Blue boats in deep waters: how aspects of IUU policy impact Vietnamese fish workers

Illegal, unreported, and unregulated (IUU) polices in the Asia-Pacific region are impacting Vietnamese blue boats. We examine several aspects of IUU policy, including the effects of hardening marine borders in the Southeast Asian region and the increased surveillance of Vietnamese blue boats, to understand how such policies impact blue boat owners, captains, and workers. We find that under increased surveillance, fishers face greater precarity as they become subject to the legal and political actions of multiple states. When blue boats are caught outside Vietnamese waters, boat owners, captains, and workers face significant, albeit differentiated, livelihood challenges. We argue that policies designed to stop IUU or unsustainable fishing should also proactively address working conditions on blue boats; if not, policies may unwittingly cause problems for those directly involved in the industry, with hired workers facing particular hardships. For these reasons, Vietnam's IUU yellow card can also be seen as an opportunity for fisheries labor reforms.

[Thyroid nodules in children: risk of malignancy for each Bethesda category]

PURPOUSE

Thyroid nodules are unusual findings in children. Some authors highlight the higher rate of malignancy in this group. The Bethesda system, created in adults to stratify thyroid nodules according to the risk of malignancy, constitutes a reference system for the management of this pathology. The American Thyroid Association promotes its use in the pediatric population, although there is no available data showing an equivalent risk. The aim of this study was to assess the risk of malignancy represented by each Bethesda stage in a pediatric study population.

METHODS

A retrospective cohort study was performed in pediatric patients with thyroid nodules biopsied by fine needle aspiration, during the period 2005-2017. During the follow-up, the outcome was assessed by comparing the Bethesda stage (cytology) with the surgical specimen histology. For patients not surgically treated, Bethesda Class was compared with the clinical and imaging follow up.

RESULTS

105 patients with fine needle aspiration of a thyroid nodule were analyzed and classified by the Bethesda system. 47 patients were excluded for incomplete follow-up. All Bethesda I nodules were benign, 6.6% of Bethesda II were malignant and all Bethesda IV, V and VI nodules were histologically malignant.

CONCLUSION

The rate of malignancy among patients with Bethesda II, IV, V and VI was higher than published in Bethesda classification for adults. The risk of malignancy in pediatric patients might be greater than expected. These results may have a significant impact on follow-up strategies and also in therapeutic algorithms.

[Total parathyroidectomy, autoimplant and cryopreservation for the treatment of hyperparathyroidism of renal origin in children and young adults]

OBJECTIVES

To describe our initial experience in the treatment of hyperparathyroidism (HPP) of renal cause using total or subtotal parathyroidectomy, autoimplant and cryopreservation in pediatric patients. Secondary HPP is the increased function of the parathyroid hormone (PTH) due to an abnormal phosphocalcic metabolism in patients with chronic renal failure (CRF). This situation produces increased bone resorption resulting in osteodystrophy and endovascular calcifications. Surgical treatment is aimed to diminish the level of PTH in CRF patients, to avoid HPP complications.

METHODS AND MATERIALS

Descriptive, monocentric and retrospective study of a case series of patients with secondary and tertiary hyperparathyroidism, who went through total or subtotal parathyroidectomy, autoimplant and cryopreservation between 2009 and 2016. We analyzed the following variables: age, calcemia, PTH, phosphatemia, alkaline phosphatase (ALP), follow-up and complications. The continuous variables are expressed in median and interquartile range or in mean and SD, according to their distribution. The categorical variables were expressed in percentages and frequencies (repeated sentence).

RESULTS

Number of patients included: 13. Mean age of the patients was 16.7 years old. Preoperative median calcium dosage was 9.1 mg/dl (IQR: 8.9-9.5). Median PTH was 2,600 pg/ml (IQR: 1,400 pg/ml to 2,785 pg/ml). Intraoperatory dosage of PTH reported a median drop of 86.6% in the first 15 minutes (IQR: 80.5-95.9). After the first 48 hours, median calcemia was 9 mg/dl (IQR: 7.7-9.4) and median PTH was 40 pg/ml (IQR: 20-113). We did not identify intraoperatory complications. In the immediate post operatory stage, mean IV calcium therapy was 4 days (SD: 2.39). Median time of follow-up was 18 months (IQR 9-36). Two patients had hungry bone syndrome and one patient had a recurrence of the pathology as remote post operatory complications. After a year, median calcemia, was 9 mg/dl (IQR: 7.6-9.3) and median PTH was 50 pg/ml (IQR: 28.5-108). The decrease in PTH and ALP were statistically significant with p value < 0.05.

