bluuebunny/crossref_metadata_2025 huggingface dataset:
Gene Therapy of Bladder Control
Authors: Seigne John D.
Published: August 2017

Background

The incidence of bladder cancer has been steadily increasing and, despite improvements in treatment, many patients will not survive five years. Gene therapy is a promising approach that may improve the management of this disease.

Methods

Gene therapy involves two steps: (1) selection of an appropriate gene and (2) transfer of that gene to the target cells.

Results

Five broad categories of cancer gene therapy are undergoing clinical evaluation: (1) immunological augmentation by cytokine or (2) foreign gene transfer into tumor cells, (3) insertion of a suicide gene into tumor cells, (4) tumor suppressor gene reconstitution, and (5) bone marrow protection by insertion of a multidrug resistence gene.

Conclusions

Although many gene transfer approaches have great intuitive appeal, several constraints, including problems with methods of gene transfer, must be overcome before this biologic approach can reach its potential.
Hormonal and Chemotherapeutic Systemic Therapy for Metastatic Prostate Cancer
Authors: Panvichian Ravat , Pienta Kenneth J.
Published: August 2017

Background

Prostate cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in men in the United States. It is estimated that over 300,000 men will have been diagnosed with prostate cancer in 1996, and more than 40,000 will have died of this disease.

Methods

The authors combined their experience with a review of the literature on management of this disease to examine the effectiveness of treatments for both localized and metastatic prostate cancer.

Results

Surgery and radiation therapy are potentially curative modalities for cancer still limited to the gland. Androgen ablation therapy results in stabilization or regression of metastatic disease in most instances but is not curative. Some new approaches are described for patients with hormone-refractory prostate cancer.

Conclusions

Newer tumor-biology-based combinations are promising in the treatment of hormone-refractory prostate cancer, but their effect on patient survival needs to be evaluated in larger clinical trials.
Hürthle Cell Carcinoma
Authors: Grossman Richard F. , Clark Orlo H.
Published: August 2017

Background

Hürthle cell carcinoma represents approximately 3% of all differentiated thyroid cancers. The terminology is often confusing, and discrimination between Hürthle cell carcinoma and benign Hürthle cell tumors can be unclear. Thus, optimal treatment of patients with these diseases remains unsettled.

Methods

The authors reviewed published evidence on the presentation, biologic behavior, and treatment outcomes for this disease. In addition, they summarized their experience involving a series of 14 patients with Hürthle cell carcinoma.

Results

Hürthle cell carcinoma generally produces thyroglobulin and rarely takes up radioactive iodine. It is frequently bilateral or multifocal within the thyroid gland and often presents with local invasion. Hürthle cell carcinoma is associated with a high rate of locoregional recurrence and significant mortality.

Conclusions

The authors advocate total thyroidectomy with central neck dissection as the therapy of choice for patients with Hürthle cell carcinoma.
Medullary Thyroid Cancer
Authors: Franz Michael G.
Published: August 2017

Background

Medullary thyroid cancer, a tumor of the parafollicular C cells, accounts for approximately 10% of all thyroid malignancies. An estimated 75% of cases are sporadic, and the remaining 25% are familial.

Methods

The author reviews the clinical features and diagnostic tests for this entity, as well as the surgical treatment of recurrent or persistent medullary carcinoma.

Results

Sporadic medullary thyroid cancer typically presents as an isolated unilateral mass. Familial tumors tend to be multifocal and bilateral. In patients with multiple endocrine neoplasia type 2A, pheochromocytomas and parathyroid hyperplasia also may develop. Care is taken to avoid operating on a patient with occult pheochromocytoma. Total thyroidectomy and central lymph node dissection are the keys for successful surgical treatment.

Conclusions

Surgery is the cornerstone of treatment for medullary carcinoma of the thyroid. Genetic testing using the ret oncogene allows identification of individuals who are at risk for the disease or those with early-stage disease.
Gastrinoma: State of the Art
Authors: Godellas Constantine A. , Fabri Peter J.
Published: August 2017

Background

The Zollinger-Ellison syndrome, implicating a gastrinoma, was first recognized as a disease entity in 1955. At that time, total gastrectomy was the most common treatment approach. Advances in several aspects of the disease have occurred since that time.

Methods

The authors reviewed the changes that have developed since 1955 in the diagnosis, imaging studies, operative and nonoperative management, and follow-up of patients with this disease.

Results

The presence of a gastrinoma can be confirmed by a secretin stimulation test. A variable number of patients have hyperparathyroidism as part of the multiple endocrine neoplasm syndrome type 1 (MEN 1). Localization of the primary gastrinoma has been assisted by selective angiography, endoscopic ultrasonography, and the octreotide scan. H2-blockers or omeprazole, sometimes at high doses, usually controls acid secretion. Surgical removal of the primary gastrinoma is performed when feasible, and parathyroidectomy is indicated in those patients with hyperparathyroidism in the MEN 1 syndrome. Follow-up is facilitated by measurement of fasting serum gastrin levels.

