Individual and regional factors of access to the renal transplant waiting list in france in a cohort of dialyzed patients

Several studies have investigated geographical variations in access to renal transplant waiting lists, but none has assessed the impact on these variations of factors at both the patient and geographic levels. The objective of our study was to identify medical and non-medical factors at both these levels associated with these geographical variations in waiting-list placement in France. We included all incident patients aged 18-80 years in 11 French regions who started dialysis between January 1, 2006, and December 31, 2008. Both a multilevel Cox model with shared frailty and a competing risks model were used for the analyses. At the patient level, old age, comorbidities, diabetic nephropathy, non-autonomous first dialysis, and female gender were the major determinants of a lower probability of being waitlisted. At the regional level, the only factor associated with this probability was an increase in the number of patients on the waiting list from 2005 to 2009. This finding supports a slight but significant impact of a regional organ shortage on waitlisting practices. Our findings demonstrate that patients' age has a major impact on waitlisting practices, even for patients with no comorbidity or disability, whose survival would likely be improved by transplantation compared with dialysis.

Volatile organic compounds in the strongly fragrant fern genus Melpomene (Polypodiaceae)

Volatile organic compounds (VOCs) are common among plants, both as attractants for pollinators and as defence against herbivores. While much studied among flowering plants, the prevalence and function of VOCs among ferns is little known. Using headspace sorption and gas chromatography, we analysed the VOCs of dried specimens of six species of grammitid fern (Polypodiaceae), including two species of the genus Melpomene, which is characterised by a distinctive sweet smell. We identified 38 VOCs, including 22 not previously recorded among ferns. The two species of Melpomene had distinct VOC cocktails, including 12 substances not found in the other four studied genera, mainly involving fatty acid derivatives (FADs) and aromatics. We propose that these VOCs have, at least in part, a function in herbivore defence, but note that the VOC bouquet of Melpomene is distinct from that typically found in angiosperms.

[Neuroendocrine adenoma of the middle ear]

BACKGROUND

Neuroendocrine adenomas of the middle ear are rare, low-grade neoplasms with potential for recurrence and metastasis. The nonspecific symptoms and preliminary clinical and radiological findings are misleading and often fail to provide the right diagnosis.

PATIENTS AND METHODS

We analyzed the findings of 3 adult patients, who were treated between 2001 and June /2012 at the Luzerner Kantonsspital in Switzerland.

RESULTS

The 3 patients reported on hearing loss, ear pressure and/or tinnitus. Otoscopy showed a thickened, intact tympanic membrane with a whitish-grayish prolapsing mass. All the patients had conductive hearing loss. Computer tomography showed an unspecified well-circumscribed soft-tissue mass. Definitive histology with immunostaining after radical tumor removal led to the proper diagnosis.

CONCLUSIONS

The typical constellation of nonspecific clinical and radiological findings leads to the right diagnosis of neuroendocrine adenoma of the middle ear. After reviewing the literature, we illustrate the differential diagnosis as well as the relevant diagnostic and therapeutic procedures, and remind ENT physicians about this rare disease entity.

[Prognosis of canine oral (gingival) squamous cell carcinoma after surgical therapy. A retrospective analysis in 40 patients]

OBJECTIVE

Retrospective analysis of dogs with gingival squamous cell carcinoma (SCC) surgically treated using jaw resection. Material and me- thods: A total of 40 dogs were enrolled in the study. Dogs with incomplete tumour resection or metastases were subjected to adjuvant chemotherapy using carboplatin. Breed, age, tumour localisation, postsurgical complications, survival times and prognostic factors were evaluated.

RESULTS

There were no breed predispositions. The median age was 9.5 years (mean 8.6 years; range 0.5-15.5 years). At the time of presentation, two dogs (5%) had lymph node metastases (N1). The median survival time (ST) of all the patients was 44.8 months. In 15 patients, the tumour was located in the maxilla, whereas 25 dogs had a mandibular tumour location. The median ST in dogs with maxillary tumours was 39 months (95% confidence interval [CI] 24 months), while patients with maxillary tumours survived a median of 43 months (95% CI 33-70 months). There was no significant difference in the ST in patients with maxillary versus man- dibular tumours (p = 0.985). On multivariate analysis, only the tumour stage was found to be significantly associated with survival (p = 0.0047). Patients with stage N0 survived a median of 44 months (95% CI 36-80 months). The two dogs with lymph node metastasis (N1) sur- vived 18 and 70 months following jaw resection and carboplatin chemotherapy, respectively. According to the histological findings, tumour resection was incomplete in five patients. These dogs received adjuvant carboplatin chemotherapy, resulting in an ST of between 6 and 146 months.

