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Background and aim Peritoneal free cancer cells (FCC) in patients with gastric cancer (GC) is poor prognostic factor. D2 gastrectomy dissection may induce exfoliated FCC spread from primary tumour or involved lymph nodes (LN). Conventional cytology for FCC detection has several limitations, and prophylactic use of extensive intraoperative peritoneal lavage (IPL) does not improve survival. A prospective single-arm observational study was conducted to verify whether D2 gastrectomy causes an increase of FCC in peritoneal lavage as in patients with GC following D2 gastrectomy. Methods Thirty GC patients underwent D2 gastrectomy, followed by objective quantitative measurements of CK19 mRNA level reflecting FCC with One-Step Nucleic Acid Amplification (OSNA) assay. The IPL with 3000 cc of saline was performed twice after: (1) gastrectomy with D2 lymphadenectomy; and (2) alimentary tract reconstruction. The IPL samples were analysed by initial cytology and four (1–4) consecutive OSNA assays (Figure 1). Three patients were excluded due to positive cytology in samples obtained after laparotomy. Results Initial OSNA measurement (1) revealed positive results (≥24.6 cCP/μl) in 7 (29.6%) patients. Subsequent OSNA measurements revealed a significant decrease in the FCC level after removal of the primary tumour with regional LNs (D2 gastrectomy) (1 vs 2; medians [95%CI]: 4.6 [1.1–18.5] vs. 0.00004 [0–0.2] cCP/μl; P = 0.0012). The first IPL induced non-significant increase in the FCCs (2 vs 3, medians [95%CI]: 0.00004 [0–0.2] vs 0 [0–0.5] cCP/μl; P = 0.3300), but the second IPL reversed it to normal levels (3 vs 4, medians [95%CI]: 0 [0–0.5] vs 0 [0–0] cCP/μl; P = 0.0.0574). At this point of operation, additional finding was a trend toward temporal increase of FCC in patients with LN involvement (pN1–3)(2 vs 3; medians [95%CI]: 0 [0–0.2] vs 0 [0–42.8] cCP/μl; P = 0.0674). One patient was still positive (FCC) at the end of operation as measured by OSNA (4). Conclusion D2 Gastrectomy does not induce increase in the peritoneal FCCs. Temporal intraoperative increase in peritoneal FCC after the IPL may be observed, especially in tumours with LN metastases. At least two consecutive IPLs (with min. 3000 mL of saline) are necessary to reverse temporal increase of peritoneal FCC.

In this work, the Ni3Al-based intermetallic alloy was subjected to room temperature dynamic plastic deformation tests by using a split Hopkinson pressure bar technique. The dynamic compression processes were carried out at strain rates in the range of =(1.9x102 / 1x104 s-1). A strong impact of applied deformation conditions on microstructure and mechanical properties evolution in the examined Ni3Al intermetallic, was documented. Generally, very high maximum compressive stress values were obtained, reaching 5500 MPa for the sample deformed at the highest strain rate (i.e. ??=1x104 s-1). The results of performed SEM/EBSD evaluation point towards an occurrence of dynamic recovery and recrystallization phenomena in Ni3Al samples deformed at high strain rates.

Background Improvements in local control are required when using preoperative chemoradiation for cT4 or advanced cT3 rectal cancer. There is therefore a need to explore more effective schedules. Patients and methods Patients with fixed cT3 or cT4 cancer were randomized either to 5 × 5 Gy and three cycles of FOLFOX4 (group A) or to 50.4 Gy in 28 fractions combined with two 5-day cycles of bolus 5-Fu 325 mg/m2/day and leucovorin 20 mg/m2/day during the first and fifth week of irradiation along with five infusions of oxaliplatin 50 mg/m2 once weekly (group B). The protocol was amended in 2012 to allow oxaliplatin to be then foregone in both groups. Results Of 541 entered patients, 515 were eligible for analysis; 261 in group A and 254 in group B. Preoperative treatment acute toxicity was lower in group A than group B, P = 0.006; any toxicity being, respectively, 75% versus 83%, grade III–IV 23% versus 21% and toxic deaths 1% versus 3%. R0 resection rates (primary end point) and pathological complete response rates in groups A and B were, respectively, 77% versus 71%, P = 0.07, and 16% versus 12%, P = 0.17. The median follow-up was 35 months. At 3 years, the rates of overall survival and disease-free survival in groups A and B were, respectively, 73% versus 65%, P = 0.046, and 53% versus 52%, P = 0.85, together with the cumulative incidence of local failure and distant metastases being, respectively, 22% versus 21%, P = 0.82, and 30% versus 27%, P = 0.26. Postoperative and late complications rates in group A and group B were, respectively, 29% versus 25%, P = 0.18, and 20% versus 22%, P = 0.54. Conclusions No differences were observed in local efficacy between 5 × 5 Gy with consolidation chemotherapy and long-course chemoradiation. Nevertheless, an improved overall survival and lower acute toxicity favours the 5 × 5 Gy schedule with consolidation chemotherapy. Clinical trial number The trial is registered as ClinicalTrials.gov number NCT00833131.

