bluuebunny/crossref_metadata_2025 huggingface dataset:
The uses of provincial administrative health databases for research on palliative care: Insights from British Columbia, Canada
Authors: Allan Diane E , Stajduhar Kelli I , Reid R Colin
Published: February 2005

Background

Research indicating that people increasingly prefer to die at home suggests that palliative care is likely to play a more prominent role in the future of Canada's health care system. Unfortunately, at a time when research evidence should be informing policy and service delivery, little is known about health service utilization by Canadians at the end of life. One existing mechanism that can help address this gap is provincial administrative health data. The purpose of this study was to explore the potential of administrative health data to identify characteristics of palliative care users, patterns of formal service utilization and predictors of palliative care use.

Methods

Bivariate and multivariate analyses were used to examine data from the Capital Health Region, British Columbia Linked Health Databases for the period 1992/93 to 1998/99. The databases examined include continuing care, physician claims, hospital separations, and vital statistics. As the name implies, these databases can be linked at the individual level using unique identifiers so that health services utilization can be tracked across sectors.

Results

General patterns of service use among palliative care patients suggest that general practitioner and medical specialist visits have decreased over time and the utilization of hospital beds has increased. Utilization of community-based services (i.e. home support and home nursing care) shows an overall pattern of decline. However, when compared to non-palliative care patients, palliative care patients spent fewer nights in hospital, used fewer hours of home support, and had a greater number of home nursing care visits.

Conclusions

Administrative health databases can provide valuable information for examining service utilization patterns over time. However, given that decisions surrounding the designation of palliative care include factors beyond the scope of administrative databases (such as quality of life, personal preferences, social support), these databases should only be seen as one source of information to inform service delivery and policy decision making.
Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia
Authors: Nelson Brett D , Dierberg Kerry , Šćepanović Milena , Mitrović Mihajlo , Vuksanović Miloš , Milić Ljiljana , VanRooyen Michael J
Published: February 2005

Background

Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model.

Methods

Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade.

Results

Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities.

Conclusions

By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings.
A case-control study to evaluate urinary tract complications in radical hysterectomy
Authors: Behtash Nadereh , Ghaemmaghami Fatemeh , Ayatollahi Haleh , Khaledi Hediyeh , Hanjani Parviz
Published: February 2005

Background

This study has evaluated urinary tract injuries and dysfunction after Radical Hysterectomy (RH) performed in patients with cervical cancer and has compared the cystometric parameters and urinary complications occurring in these patients with those occurring in patients who had undergone Simple Hysterectomy (SH).

Patients and methods

A prospective case-control study was conducted to evaluate urinary tract injuries (intra-operative and post-operative) and dysfunction in 50 patients undergoing RH for cervical cancer and to compare them with the same parameters in 50 patients who underwent SH for benign disease.

Results

Mean age in the RH group was 46.3 years and in the SH group was 50.1 (p = 0.63). There were no bladder and urethral injuries in either group of patients. There was one intra-operative ureteral injury in the RH patients but none in those who underwent SH. (p < 0.05). In the two weeks after surgery, 15% of RH patients and 11% of SH patients had experienced a urinary tract infection urinary tract infection (p = 0.61). Two week after surgery 62% of RH patients had no urinary symptoms, compared to 84% in the SH group who did (p < 0.02). Urinary residual volume, first urinary sensation and maximal bladder capacity were higher in the RH group, but this was not statistically significant. The only case of a urinary fistula appeared in a patient who received 5000 cGy radiation therapy pre-operatively, but this spontaneously healed after 3 weeks of catheterization.

Conclusions

Intra-operative and post-operative urinary tract complications are comparable in patients undergoing RH and SH and an expert gynaecological oncologist might be able to further decrease complications. However, radiation therapy before surgery may increase the risk of complications.
Direct analysis of thymic function in children with Down's syndrome
Authors: Prada Nicole , Nasi Milena , Troiano Leonarda , Roat Erika , Pinti Marcello , Nemes Elisa , Lugli Enrico , Ferraresi Roberta , Ciacci Luigi , Bertoni Davide , Biagioni Ornella , Gibertoni Milena , Cornia Cristina , Meschiari Liviana , Gramazio Elisabetta , Mariotti Mauro , Consolo Ugo , Balli Fiorella , Cossarizza Andrea
Published: February 2005

Background

Down's syndrome (DS) is characterized by several immunological defects, especially regarding T cell compartment. DS is considered the best example of accelerated ageing in humans. Direct observations of the thymus have shown that in DS this organ undergoes severe histological and morphological changes. However, no data on its capacity to generate T cells are present in the literature. Here, using a new technology based upon real time PCR, we have investigated the capacity of the thymus to produce and release newly generated T lymphocytes (the so called "recent thymic emigrants", RTE) in children with DS.

Methods

We studied 8 children affected by DS, aged 2–7 years, compared with 8 age- and sex-matched healthy controls. Flow cytometry was used to determine different lymphocytes subsets. Real time PCR with the Taqman system was used to quantify the amount of RTE,i.e.peripheral blood lymphocytes that express the T cell receptor rearrangement excision circles (TREC).

Results

In comparison with control children, those with DS had a significant lower number of TREC+ peripheral blood cells. Moreover, in DS children but not in controls, a strong negative correlation between age and the levels of TREC+ cells was found.

