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Objective.To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.Design.Prospective before-after trial.Setting.An 18-bed surgical intensive care unit.Methods.During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistantEnterococcus(VRE) and methicillin-resistantStaphylococcus aureus(MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection andClostridium difficileinfection (CDI) were determined.Results.The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P= .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters;P= .001; after patient care, 63% vs 51% of encounters;P< .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P= .10), 8.9 and 7.8 for urinary tract infection (P= .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P= .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P= .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P= .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P= .16). Hand skin health improved during phase 2.Conclusions.Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

We analyzed the $^{93}Nb$ on $^{nat}Mg$ reaction at 30 MeV/nucleon in the aim of disentangling binary sequential decay and multifragmentation decay close to the energy threshold, i.e. $\simeq 3$ MeV/nucleon. Using the backtracing technique applied to the statistical models GEMINI and SMM we reconstruct simulated charge, mass and excitation energy distributions and compare them to the experimental ones. We show that data are better described by SMM than by GEMINI in agreement with the fact that multifragmentation is responsible for fragment production at excitation energies around 3 MeV/nucleon., 16 pages, 12 figures, 5 tables Soumis \`a Nuclear Physics A

Malignant tumors of the small bowel account for less than 10% of all gastrointestinal neoplasms. The majority of these tumors are secondary neoplasms metastatic from either an intra- or extra-abdominal site. Symptoms related to these tumors include bleeding, obstruction, and perforation, although the great majority of these metastases remain asymptomatic and are only discovered at autopsy. Outcomes remain poor and most interventions are palliative. We review the current surgical recommendations for management of this challenging clinical scenario.

Background Intralumenal full-thickness gastric resection (FTGR) could be useful as a biopsy technique or in the management of gastric neoplasms. SurgASSIST is a cutting and stapling device delivered on a steerable shaft to which interchangeable stapling units are affixed. Objective This feasibility study assessed the applicability of the SurgASSIST to perform intralumenal FTGR in a swine model. Design Descriptive analysis; no statistical tests were applied. Setting Animal laboratory. Methods Four nonsurvival swine under general anesthesia were studied. An oroesophageal overtube was placed. A balloon trocar was inserted into the stomach under endoscopic guidance and served as a port for instruments and imaging. Under direct visualization, the SurgASSIST with a 55-mm straight-linear cutter and stapler unit (SLCS55) was advanced via the overtube into the stomach. We evaluated the safety and efficacy of overtube placement, SLCS55 insertion and maneuverability in the stomach, parallel versus perpendicular optics, and various tissue grasping devices to achieve FTGR. Results Overtube insertion produced limited esophageal mucosal tears in 2 subjects and a severe tear in 1 subject. Maneuverability of the SLCS55 was limited. Endoscopic guidance for FTGR via both peroral (parallel) and per gastrostomy port (perpendicular) orientations was satisfactory. FTGR was successful in 2 of 4 subjects. Resected specimens measured 6.0 × 0.6 cm and 6.0 × 0.7 cm. There were no operative complications. In the remaining 2 subjects, the depth of resection was submucosa. Limitations Animal model. Conclusions Peroral intralumenal FTGR is feasible. A gastrostomy port facilitates triangulation for optics and tissue manipulation. Further refinements are needed to yield reliable results.

The response of silicon–silicon–CsI(Tl) telescopes, developed within the FAZIA collaboration, to fragments produced in nuclear reactions 84Kr+120-124Sn at 35 A MeV, has been used to study ion identification methods. Two techniques are considered for the identification of the nuclear products in the silicon stages. The standard ΔE−E one requires signals induced in two detection layers by ions punching through the first one. Conversely, the digital Pulse Shape Analysis (PSA) allows the identification of ions stopped in the first silicon layer. The capabilities of these two identification methods have been compared for different mountings of the silicons, i.e. rear (particles entering through the low electric field side) or front (particles entering through the high electric field side) side injection. The ΔE−E identification method gives exactly the same results in both configurations. At variance, the pulse shape discrimination is very sensitive to the detector mounting. In case of rear side injection, the identification with the “energy vs. charge rise time” PSA method presents energy thresholds which are significantly lower than in the case of front side injection.

Background Efflux has been recognized as a resistance mechanism to antimicrobials in Staphylococcus aureus; however its role on the development of clinically relevant resistance is still poorly characterized. This study aimed to examine the impact of efflux on development of resistance to fluoroquinolones and other antimicrobials in S. aureus strains representing relevant phenotypes in terms of antibiotic susceptibility and efflux activity. Methods Two closely related methicillin- and ciprofloxacin-resistant Staphylococcus aureus clinical strains, with different efflux capacity and the pan-susceptible strain ATCC25923 were exposed to constant concentrations of the efflux pump (EP) substrates ciprofloxacin, ethidium bromide and cetrimide. Parental and exposed strains were tested regarding their susceptibility towards antibiotics, biocides and ethidium bromide, efflux capacity and levels of EP gene expression. Occurrence of resistance-associated mutations was screened by sequencing. Results Multidrug resistance phenotypes emerged upon exposure, independently of the substrate or its concentration, which were correlated with increased efflux capacity of the exposed strains. The temporal pattern of EP gene expression disclosed an early-response with high expression of several genes, followed by a late-response, characterized by overexpression of specific genes. The overall cell response was more pronounced for strains with an initial basal efflux activity. Remarkably, detection of the IS256 element in the promoter regions of mgrA and norA, in some cases associated with increased gene expression, suggests that these genes may be hot spots for IS256 insertion events. The results obtained with exposure of ATCC25923 to ciprofloxacin were particularly striking, revealing a step-wise development of fluoroquinolone resistance, with a first efflux-mediated response, followed by the occurrence of a mutation in grlA that resulted in phenotypic resistance. Additionally, challenge by non-fluoroquinolone agents, particularly cetrimide, promoted cross resistance to fluoroquinolones, revealing the potential role of biocides as selective pressure for the emergence of resistance to these antibiotics. Conclusions This study reveals efflux as a significant component of S. aureus resistance to fluoroquinolones and biocides and as a primary mechanism to withstand stress imposed by antimicrobials. This efflux-mediated response can result in the emergence of multidrug resistance in healthcare environments and should be taken into account in the management of this major pathogen. Electronic supplementary material The online version of this article (doi:10.1186/s12866-015-0572-8) contains supplementary material, which is available to authorized users.

