The stomach cancer pooling (StoP) project: study design and presentation.

Gastric cancer affects about one million people per year worldwide, being the second leading cause of cancer mortality. The study of its etiology remains therefore a global issue as it may allow the identification of major targets, besides eradication of Helicobacter pylori infection, for primary prevention. It has however received little attention, given its comparatively low incidence in most high-income countries. We introduce a consortium of epidemiological investigations named the 'Stomach cancer Pooling (StoP) Project'. Twenty-two studies agreed to participate, for a total of over 9000 cases and 23 000 controls. Twenty studies have already shared the original data set. Of the patients, 40% are from Asia, 43% from Europe, and 17% from North America; 34% are women and 66% men; the median age is 61 years; 56% are from population-based case-control studies, 41% from hospital-based ones, and 3% from nested case-control studies derived from cohort investigations. Biological samples are available from 12 studies. The aim of the StoP Project is to analyze the role of lifestyle and genetic determinants in the etiology of gastric cancer through pooled analyses of individual-level data. The uniquely large data set will allow us to define and quantify the main effects of each risk factor of interest, including a number of infrequent habits, and to adequately address associations in subgroups of the population, as well as interaction within and between environmental and genetic factors. Further, we will carry out separate analyses according to different histotypes and subsites of gastric cancer, to identify potential different risk patterns and etiological characteristics.

Comprender la experiencia de la mujer ingresada con pre-eclampsia y eclampsia

Introducción: La preeclampsia/eclampsia es una enfermedad del embarazo que puede producir cambios en el estado emocional de la mujer por su prolongado ingreso hospitalario. Objetivo: Conocer las experiencias vividas por las mujeres con preeclampsia/eclampsia durante el ingreso hospitalario. Los objetivos que se tendrán en cuenta serán conocer cómo se modifica el rol propio dentro de la organización familiar, conocer cómo impacta su ingreso respecto a suestado emocional, conocer cómo les afecta la estructura de la unidad a su estado emocional y conocer qué necesidades y/o cuidados terapéuticos reciben respeto al equipo sanitario. Ámbito: El estudio se realizará en el Hospital de la Vall d’ Hebrón de Barcelona. Metodología: Estudio fenomenológico. La muestra se escogerá intencionadamente que cumplirá con los criterios de inclusión (mujeres ingresadas por preeclampsia/eclampsia en launidad de materno infantil de la Vall d’ Hebrón de Barcelona), y se terminará hasta llegar al nivel de saturación teórico. Los datos se recogerán a través de entrevistas semi-estructuradas y de la observación participante. Consideraciones finales: Dada la baja incidencia que existe tanto a nivel nacional como internacional en estudios de este tipo, un estudio cualitativo que ayude a conocer las experiencias de las mujeres ingresadas por preeclampsia podría ayudar a mejorar la calidad y práctica asistencial enfermera.

What determines the wavelength of self-organized shoreline sand waves?

Shoreline undulations extending into the bathymetric contours with a length scale larger than that of the rhythmic surf zone bars are referred to as shoreline sand waves. Many observed undulations along sandy coasts display a wavelength in the order 1-7 km. Several models that are based on the hypothesis that sand waves emerge from a morphodynamic instability in case of very oblique wave incidence predict this range of wavelengths. Here we investigate the physical reasons for the wavelength selection and the main parametric trends of the wavelength in case of sand waves arising from such instability. It is shown that the existence of a minimum wavelength depends on an interplay between three factors affecting littoral drift: (A) the angle of wave fronts relative to local shoreline, which tends to cause maximum transport at the downdrift flank of the sand wave, (B) the refractive energy spreading which tends to cause maximum transport at the updrift flank and (C) wave focusing (de-focusing) by the capes (bays), which tends to cause maximum transport at the crest or slightly downdrift of it. Processes A and C cause decay of the sand waves while process B causes their growth. For low incidence angles, B is very weak so that a rectilinear shoreline is stable. For large angles and long sand waves, B is dominant and causes the growth of sand waves. For large angles and short sand waves C is dominant and the sand waves decay. Thus, wavelength selection depends on process C, which essentially depends on shoreline curvature. The growth rate of very long sand waves is weak because the alongshore gradients in sediment transport decrease with the wavelength. This is why there is an optimum or dominant wavelength. It is found that sand wave wavelength scales with λ0/β where λ0 is the water wave wavelength in deep water and β is the mean bed slope from shore to the wave base.

