Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? A propensity score-matched study.

BACKGROUND: Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. AIM: In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. PATIENTS AND METHODS: Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. RESULTS: The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p = 0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0 = 68% versus ypN0 = 40%) (p = 0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. CONCLUSION: Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinoma AEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.

Nesting and pollen preference of Osmia lignaria lignaria (Hymenoptera: Megachilidae) in Virginia and North Carolina orchards.

Cavity-nesting megachilid bees in the genus Osmia, found throughout the Palearctic and Nearctic regions, are good candidates for domestication. In North America, Osmia lignaria Say has been reported to be an excellent pollinator of tree fruit and is currently being developed for commercial use in orchards. This is largely because of research over several decades with the western subspecies of this bee, Osmia lignaria propinqua Cresson, in western orchards. The behavior of the eastern subspecies, O. lignaria lignaria Say, in eastern orchards has not previously been reported. This study evaluated the nesting activity and pollen preference of a population of the eastern subspecies in five orchards in the foothills and piedmont regions of North Carolina and Virginia over a 2-yr period. Apple was present in all orchards and all were bordered by hardwood forest. Shelters were placed both within orchards and the forest border. Emergence dates, nest construction, and orchard bloom were monitored weekly. Bee populations increased by 2-3 times annually at most orchards. Pollen species comprising nest provisions from 720 individual nest cells were identified and quantified using scanning electron microscopy. The greatest amount of pollen (46-82%) was that of a small understory tree, Eastern redbud (Cercis canadensis L.), at all orchard sites where these trees were present nearby. The quantity of orchard pollen was relatively low, <20% at full apple bloom, except for one orchard (53%) without nearby redbud. O. lignaria lignaria appears to prefer Eastern redbud pollen over orchard pollen.

Emergence phenology of Osmia lignaria subsp. lignaria (Hymenoptera: Megachilidae), its parasitoid Chrysura kyrae (Hymenoptera: Chrysididae), and bloom of Cercis canadensis.

Emergence patterns of a natural population of Osmia lignaria subsp. lignaria Say were monitored during a 5-yr period (2003-2007) in relation to air temperature, bloom of eastern redbud (Cercis canadensis L.), and emergence of the parasitoid Chysura kyrae Krombein. Bee cocoons were placed in gelatin capsules and overwintered within shelters in their natural habitat. Mean emergence of female O. l. lignaria was observed at approximately 2 d after redbud bloom began; mean male emergence was approximately 1 wk earlier than for females and was nearly identical to that of C. kyrae. Horticultural models used to predict budburst for several tree species were evaluated with respect to redbud bloom and O. l. lignaria emergence. Each model indicated that both sexes of the bee and redbud had similar chill unit requirements. Differences in emergence and bloom dates were attributed to the different requirements for growing degree hours (GDHs) after chilling requirements were met. The close phenological relationship observed between eastern redbud and bee emergence suggests an important role for this common understory tree in the early nesting success of O. l. lignaria.

A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.

Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use.