Laparoscopic total fundoplication is superior to medical treatment for reducing the cancer risk in Barrett's esophagus: a long-term analysis.

The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation. A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett's esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett's esophagus length, the groups were 180 (Group A) and 190 (Group B). Median follow-up was 80 months. Group B was significantly superior for controlling GERD symptoms. Group B was more efficient than Group A in promoting Barrett's esophagus regression or blocking its progression. Group B was more efficient than Group A in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia. Age and body mass index were used as covariates in the logistic regression models. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (odds ratio [OR]: 0.51; 95% confidence interval [CI]: 0.27-0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08-0.81, for adenocarcinoma or high-grade dysplasia). Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer.

Toxicities of acetogenin-based bioacaricides against two-spotted spider mite and selectivity to its phytoseiid predators.

Tetranychus urticae is the main pest of strawberry crops and can cause up to 80% of productivity losses under high infestations. Aiming to search T. urticae management alternatives compatible with eco-friendly or organic-based food production systems, this study evaluated the lethal and sublethal toxicities of formulated derivatives from Annonaceae (rich in acetogenins) against this pest species. In addition, it also evaluated the selectivity of the most promising formulation to the predatory mites Neoseiulus californicus and Phytoseiulus macropilis, which are largely applied in biological control in Brazil. Among the derivatives tested, the emulsion from the ethanolic seed extract of Annona mucosa-ESEAm (major component: acetogenin bis-tetrahydrofuran rolliniastatin-1) caused pronounced mortality of T. urticae after 120 h of exposure (LC50 = 465.5 mg L-1), in a comparable or superior manner to an abamectin-based synthetic acaricide used as positive control (LC50 = 1243.4 mg L-1). Moreover, ESEAm exposure resulted in a significant decrease in the number of eggs laid by females and caused the most pronounced ovicidal action for T. urticae, with only 5% embryonic viability. However, ESEAm also showed high toxicity to the predatory mites tested, causing 100% mortality for both species after 120 h exposure, similar to abamectin. The interaction between these bioacaricides and biological control agents should be tested under field conditions to further assess the potential ecological selectivity of these derivatives.

Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign.

INTRODUCTION: Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires. OBJECTIVES: To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. METHODS: To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. RESULTS: Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I-II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01-1.10)], atypical nevi [SOR = 1.04 (1.00-1.09)], lentigines [SOR = 1.16 (1.04-1.29)] and suspicion of melanoma [SOR = 1.13 (1.00-1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91-1.10)]. CONCLUSIONS: Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes.

Sunbed use legislation in Europe: assessment of current status.

BACKGROUND: The use of UV-emitting tanning devices for cosmetic purposes is associated with an increased risk of melanoma and non-melanoma skin cancer. Young women are the most frequent users, therefore, there is an increasing concern about the regulation of sunbed use. OBJECTIVE: The primary objective is to assess the current legislation on sunbed use among European countries. METHODS: We developed a 30-item questionnaire to gather the most relevant information about sunbed use legislation. The questionnaire was sent to Euromelanoma coordinators and to designated coordinators out of the Euromelanoma network. RESULTS: We obtained a response rate of 64%. More than 25% of the countries did not report any specific legislation. Roughly one-third of the countries does not have a restriction for minors. Even in countries with a specific legislation, a lack or insufficient enforcement of age limit was observed in up to 100% of the inspections based on the PROSAFE report from 2012. Self-tanning devices were reported in 50%, and almost 40% of countries do not require supervision of use. Although a warning display is required in 77% of cases, a signed informed consent is not required in 80%. In the vast majority of cases, the number of licensed or closed tanning centres is unknown. CONCLUSIONS: Despite the evidence of its harmful effects, and its frequent use by young people, many of whom are at high risk of skin cancer because of fair skin, a significant number of European countries lack a specific legislation on tanning devices. In order to limit the access of young people to sunbeds, a more strictly enforced regulation is needed, as well as regulation regarding advertisement, and location of tanning centres, in addition to health promotion campaigns that target the vulnerable population of young women seeking its use for improved cosmesis.

