Zinc Enrichment in two Contrasting Genotypes of Triticum aestivum L. Grains: Interactions between Edaphic Conditions and Foliar Fertilizers

This study aimed to assess the implications of Zn enrichment in wheat grains as a function of contrasting genotypes, edaphic conditions and foliar fertilizers. Triticum aestivum L. varieties Roxo and Paiva were grown in four production fields, and sprayed with ZnSO4 (0, 16.20 and 36.40 kg/ha) Zn-EDTA (0, 6.30 and 12.60 kg/ha) and Tecnifol Zinc (0, 3.90 and 7.80 kg/ha). The heterogeneous edaphic conditions of the wheat fields were chemically characterized, it being found that soil properties determine different Zn accumulation in the grains of both genotypes. Foliar spraying enhanced to different extents Zn content in the grains of both genotypes, but the average of enrichment indexes varied among the wheat fields. Zinc mostly accumulated in the embryo and vascular bundle and to a lesser extent in the endosperm. Grain yield and test weight sprayed by ZnSO4 gave the highest values in both genotypes, but the opposite was found for Zn-EDTA. Considering the color parameters, lightness and red-green transitions were found to be a conjunction of genotype characteristics, fertilization types and edaphic conditions prevailing in each field. It is concluded that the index of Zn enrichment in wheat grains is a docket of edaphic conditions, genotype and type of fertilization.

A systematic review on resource allocation in public health

Background

Research in resource allocation is a need arising from State interference by the allocative function, which seeks to promote resource adjustments with the provision of certain goods and public services (Musgrave, 1974; Musgrave & Musgrave, 1980, Longo & Troster, 1993). In this perspective, a research question arises: how has international literature on the field of Business, Management and Accounting been approaching resource allocation in public health?

Methods

Systematic Literature Review through the Scopus Database. keywords: “public health” and “resource allocation”. The types were Article and Review. Language: English, since it is internationally accepted in scientific articles, and Portuguese, in order to include Brazilian research. Search period: from 1976 to 2017. Areas: “Business, Management and Accounting”. The performed analysis technique was qualitative meta-synthesis and by using the MAXQDA Analytics Pro 18 software.

Results

The first identified study was in 2000 Sweden, pulished in Health Care Management Science. The most recente in 2017 Brazil, published in Evaluation and Program Planning. Among the countries that presented the largest production, the United States is highlighted (4). Dispersion of publication among reviews was noted. Generally, publications are grouped in four perspectives: adequate allocation, resource management and effective cost; resource allocation for treating specific diseases; resource allocation for decision-making; and health evaluation and the need of informing resource allocation. The prevailing lack of theoretical grounding must be highlighted.

Conclusions

Can be inferred that this production is recent, that it does not possess a specific focus or outline, as there is a variety of approaches, most of them being geared towards healthcare and disease control, such as cancer, diabetes, overweight, rabies, malaria and infectious diseases.

Key messages

International literature indicates that the theme is yet unexplored in the field of Business, Management e Accounting and most studies are geared towards healthcare and disease control. Allocation in the public-health policy as a function of the role of the State in providing the necessary budget for financial availability and not cost-wise, suggests lack of research.

Elemental Composition and Some Nutritional Parameters of Sweet Pepper from Organic and Conventional Agriculture

The increasing demand of organic agriculture (OA) is based on the consumer's belief that organic agricultural products are healthier, tastier and more nutritious. The effect of OA and conventional agriculture (CA) methods on the elemental compositions of green and red sweet peppers were studied. The highest concentrations of Ca, Cu, K and P occur in peppers from OA in both states of ripeness, with emphasis on Ca and K contents. Furthermore, the principal component analysis (PCA), points out to a clear separation, regarding concentrations, between peppers from OA and CA. The average fruit weight is higher in OA, 141 g versus 112 g in CA. Regarding productivity, CA reaches a value of 30.1 t/ha, 7% higher than the value observed for OA, i.e., 28 t/ha. Peppers from CA, exhibited greater protein content than those which originated from OA, regardless of the ripening stage, but not more ashes. Regarding nutritional ratios, the ripening stage and the production mode, can be important for an adequate choice regarding a more balanced Ca/P ratio, and the studied variety contained high Ca values ranging between 1009 and 1930 mg.kg-1. The PCA analysis also revealed that Mn and Fe are inversely correlated, confirming the importance of the Mn/Fe ratio evaluation in nutritional studies.