International audience; The elliptic-flow ratio of neutrons with respect to protons or lightcomplex particles in reactions of heavy ions at pre-relativistic energieshas been proposed as an observable sensitive to the strength of thesymmetry term of the nuclear equation of state at supra-saturationdensities. In the ASY-EOS experiment at the GSI laboratory, flows ofneutrons and light charged particles were measured for 197Au+197Au,96Zr+96Zr and 96Ru+96Ru collisions at 400 MeV/nucleon with theLarge Area Neutron Detector LAND as part of a setup with severaladditional detection systems used for the event characterization. Flowresults obtained for the Au+Au system, in comparison with predictionsof the UrQMD transport model, confirm the moderately soft to lineardensity dependence of the symmetry energy deduced from the earlierFOPI-LAND data.

Streptococcus pneumoniae is a major pathogen causing community-acquired pneumonia and acute bronchitis. Macrolides, fluoroquinolones (FQs), and, recently, telithromycin (TEL) constitute primary therapeutic options, and rare cases of resistance have been reported. In this report, we describe the emergence of an S. pneumoniae clinical isolate with high-level TEL resistance (MIC, 256 g/ml) and simultaneous resistance to FQs. Ongoing studies are oriented to elucidate the precise mechanism of resistance to TEL. Fil: Faccone, Diego. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Bacteriología. Servicio de Antimicrobianos; Argentina. Fil: Andres, Patricia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Bacteriología. Servicio de Antimicrobianos; Argentina. Fil: Galas, Marcelo F. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Bacteriología. Servicio de Antimicrobianos; Argentina. Fil: Tokumoto, Marta. Fundación Favaloro. Servicio de Microbiología; Argentina. Fil: Rosato, Adriana. Virginia Commonwealth University. Division of Infectious Diseases; Estados Unidos. Fil: Corso, Alejandra. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Bacteriología. Servicio de Antimicrobianos; Argentina.

Cyclooxygenase (COX)-2-derived prostaglandins (PGs) are thought to contribute to tumor growth and resistance to radiation therapy. COX-2 protein expression is increased in many tumors including those of the breast. COX-2-derived PGs have been shown to protect cells from radiation damage. This study evaluated the role of COX-2-derived PG in radiation treatment by using the NMF11.2 mammary tumor cell line originally obtained from HER-2/neu mice that overexpress HER-2/neu. We determined whether the effects of the COX-2 inhibitor SC236 on cell growth, radiation-induced PGE2 production and COX expression, cell cycle redistribution, and vascular endothelial growth factor (VEGF) were acting through COX-2-dependent mechanisms. The NMF11.2 cells expressed both COX-1 and COX-2 protein and mRNA. The radiation treatment alone led to a dose-dependent increase in the levels of COX-2 mRNA and COX-2 protein, which was associated with an increase in the production of PGE2 and prostacyclin (PGI2). Treating NMF11.2 cells with high concentrations (20 μm) of SC236 for 48 h reduced the radiation-induced increase in COX-2 activity and also decreased cell growth. SC236 (20 μm) increased the accumulation of the cells in the radiosensitive G2-M phase of the cell cycle. However, a low concentration (5 μm) of SC236 was adequate to reduce COX-2 activity. The lower concentration of SC236 (5 μm) also decreased cell growth after a longer incubation period (96 h) and, in combination with a 2 or 5 Gy dose, led to an accumulation of cells in G2-M phase. Restoring PG to control values in cells treated with 5 μm SC236 prevented the growth inhibition and G2-M cell cycle arrest. Radiation treatment of NMF11.2 cells also increased VEGF protein expression and VEGF secretion in a dose-dependent manner, which was blocked in those cells pretreated with 20 μm SC236 but not in those pretreated with 5 μm SC236. These findings indicate that the COX-2 inhibitor SC236 reduced cell growth and arrested cells in the G2-M phase of the cell cycle by mechanisms that are both dependent and independent of PG production while its effects on VEGF appear to be independent of COX-2.

Adiponectin is an adipocyte-derived plasma protein with insulin-sensitizing and antiatherosclerotic properties. Because adipose tissue depots differ in the strength of their association with the adverse metabolic consequences of obesity, we studied the secretion of adiponectin in vitro from paired samples of isolated human omental and sc adipocytes and its regulation by insulin and rosiglitazone. Cells were incubated for 12 or 24 h with and without treatment with 100 nM insulin, 8 micro M rosiglitazone, or both combined; adiponectin secreted into the culture medium was measured by a RIA with a human adiponectin standard and normalized for cellular DNA content. Secretion of adiponectin by omental cells was generally higher than sc cells and showed a strong negative correlation with body mass index (r = -0.78;P = 0.013). In contrast, secretion from the sc cells was unrelated to body mass index. Compared with sc-derived adipocytes, adiponectin secretion from omental cells was increased by insulin or rosiglitazone alone and was up to 2.3-fold higher following combined treatment with insulin and rosiglitazone, whereas secretion from sc adipose cells was unaffected by these treatments. These data suggest that reduced secretion from the omental adipose depot may account for the decline in plasma adiponectin observed in obesity. Furthermore, enhanced adiponectin secretion from fat cells derived from the visceral compartment in response to rosiglitazone alone or in combination with insulin may play a role in some of the systemic insulin-sensitizing and antiinflammatory properties of the thiazolidinediones.