AMADEUS es un proyecto europeo que investiga materiales y dispositivos de estado sólidopara almacenar energía a muy alta temperatura. Usando aleados de silicio como materialesde cambio de fase se alcanzan calores latentes superiores a 1000 kWh/m3, propiciando laobtención de altísimas densidades energéticas. Dichos aleados suponen temperaturas dealmacenamiento por encima de los 1000 ºC, muy por encima de las de los sistemas actualesde acumulación térmica. El artículo describe las actividades del proyecto y sus primerosresultados, explicando los principales retos de este nuevo sistema que combina laacumulación de energía en forma de calor en silicio fundido con dispositivos de estado sólidotermiónicos y termofotovoltaicos para la posterior conversión en electricidad.

AMADEUS es un proyecto europeo que investiga materiales y dispositivos de estado sólido para almacenar energía a muy alta temperatura. Usando aleados de silicio como materiales de cambio de fase se alcanzan calores latentes superiores a 1000 kWh/m3, propiciando la obtención de altísimas densidades energéticas. Dichos aleados suponen temperaturas de almacenamiento por encima de los 1000 ºC, muy por encima de las de los sistemas actuales de acumulación térmica. El artículo describe las actividades del proyecto y sus primeros resultados, explicando los principales retos de este nuevo sistema que combina la acumulación de energía en forma de calor en silicio fundido con dispositivos de estado sólido termiónicos y termofotovoltaicos para la posterior conversión en electricidad. AMADEUS is a H2020 project that researches on materials and solid-state devices for very high temperature energy storage and conversion. By exploring silicon-based alloys as new phase change materials (PCMs), latent heat higher than 1000 kWh/m3 is achievable, which implies a very high energy density. In addition, silicon-based PCMs lead to storage temperatures well beyond 1000 ºC, well beyond that of current state-of-the-art thermal energy storage (TES). This paper describes the project R&D activities and first results, and comments on challenges towards a new kind of systems combining latent heat energy storage in molten silicon with thermionic and thermophotovoltaic solid state heat-to-power conversion.

Intestinal-type columnar epithelium in the (distal) oesophagus, known as Barrett’s oesophagus (BO), is a well-defined premalignant condition [32]. The risk for the development of oesophageal adenocarcinoma in a patient with BO is at least 30 times higher as compared to the general population [9]. Invasive cancer in BO, so called Barrett cancer, is preceded by stages of progressively severe dysplastic changes [24]. For a symptomatic Barrett cancer, long-term survival rates are low. Therefore, attention should be focused on early detection of neoplastic changes, preferably in a preinvasive phase, i.e. dysplasia. An accurate and reproducible diagnosis of dysplasia in BO might ultimately lead to targeted therapeutic interventions or cancer prevention in the future. At present, dysplasia in BO is the only clinically accepted marker of neoplastic potential. Strategies for endoscopic surveillance of BO are dictated by the grade of dysplasia on endoscopic biopsy [17,23]. When a diagnosis of low-grade dysplasia is made, surveillance should be intensified by shortening the time intervals between consecutive endoscopies and by applying more aggressive biopsy sampling [35,36]. High-grade dysplasia may indicate imminent progression into invasive carcinoma or even its occult presence [1,5,10,18,27,30]. When the diagnosis of (persis

