Arrhythmogenic Left Ventricular Cardiomyopathy: From Diagnosis to Risk Management

PURPOSE OF REVIEW

Left ventricular arrhythmogenic cardiomyopathy (ALVC) is a rare and poorly characterized cardiomyopathy that has recently been reclassified in the group of non-dilated left ventricular cardiomyopathies. This review aims to summarize the background, diagnosis, and sudden cardiac death risk in patients presenting this cardiomyopathy.

RECENT FINDINGS

Although there is currently a lack of data on this condition, arrhythmogenic left ventricular dysplasia can be considered a specific disease of the left ventricle (LV). We have collected the latest evidence about the management and the risks associated with this cardiomyopathy.

SUMMARY

Left ventricular arrhythmogenic cardiomyopathy is still poorly characterized. ALVC is characterized by fibrofatty replacement in the left ventricular myocardium, with variable phenotypic expression. Diagnosis is based on a multiparametric approach, including cardiac magnetic resonance (CMR) and genetic testing, and is important for sudden cardiac death (SCD) risk stratification and management. Recent guidelines have improved the management of left ventricular arrhythmogenic cardiomyopathy. Further studies are necessary to improve knowledge of this cardiomyopathy.

Pharmacogenomics of Cardiovascular Drugs for Atherothrombotic, Thromboembolic and Atherosclerotic Risk

PURPOSE OF REVIEW

Advances in pharmacogenomics have paved the way for personalized medicine. Cardiovascular diseases still represent the leading cause of mortality in the world. The aim of this review is to summarize the background, rationale, and evidence of pharmacogenomics in cardiovascular medicine, in particular, the use of antiplatelet drugs, anticoagulants, and drugs used for the treatment of dyslipidemia.

RECENT FINDINGS

Randomized clinical trials have supported the role of a genotype-guided approach for antiplatelet therapy in patients with coronary heart disease undergoing percutaneous coronary interventions. Numerous studies demonstrate how the risk of ineffectiveness of new oral anticoagulants and vitamin K anticoagulants is linked to various genetic polymorphisms. Furthermore, there is growing evidence to support the association of some genetic variants and poor adherence to statin therapy, for example, due to the appearance of muscular symptoms. There is evidence for resistance to some drugs for the treatment of dyslipidemia, such as anti-PCSK9.

SUMMARY

Pharmacogenomics has the potential to improve patient care by providing the right drug to the right patient and could guide the identification of new drug therapies for cardiovascular disease. This is very important in cardiovascular diseases, which have high morbidity and mortality. The improvement in therapy could be reflected in the reduction of healthcare costs and patient mortality.

Catch the Cath or Not? A Hamletic Dilemma after 10 Years

In the last few years, a tremendous advancement has been made in the therapeutical management of several diseases with an increasing need for parental drug administration. To avoid repeated venous insertions and the patient's anxiety related to these procedures, it is now common practice to insert a catheter to leave it in place for a longer time. However, these procedures may generate some complications, such as failure of insertion, embolization, and infection. Different noninvasive techniques have been proposed and used for the retrieval of lost or misplaced foreign objects. Here, we presented a case of the lost fragmented catheter in a young female who underwent a central venous catheter insertion 10 years ago, incidentally detected during an echocardiographic examination. Here, we presented a case of a lost fragmented catheter in a young female who underwent a central venous catheter insertion 10 years before.

Non-Conventional Risk Factors: "Fact" or "Fake" in Cardiovascular Disease Prevention?

Cardiovascular diseases (CVDs), such as arterial hypertension, myocardial infarction, stroke, heart failure, atrial fibrillation, etc., still represent the main cause of morbidity and mortality worldwide. They significantly modify the patients' quality of life with a tremendous economic impact. It is well established that cardiovascular risk factors increase the probability of fatal and non-fatal cardiac events. These risk factors are classified into modifiable (smoking, arterial hypertension, hypercholesterolemia, low HDL cholesterol, diabetes, excessive alcohol consumption, high-fat and high-calorie diet, reduced physical activity) and non-modifiable (sex, age, family history, of previous cardiovascular disease). Hence, CVD prevention is based on early identification and management of modifiable risk factors whose impact on the CV outcome is now performed by the use of CV risk assessment models, such as the Framingham Risk Score, Pooled Cohort Equations, or the SCORE2. However, in recent years, emerging, non-traditional factors (metabolic and non-metabolic) seem to significantly affect this assessment. In this article, we aim at defining these emerging factors and describe the potential mechanisms by which they might contribute to the development of CVD.

Role of a novel nutraceutical composition for irritable bowel syndrome management: symptoms relief and unexpected triglycerides-lowering effect

Background: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and an irregular bowel habit. The prevalence is up to 20% in Western adults, which makes IBS the most common diagnosis in gastroenterology. Despite extensive interest and investigation, IBS's precise aetiology and pathophysiology are poorly understood. Current knowledge suggests that an altered gut microbiota, altered motility, visceral hyperalgesia, and dysregulation of the brain-gut axis are central to IBS. This is also significantly related to a higher prevalence of metabolic syndrome and elevated triglycerides among the adult population. This retrospective study examines the effect of a novel nutraceutical compound, Triobiotix, on gastrointestinal symptoms in IBS patients. Effects on lipid profiles have also been recorded. Objectives: The focus of this study is to evaluate the effectiveness of Triobiotix, a nutraceutical compound composed of prebiotics and probiotics. Methods:Triobiotix is a nutraceutical consisting of Maltodextrin; mineralized extract of Lithothamnion (Lithothamnion calcareum (Pallas) Areschoug, thallus dry extract); Bioecolians® gluco-oligosaccharides; Ferment mix (corn starch, Bifidobacterium animalis ssp. Lactis BLC1 (DSM 17741), Lactobacillus acidophilus LA3 (DSM 17742), Lactobacillus rhamnosus IMC 501 (DSM 16104), Lactobacillus paracasei Streptococcus 501 IMC102 SP4 (DSM 19385); short-chain fructo-oligosaccharides powder. The database of 40 Italian General Practitioners (GPs) was analyzed. A total of 587 patients with IBS treated with Triobiotix were identified. Among them, 535/587 (91.1%) completed the first (T0) and second (T1) visits and their data were available. The primary endpoint of this analysis was to assess if Triobiotix, at a dosage of 1 sachet per day for 30 days, could reduce abdominal pain and bloating, thus resulting in a lower intensity of the main gastrointestinal symptoms. Secondary endpoints were to evaluate presence of any significant changes in triglycerides blood levels and glycaemia.Results: Treatment with this nutraceutical for one month resulted in a reduction in the frequency and intensity of bloating, abdominal pain, flatulence, and tenesmus. In the 85 patients who reported evacuative urgency, the frequency of the episodes didn’t significantly change while their intensity was statistically reduced. Unexpectedly, triglyceride levels also significantly decreased.Conclusions:Our analysis demonstrates this formulation is effective in the relief of the main symptoms associated with IBS. Moreover, an unexpected effect of this combination of micronutrients on tryglicerides, beyond IBS symptoms, was also found. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect.Keywords: Irritable bowel disease; Triglyceridemia; Nutraceuticals

A pitfall in the echographic diagnosis of abdominal aortic aneurysm: when para-aortic lymph nodes are the trick

The abdominal aortic aneurysm (AAA) is a potentially fatal asymptomatic disease. It progresses silently with clinical complications that, when they occur, constitute a very serious event, frequently resulting in the patient's exitus. As a result, early detection and treatment are critical because the right therapeutic strategy can halt the disease's natural progression. AAA is frequently discovered as an incidental finding during an abdominal ultrasound or a plain X-ray of the abdomen, which is required for other pathologies. The primary diagnostic tool for AAA identification is abdominal B-mode ultrasound. It is cheap, widely available, non-invasive, and has high diagnostic sensitivity. However, this diagnostic tool may fail in rare cases due to misleading anatomical findings. We present an unusual flaw in the echographic AAA evaluation that should be considered during the diagnostic work-up.

567 BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT: THE MEASUREMENT OF OVERALL ECHOGENICITY (GSM) OF CAROTID INTIMA MEDIA COMPLEX SHOWS A POSITIVE CORRELATION WITH ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS

Beyond the Intima Media Thickness assessment: the measurement of overall echogenicity (GSM) of Carotid Intima Media Complex shows a positive correlation with Arterial Stiffness of hypertensive patients.

According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk.

Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima-media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color-Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM > 30 showed a significantly increased arterial stiffness and LVMI (P < 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, < 0.001), and duration of hypertension (r = 0.31, < 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.

551 RAPID RELATIVE EFFECTIVENESS OF A NOVEL NUTRACEUTICAL FOR THE MANAGEMENT OF HYPERCHOLESTEROLEMIA: A MULTICENTER PRIMARY CARE EXPERIENCE IN A LARGE POPULATION OF PATIENTS AT LOW TO MODERATE CARDIOVASCULAR RISK

Backgroud

In the last few years increasing evidence have reinforced the benefits of low-density lipoprotrein (LDL-C) levels reduction on cardiovascular outcome. Different targets have been suggested based on the cardiovascular risk (CVR). A goal of LDL-C less of 115mg/dL is desiderable for patients at low to moderate CVR according the current european guidelines. However, an high percentage of patients at low to moderate CVR are far from this target. Nutraceuticals are “food supplements” that may help to achieve this goal in this population. The aim of this retrospective analysis was to evaluate the effects of dietary supplementation with a novel nutraceutical formulation on plasma lipid levels in subjects with low to moderate hypercholesterolemia who are not on treatment with conventional drug and/or with other dietary supplements.

