The journey of cancer patients and the quest to equity: findings from Morocco

OBJECTIVES

Rapid diagnostic and assessment pathways for cancer patients provide timely and effective care. This study took place in Morocco, where the majority of patients treated in the public sector are diagnosed at an advanced stage. The aim of this study was to determine the duration of different time intervals along the cancer patient pathway and to highlight problem areas so that strategies can be implemented to make the process more equitable and effective.

STUDY DESIGN

Cross-sectional study.

METHODS

Recently diagnosed cancer patients were recruited from four major oncology centres in Morocco; namely, Marrakech, Casablanca, Rabat, and Fez. A questionnaire survey was administered, including sociodemographic and medical information and questions on access to the oncology centre, beliefs, and opinions on the medical staff. The dates of symptom recognition, assessment, diagnosis referral, biopsy, and treatment initiation were collected. Different time intervals (patient, diagnosis, biopsy, and treatment) were estimated and their determinants were investigated.

RESULTS

A total of 812 patients were interviewed. The majority of participants were breast cancer patients. In total, 60% of participants were at stage III-IV. The main facilitators of cancer diagnosis confirmation and treatment initiation were easy access to diagnosis and treatment facilities, financial resources, personal history of cancer, time availability, late stage at diagnosis, advanced age, and private health insurance. The patient interval (i.e., time from symptom recognition to initial healthcare assessment) had a median duration of 30 days. The biopsy and treatment intervals were within the current international recommendations (7 and 28 days, respectively). However, the diagnosis interval (52 days) was twice as long as the recommended timeframes from the UK, Australia, and the World Health Organization (<28 days).

CONCLUSIONS

Interval targets should be defined to encourage health systems to be more equitable and effective and to ensure that cancer patients are treated within a defined timeframe.

Survey of Trichogramma (Hymenoptera: Trichogrammatidae) Natural Populations in Quebec Cranberry Bogs and Identification Using rDNA ITS-2 Sequence Analysis

The province of Quebec, Canada is the most important organic cranberry growing region worldwide. However, insect pest management methods are limited, and growers face significant yield loss each year, mostly caused by lepidopteran pests. Egg parasitoids of the genus Trichogramma (Hymenoptera: Trichogrammatidae) are effective biocontrol agents of lepidopteran pests in many forests and agricultural systems. Herein, a two-year, large-scale population survey of Trichogramma spp. was performed using Ephestia kuehniella Zeller (Lepidoptera: Pyralidae) as sentinel eggs in Quebec organic cranberry bogs. Collected specimens were identified by sequencing ribosomal DNA of the Internal Transcribed Spacer 2 (ITS-2) region and subjected to resemblance analysis with reference specimens for identification. Our results confirm that at least four Trichogramma species naturally occur in the studied agroecosystem. Those species are T. brassicae Bezdenko, T. minutum Riley, T. ostriniae (Pang et Chen), and T. pretiosum Riley. While some species have already been reported in cranberry bogs, this represents the first mention of T. brassicae and T. ostriniae as well as the first mention of T. minutum in Quebec cranberry bogs. All species collected are native from Eastern Canada except T. ostriniae. These species can be considered as biocontrol agent candidates for cranberry lepidopteran pests, but further efficacy trials are needed to identify the best species for each pest.

P-436 EndoTime: Non-categorical timing estimates for luteal endometrium

Study question

Can expression measurements of a small panel of genes be used to develop a continuous, non-categorical model for the improvement of endometrial biopsy timing accuracy?

Summary answer

Measuring expression levels of six genes (IL2RB, IGFBP1, CXCL14, DPP4, GPX3, and SLC15A2) is sufficient to obtain and assess substantially more accurate timing estimates.

What is known already

Commercially available endometrial timing approaches based on gene expression require much larger gene sets and use a categorical approach that classifies samples as pre-receptive, receptive, or post-receptive.

Study design, size, duration

Gene expression was measured by RT-qPCR in different sample sets, comprising a total of 664 endometrial biopsies obtained 4 to 12 days after a self-reported positive home ovulation test. A further 36 endometrial samples were profiled by RT-qPCR as well as RNA-sequencing.

Participants/materials, setting, methods

A computational procedure, named ‘EndoTime’, was established that models the temporal profile of each gene and estimates the timing of each sample. Iterating these steps, temporal profiles are gradually refined as sample timings are being updated, and confidence in timing estimates is increased. After convergence, the method reports updated timing estimates for each sample while preserving the overall distribution of time points.

Main results and the role of chance

The Wilcoxon rank-sum test was used to confirm that ordering samples by EndoTime estimates yields sharper temporal expression profiles for held-out genes (not used when determining sample timings) than ordering the same expression values by patient-reported times (GPX3 : p &lt; 0.005; CXCL14 : p &lt; 2.7e-6; DPP4 : p &lt; 3.7e-13). Pearson correlation between EndoTime estimates for the same sample set but based on RT-qPCR or RNA-sequencing data showed high degree of congruency between the two (p = 8.6e-10, R-squared = 0.687). Estimated timings did not differ significantly between control subjects and patients with recurrent pregnancy loss or recurrent implantation failure (p &gt; 0.05).

Limitations, reasons for caution

Timing estimates are informed by glandular gene expression and will only represent the temporal state of other endometrial cell types if in synchrony with the epithelium. Additionally, methods that estimate the day of ovulation are still required as these data are essential inputs in our method.

Wider implications of the findings

Our method is the first to assay the temporal state of endometrial samples on a continuous domain, enabling accurate temporal profiling of any gene in luteal phase biopsies for a wide range of research applications and, potentially, clinical use. It is freely available, open-source software including supporting data sets.

Trial registration number

Not applicable

O-302 Lower expression of AHCY is associated with increased miscarriage risk

Study question

Are alterations in the transcript levels of genes from the methionine cycle associated with maternal associated miscarriage risk?

Summary answer

Lower expression of AHCY is associated with a greater number of prior pregnancy losses

What is known already

Around 15% of pregnancies end in miscarriage, and the risk of recurrence increases with each pregnancy loss. Aberrant differentiation (decidualization) of endometrial stromal cells into specialised decidual cells to accommodate implantation is a key maternal factor for miscarriage risk.