OBJECTIVES: A distinctive type of columnar epithelium with intestinal metaplasia is considered diagnostic for Barrett’s esophagus. The neoplastic potential of pancreatic metaplasia at the esophagogastric junction is unknown. The aims of the present study were: 1) to characterize both forms of metaplasia at the esophagogastric junction, and to estimate their prevalence; 2) to investigate c-erbB-2 expression and K-ras mutations in pancreatic metaplasia; and 3) to study the relationship between metaplasia, inflammatory changes in the cardiac mucosa, and presence of H. pylori. METHODS: A total of 76 esophagogastrectomy specimens of patients with a normally located squamocolumnar junction, were investigated immunohistochemically. K-ras mutations were evaluated using PCR. RESULTS: Intestinal metaplasia in the cardia was found in 12% of patients: six complete-type, and three incomplete-type. Pancreatic metaplasia was demonstrated in 14% of patients, and neither c-erbB-2 expression nor K-ras mutations were found. Intestinal and pancreatic metaplasia were associated with mucosal inflammation. In contrast to generalized gastritis, isolated “carditis” was not associated with H. pylori infection. CONCLUSIONS: When intestinal metaplasia occurs in a biopsy from the esophagogastric junction, it is not necessarily a marker for Barrett’s esophagus. No indication was found that pancreatic metaplasia has neoplastic potential. Both forms of metaplasia reflect mucosal inflammation. Carditis may be a distinct inflammatory condition of the gastric mucosa that is not related to H. pylori infection.

The prognostic value of the Laurén classification and of c-erbB-2 oncogene overexpression has been described for gastric cancer. The aim of this study was to investigate the clinical significance of these factors in adenocarcinoma of the esophagus and/or gastroesophageal junction (GEJ). Forty-one adenocarcinomas of the esophagus and/or GEJ were reviewed for tumor stage, lymph node status, Laurén classification, and c-erbB-2 overexpression, as assessed by immunohistochemical analysis. According to the Laurén classification, tumors were classified as intestinal-, mixed-, or diffuse-type (54%, 32%, and 15%, respectively). Diffuse-type tumors were associated with a significantly worse prognosis than were intestinal-type tumors (P = .018; log-rank test). The prognostic value of the Laurén classification was independent of stage (P = .048; Cox regression model). Overexpression of c-erbB-2 was detected in 24% of the tumors and was present exclusively in intestinal-type tumors and in intestinal-type areas of mixed-type tumors. Ten of the 30 stage III/IV tumors (33%) were c-erbB-2-positive, whereas none of the 11 stage I/II tumors (0%) overexpressed the oncogene product (P = .04; Fisher exact test). The prognostic value of c-erbB-2 overexpression was not independent of stage (P = .7; Cox regression model). (1) The Laurén classification is an independent prognostic factor in adenocarcinoma of the esophagus and GEJ. (2) c-erbB-2 overexpression is limited to (areas of) intestinal-type tumors, indicating that intestinal- and diffuse-type tumors differ oncogenetically. (3) c-erbB-2 overexpression is associated with the stage of disease, indicating that it is a late event during tumor progression

A joint analysis of clinical data from centres within the European section of the International Society of Intraoperative Radiation Therapy (ISIORT-Europe) was undertaken in order to define the range of intraoperative radiotherapy (IORT) techniques and indications encompassed by its member institutions. In 2007, the ISIORT-Europe centres were invited to record demographic, clinical and technical data relating to their IORT procedures in a joint online database. Retrospective data entry was possible. The survey encompassed 21 centres and data from 3754 IORT procedures performed between 1992 and 2011. The average annual number of patients treated per institution was 42, with three centres treating more than 100 patients per year. The most frequent tumour was breast cancer with 2395 cases (63.8 %), followed by rectal cancer (598 cases, 15.9 %), sarcoma (221 cases, 5.9 %), prostate cancer (108 cases, 2.9 %) and pancreatic cancer (80 cases, 2.1 %). Clinical details and IORT technical data from these five tumour types are reported. This is the first report on a large cohort of patients treated with IORT in Europe. It gives a picture of patient selection methods and treatment modalities, with emphasis on the main tumour types that are typically treated by this technique and may benefit from it.

