Suppression of Soilborne Diseases of Soybean With Cover Crops.

Field trials were conducted from 2010 to 2013 at four locations in Illinois to evaluate the impact of cover crops (cereal rye [Secale cereal], brown mustard [Brassica juncea], winter canola [B. napus], and winter rapeseed [B. napus]) on soybean [Glycine max] stands and yield, diseases, pathogen populations, and soil microbial communities. Cover crops were established in the fall each year and terminated the following spring either by using an herbicide (no-till farms), by incorporation (organic farm), or by an herbicide followed by incorporation (research farm). Although shifts in soilborne pathogen populations and microbial community structure were not detected, cover crops were found to induce general soil suppressiveness in some circumstances. Cereal rye and rapeseed improved soybean stands in plots inoculated with Rhizoctonia solani and decreased levels of soybean cyst nematode in the soil. Cereal rye increased soil suppressiveness to R. solani and Fusarium virguliforme, as measured in greenhouse bioassays. Cereal rye significantly improved yield when Rhizoctonia root rot was a problem.

Early-pregnancy asymmetric dimethylarginine (ADMA) levels in women prone to develop recurrent hypertension.

OBJECTIVE: To evaluate early-pregnancy levels of ADMA (asymmetric dimethylarginine) in recurrent hypertensive pregnancy. STUDY DESIGN: In this retrospective observational study, blood samples from 35 normotensive women with a previous hypertensive pregnancy were obtained preconceptionally and at 12, 16 and 20weeks in their next pregnancy. We assessed ADMA, symmetric dimethylarginine (SDMA), l-arginine and l-citrulline. We analyzed differences in longitudinal patterns between normotensive (NT, n=18) and recurrent hypertensive (HT, n=17) pregnancies by linear mixed models, with a sub-analysis for preeclampsia (PE, n=6). MAIN OUTCOME MEASURES: ADMA, SDMA, l-arginine and l-citrulline. RESULTS: Pre-pregnant SDMA and l-citrulline were lower in HT. At 12weeks, ADMA and ADMA/SDMA ratio correlated inversely with PAPP-A and ß-hCG, respectively. In both groups, ADMA-related compounds changed inconsistently with advancing (mid-trimester) pregnancy, although in HT, l-arginine tended to decrease between 16 and 20weeks, a decline consistent in PE. CONCLUSION: These data support a modest role for ADMA and related metabolites in the pathogenesis of hypertensive pregnancy.

Autonomic dysfunction associates with prolongation of QT intervals and blunted night BP in obese women with visceral obesity.

Prolonged QT intervals and a reduced fall of nocturnal blood pressure (BP) both predict an increased risk of cardiovascular events in obese subjects. We evaluated circadian BP variations (24-h ambulatory BP monitoring), autonomic function (power spectral analysis of RR interval oscillations) and cardiac repolarization times (QTc-dispersion and QTc interval) in 70 obese women, aged 25-44 yr, grouped by WHR into group A (WHR > 0.85, no.=38) and group B (WHR < or = 0.85, no.=32). Compared with non-obese age-matched women (no.=25, BMI=23+/-1.8) and obese women of group B, obese women of group A had higher values of QTc-d (p<0.05) and QTc (p<0.05), an altered sympathovagal balance (ratio of low-frequency/high-frequency power, p<0.01), and a blunted nocturnal drop in BP (p<0.01). In group A, QTc-d and the QTc interval correlated with diastolic night BP (p<0.01) and sympathovagal balance (p<0.01). WHR and plasma insulin levels correlated with QT intervals, reduced nocturnal fall in diastolic BP and sympathovagal balance (p<0.01). Prolongation of cardiac repolarization times and the reduction of nocturnal fall in BP coexist in obese women with visceral obesity, and might contribute to their raised cardiovascular risk. Autonomic dysfunction may be the common mechanism for this association.

FEC (5-fluorouracil, epidoxorubicin and cyclophosphamide) versus EM (epidoxorubicin and mitomycin-C) with or without lonidamine as first-line treatment for advanced breast cancer. A multicentric randomised study. Final results.