Our previous work identified secretory changes in cysteine and methionine metabolites upon decidualization. The methionine cycle contributes to vital cellular functions, including producing methionine for proliferation, regulating cell differentiation, and S-adenosylmethionine (SAM) production. SAM is required for protein, RNA and DNA methylation, thereby influencing pathways at the metabolic, epigenetic, and proteomic levels. AHCY clears S-adenosylhomocysteine (SAH), reducing its inhibition of methylation.

Study design, size, duration

Endometrial biopsies (n = 250) were collected during the luteal phase (LH + 6-11). Patients were grouped based on their miscarriage history. Accordingly, expression of genes from the methionine cycle were quantified using RT-qPCR.

Participants/materials, setting, methods

Endometrial biopsies were obtained, with written informed consent, from women attending the Implantation Clinic at University Hospitals Coventry and Warwickshire NHS Trust, following transvaginal ultrasounds to exclude uterine pathology. Isolated RNA was converted into cDNA. Expression of AHCY, AMD1, BHMT2, CBS, MAT2A, MAT2B, and MTR were normalised to L19. Statistical analysis was performed in Graphpad Prism; with significance accepted at p &lt; 0.05. AHCY was silenced in an endometrial cell line to determine its effect on decidualization.

Main results and the role of chance

This study reports a distinct reduction in expression of methionine cycle genes (MAT2A, AHCY, AMD1, MTR, BHMT2) in the late-luteal phase of the cycle consistent with a reduction in proliferation.

By plotting percentile graphs based on the statistical distribution in gene expression for each day of the luteal phase, comparisons have been made between groups.

AHCY expression is significantly reduced in patients with increasing number of prior miscarriages, particularly between 0-2 and 5+ previous miscarriages (p = 0.0334). Neither patient age nor BMI are a factor in this reduced expression.

In contrast, there is a stromal specific increase in AHCY upon decidualization in vitro, suggesting it is required in the decidua. Silencing AHCY in an endometrial cell line significantly reduces PRL expression upon decidualization. Reduction in AHCY may lead to a decreased “methylation potential” as SAH cannot be cleared. SAH accumulation inhibits methylation, and limits SAM production, thus compounding its effect.

Decreased methylation potential could prevent differentiation of the stromal compartment, resulting in lower levels of PRL, and altering decidual timing. Therefore, an embryo may implant into a tissue primed for disintegration, resulting a miscarriage.

In summary, AHCY may contribute to aberrant decidualization augmenting the risk of miscarriage.

Limitations, reasons for caution

Results are based on endometrial biopsies from an implantation clinic, therefore studies into biopsies from women with normal reproductive histories should also be analysed. Further functional studies are needed to ascertain the mechanism of action of AHCY in miscarriage.

Wider implications of the findings

This study identified that a decrease in AHCY in whole endometrial tissue is associated with increased risk of miscarriage. Further, silencing AHCY perturbed decidual marker expression. Thus, AHCY may act as a biomarker for atypical decidualization, and the clearance of SAH may be a potential treatment.

Trial registration number

N/A

Photonic crystal resonators for inverse-designed multi-dimensional optical interconnects

We experimentally demonstrate a 400 Gbit/s optical communication link utilizing wavelength-division multiplexing and mode-division multiplexing for a total of 40 channels. This link utilizes a novel, to the best of our knowledge, 400 GHz frequency comb source based on a chip-scale photonic crystal resonator. Silicon-on-insulator photonic inverse-designed 4 × 4 mode-division multiplexer structures enable a fourfold increase in data capacity. We show less than -10 dBm of optical receiver power for error-free data transmission in 34 out of a total of 40 channels using a PRBS31 pattern.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

H. pylori Pattern Gastritis with Negative Helicobacter Immunohistochemical Stain: Does A Specific Comment in Pathology Report Impact Clinical Management?

Introduction/Objective

The clinical significance of H. pylori (HP) pattern of gastritis with a negative Helicobacter IHC stain on gastric biopsy is unclear. Some pathologists report this pattern in cases that are highly suggestive of HP infection with a comment raising the possibility of HP infection; however, the subsequent clinical management of these patients has not been well described.

Methods/Case Report

We conducted a retrospective comparison study of patients with gastric biopsy between 2016 and 2019. Group 1 included patients with chronic active or chronic inactive gastritis and negative HP IHC with a comment stating the gastritis pattern is suggestive of HP. Group 2 included patients with chronic active or chronic inactive gastritis and negative HP IHC with no comment about HP pattern.

Results (if a Case Study enter NA)

We identified 60 patients in Group 1 which were compared to 63 patients in Group 2. Group 1 more frequently had history of HP (48.3% vs. 29.1%, p&lt;0.05). After diagnosis, Group 1 more frequently received treatment (51.7% vs. 20.6%, p&lt;0.001). Of those who received treatment, Group 1 more frequently received HP treatment (triple or quadruple therapy; 21.7% vs. 1.6%, p&lt;0.001). History of HP did not affect whether a patient was treated (p&gt;0.05). Following post-biopsy HP treatment, more patients in Group 1 received fecal antigen test (23.7% vs. 5.5%, p&lt;0.01). Age, gender, NSAID and PPI use did not differ between groups.

Conclusion

Adding the diagnostic comment raising the possibility of HP for patients with HP pattern gastritis with negative HP IHC changes clinical management and it is independent of patients’ prior HP history.

Géodes: the health indicators web portal of the French Public Health Agency

Background

Santé publique France, the French Public Health Agency, produce numerous health indicators (diseases or health determinants) from many different data sources (specific or unspecific surveillance systems, epidemiological and behavioural surveys, administrative databases). In order to improve visibility and accessibility of these indicators, a web portal “Géodes” was created.

