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When attacked by insect herbivores, plants emit blends of chemical compounds known as herbivore‐induced plant volatiles (HIPVs). Although HIPVs are produced both aboveground and belowground, how HIPVs vary across plant tissues remains unresolved, as do the selective forces shaping interspecific HIPV emission patterns. Here, we compared foliar and root HIPVs within and among closely related plant species and evaluated if different eco‐evolutionary forces, including plant domestication, coexistence histories with herbivores, or phylogenetic relatedness, explain HIPV blends. To examine aboveground and belowground patterns in HIPVs, we compared leaf and root volatile profiles for six species in the Cucurbitaceae that differed in domestication status and coexistence history with specialist insect herbivores. We predicted that within‐species HIPVs from different tissues would be more similar than HIPV blends among different species, and that plant volatile chemodiversity was reduced by domestication and enhanced by coexistence histories with herbivores. We found that herbivory induced both quantitative and qualitative changes in volatile emissions across all plant species, which were more pronounced aboveground than belowground. Each species produced tissue‐specific HIPVs, and foliar and root HIPVs differed among species. Contrary to our predictions, plant domestication enhanced foliar volatile diversity, while coexistence histories with herbivores reduced foliar and root volatile diversity. Additionally, phylogenetic relatedness did not correlate with aboveground or belowground volatiles. Overall, this work furthers our understanding of the eco‐evolutionary forces driving patterns in aboveground and belowground HIPV emissions, elucidating an important and previously undescribed component of within‐plant variation in chemodiversity. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop, validate and compare the performance of models predicting post-treatment outcomes for depressed adults based on pre-treatment data. Methods: Individual patient data from all six eligible randomised controlled trials were used to develop (k = 3, n = 1722) and test (k = 3, n = 918) nine models. Predictors included depressive and anxiety symptoms, social support, life events and alcohol use. Weighted sum scores were developed using coefficient weights derived from network centrality statistics (models 1–3) and factor loadings from a confirmatory factor analysis (model 4). Unweighted sum score models were tested using elastic net regularised (ENR) and ordinary least squares (OLS) regression (models 5 and 6). Individual items were then included in ENR and OLS (models 7 and 8). All models were compared to one another and to a null model (mean post-baseline Beck Depression Inventory Second Edition (BDI-II) score in the training data: model 9). Primary outcome: BDI-II scores at 3–4 months. Results: Models 1–7 all outperformed the null model and model 8. Model performance was very similar across models 1–6, meaning that differential weights applied to the baseline sum scores had little impact. Conclusions: Any of the modelling techniques (models 1–7) could be used to inform prognostic predictions for depressed adults with differences in the proportions of patients reaching remission based on the predicted severity of depressive symptoms post-treatment. However, the majority of variance in prognosis remained unexplained. It may be necessary to include a broader range of biopsychosocial variables to better adjudicate between competing models, and to derive models with greater clinical utility for treatment-seeking adults with depression. [ABSTRACT FROM AUTHOR]

We present STEREO observations within 1500 proton gyroradii of 12 quasiperpendicular interplanetary shocks, with long-duration burst mode electric field acquisition by S/WAVES enabling observation of the evolution of waves throughout the entire ramp of interplanetary shocks. The shocks are low Mach number (Mf ∼ 1–5), with beta (β) ∼0.2–1.8. High variability in frequency, amplitude, and wave mode is observed upstream, downstream, and in shock ramps. Observations in every region include ion acoustic-like waves, electron cyclotron drift instability (ECDI) driven waves, electrostatic solitary waves, and high frequency whistler mode waves. We also show for the first time the existence of electrostatic waves with frequencies in the ion acoustic range, which are frequency dispersed in time and the first observations of ECDI-driven waves at interplanetary shocks. The waves are bursty, large amplitude (∼5–>200 mV m−1), and seen in all three regions. All wave modes are more commonly observed downstream than upstream. [ABSTRACT FROM AUTHOR]

