bluuebunny/crossref_metadata_2025 huggingface dataset:
Larger inflow angle and incomplete occlusion predict recanalization of unruptured paraclinoid aneurysms after endovascular treatment
Authors: Ji Wenjun , Liu Aihua , Lv Xianli , Sun Liqian , Liang Shikai , Li Youxiang , Yang Xinjian , Jiang Chuhan , Wu Zhongxue
Published: April 2016

Background

Unruptured paraclinoid aneurysms have a high incidence of aneurysm recanalization (AR) after endovascular treatment. We aimed to identify the incidence and predictors of AR in these lesions.

Methods

We retrospectively analyzed consecutive patients with unruptured paraclinoid aneurysms who underwent endovascular treatment between January 2013 and December 2014. Patients with fusiform aneurysms, dissection aneurysms, traumatic aneurysms, or without digital subtraction angiography (DSA) at follow-up, were excluded. AR was defined as any aneurysm remnant that had increased in size or contrast filling that was observed via DSA at the follow-up. Univariate and multivariate logistic regression analyses were performed to assess the predictors of AR.

Results

We included 145 patients with 150 unruptured paraclinoid aneurysms in the analysis. The incidence of AR was 8.7% (95% confidence interval (CI): 4.7–13.3%) at a mean follow-up of 7.4 months. In the univariate analysis, AR was associated with aneurysm size (odd ratio (OR): 6.098; 95% CI: 1.870–19.886; p = 0.003), location (OR: 3.88; 95% CI: 1.196–12.583; p = 0.024), inflow angle (OR: 6.852; 95% CI: 1.463–32.087; p = 0.015), and Raymond scale (OR: 12.473; 95% CI: 2.7496–56.59; p < 0.001). In the adjusted multivariate analysis, AR was independently predicted by Raymond scale (OR: 9.136; 95% CI: 1.683–49.587; p = 0.001) and inflow angle (OR: 16.159; 95% CI: 3.211–81.308; p = 0.01).

Conclusions

Unruptured paraclinoid aneurysms had a high incidence of AR after endovascular treatment. An inflow angle of ≥90 degrees and incomplete occlusion were significant predictors of AR.
Burden, quality of life, and social support in caregivers of patients undergoing radiotherapy for head and neck cancer: A pilot study
Authors: Nightingale Chandylen L , Curbow Barbara A , Wingard John R , Pereira Deidre B , Carnaby Giselle D
Published: April 2016

Objective

The purpose of this pilot study was to (1) obtain preliminary data on changes in burden and quality of life in head and neck cancer caregivers during and shortly following patient radiotherapy, (2) assess the relationship between perceived social support and burden as well as perceived social support and quality of life in caregivers during radiotherapy, and (3) identify preferences for sources of support among caregivers during radiotherapy.

Methods

Caregivers completed burden and quality of life instruments at the start of patient radiotherapy (T1), 5 weeks into radiotherapy (T2), and 1 month post-radiotherapy (T3) and instruments for perceived social support and support preferences at T2 only.

Results

Caregivers showed a trend toward increased burden and worsened quality of life for the majority of subscales at T2 or T3 than at T1. Caregivers reported significantly lower esteem and significantly greater disruption at T2 than at T1 and significantly worse health at T3 than at T2. Higher perceived social support was typically associated with lower burden and higher quality of life at T2. Spouses/partners were the most commonly preferred source of support.

Discussion

These pilot findings suggest that caregivers experience psychosocial impairments during and shortly after patient radiotherapy, but more research using larger samples is warranted.
Resveratrol attenuates inflammation-induced hyperexcitability of trigeminal spinal nucleus caudalis neurons associated with hyperalgesia in rats
Authors: Sekiguchi Kenta , Takehana Shiori , Shibuya Eri , Matsuzawa Nichiwa , Hidaka Shiori , Kanai Yurie , Inoue Maki , Kubota Yoshiko , Shimazu Yoshihito , Takeda Mamoru
Published: April 2016

Background

Resveratrol, a component of red wine, has been reported to decrease prostaglandin E2 production by inhibiting the cyclooxygenase-2 cascade and to modulate various voltage-dependent ion channels, suggesting that resveratrol could attenuate inflammatory hyperalgesia. However, the effects of resveratrol on inflammation-induced hyperexcitability of nociceptive neurons in vivo remain to be determined. Thus, the aim of the present study was to determine whether daily systemic administration of resveratrol to rats attenuates the inflammation-induced hyperexcitability of spinal trigeminal nucleus caudalis wide-dynamic range neurons associated with hyperalgesia.

Results

Inflammation was induced by injection of complete Freund’s adjuvant into the whisker pad. The threshold of escape from mechanical stimulation applied to whisker pad in inflamed rats was significantly lower than in control rats. The decreased mechanical threshold in inflamed rats was restored to control levels by daily systemic administration of resveratrol (2 mg/kg, i.p.). The mean discharge frequency of spinal trigeminal nucleus caudalis wide-dynamic range neurons to both nonnoxious and noxious mechanical stimuli in inflamed rats was significantly decreased after resveratrol administration. In addition, the increased mean spontaneous discharge of spinal trigeminal nucleus caudalis wide-dynamic range neurons in inflamed rats was significantly decreased after resveratrol administration. Similarly, resveratrol significantly diminished noxious pinch-evoked mean after discharge frequency and occurrence in inflamed rats. Finally, resveratrol restored the expanded mean size of the receptive field in inflamed rats to control levels.