Staphylococci that acquire the mecA gene are usually resistant to β-lactam antibiotics (methicillin or oxacillin resistance). mecA encodes a penicillin-binding protein (PBP 2a) that has a reduced affinity for β-lactams. In some isolates with methicillin or oxacillin resistance, only a small proportion (≤0.1%) of the population expresses resistance to ≥10 μg of oxacillin per ml (heterotypic resistance [HeR]), while in other isolates most of the population expresses resistance (homotypic resistance [HoR]). In the present study, growth of Staphylococcus aureus or Staphylococcus epidermidis strains with HeR in concentrations of oxacillin (0.3 to 0.7 μg/ml) that produced a fall or a lag in optical density converted the strains from the HeR to the HoR phenotype. The conversion from the HeR to the HoR phenotype appeared to be due to the selection of a highly resistant mutant population, as determined by fluctuation analysis and the failure of populations with HoR to revert to HeR after 60 generations of growth in antibiotic-free media. The frequencies of conversion were as high as 10 −3 to 10 −2 . Conversion to HoR required an intact mecA gene and an increase in the level of mecA transcription since no highly resistant subpopulation could be selected after growth in oxacillin when mecA transcription was constitutively repressed or when mecA had been inactivated. In addition, in both S. epidermidis and S. aureus the level of resistance to vancomycin, which also acts directly on the staphylococcal cell wall, was greater among convertants with HoR than their isogenic parents. The conversion of a population from HeR to HoR involves the selection of a mutation(s) that occurs at a high frequency and most likely requires abundant PBP 2a.

Isotopic ratios for light fragments ($Z\ensuremath{\le}4$) emitted by the quasiprojectile (QP) and the mid-rapidity (MR) sources are investigated by the use of a slightly asymmetric system ($^{36}\mathrm{Ar}+^{58}\mathrm{Ni}$) and a symmetric one ($^{58}\mathrm{Ni}+^{58}\mathrm{Ni}$) for six energies between 32A and 84A MeV and three semiperipheral centrality range selections. Experimental data come from the INDRA $4\ensuremath{\pi}$ multidetector. The results show a clear neutron-rich isotope production from the MR region as compared to the QP source. The beam energy and the centrality also show interesting different trends depending on the charge of the fragments and the emission source. Experimental results are compared to antisymmetrized molecular dynamics simulations.

Galloyl catechins, in particular (-)-epicatechin gallate (ECg), have the capacity to abrogate β-lactam resistance in methicillin-resistant strains of Staphylococcus aureus (MRSA); they also prevent biofilm formation, reduce the secretion of a large proportion of the exoproteome and induce profound changes to cell morphology. Current evidence suggests that these reversible phenotypic traits result from their intercalation into the bacterial cytoplasmic membrane. We have endeavoured to potentiate the capacity of ECg to modify the MRSA phenotype by stepwise removal of hydroxyl groups from the B-ring pharmacophore and the A:C fused ring system of the naturally occurring molecule. ECg binds rapidly to the membrane, inducing up-regulation of genes responsible for protection against cell wall stress and maintenance of membrane integrity and function. Studies with artificial membranes modelled on the lipid composition of the staphylococcal bilayer indicated that ECg adopts a position deep within the lipid palisade, eliciting major alterations in the thermotropic behaviour of the bilayer. The non-galloylated homolog (-)-epicatechin enhanced ECg-mediated effects by facilitating entry of ECg molecules into the membrane. ECg analogs with unnatural B-ring hydroxylation patterns induced higher levels of gene expression and more profound changes to MRSA membrane fluidity than ECg but adopted a more superficial location within the bilayer. ECg possessed a high affinity for the positively charged staphylococcal membrane and induced changes to the biophysical properties of the bilayer that are likely to account for its capacity to disperse the cell wall biosynthetic machinery responsible for β-lactam resistance. The ability to enhance these properties by chemical modification of ECg raises the possibility that more potent analogs could be developed for clinical evaluation.

In a recent experiment performed in Naples by using the TTT-3 tandem accelerator, the 19F(p, α0) reaction has been investigated at low bombarding energies, Ep = 0.6–1 MeV. Excitation functions and angular distributions have been obtained by using several solid state detectors preceded by thin aluminium absorbers. By analysing angular distributions in terms of Legendre and cosine polynomials, a few spectroscopic ambiguities concerning the excited states of the compound nucleus, 20Ne, in the excitation energy region E* = 13.4–13.8 MeV, have been solved. Moreover, this reaction plays an important role for the description of the fluorine nucleosynthesis. For this reason, the astrophysical S-factor has also been extracted and the results have been compared with the literature data.