Prevalence and determinants of sunbed use in thirty European countries: data from the Euromelanoma skin cancer prevention campaign.

BACKGROUND: Although considered as a first-group carcinogen, indoor tanning is a common practice in Europe. Euromelanoma is a pan-European skin cancer prevention campaign. OBJECTIVES: To compare several European countries in terms of the prevalence and determinants of sunbed use. METHODS: Participants in the Euromelanoma campaigns filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for age, gender, education, skin type and year of survey were employed to assess factors independently associated with sunbed use in each country. RESULTS: In total, 227 888 individuals (67.4% females, median age 44, 63.4% highly educated, 71.9% skin types III-VI) from 30 countries participated. Overall, the prevalence of sunbed ever use was 10.6% (≤19-year-olds: 5.9%; 20 to 35-year-olds: 17.0%; >35-year-olds: 8.3%). Females displayed a higher prevalence than males in all countries. Balkan countries displayed the highest female/male ratios (≥4). Sunbed use was significantly more prevalent among skin type III-VI (14/30 countries) and highly educated participants (11/30 countries). Significant correlations were found between sunbed use prevalence and countries' latitude (P < 0.001) and sunshine (P = 0.002); Italy and Spain represented exceptions towards excessive exposure. Very different prevalence rates were found for Spain (19.3%) and Portugal (2.0%). Scandinavian countries ranked highest in sunbed use among ≤19-year-olds, Baltic countries among 20 to 35-year-olds. CONCLUSIONS: Sunbed use prevalence was higher in northern, sun-deprived countries, with the exception of Italy and Spain. The main determinants of sunbed use were age (young adults) and gender (females), whereas education and skin type had a less relevant effect. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults) and Scandinavian (highest prevalence among adolescents). These data have public health relevance for future interventions aimed at reducing sunbed use in Europe.

Skin cancer healthcare impact: A nation-wide assessment of an administrative database.

BACKGROUND: Skin cancer is an important health concern, with an increasing incidence worldwide. OBJECTIVE: To assess the clinical and economic burden of melanoma (MM) and non-melanoma skin cancer (NMSC) at public hospitals in mainland Portugal. METHODS: We used an administrative database containing a registration of all hospitalizations and ambulatory episodes occurred in Portuguese public hospitals between 2011 and 2015. We assessed all episodes with associated diagnoses of MM or NMSC regarding neoplasm location, metastases occurrence, length of stay, in-hospital mortality and hospital costs. RESULTS: We assessed 15,913 MM and 72,602 NMSC episodes. 14.3% of MM episodes presented with metastases, compared to 1.9% of NMSC episodes. Patients' median age was lower for MM (66 years) than NMSC (76 years). The trunk was the most common location for MM (32.5%), followed by the lower limbs (26.5%). NMSC presented with higher length of stay than MM (median 5 versus 4 days; p < 0.001), but with lower in-hospital mortality (7.3% versus 11.9%; p < 0.001). MM episodes had higher average hospital costs than NMSC episodes (1197.7 versus 1113.5 €; p < 0.001). Overall, NMSC episodes amounted a total of 80.8 million € in hospital costs versus 19.1 million € for MM episodes. CONCLUSION: Skin neoplasms have substantial impact on healthcare services. NMSC is an important contributor to this burden. NMSC underreporting should be tackled and it should not be downplayed in skin cancer preventative strategies.

"Retronychia--clinical and pathophysiological aspects".

Retronychia represents proximal ingrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold. It is suspected when there is a persistent paronychia, particularly in the setting of trauma. Important clinical criteria for diagnosis are inflammation of the proximal nail fold, granulation tissue emerging from under the nail fold, thickening of the proximal portion of the nail plate and interruption of nail growth. The condition is rarely diagnosed and often misinterpreted, and is therefore unnecessarily treated with systemic antibiotics and antifungals. Avulsion of the nail confirms the diagnosis and it is the curative treatment. Conservative treatment with an adhesive technique is a valid option in early cases. We report 20 cases of retronychia diagnosed in our department between 2010 and 2013.

