Extended intraoperative peritoneal lavage as prophylactic peritoneal recurrence for locally advanced gastric cancer: a prospective randomized trial

Background To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal cytology, compared to standard peritoneal lavage (SPL). Methods A prospective randomised multicenter study including 94 patients (47 per arm) to detect a 20% difference in 3-year overall survival in patients with locally advanced tumours without peritoneal carcinomatosis. Three samples of peritoneal fluid were obtained (at the beginning, the end of procedure and after the assigned peritoneal lavage). Clinicopathological and surgical data were analysed by group. Postoperative complications, location of recurrence and surgical approach were evaluated. Overall survival was calculated by the Kaplan–Meier method and the uni/multivariate analysis for prognostic factors was carried out using Cox regression analysis. Results A total of 86 patients were analysed (4 excluded per group). No statistical differences were observed in clinicopathological or surgical data between groups, considering both groups well-balanced for analysis. Overall survival at 3 years was 64.3% for SPL vs. 62.3% for EIPL (p 0.421). Only three patients had at least one positive peritoneal cytology (1:2). There were no differences regarding postoperative complications (SPL: 37.2% vs. EIPL: 32.5%, p 0.65) or between location of recurrence and number of recurrences. The number of recurrences did not differ between surgical approaches, but locoregional and peritoneal recurrences were fewer with the laparoscopic approach (p 0.048). Conclusions The regular use of extensive peritoneal lavage in patients with locally advanced gastric cancer, regardless of peritoneal cytology, has not been effective as prophylaxis of peritoneal recurrence or better survival (AU)

Extended intraoperative peritoneal lavage as prophylactic peritoneal recurrence for locally advanced gastric cancer: a prospective randomized trial.

BACKGROUND: To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal cytology, compared to standard peritoneal lavage (SPL). METHODS: A prospective randomised multicenter study including 94 patients (47 per arm) to detect a 20% difference in 3-year overall survival in patients with locally advanced tumours without peritoneal carcinomatosis. Three samples of peritoneal fluid were obtained (at the beginning, the end of procedure and after the assigned peritoneal lavage). Clinicopathological and surgical data were analysed by group. Postoperative complications, location of recurrence and surgical approach were evaluated. Overall survival was calculated by the Kaplan-Meier method and the uni/multivariate analysis for prognostic factors was carried out using Cox regression analysis. RESULTS: A total of 86 patients were analysed (4 excluded per group). No statistical differences were observed in clinicopathological or surgical data between groups, considering both groups well-balanced for analysis. Overall survival at 3 years was 64.3% for SPL vs. 62.3% for EIPL (p 0.421). Only three patients had at least one positive peritoneal cytology (1:2). There were no differences regarding postoperative complications (SPL: 37.2% vs. EIPL: 32.5%, p 0.65) or between location of recurrence and number of recurrences. The number of recurrences did not differ between surgical approaches, but locoregional and peritoneal recurrences were fewer with the laparoscopic approach (p 0.048). CONCLUSIONS: The regular use of extensive peritoneal lavage in patients with locally advanced gastric cancer, regardless of peritoneal cytology, has not been effective as prophylaxis of peritoneal recurrence or better survival.

A multi-gene panel study in hereditary breast and ovarian cancer in Colombia.

Germline mutations in BRCA1 and BRCA2 account for approximately 50% of inherited breast and ovarian cancers. Three founder mutations in BRCA1/2 have been reported in Colombia, but the pattern of mutations in other cancer susceptibility genes is unknown. This study describes the frequency and type of germline mutations in hereditary breast and/or ovarian cancer genes in a referral cancer center in Colombia. Eighty-five women referred to the oncogenetics unit of the Instituto de Cancerologia Las Americas in Medellin (Colombia), meeting testing criteria for hereditary breast and ovarian cancer syndrome (NCCN 2015), who had germline testing with a commercial 25-gene hereditary cancer panel, were included in the analysis. Nineteen patients (22.4%) carried a deleterious germline mutation in a cancer susceptibility gene: BRCA1 (7), BRCA2 (8), PALB2 (1), ATM (1), MSH2 (1) and PMS2 (1). The frequency of mutations in BRCA1/2 was 17.6%. One BRCA2 mutation (c.9246dupG) was recurrent in five non-related individuals and is not previously reported in the country. Seventeen mutation-carriers had a diagnosis of breast cancer (median age of diagnosis of 36 years) and two of ovarian cancer. All BRCA1 mutation-carriers with breast cancer had triple negative tumors (median age of diagnosis of 31 years). Variants of unknown significance were reported in 35% of test results. This is the first report of a multi-gene study for hereditary breast and/or ovarian cancer in a Latin American country. We found a high frequency and a wide spectrum of germline mutations in cancer susceptibility genes in Colombian patients, some of which were not previously reported in the country. We observed a very low frequency of known Colombian founder BRCA1/2 mutations (1.2%) and we found mutations in other genes such as PALB2, ATM, MSH2 and PMS2. Our results highlight the importance of performing multi-gene panel testing, including comprehensive BRCA1/2 analysis (full gene sequencing and large rearrangement analysis), in high-risk breast and/or ovarian cancer patients in Colombia.

