bluuebunny/crossref_metadata_2025 huggingface dataset:
A Descriptive Examination of Nonmedical Fentanyl Use in the United States: Characteristics of Use, Motives, and Consequences
Authors: Kilwein Tess M. , Hunt Preston , Looby Alison
Published: April 2018

Little is currently known about nonmedical fentanyl use (NFU; that is, use of illicit or pharmaceutically produced fentanyl without a prescription or in ways other than prescribed) despite increases in prevalence and consequences (e.g., overdose, fatality). Individuals with a lifetime history of NFU ( N = 122) in the United States completed an online survey assessing demographics and factors related to use. Results revealed diversion of prescriptions, unintentional use of illicit fentanyl, and high co-occurrence of mental illness and other illicit substance use among users. Commonly reported motives reflected negative/positive reinforcement (e.g., to relieve stress, to get high) and relieving pain/physical discomfort, regardless of frequency of use. More severe consequences (e.g., increased tolerance, withdrawal) were reported among high frequency users. This descriptive examination of NFU may aid in the identification of individuals at-risk for use, promote an understanding of reasons for use, and guide prevention and intervention developments.
Evaluation of a Mobile Phone App for Providing Adolescents With Sexual and Reproductive Health Information, New York City, 2013-2016
Authors: Steinberg Allyna , Griffin-Tomas Marybec , Abu-Odeh Desiree , Whitten Alzen
Published: April 2018

The New York City (NYC) Department of Health and Mental Hygiene released the Teens in NYC mobile phone application (app) in 2013 as part of a program to promote sexual and reproductive health among adolescents aged 12-19 in NYC. The app featured a locator that allowed users to search for health service providers by sexual health services, contraceptive methods, and geographic locations. We analyzed data on searches from the Where to Go section of the app to understand the patterns of use of the app’s search functionality. From January 7, 2013, through March 20, 2016, the app was downloaded more than 20 000 times, and more than 25 000 unique searches were conducted within the app. Results suggest that the app helped adolescents discover and access a wide range of sexual health services, including less commonly used contraceptives. Those designing similar apps should consider incorporating search functionality by sexual health service (including abortion), contraceptive method, and user location.
Challenging technocratic logics in teacher education: Seeking guidance from Indigenous and Aristotelian traditions
Authors: Kerr Jeannie
Published: April 2018

In this article, I argue that technocratic forms of education are miseducational and intricately tied to matters of social inequity and colonialism. Through outlining the epistemic limitations, as well as drawing on decolonial scholarship, I point out that technocratic logics in education intentionally ignore the people, places, and more-than-human beings in educational configurations. In response to these concerns, I engage with Indigenous and Aristotelian scholarship that takes up embodied knowledge making practices that forefront ethics, place, and relations. I conclude by sharing collaborative teacher education practices conceived through being taught by Indigenous and Aristotelian traditions of thought and practice.
Migrant margins: The streetlife of discrimination
Authors: Hall Suzanne M.
Published: April 2018

The streetlife of discrimination emerges in the intersections of global migration and urban marginalisation. Focusing on livelihoods forged by migrants on four peripheral streets in Birmingham, Bristol, Leicester and Manchester, this article draws on face-to-face surveys with over 350 self-employed proprietors. Despite significant variables amongst proprietors, these individuals had all become traders on streets in marginalised parts of UK cities, and the article addresses whether ‘race’ matters more than class for how certain groups become emplaced in the city. Narratives of inequality and racism feature prominently in the proprietors’ accounts of where they settled in the city and what limited forms of work are available in the urban margins. Yet as significant to proprietors’ experiences of trade are repertoires of entrepreneurial agility and cross-cultural exchange. Through the concept of the ‘migrant margins’ the article explores the overlap of human capacities and structural discrimination that spans global and urban space. It combines urban sociological understandings of ‘race’ and inequality with fluid understandings of makeshift city-making that have emerged in post-colonial urban studies. Such combinations encourage connections between the histories and geographies of how people and places become bordered, together with city-making practices that are both marginal and transgressive.
What’s in a word? Contextual diversity, urban ethnography and the linguistic limits of the street
Authors: Dines Nick
Published: April 2018

This article takes to task a common assumption within Anglophone scholarship that conceives the street as a preeminent site of urban life, arguing that this sociological truism has worked to obscure the role of other spaces, terms and experiences across different historical, geographical and linguistic contexts. In response, and building on recent reappraisals in sociology of the work of Raymond Williams, the aim of this article is to analyse the street as a particular keyword and reflect on how a cultural materialist approach to lexical change can be incorporated into the practices of urban ethnography and translation. To develop its methodological argument, the article draws on the author’s research on Italian cities, where rather than the strada (street), the piazza and the vicolo (alleyway) have typically commanded a more prominent place in ideas about the public realm. At the same time, the disparate meanings of these two spatial forms attest to the uneven and disputed positions of different Italian cities within national urban culture. In conclusion, the article argues for greater attention to be paid to variations in language use vis-a-vis urban spatial forms as the prerequisite for a more incisive sociology of the street.
Fiber motion and the accelerated point distribution in roller drafting
Authors: Mupfudze Kudakwashe D , Cao Qiaoli , Shen Yuanying , Sun Na , Yu Chongwen
Published: April 2018