THU0632-HPR DETERMINANTS OF HAPPINESS AND QUALITY OF LIFE IN PEOPLE WITH SYSTEMIC SCLEROSIS: A STRUCTURAL EQUATION MODELLING APPROACH

Background:

In recent years more attention has been given to patients reported outcomes (PROs). Systemic sclerosis (SSc) is no exception. As there is no effective treatment or cure to SSc, it is important to recognize the relevance to patients of the different features of the disease to improve quality and enjoyment of life: the ultimate targets of therapy. Remarkably lacking in PROs is the evaluation of the overall perspective of subjective well being, equivalent to ‘happiness’ or “positive psychological dimensions”.

Objectives:

To examine the determinants of happiness and quality of life (QoL) in patients with SSc with emphasis on disease activity, disease impact and personality traits.

Methods:

This is an observational, cross-sectional and multicenter study from six rheumatology clinics in Portugal. A total of 113 patients with SSc with a complete set of data on disease activity, disease impact, personality, quality of life and happiness were included.

Structural equation modelling (latent variable structural model) was used to estimate the association between the variables using a maximum likelihood estimation with Satorra-Bentler’s correction and performed with STATA® 15.0. Two hypotheses were pursued: H1 – Disease activity and impact of disease are negatively associated to overall QoL and happiness; H2 – ‘Positive’ personality traits are related to happiness both directly and indirectly through perceived disease impact.

Results:

Results obtained in the structural equation measurement model indicated a good fit [χ2/df=1.44; CFI=0.93; TLI=0.90; RMSEA=0.06] and supported all driving hypotheses (Figure 1). Happiness was positively related to ‘positive’ personality (β=0.45, p=0.01) and, to a lesser extent, negatively related with impact of disease (β=-0.32; p=0.01). This impact, in turn, was positively related to EUSTAR activity score (β=0.37; p<0.001) and mitigated by ‘positive’ personality traits (β=-0.57; p<0.001). Impact of disease had a much stronger relation with QoL than with happiness (β=-0.78, p<0.001). Quality of life and happiness had no statistically significant relationship.

Conclusion:

Optimization of Qol and happiness in people with SSc requires effective control of the disease process. Personality and its effects upon the patient´s perception of the disease impact, seems to play a pivotal mediating role in these relations and should deserve paramount attention if happiness and enjoyment of life is taken as the ultimate goal of health care.

Disclosure of Interests:

Tânia Santiago: None declared, Eduardo Santos: None declared, Ana Catarina Duarte: None declared, Patrícia Martins: None declared, Marlene Sousa: None declared, Franscisca Guimarães: None declared, Soraia Azevedo: None declared, Raquel Ferreira: None declared, Miguel Guerra: None declared, Ana Cordeiro Consultant of: Ana Cordeiro has acted as a consultant for Roche, Speakers bureau: Ana Cordeiro has received speaker fees from Boehringer Ingelheim, Lilly, and Vitoria, Inês Cordeiro: None declared, Sofia Pimenta: None declared, Patrícia Pinto: None declared, Maria Joao Salvador: None declared, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis

AB0606 SYSTEMIC SCLEROSIS – ARE PATIENTS WITH CALCINOSIS DIFFERENT FROM THOSE WHO DO NOT HAVE IT?

Background:

Systemic Sclerosis (SS) is a heterogenous disease with a broad range of organ involvement. Calcinosis is a common problem and although it may affect almost any body tissue, it is typically seen in the limbs.1Its presence relates with higher risk of digital ulcers and infection.2It is still unknown whether patients with calcinosis also have other clinical features that differentiate them from the remaining.

Objectives:

To determine the prevalence of calcinosis in a SS cohort and to evaluate if its presence relates with specific clinical features.

Methods:

A cross-sectional study was conducted evaluating a cohort of SS patients. Plain radiographs were taken to assess calcinosis at elbows, hands, knees and feet. Clinical data was obtained and analyzed using IBM SPSS Statistics 26®.

