[Single-center cohort study of elderly patients with surgically removed colorectal cancers]

Incidence of colorectal cancers (CRCs) increases with age. The surgical and medical management of elderly patients needs to be improved. Until recently, these patients were not included into controlled clinical trials. Between 2004 and 2007, 88 patients (median age 79) had surgery for CRC in our hospital. In half the cases, patients had an emergency surgery (40/88). Twenty patients had dementia, with no relationships between dementia and emergency surgery (50% vs. 45% for patients without dementia), nor between dementia and median length of hospital stay (16 days vs. 22 days). In metastatic setting (20 patients), chemotherapy was omitted in 10 cases, usually patients with dementia (5 patients; p = 0.002) Standard therapy was hardly applicable because many patients were frail. In the future, usefulness of participation to the staffs of a geriatrist will be assessed prospectively.

DHA metabolism: targeting the brain and lipoxygenation

Docosahexaenoic acid (DHA), the end-product of the metabolism of omega-3 family fatty acids, is the main polyunsaturated fatty acid of the brain, but its accumulation is incompletely understood. This paper reviews how it could accumulate through specific uptake of DHA-containing lysophosphatidylcholine (LysoPC-DHA). DHA migrates very easily from the sn-2 position of LysoPC, which could be considered as the physiological form of polyunsaturated LysoPC, to the sn-1 position, which is much more stable. An approach preventing migration by acetylating the sn-1 position, while retaining the main physico-chemical properties of the carrier, is described. Also, the double lipoxygenation and bond-isomerization of DHA into 10(S),17(S)-docosahexa-4Z,7Z,11E,13Z,15E,19Z-enoic acid, named PDX, by soybean lipoxygenase is described. As in other E,Z,E conjugated trienes, PDX is shown to inhibit human blood platelet aggregation at submicromolar concentrations.

[Descriptive anatomy of the orbit]

Anatomical description of the orbit is essential for an accurate understanding of its related tumoral pathologies. Numerous cadaveric pictures illustrate this chapter, which contains the description of the bony walls of the orbit and its muscular nerve, and vascular structures.

Streptococcus porci sp. nov., isolated from swine sources

Two unidentified Gram-positive, catalase-negative, coccus-shaped organisms were recovered from pigs and subjected to a polyphasic taxonomic analysis. Based on cellular morphology and biochemical criteria, the isolates were tentatively assigned to the genus Streptococcus, although the organisms did not appear to correspond to any recognized species. Comparative 16S rRNA gene sequence studies confirmed this identification and showed that the nearest phylogenetic relatives of the unknown cocci were Streptococcus plurextorum 1956-02T and Streptococcus suis NCTC 10234T (97.9 and 96.0 % 16S rRNA gene sequence similarity, respectively). The new isolates were related most closely to S. suis CIP 103217T based on rpoB gene sequence analysis (<8 % sequence divergence). DNA–DNA pairing studies showed that one of the unidentified strains (2923-03T) displayed DNA relatedness values of 26.6 and 27.2 % with S. plurextorum CECT 7308T and S. suis NCTC 10234T, respectively. On the basis of phenotypic and phylogenetic evidence, it is proposed that the unknown isolates from pigs be classified in the genus Streptococcus as members of Streptococcus porci sp. nov., with the type strain 2923-03T (=CECT 7374T =CCUG 55896T).

Binding of Ru(NH3)5pz2+ to 4-sulfocalix[4]arene sodium salt. Effects of the host-guest interaction on electron transfer processes

The reactions [Ru(NH3)5pz]2++S2O8(2-) and [Ru(NH3)5pz]2++[Co(C2O4)3]3- have been studied in solutions of 4-sulfocalix[4]arene sodium salt. Results show a binding of the ruthenium complex to the calixarene with a 2:1 stoichiometry; that is, a ruthenium molecule binds to two calixarene molecules. This stoichiometry changes when NaCl is added to the medium. Thus, a mixture of 1:1 and 2:1 adducts is found in the presence of 0.1 mol dm(-3) NaCl and only 1:1 adducts when the salt concentration is increased up to 0.3 mol dm(-3). Results show that the binding of the ruthenium complex to the calixarene is due to electrostatic and nonelectrostatic interactions. Kinetic data are interpreted by using the pseudophase model and taking into account the stoichiometry of the ruthenium binding to calixarene. The presence of a supporting electrolyte in the medium produces ion pair formation which exerts an influence on the kinetic rate constants.