Conclusion

These results suggest that chronic administration of resveratrol attenuates inflammation-induced mechanical inflammatory hyperalgesia and that this effect is due primarily to the suppression of spinal trigeminal nucleus caudalis wide dynamic range neuron hyperexcitability via inhibition of both peripheral and central cyclooxygenase-2 cascade signaling pathways. These findings support the idea of resveratrol as a potential complementary and alternative medicine for the treatment of trigeminal inflammatory hyperalgesia without side effects.
Suture configurations and biomechanical properties of flexor tendon repairs by 16 hand surgeons in Finland
Authors: Leppänen O. V. , Linnanmäki L. , Havulinna J. , Göransson H.
Published: April 2016

The aim of this study was to find out how common it is to modify standard core suture configurations in flexor tendon repair and whether the use of standard core suture configurations gives a stronger repair. A total of 16 hand surgeons or residents participated in a workshop, in which they were asked to draw the suture configurations they used and to repair a porcine tendon. The properties of the repaired tendons were measured. Seven participants used a standard core suture configuration, and nine used a modified core suture. The biomechanical properties of the repairs were not affected by modifications to the core suture. However, they were affected by the number and lengths of peripheral suture bites, type of peripheral suture and the location of the core suture knot.
Assessment of performance parameters of a series of five ‘historical’ cricket bat designs
Authors: Eftaxiopoulou Theofano , Persad Lomas , Bull Anthony MJ
Published: April 2016

The performance of five different bat designs, from different eras spanning from 1905 to 2013, was assessed to address the question whether the changes in bat design over the years have resulted in a performance advantage to the batsman. Moment of inertia and ‘freely suspended’ vibration analysis tests were conducted, as these physical properties have been directly associated with rebound characteristics of the bats. Results showed that changes in the blade’s profile such as distribution of the blade’s weight along the edges and closer to the toe have resulted in a clear performance advantage of the newest bats in comparison with older designs. These results add to the weight of evidence in cricket that the game has changed to the benefit of the batsman and additional changes to bat design are conceivable as modern engineering tools are applied to further optimise performance.
The Effects of Securitization, Foreclosure, and Hotel Characteristics on Distressed Hotel Prices, Resolution Time, and Recovery Rate
Authors: Singh Amrik
Published: April 2016

This study investigates the effects of securitization, foreclosure, and hotel characteristics on the sale prices of distressed hotels as well as their influence on resolution time and recovery rate. Using a sample of 4,763 financially distressed hotels between 2010 and 2014, this study provides evidence that hotel size, securitization, foreclosure, and disposal methods are important predictors of distressed property prices, resolution time, and recovery rate.
Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence based interventions
Authors: Hyland Michael E , Hinton Claire , Hill Charlotte , Whalley Ben , Jones Rupert CM , Davies Anthony F
Published: April 2016

As the cause of fibromyalgia is controversial, communicating with patients can be challenging, particularly if the patient adopts the narrative ‘I am damaged and so I need a more powerful pain killer’. Research shows that providing patients with alternative narratives can be helpful, but it remains unclear what particular narratives are most acceptable to patients and at the same time provide a rationale for evidence based psychological and exercise interventions. This article described the development of a new narrative and the written comments made about the narrative by fibromyalgia patients. The narrative derives from a complexity theory model and provides an alternative to biogenic and psychogenic models. The model was presented to 15 patients whose comments about comprehensibility led to the final format of the narrative. In the final form, the body is presented as ‘a very, very clever computer’ where fibromyalgia is caused by a software rather than a hardware problem. The software problem is caused by the body adapting when people have to ‘keep going’ despite ‘stop signals’, such as pain and fatigue. The narrative provides a rationale for engaging in psychological and exercise interventions as a way of correcting the body’s software. This way of explaining fibromyalgia was evaluated by a further 25 patients attending a 7-week ‘body reprogramming’ intervention, where the therapy was presented as correcting the body’s software, and included both exercise and psychological components. Attendance at the course was 85%. Thematic analysis of written patient feedback collected after each session showed that patients found the model believable and informative, it provided hope and was empowering. Patients also indicated that they had started to implement lifestyle change with perceived benefit. Fibromyalgia patients appear to respond positively to a technology-derived narrative based on the analogy of the body as a computer.
Quality of colonoscopy in an emerging country: A prospective, multicentre study in Russia
Authors: Antipova Mariya , Burdyukov Mikhail , Bykov Mikhail , Domarev Leonid , Fedorov Evgeny , Gabriel Sergey , Glebov Konstantin , Kashin Sergey , Knyazev Mikhail , Korotkevich Aleksey , Kotovsky Andrey , Kruglova Irina , Krushelnitsky Vladimir , Mayat Ekaterina , Merzlyakov Mikhail , Mtvralashvili Dmitry , Pyrkh Aleksander , Sannikov Oleg , Shitikov Evgeny , Subbotin Alexander , Taran Alexander , Veselov Viktor , Zavyalov Dmitry , Hassan Cesare , Radaelli Franco , Ridola Lorenzo , Repici Alessandro , Korolev Mikhail
Published: April 2016

Background

The quality of colonoscopy has been related to a higher risk of interval cancer, and this issue has been addressed extensively in developed countries. The aim of our study was to explore the main quality indicators of colonoscopy in a large emerging country.