In this study, the tracer fiber method was used to determine the accelerated point distribution in both the break draft and main drafting zone of the drawing frame with varying different draft parameters. Viscose, cotton, and polyester slivers were used respectively. For the different parameters, the tracer fibers of known length were embedded in the single sliver strand, and measurements of their positions before and after drafting were taken. These measurements of the positions of tracer fibers before and after drafting were then used to deduce the nature of the fiber movement, thus determining the distribution of the accelerated points. The accelerated point distribution under different parameters was obtained. Gauss distribution was found to suitably describe the accelerated point distribution curve under different parameters used in this study. The pressure bar to some degree imparts a significant control of floating fibers within the drafting zone. The relationship between the sliver unevenness and the accelerated point variance (CV) was also discussed.
Theory of Prejudice and American Identity Threat Transfer for Latino and Asian Americans
Authors: Sanchez Diana T. , Chaney Kimberly E. , Manuel Sara K. , Remedios Jessica D.
Published: April 2018

Latinos and Asian Americans confront similar stereotypes as they are often presumed to be foreigners and subjected to American identity denial. Across six studies (total N = 992), we demonstrate that Latinos and Asians anticipate ingroup prejudice and specific types of subordination (e.g., American identity threat) in the face of outgroup threats that target one another (i.e., stigma transfer). The studies explore whether stigma transfer occurred primarily when shared Latino and Asian stereotype content was a salient component of the prejudice remark (e.g., foreigner stereotypes; Study 3), or when outgroup prejudice targeted a social group with shared stereotype content (Study 4), though neither appeared to substantively moderate stigma transfer. Minority group members who conceptualize prejudiced people as holding multiple biases (i.e., a monolithic prejudice theory) were more susceptible to stigma transfer suggesting that stereotype content is not necessary for stigma transfer because people assume that prejudice is not singular.
Targeted alpha-particle therapy: imaging, dosimetry, and radiation protection
Authors: Lassmann M. , Eberlein U.
Published: April 2018

Systemic or locoregionally administered alpha-particle emitters are highly potent therapeutic agents used in oncology that are fundamentally novel in their mechanism and, most likely, overcome radiation resistance as the alpha particles emitted have a short range and a high linear energy transfer. The use of alpha emitters in a clinic environment requires extra measures with respect to imaging, dosimetry, and radiation protection. This is shown for the example of 223Ra dichloride therapy. After intravenous injection, 223Ra leaves the blood and is taken up rapidly in bone and bone metastases; it is mainly excreted via the intestinal tract. 223Ra can be imaged in patients with a gamma camera. Dosimetry shows that, after a series of six treatments for a 70-kg person with an overall administered activity of 23 MBq, 223Ra results in an absorbed alpha dose of approximately 17 Gy to the bone endosteum and approximately 1.7 Gy to the red bone marrow. During administration, special care must be taken to ensure that no spill is present on the skin of either the patient or staff. Due to the low dose rate, the treatment is normally performed on an outpatient basis; the patient and carers should receive written instructions about the therapy and radiation protection.
Academic Facility Utilization and Survival Outcomes in Adult Head and Neck Sarcomas: An NCDB Analysis
Authors: Cannon Richard B. , Carpenter Patrick S. , Boothe Dustin , Buchmann Luke O. , Hunt Jason P. , Lloyd Shane , Hitchcock Ying J. , Houlton Jeffrey J. , Weis John R. , Shepherd Hailey M. , Monroe Marcus M.
Published: April 2018

Objectives

To investigate clinicopathologic and treatment factors associated with survival in adult head and neck sarcomas in the National Cancer Database (NCDB). To analyze whether treatment settings and therapies received influence survival outcomes and to compare trends in utilization via an aggregated national data set.

Study Design

Prospectively gathered data.

Setting

NCDB.

Subjects and Methods

The study comprised a total of 6944 adult patients treated for a head and neck sarcoma from January 2004 to December 2013. Overall survival (OS) was the primary outcome.

Results

Increased age and tumor size, nodal involvement, and poorly differentiated histology had significantly reduced OS (P <. 001). Angiosarcoma, malignant nerve sheath tumor, malignant fibrous histiocytoma, osteosarcoma, and rhabdomyosarcoma histologic subtypes had significantly reduced OS, while liposarcoma, chondrosarcoma, and chordoma had improved OS (P <. 001). Utilization of surgical therapy was associated with improved OS, while positive surgical margins were associated with treatment at a community‐based cancer program and had reduced OS (P <. 001). On multivariate analysis, treatment with radiation and/or chemotherapy was not significantly associated with OS; however, primary treatment with definitive chemoradiotherapy had significantly reduced OS. Patients treated at academic/research cancer programs (n = 3874) had significantly improved 5‐ and 10‐year OS (65% and 54%, respectively) when compared with patients treated at community‐based cancer programs (n = 3027; 49% and 29%; P <. 001). The percentage utilization of these programs (56% vs 44%) did not change over the study period.

