Circularity in Europe strengthens the sustainability of the global food system

Redesigning the European food system on the basis of circularity principles could bring environmental benefits for Europe and the world. Here we deploy a biophysical optimization model to explore the effects of adopting three circularity scenarios in the European Union (EU)27 + UK. We calculate a potential reduction of 71% in agricultural land use and 29% per capita in agricultural greenhouse gas emissions, while producing enough healthy food within a self-sufficient European food system. Under global food shortages, savings in agricultural land could be used to feed an additional 767 million people outside the EU (+149%), while reducing per capita greenhouse gas emissions by 38% but increasing overall emissions by 55% due to the increased population served. Transitioning the EU's food system towards circularity implies sequential changes among all its components and has great potential to safeguard human and planetary health.

Primary Chemoradiotherapy Treatment (PCRT) for HER2+ and Triple Negative Breast Cancer Patients: A Feasible Combination

Primary systemic treatment (PST) downsizes the tumor and improves pathological response. The aim of this study is to analyze the feasibility and tolerance of primary concurrent radio−chemotherapy (PCRT) in breast cancer patients. Patients with localized TN/HER2+ tumors were enrolled in this prospective study. Radiation was delivered concomitantly during the first 3 weeks of chemotherapy, and it was based on a 15 fractions scheme, 40.5 Gy/2.7 Gy per fraction to whole breast and nodal levels I-IV. Chemotherapy (CT) was based on Pertuzumab−Trastuzumab−Paclitaxel followed by anthracyclines in HER2+ and CBDCA-Paclitaxel followed by anthracyclines in TN breast cancers patients. A total of 58 patients were enrolled; 25 patients (43%) were TN and 33 patients HER2+ (57%). With a median follow-up of 24.2 months, 56 patients completed PCRT and surgery. A total of 35 patients (87.5%) achieved >90% loss of invasive carcinoma cells in the surgical specimen. The 70.8% and the 53.1% of patients with TN and HER-2+ subtype, respectively, achieved complete pathological response (pCR). This is the first study of concurrent neoadjuvant treatment in breast cancer in which three strategies were applied simultaneously: fractionation of RT (radiotherapy) in 15 sessions, adjustment of CT to tumor phenotype and local planning by PET. The pCR rates are encouraging.

Global Burden of Animal Diseases: a novel approach to understanding and managing disease in livestock and aquaculture

Investments in animal health and Veterinary Services can have a measurable impact on the health of people and the environment. These investments require a baseline metric that describes the burden of animal health and welfare in order to justify and prioritise resource allocation and from which to measure the impact of interventions. This paper is part of a process of scientific enquiry in which problems are identified and solutions sought in an inclusive way. It poses the broad question: what should a system to measure the animal disease burden on society look like and what value would it add? Moreover, it aims to do this in such a way as to be accessible by a wide audience, who are encouraged to engage in this debate. Given that farmed animals, including those raised by poor smallholders, are an economic entity, this system should be based on economic principles. These poor farmers are negatively impacted by disparities in animal health technology, which can be addressed through a mixture of supply-led and demand-driven interventions, reinforcing the relevance of targeted financial support from government and non-governmental organisations. The Global Burden of Animal Diseases (GBADs) Programme will glean existing data to measure animal health losses within carefully characterised production systems. Consistent and transparent attribution of animal health losses will enable meaningful comparisons of the animal disease burden to be made between diseases, production systems and countries, and will show how it is apportioned by people's socio-economic status and gender. The GBADs Programme will produce a cloud-based knowledge engine and data portal, through which users will access burden metrics and associated visualisations, support for decisionmaking in the form of future animal health scenarios, and the outputs of wider economic modelling. The vision of GBADs, strengthening the food system for the benefit of society and the environment, is an example of One Health thinking in action.

Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

BACKGROUND

Axillary sentinel lymph node biopsy (SLNB) is standard treatment for patients with clinically and pathological negative lymph nodes. However, the role of completion axillary lymph node dissection (cALND) following positive sentinel lymph node biopsy (SLNB) is debated.

AIM

To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of long-term complications and create a Preoperative Clinical Risk Index (PCRI) that helps us in our clinical practice to optimize the selection of these patients.

METHODS

Patients with positive SLNB who underwent a cALND were included in this study. Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND.

RESULTS

From May 2007 to April 2014, we performed 1140 SLN biopsies, of which 125 were positive for tumor and justified to practice a posterior cALND. Pathologic findings at SLNB were micrometastases (mic) in 29 cases (23.4%) and macrometastasis (MAC) in 95 cases (76.6%). On univariate analysis of the 95 patients with MAC, statistically significant factors included: age, grade, phenotype, histology, lymphovascular invasion, lymph-node tumor size, and number of positive SLN. On multivariate analysis, only lymph-node tumor size (≤ 20 mm) and number of positive SLN (> 1) retained significance. A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND. Patients with a PCRI ≤ 15 has low probability (< 10%) of having additional lymph node involvement, a PRCI between 15-17.6 has a probability of 43%, and the probability increases to 69% in patients with a PCRI > 17.6.

CONCLUSION

The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND. Further prospective studies are necessary to validate PCRI clinical generalization.

