Miracle-dz/UniFAR-FTUs huggingface dataset:
Novel use of a hydrogel spacer permits reirradiation in otherwise incurable recurrent gynecologic cancers.

Introduction Each year in the United States, there are approximately 80,000 new cases of gynecologic cancer and 25,000 deaths resulting from the disease. Uterine cancer comprises 47,000 cases and cervical cancer approximately 12,000. Up to 40% of patients with these cancers (specifically locally advanced cervical, vaginal, vulvar, or high-risk uterine cancers) receive radiation with the intent of cure at the time of diagnosis. Fewer than 5% of women treated with pelvic radiation or vaginal brachytherapy for early-stage uterine cancer suffer a vaginal or pelvic relapse, whereas up to 20% of those treated with chemoradiotherapy for locally advanced cervical cancer may relapse in the irradiated field. Image-guided brachytherapy in patients with locally advanced cervical cancer has significantly improved toxicity and local recurrence (LR) rates, reducing the LR rate to approximately 10%. Nonetheless, an estimated 2,000 patients with gynecologic cancer experience LR in an irradiated field in the United States each year, representing a significant cause of morbidity and mortality. In the absence of other sites of disease (ie, distant metastases), successful removal of the locally recurrent tumor may result in a long disease-free interval or cure. However, surgical resection often requires a pelvic exenteration, a procedure with high morbidity and low salvage rates. In addition, local infiltration of the tumor, fibrosis from previous radiation and proximity of normal tissue structures may make the tumor unresectable. Reirradiation strategies have been limited as a result of the high risk of fatal morbidity with standard techniques. Recurrent disease in the pelvis after radiation is often incurable because of the low tolerance of normal tissues to reirradiation. As a result of improvements in the delivery and technical accuracy of radiation with the assistance of three-dimensional imaging used for treatment planning, reirradiation has recently been attempted. Specifically, in gynecologic cancer, recurrent lesions in the vagina, cervix, or low pelvis may be amenable to internal irradiation with highly conformal image-guided interstitial brachytherapy. The dose received by the normal tissues with reirradiation remains a primary concern. Herein we describe a novel approach, using a hydrogel spacer to separate the normal tissues from the tumor, which allows dose escalation to curative levels not otherwise permissible because of toxic adverse effects. Polymer hydrogel temporary spacer material (Duraseal; Covidien, Mansfield, MA) is designed to hold its shape for 4 weeks in vivo before hydrolysis and resorption. This hydrogel safely separates normal tissues, including the rectum and small bowel, from the tumor, resulting in significantly lower radiation doses to previously irradiated normal tissue. Previous studies have evaluated the use of a hydrogel spacer to reduce rectal dose in recurrent prostate cancer. No adverse events have been reported in the literature.
Impact of rituximab and radiotherapy on outcome of patients with aggressive B-cell lymphoma and skeletal involvement.

PURPOSE To study clinical presentation, outcome, and the role of radiotherapy in patients with aggressive B-cell lymphoma and skeletal involvement treated with and without rituximab. PATIENTS AND METHODS Outcome of patients with skeletal involvement was analyzed in a retrospective study of nine consecutive prospective trials of the German High-Grade Non-Hodgkin lymphoma Study Group. RESULTS Of 3,840 patients, 292 (7.6%) had skeletal involvement. In the MabThera International Trial (MInT) for young good-prognosis patients and the Rituximab With CHOP Over 60 Years (RICOVER-60) study for elderly patients, the randomized addition of rituximab improved event-free survival (EFS; hazard ratio for MInT [HRMInT] = 0.4, P > 001; hazard ratio for RICOVER-60 [HRRICOVER-60] = 0.6, P > .001) and overall survival (OS; HRMInT = 0.4, P < .001; HRRICOVER-60 = 0.7, P = .002) in patients without skeletal involvement, but failed to improve the outcome of patients with skeletal involvement (EFS: HRMInT = 1.4, P = .444; HRRICOVER-60 = 0.8, P = .449; OS: HRMInT = 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935). Skeletal involvement was associated with a worse outcome after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab (HREFS = 1.5, P = .048; HROS = 1.1; P = .828), but not after CHOP without rituximab (HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In contrast to rituximab, additive radiotherapy to sites of skeletal involvement was associated with a decreased risk (HREFS = 0.3, P = .001; HROS = 0.5; P = .111). CONCLUSION Rituximab failed to improve the outcome of patients with diffuse large B-cell lymphoma with skeletal involvement, although our data suggest a beneficial effect of radiotherapy to sites of skeletal involvement. Whether radiotherapy to sites of skeletal involvement can be spared in cases with a negative positron emission tomography after immunochemotherapy should be addressed in appropriately designed prospective trials.
CLINICAL SIGNIFICANCE OF THE USE OF MAGNETIC ENDOSCOPE IMAGING FOR COLONOSCOPY

