bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Diagnostic Models With Attribute Hierarchies: Model Estimation With a Restricted Q-Matrix Design
Authors: Tu Dongbo , Wang Shiyu , Cai Yan , Douglas Jeff , Chang Hua-Hua
Published: April 2018

Attribute hierarchy is a common assumption in the educational context, where the mastery of one attribute is assumed to be a prerequisite to the mastery of another one. The attribute hierarchy can be incorporated through a restricted Q matrix that implies the specified structure. The latent class–based cognitive diagnostic models (CDMs) usually do not assume a hierarchical structure among attributes, which means all profiles of attributes are possible in a population of interest. This study investigates different estimation methods to the classification accuracy for a family of CDMs when they are combined with a restricted Q-matrix design. A simulation study is used to explain the misclassification caused by an unrestricted estimation procedure. The advantages of the restricted estimation procedure utilizing attribute hierarchies for increased classification accuracy are also further illustrated through a real data analysis on a syllogistic reasoning diagnostic assessment. This research can provide guidelines for educational and psychological researchers and practitioners when they use CDMs to analyze the data with a restricted Q-matrix design and make them be aware of the potentially contaminated classification results if ignoring attribute hierarchies.
The work programme of EURADOS on internal and external dosimetry
Authors: Rühm W. , Bottollier-Depois J.F. , Gilvin P. , Harrison R. , Knežević Ž. , Lopez M.A. , Tanner R. , Vargas A. , Woda C.
Published: April 2018

Since the early 1980s, the European Radiation Dosimetry Group (EURADOS) has been maintaining a network of institutions interested in the dosimetry of ionising radiation. As of 2017, this network includes more than 70 institutions (research centres, dosimetry services, university institutes, etc.), and the EURADOS database lists more than 500 scientists who contribute to the EURADOS mission, which is to promote research and technical development in dosimetry and its implementation into practice, and to contribute to harmonisation of dosimetry in Europe and its conformance with international practices. The EURADOS working programme is organised into eight working groups dealing with environmental, computational, internal, and retrospective dosimetry; dosimetry in medical imaging; dosimetry in radiotherapy; dosimetry in high-energy radiation fields; and harmonisation of individual monitoring. Results are published as freely available EURADOS reports and in the peer-reviewed scientific literature. Moreover, EURADOS organises winter schools and training courses on various aspects relevant for radiation dosimetry, and formulates the strategic research needs in dosimetry important for Europe. This paper gives an overview on the most important EURADOS activities. More details can be found at www.eurados.org .
EURADOS work on internal dosimetry
Authors: Breustedt B. , Blanchardon E. , Castellani C-M. , Etherington G. , Franck D. , Giussani A. , Hofmann W. , Lebacq A-L. , Li W.B. , Noßke D. , Lopez M.A.
Published: April 2018

European Radiation Dosimetry Group (EURADOS) Working Group 7 is a network on internal dosimetry that brings together researchers from more than 60 institutions in 21 countries. The work of the group is organised into task groups that focus on different aspects, such as development and implementation of biokinetic models (e.g. for diethylenetriamine penta-acetic acid decorporation therapy), individual monitoring and the dose assessment process, Monte Carlo simulations for internal dosimetry, uncertainties in internal dosimetry, and internal microdosimetry. Several intercomparison exercises and training courses have been organised. The IDEAS guidelines, which describe – based on the International Commission on Radiological Protection’s (ICRP) biokinetic models and dose coefficients – a structured approach to the assessment of internal doses from monitoring data, are maintained and updated by the group. In addition, Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides have been elaborated on behalf of the European Commission, DG-ENER (TECHREC Project, 2014–2016, coordinated by EURADOS). Quality assurance of the ICRP biokinetic models by calculation of retention and excretion functions for different scenarios has been performed and feedback was provided to ICRP. An uncertainty study of the recent caesium biokinetic model quantified the overall uncertainties, and identified the sensitive parameters of the model. A report with guidance on the application of ICRP biokinetic models and dose coefficients is being drafted at present. These and other examples of the group’s activities, which complement the work of ICRP, are presented.
Before They Were Ties: Predicting the Value of Brand-New Connections
Authors: Levin Daniel Z. , Walter Jorge
Published: April 2018

Complementing and extending prior studies on the value of existing work relationships, this study examines whether we can predict the value of brand-new ties before people ever meet. We examine this question by developing three sets of hypotheses reflecting the three main perspectives in the social networks literature: the resource (actor), dyadic (tie), and structural (network) perspective. To test our hypotheses, we asked executives to reach out for advice from someone they had never met and to complete a survey of their various thoughts about the other person both before and after making a connection. We find support for all three perspectives after a connection has been made; however, before tie formation, we find evidence only for the structural perspective. Our results suggest that the lack of reliable information about strangers obscures which brand-new ties will turn out to be more valuable but that surrounding network structures remain a reliable predictor of value, even for brand-new ties.
Immediate Use of Uncuffed Tracheostomy after Free Flap Reconstruction of the Head and Neck
Authors: Patel Priyesh N. , Valmadrid Al C. , Hong Daniel Y. , Francis David O. , Sim Michael W. , Rohde Sarah L.
Published: April 2018

Objective

To determine if immediate postoperative uncuffed tracheostomy placement following oral cavity or oropharyngeal head and neck free flap reconstruction is associated with shorter hospital length of stay and higher inpatient decannulation rates without an increase in respiratory complications, as compared with immediate placement of cuffed tracheostomy.

Study Design

Retrospective cohort.

Setting

Tertiary referral center.

