Combined Epi Research Articles

Farm size as a factor in hydrodynamic transmission of pathogens in aquaculture fish production

Global aquaculture production has rapidly increased over recent decades, primarily through the increase in production per farm unit. However, size (biomass) may be a factor in the transmission of infectious diseases between hydrodynamically linked fish farms. A combined epi- demiological-simplified hydrodynamic model is used to demonstrate that as farm units increase they experience higher numbers of infections caused by a range of pathogen characteristics. The model demonstrates that as farm size increases in areas where faster currents prevail, there is a need to increase the separation distance between farms to prevent pathogen transmission. A com- parison of production regimes demonstrates, however, that fewer, highly separated, larger farms reduce overall losses compared to numerous smaller farms in close proximity to each other.

An open label, randomized phase II trial of primary systemic therapy with exemestane (EXE 25 mg/d) plus epirubicin (EPI, 20 vs 30 mg/m2 q1w × 8–12) in breast cancer: An interim analysis of the German Neoadjuvant Aromasin Initiative (GENARI-3)

826 Background: This randomized phase II trial explores the efficacy of EXE, a steroidal aromatase inactivator, in combination with lower doses of EPI, a topoisomerase-II targeted anthracycline, as an alternative presurgical therapy (PST) option for women who may not be eligible for more toxic primary chemotherapy regimens. Methods: Age: ≥ 50 years, postmenopausal hormone receptor (HR) + /−, primary tumors T2, 3, 4a-c, Nx, M0, ECOG PS 0–2. All patients (pts) obtained continuous EXE and were randomized to either 20 mg/m2 (A) or 30 mg/m2 (B) EPI q1w × 8–12. Endpoints (1st/2nd): pathological complete remissions (pCR), rate of breast conserving surgery (BCS), and grade/frequency of toxicity. Results: A total of 23 pts (12 in arm A, 11 in B) with median age of 68 (53–77) and tumor status T2 were enrolled. 28 patients are still under therapy and will be applicable for final analysis at the time of this presentation. All pts were HR+ and were evaluable for toxicity. Four patients (n=3: 20 mg/m2; n=1: 30 mg/m2) had reduced numbers of cycles [5(n=2), 6(n=1), 11(n=1)] after dose delay due to grade (G) 2 toxicity (NCI-CTC): leukopenia (n=2), infection (n=2) or G 3 toxicity: infection (n=1). One patient withdrew consent for pre-operative staging and surgery (arm B, no DLT). Efficacy (22 pts): Clinical responses were as follows: (A/B): clinical partial responses, n= 9/7; clinical stable disease, n= 3/3. Pathological tumor response (A/B): ypT0 (pCR), n=0/1, ypT1a, n=1/0; ypT1c, n=6/2; ypT2, n=4/5; ypT3, n=1/2. BCS: n=19/3. Conclusions: The interim results for 23 of 60 patients suggest good therapeutic efficacy and excellent tolerability of combined EXE and EPI . It has to be shown wether this treatment offers additional benefit for women with hormone- receptor positive breast cancer, who showed lower response to primary chemotherapy when compared to receptor- negative patients. In addition this supports the concept of combination PST as an alternative to hormonal PST in postmenopausal patients. No significant financial relationships to disclose.

Anatomical variations of the ten triangles around the cavernous sinus.

The dimensions of the 10 triangles around the cavernous sinus were measured to define the anatomical characteristics of the triangles and to compare their consistency in shape and area. Twelve tissue blocks containing the bilateral cavernous sinuses and medial two-thirds of the middle cranial fossae were obtained from Japanese adults at autopsy, fixed to a stereotactic frame, and examined with an operative microscope. The dimensions of each triangle were measured with calipers and compared, based on the same point and border. The anteromedial triangle and the superolateral (Parkinson's) triangle were more consistent in shape than the paramedial and oculomotor triangles, but the oculomotor triangle was larger in area than these other triangles. The posteromedial (Kawase's) triangle was more consistent in shape and larger than the anterolateral, lateral, and the posterolateral (Glasscock's) triangles. The anteromedial and superolateral (Parkinson's) triangles are important for the combined epi- and subdural approach to cavernous sinus lesions. The posteromedial (Kawase's) triangle is important for gaining access to the posterior cranial fossa from the middle cranial fossa.

