Malignant melanoma arising from a perianal fistula and harbouring a BRAF gene mutation: a case report

<p>Abstract</p> <p>Background</p> <p>Melanoma of the anal region is a very uncommon disease, accounting for only 0.2-0.3% of all melanoma cases. Mutations of the <it>BRAF </it>gene are usually absent in melanomas occurring in this region as well as in other sun-protected regions. The development of a tumour in a longstanding perianal fistula is also extremely rare. More frequent is the case of a tumour presenting as a fistula, that is, the fistula being a consequence of the cancerous process, although we have found only two cases of fistula-generating melanomas reported in the literature.</p> <p>Case Presentation</p> <p>Here we report the case of a 38-year-old male who presented with a perianal fistula of four years of evolution. Histopathological examination of the fistulous tract confirmed the presence of malignant melanoma. Due to the small size and the central location of the melanoma inside the fistulous tract, we believe the melanoma reported here developed in the epithelium of the fistula once the latter was already formed. Resected sentinel lymph nodes were negative and the patient, after going through a wide local excision, remains disease-free nine years after diagnosis. DNA obtained from melanoma tissue was analysed by automated direct sequencing and the <it>V600E </it>(<it>T1799A</it>) mutation was detected in exon 15 of the <it>BRAF </it>gene.</p> <p>Conclusion</p> <p>Since fistulae experience persistent inflammation, the fact that this melanoma harbours a <it>BRAF </it>mutation strengthens the view that oxidative stress caused by inflammatory processes plays an important role in the genesis of <it>BRAF </it>gene mutations.</p

Towards a new Integrated Beach Management System: The Ecosystem-Based Management System for Beaches

11 páginas, 5 figuras, 2 tablas.Massive use of beaches has forced traditional management of these systems to focus on the service offer to users. Consequently, human activity and behavior prevailed over other biological and physical processes and functions. Mirroring this tendency, the use of Performance Awards (Blue Flag) and Environmental/Quality Management Systems (ISO 14001, EMAS, and Q of Quality) were popularized as standards of environmental quality. In parallel to this process, recent international coastal and marine policies have emphasized the need to develop sustainable strategies for implementing the principles of the Ecosystem Approach into management with the overarching goal to maintain ecosystem integrity while enabling the sustainable use of ecosystem goods and services in systems under management. As Performance Awards and Environmental/Quality Management Systems do not follow the Ecosystem Approach, an Ecosystem-Based Management System for beaches (EBMS-Beaches) is introduced to overcome this issue. The EBMS-Beaches is intended as a formal standard framework that add new aspects not considered in a classical beach management process by the introduction of the principles of the Ecosystem Approach, between them: a) a clear vision-driven process; b) a holistic approach from a geographical perspective; c) pressure analysis and institutional coordination inside clear participatory planning; d) use of risk management techniques in planning; e) the ecosystem service concept as the central piece of the system; f) use of the DPSWR as accountable framework of indicators, g) desired vision based on state indicators and using BQI partial indices; and h) timely participation by local population. The EBMS is structured along three pillars (managerial, informative and participatory pillars) working in an adaptive management way. Based on these three pillars, existing management practices can be standardized into a viable, systematic means of implementing, in an integrated way, the new international policies for beach social-ecological systems. An initial experience of EBMS implementation in a particular beach (S'Abanell beach, Girona-Catalonia, Northwestern Mediterranean) has been initiated and it is presented.This work was carried out within the framework of the MeVaPlaya-II project (CSO2009-14589) and the PLAYAþ project (CGL2013-49061) of the National Research Plan of Spain in RþDþi, as well as the KnowSeas project (201530E018).Peer reviewe

Socioeconomic and Environmental Proxies for Comparing Freshwater Ecosystem Service Threats across International Sites: A Diagnostic Approach

In this work, we develop and test proxy-based diagnostic tools for comparing freshwater ecosystem services (FWES) risks across an international array of freshwater ecosystems. FWES threats are increasing rapidly under pressure from population, climate change, pollution, land use change, and other factors. We identified spatially explicit FWES threats estimates (referred to as threat benchmarks) and extracted watershed-specific values for an array of aquatic ecosystems in the Western Hemisphere (Ramsar sites). We compared these benchmark values to values extracted for sites associated with an international FWES threat investigation. The resulting benchmark threats appeared to provide a meaningful context for the diagnostic assessment of study site selection by revealing gaps in coverage of the underlying socio-environmental problem. In an effort to simplify the method, we tested regularly updated environmental and socioeconomic metrics as potential proxies for the benchmark threats using regression analysis. Three category proxies, aggregated from (i) external (global to regional, climate-related), (ii) internal (watershed management-related), and (iii) socioeconomic and governance related proxies produced strong relationships with water supply threat benchmarks, but only weak relationships with biodiversity-related and nutrient regulation benchmark threats. Our results demonstrate the utility of advancing global FWES status and threat benchmarks for organizing coordinated research efforts and prioritizing decisions with regard to international socio-environmental problems