From May 1991 to December 1996, 326 patients with advanced metastatic breast cancer were enrolled in a multicentre, randomised, phase III clinical trial with four arms. Patients were randomised to receive chemotherapy according to the FEC regimen (5-fluorouracil (5-FU) 500 mg/m2, epidoxorubicin (EPI) 75 mg/m2 and cyclophosphamide (CFA) 500 mg/m2, intravenously (i.v.). every 3 weeks) or the EM regimen (EPI 75 mg/m2, i.v. every 3 weeks; mitomycin C (MMC) 10 mg/m2, i.v. every 6 weeks) or the same regimens with the addition of lonidamine (LND) until disease progression (orally, thrice daily, 150+150+300 mg); a maximum of eight chemotherapy cycles were planned. The aim of the trial was 2-fold: to compare the EM regimen with the commonly used FEC regimen and to evaluate the possible role of the addition of LND. Patients were eligible if they had histologically proven breast carcinoma, metastatic or locoregional relapse with measurable and/or evaluable disease and were aged between 18 and 70 years: 318 patients were considered eligible. Patients with previous anthracycline-based adjuvant chemotherapy or those who relapsed within 6 months after any adjuvant chemotherapy regimen were excluded. Chemotherapy-related toxicity of grade > or = 3 was manageable and there was no significant difference between the arms in terms of haematological side-effects. The impact on heart function was mild. No increased toxicity was observed in the LND arms (apart from myalgias in 27-30% of the cases). A significant increase in the complete response rate was observed for the FEC/EM + LND group (20.4%) versus the FEC/EM group (10.8%). The median survival time and the median time to progression for the overall series were 608 days and 273 days, respectively; EM+/-LND achieved significantly improved survival and time to progression versus FEC+/-LND (P=0.01). This result was confirmed also when the analysis was restricted to patients previously treated with adjuvant CMF schedules. On the basis of these results, we conclude that EM may represent a valuable alternative to FEC for patients requiring a first-line regimen for advanced/ metastatic breast carcinoma, especially in patients previously treated with CMF in an adjuvant setting. Furthermore, we conclude that, in spite of a better complete response rate in the LND arms, as there was no clear advantage in time to progression or survival resulting from the addition of LND to the FEC or EM regimens, the routine use of LND is not warranted outside a clinical trial.

[Sacrococcygeal chordoma simulating pilonidal cyst]. / Cordoma sacro-coccigeo simulante una cisti pilonidale.

Chordoma is a rare neoplasm arising in the cerebrospinal axis from nothochordal remnants. The commonest location is in the sacrococcygeal area, then in the sphenooccipital region and less frequently in other parts of the vertebral column. Chordoma has been found in all age groups, but the greatest incidence was found between the fifth and the seventh decades: there is a male predominance. Signs and symptoms of chordoma are related to tumor location and are often present for a long period of time because of the slow growth of the neoplasia. Sacrococcygeal chordomas may produce lower back pain, bladder or anorectal dysfunction or mass. Three histologic subtypes are currently considered: conventional, chondroid and dedifferentiated chordoma. Comparing with conventional chordoma, chondroid chordoma shows a better prognosis while dedifferentiated chordoma has a worse prognosis. However the malignant potential of chordoma is most likely due to incomplete surgical excision because of the multifocality of the neoplastic growth. For that reason, local recurrence is common and accounts in large part for the mortality for this tumor. The best treatment consists of a wide surgical excision coupled with adjuvant radiation therapy. We report a case of sacrococcygeal chordoma arised in a 48 year-old-man; the clinical features of the tumor showed a close resemblance with a pilonidal cyst. When the diagnosis of conventional chordoma was done the patient were treated by surgery and by intraoperative radiotherapy followed by external radiotherapy. This peculiar therapy was adopted in the attempt to reduce the risk of local recurrence. Six months after this treatment the patient was well and no signs of local recurrence was found by the magnetic resonance imaging.

Adjuvant postoperative radiotherapy in rectal cancer: 148 cases treated at Florence University with 8 years median follow-up.

