bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning as a Process of Selection and Amplification
Authors: Young J Z
Published: February 2018

These are only a few examples of how learning occurs during development by a process of sculpturing, selecting among the possible variations, combinations and sequences of actions. This is how we build up what may be called programs in the brain (Young 1978). The physiologist will say that these are only, as it were, metaphorical statements, not detailed descriptions of known brain actions. ‘The programmes of elaborate sequences of movement, built up over the course of many years, are not yet on the agenda of practical neurophysiology’ (Phillips & Porter 1978, p 333). Perhaps this statement may prove to be over-pessimistic, as I am sure the authors would hope. Studies of learning, of which I have tried to give a small sample, do begin to show us how programs are assembled by selecting from the vast number of possibilities that are available and then increasing the reliability of the chosen actions. It is particularly pleasing to find that we can begin to understand the various principles that are involved. In Aplysia we see something of them due to the cellular changes. In Octopus we see how learning involves different pieces of neuronal machinery. One serves to distribute signals to allow access to the full repertoire of possibilities. Another part distributes and balances rewards and penalties. In a third the actual learning change occurs and the many minute cells suggest that we may look for the origin of learning among reciprocal reflexes.

In the vertebrate brain we see the multiplication of neuronal patterns and centres greatly increased. We get glimpses of how various parts of the brain cooperate in building and executing the programs. Learning involves many parts of the brain, each contributing in a different way. The cerebellum perhaps provides the repertoire of small variations in muscular contraction out of which those are selected that perform the acts that prove necessary. Perhaps the motivations to do these correctly come partly from the aminergic pathways such as those of the locus ceruleus, while the hippocampus provides the power to seek to make new ones. And of course the cerebral cortex and its attendant input and output centres provides the biggest repertoire of all, selection among whose modules has allowed us to build and use a program that studies itself. Surely John Hughlings Jackson would have rejoiced that there has been some advance in understanding of the ‘Relations of Different Divisions of the Central Nervous System to One Another and to Parts of the Body’, which was the title of the first Hughlings Jackson lecture, which he himself gave in 1897.
Pregnancy following Renal Transplantation
Authors: Parsons V , Bewick M , Elias J , Snowden S A , Weston M J , Rodeck C H
Published: February 2018

A series of 7 renal transplant patients with 9 pregnancies is reported. A spontaneous abortion at 10 weeks was the only major problem. Of the other 8 pregnancies, 6 were delivered per vaginam and 2 by elective caesarean section, all after 34 weeks. The birthweights were slightly under the mean for the patients’ age but had been made up to normal by three months. Only one rejection episode occurred during pregnancy. Mild rejection episodes occurred in 4 patients within two months following delivery.
Role of Computed Tomography in Staging and Management of Gastrointestinal Lymphoma
Authors: Blackledge George , Best Jonathan K , Crowther Derek
Published: February 2018

Twenty-six computed tomography (CT) examinations in 18patients with histologically proven gastrointestinal lymphomas are reported. Fourteen CT examinations were performed at the time of initial presentation, the others being performed during the course of the disease. CT did not help in the diagnosis of the disease but it is effective in assessing the extent and thus the stage of the disease. A normal CT scan during follow up is associated with good prognosis. CT may be of help in planning treatment, especially radiotherapy. It is an investigation easily tolerated by patients and can be used in circumstances where other investigations would be impossible.
An External Fixation Device: Preliminary Communication
Authors: Sukhtian Walid , Hughes Sean
Published: February 2018

The initial results of the treatment of fractures using a new external fixation device are encouraging. The indications include comminuted or compound fractures, or when there is already an established infection of the bone.
Management of Malignant Dysphagia by Intubation at Endoscopy
Authors: Atkinson Michael , Ferguson Roger , Ogilvie A L
Published: February 2018

A method of relieving dysphagia in inoperable oesophagogastric neoplasms by per oral intubation using the Nottingham tube introducer was attempted in 63 patients with 3 failures. Twelve patients died within 10days of intubation, including 4 from a perforation of the growth sustained during the procedure, and 51 patients left hospital swallowing satisfactorily. The average period of survival was 3 months and 10patients survived for a year or more, including 2 in whom the tube was removed after regression of a squamous carcinoma following radiotherapy.

