Detection of new mutations conferring resistance to linezolid in glycopeptide-intermediate susceptibility Staphylococcus hominis subspecies hominis circulating in an intensive care unit

Glycopeptides and linezolid are the most widely used antibiotics to treat infections by methicillin-resistant Staphylococcus spp. We report the presence of various isolates of methicillin-resistant S. hominis subsp. hominis with resistance to linezolid and reduced susceptibility to glycopeptides. We studied ten blood culture isolates of S. hominis subsp. hominis from nine patients admitted to our hospital. Etest was used to study susceptibility to antibiotics commonly prescribed against staphylococci. Domain V region of the 23S rRNA gene was amplified and sequenced to detect possible mutations that confer resistance to linezolid. Pulsed-field gel electrophoresis (PFGE) was used for the clonality study of isolates. All isolates were resistant to oxacillin, gentamicin, levofloxacin, cotrimoxazole, and linezolid, and susceptible to tigecycline and daptomycin. Nine of the isolates were resistant to erythromycin and clindamycin, and showed heterogeneous resistance to glycopeptides. C2190T, G2603T, and G2474T mutations were detected in domain V of the 23S rRNA gene. PFGE showed the presence of two different clones. This report alerts to the possible appearance of clinical strains of methicillin-resistant staphylococci with intermediate resistance to glycopeptides, resistance to linezolid, and multiple resistance to other second-line antibiotics.

The effect of thermal and vapor annealing treatments on the self-assembly of TiO2/PS-b-PMMA nanocomposites generated via the sol-gel process

Polystyrene-block-poly(methyl methacrylate) (SMMA) block copolymer has been used as a structure-directing agent for generating TiO2 /SMMA nanocomposites via the sol-gel process using a hydrophobic surfactant. The aim of the work has been focused on the preparation of well-defined nanostructured composites based on the self-assembling capability of the block copolymer using two different annealing methods: thermal- and solvent-induced microphase separation. The addition of different amounts of nanoparticles caused strong variations in the self-assembled morphology of the TiO2 /SMMA nanocomposites with respect to the block copolymer, as observed by atomic force microscopy (AFM). To verify the confinement of the nanoparticles in the PMMA block 3D AFM images and corresponding AFM profiles have also been reported. UV light irradiation of the nanocomposite films provoked the removal of the organic matrix and consequently led to an array of TiO2 nanoparticles on the substrate surface.

Antimicrobial activity of plant essential oils using food model media: efficacy, synergistic potential and interactions with food components

The aim of this study was to optimise the antimicrobial efficacy of plant essential oils (EOs) for control of Listeria spp. and spoilage bacteria using food model media based on lettuce, meat and milk. The EOs evaluated were lemon balm, marjoram, oregano and thyme and their minimum inhibitory concentrations (MIC) were determined against Enterobacter spp., Listeria spp., Lactobacillus spp., and Pseudomonas spp. using the agar dilution method and/or the absorbance based microplate assay. MICs were significantly lower in lettuce and beef media than in TSB. Listeria strains were more sensitive than spoilage bacteria, and oregano and thyme were the most active EOs. EO combinations were investigated using the checkerboard method and Oregano combined with thyme had additive effects against spoilage organisms. Combining lemon balm with thyme yielded additive activity against Listeria strains. The effect of simple sugars and pH on antimicrobial efficacy of oregano and thyme was assessed in a beef extract and tomato serum model media. EOs retained greater efficacy at pH 5 and 2.32% sugar, but sugar concentrations above 5% did not negatively impact EO efficacy. In addition to proven antimicrobial efficacy, careful selection and investigation of EOs appropriate to the sensory profile of foods and composition of the food system is required. This work shows that EOs might be more effective against food-borne pathogens and spoilage bacteria when applied to foods containing a high protein level at acidic pH, as well as moderate levels of simple sugars.

