bluuebunny/crossref_metadata_2025 huggingface dataset:
Coloration of bacterial cellulose using in situ and ex situ methods
Authors: Shim Euijin , Kim Hye Rim
Published: April 2018

This study aimed to produce colored bacterial cellulose (BC) by adding dye during cultivation (in situ) and by dyeing BC after cultivation (ex situ), respectively. Three different dyestuffs—direct, acid and reactive—were selected for application in the coloring of BC. In the in situ method, the dyestuff is adding into the culture medium. The effects of various dyestuff and carbon sources on the production yield were evaluated. In the ex situ method, the dyestuff, BC gel, was dyed under various dyestuff and dyeing conditions. The production yield of BC cultured by the in situ method in glucose as the carbon source and using a reactive dyestuff was the highest, at about 86%. The ex situ dyeability of BC was improved by setting the dyeing conditions to pH 3 and 135℃. Both methods were evaluated regarding the surface appearance of the BC by scanning electron microscopy (SEM). The SEM showed that the defined cellulose fibril networks retained their inherent nanostructures when the dye penetrated the site through dyeing. The surface roughness of the BC, colored by the two methods, was evaluated by atomic force microscopy. The BC colored by both methods showed smooth surfaces. For BC colored by the in situ method, the surface roughness was 194 nm, indicating that the BC was smoother and finer than that obtained via the ex situ method. In comparing hue and saturation values, the BC colored by the in situ method showed clearer blue colors than that colored by the ex situ method. The in situ method was more effective than the ex situ method for coloring BC.
Meeting the Sober Self, Recognizing the Drinking Self
Authors: Robert Julie
Published: April 2018

Temporary sobriety initiatives (TSIs), popular month-long campaigns in which people abstain from alcohol to raise money for charity, aim to change participants’ relationship with alcohol. Identifying the structural and practical mechanisms of TSIs that facilitate the desired changes is an important element in understanding their popularity and purported effectiveness as public health campaigns. Drawing upon in-depth interviews with 15 Australian FebFast participants, this article argues that TSI participants, often guided by campaign organizers, loosely adopt the self-tracking and self-experimentation practices of the Quantified Self (QS) movement, which open up aspects of oneself and of alcohol that are normally hidden in order to facilitate self-improvement via discovery. Drew Leder’s corporeal phenomenology of absence and presence underpins the analysis of how TSI participants contrast deliberate periods of sobriety and inattentive normal drinking to convert abstract knowledge about alcohol and its effects into personally salient information based on lived experience. In doing so, participants shift the valence of their ambivalence about drinking even at moderate levels and convert it from the less behaviorally impactful potential ambivalence to its more influential felt form. Through such experiments, TSI participants problematize their drinking; make real the physical, psychological, and social impacts of alcohol; and even redefine what they know it to be.
Am I Expected to Be Ethical? A Role-Definition Perspective of Ethical Leadership and Unethical Behavior
Authors: Paterson Ted A. , Huang Lei
Published: April 2018

Prior studies have demonstrated that leaders’ ethical behaviors have an impact on followers’ unethical behaviors, and yet the explanatory mechanisms in this relationship have not been fully explored. To further explicate the relationship between ethical leadership and unethical employee behavior, we adopted a role-based perspective and introduced the concept of role ethicality. That is, we explored the impact that leaders’ actions and voice behaviors, particularly regarding ethical issues, have on perceptions of ethical role requirements and in turn the effect such perceptions have on unethical behavior. In a field study involving 394 employees and 68 supervisors and a randomized experiment conducted with 121 working professionals, we find that as predicted, leaders’ behaviors and ethical voice have a significant influence on role ethicality, which in turn impacts unethical behavior. Based on our empirical findings, we describe the implications, limitations, and future directions relevant to this study.
Proof of Concept for an Automated Image Analysis Method to Quantify Rat Bone Marrow Hematopoietic Lineages on H&E Sections
Authors: Kozlowski Cleopatra , Fullerton Aaron , Cain Gary , Katavolos Paula , Bravo Joseph , Tarrant Jacqueline M.
Published: April 2018

The bone marrow is an important site for assessment of the hematopoietic toxicity of new drug candidates. Here, we extended our previous work, where we developed a computer algorithm to automatically quantitate overall bone marrow cell density by analyzing digitized images of standard hematoxylin and eosin (H&E) slides of rat bone marrow and further evaluated the capability to quantify myeloid: erythroid + lymphoid (M:EL) ratio and megakaryocyte cell density. We tested the algorithm in a toxicity study, where rats were dosed with two molecules known to affect bone marrow composition, monomethyl auristatin E, and a Bcl-xL inhibitor. The image analysis method detected significant changes in M:EL and megakaryocyte number that were either not found or semiquantitatively described by manual microscopic observation of the same slides. The image analysis results were consistent with other more established but time-consuming methods that measure changes in bone marrow cell composition: smear cytology, flow cytometry, and microscopic assessment. Our work demonstrates the feasibility of a rapid and more quantitative assessment of changes in bone marrow cell lineage composition using a computer algorithm compared to microscopic examination of H&E-stained bone marrow sections.
Effects of Aging in the Striatum and Substantia Nigra of a Parkinson’s Disease Animal Model
Authors: Ureshino Rodrigo Portes , Costa Angelica Jardim , Erustes Adolfo Garcia , Pereira Gustavo José da Silva , Sinigaglia-Coimbra Rita , Smaili Soraya Soubhi
Published: April 2018