Conclusion

For adult head and neck sarcomas, treatment at an academic/research cancer program was associated with improved survival; however, despite increasing medical specialization, the percentage utilization of these programs for this rare tumor remains constant.
Domestic Anxieties, Recalcitrant Intimacies: Representation of Servants in Hindi Print Culture of Colonial India
Authors: Gupta Charu
Published: April 2018

This essay presents a social history of power relations between domestic workers and their employers by examining the representations of servants in a wide array of Hindi print literature, including didactic manuals, popular magazines, reformist writings and cartoons, in the early twentieth-century North India. Exploring possibilities within repertoires of representation, it navigates how a contentious discourse around servant and employer developed in the Hindi print sphere. The essay links the portrayal of servants with changing class, caste and religious dynamics, in which print intersected with material circumstances to shape the hierarchical relationship between servants and employers. While imaging ‘ideal’ servants, the Hindi vernacular was also infused with their negative counterparts and anxieties around personal interactions between mistresses and servants, taking its cue from quotidian life and caste–community relations of the time. Increasing assertion by Dalits and growing antagonism between Hindus and Muslims left its imprints on portrayals of subordinate-caste and Muslim servants by dominant castes and classes. The vernacular straddled these domains of distance/desire and hate/love in the servant–employer relationship.
Populist Eurosceptic trajectories in Italy and the Netherlands during the European crises
Authors: Pirro Andrea LP , van Kessel Stijn
Published: April 2018

Multiple crises shook the European Union (EU) during the past decade. First, the economic and financial crises that unfolded since 2008 shook the foundations of the European project and its monetary union. Then, the inflow of migrants and asylum seekers into Europe in 2015 questioned the EU’s ability to jointly respond to common political issues. More recently, Brexit came across as the corollary of a prolonged legitimacy crisis. These crises have not only affected the course of European integration but also provided novel issues for political competition within the EU member states. At the party-political level, populist anti-establishment parties have traditionally listed among the principal interpreters and drivers of criticism towards ‘Europe’. In this article, we empirically address the changing Eurosceptic frames adopted by populist parties during these crises and speculate on the reverberation of these frames in respective party systems. For this purpose, we focus on two cases: Italy and the Netherlands. Both countries present instances of populist parties of different ideological persuasions within traditionally Europhile contexts. At the same time, both countries have been affected to very different extents by the recent crises, allowing us to examine how populist parties have responded to different political opportunities.
Minority size and socio-economic inequalities: A case study of Muslim minority in India
Authors: Hassan Riaz , Balaev Mikhail , Shariff Abusaleh
Published: April 2018

The authors investigate the relationship between Muslim minority size and inequality using a new cross-sectional dataset of 599 Indian districts. The authors review existing studies, propose a new population growth inequality theory, and develop three hypotheses. A newly constructed multidimensional index of social well-being is used as a proxy for intergroup inequality. A multi-level mixed effects regression analysis with controls for urbanization and state-level effects is applied. The authors find a U-shaped relationship between the size of the Muslim minority and its absolute and relative well-being. Well-being reaches the lowest point when minority reaches approximately 50% of the population in a district. The average gap in well-being tends to be larger in the districts with lower socio-economic development.
The use of periodized exercise prescription in rehabilitation: a systematic scoping review of literature
Authors: Boggenpoel Blake Yale , Nel Stephan , Hanekom Susan
Published: April 2018

Objective:

To describe the use of periodized exercise prescription with patients in the context of rehabilitation.

Data source:

The following databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, CINAHL, ScienceDirect, PEDro, Web of Science, SPORTDiscus, SAGE and Google Scholar. Databases were searched from inception to March 2018.

Results:

The literature search yielded 1772 articles with 1755 being excluded leaving 17 articles in total for the full review. Methodological quality and internal validity of the included papers were lacking. The included studies failed to indicate in which phase rehabilitation had occurred. Programme structure relating to the use of a familiarization phase, sequencing of exercises and structuring of specific phases (i.e. macrocycle, mesocycle and microcycle) was not present and lacked consistency across the board.

Conclusion:

Periodization models of exercise prescription are being used within a variety of population groups in the rehabilitation setting. Integration of periodization principles into a rehabilitation programme still however remains a challenge. Although there is a lack of consistency with regard to the structure and implementation of a periodized model of exercise prescription in the rehabilitation context, it seems to be an alternative way in which to prescribe exercise within the rehabilitation setting.
Carcinosarcoma of the Lung: A Case Report
Authors: Testa Tommaso , Nahum Mauro , Ceppa Paola , Carbone Emanuela , Motta Giovanni
Published: April 2018

The clinical and pathological data of a single case of carcinosarcoma of the lung observed in the period from 1978 to 1998 were reviewed. The diagnosis was based on immunohistochemical examination of the surgical specimen after a lower left lobectomy. The patient was given adjuvant chemotherapy. The local recurrence showed only sarcomatous features. The characteristics of this rare tumor are discussed in this case report.
Overhead Electricity Power Lines and Childhood Leukemia: A Registry-Based, Case-Control Study
Authors: Bianchi Nadia , Crosignani Paolo , Rovelli Adriano , Tittarelli Andrea , Carnelli Celeste Antonio , Rossitto Francesco , Vanelli Umberto , Porro Emma , Berrino Franco
Published: April 2018

Aims and background

To evaluate the role of exposure to low-frequency electromagnetic fields generated by overhead power lines on the risk of childhood leukemia, we carried out a case-control study in the area (Varese province) covered by the Lombardy Cancer Registry.

