bluuebunny/crossref_metadata_2025 huggingface dataset:
MicroRNA-181 Functions as an Antioncogene and Mediates NF-κB Pathway by Targeting RTKN2 in Ovarian Cancers
Authors: Lin Zilin , Li Dehao , Cheng Wenjia , Wu Jiajia , Wang Kun , Hu Yi
Published: October 2018

MicroRNA (miR)-181 has been reported to participate in carcinogenesis and tumor progression in several malignant cancers, but its expression and biological functions in ovarian cancer have remained largely unclarified. Here, we first measured miR-181 expression in clinical ovarian cancers and found the expression levels of miR-181 were significantly lower in ovarian cancer tissues than that in adjacent tissues. Next, we screened and identified a direct miR-181 target, Rhotekin2 (RTKN2). A correlation between miR-181 and RTKN2 expression was also confirmed in clinical samples of ovarian cancers. Upregulation of miR-181 would specifically and markedly suppress RTKN2 expression. The miR-181-overexpressing subclones showed significant cell growth inhibition by cell apoptosis induction and significant impairment of cell invasiveness in SKOV3 and HO8910 ovarian cancer cells. To identify the mechanisms, we investigated the NF-κB pathway and found that nuclear factor-kappa B (NF-κB), B-cell lymphoma-2 (Bcl-2), and vascular endothelial growth factor (VEGF) were suppressed, whereas IκBα was promoted in miR-181-overexpressing cells. These findings indicate that miR-181 functions as a tumor suppressor and plays a substantial role in inhibiting the tumorigenesis and reversing the metastasis of ovarian cancer through RTKN2-NF-κB signaling pathway in vitro. Taken together, we believe that miR-181 may be a promising therapeutic target for treating malignant ovarian cancers.
The Physiological Impact of Window Murals on Pediatric Patients
Authors: Pearson Michelle , Gaines Kristi , Pati Debajyoti , Colwell Malinda , Motheral Leslie , Adams Nicole Gilinsky
Published: October 2018

Objectives:

To examine the magnitude of impact of two nature-themed window murals on physiological processes, as measured by heart rate and blood pressure, of pediatric patients.

Background:

Many children and adolescents find at least one aspect of the hospitalization process frightening or anxiety provoking. One physical feature linked to stress reduction is access to positive distractions. Views of nature are one of the most common forms of positive distractions in healthcare environments. Patient room windows are the most common way patients are exposed to natural elements. Exposure to views of nature is linked to a number of positive impacts on physiological outcomes. Unfortunately, not every patient room will be able to provide a nature-filled window view. In situations where nature scenes do not occur, enhanced nature views may be utilized to replicate many of the same benefits as actual nature views.

Methods:

Pediatric patients were randomly assigned to one of the three room conditions: aquatic window mural, tree window mural, or control condition. The medical data of participants ( n = 90) who stayed in the rooms were gathered and evaluated for differences.

Results:

Data analysis supports the notion that patient stress is heightened at the time of admission. Patients in the rooms with murals were found to have improvements in heart rate and systolic blood pressure in comparison to patients in control rooms, suggesting that the murals had an impact on physiological processes. Data also suggest that subject matter played a role, as patients in tree murals rooms had the most health-related outcomes.
The Benefit of Minced Cartilage Over Isolated Chondrocytes in Atelocollagen Gel on Chondrocyte Proliferation and Migration
Authors: Tsuyuguchi Yusuke , Nakasa Tomoyuki , Ishikawa Masakazu , Miyaki Shigeru , Matsushita Ryosuke , Kanemitsu Munekazu , Adachi Nobuo
Published: October 2018

Objective

Autologous chondrocyte implantation is a necessary procedure for the repair of articular cartilage defects; however, isolated chondrocyte implantation requires a 2-step procedure (for harvesting and implantation) and is limited by cytotoxicity due to enzymatic digestion. Therefore, in this in vitro study, we evaluated the possible benefit of using minced cartilage embedded in a 3-dimensional culture scaffold and fixed with fibrin glue, in comparison with isolated chondrocytes in atelocollagen, to induce cell migration, proliferation, and matrix production, using cartilage from patients with knee joint osteoarthritis.

Design

Cartilage fragments were obtained from 7 female patients with knee osteoarthritis (OA) and embedded in atelocollagen gels. As a control, chondrocytes were isolated and embedded in gels in the same manner. These composites were cultured for 3 weeks, and cell proliferation and matrix production were evaluated using histology and immunochemistry.

Results

Histologically, minced cartilage showed cell migration from the cartilage fragments into the gel, with the Bern score and cell count in the minced cartilage group being significantly higher than those in the control group. Immunohistochemistry revealed that the number of Ki67-positive cells, the expression of LECT-1 and TGF-β, and the glycosaminoglycan content were significantly higher in the minced cartilage than in the control group. Minced cartilage exhibited superior cell migration, proliferation, and glycosaminoglycan content than isolated chondrocytes.