Conclusions

The direct measure of thymic output indicates that the impairment of the organ results in a reduced production of newly generated T cells. This observation could suggest that cytokines able to modulate thymic function, such as interleukins, could be useful to improve the functionality of the organ and to treat the immunodeficiency present in DS subjects.
Opisthobranchia (Mollusca, Gastropoda) – more than just slimy slugs. Shell reduction and its implications on defence and foraging
Authors: Wägele Heike , Klussmann-Kolb Annette
Published: February 2005

Background

In general shell-less slugs are considered to be slimy animals with a rather dull appearance and a pest to garden plants. But marine slugs usually are beautifully coloured animals belonging to the less-known Opisthobranchia. They are characterized by a large array of interesting biological phenomena, usually related to foraging and/or defence. In this paper our knowledge of shell reduction, correlated with the evolution of different defensive and foraging strategies is reviewed, and new results on histology of different glandular systems are included.

Results

Based on a phylogeny obtained by morphological and histological data, the parallel reduction of the shell within the different groups is outlined. Major food sources are given and glandular structures are described as possible defensive structures in the external epithelia, and as internal glands.

Conclusion

According to phylogenetic analyses, the reduction of the shell correlates with the evolution of defensive strategies. Many different kinds of defence structures, like cleptocnides, mantle dermal formations (MDFs), and acid glands, are only present in shell-less slugs. In several cases, it is not clear whether the defensive devices were a prerequisite for the reduction of the shell, or reduction occurred before. Reduction of the shell and acquisition of different defensive structures had an implication on exploration of new food sources and therefore likely enhanced adaptive radiation of several groups.
Review of the use of Topiramate for treatment of psychiatric disorders
Authors: Arnone Danilo
Published: February 2005

Background

Topiramate is a new antiepileptic drug, originally designed as an oral hypoglycaemic subsequently approved as anticonvulsant. It has increasingly been used in the treatment of numerous psychiatric conditions and it has also been associated with weight loss potentially relevant in reversing weight gain induced by psychotropic medications. This article reviews pharmacokinetic and pharmacodynamic profile of topiramate, its biological putative role in treating psychiatric disorders and its relevance in clinical practice.

Methods

A comprehensive search from a range of databases was conducted and papers addressing the topic were selected.

Results

Thirty-two published reports met criteria for inclusion, 4 controlled and 28 uncontrolled studies. Five unpublished controlled studies were also identified in the treatment of acute mania.

Conclusions

Topiramate lacks efficacy in the treatment of acute mania. Increasing evidence, based on controlled studies, supports the use of topiramate in binge eating disorders, bulimia nervosa, alcohol dependence and possibly in bipolar disorders in depressive phase. In the treatment of rapid cycling bipolar disorders, as adjunctive treatment in refractory bipolar disorder in adults and children, schizophrenia, posttraumatic stress disorder, unipolar depression, emotionally unstable personality disorder and Gilles de la Tourette's syndrome the evidence is entirely based on open label studies, case reports and case series. Regarding weight loss, findings are encouraging and have potential implications in reversing increased body weight, normalisation of glycemic control and blood pressure. Topiramate was generally well tolerated and serious adverse events were rare.
Expression of cytokine mRNA and protein in joints and lymphoid organs during the course of rat antigen-induced arthritis
Authors: Pohlers Dirk , Siegling Angela , Buchner Eberhard , Schmidt-Weber Carsten B , Palombo-Kinne Ernesta , Emmrich Frank , Bräuer Rolf , Kinne Raimund W
Published: February 2005

Cytokine expression was assessed during antigen-induced arthritis (AIA) in synovial membrane (SM), inguinal lymph node (LN), and spleen using competitive RT-PCR and sandwich ELISA. In the SM, early elevations of IL-1β and IL-6 mRNA (by 6 hours; 450- and 200-fold, respectively) correlated with the joint swelling; a 6-fold increase in tumor necrosis factor α (TNFα) was not significant. Not only IL-2 and IFN-γ (which increased 10,000-fold and 200-fold, respectively), but also IL-5 and IL-10, increased acutely (6 hours – day 1; 3-fold and 35-fold, respectively) in the SM. In general, the protein levels in the SM for IL-1β, IL-6, TNFα, IFN-γ, IL-4, and IL-10 (increase from 4-fold to 15-fold) matched the course of mRNA expression. In the inguinal LN, there were early mRNA elevations of IL-6 (a 2.5-fold increase by 6 hours, which correlated positively with the joint swelling) and IL-2 (4-fold by 6 hours), as well as later rises of IL-4 and IL-5 (2.5- and 4-fold, respectively, by day 3). No significant elevations of the corresponding proteins in this tissue were observed, except for IL-1β (by day 6) and IL-10 (by day 1). In the spleen, there were significant mRNA elevations at 6 hours of IL-1β (1.5-fold), IL-6 (4-fold; positively correlated with the joint swelling), IFN-γ (3-fold), and IL-2 (7- to 10-fold). IL-5 and IL-10 (2- and 3-fold, respectively) peaked from 6 hours to day 3 in the spleen. Increases of the corresponding proteins were significant in comparison with day 0 only in the case of IL-2 (day 6). By day 6 (transition to the chronic phase), the mRNA for cytokines declined to or below prearthritis levels in all the tissues studied except for IL-1β in the SM and IL-6 in the spleen. AIA is thus characterized by four phenomena: early synovial activation of macrophages, T helper (Th)1-like, and Th2-like cells; late, well-segregated Th2-like responses in the inguinal LN; late, overlapping Th1-like/Th2-like peaks in the spleen; and chronic elevation of synovial IL-1β mRNA and spleen IL-6 mRNA.
Paclitaxel-Based Chemoradiotherapy in Localized Gastric Carcinoma: Degree of Pathologic Response and Not Clinical Parameters Dictated Patient Outcome
Authors: Ajani J.A. , Mansfield P.F. , Crane C.H. , Wu T.T. , Lunagomez S. , Lynch P.M. , Janjan N. , Feig B. , Faust J. , Yao J.C. , Nivers R. , Morris J. , Pisters P.W.
Published: February 2005

