Adequate Harvest Research Articles

English

The objective of this work was to evaluate the effects of control action (natural ripening, without ripeners) and of glyphosate, paraquat, fluazi-p-butil, ethephon, etyl-trinexapac, sulfometuron methyl and KNO3 on the number of stalks per area, diameter of the median third of stalks and productivity (tons of canesstalks per hectare), and brix, pol of the sugarcane and extractable sugar. It was used a randomized block design with four replicates in a sub-split plots. KNO3 contributes to improve agronomic quality by increasing productivity of stalks and the most favorable harvest period to the variable was from 60 to 120 days after ripener application (DAA). Etyl-trinexapac, sulfometuron methyl and KNO3 increased technological variables and the most adequate harvest period for ratoon sugar cane was 120 days after application (DAA) of ripeners and control, because they provided gains for variables ATR, Brix and PC in comparison to the respective initial reference times.   Key words: Plant regulators, Saccharum spp., technological quality.

Management compromises and the sustainability of palm populations in Mayan homegardens

The sustainability of a homegarden can be evaluated not only as its species richness and eco-systemic role, but also as the result of management practices affecting resource sustainability. Sabal spp. have been managed since Colonial times into homegardens, at present, its mature leaves are mostly used in roof building of traditional Mayan homes. Along a three-year study, we evaluated management sustainability of Sabal yapa and S. mexicana populations in two homegardens of Maxcanú, Yucatan, Mexico by the use of prospective and retrospective demographic analyses. We calculated sustainability based on population growth rate ( ? ). We used the prospective elasticity model to estimate the more sensible vital rates of the palm populations, and the retrospective analysis to calculate the effect of management practices on the annual variation of the palms population ? values. Care of young plants and occasional seed planting were among the management practices that increased the density of palms having an adequate harvesting size. The stages of the palms´ life cycle that are critical for sustainable population management are the adult and juvenile stages. An event of felling of adult palms had a negative effect in the population´s sustainability. Other practices in the homegarden such as weeding and watering of fruit trees increased the probabilities of survival. Our study showed that the management of natural resources in homegardens involves compromises, and is not always focused on the sustainability of specific resources, but rather on the integrated management of the agroforestry system.

Treatment of Tuberculous Empyema by Intrathoracic Transposition of a Latissimus Dorsi Muscle Flap.

Treatment of Tuberculous Empyema by Intrathoracic Transposition of a Latissimus Dorsi Muscle Flap.

The impact of colorectal screening program on the detection of right-sided colorectal cancer. A 5-year cohort study in the Mantua District.

High rates of advanced colorectal cancer (CRC) are still diagnosed in the right side of the colon. This study aimed to investigate whether screening programs increase CRC detection and whether tumor location is associated with survival outcome. Patients affected by CRC, aged from 50 to 69 years and operated on from 2005 to 2009 were reviewed. Other than patient-, disease-, and treatment-related factors, detection mode and tumor location were recorded. Overall (OS) and disease-free survival (DFS) were investigated, using univariate and multivariate analyses. Mean age of 386 patients included was 62.0 years, 59 % were males. CRC was detected by screening in 17 % of cases, and diagnosis was made from symptoms in 67 % and emergency surgery for 16 %. Screen-detected CRCs were located in the left colon (59 %), then in rectum (25 %) and in proximal colon (16 %) (p = 0.02). Most of CRC patients urgently operated on had cancer located in proximal colon (45 %), then in the left colon (36 %) and in rectum (18 %) (p = 0.001). Right-sided CRC demonstrated higher pTNM stage (p = 0.001), adequate harvest count nodes (p = 0.0001), metastatic nodes (p = 0.02), and poor differentiation grading (p = 0.0001). With multivariate analysis, poor differentiation grade was independently associated with both worse OS (HR 3.6, p = 0.05) and worse DFS (HR 8.1, p = 0.0001), while distant recurrence was associated with worse OS (HR 20.1, p = 0.0001). Low rates of right-sided CRC are diagnosed following screening program. Proximal CRC demonstrates aggressive behavior without impact on outcome. These findings prompt concern about population awareness for CRC screening.

