Ultrastructural examination of cryodamage in Paracentrotus lividus eggs during cryopreservation

This study examinates the challenges of cryopreserving sea urchin (Paracentrotus lividus) eggs, a task hindered by factors like low membrane permeability and high sensitivity to cryoprotective agents (CPAs). While successful cryopreservation has been achieved for some marine invertebrates, eggs remain problematic due to their unique characteristics. The study explores the impact of various CPAs and cryopreservation techniques on sea urchin eggs, employing scanning and transmission electron microscopy to analyze cellular damage. The findings reveal that exposure to low CPA concentrations (0.5 M) did not induce significant damage to eggs. However, high concentrations (3 M) proved highly detrimental. Every cryopreservation approach investigated in this study resulted in irreversible damage to the sea urchin eggs, rendering them nonviable for future use. The research sheds light on the importance of understanding the structural alterations induced by CPAs and cryopreservation methods. This knowledge is essential for refining cryopreservation methods, potentially paving the way for successful preservation of these challenging cells.

A collaborative, computer-assisted, psychoeducational intervention for depressed patients with chronic disease at primary care: protocol for a cluster-randomized controlled trial

Introduction

Depression treatment recommendations seldom include chronic illness comorbidity.

Objectives

To describe the rationale and methods for a cluster-randomized trial (CRT) in primary care clinics (PCC) comparing a computer-assisted psychoeducational (CAPE) intervention to usual care (UC) for depressed patients with hypertension or diabetes.

Methods

Two-arm, single-blind CRT in Santiago, Chile. Eight PCC will be randomly assigned to the intervention or UC. A total of 360 depressed individuals aged 18 or older PHQ-9 scores ≥ 15 and hypertension or diabetes will be recruited. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and residents in long-term care facilities will be excluded. Patients in the intervention will receive eight CAPE sessions by trained therapists, structured telephone calls to track progress, and usual medical care for chronic diseases. Psychologists and psychiatrists will regularly supervise therapists. To ensure continuity of care, the PCC team will meet monthly with a research team member. Patients in UC will receive standard medical and depression treatment. Three, six, and twelve months after enrollment, outcomes will be assessed. The primary outcome will be a 50% reduction in baseline PHQ-9 scores at six months. Intention-to-treat analyses will be used.

Results

A previous, small-scale pilot study provided valuable insights for study design.

Conclusions

This study will provide first-hand evidence on the effectiveness of a CAPE for depressed patients with chronic diseases at PCC in a Latin American country.

Disclosure

No significant relationships.

Prognostic value of plasma pentraxin 3 levels in patients with septic shock admitted to intensive care

Objective

To evaluate the usefulness of a new marker, pentraxin, as a prognostic marker in septic shock patients.

Materials and methods

Single-centre prospective observational study that included all consecutive patients 18 years or older who were admitted to the intensive care unit (ICU) with septic shock. Serum levels of procalcitonin (PCT), C-reactive protein (CRP) and pentraxin (PTX3) were measured on ICU admission.

Results

Seventy-five septic shock patients were included in the study. The best predictors of in-hospital mortality were the severity scores: SAPS II (AUC = 0.81), SOFA (AUC = 0.79) and APACHE II (AUC = 0.73). The ROC curve for PTX3 (ng/mL) yielded an AUC of 0.70, higher than the AUC for PCT (0.43) and CRP (0.48), but lower than lactate (0.79). Adding PTX3 to the logistic model increased the predictive capacity in relation to SAPS II, SOFA and APACHE II for in-hospital mortality (AUC 0.814, 0.795, and 0.741, respectively). In crude regression models, significant associations were found between in-hospital mortality and PTX3. This positive association increased after adjusting for age, sex and immunosuppression: adjusted OR T3 for PTX3 = 7.83, 95% CI 1.35–45.49, linear P trend = 0.024.

Conclusion

Our results support the prognostic value of a single determination of plasma PTX3 as a predictor of hospital mortality in septic shock patients.

Major challenges in cryopreservation of sea urchin eggs

Cryopreservation of gametes, embryos and larvae of marine invertebrates has been investigated in many studies throughout the years. There are many favorable studies on sperm cryopreservation but oocytes are still under research as no successful results have been sustainably obtained for this type of cells. The preservation of both maternal and paternal gametes separately would provide a reliable source of genetic material for their application to conservation, aquaculture and fundamental research. Unfortunately to date, it has not been possible to cryopreserve eggs from marine organisms. The aim of this review is to go over the factors that have been historically considered as obstacles for oocyte cryopreservation in aquatic organisms and discern those that may specifically apply to eggs of the sea urchin Paracentrotus lividus.