Multiple ganglion cysts (‘cystic ganglionosis’): an unusual presentation in a child

A case of multifocal and recurrent ganglion cysts is described. An 11-year-old boy was referred because of symptomatic cystic masses in the extremities since the age of 2 years. Over the years, he had experienced intermittent appearance of these lesions, which were associated with pain, but without any systemic manifestations. Magnetic resonance imaging (MRI) showed cystic lesions with synovio-capsular thickening along the temporomandibular joints (TMJ), atlanto-axial synovial articulation, and tendons and joints of the right wrist and hand. Histopathological examination of one lesion showed anastomosing fibro-connective tissue surrounded by a wall of smooth muscle and fibrous connective tissue, findings that were consistent with ganglion cyst. The early onset of the disease, as well as the involvement of multiple and unusual sites, including the TMJ, implies a genetic susceptibility to these lesions that we refer to as 'cystic ganglionosis'.

Tuberculous meningitis in HIV-infected and non-infected patients: comparison of cerebrospinal fluid findings

We performed a retrospective comparison of cerebrospinal fluid (CSF) characteristics and drug susceptibility profile in human immunodeficiency virus (HIV) infected and non-infected patients with a diagnosis of tuberculous meningitis. HIV-infected patients had a higher frequency of non-inflammatory CSF (absence of pleocytosis) and of infection by multidrug-resistant strains of Mycobacterium tuberculosis. Protein CSF levels were lower in HIV-infected patients, while and glucose concentration was similar in both groups. Hospital mortality was significantly higher in HIV-infected patients (63.3% [64/101] vs. 17.5% [7/40]).

Characterization of precipitates size distribution: validation of low-voltage STEM

The size distribution of second phase precipitates is frequently determined using conventional transmission electron microscopy (CTEM). However, other techniques, which present different advantages, can also be used for this purpose. In this paper, we focus on high angle annular dark field (HAADF) in TEM and scanning TEM (STEM) in scanning electron microscopy (SEM) imaging modes. The mentioned techniques will be first described, then compared to more conventional ones for the measurement of carbides size distribution in two FeCV and FeCVNb model alloys. This comparative study shows that STEM in SEM, a technique much easier to undertake compared to TEM, is perfectly adapted for size distribution measurements of second phase particles, with sizes ranging between 5 and 200 nm in these systems.

[A serious late complication of non-operative management of splenic trauma: rupture of splenic artery aneurysm]

Over the last five past years, three patients required urgent operation in our institution for hemorrhagic shock after rupture of a post-traumatic splenic artery aneurysm. Those patients had undergone non- operative management (NOM) of grade III, IV (AAST classification) splenic injury 9, 13, and 22 months earlier. Two of them had a CT scan 30 days after initial trauma with no evidence of a developing splenic artery aneurysm. All three patients survived after proximal ligature of splenic artery and hemostatic splenectomy. Our experience with these three cases suggests that a delayed follow-up for patients at high risk is indicated in order to prevent this dramatic complication by early intervention. The modality of this follow-up should be determined by a prospective multicenter study.

Mucosal immunization against ovine lentivirus using PEI-DNA complexes and modified vaccinia Ankara encoding the gag and/or env genes

Sheep were immunized against Visna/Maedi virus (VMV) gag and/or env genes via the nasopharynx-associated lymphoid tissue (NALT) and lung using polyethylenimine (PEI)-DNA complexes and modified vaccinia Ankara, and challenged with live virus via the lung. env immunization enhanced humoral responses prior to but not after VMV challenge. Systemic T cell proliferative and cytotoxic responses were generally low, with the responses following single gag gene immunization being significantly depressed after challenge. A transient reduction in provirus load in the blood early after challenge was observed following env immunization, whilst the gag gene either alone or in combination with env resulted in significantly elevated provirus loads in lung. However, despite this, a significant reduction in lesion score was observed in animals immunized with the single gag gene at post-mortem. Inclusion of IFN-gamma in the immunization mixture in general had no significant effects. The results thus showed that protective effects against VMV-induced lesions can be induced following respiratory immunization with the single gag gene, though this was accompanied by an increased pulmonary provirus load.

Severe renal complications in chronic myelomonocytic leukemia

A 56-year-old man presented with peripheral monocytosis and massive nephrotic syndrome. He was diagnosed as having chronic myelomonocytic leukemia and membranous glomerulonephritis. He received prednisone, chlorambucil and hydroxyurea, but the nephrotic syndrome persisted. Seven months after diagnosis, he was started on cyclosporin A; 1 month later he developed acute renal failure due to radiolucent bilateral renoureteral stones. His kidney function recovered after placing ureteral catheters and urine alkalization. Afterward, he was given mycophenolate mofetil, and proteinuria decreased to subnephrotic levels (1 g/24 hours). This case highlights 2 severe renal complications in this type of leukemia. To the best of our knowledge, there are only 2 previous cases of glomerulonephritis, histologically proven, associated with chronic myelomonocytic leukemia. On the other hand, reversible acute renal failure due to radiolucent bilateral renoureteral stones has never been reported. Also, as far as we know, mycophenolate mofetil was successfully used here for the first time for treating glomerulonephritis-related chronic myelomonocytic leukemia.

