Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer

The aim of this study was to evaluate the worldwide trends in surgical techniques for esophageal cancer surgery by comparing it to our survey from 2007. In addition, new questions were added for gastroesophageal junction (GEJ) cancer. An international survey on surgery of esophageal and GEJ cancer was performed among surgical members of the International Society for Diseases of the Esophagus, the World Organization for Specialized Studies on Disease of the Esophagus, the International Gastric Cancer Association. Also, surgeons from personal networks were contacted. The participants filled out a web based questionnaire about surgical strategies for esophageal and gastroesophageal cancer. The overall response rate was 478/1147 (42%). The respondents represented 49 different countries and 6 different continents. The annual cumulative number of esophageal and gastric resections per surgeon was low (≤11) in 11%, medium (11-21) in 17%, and high (≥21) in 72% of respondents. In a subgroup analysis of esophageal surgeons the number of high volume surgeons increased from 45 to 54% over the past 7 years. The preferred lymph node dissection was two-field in 86%. A gastric conduit was the preferred method of reconstruction in 95%. In 2014, the preferred approach to esophagectomy was minimally invasive transthoracic in 43%, compared with 14% in 2007. In minimally invasive transthoracic esophagectomy the cervical anastomosis was favored in 54% of respondents in 2014 compared with 87% in 2007. The preferred technique of construction of the cervical anastomosis was hand-sewn in 64% and stapled in 36%, whereas the thoracic anastomosis was stapled in 77% and hand-sewn in 23%. The preferred surgical approach for Siewert type 1 tumors (5-1 cm proximal of the GEJ) was esophagectomy in 93% of respondents, whereas 6% favored gastrectomy and 3% combined a distal esophagectomy with a proximal gastrectomy. For Siewert type 2 tumors (1-2 cm from the GEJ) an extended gastrectomy was favored by 66% of respondents, followed by esophagectomy in 27% and total gastrectomy in 7%. Siewert type 3 tumors (2-5 cm distal of the GEJ) were preferably treated with gastrectomy in 90% of respondents, esophagectomy in 6%, and extended gastrectomy in 4%. The preferred curative surgical treatment of esophageal cancer is minimally invasive transthoracic esophagectomy with a two-field lymph node dissection and gastric conduit reconstruction. A strong worldwide trend toward minimally invasive surgery is observed. The preferred surgical treatment of GEJ tumors is esophagectomy for Siewert type 1 tumors and gastrectomy for Siewert type 3 tumors. The majority of surgeons favor an extended gastrectomy for Siewert type 2 tumors.

Dog Ecology and Barriers to Canine Rabies Control in the Republic of Haiti, 2014-2015

An estimated 59 000 persons die annually of infection with the rabies virus worldwide, and dog bites are responsible for 95% of these deaths. Haiti has the highest rate of animal and human rabies in the Western Hemisphere. This study describes the status of animal welfare, animal vaccination, human bite treatment, and canine morbidity and mortality in Haiti in order to identify barriers to rabies prevention and control. An epidemiologic survey was used for data collection among dog owners during government-sponsored vaccination clinics at fourteen randomly selected sites from July 2014 to April 2015. A total of 2005 surveys were collected and data were analysed using parametric methods. Over 50% of owned dogs were allowed to roam freely, a factor associated with rabies transmission. More than 80% of dog owners reported experiencing barriers to accessing rabies vaccination for their dogs. Nearly one-third of the dog population evaluated in this study died in the year preceding the survey (32%) and 18% of these deaths were clinically consistent with rabies. Dog bites were commonly reported, with more than 3% of the study population bitten within the year preceding the survey. The incidence of canine rabies in Haiti is high and is exacerbated by low access to veterinary care, free-roaming dog populations and substandard animal welfare practices. Programmes to better understand the dog ecology and development of methods to improve access to vaccines are needed. Rabies deaths are at historical lows in the Western Hemisphere, but Haiti and the remaining canine rabies endemic countries still present a significant challenge to the goal of rabies elimination in the region.