Salinity and temperature effects on physiological responses of Vibrio fischeri from diverse ecological niches

Vibrio fischeri is a bioluminescent bacterial symbiont of sepiolid squids (Cephalopoda: Sepiolidae) and monocentrid fishes (Actinopterygii: Monocentridae). V. fischeri exhibit competitive dominance within the allopatrically distributed squid genus Euprymna, which have led to the evolution of V. fischeri host specialists. In contrast, the host genus Sepiola contains sympatric species that is thought to have given rise to V. fischeri that have evolved as host generalists. Given that these ecological lifestyles may have a direct effect upon the growth spectrum and survival limits in contrasting environments, optimal growth ranges were obtained for numerous V. fischeri isolates from both free-living and host environments. Upper and lower limits of growth were observed in sodium chloride concentrations ranging from 0.0% to 9.0%. Sepiola symbiotic isolates possessed the least variation in growth throughout the entire salinity gradient, whereas isolates from Euprymna were the least uniform at <2.0% NaCl. V. fischeri fish symbionts (CG101 and MJ101) and all free-living strains were the most dissimilar at >5.0% NaCl. Growth kinetics of symbiotic V. fischeri strains were also measured under a range of salinity and temperature combinations. Symbiotic V. fischeri ES114 and ET101 exhibited a synergistic effect for salinity and temperature, where significant differences in growth rates due to salinity existed only at low temperatures. Thus, abiotic factors such as temperature and salinity have differential effects between free-living and symbiotic strains of V. fischeri, which may alter colonization efficiency prior to infection.

Fetal abdominal cysts in the first trimester: prenatal detection and clinical significance

OBJECTIVE

In order to determine the clinical significance of fetal abdominal cysts detected in the first trimester, we reviewed our experience with such cases collected over a 5-year period.

METHODS

Five cases in which a fetal abdominal cyst was detected by ultrasound in the first trimester were identified. Information on the ultrasound findings, antenatal course and perinatal outcome was obtained in all cases.

RESULTS

The abdominal cyst was confirmed by an early second-trimester scan at 14-16 weeks in all cases, at which time no associated anomalies were detected. The standard detailed second-trimester scan at 18-22 weeks demonstrated complete resolution in three cases. These women had an uneventful antenatal course, and normal newborn infants were delivered at term. However, one of these infants had intestinal malrotation, chronic abdominal distension and midgut volvulus requiring surgery at the age of 7 months. Among the remaining two cases in which the abdominal cyst persisted, one required prenatal aspiration at 19 weeks owing to significant enlargement and resolved. The other remained stable in size and was managed conservatively, but the infant required surgery at the age of 7 weeks owing to a choledochal cyst causing intermittent episodes of acholia.

CONCLUSION

Abdominal cysts in early pregnancy often resolve spontaneously or remain small and are usually associated with a good outcome. Nevertheless, as they can also be associated with serious underlying gastrointestinal pathological conditions, close surveillance in the perinatal period is advocated.

Temozolomide single-agent chemotherapy for newly diagnosed anaplastic oligodendroglioma

The treatment of patients with anaplastic oligodendroglioma (AO) has been significantly impacted by the molecular detection of loss of sequences on chromosomes 1p and 19q. We performed a clinical trial to prospectively evaluate the safety of treating patients with AO with temozolomide (TMZ) alone in patients with chromosome 1p/19q loss and with chemo-radiation in patients not harboring this loss. Forty-eight patients were enrolled, 36/48 (75%) with evidence of chromosome 1p/19q loss treated with TMZ alone and 12/18 (25%) without such losses, treated with pre-radiation TMZ followed by chemo-radiation. Despite more aggressive treatment, patients without 1p/19q loss had a shorter progression-free survival (PFS) of 13.5 months. With a median follow-up time of 32 months, patients with 1p/19q LOH had a median TTP of 28.7 months. Patients with AO with 1p/19q LOH can be safely treated with single-agent TMZ and do not appear to experience earlier or more frequent tumor progression. This treatment regimen should be studied as part of a formal randomized clinical trial.

Is risk of central nervous system (CNS) relapse related to adjuvant taxane treatment in node-positive breast cancer? Results of the CNS substudy in the intergroup Phase III BIG 02-98 Trial

BACKGROUND

Breast cancer central nervous system (CNS) metastases are an increasingly important problem because of high CNS relapse rates in patients treated with trastuzumab and/or taxanes.

