Sonophotocatalytic removal of organic dyes in real water environments using reusable BiSI@PVDF-HFP nanocomposite membranes

Focusing on the uncontrolled discharge of organic dyes, a known threat to human health and aquatic ecosystems, this work employs a dual-functional catalyst approach, by immobilizing a synthesized bismuth sulfur iodide (BiSI) into a poly (vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) polymeric matrix for multifunctional water remediation. The resulting BiSI@PVDF nanocomposite membrane (NCM), with 20 wt% filler content, maintains a highly porous structure without compromising morphology or thermal properties. Demonstrating efficiency in natural pH conditions, the NCM removes nearly all Rhodamine B (RhB) within 1 h, using a combined sonophotocatalytic process. Langmuir and pseudo-second-order models describe the remediation process, achieving a maximum removal capacity (Qmax) of 72.2 mg/g. In addition, the combined sonophotocatalysis achieved a degradation rate ten and five times higher (0.026 min-1) than photocatalysis (0.002 min-1) and sonocatalysis (0.010 min-1). Furthermore, the NCM exhibits notable reusability over five cycles without efficiency losses and efficiencies always higher than 90%, highlighting its potential for real water matrices. The study underscores the suitability of BiSI@PVDF as a dual-functional catalyst for organic dye degradation, showcasing synergistic adsorption, photocatalysis, and sonocatalysis for water remediation.

Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

Discovery of Gamma Rays from the Quiescent Sun with HAWC

We report the first detection of a TeV γ-ray flux from the solar disk (6.3σ), based on 6.1 years of data from the High Altitude Water Cherenkov (HAWC) observatory. The 0.5-2.6 TeV spectrum is well fit by a power law, dN/dE=A(E/1  TeV)^{-γ}, with A=(1.6±0.3)×10^{-12}  TeV^{-1} cm^{-2} s^{-1} and γ=3.62±0.14. The flux shows a strong indication of anticorrelation with solar activity. These results extend the bright, hard GeV emission from the disk observed with Fermi-LAT, seemingly due to hadronic Galactic cosmic rays showering on nuclei in the solar atmosphere. However, current theoretical models are unable to explain the details of how solar magnetic fields shape these interactions. HAWC's TeV detection thus deepens the mysteries of the solar-disk emission.

Limits to Gauge Coupling in the Dark Sector Set by the Nonobservation of Instanton-Induced Decay of Super-Heavy Dark Matter in the Pierre Auger Observatory Data

Instantons, which are nonperturbative solutions to Yang-Mills equations, provide a signal for the occurrence of quantum tunneling between distinct classes of vacua. They can give rise to decays of particles otherwise forbidden. Using data collected at the Pierre Auger Observatory, we search for signatures of such instanton-induced processes that would be suggestive of super-heavy particles decaying in the Galactic halo. These particles could have been produced during the post-inflationary epoch and match the relic abundance of dark matter inferred today. The nonobservation of the signatures searched for allows us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: α_{X}≲0.09, for 10^{9}≲M_{X}/GeV<10^{19}. Conversely, we obtain that, for instance, a reduced coupling constant α_{X}=0.09 excludes masses M_{X}≳3×10^{13}  GeV. In the context of dark matter production from gravitational interactions alone, we illustrate how these bounds are complementary to those obtained on the Hubble rate at the end of inflation from the nonobservation of tensor modes in the cosmological microwave background.

Reusable composite membranes for highly efficient chromium removal from real water matrixes

Natural or industrial hexavalent chromium water pollution continues to be a worldwide unresolved threat. Today, there is intense research on new active and cost-effective sorbents for Cr(VI), but most still exhibit a critical limitation: their powdered nature makes their recovery from water cost and energy consuming. In this work, Al(OH)₃, MIL-88-B(Fe), and UiO-66-NH₂ Cr(VI) sorbents were immobilized into a poly (vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) polymeric substrate to develop an easily reactivable and reusable water filtering technology. The immobilization of the sorbents into the PVDF-HFP porous matrix modified the macro and meso-porous structure of the polymeric matrix, tuning in parallel its wettability. Although a partial blocking of the Cr(VI) adsorptive capacity was observed for of Al(OH)₃ and MIL-88-B(Fe) when immobilized into composite membranes, PVDF-HFP/UiO-66-NH₂ filter (i) exceeded the full capacity of the non-immobilized sorbent to trap Cr(VI), (ii) could be reactivated and reusable, and (iii) it was fully functional when applied in real water effluents.

Solar Photocatalytic Membranes: An Experimental and Artificial Neural Network Modeling Approach for Niflumic Acid Degradation

The presence of contaminants of emerging concern (CEC), such as pharmaceuticals, in water sources is one of the main concerns nowadays due to their hazardous properties causing severe effects on human health and ecosystem biodiversity. Niflumic acid (NFA) is a widely used anti-inflammatory drug, and it is known for its non-biodegradability and resistance to chemical and biological degradation processes. In this work, a 10 wt.% TiO₂/PVDF-TrFE nanocomposite membrane (NCM) was prepared by the solvent casting technique, fully characterized, and implemented on an up-scaled photocatalytic membrane reactor (PMR). The photocatalytic activity of the NCM was evaluated on NFA degradation under different experimental conditions, including NFA concentration, pH of the media, irradiation time and intensity. The NCM demonstrated a remarkable photocatalytic efficiency on NFA degradation, as efficiency of 91% was achieved after 6 h under solar irradiation at neutral pH. The NCM proved effective in long-term use, with maximum efficiency losses of 7%. An artificial neural network (ANN) model was designed to model NFA's photocatalytic degradation behavior, demonstrating a good agreement between experimental and predicted data, with an R² of 0.98. The relative significance of each experimental condition was evaluated, and the irradiation time proved to be the most significant parameter affecting the NFA degradation efficiency. The designed ANN model provides a reliable framework l for modeling the photocatalytic activity of TiO₂/PVDF-TrFE and related NCM.

