Pediatric gastric cancer presenting with massive ascites.

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Pediatric gastric cancer presenting with massive ascites.

World J Gastroenterol. 2015 Mar 21;21(11):3409-13

Authors: Lin CH, Lin WC, Lai IH, Wu SF, Wu KH, Chen AC

Abstract
Gastric adenocarcinoma is quite rare in children and as a result very little experience has been reported on with regards to clinical presentation, treatment and outcome. We describe the case of a 16-year-old boy presenting with abdominal fullness and poor appetite for 7 d. Sonography showed massive ascites and computed tomography imaging revealed the presence of gastric mucosa thickness with omentum caking. The diagnosis of gastric adenocarcinoma was biopsy-proven endoscopically. Despite gastric adenocarcinoma being quite rare in the pediatric patient population, we should not overlook the possibility of gastric adenocarcinoma when a child presents with distended abdomen and massive ascites.

PMID: 25805952 [PubMed - indexed for MEDLINE]

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Giant gastrointestinal stromal tumour of rare sarcomatoid epithelioid subtype: case study and literature review.

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Giant gastrointestinal stromal tumour of rare sarcomatoid epithelioid subtype: case study and literature review.

World J Gastroenterol. 2015 Mar 21;21(11):3388-93

Authors: Lech G, Korcz W, Kowalczyk E, Guzel T, Radoch M, Krasnodębski IW

Abstract
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, but they represent less than 3% of all gastrointestinal tract malignancies. This is a detailed case study of a 52-year-old male patient treated for very uncommon histological subtype of gastric GIST with atypical clinical presentation, asymptomatic progress and late diagnosis. The resected tumour, giant in diameters, was confirmed to represent the most rare histopathologic subtype of GISTs - sarcomatoid epithelioid GIST. We report this case and review the literature with a special focus on pathomorphological evaluation, biological aggressiveness and prognostic factors. To our knowledge this is the first report of giant GIST of very uncommon sarcomatoid epithelioid subtype. It is concluded that clinicians should pay attention to the fact that initial diagnosis may be delayed due to mildly asymptomatic and non-specific clinical presentation. Asymptomatic tumours diagnosed at a late stage, which is often the case, can be large on presentation. Prognosis for patients diagnosed with GIST depend on tumour size, mitotic rate, histopathologic subtype and tumour location. That is why early diagnosis and R0 resection, which is usually feasible and safe even in giant gastric sarcomatoid epithelioid subtype of GISTs, are the key factors for further treatment and good prognosis.

PMID: 25805949 [PubMed - indexed for MEDLINE]

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Infiltrative plaques on the temple. Blastic plasmacytoid dendritic cell neoplasm (BPDCN).

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Infiltrative plaques on the temple. Blastic plasmacytoid dendritic cell neoplasm (BPDCN).

Pediatr Dermatol. 2015 Mar-Apr;32(2):283-4

Authors: Sheng N, Xiong JS, Wang YH, Chen H, Sun JF

PMID: 25801079 [PubMed - indexed for MEDLINE]

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Recurrent epistaxis in a nine-year-old boy: benign or malignant?

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Recurrent epistaxis in a nine-year-old boy: benign or malignant?

J Laryngol Otol. 2015 Mar;129(3):293-5

Authors: Dean HF, Hadjisymeou S, Morrison G, Hore I

Abstract
OBJECTIVE: We present the case of a rare cause of epistaxis in a paediatric patient, together with the diagnostic and management challenges associated with this condition.
CASE REPORT: A previously well nine-year-old boy presented with a six-month history of intermittent unilateral epistaxis. Radiological investigation and endoscopic biopsy confirmed a highly malignant nasopharyngeal mass consistent with carcinoma. The tumour continued to grow rapidly. Whilst awaiting intervention, the patient experienced a further significant haemorrhage requiring surgical intervention.
CONCLUSION: Nasopharyngeal carcinoma is a rare cause of epistaxis amongst children in the UK. Early flexible nasendoscopy can help delineate both benign and sinister causes of symptoms in this region.

PMID: 25797451 [PubMed - indexed for MEDLINE]

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Rare giant frontal sinus osteoma mimicking fibrous dysplasia.

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Rare giant frontal sinus osteoma mimicking fibrous dysplasia.