Effect of Conservation Time and the Addition of Lactic Acid Bacteria on the Biogas and Methane Production of Corn Stalk Silage

The effects of ensiling and baling processes, of the application of silage additives and of the storage period of corn stalks on methane production have been assessed through anaerobic digestion batch experiments, in order to evaluate the storage efficacy of corn stalks used as feedstock in biogas plants. Ensiling has proved to be a good method for corn stalk preservation for methane production, as it helps to maintain low pH values of the biomass and reduce volatile solid losses during storage, even for longer periods than 3 months. It has been shown that ensiling does not affect the cumulative methane production of corn stalks but does improve the methane production rate at the beginning of the process. This can be attributed to an increase in ethanol during ensiling, which favours the rapid start of anaerobic digestion. Corn stalks inoculated with lactic acid bacteria have shown similar pH and slightly higher lactic and acetic acid contents than untreated ones, but these changes have not had a practical effect on methane production. Dry baled corn stalks have shown a lower methane production than ensiled stalks, due to the respiration process that takes place in the field during the wilting period and to the reduction in degradability, because of drying. Nevertheless, the choice of an adequate harvest chain of corn stalks is very important in order to obtain higher energy efficiency from ensiled corn stalks than from dry conservation. If the harvested biomass per hectare is very low, ensiled corn stalks could be an inefficient way of managing this biomass for methane production.

Abstract C166: Phase II study of cetuximab and lenalidomide in recurrent/metastatic squamous cell carcinoma of the head and neck.

Abstract Background: IgG1 antibodies can activate immune responses including antibody dependent cellular cytotoxicity (ADCC), which can be an important facet of their efficacy. We hypothesized that FcγRIIIa polymorphic (valine/phenylalanine at position 158) genotype in the presence of lenalidomide would be associated with enhanced immune and clinical response of cetuximab, an IgG1 anti-EGFR antibody, in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). We evaluated patient's FcγRIIIa polymorphic genotype and their ex-vivo Natural Killer cell (NK) activity with an ADCC assay to determine whether there was a correlation between FcγRIIIa genotype and NK activity with clinical outcome in subjects treated with cetuximab and lenalidomide. Materials and Methods: We conducted a multi-institutional phase II study involving patients with recurrent or metastatic SCCHN who were treated w[[Unable to Display Character: ı]]th cetuximab (500 mg/m2 IV every 2 weeks) and lenalidomide (25 mg orally or via feeding tube once daily). In addition to determining patients FcγRIIIa polymorphism, we studied the activity of patient's NK cells ex-vivo to determine how effectively their NK cells could mediate ADCC against SCCHN cell line TU167 in the presence of cetuximab. Finally, subjects receiving cetuximab and lenalidomide were followed for progression-free survival (PFS) and overall survival (OS). Results: We enrolled 42 patients (32 male, 10 female, mean age 61 years) with recurrent or metastatic SCCHN from three tertiary care centers: University of Chicago, University of Maryland, and Medical College of Wisconsin. Mean duration of therapy was 12 weeks with median PFS and OS of 7.2 and 16.4 weeks, respectively. Determination of patients FcγRIIIa polymorphic genotype at position 158 was available for 36 patients: V/V 2, F/V 20, and F/F 14. Twenty-six patients had adequate harvest of NK cells to perform ex vivo ADCC. While FcγRIIIa polymorphic genotype was not associated with clinical outcomes, patients who demonstrated elevated ex-vivo ADCC compared to patients who did not, showed a trend toward increased PFS, 14 vs 6.8 weeks, respectively p=0.12. Additionally, patients who were HPV+ demonstrated a trend toward increased OS, hazard ratio of 0.3 vs 1.0, respectively p=0.09. Conclusions: This is a challenging patient population with a substantial burden of oncologic disease having failed definitive standard of care treatment as well as other palliative modalities, culminating in reduced potency of their overall immune response. Treatment with combination cetuximab and lenalidomide in patients with recurrent or metastatic SCCHN was feasible. For patients who have NK that can still mount an ex-vivo ADCC response, they may experience longer PFS. Patients who are HPV+ may also encounter better OS. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C166. Citation Format: Rodney J. Taylor, Vassiliki Saloura, Richard Wong, Olga Goloubeva, Lorna Silpino, Jonas de Souza, Tanguy Seiwert, Everett Vokes, Ezra Cohen, Victoria Villaflor. Phase II study of cetuximab and lenalidomide in recurrent/metastatic squamous cell carcinoma of the head and neck. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr C166.