We report some recent experimental results on the spectroscopy of 13C and 20Ne nuclei by means of low energy nuclear reactions carried out with high resolution electrostatic accelerators. In the case of 13C we investigated the possible existence of a-cluster states above the a emission threshold by means of low energy elastic resonant scattering α+9Be in direct kinematics. Excitation functions show the presence of various resonances that have been reproduced by R-matrix fit. We studied also the structure of 20Ne by means of the 19F(p,α0) reaction at sub-barrier energies. The spectroscopy of 20Ne excited states in the region Ex 13.5-14.0 MeV can be probed by analyzing experimental angular distributions and excitation functions. This reaction plays an important role also in the CNOF cycle and is an important ingredient to describe hydrogen-induced destruction of fluorine in massive stars. For this reason we investigated the trend of S-factor, that has been compared with results previously reported in the literature. © Published under licence by IOP Publishing Ltd

none 25 none J. P. WIELECZKO; E. BONNET; J. GOMEZ DEL CAMPO; M. LA COMMARA; M. VIGILANTE; J. D. FRANKLAND; A. CHBIHI; E. ROSATO; G. SPADACCINI; A. GALINDO-URIBARRI; D. SHAPIRA; C. BECK; B. BORDERIE; R. BOUGAULT; R. DAYRAS; G. DE ANGELIS; P. LAUTESSE; N. LE NEINDRE; D'ONOFRIO A; M. PARLOG; D. PIERROUTSAKOU; F. REJMUND; M. F. RIVET; M. ROMOLI; AND R. ROYL J. P., Wieleczko; E., Bonnet; J., GOMEZ DEL CAMPO; M., LA COMMARA; M., Vigilante; J. D., Frankland; A., Chbihi; E., Rosato; G., Spadaccini; A., GALINDO URIBARRI; D., Shapira; C., Beck; B., Borderie; R., Bougault; R., Dayras; G., DE ANGELIS; P., Lautesse; N., LE NEINDRE; D'Onofrio, Antonio; M., Parlog; D., Pierroutsakou; F., Rejmund; M. F., Rivet; M., Romoli; AND R., Royl

BACKGROUND The objective of this study was to evaluate the usefulness of resection of metastatic uveal melanoma and to analyze the characteristics of patients who may benefit from surgical intervention. PATIENTS AND METHODS Twelve patients underwent surgical removal of metastasis between 1976 and 1998. Data regarding primary uveal melanoma, systemic metastasis, surgical procedures, and outcomes were reviewed retrospectively. RESULTS There were seven patients with liver metastases, two with lung metastases, one with brain metastasis, and two patients with metastases in the liver and other organs. Median time to systemic metastasis was 8 years. Seven of 12 patients were asymptomatic when they were found to have metastasis. Ten patients underwent complete resection of metastasis. No significant surgical complications were experienced. Median recurrence free and overall survival periods after complete resection were 19 months (range, 6–78 months) and greater than 27 months (range, 11–86 months), respectively. Recurrence free and overall 5-year survival rates of those patients were 15.6% and 53.3%, respectively. Three of these patients had no further systemic recurrence. All patients whose time to systemic metastasis was within 5 years developed further systemic recurrence within 2 years after surgery. In contrast, in 8 patients whose time to systemic metastases was greater than 5 years, 4 patients either were recurrence free or developed second metastasis more than 4 years after surgery. CONCLUSIONS Complete surgical removal of metastatic uveal melanoma provided unexpectedly long survival without significant morbidity for the selected patients. These results are encouraging and justify a trial in which patients eligible for resection are randomized between standard treatment and surgery. Cancer 2000;89:1561–8. © 2000 American Cancer Society.

International audience; Multi-breakup processes for the $^{124}$Sn+$^{64}$Ni system at 35 MeV/nucleon have been studied with the forward part of the CHIMERA detector. An extensive comparison between experimental data corresponding to almost complete ternary events and constrained molecular dynamics (CoMD-II) calculations suggests different characteristic times in the selected processes. This is in agreement with previous studies of the same reaction already published concerning the prompt intermediate-mass-fragment emission. Stimulated by CoMD-II calculations, we investigate the existence of more complex dynamical multi-breakup processes occurring on the same time scale. A detailed study of the rotational dynamics leading to slower dynamical fission processes is also presented.

Excision of staphylococcal cassette chromosome mec (SCC mec ) is mediated through the ccrA - and - B -encoded recombinases. We investigated the effects of different antimicrobial agents on ccrA expression by using a ccrA :: lacZ fusion and reverse transcription-PCR with methicillin (meticillin)-resistant Staphylococcus aureus strains MW2 (SCC mec IVa) and N315 (SCC mec II). Upregulation of ccrA was observed upon exposure to β-lactam antibiotics. Vancomycin increased ccrA expression in MW2 but had no effect on N315. Vancomycin may contribute to the transfer of SCC mec IVa but have no effect in SCC mec II.

Matière Nucléaire NIM; Semiperipheral collisions in the $^{124}$Sn+${64}Ni reaction at 35 MeV/nucleon were studied using the forward part of the Charged Heavy Ion Mass and Energy Resolving Array. Nearly completely determined ternary events involving projectilelike fragments (PLF), targetlike fragments (TLF), and intermediate mass fragments (IMF) were selected. A new method of studying the reaction mechanism, focusing on the analysis of the correlations between relative velocities in the IMF+PLF and IMF+TLF subsystems, is proposed. The relative velocity correlations provide information on the time sequence and time scale of the neck fragmentation processes leading to production of IMFs. It is shown that the majority of light IMFs are produced within 40–80 fm/c after the system starts to reseparate. Heavy IMFs are formed at times of about 120 fm/c or later and can be viewed as resulting from two-step (sequential) neck rupture processes.

