Urban Roadway Runoff Is Lethal to Juvenile Coho, Steelhead, and Chinook Salmonids, But Not Congeneric Sockeye

We compared the sensitivity of closely related Pacific salmon and steelhead (Oncorhynchus spp.) to untreated urban stormwater runoff across three storm events. Juvenile coho, sockeye, steelhead, and Chinook were exposed for 24 h to untreated urban runoff and then transferred to clean water for 48 h. As anticipated from previous studies, coho were highly susceptible to runoff toxicity, with cumulative mortality rates ranging from 92%-100% across the three storms. By contrast, juvenile sockeye were unaffected (100% survival), and cumulative mortality rates were intermediate for steelhead (4%-42%) and Chinook (0%-13%). Furthermore, coho died rapidly following the onset of stormwater exposure (generally <4 h), whereas mortality in Chinook and steelhead was delayed by 1-2 days. Similar to previous findings for coho, steelhead and Chinook did not recover when transferred to clean water. Lastly, significant mortality occurred in coho even when roadway runoff was diluted by 95% in clean water. Our findings extend the urban runoff mortality syndrome in salmonids and point to a near-term need for sublethal studies in steelhead and Chinook to more precisely understand stormwater risks to threatened species recovery efforts in the western United States.

Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

Cosmological Constraints from Multiple Probes in the Dark Energy Survey

The combination of multiple observational probes has long been advocated as a powerful technique to constrain cosmological parameters, in particular dark energy. The Dark Energy Survey has measured 207 spectroscopically confirmed type Ia supernova light curves, the baryon acoustic oscillation feature, weak gravitational lensing, and galaxy clustering. Here we present combined results from these probes, deriving constraints on the equation of state, w, of dark energy and its energy density in the Universe. Independently of other experiments, such as those that measure the cosmic microwave background, the probes from this single photometric survey rule out a Universe with no dark energy, finding w=-0.80_{-0.11}^{+0.09}. The geometry is shown to be consistent with a spatially flat Universe, and we obtain a constraint on the baryon density of Ω_{b}=0.069_{-0.012}^{+0.009} that is independent of early Universe measurements. These results demonstrate the potential power of large multiprobe photometric surveys and pave the way for order of magnitude advances in our constraints on properties of dark energy and cosmology over the next decade.

Blue Nevus of the Cervix

Six cases of blue nevus of the endocervix are reported with a review of the literature. The lesion is interpreted as a visceral analogue of the cutaneous blue nevus.

[When should gestation of a gastroschisis be terminated?]

OBJECTIVES

In gastroschisis pregnancies, a) to correlate prenatal ultrasound variables with postnatal outcome and b) to determine the ideal time for setting the delivery in order to achieve the best neonatal outcome.

MATERIAL AND METHODS

Retrospective review (2000-2015) of all available gastroschisis whose prenatal findings could be correlated with the neonatal outcome. Two study groups have been defined according to the complications present after birth: favorable gastrosquisis and complicated. Prenatal variables were compared by groups using McWhitney or Chi tests as needed.

RESULTS

Twenty-two gastroschisis fulfilled the requirement. Twelve cases had uneventful outcomes. Ten patients experienced complications, including death in five. In the complicated group there were 15 episodes of sepsis and 17 reoperations. Any single ultrasound parameter could predict a bad follow up. In thirteen cases, delivery was forced due to sudden changes on ultrasound bowel appearance. Nine of these patients had very good neonatal outcome.

CONCLUSIONS

Finishing pregnancy when sudden changes on the fetal bowel were identified was the only strategy that leaded us to diminish the complication rate in gastroschisis.