The Use of an Automated System (GreenFeed) to Monitor Enteric Methane and Carbon Dioxide Emissions from Ruminant Animals.

Ruminant animals (domesticated or wild) emit methane (CH4) through enteric fermentation in their digestive tract and from decomposition of manure during storage. These processes are the major sources of greenhouse gas (GHG) emissions from animal production systems. Techniques for measuring enteric CH4 vary from direct measurements (respiration chambers, which are highly accurate, but with limited applicability) to various indirect methods (sniffers, laser technology, which are practical, but with variable accuracy). The sulfur hexafluoride (SF6) tracer gas method is commonly used to measure enteric CH4 production by animal scientists and more recently, application of an Automated Head-Chamber System (AHCS) (GreenFeed, C-Lock, Inc., Rapid City, SD), which is the focus of this experiment, has been growing. AHCS is an automated system to monitor CH4 and carbon dioxide (CO2) mass fluxes from the breath of ruminant animals. In a typical AHCS operation, small quantities of baiting feed are dispensed to individual animals to lure them to AHCS multiple times daily. As the animal visits AHCS, a fan system pulls air past the animal's muzzle into an intake manifold, and through an air collection pipe where continuous airflow rates are measured. A sub-sample of air is pumped out of the pipe into non-dispersive infra-red sensors for continuous measurement of CH4 and CO2 concentrations. Field comparisons of AHCS to respiration chambers or SF6 have demonstrated that AHCS produces repeatable and accurate CH4 emission results, provided that animal visits to AHCS are sufficient so emission estimates are representative of the diurnal rhythm of rumen gas production. Here, we demonstrate the use of AHCS to measure CO2 and CH4 fluxes from dairy cows given a control diet or a diet supplemented with technical-grade cashew nut shell liquid.

Effect of surface structure of kaolinite on aggregation, settling rate, and bed density.

The flocculation and solid/liquid separation of four well-characterized kaolinites (2 well, 2 poorly crystallized) have been studied for comparison of surface structure (SEM), aggregate structure during flocculation (cryo-SEM), settling rate, and bed density (with raking). It is shown that major differences in these properties are largely due to crystallinity and consequent surface structure of the extensive (larger dimension "basal") face. Well-crystallized kaolinites, with higher Hinckley indices and lower aspect ratios, have relatively smooth, flat basal surfaces and thicker edge planes promoting both effective initial bridging flocculation (largely edge-edge) and structural rearrangement to face-face during the raking process. This results in faster settling rates and more compact bed structures. Poorly crystallized kaolinites, with low Hinckley indices and high aspect ratios, exhibit ragged, stepped structures of the extensive face with a high proportion of nanosized islands forming cascade-like steps (i.e., multiple edges) contributing up to 30% of the specific surface area and providing flocculant adsorption sites (hydroxyl groups) across this extensive face. This leads to bridging flocculation taking place on both edge and extensive ("basal") planes, producing low-density edge-face structures during flocculation which leads to slow settling rates and poor bed densities. In particular, the complex surface morphology of the poorly crystallized kaolinites resists the transformation of edge-face structures to dense face-face structures under shear force introduced by raking. This results in low sediment density for poorly crystallized kaolinites. The studies suggest that the main influence on settling rates and bed densities of kaolinites in mineral tailings is likely to be related to the crystallinity and surface morphology of the kaolinite. They also suggest that interpretation of kaolinite behavior based on models of a flat (001) basal plane and edge sites only at the particle boundaries is not likely to be adequate for many real, less-crystallized kaolinites.

Observation of gaseous films at solid-liquid interfaces: removal by ultrasonic action.

