Impact of Solitary Involved Lymph Node on Outcome in Localized Cancer of the Esophagus and Esophagogastric Junction

Node-positive esophageal cancer is associated with a dismal prognosis. The impact of a solitary involved node, however, is unclear, and this study examined the implications of a solitary node compared with greater nodal involvement and node-negative disease. The clinical and pathologic details of 604 patients were entered prospectively into a database from1993 and 2005. Four pathologic groups were analyzed: node-negative, one lymph node positive, two or three lymph nodes positive, and greater than three lymph nodes positive. Three hundred and fifteen patients (52%) were node-positive and 289 were node-negative. The median survival was 26 months in the node-negative group. Patients (n = 84) who had one node positive had a median survival of 16 months (p = 0.03 vs node-negative). Eighty-four patients who had two or three nodes positive had a median survival of 11 months compared with a median survival of 8 months in the 146 patients who had greater than three nodes positive (p = 0.01). The survival of patients with one node positive [number of nodes (N) = 1] was also significantly greater than the survival of patients with 2–3 nodes positive (N = 2–3) (p = 0.049) and greater than three nodes positive (p < 0001). The presence of a solitary involved lymph node has a negative impact on survival compared with node-negative disease, but it is associated with significantly improved overall survival compared with all other nodal groups

Relative efficacy of topical non-steroidal anti-inflammatory drugs and topical capsaicin in osteoarthritis: protocol for an individual patient data meta-analysis

Background Pain is the most troubling issue to patients with osteoarthritis (OA), yet current pharmacological treatments offer only small-to-moderate pain reduction. Current guidelines therefore emphasise the need to identify predictors of treatment response. In line with these recommendations, an individual patient data (IPD) meta-analysis will be conducted. The study aims to investigate the relative treatment effects of topical non-steroidal anti-inflammatory drugs (NSAIDs) and topical capsaicin in OA and to identify patient-level predictors of treatment response. Methods IPD will be collected from randomised controlled trials (RCTs) of topical NSAIDs and capsaicin in OA. Multilevel regression modelling will be conducted to determine predictors for the specific and the overall treatment effect. Discussion Through the identification of treatment responders, this IPD meta-analysis may improve the current understanding of the pain mechanisms in OA and guide clinical decision-making. Identifying and prescribing the treatment most likely to be beneficial for an individual with OA will improve the efficiency of patient management

Changes in Whole Blood Gene Expression in Obese Subjects with Type 2 Diabetes Following Bariatric Surgery: a Pilot Study

A pilot study was performed in order to investigate the effects of bariatric surgery on whole blood gene expression profiles in obese subjects with type 2 diabetes.Whole blood from eleven obese subjects with type 2 diabetes was collected in PAXgene tubes prior to and 6-12 months after bariatric surgery. Total RNA was isolated, amplified, labeled and hybridized to Illumina gene expression microarrays. Clinical and expression data were analyzed using a paired t-test, and correlations between changes in clinical trait and transcript levels were calculated. Pathways were identified using Ingenuity Pathway Analysis and DAVID gene ontology software. Overall, bariatric surgery resulted in significant reduction of body mass index, fasting plasma glucose, fasting plasma insulin, and normalization of glycosylated hemoglobin levels. The expression levels of 204 transcripts, representing 200 unique genes, were significantly altered after bariatric surgery. Among the significantly regulated genes were GGT1, CAMP, DEFA1, LCN2, TP53, PDSS1, OLR1, CNTNAP5, DHCR24, HHAT and SARDH, which have been previously implicated in lipid metabolism, obesity and/or type 2 diabetes. Selected findings were replicated by quantitative real-time-PCR. The changes in expression of seven transcripts, WDR35, FLF45244, DHCR24, TIGD7, TOPBP1, TSHZ1, and FAM8A1 were strongly correlated with the changes in body weight, fasting plasma glucose and glycosylated hemoglobin content. The top pathways associated with gene expression changes after bariatric surgery was lipid metabolism, small molecule biochemistry and gene expression. Two antimicrobial peptides were among the transcripts with the largest changes in gene expression after bariatric surgery.Data from this pilot study suggest that whole blood expression levels of specific transcripts may be useful as biomarkers associated with susceptibility for type 2 diabetes and/or therapeutic response