Molecular genetic heterogeneity in undifferentiated endometrial carcinomas

Undifferentiated and dedifferentiated endometrial carcinomas are rare and highly aggressive subtypes of uterine cancer, not well characterized at a molecular level. To investigate whether dedifferentiated carcinomas carry molecular genetic alterations similar to those of pure undifferentiated carcinomas, and to gain insight into the pathogenesis of these tumors, we selected a cohort of 18 undifferentiated endometrial carcinomas, 8 of them with a well-differentiated endometrioid carcinoma component (dedifferentiated endometrioid carcinomas), and studied them by immunohistochemistry and massive parallel and Sanger sequencing. Whole-exome sequencing of the endometrioid and undifferentiated components, as well as normal myometrium, was also carried out in one case. According to The Cancer Genome Atlas classification, we distributed 95% of the undifferentiated carcinomas in this series as follows: (a) hypermutated tumors with loss of any mismatch repair protein expression and microsatellite instability (eight cases, 45%); (b) ultramutated carcinomas carrying mutations in the exonuclease domain of POLE (two cases, 11%); (c) high copy number alterations (copy-number high) tumors group exhibiting only TP53 mutations and high number of alterations detected by FISH (two cases, 11%); and (d) low copy number alterations (copy-number low) tumors with molecular alterations typical of endometrioid endometrial carcinomas (five cases, 28%). Two of the latter cases, however, also had TP53 mutations and higher number of alterations detected by FISH and could have progressed to a copy-number high phenotype. Most dedifferentiated carcinomas belonged to the hypermutated group, whereas pure undifferentiated carcinomas shared molecular genetic alterations with copy-number low or copy-number high tumors. These results indicate that undifferentiated and dedifferentiated endometrial carcinomas are molecularly heterogeneous tumors, which may have prognostic value.

Placebo-Controlled Comparison of Effervescent Acetylsalicylic Acid, Sumatriptan and Ibuprofen in the Treatment of Migraine Attacks

Acetylsalicylic acid (ASA) in combination with metoclopramide has been frequently used in clinical trials in the acute treatment of migraine attacks. Recently the efficacy of a new high buffered formulation of 1000 mg effervescent ASA without metoclopramide compared to placebo has been shown. To further confirm the efficacy of this new formulation in comparison with a triptan and a nonsteroidal anti-inflammatory drug (ibuprofen) a three-fold crossover, double-blind, randomized trial with 312 patients was conducted in Germany, Italy and Spain. Effervescent ASA (1000 mg) was compared to encapsulated sumatriptan (50 mg), ibuprofen (400 mg) and placebo. The percentage of patients with reduction in headache severity from moderate or severe to mild or no pain (primary endpoint) was 52.5% for ASA, 60.2% for ibuprofen, 55.8% for sumatriptan and 30.6% for placebo. All active treatments were superior to placebo ( P < 0.0001), whereas active treatments were not statistically different. The number of patients who were pain-free at 2 h was 27.1%, 33.2%, 37.1% and 12.6% for those treated with ASA, ibuprofen, sumatriptan or placebo, respectively. The difference between ASA and sumatriptan was statistically significant ( P = 0.025). With respect to other secondary efficacy criteria and accompanying symptoms no statistically significant differences between ASA and ibuprofen or sumatriptan were found. Drug-related adverse events were reported in 4.1%, 5.7%, 6.6% and 4.5% of patients treated with ASA, ibuprofen sumatriptan or placebo. This study showed that 1000 mg effervescent ASA is as effective as 50 mg sumatriptan and 400 mg ibuprofen in the treatment of migraine attacks regarding headache relief from moderate/severe to mild/no pain at 2 h. Regarding pain-free at 2 h sumatriptan was most effective.

Surface behavior of peptides from E1 GBV-C protein: Interaction with anionic model membranes and importance in HIV-1 FP inhibition

The interaction between a peptide sequence from GB virus C E1 protein (E1P8) and its structural analogs (E1P8-12), (E1P8-13), and (E1P8-21) with anionic lipid membranes (POPG vesicles and POPG, DPPG or DPPC/DPPG (2:1) monolayers) and their association with HIV-1 fusion peptide (HIV-1 FP) inhibition at the membrane level were studied using biophysical methods. All peptides showed surface activity but leakage experiments in vesicles as well as insertion kinetics in monolayers and lipid/peptide miscibility indicated a low level of interaction: neither E1P8 nor its analogs induced the release of vesicular content and the exclusion pressure values (πe) were clearly lower than the biological membrane pressure (24-30 mN m(-1)) and the HIV-1 FP (35 mN m(-1)). Miscibility was elucidated in terms of the additivity rule and excess free energy of mixing (GE). E1P8, E1P8-12 and E1P8-21 (but not E1P8-13) induced expansion of the POPG monolayer. The mixing process is not thermodynamically favored as the positive GE values indicate. To determine how E1 peptides interfere in the action of HIV-1 FP at the membrane level, mixed monolayers of HIV-1 FP/E1 peptides (2:1) and POPG were obtained. E1P8 and its derivative E1P8-21 showed the greatest HIV-1 FP inhibition. The LC-LE phase lipid behavior was morphologically examined via fluorescence microscopy (FM) and atomic force microscopy (AFM). Images revealed that the E1 peptides modify HIV-1 FP-lipid interaction. This fact may be attributed to a peptide/peptide interaction as indicated by AFM results. Finally, hemolysis assay demonstrated that E1 peptides inhibit HIV-1 FP activity.

