bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinematic analysis of a novel 3-CRU translational parallel mechanism
Authors: Li B. , Li Y. M. , Zhao X. H. , Ge W. M.
Published: April 2015

Abstract. In this paper, a modified 3-DOF (degrees of freedom) translational parallel mechanism (TPM) three-CRU (C, R, and U represent the cylindrical, revolute, and universal joints, respectively) structure is proposed. The architecture of the TPM is comprised of a moving platform attached to a base through three CRU jointed serial linkages. The prismatic motions of the cylindrical joints are considered to be actively actuated. Kinematics and performance of the TPM are studied systematically. Firstly, the structural characteristics of the mechanism are described, and then some comparisons are made with the existing 3-CRU parallel mechanisms. Although these two 3-CRU parallel mechanisms are both composed of the same CRU limbs, the types of freedoms are completely different due to the different arrangements of limbs. The DOFs of this TPM are analyzed by means of screw theory. Secondly, both the inverse and forward displacements are derived in closed form, and then these two problems are calculated directly in explicit form. Thereafter, the Jacobian matrix of the mechanism is derived, the performances of the mechanism are evaluated based on the conditioning index, and the performance of a 3-CRU TPM changing with the actuator layout angle is investigated. Thirdly, the workspace of the mechanism is obtained based on the forward position analysis, and the reachable workspace volume is derived when the actuator layout angle is changed. Finally, some conclusions are given and the potential applications of the mechanism are pointed out.
Regional trends and controlling factors of fatal landslides in Latin America and the Caribbean
Authors: Sepúlveda S. A. , Petley D. N.
Published: April 2015

Abstract. A database of landslides that caused loss of life in Latin America and the Caribbean in the period from 2004 and 2013 inclusive has been compiled using established techniques. This database indicates that in the ten year period a total of 11 631 people lost their lives across the region in 611 landslides. The geographical distribution of the landslides is very heterogeneous, with areas of high incidence in parts of the Caribbean (most notably Haiti), Central America, Colombia, and SE. Brazil. The number of landslides varies considerably between years; the El Niño/La Niña cycle emerges as a major factor controlling this variation, although the study period did not capture a large event. Analysis suggests that on a continental scale the mapped factors that best explain the observed distribution are topography, annual precipitation and population density. On a national basis we have compared the occurrence of fatality-inducing landslide occurrence with the production of research articles with a local author, which shows that there is a landslide research deficit in Latin America and the Caribbean. Understanding better the mechanisms, distributions causes and triggers of landslides in Latin America and the Caribbean must be an essential first step towards managing the hazard.
Pinch and swell structures: evidence for brittle-viscous behaviour in the middle crust
Authors: Gardner R. , Piazolo S. , Daczko N.
Published: April 2015

Abstract. The flow properties of middle to lower crustal rocks are commonly represented by viscous flow. However, examples of pinch and swell structures found in a mid-crustal high strain zone at St. Anne Point (Fiordland, New Zealand) suggest pinch and swell structures are initiated by brittle failure of the more competent layer in conjunction with material softening. On this basis we develop a flexible numerical model using brittle-viscous flow where Mohr–Coulomb failure is utilised to initiate pinch and swell structure development. Results show that pinch and swell structures develop in a competent layer in both Newtonian and non-Newtonian flow provided the competent layer has enough viscosity contrast and initially fails brittlely. The degree of material softening after initial failure is shown to impact pinch and swell characteristics with high rates of material softening causing the formation of thick necks between swells by limiting the successful localisation of strain. The flow regime and yielding characteristics of the matrix do not impact pinch and swell structure formation itself, so long as the matrix is less competent. To aid analysis of the structures and help derive the flow properties of rocks in the field, we define three stages of pinch and swell development and offer suggestions for measurements to be made in the field. Our study suggests that Mohr–Coulomb behaviour combined with viscous flow is an appropriate way to represent the heterogeneous rocks of the middle to lower crust. This type of mid-crustal rheological behaviour has significant influence on the localization of strain at all scales. For example, inclusion of Mohr–Coulomb brittle failure with viscous flow in just some mid-crustal layers within a crustal scale model will result in strain localisation throughout the whole crustal section allowing the development of through-going high strain structures from the upper crust into the middle and lower crust. This localization then has a significant effect on developing near-surface structures.
Effect of Inhaled Fluticasone Propionate on Retinal Nerve Fiber Layer Thickness in Asthmatic Children
Authors: Dereci Selim , Pirgon Ozgur , Akcam Mustafa , Turkyilmaz Kemal , Dundar Bumin
Published: April 2015

Purpose

Corticosteroids are under suspicion of playing an important role in the development of retinopathy. We aimed to determine peripapillary retinal nerve fiber layer (RNFL) thinning by spectral-domain optical coherence tomography (OCT) in children being treated with inhaled fluticasone propionate due to asthma.

Methods

Thirty-eight children diagnosed with allergic asthma (mean age 9.8 ± 2.8 years, age range 6–13 years) and 40 age-similar controls were enrolled in this study. All children with asthma were taking inhaled fluticasone propionate at a dosage of 250 μg or more per day for at least 1 year. The RNFL thickness measurements were performed using Cirrus HD spectral-domain OCT 400. Central subfield thickness, cube average thickness, and cube volume were also measured.