CONCLUSION AND CLINICAL RELEVANCE

Prognosis depends on the tumour stage, while for complete local excision of the affected jaw segment a good prognosis can be given and the majority of the patients can be cured. The supposedly more malignant behaviour of gingival SCCs located in the caudal aspects of the oral cavity could not be confirmed. Patients with metastasis of the local lymph nodes can achieve acceptable survival times. Jaw resections have low complication rates and a good functional outcome.

Models of short bowel syndrome in pigs: a technical review

BACKGROUND

Short bowel syndrome (SBS) is still a life-threatening disease in both children and adults. Although the therapeutic options are improving, challenges still remain, and to overcome these challenges is a major focus of SBS research today. In order to simulate anatomical and physiological conditions similar to those in humans for research, porcine models of SBS are often used. Various approaches for generating SBS models have been described in the literature.

METHODS/RESULTS

In this work, we present a review of different types of porcine models of SBS and outline the differences between those models regarding types of animals, surgical procedures, monitoring, and methods of assessment.

CONCLUSION

The aim of this study was to select the most suitable SBS model regarding the purpose of the research.

Determination of MDR1 gene expression for prediction of chemotherapy tolerance and treatment outcome in dogs with lymphoma

The multidrug resistance gene 1(MDR1) expression levels were analysed in 27 dogs with different types of malignant lymphomas receiving a standard chemotherapy protocol. Blood samples were used for MDR1 real-time PCR expression analysis. Treatment tolerance and outcome were evaluated on a regular basis by clinical examination and client questioning. Dogs developing severe adverse effects under treatment showed significantly lower basal MDR1 gene expression levels when compared with those who tolerated the drugs well. In the longitudinal MDR1 gene expression analysis during treatment, four dogs showed a greater than two-fold MDR1 up-regulation, compared to baseline expression. All four of these dogs, but none of the others, showed disease progression. In conclusion, basal and follow-up MDR1 gene expression levels could be of predictive value for the occurrence of severe adverse drug reactions and/or the development of MDR during chemotherapy for lymphoma in dogs.

Clinical efficacy and safety of a water-soluble micellar paclitaxel (Paccal Vet) in canine mastocytomas

OBJECTIVE

To determine the clinical efficacy and safety of a cremophor-free formulation of paclitaxel (Paccal Vet, Oasmia Pharmaceuticals) in dogs with mast cell tumours.

METHODS

Paccal Vet was administered at a median dose of 145 (range, 135 to 150) mg/m(2) intravenously once every 21 days for three cycles to 29 dogs with macroscopic grade 2 or 3 mast cell tumour. Efficacy was assessed by tumour response (Response Evaluation Criteria in Solid Tumours version 1.0) and performance status score. Progression-free survival, quality of life and safety/adverse events were also evaluated. Clinical safety was assessed by clinicopathological analyses and recording of adverse events.

RESULTS

Complete or partial response was observed in 59% of dogs. Performance status score remained constant or improved for 20 dogs and decreased by one grade for 9 dogs. Median time to progression was 247 (range, 42 to 268) days. Expected, transient frequently subclinical adverse events (primarily grade 3/4 neutropenia and grade 1/2 leukopenia) were observed in the majority of dogs. Nine dogs were euthanased and one dog died due to disease progression.

CLINICAL SIGNIFICANCE

Paccal Vet appears to be a clinically safe and effective treatment for canine mast cell tumours. Further controlled confirmatory investigation is warranted.

[Combined palliative hypofractionated radiation and carboplatin chemotherapy of intranasal tumours in dogs]

OBJECTIVE

Combination therapy of intranasal tumours in dogs with palliative 60 cobalt radiation and carboplatin chemotherapy.

MATERIAL AND METHODS

Twenty-five dogs with intranasal tumours were treated in the Hofheim Veterinary Hospital (Germany) from 2004 to 2006 with a total radiation dose of 24Gy (3 fractions of 8 Gy on days 0, 7 and 21) and five doses of Carboplatin (270-300 mg/m² BSA i.v. every 21-28 days).

