Clinicopathological and molecular characterization of gastroesophageal junction (GEJ) adenocarcinoma before age of 40 years

Gastroesophageal junction (GEJ) adenocarcinoma are uncommon before age of 40 years. While certain clinical, pathological and molecular features of GEJ adenocarcinoma in older patients have been extensively studied, these characteristics in the younger population remain to be determined. In the recent literature, a high sensitivity and specificity for the detection of dysplasia and esophageal adenocarcinoma was demonstrated by using multicolor fluorescence in situ hybridization (FISH) DNA probe set specific for the locus specific regions 9p21 (p16), 20q13.2 and Y chromosome. We evaluated 663 patients with GEJ adenocarcinoma and further divided them into 2 age-groups of or= 50 years, rispectively. FISH with selected DNA probe for Y chromosome, locus 9p21 (p16), and locus 20q13.2 was investigated with formalin fixed and parassin embedded tissue from surgical resections of 17 younger and 11 older patients. Signals were counted in > 100 cells with each given histopathological category. The chromosomal aberrations were then compared in the 2 age-groups with the focus on uninvolved squamous and columnar epithelium, intestinal metaplasia (Barrett's mucosa), glandular dysplasia, and adenocarcinoma. Comparisons were performed by the X2 test, Fisher's exact test, Student's t-test and Mann-Whitney U-test as appropriate. Survival was estimated by the Kaplan-Meier method with univariate analysis by the log-rank. Significance was taken at the 5% level. There was no difference in the surgical technique applied in both age groups and most patients underwent Ivor Lewis esophagectomy. Among clinical variables there was a higher incidence of smocking history in older patient group. We identified a progressive loss of Y chromosome from benign squamos epithelium to Barrett's mucosa and glandular dysplasia, and, ultimately, to a near complete loss in adenocarcinoma in both age groups. The young group revealed significantly more losses of 9p21 in both benign and neoplastic cells when compared to the older patients group. In addition, we demonstrated an increase in the percentage of cells showing gain of locus 20q13.2 with progression from benign epithelium through dysplasia to adenocarcinoma with almost the same trend in both the young and the older patients. When compared with the older age-group, younger patients with GEJ adenocarcinoma possess similar known demographics, environmental factors, clinical, and pathologic characteristics. The most commonly detected genetic aberrations of progressive Y chromosomal loss, 9p21 locus loss, and 20q13 gains were similar in the younger and older patients. However the rate of loss of 9p21 is significantly higher in young patients, in both the benign and the neoplastic cells. The loss of 9p21, and possibly, the subsequent inactivation of p16 gene may be one of the molecular mechanisms responsible for the accelerated neoplastic process in young patients.

Kernspektroskopie an N=40 und N=82 Nukliden

Der astrophysikalische r-Prozeß (schneller Neutroneneinfang), ist verantwortlich für die Nukleosynthese einer großen Zahl von Elementen, die schwerer als Eisen sind. Benutzt man das ''waiting-point''-Modell, so kann die Häufigkeitsverteilung der Elemente durch drei nukleare und drei stellare Input-Parameter beschrieben werden. Für einen gegebenen Satz von stellaren Parametern definiert die Neutronenseparationsenergie (Sn) den r-Prozeß-Pfad. Die beta-Zerfall-Halbwertszeit (T1/2) der Kerne im r-Prozeß-Pfad bestimmt die Häufigkeit des Vorläufers und bezieht man die Neutronenemissionswahrscheinlichkeit (Pn) mit ein, so auch die endgültige Häufigkeitsverteilung. Von besonderer Wichtigkeit sind die neutronenreichen ''waiting-point''-Isotope. Zum Beispiel sind die N=82 Isotope verantwortlich für den solaren A~130 Häufigkeits-Peak. Diese Arbeit befaßt sich mit der Identifizierung und der Untersuchung von Zerfallseigenschaften neutronenreicher Isotope des Mangan (A=61 bis 69) und Cadmium (A=130 bis 132). Neutronenreiche Nuklide zu erzeugen und zu detektieren ist ein komplizierter und zeitaufwendiger Prozeß, nichts desto trotz erfolgreich. Das Hauptproblem bei dieser Art von Experimenten ist der hohe isobare Untergrund. Aus diesem Grunde wurden speziell entwickelte Anregungsschemata für Mangan und Cadmium eingesetzt, um die gewünschten Isotope mittels Laser-Resonanzionisation chemisch selektiv zu ionisieren. Bei CERN/ISOLDE war es möglich im Massenbereich von 60^Mn bis 69^Mn neue Halbwertszeiten und Pn-Werte zu bestimmen. Für 64^Mn und 66^Mn konnten darüber hinaus erstmals noch partielle Zerfallsschemata aufgestellt werden. Es zeigte sich, daß die Ergebnisse teilweise recht überraschend waren, da sie nicht durch das QRPA-Modell vorhergesagt wurden. Mit Hilfe vergleichender Studien des Gesamttrends der Niveausystematiken der gg-Kerne von 26_Fe, 30_Zn, 32_Ge, 24_Cr und 28_Ni konnte ein Verschwinden der sphärischen N=40 Unterschale und die Existenz einer neuen Region mit signifikanter Deformation nachgewiesen werden, die vermutlich ihr ''Zentrum'' bei 64^Cr hat. Ebenfalls zeigen Studien der Niveausystematik bei 48Cd und der Vergleich mit 46_Pd, 54_Xe, 52_Te und 50_Sn, erste Hinweise eines Schalenquenchings bei N=82. Es wurde die Messung der Halbwertszeit von 130^Cd verbessert und die Halbwertszeiten von 131^Cd und 132^Cd erstmals bestimmt. Die neuen Daten können nur erklärt werden, wenn man bei der QRPA-Rechnung verbotene Übergänge mitberücksichtigt. Es genügt nicht, die Rechnung für reinen Gamow-Teller-Zerfall durchzuführen.