Results

Among the 38 children with asthma and 40 healthy subjects who completed follow-up, children with asthma had similar mean peripapillary RNFL thicknesses compared with control children. The mean central subfield thickness was significantly higher than that of controls (248.8 ± 23.4 vs 237.5 ± 23.5, p<0.037). There was a positive linear relationship between cube average thickness and eosinophil count with a Pearson correlation coefficient of 0.336 (p<0.039) and a negative correlation was found between central subfield thickness and disease duration (r = −0.385, p = 0.017) in children with asthma.

Conclusions

Asthmatic children have similar peripapillary RNFL measurements compared to controls on spectral -domain OCT. Raised eosinophil counts in asthmatic children were found to be significantly associated with cube average thickness.
Clinical Assessment of Retinal Changes by Spectral-Domain OCT
Authors: Iester Michele , Violanti Sara , Borgia Luigi
Published: April 2015

Purpose

To evaluate optical coherence tomography changes in patients with retinal thinning at the posterior pole.

Methods

In this cross-sectional and retrospective study, 648 files were reviewed, and 67 patients were selected. Optical coherence tomography images that showed an area with a retinal thickness reduction at the macular region by using the Asymmetry Analysis Map in Heidelberg Spectralis were selected. The presence of hemisphere asymmetry in the same eye and asymmetry between the paired eyes were calculated and used for the analysis. Retinal thickness was measured in 3 different retinal areas (squares): ( 1 ) the area (square) involved by the pathology (IA), ( 2 ) the specular area (square) in the opposite hemifield (SA), and ( 3 ) the corresponding IA in the contralateral eye (CIA) (area used to recruit the patients). Retinal layer morphology was analyzed observing the Spectralis screen.

Results

The thickness of the IA was 235.54 ± 39.95 μm (mean ± standard deviation), while it was 269.84 ± 36.16 μm and 293.81 ± 37.52 μm for SA and CIA, respectively.

Conclusions

Different retinal layers could be involved in reduction of the retinal thickness: a reduction of the inner layers was related to disease in which ciliary or retinal arterial vessel flow was involved, while a reduction of the outer retinal layer was related to pathologies related to choroidal flow diseases.
A Case of Acute Exudative Polymorphous Vitelliform Maculopathy: Follow-Up and Wide-Field Spectral-Domain Optical Coherence Tomography
Authors: Massaro Domenico , Pece Alfredo , Pichi Francesco , Yannuzzi Lawrence A. , Gilardoni Francesca , Carrai Paola , Bonsignore Francesco , Nucci Paolo
Published: April 2015

Purpose

To present a case of an HIV-positive patient with acute exudative polymorphous vitelliform maculopathy (AEPVM) and evaluate the presence of specific spectral-domain optical coherence tomography (SD-OCT) findings.

Methods

Case report.

Results

We reviewed the AEPVM cases reported in the literature and compared those to our patient to determine if there is a correspondence between the etiology that leads to the onset of AEPVM and clinical and SD-OCT findings.

Conclusions

Acute exudative polymorphous vitelliform maculopathy is a disease that involves the outer retinal layers with lipofuscin deposits and serous detachment of the neuroepithelium with or without intraretinal cysts. Not much is known about the etiology and pathogenesis, and not many cases have been described. A review of the few clinical cases reported in the literature does not show a specific correspondence between etiology and SD-OCT findings.
Revision of a Single Type of Large Metal Head Metal-on-Metal Hip Prosthesis
Authors: van Lingen Christiaan P. , Ettema Harmen B. , Bosker Bart H. , Verheyen Cees C.P.M.
Published: April 2015

Large-head metal-on-metal (MoM) total hip arthroplasties were introduced because of their purported advantages. Inflammatory pseudotumours occasionally occur after MoM hip arthroplasty and often lead to revision. The purpose of this study was to assess the outcome of revision of large-head MoM total hip arthroplasties after an extensive screening protocol for all MoM articulations with a minimum 2 year follow-up. We identified 50 hips that had undergone large-head MoM total hip arthoplasty and required revision at a mean of 44 months after index operation. Of these, 38 were revised for pseudotumours, 7 for loosening, 2 for infection and 3 for instability. There was bone loss in 44 hips. The majority were revised to a 28 mm metal or ceramic head on a polyethylene-cemented cup. In 12 patients there was a complication. There was a decrease of whole blood cobalt from 20.8 µg/L preoperatively to 1.8 µg/L 1 year after revision. We found 6 residual masses on routine postoperative CT scans. The indication for revision of this cohort is inevitable but the clinical outcome 2 years after revision for pseudotumour is disappointing. Revising a MoM hip arthroplasty to a conventional cemented polyethylene or dual-mobility cup with bone impaction grafting and a 28 mm head can adequately treat the high ion levels and probably the disease of ARMD.
Small Diameter Acetabulum and Femoral Head in Total Hip Arthroplasty for Developmental Dysplasia of the Hip, with no Femoral Osteotomy
Authors: Verettas Dionysios-Alexandros , Chloropoulou Pelagia , Xarchas Konstantinos , Drosos Georgios , Ververidis Athanasios , Kazakos Konstantinos
Published: April 2015