RESULTS

In 88% patients, clinical symptoms subsided partially or completely resulting in improvement in quality of life. Computed tomography revealed partial (5/25) or complete (5/25) tumour remissions. Chemotherapy was well tolerated. Radiation therapy caused no or minimal side effects except for 3 dogs (12%), which experienced serious ocular side effects resulting in loss of vision of the affected eye and one dog with epileptic seizures. Survival times ranged from 10-639 days with a median of 156 days. There was no statistically significant correlation between the parameters breed, age, sex, brain invasion or tumour stage and survival time or progression free interval. Survival time and progression free interval were significantly correlated with the degree of tumour remission.

CONCLUSION AND CLINICAL RELEVANCE

It can be concluded from this study that palliative radiation therapy combined with chemotherapy results in excellent palliation of clinical symptoms and acceptable survival times. There was no advantage of combined therapy (radiation with carboplatin) when compared to literature data on results of radiation therapy alone.

Imaging EGFR phosphorylation in intact human pancreatic carcinoma cells

BACKGROUND/AIM

Carcinoma of the pancreatic duct is a highly malignant tumor characterized by aggressive and early metastastatic growth. A high rate of tumor recurrence after surgical resection and the lack of effective chemotherapeutic approaches result in low 5-year survival rates. Overexpression of epidermal growth factor (EGF) and its receptor have been correlated to a higher tumor biological aggressiveness.

MATERIALS AND METHODS

We investigated EGFR RNA and protein expressions in different pancreatic carcinoma cell lines. EGFR phosphorylation was determined using acceptor photobleaching fluorescence resonance energy transfer (FRET).

RESULTS

The imaging method allowed determination of receptor phorphorylation in intact cells without external calibration. Significant differences between the cell lines were found in EGFR expression but not in phosphorylation of EGFR without EGF stimulation. After stimulation with EGF, significant differences were found in receptor phorphorylation. EGFR expression did not correlate with EGFR phorphorylation.

CONCLUSION

Since EGFR phosphorylation conveys signal transduction within cells, this molecular imaging method could be useful for the identification of patients with a high level of EGFR phosphorylation within tumor cells and, thus, to select patients for an EGFR-targeted therapy.

[Computed tomographic characteristics of canine acanthomatous ameloblastoma - a retrospective study in 52 dogs]

OBJECTIVE

Investigation of the computed tomographic appearance of canine acanthomatous ameloblastoma to describe characteristic imaging features of this neoplasia within the jaw bone.

MATERIAL AND METHODS

Retrospective evaluation of epidemiological data and imaging results in 70 dogs with histologically confirmed acanthomatous ameloblastoma. In 52 dogs a computed tomography study was available, while radiographs of the rostral maxilla or mandible were available in 18 dogs.

RESULTS

The neoplasia was most commonly located in the rostral parts of the mandible. Dogs of medium and large breeds were most commonly affected with no apparent breed predisposition. A bimodal age distribution could be demonstrated. 19% of the dogs were under 5 years of age. In 45 (86%) of 52 dogs examined by computed tomography osteolysis was present, which in some cases was extensive. An expansile bone destruction of the dental alveolar cavity with osteolysis of the apical border was recognized as the characteristic computed tomographic feature.

CONCLUSION AND CLINICAL RELEVANCE

Canine acanthomatous ameloblastoma commonly displays a characteristic computed tomographic appearance, which in combination with histopathological confirmation helps in the diagnosis of this tumour.

B-mode ultrasound and grey-scale analysis of the epididymis in boars, and the relationship to semen parameters

This study investigated the epididymis of mature boars (n=10) by means of B-mode ultrasound and grey-scale analysis (GSA) for echogenicity (EG) determination using an ultrasound unit HS 1500V, a linear transducer (frequencies 7.5-9.0 MHz), and standardized unit settings. All boars had their epididymal caput, corpus and cauda scanned six times before and after semen collection, respectively, at weekly intervals. Semen was subjected to spermatological examination including volume, total and forward motility, sperm abnormalities, as well as total sperm count and concentration. The caput and corpus both had a homogeneous fine echotexture. The cauda was homogeneous too but had a marbled echotexture. Echogenicity before and after semen collection was caput > corpus > cauda, respectively (p<0.001). Echogenicity was higher before than after semen collection for all parts of the epididymis, respectively (p<0.001). Echogenicity of the caput correlated slightly positively with the total sperm count pre-collection (r=0.301; p=0.020) and with ejaculate volume pre- and post-collection (r=0.302 vs 0.306; p=0.017 vs 0.019), and slightly negatively with sperm concentration post-collection (r= -0.275; p=0.034). No relationship was found for EG of the corpus and cauda for any of the ejaculate parameters. In conclusion, B-mode ultrasound and GSA proved feasible for imaging the epididymis in boars. Single relationships between EG and ejaculate parameters were found and deserve further investigation.

