Diagnosis, staging and treatment of hepatocellular carcinoma

Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC) attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies.

Influence of thermal treatment of wood on the aroma of a sugar cane spirit (cachaça) model-solution

The aging process of alcoholic beverages is generally conducted in wood barrels made with species from Quercus sp. Due to the high cost and the lack of viability of commercial production of these trees in Brazil, there is demand for new alternatives to using other native species and the incorporation of new technologies that enable greater competitiveness of sugar cane spirit aged in Brazilian wood. The drying of wood, the thermal treatment applied to it, and manufacturing techniques are important tools in defining the sensory quality of alcoholic beverages after being placed in contact with the barrels. In the thermal treatment, several compounds are changed by the application of heat to the wood and various studies show the compounds are modified, different aromas are developed, there is change in color, and beverages achieve even more pleasant taste, when compared to non-treated woods. This study evaluated the existence of significant differences between hydro-alcoholic solutions of sugar cane spirits elaborated from different species of thermo-treated and non-treated wood in terms of aroma. An acceptance test was applied to evaluate the solutions preferred by tasters under specific test conditions.

Conceptual design of wastewater treatment plants using multiple objectives

La implementació de la Directiva Europea 91/271/CEE referent a tractament d'aigües residuals urbanes va promoure la construcció de noves instal·lacions al mateix temps que la introducció de noves tecnologies per tractar nutrients en àrees designades com a sensibles. Tant el disseny d'aquestes noves infraestructures com el redisseny de les ja existents es va portar a terme a partir d'aproximacions basades fonamentalment en objectius econòmics degut a la necessitat d'acabar les obres en un període de temps relativament curt. Aquests estudis estaven basats en coneixement heurístic o correlacions numèriques provinents de models determinístics simplificats. Així doncs, moltes de les estacions depuradores d'aigües residuals (EDARs) resultants van estar caracteritzades per una manca de robustesa i flexibilitat, poca controlabilitat, amb freqüents problemes microbiològics de separació de sòlids en el decantador secundari, elevats costos d'operació i eliminació parcial de nutrients allunyant-les de l'òptim de funcionament. Molts d'aquestes problemes van sorgir degut a un disseny inadequat, de manera que la comunitat científica es va adonar de la importància de les etapes inicials de disseny conceptual. Precisament per aquesta raó, els mètodes tradicionals de disseny han d'evolucionar cap a sistemes d'avaluació mes complexos, que tinguin en compte múltiples objectius, assegurant així un millor funcionament de la planta. Tot i la importància del disseny conceptual tenint en compte múltiples objectius, encara hi ha un buit important en la literatura científica tractant aquest camp d'investigació. L'objectiu que persegueix aquesta tesi és el de desenvolupar un mètode de disseny conceptual d'EDARs considerant múltiples objectius, de manera que serveixi d'eina de suport a la presa de decisions al seleccionar la millor alternativa entre diferents opcions de disseny. Aquest treball de recerca contribueix amb un mètode de disseny modular i evolutiu que combina diferent tècniques com: el procés de decisió jeràrquic, anàlisi multicriteri, optimació preliminar multiobjectiu basada en anàlisi de sensibilitat, tècniques d'extracció de coneixement i mineria de dades, anàlisi multivariant i anàlisi d'incertesa a partir de simulacions de Monte Carlo. Això s'ha aconseguit subdividint el mètode de disseny desenvolupat en aquesta tesis en quatre blocs principals: (1) generació jeràrquica i anàlisi multicriteri d'alternatives, (2) anàlisi de decisions crítiques, (3) anàlisi multivariant i (4) anàlisi d'incertesa. El