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Introduction: intestinal-type sinonasal adenocarcinoma (ITAC) is a rare epithelium tumor of the nasal cavities and paranasal sinuses. Exposure to wood and leather dusts is a strong etiological factor related to its development. Prolonged cork exposure has rarely been associated., Materials and Methods: thirty-seven-year (1981-2018) retrospective cohort analysis of all consecutive patients with sinonasal cancer (SNC) followed at our institution. Medical records were reviewed to determine patient demographics, occupational/environmental exposure, location and extent of the tumor, stage, histopathology findings, treatment strategies, and oncologic outcomes. Survival analysis was done using Kaplan-Meier method., Results: we evaluated 379 patients with SNC, including 39 (10.3%) ITAC. Patient median age was 73 years (range 49-87), 56% male and 69% with identified professional occupational exposure (54% for cork; 69.2% considering only those for which an agent has been identified). Seventy-two percent had locally advanced disease (stage III or IVA-B). The initial treatment was surgery in 77%, and 54% received adjuvant radiotherapy. The median time to progression, progression-free survival, and overall-survival was 2.36 years (95% CI 1.54-8.70), 1.96 years (95% CI 1.43-3.74), and 3.51 years (95% CI 2.33-10.02), respectively., Conclusion: ITAC is an uncommon malignancy that grows silently, which contributes to delayed diagnosis, advanced stage and low survival rates. In our cohort, we observed a high prevalence of cork occupational exposure. This finding may lead to the implementation of protection measures and suggest a potential link to be further studied., (Copyright © 2020 Alpuim Costa, Monteiro, André, Esteves, Sargento, Ferreira, Alexandre, Clara, Freire and Moreira.)

Purpose: Report our matured outcomes of European nasopharyngeal carcinoma (NPC) treatment from a non-endemic region in the IMRT era., Methods: We reviewed 109 consecutive patients with biopsy proven NPC treated between 2009 and 2013. All received IMRT as per RTOG 0615. Toxicity was scored accordingly to CTCAE 4.03. Platinum-based chemotherapy was delivered following the Intergroup 0099., Results: Median age of 53 years; 97% Caucasian; 74% male; 72% WHO grade III; 43% T1; 14% T2; 18% T3, 25% T4; 17% N0; 17% N1; 39% N2; 27% N3. Compliance to adjuvant chemotherapy was 88%. With a median follow up of 56 months, the 4-year local control was 90.2% (88.6% for T1; 100% for T2; 85% for T3; and 91.7% for T4), the 4-year distant metastases-free survival was 86% and an overall survival rate was 77%. Local control and survival were better in G3 (p < 0.001 and p = 0.032, respectively). Xerostomia was the most frequent late toxicity in 55% (n = 60). Hypothyroidism requiring hormonal reposition occurred in 15.5% (n = 17). From the 36 deaths, 20 were due to distant metastases, 3 grade 5 toxicity, 2 from local progression, 5 non-cancer deaths and unknown cause in the remaining 6. On multivariable analysis, age (p = 0.017), local recurrence and distant metastases were associated with death (p < 0.001, both)., Conclusion: Our matured data from the IMRT era showed a major improvement from our 3D cohort series reaching excellent local and regional control, even in T4. Local recurrences, despite few, and distant metastases were correlated with the risk of death., (© 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.)

Background: To explore the relationship between individual skeletal maturity as assessed by Cervical Vertebral Maturity method (CVM), circum-pubertal phases of the dentition (early mixed, intermediate mixed, late mixed and early permanent) and chronlogical age in a cohort of Portuguese individuals., Material and Methods: This was a retrospective cross-sectional study. The sample comprised 300 Caucasian Portuguese subjects aged 6 to 16 years, (137 boys and 163 girls). All the participants had good quality panoramic and lateral cephalometric radiographs. Subject skeletal maturity was evaluated using the CVM method. Dental age evaluation was determined by using panoramic radiographs and dental casts. Descriptive statistics (absolute and relative frequencies) and percentages were obtained for the prevalence of the CVM stages in the various phases of the dentition and for the different ages for each of males and females., Results: Prepubertal stage 1 (CS1) was predominently observed in the early mixed dentition phase followed by the intermediate mixed dentition phase. While, the CS1 stage was found in all the other phases of tooth development. There was a wide distribution of all CVM stages in the late mixed dentition and early permanent dentition phases. While, the CS3 stage was predominantly present in both the late mixed dentition and in the early permanent dentition phases. Moreover, the chronological age did not seem to be an accurate indicator in differentiating between the pre-pubertal and the pubertal growth spurt stages., Conclusions: Early mixed dentition phase could determine with a high accuracy the prepubertal skeletal maturity stage (CS1), Furthermore, the chronological age did not seem to be an accurate indicator in differentiating between the pre-pubertal and the pubertal growth spurt stages. Key words: Cervical vertebrae, cephalometric, panoramic, tooth calcification, portuguese., Competing Interests: Conflict of interest statement:The authors have declared that no conflict of interest exist.