Methods

Adult patients with hypercholesterolemia were retrospectively selected from the database of participant family practitioners. All patients had a baseline evaluation already recorded, including family and medical history, physical examination, and blood test that included total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), C-reactive protein (CRP), and transaminases (AST and ALT) and have started a dietary supplementation with nutraceuticals. After this selection, a total of 504 patients under this novel nutraceutical (given 1 tablet daily at dinner) with blood test at 30-days already performed, were identified. Similarly, 108 subjects with comparable clinical features but not treated with any supplements were also selected.

Results

At 30-day of follow-up, the use of this novel dietary supplement was associated with significant reduction of LDL-C 124 ± 16 vs. 100 ± 13 mg/dL, p-value <0.001) and TC levels (210 ± 56 vs. 187 ± 60, p-value < 0.0001), in absence of a significant changes of transaminase levels (AST: 30 ± 6 vs. 30 ± 6 U/L, p-value 0.198; ALT: AST: 30 ± 6 vs. 30 ± 6 U/L, p-value 0.325) and in CRP (3.9 ± 1.5 vs. 3.9 ± 1.4 mg/dL, p-value 0.889). No side effects were reported in the database along to the observation period.

Conclusion

This novel nutraceutical formulation is an effective dietary supplement in obtaining a significant and early reduction of LDL-C in patients with hypercholesterolemia at low to moderate cardiovascular risk.

564 AN UNUSUAL PRESENTATION OF ICA DISSECTION. A CASE OF TRANSIENT GLOBAL AMNESIA IN A PATIENT WITH PAINLESS SPONTANEOUS INTERNAL CAROTID ARTERY DISSECTION

Image focus

A 42-year-old woman was carried to emergency room lamenting sudden memory loss. Her husband witnessed the onset of the episode. No recent head trauma was reported, blood pressure was under control.

Anterograde and retrograde memory loss was present and confirmed by a neurologist. No other neurological signs were elicitable. Blood exams and toxicological analysis were negative. ECG, chest radiography, and cerebral TC showed no abnormalities. At physical examination a carotid bruit could be appreciated.

We performed an eco-color-Doppler of carotid artery that showed a left common and internal carotid artery dissection (figure 1). The diagnosis of ICA dissection was confirmed with a contrast CT. The coexistence of an aortic dissection was excluded with the same imaging technique.

The anterograde amnesia resolved 15 h after the admission. A neurologist confirmed that the patient experimented an episode of transient global amnesia (TGA).

After a vascular surgery consultation, a conservative treatment was deemed appropriate. After a 6 month follow up the patient didn't complain of any other neurological symptom or sign.

Transient global amnesia (TGA) is characterized by reversible anterograde and retrograde amnesia of sudden onset. This amnesic syndrome resolves spontaneously within 24 h. Annual incidence rate for all ages of spontaneous ICA dissection is approximately of 2.6 per 100 000 inhabitants, however data are extremely variable among different studies. TGA has never been associated with a spontaneous ICA dissection. In order to not miss a spontaneous ICA dissection as a rare ethology of TGA, we suggest performing an eco-color-Doppler of the epi-aortic vessels in patient affected by such amnesic syndrome.

682 UNEXPECTED TRIGLYCERIDES-LOWERING EFFECT OF A NOVEL NUTRACEUTICAL COMPOUND FOR IBS

Background

In the last few years the role of gut microbiome in human health has been reported. Growing evidence indicate that it is linked to intestinatal diseases, such as the irritable bowel syndrome (IBS), and atherosclerotic disorders. The effect on lipid metabolism seems to be one of the potential mechanisms by which gut microbiome might favour the atherosclerotic process. IBS is a functional bowel disorder defined by the presence of recurrent episodes of abdominal pain associated with altered bowel habits. The severity of psychological and gastrointestinal symptoms in IBS has been linked with a distinct intestinal microbiota signature. In this retrospective study the effect of a novel nutraceutical compound, namely Triobiotix, on gastrointestinal symptoms in IBS patients has been evaluated. Effects on lipid profile have bee also recorded.

Methods

Triobiotix is a nutraceutical consisting of: Maltodextrin; mineralized extract of Lithothamnion (Lithothamnion calcareum (Pallas) Areschoug, thallus dry extract); Bioecolians® gluco-oligosaccharides; Ferment mix (corn starch, Bifidobacterium animalis ssp. Lactis BLC1 (DSM 17741), Lactobacillus acidophilus LA3 (DSM 17742), Lactobacillus rhamnosus IMC 501 (DSM 16104), Lactobacillus paracasei Streptococc5 501 IMC102 SP4 (DSM 19385); short-chain fructo-oligosaccharides powder. The database of 40 Italian General Practitioners (GPs) were analyzed. At total of 587 patients with IBS and on Triobiotix were identified. Of these in only 535, a complete first and second control data was available. The primary endpoint of these analysis was to assess whether Triobiotix resulted in a reduction in pain and meteorism, thus resulting in a lesser intensity of the main gastrointestinal symptoms. Secondary endpoints were to look for significative changes in lab values of total cholesterol, triglycerides levels and glycaemia.

Results

Treatment with Triobiotix for four weeks resulted in a reduction in the frequency and intensity of bloating, abdominal pain, and tenesmus. Unexpectedly, at the T1 control, mean cholesterol values were significatively reduced compared to the T0 evaluation. Triglycerides levels were also significantly decreased (186.37±66.4 vs. 176.13±67.9; p < 0.05).

Conclusions

Our analysis showed an unexpected effect of this combination of micronutrients on lipid profile beyond IBS symptoms. However, further studies are needed to confirm this evidence and to evaluate the particular compound responsible of this effect. A goal of LDL-C less of 115mg/dL is desirable for patients at low to moderate CVR, a significative portion of population is far from this target. The discovery of novel micronutrients combinations with cholesterol lowering effects could be of great importance for the management of patients with low-moderate dyslipidaemia.

676 A PITFALL IN ECHOGRAPHIC DIAGNOSIS OF ABDOMINAL AORTIC ANEURYSM: WHEN PARA-AORTIC LYMPH NODES REQUIRE ATTENTION

Image focus

A 65-year-old women was scheduled for coronary angiography during the pre-surgery evaluation because of an abdominal aortic aneurysm (AAA) detected at ultrasound (Figure). The patient referred worsening dyspnoea and asthenia in the last few months, associated with atypical chest pain. Because of these symptoms and taking into account that AAA patients are at very high cardiovascular risk, exclusion of coronary artery disease seemed appropriate. At admission, patient showed enlarged lymph nodes at cervical and inguinal region. In the suspicion of a malignant cancer, a contrast enhanced computed tomography was scheduled, showing an increase in para-aortic, inguinal, cervical and axillary lymph nodes size in absence of the AAA (Figure). After blood tests and an haematologic consultation, a final diagnosis of chronic myeloid leukaemia was made.

The Echo-colour Doppler is the first line imaging test for the diagnosis of AAA. However, in some cases it might be not sufficient. Para-aortic lymphadenopathy should be considered as a possible pitfall in the differential diagnosis of abdominal aortic aneurysm.

Effectiveness in the short-term of a novel nutraceutical for the management of hypercholesterolemia: an observational multicenter primary care experience

Purpose: Increasing evidence reinforces the benefits of reduction of low-density lipoprotein (LDL-C) levels on cardiovascular outcomes. Different targets are suggested based on cardiovascular risk (CVR). According to the current European guidelines, a goal of LDL-C≤ 115mg/dL is desirable for patients with low-moderate CVR. However, a high percentage of these patients are far from this target. Nutraceuticals are “food supplements” that may help to achieve this goal in this population. In this retrospective analysis, we evaluate the effects of dietary supplementation with a novel monacolin/berberine/bergamot nutraceutical formulation on plasma lipid levels of subjects with low-moderate hypercholesterolemia who are not treated with conventional drug or other dietary supplements. Patients and Methods:526 adult patients with hypercholesterolemia were retrospectively selected from the database of participant family practitioners according to prespecified criteria. All selected patients had a baseline and 30-day value of total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, and transaminases and have started a dietary supplementation with this novel nutraceutical. Similarly, 104 subjects with comparable clinical features but not treated with any supplements were also selected. Results:At 30-day, the administration of nutraceuticals was associated with a significant reduction of LDL-C (124 ± 14 vs. 100 ± 13 mg/dL, Δ 24.5mg, p-value <0.0001) and TC levels (210 ± 56 vs. 187 ± 60, p-value < 0.0001), in the absence of a significant change of transaminase levels. No side effects were reported in the database during the observation period. Conclusion: This novel nutraceutical is an effective dietary supplement to achieve a significant and early  LDL-C reduction in patients with hypercholesterolemia at low-moderate CVR.Keywords:Cardiovascular Risk; Hypercholesterolemia; Nutraceuticals

The cardiac paradox of losing weight: a case of gastro-cardiac syndrome

Thanks to an unusual reversible cause of reflex syncope, a young physician avoided pacemaker implantation. We present the treatment of a bizarre case of gastro-cardiac syndrome, an often-overlooked clinical entity.

Machine Learning Approach for Prediction of Hematic Parameters in Hemodialysis Patients

Objective: This paper shows the application of machine learning techniques to predict hematic parameters using blood visible spectra during ex-vivo treatments. Methods: A spectroscopic setup was prepared for acquisition of blood absorbance spectrum and tested in an operational environment. This setup is non invasive and can be applied during dialysis sessions. A support vector machine and an artificial neural network, trained with a dataset of spectra, have been implemented for the prediction of hematocrit and oxygen saturation. Results & Conclusion: Results of different machine learning algorithms are compared, showing that support vector machine is the best technique for the prediction of hematocrit and oxygen saturation.

