Corrección anterior aislada con instrumentación TSRH en el tratamiento de la escoliosis idiopática

Se presentan los resultados de 14 enfermos con escoliosis idiopática intervenidos mediante artrodesis anterior aislada con instrumentación TSRH. La serie la componen 10 mujeres y 4 varones con una edad media de 18 años. Las curvas fueron 6 toracolumbares, 5 lumbares y 3 dobles curvas. Se instrumentaron 4,6 vértebras de media. La extensión caudal de la instrumentación llegó a L2 en 1 caso, a L3 en 12 casos y a L4 en 1 caso. En el plano frontal la curva instrumentada pasó de 49° de valor medio preoperatorio a 19° en el postoperatorio final, con una ganancia de 1º respecto al bending. La curva no instrumentada mejoró de 30° en el preoperatorio a 18° en el postoperatorio final, que fue 9° menor de lo esperado con el bending. La descompensación de C7 a la línea central sacra y la descompensación del centro del tronco fue de 0,8 cm y 0,5 cm respectivamente en el preoperatorio y mejoró en ambos parámetros en 0,2 cm. La rotación de la vértebra apical fue de 26° mejorando 10" tras la cirugía. En el plano sagital la lordosis lumbar varió de 53° en el preoperatorio a 46° en el postoperatorio, correspondiendo 4° de esta pérdida al área no instrumentada. La última vértebra instrumentada tenía una inclinación media de 20° y tras la intervención se redujo a 9°. No hubo complicaciones sépticas ni neurológicas y ningún caso de pseudoatrosis o fallo de material.We report the results on 14 patients with idiopathic scoliosis treated by isolated anterior arthrodesis using TSRH instrumentation. The curves were 6 toracolumbar,5 lumbar and 3 double curves. The average vertebrae instrumented was 4.6. The caudalextension of the fusion reached to L2 in 1 case, L1 in 3 cases, L3 in 12 cases and L4 in 1 case. In the frontal plane the curve measured 49° preoperatively and corrected to 19° postoperatively at the end of follow up, 1° more than expected in bending roentgenograms. The upper uninstrumented curve improved from 30" preoperatively to 18° postoperatively, that is 9° less than expected in bending. The disbalance from C7 to the central sacral line and the disbalance of the center of the trunk was 0.8 cm and 0.5 cm and improved in both in 0.2 c. The apical vertebral rotation was 26° diminishing to 10° after surgery. In the sagital plane, lumbar lordosis changed from 53" to 46° postoperatively, being 4º due to the lumbar uninstrumented area. The tilt of the last instrumented vertebrae was 20" and after the procedure reduced to 9°. There were not any septic nor neurological complications and were not found any case of pseudoarthrosis nor instrumentation failure

Personal eBanking Solutions Based on Semantic Web Services

We describe how Semantic Web Service technology can be used for the provision of personal e-banking online services. We describe two deployed applications: an overdraft notification service and a mortgage comparison service. The former accesses the bank accounts of a user as well as utility goods Web sites where invoicing information is stored and estimates whether the user will be in an overdraft situation in the near future, alerting him/her by e-mail or SMS. The latter accesses the mortgage information provided by the heterogeneous Web sites of different banks and allows users to compare them according to different types of criteria. The chapter not only focuses on the technological decisions followed to implement and deploy these services, but also on the added value of applying Semantic Web Services for them

How to make it faster and at lower cost? B2B integration with semantic web services

Web services and service oriented architectures present a new approach to application integration. While it is reasonable inside an enterprise, it has certain deficiencies when applied in a B2B environment. This deficiencies apply to the discovery, invocation and composition phases, which require considerable manual effort. In the paper, we show on example of a mortgage simulator how these deficiencies can be overcome by applying-semantic web services. The application is compatible with the Web Services Modelling Ontology and makes use of an execution environment automating the processes of discovery, composition and invocation of semantic web services, enabling faster and cheaper B2B application integration

Mechanistic target of rapamycin (MTOR) protein expression in the tumor and its microenvironment correlates with more aggressive pathology at cystectomy

