Outcomes with multimodal therapy for elderly patients with rectal cancer.

BACKGROUND: Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older). METHODS: This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan-Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival. RESULTS: A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60-month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98). CONCLUSION: A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.

Production of acute pulmonary injury by leukocytes and activated complement.

The adult respiratory distress syndrome (ARDS) frequently occurs after sepsis and major trauma. Since both sepsis and trauma may cause activation of the complement system, we have infused rabbits with complement-activated plasma (AP) and have studied the effects on leukocyte counts, respiratory rate, PaO2, and lung morphology. Sustained AP infusion caused: (1) early granulocytopenia, (2) progressive hypoxemia and tachypnea, and (3) pulmonary vascular plugging by aggregates of degenerating granulocytes with interstital edema and endothelial injury. These changes were not observed in control animals infused with unactivated plasma or in animals rendered leukopenic with nitrogen mustard. Complement activation in patients with sepsis and trauma may be an etiologic factor in the development of ARDS.

Obligate methylotrophy: evaluation of dimethyl ether as a C1 compound.

The suitability of dimethyl ether as a C1 compound was examined with the obligate methylobacterium Methylococcus capsulatus (Texas). The ether did not support growth and was not formed during growth on methane; it was an inhibitor of growth and oxidation of methane and a poor oxidation substrate for cell suspensions. NADH stimulation of methane, but not dimethyl ether, oxidation occurred in cell extracts.

Analgesic nephropathy.

Sixty-six patients were seen from January 1963 to December 1970 in whom a diagnosis of analgesic nephropathy was made. The ratio of women to men was 2.7:1 and women presented at an earlier age. Over 60% of patients had or developed urinary tract infection and over one-third presented with serum urea levels over 300 mg/100 ml. Hypertension was present in 60% of patients and almost 20% had a history of peptic ulcer; hysterectomy had been done in 35% of the women. Most patients improved initially but more than half of those followed up died within five years of presentation. A direct relation was found between prognosis and the degree of functional renal impairment at presentation. Hypertension appeared to have an adverse effect on prognosis but no relation of prognosis to papillary necrosis, infection, or surgical procedures was found.

Quantification of Hyphomicrobium populations in activated sludge from an industrial wastewater treatment system as determined by 16S rRNA analysis.

The bacterial community structure of the activated sludge from a 25 million-gal-per-day industrial wastewater treatment plant was investigated using rRNA analysis. 16S ribosomal DNA (rDNA) libraries were created from three sludge samples taken on different dates. Partial rRNA gene sequences were obtained for 46 rDNA clones, and nearly complete 16S rRNA sequences were obtained for 18 clones. Seventeen of these clones were members of the beta subdivision, and their sequences showed high homology to sequences of known bacterial species as well as published 16S rDNA sequences from other activated sludge sources. Sixteen clones belonged to the alpha subdivision, 7 of which showed similarity to Hyphomicrobium species. This cluster was chosen for further studies due to earlier work on Hyphomicrobium sp. strain M3 isolated from this treatment plant. A nearly full-length 16S rDNA sequence was obtained from Hyphomicrobium sp. strain M3. Phylogenetic analysis revealed that Hyphomicrobium sp. strain M3 was 99% similar to Hyphomicrobium denitrificans DSM 1869(T) in Hyphomicrobium cluster II. Three of the cloned sequences from the activated sludge samples also grouped with those of Hyphomicrobium cluster II, with a 96% sequence similarity to that of Hyphomicrobium sp. strain M3. The other four cloned sequences from the activated sludge sample were more closely related to those of the Hyphomicrobium cluster I organisms (95 to 97% similarity). Whole-cell fluorescence hybridization of microorganisms in the activated sludge with genus-specific Hyphomicrobium probe S-G-Hypho-1241-a-A-19 enhanced the visualization of Hyphomicrobium and revealed that Hyphomicrobium appears to be abundant both on the outside of flocs and within the floc structure. Dot blot hybridization of activated sludge samples from 1995 with probes designed for Hyphomicrobium cluster I and Hyphomicrobium cluster II indicated that Hyphomicrobium cluster II-positive 16S rRNA dominated over Hyphomicrobium cluster I-positive 16S rRNA by 3- to 12-fold. Hyphomicrobium 16S rRNA comprised approximately 5% of the 16S rRNA in the activated sludge.