Multifunctional hybrid membranes for photocatalytic and adsorptive removal of water contaminants of emerging concern

This work focuses on the combination of multifunctional photocatalytic and adsorbent materials in a unique polymeric membrane. For this purpose, Au/TiO₂ and Y₂(CO₃)₃ nanoparticles were immobilised onto a poly (vinylidene fluoride-hexafluoropropylene), (PVDF-HFP) membrane, and the physical-chemical characterisation of these materials was performed, as well as pollutant removal efficiency. An efficient TiO₂ functionalisation with gold nanoparticles was achieved, endowing these particles with the capability to absorb visible radiation absorption. A favourable porous structure was obtained for the membranes, with an average pore size of 4 μm, and the nanoparticles immobilisation did not alter the chemical properties of the polymeric membrane. The produced hybrid materials, including both the Au/TiO₂ and Y₂(CO₃)₃ nanoparticles, presented an efficiency of 57% in the degradation of norfloxacin (5 mg/L) under ultraviolet radiation for 120 min, 80% under visible radiation for 300 min, and 58% in arsenic adsorption for 240 min. These membranes represent a new multifunctional platform for removing several pollutants, which may allow their incorporation in more efficient and less energy-consuming water treatment processes favouring its application, even in low energy resources countries.

Differences in the Most Demanding Scenarios of Basketball Match-Play between Game Quarters and Playing Positions in Professional Players

The purpose of this study was to compare the most demanding scenarios (MDS) encountered by professional basketball players across game quarters and playing positions during official match-play. Ten professional bas- ketball players were monitored during 11 matches using a local positioning system. Peak physical demands were measured via total distance, distance >18 and >21 km·h -1 , number of sprints >18 and >21 km·h -1 , and number of accelerations and decelerations >2 and >3 m∙s -2 captured over 30, 60, 120, 180, and 300-s rolling averages. Linear mixed models and effect sizes (ES) were used to compare MDS encountered between game quarters and playing positions. Between Quarters 1 and 2, there was a reduction in the total distance (ES = 0.64-1.39) for all playing groups along with a reduction in distance >21 km·h -1 in centres (ES = 0.77-0.81) and a reduction in accelerations and decelerations >2 m∙s -2 in guards (ES = 0.66-0.78) across longer sample periods (180-300-s). Between Quarters 1 and 4, reductions in the total distance were evident for forwards and centres (ES = 0.64-0.91) as well as distance and sprints >21 km·h -1 in centres (ES = 0.64-0.97). Regarding positional differences, guards and forwards covered a higher total distance than centres across most quarters and sample periods (ES = 0.22-1.44). Our data suggest a decrease in MDS with game progression in basketball. In addition, MDS appear to be duration-specific and posi- tion-dependent in basketball. Therefore, practitioners should consider these differences in MDS based on game quarters and positional demands to optimise individual and team performance.

Reusable Ag@TiO2-Based Photocatalytic Nanocomposite Membranes for Solar Degradation of Contaminants of Emerging Concern

Two significant limitations of using TiO2 nanoparticles for water treatment applications are reduced photocatalytic activity under visible radiation and difficulty recovering the particles after use. In this study, round-shaped Ag@TiO2 nanocomposites with a ≈21 nm diameter and a bandgap energy of 2.8 eV were synthesised by a deposition-precipitation method. These nanocomposites were immobilised into a porous poly (vinylidene fluoride-hexafluoropropylene) (PVDF-HFP) matrix and well-distributed within the pores. The photocatalytic activity of Ag@TiO2/PVDF-HFP against metronidazole (MNZ) under solar radiation was evaluated. Further, an adaptive neuro-fuzzy inference system (ANFIS) was applied to predict the effect of four independent variables, including initial pollutant concentration, pH, light irradiation intensity, and reaction time, on the photocatalytic performance of the composite membrane on MNZ degradation. The 10% Ag@TiO2/PVDF-HFP composite membrane showed a maximum removal efficiency of 100% after 5 h under solar radiation. After three use cycles, this efficiency remained practically constant, demonstrating the membranes' reusability and suitability for water remediation applications.

Physical Demands in Three Different Basketball Competitions Played By the Same Under-18 Players

The goal of this study was to compare the physical demands of the same team in three different basketball com- petitions (EBA league (EBA), U18 regional league (U18L), and a U18 international tournament (U18T)) during the same season. Data from eleven U18 players (age: 16.92 ± 0.67 years) were collected using inertial movement units. As external load variables, Player Load (PL), accelerations (ACC), decelerations (DEC), changes of direction (COD), and jumps (JUMP) were expressed in their total (t) and high intensity (h) values. The analysis of variances (ANOVA) and effect size (ES, Cohen’s d) with their respective 90% confidence intervals were applied to identify differences between the competitions. U18T showed the highest values in PL, tACC, tDEC, hDEC, tCOD, tJUMP, and hJUMP (small to moderate ES). However, the hACC and hCOD values were greater in EBA (small ES) than in U18L and U18T. In conclusion, all three competitions presented different external load demands for the same group of players. This data could help basketball coaches to optimize the training process based on the competition in which their team plays. Furthermore, data could also indicate the most suitable competition for players’ development.

Measurement of the Fluctuations in the Number of Muons in Extensive Air Showers with the Pierre Auger Observatory

We present the first measurement of the fluctuations in the number of muons in extensive air showers produced by ultrahigh energy cosmic rays. We find that the measured fluctuations are in good agreement with predictions from air shower simulations. This observation provides new insights into the origin of the previously reported deficit of muons in air shower simulations and constrains models of hadronic interactions at ultrahigh energies. Our measurement is compatible with the muon deficit originating from small deviations in the predictions from hadronic interaction models of particle production that accumulate as the showers develop.

