Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Glyphosate, AMPA and glufosinate in soils and earthworms in a French arable landscape

Although Glyphosate-based herbicides are often marketed as environmentally friendly and easily biodegradable, its bioavailability and risks to wildlife raise significant concerns. Among non-target organisms, earthworms which live in close contact with the soil can be directly exposed to pesticides and harmed. We investigated soil contamination and the exposure of earthworms to glyphosate, its metabolite AMPA, and glufosinate in an arable landscape in France, both in treated (i.e. temporary grasslands and cereal fields under conventional farming), and nontreated habitats (i.e. hedgerows, permanent grasslands and cereal fields under organic farming) (n = 120 sampling sites in total). Glyphosate, AMPA and glufosinate were detected in 88%, 58% and 35% of the soil samples, and in 74%, 38% and 12% of the earthworm samples, respectively. For both glyphosate and AMPA, concentrations in soils were at least 10 times lower than predicted environmental concentrations. However, the maximum glyphosate soil concentration measured (i.e., 0.598 mg kg-1) was only 2 to 3 times lower than the concentrations revealed to affect earthworms (survival and avoidance) in the literature. These compounds were found both in conventional and organic farming fields, thus supporting a recent study, and for the first time they were detected in hedgerows and grasslands. However, glyphosate and AMPA were more frequently detected in soils from cereal fields and hedgerows than in grasslands, and median concentrations measured in soils from cereal fields were significantly higher than in the two other habitats. Bioaccumulation of glyphosate and AMPA in earthworms was higher than expected according to the properties of the molecules. Our findings raised issues about the high occurrence of glyphosate and AMPA in soils from cropped and more natural areas in arable landscapes. They also highlight the potential for transfer of these molecules in terrestrial food webs as earthworms are prey for numerous animals.

Chemical surface modification of lithium disilicate needles of a silica-based ceramic after HF-etching and ultrasonic bath cleaning: Impact on the chemical bonding with silane

OBJECTIVE

Recommendations to obtain the best bonding to silica-based ceramics are to prepare its surface by hydrofluoric-acid HF etching and regular application of a silane. This study investigated how the HF-etching following by ultrasonic water bath cleaning (recommended protocol to improve the bonding with a composite resin), modifies the surface chemistry of a lithium disilicate glass-ceramic and impacts the chemical bonding with silane.

METHODS

Lithium disilicate glass-ceramic discs (IPS Emax Press, Ivoclar Vivadent) were mirror polished, etched with 9% HF for 20 s and rinsed 1 min under water. Two post-etching cleaning were compared: (1) no additional cleaning and (2) immersion in water ultrasonic bath for 4 min. Morphology evolution of the surfaces was carried out by scanning electron microscopy. Chemical changes were studied using X-ray Photoelectron Spectroscopy and Nano Auger Electron Spectroscopy analyses. Identification of the compounds formed with fluorine was based on by High Resolution Transmission Tlectronic Microscopy .

RESULTS

Residues left on the surface of the discs after etching, the fluorine salts, were eliminated after the ultrasonic bath cleaning. However, analyses showed presence of fluorine on the lithium disilicate needles associated among others with the lithium. HR-TEM validates the presence of Li₂SiF₆ crystallized phased. A mechanism to explain silane bonding when Li₂SiF₆ phase is formed on the Li₂Si₂O₅ needles, is proposed.

SIGNIFICANCE

HF-etching leads to the formation of lithium and fluorine contain LiSi₂F₆ nano-precipitates on the Li₂Si₂O₅ needles which helps to improve the bonding with silane.

Aide médicale urgente — établissement d’hébergement des personnes âgées dépendantes : retour d’expérience d’une organisation innovante pendant la crise Covid-19

La crise sanitaire Covid-19 a obligé les Samu–Smur à adapter leurs organisations au jour le jour. La régulation a dû trouver des réponses spécifiques aux types d’appels, au plan quantitatif et qualitatif. En lien avec la médecine générale et les recommandations ministérielles, le Samu devait être le garant d’une juste orientation des patients vers les services hospitaliers. Le Samu 94 et la faculté de santé de Créteil ont créé une cellule dédiée aux établissements d’hébergement des personnes âgées dépendantes, accessible via une ligne spécialisée du Samu–centre 15, offrant 24 heures/24 l’accès à des compétences gériatriques et conseils divers, véritable lien ville–hôpital. Le retour d’expérience montre que cette cellule est une des facettes, dans le domaine de la gériatrie, de ce qu’est le concept de service d’accès aux soins (SAS) et qu’il ne faut pas attendre un rebond de crise pour en consolider les fondements.