J Laryngol Otol. 2015 Mar;129(3):283-7

Authors: Exley RP, Markey A, Rutherford S, Bhalla RK

Abstract
OBJECTIVE: To present the first report of a giant frontal sinus osteoma treated by excision and single-stage reconstruction with custom-made titanium cranioplasty and left orbital roof prostheses.
CASE REPORT: A 31-year-old man with a history of chronic frontal sinusitis presented with a deforming, painless, midline forehead swelling of 11 years' duration, which had been treated unsuccessfully in Nigeria. Differential diagnosis included both benign and malignant bony tumours. Computerised tomography revealed a giant bony frontal sinus tumour extending beyond the sinus roof and breaching the left orbit, consistent with fibrous dysplasia. Given the extent of the tumour, open craniectomy was performed for surgical extirpation. Histological analysis identified multiple osteomas. This surgical approach achieved excellent cosmesis, with no evidence of recurrence at 12-month follow up.
CONCLUSION: Forehead swelling may pose diagnostic and management dilemmas for the ENT surgeon; however, effective management is facilitated by a multidisciplinary approach.

PMID: 25797450 [PubMed - indexed for MEDLINE]

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Should we abandon all conservative treatments for uterine fibroids? The problem with leiomyosarcomas.

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Should we abandon all conservative treatments for uterine fibroids? The problem with leiomyosarcomas.

Womens Health (Lond Engl). 2015 Mar;11(2):151-9

Authors: Odejinmi F, Agarwal N, Maclaran K, Oliver R

Abstract
Fibroids are the most common tumor in women and many medical and surgical options exist for their management. The incidence of uterine sarcoma in women undergoing treatment for fibroids has previously been thought to be extremely rare, however there has been recent controversy as to whether this risk has been underestimated. This article reviews the literature investigating the incidence of leiomyosarcoma and explores how different treatment modalities may affect risk from occult malignancy. We aim to provide a tool for counseling women who are considering options for the management of their fibroids.

PMID: 25776289 [PubMed - indexed for MEDLINE]

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Gorham disease of the mandible.

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Gorham disease of the mandible.

J Craniofac Surg. 2015 Mar;26(2):e160-2

Authors: Zhao SF, Wang YX, Yang XD, Tang EY

Abstract
Gorham disease, or massive osteolysis, is a rare condition of unknown etiology. The disease is characterized by spontaneous progressive osteolysis of 1 or more skeletal bones. The mandible is the most commonly involved bone in the maxillofacial region. This article reports a case of Gorham disease with mandibular involvement in a 46-year-old male patient with a 7-year follow-up. In this case, we performed lower right mandibular osteotomy and reconstruction with a phased titanium plate. Postoperative follow-up showed continued mandibular bone loss that was progressing to the contralateral mandible. Massive osteolysis of the mandible is a rare clinical condition that must be differentiated from mandibularosteomyelitis, benign and malignant tumors, as well as hyperparathyroidism. Improved differential diagnoses and disease follow-up are required to effectively manage massive osteolysis.

PMID: 25759934 [PubMed - indexed for MEDLINE]

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Chondromyxoid fibroma of the frontal bone mimicking meningioma.

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Chondromyxoid fibroma of the frontal bone mimicking meningioma.

J Craniofac Surg. 2015 Mar;26(2):e179-81

Authors: Wang H, Shu H, Tian X, Zhang H, Zhang Q, Guo L

Abstract
Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor that usually arises from lower-extremity long-bone metaphyses, with approximately 5.4% of all CMFs presenting in the craniofacial bones. Chondromyxoid fibroma of the frontal bone is exceedingly rare, with only a few cases reported. Herein, we report another case of CMF arising from the frontal bone mimicking meningioma. We suggest that histopathologic examination is of vital importance for the diagnosis of CMF; complete surgical resection is the best treatment option for frontal CMF.

PMID: 25748938 [PubMed - indexed for MEDLINE]

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Temporal lobe epilepsy in infants and children.

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Temporal lobe epilepsy in infants and children.

Rev Neurol (Paris). 2015 Mar;171(3):252-8

Authors: Gataullina S, Dulac O, Bulteau C

Abstract
Clinical expression of temporal lobe seizures is different with a more diverse and more extensive etiology in infants and children than it is in adults. It is dominated by cortical dysplasia, low-grade tumors and perinatal damage. Hippocampal sclerosis, although less frequent, exists in children usually as a dual pathology associated with ipsilateral neocortical lesions. The clinical semiology of temporal seizures is more varied, and sometimes misleading. Motor features including tonic, clonic or myoclonic behaviors, and infantile spasms predominate in infants. Classical complex partial seizures with behavioral arrest and automatisms, as well as lateralizing signs are rare and occur mostly with onset after the age of two years. Interestingly, aura, emotional, and autonomic signs seem to be independent on the brain maturation process. Moreover, the neuropsychological profile varies according to age of onset and duration, lateralization of the focus and etiology. Quality of care benefits from individual cognitive assessment for memory and emotional processes.