Les esthésioneuroblastomes Esthesioneuroblastoma.

Esthesioneuroblastoma is an uncommon malignancy originating from olfactive epithelium. Men are more frequently affected than women. Nasal symptoms are the most common revealing signs. Immunohistochemistry helps diagnosis. There is no randomized trial evaluating treatment due to the low incidence of this tumor. Radiotherapy and surgery are the standard of care. Radiotherapy is benefic even in early stage disease. Chemotherapy is indicated in case of locally advanced or metastatic disease.

Fungal infection as a risk factor for HIV disease progression among patients with a CD4 count above 200/microl in the era of cART.

The identification of clinical risk factors for AIDS in patients with preserved immune function is of significant interest. We examined whether patients with fungal infection (FI) and CD4 cell count >or=200/microl were at higher risk of disease progression in the era of cART. 11,009 EuroSIDA patients were followed from their first CD4 cell count >or=200/microl after 1 January 1997 until progression to any non-azoles/amphotericin B susceptible (AAS) AIDS disease, last visit or death. Initiation of antimycotic therapy (AMT) was used as a marker of FI and was modelled as a time-updated covariate using Poisson regression. After adjustment for current CD4 cell count, HIV-RNA, starting cART and diagnosis of AAS-AIDS, AMT was significantly associated with an increased incidence of non-AAS-AIDS (IRR=1.55, 95% CI 1.17-2.06, p=0.0024). Despite low incidence of AIDS in the cART era, FI in patients with a CD4 cell count >or=200/microl is associated with a 55% higher risk of non-AAS-AIDS (95% confidence interval 1.17-2.06, p=0.0024). These data suggest that patients with FI are more immune compromized than would be expected from their CD4 cell count alone. FI can be used as a clinical marker for disease progression and indirect indicator for initiation/changing cART in settings where laboratory facilities are limited.

Seroepidemiology of herpes simplex virus type 1 and 2 in pregnant women in Switzerland: an obstetric clinic based study.

OBJECTIVE: To assess the seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) IgG antibodies and the seroincidence of HSV-1 and HSV-2 infections in pregnant women attending the maternity clinic of the University Hospital Lausanne. STUDY DESIGN: Blood samples from 1030 women were taken at the usual pregnancy visit in the first trimester to assess the prevalence rate of IgG antibodies against HSV-1 and HSV-2 using a type-specific assay. A second blood sample was taken 6-8 weeks postpartum from returning women who were seronegative for HSV-2 or HSV-1 to assess the incidence of seroconversion (primary infection). RESULTS: The seroprevalence rates were 79.4% (95% CI: 76.9-81.9) for HSV-1 and 21.2% (18.7-23.7) for HSV-2 in women 14-46 years old. Type-specific serostatus patterns were as follows: 17.3% HSV-1/-2: +/+, 62.1% HSV-1/-2: +/-, 3.9% HSV-1/-2: -/+, 16.7% HSV-1/-2: -/-. Two hundred and sixty five women (59 of the 212 seronegative for HSV-1 (27.8%) and 265 of the 812 seronegative for HSV-2 (32.6%)) returned to the outpatient clinic for the post-delivery check and a second blood sample was obtained. One HSV-1 seroconversion was detected (HSV-1 seroconversion rate 2.4%/100 patient×year (95% CI: 0.06-13.4)) in a patient who had symptoms compatible with primary genital herpes. No HSV-2 seroconversion was detected (HSV-2 seroconversion rate: 0/100 patient×year (97.5% one-sided CI: 0-2)). CONCLUSION: Compared to a previous population-based study, our study results suggest a rise in the prevalence of HSV-2 among pregnant women in Switzerland. The low incidence of seroconversion detected during pregnancy is consistent with the very low reported incidence of neonatal herpes in Switzerland. CONDENSATION: This study in a public hospital in Western Switzerland suggests an increasing prevalence of HSV-2, but a low incidence of primary infections in women of childbearing age.

