bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Stromal Tumor Consistent with Fibrosarcoma Arising from Meckel's Diverticulum. Clinicopathological Study of an Incidentally Discovered Tumor and Review of the Literature
Authors: Calderale Stefano Massimiliano , Marchioni Luisa , Malizia Alberto , Riminucci Mara , Corsi Alessandro
Published: April 2018

The authors report a case of a Meckel's diverticulum mesenchymal tumor incidentally discovered in a 69-year-old woman undergoing laparotomy for an ovarian cyst. Histological examination of the tumor revealed a fasciculated proliferation of spindle cells that proved to be immunoreactive to vimentin only; pleomorphism was mild, necrosis extensive and mitotic count high. Because these features were consistent with those of fibrosarcoma, the tumor was classified in the category of gastrointestinal stromal tumors; more specifically, it was considered malignant for the presence of spread beyond the primary site in the form of peritoneal nodules and for the high mitotic count. We have been able to find only one previously reported case of mesenchymal malignant tumor of Meckel's diverticulum classified as fibrosarcoma among the 199 malignant tumors described in the literature. Based on this personal experience and on the review of the literature concerning malignant tumors of Meckel's diverticulum, we discuss both the rarity of these tumors and the importance of removing Meckel's diverticulum every time it is found during laparotomy.
Increased C-MYC Oncogene Expression in Ewing's Sarcoma: Correlation with Ki67 Proliferation Index
Authors: Sollazzo Maria Rosa , Benassi Maria Serena , Magagnoli Giovanna , Gamberi Gabriella , Molendini Lara , Ragazzini Paola , Merli Mara , Ferrari Cristina , Balladelli Alba , Picci Piero
Published: April 2018

Aims and Background

Ewing's sarcoma is a highly malignant musculoskeletal tumor composed of small round cells. Although important results have been achieved with surgery associated with chemotherapy, recurrent disease is still a major problem. In order to define new prognostic factors useful for therapeutic decision-making, we conducted a study on 38 Ewing's sarcoma samples in which c-myc oncogene expression and Ki67 proliferation index were correlated with clinical outcome.

Methods and Study Design

Nineteen patients developed metastases during follow-up and 10 of these patients died. C-myc and Ki67 protein expression was evaluated by immunohistochemistry performed on 5 μm formalin-fixed and paraffin-embedded sections, while the c-myc mRNA transcript was localized using in situ hybridization.

Results

A statistically positive correlation was found between c-myc protein and Ki67 (P = 0.001) and c-myc mRNA and Ki67 expression (P = 0.047). The 38 patients were divided into two groups using as the cutoff 50% of Ki67-positive cells. The disease-free survival and overall survival estimates were 68% and 90%, respectively, in the group of patients with a percentage of Ki67-positive cells <50%, and 25% and 50%, respectively, in the group with a percentage of Ki67-positive cells ≥50%. The difference between the survival curves was statistically significant (P <0.05 and P <0.01). Furthermore, relapsed patients had a high and uniform expression of c-myc protein and mRNA compared to disease-free patients.

Conclusion

These results suggest a possible role of the c-myc oncogene and Ki67 antigen in the malignant progression of Ewing's sarcoma.
Combined Malignant Hemangiopericytoma and Deep Venous Thrombosis. A Case Report
Authors: Campanella Nando , Ferretti Maurizio , Daher Walid , Pergolini Martina , De Nictolis Michele
Published: April 2018

Malignancies, antiproliferative drug treatment, cancer-related conditions like immobilization, perioperative status and radiotherapy are risk factors for hypercoagulability. Setting aside mass or invasion-related venous thrombosis, the differential diagnosis regarding the etiopathogenesis (paraneoplastic syndrome or antiproliferative treatment) is usually problematic. The authors report a case of combined malignant hemangiopericytoma and recurrent deep venous thrombosis in the right inferior limb.

Through a literature review, the following issues are discussed: 1) the criteria for cyto-histopathologic assessment; 2) the involvement of pericytes both in coagulation and platelet aggregation; 3) the importance of discriminating true paraneoplastic syndromes from other tumor-related clinical manifestations; 4) the response to external radiotherapy of malignant hemangiopericytoma as limited disease; 5) the poor results of doxorubicin-ifosfamide polychemotherapy and dacarbazine monochemotherapy in metastatic disease.

Although doxorubicin-ifosfamide treatment was in progress in the reported case, the authors conclude that the recurrent deep venous thrombosis is likely to be paraneoplastic, even if such a diagnosis has not been previously reported in the literature.
A Phase I-II Trial of High-dose Ifosfamide in Patients with Ovarian Cancer Refractory or Resistant to Platinum and/or Paclitaxel-containing Chemotherapy
Authors: Scarfone Giovanna , Villa Antonella , Parazzini Fabio , Sciatta Cesarina , Polverino Giampiero , Bolis Giorgio
Published: April 2018

Aims and Background

To evaluate the toxicity of high-dose ifosfamide in ovarian cancer patients refractory or resistant to platinum and/or paclitaxel-containing chemotherapy.

Methods

This was an open, non-randomized phase I-II trial of high-dose ifosfamide. Eligibility criteria were: patients aged 18-75 years affected by ovarian cancer with refractory or resistant disease or early relapse after first-line treatment including platinum or paclitaxel. Three patients were given escalating ifosfamide doses; if no severe adverse events occurred, the ifosfamide dose was increased. The starting dose of ifosfamide was 10 g/m2 iv and the dose increase was 1 g/m2 every four weeks for a total of five courses; 12 g/m2 was the maximum ifosfamide dose to be administered. The trial then progressed to a phase II trial, in which ifosfamide was given at the maximum tolerated dose reached during the escalating dose phase.