Different neighborhood walkability indexes for active commuting to school are necessary for urban and rural children and adolescents

BACKGROUND

Literature focusing on youth has reported limited evidence and non-conclusive associations between neighborhood walkability measures and active commuting to and from school (ACS). Moreover, there is a lack of studies evaluating both macro- and micro-scale environmental factors of the neighborhood when ACS is analyzed. Likewise, most studies on built environment attributes and ACS focus on urban areas, whereas there is a lack of studies analyzing rural residential locations. Moreover, the relationship between built environment attributes and ACS may differ in children and adolescents. Hence, this study aimed to develop walkability indexes in relation to ACS for urban and rural children and adolescents, including both macro- and micro-scale school-neighborhood factors.

METHODS

A cross-sectional study of 4593 participants from Spain with a mean age of 12.2 (SD 3.6) years was carried out. Macro-scale environmental factors were evaluated using geographic information system data, and micro-scale factors were measured using observational procedures. Socio-demographic characteristics and ACS were assessed with a questionnaire. Several linear regression models were conducted, including all the possible combinations of six or less built environment factors in order to find the best walkability index.

RESULTS

Analyses showed that intersection density, number of four-way intersections, and residential density were positively related to ACS in urban participants, but negatively in rural participants. In rural children, positive streetscape characteristics, number of regulated crossings, traffic calming features, traffic lanes, and parking street buffers were also negatively related to ACS. In urban participants, other different factors were positively related to ACS: number of regulated crossings, positive streetscape characteristics, or crossing quality. Land use mix acted as a positive predictor only in urban adolescents. Distance to the school was a negative predictor on all the walkability indexes. However, aesthetic and social characteristics were not included in any of the indexes.

CONCLUSIONS

Interventions focusing on improving built environments to increase ACS behavior need to have a better understanding of the walkability components that are specifically relevant to urban or rural samples.

GEOTECNOLOGIAS APLICADA NOS CONFLITOS DE USO DO SOLO EM ÁREAS DE PRESERVAÇÃO PERMANENTE NO MUNICÍPIO DE BARRA BONITA/SP

As áreas de conflito são definidas pelo mau uso do solo pelo homem e vem causando sérios problemas ao meio ambiente, resultando em desequilíbrio ecológico e desgaste dos recursos naturais, especialmente quando se refere às áreas de preservação permanente, que têm importância fundamental para os ecossistemas de equilíbrio e preservação dos recursos hídricos. O planejamento é um fator chave para o controle dos impactos ambientais ao meio ambiente. As áreas de preservação permanente evitam o assoreamento e erosão proporcionando uma proteção natural, principalmente em áreas das nascentes. Os serviços ambientais prestados auxiliam a proteção da flora e fauna, na preservação dos corredores ecológicos, e na continuação das espécies ali presentes. Este estudo teve por objetivo avaliar os conflitos de uso e ocupação da terra em áreas de Preservação Permanente do município de Barra Bonita/SP, utilizando como base cartográfica, o Sistema de Informação Geográfica (SIG) e imagem de satélite Sentinel 2-A de 2017, em escala 1:10.000. Os resultados mostraram que quase ¾ da área é ocupado com cana-de-açúcar (72,72%) e que as áreas de preservação permanente estão sendo usados inadequadamente por cana-de-açúcar (72,75%). O SIG ArcGis e as técnicas de geoprocessamento demonstraram agilidade e eficiência na identificação, quantificação e edição de mapas de uso do solo, preservação permanente e de conflitos em áreas de preservação permanente.