Methods and study design

Exposure to magnetic fields was estimated using line load data and the distance between subjects’ homes and the nearest power line. A total of 101 cases and 412 controls were investigated.

Results

Twenty subjects (9 cases and 11 controls) were considered exposed. A significant fourfold increase in risk for leukemia in exposed subjects and a dose-response relationship were found. The risk was higher than that reported by other studies. Potential biases related to the representativity of controls and validity of exposure assessment do not seem to have influenced the risk estimates.

Conclusions

We suggest that measures to remedy residential exposure should be taken wherever practicable.
Low Incidence of Hereditary Nonpolyposis Colorectal Cancer Syndrome in a Selected Area of the Lombardy Cancer Registry
Authors: Cornaggia Matteo , Tibiletti Maria Grazia , Albarello Luca , Taborelli Monica , Longa Elena Dalla , Capella Carlo
Published: April 2018

Aims and background

Epidemiological investigations on the frequency of hereditary nonpolyposis colorectal cancer (HNPCC) syndrome are few and have shown a variable worldwide incidence ranging from 1% to 7% of all colorectal cancers (CRCs). In Italy, relevant differences have been observed: 2.8-3% of all CRCs in northern regions and less than 1% in southern regions. The aim of the present study was to investigate the HNPCC incidence in a selected area of northern Italy belonging to the Lombardy Cancer Registry.

Methods and study design

We analyzed 197 consecutive patients with newly diagnosed CRCs, histologically verified, and resident in two areas of the Lombardy Cancer Registry. For each case, genetic counseling with at least three generations pedigree reconstruction, HNPCC classification according to Amsterdam criteria, molecular analysis for microsatellite instability and immunohistochemistry for hMLH1 and hMSH2 were performed.

Results

A very low frequency (0.5%) of HNPCC fulfilling the Amsterdam criteria was found in comparison to the other Italian areas. Such an incidence seems to be due to actual population differences and reflects a genetic heterogeneity.

Conclusions

The data underline the importance of a precise knowledge of actual HNPCC incidence in different populations in order to optimize effectiveness and efficiency of screening programs for the disease.
Prognostic Effects of Lymph Node Micrometastases in Patients Undergoing Curative Gastrectomy for Cancer
Authors: Bozzetti Federico , Andreola Salvatore , Bignami Paola , Sirizzotti Grazia
Published: April 2018

Aims & background

It is not known whether the presence of micrometastases in the regional lymph nodes has an impact on the oncologic outcome of patients undergoing a curative (Ro) gastrectomy for cancer. The aim of the study was to assess the effects of the presence of micrometastases on survival.

Methods

We reviewed 29 patients operated on for curative (Ro) gastrectomy, with a final diagnosis of pN0, 16 or more lymph nodes in the specimen, and a follow-up of at least 4 years. The original hemotoxylin and eosin slides were reviewed, and a new section was cut from the lymph nodes and immunostained with a pool of antibodies against different types of cytokeratins. Micrometastases were detected in 5 patients (27.5% of the series) and 11 lymph nodes (1.51% of all removed lymph nodes).

Results

Mortality due to cancer progression occurred in 3 patients from the pN0 group (14.2%) and 1 patient from the pN1 group (12.5%).

Conclusions

There was no suggestion from the data that the presence of micrometastases carries an ominous prognosis in terms of survival.
Intra-Arterial Liver Chemotherapy and Hormone Therapy in Malignant Insulinoma: Case Report and Review of the Literature
Authors: Moscetti Luca , Saltarelli Rosa , Giuliani Rosa , Fornarini Giuseppe , Bezzi Mario , Cortesi Enrico
Published: April 2018

Background

Malignant insulinoma is a rare tumor. Metastatic disease confined to the liver can be treated with various locoregional treatments.

Case report

We report a case of a young woman who developed liver metastases twelve years following resection of a pancreatic insulinoma positive to anti-insulin antibodies. With five cycles of intra-arterial locoregional chemotherapy (fluorouracil and epirubicin) to the liver and monthly hormone therapy (octreotide) the patient obtained a clinical complete response. After twelve months she is still disease free.

Conclusion

Locoregional therapy for insulinoma metastatic to the liver might represent the treatment of choice; hepatic intra-arterial chemotherapy is an interesting therapeutic approach which deserves attention. The role of somatostatin analogs is limited to symptom control.
Testicular Plasmacytoma in a Patient with the Acquired Immunodeficiency Syndrome
Authors: Ramadan Ali , Naab Tammey , Frederick Winston , Green William
Published: April 2018

Clinical, laboratory, and pathologic findings from a case of primary extramedullary plasmacytoma of the testis and sinuses in a patient with acquired immunodeficiency syndrome (AIDS) are presented. To our knowledge this is the first case in the English literature of a primary testicular plasmacytoma in an HIV-infected patient. The findings in this report and those of others confirm the difference in the pattern of plasma cell tumor (PCT) presentation in patients infected with AIDS from those in non-infected individuals, suggesting that these tumors should be considered in the differential diagnosis of AIDS-associated malignancies.
Two Episodes of Ifosfamide-Related Neurotoxicity in the Same Patient following Different Schedules and Doses of the Drug. A Case Report
Authors: Comandone Alessandro , Liboni William , Picci Piero , Oliva Cristiano , Pignatta Piero , Dal Canton Orietta , Bergnolo Paola , Cutin Simona Chiadò , Boglione Antonella
Published: April 2018