Purpose

Preoperative chemoradiotherapy may increase the R0 (curative) resection rate, overall survival (OS) duration, and disease-free survival (DFS) duration. We evaluated paclitaxel-based induction chemotherapy and chemoradiotherapy in patients with localized gastric or gastroesophageal adenocarcinoma to determine its feasibility, impact on the R0 resection rate, type of pathologic response, OS, and DFS.

Patients and Methods

Patients with operable, localized gastric, or gastroesophageal adenocarcinoma were eligible. Staging included endoscopic ultrasonography (EUS) and laparoscopy. Patients received two 28-day cycles of induction chemotherapy of fluorouracil, paclitaxel, and cisplatin followed by 45 Gy of radiation and concurrent fluorouracil plus paclitaxel. The cancer was restaged and surgery was attempted. Postsurgery pathologic findings and R0 resection were correlated with OS and DFS.

Results

Forty-one patients were enrolled. Most carcinomas were proximal (83%) and pretreatment stage EUST3 (85%). Forty patients (98%) underwent surgery, and 78% had an R0 resection. We observed a pathologic complete response (pathCR) rate of 20% and a pathologic partial response (pathPR) rate of 15% (< 10% residual cancer cells in the resected specimen). No pretreatment parameter (sex, cancer location, baseline T stage, or baseline N stage) predicted the type of postsurgery pathologic response, OS, or DFS. However, pathCR (P = .02), pathCR + pathPR (P = .006), R0 resection (P < .001), and postsurgery T and N stages (P = .01 and P < .001, respectively) were associated with OS. Same parameters were significantly correlated with DFS. Toxicity was manageable.

Conclusion

The type of pathologic response but not pretreatment parameters was associated with OS and DFS. Efforts to increase the rate of pathologic response and better systemic cancer control are warranted.
Molecular Staging in Stage II and III Melanoma Patients and Its Effect on Long-Term Survival
Authors: Voit Christiane , Kron Martina , Rademaker Juergen , Schwürzer-Voit Markus , Sterry Wolfram , Weber Lutz , Özdemir Cueneyt , Proebstle Thomas , Keilholz Ulrich
Published: February 2005

Purpose

To assess the prognostic value of serial reverse transcriptase polymerase chain reaction (RT-PCR) -based measurements of tyrosinase mRNA in peripheral blood of stage II and III melanoma patients.

Patients and Methods

During routine follow-up of American Joint Committee on Cancer stage II and III melanoma patients, serial testing for tyrosinase transcripts in peripheral blood was performed by RT-PCR. The PCR results were compared with the clinical data collected during the follow-up.

Results

Over a period of 3 years, 111 patients (78 stage II and 33 stage III patients) were enrolled, and tyrosinase determinations were carried out. The 6-year disease-specific survival probability was 97% for patients always showing negative RT-PCR results and 67% for patients who tested positive at least once. In a Cox proportional hazards model, the prognostic value of sex, age, site of primary tumor, histologic subtype, stage, Breslow's tumor thickness, Clark level, and the time-dependent variable PCR result was assessed. Patients with a positive RT-PCR test had a distinctly higher risk of dying from melanoma, with a hazard ratio of 12.6 (95% CI, 3.4 to 46.3; P < .001).

Conclusion

Our study shows a strong association between PCR and disease-specific survival time. Detection of tyrosinase mRNA in peripheral blood may be of similar importance for the clinical course of melanoma as the detection of micrometastatic disease in the sentinel lymph node. Whether a combination of these two factors leads to a better definition of the prognosis of melanoma patients is under investigation in current studies.
Selective Excision of Metastatic Brain Tumors Originating in the Motor Cortex With Preservation of Function
Authors: Weil Robert J. , Lonser Russell R.
Published: February 2005

Purpose

Brain metastases are common in patients with cancer and can cause considerable morbidity or death. Metastasis in eloquent areas of the brain, particularly the primary motor cortex, may present significant treatment challenges.

Patients and Methods

Seventeen consecutive patients with metastasis within the primary motor cortex underwent selective microsurgical tumor resection. Operative, hospital, neuroimaging, and follow-up information was reviewed.

Results

There were 10 women and seven men (mean age, 54.3 years) who underwent 17 operations for symptomatic brain metastases. Motor cortex was identified and tumor (mean volume, 10.2 cm3) was completely resected in all patients. Three patients had transient or reversible complications. Karnofsky performance scores improved in 16 of 17 patients at 4 weeks postoperatively, with a mean improvement of 1.8 grades compared with preoperative scores (P < .05). Overall survival of 16 patients with distant follow-up (> 6 months or until death) averaged 10.6 ± 4.4 months, with nine of 16 (56%) assessable patients surviving 1 year or longer. Survival of these 16 patients, by recursive partitioning analysis (RPA), was 11.2, 13.3, and 6.7 months for RPA classes I, II, and III, respectively. The cause of death in 14 of 15 patients who have died was progressive systemic disease; in one patient it was a combination of systemic and distant CNS disease progression. There were no local CNS recurrences.