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments., Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study., Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%., Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low., Competing Interests: The data was completely anonymized, and no patient or hospital information was collected in the database. The study protocol was approved by the board of the WSES, and the study was conducted under its supervision. The board of the WSES grants the proper ethical conduct of the study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Afferent loop syndrome (ALS) is a rare complication of Billroth-II gastrojejunostomy. Causes of afferent loop obstruction include adhesions, internal hernias, intestinal strictures or malignancy. Obstruction caused by enteroliths is rare and usually requires surgery. We present the case of a 90-year-old man with a Billroth-II performed 50 years earlier and three acute pancreatitis. He presented with acute abdominal pain, without signs of pancreatitis. Upper digestive endoscopy revealed a punctiform anastomotic stricture of the afferent loop. Fluoroscopy-guided contrast injection showed a dilated loop with multiple filling defects. After through-the-scope balloon dilation, multiple calculi similar to gallstones were observed in the afferent loop and were removed with a basket. There were no signs of choledochoduodenal fistula or abnormalities in the ampulla of Vater, leading us to assume the formation of intestinal calculi. This case represents a rare cause of ALS, emphasizing the possibility of solely endoscopic treatment. The stone was removed and the anastomotic stricture which was the underlying cause of the enterolith formation was treated by endoscopy. Endoscopic management of enterolith-related ALS is technically difficult and rarely reported. To our knowledge, there are two cases in which electrohydraulic lithotripsy was used to fragment a large enterolith in the afferent loop. This includes one report of failed endoscopic retrieval of an enterolith and in another case a perforation after an attempt to grasp the stone with a basket. ALS has multiple causes and non-specific clinical manifestations. We highlight the importance of high clinical suspicion and individualized treatment according to the patient's condition, severity, ALS etiology and locally available treatment possibilities.

With the release of Regulation 1394/2007, a new framework for gene and cell therapy medicinal products and tissue-engineered products was established in the European Union. For all three product classes, called advanced therapy medicinal products, a centralised marketing authorisation became mandatory. The European Medicines Agency (EMA) together with its Committee for Advanced Therapies, Committee for Human Medicinal Products and the network of national agencies is responsible for scientific evaluation of the marketing authorisation applications. For a new application, data and information relating to manufacturing processes and quality control of the active substance and the final product have to be submitted for evaluation together with data from non-clinical and clinical safety and efficacy studies. Technical requirements for ATMPs are defined in the legislation, and guidance for different products is available through several EMA/CAT guidelines. Due to the diversity of ATMPs, a tailored approach for regulating these products is considered necessary. Thus, a risk-based approach has been introduced for ATMPs allowing flexibility for the regulatory requirements. Since the regulatory framework for ATMPs was established, five products have been licenced in the European Union. However, the pipeline of new ATMPs is much bigger, as seen from the significant numbers of different products discussed by the CAT in scientific advice and classification procedures. In 2013, a public consultation on the ATMP Regulation was conducted by the European Commission, and the results were published in 2014. The report proposes several improvements for the current framework and established procedures for the regulation of ATMPs.

