Investigating isotopic markers for hazelnut geographical authentication: Promising variables and potential applications

Hazelnuts' features and price are influenced by their geographical origin, making them susceptible to fraud, especially counterfeit claims regarding their provenance. Stable isotope analysis is a recognised approach to establish the geographical origin of foods, yet its potential in hazelnut authentication remains unexplored. In this prospective study, we assessed multiple isotopic markers in hazelnuts from different origins and evaluated the most promising variables for geographical authentication by chemometric tools. Our findings indicate that bulk δ18O, along with δ2H and δ13C in the main fatty acid methyl esters, exhibit significant potential in discriminating geographical origins, and 87Sr/86Sr analysis could serve as a proficient confirmatory tool. Though no single marker alone can differentiate between all the studied origins, employing a multi-isotopic approach based on PLS-DA models achieved up to 92.5 % accuracy in leave-10 %-out cross-validation. These findings will probably lay the groundwork for developing robust models for hazelnut geographical authentication based on larger datasets.

Prospective exploration of hazelnut's unsaponifiable fraction for geographical and varietal authentication: A comparative study of advanced fingerprinting and untargeted profiling techniques

This study compares two data processing techniques (fingerprinting and untargeted profiling) to authenticate hazelnut cultivar and provenance based on its unsaponifiable fraction by GC-MS. PLS-DA classification models were developed on a selected sample set (n = 176). As test cases, cultivar models were developed for "Tonda di Giffoni" vs other cultivars, whereas provenance models were developed for three origins (Chile, Italy or Spain). Both fingerprinting and untargeted profiling successfully classified hazelnuts by cultivar or provenance, revealing the potential of the unsaponifiable fraction. External validation provided over 90 % correct classification, with fingerprinting slightly outperforming. Analysing PLS-DA models' regression coefficients and tentatively identifying compounds corresponding to highly relevant variables showed consistent agreement in key discriminant compounds across both approaches. However, fingerprinting in selected ion mode extracted slightly more information from chromatographic data, including minor discriminant species. Conversely, untargeted profiling acquired in full scan mode, provided pure spectra, facilitating chemical interpretability.

Effect of feeding olive pomace acid oil on pork lipid composition, oxidative stability, colour, and sensory acceptance

One of the targets of the meat industry is to reduce production costs and to increase the sustainability of the food chain, which has driven the attention towards the use of by-products as feed ingredients. Acid oils are fat by-products coming from the chemical refining process of edible oils, with a high energy value and that are approved as feed ingredients in the European Union. However, meat producers are hesitant to utilise them due to their varying composition and the limited understanding of their impact on animal performance and meat quality. The objective of this study was to evaluate the effects of using olive pomace acid oil (OPAO) instead of its corresponding crude olive pomace oil (OPO) or crude palm oil (PO) in pig diets on lipid composition, lipid oxidation and quality of pork loin (longissimus dorsi), fresh and after commercial refrigerated storage for 8 days. The experimental design consisted of feeding pigs with four diets supplemented with a 5% of PO, OPO, OPAO or a blend (B) of PO and OPAO (50:50, w/w). Fresh and refrigerated pork loin samples were assessed for fatty acid profile; tocopherol (T) and tocotrienol (T3) composition; lipid oxidative stability with the ferrous oxidation-xylenol orange method; 2-thiobarbituric acid (TBA) value; volatile compounds; colour; and sensory acceptance. Results showed that refrigeration reduced the total T + T3 levels and increased the TBA values and the volatile compound concentrations. The refrigerated storage also affected the instrumental colour parameters (L*, a* and b*) but not the overall acceptance of pork. Regarding the diet, pork from OPAO diet showed a higher unsaturated-to-saturated fatty acid ratio than pork from PO and B diets. The lowest T + T3 concentration was found in OPO and OPAO fresh pork and in OPAO refrigerated pork. The oxidative stability of fresh pork was lower for OPAO than for PO diet, but no significant effect of the diet was observed for this parameter in refrigerated pork. The TBA values and volatile compound concentrations of fresh pork were not affected by the diet. After refrigeration, OPAO pork had the highest TBA value and volatile compound concentrations. In any case, colour and consumer acceptance of pork were not affected by diet. In conclusion, in order to upcycle acid oils in pig diets, and considering results on the lipid oxidative stability of pork, it would be preferable to add the OPAO used in this study blended with PO.

Influence of free fatty acid content and degree of fat saturation in laying hen diets on egg quality, yolk fatty acid profile, and cholesterol content

The aim of the present study was to evaluate the effect of dietary free fatty acid (FFA) content and the degree of saturation on egg quality, yolk fatty acid (FA) profile, and yolk cholesterol content. For a 15-wk period, a total of 144 laying hens (19-wk-old) were randomly assigned to 8 treatments arranged in a 2 × 4 factorial design, with 2 sources of crude oil (soybean oil and palm oil) and 4 levels of FFA (10, 20, 30, and 45%). The dietary treatments were achieved by progressively substituting the original oils with equivalent amounts of their corresponding acid oils (soybean acid oil and palm fatty acid distillate, respectively). No differences in ADFI or egg mass were found. However, dietary FFA reduced egg production (linear, P < 0.05) and increased the feed conversion ratio (linear, P < 0.05). Higher levels of FFA in soybean diets resulted in higher egg weight with higher albumen and yolk weights (linear, P < 0.01). Palm diets presented higher yolk:albumen ratio than soybean diets (P < 0.001), but the effect of FFA did not follow a linear trend. Hens fed soybean diets laid eggs with higher Haugh units (HU) than palm diets (P < 0.001), although increasing the dietary FFA% reduced the HU values in both (linear, P < 0.001). Palm diets enhanced shell quality with greater resistance to breakage, and higher dry matter and ash content than soybean diets (P < 0.05). No differences in egg chemical composition and yolk cholesterol content were found (P > 0.05). The saturation degree had a significant effect on all the analyzed yolk FA (P < 0.001) except for arachidonic acid (C20:4 n-6), whereas increasing the FFA content did not affect to a great extent. These results show that varying dietary FFA level did not affect egg quality and yolk composition as much as the dietary fat source did, supporting the use of acid oils and fatty acid distillates as fat ingredients for feed.