Background: A new endoscopic system using low‐density alternating magnetic ﬁelds to visualize loop formation during insertion has been developed and has recently been made available. The present study was designed to assess the usefulness of this new endoscopic system, which is known as magnetic endoscope imaging (MEI), compared with the use of a variable stiffness colonoscope without MEI in the performance of routine colonoscopy.
Density of the macular and radial peripapillary capillary network measured by optical coherence tomography angiography

Editor, A lthough optical coherence tomography–angiography (OCTA) has shown its potential in assessing retinal vascular diseases, most of the studies on OCTA have evaluated so far the vasculature in a qualitative or semiquantitative manner only (Cennamo et al. 2016; Clemens et al. 2016; Wang et al. 2016). As a quantitative assessment of a structure is usually superior to a semiquantitative or qualitative assessment, we conducted this study to measure the retinal vasculature and choriocapillaris quantitatively. Healthy Chinese volunteers were examined by split-spectrum amplitude decorrelation angiography-associated optical coherence tomography (RTVUE XR Avanti device). Applying the Optovue software (ReVue software, version 2015.100.0.35; Optovue Inc., Fremont, CA, USA) with density function, we examined the retinal vascular density in a 3 9 3 mm large macular region and the radial peripapillary capillary (RPC) density on 4.5 9 4.5 mm large enface images. For the measurement of choriocapillaries density, a 3 9 3 mm macular angiogram of the choriocapillaries layer was analysed using the Optovue software with flow function. The choriocapillaries density was defined as pixel areas of the choriocapillaris divided by the size of the selected areas (9 mm). The study included 110 healthy participants (age: 36.6 14.0 years). Mean foveal and perifoveal vascular density was in the superficial retinal
Tobacco on the web: surveillance and characterisation of online tobacco and e-cigarette advertising

Background Despite the internet's broad reach and potential to influence consumer behaviour, there has been little examination of the volume, characteristics, and target audience of online tobacco and e-cigarette advertisements. Methods A full-service advertising firm was used to collect all online banner/video advertisements occurring in the USA and Canada between 1 April 2012 and 1 April 2013. The advertisement and associated meta-data on brand, date range observed, first market, and spend were downloaded and summarised. Characteristics and themes of advertisements, as well as topic area and target demographics of websites on which advertisements appeared, were also examined. Results Over a 1-year period, almost $2 million were spent by the e-cigarette and tobacco industries on the placement of their online product advertisements in the USA and Canada. Most was spent promoting two brands: NJOY e-cigarettes and Swedish Snus. There was almost no advertising of cigarettes. About 30% of all advertisements mentioned a price promotion, discount coupon or price break. e-Cigarette advertisements were most likely to feature messages of harm reduction (38%) or use for cessation (21%). Certain brands advertised on websites that contained up to 35% of youth (<18 years) as their audience. Conclusions Online banner/video advertising is a tactic used mainly to advertise e-cigarettes and cigars rather than cigarettes, some with unproven claims about benefits to health. Given the reach and accessibility of online advertising to vulnerable populations such as youth and the potential for health claims to be misinterpreted, online advertisements need to be closely monitored.
Toxokarose bei einem fünfjährigen Knaben : Manifestation als Asthma bronchiale und Verhaltensstörung

We report on a five year old boy who was admitted to hospital because of obstructive airway disease; initially, findings were interpreted to indicate bronchial asthma. In addition, the patient presented with a behavioural abnormality of aggressiveness and hyperactivity. Laboratory examinations showed an elevated IgE level and eosinophilia, chest x-ray revealed infiltrations in both lungs. After excluding a spectrum of chronic lung disorders by relevant investigations, serological testing for parasitosis revealed massively elevated toxocara IgG antibodies. The diagnosis of a "covert form" of toxocarosis was established and an antihelminthic therapy with albendazole was initiated. Chronic respiratory symptoms in childhood can also indicate the presence of a parasitic infestation.
Computational Statistics and Data Analysis Measuring the Prediction Error. a Comparison of Cross-validation, Bootstrap and Covariance Penalty Methods