Peak External Intensity Decreases across Quarters during Basketball Games

The purpose of this study was to compare peak external intensities across game quarters in basketball. Eight semi-professional male players were monitored using accelerometers. For all quarters, peak intensities were determined via moving averages for PlayerLoad/minute (PL·min-1) using sample durations of 15 s, 30 s, 1 min, 2 min, 3 min, 4 min, and 5 min. Linear mixed models and effect sizes (ES) were used to compare peak intensities between quarters for each sample duration. Small decreases in peak PL·min-1 occurred between Quarters 1 and 4 for all sample durations (ES = 0.21-0.49). Small decreases in peak PL·min-1 were apparent between quarters 1 and 2 for 30-s, 1-min, and 3-min sample durations (ES = 0.24-0.33), and between quarters 3 and 4 for 2-5-min sample durations (ES = 0.20-0.24). Peak intensities decline across quarters with game progression in basketball, providing useful insight for practitioners to develop game-specific training and tactical strategies.

Crystal morphology control of synthetic giniite for enhanced photo-Fenton activity against the emerging pollutant metronidazole

Metronidazole (MNZ) is a recalcitrant antibiotic with toxic and carcinogenic effects in aquatic environments. In this work, Fe₅(PO₄)₄(OH)₃·2H₂O (giniite) particles were synthesised with three different alkaline cations (Li⁺, Na⁺ and K⁺) and used as Fenton catalysts for MNZ removal. It is shown that the addition of different cations during the hydrothermal synthesis process promote different morphologies from asterisk-like to flower-like and branches-like, maintaining the crystalline structure of pure giniite. The photo-Fenton activity of these particles was then evaluated through the degradation of MNZ under sunlight radiation for 9 h. The results indicate that the alkaline cation has a predominant role in the photo-Fenton efficiency, as demonstrated by the superior degradation efficiencies of Na@giniite particles (91.2% and 72.5% with giniite concentration of 0.2 g L^-1 and 0.07 g L^-1, respectively), related with its high surface area (10.7 m² g^-1). Thus, it is demonstrated the suitability of Na@giniite particles as Fenton catalyst for MNZ removal from water.

Differences in External Load Variables Between Playing Positions in Elite Basketball Match-Play

The purpose of this study was to describe the specific demands and structure of interrelationships of external load variables in order to generate a position-related time motion profile in elite basketball. Seventeen professional players from three different playing positions (6 guards, 4 forwards, and 7 centers) were analyzed in five friendly games. Player load per minute (PLmin) was used as an indicator of intensity to compare positions. Furthermore, high and total external variables of jumping (hJUMP and tJUMP), acceleration (hACC and tACC), deceleration (hDEC and tDEC) and change of direction (hCOD and tCOD), respectively, were used for the principal component analysis (PCA). The Kaiser criterion (eigenvalue > 1) was applied, and the Varimax rotation mode was used to extract multiple principal components. PCA showed that all positions had three or four principal components, but the configuration of each factor was different: tCOD, hCOD, hDEC and hJUMP for guards, hCOD, tCOD, tACC and hDEC for forwards, and tJUMP, hJUMP, hDEC and tACC for centers were specifically demanded in match-play. For guards and forwards, a significant correlation was found between COD variables, while for centers tCOD and PLmin had the strongest correlation. When monitoring the external load via tri-axial accelerometers in basketball match-play, each playing position showed specific physical demands. Therefore, these variables must be prioritized in load monitoring programs.

Features of the Energy Spectrum of Cosmic Rays above 2.5×10^{18} eV Using the Pierre Auger Observatory

We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18}  eV based on 215 030 events. New results are presented: at about 1.3×10^{19}  eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19}  eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18}  eV is [5.66±0.03(stat)±1.40(syst)]×10^{53}  erg Mpc^{-3}.

Photocatalytic and antimicrobial multifunctional nanocomposite membranes for emerging pollutants water treatment applications

Emerging pollutants represent a new global problem for water quality. As these compounds get into the environment, they cause severe threats to aquatic environments and human health and are typically resistant to conventional wastewater treatments. In this work, TiO₂ nanoparticles surface was functionalized with silver (Ag) nanoparticles, and solvent cast and electrospun membranes of poly (vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) were prepared with different concentrations of TiO₂ and Ag-TiO₂ to produce a multifunctional material. The photocatalytic activity of the nanocomposites was evaluated through the degradation of norfloxacin under ultraviolet (UV) and visible radiation. It is shown that nanocomposites with Ag-TiO₂ show the highest degradation efficiencies: 64.2% under UV and 80.7% under visible radiation, for 90 and 300 min, respectively. Furthermore, the recyclability of the membranes has also been demonstrated. Finally, it is shown the antimicrobial activity of the nanocomposite membranes, demonstrating the suitability of the Ag-TiO₂/PVDF-HFP nanocomposites as multifunctional photocatalytic and antimicrobial membranes for water remediation applications.

Differences in Weekly Load Distribution Over Two Euroleague Seasons with a Different Head Coach

The weekly training management and competition loads are important aspects to optimize the performance of professional basketball players. The objectives of the study were (a) to describe the weekly external load (EL), as well as the internal response (IR), of elite basketball players over two consecutive seasons with a different head coach and (b) to compare weekly loads of different competitive densities. The data were collected from 27 elite players from the same team competing in the Spanish first division league (ACB) and EuroLeague during 2017–2018 and 2018–2019 seasons. EL was measured using microsensor technology to determine PlayerLoad values, expressed in arbitrary units (AU). Session rating of perceived exertion (sRPE) was used for IR quantification. Comparisons between the two seasons and of weeks with different competitive densities were made. The inter-week load variability was moderate-high for both seasons. The highest EL values were measured during the weeks with three games (W3) (W3 > W0 > W2 > W1), while the most demanding week for players’ IR was observed during weeks with no competition (W0). Additionally, higher EL (d = 0.31) and IR (d = 0.37) values were observed in season 2018–2019 compared to 2017–2018. The results obtained in this study contributed new data on the internal and external load required by professional basketball players in weeks with different number of games and showed that different coaching strategies may demand a different external and internal workload in consecutive seasons. Furthermore, the results highlighted the need to carry out an adequate load management program.

Constraints on Lorentz Invariance Violation from HAWC Observations of Gamma Rays above 100 TeV

Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2×10^{31}  eV, over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.