Conclusion

Our findings support that minced cartilage has a favorable potential for cell proliferation and matrix production compared with the isolated chondrocytes after enzymatic treatment.
Islam and ideology at the movies: Prototypes, stereotypes, and the political economy
Authors: Touzani Mourad , Hirschman Elizabeth C.
Published: October 2018

Marketing controversial Islamic images in Western settings led recently to several deaths. Consumer researchers should examine the societal impact of such ideologically laden commercial representations. Our research analyses and interprets the stereotypes applied to Muslims in American motion pictures, within a political economic framework that incorporates notions of historic Western colonial/postcolonial perspectives.
Navigating medically complex patients through system barriers: Patients’ perspectives on care coordination
Authors: Siañez Monica , Pennel Cara , Tamayo Loida , Wells Rebecca
Published: October 2018

Introduction

Care coordination can improve healthcare quality and reduce costs. The objective of this study was to provide a qualitative understanding of the most helpful coordination services as experienced by patients receiving these services to reduce emergent hospital use.

Methods

Using case study methodology, we conducted focus group conversations with 51 care coordination patients and semi-structured interviews with 29 care coordinators at nine sites throughout Texas. The study team performed constant comparative analysis, beginning with start codes based on prior research.

Results

On average, focus group participants were 47 years old. The majority of participants reported a high school or General Equivalency Diploma level of education or less (84%), an annual income less than $14,999 (87%), and living with multiple chronic health conditions (60%). The majority (85%) of care coordinators reported backgrounds in nursing or social work. In our analysis, themes of what patients found most helpful fell under a broad social support framework (instrumental, informational, emotional, and advocacy) that care coordinators were uniquely situated to provide.

Discussion

Our paper adds to existing evidence by providing perspectives of patients with complex medical and non-medical needs about which care coordination services are most helpful. In this sample, patients with high needs describe reliance on professional sources, rather than their own social networks, to address several aspects of social support and to help meet non-health-related, as well as health-related needs. This can inform providers’ approaches to treatment as well as program administrators’ decisions about addressing and prioritizing services in care coordination programs.
Socioeconomic status differences in food consumption following a laboratory-induced stressor
Authors: Langer Shelby L , Soltero Erica G , Beresford Shirley AA , McGregor Bonnie A , Albano Denise L , Patrick Donald L , Bowen Deborah J
Published: October 2018

We examined food consumption in response to a laboratory-induced stressor (two challenging neuropsychological tasks) among non-Hispanic White women categorized as lower or higher in socioeconomic status based on education. The two socioeconomic status groups did not differ with respect to current hunger or baseline dietary habits. Perceived stress was measured pre- and post-challenge. Snacks were offered post-challenge; food consumption was measured by weighing snack bowls pre- and post-offering. Perceived stress increased pre- to post-challenge for both groups, but this effect was stronger for women lower in socioeconomic status. In addition, women lower versus higher in socioeconomic status consumed more food overall and more high-fat sweet food in particular (large effect sizes). These findings provide evidence of socioeconomic status differences in food consumption following an acute stressor.
Portrait of glial scar in neurological diseases
Authors: Wang Haijun , Song Guobin , Chuang Haoyu , Chiu Chengdi , Abdelmaksoud Ahmed , Ye Youfan , Zhao Lei
Published: October 2018

Fibrosis is formed after injury in most of the organs as a common and complex response that profoundly affects regeneration of damaged tissue. In central nervous system (CNS), glial scar grows as a major physical and chemical barrier against regeneration of neurons as it forms dense isolation and creates an inhibitory environment, resulting in limitation of optimal neural function and permanent deficits of human body. In neurological damages, glial scar is mainly attributed to the activation of resident astrocytes which surrounds the lesion core and walls off intact neurons. Glial cells induce the infiltration of immune cells, resulting in transient increase in extracellular matrix deposition and inflammatory factors which inhibit axonal regeneration, impede functional recovery, and may contribute to the occurrence of neurological complications. However, recent studies have underscored the importance of glial scar in neural protection and functional improvement depending on the specific insults which involves various pivotal molecules and signaling. Thus, to uncover the veil of scar formation in CNS may provide rewarding therapeutic targets to CNS diseases such as chronic neuroinflammation, brain stroke, spinal cord injury (SCI), traumatic brain injury (TBI), brain tumor, and epileptogenesis. In this article, we try to describe the new portrait of glial scar and trending of research in neurological diseases to readers.
Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment
Authors: Alang Sirry M. , McAlpine Donna D.
Published: October 2018