Results

A total of 36 patients entered the trial. Nine patients were involved in phase I of the study; 3 received 10 g/m2 ifosfamide, 3 11 g/m2 and 3 12 g/m2. Of the 32 evaluable patients 6 (18.8%) achieved a complete response and three (9.4%) a partial response, giving an overall response rate of 28.1% (95% CI, 15-61% based on Poisson's approximation). The median number of ifosfamide courses was five. G1, G2 and G3 neurotoxicity was reported in 3 (8%), 2 (5%) and 2 (5%) patients, respectively.

Conclusion

This phase I-II trial indicates that high-dose ifosfamide has some activity but also a relevant degree of toxicity in resistant or refractory platinum and paclitaxel-pretreated ovarian cancer.
Treatment of Inoperable Non-small Cell Lung Carcinoma Stage IIIB and IV with Cisplatin, Epidoxorubicin, Vindesine and Lonidamine: A Phase II Study
Authors: Portatone Luigi , Lombardi Alessandra , Antilli Antonio , Cruciani Anna Rita , Magliacani Vinicio , Mugnaini Luigi , Nunziati Francesco , Perrone Nicola , Signora Mauro , Salvati Franco
Published: April 2018

Aims and Background

The polychemotherapeutic regimen PEV (cisplatin, epidoxorubicin and vindesine) + lonidamine proved to be valid in terms of activity and efficacy in the treatment of patients with advanced, previously untreated non-small cell lung carcinoma. The goal of the study was to verify whether a different dose of lonidamine, together with an increase in cisplatin and epidoxorubicin compared to the standard regimen, is able to improve the activity and efficacy of PEV without increasing toxicity.

Patients and Methods

Thirty-one patients were treated with cisplatin (80 mg/m2/iv), epidoxorubicin (70 mg/m2/iv) and vindesine (3 mg/m2/iv) every 28 days for 6 courses in combination with lonidamine (600 mg/day on days 1 and 2 of each course followed by 450 mg/day until progression of disease or intolerance). All the patients were monitored for clinical response, median duration of response and survival and for toxicity.

Results

The clinical response in the 29 assessable patients was: 41.4% partial remission, 48.3% stable disease, and 10.3% progression of disease. The median duration of response was 8.5 months (range, 4-26+) and median survival was 12 months (range, 4-26+). Survival was above the median in 15 stage lIIb patients, and 2 patients were long survivors at 26+ months. The toxicity of PEV + lonidamine was mild; there were no toxic deaths nor acute toxicity of grade 4 according to the WHO scoring system.

Conclusions

Our polychemotherapeutic regimen proved to be valid in terms of activity and efficacy, and a further dose increase in single chemotherapeutic agents as well as lonidamine could therefore be justified.
Efficacy of Total Androgen Blockade in Metastatic Prostatic Carcinoma with Transient Hypogonadotropic Hypogonadism: A Case Report
Authors: Lo Re Giovanni , Buonadonna Angela , Duati Mario , Colussi Anna Maria , Canzonieri Vincenzo , Frustaci Sergio , Morassut Sandro , Cimitan Marino , Tumolo Salvatore
Published: April 2018

A patient affected by metastatic prostatic carcinoma and hypogonadotropic hypogonadism (HH) was treated with flutamide 750 mg/day plus an LH-RH analog. After confirmation of basal castration during treatment, he continued with antiandrogens alone. Following the normalization of gonadic function and subjective mild bone flare-up, the patient resumed the initial treatment and obtained a partial response. When flutamide was interrupted because of liver toxicity, the patient showed progressive disease in the bone, which was unresponsive to both flutamide resumption and salvage hormone therapy (bicalutamide). The patient is currently receiving chemotherapy with VP16 and estramustine phosphate and is showing both serologic (PSA) and symptomatic response. The interest of this case lies in the incidental detection of HH during therapy and in the responsiveness to treatment.
Spontaneous Hemorrhage of a Liver Metastasis from Squamous Cell Cervical Carcinoma: Case Report and Review of the Literature
Authors: La Fianza Alfredo , Alberici Elisa , Biasina Alberto Magenta , Preda Lorenzo , Tateo Saverio , Campani Rodolfo
Published: April 2018

Liver metastases are an uncommon cause of spontaneous bleeding compared with primary benign/malignant liver lesions. Since metastatic lesions tend to maintain the vascular characteristics of the primary tumor, some metastases have a greater proclivity for hemorrhage into the host organ than others. We describe the clinical and computed tomography (CT) features of a patient previously treated for nonkeratinizing small cell squamous carcinoma of the cervix uteri. As the metastatic rupture was diagnosed while still intraparenchymal and subcapsular, with minimal peritoneal reaction, the patient's outcome was favorable.
The Prevalence of Tumors of the Breast and Female Genital Tract in Italy
Authors: Sant Milena , Barchielli Alessandro , Francisci Silvia , Canario Francesca
Published: April 2018

Data from 10 Italian population-based cancer registries were used to estimate the prevalence of female tumors of the breast and genital tract. The total prevalence, expressed in number per 100,000, was highest for breast cancer (1,117), followed by cancer of the corpus (264) and cervix uteri (146), ovary (110), and vagina and vulva (23). For all tumors the prevalence increased with age at diagnosis.