Methods

Géodes was built with Géoclip Air© developped by a French start-up. This ergonomic tool allows to explore the geographical dimension of health indicators through interactive maps along with graphs and tables. In addition, Géodes is designed to explore the temporal dimension of indicators produced yearly or weekly through dynamic maps or time series. All indicators are linked to an explanatory sheets. Description, sources, precisions or limits of interpretation are discribed. It is also easy to present indicators in interactive tables, exportable in different formats such as Excel spreadsheets.

Results

Since February 1st 2019, Géodes is available online without any access restriction (https://geodes.santepubliquefrance.fr). Over 300 health indicators are provided related to infectious and chronic diseases, occupational and environmental health, behaviours, emergency departement attendances, etc. An indicator is either a number of cases, a proportion or an incidence rate. Most indicators are stratified by categories such as sex or age group. It is possible to represent two indicators on a single map, e.g. the smoking prevalence and the standardised rate of lung cancer.

Conclusions

The days following the opening to the public, the site recorded up to 10,000 connections per day. In routine, the site knows up to 200 visits per day, up to 3,000 in case of quoting aparticular indicator in the media. These figures show that this health data observatory meet a real need.

Key messages

A web portal of health indicators created by Santé Publique France is now available. More than 300 health indicators are integrated in the portal. Indicators can be visualized through interactive maps, tables and time series and their values are easily exportable and communicable.

High Treatment Uptake in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients After Unrestricted Access to Direct-Acting Antivirals in the Netherlands

Background

The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide hepatitis C virus (HCV) treatment uptake among patients coinfected with human immunodeficiency virus (HIV) and HCV.

Methods

Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA result, did not have spontaneous clearance, and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, data were included from only the most recent treatment episode. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved sustained virological response.

Results

Of 23574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men, 15% persons who [formerly] injected drugs, and 15% with another HIV transmission route) fulfilled the inclusion criteria. Of these, 87% (1284 of 1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124 of 1471) had their HCV infection cured; DAA treatment results were pending in 6% (92 of 1471). Among men who have sex with men, 83% (844 of 1022) had their HCV infection cured, and DAA treatment results were pending in 6% (66 of 1022). Overall, 187 patients had never initiated treatment, DAAs had failed in 14, and a pegylated interferon-alfa-based regimen had failed in 54.

Conclusions

Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands have their HCV infection cured (76%) or are awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients.

A-23 Mental Illness and Emotional Functioning as Moderated by Executive Functioning: Incarcerated Population

Objective

The purpose of this study is to investigate whether executive functioning will moderate the relationship of a history of mental illness on aggression in a male forensic population.

Method

Using an archival database from a larger study, 232 male inmates (ages 21 and 49 years old) from three medium/maximum Maryland Correctional facilities were recruited using a pseudo-random selection process during intake. Participants were administered three EF tasks (Cambridge Decision Making Task, Logan Stop-Signal Task, and Stroop Interference Task), history of mental illness was obtained using the Symptom Checklist-90, and aggression was assessed with the Novaco Reaction to Provocation Questionnaire.

Results

Hierarchical multiple regressions were conducted. For overall aggression reactivity, inhibition moderated depression (IR2 = .025, F(3, 224) = 9.977, p < .001, β = -.246, p = .015) and psychoticism (IR2 = .019, F(3, 224) = 8.216, p < .001, β = -.136, p = .031). For reactive aggression subtype, inhibition moderated depression (IR2 = .025, F(3, 224) = 2.679, p = .048, β = .071, p = .017). For proactive aggression subtype, cognitive flexibility moderated anxiety (IR2 = .018, F(3, 224) = 4.731, p = .003, β = -.014, p = .039); and depression (IR2 = .022, F(3, 224) = 3.888, p = .010, β = -.017, p = .025).

Conclusions

Overall, there was mixed findings for inhibition. On Cambridge Decision Making task, inhibition moderated the predictive relationship of depression on reactive aggression and psychoticism and overall aggression but not for other measures of inhibition. For another inhibition task (Stroop), inhibition did not significantly moderate any mental illness on severity of aggression. Cognitive flexibility moderated the predictive relationships of anxiety and depression on proactive aggression. Findings suggest targeting cognitive flexibility for inmates diagnosed with anxiety depression, and psychosis when treating aggression in a male forensic population.

Leucopis glyphinivora Tanasijtshuk (Diptera: Chamaemyiidae), a new aphidophagous biocontrol agent; development, survival and comparison with Aphidoletes aphidimyza Rondani (Diptera: Cecidomyiidae)

The silver fly Leucopis glyphinivora Tanasijtshuk (Diptera: Chamaemyiidae) is an aphidophagous predator during its larval stage. Our study describes the life cycle of L. glyphinivora and evaluates its potential as a biocontrol agent. The development, survival and longevity of L. glyphinivora were observed and compared with those of the aphid gall midge Aphidoletes aphidimyza Rondani (Diptera: Cecidomyiidae). Tests were conducted under laboratory conditions in Petri dishes with the green peach aphid Myzus persicae Sulzer (Hemiptera: Aphididae) on potato leaves. Leucopis glyphinivora has a 42% longer life cycle than A. aphidimyza. Larval development was 27% longer in L. glyphinivora than in A. aphidimyza. Egg hatch rate and pupal emergence rate were similar in both species, but larval survival was 20% lower for L. glyphinivora than for A. aphidimyza. Sex ratio was approximately 50% in both species. A longer development time for L. glyphinivora in the larval stage could be an advantage for biocontrol by providing more time to exert predation pressure against aphids. However, this may be offset by the lower survival rate found in the silver fly larvae.