Subjects and Methods

Patients were included if they underwent free flap reconstruction for oral cavity or oropharyngeal squamous cell carcinoma and had an intraoperative tracheostomy placed between 2005 and 2016. In 2012, head and neck surgeons changed from routine placement of cuffed to uncuffed tracheostomy tubes immediately after free flap reconstruction. This study compares length of hospital stay, inpatient decannulation rates, and respiratory complications between patients who had cuffed and uncuffed tracheostomies. Analysis of variance and chi‐square test were used to examine continuous and categorical variables, respectively. Multivariable regression analyses were performed to determine whether cuff status was independently associated with primary outcomes of length of hospital stay, decannulation, and respiratory complications.

Results

Of 752 patients who underwent free flap reconstruction, 493 patients met inclusion criteria (cuffed, n = 366; uncuffed, n = 127). Patient variables (ie, age, sex, body mass index, prior chemoradiation) and tumor characteristics (ie, location, stage) did not differ significantly between groups. Adjusted analysis showed that an uncuffed tracheostomy (vs a cuffed tracheostomy) was associated with shorter length of stay (7.7 vs 9.7 days, P <. 001) and did not increase the rate of respiratory complications.

Conclusion

Immediate placement of a uncuffed tracheostomy after oral cavity or oropharyngeal free flap reconstruction is associated with shorter hospital stays without an increase in respiratory complications.
Differential Diagnosis of Sinonasal Lymphoma and Squamous Cell Carcinoma on CT, MRI, and PET/CT
Authors: Kim Seok‐Hyun , Mun Sue‐Jean , Kim Hak‐Jin , Kim Seon Lin , Kim Sung‐Dong , Cho Kyu‐Sup
Published: April 2018

Objective

The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT parameters between sinonasal non‐Hodgkin's lymphoma (NHL) and squamous cell carcinoma (SCC), knowing the imaging features that distinguish sinonasal NHL from SCC.

Study Design

Case series with chart review.

Setting

University tertiary care facility.

Subjects and Methods

We analyzed the features on CT, MR imaging, and PET/CT of 78 patients diagnosed with sinonasal NHL or SCC histopathologically. The CT (n = 34), MRI (n = 25), and PET/CT (n = 33) images of 39 patients with sinonasal NHL and the CT (n = 38), MR (n = 28), and PET/CT (n = 31) images of 39 patients with SCC were evaluated. The sinonasal NHL was diagnosed as natural killer/T‐cell lymphoma (n = 28) and diffuse large B‐cell lymphoma (n = 11).

Results

Patients with sinonasal NHL had a larger tumor volume and higher tumor homogeneity than patients with SCC on T2‐weighted and postcontrast MR images. Most of the sinonasal NHL and SCC showed a high degree of enhancement. The apparent diffusion coefficient (ADC) values and adjacent bone destruction were significantly lower in sinonasal NHL than in SCC. However, cervical lymphadenopathy, Waldeyer's ring involvement, and PET/CT SUV max showed no significant differences between sinonasal NHL and SCC.

Conclusion

CT and MR images of sinonasal masses showing a bulky lesion, marked homogeneity, and low ADC values without adjacent bone destruction are more suggestive of sinonasal NHL than SCC.
Junagadh, India and the Logic of Occupation and Appropriation, 1947–49
Authors: Ankit Rakesh
Published: April 2018

This article shows the logic of occupation and appropriation that operated in the wake of the integration of the princely state of Junagadh to the dominion of India in November 1947. This re-created the ‘everyday’ state and society in Junagadh and triggered questions of loyalty of Indian Muslims and suspicions about their presence in the country. The old-new Indian state had a heavy-handed response in line with the newly majoritarian, nationalist society. Using unused archival records to furnish fresh evidence of the maltreatment of Muslims— from appropriation of their properties to questioning their citizenship by the Indian ‘official mind’, to the latter’s confiscation of Junagadh state’s assets—the article provides an account of an arduous amalgamation in the post-1947 Indian ‘state-nation’ of the Muslims of Junagadh.
Synthesis, characterization and application of composite derived from rice husk ash with aluminium oxide for sorption of uranium
Authors: Youssef W. M. , Hagag M. S. , Ali A. H.
Published: April 2018

A composite of rice husk (RH), caustic soda and aluminium oxide was synthesized at 500°C. The activated carbon and amorphous silica dispersed over the aluminium oxide selectively adsorbed uranium in the presence of other elements. At equilibrium time 1 h, phase ratio S/L (0.1 g/10 ml), pH = 5 and uranium initial concentration 120.6 mg/l uranium adsorption efficiency was 96.35%. The uranium stripping efficiency from the load RHA–alumina composite fulfilled 99.9% at 1 h equilibrium time, a phase ratio (S/A) of 0.05 g/10 ml and 0.5 mol/l HNO3. The scanning electron microscopy photos revealed that the rice husk ash (RHA)–alumina composite has vacant or regular cavities before the adsorption, and the cavities are fully occupied by uranium after adsorption. The Fourier transform infrared spectroscopy shows a more broadening of the band υ = 3526 and 3462 cm−1 which was ascribed to the uranium adsorption. The composite adsorbed 93.75% of uranium from a waste sample. The uranium adsorption exhibited a Langmuir isotherm.
Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review
Authors: Badran Abdul , Davies Benjamin M , Bailey Heidi-Marie , Kalsi-Ryan Sukhvinder , Kotter Mark RN
Published: April 2018

Objective:

To review peer-reviewed literature relating to postoperative physiotherapy for degenerative cervical myelopathy (DCM), to determine efficacy in improving clinical outcome and recovery.