We report the first case of recurrent ifosfamide-related neurotoxicity in the same patient following two distinct administrations of the drug at different doses and schedules and with a long interval between the two episodes. Remarkably, the first event was characterized by confusion and hallucinations, while the second, 29 months later, was characterized by partial and generalized seizures. Between the two episodes the patient had received high-dose cyclophosphamide, an oxazophoshorine agent closely related to ifosfamide, without any neurological side effects. We briefly discuss the diagnosis and management of ifosfamide-related encephalopathy.
Epirubicin, Cisplatin and Continuous Infusion 5-Fluorouracil (ECF) in Locally Advanced or Metastatic Gastric Cancer: A Single Institution Experience
Authors: Aitini Enrico , Rabbi Carla , Mambrini Andrea , Cavazzini Giovanna , Pari Franca , Zamagni Donatella , Cantore Maurizio , Pagani Mauro , Sorio Marco , Lusenti Annita , Adami Francesca , Smerieri Franco
Published: April 2018

Aims and Background

The role of chemotherapy in locally advanced or metastatic gastric cancer has been controversial, but chemotherapy has recently been shown to relieve tumor-related symptoms, improve quality of life and prolong survival when compared with best supportive care. Furthermore, palliative chemotherapy is also cost-effective. “Second-generation” combination chemotherapy regimens were developed in the 1980s with high activity in advanced or metastatic gastric cancer (EAP, FAMTX, PELF, ECF). In randomized studies, EAP demonstrated no difference in activity but a significantly higher overall toxicity and toxic death rate than FAMTX, and the ECF (epirubicin, cisplatin, 5-fluorouracil) regimen gave a survival and response advantage, tolerable toxicity, better quality of life and was more cost-effective than FAMTX.

Methods

Sixty patients with locally advanced or metastatic gastric cancer were treated with the ECF regimen (21 weeks of 5-fluorouracil given by continuous infusion through a central line at 200 mg/m2 for 24-hr combined with cisplatin at 60 mg/m2 iv and epirubicin at 50 mg/m2 iv beginning on day 1 and repeated every 3 weeks for 8 courses). There were 42 males and 18 females, with a median age of 64 years (range, 40-74). The median performance status was 1. The histologic type was adenocarcinoma in 44 patients and undifferentiated carcinoma in 16 (27%). Three patients had locally advanced disease (5%) and 57 had metastatic disease (95%). Seven patients (12%) had received prior chemotherapy for advanced disease.

Results

All patients were assessable for toxicity and 55 for response (5 had insufficient treatment). Toxicity was mild or moderate, and there was no toxic death. Incidence of WHO toxicity ≥ 2 was nausea and vomiting in 3%, mucositis in 3%, leukopenia in 7%, anemia in 3%, and thrombocytopenia in 2%. Port-a-Cath toxicity was thrombosis in 4, dislocation in 2 and infection in 3 patients. Seven complete responses and 13 partial responses (overall response rate, 36%) were achieved, with a response rate of 39% in untreated and 17% in pretreated patients. Nine patients (16%) had stable disease and 26 (47%) progressive disease. Most patients felt symptomatically improved on ECF.

Conclusions

Our study confirms that the ECF regimen has a favorable pattern of toxicity and is feasible on an outpatient basis. However, it did not confirm the high response rate reported in other phase II trials.
Short-Term Weekly Neoadjuvant Chemotherapy in the Treatment of Locally Advanced Cervical Cancer
Authors: Porzio Giampiero , Ficorella Corrado , Toro Gianluigi , Paris Ida , Ricevuto Enrico , Marchetti Paolo
Published: April 2018

Twenty patients with locally advanced cervical cancer (FIGO stage Ib-IIa “bulky”/VIIb) were treated with three courses of weekly PVB (day 1: cisplatin, 50 mg/m2; vincristin, 1 mg/m2; bleomycin, 30 IU over 24-hr) in a neoadjuvant setting. Toxicity was generally mild (no grade 3-4 toxicity was observed), and the treatment was well tolerated without reduction of programmed dose intensity. Fourteen patients (70%) experienced a clinical response and underwent surgery within 20 days after the third course of chemotherapy. Six patients (30%) with stable disease were treated with salvage radiotherapy. Two of the 14 responders experienced a pathologic complete response (14.2%); microscopic disease was detected in one patient with clinical complete response. Pelvic node metastases were found in 4/14 patients (28.5%) and microscopic parametrium involvement in 3/14 (21.4%). All 14 patients had free margins of resection. A short-term weekly platinum-based chemotherapy is highly effective, has little toxicity, and allows a prompt salvage therapy for nonresponding patients.
The Value of Cell Proliferation and Angiogenesis in the Prognostic Assessment of Ovarian Granulosa cell Tumors
Authors: Jurić Gordana , Žarković Neven , Nola Marin , Tillian Manfred , Jukić Stanko
Published: April 2018

Objectives

Most cases of granulosa cell tumors (GCT) of the ovary are characterized by a relatively good outcome. However, some tumors behave aggressively and some tend to recur many years after the initial diagnosis. Tumor growth depends on cell proliferation and angiogenesis. Thus, proliferative indices and microvessel density were studied to determine possible valuable methods to assess the GCT patient's outcome.