Impact of the Lockdown Due to COVID-19 Pandemic in the Use of Combined Hormonal Oral Contraception in Spain - Results of a National Survey: Encovid

Objective

To know the contraceptive behaviour of Spanish women who use combined oral contraception (COC) during the period of lockdown due to COVID-19.

Methods

Cross-sectional, descriptive study of a sample of Spanish women who use COC based on a survey conducted through social networks using the online platform Survey Monkey. The survey was conducted during the period of home confinement.

Results

A total of 1407 women answered the survey and 937 were valid for the analysis. A total of 675 women (71.8%) were confined all day at home. During confinement 96,6% of women continued to use the COC, 53.5% responded that their sexual activity decreased during this time and 54% that their physical activity had decreased. A significant percentage of women (10.3%) recognized a worsening of premenstrual symptoms.

Conclusion

Despite the lockdown and the decrease in the frequency of sexual intercourse, the Spanish women who use COC did not abandon its use during the period of time analysed.

Impacts of climate change on the livestock food supply chain; a review of the evidence

The potential impacts of climate change on current livestock systems worldwide are a major concern, and yet the topic is covered to a limited extent in global reports such as the ones produced by the Intergovernmental Panel on Climate Change. In this article, we review the risk of climate-related impacts along the land-based livestock food supply chain. Although a quantification of the net impacts of climate change on the livestock sector is beyond the reach of our current understanding, there is strong evidence that there will be impacts throughout the supply chain, from farm production to processing operations, storage, transport, retailing and human consumption. The risks of climate-related impacts are highly context-specific but expected to be higher in environments that are already hot and have limited socio-economic and institutional resources for adaptation. Large uncertainties remain as to climate futures and the exposure and responses of the interlinked human and natural systems to climatic changes over time. Consequently, adaptation choices will need to account for a wide range of possible futures, including those with low probability but large consequences.

•

Risk results from the interaction of climate-related hazards with the exposure and vulnerability of human and natural systems.

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Climate change will impact the livestock sector throughout the food supply chain⁠—from farm production to human consumption.

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Key hazards relate to climate change trends but also, and importantly, to climate variability and climate extremes.

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Large uncertainties remain as to climate futures and the exposure and responses of the interlinked human and natural systems.

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Adaptation choices will need to account for a wide range of possible futures.

Changes in brain activity associated with cognitive-behavioral exposure therapy for specific phobias: searching for underlying mechanisms

INTRODUCTION

The current evidence collected consistent results about morphological and functional brain changes produced by psychological treatment. Exposure cognitive-behavioral therapy (CBT) is currently the most effective psychological treatment for phobias.

AIMS

To explore the brain activation and self-reported changes in patients with specific phobias to small animals who underwent a CBT exposure program and to prove if the CBT program made phobic patients process feared stimuli similarly to non-phobic persons.

SUBJECTS AND METHODS

The sample consisted of 32 adults, of which 16 (5 males and 11 females; mean age: 38.08) had specific phobia to small animals and 16 (4 males and 12 females; mean age: 21.81) had no phobias. A univariate before-and-after treatment design were used. In addition, the scores of the non-phobic group in self-reports and brain activity were compared with the post-treatment scores of the phobic group.

RESULTS

Data show significant changes in brain activity, and improvements in self-reported measures because of applying CBT to specific phobias. As a highlight, participants showed a greater activation in points of the precuneus after receiving CBT. Also, when compared with non-phobic participants, phobic patients still remain with both fear and defensive responses to phobic stimuli.

CONCLUSIONS

The precuneus seems to be a regulator that reorganizes the processing of phobic stimuli. It can imply as CBT/ exposure also active acceptance, self-awareness, and self-efficacy mechanisms.

A Case of Transcranial Direct-Current Stimulation for Childhood Stroke Hemiparesis: A Brief Report

Purpose: Survivors of childhood stroke incur lifelong physical disability. Treatment options are limited, however, models of motor reorganization after stroke are revealing cortical targets for neuromodulation. Transcranial direct-current stimulation (tDCS) enhances motor learning and may improve motor recovery in adult stroke, but remains uninvestigated in childhood-onset stroke. Here we documented the feasibility and safety of tDCS in an adolescent with chronic stroke-induced hemiparesis.Materials and methods: Over 10 days, the participant underwent occupational therapy paired with contralesional, primary motor cortex-targeting, cathodal tDCS. Clinical motor outcomes, and safety and tolerability measures were completed.Results: tDCS was well-tolerated with no adverse events. Motor outcomes did not regress post-intervention, with clinically significant changes still evident at 6 months.Conclusions: Application of controlled trials of non-invasive neuromodulation are safe and tolerability in childhood-onset stroke.

Heterogeneous nuclear ribonucleoprotein C1 may control miR-30d levels in endometrial exosomes affecting early embryo implantation

STUDY QUESTION

Is there a specific mechanism to load the microRNA (miRNA), hsa-miR-30d, into exosomes to facilitate maternal communication with preimplantation embryos?

SUMMARY ANSWER

The heterogeneous nuclear ribonucleoprotein C1 (hnRNPC1) is involved in the internalization of endometrial miR-30d into exosomes to prepare for its subsequent incorporation into trophectoderm cells.