Endoscopic per oral intubation is a simple and relatively safe procedure which when used in patients with oesophagogastric neoplasms gives adequate symptomatic relief and allows home management in the terminal stages of the illness.
Flight control and flight experiments of a tilt-propeller VTOL UAV
Authors: Öznalbant Zafer , Kavsaoğlu Mehmet Ş.
Published: February 2018

The purpose of this work is to present a study on the stability and control of an unmanned, fixed wing, vertical take-off and landing aerial vehicle. This airplane is driven by a fixed-pitch tilt-propeller system with the capability of vertical take-off and landing as well as conventional flight. The novelty of the vehicle is the use of a fixed-pitch propeller system instead of variable-pitch tilt-rotors. There are three flight modes: vertical, transitional and conventional flight modes. Each flight mode has different dynamic characteristics. Therefore, these modes each need dedicated flight control methods. In this paper, the equations of motion are generated by modelling the aerodynamic and propulsion forces and moments. After performing trim condition calculations, longitudinal stability characteristics are investigated for each flight mode. The control methods are described for vertical, transitional and conventional flight modes. Stability augmentation systems, which consist of proportional and proportional/integral controller, are applied. A number of flight tests, including vertical, transitional and conventional flights, have been successfully performed with a prototype aircraft.
Power Corrupts, but Control Does Not: What Stands Behind the Effects of Holding High Positions
Authors: Cislak Aleksandra , Cichocka Aleksandra , Wojcik Adrian Dominik , Frankowska Natalia
Published: February 2018

People seek high positions not to gain influence over others but to satisfy their need for personal control. Personal control tends to have positive interpersonal consequences. If this is the case, does power indeed corrupt? We argue that holding a high position is associated both with perceptions of power (influence over others) and personal control (influence over one’s life). Three studies showed that these two aspects might have opposite consequences: Power over others positively predicted aggressiveness (Study 1, N = 793) and exploitativeness (Study 2, N = 445), whereas personal control predicted these outcomes negatively. In Study 3 ( N = 557), conducted among employees at various organizational positions, the effects of holding a high position on exploitativeness and aggressiveness were differentially mediated by power over others and personal control. We discuss these findings in light of contradicting evidence on the corruptive effects of power.
Bread, dignity and social justice
Authors: Anderson Lisa
Published: February 2018

Although they produced vastly more turmoil, the uprisings in the Arab world shared many characteristics with other early 21st-century popular protests on both the left and the right, from Spain’s Indignados and Occupy Wall Street to the anti-elite votes for Brexit and Trump. The conviction that political elites and the states they rule, which were once responsible for welfare and development, now ignore and demean the interests and concerns of ordinary citizens takes many forms, but is virtually universal. The Arab world was only one site of this discontent, but the story of the Arab Spring insurrections provides a cautionary illustration of the perils in abdication of political authority and accountability and provokes questions about how we understand historical moments when passions outstrip interests.
A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course
Authors: Lind Meredith Merz , Corridore Marco , Sheehan Cameron , Moore‐Clingenpeel Melissa , Maa Tensing
Published: February 2018

Objective

To design and assess an advanced pediatric airway management course, through simulation‐based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base.

Methods

Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1‐day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork. Participants completed pre‐ and postworkshop questionnaires.

Results

Thirty‐nine trainees participated over the 3‐year study period. Compared with their precourse responses, participants’ postcourse responses indicated either agreement or strong agreement that the multidisciplinary format (1) helped in the development of team communication skills and (2) was preferred over single‐discipline training. Improvement in confidence in managing critical airway situations and in advanced airway management skills was significant (P <. 05). Eighty‐one percent of participants had improved confidence in following the hospital's critical airway protocol, and 64% were better able to locate advanced airway management equipment.

Discussion

Multiple subspecialists manage pediatric respiratory failure, where successful care requires complex handoffs and teamwork. Multidisciplinary education to teach advanced airway management, teamwork, and communication skills is practical and preferred by learners and is possible to achieve despite differences in experience. Future study is required to better understand the impact of this course on patient care outcomes.

Implications for Practice

Implementation of a pediatric difficult airway course through simulation‐based team training is feasible and preferred by learners among multiple disciplines. A multidisciplinary approach exposes previously unrecognized knowledge gaps and allows for better communication and collaboration among the fields.
Cognition in High-Frequency Trading: The Costs of Consciousness and the Limits of Automation
Authors: Beverungen Armin , Lange Ann-Christina
Published: February 2018

Certain strands of contemporary media theory are concerned with the ways in which computational environments exploit the ‘missing half-second’ of human perception and thereby influence, control or exploit humans at an affective level. The ‘technological unconscious’ of our times is often understood to work at this affective level, and high-frequency trading is regularly provided as a primary illustrative example of the contagious dynamics it produces. We challenge and complicate this account of the relation between consciousness, affect and media technologies by drawing on the recent work of N. Katherine Hayles and by focusing in detail on the ways in which the ‘costs of consciousness’ are accounted for and negotiated in high-frequency trading. We suggest that traders actively develop modes of awareness accounting for the costs of consciousness, and that the necessary ‘stupidity’ of high-frequency trading algorithms as well as competition pose limits to the full automation of financial markets.
An index of fatal toxicity for new psychoactive substances
Authors: King Leslie A , Corkery John M
Published: February 2018

