bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumor Protein p53 (TP53) Gene and Left Main Coronary Artery Disease
Authors: Kolovou Vana , Tsipis Angelos , Mihas Constantinos , Katsiki Niki , Vartela Vasiliki , Koutelou Maria , Manolopoulou Dionisia , Leondiadis Evaggelos , Iakovou Ioannis , Mavrogieni Sophie , Kolovou Genovefa
Published: February 2018

Patients with left main (LM) coronary artery disease (CAD) are at the highest risk of cardiovascular events. We evaluated possible gene polymorphisms of tumor protein 53 ( TP53, rs1042522, p.Arg72Pro) that can differentiate LM-CAD from patients with more peripheral CAD (MP-CAD) and healthy participants (control group) in 520 individuals (LM-CAD, n = 175; MP-CAD, n = 185; and control group, n = 160). Patients with LM-CAD had the lowest Arg/Arg genotype frequency (36.0%) compared with the MP-CAD (57.3%) and control groups (61.9%), P < .001 for both comparisons. Similarly, the Arg allele was more frequent in the control group than in patients with MP-CAD (78.8% vs 73.2%; P = .007) and LM-CAD (78.8% vs 64.0%; P < .001). The Arg/Pro genotype was more frequent in the LM-CAD group compared with the MP-CAD and control groups (56.0, 31.9, and 33.8, respectively, P < .001 for both comparisons). Furthermore, the frequency of Arg/Arg genotypes was the lowest in the LM-CAD group compared with the MP-CAD and control groups. Knowing that TP53 is an antioncogene protein that acts as a tumor suppressor and regulator of apoptosis, the lowest frequency of Arg/Arg genotype observed in these high-risk patients may indicate lower protection from the atherosclerosis process. Replication studies are needed to evaluate this association.
Community treatment orders increase community care and delay readmission while in force: Results from a large population-based study
Authors: Harris Anthony , Chen Wendy , Jones Sharon , Hulme Melissa , Burgess Philip , Sara Grant
Published: February 2018

Objective:

There is debate about the effectiveness of community treatment orders in the management of people with a severe mental illness. While some case–control studies suggest community treatment orders reduce hospital readmissions, three randomised controlled trials find no effects. These randomised controlled trials measure outcomes over a longer period than the community treatment order duration and assess the combined effectiveness of community treatment orders both during and after the intervention. This study examines the effectiveness of community treatment orders in a large population-based sample, restricting observation to the period under a community treatment order.

Methods:

All persons ( n = 5548) receiving a community treatment order in New South Wales, Australia, over the period 2004–2009 were identified. Controls were matched using a propensity score based on demographic, clinical and prior care variables. A baseline period equal to each case’s duration of treatment was constructed. Treatment effects were compared using zero-inflated negative binomial regression, adjusting for demographics, clinical characteristics and pre-community treatment order care.

Results:

Compared to matched controls, people on community treatment orders were less likely to be readmitted (odds ratio = 0.90, 95% confidence interval = [0.84, 0.97]) and had a significantly longer time to their first readmission (incidence rate ratio = 1.47, 95% confidence interval = [1.36, 1.58]), fewer hospital admissions (incidence rate ratio = 0.90, 95% confidence interval = [0.84, 0.96]) and more days of community care (incidence rate ratio = 1.55, 95% confidence interval = [1.51, 1.59]). Increased community care and delayed first admission were found for all durations of community treatment order care. Reduced odds of readmission were limited to people with 6 months or less of community treatment order care, and reduced number of admissions and days in hospital to people with prolonged (>24 months) community treatment order care.

Conclusion:

In this large population-based study, community treatment orders increase community care and delay rehospitalisation while they are in operation. Some negative findings in this field may reflect the use of observation periods longer than the period of active intervention.
The Just World Fallacy as a Challenge to the Business-As-Community Thesis
Authors: Sinnicks Matthew
Published: February 2018

The notion that business organizations are akin to Aristotelian political communities has been a central feature of research into virtue ethics in business. In this article, I begin by outlining this “community thesis” and go on to argue that psychological research into the “just world fallacy” presents it with a significant challenge. The just world fallacy undermines our ability to implement an Aristotelian conception of justice, to each as he or she is due, and imperils the relational equality required for shared participation in communities. In the final section, I offer a description of what Aristotelian community might look like within organizations, and some suggestions about how it may be possible to resist the challenge posed by the just world fallacy.
Dropping the “N-Word”: Examining How a Victim-Centered Approach Could Curtail the Use of America’s Most Opprobrious Term
Authors: Holt Lanier F.
Published: February 2018

The “N-word.” It’s what one scholar called “the nuclear bomb or racial epithets.” Few words are so abhorrent that just their utterance can provoke rage, hatred, and conflict. Unlike other slurs, it is perhaps the only one so vile that it has been truncated to a single letter: “N-” (i.e., the “N-word”), because of the negative connotations associated with it. This analysis addresses the N-word from multiple perspectives. It first examines the etiology of the word and how it became the derisive term it is today. Second, it examines the legal problems that courts have had in banning it as a form of hate speech, and how the N-word blurs the line between speech and conduct. Third, and finally, this analysis details how understanding the intent of the speaker, and using a victim-centered approach, can assist in creating polices that curtail the use of the problematic N-word.
Governance costs and the problems of large traditional co-operatives
Authors: Nilsson Jerker
Published: February 2018

