2.55- (95%CI 1.52–4.3) in the presence of FN14 and GRP94, respectively. Moreover, FN14 was more sensitive than ErbB2 (38.27 vs. 24.68) with similar specificity (89.43 vs. 89.55) to predict brain metastasis and had identical prognostic value than triple negative patients (p < 0.0001). Furthermore, we used GRP94 and FN14 pathways and GUILD, a network-based disease-gene prioritization program, to pinpoint the genes likely to be therapeutic targets, which resulted in FN14 as the main modulator and thalidomide as the best scored drug. The treatment of mice with brain metastasis improves survival decreasing reactive astrocytes and angiogenesis, and down-regulate FN14 and its ligand TWEAK. In conclusion our results indicate that FN14 and GRP94 are prediction/prognosis markers which open up new possibilities for preventing/treating brain metastasis.     

A new classification system for the restoration of root filled teeth

The aim of this report is to (i) review the current literature on the status of root filled teeth, (ii) analyse the most important factors in decision‐making, (iii) discuss the current restorative concepts, and (iv) classify both the evidence and clinical practice in a way that seeks to be clear, understandable and helpful for clinicians. Restoration of root filled teeth represents a challenge for the clinician and remains a controversial subject. The guidelines describe a new classification that is drawn from evidence presented in the literature and also from clinical expertise‐based reviews. It describes five categories of teeth.