Conclusions

Several innovations have improved our capability to diagnose and effectively manage patients with gastrinoma.
Ethical Issues of Chemoprevention Clinical Trials
Authors: Vogel Victor G. , Parker Lisa S.
Published: August 2017

Background

Chemoprevention of malignancy is a new concept in clinical medicine, and little is written about the ethics of identifying and enrolling eligible subjects in chemoprevention clinical trials.

Methods

The authors identify the ethical issues raised in the conduct of clinical chemoprevention trials and review the ethical considerations that should guide clinical researchers in the design and conduct of this new type of clinical trial.

Results

The ethics of chemoprevention clinical trials are complicated because (1) chemoprevention lies at the intersection of disease management and health promotion, (2) there are conflicting interests competing in these trials, and (3) multiple values play a role in determining the nature and magnitude of the risks and benefits of chemoprevention of cancer. Ethical questions related to these trials concern the enrollment of healthy individuals rather than cancer patients, confidentiality in recruitment, the enrollment of “high-risk” subjects, randomization, informed consent, trial monitoring, and competing outcomes and toxicities.

Conclusions

These issues will be resolved with the accumulating clinical experience and ethical deliberations that accompany ongoing clinical chemoprevention research studies.
Malignancy and Rheumatic Disease
Authors: Valeriano Joanne
Published: August 2017

Background

A wide variety of clinically significant interactions occur between neoplastic and rheumatic diseases, and many are clinically significant.

Methods

The types of interactions between rheumatologic and neoplastic diseases and their clinical manifestations are reviewed and described.

Results

Several diseases included in the classic definition of rheumatology are associated with an increased incidence of specific neoplasms. Conversely, many neoplasms, by a variety of mechanisms, can cause or simulate many rheumatic diseases.

Conclusions

Knowledge of the increased propensity for neoplasia in certain conditions and of the possibility that cancer may be the cause of specific rheumatologic syndromes will assist the physician in providing optimal clinical care to affected patients.
Primary Gastric Lymphoma
Authors: Al-Sheneber Ibrahim , Shibata Henry R.
Published: August 2017

Background

Gastric lymphoma is a common presentation of non-Hodgkin's lymphoma. Controversy reigns about many aspects of its classification and management, especially regarding roles for surgical resection.

Methods

The authors review the clinical features, staging, pathology, prognosis, and management issues with an emphasis on the role of surgical resection.

Results

Staging usually can be completed using noninvasive techniques. Those with a low-grade B-cell MALT type lymphoma with Helicobacter pylori infection may be treated with antibiotics and close follow-up. Patients with stage I or II disease may be treated with chemotherapy and radiation. Surgery is indicated for those with perforation or uncontrolled bleeding.

Conclusions

Gastric lymphoma, primarily a B-cell tumor, can be diagnosed and managed effectively with various approaches. Few prospective, randomized trials of alternative approaches have been performed.
Postoperative and Preoperative Chemotherapy for Non-Small-Cell Lung Cancer
Authors: Bonomi Philip , Faber L. Penfield
Published: August 2017

Background

Few randomized trials of preoperative and postoperative adjuvant systemic therapy have been performed in patients with non-small-cell lung cancer (NSCLC).

Methods

The authors reviewed the recent literature on comparative trials and meta-analyses to determine the current status of adjuvant therapy for patients with NSCLC.

Results

Postoperative adjuvant therapy with cisplatin-containing regimens reduces the risk of death by 3% at two years and by 5% at five years. Preoperative therapy can clear tumor in the resected specimen in approximately 15% of cases, and two small trials report substantial survival benefit.

Conclusions

The development of new and more active regimens for NSCLC may provide the biologic basis for clinical trials to demonstrate more pronounced benefit for adjuvant systemic therapy.
Current Therapy for Mesothelioma
Authors: Sugarbaker David J. , Norberto Jose J. , Bueno Raphael
Published: August 2017

Background

Diffuse malignant pleural mesotheliomas (DMPMs) are highly lethal tumors that are becoming more common. Standard management approaches have provided limited effectiveness.

Methods

The literature on management has been revised, and the authors present their data on outcomes for 120 patients treated with an aggressive trimodality approach.

Results

An aggressive trimodality approach including extrapleural pneumonectomy followed by chemoradiation produces low mortality and acceptable morbidity. The five-year survival rate in patients with epithelial histology and negative nodes approaches 40%.

Conclusions

Nodal status and histologic subtype are major predictors for survival in patients with early DMPM. A uniformly accepted staging system would allow comparison of treatment approaches from various institutions. More effective management interventions are required.
Menopausal Status and the Impact of Early Recurrence on Breast Cancer Survival
Authors: Lyman Gary H. , Kuderer Nicole M. , Lyman Stephen L. , Debus Markus , Minton Susan , Balducci Lodovico , Horton John , Reintgen Douglas , Cox Charles
Published: August 2017

Background

Breast cancer represents the leading form of invasive cancer among American women, killing nearly 50,000 annually. Several prognostic factors that are associated with survival include age, race, menopausal status, and the stage of disease at presentation.

Methods

Patient characteristics were collected based on a systematic chart audit of demographic features and medical, family, and social histories. We studied the survival of 220 patients with recurrent disease out of 1,429 consecutive patients with breast cancer seen over a 15-year period.