Preparedness for chemical crisis situations: experiences from European medical response exercises

OBJECTIVE

This study investigated how European first responders and hospital personnel, along with CBRN experts, approach an overwhelming surge situation after a chemical incident. Surge capacity and capability bottlenecks were discussed.

MATERIALS AND METHODS

Two chemical warfare agent (CWA) scenarios were developed: in the first, a nerve agent was released indoors; in the second, there was an outdoor explosion containing a blister agent. CBRNE experts, first responders and hospital specialists from across Europe participated in a two-day table-top exercise to discuss pre-hospital and hospital CBRNE preparedness, triage, surge capacity and communication issues. This was followed by a medical response exercise at a level 2 Emergency Department in Italy.

RESULTS

Several surge capacity challenges and lessons were identified. Critical resources were rapidly exhausted and sourcing from national/international medical stockpiles was not feasible in the time critical scenarios. Secondary contamination in the blister agent scenario was considered plausible and hospitals are currently unprepared for this situation. The medical response exercise highlighted further training needs.

CONCLUSIONS

The majority of the lessons are not new and have been reported in North American studies. However, this study is the first to describe these CWA challenges from a European perspective. Medical facilities across the region should consider these lessons to evaluate and improve their surge capacity, capability and response.

Influence of external cooling on the femtosecond laser ablation of dentin

In the present work, the influence of external cooling on the temperature rise in the tooth pulpal chamber during femtosecond laser ablation was investigated. The influence of the cooling method on the morphology and constitution of the laser-treated surfaces was studied as well. The ablation experiments were performed on dentin specimens using an Yb:KYW chirped-pulse-regenerative amplification laser system (560 fs, 1030 nm). Cavities were created by scanning the specimens at a velocity of 5 mm/s while pulsing the stationary laser beam at 1 kHz and with fluences in the range of 2-14 J/cm². The experiments were performed in air and with surface cooling by a lateral air jet and by a combination of an air jet and water irrigation. The temperature in the pulpal chamber of the tooth was measured during the laser experiments. The ablation surfaces were characterized by scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) spectroscopy. The temperature rise reached 17.5 °C for the treatments performed with 14 J/cm² and without cooling, which was reduced to 10.8 ± 1.0 and 6.6 ± 2.3 °C with forced air cooling and water cooling, respectively, without significant reduction of the ablation rate. The ablation surfaces were covered by ablation debris and resolidified droplets containing mainly amorphous calcium phosphate, but the amount of redeposited debris was much lower for the water-cooled specimens. The redeposited debris could be removed by ultrasonication, revealing that the structure and constitution of the tissue remained essentially unaltered. The present results show that water cooling is mandatory for the femtosecond laser treatment of dentin, in particular, when high fluences and high pulse repetition rates are used to achieve high material removal rates.

Surgery for massive splenomegaly

BACKGROUND

Splenectomy for massive splenomegaly (spleen weight more than 1·5 kg) is commonly believed to be hazardous and to provide poor palliation. The aim of this cohort study was to investigate these issues and examine the many definitions of massive splenomegaly to see whether a better tool might be proposed for preoperative evaluation of these patients.

METHODS

Morbidity and long-term outcomes were assessed in consecutive patients. Relief of pressure-volume-related symptoms and sustainable independence from transfusion in patients were used to ascertain the impact of splenectomy.

RESULTS

Splenectomy was performed in 56 patients, mainly for non-Hodgkin's lymphoma and myeloproliferative diseases. Median spleen weight was 2·3 (range 1·5-6·0) kg. Mortality at 180 days was zero, and the postoperative complication rate was 25 per cent (17 complications in 14 patients). At 2 years, relief of pain was maintained in 33 of 34 patients, with sustained independence from transfusion in 15 of 19 patients with anaemia and nine of 11 with thrombocytopenia. Spleen weight correlated negatively with BMI (P = 0·036).

CONCLUSION

Splenectomy for massive splenomegaly is safe and provides effective palliation. Provisional cut-off points relating to spleen size and BMI help to identify patients benefiting from a splenectomy, even those in a critical state.

Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer

Background

The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.

Methods

Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.

Results

Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).

Conclusion

NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

The FORBIO Climate data set for climate analyses

Abstract. In the framework of the interdisciplinary FORBIO Climate research project, the Royal Meteorological Institute of Belgium is in charge of providing high resolution gridded past climate data (i.e. temperature and precipitation). This climate data set will be linked to the measurements on seedlings, saplings and mature trees to assess the effects of climate variation on tree performance. This paper explains how the gridded daily temperature (minimum and maximum) data set was generated from a consistent station network between 1980 and 2013. After station selection, data quality control procedures were developed and applied to the station records to ensure that only valid measurements will be involved in the gridding process. Thereafter, the set of unevenly distributed validated temperature data was interpolated on a 4 km × 4 km regular grid over Belgium. The performance of different interpolation methods has been assessed. The method of kriging with external drift using correlation between temperature and altitude gave the most relevant results.

Precipitation climate maps of Belgium

Abstract. Investigations are conducted to best estimate precipitation climate maps over Belgium from daily observations available for the period 1981–2010. Several mapping approaches are compared in a cross-validation exercise. These approaches differ by several aspects and in particular by the order in which the temporal aggregation (i.e. computation of climate mean values from daily data) and spatial interpolation steps are performed, and by the integration of ancillary information in the spatial interpolation method. The selected approach is used to derive a large panel of climate maps. In particular, the main spatio-temporal features of the annual cycle of rainfall in Belgium are extracted by principal component analysis (PCA).

Quality control of 10-min soil temperatures data at RMI

Abstract. Soil temperatures at various depths are unique parameters useful to describe both the surface energy processes and regional environmental and climate conditions. To provide soil temperature observation in different regions across Belgium for agricultural management as well as for climate research, soil temperatures are recorded in 13 of the 20 automated weather stations operated by the Royal Meteorological Institute (RMI) of Belgium. At each station, soil temperature can be measured at up to 5 different depths (from 5 to 100 cm) in addition to the bare soil and grass temperature records. Although many methods have been developed to identify erroneous air temperatures, little attention has been paid to quality control of soil temperature data. This contribution describes the newly developed semi-automatic quality control of 10-min soil temperatures data at RMI.

Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas (Observatoire dédié au Cancer Bretagne / Pays de la Loire)

BACKGROUND

In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer.

METHODS/RESULTS

A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks.

CONCLUSION

Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.

A belgian multicenter prospective observational cohort study shows safe and efficient use of a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair

BACKGROUND

A variety of anti-adhesive composite mesh products have become available to use inside the peritoneal cavity. However, reimbursement of these meshes by the Belgian Governemental Health Agency (RIZIV/INAMI) can only be obtained after conducting a prospective study with at least one year of clinical follow-up. This -Belgian multicentric cohort study evaluated the experience with the use of Proceed®-mesh in laparoscopic ventral hernia repair.

METHODS

During a 25 month period 210 adult patients underwent a laparoscopic primary or incisional hernia repair using an intra-abdominal placement of Proceed®-mesh. According to RIZIV/INAMI criteria recurrence rate after 1 year was the primary objective, while postoperative morbidity, including seroma formation, wound and mesh infections, quality of life and recurrences after 2 years were evaluated as secondary endpoints (NCT00572962).

RESULTS

In total 97 primary ventral and 103 incisional hernias were repaired, of which 28 (13%) were recurrent. There were no conversions to open repair, no enterotomies, no mesh infections and no mortality. One year cumulative follow-up showed 10 recurrences (n = 192, 5.2%) and chronic discomfort or pain in 4.7% of the patients. Quality of life could not be analyzed due to incomplete data set.

CONCLUSIONS

More than 5 years after introduction of this mesh to the market, this prospective multicentric study documents a favorable experience with the Proceed mesh in laparoscopic ventral hernia repair. However, it remains to be discussed whether reimbursement of these meshes in Belgium should be limited to the current strict criteria and therefore can only be obtained after at least 3-4 years of clinical data gathering and necessary follow-up.