Phenotypic characterization of hereditary epithelial ovarian cancer based on a tissue microarray study

The pathologic and immunohistochemical features of familial epithelial ovarian cancers are not well understood. We have carried out a comprehensive immunohistochemical study of familial ovarian carcinomas from women with and without BRCA1 or BRCA2 mutations, in order to identify specific and/or common features among these different familial case groups (BRCA1, BRCA2 and non-BRCA1/2) and to identify markers of diagnostic value that might help to select more specific treatments. 73 familial primary ovarian carcinomas were analyzed for the expression of 40 antibodies involved in different genetic pathways using a tissue microarray. Serous carcinomas comprised the majority of all three familial case groups. On the other hand, BRCA1 and BRCA2 carcinomas have similar histopathologic features; i.e. they are often high-grade and are usually diagnosed at a more advanced FIGO stage than non-BRCA1/2 carcinomas. In our series, BRCA1 carcinomas had better clinical evolution and they also more frequently over-expressed PR and P53 than BRCA2 and non-BRCA1/2 carcinomas. Unsupervised cluster analysis and survival analysis identified ERCC1 as a potential marker of better clinical outcome for hereditary epithelial ovarian cancer.

Spectroscopic analysis of the interaction of a peptide sequence of Hepatitis G virus with bilayers

Merocyanine 540 (MC540) has been used as external probe to determine the interaction of the peptide sequence 125-139 corresponding to the E2 protein of Hepatitis G virus, with lipid bilayers. The probe was incorporated into large unilamellar vesicles (LUVs) or small unilamellar vesicles (SUVs) of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC). When incorporated into bilayers, MC540 shows two absorption maxima corresponding to the monomer (570 nm) and dimer (530 nm) form of the probe. Changes in the probe microenvironment are reflected by a modification in the position and/or intensity of these maxima. Addition of increasing amounts of peptide resulted in a slight decrease of the ratio A570/A530 thus indicating a change in MC540 partition into the membrane, going from a hydrophobic to a more hydrophilic environment. This effect was concomitant with an increase in dimer formation as stated from the values of the apparent dimerization constant (K(app)) obtained. Fluorescence spectra as well as steady state anisotropy measurements were in agreement with the above results indicating that the peptide was able to relocate the probe and displacing MC540 from its initial location into the bilayer. Results with SUVs or LUVs were similar for what curvature does not seem to play any role on peptide activity. These results reflect the ability of peptide to interact with biomimetic membranes in the lipid head group region.

Interaction of two overlapped synthetic peptides from GB virus C with charged mono and bilayers

The physical chemistry properties and interactions of E2 (125-139) and E2 (120-139) peptide sequences from GB virus C with model cell membranes were investigated by means of several biophysical techniques in order to gain better understanding of the effect of peptide length and lipid charge on membrane binding. The peptides, having one net negative charge at the pH of the assays, interacted with monolayers of all the phospholipids regardless of the charge but with more extent with the cationic DPTAP thus indicating that the interaction had both a hydrophobic and an electrostatic component as has been observed for other peptides of the same family. The peptides were able to leakage contents of liposomes and showed fluorescence energy transfer in vesicles depending on the vesicles lipid composition. On another hand, circular dichroism has shown that the peptides exist mainly as a mixture of disordered structure and β-type conformations in aqueous solution but diminished its unstructured content, folding preferentially into α-helical conformation upon interaction with hydrophobic solvents or positively charged lipid surfaces. Altogether, results of this work indicate that the peptides interact at a surface level, penetrate into bilayers composed of fluid lipids and that conformational changes could be responsible for this effect.

Atherosclerosis prevention by nutritional factors: a meta-analysis in small animal models

BACKGROUND AND AIMS

Atherosclerosis prevention in small laboratory models has been used as a preclinical stage in the development of functional foods with claimed antiatherogenic properties. However, a high heterogeneity of experimental atherosclerosis models as well as species-specific differences in lipoprotein metabolism could limit the usefulness of these developments. To solve this, we have performed a meta-analysis on the effects of nutritional complements (i.e. less than 2% of diet) with potential antiatherogenic properties in mice, rabbits and hamsters, and compared the outcomes with those obtained in humans.