Conclusion

Complete microsurgical resection of metastatic tumors in the primary motor cortex is feasible and efficacious, results in a sustained improvement in performance outcomes, and permits satisfactory long-term survival.
Analysis of Concerted Expression of Angiogenic Growth Factors in Acute Myeloid Leukemia: Expression of Angiopoietin-2 Represents an Independent Prognostic Factor for Overall Survival
Authors: Loges Sonja , Heil Gerhard , Bruweleit Melanie , Schoder Volker , Butzal Martin , Fischer Uta , Gehling Ursula M. , Schuch Gunter , Hossfeld Dieter K. , Fiedler Walter
Published: February 2005

Purpose

Bone marrow neoangiogenesis plays an important pathogenetic and possible prognostic role in acute myeloid leukemia (AML). Members of the vascular endothelial growth factor (VEGF) and angiopoietin family represent the most specific inducers of angiogenesis secreted by AML blasts. We therefore correlated expression of angiogenic factors with clinical variables.

Patients and Methods

We investigated the expression of VEGF-A, VEGF-C, angiopoietin-1 (Ang1), angiopoietin-2 (Ang2), and the receptor Tie2 by quantitative polymerase chain reaction in a cohort of 90 patients younger than 61 years with de novo AML entered into the German AML Süddeutsche Hämoblastose Gruppe Hannover 95 trial. Uni- and multivariate analyses were performed using clinical and gene expression variables.

Results

Univariate analysis of overall survival indicated the following variables as prognostic factors: good response on a day-15 bone marrow examination after initiation of induction chemotherapy, karyotype, and high Ang2 expression. In multivariate analysis, only bad response and log Ang2 expression remained of statistical significance, with a hazard ratio of 3.51 (95% CI, 1.91 to 6.47) and 0.75 (95% CI, 0.61 to 0.91), respectively. Subgroup analysis suggested that the prognostic impact of Ang2 expression was especially evident in cohorts with low VEGF-C and Ang1 mRNA levels.

Conclusion

These results show that expression of Ang2 represents an independent prognostic factor in AML. Additional research into interactions of angiogenic cytokines in the pathogenesis of bone marrow angiogenesis in AML is warranted.
Irinotecan Plus Oxaliplatin and Leucovorin-Modulated Fluorouracil in Advanced Pancreatic Cancer—A Groupe Tumeurs Digestives of the Fédération Nationale des Centres de Lutte Contre le Cancer Study
Authors: Conroy Thierry , Paillot Bernard , François Eric , Bugat Roland , Jacob Jacques-Henri , Stein Ulrich , Nasca Salvador , Metges Jean-Philippe , Rixe Olivier , Michel Pierre , Magherini Emmanuelle , Hua Aliette , Deplanque Gael
Published: February 2005

Purpose

To evaluate response rate and toxicity of irinotecan and oxaliplatin plus fluorouracil (FU) and leucovorin (Folfirinox) in advanced pancreatic adenocarcinoma (APA).

Patients and Methods

Chemotherapy-naive patients with histologically proven APA and bidimensionally measurable disease were treated with Folfirinox therapy every 2 weeks, which comprised oxaliplatin 85 mg/m2 and irinotecan 180 mg/m2 plus leucovorin 400 mg/m2 followed by bolus FU 400 mg/m2 on day 1, then FU 2,400 mg/m2 as a 46-hour continuous infusion. Quality of life (QOL) was assessed using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30).

Results

Forty-seven patients were entered, and 46 received treatment. Thirty-five patients (76%) had metastatic disease. A total of 356 cycles were delivered, with a median of eight cycles per patient (range, one to 24 cycles). All patients were assessable for safety. No toxic death occurred. Grade 3 to 4 neutropenia occurred in 52% of patients, including two patients with febrile neutropenia. Other relevant toxicities included grade 3 to 4 nausea (20%), vomiting (17%), and diarrhea (17%) and grade 3 neuropathy (15%; Levi's scale). The confirmed response rate was 26% (95% CI, 13% to 39%), including 4% complete responses. Median time to progression was 8.2 months (95% CI, 5.3 to 11.6 months), and median overall survival was 10.2 months (95% CI, 8.1 to 14.4 months). Between baseline and end of treatment, patients had improvement in all functional scales of the EORTC QLQ-C30, except cognitive functioning. Responders had major improvement in global QOL.

Conclusion

With a good safety profile, a promising response rate, and an improvement in QOL, Folfirinox will be further assessed in a phase III trial.
Randomized Trial Comparing Iridium Implant Plus External-Beam Radiation Therapy With External-Beam Radiation Therapy Alone in Node-Negative Locally Advanced Cancer of the Prostate
Authors: Sathya Jinka R. , Davis Ian R. , Julian Jim A. , Guo Qing , Daya Dean , Dayes Ian S. , Lukka Himu R. , Levine Mark
Published: February 2005

Purpose

To determine if iridium implant (IM) and external-beam radiation therapy (EBRT) is better than standard EBRT in locally advanced prostate cancer.

Methods

Patients with T2 and T3 prostate cancer with no evidence of metastatic disease were randomly assigned to EBRT of 66 Gy in 33 fractions during 6.5 weeks or to IM of 35 Gy delivered to the prostate during 48 hours plus EBRT of 40 Gy in 20 fractions during 4 weeks. The primary outcome consisted of biochemical or clinical failure (BCF). BCF was defined by biochemical failure, clinical failure, or death as a result of prostate cancer. Secondary outcomes included 2-year postradiation biopsy positivity, toxicity, and survival.