Combination of low dose of the anti-adipogenic agents resveratrol and phenelzine in drinking water is not sufficient to prevent obesity in very-high-fat diet-fed mice

PURPOSE

Resveratrol inhibits lipid accumulation but suffers from limited bioavailability. The anti-depressive agent phenelzine limits adipogenesis in various models of cultured preadipocytes, and this hydrazine derivative also inhibits de novo lipogenesis in mature adipocytes. It was therefore tested whether resveratrol effects on adiposity reduction and glucose tolerance improvement could be reinforced by co-administration with phenelzine.

METHODS

Mice fed a very-high-fat diet (VHFD, 60% calories as fat) were subjected to drinking solution containing low dose of resveratrol (0.003%) and/or 0.02% phenelzine for 12 weeks. Body fat content, glucose tolerance, food and water consumption were checked during treatment while fat depot mass was determined at the end of supplementation. Direct influence of the agents on lipogenesis and glucose uptake was tested in adipocytes.

RESULTS

Epididymal fat depots were reduced in mice drinking phenelzine alone or with resveratrol. No limitation of body weight gain or body fat content was observed in the groups drinking resveratrol or phenelzine, separately or in combination. The altered glucose tolerance and the increased fat body composition of VHFD-fed mice were not reversed by resveratrol and/or phenelzine. Such lack of potentiation between resveratrol and phenelzine prompted us to verify in vitro their direct effects on mouse adipocytes. Both molecules inhibited de novo lipogenesis, but did not potentiate each other at 10 or 100 μM. Only resveratrol inhibited hexose uptake in a manner that was not improved by phenelzine.

CONCLUSIONS

Phenelzine has no interest to be combined with low doses of resveratrol for treating/preventing obesity, when considering the VHFD mouse model.

Outcome following laparoscopic and open total mesorectal excision for rectal cancer

BACKGROUND

There are few reports on the oncological quality of resection and outcome after laparoscopic versus open total mesorectal excision (TME) for rectal cancer in everyday surgical practice.

METHODS

Between January 2006 and October 2011, data for patients with mid or low rectal adenocarcinoma who underwent elective TME were recorded in the PROCARE database. A multivariable model and the propensity score as a co-variable in Cox or logistic regression models were used for adjustment of differences in patient mix and non-random assignment of surgical approach.

RESULTS

Data for 2660 patients from 82 hospitals were recorded. Implementation of laparoscopic TME was highly variable. The oncological quality of resection was similar in the laparoscopic and the open group: incomplete mesorectal excision in 13·2 and 11·4 per cent respectively, circumferential resection margin positivity in 18·1 per cent, and a median of 11 lymph nodes examined per specimen in both groups. The hazard ratio for survival after laparoscopic versus open TME was 1·05 (95 per cent confidence interval 0·88 to 1·24) after correction for differences in patient mix, and 1·06 (0·89 to 1·25) after correction for the propensity score. The definitive colostomy rate was similar in the two groups: 31·0 per cent after open and 31·4 per cent after laparoscopic TME. Postoperative morbidity was lower and length of stay was shorter after laparoscopic TME compared with open TME. Survival was not negatively affected by converted laparoscopic resection, whereas postoperative morbidity, mortality and length of stay after converted laparoscopy were comparable with those after open TME.

CONCLUSION

Oncological outcome is comparable after laparoscopic and open TME in everyday surgical practice.

Lysophosphatidic acid impairs glucose homeostasis and inhibits insulin secretion in high-fat diet obese mice

AIMS/HYPOTHESIS

Lysophosphatidic acid (LPA) is a lipid mediator produced by adipocytes that acts via specific G-protein-coupled receptors; its synthesis is modulated in obesity. We previously reported that reducing adipocyte LPA production in high-fat diet (HFD)-fed obese mice is associated with improved glucose tolerance, suggesting a negative impact of LPA on glucose homeostasis. Here, our aim was to test this hypothesis.

METHODS

First, glucose tolerance and plasma insulin were assessed after acute (30 min) injection of LPA (50 mg/kg) or of the LPA1/LPA3 receptor antagonist Ki16425 (5 mg kg(-1) day(-1), i.p.) in non-obese mice fed a normal diet (ND) and in obese/prediabetic (defined as glucose-intolerant) HFD mice. Glucose and insulin tolerance, pancreas morphology, glycogen storage, glucose oxidation and glucose transport were then studied after chronic treatment (3 weeks) of HFD mice with Ki16425.

