Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis.

BACKGROUND: Mucinous adenocarcinoma (MAC) of the colorectum has been known and studied for many years. The prognostic significance of this histological subtype remains controversial. The authors reviewed the prognostic significance of mucinous differentiation in colorectal cancer. MATERIALS AND METHODS: A systematic web-based search was performed using Web of Knowledge and Medline. Articles published in English, German or French which used the WHO definition of MAC and described cohort studies, case-control studies or cross-sectional studies comparing survival in patients with MAC and adenocarcinoma (AC) not otherwise specified were included. Data on first author, year of publication, country, number of patients included, prevalence of MAC, % stage IV disease, % disease located in the proximal colon, mean age at presentation, % male patients and 5-year overall survival were extracted from individual studies. A fixed-effects meta-analysis model was used for analysis. The primary outcome was survival, expressed as the HR. Differences between categorical outcome parameters were quantified using the RR and corresponding 95% CI. RESULTS: 44 studies and 222 256 patients were included. The RR for proximal disease versus distal disease was 1.55 (95% CI 1.53 to 1.58). Mucinous differentiation was less frequent in male subjects (RR 0.93 (95% CI 0.91 to 0.94)). Interestingly, the prevalence of stage IV disease was similar in MAC and AC (RR 0.99 (95% CI 0.96 to 1.02)). Thirty-five articles were included in the survival analysis. A worse survival in MAC versus AC was demonstrated (HR 1.05 (95% CI 1.02 to 1.08)). Conversely, three out of four studies reported a better survival in MAC with microsatellite instability (MSI). Due to heterogeneity a meta-analysis on the effect of MSI was not possible. CONCLUSION: MAC more often originates from the right colon and is less frequent in male subjects. The authors did not identify a difference in the proportion of stage IV patients at presentation. Mucinous differentiation results in a 2-8% increased hazard of death, which persists after correction for stage. More research is needed to define the interaction between mucinous differentiation, MSI and outcome.

Flip angle optimization for dynamic contrast-enhanced MRI-studies with spoiled gradient echo pulse sequences.

Spoiled gradient echo pulse (SPGRE) sequences are commonly used in dynamic contrast-enhanced MRI (DCE-MRI) studies to measure the contrast agent concentration in a tissue of interest over time. However, due to improper tuning of the SPGRE parameters, concentration uncertainty can be very high, even at high signal-to-noise ratio in the MR measurement. In this work, an optimization procedure is proposed for selecting the optimal value of the SPGRE-flip angle FA(opt), given the expected concentration range. The optimization condition ensures that every concentration in the assumed range has the lowest possible uncertainty. By decoupling the R(1)- and R*(2)-effects caused by the presence of the contrast agent, a contour plot has been generated from which FA(opt) can be read off for any study design. Investigation of ten recent DCE-MRI studies showed that improper flip angle selection unnecessarily increases the concentration uncertainty, up to 742% and 72% on average for the typical physiological concentration ranges of 0-2 mM in tumour tissue and 0-10 mM in blood, respectively. Simulations show that the reduced noise levels on the concentration curves, observed at the optimal flip angle, effectively increase the precision of the kinetic parameters estimates (up to 82% for K(trans), 82% for ν(e) and 92% for ν(p) in the case of an individually measured arterial input function (AIF), up to 53% for K(trans), 59% for ν(e) and 67% for ν(p) in the case of a standard AIF). In vivo experiments confirm the potential of flip angle optimization to increase the reproducibility of the kinetic parameter estimates.

On the relationship between farmland biodiversity and land-use intensity in Europe.