Methods

Consecutive patients referred for colonoscopy in 14 centres were prospectively included between July and October 2014. Before colonoscopy, several clinical and demographic variables were collected. Main quality indicators (i.e. caecal intubation rate, (advanced) adenoma detection rate, rate of adequate cleansing and sedation) were collected. Data were analysed at per patient and per centre level (only for those with at least 100 cases). Factors associated with caecal intubation rate and adenoma detection rate were explored at multivariate analysis.

Results

A total of 8829 (males: 35%; mean age: 57 + 14 years) patients were included, with 11 centres enrolling at least 100 patients. Screening (including non‐alarm symptoms) accounted for 59% (5188/8829) of the indications. Sedation and split preparation were used in 26% (2294/8829) and 25% (2187/8829) of the patients. Caecal intubation was achieved in 7616 patients (86%), and it was ≥85% in 8/11 (73%) centres. Adenoma detection rate was 18% (1550/8829), and it was higher than 20% in five (45%) centres, whilst it was lower than 10% in four (33%) centres. At multivariate analysis, age (OR: 1.020, 95% CI: 1.015–1.024), male sex (OR: 1.2, 95% CI: 1.1–1.3), alarm symptoms (OR: 1.8, 95% CI: 1.7–2), split preparation (OR: 1.4, 95% CI: 1.2–1.6), caecal intubation rate (OR: 1.6, 95% CI: 1.3–1.9) and withdrawal time measurement (OR: 1.2, 95% CI: 1.6–2.1) were predictors of a higher adenoma detection rate, while adequate preparation (OR: 3.4: 95% CI: 2.9–3.9) and sedation (OR: 1.3; 95% CI: 1.1–1.6) were the strongest predictors of caecal intubation rate.

Conclusions

According to our study, there is a substantial intercentre variability in the main quality indicators. Overall, the caecal intubation rate appears to be acceptable in most centres, whilst the overall level of adenoma detection appears low, with less than half of the centres being higher than 20%. Educational and quality assurance programs, including higher rates of sedation and split regimen of preparation, may be necessary to increase the key quality indicators.
Knowledge and Acceptability of Long-Acting Reversible Contraception Among Adolescent Women Receiving School-Based Primary Care Services
Authors: Hoopes Andrea J. , Ahrens Kym R. , Gilmore Kelly , Cady Janet , Haaland Wren L. , Amies Oelschlager Anne-Marie , Prager Sarah
Published: April 2016

Background: A key strategy to reduce unintended adolescent pregnancies is to expand access to long-acting reversible contraceptive (LARC) methods, including intrauterine devices and subdermal contraceptive implants. LARC services can be provided to adolescents in school-based health and other primary care settings, yet limited knowledge and negative attitudes about LARC methods may influence adolescents’ utilization of these methods. This study aimed to evaluate correlates of knowledge and acceptability of LARC methods among adolescent women at a school-based health center (SBHC). Methods: In this cross-sectional study, female patients receiving care at 2 SBHCs in Seattle, Washington completed an electronic survey about sexual and reproductive health. Primary outcomes were (1) LARC knowledge as measured by percentage correct of 10 true-false questions and (2) LARC acceptability as measured by participants reporting either liking the idea of having an intrauterine device (IUD)/subdermal implant or currently using one. Results: A total of 102 students diverse in race/ethnicity and socioeconomic backgrounds completed the survey (mean age 16.2 years, range 14.4-19.1 years). Approximately half reported a lifetime history of vaginal sex. Greater LARC knowledge was associated with white race (regression coefficient [coef] = 26.8; 95% CI 13.3-40.4; P < .001), history of vaginal intercourse (coef = 29.9; 95% CI 17.1-42.7; P < .001), and current/prior LARC use (coef = 22.8; 95% CI 6.5-40.0; P = .007). Older age was associated with lower IUD acceptability (odds ratio = 0.53, 95% CI 0.30-0.94; P = .029) while history of intercourse was associated with greater implant acceptability (odds ratio 5.66, 95% CI 1.46-22.0; P = .012). Discussion: Adolescent women in this SBHC setting had variable knowledge and acceptability of LARC. A history of vaginal intercourse was the strongest predictor of LARC acceptability. Our findings suggest a need for LARC counseling and education strategies, particularly for young women from diverse cultural backgrounds and those with less sexual experience.
Appraisal of HIV Counseling and Testing Services Provided for Pregnant Women in Selected Government Hospitals in Ibadan Metropolis, Nigeria
Authors: Asiyanbola Olanipekun , Adejumo Prisca O. , Arulogun Oyedunni S.
Published: April 2016