Not for resuscitation (NFR) orders are often suspended during anaesthesia, as perioperative care is believed to inherently involve the need for resuscitation including ventilation support. Recent legislative changes in Australia, New Zealand and the UK have enacted the binding nature of advance care directives (ACDs) in healthcare. National guidelines regarding codes of practice and government strategic plans for implementing advance care planning have reinforced the role for advance care planning in modern healthcare. We surveyed a random selection of Australian and New Zealand consultant and trainee anaesthetists to assess their attitudes towards NFR orders and ACDs in the perioperative setting. We received 290 of 790 distributed surveys (37% response rate). The majority (75%) of respondents reported their knowledge as very low, low, or moderate; 37% never or rarely were treating a patient who had an ACD. Over 90% reported that patient's wishes and understanding of ACDs is important and 89% agreed or strongly agreed that advance care planning should be a routine part of hospital admission for high risk patients. Despite this, only 45% of the respondents would always follow an ACD. Although the majority of respondents to this survey support their use in the perioperative setting, clarification of the specific applicability of ACDs to anaesthesia and their binding nature is required. [ABSTRACT FROM AUTHOR]

Background The most common indications for surgery for patients with ileocolic Crohn's disease are fibrostenotic or perforating disease. The objective was to compare surgical outcomes of patients with perforating versus non-perforating disease following ileocolic resection. Methods This was a retrospective review of all patients who had their first ileocolic resection between 1990 and 2010, identified from a prospectively maintained inflammatory bowel disease database. Demographic information, preoperative medication, intraoperative findings and postoperative outcome data were collected. Outcomes in patients who had an abscess drained before surgery or were found to have a fistula or abscess at surgery or at pathology were compared with outcomes in all others. Results A total of 434 patients (56·2 per cent women) were included, 293 with perforating and 141 with non-perforating disease. Median age, tobacco use, and preoperative steroid and biological agent use were similar in the two groups. Forty patients (13·7 per cent) in the perforating group had abscesses drained before surgery and 251 patients had at least one fistula, most commonly to the sigmoid colon. Patients with perforating disease were more likely to require preoperative total parenteral nutrition, need another resection, have an ileostomy and a longer mean postoperative stay, and less likely to undergo a laparoscopic procedure. Patients in this group also developed more postoperative abscesses or leaks (4·8 versus 0 per cent; P = 0·006). The reoperation rate was similar (3·1 versus 0·7 per cent; P = 0·178). Conclusion Patients with penetrating Crohn's disease are more likely to require a more complex procedure, and an ileostomy, and to a have longer postoperative stay. [ABSTRACT FROM AUTHOR]

Background:Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) was recently extensively studied as a candidate gene for obesity phenotypes. As the human homologue of the mouse progressive ankylosis (ANKH) and alkaline phosphatase (ALPL) are known functional partners of ENPP1 in bone mineralization, we hypothesized that these genes may also be jointly involved in determining obesity features.Aim:To examine the effects of the three genes, possible gene–sex and gene–gene interactions on variability of four obesity phenotypes: the body mass index (BMI), the waist–hip ratio (WHR), the epidermal growth factor receptor (EGFR), and leptin.Subjects and methods:In all, 962 healthy individuals from 230 families were genotyped for 45 single nucleotide polymorphisms (SNPs). The association analysis was performed using two family based association tests (family based association test and pedigree disequilibrium test). The combined P-values of the two tests were estimated by Monte-Carlo simulations. Relative magnitude of the genetic and familial effects, gene–sex and gene–gene interactions were assessed using variance component models.Results:Associations were observed between ENPP1 polymorphisms and BMI (P=0.0037) and leptin (P=0.0068). ALPL markers were associated with WHR (P=0.0026) and EGFR (P=0.0001). The ANKH gene was associated with all four studied obesity-related traits (P<0.0184), and its effects were modulated by sex. Gene–gene interactions were not detected.Conclusion:The observed pattern of association signals indicates that ANKH may have a generalized effect on adipose tissue physiology, whereas ENPP1 and ALPL affect distinct obesity features. The joint analysis of related genes and integration of the results obtained by different methods used in this research should benefit other studies of similar design. [ABSTRACT FROM AUTHOR]

Elevated levels of extrachromosomal circular DNA (eccDNA or spcDNA) are closely associated with genomic instability and aging. Despite extensive studies, the mechanism of its generation in mammalian cells is unknown. We report here that mouse major satellite DNA (MSD) is prone to eccDNA formation and that the resulting molecules are multimeres of the basic repeat. Extrachromosomal circular major satellite (ECMS) DNA constitutes the majority of eccDNA in B16 mouse melanoma cells and is highly abundant in other mouse cells. Production of these molecules is enhanced in proliferating cells, suggesting that processes associated with DNA replication are involved in their appearance. Using siRNA technique we show that DNA Ligase IV is engaged in ECMS synthesis. Based on our findings we propose a novel two-step model for eccDNA formation in mammalian cells.Oncogene (2006) 25, 4515–4524. doi:10.1038/sj.onc.1209485; published online 20 March 2006 [ABSTRACT FROM AUTHOR]