Influence of Microsatellite Instability and KRAS and BRAF Mutations on Lymph Node Harvest in Stage I–III Colon Cancers

Lymph node (LN) harvest is influenced by several factors, including tumor genetics. Microsatellite instability (MSI) is associated with improved node harvest, but the association to other genetic factors is largely unknown. Research methods included a prospective series of stage I-III colon cancer patients undergoing ex vivo sentinel-node sampling. The presence of MSI, KRAS mutations in codons 12 and 13, and BRAF V600E mutations was analyzed. Uni- and multivariate regression models for node sampling were adjusted for clinical, pathological and molecular features. Of 204 patients, 67% had an adequate harvest (≥ 12 nodes). Adequate harvest was highest in patients whose tumors exhibited MSI (79%; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.2-4.9; P = 0.007) or were located in the proximal colon (73%; 2.8, 1.5-5.3; P = 0.002). In multiple linear regression, MSI was a significant predictor of the total LN count (P = 0.02). Total node count was highest for cancers with MSI and no KRAS/BRAF mutations. The independent association between MSI and a high LN count persisted for stage I and II cancers (P = 0.04). Tumor location in the proximal colon was the only significant predictor of an adequate LN harvest (adjusted OR 2.4, 95% CI 1.2-4.9; P = 0.01). An increase in the total number of nodes harvested was not associated with an increase in nodal metastasis. In conclusion, number of nodes harvested is highest for cancers of the proximal colon and with MSI. The nodal harvest associated with MSI is influenced by BRAF and KRAS genotypes, even for cancers of proximal location. Mechanisms behind the molecular diversity and node yield should be further explored.

Evaluation of Graft Cell Viability—Efficacy of Piezoelectric Versus Manual Bone Scraper Technique

The aim of the present study was to compare the influence of 2 different bone scrapers with respect to graft quality. The study was conducted as a prospective, controlled experimental study of patients selected from the outpatient unit of the Department of Oral Surgery and Radiology (Dental Clinic, Medical University, Graz, Austria). Bone samples were obtained during routine lower third molar removal. Both a manual bone scraper (MS) and a piezoelectric device (PD) were used in directly adjacent regions in each case. As variables, the chip morphology, cell viability, and osteogenic differentiation were investigated. For statistical analysis, the Student t test and Fisher's exact test (P < .05) were applied. A total of 20 patients (12 women and 8 men, mean age 28.15 ± 5.8 years) were included in the study. A series of 40 bone samples was obtained during lower third molar removal. MS and PD enabled similar intraoral harvest of bone chips. In vitro outgrowth of adherent cells was found in 90% of the MS and 80% of the PD samples after 7 to 18 days, without statistical significance (P = .67). Similar cell viability of outgrowing cells in both groups was observed (94.7% ± 2.2% in the MS group and 94.1% ± 1.6% in the PD group). Reverse transcriptase-polymerase chain reaction analysis and the staining pattern verified osteopotent cells in both groups. Both manual and piezoelectric techniques are adequate harvesting technologies for limited intraoral augmentations. Our results did not show an advantage for the piezoelectric device.

Preharvest hematopoietic progenitor cell counts predict CD34+ cell yields in granulocyte–colony‐stimulating factor–mobilized peripheral blood stem cell harvest in healthy donors

The hematopoietic progenitor cell (HPC) count measured by the Sysmex hematology analyzer can determine the timing for leukapheresis in autologous peripheral blood stem cell (PBSC) harvest. We evaluated whether a HPC count could predict CD34+ cell yield in healthy, unrelated donors after granulocyte-colony-stimulating factor mobilization. A total of 117 healthy donors underwent 161 PBSC leukapheresis procedures in our institution. The HPCs and CD34+ cells were identified by an automated hematology analyzer and flow cytometry, respectively. Using Spearman's rank test, we evaluated the relationships between preharvest HPCs, CD34+ cell counts, and CD34+ cell yields in the apheresis product. A receiver operating characteristic (ROC) curve analysis was used to identify the cutoff value of HPC for adequate mobilization and harvest yield. The HPC count had a moderate correlation with the preharvest CD34+ cell count (r = 0.502, p < 0.001), and an HPC count of more than 21.3 x 10(6)/L could exclude poor mobilization (<20 x 10(6) CD34+ cells/L) with sensitivity and specificity of 89.2 and 83.3%. However, the relationship between HPC count and CD34+ cell yield was not marked (r = 0.321, p < 0.001). The area under the curve for HPCs was significantly smaller than the preharvest CD34+ cell count on the ROC curve for predicting adequate harvest yield (>10 x 10(6) CD34+ cells/L of processed blood volume, 0.678 vs. 0.850, p = 0.001). Although the preapheresis HPC count could predict mobilization in healthy donors before leukapheresis, it may not be a superior index for predicting CD34+ cell yield compared with the preharvest CD34+ cell count.

Two Cycles of PAD Combination (PS-341/Bortezomib, Adriamycin and Dexamethasone) Followed by Autologous Hematopoietic Cell Transplantation (AHCT) in Newly Diagnosed Multiple Myeloma (MM) Patients.