The cancer prevalence was divided into intervals from diagnosis, expressing different health needs in terms of therapy and intensity of clinical follow-up. For all tumors considered, 1-year prevalence was higher than 1-2-year prevalence, reflecting a high death risk due to perioperative mortality and to the proportion of patients diagnosed at advanced stages. The prevalence decreased in the following intervals considered.

Noticeable geographic variability was observed in the prevalence across Italy, with higher proportions being registered in the northern-central regions than in the South. The two extreme 0-5-year prevalence figures (per 100,000) were: for breast cancer 568 (Genova) and 259 (Ragusa); for corpus uteri cancer 94 (Romagna) and 21 (Latina); for cervix uteri cancer 63 (Romagna) and 26 (Latina); for ovarian cancer 49 (Parma) and 21 (Latina); for cancer of the vagina and vulva 17 (Genova) and 5 (Ragusa). This variability depends mainly on incidence and on the proportion of elderly in the general population.

From 1987 to 1992 there was an increase in the prevalence of tumors of the breast, ovary and vagina and vulva, especially in the elderly. The prevalence of corpus uteri cancer decreased slightly in the elderly only, whereas that of cervix uteri cancer decreased at all ages.
The Prevalence of Cancer: A Review of the Available Data
Authors: Zanetti Roberto , Micheli Andrea , Rosso Stefano , Sant Milena
Published: April 2018

Aims and Background

Cancer prevalence in a population, defined as the proportion – or the number – of people who were diagnosed with a cancer during their lives and are still alive at a given date, is a crucial indicator for heath care planning and resource allocation. Long-term population-based cancer registries (CR) are the appropriate tools to produce prevalence figures, which, however, are scarcely available. This paper contains a review up to 1999 of the published data world-wide (reports and articles) on cancer prevalence: including measured and estimated figures.

Materials and Methods

Data on cancer prevalence from CRs are available for the Nordic countries, Connecticut, and Italy. In addition, electronic data are available for the European Union (EU). Data for the Nordic countries were first published in the mid-seventies, reporting the prevalence for 1970. The first data from Connecticut were available 10 years later. Estimates for all EU countries were published by the International Agency for Research on Cancer (IARC) in 1997. In Italy, observed and estimated data on the prevalence of respiratory and digestive tract cancer and breast cancer have been published during the nineties, followed by a systematic analysis for all cancers in 1999. By using information obtained from CRs, cancer prevalence data were calculated directly (observed prevalence) by means of incidence and follow-up information on individual cancer patients, or indirectly (estimated prevalence) by means of mathematical models, which generally use epidemiological information at the aggregate level.

Results

Cancer prevalence for all cancers combined (proportions per 100,000 inhabitants) showed values of less than 700 in males and less than 800 in females in 1970 (Finland) to over 2,300 in males and over 3,000 in females in 1992 (Italian registries). With few exceptions, in each country and period considered the cancer sites contributing most to cancer prevalence are lung, colon-rectum, prostate and bladder in males, colon-rectum, breast, uterus (both cervix and corpus) and ovary in females. At present, comparison of measurements from different areas is difficult because there exists no standardized mode of presentation.

Conclusions

In spite of their being potentially useful for health care planning, prevalence data have been produced inconsistently and late by cancer registries, at least in comparison with the systematic availability of incidence and survival statistics. The available data can be compared only to a limited extent due to differences in completeness, in the choice of indicators, in the standard populations, and in the frequency of publication. It would be desirable that in the future data will be produced systematically, with a higher level of standardization compared to the past, and, most importantly, on the same geographic and administrative scale as health-care decision-making.
Breast Cancer in Elderly Women (≥70 Years): Which Treatment?
Authors: Martelli Gabriele , De Palo Giuseppe
Published: April 2018

Breast cancer is a disease that affects women >70 years of age much more frequently than other age groups. Epidemiologic data show that more than 40% of breast cancers occur in the elderly. The optimal primary treatment for elderly patients with breast cancer is controversial and ranges from tamoxifen as sole therapy to surgery. Despite the high prevalence of the disease, the elderly have been excluded from clinical trials mainly for the presence of concurrent medical conditions that adversely affect treatment strategies. Since life expectancy continues to increase in western countries, an appropriate treatment that respects quality of life needs to be determined for the elderly age group. In the light of randomised and retrospective studies carried out to date, limited surgery without axillary dissection plus adjuvant tamoxifen seems to achieve, mainly for elderly patients with early stage breast cancer, a local-regional control rate comparable to that obtained with more aggressive therapeutic strategies. The results of ongoing prospective clinical trials will show whether or not conservative surgery without axillary clearance and tamoxifen may be routinely used for elderly patients with early breast cancer.
Sentinel Lymph Node Mapping and Biopsy for Breast Cancer: A Review of the Literature Relative to 4791 Procedures
Authors: Sandrucci Sergio , Casalegno Paola Sorba , Percivale Pierluigi , Mistrangelo Marinella , Bombardieri Emilio , Bertoglio Sergio
Published: April 2018

The status of axillary nodes is the most important prognostic factor in breast cancer to select patient subgroups for adjuvant chemotherapy; the current standard of care for surgical management of invasive breast cancer is complete removal of the tumor by either mastectomy or lumpectomy followed by axillary lymph node dissection (ALND). The recent introduction of intraoperative lymphatic mapping and sentinel lymph node biopsy (SLND) represents a major new opportunity for appropriate and less invasive surgical management of many tumors. There is an almost uniformly enthusiasm concerning the potential of this technique in breast carcinoma management, shown by published data. A peculiar attention to the so-called “sentinel node debate” in breast cancer surgery is a constant in the last years issues of the major medical journals. Even patients have become more aware about medical enthusiasm and their request of concise information on the topic and the possibilities of this approach is an increasing reality in medical practice.