We present the results of 66 total hip arthroplasties in 62 patients of mean age 46 years (24-74 years), with developmental dysplasia of the hip. In all cases the centre of rotation of the new hip was positioned at the site of the true acetabulum. In all patients cementless press fit acetabular components of small diameter (42-44 mm) were used, articulating exclusively with a 22.25 mm modular metal femoral head, without the use of bone grafts or shortening osteotomies of the femur. Despite the use of small diameter femoral heads the rate of dislocation was 3%. After an average follow-up period of 9 years (4-18 years), no revisions were required for infection, loosening or wear or implant migration. Osteolytic lesions were seen in the periacetabular region in 3 patients who were symptom free. A total of 2 revisions were required for instability and 2 patients had the wires of their trochanteric osteotomy removed because of bursitis. Leg length inequality was improved in 55% of the patients and one postoperative transient sciatic nerve lesion settled within 4 months. We believe that in patients with painful dysplastic hips, the use of small diameter implants with the centre of rotation at the true acetabulum, can give very satisfactory results, without any supplementary procedures.
A Novel Technique for Identification of Fractured Ceramic Acetabular Liner in Total Hip Arthroplasty: A Case Report
Authors: Shafafy Roozbeh , Foote Julian , Hargrove Richard
Published: April 2015

In total hip arthroplasty ceramic bearings are liable to fracture. We present the case of an 82-year-old male with groin pain and an audible squeak 6 months post ceramic on ceramic hip arthroplasty. Initial plain radiography and examination under anaesthetic (EUA) were normal. Fluoroscopy with normal image exposure was also unremarkable. Over penetration of the image intensifier film demonstrated a fracture of the ceramic acetabular liner. The patient subsequently underwent a revision of both acetabular and femoral bearing surfaces.

Displaced ceramic liner fractures are easy to identify with plain radiographs. We recommend the use of over penetration using image intensification as a technique to help identify subtle ceramic liner fractures. To our knowledge this has not been previously reported in the literature.
Highly Cross-Linked Polyethylene Improves wear and Mid-Term Failure Rates for Young Total Hip Arthroplasty Patients
Authors: Keeney James A. , Martell John M. , Pashos Gail , Nelson Christopher J. , Maloney William J. , Clohisy John C.
Published: April 2015

We compared clinical outcomes and polyethylene wear for 2 young primary THA patient cohorts (<50 years of age) at mid-term follow-up. In total, 72 patients (84 hips) received a coventional polyethylene liner (CPE) and 84 patients (89 hips) received a highly cross-linked polyethylene liner (HXLPE). Mean Harris Hip Score improved to 81 points for both groups. UCLA activity scores were higher for HXLPE patients (6.0 vs 5.3, p = 0.03), with lower mean linear wear (0.02 vs 0.13 mm/year, p<0.001) and lower mean volumetric wear (75.1 vs 229.8 mm3, p<0.001) at an average of 70 months follow-up. No HXLPE patient required revision for wear related concerns, compared to 5 CPE patients with revision for aseptic loosening or impending radiographic failure (0% vs 5.9%, p = 0.02). HXLPE is associated with reduced wear among young, active THA patients without increased risk of early mechanical failure.
Endocarditis and Spondylodiscitis Associated with Tunneled Cuffed Hemodialysis Catheters: Hospitalizations with Poor Outcomes
Authors: Rocha Ana , Castro Rui , Santos Josefina
Published: April 2015

Introduction

Patients undergoing chronic hemodialysis using tunneled cuffed catheters (TCCs) are at increased risk of metastatic infections, namely endocarditis and spondydodiscitis, and mortality is high in this group. The aim of this study was to determine the clinical features, causative organisms, its susceptibility and outcomes in patients hospitalized with these infections from a single center.

Methods

All consecutive patients with TCC and endocarditis and/or spondylodiscitis treated at the authors’ institution between 2005 and 2011 were selected retrospectively.

Results

A total of 7 cases of endocarditis and 7 cases of spondylodiscitis were diagnosed. Concurrent infection was present in 1 patient. The mean age was 63.4 years, 53.8% were male, 23% had diabetes and 31% had previous immunosuppression. The average time on hemodialysis was 24 months. Those patients with endocarditis presented with fever, and 43% had previous valvular disease; mitral valve involvement was the most common. Early surgery was performed in 2 patients. Concerning spondylodiscitis, the median time from first symptom to diagnosis was 48 days. The first manifestation was back pain in 86% percent of patients, and 71% had an epidural or paraspinous abscess demonstrated by neuroimaging. One patient underwent surgical drainage of the abscess. Regarding both infections, staphylococcus aureus was the most common causative agent with a lower rate of negative blood cultures. All patients received intravenous antibiotics for a mean duration of six weeks. The mortality rate was 46%.

Conclusions

A high index of suspicion is critical in the early recognition and management of both of these infections.
Serum Interleukin 17 as An Early Prognostic Biomarker of Severe Acute Pancreatitis Receiving Continuous Blood Purification
Authors: Dai Shu R. , Li Zhen , Zhang Jian B.
Published: April 2015

Background

Severe acute pancreatitis (SAP) is associated with systemic inflammation, immunoparalysis, and sepsis, and may lead to vital organ failure and death. We evaluated the efficacy of serum interleukin 17 (IL-17) concentration for predicting eventual SAP severity and the clinical benefits of removing IL-17 by continuous veno-venous hemofiltration (CVVH).

Methods

Patients were divided into 2 groups according to severity: Grade 1 (n = 18, SAP without organ dysfunction) and Grade 2 (n = 18, SAP with organ dysfunction). 20 healthy volunteers served as controls. All patients underwent 24-h CVVH and blood samples were taken at 0, 6, 12, and 24 h for measurement of bacterial load and serum IL-17, IL-6, and endotoxin. Clinical condition was graded by the sequential organ failure assessment (SOFA) score.