During recent decades, there have been many failures among large and complex agricultural co-operatives with a traditional organizational structure, that is, with mainly collective governance and collective ownership. Many co-operatives have been converted into the so-called hybrid co-operatives, owned together with external financiers. This article applies governance cost theory to explain this development. The results show that members are not able to govern a collectively owned firm that is large and complex; members are thus reluctant to invest in co-operatives; and members do not perceive that co-operatives benefit them economically. Thus, strong leaders take control and non-member investors gain ownership and influence.
Child Sexual Trauma, Dissociation, and the Soul: A Christian Psychology Conceptualization
Authors: Badgett Jonathan P.
Published: February 2018

Over the past 30 years, the field of knowledge and insight into the phenomenon of structural or pathological dissociation has grown immensely. Recent findings have shed light on the etiology of complex traumatic stress disorders (CTSDs) like dissociative identity disorder (DID) and the intimate connection between chronic childhood sexual trauma and the persistent barriers to psychotherapeutic remediation in adult survivors. Modern scientific and theoretical advances notwithstanding, Christian counselors and pastors who counsel may benefit from a conceptualization of severe dissociative disorders, their treatment, and therapeutic outcomes that entails a thoroughgoing Christian perspective. This integrative task requires a broad survey of the pertinent psychological literature in the light of the Bible’s teaching on interpersonal suffering, the gospel of Jesus Christ, and the healing power of the triune God.
Bacteraemia and Upper Gastrointestinal Fibre-Endoscopy
Authors: Kirk A , Graham-Brown R , Perinpanayagam R M , Smith R G , Barnardo D E
Published: February 2018

A prospective study of fifty-two patients undergoing fibreoptic upper gastrointestinal endoscopy was carried out in order to determine whether bacteraemia was a significant risk. Aerobic and anaerobic blood cultures were performed before, during and after endoscopy. Cultures were also taken from lesions (if any found) in the oesophagus, stomach or duodenum.

No significant bacteraemia was identified, and bacterial growth was found in only one upper gastrointestinal lesion.
Diagnostic Reliability of Pleural Fluid Protein Estimation
Authors: Melsom R D
Published: February 2018

In a series of 86 elderly patients the measurement of pleural fluid protein was found to be of limited value in distinguishing exudates from transudates, although levels above 49 gil were all found to be exudates. However, the difference in mean pleural fluid proteins in the two groups when analysed statistically was highly significant. In addition, there was a significant difference between the means within the exudative group when analysed in groups according to aetiology.

Correcting for plasma albumin values did not improve discrimination between exudates and transudates despite a significant correlation between albumin and pleural fluid protein concentration.
Influence of Cimetidine on Cardiovascular Parameters in Man
Authors: Samuel I O , Dundee J W
Published: February 2018

Cardiac output was measured in 10 patients using the dye dilution method, before and after the intravenous injection of 400 mg cimetidine. The subjects were in the intensive care unit and required intermittent positive pressure ventilation. There was no change in the average blood pressure, heart rate and cardiac output during the 60 minutes following the cimetidine, although one patient showed a marked fall in cardiac output. The results suggest that cimetidine is without a marked depressant effect on cardiovascular system.
Asynchronously finite-time H∞ control for morphing aircraft
Authors: Cheng Haoyu , Fu Wenxing , Dong Chaoyang , Wang Qing , Hou Yanze
Published: February 2018

This paper investigates the problem of asynchronously finite-time H∞ control for morphing aircraft with controller uncertainties. Based on the switched linear parameter-varying model of morphing aircraft, the inherent packet dropouts of system are taken into consideration, which will lead to asynchronous switching. The asynchronous switching means that the switching of controllers will lag behind the switching of corresponding subsystem. Moreover, in order to overcome the undesirable influence of controller uncertainties and guarantee that the corresponding closed-loop system is finite-time bounded with a specified H∞ performance index, the non-fragile finite-time H∞ controller is developed via asynchronously switched control. For the purpose of less conservative controller design, the finite-time robust stability analysis of the system is verified by combining mode-dependent average dwell time method and multiple Lyapunov functional method. The sufficient existing conditions and solutions of the controllers are found by solving a series of linear matrix inequalities. Finally, the method proposed in this paper is demonstrated by an illustrative numerical example.
Mother-Ready Jobs: Employment That Works for Mothers of Children With Disabilities
Authors: Scott Ellen K.
Published: February 2018

Feminist researchers focus on work–family conflict and the impact on maternal employment. They find jobs are not structured to allow for work–family fit. Using qualitative data, I examine those unusual circumstances in which work does work in the challenging case of mothers of children with disabilities. Their experiences make clear the problem for all caregivers when employment is based on a male model, and the importance of workplace norms that diminish work–family conflict. I find that with flexibility, paid leave, job security, and health insurance, that is, with jobs that policy analysts refer to as “good jobs,” and Randy Albelda calls “mother-ready” jobs, caregivers can manage work and family. I argue that through a combination of mandatory workplace restructuring and social supports, the state could facilitate the reorganization of jobs so that they are mother-ready and therefore make possible the performance of daily required tasks as care givers and employees.
A Novel Pathologic Variant in OTOF in an Iranian Family Segregating Hereditary Hearing Loss
Authors: Tabatabaiefar Mohammad Amin , Pourreza Mohammad Reza , Tahmasebi Parisa , Saki Nader , Hashemzadeh Chaleshtori Morteza , Salehi Rasoul , Mohammadi‐asl Javad
Published: February 2018

Objective

Hearing loss (HL) is the most common sensory‐neural defect and the most heterogeneous trait in humans, with the involvement of >100 genes, which make a molecular diagnosis problematic. Next‐generation sequencing (NGS) is a new strategy that can overcome this problem.

