Palliative gastrojejunostomy in unresectable cancer and gastric outlet obstruction: a retrospective cohort study.

INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.

A pilot investigation of differential neuroendocrine associations with fronto-limbic activation during semantically-cued list learning in mood disorders.

BACKGROUND: Decreased volume and disrupted function in neural structures essential for memory formation (e.g. medial temporal lobe and prefrontal cortex) are common among individuals with depression. Hypothalamic-pituitary-axis function, as reflected by measurement of cortisol levels, is linked to neural activity during memory encoding in healthy people. However, it is not as well understood whether cortisol is associated with alterations in fronto-temporal recruitment during memory encoding in depression. METHODS: In this pilot study, we evaluated associations between cortisol and neural activation during memory encoding in 62 adults (18-65 years) with mood disorders (MD; n = 39, 66.7% female), including major depression (n = 28) and bipolar I disorder (n = 11), and healthy controls (HC; n = 23, 43.5% female). Participants provided salivary cortisol samples before and after completing a semantically-cued list-learning task during 3-Tesla fMRI. Links between pre-scan cortisol (and cortisol change) and activation during encoding were evaluated using block and event-related models. RESULTS: Overall, pre-scan cortisol level was positively associated with greater engagement of fronto-limbic activation during the encoding block. However, in MD, pre-scan cortisol was associated with attenuated activation during encoding in medial frontal, superior and middle temporal gyri, insula, lingual gyrus, and claustrum relative to HCs. Cortisol-related attenuation of activation in MD was also observed during encoding of words subsequently recalled in the ventral anterior cingulate, hypothalamus, and middle temporal gyrus. By and large, cortisol change (pre/post scan) predicted the same pattern of findings in both block and event-related contrasts. LIMITATIONS: Although analyses accounted for variations in scanner time of day, circadian alterations in cortisol may have introduced variability into the results. CONCLUSIONS: Pre-scan cortisol may selectively interfere with recruitment of important fronto-temporal memory circuitry in mood disorders. The inverted associations between cortisol and neural function in MD relative to HC also elucidate potentially unique pathophysiological markers of mood disorders.

Improvement in postoperative mortality in elective gastrectomy for gastric cancer: Analysis of predictive factors in 1066 patients from a single centre.

BACKGROUND: Gastrectomy represents the main treatment for gastric adenocarcinoma. This procedure is associated with substantial morbidity and mortality. The aim of this study was to evaluate the postoperative mortality changes across the study period and to identify predictive factors of 30-day mortality after elective gastrectomy for gastric cancer. METHODS: This was a retrospective cohort study of a prospective database from a single centre. Patients treated with an elective gastrectomy from 1996 to 2014 for gastric adenocarcinoma were included. We compared postoperative mortality between four time periods: 1996-2000, 2001-2005, 2006-2010, and 2011-2014. Univariate and multivariate analyses were applied to identify predictors of 30-day postoperative mortality. RESULTS: We included 1066 patients (median age 65 years; 67% male). The 30-day mortality rate was 4.7%. Mortality decreased across the four time periods; from 6.5% to 1.8% (P = 0.022). In the univariate analysis, age, ASA score, albumin <3.5, multivisceral resection, splenectomy, intrathoracic esophagojejunal anastomosis, R status, and T status were significantly associated with postoperative mortality. In the multivariate analysis, ASA class 3 (OR 10.06; CI 1.97-51.3; P = 0.005) and multivisceral resection (OR 1.6; CI 1.09-2.36; P = 0.016) were associated with higher postoperative 30-day mortality; surgery between 2011 and 2014 was associated with lower postoperative 30-day mortality (OR 0.55; CI 0.33-0.15; P = 0.030). CONCLUSION: There was a decrease in postoperative 30-day mortality during this 18-year period at our institution. We have identified ASA score and multivisceral resection as predictors of 30-day mortality for elective gastrectomy for cancer.