Untersuchungen an gespeicherten 40 Ca +-Ionen in einer linearen Paulfalle

In Experimenten an lasergekühlten, in einer linearen Paulfalle gespeicherten $Ca^+$-Ionen wurde dieLebensdauer des metastabilen $3D_{5/2}$-Niveaus durch Beobachtung von Quantensprüngen einzelner Ionen zu 1100(18)msbestimmt. Systematische Fehler durch quenchende Stöße oder Stark-Mischen durch das Speicherfeld liegen unterhalb dererreichten Genauigkeit. Abweichungen von früheren Messungen konnten durch eine vernachlässigte Abhängigkeit derLebensdauer von der Laserleistung des Rückpumplasers erklärt werden. Das Endergebnis zeigt gute Übereinstimmung mitneueren theoretischen Werten. In weiteren Messungen an zehn Ionen wurde in einigen Messreihen eine deutliche Reduktionder Lebensdauer gegenüber einem einzelnen Ion festgestellt. Dabei wurden mehr koinzidente Zerfälle von zwei und dreiIonen beobachtet als für unabhängige Teilchen zu erwarten. In einem Ionenkristall wurde eine räumliche Trennung atomarer Zustände erreicht. Dabei wurde ein Teil der Ionen einesKristalls aus einigen hundert Ionen in den metastabilen Zustand gepumpt, der von den Kühllasern vollständig entkoppeltist. Durch sympathetische Kühlung werden diese Ionen weiterhin gekühlt und der Kristall schmilzt nicht. Durch denLichtdruck, den die Kühllaser ausgeüben, werden die Ionen nach atomaren Zuständen sortiert, weil die lasergekühltenIonen einen Rückstoß erfahren, die übrigen aber nicht. Für zukünftige Experimente wurden Verbesserungen des experimentellen Aufbaus auf den Weg gebracht. So wurden Methodenund Komponenten für eine verbesserte Frequenzstabilisierung der Diodenlaser entwickelt.

Systematische Untersuchung von Instabilitäten an lasergekühlten 40 Ca + - Ionen in einer linearen Paulfalle