Abstract: Two trials were conducted to determine the effect of dietary enrichment with arachidonic acid (ARA)-rich triacylglycerols fraction, obtained from the microalga Parietochloris incisa, on the recovery of guppies, Poecilia reticulata, from infection with Tetrahymena sp. Commercial feed (0.7 mg ARA g−1 feed) was directly enriched with the algal hexane lipid extract. Three (12.5, 25.0, 50.0 mg ARA g−1 feed) and four (12.5, 25.0, 37.5, 50.0 mg ARA g−1 feed) experimental diets were utilized in the first and second trials, respectively. Guppies were fed with ARA-supplemented feed for 14 days followed by infection with 1000 Tetrahymena sp. cells mL−1. Supplemented diets significantly altered the fatty acid composition in fish body (whole body with the exception of the digestive tract and liver) and liver. The share of ARA in fatty acids of bodies and livers increased commensurately with the amount of ARA in feed. Livers accumulated the highest levels of ARA, resulting in drastic changes in the docosahexaenoic acid (DHA)/ARA and eicosapentaenoic acid (EPA)/ARA ratios. Feeding with an algal extract that produced an ARA concentration in feed of 25 mg g−1 significantly enhanced the ability of fish to recover from the disease in both experiments, as compared to the control and feed supplemented with 12.5 mg g−1of ARA. Although not significantly different, further increase in fed ARA (50 mg g−1 feed) reduced the recovery as compared to the 25 mg g−1 treatment. [Copyright &y& Elsevier]

Endothelial monolayers were prepared from neonatal heart or liver tissue of Lewis (Le) rats. Cells in their first passage of culture were used to investigate the short-term (1 hr at 37°) binding of 51Cr-labelled Le rat lymphocytes prepared from the mesenteric lymph node (MLN), peripheral lymph node (PLN) or Peyer's patches (PP) to those endothelia, or the activation by concanavalin A (Con A) or irradiated (Lewis x Brown Norway)F1 (LBNF1), of Le cells on the monolayers after 84 hr in culture. MLN and PP showed preferential binding to, and activation on, liver endothelium compared with heart endothelium (approximately twofold difference), while the converse was seen with PLN. No inhibition of binding was seen with antibodies to intracellular adhesion molecule-1 (ICAM-1) or lymphocyte function-associated antigen-1 (LFA-1). Preincubation of endothelial cells with plasma isolated from the portal or hepatic vein of normal adult mice (5% plasma, 37° for 14 hr) caused a 1·5-2-fold stimulation of binding of MLN/PP to heart endothelium, which was inhibited (≥75%) by anti-ICAM-1 or anti-LFA-1, and a fourfold stimulation of binding to liver endothelium, which was not inhibited by these monoclonal antibodies (

Examines the fecal impaction of children after eating seeds of Opuntia ficus indica. Signs and symptoms of fecal impaction; Diagnosis; Treatment.

Dietary enrichments with the arachidonic acid (ARA)-rich microalga, Parietochloris incisa, on the survival of guppy ( Poecilia reticulata) fry were examined. Diets were applied via Artemia enrichment to fish from two commercial farms for 34 and 36 days of experimental period (trials 1 and 2, respectively). In trial 1, Artemia nauplii were enriched with dry biomass of whole algal cells at 0 (control), 0.1, 0.2 and 0.4 mg mL−1. Fry fed with Artemia enriched with 0.4 mg mL−1 demonstrated the lowest mortality rates (24% and 1% in farms 1 and 2, respectively) compared with controls (36% and 13% in farms 1 and 2, respectively). In trial 2, fry were fed with Artemia, enriched with whole algal cells (0.4 mg ml−1), algal hexane extract (HE; containing primarily ARA-rich triacylglycerols and β-carotene; 0.19 mg ml−1) or the extraction residue (0.28 mg ml−1). Acute stress (5 min air exposure) was applied after 18 days. The lowest mortality was recorded in the whole alga-fed group (av. 26% and 2.6% in farms 1 and 2, respectively), with a slightly, but not significantly higher mortality in the HE-fed group (av. 29% and 6.2% in farms 1 and 2, respectively). Elevated lysozyme was associated with the reduced mortality. Overall, the use of P. incisa as a dietary supplement for guppy fry during their first month of life enhanced their survival and stress resistance. [ABSTRACT FROM AUTHOR]