Clinical Trials with Adriamycin by Prolonged Arterial Infusion

Adriamycin, a new antitumor antibiotic of the anthracycline group, was given by arterial infusion to 20 patients with different types of advanced cancer. Two doses and schedules were used: 0.3 mg/kg daily for 10 consecutive days and 0.4 mg/kg on alternate days for 20 days. The drug was used for inducing the first remission. In responsive cases maintenance treatment was given with methotrexate. 15 patients were adequately evaluable. 12 patients adequately treated showed objective improvement and 5/15 regression > 50%. Head and neck cancer and undifferentiated reticulosarcoma of the liver were the diseases most sensitive to adriamycin by arterial infusion. Melanoma, metastatic liver cancer and pelvic cancer showed little improvement. Of 20 patients receiving adriamycin, 15 (75%) had one or more side effects: 12 had stomatitis with oral ulcerations, 17 varying degrees of bone marrow depression, 10 alopecia, 5 hyperthermia. Complications are observed in 11 patients. Adriamycin at 0.3 mg/kg daily by prolonged arterial infusion appears to be a potent growth-inhibiting compound useful for inducing the first remission only in head and neck cancer.

Clinical Evaluation of High Weekly Intravenous Doses of Methotrexate in Advanced Oropharyngeal Carcinoma

Methotrexate (MTX) was given by weekly rapid intravenous injections to 27 patients with inoperable oropharyngeal carcinoma. 9 cases were untreated while 18 had received radiotherapy or chemotherapy before administration of MTX. In 20 cases the dose was 40 mg/m2/week (patients over 50 years) and in 7 cases 60 mg/m2/week (table 1). In responsive patients, maintenance treatment was given at the dose of 15 mg/m2 every 4 days either orally or intramuscularly. 23 cases were adequately evaluable, i.e. they received treatment for a minimum of 3 weeks. Response to treatment was evaluated according to Karnofsky's scale. Considering only category 1 regressions, 11/16 (75%) patients adequately treated with 40 mg/m2 showed objective improvement and respectively 4/7 (57%) given 60 mg/m*. 8 out of 15 cases (41%) with category 1 response showed a regression greater than 50%. The mean duration of response for category 1 patients was 3.5 months, while the longest regression lasted 9 months (table 2). 18 patients had one or more side effects: 9 had oral lesions or gastroenteritis, 12 bone marrow depression, 3 hepatic and 1 renal toxicity. One patient died from hepatic and renal toxicity; in the remaining cases the side effects were quickly reversible (table 3). The percent regression rate for category 1 response and its average duration obtained with intravenous MTX seems comparable to intraarterial infusion (table 4). Systemic toxicity seems also comparable (table 5). Furthermore, intravenous administration obviates the typical local complications occurring with intra-arterial treatment and therapy can be given also at outpatients. For this reason, intravenous administration of MTX is preferred to intra-arterial infusion in the control of primary inoperable oropharyngeal carcinomas, provided no severe depression of liver, kidney and bone marrow is present.

Metastatic Basal Cell Carcinoma

Report on a case of primary basal cell carcinoma in the skin of the eyelid. Only bone metastases were detected after many local recurrences. The metastases were associated with myelophthisic anemia, leukoerythroblastosis in the peripheral blood and extramedullary hepatic hemopoiesis; these findings have not been reported before.

CO2 Laser Surgery in Laryngeal Cancers: Three Year Results

The purpose of this paper is to evaluate the relapse-free survival and the overall survival at three years of 39 laryngeal cancers (10 T1 and 29 small recurrent carcinomas with mobile vocal cord) operated on by CO2 laser surgery at the Istituto Nazionale Tumori in Milan from 1982 to 1987. The 10 patients with T1 cancers had two local recurrences, whereas the 29 patients with recurrent carcinomas had 14 local recurrences. Local relapses occurred in 2/16 patients with cancer limited to the vocal cord and in 9/17 patients with glottic tumors extended to the anterior commissure or to the ventricular band or to the arytenoid. Supraglottic cancers recurred in 3/4 patients. The authors conclude that transoral laser surgery is an effective modality for treatment of T1 primary and small recurrent carcinomas of the larynx, when limited to the middle third of the vocal cord.

VBM Chemotherapy before Curietherapy in the Treatment of T2 Oral Carcinomas

According to previous personal experience with conventional 226-Ra sources, in T2 oral carcinomas treated with curietherapy alone the incidence of local failures was 23%. Moreover, 50% of the local relapses were marginal with respect to the treated volume. From May 1980 to November 1981, 29 T2 oral carcinomas suitable for correct curietherapy received 3 weekly courses of VBM chemotherapy: i.e., vincristine, 1 mg i.v.; bleomycin, 15 mg i.m. after 6 and 24 h; and methotrexate, 30 mg p.o. after 48 h. A full dose curietherapy was performed 2 weeks after the completion of VBM. Twenty-seven patients have had a minimum follow-up of 12 months. The overall treatment was well tolerated and immediate results were encouraging. However, the local failure rate does not seem to have decreased by the combined treatment in comparison with curietherapy alone in historical series.

Recurrences in the Soft Tissues of the Neck after Surgery or Radiotherapy plus Surgery on Regional Lymph Nodes in Patients Bearing Carcinomas of the Head and Neck

A series of 45 recurrences in the soft tissues of the neck following lymph node dissection in 497 patients bearing carcinoma of the upper aerodigestive passages is reported. Only 22 cases that presented perilymph node metastases and/or in which there were reasons to indicate insufficient surgical radicality had been subjected to radiotherapy after surgical lymph node dissection; the other 23 cases had not been subjected to radiotherapy because the aforementioned premises had been lacking. All the recurrences therefore occurred in patients with clinically and histologically ascertained metastatic lymph nodes. The presence of perilymph node metastases and the judgement of surgical radicality was thus found insufficient criteria to plan future complementary postoperative radiotherapy. However, even in those cases in which postoperative radiotherapy was performed, there was a rather high incidence of recurrences, as high as 64.7% in patients with carcinoma of the tongue. Our data indicate the opportunity of a clinical trial with preoperative radiation therapy in patients with clinically evident lymph node metastases. Thirty-six of these recurrences were situated in the upper parts of the cervical region. The prognosis is very poor in such cases, so much so that only 2 of our series were disease free at 3 years after the treatment.

Local Adoptive Immunotherapy of Advanced Head and Neck Tumors with Lak Cells and Interleukin-2

Since October 1987 a pilot phase I-II study on the effect of loco-regional injections of recombinant interleukin 2 (rIL-2) in association with LAK cells has been performed in advanced, recurrent head and neck cancer patients. Fourteen patients were treated with autologous LAKs and rIL-2 (Glaxo) given peritumorally and in the mastoid region (rIL-2 only in the latter site). LAKs (2-70 × 107) + rIL-2 were injected on the first day of therapy, followed by 9 daily injections of rIL-2 only. The total daily dose of rIL-2 was escalated from 2,400 to 1.8 × 106 IU. Clinical evaluation was performed 30 days from the onset of therapy; 3 partial (95%, 66% and 50% reduction) and 3 minor responses were seen in the evaluated patients. All the other patients with a progressive disease after the first cycle were shifted to palliative chemotherapy. The partial responses were found in patients with a tumor burden « 20 cm2. Cervical node metastasis did not respond to treatment. No relevant side effects occurred. These results indicate that loco-regional immunotherapy with rIL-2 and LAK cells can produce clinical responses in advanced head and neck cancer patients.

A Statistical Approach to Detection of the Primary Cancer Based on the Site of Neck Lymph Node Metastases

Preoperative differential diagnosis of a swelling in the neck is mandatory for a good therapeutic planning. Indiscriminate biopsy as first approach is to be disregarded, since it can compromise the result of a radical neck dissection in cases where a metastasis of epidermoid cancer is histologically recognized. A cervical biopsy is not to be performed until a complete HNT examination (including the thyroid and major salivary glands) has excluded the presence of a primary tumor in these regions. Since every localization of the head and neck malignancies shows rather fixed patterns in its lymphatic spreading, a correlation between site of T and particular localizations of N within the neck can be found. The knowledge of the probabilities that an adenopathy in a given region of the neck correlates with a primary tumor located in a given site of the body could strongly aid the physician in detecting the latter, following a rational statistically based approach. This study was performed applying Bayes theorem for probability calculus to the maps of distribution of metastases of tumors of different site in 3,700 patients who were taken into National Cancer Institute of Milan during 7 consecutive years. The results are gathered in tables and text-figures showing the great significance of some correlations, who become more evident when the adenopathies are multiple, but who usefully direct the physician also when the adenopathy is only one.

Pathogenesis of Tumor Recurrences on the Tracheostoma in Patients Laryngectomised for Carcinoma

Of 519 patients subjected to total laryngectomy for cancer 14 had a recurrence of the tumor on the tracheostoma. The various possible pathogenetic mechanisms are reviewed critically in the light of this material. Non-radicality of the operation seems to be the most probable, in view of the peculiar lymph spread of neoplastic cells. The lymph drainage system of the larynx is described, with special reference to the crossing of the lymphatic networks at the level of the subglottic region. Although the normal direction of the lymph flow of this region is almost entirely upward, several anatomic and pathologic alterations can stop these pathways and reverse the lymph flow, in which case some of the lymph reaches the vessels of the tracheal network. When the trachea is divided during laryngectomy or when tracheotomy is performed, neoplastic cells spread out of the severed vessels and are imprisoned by the suture of the tracheostoma and the healing process. They thus elude the biological defense mechanisms (which may be present also in the lymph nodes) and so a tumor forms on the new site. This interpretation is supported by the high rate of recurrence on the tracheostoma (17.5%) after long-term use of a tracheostomy tube, especially in cases of tumor of the subglottic region or of the glottis.