Aging is a multifactorial process associated with functional deficits, and the brain is more prone to developing chronic degenerative diseases such as Parkinson’s disease. Several groups have tried to correlate the age-related ultrastructural alterations to the neurodegeneration process using in vivo pharmacological models, but due to the limitations of the animal models, particularly in aged animals, the results are difficult to interpret. In this work, we investigated neurodegeneration induced by rotenone, as a pharmacological model of Parkinson’s disease, in both young and aged Wistar rats. We assessed animal mobility, tyrosine hydroxylase staining in the substantia nigra pars compacta (SNpc), and TdT-mediated dUTP-biotin nick end labeling-positive nuclei and reactive oxygen species production in the striatum. Interestingly, the mobility impairment, dopaminergic neuron loss, and elevated number of apoptotic nuclei in the striatum of aged control rats were similar to young rotenone-treated animals. Moreover, we observed many ultrastructural alterations, such as swollen mitochondria in the striatum, and massive lipofuscin deposits in the SNpc of the aged rotenone-treated animals. We conclude that the rotenone model can be employed to explore age-related alterations in the ontogeny that can increase vulnerability in the striatum and SNpc, which may contribute to Parkinson’s disease pathogenesis.
Göttingen Minipigs in Ocular Research
Authors: Shrader Stephanie M. , Greentree William F.
Published: April 2018

Since their development in the 1960s, Göttingen minipigs have become a popular nonrodent animal model in biomedical research, especially for ocular studies, because of their ease of handling, size, well-monitored genetics, and ocular anatomy that is similar to humans. The purpose of this mini-review is to introduce the reader to the various ways in which this animal model is currently being utilized in ocular research and to provide an overview of the diagnostic modalities that aid in this research. To date, the Göttingen minipig has been used for a variety of ocular research endeavors, including studies evaluating the safety and efficacy of ocular therapeutics, glaucoma etiopathogenesis and treatment, novel biomaterials, surgical procedures, and implantable materials/devices. In addition to histopathologic evaluation of enucleated globes, the majority of these studies make use of advanced in vivo diagnostic techniques, including electroretinography, optical coherence tomography, fundoscopic imaging, and fluorescein angiography.
Reproducing disposability: Unsettled labor strategies in the construction of e-commerce markets
Authors: Loewen Kyle
Published: April 2018

Once the logistics revolution’s paradigmatic retail model, big box retail’s declining growth over the last 15 years has left retailers searching for new outlets of expansion. One solution to this problem has been to construct e-commerce markets in order sell delivery as much as the goods delivered. Similar to Walmart’s ascendance, warehousing is again at the vanguard of these new retail models. Significantly, e-commerce’s demands on warehousing dramatically increase the amount of labor warehouses employ and the quality requirements of warehouse work. This article investigates how warehouse labor is being reproduced and restructured in order to construct e-commerce markets. My research indicates an emerging management strategy to meet these demands by scaling back their reliance on labor market intermediaries. I demonstrate this trend through the examples of two different warehouses where management stopped using temp agencies in one case and reduced their reliance on agencies and third parties in a second case. While these changes moved workers closer to “standard” forms of employment, their disposability was reproduced through discourses of “unskilled” labor and logistical practices of retention. These insights develop our understanding of flexible labor’s production in logistics and challenge broader understandings of labor market intermediaries’ significance.
A window to the true self: The importance of I-sharing in romantic relationships
Authors: Rivera Grace N. , Smith Christina M. , Schlegel Rebecca J.
Published: April 2018

This article examines the importance of I-sharing within romantic relationships. Results from four independent samples indicate that perceived frequency of I-sharing with one’s romantic partner predicts relationship satisfaction and that this relationship is potentially mediated by perceptions that one’s partner knows one’s true self. These results fit with theories about increasing expectations on modern relationships to fulfill self-expression needs.
A mare in a pub? Nonnative facilitation in phonological priming
Authors: Gor Kira , Cook Svetlana V
Published: April 2018

A phonological priming experiment reports inhibition for Russian prime-target pairs with onset overlap in native speakers. When preceded by the phonological prime /kabɨla/, the target /kabak/ ( кобыла – КАБАК, mare – PUB) takes longer to respond than the same target preceded by a phonologically unrelated word. English-speaking late learners of Russian also show inhibition, but only for high-frequency prime-target pairs. Conversely, they show facilitation for low-frequency pairs. In semantic priming (e.g. carnation – DAISY), facilitation is observed for the same two lexical frequency ranges both in native speakers and learners of Russian, suggesting that the primes and targets in the low-frequency range are familiar to the nonnative participants. We interpret nonnative phonological facilitation for low-frequency words as evidence for sublexical processing of less familiar words that is accompanied by reduced lexical competition in nonnative lexical access. We posit that low lexical competition is due to unfaithful, or fuzzy phonolexical representations: nonnative speakers are unsure about the exact phonological form of low-frequency words. Such unfaithful representations are not strongly engaged in lexical competition and selection. High reliance on sublexical rather than lexical processing may be a general property of nonnative word recognition in case when the words are less familiar and have a low level of entrenchment.
Carbon Monoxide, Cigarettes and Family Doctors
Authors: Invernizzi Giovanni , Bettoncelli Germano , D'Ambrosio Gaetano , Zappa Mario , Calzolari Mauro , Paredi Paolo , Mazza Roberto , Soresi Enzo , Boffi Roberto
Published: April 2018

Aims and Background

General practitioners could play a key role in preventive programs against tobacco-related diseases. However, they seldom take action in the office even with minimal advice counselling. Such behaviour might reflect the lack of academic teaching and the lack of practice with motivational and dependence questionnaires, considered basic tools to help smokers to quit successfully. The study was aimed to investigate the awareness of a sample of Italian family doctors as regards tobacco epidemiology and smoking cessation strategies.