The aim of this paper is to review recent literature to offer an overview about the main controversial methodological aspects and a wide analysis of reported results. The most significative international literature papers from Medline were retrieved from 1993 to September 1999, and 4782 procedures were analysed. This extensive review of the literature has confirmed accuracy, feasibility and reliability of the SN detecting technique in axillary mapping. Provided a good proficiency in SN localisation and pathological evaluation, human resources and efforts should be mainly focused on its clinical validation as an alternative to ALND instead of on further phase I–-II clinical studies.
Intrahepatic Chemotherapy with Floxuridine, Leucovorin and Dexamethasone in Continuous Infusion and Mitomycin-c Bolus in Unresectable Hepatic Metastases from Colorectal Cancer: A Phase II Study
Authors: Bertuccelli Maurizio , Falcone Alfredo , Campoccia Silvana , Conti Monica , Brunetti Isa , Caramella Davide , Giulianotti PierCristoforo , Mosca Franco , Bartolozzi Carlo , Conte PierFranco
Published: April 2018

Background

Intrahepatic continuous infusion FUDR induces a 50% response rate in patients with hepatic metastases from colorectal cancer. Lower rates have been observed in pretreated patients. The combination of floxuridine plus leucovorin has obtained over 70% responses, with high hepatic toxicity. The use of dexamethasone can decrease hepatic toxicity. A randomized study reported an increase in response rate and a decrease in hepatic toxicity in a group of patients treated with floxuridine plus dexamethasone compared to a group receiving only floxuridine. Moreover, the combination of mitomycin C, carmustine and floxuridine is also effective in pretreated patients.

Methods

On such premises, since July 1993 we have treated 39 patients affected by unresectable hepatic metastases from colon carcinoma (26 patients) and rectal carcinoma (13 patients) with the combination continuous infusion of floxuridine (0.20 mg/kg per day) + leucovorin (7.5 mg/m2/day) + dexamethasone (20 mg on days 1 to 14) and bolus mitomycin C (10 mg/m2 on day 1) via the hepatic artery. Cycles were administered every four weeks. There were as 28 males and 11 females, with a median age of 64 years (range, 39-75) and a median PS = 0. Twenty-two patients were pretreated with systemic chemotherapy including 5-fluorouracil plus leucovorin. Total number of cycles was 189, with a median of 6 cycles per patient (range, 1-12).

Results

Of 39 patients 37 were assessable for response (2 patients were not assessable because they stopped chemotherapy for occlusion of the catheter after the first cycle). There were 3 complete responses (1 in a naive patient and 2 in pretreated patients), 16 partial responses (11 in pretreated patients and 5 in chemonaive patients), 4 minor responses, 4 stable disease and 10 progressive disease. The overall response rate was 51.3% (95 CI, 51.3-86.7%). Median time to progression was 6 months (range, 1-34+). Overall survival was 18 months (range, 1-34+). Of 39 patients, 36 were assessable for toxicity (WHO) (3 patients died after the first cycle for progression of disease): diarrhea and nausea-vomiting grade 3-4 occurred respectively in 15 (41%) and 3 patients (8%); hepatic toxicity was mild.

Conclusions

The treatment we used showed an elevated activity in liver metastases from colorectal cancer even in patients pretreated and resistant to systemic chemotherapy, although toxicity grade 3-4 diarrhea occurred in approximately 40% of the patients.
Subclinical Ductal Carcinoma in Situ of the Breast: Treatment with Conservative Surgery and Radiotherapy
Authors: Amichetti Maurizio , Caffo Orazio , Richetti Antonella , Zini Giampaolo , Rigon Alberto , Antonello Michele , Roncadin Mario , Coghetto Francesca , Valdagni Riccardo , Fasan Stefano , Maluta Sergio , Di Marco Adriano , Neri Stefano , Vidali Cristiana , Panizzoni Gino , Aristei Cynthia
Published: April 2018

Aims and Background

In spite of the fact that ductal carcinoma in situ (DCIS) of the breast is a frequently encountered clinical problem, there is no consensus about the optimal treatment of clinically occult (i.e., mammographic presentation only) DCIS. Interest in breast conservation therapy has recently increased. Few data are available in Italy on the conservative treatment with surgery and adjuvant postoperative radiotherapy.

Methods

A retrospective multi-institutional study was performed in 15 Radiation Oncology Departments in northern Italy involving 112 women with subclinical DCIS of the breast treated between 1982 and 1993. Age of the patients ranged between 32 and 72 years (median, 50 years). All of them underwent conservative surgery: quadrantectomy in 89, tumorectomy in 11, and wide excision in 12 cases. The most common histologic subtype was comedocarcinoma (37%). The median pathologic size was 10 mm (range 1 to 55 mm). Axillary dissection was performed in 83 cases: all the patients were node negative. All the patients received adjunctive radiation therapy with 60Co units (77%) or 6 MV linear accelerators (23%) for a median total dose to the entire breast of 50 Gy (mean, 49.48 Gy; range, 45-60 Gy). Seventy-six cases (68%) received a boost to the tumor bed at a dose of 8-20 Gy (median 10 Gy) for a minimum tumor dose of 58 Gy.