PATIENTS AND METHODS

We evaluated data from 2887 node-positive breast cancer patients randomised in the BIG 02-98 trial comparing anthracycline-based adjuvant chemotherapy (control arms) to anthracycline-docetaxel-based sequential or concurrent chemotherapy (experimental arms). After a median follow-up of 5 years, 403 patients had died and detailed information on CNS relapse was collected for these patients.

RESULTS

CNS relapse occurred in 4.0% of control patients and 3.7% of docetaxel-treated patients. CNS relapse occurred in 27% of deceased patients in both treatment groups. CNS relapse was usually accompanied by neurologic symptoms (90%), and 25% of patients with CNS relapse died without evidence of extra-CNS relapse. Only 20% of patients survived 1 year from the diagnosis of CNS relapse. Prognosis of CNS relapse was worse for patients with meningeal carcinomatosis when compared with brain metastases. Unexpected findings included a higher rate of positive cerebrospinal fluid cytology (8% versus 3%) and more frequent use of magnetic resonance imaging for diagnosis (47% versus 30%) in the docetaxel-treated patients.

CONCLUSION

There is no evidence that adjuvant docetaxel treatment is associated with an increased frequency of CNS relapse.

Hybrid titanium dioxide/PS-b-PEO block copolymer nanocomposites based on sol-gel synthesis

The poly(styrene)-b-poly(ethylene oxide) (SEO) amphiphilic block copolymer, with two different molecular weights, has been used as a structure directing agent for generating nanocomposites of TiO(2)/SEO via the sol-gel process. SEO amphiphilic block copolymers are designed with a hydrophilic PEO-block which can interact with inorganic molecules, as well as a hydrophobic PS-block which builds the matrix. The addition of different amounts of sol-gel provokes strong variations in the self-assembled morphology of TiO(2)/SEO nanocomposites with respect to the neat block copolymer. As confirmed by atomic force microscopy (AFM), TiO(2)/PEO-block micelles get closer, forming well-ordered spherical domains, in which TiO(2) nanoparticles constitute the core surrounded by a corona of PEO-blocks. Moreover, for 20 vol% sol-gel the generated morphology changes to a hexagonally ordered structure for both block copolymers. The cylindrical structure of these nanocomposites has been confirmed by the two-dimensional Fourier transform power spectrum of the corresponding AFM height images. Affinity between titanium dioxide precursor and PEO-block of SEO allows us to generate hybrid inorganic/organic nanocomposites, which retain the optical properties of TiO(2), as evaluated by UV-vis spectroscopy.

Quantitative estimation of permeability surface-area product in astroglial brain tumors using perfusion CT and correlation with histopathologic grade

BACKGROUND AND PURPOSE

Glioma angiogenesis and its different hemodynamic features, which can be evaluated by using perfusion CT (PCT) imaging of the brain, have been correlated with the grade and the aggressiveness of gliomas. Our hypothesis was that quantitative estimation of permeability surface area product (PS), cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) in astroglial brain tumors by using PCT will correlate with glioma grade. High-grade gliomas will show higher PS and CBV as compared with low-grade gliomas.

MATERIALS AND METHODS

PCT was performed in 32 patients with previously untreated astroglial tumors (24 high-grade gliomas and 8 low-grade gliomas) by using a total acquisition time of 170 seconds. World Health Organization (WHO) glioma grades were compared with PCT parameter absolute values by using Student or nonparametric Wilcoxon 2-sample tests. Receiver operating characteristic (ROC) analyses were also done for each of the parameters.

RESULTS

The differences in PS, CBV, and CBF between the low- and high-grade tumor groups were statistically significant, with the low-grade group showing lower mean values than the high-grade group. ROC analyses showed that both CBV (C-statistic 0.930) and PS (C-statistic 0.927) were very similar to each other in differentiating low- and high-grade gliomas and had higher predictability compared with CBF and MTT. Within the high-grade group, differentiation of WHO grade III and IV gliomas was also possible by using PCT parameters, and PS showed the highest C-statistic value (0.926) for the ROC analyses in this regard.