HIV counseling and testing (HCT) is a critical gateway to treatment, care, and support services. For pregnant women, it is to access prevention of mother-to-child-transmission (PMTCT) services. However, not much has been done to appraise this service from the perspective of the recipients in Nigeria. This study documents the appraisal of the HCT services received at the antenatal care (ANC) services in three government hospitals in Ibadan, Nigeria, from the perspectives of pregnant women. Data were collected using focus group discussion guide among purposively selected 40 (21 primigravida and 19 multigravida) pregnant women. Observation and inventory checklists were used to collect data on procedures and basic requirements of HCT. Content analysis was used to analyze the data. Participants were neither counseled nor given opportunity to voluntarily participate in HCT services as it was made compulsory before accessing ANC. Test results were reportedly handed over directly to participants without post-test counseling. Observation of HCT procedure showed that guidelines for counseling were not strictly adhered to. Inventory of facilities, staff, and materials revealed inadequate staffing, lack of a dedicated counseling room, and inadequate antiretroviral drugs and test kits. The HCT services as provided for pregnant women are fraught with procedural inadequacies. Training and supervision of health care workers as well as provision of resources are needed to address the situation.
The effect of breastfeeding on lung function at 12 and 18 years: a prospective cohort study
Authors: Waidyatillake Nilakshi T. , Simpson Julie A. , Allen Katrina J. , Lodge Caroline J. , Dharmage Shyamali C. , Abramson Michael J. , De Livera Alysha M. , Matheson Melanie C. , Erbas Bircan , Hill David J. , Lowe Adrian J.
Published: April 2016

The objective was to assess associations between duration of total and exclusive breastfeeding and lung function up to adolescence.

A birth cohort (Melbourne Atopy Cohort Study) of 620 infants with a family history of allergic disease was recruited. Mothers were encouraged to breastfeed exclusively for 6 months. Lung function was assessed at 12 and 18 years of age. Associations between breastfeeding and lung function were investigated using multivariable linear regression and path analysis was used to assess the potential mediating factors.

Duration of breastfeeding (total and exclusive) was not associated with most assessed lung function outcomes. However, there was a trend for increased pre-bronchodilator mid-expiratory flow (MEF) at both 12 (adjusted mean difference (95% CI) per week of breastfeeding of 10 (−1–20) mL·s−1) and 18 years (11 (−1–22) mL·s−1) (p-values of 0.07 and 0.08, respectively). There was a strong indirect effect of height on these observed associations.

Duration of breastfeeding does not appear to greatly influence lung function outcomes in children with a family history of allergic diseases. Longer duration of exclusive breastfeeding may be associated with an increase in MEF, partly due to greater attained height of the child.
Multicentre chest computed tomography standardisation in children and adolescents with cystic fibrosis: the way forward
Authors: Kuo Wieying , Kemner-van de Corput Mariette P.C. , Perez-Rovira Adria , de Bruijne Marleen , Fajac Isabelle , Tiddens Harm A.W.M. , van Straten Marcel
Published: April 2016

Progressive cystic fibrosis (CF) lung disease is the main cause of mortality in CF patients. CF lung disease starts in early childhood. With current standards of care, respiratory function remains largely normal in children and more sensitive outcome measures are needed to monitor early CF lung disease. Chest CT is currently the most sensitive imaging modality to monitor pulmonary structural changes in children and adolescents with CF. To quantify structural lung disease reliably among multiple centres, standardisation of chest CT protocols is needed. SCIFI CF (Standardised Chest Imaging Framework for Interventions and Personalised Medicine in CF) was founded to characterise chest CT image quality and radiation doses among 16 participating European CF centres in 10 different countries. We aimed to optimise CT protocols in children and adolescents among several CF centres. A large variety was found in CT protocols, image quality and radiation dose usage among the centres. However, the performance of all CT scanners was found to be very similar, when taking spatial resolution and radiation dose into account. We conclude that multicentre standardisation of chest CT in children and adolescents with CF can be achieved for future clinical trials.
Asthma and bronchiectasis exacerbation
Authors: Mao Bei , Yang Jia-Wei , Lu Hai-Wen , Xu Jin-Fu
Published: April 2016

Bronchiectasis and asthma are common respiratory diseases worldwide. However, the influence of asthma on bronchiectasis remains unclear. The objective of this study is to analyse the effects of asthma on bronchiectasis exacerbation.

Data from inpatients diagnosed with bronchiectasis with or without asthma at Shanghai Pulmonary Hospital (Shanghai, China) between January 2013 and December 2014 were retrospectively collected and analysed. 249 patients with only bronchiectasis and 214 patients with both bronchiectasis and asthma were included in the study. Follow-up records were used to evaluate the effect of asthma on bronchiectasis exacerbation.

The variables found to be independently associated with bronchiectasis exacerbations were age (OR 1.07, 95% CI 1.03–1.11; p<0.001), duration of symptoms (OR 1.06, 95% CI 1.03–1.09; p<0.001), the presence of asthma (OR 2.6, 95% CI 1.15–5.88; p=0.021), forced expiratory volume in 1 s <50% predicted (OR 4.03, 95% CI 1.75–9.26; p=0.001), isolation ofPseudomonas aeruginosain sputum (OR 2.41, 95% CI 1.00–5.79; p=0.05) and lung lesion extension to more than two lobes (OR 2.73, 95% CI 1.16–6.45; p=0.022).