Postoperative adjuvant treatment for gastric cancer improves long-term survival after curative resection and D2 lymphadenectomy. Results from a Latin American Center.

BACKGROUND: The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection. METHODS: We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage. RESULTS: The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p < 0.001), had a lower rate of multiple organ resection (21% versus 39%, p < 0.001) and had less postoperative complications (14% versus 32%, p < 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p < 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment. CONCLUSIONS: These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.

Shifted inferior frontal laterality in women with major depressive disorder is related to emotion-processing deficits.

BACKGROUND: Facial emotion perception (FEP) is a critical human skill for successful social interaction, and a substantial body of literature suggests that explicit FEP is disrupted in major depressive disorder (MDD). Prior research suggests that weakness in FEP may be an important phenomenon underlying patterns of emotion-processing challenges in MDD and the disproportionate frequency of MDD in women. Method Women with (n = 24) and without (n = 22) MDD, equivalent in age and education, completed a FEP task during functional magnetic resonance imaging. RESULTS: The MDD group exhibited greater extents of frontal, parietal and subcortical activation compared with the control group during FEP. Activation in the inferior frontal gyrus (IFG) appeared shifted from a left >right pattern observed in healthy women to a bilateral pattern in MDD women. The ratio of left to right suprathreshold IFG voxels in healthy controls was nearly 3:1, whereas in the MDD group, there was a greater percentage of suprathreshold IFG voxels bilaterally, with no leftward bias. In MDD, relatively greater activation in right IFG compared with left IFG (ratio score) was present and predicted FEP accuracy (r = 0.56, p < 0.004), with an inverse relationship observed between FEP and subgenual cingulate activation (r = - 0.46, p = 0.02). CONCLUSIONS: This study links, for the first time, disrupted IFG activation laterality and increased subgenual cingulate activation with deficient FEP in women with MDD, providing an avenue for imaging-to-assessment translational applications in MDD.

Neofusicoccum spp. Associated with Stem Canker and Dieback of Blueberry in Chile.

Blueberry (Vaccinium spp.) plantings have significantly increased in Chile during the last decade and, currently, over 10,700 ha are cultivated throughout the country. Among other diseases, stem canker and dieback has been frequently observed in commercial plantations with incidences between 15 and 45%. The aim of this study was to identify and characterize Neofusicoccum spp. causing stem canker and dieback of blueberry in Chile. Three species, N. arbuti, N. australe, and N. parvum, were identified based on colony and conidia morphology, and nucleotide sequence analysis of the internal transcribed spacer (ITS) region (ITS1-5.8S-ITS2). These Neofusicoccum spp. were found alone or coexisting with Pestalotiopsis spp., Truncatella spp., or Phomopsis spp. Koch's postulates showed all Neofusicoccum spp. isolated from infected plants to be pathogenic when inoculated on blueberry fruit and twigs using both mycelia and conidia suspension. All blueberry cultivars tested, including, Brigitta, Bluecrop, Brightwell, Duke, Elliott, Misty, and O'Neal, were susceptible to Neofusicoccum spp. infection. Pathogenicity tests showed N. parvum to be the most virulent species and Elliott to be the most susceptible cultivar. This report represents the first description of N. arbuti, N. australe, and N. parvum as canker-causing agents on blueberry in Chile.

[Increased risk of neoplasia among relatives of glioma patients]. / Incremento en el riesgo de neoplasia entre familiares de pacientes con glioma.

INTRODUCTION: Some previous studies have suggested familial aggregation of gliomas, although the results have not always been replicated. SUBJECTS AND METHODS: In the present study of a Mexican population, we compared 100 cases of glioma with 124 healthy unrelated controls, as well as their 1st, 2nd and 3rd degree relatives (n = 3,575 and 4,520 respectively). RESULTS: The relatives of the cases had a significantly higher risk of developing brain tumors than the relatives of controls (OR = 5.3; p < 0.05; 95% CI = 1.1-25.7), and their risk of developing any cancer was also increased (OR = 2; p < 0.05; 95% CI = 1.16-3.51), this risk was twofold for men when compared to females (OR = 2; p < 0.05; 95% CI = 1.15-3.37). CONCLUSION: The present study supports familial aggregation of brain tumors and warrants further research into their genetic etiology.