Abstract 2322Poster Board II-299 Introduction:Clinical trials have demonstrated that various combinations including Bortezomib (PS-341) are effective in newly diagnosed MM patients. We investigated the effectiveness of PAD (PS-341/Bortezomib, Adriamycin and Dexamethasone) and the feasibility of harvesting peripheral blood stem cells (PBSC) and performing AHCT after 2 cycles of PAD in newly diagnosed MM. Patients and Methods: Patients received two 21-day cycles of PAD consisting of bortezomib 1.3 mg/m2 on days 1, 4, 8, and 11; adriamycin 9 mg/m2 on days 1-4; and dexamethasone 40 mg on days 1-4 and 8-11. For mobilization of PBSC, G-CSF 10 mcg/kg was given subcutaneously for 4 days starting on day 12 of the second cycle of PAD. Following PBSC harvesting, AHCT was performed with a conditioning therapy of high-dose melphalan. Thalidomide 100-200 mg/d was given following AHCT. Results: Between April 2005 and October 2008, a total of 32 previously untreated patients, 18 males and 14 females, with symptomatic MM were enrolled into this study. Median age was 58.5 years (range, 44-69). Durie-Salmon stage was 1A in 3 (9.4%), 2A in 7 (21.9%), 3A in 19 (59.4%), and 3B in 3 (9.4%), while SWOG stage was I in 4 (12.5%), II in 18 (56.3%), III in 6 (18.8%), IV in 2 (6.3%), and unknown in 2 (6.3%). Of 31 patients who completed 2 planned cycles of PAD chemotherapy, 25 (80.6%) showed PR or better responses: CR in 6 (19.4%), VGPR in 5 (16.1%), and PR in 14 (45.2%). Severe (grade 3 or 4) non-hematologic toxicities after PAD were uncommon and included transient elevation of AST/ALT (3.2%), while severe hematologic toxicities were common (anemia, 4.8%; neutropenia, 38.1%; thrombocytopenia, 47.6%). All but two patients, who were removed from the study before PBSC collection, successfully mobilized PBSC with G-CSF for a median collection number of 3 (range, 2-7). The second attempt of PBSC collection was needed in 7 patients. Median number of collected CD34+ cells was 9.2 × 106/kg (range, 4.4-30.1). Thirty patients underwent AHCT on a median day of 73 (range, 50-126) from the first cycle of PAD. Tandem AHCT was performed in one patient. Median number of infused CD34+ cells was 7.6 × 106/kg (range, 4.4-18.5). Melphalan dose for conditioning therapy was 200 mg/m2 in 26 patients, 140 mg/m2 in one, and 120 mg/m2 in three. All patients showed adequate hematologic recovery after AHCT with a median day of 12 (range, 11-38) for neutrophils > 500/mcL and a median day of 17 (range, 10-54) for platelets > 20,000/mcL. Response after AHCT was CR in 14 (46.7%), VGPR in 8 (26.7%), PR in 6 (20.0%), SD in 1 (3.1%), and PD in 1 (3.1%). Thalidomide was given to 24 patients after AHCT as maintenance therapy. The median interval to starting thalidomide from AHCT was 61 days (range, 32-206) and the median duration of thalidomide administration was 283.5 days (range, 2-741). Nine patients showed better response after thalidomide (VGPR → CR in 4, PR → CR in 1, SD → CR in 1, PR → VGPR in 3, and PD → PR in 1), thus after all, 20 patients (66.7%) achieved CR. With a median follow-up duration of 736 days (range, 178-1398) among surviving patients, 14 patients progressed and 6 died. Probabilities of overall and progression-free survival (PFS) were 62.5% and 32.7% at 3 years, respectively. PFS was significantly longer in patients receiving thalidomide after AHCT compared to those not receiving thalidomide (41.5% vs. 0% at 3 years, P & 0.001). Conclusion: Our study results confirmed excellent activity of PAD in newly diagnosed MM patients and showed that adequate harvesting and autografting of PBSC after 2 cycles of PAD chemotherapy was feasible. Post-transplant maintenance of thalidomide appears to be beneficial in preventing disease progression after AHCT. Disclosures:No relevant conflicts of interest to declare.