Serum total bile acids (tBA) determination is a non-invasive, simple and very sensitive diagnostic test in evaluation of liver disorders. However, its usefulness is limited by lack of the data on normal value range of serum tBA concentrations in children, especially neonates and infants. The aim of the study was evaluation of serum tBA concentrations according to the age and gender of children, and their comparison with the values found in adults.Serum tBA concentration measurements were performed using enzymatic-colorimetric test Enzabile (Nycomed Pharma, N) in blood samples collected 3 hours after last meal in newborns and infants, and fasting in children over 1 year of age. The studied children were healthy, without any abnormalities on physical examination. In adults, the measurements were performed in fasting patients with inguinal hernia without any other concomitant diseases scheduled for elective surgery. Two hundred seventy eight children (145 females and 133 males) of ages ranging from the 1st day of life to 16 years, and 63 adults (39 males and 24 females) were investigated.Serum tBA concentrations in newborns (mean (SD: 19.6 +/- 5.2 mumol/l) were significantly higher than the values found in adults (5.1 +/- 2.9 mumol/l). Serum tBA concentrations increased gradually after delivery, with peak values occurring at the age of 1 month (22.2 +/- 5.1 mumol/l), which then gradually declined to nearly adult levels. No gender-related differences were observed in serum tBA concentrations in children.It is mandatory to refer to the age of the patient, interpreting values of serum tBA concentration in children.

EXPERIENCE WITH IORT AS INTRAOPERATIVE INTENSIFICATION THERAPY IN THE TREATMENT OF LOCALLY ADVANCED RETROPERITONEAL AND PELVIC SARCOMAS E. Velasco Sanchez1, J. L. Garcia-Sabrido1, F. Calvo2, L. Gomez Lanz1, L. Gonzalez-Bayon1, L. Rodriguez-Bachiller1, B. Diaz-Zorita1, E. Ruiz Ucar1, P. Alvarez de Sierra1 1 HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARANON, Oncological Surgery, Madrid, Spain 2 HOSPITAL GREGORIO MARANON, Oncology and Radiotherapy, Madrid, Spain

Decision models for surveillance of Barrett's oesophagus (BO) are governed by the grade of dysplasia on endoscopic biopsy, but subjective grading is prone to observer variation. Computerized morphometry and immunoquantitation can objectively discriminate between different grades of dysplasia in oesophagectomy specimens with BO. The present study evaluated the feasibility of such quantitative analysis on surveillance biopsies of BO. Biopsy criteria for quantitative analysis were defined, excluding 101 (21%) of 472 archival BO surveillance biopsies. In the remaining haematoxylin and eosin (HE) sections, 105 areas that distinctively displayed no dysplasia (ND), low-grade dysplasia (LGD) or high-grade dysplasia (HGD) were demarcated. Agreement on double-blind examination by two experienced pathologists was reached in 66 areas (63%; kappa: 0.44). For 21 ND/LGD and 11 LGD/HGD disagreement areas, corresponding sections for p53 and Ki67 immunohistochemistry were available. The best combination of two discriminating features was stratification index (SI) with p53 area % for ND versus LGD (89% correct classification), and SI with Ki67 area % for LGD versus HGD (91% correct classification). Fifteen of the 21 ND/LGD disagreement areas could be classified uniquely as either ND or LGD by SI and p53, and eight of the 11 LGD/HGD disagreement areas as either LGD or HGD by SI and Ki67. Correlation coefficients for repeated measurements of SI, Ki67, and p53 by the same observer were 0.94, 0.92, and 0.86, and by two independent observers 0.86, 0.93, and 0.92, respectively. Computerized quantitative pathology on BO surveillance biopsies is feasible provided that well-defined biopsy criteria are used. Using a combination of features associated with cellular differentiation and proliferation, such as SI, p53, and Ki67, quantitative pathological analysis assists in reducing diagnostic variability in the grading of dysplasia during surveillance of BO.