Incremento en el riesgo de neoplasia entre familiares de pacientes con glioma / Increased risk of neoplasia among relatives of gliomapatients

Introducción. Estudios previos han sugerido que existe agregación familiar de gliomas; sin embargo, los resultados no siempre han sido replicables. Sujetos y métodos. En el presente estudio de una población mexicana, comparamos 100 casos de glioma con 124 controles sanos no emparentados, así como sus familiares de primer, segundo y tercer grado (n = 3.575 y 4.520, respectivamente). Resultados. Los familiares de los casos tuvieron un riesgo significativamente mayor de desarrollar tumores cerebrales que los familiares de los controles (odds ratio, OR = 5,3; p < 0,05; intervalo de confianza al 95%, IC 95% = 1,1-25,7), su riesgo de desarrollar cualquier tipo de cáncer también fue mayor (OR = 2; p < 0,05; IC 95% = 1,16-3,51), y este riesgo fue el doble para varones que para mujeres (OR = 2; p < 0,05; IC 95% = 1,15-3,37). Conclusión. El presente estudio apoya la existencia de agregación familiar de neoplasias cerebrales y obliga a profundizar en el estudio de su etiología genética

Introduction. Some previous studies have suggested familial aggregation of gliomas, although the results have not always been replicated. Subjects and methods. In the present study of a Mexican population, we compared 100 cases of gliomawith 124 healthy unrelated controls, as well as their 1st, 2nd and 3rd degree relatives (n = 3,575 and 4,520 respectively).Results. The relatives of the cases had a significantly higher risk of developing brain tumors than the relatives of controls (OR = 5.3; p < 0.05; 95% CI = 1.1-25.7), and their risk of developing any cancer was also increased (OR = 2; p < 0.05; 95% CI = 1.16-3.51), this risk was twofold for men when compared to females (OR = 2; p < 0.05; 95% CI = 1.15-3.37). Conclusion. The present study supports familial aggregation of brain tumors and warrants further research into their genetic etiology

¿Se justifica el uso rutinario de catéter ureteral post trasplante renal? / Is routinary ureteral stenting indicated in kidney transplant?

Introducción: El uso rutinario de de stent ureterales en trasplante renal (TR) es controvertido. Nosotros evaluamos la experiencia del stent selectivo basado en la decisión del cirujano comparando las tasas de complicaciones ureterales (filtración y/o obstrucción) en el grupo que recibió o (SU+) o no un stent (SU-). El objetivo del estudio es identificar factores de riesgo para filtración y/o obstrucción. Materiales y Métodos: Entre septiembre de 1994 y octubre de 2005, 160pacientes consecutivos se sometieron a un trasplante renal en nuestro centro. El uso de SU estuvo basado en la decisión del cirujano y fue insertado después de que un lado de la anastomosis estuvo completada. Se identificaron las complicaciones urológicas dentro de los primeros 90 días después del TR. Las complicaciones ureterales fueron definidas como: filtración, obstrucción, Infección del tracto urinario, lesión arterial y necrosis tubular aguda. Los datos demográficos fueron recolectados desde la revisión de fichas clínicas y base de datos computarizada de TR. Resultados: Se evaluaron 113 pacientes del grupo total. La incidencia global de complicaciones urológicas en este estudio fue de 8 por ciento (9), filtración fue vista en 5 por ciento (6), obstrucción en 3 por ciento (3) y 28 por ciento de TU entre los primeros 90 días después de un IR. Cuarenta y un pacientes (36 por ciento) recibieron un stent (SU+) y setenta y dos (64 por ciento) no (SU-). Los grupos fueron comparables. La frecuencia complicaciones ureterales (obstrucción, filtración y obstrucción más filtración) y de TU entre los grupos no mostró diferencia estadística. En el análisis univariado se demostró que la edad y sexo del receptor, edad del donante, la fuente del donante (cadáver o vivo), tiempo de isquemia (caliente y fría), presencia de NTA y lesiones arteriales no fueron asociadas con la presencia de obstrucción, filtración o ambas...

