bluuebunny/crossref_metadata_2025 huggingface dataset:
Portopulmonary Shunt by Splenopneumopexy as a Treatment for Portal Hypertension Due to Extrahepatic Portal Vein Obstruction: Case Report
Authors: Tanaka Koki , Nakayama Hiromi , Yoshimine Meguru , Honbo Kenzo , Ohno Takashi , Taira Akira
Published: August 2008

A case of secondary portal hypertension due to extrahepatic portal vein ob struction that was treated by splenopneumopexy approximately nine years ago is presented. The patient was a forty-seven-year-old man suffering from hema temesis. On preoperative portography, the portal trunk could not be visualized, and cavernous transformation of the portal vein and moderate esophageal varices were demonstrated.

Splenopneumopexy for management of esophageal varices was accomplished as treatment. After the operation, significant portopulmonary shunt was devel oped and findings of the esophageal varices were improved. Results from pul monary and hepatic function tests after operation were essentially unchanged. For nine years since the operation he has had no episode of recurrent variceal bleeding.

Splenopneumopexy, which diverts the portal blood into the pulmonary vein, is one of the shunt procedures used as treatment for portal hypertension. In Japan, endoscopic sclerotherapy is the first choice of treatment for variceal bleeding. However, splenopneumopexy is still useful as a treatment for patients with secondary portal hypertension such as extrahepatic portal vein obstruc tion.
Cranial Nerve Injury Associated with Surgery of the Carotid System
Authors: Papachristou Euripides , Dragojevic Dusan
Published: August 2008

Injury of the cranial nerves during surgery of the carotid system is a rela tively common problem. The damage often escapes the attention of the surgeon, and its severity and consequences for the patient are not usually properly evalu ated. In this study the authors examined the immediate postoperative status of the cranial nerves in 404 patients who underwent 519 operative procedures for a variety of conditions affecting the carotid artery system.

The authors identified 13 instances of injury (2.5%) 4 of which were perma nent (0.8%) and 9 transient (1.7%). The hypoglossal nerve was permanently injured in 2 instances (0.4%) and the recurrent laryngeal nerve in another 2 (0.4%). In 6 instances (1.2%) the injury to the hypoglossal was transient, as it was in 3 instances of recurrent laryngeal nerve injury (0.6%).
Duplex Scanning of Expanded Polytetrafluoroethylene Dialysis Shunts: Impact on Patient Management and Graft Survival
Authors: Mayer David A. , Zingale Robert G. , Tsapogas Makis J.
Published: August 2008

The steady decline with time in patency of expanded polytetrafluoroethylene (e-PTFE) dialysis shunts led to a trial protocol of postimplantation surveillance to identify those grafts at risk for thrombosis. Duplex scanning is a noninvasive, reproducible method of monitoring anatomic and hemodynamic aspects of graft function that provides the surgeon with an opportunity for early operative intervention. The data from this randomized prospective study suggest that early intervention based on surveillance findings is more successful in terms of access site salvage and morbidity reduction than intervention prompted by graft thrombosis or malfunction is. Duplex scanning appears to be the preferred modality that, together with timely reoperation, impacts favorably on functional graft survival.
Operative Technique of First Rib Resection Via Subclavicular Approach
Authors: Molina J. Ernesto
Published: August 2008

A subclavicular approach to the first rib for resection in cases of subclavian vein thrombosis or chronic obstruction is described. The steps of the surgical procedure are described. The technique is ideally suited for emergency care of Paget-Schroetter syndrome patients.
Review: Stroke prevention: modifying risk factors
Authors: Romero José Rafael , Morris Jane , Pikula Aleksandra
Published: August 2008

Risk factor modification remains as the principal aspect of care for stroke prevention. Understanding of risk factors has advanced and several options are now available to treat modifiable risk factors. However, effective treatment remains a challenging task in clinical practice. Prevention begins with awareness of risk factors by patients and clinicians. Risk factor assessment along with overall stroke risk estimation should be part of evaluation of patients with stroke, and used with careful clinical judgment. In this review, we discuss the impact of modifiable traditional vascular risk factors on ischemic stroke, interventions for stroke prevention, and evidence for early treatment of risk factors where available, as well as areas of research progress. Emphasis should be put on the education of patients, the community, and medical personnel. Future research in the field of genetic determinants of vascular risk factors and stroke will increase our understanding of the underlying mechanisms of cerebrovascular disease and likely result in development of new therapies and individualized programs for stroke prevention.
Review: Does lowering cholesterol have an impact on the progression of aortic stenosis?
Authors: Greve Anders M. , Wachtell Kristian
Published: August 2008

Several studies suggest that atherosclerotic disease is not a focal disease restricted to culprit lesions in the intima of the arterial wall, but seems to act as a general disease affecting the entire cardiovascular system. Evolving research has lately focused on the atherosclerotic component in calcific aortic stenosis (AS) as it seems that the valve is affected in a pattern similar to that of the vasculature. The hope is therefore, that we someday in the management of patients with calcific AS can apply some of the same treatment strategies as in atherosclerotic vascular disease. This article reviews the pathophysiological mechanisms of calcific AS, reviews current clinical trials of statin use in aortic stenosis and reports on on-going trials, evaluating whether cholesterol lowering therapy can slow disease progression in different populations. Finally, we review if computerized tomography, biomarkers, and clinical characteristics such as left ventricular ejection fraction, can be useful in stratifying patients to potential benefit of statin therapy.
Review: Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test?
Authors: Craici Iasmina , Wagner Steven , Garovic Vesna D.
Published: August 2008