Objective: Selection of the optimal treatment strategy for patients with rectal cancer requires appropriate investigation, but published guidelines provide no clear consensus. We examined the current practice pattern for the investigation of primary rectal cancer by general surgeons in the province of Ontario, Canada. Methods: A telephone interview was completed by 124 surgeons in Ontario who manage patients with rectal cancer, who indicated the investigations they routinely perform in assessment before treatment. An exploratory cluster analysis was used to identify surgeon-related variables that predicted the pattern of investigation; these were tested in univariate and multivariate analyses. Results: Cluster analysis identified 3 distinct groups of surgeons based on patterns of test usage. Univariate analysis showed that the use of chest radiography, computed tomography of the abdomen and pelvis, and ultrasound of the abdomen varied significantly with the surgeon's subspecialty training, practice location and years in practice. Regression analysis confirmed that each of these 3 variables independently predicted the pattern of preoperative investigation. There were no significant predictors of the use of colonoscopy, sigmoidoscopy or carcinoembryonic antigen level. Over half of surgeons reported that they would have ordered additional imaging tests but did not because of lack of availability. The perceived desirability of additional tests, endorectal ultrasound in particular, varied with training. Conclusions: The current practice pattern for the preoperative investigation of primary rectal cancer by general surgeons varies significantly with specific surgeon-related variables, with potential impact on the management and outcome of patients with rectal cancer. [ABSTRACT FROM AUTHOR]

This paper examines the safety and feasibility of providing short-term, in-home total parenteral nutrition (TPN) for patients with inflammatory bowel disease (IBD) for whom the alternative is prolonged hospitalization or early surgery. The records of all patients with IBD who were receiving temporary home TPN between June 1996 and July 2000 were reviewed. A quality-of-life phone interview was conducted at the time of review. Fifteen patients (11 men and 4 women) were identified whose average age was 35 years. The underlying diagnosis was Crohn''s disease in 10 and ulcerative colitis in five. The indications for home TPN were complex internal fistulas and resolving sepsis in two, postoperative septic complications (anastomotic leak/enterocutaneous fistula) in five, high-output proximal stomas in four, prolonged ileus/partial obstruction in three, and spontaneous enterocutaneous fistula in one. The average duration of home TPN was 75 days (range 7 to 240 days). Two patients (13%) failed home TPN (1 with uncontrolled sepsis; 1 with dehydration) and were readmitted to the hospital. Home TPN was discontinued in one patient whose enterocutaneous fistula failed to heal with nonoperative treatment. Home TPN was successful in 12 patients (80%): eight (53%) who underwent planned definitive surgery and four (27%) whose conditions resolved without surgery. Complications of home TPN were line sepsis and pulmonary aspergillosis in one patient. All patients preferred home TPN to further hospitalization and reported good or excellent quality of life at home. Home TPN is a safe alternative to prolonged hospitalization or early surgery in patients with complicated IBD. (J Gastrointest Surg 2003;7:562–566.) [Copyright &y& Elsevier]

The "Acceleration, Reconnection, Turbulence and Electrodynamics of the Moon's Interaction with the Sun" mission provides a unique opportunity to study the structure of interplanetary shocks and the associated generation of plasma waves with frequencies between ∼50 and 8000 Hz due to its long duration electric and magnetic field burst waveform captures. We compare wave properties and occurrence rates at 11 quasi-perpendicular interplanetary shocks with burst data within 10 minutes (∼3200 proton gyroradii upstream, ∼1900 downstream) of the shock ramp. A perturbed shock is defined as possessing a large amplitude whistler precursor in the quasi-static magnetic field with an amplitude greater than 1/3 the difference between the upstream and downstream average magnetic field magnitudes; laminar shocks lack these large precursors and have a smooth, step function-like transition. In addition to wave modes previously observed, including ion acoustic, whistler, and electrostatic solitary waves, waves in the ion acoustic frequency range that show rapid temporal frequency change are common. Three shocks had burst captures in the ramp; of these, the two laminar shocks contained a wide range of large amplitude wave modes in the ramp whereas the one perturbed shock contained no such waves. Thus, energy dissipation through wave–particle interactions is more prominent in these two laminar shocks than in the perturbed shock. Based on observations from all 11 shocks, the wave occurrence rates for laminar shocks are higher in the transition region, especially the ramp, than downstream. In contrast, perturbed shocks have approximately 2–3 times the wave occurrence rate downstream than laminar shocks. [ABSTRACT FROM AUTHOR]