The quality of the water from 62 home wells in a section (with no sewerage system) of the agricultural-industrial area of La Plata, was analyzed. The measurement of the studied parameters concentrations were compared with those obtained in seventeen water wells located in another area of town, with commercial characteristics. The pH, total dissolved salts (TDS), nitrates, chlorides, total hardness (TH) and coliform bacteria, these being differentiated between colifaecals and IAC group bacteria, were studied. The average concentration of TDS was 619 and 497 mg L-1 respectively. 34% of the samples exceeded the limit of 45 mg L-1 established by the World Health Organization (WHO). The nitrate levels varied widely from 6 to 216 mg L-1, with an average value of 56 mg L-1 in the agricultural area, and between 5 and 61 mg L-1 in the commercial area, with an average of 19 mg L-1. The average concentrations of chlorides and TH were 89 mg L-1 and 177 mg L-1, respectively in the agricultural area; while in the other area, the average levels were 38 mg L-1 chloride and 107 mg L-1 TH. Significant differences were observed between the chemical parameters evaluated in the two areas analyzed. E. Coli bacterium was detected in 49% of the well water samples analyzed. IAC group bacteria were confirmed in 28% of the samples. The average depth of the water wells within 10 m from the cesspits was 28.2 m, and those situated farther than 10 m. had an average of 39.9 m depth. Results indicated a remarkable quality degradation of the well waters as regards their contents of E. Coli bacteria and nitrate. This could be due to the deficient construction of the absorption wells, to their closeness with cesspits and the inexistence of septic chambers within every dwelling.

OBJECTIVE: The objective of the study was to analyze a single center's experience in the treatment of pancreatic carcinoma with a combination of pancreatic resection and intraoperative radiation therapy (IORT). SUMMARY BACKGROUND DATA: Pancreatic cancer is the most lethal form of gastrointestinal malignancy. Historically, it carries a 20% 1-year survival and a 5-year survival of 3% to 5%. Since 1987, patients at Thomas Jefferson University Hospital have been offered IORT in an attempt to improve their survival. METHODS: The authors reviewed all patients treated at Thomas Jefferson University Hospital with pancreatic adenocarcinoma from 1987 to 1994. From this population, 14 patients were identified who received IORT in conjunction with curative surgery. Duration of hospital stay, perioperative complications, duration of postoperative ileus, and survival were assessed by retrospective review. RESULTS: Of the 14 patients, 6 were male and 8 were female. Patient median age was 61. Six patients had stage I disease, 2 had stage II, 6 had stage III. Two patients had total pancreatectomy, 2 had distal pancreatectomy, and the remaining had pancreaticoduodenectomy (Whipple resection). Median survival was 16 months with a 15.5% 5-year survival. Postoperative complications, duration of hospital stay, and duration of postoperative ileus were not adversely affected by the addition of IORT when compared to in-house control subjects. CONCLUSIONS: Intraoperative radiation therapy is a useful adjunct to surgical resection as treatment of pancreatic cancer. The authors' data suggested it can prolong median survival and long-term survival without adding significant morbidity.

Background Intraoperative ultrasound has been shown to provide significant assistance in operative staging and management of patients with liver tumors during open surgery. The availability of the 5.0–7.5 Mhz semiflexible ultrasound transducer with gray-scale, color and spectral Doppler capabilities can provide similar information laparoscopically. Methods Twenty-four consecutive patients with liver tumors (18 metastatic and six primary), in technically resectable locations determined by a variety of conventional imaging studies, were brought to the operating room. There was no known extrahepatic disease, and there was no recurrence at the primary site in the metastatic subgroup. These patients were evaluated intraoperatively with laparoscopy and intraoperative laparoscopic ultrasound to assess resectability prior to performing a major laparotomy. Laparoscopy was successful in 23 of the patients and in 19 of 23, laparoscopic ultrasound was also employed, using the 5.0–7.5 MHz semi-flexible transducer. The use of the open entry technique, selection of alternate entry sites, coupled with expertise in laparoscopic lysis of adhesions, has allowed safe laparoscopic tumor staging. Results The laparoscopic evaluation was aborted only once due to dense adhesions, despite the fact that 67% of the patients had undergone previous abdominal surgery. There was only one complication: bleeding from a liver biopsy in an unresectable cirrhotic patient, necessitating laparotomy. Laparoscopy and ultrasound together predicted nonresectability in six of eight unresectable patients, all of whom were spared an unnecessary laparotomy. Conclusions Laparoscopic ultrasonographic evaluation for the staging of liver tumors should be a prerequisite to definitive laparotomy, with the objective of avoiding unncessary surgery. J. Surg. Oncol. 64: 63–67 © 1997 Wiley-Liss, Inc.

Simulations based on experimental data obtained from multifragmenting quasi-fused nuclei produced in central $^{129}$Xe + $^{nat}$Sn collisions have been used to deduce event by event freeze-out properties in the thermal excitation energy range 4-12 AMeV [Nucl. Phys. A809 (2008) 111]. From these properties and the temperatures deduced from proton transverse momentum fluctuations, constrained caloric curves have been built. At constant average volumes caloric curves exhibit a monotonic behaviour whereas for constrained pressures a backbending is observed. Such results support the existence of a first order phase transition for hot nuclei., 14 pages, 5 figures, accepted in Physics Letters B