Polymer-Based Membranes for Oily Wastewater Remediation

The compounds found in industrial wastewater typically show high toxicity, and in this way, they have become a primary environmental concern. Several techniques have been applied in industrial effluent remediation. In spite of the efforts, these techniques are yet to be ineffective to treat oily wastewater before it can be discharged safely to the environment. Membrane technology is an attractive approach to treat oily wastewater. This is dedicated to the immobilisation of TiO₂ nanoparticles on poly(vinylidene fluoride–trifluoro ethylene) (PVDF-TrFE) porous matrix by solvent casting. Membranes with interconnected pores with an average diameter of 60 µm and a contact angle of 97°, decorated with TiO₂ nanoparticles, are obtained. The degradation of oily wastewater demonstrated the high photocatalytic efficiency of the nanocomposite membranes: Under sunlight irradiation for seven hours, colourless water was obtained.

Extended gamma-ray sources around pulsars constrain the origin of the positron flux at Earth

The unexpectedly high flux of cosmic-ray positrons detected at Earth may originate from nearby astrophysical sources, dark matter, or unknown processes of cosmic-ray secondary production. We report the detection, using the High-Altitude Water Cherenkov Observatory (HAWC), of extended tera-electron volt gamma-ray emission coincident with the locations of two nearby middle-aged pulsars (Geminga and PSR B0656+14). The HAWC observations demonstrate that these pulsars are indeed local sources of accelerated leptons, but the measured tera-electron volt emission profile constrains the diffusion of particles away from these sources to be much slower than previously assumed. We demonstrate that the leptons emitted by these objects are therefore unlikely to be the origin of the excess positrons, which may have a more exotic origin.

Testing Hadronic Interactions at Ultrahigh Energies with Air Showers Measured by the Pierre Auger Observatory

Ultrahigh energy cosmic ray air showers probe particle physics at energies beyond the reach of accelerators. Here we introduce a new method to test hadronic interaction models without relying on the absolute energy calibration, and apply it to events with primary energy 6-16 EeV (E_{CM}=110-170  TeV), whose longitudinal development and lateral distribution were simultaneously measured by the Pierre Auger Observatory. The average hadronic shower is 1.33±0.16 (1.61±0.21) times larger than predicted using the leading LHC-tuned models EPOS-LHC (QGSJetII-04), with a corresponding excess of muons.

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8±0.7(stat)±6.7(syst)  MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principles calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.

Search for patterns by combining cosmic-ray energy and arrival directions at the Pierre Auger Observatory

Energy-dependent patterns in the arrival directions of cosmic rays are searched for using data of the Pierre Auger Observatory. We investigate local regions around the highest-energy cosmic rays with [Formula: see text] eV by analyzing cosmic rays with energies above [Formula: see text] eV arriving within an angular separation of approximately 15[Formula: see text]. We characterize the energy distributions inside these regions by two independent methods, one searching for angular dependence of energy-energy correlations and one searching for collimation of energy along the local system of principal axes of the energy distribution. No significant patterns are found with this analysis. The comparison of these measurements with astrophysical scenarios can therefore be used to obtain constraints on related model parameters such as strength of cosmic-ray deflection and density of point sources.

Measurement of the proton-air cross section at √s=57 TeV with the Pierre Auger Observatory

We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505±22(stat)(-36)(+28)(syst)] mb is found.

Acute mountain sickness impact among travelers to Cusco, Peru

BACKGROUND

Increasing numbers of travelers are visiting high altitude locations in the Andes. The epidemiology of acute mountain sickness (AMS) among tourists to high altitude in South America is not well understood.

METHODS

A cross-sectional study to evaluate the epidemiology, pre-travel preparation, and impact of AMS among travelers to Cusco, Peru (3,400 m) was performed at Cusco's International Airport during June 2010. Foreign travelers, 18 years or older, staying 15 days or less, departing Cusco were invited to participate. Demographic, itinerary, and behavioral data were collected. The Lake Louise Clinical score (LLCS) was used to assess AMS symptoms.

RESULTS

In total, 991 travelers participated, median age 32 years (interquartile range 25-49), 55.5% female, 86.7% tourists, mostly from the United States (48.2%) and England (8.1%). Most (76.7%) flew from sea level to Cusco and 30.5% visited high altitude in the previous 2 months. Only 29.1% received AMS advice from a physician, 19% recalled advice on acetazolamide. Coca leaf products (62.8%) were used more often than acetazolamide (16.6%) for prevention. AMS was reported by 48.5% and 17.1% had severe AMS. One in five travelers with AMS altered their travel plans. Travelers older than 60 years, with recent high altitude exposure, who visited lower cities in their itinerary, or used acetazolamide were less likely to have AMS. Using coca leaf products was associated with increased AMS frequency.

CONCLUSIONS

AMS was common and adversely impacted plans of one in five travelers. Acetazolamide was associated with decreased AMS but was prescribed infrequently. Other preventive measures were not associated with a decrease in AMS in this population. Pre-travel preparation was suboptimal.

Measurement of the depth of maximum of extensive air showers above 10{18} eV

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

A Retrospective Review of Association between Clinico-Pathologic Prognostic Factors and Disease Outcome in Node-Positive or High-Risk Node Negative Breast Cancer Patients Treated with Adjuvant Cyclophosphamide, Doxorubicin Followed by Paclitaxel: A Venezuelan Study