PMID: 25744768 [PubMed - indexed for MEDLINE]

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Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma.

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Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma.

Eur Spine J. 2015 May;24 Suppl 4:S614-8

Authors: Jeong JH, Im SB, Shin DS, Hwang SC, Kim BT

Abstract
INTRODUCTION: Hiccups caused by a neoplasm in the spinal cord are rare.
MATERIALS AND METHODS: We report a case of intractable hiccups caused by syringobulbia and syringomyelia associated with cervical intramedullary spinal hemangioblastoma, which was successfully treated by surgical excision. A 60-year-old man was referred from the neurology department after presenting with hiccups for 1 year. The hiccups were aggravated 3 months ago and were sustained during eating or sleeping. Several doctors administered a muscle relaxant and an anticonvulsant, but they were ineffective. Spinal MRI revealed a huge syringomyelia from C2 to T2, associated with a highly enhancing intramedullary mass lesion at the C5 level. The hiccups were ceased after removal of the tumor through a right hemilaminectomy. The pathology of the specimen was hemangioblastoma. The size of the syringobulbia and syringomyelia decreased markedly on MRI checked 5 months after surgery.
CONCLUSIONS: Intractable hiccups can be caused by syringobulbia associated with an intramedullary cord tumor in the cervical area and possible mechanisms of hiccups were reviewed.

PMID: 25716660 [PubMed - indexed for MEDLINE]

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Crystal storing histiocytosis clinically mimicking metastatic carcinoma: Report of a case and reviews of literature.

Crystal storing histiocytosis clinically mimicking metastatic carcinoma: Report of a case and reviews of literature.

Head Neck. 2015 Dec 21;

Authors: Balakrishna J, Chen A, Urken M

Abstract
BACKGROUND: Crystal storing histiocytosis (CSH) is a rare disorder characterized by accumulation of histiocytes containing crystalline material inclusions. This entity can be misdiagnosed as infection or tumor. We present a case of idiopathic CSH mimicking metastatic squamous cell carcinoma in a cervical lymph node and review of literature regarding this rare entity.
METHODS AND RESULTS: The patient was a 70-year-old man with a medical history of squamous cell carcinoma of the right base of the tongue. The patient presented with an enlarged cervical lymph node, which was clinically diagnosed as metastatic carcinoma. At intraoperative consultation, it was unexpectedly discovered that the lymph node exhibited extensive histiocytosis containing crystal materials. Final pathology identified "crystal storing histiocytosis" because of amyloidal depositions. No metastatic carcinoma was seen.
CONCLUSION: After 10 months of follow-up, the patient is disease free. To the best of our knowledge, this unusual clinical presentation is the first to describe CSH mimicking a metastatic carcinoma. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26686203 [PubMed - as supplied by publisher]

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Improving the rate of negative margins after surgery for oral cavity squamous cell carcinoma: A prospective randomized controlled study.

Improving the rate of negative margins after surgery for oral cavity squamous cell carcinoma: A prospective randomized controlled study.

Head Neck. 2015 Dec 21;

Authors: Amit M, Na'ara S, Leider-Trejo L, Akrish S, Cohen JT, Billan S, Gil Z

Abstract
BACKGROUND: A positive margin is among the most significant factors that affects the outcome in head and neck squamous cell carcinoma (SCC). The purpose of this study was to compare the negative margin rates between 2 methods of intraoperative margin assessment in patients with oral cavity SCC.
METHODS: A prospective, randomized controlled trial comparing 2 methods of intraoperative margin assessment: specimen-driven margins and patient-driven margins.
RESULTS: The final analysis included 71 patients, 20 (29%) in the patient-driven margin arm. Frozen section analysis revealed positive/close surgical margins that led to an extension of the surgical resection in 22 of 51 patients (43%) in the specimen-driven margin arm, and 2 of 20 patients (10%) in the patient-driven margin arm (p = .01). After final pathological analysis, the wide negative margin rate was 84% in the specimen-driven margin arm, compared to 55% in the patient-driven margin arm (p = .02). Extension of the surgical resection prevented escalation of adjuvant treatment in 19 patients (38%) in the specimen-driven margin arm and 10% in the patient-driven margin arm.
CONCLUSION: Specimen derived margin assessment led to significant improvement in the rate of negative margins. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26685937 [PubMed - as supplied by publisher]

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Parathyroid carcinoma with contralateral subcutaneous and breast recurrences: A rare presentation.