DECLIVIDADE E POTENCIAL PARA MECANIZAÇÃO AGRÍCOLA DA BACIA HIDROGRÁFICA DO RIBEIRÃO PEDERNEIRAS - PEDERNEIRAS/SP

A declividade do terreno contribui para o escoamento das águas, pois quanto maior for o trecho em declive, maior será o escoamento da água pela superfície, arrastando outros materiais para os recursos hídricos superficiais, influenciando a qualidade da água e a infiltração e nos processos erosivos fluviais e pluviais, assim como na tipologia da vegetação, bem como contribui para a formação do solo e serve de indicador na definição de áreas de risco e restrição de uso. A declividade dos rios pode ser associada à velocidade do escoamento, transporte de sedimentos e conformação das áreas de preservação permanentes. Este trabalho teve como objetivo analisar a declividade do terreno na bacia hidrográfica do ribeirão Pederneiras, estado de São Paulo e classificá-la quanto as áreas aptas e inaptas à mecanização agrícola. A área de estudo está localizada entre as coordenadas geográficas 22°20' e 22°26' de latitude S e 48°44' e 48°56' de longitude W Gr., situadas nos municípios de Agudos e Pederneiras, do estado de São Paulo, com uma área de 14918,28 ha. Os mapas de declividade foram elaborados por meio de técnicas de geoprocessamento, tendo-se como base cartográfica: as cartas planialtimétricas do Instituto Brasileiro de Geografia e Estatística e a imagem do satélite Sentinel-2 em ambiente de Sistema de Informação Geográfica – ArcGis 10.4.1. As classes de declividade do solo foram classificadas como relevo plano (0 – 3%), suave ondulado (3 – 8%), ondulado (8 – 20%), forte ondulado (20 – 45%), montanhoso (45 – 75%) e escarpado (> 75%) e áreas para mecanização agrícola como aptas (áreas mecanizáveis) e inaptas (áreas não mecanizáveis). Os resultados mostraram que o relevo plano e suavemente ondulado predominou em quase 89% da área, enquadrando-as em áreas aptas à mecanização com pequenas restrições. v

Young Drug Users: a Vulnerable Population and an Underutilized Resource in HIV/HCV Prevention

PURPOSE OF REVIEW

The social networks of people who inject drugs (PWID) have long been studied to understand disease transmission dynamics and social influences on risky practices. We illustrate how PWID can be active agents promoting HIV, HCV, and overdose prevention.

RECENT FINDINGS

We assessed drug users' connections and interactions with others at risk for HIV/HCV in three cities: New York City (NYC), USA (n = 539); Pereira, Colombia (n = 50); and St. Petersburg, Russia (n = 49). In all three cities, the majority of participants' network members were of a similar age as themselves, yet connections across age groups were also present. In NYC, knowing any opioid user(s) older than 29 was associated with testing HCV-positive. In NYC and St. Petersburg, a large proportion of PWID engaged in intravention activities to support safer injection and overdose prevention; in Pereira, PWID injected, had sex, and interacted with other key groups at risk. People who use drugs can be active players in HIV/HCV and overdose risk- reduction; their networks provide them with ample opportunities to disseminate harm reduction knowledge, strategies, and norms to others at risk. Local communities could augment prevention programming by empowering drug users to be allies in the fight against HIV and facilitating their pre-existing health-protective actions.

Catheter-related bacteraemia caused by Raoultella ornithinolytica

Infections in humans by Raoultella spp. are rare and the effect that Raoultella spp. might have as a human pathogen is currently unknown. A clinical case is presented of catheter-related bacteraemia caused by Raoultella ornithinolytica, treated successfully with applied antibiotic therapy (intravenous cefepime and sealed the catheter with amikacin).

The Reliability and Validity of Liu´s Self-Report Questionnaire for Screening Putative Pre-Psychotic States (BQSPS) in Adolescents

The usage of rigorous analyses based on contemporary methods to enhance psychometric properties of screening questionnaires aimed to address psychotic-like experiences (PLE) is currently being encouraged. The Brief Self-Report Questionnaire for Screening Putative Pre-psychotic States (BQSPS) is a recently created tool addressing PLE beyond attenuated positive symptoms (APS). Its psychometric properties as a screening tool for first step assessment seems to be adequate, but further research is needed to evaluate certain validity aspects, particularly its dimensionality, internal structure, and psychometric properties in different populations. We assessed the reliability, construct validity, and criterion validity of BQSPS in two samples: 727 adolescents aged 13-18 years, and 245 young adults aged 18-33 years. We used exploratory structural equation modeling (ESEM), confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM). The original four-factor structure was not replicated. The best fit in adolescents was obtained by a structure of three-correlated factors: social anxiety (SA), negative symptoms (NS), and positive symptoms (PS). This structure was confirmed in young adult subjects. The three-factor model reached a predictive capability with suicidality as external criterion. PLE are represented by a three-factor structure, which is highly stable between adolescent and young-adult samples. Although the BQSPS seems to be a valid tool for screening PLE, its psychometric properties should be improved to obtain a more accurate measurement.