Paradigms and experimental set-up for the determination of the acceptable delay in telesurgery

The aim of this work was to develop an experimental set-up and realistic paradigms to study the effect of delay on video flux transmission and surgical performance. Four exercises were performed by 15 surgeons with 5 different simulated transmission delays. Large standard deviation of the duration of an exercise was found. Even with a short transmission delay of 150ms, some surgeon found that the surgical procedure was not possible. Further work has to be done to have a better evaluation of the surgical precision.

Performance of anaerobic thermophilic fluidized bed in the treatment of cutting-oil wastewater

This paper examines the effect of organic loading rate on the removal efficiency of COD and TOC anaerobic thermophilic fluidized bed reactor (AFBR) in the treatment of cutting-oil wastewater at different hydraulic retention time (HRT) conditions. The essays are development at laboratory scale using a porous support medium. The AFBR reactor was subjected to a programme of steady-state operation over a range of hydraulic retention times, HRTs, in the range 12-2h and organic loading rates, OLRs, between 11.9 and 51.3kgCOD/m(3)d. The highest efficiency was 95.9% for an OLR of 13kgCOD/m(3)d and HRT of 11h. Over an operating period of 92 days, an OLR of 51.3kgCOD/m(3)d was achieved with 67.1% COD removal efficiency (71.3% TOC) in the experimental AFBR reactor. Although the level of biogas generation was not high, the anaerobic fluidized bed technology provided significant advantages over the conventional physico-chemical treatment applied in the factory. The effluent had a better quality (lower organic loading) and it was possible to reuse it in different applications in the factory (e.g., irrigation of gardens). The biological treatment did not lead to the generation of oily sludge, which is considered as hazardous waste by legislation. Furthermore, a continuous stream is produced and this reduced the impact of large flows discharged 4-5 times per week to the urban collector and MWWTP (municipal wastewater treatment plant).

Functional specifications of an integrated proteomics information management and analysis platform

Detecting proteins in human blood holds the promise of a revolution in cancer diagnosis. Also, the ability to perform laboratory operations on small scales using miniaturized (lab-on-a-chip) devices has many benefits. Designing and fabricating such systems is extremely challenging, but physicists and engineers are beginning to construct such highly integrated and compact labs on chips with exciting functionality. This paper focuses on the presentation of the requirements of the information technology layer in such an integrated platform been developed in the LOCCANDIA project. LOCCANDIA is a Specific Targeted Research project (STREP) funded under the 6th Framework program of the EC. Its ultimate objective is to develop an innovative nano-technology based (lab-on-a-chip) platform for the medical-proeomics field. The paper presents the main engineering aspects, challenges and architecture for creating an Integrated Clinico-Proteomic Environment. The environment will be used to monitor and document the analysis and discovery chain and to allow the physician to interpret the digital spectrogram data delivered by the mass spectrometer, for diagnostic purposes.

Evaluating the strengths and weaknesses of tuberculosis educational activities for prisoners in Honduras

SETTING

Prisons throughout Honduras.

OBJECTIVE

To assess the strengths, weaknesses, and opportunities to improve non-standardized tuberculosis (TB) educational campaign materials utilized in prisons.

DESIGN

A qualitative assessment was conducted. Prison staff completed a survey describing development and implementation of educational activities at each prison (n=25). Completed surveys with photographs or copies of educational materials were collected and cataloged. The content, literacy demand, illustrations, learning stimulation, and cultural appropriateness of cataloged items were assessed using an adapted version of the Suitability Assessment of Materials Instrument. Results from this assessment were examined in conjunction with information collected through focus groups conducted with prisoners and interviews with prison staff.

RESULTS

Campaign strengths included the development and dissemination of print materials appropriate for individuals with low literacy levels. By actively engaging prisoners in the campaigns, materials often incorporated the language, values, and experiences encountered within prison culture. Content of print materials and presentations focused on correcting misperceptions and facilitating acceptance of TB control activities. Campaign weaknesses included the creation of illustrations that could perpetuate the stigma associated with TB and use of some materials in which the purpose was not apparent.

CONCLUSIONS

The campaigns were generally suitable, and the evaluation allowed for their improvement.

Expression of TCL1 and CD27 in primary cutaneous B-cell lymphomas

AIMS

To investigate by immunohistochemical analysis the expression of the TCL1 oncogene product and of CD27 in 25 cases of primary cutaneous B-cell lymphomas (PCBCL) classified according to the World Health Organization-European Organization for Research and Treatment of Cancer classification of cutaneous lymphomas. In B-cell ontogenesis TCL1 is mainly expressed by 'naive' B lymphocytes and by a subset of germinal centre B cells, whereas CD27 is expressed by a subset of germinal centre B cells, 'memory' B lymphocytes and plasma cells, suggesting that their expression in physiological conditions is mutually exclusive.