Methods

A total of 428 family doctors were administered a questionnaire with a set of questions on their personal smoking habits and on personal initiatives in the office towards smokers. Another set of questions regarded their knowledge on tobacco issues, with special attention to carbon monoxide, which is widely perceived as a very dangerous poison and works as a motivational tool on smokers and adolescents. Carbon monoxide measurement was carried out on all participants to obtain objective data on smoking and to show the feasibility of the test.

Results

The percentage of self-reported current smokers among general practitioners was 24%, with a high prevalence of ex-smokers (46%), and 29% of never smokers. Family doctors were more keen to counsel adolescents than adults about tobacco, and they were very interested in continuing medical education on the issue. The doctors who took part in our study showed a surprising limited knowledge of all the issues associated with smoking cessation and prevention such as epidemiology, cigarette characteristics, success rate of smoking cessation programs, Fagerström's tolerance questionnaire, safety of nicotine replacement therapy and the knowledge of carbon monoxide as a product of cigarette smoke.

Conclusions

The scenario depicted by our survey underscores the necessity to improve the knowledge and performance of primary care physicians on tobacco-related issues in order to implement primary and secondary prevention in clinical practice.
Cytoreductive Surgery Followed by Intraperitoneal Hyperthermic Perfusion in the Treatment of Recurrent Epithelial Ovarian Cancer: A Phase II Clinical Study
Authors: Deraco Marcello , Rossi Carlo R , Pennacchioli Elisabetta , Guadagni Stefano , Somers Danielle Carlier , Santoro Nicola , Raspagliesi Francesco , Kusamura Shigeki , Vaglini Maurizio
Published: April 2018

Aims and Background

The optimal salvage therapy for recurrent ovarian carcinoma has not been clearly established. Response to second-line chemotherapy is low, with a short median survival (8.8-15 months). We investigated the effect of an aggressive approach consisting of surgery followed by intraperitoneal drug delivery and local hyperthermia.

Patients and Methods

In a phase II clinical study, 27 patients with advanced/recurrent ovarian carcinoma were treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Median patient age was 53 years (range, 30-67) and mean follow-up was 17.4 months (range, 0.3-36.0). Patients had been surgically staged and heavily pretreated with cisplatin-based, taxol-based or taxol/platinum-containing regimens. Nineteen (70%) patients were cytoreduced to minimal residual disease <2.5 mm. The intraperitoneal hyperthermic perfusion was performed with the closed abdomen technique, using a preheated polysaline perfusate containing cisplatin (25 mg/m2/L) + mitomycin C (3.3 mg/m2/L) through a heart-lung pump (mean flow of 700 mL/min) for 60 min in the hyperthermic phase (42.5 °C).

Results

Two-year overall survival was 55%. Median times to overall progression and local progression were 16 months and 21.8 months, respectively. Variables that affected the overall survival or time to progression were as follows: residual disease (P = 0.00025), patient age (P = 0.04), and lag time between diagnosis and cytoreductive surgery + intraperitoneal hyperthermic perfusion (P = 0.04). Treatment-related morbidity, mortality and acute toxicity (grade II-III) rates were 11%, 4% and 11%, respectively. Eight (89%) of 9 patients had ascites resolution.

Conclusion

Our results suggest that cytoreductive surgery + intraperitoneal hyperthermic perfusion is a well-tolerated, feasible and promising alternative in the management of selected patients with recurrent ovarian cancer, but further randomized controlled studies are needed in order to confirm our findings.
Roach's Mathematical Equations in Predicting Pathological Stage in Men with Clinically Localized Prostate Cancer
Authors: Medica Mauro , Giglio Matteo , Germinale Francesco , Timossi Luca , Romagnoli Andrea , Bertolotto Franco , Carmignani Giorgio
Published: April 2018

Aims and Background

The therapeutic choice in patients with clinically localized prostate cancer depends on preoperative clinical stage. Diagnostic instruments currently available for such an evaluation – considered separately – have not shown enough efficacy. Roach has recently introduced three simple mathematical equations that – on the basis of prostate-specific antigen and the biopsy Gleason score – are aimed at calculating the definitive pathological stage. We retrospectively analyzed our radical prostatectomy data base to assess the accuracy of the equations in predicting the final stage in patients with clinically localized prostate cancer.

Methods Study Design

The study included 173 patients who had undergone radical retropubic prostatectomy at our Institution. Patients were divided into 25 groups, depending on preoperative PSA and the biopsy Gleason score. The risk of extracapsular neoplastic growth, seminal vesicle involvement and lymph node involvement was calculated for each group by means of Roach's equations. On the basis of definitive histological examinations, we compared the expected risk to the observed risk.

