Background While obesity increases risk and negatively impacts survival for many malignancies, the prognostic implications in squamous cell carcinoma (SCC) of the oral tongue, a disease often associated with pre-diagnosis weight loss, are unknown. Methods Patients with T1–T2 oral tongue SCC underwent curative-intent resection in this single-institution study. All patients underwent nutritional assessment prior to surgery. Body mass index (BMI) was calculated from measured height and weight and categorized as obese (≥30 kg/m2), overweight (25 to 29.9 kg/m2), or normal (18.5 to 24.9 kg/m2). Clinical outcomes including disease specific survival (DSS), recurrence free survival (RFS), and overall survival (OS), were compared by BMI group using Cox regression. Results From 2000–2009, 155 patients (90 men, 65 women) of median age 57 (range 18 to 86) were included. Baseline characteristics were similar by BMI group. Obesity was significantly associated with adverse DSS compared with normal weight in univariable (hazard ratio [HR] = 2.65, 95% confidence interval [CI], 1.07 to 6.59; P = .04) and multivariable analyses (HR = 5.01; 95% CI, 1.69 to 14.81; P = .004). A consistent association was seen between obesity and worse RFS (HR =1.87; 95% CI, .90 to 3.88) and between obesity and worse OS (HR=2.03; 95% CI, .88 to 4.65) though without reaching statistical significance (P = .09 and P = .10 respectively) in multivariable analyses. Conclusions In this retrospective study, obesity was an adverse independent prognostic variable. This association may not have been previously appreciated due to confounding by multiple factors including pre-diagnosis weight loss.

Level III, retrospective comparative study.

Salmon rickettsial septicaemia (SRS) is the infectious disease that produces the highest losses in the Chilean salmon industry. As a new strategy for the control of SRS outbreaks, in this study we evaluated the effect of alginate-encapsulated Piscirickettsia salmonis antigens (AEPSA) incorporated in the feed as an oral vaccine to induce the immune response in Atlantic salmon (Salmo salar). Fish were distributed into three vaccination groups (injectable, oral high dose, oral low dose). Feed intake and fish growth were recorded during the trial. The P. salmonis-specific IgM levels in blood plasma were measured by ELISA. Alginate microparticles containing the antigen were effectively incorporated in fish feed to produce the oral vaccine. Incorporation of AEPSA did not affect the palatability of the feed or the fish appetite. Furthermore, the oral vaccine did not have a negative effect on fish growth. Finally, the oral vaccine (high and low dose) produced an acquired immune response (IgM) similar to the injectable vaccine, generating a statistically significant increase in the IgM levels at 840-degree days for both experimental groups. These findings suggest that AEPSA incorporated in the feed can be an effective alternative to boost the immune response in Atlantic salmon (S. salar).

Level III, prognostic study.

It is estimated that approximately 23.6 million people in the United States have diabetes mellitus. With adequate control of this disease and appropriate foot care and basic surveillance, many patients can lead active and healthy lifestyles. However, some patients experience complications associated with poorly controlled glucose levels, including lower-extremity ulcerations and infections. When conservative measures have failed in treating these conditions, a lower-extremity amputation is an option for patients seeking to gain maximal functional recovery. A complete preoperative workup includes assessment of healing potential and preoperative ambulatory status, control or optimization of comorbidities when possible, and determination of amputation level using modern diagnostic modalities. Once the decision to proceed with an amputation has been made, it is important to choose an appropriate level of amputation and practice sound surgical technique. This article describes the preoperative evaluation and operative techniques involved in performing amputations on diabetic patients and reviews the current literature on the most common lower-extremity amputations performed in the care of infections in the feet of patients with diabetes mellitus.