WHAT IS KNOWN ALREADY

Our group previously described a novel cell-to-cell communication mechanism involving the delivery of endometrial miRNAs from the maternal endometrium to the trophectoderm cells of preimplantation embryos. Specifically, human endometrial miR-30d is taken up by murine blastocysts causing the overexpression of certain genes involved in embryonic adhesion (Itb3, Itga7 and Cdh5) increasing embryo adhesion rates.

STUDY DESIGN, SIZE, DURATION

Transfer of maternal miR-30d to preimplantation embryos was confirmed by co-culture of wild-type (WT) and miR-30d knockout (KO) murine embryos with primary cultures of human endometrial epithelial cells (hEECs) in which mir-30d was labeled with specific Molecular Beacon (MB) or SmartFlare probes. Potential molecules responsible for the miR-30d loading into exosomes were purified by pull-down analysis with a biotinylated form of miR-30d on protein lysates from human endometrial exosomes, identified using mass spectrometry and assessed by flow cytometry, western blotting and co-localization studies. The role of hnRNPC1 in the miR-30d loading and transportation was interrogated by quantification of this miRNA in exosomes isolated from endometrial cells in which hnRNPC1 was transiently silenced using small interference RNA. Finally, the transfer of miR-30d to WT and KO embryos was assessed upon co-culture with sihnRNPC1 transfected cells.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Murine embryos from miR-30d WT and KO mice, (strain MirC26tm1Mtm/Mmjax), were obtained by oviduct flushing of superovulated females. Endometrial Exosomes were purified by ultracentrifugation of supernatants from primary cultures of hEECs or Ishikawa cells. MB and Smartflare miR-30d probes were detected by confocal and/or transmission electron microscopy (TEM). hEECs and exosomes derived from them were subjected to pull-down with a biotinylated form of miR-30d. Captured proteins were identified by mass spectrometry (MS/MS). Western blotting was performed to detect hnRNPC1 and CYR61 in whole lysates, subcellular fractions and secreted vesicles from hEECs. Co-localization studies of the selected proteins with the exosomal marker CD63 were performed. FACS analysis was carried out to determine the presence of hnRNPC1 inside exosomes. Silencing of hnRNPC1 was conducted in the Ishikawa Cell Line with the Smart Pool Accell HNRNPC siRNA at a final concentration of 50 nM. RT-qPCRs were done to determine the messenger levels of miR-30d in cells and exosomes. Co-cultures of WT and KO embryos were established with Ishikawa cells double-transfected with sihnRPNC1 and MB probes.

MAIN RESULTS AND THE ROLE OF CHANCE

MS/MS analysis allowed us to identify hnRNPC1 as a possible protein to influence miR-30d loading into exosomes. Co-localization studies of hnRNPC1 with CD63 and FACS analyses suggested the presence of hnRNPC1 inside exosomes. Silencing of hnRNPC1 in Ishikawa cells resulted in a sharp decrease of the levels of miR-30d in both epithelial-like cells (P = 0.0001) and exosomes (P = 0.0152), suggesting its potential role in miR-30d biogenesis and transfer. Co-culture assays of miR-30d KO embryos with sihnRNPC1 hEECs revealed a decrease in embryo-miR-30d acquisition during the adhesion and invasion stages. In turn, transient silencing of hnRNPC1 results in a significant decrease of blastocyst adhesion compared to mock transfection conditions using Block-it, in both WT [Mean ± SD; 67 ± 10.0% vs. 38 ± 8.5%(P = 0.0006)] and miR-30d KO embryos [Mean ± SD; 50 ± 11.5% vs. 26 ± 8.8% (P = 0.0029) (n = 2); 14 embryos transferred per condition tested].

LARGE-SCALE DATA

MS/MS data are available via ProteomeXchange with identifier PXD008773.

LIMITATIONS, REASONS FOR CAUTION

The Ishikawa Cell Line was used as a model of hEECs in silencing experiments due to the low survival rates of primary hEECs after transfection.

WIDER IMPLICATIONS OF THE FINDINGS

The data show that hnRNPC1 may be involved in the internalization of miR-30d inside exosomes. The decreased rates of embryo adhesion in endometrial epithelial-like cells transiently silenced with sihnRNPC1evidence that hnRNPC1 could be an important player in the maternal-embryo communication established in the early stages of implantation.

STUDY FUNDING AND COMPETING INTEREST(S)

This work was supported by the Miguel Servet Program Type I of Instituto de Salud Carlos III [CP13/00038]; FIS project [PI14/00545] to F.V.; the 'Atracció de Talent' Program from VLC-CAMPUS [UV-INV-PREDOC14-178329 to NB]; a Torres-Quevedo grant (PTQ-13-06133) by the Spanish Ministry of Economy and Competitiveness to IM and MINECO/FEDER Grant [SAF2015-67154-R] to C.S. The authors declare there is no conflict of interest.