CONCLUSION

In our study, total parathyroidectomy with auto implant is a safe and effective option for the treatment of secondary and tertiary hyperparathyroidism in pediatric patients. This could also prevent bone complications.

Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition

OBJECTIVE

To report the prevalence of hypophosphatemia during the first week of life in preterm infants receiving aggressive parenteral nutrition and to analyze population variables associated with severe hypophosphatemia.

STUDY DESIGN

A retrospective cohort of 61 neonates below 1250 g birth weight consecutively born at Hospital Italiano de Buenos Aires exposed to high caloric and protein intake from the first day of birth. Primary outcome was hypophosphatemia (phosphate <4 mg dl(-1)). A one-sample mean comparison test was used to compare our sample with a hypothesized population mean.

RESULTS

The prevalence of hypophosphatemia was 91% (95% confidence interval (CI) 82 to 97%). The mean phosphatemia value was 2.52 mg dl(-1) (95% CI 2.18 to 2.86), significantly different from the hypothesized population mean (P<0.001). Patients with severe hypophosphatemia (<2 mg dl(-1)) were smaller. They presented with sepsis more frequently and received more vasoactive drugs and mechanical ventilation.

CONCLUSION

The prevalence of hypophosphatemia in this group of preterm infants is high. The potential association with adverse clinical outcomes deserves further research.

Pavlovian discrimination in rats using voluntary exposure to a lithium chloride procedure

In a conditioned taste aversion (CTA) procedure, the consumption of a flavor is followed by the administration of a toxin (e.g. lithium chloride, LiCl), resulting in the future avoidance of the flavor. CTA studies typically make use of forced-exposure paradigms where a volume of the toxin dependent upon the weight of the animal is injected. The use of forced paradigms can be problematic when extended training is required, such as in stimulus discrimination training involving similar flavors, since the animals can be exposed to a high amount of the toxin. In the present study we confirmed the viability of an alternative voluntary-exposure paradigm that more closely mimics natural conditions and is more considerate of the welfare of the animals as a useful tool for investigating discrimination training. In three experiments, rats received free access to either a flavor (sucrose in Experiments 1a and 1b, and saccharin in Experiment 2) or a compound of the flavor mixed with LiCl. The presence of LiCl in the compound induced post-consumption illness. Rats acquired an aversion to the flavor + LiCl compound, thus reducing both their consumption of, and exposure to, LiCl, and gradually increased their consumption of the flavor alone. The present paradigm is more similar to natural conditions than the forced-exposure paradigm as it allows the animals to experience a direct relationship between the amount of the flavor consumed and the magnitude of the illness induced by the toxin.

The effect of context change upon long-term memory of CS duration

An experiment with rats investigated forgetting of inhibition of delay in the conditioned suppression paradigm. The combined effects of contextual change and retention interval were tested. After a reliable temporal discrimination was reached, half of the rats received a test in the training context after a retention interval of 3 or 20 days. The other half received it in a different but equally familiar context at either retention interval. The longest retention interval flattened the temporal discrimination gradient and increased suppression to the CS. A similar but weaker pattern was found with the change of context; this effect was independent of the retention interval. The implications for retrieval and interference theory [Bouton, M.E., 1993. Psychol. Bull., 114: 80-99] and hypotheses concerning the forgetting of specific features of stimuli over time [Riccio, D.C., Richardson, R. and Ebner, D.L., 1984. Psychol. Bull., 96: 152-165] are discussed.