Results

Baseline IL-17, IL-6, endotoxin, and bacterial load were higher in Grade 2 patients. SOFA scores improved significantly, and serum IL-17, IL-6, endotoxin, and bacterial load decreased significantly in all patients after CVVH. Serum IL-17 was significantly and positively correlated with IL-6, bacterial load, and endotoxin during CVVH treatment. In addition, post-CVVH serum IL-17 was directly correlated with SOFA scores on days 1 and 7, and with duration of hospital stay. Non-survivors showed both higher SOFA scores on day 1 and higher baseline IL-17 than survivors.

Conclusions

Earlier and higher serum IL-17 elevation predicted prolonged hospitalization, organ failure, and death, possibly by disrupting gut barrier function. CVVH can remove inflammatory cytokines from serum, including IL-17 and IL-6, thereby attenuating the inflammatory response and diminishing associated systemic complications.
HOGG1 C1245G Gene Polymorphism Associated with Prostate Cancer: A Meta-Analysis
Authors: Chen Yang , Li Jie , Li Tianyu , Mo Zengnan
Published: April 2015

Background

Prostate cancer (Pca) is one of the most frequently encountered multifactorial malignant diseases worldwide. The human oxoguanine glycosylase 1 ( hOGG1) C1245G polymorphism (rs1052133) has been found to be associated with Pca. However, the conclusions have been controversial.

Methods

Based on the PubMed, Embase, HuGENet and Chinese National Knowledge Infrastructure (CNKI) databases, this meta-analysis was conducted with 4 models. Eleven qualified studies were included.

Results

Although no positive relation was discovered in the pooled analysis, significant associations between rs1052133 and Pca were found in the Asian population (recessive: odds ratio [OR] = 1.580, 95% confidence interval [95% CI], 1.189-2.098; GG vs. GC: OR = 1.504, 95% CI, 1.114-2.030; GG vs. CC: OR = 1.677, 95% CI, 1.201-2.342; allele analysis: OR = 1.249, 95% CI, 1.077-1.449), whites (dominant: OR = 2.138, 95% CI, 1.483-3.083; recessive: OR = 3.143, 95% CI, 1.171-8.437; GG vs. CC: OR = 3.992, 95% CI, 1.891-8.431; allele analysis: OR = 1.947, 95% CI, 1.467-2.586) and mixed populations (recessive: OR = 0.636, 95% CI, 0.484-0.834; GG vs. GC: OR = 0.654, 95% CI, 0.492-0.871; GG vs. CC: OR = 0.624, 95% CI, 0.473-0.823; allele analysis: OR = 0.857, 95% CI, 0.771-0.954). After excluding studies deviating from the Hardy-Weinberg equilibrium, a significant association was also found in the same ethnic groups. In addition, a new positive relation was identified in the “other country” subgroup (with China, South Korea and Australia included) (dominant: OR = 1.622, 95% CI, 1.163-2.261; recessive: OR = 1.773, 95% CI, 1.308-2.404; GG vs. GC: OR = 1.614, 95% CI, 1.169-2.230; GG vs. CC: OR = 2.108, 95% CI, 1.456-3.051; allele analysis: OR = 1.494, 95% CI, 1.235-1.808) and among the Chinese-Korean population.

Conclusions

In conclusion, we suggest that the hOGG1 C1245G polymorphism might be potentially associated with Pca risk in different ethnicities and countries, especially among Asians. Further studies are needed to confirm these relations.
BDE-99 (2,2′,4,4′,5-pentabromodiphenyl Ether) Triggers Epithelial-mesenchymal Transition in Colorectal Cancer Cells via PI3K/Akt/Snail Signaling Pathway
Authors: Wang Fei , Ruan Xin-Jian , Zhang Hong-Yan
Published: April 2015

Purpose

The gut is in direct contact with BDE-99 (2,2′,4,4′,5-pentabromodiphenyl ether), one of the most abundant PBDE congeners in the environment and in human tissues. The objective of the present study was to investigate the effects of BDE-99 on colorectal cancer (CRC) cells.

Methods

The effects of BDE-99 on cell proliferation were measured by CCK-8 assay in the CRC cell line HCT-116. Wound healing and transwell migration/invasion assays were used to test the migration and invasion of CRC cells. Factors related to epithelial-to-mesenchymal transition (EMT) were measured by real-time PCR and Western blot analysis for mRNA and protein levels, respectively.

Results

BDE-99 was found to increase migration and invasion and trigger EMT in HCT-116 cells; EMT was characterized by cells acquiring mesenchymal spindle-like morphology and by increased expression of N-cadherin with a concomitant decrease in E-cadherin. BDE-99 treatment also increased the protein and mRNA levels of the transcription factor Snail, but not Slug, Twist, and ZEB1. Knockdown of Snail by siRNA significantly attenuated BDE-99-induced EMT in HCT-116 cells, suggesting that Snail plays a crucial role in BDE-99-induced EMT. The PI3K/Akt inhibitor LY294002 completely blocked BDE-99-induced Snail and invasion of HCT-116 cells.

Conclusions

Our results revealed that BDE-99 can trigger the EMT of colon cancer cells via the PI3K/AKT/Snail signaling pathway. This study provides new insight into the tumorigenesis and metastasis of CRC stimulated by BDE-99 and possibly other PBDE congeners.
Loss of YAP Protein in Prostate Cancer is Associated with Gleason Score Increase
Authors: Hu Xiaoyong , Jia Yingying , Yu Jianjun , Chen Jie , Fu Qiang
Published: April 2015

Aims and Background

To investigate the expression of YAP protein by immunohistochemistry in prostate cancer tissues and hyperplasia or normal prostate tissues adjacent to cancer, and establish the correlation of YAP expression with Gleason score.