Climate change and pastoralism: impacts, consequences and adaptation

The authors discuss the main climate change impacts on pastoralist societies, including those on rangelands, livestock and other natural resources, and their extended repercussions on food security, incomes and vulnerability. The impacts of climate change on the rangelands of the globe and on the vulnerability of the people who inhabit them will be severe and diverse, and will require multiple, simultaneous responses. In higher latitudes, the removal of temperature constraints might increase pasture production and livestock productivity, but in tropical arid lands, the impacts are highly location specific, but mostly negative. The authors outline several adaptation options, ranging from implementing new technical practices and diversifying income sources to finding institutional support and introducing new market mechanisms, all of which are pivotal for enhancing the capacity of pastoralists to adapt to climate variability and change. Due to the dynamism of all the changes affecting pastoral societies, strategies that lock pastoral societies into specified development pathways could be maladaptive. Flexible and evolving combinations of practices and policies are the key to successful pastoral adaptation.

Towards a New Strategy for Diagnosis of Congenital Trypanosoma cruzi Infection

The immigration of Latin American women of childbearing age has spread the congenital transmission of Chagas disease to areas of nonendemicity, and the disease is now a worldwide problem. Some European health authorities have implemented screening programs to prevent vertical transmission, but the lack of a uniform protocol calls for the urgent establishment of a new strategy common to all laboratories. Our aims were to (i) analyze the trend of passive IgG antibodies in the newborn by means of five serological tests for the diagnosis and follow-up of congenital Trypanosoma cruzi infection, (ii) assess the utility of these techniques for diagnosing a congenital transmission, and (iii) propose a strategy for a prompt, efficient, and cost-effective diagnosis of T. cruzi infection. In noninfected newborns, a continuous decreasing trend of passive IgG antibodies was observed, but none of the serological assays seroreverted in any the infants before 12 months. From 12 months onwards, serological tests achieved negative results in all the samples analyzed, with the exception of the highly sensitive chemiluminescent microparticle immunoassay (CMIA). In contrast, in congenitally infected infants, the antibody decline was detected only after treatment initiation. In order to improve the diagnosis of congenital T. cruzi infection, we propose a new strategy involving fewer tests that allows significant cost savings. The protocol could start 1 month after birth with a parasitological test and/or a PCR. If negative, a serological test would be carried out at 9 months, which if positive, would be followed by another at around 12 months for confirmation.

Climate change and pastoralism: impacts, consequences and adaptation

The authors discuss the main climate change impacts on pastoralist societies, including those on rangelands, livestock and other natural resources, and their extended repercussions on food security, incomes and vulnerability. The impacts of climate change on the rangelands of the globe and on the vulnerability of the people who inhabit them will be severe and diverse, and will require multiple, simultaneous responses. In higher latitudes, the removal of temperature constraints might increase pasture production and livestock productivity, but in tropical arid lands, the impacts are highly location specific, but mostly negative. The authors outline several adaptation options, ranging from implementing new technical practices and diversifying income sources to finding institutional support and introducing new market mechanisms, all of which are pivotal for enhancing the capacity of pastoralists to adapt to climate variability and change. Due to the dynamism of all the changes affecting pastoral societies, strategies that lock pastoral societies into specified development pathways could be maladaptive. Flexible and evolving combinations of practices and policies are the key to successful pastoral adaptation.

Serological Diagnosis of Chronic Chagas Disease: Is It Time for a Change?

Chagas disease has spread to areas that are nonendemic for the disease with human migration. Since no single reference standard test is available, serological diagnosis of chronic Chagas disease requires at least two tests. New-generation techniques have significantly improved the accuracy of Chagas disease diagnosis by the use of a large mixture of recombinant antigens with different detection systems, such as chemiluminescence. The aim of the present study was to assess the overall accuracy of a new-generation kit, the Architect Chagas (cutoff, ≥1 sample relative light units/cutoff value [S/CO]), as a single technique for the diagnosis of chronic Chagas disease. The Architect Chagas showed a sensitivity of 100% (95% confidence interval [CI], 99.5 to 100%) and a specificity of 97.6% (95% CI, 95.2 to 99.9%). Five out of six false-positive serum samples were a consequence of cross-reactivity with Leishmania spp., and all of them achieved results of <5 S/CO. We propose the Architect Chagas as a single technique for screening in blood banks and for routine diagnosis in clinical laboratories. Only gray-zone and positive sera with a result of ≤6 S/CO would need to be confirmed by a second serological assay, thus avoiding false-positive sera and the problem of cross-reactivity with Leishmania species. The application of this proposal would result in important savings in the cost of Chagas disease diagnosis and therefore in the management and control of the disease.

Closing system-wide yield gaps to increase food production and mitigate GHGs among mixed crop-livestock smallholders in Sub-Saharan Africa

In this study we estimate yield gaps for mixed crop-livestock smallholder farmers in seven Sub-Saharan African sites covering six countries (Kenya, Tanzania, Uganda, Ethiopia, Senegal and Burkina Faso). We also assess their potential to increase food production and reduce the GHG emission intensity of their products, as a result of closing these yield gaps. We use stochastic frontier analysis to construct separate production frontiers for each site, based on 2012 survey data prepared by the International Livestock Research Institute for the Climate Change, Agriculture and Food Security program. Instead of relying on theoretically optimal yields-a common approach in yield gap assessments-our yield gaps are based on observed differences in technical efficiency among farms within each site. Sizeable yield gaps were estimated to be present in all of the sites. Expressed as potential percentage increases in outputs, the average site-based yield gaps ranged from 28 to 167% for livestock products and from 16 to 209% for crop products. The emission intensities of both livestock and crop products registered substantial falls as a consequence of closing yield gaps. The relationships between farm attributes and technical efficiency were also assessed to help inform policy makers about where best to target capacity building efforts. We found a strong and statistically significant relationship between market participation and performance across most sites. We also identified an efficiency dividend associated with the closer integration of crop and livestock enterprises. Overall, this study reveals that there are large yield gaps and that substantial benefits for food production and environmental performance are possible through closing these gaps, without the need for new technology.