The gap between need and effective treatment for mental health problems continues to be a challenge for researchers and policymakers. Much of the attention has been on differences in treatment rates, with insufficient attention to variation in pathways that people take into treatment. Individuals may choose to seek help but may also be substantially influenced by others or coerced into care. The chances of each type of pathway are influenced by social characteristics and may shape perceptions of effectiveness of care. This paper investigates variation in pathways into care and perceived effectiveness of care. We also examine whether choice or coercion into care are associated with whether individuals perceive care as effective and if severity of illness moderates this relationship. We use data from the 2010–2014 National Survey on Drug Use and Health (N = 10,020). Persons who independently sought mental health care were more likely to rate treatment as effective compared to persons ordered into care. Among people with severe mental illnesses, the probability of rating treatment as effective is lowest among those who were ordered into care. Entry into mental health care is not sufficient for closing the treatment gap if coerced care leads to poorer quality outcomes.
Complementary and Alternative Medical Service Use for Mental Health Problems among Chinese Americans: The Roles of Acculturation-related Factors
Authors: Zhu Lin
Published: October 2018

The author used data from the Collaborative Psychiatric Epidemiology Surveys to examine the 12-month prevalence and predictors of the use of complementary and alternative medicine (CAM) relative to conventional Western medical services among Chinese Americans. The author examined the differences in service utilization patterns between Chinese Americans and non-Hispanic whites and the effects of acculturation factors such as generational status and English proficiency within the population of Chinese Americans. Multinomial logistic regression analyses revealed significant heterogeneity of exclusive CAM use in response to mental health problems by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first-generation Chinese immigrants lagged behind second-, third-, or higher generation Chinese Americans and non-Hispanic whites in the likelihood of using exclusive CAM services for mental health problems. In addition, this study revealed that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans. Implications for policy and research are discussed.
(De)Criminalizing Adolescent Sex: A Rights-Based Assessment of Age of Consent Laws in Eastern and Southern Africa
Authors: Kangaude Godfrey Dalitso , Skelton Ann
Published: October 2018

Age of consent criminal laws imposed on African states during colonialism were inherently patriarchal and gender-stereotypic, and continue to influence country approaches toward adolescent consensual sexual conduct. There are two major policy positions: a punitive and a nonpunitive approach. Most countries adopt the punitive approach. Mostly, legislation does not explicitly criminalize consensual sexual conduct between adolescents, and this leaves a gray area to be filled in by social and cultural norms that perceive adolescent sexual conduct negatively. Punitive approaches have been justified as necessary to curb harms to adolescents resulting from sexual conduct, including teenage pregnancies and sexual abuse. Age of consent laws, especially in their original colonial formulation deny adolescents, especially girls, sexual autonomy and agency. States focus more on punishment than on taking measures to address the structural antecedents of harms associated with sexual intercourse. States should reform age of consent laws to decriminalize consensual sex between adolescents in accordance with recognized rights of the child.
Exploring the “Blesser and Blessee” Phenomenon: Young Women, Transactional Sex, and HIV in Rural South Africa
Authors: Mampane Johannes N.
Published: October 2018

The “blesser and blessee” phenomenon has been prominent in South African media since the year 2016. This is a form of transactional sex in which older rich men (“blessers”) tend to entice young women (“blessees”) with money and expensive gifts in exchange for sexual favors. In most cases, these older men are married men who secretly engage in extramarital affairs with these young women. In this light, there have been many debates on whether transactional sex should be equated to prostitution or sex work. However, many researchers argue that both practices at the end of the day are proven to be equally high-risk sexual behaviors for HIV infection in sub-Saharan Africa. In this regard, the purpose of this study was to explore and describe perceptions and experiences of young women regarding factors that influence their susceptibility to transactional sex and the risk of HIV infection in rural South Africa. Twelve young women aged 18 to 30 years participated in two focus group discussions and 12 individual in-depth interviews. The findings of the study revealed that there are sociobehavioral, sociocultural, and socioeconomic factors that influence the susceptibility of young women to transactional sex and HIV risk. The study concluded that it was imperative for researchers to explore the context and motivation for transactional sex among young women in sub-Saharan Africa to be able to develop and implement appropriate and relevant HIV prevention interventions for this vulnerable population.
Cervical Deformity Patients Have Baseline Swallowing Dysfunction but Surgery Does Not Increase Dysphagia at 3 Months: Results From a Prospective Cohort Study
Authors: Iyer Sravisht , Kim Han Jo , Bao Hongda , Smith Justin S. , Protopsaltis Themistocles S. , Mundis Gregory M. , Passias Peter , Neuman Brian J. , Klineberg Eric O. , Lafage Virginie , Ames Christopher P. ,   The International Spine Study Group (ISSG)
Published: October 2018

Study Design:

Prospective cohort study.

Objectives:

Most studies of dysphagia in the cervical spine have focused on a degenerative patient population; the rate of dysphagia following surgery for cervical deformity (CD) is unknown. This study aims to investigate if surgery for cervical deformity results in postoperative dysphagia.

Methods:

Patients with CD undergoing surgery from 2013 to 2015 were prospectively enrolled to evaluate dysphagia. Demographic, operative, and radiographic variables were analyzed. The Quality of Life in Swallowing Disorders (SWAL-QoL) was used to measure dysphagia. Paired t test, independent t tests, and bivariate Pearson correlations were performed.