Olive pomace oil and acid oil as alternative fat sources in growing-finishing broiler chicken diets

The aim of the present study was to investigate the effect of dietary supplementation of olive pomace oil and olive pomace acid oil, which are rich in monounsaturated fatty acids (FA) but differ in free FA content, on growth performance, digestibility and FA profile of abdominal fat and breast meat. A total of 3,048 one-day-old mixed-sex broiler chickens (Ross 308) were randomly distributed into 24 pens and 3 dietary treatments (8 replicates per treatment). Experimental diets were administered for growing (from 22 to 29 d) and finishing (from 30 to 39 d) periods, consisting of a basal diet supplemented with 6% (as-fed basis) palm oil (PO), olive pomace oil (O), or olive pomace acid oil (OA). Animals fed O achieved the lowest feed conversion ratio (P < 0.01), together with the highest AME value (P = 0.003), but no differences were observed between OA and PO. Regarding FA digestibility, O and OA showed higher values than PO for all FA in both apparent ileal digestibility (AID) and apparent total tract digestibility. Comparing the AID between O and OA, no differences were observed for total FA, monounsaturated FA, or polyunsaturated FA, but animals fed OA showed lower AID values for saturated FA than those fed O (P < 0.001). The FA profile of abdominal fat and breast meat reflected that of the diet, with higher monounsaturated FA and lower saturated FA in animals fed O and OA compared to those fed PO. In sum, the inclusion of both olive pomace oil and acid oil in growing-finishing broiler chicken diets led to great performance parameters and high FA digestibility values, together with an enrichment with monounsaturated FA in abdominal fat and breast meat compared to the use of palm oil. However, a better AID of saturated FA and feed conversion ratio is achieved with O compared to OA.

Effects of free-fatty-acid content and saturation degree of the dietary oil sources on lipid-class content and fatty-acid digestibility along the gastrointestinal tract in broilers from 22 to 37 days of age

The aim of the present study is to assess the effect of the free-fatty-acid (FFA) content and saturation degree of dietary fat (added at 6%) on the fatty-acid (FA) digestibility and lipid-class content along the gastrointestinal tract and excreta in broilers from 22 to 37 d of age. This is essential to determine the potential use of acid oils (refining by-products rich in FFA) in broiler diets as an alternative to crude oils. The study consisted of a 2 × 4 factorial arrangement, which included 2 fat sources (soybean oils – unsaturated, or palm oils – saturated) and 4 levels of FFA (5, 15, 35, and 50%). Samples of digestive content of the gizzard, duodenum, jejunum, ileum and of the excreta were obtained at 37 d of age. Irrespective of the dietary fat source, more than 80% of total FA (TFA) was absorbed in the jejunum. Broilers fed with unsaturated diets had a higher absorption efficiency of FA than did those fed with saturated diets. This conclusion is supported by the lower FFA content and the higher TFA and polyunsaturated FA (PUFA) digestibility coefficients in the ileum (P < 0.001) observed in the former group. The dietary FFA level did not affect the FA absorption process as much as the dietary fat source did. This was supported by the lack of statistical differences among the diets with a similar saturation degree but rather different levels of FFA, for TFA, saturated FA, and PUFA digestibility coefficients both in the jejunum and ileum. However, the interactions reported in the ileum for triacylglycerol and diacylglycerol contents (P < 0.001), as well as for monounsaturated FA digestibility coefficients (P < 0.05) show that the dietary FFA content affects the FA absorption process. The present results show that the inclusion of acid oils in grower-finisher broiler diets with FFA levels up to 35% does not have a negative impact on the FA absorption process.

Effects of dietary free fatty-acid content and saturation degree on lipid-class composition and fatty-acid digestibility along the gastrointestinal tract in broiler starter chickens

The aim of the present study is to assess the effect of the dietary free fatty acid (FFA) content and dietary fat saturation degree on the fatty-acid (FA) digestibility and lipid-class content along the gastrointestinal tract and excreta in broiler chickens. The 8 experimental diets resulted from replacing crude soybean oil with soybean acid oil from chemical refining, or crude palm oil with palm FA distillate from physical refining. Thus, there were 4 soybean and 4 palm diets with 6% added fat varying in their FFA% (5, 15, 35, and 50%). Samples of digestive content (gizzard, duodenum, jejunum, and ileum) and excreta were collected at 14 D for the determination of the FA digestibility and lipid-class content. The total FA digestibility coefficients reported for the chickens fed S diets in the jejunum, ileum, and excreta were higher than for those fed P diets (P ≤ 0.02). The general greater digestibility of the unsaturated diets was mainly explained by a higher contribution of the ileum to the absorption of saturated FA. The dietary FFA content mainly affected the FA absorption process. The diets with 50% FFA presented lower saturated FA digestibility coefficients in the jejunum and ileum (P ≤ 0.03), and higher content of FFA in the ileum and excreta (P ≤ 0.014), in comparison to the diets with 5% FFA. The 15% FFA diets were not different from the 5% FFA diets, regarding the saturated FA digestibility in the jejunum and excreta, and the FFA content in the ileum and excreta. It was concluded that unsaturated diets with moderate content of dietary FFA (up to 15%) could be used in broiler-chicken starter diets, as they led to similar FA absorption and performance results to the diets with the lowest dietary FFA content. From the present study, it has also been concluded that dietary saturated FA content has a greater impact on FA absorption than the dietary FFA content has.