It is estimated that 10% of pregnancies are affected by hypertension worldwide. Approximately one-half of all hypertensive pregnancy disorders are due to preeclampsia, a pregnancy-specific disorder, its distinctive feature being either sudden onset, or worsening of pre-existing proteinuria. It has become increasingly recognized that women with a history of preeclampsia are at increased risk for future cardiovascular disease (CVD), but the mechanisms of this increase in risk are unclear. One possible explanation is that these two conditions share several common metabolic abnormalities as risk factors, including obesity, insulin resistance, and lipid abnormalities that may lead to preeclampsia and CVD at different times of a woman's life. Recent studies have revealed that, similar to CVD, several mediators of endothelial cell dysfunction are up-regulated in preeclampsia. Free radical derived oxidative stress, various inflammatory markers, including neutrophil response, C-reactive protein, and leukocyte adhesion, may contribute to endothelial dysfunction in both preeclampsia and coronary atherosclerosis. Alternatively, preeclampsia itself may induce metabolic and vascular changes that may increase the overall future risk for CVD in affected women. Therefore, at present, it remains unclear whether preeclampsia is a formal risk factor for CVD, or identifies women at increased risk for CVD later in life. Pending large-scale studies aiming to examine the causality of this association, women with a history of preeclampsia should be counseled regarding their increased risks for hypertension and other cardiovascular sequelae later in life, followed closely and treated aggressively for modifiable CVD risk factors.
Selection of covering materials for synthesising fabrication of TiB2 based coating with PTA process
Authors: Wang X. B. , Cai L. J. , Yang Z. H. , Xiao C. , Xu L. F.
Published: August 2008

A technique for the synthesising fabrication of TiB2 based coating using plasma transferred arc (PTA) process on the surface of plain steel was explored. For the selection of the precursors, various covering materials contained both of B contained powders and Ti contained powders were tested using PTA process. By the analysis of the coatings surface quality and the interface to the substrate, the possibility of some powder combinations between B contained powder materials and Ti contained powder materials used as precursors for TiB2 based coating fabrication were evaluated. The experiment results show that the covering materials contained TiO2 and/or B2O3 powders are not suitable for TiB2 based coating fabrication by PTA process, whereas the powder mixtures just as Fe–B + Ti, Fe–Ti + Fe–B or Fe–Ti (or Ti) + B4C are suitable for TiB2 based coating fabrication by PTA process.
Laser gas assisted nitriding of Ti–6Al–4V alloy and residual stress analysis
Authors: Yilbas B. S. , Arif A. F. M. , Karatas C.
Published: August 2008

The stress field generated during laser gas assisted nitriding is considered and temperature and stress fields are predicted in the nitride layer using the finite element method. The residual stress in the resulting nitrided layer is measured using the X-ray diffraction technique and indentation tests. It is found that predictions of residual and measurements are in qualitative and quantitative agreement in the nitride layer. The magnitude of residual stress is in the order of 280 MPa in the surface region and reduces to 100 MPa at a depth of 80 μm where nitride layer diminishes.
Wrought magnesium alloys for structural applications
Authors: Letzig D. , Swiostek J. , Bohlen J. , Beaven P. A. , Kainer K. U.
Published: August 2008

Wrought magnesium alloys are of special interest as lightweight structural components as a result of their more homogeneous microstructures and improved mechanical properties compared to cast components. Extrusion as a shaping technology offers the possibility to produce a wide variety of magnesium alloy profiles. In this contribution, the authors describe the role of extrusion parameters such as extrusion rate, ratio and temperature as well as the type of extrusion process on the microstructure of AZ series magnesium alloys and the resulting mechanical properties. The effect of microstructure on the tensile/compression deformation behaviour of the alloys has also been investigated. In a further step, extruded material has been used in die forging experiments. Aspects of alloy development and process optimisation designed to overcome technical and economic limitations and thus establish magnesium alloy profiles for industrial applications will also be discussed.
Morphological investigation of aluminium nitride films on various substrates for MEMS applications
Authors: Kar J. P. , Bose G. , Tuli S. , Myoung J. M. , Mukherjee S.
Published: August 2008

Piezoelectric films, such as aluminium nitride (AlN), are of great interest for the fabrication of thin film bulk/surface acoustic resonators, where the growth parameters and the substrate material influence the morphological properties. Herein, AlN films were deposited using RF reactive sputtering on Si, SiO2, metal (Al, Cu, Cr and Au) coated silicon, GaAs and InP substrates. C-axis (002) oriented AlN films were observed on most of the substrates, where the surface morphologies of the films grown on the 1·5 μm thick SiO2 layer and GaAs substrate were found to be non-uniform. Moreover, AlN films deposited on the Cr electrode exhibit well textured film with fairly uniform grains, while the films deposited on other metal electrodes exhibit a granular type of structure with mixed small and large grains. After optimisation of growth parameters, silicon micromachining was performed by the wet chemical etching method. Suspended Cr–AlN–Cr–SiO2 cantilevers of 20 μm in width were fabricated for futuristic microelectromechanical systems (MEMS) applications.
Laser surface modification of plasma sprayed yttria stabilised zirconia coatings on type 316L stainless steel
Authors: Shankar A. Ravi , Mudali U. Kamachi
Published: August 2008