Data sources:

MEDLINE, EMBASE, CENTRAL, PEDro, ISRCTN registry, WHO ICTRP and Clinicaltrials.gov . References and citations of relevant articles were searched.

Methods:

A systematic search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42016039511) from the origins of the databases till 15 February 2018. Included were all studies investigating physiotherapy as an intervention after surgical treatment of DCM to determine effect on clinical outcome and recovery. Study quality was determined using the Grades of Recommendation, Assessment, Development and Evaluation guidelines.

Results:

In all, 300 records were identified through tailored systematic searches, after removing duplicates. After screening, only one investigated postoperative rehabilitation using physiotherapy for DCM; however, this was retrospective with no controls. This study suggested that rehabilitation including physiotherapy improved postoperative recovery. There are currently two registered trials investigating the use of postoperative physiotherapy for DCM.

Conclusions:

The literature provides insufficient evidence to make any evidence-based recommendations regarding postoperative physiotherapy use in DCM.
Histopathologic Interobserver Agreement on the Diagnosis of Melanocytic Skin Lesions with Equivocal Dermoscopic Features: A Pilot Study
Authors: Ferrara Gerardo , Argenziano Giuseppe , Soyer H. Peter , D'Argenio Paolo , Carli Paolo , Cerroni Lorenzo , Chimenti Sergio , De Giorgi Vincenzo , Delfino Mario , De Rosa Gaetano , Shabrawi-Caelen Laila El , Ferrari Angela , Massi Daniela , Mazzocchetti Giampiero , Peris Ketty , Piccolo Domenico , Santucci Marco , Scalvenzi Massimiliano , Staibano Stefania
Published: April 2018

Aims and background

Dermoscopy (dermatoscopy, skin surface microscopy, epiluminescence microscopy) has been increasingly employed in recent years for the preoperative detection of cutaneous melanoma, and dermatoscopic features of pigmented skin lesions have been previously defined using histopathology (HP) as the “key to the code”. The aim of the present study was to evaluate the interobserver agreement on the HP diagnosis in a series of epiluminescence microscopy equivocal melanocytic skin lesions.

Study design

Ten melanocytic skin lesions were selected on the basis of diagnostic disagreement of at least 2 out of 9 epiluminescence microscopy observers. The histologic specimens from the 10 lesions were examined by 9 HP observers. The agreement of the HP diagnoses was calculated by means of Fleiss' k statistics.

Results

The overall HP agreement was less than excellent (k = 0.5). When considering the prevailing epiluminescence microscopic and HP diagnoses, 2 cases were shown to be epiluminescence microscopy false-negative melanomas. Virtually no agreement was found among epiluminescence microscopy observers in 4 cases (40%) or among HP observers in 3 cases (30%). However, only one pigmented skin lesion remained un-classifiable on epiluminescence microscopy as well as HP.

Conclusions

When at least 2 epiluminescence microscopy experts disagree in the evaluation of a given melanocytic skin lesion, even HP consultations may give equivocal results. The need to establish more reliable epiluminescence microscopic and HP criteria by performing an improved and meticulous clinicopathologic correlation, e.g. by using telecommunication via Internet, is emphasized.
Primary Non-Hodgkin's Lymphoma of the Liver (Case Report)
Authors: Özet Ahmet , Çalişkaner Zafer , Deveci Salih , Özet Gülsüm , Celasun Bülent , Arpacı Fikret , Öztürk Bekir , Karaayvaz Mehmet
Published: April 2018

Primary non-Hodgkin's lymphoma of the liver is very uncommon, and fewer than 100 cases have been reported in the literature. Most reports describe either solitary or multiple mass lesions in the liver. A diffuse lesion without nodule formation is a relatively rare form of the disease. The histologic feature of the disease is a predominantly large cell lymphoma of B-cell lineage. We report a case of primary B-cell non-Hodgkin's lymphoma which had diffusely infiltrated the liver without nodule formation.
Combination of Docetaxel and Doxorubicin as First-Line Chemotherapy in Metastatic Breast Cancer
Authors: Baltalı Eşmen , Özışık Yavuz , Güler Nilüfer , Fırat Dinçer , Altundağ Kadri
Published: April 2018

Docetaxel (Taxotere®) and doxorubicin have previously demonstrated a significant antitumor activity in patients with metastatic breast cancer. Furthermore, a lack of cross resistance and overlapping toxicities between the two agents have been reported. In a prospective study, docetaxel (80 mg/m2, 1-hr iv infusion) and doxorubicin (60 mg/m2, 1-hr iv infusion) were administered as first-line chemotherapy in metastatic breast cancer patients to evaluate the clinical efficacy and toxicity of the combination. Forty-three patients were enrolled in the study. The median age was 47 years (range, 30-69). The docetaxel-doxorubicin combination was applied with 3-week intervals until progression. Complete response was achieved in 9 (21.4%) of 42 assessable patients and partial response in 24 (57.2%) patients, for an overall response rate of 78.6%. Median response duration was 8 months (3-18 months). Nausea and vomiting (76%), alopecia (64%), neutropenia (35.7%) and mucositis (33%) were the major side effects of the combination. There was one case of cardiac toxicity. In conclusion, the docetaxel-doxorubicin protocol can be considered as an active regimen for the treatment of patients with metastatic breast cancer with acceptable toxicity and a fairly high response rate.
Weekly Paclitaxel in Metastatic Breast Cancer Patients: A Phase II Study
Authors: Gori Stefania , Mosconi Anna Maria , Basurto Carlo , Cherubini Roberta , De Angelis Verena , Tonato Maurizio , Colozza Mariantonietta
Published: April 2018

Aims and background

Paclitaxel, a microtubule inhibitor, is one of the most active drugs in metastatic breast cancer. A weekly schedule, at a median dose-intensity of 91 mg/m2, is effective and has less side effects than a 3-week schedule. In this phase II study, we evaluated the toxicity and the activity of weekly 1 hr paclitaxel infusions in metastatic breast cancer patients.