Phase II Trial of Oral Tegafur and Folinic Acid with Mitoxantrone as First-Line Regimen in Patients with Metastatic Breast Cancer

Background

Tegafur acts as a deport form of 5-fluorouracil when administered orally for longs periods of time, since it is an active drug in metastatic breast cancer, with response rates of 29-44%. Biochemical modulation with folinic acid and the addition of mitoxantrone could increase the efficacy of tegafur in patients with metastatic breast cancer.

Methods

A prospective phase II trial in patients with previously untreated metastatic breast cancer was carried out. The scheme consisted of mitoxantrone, 12 mg/m2 intravenous day 1, oral tegafur, 750 mg/m2/day divided in three equal doses, and leucovorin 15 mg/8 h orally for days 1-21, given in a 4-week schedule. None patient had received chemotherapy for metastatic breast cancer, although 16 patients had received previous adjuvant chemotherapy.

Results

Thirty-four patients were included. Objective responses were achieved in 20 of 32 patients assessable for response, with 1 complete response and 19 partial responses. The objective response rate was 62.5% (95% confidence intervals, 48-76%). The median duration of response was 10 months. Grade III-IV toxicity according to WHO criteria was digestive (nausea/vomiting) in 12.5%, diarrhea in 25% and stomatitis in 25% of patients. Other toxicities were low. Eight patients required dose-reduction.

Conclusions

We achieved a significant response rate with the scheme, which was administered on an outpatient basis. It seems to be safe and effective as first-line treatment in metastatic breast cancer, with a short median response duration. The size of the trial does not permit definitive conclusions, and the role of biochemical modulation of tegafur in combination with mitoxantrone remains to be defined.

An analytical approach for a nodal formulation of a two-dimensional fixed-source neutron transport problem in heterogeneous medium

A nodal formulation of a fixed-source two-dimensional neutron transport problem, in Cartesian geometry, defined in a heterogeneous medium, is solved by an analytical approach. Explicit expressions, in terms of the spatial variables, are derived for averaged fluxes in each region in which the domain is subdivided. The procedure is an extension of an analytical discrete ordinates method, the ADO method, for the solution of the two-dimensional homogeneous medium case. The scheme is developed from the discrete ordinates version of the two-dimensional transport equation along with the level symmetric quadrature scheme. As usual for nodal schemes, relations between the averaged fluxes and the unknown angular fluxes at the contours are introduced as auxiliary equations. Numerical results are in agreement with results available in the literature.

Re-esterified palm oils, compared to native palm oil, do not alter fat absorption, postprandial lipemia or growth performance in broiler chicks

Re-esterified palm oils are obtained from the chemical esterification of palm acid oils (rich in free fatty acids) with glycerol, both economically interesting by-products from oil refining and biodiesel industries, respectively. Thus, re-esterified palm oils could be an economically interesting alternative to native palm oil in broiler chick diets. However, because they may have different physicochemical properties than have their corresponding native oil, we assessed the effect of fatty acid (FA) positional distribution within acylglycerol molecules and the effect of acylglycerol composition on FA apparent absorption, and their possible consequences on the evolution of postprandial lipemia and growth performance in broiler chicks. Seventy-two 1-day-old female broiler chicks were randomly distributed into 18 cages. The three treatments used were the result of a basal diet supplemented with 6 wt% of native palm oil (N-TAG), re-esterified palm oil (E-TAG), or re-esterified palm oil high in mono- and diacylglycerols (E-MDAG). Chemical esterification raised the fraction of palmitic acid at the sn-2 position from 9.63 mol% in N-TAG oil to 17.9 mol% in E-TAG oil. Furthermore, E-MDAG oil presented a high proportion of mono- (23.1 wt%) and diacylglycerols (51.2 wt%), with FA mainly located at the sn-1,3 positions, which resulted in a lower gross-energy content and an increased solid-fat index at the chicken’s body temperature. However, re-esterified palm oils did not alter fat absorption, postprandial lipemia, or growth performance, compared to native palm oil, so they can be used as alternative fat sources in broiler chick diets.

Explicit formulation of a nodal transport method for discrete ordinates calculations in two-dimensional fixed-source problems

In this work a study of two-dimensional fixed-source neutron transport problems, in Cartesian geometry, is reported. The approach reduces the complexity of the multidimensional problem using a combination of nodal schemes and the Analytical Discrete Ordinates Method (ADO). The unknown leakage terms on the boundaries that appear from the use of the derivation of the nodal scheme are incorporated to the problem source term, such as to couple the one-dimensional integrated solutions, made explicit in terms of the x and y spatial variables. The formulation leads to a considerable reduction of the order of the associated eigenvalue problems when combined with the usual symmetric quadratures, thereby providing solutions that have a higher degree of computational efficiency. Reflective-type boundary conditions are introduced to represent the domain on a simpler form than that previously considered in connection with the ADO method. Numerical results obtained with the technique are provided and compared to those present in the literature.