The critical role of dissolved gas nano-bubbles at solid surfaces in particle association, aggregation, adsorption and flotation has been recognised in the recent literature. The principles of mineral processing, fine particle separation, and water recovery depend upon changing the surface properties at the solid-liquid interface. It has been assumed that the solid surfaces are either in direct contact with the liquid or may have nano-bubbles attached only at hydrophobic surfaces. This paper shows that gaseous layers 50-100 nm thick can be attached surrounding high proportions of solid clay mineral surfaces restricting reagent access, producing buoyancy and aggregation. Ultrasonic treatment before flocculant addition effectively removes these gaseous layers as well as dispersed micro-bubbles. Re-aggregation after brief ultrasonication produces denser (less buoyant) flocs, demonstrated with cryo-SEM statistical analysis, giving more complete access of the flocculant to the aggregate surfaces. In the subsequent flocculant addition, the settling rates of the denser flocs can be increased up to 40%. If ultrasonic action is continued, the bridged flocs are disturbed with some redispersion of smaller flocs and individual platelets and consequent slower settling rates.

Insuficiencia de la identificación psicopatológica en un caso de esquizofrenia no procesual / Insufficiency of psychopathological identification in a case on non-processual schizophrenia

Se presenta un caso clínico de esquizofrenia no procesual y primariamente no productiva, pero cuyo desarrollo evolutivo y manifestaciones sintomáticas de alteraciones de la vivencia del «yo» resultan prototípicas del cuadro que representan, a pesar de lo cual el caso permaneció sin diagnóstico a lo largo de toda una década de observación. A través de la exposición de la paciente se ejemplifica cómo la práctica clínica disocia la teoría de la experiencia del enfermo. La consiguiente discusión, elaborada desde la historia conceptual y del self en la esquizofrenia, sugiere que los fenómenos subjetivos que se manifiestan en estos enfermos no son abarcables a través de los criterios operativos vigentes en la psiquiatría, pero tampoco desde un criterio unificador en torno a un enfoque nuclear exclusivo que pretenda dar cuenta de la causa última. Todo ello remite hacia la insuficiencia de la psicopatología como mera semiología y la necesidad de una práctica psicopatológica capaz de poner en activo los rendimientos de la teoría (AU)

A case of non-processual and primarily non-productive schizophrenia is presented. However, its evolutive development and clinical manifestations of «self» experiences alterations are prototypic of the picture they represent. Nevertheless, this case was not diagnosed during more than one decade of observation. The presentation of this patient's case history shows how clinical praxis dissociates the theory of schizophrenia from the patient's experience. The discussion elaborated from the conceptual history and the self in schizophrenia suggests that the subjective phenomena manifested in these patients cannot be approached by the present applicable operatives criteria in psychiatry nor from a unifying criterion based on an exclusive nuclear approach that aims to explain the final cause. All of this refers to the insufficiency of psychopathology as mere semiology and raises the need for a psychopathological praxis that can implement the results of the theory (AU)

Bubble-solid interactions in water and electrolyte solutions.

Surface forces between an air bubble and a flat mica surface immersed in aqueous electrolyte solutions have been investigated using a modified surface force apparatus. An analysis of the deformation of the air bubble with respect to the mutual position of the bubble and the mica surface, the capillary pressure, and the disjoining pressure allows the air-liquid surface electrical potential to be determined. The experiments show that a long-range, double-layer repulsion acts between the mica (which is negatively charged) and an air bubble in water and in various electrolyte solutions at low concentration, thereby indicating that the air bubble surface is negatively charged. However, there is clear evidence that charge regulation occurs at the air-water interface to maintain a constant surface potential, and as a result of this, the charge at this interface changes from negative to positive as the bubble approaches the mica surface. Because of the attraction that arises as a result of the charge reversal, a finite force is required to separate the bubble from the mica, though the mica remains wetted by the aqueous phase. At the low concentrations investigated, the potential on the gas-liquid interface is independent of the electrolyte type within experimental uncertainty.

Identification of interleukin-13 receptor alpha2 chain overexpression in situ in high-grade diffusely infiltrative pediatric brainstem glioma.

Human malignant glioma cell lines and adult brain tumors overexpress high levels of interleukin-13 receptor alpha2 chain (IL-13Ralpha2). Because the IL-13Ralpha2 chain is an important target for cancer therapy and prognosis for patients with brainstem glioma (BSG) remains dismal, we investigated the expression of this receptor in specimens of diffusely infiltrative pediatric BSG relative to normal brain tissue. Twenty-eight BSG specimens and 15 normal brain specimens were investigated for IL-13Ralpha2 protein expression by immunohistochemical analysis (IHC) using two different antibodies in two different laboratories. Highly sensitive Q-dot-based IHC and in situ hybridization (ISH) assays were also developed to identify IL-13Ralpha2 protein and RNA in these specimens. The results were evaluated independently in two laboratories in a blinded fashion. By Q-dot IHC or a standard IHC assay, 17 of 28 (61%) tumor specimens showed modest to strong staining for IL-13Ralpha2, while 15 normal brain tissue samples showed weak expression for IL-13Ralpha2 protein. Significant interrater agreement between the two laboratories was seen in the assessment of IL-13Ralpha2 intensity. High-level IL-13Ralpha2 RNA expression was detected in tumor samples by Q-dot ISH, but only weak RNA expression was observed in normal brain. Significant agreement between ISH and IHC assays was observed (simple kappa [kappa] estimate=0.358, weighted kappa=0.89, p=0.001). IL-13Ralpha2 protein and mRNA are expressed to significantly higher levels in BSG than in normal brain tissue. Both IHC and ISH represent robust methods to detect expression of the IL-13Ralpha2 receptor in BSG that could represent an important new drug target for treatment of this disease.