An index of fatal toxicity for new psychoactive substances has been developed based solely on information provided on death certificates. An updated index of fatal toxicity (Tf), as first described in 2010, was calculated based on the ratio of deaths to prevalence and seizures for the original five substances (amphetamine, cannabis, cocaine/crack, heroin and 3,4-methylenedioxymethylamphetamine)*. These correlated well with the 2010 index. Deaths were then examined for cases both where the substance was and was not found in association with other substances. This ratio (sole to all mentions; S/A) was then calculated for deaths in the period 1993 to 2016. This new measure of fatal toxicity, expressed by S/A, was well-correlated with the index Ln (Tf) of the original reference compounds. The calculation of S/A was then extended to a group of new psychoactive substances where insufficient prevalence or seizure data were available to directly determine a value of Tf by interpolation of a graph of Tf versus S/A. Benzodiazepine analogues had particularly low values of S/A and hence Tf. By contrast, γ-hydroxybutyrate/γ-butyrolactone, α-methyltryptamine, synthetic cannabinoid receptor agonists and benzofurans had a higher fatal toxicity.
Brain susceptibility changes in neurologically asymptomatic pediatric patients with Wilson’s disease: evaluation with quantitative susceptibility mapping
Authors: Saracoglu Sibel , Gumus Kazim , Doganay Selim , Koc Gonca , Kacar Bayram Ayse , Arslan Duran , Gumus Hakan
Published: February 2018

Background

Wilson’s disease (WD) is a copper metabolism disorder that causes hepatolenticular degeneration. It is important to diagnose WD before central nervous system involvement.

Purpose

To demonstrate the early susceptibility changes associated with the copper accumulation in the brain of neurologically asymptomatic pediatric patients with WD using quantitative susceptibility mapping (QSM).

Material and Methods

Twelve patients with neurologically asymptomatic WD (mean age = 13.7 ± 3.3 years) and 14 age-matched controls were prospectively examined using a 1.5-T clinical scanner. Routine magnetic resonance (MR) sequences and a three-dimensional multi-echo spoiled gradient echo (GRE) sequence were used and QSM maps were reproduced. The quantitative susceptibility of corpus striatum, thalamus, substantia nigra, and pons were analyzed with the region of interest analysis on QSM maps. The susceptibility values of two groups were statistically compared using a two-sample t-test.

Results

Conventional MR images of the patients and control group were similar. However increased magnetic susceptibility in the thalamus, pons and left posterior putamen were observed in the patients compared to the control group ( p < 0.05).

Conclusion

We observed statistically increased susceptibility values in the brains of neurologically asymptomatic patients with WD although the conventional MR images were normal. This might be compatible with early brain impairment, before neurological symptoms occur.
Risk Factors for Bladder Cancer
Authors: Janković Slavenka , Radosavljević Vladan
Published: February 2018

Aims and background

To summarize risk factors for bladder cancer, emphasizing the role of recently established associations and to present some ongoing debates on the issue.

Methods

A systematic literature search was performed using MEDLINE database on bladder cancer risk factors between January 1985 and June 2006 and by detailed examination of the references of original articles, reviews and monographs retrieved.

Results

Cigarette smoking is recognized as the main cause of bladder cancer and accounts for about 50% of cases in developed countries. A strong link exists between the amount and duration of cigarette smoking. A high risk of bladder carcinoma has been observed in workers exposed to some aromatic amines. Based on these and other occupational risks, it has been estimated that 5-10% of bladder carcinomas in industrialized countries were due to exposures of occupational origin. Infectious agents have a major influence on bladder cancer risks in the areas of the world where Schistosoma haematobium infestation is endemic. Other potential risk factors for bladder cancer are other urinary tract infections and drinking tap water with chlorination by-products or arsenic. Exposure to certain drugs, like cyclophosphamide used in chemotherapy and heavy consumption of phenacetin-containing analgesics, has been shown to cause bladder cancer in humans. Total fluid intake and high consumption of fruits and vegetables are probably associated with a small decrease in risk.

Conclusions

Avoidance of tobacco smoking and incriminated occupational exposures, habitual intake of fresh fruits and vegetables, and prevention and control of urinary tract infections should be recommended for bladder cancer prevention. Further studies are required to assess the role of genetic polymorphisms and their modifying effect of lifestyle risk factors for bladder cancer occurrence and to evaluate the benefit of bladder cancer screening, particularly in those at high risk.
Epidemiology of Colorectal Cancer in the Umbria Region of Italy: Prescreening Period
Authors: Cassetti Tiziana , Stracci Fabrizio , Canosa Antonio , Minelli Liliana , Scheibel Massimo , Romagnoli Carlo , La Rosa Francesco
Published: February 2018

Aims and background

The epidemiology of colorectal cancer in Umbria, Italy, was evaluated, and data were analyzed in the pre-screening period to better understand the etiology of the disease and to develop screening strategies.