The existence of asthma was associated with an independent increase in risk of bronchiectasis exacerbation.
Collapse phenomenon during Chartis collateral ventilation assessment
Authors: Gesierich Wolfgang , Samitas Konstantinos , Reichenberger Frank , Behr Juergen
Published: April 2016

Chartis is increasingly used for bronchoscopic assessment of collateral ventilation before endobronchial valve (EBV) treatment for severe emphysema. Its prognostic value is, however, limited by the airway collapse phenomenon. The frequency and clinical significance of the collapse phenomenon remain largely unknown.

We performed a retrospective analysis of 92 patients undergoing Chartis evaluation under spontaneous breathing (n=55) or jet ventilation (n=37) from May 2010 to November 2013. Collateral ventilation status (positive/negative/collapse phenomenon/unclear) was reassessed and correlated with high-resolution computed tomography (HRCT) fissure analysis and clinical response.

In the absence of the collapse phenomenon, the predictive value of Chartis measurements and HRCT fissural analysis was comparable. The collapse phenomenon was observed in 31.5% of all assessments, and was more frequent in lower lobes (44.9%versus16.9% in upper lobes) and under jet ventilation (41.4%versus22.1% under spontaneous breathing). 69.8% of lobes with the collapse phenomenon had complete fissures. Most patients with the collapse phenomenon in the target lobe and complete fissures treated with EBVs were responders (n=11/15). All valve-treated collapse phenomenon patients with fissure defects were nonresponders (n=3).

In the absence of the collapse phenomenon Chartis measurement is reliable to predict response to valve treatment. In patients with the collapse phenomenon, treatment decisions should be based on HRCT detection of fissure integrity. Chartis assessment should be performed under spontaneous breathing.
Maximising follow-up participation rates in a large scale 45 and Up Study in Australia
Authors: Bauman Adrian , Phongsavan Philayrath , Cowle Alison , Banks Emily , Jorm Louisa , Rogers Kris , Jalaludin Bin , Grunseit Anne
Published: April 2016

Background

The issue of poor response rates to population surveys has existed for some decades, but few studies have explored methods to improve the response rate in follow-up population cohort studies.

Methods

A sample of 100,000 adults from the 45 and Up Study, a large population cohort in Australia, were followed up 3.5 years after the baseline cohort was assembled. A pilot mail-out of 5000 surveys produced a response rate of only 41.7 %. This study tested methods of enhancing response rate, with three groups of 1000 each allocated to (1) receiving an advance notice postcard followed by a questionnaire, (2) receiving a questionnaire and then follow-up reminder letter, and (3) both these strategies.

Results

The enhanced strategies all produced an improved response rate compared to the pilot, with a resulting mean response rate of 53.7 %. Highest response was found when both the postcard and questionnaire reminder were used (56.4 %) but this was only significantly higher when compared to postcard alone (50.5 %) but not reminder alone (54.1 %). The combined approach was used for recruitment among the remaining 92,000 participants, with a resultant further increased response rate of 61.6 %.

Conclusions

Survey prompting with a postcard and a reminder follow-up questionnaire, applied separately or combined can enhance follow-up rates in large scale survey-based epidemiological studies.
Generalized probabilistic G-contractions
Authors: Cho Seong-Hoon
Published: April 2016

In this paper, the notion of generalized probabilistic G-contractions in Menger probabilistic metric spaces endowed with a directed graph G is introduced and some new fixed point theorems for such mappings are established.
New insights on the natural killer cell repertoire from a thorough analysis of cord blood cells
Authors: Rettman Pauline , Willem Catherine , David Gaëlle , Riou Raphaëlle , Legrand Nolwenn , Esbelin Julie , Cesbron Anne , Senitzer David , Gagne Katia , Retière Christelle
Published: April 2016

Although CB NK cells are characterized as immature lymphocytes, their impressive expansion and efficient graft-versus-leukemia response have been highlighted early after UCBT. To better evaluate their potential as source of effective NK cells, we revisited the study of NK cell repertoire from a large cohort of CB samples. Our study showed that the CB NK cell repertoire appears to be constructed early, depending on KIR gene content, but not on the autologous HLA environment. NKG2A was expressed on a large proportion of CB NK cells that inversely correlated with KIR+ NK cell frequency. Self-HLA class I molecule–educated CB KIR+ NK cells present a lower spontaneous lysis than do their adult counterparts, which is probably related to the low expression of activating NK receptors. We describe for the first time a proliferative and cytotoxic NKG2C+ NK cell subset representing more than 10% of CB NK cells. NKG2A strongly inhibited CB NK cell degranulation, and its coexpression on NKG2C+ NK cells may contribute to limiting their activation. Overall, the CB NK cell repertoire is constructed early and harbors numerous functional abilities shared by adult NK cells. In addition, their naïve viral status and fast expansion confer numerous advantages in immunotherapy on CB NK cells.
Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement
Authors: Kissane David W. , Zaider Talia I. , Li Yuelin , Hichenberg Shira , Schuler Tammy , Lederberg Marguerite , Lavelle Lisa , Loeb Rebecca , Del Gaudio Francesca
Published: April 2016

Purpose

Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer.

Patients and Methods

Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis.

Results

On the CGI, a significant treatment effect (Wald χ2= 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ2= 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ2= 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II.