Therapeutic approaches to the challenge of neuronal ceroid lipofuscinoses

The Neuronal Ceroid Lipofuscinoses (NCLs) are lysosomal storage diseases (LSDs) affecting the central nervous system (CNS), with generally recessive inheritance. They are characterized by pathological lipofuscin-like material accumulating in cells. The clinical phenotypes at all onset ages show progressive loss of vision, decreasing cognitive and motor skills, epileptic seizures and premature death, with dementia without visual loss prominent in the rarer adult forms. Eight causal genes, CLN10/CTSD, CLN1/PPT1, CLN2/TPP1, CLN3, CLN5, CLN6, CLN7/MFSD8, CLN8, with more than 265 mutations and 38 polymorphisms (http://www.ucl.ac.uk/ncl) have been described. Other NCL genes are hypothesized, including CLN4 and CLN9; CLCN6, CLCN7 and possibly SGSH are under study. Some therapeutic strategies applied to other LSDs with significant systemic involvement would not be effective in NCLs due to the necessity of passing the blood brain barrier to prevent the neurodegeneration, repair or restore the CNS functionality. There are therapies for the NCLs currently at preclinical stages and under phase 1 trials to establish safety in affected children. These approaches involve enzyme replacement, gene therapy, neural stem cell replacement, immune therapy and other pharmacological approaches. In the next decade, progress in the understanding of the natural history and the biochemical and molecular cascade of events relevant to the pathogenesis of these diseases in humans and animal models will be required to achieve significant therapeutic advances.

Erlotinib as maintenance therapy after concurrent chemoradiotherapy in patients (p) with stage III non-small cell lung cancer (NSCLC): A Galician Lung Cancer Group phase II study

7537

Background: Combination of platinum-based chemotherapy and radiotherapy is the standard treatment for p with unresectable stage III NSCLC, but considering the high rates of recurrence, it is necessary to improve these results. Erlotinib is an EGFR TKI that prolongs survival in p with recurrent and metastatic NSCLC. In this study, we aim to evaluate the role of erlotinib as maintenance therapy after a standard concurrent chemo-radiotherapy regimen in p with stage III NSCLC. Methods: P with unresectable stage IIIA/IIIB—without malignant effusions—NSCLC who had received a standard concurrent chemo-radiotherapy regimen and had no evidence of tumor progression were enrolled in this single arm, open-label phase II study and received erlotinib 150 mg/day po for 6 months. Main eligibility criteria were: PS 0–2, adequate bone marrow, hepatic and renal function and measurable disease by RECIST criteria. Primary endpoint was the percentage of p without evidence of disease progression after 6 months of erlotinib therapy and secondary endpoints were: PFS, OS, ORR and safety profile. Results: 49 p have been included in the study and data from 37 p are presented in this analysis. Baseline characteristics: median age 62 years (range 41–76); male 94.6%; caucasian 100%; smokers/never smokers (%) 97.3/2.7; ECOG PS 0/1/2 (%) 18.9/75.7/2.7; adenocarcinoma/squamous cell carcinoma/large cell carcinoma (%) 16.2/75.7/5.4; stage IIIA/IIIB (%) 16.2/83.8. Most common previous chemo-radiotherapy regimen is cisplatin/docetaxel/RT (83.8%). 27 p were evaluable for tumor response: CR 22.2%; PR 12.8%; SD 55.6%; PD 7.4%. Median TTP was 7.3 months (95% CI 5.8–16.9) and median OS was 18.7 months (95% CI 11.8-NA). Most common adverse events related to erlotinib were rash 30.6% (3 p gr. 3) and diarrhea 16.7%. Conclusions: Erlotinib as maintenance therapy is an active and well tolerated treatment after concurrent chemo- radiotherapy in p with stage III NSCLC. In spite of the majority of patients are caucasian, males, smokers with squamous cell carcinoma, maintenance with single agent erlotinib reached a promising median OS of 18.7 months. Updated data will be presented.

No significant financial relationships to disclose.

A phase II randomized trial of gemcitabine-docetaxel versus gemcitabine-cisplatin in patients with advanced non-small cell lung carcinoma

PURPOSE

To test efficacy and tolerability of non-platinum regimens for advanced non-small-cell lung cancer (NSCLC).

METHODS

Chemonaive patients with measurable stage IIIB/IV NSCLC treated with gemcitabine and cisplatin (GC), or gemcitabine and docetaxel (GD), maximumsix cycles in a phase IIB trial.