Authentication of organic feed by near-infrared spectroscopy combined with chemometrics: a feasibility study

Organic products tend to retail at a higher price than their conventional counterparts, which makes them susceptible to fraud. In this study we evaluate the application of near-infrared spectroscopy (NIRS) as a rapid, cost-effective method to verify the organic identity of feed for laying hens. For this purpose a total of 36 organic and 60 conventional feed samples from The Netherlands were measured by NIRS. A binary classification model (organic vs conventional feed) was developed using partial least squares discriminant analysis. Models were developed using five different data preprocessing techniques, which were externally validated by a stratified random resampling strategy using 1000 realizations. Spectral regions related to the protein and fat content were among the most important ones for the classification model. The models based on data preprocessed using direct orthogonal signal correction (DOSC), standard normal variate (SNV), and first and second derivatives provided the most successful results in terms of median sensitivity (0.91 in external validation) and median specificity (1.00 for external validation of SNV models and 0.94 for DOSC and first and second derivative models). A previously developed model, which was based on fatty acid fingerprinting of the same set of feed samples, provided a higher sensitivity (1.00). This shows that the NIRS-based approach provides a rapid and low-cost screening tool, whereas the fatty acid fingerprinting model can be used for further confirmation of the organic identity of feed samples for laying hens. These methods provide additional assurance to the administrative controls currently conducted in the organic feed sector.

Controlled cell death by magnetic hyperthermia: effects of exposure time, field amplitude, and nanoparticle concentration

PURPOSE

To investigate the effects of alternating magnetic fields (AMF) on the death rate of dendritic cells (DCs) loaded with magnetic nanoparticles (MNPs) as heating agents. AMF exposure time and amplitude as well as the MNPs concentration were screened to assess the best conditions for a controlled field-induced cell death.

METHODS

Human-monocyte-derived DCs were co-incubated with dextran-coated MNPs. The cells were exposed to AMF (f = 260 kHz; 0 < H(0) < 12.7 kA/m) for intervals from 5 to 15 min. Morphology changes were assessed by scanning electron microscopy. Cell viability was measured by Trypan blue and fluorescence-activated cell sorting (FACS) using Annexin-propidium iodide markers.

RESULTS

We were able to control the DCs viability by a proper choice AMF amplitude and exposure time, depending on the amount of MNPs uploaded. About 20% of cells showed Annexin-negative/PI-positive staining after 5-10 min of AMF exposure.

CONCLUSIONS

Controlled cell death of MNP-loaded DCs can be obtained by adequate tuning of the physical AMF parameters and MNPs concentration. Necrotic-like populations were observed after exposure times as short as 10 min, suggesting a fast underlying mechanism for cell death. Power absorption by the MNPs might locally disrupt endosomic membranes, thus provoking irreversible cell damage.

Cell death induced by the application of alternating magnetic fields to nanoparticle-loaded dendritic cells

In this work, the capability of primary, monocyte-derived dendritic cells (DCs) to uptake iron oxide magnetic nanoparticles (MNPs) is assessed and a strategy to induce selective cell death in these MNP-loaded DCs using external alternating magnetic fields (AMFs) is reported. No significant decrease in the cell viability of MNP-loaded DCs, compared to the control samples, was observed after five days of culture. The number of MNPs incorporated into the cytoplasm was measured by magnetometry, which confirmed that 1-5 pg of the particles were uploaded per cell. The intracellular distribution of these MNPs, assessed by transmission electron microscopy, was found to be primarily inside the endosomic structures. These cells were then subjected to an AMF for 30 min and the viability of the blank DCs (i.e. without MNPs), which were used as control samples, remained essentially unaffected. However, a remarkable decrease of viability from approximately 90% to 2-5% of DCs previously loaded with MNPs was observed after the same 30 min exposure to an AMF. The same results were obtained using MNPs having either positive (NH(2)(+)) or negative (COOH(-)) surface functional groups. In spite of the massive cell death induced by application of AMF to MNP-loaded DCs, the number of incorporated magnetic particles did not raise the temperature of the cell culture. Clear morphological changes at the cell structure after magnetic field application were observed using scanning electron microscopy. Therefore, local damage produced by the MNPs could be the main mechanism for the selective cell death of MNP-loaded DCs under an AMF. Based on the ability of these cells to evade the reticuloendothelial system, these complexes combined with an AMF should be considered as a potentially powerful tool for tumour therapy.

Oncologic patients in the emergency room

e20748

Background: Cancer is a very frequent pathology with a gradual increase of its prevalence. Oncologic patients are exposed to suffer many complications which may need emergency attention. The aim of this study is to describe patients which consult in the emergency room and frecuency of different causes of complaint. Methods: Between October 2007 and October 2008, we collected all oncologic patients who consulted in our emergency room. We describe tumor location and causes of complaint. Results: 560 oncologic patients were attended in 12 months (median 12 per week). By tumor location, 134 (23,9%) patients had not small cell lung cancer (NSCLC), 101 (18%) colorrectal cancer, 64 (11.4%) breast cancer, and 261 (53%) other malignancies. Of all patients, 440 (82.7%) had stage IV disease and 318 (56.8%) were receiving chemotherapy treatment The most common causes to complaint were oncologic pain (22.5%), fever (17.5%), dysphnea (12.7%), neurologic symptoms (9.1%), and asthenia (8.6%). Conclusions: Oncologic patients consult frecuently in the emergency room, mainly those with NSCLC and colorrectal cancer. Metastasic disease and chemotherapy treatment are common too. Oncologic pain, fever and dysphnea are the most frequent causes of complaint,with an important impact on their quality of life.

No significant financial relationships to disclose.