Results

Patients with a disease-free interval following diagnosis of less than 24 months were more frequently premenopausal and hormone receptor-negative than those with a disease-free interval of 24 months or greater. Patients with early recurrence had a shorter survival than patients with late recurrence. Menopausal status, nodal involvement, receptor status, and the site of recurrent disease were independent predictors of survival following recurrence.

Conclusions

Premenopausal women with early recurrence of breast cancer experience a significantly shorter survival than those with late recurrence, even after adjustment for hormone receptor status and site of recurrence. This effect was not seen in postmenopausal women.
Cytogenetic and Molecular Evaluation in Myelodysplastic Syndrome and in Acute and Chronic Leukemia
Authors: Papenhausen Peter R. , Moscinski Lynn C. , Binnie Cameron G.
Published: August 2017

Background

The majority of the presently known nonrandom chromosome changes in hematologic malignancy were described during the 1970s and 1980s. The last 10 years have been devoted to the location of oncogenes and tumor suppressor genes altered as a consequence of those changes. New molecular methodology has helped speed this process, which has resulted in DNA sequencing of many of the genes involved, permitting molecular detection of abnormal clones.

Methods

This review examines the most common alteration-based subgroups of cytogenetics and molecular genetics in hematologic disorders with the exclusion of lymphoma. Prognosis has been updated to reflect improving treatment protocols.

Results

The versatility of cytogenetics for delineating genetic changes is difficult to match by molecular testing. Once a clonal anomaly is identified, molecular methodology can detect residual disease with far greater sensitivity than cytogenetics, but relies on translocation junction targets that exclude clones characterized by deletion or trisomy.

Conclusions

Cytogenetic and molecular testing offers independent diagnostic and prognostic evaluation for most patients with hematologic malignancy.
Leukemia Support Groups: How Are They Doing?
Authors: Moss Donna Corwin
Published: August 2017

Background

Support groups help their participants to cope with the emotional and practical impact of their illnesses.

Methods

The effectiveness of the Leukemia Society of America support groups in enhancing the quality of life for their participants is reviewed. The groundwork, purpose, and structure of such groups, as well as alternate sources of support, are presented. Evaluation and future directions for oncology groupwork are discussed.

Results

Support groups complement the therapies provided by clinical practitioners and scientists by addressing the additional needs of cancer patients over the course of illness and survival.

Conclusions

New concepts and methods that address the needs of specific age-groups and incorporate the newly generated data on cancer treatments will further enhance the benefits provided by support groups.
Lymphatic Mapping for Melanoma: Long-term Results of Regional Nodal Sampling with Radioguided Surgery
Authors: Ramnath Erik M. , Kamath Deepa , Brobeil Andrea , Stall Alec , Kamath Vidya , Cruse C. Wayne , Glass Frank , Messina Jane , Fenske Neil , Berman Claudia , Ross Merrick I. , Cantor Alan , Cuthbertson David , Reintgen Douglas S.
Published: August 2017

Background

Lymphatic mapping and sentinel lymph node (SLN) biopsy are new techniques used in the surgical treatment of patients with malignant melanoma. These procedures have the potential to change the surgical treatment of the disease to provide a more rational approach to adjuvant therapy.

Methods

A prospective database of melanoma patients undergoing lymphatic mapping and SLN biopsy was reviewed to identify prognostic factors for overall and disease-free survival in this patient population.

Results

Five-year overall and disease-free survival was 92.3% and 79.0%, with a median follow-up of 17 months. The number of histologically positive SLNs was the most powerful predictor of overall and disease-free survival. Patients with no histologically positive SLNs had a five-year overall and disease-free survival of 97.9% and 93.3%, respectively. Tumor ulceration and Clark level greater than or equal to III were the significant prognostic factors for survival.

Conclusions

The use of lymphatic mapping and SLN biopsy effectively stages patients with primary cutaneous melanoma. Additionally, the presence of histologically positive SLNs is the most powerful indicator of overall and disease-free survival for these patients.
Cutaneous T-cell Lymphoma
Authors: Glass L. Frank , Keller Karen L. , Messina Jane L. , Dalton John , Yag-Howard Cynthia , Fenske Neil A.
Published: August 2017

Background:

Cutaneous T-cell lymphoma (CTCL) represents a spectrum of diseases composed of malignant helper T lymphocytes. An accurate diagnosis of early CTCL is difficult because of the varied clinical and histologic expressions of the disease.

Methods:

The authors review the epidemiology, possible risk factors, clinical manifestations, diagnostic techniques, staging, prognosis, and treatment options for CTCL.

Results:

The varied and often nonspecific clinical and histologic presentations of CTCL may delay diagnosis and staging, thus necessitating further studies such as immunophenotyping flow cytometry, and T-cell receptor gene rearrangement analysis.