RESULTS

A total of 108 patients were randomized. Response rates (GC vs. GD, respectively): complete 3.6/2.0%, Partial 30.9/38.0%. Median Overall Survival (OS): 8.9 months in both groups (P = 0.53); and median time to progression (TTP): 6.2/5.5 months respectively (P = 0.61). Toxicities included (GC vs. GD, respectively): grade 3-4 neutropenia 49.1/41.2%; grade 3 thrombocytopenia 30.9/3.9%; grade 3 anemia 14.5/3.9%. Non-haematological toxicity was similar, except for nausea and vomiting, (16.3/2%); renal toxicity (3.7/0%) and hepatic toxicity (5.6/12.7%).

CONCLUSIONS

With a higher overall response rate and lower toxicity, GD is a good first treatment option for advanced NSCLC.

Effects of raloxifene therapy on circulating osteoprotegerin and RANK ligand levels in post-menopausal osteoporosis

Previous in vitro studies suggest that the anti-resorptive effect of raloxifene might be mediated by changes in several cytokines involved in the bone remodeling process. In this context, the osteoprotegerin (OPG)- receptor activator of NF kappa B ligand (RANKL) system is considered a key component in the osteoclastogenesis regulation. The aim of this study was to determine the effects of raloxifene treatment on serum concentrations of OPG, receptor RANKL and its relationship with biochemical markers of bone turnover and bone mineral density (BMD) in previously untreated women with post-menopausal osteoporosis. We selected 47 post-menopausal women (mean age 63+/-7 yr) with densitometric criteria of osteoporosis. We determined at baseline, 3, 6, and 12 months anthropometric parameters, biochemical markers of bone turnover, serum levels of 25(OH) D, serum levels of OPG and RANKL. BMD (dual-energy x-ray absorptiometry) in lumbar spine (LS) femoral neck and total hip was measured at baseline and 12 months after raloxifene (60 mg/day) treatment. Serum levels of OPG decreased in the 3rd and 6th month of treatment (p<0.001) and returned to basal levels in the 12th month. There was a significant decrease of RANKL levels and OPG/RANKL ratio after 1 yr of raloxifene treatment. In addition, BMD in LS increased significantly (2.5%) in the 12th month of treatment (p=0.031). Finally, the biochemical markers of bone turnover (total alkaline phosphatase, bone alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase, urine cross-linked carboxi-terminal telopeptide of type I collagen) decreased significantly from the 3rd month of treatment. In conclusion, our results support the hypothesis that raloxifene may inhibit osteoclast activity, at least partly modulating the OPG-RANKL system.

Synergistic activation of astrocytes by ATP and norepinephrine in the rat supraoptic nucleus

Supraoptic nucleus (SON) neurons receive a dense innervation from noradrenergic fibers, the activity of which stimulates vasopressin (VP) and oxytocin (OT) release, notably during homeostatic regulation of blood pressure and volume. This regulation is known to involve the co-release of norepinephrine (NE) and ATP, which act in synergy to stimulate Ca(2+) increase in SON neurons and to enhance release of VP and OT from hypothalamo-neurohypophysial explants. We here demonstrate that both ATP and NE also trigger transient intracellular Ca(2+) rise in rat SON astrocytes, the two agonists showing a synergistic action similarly to what has been reported in SON neurons. The responses to both agonists are not or are only moderately affected after blockade of neuronal activity by tetrodotoxin, or of neurotransmitter release by removal of extracellular Ca(2+), suggesting that the receptors involved are located on the astrocytes themselves. ATP acts via P2Y(1) receptors, as indicated by the pharmacological profile of Ca(2+) responses and the strong immunolabeling for this receptor in SON astrocytes. Responses to NE involve both alpha and beta adrenergic receptors, the latter showing a permissive role on the former. These results point to further implication of SON astrocytes in the regulation of VP and OT secretion, and suggest that they are potentially important elements participating in all regulatory processes of hypothalamo-neurohypophysial function that involve activation of noradrenergic pathways.

Behçet's disease and Chiari's network

Behçet's disease (BD) is a chronic, multisystemic, inflammatory process of uncertain origin. Diagnosis criteria consist of recurrent oral ulceration plus two of the following: genital ulceration, ocular and skin lesions, and positive pathergy test. Pulmonary embolism and, especially intracardiac thrombi, are very rare. We report the case of a patient with BD presenting with bilateral pulmonary embolism and intracardiac mass in right atrium.