Hipercolesterolemia en la infancia y la adolescencia / Hypercholesterolemia during childhood and adolescence

La enfermedad cardiovascular continúa siendo la primera causa de morbimortalidad en los países industrializados en la edad adulta, pero de los datos disponibles podemos afirmar que las alteraciones iniciales, poco evidentes pero con gran significado futuro, se inician en la mayoría de las personas durante la infancia. El objeto de este trabajo es una puesta al día de esta epidemia, contemplando inicialmente el metabolismo complejo del colesterol, la evaluación del riesgo futuro y las medidas que deben adoptarse, tanto desde un punto de vista preventivo como de enfoque de esta situación, así como de los tratamientos farmacológicos de que disponemos, sus indicaciones y sus riesgos, que no deben ser minusvalorados. Las medidas preventivas que se pueden aconsejar en la población pediátrica sin factores de riesgo no son fáciles de tomar y, hasta que no se disponga de un marcador biológico, el problema continuará sin resolverse. Distinto es el problema cuando se conocen los factores de riesgo por la historia familiar, en cuyo caso, además de medidas dietéticas y ejercicio regular, puede ser aconsejable el uso de estatinas, pero sin olvidar sus riesgos potenciales y la experiencia escasa que existe todavía al respecto(AU)

Cardiovascular disease continues to be the leading cause of morbidity and mortality among adults in the industrialized countries, but the available information indicates that the initial changes, which are barely evident but are of great significance for the future, begin to take place in the majority of individuals during childhood. The objective of this work is to provide an update on this epidemic, first taking into account the complexity of cholesterol metabolism, the evaluation of future risk and the measures to be taken, both from a preventive point of view, and as an approach to this situation and to the pharmacological treatments available to us, as well as the indications and risks, which should not be underestimated. The preventive measures that can be recommended in the pediatric population with no risk factors are not easy to take, and until we discover a biological marker, the problem will remain unsolved. The problem changes when the family history reveals the existence of risk factors. In this case, in addition to dietary measures and regular exercise, the use of statins or other drugs might be advisable, without overlooking the potential risks and the still limited experience available(AU)

Patrón de apoptosis de células blancas de sangre de cordón umbilical (CBSCU) en cultivos in vitro producido por la carbamacepina, Metotrexate y Acido Fólico / Pattern of apoptosis of white cells of blood of umbilical cord (CBSCU) in cultivations in vitro taken place by the carbamacepina, Metotrexate and Folic Acid

Se evaluó el patrón de apoptosis de células blancas de sangre de cordón umbilical producido por la carbamecepina y metotrexate de potencial teratógénico conocido y ácido fólico con efecto protector de defectos de tubo neural, en cultivos in vitro. Se empleó un diseño completamente al azar con 9 repeticiones, el cual responde a un modelo lineal aditivo. Se estudió la acción protectora de ácido fólico en presencia de MTX y CBZ en cultivos in vitro de células blancas de cordón umbilical. Se demopstró que el anticonvulsivante CBZ y el agente anti-inflamatorio MTX inducen apoptosis a 100uM y 50uM respectivamente (dosis terapéutica). En este estudio se encontró que la presencia de ACF (o,1 - 10uM) protege a las células blancas de cordón umbilical contra la inducción de la apoptosis producida por la CBZ y MXT. Por el contrario el ACF no suprime la muerte celular debida al tiempo de cultivo. Entonces el ACF tiene un efecto robusto de protección contra la apoptosis en células blancas de cordón umbilical, esta propiedad provee una nueva vía para el estudio de los mecanismos moleculares y celulares de esta vitamina. Los datos reportados en este estudio son los primeros resultados generados sobre el efecto del MTX, CBZ y ACF y co-cultivos CBZ + ACF, MTX +ACF en cultivos de células blancas de sangre de cordón umbilical humano, demostándose que esta metodología in vitro es capaz de detectar el efecto de agentes protectores y teratogénicos justificándose estudios posteriores de validación de la técnica y evaluación de otros medicamentos para su aplicación.