Methods and study design

Paraffin-embedded tissue blocks were available for 60 patients with primary GCT and were investigated by immunostaining with monoclonal antibodies against PCNA, Ki-67 and factor VIII-related antigen. The follow-up was available for 51 patients and ranged from 25 to 206 months. A clinical follow-up distribution of patients was made: 8 patients with recurrence (group I); 6 patients who lived with no evidence of recurrence for 100 months or more (group II), and 37 patients alive with no evidence of recurrence in the follow-up period of less than 100 months (group III).

Results

There was a statistical correlation between PCNA and Ki-67 proliferative indices. A significant increase (P «0.05) of mean PCNA and Ki-67 proliferative indices and mean tumor size was seen in patients of Group I compared to those of Group II. The mean PCNA proliferative index positively correlated with the mean Ki-67 proliferative index for Groups I and II. Mean microvessel density showed a positive correlation with mean PCNA and Ki-67 proliferative indices and with mean tumor size for Group I, whereas it was negatively correlated with PCNA proliferative index and tumor size for Group II. A positive correlation was found between mean mitotic count and both proliferative indices only for Group II. The following features were indicative of a relatively poor prognosis: GCT measuring >9 cm in diameter, PCNA >4.0%, Ki-67 >1.2%, and diffuse, insular and sarcomatoid histologic patterns.

Conclusions

The findings support the importance of proliferative factors, tumor size and histologic patterns as possible prognostic indicators for estimating the biologic behavior of patients with GCT. Unfortunately, angiogenesis did not seem to be a useful determinant parameter of a possible aggressive behavior. However, a longer follow-up period with larger series may be required to assess the value of the parameters in prediction of patient survival.
Gliosarcoma Associated with Neurofibromatosis Type I: A Case Report
Authors: Elmaci Ilhan , Kurtkaya Özlem , Boran Burak , Kiliç Türker , Pamir M. Necmettin
Published: April 2018

Neurofibromatosis type I (NF I) is the most common hereditary syndrome predisposing to neoplasia. We report the third case in the literature, documenting the combination of gliosarcoma with NF I. The patient's son was known at our center because of a history of pleomorphic xanthoastrocytoma (PXA) with NF I.

A 48-year-old man who had a number of café-au-lait spots with neurofibroma since birth presented with severe headache. Neuroradiological studies revealed a cystic tumor of the right temporal lobe of high grade nature. Surgical excision was performed and the tumor was found to be located on the surface of the temporoparietal area with cystic formation and vascular and infiltrative features. Postoperative MRI showed no detectable contrast enhancing tissue. Immunohistochemical examination evidenced the characteristics of typical gliosarcoma. The patient received radiation therapy but five months following surgery recurrence of the tumor was diagnosed. Reoperation was performed and histopathological studies confirmed the diagnosis of gliosarcoma. We believe that the neurofibromatosis was inherited by the son with PXA from the father with gliosarcoma.

The rarity of the combined occurrence of gliosarcoma and NF I, in addition to this uncommon family history, makes this case remarkable. Our findings suggest that NF I is a multifac-eted disease associated with benign as well as malignant astrocytic tumors.
Neoadjuvant Chemotherapy with Taxotere-Epirubicin-5-Fluorouracil (TEF) in Local-Regionally Advanced Breast Cancer: A Preliminary Report
Authors: Baltali Eşmen , Altundağ M Kadri , Onat Demir Ali , Abbasoğlu Osman , Özişik Yavuz , Güler Nilüfer , Atahan Lale , Berberoğlu Uğur , Altinok Mehmet , Baran Ismet , Çelik İsmail , Tekuzman Gülten
Published: April 2018

Aims and background

Sixty-three patients with local-regionally advanced breast cancer were treated with neoadjuvant chemotherapy consisting of docetaxel (Taxotere), epirubicin, and 5-fluorouracil (TEF).

Methods and study design

Preoperatively, patients received four cycles of Taxotere (80 mg/m2), epirubicin (60 mg/m2), and 5-fluorouracil (500 mg/m2), repeated every 21 days. Following completion of four cycles of chemotherapy, appropriate surgery was performed. After the surgery, patients received one cycle of the TEF chemotherapy regimen; following chemotherapy, radiotherapy was applied, and at the end two more cycles of TEF chemotherapy regimen were given.

Results

Sixty-three patients with locally advanced breast cancer were treated. Three patients were excluded from the study before the evaluation of response. Median age of the patients was 50 years (range, 25–77). Twenty-seven and 33 patients were premenopausal and postmenopausal, respectively. Thirty-nine patients were in stage IIIA and 21 in stage IIIB. Complete and partial responses were observed in 15 (25%) and 42 (70%) of the patients following four cycles of preoperative TEF chemotherapy regimen, respectively. Overall response was 95%, and primary lesion progressed only in 3 (5%) patients. The mean disease-free survival was 15.9 ± 6.8 (range, 3.5–28) months and the mean overall survival was 18.6 ± 7.2 (range, 5–30) months. The most frequent side effects were nausea-vomiting, mucositis, alopecia and leukopenia.