Plasma sprayed yttria stabilised zirconia/NiCrAlY thermal barrier coatings proposed for molten LiCl–KCl salt environments contain pores and microcracks that may cause corrosion of the substrate on prolonged exposure. In the present work the as sprayed samples were laser remelted with various scan speeds of 1, 2·5 and 5 mm s−1 to reduce the segmented cracks. Microstructural inhomogeneities like pores and voids have been eliminated on laser remelting, however, segmented cracks were formed irrespective of scan speed. Distinct interface separating fine and coarse grains were observed at all scan speeds. The microhardness of the glazed surface improved and surface roughness was reduced. The beneficial non-transformable tetragonal phase was formed after laser remelting while the as sprayed coating consisted of insignificant monoclinic phase. An attempt was made to seal the pores of the zirconia coating by applying ZrO2 and ZrO2 + SiO2 powder.
Influence of pH value of TiO2 sol on surface gloss of corresponding TiO2 film coated on ceramic tiles
Authors: Dai W. X. , Chen X. , Li E. , Wang X. X. , Liu P. , Fu X. Z.
Published: August 2008

A series of TiO2 sols with different pH values prepared by the sol-gel method under acid conditions were coated onto the surfaces of ceramic tiles to obtain the corresponding TiO2 films respectively. The surface gloss and roughness of the as-prepared TiO2 films were measured by a glossmeter and an atomic force microscope (AFM) respectively. It has been found that the surface gloss of the as-prepared TiO2 films is decreased but its roughness is increased with the increase of the pH value of TiO2 sol. Moreover, the measurement result of the as-prepared TiO2 sols by Zetasizer shows that the ζ potential of TiO2 sol is increased with the increase of pH value of TiO2 sol. It is proposed that the increase of ζ potential will cause a stronger repulsion of particles in TiO2 sol, resulting in a rougher surface and then lower surface gloss of the corresponding TiO2 film.
Evaluation of protection against corrosion of thick polyurethane coating by electrochemical impedance spectroscopy
Authors: Neshati J. , Rezaei F. , Akbarinezhad E.
Published: August 2008

The protection performance of a thick polyurethane coating was studied by using an electrochemical impedance spectroscopy in 3% NaCl solution. Electrolytic penetration through the coating changes the dynamic characteristics of the conduction and resistance of the coating film of the protected system over time. Equivalent circuits were used to interpret the physical and electrochemical properties. The mechanism and kinetic of electrochemical systems were assessed by measuring the fluctuations in resistance, capacitance, percentage of water uptake and dielectric constant through coating. A series of accelerated test, e.g. salt spary, 100% relative humidity, cathodic disbonding and adhesion tests have been used to evaluate pipeline coatings. The results revealed that tested coating has very high protection efficiency and can be a very good alternative for conventional pipeline coatings. In the meantime, percentage of water uptake and dielectric constant through the coating were measured maximum 15˙9 and 3˙2% respectively.
Tumor necrosis factor SNP haplotypes are associated with iron deficiency anemia in West African children
Authors: Atkinson Sarah H. , Rockett Kirk A. , Morgan Gareth , Bejon Philip A. , Sirugo Giorgio , O'Connell Maria A. , Hanchard Neil , Kwiatkowski Dominic P. , Prentice Andrew M.
Published: August 2008

Plasma levels of tumor necrosis factor-α (TNF-α) are significantly raised in malaria infection and TNF-α is thought to inhibit intestinal iron absorption and macrophage iron release. This study investigated putative functional single nucleotide polymorphisms (SNPs) and haplotypes across the major histocompatibility complex (MHC) class III region, including TNF and its immediate neighbors nuclear factor of κ light polypeptide gene enhancer in B cells (lκBL), inhibitor-like 1 and lymphotoxin alpha (LTA), in relation to nutritional iron status and anemia, in a cohort of 780 children across a malaria season. The prevalence of iron deficiency anemia (IDA) increased over the malaria season (P < .001). The TNF−308 AA genotype was associated with an increased risk of iron deficiency (adjusted OR 8.1; P = .001) and IDA (adjusted OR 5.1; P = .01) at the end of the malaria season. No genotypes were associated with IDA before the malaria season. Thus, TNF appears to be a risk factor for iron deficiency and IDA in children in a malaria-endemic environment and this is likely to be due to a TNF-α–induced block in iron absorption.
Atypical evening cortisol profile induces visual recognition memory deficit in healthy human subjects
Authors: Gilpin Heather , Whitcomb Daniel , Cho Kwangwook
Published: August 2008

Background

Diurnal rhythm-mediated endogenous cortisol levels in humans are characterised by a peak in secretion after awakening that declines throughout the day to an evening trough. However, a significant proportion of the population exhibits an atypical cycle of diurnal cortisol due to shift work, jet-lag, aging, and mental illness.