Paternal-specific S-allele transmission in sweet cherry (Prunus avium L.): the potential for sexual selection

Homomorphic self-incompatibility is a well-studied example of a physiological process that is thought to increase population diversity and reduce the expression of inbreeding depression. Whereas theoretical models predict the presence of a large number of S-haplotypes with equal frequencies at equilibrium, unequal allele frequencies have been repeatedly reported and attributed to sampling effects, population structure, demographic perturbation, sheltered deleterious mutations or selection pressure on linked genes. However, it is unclear to what extent unequal segregations are the results of gametophytic or sexual selection. Although these two forces are difficult to disentangle, testing S-alleles in the offspring of controlled crosses provides an opportunity to separate these two phenomena. In this work, segregation and transmission of S-alleles have been characterized in progenies of mixed donors and fully compatible pollinations under field conditions in Prunus avium. Seed set patterns and pollen performance have also been characterized. The results reveal paternal-specific distorted transmission of S-alleles in most of the crosses. Interestingly, S-allele segregation within any given paternal or maternal S-locus was random. Observations on pollen germination, pollen tube growth rate, pollen tube cohort size, seed set dynamics and transmission patterns strongly suggest post-pollination, prezygotic sexual selection, with male-male competition as the most likely mechanism. According to these results, post-pollination sexual selection takes precedence over frequency-dependent selection in explaining unequal S-haplotype frequencies.

Hsa-miR-30d, secreted by the human endometrium, is taken up by the pre-implantation embryo and might modify its transcriptome

During embryo implantation, the blastocyst interacts with and regulates the endometrium, and endometrial fluid secreted by the endometrial epithelium nurtures the embryo. Here, we propose that maternal microRNAs (miRNAs) might act as transcriptomic modifier of the pre-implantation embryo. Microarray profiling revealed that six of 27 specific, maternal miRNAs were differentially expressed in the human endometrial epithelium during the window of implantation--a brief phase of endometrial receptivity to the blastocyst--and were released into the endometrial fluid. Further investigation revealed that hsa-miR-30d, the expression levels of which were most significantly upregulated, was secreted as an exosome-associated molecule. Exosome-associated and free hsa-miR-30d was internalized by mouse embryos via the trophectoderm, resulting in an indirect overexpression of genes encoding for certain molecules involved in the murine embryonic adhesion phenomenon--Itgb3, Itga7 and Cdh5. Indeed, this finding was supported by evidence in vitro: treating murine embryos with miR-30d resulted in a notable increase in embryo adhesion. Our results suggest a model in which maternal endometrial miRNAs act as transcriptomic modifiers of the pre-implantation embryo.

Application of Hansen solubility approach for the subcritical and supercritical selective extraction of phlorotannins from Cystoseira abies-marina

A new theoretical approach based on Hansen solubility parameters has been employed for the first time to select the best green solvent to extract complex bioactive molecules such as phlorotannins from brown macroalgae Cystoseira abies-marina.

Bioaugmentation and its application in wastewater treatment: A review

Bioaugmentation (the process of adding selected strains/mixed cultures to wastewater reactors to improve the catabolism of specific compounds, e.g. refractory organics, or overall COD) is a promising technique to solve practical problems in wastewater treatment plants, and enhance removal efficiency. The potential of this option can now be enhanced in order to take advantage of important advances in the fields of microbial ecology, molecular biology, immobilization techniques and advanced bioreactor design. Reports on bioaugmentation in WWT show the difficulties in evaluating the potential parameters involved, leading frequently to inconclusive outcomes. Many studies have been carried out on the basis of trial-and-error approaches, and it has been reported that reactors bioaugmented with pure cultures often fail to perform as well as the pure cultures under laboratory conditions. As an interesting technical challenge, the feasibility of bioaugmentation should ultimately be assessed by data from field implementation, and this review highlights several promising areas to explore in the future.