primer dels blocs combina un procés de decisió jeràrquic amb anàlisi multicriteri. El procés de decisió jeràrquic subdivideix el disseny conceptual en una sèrie de qüestions mes fàcilment analitzables i avaluables mentre que l'anàlisi multicriteri permet la consideració de diferent objectius al mateix temps. D'aquesta manera es redueix el nombre d'alternatives a avaluar i fa que el futur disseny i operació de la planta estigui influenciat per aspectes ambientals, econòmics, tècnics i legals. Finalment aquest bloc inclou una anàlisi de sensibilitat dels pesos que proporciona informació de com varien les diferents alternatives al mateix temps que canvia la importància relativa del objectius de disseny. El segon bloc engloba tècniques d'anàlisi de sensibilitat, optimització preliminar multiobjectiu i extracció de coneixement per donar suport al disseny conceptual d'EDAR, seleccionant la millor alternativa un cop s'han identificat decisions crítiques. Les decisions crítiques són aquelles en les que s'ha de seleccionar entre alternatives que compleixen de forma similar els objectius de disseny però amb diferents implicacions pel que respecte a la futura estructura i operació de la planta. Aquest tipus d'anàlisi proporciona una visió més àmplia de l'espai de disseny i permet identificar direccions desitjables (o indesitjables) cap on el procés de disseny pot derivar. El tercer bloc de la tesi proporciona l'anàlisi multivariant de les matrius multicriteri obtingudes durant l'avaluació de les alternatives de disseny. Específicament, les tècniques utilitzades en aquest treball de recerca engloben: 1) anàlisi de conglomerats, 2) anàlisi de components principals/anàlisi factorial i 3) anàlisi discriminant. Com a resultat és possible un millor accés a les dades per realitzar la selecció de les alternatives, proporcionant més informació per a una avaluació mes efectiva, i finalment incrementant el coneixement del procés d'avaluació de les alternatives de disseny generades. En el quart i últim bloc desenvolupat en aquesta tesi, les diferents alternatives de disseny són avaluades amb incertesa. L'objectiu d'aquest bloc és el d'estudiar el canvi en la presa de decisions quan una alternativa és avaluada incloent o no incertesa en els paràmetres dels models que descriuen el seu comportament. La incertesa en el paràmetres del model s'introdueix a partir de funcions de probabilitat. Desprès es porten a terme simulacions Monte Carlo, on d'aquestes distribucions se n'extrauen números aleatoris que es subsisteixen pels paràmetres del model i permeten estudiar com la incertesa es propaga a través del model. Així és possible analitzar la variació en l'acompliment global dels objectius de disseny per a cada una de les alternatives, quines són les contribucions en aquesta variació que hi tenen els aspectes ambientals, legals, econòmics i tècnics, i finalment el canvi en la selecció d'alternatives quan hi ha una variació de la importància relativa dels objectius de disseny. En comparació amb les aproximacions tradicionals de disseny, el mètode desenvolupat en aquesta tesi adreça problemes de disseny/redisseny tenint en compte múltiples objectius i múltiples criteris. Al mateix temps, el procés de presa de decisions mostra de forma objectiva, transparent i sistemàtica el perquè una alternativa és seleccionada en front de les altres, proporcionant l'opció que més bé acompleix els objectius marcats, mostrant els punts forts i febles, les principals correlacions entre objectius i alternatives, i finalment tenint en compte la possible incertesa inherent en els paràmetres del model que es fan servir durant les anàlisis. Les possibilitats del mètode desenvolupat es demostren en aquesta tesi a partir de diferents casos d'estudi: selecció del tipus d'eliminació biològica de nitrogen (cas d'estudi # 1), optimització d'una estratègia de control (cas d'estudi # 2), redisseny d'una planta per aconseguir eliminació simultània de carboni, nitrogen i fòsfor (cas d'estudi # 3) i finalment anàlisi d'estratègies control a nivell de planta (casos d'estudi # 4 i # 5).