METHODS AND RESULTS

A meta-analysis comprising works dealing with dietary prevention of experimental atherosclerosis (i.e. macroscopic and/or pathological evidences of atheromatosis in aorta) has been performed (n = 110 works). Quality criteria were applied resulting in selection of 16 works comprising 511 animals. Despite high heterogeneity, there is a significant effect of nutritional interventions reducing atheroma globally (mean effect 24.38% (95% CI: 13.24-35.51%) of prevention). In mouse studies (20.64% (95% CI: 8.38-32.90%)) and in rabbits (40.48% (95% CI: 6.73-74.23%)) this effect was significant, in contrast with hamster-based works (95% CI: 13.66-49.48%). Meta-regression showed that reduction of atheroma plaque formation was not linked to changes either in total circulating cholesterol or LDL cholesterol levels.

CONCLUSION

Nutritional addition of selected compounds significantly prevents experimental atheromatosis, but the reproduction of positive effects observed in humans was very limited. These analyses reinforce the need for adequate standardization of atherosclerosis studies in preclinical models and for human intervention trials.

Dimensioning of OFDMA PON with non-preselected independent ONUs sources and wavelength-control

A simple and low cost method for wavelength control of economical random non-preselected independent ONU sources is shown to increase the number of users in an OFDMA-PON. The method is based on OLT monitoring and thermal tuning control; it has been validated through Monte-Carlo simulations and a probabilistic model. The minimum optical spectral gap between the ONUs wavelengths that guarantees a tolerable amount of optical beat interference has been determined through an experiment.

10 Gb/s full-duplex bidirectional transmission with RSOA-based ONU using detuned optical filtering and decision feedback equalization

Full-duplex bidirectional transmission at 10 Gb/s is demonstrated for extended wavelength division multiplexed passive optical network (WDM-PON) applications, achieving transmission distances up to 25 km of standard single mode fiber (SSMF) when using a low-bandwidth (approximately 1.2 GHz) reflective semiconductor optical amplifier (RSOA) for signal re-modulation at the optical network unit (ONU). The system is assisted by optimum offset filtering at the optical line terminal (OLT)-receiver and the performance is further improved with the use of decision-feedback equalization (DFE). Chromatic dispersion (CD) and Rayleigh Backscattering (RB) effects are considered and analyzed.

Activation of the NF-kappaB signalling pathway in diffuse large B-cell lymphoma: clinical implications

AIM

To characterize the activation of the nuclear factor (NF)-kappaB pathway in diffuse large B-cell lymphoma (DLBCL) by immunohistochemistry.

METHODS AND RESULTS

Sixty-six DLBCLs treated with anthracycline-containing chemotherapy were evaluated with antibodies against phosphorylated p65 (P-p65), p65, p50, p52, IKK alpha, and phosphorylated I kappaB (P-I kappaB). NF-kappaB activation was based on the expression of P-p65, P-I kappaB, and nuclear expression of p65 or p52 in the tumour cells. P-p65 and P-I kappaB were expressed in 13 (20%) and 17 cases (26%), respectively. p65, p52 and IKK alpha were found in the cytoplasm. A correlation was found between expression of P-p65 and P-I kappaB (P < 0.0001), but not between the two subtypes of DLBCL [germinal centre B cell and non-germinal centre (GC)]. P-p65+ tumours showed a better response to chemotherapy (P = 0.025) and a trend to increased event-free survival (P = 0.08). However, P-I kappaB expression was not associated with either clinical response or survival. Bcl-2 was not preferentially expressed on DLBCL tumours with NF-kappaB activation, as determined by expression of P-p65 and P-I kappaB proteins.

CONCLUSIONS

NF-kappaB activation in DLBCL is preferentially mediated through the classical pathway and a novel mechanism involving phosphorylation of p65. Activation of NF-kappaB by P-p65 is associated with good prognosis. NF-kappaB activation is not confined to non-GC DLBCL exclusively.

[Our experience in the treatment of proximal hypospadias in a single surgical intervention]

BACKGROUND

The surgical correction of proximal severe hypospadias, especially those with penoscrotal transposition (penis buried in scrotum), represents a true challenge for paediatric surgeons. A sequential approach to their repair is widely accepted, to preserve the vascularization of the neourethra and to avoid injuries in penis covering. In our experience, we believe that all hypospadias, even those associated with penoscrotal transposition, can be repaired in one surgical time by using a vascularized flap from dorsal prepuce in one or two layers (mucosal portion for urethra and skin face for ventral island).

MATERIALS AND METHODS

From 1997 until 2007, 88 patients with proximal severe hypospadias have been operated. 35 patients associated penoscrotal transposition. Since 2005, we introduced a modification consisting in drawing the incisions following the own cutaneous folds resulting from the fusion of the lateral folds in penis skin.