Background: Breast cancer is a disease with a biologic and clinical heterogeneity explained by differences in the genetic composition, which translate into variability in estrogen receptor (ER), progesterone receptors (PR), Her2–Neu receptor (HER2) expression and permit to identify subgroups that show different prognoses and that also respond differently to treatment. The goal of this study was to determine disease-free survival (DFS) in relation to clinico-pathologic features and ER/PR/HER2 subgroups, in node-positive or high-risk breast cancer patients in a Venezuelan single institution. Methods: We reviewed data between May 1999 to July 2006, from our breast tumor registry with attention to clinical and pathologic prognostic factors. All patients were treated with either mastectomy or breast conserving surgery-with axillary node assessment for stage and adjuvant chemotherapy with doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2 both IV day 1 x 4 cycles, followed by paclitaxel 175mg/m2 day 1 x 4 cycles every 3 weeks or every 2 weeks. All patient received radiation therapy and adjuvant hormonal therapy when indicated. Disease-free survival (DFS) was measured from the date of biopsy to the date of relapse. DFS was estimated using the univariate Kaplan-Meier method. Twelve clinico-pathologic factors that could influence relapse were selected and analyzed using the Cox Proportional Hazards Model. All analyses were carried out using Stata (version 6.0).Results: A total of 92 breast cancer patients all received adjuvant chemotherapy and radiotherapy, 79% of the patients received hormonal therapy with either Tamoxifen or an Aromatase Inhibitor according to their menopausal status. The median follow-up is 55.42 months (range 9.5-110 months). Median age was 50 years (27-70). Local and distant failures were 3% and 11% respectively. For the overall population, the probability of DFS at 2, 5 and 9 years was respectively 93%, 83% and 83%. The results of univariate analysis showed that the mayor significant prognostic factor for influencing relapse was Estrogen receptor (HR:0.29) (p=0.06). Univariate survival analyses comparing grade of differentiation, stage of disease and number of metastasis in axillary lymph nodes with respect to Disease-free survival were performed and showed no significant difference. Patients with triple negative tumors showed an increased risk of relapse with a significant decrease in 9-year disease-free survival 38.1% (p&lt;0.001) and patients with ER+/PR+/HER2- had the best DFS 90% (p&lt;0.001). Conclusions: Estrogen receptor expression was the most significant biologic prognostic factors for relapse in this population. Triple negative tumors were associated with worse DFS. Different DFS in ER/PR/HER2 subgroups clearly illustrates the heterogeneity of this disease and support the importance of tailored therapy in this era.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6056.

[The TRPV1 channel as a target for the treatment of pain]

INTRODUCTION

Pain results from the processing of a large number of signals produced at different levels of the central and peripheral nervous system, which are generated in response to stimuli from the environment or from the organism itself. One of the strategies for generating new analgesics consists in studying the molecular bases that underlie the detection of painful stimuli, that is to say, the receptors. One receptor that plays a very important role in sensory and pain physiology is TRPV1, which is responsible for detecting mechanical, chemical and thermal stimuli. AIMS. The aim of this study is to discuss the structural and functional aspects of the TRPV1 channel, as well as its participation in certain pathological processes and the possible perspectives for clinical research.

DEVELOPMENT

TRPV1 activation in sensory neurons generates signals that reach the central nervous system, where they are interpreted as pain, as well as triggering the peripheral release of pro-inflammatory substances that make other neurons sensitive to subsequent stimuli. TRPV1 is a receptor that is structurally similar to other voltage-dependent ion channels, with the capacity to detect and integrate several different stimuli from the environment, such as dangerously high temperatures or irritants. Furthermore, the activity of this channel is linked to several signalling chains related with inflammatory processes.

CONCLUSIONS

The central role of TRPV1 in the physiology of pain will surely encourage the development of drugs aimed at this receptor which can be used in the treatment of several types of pain.

Observation of the suppression of the flux of cosmic rays above 4 x 10 (19) eV

The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.

Upper limit on the diffuse flux of ultrahigh energy tau neutrinos from the Pierre Auger Observatory

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.

Cadherin expression in glandular tumors of the cervix

BACKGROUND

The cadherins are homotypic adhesion proteins that are important in cell sorting during organogenesis. Classic cadherins include several different types that show tissue specific expression. Specific tissue expression of cadherins often is preserved in neoplastic transformation, and cadherin phenotype can be used to differentiate morphologically similar but histogenetically distinct tumors.

METHODS

The authors examined by using immunohistochemistry in paraffin sections the expression of E- (epithelial) and P- (placental) cadherin in 39 patients with glandular tumors of the cervix, including invasive adenocarcinoma, villoglandular adenocarcinoma, adenocarcinoma in situ (AIS), and adenoma malignum.

RESULTS

In all cases, E-cadherin was expressed in both normal and malignant glands without appreciable differences. P-cadherin, normally confined to basal epithelial cells and not observed in benign glands, was aberrantly expressed in neoplastic glands in 27 cases, including 96%(23 of 24 cases) of invasive cancers, 40% (2 of 5) of villoglandular carcinomas, 25% (2 of 8) of AIS, and 0% (0 of 2) of adenoma malignum.

CONCLUSIONS

The authors' results show that E-cadherin is uniformly expressed in glandular tumors of the cervix with no evidence of decreased expression in these tumors. In addition, P-cadherin is aberrantly expressed in most adenocarcinomas and appears to be preferentially expressed in invasive rather than in situ lesions. Thus, aberrant expression of P-cadherin may be a useful marker of invasive or aggressive clinical behavior in glandular lesions of the cervix.

Nuclear localization of E-cadherin expression in Merkel cell carcinoma

CONTEXT

Cadherins are cell-cell adhesion proteins that act as tumor suppressor genes and have a critical role in cell sorting and tissue formation during organogenesis. The pattern of cadherin expression constitutes a useful diagnostic and prognostic tool in the evaluation of tumors and for determining the histogenesis of tumor cells. We have previously characterized the cell types of several tumors based on the expression of individual cadherins.

OBJECTIVE

To investigate the expression of cadherins in Merkel cell carcinomas.

DESIGN

Paraffin immunohistochemical analysis of the 3 best-studied cadherins was performed on 35 cases of Merkel cell carcinoma.

RESULTS

E-cadherin was expressed in 34 (97%) of 35 Merkel cell carcinomas examined, N-cadherin was expressed in 22 (63%) of 35 cases, and P-cadherin was expressed in 15 (43%) of 35 cases. This frequency of cadherin expression was similar to a group of small cell and neuroendocrine tumors from other primary sites. Interestingly, the localization of E-cadherin expression was unique in Merkel cell carcinomas compared with other primary neuroendocrine tumors. Merkel cell carcinomas showed marked preference for nuclear versus membrane localization, whereas small cell tumors from other sites showed fewer cases of nuclear E-cadherin expression. The nuclear localization of E-cadherin did not correlate with cadherin-associated protein beta-catenin nuclear expression.