Results

The present study has demonstrated a correlation between elevation of cortisol in the evening and deterioration of visual object recognition memory. However, high evening cortisol levels have no effect on spatial memory.

Conclusion

This study suggests that atypical evening salivary cortisol levels have an important role in the early deterioration of recognition memory. The loss of recognition memory, which is vital for everyday life, is a major symptom of the amnesic syndrome and early stages of Alzheimer's disease. Therefore, this study will promote a potential physiologic marker of early deterioration of recognition memory and a possible diagnostic strategy for Alzheimer's disease.
Gemcitabine Plus Paclitaxel Versus Paclitaxel Monotherapy in Patients With Metastatic Breast Cancer and Prior Anthracycline Treatment
Authors: Albain Kathy S. , Nag Shona M. , Calderillo-Ruiz German , Jordaan Johann P. , Llombart Antonio C. , Pluzanska Anna , Rolski Janusz , Melemed Allen S. , Reyes-Vidal Jose M. , Sekhon Jagdev S. , Simms Lorinda , O'Shaughnessy Joyce
Published: August 2008

Purpose

The objective of this phase III global study was to compare the efficacy of gemcitabine plus paclitaxel (GT) versus paclitaxel in patients with advanced breast cancer. It was designed as a pivotal study for the approval of G for a breast cancer treatment indication.

Patients and Methods

Patients who relapsed after adjuvant anthracyclines were randomly assigned to gemcitabine,1,250 mg/m2 days 1 and 8 plus paclitaxel, 175 mg/m2 on day 1; or, to paclitaxel at same dose on day 1 (both arms administered every 21 days, unblinded). The primary end point was overall survival (OS) and secondary end points were time to progression (TTP), response rate (RR), progression-free survival, response duration, and toxicity. This final OS analysis was planned at 380 deaths.

Results

A total of 266 patients were randomly assigned to GT and 263 to paclitaxel. Median survival on GT was 18.6 months versus 15.8 months on paclitaxel (log-rank P = . 0489), with an adjusted Cox hazard ratio of 0.78 (95% CI, 0.64 to 0.96; P = .0187). The TTP was longer (6.14 v 3.98 months; log-rank P = .0002) and the RR was better (41.4% v 26.2%; P = .0002) on GT. There was more grade 3 to 4 neutropenia on GT and grade 2 to 4 fatigue and neuropathy were slightly more prevalent on GT.

Conclusion

This phase III study documents a role for gemcitabine in advanced breast cancer after anthracycline-based adjuvant therapy. The results establish GT as a reasonable choice for women who require cytoreduction with manageable toxicities and validate ongoing testing of GT in the adjuvant setting.
Choice and Interpretation of Statistical Tests Used When Competing Risks Are Present
Authors: Dignam James J. , Kocherginsky Maria N.
Published: August 2008

In clinical cancer research, competing risks are frequently encountered. For example, individuals undergoing treatment for surgically resectable disease may experience recurrence near the removed tumor, metastatic recurrence at other sites, occurrence of second primary cancer, or death resulting from noncancer causes before any of these events. Two quantities, the cause-specific hazard function and the cumulative incidence function, are commonly used to summarize outcomes by event type. Tests for event-specific differences between treatment groups may thus be based on comparison of (a) cause-specific hazards via a log-rank or related test, or (b) the cumulative incidence functions via one of several available tests. Inferential results for tests based on these different metrics can differ considerably for the same cause-specific end point. Depending on the questions of principal interest, one or both metrics may be appropriate to consider. We present simulation study results and discuss examples from cancer clinical trials to illustrate these points and provide guidance for analysis when competing risks are present.
Economic Evaluation of Sunitinib Malate for the First-Line Treatment of Metastatic Renal Cell Carcinoma
Authors: Remák Edit , Charbonneau Claudie , Négrier Sylvie , Kim Sindy T. , Motzer Robert J.
Published: August 2008

Purpose

To assess the cost effectiveness and cost utility of sunitinib malate as a first-line treatment in metastatic renal cell carcinoma (mRCC) compared with interferon-alfa (IFN-α) and interleukin-2 (IL-2) from a US societal perspective.

Methods

A Markov model was developed to simulate disease progression and to determine progression-free survival, total life-years (LYs), and quality-adjusted life-years (QALYs) gained. Model parameters were derived from the pivotal trial of sunitinib, published literature, government sources, and clinical experts’ opinions. The model included trial-based adverse events (AEs). Costs of drug treatment, routine follow-up, AEs, disease progression, and best supportive care (BSC) of terminally ill patients were included. Results were tested using probabilistic and deterministic sensitivity analyses.

Results

Treatment with sunitinib is associated with a gain in progression-free years of 0.41 and 0.35 over IFN-α and IL-2. The estimated gains over IFN-α were 0.11 LYs and 0.14 QALYs, and over IL-2 were 0.24 LYs and 0.20 QALYs. Both IFN-α and sunitinib treatments dominate IL-2 treatment; the incremental cost-effectiveness ratio of sunitinib versus IFN-α was $18,611 per progression-free year gained and $67,215 per LY gained, and the cost-utility ratio is $52,593 per QALY gained (at a 5% discount rate). Sensitivity analyses found the results to be most sensitive to utility values during treatment, the cost of sunitinib, and the cost of BSC. Model results were robust to changes in other model variables.