The Space Physics Environment Data Analysis System (SPEDAS)

With the advent of the Heliophysics/Geospace System Observatory (H/GSO), a complement of multi-spacecraft missions and ground-based observatories to study the space environment, data retrieval, analysis, and visualization of space physics data can be daunting. The Space Physics Environment Data Analysis System (SPEDAS), a grass-roots software development platform (www.spedas.org), is now officially supported by NASA Heliophysics as part of its data environment infrastructure. It serves more than a dozen space missions and ground observatories and can integrate the full complement of past and upcoming space physics missions with minimal resources, following clear, simple, and well-proven guidelines. Free, modular and configurable to the needs of individual missions, it works in both command-line (ideal for experienced users) and Graphical User Interface (GUI) mode (reducing the learning curve for first-time users). Both options have "crib-sheets," user-command sequences in ASCII format that can facilitate record-and-repeat actions, especially for complex operations and plotting. Crib-sheets enhance scientific interactions, as users can move rapidly and accurately from exchanges of technical information on data processing to efficient discussions regarding data interpretation and science. SPEDAS can readily query and ingest all International Solar Terrestrial Physics (ISTP)-compatible products from the Space Physics Data Facility (SPDF), enabling access to a vast collection of historic and current mission data. The planned incorporation of Heliophysics Application Programmer's Interface (HAPI) standards will facilitate data ingestion from distributed datasets that adhere to these standards. Although SPEDAS is currently Interactive Data Language (IDL)-based (and interfaces to Java-based tools such as Autoplot), efforts are under-way to expand it further to work with python (first as an interface tool and potentially even receiving an under-the-hood replacement). We review the SPEDAS development history, goals, and current implementation. We explain its "modes of use" with examples geared for users and outline its technical implementation and requirements with software developers in mind. We also describe SPEDAS personnel and software management, interfaces with other organizations, resources and support structure available to the community, and future development plans.

ELECTRONIC SUPPLEMENTARY MATERIAL

The online version of this article (10.1007/s11214-018-0576-4) contains supplementary material, which is available to authorized users.

Optimization of a Banker Box System to Rear and Release the Parasitoid Habrobracon hebetor (Hymenoptera: Braconidae) for the Control of Stored-Product Moths

Pyralid moths, such as Ephestia kuehniella (Zeller) or Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae), are among the pests of most concern in mills and food industries worldwide. One option for their control, which presents an alternative to the application of insecticides, is the release of natural enemies. Habrobracon hebetor (Say) (Hymenoptera: Braconidae) is a larval parasitoid of pyralid moths that is commercially available for augmentative release in storehouses. They are delivered as adults that limit their performance. To improve their quality when released at the target location, a banker box has been developed consisting of a rearing box that optimizes the release of the parasitoid. In the present study, the nonpest larvae Galleria mellonella (L.) (Lepidoptera: Pyralidae) have been used as a host, substituting for E. kuehniella larvae which were used in the previous design. The best results were obtained when a mixture of two larval sizes of the host were offered to the female parasitoid, producing five times more adults than with E. kuehniella larvae. Quality of the released parasitoids was optimal because they were delivered in the pupal stage inside the rearing box and adults began to emerge in situ. The banker box released adult parasitoids over a prolonged period of approximately 25 d at the target location. The use of this banker box may significantly help in the biological control of stored-product moths.

Soliton dual frequency combs in crystalline microresonators

We present a novel compact dual-comb source based on a monolithic optical crystalline MgF₂ multi-resonator stack. The coherent soliton combs generated in the two microresonators of the stack with the repetition rate of 12.1 GHz and difference of 1.62 MHz provided after heterodyning a 300 MHz wide radio frequency comb. An analogous system can be used for dual-comb spectroscopy, coherent LIDAR applications, and massively parallel optical communications.

Phytophagy by the Mullein Bug (Hemiptera: Miridae) on Apples: Feeding Behavior and Fruit Damage

The zoophytophagous mullein bug, Campylomma verbasci (Meyer-Dür) (Hemiptera: Miridae), is a beneficial predator of mites and aphids, but also a pest causing damage when it feeds on apples. The aim of this study was to evaluate three different parameters of phytophagy of the mullein bug both in laboratory (phytophagous behavior) and field (fruit damage) tests: 1) apple cultivar, 2) fruit size, and 3) nymphal instar. In the laboratory, nymphs were observed individually for 15 min in Petri dishes containing agar gel and an apple fruitlet to evaluate feeding punctures of four apple cultivars, four fruit sizes, and five nymphal instars. In the orchard, nymphs were caged at bloom in sleeve cages to evaluate damage on the developing fruit of seven apple cultivars and three nymphal instars on 'Red Delicious'. The feeding punctures in the laboratory were higher on 'Red Delicious' than on 'Honeycrisp'; fruit damage in the orchard did not differ among cultivars at mid-season, but was higher on 'Red Delicious' than on 'Lobo' and 'Marshall McIntosh' at harvest. The number of feeding punctures in the laboratory was higher on 7-9 mm than on 18-20 mm size fruit for 'Red Delicious', but not for 'Honeycrisp'. The number of feeding punctures in the laboratory made by the fifth nymphal instar was higher than those made by younger nymphs, but fruit damage in the orchard did not differ among nymphal instars. Our results will help to elaborate a management chart for this insect by minimizing risks and promoting its use for biocontrol.

RÉSUMÉ

 .

La punaise de la molène, Campylomma verbasci (Meyer-Dür) (Hemiptera: Miridae), est un prédateur bénéfique zoophytophage des acariens et pucerons dans les vergers, mais également un ravageur causant des dommages lorsqu'il se nourrit sur les pommes. Le but de cette étude était d'évaluer trois paramètres différents sur la phytophagie de la punaise de la molène, à la fois en laboratoire (comportement phytophage) et sur le terrain (dommages aux fruits) : 1) les cultivars de pommes, 2) la taille des fruits, et 3) les stades larvaires. En laboratoire, les larves étaient observées individuellement pendant 15 min dans des boites de Petri contenant un gel d'agar et une jeune pomme afin de déterminer les piqûres de nutrition sur quatre cultivars de pommes, quatre tailles de fruit et cinq stades larvaires différents. En verger, des larves ont été encagées à la floraison dans des manchons en mousseline afin d'évaluer les dommages sur les fruits en développement. Les essais ont été effectués sur sept cultivars de pommes ainsi qu'avec trois stades larvaires sur le cultivar "Délicieuse rouge". Les piqûres de nutrition en laboratoire étaient plus nombreuses sur "Délicieuse rouge" que sur "Honeycrisp"; les dommages aux fruits en verger ne différaient pas entre les cultivars à mi-saison, mais étaient plus nombreux sur "Délicieuse rouge" que sur "Lobo" et "Marshall McIntosh" à la récolte. Les piqûres de nutrition en laboratoire étaient plus nombreuses pour la taille de fruit 7-9 mm que 18-20 mm sur "Délicieuse rouge", mais pas sur "Honeycrisp". Le nombre de piqûres de nutrition (en laboratoire) faites par les larves de stade 5 étaient plus nombreuses que celles faites par les larves plus jeunes, mais les dommages aux fruits (en verger) ne différaient pas entre les stades larvaires. Ces résultats vont aider à élaborer une charte de gestion de cet insecte en minimisant les risques et en favorisant son rôle d'agent de lutte biologique.