GEOTECNOLOGIA APLICADA NA OBTENÇÃO DAS SUBCLASSES DE CAPACIDADE DE USO DAS TERRAS DE UMA MICROBACIA, VISANDO A CONSERVAÇÃO DOS RECURSOS NATURAIS

A exploração da terra para produzir alimentos para o sustento do homem quase sempre foi de forma desordenada e sem planejamento.Aconsequência dessa exploração predatória foi oempobrecimento do solo por erosão intensa, assoreamento de cursos d’água, desertificação, entre outros. O trabalho objetivou a utilização de geotecnologias na elaboração dos mapas de classes de declive, de solos e da capacidade de uso do solo numa microbacia, de forma a contribuirno processo de gestão ambiental e na tomada de decisões por parte dos Administradores Públicos.A microbacia do Ribeirão das Agulhas, Botucatu (SP) apresenta uma área de 1.429,28ha e está localizada entre os paralelos 22o47'05" a 22o05'55" de latitude S e 48o28'10” a 48o30'04" de longitude W Gr. Os resultados permitiram inferir que a subclasse mais significativa foi a IIIs,e(44,50%)e orelevo ondulado (57,59%). Assubclasses de capacidade de uso IIIs, IIIs,e,IVs, IVs,e e IVeocuparam 89,36% da área, mostrando o grande potencial de uso para culturas anuais, perenes, pastagens e reflorestamentos. O Sistema de Informações Geográficas (SIG)mostrou-se uma excelente ferramenta para determinação da capacidade de uso da terra, demonstrando que a utilização do geoprocessamento facilita e dá maior rapidez no cruzamento dos dados digitais, permitindo seu armazenamento, que poderão ser utilizados para outras análises em futuros planejamentos geoambientais.

TÉCNICAS DE GEOPROCESSAMENTO PARA ANÁLISE MORFOMÉTRICA DA MICROBACIA DO RIBEIRÃO ALTO ÁGUA FRIA – BOFETE (SP)

Técnicas de geoprocessamento foram realizadas para a caracterização morfométrica da microbacia do Ribeirão Alto Água Fria – Bofete (SP) pelo Sistema de Informação Geográfica, visando à preservação, racionalização do seu uso e recuperação ambiental. A microbacia apresenta uma área de 4012,17 ha e está localizada entre as coordenadas geográficas: 22o 57’ 41” a 23o 02’ 42” S e 48o 11’ 29” a 48o 20’ 09” WGR. A base cartográfica utilizada foi a carta planialtimétrica de Bofete (SP) para extração das curvas de nível e hidrografia, para determinação dos índices morfométricos. Os resultados apresentaram que os baixos valores da densidade de drenagem, associados à presença de rochas permeáveis, facilitam a infiltração da água no solo, diminuindo o escoamento superficial e o risco de erosão e da degradação ambiental. Os baixos valores do fator de forma e do índice de circularidade indica que a microbacia tende a ser mais alongada com menor susceptibilidade à ocorrência de enchentes mais acentuadas. O parâmetro ambiental, coeficiente de rugosidade, permitiu classificar a microbacia para vocação com agricultura.

Abstracts of the 24th international isotope society (UK group) symposium: synthesis and applications of labelled compounds 2015

The 24th annual symposium of the International Isotope Society's United Kingdom Group took place at the Møller Centre, Churchill College, Cambridge, UK on Friday 6th November 2015. The meeting was attended by 77 delegates from academia and industry, the life sciences, chemical, radiochemical and scientific instrument suppliers. Delegates were welcomed by Dr Ken Lawrie (GlaxoSmithKline, UK, chair of the IIS UK group). The subsequent scientific programme consisted of oral presentations, short 'flash' presentations in association with particular posters and poster presentations. The scientific areas covered included isotopic synthesis, regulatory issues, applications of labelled compounds in imaging, isotopic separation and novel chemistry with potential implications for isotopic synthesis. Both short-lived and long-lived isotopes were represented, as were stable isotopes. The symposium was divided into a morning session chaired by Dr Rebekka Hueting (University of Oxford, UK) and afternoon sessions chaired by Dr Sofia Pascu (University of Bath, UK) and by Dr Alan Dowling (Syngenta, UK). The UK meeting concluded with remarks from Dr Ken Lawrie (GlaxoSmithKline, UK).

Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center

There is a lack of universally accepted clinical parameters to guide the utilization of donation after cardiac death (DCD) donor livers and it is unclear as to which patients would benefit most from these organs. We reviewed our experience in 141 patients who underwent liver transplantation using DCD allografts from 1993 to 2007. Patient outcomes were analyzed in comparison to a matched cohort of 282 patients who received livers from donation after brain death (DBD) donors. Patient survival was similar, but 1-, 5- and 10-year graft survival was significantly lower in DCD (69%, 56%, 44%) versus DBD (82%, 73%, 63%) subjects (p < 0.0001). Primary nonfunction and biliary complications were more common in DCD patients, accounting for 67% of early graft failures. A donor warm ischemia time >20 min, cold ischemia time >8 h and donor age >60 were associated with poorer DCD outcomes. There was a lack of survival benefit in DCD livers utilized in patients with model for end-stage liver disease (MELD) < or =30 or those not on organ-perfusion support, as graft survival was significantly lower compared to DBD patients. However, DCD and DBD subjects transplanted with MELD >30 or on organ-perfusion support had similar graft survival, suggesting a potentially greater benefit of DCD livers in critically ill patients.

Aflatoxigenic fungi and aflatoxin B1 in commercial pet food in Brazil

The aims of this study were to determine the aflatoxigenic mycoflora and the incidence of aflatoxin B1 in commercial samples of ready dog food. This in turn demonstrated the ability of the Aspergillus flavus and Aspergillus parasiticus strains to produce aflatoxin B1. 180 samples (standard, premium and super premium) were collected. Aspergillus was the prevalent genera followed by Penicillium and Fusarium. A. flavus and A. parasiticus were the prevalent species. All A. flavus and A. parasiticus strains from super premium samples were able to produce aflatoxin B1, whereas toxigenic strains isolated from standard and premium samples varied from 80 to 100%. A high percentage of ready pet food contaminated by toxigenic species from section Flavi was found and aflatoxin B1 levels were detected. The fungal counts from the three kinds of feed did not exceed the proposed value (1×104 cfu/g) and none of the samples exceeded the aflatoxin B1 recommended level (20 ng/g). The presence of A. flavus and A. parasiticus with aflatoxigenic ability could be a potential risk for production of AFB1 in feedstuffs when environmental storage conditions are not adequate.

Brain Metastasis from an Unknown Primary, or Primary Brain Tumour? A Diagnostic Dilemma

Brain metastasis is increasingly common, affecting 20%–40% of cancer patients. After diagnosis, survival is usually limited to months in these patients. Treatment for brain metastasis includes whole-brain radiation therapy, surgical resection, or both. These treatments aim to slow progression of disease and to improve or maintain neurologic function and quality of life. Although less common, primary brain tumours produce symptoms that are similar to those of brain metastasis. Glioblastoma, the most common malignant tumour of the brain, has a median survival of less than 12 months. Patients are often treated with surgical resection followed by radical radiation therapy and chemotherapy. Here, we present 2 separate cases of lesions in the brain radiologically compatible with brain metastasis. In both cases, no primary cancer site had been established, and neurosurgical intervention was sought to obtain a pathologic diagnosis. Both cases were pathologically confirmed as glioblastoma. These cases demonstrate the importance of differentiation between brain metastases and primary brain tumours to ensure that the appropriate management strategy is implemented.

A Phase II study of trabectedin single agent in patients with recurrent ovarian cancer previously treated with platinum-based regimens