Conclusions:

A multidisciplinary approach to the diagnosis, staging, and treatment of CTCL assists in optimizing outcomes from management of patients with this disease.
Management of Cerebral Metastases: The Role of Surgery
Authors: Lang Frederick F. , Wildrick David M. , Sawaya Raymond
Published: August 2017

Background:

Metastatic brain tumors represent the most common neurological complication in patients with systemic cancer. They are predominantly cerebrally located and constitute a significant source of morbidity and mortality. The overall incidence of brain metastases exceeds that of all other intracranial tumors, and as improved systemic cancer treatments have extended patients’ lives, this number is rising.

Methods:

The role of surgery in the management of cerebral metastases is reviewed by considering patient selection criteria, surgical approaches to metastases, intraoperative adjuncts, whole-brain irradiation as a postoperative adjuvant, resection of multiple vs single metastases, and the relative roles of stereotactic radiosurgery and conventional surgery.

Results:

Surgical resection of single or multiple metastases can be effective management for patients with otherwise good prognoses, providing all the known metastases can be removed without producing significant neurologic deficit. Radiosurgery, an alternate approach, can be used for smaller or inaccessible tumors.

Conclusions:

The presence of multiple brain metastases does not automatically contraindicate surgery because in properly selected patients, resection of multiple metastases can extend survival and enhance the quality of life. An awareness of how the modalities of open craniotomy, whole-brain radiotherapy, and stereotactic radiosurgery best complement each other will result in the best outcomes.
Hematopoietic Cell Transplantation for Multiple Myeloma
Authors: Bensinger William I.
Published: August 2017

Background

Multiple myeloma (MM) is a malignant plasma cell disorder with a median survival of three years. Despite the development of numerous conventional chemotherapy regimens and interferons, there has been little progress in improving the survival of patients with MM. Very high-dose chemoradiotherapy and autologous or allogeneic hematopoetic stem cell transplantation (HSCT) can result in high complete remission rates, even in patients with advanced disease.

Methods

A prospective, randomized study has shown that autologous HSCT results in superior response rates, progression-free survival, and disease-free survival compared with conventional chemotherapy. This is the first real advance in the treatment of this disease in 30 years. Unfortunately, few, if any, patients with MM who receive autologous HSCT are cured.

Results

Allogeneic HSCT can be curative for a fraction of patients with MM. However, very high transplant-related morbidity and mortality limit the application of allografts to younger patients with compatible donors.

Conclusions

Challenges for the future include the development of less intensive or more disease-specific chemotherapy regimens that preserve the antitumor activity but are less toxic, improvement in the control of graft-vs-host disease in the case of allografts and, for autologous graft recipients, the development of vaccines and cytotoxic lymphocytes to augment a graft vs myeloma effect.
Clinical Applications of Radioimmunoscintigraphy with Prostate-Specific Antibodies for Prostate Cancer
Authors: Manyak Michael J.
Published: August 2017

Background

The presence of metastasis is the most important prognostic indicator in patients with prostate carcinoma and is the predominant determinant of therapeutic choices. Current tools for detection of recurrence or metastasis are less than optimal. Recent clinical trials with radiolabeled monoclonal antibodies appear to provide more precise localization of prostate cancer in these clinical circumstances

Methods

Multicenter national trials of patients at relatively high risk for metastasis at diagnosis and patients with biochemical evidence of recurrence after prostatectomy underwent radioimmunoscintigraphy with capromab pendetide.

Results

Tissue confirmation of scan results demonstrated a 15-fold and 4-fold increase in sensitivity over computed tomography and magnetic resonance imaging, respectively, for newly diagnosed patients. Preliminary data have shown a 3- to 4-fold increase in durable complete response to radiation therapy in patients with biochemical failure following radical prostatectomy.

Conclusions

Patients at relatively high risk for metastasis at diagnosis and those with biochemical evidence of recurrence after prostatectomy may benefit from radioimmunoscintigraphy.
The Current Status of Gene Therapy for Prostate Cancer
Authors: Nowroozi Mohammad R. , Pisters Louis L.
Published: August 2017

Background

Due to limitations of local and systemic therapies for prostate cancer, interest has continued in the development of new treatment modalities. Gene therapy has emerged as a new approach that may prevent or treat disease by using the therapeutic information encoded in DNA sequences. Several institutions are actively experimenting with this approach.

Methods

The authors review the most common genetic alterations in prostate cancer, the principles of gene therapy, and gene delivery including both viral and nonviral vectors. Treatment strategies for both cytoreductive gene therapy as well as corrective gene therapy are described, and the available protocols to date with gene therapy for the treatment of prostate cancer are presented.

Results and Conclusions

More than 150 active protocols are ongoing to evaluate gene therapy in the treatment of cancer, with 13 of these open for patients with prostate cancer. The future of gene therapy as applicable to prostate cancer depends on additional development of vector systems and a better understanding of the genes involved in tumor induction and proliferation. Although gene therapy is clearly in its infancy, it is in an explosive growth phase and holds tremendous promise as a treatment modality for prostate cancer.
Hematopoietic Abnormalities in Patients with Cancer
Authors: Zuckerman Kenneth S.
Published: August 2017

Understanding the concepts of normal hematopoiesis and the mechanisms of both disease- and treatment-related cytopenias assists in the proper management of patients and rational uses of hematopoietic growth factors, particularly in those cancer patients receiving chemotherapy with or without stem and progenitor cell transplantation.
Reforming the Care System to Support those Coming to the End of Life
Authors: Lynn Joanne
Published: August 2017

Background:

Health care has shifted its focus regarding dying patients toward improving care rather than striving for cure.