Decision models for surveillance of Barrett's oesophagus (BO) are governed by the grade of dysplasia on endoscopic biopsy, but subjective grading is prone to observer variation. Computerized morphometry and immunoquantitation can objectively discriminate between different grades of dysplasia in oesophagectomy specimens with BO. The present study evaluated the feasibility of such quantitative analysis on surveillance biopsies of BO. Biopsy criteria for quantitative analysis were defined, excluding 101 (21%) of 472 archival BO surveillance biopsies. In the remaining haematoxylin and eosin (H&E) sections, 105 areas that distinctively displayed no dysplasia (ND), low-grade dysplasia (LGD) or high-grade dysplasia (HGD) were demarcated. Agreement on double-blind examination by two experienced pathologists was reached in 66 areas (63%; kappa: 0.44). For 21 ND/LGD and 11 LGD/HGD disagreement areas, corresponding sections for p53 and Ki67 immunohistochemistry were available. The best combination of two discriminating features was stratification index (SI) with p53 area % for ND versus LGD (89% correct classification), and SI with Ki67 area % for LGD versus HGD (91% correct classification). Fifteen of the 21 ND/LGD disagreement areas could be classified uniquely as either ND or LGD by SI and p53, and eight of the 11 LGD/HGD disagreement areas as either LGD or HGD by SI and Ki67. Correlation coefficients for repeated measurements of SI, Ki67, and p53 by the same observer were 0.94, 0.92, and 0.86, and by two independent observers 0.86, 0.93, and 0.92, respectively. Computerized quantitative pathology on BO surveillance biopsies is feasible provided that well-defined biopsy criteria are used. Using a combination of features associated with cellular differentiation and proliferation, such as SI, p53, and Ki67, quantitative pathological analysis assists in reducing diagnostic variability in the grading of dysplasia during surveillance of BO

Partial gastrectomy is a well-established pre-malignant condition. It is postulated that in the gastric stump an accelerated neoplastic process takes place, similar to that of (intestinal type) adenocarcinoma from the non-operated stomach. K-ras codon 12 mutation is one of the most frequent oncogenic alterations in human solid neoplasms. It is rare in conventional gastric carcinoma and has not been studied in gastric stump carcinoma. The aim of this study was to compare the prevalence of K-ras codon 12 point mutations in gastric stump carcinomas with those in conventional carcinomas from the non-operated stomach.Twenty-four gastric stump carcinomas were compared with 26 conventional gastric carcinomas. Stage, histology, and demographics were comparable in both groups. Mutations in codon 12 of the K-ras gene were examined with a polymerase chain reaction (PCR)-based method and subsequent dot blot hybridization with mutation-specific probes. The results of Helicobacter pylori infection, Epstein-Barr virus infection and p53 immunohistochemistry were partially known from a previous study.In one of the gastric stump carcinomas as well as in one of the conventional gastric carcinomas a K-ras codon 12 point mutation was found. p53 immunohistochemistry results were comparable in both groups. Interestingly, Helicobacter pylori infection rate and Epstein-Barr virus in situ hybridization for EBER1, as previously studied, appeared were significantly different in the two groups.K-ras codon 12 point mutations are rare in both gastric stump carcinomas and conventional gastric carcinomas. This supports the postulated hypothesis that the pathways of carcinogenesis in both gastric stump carcinoma and conventional gastric carcinoma share common features. However, these groups differ in infection rate of Helicobacter pylori and of Epstein-Barr virus, which suggests that some neoplastic stimuli differ as well.

A metaplastic process, in which native squamous epithelium of the distal esophagus is replaced by columnar epithelium, is known as Barrett esophagus (BE). Over the past years, intestinal metaplasia was recognized as a marker for BE. The risk for the development of esophageal adenocarcinoma in a patients with BE is much higher when compared to the normal population. Duodeno-gastro-esophageal reflux is supposed to play a role in the pathogenesis of BE and rising incidence of adenocarcinoma of the esophagus. With current therapeutic options, when clinical manifestation of this cancer occurs, it is too late for cure in the majority of patients. Therefore, attention should be focused on early diagnosis, for which molecular genetic techniques might become available. Current data on genetic alterations involved in carcinogenesis of BE are discussed. Grading of dysplasia in BE carries important clinical consequences for the individual patient: intensification of endoscopic surveillance or 'prophylactic esophagectomy'. Several morpho- and/or cytometric parameters may be used for discrimination between different grades of dysplasia in BE. Therefore, a new and original algorythm for the potential application of quantitative pathology in grading of dysplasia in patients with BE has been proposed. Molecular biology together with image analysis of histological spectrum of BE enable better understanding of the mechanisms of malignant degeneration and might ultimately lead to targeted cancer prevention and/or therapeutic interventions.