Self-expandable metal stents in the treatment of acute esophageal variceal bleeding.

Acute variceal bleeding (AVB) is a life-threatening complication in patients with cirrhosis. Hemostatic therapy of AVB includes early administration of vasoactive drugs that should be combined with endoscopic therapy, preferably banding ligation. However, failure to control bleeding or early rebleed within 5 days still occurs in 15-20% of patients with AVB. In these cases, a second endoscopic therapy may be attempted (mild bleeding in a hemodynamically stable patient) or we can use a balloon tamponade as a bridge to definitive derivative treatment (i.e., a transjugular intrahepatic portosystemic shunt). Esophageal balloon tamponade provides initial control in up to 80% of AVB, but it carries a high risk of major complications, especially in cases of long duration of tamponade (>24 h) and when tubes are inserted by inexperienced staff. Preliminary reports suggest that self-expandable covered esophageal metallic stents effectively control refractory AVB (i.e., ongoing bleeding despite pharmacological and endoscopic therapy or massive bleeding precluding endoscopic therapy) with a low incidence of complications. Thus, covered self-expanding metal stents may represent an alternative to the Sengstaken-Blakemore balloon for the temporary control of bleeding in treatment failures. Further studies are required to determine the role of this new device in AVB.

Long-Lasting Fever and Lymphadenitis: Think about F. tularensis.

We report the case of glandular tularemia that developed in a man supposedly infected by a tick bite in Western Switzerland. Francisella tularensis (F. tularensis) was identified. In Europe tularemia most commonly manifests itself as ulcero-glandular or glandular disease; the diagnosis of tularemia may be delayed in glandular form where skin or mucous lesion is absent, particularly in areas which are assumed to have a low incidence of the disease.

Prevalence of ragweed allergy in rural Geneva - a pilot study.

OBJECTIVE: The prevalence of ragweed allergy is increasing worldwide. Ragweed distribution and abundance is spreading in Europe in a wide area ranging from the Rhone valley in France to Hungary and Ukraine, where the rate of the prevalence can peak at as high as 12%. Low-grade ragweed colonisation was seen in Geneva and Ticino, less than two decades ago. There were fears that allergies to ragweed would increase Switzerland. The intent of this study was to assess the rate of prevalence of sensitisation and allergy to ragweed in the population living in the first rural Swiss setting where ragweed had been identified in 1996, and to evaluate indirectly the efficacy of elimination and containment strategies. MATERIAL AND METHODS: In 2009, 35 adults in a rural village in the Canton of Geneva were recruited. Data were collected by means of questionnaires and skin-prick tests were done on each participant. The study was approved by the local Ethics Committee. RESULTS: Based on questionnaires, 48.6% had rhinitis (95% confidence interval [CI] 32.9-64.4; n = 17/35) and 17.1% asthma (95% CI 8.1-32.6; n = 6/35). Atopy was diagnosed in 26.4% (95% CI 12.9-44.4) of the sample (n = 9/34). Ragweed sensitisation was found in 2.9% (95% CI 0.7-19.7; n = 1/34), mugwort sensitisation in 2.9% (95% CI 0.1-14.9; n = 1/35), alder sensitisation in 17.1% (95% CI 6.6-33.6; n = 6/35), ash sensitisation in 12.5% (95% CI 3.5-29.0; n = 4/32) and grass sensitisation in 22.9% (95% CI 10.4-40.1; n = 8/35). Ragweed (95% CI 0.1-14.9; n = 1/34) and mugwort allergies (95% CI 0.1-14.9; n = 1/35) were both found in 2.9% of the population. CONCLUSION: This study showed a surprisingly low incidence of ragweed sensitisation and allergy, of 2.9% and 2.9%, respectively, 20 years after the first ragweed detection in Geneva. The feared rise in ragweed allergy seems not to have happened in Switzerland, compared with other ragweed colonised countries. These results strongly support early field strategies against ragweed.