Background: Depression is commonly perceived as a single underlying disease with a number of potential treatment options. However, patients with major depression differ dramatically in their symptom presentation and comorbidities, e.g. with anxiety disorders. There are also large variations in treatment outcomes and associations of some anxiety comorbidities with poorer prognoses, but limited understanding as to why, and little information to inform the clinical management of depression. There is a need to improve our understanding of depression, incorporating anxiety comorbidity, and consider the association of a wide range of symptoms with treatment outcomes.Method: Individual patient data from six RCTs of depressed patients (total n = 2858) were used to estimate the differential impact symptoms have on outcomes at three post intervention time points using individual items and sum scores. Symptom networks (graphical Gaussian model) were estimated to explore the functional relations among symptoms of depression and anxiety and compare networks for treatment remitters and those with persistent symptoms to identify potential prognostic indicators.Results: Item-level prediction performed similarly to sum scores when predicting outcomes at 3 to 4 months and 6 to 8 months, but outperformed sum scores for 9 to 12 months. Pessimism emerged as the most important predictive symptom (relative to all other symptoms), across these time points. In the network structure at study entry, symptoms clustered into physical symptoms, cognitive symptoms, and anxiety symptoms. Sadness, pessimism, and indecision acted as bridges between communities, with sadness and failure/worthlessness being the most central (i.e. interconnected) symptoms. Connectivity of networks at study entry did not differ for future remitters vs. those with persistent symptoms.Conclusion: The relative importance of specific symptoms in association with outcomes and the interactions within the network highlight the value of transdiagnostic assessment and formulation of symptoms to both treatment and prognosis. We discuss the potential for complementary statistical approaches to improve our understanding of psychopathology. [ABSTRACT FROM AUTHOR]

Background CDH1 pathogenic variants (pvs) cause most cases of inherited diffuse gastric cancer (dgc), but have low detection rates and vary geographically. In the present study, we examined hereditary causes of dgc in patients in Ontario. Methods CDH1 testing through single-site or multi-gene panels was conducted for patients with dgc meeting the 2015 International Gastric Cancer Linkage Consortium (igclc) criteria, or with isolated dgc at less than 50 years of age, or with a strong family history of cancer identified at the Zane Cohen Centre (zcc). All CDH1-positive patients at zcc, regardless of cancer history, were summarized. Results In 15 of 85 patients with dgc (17.6%), a pv or likely pv was identified through CDH1 single-site (n = 43) or multi-gene panel (n = 42) testing. The detection rate was 9.4% overall (8 of 85) and 11% using igclc criteria (7 of 65). No CDH1 pvs were identified in patients with isolated dgc at less than 40 years of age, but 1 pv was identified in a patient with isolated dgc at less than 50 years of age. Multi-gene panels identified 9 pvs (21.4%), including CDH1, STK11, ATM, BRCA2, MLH1, and MSH2. Review of 81 CDH1 carriers identified 10% with dgc (median age: 48 years; range: 38-59 years); 41% were unaffected (median age: 53 years; range: 26-89 years). Observed malignancies other than dgc or lobular breast cancer (lbc) included colorectal, gynecologic, kidney or bladder, prostate, testicular, and ductal breast cancers. Lobular-breast cancer was seen only in 3 families. Conclusions In Ontario, the detection rate of CDH1 pvs in patients with dgc was low: no pvs were identified in patients with isolated dgc at less than 40 years of age, and 1 was identified in a patient with isolated dgc at less than 50 years of age. Isolated lbc with no dgc was observed in CDH1-positive families, as were pathology-confirmed nondgc or non-lbc malignancies, which had not previously been reported. Given a phenotype that overlaps with other hereditary conditions, multi-gene panels are recommended for all patients with dgc at less than 50 years of age and for those meeting igclc criteria. [ABSTRACT FROM AUTHOR]

