Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery.

BACKGROUND: This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. MATERIAL AND METHODS: A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. RESULTS: 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. CONCLUSIONS: Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions.

Long-term experience and Visual Acuity outcomes in Peters Anomaly cases.

PURPOSE: To report the results in a series of Peters Anomaly cases, and propose management and treatment approaches according to the alterations associated with each case. MATERIAL AND METHODS: A retrospective analysis was performed on the records of 27 patients (32 eyes) clinically diagnosed with Peters Anomaly. Each patient was subjected to different treatment modalities according to the type of Peters Anomaly, anywhere from medical follow-up clinics to a Penetrating Keratoplasty procedure (PKP). RESULTS: Of the 27 patients (32 eyes), 74% were male and 26% female, with 18.5% (5) being bilateral and 81.5% (22) unilateral. The mean number of years of follow-up was 10.2 years (Range: 3.5 to 18 years). The results of long-term VA correlate directly with the type of Peters Anomaly. For the total number of patients, the VA results were LogMAR 1.71 ±â€¯1.04. The results by groups were: Type I with only medical monitoring LogMAR 0.3 ±â€¯0, Type I with only Optical Iridectomy (OI) LogMAR 0.97 ±â€¯0.78, Type I with PKP LogMAR 1.22 ±â€¯0.97, Type II without a compromised posterior pole with PKP LogMAR 2.41 ±â€¯0.80, and Type II with a compromised posterior pole with PKP LogMAR 2.56 ±â€¯0.48. CONCLUSIONS: The result of VA and long-term corneal failure is directly related to the type of Peters Anomaly. Patients with Type I who only required medical follow-ups had the most favourable prognosis. Patients who underwent Peripheral Iridectomy followed and patients in which PKP was performed had an inferior prognosis.

Experiencia a largo plazo de pacientes con anomalía de Peters / Long-term experience and Visual Acuity outcomes in Peters Anomaly cases

ObjetivoComunicar los resultados de una serie de casos con anomalía de Peters, y proponer el manejo y sugerencias terapéuticas según alteraciones asociadas.Material y métodosSe analizaron las historias clínicas de 27 pacientes (32 ojos) con diagnóstico clínico de anomalía de Peters, los cuales fueron sometidos a diferentes tratamientos. Distintos parámetros y condiciones asociadas fueron evaluadas: presión intraocular (PIO), agudeza visual (AV), técnica quirúrgica y complicaciones postoperatorias.ResultadosDe los 27 pacientes (32 ojos), 74% sexo masculino y 26% femenino. El promedio de años de seguimiento fue de 10,2 años. La PIO preoperatoria fue de 23 ± 9,21 mmHg y al último control fue de 18,81 ± 7,45 mmHg. El resultado de AV a largo plazo se correlaciona directamente con el tipo de anomalía de Peters. Para el total los resultados de AV fueron LogMAR 1,71 ± 1,04 y por grupos: Tipo I sólo con seguimiento médico LogMAR 0,3 ± 0, Tipo I sólo con iridectomía periférica LogMAR 0,97 ± 0,78, Tipo I con queratoplastia penetrante (QPP) LogMAR 1,22 ± 0,97, Tipo II sin compromiso de polo posterior LogMAR 2,41 ± 0,80 y Tipo II con compromiso de polo posterior LogMAR 2,56 ± 0,48.ConclusionesEl resultado de AV y fracaso del injerto corneal a largo plazo se correlaciona directamente al tipo de anomalía de Peters, con mejor pronóstico la Tipo I en que se realizó sólo seguimiento médico, luego en los que se practicó iridectomía periférica, en los que se realizó QPP los que presentan peor pronóstico visual son con anomalía de Peters Tipo II con compromiso de polo posterior (p = 0.0087).

PurposeTo report the results in a series of Peters Anomaly cases, and propose management and treatment approaches according to the alterations associated with each case.Material and methodsA retrospective analysis was performed on the records of 27 patients (32 eyes) clinically diagnosed with Peters Anomaly. Each patient was subjected to different treatment modalities according to the type of Peters Anomaly, anywhere from medical follow-up clinics to a Penetrating Keratoplasty procedure (PKP).ResultsOf the 27 patients (32 eyes), 74% were male and 26% female, with 18.5% (5) being bilateral and 81.5% (22) unilateral. The mean number of years of follow-up was 10.2 years (Range: 3.5 to 18 years). The results of long-term VA correlate directly with the type of Peters Anomaly. For the total number of patients, the VA results were LogMAR 1.71 ± 1.04. The results by groups were: Type I with only medical monitoring LogMAR 0.3 ± 0, Type I with only Optical Iridectomy (OI) LogMAR 0.97 ± 0.78, Type I with PKP LogMAR 1.22 ± 0.97, Type II without a compromised posterior pole with PKP LogMAR 2.41 ± 0.80, and Type II with a compromised posterior pole with PKP LogMAR 2.56 ± 0.48.ConclusionsThe result of VA and long-term corneal failure is directly related to the type of Peters Anomaly. Patients with Type I who only required medical follow-ups had the most favourable prognosis. Patients who underwent Peripheral Iridectomy followed and patients in which PKP was performed had an inferior prognosis.

Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews.

BACKGROUND: Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. METHODS: We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. RESULTS: We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. CONCLUSIONS: The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. TRIAL REGISTRATION: Open Science Framework, https://doi.org/10.17605/OSF.IO/7CHX6 .

Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas.

PURPOSE: Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. METHODS: We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. RESULTS: The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. CONCLUSIONS: This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.

Quality traits of pork semimembranosus and triceps brachii muscles sourced from the United States and Mexico.

The study included fresh pork semimembranosus (SM, n=289) and triceps brachii (TB, n=283) muscles sourced from meat packers of Mexico and the USA. Samples were analyzed for moisture, protein, and fat content, pH, shear force (WBSF), cook loss, water holding capacity (WHC), instrumental color, emulsion capacity (EC) and stability (ES), and consumer sensory ratings. SM from the USA had lower WBSF (P<0.05) than that from Mexico (26.7 vs. 29.7N), higher WHC (44.7 vs. 38.4%; P<0.05) and a better appearance, as indicated by its lower h* (52.3 vs. 56.6; P<0.05) and higher C* (23.1 vs. 21.3; P<0.05). Consumer acceptance of SM was similar (P>0.05) across countries. TB from Mexico had higher (P<0.05) fat content (2.5 vs. 2.0%), lower (P<0.05) WBSF values (32.0 vs. 36.9N), and received more positive ratings by Mexican consumers (87.1 vs. 81.7%) than its US equivalent. In general, US pork exhibits better technological properties, while country of origin has less effect on consumer acceptability.

Epigenetic regulation of ID4 in the determination of the BRCAness phenotype in breast cancer.

BRCAness breast tumors represent a group of sporadic tumors characterized by a reduction in BRCA1 gene expression. As BRCA1 is involved in double-strand breaks (DSBs) repair, dysfunctional BRCA pathway could make a tumor sensitive to DNA damaging drugs (e.g., platinum agents). Thus, accurately identifying BRCAness could contribute to therapeutic decision making in patients harboring these tumors. The purpose of this study was to identify if BRCAness tumors present a characteristic methylation profile and/or were related to specific clinico-pathological features. BRCAness was measured by MLPA in 63 breast tumors; methylation status of 98 CpG sites within 84 cancer-related genes was analyzed by MS-MLPA. Protein and mRNA expressions of the selected genes were measured by quantitative real-time PCR and Western Blot. BRCAness was associated with younger age, higher nuclear pleomorphism, and triple-negative (TN) status. Epigenetically, we found that the strongest predictors for BRCAness tumors were the methylations of MLH1 and PAX5 plus the unmethylations of CCND2 and ID4. We determined that ID4 unmethylation correlated with the expression levels of both its mRNA and protein. We observed an inverse relation between the expressions of ID4 and BRCA1. To the best of our knowledge, this is the first report suggesting an epigenetic regulation of ID4 in BRCAness tumors. Our findings give new information of BRCAness etiology and encourage future studies on potential drug targets for BRCAness breast tumors.

Prevention of groin injuries in sports: a systematic review with meta-analysis of randomised controlled trials.

BACKGROUND/AIM: Groin injuries are common in football and ice hockey, and previous groin injury is a strong risk factor for future groin injuries, which calls for primary prevention. The aim of this systematic review was to evaluate the effect of specific groin-injury prevention programmes in sports. METHODS: A comprehensive search was performed in May 2014 yielding 1747 potentially relevant references. Two independent assessors evaluated randomised controlled trials for inclusion, extracted data and performed quality assessments using Cochrane's risk of bias tool. Quantitative analyses were performed in Review Manager 5.3. RESULTS: Seven trials were included: six on football players (four male and two female populations) and one on male handball players. In total there were 4191 participants with a total of 157 injuries. The primary analysis, including all participants, did not show a significant reduction in the number of groin injuries after completing a groin injury prevention programme (relative risk (RR) 0.81; 95% CI 0.60 to 1.09). Subgroup analysis based on type of sports, gender and type of prevention programme showed similar non-significant estimates with RR ranging from 0.48 to 0.81. CONCLUSION: Meta-analysis revealed a potential clinically meaningful groin injury reduction of 19%, even though no statistical significant reduction in sport-related groin injuries could be documented. TRIAL REGISTRATION: PROSPERO registration ID CRD42014009614.

Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial.

BACKGROUND: Postoperative blood loss in patients after total knee arthroplasty may cause local and systemic complications and influence clinical outcome. The aim of this study was to assess whether fibrin glue or tranexamic acid reduced blood loss compared with routine hemostasis in patients undergoing total knee arthroplasty. METHODS: A randomized, single-center, parallel, open clinical trial was performed in adult patients undergoing primary total knee arthroplasty. Patients were divided into four groups. Group 1 received fibrin glue manufactured by the Blood and Tissue Bank of Catalonia, Group 2 received Tissucol (fibrinogen and thrombin), Group 3 received intravenous tranexamic acid, and Group 4 (control) had no treatment other than routine hemostasis. The primary outcome was total blood loss collected in drains after surgery. Secondary outcomes were the calculated hidden blood loss, transfusion rate, preoperative and postoperative hemoglobin, number of blood units transfused, adverse events, and mortality. RESULTS: One hundred and seventy-two patients were included. The mean total blood loss (and standard deviation) collected in drains was 553.9 ± 321.5 mL for Group 1, 567.8 ± 299.3 mL for Group 2, 244.1 ± 223.4 mL for Group 3, and 563.5 ± 269.7 mL for Group 4. In comparison with the control group, Group 3 had significantly lower total blood loss (p < 0.001), but it was not significantly lower in Groups 1 and 2. The overall rate of patients who had a blood transfusion was 21.1% (thirty-five of 166 patients analyzed per protocol). Two patients required transfusion in Group 3 compared with twelve patients in Group 4 (p = 0.015). No significant difference was observed between the two fibrin glue groups and the control group with regard to the need for transfusion. There was no difference between groups with regard to the percentage of adverse events. CONCLUSIONS: Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.

Los betabloqueantes en pacientes sometidos a cirugía no cardiaca: implicaciones del estudio POISE* / No disponible

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Amitriptyline in the treatment of fibromyalgia: a systematic review of its efficacy.

The objective of this study was to assess the efficacy and safety of amitriptyline as a treatment of FM. A comprehensive computerized search in Medline (Pubmed), EMBASE and The Cochrane Library was performed. Randomized controlled trials (RCTs) comparing amitriptyline vs placebo in adult patients suffering from FM were identified, the methodological quality was assessed and the results of the main outcomes were evaluated. Ten RCTs were identified. Large clinical variability and statistical heterogeneity precluded quantitative meta-analysis. Overall, the study quality was moderate to high. Amitriptyline 25 mg/day (six RCTs) demonstrated a therapeutic response compared with placebo in the domains of pain, sleep, fatigue and overall patient and investigator impression. This benefit was generally seen at 6-8 weeks of treatment but no effect was noted at 12 weeks. Amitriptyline 50 mg/day (four RCTs) did not demonstrate a therapeutic effect compared with placebo. Neither dose of amitriptyline had an effect on tender points count. No clear statements on adverse events with amitriptyline can be made due to inconsistencies in data among the studies. A definitive clinical recommendation regarding the efficacy of amitriptyline for FM symptoms cannot be made. There is some evidence to support the short-term efficacy of amitriptyline 25 mg/day in FM. There is no evidence to support the efficacy of amitriptyline at higher doses or for periods >8 weeks. More stringent RCTs with longer follow-up periods are required to determine the long-term efficacy and safety of the amitriptyline and define its role in the multidisciplinary management of FM.

A randomized, double-blind multicentre clinical trial comparing the efficacy of calcium dobesilate with placebo in the treatment of chronic venous disease.

