Significant understaging is seen in clinically staged T2N0 esophageal cancer patients undergoing esophagectomy.

This study aimed to determine the impact of preoperative staging on the treatment of clinical T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy. We reviewed a retrospective cohort of 27 patients treated at a single institution between 1999 and 2011. Clinical staging was performed with computed tomography, positron emission tomography, and endoscopic ultrasound. Patients were separated into two groups: neoadjuvant therapy followed by surgery (NEOSURG) and surgery alone (SURG). There were 11 patients (41%) in the NEOSURG group and 16 patients (59%) in the SURG group. In the NEOSURG group, three of 11 patients (27%) had a pathological complete response and eight (73%) were partial or nonresponders after neoadjuvant therapy. In the SURG group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged, and 1 (6%) was correctly staged. In the entire cohort, despite being clinically node negative, 14 of 27 patients (52%) had node-positive disease (5/11 [45%] in the NEOSURG group, and 9/16 [56%] in the SURG group). Overall survival rate was not statistically significant between the two groups (P = 0.96). Many cT2N0 patients are clinically understaged and show no preoperative evidence of node-positive disease. Consequently, neoadjuvant therapy may have a beneficial role in treatment.

Socio-economic drivers for UK organic pullet rearers and the implications for poultry health.

1. Certified organic pullet producers were surveyed to gain a better understanding of the production environment, to identify the key constraints to organic pullet rearing and to identify factors that affected bird health. 2. Pullet rearers had been involved in organic production for between 1 and 12 years. 3. The number of pullets reared per annum ranged from 6 to 12 000 and the number of birds housed per unit from <50 to >1000. 4. The primary reason for being involved in organic production was given as 'commercial' with 'environmental' and 'welfare' being the next most popular categories. 5. Fewer than 50% of the respondents vaccinated their flocks and, for those that were protected, the diseases vaccinated against frequently were Newcastle disease, infectious bronchitis and Marek's disease. Annual mortality ranged from <2 to >7% with smothering accounting for 25% of all mortality. 6. Approximately 40% of respondents saw no constraints to rearing organic pullets while others identified a range of factors including capital, availability of land and inadequate margins as being the primary constraint.

On the contribution of perceptual fluency and priming to recognition memory.

Repetition priming has been shown to be independent of recognition memory. Thus, the severely amnesic patient E.P. has demonstrated intact stem completion priming and perceptual identification priming, despite at-chance performance on recognition memory tasks. It has also been shown that perceptual fluency can influence feelings of familiarity, in the sense that items perceived more quickly tend to be identified as familiar. If studied items are identified more fluently, due to perceptual priming, and fluency leads to familiarity, why do severely amnesic patients perform no better than chance on recognition memory tasks? One possibility is that severely amnesic patients do not exhibit normal fluency. Another possibility is that fluency is not a sufficiently strong cue for familiarity. In two experiments, 2 severely amnesic patients, 3 moderately amnesic patients, and 8 controls saw words slowly clearing from a mask. The participants identified each word as quickly as possible and then made a recognition (old/new) judgment. All the participants exhibited fluency, in that old responses were associated with shorter identification times than new responses were. In addition, for the severely amnesic patients, priming was intact, and recognition memory performance was at chance. We next calculated how much priming and fluency should elevate the probability of accurate recognition. The tendency to identify studied words rapidly (.6) and the tendency to label these rapidly identified words old (.6) would result in 36% of the studied words being labeled old. Other studied words were identified slowly (.4) but were still labeled old (.4), resulting in an additional 16% of studied words labeled old. Thus, the presence of fluency increases the probability of accurate recognition judgments to only 52% (chance = 50%). This finding explains why amnesic patients can exhibit both priming and fluency yet still perform at chance on recognition tests.