Introduction: Routine use of ureteral stent (US) after transplanstation remains controversial. We evaluate the experience of selective stent use based on surgeon decision comparing the ureteral complicationrates (leaking and / or obstruction) between the group receiving (US+) or another group without not astent (SU-). The aim of the study was to identify risk factors for leaking and / or obstruction in patients receiving ureteral stent after transplantation. Materials and Methods: Between September 1994 and October 2005, 160 consecutive patients underwent a renal transplant in our center. The use of US was based on the decision of the surgical team. Urological complications were identified within the first 90 days after RT. The ureteral complications were defined as: leaking, obstruction, urinary tract infection, arterial injury and acute tubular necrosis (ATN). Demographic data were collected prospectively and retrospectively analized from the review of clinical data base. Results: We evaluated 113 patients of the total group. The overall incidence of urological complications in this study was 8 percent (9), leaking was seen in 5 percent (6), obstruction in 3 percent (3) and 28 percent of the TU first 90days after an IR. Forty-one patients (36 percent ) received a stent (SU +) and seventy and two (64 percent) no(SU-). The groups were comparable. The frequency of ureteral complications (obstruction, leaking and obstruction-filtration) and TU between groups showed no statistical difference. In the Univariate analysis showed age, sex of recipient, donor´s age, the source of graft (living of dead), ischemia time(hot and cold), presence of ATN and arterial lesions were not associated with the presence of obstruction, leaking or both. However, among patients with obstruction leaking a higher probability of developing TU was verified. Conclusions: Our experience shows that routine stent use has no clear benefit in transplantation´s outcomes...

Outbreaks of Cladosporium Rot Associated with Delayed Harvest Wine Grapes in Chile.