CONCLUSIONS

Our findings show that E-cadherin is the most frequently expressed cadherin in Merkel cell carcinoma, followed in frequency by N-cadherin then P-cadherin. The pattern of nuclear E-cadherin expression is more frequent for Merkel cell carcinoma than small cell tumors of other primary sites. These observations suggest that E-cadherin expression and function are altered in Merkel cell carcinoma, and this finding has potential use in the differential diagnosis of these tumors.

The International Society of Gynecological Pathologists. Its founding and early years

The International Society of Gynecological Pathologists was founded in 1976 to facilitate an exchange of knowledge about gynecological disease throughout the world. The Society moved quickly to schedule companion meetings with established international and regional pathology and gynecology societies, including the International Academy of Pathology, its United States-Canadian Division, and the International Federation of Gynecology and Obstetrics, and to sponsor smaller meetings within individual countries. In 1981 the Society founded this journal, and in 1983, at the invitation of the World Health Organization, it assumed the responsibility of revising the WHO classifications of tumors of the female genital tract. The foundation of the Society appears to have been solid in view of its present robust health.

P-cadherin expression in breast carcinoma indicates poor survival

BACKGROUND

The cadherin family of cell-cell adhesion molecules and their associated proteins, the catenins, are essential to embryonic development and the maintenance of adult tissues. During development, the homotypic interaction of a particular cadherin with an identical cadherin expressed on a neighboring cell results in the sorting of cells to form distinctive tissues. Cadherins are believed to be tumor suppressors, and their altered expression and function have been associated with tumor development.

METHODS

The authors examined the expression of P-cadherin, E-cadherin, and N-cadherin, and alpha-catenin and beta-catenin in 183 cases of invasive breast carcinoma by immunohistochemistry on paraffin sections using specific antibodies and a steam-based antigen retrieval method.

RESULTS

P-cadherin was positive in 95 cases and negative in 88 cases of breast carcinoma. Positive P-cadherin expression in breast carcinoma showed a strong correlation with poor patient prognosis. Five years after surgery, 90% of the patients with P-cadherin negative tumors were alive in contrast to only 59% of patients with P-cadherin positive tumors. The difference in survival reached statistical significance (P = 0.0001) as early as 2 years after surgical treatment. Expression of N-cadherin, alpha-catenin, and beta-catenin did not correlate with patient survival. Multivariable statistical analyses of the data showed that expression of P-cadherin was independent of tumor size and lymph node metastases, but correlated inversely with estrogen/progesterone receptor status. In ductal carcinomas, positive P-cadherin expression correlated with a higher histologic grade. In contrast, expression of E-cadherin was low in high grade ductal carcinomas but negative tumors were uncommon. Negative or low E-cadherin expression did not correlate with poor survival. In lobular carcinomas, E-cadherin expression frequently was negative or low, and P-cadherin always was negative.

CONCLUSIONS

Expression of P-cadherin in breast carcinoma is associated strongly with poor survival and constitutes an independent prognostic predictor. P-cadherin expression is a better indicator of clinical outcome than alterations in the expression of E-cadherin, N-cadherin, alpha-catenin, or beta-catenin.

Distinct cadherin profiles in special variant carcinomas and other tumors of the breast

The cadherins are homotypic adhesion proteins that are important in cell sorting during organogenesis. Classical cadherins include several different types that show tissue-specific expression. Cell lineage-specific expression of different cadherin subtypes can differentiate morphologically similar but histogenetically distinct tumors. We examined by immunohistochemistry in paraffin sections, the expression of E (epithelial), N- (neural), and P- (placental) cadherin in 36 unusual tumors of the breast (22 medullary carcinomas, 5 metaplastic carcinomas, 2 carcinosarcomas, 4 phyllodes tumors, and 3 periductal stromal tumors). All carcinomas stain with E-cadherin (22 of 22 medullary and 5 of 5 metaplastic). E-cadherin also stained the epithelial component but not the sarcomatous areas of 2 of 2 cases of carcinosarcomas. E-cadherin was not detected in the stromal tumors (phyllodes, periductal stromal tumor). N-cadherin was most frequently expressed in sarcomatoid metaplastic carcinomas (5 of 5), and variably in other tumors, including the sarcomatous area of carcinosarcoma (1 of 2), and 6 of 22 medullary carcinomas. P-cadherin was frequently identified in medullary carcinomas (20 of 22), in 5 of 5 metaplastic carcinomas, and in the proliferating stroma and benign epithelium of 3 of 3 periductal stromal, but not in phyllodes tumors (0 of 4). All sarcomatoid metaplastic carcinomas co-expressed all 3 classical cadherins. Our results show that these breast tumors have unique patterns of cadherin expression suggesting different histogenetic origin or lines of differentiation. The cadherin profiles in these tumors may be useful for classification and diagnosis.

N-cadherin distinguishes pleural mesotheliomas from lung adenocarcinomas: a ThinPrep immunocytochemical study

BACKGROUND

Cadherins are a family of cell-cell adhesion proteins. The homotypic binding of cadherins is critical for cell sorting and tissue formation during organogenesis. Different cadherin subtypes show lineage specific tissue expression, which has been exploited to differentiate histologically similar tumors of varying ontogeny. By applying immunohistochemistry to tissue sections, the authors have previously documented the utility of N-cadherin in distinguishing between pleural mesotheliomas and lung adenocarcinomas, based on the observation that N-cadherin is expressed in the former disease but not in the latter. Because the diagnosis of these diseases is frequently rendered on cytologic material rather than tissue biopsies, the authors wanted to assess the utility of N-cadherin immunocytochemistry in evaluating material prepared with ThinPrep.

METHODS

The authors examined the cytologic material from 12 patients for the expression of N-cadherin using immunocytochemistry. Four patients had mesotheliomas and eight had adenocarcinomas. ThinPrep slides of the patients' pleural fluid were prepared and stained with the monoclonal antibody 13A9, which is specific for N-cadherin.