The objective of this study was to determine the objective response rate in patients with platinum-sensitive and platinum-resistant recurrent ovarian cancer to treatment with trabectedin (Yondelis®) administered as a 3-h infusion weekly for 3 weeks of a 4-week cycle. We carried out a multicentre Phase II trial of trabectedin in patients with advanced recurrent ovarian cancer. Trabectedin (0.58 mg m⁻²) was administered via a central line, after premedication with dexamethasone, to 147 patients as a 3-h infusion weekly for 3 weeks followed by 1-week rest. Major eligibility criteria included measurable relapsed advanced ovarian cancer and not more than two prior platinum-containing regimens. Patients were stratified according to the treatment-free interval (TFI) between having either platinum-sensitive (⩾6 months TFI) or platinum-resistant disease (<6 months TFI)/platinum-refractory disease (progression during first line therapy). In the platinum-sensitive cohort, 62 evaluable patients with measurable disease had an overall response rate (ORR) of 29.0% (95% CI: 18.2–41.9%) and median progression-free survival (PFS) was 5.1 months (95% CI: 2.8–6.2). Four patients with measurable disease per Response Evaluation Criteria in Solid Tumours (RECIST) criteria had no follow-up scans at the end of treatment. In the platinum-resistant/refractory cohort, 79 patients were evaluable with an ORR of 6.3% (95% CI: 2.1–14.2%). Median PFS was 2.0 months (95% CI: 1.7–3.5 months). Two patients with measurable disease per RECIST criteria had no follow-up scans at the end of treatment. The most frequent (⩾2% of patients) drug-related treatment-emergent grade 3/4 adverse events were reversible liver alanine transferase elevation (10%), neutropaenia (8%), nausea, vomiting, and fatigue (5% each). Trabectedin is an active treatment, with documented responses in patients with platinum sensitive advanced relapsed ovarian cancer, and has a manageable toxicity profile.

Chemotherapy and radiation therapy in UPSC

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Purpose: To analyze the impact of chemotherapy (Ch) and radiation therapy (RT) on relapse rates in patients with uterine papillary serous carcinoma (UPSC). Materials and Methods: The outcomes of 160 women with UPSC seen between 1980–2005 at the BW/DFCC were analyzed. Exclusion criteria included stage IVB disease, no hysterectomy, unknown stage, or unknown type of RT. Results: The median age was 67 years (range 31–90). FIGO Stage was IA (21), IB (28), IC (13), IIA (7), IIB (10), IIIA (42), IIIB (2), IIIC (21), and IVA (16). Treatment included none (40), Ch alone (20), Ch and whole abdominal radiation (WA) (11), Ch and pelvic radiation (P) (30), Ch and vaginal brachytherapy (VB) (2), WA alone (24), P alone (19), and VB alone (14). The median dose of RT was WA 30 Gy and P 45 Gy. Ch was given to 63 patients; the median number of cycles of Carboplatin, Adriamycin and Paclitaxel was 3. Overall survival (OS) and disease-free survival (DFS) for the entire group were 67% and 57% at 2 years, 62% and 51% at 3 years and 51% and 38% at 5 years. A total of 58 patients relapsed. Among those who received no RT or Ch, 48% (19/40) relapsed; among those treated with Ch only, 50% (10/20) relapsed; in the group treated with RT only, 26% (15/57) relapsed; and, in those treated with Ch and RT, 33% (14/43) relapsed. A significant difference in recurrence rate was seen in patients treated with RT compared to those who received no treatment (OR 0.40, p=0.03). This difference persisted after controlling for Stage, which did significantly affect the relationship between RT treatment and recurrence. Local recurrence (in an RT field) was a component of failure for 14% (14/100) treated with RT, versus 42% (25/59) that received no RT (OR 0.22, p=0.0001). Distant metastases were a component of first failure in 15% (9/61) that received Ch versus 11% (11/97) that did not; there was no significant difference in distant recurrence rate for patients treated with Ch (OR 1.35, p=0.53). Conclusion: This single-institution study represents the largest series of UPSC to date. The use of RT significantly decreases the overall recurrence rate of UPSC in this series and should be considered in patients with stages I-IVA UPSC. Future studies looking at the optimal type, dose and duration of chemotherapy, as well as the use of novel agents, are needed to improve outcomes in this population.

No significant financial relationships to disclose.

Three sequential chemotherapy doublets for the treatment of newly diagnosed advanced müllerian malignancies: The modified triple doublet regimen

OBJECTIVE

Previously, we reported the use of three sequential doublets (Triple Doublets) in the treatment of women with newly diagnosed and advanced stage müllerian malignancies. The surgically defined negative second look operation (SLO) rate to Triple Doublets was 38%. Modifications were made to this treatment regimen that were predicted to reduce toxicity and possibly increase efficacy.

METHODS

Open label two-cohort study. Patients with a new diagnosis of Stages II-IV müllerian malignancy were eligible. After cytoreductive surgery, patients were treated with three sequential doublets including 3 cycles of carboplatin and gemcitabine, and 3 cycles of carboplatin and paclitaxel, and 3 cycles of doxorubicin and topotecan. After therapy, all women were clinically staged and evaluated at SLO if clinical staging was negative for residual disease. Primary endpoints were toxicity and negative SLO rate with rates of 60% and 40% defined a priori in optimally cytoreduced (cohort 1) and suboptimally cytoreduced or Stage IV (cohort 2), respectively.