Conclusion

Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder.
US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose–Positron Emission Tomography Imaging: Southwest Oncology Group S0816
Authors: Press Oliver W. , Li Hongli , Schöder Heiko , Straus David J. , Moskowitz Craig H. , LeBlanc Michael , Rimsza Lisa M. , Bartlett Nancy L. , Evens Andrew M. , Mittra Erik S. , LaCasce Ann S. , Sweetenham John W. , Barr Paul M. , Fanale Michelle A. , Knopp Michael V. , Noy Ariela , Hsi Eric D. , Cook James R. , Lechowicz Mary Jo , Gascoyne Randy D. , Leonard John P. , Kahl Brad S. , Cheson Bruce D. , Fisher Richard I. , Friedberg Jonathan W.
Published: April 2016

Purpose

Four US National Clinical Trials Network components (Southwest Oncology Group, Cancer and Leukemia Group B/Alliance, Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium) conducted a phase II Intergroup clinical trial that used early interim fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to determine the utility of response-adapted therapy for stage III to IV classic Hodgkin lymphoma.

Patients and Methods

The Southwest Oncology Group S0816 (Fludeoxyglucose F 18-PET/CT Imaging and Combination Chemotherapy With or Without Additional Chemotherapy and G-CSF in Treating Patients With Stage III or Stage IV Hodgkin Lymphoma) trial enrolled 358 HIV-negative patients between July 1, 2009, and December 2, 2012. A PET scan was performed after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and was labeled PET2. PET2-negative patients (Deauville score 1 to 3) received an additional four cycles of ABVD, whereas PET2-positive patients (Deauville score 4 to 5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles. Among 336 eligible and evaluable patients, the median age was 32 years (range, 18 to 60 years), with 52% stage III, 48% stage IV, 49% International Prognostic Score 0 to 2, and 51% score 3 to 7.

Results

Three hundred thirty-six of the enrolled patients were evaluable. Central review of the interim PET2 scan was performed in 331 evaluable patients, with 271 (82%) PET2-negative and 60 (18%) PET2-positive. Of 60 eligible PET2-positive patients, 49 switched to eBEACOPP as planned and 11 declined. With a median follow-up of 39.7 months, the Kaplan-Meier estimate for 2-year overall survival was 98% (95% CI, 95% to 99%), and the 2-year estimate for progression-free survival (PFS) was 79% (95% CI, 74% to 83%). The 2-year estimate for PFS in the subset of patients who were PET2-positive after two cycles of ABVD was 64% (95% CI, 50% to 75%). Both nonhematologic and hematologic toxicities were greater in the eBEACOPP arm than in the continued ABVD arm.

Conclusion

Response-adapted therapy based on interim PET imaging after two cycles of ABVD seems promising with a 2-year PFS of 64% for PET2-positive patients, which is much higher than the expected 2-year PFS of 15% to 30%.
KIR3DL1 Allelic Polymorphism and HLA-B Epitopes Modulate Response to Anti-GD2 Monoclonal Antibody in Patients With Neuroblastoma
Authors: Forlenza Christopher J. , Boudreau Jeanette E. , Zheng Junting , Le Luduec Jean-Benoît , Chamberlain Elizabeth , Heller Glenn , Cheung Nai-Kong V. , Hsu Katharine C.
Published: April 2016

Purpose

In patients with neuroblastoma (NB), treatment with anti-GD2 monoclonal antibody (mAb) directs natural killer (NK) cell–mediated antibody-dependent cellular cytotoxicity (ADCC) against tumor cells. However, tumor cytotoxicity is attenuated by ligation of inhibitory killer immunoglobulin-like receptors (KIRs) by HLA class I molecules. KIR3DL1 polymorphism influences its ability to engage HLA-Bw4 ligands. We tested the hypothesis that poorly interacting combinations of KIR3DL1 and HLA ligands are more permissive of mAb-mediated antitumor effect.

Methods

KIR3DL1 and HLA-B subtyping were performed with a multiplex intermediate-resolution polymerase chain reaction assay for a cohort of 245 patients who were treated with antibody 3F8 for high-risk NB. Patient outcomes were analyzed according to expected degree of interaction between KIR3DL1 and HLA-B subtypes and grouped as strong, weak, or noninteractors. A comparison of NK response to 3F8 mAb opsonized NB cells between strong- and noninteracting donors was performed by flow cytometry.

Results

KIR3DL1 and HLA-B subtype combinations associated with noninteraction as a result of lack of receptor expression [KIR3DL1(−)], failure of interaction with inhibitory ligands [KIR3DS1(+)], or absence of KIR ligands resulted in significantly improved overall and progression-free survival. Patients with KIR3DL1 and HLA-B subtype combinations that were predictive of weak interaction had superior outcomes compared with those that were predictive of strong interaction; however, both groups were inferior to those with noninteracting subtype combinations. In vitro analysis of 3F8-mediated ADCC showed that KIR3DL1(−) and 3DS1(+) NK cells were insensitive to inhibition by HLA-Bw4–expressing NB targets.