CONCLUSIONS

Both PS and CBV showed strong association with glioma grading, high-grade gliomas showing higher PS and CBV as compared with low-grade gliomas. Perfusion parameters, especially PS, can also be used to differentiate WHO grade III from grade IV in the high-grade tumor group.

Kidney graft survival in patients with hepatitis C: a single center experience

Hepatitis C virus (HCV) infection is highly prevalent in renal transplant candidates; however, its effect on the transplant outcome is still controversial. The aim of the present study was to determine the effect of HCV infection in the outcome of kidney transplantation in a single transplant center. The study population 144 HCV- randomized selected patients and 64 HCV+ patients transplanted from 1973 to 2000, followed for up to 60 months post-transplantation. This retrospective study included the following variables: type of dialysis, time on renal replacement therapy, number of transfusions before and after transplantation, number of transplants, type of donor, immunosuppression, and rejection episodes. The Kaplan-Meier method was used to estimate graft and patient survival. Log-rank test was used to assess the difference in survival between HCV+ and HCV-. A multivariate Cox proportional hazards model was used to analyze the relation between graft and patient survival. HCV+ and HCV- patients had similar demographic and clinical characteristics; however, a higher number of HCV+ patients received blood transfusions after transplantation. Patient survival was not significantly different in 39 HCV+ and 96 HCV- patients transplanted with living-related donors (71% and 77% at five yr, respectively). Similarly, there was not significant difference in 25 HCV+ and 48 HCV- patients transplanted with kidneys from deceased donors, although there was a tendency to better outcome in HCV- patients (55% and 72% at five yr respectively). Regarding graft survival, there was also no differences in HCV+ and HCV- recipients of living-related grafts (61% and 66% at five yr post-transplant, respectively) and recipients of kidneys from deceased donors (44% and 41%, respectively). The results show that HCV+ patients can be transplanted with the same success than HCV- patients.

32 FIRST SHEEP CLONES BORN IN SOUTH AMERICA

Since the birth of the first animal produced by nuclear transfer using adult somatic cells (Wilmut et al. 1997 Nature 385, 810–813), cloning has been used in many species. Although sheep were the first species to be cloned, the limited data available from different research groups indicate sheep to be among the lowest in terms of efficiency (0.5–2%), mainly due to high losses during pregnancy and the postnatal period. Since there were no previous reports on cloning of small ruminants in South America, the aims of the present study were to perform a larger scale sheep cloning program to evaluate the efficiency under local conditions in Argentina and describe the main postmortem findings observed in fetuses and extraembrionary membranes. Male adult fibroblast cell lines from different animals were used. Matured oocytes were recovered by flushing the oviducts of synchronized and superovulated donor ewes. From 437 ewes, 4720 oocytes were recovered (10.8 oocytes/ewe). Enucleation and nuclear transfer were performed as described previously, with modifications. Cell fusion was induced by a double electrical pulse in sorbitol medium (1.20 kV cm–1, 30 μs). Fused couplets were activated using ionomycin for 5 min and then cycloheximide and cytochalasin B for 5 h. Embryo culture was performed at 38.5°C in a 5% O2, 5% CO2, 90% N2 atmosphere, in KSOM supplemented with 2% FCS and 0.2 mm glucose on Day 3 of culture. After 6 to 7 days in culture, embryos were graded and then surgically transferred into synchronized recipients. Pregnancy rate was checked 23 days after embryo transfer and then weekly until 60 days, using a transrectal 5-MHz probe (Toshiba, Tokyo, Japan). From 70 to 150 days, a 3-MHz convex probe was used to perform monthly transabdominal scans. Most of the losses (70%) occurred within the first 90 days of pregnancy, and 15% of the fetuses were aborted late in gestation. Main ultrasound findings were fetal and placental hydrops and bilateral hydronefrosis. In addition, 6 of the ewes developed hydrallantois. Ewes beyond 148 days of gestation were induced for parturition using four IM injections of betamethasone 12 h apart (3.96 mg each). If labor did not commence, a C-section was performed (9/11). Eleven cloned lambs were born; two of them are still alive (6 months). All newborns were clinically evaluated after birth and their health assessed. Of the newborns, 80% died in the first 24 h after birth; they were depressed, with severe respiratory distress that developed into acidosis. At necropsy, fetuses were found with: collapsed lungs (9/9), fatty liver (6/9), ascitis (7/9), hydronefrosis (6/9), and placental edema with partial degeneration of placentomes (8/9). The final efficiency obtained in this large-scale cloning program (0.6%) was very similar to that reported by others in a smaller trials. Many studies on gene expression of cloned embryos and placental development have partially explained why this technique has a particular low efficiency in the sheep species; therefore further studies should be done in order to improve the outcome. Table 1. Efficiency of sheep cloning