Results:

A total of 88 CD patients, aged 61.52 ± 10.52 years, were enrolled. All patients (100%) had 3-month SWAL-QoL for analysis. The baseline preoperative SWAL-QoL was 78.35. This is roughly the same level of dysphagia as an anterior cervical discectomy patient that is 3 weeks removed from surgery. Increasing body mass index (BMI) was correlated with decreased SWAL-QoL score ( r = −0.30, P = .001). Age, gender, smoking, and Charlson Comorbidity Index (CCI) showed no significant correlations with preoperative SWAL-QoL. Patients with prior cervical surgery had a lower preoperative SWAL-QoL ( P = .04). While 11 patients had acute postoperative dysphagia, CD surgery did not result in lower SWAL-QoL at 3 months (77.26 vs 78.35, P = .53). Surgical variables, including estimated blood loss (EBL), anterior or posterior fusion levels, steroid use, preoperative traction, staged surgery, surgical approach, anterior corpectomy, posterior osteotomy, and UIV (upper instrumented vertebrae) location, showed no impact on postoperative SWAL-QoL. Correction of cervical kyphosis was not correlated to 3-month SWAL-QoL scores or the change in SWAL-QoL scores.

Conclusions:

While patients undergoing surgery for cervical deformity had swallowing dysfunction at baseline, we did not observe a significant decline in SWAL-QoL scores at 3 months. Patients with prior cervical surgery and higher BMI had a lower baseline SWAL-QoL. There were no surgical or radiographic variables correlated to a change in SWAL-QOL score.
Technology Readiness and Likelihood to Use Self-Checkout Services Using Smartphone in Retail Grocery Stores: Empirical Evidences from Hyderabad, India
Authors: Mukerjee Hory Sankar , Deshmukh G. K. , Prasad U. Devi
Published: October 2018

Present study is an attempt to measure technology readiness of Indian customers towards self checkout service (SCS) through mobile app at retail stores at Hyderabad, India. Self-checkout services (SCS), a key offering of self service technology (SST), ‘is the technological enablement of customers to make payments and complete a checkout, after shopping, with little or no interaction with a service employee.’ Researchers also studied correlations between technology readiness, perceived usefulness, perceived ease of use, and likelihood to use SCS. For the purpose of the study TRI 2.0 developed by Parasuraman and Colby (2015) was used along with items of perceived usefulness and perceived ease of use, adapted from Davis (1989) , and items of ‘likelihood to use’ adapted from Bitner, Ostrom and Meuter (2002) . The findings of the study reveal that respondents’ technology readiness was moderate with respect to mobile based SCS. Significant positive correlations were found between: technology readiness and perceived ease of use, perceived ease of use and perceived usefulness, perceived ease of use and likelihood to use, perceived usefulness and likelihood to use. Further the respondents were categorised in to five technology segments as sceptics, explorers, pioneers, avoiders and hesitators.
Personal Technique of Microinfiltration With Botulin Toxin: The SINB Technique (Superficial Injection Needling Botulinum)
Authors: Calvani Francesco , Santini Stefania , Bartoletti Emanuele , Alhadeff Alessandra
Published: October 2018

The superficial injection needling botulinum (SINB) technique is the dermal injection of microdoses of botulin toxin, not by traditional syringe but with needling technique that consists in multiple microdroplets by electrical device. The intention is to decrease sweat and sebaceous gland activity to improve skin texture and sheen and to target the superficial layer of muscles that find attachment to the undersurface of the dermis causing visible rhytides. The technique is for treatment of face and neck by the injection of the botulin toxin into the dermis or in subdermal plane to improve skin texture, smoothen horizontal creases, and decrease vertical banding of the neck as well as to achieve better apposition of the platysma to the jawline and neck, improving contouring of the cervicomental angle. The botox solution is hyperconcentrated when compared to traditional dilution or compared to microbotox or mesobotox. Furthermore, the injection technique is different because spreading superficial microdroplets are not performed, but small, homogeneous, and controlled amounts of solution are injected. Each 0.8-mL syringe contains 50 units of onabotulinumtoxinA. The solution is delivered intradermally, using an electrical needling pen and setting the depth penetration of the needles at 3 to 3.5 mm. The 2 conjugated techniques play a 2-fold action on the skin. The technique was applied to a group of 63 patients dealing with face, forehead, cheekbones, and neck.
The Effect of Platelet-Rich Plasma on the Zone of Stasis and Apoptosis in an Experimental Burn Model
Authors: Uraloğlu Muhammet , Ural Alper , Efe Gökhan , Yuluğ Esin , Livaoğlu Murat , Karaçal Naci
Published: October 2018

Background:

The zone of stasis that forms in acute burn is initially viable, but coagulation progresses to necrosis in the process that follows.