[Impact of acid mining drainage on the quality of superficial waters and sediments in the Marrakesh region, Morocco]. / Impact du drainage acide minier sur la qualite des eaux de surface et des sediments dans la region de Marrakech, Maroc.

The aim of the present study is the evaluation of the effects of the acid drainage of three abandoned mining sites: SB-Othmane, Kettara and Draâ-sfar, on water and sediment quality of the Tensift River and its two temporary tributaries, the Kettara and El-Coudia Oueds. These mining sites located near Marrakesh contain mining residues abandoned for ten to twenty years. They are presently in an agricultural region of the Haouz district. In each site, these uncontrolled mining residues present a high level of metallic sulphide and generate, during rainy periods, leaching products which have physical and chemical characteristics of acid mine drainage (AMD). These percolates display an acidic pH ranging from 2.5 to 5.2, a high electric conductivity, large amounts of sulphate and heavy metals, especially under dissolved form (e.g. Cd: 17.34 mg l(-1); Fe: 1734 mg l(-1); Zn: 3935 mg l(-1)). Except for Pb, the free ionic form is the most abundant metallic form, as showed by calculations using the speciation GEOCHEM program. The analysis of water and sediments of the surrounding superficial aquatic ecosystems shows a modification of water chemical facies and an enrichment in heavy metals, mainly under the solid phase for Fe, Pb, Cu, Co, Cr and Ni, and under dissolved fraction for Cd and Zn. The dissolved fraction of these metals is dominated by the free ionic form, considered as available for organisms. Furthermore, sediments contain important quantities of heavy metals (Pb: 1450 microg g(-1), Zn: 1562 microg g(-1)) with an available fraction which is higher than 40% for the Cd and Zn. The abundance of trace elements (free ionic and available forms) in water and sediment presents a durable risk of their transfer to food chains.

[Study of the effect of earthworm Lumbricus terrestris on the speciation of heavy metals in soils]. / Etude de l'effet du ver de terre Lumbricus terrestris sur la speciation des metaux lourds du sol.

Evaluation of the effect of earthworm Lumbricus terrestris on the speciation of copper and cadmium was carried out on two types of soils with a high metallic contamination due to municipal wastes spreading. The concentrations of total dissolved metals were higher in the soil containing earthworms. This increase was larger for the soil submitted to disturbance by earthworms for a long time (3 months). The main chemical species in the lixiviates of all type of soils including controls, were labile forms of cadmium with 52 to 87% and stable forms of copper which represents 67 to 95% of total concentration of dissolved metal. In the solid phase, there was a slight transfer of cadmium and copper from the oxidizable fraction into the exchangeable and acid soluble fractions. This suggests that soil disturbance by earthworms increases the mobility of these metals particularly cadmium. On the contrary copper appears in lixiviates as non labile organic complexes. Analysis of the whole results showed differences between soils as regards the mobility of the metals studied, which reflected the role of the mains physico-chemical characteristics (pH, C.E.C. and total calcareous content).

[Influence of the earthworm Lumbricus terrestris on soil solution complexation capacity]. / Etude de l'influence du ver de terre Lumbricus terrestris sur la capacite complexante de la solution du sol.

Four soil samples highly contaminated with metals of urban and mine origin (SE1, SE2, SM1, SM2) and having different physico-chemical proprieties were selected to study copper complexation capacity (LT) of soil solution. The effect of Lumbricus terrestris on copper complexation capacity of soil solution was investigated on SE1 and SE2. The complexation capacity was estimated by amperometric titration of soil solution by copper. Free hydrated cation and labile complexes of copper were determined by DPASV. The results show that the copper complexation capacity variation depends on the physico-chemical characteristics of soils, particularly pH. Thus, the values of copper complexation capacity are 0; 0.6 x 10(-7); 1.8 x 10(-7) and 5.5 x 10(-7) mol l-1 respectively for SM2; SM1; SE1 and SE2 which are pH 5; 5.4; 6.5 and 7.4. Based on these results, the bioavailability levels of heavy metals show the following pool ranking: SM2 > SM1 > SE1 > SE2. The copper complexation capacity of soil solution increases with the soil disturbance by Lumbricus terrestris. This is more obvious when the time of disturbance by lumbrics is longer. Indeed, average values determined for 1 month and 3 months are 3.8 x 10(-7) and 7.8 x 10(-7) mol l-1 for SE1; 7.7 x 10(-7) and 15.2 x 10(-7) mol l-1 for SE2 respectively. It seems that the action of earthworm on soil can contribute to the decrease of bioavailability of heavy metals, particularly copper.