Parathyroid carcinoma with contralateral subcutaneous and breast recurrences: A rare presentation.

Head Neck. 2015 Dec 21;

Authors: Agarwal S, Kumar T, Sharma MC, Damle NA, Gandhi AK

Abstract
BACKGROUND: Parathyroid carcinoma is extremely rare. Correct preoperative and even histopathological diagnosis may be difficult owing to the deceptively bland cytoarchitectural features, especially when presenting with localized disease. Recurrence/metastases developing years later then make the malignant nature obvious.
METHODS AND RESULTS: We present here an unusual case of a 32-year-old patient with carcinoma of the left upper parathyroid gland, initially diagnosed as parathyroid adenoma, treated with endoscopic left parathyroidectomy, and later developing subcutaneous metastatic nodules over the medial end of the right clavicle and right anterior chest wall, followed by a right breast deposit. The recurrences, especially subcutaneous ones, were probably secondary to tumor seeding along the track of insertion of the endoscope.
CONCLUSION: Involvement of subcutaneous tissue and the breast in parathyroid carcinoma is extremely rare. The case is being reported for its uniqueness along with a discussion of possible appropriate course of management, which may have averted the aggressive clinical course of the disease. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26685878 [PubMed - as supplied by publisher]

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Regulatory effects of WRAP53 on radiosensitivity of laryngeal squamous cell carcinoma cells.

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Regulatory effects of WRAP53 on radiosensitivity of laryngeal squamous cell carcinoma cells.

Asian Pac J Cancer Prev. 2015;16(7):2975-9

Authors: Qiu H, Zhao DY, Yuan LM, Zhang G, Xie CH

Abstract
BACKGROUND: Telomere length is closely associated with cellular radiosensitivity and WRAP53 is required for telomere addition by telomerase. In this research we assessed radiosensitivity of laryngeal squamous cell carcinoma Hep-2 cell lines after WRAP53 inhibition, and analyzed the molecular mechanisms.
MATERIALS AND METHODS: phWRAP53-siRNA and pNeg-siRNA were constructed and transfected into Hep-2 cells with lipofectamine. Expression of WRAP53 was analyzed by RT-PCR and Western-blottin, radiosensitivity of Hep-2 cells was assessed colony formation assay, and the relative length of telomeres was measured by QPCR.
RESULTS: The data revealed that the plasmid of phWRAP53-siRNA was constructed successfully, and the mRNA and protein levels of WRAP53 were both obviously reduced in the Hep-2 cell line transfected with phWRAP53-siRNA. After Hep-2 cells were irradiated with X-rays, the D0 and SF2 were 2.481 and 0.472, respectively, in the phWRAP53-siRNA group, much lower than in the control group (D0 and SF2 of 3.213 and 0.592) (P<0.01). The relative telomere length in the phWRAP53-siRNA group was 0.185±0.01, much lower than in the untreated group (0.523±0.06) and the control group (0.435±0.01).
CONCLUSIONS: Decreasing the expression of WRAP53 using RNA interference technique can enhance the radiosensitivity of Hep-2 cell lines by influencing the telomere length. WRAP53 is expected to be a new target to regulate the radiosensitization of tumor cells.

PMID: 25854392 [PubMed - indexed for MEDLINE]

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Adolescents with vascular frontal lesion: A neuropsychological follow up case study.

Adolescents with vascular frontal lesion: A neuropsychological follow up case study.

Neurocirugia (Astur). 2015 Dec 10;

Authors: Chávez CL, Yáñez G, Catroppa C, Rojas S, Escartin E, Hearps SJ, García A

Abstract
The objective of this research was to identify clinically significant changes in cognitive functions in three adolescents who underwent surgery for resection of a focal vascular lesion in the frontal lobe. Cognitive functions, executive function, behavior regulation, emotion regulation, and social abilities were assessed prior to surgery, six and 24 months post-discharge. Significant clinical changes were observed during all the assessments. Cognitive changes after surgery are not homogeneous. Most of the significant clinical changes were improvements. Especially the significant clinical changes presented in EF domains were only improvements; these results suggest that EF were affected by the vascular lesion and benefitted by the surgery. After resection of a vascular lesion between 15 and 16 years of age the affected executive functions can continue the maturation process. Our results highlight the importance that assessments must include emotional aspects, even if deficits in these domains are not presented in the acute phase. Rehabilitation methods should promote the development of skills that help patients and their families to manage the emotional and behavioral changes that emerge once they are discharged from the hospital.