Injecting Methylene Blue Into the Inferior Mesenteric Artery Assures an Adequate Lymph Node Harvest and Eliminates Pathologist Variability in Nodal Staging for Rectal Cancer

The American Joint Committee on Cancer recommends examination of a minimum of 12 lymph nodes in rectal cancer for accurate staging. Despite this, several studies have demonstrated that nodal harvest is highly variable and often inadequate. This study was designed to determine if staining the nodes with methylene blue dye produced a better and more accurate harvest in comparison with standard pathologic lymph node dissection. Fifty patients with primary resectable rectal cancer were randomly assigned to undergo a standard nodal harvest or a harvest after ex vivo injection of the inferior mesenteric artery with methylene blue. A fat clearance technique was subsequently used to identify the maximum possible number of lymph nodes and metastasis. The average lymph node harvest was 30 +/- 13.5 in the stained group and 17 +/- 11 in the unstained group (P < 0.001). At least 12 nodes were identified in every case in the stained group. In the unstained group, 7 of 25 cases (28 percent) did not meet the minimum criteria of 12 nodes (P < 0.01). Among the pathologists for the stained group, no difference was found in the harvest (P < 0.05), but variability was detected between the pathologists in the unstained group (P = 0.6). After fat clearance, one case in the unstained group was upstaged, whereas no cases in the stained group were upstaged. Staining the lymph nodes with methylene blue dye is an accurate staging technique and reliably produces an adequate harvest.

From wastewater treatment to biorefining

Wastewater, whether it is domestic or industrial, represents a great opportunity to recover water, energy or chemicals, and nutrients. Today, wastewater treatment is energy-consuming, and does not recover the resources from the wastewater. Bioelectrochemical systems (BESs), which have recently been developed, allow for adequate harvesting of the energy or for the production of high quality chemicals. In this article, the basic principles and opportunities of BESs in the context of wastewater treatment are explained.

O.097 Indications and results of oral and maxillofacial piezosurgery

The aim of the present study was to compare the influence of 2 different bone scrapers with respect to graft quality.The study was conducted as a prospective, controlled experimental study of patients selected from the outpatient unit of the Department of Oral Surgery and Radiology (Dental Clinic, Medical University, Graz, Austria). Bone samples were obtained during routine lower third molar removal. Both a manual bone scraper (MS) and a piezoelectric device (PD) were used in directly adjacent regions in each case. As variables, the chip morphology, cell viability, and osteogenic differentiation were investigated. For statistical analysis, the Student t test and Fisher's exact test (P < .05) were applied.A total of 20 patients (12 women and 8 men, mean age 28.15 ± 5.8 years) were included in the study. A series of 40 bone samples was obtained during lower third molar removal. MS and PD enabled similar intraoral harvest of bone chips. In vitro outgrowth of adherent cells was found in 90% of the MS and 80% of the PD samples after 7 to 18 days, without statistical significance (P = .67). Similar cell viability of outgrowing cells in both groups was observed (94.7% ± 2.2% in the MS group and 94.1% ± 1.6% in the PD group). Reverse transcriptase-polymerase chain reaction analysis and the staining pattern verified osteopotent cells in both groups.Both manual and piezoelectric techniques are adequate harvesting technologies for limited intraoral augmentations. Our results did not show an advantage for the piezoelectric device.

79: Pegfilgrastim (P) Appears to be Equivalent to Multiple Daily Doses of Filgrastim (F) to Treat Neutropenia Post-Autologous Peripheral Blood Stem Cell Transplant (PBSCT) in Patients with Non-Hodgkin's Lymphoma: Results of a Randomized Phase II Trial