The SOS response, a conserved regulatory network in bacteria that is induced in response to DNA damage, has been shown to be associated with the emergence of resistance to antibiotics. Previously, we demonstrated that heterogeneous (HeR) MRSA strains, when exposed to sub-inhibitory concentrations of oxacillin, were able to express a homogeneous high level of resistance (HoR). Moreover, we showed that oxacillin appeared to be the triggering factor of a β-lactam-mediated SOS response through lexA/recA regulators, responsible for an increased mutation rate and selection of a HoR derivative. In this work, we demonstrated, by selectively exposing to β-lactam and non-β-lactam cell wall inhibitors, that PBP1 plays a critical role in SOS-mediated recA activation and HeR-HoR selection. Functional analysis of PBP1 using an inducible PBP1-specific antisense construct showed that PBP1 depletion abolished both β-lactam-induced recA expression/activation and increased mutation rates during HeR/HoR selection. Furthermore, based on the observation that HeR/HoR selection is accompanied by compensatory increases in the expression of PBP1,-2, -2a, and -4, our study provides evidence that a combination of agents simultaneously targeting PBP1 and either PBP2 or PBP2a showed both in-vitro and in-vivo efficacy, thereby representing a therapeutic option for the treatment of highly resistant HoR-MRSA strains. The information gathered from these studies contributes to our understanding of β-lactam-mediated HeR/HoR selection and provides new insights, based on β-lactam synergistic combinations, that mitigate drug resistance for the treatment of MRSA infections.

We will discuss new experimental data concerning the elastic resonant scattering of α- particles on 9Be nuclei at bombarding energies from 3.5 MeV up to 9.9 MeV. Several excitation functions have been obtained at different polar angles, mainly in the backward hemisphere in the centre of mass frame. Excitation functions show various anomalies that can be linked to the presence of various excited states in the 13C compound nucleus. In the literature, some of these states have been proposed to belong to rotational bands built on deformed a-cluster excited state. Unfortunately, up to date the spin-parity assignment of many of these states is doubtful. The set of excitation functions we obtained from the present experiment can contribute to improve spectroscopy of highling excited states of 13C.

The investigation of the 19F(p, α0) reaction at low bombarding energies allows the study of the spectroscopy of the 20Ne compound nucleus in an energy region where the existence of quartet excitations has been suggested in the literature. Moreover, this reaction plays a major role in the fourth branch of the CNO cycle since it is relevant for the correct description of the hydrogen burning of fluorine in stars. For these reasons, we decided to investigate the 19F(p, α0) reaction in the Ep ≃ 0.6-1 MeV energy range. The analysis of angular distributions and excitation functions allows one to improve the 20Ne spectroscopy in an excitation energy region where some ambiguities concerning Jπ assignments exist in the literature. In particular, the present data suggest a Jπ = 0 + assignment to the Ex = 13.642 MeV resonance. For this state, both partial and reduced widths for the α0 channel have been deduced. The trend of the astrophysical factor has been obtained from the integrated cross section. A comparison of the present results with data reported in the literature is also discussed.

Laparoscopic surgery has been accepted as the surgery of choice for many diagnostic and therapeutic abdominal procedures because of decreased morbidity, reduced cost, and improvement in long-term outcomes compared with open procedures. However, this approach has inherent limitations in the evaluation of diseases concealed within solid organs, hollow viscera, or the retroperitoneum. Laparoscopic ultrasound, which evolved from the concepts of intraoperative and endoscopic ultrasound, opens a whole new dimension to accurately diagnose and treat conditions laparoscopically. This technique shows promise of becoming a valuable new adjunct to a variety of laparoscopic procedures for the diagnosis and treatment of various abdominal and pelvic abnormalities.

A 4 pi multidetector array with a high efficiency has been used ia detect the charged products from reactions induced by Ar-36 on Al-27 at energies ranging from 55 to 95 MeV/u. Well characterized events were selected and sorted as a function of the impact parameter. Fusion or full stopping events have a very small cross section. Dissipative binary collisions accompanied by pre-equilibrium (mid-rapidity) emission, and followed by de-excitation of the quasi-projectile and quasi-target, were found to dominate for all impact parameters. The mass of the quasi-projectile has been reconstructed from its products and found to be slightly below the projectile mass. Isotropic emission in its rest frame has been observed at all energies and impact parameters, indicating that equilibrated nuclei may have been formed. The excitation energy of the quasi-projectile, determined via calorimetry, and the slope of kinetic energy spectra of alpha-particles were found to increase with incident energy and with decreasing impact parameter. Excitation energies per nucleon above II MeV are reached in a sizable cross section (70 mb). The mass distribution and kinetic energy spectra of emitted particles and fragments are essentially governed by the excitation energy, with a weak dependence on the impact parameter. The evolution of dissipative processes from deep inelastic collisions to the participant-spectator regime is discussed.

The most forward ring (2 ≤ θ ≤ 3°) of the INDRA multidetector has been equipped with 12 plastic phoswich detectors able to withstand the high counting rates encountered at very small angles. Each phoswich detector is composed of a 500 μm thick fast scintillator and a 25 cm thick slow scintillator. Elemental identification is achieved on a fairly large domain, ranging from Z = 1 up to Z = 37. A new method of Z separation, using an identification function technique, is described.

Background. One thousand seventy patients treated conservatively for Stages I and II breast cancer between the years 1982 and 1994 were reviewed. The median follow-up was 40 months with a maximum follow-up of 152 months. Methods. All patients had a wide local excision and lower lymph axillary node dissection followed by radiation therapy. The entire breast received an external beam dose of 4500 cGy at 180 cGy/5 days/week. An additional boost dose of 2000 cGy to the tumor bed was given at the time of lumpectomy (perioperative) with an Ir-192 implant or with electron beam therapy after the external beam therapy. Results. The 5- and 10-year disease specific survival results were 97 and 90%, respectively for Stage I and 87 and 69% for patients with Stage II disease. The 5- and 10-year local control rates were 93 and 85% for Stage I and 92 and 87% for Stage II, respectively. The risk factors for local failure were premenopausal status and estrogen receptor-negative status at the univariate level but at the multivariate level the premenopausal and margins status were significant. Conclusion. These 10-year results were at least equivalent to reported series of similarly staged patients treated by mastectomy. This should encourage more surgeons to offer conservative treatment as an alternative to mastectomy to patients with Stage I and II breast cancer. Cancer 1995 ; 75 :2328-36.