Background: We aimed to summarize the outcomes of ulcerative colitis (UC) patients receiving an ileal pouch-anal anastamosis (IPAA) over an 11-year period at a high-volume Canadian inflammatory bowel disease (IBD) center. Methods: A retrospective chart review was performed for subjects with UC who underwent IPAA between 2002 and 2013. Patient charts were reviewed for demographic data, clinical characteristics, preoperative medical treatment, and surgical outcomes. Univariate and multivariate logistic regression modeling were used to determine significant factors in postoperative outcomes. Results: Seven hundred fifty-eight were included from the IBD database. The median age at the time of surgery was 37.1 (±12.1). Mean preoperative disease duration was 8.1 years (±8.7). Three hundred sixty-nine patients (48.7 %) had systemic corticosteroids (>15 mg/day) within 30 days prior to surgery. Of these, 286 patients had high dose (>30 mg/day) corticosteroids within 7 days of their first surgery. One hundred nine (14.0 %) IPAA procedures were performed laparoscopically. Pelvic pouches were created in traditional 2 ( n = 460) and 3 ( n = 285) stages; the remainder ( n = 13) was performed in non-traditional staged operations. Early complications, defined as occurring within the same stay in hospital, consisted of pelvic abscess ( n = 135, 17.8 %), small bowel obstruction ( n = 134, 17.7 %), wound infection ( n = 108, 14.3 %), and deep vein thrombosis ( n = 33, 4.4 %). The overall pouch leak rate was 92 (12.1 %). There was one death in our study. The median length of stay was 10.3 days (SD6.0). Late complications, defined as occurring after discharge from hospital, consisted of anal stricture ( n = 55, 7.3 %), pouch fistula ( n = 26, 3.4 %), and functional pouch failure ( n = 7, 0.9 %). Conclusions: IPAA has been found to be a safe and effective method of surgical management of UC patients in a high-volume IBD center. [ABSTRACT FROM AUTHOR]

Describes a case of a gastric trichobezoar presenting as abdominal mass in an eight-year-old girl. Diagnosis; Surgical removal of the trichobezoar; Association of gastric trichobezoars with psychiatric disorders.

Aim Curing complex anal fistula without compromising continence can be extremely challenging. This study investigated the healing rate, continence and quality of life of patients after treatment of complex anal fistula of cryptoglandular origin with a bioprosthetic plug. Method Consecutive patients were prospectively followed in four referral centres. Following seton conditioning, a bioprosthetic plug was inserted into the fistula and sutured to the anal sphincter. Clinical evaluation was performed at 10 days, 6 weeks and 6 months after surgery, and was completed by telephone interviews. Anal continence and quality of life were evaluated using the Fecal Incontinence Score Index and the Short Form-36 Health Survey, version 2 ( SF-36 v2) questionnaire. Results Forty-six patients presenting with a complex anal fistula and a median of three previous fistula surgeries were included. The 6-month recurrence rate was 30.7% (95% CI: 15.9-42.8%), increasing to 48.0% (95% CI: 30.6-61.1%) after 2 years. Follow up was continued for a median of 68.1 months, and 26 (56.5%) recurrences were identified. Anal continence improved from a median of 19 points to 12 points at 6 months of follow up ( P = 0.008). Quality of life markedly improved in all scales. The physical summary score increased from 47.2 to 56.2 ( P < 0.001), and the mental summary score increased from 48.5 to 55.3 ( P = 0.013). Conclusion The bioprosthetic fistula plug demonstrated a healing rate close to 50% in complex cryptoglandular fistula. Also, it markedly improved anal continence and quality of life. These data support the use of a bioprosthetic plug as first-line therapy for complex fistula instead of more aggressive and potentially debilitating surgical options. [ABSTRACT FROM AUTHOR]

At a consensus meeting held in Montreal, October 28, 2011, a multidisciplinary group of Canadian experts in the fields of genetics, gastroenterology, surgery, oncology, pathology, and health care services participated in presentation and discussion sessions for the purpose of developing consensus statements pertaining to the development and maintenance of hereditary colorectal cancer registries in Canada. Five statements were approved by all participants. [ABSTRACT FROM AUTHOR]

We compared nerve blockade with and without the InfinitiTM needle guide in an ultrasound in-plane porcine simulation. We recruited 30 anaesthetists with varying blockade experience. Using the guide, the needle tip was more visible (for a median (IQR [range]) of 67 (56-100]) % of the time; and invisible for 2 (1-4 [0-19]) s) than when the guide was not used (respectively 23 (13-43 [0-80]) % and 25 (9-52 [1-198]) s; both p < 0.001). The corresponding block times were 8 (6-10 [3-28]) s and 32 (15-67 [5-225]) s, respectively; p < 0.001. The needle guide reduced the block time and the time that the needle was invisible, irrespective of anaesthetist experience. [ABSTRACT FROM AUTHOR]