Evaluation of neurological symptoms in oncologic patients at the emergency department

e20728

Background: Neurological symptoms in cancer patients are common and some of them represent a potentially serious situation. They are a frequent cause of complaint at the Emergency Department (ED). The aim of the study is to describe the profile of cancer patient who consult at ED for neurological symptoms, their diagnosis and management. Methods: From October 2007 to October 2008, all cancer patients treated at the ED of our hospital were prospectively collected. The reasons for consultation, diagnosis and clinical management are described. Results: A total of 560 cancer patients were enrolled. Of them, 61 patients (11%) consulted for a neurologic symptom: 50 of these patients (82%) were stage IV disease and 30 (49,2%) were receiving chemotherapy treatment. Of the total of patients, 14 (23%) had lung cancer; 10 patients (16%) had colorectal cancer; and 8 patients (13%) had primary central nervous system tumor. Most frequent causes of complaint were: low level of consciousness, 13 patients (21%); mobility deficit, 12 patients (19%); syncope, 9 patients (15%) and comitial crisis, 6 patients (10%). Of the patients who consulted for a neurological symptom, 52% of cases (32 patients) the cause was a structural lesion of central nervous system. Tumor progression was the diagnosis made in 27 patients (44,3%), in 14 patients (23%) the diagnosis was a metabolic alteration. A 69% of patients (42 patients) required hospitalization, 26% was discharged (16 patients) and 5% (3 patients) needed to be under observation during at least 24 hours. Conclusions: Neurological symptom is a frequent cause of complaint at ED for cancer patients. especially in patients in advanced stages. The most frequent diagnosis made because of these symptoms is tumor progression. Metabolic alterations are also an important diagnosis because of their frequency and because they can be solved by medical treatment. Most patients who consult for neurological symptoms need hospitalization.

No significant financial relationships to disclose.

Adverse events due to chemotherapy in emergency room

e20701

Background: High rates of mortality due to cancer make necessary improve oncologic treatments. Relationship between adverse events and chemotherapy schedule and dose is well known thanks to large observational studies. Our study´s objective is to estimate the prevalence of chemotherapy adverse events in oncologic patients attended in Emergency room. Methods: From October 2007 to October 2008 560 patients were recollected. It was revised tumors location and stage, chemotherapy schedule and date of the last treatment, diagnosis and therapheutic in Emergency. Results: 87 of the 560 patients (15%) were attended in Emergency room because of chemotherapy toxicity. The most common cause of consultation was fever (27 patients, 31%) followed by diarrhea (18 patients, 20.7%) and nausea-vomiting (12 patients, 13.8%). Most of the patients were being treated with classic chemotherapy schedules (70.1%). Comparing as a whole all the chemotherapy schedules there were not statistically significant differences due to toxicity between them. Nevertheless analyzing by subgroups we found there was no difference between toxicity in patients treated with classic chemotherapy and chemotherapy plus target agents (33.8% vs 5.5%, p=0.30), but there was differences between chemotherapy and target agents in monotherapy (33.8% vs 13.2%, p<0.05). In 39 of the 87 patients (39%) admission was required with a good evolution in most of them. Conclusions: Adverse events due to chemotherapy is a common cause of consultation in Emergency room. In our sample new target agents did not add toxicity to classic chemotherapy and given as monotherapy they had really good tolerance. More randomized studies are necessary to do a better evaluation of adverse events due to new agents.

No significant financial relationships to disclose.

Fever in cancer patients as a cause of attendance in emergency room

e20706

Background: Normal human body temperature displays a circadian rhythm, ranging from 36.1 C or lower in predawn hours to 37.4 C or higher in the afternoon. Abnormal elevation of temperature occurs as a result of hyperthermia or fever. Cancer patients frequently experience fever. Nearly two-thirds of the cases of fever in patients with prolonged neutropenia could be attributed to infection, a major cause of morbidity in cancer patients. Purpose: The aim of our study is to evaluate the prevalence of cancer patients who were attended in the emergency room for fever, the diagnosis and clinical management. Methods: From October 2007 to October 2008, 560 cancer patients were seen in the emergency department of the University Hospital of Zaragoza. The purpose of this paper is to describe the characteristics of patients who presented with fever. Results: A total of 560 patients were seen. Ninety-eight (17.5%) presented with fever. 63% of patients were stage IV. Cancer tumor type, 35 had lung cancer (35.7%), 14 had breast cancer (14.3%), 9 had colorectal cancer (9.2%), 9 had urothelial cancer (9.2%), 5 had head neck cancer (5.1%), 5 had pancreatic cancer (5.1%), 3 had esophageal cancer (3%), 2 had prostate cancer (2%), and 14,3% had other neoplasm. 18 patients (18.36%) had been received chemotherapy treatment in a period of 10 days before. they were attended in emergency room. By diagnosis: 23 patients (23,46%) were diagnosed of febrile neutropenia, and 19 of them (82,6%) required admission to the hospital. 30 were diagnosed of respiratory tract infection (30,6%), 12 were diagnosed of urinary infection (12.24%). Considering all the patients who presented with fever: 45 patients were sent home with new treatment (45,9%), 6 patients were observed for 24 hours in the emergency room (6.2%) and 47 patients required admission to the hospital (47.9%). Conclusions: Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. Infection in the immunocompromised host is a serious clinical situation due to high morbimortality and is one of the most frequent complications in the patient with cancer.

No significant financial relationships to disclose.