[Primary hyperparathyroidism in the dog. Diagnosis, therapy and postoperative management in 19 dogs]

OBJECTIVE

Retrospective evaluation of diagnosis and outcome in 20 dogs with primary hyperparathyroidism.

MATERIAL AND METHODS

In 20 dogs primary hyperparathyroidism was diagnosed and 19 patients were treated via parathyroidectomy, 10 additionally with partial thyroidectomy. Medical records of the dogs were reviewed for signalment, clinical features, laboratory findings and results of histopathologic examination. In some cases postsurgical rehabilitation of calcium metabolism required substitution with calcium and vitamin D preparations.

RESULTS

Mean age of the dogs was 11.5 years. The most common clinical signs comprised polydipsia, polyuria, reduced activity, and stiff gait. Laboratory findings were moderate to extensive hypercalcaemia, low or low-normal serum phosphorus concentrations and normal or increased serum parathyroid hormone concentrations. None of the dogs had an elevated parathyroid hormone-related polypeptide level. Histological examination revealed 11 adenomas, six carcinomas and two glandular hyperplasias. Postsurgical management of calcium homeostasis was challenging in some cases.

CONCLUSION

Tumours of the parathyroid gland can be easily treated by parathyroidectomy and usually have a good prognosis.

CLINICAL RELEVANCE

With careful interpretation of laboratory findings of a patient presenting with hypercalcaemia and ruling out other causes of hypercalcaemia diagnosis of primary hyperparathyroidism can be easily achieved and successfully treated byparathyroidectomy.

An Andean radiation: polyploidy in the tree genus Polylepis (Rosaceae, Sanguisorbeae)

The Andean tree genus Polylepis (Rosaceae) is notorious for the high morphological plasticity of its species and the difficulty in their circumscription. The evolutionary mechanisms that have driven diversification of the genus are still poorly understood, with factors as diverse as ecological specialisation, reticulate evolution, polyploidisation and apomixis being proposed to contribute. In the present study, chromosome counts, flow cytometry and stomata guard cell size measurements were employed to document for the first time the presence of polyploidy in the genus and to infer ploidy levels for most species. Inferred ploidy levels show a clear progression from diploidy in cloud forest species to polyploidy (tetra- to octoploidy) in the morphologically and ecologically specialised incana group, indicating that polyploidisation may have played a major role in speciation processes and the colonisation of novel habitats during the Andean uplift. At least two species of Polylepis comprise populations with varying degrees of ploidy. More extensive studies are needed to obtain a better understanding of the prevalence and effects of intraspecific polyploidy in the genus.

A review of polycystic ovarian syndrome in adolescents

Polycystic ovary syndrome (PCOS) is a complex disorder, involving primarily ovarian hyperandrogenism in females and linked with insulin resistance in the majority of cases. Clinical features are widely variable and include a combination of menstrual irregularities, acne, hirsutism, and alopecia. Although it typically presents around puberty, several risk factors during childhood may help raise a high index of suspicion for the development of PCOS in adolescents. The pathophysiology of PCOS still remains unknown and likely includes a combination of genetic factors, insulin resistance, and environmental factors. A thorough diagnostic work up is required in suspected cases and several management modalities have been suggested. Since various long term complications and comorbidities are associated with PCOS, early diagnosis and therapeutic intervention is warranted in these cases.