Study design

Between February 1999 and February 2001, 26 patients with metastatic breast cancer were treated with weekly paclitaxel (60–90 mg/m2/1 hour iv infusion/weekly). The treatment was planned to continue until disease progression or prohibitive toxicity; in patients with responsive or stable disease, paclitaxel was stopped after 6 months of therapy.

Results

At a median follow-up of 18.7 months (range, 6.8–30.8), all patients are assessable for response and toxicity. We obtained 8 partial responses (30.8%), 8 stable disease (30.8%) and 10 disease progression (38.4.%). The overall response was 30.8% (95% CI, 13.1–48.5). The median duration of response was 7.6 months (range, 1.8–12.4); median time to progression was 4.86 months (range, 1.4–12.4); median overall survival was 9.9 months (range, 1.7–29.2+). Treatment was well tolerated. Hematological toxicity was mild and only one patient developed grade 3 anemia. Two patients experienced grade 3 cardiovascular toxicity; both had received anthracycline-based regimens.

Conclusions

In our experience, weekly administration of paclitaxel shows a substantial degree of activity even in pretreated metastatic breast cancer patients. The toxicity profile is favorable.
Analysis of the Evolution in the Management of Endometrial Cancer in Italy: A CTF Study
Authors: Zola Paolo , Jacomuzzi Maria Elena , Mazzola Simona , Fuso Luca , Ferrero Annamaria , Landoni Fabio , Gadducci Angiolo , Sartori Enrico , Maggino Tiziano
Published: April 2018

Objective

In 1994 we mailed questionnaires to referral centers in Italy in order to evaluate the different opinions concerning aspects of endometrial cancer treatment, which is still controversial. The data processing showed a significant nonhomogeneity in disease management and prompted the Italian Society of Gynecologic Oncology to define guidelines for endometrial cancer adjuvant treatment. In 2001, we mailed again the same questionnaire to the same referral Centers in Italy. The aim of the second enquiry was the evaluation of changes in endometrial cancer management and the effective impact of the guidelines published.

Methods

The enquiry used the same questionnaires mailed in 1994; actually, we mailed those questionnaires to the same referral centers in Italy twice: in December 2000 and March 2001. The results of both the enquiries were collected in a relational data base, and the statistical evaluations were calculated using SPSS-statistics (Window ver. 8).

Results

Endometrial cancer treatment consists in abdominal hysterectomy and bilateral salpingo-oophorectomy. The unique relevant difference as to 1994 consists in the systemic performing of peritoneal cytology in endometrial cancer staging. Unlike the previous enquiry, adjuvant radiotherapy is not systematically performed in disease at stage Ic because of the substantial absence of confirmed data demonstrating a real benefit in terms of survival rate. The comparison between the two enquiries shows a significant change in medical planning and diversification attitude according to patient age and menopausal state. The disease management changes in patients over 75 years old, mainly with respect to surgery and primary therapy.

Conclusions

We noted a resistance of many centers to accept some trends actually widespread in the literature but not yet performed in practical clinical.
Paclitaxel and Carboplatin in Neo-Adjuvant and Concomitant Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma
Authors: Fornari Gianni , Artusio Elisa , Mairone Lorenza , Airoldi Mario , Bongioannini Guido , Amasio Enrica , Rosmino Claudia , Gabriele Pietro
Published: April 2018

Aim and background

To evaluate feasibility of neoadjuvant chemotherapy (NA-CT) followed by CT + radiotherapy (RT) in locally advanced or unresectable head and neck squamous cell carcinoma (HNSCC).

Methods

22 HNSCC patients were enrolled (18 males, 4 females; median age, 59.5 years; median ECOG PS, 1). Sites of disease: oral cavity, 18.2%; oropharynx, 40.9%; hypopharynx, 18.2%; larynx, 4.6%, multiple sites, 18.2%. T (tumor) category: T2, 13.6%; T3, 31.8%;T4, 54.5%. N (nodes) category: N0, 9.1%; N1, 18.1%; N2, 40.9%; N3, 31.8%. Stage: III, 4.6%; IVA, 63.6%; IVB, 31.8%. Induction carboplatin (AUC = 6) and paclitaxel (200 mg/m2) × 3 cycles (q21 days) were given. Responders received definitive radiotherapy with concurrent carboplatin (35 mg/m2/day from days 1 to 5 in weeks 1, 3, 5 and 7) and paclitaxel (50 mg/m2 on days 10, 24 and 38). Patients with node involvement were suggested to undergo postradiotherapy neck dissection.

Results

NA-CT. 97% of planned chemotherapy cycles were administered. Prevalent toxicity was hematologic: 50% G4 neutropenia and 31.8% G3, one neutropenic fever. All patients had alopecia. Complete responses in T and N were 4 (18.2%) and 3 (15%), respectively. Partial responses were 13 (59%) and 9 (45%). There was 1 progressive disease. CT + RT. 79.9% of planned cycles of CT were administered. In 19 patients (86.4%) more than 50% of planned cycles of CT were completed. Median dose of RT was 70.2 Gy on T/N+ and 54 Gy on N0. Limiting toxicity was mucositis in 77.3%, followed by neutropenia (59.1% G3–G4). Median weight loss was 4.9%. 18.2% of patients required hospitalization. Complete responses in T and N were 15 (68.1%) and 8 (40%), respectively. Partial responses were 5 (22.7%) and 7 (35%).