Anastomotic leakage after colon cancer resection: does the individual surgeon matter?

AIM

Anastomotic leakage is one of the most feared complications after colonic resection. Many risk factors for anastomotic leakage have been reported, but the impact of an individual surgeon as a risk factor has scarcely been reported. The aim of this study was to assess if the individual surgeon is an independent risk factor for anastomotic leakage in colonic cancer surgery.

METHOD

This was a retrospective analysis of prospectively collected data from patients who underwent elective resection for colon cancer with anastomosis at a specialized colorectal unit from January 1993 to December 2010. Anastomotic leaks were diagnosed according to standardized criteria. Patient and tumour characteristics, surgical procedure and operating surgeons were analysed. A logistic regression model was used to discriminate statistical variation and identify risk factors for anastomotic leakage.

RESULTS

A total of 1045 patients underwent elective colon cancer resection with primary anastomosis. Anastomotic leakage occurred in 6.4% of patients. Ileocolic anastomosis had an anastomotic leakage rate of 7.2%, colo-colonic/colorectal anastomosis 5.2% and ileorectal anastomosis 12.7%, with intersurgeon variability. The independent risk factors associated with anastomotic leakage were the use of perioperative blood transfusion (OR 2.83, CI 1.59-5.06, P < 0.0001) and the individual surgeon performing the procedure (OR up to 8.44, P < 0.0001).

CONCLUSION

In addition to perioperative blood transfusion, the individual surgeon was identified as an important risk factor for anastomotic leakage. Efforts should be made to reduce performance variability amongst surgeons.

Population Dynamics of the Soybean Aphid (Hemiptera: Aphididae) in Quebec (Canada)

The population dynamics of the soybean aphid ( Aphis glycines Matsumura) was studied over a 12-yr period (2004-2015) from archive and field data collected in the Montérégie area of Quebec (Canada). As observed in the United States, a 2-yr oscillation cycle was observed from 2005 to 2011 in Quebec, with high infestations during odd years, while the opposite was found in 2014 and 2015. A broader pattern could also be observed, with high infestation in two consecutive years every 10 yr. In addition, the infestation intensity observed in high infestation years decreases throughout the years, which questions the evolution of the oscillation cycle in the future.

All-optical stabilization of a soliton frequency comb in a crystalline microresonator

We demonstrate the all-optical stabilization of a low-noise temporal soliton based microresonator based optical frequency comb in a crystalline resonator via a new technique to control the repetition rate. This is accomplished by thermally heating the microresonator with an additional probe laser coupled to an auxiliary optical resonator mode. The carrier-envelope offset frequency is controlled by stabilizing the pump laser frequency to a reference optical frequency comb. We analyze the stabilization by performing an out-of-loop comparison and measure the overlapping Allan deviation. This all-optical stabilization technique can prove useful as an actuator for self-referenced microresonator frequency combs.

European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

Cancer survival in Africa, Asia, the Caribbean and Central America: database and attributes

Thirty-one registries in 17 countries submitted data for systematic and centralized scrutiny. Data on 564 606 cases of different cancers ranging 1-56 sites/types from 27 registries in 14 low-/medium-resource countries in Eastern and Western Africa, the Caribbean, Central America and four regions of Asia, registered during 1990-2001 (period varying for individual registries) were reported. The database for this survival study comprised data that were classified as mandatory and optional. Mandatory variables provided by all registries included case-ID, age at diagnosis, sex, incidence date, most valid basis of diagnosis, cancer site/type (ICD-10 codes C00-96), vital status at follow-up and corresponding date. Clinical extent of disease was prominent among the optional variables provided by 17 registries and analysed. The grouping of cancer sites for analysis was based on standard norms, and only categories with at least 25 cases were reported. Cases registered based on a death certificate only, cases lacking any follow-up after initial registration, or cases rejected based on validation checks were excluded from the survival analysis. An easy guide to contents in subsequent chapters, especially tables and graphs describing data quality indices, survival statistics and online dynamic functions, is provided.

Are paediatric medicines risk factors for dental caries and dental erosion?

THE OBJECTIVE

To assess in vitro the cariogenic and erosive potentials of Brazilian liquid oral paediatric medicines.

SETTING

Twenty-three paediatric medicines available on the Brazilian market were evaluated. The sample consisted of antihistamines, antitussives, bronchodilators and mucolytics.

MAIN OUTCOME MEASURES

Duplicates of each bottle were analyzed for sugar concentration using normal-phase- high-performance liquid chromatography (HPLC). Quantification of sugars and sorbitol was calculated using the peak heights of commercial standards as references. pH measurements were determined using a digital pH meter. Titratable acidity was assessed by diluting three aliquots of each medicine, and increments of 0.1N NaOH were titrated until neutrality was reached. Viscosity was determined using a viscosemeter.

RESULTS

Sugars were detected in 56.5% of the medicines. Sucrose was identified in 10 medicines, with concentrations ranging from 11.36 g% to 85.99 g%. Glucose was detected in five medicines, with concentrations varying from 4.64 g% to 40.19 g%; fructose in six medicines, with concentrations ranging from 5.09 g% to 46.71 g%. Twelve medicines exhibited sorbitol, with values ranging from 5.39 g% to 46.09 g%. Most tested medicines were acidic, with pH values ranging between 2.6 and 5.7. Only two medicines (Fluimucil and Polaramine) presented pH 6.4 and 6.0, respectively. Titratable acidity mean values ranged between 0.28 and 16.33 mL. Viscosity values varied between 2.8 cP and 412.3 cP.