Compensatory T Cell Responses in IRG-Deficient Mice Prevent Sustained Chlamydia trachomatis Infections

The obligate intracellular pathogen Chlamydia trachomatis is the most common cause of bacterial sexually transmitted diseases in the United States. In women C. trachomatis can establish persistent genital infections that lead to pelvic inflammatory disease and sterility. In contrast to natural infections in humans, experimentally induced infections with C. trachomatis in mice are rapidly cleared. The cytokine interferon-γ (IFNγ) plays a critical role in the clearance of C. trachomatis infections in mice. Because IFNγ induces an antimicrobial defense system in mice but not in humans that is composed of a large family of Immunity Related GTPases (IRGs), we questioned whether mice deficient in IRG immunity would develop persistent infections with C. trachomatis as observed in human patients. We found that IRG-deficient Irgm1/m3(-/-) mice transiently develop high bacterial burden post intrauterine infection, but subsequently clear the infection more efficiently than wildtype mice. We show that the delayed but highly effective clearance of intrauterine C. trachomatis infections in Irgm1/m3(-/-) mice is dependent on an exacerbated CD4+ T cell response. These findings indicate that the absence of the predominant murine innate effector mechanism restricting C. trachomatis growth inside epithelial cells results in a compensatory adaptive immune response, which is at least in part driven by CD4+ T cells and prevents the establishment of a persistent infection in mice

Biophilic architecture: a review of the rationale and outcomes

Contemporary cities have high stress levels, mental health issues, high crime levels and ill health, while the built environment shows increasing problems with urban heat island effects and air and water pollution. Emerging from these concerns is a new set of design principles and practices where nature needs to play a bigger part called “biophilic architecture”. This design approach asserts that humans have an innate connection with nature that can assist to make buildings and cities more effective human abodes. This paper examines the evidence for this innate human psychological and physiological link to nature and then assesses the emerging research supporting the multiple social, environmental and economic benefits of biophilic architecture

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

Small-variation Linear Model Of The Three-phase Double-fed Induction Motor Uner Synchronous Operation: Stability

The double-fed induction motor (DFIM) is analysed in this paper with regard to stability. Firstly, its characteristic equation is obtained by means of a linear model for small variations, with the stator resistance equal to zero. The range of speeds for which the DFIM/Load system presents stable synchronous operation is obtained by applying the Routh-Hurwitz Criterion to the characteristic equation. Secondly, by employing the equation for the steady-state electromagnetic torque, with a non-zero stator resistance, another range of speeds giving stable synchronous operation is obtained, and confirmed by some experimental results. In order to confirm the stability, some results of the DFIM/Load system simulation and the characteristic equation root-locus are also presented. Copyright © 2005 John Wiley & Sons, Ltd.154325342Holmes, P.G., Elsonbaty, N.A., Cyclo-convertor-excited divided-winding doubly-fed machine as a wind-power converter (1984) IEE Proceedings B - Electric Power Applications, 131, pp. 61-69Krause, P.C., Wasynczuk, O., Sudhoff, S.D., (1995) Analysis of Electric Machinery, , IEEE Press: New York, U.S.AGonzaga, D.P., Burian Jr., Y., Simulation of the 3-phase double-feed induction motor (DFIM): A range of stable synchronous operation (2001) IEEE - Canadian Conference on Electrical and Computer Engineering, pp. 539-544. , Toronto, Canada, Proc. (CD-ROM)Slemon, G.R., (1966) Magnetoelectric Devices: Transducers, Transformers and Machines, , Wiley: New YorkLyon, W.V., (1952) Transient Analysis of Alternating-Current Machinery: An Application of the Method of Symmetrical Components, , Wiley: New YorkDorf, R.C., Bishop, R.H., (1998) Modern Control Systems, 8th Edn., , Addison-Wesley-Longman: Menlo Park, U.S.ANetushil, A., (1978) Theory of Automatic Control, , MIR: Moscow, USSRPrescott, J.C., Raju, B.P., The inherent instability of induction motor under conditions of doubly-supply (1958) IEE Proceedings C, 105, pp. 319-330Nelson, R.H., Lipo, T.A., Krause, P.C., Stability analysis of a symmetrical induction machine (1969) IEEE Transactions on Power Apparatus and Systems, 88, pp. 1710-171