Methods and Study Design

The expression of YAP protein was evaluated in tissue microarray by immunohistochemistry. The samples included 66 radical prostatectomy specimens with clinically detected prostate cancer and 54 hyperplasia or normal prostate tissues adjacent to cancer.

Results

YAP expression was present mainly in the nuclei of basal cells in both prostate cancer tissues and normal prostate or hyperplasia tissues adjacent to cancer. Cytoplasmic expression of YAP was weaker than nuclear expression in both malignant and nonmalignant luminal epithelial cells. YAP expression was decreased or lost in prostate cancer tissues; hyperplasia or normal prostate tissues adjacent to cancer exhibited stronger nuclear and cytoplasmic expression of YAP (p = 0.0001). Downregulation of YAP expression in prostate cancer samples correlated with Gleason score increase (p = 0.002).

Conclusions

This immunohistochemical study expands our knowledge of the expression and localization of YAP in prostate cancer tissue and nonmalignant prostate tissue adjacent to cancer. YAP might function as a tumor suppressor in prostate cancer. Such information may provide the foundation for the treatment of preneoplastic and neoplastic lesions of the prostate.
Ampulla of Vater Carcinoma in Real-World Clinical Practice: A Case Series
Authors: Giuliani Jacopo , Piacentini Paolo , Bonetti Andrea
Published: April 2015

Aims and Background

The aim of this report was to describe the way in which a rare and niche disease like ampulla of Vater carcinoma (AVC) was treated in real-world clinical practice.

Methods and Study Design

A retrospective analysis of consecutive patients with a diagnosis of AVC treated at our medical oncology unit between August 2004 and August 2013 was performed.

Results

We evaluated 8 consecutive patients with a median age of 60 years (range 56–84). At the last follow-up, 4 patients were alive without evidence of disease and 4 patients had died. The median follow-up time was 21.51 months (range 1–100.43), the median overall survival 23.19 months (range 7.07–102.2), and the median disease-free survival 18.26 months (range 0–102.2). Six patients underwent surgery, which consisted of pylorus-preserving pancreaticoduodenectomy, R0 in all cases. Tumor histology was adenocarcinoma in all patients. Two patients presented with locally advanced disease. Only 1 patient presented with metastases while 3 patients subsequently developed metastases. Two patients received chemotherapy for metastatic disease; in both cases disease progression was observed at the first disease evaluation.

Conclusions

We can consider AVC as a pathology niche and pancreaticoduodenectomy as the effective treatment for these patients.
Inferior Mesenteric Artery Chemoembolization and Chemotherapy for Advanced Rectal Cancer: Report of a Clinical Case
Authors: Bini Roberto , Comelli Simone , Addeo Alfredo , Viora Tiziana , Vana Federica , Vaudano Giacomo Paolo , Savio Daniele , Leli Renzo
Published: April 2015

Patients with advanced and incurable colorectal cancer have a very poor prognosis. Curative-intent resection was performed in 70%–90% of cases in reported series of colorectal cancer, sometimes after neoadjuvant chemotherapy and radiotherapy. The remaining 10%-30% of patients are treated with palliative intent, where treatment is aimed at relieving disease-related symptoms and improving quality of life. The provision of palliative care for these patients is complicated and outcomes are often disappointing. Although there are many available options including a variety of surgical and nonsurgical interventions, the best management remains controversial. Transarterial chemoembolization with irinotecan-loaded drug-eluting beads (DEBIRI) is an effective, minimally invasive procedure performed by interventional radiologists that allows intra-arterial drug delivery to stop vascular feeding and exert local cytotoxic effects. We here report on a patient treated with DEBIRI followed by systemic chemotherapy with the FOLFOX regimen for locally advanced, inoperable colorectal cancer.
Comparison of Stereotactic Body Radiation Therapy for Biopsy-Proven versus Radiographically Diagnosed Early-Stage Non-Small Lung Cancer: A Single-Institution Experience
Authors: Fischer-Valuck Benjamin W. , Boggs Hunter , Katz Sanford , Durci Michael , Acharya Sahaja , Rosen Lane R.
Published: April 2015

Introduction

Histological confirmation of non-small cell lung cancer (NSCLC) is often required before patients are offered stereotactic body radiation therapy (SBRT) as a treatment option. Many patients, however, are unsuitable to undergo a biopsy procedure because of comorbidity. Our objective is to compare the outcomes of patients with biopsy-proven (BxPr) or clinically/radiographically diagnosed (RadDx) early-stage NSCLC treated with SBRT.

Methods

Records of 88 patients treated with SBRT at a single institution were reviewed. Sixty-five patients had BxPr early-stage NSCLC. Twenty-three patients were RadDx with early-stage NSCLC based on an FDG-avid chest nodule on PET scan, serial sequential CT-findings compatible with NSCLC, and consensus of a multidisciplinary team. Outcomes of patients with BxPr and RadDx NSCLC were evaluated in regard to local control, regional lymph node metastasis-free and distant metastasis-free rates, and overall survival using Kaplan-Meier survival curves.

Results

Median follow-up for all patients was 29 months (range, 4–82 months). Cumulative local progression-free rate after 3 years for the BxPr group was 93.1% (95% confidence interval [CI], 85.2%-97.6%) and 94.10% (95% CI, 73.2%-97.6%) for the RadDx group (p = 0.98). No differences regarding regional lymph node metastasis-free and distant metastasis-free rates by subgroup were observed. The overall 3-year survival rate for the BxPr group was 59.9% (95% CI, 44.8%-68.2%) and 58.9% (95% CI, 40.1%-77.8%) for the RadDx group (p = 0.46).