Arguments in Favor of Precautional Treatment of Cervical Nodes in Clinically N0 Oral Cancer

Our retrospective and unrandomized clinical study covers 317 squamous cell carcinomas of the oral cavity initially N0 and treated with curietherapy from January 1959 to December 1970. Upon conclusion of the treatment on T, a radical dissection of the neck was performed only on 110 patients (34.7%) and the other 207 were not submitted to surgery. The incidence of N0 N+ cases was 27.3% (30/110). The clinical evolution showed that in the group not submitted to radical dissection 53 of 179 cases (29.6%) with adequate follow-up had lymph nodal relapses; 15/69 of these were initially T1 (21.7%) and 38/110 initially T2,3 (34.5%). The data concerning clinical evolution and analysis of the survival curves for the 2 groups supply arguments in favor of the systematic treatment of the lymphatic areas of the neck in initially N0 oral carcinomas.

Radiotherapy as Initial Treatment for Carcinomas of Tonsillar Region

For this study we have reviewed 186 carcinomas of the tonsillar region, i.e., the lateral wall of the oropharynx, treated from January 1959 to December 1973 at this Institute. In 148 patients (79.6%) the primary tumor and the lymphatic areas were treated with 60Co-teletherapy (TCT). In 15 cases (8.1%) the primary lesion was removed by transoral surgery, followed by irradiation of the tonsillar region and lymphatic areas with TCT. In 23 patients (12.3%) the primary tumor was treated with interstitial curietherapy, after which a radical homolateral neck dissection was performed on 10 of them; the neck was not treated in the remaining 13 cases, initially N0. As far as the cases initially treated with TCT alone are concerned, disease-free survival at 5 years was 42.5% for T1 cases and under 30% for T2, T3, whereas it was only 6.5% for T4. The most frequent failure cause of TCT was local relapse, isolated or associated with a nodal relapse. Local failures were nearly always central. On the contrary, if the field extension was adequate, there were very few nodal failures, at least in initially N0 or N1 cases. Our study recommends a revision of the current attitude towards the treatment of carcinomas of the tonsillar region.

Pathogenesis of Metastatic Recurrences on the Operative Field after Radical Neck Dissection for Oropharyngeal Cancer

In 1080 patients operated on at the National Cancer Institute of Milan from 1937 to 1964, 84 recurrences appeared on the operative field after radical neck dissection for oropharyngeal cancer. There was no evidence of the primary tumor almost 2 years after treatment. 78 recurrences concerned 930 determined cases (8.9%): 7 appeared among 407 dissections in which no microscopic involvement of lymph nodes was demonstrated (1.72%); 77 among 673 operations for histologically positive nodes. Most recurrences (75/84) were localized in the upper regions of the operative field (upper carotid, retromandibular, submastoid area). In all but 3 cases they occurred in the region nearest to the primary. Clinically, recurrences appeared as isolated or multiple tumor nodes adherent to the skin or to deep structures or both; only in 7 cases they were movable, and among these 5 were external to the operative field. Histological examination of the node was performed in 35 cases; residual lymph node tissue was found only in the movable ones. In nearly all cases isolated « foci» were found, and these findings suggest a sowing of cancer cells. Pathogenesis of recurrences is discussed, and the conclusions are that:

— In 50% of cases cancer cells spread out actively from the walls of the lymph node by an invasive mechanism;

— In 40% of cases sowing was due to the surgical section of lymph vessels or, rarely, of the lymph node capsule;

— In 2.7% of cases the recurrence was localized in lymph nodes not removed at surgery;

— In 4.7% of cases the typical dissection was not sufficiently extensive, and recurrences can appear outside the operative field, often in the parotid gland, very seldom in the spinal chain. Since the therapy of cervical recurrences is very deceptive prognosis can be improved only by preventing them, and this can be attained by earlier operations (prophylactic dissections) and surgical refinements in technique and tactics.

Importance of the Long-term Preoperative Tracheostomy as a Factor Determining the Occurrence of Tumor Recurrences on the Tracheostoma in Patients Laryngectomised for Carcinoma

In previous investigations the authors have reported a high incidence of recurrences at the level of tracheostoma in patients subjected to total laryngectomy for carcinoma, when the tracheostomy tube was left in place for a long period of time. The present report deals with a large number of cases collected from the National Cancer Institute of Milan and from the Otolaryngology Clinic, University of Milan. A total of 1842 total laryngectomies has been evaluated: stomal recurrences were observed in 63 cases (3.42%). In particular, 18 recurrences occurred among 1578 patients who did not undergo preoperative tracheostomy (1.14 %) and 45 recurrences among 205 patients after long-term use of a tracheostomy tube (21.9%). The lower was the endolaryngeal level of primary carcinoma, the higher was the incidence of recurrence. The length of interval between tracheostomy and laryngectomy influences proportionally the frequency of recurrences (from 16 % for an interval of 10–20 days, to 32 % for an interval higher than 50 days). Although a preoperative thacheostomy may slightly reduce the incidence of mortality due to pulmonary complications, the use of long-term tracheostomy tube is not advisable since it can increase the mortality for recurrent carcinoma of at least 20%.

Curietherapy of Oral Cancer

This work concerns 406 oral carcinomas treated with curietherapy (interstitial applications and surface molds) from January 1959 to December 1970. There were 65 (16.0%) carcinomas of the mucosal surface of cheeks, 15 of the retromolar areas, alveolus and gingiva, and hard palate (3.7%), 211 of the mobile tongue (51.9%), and 115 of the floor of mouth (28.4%). There were 132 (32.5%) T1 cases, 245 (60.3%) T2 and 29 (7.2%) T3. In 376 cases with adequate follow-up (92.6%) there were 93 (24.7%) local relapses: 83 isolated and 10 associated with a lymph nodal relapse; 49.5% of the local relapses were peripheral with respect to the treated volume (46/93). The incidence of local relapses only slightly differed for initially T1 and T2 cases (respectively 21.8% and 22.7%), whereas it was more than twice as much for initially T3 cases (53.6%). The overall incidence of radionecrotic complications was 22.0% (83/376 cases with adequate follow-up). Altogether the disease-free survival was 41.1% and 31.4% at 5 and 10 years, respectively. We think that local control of practically all treatable oral carcinomas can be obtained with a combined treatment.

Treatment of Cancer of the Base of the Tongue and Glosso-Epiglottic Region: A Multicenter Italian Survey

BACKGROUND

The current treatment options for cancer of the base of the tongue and glosso-epiglottic region are surgery, radiotherapy, or a combination of both modalities. Comparisons between different modalities are not common in the literature, and a real standard of treatment has not yet been established. The purpose of our study was to evaluate the results of treatment in a large series of patients from 18 Italian institutions in relation to the main treatment adopted.

METHODS

The present study is a retrospective survey. The series was divided into a combined surgery group and a radiotherapy group. The Kaplan-Meier method and the log-rank test were used for survival calculations and comparisons.

RESULTS

Eight hundred patients were registered (25.7% stage III and 62% stage IV), 336 in the surgery and 372 in the radiotherapy group. Conventional fractionation was adopted in almost all cases. The five-year overall and disease free survival of the whole series was 32% and 38%, respectively. Survival was slightly better for patients with tumors of the glosso-epiglottic region than for those with a tumor of the base of the tongue. Five-year disease-free survival was 55% for patients treated with surgery +/- radiochemotherapy and 26% for those submitted to radiotherapy alone or in combination with chemotherapy. As far as the total dose and the treatment duration were concerned, only 26% of the patients of the radiotherapy group met the established criteria of adequacy, but in patients with adequate radiation the control rate was better only for small tumors (T1-T2).

CONCLUSIONS

The results in patients treated with surgery +/- postoperative radiotherapy were similar to or better than those reported in the best series in the literature. By contrast, the survival rate of irradiated patients was lower than those reported by other centers.