Resistance to the anticoagulant rodenticides – the deployment of the new molecular methodology to identify mutations of the VKORC1 ‘resistance gene’, and understanding their potential impact on treatment outcome

Anticoagulants rodenticides have already known for over half a century, as effective and safe method of rodent control. However, discovered in 1958 anticoagulant resistance has given us a very important problem for their future long-term use. Laboratory tests provide the main method for identification the different types of anticoagulant resistances, quantify the magnitude of their effect and help us to choose the best pest control strategy. The main important tests are lethal feeding period (LFP) and blood clotting response (BCR) tests. These tests can now be used to quantify the likely effect of the resistance on treatment outcome by providing an estimate of the ‘resistance factor’. In 2004 the gene responsible for anticoagulant resistance (VKORC1) was identified and sequenced. As a result, a new molecular resistance testing methodology has been developed, and a number of resistance mutations, particularly in Norway rats and house mice. Three mutations of the VKORC1 gene in Norway rats have been identified to date that confer a degree of resistance to bromadiolone and difenacoum, sufficient to affect treatment outcome in the field.

Quasispecies of hepatitis C virus genotype 1 and treatment outcome with Peginterferon and Ribavirin

The majority of patients with chronic hepatitis C fail to respond to antiviral therapy. The genetic basis of this resistance is unknown. The quasispecies nature of HCV may have an important implication concerning viral persistence and response to therapy. The HCV nonstructural 5A (NS5A) protein has been controversially implicated in the inherent resistance of HCV to interferon (IFN) antiviral therapy. To evaluate whether the NS5A quasispecies pre-treatment composition of HCV 1a/1b is related to responsiveness to combined pegylated interferon (PEG-IFN) and Ribavirin therapy, detailed analyses of the complete NS5A were performed. Fifteen full-length NS5A clones were sequenced from 11 pretreatment samples of patients infected with genotype 1 HCV (3 virological sustained responders, 4 non-responders, and 4 end-of-treatment responders). Our study could not show a significant correlation between the mean number of mutations in HCV NS5A before treatment and treatment outcome, and the phylogenetic construction of complete NS5A sequences obtained from all patients failed to show any clustering associated with a specific response pattern. No single amino acid position was associated with different responses to therapy in any of the NS5A regions analyzed, and mutations were clustered downstream the ISDR, primarily in the V3 region. We observed that the CRS and NLS regions of the NS5A protein were conflicting for some variables analyzed, although no significant differences were found. If these two regions can have antagonistic functions, it seems viable that they present different mutation profiles when compared with treatment response. The patient sample that presented the lowest genetic distance values also presented the smallest number of variants, and the most heterogeneous pattern was seen in the end-of-treatment patients. These results suggest that a detailed molecular analysis of the NS5A region on a larger sample size may be necessary for understanding its role in the therapy outcome of HCV 1a/1b infection. (C) 2008 Elsevier B.V. All rights reserved.

On Hepatitis C Virus Evolution: The Interaction between Virus and Host towards Treatment Outcome

Background:Hepatitis C is a disease spread throughout the world. Hepatitis C virus (HCV), the etiological agent of this disease, is a single-stranded positive RNA virus. Its genome encodes a single precursor protein that yields ten proteins after processing. NS5A, one of the non-structural viral proteins, is most associated with interferon-based therapy response, the approved treatment for hepatitis C in Brazil. HCV has a high mutation rate and therefore high variability, which may be important for evading the immune system and response to therapy. The aim of this study was to analyze the evolution of NS5A quasispecies before, during, and after treatment in patients infected with HCV genotype 3a who presented different therapy responses.Methods:Viral RNA was extracted, cDNA was synthesized, the NS5A region was amplified and cloned, and 15 clones from each time-point were sequenced. The sequences were analyzed for evolutionary history, genetic diversity and selection.Results:This analysis shows that the viral population that persists after treatment for most non-responder patients is present in before-treatment samples, suggesting it is adapted to evade treatment. In contrast, the population found in before treatment samples from most end-of-treatment responder patients either are selected out or appears in low frequency after relapse, therefore changing the population structure. The exceptions illustrate the uniqueness of the evolutionary process, and therefore the treatment resistance process, in each patient.Conclusion:Although evolutionary behavior throughout treatment showed that each patient presented different population dynamics unrelated to therapy outcome, it seems that the viral population from non-responders that resists the treatment already had strains that could evade therapy before it started. © 2013 Bittar et al.

Historic of therapeutic efficacy of albendazol sulphoxide administered in different routes, dosages and treatment schemes, against Taenia saginata in cattle experimentally infected

The present study aimed to notify the history of albendazole sulphoxide (ALB-SO) and albendazole (ALBZ) efficacy against Taenia saginata cysticercus (Cysticercus bovis) parasitizing experimentally infected bovines. A total of 11 efficacy trials were performed between the years of 2002 and 2010. In order to perform these trials, animals were individually inoculated with 2 x 104 eggs of T. saginata in each study's day zero (DO). For every trial, a positive control group (untreated infected animals) and a negative control group (animals that were neither infected nor treated) were used. ALB-SO or ALB were administered in the different dosages, in different days of treatments. In a last study with this formulation, this active principle was administered orally, mixed with the mineral supplement, on the 60th DPI, in a dosage of 30 mg/kg. In all trials, on the 100th DPI, all animals were euthanized and submitted to the sequenced slicing of 26 anatomical segments (fragments of approximately five millimeters) for the survey of T. saginata cysticercus. With the obtained results it is possible to verify that in the first trials, conducted in 2002, ALB-SO reached, independently of dosage and treatment scheme, efficacies superior to 98% (arithmetic means). The trials conducted in 2005 (2.5 mg/kg on the 30th, 60th, and 90th DPI) obtained values of efficacy all inferior to 60%. In 2008, the trials with 2.5 and 7.7 mg/kg demonstrated efficacy values inferior to 40%, for both dosages and treatment schemes (30th/60th/90th DPI and 60th DPI). When this formulation was administered orally on the dosage of 30 mg/kg on the 60th DPI, the efficacy against T. saginata cysticercus reached 88.28%. ALB administered orally showed efficacy values of 0.0%, 29.88% and 28.64% in the dosages of 5, 10 and 15 mg/kg, respectively, using the treatment schemes described above for each dosage. Based on the results of these trials, conducted in an eight year period (2002-2010) using the sequenced slicing method for evaluating the efficacy of the aforementioned formulations against T. saginata cysticercus, it is possible to observe that, amongst the few molecules used in the chemotherapic treatment against T. saginata larvae, ALB-SO, administered in varied routes, dosages and treatment schemes, the studies conducted in 2008, 2009, and 2010, have a low therapeutic efficacy against C bovis in Brazil, while ALBZ had insignificant efficacy values against T. saginata larvae parasitizing experimentally infected bovines. However, future studies using molecular biology will be necessary to assess whether the difference on the efficacy of the ALB-SO can be related to strain or another specific factor. (C) 2013 Elsevier Inc. All rights reserved.

Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Surgical Treatment of Type 2 Diabetes in Patients with BMI Below 35: Mid-term Outcomes of the Laparoscopic Ileal Interposition Associated with a Sleeve Gastrectomy in 202 Consecutive Cases

The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35. The procedures were performed on 202 consecutive patients. Mean age was 52.2 +/- 7.5. Mean duration of T2DM was 9.8 +/- 5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%. Mean follow-up was 39.1 months (range, 25-61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m(2), mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A(1c) (HbA(1c)) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA(1c) below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications. Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI < 35. Beyond glycemic control, other benefits were achieved.

Conservative Treatment of Comminuted Mandibular Fracture Involving Maxillomandibular Fixation With Miniplates

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

Glycerol as a by-product of biodiesel production in Brazil: Alternatives for the use of unrefined glycerol

On January 1 2008, Brazil included yet another element into its energy matrix: biodiesel. The predominant biodiesel production process involves a phase of transesterification that yields glycerol as a by-product. The use of this glycerol is limited since it is considered an unrefined raw material that must be refined for its various types of use. Several studies have addressed identification of possible uses for unrefined glycerol. Given the diversity of uses, an overview is necessary. The purpose of this work is to present alternatives currently being considered for the use of unrefined glycerol as a by-product of biodiesel production, aiming to contribute to the sustainable consolidation of the biofuel market. Exploratory research was carried out to identify these viable alternatives for the use of this by-product. The possibilities include the production of chemical products, fuel additives, production of hydrogen, development of fuel cells, ethanol or methanol production, animal feed, co-digestion and co-gasification, and waste treatment among others. The present research reveals that there are promising possibilities for the use of unrefined glycerol, which may help consolidate the sustainability of the biofuel market. (C) 2012 Elsevier Ltd. All rights reserved.

Restructuring Justice: Moving Towards Gender-Responsive Programming and Alternatives to Incarceration for Non-Violent Female Offenders

The United States¿ Federal and State laws differentiate between acceptable (or, legal) and unacceptable (illegal) behavior by prescribing restrictive punishment to citizens and/or groups that violate these established rules. These regulations are written to treat every person equally and to fairly serve justice; furthermore, the sanctions placed on offenders seek to reform illegal behavior through limitations on freedoms and rehabilitative programs. Despite the effort to treat all offenders fairly regardless of social identity categories (e.g., sex, race, ethnicity, socioeconomic status, age, ability, and gender and sexual orientation) and to humanely eliminate illegal behavior, the American penal system perpetuates de facto discrimination against a multitude of peoples. Furthermore, soaring recidivism rates caused by unsuccessful re-entry of incarcerated offenders puts economic stress on Federal and State budgets. For these reasons, offenders, policy-makers, and law-abiding citizens should all have a vested interest in reforming the prison system. This thesis focuses on the failure of the United States corrections system to adequately address the gender-specific needs of non-violent female offenders. Several factors contribute to the gender-specific discrimination that women experience in the criminal justice system: 1) Trends in female criminality that skew women¿s crime towards drug-related crimes, prostitution, and property offenses; 2) Mandatory minimum sentences for drug crimes that are disproportionate to the crime committed; 3) So-called ¿gender-neutral¿ educational, vocational, substance abuse, and mental health programming that intends to equally rehabilitate men and women, but in fact favors men; and 4) The isolating nature of prison structures that inhibits smooth re-entry into society. I argue that a shift in the placement and treatment of non-violent female offenders is necessary for effective rehabilitation and for reducing recidivism rates. The first component of this shift is the design and implementation of gender- responsive treatment (GRT) rather than gender-neutral approaches in rehabilitative programming. The second shift is the utilization of alternatives to incarceration, which provide both more humane treatment of offenders and smoother reintegration to society. Drawing on recent scholarship, information from prison advocacy organizations, and research with men in an alternative program, I provide a critical analysis of current policies and alternative programs, and suggest several proposals for future gender- responsive programs in prisons and in place of incarceration. I argue that the expansion of gender-responsive programming and alternatives to incarceration respond to the marginalization of female offenders, address concerns about the financial sustainability of the United States criminal justice system, and tackle high recidivism rates.