Conclusions

SBRT is a practical treatment modality for patients with RadDx early-stage NSCLC. Outcomes of patients RadDx with NSCLC mirror the results of patients treated with BxPr disease.
Stereotactic Body Radiotherapy with Cyberknife for Cardiac Malignancies
Authors: Bonomo Pierluigi , Cipressi Samantha , Desideri Isacco , Masi Laura , Doro Raffaela , Iermano Carmine , Greto Daniela , Simontacchi Gabriele , Mangoni Monica , Paiar Fabiola , Meattini Icro , Scoccianti Silvia , Santoro Gennaro , Valente Serafina , Gensini Gian Franco , Livi Lorenzo
Published: April 2015

Aims and Background

Radiobiological and technical considerations have traditionally limited the role of radiation therapy in the context of primary and secondary cardiac malignancies. Stereotactic body radiotherapy (SBRT) is a promising modality for the delivery of focused high-dose radiation with ablative potential to complex targets such as small, deep-seated, moving lesions, allowing also for re-irradiation.

Methods

Between January 2013 and October 2013, 3 patients underwent SBRT for cardiac lesions: 2 patients had recurrent, previously irradiated cardiac angiosarcomas (PCA) and 1 patient had a cardiac metastasis from melanoma. They were treated with fiducial-guided robotic radiotherapy with CyberKnife. As for dose prescription, 24 Gy in 3 fractions (80% isodose) and 30 Gy in 5 fractions (80% isodose) were administered to the recurrent PCAs and cardiac metastasis, respectively.

Results

At 2 months after SBRT, cardiac MRI showed a partial response in the patients treated for recurrent PCA while the cardiac metastasis remained stable. In all cases, absence of local progression was subsequently confirmed by contrast-enhanced cardiac MRI after 6 months, without any evidence of treatment-related side effects.

Conclusions

Fiducial-guided SBRT proved to be feasible and effective in preventing local disease progression in selected patients with cardiac malignancies.
Management of Oropharyngeal Mycosis in Head and Neck Cancer Occurring during (Chemo) Radiotherapy: An Italian Radio-Oncologist Survey
Authors: Belgioia Liliana , Bacigalupo Almalina , Alterio Daniela , Russi Elvio , Corvò Renzo
Published: April 2015

Aims and Background

Oropharyngeal candidiasis is a common disorder in head and neck cancer patients (HNCPs) who underwent (chemo)-radiotherapy. An Italian survey was conducted in order to investigate radiation oncologists' behavior in regard to diagnosis, prevention, and treatment of oral candidiasis.

Methods and Study Design

Between April and May 2013, a national online 18-question survey was sent to major Italian radiotherapy centers.

Results

All Italian regions were represented and 86 radiation oncologists were involved. Eighty-three percent of responders estimated that oropharyngeal candidiasis occurred in 30%-40% of their HNCPs. The majority of responders were able to recognize oral mycosis when it occurred in a localized pseudomembranous form and all responders agreed with the fact that oral candidiasis was always associated with mucositis. A prophylactic therapy was prescribed occasionally by 35% and routinely by 20% of responders. Forty percent prescribed an antifungal drug in the case of suspected mycotic infection and 20% waited for symptomatic clinical evidence before prescribing a therapy. In the presence of candidiasis, mainly topical fluconazole (59%) and itraconazole (36%) were prescribed. Concomitant chemo-radiotherapy was first identified as a risk factor for mycosis occurrence and development. Ninety-nine percent of responders believed that oral mycosis was associated with increased toxicity and 44% of them interrupted treatment due to candidiasis.

Conclusions

A variety of approaches to oropharyngeal candidiasis emerges from this survey; further clinical trials are necessary to identify the best approach for oral mycosis prevention and treatment and to establish specific international guidelines for HNCPs.
Risk Patterns of Subsequent Primary Cancers following Esophagectomy in Early-Stage Thoracic Esophageal Squamous Cell Cancer Patients
Authors: Hu Wen-Si , Liu Zeng-Jun , Zhang Jian-Bo , Wang Zeng-Liang , Yang Ning , Xu Liang , Tian Hui , Zhang Pin-Liang
Published: April 2015

Aims and Background

Subsequent primary cancers (SPCs) have been demonstrated to be the major causes of death among patients with thoracic esophageal squamous cell cancer (ESCC) negative for lymph node involvement. We designed this study to investigate clinical characteristics and risk patterns of SPCs following esophagectomy in patients with early-stage thoracic ESCC.

Methods

We retrospectively analyzed clinical factors in 512 patients with early-stage thoracic ESCC collected from 3 independent hospitals over a 10-year interval.

Results

The overall standard incidence rate (SIR) of SPCs was 3.84 (95% confidence interval 2.98–4.95). The most common SPCs were head and neck cancers, lung cancer, and stomach cancer. The risk patterns of SPCs varied across organs. A 3-phase risk pattern with a U-shaped curve between 2 rising phases was seen for head and neck cancers, while for the other cancers, the risk patterns all displayed as an approximately linear upward trend. It was further noted that sex, smoking habits, and cancer histories among first-degree relatives were 3 significant independent risk factors in the development of SPCs.