Worldwide agriculture is one of the main drivers of biodiversity decline. Effective conservation strategies depend on the type of relationship between biodiversity and land-use intensity, but to date the shape of this relationship is unknown. We linked plant species richness with nitrogen (N) input as an indicator of land-use intensity on 130 grasslands and 141 arable fields in six European countries. Using Poisson regression, we found that plant species richness was significantly negatively related to N input on both field types after the effects of confounding environmental factors had been accounted for. Subsequent analyses showed that exponentially declining relationships provided a better fit than linear or unimodal relationships and that this was largely the result of the response of rare species (relative cover less than 1%). Our results indicate that conservation benefits are disproportionally more costly on high-intensity than on low-intensity farmland. For example, reducing N inputs from 75 to 0 and 400 to 60kgha-1yr-1 resulted in about the same estimated species gain for arable plants. Conservation initiatives are most (cost-)effective if they are preferentially implemented in extensively farmed areas that still support high levels of biodiversity.

[Supra and infra hyoid midline cervical cysts or hyoglossal abnormalies: a propos of 45 cases]. / Kystes médio-cervicaux sus et sous-hyoïdiens ou anomalies hyo-glosses: a propos de 45 observations.

OBJECTIVES: To specify the embryologic origin of the sus and sub hyoidal midline cervical cysts after studying a series of 45 patients. MATERIALS AND METHODS: 45 files were analyzed retrospectively between 1983 and 2004. RESULTS: The population concerns 21 women and 24 men with ages going from 3 to 71 years (8 children of less than 10 years). The location of the lesions is supra-hyoidal (12), sub-hyoidal (27), pre-hyoidal (2), basi-lingual (4), a cyst was a fortuitous discovery at the time of a laryngeal surgery. All these patients were operated by external way with resection of the hyoid bone in 40 cases. The histological examination made it possible to differenciate 18 cysts associated with thyroid vesicules, 24 granulomatous cysts, 1 mucoid cyst, 1 epidermidal cyst and 1 ectopic thyroid. Four observations are more precisely detailed. CONCLUSION: In spite of the strong proportion of cysts of the thyroglossal tract there is different types of cysts evoking a median dysraphy. Rather than speaking about thyroglossal anomalies, the authors propose to call them hyo-glossal anomalies because these lesions are always involving the hyoid bone. The situation of thyroid gland must always be located before surgery, clinically, by echography or scintigraphy. The surgical technique must remove the hyoid bone in monobloc while going up until the contact of the base of the tongue.

Mixed biodiversity benefits of agri-environment schemes in five European countries.

Agri-environment schemes are an increasingly important tool for the maintenance and restoration of farmland biodiversity in Europe but their ecological effects are poorly known. Scheme design is partly based on non-ecological considerations and poses important restrictions on evaluation studies. We describe a robust approach to evaluate agri-environment schemes and use it to evaluate the biodiversity effects of agri-environment schemes in five European countries. We compared species density of vascular plants, birds, bees, grasshoppers and crickets, and spiders on 202 paired fields, one with an agri-environment scheme, the other conventionally managed. In all countries, agri-environment schemes had marginal to moderately positive effects on biodiversity. However, uncommon species benefited in only two of five countries and species listed in Red Data Books rarely benefited from agri-environment schemes. Scheme objectives may need to differentiate between biodiversity of common species that can be enhanced with relatively simple modifications in farming practices and diversity or abundance of endangered species which require more elaborate conservation measures.

[The infrahyoid musculocutaneous flap: experience of 153 cases in the reconstruction of the oropharynx and oral cavity after tumoral excision]. / Le lambeau musculo-cutané infra-hyoïdien: expérience de 153 cas dans la reconstruction de l'oropharynx et de la cavité buccale, après exérèse tumorale.

The infrahyoid musculocutaneous flap was described by Wang in 1986. The authors utilize this type of flap since 1994 with an importance that increases in the field of head and neck reconstructive surgery. Their experience of 153 reconstructions in oropharynx and oral cavity showed 128 (84%) cases with good cicatrisation and 25 (16%) with complications. In the cases with complications, they noted 17 partials necrosis (50% of the skin area), 4 late cicatrisation and 4 total necrosis. Only the total necrosis necessitated the other new flap. These results show that the fiability and function of this flap creates an indispensable flap in reconstruction of the oropharynx and oral cavity.