Semi-selective culture medium for Exserohilum turcicum isolation from corn seeds

Northern corn leaf blight, caused by Exserohilum turcicum (Et), is a disease of widespread occurrence in regions where corn, sweetcorn and popcorn are grown. This disease has great potential to cause damage and has been studied for years, but the association of its causal agent with seeds remains unconfirmed. Thus, the availability of a sensitive method to detect and quantify the inoculum in seeds, even at low incidence, is essential. The aim of this study was to develop a method to detect and quantify the presence of the fungus infecting and infesting corn and popcorn seeds. Artificially and naturally infected seeds were employed to develop the medium. The semi-selective medium was composed of carbendazim (active ingredient) (60 mg/L), captan (30 mg/L), streptomycin sulfate (500 mg/L) and neomycin sulfate (600 mg/L) aggregated to the medium lactose casein hydrolysate agar medium. By using this, Et was detected in naturally infected corn seeds, showing 0.124% incidence, in four out of ten analyzed samples. In addition, 1.04 conidia were detected per infested seed. By means of isolation, pathogenicity test, morphological characterization and comparison with descriptions of the species in the literature, the fungus isolated from the seeds was confirmed to be Et. Both infection and infestation were considered low; thus, for studies of Et detection in corn seeds, the use of semi-selective medium and more than 1,200 seeds/sample is suggested.

Plasma metanephrines: a novel and cost-effective test for pheochromocytoma

Pheochromocytomas are rare chromaffin cell tumors that nevertheless must be excluded in large numbers of patients who develop sustained or episodic hypertension as well as in many others with suggestive symptoms or with a familial history of pheochromocytoma. Diagnosis of pheochromocytoma depends importantly on biochemical evidence of excess catecholamine production by a tumor. Imperfect sensitivity and specificity of commonly available biochemical tests and the low incidence of the tumor among the tested population mean that considerable time and effort can be expended in confirming or ruling out pheochromocytoma in patients where the tumor is suspected. Measurements of plasma free metanephrines provide a superior test compared to other available tests for diagnosis of pheochromocytoma. In particular, the high sensitivity of plasma free metanephrines means that a normal test result reliably excludes all but the smallest of pheochromocytomas so that no other tests are necessary. Measurements of plasma free metanephrines, when systematically combined with other diagnostic procedures outlined in this review, provide a more efficient, reliable and cost-effective approach for diagnosis of pheochromocytoma than offered by previously available approaches.

Ovariectomy does not affect the cardiac sympathovagal balance of female SHR but estradiol does

