In vivo molecular imaging of HER2 expression in a rat model of Barrett's esophagus adenocarcinoma.

Human epidermal growth factor receptor 2 (HER2) is involved in the malignant progression of several human cancers, including esophageal adenocarcinoma (EAC). The purpose of this study was to evaluate HER2 overexpression and to explore the feasibility of confocal laser endomicroscopy for in vivo molecular imaging of HER2 status in an animal model of Barrett's-related EAC. Rats underwent esophagojejunostomy with gastric preservation. At 30 weeks post-surgery, the esophagus of 46 rats was studied; endoscopic and histological findings were correlated with HER2 immunofluorescence on excised biopsies and gross specimens. At this age, 23/46 rats developed Barrett's esophagus (BE), and 6/46 had cancer (four EAC and two squamous cell carcinomas). A significant overexpression of HER2 was observed in esophageal adenocarcinoma compared with normal squamous esophagus (9.4-fold) and BE (6.0-fold). AKT and its phosphorylated form were also overexpressed in cancer areas. Molecular imaging was performed at 80 weeks post-surgery in four rats after tail injection of fluorescent-labeled anti-HER2 antibody. At this age, 3/4 rats developed advance adenocarcinoma and showed in vivo overexpression of HER2 by molecular confocal laser endomicroscopy with heterogeneous distribution within cancer; no HER2 signal was observed in normal or Barrett's tissues. Therefore, HER2 overexpression is a typical feature of the surgical induced model of EAC that can be easily quantified in vivo using an innovative mini-invasive approach including confocal endomicroscopy; this approach may avoid limits of histological evaluation of HER2 status on 'blinded' biopsies.

Epidemiology and survival rate of out-of-hospital cardiac arrest in north-east Italy: The F.A.C.S. study. Friuli Venezia Giulia Cardiac Arrest Cooperative Study.

The results of the first epidemiological, prospective, multicentric study on cardiac arrest in a geographical Italian region are reported. On 708 consecutive cardiac arrests, 438 underwent cardiopulmonary resuscitation (CPR). Of these, 344 were identified of cardiac aetiology. The underlying initial rhythm was: 166 asystole (48.3%), 104 ventricular fibrillation (30.2%), 74 pulseless electrical activity (21.5%). The best outcome occurred in patients whose cardiac arrest was witnessed by the EMS (49% return of spontaneous circulation (ROSC), 21% hospital discharge). When cardiac arrest was witnessed by lay people, 20.5% had ROSC and 4.4% were discharged alive from the hospital. When it was unwitnessed ROSC and hospital discharge were 8.6 and 1.7%, respectively. Ventricular fibrillation was highly predictive of outcome. Both ROSC and hospital discharge correlated inversely with the delay of the first defibrillation. Overall, the highest probability of survival was achieved when CPR interventions were started within the first minutes after collapse. Basic Life Support (BLS) manoeuvres began after 9 min of untreated cardiac arrest were still followed by a ROSC, but none of these patients survived. The incidence of prehospital cardiac arrest in our population was estimated to be in proportion of 0.95/1000 per year with a survival rate of 6.7%.