Conclusions

The preliminary results of this study are encouraging, despite the toxicity. Adequate follow-up is required to evaluate efficacy in terms of local-regional control and overall survival.
Hormono-Radiotherapy in Prostatic Carcinoma: Prognostic Factors and Implications for Combined Modality Treatment
Authors: Cellini Numa , Luzi Stefano , Morganti Alessio Giuseppe , Mantini Giovanna , Valentini Vincenzo , Racioppi Marco , Leone Mariavittoria , Mattiucci Gian Carlo , Di Gesù Cinzia , Giustacchini Mario , Destito Antonio , Smaniotto Daniela , Alcini Eugenio
Published: April 2018

The aim of this study was to evaluate the prognostic role of several clinical variables in a patient population undergoing neoadjuvant hormonotherapy (NHT) with external beam radiotherapy (ERT) to identify subsets of patients with an unfavorable prognosis who require intensified therapy. Eighty-four patients (mean age, 68.2 +/– 6.1 years; range, 52–81 years) underwent ERT (45 Gy to pelvic volume; 65 Gy mean dose to prostate volume) and NHT (oral flutamide: 250 mg three times daily for 30 days; LH-RH analogue: one vial every 28 days starting two months before radiotherapy and for its entire duration). The distribution according to clinical stage was T2: 46.4%, T3: 50.0%, T4: 3.6%. The distribution according to the Gleason score was grade 2–4: 17.9%; grade 5–7: 53.6%; grade 8–10: 28.5%. The distribution according to pretreatment PSA levels (in ng/mL) was 0–4: 5.9%; 4–10: 26.2%; 10–20: 16.7%; ≥20: 51.2%. With a median follow-up of 36 months, 3.6% of patients died; hematogenous metastases and local disease progression were found in 16.7% and 6% of patients, respectively. Overall, the incidence of disease progression was 17.9%. 32.9% of patients showed biochemical failure during follow-up. Overall, metastasis-free, local progression-free and biochemical failure-free actuarial survival at five years was 89.2%, 66.5%, 85.0% and 41.9%, respectively. At univariate analysis (log-rank) clinical stage (cT) was shown to be significantly correlated with the incidence of metastasis (P = 0.0004), local progression (P <0.0001) and disease-free survival (P = 0.0005). At multivariate analysis (Cox) the correlations between clinical stage and metastasis (P = 0.0175), local progression (P = 0.0200) and disease-free survival (P = 0.0175) were confirmed. Gleason score and pretreatment PSA levels did not show any significant correlation with these endpoints. These results confirm the indications of the recent literature, which, in prostate carcinoma at higher clinical stages, suggest the use of prolonged hormonal therapy after radiotherapy.
Chemoprevention of Prostate Carcinogenesis by DFMO and/or Finasteride Treatment in Male Wistar Rats
Authors: Esmat Amr Y , Refaie Fawzia M , Shaheen Mohamed H , Said Mahmoud M
Published: April 2018

In the present study the chemopreventive activities of DFMO, the irreversible inhibitor of ornithine decarboxylase, and finasteride, the inhibitor of prostatic 5a-reductase, against the development of chemically induced prostate adenocarcinoma by methylnitrosourea/testosterone propionate in male Wistar rats were investigated. According to histological examination, oral administration of DFMO and finasteride, either alone or combined, for two months to MNU/TP-inoculated rats reduced the tumor incidence to 11.11%, 10% and 10%, respectively, compared to tumored controls (64.3%). DFMO and/or finasteride treatment resulted in significant reductions in the wet weight of the prostate gland and seminal vesicles and its ratio relative to the total body weight, as well as the levels of prostate total protein, DNA, RNA and DNA/RNA ratio, compared to tumored controls. However, the effect of the combined treatment was of no statistical significance compared to single DFMO or finasteride treatment, as demonstrated by the non-significant differences between the mean values of most of the studied parameters. The tumor chemopreventive activity and the prostate growth inhibitory effect of DFMO and finasteride were due to suppression of prostate polyamine synthesis. ANOVA test revealed that the relative weight of the prostate as well as blood and tissue polyamine levels could be used as significant endpoint biomarkers for DFMO and finasteride as cancer chemopreventive agents.
Axillary Metastasis as First Symptom of Occult Breast Cancer: A Case Report
Authors: Frattaroli Fabrizio Maria , Carrara Alessandro , Conte Anna Maria , Pappalardo Giuseppe
Published: April 2018

Axillary lymph node metastasis from an occult breast carcinoma is a rare occurrence. We report this condition in a 59-year-old woman who presented with a swelling in the right axilla. No breast mass was clinically evident. Mammography, ultrasonography and multiple random fine-needle breast biopsies yielded no pathological findings. No extramammary primary lesions were present. Axillary sampling was performed and histological examination revealed the presence of metastatic adenocarcinoma in three of the 12 dissected lymph nodes. Estrogen receptors were positive and immunohistochemistry pointed to a breast origin. All these data were suggestive of occult breast cancer. The patient refused any further treatment but accepted clinical and radiological follow-up. Eight years later mammography revealed in the same breast a 10-mm nodule containing microcalcifications, which was not evident at physical examination. The patient underwent a lumpectomy. Intraoperative histology was positive for breast carcinoma and complete axillary clearance was performed. Histological examination revealed a lobular invasive breast carcinoma and the presence of micrometastasis in one of the 23 removed lymph nodes. The patient was given radiotherapy to the breast and axilla and tamoxifen. At present, one year after the appearance of the primary tumor, she is free of disease. Based on this case report we suggest an eclectic approach in the management of patients with axillary metastasis from occult breast cancer, depending on the clinical, pathological and biological findings.
Tumor-Associated Macrophages and Dendritic Cells as Prototypic Type II Polarized Myeloid Populations
Authors: Mantovani Alberto , Schioppa Tiziana , Biswas Subhra K , Marchesi Federica , Allavena Paola , Sica Antonio
Published: April 2018