Results

Between 1992 and 1997, 51 patients were randomly assigned to receive IM plus EBRT, and 53 patients were randomly assigned to receive EBRT alone. The median follow-up was 8.2 years. In the IM plus EBRT arm, 17 patients (29%) experienced BCF compared with 33 patients (61%) in the EBRT arm (hazard ratio, 0.42; P = .0024). Eighty-seven patients (84%) had a postradiation biopsy; 10 (24%) of 42 in the IM plus EBRT arm had biopsy positivity compared with 23 (51%) of 45 in the EBRT arm (odds ratio, 0.30; P = .015). Overall survival was 94% in the IM plus EBRT arm versus 92% in the EBRT arm.

Conclusion

The combination of IM plus EBRT was superior to EBRT alone for BCF and postradiation biopsy. This trial provides evidence that higher doses of radiation delivered in a shorter duration result in better local as well as biochemical control in locally advanced prostrate cancer.
Concurrent Hyperfractionated Radiotherapy and Low-Dose Daily Carboplatin and Paclitaxel in Patients With Stage III Non–Small-Cell Lung Cancer: Long-Term Results of a Phase II Study
Authors: Jeremic Branislav , Milicic Biljana , Acimovic Ljubisa , Milisavljevic Slobodan
Published: February 2005

Purpose

To investigate the feasibility and activity of hyperfractionated radiation therapy (Hfx RT) and concurrent chemotherapy (CT) consisting of low-dose, daily carboplatin and paclitaxel in patients with stage III non–small-cell lung cancer (NSCLC).

Patients and Methods

Sixty-four patients started their treatment on day 1 with 30 mg/m2 of paclitaxel administered by 1-hour infusion. Hfx RT began on day 2 using 1.3 Gy bid to a total dose of 67.6 Gy and concurrent low-dose daily CT consisting of 25 mg/m2 of carboplatin and 10 mg/m2 of paclitaxel, both given Mondays to Fridays during RT course.

Results

Objective response rate was 83% and included complete response in 27 patients (42%) and partial response in 26 patients (41%). Ten patients (16%) had stable disease, whereas only one patient (2%) had progressive disease. The median survival time was 28 months, and 3- and 5-year survival rates were 37% and 26%, respectively. The median time to local progression was 26 months, and 3- and 5-year local progression-free survival rates were 37% and 33%, respectively. The median time to distant metastasis was 25 months, and 3- and 5- year distant metastasis-free survival rates were 37% and 31%, respectively. Acute high-grade (≥ grade 3) toxicity was hematologic (25%), esophageal (17%), bronchopulmonary (13%), and skin (9%). Late high-grade toxicity was infrequent.

Conclusion

This combined Hfx RT/TC regimen produced results that are among the best ever reported and warrants further study in a prospective randomized fashion.
Predictive Value of the Pretreatment Extent of Disease System in Hepatoblastoma: Results From the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 Study
Authors: Aronson Daniël C. , Schnater J. Marco , Staalman Chris R. , Weverling Gerrit J. , Plaschkes Jack , Perilongo Giorgio , Brown Julia , Phillips Angela , Otte Jean-Bernard , Czauderna Piotr , MacKinlay Gordon , Vos Anton
Published: February 2005

Purpose

Preoperative staging (pretreatment extent of disease [PRETEXT]) was developed for the first prospective liver tumor study by the International Society of Pediatric Oncology (SIOPEL-1 study; preoperative chemotherapy and delayed surgery). Study aims were to analyze the accuracy and interobserver agreement of PRETEXT and to compare the predictive impact of three currently used staging systems.

Patients and Methods

Hepatoblastoma (HB) patients younger than 16 years who underwent surgical resection (128 of 154 patients) were analyzed. The centrally reviewed preoperative staging was compared with postoperative pathology (accuracy) in 91 patients (81%), and the local center staging was compared with the central review (interobserver agreement) in 97 patients (86%), using the agreement beyond change method (weighted κ). The predictive values of the three staging systems were compared in 110 patients (97%) using survival curves and Cox proportional hazard ratio estimates.

Results

Preoperative PRETEXT staging compared with pathology was correct in 51%, overstaged in 37%, and understaged in 12% of patients (weighted κ = 0.44; 95% CI, 0.26 to 0.62). The weighted κ value of the interobserver agreement was 0.76 (95% CI, 0.64 to 0.88). The Children's Cancer Study Group/Pediatric Oncology Group–based staging system showed no predictive value for survival (P = .516), but the tumor-node-metastasis–based system and PRETEXT system showed good predictive values (P = .0021 and P = .0006, respectively). PRETEXT seemed to be superior in the statistical fit.

Conclusion

PRETEXT has moderate accuracy with a tendency to overstage patients, shows good interobserver agreement (reproducibility), shows superior predictive value for survival, offers the opportunity to monitor the effect of preoperative therapy, and can also be applied in patients who have not had operations. For comparability reasons, we recommend that all HB patients included in trials also be staged according to PRETEXT.
Relationship of Epidermal Growth Factor Receptor Expression to ErbB-2 Signaling Activity and Prognosis in Breast Cancer Patients
Authors: DiGiovanna Michael P. , Stern David F. , Edgerton Susan M. , Whalen Steve G. , Moore Dan , Thor Ann D.
Published: February 2005

Purpose

To examine the relationship of epidermal growth factor receptor (EGFR) expression to ErbB-2 signaling activity in breast cancer and the impact that this interaction has on the prognosis of patients with early-stage breast cancer.