Preliminary Phase I Evaluation of Bleomycin, a New Antitumor Antibiotic

Bleomycin (BLM), a new antitumor antibiotic isolated in Japan from cultures of Streptomyces Verticillus, was administered by single intravenous injections to patients with different types of lymphomas and miscellaneous solid tumors for phase I evaluation. 85 out of the 110 patients included in the study were suitable for the evaluation of acute and delayed toxicity, while 93 patients were evaluable to detect the therapeutic effects of the drug. The average age of the patients was 54 years (range 7–83). 16 patients were untreated and 77 had received one or more courses of radiotherapy and/or chemotherapy. During this trial different doses and schedules were employed (table 2): A) 30 mg/m2 × 2/week × 4 weeks; B) 30 mg/m2/day × 8 days; C) 15 mg/m2/day × 8 days. After a month interval all 3 courses were repeated; D) 15 mg/m2/day × 5 days to be repeated twice after 3 weeks interval. Maintenance therapy consisted of 15–30 mg/m2/week. To diminish the febrile reaction, a suppository of indometacin (100 mg) was given 30–60 minutes prior to drug administration. The incidence of toxic manifestations, irrespective of dose and schedule, was as follows (fig. 4): sclerotic changes of the skin of hands (80%), fever (67%), alopecia (61 %), skin hyperpigmentation (60 %), stomatitis (48 %), gastrointestinal disturbances (20%) and pulmonary symptoms (19%). No definite signs of marrow toxicity nor significant changes in the blood chemistry attributable to the drug were observed. Symptoms and signs of pulmonary toxicity, appearing 1–4 weeks after the last dose were: rhonchi, rales and pleural friction rubs, in some cases associated with fever and dyspnea. The chest X-ray showed evidence of interstitial lesions (in early phases most marked at the costophrenic angle) which may become widespread with a bronchopneumonia-like appearance (fig. 5 and 6). No clearcut radiological signs of pulmonary fibrosis were observed (patients were not followed for a period longer than 5 months). If BLM is stopped in time and carticosteroids are given in association to antibiotics, both clinical and radiological findings may disappear completely (fig. 7). Of the 7 patients studied post mortem, 6 revealed lesions attributable to drug toxicity (alveolar collapse with edema, histiocytic proliferation, hyaline membranes, alveolar and interstitial fibrosis (fig. 8–11). In 7 patients pulmonary toxicity was suspected only on clinical grounds, in 2 cases the radiological aspect of the lungs was suggestive of interstitial lesions without concomitant physical findings, in 9 cases a good correlation between clinical and radiological diagnosis was observed and, finally, in 6 patients the pulmonary fibrosis was detected on histological examination (table 3). In the 17 patients in whom the diagnosis of pulmonary toxicity was documented either radiologically or histologically, the average age was 56,5 years (7–78 years) and the mean total dose, producing toxicity was 230 mg/m2 (range 60–480). Practically, all these patients prior to the treatment had different grades of chronic pulmonary lesions (emphysema, fibrosis post RT or tuberculosis, silicosis in 1 case). It is difficult to estimate in what proportion BLM could have contributed to the cause of death, since most patients dying during treatment had also lung metastases. However, at least in 1 case in whom postmortem examination did not disclose lymphosarcoma cells (complete remission), the cause of death could be related to drug administration (total 225 mg/m2) since extensive pulmonary fibrosis was seen on histological examination (table 4). Table 5 shows the incidence of side-effects after the first course of BLM. No significant differences were observed among cases treated with 4 different schedules, and the first sign of toxicity appeared in all groups after the 4th–6th dose irrespective of the dose and schedule. Regressions in different types of tumors were observed during this phase I study (table 6). The overall regression rate was 69 % (24 % greater than 50 % and 5% complete). The therapeutic response was prompt but usually short-lived (average 4–6 weeks). No cross-resistance with radiotherapy nor with some of the conventional agents was observed. The most responsive tumors were carcinomas of head and neck, carcinomas of esophagus (fig. 17) and malignant lymphomas (fig. 16). One 7-year-old boy with acute lymphosarcoma cell leukemia had a complete remission and autopsy revealed no signs of neoplastic disease. In 2/3 patients with CLL a moderate decrease in the volume of hepato-splenomegaly was observed without significant fall in the WBC. The minimal toxic dose was 45–60 mg/m2 in malignant lymphomas and 60–120 mg/m2 in the other solid tumors. BLM appears to be a potent new growth-inhibiting compound specific for epidermoid carcinomas and devoid of bone marrow toxicity. The optimal dose schedule as well as the real incidence and course of pulmonary toxicity should be more clearly defined in future studies.

Prolonged Arterial Infusion Chemotherapy in Advanced Head and Neck Tumors

The cases of advanced head and neck tumors treated with palliative chemotherapy by prolonged arterial infusion at the National Cancer Institute of Milan, Italy, between 1960 and 1970 are reviewed. The drugs most frequently used were: Methotrexate (alone or associated with Daunorubycin), Daunorubycin and Adriamycin. 97 infusions were performed in 92 patients and 63 had lesions suitable for evaluation. Regression occurred in 43 (68.3%): over 50% of the starting size of the tumor in 15 and under 50% in 28; 13 patients died as a result of the treatment. Side-effects were numerous and frequent and the incidence of local complications was high, especially in cases of direct cannulation, which also ensured the biggest decreases in tumor size. Cancer of the movable part of the tongue was most responsive to the treatment. Adriamycin with 88 % of regressions and Methotrexate with 73 % were the most effective drugs. The results of this series show that prolonged intra-arterial chemotherapy can yield a high regression rate in head and neck cancer but is is not devoid of serious side-effects and the incidence of local toxic and technical complications is high. Because of this and of the short duration of regression, it is doubtful whether arterial infusion represents an advance over other modes of administering chemotherapy.

Adenolymphoma of the Parotid Gland

In the period 1928–1968 in a series of 355 benign and malignant tumors of the parotid observed at the National Cancer Institute in Milan there were 36 cases of adenolymphoma. The clinical, morbid anatomy and histogenetic features of these cases are described. On the strength of the following findings: normal salivary tissue enclosed within an intraparotid lymph node, the association of a mixed tumor and an adenolymphoma in the same gland, the bilaterality of the tumor in 2 cases and the functional activity demonstrated with 131I, the salivary origin of adenolymphoma is argued. As to treatment, given the biological characteristics of the tumor, enucleation/resection would seem to be the operation of choice. For various reasons, however, including the difficulty of a precise preoperative diagnosis, total parotidectomy, sparing the 7th cranial nerves, is more often performed.

Arsenic removal from water by coupling photocatalysis and complexation-ultrafiltration processes: A preliminary study

Inorganic As removal from contaminated water has been studied by off-line coupling of photocatalysis and complexation-ultrafiltration (CP-UF), showing that this combination permits to obtain a quite complete arsenic removal from the treated water. Two commercial polymers, poly(dimethylamine-coepichlorohydrin-coethylenediamine) (PDEHED) and poly(diallyl dimethyl amnmonium chloride) (PolyDADMAC) have been tested in the CP-UF process. The operating conditions (pH and polymer/As weight ratio) for As(V) complexation were determined finding values of 7.5/20 and 9.2/30 for PDEHED and polyDADMAC, respectively. The UF tests were performed by continuous diafiltration and diafiltration with volume reduction modes. The latter method permits to save the volume of washing solution during polymer regeneration. As(III) was not complexed, operating under the As(V) complexation conditions, thus a pre-oxidation step by using the photocatalytic approach was carried out to remove As(III) species. As(III) conversion to As(V) was evaluated by As speciation by using the CP-UF process for analytical purposes. Photocatalytic oxidation was successfully performed under UV radiation by using TiO₂ (0.05 mg L^-1), O₂ and pH = 9. The oxidation was very fast during the first 10 min following a zero order kinetics (k = 0.83 mg L^-1 min^-1) and reaching 90% As(III) oxidation. A conceptual scheme coupling photocatalysis and CP-UF and some criteria to operate the CP-UF process, useful to address it towards application, are reported.