In linearen Paulfallen gespeicherte und lasergekühlte Ionen stellen in weiten Bereichen der Physik ideale Objekte hinsichtlich störungsfreier und präziser Messungen atomarer Übergangsfrequenzen und der gezielten Manipulation von Quantenzuständen dar. Eine Einschränkung dieser optimalen Bedingungen erfolgt durch Heizmechanismen, die aus Abweichungen des Speicherpotentials von der idealen Quadrupolform resultieren. Höhere Potentialordnungen führen zu einer Kopplung der radialen Bewegungsmoden und bei bestimmten Speicherparametern zu nichtlinearen Resonanzen. Hierbei werden die Ionenbahnen durch eine Energieaufnahme aus dem Speicherfeld destabilisiert. Dieses kann zu Linienverbreiterungen, einer Limitierung der Kohärenzzeiten und unter Umständen zu einem Ionenverlust führen. Die systematische Untersuchung dieser Instabilitäten in einer linearen Paulfalle erfolgt durch Spektroskopie an einer kleinen Anzahl lasergekühlter ^40Ca^+ - Ionen. Der experimentell zugängliche Speicherbereich wird mit hoher Auflösung abgetastet. Durch eine eingehende Quantifizierung der Falleneigenschaften werden die nichtlinearen Resonanzen eindeutig den erzeugenden Potentialtermen zugeordnet. Die Resonanzlinien zeigen eine charakteristische Aufspaltung, deren Größe vom angelegten Axialpotential bestimmt wird. Diese zusätzliche Kopplung der Radialbewegung an die Axialbewegung führt zu einer modifizierten Resonanzbedingung. Nichtlineare Resonanzen treten massenspezifisch auf. Da eine präzise Kontrolle der Axialpotentiale sehr einfach ist, könnten die beobachteten radial-axial koppelnden Resonanzen eine Anwendung in der Massenspektrometrie finden.

Deutsche Forschungsreisende im westlichen Zentralafrika des 19. Jahrhunderts /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 40

Forschungsreisen, deutsche Forschungsreisende, Wissenschaftsgeschichte, Ethnographie, ethnographische Quellen, Karawanenreisen, Sklaverei, Kolonialismus, Portugiesen in Afrika, westliches Zentralafrika, Angola

La qualità del binario nelle linee AV/AC: studio dei dati rilevati dai treni diagnostici di RFI e analisi degli interventi manutentivi in previsione dell'aumento di velocità a 360 km/h.

Dal punto di vista geometrico, il tracciato delle linee AV/AC è determinato in funzione delle velocità di progetto, attualmente variabili tra 250 e 300 km/h, e in modo da limitare i parametri cinematici. In questa maniera è assicurata la corretta qualità di marcia dei treni ad alta velocità. La sovrastruttura ferroviaria è realizzata in modo da sopportare i carichi dinamici trasmessi dai convogli transitanti a elevate velocità, e da garantire la sicurezza della circolazione e il comfort di marcia. In particolare, la qualità del binario ferroviario è determinata attraverso una serie di parametri geometrici fondamentali, definiti da Rete Ferroviaria Italiana. A seconda dei valori assunti da tali parametri, il binario rientra in un livello di qualità geometrica: sono definiti tre livelli per i quali la circolazione ferroviaria avviene senza limitazioni e un livello che richiede l’imposizione di vincoli all’esercizio (rallentamenti o interruzioni). L’introduzione dei parametri geometrici e dei rispettivi valori di riferimento ha lo scopo di mantenere elevati livelli qualitativi e di sicurezza per l’infrastruttura ferroviaria, in materia di geometria dell’armamento. Infatti, il superamento di certe soglie da parte dei parametri, implica l’intervento manutentivo sul binario, al fine di ripristinare la corretta geometria e di garantire così la qualità della marcia dei treni. La politica è quella d’intervento prima del raggiungimento del quarto livello di qualità, per il quale sono necessarie restrizioni alla circolazione e interventi correttivi immediati.

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. We thus performed a systematic review with meta-analysis of randomized controlled trials comparing chemotherapy alone with CMT in patients with early stage Hodgkin's lymphoma with respect to response rate, tumor control and overall survival (OS). We searched Medline, EMBASE and the Cochrane Library as well as conference proceedings from January 1980 to February 2009 for randomized controlled trials comparing chemotherapy alone versus the same chemotherapy regimen plus radiotherapy. Progression free survival and similar outcomes were analyzed together as tumor control. Effect measures used were hazard ratios for OS and tumor control as well as relative risks for complete response (CR). Meta-analyses were performed using RevMan5. Five randomized controlled trials involving 1,245 patients were included. The hazard ratio (HR) was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumor control and 0.40 (95% CI 0.27 to 0.59) for OS for patients receiving CMT compared to chemotherapy alone. CR rates were similar between treatment groups. In sensitivity analyses another 6 trials were included that did not fulfill the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis. In conclusion, adding radiotherapy to chemotherapy improves tumor control and OS in patients with early stage Hodgkin's lymphoma.