Study Design

Descriptive experimental study.

Setting

Diagnostic laboratory.

Subjects and Methods

A comprehensive family history was obtained, and clinical evaluations and pedigree analysis were performed in a family with multiple individuals with HL. As the first tier, GJB2 was sequenced, and genetic linkage analysis of DFNB1A/B was performed to rule out the most common cause of the disease. Targeted NGS was used to unravel the molecular etiology of the disease in the HL‐associated genes in the proband. Two homozygous variants remained in OTOF after proper filtration. Cosegregation and in silico analysis were done. Preimplantation genetic diagnosis (PGD) was accomplished via linkage analysis and direct sequencing of the pathogenic variant.

Results

Clinical evaluations suggested autosomal recessive nonsyndromic HL. Two homozygous variants, c.367G>A (p.Gly123Ser) and c.1392+1G>A, were identified in cis status. c.1392+1G>A met the criteria for being pathogenic according to the variant interpretation guideline of the American College of Medical Genetics and Genomics. PGD was successfully performed to prevent the recurrence of the disease in the related family.

Conclusion

A novel OTOF mutation causing HL was identified. Here, we report the effectiveness of the combined application of targeted NGS and PGD in diagnosis and prevention of hereditary HL.
Equality Promotes Wellness
Authors: Chandrasekhar Sujana S.
Published: February 2018

Women otolaryngologists face issues that interfere with their wellness on a regular basis. Over the course of my career—in positions of leadership in academic practice and at the Academy's Board of Governors and Women in Otolaryngology Section and as past president of the AAO‐HNS/F—I have had experiences and observations that I feel can help move the needle forward on these very important conversations.
A qualitative exploration of proxy decision makers’ expectations of prescribed medications for people with advanced dementia
Authors: McCloskey Bridgeen , Hughes Carmel , Parsons Carole
Published: February 2018

Background:

Proxy decision makers often have to make decisions for people with advanced dementia. Their expectations regarding prescribed medications have the potential to influence prescription or withdrawal of medications. However, few studies to date have explored this.

Aim:

To explore proxy decision makers’ expectations of prescribed medications for people with advanced dementia and to consider how these change with changing goals of care and dementia progression.

Design:

This is a qualitative semi-structured interview study.

Setting/participants:

In total, 15 proxy decision makers of people with advanced dementia were recruited via general practitioners ( n = 9), Join Dementia Research ( n = 3) and the Alzheimer’s Society Northern Ireland ( n = 3).

Results:

Five key themes emerged: the role as advocate, attitudes to medicines and medicine taking, uncertainty over the benefit of anti-dementia medications, stopping medications, and communication and decision-making. Proxy decision makers desired more information about prescribed medicines, particularly the indications, benefits and risks of treatment. Despite uncertainty about the benefits of anti-dementia medications, proxy decision makers were reluctant for these medications to be withdrawn. Reluctance to stop other prescribed medicines was also expressed but reduced with changing goals of care and dementia progression. Although some proxy decision makers expected to be involved in medication-related decisions, the majority preferred to delegate these decisions to healthcare professionals. However, they expected to be informed of any medication-related decisions made.

Conclusion:

Proxy decision makers vary in terms of their desire for active involvement in the medication decision-making process. Healthcare professionals should facilitate proxy decision maker involvement if desired. Further research is required to consider the impact of proxy decision maker involvement in decision-making.
Using the ‘Social Marketing Mix Framework’ to explore recruitment barriers and facilitators in palliative care randomised controlled trials? A narrative synthesis review
Authors: Dunleavy Lesley , Walshe Catherine , Oriani Anna , Preston Nancy
Published: February 2018

Background:

Effective recruitment to randomised controlled trials is critically important for a robust, trustworthy evidence base in palliative care. Many trials fail to achieve recruitment targets, but the reasons for this are poorly understood. Understanding barriers and facilitators is a critical step in designing optimal recruitment strategies.

Aim:

To identify, explore and synthesise knowledge about recruitment barriers and facilitators in palliative care trials using the ‘6 Ps’ of the ‘Social Marketing Mix Framework’.

Design:

A systematic review with narrative synthesis.

Data sources:

Medline, CINAHL, PsycINFO and Embase databases (from January 1990 to early October 2016) were searched. Papers included the following: interventional and qualitative studies addressing recruitment, palliative care randomised controlled trial papers or reports containing narrative observations about the barriers, facilitators or strategies to increase recruitment.

