Bax, cytochrome c, and caspase-8 staining in parotid cancer patients: Markers of susceptibility in radiotherapy?

OBJECTIVE: Negative bcl-2 and HLA-DR protein expression have been associated with responsiveness to adjuvant radiotherapy in surgically treated parotid cancer patients. The aim of this study was to investigate the prognostic significance of bax, cytochrome c, and caspase-8 protein expression in a group of surgically treated patients to determine whether they also suggest markers of responsiveness to adjuvant radiotherapy. STUDY DESIGN: Historical cohort study. SETTING: Otolaryngology department in a university hospital. SUBJECTS AND METHODS: The immunohistochemical expression of bax, cytochrome c, and caspase-8 were studied in paraffin-embedded tissue specimens originating from 27 surgically treated parotid cancer patients and nine patients with Warthin parotid tumors (control group) and correlated with the patients’ clinicopathological characteristics and clinical outcome. RESULTS: Caspase-8 negative staining was more frequently observed in higher TNM stages and in tumors measuring more than 4 cm (P = 0.009 and P = 0.018, respectively). Caspase-8 (-)/cytochrome c (-) patients carried low-grade lesions without nodal involvement (P = 0.01 and P = 0.05, respectively). Caspase-8 (-) patients who received postoperative radiotherapy presented a significantly increased disease-free survival compared to those who did not (P = 0.04). Patients bearing bax (-) tumors who received postoperative radiotherapy presented an improved four-year disease-free survival compared to bax (-) patients who did not receive any type of adjuvant radiotherapy (P = 0.017). CONCLUSION: Bax, cytochrome c, and caspase-8 protein expression failed to independently predict survival in parotid cancer patients. However, patients with bax (-) or caspase-8 (-) tumors should be considered as candidates for adjuvant radiotherapy in order to achieve better local disease control. (C) 2010 American Academy of Otolaryngology Head and Neck Surgery Foundation. All rights reserved

Review of the molecular profile and modern prognostic markers for gastric lymphoma: How do they affect clinical practice?

Primary gastric lymphoma is a rare cancer of the stomach with an indeterminate prognosis. Recently, a series of molecular prognostic markers has been introduced to better describe this clinical entity. This review describes the clinical importance of several oncogenes, apoptotic genes and chromosomal mutations in the initiation and progress of primary non-Hodgkin gastric lymphoma and their effect on patient survival. We also outline the prognostic clinical importance of certain cellular adhesion molecules, such as ICAM and PECAM-1, in patients with gastric lymphoma, and we analyze the correlation of these molecules with apoptosis, angiogenesis, tumour growth and metastatic potential. We also focus on the host-immune response and the impact of Helicobacter pylori infection on gastric lymphoma development and progression. Finally, we explore the therapeutic methods currently available for gastric lymphoma, comparing the traditional invasive approach with more recent conservative options, and we stress the importance of the application of novel molecular markers in clinical practice

Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy

Background Staple-line reinforcement has been used with promising results in laparoscopic gastric bypass in order to reduce leakage, increase staple-line integrity, and diminish staple-site bleeding. The purpose of this study was to determine if staple-line reinforcement with bovine pericardial strips reduces surgical complications of laparoscopic sleeve gastrectomy (LSG). Methods This is a prospective comparative study of all patients who underwent LSG by a standard operative team in an 18-month period. Patients were enrolled in group A if they received staple-line reinforcement and in group B when not. The staple line was reinforced with bovine pericardium strips [Peri-Strips Dry (R) (PSD)]. Results In total, 187 patients, with a median preoperative BMI of 45.3 kg/m(2) (range = 35.1-72.7), underwent LSG. Ninety-six patients were enrolled in group A and 91 in group B; the two groups were comparable in their various characteristics. Morbidity rate representing grade III-IV surgical complications reached 7.4% and mortality rate was 0.5%. Reinforcement with PSD significantly reduced the occurrence of bleeding from the staple line and intra-abdominal collections (P = 0.012 and 0.026). The leak rate was not significantly reduced in group A. Patients in group A required fewer days of hospitalization. Conclusions Reinforcement of the staple line in LSG resulted in significantly fewer surgical complications compared to standard stapling of the gastric tube. The additional cost due to the reinforcement of the staple line may be counterbalanced by the reduction in the length of hospitalization

Prospective appraisal of a 2-day training course on laparoscopic sleeve gastrectomy: the ELTC experience

Background The increasing role of laparoscopic sleeve gastrectomy (LSG) in the treatment of morbid obesity dictates the need for greater acquaintance with this type of surgery. This study was designed to evaluate the impact of a 2-day LSG course and a 4-day laparoscopic bariatric mini-training program on the knowledge and training gained by participating surgeons. Methods A total of 73 trainees (31 residents and 42 surgeons) completed a question survey immediately after completion of the respective courses. Questions probed demographic data, training experience before and after course completion, evaluation of course content, and operative experience. Results All residents and four of the general surgeons found the laparoscopic bariatric mini-training program to be of value with respect to future professional orientations. Seven surgeons started performing LSGs, while another five surgeons decided to occupy themselves with various types of laparoscopic bariatric procedures. The most useful parts of the course included the identification and treatment of complications, the use of new instrumentation, and surgical demonstrations (video or live), as decided by more than 80% of the participants. On a 1-5 scale, the presentation of novel knowledge was evaluated to be >= 3 by all participants. Conclusion The 2-day LSG course offered participants high-quality novel knowledge and excellent training quality, and exerted impact on their personal career

Geomorphology of the Anthropocene in Mediterranean urban areas

Urban-geomorphology studies in historical cities provide a significant contribution towards the broad definition of the Anthropocene, perhaps even including its consideration as a new unit of geological time. Specific methodological approaches to recognize and map landforms in urban environments, where human-induced geomorphic processes have often overcome the natural ones, are proposed. This paper reports the results from, and comparison of, studies conducted in coastal historical cities facing the core of the Mediterranean Sea – that is, Genoa, Rome, Naples, Palermo (Italy) and Patras (Greece). Their settlements were facilitated by similar climatic and geographical contexts, with high grounds functional for defence, as well as by the availability of rocks useful as construction materials, which were excavated both in opencast and underground quarries. Over centuries, urbanization has also required the levelling of relief, which was performed by the excavation of heights, filling of depressions and by slope terracing. Consequently, highly modified hydrographic networks, whose streams were dammed, diverted, modified in a culvert or simply buried, characterize the selected cities. Their urban growth, which has been driven by maritime commercial activities, has determined anthropogenic coastal progradation through port and defence or waterfront works. Aggradation of artificial ground has also occurred as a consequence of repeated destruction because of both human and natural events, and subsequent reconstruction even over ruins, buried depressions and shallow cavities. As a result, the selected cities represent anthropogenic landscapes that have been predominately shaped by several human-driven processes, sometimes over centuries. Each landform represents the current result, often from multiple activities with opposing geomorphic effects. Beyond academic progress, we believe that detecting and mapping these landforms and processes should be compulsory, even in risk-assessment urban planning, because of the increase of both hazards and vulnerability as a result of climate-change-induced extreme events and extensive urbanization, respectively