RESULTS

Of the 12 cases studied, all 4 cases of pleural mesothelioma expressed N-cadherin in a specific cell-cell membrane location, and all 8 cases of lung adenocarcinoma were negative for N-cadherin.

CONCLUSIONS

These results show that the N-cadherin specific antibody 13A9 is a suitable marker in material prepared with ThinPrep for the differentiation of pleural mesotheliomas from lung adenocarcinomas. This antibody should be included in the diagnostic immunocytochemical panel for evaluation of these malignancies.

Adenocarcinoma arising in extragonadal endometriosis: an immunohistochemical study

BACKGROUND

Malignant transformation is an infrequent but reported complication of endometriosis. Previous reports of these cases have been limited to clinicopathologic studies based on routine histologic examination of these tumors, whereas, to the authors' knowledge, characterization of these lesions based on immunophenotype and hormone receptor and oncoprotein expression has not been described.

METHODS

Using commercially available monoclonal antibodies, the authors studied three recent cases of adenocarcinoma arising in extragonadal endometriosis using paraffin immunohistochemistry. Proteins examined included different cytokeratin (CK) subtypes, as well as hormone receptor status, proliferation rate, and oncoprotein expression.

RESULTS

All three cases presented clinically and macroscopically as colonic masses, and the tumors expressed an endometrial CK phenotype (CK7+, CK20-). In contrast, the adjacent benign colonic epithelium expressed the expected opposite phenotype (CK7-, CK20+). Estrogen receptor (ER) and progesterone receptor (PR) were expressed in one of the three tumors. Interestingly, in the ER/PR negative tumors, receptor expression was present in areas of benign endometriosis adjacent to malignancy, suggesting a loss of receptor expression with malignant transformation. The tumors also were examined for proliferation by Ki-67, and the expression of oncoproteins c-erb B-2, p53, cyclin D1, and bcl-2. All cases of malignancy had a high proliferation rate as measured by Ki-67, which was in contrast to areas of benign endometriosis which had a low proliferation rate. Of the other oncoproteins only p53 protein was detected at a significant level in all three cases. Cyclin D1 was overexpressed in two of the three cases. c-erb B2 and bcl-2 overexpression was not detected.

CONCLUSIONS

The results of the current study 1) show the utility of CK subtypes in confirming endometrioid phenotype in tumors arising in extragonadal endometriosis with colonic involvement and 2) suggest that loss of hormone receptor expression and p53 oncoprotein abnormalities may be involved as mechanisms in malignant transformation in extragonadal endometriosis.

Expression of P-cadherin identifies prostate-specific-antigen-negative cells in epithelial tissues of male sexual accessory organs and in prostatic carcinomas. Implications for prostate cancer biology

Cadherins constitute a family of calcium-dependent cell-cell adhesion molecules the individual members of which are essential for the sorting of cells into tissues during development. In this study, we examined the expression of E-cadherin, N-cadherin, and P-cadherin in tissues obtained from radical prostatectomies. Epithelial cells of prostatic glands, ejaculatory ducts, and seminal vesicles expressed E-cadherin but not N-cadherin. P-cadherin was expressed in epithelial cells of the seminal vesicles and ejaculatory ducts. In the prostate it was limited to the basal cells of prostatic acini, glands with basal cell hyperplasia, and atrophic glands denuded of the luminal cells. All P-cadherin-positive cells were negative for prostatic-specific antigen. Prostatic cancers were mostly P-cadherin negative, but some tumors had P-cadherin-positive areas frequently located close to ejaculatory ducts and negative for prostatic-specific antigen. The mutually exclusive expression of P-cadherin and prostatic-specific antigen suggests that these proteins are involved in differential mechanisms of cell regulation in prostate cancer. P-cadherin may become a useful marker in the diagnosis and management of patients with prostate cancer and low levels of prostatic-specific antigen.

Differential expression of N-cadherin in pleural mesotheliomas and E-cadherin in lung adenocarcinomas in formalin-fixed, paraffin-embedded tissues

The differential diagnosis of pleural mesotheliomas and lung adenocarcinomas presents a continued challenge in the practice of surgical pathology. Paraffin immunohistochemistry (IHC) using different panels of antibodies can be helpful in some cases, but, as yet, no antigen is expressed specifically in mesotheliomas nor in adenocarcinomas. Using well characterized monoclonal antibodies (MAb) that recognized distinct mesenchymal and epithelial adhesion proteins, N-cadherin (13A9 MAb) and E-cadherin (E9 MAb), respectively, we found previously that in frozen-section IHC mesotheliomas and adenocarcinomas had distinct cadherin phenotypes: mesotheliomas were positive for N-cadherin, and lung adenocarcinomas were positive for E-cadherin. Using antigen-retrieval methods, we successfully extended our study to formalin-fixed, paraffin-embedded tissue sections. Tumors from 28 patients (14 originally diagnosed as mesotheliomas, and 14 diagnosed as adenocarcinomas) were stained with 13A9 MAb and E9 MAb. Review of hematoxylin-eosin sections excluded from analysis one case previously diagnosed as mesothelioma, which represented a hemangiopericytoma. Of the remaining 27 cases, 12 of 13 mesotheliomas were positive for N-cadherin and negative for E-cadherin. The exception was a multifocal microscopic papillary tumor of apparent mesothelial origin, which was negative for both N-cadherin and E-cadherin. Conversely, 13 of 14 adenocarcinomas were E-cadherin positive and N-cadherin negative except for one adenocarcinoma with focal N-cadherin expression. One case of a poorly differentiated adenocarcinoma invading skeletal muscle was negative for both 13A9 and E9. These studies confirmed the utility of the cadherin antibodies in distinguishing pleural mesotheliomas from lung adenocarcinomas. The reactivity of the cadherin-specific antibodies with antigens in paraffin sections make them powerful and reliable markers in the practice of diagnostic surgical pathology.