The low incidence of cardiovascular diseases, including hypertension, in premenopausal women has led to the conclusion that ovarian hormones may have a protective effect on the cardiovascular system. We evaluated the effects of ovariectomy and/or estradiol on sympathovagal balance and heart rate variability (HRV) in female spontaneously hypertensive rats (SHR) with tachycardia and compared them to Wistar rats (12 weeks old; N = 8-12). Ovariectomy (OVX) and/or estradiol (10 µg/kg) did not affect basal arterial pressure in either rat strain, but estradiol increased basal heart rate (HR) in OVX SHR (454 ± 18 vs 377 ± 9 bpm). HR changes elicited by methylatropine and propranolol were used to evaluate the sympathovagal balance. Ovariectomy did not affect the cardiac sympathovagal balance of any group, while estradiol increased sympathetic tone in OVX SHR (120 ± 8 vs 56 ± 10 bpm) and sham-operated Wistar rats (57 ± 7 vs 28 ± 4 bpm), and decreased the parasympathetic tone only in OVX SHR (26 ± 7 vs 37 ± 5 bpm). HRV was studied in the frequency domain (Fast Fourier Transformation). Spectra of HR series were examined at low frequency (LF: 0.2-0.75 Hz) and high frequency (HF: 0.75-3 Hz) bands. The power of LF, as well as the LF/HF ratio, was not affected by ovariectomy, but estradiol increased both LF (29 ± 4 vs 18 ± 3 nu in Wistar sham-operated, 26 ± 5 vs 15 ± 3 nu in Wistar OVX, 50 ± 3 vs 38 ± 4 nu in SHR sham-operated, and 51 ± 3 vs 42 ± 3 nu in SHR OVX) and LF/HF (0.48 ± 0.08 vs 0.23 ± 0.03 nu in Wistar sham-operated, 0.41 ± 0.14 vs 0.19 ± 0.05 nu in Wistar OVX, 0.98 ± 0.11 vs 0.63 ± 0.11 nu in SHR sham-operated, and 1.10 ± 0.11 vs 0.78 ± 0.1 nu in SHR OVX). Thus, we suggest that ovariectomy did not affect the cardiac sympathovagal balance of SHR or Wistar rats, while estradiol increased the sympathetic modulation of HR.

Closing the summer learning gap for vulnerable junior kindergarten students

Under current academic calendars across North America, summer vacation creates a significant gap in the learning cycle. I t has been argued that this gap actually decreases student achievement levels over the course of the summer. In a synthesis of 39 studies Cooper, Nye, Charlton, Lindsay, & Greathouse (1996) indicated that summer learning loss equaled at least one month of instruction as measured by grade level equivalents on standardized test scores whereby children's test scores were at least one month lower when they returned to school in the fall than scores were when students left in the summer. Specifically, Cooper et aI., (1996) found that the summer learning loss phenomena may be particularly troublesome for less advantaged children including those with speech and language delays, children at-risk for reading disabilities, children from lower socio-economic backgrounds, and children learning English as a second language. In general, research illustrated clearly that the summer learning gap can be particularly problematic for vulnerable children and furthermore, that literacy skills may be the area of achievement that is most affected. A foundational pillar to this research project is including primary caregivers as authentic partners in a summer literacy program designed to support their children's literacy needs. This pillar led the research team to use the Learning Begins at Home: A Research-Based Family Literacy Program Curriculum designed by Antoinette Doyle, Kathleen Hipfner-Boucher, and Janette Pelletier from the Ontario Institute for the Studies of Education. The LBH program is designed to be flexibly adapted to suit the needs of each individual participating family. As indicated by Timmons (2008) literacy interventions are most powerful when they include authentic family involvement. Based on this research, a requirement for participating in the summer literacy program was involvement of a child and one of their primary caregivers. The participating caregiver was integrally involved in the program, participating in workshop activities prior to and following hands-on literacy work with their child. By including primary caregivers as authentic partners, the research team encouraged a paradigmatic shift in the family whereby literacy activities become routine within their household. 5 Participants in this study were 14 children from junior kindergarten classrooms within the Niagara Catholic District School Board. As children were referred to the program, they were assessed by a trained emergent literacy specialist (from Speech Services Niagara) to identify whether they met the eligibility requirements for participation in the summer program. To be eligible to participate, children demonstrated significant literacy needs (i.e. below 25%ile on the Test of Preschool Early Literacy described below). Children with low incidence disabilities (i.e. profound sensory impairments, severe intellectual impairments, developmental disabilities, etc) were excluded as participants. The research team used a standard pre- and posttest design whereby all participating children were assessed with the Test of Preschool Early Literacy (Lonigan et aI., 2007), and a standard measure of letter names and sounds. Pretests were administered two weeks prior to the commencement of the program and the first set of posttests was administered immediately following the program. A second set of posttests was administered in December 2009 to measure the sustainability of the program. As a result of the program, all children scored statistically significantly higher on their literacy scores at the post-program assessment point immediately following the program and also at the Dec-post-program assessment point. These results in general indicated that the summer family literacy program made an immediate impact on the emergent literacy skills of participating children. All participating children demonstrated significant increases in print and phonological awareness as well as their letter sound understanding.