Materials and methods

Incident data were collected by the Umbrian Population Cancer Registry and mortality data by the Nominative Regional Mortality Registry from 1994 to 2002. The survival rates relative to Italian cancer registries were derived from the Italian Associations of Cancer Registries publications. Time trends were analyzed by joinpoint regression. The follow-up for survival rates referred to December 31, 2005.

Results

The trend of colorectal cancer age-adjusted incidence showed a slight, constant, but non significant increase over time. The mortality trend showed a slight, constant, but non-significant decrease. Age at diagnosis remained constant in males, whereas in females it showed a significant increase of about 1.5 years. In the last period, all incidence rates increased with age, but in males they presented a rapid increase in the 55-74 age group, levelled and declined up to 84 and after again reached, which could be a consequence of opportunistic screening practice, probably undergone by males. Mortality in both sexes increased with age, whereas survival rates fell. Comparison of survival rates in some Italian cancer registries showed that the Umbria region, in the 1994-1996 period, was the zone with the highest relative survival; in the 1996-1999 period, the rate stopped, differently from other Italian zones. In the last period, the highest survival rates were recorded by registries covering zones with active screening programs.

Conclusions

The present reduction of mortality in Umbria, as in other Italian areas, is dependent on the natural behavior of the disease, which is linked to a birth cohort-related effect of stabilization and decrease in exposure to risk factors.
Efficacy of Different Regimens of Adjuvant Radiochemotherapy for Treatment of Glioblastoma
Authors: Scheda Antonella , Finjap Janvier Kaba , Tuettenberg Jochen , Brockmann Marc Alexander , Hochhaus Andreas , Hofheinz Ralf , Lohr Frank , Wenz Frederik
Published: February 2018

Aims and background

We retrospectively analyzed the impact of different adjuvant chemotherapy regimens in a group of patients treated for glioblastoma compared to patients receiving only postoperative radiotherapy.

Material and methods

Eighty-six consecutive patients underwent radiotherapy between January 2000 and December 2003: 52 patients received radiotherapy alone, 17 patients radiochemotherapy with low-dose temozolomide (20 mg/m2) + cyclooxygenase-2-inhibitors (200 mg), 6 patients radiochemotherapy with high-dose temozolomide (50 mg/m2). Eleven patients, with unfavorable prognostic factors, were treated with imatinib and 55/2.5 Gy.

Results

The groups treated with high- and low-dose temozolomide showed the longest overall survival (median, 21 months and 17 months, respectively). Median overall survival was 9 months for radiation alone and 4 months for the imatinibtreated group. The same positive trend of temozolomide on prolonged overall survival was confirmed when only patients submitted to maximally radical resection or patients with KPS >70 were considered. Differences in progression-free survival were not statistically significant.

Conclusions

Patients treated with adjuvant temozolomide either inside or outside of study protocols had survival times similar to other reports or randomized studies. The absence of a significant influence of temozolomide on progression-free survival could depend on the unavoidable drawbacks and biases of retrospective investigations or on the definition of relapse used. The unsatisfactory results of radiotherapy plus imatinib may have been due to a high prevalence of unfavorable prognostic factors in the respective patients. The ongoing controlled trial will further define the efficacy of adjuvant/concomitant imatinib.
Three-Dimensional Conformal External Beam Radiotherapy versus the Combination of External Radiotherapy with High-Dose Rate Brachytherapy in Localized Carcinoma of the Prostate: Comparison of Acute Toxicity
Authors: Soumarová Renata , Homola Luboš , Perková Hana , štursa Miroslav
Published: February 2018

Aims and background

Radiotherapy represents one of the basic therapeutic methods in treatment of localized carcinoma of the prostate. Optimal irradiation dose is the cornerstone of a successful treatment. Along with local control of the disease and overall survival of the patient, possible acute and long-term side effects need to be monitored very closely.

Methods

A non-randomized prospective study comparing the acute genitourinary and gastrointestinal toxicity in patients irradiated for localized carcinoma of the prostate. Fifty-seven patients were treated with three-dimensional conformal external beam radiotherapy alone, and in the second treatment arm a combination of external beam radiotherapy and high-dose rate brachytherapy was employed in 40 patients.