Expression of E-cadherin and N-cadherin in surface epithelial-stromal tumors of the ovary distinguishes mucinous from serous and endometrioid tumors

This study examines the expression of E-cadherin and N-cadherin in the most common epithelial tumors of the ovary. The homotypic interactions of distinctive members of the cadherin family of cell-cell adhesion molecules segregate cells into tissues during embryonic development, and their expression in tumors can be used to trace the histogenesis of tumor cells. Because the surface epithelium of the ovary is a modified mesothelium, we speculated that the expression of E (epithelial)-cadherin and N (neural, mesodermal)-cadherin may provide clues about the controversial origin of common epithelial ovarian tumors. Immunohistochemistry was performed in paraffin sections using well-characterized monoclonal antibodies to E- and N-cadherin and heat-induced antigen-retrieval methods. We found that serous and endometrioid tumors express both E- and N-cadherin. In contrast, mucinous tumors strongly express E-cadherin, but no N-cadherin. The presence of N-cadherin in serous and endometrioid tumors traces their origin to the mesoderm-derived ovarian surface epithelium. The absence of N-cadherin in mucinous tumors clearly distinguishes them from the former, suggesting histogenesis from a cell lineage other than the ovarian surface epithelium or aberrant differentiation mechanisms associated with neoplastic transformation.

Immunohistochemical analysis of beta-tubulin isotypes in human prostate carcinoma and benign prostatic hypertrophy

BACKGROUND

beta-tubulin, the intracellular target of several antimicrotubule agents, is encoded by at least six genes and exists as multiple isotypes with tissue-specific expression. Previous in vitro studies indicated that tubulin isotype composition may affect polymerization properties, dynamics, and sensitivity to drugs.

METHODS

To investigate the isotype composition of beta-tubulin in human prostate, tissues were collected from 26 patients after radical prostatectomy and sections were stained with isotype-specific antibodies.

RESULTS

beta IV tubulin is the predominant isotype in benign prostatic hyperplasia (BPH) and adenocarcinoma, showing significantly stronger immunohistochemical expression than beta II and beta III, particularly in Gleason's grade 3 and 4 cancers. Staining for the beta II isotype was invariably weak and often absent in BPH and normal glands. There was a marked increase in beta II isotype stain from BPH to cancer in 77% of the patients, suggesting that the expression of this isotype is related to malignant status.

CONCLUSIONS

The beta II tubulin isotype is a potential marker for prostate adenocarcinoma. The possibility that tumor beta-tubulin isotype composition may effect the response to antimicrotubule drug therapy in prostate cancer and other tumors merit investigation.

[Late reopening of patent ductus arteriosus after complete closure with the Rashkind prosthesis. Possible traumatic origin]

We report the case of a symptomatic adult with an occluded persistent duct with a transcatheter proceeding using a Rashkind prosthesis. After a month of follow up the color-coded Doppler-flow echocardiogram did not show residual shunt, posteriorly the patient's symptoms disappeared and the left ventricular dimensions were reduced. At the thirteen month of follow-up, the patient had an accident while working, falling down from a scaffold. Afterwards, a ductal jet was observed in the echocardiogram with an increased size of the left ventricle, symptoms also appeared. A cardiac catheterism was then performed showing a pulmonary/systemic flow rate of 2 and a 3 mm flow jet at the superior border of the prosthesis. A second prosthesis was implanted with no residual shunts.

Microscopic benign and invasive malignant neoplasms and a cancer-prone phenotype in prophylactic oophorectomies

BACKGROUND

The occurrence of approximately 5% of common epithelial malignant tumors of the ovary can be traced to inheritance of risk. One prophylactic strategy to decrease the probability of development of disease in individuals within families where this mendelian-dominant pattern of occurrence is apparent is to remove the ovaries of individuals at risk for ovarian cancer. The procedure, when done for this purpose, is recommended soon after completion of childbearing.

PURPOSE

Our goal was to compare the histologic features of the ovaries of women at increased risk for ovarian cancer to those at no known increased risk for the disease.

METHODS

Ovaries removed for prophylaxis from 20 women considered to be at increased risk for developing ovarian cancer were examined histologically. During the course of this work, it seemed apparent that these ovaries contained numerous atypical features compared with the expected appearance of normal ovaries. Hence, we expanded the study to include a control group whose ovaries were removed for reasons unrelated to cancer. The study, therefore, was not blinded. The increased risk in the cancer-prone individuals was determined by family history, specifically the presence of at least one first-degree relative and one second-degree relative with ovarian and/or breast cancer and positive linkage or mutational analysis of BRCA1 in some. The difference in mean ages of patients in the control and high-risk groups was not statistically significant. The difference among both groups with respect to the number of atypical features as well as the intensity of those features was ascertained by computing probabilities using Fisher's exact test (two-sided) for rows x columns contingency tables.

RESULTS

Two unanticipated microscopic or near-microscopic malignant neoplasms and other benign and borderline tumors were discovered in the ovaries of the high-risk individuals. Of substantial interest was the finding that among the ovaries of high-risk women, 85% presented two or more and 75% presented three or more of the following histologic features: surface epithelial pseudostratification; surface papillomatosis; deep cortical invaginations of the surface epithelium, frequently with multiple papillary projections within small cystic spaces (microscopic papillary cystadenomas); epithelial inclusion cysts, frequently with epithelial hyperplasia and papillary formations; cortical stromal hyperplasia and hyperthecosis; increased follicular activity; corpus luteum hyperplasia; or hilar cell hyperplasia. Two or more or three or more such changes were observed in a lesser percentage (30% or 10%, respectively) of ovaries obtained from the control individuals, with a statistically significant difference (P = .001 or P = .00007, respectively), particularly considering that a detailed determination of a family history of cancer in the control group was not possible.

CONCLUSIONS

The frequency of these changes in the high-risk ovaries compared with control ovaries suggests a characteristic histologic preneoplastic phenotype defined by an increased frequency and intensity of the above-described histologic features in the high-risk ovaries. Limited access to numerous small (stage I) ovarian cancers or cancer-prone ovaries by any one pathologist may explain the failure to identify the phenotype in the past.

IMPLICATIONS

We suggest that the ovaries removed from ovarian cancer-prone individuals as a preventative measure should be thoroughly examined histologically to identify or rule out microscopic or near-microscopic invasive neoplasms.