Grading of dysplasia in Barrett's oesophagus has a therapeutic impact, but subjective grading is associated with substantial observer variation. Quantitative pathological methods could help to achieve a more accurate and reproducible diagnosis. In the present study, the immunoquantitation of p53 and Ki67 and the morphometric analysis of features associated with proliferation and differentiation were evaluated for this purpose. In slides of 35 oesophagectomy specimens, 73 areas that displayed either no dysplasia (ND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal carcinoma (ImCa) were initially considered. Agreement on double blind examination by two experienced pathologists was reached in 58 areas, which were used as the 'learning set'. The 15 areas of disagreement were used as a second set. In the univariate analysis, the most significant differences in the learning set were found for Ki67, p53, stratification index (SI), mean nuclear area, and volume. Further multivariate analysis showed that for discrimination between ND and LGD, the combination of Ki67 and SI resulted in 94 per cent correctly classified areas. Likewise, for the discrimination between LGD and HGD, Ki67 and SI were the most powerful combination (again, 94 per cent of areas classified correctly). The discrimination between HGD and ImCa with any combination of the quantitative parameters never exceeded 80 per cent correct classification. The addition of p53 was of no value in improving the discrimination of ND vs. LGD, or of LGD vs. HGD. In the 15 original disagreement areas of the initial set of 73, three of the five ND/LGD areas could be uniquely classified as either ND or LGD by Ki67 and SI. Moreover, three of the four LGD/HGD disagreement areas could be uniquely classified with the combination of Ki67 and SI as either LGD or HGD. We conclude that the quantitative assessment of cytometric and morphometric features associated with proliferation and differentiation (especially Ki67 and SI) can be a valuable adjunct tool for clinical decision making in Barrett's oesophagus.

Grading of dysplasia in Barrett's oesophagus has a therapeutic impact, but subjective grading is associated with substantial observer variation. Quantitative pathological methods could help to achieve a more accurate and reproducible diagnosis. In the present study, the immunoquantitation of p53 and Ki67 and the morphometric analysis of features associated with proliferation and differentiation were evaluated for this purpose. In slides of 35 oesophagectomy specimens, 73 areas that displayed either no dysplasia (ND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal carcinoma (ImCa) were initially considered. Agreement on double blind examination by two experienced pathologists was reached in 58 areas, which were used as the 'learning set'. The 15 areas of disagreement were used as a second set. In the univariate analysis, the most significant differences in the learning set were found for Ki67, p53, stratification index (SI), mean nuclear area, and volume. Further multivariate analysis showed that for discrimination between ND and LGD, the combination of Ki67 and SI resulted in 94 per cent correctly classified areas. Likewise, for the discrimination between LGD and HGD, Ki67 and SI were the most powerful combination (again, 94 per cent of areas classified correctly). The discrimination between HGD and ImCa with any combination of the quantitative parameters never exceeded 80 per cent correct classification. The addition of p53 was of no value in improving the discrimination of ND vs. LGD, or of LGD vs. HGD. In the 15 original disagreement areas of the initial set of 73, three of the five ND/LGD areas could be uniquely classified as either ND or LGD by Ki67 and SI. Moreover, three of the four LGD/HGD disagreement areas could be uniquely classified with the combination of Ki67 and SI as either LGD or HGD. We conclude that the quantitative assessment of cytometric and morphometric features associated with proliferation and differentiation (especially Ki67 and SI) can be a valuable adjunct tool for clinical decision making in Barrett's oesophagus.

This prospective study was undertaken to assess the motility of the middle and lower esophagus and LES resting pressure changes following the N-R fundoplication for GER. The study was carried out in 53 consecutive patients (37 women, 16 men, median age 49.1 +/- 6.2 years), operated due to antireflux mechanism insufficiency. Threefold solid state for manometry and double channel for pH metry catheters in the body of the esophagus were used before and after the operation (median follow up time was 18 months). The LES length and resting pressure were evaluated with Synectics On-line interface. The objective results obtained during 24-h pH metry and manometry were shown as median and standard deviation, with statistical significances determined using the SPSS/PC+ packet (p0.05 considered as significant). The individual patients' data were analyzed by Synectics software. 24-h pH metry confirmed that Nissen-Rossetti fundoplication efficaciously reduced pathological GER (significant decrease of DeMeester score from 105.6 +/- 12.2 to 5.2 +/- 3.4, p0.0002). Manometry proved the increase of the LES resting pressure from 7.6 +/- 3.2 to 18.2 +/- 4.2, p0.0005, and its total length from 3.1 +/- 0.8 to 4.2 +/- 1.0, p0.01. The improvement of the esophageal body peristalsis was found first of all in total period. Motility changes following N-R fundoplication during the reflux period were unsatisfactory. The frequency of peristalic contractions with higher amplitude and longer duration significantly increased after the operation in total period in all levels. The increase of the complete peristaltic contractions following N-R fundoplication was high significant from 22.15% to 60.21%, p0.0001. Although significant improvement of the efficacy of esophageal peristalis was observed, however it was still under 50% of normal level all the time (15.4% v. 41.7%, p0.002). The most impressive improvement of esophageal peristalis was noticed in the lower part of the esophagus. The increase of the complete peristaltic contractions during the reflux period was observed only in upright position. Least profitable changes in esophageal body motility were noticed during the reflux period in supine position. In comparison with the total period manometry results the efficacy of the esophageal perystalsis during the reflux period was defected before as well as after the operation, (11.2% v. 22.5%, p = NS).