Conclusion

These results suggest that sunitinib is a cost-effective alternative to IFN-α as a first-line treatment for mRCC.
Psychological Reactions, Quality of Life, and Body Image After Bilateral Prophylactic Mastectomy in Women At High Risk for Breast Cancer: A Prospective 1-Year Follow-Up Study
Authors: Brandberg Yvonne , Sandelin Kerstin , Erikson Staffan , Jurell Göran , Liljegren Annelie , Lindblom Annika , Lindén Ann , von Wachenfeldt Anna , Wickman Marie , Arver Brita
Published: August 2008

Purpose

To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives.

Patients and Methods

A total of 90 of 98 consecutive women who underwent BPM during October 1997 to December 2005 were included. Data were collected by self-administered questionnaires (eg, Hospital Anxiety and Depression scale, Swedish Short Term-36 Health Survey, Body Image Scale, Sexual Activity Questionnaire) before the operation (n = 81), and 6 (n = 71) and 12 months (n = 65) after BPM.

Results

Anxiety decreased over time (P = .0004). No corresponding difference was found for depression. No differences in health-related quality of life over time were found, with one exception. A substantial proportion of the women reported problems with body image 1 year after BPM (eg, self consciousness, 48%; feeling less sexually attractive, 48%; and dissatisfaction with the scars, 44%). Sexual pleasure was rated lower 1-year post-BPM as compared with before operation (P = .005), but no differences over time in habit, discomfort, or activity were found.

Conclusion

No negative effects on anxiety, depression, and quality of life were found. Anxiety and social activities improved. Negative impact on sexuality and body image was reported.
New Technologies for Human Cancer Imaging
Authors: Frangioni John V.
Published: August 2008

Despite technical advances in many areas of diagnostic radiology, the detection and imaging of human cancer remains poor. A meaningful impact on cancer screening, staging, and treatment is unlikely to occur until the tumor-to-background ratio improves by three to four orders of magnitude (ie, 103- to 104-fold), which in turn will require proportional improvements in sensitivity and contrast agent targeting. This review analyzes the physics and chemistry of cancer imaging and highlights the fundamental principles underlying the detection of malignant cells within a background of normal cells. The use of various contrast agents and radiotracers for cancer imaging is reviewed, as are the current limitations of ultrasound, x-ray imaging, magnetic resonance imaging (MRI), single-photon emission computed tomography, positron emission tomography (PET), and optical imaging. Innovative technologies are emerging that hold great promise for patients, such as positron emission mammography of the breast and spectroscopy-enhanced colonoscopy for cancer screening, hyperpolarization MRI and time-of-flight PET for staging, and ion beam-induced PET scanning and near-infrared fluorescence-guided surgery for cancer treatment. This review explores these emerging technologies and considers their potential impact on clinical care. Finally, those cancers that are currently difficult to image and quantify, such as ovarian cancer and acute leukemia, are discussed.
Systems Pathology Approach for the Prediction of Prostate Cancer Progression After Radical Prostatectomy
Authors: Donovan Michael J. , Hamann Stefan , Clayton Mark , Khan Faisal M. , Sapir Marina , Bayer-Zubek Valentina , Fernandez Gerardo , Mesa-Tejada Ricardo , Teverovskiy Mikhail , Reuter Victor E. , Scardino Peter T. , Cordon-Cardo Carlos
Published: August 2008

Purpose

For patients with prostate cancer treated by radical prostatectomy, no current personalized tools predict clinical failure (CF; metastasis and/or androgen-independent disease). We developed such a tool through integration of clinicopathologic data with image analysis and quantitative immunofluorescence of prostate cancer tissue.

Patients and Methods

A prospectively designed algorithm was applied retrospectively to a cohort of 758 patients with clinically localized or locally advanced prostate cancer. A model predicting distant metastasis and/or androgen-independent recurrence was derived from features selected through supervised multivariate learning. Performance of the model was estimated using the concordance index (CI).

Results

We developed a predictive model using a training set of 373 patients with 33 CF events. The model includes androgen receptor (AR) levels, dominant prostatectomy Gleason grade, lymph node involvement, and three quantitative characteristics from hematoxylin and eosin staining of prostate tissue. The model had a CI of 0.92, sensitivity of 90%, and specificity of 91% for predicting CF within 5 years after prostatectomy. Model validation on an independent cohort of 385 patients with 29 CF events yielded a CI of 0.84, sensitivity of 84%, and specificity of 85%. High levels of AR predicted shorter time to castrate prostate-specific antigen increase after androgen deprivation therapy (ADT).

