Assessing surgical difficulty in locally advanced mid-low rectal cancer: the accuracy of two MRI-based predictive scores.

AIM: Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery. METHODS: This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L-TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC). RESULTS: In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage ≥ T3b and male sex. It demonstrated high accuracy (AROC 0.802). CONCLUSION: The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L-TME. However, this score has yet to be externally validated.

Spectroscopy and Theoretical Modeling of Phonon Vibration Modes and Band Gap Energy of Cu2ZnSn(S x Se1-x )4 Bulk Crystals and Thin Films.

Semiconductor Cu2ZnSn(S x Se1-x )4 (CZTSSe) solid solution is considered as a perspective absorber material for solar cells. However, during its synthesis or deposition, any modification in the resulting optical properties is hardly predicted. In this study, experimental and theoretical analyses of CZTSSe bulk crystals and thin films are presented based on Raman scattering and absorption spectroscopies together with compositional and morphological characterizations. CZTSSe bulk and thin films are studied upon a change in the x = S/(S + Se) aspect ratio. The morphological study is focused on surface visualization of the solid solutions, depending on x variation. It has been discovered for the first time that the surface of the bulk CZTSSe crystal with x = 0.35 has pyramid-like structures. The information obtained from the elemental analysis helps to consider the formation of a set of possible intrinsic lattice defects, including vacancies, self-interstitials, antisites, and defect complexes. Due to these results and the experimentally obtained values of the band gap within 1.0-1.37 eV, a deviation from the calculated band gap values is estimated in the range of 1.0-1.5 eV. It is suggested which defects can have an influence on such a band gap change. Also, on comparing the experimental Raman spectra of CZTSSe with the theoretical modeling results, an excellent agreement is obtained for the main Raman bands. The proposed theoretical approach allows to estimate the values of concentration of atoms (S or Se) for CZTSSe solid solution directly from the experimental Raman spectra. Thus, the visualization of morphology and the proposed theoretical approach at various x values will help for a deeper understanding of the CZTSSe structure to develop next-generation solar cells.

Sentinel node biopsy for high-risk cutaneous nonanogenital squamous cell carcinoma: a preliminary result.

BACKGROUND: Certain patients with squamous cell carcinoma (SCC) have much higher rates of regional nodal metastases than is often reported. This study aims to further validate sentinel lymph node biopsy (SNB) for SCC and the outcome of these patients following SNB. METHODS: 20 patients with high-risk nonanogenital SCC who underwent SNB between 1998 and 2007 were retrospectively reviewed. SNB was performed under local or general anesthesia following lymphoscintigraphy and blue dye injection. RESULTS: The median follow-up from SNB was 24 months. Tumor location included the head and neck (n = 11), extremities (n = 9) and trunk (n = 1). One patient had a positive sentinel node. This patient developed parotid metastases 13 months after refusing a complete neck dissection and is alive with progressive disease after 31 months. Two patients developed regional recurrence after negative SNB (1 is alive and disease free, the other died of progressive disease). Of the remaining patients, 15 are alive and disease free, 1 died of another malignancy and 1 was lost to follow-up. CONCLUSION: SNB for high-risk SCC is feasible and allows early detection and treatment of nodal metastases. Currently, SNB for SCC is not a standard treatment and requires further investigation to determine which patients would benefit best from this procedure.

Concordance of four commercial enzyme immunoassay and three immunoblot formats for the detection of Lyme borreliosis antibodies in human serum: the two-tier approach remains.

Serological tests show considerable variation in their ability to correctly diagnose Lyme borreliosis (LB). This study compared four commercially available screening enzyme immunoassays (EIA) for the detection of LB IgG using either whole cell lysate (WCL) antigens, purified proteins or recombinant antigens with the second-tier whole cell sonicate (WCS) western immunoblots or recombinant antigen line blots. A consensus between three EIA results from 222 patient sera was designated as a point of comparison for each method which gave 66 positive and 156 negative results. The positive predictive values (PPV) of WCL EIA were 40% for the MarDx Diagnostics Borrelia burgdorferi EIA 'combined' IgG and IgM (Trinity Biotech) and 55% for the EUROIMMUN plus VlsE IgG. These were significantly lower PPVs than that produced by the recombinant antigen-based EIA NovaLisa Borrelia burgdorferi IgG-ELISA (NovaTec Immunodiagnostica) and the EUROIMMUN Anti-Borrelia Select ELISA IgG (90% and 100%, respectively; p = 0.02). The WCS western immunoblot using B. burgdorferi and B. afzelii separately showed a high PPV of 91% but its positive agreement with consensus EIA result was only 65%. Another WCL western immunoblot with purified extracts of Osp C and VlsE, the Trinity Biotech EU Lyme + VlsE IgG Western Blot had a PPV of 92% while the recombinant line blot from EUROIMMUN, the Anti-Borrelia (IgG) EUROLINE-RN-AT, demonstrated a significantly reduced PPV of 70% with some non-specific reactions in sera containing antibodies to Leptospira species, Helicobacter pylori and Treponema pallidum. The use of recombinant antigens in EIA for LB IgG screening significantly improves the predictive values of serological results above those of WCL antigen EIA. Second tier WCS western immunoblots offer high PPVs, especially with added specific purified proteins, more so than in one recombinant line blot.