Anemia evaluation in oncologic patients in the emergency room

e20714

Background: Anemia is a very common diagnosis in oncologic patients and it can be produced by different causes. The aim of this study is to describe the prevalence and causes of anemia in oncologic patients who consults in the emergency room. Methods: From October 2007 to October 2008, all oncologic patiens who consulted in the emergency room were collected. We analyze the prevalence of anemia and its causes. Tumor location is described too. Results: Of the 560 patients collected, 223 (39.82%) were diagnosed of anemia. 64 of them (28.7%) had lung cancer, 33 (14.8%) breast cancer, 32 (14.3%) colon cancer, 15 (6.7%) bladder cancer, 15 (6.7%) prostate cancer, 13 (5.8%) head and neck cancer, and 51 (22.5%) other malignancies. Median haemoglobin level was 10 (range 4.2–11.9). As etiology was identified chemotherapy toxicity in 113 patients (50.7%), anemia of chronic disease in 65 (29.1%), tumoral bleeding in 41 (18.4%), and non-tumoral upper gastrointestinal bleeding in 4 (1.8%). Conclusions: Anemia is a very common diagnosis in oncologic patients, mainly in lung and breast cancer. The most frequent causes of anemia are chemotherapy toxicity and chronic disease.

No significant financial relationships to disclose.

Dyspnea in oncologic patients as an important cause of attendance in emergency room

e20705

Background: Attending oncologic patients in emergency room because of a large variety of symptoms due to treatments or tumor complications is very common. Our objective is to estimate the prevalence of dyspnea in oncologic patients and its etiology. Methods: From October 2007 to October 2008 we recollected 560 oncologic patients who were seen on Emergency room. It was revised cause of consultation, tumors´ location and stage, active or palliative care, diagnosis and treatment. Results: 71 of the 560 patients (12.7%) related dyspnea as cause of consultation, being the third cause of attendance in Emergency room after pain (126 patients, 22.5%) and fever (98 patients, 17.5%). The most common tumor´s location was lung in 38 of the 71 patients (53.52%), followed by colorectal cancer (11.3%) and breast (9.9%). 76.8% were advanced oncologic patients (stage IV). Diagnosis was respiratory infection in 19 patients (26.8 %) followed by malignant pleural bleeding (10 patients, 14.1%), disease progression (9 patients, 12.7%) and pulmonary embolism (5 patients, 7%). Dyspnea was a multifactorial symptom in 21 of the 71 patients (29.6%) without an etiological diagnosis. In 47 patients (66.2%) was required admission with a mortal evolution in more than 50%. Conclusions: In oncologic patients dyspnea is a frequent cause of consultation in Emergency room with high rates of morbility and mortality. It affects to patients´quality of life. When etiology is diagnosed the most common is respiratory infection. We should make an effort to offer the best supportive care.

No significant financial relationships to disclose.

Dendritic cell uptake of iron-based magnetic nanoparticles

We have investigated the internalization of magnetic nanoparticles (NPs) into dendritic cells (DCs) in order to assess both the final location of the particles and the viability of the cultured cells. The particles, consisting of a metallic iron core covered with carbon, showed no toxic effects on the DCs and had no effect in their viability. We found that mature DCs are able to incorporate magnetic nanoparticles in a range of size from 10 nm to ca. 200 nm, after 24 h of incubation. We describe a method to separate cells loaded with NPs, and analyze the resulting material by electron microscopy and magnetic measurements. It is found that NPs are internalized in lysosomes, providing a large magnetic signal. Our results suggest that loading DCs with properly functionalized magnetic NPs could be a promising strategy for improved vectorization in cancer diagnosis and treatment.

What is the yield of regional lymph node dissection following sentinel lymph node involvement in patients with breast cancer?

10782

Background: Sentinel lymph node is a minimally invasive and accurate staging procedure for patients with invasive breast cancer. Histological SLN involvement with cancer cells requires regional lymph node dissection. Aim: To verify if subgroups of patients with sentinel lymph node involvement in which the risk of histological involvement of additional regional lymph nodes is minimal can be identified. Methods: Ninety six consecutive patients with invasive breast cancer and tumour size less than two centimeters by mammography, had lymphoscintigraphy with colloidal 99Tc and radioisotope-guided sentinel lymph node biopsy in the University Hospital of Zaragoza from 1999 to 2005.Pathological assessment included serial sections of the sentinel lymph node with inmunohistochemistry for cytokeratins in selected cases.39 patients had histological involvement and are presented in this analysis. Results: All 39 patients were females. Median tumour size was 20 mm (range 5–52) Median number of resected sentinel lymph node was 2 (range 1–5) Median number of involved sentinel lymph node was 1 (range 1–4) Regional lymph node dissection was performed in all patients (Axillary dissection in 31; internal mammary dissection in 1, both in 7). Median number of nodes was 13 (range 2–34) At least 1 additional involved lymph node was found in 19 patients (48%) We have correlated patient age, menopausal status, pathological tumour size, histological grade, estrogen receptors, progesterone receptors and Her2 with the risk of histological lymph node involvement in regional lymph node dissection. Conclusions: Tumour size was significantly associated to such risk:

No significant financial relationships to disclose.

Axillary lymphadenectomy can be safely avoided in patients with breast cancer and negative sentinel lymph node biopsy

10787

Background: Patients with breast cancer in which sentinel lymph node biopsy is histologically negative for tumor cells, have a low probability of having involvement of additional regional lymph nodes. Lymph node dissection may be avoided in these cases. Methods: Ninety-six consecutive patients with invasive breast cancer and tumour size less than 2 centimeters by mammography, had lymphoscintigraphy with colloidal 99Tc and radioisotope-guided sentinel lymph node biopsy in the University Hospital of Zaragoza from 1999 to 2005.Pathological assessment included serial sections of the sentinel lymph node with immunohistochemistry for cytokeratins in selected cases. Results: Sentinel lymph node biopsy was negative in 57 patients. There were 56 females and 1 male. Median age was 57 years (range 24–87). Median pathological tumor size was 15 mm (range 5–31). Location of the sentinel lymph node was axillary in 47patients, internal mammary in 0 patients, and both in 10 patients. Median number of resected lymph nodes was 2 (range 1–4). With median follow-up of 33 months, no local or systemic relapses have occurred. Conclusions: Avoidance of regional lymph node dissection is safe in patients with breast cancer and histologically negative sentinel lymph node biopsy.