Objective:

This study investigates the effects of platelet-rich plasma (PRP) on apoptosis in the burn zone of stasis and on the viability of living tissue.

Methods:

Burns were established in the right ears of 20 female New Zealand rabbits using the “comb burn” model. Platelet-rich plasma was obtained from blood collected from rabbits’ ears (n = 10) and was injected subcutaneously into the zone of stasis (n = 10). The same amount of saline solution was injected into the zone of stasis of the control group rabbits (n = 10). Histological and immunohistochemical apoptosis analysis was performed to evaluate viable areas.

Results:

Apoptosis levels were higher in the control group than in the experimental group. The area of viable tissue in the zone of stasis was greater than in the control group. Infection-induced neutrophil infiltration was statistically significantly lower in the experimental group.

Conclusion:

In this animal model, apoptosis count and viable tissue area measurement and the anti-inflammatory results in the burn area confirm that PRP therapy has a statistically significant positive impact on the survival of the zone of stasis and in acute burn injury.
Iran and India in the early historic period: A preview of their politico-cultural interface
Authors: Ghosh Suchandra
Published: October 2018

The Achaemenid Empire’s expansion towards the Indus basin initiated a new confluence of Iranic and Indian cultures. Alexander’s conquests added a Greek component to this confluence, marked by Aśoka’s Aramaic and Greek edicts. The Seleucids and their successor Greek states in Bactria and other parts of Afghanistan, while continuing their homage to Greek divinities on coins, also incorporated concepts, customs and art inherited from the Achaemenids. Their Saka and Parthian successors continued the same policy as indicated by their cons. It was the Kushans beginning with Kanishka (with Huvishka continuing the practice) who shifted to Iranian gods and goddesses.
The genetics of neuropsychiatric disorders
Authors: Bray Nicholas J. , O’Donovan Michael C.
Published: October 2018

Neuropsychiatric disorders are complex conditions with poorly defined neurobiological bases. In recent years, there have been significant advances in our understanding of the genetic architecture of these conditions and the genetic loci involved. This review article describes historical attempts to identify susceptibility genes for neuropsychiatric disorders, recent progress through genome-wide association studies, copy number variation analyses and exome sequencing, and how these insights can inform the neuroscientific investigation of these conditions.
Portfolios of Agile Projects
Authors: Sweetman Roger , Conboy Kieran
Published: October 2018

While agile approaches can be extremely effective at a project level, they can impose significant complexity and a need for adaptiveness at the project portfolio level. While this has proven to be highly problematic, there is little research on how to manage a set of agile projects at the project portfolio level. What limited research that does exist often assumes that portfolio-level agility can be achieved by simply scaling project level agile approaches such as Scrum. This study uses a complex adaptive systems lens, focusing specifically on the properties of projects as agents in a complex adaptive portfolio to critically appraise current thinking on portfolio management in an agile context. We then draw on a set of 30 expert interviews to develop 16 complex adaptive systems (CAS)-based propositions as to how portfolios of agile projects can be managed effectively. We also outline an agenda for future research and discuss the differences between a CAS-based approach to portfolio management and traditional approaches.
Rationalization, working conditions and living standards in postwar Japanese coalmining communities
Authors: Thomann Bernard
Published: October 2018

After 1945, unionization, the introduction of a new wage system, a huge effort by experts to understand the social and biological lives of miners and their families, the introduction of a new form of solidarity, and closer monitoring of the health of mining community members contributed, along with the development of the welfare state, to the formation of a more stable community around the mines and a more secure life for a new generation of miners recruited en masse just after the war to replace Korean and Chinese forced labor. Yet there is also more to the story than the narrative of a social compromise driven by rationalization and productivity policies that generated an inexorable, universal Fordist virtuous circle leading the working class to security. A close look at the social history of postwar mining communities highlights the divide between the growing stabilization of miners’ lives with the advance of the welfare state and the increasing physical and economic risks they faced with the advance of the industry’s rationalization policies driven by the decline of Japanese coal.
Application of a new hybrid particle swarm optimization-mixed kernels function-based support vector machine model for reservoir porosity prediction: A case study in Jacksonburg-Stringtown oil field, West Virginia, USA
Authors: Zhong Zhi , Carr Timothy R.
Published: October 2018