RESULTS

We performed Duckett type urethroplasty in 10 patients, Onlay type flap in 74, Onlay with oral mucosa in 2 and vesical mucosa urethroplasty in 2 of them. The fistula rate needing surgical closure was 17% (15/88), urethral stenosis was present in 5 patients (5.7%, 1 vesical mucosa, 2 Duckett urethrolpasties and 2 Onlay flaps). Severe complications were represented by partial necrosis of the skin flap in 3 patients (3.4%) needing a reurethroplasty. 1 patient presented surgical wound infection without later problems. Before 2005, among the 22 patients with penoscrotal transposition, 5 needed a new cutaneoplasty, associated in 2 occasions to a dorsal Nesbitt plicature to obtain the complete penis alignment. From 2005 until now, None of the 13 patients presenting with penoscrotal transposition needed any posterior cutaneoplasty. The follow up goes from 1 month until 10 years (median 45 months). At present time, urine spurt shows a correct range in all cases and the penis is located out of scrotal bag except in one patient, waiting for a new plasty.

DISCUSSION

In our experience, we believe that all of the hypospadias may be repaired in a unique surgical time, including those of them associated with buried penis. Modification on skin incisions design following penoscrotal lateral folds with mucocutaneous preputial flap is an excellent option both for urethroplasty and correcting penis transposition.

[Orbital approach for treatment of carotid-cavernous sinus fistula]

CASE REPORT

A male patient with a left carotid-cavernous sinus fistula (CCSF) and two previous attempts of embolization via the femoral vein was treated with embolization through the superior ophthalmic vein (SOV).

DISCUSSION

The main modality of treatment for CCSF is intervention radiology. This aims to occlude the fistula via an arterial route, through the cavernous sinus, or via a venous route, through the inferior petrosus sinus. However, the CCSF is also accessible through the SOV.

Long-haul 10 Gbit/s linear and non-linear IMDD transmission over uncompensated standard fiber using a SQRT-metric MLSE receiver

We experimentally demonstrated Intensity-Modulated Direct-Detection (IMDD) single-channel 1,040 km linear transmission and 800 km non-linear transmission at 10 Gb/s over standard single-mode (G.652) fiber, without any optical dispersion compensation or mitigation, using a Maximum-Likelihood Sequence-Estimation (MLSE) receiver employing the square-root (SQRT) branch metric with off-line processing. These experiments were designed as to probe the limits of the MLSE approach. They successfully showed that long-haul uncompensated transmission is in principle possible with MLSE, even in the presence of large uncompensated dispersion and strong intra-channel fiber non-linearities, provided that enough complexity can be built into the receiver. In the linear 1,040 km experiment, a Bit Error Rate (BER) of 10(-3) was achieved with an Optical Signal-to-Noise Ratio (OSNR) penalty with respect to back-to-back of 2.9 dB, using two samples per bit and 16,384 trellis states. Several other set-ups were tested as well, including the use of only one sample per bit and fewer trellis states. In the non-linear 800 km experiment, power was ramped up to 12 dBm, exciting substantial Kerr non-linearity, whose induced spectral-broadening exacerbated the effects of the large uncompensated dispersion of the link. Using an MLSE receiver with 1,024 states, we demonstrated a non-linear threshold of 9 dBm. We benchmarked this experiment towards simulations addressing various electrical and optical dispersion compensation strategies. We also carried out an analysis of error run-lengths, on both experiments, which showed that error burstiness may change considerably depending on the number of processor states, OSNR and the amount of non-linearity in the link.

Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia

We report our experience in the postnatal management of congenital diaphragmatic hernia (CDH) after fetal endoluminal balloon tracheal occlusion (FETO).

MATERIAL AND METHODS

Out of 19 CDH fetuses diagnosed since December 2005, 13 had a lung-to-head ratio (LHR) < 1.1 (0.86 +/- 0.11) and underwent FETO at a mean gestational age (GA) of 27.9 weeks. The balloon was removed in 3 cases through puncture in EXIT (ex utero intrapartum treatment); there were 3 trans-utero punctures, 3 fetoscopies and 3 balloons deflated spontaneously. One patient died from bleeding during the FETO procedure. Six patients were not subjected to FETO: 3 had a LHR > or = 1.4 and 3 did not come to consultation prenatally.