Conclusions

TEF therapy is a treatment with a high overall response rate and toxicities similar to other taxotere combinations. A longer follow-up of patients is necessary for the determination of disease-free survival and overall survival.
Atrial Fibrillation during Adjuvant Chemotherapy with Docetaxel: A Case Report
Authors: Palma Marzia , Mancuso Andrea , Grifalchi Federico , Lugini Antonio , Pizzardi Nicoletta , Cortesi Enrico
Published: April 2018

A 46-year-old woman had an episode of atrial fibrillation during infusion of docetaxel as adjuvant chemotherapy for an infiltrating ductal carcinoma of the breast. All cardiological tests performed before treatment were normal and there was no evidence of thyroid dysfunction nor any objective or anamnestic data indicating acute or chronic cardiovascular disease. None of the drugs administered has ever shown any proarrhythmic activity. In controlled clinical trials docetaxel was found to have a very low cardiotoxicity.
Management of Metastatic Spinal Cord Compression
Authors: Maranzano Ernesto , Trippa Fabio , Chirico Luigia , Basagni Maria Luisa , Rossi Romina
Published: April 2018

Metastatic spinal cord compression, diagnosed in 3–7% of cancer patients, is one of the most dreaded complications of metastatic cancer. It is an oncologic emergency, which must be diagnosed early and treated promptly to achieve the best results and avoid progressive pain, paralysis, sensory loss and sphincter incontinence. Patients who are ambulatory at the time of the diagnosis have a higher probability of obtaining good response to treatment and a longer survival. In clinical practice, back pain accompanies metastatic spinal cord compression in most cases, even in patients with no neurologic deficits. Magnetic resonance imaging is the best tool for diagnosing metastatic spinal cord compression and is able to identify spinal cord compression in 32–35% patients with back pain, bone metastases and normal neurologic examination. Moreover, magnetic resonance imaging gives the extension of the lesion, can diagnose other unsuspected clinical metastatic spinal cord compression sites, and is useful for the radiation oncologist in defining the target volume. Radiotherapy is the treatment of choice in most cases, whereas surgery is advised only in selected patients (ie, if stabilization is necessary, if radiotherapy has already been given in the same area, when vertebral body collapse causes bone impingement on the cord or nerve roots, when there are diagnostic doubts, or when computed tomography-guided percutaneous vertebral biopsy cannot be performed). Laminectomy should be abandoned in favor of more aggressive surgery (ie, posterior, anterior, and/or lateral approach, tumor mass resection, and stabilization of the spine). Generally, radiotherapy must be administered 7–10 days after surgery. The optimal radiation schedule has not been defined. However, as recently suggested by some clinical trials, even the hypofractionated radiotherapy regimens are effective and can be used without increasing radiation-induced myelopathy. Moderate doses of dexamethasone should be used in the early phases of therapy. After radiotherapy, spinal recurrence is generally found in sites different from the first compression area. A close post-treatment follow-up is suggested using clinical parameters (pain, motor and sphincter function), and magnetic resonance imaging should be performed only when a second metastatic spinal cord compression and/or myelopathy are clinically suspected.
High-Dose Chemotherapy with Mitoxantrone + Melphalan and Autologous Stem Cell Rescue in Metastatic Breast Cancer Patients: A Study of Feasibility and Tolerability
Authors: Martino Massimo , Morabito Fortunato , Console Giuseppe , Irrera Giuseppe , Pucci Giulia , Penna Giuseppa , Dattola Antonella , Callea Ida , Pontari Antonella , Condemi Antonia , Messina Giuseppe , Nardi Mario , Cicero Giovanni , Molica Stefano , Palazzo Salvatore , Iacopino Pasquale
Published: April 2018

Hematological and extra-hematological toxicity of mitoxantrone-containing regimens with autologous stem cell rescue was evaluated in 32 metastatic breast cancer patients. The schedule was the final part of two high-dose chemotherapy programs, including an induction phase with three courses of conventional chemotherapy with epirubicin (120 mg/m2) and cyclophosphamide (600 mg/m2) plus three courses of docetaxel (100 mg/m2) and a first high-dose chemotherapy consisting of cyclophosphamide (6000 mg/m2), thiotepa (500 mg/m2) and carboplatin (800 mg/m2) or melphalan (160 mg/m2) plus thiotepa (600 mg/m2). The final second autograft phase included mitoxantrone (60 mg/m2) associated with melphalan (160 mg/m2) and autologous stem cell rescue infusion. The median duration of severe neutropenia and thrombocytopenia was 9 (range, 7–13) and 11.5 (range, 9–29) days. The median number of units of erythrocytes and platelets transfused was 1 (0–11) and 4 (1–9), respectively. Fever for a median of 2 (0–8) days developed in 71.8% of the patients. Mucositis was observed in 81.2% (WHO grade 3–4 in 25%). No acute or late cardiac toxicity was observed. One patient died because of a transplant-unrelated cause. The response according to the program phase showed an increased rate of complete response, from 12.5% at the end of conventional chemotherapy to 21.9% after the first high-dose chemotherapy course, to increase to 43.9% after the treatment with mitoxantrone-melphalan. We conclude that a conditioning regimen with high dose mitoxantrone-melphalan fits well within the high-dose chemotherapy program.
Nerve-Sparing Radical Hysterectomy: A Pilot Study
Authors: Raspagliesi Francesco , Ditto Antonino , Kusamura Shigeki , Fontanelli Rosanna , Spatti Gianbattista , Solima Eugenio , Zanaboni Flavia , Carcangiu Maria L
Published: April 2018