Effect of irrigation and stainless steel drills on dental implant bed heat generation

The objective of this study is assessing the influence of the use of different drill types and external irrigation on heat generation in the bone. In-vitro study to compare two different sequences for implant-bed preparation by means of two stainless steels: precipitation-hardening stainless steel (AISI 420B) (K drills), and martensitic stainless steel (AISI 440) (S drills). Besides, the drilled sequences were realized without irrigation, and with external irrigation by means of normal saline solution at room temperature. The study was realized on bovine ribs using: K without irrigation (KSI) and with irrigation (KCI) and S without irrigation (SSI) and with irrigation (SCI) with five drills for each system. Each drill was used 100 times. Bone temperature was measured with a thermocouple immediately after drilled. Average bone temperature with irrigation was for K drills 17.58±3.32 °C and for S drills 16.66±1.30 °C. Average bone temperature without irrigation was for K drills 23.58±2.94 °C and for S drills 19.41±2.27 °C. Statistically significant differences were found between K without irrigation versus S with irrigation and K with irrigation (p<0.05, Bonferroni correction). Lower temperature variation coefficient throughout the 50 measurements was observed in irrigated groups (K=5.6%, S=5.1% vs. without irrigation groups K=9.4%, S=9.3%). The first K drill generated more heat than the remaining drills. No significant differences were detected among temperature values in any of the analyzed drill groups. Unlike irrigation, drill use and type were observed to have no significant impact on heat generation. The stainless steel AISI 420B presents better mechanical properties and corrosion resistance than AISI440.

Molecular effects of lapatinib in patients with HER2 positive ductal carcinoma in situ

Introduction

Human epidermal growth factor receptor 2 (HER2) amplification is frequent in ductal carcinoma in situ (DCIS) of the breast and is associated with poorly differentiated tumors and adverse prognosis features. This study aimed to determine the molecular effects of the HER2 inhibitor lapatinib in patients with HER2 positive DCIS.

Methods

Patients with HER2 positive DCIS received 1,500 mg daily of lapatinib for four consecutive weeks prior to surgical resection. Magnetic resonance imaging (MRI) was used to determine changes in tumor volume. The molecular effects of lapatinib on HER2 signaling (PI3K/AKT and RAS/MAPK pathways), cell proliferation (Ki67 and p27) and apoptosis (TUNEL) were determined in pre and post-lapatinib treatment samples.

Results

A total of 20 patients were included. Lapatinib was well tolerated with only minor and transient side effects. The agent effectively modulated HER2 signaling decreasing significantly pHER2 and pERK1 expression, together with a decrease in tumor size evaluated by MRI. There was no evidence of changes in Ki67.

Conclusions

Four weeks of neoadjuvant lapatinib in patients with HER2-positive DCIS resulted in inhibition of HER2 and RAS/MAPK signaling pathway.

Trial registration

2008-004492-21 (Registered June 25th 2008).

Electronic supplementary material

The online version of this article (doi:10.1186/bcr3695) contains supplementary material, which is available to authorized users.

Phenolic profile evolution of different ready-to-eat baby-leaf vegetables during storage

Ready-to-eat baby-leaf vegetables market has been growing and offering to consumers convenient, healthy and appealing products, which may contain interesting bioactive compounds. In this work, the composition and the evolution of the phenolic compounds from different baby-leaf vegetables during refrigerated storage was studied. The phenolic compounds were extracted using pressurized liquid extraction (PLE) and the phenolic profile of each sample was analyzed and quantified by using LC-MS and LC-DAD methods, respectively, at the beginning and at the end of a 10-day storage period. The baby-leaf vegetables studied included green lettuce, ruby red lettuce, swiss chard, spinach, pea shoots, watercress, garden cress, mizuna, red mustard, wild rocket and spearmint samples and a total of 203 phenolic compounds were tentatively identified and quantified. The main naturally phenolic compounds identified correspond to glycosylated flavonoids, with exception of green lettuce and spearmint leaves which had a higher content of hydroxycinnamic acids. Quantification of the main compounds showed a 10-fold higher content of total phenolic content of ruby red lettuce (483mgg(-1)) in relation to the other samples, being the lowest values found in the garden cress (12.8mgg(-1)) and wild rocket leaves (8.1mgg(-1)). The total phenolic content only showed a significant change (p<0.05) after storage in the green lettuce (+17.5%), mizuna (+7.8%), red mustard (-23.7%) and spearmint (-13.8%) leaves. Within the different classes of phenolic compounds monitored, the flavonols showed more stable contents than the hydroxycinnamic and hydroxybenzoic acids, although the behavior of each compound varied strongly among samples.

Enrichment of antioxidant compounds from lemon balm (Melissa officinalis) by pressurized liquid extraction and enzyme-assisted extraction

In this work enzyme-assisted extraction (EAE) and pressurized liquid extraction (PLE) are applied for extraction of natural compounds from lemon balm (Melissa officinalis). Cellulase, endo-β-1,4 xylanase and pectinase were studied in order to degrade cell wall of lemon balm leaves and to release phenolic compounds. On the other hand, in order to compare the performance obtained with EAE, PLE using water and ethanol was employed maintaining 150°C as extraction temperature. The obtained extracts were characterized in terms of antioxidant capacity by using DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging and trolox equivalent antioxidant capacity (TEAC) in vitro assays, whereas the Folin-Ciocalteu procedure was employed to estimate the total phenols content. On the other hand, extracts were chemically characterized by liquid chromatography tandem mass spectrometry (LC-MS/MS). The results showed that EAE enhanced the total phenolic content and the antioxidant capacity compared to a non-enzymatic control. PLE extracts presented higher amount of phenols and antioxidant capacity than enzyme-assisted extracts, reaching the highest values on water extracts (193.18mggallicacid/gextract and EC50=6.81μg/mL). Among the bioactive phenolic compounds identified in lemon balm, rosmarinic acid was the main component, although other important compounds were also identified, such as caffeic acid derivatives (salvianolic acids, lithospermic acid) and rosmarinic acid derivatives (rosmarinic acid hexoside, sagerinic acid, sulfated rosmarinic acid). The present study confirms that EAE and PLE can be considered alternative methods for the extraction of natural compounds with biological activity from natural sources.

Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people

BACKGROUND

The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms.

METHODS

We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed.

RESULTS

Overall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy.

CONCLUSIONS

Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.

Abstract P5-18-15: Molecular effects of lapatinib in HER2 positive ductal carcinoma in situ (DCIS)

Background: HER2 amplification is frequent in DCIS and is associated with poor prognosis features. This study aimed to determine the molecular effects in Ras/Raf/MAK and PI3K/AKT signaling pathway of the HER2 inhibitor lapatinib in patients with HER2 positive DCIS as well as correlation with radiological and pathological response.

Patients and Methods: Patients (pts) with HER2 positive DCIS received 1500 mg daily of lapatinib for 4 consecutive weeks prior to surgical resection. Changes in tumor volume were evaluated by MRI. The molecular effects of lapatinib on apoptotic level (TUNEL), cell proliferation (Ki67) and HER2 signaling pathway were determined in pre and post-treatment tumor biopsies.

Results: A total of 20 pts were included. Lapatinib was well tolerated with only minor and transient side effects reported. The agent effectively modulated HER2 signaling by affecting cell cycle kinetics through decreasing cytoplasm pERK1 in 11 pts with no change or slight increase activation in 5 pts. Of those 11 pts: eight had parallel inactivation of pHER2, two pts had paradoxical activation of pAkt and three pts had an increase in apoptotic level. In addition, seven pts also presented with decrease in MRI signal intensity and tumor size.

Conclusions: Four weeks of lapatinib for patients with HER2-positive DCIS result in significant antiproliferative changes through RAS/MAPK signaling pathway together with a decrease in MRI signal.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-18-15.

Abstract P1-14-10: Final results of neoadjuvant trial of bevacizumab (B) and trastuzumab (T) in combination with weekly paclitaxel (P) as neoadjuvant treatment in HER2-positive breast cancer: A phase II trial (AVANTHER)

Background: B in combination with T has shown meaningful activity in patients (pts) with metastatic HER2-positive breast cancer. Pathological complete response (pCR) was defined as the absence of invasive disease at the time of histological study and there is a relationship between pCR and disease-free survival (DFS) and overall survival (OS). The complete pathological response rate is between 9 to 34% of patients receiving primary treatment prior to surgery with chemotherapy and when the Herceptin was administrated, a pCR of 39% was reached.

AVANTHER is a Phase II trial of preoperative systemic therapy combining B with T and P in a weekly regimen in HER2 positive breast cancer to assess safety and efficacy of the combination.

Methods: Pts with centrally-confirmed HER2− positive (IHC 3+ or FISH positive) breast cancer (stage II or III including locally advanced) received neoadjuvant chemotherapy (NC) with weekly P (80mg/m2/week) for 12 weeks in combination with weekly T (4mg/kg loading dose and 2 mg/kg maintenance) and B (15mg/kg every 3 weeks) for 4 cycles. After surgery all pts received T (1 year) and liposomal doxorubicin plus cyclophosphamide every 3 weeks (4 cycles); primary endpoint was rate of pathological complete response (pCR) in breast and axilla. For all patients, a tissue sample at baseline as well as at surgery was collected for biomarker analyses.

Results: A total of 44 pts have been enrolled. Median tumor size: 3.9 cm. Nine (21%) pts had stage IIA; 19 (45%) stage IIB; 10 (24%) stage IIIA and 4 (10%) stage IIIB. Twenty-nine (69%) pts had estrogen positive receptors.

Data from surgery of 42 patients from a total of 44 patients enrolled were presented in this abstract, but the final results will be present in the symposium. pCR was achieved in 18 (42.9%) pts. Safety and tolerability were good, with rare adverse events of grade 3 [1 (2.4%) episode of severe hypertension, 1 (2,4%) mucosal inflammation].

We presented the results of relationship between magnetic resonance imaging (MRI) and pCR that is one of the secondary objectives of the study.

100% of the patients without pathologic response had stable disease at resonance imaging. Of all patients who had pCR only 55.6% had complete radiological response.

Conclusions: These data show that the combination of P with T and B without an anthracycline for 12 weeks is very effective as NC in HER2 positive breast cancer pts with a high rate of pCR and minimal side effects.

And the MRI is useful for identifying the persistence of residual disease however it only predicts half of the complete pathological responses

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-10.