RESULTS

In ND and HFD mice, LPA acutely impaired glucose tolerance by inhibiting glucose-induced insulin secretion. These effects were blocked by pre-injection of Ki16425 (5 mg/kg, i.p.). Inhibition of glucose-induced insulin secretion by LPA also occurred in isolated mouse islets. Plasma LPA was higher in HFD mice than in ND mice and Ki16425 transiently improved glucose tolerance. The beneficial effect of Ki16425 became permanent after chronic treatment and was associated with increased pancreatic islet mass and higher fasting insulinaemia. Chronic treatment with Ki16425 also improved insulin tolerance and increased liver glycogen storage and basal glucose use in skeletal muscle.

CONCLUSIONS/INTERPRETATION

Exogenous and endogenous LPA exerts a deleterious effect on glucose disposal through a reduction of plasma insulin; pharmacological blockade of LPA receptors improves glucose homeostasis in obese/prediabetic mice.

The effect of recombinant human bone morphogenetic protein-2 in single-level posterior lumbar interbody arthrodesis

BACKGROUND

In this prospective, randomized controlled trial, our objective was to assess both the clinical and radiographic effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in patients treated with an instrumented single-level posterior lumbar interbody arthrodesis with polyetheretherketone cages.

METHODS

Forty patients were randomized with a 1:1 ratio. Two patients who had a two-level arthrodesis (L4-L5 and L5-S1) were excluded. Patients completed the Oswestry Disability Index, the Short Form-36, and the visual analog scale preoperatively and postoperatively at three, six, twelve, and twenty-four months. Computed tomography scans with coronal and sagittal reconstructions were made at three, six, and twelve months postoperatively. Interbody arthrodesis was performed using polyetheretherketone cages, which were filled with 8 mg of rhBMP-2 in the study group and 2.5 mL of autologous bone in the control group.

RESULTS

Baseline demographic data showed no significant difference between groups, except for the body mass index, which was higher in the study group (p = 0.032). There were no significant differences in the clinical results (visual analog scale, Oswestry Disability Index, and Short Form-36) between the groups at each postoperative visit. At three months, end-plate resorption was noted around the cages filled with rhBMP-2 in all patients in the study group. No cage migration or subsidence was observed. Bridging trabecular bone scale scores and bone density measures were significantly lower in the study group. Osteolysis and ectopic bone formation occurred in seven of nineteen patients in the study group and did not occur in the control group. This did not result in radicular symptoms within the time span of this study. At one year, computed tomography scans showed osseous healing in all patients. There were no revision procedures.

CONCLUSIONS

This trial showed no clinical difference when rhBMP-2 was used in posterior lumbar interbody arthrodesis compared with autologous bone. On computed tomography scans, fusion was equally achieved, but trabecular bone formation occurred at a slower rate and interbody bone density was lower within the first year after surgery when rhBMP-2 was used. End-plate resorption, osteolysis, and ectopic bone formation were frequently noted in the rhBMP-2 group.

Sunshine duration climate maps of Belgium and Luxembourg based on Meteosat and in-situ observations

Abstract. Sunshine duration was historically the traditional parameter to quantify solar radiation. In the present study, we propose to benefit from the measurements made with Campbell-Stokes recorders at 18 sites in Belgium and Luxembourg to generate maps of daily sunshine duration for the period 1995–2005. In order to provide maps with the highest degree of confidence as possible, ancillary data of high spatial resolution derived from Meteosat satellites images are used within the mapping process. Different methods combining in situ sunshine duration measurements and Meteosat-derived data are evaluated. The best performing method is then used to compile a dataset of gridded daily sunshine duration data over Belgium and Luxembourg. The 1995–2005 sunshine duration climate map is finally provided. Various areal mean values are computed and discussed.

Sensitivity of the RMI's MAGIC/Heliosat-2 method to relevant input data

Abstract. Appropriate information on solar resources is very important for a variety of technological areas. Based on the potential of retrieving global horizontal irradiance from satellite data, an enhanced version of the Heliosat-2 method has been implemented at the Royal Meteorological Institute of Belgium to estimate surface solar irradiance over Belgium from Meteosat Second Generation at the SEVIRI spatial and temporal resolution. In this contribution, sensitivity of our retrieval scheme to surface albedo, atmospheric aerosol and water vapor contents is investigated. Results indicate that while the use of real-time information instead of climatological values can help to reduce to some extent the RMS error between satellite-retrieved and ground-measured solar irradiance, only the correction of the satellite-derived data with in situ measurements allows to significantly reduce the overall model bias.