METHODS AND RESULTS

Overall, TCL1 was expressed in 5/25 cases (20%) and CD27 in 15/25 cases (60%). Furthermore, 7/25 cases (28%) were TCL1- and CD27- and 2/25 cases (8%) were TCL1+ and CD27+. In particular, primary cutaneous follicle-centre lymphomas (10 cases) showed a variable expression of both TCL1 and CD27, whereas primary cutaneous marginal-zone B-cell lymphomas (eight cases) showed, with the exception of a single case, a definite CD27+/TCL1- profile.

CONCLUSIONS

These findings indicate: (i) the TCL1 oncogene product is uncommonly expressed in PCBCL (20% of cases, mainly of the follicle-centre subtype); (ii) in contrast, CD27 is often expressed in PCBCL (60% of cases), mainly of the marginal-zone subtype; (iii) the coexpression of TCL1 and CD27 may be seldom observed in PCBCL (8% of cases); (iv) PCBCL does not seem to show, in terms of either TCL1 or CD27 expression, significant differences compared with its systemic counterparts.

Exercise capacity in a 78 year old patient with McArdle's disease: it is never too late to start exercising

The case is reported of a 78 year old man with McArdle's disease and a history of treated coronary heart disease. Despite the pre-exercise administration of sucrose allowing the patient to exercise with normal physiological responses, and without typical McArdle's symptoms or biochemical evidence of muscle damage, his exercise capacity was very low (V(O2)peak = 10.7 ml/min/kg), probably attributable to his lifetime of sedentary living. The data suggest that, with pre-exercise sucrose administration, such patients may be candidates for systematic reconditioning, which may improve functional capacity and quality of life.

Unintentional injury depictions in popular children's television programs

OBJECTIVES

The frequency and magnitude of depictions of risky events and unintentional injuries in top ranked children's animated and live action television programs was assessed.

METHODS

Qualitative and quantitative media content analysis were used. Scenes from television episodes were examined for the depiction of risky events and unintentional injuries.

RESULTS

A total of 201 actual and potential injury related events were tabulated in 99 episodes aired in 2003 and 2004. Only 26% of the risky events depicted led to an injury or physical consequence. More than 80% of the events involved behavioral or environmental risk factors. Safety factors were not present in over 90% of risky events depicted. The general tone and context of events was humor or indifference rather than concern or action, with little or no relevance to the plot.

CONCLUSION

Unintentional injuries are the leading cause of death and disability for children, yet animated and live action television programs marketed to children continue to portray injury risk inaccurately. Working with the children's television production industry to improve injury depiction is a much needed advocacy activity.

Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH): a systematic analysis of expert opinion

Disease progression has become an important issue for the management of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). Although several risk factors have been identified, no specific patient risk profiles have been established that can be useful in the day-to-day management of LUTS/BPH. In this study, an international panel of urologists developed a risk classification based on the attribution of a risk score to 243 unique patient profiles. From the perspective of clinical decision making, it was concluded that postvoid residual, symptom severity and maximum flow rate are the most relevant determinants of the risk of disease progression.

Integrating risk profiles for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia: a combined analysis of external evidence and clinical expertise

The RAND appropriateness method was used to explore the relevance of risk factors for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). A total of, 12 international experts assessed the appropriateness of various treatments for 243 risk profiles. Highest appropriateness rates were found for alpha1-adrenoceptor antagonists (68% of profiles) and combination therapy (46%). A large prostate volume was the dominant argument in favour of 5alpha-reductase inhibitors and combination therapy, but was irrelevant for the choice of surgery. Considerable postvoid residual, severe symptoms and poor maximum flow rate were the most important factors in favour of surgery.

The Role of Mesopores in Intracrystalline Transport in USY Zeolite: PFG NMR Diffusion Study on Various Length Scales

PFG NMR has been applied to study intracrystalline diffusion in USY zeolite as well as in the parent ammonium-ion exchanged zeolite Y used to produce the USY by zeolite steaming. The diffusion studies have been performed for a broad range of molecular displacements and with two different types of probe molecules (n-octane and 1,3,5-triisopropylbenzene) having critical molecular diameters smaller and larger than the openings of the zeolite micropores. Our experimental data unambiguously show that, in contrast to what is usually assumed in the literature, the intracrystalline mesopores do not significantly affect intracrystalline diffusion in USY. This result indicates that the intracrystalline mesopores of USY zeolite do not form a connected network, which would allow diffusion through crystals only via mesopores.