Results:

We included 25 patients, 21 females [n= 21 (84%)], median (min, max) age was 58 (27, 75) years-old. Regarding disease classification, 16 (64%) had limited SS, 4 (16%) had diffuse SS, 3 (12%) had overlap syndrome and 2 (8%) had early SS. Ten (40%) patients had radiological calcinosis in at least one site, seven of which (70%) were subclinical. The most affected areas were knees and hands [n=6 (24%)]. Table 1 summarizes the clinical characteristics of patients with and without calcinosis. Limited SS was significantly more prevalent in the calcinosis group [n=9 (90%) vs. n=7 (46.7%), p=0.04]. All patients had Raynaud phenomenon [n=10 (100%) vs. 15 (100%)]. Current or past digital ulcers [n=5 (50%) vs. n=6 (40%), p=0.697], telangiectasias [n=9 (90%) vs. n=11 (73.3%), p=0.615], pulmonary hypertension [n=2 (20%) vs. n=1 (6.7%), p=0.550] and esophageal involvement [n=6 (60%) vs. n=6 (40%), p=0.428] were more frequent in the calcinosis group but with no statistical significance. Although late capillaroscopic pattern was more frequent in the calcinosis group, there was no statistical significance difference [n=4 (40%) vs. n=1 (6.7%), p=0.121]. Seropositivity for centromere-B antibodies was more frequent in the calcinosis group but with no statistical significance [n=7 (70%) vs. n=8 (53.3%), p=0.678].

Table 1.

Demographic and clinical data of patients with and without calcinosis.

Demographic and clinical dataCalcinosis (n=10)No calcinosis (n=15)p-valueFemale gender, n (%)9 (90)12 (80)0.626Age (years), median [min,max]68.5 [27, 75]52 [36, 73]0.129Cutaneous classificationLimited, n (%)9 (90)7 (46.7)0.04Diffuse, n (%)1 (10)3 (20)0.626Early, n (%)0 (0)2 (13.3)0.500Overlap, n (%)0 (0)3 (20)0.250Clinical manifestationsCurrent or previous digital ulcers, n (%)5 (50)6 (40)0.697Interstitial lung disease, n (%)2 (20)4 (26.7)1.000Pulmonary hypertension, n (%)2 (20)1 (6.7)0.550Arthritis, n (%)2 (20)3 (20)1.000Calcinosis, n (%)3 (30)0 (0)0.052Esophageal involvement, n (%)6 (60)6 (40)0.428NFC patternsNon specific abnormalities, n (%)1 (10)3 (20)0.626Early scleroderma, n (%)1 (10)1 (6.7)1.000Active scleroderma, n (%)3 (30)10 (58.8)0.111Late scleroderma, n (%)4 (40)1 (6.7)0.121AutoantibodiesCentromere B, n (%)7 (70)8 (53.3)0.678Scl-70, n (%)1 (10)4 (26.7)0.615

Conclusion:

The prevalence of calcinosis was similar to that reported in literature (18-49%). This study confirmed the association, already found in previous studies, between calcinosis and the limited form of SS and raises attention for the importance of calcinosis radiographic screening since there was a high prevalence of subclinical calcinosis.1Although there were some clinical differences between patients with and without calcinosis, given the small cohort, statistical significance was not obtained. Larger studies are needed to increase statistical power.

References:

[1]Valenzuela A et al. Calcinosis in scleroderma. Curr Opin Rheumatol. 2018 Nov;30(6):554-561.

[2]Bartoli F et al. Calcinosis in systemic sclerosis: subsets, distribution and complications. Rheumatology (Oxford). 2016 Sep;55(9):1610-4.

Disclosure of Interests:

None declared

The relationship between neuropsychological, emotional and family functioning within a group of patients with multiple sclerosis

MS is a heterogeneous entity that varies in its etiology, classification, clinical course and sequelae, and is included as part of the chronic diseases that cause limitations in many areas. This study aims to assess neuropsychological functions, anxiety and depression in patients with MS, and realize that these variables can be influenced by family functioning.

This study consists of a group of 25 individuals were women with diagnosis of Multiple Sclerosis (ages 25 to 58 years). Data collection was done through: a demographic questionnaire and clinical, a neuropsychological assessment battery (LNNB), a range of Hospital Anxiety and Depression Scale (HADS), and a questionnaire of family functioning (FACES-III). The results suggest that the group of patients evaluated present neuropsychological deficits in several areas, as well as depression and anxiety. They also suggest that there is a higher prevalence of neuropsychological deficits associated with a higher incidence of depressive symptoms and family dissatisfaction. Taken together, these results reveal an involvement of emotional and family functioning on neuropsychological functioning. As such, these factors should be considered in the implementation of intervention programs, both in terms of individual psychotherapy, or the level of family psychotherapy as well as in neuropsychological and psychosocial rehabilitation programs and these patients.