Conclusion

We conclude that KIR3LD1 and HLA-B allele combinations can have a prognostic impact on patient survival after treatment with anti-GD2 mAb that relies on NK-ADCC. The survival advantage seen in noninteracting combinations supports the therapeutic disinhibition of individuals with strongly interacting KIR and ligand pairs.
Economic Implications of Widespread Expansion of Frozen Section Margin Analysis to Guide Surgical Resection in Women With Breast Cancer Undergoing Breast-Conserving Surgery
Authors: Boughey Judy C. , Keeney Gary L. , Radensky Paul , Song Christine P. , Habermann Elizabeth B.
Published: April 2016

Purpose:

In the current health care environment, cost effectiveness is critically important in policy setting and care of patients. This study performed a health economic analysis to assess the implications to providers and payers of expanding the use of frozen section margin analysis to minimize reoperations for patients undergoing breast cancer lumpectomy.

Methods:

A health care economic impact model was built to assess annual costs associated with breast lumpectomy procedures with and without frozen section margin analysis to avoid reoperation.

Results:

If frozen section margin analysis is used in 20% of breast lumpectomies and under a baseline assumption that 35% of initial lumpectomies without frozen section analysis result in reoperations, the potential annual cost savings are $18.2 million to payers and $0.4 million to providers. Under the same baseline assumption, if 100% of all health care facilities adopted the use of frozen section margin analysis for breast lumpectomy procedures, the potential annual cost savings are $90.9 million to payers and $1.8 million to providers. On the basis of 10,000 simulations, use of intraoperative frozen section margin analysis yields cost saving for payers and is cost neutral to slightly cost saving for providers.

Conclusion:

This economic analysis indicates that widespread use of frozen section margin evaluation intraoperatively to guide surgical resection in breast lumpectomy cases and minimize reoperations would be beneficial to cost savings not only for the patient but also for payers and, in most cases, for providers.
The National Practice Benchmark for Oncology: 2015 Report for 2014 Data
Authors: Balch Carla , Ogle John D. , Senese James L.
Published: April 2016

The National Practice Benchmark (NPB) is a unique tool used to measure oncology practices against others across the country in a meaningful way despite variations in practice demographics, size, and setting. In today’s challenging economic environment, each practice positions service offerings and competitive advantages to attract patients. Although the data in the NPB report are primarily reported by community oncology practices, the business structure and arrangements with regional health care systems are also reflected in the benchmark report. The ability to produce detailed metrics is an accomplishment of excellence in business and clinical management. With these metrics, a practice should be able to measure and analyze its current business practices and make appropriate changes, if necessary. In this report, we build on the foundation initially established by Oncology Metrics (acquired by Flatiron Health in 2014) over years of data collection and refine definitions to deliver the NPB, which is uniquely meaningful in the oncology market.
Board-Certified Oncology Pharmacists: Their Potential Contribution to Reducing a Shortfall in Oncology Patient Visits
Authors: Ignoffo Robert , Knapp Katherine , Barnett Mitchell , Barbour Sally Yowell , D’Amato Steve , Iacovelli Lew , Knudsen Jasen , Koontz Susannah E. , Mancini Robert , McBride Ali , McCauley Dayna , Medina Patrick , O'Bryant Cindy L. , Scarpace Sarah , Stricker Steve , Trovato James A.
Published: April 2016

Purpose:

With an aging US population, the number of patients who need cancer treatment will increase significantly by 2020. On the basis of a predicted shortage of oncology physicians, nonphysician health care practitioners will need to fill the shortfall in oncology patient visits, and nurse practitioners and physician assistants have already been identified for this purpose. This study proposes that appropriately trained oncology pharmacists can also contribute. The purpose of this study is to estimate the supply of Board of Pharmacy Specialties–certified oncology pharmacists (BCOPs) and their potential contribution to the care of patients with cancer through 2020.

Methods:

Data regarding accredited oncology pharmacy residencies, new BCOPs, and total BCOPs were used to estimate oncology residencies, new BCOPs, and total BCOPs through 2020. A Delphi panel process was used to estimate patient visits, identify patient care services that BCOPs could provide, and study limitations.

Results:

By 2020, there will be an estimated 3,639 BCOPs, and approximately 62% of BCOPs will have completed accredited oncology pharmacy residencies. Delphi panelists came to consensus (at least 80% agreement) on eight patient care services that BCOPs could provide. Although the estimates given by our model indicate that BCOPs could provide 5 to 7 million 30-minute patient visits annually, sensitivity analysis, based on factors that could reduce potential visit availability resulted in 2.5 to 3.5 million visits by 2020 with the addition of BCOPs to the health care team.

Conclusion:

BCOPs can contribute to a projected shortfall in needed patient visits for cancer treatment. BCOPs, along with nurse practitioners and physician assistants could substantially reduce, but likely not eliminate, the shortfall of providers needed for oncology patient visits.
Cancer Screening Patterns and Concerns in Caregivers of Patients Undergoing Radiation Therapy
Authors: Lin Jolinta Y. , Diwanji Tejan P. , Snider James W. , Knight Nancy , Regine William F.
Published: April 2016

Purpose:

Evolving cancer screening guidelines can confuse the public. Caregivers of patients undergoing radiation oncology may represent a promising outreach target for disseminating and clarifying screening information. We aimed to: (1) determine the incidence of cancer screening in this cohort, and (2) identify barriers to and deficiencies in screening.