Porosity is a fundamental property that characterizes the storage capability of fluid and gas-bearing formations in a reservoir. An accurate porosity value can be measured from core samples in the laboratory; however, core analysis is expensive and time consuming. Well-log data can be used to calculate porosity, but the availability of log suites is often limited in mature fields. Therefore, robust porosity prediction requires integration of core-measured porosity with available well-log suites to control for changes in lithology and fluid content. A support vector machine (SVM) model with mixed kernel function (MKF) is used to construct the relationship between limited conventional well-log suites and sparse core data. Porosity is the desired output, and two conventional well-log responses (gamma ray [GR] and bulk density) and three well-log-derived parameters (the slope of GR, the slope of density, and [Formula: see text]) are input parameters. A global stochastic searching algorithm, particle swarm optimization (PSO), is applied to improve the efficiency of locating the appropriate values of five control parameters in MKF-SVM model. The results of SVM with different traditional kernel functions were compared, and the MKF-SVM model provided an improvement over the traditional SVM model. To confirm the advantage of the hybrid PSO-MKF-SVM model, the results from three models: (1) radial basis function (RBF)-based least-squares SVM, (2) multilayer perceptron artificial neural network (ANN), and (3) RBF ANN, are compared with the result of the hybrid PSO-MKF-SVM model. The results indicate that the hybrid PSO-MKF-SVM model improves porosity prediction with the highest correlation coefficient ([Formula: see text] of 0.9560), the highest coefficient of determination ([Formula: see text] of 0.9140), the lowest root-mean-square error (1.6505), average absolute error value (1.4050), and maximum absolute error (2.717).
Risk Factors for Transformation to Higher-Grade Lymphoma and Its Impact on Survival in a Large Cohort of Patients With Marginal Zone Lymphoma From a Single Institution
Authors: Alderuccio Juan Pablo , Zhao Wei , Desai Amrita , Gallastegui Nicolas , Ramdial Jeremy , Kimble Erik , de la Fuente Macarena I. , Rosenblatt Joseph D. , Chapman Jennifer R. , Vega Francisco , Reis Isildinha M. , Lossos Izidore S.
Published: October 2018

Purpose

Given the paucity of data on higher-grade transformation (HGT) to aggressive lymphoma in patients with marginal zone lymphoma (MZL), we report on a large cohort of patients, identify risk factors, and determine HGT impact on overall survival (OS).

Methods

We analyzed 453 patients with biopsy-proven MZL seen at our institution between 1995 and 2016. Kaplan-Meier, Cox proportional hazards regression, and competing risk methods were used in analyses of time-to-event outcomes.

Results

Thirty-four patients (7.5%) had biopsy-proven HGT to diffuse large B-cell lymphoma, including seven (21%) diagnosed at the time of initial MZL diagnosis. Among 27 incident patients, median time to HGT was 29 months (range, 1.3 to 135 months). Higher risk of HGT was observed in those with nodal/splenic MZL (subdistribution hazard ratio [SHR], 2.60; P = .023). On multivariable competing risk analysis, elevated lactate dehydrogenase (SHR, 2.71), more than four nodal sites (SHR, 2.97), and failure to achieve complete remission (CR) after initial treatment (SHR, 3.76) conveyed significantly higher risk for HGT ( P < .02). International Prognostic Index (IPI), Follicular Lymphoma IPI, and Mucosa-Associated Lymphoid Tissue Lymphoma IPI were only significant predictors of HGT univariably. Patients with HGT had shorter OS (5-year rate, 65% v 86%; P < .001). Patients who presented with HGT within 12 months since MZL diagnosis had shorter OS than those with HGT at MZL diagnosis combined with those with HGT more than 12 months later (4-year rate, 43% v 81%, P < .001). Non-CR and higher scores of IPI, Follicular Lymphoma IPI, and Mucosa-Associated Lymphoid Tissue Lymphoma IPI were the main significant predictors for shorter progression-free survival and OS.

Conclusion

Failure to achieve CR after initial treatment, elevated lactate dehydrogenase, and more than four nodal sites at the time of MZL diagnosis are the main predictors of increased risk of HGT. Patients with HGT have shorter OS.
Resource-Stratified Diagnostics in India: Current Practices and Aspirations for a National Standard
Authors: Bhattacharya Manisha
Published: October 2018

Purpose

As international health systems set goals to improve and expand access to cancer care services, the global health community has applied evidence-based principles to develop resource-stratified pathways for cancer detection, diagnosis, and treatment. The Breast Health Global Initiative (BHGI) defines four detailed sets of infrastructure at the levels of basic, limited, enhanced, and maximal. Operationalizing these pathways to improve and expand breast cancer care requires an assessment of current resource availability and use, as well as an understanding of how clinical stakeholders value and prioritize various modalities. This study adapted the BHGI framework for breast cancer diagnostics to characterize the natural state of health system capabilities in India. This work aims to contribute to the validation of the resource stratification schema while collecting implicit practitioner impressions of an aspirational resource level, as would be codified by a national standard.

Methods

We interviewed oncologists at public and private hospitals in six urban areas throughout India with a multisection survey tool about the effects of cancer care infrastructure on patient care. In this section, respondents filled out a grid representation of 30 BHGI 2.5 diagnostic modalities divided into clinical tools, imaging and laboratory tests, and pathology. Respondents indicated whether they currently used each modality, and whether they would recommend that this should be included in a national standard of breast cancer care for India.