The quantification of epidermal growth factor receptor (EGFR) in plasma is a prognostic factor in advanced non-small cell lung cancer (NSCLC) patients

7597

Background: EGFR has an extracellular ligand-binding domain that can be proteolitically cleaved from the cell surface and can be accurately quantified in blood by ELISA. We have investigated the usefulness of plasma EGFR measurements as prognostic marker in advanced NSCLC. Methods: The cohort consisted in 329 patients (p) with advanced NSCLC that received first-line therapy with cisplatin and docetaxel. The concentration levels of the EGFR extracellular binding domain were determined by a sandwich quantitative ELISA in the baseline, before therapy. Results: Median age was 61, range [39–80], 84% males, 100% caucasian, 68% stage IIIB and 32% IV and 99% PS 0–1. The histological subtypes were: 31% squamous cell carcinoma, 49% adenocarcinoma, 15% large cell, and 5% undifferentiated. 181 p achieved complete response (CR), partial response (PR) or stable disease (SD) and 109 p progressive disease (PD). Median patient's plasma levels of EGFR were 32.4 ng/ml. There were not differences in p according to histology, site of metastasis and ECOG. There were differences in response to therapy; CR+PR+SD p presented median EGFR of 31.97 ng/ml [13.2–48.6] vs 30 ng/ml [16.9–46.8] in the PD group (p=0.024). Dividing the cohort in two sets according to EGFR median we found two significantly different groups in terms of Overall Survival (OS) and Time To Progression (TTP). Patients with EGFR<32.4 ng/ml had a median TTP of 3.9 months (m) [3.3–4.6] while for EGFR>32.4 ng/ml was 4.7 m [4.0–5.4], (p=0.024). OS when EGFR<32.4 ng/ml was 6.9 m [5.9–7.8] and for EGFR>32.4 ng/ml was 9.1 m [8.2–10.1], (p=0.038). Conclusions: Patients with PD presented significantly lower levels of serum EGFR than those patients with CR+PR+SD. There is a relationship among lower EGFR concentration in serum with a worst prognosis in advanced NSCLC p in terms of TTP and OS.

No significant financial relationships to disclose.

Elevated levels of thioredoxin (Trx) in serum correlate with poor outcome in docetaxel (doc)/cisplatin (cis)-treated stage IV non-small cell lung cancer (NSCLC) patients (p)

7628

Background: Chemotherapy causes the production of reactive oxygen species (ROS), which facilitates cancer cell death. Trx protein functions as a ROS scavenger and a negative regulator of apoptosis signal regulating kinase-1 (ASK-1). High levels of Trx are associated with chemoresistance. 14–3-3s proteins are involved in cell cycle control and protein trafficking. Methods: Trx ELISA and 14- 3–3s methylation-specific PCR were performed in baseline serum from 107 stage IV NSCLC p treated with doc/cis. Results: Median age, 60 (range, 32–79); male, 87 (81.3%). PS: 0, 27 (25.2%); 1, 80 (74.8%). Adenocarcinoma, 46 (43.8%); squamous cell carcinoma, 40 (38.1%); 21 p had large cell or unspecified histology. Complete response, 1 p; partial response, 20 p; overall response rate, 20%. Median Trx level, 97.4 (range, 18.8–763.1). Serum was available for 14–3-3s methylation analysis in only 88 p. 14–3-3s was methylated in 43 p (48.9%). A significant correlation was observed between 14–3-3s methylation status and Trx levels ( Table ). 4 p with methylated and 17 with unmethylated 14–3-3s had Trx levels >182.8 (P=0.003). Median Trx levels were 103.5 in responders and 94.3 in non-responders (P=0.96). Time to progression (TTP) was 5.6 months (m) for 27 p with Trx <49.6, 4.4 m for 53 p with Trx 49.6–182.8, and 3.8 m for 27 p with Trx >182.8 (P=0.02). In a Cox multivariate analysis, Trx levels emerged as an independent variable for TTP when 14–3-3s was included in the model. Hazard ratios: 1.3 for PS1 (P=0.84); 1.05 for 14–3-3s unmethylated (P=0.22); 1.4 for Trx 49.6–182.8 and 1.95 for Trx >182.8 (P=0.04). Conclusions: Serum Trx levels can predict TTP in doc/cis-treated p. The additional role of 14–3-3s methylation may be more clearly demonstrated in cis/gemcitabine regimens.

No significant financial relationships to disclose.

[Table: see text]