Conclusions

We observed significant associations between early-stage ESCC and SPCs arising from anatomically adjacent sites. The different risk patterns of SPCs indicated that follow-up strategies should be established accordingly in different organs at different times, with particularly close follow-up for head and neck cancers in the first 5 years and beyond 15 years after diagnosis of ESCC.
Single Synchronous Pulmonary Metastasis from Placental Site Trophoblastic Tumor and Teratoma
Authors: Billè Andrea , Girelli Lara , Colecchia Maurizio , Pastorino Ugo
Published: April 2015

Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic tumor (GTN), accounting for 1–2% of all GTNs. Primary testicular PSTTs are extremely rare. Thirty percent of patients with PSTT show multiple lung and brain metastases at the time of diagnosis. We present the first case of a synchronous single pulmonary trophoblastic placental tumor metastasis together with a teratoma and a mixed germinal tumor of the testis, treated with minimally invasive lung metastasectomy.
Role of Multidetector Computed Tomography in Evaluating Incidentally Detected Breast Lesions
Authors: Moschetta Marco , Scardapane Arnaldo , Lorusso Valentina , Rella Leonarda , Telegrafo Michele , Serio Gabriella , Angelelli Giuseppe , Ianora Amato Antonio Stabile
Published: April 2015

Aims and Background

Computed tomography (CT) does not represent the primary method for the evaluation of breast lesions; however, it can detect breast abnormalities, even when performed for other reasons related to thoracic structures. The aim of this study is to evaluate the potential benefits of 320-row multidetector CT (MDCT) in evaluating and differentiating incidentally detected breast lesions by using vessel probe and 3D analysis software with net enhancement value.

Methods and Study design

Sixty-two breast lesions in 46 patients who underwent 320-row chest CT examination were retrospectively evaluated. CT scans were assessed searching for the presence, location, number, morphological features, and density of breast nodules. Net enhancement was calculated by subtracting precontrast density from the density obtained by postcontrast values. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CT were calculated for morphological features and net enhancement.

Results

Thirty of 62 lesions were found to be malignant at histological examination and 32 were found to be benign. When morphological features were considered, the sensitivity, specificity, accuracy, PPV, and NPV of CT were 87%, 100%, 88%, 100%, and 50%, respectively. Based on net enhancement, CT reached a sensitivity, specificity, accuracy, PPV, and NPV of 100%, 94%, 97%, 94%, and 100%, respectively.

Conclusions

MDCT allows to recognize and characterize breast lesions based on morphological features. Net enhancement can be proposed as an additional accurate feature of CT.
Knowledge, Opinions and Attitudes of Italian Mothers towards HPV Vaccination and Pap test
Authors: La Torre Giuseppe , De Vito Elisabetta , Ficarra Maria Giovanna , Firenze Alberto , Gregorio Pasquale , Miccoli Silvia , Giraldi Guglielmo , Unim Brigid , De Belvis Giulio , Boccia Antonio ,   HPV Collaborative Group, Saulle Rosella , Semyonov Leda , Ferrara Maria , Langiano Elisa , Capizzi Silvio , Nardella Rosaria , Marsala Maria Grazia Laura , Bonanno Valentina , Ferrara Clara , Guidi Enrica , Bergamini Mauro , Lupi Silvia
Published: April 2015

Aim

This study evaluated the knowledge and attitudes of Italian mothers – whose daughters had been vaccinated in 2012 – towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues.

Methods

The survey – part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) – was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test.

Results

The sample proved knowledgeable about the correlation between HPV and cervical cancer (>85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test.

Conclusions

The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.
Image-Guided Radiotherapy for Prostate Cancer using 3 Different Techniques: Localization Data of 186 Patients
Authors: Garibaldi Cristina , Jereczek-Fossa Barbara Alicja , Zerini Dario , Cambria Raffaella , Ferrari Annamaria , Serafini Flavia , Cattani Federica , Tagaste Barbara , Fodor Cristiana , Luraschi Rosa , Orecchia Roberto
Published: April 2015

Aims and Background

This study evaluates 3 different imaging modalities—ultrasound (US), stereoscopic X-ray imaging of implanted markers (Visicoils) (X-ray), and kV cone-beam computed tomography (CBCT)—to assess interfraction and intrafraction localization error during conformal radiation therapy of prostate cancer.

Methods and Study Design

The study population consisted of 186 consecutive prostate cancer patients treated with an image-guided radiotherapy (IGRT) hypofractionated protocol using 3 techniques: 32 with X-ray, 30 with CBCT, and 124 with US. Treatment dose of 70.2 Gy was delivered in 26 fractions with a conformal dynamic arcs technique. Interfraction prostate localization errors were determined for the 3 techniques. Moreover, interfraction and intrafraction prostate motion in terms of translations and rotations, as well as residual errors, were determined with X-ray.

Results

The systematic and random components of the prostate localization errors were as follows: ( 1 ) with X-ray 3.0 ± 3.4, 2.3 ± 2.7, 1.8 ± 2.3 mm in anterior-posterior (AP), superior-inferior (SI), and left-right (LR) directions and 1.8° ± 1.2°, 2.3° ± 1.5°, 2.7° ± 3.1°, for the yaw, roll, and pitch rotations; ( 2 ) with CBCT3.5 ± 4.2, 3.3 ± 3.3, 2.5 ± 3.1 mm in AP, SI, and LR directions; ( 3 ) with US 3.7 ± 4.7, 3.4 ± 4.3, 2.3 ± 3.5 mm in AP, SI, and LR directions. Residual errors with X-ray were less than 1 mm in all directions. Intrafraction prostate motion of less than 0.5 mm in LR and of the order of 1 mm in AP and SI directions was found. This led to a significant reduction of the margins, potentially important for dose escalation studies.