Methods:

The Center to Improve Care of the Dying and the Institute for Healthcare Improvement sponsored a quality improvement collaborative from July 1997 through July 1998 to learn how to accomplish this.

Results:

(1) Classifying persons as “dying” or “not dying” does not help to ensure quality care at the end of life. The impossibility of predicting time of death in many illnesses demands not only a shift to asking whether a patient is sick enough to die of the current illness, but also targeting special services to those patients. (2) Quality improvement strategies in this arena regularly yield important gains in such fields as pain control, bereavement support, and advance planning. (3) Serious reform probably must originate in system design and routine practice rather than in exhortations to customize decision making. The Study to Understand Prognoses and Preferences in Outcomes and Risks of Treatment (SUPPORT) found that 80% of the substantial variation in the rate of death at home correlated with hospital bed supply.

Conclusions:

Based on the inadequacy of the current classification system and on the unpredictability of the timing of death, a conceptual model is proposed for many patients that mixes conventional “aggressive” care with palliative care and is triggered by illness severity rather than by prognosis. High leverage reform in end-of-life care is available now through quality improvement strategies.
Advanced Cancer and Comorbid Conditions: Prognosis and Treatment
Authors: Stuart Brad
Published: August 2017

Background:

Nonmalignant comorbid medical conditions, such as heart failure and emphysema, may complicate cancer treatment.

Methods:

Guidelines from the National Hospice Organization for cancer and selected nonmalignant diseases are outlined, and treatment principles for end-stage heart failure and emphysema are reviewed.

Results:

Estimates by clinicians of survivability in advanced cancer and nonmalignant disease are important in order to allow patients and family members to begin realistic advance planning. As disease progresses through its end stages to death, optimal management may include both disease-modifying and symptom-relieving interventions.

Conclusions:

A well-managed end of life is an important therapeutic option in informed consent discussions with seriously ill patients and their families.
Bisphosphonates in the Management of Breast Cancer
Authors: Cristofanilli Massimo , Hortobagyi Gabriel N.
Published: August 2017

Background:

Bone is the most frequent site of metastasis in patients with breast cancer. Bone metastasis, particularly osteolytic bone destruction, is usually associated with significant morbidity and deterioration of quality of life. Bisphosphonates are specific inhibitors of osteoclast activity used in the treatment of hypercalcemia of malignancy and osteolytic bone disease.

Methods:

We reviewed pertinent literature on the use of bisphosphonates therapy to treat metastatic breast cancer.

Results:

The use of bisphosphonates in the management of osteolytic bone metastases results in improved palliation of symptoms. Use of these agents in the adjuvant setting may help to prevent bone metastases.

Conclusions:

Bisphosphonates represent an effective palliative treatment when combined with chemotherapy and hormonal therapy for the management of osteolytic bone metastases. Identifying the exact mechanism of action requires further investigation to better define the possibility of a direct antitumor effect. The role of bisphosphonates in the adjuvant setting is still controversial, pending the results of large randomized trials.
New Hormonal Therapies for Breast Cancer
Authors: Minton Susan E.
Published: August 2017

Background:

There has been an explosion in the development of hormonal therapies for the treatment of breast cancer. Several new agents have been approved for the treatment of breast cancer in the metastatic setting, and trials are ongoing in the adjuvant and prevention setting to improve hormonal therapy for the prevention and treatment of breast cancer.

Methods:

The literature on new hormonal therapies for the treatment of breast cancer is reviewed, with an emphasis on newer agents.

Results:

Two antiestrogens are now approved in the United States for the treatment of metastatic breast cancer. Other antiestrogens have activity in metastatic breast cancer as well as in osteoporosis. Newer pure antiestrogens may overcome resistance to tamoxifen. Several aromatase inhibitors are available for the treatment of metastatic breast cancer.

Conclusions:

Many hormonal agents are now available for both adjuvant and advanced disease settings. Developments will depend on clarifying mechanisms of resistance to antiestrogens and identifying new classes of agents that lack cross-resistance to standard therapy.
Is Fatigue a Long-term Side Effect of Breast Cancer Treatment?
Authors: Jacobsen Paul B. , Stein Kevin
Published: August 2017

Background:

Fatigue is one of the most common and distressing symptoms experienced by breast cancer survivors. Despite its prevalence, relatively little is known about the characteristics, etiology, or treatment of fatigue in breast cancer survivors.

Methods:

This report reviews studies that assessed fatigue in breast cancer patients previously treated with adjuvant radiotherapy, adjuvant chemotherapy, or autologous bone marrow transplantation.

Results:

A review of the literature suggests that breast cancer patients who undergo adjuvant chemotherapy or autologous bone marrow transplantation experience clinically significant levels of fatigue for months or even years following the completion of active treatment. In contrast, there is little evidence that patients who receive only regional therapy (ie, surgery plus adjuvant radiotherapy) experience clinically significant fatigue as a long-term treatment side effect.