Environmental signals polarize mononuclear phagocytes which can express different functional programmes. Fully polarized type I and type II (or alternatively activated) macrophages are the extremes of a continuum of functional states. Tumor-derived and T cell-derived cytokines stimulate tumor associated macrophages (TAM) to acquire a polarized type II phenotype. These functionally polarized cells, and similarly oriented or immature dendritic cells present in tumors, play a key role in subversion of adaptive immunity and in inflammatory circuits which promote tumor growth and progression.
Acceptance of External Infusion Pumps in Patients with Advanced Breast Cancer Receiving Continuous Infusion Fluorouracil
Authors: Lombardi Davide , Di Lauro Vincenzo , Piani Barbara , Scuderi Cristina , Spazzapan Simon , Magri Maria Donatella , Crivellari Diana , Annunziata Maria Antonietta , De Cicco Marcello , Veronesi Andrea
Published: April 2018

Background

We investigated the physical and psychological adaptation to a protracted continuous infusion system in a series of patients receiving protracted continuous infusion of 5-fluorouracil for advanced breast cancer.

Patients and methods

The protracted continuous infusion of 5-fluorouracil was administered by means of a portable elastomeric pump (Baxter Seven-Day Infusor, 0.5 mL/hr) via an indwelling Groshong catheter. Patients were asked to complete a questionnaire exploring the impact of the continuous infusion system upon various aspects of daily life, the overall level of disturbance, the general judgement on its quality, and their willingness to resume the same kind of treatment in the future. All items were graded on a 4-point scale from 0 = not at all, to 4 = very much.

Results

Seventy-one patients were evaluated. All patients received 5-fluorouracil at the dose of 250 mg/m2/day as a protracted continuous infusion alone (n = 14) or in combination with vinorelbine (n = 45) or Taxol (n = 12). The median duration of the protracted continuous infusion before evaluation was 9 months (3–31). The mean level of disturbance to daily activities was 0.86 points. The activities most frequently disturbed by treatment included daily personal care (mean, 1.76 points) and sexual activity (mean, 1.20 points). Twenty-one patients required medical intervention because of problems related to the protracted continuous infusion system. The overall level of disturbance was rated at a mean level of 0.72 points, whereas the overall merits of the protracted continuous infusion system and the willingness of the patient to resume protracted continuous infusion in the future were rated at a mean level of 2.90 and 2.55 points, respectively.

Conclusions

The system for the protracted continuous infusion of 5-fluorouracil was well tolerated by the patients, who were able in most cases to perform their daily activities with little or no disturbance, needing only occasional help, and were willing to resume the same treatment modality if necessary.
Integrated Therapeutic Strategies for Anaplastic Thyroid Carcinoma
Authors: Buzzoni Roberto , Catena Laura , Cortinovis Diego , Dognini Giuseppina , Bajetta Emilio
Published: April 2018

Anaplastic thyroid carcinoma (ATC) is a very rare neoplasm with an aggressive course. The prognosis has not changed in the last decades and the median survival does not exceed six months. Only few patients with incidental limited ATC will be cured. Different therapeutic options have been explored but the results are disappointing. At present, new drugs and new timing for proper treatment are under investigation. In this short review we have summarized these recent developments.
RETMEN2A and RETMEN2B Oncoproteins are Targets of PP1 Inhibitor
Authors: Bongarzone Italia , Carniti Cristiana , Perego Carla , Mondellini Piera , Pierotti Marco Alessandro
Published: April 2018

Medullary thyroid carcinoma (MTC) responds very poorly to chemotherapy. Mutations in the RET gene are critical for MTC pathogenesis. RET therefore represents a rational target for the development of novel MTC therapies. The accumulation of evidence from laboratory studies strongly suggests that PP1 inhibitor is a cytostatic agent for cells expressing RET oncoproteins. PP1 functions as a potent and selective inhibitor of RET oncoprotein phosphorylation, promoting its proteasomal degradation.
Laparoscopic Adrenalectomy
Authors: Nicolai Nicola
Published: April 2018

Purpose

We investigated the following issues regarding laparoscopic adrenalectomy: techniques and advantages, indications in adrenal diseases, and the special case of pheochromocytoma.

Methods

Qualified literature reports were reviewed and integrated with results of our initial experience with laparoscopic adrenalectomy.

Results

Most authors prefer a transperitoneal approach, but some (including ourselves) use the retroperitoneal approach. Laparoscopic adrenalectomy is as effective and safe as traditional surgery, but the associated morbidity was found to be much lower in laparoscopic series. The need for conversion to open surgery does not exceed 5% of all cases. Practically all adrenal masses can be managed by laparoscopy. The only clinical situations where laparoscopy is not recommended as first choice are large adrenal masses (>6 cm) and gross cortical carcinoma, which are related conditions. Laparoscopy is also indicated in pheochromocytoma. No mortality and an elevated hypertension cure rate (75–100%) have been reported. Hypertension and plasma volume contraction must be normalized prior to surgery. Special attention should be paid to possible severe blood pressure variations during surgery. Partial adrenalectomy has been recently proposed for bilateral and familial pheochromocytoma in order to avoid lifelong mineral corticoid replacement therapy.