Severe outbreaks of Cladosporium rot have occurred on berries in clusters of late harvest wine grapes (Vitis vinifera L.) during the 2003 to 2006 growing seasons. This disease was especially prevalent on Cabernet Sauvignon (CS) vineyards in central Chile where disease incidence commonly comprised 50 to 100% of the clusters at harvest. Symptoms appeared on mature grapes (total soluble solids [TSS] >22%) and were characterized by berry dehydration, a firm decay affecting a small portion of the berry and a superficial olive-green mold. Isolations made on acidified potato dextrose agar (APDA) consistently yielded olive-green colonies after 7 days at 20°C. On the basis of colony morphology and morphological characteristics of conidiophores and conidia, Cladosporium herbarum (Pers.:Fr) Link and C. cladosporioides (Fres.) de Vries were identified (1). These species were primarily separated by the presence of rough and smooth conidial surfaces, respectively. Koch's postulates were completed by inoculating 80 wounded mature (20% TSS) CS berries and incubating them at 10, 20, and 30°C. An equal number of wounded but noninoculated berries were left as controls. Berries were surface sterilized (75% ethanol for 30 s and 0.5% sodium hypochlorite for 60 s), inoculated with 10 µl of a 106 conidial suspension per ml applied to the wounds made with a sterile hypodermic needle. Dark, necrotic lesions, 1 to 6 mm in diameter, and a dark mycelial colony appeared on the surface after 7 days in chambers with relative humidity of >95%. Disease incidence was significantly (P < 0.05) influenced by temperature, with 90, 100, and 49% of inoculated berries becoming infected when incubated at 10, 20, or 30°C, respectively. C. herbarum and C. cladosporioides appeared to be equally pathogenic, producing symptoms similar to naturally infected CS berries, and were reisolated (100%) on APDA. These same isolates were pathogenic when tested on mature (TSS >16%) Thompson Seedless (TS) berries. Fungicide sensitivity tests were performed on detached TS berries challenged by placing 10 µl of a 106 conidial suspension per ml of C. herbarum on injured berries. Boscalid (0.5 mg/ml, Cantus WG; BASF, Santiago, Chile), iprodione (0.5 mg/ml, Rovral WP; Bayer Crop Science, Santiago, Chile), pyraclostrobin (0.085 mg/ml, Comet SC; BASF), and pyraclostrobin (0.009 mg/ml) mixed with boscalid at 0.017 mg/ml (Bellis WG; BASF) provided a significant control (P < 0.05) with efficacy between 84.3 and 95.9%. Azoxystrobin (0.188 mg/ml, Quadris SC; Syngenta Crop Protection, Santiago, Chile), kresoxim methyl (0.067 mg/ml, Stroby SC; BASF), and trifloxystrobin (0.06 mg/ml, Flint WG; Bayer Crop Science) provided partial control with efficacy between 23.1 and 42.1%. Cladosporium spp. have been previously reported (2). However, severe outbreaks of Cladosporium rot occur when berries become partially senescent because of a considerable delay in harvest (3). This appears to favor the development of these pathogens. References: (1) B. U. Heuchert et al. Schlechtendalia 13:1, 2005. (2) W. Hewitt. Compendium of Grape Diseases. R. Pearson and A. Goheen, eds. The American Phytopathological Society, St. Paul, MN, 1988. (3) Ph. Pszczolkowski et al. Cien. Inv. Agr. 28(3):157, 2001.

Two models of peripheral sympathetic autoregulation: role of neuronal histamine.

We have studied the influence of a peripheral histamine-containing neuronal system on the sympathetic activity of the rat vas deferens. Chronic surgical interruptions of the sympathetic structures involving the adjacent histamine-containing neuronal system cause changes of sympathetic activity, as measured by the rate of disappearance of norepinephrine after reserpine administration to the awake rat. Sympathetic ganglionectomy performed on either side causes an enhancement of the sympathetic activity in the contralateral vas deferens. When the decussation of histamine-containing pathways is surgically interrupted (interganglionic section), a bilateral enhancement of sympathetic activity occurs. The histamine-containing neuronal system seems to exert a contralateral reciprocal inhibitory modulation of sympathetic activity at the vas deferens. This modulation is evoked by nervous impulses traveling in the preganglionic fiber because enhancement of sympathetic activity due to contralateral ganglionectomy is suppressed by ipsilateral decentralization. No compensatory reflexes of central origin are observed. Sympathetic enhancement due to interruption of histamine-containing nervous pathways is reversed by i.v. infusion of histamine. An H-1 or H-2 histamine receptor antagonist does not have any effect on the vas deferens sympathetic activity of the intact rat. In the heart of the deafferentated dog, removal of the left stellate sympathetic ganglion causes facilitation of the chronotropic responses induced by stimulation of the right sympathetic postganglionic nerve, also suggesting a peripheral contralateral inhibitory modulation of sympathetic activity at the heart. It appears from all these findings that a peripheral inhibitory reflex is evoked when sympathetic activity is enhanced, thus contributing to maintaining homeostasis.

Mutagenicity obtained experimentally by oral administration of dextroamphetamine sulphate to the rat.

Research work on the possible mutagenic effects of the amphetamine, sympathomimetic amine, was carried out on the rat. The method used was the dominant lethal assay, in its sub-acute form. Dextroamphetamine sulphate was administered orally. At the dosage and frequency of the test, dextroamphetamine sulphate was found to be a significantly mutogenic agent. The over-all mutagenic index was 13.92% (P less than 0.01) for the test group and 8.90% for the control group.