Dimerization of the class A G protein-coupled neurotensin receptor NTS1 alters G protein interaction

G protein-coupled receptors (GPCRs) have been found as monomers but also as dimers or higher-order oligomers in cells. The relevance of the monomeric or dimeric receptor state for G protein activation is currently under debate for class A rhodopsin-like GPCRs. Clarification of this issue requires the availability of well defined receptor preparations as monomers or dimers and an assessment of their ligand-binding and G protein-coupling properties. We show by pharmacological and hydrodynamic experiments that purified neurotensin receptor NTS1, a class A GPCR, dimerizes in detergent solution in a concentration-dependent manner, with an apparent affinity in the low nanomolar range. At low receptor concentrations, NTS1 binds the agonist neurotensin with a Hill slope of approximately 1; at higher receptor concentrations, neurotensin binding displays positive cooperativity with a Hill slope of approximately 2. NTS1 monomers activate G alpha q beta(1)gamma(2), whereas receptor dimers catalyze nucleotide exchange with lower affinity. Our results demonstrate that NTS1 dimerization per se is not a prerequisite for G protein activation.

Down-regulation of bbc3, flt1 and gstm3 is associated with lymph node metastases in breast carcinoma

21171

Background: Background: Axillary lymph node metastasis is the most significant marker for the pathologic staging of breast cancer. However a proportion of lymph node-negative breast cancer will develop metastatic disease. Therefore, molecular markers of invasion in these patients are needed Methods: We selected 10 primary breast cancer cases, 5 lymph node-negative (T1N0) and 4 lymph node-positive (T1N1). In these cases we searched for gene expression of 8 genes (bbc3, cegp1, fgf18, flt1, cffm4, gstm3, hec, tgfb3) selected from previous studies as a good candidates for metastasis prediction. A quantitative Real-Time PCR was performed using beta-2- microglobulin gene expression to normalized gene expression of each gene. The expression average of beta-2-microglobulin was 303,291 among T1N0 and 342,533 among T1N1 cases (ratio 0.88). The expression average of these 8 genes was 2.11 and 0.002 at T1N0 and T1N1 respectively (ratio 1,055). At least 3 genes were significantly down-regulated in T1N1 (bbc3, flt1, gstm3) in comparison with T1N1 breast carcinomas Results: Computational analysis reveals that these 3 genes (bbc3, flt1, gstm3) contain CpG islands in their promoter regions. Although preliminary data, we found group of genes that are down-regulated in T1N1 tumor Conclusions: The finding that these genes are epigenetically regulated, suggest that could be a good candidates for metastasis prediction, by methylation approach (MethyLight System). Since this down-regulation occurs in primary tumor, the analysis of these genes might be useful to predict metastasis in lymph node-negative breast cancer.

No significant financial relationships to disclose.