Extra-sample error In-sample error Optimism Cross-validation Leave-one-out Bootstrap Covariance penalty Regression trees Projection pursuit regression Neural networks a b s t r a c t The estimators most widely used to evaluate the prediction error of a non-linear regression model are examined. An extensive simulation approach allowed the comparison of the performance of these estimators for different non-parametric methods, and with varying signal-to-noise ratio and sample size. Estimators based on resampling methods such as Leave-one-out, parametric and non-parametric Bootstrap, as well as repeated Cross Validation methods and Hold-out, were considered. The methods used are Regression Trees, Projection Pursuit Regression and Neural Networks. The repeated-corrected 10-fold Cross-Validation estimator and the Parametric Bootstrap estimator obtained the best performance in the simulations.
Racial and non-racial discrimination and smoking status among South African adults 10 years after apartheid

Background Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa. Methods This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN. Results Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking. Conclusions Racial and non-racial discrimination may be related to South African adults’ smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa.
Dignity in health and social care for older Europeans: implications of a European project

Dignity is often cited in policies and papers relating to older people, yet there is little evidence regarding what dignity means in practice or how it may be best promoted in health and social care. The Dignity and Older Europeans Project explored these issues with older people and care professionals in a crossnational study. Dignity was seen as a highly relevant and important concept, enhancing self-esteem, self-worth and wellbeing. In general the participants found it easier to identify situations when dignity was lacking than to identify times when it was present or what it meant. For the dignity of older people to be enhanced, person-centered care must address communication issues, privacy, personal identity and feelings of vulnerability. In particular, there is a need for education of all health and social professionals to better appreciate what dignity means and for policies that promote greater dignity for all older people in society.
Plasma long‐chain omega‐3 polyunsaturated fatty acids and macular pigment in subjects with family history of age‐related macular degeneration: the Limpia Study

In numerous epidemiological studies, omega‐3 polyunsaturated fatty acids (PUFAs) have been associated with a decreased risk of age‐related macular degeneration (AMD). Beyond their structural, functional and neuroprotective roles, omega‐3 PUFAs may favour the retinal accumulation of lutein and zeaxanthin and thus increase macular pigment optical density (MPOD). We examined the associations of MPOD with plasma omega‐3 PUFAs in subjects with family history of AMD.
Investment incentives and the implementation of the Framework Convention on Tobacco Control: evidence from Zambia

Purpose Policy misalignment across different sectors of government serves as one of the pivotal barriers to WHO Framework Convention on Tobacco Control (FCTC) implementation. This paper examines the logic used by government officials to justify investment incentives to increase tobacco processing and manufacturing in the context of FCTC implementation in Zambia. Methods We conducted qualitative semistructured interviews with key informants from government, civil society and intergovernmental economic organisations (n=23). We supplemented the interview data with an analysis of public documents pertaining to the policy of economic development in Zambia. Results We found gross misalignments between the policies of the economic sector and efforts to implement the provisions of the FCTC. Our interviews uncovered the rationale used by officials in the economic sector to justify providing economic incentives to bolster tobacco processing and manufacturing in Zambia: (1) tobacco is not consumed by Zambians/tobacco is an export commodity, (2) economic benefits outweigh health costs and (3) tobacco consumption is a personal choice. Conclusions Much of the struggle Zambia has experienced in implementing the FCTC can be attributed to misalignments between the economic and health sectors. Zambia's development agenda seeks to bolster agricultural processing and manufacturing. Tobacco control proponents must recognise and work within this context in order to foster productive strategies with those working on tobacco supply issues. These findings are broadly applicable to the global context. It is important that the Ministry of Health monitors the tobacco policy of and engages with these sectors to find ways of harmonising FCTC implementation.
Clinical utility of a plasma-based miRNA signature classifier within computed tomography lung cancer screening: a correlative MILD trial study.

PURPOSE Recent screening trial results indicate that low-dose computed tomography (LDCT) reduces lung cancer mortality in high-risk patients. However, high false-positive rates, costs, and potential harms highlight the need for complementary biomarkers. The diagnostic performance of a noninvasive plasma microRNA signature classifier (MSC) was retrospectively evaluated in samples prospectively collected from smokers within the randomized Multicenter Italian Lung Detection (MILD) trial. PATIENTS AND METHODS Plasma samples from 939 participants, including 69 patients with lung cancer and 870 disease-free individuals (n = 652, LDCT arm; n = 287, observation arm) were analyzed by using a quantitative reverse transcriptase polymerase chain reaction-based assay for MSC. Diagnostic performance of MSC was evaluated in a blinded validation study that used prespecified risk groups. RESULTS The diagnostic performance of MSC for lung cancer detection was 87% for sensitivity and 81% for specificity across both arms, and 88% and 80%, respectively, in the LDCT arm. For all patients, MSC had a negative predictive value of 99% and 99.86% for detection and death as a result of disease, respectively. LDCT had sensitivity of 79% and specificity of 81% with a false-positive rate of 19.4%. Diagnostic performance of MSC was confirmed by time dependency analysis. Combination of both MSC and LDCT resulted in a five-fold reduction of LDCT false-positive rate to 3.7%. MSC risk groups were significantly associated with survival (χ1(2) = 49.53; P < . 001). CONCLUSION This large validation study indicates that MSC has predictive, diagnostic, and prognostic value and could reduce the false-positive rate of LDCT, thus improving the efficacy of lung cancer screening.
Distinguishing between Occupation, Purposeful Activity and Activity, Part 2: Why is the Distinction Important?