Neoadjuvant bevacizumab (B) and trastuzumab (T) in combination with weekly paclitaxel (P) as neoadjuvant treatment in HER2-positive breast cancer: Results from a phase II trial (AVANTHER)

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Background: B in combination with T has showed meaningful activity in patients (pts) with metastatic HER2-positive breast cancer. AVANTHER is a Phase II trial of preoperative systemic therapy combining B with T and P in a weekly regimen in HER2 positive breast cancer to assess safety and efficacy of the combination. Methods: Pts with centrally-confirmed HER2-positive (IHC 3+ or FISH positive) breast cancer (stage II or III including locally advanced) received neoadjuvant chemotherapy (NC) with weekly P (80mg/m2/week) for 12 weeks in combination with weekly T (4mg/kg loading dose and 2 mg/kg maintenance) and B (15mg/kg every 3 weeks) for 4 cycles. After surgery all pts received T (1 year) and liposomal doxorubicin plus cyclophosphamide every 3 weeks (4 cycles); primary endpoint was rate of pathological complete response (pCR) in breast and axilla. For all patients, a tissue sample at baseline as well as at surgery was collected for biomarker analyses. Results: A total of 44 pts have been enrolled. Median tumor size: 3.9 cm. Seven (19.4%) pts had stage IIA; 17 (47.2%) stage IIB; 8 (22.2%) stage IIIA and 4 (11.1%) stage IIIB. Twenty-one (58.3%) pts had both positive-hormonal receptors and 10 (27.8%) were hormone receptor negative. Eight (22.2%) pts had sentinel biopsy before NC, being negative in 6 (16.7%) cases. Data from surgery (only from 36 pts): pCR was achieved in 16 (44.4%) pts. Safety and tolerability were good, with rare adverse events of grade ≥3 [1 (2.8%) episode of severe hypertension]. Conclusions: These data show that the combination of P with T and B without an anthracycline for 12 weeks is very effective as NC in HER2 positive breast cancer pts with a high rate of pCR and minimal side effects.

Relationship between positive sentinel node (SN) and micrometastases (mMTS) or isolated tumor cells (ITC) with breast tumor pathological features

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Background: Aim:To study the relation of positive(pos) SN and mMTS or ITC in negative(neg) SN at surgery with tumor pathological(pathol) features (grade;carcinoma type;Ki67;Her2;hormonal status;tumor size). Methods: Cohort of 271 patients with clinically and ultrasonographically node-neg pT1-2 breast cancer and high grade or extended intraductal who received breast cancer surgery with SN biopsy alone in the last 2 years was studied. No previous chemotherapy was administered. Hormone(ER/RP) and Ki67 status were analyzed by inmunohistochemistry(IHC) while HER2 by FISH. Presence of mMTS and ITC were studied by IHC(AE1-AE3). Statistical analysis was conducted to ascertain significant relation among pos-SN or detection of mMTS/ITC in neg-SN and each of the tumor pathol features (test U-Mann-Whitney). Results: Data from 263 patients were analyzed (28 pos-SN;235 neg-SN;8 technique failures). Carcinoma type: Ductal (158;60%);lobular (46;17.5%);in-situ(53;20.2%);others(6;2.3%). Infiltrative cancer:(56% grade 2;20% grade 3;10% Her2+;9% triple-neg;81% pos-RE/RP). In-situ:(28% grade 2;64% grade 3;39% Her2+;55% pos-RE/RP). Mean pathological size 16.2mm(1-118) for infiltrative tumor and 20.1mm(1-90) for in-situ. Mean of SN found at surgery 1.98(1-5). In neg-SN, 35 cases with mMTS(14;6.2%) or ITC(21;9.2%) were found. No statistically significant relation was established between the finding of mMTS or ITC and any of the pathol features at in-situ or infiltrative tumors. In pos-SN a statistically significant relation between pos-SN and pathol size was found (p=0.003; mean pathol size 20.16mm and 15.69mm for pos and neg-SN). Conclusions: A significant relation was established with pathol size and pos-SN. In patients with neg-SN no significant relationship was found between detection of mMTS or ITC and the pathol features of the tumor.

Sequential determination of fat- and water-soluble vitamins in green leafy vegetables during storage

The simultaneous analysis of fat- and water-soluble vitamins from foods is a difficult task considering the wide range of chemical structures involved. In this work, a new procedure based on a sequential extraction and analysis of both types of vitamins is presented. The procedure couples several simple extraction steps to LC-MS/MS and LC-DAD in order to quantify the free vitamins contents in fresh-cut vegetables before and after a 10-days storage period. The developed method allows the correct quantification of vitamins C, B(1), B(2), B(3), B(5), B(6), B(9), E and provitamin A in ready-to-eat green leafy vegetable products including green lettuce, ruby red lettuce, watercress, swiss chard, lamb's lettuce, spearmint, spinach, wild rocket, pea leaves, mizuna, garden cress and red mustard. Using this optimized methodology, low LOQs were attained for the analyzed vitamins in less than 100 min, including extraction and vitamin analysis using 2 optimized procedures; good repeatability and linearity was achieved for all vitamins studied, while recoveries ranged from 83% to 105%. The most abundant free vitamins found in leafy vegetable products were vitamin C, provitamin A and vitamin E. The richest sample on vitamin C and provitamin A was pea leaves (154 mg/g fresh weight and 14.4 mg/100g fresh weight, respectively), whereas lamb's lettuce was the vegetable with the highest content on vitamin E (3.1 mg/100 g fresh weight). Generally, some losses of vitamins were detected after storage, although the behavior of each vitamin varied strongly among samples.