[A retrospective study of 91 injections of botulinus toxin into the upper sphincter of the oesophagus]. / Analyse rétrospective de 91 injections de toxine botulique dans le sphincter supérieur de l'oesophage.

OBJECTIVE: To evaluate the results of botulinus toxin in dysphagia arising in the upper sphincter of the oesophagus. MATERIALS AND METHODS: Since June 1995, 64 patients have had botulinus toxin injected into the upper sphincter of the oesophagus for major swallowing disorders. All cases were treated in the dysphagia service, and underwent clinical assessment, video-swallow screening, and swallowing therapy. The patient cohort included various pathological groups--neurological (vascular accident, head injury, cranial nerve disorders, degenerative diseases), postoperative (surgery for carcinoma of the laryngo-pharynx), and functional, whether purely idiopathic or attributable. RESULTS AND CONCLUSIONS: Global analysis of the results shows that botulinus toxin has good efficacy in relaxing the upper sphincter of the oesophagus; this does not always lead to recovery of normal swallowing, but can bring about improvement by assisting in the therapeutic management of the swallowing problem, and in improving the dietary intake.

Being a mother and living with asthma: an exploratory analysis of discourse.

Although contemporary scholarship on the psychology of women has recognized the significance of motherhood for women, this positioning has received little attention from researchers interested in women and chronic illness. In this article we begin to fill this gap by exploring the complexity of being a mother when women are chronically ill. We focus on mothers with asthma and, adopting a discursive approach, analyze three interviews with asthmatic mothers using discourse analysis to explore how they negotiate their identities. The women were white, Dutch autochthones, who ranged in age from 31 to 60 years. Two were diagnosed with asthma in early childhood and one was diagnosed at age 40. We argue that being a mother is relevant to how women live with asthma.

World cup soccer players tend to be born with sun and moon in adjacent zodiacal signs.

The ecliptic elongation of the moon with respect to the sun does not show uniform distribution on the birth dates of the 704 soccer players selected for the 1998 World Cup. However, a uniform distribution is expected on astronomical grounds. The World Cup players show a very pronounced tendency (p = 0.00001) to be born on days when the sun and moon are in adjacent zodiacal signs.

Postintubation interarytenoid adhesion.

Interarytenoid fibrous adhesion is a poorly recognized complication of intubation and is frequently confused with bilateral vocal cord paralysis. Early diagnosis and treatment is essential for optimal management. Otolaryngologists should constantly remain alert for interarytenoid fibrous scar to establish the diagnosis as early as possible, optimizing the probability of restoring normal breathing and quality of life and avoiding an unnecessary tracheotomy. Surgical laser reduction is appropriate in all cases when other miscellaneous laryngeal injury lesions are eliminated. Direct laryngoscopy with careful examination of the posterior commissure and laryngeal electromyography are the 2 main clinical diagnostic aids contributing to establish the diagnosis.

Moon phase at the dates of birth and decease of anthroposophic pioneers.

Early adherents of Rudolf Steiner, the founder of the anthroposophical movement, tend to be born and to die during the dark half of the lunar month. There is significant correlation (P = 0.03) between the distributions of the lunar elongation at birth and at decease. However, this correlation does not operate at the level of individuals, suggesting that the effects of birth date and death date are statistically independent.

Bolkian and Bokian retardation in Homo sapiens.