Patients and Methods

Paraffin tumor sections were collected retrospectively from 807 breast cancer patients diagnosed between 1976 and 1983. Immunohistochemical assays for ErbB-2, phosphorylated (activated) ErbB-2, and EGFR were performed, and the results were correlated with clinicopathologic variables and outcome.

Results

EGFR expression was detectable in 15% of 807 invasive breast cancers, including 35% of the 306 ErbB-2–positive patients. Conversely, the majority (87%) of EGFR-positive tumors co-overexpressed ErbB-2. Ninety-seven percent of tumors with phosphorylated ErbB-2 co-overexpressed EGFR. Patients whose cancers demonstrated ErbB-2 phosphorylation or co-overexpression of ErbB-2 and EGFR had the shortest survival. In contrast, patients whose tumors were negative for all three markers and those tumors that expressed only EGFR or only nonphosphorylated ErbB-2 had a relatively favorable outcome.

Conclusion

These data provide the first clinical evidence that EGFR expression is linked to activation of ErbB-2 in human breast cancers. We have further shown that the adverse prognostic value of ErbB-2 overexpression is observed only when ErbB-2 is in the phosphorylated (activated) state or coexpressed with EGFR. These data suggest that ligand-dependent mechanisms of ErbB-2 activation are important in human breast cancer. These results also suggest that agents targeting EGFR may be useful in the treatment of tumors with activated ErbB-2.
The Role of the Vagal Nerve in Peripheral PYY3–36-Induced Feeding Reduction in Rats
Authors: Koda Shuichi , Date Yukari , Murakami Noboru , Shimbara Takuya , Hanada Takeshi , Toshinai Koji , Niijima Akira , Furuya Mayumi , Inomata Norio , Osuye Kazuhiro , Nakazato Masamitsu
Published: February 2005

Peptide YY (PYY), an anorectic peptide, is secreted postprandially from the distal gastrointestinal tract. PYY3–36, the major form of circulating PYY, binds to the hypothalamic neuropeptide Y Y2 receptor (Y2-R) with a high-affinity, reducing food intake in rodents and humans. Additional gastrointestinal hormones involved in feeding, including cholecystokinin, glucagon-like peptide 1, and ghrelin, transmit satiety or hunger signals to the brain via the vagal afferent nerve and/or the blood stream. Here we determined the role of the afferent vagus nerve in PYY function. Abdominal vagotomy abolished the anorectic effect of PYY3–36 in rats. Peripheral administration of PYY3–36 induced Fos expression in the arcuate nucleus of sham-operated rats but not vagotomized rats. We showed that Y2-R is synthesized in the rat nodose ganglion and transported to the vagal afferent terminals. PYY3–36 stimulated firing of the gastric vagal afferent nerve when administered iv. Considering that Y2-R is present in the vagal afferent fibers, PYY3–36 could directly alter the firing rate of the vagal afferent nerve via Y2-R. We also investigated the effect of ascending fibers from the nucleus of the solitary tract on the transmission of PYY3–36-mediated satiety signals. In rats, bilateral midbrain transections rostral to the nucleus of the solitary tract also abolished PYY3–36-induced reductions in feeding. This study indicates that peripheral PYY3–36 may transmit satiety signals to the brain in part via the vagal afferent pathway.
Maternal Diabetes Adversely Affects Preovulatory Oocyte Maturation, Development, and Granulosa Cell Apoptosis
Authors: Chang Aimee S. , Dale Alexis N. , Moley Kelle H.
Published: February 2005

Maternal diabetes adversely affects preimplantation embryo development and pregnancy outcomes. The objective of this study was to determine whether diabetes has an impact at an earlier stage of development, the preovulatory oocyte. Models of both acute and chronic insulin-dependent diabetes were used. Acute hyperglycemia was induced by a single streptozotocin injection. Akita mice, which harbor an autosomal dominant mutation causing them to be chronically hypoinsulinemic and hyperglycemic, were used. In both models, preovulatory oocytes were markedly smaller when compared with control animals. A significantly greater number of control oocytes had progressed to meiotic maturation before diabetic oocytes. Both models were found to have smaller, less developed ovarian follicles with a greater number of apoptotic foci by histological evaluation as well as by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling staining. Immunohistochemistry displayed a greater amount of TNF-related apoptosis-inducing ligand (TRAIL) and KILLER, a key murine ligand and receptor involved in the extrinsic pathway, expressed in cumulus cells from hyperglycemic mice compared with controls, suggesting that this apoptotic pathway may be up-regulated under diabetic stress. Elevated KILLER expression was also confirmed through Western blotting. Connexin-43 expression was found to be lower by immunohistochemistry and Western blot analysis in the diabetic samples. Both models of maternal hyperglycemia and hypoinsulinemia may have a detrimental effect on oocyte maturation and development as detailed by the smaller sizes of oocytes and developing ovarian follicles, the lowered percentage reaching germinal vesicle breakdown, and the greater amount of apoptosis. In addition, there may be dysfunctional or decreased communication in diabetic oocytes, as demonstrated by lower expression of connexin-43.
The Mediating Roles of Anxiety, Depression, and Hopelessness on Adolescent Suicidal Behaviors
Authors: Thompson Elaine Adams , Mazza James J. , Herting Jerald R. , Randell Brooke P. , Eggert Leona L.
Published: February 2005