OBJECTIVE: To assess the efficacy of calcium dobesilate on the quality-of-life (QoL) of patients with chronic venous disease (CVD). DESIGN: Randomised, parallel, double blind, placebo-controlled clinical trial. METHODS: Patients were recruited from vascular surgery clinics and randomised to 500mg capsules of calcium dobesilate twice a day for 3 months or placebo. The primary outcome measure was 'QoL after 3 months' treatment measured by the specific Chronic Insufficiency Venous International Questionnaire (CIVIQ). Secondary outcomes were QoL at 12 months and assessment of the CVD signs and symptoms. The principal analysis was undertaken on the intention-to-treat (ITT) data. RESULTS: Five hundred and nine patients were recruited (246 to calcium dobesilate and 263 to placebo). The analysis of the 'QoL after 3 months' showed no significant differences between groups (p=0.07). For secondary outcomes, oedema and symptoms of CVD, there were no significant differences between groups. In a multi-factorial analysis, the 'QoL at 12 months' was better in the calcium dobesilate group than in placebo group (p=0.02). CONCLUSIONS: Treatment with calcium dobesilate was not found to be superior to placebo on the QoL of CVD patients. The sustained effect of calcium dobesilate observed after treatment should be confirmed in future studies.

Memoria verbal y no verbal a corto plazo en adolescentes con organización límite de personalidad / Memory in adolescents who have a borderline personality

El presente estudio intenta establecer si existen signos que indiquen alteración de una función psicológica básica, como la memoria, en adolescentes con una organización límite de personalidad. En la muestra analizada se observaron indicadores de alteración mnémica, especialmente en memoria visual, en este tipo de pacientes. Ello podría explicar algunas alteraciones en la interpretación de eventos significativos relativos a la concepción de sí mismos y del mundo que presentan estos adolescentes y sustentar la idea de alguna disfunción neuropsicológica a la base de la organización límite de la personalidad.

Neuroreflexotherapy for non-specific low-back pain.

BACKGROUND: Among the wide range of therapeutic alternatives proposed for the management of low-back pain (LBP), a less widely used technique from Spain, called neuroreflexotherapy (NRT) has claimed to show very favourable results, mainly in patients with chronic low-back pain. OBJECTIVES: The aim of this review was to systematically assess the effectiveness of NRT for the treatment of non-specific LBP in adult patients, aged 16 to 65 years. A secondary objective was to compare NRT with other conventional interventions. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to October 1, 2002. SELECTION CRITERIA: Only randomised controlled trials (RCTs) of NRT for the treatment of patients with a clinical diagnosis of non-specific LBP were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials and extracted data using pre-designed forms. Because the outcome variables were not assessed in a homogenous way, it was not possible to pool the results to obtain an estimate of global effect, as initially planned. MAIN RESULTS: Three RCT were included, with a total of 125 subjects randomised to the control groups and 148 subjects receiving active NRT. Neuroreflexotherapy was the same in all three trials, while the control groups received sham-NRT in two trials and standard care in one. Two trials studied patients with chronic LBP, the third studied patients with a mix of chronic and sub-acute LBP. Clinical outcomes were measured in the short-term (15 to 60 days) in all three trials; in one trial, resource utilization was measured after one year. Individuals who received active NRT showed statistically significantly better outcomes than the control groups for measures of pain, degree of mobility, disability, medication use, consumption of resources and costs. No significant differences were observed for quality of life measures. Side effects were more frequently reported in the control groups during short-term follow-up, with no major side effects reported by those receiving active NRT. REVIEWERS' CONCLUSIONS: NRT appears to be a safe and effective intervention for the treatment of chronic non-specific LBP. The efficacy is less clear for sub-acute LBP. However, these results are limited to three trials conducted by a small number of specifically trained and experienced clinicians, in a limited geographical location. No data are available on the ease and time-frame needed to achieve that level of expertise. RCTs by other practitioners, in other locations, that replicate the effects reported in this review are needed before recommending a broader practice.

Importancia de las bases de datos en la búsqueda bibliográfica. Primer paso de una revisión sistemática / Importance of the database in the literature search: the first step in a systematic review

El crecimiento del conocimiento científico y de las bases de datos a disposición del investigador hace que cada vez sean necesarias búsquedas más complejas, para poder recopilar la cantidad de información más completa y de mejor calidad sobre el tema que se pretende investigar. Este estudio analiza el número de referencias identificadas en Cumulative Index to Nursing and Allied Health Literature (CINAHL) y en Medline y cuantifica su relevancia para llevar a cabo una revisión sistemática. Las variables a analizar son: número de referencias recuperadas con y sin abstract, grado de solapamiento entre las bases de datos, accesibilidad y grado de relevancia de las referencias. Se han recuperado 116 artículos, 49 (42,2 per cent) en CINAHL y 67 (57,8 per cent) en Medline, sin que se haya producido solapamiento. De las referencias recuperadas el 60,3 per cent (70) incluye abstract, 13 (26,5 per cent) en CINAHL y 57 (85,1 per cent) en Medline (p < 0,005). El 62,9 per cent (73) de las referencias identificadas puede obtenerse en bibliotecas españolas, 42,5 per cent (31) en CINAHL y 57,5 per cent (42) en Medline (p = ns). Se han considerado relevantes 23 (18,9 per cent del total), de las cuales 7 (30,4 per cent) se han identificado en CINAHL y 16 (69,6 per cent) en Medline (p = ns), la concordancia entre la clasificación de relevancia en función del título y del abstract muestra una coincidencia en el 72,9 per cent de las referencias (p < 0,005).Cuando se plantee una búsqueda bibliográfica relacionada con temas de enfermería es necesario que se consulte tanto CINAHL como Medline (AU)