Carnitine supplementation in human idiopathic asthenospermia: clinical results.

On the basis of reported experimental and clinical studies we investigated the effectiveness of L-carnitine administration in a group of patients with idiopathic asthenospermia. A favourable effect of the compound on sperm motility and rapid linear progression has been shown in 37 out of 47 patients treated. In addition, the total number of sperms increased. L-carnitine was supplemented orally by a daily dosage of 3 g for three months.

[Intra-abdominal foreign bodies following laparotomy interventions: report of a case]. / Il problema dei corpi estranei endoaddominali dopo intervento laparotomico: considerazioni su un caso.

The authors report their own observation of a case of post-laparotomic endoabdominal foreign body, which for a long period had remained asymptomatic. Starting from the clinical case, they effect a short study of such iatrogenic pathology, and state the diagnostic and therapeutic criteria thereabout. They subsequently dissertate on the possible preventing means.

Lymphoscintigraphy in clinical routine practice: reproducibility and accuracy in melanoma patients with a long-term follow-up.

INTRODUCTION: The sentinel node status is the most important single factor determining overall survival for patients with localized melanoma. Preoperative lymphoscintigraphy (LS) is essential in locating the correct sentinel lymph node (SN) and the reproducibility of the method determines the accuracy of the sentinel node biopsy (SNB). This study aims at determining the reproducibility and accuracy of LS in routine clinical practice after long-term follow-up. PATIENTS AND METHODS: One hundred and eight melanoma patients with clinically unpredictable lymphatic drainage were prospectively enrolled to undergo two LS. The first LS was performed to determine the site and number of the lymphatic basins to plan SNB anesthesia and the second preoperative LS was to allow SN localization intra-operatively. RESULTS: Lymphatic drainage was demonstrated in all patients. In 84 of 108 cases, both LSs were concordant in terms of site and number of nodal basins visualized. After a median follow-up of 80 months, no nodal recurrence was observed in the five patients with a decreased number of lymph node basins. In the group with increased number of lymph node basins, one patient developed nodal metastases in the same regional lymph node basin visualized by both LS studies. CONCLUSION: LS is an accurate and reproducible method to determine the localization of the sentinel node in the day-to-day routine to clinical practice when primary melanoma is also located in body sites with variable lymphatic drainage.

Randomized controlled trials in pouchitis.

Pouchitis is the most common complication of Proctocolectomy with ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). The diagnosis of pouchitis requires the presence of symptoms, together with characteristic endoscopic and histological abnormalities. The exact cause of pouchitis is not known. Whereas 'acute' pouchitis can be treated rapidly and successfully in the majority of patients, "refractory" and 'chronic pouchitis' remain therapeutic challenges to patients and physicians. Metronidazole and Ciprofloxacin budesonide enemas and oral probiotic therapy with VSL#3 all appear to be effective therapies for acute and/or chronic pouchitis. The medical therapy of pouchitis remains largely empiric, and additional multicenter, randomized, double-blind, placebo-con- trolled, dose-ranging trials are needed. In future trials, treatment indications such as active acute or chronic pouchitis and maintenance of remission for acute or chronic pouchitis should be clearly defined.

Withanolide composition and in vitro culture of Italian Withania somnifera.

From Italian plants of Withania somnifera six withanolides were isolated, whose structures allowed us to assign the Italian race of W. somnifera to the Israel chemotype III. In vitro cultures of Italian W. somnifera under different conditions were obtained, as well as infection by agrobacterium rhizogenes. HPLC analysis of IN vitro derived tissues showed low contents of withanolides.

Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease.