Filgrastim has previously been shown to decrease the time to neutrophil recovery following autologous PBSCT. Therefore, it was hypothesized that a single injection of pegfilgrastim (P) would mimic the role of filgrastim (F), resulting in at least an equivalent shortening of post-PBSCT neutropenia.NHL patients over the age of 18 years who were deemed eligible for PBSCT were identified prior to the administration of high-dose chemotherapy, and following adequate harvest and cryopreservation of peripheral blood progenitor cells (ie, > 2.5 × 106 CD34+ cells/kg). Eligible patients with preserved end organ function received either standard BEAM or BEAC high-dose chemotherapy. Prior to high-dose therapy, patients were randomly assigned to receive either P at a fixed-dose of 6 mg on Day +1(Arm A), or weight-based, dose-adjusted F rounded to the nearest prefilled syringe beginning on Day +1(Arm B) following transplantation.One-hundred one eligible patients were enrolled within US Oncology Transplant Network between July 2003 and April 2007. Three patients were deemed ineligible (CHF death, consent withdrawn, other). The analyses and results presented below outline the remaining 98. The demographic characteristics of both arms were well-balanced with regards to stage at diagnosis and treatment, ECOG Performance Status, histology, and lines of prior therapy. The comparison of P vs F is summarized in the table that follows.Transplant-related mortality and the incidence of Grade 3–4 adverse events were comparable in both arms.Tabled 1Comparison of Pegfilgrastim (P) versus Filgrastim (F)VariableArm A (Pegfilgrastim)Arm B (Filgrastim)No. of Patients Treated (n)5048Doses Received (mean ± SD)1.0 ± 012.7 ± 2.6ANC Recovery (days) (mean ± SD)8.3 ± 1.18.9 ± 1.5RBC Transfusions (mean ± SD)1.7 ± 0.91.9 ± 1.2Platelet Transfusions (mean ± SD)3.0 ± 1.92.8 ± 1.8Positive Blood Culture Rate (%)18.0%29.0%Febrile Neutropenia Rate (FN) (%)18.0%16.7%Duration of FN (days) (mean ± SD)5.1 ± 3.45.5 ± 4.9 Open table in a new tab Filgrastim has previously been shown to decrease the time to neutrophil recovery following autologous PBSCT. Therefore, it was hypothesized that a single injection of pegfilgrastim (P) would mimic the role of filgrastim (F), resulting in at least an equivalent shortening of post-PBSCT neutropenia. NHL patients over the age of 18 years who were deemed eligible for PBSCT were identified prior to the administration of high-dose chemotherapy, and following adequate harvest and cryopreservation of peripheral blood progenitor cells (ie, > 2.5 × 106 CD34+ cells/kg). Eligible patients with preserved end organ function received either standard BEAM or BEAC high-dose chemotherapy. Prior to high-dose therapy, patients were randomly assigned to receive either P at a fixed-dose of 6 mg on Day +1(Arm A), or weight-based, dose-adjusted F rounded to the nearest prefilled syringe beginning on Day +1(Arm B) following transplantation. One-hundred one eligible patients were enrolled within US Oncology Transplant Network between July 2003 and April 2007. Three patients were deemed ineligible (CHF death, consent withdrawn, other). The analyses and results presented below outline the remaining 98. The demographic characteristics of both arms were well-balanced with regards to stage at diagnosis and treatment, ECOG Performance Status, histology, and lines of prior therapy. The comparison of P vs F is summarized in the table that follows. Transplant-related mortality and the incidence of Grade 3–4 adverse events were comparable in both arms.

Intermediate Dose Ara-C Followed by G-CSF: An Effective and Predictable Mobilization Regimen in Hematological Malignancies.

High dose (HD) chemotherapy followed by peripheral blood stem cell (PBSC) is widely used in the management of hematological malignancies and chemosensitive solid tumors. Different strategies of PBSC mobilization have been described, but currently the standard approach has not been established. Satisfactory results have been obtained by different chemotherapy schedules followed by haemopoietic growth factors: particularly HD Cyclophosphamyde or HDAra-C have a well known high mobilizing activity. With the intention to minimize hematological toxicity due to HD chemotherapy we performed this study to evaluate the mobilizing efficacy of intermediate dose Ara-C (IDAra-C).Methods: Pts with haematological malignancies received as mobilization treatment Ara-C 800 mg/m2 every 12 h for 6 doses followed by G-CSF 300 μg/d starting day +3 from the end of treatment until completion of leukapheresys (LP). CD34+ cells count was performed from day + 9. Failure of mobilization was defined as a persistent CD34+ cells count <10/μL. All pts reaching >10/μL CD34+ underwent LP. Pts not reaching the target of 2.5 x 106/kg CD34+ were considered as low mobilizer.Results: 98 pts, median age 56 y (range 27–70), underwent priming with IDAra-C. Disease characteristics are listed in table 1. All but 5 pts presented bone marrow involvement at diagnosis. Sixty-nine pts had previously received fludarabine, 56 anthracyclines and 30 alkilating agents. Thirty-three of the 98 pts had been considered low mobilizer or had failed a previous mobilization attempt, with HDAra-C in 20 cases A successful mobilization (threshold level >2.5 x 106/kg CD34+) was obtained in 73 pts (74,5%) (9/14 NHL, 42/43 CLL, 6/7 MM, 16/34 AML) with a median collection of 12,34 x 106/kg CD34+ (range 2,57–76,5). The peak value of CD34+ cells in the peripheral blood was achieved after a median of 13 d (range 10–19) from the end of therapy and a median of 1 LP (range 1–3) was required for a target collection. An adequate harvest was also observed among 17 of the 33 (51.5%) pts failing a previous mobilization attempt. After IDAra-C the median time to reach PMN >1000/μL and PLT >50000/μL was of 6 and 8 days respectively. There were no treatment-related deaths. During neutropenia we recorded 25 episodes of FUO, 9 infections microbiologically documented and 2 infections clinically documented. Median days temperature > 38°C was 2 (range 1–6). Extraematological toxicity consisted of: 1 gastrointestinal bleeding WHO III and 1 episode of atrial fibrillation. Overall 39 pts have been transplanted so far; median days for PMN >500/μL and PLT >50000/μL engraftment was of 9 and 12 d respectively. In conclusion IDAra-C and sequential G-CSF allowed predictable and efficient PBSC harvest in a limited number of leukapheresis session. Hematological recovery was rapid and toxicity manageable. These data confirm, in a larger series, the high mobilization activity of IDAra-C in CLL as previously reported. Moreover satisfactory efficacy has been observed in pts failing previous mobilization attempt with alternative regimen. This approach should be considered as an effective way to exploit a known mobilizing activity of Ara-C minimizing toxicity.Table 1Disease characteristicsAMLNHLCLLMMToTCR32335373CR > 123−−5PR−2−24nPR−−6−6SD−1124PD/RELAPSE−51−6Tot341443798median time from last treatment (months)2,02,34,32,63,4