Although a low genetic barrier is said to separate humans from apes, Homo sapiens is characterized by striking developmental and anatomical particularities. On the one hand, humans have a very extended life history (retardation). On the other hand, human anatomy shows many instances of both neoteny and hypermorphosis. In 1918, Bolk proposed his 'retardation theory' that links both aspects of the human condition. We show in this paper that his theory becomes surprisingly powerful when Bolk's retardation principle is applied to generalized developmental gradients (such as the cephalocaudal gradient that dominates overall ontogeny). In this way, the main particularities of the human body (extended life history; long limbs, and very long legs; very low brachial and crural indices; highly developed pollex and hallux; reduced prognathism; advanced telencephalization etc.) can be reduced to a single developmental matrix. In 1926, Bok noted that, in a series of equivalent organs (such as the finger row), the ontogenetic latecomer tends to be more neotenic than a corresponding forerunner. We show that Bok's observation is a logical corollary of Bolk's retardation theory and that it is important for understanding some pecularities of human anatomy such as the pronounced differentiation between hands and feet.

Dealing with fatigue: the importance of health-related action patterns.

Fatigue complaints are frequent and important problems affecting people's quality of life and creating puzzles for the General Practitioners they consult. Little is known about what actions people undertake to deal with fatigue, and even less about their success. As revealed by multivariate analyses health-related action patterns can classify people as being particularly successful or unsuccessful in dealing with their complaints of chronic fatigue. This study suggests that a few actions applied in combination and in a concentrated manner constitute the basis for a successful action pattern. The number, type and predictive power of the relevant actions vary depending on the persons in question: having chronic diseases or not and being under 44 or over 44 years old.

Distinguishing between chronic and nonchronic fatigue, the role of gender and age.

In this study the authors try to clarify the ambiguities in previous studies on demographic and social factors and fatigue. We have divided people with fatigue complaints and associated symptoms into those who have chronic and non-chronic complaints, and into men and women. The research is based on diaries kept by Dutch citizens over a 21-day period, and uses univariate and discriminant analyses. The results show the utility of stratification for chronicity, gender and age. Compared to non-chronically fatigued subjects (NCFd) the chronically fatigued subjects (CFd) reveal multiple sources of vulnerability: physical, psychological, psycho-social and socio-economic. They report more days of fatigue, they tend to be older, and their physical health is characterized by significantly more acute complaints and chronic disease. Their sum scores on psychological and psycho-social problems are above average. Their health histories are worse, they express greater feelings of frustration and irritation due to their ailments and report more health-related initiatives. The socio-economic profile of the CFd is disadvantaged: their educational level, occupational classification and income are lower than that of the NCFd, and they are more frequently unemployed. CFd women are more frequently divorced or widowed than NCFd women. The factors predicting chronic vs non-chronic fatigue vary with the age and gender of the population. It is easier to predict non-chronic than chronic fatigue. Additional stratification within the group of CFd is recommended.

Circaseptennian (about 7-year) periodicity in the distribution of birth years of Nobel laureates for physics.

The distribution of birth years for Nobel physicists shows a circaseptennian (about 7-year) periodicity. This observation extends an earlier observation of a circaseptennian pattern in the distribution of birth years for early quantum physicists. In both categories, birth rate tends to maximize in years belonging to the (7n + 4) phase.

Cranial suture closing in Homo sapiens: evidence for circaseptennian periodicity.

In their classical study on cranial suture closing. Todd and Lyon (1924-25) expressed their belief that suture closure proceeds according to some periodic pattern. Spectral analysis applied to their data corroborates the opinion of Todd and Lyon. Closure of the cranial sutures in humans is pervaded by a circaseptennian periodicity. Pulses of accelerated closure occur at intervals of about 7 years, and are separated by periods of relative quiescence.

[Infrahyoid musculocutaneous flaps: anatomical bases and indications in cervicofacial oncologic surgery]. / Le lambeau musculo-cutané infra-hyoïdien: bases anatomiques et indications en chirurgie carcinologique cervico-faciale.

The infrahyoïd myocutaneous flap has been described by Wang in 1986. Its use seems still limited, although its obvious interest in head and neck reconstructive surgery, especially in oropharyngeal area. Authors expound anatomic bases of this flap, and a 62 case's experience confirming its potential.