Bundling under the Threat of Parallel Trade

This paper examines the use of bundling by a firm that sells in two national markets and faces entry by parallel traders. The firm can bundle its main product, - a tradable good- with a non-traded service. It chooses between the strategies of pure bundling, mixed bundling and no bundling. The paper shows that in the low-price country the threat of grey trade elicits a move from mixed bundling, or no bundling, towards pure bundling. It encourages a move from pure bundling towards mixes bundling or no bundling in the high-price country. The set of parameter values for which the profit maximizing strategy is not to supply the low price country is smaller than in the absence of bundling. The welfare effects of deterrence of grey trade are not those found in conventional models of price arbitrage. Some consumers in the low-price country may gain from the threat of entry by parallel traders although they pay a higher price. This is due to the fact that the firm responds to the threat of arbitrageurs by increasing the amount of services it puts in the bundle targeted at consumers in that country. Similarly, the threat of parallel trade may affect some consumers in the hight-price country adversely.

Les cellules dendritiques plasmacytoides dans le sang de cordon et après greffe de sang de cordon

La greffe de sang de cordon est de plus en plus utilisée et a permis de traiter avec succès chez l’enfant des déficits immunitaires ainsi que des hémopathies malignes comme les leucémies. Malgré d’importants avantages tels que l’absence de risque pour le donneur ou la plus faible incidence de maladie du greffon contre l’hôte (GvHD), utiliser le sang de cordon comporte certains inconvénients. En effet, une reconstitution immunitaire retardée, des infections opportunistes en plus grand nombre et un risque de rechute sont des complications qui peuvent survenir et engendrer un risque pour le pronostic vital du patient. Par conséquent, de nouvelles stratégies d’immunothérapies doivent être envisagées. Dans le cadre de ce travail, nous nous sommes particulièrement intéressés aux cellules dendritiques plasmacytoides (pDC) dont les fonctions sont importantes pour l’initiation des réponses immunitaires innée et adaptative et particulièrement pour leur capacité à activer les cellules NK. Afin d’élucider le rôle et l’impact de ces cellules dans les greffes de sang de cordon, le nombre et la fonction des pDC et des NK a été suivi longitudinalement chez des patients ayant subi une greffe de sang de cordon comparativement à des patients transplantés avec de la moelle osseuse. Nous avons ainsi démontré que les pDC et les NK apparaissent précocement suite à une greffe de sang de cordon et que ces cellules sont fonctionnelles. Ces résultats mettent donc en lumière que ces cellules pourraient être de bons outils pour l’établissement d’une immunothérapie après greffe de sang de cordon. De plus, la caractérisation fonctionnelle des pDC du greffon de sang de cordon a permis de révéler une plus faible production d’IFN-α par les pDC, comparativement aux pDC de sang d’adulte. Cette différence pourrait jouer un rôle dans la plus faible incidence de GvHD après les greffes de sang de cordon. Dans le but de préciser les mécanismes moléculaires de régulation négative de la production d’IFN-α par les pDC de sang de cordon, nous avons étudié les protéines de la voie de signalisation TLR9-IRF7. L’expression similaire de l’ARN du TLR9, MyD88, IRAK1 et IRF7 contraste avec la plus faible expression des protéines correspondantes. De plus, l’expression des MicroARNs miR-146a et miR-155 est plus élevé dans les pDC de sang de cordon comparativement aux pDC de sang d’adultes. Ensemble, ces données pointent une régulation négative post-transcriptionnelle de la voie TLR9-IRF7 qui pourrait expliquer la plus faible production d’IFN-α des pDC du sang de cordon. L’ensemble des ces travaux suggère que les pDC pourraient représenter une cible de choix dans le développement de nouvelles approches thérapeutiques dans les greffes de sang de cordon.