RESULTS

Twelve babies were born after FETO at 34.9 +/- 1.7 weeks GA; 3 died before surgery from refractory hypoxia. Six needed high frequency oscillatory ventilation (HFOV), and inhaled nitric oxide (NO), one progressing to extracorporeal membrane oxygenation (ECMO), and 3 needed conventional ventilation. CDH was repaired in 9: 2 with direct sutures and 7 with prosthetic patches. Extubation was at median of 5 days (range: 2 - 40), discharge was at 30.4 +/- 16.4 days. Early complications were 1 reherniation and 2 intestinal occlusions. Two patients died after CDH repair: the ECMO case at 15 days, and an infant discharged on oxygen at home, at age 4 months. Of the non-FETO patients, four needed HFOV and NO. CDH repair was performed in 5: 3 had direct repair and 2 had prosthetic patches. Extubation was at 13.4 +/- 12.9 days and discharge was at 43.8 +/- 26.5 days. One patient died before surgery from severe cardiac malformation. Early complications were 1 reherniation and 1 hiatus hernia. Late complication was 1 reherniation at 5 months of life. There was no postoperative mortality. One patient needs oxygen at home.

CONCLUSION

CDH patients with a poor prognosis undergoing FETO had postnatal outcomes similar to non-prenatally studied cases and good prognosis cases.

Microtubule-regulatory phosphoproteins and NER system are involved in platinum and paclitaxel-based chemotherapy resistance in ovarian cancer

5567

Background: The treatment of ovarian cancer is hindered by intrinsic resistance to platinum and paclitaxel-based chemotherapy (CT). Nucleotide excision repair system plays a central role in DNA repair and is related with resistance to platinum compounds. Excision repair cross-complementation 1 (ERCC1) and 3 (ERCC3) genes confer a differential sensitivity to CT. OP18/stathmin and mDIA are involved in regulation of microtubules dynamics and may represent a mechanism of resistance to paclitaxel. Both mechanisms have been recently investigated in ovarian cancer (OC). Methods: Formalin and paraffin-embedded tissues obtained from 33 patients with advanced OC were retrospectively collected to investigate ERCC1, ERCC3, OP18, and mDIA mRNA levels by quantitative RT- PCR. All patients received a median of 6 cycles platinum based CT in combination with taxanes. Median age was 62 years. Tumors were classified: 52% serous, 9% endometrioid, 27% clear cell, and 12% poorly differentiated carcinomas. FIGO stage: 4 (12%) stage II, 19 (58%) stage III, and 10 (30%) stage IV. 12 chemoresistant tumors (time to recurrence (TTR) < 6 months) and 21 chemosensitive tumors (TTR = 6 months) were analyzed. Median follow-up was 31 months. Results: An increase in mRNA levels was consistently observed in the chemoresistent group: 1.9-fold increased in ERCC1 and 1.6-fold increased in ERCC3. Both genes exhibited comparable expression levels. Statistically significant differences on ERCC1 and ERCC3 mRNA levels were encountered when chemoresistant and chemosensitive tumors were compared (p=0.01 and p= 0.03, respectively). Statistically differences on OP18 mRNA levels were found when chemoresistant and chemosensitive tumors were compared (p=0.05). No differences in mDIA mRNA levels were encountered. Conclusions: Our results suggest that determination of ERCC1-ERCC3 before chemotherapy is potentially useful to predict the effectiveness of platinum-based therapy. Microtubule drug resistance in OC may be associated with altered OP18/stathmin expression. Novel treatment approaches based on molecular markers could be useful predictors of response and could identify targets for therapeutic strategies. Further studies are required.

No significant financial relationships to disclose.

Clonal analysis favours a monoclonal origin for serous borderline tumours with peritoneal implants

Serous borderline tumours (SBTs) of the ovary were originally classified as such because the vast majority behave in a remarkably indolent manner, even in the presence of widespread tumour deposits, termed implants, and/or lymph node involvement. The pathogenesis of the implants is currently unknown. Two major hypotheses have been proposed: the first favours a monoclonal origin, arguing that the peritoneal lesions derive from neoplastic cells that are shed from the primary ovarian tumour. The second hypothesis favours a polyclonal origin as a result of a field defect of susceptible Müllerian cells from which multiple independent tumours arise. To test both hypotheses, genome-wide allelotyping and B-RAF/K-RAS mutation analyses were employed to assess clonality in 25 metachronous or synchronous tumours from ten SBT patients. Loss of heterozygosity (LOH) profiling and K-RAS/B-RAF mutation analysis showed concordance of the genetic changes in all sites in 21 tumours from eight patients who were informative. These results favour a common origin, underscored by a likelihood ratio (probability of common origin/probability of independent origin) ranging from 2.43 to 7,662,850. In conclusion, this study strongly supports the hypothesis that both non-invasive and invasive implants arise as a consequence of spread from a single ovarian site.