Results

At a median follow-up of 66 months, 8 local recurrences were observed, 4 intraductal and 4 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease at this writing. The 10-year actuarial overall, cause-specific, and recurrence-free survival was of 98.8%, 100%, and 91%, respectively.

Conclusions

The retrospective multicentric study, with a local control rate of more than 90% at 10 years with 100% cause-specific survival, showed that conservative surgery and adjuvant radiation therapy is a safe and efficacious treatment for patients with occult, non-palpable DCIS.
Endocrinological Study of the Dopaminergic Regulation of Prolactin Release in Metastatic Breast Cancer
Authors: Mandalà Mario , Lissoni Paolo , Ardizzoia Antonio , Barni Sandro , Rovelli Franco , Confalonieri Giorgio , Malugani Fabio , Moro Cecilia , Fumagalli Gabriele , Giani Luisa , Tancini Gabriele
Published: April 2018

Aims and Background

Prolactin (PRL) may be a growth factor for breast cancer. Abnormally high levels of PRL have been proven to be associated with a poor prognosis in metastatic breast cancer. However, most studies have been limited to the evaluation of basal levels of PRL rather than its response to the classical endocrine dynamic tests. This study was performed to analyse the dynamic secretion of PRL under stimulatory and inhibitory tests in metastatic breast cancer.

Methods

The study included 10 untreated metastatic breast cancer women, who were evaluated after the classical stimulatory and inhibitory tests for PRL secretion with the antidopaminergic agent Metoclopramide (10 mg iv as a bolus) and with L-dopa, respectively. Serum levels of PRL were measured by RIA before and at subsequent intervals after drug administration. PRL levels were considered to be elevated when they were higher than 25 ng/ml.

Results

Abnormally high basal levels of PRL were seen in 6/10 patients. L-dopa was unable to inhibit PRL secretion, whose mean concentrations paradoxically significantly increased in response to L-dopa, with values comparable to those observed after the classical stimulatory test with metoclopramide.

Conclusions

This study confirm the existence of hyperprolactinemia associated with metastatic breast cancer. In addition, by showing a paradoxical rise of PRL in response to L-dopa, which inhibits PRL secretion in physiological conditions, this study would suggest that breast cancer-related hyperprolactinemia may depend at least in part on endogenous disease-related neuroendocrine alterations.
Uterine Tumors Resembling Ovarian Sex Cord Tumors in Four Baboons (Papio spp.)
Authors: Mangosing Sara , Perminov Ekaterina , Gonzalez Olga , Barkei Erica K. , Corbin Emily M. , Kumar Shyamesh , Dick Edward J.
Published: April 2018

Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are rare uterine neoplasms that exhibit prominent sex cord-like differentiation. The authors describe 4 cases of UTROSCTs that were identified as incidental lesions in female baboons. All baboons were in good body condition. One animal had a 2-mm-diameter yellow-tan mass in the uterine body along the attachment of the left broad ligament; the other 3 did not have any gross lesions in the uterus. Histologically, the myometrium contained multifocal well-demarcated neoplasms composed of cuboidal to columnar cells arranged in variable arrangements of sheets, nests, cords, trabecular, and retiform patterns that occasionally formed Call-Exner-like bodies. In all cases, the neoplastic cells were diffusely positive for WT-1 and negative for calretinin, CD99, and desmin. One case was positive for inhibin and CD10. To the best of the authors’ knowledge, this is the first report of UTROSCTs in nonhuman primates and in the veterinary literature.
Lymphocytic Mural Folliculitis Resembling Epitheliotropic Lymphoma in Tigers (Panthera tigris)
Authors: Sula Mee-Ja M. , Frank Linda A. , Ramsay Edward C.
Published: April 2018

A striking form of lymphocytic mural folliculitis is described in 6 tigers ( Panthera tigris). Clinically, all tigers exhibited regionally extensive chronic, variably waxing and waning alopecia with minimal scaling and crusting most pronounced over the head, neck, and shoulders. More severely affected tigers exhibited marked hyperpigmentation and lichenification. Pruritus was not a feature. Tigers generally lacked signs of systemic illness and clinical pathology findings were unremarkable. Histologic examination of skin biopsies revealed infiltrative lymphocytic mural folliculitis extending the length of the hair follicle. Mild epidermal lymphocytic infiltrates were frequent. The surrounding dermis was histologically unremarkable in 4 of 6 tigers or associated with mild perifollicular and periadnexal mixed inflammation in 2 of 6 tigers. The cause of the mural folliculitis was not identified, and tigers responded poorly to immunomodulatory therapy. Lymphocytic mural folliculitis might be a nonspecific hypersensitivity reaction pattern in tigers, and care should be taken to differentiate this reaction pattern from epitheliotropic T-cell lymphoma.
The affective economy of transnational surrogacy
Authors: Schurr Carolin , Militz Elisabeth
Published: April 2018