Human genome meeting 2016 : Houston, TX, USA. 28 February - 2 March 2016

O1 The metabolomics approach to autism: identification of biomarkers for early detection of autism spectrum disorder A. K. Srivastava, Y. Wang, R. Huang, C. Skinner, T. Thompson, L. Pollard, T. Wood, F. Luo, R. Stevenson O2 Phenome-wide association study for smoking- and drinking-associated genes in 26,394 American women with African, Asian, European, and Hispanic descents R. Polimanti, J. Gelernter O3 Effects of prenatal environment, genotype and DNA methylation on birth weight and subsequent postnatal outcomes: findings from GUSTO, an Asian birth cohort X. Lin, I. Y. Lim, Y. Wu, A. L. Teh, L. Chen, I. M. Aris, S. E. Soh, M. T. Tint, J. L. MacIsaac, F. Yap, K. Kwek, S. M. Saw, M. S. Kobor, M. J. Meaney, K. M. Godfrey, Y. S. Chong, J. D. Holbrook, Y. S. Lee, P. D. Gluckman, N. Karnani, GUSTO study group O4 High-throughput identification of specific qt interval modulating enhancers at the SCN5A locus A. Kapoor, D. Lee, A. Chakravarti O5 Identification of extracellular matrix components inducing cancer cell migration in the supernatant of cultivated mesenchymal stem cells C. Maercker, F. Graf, M. Boutros O6 Single cell allele specific expression (ASE) IN T21 and common trisomies: a novel approach to understand DOWN syndrome and other aneuploidies G. Stamoulis, F. Santoni, P. Makrythanasis, A. Letourneau, M. Guipponi, N. Panousis, M. Garieri, P. Ribaux, E. Falconnet, C. Borel, S. E. Antonarakis O7 Role of microRNA in LCL to IPSC reprogramming S. Kumar, J. Curran, J. Blangero O8 Multiple enhancer variants disrupt gene regulatory network in Hirschsprung disease S. Chatterjee, A. Kapoor, J. Akiyama, D. Auer, C. Berrios, L. Pennacchio, A. Chakravarti O9 Metabolomic profiling for the diagnosis of neurometabolic disorders T. R. Donti, G. Cappuccio, M. Miller, P. Atwal, A. Kennedy, A. Cardon, C. Bacino, L. Emrick, J. Hertecant, F. Baumer, B. Porter, M. Bainbridge, P. Bonnen, B. Graham, R. Sutton, Q. Sun, S. Elsea O10 A novel causal methylation network approach to Alzheimer’s disease Z. Hu, P. Wang, Y. Zhu, J. Zhao, M. Xiong, David A Bennett O11 A microRNA signature identifies subtypes of triple-negative breast cancer and reveals MIR-342-3P as regulator of a lactate metabolic pathway A. Hidalgo-Miranda, S. Romero-Cordoba, S. Rodriguez-Cuevas, R. Rebollar-Vega, E. Tagliabue, M. Iorio, E. D’Ippolito, S. Baroni O12 Transcriptome analysis identifies genes, enhancer RNAs and repetitive elements that are recurrently deregulated across multiple cancer types B. Kaczkowski, Y. Tanaka, H. Kawaji, A. Sandelin, R. Andersson, M. Itoh, T. Lassmann, the FANTOM5 consortium, Y. Hayashizaki, P. Carninci, A. R. R. Forrest O13 Elevated mutation and widespread loss of constraint at regulatory and architectural binding sites across 11 tumour types C. A. Semple O14 Exome sequencing provides evidence of pathogenicity for genes implicated in colorectal cancer E. A. Rosenthal, B. Shirts, L. Amendola, C. Gallego, M. Horike-Pyne, A. Burt, P. Robertson, P. Beyers, C. Nefcy, D. Veenstra, F. Hisama, R. Bennett, M. Dorschner, D. Nickerson, J. Smith, K. Patterson, D. Crosslin, R. Nassir, N. Zubair, T. Harrison, U. Peters, G. Jarvik, NHLBI GO Exome Sequencing Project O15 The tandem duplicator phenotype as a distinct genomic configuration in cancer F. Menghi, K. Inaki, X. Woo, P. Kumar, K. Grzeda, A. Malhotra, H. Kim, D. Ucar, P. Shreckengast, K. Karuturi, J. Keck, J. Chuang, E. T. Liu O16 Modeling genetic interactions associated with molecular subtypes of breast cancer B. Ji, A. Tyler, G. Ananda, G. Carter O17 Recurrent somatic mutation in the MYC associated factor X in brain tumors H. Nikbakht, M. Montagne, M. Zeinieh, A. Harutyunyan, M. Mcconechy, N. Jabado, P. Lavigne, J. Majewski O18 Predictive biomarkers to metastatic pancreatic cancer treatment J. B. Goldstein, M. Overman, G. Varadhachary, R. Shroff, R. Wolff, M. Javle, A. Futreal, D. Fogelman O19 DDIT4 gene expression as a prognostic marker in several malignant tumors L. Bravo, W. Fajardo, H. Gomez, C. Castaneda, C. Rolfo, J. A. Pinto O20 Spatial organization of the genome and genomic alterations in human cancers K. C. Akdemir, L. Chin, A. Futreal, ICGC PCAWG Structural Alterations Group O21 Landscape of targeted therapies in solid tumors S. Patterson, C. Statz, S. Mockus O22 Genomic analysis reveals novel drivers and progression pathways in skin basal cell carcinoma S. N. Nikolaev, X. I. Bonilla, L. Parmentier, B. King, F. Bezrukov, G. Kaya, V. Zoete, V. Seplyarskiy, H. Sharpe, T. McKee, A. Letourneau, P. Ribaux, K. Popadin, N. Basset-Seguin, R. Ben Chaabene, F. Santoni, M. Andrianova, M. Guipponi, M. Garieri, C. Verdan, K. Grosdemange, O. Sumara, M. Eilers, I. Aifantis, O. Michielin, F. de Sauvage, S. Antonarakis O23 Identification of differential biomarkers of hepatocellular carcinoma and cholangiocarcinoma via transcriptome microarray meta-analysis S. Likhitrattanapisal O24 Clinical validity and actionability of multigene tests for hereditary cancers in a large multi-center study S. Lincoln, A. Kurian, A. Desmond, S. Yang, Y. Kobayashi, J. Ford, L. Ellisen O25 Correlation with tumor ploidy status is essential for correct determination of genome-wide copy number changes by SNP array T. L. Peters, K. R. Alvarez, E. F. Hollingsworth, D. H. Lopez-Terrada O26 Nanochannel based next-generation mapping for interrogation of clinically relevant structural variation A. Hastie, Z. Dzakula, A. W. Pang, E. T. Lam, T. Anantharaman, M. Saghbini, H. Cao, BioNano Genomics O27 Mutation spectrum in a pulmonary arterial hypertension (PAH) cohort and identification of associated truncating mutations in TBX4 C. Gonzaga-Jauregui, L. Ma, A. King, E. Berman Rosenzweig, U. Krishnan, J. G. Reid, J. D. Overton, F. Dewey, W. K. Chung O28 NORTH CAROLINA macular dystrophy (MCDR1): mutations found affecting PRDM13 K. Small, A. DeLuca, F. Cremers, R. A. Lewis, V. Puech, B. Bakall, R. Silva-Garcia, K. Rohrschneider, M. Leys, F. S. Shaya, E. Stone O29 PhenoDB and genematcher, solving unsolved whole exome sequencing data N. L. Sobreira, F. Schiettecatte, H. Ling, E. Pugh, D. Witmer, K. Hetrick, P. Zhang, K. Doheny, D. Valle, A. Hamosh O30 Baylor-Johns Hopkins Center for Mendelian genomics: a four year review S. N. Jhangiani, Z. Coban Akdemir, M. N. Bainbridge, W. Charng, W. Wiszniewski, T. Gambin, E. Karaca, Y. Bayram, M. K. Eldomery, J. Posey, H. Doddapaneni, J. Hu, V. R. Sutton, D. M. Muzny, E. A. Boerwinkle, D. Valle, J. R. Lupski, R. A. Gibbs O31 Using read overlap assembly to accurately identify structural genetic differences in an ashkenazi jewish trio S. Shekar, W. Salerno, A. English, A. Mangubat, J. Bruestle O32 Legal interoperability: a sine qua non for international data sharing A. Thorogood, B. M. Knoppers, Global Alliance for Genomics and Health - Regulatory and Ethics Working Group O33 High throughput screening platform of competent sineups: that can enhance translation activities of therapeutic target H. Takahashi, K. R. Nitta, A. Kozhuharova, A. M. Suzuki, H. Sharma, D. Cotella, C. Santoro, S. Zucchelli, S. Gustincich, P. Carninci O34 The undiagnosed diseases network international (UDNI): clinical and laboratory research to meet patient needs J. J. Mulvihill, G. Baynam, W. Gahl, S. C. Groft, K. Kosaki, P. Lasko, B. Melegh, D. Taruscio O36 Performance of computational algorithms in pathogenicity predictions for activating variants in oncogenes versus loss of function mutations in tumor suppressor genes R. Ghosh, S. Plon O37 Identification and electronic health record incorporation of clinically actionable pharmacogenomic variants using prospective targeted sequencing S. Scherer, X. Qin, R. Sanghvi, K. Walker, T. Chiang, D. Muzny, L. Wang, J. Black, E. Boerwinkle, R. Weinshilboum, R. Gibbs O38 Melanoma reprogramming state correlates with response to CTLA-4 blockade in metastatic melanoma T. Karpinets, T. Calderone, K. Wani, X. Yu, C. Creasy, C. Haymaker, M. Forget, V. Nanda, J. Roszik, J. Wargo, L. Haydu, X. Song, A. Lazar, J. Gershenwald, M. Davies, C. Bernatchez, J. Zhang, A. Futreal, S. Woodman O39 Data-driven refinement of complex disease classification from integration of heterogeneous functional genomics data in GeneWeaver E. J. Chesler, T. Reynolds, J. A. Bubier, C. Phillips, M. A. Langston, E. J. Baker O40 A general statistic framework for genome-based disease risk prediction M. Xiong, L. Ma, N. Lin, C. Amos O41 Integrative large-scale causal network analysis of imaging and genomic data and its application in schizophrenia studies N. Lin, P. Wang, Y. Zhu, J. Zhao, V. Calhoun, M. Xiong O42 Big data and NGS data analysis: the cloud to the rescue O. Dobretsberger, M. Egger, F. Leimgruber O43 Cpipe: a convergent clinical exome pipeline specialised for targeted sequencing S. Sadedin, A. Oshlack, Melbourne Genomics Health Alliance O44 A Bayesian classification of biomedical images using feature extraction from deep neural networks implemented on lung cancer data V. A. A. Antonio, N. Ono, Clark Kendrick C. Go O45 MAV-SEQ: an interactive platform for the Management, Analysis, and Visualization of sequence data Z. Ahmed, M. Bolisetty, S. Zeeshan, E. Anguiano, D. Ucar O47 Allele specific enhancer in EPAS1 intronic regions may contribute to high altitude adaptation of Tibetans C. Zeng, J. Shao O48 Nanochannel based next-generation mapping for structural variation detection and comparison in trios and populations H. Cao, A. Hastie, A. W. Pang, E. T. Lam, T. Liang, K. Pham, M. Saghbini, Z. Dzakula O49 Archaic introgression in indigenous populations of Malaysia revealed by whole genome sequencing Y. Chee-Wei, L. Dongsheng, W. Lai-Ping, D. Lian, R. O. Twee Hee, Y. Yunus, F. Aghakhanian, S. S. Mokhtar, C. V. Lok-Yung, J. Bhak, M. Phipps, X. Shuhua, T. Yik-Ying, V. Kumar, H. Boon-Peng O50 Breast and ovarian cancer prevention: is it time for population-based mutation screening of high risk genes? I. Campbell, M.