PMID: 26687848 [PubMed - as supplied by publisher]

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[Prognostic variability in atypical meningioma with complete resection. Proposed treatment algorithm].

[Prognostic variability in atypical meningioma with complete resection. Proposed treatment algorithm].

Neurocirugia (Astur). 2015 Dec 10;

Authors: Real-Peña L, Talamantes Escribá F, Quilis-Quesada V, González-Darder JM

Abstract
OBJECTIVE: The authors attempt to show how the current prognostic factors that try to assess the risk of recurrence of atypical meningiomas are insufficient to predict the future of this disease.
MATERIALS AND METHOD: Using data obtained from hospital databases, a sample of 27 patients was obtained with pathological diagnosis of atypical meningioma, and who had a minimum follow-up time of 6months after diagnosis. Later prognostic factors (age <50years, male gender, bone involvement, peri-lesional swelling, tumour volume, location, Ki67/MIB-1) were evaluated after the stratification of patients undergoing complete resection in recurrencies and non-recurrencies. Univariate analysis was performed using Mann-Whitney test, χ(2) homogeneity test/Fisher exact test. Finally, multivariate analysis was performed using binary logistic regression to obtain the values for R(2) Nagelkerke and the Hosmer-Lemeshow to evaluate the goodness of fit.
RESULTS: The uni- and multivariate analysis showed no statistically significant differences between recurrent and non-recurrent subgroups of patients undergoing complete resection. It is noted in the results that for each year of age above 50years, the risk of recurrence is decreased by 5.8%.
CONCLUSIONS: Although current prognostic factors may show an increased risk of recurrence once patients are stratified by the two most important factors (pathology and extent of resection), those factors are insufficient to predict the ultimate outcome of patients affected by this pathology.

PMID: 26687847 [PubMed - as supplied by publisher]

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Fluid Therapy: Double-Edged Sword during Critical Care?

Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.

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Effect of Short-Term Stimulation with Interleukin-1β and Differentiation Medium on Human Mesenchymal Stromal Cell Paracrine Activity in Coculture with Osteoblasts

Introduction. Human mesenchymal stromal cells (hMSCs) exhibit the potential to accelerate bone healing by enhanced osteogenic differentiation. Interleukin-1β is highly expressed during fracture healing and has been demonstrated to exert a significant impact on the differentiation behaviour of hMSCs. Here, we investigate the effect of 2-hour IL-1β stimulation on the differentiation and paracrine activity of hMSCs in coculture with osteosarcoma cells in vitro. Methods. hMSCs from 3 donors were incubated for 2 hours with 10 ng/mL IL-1β and subsequently cocultured with MG63-GFP cells either in control or in differentiation medium in a transwell system for 28 days. Genetic and functional effects were investigated. Results. hMSCs cultured in control medium exhibited a regulatory effect on cocultured MG63-GFP cells, resulting in upregulation of osteogenic gene expression in combination with increased ALP activity. However, while stimulated hMSCs cultured under differentiation conditions exhibit signs of osteogenic differentiation, osteogenic differentiation also caused an impaired regulatory effect on the cocultured MG63-GFP cells. Conclusion. Short stimulation of hMSCs has the potential to modify their long-term behaviour. In addition, undifferentiated hMSCs are able to regulate osteoblast differentiation; however, this regulatory function is lost upon osteogenic differentiation in vitro. This offers a novel approach for clinical cell therapy protocols.