Results

Three-dimensional conformai external beam radiotherapy. Acute G1 genitourinary toxicity was recorded in 35.1% of patients, G2 in 22.8%, and G2-3 in one patient (1.7%). Acute gastrointestinal toxicity was experienced by 54.4% of patients, G1 in 28.1%, G2 in 17.5%, and G3 in 8.8%. Three-dimensional conformal external beam radiotherapy + brachytherapy. Acute G1 genitourinary toxicity was recorded in 37.5% and grade 2 in 15% of the patients. Only G1 acute gastrointestinal toxicity was recorded in 40% of the patients.

Conclusions

Acute G1 genitourinary toxicity was experienced by a similar percentage of patients in both treatment arms. Acute G2 genitourinary toxicity was more frequent in the three-dimensional conformal radiotherapy arm. Higher acute genitourinary toxicity, G3 or G4, was recorded only in one patient per treatment arm. Acute gastrointestinal toxicity was more frequent in the three-dimensional conformal radiotherapy arm. Higher acute gastrointestinal toxicity, G2 and G3, was only observed in the three-dimensional conformal radiotherapy arm. The acute toxicity observed was of a low grade. The combination of external beam radiotherapy with brachytherapy resulted in a lower incidence of gastrointestinal toxicity than external beam radiotherapy alone.
Postoperative Radiotherapy for Synovial Sarcoma of the Head and Neck during Pregnancy: Clinical and Technical Management and Fetal Dose Estimates
Authors: Orlandi Ester , Zonca Giancarlo , Pignoli Emanuele , Stucchi Claudio , Borroni Marta , Collini Paola , Cantù Giulio , Casali Paolo G. , Grosso Federica , Cerrotta Annamaria , Fallai Carlo , Olmi Patrizia
Published: February 2018

Aims and background

In vivo and phantom dosimetry is reported to estimate the fetal dose and evaluate the effectiveness of a special shielding device to reduce fetal exposure in a woman undergoing postoperative radiation therapy for synovial oral cavity sarcoma at the 30th week of pregnancy.

Methods

In vivo measurements were performed by placing thermoluminescent dosimeters on 3 points for fetal dose estimation: uterine fundus, umbilicus and pubis. A Rando anthropomorphic phantom was used to simulate radiotherapy. We also performed off-axis dose measurements for wedged beams to estimate the dose contribution of this accessory used in the treatment.

Results

The special shielding device reduced the fetal dose by 70% on average, despite the presence of wedges, which increased the dose by a factor of about 2.5. Before delivery the patient received 48 Gy, and from the in vivo measurements a fetal dose of 8.5, 1.7 and 0.7 cGy was estimated to the uterine fundus, umbilicus and pubis, respectively.

Conclusions

Pre-treatment simulation in the same irradiation conditions is the only reliable approach to predict the fetal dose. By using a special shielding device, radiotherapy can be optimized while keeping the fetal exposure below the risk of deterministic damage.
Skeletal Involvement in Infants with Neuroblastoma a Quality Control Attempt
Authors: Angelini Paola , De Bernardi Bruno , Granata Claudio , Villavecchia Giampiero , Morbelli Silvia , Luksch Roberto , Di Cataldo Andrea , Garaventa Alberto , Castellani Rita
Published: February 2018

Aims and background

In 1994, French authors hypothesized that positive skeletal mIBG spots in infants with stage 4 neuroblastoma were not prognostically unfavorable unless associated to abnormal standard X-ray or CT findings. In 1999, the European Infant Neuroblastoma Study adopted this definition, indeed reducing the number of patients candidate to chemotherapy. Such an approach requires high quality scans and standardized procedures. The present study critically reviewed and assessed the quality of mIBG scans performed in Italian patients enrolled in the European Infant Neuroblastoma Study.

Methods

Three independent nuclear medicine specialists reviewed scans of 25 Italian patients enrolled in Trials 99.2, 99.3, and 99.4 of the European Infant Neuroblastoma Study between January 2000 and September 2002. An arbitrary quality score was attributed to each mIBG scintigraphy, ranging from 1 (less than adequate) to 3 (excellent). One radiologist and 2 oncologists reviewed the X-rays and CT scans and correlated the results with clinical assessment.

Results

The quality of mIBG scans was rated from good to excellent in 15 of 25 cases, poor in 4, and inadequate for diagnostic evaluation in 6. X-rays confirmed the presence of metastases in 3 of 7 cases with mIBG bone uptake. CT scan confirmed skull metastases in 6 of 9 mIBG-positive cases. Discrepancies in scan interpretation, making trial and stage attribution questionable, were found in 2 patients and are discussed.