Results

At least three fourths of respondents indicated that they personally use 21 of the diagnostic modalities (n = 52), but only recommended 15 modalities for the national standard (n = 50). The top 11 modalities currently used included six basic, three limited, and two enhanced, whereas the top 11 modalities recommended for the national standard included four basic, one limited, three enhanced, and three maximal.

Conclusion

Diagnostic modalities consistently used by urban oncologists are not fully congruent with the group’s collective vision for a national standard of care, nor do the oncologists recommend a consistently more basic or limited national approach compared with urban practice. These heterogeneous results indicate that expanding breast cancer care in India will likely require dynamic recalibration of goal resource level definitions across the nodes of each regional referral network.

AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs for the author.
New Horizons for Breast Cancer Care: Patient Navigation in a Low- and Middle-Income Country
Authors: Jaganathan Maheswari , Siu-Hoong Stephanie Teh , Zi-Yi Yeoh , Rajaram Nadia , Zainal Nur Hidayati , Hwang Teo Soo , Abdul Wahab Mohamed Yusof
Published: October 2018

Purpose

We established a patient navigation program in a secondary hospital in Malaysia. Here, we report on its impact on diagnostic and treatment timeliness for patients in the first 2 years of its implementation (n = 135 in 2015 and n = 155 in 2016) and compare these patients’ timeliness outcomes with those of patients who were diagnosed in 2014 (n = 147).

Methods

A dedicated navigation team provided education, supportive care, and practical help in overcoming individual barriers. Demographic, clinical, and timeliness data were collected and analyzed using Kruskal-Wallis and Fisher’s exact tests.

Results

Navigated patients were more likely to meet national service targets for mammography (95% in 2015 and 96% in 2016 v 74% in 2014; P < .001), biopsy (92% in 2015 and 94% in 2016 v 77% in 2014; P < .001), and communication of news (80% in 2015 and 82% in 2016 v 58% in 2014; P < .001). There was a modest impact on primary surgery (58% in 2015 and 65% in 2016 v 52% in 2014; P = .077) and neoadjuvant chemotherapy (42% in 2015 and 54% in 2016 v 56% in 2014; P = .284). We observed improvements in surgery timeliness among patients with early-stage disease but not in late-stage patients’ surgery and neoadjuvant timeliness. Barriers typically associated with late-stage disease at presentation, such as health literacy, residential distance from the hospital, and financial barriers, were not associated with delayed treatment initiation. Of interest, patients who delayed treatment initiation were less likely to have dependents younger than age 17 years (29% v 63%; P = .033).

Conclusion

Our results demonstrate that a navigation program is feasible and sustainable in a state-run hospital in a low-resource community. Whereas the program improved overall diagnostic timeliness, opportunities to improve outcomes in patients with late-stage disease may lie in diversifying navigation solutions. This includes addressing challenges that are specific to late-stage presenters and harnessing efforts at the primary care and community level to downstage breast cancer burden in Malaysia.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Teo Soo Hwang Speakers’ Bureau: AstraZeneca Research Funding: AstraZeneca Patents, Royalties, Other Intellectual Property: Cancer Research Malaysia Travel, Accommodations, Expenses: AstraZeneca
Access to Human Epidermal Growth Factor Receptor 2–Targeted Therapy at a Tertiary Care Center in India: An Evolution
Authors: Nair Nita S. , Gupta Sudeep , Ghosh Jaya , Desai Sangeeta , Parmar Vani , Shet Tanuja , Badwe Rajendra A.
Published: October 2018

Purpose

In a previous retrospective audit from our institution, access to human epidermal growth factor receptor 2 (HER2) –targeted therapy (H2T) in patients registered and treated in 2008 was reported, wherein only 38 (8.61%) of 441 patients received some form of H2T. Three developments occurred in subsequent years that potentially affected access to H2T at our institution—that is, a patient access program supported by the innovator pharmaceutical company, a generous philanthropic donor, and the use of biosimilars.

Methods

To evaluate the cumulative impact of these developments on access to trastuzumab, we reviewed access to H2T in a recent cohort of patients with breast cancer registered in at our institution.

Results

In 2016, 4,717 new patients with breast cancer were registered at our institution. Among these patients, HER2 3+ expression by immunohistochemistry or fluorescent in situ hybridization (FISH) was reported in 828 patients (22.77%). Assuming the same 33.22% amplification rate in the 343 patients who did not undergo FISH testing, there were potentially 114 more patients with HER2-amplified tumors. Thus, the final number of HER2-overexpressing/-amplified tumors is estimated to be 942 in 2016 (729 HER2 immunohistochemistry 3+, 99 known FISH amplified, and 114 estimated FISH amplified). Of these 942 patients, 13 were not deemed suitable for H2T and 94 did not follow-up for additional treatment at our institution. The remaining 835 patients were eligible to receive H2T and were analyzed for access to this treatment. Overall, 444 (53.2%) of these 835 patients received trastuzumab for durations that ranged from 12 weeks to 12 months in the (neo)adjuvant setting or other durations in the metastatic setting. This is in contrast to the previously reported 8.61% use of H2T in the cohort of patients registered in 2008.