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Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial

Background: Bone and joint infection in adults arises most commonly as a complication of joint replacement surgery, fracture fixation and diabetic foot infection. The associated morbidity can be devastating to patients and costs the National Health Service an estimated £20,000 to £40,000 per patient.Current standard of care in most UK centres includes a prolonged course (4–6 weeks) of intravenous antibiotics supported, if available, by an outpatient parenteral antibiotic therapy service. Intravenous therapy carries with it substantial risks and inconvenience to patients, and the antibiotic-related costs are approximately ten times that of oral therapy. Despite this, there is no evidence to suggest that oral therapy results in inferior outcomes.We hypothesise that, by selecting oral agents with high bioavailability, good tissue penetration and activity against the known or likely pathogens, key outcomes in patients managed primarily with oral therapy are non-inferior to those in patients treated by intravenous therapy. Methods: The OVIVA trial is a parallel group, randomised (1:1), un-blinded, non-inferiority trial conducted in thirty hospitals across the UK. Eligible participants are adults (>18 years) with a clinical syndrome consistent with a bone, joint or metalware-associated infection who have received ≤7 days of intravenous antibiotic therapy from the date of definitive surgery (or the start of planned curative therapy in patients treated without surgical intervention). Participants are randomised to receive either oral or intravenous antibiotics, selected by a specialist infection physician, for the first 6 weeks of therapy. The primary outcome measure is definite treatment failure within one year of randomisation, as assessed by a blinded endpoint committee, according to pre-defined microbiological, histological and clinical criteria. Enrolling 1,050 subjects will provide 90 % power to demonstrate non-inferiority, defined as less than 7.5 % absolute increase in treatment failure rate in patients randomised to oral therapy as compared to intravenous therapy (one-sided alpha of 0.05).DiscussionIf our results demonstrate non-inferiority of orally administered antibiotic therapy, this trial is likely to facilitate a dramatically improved patient experience and alleviate a substantial financial burden on healthcare services.Trial registrationISRCTN91566927 - 14/02/2013

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Fluid loading in abdominal surgery - saline versus hydroxyethyl starch (FLASH Trial): study protocol for a randomized controlled trial

Background: Inappropriate fluid therapy during surgery is associated with significant morbidity and mortality. Few studies have examined the effects of particular types of fluids (crystalloid or colloid solutions) in surgical patients, especially with the goal of hemodynamic optimization. Isotonic saline is the most commonly used fluid worldwide but may be associated with potential nephrotoxicity. Hydroxyethyl starch (HES) solutions are widely used in surgical patients as a component of goal-directed fluid optimization strategies, but several large multicenter studies have suggested increased rates of acute kidney injury and adverse events with the use of HES in ICU patients. Despite what may be inferred from physiological studies, the benefit and harm of 0.9 % saline and HES during hemodynamic therapy have not been clearly established in surgical patients.Methods/DesignThe FLASH trial is an investigator-initiated, prospective, multicenter, randomized, double-blinded, two-arm trial, randomizing 826 patients with moderate-to-high risk of postoperative complications to receive 6 % HES 130/0.4 or 0.9 % saline during individualized goal-directed fluid optimization. The primary outcome measure is a composite of death or major postoperative complications within 14 days following surgery.The sample size will allow the detection of a 10 % absolute between-group difference in the primary outcome measure with a type 1 error rate of 5 % and power of 95 %, assuming a 5 % mortality rate and 20 % morbidity (thus 25 % for the composite endpoint).DiscussionThe FLASH trial may provide important data on the efficacy and safety of commonly used fluid solutions and could have a significant impact on future treatment of surgical patients.Trial registrationClinicalTrials.gov Identifier: NCT02502773. Registered 16 June 2015.

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Comparing cognitive behavioural therapy for eating disorders integrated with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a randomised controlled trial

Background: Around 40 % of individuals with eating disorders of recurrent binge eating, namely bulimia nervosa and binge eating disorder, are obese. In contrast to binge eating disorder, currently there is no evidence base for weight management or weight loss psychological therapies in the treatment of bulimia nervosa despite their efficacy in binge eating disorder. Thus, a manualised therapy called HAPIFED (Healthy APproach to weIght management and Food in Eating Disorders) has been developed. HAPIFED integrates the leading evidence-based psychological therapies, cognitive behavioural therapy-enhanced (CBT-E) and behavioural weight loss treatment (BWLT) for binge eating disorder and obesity respectively. The aim of the present study is to detail the protocol for a randomised controlled trial (RCT) of HAPIFED versus CBT-E for people with bulimia nervosa and binge eating disorder who are overweight/obese.Method/DesignA single-blind superiority RCT is proposed. One hundred Brazilian participants aged ≥ 18 years, with a diagnosis of bulimia nervosa or binge eating disorder, BMI > 27 to < 40 kg/m 2 , will be recruited from both community and clinics and individually randomised to a therapy arm. Five groups of ten participants will receive the experimental intervention (HAPIFED) and the other five groups of ten the control intervention (CBT-E). Both therapies are manualised, and in this RCT will comprise 1 individual session and 29 office-based group sessions over 6 months. Assessment points will be at baseline, end of therapy, and 6 and 12 months after end of therapy. The primary outcome of this intervention will be reduced weight. Secondary outcomes will be improved metabolic indicators of weight management, reduction in eating disorder symptoms including improved control over eating, improved adaptive function, physical and mental health-related quality of life, and reduced levels of depression and anxiety.DiscussionThis study will be the first to investigate a psychological therapy that aims to assist weight management in people with co-morbid overweight or obesity bulimia nervosa as well as with binge eating disorder. It will have the potential to improve health outcomes for the rapidly increasing number of adults with co-morbid obesity and binge eating disorder or bulimia nervosa.Trial registrationUS National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015.