No significant financial relationships to disclose.

Frequency of familiar cancer in a cohort of newly-diagnosed patients with colorectal cancer

13588

Background: Incidence on Hereditary Non Poliposis Colorectal Cancer (HNPCC) is 3–5% of all colorectal cancers (CRC). Primary identification of patients (p) with high risk of this hereditary syndrome is the first step before genetic testing for MSH2, MLH1 or MSH6 mutations. AIMS: To determine the frequency of family history of CRC in our population Methods: We have assessed cancer history (full family pedigree, including at least 2 generations of ascendants plus all descendants) in a cohort of 100 newly-diagnosed p with CRC cancer seen as first visit at the Division of Medical Oncology of the University Hospital of Zaragoza, Spain, from 2005. We have used the revised Bethesda Guideline for HNPCC published in JNCI (Vol 96. Feb 2004) Results: Median age was 72 (range: 26 - 85). 29 females/71 males. Considering Bethesda criteria for genetic testing, percentages of families fulfilling them were: Cancer before age 50: 7 (7%), synchronous/metachronous cancer: 1 (1%), other HNPCC associated tumors before age 50: 1 (ovarian 1%), One first-degree relative with HPNCC related tumor before age 50: 4 (4%), Two or more family members with HNPCC related cancer: 5 (5%). Overall, 14 (14%) fulfilled at least 1 of these criteria. Number of cases of tumors in the family (for a total of 909 family members) was 82, 10 cases of breast cancer, 23 of colorectal, 6 of gastric, 5 of prostate, 3 gynecologic, 11 lung, and 21 others. Conclusions: Frequency of familiar CC in unselected breast cancer patients of Zaragoza, Spain, is substantially higher than that expected. Assessment of cancer familiar history in the newly-diagnosed patients with CC cancer, helps us to identify families in which a genetic study is to be considered, and this could be useful to prevent new case of cancer.

No significant financial relationships to disclose.

Promising targets in renal cell cancer: Met and ron-beta

20119

Background: The activation of Tyrosin Kinase Receptors (RTKs) produces several effects about cellular response. These are membrane receptors that bind differentiation signals, grow factors and cellular mediators. The interaction with their ligand causes the phosphorilation and internalization in the endosome. By a metabolic way, these receptors are degradated into the proteasome to small peptides that are expressed over the cellular surface joined to MHC class I mollecules, getting a better immunogenic recognition of the tumor cells. It is known that the bigger expression of the tyrosin kinase receptors in tumors is associated with an aggressive phenotype. For example overexpression of ephA2 or EGFR. Our study is based in the demostration of the overexpression of other receptors in renal cell cancer, a tumour with a disappointing response with treatment in advanced stages. On this way we can use them as targets for monoclonal antibodies and for citotoxic lymphocites CD8 stimulated that will join to peptides presented in MHC class I after the proteasomic degradation. Methods: We use Western-Blot for identifying the overexpressed RTKs in relation to normal tissue and as a reference the expression of beta-actin, that is present in every cells. The cells are from 5 murine renal cell cancer lines, (thanks to Hillman Cancer Center Institute, University of Pittsburgh. Pennsylvania. USA). The control is a murine cell line that is very similar to normal renal tissue (HK). We calculate the ratio of expression compared with the expression of normal tissue with an statistical analysis. Results: HER-2, VEGFR-2, Met, Ron-beta are overexpresed in renal cell cancer in a murine model, as EGFR (epidermic growing factor receptor). Conclusions: Met may be excellent therapeutic and inmunologic target and in selected cases of renal cell cancer. It’s known that EGFR and VEGFR are also good targets. Future research about these targets will get new options of combined immunotherapy (vaccines and monoclonal antibodies).

No significant financial relationships to disclose.

Randomized phase III trials of adjuvant FAMTX or FEMTX compared with surgery alone in resected gastric cancer. A combined analysis of the EORTC GI Group and the ICCG

BACKGROUND

In patients who underwent radical resection for gastric cancer, we investigate the relative efficacy of combined 5-fluorouracil+adriamycin or epirubicin and methotrexate with leucovorin rescue (FAMTX or FEMTX) compared with a control arm.

PATIENTS AND METHODS

This report is a prospective combined analysis of two randomized clinical trials conducted on patients who underwent radical resection for histologically proven adenocarcinoma of the stomach or esophago-gastric junction. Three hundred and ninety-seven untreated patients, 206 from 23 European Organization for Research and Treatment of Cancer (EORTC) institutions and 191 from 16 International Collaborative Cancer Group (ICCG) institutions, were randomized. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and the treatments were compared for these end-points by means of the log-rank test, retrospectively stratified by trial.

RESULTS

In a planned combined analysis of the two trials, no significant differences were found between the treatment and control arms for either DFS (hazards ratio: 0.98, P=0.87) or OS (hazards ratio: 0.98, P=0.86). The 5-year OS was 43% in the treatment arm and 44% in the control arm and the 5-year DFS was 41% and 42%, respectively.

CONCLUSION

Neither FAMTX nor FEMTX can be advocated as adjuvant treatment in patients who undergo resection for gastric cancer.