Conclusions

Laparoscopic adrenalectomy currently represents the first surgical choice for adrenal masses. Only large lesions that are suspected to be malignant should not be electively submitted to this procedure. Pheochromocytoma can be safely and effectively treated with laparoscopic surgery; special care for related symptoms is required.
Mesothelioma following Exposure to Asbestos used in Sugar Refineries: Report of Two Cases and Review of the Literature
Authors: Panetta Achille , Geminiani Maria Luisa
Published: April 2018

We report two cases of pleural mesothelioma occurring simultaneously in a sugar refinery worker exposed to asbestos fibers and his wife, who used to wash his working clothes for at least 22 years. A review of the literature is also presented. While demonstrating the carcinogenic risk of asbestos used in sugar refinery plants, our data and those of the literature in no way reflect the real dimension of the risk. Further research will be necessary to assess this risk.
Rapid Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer as a Complication of Treatment with 5-Fluorouracil/Leucoverin and Irinotecan
Authors: Oztop Ilhan , Demirkan Binnaz , Yaren Arzu , Tarhan Oktay , Sengul Bulent , Ulukus Cagnur , Akin Davut , Sen Mehmet , Yilmaz Ugur , Alakavuklar Mehmet
Published: April 2018

Tumor lysis syndrome is a potentially fatal complication of anticancer therapy that is usually seen in patients with bulky, rapidly proliferating, treatment-sensitive tumors such as hematological malignancies, but it rarely occurs in a variety of solid tumors such as colorectal carcinoma. Combination chemotherapy with infusional 5-fluorouracil/leucoverin and irinotecan has been recently accepted as the first treatment option for metastatic colorectal cancer. We present a case of tumor lysis syndrome in a patient with metastatic colon carcinoma that occurred 72 hrs after the initial course of a combination chemotherapy with irinotecan and 5-fluorouracil/leucoverin. Despite the immediate treatment with aggressive hydration by a sodium bicarbonate infusion, followed by forced diuresis and uricolytic therapy, he died of a sudden cardiac arrest complicated by acute renal failure. Our case indicates that administration of 5-fluorouracil/leucoverin and irinotecan for bulky tumors of colorectal origin with a rapid doubling time may induce an acute tumor lysis syndrome, which necessitates frequent laboratory monitoring and a close follow-up of the patient as well as prompt initiation of appropriate therapeutic measures.
Cholestatic Liver Disease with Ductopenia (Vanishing Bile Duct Syndrome) in Hodgkin's Disease: Report of a Case
Authors: Guliter Sefa , Erdem Ozlem , Isik Mine , Yamac Kadri , Uluoglu Omer
Published: April 2018

Liver involvement is common in advanced stages of Hodgkin's disease. However, only a small percentage of patients with Hodgkin's disease develops jaundice due to several causes. Vanishing bile duct syndrome secondary to Hodgkin's disease is a rare cause of cholestasis in these patients. Only 20, cases, to our knowledge, have been reported so far in adults. We report a case of Hodgkin's disease presenting with obstructive jaundice without detectable liver involvement. Liver biopsies revealed intrahepatic cholestasis and ductopenia. Although the patient was given chemotherapy, he died of sepsis and disseminated intravascular coagulation after 24 weeks of admission to hospital.
Evaluation of Sentinel Nodes in the Assessment of Cervical Metastases from Head and Neck Squamous Cell Carcinomas
Authors: Akmansu Halit , Oğuz Haldun , Atasever Tamer , Abamor Evrim , Şafak Mustafa Asım , Haberal İlknur , Samim Erdal
Published: April 2018

Aims and Background

To delineate the lymphatic drainage in head and neck squamous cell carcinoma (SCC) patients by lymphoscintigraphy and to investigate whether the results of histopathological evaluation of sentinel nodes have any diagnostic relevance with regard to the metastatic involvement of all cervical lymph nodes.

Methods

Forty-one patients clinically pre-diagnosed as having primary head and neck SCC underwent Tc-99m nanocolloid lymphoscintigraphy and were evaluated according to the Memorial Sloan Kettering cervical lymph nodes level system. Treatment of 24 of these patients included neck dissection in addition to surgery for the primary tumor.

Results

Among the 24 operated patients nine were found to be pathologically N+. In two (22%) of these nine patients there were histopathological metastases in non-sentinel lymph nodes. In one patient with a metastatic lymph node, no sentinel nodes were identified. Altogether, lymphoscintigraphic sentinel node detection failed in three (33%) cases.

Conclusion

The procedure of lymphoscintigraphic imaging of sentinel lymph nodes and its use in the determination of squamous cell carcinoma metastases is theoretically promising. However, in order to assess the true value of sentinel lymph node imaging and make treatment plans based on this technique, it's necessary to increase the number of cases included in the studies, and obtain results that are specific for the primary tumor and involved lymph nodes.
Post-irradiation Sarcoma after External Beam Radiation Therapy for Localized Adenocarcinoma of the Prostate
Authors: Prevost Jean-Briac , Bossi Alberto , Sciot Ralf , Debiec-Rychter Maria
Published: April 2018