Conclusions

Daily on-line IGRT with stereoscopic X-ray imaging allowed a consistent PTV margin reduction considering residual interfraction prostate localization error and intrafraction motion. X-ray offers the best compromise among accuracy, reliability, dose to the patient, and time investment for daily IGRT treatment of prostate.
Investigation of Prognostic Factors Affecting Efficacy in Carboplatin- and Paclitaxel-based First-line Chemotherapies for Advanced Non-small-cell Lung Cancer
Authors: Komuro Masato , Kaneko Masayuki , Narukawa Mamoru
Published: April 2015

Aims and Background

First-line chemotherapies for advanced non-small-cell lung cancer (NSCLC) are platinum-based regimens. An analysis of efficacy outcomes has not yet been systematically performed and fully evaluated using large patient cohorts in each of the platinum-based chemotherapies. The present meta-analysis aims to investigate prognostic factors affecting overall survival (OS), progression-free survival (PFS) or time to progression (TTP), and overall response rate (ORR) in carboplatin and paclitaxel-based first-line chemotherapies for advanced NSCLC.

Methods

We performed a literature search in PubMed for randomized phase II and III clinical trials in patients with NSCLC treated with carboplatin and paclitaxel as first-line chemotherapy published from January 2000 to December 2013 to investigate prognostic factors affecting OS, PFS or TTP, and ORR by linear regression analysis and logistic regression analysis.

Results

We identified 61 treatment arms in 53 phase II and III clinical trials for the analysis. Asian region was found to be a prognostic factor that affects longer OS in treatment with carboplatin and paclitaxel as first-line chemotherapy. In addition, we identified weekly administration schedule of paclitaxel, Asian region, and lower percentage of patients with adenocarcinoma as factors affecting higher ORR.

Conclusions

Our findings of prognostic factors affecting ORR and OS in carboplatin and paclitaxel-based chemotherapies as first-line therapy should be considered in the interpretation of efficacy results in global phase II and III clinical trials.
Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer: What to Avoid. Preliminary Analysis of a Consecutive Series of Patients
Authors: Rausei Stefano , Lianos Georgios D. , Proserpio Ilaria , Ruspi Laura , Galli Federica , Frattini Francesco , Mangano Alberto , Rovera Francesca , Boni Luigi , Roukos Dimitrios H. , Pinotti Graziella , Dionigi Gianlorenzo
Published: April 2015

Aims and background

The role of neoadjuvant (NAD) chemotherapy (CHT) in patients with locally advanced gastric cancer (LAGC) is validated. However, some important limitations emerged from the literature, including patient selection, quality of surgery, and pathologic response evaluation. Neoadjuvant CHT for LAGC has been evaluated with a focus on safety and efficacy of the preoperative approach in terms of patient compliance, surgical outcomes, and pathologic response.

Methods and Study Design

Ninety-one patients with gastric adenocarcinoma were prospectively observed. All patients received computed tomography scan and laparoscopy staging. Ten patients with LAGC (including 2 with LAGC suspected for cM+/lapM+) had been recruited in the preoperative ECF/EOX CHT protocol and were compared with 61 patients who underwent surgery alone.

Results

The overall compliance for the preoperative CHT group was higher than compliance for adjuvant CHT observed in both the NAD CHT group and the surgery alone group. There were 2 treatment shifts to FOLFOX in the preoperative regimen. In the preoperative CHT group, D2-gastrectomy was possible only in 6/10 of cases, with a R0 resection rate of 67% (versus 64% in the LAGC patients treated by surgery alone). The postoperative mortality and morbidity were 0% and 17% in the NAD CHT group versus 2% and 26% in the surgery alone group. The overall pathologic response rate after NAD CHT was 83% (5/6).

Conclusions

Staging and CHT management problems can negatively affect patient outcomes. In the LAGC setting, when well applied, NAD CHT could be considered a valuable treatment option.
Understanding Tipping Behaviour — An Economic Perspective
Authors: Saayman Melville , Saayman Andrea
Published: April 2015

There are generally three explanations for tipping: social approval, equitable service exchange and other reasons. The combination and importance of these reasons differ between countries and cultures. In this study, three distinct questions were asked. What influences the frequency of the tipping decision? What influences the magnitude of the tip given? Who is likely to tip more than the norm? A survey among diners was conducted at one of South Africa's largest arts festivals. Using regression analyses, this paper aims to identify the factors that influence tipping behaviour in South Africa. While most previous research has focused on motivational and/or psychological reasons for tipping, this research contributes towards understanding tipping from an economic perspective. The results show that the frequency of tipping and its magnitude are a function of the ability to pay. However, socio-demographics play an important role, especially in the paying of the above-normal tip.
Comparison of Destination Competitiveness Ranking in the European Union Using a Non-Parametric Approach
Authors: Abad Arnaud , Kongmanwatana Papangkorn
Published: April 2015

This paper seeks to improve accuracy when presenting the tourism performance of European countries and, in particular, the position of destination management organizations, which play a central role in the tourism development of their countries. The paper measures the performance of European countries and endeavours to explain the dispersion of the efficiency ranking scores in the European Union (EU). Three types of methodology are applied to establish the tourism performance of the destinations. The study covers 27 large and small countries in the EU, but excludes Malta. In addition, two representative indicators of output are used: destination attractiveness and annual data on bed-nights and nights spent. Therefore, the paper uses data envelopment analysis (DEA), super-efficiency DEA and the non-radial Nerlove—Luenberger super-efficiency DEA model to narrow down the partition between efficiency and inefficiency scores in large and small countries in terms of development.