Conclusions

The quality of mIBG scans proved to be at least acceptable in most Italian pediatric oncology centers. Efforts should be made to further standardize evaluation of the scans. Additional techniques (99mTc scintigraphy, MRI, SPECT) might be useful to help understand the most complex cases.
Role of Computed Tomographyand [18F] Fluorodeoxyglucose Positron Emission Tomography Image Fusion in Conformal Radiotherapy of Non-Small Cell Lung Cancer: A Comparison with Standard Techniques with and without Elective Nodal Irradiation
Authors: Ceresoli Giovanni Luca , Cattaneo Giovanni Mauro , Castellone Pietro , Rizzo Giovanna , Landoni Claudio , Gregorc Vanesa , Calandrino Riccardo , Villa Eugenio , Messa Cristina , Santoro Armando , Fazio Ferruccio
Published: February 2018

Aims and background

Mediastinal elective node irradiation (ENI) in patients with non-small cell lung cancer candidate to radical radiotherapy is controversial. In this study, the impact of co-registered [18F]fluorodeoxyglucose-positron emission tomography (PET) and standard computed tomography (CT) on definition of target volumes and toxicity parameters was evaluated, by comparison with standard CT-based simulation with and without ENI.

Methods

CT-based gross tumor volume (GTVCT) was first contoured by a single observer without knowledge of PET results. Subsequently, the integrated GTV based on PET/CT coregistered images (GTVPET/CT) was defined. Each patient was planned according to three different treatment techniques: 1) radiotherapy with ENI using the CT data set alone (ENI plan); 2) radiotherapy without ENI using the CT data set alone (no ENI plan); 3) radiotherapy without ENI using PET/CT fusion data set (PET plan). Rival plans were compared for each patient with respect to dose to the normal tissues (spinal cord, healthy lungs, heart and esophagus).

Results

The addition of PET-modified TNM staging in 10/21 enrolled patients (48%); 3/21 were shifted to palliative treatment due to detection of metastatic disease or large tumor not amenable to high-dose radiotherapy. In 7/18 (39%) patients treated with radical radiotherapy, a significant (≥25%) change in volume between GTVCT and GTVPET/CT was observed. For all the organs at risk, ENI plans had dose values significantly greater than no-ENI and PET plans. Comparing no ENI and PET plans, no statistically significant difference was observed, except for maximum point dose to the spinal cord Dmax, which was significantly lower in PET plans. Notably, even in patients in whom PET/CT planning resulted in an increased GTV, toxicity parameters were fairly acceptable, and always more favorable than with ENI plans.

Conclusions

Our study suggests that [18F]-fluorodeoxyglucose-PET should be integrated in no-ENI techniques, as it improves target volume delineation without a major increase in predicted toxicity.
An Adrenal Gland Nodule Presenting as an Early Sign of Metastatic Spread from Colorectal Cancer: Report of Two Cases
Authors: Rosati Gerardo , Tramutola Giuseppe , D'alessandro Nicola , Chiacchio Rosistella , Vita Giulia , Scutari Franco , Manzione Luigi
Published: February 2018

The presence of an adrenal gland nodule may be an early or late sign of metastatic spread from colorectal cancer. It usually appears when the internal malignancy is widely disseminated and has been previously diagnosed. Adrenal insufficiency can be compatible with bilateral and diffuse involvement of this uncommon site of disease. Although a surgical approach can be proposed in some circumstances, chemotherapy is usually the only therapeutic option. We present 2 cases that document examples of both events, so as to illustrate the most relevant aspects of this condition.
Simultaneous Occurrence of Medullary Carcinoma and Papillary Microcarcinoma of Thyroid in a Patient with Men 2A Syndrome. Report of a Case
Authors: Giacomelli Laura , Guerriero Gabriella , Falvo Laura , Altomare Vittorio , Chiesa Carlo , Ferri Simone , Stio Francesco
Published: February 2018

We report a case of simultaneous multifocal medullary carcinoma and papillary microcarcinoma in a patient with several distinctive features of MEN 2A. The patient underwent total thyroidectomy and central lymph node dissection. The extreme rarity and pathological features of this occurrence are discussed. There is no known common cause of these 2 different tumor types; it may be a stochastic exception. However, several other possibilities such as a common precursor cell or a common tumorigenic stimulus offer interesting perspectives for speculation.
Induction Therapy with Paclitaxel and Carboplatin Followed by Hyperfractionated Radiotherapy plus Weekly Concurrent Chemotherapy and Subsequent Consolidation Therapy in Unresectable Locallyadvanced Non-Small-Cell Lung Cancer
Authors: Cortesi Enrico , Moscetti Luca , Nelli Fabrizio , De Marinis Filippo , De Paula Ugo , Bangrazi Caterina , Migliorino Maria Rita , Donato Vittorio
Published: February 2018

Aims and Background

The purpose of this pilot study was to determine the safety and feasibility of a complete integrated approach, including induction chemotherapy with carboplatin/paclitaxel followed by accelerated hyperfractionated radiotherapy with concurrent chemotherapy, and then by consolidation chemotherapy for locally advanced stage III non-small cell lung carcinoma.