The booming business of global surrogacy has come to a halt: one surrogacy hub after the other has started to regulate the incremental flow of intended parents to the Global South hoping to fulfill their desire for a baby with the help of a foreign surrogate laborer. Thailand and Nepal have banned surrogacy altogether; India and Mexico insist on the altruistic nature of their surrogacy arrangements. As the drive for altruistic surrogacy suggests, the baby holds an exceptional position in many societies: ideas about the ‘unique’ maternal bond create public unease about the commercialization of babies in surrogacy markets. Drawing on economic sociology and theories of affect, this paper argues that multiple processes of affective attachment, detachment and reattachment shape transnational surrogacy journeys. Based on ethnographic fieldwork in Mexico’s surrogacy industry, the paper studies processes of commodification and decommodification in three instances of market-making: (1) the assignment of value and a price to reproductive laborers’ bodies on the basis of affective postcolonial geographies of beauty; (2) the affective/effective organization of the market encounter through contracts and communication rules and (3) the detachment of the final ‘good’ of the baby from the surrogate laborer. Transnational surrogacy arrangements, the paper concludes, are always forms of partial commodification – no matter whether they are framed as altruistic or commercial – because processes of affective/effective attachment and detachment are fundamental for delineating the intimate boundaries of families that come into life with the assistance of the globally operating surrogacy industry.
When migraine mimics stroke: A systematic review
Authors: Terrin Alberto , Toldo Giulia , Ermani Mario , Mainardi Federico , Maggioni Ferdinando
Published: April 2018

Background

Migraine with aura may mimic an acute ischemic stroke, so that an improper administration of thrombolytic treatment can expose migrainous patients to severe adverse effects.

Methods

This systematic review quantifies the relevance of migraine with aura among stroke mimics, checking for thrombolysis’ safety in these patients. We reviewed the literature after 1995, distinguishing from studies dealing with stroke mimics treated with systemic thrombolysis and those who were not treated with systemic thrombolysis.

Results

Migraine with aura is responsible for 1.79% (CI 95% 0.82–3.79%) of all the emergency Stroke Unit evaluations and it represents 12.24% (CI 95% 6.34–22.31%) of stroke mimics in the group not treated with systemic thrombolysis. 6.65% (CI 95% 4.32–9.78%) of systemic thrombolysis administrations are performed in patients without an acute ischemic stroke. Migraine with aura is responsible for 17.91% of these (CI 95% 13.29–23.71%). The reported rate of adverse events seems extremely low (0.01%).

Conclusion

Migraine with aura is the third most common stroke mimic, following seizures and psychiatric disorders; it is responsible for about 18% of all improper thrombolytic treatments. Despite the absence of strong supporting data, thrombolysis in migraine with aura seems to be a procedure with an extremely low risk of adverse events.
Understanding Elementary Students’ Use of Digital Textbooks on Mobile Devices: A Structural Equation Modeling Approach
Authors: Wang Xianhui , Xing Wanli
Published: April 2018

The purpose of this study is to design a structural model explaining how elementary students use digital textbooks on mobile devices. This study extends the technology acceptance model framework, with self-efficacy, learning motivation, learning strategies, and parent education level as external variables. Results show that perceived usefulness was a significant mediating factor for students’ actual usage of digital textbook on mobile devices. Self-efficacy and learning strategies influence self-reported actual usage through perceived usefulness and perceived ease of use. In addition, parent education level has a significant influence on students’ self-efficacy and especially learning motivation. These findings have broadened research on technology acceptance with emphasis on a more learning-centered framework that focuses on the learners’ characteristics and their unique contexts when using digital textbooks via mobile devices.
High-Fidelity Simulation of Pediatric Emergency Care: An Eye-Opening Experience for Baccalaureate Nursing Students
Authors: Small Sandra P. , Colbourne Peggy A. , Murray Cynthia L.
Published: April 2018

Background

Little attention has been given to in-depth examination of what high-fidelity simulation is like for nursing students within the context of a pediatric emergency, such as a cardiopulmonary arrest. It is possible that such high-fidelity simulation could provoke in nursing students intense psychological reactions.

Purpose

The purpose of this study was to learn about baccalaureate nursing students’ lived experience of high-fidelity simulation of pediatric cardiopulmonary arrest.

Method

Phenomenological methods were used. Twenty-four interviews were conducted with 12 students and were analyzed for themes.

Results

The essence of the experience is that it was eye-opening. The students found the simulation to be a surprisingly realistic nursing experience as reflected in their perceiving the manikin as a real patient, thinking that they were saving their patient’s life, feeling like a real nurse, and feeling relief after mounting stress. It was a surprisingly valuable learning experience in that the students had an increased awareness of the art and science of nursing and increased understanding of the importance of teamwork and were feeling more prepared for clinical practice and wanting more simulation experiences.

Conclusion

Educators should capitalize on the benefits of high-fidelity simulation as a pedagogy, while endeavoring to provide psychologically safe learning.
Calcitonin Stewardship Strategies
Authors: Allison Steven L. , Davis Kevin W.
Published: April 2018

Despite being approved by the Food and Drug Administration for over 30 years, calcitonin salmon has seen a dramatic increase in acquisition cost over the last few years. Being commonly used for the treatment of hypercalcemia of malignancy, health systems must implement stewardship strategies in order to curtail usage. This review is intended to provide a background on calcitonin usage for hypercalcemia of malignancy and associated strategies to ensure appropriateness of utilization within health systems.
Multi-objective design optimization of power-cycling hydrodynamic mechanical transmissions
Authors: Liu Xiaojun , Sun Dongye , Qin Datong , Liu Junlong
Published: April 2018