Increasing prevalence of adenocarcinoma of the esophagus and esophago-gastric junction has been reported. The aim of the study was to determine whether this phenomenon is reflected in the cohort of patients referred for surgery to our institution. Clinical and pathological records of patients with adenocarcinoma of the stomach (n = 433) or gastro-esophageal junction (n = 302), and squamous cell carcinoma of the esophagus (n = 266) were reviewed from 1981 to 1996. Yearly prevalence of carcinoma of the gastric cardia in comparison to carcinoma of (a more distal) stomach has not changed, ranging 19-46%. From 1981 to 1984 out of 58 gastric resections, 14 (24%) total gastrectomies were done, whereas from 1993 to 1996 total gastrectomies were performed in 104 out of 138 (75%) patients with gastric cancer (p0.001). In the first 4 years of the study period adenocarcinoma of the cardia and/or esophagus was found in 19% of all patients with esophageal and junctional tumors, while in the last 4 years,-in 30%. Resection rates for gastric and cardiac cancers have not changed significantly, 75-100% and 21-65% respectively. Resection rate for carcinoma of the esophagus increased from 50% (17/34) to 79% (53/67) (p = 0.006, test chi2). Increasing rate of total gastrectomies can be explained by a trend towards more proximal localisation of the primary gastric tumors and/or clinical application of Laurén classification for the choice of operative procedure. Higher resection rate for carcinoma of the esophagus is a result of increasing experience of the surgical team, improvement in preoperative staging, new palliative modalities, and application of preoperative chemo-/radiotherapy.

The aim of the study was to investigate the influence of perioperative changes of the cellular immunity parameters on long-term survival following esophagectomy for carcinoma of the esophagus. In 39 patients several immunological parameters have been assessed before and 2 weeks after the operation: WBC, lymphocyte count, lymphocyte T% (E-rosette test), helper/suppressor lymphocyte T subpopulations (teophylline test), NBT test, and in vivo Multitest CMI (skin delayed hypersensitivity for recall antigens). Survival was analyzed using Kaplan-Meier method according to the stage (pTNM, UICC'92) and to the grade of perioperative cellular immunity (pCI) deterioration. Three groups of patients were identified with: 1) improvement or stabilization of pCI (n = 5); 2) deterioration of 1 or 2 pCI parameters (n = 21); and 3) deterioration of 3 or more pCI parameters (n = 13). Follow-up time ranged from 4 to 65 months. Eight patients died in hospital due to postoperative complications, 3 patients are alive (1 of them with Tis alive at 52 months of follow-up), and the remaining patients died during follow-up. Mean survival time of patients in stage II (n = 7), III (n = 17), and IV (n = 14) was 18, 17, and 6 months respectively (p = 0.017, log rank test). Mean survival time of patients in group 1, 2, and 3 was 21, 20, and 5 months respectively (p0.001, log rank test). On bivariate survival analysis encountering both factors, stage was found to be the only independent prognostic factor (p = 0.008, Cox regression model). Deterioration of the cellular immunity in the perioperative period is entirely related to the stage of the disease, which is the only independent prognostic factor in carcinoma of the esophagus.

