Prognostic factors in patients with uterine sarcoma: the SARCUT study.

OBJECTIVE: Uterine sarcomas are a rare and heterogeneous group of malignancies that include different histological sub-types. The aim of this study was to identify and evaluate the impact of the different prognostic factors on overall survival and disease-free survival of patients with uterine sarcoma. METHODS: This international multicenter retrospective study included 683 patients diagnosed with uterine sarcoma at 46 different institutions between January 2001 and December 2007. RESULTS: The 5-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma, and adenosarcoma was 65.3%, 78.3%, 52.4%, and 89.5%, respectively, and the 5-year disease-free survival was 54.3%, 68.1%, 40.3%, and 85.3%, respectively. The 10-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma and adenosarcoma was 52.6%, 64.8%, 52.4%, and 79.5%, respectively, and the 10-year disease-free survival was 44.7%, 53.3%, 40.3%, and 77.5%, respectively. The most significant factor associated with overall survival in all types of sarcoma except for adenosarcoma was the presence of residual disease after primary treatment. In adenosarcoma, disease stage at diagnosis was the most important factor (hazard ratio 17.7; 95% CI 2.86 to 109.93). CONCLUSION: Incomplete cytoreduction, tumor persistence, advanced stage, extra-uterine and tumor margin involvement, and the presence of necrosis were relevant prognostic factors significantly affecting overall survival in uterine sarcoma. The presence of lymph vascular space involvement and administration of adjuvant chemotherapy were significantly associated with a higher risk of relapse.

[Recognition of excretory/secretory antigens of Anisakis type I and evolution of IgE in experimentally infected rats]. / Reconocimiento de los antígenos excretores/secretores de Anisakis tipo I y evolución de la IgE en ratas infectadas experimentalmente.

INTRODUCTION: Anisakis spp., during parasitism, release excretory-secretory antigens that, in contact with the human immune system, can trigger a hypersensitivity response mediated by IgE, causing various allergic symptoms. OBJECTIVES: To evaluate the IgE response in Wistar rats after infection with L3 larvae of the parasite Anisakis spp. METHODS: Some determining factors involved in the technique have been improved in this work, such as: the concentration of polyacrylamide used in the preparation of the gels, the antigen concentration used, and the temperature required for denaturation of proteins. RESULTS: Immune responses (Ag-Ab) observed by the immunoblotting technique showed a greater intensity with serum obtained after reinfection, which have recognized proteins that may correspond to the major antigen Ani s 1 and other polypeptides of interest in the diagnosis of human anisakiasis. CONCLUSION: This paper concludes that immunoblotting is a useful technique to detect IgE antibodies against Anisakis proteins.

Fast detection of Vibrio species potentially pathogenic for mollusc.

Vibrio tasmaniensis, Vibrio splendidus and Vibrio neptunius species were distributed worldwide and associated with aquaculture and have been reported as the cause of diseases in aquatic organisms. Polyphasic analyses for bacterial identification are not feasible for routine diagnostic because of the time involved. The aim of this study is to design three PCR primer sets that can assist with fast detection of these species. They were designed from the 16S ribosomal RNA gene, and PCR conditions were found. Each PCR test successfully identified all the tested strains of each target species. The combined specificity of V. tasmaniensis and V. splendidus primer sets offered the best coverage (86%) in terms of separating target organisms from other related species. The primer set of V. tasmaniensis showed a lower sensitivity limit (500 fg of DNA) than the V. splendidus set (1 pg) and both sets gave positive amplification using homogenized tissues from inoculated clams, with 10(2) and 10(4) cfu/g of clam, respectively. The primer set of V. neptunius was highly specific, showing only cross-reaction with V. parahaemolyticus species from 44 tested species. Its sensitivity limit was 100 pg of DNA. A small number of biochemical tests were proposed concurrently with the PCR to differentiate the cross-reacting bacteria. The time of detection of the three tested species was reduced and the further affected animals can be diagnosed in a rapid fraction of time. The detection of virulent strains of V. tasmaniensis pointed to the risk of mollusc culture outbreaks.

New chemotherapy treatments in advanced cancer patients: an easily applicable evaluation of clinical efficacy and cost-effectiveness.

Novel cytostatic drugs have recently been introduced to treat advanced cancer patients. Although of only modest efficacy, their use is widespread, considerably increasing treatment costs. An easily applicable method to assess their efficacy and cost-effectiveness is needed. We have documented new cytostatic drugs whose consumption increased by over 60% from January 1998 to December 2000 in patients with advanced or metastatic cancer of the colorectum, lung (non-small cell), breast, ovary or brain. A review of the literature yielded 17 treatments that included these agents. For each regimen, we recorded six efficacy variables [median survival time (MS), survival rate at 1 year, absolute risk reduction, time to progression, quality of life (QoL), and patients needed to treat (NNT)]. A four-point (A-D) efficacy (E) scale and a five-point (1-5) strength of evidence (SE) scale were applied. We obtained the cost differential of each regimen for a 4-week treatment, cost per extra month of MS. and cost per NNT. One combination was rated with A efficacy (MS > 9 months+improved QoL) and nine with D (no MS or QoL improvement); 12 studies presented good quality (grade 1-2) evidence. The QoL of patients was significantly improved in only two regimens. The average cost differential was 1 311 Euro (all new regimens except one showed higher cost); the average cost per extra month of MS was 6 415 Euro; and treatment cost per NNT was 87 767 Euro. Our method proved to be easy to apply, enabled comparisons with other treatments to be made and revealed that these very costly changes in clinical practice are not justified by available studies.