RESULTS

Eighty-five eligible patients were enrolled with a median age of 52 years. Forty-seven and thirty-eight women were in cohorts 1 and 2, respectively. 723 cycles of chemotherapy were delivered with no toxic deaths. Grades 3 and 4 toxicities included neutropenia in 75% of patients and thrombocytopenia in 65% of patients during at least one cycle of therapy. Fever and neutropenia were seen in 3.5% of patients. All Grades 3 and 4 non-hematologic toxicities were seen at a frequency of <10%. Seventy women underwent SLO with a negative SLO rate of 53% with an additional 9% having microscopically positive procedures. Negative SLO rate was 74% in cohort 1 and 36% in cohort 2.

CONCLUSIONS

Treatment with the modified triple doublet regimen is tolerable with an encouraging pathologic CR rate.

[Diffuse uveal melanoma. A clinical case]

CASE REPORT

We report the case of a 58-year-old man who presented at our emergency department with ocular pain and progressive loss of vision in his left eye. Ophthalmic examination detected a pigmented mass in the iridocorneal angle, involving the ciliary body. Glaucoma had also developed secondary to the melanotic lesion. Ophthalmoscopy showed a large pigmented choroidal tumor. After enucleation, pathologic examination confirmed the diagnosis of a diffuse ocular melanoma.

DISCUSSION

Diffuse uveal melanoma is a malignant tumor that metastasises early. Enucleation is the treatment of choice.

Phase I/II dose finding study of combination cisplatin and gemcitabine in patients with recurrent cervix cancer

OBJECTIVES

To evaluate the toxicity and efficacy of cisplatin and gemcitabine in women with recurrent cervical cancer.

METHODS

A multi-institutional phase I/II dose finding study of cisplatin and gemcitabine delivered to women with recurrent previously radiated cervical carcinoma.

RESULTS

Twenty eight patients were enrolled. The mean and median age of patients was 51 years (age range 35 to 70 years). Chemotherapy was given on a 28-day cycle; cisplatin was administered at a fixed dose of 50 mg/m(2), day 1 and gemcitabine, days 1, 8, and 15. Gemcitabine doses started at 600 mg/m(2) (dose level 1) and were escalated by 100 mg/m(2)/dose level until 1000 mg/m(2) (dose level 5). Twenty seven patients were evaluable for toxicity and disease response, and 75 cycles of chemotherapy were administered. Toxicities were predominantly hematological; 18% of patients experienced grade 3 anemia, 37% grade 3 and 11% grade 4 leukopenia, 41% grade 3 neutropenia, and 26% grade 3 thrombocytopenia. The maximally tolerated dose (MTD) was not reached. One patient experienced a dose-limiting toxicity on dose level 2 (febrile neutropenia). One patient had a CR and 3 patients had a PR to therapy (15% response rate), 41% of patients had SD, and 44% had progression of cancer. Median survival was 11.9 months.

CONCLUSION

Although this 28-day gemcitabine and cisplatin regimen in recurrent cervix cancer has tolerable toxicity, 21-day regimens are recommended because of improved practicality, higher dose intensity, and higher response rates.

Cortical reorganization during PASAT task in MS patients with preserved working memory functions

Cortical reorganization in multiple sclerosis (MS) is defined as a compensatory mechanism which requires MS patients to overactivate specific brain areas in order to perform the task as controls. To investigate this process with the Paced Auditory Serial Addition Test (PASAT) task, we selected 15 MS patients who performed the PASAT task within-normal limits and 10 healthy controls. Once selected, we used functional magnetic resonance imaging (fMRI) to investigate brain areas involved in PASAT performance in both groups. Results showed that the task activated the left frontal (BA6 and 9) and parietal cortex (BA7 and 40) in both groups, but MS patients showed a stronger activation in the left prefrontal cortex (BA9, 44 and 45) when compared with controls. These results confirmed those obtained post hoc by Audoin et al. [Audoin, B., Ibarrola, D., Ranjeva, J.P., Confort-Gouny, S., Malikova, I., Ali-Chérif, A.M., Pelletier, J., Cozzone, P., et al., 2003. Compensatory cortical activation observed by fMRI during cognitive task at the earliest stage of MS. Hum. Brain Mapp. 20, 51-58], and we interpreted this as showing true cortical reorganization.