Efeito de diferentes técnicas extrativas no rendimento, atividade antioxidante, doseamentos totais e no perfil por clae-dad de dicksonia sellowiana (presl. ). Hook, dicksoniaceae / Effect of different extraction techniques on the yield, antioxidant activity, total dosages, and profile by hplc-dad of Dicksonia sellowiana (Presl. ). Hook, dicksoniaceae.

RESUMO A espécie Dicksonia sellowiana, conhecida popularmente como xaxim, é uma samambaia natural do continente americano e encontrada no Brasil na Mata Atlântica. Em 2001 sua utilização para confecção de vasos para jardinagem foi proibida, e a mesma foi inserida na lista do IBAMA como espécie ameaçada de extinção. O presente trabalho descreve o efeito de diferentes técnicas de extração, incluindo ultra-som, turbólise, maceração, infusão, decocto e soxhlet utilizando etanol e solvente hidroalcoólico 70%, sob aspectos físicos e químicos. Foi avaliado o rendimento de cada extração, o perfil por CLAE-DAD, o conteúdo de polifenóis, flavonoides, proantocianidinas e esteroides além das atividades antioxidantes pelos métodos DPPH e redução do complexo fosfomolibdênio. Os dados foram avaliados estatisticamente através de desvio padrão, Tuckey e PCA. Os resultados demonstraram que a extração por Soxhlet utilizando ambos os solventes é a que possui maior rendimento final, porém o rendimento não está diretamente relacionado com o aumento nos teores de bioativos totais e atividades antioxidantes. As extrações por decocção e turbólise utilizando solvente hidroalcoólico foram as que apresentaram melhores resultados nos teores totais e na atividade antioxidante, resultados que ficam evidentes quando avaliados por PCA, demonstrando que este solvente e estas extrações são mais seletivas no estudo proposto.

ABSTRACT The species Dicksonia sellowiana, popularly known as xaxim, is a fern native to the Americas and found in Brazil in the Atlantic Forest. In 2001, its use for making gardening pots was banned, and it was added to the IBAMA [Brazilian Institute of the Environment and Renewable Natural Resources] list as an endangered species. This paper describes the effect of different extraction techniques – including ultrasound, turbolysis, maceration, infusion, decoction, and soxhlet using ethanol and 70% hydroalcoholic solvent on its physical and chemical aspects. The yield of each extraction was evaluated, as well as the profile by HPLC-DAD, the polyphenol content, flavonoids, proanthocyanidins, and steroids, in addition to the antioxidant activities through the DPPH and phosphomolybdenum complex reduction methods. The data were statistically analyzed through standard deviation, Tukey, and PCA. The results showed that the soxhlet extraction using both solvents had the highest overall yield; however, the yield is not directly related to the increase in total bioactive content and antioxidant activities. Extractions by decoction and turbolysis using a hydroalcoholic solvent exhibited the best results in total content and antioxidant activity – results that are evident when evaluated through PCA, demonstrating that this solvent and these extractions are the most selective in the proposed study.

Avaliação do potencial antioxidante frente à oxidação lipídica e da toxicidade preliminar do extrato e frações obtidas das frondes de Dicksonia sellowiana (Presl. ) Hook / Evaluation of antioxidant potential against lipid oxidation and preliminary toxicity of extract and fractions obtained from the fronds of Dicksonia sellowiana (Presl. ) Hook