Results

The observed risk fell within the interval of expected risk in I6 of 17 groups (94%) regarding the evaluation of extracapsular growth, in I5 of 17 (88%) regarding the analysis of seminal vesicle involvement, and in 14 of 17 (82%) regarding the evaluation of lymph node involvement. Therefore, the observed event was in agreement with the expected event in 45 of 51 groups (88%).

Conclusions

The equations represent a practical and effective instrument for preoperative clinical staging in patients with localized prostate cancer. By means of these mathematical formulas, one can assess the correct prognosis and – above all – plan the best therapeutic approach.
Two Cases of Histopathologically Advanced (STAGE IV) Early Gastric Cancers
Authors: Shiomi Mikio , Kamisako Toshinori , Yutani Itsuro , Kudo Masatoshi , Shigeoka Hironori , Tanaka Akira , Okuno Kiyotaka , Yasutomi Masayuki
Published: April 2018

We report two cases of early gastric cancer with distant metastases (stage IV). At our institute 1428 cases of primary gastric cancer were resected between 1980 and 1997; 536 were diagnosed as early gastric cancer based on the resected specimens (304 cases of mucosal cancer, Tis – TNM classification – and 232 of submucosal cancer, T1). 528 of these 536 cases were classified as histological stage I, six as stage II, none as stage III and two as stage IV. The incidence of stage IV early gastric cancer was 0.14% of all gastric cancers and 0.37% of the early gastric cancers. The two patients with stage IV early gastric cancer were women. Both tumors were defined as early cancer because they were confined to the submucosa. One was a type 0 IIc + III early cancer, histologically classifiable as a small, moderately differentiated adenocarcinoma (tub2 according to the Japanese Classification of Gastric Carcinoma1,2, G2; TNM classification: ICD-0 C16), size 10 × 8 mm; the other was a surface spreading type 0 lic, classifiable as a signet-ring cell carcinoma (sig, G3), size 50 × 35 mm. Stage IV factors were N3 in the first and ovarian metastasis (Krukenberg tumor) in the second case.
Suicide and Suicidal Thoughts in Cancer Patients
Authors: Filiberti Antonio , Ripamonti Carla
Published: April 2018

Backround

Many factors increase vulnerability to suicide in cancer patients. Uncontrolled pain and other physical symptoms, psychological distress, and existential suffering are related to suicide in oncology. There is a strong consensus that physicians and nurses are not adequately trained to manage the potential suicide patient. This paper offers suggestions for the early recognition of cancer patients at risk of suicide, for the planning of crisis intervention and a physician-patient communication strategy.

Methods

A review of the literature about suicide in cancer patients was carried out by MEDLINE and PSYLIT and peer contacts.

Results

Through a review of the literature and their clinical experience, the authors outline a number of vulnerability factors of suicide with the intention to help health professionals to face the dilemma of suicide in cancer patients. Clinical vignettes reveal how a patient may reject his/her suicidal intention if adequate pharmacological and psychosocial supports are offered. Other case reports of patients refusing cancer therapy show that suicide is a complex phenomenon touching ethical, sociological, medical and psychiatric issues.

Conclusions

Our findings support the hypothesis that improved patient-physician communication, to supply adequate psychological crisis intervention, respect for patient-centered care, familiarity with the tenets of palliative medicine alongside effective education in suicidology, and the routine use of teamwork may reduce the need of suicide in cancer patients and probably the need to hasten death.
Paclitaxel and Doxorubicin Combination in the First-line Treatment of Metastatic Breast Cancer
Authors: Baltalı Eşmen , Altundağ M Kadri , Güler Nilüfer , Özışık Yavuz , Fırat Dinçer , Baran İsmet , Tekuzman Gülten
Published: April 2018

Anthracyclines and taxanes are currently the most effective drugs in the treatment of metastatic breast carcinoma. The aim of this study was to determine the efficacy and toxicity of paclitaxel and doxorubicin combination in the first-line treatment of metastatic breast cancer. Forty-five women with metastatic breast cancer were recruited in the study. Median age was 49 years (range, 33-70). Treatment protocol: doxorubicin (50 mg/m2/day, 30-min infusion) followed by paclitaxel (200 mg/m2/day, 3-hr infusion) every 3 weeks. Response rates included complete response in 13 (28.9%) patients and partial response in 19 (42.2%) patients, with an overall response rate of 71%. Five (11%) patients had stable disease and 8 (18%) patients had progressive disease. At a median follow-up of 19.7 months, median time to progression for all patients was 19.9 months (95% confidence interval, 12.8 to 27 months). Median overall survival time was 28.4 months. Grade 3-4 nausea/vomiting and hematological toxicities were observed in 12 (26%) and 6 (13.3%) patients, respectively. Cardiac toxicity was observed in 2 (4.4%) patients. In this trial, paclitaxel and doxorubicin combination was demonstrated to be a favorable and active regimen in the first-line treatment of metastatic breast cancer.
Amitriptyline in Neuropathic Cancer Pain in Patients on Morphine Therapy: A Randomized Placebo-controlled, Double-blind Crossover Study
Authors: Mercadante Sebastiano , Arcuri Edoardo , Tirelli Walter , Villari Patrizia , Casuccio Alessandra
Published: April 2018

Aims and Background

Amitriptyline is the most common analgesic adjuvant used in cancer patients with neuropathic pain, even though no specific studies have demonstrated a benefit. A randomized placebo-controlled, double-blind crossover study was designed to evidence the effects of amitriptyline in patients with neuropathic cancer pain.

