Treatment approach in patients with hyperbilirubinemia secondary to liver metastases in gastrointestinal malignancies: a case series and review of literature

BACKGROUND: Treatment of patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastases of gastrointestinal (GI) cancer is challenging. Regimen of oxaliplatin and fluoropyrimidine (FP)/folinic acid (FA) ± a monoclonal antibody (moAb), represents a feasible option considering the pharmacokinetics. Clinical data on the respective dosage and tolerability are limited and no recommendations are available. METHODS: Consecutive patients with severe hyperbilirubinemia [>2 × upper limit of the normal range (ULN) and >2.4 mg/dl] due to liver metastases of GI cancer without options for drainage receiving oxaliplatin, FP/FA ± moAb were analyzed. To collect further data a review of the literature was performed. RESULTS: A total of 12 patients were identified between 2011 and 2015. At treatment start, median bilirubin level was 6.1 mg/dl (>5 × ULN, range 2.7-13.6). The majority of patients (n = 11) received dose-reduced regimen with oxaliplatin (60-76%) and FP/FA (0-77%), rapidly escalating to full dose regimen. During treatment, bilirubin levels dropped more than 50% within 8 weeks or normalized within 12 weeks in 6 patients (responders). Median overall survival was 5.75 months (range 1.0-16.0 months) but was significantly prolonged in responders compared to nonresponders [9.7 and 3.0 months, p = 0.026 (two-sided test); 95% confidence interval (CI): 1.10-10.22]. In addition, case reports or series comprising a further 26 patients could be identified. Based on the obtained data a treatment algorithm was developed. CONCLUSION: Treatment with oxaliplatin, FP/FA ± moAb is feasible and may derive relevant benefits in patients with severe liver dysfunction caused by GI cancer liver metastases without further options of drainage.

The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review

This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l'ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

Chronostratigraphic summary and raw counts of selected dinoflagellate cysts and architarch taxa of ODP Hole 151-907A

A detailed dinoflagellate cyst investigation of the almost continuous Middle Miocene through Pliocene of Ocean Drilling Program Hole 907A in the Iceland Sea has been conducted at 100-kyr resolution. The investigated section is well constrained by magnetostratigraphy, providing for the first time an independent temporal control on a succession of northern high-latitude dinoflagellate cyst bioevents. Based on the highest/lowest occurrences (HO/LO) and highest common occurrence (HCO) of 20 dinoflagellate cyst taxa and one acritarch species, 26 bioevents have been defined and compared with those recorded at selected DSDP, ODP, and IODP sites from the North Atlantic and contiguous seas, and in outcrops and boreholes from the onshore and offshore eastern U.S.A., and the North Sea and Mediterranean basins. Comparisons reveal near-synchronous HOs of the dinoflagellate cysts Batiacasphaera micropapillata (3.8-3.4 Ma, mid-Pliocene) and Reticulatosphaera actinocoronata (4.8-4.2 Ma, Lower Pliocene) across the Nordic Seas and North Atlantic, highlighting their value on a supraregional scale. This probably applies also to Hystrichosphaeropsis obscura (upper Tortonian), when excluding ODP Hole 907A where its sporadic upper stratigraphic range presumably relates to cooling in the early Tortonian. Over a broader time span within the upper Tortonian, the HO of Operculodinium piaseckii likely also permits correlation across the Nordic Seas and North Atlantic, and the HO of Labyrinthodinium truncatum appears useful in the Labrador and Nordic Seas. Biostratigraphic markers useful for regional rather than supraregional correlation are the HOs of Batiacasphaera hirsuta (c. 8.4 Ma, upper Tortonian) and Unipontidinium aquaeductus (c. 13.6-13.9 Ma, upper Langhian), the HCO of the acritarch Decahedrella martinheadii (c. 6.7-6.3 Ma, Messinian), and possibly the LO of Cerebrocysta irregulare sp. nov. (c. 13.8 Ma, uppermost Langhian) across the Nordic Seas. Since Habibacysta tectata, B. micropapillata, R. actinocoronata and D. martinheadii have been observed in the Arctic Ocean, they are potentially useful for high latitude correlations in the polar domain. The LOs of Habibacysta tectata and Unipontidinium aquaeductus suggest a mid- to late Langhian age (15.1-13.7 Ma) for deposits at the base of Hole 907A, thus providing new constraints on the age of basalts at the base of ODP Hole 907A. The stratigraphically important dinoflagellate cysts Cerebrocysta irregulare sp. nov., and Impagidinium elongatum sp. nov. are formally described.

(Table A1) Uranium and Thorium determination from IODP Site 310-M0007B

The Integrated Ocean Drilling Program (IODP) Expedition 310 recovered drill cores from the drowned reefs around the island of Tahiti (17°40'S, 149°30'W), many of which contained samples of massive corals from the genus Porites. Herein we report on one well-preserved fossil coral sample: a 13.6 cm long Porites sp. dated by uranium series techniques at 9523 ± 33 years. Monthly delta18O and Sr/Ca determinations reveal nine clear and robust annual cycles. Coral delta18O and Sr/Ca determinations estimate a mean temperature of ca. 24.3°C (ca. 3.2°C colder than modern) for Tahiti at 9.5 ka; however, this estimate is viewed with caution since potential sources of cold bias in coral geochemistry remain to be resolved. The interannual variability in coral delta18O is similar between the 9.5 ka coral record and a modern record from nearby Moorea. The seasonal cycle in coral Sr/Ca is approximately the same or greater in the 9.5 ka coral record than in modern coral records from Tahiti. Paired analysis of coral delta18O and Sr/Ca indicates cold/wet (warm/dry) interannual anomalies, opposite from those observed in the modern instrumental record.