Colorectal liver metastases: Surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial

Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted techniques to eliminate small unresectable colorectal liver metastases (CRLM). Although previous studies labelled thermal ablation inferior to surgical resection, the apparent selection bias when comparing patients with unresectable disease to surgical candidates, the superior safety profile, and the competitive overall survival results for the more recent reports mandate the setup of a randomized controlled trial. The objective of the COLLISION trial is to prove non-inferiority of thermal ablation compared to hepatic resection in patients with at least one resectable and ablatable CRLM and no extrahepatic disease. Methods: In this two-arm, single-blind multi-center phase-III clinical trial, six hundred and eighteen patients with at least one CRLM (≤3cm) will be included to undergo either surgical resection or thermal ablation of appointed target lesion(s) (≤3cm). Primary endpoint is OS (overall survival, intention-to-treat analysis). Main secondary endpoints are overall disease-free survival (DFS), time to progression (TTP), time to local progression (TTLP), primary and assisted technique efficacy (PTE, ATE), procedural morbidity and mortality, length of hospital stay, assessment of pain and quality of life (QoL), cost-effectiveness ratio (ICER) and quality-adjusted life years (QALY). Discussion: If thermal ablation proves to be non-inferior in treating lesions ≤3cm, a switch in treatment-method may lead to a reduction of the post-procedural morbidity and mortality, length of hospital stay and incremental costs without compromising oncological outcome for patients with CRLM. Trial registration:NCT03088150 , January 11th 2017

The effect of adding urea, manganese and linoleic acid to wheat straw and wood chips on lignin degradation by fungi and subsequent <em>in</em> <em>vitro</em> rumen degradation

The aim of this study was optimizing Ceriporiopsis subvermispora and Lentinula edodes pre-treatment of wheat straw and wood chips by adding urea, manganese and linoleic acid. Optimization was defined as more lignin degradation and an increase in in vitro gas production (IVGP), which is a model for rumen degradation, in comparison to fungal treatment without additives. First urea, manganese and linoleic acid were added separately to C. subvermispora or L. edodes treatment of wheat straw and wood chips. Only manganese and linoleic acid addition improved lignin degradation and IVGP compared to the same treatment without additives. Mn (150 μg/g wheat straw) influenced C. subvermispora treatment most. A combination of manganese and linoleic acid was also applied since both act on manganese peroxidase. This combination did indeed increase lignin degradation in wheat straw by C. subvermispora, but IVGP was not changed. None of the additions had a significant effect on the other fungus–substrate combinations tested her

Fungal treatment of lignocellulosic biomass: Importance of fungal species, colonization and time on chemical composition and in vitro rumen degradability

The aim of this study is to evaluate fungal treatments to improve in vitro rumen degradability of lignocellulosic biomass. In this study four selective lignin degrading fungi, Ganoderma lucidum, Lentinula edodes, Pleurotus eryngii and Pleurotus ostreatus, were used to pre-treat lignocellulosic biomass and to make the carbohydrates in the lignocellulose available for rumen microbes. Wheat straw, miscanthus, wood chips and rice straw were used as models for lignocellulosic biomass. Samples obtained after 12 wks of incubation were assessed for fungal growth, in vitro gas production (IVGP72) as measure of rumen fermentation capacity and fibre composition. Most effects on IVGP72 and lignin degradation were found after 12 wks of fungal treatment. Twelve weeks of treatment with L. edodes improved the IVGP72 of wheat straw by 58.5 ml/g OM (23.1% increase), of miscanthus by 80.5 ml/g OM (43.7% increase) and of wood chips by 123.4 ml/g OM (229% increase). All fungi improved the IVGP72 of wood chips. Although all fungi grew on rice straw, the IVGP72 was not improved. All four fungal species caused increased cellulose concentration of wheat straw, miscanthus and wood chips. However, when expressed as absolute amounts, cellulose degradation occurred. In wheat straw and miscanthus, lignin was degraded best by L. edodes. Improvement of IVGP72 by L. edodes was correlated to lignin degradation. Lignin degradation and dry matter loss were correlated to the mycelium growth of L. edodes. These correlations differed between substrates and fungi. Fungal growth was not always a good predictor for the performance of the fungus. Here, L. edodes performed best, regarding IVGP72 and selective lignin degradation