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The Happy Older Latinos are Active (HOLA) health promotion and prevention study: study protocol for a pilot randomized controlled trial

Background: Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos.Methods/DesignHOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). This prevention approach will be tested against a fotonovela, an enhanced psychoeducation control condition, in a sample of Latino elderly with minor or subthreshold depression or anxiety. A total of 60 older Latinos (aged 60+) will be randomized to receive HOLA or the fotonovela. The primary outcomes of interest are recruitment, adherence, retention, and acceptability. Data will also be collected on: preemption of incident and recurrent major depression, generalized anxiety, and social phobia; reduction in depression and anxiety symptom severity; physical functioning; sedentary behaviors; social engagement; and self-efficacy.DiscussionThe results of this study could have implications for other high-risk, highly disadvantaged populations. The development of a health promotion intervention designed to prevent common mental disorders could be a means of addressing multiple disparities (for example, mental health outcomes, mental health service use, stigma) among racial/ethnic minority elderly.ClinicalTrials.gov IdentifierNCT02371954. Date of registration: 21 January 2015.

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Juego estético en Vidas improbables de Felipe Benítez Reyes

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El viento espira desencanto: estudios de literatura española contemporánea

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Assessment of supra-additive effects of cytotoxic drugs and low dose rate irradiation in an in vitro model for hepatocellular carcinoma

The use of 5-fluorouracil, topotecan, or gemcitabine was tested for enhancement of the effects of low dose rate (LDR) irradiation in,in in vitro model for hepatocellular carcinoma. For comparison, all drugs were tested in combination with high dose rate (HDR) gamma-irradiation as well. Multicellular spheroids of HepG2 cells were exposed to HDR or LDR irradiation by means of external beam cobalt-60 or rhenium-188 (Re-188), respectively, dissolved in the Culture medium. Secondly, exposure to irradiation was combined with the cytotoxic drug. Toxicity was evaluated by means of a quantitative spheroid outgrowth assay and histology. For 5-fluorouracil, supra-additive effects were observed in combination with HDR irradiation. With Re-188, the supra-additive toxicity was only transient. For topotecan and Re-188, 110 supra-additive effects were seen, whereas the addition of HDR irradiation at the end of the topotecan exposure yielded lasting supra-additive effects. Incubation with gemcitabine followed by exposure to HDR irradiation, induced a synergistic toxicity on the outgrowth. No supra-additive effects were observed when HDR irradiation was added at the start of the incubation with gemicitabine or combined with LDR irradiation. For all drugs tested, supra-additive effects were observed with HDR irradiation if the timing of the irradiation was appropriate. For Re-188, no lasting supra-additive effects were observed.

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Screening for supra-additive effects of cytotoxic drugs and gamma irradiation in an in vitro model for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. A wide variety of treatment modalities is available for palliative therapy of HCC, although there is no strong evidence that these treatments can have a significant impact on survival. The aim of this work was to screen cytotoxic drugs relevant in the treatment of HCC for enhancement of the effect of irradiation in an in vitro model. As the majority of patients presenting with HCC suffer reduced liver function, attention was paid to low-dose effects of the cytotoxic drugs tested. To reflect this situation in vivo, multicellular tumor aggregates or "spheroids" of HepG2 cells were cultured and exposed to gamma irradiation alone or in combination with cisplatin for 4 h, gemcitabin for 4 or 24 h, or 5-fluorouracil for 4 h. In one experiment, the spheroids were cultured for 4 weeks in multiwell plates that allowed adhesion. Measurement of two-dimensional spheroid outgrowth was made every week for each spheroid. This kind of growth depends on the proliferation and motility of the cells that form the spheroid. In a second experiment, toxicity was evaluated by comparative growth curves by means of a three-dimensional growth assay and by histology. Supra-additive effects lasting for 4 weeks were observed for all drugs tested in combination with a gamma irradiation of 10 Gy.