Functional characterization of human bitter taste receptors

The T2Rs belong to a multi-gene family of G-protein-coupled receptors responsible for the detection of ingested bitter-tasting compounds. The T2Rs are conserved among mammals with the human and mouse gene families consisting of about 25 members. In the present study we address the signalling properties of human and mouse T2Rs using an in vitro reconstitution system in which both the ligands and G-proteins being assayed can be manipulated independently and quantitatively assessed. We confirm that the mT2R5, hT2R43 and hT2R47 receptors respond selectively to micromolar concentrations of cycloheximide, aristolochic acid and denatonium respectively. We also demonstrate that hT2R14 is a receptor for aristolochic acid and report the first characterization of the ligand specificities of hT2R7, which is a broadly tuned receptor responding to strychnine, quinacrine, chloroquine and papaverine. Using these defined ligand-receptor interactions, we assayed the ability of the ligand-activated T2Rs to catalyse GTP binding on divergent members of the G(alpha) family including three members of the G(alphai) subfamily (transducin, G(alphai1) and G(alphao)) as well as G(alphas) and G(alphaq). The T2Rs coupled with each of the three G(alphai) members tested. However, none of the T2Rs coupled to either G(alphas) or G(alphaq), suggesting the T2Rs signal primarily through G(alphai)-mediated signal transduction pathways. Furthermore, we observed different G-protein selectivities among the T2Rs with respect to both G(alphai) subunits and G(betagamma) dimers, suggesting that bitter taste is transduced by multiple G-proteins that may differ among the T2Rs.

365 COMPARISON OF IN VITRO FERTILIZING CAPACITY OF FROZEN - THAWED SEX-SORTED AND SEX-SORTED FROZEN - THAWED BULL SPERMATOZOA

Sperm sexing has become a world-wide technology, now available in many countries. The method has been incorporated into many reproductive technologies such as embryo production (Zhang et al. 2003 Theriogenology 60, 1657–1663), but sex-sorting is limited when bulls are located far from sorters or when only frozen semen is available. Previous studies on sexing frozen–thawed spermatozoa have been done in rams, which resulted in retention of the spermatozoan functional capacities (Hollinshead et al. 2004 Reproduction 127, 557–568). In vitro characteristics were assessed in bulls after sexing of thawed sperm (Hollinshead et al. 2004 Theriogenology 62, 958–968); however, the fertilizing capacity of frozen–thawed sex-sorted (FTSS) spermatozoa was not tested. The aim of the present study was to compare cleavage and embryo development rate among frozen–thawed (FT), sex-sorted frozen–thawed (SSFT), and FTSS bull spermatozoa. For FT, sperm were diluted to a final concentration of 60 × 106 sperm/mL, packaged in 0.5-mL straws, and frozen. In SSFT, spermatozoa were sex-sorted by flow cytometry following Schenk protocols (1999 Theriogenology 52, 1375–1391). Three × 106 spermatozoa were packaged into 0.25-mL straws and frozen. The final treatment (FTSS) consisted of thawing 6 to 10 frozen straws of 4 different bulls containing an average of 25 × 106 spermatozoa and centrifuging at 600g for 15 min at 21°C to extract cryodiluent. Spermatozoa were diluted and stained with Hoechst 33342 (stain concentration of 112.5 µM, the same used for SSFT treatment) following Schenk sexed-semen protocols (1999), sex-sorted by a flow cytometer, and collected in Tris-base extender containing 20% egg yolk. For each ejaculate frozen–thawed, SSFT and FTSS spermatozoa were prepared for oocyte in vitro fertilization. Also, semen from a bull routinely used as a control in the laboratory was added for a better comparison of results. Oocytes from a slaughterhouse were processed following standard in vitro fertilization procedures (Ferré 2002 Theriogenology 57, 664) 4 times for each bull, and comparison was made between treatments. Results were analyzed by ANOVA. No significant differences were observed among bulls (data not shown) (P &gt; 0.05). Although embryo development rate was statistically different between sexed and non-sexed groups (P &lt; 0.05), results showed that frozen–thawed bull spermatozoa can be sex-sorted and used for in vitro fertilization with comparable developmental rates comparable to those when frozen sexed semen is used (Table 1). This opens a new commercial window for cases where pre-selected sexed embryos from bulls that are not in AI centers are desired, also giving an opportunity for dead bulls. Nevertheless, since a large number of straws are necessary, further studies must be carried out to make this procedure more efficient and economically profitable. Table 1. Results of cleavage and embryo development rates between spermatozoa treatments