OBJECTIVE: To ascertain whether oral propionyl-l-carnitine combined with intraplaque verapamil is a useful therapy for advanced or resistant Peyronie's disease. PATIENTS AND METHODS: The combined drugs were assessed in two studies. In the first, 60 patients with advanced Peyronie's disease, diagnosed using accepted definitions, were randomized in two subgroups treated with verapamil intraplaque infiltration (10 mg weekly for 10 weeks) plus a 3-month administration of propionyl-l-carnitine (2 g/day), or verapamil infiltration plus oral tamoxifen (40 mg/day) for 3 months. In the second study, 15 patients with resistant Peyronie's disease (progression despite previous therapy) received verapamil plus propionyl-l-carnitine. The differences between subgroups or between the variables before and after therapy were compared using analysis of variance or the chi-squared test. RESULTS: In the first study, the reduction in pain was the same in both subgroups. Propionyl-l-carnitine plus verapamil significantly reduced penile curvature, plaque size, cavernosal artery end-diastolic velocity, the need for surgery and disease progression, and increased the International Index of Erectile Function score and resistivity index of the cavernosal arteries. Tamoxifen plus verapamil had none of these effects. No drug combination affected the peak systolic velocity. Patients receiving verapamil had no side-effects but those taking tamoxifen did. In the second study propionyl-l-carnitine and verapamil modified the disease patterns as in the first and no patient had side-effects. CONCLUSION: The combination of propionyl-l-carnitine and verapamil can be considered the therapy of choice for advanced and resistant Peyronie's disease.

[Persistent bradycardia and apnea due to hypothyroidism in a very low-weight newborn infant]. / Bradicardia persistente e apnea da ipotiroidismo in un neonato di peso molto basso.

Alterations in thyroid function are quite heterogeneous in VLBW preterm neonates. The case of a 1160-g newborn is reported, affected by severe RDS and persistent bradycardia during the first week of life, who later developed symptoms and signs of low-output cardiac failure. ECG showed low QRS. Echocardiography revealed small pericardial effusion. Therapy with L-thyroxine led to rapid improvement of clinical conditions and to normalization of ECG and echocardiographic pattern. Levels of thyroid hormones should be monitored in VLBW infants, since their deficiency may play a role in compromised clinical conditions.

[Cardiac rhabdomyoma in tuberous sclerosis. A report of five cases and review of the literature]. / Il rabdomioma cardiaco nella sclerosi tuberosa. Descrizione di cinque casi e revisione della letteratura.

Five children with tuberous sclerosis (TS), a polysystemic disease, had cardiac tumors detected by B-mode echocardiography. In a fetus, sonography performed at the eighth month showed the presence of a cardiac mass and of polycystic kidneys: the diagnosis of TS was confirmed postnatally because of the presence of calcified cerebral nodules. A newborn dichorial twin had paroxysmal tachycardia at ten days. B-mode echocardiography showed the presence of seven intracardiac tumors, and cerebral CT the presence of multifocal periventricular calcifications. An absence in a nine month old baby prompted an electrocardiogram that proved abnormal; a B-mode echocardiography showed large apical cardiac tumor; again cerebral CT showed periventricular calcified nodules. Two girls, 9 and 10 y.o. respectively, affected by TS, with normal electrocardiograms, both presented a small, asymptomatic, intracardiac mass demonstrated sonographically. In recent years, prenatal sonography and B-mode echocardiography in patients with TS demonstrated with increasing frequency the association of cardiac tumors (rhabdomyomas) with TS. Tumor detection often precedes the appearance of the cutaneous and neurological signs typical of the disease. This paper emphasizes the role of echocardiography in detecting cardiac tumors, as an early sign for the diagnosis of tuberous sclerosis, and to depict the natural history of cardiac rhabdomyoma with its variable clinical presentation and prognosis.

[Quantitative aspects of ciliary apparatus motility of fungiform papillae]. / Aspetti quantitativi della motilità dell'apparato ciliare delle papille fungiformi.

The present research is intended to evaluate the frequency of the ciliary beat in different formations of the frog's oral cavity. The phenomenon has been quantitatively evaluated on the television images of mucus-ciliary waves by means of a photometric method, in order to obtain an electrical indication of the beat frequency. The results show that frequency of the ciliary beat is not uniform in all formations examinated. Differences in the beat frequency were evidenced in the single coronae ciliatae, further the frequencies of the beat decreases sistematically from the base to the tip of the tongue. The cilia on the lingual edge and on the palat exhibit a similar behaviour. The uniformity of the ciliary behaviour in the whole oral cavity is stressed and the factors contributing to a particular ciliary frequency in the fungiform papillae are discussed.