Clinical relevance of soluble c-erbB-2 for patients with metastatic breast cancer predicting the response to second-line hormone or chemotherapy

Concentrations of soluble c-erbB-2 were determined in the sera of 64 patients with distant metastasis from advanced breast cancer receiving second-line hormone or chemotherapy in comparison to 35 breast cancer patients without detectable recurrent disease and 17 healthy blood donors. The sera of non-metastatic breast cancer patients contained s-erbB-2 concentrations similar to those of healthy blood donors. Patients with distant metastasis from advanced breast cancer had significantly higher values of s-erbB-2 in comparison to patients with non-disseminated disease (mean: 59.6 vs. 11.6 U/ml; p = 0.022). A significant correlation was observed between s-erbB-2 serum levels and serum LDH concentrations (p < 0.001), levels of alkaline phosphatase (p < 0.001), and the presence of hepatic metastasis (p = 0.001). Time to tumor progression was significantly shorter in patients with s-erbB-2 levels above 40 U/ml (mean: 23.4 vs. 56.7 months; p = 0.002). Furthermore, breast cancer patients with hepatic metastasis and those with elevated s-erbB-2 serum levels above 40 U/ml had limited response to hormone or chemotherapy. Non-responders had significantly higher s-erbB-2 levels (mean: 270.3, range: 42-500 U/ml;) compared with the responder group (mean: 23.1, range: 0-149 U/ml; p < 0.001). Logistic regression analysis indicated that elevated s-erbB-2 serum levels above 40 U/ml independently predicted an unfavorable response to second-line hormone or chemotherapy in patients with advanced metastatic breast cancer. Copyright (C) 2002 S. KargerAG, Basel

Optical, mechanical and sensory properties of based-isomaltulose gummy confections

The replacement of traditional sugars by isomaltulose could be a revolution in the confectionery sector, since isomaltulose is a functional, digestible, non-cariogenic and low glycemic disaccharide. This study assesses the addition of isomaltulose (ranging between 30-70% in combination with fructose) with different percentages of gelatine (6-10%) in gummy confection by analyzing its effect on composition, water activity (aw), pH, mechanical and optical properties, and sensory perception. Results show that the combination of 30% isomaltulose and 70% fructose in the total amount of sugars would be suitable for developing functional gummy confections. Besides its stability (aw (0.79±0.02) and ºBrix (73.5±1.3)) and great similarity to commercial gummies in terms of optical and mechanical properties, it received high global acceptability and intention of buying scores. Additionally, the correlation between instrumental and sensory parameters leads to the conclusion that the instrumental texture could be suitable for evaluating consumer s global acceptability for this innovative product.The authors thank the Universitat Politecnica de Valencia for funding the Project PAID 2011-ref.: 2012 and the Ph.D. scholarship.Periche Santamaría, A.; Heredia Gutiérrez, AB.; Escriche Roberto, MI.; Andrés Grau, AM.; Castelló Gómez, ML. (2014). Optical, mechanical and sensory properties of based-isomaltulose gummy confections. Food Bioscience. 7:37-44. https://doi.org/10.1016/j.fbio.2014.05.006S3744

Vacuum assisted closure in coloproctology

Vacuum-assisted closure has earned its indications in coloproctology. It has been described with variable results in the treatment of large perineal defects after abdominoperineal excision, in the treatment of stoma dehiscence and perirectal abscesses. The most promising indication for vacuum-assisted closure is probably the treatment of para-anastomotic presacral abscesses following anastomotic leakage after total mesorectal excision. Early initiation of vacuum-assisted closure has the potential to prevent debilitating persistent presacral sinuses precluding stoma closure and bad function of the neorectum. Prompt initiation of endosponge treatment is advised after the anastomotic leakage with the purulent cavity is diagnosed. The endosponge is inserted transanally and connected with a low vacuum bottle. With the gradual reduction in the cavity, the endosponge is reduced in size every 3–4 days when the endosponge is exchanged. It takes 3–6 weeks to close the cavity. Future studies should focus on the stoma closure rate and function to assess whether this intensive postoperative treatment of anastomotic leakages is justified

Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report

<p>Abstract</p> <p>Introduction</p> <p>The management of intestinal injury can be challenging, because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries.</p> <p>Case presentation</p> <p>A 78-year-old Japanese woman had undergone several abdominal surgeries including urinary cystectomy for bladder cancer. After this operation, she developed peritonitis as a result of a small bowel perforation thought to be due to an injury sustained during the operation, with signs consistent with systemic inflammatory response syndrome: body temperature 38.5°C, heart rate 92 beats/minute, respiratory rate 23 breaths/minute, white blood cell count 11.7 × 10⁹/L (normal range 4-11 × 10⁹/μL). Two further surgical interventions failed to control the leak, and our patient's clinical condition and nutritional status continued to deteriorate. We then performed percutaneous endoscopic gastrojejunostomy, and continuous suction was applied as an alternative to a third surgical intervention. With this endoscopic intervention, the intestinal leak gradually closed and oral feeding became possible.</p> <p>Conclusion</p> <p>We suggest that the technique of percutaneous endoscopic gastrojejunostomy combined with a somatostatin analog is a feasible alternative to surgical treatment for small bowel leakage, and is less invasive than a nasojejunal tube.</p

Detection of Atherosclerosis by Small RNA-Sequencing Analysis of Extracellular Vesicle Enriched Serum Samples

Atherosclerosis can occur throughout the arterial vascular system and lead to various diseases. Early diagnosis of atherosclerotic processes and of individual disease patterns would be more likely to be successful if targeted therapies were available. For this, it is important to find reliable biomarkers that are easily accessible and with little inconvenience for patients. There are many cell culture, animal model or tissue studies that found biomarkers at the microRNA (miRNA) and mRNA level describing atherosclerotic processes. However, little is known about their potential as circulating and liquid biopsy markers in patients. In this study, we examined serum-derived miRNA – profiles from 129 patients and 28 volunteers to identify potential biomarkers. The patients had four different atherosclerotic manifestations: abdominal aneurysm (n = 35), coronary heart disease (n = 34), carotid artery stenosis (n = 24) and peripheral arterial disease (n = 36). The samples were processed with an extracellular vesicle enrichment protocol, total-RNA extraction and small RNA-sequencing were performed. A differential expression analysis was performed bioinformatically to find potentially regulated miRNA biomarkers. Resulting miRNA candidates served as a starting point for an overrepresentation analysis in which relevant target mRNAs were identified. The Gene Ontology database revealed relevant biological functions in relation to atherosclerotic processes. In patients, expression of specific miRNAs changed significantly compared to healthy volunteers; 27 differentially expressed miRNAs were identified. We were able to detect a group-specific miRNA fingerprint: miR-122-5p, miR-2110 and miR-483-5p for abdominal aortic aneurysm, miR-370-3p and miR-409-3p for coronary heart disease, miR-335-3p, miR-381-3p, miR493-5p and miR654-3p for carotid artery stenosis, miR-199a-5p, miR-215-5p, miR-3168, miR-582-3p and miR-769-5p for peripheral arterial disease. The results of the study show that some of the identified miRNAs have already been associated with atherosclerosis in previous studies. Overrepresentation analysis on this data detected biological processes that are clearly relevant for atherosclerosis, its development and progression showing the potential of these miRNAs as biomarker candidates. In a next step, the relevance of these findings on the mRNA level is to be investigated and substantiated

Potential use of isomaltulose to produce healthier marshmallows

Isomaltulose is a non-cariogenic sugar with a lower glycemic index but with the same caloric value and visual appearance as sucrose. Therefore, isomaltulose could potentially be used to produce healthier candies. In this regard, the aim of this research was to evaluate isomaltulose as a traditional sugar replacer in soft marshmallow type candies, in order to provide added value to these widely consumed products, making it possible to capture a new market niche. 18 formulations were studied combining different sugars (sucrose, glucose syrup, fructose and isomaltulose) and different percentages of gelatine (4, 5 and 6). Analyses of composition (degrees Brix and moisture content), pH and water activity (a(w)), instrumental colour and texture as well as a sensorial analysis were performed. Marshmallows with isomaltulose combined with fructose exhibited the lowest values of pH (4.99-5.14). Moreover, formulations with similar amount of isomaltulose and fructose presented lower instrumental hardness, higher cohesiveness and springiness, and the best sensory acceptance. A PLS multivariate analysis showed a good correlation between instrumental and sensory mechanical parameters. Therefore, instrumental measures of texture could be suitable for discerning an overall preference for marshmallows without using trained panellists. (C) 2014 Elsevier Ltd. All rights reserved.The authors thank the Universitat Politecnica de Valencia for funding the project PAID 2011-ref: 2012 and the PhD scholarship.Periche Santamaría, A.; Heredia Gutiérrez, AB.; Escriche Roberto, MI.; Andrés Grau, AM.; Castelló Gómez, ML. (2015). Potential use of isomaltulose to produce healthier marshmallows. Food Science and Technology. 62(1):605-612. https://doi.org/10.1016/j.lwt.2014.12.024S60561262

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed