Medicamentos del año 2004. Perspectiva histórica de la investigación y el desarrollo

Medicines of the year 2004. Historical perspective of the investigation and the developmentMedicamentos del año 2004. Perspectiva histórica de la investigación y el desarroll

Strict Selection Alone of Patients Undergoing Liver Transplantation for Hilar Cholangiocarcinoma is Associated with Improved Survival

Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between 1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR). Twenty-one centers reported 173 patients (69%) of a total of 249 patients in the ELTR. Twenty-six patients were wrongly coded, resulting in a study group of 147 patients. We identified 28 patients (19%) who met the strict selection criteria of the Mayo Clinic protocol, but had not undergone neo-adjuvant chemoradiation therapy. Five-year survival in this subgroup was 59%, which is comparable to patients with pretreatment pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic. In conclusion, although the results should be cautiously interpreted, this study suggests that with strict selection alone, improved survival after transplantation can be achieved, approaching the Mayo Clinic experience

Strict Selection Alone of Patients Undergoing Liver Transplantation for Hilar Cholangiocarcinoma Is Associated with Improved Survival

Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR). Twenty-one centers reported 173 patients (69%) of a total of 249 patients in the ELTR. Twenty-six patients were wrongly coded, resulting in a study group of 147 patients. We identified 28 patients (19%) who met the strict selection criteria of the Mayo Clinic protocol, but had not undergone neo-adjuvant chemoradiation therapy. Five–year survival in this subgroup was 59%, which is comparable to patients with pretreatment pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic. In conclusion, although the results should be cautiously interpreted, this study suggests that with strict selection alone, improved survival after transplantation can be achieved, approaching the Mayo Clinic experience

Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry

Background: Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. This study aimed to investigate the prognostic value of micro and macrovascular invasion in a large database material. Methods: Patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database were included. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses. Results: Of 23,124 patients transplanted for HCC, 9324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without micro or macrovascular invasion still had a five-year overall survival of 65.8%. Conclusion: Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, microvascular invasion may be used for selecting patients for transplantation in the future

On Scottish sawflies, with results of the 14th International Sawfly Workshop, in the southern Highlands, 2010 (Hymenoptera, Symphyta).