Results:

A total of 48 papers met the inclusion criteria. Uninterested participants (Product), burden of illness (Price) and ‘identifying eligible participants’ were barriers. Careful messaging and the use of scripts/role play (Promotion) were recommended. The need for intensive resources and gatekeeping by professionals were barriers while having research staff on-site and lead clinician support (Working with Partners) was advocated. Most evidence is based on researchers’ own reports of experiences of recruiting to trials rather than independent evaluation.

Conclusion:

The ‘Social Marketing Mix Framework’ can help guide researchers when planning and implementing their recruitment strategy but suggested strategies need to be tested within embedded clinical trials. The findings of this review are applicable to all palliative care research and not just randomised controlled trials.
Propranolol for treating emotional, behavioural, autonomic dysregulation in children and adolescents with autism spectrum disorders
Authors: Sagar-Ouriaghli Ilyas , Lievesley Kate , Santosh Paramala J
Published: February 2018

Objectives:

To date, there is no single medication prescribed to alleviate all the core symptoms of Autism Spectrum Disorder (ASD; National Institute of Health and Care Excellence, 2016). Both serotonin reuptake inhibitors and drugs for psychosis possess therapeutic drawbacks when managing anxiety and aggression in ASD. This review sought to appraise the use of propranolol as a pharmacological alternative when managing emotional, behavioural and autonomic dysregulation (EBAD) and other symptoms.

Materials and methods:

Sixteen reports examined the administration of propranolol in the context of ASD.

Results:

Sixteen reports broadly covered cognitive domains, neural correlates, and behavioural domains. From the eight single-dose clinical trials, propranolol led to significant improvements in cognitive performance – verbal problem solving, social skills, mouth fixation, and conversation reciprocity; and changes in neural correlates – improvement in semantic networks and functional connectivity. The remaining eight case series and single case reports showed improvements in EBAD, anxiety, aggressive, self-injurious and hypersexual behaviours. Additionally, propranolol significantly improved similar behavioural domains (aggression and self-injury) for those with acquired brain injury.

Conclusion:

This review indicates that propranolol holds promise for EBAD and cognitive performance in ASD. Given the lack of good quality clinical trials, randomised controlled trials are warranted to explore the efficacy of propranolol in managing EBAD in ASD.
Results of a Pilot Trial of Immunotherapy with Dendritic Cells Pulsed with Autologous Tumor Lysates in Patients with Advanced Cancer
Authors: Mayordomo Jose Ignacio , Andres Raquel , Isla Maria Dolores , Murillo Laura , Cajal Rosana , Yubero Alfonso , Blasco Carmen , Lasierra Pilar , Palomera Luis , Fuertes Miguel Angel , Güemes Antonio , Sousa Ramon , Garcia-Prats Maria Dolores , Escudero Pilar , Saenz Alberto , Godino Javier , Marco Ivan , Saez Berta , Visus Carmen , Asin Laura , Valdivia Gabriel , Larrad Luis , Tres Alejandro
Published: February 2018

Aims and background

The purpose of the study was to test the immunological and clinical effects of infusions of dendritic cells pulsed with autologous tumor lysate in patients with advanced cancer.

Patients and methods

Peripheral blood mononuclear cells from 15 patients with metastatic cancer (melanoma in 10, lung cancer in 2, renal cell carcinoma in 1, sarcoma in 1, breast cancer in 1) were harvested by leukapheresis after mobilization with GM-CSF (5 μg/kg/day s.c. for 4 days). Mononuclear cells were separated and cultured in GM-CSF (1000 U/ml) and interleukin-4 (1000 U/ml) for 7 days. Phenotype was assessed by 2-color flow cytometry and immunocytochemistry. On day 6, dendritic cells were pulsed with 1 g of fresh autologous tumor lysate for 24 h and infused intravenously. Interleukin-2 (6 million IU), interferon a (4 million IU) and GM-CSF (400 μg) were injected s.c. daily for 10 days beginning on the day of dendritic cell infusion. Treatment was repeated every 21 days for 3 courses.

Results

The morphology, immunocytochemistry and phenotype of cultured cells was consistent with dendritic cells: intense positivity for HLA-DR and CD86, with negativity for markers of other lineages, including CD3, CD4, CD8 and CD14. More than 5 × 107 dendritic cells were injected in all patients. Nine patients developed >5 mm delayed type cutaneous hypersensitivity reactions to tumor lysate ± GM-CSF after the first immunization (larger than GM-CSF in all cases). Median delayed type cutaneous hypersensitivity to lysate + GM-CSF was 3 cm after the third immunization. One melanoma patient with skin, liver, lung and bone metastases had a partial response lasting 8 months (followed by progression in the brain). Seven patients had stable disease for >3 months, and 7 had progression.

Conclusions

Infusion of tumor lysate-pulsed dendritic cells induces a strong cell-mediated antitumor immune reaction in patients with advanced cancer and has some clinical activity.
Effect of Symptom-To-Treatment Interval on Prognosis in Lung Cancer
Authors: Annakkaya Ali Nihat , Arbak Peri , Balbay Oner , Bilgin Cahit , Erbas Mete , Bulut Ismet
Published: February 2018

Aims and background

To evaluate the relationship between delayed diagnosis and the degree of invasion and survival in lung cancer.