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Isolation, proliferation and differentiation of osteoblastic cells to study cell/biomaterial interactions: comparison of different isolation techniques and source

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Chromosomal radiosensitivity in breast cancer patients with a known or putative genetic predisposition

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Cathepsin B-mediated activation of the proinflammatory caspase-11

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Invasiveness of hyperplastic nodule cells from diethylnitrosamine treated rat liver

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Human papillomavirus (HPV)-induced neoplasia in the urinary bladder: a missing link?

Human papillomavirus (HPV)-induced neoplasia in the urinary bladder: a missing link?

Histol Histopathol. 2015 Dec 21;:11715

Authors: Alexander RE, Wang L, Lopez-Beltran A, Emerson RE, Montironi R, Pedrosa JA, Kaimakliotis HZ, Koch MO, Cheng L

Abstract
The discovery that the role human papillomavirus (HPV) plays in the induction of human cancer represents an important achievement in oncologic research. It has taken on even greater importance since the development of vaccines, which promise the hope of preventing these cancers from ever occurring. Because of these important implications, many have attempted to determine a possible role for the virus in cancers of the urinary bladder-an organ in close anatomic proximity to the primary sites of HPV-induced neoplasia and one which already has an established oncogenic infectious agent in Schistosoma haematobium. Here we review the current literature exploring this possible role in the most common subtype of cancer of the urinary bladder, urothelial carcinoma, and two much more rare histologic subtypes that have well established roles for HPV-induced neoplasia in other anatomic sites-squamous cell carcinoma and adenocarcinoma.

PMID: 26687533 [PubMed - as supplied by publisher]

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Intra-abdominal pressure reduction after percutaneous catheter drainage is a protective factor for severe pancreatitis patients with sterile fluid collections

Pancreas

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Comparison of 10-day sequential therapy with 7-day standard triple therapy for Helicobacter pylori eradication in inactive peptic ulcer disease and the efficiency of sequential therapy in inactive peptic ulcer disease and non-ulcer dyspepsia

BMC Gastroenterology

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Aldehyde dehydrogenase 1B1 as a modulator of pancreatic adenocarcinoma

Pancreas

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Hepatitis C virus as a systemic disease: Reaching beyond the liver

Hepatology International

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Genetic variants in IL12 influence both hepatitis B virus clearance and HBV-related hepatocellular carcinoma development in a Chinese male population

Tumor Biology

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The long-term functional consequences of acute infectious diarrhea

Current Opinion in Gastroenterology

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Respiratory infections by Enterovirus D68 in outpatients and inpatients Spanish children

The Pediatric Infectious Disease Journal

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Hepatitis B and C virus-induced hepatitis: Apoptosis, autophagy, and unfolded protein response

World Journal of Gastroenterology

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Baseline abnormal liver function tests are more important than age in the development of isoniazid-induced hepatoxicity for patients receiving preventive therapy for latent tuberculosis infection

Internal Medicine Journal

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Colorectal cancer, comorbidity, and risk of venous thromboembolism: assessment of biological interactions in a Danish nationwide cohort

British Journal of Cancer

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Low expression of N-myc downstream-regulated gene 2 (NDRG2) correlates with poor prognosis in hepatoblastoma

Hepatology International

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Difficulty of predicting the presence of lymph node metastases in patients with clinical early stage gastric cancer: a case control study

BMC Cancer

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The burden of anaemia in patients with inflammatory bowel diseases

Digestive and Liver Diseases

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Identification and phylogeny of the first T cell epitope identified from a human gut bacteroides species

PLOS ONE

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Impact of intratumoral inflammation on survival after pancreatic cancer resection

Pancreas

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Computer-aided diagnosis for estimating the malignancy grade of hepatocellular carcinoma using contrast-enhanced ultrasound: An ROC observer study

Liver International

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Elevated serum soluble CD14 levels in chronic HBV infection are significantly associated with HBV-related hepatocellular carcinoma

Tumor Biology

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Investigating the association between periodontal disease and risk of pancreatic cancer

Pancreas

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Elevation of gamma-glutamyl transferase in adult: Should we think about progressive familiar intrahepatic cholestasis?

Digestive and Liver Diseases

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