Aesthetic Management of the Ear as a Donor Site

The ear is a frequently used donor site for facial reconstruction. It serves as an ideal source for skin, cartilage, and composite grafts because of its color and texture match. However, because of the prominent location of the ears, the prevention of donor-site problems such as scarring and resultant asymmetries is equally important in creating an overall aesthetic facial reconstruction. The purpose of this review was to describe surgical techniques of minimizing ear donor-site morbidity as a consequence of harvesting of composite chondrocutaneous grafts. A retrospective analysis was performed of all patients who underwent nasal reconstruction performed by the senior surgeon (D.J.S.) between 1987 and 2003, to identify those patients in whom a composite chondrocutaneous auricular graft was used. Photographs, surgical technique, and aesthetic outcomes were reviewed for those patients identified as having donor auricular composite grafts. Three hundred fifty-seven nasal reconstructions were performed. Of the 357 reconstructions, 67 involved harvest of preauricular or postauricular full-thickness skin graft, and 79 involved use of auricular cartilage. Sixteen of the 79 involved harvesting of auricular composite grafts. For these 16 patients, defect size, donor site, and closure of donor site are described and indications for certain techniques are delineated. The harvest of composite grafts is challenging in technical design and in closure of the defect. In this patient series, the donor defects were closed primarily in one of six ways, depending on the size of the cartilage and skin graft required. These techniques allowed adequate harvest of donor tissue while preserving the aesthetics of the ear.

Endoscopic ultrasound (EUS)-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: A prospective study

Objective. Endoscopic ultrasound (EUS)-guided Trucut biopsy (EUS-TCB) has recently emerged as a method that seeks to overcome the limitations of EUS-guided fine needle aspiration (EUS-FNA) by providing a core-tissue specimen needed to increase the yield and accuracy of the diagnosis. The aim of our study was to evaluate whether EUS-TCB adds any information to EUS-FNA in selected patients and to assess the diagnostic yield, overall accuracy and complications of EUS-TCB as compared with EUS-FNA. Material and methods. The study prospectively included 30 patients who had undergone both procedures. Results. The yield of adequate tissue harvesting was similar for EUS-FNA and EUS-TCB (96.4% versus 89.3%, p=NS), with the same number of passes done. The diagnostic accuracy of EUS-FNA was also similar to that of EUS-TCB for the diagnosis of malignant mediastinal masses (73.7% versus 68.4%, p=NS). However, the accuracy for obtaining a specific diagnosis was significantly lower for EUS-FNA compared with EUS-TCB (5.3% and 68.4%, p<0.005). EUS-TCB did not appear to help as a rescue procedure in mediastinal tumours, after a false negative result of EUS-FNA. All cases of submucosal tumours were correctly classified by EUS-TCB as gastrointestinal stromal cell tumours (GISTs) or leiomyomas, while EUS-FNA raised only a suspicion of mesenchymal tumour. Conclusions. EUS-TCB was certainly useful when immunohistochemistry was needed, for example in submucosal tumours and lymphoma, as well as to confirm and characterize the primary or metastatic origin of mediastinal masses. The information provided by EUS-FNA and EUS-TCB is complementary, especially in selected cases where a complete histological diagnosis has an important impact on the clinical management.