Conclusion

The integration of clinicopathologic variables with imaging and biomarker data (systems pathology) resulted in a highly accurate tool for predicting CF within 5 years after prostatectomy. The data support a role for AR signaling in clinical progression and duration of response to ADT.
Palliative Thoracic Radiotherapy for Lung Cancer: A Systematic Review
Authors: Fairchild Alysa , Harris Kristin , Barnes Elizabeth , Wong Rebecca , Lutz Stephen , Bezjak Andrea , Cheung Patrick , Chow Edward
Published: August 2008

Purpose

The optimal dose of radiotherapy (RT) to palliate symptomatic advanced lung cancer is unclear. We systematically reviewed randomized controlled trials (RCTs) of palliative thoracic RT.

Methods

RCTs comparing two or more dose fractionation schedules were reviewed using the random-effects model of a freely available information management system. The relative risk and 95% CI for each outcome were presented in Forrest plots. Exploratory analysis comparing dose schedules after conversion to the time-adjusted biologically equivalent dose (BED) was performed to investigate for a dose-response relationship.

Results

A total of 13 RCTs involving 3,473 randomly assigned patients were identified. Outcomes included symptom palliation, overall survival, toxicity, and reirradiation rate. For symptom control in assessable patients, lower-dose (LD) RT was comparable with higher-dose (HD), except for the total symptom score (TSS): 65.4% of LD and 77.1% of HD patients had improved TSS (P = .003). Greater likelihood of symptom improvement was seen with schedules of 35 Gy10 versus lower BED. At 1 year after HD and LD RT, 26.5% versus 21.7% of patients were alive, respectively (P = .002). Sensitivity analysis suggests this survival improvement was seen with 35 Gy10 BED schedules compared with LDs. Physician-assessed dysphagia was significantly greater in the HD arm (20.5% v 14.9%; P = .01), and the likelihood of reirradiation was 1.2-fold higher after LD RT.

Conclusion

No significant differences were observed for specific symptom-control end points, although improvement in survival favored HD RT. Consideration of palliative thoracic RT of at least 35 Gy10 BED may therefore be warranted, but must be weighed against increased toxicity and greater time investment.
Influence of Pre- and Postdiagnosis Physical Activity on Mortality in Breast Cancer Survivors: The Health, Eating, Activity, and Lifestyle Study
Authors: Irwin Melinda L. , Smith Ashley Wilder , McTiernan Anne , Ballard-Barbash Rachel , Cronin Kathy , Gilliland Frank D. , Baumgartner Richard N. , Baumgartner Kathy B. , Bernstein Leslie
Published: August 2008

Purpose

To investigate the association between pre- and postdiagnosis physical activity (as well as change in prediagnosis to postdiagnosis physical activity) and mortality among women with breast cancer.

Patients and Methods

This was a prospective observational study of 933 women enrolled onto the Health, Eating, Activity, and Lifestyle Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or September 2004, whichever came first. The primary outcomes measured were total deaths and breast cancer deaths. The primary exposures were physical activity in the year before and 2 years after diagnosis and the pre- to postdiagnosis change in physical activity.

Results

Compared with inactive women, the multivariable hazard ratios (HRs) for total deaths for women expending at least 9 metabolic equivalent hours per week (approximately 2 to 3 h/wk of brisk walking) were 0.69 (95% CI, 0.45 to 1.06; P = .045) for those active in the year before diagnosis and 0.33 (95% CI, 0.15 to 0.73; P = .046) for those active 2 years after diagnosis. Compared with women who were inactive both before and after diagnosis, women who increased physical activity after diagnosis had a 45% lower risk of death (HR = 0.55; 95% CI, 0.22 to 1.38), and women who decreased physical activity after diagnosis had a four-fold greater risk of death (HR = 3.95; 95% CI, 1.45 to 10.50).

Conclusion

Moderate-intensity physical activity after a diagnosis of breast cancer may improve prognosis.
Predicting Change in Academic Abilities After Conformal Radiation Therapy for Localized Ependymoma
Authors: Conklin Heather M. , Li Chenghong , Xiong Xiaoping , Ogg Robert J. , Merchant Thomas E.
Published: August 2008

Purpose

Conformal radiation therapy (CRT) aims to limit the highest radiation dose to the tissue volume at risk while sparing surrounding normal tissues. This study investigated whether treatment of childhood ependymoma with CRT would preserve cognitive function. Academic competence was chosen as the primary outcome measure given it is a measure of applied cognitive abilities in a child's natural setting.

Patients and Methods

Eighty-seven pediatric patients diagnosed with ependymoma received CRT in which doses ranging from 54.0 to 59.4 Gy were prescribed to the postoperative tumor bed with a 10-mm clinical target volume margin. Cognitive testing was conducted at the start of CRT, 6 months, and annually after the start of CRT. The median length of follow-up was 59.6 months. Academic testing included subtests from the Wechsler Individual Achievement Test (WIAT) and the Achenbach Child Behavior Checklist.

Results

Linear mixed models with random coefficients revealed a modest but significant decline in reading scores during follow-up (WIAT slope estimate −0.064 ± 0.028 points/month; P = .026). Math and spelling performance remained stable. Supratentorial tumor location and multiple surgeries were predictive of worse reading performance at CRT baseline. Male sex, longer symptomatic interval, pre-CRT chemotherapy, pre-existing endocrine deficiencies, hydrocephalus, and younger age at CRT (< 5 years) were predictive of a significant decline in reading scores over time.