The power-cycling hydrodynamic mechanical transmissions have the advantages of continuously adjustable speed ratio and high efficiency compared with the traditional automatic transmissions, so they may be a good substitute for the prior art. For off-highway vehicles which frequently work in low speed and confront great resistance, the zero-speed-ratio torque ratio (TR) of the power-cycling hydrodynamic mechanical transmissions represents the power performance of the vehicles. Furthermore, the complexity of the transmissions is an indispensable consideration for industrial designers. The radial and axial dimensions of the power-cycling hydrodynamic mechanical transmissions are determined by the effective diameter of the torque converter’s circuit and the number of transmissions gears, respectively. In order to optimize the zero-speed-ratio TR and the complexity of the power-cycling hydrodynamic mechanical transmissions, a design methodology is proposed. Considering that there is no explicit mathematical relationship between the design variables and the multi-objective functions, the parametric design and numerical simulation for the torque converter are carried out. The intrinsic mapping between the design variables and the multi-objective functions is fitted by the radial basis function neural network. On this basis, the fast and elitist non-dominated sorting genetic algorithm (NSGA-ΙΙ) is used to solve the multi-objective optimization problem. The numerical simulation for one group of solution selected from the Pareto optimal solutions is conducted. The simulation results indicate that the design methodology proposed in this study is effective. The optimal results show that the zero-speed-ratio TR of the power-cycling hydrodynamic mechanical transmissions is heavily influenced by the radial and axial space of such transmissions. The design optimization helps to find the optimal solutions for the power-cycling HMTs, which are superior to the traditional automatic transmissions and match well the prime mover.
New directions in computational, combinational and structural creativity
Authors: Garvey Bruce , Chen Liuqing , Shi Feng , Han Ji , Childs Peter RN
Published: April 2018

This paper examines how new and creative relationships in datasets, not easily revealed by conventional information retrieval methods and technologies, can be identified using a mix of established and new methods. The authors present how the integration of computerised morphological analysis with new computational models, incorporating web crawler, data processing networking and data mining algorithms, can help facilitate the identification of new ideas. Boden’s concept of ‘Combinational Creativity’ indicates a structured process, which generates unfamiliar combinations of familiar concepts and constructs allowing creative styles of thought. This structured approach has been constrained by the resultant combinatorial explosion and the dearth of easily accessible computer software and supporting methodologies, to help identify viable new solutions. Feature-enhanced computerised morphological analysis provides a new structural support tool for creativity and innovation. Morphological analysis systematically structures and examines all the possible relationships in a multidimensional, highly complex, usually non-quantifiable problem space. Computerisation of the process now permits large number of configurations (millions) in the problem space to be majorly reduced (typically > 95%), identifying only internally consistent solutions. These solutions are likely to embrace configurations containing something, which has not previously been considered, thus increasing the probability of some form of technological or design breakthrough and hence truly creative.
Cyclin-dependent kinase 1 targeting improves sensitivity to radiation in BRAF V600E colorectal carcinoma cells
Authors: Spagnoletti Girolamo , Li Bergolis Valeria , Piscazzi Annamaria , Giannelli Francesca , Condelli Valentina , Sisinni Lorenza , Bove Giuseppe , Storto Giovanni , Landriscina Matteo
Published: April 2018

Objectives:

Preoperative chemoradiation is currently the standard of care in locally advanced rectal carcinoma, even though a subset of rectal tumors does not achieve major clinically meaningful responses upon neoadjuvant chemoradiation. At present, no molecular biomarkers are available to predict response to neoadjuvant chemoradiation and select resistant tumors willing more intense therapeutic strategies. Thus, BRAF mutational status was investigated for its role in favoring resistance to radiation in colorectal carcinoma cell lines and cyclin-dependent kinase 1 as a target to improve radiosensitivity in BRAF V600E colorectal tumor cells.

Methods:

Colony-forming assay and apoptotic rates were evaluated to compare the sensitivity of different colon carcinoma cell lines to ionizing radiation and their radiosensitivity upon exposure to BRAF and/or cyclin-dependent kinase 1 inhibitory/silencing strategies. Cyclin-dependent kinase 1 expression/subcellular distribution was studied by immunoblot analysis.

Results:

Colon carcinoma BRAF V600E HT29 cells exhibited poor response to radiation compared to BRAF wild-type COLO320 and HCT116 cells. Interestingly, neither radiosensitizing doses of 5-fluoruracil nor BRAF inhibition/silencing significantly improved radiosensitivity in HT29 cells. Of note, poor response to radiation correlated with upregulation/relocation of cyclin-dependent kinase 1 in mitochondria. Consistently, cyclin-dependent kinase 1 inhibition/silencing as well as its targeting, through inhibition of HSP90 quality control pathway, significantly inhibited the clonogenic ability and increased apoptotic rates in HT29 cells upon exposure to radiation.

