Prognostic factors in patients with uterine sarcoma: the SARCUT study.

OBJECTIVE: Uterine sarcomas are a rare and heterogeneous group of malignancies that include different histological sub-types. The aim of this study was to identify and evaluate the impact of the different prognostic factors on overall survival and disease-free survival of patients with uterine sarcoma. METHODS: This international multicenter retrospective study included 683 patients diagnosed with uterine sarcoma at 46 different institutions between January 2001 and December 2007. RESULTS: The 5-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma, and adenosarcoma was 65.3%, 78.3%, 52.4%, and 89.5%, respectively, and the 5-year disease-free survival was 54.3%, 68.1%, 40.3%, and 85.3%, respectively. The 10-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma and adenosarcoma was 52.6%, 64.8%, 52.4%, and 79.5%, respectively, and the 10-year disease-free survival was 44.7%, 53.3%, 40.3%, and 77.5%, respectively. The most significant factor associated with overall survival in all types of sarcoma except for adenosarcoma was the presence of residual disease after primary treatment. In adenosarcoma, disease stage at diagnosis was the most important factor (hazard ratio 17.7; 95% CI 2.86 to 109.93). CONCLUSION: Incomplete cytoreduction, tumor persistence, advanced stage, extra-uterine and tumor margin involvement, and the presence of necrosis were relevant prognostic factors significantly affecting overall survival in uterine sarcoma. The presence of lymph vascular space involvement and administration of adjuvant chemotherapy were significantly associated with a higher risk of relapse.

Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps.

PURPOSE: Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that vary by type. We aimed to compare demographic, clinical, and laboratory characteristics at diagnosis of pediatric T1D and T2D. METHODS: We studied children who visited a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis. RESULTS: At diagnosis, children with T2D, compared with those with T1D, were older (13.6 years vs. 9.7 years), more likely female (63.2% vs. 47.8%), of racial/ethnic minority (91.1% vs. 42.3%), and obese (90.9% vs. 19.4%) and were less likely to have DKA (7.8% vs. 35.0%) and diabetes autoantibodies (5.5% vs. 95.4%). Children with T2D also had significantly lower glucose, lower hemoglobin A1c and lower C-peptide level (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide, and negative islet autoantibodies were independently associated with T2D (all, p<0.05), while sex, glucose, hemoglobin A1c, and DKA were not (model p<0.0001). CONCLUSION: There are important demographic, clinical, and laboratory differences between T1D and T2D in children. However, none of the characteristics were unique to either diabetes type, which poses challenges to diabetes classification at diagnosis.

Increased survival of juvenile turbot Scophthalmus maximus by using bacteria associated with cultured oysters.

Preventing vibriosis in juvenile cultured Turbot Scophthalmus maximus caused by Vibrio anguillarum frequently requires the use of feed supplemented with antibiotics in addition to vaccines. Whether the use of probiotics instead of antibiotics in juvenile Turbot is a safer strategy requires more study. The antibacterial potential of 148 Vibrio spp. strains (mostly isolated from cultures of healthy oysters, clams, and Turbot) was analyzed in vitro against V. anguillarum and other pathogens by means of an agar diffusion assay. A wide spectrum of inhibitory activity was shown by 9 strains. Based on their easy phenotypic differentiation from V. anguillarum, we selected two strains (S1 and S2, both isolated from the European flat oyster Ostrea edulis) for testing in juvenile Turbot (3 g). None of the strains were virulent by intraperitoneal or bath challenges, and all were susceptible to the antibiotics most frequently used in aquaculture. Three different stocks of Turbot, which were assayed separately, were significantly protected from infection with V. anguillarum. The final survival rates of fish treated in mixed challenges with S1 or S2 and V. anguillarum were 44% and 66%, respectively, whereas only 17% of the fish treated with only the pathogenic strain survived. The application of probiotic strains also increased the survival time of juvenile Turbot after infection with V. anguillarum. Both strains persisted in the epidermal mucus layer of the fish for 30 d, and they were not displaced by the pathogen. These data prove the efficacy of using bacteria well adapted to the dynamics of culture production as a way to provide juvenile Turbot immediate protection against infection by V. anguillarum. Moreover, the epidermal mucus sampling was useful for investigating the persistence of both probiotic strains when exposed to the pathogen.