Revision Rhinoplasty Using Porous High-Density Polyethylene Implants to Reestablish Ethnic Identity

As is widely known, no ideal alloplastic material exists for augmentation or secondary rhinoplasty. This is an interesting article because it describes another attempt to achieve success managing the different problems with alloplastic materials when autologous cartilage is not available. I remark from my experience that the only justification for using these materials is that no septal or conchal cartilage was available. Besides, an important fact to mention is that the thick skin of some ethnic groups is ideal for success in augmentation rhinoplasty with alloplastic materials. In my experience, an adequate harvest of conchal cartilage leaves no deformity, and with the ‘‘tandem’’ method described by Dr. Ronald Gruber [1], it is very useful for restoration of dorsal height and regularity. The costal cartilage tends to warp, and osseus grafts resorb at a very high rate. Although there is no ideal alloplastic material, the surgeon must maximize perfection by managing the material he uses. I emphasize that when a surgeon places these kinds of implants, careful closure of incisions should be done. I believe, according to my experience with alloplastic materials, which includes more than 1,100 patients and more than 18 years of follow-up evaluation [2], that the advantages the authors mention in their article regarding the porosity of this material might represent a problem in the long term. If the material ever needs to be removed, it might be a difficult task. I agree with the importance of antibiotic prophylaxis to increase success in dealing with alloplastic materials. Finally, besides congratulating the authors for their enthusiasm, I encourage them to share with us, in the future, a long-term report with radiographic and clinical controls.

R-DHAOX as salvage treatment in CD20+ relapsed/refractory (R/R) non-Hodgkin lymphomas (NHL). An institutional experience

17508 Background: Second line chemotherapeutic regimens in NHL are mainly based on cisplatin (DDP) and are frequently employed as cytoreductive regimens for preparation to high dose chemotherapy (HDC). The substitution of DDP with oxaliplatin in DHAP-like regimens can result in a lower toxicity and higher activity. In R/R CD20+ NHL the synergistic activity of Rituximab with chemotherapy has been shown to improve the outcome. We assessed the tolerability and efficacy of R-DHAOX (Rituximab 375 mg/m2, i.v. day 1, Dexametasone 40 mg i.v. days 1–4, Oxaliplatin 130 mg/m2 i.v. day 2 and Cytarabine 2000 mg/m2 i.v. twice a day, day 3) regimen in a fase II study including 35 pts (M/F = 22/13; median age 55 yrs, range 38–74) affected by R/R CD20+ NHL and enrolled from November 2002 until September 2005. 34 (97%) pts were staged III-IV. 31 pts (89%) were relapsed and 4 (11%) refractory. International Prognostics Index at relapse (s-IPI) was &gt;2 for 10 (71%) DLBCL, 2 (14%) FL and 2 (29%) MCL. A total of 147 cycles were administered (range 1–7). Dose reduction due to Oxaliplatin neuropathy or Cytarabine haematological toxicity occurred in 13% and in 58% of pts, respectively. NCI G3-G4 toxicities were thrombocytopenia (58%), neutropenia (55%), anaemia (13%), infection (10%) and neurotoxicity (3%). No renal failure was observed. Results spitted according to histology were summarised in the table . R-DHAOX had significant clinical activity both in FL and MCL patients (overall response rates (OR) of 93% and 86%, respectively), as well as in DLBCL (OR of 79%) despite the very high S-IPI score observed. R-DHAOX allowed adequate stem cell harvest with G-CSF mobilisation in 25/35 (71%) pts. Three-yrs projected overall survival, according to the histology, were 71% for FL, 67% for MCL and 28% for DLBCL. These data suggested that the R-DHAOX is a novel combination highly effective for R/R CD20+ NHL. [Table: see text] No significant financial relationships to disclose.

Farmer Choice of Sorghum Varieties in Southern Mali

In southern Mali and throughout the semiarid tropics, small-scale family farmers are faced with the challenge of producing adequate harvests in difficult biophysical and socioeconomic environments. Professional plant breeders have had much difficulty developing modern varieties that outperform farmers’ traditional varieties in these environments, in part because of an incomplete understanding of why farmers choose the varieties they grow. Improved understanding of farmers’ varietal choices can contribute to collaboration between farmers and formal plant breeders. Based on a 15-month field study in Dissan, Mali, we examine farmer's choices among their traditional sorghum varieties in terms of one or more than one variety, and short-cycle or long-cycle varieties, and the interaction between these two choices. Results support our general hypothesis that farmers choose varieties to optimize outputs in the face of variation in the growing environment and in human managed inputs such as labor and tools.