The purpose of this study was to explore the roles of anxiety, depression, and hopelessness as mediators between known risk factors and suicidal behaviors among 1,287 potential high school dropouts. As a step toward theory development, a model was tested that posited the relationships among these variables and their effects on suicidal behaviors. Structural equation models, estimated separately by gender, revealed support for the model, and substantial similarities between males and females. The results showed direct effects of depression and hopelessness on suicidal behaviors for males, and direct effects of hopelessness, but not depression, for females. For both males and females, anxiety was directly linked to depression and hopelessness; drug involvement had both direct and indirect effects on suicidal behavior. As hypothesized, lack of family support showed indirect influences on suicidal behaviors through anxiety for both males and females. The results have important implications for future model development regarding adolescent suicidal behaviors.
Aspects of Suicidal Behavior, Depression, and Treatment in College Students: Results from the Spring 2000 National College Health Assessment Survey
Authors: Kisch Jeremy , Leino E. Victor , Silverman Morton M.
Published: February 2005

The National College Health Assessment Survey (NCHA), sponsored by the American College Health Association, measured depression, suicidal ideation, and suicide attempts among 15,977 college students in the academic year 1999–2000. Similar to the National College Health Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention in 1995, 9.5% of students reported that they had seriously considered attempting suicide and 1.5% of students reported that they had attempted suicide within the last school year. The NCHA findings show a relationship between suicidal behavior and depressed mood. Depressed mood, difficulties of sexual identity, and problematic relationships all increase the likelihood of vulnerability to suicidal behavior. Less than 20% of students reporting suicidal ideation or attempts were receiving treatment.
Intimate Femicide Followed by Suicide: Examining the Role of Premeditation
Authors: Dawson Myrna
Published: February 2005

People who kill others rarely kill themselves afterwards. When they do, they are more likely to have killed someone with whom they were intimate. Two broad types of suicidal killers have been identified in research that presumes varying degrees of premeditation. Using data on over 700 intimate femicides, the role of premeditation in cases of intimate femicide‐suicide compared to killings that do not culminate in a suicide was examined. My results show that premeditation is more likely to occur in cases involving the offenders' suicide, but that evidence of premeditation varies depending upon the type of suicidal killer.
Correlates of Suicide in the Older Adult Population in Quebec
Authors: Préville Michel , Boyer Richard , Hébert Réjean , Bravo Gina , Seguin Monique
Published: February 2005

This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998–1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty‐five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub‐threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6‐month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2‐week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.
Doing Our Home Work: Anthropologists on Homelessness and Housing in the United States
Authors: Waterston Alisse
Published: February 2005

There's No Place like Home: Anthropological Perspectives on Housing and Homelessness in the United States. Anna Lou Dehavenon. Westport, CT: Bergin and Garvey, 1996.206 pp.

Ttie Unequal Homeless: Men on tlie Street, Women in Their Place. Joanne Passaro. New York: Routledge, 1996. 128 pp.

Homesteading in New York City, 1978‐1993: The Divided Heart of Loisaida. Malve von Hassell. Westport, CT: Bergin and Garvey, 1996. 205 pp.
Senses of Place
Authors: Herzfeld Michael
Published: February 2005

Senses of Place. Steven Feld and Keith H. Basso. eds. Santa Fe, NM: School of American Research Press, 1996. 293 pp.
The Fate of Place: A Philosophical History
Authors: Richardson Miles
Published: February 2005

The Fate of Place:. Philosophical History. Edward S. Casey. Berkeley: University of California Press, 1997.488 pp.
Displacement, Diaspora, and Geographies of Identity
Authors: Maira Sunaina
Published: February 2005

Displacement, Diaspora, and Geographies of Identity. Smadar Lavie and Ted Swedenburg. eds. Durham, NC: Duke University Press, 1996. 332 pp.
Anthropological Demography: Toward a New Synthesis
Authors: Carter Anthony T.
Published: February 2005

Anthropological Demography: Toward. New Synthesis. David I. Kertzer and Tom Fricke. eds. Chicago: University of Chicago Press, 1997. 294 pp.
Marginalized in the Middle
Authors: Brown Michael F.
Published: February 2005

Marginalized in the Middle. Alan Wolfe. Chicago: University of Chicago Press, 1996. 291 pp.
Sensuous Scholarship
Authors: Jackson Michael
Published: February 2005

Sensuous Scholarship. Paul Stoller. Philadelphia: University of Pennsylvania Press, 1997.166 pp.
For the Sake of Our Future: Sacrificing in Eastern Indonesia
Authors: Metcalf Peter
Published: February 2005

For tfie Sake of Our Future: Sacrificing in Eastern Indonesia. Signe Howell. ed. Leiden, Netherlands: Leiden University, 1996. 398 pp.
Understanding Disputes: The Politics of Argument
Authors: Maurer Bill
Published: February 2005

Understanding Disputes: The Politics of Argument. Pat Caplan. ed. Oxford, England: Berg Publishers, 1995. 248 pp.
The Sámi and Their Land. The Sámi versus the Swedish Crown. A Study of the Legal Struggle for Improved Land Rights: The Taxed Mountains Case
Authors: Anderson Myrdene
Published: February 2005