Methods

One hundred and three patients (96 men) with lung cancer were included. Stages in the diagnosis of lung cancer were classified as follows: symptom-to-doctor interval, i.e., the interval from the first symptoms related to the presence of lung cancer to the first consultation with a medical professional; doctor-to-diagnosis interval, i.e., the interval between the first medical visit and confirmation of the diagnosis; and diagnosis-to-treatment interval, i.e., the interval between diagnosis and complete TNM staging and treatment. The symptom-to-treatment interval (STI) was the sum of the 3 intervals. The degree of invasion was determined by the TNM classification.

Results

The patients were followed up for a mean period (± SD) of 7.4 ± 8.7 months. Seventy-six (74%) patients were diagnosed with non-small cell lung cancer (NSCLC) and 27 patients (26%) with small cell lung cancer (SCLC). The mean length of STI was 120 ± 101 days (median, 90). The mean length of the symptom-to-doctor interval was 63 ± 62 days (median, 45), while the doctor-to-diagnosis and diagnosis-to-treatment intervals were 41 ± 82 days (median, 10) and 16 ± 12 days (median, 12), respectively. When the STIs of the patients were correlated with tumor stage, tumor invasion, lymph node involvement and metastasis, no significant differences were found. Patients with an STI longer than 60 days had a significantly longer survival. Regarding the type of lung cancer and STI, the median survival was shorter in patients with an STI of less than 60 days both in NSCLC and SCLC, although this was not statistically significant in SCLC.

Conclusions

The shorter the diagnostic interval, the shorter was the median survival in our study. The reason for the apparent discrepancy between poor prognosis of lung cancer patients in spite of early diagnosis might be much faster progression of the disease itself.
Perivascular Epithelioid Cell Tumor (Pecoma) in the Transverse Colon of an Adolescent: A Case Report
Authors: Baek Jeong-Heum , Gi Chung Moon , Hae Jung Dong , Oh Jae Hwan
Published: February 2018

Perivascular epithelioid cell tumor (PEComa) is defined as a very rare mesenchymal tumor of histologically and immuno-histochemically distinctive perivascular epithelioid cells. PEComa in the colon is very rare, with only a few reported cases so far. Because of its rarity, the clinical features and biological behavior of PEComa in the colon have yet to be established. A 16-year-old female patient with PEComa in the transverse colon was referred to our hospital for rectal bleeding. Laboratory data showed a hemoglobin level of 6.6 g/dL, WBC of 8,800/mm3, and platelet count of 191,000/mm3. Colonoscopy, barium enema, and abdominal computed tomography revealed a 2-cm, smooth-surfaced, round tumor with focal ulceration in the proximal transverse colon. The patient complained of abdominal pain one day after endoscopic polypectomy. She underwent a segmental resection for a perforated transverse colon. Immunohistochemically, the tumor cells showed strong diffuse positivity for HMB-45 while they were negative for c-kit, smooth muscle actin, cytokeratin, S-100, vimentin, desmin, chromogranin, synaptophysin, EMA, and CD-34. The diagnosis of PEComa was based on histological and immunohistochemical staining. The patient did not receive any adjuvant therapy and was discharged on postoperative day 11 without complications. Whole-body fluorine-18 fluorodeoxyglucose fusion positron emission tomography performed 2 months after surgery showed no signs of recurrence or metastasis. There was also no recurrence or metastasis at 24 months' follow-up.
Brain Metastases from Endometrial Carcinoma: Report of Three Cases and Review of the Literature
Authors: Orrù Silvia , Lay Giancarlo , Dessì Marina , Murtas Rita , Deidda Maria Assunta , Amichetti Maurizio
Published: February 2018

Aims and background

Endometrial carcinoma is a rare cause of brain metastases, accounting for less than 1% of all metastatic lesions to the brain. This report aims to review our experience in the treatment of patients with brain metastases from endometrial carcinoma in order to establish the characteristics of these patients and evaluate the results and efficacy of whole-brain radiation therapy as a palliative measure.

Methods

Three cases of brain metastases from endometrial carcinoma treated with radiotherapy were identified in the files of the Division of Radiotherapy at the A. Businco Regional Oncological Hospital of Cagliari between 1999 and 2005.

Results

All patients had brain metastases as the only sign of systemic disease (a single lesion in 2 patients and 2 lesions in 1 patient). Two patients were classified as RTOG RPA class I and 1 patient as class III. Radiotherapy to the brain was delivered after surgical resection in the first 2 patients and as the only method of palliation in the third patient. The delivered radiation dose was 3000 cGy in 10 fractions over 2 weeks in the postoperative setting and 2000 cGy in 5 fractions over 1 week to the patient treated with irradiation alone. The 2 surgically treated patients are alive and well after 16 and 64 months, respectively. The patient treated with palliative intent died 2 months after irradiation.