Assessment of Toxic Metals and Hazardous Substances in Tattoo Inks Using Sy-XRF, AAS, and Raman Spectroscopy

Synchrotron radiation X-ray fluorescence spectroscopy, in conjunction with atomic absorption and Raman spectroscopy, was used to analyze a set of top brand tattoo inks to investigate the presence of toxic elements and hazardous substances. The Cr, Cu, and Pb contents were found to be above the maximum allowed levels established by the Council of Europe through the resolution ResAP(2008)1 on requirements and criteria for the safety of tattoos and permanent makeup. Raman analysis has revealed the presence of a set of prohibited substances mentioned in ResAP(2008)1, among which are the pigments Blue 15, Green 7, and Violet 23. Other pigments that were identified in white, black, red, and yellow inks are the Pigment White 6, Carbon Black, Pigment Red 8, and a diazo yellow, respectively. The present results show the importance of regulating tattoo ink composition.

Metal content in edible crops and agricultural soils due to intensive use of fertilizers and pesticides in Terras da Costa de Caparica (Portugal)

Soils and different vegetable species in Costa de Caparica (Portugal) are subject to the intensive use of inorganic fertilizers and pesticides. Thus, the concentrations of As, Cu, Fe, Mn, Pb, and Zn were evaluated. Lettuce, spinach, and potatoes collected in station 9 cause reason for concern due to their high Pb concentrations close to 20 μg g^-1 which is probably related to an intensive use of copper and iron sulphate fertilizers. Additionally, the consumption of Portulaca oleracea collected in stations 3 and 4 must be avoided due to the high concentrations of Zn, and even Cu. The derived estimated daily intake (EDI) dose of Zn will be a risk to human consumption if P. oleracea was the single basis of a soup, although the addition of other ingredients might lower the tolerable upper intake (TUI) value of 39 mg/day of P. oleracea, to admissible levels, i.e., not exceeding 25 mg/day. Pumpkin collected in station 1 contained 44.1 μg g^-1 Cu and a TUI value of 9.8 mg/day, when the recommendation must not exceed 5.0 mg/day. In this context, it is strongly advised to not include this vegetable in household menus.

Heavy metal content of edible plants collected close to an area of intense mining activity (southern Portugal)

The Neves-Corvo mining complex (MC) situated in southern Portugal exploits one of the most world's important copper deposits. Agricultural soils surrounding the MC, used by the inhabitants for crop production, contain excessive amounts of As, Cu, Pb, and Zn. Thus, a potential risk to human consumption exists if edible plants grow on these substrata. Arsenic and Pb were not detected in edible samples collected near the MC and 5 km away, but in the leaves-structural or adsorbed onto the surface. In general, Zn was the most mobile element in both contaminated and reference areas as seen by the bioaccumulation factors (BAF). The tolerable upper intake (TUI) values for Cu are a reason of concern, since in 57.1% of the cases, the TUI values are above the recommended upper limit of 5 mg/day, in the case of Ficus carica, Cucurbita pepo, and Phaseolus vulgaris, whereas in 28.6% of the cases, the TUI values are near this limit (C. pepo and Citrus x sinensis). The consumption of such vegetables from these areas must be banned or strongly reduced, since long-term accumulation of Cu can cause a chronic toxicity in humans.

Gut microbiota characterisation in obese patients before and after bariatric surgery

Intestinal microbiota analysis of obese patients after bariatric surgery showed that Proteobacteria decreased after laparoscopic sleeve gastrectomy (SG), while it increased after laparoscopic gastric bypass (LGB). Comparing to normal weight (NW) patients, obese patients that were selected for SG showed an almost equal amount of Firmicutes and Bacteroidetes and the ratio was not affected by the surgery. Obese patients before LGB showed a predominance of Bacteroidetes, whose amount regained a relative abundance similar to NW patients after surgery. Obese patients before LGB showed the predominance of Bacteroides, which decreased after surgery in favour of Prevotella, a bacterium associated with a healthy diet. The bacteria detected at the highest percentages belonged to biofilm forming species. In conclusion, in this study, we found that the characterization of the gut microbial communities and the modality of mucosal colonisation have a central role as markers for the clinical management of obesity and promote the maintenance of good health and the weight loss.