The Sámi and Their Land. The Sámi versus the Swedish Crown. Study of the Legal Straggle for Improved Land Rights: The Taxed Mountains Case. Tom G. Svensson. Institute for Comparative Research in Human Culture Series B, 96. Oslo: Novus forlag; Instituttet for sammenlignende kulturforskning, 1997. 213 pp.
Origins of the Human Brain
Authors: Gibson Kathleen R.
Published: February 2005

Origins of the Human Brain. J. P. Changeux and J. Chavaillon. eds. Oxford, England: Oxford University Press, 1995. 321 pp.
The New Colored People: The Mixed‐Race Movement in America
Authors: Dominguez Virginia R.
Published: February 2005

The New Colored People: The Mixed‐Race Movement in America. Jon Michael Spencer. New York: New York University Press, 1997. 169 pp.
Clothing Matters: Dress and Identity in India
Authors: Hendrickson Hildi
Published: February 2005

Clothing Matters: Dress and Identity in India. Emma Tarlo. Chicago: University of Chicago Press, 1996. 360 pp.
Image Acts
Authors: Bakewell Liza
Published: February 2005

Over 80 years ago, Bronistaw Malinowski documented the verbal magic of Trobiand gardeners as they tended their crops. More than 40 years later, J. L. Austin argued that words are not simply descriptive but are equally engaged in the productions of actions, indeed are actions themselves. Not long afterward, this idea was given a name: speech acts. This article expands that concept to include what may be termed image acts and argues that a theory of action should include a theory of images.
Emergence and Change in Early Urban Societies
Authors: Nichols Deborah L.
Published: February 2005

Emergence and Change in Early Urban Societies. Linda Manzanilla. ed. New York: Plenum Press, 1997. 301 pp.
Cahokia: Domination and Ideology in the Mississippian World
Authors: Saitta Dean J.
Published: February 2005

Cahokia: Domination and Ideology in the Mississippian World. Timothy R. Pauketat and Thomas E. Emerson. eds. Lincoln: University of Nebraska Press, 1997. 360 pp.
Tlie Two Milpas of Chan Kom: A Study of Socioeconomic and Political Transformations in a Maya Community
Authors: Kahn Hilary E.
Published: February 2005

Tlie Two Milpas of Chan Kom:. Study of Socioeconomic and Political Transformations in. Maya Community. Alicia Re Cruz. Albany: State University of New York Press, 1996. 203 pp.
Making Ends Meet: How Single Mothers Survive Welfare and Low‐Wage Work
Authors: McClaurin Irma
Published: February 2005

Making Ends Meet: How Single Mothers Survive Welfare and Low‐Wage Work. Kathryn Edin and Laura Lein. New York: Russell Sage Foundation, 1997. 320 pp.
Gender, Family and Work in Naples
Authors: Kertzer David I.
Published: February 2005

Gender, Family and Work in Naples. V. A. Goddard. Oxford, England: Berg, 1996. 264 pp.
Wives and Warriors: Women and the Military in the United States and Canada
Authors: Moran Mary H.
Published: February 2005

Wives and Warriors: Women and the Military in the United States and Canada. Laurie Weinstein and Christie C. White. eds. Westport, CT: Bergin and Garvey, 1997. 252 pp.
Carnival Song and Society: Gossip, Seocuality and Creativity in Andalusia
Authors: Razak Victoria M.
Published: February 2005

Carnival Song and Society: Gossip, Seocuality and Creativity in Andalusia. Jerome R. Mintz. New York: Berg, 1997.267 pp.
Large‐Scale Design of Cubic Ia3d Mesoporous Silica Monoliths with High Order, Controlled Pores, and Hydrothermal Stability (Adv. Mater. 2005, 1, 47)
Authors: El‐Safty S. A. , Hanaoka T. , Mizukami F.
Published: February 2005

To view the original paper use http://dx.doi.org/10.1002/adma.200401317.
The serotonin transporter gene as a QTL for ADHD
Authors: Curran Sarah , Purcell Shaun , Craig Ian , Asherson Philip , Sham Pak
Published: February 2005

Molecular studies of attention deficit hyperactivity disorder (ADHD) have identified susceptibility genes for the categorically diagnosed disorder using operational diagnostic criteria. Here, we take a QTL approach to mapping genes for ADHD using a composite continuous index of ADHD behavior in a large epidemiological sample. Previous studies of clinical ADHD suggest that two functional polymorphisms in the serotonin transporter gene (SLC6A4), one in the 5′‐regulatory region of the gene (5‐HTTLPR) and the other a VNTR (5‐HTTVNTR) in the second intron, as well as a single nucleotide polymorphism in the 3′‐untranslated region (3′‐UTR SNP), may be associated with the disorder. Here, we investigate these polymorphisms as well as an additional ten SNPs spread across the gene. We found significant association with the long (L) allele of the 5‐HTTLPR; P = 0.019, but neither the 5‐HTTVNTR nor the 3′‐UTR SNP were significantly associated. Significant associations (P < 0.05) were found for a further 5 the 10 other markers tested. We found evidence for two haplotype blocks spanning the region. We found strong evidence for association with the first haplotype block (comprised of four markers), with the significance of a combined primary and secondary test of association reaching an empirical P value = 0.0054 for the global test and an empirical P value = 0.00081 for the largest local test. Thus, we show here that SLC6A4, which has a major influence on brain serotonin availability, may be a QTL for ADHD. © 2005 Wiley‐Liss, Inc.