Methods

Systemic doses of carboplatin AUC 6 and paclitaxel (200 mg/m2), 3 weeks out of 4, were planned as induction and consolidation chemotherapy. Weekly carboplatin AUC of 2 plus paclitaxel (50 mg/m2) were given during thoracic radiotherapy.

Results

Eighteen patients were enrolled: 10 were evaluated at the end of chemoradiation and 8 received consolidation chemotherapy. On an intent-to-treat basis, 55% of patients achieved a response after induction therapy, whereas chemoradiation and consolidation therapy increased the response rate by 33% and 16%, respectively. No patient experienced grade >3 acute hematologic toxicity during systemic-dose chemotherapy. With the exception of one episode of a severe cardiac adverse event, non-hematologic toxicity was similarly tolerable. Severe acute adverse events observed during concurrent chemoradiation were mainly represented by esophagitis, resulting in interruption of the radiotherapy in 25% of patients. More notably, only one patient experienced serious non-hematologic late toxicity.

Conclusions

Although the present approach seemed feasible, our data did not support any possible advantage in favor of this three-phase integrated treatment, and therefore the design will not be investigated in a subsequent phase II study.
Short Hydration Regimen and Nephrotoxicity of Intermediate to High-Dose Cisplatin-Based Chemotherapy for Outpatient Treatment in Lung Cancer and Mesothelioma
Authors: Tiseo Marcello , Martelli Olga , Mancuso Andrea , Sormani Maria Pia , Bruzzi Paolo , Di Salvia Roberto , De Marinis Filippo , Ardizzoni Andrea
Published: February 2018

Aims and Background

Cisplatin, a standard component of combination chemotherapy for several tumors, presents important anti-tumor properties but also several toxic effects. In particular, the major dose-limiting effect appears to be renal toxicity. In several countries, to reduce nephrotoxicity after cisplatin administration, a 24-h hydration is recommended following a chemotherapy treatment in a hospital regimen. In our Institutions, cisplatin chemotherapy is an outpatient treatment that provides adequate hydration with an NaCl solution plus furosemide and diuresis monitoring during treatment.

Methods and Study Design

To assess incidence of cisplatin nephrotoxicity using a short hydration regimen, which included 2000 ml of fluids with control of diuresis, individual outpatient data was pooled retrospectively from patients enrolled in large randomized studies regarding cisplatin-based chemotherapy in lung cancer and mesothelioma. From February 1999 to November 2002, 107 patients treated with cisplatin (≥75 mg/m2/cycle) were examined, monitoring serum creatinine and creatinine clearance levels.

Results

Five patients out of 107 (4.6%) were withdrawn from chemotherapy because of renal toxicity. For the other 102 patients, serum creatinine and creatinine clearance measurements were stable around the normal values during treatment. No time trends relating to serum creatinine levels or creatinine clearance and cycle numbers or cisplatin-cumulative doses were detected (P = 0.36 and P = 0.64, for the relationship with cycle number, and P = 0.39 and P = 0.65 for the relationship with cumulative dose, respectively, random effect model) after adjusting for the total number of cycles administered.

Conclusions

These observations indicate that intermediate to high-dose cisplatin administration is feasible in outpatient management with a short hydration regimen without high risk of nephrotoxicity.
A Pilot Study of a Day One and Eight Every Three Weeks Administration of Docetaxel in Metastatic Cancer Patients
Authors: Martella Francesca , Giannessi Pier Giorgio , Di Marsico Roberta , Coltelli Luigi , Safina Valentina , Giuntini Nicola , Falcone Alfredo
Published: February 2018

Aims and Background

Docetaxel is an active agent in metastatic cancers. The standard administration every 3 weeks frequently causes gastrointestinal toxicity and severe myelosuppression. These are rare with a weekly docetaxel regimen, which instead produces severe asthenia. To develop a new docetaxel schedule associated with mild myelosuppression and less fatigue, we conducted this pilot study to determine the feasibility and the maximum tolerated dose of a day one and eight every three weeks administration of docetaxel.

Patients and Methods

The first 3 patients were treated with a dose of 40 mg/m2 on day one and eight, which was then escalated by increments of 5 mg/m2 on both days up to determine the maximum tolerated dose, defined as the dose level associated with the same dose-limiting toxicity in at least 33% of patients.