High dose chemotherapy and autologous stem cell transplantation as adjuvant therapy for primary breast cancer patients with four or more lymph nodes involved: long-term results of an international randomised trial

BACKGROUND

The purpose of this study was to assess whether a short course of anthracycline containing chemotherapy followed by high dose therapy with autologous stem-cell support improves disease-free and overall survival as compared with conventional, anthracycline containing chemotherapy, in patients with primary breast cancer and four or more histologically involved lymph nodes.

PATIENTS AND METHODS

Two hundred and eighty one patients entered into a randomised clinical trial were allocated to receive standard, conventional treatment (5-fluorouracil, epirubicin and cyclophosphamide-FEC for six cycles) or FEC for three cycles followed by high dose therapy consisting of cyclophosphamide, thiotepa and carboplatin and stem cell rescue (HDT). To be eligible, patients had to be free of overt metastatic disease and be < or =60 years of age. Analyses were according to intention to treat.

RESULTS

At a median follow up of 68 months, 118 patients have experienced a relapse or death from breast cancer (62 in the FEC followed by HDT arm and 56 in the conventional FEC arm) and a total of 100 patients have died (54 in the FEC followed by HDT arm and 46 in the conventional FEC arm). No significant difference was observed in relapse-free survival [hazard ratio 1.06, 95% CI 0.74-1.52, p = 0.76] or overall survival [hazard ratio 1.18, 95% CI 0.80-1.75, p = 0.40]. Five patients died from treatment related causes, three as a consequence of HDT and two in the conventional FEC arm.

CONCLUSIONS

At the present time, no benefit has been observed from replacing three cycles of conventional chemotherapy with the HDT regimen described here. Patients should continue to receive conventional chemotherapy as adjuvant therapy for breast cancer.

[Surveillance of commensal flora evolution and infections in neutropenic cancer patients submitted to chemoprophylaxis]

The evolution of the flora and its resistance to different antimicrobials in neutropenic patients submitted to high-dose chemotherapy with autologous blood stem-cell transplantation, and the relation of these findings to the etiology of the infections the patients developed was studied in order to evaluate the suitability of the chemoprophylaxis and the empirical antibiotic therapy used. Forty-one patients were analyzed in a period of 28 months. The chemoprophylaxis used was levofloxacin, fluconazole and acyclovir. The empirical sequential treatment was an initial administration of cefepime, followed by teicoplanin and amikacin. Cultures were done of nasal and pharyngeal smears, Hickman catheter and stools, 1 day before chemoprophylaxis started and then on days 5 and 9. In the case of fever, three sets of blood cultures and urine cultures were done and samples from areas related to the clinical condition were analyzed. Levofloxacin induced the selection of resistant strains or species in the flora and in the infectious agents. Fluconazole also selected resistant species in the flora. Seventeen infections were documented in eleven patients, produced by Gram-positive bacteria in thirteen cases (81.25%) and by Gram-negative bacteria in three (18.75%). The coagulase negative staphylococci and Enterococcus faecalis were the most frequent agents of infection. We identified on nine occasions the same microorganism in the flora and in the pathological product; this suggests its endogenous origin and supports the use of prospective cultures of the flora, monitoring the sensibility of the microorganisms isolated to the antimicrobials used in chemoprophylaxis and empirical treatment.

Effect of dietary fish oil, alpha-tocopheryl acetate, and zinc supplementation on the composition and consumer acceptability of chicken meat

A factorial design was used to study the effect of dietary fish oil (1.25% and 2.5%), all-rac-alpha-tocopheryl acetate (70 and 140 mg/kg), and Zn supplementation (0 and 200 mg/kg) on the composition and consumer acceptability of chicken meat stored at -20 degrees C for 5 mo. Supplementation of the diet with all-rac-alpha-tocopheryl acetate increased the alpha-tocopherol content in meat. The fatty acid composition of the meat was affected only by the amount of fish oil. Diets supplied with 2.5% fish oil produced meat with an eicosapentaenoic and docosahexaenoic acid content double that of diets supplied with 1.25% fish oil. Zn supplementation did not affect the content of this mineral in the meat. Moreover, the consumer acceptability of meat samples showed no significant differences between dietary treatments after 5 mo of storage at -20 degrees C or with respect to a freshly cooked commercial sample used as a blind control.

Epirubicin-cyclophosphamide adjuvant chemotherapy plus tamoxifen administered concurrently versus sequentially: randomized phase III trial in postmenopausal node-positive breast cancer patients. A GEICAM 9401 study

BACKGROUND

A prospective randomized clinical trial was implemented to assess whether the concomitant or the sequential addition of tamoxifen to chemotherapy provides improved clinical benefit in the adjuvant treatment of breast cancer in postmenopausal patients.

PATIENTS AND METHODS

Four-hundred and eighty-five patients with node-positive operable disease were randomized to receive tamoxifen (20 mg/day) concomitantly (CON) or sequentially (SEQ) to EC chemotherapy (epirubicin 75 mg/m(2) + cyclophosphamide 600 mg/m(2) on day 1, every 21 days for four cycles).

RESULTS

In the 474 fully evaluable patients there were 96 events; eight being second neoplasms and 88 being related to the breast cancer. Of these, 48 of 88 occurred in the CON arm and 40 of 88 in the SEQ arm. The Kaplan-Meier estimation of disease-free survival (DFS) at 5 years was 70% in the CON and 75% in the SEQ group (log-rank test, P = 0.43). Adjusted hazard ratio for treatment was 1.11 (95% confidence interval 0.71-1.73; P = 0.64).

CONCLUSION

This study fails to show an advantage of one treatment arm over the other, but a trend, albeit non-significant, appears to favor the sequential addition of tamoxifen to epirubicin + cyclophosphamide and, as such, warrants further investigation.