[Which surgical technique should we perform for benign renal disease in children?]

AIM

The aim of this paper is to analyze our experience in different surgical techniques to perform a nephrectomy for benign renal diseases in children.

MATERIAL AND METHODS

From 1993 to 2005 we have performed 98 nephrectomies. We have three groups of patients depending on the surgical technique: open nephrectomy (ON), transperitoneal laparoscopic nephrectomy (TLN) and retroperitoneal laparoscopic nephrectomy (RLN). ON was performed in 36 patients. Mean age was 3.3 years. TLN was performed in 39 patients. Mean age was 4.7 years old. RLN was performed in 23 patients. Mean age was 3.6 years old. Criteria to nephrectomy was a renographic function under 19%. We have compared the three surgical techniques in relation with surgical time and mean hospital stay.

RESULTS

Mean operative time was 126.2 minutes in ON, 132.3 minutes in TLN and 134.1 minutes in RLN. Mean stay was 5.02 days in ON, 2.35 days in TLN and 1.86 days in RLN. The median hospital stay of the ON group is significantly longer than that of NLT and NR groups (p < 0.05). However, there are no differences related to surgical time between all the groups.

CONCLUSIONS

Nephrectomy may be performed for benign disease in children using less invasive surgical techniques. They are associated with minimal morbidity, minimal postoperative discomfort, improve cosmesis and a shorter hospital stay. However, we haven't found differences between TLN and RLN.

[Nutritional and surgical management of short bowel syndrome. Our last 6 patients' experience]

BACKGROUND

Children cause of intestinal failure is short-bowel syndrome. It provokes an altered absorption of nutrients and makes patients to be dependent on parenteral nutrition (PN) while they wait or not for an intestinal transplantation, with its side effects. It is crucial to achieve the maximum efficiency of remaining intestine. Many surgical techniques have been led to reduce stasis of dilated small intestine and improve the mucosal surface area for absorption.

METHODS

Six patients have presented intestinal failure because of a surgical resection during newborn period. 2 gastroschisis, 2 intestinal atresias (Apple-peel), 1 necrotizing enterocolitis (NEC) and 1 midgut volvulus. 4 preserve ileocecal valve (ICV): 2 Apple-peel, 1 NEC and the midgut volvulus. The shortest length of bowel after resection were 12cm without ICV (gastroschisis) and 18cm with ICV in a preterm newborn of 24 weeks of gestational age (midgut volvulus). Tapering and plication have been done in Apple-peel cases. No complementary surgical techniques have been necessary in NEC and volvulus. Gastroschisis cases had 12 and 40 cm of small bowel without ICV. In the first one, during newborn period an intestinal lengthening according to Bianchi was done, followed by sequential transversal enteroplasty (STEP), partial gastrectomy and plication of 1st and 2nd duodenal portion. In the second, an STEP was done. All patients have received cycled and optimized PN (COPN) in our centre, only one case (gastroschisis) proceeding from another centre had received standard PN and developed a great hepatic affectation.

RESULTS

2 Apple-peel have been adapted to normal enteral nutrition after 3 and 18 months of COPN, such as NEC and volvulus (3-6 months). One gastroschisis (12cm) has a normal hepatic function with free oral nutrition and home COPN at 23 months. The other one (40cm) has COPN and started enteral nutrition 1 month after surgery, although its hepatic function remains altered.

CONCLUSIONS

Parenteral nutrition is essential for these patients to survive. We would like to enhance the importance of COPN in order to preserve hepatic function. Surgical procedures aim to avoid stasis and bacterial overgrowth and improve intestinal motility. Different techniques may be used alone or sequentially. The purpose of this management is to achieve nutritional autonomy or increase waiting time before intestinal transplantation.