Docetaxel (T) given concurrently with or sequentially to anthracycline-based (A) adjuvant therapy (adjRx) for patients (pts) with node-positive (N+) breast cancer (BrCa), in comparison with non-T adjRx: First results of the BIG 2–98 Trial at 5 years median follow-up (MFU)

LBA519

Background: The activity of T in metastatic BrCa mandated evaluation as adjRx. We compared the efficacy of T with, or after A, both followed by CMF (cyclophosphamide/ methotrexate/ 5-fluorouracil), versus non-T adjRx. Methods: Random assignment trial in resected N+ pts, 18–70 yrs, stratified by: center, 1–3 vs >3 nodes and age <50 vs ≥50. The treatment arms were (mg/m2, intravenously unless otherwise stated): Ia: A 75 q 3 weeks × 4 ⋄ CMF ×3 (oral C 100 day 1–14, F 600 + M 40 d 1+8; q 28 days). Arm Ib; AC 60/600 × 4⋄CMF × 3. Arm II: A75 × 3 ⋄T100 ×3 ⋄CMF ×3. Arm III: AT 50/75 ×4 ⋄ CMF × 3. Pts subsequently received hormono-(receptor+), and radiotherapy per local guidelines. Randomization was in the ratio (1:1:2:2). The trial was designed to have 80% power to detect a 78% hazard ratio (HR) for relapse in II+III v I, with final analysis at 1215, and interim at 405 and 810 events. The primary comparison between the II+III and I would be done at a one-tailed significance level of 0.025. Secondary comparisons of II vs Ia and III vs Ib would be done using a closed testing procedure at a one-tailed significance level of 0.025. The 95% confidence limits of the HR of III v II would be calculated. Due to a low relapse rate, the plan was amended with main analysis after 810 events or 5 years MFU. Results: 2887 pts were enrolled (6/1998–6/2001). Characteristics were well-balanced, 46% had >3N+. Grade 3/4 toxicity occurred in 22.9, 24.7, 35.3 and 28.6 % of pts in Ia, Ib, II and III respectively. At 62.2 months MFU (3/2006), 732 pts (25%) had events. Planned event-free survival (EFS) comparisons were: Conclusion: In this study, the HR for T v non-T adjRx was of borderline significance. There were possibly important differences related to schedule, sequential but not concurrent appearing superior to non-T adjRx. Overall survival analysis will require longer follow-up. Translational studies are underway.

[Table: see text] [Table: see text]

Nonesophageal side-effects after antireflux surgery plus acid-suppression duodenal diversion surgery in patients with long-segment Barrett's esophagus*

During the last years we have employed acid-suppression duodenal diversion procedures (truncal vagotomy-partial gastrectomy plus Roux-en-Y gastrojejunostomy) in addition to antireflux surgery in order to treat all the pathophysiological factors involved in the genesis of Barrett's esophagus. We have observed very good results concerning the clinical and objective control of GERD at the long-term follow up after this procedure. However, it could be associated with other nonesophageal symptoms or side-effects. This study was conducted to evaluate the presence of gastrointestinal symptoms (diarrhea, vomiting, dumping, weight loss and anastomotic ulcers) after this operation. In this prospective study 73 patients were assessed using a careful clinical questionnaire asking regarding these complications at the early (< 6 months) and late (> 6 months) follow-up (average of 32.4 months). In the early postoperative period, diarrhea was present in 64% (19% considered severe 10-90 days after surgery), dumping in 41% and loss of weight in 71% of cases. Diarrhea occurred daily in 47.7% in the early postoperative period, but only in 16% of cases after 1 year. Shortly after surgery, steatorrea was observed in 9% of cases and responded well to medical treatment. Severe diarrhea or dumping was rare (5% of cases). These symptoms improved significantly after 1 year with medical management (45%, 20% and 30%, respectively) and 42% of patients regained their normal body weight. Only two patients presented anastomotic ulcers and were treated satisfactory with proton pump inhibitors. Revisional surgery was indicated in two patients with severe dumping syndrome. Most side-effects identified by this study were mild and diminished 1 year after operation.