Conclusions

The combination of surgery and postoperative whole-brain irradiation in selected patients with solitary brain metastases from endometrial carcinoma is an effective method of palliation.
The Expression of Metallothioneins on Imprint Smears of Prostate Carcinoma: Correlation with Clinicopathologic Parameters and Tumor Proliferative Capacity
Authors: Athanassiadou Paulina , Bantis Athanasios , Gonidi Maria , Athanassiades Peter , Agelonidou Eleni , Grapsa Dimitra , Nikolopoulou Polyxeni , Patsouris Efstratios
Published: February 2018

Aims and Background

Metallothioneins are a family of metal- binding cysteine-rich proteins that play an important role in cellular processes such as proliferation and apoptosis, protection against oxidative stress and metal ion homeostasis and detoxification. Recent findings suggest that metallothioneins might play a significant role in the development and progression of prostate cancer. It has been also demonstrated that Ki-67 expression may have prognostic value for disease-free survival in cases of prostate carcinoma.

Study Design

Imprint smears samples obtained from 70 patients immediately after radical prostatectomy for prostatic carcinoma were immunostained with monoclonal antibodies against metallothioneins and Ki-67. Metallothionein expression was correlated with Ki-67 immunostaining, Gleason score, stage, preoperative prostate-specific antigen levels and biochemical recurrence.

Results

Metallothionein expression was shown to correlate strongly with Gleason score (P <0.001) and significantly with pathological staging and Ki-67 immunostaining (P <0.001, P <0.05, respectively). In contrast, no significant association between metallothioneins and preoperative PSA was demonstrated. Both of the studied markers (metallothioneins and Ki-67) correlated with recurrence (P = 0.009, P = 0.006, respectively).

Conclusions

The present findings support the independent predictive value of metallothioneins and Ki-67 in prostate cancer. However, additional data are needed in order to reveal the factors that influence the expression of metallothioneins in epithelial neoplastic cells and clarify their mechanism of action.
Mediastinal Thymolipoma: A Rare Occurrence with Striated Myoid Cells
Authors: Gannon Brian R , Dexter David F , Petsikas Dimitri , Isotalo Phillip A
Published: February 2018

We describe a 49-year-old man who presented to hospital with unstable angina and who underwent emergency coronary artery bypass grafting. During the surgical procedure, an incidental anterior mediastinal mass was discovered. Histological examination of this mediastinal mass revealed a thymolipoma containing numerous polygonal, striated myoid cells that were immunoreactive for desmin, muscle-specific actin and myoglobin. Electron microscopy demonstrated numerous Z band structures confirming myoid differentiation. Even though the appearance of myoid cells in thymolipoma may be alarming, this tumor should be recognized as a benign entity. Thymolipomas containing striated myoid cells should be differentiated from more ominous thymic neoplasms, including teratomas and thymic liposarcomas. To our knowledge, this is only the third reported case of thymolipoma containing striated myoid cells.
Ewing's Sarcoma of the Third Metatarsal: A Case Report and Review of the Literature
Authors: Potocki Kristina , Prutki Maja , Kralik Marko , Hrabak Maja , Padovan Ranka Stern
Published: February 2018

We report a rare case of Ewing's sarcoma involving the third metatarsal bone and spreading into adjacent bone in a 23-year-old man, with special emphasis on imaging characteristics. On radiographs the tumor presented as a permeative lytic lesion with aggressive periosteal reaction and cortical destruction. Computed tomography and magnetic resonance imaging delineated the osseous and soft tissue extent of the tumor. A large soft-tissue mass around the involved bone was highly indicative of Ewing's sarcoma. Cortical invasion of the neighboring second metatarsal was seen only on magnetic resonance imaging. Increased uptake of technetium 99m methylene diphosphonate was noticed on bone scintigraphy. An early diagnosis of Ewing's sarcoma, even when it occurs in unusual locations, is necessary for adequate treatment and is of particular importance in terms of prognosis. The optimal imaging modality for the diagnosis of Ewing's sarcoma is magnetic resonance imaging since it allows accurate analysis of the soft- tissue component and visualization of possible local invasion of adjacent structures.
High Risk of Malignancy in Patients with Incidentally Discovered Adrenal Masses: Accuracy of Adrenal Imaging and Image-Guided Fine-Needle Aspiration Cytology
Authors: Lumachi Franco , Borsato Simonetta , Tregnaghi Alberto , Marino Filippo , Fassina Ambrogio , Zucchetta Pietro , Marzola Maria Cristina , Cecchin Diego , Bui Franco , Iacobone Maurizio , Favia Gennaro
Published: February 2018

Aims and background

The incidental finding of nonfunctioning adrenal masses (incidentalomas) is common, but no reliable criteria in differentiating between benign and malignant adrenal masses have been defined. The aim of this preliminary study was to assess the usefulness of adrenal imaging and image-guided fine-needle aspiration cytology in patients with nonfunctioning adrenal incidentalomas with the aim of excluding or confirming malignancy before surgery.

Methods

Forty-two consecutive patients (18 men and 24 women; median age, 54 years; range, 25-75 years) with incidentally discovered adrenal masses of 3 cm or more in the greatest diameter were prospectively enrolled in the study. All patients underwent helical computerized tomography scan and image-guided fine-needle aspiration cytology, 33 (78.6%) underwent magnetic resonance imaging, and 26 (61.9%) underwent norcholesterol scintigraphy before adrenalectomy.