Nerve-sparing radical hysterectomy has increasingly been used for cervical cancer, with less morbidity. We aimed with this study: i) to describe an alternative technique of nerve-sparing radical Piver III hysterectomy, using the CUSA®, in which attention was given to the uterosacral ligament and cardinal ligament; ii) to evaluate the feasibility of this new nerve-sparing technique; iii) to describe the surgical anatomy of the autonomic nervous system; iv) to assess the early incidence of bladder dysfunction. Twelve consecutive patients with local-regional advanced cervical cancer were enrolled in the study on nerve-sparing radical hysterectomy with extended pelvic lymphadenectomy. The mean age was 44 years (range, 30–59), mean body mass index was 24 kg/m2 (range, 18–30), mean operating time was 217 mins (range, 195–240), and mean blood loss was 437 cc (range, 200–750). The average hospitalization time was 9 days (range, 5–15 days). Two patients presented pathologically positive parametrium. Two of 12 (17%) patients were discharged with self-catheterism. In the first outpatient follow-up, 1 patient had recovered spontaneous voiding. The nerve-sparing technique with CUSA® can be an option to reduce radical hysterectomy-related morbidity. The technique proved to be feasible, with promising results in terms of preventing bladder dysfunction. An elevated body mass index and large tumors can impair the performance of the technique. Further studies clarifying neuroanatomy and neurophysiology of autonomic nervous structures, as well as a prospective controlled trial on nerve-sparing radical hysterectomy should be carried out to confirm our data.
Evaluation of Standard Tangential Irradiation versus Breast Ring Technique Using Three-Dimensional Tools in Cancerous Large Breasts
Authors: Bora Huseyin , Akmansu Muge , Gürel Ozgur
Published: April 2018

Aims and background

In patients with large breasts, tangential irradiation after lumpectomy is technically difficult. Tangential plans of large breasts comprise a large volume of the lung, axilla and heart, as well as an important volume of the opposite breast and lung.

Methods

Instead of classical positioning of the breast, we encircled the breast with a plastic polyvinyl ring-shaped tube. All five left-sided breast cancer patients underwent CT scan planning with and without the plastic ring in conventional treatment positioning. Skin treatment portals at the midline and mid axilla were marked with radio-opaque markers. The scan volume encompassed the region from just below the diaphragm to the lung apex. Patients' plans were evaluated with regard to dose-volume coverage of the breast planning target volume, ipsilateral lung, contralateral lung, heart and contralateral breast. End points were maximum dose, minimum dose, and mean dose delivered to the target or critical structure.

Results

As expected, the average volume of the left lung treated above a tolerance dose of 2000 cGy was less than 10% in the ringed breast, whereas in the other method without the ring the corresponding lung volume was 30%. The cardiac volume receiving a dose over 4000 cGy was 2% in the ringed breast and 18% in the breast without a ring.

Conclusions

With the use of a simple technique with a fairly low expenditure, acute skin reactions and late cardiac and lung morbidity can be minimized in patients with large breasts.
Immunohistochemical Markers of Thyroid Tumors Significance and Diagnostic Applications
Authors: Rosai Juan
Published: April 2018

Immunohistochemical markers of thyroid tumors can be divided into two major categories: those related to the cell types and those related to the type of pathology. The most important markers in the first category are thyroglobulin and TTF-1 for follicular cells, and calcitonin, CEA, and chromogranin for C cells. Markers in the second category are primarily directed at papillary carcinoma and include cytokeratin 19, high-molecular weight keratin (identifiable with antibody 34βE12), S-100 protein, HBME-1, galectin 3, and p27kip1. At the practical level, cell type-related markers are much more useful than disease-related markers. Markers said to be of prognostic value in medullary carcinomas are calcitonin, bcl-2, and N-myc.
Biology and Clinical Application of the Ms Gene
Authors: Elisei Rossella , Vivaldi Agnese , Pacini Furio
Published: April 2018

The sodium iodide symporter (NIS) is a plasma basolateral membrane protein that actively transports iodide to the thyroid follicular cells as the first step of thyroid hormone biosynthesis. NIS also mediates active iodide transport in other human tissues including the salivary glands, lactating mammary gland and gastric mucosa. NIS expression has been recently reported also in several other human tissues but its physiological role is still unclear. Cloning of the NIS gene and the development of specific NIS antibodies have allowed the characterization of the pathogenic role of NIS in thyroid cancer, thyroid autoimmune diseases, congenital hypothyroidism and other, non-thyroidal human diseases. The possibility to increase its levels of expression or to reinduce its expression in thyroid carcinomas that have lost the ability to take up radioiodine is one of the most promising clinically related fields of research. The recent discovery that more than 80% of human breast carcinomas endogenously express NIS protein has opened a very interesting new area of research into the possibility of using radioiodide in the diagnosis and treatment of breast cancer. In an attempt to make tumor cells susceptible to radioiodide destruction, several types of cancer cells have been transfected with the NIS gene. This has demonstrated the feasibility of the in vitro technique but also raised the problem of the absence of the iodide organification machinery in non-thyroidal cells, which, at the moment, represents the major limit of this strategy.