Conclusion:

These data suggest that BRAF V600E colorectal carcinoma cells are poorly responsive to radiation, and cyclin-dependent kinase 1 represents a target to improve radiosensitivity in BRAF V600E colorectal tumor cells.
Trauma-Informed Care and LGBTQ Youth: Considerations for Advancing Practice With Youth With Trauma Experiences
Authors: McCormick Adam , Scheyd Karey , Terrazas Samuel
Published: April 2018

LGBTQ youth are disproportionately impacted by multiple forms of childhood trauma, including physical abuse, sexual abuse, dating violence, sexual assault, and peer violence. The emerging practices of trauma-informed care and trauma-specific interventions have made significant contributions to the manner in which systems respond to the needs of traumatized youth. However, these youth are largely excluded from many trauma-informed conversations. This article seeks to use the Concepts for Understanding Traumatic Stress Responses in Children and Families, developed by the National Child Traumatic Stress Network, to address the traumatic experiences and responses of LGBTQ youth.
Measuring Visualized Tendon Length in Peroneal Tendoscopy
Authors: Hull Michael , Campbell John T. , Jeng Clifford L. , Henn R. Frank , Cerrato Rebecca A.
Published: April 2018

Background:

Despite multiple studies outlining peroneal tendoscopy, no study exists to evaluate how effective tendoscopy is at visualizing the peroneal tendons without missing a lesion. We sought to measure the length of the peroneal tendons that could be visualized using tendoscopy.

Methods:

Ten fresh cadaveric specimens were evaluated using standard peroneal tendoscopy techniques. Peroneus longus and brevis tendons were pierced percutaneously with Kirschner wires at the edge of what could be seen through the camera. The tendon sheaths were then dissected and the distances from anatomic landmarks were directly measured. During zone 3 peroneus longus tendoscopy, a more distal portal site was created for the final 5 specimens.

Results:

The peroneus brevis could be visualized through the entirety of zone 1 and up to an average of 19.5 mm (95% confidence interval, 16.5-22.5) from its insertion onto the base of the fifth metatarsal in zone 2. Peroneus longus could be visualized through the entirety of zones 1 and 2 and up to an average of 9.7 mm from its insertion onto the base of the first metatarsal in zone 3. This distance was decreased significantly with a more distal portal. The muscle belly of peroneus brevis terminated an average of 1.8 mm (–3.7 to 7.3) above the tip of the lateral malleolus.

Conclusions:

Despite limitations, these results suggest that the vast majority of the length of the peroneal tendons can be seen during routine peroneal tendoscopy. A more distal skin portal site may improve visualization of zone 3 of peroneus longus.

Clinical Relevance:

This study confirms the ability of peroneal tendoscopy to see the entire tendon length with appropriate portal placement.
Childhood Trauma and Dissociative Intimate Partner Violence
Authors: Webermann Aliya R. , Murphy Christopher M.
Published: April 2018

The present study assesses childhood abuse/neglect as a predictor of dissociative intimate partner violence (IPV) among 118 partner-abusive men. One third (36%) endorsed dissociative IPV, most commonly losing control (18%), surroundings seeming unreal (16%), feeling someone other than oneself is aggressing (16%), and seeing oneself from a distance aggressing (10%). Childhood physical abuse/neglect predicted IPV-specific derealization/depersonalization, aggressive self-states, and flashbacks to past violence. Childhood emotional abuse/neglect predicted derealization/depersonalization, blackouts, and flashbacks. Childhood sexual abuse uniquely predicted amnesia. Other potential traumas did not predict dissociative IPV, suggesting dissociative IPV is influenced by trauma-based emotion dysregulation wherein childhood abuse/neglect survivors disconnect from their abusive behavior.
Healthcare resource use and costs associated with chronic kidney disease in US private insurance patients with multiple myeloma
Authors: Bhowmik Debajyoti , Song Xue , Intorcia Michele , Kent Shia T , Shi Nianwen
Published: April 2018

Objectives

Within a median 1.2 years after patients have an initial diagnosis with multiple myeloma, up to 61% were diagnosed with renal impairment and 50% were diagnosed with chronic kidney disease. This study estimated economic burden associated with chronic kidney disease in multiple myeloma patients in the US.

Methods

In this retrospective cohort study, patients ≥18 years old with ≥1 inpatient or ≥ 2 outpatient multiple myeloma diagnoses between 1 January 2008 and 31 March 2015 were identified from MarketScan® Commercial and Medicare Supplemental Databases. Chronic kidney disease patients had ≥1 diagnosis of chronic kidney disease Stages 1–5 (first chronic kidney disease diagnosis date = index date) on or after the first multiple myeloma diagnosis, and were propensity score matched 1:1 to multiple myeloma patients without chronic kidney disease, end-stage renal disease, dialysis, or other type of chronically impaired renal function. All patients had ≥six-month continuous enrollment prior to index date and were followed for ≥one month from index date until the earliest of inpatient death, end of continuous enrollment, or end of the study period (30 September 2015). The per-patient per-year healthcare resource utilization and costs were measured during follow-up. Costs were total reimbursed amount in 2016 US dollars.

Results

A total of 2541 multiple myeloma patients with chronic kidney disease stages 1–5 and 2541 matched controls met the study criteria and were respectively 69.3 and 69.6 years, 54.5% and 55.3% men, and had 572.2 and 533.4 mean days of follow up. Compared to controls, chronic kidney disease patients had significantly (all P < 0.001) higher proportions (57.1% vs. 32.1%) and frequency (1.2 vs. 0.5) of inpatient admissions, frequency of emergency room visits (5.1 vs. 3.3), and total costs ($106,634 vs. $71,880). Sensitivity analyses found that patients with chronic kidney disease, end-stage renal disease, or dialysis had $78,455 ( P < 0.001) higher costs (per-patient per-year) than matched controls.

Conclusions

The economic burden associated with chronic kidney disease in patients with multiple myeloma was estimated to be between $34,754 and $78,455 per-patient per-year. Given its substantial clinical and economic impact, preservation of renal function is important in multiple myeloma patient care.