-A. Young, P. James, Lifepool O53 Comprehensive coverage from low DNA input using novel NGS library preparation methods for WGS and WGBS C. Schumacher, S. Sandhu, T. Harkins, V. Makarov O54 Methods for large scale construction of robust PCR-free libraries for sequencing on Illumina HiSeqX platform H. DoddapaneniR. Glenn, Z. Momin, B. Dilrukshi, H. Chao, Q. Meng, B. Gudenkauf, R. Kshitij, J. Jayaseelan, C. Nessner, S. Lee, K. Blankenberg, L. Lewis, J. Hu, Y. Han, H. Dinh, S. Jireh, K. Walker, E. Boerwinkle, D. Muzny, R. Gibbs O55 Rapid capture methods for clinical sequencing J. Hu, K. Walker, C. Buhay, X. Liu, Q. Wang, R. Sanghvi, H. Doddapaneni, Y. Ding, N. Veeraraghavan, Y. Yang, E. Boerwinkle, A. L. Beaudet, C. M. Eng, D. M. Muzny, R. A. Gibbs O56 A diploid personal human genome model for better genomes from diverse sequence data K. C. C. Worley, Y. Liu, D. S. T. Hughes, S. C. Murali, R. A. Harris, A. C. English, X. Qin, O. A. Hampton, P. Larsen, C. Beck, Y. Han, M. Wang, H. Doddapaneni, C. L. Kovar, W. J. Salerno, A. Yoder, S. Richards, J. Rogers, J. R. Lupski, D. M. Muzny, R. A. Gibbs O57 Development of PacBio long range capture for detection of pathogenic structural variants Q. Meng, M. Bainbridge, M. Wang, H. Doddapaneni, Y. Han, D. Muzny, R. Gibbs O58 Rhesus macaques exhibit more non-synonymous variation but greater impact of purifying selection than humans R. A. Harris, M. Raveenedran, C. Xue, M. Dahdouli, L. Cox, G. Fan, B. Ferguson, J. Hovarth, Z. Johnson, S. Kanthaswamy, M. Kubisch, M. Platt, D. Smith, E. Vallender, R. Wiseman, X. Liu, J. Below, D. Muzny, R. Gibbs, F. Yu, J. Rogers O59 Assessing RNA structure disruption induced by single-nucleotide variation J. Lin, Y. Zhang, Z. Ouyang P1 A meta-analysis of genome-wide association studies of mitochondrial dna copy number A. Moore, Z. Wang, J. Hofmann, M. Purdue, R. Stolzenberg-Solomon, S. Weinstein, D. Albanes, C.-S. Liu, W.-L. Cheng, T.-T. Lin, Q. Lan, N. Rothman, S. Berndt P2 Missense polymorphic genetic combinations underlying down syndrome susceptibility E. S. Chen P4 The evaluation of alteration of ELAM-1 expression in the endometriosis patients H. Bahrami, A. Khoshzaban, S. Heidari Keshal P5 Obesity and the incidence of apolipoprotein E polymorphisms in an assorted population from Saudi Arabia population K. K. R. Alharbi P6 Genome-associated personalized antithrombotical therapy for patients with high risk of thrombosis and bleeding M. Zhalbinova, A. Akilzhanova, S. Rakhimova, M. Bekbosynova, S. Myrzakhmetova P7 Frequency of Xmn1 polymorphism among sickle cell carrier cases in UAE population M. Matar P8 Differentiating inflammatory bowel diseases by using genomic data: dimension of the problem and network organization N. Mili, R. Molinari, Y. Ma, S. Guerrier P9 Vulnerability of genetic variants to the risk of autism among Saudi children N. Elhawary, M. Tayeb, N. Bogari, N. Qotb P10 Chromatin profiles from ex vivo purified dopaminergic neurons establish a promising model to support studies of neurological function and dysfunction S. A. McClymont, P. W. Hook, L. A. Goff, A. McCallion P11 Utilization of a sensitized chemical mutagenesis screen to identify genetic modifiers of retinal dysplasia in homozygous Nr2e3^rd7 mice Y. Kong, J. R. Charette, W. L. Hicks, J. K. Naggert, L. Zhao, P. M. Nishina P12 Ion torrent next generation sequencing of recessive polycystic kidney disease in Saudi patients B. M. Edrees, M. Athar, F. A. Al-Allaf, M. M. Taher, W. Khan, A. Bouazzaoui, N. A. Harbi, R. Safar, H. Al-Edressi, A. Anazi, N. Altayeb, M. A. Ahmed, K. Alansary, Z. Abduljaleel P13 Digital expression profiling of Purkinje neurons and dendrites in different subcellular compartments A. Kratz, P. Beguin, S. Poulain, M. Kaneko, C. Takahiko, A. Matsunaga, S. Kato, A. M. Suzuki, N. Bertin, T. Lassmann, R. Vigot, P. Carninci, C. Plessy, T. Launey P14 The evolution of imperfection and imperfection of evolution: the functional and functionless fractions of the human genome D. Graur P16 Species-independent identification of known and novel recurrent genomic entities in multiple cancer patients J. Friis-Nielsen, J. M. Izarzugaza, S. Brunak P18 Discovery of active gene modules which are densely conserved across multiple cancer types reveal their prognostic power and mutually exclusive mutation patterns B. S. Soibam P19 Whole exome sequencing of dysplastic leukoplakia tissue indicates sequential accumulation of somatic mutations from oral precancer to cancer D. Das, N. Biswas, S. Das, S. Sarkar, A. Maitra, C. Panda, P. Majumder P21 Epigenetic mechanisms of carcinogensis by hereditary breast cancer genes J. J. Gruber, N. Jaeger, M. Snyder P22 RNA direct: a novel RNA enrichment strategy applied to transcripts associated with solid tumors K. Patel, S. Bowman, T. Davis, D. Kraushaar, A. Emerman, S. Russello, N. Henig, C. Hendrickson P23 RNA sequencing identifies gene mutations for neuroblastoma K. Zhang P24 Participation of SFRP1 in the modulation of TMPRSS2-ERG fusion gene in prostate cancer cell lines M. Rodriguez-Dorantes, C. D. Cruz-Hernandez, C. D. P. Garcia-Tobilla, S. Solorzano-Rosales P25 Targeted Methylation Sequencing of Prostate Cancer N. Jäger, J. Chen, R. Haile, M. Hitchins, J. D. Brooks, M. Snyder P26 Mutant TPMT alleles in children with acute lymphoblastic leukemia from México City and Yucatán, Mexico S. Jiménez-Morales, M. Ramírez, J. Nuñez, V. Bekker, Y. Leal, E. Jiménez, A. Medina, A. Hidalgo, J. Mejía P28 Genetic modifiers of Alström syndrome J. Naggert, G. B. Collin, K. DeMauro, R. Hanusek, P. M. Nishina P31 Association of genomic variants with the occurrence of angiotensin-converting-enzyme inhibitor (ACEI)-induced coughing among Filipinos E. M. Cutiongco De La Paz, R. Sy, J. Nevado, P. Reganit, L. Santos, J. D. Magno, F. E. Punzalan , D. Ona , E. Llanes, R. L. Santos-Cortes , R. Tiongco, J. Aherrera, L. Abrahan, P. Pagauitan-Alan; Philippine Cardiogenomics Study Group P32 The use of “humanized” mouse models to validate disease association of a de novo GARS variant and to test a novel gene therapy strategy for Charcot-Marie-Tooth disease type 2D K. H. Morelli, J. S. Domire, N. Pyne, S. Harper, R. Burgess P34 Molecular regulation of chondrogenic human induced pluripotent stem cells M. A. Gari, A. Dallol, H. Alsehli, A. Gari, M. Gari, A. Abuzenadah P35 Molecular profiling of hematologic malignancies: implementation of a variant assessment algorithm for next generation sequencing data analysis and clinical reporting M. Thomas, M. Sukhai, S. Garg, M. Misyura, T. Zhang, A. Schuh, T. Stockley, S. Kamel-Reid P36 Accessing genomic evidence for clinical variants at NCBI S. Sherry, C. Xiao, D. Slotta, K. Rodarmer, M. Feolo, M. Kimelman, G. Godynskiy, C. O’Sullivan, E. Yaschenko P37 NGS-SWIFT: a cloud-based variant analysis framework using control-accessed sequencing data from DBGAP/SRA C. Xiao, E. Yaschenko, S. Sherry P38 Computational assessment of drug induced hepatotoxicity through gene expression profiling C. Rangel-Escareño, H. Rueda-Zarate P40 Flowr: robust and efficient pipelines using a simple language-agnostic approach;ultraseq; fast modular pipeline for somatic variation calling using flowr S. Seth, S. Amin, X. Song, X. Mao, H. Sun, R. G. Verhaak, A. Futreal, J. Zhang P41 Applying “Big data” technologies to the rapid analysis of heterogenous large cohort data S. J. Whiite, T. Chiang, A. English, J. Farek, Z. Kahn, W. Salerno, N. Veeraraghavan, E. Boerwinkle, R. Gibbs P42 FANTOM5 web resource for the large-scale genome-wide transcription start site activity profiles of wide-range of mammalian cells T. Kasukawa, M. Lizio, J. Harshbarger, S. Hisashi, J. Severin, A. Imad, S. Sahin, T. C. Freeman, K. Baillie, A. Sandelin, P. Carninci, A. R. R. Forrest, H. Kawaji, The FANTOM Consortium P43 Rapid and scalable typing of structural variants for disease cohorts W. Salerno, A. English, S. N. Shekar, A. Mangubat, J. Bruestle, E. Boerwinkle, R. A. Gibbs P44 Polymorphism of glutathione S-transferases and sulphotransferases genes in an Arab population A. H. Salem, M. Ali, A. Ibrahim, M. Ibrahim P46 Genetic divergence of CYP3A5*3 pharmacogenomic marker for native and admixed Mexican populations J. C. Fernandez-Lopez, V. Bonifaz-Peña, C. Rangel-Escareño, A. Hidalgo-Miranda, A. V. Contreras P47 Whole exome sequence meta-analysis of 13 white blood cell, red blood cell, and platelet traits L. Polfus, CHARGE and NHLBI Exome Sequence Project Working Groups P48 Association of adipoq gene with type 2 diabetes and related phenotypes in african american men and women: The jackson heart study S. Davis, R. Xu, S. Gebeab, P Riestra, A Gaye, R. Khan, J. Wilson, A. Bidulescu P49 Common variants in casr gene are associated with serum calcium levels in koreans S. H. Jung, N. Vinayagamoorthy, S. H. Yim, Y. J. Chung P50 Inference of multiple-wave population admixture by modeling decay of linkage disequilibrium with multiple exponential functions Y. Zhou, S. Xu P51 A Bayesian framework for generalized linear mixed models in genome-wide association studies X. Wang, V. Philip, G. Carter P52 Targeted sequencing approach for the identification of the genetic causes of hereditary hearing impairment A. A. Abuzenadah, M. Gari, R. Turki, A. Dallol P53 Identification of enhancer sequences by ATAC-seq open chromatin profiling A. Uyar, A. Kaygun, S. Zaman, E. Marquez, J. George, D. Ucar P54 Direct enrichment for the rapid preparation of targeted NGS libraries C. L. Hendrickson, A. Emerman, D. Kraushaar, S. Bowman, N. Henig, T. Davis, S. Russello, K. Patel P56 Performance of the Agilent D5000 and High Sensitivity D5000 ScreenTape assays for the Agilent 4200 Tapestation System R. Nitsche, L. Prieto-Lafuente P57 ClinVar: a multi-source archive for variant interpretation M. Landrum, J. Lee, W. Rubinstein, D. Maglott P59 Association of functional variants and protein physical interactions of human MUTY homolog linked with familial adenomatous polyposis and colorectal cancer syndrome Z. Abduljaleel, W. Khan, F. A. Al-Allaf, M. Athar , M. M. Taher, N. Shahzad P60 Modification of the microbiom constitution in the gut using chicken IgY antibodies resulted in a reduction of acute graft-versus-host disease after experimental bone marrow transplantation A. Bouazzaoui, E. Huber, A. Dan, F. A. Al-Allaf, W. Herr, G. Sprotte, J. Köstler, A. Hiergeist, A. Gessner, R. Andreesen, E. Holler P61 Compound heterozygous mutation in the LDLR gene in Saudi patients suffering severe hypercholesterolemia F. Al-Allaf, A. Alashwal, Z. Abduljaleel, M. Taher, A. Bouazzaoui, H. Abalkhail, A. Al-Allaf, R. Bamardadh, M. Athar