BACKGROUND AND PURPOSE: To analyse the outcome, the treatment related side effects, the prognostic significance of clinical parameters in a group of patients with rectal cancer receiving postoperative radiotherapy after radical resection. MATERIALS AND METHODS: From 1980 to 1990 148 consecutive patients with rectal carcinoma stage B2-B3 or C1-C2-C3 were treated with postoperative radiotherapy after radical surgery. All patients received 50 Gy in 25 sessions in 5 weeks. In 42 a "flash' dose of 5 Gy was also given within 24 h before surgery. Median follow up was 8.1 years. RESULTS: At 5 years the overall survival was 54%, the determined (cancer specific) survival 61%, the local recurrence-free survival 88%. The influence of stage, histotype, distance from anal margin, type of surgery, number of involved nodes and flash dose were analysed. Overall and determined survival and distant metastasis rate were significantly influenced (P < 0.005) by the pathological stage. Patients with more than 3 involved nodes presented a significantly lower determined survival (P < 0.001) and a higher distant relapse rate (P < 0.005) than those with 3 or less involved nodes. A higher determined survival (P < 0.01) was also found in patients receiving the preoperative "flash'; this group was however unbalanced in respect to the relative number of cases with 3 or less involved nodes. The incidence of major side effects requiring surgery or hospitalization for medical treatment was 35% before 1985 and 12% thereafter. The systematic use of small bowel visualization during simulation and the discontinuation of the flash dose were the main modifications introduced in the second period. As a consequence of the small bowel visualization the size of lateral fields was slightly reduced and some patients were excluded from the treatment. CONCLUSIONS: Value of postoperative radiotherapy to decrease the incidence of local recurrence was confirmed in this retrospective study; the incidence of side effects was however considerable and did not support the addition of chemotherapy as advised by the NIH consensus meeting. Our policy was therefore moved to preoperative irradiation whose combination with chemotherapy was recently reported to be better tolerated and highly effective.

Soft tissue sarcomas: experience with intraoperative brachytherapy in the conservative management.

Forty-eight patients with soft tissue sarcomas were treated with Iridium implant after wide local excision between 1980 and 1990 at our institution. External irradiation was also given postoperatively in 33 patients with initially resectable tumours (treatment A) and preoperatively in 3 with initially unresectable tumours (treatment C); brachytherapy was the only treatment in 12 patients presenting small superficial tumours or recurring after previous irradiation (treatment B). Median follow up was 51 months (range 6-148). Fifteen patients (31%) failed; local recurrence was present in 9 (18.8%) and distant metastases in 11 (22.9%). Local failures were 3/33 (9%) after the treatment A, 4/12 after the treatment B, 3/2 after the treatment C. The incidence of local failures was affected by the tumor size, the presence of positive histology at the resection margins, and the total radiation dose. There was no impairment of wound healing and no necrosis; a severe sclerosis was observed only in the 3 patients receiving preoperative irradiation probably because large size fractions were used. We concluded that brachytherapy should be included in the radiation program for soft tissue sarcomas when a satisfactory geometry may be achieved and in particular when the tumor is located in sites where external irradiation only has a higher probability of producing major side effects.

The role of CA 15-3 and MCA monoclonal antibody assays in the detection of primary and recurrent breast cancer.

CA 15-3 and MCA assays were tested in 103 operable patients (preoperative determination) and 100 patients with advanced breast cancer. Normal CA 15-3 and MCA values were determined in a series of 68 healthy women. The negative/positive cut-off was set at 28.8 U/ml and 15.5 U/ml respectively for CA 15-3 and MCA (mean value + 2SD). Results were analyzed in the two groups and with respect to T and N pathological categories in the preoperative series. In pT1 (59 pts), pT2 (30 pts), pT3 + pT4 (14 pts), pNO (58 pts), pN1 (45 pts) and overall preoperative series CA 15-3 and MCA sensitivities were respectively 25%, 40%, 57%, 22%, 42%, 30% and 27%, 30%, 35%, 21%, 33%, 26%. In the patients affected by widespread disease, sensitivity was 92% and 80% for CA 15-3 and MCA. Results were significantly different among normal, preoperative and advanced patients (P less than 0.05). Our results suggest that CA 15-3 and MCA levels are correlated with the tumor mass. Nevertheless, the low sensitivity in pT1 and pNO cases indicates that these two assays have no role in the diagnosis of early breast cancer. In the advanced patients, too, the results can be questioned: in the present study, in fact, recurrent cases were characterized by gross disease with multiple site involvement and cannot be considered as an example of early diagnosis of breast cancer recurrence.