Reconocimiento de los antígenos excretores/secretores de Anisakis tipo I y evolución de la IgE en ratas infectadas experimentalmente / Recognition of excretory/secretory antigens of Anisakis type I and evolution of IgE in experimentally infected rats

INTRODUCCIÓN: Anisakis spp., durante la parasitación, libera antígenos de excreción secreción (ES) que, al ponerse en contacto con el sistema inmunológico del hombre, pueden desencadenar una respuesta de hipersensibilidad mediada por la IgE, provocando diversos síntomas alérgicos. OBJETIVOS: Evaluar la respuesta de la IgE en ratas Wistar tras la infección con larvas L3 del parásito. MÉTODOS: Se ha procedido a la obtención de antígenos ES del parásito y suero anti-Anisakis. Se investigan también en este trabajo ciertos factores que intervienen en la técnica de inmunotransferencia, como la concentración de poliacrilamida empleada en la preparación de los geles, la concentración antigénica utilizada y la temperatura requerida para la desnaturalización de las proteínas. RESULTADOS: Las reacciones inmunológicas (Ag-Ac) observadas mediante esta técnica muestran mayor intensidad con los sueros obtenidos después de la reinfección, los cuales han reconocido proteínas que podrían corresponder al antígeno principal Ani s 1 y a otros polipéptidos de interés en el diagnóstico de la anisakiosis humana. CONCLUSIÓN: En este trabajo, se pone de manifiesto que inmunotransferenciala inmunotransferencia es una técnica útil para detectar anticuerpos de tipo IgE frente a proteínas de Anisakis

INTRODUCTION: Anisakis spp., during parasitism, release excretory-secretory antigens that, in contact with the human immune system, can trigger a hypersensitivity response mediated by IgE, causing various allergic symptoms. OBJECTIVES: To evaluate the IgE response in Wistar rats after infection with L3 larvae of the parasite Anisakis spp. METHODS: Some determining factors involved in the technique have been improved in this work, such as: the concentration of polyacrylamide used in the preparation of the gels, the antigen concentration used, and the temperature required for denaturation of proteins. RESULTS: Immune responses (Ag-Ab) observed by the immunoblotting technique showed a greater intensity with serum obtained after reinfection, which have recognized proteins that may correspond to the major antigen Ani s 1 and other polypeptides of interest in the diagnosis of human anisakiasis. CONCLUSION: This paper concludes that immunoblotting is a useful technique to detect IgE antibodies against Anisakis proteins

[Recognition of excretory/secretory antigens of Anisakis type I and evolution of IgE in experimentally infected rats]. / Reconocimiento de los antígenos excretores/secretores de Anisakis tipo I y evolución de la IgE en ratas infectadas experimentalmente.

INTRODUCTION: Anisakis spp., during parasitism, release excretory-secretory antigens that, in contact with the human immune system, can trigger a hypersensitivity response mediated by IgE, causing various allergic symptoms. OBJECTIVES: To evaluate the IgE response in Wistar rats after infection with L3 larvae of the parasite Anisakis spp. METHODS: Some determining factors involved in the technique have been improved in this work, such as: the concentration of polyacrylamide used in the preparation of the gels, the antigen concentration used, and the temperature required for denaturation of proteins. RESULTS: Immune responses (Ag-Ab) observed by the immunoblotting technique showed a greater intensity with serum obtained after reinfection, which have recognized proteins that may correspond to the major antigen Ani s 1 and other polypeptides of interest in the diagnosis of human anisakiasis. CONCLUSION: This paper concludes that immunoblotting is a useful technique to detect IgE antibodies against Anisakis proteins.

Fast detection of Vibrio species potentially pathogenic for mollusc.

Vibrio tasmaniensis, Vibrio splendidus and Vibrio neptunius species were distributed worldwide and associated with aquaculture and have been reported as the cause of diseases in aquatic organisms. Polyphasic analyses for bacterial identification are not feasible for routine diagnostic because of the time involved. The aim of this study is to design three PCR primer sets that can assist with fast detection of these species. They were designed from the 16S ribosomal RNA gene, and PCR conditions were found. Each PCR test successfully identified all the tested strains of each target species. The combined specificity of V. tasmaniensis and V. splendidus primer sets offered the best coverage (86%) in terms of separating target organisms from other related species. The primer set of V. tasmaniensis showed a lower sensitivity limit (500 fg of DNA) than the V. splendidus set (1 pg) and both sets gave positive amplification using homogenized tissues from inoculated clams, with 10(2) and 10(4) cfu/g of clam, respectively. The primer set of V. neptunius was highly specific, showing only cross-reaction with V. parahaemolyticus species from 44 tested species. Its sensitivity limit was 100 pg of DNA. A small number of biochemical tests were proposed concurrently with the PCR to differentiate the cross-reacting bacteria. The time of detection of the three tested species was reduced and the further affected animals can be diagnosed in a rapid fraction of time. The detection of virulent strains of V. tasmaniensis pointed to the risk of mollusc culture outbreaks.