Background: We sought to assess the feasibility of applying Cancer Care Ontario's quality of care indicators to a single institution's colorectal cancer (CRC) database. We also sought to assess their utility in identifying areas that require improvement.Methods: We included patients who had surgery for CRC between 1997 and 2006 at Mount Sinai Hospital, Toronto, Ont. We excluded patients who had transanal excisions, carcinoma in situ or recurrences that required pelvic exenteration, as well as those whose information was incomplete. We obtained data from a prospective database and verified the data with hospital and office charts. We evaluated trends over a 10-year period using the Cochran-Armitage trend test.Results: During the study period there were 1005 surgical procedures performed in 987 patients with a mean age of 65.6 (standard deviation 15) years; the male:female ratio was 1:2. The most frequent tumour sites were the rectum and sigmoid colon (68%). Over the 10-year period, 9 indicators improved, including the proportion of patients with CRC identified by screening (p < 0.001), the proportion of patients who received preoperative liver imaging (p = 0.05), the proportion of rectal cancer patients who received preoperative pelvic imaging (p = 0.04), the proportion of patients with stage II or III rectal cancer who received radiotherapy (p = 0.03), the proportion of surgical specimens with more than 12 lymph nodes (p < 0.001), the proportion of pathology reports that included quantitative distal (p = 0.004) and radial (p < 0.001) margin measurements, the proportion of patients with an anastomotic leak (p = 0.03), the proportion of patients who received a colonoscopy 1 year after surgery (p < 0.001) and the proportion of operative reports that were complete (p < 0.001).Conclusion: The use of quality of care indicators to assess the quality of colorectal surgery is feasible. This study provides benchmarks that can be used to assess changes in the quality of CRC care at our institution. [ABSTRACT FROM AUTHOR]

The changes in pigment content and composition of the unicellular alga Parietochloris incisa comb. nov (Trebouxiophyceae, Chlorophyta) were studied. This alga is unique in its ability to accumulate high amounts of arachidonic acid in the cell during cultivation under different irradiances and nitrogen availability in the medium. Under low irradiance of 35 μE/(m2 s) photosynthetically active radiation the P. incisa cultures possessed slow growth and a relatively low carotenoid-to-chlorophyll ratio. At higher irradiances (200 and 400 μE/(m2 s)) on complete medium, the alga displayed higher growth rate and an increase in the carotenoid content, especially that of β-carotene and lutein. Both on nitrogen-free (regardless of illumination intensity) and nitrogen-replete medium (under high light), a considerable increase in the ratio of carotenoid and chlorophyll contents was recorded. Predominant accumulation of xanthophylls took place in thylakoid membranes, whereas β-carotene deposition occurred mainly in the cytoplasmic lipid globules (oil bodies); lower amounts of carotenoids were accumulated in the absence of nitrogen. Under high light and nitrogen-deficiency conditions, an increase in violaxanthin de-epoxidation and nonphotochemical quenching was recorded together with a decline in variable chlorophyll fluorescence ( F v/ F m) level. A possible photoprotective role of carotenoids in adaptation of P. incisa to high light under nitrogen starvation conditions is discussed. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is extremely rare in childhood. Published case series reporting children and adolescents with colorectal cancer have not focused on the underlying genetic aspects of the tumour or genetic susceptibility of the families. Aims: We examined a cohort of patients with early onset colorectal cancer to determine whether a specific genetic predisposition could be elucidated. In particular, we focused on whether DNA mismatch repair gene deficiency which causes hereditary non-polyposis colorectal cancer (HNPCC) could be elucidated. Methods: Patients with colorectal cancer ⩽ 24 years of age were identified from a database at the Familial Gastrointestinal Cancer Registry at Mount Sinai Hospital, Toronto. Detailed pedigrees were ascertained from the proband or parents. Tumours were tested for microsatellite instability, a hallmark of HNPCC. Germline mismatch repair gene mutations (MSH2 and MLH1) were sought in some cases. Clinical data were obtained by chart audit. Results: Among 1382 probands in our registry, 16 (1%) colorectal cancer patients were 24 years or younger at the time of diagnosis. Microsatellite instability was identified in tumours from eight (73%) of 11 evaluated patients. Germline mutations in mismatch repair genes were identified in six of 12 patients, including MSH2 (n=3), MLH1 (n=2), and PMS2 (n= 1). Ten (63%) of 16 families met the Amsterdam criteria for HNPCC. Among these, six were screened for mismatch repair gene mutations and three were found to carry MSH2 or MLH1 germline mutations. Location of the colorectal cancers included rectum! sigmoid (n = 9), splenic flexure (n = 2), hepatic Hexure (n = 3), and caecum (n = 2). Forty four per cent (7/ 16) of these young cases developed additional malignancies (gastrointestinal (n = 8) and extraintestinal (n=4)) during follow up (mean 12.8 (SD 12.4) years (range 0.08-30)). Conclusions: Patients with early onset colorectal carcinoma often have an inherited predisposition to the disease. Tumours with high frequency microsatellite instability and germline mutations of mismatch repair genes are sufficiently common in this patient population that they should be considered, even though family histories may not satisfy the stringent Amsterdam criteria for HNPCC. Young colorectal cancer patients are at increased risk of developing second gastrointestinal and extraintestinal malignancies. [ABSTRACT FROM AUTHOR]