Abstract P6-11-16: Dysgeusia, weight and eating habits changes in breast cancer patients undergoing chemotherapy: A prospective cohort study

Background: Dysgeusia is a frequent side effect in breast cancer patients undergoing adjuvant chemotherapy. The effect of dysgeusia on changes in diet and patient weight has been poorly investigated. We evaluated prospectively dysgeusia in a consecutive series of early breast cancer patients (EBCP) with the aim to explore its impact on food selection and weight changes.

Patients and methods: From May 2014 to April 2017, 130 consecutive EBCP were enrolled at the Oncology and Breast Units at Spedali Civili in Brescia. Dysgeusia was categorized as present or absent, changes in types and frequencies of food consumptions during chemotherapy were assessed by a specific questionnaire and photography atlas. Evaluations were performed at baseline, after 3 cycles, at the end of chemotherapy plan and during follow-up.

Results: all 130 pts were evaluable. Median age was 53 years (range 26-76), median weight 64 Kg (range 45-115), median BMI 23,86 Kg/m2 (range 17,01-35,49), 73 pts (56%) performed physical activity, 57 pts (44%) were abstemious, 22 pts (17%) received neoadjuvant and 108 pts (83%) adjuvant chemotherapy, 25 pts (19%) were treated with antracycline based schemes, 83 (64%) with antracycline and taxane plus or minus trastuzumab, and 22 pts (17%) other regimens. Seventy-three per cent of pts developed dysgeusia during chemotherapy (p=&lt; 0.001), and in 19% this side effect persisted three months after chemotherapy.

Dysgeusia was associated with the length of chemotherapy treatment and taxane use. A statistically significant increase of taste alteration was reported for all metallic, sweet, bitter, salted and acid taste (p&lt;0.001). Dysgeusia was more frequent in pts reporting meteorism and fatigue and in pts without oral mucositis (p=0.002). Dysgeusia correlated with a lower intake of bread, cheese, fat salami, butter and wine and a high intake of biscuits and cakes. However, no correlation was observed with weight and BMI changes.

Conclusion: Dysgeusia was frequent in EBCP undergoing adjuvant chemotherapy. It directly correlated with fatigue and meteorism and inversely correlated with mucositis. This adverse event had no impact on weight and BMI but significantly influenced food intake with a preference of glucose containing instead of fat containing foods.

Acknowledgments: a thank you to Beretta foundation for the costant support to Breast Unit and Oncology Department.

Citation Format: Pedersini R, Zanini A, Romelli M, Coccoli V, Guerra M, Bosio S, Schivardi G, Rodella F, Vassalli L, Amoroso V, Claps M, Simoncini EL, Berruti A. Dysgeusia, weight and eating habits changes in breast cancer patients undergoing chemotherapy: A prospective cohort study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-16.

Can Elevated Air [CO2] Conditions Mitigate the Predicted Warming Impact on the Quality of Coffee Bean?

Climate changes, mostly related to high temperature, are predicted to have major negative impacts on coffee crop yield and bean quality. Recent studies revealed that elevated air [CO₂] mitigates the impact of heat on leaf physiology. However, the extent of the interaction between elevated air [CO₂] and heat on coffee bean quality was never addressed. In this study, the single and combined impacts of enhanced [CO₂] and temperature in beans of Coffea arabica cv. Icatu were evaluated. Plants were grown at 380 or 700 μL CO₂ L^-1 air, and then submitted to a gradual temperature rise from 25°C up to 40°C during ca. 4 months. Fruits were harvested at 25°C, and in the ranges of 30-35 or 36-40°C, and bean physical and chemical attributes with potential implications on quality were then examined. These included: color, phenolic content, soluble solids, chlorogenic, caffeic and p-coumaric acids, caffeine, trigonelline, lipids, and minerals. Most of these parameters were mainly affected by temperature (although without a strong negative impact on bean quality), and only marginally, if at all, by elevated [CO₂]. However, the [CO₂] vs. temperature interaction strongly attenuated some of the negative impacts promoted by heat (e.g., total chlorogenic acids), thus maintaining the bean characteristics closer to those obtained under adequate temperature conditions (e.g., soluble solids, caffeic and p-coumaric acids, trigonelline, chroma, Hue angle, and color index), and increasing desirable features (acidity). Fatty acid and mineral pools remained quite stable, with only few modifications due to elevated air [CO₂] (e.g., phosphorous) and/or heat. In conclusion, exposure to high temperature in the last stages of fruit maturation did not strongly depreciate bean quality, under the conditions of unrestricted water supply and moderate irradiance. Furthermore, the superimposition of elevated air [CO₂] contributed to preserve bean quality by modifying and mitigating the heat impact on physical and chemical traits of coffee beans, which is clearly relevant in a context of predicted climate change and global warming scenarios.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Blood-brain barrier and foetal-onset hydrocephalus, with a view on potential novel treatments beyond managing CSF flow