Die Ergebnisse der Feldarbeit aus dem 14. Internationalen Sawfly Workshop werden vorgestellt. Dies fand im südlichen schottischen Hochland, überwiegend in Perthshire, statt. Einige Nachweise von Pflanzenwespen aus anderen Teilen von Schottland sind enthalten. Erstnachweise für die Britischen Inseln werden für acht tenthredinide Arten erbracht: Amauronematus mimus, Phyllocolpa alienata, P. erythropyga, P. plicalapponum, P. plicaphylicifolia, P. prussica, Pristiphora thalictri und Tenthredo ignobilis. A. mimus ist auch aus Irland nachgewiesen. Amauronematus stenogaster ist aus der Liste der Symphyta der Britischen Inseln zu entfernen. Erstmalig sind in Schottland eine Cephiden-Art (Hartigia xanthostoma) und zehn Tenthrediniden gefunden worden (Claremontia uncta, Dolerus brevicornis, Empria basalis, Empria parvula, Parna apicalis, Pristiphora decipiens, Pristiphora leucopus, Pristiphora testacea, Tenthredo mandibularis und Tenthredopsis ornata). Merkmale für die Unterscheidung einzelner Arten werden dargestellt. Der Locus typicus von Nematus herbaceae Cameron, 1876 ist geklärt. Geranium pratense ist als Wirtspflanze von Macrophya albipuncta bestätigt. Salix reticulata ist eine Wirtspflanze von Amauronematus mcluckieae. Sedum rosea kann eine Wirtspflanze von Tenthredo ignobilis sein. Allgemeine Schlussfolgerungen: hoher Artenreichtum der Pflanzenwespenfauna von Perthshire im Vergleich zu anderen Regionen in Schottland, darunter mehrere Arten, die auf den Britischen Inseln nur von dort bekannt sind; die Wichtigkeit der Erhaltung der Lebensräume von Felssimsen; große Defizite in unseren Kenntnissen bei vielen Arten, insbesondere zu Wirtspflanzen, Phänologie und Verbreitung; hoher Wert der Malaise-Falle in faunistischen Untersuchungen von Symphyta, weil das Spektrum von erfassten Taxa sich unterscheidet von dem was mit Streifnetz erfasst wird; Zusammensetzung des 'fall-out’ auf Schneeresten deutet darauf hin, dass Pflanzenwespen in einem größeren Ausmaß als bisher angenommen, aktiver Dispersion innerhalb von Landmassen unterliegen.StichwörterBritish Isles, Cephidae, Pamphiliidae, Tenthredinoidea, hosts, phenology, distribution.Results of fieldwork are presented from the 14th International Sawfly Workshop, held in the southern Highlands of Scotland, mostly in Perthshire. Some records of Symphyta from other parts of Scotland are included. First records in the British Isles are given for eight tenthredinid species: Amauronematus mimus, Phyllocolpa alienata, P. erythropyga, P. plicalapponum, P. plicaphylicifolia, P. prussica, Pristiphora thalictri and Tenthredo ignobilis. A. mimus is also recorded from Ireland. Amauronematus stenogaster is removed from the list of British Isles Symphyta. Recorded for the first time in Scotland are one cephid (Hartigia xanthostoma) and ten tenthredinids (Claremontia uncta, Dolerus brevicornis, Empria basalis, Empria parvula, Parna apicalis, Pristiphora decipiens, Pristiphora leucopus, Pristiphora testacea, Tenthredo mandibularis and Tenthredopsis ornata). Characters useful for the distinction of some species are illustrated. The type locality of Nematus herbaceae Cameron, 1876 is clarified. Geranium pratense is confirmed as a host of Macrophya albipuncta. Salix reticulata is a host of Amauronematus mcluckieae [mandatory correction of spelling of species name]. Sedum rosea may be a host of Tenthredo ignobilis. General conclusions: high species richness of Perthshire sawfly fauna compared to other regions of Scotland, including several species only known in British Isles from there; importance to conservation of rock-ledge habitats; large data deficits for many species, particularly on hosts, phenology and distribution; high value of Malaise traps in faunal survey of Symphyta, because spectrum of taxa captured differs from that recorded by hand-netting; as indicated by species and sex composition of ‘fall-out’ on snow patches, adult sawflies undertake active dispersal, within landmasses, to a greater extent than is often assumed.KeywordsBritish Isles, Cephidae, Pamphiliidae, Tenthredinoidea, hosts, phenology, distribution

Pedoarqueologia em ambiente carstico, sítio arqueológico samambaia, região de Lagoa Santa, Minas Gerais, Brasil.

Os sítios arqueológicos de Minas Gerais foram muito importantes para o desenvolvimento da arqueologia brasileira e mundial. Peter W.Lund, foi o primeiro grande pesquisador a estudar a região em 1835. Em meados do século XX, escavações amadorísticas puseram a descoberto no sítio Samambaia, na região cárstica de Lagoa Santa no Estado de Minas Gerais, Brasil, vestígios arqueológicos diversos nos níveis superiores, ossadas de animais extintos nos níveis inferiores e ossos humanos. Nos dias de hoje as partes remanescentes dos níveis holocênicos do sítio Samambaia apresentam material siltoso pulverulento, com aparência de cinza de fogueira. Este trabalho tem o objetivo de analisar as características químicas e físicas deste material. Com as análises feitas foi possível concluir que sua origem é heterogênea. Parte do material tem origem coluvial (o que é indicado pelos altos teores totais de Al e presença de quartzo rolado). A atividade antrópica pré-histórica, por sua vez, decorrente da instalação de fogueiras, é atestada pelos altos teores de K disponível e total, assim como pela presença de minerais magnéticos que são produto da redução e recristalização de óxidos de Fe em pirólise

Comparative antimicrobial susceptibility of aerobic and facultative bacteria from community-acquired bacteremia to ertapenem in Taiwan