Methods

Sixteen advanced cancer patients with neuropathic pain on systemic morphine therapy, no longer receiving oncologic treatment, presenting moderate pain (about 4 or more, but less than 7, on a numerical scale of 0-10) in the last week, and given a stable morphine dose in the last 2 days were admitted to the study. During the first week of study, patients were administered 25 mg of amitriptyline or equivalent drops of placebo at night for 3 days and 50 mg for the following 4 days. Doses for patients aged more than 65 years were 15 mg (first 3 days) and 30 mg (3 days after). After a week, a crossover took place for the second week, with the other treatment at an inverse sequence. Opioid consumption, pain intensity, symptoms and adverse effects, mood, sleep, patient's preference, quality of life before starting the study, the first week after and the second week after were recorded.

Results

No significant benefits in analgesia were found in the global pain intensity of the previous week of treatment, the least pain intensity or the pain evaluated just after a week of treatment, at the moment of the visit, when amitriptyline was compared with placebo. A significant difference was evidenced for the worst pain (P < 0.035). No differences in opioid doses during the period of study were found. Drowsiness, confusion and dry mouth were significantly more intense with amitriptyline than with placebo (P < 0.036, 0.003, and 0.034, respectively). There were no substantial differences between the two treatments in Spitzer's quality of life score and for each item. No differences in patients' preference for the two treatment periods were found. The analgesic effects of amitriptyline were slight and associated with adverse effects.

Conclusions

In light of the results obtained in the study, the extensive use of the drug for cancer pain should be questioned.
Sentinel Lymph Node Biopsy to Stage Patients with Cutaneous Melanoma at the National Cancer Institute of Naples. Results from 240 Sentinel Node Biopsies
Authors: Caracò C , Chiofalo MG , Niro J , Ascierto PA , Botti G , Lastoria S , Mozzillo N
Published: April 2018

Aimsand background

The presence of lymph node metastases in patients with cutaneous melanoma represents the basis for correct therapy planning and is the most powerful prognostic factor to evaluate overall survival at diagnosis.

Methods and Study Design

Since 1992, when Dr Morton published his first experience, the sentinel lymph node (SLN) biopsy technique seems to have resolved this matter by correctly staging patients. We analyzed our data from 240 SLN biopsies performed in the last five years at the National Cancer Institute of Naples, evaluating the total identification rate and the nodal recurrence rate, and compared them with the preliminary data of the MSLT (melanoma sentinel lymph node trial).

Results

Of all SLNs evaluated 18.5% were micrometastatic and 14% were identified by immunohistochemical staining. Forty-one patients had metastatic SLNs and nodal dissection of the positive basins revealed no other tumor-positive lymph nodes in more than 80% of them. All patients with a Breslow thickness of less than 2 mm had micrometastases only in the SLN, while with increasing thickness two, three or more positive nodes were found. Among SLN-negative patients nine (4%) developed lymph node recurrence in the previously treated basin and were therefore considered as false negative SLN biopsies.

Conclusions

The prognostic value of SLN biopsy needs to be confirmed by the final results of the MSLT evaluating the therapeutic use of this procedure in patients with a Breslow thickness of less than 2 mm and its possible impact on the course of the disease.
Recent Applications of the Sentinel Lymph Node Concept: Preliminary Experience in Prostate Cancer
Authors: Rudoni M , Sacchetti GM , Leva L , Inglese E , Monesi G , Minocci D , Frea B
Published: April 2018

Aims and Background

Following the widespread use of radioguided surgery (RGS) in melanoma and breast cancer, we applied this new surgical strategy to prostate cancer (PC). The aims of this study were 1) to evaluate the accuracy of RGS in the detection of prostatic sentinel lymph nodes (SLN), and 2) to verify if pelvic lymphadenectomy (LAD) is an accurate means to detect solitary micrometastases.

Study design

We investigated 48 patients with PC confirmed by transrectal biopsy who underwent radical prostatectomy and bilateral LAD. A dose of 99mTc-labeled nanocolloid particles was injected into the prostate after needle positioning by ultrasonography. Serial imaging was obtained with a gamma camera, identifying 1) the first radioactive lymph node (sentinel lymph node, SLN); 2) other radioactive lymph nodes, and 3) non-active lymph nodes.

Results

Forty-three SLNs were identified in 48 patients. Twenty SLNs were located at unusual sites with respect to the extent of conventional LAD. Five SLNs were positive for micrometastases and two of these were located outside the usual LAD area. No micrometastases were found in any of the remaining lymph nodes (active and non-active).

Conclusions

These preliminary results are in agreement with the few previous scientific contributions available on this topic and indicate that it is possible to reduce the extent and duration of surgery and necessary to reevaluate the conventional sites of lymphatic drainage.
Radioguided Occult Colonic Lesion Identification (Rocli) during Open and Laparoscopic Surgery
Authors: Rezzo R , Scopinaro G , Gambaro M , Michetti P , Anfossi G
Published: April 2018

Aims and Background

Intraoperative localization, during open and laparoscopic surgery, of small, nonpalpable colonic lesions located at peculiar sites or with concurrent inflammatory bowel alterations (diverticulosis, perivisceritis) is often difficult. The aim of our work was to assess the validity of radioguided identification after preoperative labeling.