RESUMOA espécie Dicksonia sellowiana, conhecida popularmente como xaxim, é uma samambaia natural do continente americano e encontrada no Brasil na Mata Atlântica. Em 2001 foi inserida na lista do IBAMA como espécie ameaçada de extinção em decorrência da exploração para a confecção de vasos para a jardinagem. O presente trabalho descreve o potencial antioxidante lipídico (TBARS e Sistema β-caroteno/ácido linoleico) do extrato bruto e frações obtidos através de aparato de Soxhlet de frondes de Dicksonia sellowiana, além da atividade citotóxica e hemolítica in vitro. Pelo método TBARS, todas as amostras testadas apresentaram atividade, destacando a fração acetato de etila e extrato bruto cuja atividade foi comparável ao padrão ácido ascórbico. No sistema β-caroteno/ácido linoleico, a fração acetato de etila e extrato bruto apresentaram inibição da oxidação do ácido linoleico, destaque para a fração acetato de etila que não se diferenciou estatisticamente do padrão BHT. Na avaliação da toxicidade preliminar, não fora observado atividade citotóxica e hemolítica do extrato bruto e frações nos modelos testados. Os resultados demonstram o potencial antioxidante da espécie vegetal nos modelos de inibição da oxidação lipídica sem apresentar toxicidade.

ABSTRACTThe species Dicksonia sellowiana, popularly known as tree fern, are a natural fern from American continent found in the Atlantic Forest in Brazil. In 2001 it was added to the list of IBAMA as endangered species due to its exploitation for pots craft for gardening species. This paper describes the antioxidant lipid potential (TBARS and System β-carotene / linoleic acid) of the crude extract and fractions obtained by Soxhlet apparatus of Dicksonia sellowianafronds, besides the cytotoxic and hemolytic activity in vitro. By the TBARS method, all samples tested showed activity, particularly the fraction ethyl acetate and the crude extract whose activity was comparable to standard ascorbic acid. In the system β-carotene / linoleic acid, the fraction of ethyl acetate and crude extract inhibited the oxidation of linoleic acid, especially the ethyl acetate fraction which did not differ statistically from the standard BHT. In a preliminary assessment of toxicity,cytotoxic and hemolytic activity of crude extracts and fractions in the tested models were not observed. The results of this study indicate the antioxidant potential of this plant species in models of inhibiting lipid oxidation without producing toxicity.

Análise fitoquímica, potencial antioxidante e toxicidade do extrato bruto etanólico e das frações da espécie Senecio westermaniiDusén frente à Artemia salina / Phytochemical analysis, antioxidant potential and toxicity of crude ethanol extract and fractions of the species Senecio westermanii Dusén against Artemia salina

RESUMO A espécie Senecio westermanii Dusén pertencente à família Asteraceae é planta endêmica e nativa do Brasil encontrada na região da Floresta Atlântica, nos estados do Paraná e São Paulo. O objetivo deste trabalho foi avaliar a composição fitoquímica do extrato bruto etanólico e frações das partes aéreas (folha e caule) de S. westermanii utilizando-se a análise fitoquímica qualitativa e cromatografia líquida de alta eficiência com detector de arranjo de diodos (CLAE-DAD), avaliar in vitro a toxicidade preliminar utilizando Artemia salina e o potencial antioxidante. O estudo fitoquímico qualitativo revelou a presença de alcaloides, flavonoides, iridoides, esteroides/triterpenos, heterosídeos saponínicos e aminogrupos. Através da análise realizada por CLAE-DAD obteve-se o fingerprint característico de cada amostra. No ensaio frente à A. salina houve ausência de toxicidade das amostras, o resultado da DL50 para todas as amostras foi superior a 1000 μg/mL. Todas as amostras apresentaram atividade antioxidante pela redução do complexo fosfomolibdênio, com destaque para a fração clorofórmio que apresentou atividade antioxidante de 92,51% em relação ao padrão rutina. Com relação ao ensaio de redução do radical DPPH•, a fração acetato de etila apresentou IC50 de 26,98 μg/mL. Pelo ensaio do ácido tiobarbitúrico (TBARS) a fração hexano apresentou o melhor índice antioxidante em relação ao padrão rutina. Os resultados obtidos demonstram evidências de que a espécie é fonte potencial de antioxidantes naturais, estimulando assim novos estudos que viabilizam sua utilização no tratamento de patologias associadas aos radicais livres. Além disso, a espécie não apresentou atividade tóxica preliminar, assegurando sua aplicabilidade.