Results

The revised final pathology showed 30 (71.4%) benign (26 adrenocortical adenomas, of which 3 were atypical, 2 ganglioneuromas, and 2 nonfunctioning benign pheochromocytomas) and 12 (28.6%, 95% CI = 15-42) adrenal malignancies (8 adrenocortical carcinomas and 4 unsuspected adrenal metastases). The definitive diagnosis of adrenocortical carcinoma was made according to Weiss criteria and confirmed on the basis of local invasion at surgery or metastases. The sensitivity, specificity and accuracy were 75%, 67% and 83% for computerized tomography scan, 92%, 95% and 94% for magnetic resonance imaging, 89%, 94% and 92% for norcholesterol scintigraphy, and 92%, 100% and 98% for fine-needle aspiration cytology. The sensitivity and accuracy of image-guided fine-needle aspiration cytology and magnetic resonance imaging together reached 100%. Immediate periprocedural complications of fine-needle aspiration cytology occurred in 2 (4.7%) patients: self-limited pneumothorax (n = 1), and severe pain (n = 1) requiring analgesic therapy. No postprocedural or late complications were observed.

Conclusions

With the aim of selecting for surgery patients with a non-functioning adrenal incidentaloma of 3 cm or more in diameter, the combination of magnetic resonance imaging and fine-needle aspiration cytology should be considered the strategy of choice.
Retroperitoneal Schwannomas: Diagnostic and Therapeutic Implications
Authors: Tortorelli Antonio Pio , Rosa Fausto , Papa Valerio , Rotondi Fabio , Sanchez Alejandro Martin , Bossola Maurizio , Pacelli Fabio , Doglietto Giovanni Battista
Published: February 2018

Aims and background

Schwannomas are a rare group of soft-tissue tumors that are derived from the peripheral nerve sheath and rarely develop in the retroperitoneum.

Methods and study design

We reviewed the clinicopathological features of 4 patients referred to our unit between October 1999 and March 2004 who on radiological examination were diagnosed with pancreatic, adrenal, psoas and retroperitoneal fat tissue tumors and subsequently underwent surgical treatment.

Results

The preoperative diagnosis was incorrect in all cases. At time of surgery, we found a mass probably arising from the adrenal gland in 2 patients, a lesion originating from the femoral nerve in 1 patient, and a retroperitoneal mass without a clear site of origin in 1 patient. Pathological evaluation revealed schwannomas in all cases, with no signs of malignancy. Complete surgical excision was performed in all patients without any major postoperative complications. At the time of writing all patients are alive with no evidence of local or distant recurrence.

Conclusions

Radical surgical excision is considered the best treatment for these neoplasms, resulting in a very good long-term prognosis.
Methodology for Estimation of Cancer Incidence, Survival and Prevalence in Italian Regions
Authors: Verdecchia Arduino , De Angelis Roberta , Francisci Silvia , Grande Enrico
Published: February 2018

Background

The Italian health care system is based on a regional responsibility and organization. Incidence, survival and prevalence of cancer patients were estimated for major cancer sites by single regions in Italy within a collaborative project “I TUMORI IN ITALIA” aimed at providing epidemiological information in a web site, www.tumori.net , for health operators, health programmers, epidemiologists and the general public. The aim of this paper is to present the methodology used to derive regional estimates of cancer burden indicators in Italy for major cancer sites.

Methods

Estimates require a complex methodology to be used. We present herein the methodology to provide regional estimates that involves a combined use of multiple methods to model and extrapolate patient survival to derive incidence and prevalence estimates and future projections.

Results

Regional patient survival estimates in Italy are presented and discussed. Cancer survival has greatly improved over the years and differences between northern-central and southern regions have persisted. The fraction of patients cured from cancer is today over 50% for young men and women aged 15-44 and declines to 15%-25% at older ages (75-99).

Discussion

We integrated different methods to derive estimates of cancer burden in Italy, at a regional level, in order to take advantage of all information available and to obtain the most reliable estimates. The value of producing regional estimates of cancer burden indicators was motivated by the lack of such information systematically on the Italian national territory.
Regional Estimates of all Cancer Malignancies in Italy
Authors: Grande Enrico , Inghelmann Riccardo , Francisci Silvia , Verdecchia Arduino , Micheli Andrea , Baili Paolo , Capocaccia Riccardo , De Angelis Roberta
Published: February 2018

Aims and background

The aim of this paper is to present regional and national estimates of mortality, incidence and prevalence for all cancers in Italy over the period 1970-1999, with projections up to 2010.

Methods

The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach, to derive incidence and prevalence starting from mortality and relative survival data. Published data from the Italian Cancer Registries were modeled in order to estimate regional and national cancer survival.

Results

Cancer time trends resulted more favorable in northern-central regions than in southern regions, both for men and women. Mortality started to decrease in the northern-central area approximately from the mid 1980s, whereas it was expected to slightly decline only after the year 2000 in the southern area. Incidence was estimated to decrease in men from 1995 in northern and central areas only; no incidence reduction is expected for women during the study period. Overall, 130,000 cancer deaths, 250,000 new cancer cases and 1,700,000 prevalent cancer cases are estimated in Italy in the year 2005.