Novas perspectivas no estadiamento e tratamento do câncer de esôfago New perspectives in esophageal cancer staging and treatment

INTRODUÇÃO: O câncer de esôfago apresenta-se como uma das neoplasias mais freqüentes e letais. O acometimento linfático aparece como principal fator individual de pior prognóstico, sendo a esofagectomia com linfadenectomia extensa ainda seu tratamento de escolha. Ressecções mais extensas através da toracotomia estão associadas com maior sobrevida, mas apresentam altas taxas de morbimortalidade. O conceito de micrometástases pode nos trazer avaliação mais acurada do estadiamento dos tumores operados, com detecção através de imunoistoquímica ou reação em cadeia de polimerase de metástases não diagnosticadas pelos métodos convencionais. MÉTODOS: Realizou-se revisão bibliográfica de artigos científicos publicados e disponíveis no PubMed, através do site www.pubmed.gov. cruzando-se os descritores neoplasias esofágicas, biologia molecular, estadiamento de neoplasias, linfonodo sentinela, metástase linfática. REVISÃO DA LITERATURA: O conceito do linfonodo sentinela, onde se pesquisa durante a cirurgia os possíveis primeiros sítios de metástases, direcionando desta maneira a rota da ressecção linfática no intuito de permitir ressecções completas não necessariamente extensas, possibilita diminuir a morbimortalidade e restringir as indicações de procedimentos muitas vezes super-dimensionados que podem não trazer benefício aos pacientes. CONCLUSÃO: O estadiamento preciso através da procura de micrometástase e o tratamento mais regrado pelo método do linfonodo sentinela, podem trazer novas perspectivas no tratamento do câncer de esôfago, principalmente em casos de tumores precoces.<br>BACKGROUND: The esophageal cancer presents as one of the most frequent and lethal neoplasia. Lymphatic involvement appears to be the principal individual factor for poor prognosis, thus esophagectomy with extensive lymphadenectomy still is the choice treatment. Thoracotomy for extensive resection is related to higher survival rate, as well as higher morbid-mortality rates. Micrometastasis concept involves a more accurate staging method for resected tumors, using immunohistochemistry or polymerase chain reaction techniques, which were not diagnosed by conventional methods. METHODS: A literature review was made over scientific articles published and available at PubMed site (www.pubmed.gov), crossing the following headings: esophageal neoplasm, molecular biology, neoplasm staging, sentinel lymph node, lymphatic metastasis. LITERATURE REVIEW: Sentinel lymph node concept consist of intraoperative identification of possible primary dissemination metastasis sites, thus guiding to a more complete and not so extensively lymphatic resection, decreasing morbid-mortality and restraining an over-dimensioned procedure that may not benefit the patient. CONCLUSION: Accurate staging by micrometastasis identification and precise treatment using sentinel lymph node method may bring new perspectives in the esophageal cancer treatment, especially on early-stages tumors

Hierarchical organization of perylene bisimides and polyoxometalates for photo-assisted water oxidation

The oxygen in Earth\u2019s atmosphere is there primarily because of water oxidation performed by photosynthetic organisms using solar light and one specialized protein complex, photosystem II (PSII). High-resolution imaging of the PSII \u2018core\u2019 complex shows the ideal co-localization of multi-chromophore light-harvesting antennas with the functional reaction centre. Man-made systems are still far from replicating the complexity of PSII, as the majority of PSII mimetics have been limited to photocatalytic dyads based on a 1:1 ratio of a light absorber, generally a Ru\u2013polypyridine complex, with a water oxidation catalyst. Here we report the self-assembly of multi-perylene-bisimide chromophores (PBI) shaped to function by interaction with a polyoxometalate water-oxidation catalyst (Ru4POM). The resulting [PBI]5Ru4POM complex shows a robust amphiphilic structure and dynamic aggregation into large two-dimensional paracrystalline domains, a redshifted light-harvesting efficiency of >40% and favourable exciton accumulation, with a peak quantum efficiency using \u2018green\u2019 photons (\u3bb > 500 nm). The modularity of the building blocks and the simplicity of the non-covalent chemistry offer opportunities for innovation in artificial photosynthesis