ABSTRACT The species Senecio westermanii Dusén, which belongs to the Asteraceae family, is an endemic and native plant from Brazil. It is found mainly in the Atlantic Forest region, in Paraná and São Paulo states. This study aimed to evaluate the phytochemical composition using a qualitative phytochemical analysis and high performance liquid chromatography with diode array detector (HPLC-DAD), to evaluate preliminary toxicity in vitro using Artemia salina and antioxidant potential. Qualitative phytochemical analysis revealed the presence of alkaloids, flavonoids, iridoids, steroids, triterpenes, saponinic glycosides and aminogroups. The analysis by HPLC-DAD provided the characteristic fingerprint of each sample. In the A. salina assay, the results of LD50 over 1000 μg/mL for all samples did not indicate toxicity of the evaluated extracts. All samples demonstrated antioxidant activity by reducing phosphomolybdenum complex. The highest activity was detected in the chloroform fraction, which presented activity of 92.51% compared to the standard rutin. Regarding the trial to reduce the radical DPPH•, the ethyl acetate fraction showed an IC50 of 26.98 µg/mL. In the thiobarbituric acid assay (TBARS), the hexane fraction showed the highest antioxidant activity compared to the standard rutin. These findings indicate that the Senecio westermanii is a potential source of natural antioxidants, stimulating new studies that enable their use in the treatment of disorders associated with free radicals. In addition, the species did not present toxicity in its evaluation, ensuring its applicability.

Development of disseminated superficial porokeratosis in a patient with complicated acute pancreatitis.

Porokeratosis is a group of hereditary or acquired diseases with abnormal epidermal keratinization. A 71-year-old man was admitted to the Surgery Department after an attack of acute pancreatitis complicated with pancreatic necrosis, which required surgical resection. Three weeks after the admission, the patient was observed by our Dermatology department with sudden onset of a generalized eruption of asymptomatic flat papules with a hyperkeratotic rim, sparing the face, palms, soles, and mucous membranes. A skin biopsy was performed at the border of a leg lesion, which disclosed the presence of cornoid lamella, confirming the clinical diagnosis of disseminated superficial porokeratosis (DSP). The skin eruption spontaneously subsided about one month after pancreatic resection. The late onset of DSP in our patient may represent a type of immunosuppression-induced porokeratosis. Possibly, the pathologic clone of keratinocytes for porokeratosis was present, but remained latent until there was a decrease in the immunological status. It is possible that this relative and transient state of immunosuppression was the result of the concurrent necrotizing pancreatitis. This case represents an unusually good outcome of DSP. To the authors best knowledge, this is the first case of DSP related to severe acute pancreatitis.

Rowell syndrome - case report and review of the literature.

Rowell syndrome is a rare distinctive entity first described in 1963 by Rowell and coworkers. It consists in erythema multiforme-like lesions associated with lupus erythematosus. Zeitouni et al. recently redefined the major and minor diagnostic criteria. Major criteria are lupus erythematosus, erythema multiforme-like lesions and speckled pattern of antinuclear antibody. Minor criteria are chilblains, positive anti-La (SS-B) or anti-Ro (SS-A) antibody and reactive rheumatoid factor. We report a case of a 63-year-old woman, with no previous history of lupus erythematosus, who developed erythema multiforme-like lesions and laboratory findings consistent with Rowell syndrome.

Delta-aminolevulinate dehydrase (ALAD) polymorphism in mixed Brazilians from the State of Bahia.

Electrophoretic polymorphism of delta-aminolevulinate dehydrase (ALAD) was studied on 519 individuals from Bahia, Brazil. Subjective assessment of Black ancestries carried out in a five point visual scale (White, Light Mulatto, Medium Mulatto, Dark Mulatto and Black) allowed to show that the ALAD*2 allele frequency decreases from 8% in Whites to 0% in Blacks. These findings agree with previous reports of ALAD in Africans, American Indians and Spanish. The powerful peculiarity of the ALAD system in assessing racial admixture is stressed.