Quadriceps muscle fatigue in trained and untrained boys

This study aimed to explore muscle oxygen extraction and muscle activation pattern during bilateral intermittent submaximal isometric knee-extensions by combining Near-infrared Spectroscopy (NIRS) and Electromyography (EMG) measurements from the M. Vastus Lateralis. A group of highly specifically trained boys (youth sailors) (n=10) and untrained matched controls (n=10) performed 12 bouts of 90 s bilateral submaximal (30-40% MVC) isometric knee-extension interspersed with 6 s recovery-periods. Patterns of deoxygenated haemoglobin and myoglobin concentration (Deoxy[Hb+Mb]) were observed during each bout and the entire protocol. Reoxygenation Index (RI) was assessed for each recovery period as the amplitude of Deoxy[Hb+Mb]-decrease relative to amplitude of Deoxy[Hb+Mb]-increase during each bout. Root Mean Square (RMS) and Mean Power Frequency (MPF) were calculated for each bout as an average of the final 60 s. Deoxy[Hb+Mb], RI, RMS and MPF were analyzed by repeated-measures ANOVA. Results indicated significantly higher Deoxy[Hb+Mb]-increase and lower RI in specifically trained boys compared to untrained controls. These differences are presumably related to the differences in EMG-measurements which demonstrated lower RMS-increase and MPF-decrease for trained compared to untrained boys. In conclusion, specifically trained boys indicate delayed onset of muscle fatigue in comparison to untrained controls, which might be associated with the different pattern of muscle O2-extraction or muscle activation pattern (i. e., a more accurate recruitment of slow-twitch fibres).

TU-E-217BCD-03: Characterization of Anatomical Noise in Mammography, Tomosynthesis and Breast CT

PURPOSE

The role of breast density in cancer detection has been well characterized, and newer modalities such as breast tomosynthesis and breast CT (bCT) were developed to improve cancer detection in the dense breast by reducing anatomical complexity. Anatomical noise was characterized on a small cohort of patient images and compared across digital mammography, tomosynthesis, and bCT images.

METHODS AND MATERIALS

An IRB-approved and HIPPA-compliant clinical study was performed on women undergoing breast biopsy, and mammography, tomosynthesis, and bCT were performed on both breasts immediately prior to biopsy. A total of 23 women participated in this study, and the unaffected breast (no lesion) was evaluated. A total of 1000 regions of interest were sampled on each image data set, and the 2D noise power spectrum (NPS) was evaluated. This was radially averaged to produce a 1D NPS, and the NPS was fit to a power law: ln{NPS(f)} = alpha+betaxln(f), over an anatomically-relevant range of spatial frequencies. The slope, beta, was averaged across patients and compared between modalities and projections.

RESULTS

The value of beta was determined for bCT data sets, and they were 1.75 (0.424), 1.83 (0.352), and 1.79 (0.397), for the coronal, sagittal and axial views, respectively. For tomosynthesis, beta was 3.06 (0.361) and 3.10 (0.315) for the CC and MLO views, respectively. For mammography, these values were 3.17 (0.226) and 3.30 (0.236), for the CC and MLO views, respectively. The values of beta for breast CT were significantly different than those for tomosynthesis and mammography (p<0.001, all 12 comparisons).

CONCLUSIONS

The results of this investigation demonstrate that the anatomical complexity of the breast, as characterized by the parameter beta, is statistically similar between mammography and tomosynthesis, a somewhat surprising finding. The breast CT image data, however, demonstrate a statistically-significant reduction in beta across all projections. Funded in part by Hologic Corporation and by a grant from the National Institute of Biomedical Imaging and Bioengineering, EB002138.

Temporal and spatial variations in microclimate influence the larval foraging behaviors and performance of a conifer-feeding sawfly

Herbivorous insects are often exposed to broad temporal and spatial variations in microclimate conditions within their host plants and have adapted a variety of behaviors, such as avoidance or basking, to either offset or benefit from such variation. Field experiments were carried out to investigate the influence of daily and intratree variations in microclimate on the behaviors (feeding, resting, dispersal, and hiding) and associated performance of late-instar larvae of the yellowheaded spruce sawfly, Pikonema alaskensis (Rohwer) (Hymenoptera: Tenthredinidae) within crowns of 1.25-1.5 m tall black spruce (Picea mariana [Miller] Britton Sterns Poggenburg); late instars feed on developing shoots of young spruce and are often exposed to microclimatic extremes with unknown effects on performance. Larvae fed diurnally from just after dawn (0800 h) until dusk (2000 h) and rested throughout the night, with brief periods of dispersal occurring in the morning and evening. Neither larval behavior nor abiotic conditions differed significantly between the upper and lower crowns of trees. Temperature, humidity, and solar insolation all explained >90% of variation in feeding; however, sunrise and sunset were the most likely cues influencing diurnal behavior. Most larvae (94%) fed on the bottom, shaded side of shoots, and field experiments indicated that this behavior is adaptive with respect to microclimate, probably reducing hygrothermal stress. Thus, behavioral adaptations by P. alaskensis to daily and within-shoot microclimatic variation may reduce the risk of hygrothermal stress during dispersal or feeding, while still allowing larvae to feed on the preferred and highly nutritious upper crown foliage of young spruce.

Fecal lactoferrin as a noninvasive biomarker in inflammatory bowel diseases

The diagnosis and management of inflammatory bowel diseases (IBD), i.e., Crohn's disease and ulcerative colitis, still present a number of challenges. The fecal biomarker lactoferrin has been shown to be useful in the diagnosis and management of these diseases. This review includes a discussion of the current literature on lactoferrin as a biomarker of intestinal disease, detection of disease activity in IBD, comparison of lactoferrin to endoscopy and histology, lactoferrin measurement in pediatric IBD and lactoferrin as a biomarker for monitoring medical treatment in IBD.