Stratification of the normal range of CA125 after chemotherapy as a predictive factor in carcinoma of the ovary

5059

Background: CA125 is an accurate and reliable marker for monitoring the response to treatment and detecting early relapse in ovarian cancer. The implications of the variation of its normal range are not known.The purpose of this study was to evaluate such variations as a prognostic indicator after first-line chemotherapy Methods: Over a 7 years period (1998–2005), 114 patients (pts) were treated with standard chemotherapy regimen for FIGO stage Ic-IV epithelial ovarian cancer. The median age was 63 years old (24–87) years. The tumors were classified: 56% serous, 12% endometroid, 16% poorly differentiated and 16% clear cell carcinomas. FIGO stage: 12 (11%) Ic, 14 (12%) II, 72 (63%) III, 16, (14%) IV. After surgery, 90% of the patients received a median of 6 cycles/patient with platinum based (cisplatin or carboplatin) chemotherapy in combination with taxane. Serial measurement of CA12.5 had been made before each cycle of chemotherapy and response was assessed according to RECIST or Rustin criteria. Median follow-up has been 31 months. 87 pts achieved levels below 35 u/ml after completion of treatment. The nadir value of CA125 was stratified into three arbitrary groups: group 1, ≤ 10 U/ml, group 2, 11–20 U/ml, and group 3, 21–35 U/ml. The χ2/Fisher’s exact test was used to examine patients characteristics for categorical variables. Survival analysis was performed by Kaplan-Meier method with long-rank test for determining statistical significance. Results: No statistical relationship between FIGO stage and gross residual tumor vs nadir groups (p = 0.48 and p = 0.2) was found. Median duration of progression free survival according to 3 groups was 34, 20, 14 months, respectively (p= 0.003). The median overall survival for the group 1 is not yet available, however, the corresponding median overall survival for groups 2 and 3 were 3.8 and 2.7 years, respectively (p = 0.006) Conclusions: Within normal range, the differences between CA125 levels could add prognostic information and stratify patients according to the risk of progression.

No significant financial relationships to disclose.

[Lessons we've learned in the treatment of long gap esophageal atresias]

BACKGROUND

A gap greater than 3 cm between both esophageal pouches is observed in 1 of 20 cases of esophageal atresia. Our goal was to critically review our experience in the management of these patients.

MATERIAL AND METHODS

During 1995-2004, 15 patients were treated for a long gap esophageal atresia (LEA). Gaps ranged from 3 to 8 cm. Ten patients presented a pure esophageal atresia. They were managed with a gastrostomy and delayed repair: 8 Schärli interventions and 2 esophageal flaps. The other 5 patients had an esophageal atresia with distal fistula (LEA-DF), and primary repair was attempted: 3 end-to-end esophageal anastomosis were achieved under a strong tension; 1 a Schärli procedure; 1 ligation of the fistula, feeding gastrostomy and delayed esophageal flap. The use of esophageal flaps is a late event in our series. since its introduction we've performed 5 esophageal atresia repairs using 3 flaps (2 pure atresias and 1 LEA-DF).

RESULTS

From 9 Schärli we have to practice 2 reinterventions for anastomotic leak; there was 1 parahiatal hernia that needed surgery after 8 years. From 3 flaps 2 patients presented a persistent stricture that needed reintervention. All of the 3 E-E anastomosis had reintervention for persistent stricture and also anti-reflux procedures (Nissen). Eight patients showed a normal growth and development (4/9 Schärli, 3/3 flaps and 1/3 E-E). Seven patients are growth retarded (4/7 with associated malformations, 1/7 who developed an eosinophilic esophagitis and 2/7 preterm babies).

CONCLUSIONS

The esophageal flap is our first choice, because the own esophagic tissue fills in the gap. In LEA-DF, we prefer fistula ligation, gastrostomy and delayed rise of a flap (as we did in our last patient) better than a very tense primary anastomosis. As a second option, a Schärli procedure offers satisfying mid-term results. Keeping the patient paralyzed and mechanically ventilated for 5-7 days after surgery helps to avoid disrupting forces on the anastomosis.

A cardiological web as an adjunct to medical teaching: prospective analysis

The aim of the study was to deliver and evaluate an educational web for medical students. A web of the complete cardiovascular course was prepared as an adjunct educational material for the classes. The use and utility of the web was assessed through a questionnaire (frequency of use, impact on in-class attendance and students' satisfaction). The number of visits, the time of the week and the hour when the web was used were registered. A total of 76 students returned the questionnaire. The web was available for 10 weeks and was visited 1062 times, especially at weekends. An increase in visits was noted prior to final examination. The web was accessed preferentially from the faculty or hospital computers. The quality of the web was assessed and rated a mean of 7.7 (score: 1-10); 93.4% students attended the class, but the web freed them from transcribing the contents; 88.2% of students evaluated the web as a useful or very useful adjunct to medical teaching. The Internet can be used to deliver learning in medical students and could be considered as added value to the pedagogic process and did not deter students from attending ordinary classes.