Conclusion

CRT may result in better long-term cognitive outcomes when compared to conventional radiation therapy approaches. Reading appears more vulnerable than other academic skills and may decline over time despite stable intellectual functioning.
Performing Nondiagnostic Research Biopsies in Irradiated Tissue: A Review of Scientific, Clinical, and Ethical Considerations
Authors: Brown Aaron P. , Wendler David S. , Camphausen Kevin A. , Miller Franklin G. , Citrin Deborah
Published: August 2008

Purpose

Recent development of drugs that target specific pathways in tumors has increased scientific interest in studying drug effects on tumor tissue. As a result, biopsies have become an important part of many early-phase clinical trials. Performing nondiagnostic tumor biopsies raises technical and ethical concerns mostly related to the use of a potentially harmful procedure with no potential benefit to the patient. This issue is complicated by uncertainty about whether performing biopsies in irradiated fields adds significant risk. This article reviews the clinical, scientific, and ethical considerations involved in performing nondiagnostic tumor biopsies in competent adults for research purposes, with a focus on biopsies performed in the setting of therapeutic irradiation.

Methods

Clinical trials that performed biopsies during or within 4 months of the completion of radiotherapy were identified with a literature review.

Results

Twenty-nine studies with 2,160 patients were identified. Sixteen of 29 studies reported adverse events (AEs) but did not report active evaluation for biopsy complications. Ten studies did not mention AEs within the study report. At least three studies actively evaluated patients for biopsy complications. Taking this into consideration, 17 (>1%) of 2,160 patients were reported to have biopsy complications, although reporting of AEs was suboptimal in most studies.

Conclusion

Limited data suggest that biopsies can be performed in irradiated tissues without clinically significant excess risk. Ongoing and future trials including nondiagnostic research biopsies should record and report AEs related to this procedure to provide additional data on safety and toxicity.
American Society of Clinical Oncology Clinical Practice Guidelines: Opportunities and Challenges
Authors: Somerfield Mark R. , Einhaus Kaitlin , Hagerty Karen L. , Brouwers Melissa C. , Seidenfeld Jerome , Lyman Gary H.
Published: August 2008

The American Society of Clinical Oncology (ASCO) published its first clinical practice guideline, which focused on the use of hematopoietic colony-stimulating factors, in 1994. Since then, ASCO has published 24 additional guidelines or technology assessments on a range of topics and is developing 11 additional guidelines. Guidelines are among ASCO's most valued products, according to membership surveys and data from the JCO.org Web site. However, the same data from ASCO members have highlighted a number of limitations to the guideline program. These relate to the timelines of guideline updates, difficulties locating guidelines and related products, and challenges to implementing ASCO guidelines in everyday clinical practice. This article outlines the concrete steps that the ASCO Health Services Committee (HSC) is taking to address these limitations, including the institution of a more aggressive guideline updating schedule, a transition from narrative to systematic literature reviews to support the practice recommendations, a new Board of Directors–approved policy to permit endorsement of other groups’ guidelines, and a robust Clinical Tools and Resources program that offers a range of guideline dissemination and implementation aids. Additional work is underway to establish stronger and deeper collaborations with practicing oncologists to expand their role in the review, field testing, and implementation of guideline clinical tools and resources. Finally, the HSC is discussing evaluation of the guidelines program to maximize the impact of ASCO clinical practice guidelines on clinical decision making and, ultimately, the quality of cancer care.
Conditional inactivation of Myc impairs development of the exocrine pancreas
Authors: Nakhai Hassan , Siveke Jens T. , Mendoza-Torres Lidia , Schmid Roland M.
Published: August 2008

Recent studies have shown that Wnt/β-catenin signaling is essential for development of the exocrine pancreas, but the role ofβ-catenin-dependent target genes such as Myc during pancreatic development is not well known. Here, we show that tissue-specific deletion of Myc causes a slightly accelerated differentiation of pancreatic epithelial cells into endocrine cells and perturbs the proliferation of pancreatic progenitors and acinar precursor cells during early development,resulting in a severe reduction of the epithelial cell mass of pancreatic buds and an extensive acinar hypoplasia. Loss of Myc does not affect the expression of the tissue-specific transcription factor PTF1a, which is required for the differentiation of acinar cells. In contrast to its role for exocrine cell growth, the development of endocrine cell lineages is not significantly disturbed. These data suggest that Myc is required for the expansion of the exocrine pancreas. Our observations are consistent with the findings in β-catenin-deficient pancreas, suggesting that Wnt/β-catenin signaling affects the proliferation of pancreatic epithelial cells and acinar precursors through its target gene Myc.
Family Experience of Borderline Personality Disorder
Authors: Giffin Jan
Published: August 2008

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.
How Qualitative Research Can Inform Clinical Interventions in Families Recovering From Sibling Sexual Abuse
Authors: Welfare Anne
Published: August 2008