In the Barrett's oesophagus (BE) progression from metaplasia, via dysplasia, into invasive cancer, an aberrant cell proliferation governed by genetic change plays a central role. Alterations of the p53 tumour-suppressor gene appear especially critical and, like the proliferation marker Ki67, can be detected by immunohistochemistry. The purpose of this study therefore was to investigate the clinical value of p53 and Ki67 as markers for tumour progression in BE, and at the same time test the validity of the concept of a metaplasia-dysplasia-carcinoma sequence in BE by correlating the expression of these markers with various grades of dysplasia. Thirty-two lesions (seven negative for dysplasia, five indefinite for dysplasia, 11 low-grade dysplasia and nine high-grade dysplasia) from 25 archival resection specimens were selected for study. Increasing grades of dysplasia showed increasingly p53 accumulation; p53 accumulation was never observed in mucosa without dysplasia. The increasing p53 expression was accompanied by an increased Ki67-labelling index and an upward shift of the proliferative compartment. The results lend support to the multistep progression model of a metaplasia-dysplasia-carcinoma sequence in BE. Expression of p53 and Ki67, markers which can be easily applied on archival material, can be valuable adjuncts for the histopathological diagnosis of dysplasia and may have predictive value for cancer risk.

Turbulent flow in an annular gap between coaxial cylinders with the inner cylinder rotating is studied. It is shown that the circumferential and axial flows are independent of each other after the moment of momentum of the axial through flow acquires its final value along certain initial distance of the duct. This implies the applicability of Dorfman’s solution of the momentum equation (developed for a purely circumferential motion) to the system with axial through flow; the moment coefficient is a function of circumferential flow only, being insensitive to the possible existence of Taylor vortices. Using a mixing length profile identical to that used by Dorfman, an analytic solution of the energy equation, which includes dissipation function, is found for a simplified model of Couette flow with crossflow and with constant heat flux at the boundaries. The correlation between the two flow models is assessed. The influence of the thickness of the laminar sublayer and of the mixing length profile on the solution of the momentum and energy equations is quantified.

An influence of the thickness of the laminar sub-layer and mixing length profile on skin friction and heat transfer in the incompressible boundary layer is studied. Solution of the momentum and energy equations for different algebraic expressions for the mixing length is presented. Relationships between the specific forms of Reynolds analogy and boundary conditions (temperature or heat flux) as well as the limitations of Reynolds analogy are discussed.Copyright © 1987 by ASME

This document reports the technical progress during the first year of the AMADEUS project. AMADEUS project (www.amadeus-project.eu) aims to develop a new technology for energy storage based on ultra-high temperature (UHT) latent heat thermal energy storage (LHTES) materials and solid state energy converters. The main motivation of this research is the very high latent heat of silicon and silicon-boron alloys if compared with other kinds of phase change materials (PCM) such as molten salts. Energy densities beyond 1 kWh per liter are attainable, which is among the largest energy densities of any other storage technologies. The main challenge concerning the use of these new PCMs is their ultra-high temperature (UHT) of fusion, which implies several concerns on the material compatibilities for the container, along with other issues such as thermal insulation and heat transfer during melting and solidification. Another relevant aspect is the energy conversion of the latent heat into electricity at very high temperatures. In this regard, solid state energy converters based on radiative (rather than conductive) heat transfer mechanisms are being investigated in this project, i.e. thermionics and thermophotovoltaics. In particular, AMADEUS project investigates a new concept for heat-to-power conversion at UHT named hybrid thermionic photovoltaic (TIPV) converter that directly converts into electricity both the electron and photon fluxes that irradiated by incandescent surfaces.

This documentreports the technical progress during the first year of the AMADEUS project.AMADEUS project (www.amadeus-project.eu) aims to develop a new technology for energy storage based on ultra-high temperature (UHT) latent heat thermal energy storage (LHTES) materials and solid state energy converters. The main motivation of this research is the very high latent heat of silicon and silicon-boron alloys if compared with other kinds of phase change materials (PCM) such as molten salts. Energy densities beyond 1 kWh per liter are attainable, which is among the largest energy densities of any other storage technologies.The main challenge concerning the use of these new PCMs is their ultra-high temperature (UHT) of fusion, which implies several concerns on the material compatibilities for the container, along with other issues such as thermal insulation and heat transfer during melting and solidification.Another relevant aspect is the energy conversion of the latent heat into electricity at very high temperatures. In this regard, solid state energy converters based on radiative (rather than conductive) heat transfer mechanisms are being investigated in this project, i.e. thermionics and thermophotovoltaics. In particular, AMADEUS project investigates a new concept for heat-to-power conversion at UHT named hybrid thermionic photovoltaic (TIPV) converter that directly converts into electricity both the electron and photon fluxes that irradiated by incandescent surfaces.