Methods:

We distributed a 21-item survey on cancer screening history and related concerns to caregivers ≥ 18 years old at one urban and two suburban radiation oncology centers. Reported screening habits were compared with American Cancer Society/American Urological Association guidelines for breast, cervical, colon, and prostate cancer. Statistical analysis included Pearson χ2 tests.

Results:

A total of 209 caregivers (median age, 55.5 years; 146 women) were surveyed. Although 92% had primary care physicians (PCPs), only 58% reported being informed about recommended screening intervals. Participants ≤ 49 years old were less likely to report PCP discussion of cancer screening than older participants (41% and 66%, respectively; P = .006). Ninety-eight respondents (47%) had one or more screening concern(s). Among screening-eligible caregivers, 23 (18%) reported not undergoing regular colonoscopies. Fourteen women (13%) did not have Papanicolaou smears at recommended intervals, and 21 (18%) did not have annual mammograms. Six men (21%) did not undergo annual prostate screening. Decreased recommended screening with colonoscopy and mammography correlated with younger age.

Conclusion:

This survey of relatively unexplored caregivers identified cancer screening deficiencies and concerns that might be addressed by targeted interventions. With approximately 60% of patients with cancer receiving radiation therapy, advice in the radiation oncology setting could positively affect cancer screening behaviors in caregivers.
Ductal Carcinoma In Situ of the Breast: Should Breast Irradiation Be Routinely Added to Surgical Excision?
Authors: Wood William C.
Published: April 2016

Confusion exists among women with a new diagnosis of ductal carcinoma in situ and their physicians regarding choice of treatment. The press has accused the medical community of overtreatment and found many physicians eager to support or deny the charge. Improvements in treatment delivery have been matched with better definitions of risk on the basis of biology as defined by genomic analysis rather than only lesion size, margins, receptor status, and patient age. Understanding both the risk of a specific ductal carcinoma in situ progressing to invasive breast cancer and the risks of the treatment options allows tailored recommendations.
Nightlife as Form
Authors: Moore Madison
Published: April 2016

Madison Moore examines nightlife as a staged experience and club culture as a source of artistic innovation. Tracing its development from 1920s Harlem to its current manifestations around the globe, Moore explores how nightlife leverages darkness, the “just-beginning-to-stir,” and scenes to become incubators of popular culture.
“I Know My Way Around a Little Bit”: Bishop Joseph Donnelly and American Labor, 1941–1977
Authors: Schatz Ronald W.
Published: April 2016

In recent years labor historians have written extensively on how members of the clergy have assisted or impeded the organization of unions. However, they have largely overlooked the role of the clergy as mediators. This article discusses Bishop Joseph Donnelly, who directed the Diocesan Labor Institute of Connecticut in the 1940s and 1950s and chaired the Bishops' Ad Hoc Committee on Farm Labor in California in the early 1970s. Rev. Donnelly not only helped strengthen conservative forces in Connecticut unions and mediated disputes between unions and employers in Hartford for two decades but played a crucial role in helping the United Farm Workers win its contracts with grape owners in California. Nonetheless, Bishop Donnelly was never able to reach his ultimate objective—forging genuine respect and cooperation among rank-and-file workers, union leaders, and employers.
The Making and Remaking of a Labor Historian: Interview with James R. Barrett
Authors: Mapes Kathleen , Storch Randi
Published: April 2016

On the eve of his 2014 retirement from the University of Illinois, a group of James R. Barrett's former students gathered to interview him at his home in Champaign, Illinois. Jim's career illuminates the trajectory of the field of labor and working-class history. The interview's questions and Barrett's responses document his contribution to the field and suggest new directions that may lie ahead.
Training differentially regulates elastin level and proteolysis in skeletal and heart muscles and aorta in healthy rats
Authors: Gilbert Anna , Wyczalkowska-Tomasik Aleksandra , Zendzian-Piotrowska Malgorzata , Czarkowska-Paczek Bozena
Published: April 2016

Exercise induces changes in muscle fibers and the extracellular matrix that may depend on elastin content and the activity of proteolytic enzymes. We investigated the influence of endurance training on the gene expression and protein content and/or activity of elastin, elastase, cathepsin K, and plasmin in skeletal and heart muscles and in the aorta. Healthy rats were randomly divided into untrained (n=10) and trained (n=10; 6 weeks of endurance training with increasing load) groups. Gene expression was evaluated via qRT-PCR. Elastin content was measured via enzyme-linked immunosorbent assay and enzyme activity was measured fluorometrically. Elastin content was significantly higher in skeletal (P=0.0014) and heart muscle (P=0.000022) from trained rats versus untrained rats, but not in the aorta. Although mRNA levels in skeletal muscle did not differ between groups, the activities of elastase (P=0.0434), cathepsin K (P=0.0343) and plasmin (P=0.000046) were higher in trained rats. The levels of cathepsin K (P=0.0288) and plasminogen (P=0.0005) mRNA were higher in heart muscle from trained rats, but enzyme activity was not. Enzyme activity in the aorta did not differ between groups. Increased elastin content in muscles may result in better adaption to exercise, as may remodeling of the extracellular matrix in skeletal muscle.