Conclusions:

A growing body of evidence indicates that persistent fatigue can be a long-term side effect of certain forms of breast cancer treatment. The challenges for the future will be to determine the etiology of fatigue among breast cancer survivors and to develop interventions that are effective in preventing or reducing fatigue following breast cancer treatment.
Vaccines for Ovarian Carcinoma
Authors: Butts Cherie , Freedman Ralph S.
Published: August 2017

Background

Metastasis to the abdominal cavity is the primary cause of morbidity and mortality in patients with ovarian cancer. Beyond surgery and chemotherapy combinations, strategies that target tumor cells in vivo are being investigated, such as the use of recombinant cytokines to up-regulate or modulate the cell-mediated or humoral immune response.

Methods

The authors report on their experience with tumor vaccines, including first-generation vaccines, peptide vaccines, and polynucleotide vaccines, in the treatment of ovarian cancer

Results

Cytokines may stimulate proliferation or activation of effector cells that mediate either major histocompatibility restricted cytotoxicity (adaptive immunity) or natural (innate) immunity. Cytokines are often pleiotropic, and their effects may depend on concentration, scheduling, and responsiveness of the cell populations to which they are directed. They also have been used to enhance the efficacy of tumor vaccines that have reached a higher level of sophistication. Recently designed tumor vaccines are capable of stimulating antitumor immune responses that recognize tumor cell epitopes or that have the potential to act synergistically with cytokines such as interleukin-2 and interleukin-12.

Conclusions

Enthusiasm for antitumor vaccine strategies is supported by accumulating clinical reports of responses following treatments using a variety of vaccines. Additional research is needed to determine optimum vaccine approaches for the treatment or prevention of ovarian cancer.
Modification of the Radiation Response of Patients with Carcinoma of the Uterine Cervix
Authors: Grigsby Perry W.
Published: August 2017

Background

The purpose of this review is to summarize clinical trials for patients with cervical cancer treated with irradiation and modifiers of the irradiation response.

Methods

The Medline database was used to identify clinical studies that evaluated modifiers of the irradiation response for patients with carcinoma of the uterine cervix from 1970 through 1998. The studies included were prospective, randomized phase III clinical trials comparing irradiation alone to irradiation plus a chemical modifier for carcinoma of the uterine cervix.

Results

Various chemical agents have been combined with irradiation in the treatment of patients with carcinoma of the uterine cervix. These agents include hyperbaric oxygen, hydroxyurea, nitroimidazoles, neoadjuvant chemotherapy, and concurrent chemotherapy.

Conclusions

Many prospective, randomized studies evaluating the use of chemical agents to modify the irradiation response in patients with carcinoma of the uterine cervix indicate no improvement over radiation therapy alone. However, the February 1999 NCI clinical announcement describes a survival advantage for cisplatin-based therapy and concurrent irradiation.
Imaging in Oncology
Authors: Hazelton Todd R. , Lee Jin Seong
Published: August 2017

This regular feature will enhance your knowledge of imaging technology in oncologic diagnosis, treatment, and evaluation.
Angiogenesis and Cancer Control: From Concept to Therapeutic Trial
Authors: Brem Steven
Published: August 2017

Background

There is extraordinary interest in developing angiosuppressive agents for cancer treatment. Several new agents appear promising for the treatment of a variety of human cancers. Current concepts and new agents in clinical trials are the focus of this article. In particular, the introduction of a new treatment for human brain tumors is presented in detail, using an antiangiogenic agent, penicillamine, and depletion of an obligatory cofactor of angiogenesis, copper.

Methods

The explosive increase in literature on antiangiogenesis is reviewed using computerized search, findings presented at the recent national cancer and angiogenesis meetings. A specific protocol, NABTT 97-04, “Penicillamine and Copper Reduction for Newly Diagnosed Glioblastoma,” is presented as an example of angiotherapeutic drug discovery.

Results

A number of promising molecular approaches are being introduced to suppress tumor angiogenesis. Major categories of angiogenesis antagonists include protease inhibitors, direct inhibitors of endothelial cell proliferation and migration, suppression of angiogenic growth factors, inhibition of endothelial-specific integrin/survival signaling, chelators of copper, and inhibitors with specific other mechanisms. The preliminary results of early trials offer a glimpse into how antiangiogenesis therapy will be integrated into future care of the patient with cancer.

Conclusions

Thirty-five antiangiogenesis therapies are currently being evaluated in clinical trials. As we learn more about the fundamental mechanisms of angiogenesis, eg, the role of copper in growth factor activation, effective methods of cancer control will be implemented.
Chemotherapy of Testis Cancer
Authors: Benedetto Pasquale
Published: August 2017

Background

Prior to the use of cisplatin, durable complete remissions of metastatic testis cancer were rare. In 1977, a treatment program including a chemotherapy program of cisplatin, vinblastine, and bleomycin (PVB) led to high response rates and acceptable toxicities in patients with disseminated testis cancer. Since then, the BEP (bleomycin, etoposide, and cisplatin) regimen has been established as standard therapy for good- and poor-risk disease and ifosfamide-based regimens or high-dose chemotherapy with stem cell rescue as salvage therapy.