Older Breast Cancer Survivors: Geriatric Assessment Domains Are Associated With Poor Tolerance of Treatment Adverse Effects and Predict Mortality Over 7 Years of Follow-Up

Purpose To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. Methods Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age ≥ 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, χ2 tests, and regression analyses. Results In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI ≥ 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI ≥ 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. Conclusion This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.

Phenotypes of childhood asthma: are they real?

It has been suggested that there are several distinct phenotypes of childhood asthma or childhood wheezing. Here, we review the research relating to these phenotypes, with a focus on the methods used to define and validate them. Childhood wheezing disorders manifest themselves in a range of observable (phenotypic) features such as lung function, bronchial responsiveness, atopy and a highly variable time course (prognosis). The underlying causes are not sufficiently understood to define disease entities based on aetiology. Nevertheless, there is a need for a classification that would (i) facilitate research into aetiology and pathophysiology, (ii) allow targeted treatment and preventive measures and (iii) improve the prediction of long-term outcome. Classical attempts to define phenotypes have been one-dimensional, relying on few or single features such as triggers (exclusive viral wheeze vs. multiple trigger wheeze) or time course (early transient wheeze, persistent and late onset wheeze). These definitions are simple but essentially subjective. Recently, a multi-dimensional approach has been adopted. This approach is based on a wide range of features and relies on multivariate methods such as cluster or latent class analysis. Phenotypes identified in this manner are more complex but arguably more objective. Although phenotypes have an undisputed standing in current research on childhood asthma and wheezing, there is confusion about the meaning of the term 'phenotype' causing much circular debate. If phenotypes are meant to represent 'real' underlying disease entities rather than superficial features, there is a need for validation and harmonization of definitions. The multi-dimensional approach allows validation by replication across different populations and may contribute to a more reliable classification of childhood wheezing disorders and to improved precision of research relying on phenotype recognition, particularly in genetics. Ultimately, the underlying pathophysiology and aetiology will need to be understood to properly characterize the diseases causing recurrent wheeze in children.

Mood and nonmood components of perceived stress and exacerbation of Crohnʼs disease

BACKGROUND: Diverse psychological factors are involved in the pathophysiology of stress. In order to devise effective intervention strategies, it is important to elucidate which factors play the most important role in the association between psychological stress and exacerbation of Crohn's disease (CD). We hypothesized that the association between perceived stress and exacerbation of CD would remain after removal of mood and anxiety components, which are largely involved in stress perception. METHODS: In all, 468 adults with CD were recruited and followed in different hospitals and private practices of Switzerland for 18 months. At inclusion, patients completed the Perceived Stress Questionnaire and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. During the follow-up, gastroenterologists assessed whether patients presented with a CD exacerbation. By means of binary logistic regression analysis, we estimated the factor by which one standard deviation of perceived stress would increase the odds of exacerbation of CD with and without controlling for anxiety and depression. RESULTS: The odds of exacerbation of CD increased by 1.85 times (95% confidence interval 1.43-2.40, P < 0.001) for 1 standard deviation of perceived stress. After removing the anxiety and depression components, the residuals of perceived stress were no longer associated with exacerbation of CD. CONCLUSIONS: The association between perceived stress and exacerbation of CD was fully attributable to the mood components, specifically anxiety and depression. Future interventional studies should evaluate the treatment of anxiety and depression as a strategy for potential prevention of CD exacerbations. (Inflamm Bowel Dis 2011;).

Work-related behavior and experience patterns and predictors of mental health in German physicians in medical practice

Background and Objectives: Work-related stress and burnout among physicians are of increasing relevance. The aim of this study was to investigate work-related behavior and experience patterns and predictors of mental health of physicians working in medical practice in Germany. Methods: We surveyed a stratified, random sample of 900 physicians from different specialties. The questionnaire included the standardized instruments Work-related Behavior and Experience Pattern (AVEM) and the Short Form-12 Health Survey (SF-12). Results: Only one third of physicians reported high or very high general satisfaction with their job, but 64% would choose to study medicine again. Only 18% of physicians presented a healthy behavior and experience pattern. Almost 40% presented a pattern of reduced motivation to work, 21% were at risk of overexertion, and 22% at risk for burnout. Willingness to study medicine again, fulfilled job expectations, professional years, marital status, and behavior patterns were significant predictors of mental health and accounted for 35.6% of the variance in mental health scores. Job-related perceptions also had a significant effect on burnout. Conclusions: The strong influence of work-related perceptions suggests a need for realistic expectation management in medical education, as well as support in stress management and coping strategies during medical training.