内頸動脈硬膜輪近傍動脈瘤に対するcombined epi- and subdural approach (Dolenc)

Between January 1990 and August 1991, 103 patients with intracranial aneurysms were admitted to our hospital and underwent microsurgical operations. Of the 103 patients, 6 had juxta DURAL-RING aneurysms. Kobayashi and his collaborators classify Juxta DURAL-RING aneurysms into 3 types: infraclinoid type, carotid cave type and intradural type. Of the present 6 cases, 3 cases were carotid cave type and 3 intradural type.We applied Dolenc' pterional combined epi- and subdural approach to these aneurysms.Surgical procedures are as follows: (1) a standard pterional craniotomy; (2) in the epidural approach, removal of the orbital roof together with the sphenoid wing, removal of the dorsal wall of the optic canal and the anterior clinoid process. Following these procedures, the anterior loop of the internal carotid artery (IC) can be traced through the thin membrane (Dolenc' anteromedial trangle); (3) in the subdural approach, complete opening of the dural ring, and the exposure of the surgical genu and axilla of the IC. (4) Utilizing these procedures, clipping is relatively easy with the use of Sugita's curved-blad ring (fenestrated) clip.Postoperative carotid angiograms revealed that all 6 aneurysms were completely obliterated by the clips.There were 2 complications: l is transient CSF leakage due to opening of the ethomoid sinus; the other is transient oculomotor nerve paresis presumably due to packing the oxycel into the cavernous sinus. All patients returned to their preoperative occupations without any neurological deficits.From these results, we conclude that the pterional combined epi- and subdural approach is the procedure of choice for the juxta-Dural Ring aneurysms.

Large basilar top aneurysmに対するpterional transcavernous approach

Even with the recent progress in microneurosurgery on intracranial aneurysms, there are still many controversial problems in dealing with intracavernous, paraclinoidal and basilar aneurysms. A series of 8 patients with these aneurysms has been treated by“a combined epi- and subdural direct approach (Dolenc's method)”in our institute since 1988.This elegant surgical approach can be performed by the same technical procedure used in the conventional pterional approach except that the exposure of anteromedial part of the cavernous sinus (Dolenc's triangle) is mandatory. We would regard this sophisticated approach as“pterional transcavernous approach.”Using this approach for basilar aneurysm, sufficient spaces are obtained for neck-clipping with/without temporary basilar artery occlusion and a good visualization of perforating arteries around the lesion. An illustrative case of a large basilar top aneurysm treated with“pterional transcavernous approach”is presented in this paper. These surgical advantages will be emphasized and the limits of this approach will be discussed.

The crustacean cuticle—III. Composition of the individual layers in cancer pagurus cuticle

1. Cancer pagurus cuticle has been separated into three layers: a combined epi- and exocuticle, an endocuticle, and a membranous layer. 2. The layers are characterized with respect to weight, protein and chitin content, solubility, and amino acid composition. 3. The amino acid compositions of the protein mixtures, obtained by extraction of the layers with dilute ammonia, are reported together with the molecular weights of the individual proteins in the mixtures. 4. According to their composition arthropod cuticles can be divided into two types: one which mainly comprises “soft” cuticles and which is characterized by having a relatively high chitin content, high protein solubility, high content of acidic amino acid residues and a relatively low content of non-polar amino acids. The other type which mainly includes “hardened” cuticle, is relatively poor in chitin, the proteins are not easily extracted, and the content of non-polar amino acid residues is high. The Cancer cuticle appears to belong to the first group.