Background: Stress urinary incontinence (SUI) is involuntary leakage from effort or exertion or from sneezing or coughing and it is usually related to increased urethral mobility and/or poor intrinsic sphincter function. Pelvic floor muscle training (PFMT) has principally been recommended in the management of SUI. The aims of PFMT are to improve pelvic organ support (bladder, bladder neck, and urethra) and increase intraurethral pressure during exertion. The PFMT programmes are prescribed to increase strength, endurance and coordination muscle., Objectives: To determine the effects of pelvic floor muscle training in the management of female stress urinary incontinence. The following hypothesis was tested: What is the evidence for PFMT, either alone or in combination with adjunctive therapies? What is the evidence for different types of PFMT? What is the length of treatment and number of PFMT?, Material and Methods: [corrected] Types of studies: randomised controlled trials and quasirandomised studies were included. Searches of MEDLINE, PUBMED, COCHRANE, PEDro e SCOPUS review articles published between 1999-2009., Types of Participants: all women with stress urinary incontinence and diagnosed on the basis of symptoms, signs, or urodinamic evaluation. Other forms of controlled clinical trial were excluded, for example whose symptoms might be due to significant factors outside the urinary tract (neurological disorders, cognitive impairments, lack of independent mobility)., Types of Interventions: PFMT was defined as a programme of repeated voluntary pelvic floor muscle contraction and with or without supervised by health care professional. All studies were eligible for inclusion if there was at least one arm with a PFMT protocol, alone or together with other adjunctive therapies (biofeedback, electrical stimulation or vaginal weights) compared with or without control group., Types of Outcome Measures: The outcomes of interest were symptomatic cure and cure/improvement; symptom and condition specific quality of life assessment, quantification of leakage episodes; measures of pelvic floor muscle contraction., Results: Nineteen studies met the inclusion criteria. The review found consistent evidence from of high quality randomised controlled trials, that PFMT alone and in combination with adjunctive therapies (biofeedback and electrical stimulation) was effective treatment for women with SUI with of «cure» and «cure/improvement» up to 70% and 97% respectively., Conclusions: Based on the few data available there is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further studies are needed to evaluate the optimal training protocol and length of treatment.

The Sclerosing Mesenteritis is a rare idiopathic disease. It represents the final stadium of progression of the chronic inflammatory illnesses of the intestinal mesentery, with predominance of fibrosis. The clinical manifestations are varied and unspecific. Diagnosis, that demands high degree of suspicion, can be presumed for imaging study, that discloses heterogeneous mass with tumor-like appearance, and confirmed on the basis of anatomo-pathological examination. The treatment is empirical and the prognostic is habitually favourable, over all in initial stadiums of the illness, being in a minority fatal. The authors describe the clinical case of a 50 years-old woman, admitted in the hospital for abdominal pain, ascitis and fever and that by radiological suspicion of peritoneal carcinomatosis and negative complementary study for primitive neoplasm, was submitted to an exploring laparotomy. Observed accented thickening of the mesentery that formed an extensive adherent conglomerate of bowel loops, whose biopsy had disclosed to be a sclerosing mesenteritis. Was verified an irrelevant answer to the treatment and an unfavourable, lethal, clinical course. The authors provide a literature review concerning the most relevant aspects of this disease.

Objectives: Elevated lipase and amylase are commonly found in patients in intensive care unit without a previously recognized pancreatic illness, constituting a diagnostic and therapeutic challenge. The authors therefore proposed to determine the frequency of asymptomatic high serum lipase in critically ill patients, involved risk factors and outcome., Methods: Retrospective study of patients admitted in an intensive care unit from January 1 to December 31, 2006, excluding admissions for acute pancreatitis, history of pancreatic disease, renal insufficiency or lacking of data. Patients were divided in two groups (with and without high serum lipase) that were compared for clinical, laboratory and radiological variables., Statistical Analysis: SPSS 13; Student's t test and Chi-square test (CI 95%) with statistical significance if p< 0.05)., Results: 102 patients were included with high serum lipase was present in 39.2% of patients, mean lipase of 797U/L. Patients with high serum lipase had longer hospital stay (p< 0.001), parenteral nutrition (p< 0.001), ventilator support (p=0.04), fever (p< 0.001), hyperamylasemia (p<0.05), hyperbilirrubinemia (p=0.003) and rise of transaminases (p=0.001), with no significant differences in diagnosis, gender, age, APACHE II, SOFA, SAPS, mortality, hypotension, alkaline phosphatase, hemoglobin, lactate, tolerance to enteral nutrition and use of propofol. Imaging study revealed pancreatic alterations in two patients with high serum lipase., Conclusions: Elevated lipase was commonly found in critical patients, it related with longer length of stay but was not accompanied by increased clinical severity or mortality. It was more frequent with parenteral nutrition. A minority of patients met the criteria of acute pancreatitis.