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[Incidence of urinary bladder cancer in an industrialized area of Spain]. / Incidencia del cáncer de vejiga urinaria en un área industrializada de España.

AIM: To identify all incident cases of bladder cancer in the county of Vallès Occidental (Spain), describe their histopathological characteristics, and make comparisons with other Spanish and European areas. METHOD: The study was carried out from the Corporació Parc Taulí (Sabadell). All new cases of bladder cancer in residents of the county Vallès Occidental, a highly industrialised area of Catalonia (Spain), were included between 1992 and 1994. Incidence rates of bladder cancer were adjusted and were compared with adjusted incidence rates reported by registries in other Spanish and European countries. RESULTS: 485 new cases were identified. Transitional cell carcinomas predominated (95.5%). The majority of tumours were diagnosed in their initial stages, 75.9% being superficial and 62.6% well to moderately differentiated. Bladder cancer was more common in men than in women, but women presented tumours of worse prognosis. The mean age at diagnosis was also higher in women than men (71 vs. 66 years, p = 0.03). The adjusted incidence rate in men (52.2 cases/100,000) was among the highest of the observed areas, whereas for women (5.4 cases/100,000) was relatively low. CONCLUSIONS: The incidence of bladder cancer among men in Vallès Occidental is among the highest in Europe, and intermediate for women. The high male/female ratio seen in all Spanish areas could be attributed to the fact that women in Spain have been less exposed than men to the risk factors, or their exposure occurred more recently.

Patterns of shell penetration by Chorus giganteus juveniles (Gastropoda: Muricidae) on the mussel Semimytilus algosus.

Patterns are described for shell penetration by the sublittoral muricid snail Chorus giganteus during predatory attacks on the mussel Semimytilus algosus. Location, form and size of shell penetrations were observed in relation to the size of the predator. The results suggested that positions of the perforations on the mussel shells were related to size of the attacking snail. Smaller snails perforated areas near the shell ligament and in the central zone of the shell, while larger snails more frequently attacked shell borders, principally on the ventral side. These observations may be related to: (a) changes in the process of manipulation of the prey during development of the foot and the shell tooth of the predator, (b) changes in internal structure of the snails related to the shell perforation mechanism, or (c) learned behavior acquired experientially by the snails during early growth. Although in other studies of muricid penetration patterns larger boreholes made in shells of the prey were positively correlated with increasing predator size, this relation did not appear to hold with C. giganteus, as larger specimens often made relatively small shell perforations. Areas of boreholes made in the mussel shells by this snail varied from 0.01 to 1.1 mm(2), and were unusually variable in size and shape, especially when compared with literature results on bores characteristic of other muricid species.

Bladder cancer in the textile industry.

OBJECTIVES: This study examined the occupations and industries at high risk for bladder cancer in an area where the textile industry is plentiful and the incidence of the disease is very high. METHODS: A case-referent study concerning 218 incident bladder cancer cases diagnosed during 1993-1995 in the county of Vallès Occidental, Barcelona, was carried out. A reference group (N=344) was selected from municipal lists matched to the cases by age, gender, and area of residence. All the subjects were personally interviewed, and a complete occupational history was abstracted together with other sociodemographic and life-style factors. All odds ratios (OR) and 95% confidence intervals (95% CI) were adjusted for age, gender, and smoking. RESULTS: No overall excess risk was found forever having worked in the textile industry (OR 1.13, 95% CI 0.79-1.63) nor for specific sectors of this industry (ie cotton, wool, silk). An excess risk was observed for spinners and winders employed for more than 20 years (OR 3.28, 95% CI 1.08-9.97) and for machine setters employed between 1960 and 1974 (OR 4.26, 95% CI 1.09-16.7). CONCLUSIONS: The results of this study do not support the findings of some earlier studies for an increased bladder cancer risk in the textile industry. However, some elevated risks were observed among the workers with the highest exposures.