CONCLUSIONS

Many paediatric medicines showed high sugar concentration, pH values below the critical value and high titratable acidity values, all of which increase the medicines' cariogenic and erosive potentials.

Severe hospitalised 2009 pandemic influenza A(H1N1) cases in France, 1 July-15 November 2009

From 1 July 2009 to 15 November 2009, 244 patients with 2009 pandemic influenza A(H1N1) were admitted to intensive care unit (ICU) and were compared with 514 cases hospitalised in medical wards in France until 2 November 2009. Detailed case-based epidemiological information and outcomes were gathered for all hospitalised cases. Infants and pregnant women are overrepresented among cases admitted to ICU with seven per cent for both groups respectively, and twenty per cent of ICU cases did not belong to a risk group. Chronic respiratory disease was the most common risk factor among cases but obesity (body mass index >or= 30 Kg/m(2)), chronic cardiac disease and immunosuppression were risk factors associated with severe illness after adjustment for age and for other co-morbidities.

The Role of microRNA Genes in Breast Cancer Progression and Metastasis

MicroRNAs influence tumor progression and metastasis via action as metastasis promoting genes (for example mir-373 and mir-520) or metastasis suppressor genes (for example mir-335). To identify additional microRNAs capable of driving breast cancer metastasis in vivo, we employed a functional genomics screen using the '4T1' syngeneic (Balb/c) mouse model of breast cancer progression. Approximately 400 microRNA sequences were subcloned into the pMSCV_puro retroviral expression vector and the resultant microRNA expression library transduced into fluorescent non-metastatic 67NR-pMSCV_mCherry and mildy-metastatic 66cl4-pMSCV_mCherry cells and selected with puromycin. The transduced cell lines were then implanted into the mammary fat pads of 20 syngeneic Balb/c mice per cell line. Following establishment of primary tumors, the primary tumors and secondary organs (lung, liver, spine, femurs), including any overt metastatic deposits, were dissected under a fluorescent stereomicroscope and the microRNA inserts amplified from the integrated retroviral genome by PCR.In an alternative approach, we have studied two populations of MDA-MB-231 human breast cancer cells that exhibit different behavior in vitro and in vivo to elucidate processes involved in cellular invasion and metastasis. A late-passage MDA-MB-231 (231variant) population formed invasive clusters when embedded in Matrigel, whereas early-passage (P3) MDA-MB-231 (231) cells did not. Moreover, 231v cells were more motile than 231 cells and showed enhanced tumorigenicity when grown as subcutaneous xenografts in nude mice, whereas proliferation and apoptotic response were indistinguishable between the two lines in vitro. Molecular characterization of the two cell populations cultured in 3D by array-based gene expression profiling revealed elevated expression of NF kappa B target genes in 231v cells (IL1A, IL1B, IL6, PTX3, NR4A2, HMOX1, FLIP). MicroRNA array analysis of 3D cultures also revealed marked induction (approximately 8-fold) of the related NF kappa B target microRNAs, mir-146a and mir-146b (Figure 1). Further evaluation of a panel of human breast cancer cell lines revealed that mir-146a and mir-146b were dramatically elevated in metastatic human breast cancer cell lines that display both epithelial-to-mesenchymal transition and high NF kappa B activity (MDA-MB-231, Hs578T, MDA-MB-436), compared to non-metastatic lines. Experiments to elucidate the function of mir-146a and mir-146b during breast cancer progression are underway. Figure 1: TaqMan qPCR analysis of mir-146a and mir-146b expression in 231 and 231v cells.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6142.

Initial experience with transvaginal incisional hernia repair

INTRODUCTION

Natural orifice surgery has evolved from a preclinical setting into a common occurrence at the University of California San Diego (UCSD). With close to 40 transvaginal cases, we have become comfortable with this technique and are exploring other indications. One of the perceived advantages in natural orifice surgery is the potential reduction in the incidence of hernia formation. Patients with abdominal wall hernias may be at increased risk of forming additional hernias at incision sites. In addition, patients with recurrent incisional hernias may, likewise, be at increased risk. We believe that reducing or eliminating abdominal wall incisions may be of benefit in the repair of abdominal wall hernias. Here, we describe what we believe to be the first natural orifice transluminal endoscopic surgical (NOTES) approach to the repair of an abdominal wall hernia.

METHODS

The patient is a 38-year-old female with a painful recurrent umbilical hernia, previously repaired 8 years prior with a polypropylene-based mesh. The patient underwent a transvaginal recurrent umbilical hernia repair with one other 5-mm port in the abdomen for safety.

RESULTS

The patient had no intraoperative or postoperative complications. At 5 months follow up, the patient had no complaints, no evidence of hernia recurrence, and was very pleased with her result.

CONCLUSIONS

The repair of primary and incisional hernias of the ventral abdominal wall via a transvaginal approach is technically feasible, and the result of our initial case was exceptional. However, there are still significant obstacles which must be addressed before this approach can be widely utilized. These obstacles include safe entrance into the abdominal cavity via a transvaginal approach, the proper mesh to be placed during the repair, and the risk of infection.

EEG feature extraction for classification of sleep stages

Automated sleep staging based on EEG signal analysis provides an important quantitative tool to assist neurologists and sleep specialists in the diagnosis and monitoring of sleep disorders as well as evaluation of treatment efficacy. A complete visual inspection of the EEG recordings acquired during nocturnal polysomnography is time consuming, expensive, and often subjective. Therefore, feature extraction is implemented as an essential preprocessing step to achieve significant data reduction and to determine informative measures for automatic sleep staging. However, the analysis of the EEG signal and extraction of sensitive measures from it has been a challenging task due to the complexity and variability of this signal. We present three different schemes to extract features from the EEG signal: relative spectral band energy, harmonic parameters, and Itakura distance. Spectral estimation is performed by using autoregressive (AR) modeling. We then compare the performance of these schemes with the view to select an optimal set of features for specific, sensitive, and accurate neuro-fuzzy classification of sleep stages.