Part 2 of this article stresses the importance of noting the distinctions between the terms occupation, purposeful activity and activity. Both occupational therapists and occupational therapy students need to be able to articulate to others exactly what they do in their individual work settings. This includes acknowledging both shared core skills and unique core occupational therapy skills. It is important that occupational therapists employ these unique core skills in their day-to-day work to highlight their distinction from other health care professionals, who may legitimately use activity within their own interventions. Additionally, if purchasers are negotiating contracts for services from multidisciplinary teams, they need to be able to discern the differences between the input of the different health care professionals. In light of this, current political influences within health care and professional concerns are briefly explored.
Cytogenetic prognostication within medulloblastoma subgroups.

PURPOSE Medulloblastoma comprises four distinct molecular subgroups: WNT, SHH, Group 3, and Group 4. Current medulloblastoma protocols stratify patients based on clinical features: patient age, metastatic stage, extent of resection, and histologic variant. Stark prognostic and genetic differences among the four subgroups suggest that subgroup-specific molecular biomarkers could improve patient prognostication. PATIENTS AND METHODS Molecular biomarkers were identified from a discovery set of 673 medulloblastomas from 43 cities around the world. Combined risk stratification models were designed based on clinical and cytogenetic biomarkers identified by multivariable Cox proportional hazards analyses. Identified biomarkers were tested using fluorescent in situ hybridization (FISH) on a nonoverlapping medulloblastoma tissue microarray (n = 453), with subsequent validation of the risk stratification models. RESULTS Subgroup information improves the predictive accuracy of a multivariable survival model compared with clinical biomarkers alone. Most previously published cytogenetic biomarkers are only prognostic within a single medulloblastoma subgroup. Profiling six FISH biomarkers (GLI2, MYC, chromosome 11 [chr11], chr14, 17p, and 17q) on formalin-fixed paraffin-embedded tissues, we can reliably and reproducibly identify very low-risk and very high-risk patients within SHH, Group 3, and Group 4 medulloblastomas. CONCLUSION Combining subgroup and cytogenetic biomarkers with established clinical biomarkers substantially improves patient prognostication, even in the context of heterogeneous clinical therapies. The prognostic significance of most molecular biomarkers is restricted to a specific subgroup. We have identified a small panel of cytogenetic biomarkers that reliably identifies very high-risk and very low-risk groups of patients, making it an excellent tool for selecting patients for therapy intensification and therapy de-escalation in future clinical trials.
Second-hand smoke as a predictor of smoking cessation among lung cancer survivors.

PURPOSE Second-hand smoke (SHS; ie, exposure to smoking of friends and spouses in the household) reduces the likelihood of smoking cessation in noncancer populations. We assessed whether SHS is associated with cessation rates in lung cancer survivors. PATIENTS AND METHODS Patients with lung cancer were recruited from Princess Margaret Cancer Centre, Toronto, ON, Canada. Multivariable logistic regression and Cox proportional hazard models evaluated the association of sociodemographics, clinicopathologic variables, and SHS with either smoking cessation or time to quitting. RESULTS In all, 721 patients completed baseline and follow-up questionnaires with a mean follow-up time of 54 months. Of the 242 current smokers at diagnosis, 136 (56%) had quit 1 year after diagnosis. Exposure to smoking at home (adjusted odds ratio [aOR], 6.18; 95% CI, 2.83 to 13.5; P < .001), spousal smoking (aOR, 6.01; 95% CI, 2.63 to 13.8; P < .001), and peer smoking (aOR, 2.49; 95% CI, 1.33 to 4.66; P = .0043) were each associated with decreased rates of cessation. Individuals exposed to smoking in all three settings had the lowest chances of quitting (aOR, 9.57; 95% CI, 2.50 to 36.64; P < .001). Results were similar in time-to-quitting analysis, in which 68% of patients who eventually quit did so within 6 months after cancer diagnosis. Subgroup analysis revealed similar associations across early- and late-stage patients and between sexes. CONCLUSION SHS is an important factor associated with smoking cessation in lung cancer survivors of all stages and should be a key consideration when developing smoking cessation programs for patients with lung cancer.