Conclusions

This up-to-date picture of cancer risk and burden in the Italian regions shows as a relevant epidemiological change is ongoing in Italy. Although a clear geographical variability in mortality and morbidity levels still exists across the country, the historical North-to-South gap appears smaller than in the past. This change is particularly remarkable for men, as a consequence of trends that are favorable in northern-central regions but not yet in southern regions.
Regional Estimates of Colorectal Cancer Burden in Italy
Authors: Grande Enrico , Inghelmann Riccardo , Francisci Silvia , Verdecchia Arduino , Micheli Andrea , Baili Paolo , Capocaccia Riccardo , De Angelis Roberta
Published: February 2018

Aims and background

In terms of new diagnoses, colorectal cancer is one of the most important cancers in Italy and worldwide. The aim of this paper is to present estimates of the mortality, incidence and prevalence of colorectal cancer in Italy at a national and regional scale over the period 1970-1999, with projections up to 2010.

Methods

The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence estimates from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of colorectal cancer survival.

Results

Different incidence patterns were observed for men and women, especially in the projection period: the national age-standardized rate is estimated to increase throughout the study period 1970-2010 for men from 30 to 70 per 100,000, and to stabilize from the end of the 1990s for women at around 38 per 100,000. A stabilization or a slight decrease in age-standardized incidence rates is expected in most regions for women and in most northern-central regions for men. The most critical situation is estimated among men for southern regions, where the rise in incidence is accompanied by a dramatic increase in mortality. About 46,000 incident cases, 267,000 prevalent cases, and 16,000 deaths from colorectal cancer are estimated in Italy for the year 2005.

Conclusions

Despite the risk reduction estimated in most northern-central regions among men and in the large majority of regions among women, the colorectal cancer burden in Italy is expected to remain relevant in the next years. Prospects for reducing this burden appear mainly connected to the adoption of prevention policies aimed at increasing the awareness of the risk related to dietary habits and lifestyles and at promoting colorectal cancer screening.
Cancer Chemotherapy near the End of Life: The Time has come to set Guidelines for its Appropriate Use
Authors: Martoni Andrea Angelo , Tanneberger Stephan , Mutri Vita
Published: February 2018

Aims and Background

This study retrospectively analyzes the use of chemotherapy in patients who died of advanced cancer either after having been in care at the Medical Oncology Unit (MOU) of the University Hospital of Bologna, Italy, or after having been assisted in their terminal disease phase by the Bologna Oncological Hospice at Home (OHH) of the Associazione Nazionale Tumori (ANT) Italia Foundation. In the latter group, the prescription and delivery of chemotherapy had been performed by doctors of medical oncology departments other than the MOU.

Results

Between January 2003 and September 2005, 793 deaths of patients were recorded (MOU: 312; OHH: 481). At least one cycle of chemotherapy had been received by 445 patients (56.1%). The most common cancer types were lung cancer (26.7%), colorectal cancer (14.8%), and breast cancer (11.2%). At the time of the last chemotherapy (l-CT), the median age of the patients was 68 years (range, 22–98 years) and the median KPS was 70 (range, 40–100). The median interval between l-CT and death was 71 days (range, 1-1913 days). One hundred and one patients (22.7%) had received their l-CT in the last 30 days of their life, 86% of them having intermediately chemosensitive (71%) or chemoresistant (14%) tumors. The l-CT in the last month of life was first line in 56% of cases and consisted of costly new-generation drugs in 36.6% of cases.

Conclusions

The study suggests the urgent need to lay down guidelines for the appropriate use of chemotherapy in advanced cancer patients with a short life expectancy.
Patterns of Care for Brachytherapy in Europe, in Spain and Italy: Comparative Results
Authors: Guedea Ferran , Ventura Montse , Marchetti Cristina , Polo Alfredo , Torrecilla José López , Bilbao Pedro , Borràs Josep Maria
Published: February 2018

Aims and Background

The aim of the study was to compare the facilities for brachytherapy in two similar countries, as are Italy and Spain. This survey reports the differences in the use of brachytherapy in these countries.

Methods

The data regarding brachytherapy was obtained in 2002 by means of a specially designed web site, because Internet allowed the access to the questionnaire in an easy and safe way. In the first edition of the survey, only the countries in which more than 50% of its centers had completed the questionnaire were included. Among these countries there were Italy and Spain.

Results

Data was available in 127 centers in Italy and 72 centers in Spain, where 35 and 39, respectively, provided brachytherapy. Although both countries had a similar number of radiotherapy patients and the average number of radiotherapy patients per center was similar in both countries (P = 0.29), there were several differences related to brachytherapy. For instance, the mean number of radiation oncologists regularly performing brachytherapy per center was higher in Spain (P = 0.001). There were also differences in the average number of patients per center in the following tumor sites: breast (P <0.001) and gynaecological (P <0.001). In fact, the average number of patients per center who were treated with brachytherapy in these tumor sites was higher in Spain than Italy.

Conclusions

Although the estimated workload of the radiation oncologists, physicists and radiation technologists was higher in Spain, no statistically significant differences were found in the average number of patients per center for the following tumor sites: bronchus, head and neck, intracoronary, esophagus, prostate, rectum and skin. Several differences in the use of the brachytherapy procedures applied were also found.