Despite decades of research, no compelling non-surgical therapies have been developed for foetal hydrocephalus. So far, most efforts have pointed to repairing disturbances in the cerebrospinal fluid (CSF) flow and to avoid further brain damage. There are no reports trying to prevent or diminish abnormalities in brain development which are inseparably associated with hydrocephalus. A key problem in the treatment of hydrocephalus is the blood–brain barrier that restricts the access to the brain for therapeutic compounds or systemically grafted cells. Recent investigations have started to open an avenue for the development of a cell therapy for foetal-onset hydrocephalus. Potential cells to be used for brain grafting include: (1) pluripotential neural stem cells; (2) mesenchymal stem cells; (3) genetically-engineered stem cells; (4) choroid plexus cells and (5) subcommissural organ cells. Expected outcomes are a proper microenvironment for the embryonic neurogenic niche and, consequent normal brain development.

Karyotype diversity and genome size variation in Neotropical Maxillariinae orchids

Orchidaceae is a widely distributed plant family with very diverse vegetative and floral morphology, and such variability is also reflected in their karyotypes. However, since only a low proportion of Orchidaceae has been analysed for chromosome data, greater diversity may await to be unveiled. Here we analyse both genome size (GS) and karyotype in two subtribes recently included in the broadened Maxillariinea to detect how much chromosome and GS variation there is in these groups and to evaluate which genome rearrangements are involved in the species evolution. To do so, the GS (14 species), the karyotype - based on chromosome number, heterochromatic banding and 5S and 45S rDNA localisation (18 species) - was characterised and analysed along with published data using phylogenetic approaches. The GS presented a high phylogenetic correlation and it was related to morphological groups in Bifrenaria (larger plants - higher GS). The two largest GS found among genera were caused by different mechanisms: polyploidy in Bifrenaria tyrianthina and accumulation of repetitive DNA in Scuticaria hadwenii. The chromosome number variability was caused mainly through descending dysploidy, and x=20 was estimated as the base chromosome number. Combining GS and karyotype data with molecular phylogeny, our data provide a more complete scenario of the karyotype evolution in Maxillariinae orchids, allowing us to suggest, besides dysploidy, that inversions and transposable elements as two mechanisms involved in the karyotype evolution. Such karyotype modifications could be associated with niche changes that occurred during species evolution.

Endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in non-small cell lung carcinoma

INTRODUCTION

Lung cancer staging has recently evolved to include endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for nodal assessment.

AIM

Evaluate the performance and safety of EBUS-TBNA as a key component of a staging algorithm for non-small cell lung carcinoma (NSCLC) and as a single investigation technique for diagnosis and staging of NSCLC.

METHODS

Patients undergoing EBUS-TBNA for NSCLC staging at our institution between April 1, 2010 and December 31, 2014 were consecutively included with prospective data collection. EBUS-TBNA was performed under general anesthesia through a rigid scope.

RESULTS

A total of 122 patients, 84.4% males, mean age 64.2 years. Histological type: 78 (63.9%) adenocarcinoma, 33 (27.0%) squamous cell carcinoma, 11 (8.9%) undifferentiated/other NSCLC. A total of 435 lymph node stations were punctured. Median number of nodes per patient was 4. EBUS-TBNA nodal staging: 63 (51.6%) N0; 8 (6.5%) N1; 34 (27.9%) N2, and 17 (13.9%) N3. EBUS-TBNA was the primary diagnostic procedure in 27 (22.1%) patients. EBUS-TBNA NSCLC staging had a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy rate of 83.3, 100, 100, 86.1, and 91.8%, respectively. No complications were attributable to the procedure.

CONCLUSION

A comprehensive lung cancer staging strategy that includes EBUS-TBNA seems to be safe and effective. Our EBUS-TBNA performance and safety in this particular setting was in line with previously published reports. Additionally, our study showed that, in selected patients, lung cancer diagnosis and staging are achievable with a single endoscopic technique.