Genotypic and phenotypic characterization of Trypanosoma brucei gambiense isolates from Ibba, South Sudan, an area of high melarsoprol treatment failure rate

Resistance of trypanosomes to melarsoprol is ascribed to reduced uptake of the drug via the P2 nucleoside transporter. The aim of this study was to look for evidence of drug resistance in Trypanosoma brucei gambiense isolates from sleeping sickness patients in Ibba, South Sudan, an area of high melarsoprol failure rate. Eighteen T. b. gambiense stocks were phenotypically and only 10 strains genotypically characterized. In vitro, all isolates were sensitive to melarsoprol, melarsen oxide, and diminazene. Infected mice were cured with a 4 day treatment of 2.5mg/kg bwt melarsoprol, confirming that the isolates were sensitive. The gene that codes for the P2 transporter, TbATI, was amplified by PCR and sequenced. The sequences were almost identical to the TbAT1(sensitive) reference, except for one point mutation, C1384T resulting in the amino acid change proline-462 to serine. None of the described TbAT1(resistant)-type mutations were detected. In a T. b. gambiense sleeping sickness focus where melarsoprol had to be abandoned due to the high incidence of treatment failures, no evidence for drug resistant trypanosomes or for TbAT1(resistant)-type alleles of the P2 transporter could be found. These findings indicate that factors other than drug resistance contribute to melarsoprol treatment failures.

Effective water treatment for rural communities in Suriname : a comparison of point-of-use ceramic filters and centralized treatment with sand filters

For countless communities around the world, acquiring access to safe drinking water is a daily challenge which many organizations endeavor to meet. The villages in the interior of Suriname have been the focus of many improved drinking water projects as most communities are without year-round access. Unfortunately, as many as 75% of the systems in Suriname fail within several years of implementation. These communities, scattered along the rivers and throughout the jungle, lack many of the resources required to sustain a centralized water treatment system. However, the centralized system in the village of Bendekonde on the Upper Suriname River has been operational for over 10 years and is often touted by other communities. The Bendekonde system is praised even though the technology does not differ significantly from other failed systems. Many of the water systems that fail in the interior fail due to a lack of resources available to the community to maintain the system. Typically, the more complex a system becomes, so does the demand for additional resources. Alternatives to centralized systems include technologies such as point-of-use water filters, which can greatly reduce the necessity for outside resources. In particular, ceramic point-of-use water filters offer a technology that can be reasonably managed in a low resource setting such as that in the interior of Suriname. This report investigates the appropriateness and effectiveness of ceramic filters constructed with local Suriname clay and compares the treatment effectiveness to that of the Bendekonde system. Results of this study showed that functional filters could be produced from Surinamese clay and that they were more effective, in a controlled laboratory setting, than the field performance of the Bendekonde system for removing total coliform. However, the Bendekonde system was more successful at removing E. coli. In a life-cycle assessment, ceramic water filters manufactured in Suriname and used in homes for a lifespan of 2 years were shown to have lower cumulative energy demand, as well as lower global warming potential than a centralized system similar to that used in Bendekonde.

Alveolar and cystic echinococcosis: towards novel chemotherapeutical treatment options

Echinococcus granulosus and Echinococcus multilocularis are cestode parasites, of which the metacestode (larval) stages cause the neglected diseases cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. The benzimidazoles albendazole and mebendazole are presently used for the chemotherapeutical treatment, alone or prior to and after surgery. However, in AE these benzimidazoles do not appear to be parasiticidal in vivo. In addition, failures in drug treatments as well as the occurrence of side-effects have been reported, leading to discontinuation of treatment or to progressive disease. Therefore, new drugs are needed to cure AE and CE. Strategies that are currently employed in order to identify novel chemotherapeutical treatment options include in vitro and in vivo testing of broad-spectrum anti-infective drugs or drugs that interfere with unlimited proliferation of cancer cells. The fact that the genome of E. multilocularis has recently been sequenced has opened other avenues, such as the selection of novel drugs that interfere with the parasite signalling machinery, and the application of in silico approaches by employing the Echinococcus genome information to search for suitable targets for compounds of known mode of action.