The impact of sibling sexual abuse (SSA) has been culturally and therapeutically minimised and has received scant research attention. Furthermore, prior research has focused upon the separate experiences of the victim or the offender, or upon seeking family dysfunction explanations. In contrast, this qualitative study attempts to understand the experiences of all family members (victims, offenders, parents and other siblings) when SSA is disclosed. The pathway to recovery for each family member is identified. A systemic analysis of these (often conflicted) pathways of recovery provides some surprising findings and contributes to an understanding of the difficulties facing families in this situation, the constraints on family support and connectedness, validation for the victim and offender accountability.
Remaking Self After Domestic Violence: Mongolian and Australian Women's Narratives of Recovery
Authors: Oke Marion
Published: August 2008

My feminist, narrative research comprises a cross‐cultural narrative analysis of 11 Mongolian and 11 Australian women's stories of survival, recovery and remaking of self, following intimate partner violence. With a major focus on narrative identity, the research process involved me as researcher, as well as the participants themselves, bearing witness to and reflecting on their stories. While similarities between the Mongolian and Australian stories stood out above differences, there was some evidence that the Mongolian women had moved further away from the violence and its effects than their Australian counterparts. Perhaps the cohesive nature of the Mongolian women's family supports strengthened their narrative identities, enabling their greater resilience.
Specific Cases, Techniques and Approaches: Talking Pictures in Family Therapy
Authors: Shafer Mina
Published: August 2008

This article presents a case study on the use of arts‐based resources in family therapy to help children and their post‐separation families describe their experience, communicate and collaborate with each other, witness and learn about each other, and develop their individual and family well‐being.
Clinicians Play with Mud, and It's the Best Thing for Us: An Interview With Alistair Campbell
Authors: Hansen Ben
Published: August 2008

Alistair Campbell is Research Editor for the ANZJFT. He is a Senior Lecturer in Clinical Psychology and Director of the Psychology Clinic at James Cook University in Townsville. He speaks provocatively with Ben Hansen about research and training in family therapy, about accountability to our clients, and about practice.
Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials
Authors: Jimenez Camilo , Burman Pia , Abs Roger , Clemmons David R , Drake William M , Hutson Kent R , Messig Michael , Thorner Michael O , Trainer Peter J , Gagel Robert F
Published: August 2008

Objective

We examined pituitary tumor volumes in patients treated with pegvisomant for 18 months or longer, and in whom the tumors were monitored for at least 3 years. We present details on 9 of 304 patients in clinical trials with pegvisomant who experienced tumor growth within the first year of treatment.

Method

Magnetic resonance images prior to start of pegvisomant and at last follow-up were examined in 43 patients (14% of participating patients). Twenty-nine had received prior radiation therapy (18% of irradiated patients) and all but five received somatostatin analogs between periods of pegvisomant treatment.

Results

At follow-up, the median tumor volume was 0.6 cc (range 0.0–19.7 cc), in comparison with 1.6 cc (0.0–19.7 cc) at baseline (P<0.001). Twenty-five patients, of which 23 received radiation therapy, had tumor volume reduction. Seventeen patients had no significant change. One patient, who had not received radiation therapy, had an increase in tumor volume from 1.61 to 1.93 cc. Of the nine patients with tumor growth, six had progressive growth before initiating pegvisomant. Two patients with stable tumors while on octreotide experienced enlargement after octreotide discontinuation but remained stable on long-term pegvisomant therapy.

Conclusion

The present data indicate that pegvisomant does not promote tumor growth and suggest that the nine observed cases of tumor progression, which occurred within 8 months after commencing pegvisomant, are likely rebound expansions after discontinuation of somatostatin analogs and/or the natural history of aggressively growing pituitary tumors. Continued long-term surveillance of tumor volume, particularly in non-irradiated patients, is recommended.
Clinical use of cabergoline as primary and adjunctive treatment for acromegaly
Authors: Moyes V J , Metcalfe K A , Drake W M
Published: August 2008

Background

Cabergoline is a dopamine agonist that may be used as primary or adjunctive therapy for acromegaly. Although one study suggested biochemical control may be achieved in a substantial proportion of patients, it is still commonly perceived to be a relatively ineffective treatment.

Design and method

A prospective audit was performed of 15 consecutive acromegalic patients (eight males, seven females, median age 55, range 31–92 at presentation) treated with cabergoline to determine the effective dose and tolerability. All had normal anterior pituitary function; two patients had hyperprolactinaemia. Magnetic resonance imaging revealed nine adenomata, two partially empty sellae and four structurally normal pituitary glands. Nine patients had undergone transsphenoidal surgery 1–12 months, and one patient had received pituitary radiotherapy 18 years, prior to commencement of cabergoline. All patients had biochemical GH excess; median serum IGF1 471 ng/ml, range 239–746 ng/ml. The calculated mean of a series of GH measurements ranged from 2.7–45.8 mIU/l, median 9.7 mIU/l.

Results

On a median weekly dose of cabergoline of 1.75 mg (range 0.5–7 mg) normalisation of both IGF1 and GH occurred in 4 out of the 15 patients (27%). Out of the 15 patients (33%), 5 achieved a serum IGF1 within the reference range with notable reductions seen in a further five patients. Nine patients (60%) achieved a mean serum GH level of less than 5 mIU/l. Duration of treatment was 2–52 months and was well tolerated in 14 patients.

Conclusion

Cabergoline can be an effective and well tolerated primary or adjunctive therapy for acromegaly and useful clinical responses are noted even with modest doses.