Shorten fungal treatment of lignocellulosic waste with additives to improve rumen degradability

Selective lignin degrading fungi can be used as pre-treatment to make cellulose in plant cell walls accessible for rumen microbes. According to previous studies, Ceriporiopsis subvermispora and Lentinula edodes can increase the in vitro rumen degradability of lignocellulosic biomass in 7 to 8 weeks. To shorten this treatment three additives, urea (1 µg/g or 10 µg/g), manganese (15 µg/g or 150 µg/g) and linoleic acid (0.5 mM or 1 mM), were tested during C. subvermispora or L. edodes treatment of wheat straw and wood chips. After 2 and 4 weeks samples were taken to analyse the in vitro rumen degradability and fibre content. Two weeks of fungal treatment did not increase the in vitro rumen degradability of wheat straw or wood chips and additives did not have an effect on this. Addition of manganese (both concentrations) to C. subvermispora on wood chips did result in more lignin degradation. Linoleic acid (1 mM) and manganese (15 µg/g) enhanced lignin degradation of wood chips by L. edodes after 2 weeks of treatment. Fungal treatment for four weeks increased the in vitro rumen degradability. However additives did not enhance this. Urea and manganese did result in higher lignin degradation after 4 weeks of treatment of wheat straw with C. subvermispora. The cellulose content was not changed during the fungal treatment, without or with either additive

Selective ligninolysis of wheat straw and wood chips by the white-rot fungus Lentinula edodes and its influence on in vitro rumen degradability

Background: The present work investigated the influence of lignin content and composition in the fungal treatment of lignocellulosic biomass in order to improve rumen degradability. Wheat straw and wood chips, differing in lignin composition, were treated with Lentinula edodes for 0, 2, 4, 8 and 12 wk and the changes occurring during fungal degradation were analyzed using pyrolysis-gas chromatography-mass spectrometry and detergent fiber analysis.Results: L. edodes preferentially degraded lignin, with only limited cellulose degradation, in wheat straw and wood chips, leaving a substrate enriched in cellulose. Syringyl (S)-lignin units were preferentially degraded thanguaiacyl (G)-lignin units, resulting in a decreased S/G ratio. A decreasing S/G ratio (wheat straw: r = −0.72, wood chips: r = −0.75) and selective lignin degradation (wheat straw: r = −0.69, wood chips: r = −0.88) were correlatedwith in vitro gas production (IVGP), a good indicator for rumen degradability.Conclusions: L. edodes treatment increased the IVGP of wheat straw and wood chips. Effects on IVGP were similar for wheat straw and wood chips indicating that lignin content and 3D-structure of cell walls influence in vitro rumen degradability more than lignin composition

Medical Students' Perspective on Current and Future Training in Anatomy

Item does not contain fulltextGaining sufficient knowledge of anatomy is an important part of medical education. Factors that influence how well students learn anatomical structures include available sources, learning time and study assistance. This study explores the attitude of medical students with regard to studying anatomy and evaluates possibilities for improvement of training in anatomy. Twenty medical students participated in a focus group meeting. Based on this focus group, an online survey consisting of 27 questions was developed and distributed amongst medical students of Maastricht University, the Netherlands. A total of 495 medical students (both Bachelor and Master level) participated in this survey. Master students found studying anatomy less attractive than Bachelor students (36.8% of the Master students vs. 47.9% of the Bachelor students (p=0.024)). Although most students responded that they thought it is important to study anatomy, 48% of all students studied anatomy less than 10hours per study block of 8 weeks. Only 47.9% of the students rated their knowledge of anatomy as adequate. Students suggested that three-dimensional techniques would help improve their knowledge of anatomy. Therefore investing in three-dimensional tools could prove beneficial in the future