Genotypic diversity of Vibrio isolates associated with turbot (Scophthalmus maximus) culture.

One hundred environmental strains of Vibrio isolated from seawater and skin of healthy turbot in an aquaculture system were analyzed. Chromosomal DNA was digested with HindIII and MluI, and hybridized using a digoxigenin-labeled probe complementary to 16S and 23S rRNA of Escherichia coli. Nineteen riboclusters were defined by ribotyping analysis at a value of SD> or = 70%, using the Dice coefficient (S(D)) and UPGMA. The phylogenetic position of each ribocluster was achieved by 16S rRNA gene sequencing of representative isolates. Both techniques were necessary and useful for identifying the isolates. V. parahaemolyticus, V. scophthalmi, V. splendidus-V. lentus related group, V. halioticoli, V. fischeri and V. ichthyoenteri were identified and clustered separately. Their ribocluster diversity was studied. Throughout the year, ribotypic profiles of corresponding strains isolated from both seawater and turbot skin appeared, indicating that environmental strains can easily colonize turbot. No correspondence between riboclusters and the season of isolation was found. Some ribotypes had been found in previous studies, demonstrating that ribotyping is a useful tool for monitoring environmental isolates and to finding strains that can colonize aquatic organisms and are able to produce outbreaks. The ribotype schemes defined here can be used as a ribotype database of environmental isolates of these species.

Effect of temperature, salinity and nutrient content on the survival responses of Vibrio splendidus biotype I.

The aim of this study was to evaluate the survival responses of two strains of Vibrio splendidus, both in natural and in defined media. For this purpose, freshwater and defined media containing different salinities (3.3-0.9 %) and nutrient concentrations (17-0.005 mg x l(-1)) were assayed. The incubation temperatures were established at 4, 10 and 22 degrees C. The acridine orange staining technique was used for total cell enumeration and the number of viable cells was determined using two direct assays, nalidixic acid and tetrazolium salt reduction and plate spreading. Resuscitation assays of viable but non-culturable (VBNC) cells were conducted. According to the counting procedures employed, at least four different subpopulations were found: (i). active (positive response in both nalidixic acid and tetrazolium assays) culturable cells; (ii). active non-culturable cells; (iii). tetrazolium-salt-responsive non-culturable cells and (iv). non-active (responsive to none of the direct viable assays) non-culturable cells. Long-term survival was found at salinities and nutrient concentrations of seawater environments (3.3 % and 5 mg x l(-1) or 1 g l(-1)), whereas the strains entered a VBNC state in freshwater and in brackish (0.9 or 1.6 % salinities) or high nutrient content (17 g x l(-1)) defined medium. The recovery of VBNC cells was not achieved.

Criterios de priorización para el acceso al trasplante. El caso del trasplante hepático en España / Priority criteria for the access to transplantation. The case of liver transplant in Spain

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New chemotherapy treatments in advanced cancer patients: an easily applicable evaluation of clinical efficacy and cost-effectiveness.

Novel cytostatic drugs have recently been introduced to treat advanced cancer patients. Although of only modest efficacy, their use is widespread, considerably increasing treatment costs. An easily applicable method to assess their efficacy and cost-effectiveness is needed. We have documented new cytostatic drugs whose consumption increased by over 60% from January 1998 to December 2000 in patients with advanced or metastatic cancer of the colorectum, lung (non-small cell), breast, ovary or brain. A review of the literature yielded 17 treatments that included these agents. For each regimen, we recorded six efficacy variables [median survival time (MS), survival rate at 1 year, absolute risk reduction, time to progression, quality of life (QoL), and patients needed to treat (NNT)]. A four-point (A-D) efficacy (E) scale and a five-point (1-5) strength of evidence (SE) scale were applied. We obtained the cost differential of each regimen for a 4-week treatment, cost per extra month of MS. and cost per NNT. One combination was rated with A efficacy (MS > 9 months+improved QoL) and nine with D (no MS or QoL improvement); 12 studies presented good quality (grade 1-2) evidence. The QoL of patients was significantly improved in only two regimens. The average cost differential was 1 311 Euro (all new regimens except one showed higher cost); the average cost per extra month of MS was 6 415 Euro; and treatment cost per NNT was 87 767 Euro. Our method proved to be easy to apply, enabled comparisons with other treatments to be made and revealed that these very costly changes in clinical practice are not justified by available studies.