Methods and Study Design

Patients who were candidates for colon surgery for occult lesions that, because of their size and location, were assumed to be difficult to detect, underwent colonoscopy 1 to 2.5 hours before surgery. A small dose of labeled albumin macroaggregates was injected with a sclerotherapy needle into the subserosa underneath the lesion. Immediately following injection the lesion was identified with a transcutaneously placed gamma detecting probe. Intraoperative tracer detection was performed either during open surgery or by means of a laparoscopic probe (detection time 3-5 mins). The position of the lesion was marked with a suture or with a clip. Surgery was performed according to the type of lesion to be treated.

Results

In our initial clinical experience 15 colon lesions were preoperatively marked in 14 patients and were subsequently detected during surgery (four under laparoscopy) with a gamma detecting probe. This technique allows highly accurate, fast, and inexpensive surgical localization of lesions without irradiation and without complications.

Conclusion

Our experience shows that preoperative endoscopic marking of nonpalpable colon lesions with 99mTc-labeled albumin macroaggregates followed by intraoperative detection with a gamma probe is a useful clinical method that is highly accurate and without complications.
Technetium-99m Tetrofosmin Imaging in Malignant Lymphomas
Authors: Schillaci O , Filippis AM , Anselmo AP , Monteleone F , Capoccetti F , Massa R , Enrici R Maurizi , Scopinaro F
Published: April 2018

Aim

To assess the utility of 99mTc tetrofosmin (TF) scintigraphy as a diagnostic modality in lymphomas.

Methods

Seventeen patients (14 with Hodgkin's disease and three with non-Hodgkin's lymphomas; age range, 10-59 years) were investigated. Planar and SPECT images of the supradiaphragmatic region (including neck and chest) were obtained. All patients were untreated at the time of the first scintigraphy. Follow-up scans after therapy were acquired in six patients (in five twice), so a total of 28 scintigraphic studies were performed. Mediastinal, pulmonary, cervical, supraclavicular and axillary activity was evaluated and results were compared in a blinded fashion with those of CT.

Results

TF imaging demonstrated pathological focal uptake at 38 sites (16 in the mediastinum, eight in the lungs, four in the axillae, eight in the supraclavicular region and two in the cervical region) in 16 of 17 untreated patients; CT identified 24 lesions (16 in the mediastinum, two in the lungs, two in the axillae, two in the supraclavicular and two in the cervical region) in 17 patients. Scintigraphy detected 22 of the 24 lesions demonstrated by CT and revealed 16 unknown tumor sites in 10 patients. The only negative pre-treatment scintigraphy result was found in a patient with axillary lymph node involvement. On the first post-treatment scintigrams there was a reduction in the number of visualized pathological sites (seven vs 16) in five of the six patients examined. The second follow-up study demonstrated only two lesions in two of the five patients examined.

Conclusions

Our preliminary results indicate that TF imaging is effective in depicting supradiaphragmatic lymphoma lesions in untreated patients and suggest that serial scintigraphic studies may be suitable for monitoring response to treatment. However, larger series are needed to better define the possible role of TF scintigraphy in the follow-up of the response to therapy.
Sentinel Node Detection with Imaging Probe
Authors: Schillaci O , D'Errico G , Scafè R , Soluri A , Burgio N , Santagata A , Spanu A , Mangano AM , David V , Schiaratura A , Scopinaro F
Published: April 2018

A one-square-inch-field-of-view mini gamma camera, whose first prototype was built by us in 1998 and given the name imaging probe (IP), was initially employed in sentinel lymph node (SLN) detection. This is probably the best way of learning how to use it. In the present work IP was used for SLN localization by a medical team that, after having been trained by the group of nuclear physicians of “La Sapienza” University who designed and first used the detector, used IP at their own hospital to 1) acquire experience for future use during surgery (a cooperative project on IP-radioguided orthopedic surgery is ongoing) and 2) start multicenter trials with IP. The SLN was identified and localized with IP and a non-imaging probe, Neoprobe 2000, in six patients with breast cancer who underwent lymphoscintigraphy for SLN biopsy. The operators who used Neoprobe and IP were blinded to each other's findings and to the results obtained with the large-field-of-view Anger camera that was used for lymphoscintigraphy. The Anger camera, IP and Neoprobe detected seven SLNs in six patients. The mean detection time was 2 mins 6 s (standard deviation (SD) 26 s) with IP, and 2 mins 18 s (SD 47 s) with Neoprobe 2000. The SLN that was most difficult to find was detected in 2 mins 56 s with IP and 3 mins 45 s with Neoprobe. The operators' subjective impression of having detected the SLN was “absolutely sure” for 7/7 nodes with IP and “absolutely sure” for 5/7 nodes with Neoprobe.
What is Hidden behind Urban and Semiurban Cancer Incidence and Mortality Differences in Central Italy?
Authors: Crocetti Emanuele , Miccinesi Guido , Paci Eugenio , Cislaghi Cesare
Published: April 2018

Aims and backround

To analyze differences in cancer incidence and mortality between urban and semiurban municipalities in central Italy.

Methods and Study Design

Population-based survey in the provinces of Florence and Prato in Central Italy involving cancer patients diagnosed between 1985 to 1997 and cancer deaths from 1985 to 1998.