Quality control of 10-min air temperature data at RMI

Abstract. In the '90s, the Royal Meteorological Institute (RMI) of Belgium started to replace its conventional ''manual'' meteorological network by automated weather stations (AWSs). The meteorological measurement network is now fully automated. RMI counts 18 AWSs that made automated observations centrally available in our headquarters in Uccle, Brussels to internal as well as external users. Due to the large increase in the data amount associated with the automation, quality assurance (QA) procedures are being automated. However, human operators continue to play an essential role in the data validation processes. This contribution describes our newly developed semi-automatic quality control (QC) of 10-min air temperature data. After an existence test, the data are checked for limits consistency, temporal consistency and spatial consistency. At the end of these automated checks, a decision algorithm attributes a flag to each particular data. Each day the QC staff analyzes the preceding day observations in the light of the quality flags assigned by automated QA procedures during the night. It is the human decision whether or not a value is accepted.

Exploring limits for data registration in the context of PROCARE, a quality improvement project on rectal cancer

BACKGROUND

A high burden of registration in the context of quality improvement projects may result in registration fatigue.

METHODS

Time required for data collection and registration was measured. Quality of care indicators (QCI) were scored and factors for adjusted benchmarking were identified. The PROCARE data set was compared with 5 other European data sets.

RESULTS

Time required for data collection varied per domain while time for registration was more uniform. On average, per item 33 seconds were needed for collection and registration. The number of data to be registered per patient was 48-276, depending on the stage of the disease, resulting in a minimum of 25 minutes and a maximum of 2 hours 4 minutes per patient, follow-up not included. Focusing on 43 clinically relevant QCIs would result in a 50% reduction, using aggregate scores for performance audit in a 71% reduction. The PROCARE data set was larger than comparable European data sets. Linkage of the PROCARE database with administrative databases provided confident data on the patients' survival status, but did not appear to be a practical option for other QCIs.

CONCLUSIONS

Limiting the aim to performance audit could significantly reduce the burden of registration. In the context of a quality improvement project, the PROCARE Steering Group concluded that detailed clinical data from all centres are still required, which can be reconsidered in the future. Maintenance of a specific database remains of crucial value. Data collection and registration cannot be based on benevolence but should be compensated for.

Experimental measurements within a phase change metallurgical reactor

The measurement of solidification front evolution is essential for the optimization and control of many important metallurgical processes. However, this measurement is tedious, imprecise, and time consuming. More generally, industry needs reliable instruments for the thermal characterization of phase change reactors. This paper enables researchers with means and instruments to study the thermal behavior of processes involving the transformation of phase change materials up to 1000 °C. In this work, an original experimental setup is described to analyze the behavior of two high temperature phase change materials: zinc and molten salts. In particular, it is possible to evaluate the 2D solid solidification front evolution with time. The measurements done with zinc show the presence of two thermal regimes. A solidification rate of 20 mm h(-1) is measured with two different approaches: thermocouples and a mechanical probe. Finally, an infrared camera is also used to make the link between the external thermal behavior and the solidification front evolution inside the reactor. When implemented within an inverse numerical method, the use of this instrument as a new external sensor looks promising.

XUTs are a class of Xrn1-sensitive antisense regulatory non-coding RNA in yeast

Non-coding (nc)RNAs are key players in numerous biological processes such as gene regulation, chromatin domain formation and genome stability. Large ncRNAs interact with histone modifiers and are involved in cancer development, X-chromosome inactivation and autosomal gene imprinting. However, despite recent evidence showing that pervasive transcription is more widespread than previously thought, only a few examples mediating gene regulation in eukaryotes have been described. In Saccharomyces cerevisiae, the bona-fide regulatory ncRNAs are destabilized by the Xrn1 5'-3' RNA exonuclease (also known as Kem1), but the genome-wide characterization of the entire regulatory ncRNA family remains elusive. Here, using strand-specific RNA sequencing (RNA-seq), we identify a novel class of 1,658 Xrn1-sensitive unstable transcripts (XUTs) in which 66% are antisense to open reading frames. These transcripts are polyadenylated and RNA polymerase II (RNAPII)-dependent. The majority of XUTs strongly accumulate in lithium-containing media, indicating that they might have a role in adaptive responses to changes in growth conditions. Notably, RNAPII chromatin immunoprecipitation followed by DNA sequencing (ChIP-seq) analysis of Xrn1-deficient strains revealed a significant decrease of RNAPII occupancy over 273 genes with antisense XUTs. These genes show an unusual bias for H3K4me3 marks and require the Set1 histone H3 lysine 4 methyl-transferase for silencing. Furthermore, abolishing H3K4me3 triggers the silencing of other genes with antisense XUTs, supporting a model in which H3K4me3 antagonizes antisense ncRNA repressive activity. Our results demonstrate that antisense ncRNA-mediated regulation is a general regulatory pathway for gene expression in S. cerevisiae.