To evaluate a semiflexible ultrasound (US) transducer inserted through a laparoscopic port to image abdominal structures.Laparoscopic US with a 9.6-mm-diameter, 5.0-7.5-MHz semiflexible transducer with gray-scale, color, and spectral Doppler capabilities was performed in three miniature swine and in 25 patients with a variety of abdominal abnormalities.This miniature US probe was used to locate normal structures such as blood vessels, allowing the surgeon to decide the best approach for dissection. Color and spectral Doppler US proved especially useful in differentiating vascular from nonvascular structures. The presence or absence of stones in the gallbladder and common bile duct was readily determined. It was possible to detect masses and to provide guidance for their aspiration or biopsy within abdominal organs. In 10 cases (40%), laparoscopic US helped the surgeon make the decision for clinical management and altered the surgical procedures.Laparoscopic US was useful in assisting laparoscopic evaluation of abnormalities in the abdomen.

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as one of the most important pathogens both in health care and community-onset infections. The prerequisite for methicillin resistance is mecA, which encodes a β-lactam-insensitive penicillin binding protein PBP2a. A characteristic of MRSA strains from hospital and community associated infections is their heterogeneous expression of resistance to β-lactam (HeR) in which only a small portion (≤ 0.1%) of the population expresses resistance to oxacillin (OXA) ≥ 10 µg/ml, while in other isolates, most of the population expresses resistance to a high level (homotypic resistance, HoR). The mechanism associated with heterogeneous expression requires both increase expression of mecA and a mutational event that involved the triggering of a β-lactam-mediated SOS response and related lexA and recA genes. In the present study we investigated the cellular physiology of HeR-MRSA strains during the process of β-lactam-mediated HeR/HoR selection at sub-inhibitory concentrations by using a combinatorial approach of microarray analyses and global biochemical profiling employing gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS) to investigate changes in metabolic pathways and the metabolome associated with β-lactam-mediated HeR/HoR selection in clinically relevant heterogeneous MRSA. We found unique features present in the oxacillin-selected SA13011-HoR derivative when compared to the corresponding SA13011-HeR parental strain that included significant increases in tricarboxyl citric acid (TCA) cycle intermediates and a concomitant decrease in fermentative pathways. Inactivation of the TCA cycle enzyme cis-aconitase gene in the SA13011-HeR strain abolished β-lactam-mediated HeR/HoR selection demonstrating the significance of altered TCA cycle activity during the HeR/HoR selection. These results provide evidence of both the metabolic cost and the adaptation that HeR-MRSA clinical strains undergo when exposed to β-lactam pressure, indicating that the energy production is redirected to supply the cell wall synthesis/metabolism, which in turn contributes to the survival response in the presence of β-lactam antibiotics.

Simulations based on experimental data obtained from multifragmenting quasifused nuclei produced in central 129Xe + natSn collisions have been used to deduce event by event freeze-out properties on the thermal excitation energy range 4-12 AMeV. From these properties and temperatures deduced from proton transverse momentum fluctuations constrained caloric curves have been built. At constant average volumes caloric curves exhibit a monotonous behaviour whereas for constrained pressures a backbending is observed. Such results support the existence of a first order phase transition for hot nuclei., Comment: 11th International Conference on Nucleus-Nucleus Collisions (NN2012), San Antonio, Texas : United States (2012)

Nontumorous perfusion defects occur during CT arterial portography (CTAP) as normal variants or in cirrhosis, focal fatty infiltration, and portal vein obstruction. The purpose of this study was to determine whether delayed CT 4-6 hr after CTAP improves sensitivity to hepatic tumors and differentiates them from other hepatic perfusion defects.CTAP was done at 1-cm increments on 26 patients for evaluation of hepatic tumors. Delayed CT scans were obtained 4-6 hr later in all patients. Two observers retrospectively reviewed the CT scans obtained during CTAP and recorded size, shape, and location of suspected hepatic tumors. Confidence levels were assigned for each tumor. The delayed CT scan was then interpreted in conjunction with the CT scans obtained during CTAP, and confidence levels were reassigned. Surgical correlation was obtained for all patients. In the 26 patients, 86 masses were found at surgery. The sensitivity and number of false-positives for both CTAP alone and CTAP combined with delayed CT were compared with a two-tailed Student t-test. Receiver-operating-characteristic analysis also was performed.CTAP detected 73 (85%) of the 86 hepatic masses. Delayed CT had no effect on the sensitivity of CTAP. However, adding delayed CT decreased the total number of false-positives by 11, a statistically significant difference (p.05). Receiver-operating-characteristic analysis revealed a significantly greater (p.05) area under the curve (Az index) of 0.927 +/- 0.025 for CTAP combined with delayed CT compared with 0.886 +/- 0.032 for CTAP alone. Delayed CT was most useful for larger (1 cm) wedge-shaped perfusion defects and least useful for smaller (1 cm) round defects.Delayed CT has no effect in detecting tumors but may be useful for differentiating tumors from other hepatic perfusion defects seen on CTAP. The greatest benefit of delayed CT is in evaluating regions obscured by large wedge-shaped perfusion defects on CT scans obtained during CTAP.