Conclusion

We suggest that other institutions, especially public hospitals that treat underprivileged patients, make concerted efforts to increase access to potentially curative treatments, such as trastuzumab, using targeted programs and philanthropic support, and consider using a shorter duration of 12 weeks of trastuzumab to improve patient outcomes.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
Two-Phased Strategy for Improvement of Breast Cancer Care in Bangladesh
Authors: Sarker Masuma , Masum Nazmul Hoque
Published: October 2018

Purpose

Bangladesh has a low incidence of breast cancer; however, the incidence is rising rapidly and the mortality rate is significantly higher, which is complicated by limited resources. Hence, a screening and treatment strategy will not be the same as those of high-income countries.

Methods

We did a literature review, resource evaluation, and finally propose a resource-stratified two-phased implementation strategy to improve breast cancer care in Bangladesh.

Results

There is a lack of qualitative and quantitative epidemiologic data. According to limited available data, breast cancer demography is different, as almost all patients present in advanced stage and most are premenopausal women. We have identified the three most important factors that affect breast cancer management: social, cultural, and religious barriers to early detection; few treatment facilities, which are concentrated mainly in the capital; and a lack of female health care providers while seeking treatment. We propose a two-phased approach. A female-orientated primary health care system has been successful in Bangladesh in achieving many health goals. In the first phase, we propose involving a female health assistant of the primary health care system to increase awareness, early detection (clinical downstaging), and effective referral of patients with breast cancer. This program can be integrated into existing perinatal care, as a majority of patients with breast cancer are of reproductive age. At the same time, we will modify tertiary health care (THC) to establish a model one-stop breast cancer facility and we propose a single day of a week when female health care providers will be available to provide care. THC providers will conduct outreach programs at the district level. In addition, a population-based epidemiologic study and cancer registry should be started immediately. In the second phase, we aim to establish an effective breast cancer care facility at the secondary health care level, as this is accessible by a large portion of the population. We propose establishing a one-stop breast cancer facility in every district that will be inspired by the THC model clinic. Adequate resources should be allocated to achieve this goal.

Conclusion

This strategy could be a model for other resource-limited developing countries.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
Chemotherapy Affordability on Basic and Enhanced Therapy Levels in Kyrgyzstan and Tajikistan
Authors: Soldak Tatiana , Sabyrbekova Taalaigul , Abdullaeva Firuza
Published: October 2018

Purpose

Kyrgyzstan and Tajikistan are Central Asian low-income countries. Breast cancer is the most common cancer in the Kyrgyz Republic and in Tajikistan. Almost 40% of breast cancer cases are detected in advanced stages. The Kyrgyzstan and Tajikistan health care systems do not guarantee equal access to treatment to all people, and patients with breast cancer have to pay out of pocket for the entire course of chemotherapy treatment. Therefore, evaluation of the cost of a chemotherapy regimen represents a first step in the policy discussion and the creation of a government copayment system that would guarantee access to chemotherapy and ensure the effective and sustainable basic-level treatment of most patients.

Methods

Resource and Policy Exchange, Tajik, and Kyrgyz experts calculated the average drug dose per patient for adriamycin and cyclophosphamide; cyclophosphamide, methotrexate, and fluorouracil; and fluorouracil, adriamycin, and cyclophosphamide regimens recommended by the Breast Health Global Initiative as basic-level therapy and the taxanes average dose—docetaxel and paclitaxel—as enhanced-level therapy. The drug procurement cost per cycle was calculated for each chemotherapy regimen on the basis of on an average dose per patient (standard 1.75 m2), the average number of doses per cycle, and the average list price per milligram. Experts acquired cancer drug price lists from different pharmacies using the lowest generic prices available in Kyrgyzstan and Tajikistan.

Results

The cost of the basic chemotherapy regimen adriamycin and cyclophosphamide is $249 USD in Kyrgyzstan and $222 USD in Tajikistan. That of the cyclophosphamide, methotrexate, and fluorouracil regimen is $587 USD in Kyrgyzstan and $486 USD in Tajikistan. That of the fluorouracil, adriamycin, and cyclophosphamide regimen is $326 USD in Tajikistan and $526 USD in Kyrgyzstan. However, the cost of the taxanes regimen—enhanced level—is more expensive. The cost of a paclitaxel monotherapy regimen is $4896 USD in Kyrgyzstan and $4,695 USD in Tajikistan, and that of a docetaxel monotherapy regimen $1,411 USD in Kyrgyzstan and $1,086 USD in Tajikistan.

Conclusion

Chemotherapy regimen cost calculation is an integral part of advocacy and policy work. It helped to negotiate basic-level chemotherapy treatment insurance coverage for women with breast cancer. The cost of a monotherapy taxanes regimen is expensive and requires additional financial resources.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.