Generation of antibody- and B cell-deficient pigs by targeted disruption of the J-region gene segment of the heavy chain locus

A poly(A)-trap gene targeting strategy was used to disrupt the single functional heavy chain (HC) joining region (J_H) of swine in primary fibroblasts. Genetically modified piglets were then generated via somatic cell nuclear transfer (SCNT) and bred to yield litters comprising J_H wild-type littermate (+/+), J_H heterozygous knockout (±) and J_H homozygous knockout (−/−) piglets in the expected Mendelian ratio of 1:2:1. There are only two other targeted loci previously published in swine, and this is the first successful poly(A)-trap strategy ever published in a livestock species. In either blood or secondary lymphoid tissues, flow cytometry, RT-PCR and ELISA detected no circulating IgM⁺ B cells, and no transcription or secretion of immunoglobulin (Ig) isotypes, respectively in J_H −/− pigs. Histochemical and immunohistochemical (IHC) studies failed to detect lymph node (LN) follicles or CD79α⁺ B cells, respectively in J_H −/− pigs. T cell receptor (TCR)_β transcription and T cells were detected in J_H −/− pigs. When reared conventionally, J_H −/− pigs succumbed to bacterial infections after weaning. These antibody (Ab)- and B cell-deficient pigs have significant value as models for both veterinary and human research to discriminate cellular and humoral protective immunity to infectious agents. Thus, these pigs may aid in vaccine development for infectious agents such as the pandemic porcine reproductive and respiratory syndrome virus (PRRSV) and H1N1 swine flu. These pigs are also a first significant step towards generating a pig that expresses fully human, antigen-specific polyclonal Ab to target numerous incurable infectious diseases with high unmet clinical need.

Targeted disruption of the porcine immunoglobulin kappa light chain locus

Inactivation of the endogenous pig immunoglobulin (Ig) loci, and replacement with their human counterparts, would produce animals that could alleviate both the supply and specificity issues of therapeutic human polyclonal antibodies (PAbs). Platform genetics are being developed in pigs that have all endogenous Ig loci inactivated and replaced by human counterparts, in order to address this unmet clinical need. This report describes the deletion of the porcine kappa (κ) light chain constant (Cκ) region in pig primary fetal fibroblasts (PPFFs) using gene targeting technology, and the generation of live animals from these cells via somatic cell nuclear transfer (SCNT) cloning. There are only two other targeted loci previously published in swine, and this is the first report of a targeted disruption of an Ig light chain locus in a livestock species. Pigs with one targeted Cκ allele (heterozygous knockout or ±) were bred together to generate Cκ homozygous knockout (-/-) animals. Peripheral blood mononuclear cells (PBMCs) and mesenteric lymph nodes (MLNs) from Cκ -/- pigs were devoid of κ-containing Igs. Furthermore, there was an increase in lambda (λ) light chain expression when compared to that of wild-type littermates (Cκ +/+). Targeted inactivation of the Ig heavy chain locus has also been achieved and work is underway to inactivate the pig lambda light chain locus.

A novel multidisciplinary educational programme for patients with chronic skin diseases: Ghent pilot project and first results

Chronic inflammatory skin disorders have a major impact on the patients' health related quality of life. Preliminary studies to date have suggested that additional educational and psychological training programmes may be effective in the management of chronic skin diseases, although more rigid methodology is needed. Our purpose was to investigate the effect on quality of life of a novel multidisciplinary educational programme for patients, 18 years or older, with chronic skin diseases. The 12-week intervention encompasses cognitive education on skin and general health issues, and stress-reducing techniques. Quality of life questionnaires were used to assess the participants at baseline and at the end of the program. These comprehend Dermatology Life Quality Index (DLQI), Skindex-29, Psoriasis Disability Index (PDI) and Quality of Life Index for Atopic Dermatitis (QoLIAD). Fifty-five patients participated in six programmes since 2006. Forty-three patients completed the programme. Overall, compared to baseline, DLQI (n = 39) improved by 5.64 points (p < 0.001; SD ±6.09), Skindex-29 (n = 27) by 19.67 points (p < 0.001; SD ±17.37), PDI (n = 9) improved by 7.44 points (p = 0.019; SD ±7.60) and QoLIAD (n = 13) improved by 4.39 points (p = 0.036; SD ±6.69) by the end of the intervention. Preliminary results show that the quality of life of the patients with chronic skin diseases improved significantly after participation to the programme. These positive initial results are stimulating to set up a prospective controlled randomised trial investigating the impact on quality of life, the clinical efficacy and the cost-effectiveness of this educational intervention programme.