<p>Abstract</p> <p>Background</p> <p>Ertapenem is a once-a-day carbapenem and has excellent activity against many gram-positive and gram-negative aerobic, facultative, and anaerobic bacteria. The susceptibility of isolates of community-acquired bacteremia to ertapenem has not been reported yet. The present study assesses the in vitro activity of ertapenem against aerobic and facultative bacterial pathogens isolated from patients with community-acquired bacteremia by determining and comparing the MICs of cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin. The prevalence of extended broad spectrum β-lactamases (ESBL) producing strains of community-acquired bacteremia and their susceptibility to these antibiotics are investigated.</p> <p>Methods</p> <p>Aerobic and facultative bacteria isolated from blood obtained from hospitalized patients with community-acquired bacteremia within 48 hours of admission between August 1, 2004 and September 30, 2004 in Chang Gung Memorial Hospital at Keelung, Taiwan, were identified using standard procedures. Antimicrobial susceptibility was evaluated by Etest according to the standard guidelines provided by the manufacturer and document M100-S16 Performance Standards of the Clinical Laboratory of Standard Institute. Antimicrobial agents including cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin were used against the bacterial isolates to test their MICs as determined by Etest. For <it>Staphylococcus aureus </it>isolates, MICs of oxacillin were also tested by Etest to differentiate oxacillin-sensitive and oxacillin-resistant <it>S. aureus</it>.</p> <p>Results</p> <p>Ertapenem was highly active in vitro against many aerobic and facultative bacterial pathogens commonly recovered from patients with community-acquired bacteremia (128/159, 80.5 %). Ertapenem had more potent activity than ceftriaxone, piperacillin-tazobactam, or ciprofloxacin against oxacillin-susceptible <it>S</it>. <it>aureus </it>(17/17, 100%)and was more active than any of these agents against <it>enterobacteriaceae </it>(82/82, 100%).</p> <p>Conclusion</p> <p>Based on the microbiology pattern of community-acquired bacteremia, initial empiric treatment that requires coverage of a broad spectrum of both gram-negative and gram-positive aerobic bacteria, such as ertapenem, may be justified in moderately severe cases of community-acquired bacteremia in non-immunocompromised hosts.</p

Dog Burials Associated with Human Burials in the West Indies during the Early Pre-Columbian Ceramic Age (500 BC-600 AD)

Across the Caribbean, the widespread presence of canine remains at archaeological sites from the Saladoid period raises questions about the role of “man’s best friend.” Dog (Canis familiaris) remains have been found located in both refuse middens and burials adjacent to human graves in a number of sites in the French Antilles and Barbuda, West Indies. This paper will critically examine dog remains and discuss the varied duality of the dog’s role in the Saladoid world: from food source to lifelong companion. The importance of dogs within Amerindian sites from Saint Martin, the Guadeloupe archipelago, Martinique and Barbuda will be explored from a zooarchaeological perspective, concluding with a critical discussion of changes in cultural patterns, as seen through the decline in dog remains during the Troumassoid and Suazoid period at the sites in the French Antilles. Résumé Sépultures de chiens associées à des sépultures humaines dans les Petites Antilles à l’Âge du Néoindien ancien (500 av. – 600 ap. J.-C.). Dans les Antilles, la présence généralisée de restes de chiens sur les sites de la période céramique ancienne Saladoïde soulève des questions sur le rôle de ce « meilleur ami de l’homme ». En effet, des chiens (Canis familiaris) ont été trouvés aussi bien dans des zones de rejets, qu’enterrés aux côtés de sépultures humaines dans un certain nombre de sites des Petites Antilles. Ce document examinera ces restes de chiens de façon critique et décrira les morphologies particulières des chiens des sites amérindiens de l’île de Saint-Martin, l\u27archipel de la Guadeloupe, la Martinique et de l’île de Barbuda, dans une perspective archéozoologique. Une discussion critique portera sur l\u27évolution des changements des modèles culturels, comme celui de la chute drastique des chiens enterrés pendant les périodes archéologiques plus tardives, Troumassoïde et Suazoïde, des sites des Antilles françaises. Enfin, la discussion portera sur la dualité du rôle du chien dans le monde Saladoïde, à la fois source de nourriture et compagnon de vie