A survey of the mycorrhization of Southeast Asian ferns and lycophytes

The colonisation of land by plants may not have been possible without mycorrhizae, which supply the majority of land plants with nutrients, water and other benefits. In this sense, the mycorrhization of basal groups of land plants such as ferns and lycophytes is of particular interest, yet only about 9% of fern and lycophyte species have been sampled for their mycorrhization status, and no community-level analyses exist for tropical fern communities. In the present study, we screened 170 specimens of ferns and lycophytes from Malaysia and Sulawesi (Indonesia), representing 126 species, and report the mycorrhization status for 109 species and 19 genera for the first time. Mycorrhizal colonisations were detected in 96 (56.5%) of the specimens, 85 of which corresponded to arbuscular mycorrhizae (AMF), three to dark-septate endophytes (DSE) and four to mixed colonisations (AMF + DSE). DSE colonisations were lower than in comparable samples of ferns from the Andes, suggesting a geographical or taxonomic pattern in this type of colonisation. Epiphytes had significantly lower levels of colonisation (26.1%) than terrestrial plants (70.7%), probably due to the difficulty of establishment of mycorrhizal fungi in the canopy habitat.

Reduction of workplace contamination with platinum-containing cytostatic drugs in a veterinary hospital by introduction of a closed system

The objective of this study was to determine the level of workplace contamination with platinum-containing cytostatic drugs in a veterinary hospital. A closed chemotherapy application system was then added to the safety regimen. Workplace contamination was measured over a nine-month period by taking wipe samples from seven locations. Before the introduction of the closed system, amounts of platinum were detected at four locations. After the introduction of the closed system, there was a temporary increase in contamination at two locations, followed by an overall reduction in contamination by the end of the study period.

Malignant T cells in cutaneous T-cell lymphoma lesions contain decreased levels of the antiapoptotic protein Ku70

BACKGROUND

Malignant T cells in primary cutaneous T-cell lymphoma (CTCL) are genetically unstable and exhibit prolonged lifespans potentially explained by dysregulation of apoptosis, yet are responsive to apoptosis-inducing therapies. The heterodimeric protein Ku70/80 is known to play a role in DNA repair (Ku70 and Ku80) and inhibition of apoptosis (Ku70 only).

OBJECTIVES

To investigate the expression of Ku70/80 in CD3+ T cells derived from skin and blood in patients with CTCL and normal samples, as well as benign dermatoses.

METHODS

Normal (n=10), CTCL (n=9) and benign dermatoses (n=13) skin samples were stained for confocal imaging of Ku70/80 and CD3 and analysed using imaging software. Circulating CD4+ T cells in normal and CTCL peripheral blood were analysed by flow cytometry and Western blot for Ku70/80 expression (n=6).

RESULTS

Ku70 and Ku80 were significantly diminished in T cells of CTCL lesions relative to T cells of control skin. Decreased T-cell Ku70 expression was not a feature of the benign dermatoses psoriasis and contact dermatitis, suggesting that loss of Ku70/80 in CTCL is not simply the result of cutaneous inflammation. Reduced Ku70 was also noted in circulating CD4+ T cells in patients with CTCL with peripheral blood involvement.

CONCLUSIONS

Deficient expression or lack of Ku70/80 may result in genomic instability and play a role in tumorigenesis, as well as account for the increased susceptibility of malignant T cells to apoptosis-inducing treatment modalities in the setting of intrinsic resistance to apoptosis.

Aspects of nitrogen dioxide toxicity in environmental urban concentrations in human nasal epithelium

Cytotoxicity and genotoxicity of nitrogen dioxide (NO(2)) as part of urban exhaust pollution are widely discussed as potential hazards to human health. This study focuses on toxic effects of NO(2) in realistic environmental concentrations with respect to the current limit values in a human target tissue of volatile xenobiotics, the epithelium of the upper aerodigestive tract. Nasal epithelial cells of 10 patients were cultured as an air-liquid interface and exposed to 0.01 ppm NO(2), 0.1 ppm NO(2), 1 ppm NO(2), 10 ppm NO(2) and synthetic air for half an hour. After exposure, genotoxicity was evaluated by the alkaline single-cell microgel electrophoresis (Comet) assay and by induction of micronuclei in the micronucleus test. Depression of proliferation and cytotoxic effects were determined using the micronucleus assay and trypan blue exclusion assay, respectively. The experiments revealed genotoxic effects by DNA fragmentation starting at 0.01 ppm NO(2) in the Comet assay, but no micronucleus inductions, no changes in proliferation, no signs of necrosis or apoptosis in the micronucleus assay, nor did the trypan blue exclusion assay show any changes in viability. The present data reveal a possible genotoxicity of NO(2) in urban concentrations in a screening test. However, permanent DNA damage as indicated by the induction of micronuclei was not observed. Further research should elucidate the effects of prolonged exposure.