Results

Urban-semiurban incidence ratios were significantly high in both genders for all cancer sites combined (males 1.06, females 1.09), lung (1.11 and 1.37), Kaposi's sarcoma (1.96 and 2.39) and urinary bladder (1.23 and 1.44) and significantly low for stomach cancer (0.76 and 0.84). Among females, urban incidence excesses were present for breast, cervix uteri and skin melanoma and among males for prostate, Hodgkin disease, non-Hodgkin lymphomas and mesotheliomas. Most of the cancer mortality rate ratios corresponded to the incidence rate ratios.

Conclusions

We found that cancer risks and deaths were not homogeneously distributed in the analyzed area, but an urban gradient was present. Part of the differences can probably be attributed to environmental exposures and lifestyle.
Megestrol Acetate for Cachexia and Anorexia in Advanced Non-small Cell Lung Cancer: A Randomized Study Comparing Two Different Doses
Authors: Ulutin H Cüneyt , Arpaci Fikret , Pak Yücel
Published: April 2018

Background

The primary aim of the study was to compare two different dose levels of megestrol acetate, administered for cancer-related anorexia and cachexia for 3 months.

Methods

From August 1996 to December 2000, 119 patients with advanced non-small cell lung cancer were randomized to take 160 mg/day or 320 mg/day of megestrol acetate for 3 months at the Gülhane Military Medicine Academy of Ankara, Turkey. Patients were controlled at biweekly periods.

Results

There were 59 patients in the single dose arm (group 1) and 60 patients in the twice a day dose arm (group 2). The mean percentages of weight loss were 16.9% and 16.7% in group 1 and 2, respectively. In the first and the second month of weight gain, there were no significant differences in the two groups (P = 0.23 and P = 0.11). In the third month, weight gain was significantly higher in group 2 than in group 1 (P = 0.038). Toxicity was similar for both dose levels.

Conclusions

Megestrol acetate can be safely and effectively given to patients with advanced non-small cell lung cancer. Although lower doses of megestrol acetate can be effective for anorexia and cachexia, the higher dose level seems to be more efficient.
Late Local Treatment Morbidity after Accelerated Radiotherapy or Alternating Chemoradiotherapy for Advanced Head and Neck Carcinoma
Authors: Sanguineti Giuseppe , Sormani Maria Pia , Benasso Marco , Corvò Renzo , Foppiano Franca , Ricci Isabella , Marcenaro Michela , Rosso Riccardo , Vitale Vito
Published: April 2018

Background

To report local long-term morbidity after concomitant boost radiotherapy (AFRT) or alternating chemoradiotherapy (CTRT), we analyzed the toxicity data recorded in 168 patients with advanced head and neck squamous cell carcinoma treated at our institution within phase II-III studies.

Patients and Methods

All patients enrolled in three consecutive phase II-III studies and followed for a minimum of three months after the end of treatment were included in the present analysis. Local late reactions were scored prospectively. The actuarial incidence of grade 2 or more (2-4) late local toxicity according to RTOG/EORTC was taken as endpoint. The median follow-up is 32.0 months (range, 3.3-138.1 months). For living patients the minimum and median follow-up are 12.1 and 69.3 months, respectively.

Results

The five-year actuarial incidence of grade 2+ and grade 3+ toxicity are 56.7 ± 5% and 21 ± 4%, respectively. At multivariate analysis, acute mucositis grade, complementary surgery, primary site and performance status proved to be independent predictive factors of grade 2+ late toxicity with P values of <0.001, 0.009, 0.022 and 0.033, respectively. No effect was found for treatment itself on the incidence of late toxicity, although patients treated with accelerated radiotherapy had a higher probability of confluent mucositis than patients treated with alternating chemoradiotherapy (68% vs 32%, P <0.01).

Conclusions

A substantial proportion of surviving patients develops late complications, although severe irreversible reactions occur in a minority of patients. Acute local toxicity can be used to predict local late toxicity that arises within five years of the end of treatment.
Post-Traumatic Intracranial Meningiomas
Authors: Caroli Emanuela , Salvati Maurizio , Rocchi Giovanni , Frati Alessandro , Cimatti Marco , Raco Antonino
Published: April 2018

The authors present 20 cases of likely post-traumatic intracranial meningiomas selected according to the conditions specified in the relevant literature. The relationship between head injury and subsequent development of meningioma remains a controversial and fascinating subject. The etiopathogenetic mechanisms and clinical features of our patients and those of the literature are discussed.
Risk Factors Associated with Genital Warts in Hiv-Positive Brazilian Women
Authors: Gonçalves Maria Alice G , Burattini Marcelo N , Donadi Eduardo A , Massad Eduardo
Published: April 2018

Aims and Background

In Brazil, the female population has been increasingly infected with human immunodeficiency virus (HIV), and uterine cervix carcinoma now represents the second highest cause of mortality. Although HIV infection among women is associated with an increased prevalence of cervical cancer precursors, the co-infection with human papillomavirus (HPV) is considered to be a necessary but not sufficient factor to induce genital lesions. This study was conducted to identify risk factors associated with the history of genital warts among HIV-positive women.

Methods

A comparative cross-sectional evaluation was applied to 141 HIV-positive women. All patients were submitted to colposcopy, smear cytology, directed biopsy, and HPV-DNA detection. The chi-square, Fisher's exact test, and the odds ratio (OR, 95%; confidence interval, CI) were used to evaluate associations between history of genital warts and risk factors.