This paper presents a large amount of data on the composition of quince fruit with regard to phenolic compounds, organic acids, and free amino acids. Subsequently, principal component analysis (PCA) is carried out to characterize this fruit. The main purposes of this study were (i) the clarification of the interactions among three factors-quince fruit part, geographical origin of the fruits, and harvesting year-and the phenolic, organic acid, and free amino acid profiles; (ii) the classification of the possible differences; and (iii) the possible correlation among the contents of phenolics, organic acids, and free amino acids in quince fruit. With these aims, quince pulp and peel from nine geographical origins of Portugal, harvested in three consecutive years, for a total of 48 samples, were studied. PCA was performed to assess the relationship among the different components of quince fruit phenolics, organic acids, and free amino acids. Phenolics determination was the most interesting. The difference between pulp and peel phenolic profiles was more apparent during PCA. Two PCs accounted for 81.29% of the total variability, PC1 (74.14%) and PC2 (7.15%). PC1 described the difference between the contents of caffeoylquinic acids (3-O-, 4-O-, and 5-O-caffeoylquinic acids and 3,5-O-dicaffeoylquinic acid) and flavonoids (quercetin 3-galactoside, rutin, kaempferol glycoside, kaempferol 3-glucoside, kaempferol 3-rutinoside, quercetin glycosides acylated with p-coumaric acid, and kaempferol glycosides acylated with p-coumaric acid). PC2 related the content of 4-O-caffeoylquinic acid with the contents of 5-O-caffeoylquinic and 3,5-O-dicaffeoylquinic acids. PCA of phenolic compounds enables a clear distinction between the two parts of the fruit. The data presented herein may serve as a database for the detection of adulteration in quince derivatives.

Laser-induced room temperature luminescence of air-equilibrated benzophenone/O-propylated p-tert-butylcalix[4]arene solid powdered samples revealed the existence of a novel emission, in contrast with benzophenone/p-tert-butylcalix[4]arene complexes, where only benzophenone emits. This novel emission was identified as phosphorescence of 1-phenyl-1,2-propanedione, which is formed as the result of an hydrogen atom abstraction reaction of the triplet excited benzophenone from the propoxy substituents of the calixarene. Room temperature phosphorescence was obtained in air-equilibrated samples in all propylated hosts. The decay times of the benzophenone emission vary greatly with the degree of propylation, the shortest lifetimes being obtained in the tri- and tetrapropylated calixarenes. Triplet-triplet absorption of benzophenone was detected in all cases, and is the predominant absorption in the p-tert-butylcalix[4]arene case. where an endo-calix complex is formed. Benzophenone ketyl radical formation occurs with the O-propylated p-tert-butylcalix[4]arenes hosts, suggesting a different type of host/guest molecular arrangement. Diffuse reflectance laser flash photolysis and gas chromatography-mass spectrometry techniques provided complementary information, the former about transient species and the latter regarding the final products formed after light absorption. Product analysis and identification clearly show that the two main degradation photoproducts following laser excitation in the propylated substrates are 1-phenyl-1,2-propanedione and 2-hydroxybenzophenone, although several other minor photodegradation products were identified. A detailed mechanistic analysis is proposed. While the solution photochemistry of benzophenone is dominated by the hydrogen abstraction reaction from suitable hydrogen donors, in these solid powdered samples, the alpha-cleavage reaction also plays an important role. This finding occurs even with one single laser pulse which lasts only a few nanoseconds, and is apparently related to the fact that scattered radiation exists, due to multiple internal reflections possibly trapping light within non-absorbing microcrystals in the sample, and is detected until at least 20 micros after the laser pulse. This could explain how photoproducts thus formed could also be excited with only one laser pulse.