Methods

The results of those prospective, randomized clinical trials that have markedly improved the outlook of patients with this type of cancer have been reviewed.

Results

Categories of risk have been defined. Standard therapy for both good-risk and poor-risk disease remains BEP therapy. High-dose chemotherapy with autologous bone marrow or peripheral stem cell rescue transplantation is being investigated to overcome chemotherapy resistance.

Conclusions

While the present state of the art for treating metastatic testicular cancer is promising, approximately one third of patients with “poor-risk” disease will not achieve a remission. Trials of new agents and approaches are needed to increase patient survival.
Dynamic and tribological study of a planetary gearbox with local nonlinearities
Authors: Salagianni Konstantina , Nikolakopoulos Pantelis , Theodossiades Stephanos
Published: August 2017

A planetary gearbox model comprising five spur gears (sun, ring and three planets) and the carrier has been developed and analysed. The influence of gear teeth backlash and friction during mixed regime of lubrication has been taken into consideration. Greenwood and Tripp model is employed, while viscous friction is calculated analytically using the functions of Evans and Johnson. A combined tribodynamics modeling approach has been implemented and modal analysis is performed in order to predict the coupled mechanism of tribological and dynamic behavior, subjected to backlash and excited at the gear meshing frequency. The software used for the simulations is ADAMS MSc (Student Edition), where the model variables (concerning gear geometry and forcing functions) have been added in a parametric way. The results showed that small variations of the dynamic transmission error affect notably the viscous friction through changing the contact load between the engaged teeth pairs. Also, higher values of the Stribeck oil parameter due to higher film thickness or lower surface roughness in the mixed lubrication regime lead to reduction of the boundary friction, whereas a reduction of the total generated friction occurs when increasing the angular velocity of the input gear body (due to higher film thickness and smaller asperity interactions). The above lead to reduced power loss of the mechanism. Finally, a characterization of the system dynamics is presented using the calculated eigenvalues and eigenmodes of the corresponding linearized system. Potential interactions with the gear meshing frequency of the system are also examined.
Coupled elastodynamics of piston compression ring subject to sweep excitation
Authors: Turnbull R , Mohammadpour M , Rahmani R , Rahnejat H , Offner G
Published: August 2017

The piston compression ring's primary function is to seal the combustion chamber, thus mitigating gas leakage to the crankcase and avoiding loss of pressure loading. As a result, the ring is meant to conform closely to the cylinder surface which promotes increased friction. The compression ring is subjected to combustion pressure loading, ring tension, varying inertial force and friction. It is a slender ring of low mass, thus undergoes complex elastodynamic behaviour, when subjected to a multitude of forces. These motions occur in the ring's radial in-plane and axial out-of-plane dynamics, which comprise flutter, ring axial jump, compression-extension, ring twist and rotational drag. An implication of these motions can be loss of sealing, gas blow-by, loss of power and lubricant degradation/oil loss, to name but a few. Consequently, understanding and accurately predicting ring dynamic behaviour under transient conditions is an important step in any subsequent modelling for evaluation of cylinder system efficiency. There have been a plethora of investigations for ring dynamics, often decoupling the ring behaviour in its in-plane and out-of-plane motions. This approach disregards any transfer of dynamic energy from one degree of freedom to another which is only applicable to rectangular ring cross-sections. Alternatively, there are computationally intensive approaches such as finite element analysis which are not conducive for inclusion in any subsequent system level engine modelling where ring response alters in an instantaneous manner. This would require embedded finite element analysis within a transient analysis. This paper presents a finite difference numerical analysis for coupled in-plane and out-of-plane motions of compression rings with practical cross-sectional geometries, which are mostly not rectangular. The formulated method can be integrated into a system level transient cyclic analysis of ring-bore contact. The presented approach takes into account the energy transfer between different degrees of freedom. The predictions are validated against precise non-contact measurements of ring elastodynamic behaviour under amplitude-frequency sweeps. This approach has not hitherto been reported in literature and constitutes the main contribution of the paper.
Selection of candidate materials for reactor pressure vessels: Application of irradiation embrittlement prediction models and a stringency level methodology
Authors: Rodríguez-Prieto Álvaro , Camacho Ana María , Sebastián Miguel Ángel
Published: August 2017

The selection of materials for the reactor pressure vessel manufacturing is a complex process that involves great responsibility because small differences in chemical composition can adversely affect the manufacturing process and the in-service behavior of the material. Thus, it is recommendable to perform previous materials pre-selection stages based on the state-of-the-art knowledge, integrating research results with standardized requirements and using simplifier materials selection methodologies like the stringency level method. To address this issue, an evaluation of the influence of chemical composition on the shift of the ductile-to-brittle transition temperature has been performed using the most used and consolidated prediction models that are R.G. 1.99 Rev.2, NUREG/CR-6551, and ASTM E 900-02. A proposal of maximum limits for copper, nickel, and phosphorous to avoid irradiation embrittlement has been presented to carry out the process. The results have been analyzed by using the stringency level methodology to support the decision process. To this end, a materials data collection has been carried out to analyze the requirements described by 20 different specifications of materials from first to fourth generation of light water reactors, covering the main designs of pressurized reactors from Western Europe, North America, Japan, and Russia. It can be concluded that more recently developed materials exhibit more stringent requirements than earlier developed materials.
Topological development of homogeneous-charge and spray-guided stratified-charge flames in an internal combustion engine
Authors: Lillo Peter Mark , Zhuang Hanyang , Sick Volker
Published: August 2017