Results

A history of genital warts presented associations with: a) age at first sexual intercourse ≤17 years (OR, 0.42; CI, 0.16-1.11); b) history of genital warts in sex partners (OR, 11.39; CI, 4.21–30.76), especially with recurrent episodes (OR, 6.60; CI, 2.69–16.12); c) drug addiction (OR, 2.38; CI, 1.09–5.19), especially in crack users (OR, 5.34; CI, 1.64–17.41); d) cervical HPV infection (OR, 2.75; CI 1.09–6.90); e) cervical infection caused by only one HPV type (OR, 2.77; CI 1.06–7.20); f) perianal HPV infection (OR, 2.30; CI, 0.70–7.56), associated with negative results for undetermined risk HPV (OR, 8.41; P = 0.04); and g) no antiretroviral therapy (OR, 3.41; P = 0.07).

Conclusions

Evaluation of behavioral risk factors associated with a genital wart history is an important tool to prevent and reduce persistent HPV infection, and consequently genital cancer precursors in HIV infected women.
Analysis of Irradiated Lung and Heart Volumes using Virtual Simulation in Postoperative Treatment of Stage I Breast Carcinoma
Authors: Leonardi Maria Cristina , Brambilla Maria Grazia , Zurrida Stefano , Intra Mattia , Frasson Antonio , Severi Gianluca , Robertson Chris , Orecchia Roberto
Published: April 2018

Aims and Background

The aim of the study was to assess the usefulness of virtual simulation in postoperative radiotherapy treatment planning of early-stage breast cancer and to evaluate its potential to reduce the volume of critical structures exposed compared to treatment plans produced by a conventional 2D system.

Methods and Study Design

Eighteen patients undergoing breast radiotherapy following conservative surgery for small breast carcinomas were studied. Scans from spiral CT equipment (with the patient in the treatment position) were transferred to a virtual simulator. From the screen images the operator contoured breast, lung and heart. Calculations were made of the extent to which the heart and lung were included in the irradiation fields (50% isodose line of tangential fields).

Results

Manual contouring was time-consuming, but when virtual simulation was used, the mean volume of the lung included in the radiation fields was significantly reduced compared to the 2D treatment plan (4.5% vs 5.4%, P = 0.034); in addition, a slight reduction was observed for the heart (0.5% to 1.2%), but this was not statistically significant.

Conclusions

With a 3D system we obtained optimal target coverage and a reduction of the dose to critical structures (statistically significant only for the lung). From a clinical point of view, this 0.9% reduction in the mean irradiated lung volume is probably not significant, as the percentage irradiated with a 2D system is considerably below the recommended value. Furthermore, our analysis was performed in a relatively small group of patients; for a reliable estimate larger series would be required. Consequently, the 3D system should not be considered in routine treatment after breast conserving surgery for early stage carcinomas; for the time being it should be reserved for selected cases.
Primary Rectal Lymphoma as a Cause of Bowel Obstruction Report of a Case
Authors: Navarra Giuseppe , Adani Gian Luigi , Bardella Elisabetta , Ascanelli Simona , Turini Alessandro , Pozza Enzo
Published: April 2018

Background

Malignant lymphoma involving the rectum either as a localized process or as a manifestation of disseminated disease is rare. Several treatments have been proposed and reported, including surgical resection alone or associated with adjuvant chemoradiation, chemotherapy alone, and radiotherapy alone.

Methods

A case of bowel obstruction caused by a primary rectal MALT lymphoma is reported. Following emergency loop sigmoid colostomy the patient was started on multiple specific cycles of chemotherapy according to the MACOP-B protocol.

Results

At the end of chemotherapy a remarkable reduction in the size of the tumor was noted. Subsequently the patient underwent an ultralow anterior resection followed by a straight coloanal anastomosis. At 36 months of follow-up the patient is alive with no tumor recurrence.

Conclusions

The present report describes the unique case of a patient with primary obstructing rectal lymphoma treated with neoadjuvant chemotherapy and sphincter-saving curative surgery.
Current Treatments of Neuroendocrine Tumors Role of Biotherapy and Chemotherapy
Authors: Della Torre Silvia , Procopio Giuseppe , Fusi Alberto , Catena Laura , Ferrari Leonardo , Nova Paola , Denaro Angela , Bichisao Ettore , Bajetta Emilio
Published: April 2018

Neuroendocrine tumors are rare neoplasms originating from cells belonging to a diffuse or confined neuroendocrine system and characterized by a significant histopatologic and biologic heterogeneity. Timely diagnosis is delayed because they are often clinically silent for their low differentiation grade and the absence of any symptom due to abnormal hormone release. For these reasons, many neuroendocrine tumor patients are not treated medically for metastatic or inoperable disease. Medical treatments include biotherapy, with interferon-α and somatostatin analogues, and chemotherapy. Somastostatin analogues are widely used in patients with symptoms and with carcinoids of low differentiation grade. Interferon-α is used alone or in combination with somatostatin analogues. Chemotherapy is active in patients with poorly differentiated neuroendocrine tumors. The therapeutic regimen commonly used is the combination of cisplatinum and etoposide. In conclusion, no standard treatment for NET has yet been identified, and the response criteria suggested by ITMO remain a reference point. The clinical aspect of the disease and biologic features suggest the identification of neuroendocrine tumors patients suitable for the appropriate therapies. On these bases, it is recommended that diagnosis and treatment of neuroendocrine tumors be carried out at specialized oncological centers involved in clinical trials.