Median arcuate ligament syndrome results from external compression of the celiac axis by attachments of the diaphragmatic crura. It has been treated with open or laparoscopic surgical decompression of the celiac axis with neurolysis. We describe our initial experience treating three patients using a robotic-assisted technique with median arcuate ligament release and celiac neurolysis. Average operative time was 2.2 hours. No intraoperative complications occurred. At an average of 11 months postoperative (14, 11, and 8 months), two patients continue with resolution of preoperative symptoms. Our experience affirms that further study using the robotic approach appears warranted.

Daptomycin (DAP) is a new class of cyclic lipopeptide antibiotic highly active against methicillin-resistant Staphylococcus aureus (MRSA) infections. Proposed mechanisms involve disruption of the functional integrity of the bacterial membrane in a Ca-dependent manner. In the present work, we investigated the molecular basis of DAP resistance in a group of isogenic MRSA clinical strains obtained from patients with S. aureus infections after treatment with DAP. Different point mutations were found in the mprF gene in DAP-resistant (DR) strains. Investigation of the mprF L826F mutation in DR strains was accomplished by inactivation and transcomplementation of either full-length wild-type or mutated mprF in DAP-susceptible (DS) strains, revealing that they were mechanistically linked to the DR phenotype. However, our data suggested that mprF was not the only factor determining the resistance to DAP. Differential gene expression analysis showed upregulation of the two-component regulatory system vraSR . Inactivation of vraSR resulted in increased DAP susceptibility, while complementation of vraSR mutant strains restored DAP resistance to levels comparable to those observed in the corresponding DR wild-type strain. Electron microscopy analysis showed a thicker cell wall in DR CB5012 than DS CB5011, an effect that was related to the impact of vraSR and mprF mutations in the cell wall. Moreover, overexpression of vraSR in DS strains resulted in both increased resistance to DAP and decreased resistance to oxacillin, similar to the phenotype observed in DR strains. These results support the suggestion that, in addition to mutations in mprF , vraSR contributes to DAP resistance in the present group of clinical strains.

The cross section, kinetic energy distribution and angular distribution of frag- ments with atomic number 3 Z 28 emitted in the reaction 78 Kr + 40 Ca at the bombard- ing energy of 5.5 MeV/nucleon and coincidence between light charged particles and frag- ments were measured by means of the 4 -INDRA array to study the decay mechanism of medium mass excited nucleus. Global features indicate a high degree of relaxation and are compatible with a binary fission from compound nucleus. The mean value of the kinetic energy distributions of fragments indicates dominance of Coulomb interaction, while the width of the distribution signals large fluctuations. Inclusive cross-section distributions of fragments with charge 3 Z 28 are bell-shaped and a strong even-odd-staggering (o-e- s) is observed for 3 Z 12. Coincidence measurements suggest that the light partners in very asymmetric fission are emitted at excitation energies below the particle emission thresholds. Data were confronted to the predictions of statistical model describing the decay of compound nuclei by emission of light particles and fragments. Calculations as- suming spherical fission fragments and finite-range liquid drop fission barriers are not able to explain the experimental features. Attempts have been made to improve the agreement with experimental data. The analysis indicates the strong influence of the shape parame- terization of the potential energy surface in describing the fission process of intermediate mass compound nuclei.

Over the past 10 years, minimally invasive esophagectomy has become an accepted approach to the management of esophageal and gastroesophageal benign and malignant neoplasms. There are many interpretations of the minimally invasive esophagectomy. Currently, the most frequently performed surgeries include combined thoracoscopic esophageal mobilization and laparoscopic gastric mobilization with creation of a cervical esophagogastrostomy anastomosis (“3-hole” esophagectomy); laparoscopic Ivor-Lewis technique, utilizing a laparoscopic mobilization of the stomach followed by a thoracoscopic intrathoracic esophagogastrostomy anastomosis; laparoscopic transhiatal esophagectomy, utilizing a laparoscopic mobilization of the stomach and a trans-abdominal laparoscopic mediastinal esophageal dissection, combined with a cervical esophageal blunt dissection and creation of an esophagogastrostomy anastomosis in the neck.

During a multicentre study performed in 26 French hospitals, 287 (3.2%) of 9038 Enterobacteriaceae isolated, mainly Enterobacter spp., Serratia spp., Citrobacter spp. and Klebsiella spp. were classified as ceftriaxone resistant on the basis of an MIC > 4 mg/L or the presence of an extended-spectrum beta-lactamase. Extended-spectrum beta-lactamase was present mainly in Klebsiella pneumoniae (65 strains, 10.2%) and very rarely in Escherichia coli, Proteus mirabilis, Klebsiella oxytoca, Citrobacter spp. and Enterobacter spp. The extended-spectrum beta-lactamases conferred low-level resistance to ceftriaxone in nearly 60% of the strains harbouring them, emphasizing the need for routine testing for the presence of these enzymes. Among transconjugants three types of extended-spectrum beta-lactamase were identified. Those resembling TEM-3 were the most common, but TEM-21, and SHV-4 were also found. Clavulanate and to a lesser extent sulbactam inhibited all the extended-spectrum beta-lactamases encountered in this study.

Expérience GANIL; Nuclear stopping has been investigated in central nuclear collisions at intermediate energies by analyzing kinematically complete events recorded with the help of the 4π multidetector INDRA for a large variety of symmetric systems. It is found that the mean isotropy ratio defined as the ratio of transverse to parallel momenta (energies) reaches a minimum near the Fermi energy, saturates or slowly increases depending on the mass of the system as the beam energy increases, and then stays lower than unity, showing that significant stopping is not achieved even for the heavier systems. Close to and above the Fermi energy, experimental data show no effect of the isospin content of the interacting system. A comparison with transport model calculations reveals that the latter overestimates the stopping power at low energies.