In this work, engine flame topological development was studied to improve the understanding of flame growth in direct-injection engines, in particular when operated under homogeneous-charge and spray-guided stratified-charge combustion conditions. Flame wrinkledness is one of the most important and poorly understood engine combustion phenomena. Generally, a flame may wrinkle for two reasons: (1) its own natural instabilities and/or (2) through interaction with turbulent flow. The relative contribution of these two causes toward flame wrinkledness in the engine environment was unclear, so targeted experiments were performed to provide some clarity. The development of flame wrinkledness within an optically accessible engine was measured with a combination of planar laser–induced fluorescence and stereo particle image velocimetry under homogeneous-charge and stratified-charge conditions. Using the resulting data, equivalence ratio, charge velocities, and flame wrinkledness were quantified and analyzed. For the iso-octane–toluene mixtures studied, flame wrinkling was insensitive to thermo-diffusive flame front instabilities. The relative contribution of wrinkles of various spatial scales toward overall flame wrinkledness was also measured. Homogeneous-charge flames generally had lower wrinkling factors than stratified-charge flames. Overall, flame wrinkledness increased with flame size under both modes of engine operation. Large flames demonstrated an ability to maintain more large-scale wrinkles than small flames, which contributed to their overall higher levels of wrinkledness.
A Systematic Review of the Autism Research With Children Who Are Deaf or Hard of Hearing
Authors: Hansen Sarah , Scott Jessica
Published: August 2017

The current study is a systematic review on the available evidence on language development, assessment, challenging behavior, and instruction for children dually diagnosed with autism spectrum disorder and deafness. Results indicate a strong need for additional research in these areas, especially in the areas of evidence-based practices.
A methodology for assessing the reliability and security of cascade reservoir systems
Authors: Tian Ying , Ren Qingwen , Yang Yin , Xiong Yao
Published: August 2017

The scale of cascade reservoir systems is increasing rapidly along with the development of hydroelectric projects in these systems. Related security problems are receiving increasing public attention. However, no security evaluation method for this type of system can be found in the literature. Reliability is an essential indicator to measure system security. Because of the brittleness, complexity, and polymorphism of the system, a Bayesian network and set pair analysis theory–based methodology suitable for the reliability analysis of cascade reservoir systems is suggested in this article. First, the topological structure of the Bayesian network is constructed, and the brittle effect is measured using the powerful probabilistic inference capability of the Bayesian network. Then, the probability distribution of each subsystem is obtained, and probabilities of the system in all states are integrated using set pair analysis theory. Furthermore, the composite reliability is proposed as a generic reliability representation for cascade reservoir systems. On this basis, through constructing a composite probability vector and composite probability matrix, the Bayesian network and set pair analysis theory–based reliability measure models for both subsystems and the whole system are proposed. Finally, the effectiveness and practicability of the method described above are verified by introducing an example application. The results show that this research provides a theoretical basis and practical method for assessing the reliability and security of cascade reservoir systems.
Memory politics in contemporary Ukraine: Reflections from the postcolonial perspective
Authors: Törnquist-Plewa Barbara , Yurchuk Yuliya
Published: August 2017

Reporting from the events of the so-called ‘Euro-revolution’ in Ukraine 2013–2014, the Western media were prompt to point out the excessive use of national symbols, including those connected with the memory of the Ukrainian nationalist organizations ‘OUN’ and ‘UPA’, which for some periods of time had cooperated with Nazi Germany and were involved in the killing of civilians. By using a postcolonial perspective, the article aims to explain this phenomenon, as well as a number of other elements of the politics of memory in contemporary Ukraine, such as the so-called ‘Decommunization Laws’ adopted in 2015. Special attention is paid to Frantz Fanon’s idea of ‘anticolonial nationalism’ and Homi Bhabha’s idea of hybridity and their realization in Ukraine.
Grip strength feigning is hard to detect: an exploratory study
Authors: Vollert Jan , Pasqualicchio Carina , Papenhoff Mike , Heitmann Burkhard , Müller Frank , Maier Christoph
Published: August 2017

Detecting submaximal effort when testing grip strength is difficult. Research so far has focused on the discrimination between sincere and feigning healthy participants, whereas the clinically relevant distinction is between injured patients and feigning participants. The aim of our study was to compare rapid exchange grip and isometric grip strength testing in 41 participants feigning weakness with 39 patients with decreased hand function. Various parameters that describe grip strength were recorded and tested for differences between the groups. Only the maximum grip strength during rapid exchange grip was found to be significantly higher in feigning participants compared with patients, but this cannot be used for decision-making on an individual basis. We found no parameters that are useful for the detection of feigned weakness in an individual case.

Level of evidence: III