[Cardiac arrest in France: Why a national register?]

Cardiac arrest is a public health issue for which international guidelines are updated every five years (last bringing up to date on 2010 october). The lake of epidemiologic data on cardiac arrest justifies the building of a national register. French SAMU experienced registers especially in the field of acute coronary syndrom. Our national register "RéAC"is planned to deploy the present year for out-of-hospital cardiac arrest with the help of our scientific societies and the Department of Health. It is integrated in a program of evaluation and improvement of professional practices for physicians and prehospital teams who will be involved in its exhaustive use.

Geostatistical merging of ground-based and satellite-derived data of surface solar radiation

Abstract. In this paper, we demonstrate the benefit of using observations from Meteosat Second Generation (MSG) satellites in addition to in-situ measurements to improve the spatial resolution of solar radiation data over Belgium. This objective has been reached thanks to geostatistical methods able to merge heterogeneous data types. Two geostatistical merging methods are evaluated against the interpolation of ground-data only and the single use of satellite-derived information. It results from our analysis that merging both data sources provides the most accurate mapping of surface solar radiation over Belgium.

Effect of temporal pulse shaping on the reduction of laser weld defects in a Pd-Ag-Sn dental alloy

OBJECTIVES

To describe the influence of pulse shaping on the behavior of a palladium-based dental alloy during laser welding and to show how its choice is effective to promote good weld quality.

METHODS

Single spots, weld beads and welds with 80% overlapping were performed on Pd-Ag-Sn cast plates. A pulsed Nd:Yag laser was used with a specific welding procedure using all the possibilities for pulse-shaping: (1) the square pulse shape as the default setting, (2) a rising edge slope for gradual heating, (3) a falling edge slope to slow the cooling and (4) a combination of a rising and falling edges called bridge shape. The optimization of the pulse shape is supposed to enhance weldability and produce defect-free welds (cracks, pores…) Vickers microhardness measurements were made on cross sections of the welds.

RESULTS

A correlation between laser welding parameters and microstructure evolution was found. Hot cracking and internal porosities were systematically detected when using rapid cooling. The presence of these types of defects was significantly reduced with the slow cooling of the molten pool. The best weld quality was obtained with the use of the bridge shape.

SIGNIFICANCE

The use of a slow cooling ramp is the only way to significantly reduce the presence of typical defects within the welds for this Pd-based alloy studied.

Evaluation of the treatment of peritoneal carcinomatosis of colorectal cancer (CRC) with complete cytoreduction and hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) with oxaliplatin: A Belgian multicenter prospective phase II clinical study