We report a case of postirradiation sarcoma that arose in the right inguinal region 8 years after completion of external beam radiation therapy for a localized adenocarcinoma of the prostate. The patient was treated in 1995 with a “mixed-beams” technique (18 MV photons and 65 MeV fast neutrons). Eight years after the end of treatment, he presented with a radio-induced, high-grade spindle-cell sarcoma. Cytogenetic analysis was performed to confirm the diagnosis. Although the use of external beam radiation therapy for the treatment of prostate cancer has been common practice for decades, postirradiation sarcomas have been reported to be rare sequelae of irradiation and, to our knowledge, only a few of them were cytogenetically investigated.
Concomitant Chemotherapy and External Radiotherapy plus Brachytherapy for Locally Advanced Esophageal Cancer Results of a Retrospective Multicenter Study
Authors: Tessa Maria , Rotta Paolo , Ragona Riccardo , Sola Barbara , Grassini Mario , Nassisi Daniela , Sciacero Piera , Airoldi Mario , Filippi Andrea , Gianello Luca , De Angelis Claudio , Ozzello Franca , Trotti Alessandro Boidi , Ricardi Umberto , Sannazzari Gian Luca
Published: April 2018

Aims and Background

In October 1995, the Piedmont AIRO (Italian Society of Radiation Oncology) Group started a multi-institutional study of radiochemotherapy on locally advanced esophageal cancer, characterized by external radiotherapy followed by an intraluminal high dose-rate brachytherapy boost. Most patients were re-evaluated for surgery at the end of the program. The primary aim of the study was to assess efficacy of curative radiochemotherapy regarding overall survival and local control rates. The secondary aim was to evaluate the ability of radiochemotherapy to make resectable lesions previously considered inoperable.

Methods and Study Design

Between January 1996 and March 2000, 75 patients with locally advanced esophageal cancer were enrolled. All were treated with definitive radiotherapy; due to age or high expected toxicity, chemotherapy was employed only in 53 of them. Treatment schedule consisted of 60 Gy external radiotherapy (180 cGy/d, 5 days/week for 7 weeks) concomitant with two 5-day cycles of chemotherapy with cisplatin and fluorouracil (weeks 1 and 5). One or two sessions of 5-7 Gy intraluminal high dose-rate brachytherapy were carried out on patients whose restaging showed a major tumor response. Surgery was performed in 14 patients.

Results

At the end of radiotherapy, dysphagia disappeared in 46/75 cases (61%), and in 20/75 (27%) a significant symptom reduction was recorded. Complete objective response at restaging after radiotherapy was obtained in 33% of patients and a partial response in 53%. At the end of the multimodal treatment program, including esophagectomy, complete responses were 34 (45%); 4 of 14 (28.5%) cases proved to be disease free (pTO) at pathological examination. No G3-G4 toxicity was recorded. Two- and 5-year overall survival rates of all patients were, respectively, 38% and 28%; 2- and 5-year local control rates were, respectively, 35% and 33%. In a subgroup of 20 nonsurgical patients in complete response after radiochemotherapy, the overall survival rate at 3 and 5 years was 65% and the local control rate at 3 and 5 years was 75%. According to multivariate analysis, prognostic factors for survival were Karnofsky index and esophagectomy.

Conclusions

For patients with locally advanced disease, radiochemotherapy showed improved clinical and pathologic tumor response and survival compared to surgery or radiotherapy alone. Intraluminal brachytherapy with a small fraction size allows an increased dose to the tumor without higher toxicity. Esophagectomy following radiochemotherapy could improve survival rates compared to definitive radiochemotherapy, but it is necessary to optimize selection criteria for surgery at the re-evaluation phase.
Cavernous Hemangioma of the Gallbladder Case Report and Review of the Literature
Authors: Crucitti Antonio , La Greca Antonio , Antinori Armando , Antonacci Vincenzo , Magistrelli Paolo
Published: April 2018

Hemangiomas are common benign tumors; they frequently occur in the liver but very rarely in the gallbladder, with only seven cases reported in the scientific literature to date. We here report an additional patient, a 49-year-old white woman presenting with an echogenic lesion of the gallbladder that was incidentally discovered. Cholecystectomy was performed after computed tomography had revealed a gallbladder neoplasm; pathological examination showed the mass to be a cavernous hemangioma. No postoperative complications occurred and the patient is alive and free of recurrence five years after the operation. We present a review of the literature on this topic with special emphasis on the diagnostic and therapeutic challenges these lesions may entail. Hemangiomas of the gallbladder may have extremely variable presentations (from non-specific abdominal pain to acute syndromes resembling cholangitis or choledocholithiasis) and can mimic different lesions (liver tumors, sarcoma). Only surgical exploration can provide a correct diagnosis. Excision is indicated as these lesions may grow to huge sizes, compress adjacent structures or bleed.

Conclusions

Gallbladder hemangiomas are uncommon benign tumors. A preoperative diagnosis is difficult to make. Surgical excision is mandatory both in reaching a final diagnosis and in preventing bleeding or compression of vital structures.
Safety of Epirubicin Adjuvant Chemotherapy in a Breast Cancer Patient with Chronic Renal Failure Undergoing Hemodialytic Treatment
Authors: Gori Stefania , Rulli Antonio , Mosconi Anna Maria , Sidoni Angelo , Colozza Mariantonietta , Crinò Lucio
Published: April 2018

Anthracycline-based adjuvant chemotherapy is very effective in early breast cancer, but there are limited data on the use of epirubicin in patients with chronic renal failure undergoing hemodialytic treatment. We report the case of a patient with early breast cancer and chronic renal failure who was treated with adjuvant weekly epirubicin. Treatment was well tolerated. The patient is still alive and relapse free 58 months after surgery. If the patient will be disease free after 5 years, she will be reconsidered for renal transplantation. In conclusion, weekly epirubicin appears to be a safe adjuvant chemotherapy option for early breast cancer patients with chronic renal failure undergoing hemodialytic treatment.