Early prediction of the highest workload in incremental cardiopulmonary tests

Incremental tests are widely used in cardiopulmonary exercise testing, both in the clinical domain and in sport sciences. The highest workload (denoted W peak ) reached in the test is key information for assessing the individual body response to the test and for analyzing possible cardiac failures and planning rehabilitation, and training sessions. Being physically very demanding, incremental tests can significantly increase the body stress on monitored individuals and may cause cardiopulmonary overload. This article presents a new approach to cardiopulmonary testing that addresses these drawbacks. During the test, our approach analyzes the individual body response to the exercise and predicts the W peak value that will be reached in the test and an evaluation of its accuracy. When the accuracy of the prediction becomes satisfactory, the test can be prematurely stopped, thus avoiding its entire execution. To predict W peak , we introduce a new index, the CardioPulmonary Efficiency Index (CPE), summarizing the cardiopulmonary response of the individual to the test. Our approach analyzes the CPE trend during the test, together with the characteristics of the individual, and predicts W peak . A K-nearest-neighbor-based classifier and an ANN-based classier are exploited for the prediction. The experimental evaluation showed that the W peak value can be predicted with a limited error from the first steps of the test.

Early predictors of late dilation and remodeling after thrombolized anterior transmural myocardial infarction

BACKGROUND AND HYPOTHESIS

Dilation of the left ventricle after myocardial infarction is associated with an adverse prognosis. There are no clinical studies on the role viable myocardium in the infarcted area assumes in relation to the development of late ventricular remodeling. The hypothesis of this study was to define the relation between remodeling and the presence of viable but akinetic myocardium in the infarct area and to identify early predictors of left ventricular (LV) dilation at 1 year.

METHODS

In all, 92 consecutive patients with myocardial infarction were divided into two groups according to their ventricular volumes. Group I included 57 patients with normal volumes at discharge (9 +/- 3 days after acute infarction) and after 12 months or with LV dilation at discharge who had a normalization of their volumes over a 12-month period. Group II included 35 patients who, independent of their initial volumes, developed LV dilation during follow-up. Low-dose dobutamine infusion was utilized at discharge for echocardiographic evaluation of contractile recovery of viable myocardial segments.

RESULTS

At the first control, patients in Group I presented an end-diastolic volume index (EDVI) of 100 +/- 7 ml/m2 which decreased to 68.8 +/- 6.5 ml/m2 12 months later (p < 0.0001), and an end-systolic volume index (ESVI) of 47.6 +/- 6.7 ml/m2 at the first control and 30.5 +/- 8.8 ml/m2 after 12 months (p < 0.001). Patients in Group II presented a mean EDVI of 116.2 +/- 8.1 ml/m2 at the first control and 138.8 +/- 8 ml/m2 12 months later (p < 0.001), and a mean ESVI of 68.8 +/- 6.5 ml/m2 at the first control and 79.5 +/- 5.4 after 12 months (p < 0.01). Ventricular mass index (VMI) in Group I increased from 106.4 +/- 11 to 122.3 +/- 15 g/m2 (p < 0.01), while in Group II it decreased from 101.1 +/- 10 to 98.7 +/- 8 g/m2 (p = NS). In Group I, mass-to-volume ratio was 1.15 +/- 0.1 g/ml at the first control and 1.67 +/- 0.1 g/ml 12 months later (p < 0.001), while in Group II it declined from 0.88 +/- 0.1 to 0.69 +/- 0.1 g/ml (p < 0.01). The multivariate analysis revealed that ejection fraction < or = 40%, restrictive filling pattern, wall motion score index > 2.5 in response to dobutamine infusion, and mass-to-volume ratio < or = 1 g/ml, all at discharge, as well as an occluded left anterior descending artery discriminate in favor of late LV dilation and remodeling.

CONCLUSIONS

Correct use of noninvasive strategies should result in early identification of postinfarct patients who are at risk of developing LV remodeling.

Oromandibular reconstruction using titanium plate and pectoralis major myocutaneous flap

To assess whether locking-screw titanium plates (UniLOCK) and pedicled pectoralis major myocutaneous flaps are a valid alternative to complex reconstruction with bony free flaps in poor prognosis or poor performance status oncological patients with mandibular defects, a retrospective evaluation has been made of outcomes in 27 consecutive cases. No patient died perioperatively. Mean operating time was 270 minutes. Post-operative course was uneventful in 14. Mean follow-up was 13 months with no loss to follow-up. Twelve patients are alive and well, 12 died from their malignancy, two from non-neoplastic causes, and one from second cancer. Plate exposure - the main problem with bridging plates - occurred in 6 (22%, 4 early, 2 late), 4 with symphyseal and 2 with postero-lateral defects: removal was necessary in 2; 2 died with the plate exposed, and 2 had successful re-coverage, increasing the final success rate from 78% to 85%. Most patients considered the aesthetic outcome acceptable, however all edentulous patients complained of unsatisfactory dental rehabilitation. From the acceptable success rate, it may be concluded that bridging plates represent a useful reconstruction method, provided they are well covered by viable muscular tissue. They should be offered to patients contraindicated for more invasive procedures or with limited functional needs, or poor prognosis.

Review of 346 patients with free-flap reconstruction following head and neck surgery for neoplasm

We present our 14-year experience of free tissue transfer following surgery for head and neck neoplasm. We evaluated 346 patients mean age 57 years, 65% had squamous cell carcinoma; the most frequent sites were oral cavity and mandible (168) craniomaxillo facial region (94) pharynx +/- cervical oesophagus and oropharyngostomes (84). In 327 (95%) cases the reconstruction was a success. Flap revision was necessary in 29 (8.4% of total) and recovery was successful in 10/29. Nine patients (2.6%) died perioperatively. Poor preoperative condition, previous treatment, and requirement for vein graft were significantly associated with increased risk of major complications after surgery. Cosmetic and functional outcomes were assessed on 1-10 scales: 69 and 77% of patients, respectively, had cosmetic and functional results in the 7-10 range, indicating successful outcome. Overall survival probabilities, estimated on 338 patients with malignant disease, were 53% at 2 years and 32% at 5 years. Most patients, but not all, had advanced disease stage, and 188 (54%) had recurrent disease. Hence, overall survival rates are acceptable and justify the use of complex reconstruction procedures in such patients.

Chromium (III) removal by supported liquid membranes: a comparison among D2HEPA, DNNSA, and a novel extractant as carriers

A facilitated transport study in supported liquid membranes (SLM) using the extraction reagents di-2-ethylexilfosphoric acid (D2HEPA), dinonylnaftalene sulfuric acid (DNNSA), and a novel complexing agent, trimethyl cis,cis-1,3,5-tripropyl-1,3,5 cyclohexenetricarboxilic acid (TTCHTCA) as carriers has been carried out. Organic solvents with different dielectric constants as diluents have been used to obtain the highest extraction and transport values. The results obtained have shown that, by using different organic phases (carrier and/or diluent), SLMs with different ion flux and transport ability can be obtained. The carrier concentration in the membrane and the chromium (III) [Cr(III)] ions concentration in aqueous phase have been varied to see the effect on transport of Cr(III) ions across the membrane. For the carriers D2HEPA and TTCHTCA, the transport of Cr(IlI), both in batch and in recirculation operation mode, has been studied. Very good results in terms of flux and transport have been obtained using TTCHTCA.