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Background: Up to 25% of patients with metastatic CRC present with peritoneal carcinomatosis (PC) as the only site of metastases. The concept of Complete Cytoreductive Surgery (CCRS) followed by Hyperthermia and Intraperitoneal Chemotherapy (HIPEC) was developed, aiming for locoregional disease control and long-term survival. Methods: This prospective multicentre registry included 48 patients (M/F ratio 17/31) with PC from CRC, who underwent CCRS and HIPEC with oxaliplatin(460mg/m2). In 72.9% of patients the primary tumor had been previously resected. Median PCI (peritoneal cancer index) was 11 [1–22], with a median of 6 [1–11] abdominal regions involved and a median lesion size score of 3 [1–3]. In 11 cases associated lymph nodes (63.6% mesenteric, 27.3% para-aortic) were resected. To obtain CCRS a median of 2 [2–6] organs needed to be resected, with anterior resection in 45.8%, total colectomy in 8.3% and small bowel resection in 12.5% of cases. A median of 1 [0–6] anastomosis was performed per patient, of which one third were low and 82.1% were performed after HIPEC. Eleven ileostomies and 5 colostomies were constructed. Results: Median operation time was 460min.[125–840], with a median blood loss of 475ml [2- 6000]. HIPEC posed few procedural problems. There was no postoperative mortality. Complication rate was 52.1%, with 18 intra- and 17 extra-abdominal complications. Anastomotic leakage occurred in 10.4% of patients, bleeding in 6.3% and prolonged ileus in 22.9%. Median hospital stay was 20 [5–65] days. Occurrence of intra-abdominal complications significantly affected hospital stay (p=0.0012), but no risk factors for occurrence of postoperative complications could be clearly identified. Median follow-up was 22.7 [3.2–55.7] months, with 91.7% 2-year overall survival. Progression-free survival at 2 years is 64.6%, with PC recurrence in 29.2% of patients and other metastatic disease in 25%. Multivariate analysis only retained the CEA-level as a significant prognostic factor (p=0.0065). Conclusions: CCRS followed by HIPEC for PC of colorectal origin is safe and has longer than expected PFS and OS.

No significant financial relationships to disclose.

Laparoscopic ultrasonography as a good alternative to intraoperative cholangiography (IOC) during laparoscopic cholecystectomy: results of prospective study

Intraoperative cholangiography (IOC), used routinely or selectively, is the standard method for bile duct imaging during cholecystectomy. Laparoscopic ultrasonography (LUS) has emerged as a possible, safe and quick alternative. This study examined the evolving use and the performance of these two methods as primary technique for routine bile duct imaging, so as to detect common bile duct stones (CBDS) and to prevent common bile duct injury (CBDI). A prospective database permitted to evaluate the results of the two methods in 968 consecutive cholecystectomies. Nine hundered and twenty five were performed by laparoscopy, 18 (1.9%) by laparotomy and 25 (2.6) necessitated a conversion. The systematic use of the IOC was gradually replaced by a systematic use of the LUS. The success to delineate and evaluate the CBD, the detection of a CBDS, any type of bile duct complication, especially of CBDI, were registered. All the CBDS suspected by LUS were controlled by IOC. The patients were followed during 1 and 6 months. Six hundred and eighty five IOC and 269 LUS were performed. The procedure was technically unsuccessful in 35 IOC (5.1%) (mainly due to difficulty in catheterising the cystic duct) and in 2 LUS (1%) (due to steatosis). Concerning the detection of CBDS, 31 were detected by IOC (4.5%) and 16 by LUS (6%). Five IOC were considered as false positive, 1 as false negative (sensitivity and specificity of 96,9 and 99,2%) and 1 LUS as false positive (sensitivity and specificity of 100 and 99,6%). Five CBDI were detected in the complete seria: 2 during the dissection before the IOC, 1 thermic injury, 1 late stenosis, 1 lateral stenosis by the cystic clip detected by LUS. However none of these CBDI could have been prevented by IOC. In our experience, in this prospective study, LUS has been certainly as effective as IOC as a primary imaging technique for bile duct. It permitted to detect CBDS with a high specificity and sensitivity, and CBDS and was not followed by an increase in CBDI.

Intra-oral laser welding: an in vitro evaluation of thermal increase

The neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is currently used in dental laboratories to weld metals on dental prostheses. Recently, the use of Nd:YAG has been suggested so that dentists themselves can repair broken fixed, removable and orthodontic prostheses by welding metals directly in the mouth. This work aimed to evaluate, through a four k-type thermocouple system on calf jaws, the thermal increase in the biological structures close to the metal parts during laser welding. We put two hemispherical metal plates onto mandibular molars and then laser welded them at three points with a four k-thermocouple system to determine the thermal rise in the pulp chamber, sulcus, root and bone. This procedure was carried out on 12 samples, and the results were processed. The highest values of thermal increase were found in the pulp chamber, 1.5 degrees C; sulcus, 0.7 degrees C; root, 0.3 degrees C; and bone, 0.3 degrees C. This study showed that thermal increases in pulp chamber, sulcus, root and bone were biologically compatible and that intra-oral laser welding, at the parameters used in this work, seems to be harmless to the biological structures close to the welding and thermally affected zones.