Itakura Distance: A Useful Similarity Measure between EEG and EOG Signals in Computer-aided Classification of Sleep Stages

Sleep is a natural periodic state of rest for the body, in which the eyes usually close and consciousness is completely or partially lost. Consequently, there is a decrease in bodily movements and responsiveness to external stimuli. Slow wave sleep is of immense interest as it is the most restorative sleep stage during which the body recovers from weariness. During this sleep stage, electroencephalographic (EEG) and electro-oculographic (EOG) signals interfere with each other and they share a temporal similarity. In this investigation we used the EEG and EOG signals acquired from 10 patients undergoing overnight polysomnography with their sleep stages determined by certified sleep specialists based on RK rules. In this pilot study, we performed spectral estimation of EEG signals by Autoregressive (AR) modeling, and then used Itakura Distance to measure the degree of similarity between EEG and EOG signals. We finally calculated the statistics of the results and displayed them in an easy to visualize fashion to observe tendencies for each sleep stage. We found that Itakura Distance is the smallest for sleep stages 3 and 4. We intend to deploy this feature as an important element in automatic classification of sleep stages.

FOXP3, a selective marker for a subset of adult T-cell leukaemia/lymphoma

FOXP3 is a forkhead transcription factor family member, implicated in T-cell regulation, activation and differentiation. FOXP3 has been shown to be a master control gene for the development and function of CD4+/CD25+ regulatory T-cells (T(reg)). In this study, FOXP3 protein expression has been analysed using a new anti-FOXP3 monoclonal antibody in 172 paraffin-embedded lymphoma samples. FOXP3 expression in tumour cells was confined to adult T-cell leukaemia/lymphoma (ATLL) cases (17/25, 68%), with some variability in the intensity of the staining and the proportion of positive cells. No other lymphoma types studied exhibited FOXP3 expression in the malignant population. The selective expression of FOXP3 by tumour cells in ATLL makes this antibody a potentially useful diagnostic tool.

Vesicular pityriasis rosea: response to erythromycin treatment

Pityriasis rosea (PR) is a relatively common disease although its aetiology has not yet been identified. It occurs worldwide and there is no racial susceptibility factor. It usually affects teenagers and young adults between 10 and 35 years of age. Typical PR is much easier to diagnose than the rare atypical forms. We report a rare case of vesicular PR in a black woman who had vesicular lesions limited to her palms and soles in addition to regular typical lesions. We devised an efficient oral erythromycin treatment for this patient.

Factors affecting intra- and inter-specific variations in the difference between alert distances and flight distances for birds in forested habitats

Studies of escape from predators have usually focused on fleeing. We studied intra- and inter-specific variations in a previous level of decision-making during predator–prey encounters by determining the difference between the distance at which a predator is detected and the distance at which the prey flees from the predator (buffer distance). We measured buffer distances of four bird species (ground foragers) living in forested habitats (wooded recreational parks) to approaching humans. Buffer distances increased with group size and temperature, and this was probably related to dilution of the predation risk and a higher risk of heat stress, respectively. Buffer distances decreased with shrub and coniferous cover, probably because of increased visual obstruction, and increased with tree height, probably because of the increased security provided by taller trees. Grass cover increased buffer distances of wood pigeons (Columba palumbus) but decreased those of house sparrows (Passer domesticus) and magpies (Pica pica); this may be related to higher food availability, i.e., vegetation in grassy areas for wood pigeons and food left by humans in areas with bare ground for house sparrows and magpies. Buffer distances of blackbirds (Turdus merula) and house sparrows were greater in highly visited parks, which may be related to habituation. Finally, larger species showed greater buffer distances, landed farther away, used higher landing substrates (trees), and flew higher, probably because they need to ensure a certain margin of security from predators. Alternatively, the increased buffer distances of large species may be related to the increasing energy expenditure of flight. The buffer distance appears to be a good indicator of tolerance toward predators and (or) risk taken by prey after detecting predators.

Mixed-inhibitor-prodrug as a new approach toward systemically active inhibitors of enkephalin-degrading enzymes

In order to evaluate the possible advantages of potentiating the effects of the endogenous enkephalins, to obtain analgesia without the serious drawbacks of morphine, it was essential to design systemically active compounds which inhibit the two metabolizing enzymes, aminopeptidase N (APN) and neutral endopeptidase 24.11 (NEP). A new concept combining the idea of "prodrug" and "mixed inhibitor" was therefore developed. Given the high efficiency of beta-mercaptoalkylamines as APN inhibitors and of N-(mercaptoacyl) amino acids as NEP inhibitors, compounds associating these molecules through disulfide or thioester bonds, which are known to increase lipophilicity and to favor passage across the blood-brain barrier, have been synthesized. An HPLC study indicated that the disulfide bridge was resistant to serum enzymes but was cleaved by brain membrane homogenates, suggesting that the active inhibitors were released in the central nervous system. The validity of the approach was verified by the efficient antinociceptive responses obtained in the hot plate test in mice after iv administration of disulfide-containing inhibitors (ED50s of from 4 to 26 mg/kg on the jump latency time). The analgesic potencies of the "mixed inhibitor-prodrug" RB 101 [H2NCH(CH2CH2SCH3)CH2SSCH2CH(CH2Ph)CONHCH( CH2Ph)COOCH2Ph] after iv administration were three times greater than those of a similar combined dose of its two constitutive moieties. The separation of the two diastereoisomers constituting RB 101 showed that the analgesia has a stereochemical dependence, the (S,S,S)-isomer being more active than the (S,R,S)-isomer. Furthermore, in the tail flick test in the rat, RB 101 gave 38% analgesia at a dose of 80 mg/kg. Due to its high efficiency and its longer pharmacological effect, RB 101 was selected for a complete study of its analgesic properties.