Malignant osteopetrosis (MOP) is an autosomal recessive disease in which osteoclast dysfunction results in excessive bone deposition and early infant death. Thirteen children suffering from MOP from four related families all belonging to one Bedouin tribe, were studied. The disease was diagnosed as early as at a few days postnatal to 5 months. Nine children underwent BMT, four of whom are still alive; one is blind and two have markedly reduced vision. Four children who did not undergo BMT died between 4 and 6 months of age. Recently, the gene for MOP has been mapped for this Bedouin tribe allowing prenatal diagnosis. Seven pregnancies were subsequently prenatally diagnosed and two fetuses were found to be affected. Pregnancy was electively terminated in one case. In the other case the parents refused and after establishing the diagnosis, the newborn was transplanted at the age of 7 days. Bone Marrow Transplantation (2001) 27, 129–132. [ABSTRACT FROM AUTHOR]

Purpose: Radio-necrosis (RN) occurs in up to 10% of lesions treated with stereotactic radiosurgery (SRS). Currently there are no reliable tools to distinguish between RN and viable tumor progression, a distinction that has important clinical consequences. We aimed to assess a novel technique, based on delayed contrast extravasation MRI, for differentiating metastatic tumor progression from RN after SRS. Methods: Thirty six patients with brain metastases: 15 with non small cell lung cancer (NSCLC), 14 with breast cancer, 5 with malignant melanoma, one with adenoid cystic carcinoma and one with clolon cancer, were recruited. Their scheduled follow-up MRI, performed 1.6-41 months post LINAC SRS, had features suggestive of either tumor progression or RN. All patients were scanned by delayed contrast extravasation MRI. Enhancement subtraction maps were calculated by subtracting high resolution MR images acquired shortly after contrast injection from images acquired 75 minutes later. Patients were followed by conventional and delayed contrast extravasation MRI unless their medical condition necessitated surgical intervention. Ten patients (4 NSCLC, 4 breast cancer, one malignant melanoma and one with adenoid cystic carcinoma) underwent surgery for 12 metastases. Their mean age when receiving SRS was 50.2 (30-67) years. They were treated with a single dose of 18-20 Gy, delivered to the 80% isodose line, 13.1±2.9 months prior to resection. Results: The subtraction maps revealed two distinct enhancement patterns-- regions with contrast clearence from tissue at the 75 minute scan (fast) and regions where contrast accumulated with time (slow). Stereotactic biopsies from four patients (12 specimens) were taken according to the generated pre-surgical subtraction maps. The histological characteristics of each sample were compared with the corresponding regions in the maps. One metastasis was removed en block and the macro histological features were compared with the corresponding subtraction maps. In 7 additional brain metastases (resected from 6 patients) the histological existence/absence of tumor was compared with the maps as well. In all cases histological data confirmed that fast regions in our maps represent active tumor and slow regions represent non-tumoral tissue, consistent with RN. Additionally, blood vessel morphology was different in these two regions, possibly explaining the different appearance of tumor vs RN in the subtraction maps. Thus the subtraction maps seem to reflect vascular integrity- a surrogate marker of tissue characterization. Conclusion: These results demonstrate the feasibility of applying delayed contrast extravasation MRI as a valuable clinical tool for distinguishing radiation induced changes from metastatic tumor progression. Disclosure: No significant relationships. [ABSTRACT FROM AUTHOR]