Background: The mechanistic target of rapamycin (mTOR) has been implicated in driving tumor biology in multiple malignancies, including urothelial carcinoma (UC). We investigate how mTOR and phosphorylated mTOR (pmTOR) protein expression correlate with chemoresponsiveness in the tumor and its microenvironment at final pathologic staging after neoadjuvant chemotherapy (NAC). Methods: A single-institution retrospective analysis was performed on 62 patients with cT2–4Nany UC undergoing NAC followed by radical cystectomy. Diagnostic (transurethral resection specimens, TURBT) and postchemotherapy radical cystectomy specimens were evaluated for mTOR and pmTOR protein expression using immunohistochemistry of the tumor, peritumoral stroma, and normal surrounding stroma. Protein expression levels were compared between clinical and pathologic stage. Whole transcriptome analysis was performed to evaluate mRNA expression relative to mTOR pathway activation. Results: Baseline levels of mTOR and pmTOR within TURBT specimens were not associated with clinical stage and response to chemotherapy overall. Nonresponders with advanced pathologic stage at cystectomy (ypT2–4/ypTanyN+) had significantly elevated mTOR tumor staining (P = 0.006) and a sustained mTOR and pmTOR staining in the peritumoral and surrounding normal stroma (NS). Several genes relevant to mTOR activity were found to be up-regulated in the tumors of nonresponders. Remarkably, complete responders at cystectomy (ypT0) had significant decreases in both mTOR and pmTOR protein expression in the peritumoral and normal stroma (P = 0.01–0.03). Conclusions: Our results suggest that mTOR pathway activity is increased in tumor and sustained in its microenvironment in patients with adverse pathologic findings at cystectomy. These findings suggest the relevance of targeting this pathway in bladder cancer

A Population-based Study on Lymph Node Retrieval in Patients with Esophageal Cancer: Results from the Dutch Upper Gastrointestinal Cancer Audit

Background: For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. Study Design: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with ≥ 15 LNs. Patients and Results: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57–0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63–0.92]), cN2 category (reference: cN0, 1.32 [1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29–2.32] and 2.15 [1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23–0.36] and 0.43 [0.32–0.59]), hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94 [1.55–2.42] and 3.01 [2.36–3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of ≥ 15 LNs with short-term outcomes. Conclusions: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yield. Retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality

Vedolizumab for Inflammatory Bowel Disease: Two-Year Results of the Initiative on Crohn and Colitis (ICC) Registry, A Nationwide Prospective Observational Cohort Study: ICC Registry – Vedolizumab

Prospective data of vedolizumab treatment for patients with inflammatory bowel disease (IBD) beyond 1 year of treatment is scarce but needed for clinical decision making. We prospectively enrolled 310 patients with IBD (191 with Crohn's disease (CD) and 119 patients with ulcerative colitis (UC)) with a follow-up period of 104 weeks (interquartile range: 103–104) in a nationwide registry. The corticosteroid-free clinical remission rate (Harvey Bradshaw Index ≤ 4, Short Clinical Colitis Activity index ≤ 2) at weeks 52 and 104 were 28% and 19% for CD and 27% and 28% for UC, respectively. Fifty-nine percent maintained corticosteroid-free clinical remission between weeks 52 and 104. Vedolizumab with concomitant immunosuppression showed comparable effectiveness outcomes compared with vedolizumab monotherapy (week 104: 21% vs. 23%; P = 0.77), whereas 8 of 13 severe infections occurred in patients treated with concomitant immunosuppression. To conclude, the clinical effect was 19% for CD and 28% for UC after 2 years of follow-up regardless of concomitant immunosuppression

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

Background: Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods: Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results: A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3–23). Conclusion: Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed

Procyanidins are potent inhibitors of LOX-1: a new player in the French Paradox

Lectin-like oxidized LDL receptor-1 (LOX-1) is an endothelial receptor for oxidized LDL (oxLDL) and plays multiple roles in the development of cardiovascular diseases. We screened more than 400 foodstuff extracts for identifying materials that inhibit oxLDL binding to LOX-1. Results showed that 52 extracts inhibited LOX-1 by more than 70% in cell-free assays. Subsequent cell-based assays revealed that a variety of foodstuffs known to be rich in procyanidins such as grape seed extracts and apple polyphenols, potently inhibited oxLDL uptake in Chinese hamster ovary (CHO) cells expressing LOX-1. Indeed, purified procyanidins significantly inhibited oxLDL binding to LOX-1 while other ingredients of apple polyphenols did not. Moreover, chronic administration of oligomeric procyanidins suppressed lipid accumulation in vascular wall in hypertensive rats fed with high fat diet. These results suggest that procyanidins are LOX-1 inhibitors and LOX-1 inhibition might be a possible underlying mechanism of the well-known vascular protective effects of red wine, the French Paradox