Nanocrystalline metal oxides as unique chemical reagents/sorbents

A new family of porous inorganic solids based on nanocrystalline metal oxides is discussed. These materials, made up of 4-7 nm MgO, CaO, Al2O3, ZnO, and others, exhibit unparalleled destructive adsorption properties for acid gases, polar organics, and even chemical/biological warfare agents. These unique sorption properties are due to nanocrystal shape, polar surfaces, and high surface areas. Free-flowing powders or consolidated pellets are effective, and pore structure can be controlled by consolidation pressures. Chemical properties can be adjusted by choice of metal oxide as well as by incorporating other oxides as monolayer films.

Self-monitoring of water quality in sewer systems using absorbance of ultraviolet and visible light

Continuous pollution measurement is interesting to optimize the operation of sanitary facilities as well as to minimize the stormwater discharges. An experimental study was carried out for the determination of Suspended Solids (SS) and Chemical Oxygen Demand (COD) concentrations in combined sewers using ultraviolet and visible absorbances. The maintenance of the measurement system requires six hours a month for the cleaning of the hydraulic feeding system and adjustment of the optical device. The feeding system developed increased the representativeness and reliability of the pollution measurement, but needs to be validated on other measurement sites. The determination of SS concentrations from visible absorbances requires 2 calibration curves for dry and rainy weather respectively. The corresponding accuracies appear satisfactory when compared with the results of standard sampling/laboratory analysis. The accuracy of COD determination from ultraviolet absorbance is less satisfactory, but could perhaps be improved taking into account another parameter. Then the optical measurement of SS and COD is interesting to determine average or long term pollution loads, for example the yearly impact of urban stormwater discharges. With this kind of continuous and on-line measurement, it is possible to react with short delay to unexpected phenomena which could damage the environment or water treatment efficiency.

Optimisation of operational management practices for the detention basins

The objective of this study is to develop new operational management practices for detention basins during rainfall events in order to limit flooding risk and, at the same time, to reduce pollutant discharges by optimising the settling process. For this work, a methodology was developed to study the integration of the stormwater treatment into existing detention structures. In this article, it was applied on two experimental sites. The current operation of the basins and "on/off" regulation studies were first carried out to quantify the freedom to act to change the control schemes. Relying on the support of these studies, new operational rules based on the current or "on/off" principle were then elaborated and tested on the experimental basins using a hydraulic model. Finally, their efficiency to protect against flooding and to reduce pollutant discharges was assessed.

Lethal and sublethal effects of rice polishing process on Sitophilus oryzae (Coleoptera: Curculionidae)

The mechanical impact of rice polishingon the rice weevil, Sitophilus oryzae (L.), and the subsequent postpolishing effects associated with rice quality were studied. "Brown" rice (not polished), "White (infest then polish)" rice, and "White (polish then infest)" rice were used with different polishing process intensities and different initial weevil densities. Weevil progeny were more numerous in Brown than in White (infest then polish) or White (polish then infest) rice. Polishing corresponding to a weight loss of 11% in rice generated an immediate mortality of approximately 40%; the subsequent mortality caused by rice quality was also 40% (total >80%). A polishing process corresponding to 14 and 16% of rice weight loss generated a drastic mortality in the weevil population (>95%). The progeny per adult weevil was similar with high and low initial weevil densities. The development of weevil progeny was also delayed by about 1 wk in White (infest then polish) rice compared with Brown rice. Furthermore, weevil adults of the progeny were significantly heavier in Brown than in White (infest then polish) or White (polish then infest) rice.

[Calcifications from cardiac etiology in chest radiography]

OBJECTIVE: Children s chest X-ray calcification images can be related to pulmonary, mediastinal and rarely cardiac parenchymatous pathology. This report describes cases of cardio thoracic calcifications. We emphasize the importance of chest X-ray to track thoracic calcifications. In spite of the fact that it is rare, the cardiac etiology must be considered due to the possibility of surgical treatment.METHODS: Regarding the period from 1988 to 1997 the authors reviewed the chest X-rays of 2108 patients. In 3 of them thoracic calcifications of cardiac etiology were observed.RESULTS: Of these three patients, two were 7 years old and the third was 3 years old. Case 1 presented a calcification in the right atrium topography caused by a heart tumor of Fibroma type. In case 2 the calcification was in the pulmonary trunk, presenting as a calcified aneurysm of the ductus arteriosus. In case 3 the child had pulmonary stenosis and the chest X-ray showed a calcified image on the left cardiac boards caused by a thrombo in the right ventricle wall.CONCLUSION: The authors emphasize the importance of chest X-ray in the diagnosis of thoracic calcifications, and comment that in spite of the being rare, the cardiac causes should be considered due to the possibility of surgical treatment.

Development of reactive topical skin protectants against sulfur mustard and nerve agents

The potential for highly reactive nanoparticles (RNP) to absorb destructively, i.e. to neutralize highly toxic substances such as the warfare agents GA, GB, HD and VX, has been demonstrated in the laboratory. Reactive nanoparticles represent a new class of nanoscale particles of metals and metal oxides that differ from other nanoparticles in reactivity and crystalline morphology. The potential for incorporating RNP into a protective barrier skin cream also has been demonstrated. Preliminary studies indicate that RNP are physically and chemically compatible with a base cream provided by the Army Medical Research Office and, importantly, remain reactive with chemical agents while promising to be compatible with skin contact.

[The importance of chest radiograph in the diagnosis of Scimitar syndrome]

OBJECTIVE: To emphasize the importance of chest X-Rays in the diagnosis of Scimitar Syndrome. This anomaly is usually characterized by the presence of anomalous venous drainage of the right lung to the inferior vena cava, abnormal bronchial segmentation, and alterations of pulmonary artery and right lung vascularization.METHODS: The authors report a case of Scimitar Syndrome in an 8 year-old-child, discussing its diagnostic methods and surgical treatment.RESULTS: The child presented good outcome after surgical therapy, with an uneventful follow-up.CONCLUSION: The Scimitar Syndrome is a rare anomaly, which may present few clinical manifestations. The chest X-Ray is a very relevant tool in the screening of this disease, since it discloses a persisting right paracardiac image, as a result of abnormal right pulmonary venous drainage to inferior vena cava ("Scimitar sign").