Results

Twenty-one metastatic cancer patients entered the study, with a median age of 57 years and a median performance status of 1. The escalation of dose continued up to 55 mg/m2, where 2 of the 6 enrolled patients presented grade 3 diarrhea, which was our dose-limiting toxicity. Myelosuppression was mild, and no febrile neutropenia was observed. None of the patients showed grade 4 non-haematological toxicity. Only 9.5% of them presented grade 3 asthenia, whereas grade 3 diarrhea and mucositis were revealed in 19% and 9.5%, respectively. All grade 3 non-hematological toxicities were observed in heavily pretreated or elderly patients.

Conclusions

The recommended dose of docetaxel was 50 mg/m2, but the regimen could not be recommended in heavily pretreated patients. However, it could become an option in an outpatient setting after a phase II study that better defines its toxicity profile and evaluate its antitumor activity.
Significance of Suspicious Lesions at Transrectal Ultrasonography in Men with Serum Prostate-Specific Antigen Levels of <20 ng/ml
Authors: Shim Hong Bang , Lee Sang Eun , Park Hyoung Keun , Ku Ja Hyeon
Published: February 2018

Aims and Background

The objective of the study was to evaluate the significance of suspicious lesions at transrectal ultrasonography for prostate cancer diagnosis.

Patients and Methods

A total of 1,009 men with a mean age of 65.0 ± 7.7 years (range, 40.0-79.0) constituted the study cohort and 265 (26.3%) were diagnosed with prostate cancer on initial biopsy.

Results

The cancer detection rate was higher in patients with suspicious lesions (33.2%) than in those with no suspicious lesion (21.5%) (P<0.001). Pathologic findings of the needle biopsy samples also showed more aggressive characteristics in men with suspicious lesions (P <0.05). Of 413 men with suspicious lesions, additional lesion-directed biopsies were performed in 133 patients. The positive predictive value of additional lesion-directed biopsy was 18.0%. Of patients who had positive cores on lesion-directed biopsies, all were also found to have positive cores on random biopsies, and no patient had positive cores only on lesion-directed biopsies. The Gleason score was not changed by the findings of lesion-directed biopsies in these patients.

Conclusions

Our findings do not provide a rationale to recommend the addition of lesion-directed biopsy in patients with suspicious lesions at transrectal ultrasonography. However, men with suspicious lesions at transrectal ultrasonography had a higher risk of being diagnosed with prostate cancer.
Mutational Analysis of the BH3 Domains of Proapoptotic Bcl-2 Family Genes Bad, Bmf and Bcl-G in Laryngeal Squamous Cell Carcinomas
Authors: Yoo Nam Jin , Soung Young Hwa , Lee Sang Hak , Jeong Eun Goo , Lee Sug Hyung
Published: February 2018

Aims

There is mounting evidence that deregulation of apoptosis is involved in the mechanisms of cancer development. Somatic mutations of apoptosis-related genes have been reported in many human cancers. The aim of this study was to explore the possibility that mutation of the BH3 domains of the proapoptotic Bcl-2 genes Bad, Bmf and Bcl-G might be involved in the development of laryngeal cancer.

Methods

We analyzed the BH3 domains of Bad, Bmf and Bcl-G for the detection of somatic mutations in 33 squamous cell carcinomas of the larynx by a polymerase chain reaction-based single-strand conformation polymorphism assay.

Results

There were no somatic mutations of the BH3 domains of Bad, Bmf and Bcl-G in the laryngeal squamous cell carcinoma samples.

Conclusions

The data presented here indicate that BH3 domain mutation of the proapoptotic genes Bad, Bmf and Bcl-G is rare in laryngeal squamous cell carcinoma and may not contribute to the apoptosis-resistance mechanisms of laryngeal squamous cell carcinoma.
Lack of Cardiotoxicity with Liposomal Doxorubicin in an Elderly Case of Ovarian Cancer
Authors: Nicoletto Maria Ornella , Donach Martin , Borgato Lucia , Falci Cristina , Zanin Lucia , De Masi Giovanni
Published: February 2018

Ovarian cancer is typically a disease of elderly women, usually occurring after menopause with a peak incidence in the eighth decade of life. Elderly patients are more likely to suffer the adverse effects of chemotherapy, which may influence successive lines of treatment. We describe the case of an elderly woman with platinum-sensitive ovarian cancer treated with several lines of chemotherapy who developed acute cardiogenic pulmonary edema with her first line of therapy, which included paclitaxel, and her fourth line containing gemcitabine. However, a complete regimen of pegylated liposomal doxorubicin in association with oxaliplatin was well tolerated. Other authors have reported absence of cardiotoxicity with liposomal doxorubicin in their study populations, but no mention was made of patients with a known prior susceptibility to transient heart failure when treated with other chemotherapeutic agents. Our case provides evidence that even in these more difficult-to-treat cases, where cumulative cardiotoxicity may be relatively unpredictable, liposomal doxorubicin does not affect cardiac function.
Wernicke's Encephalopathyafter Allogeneic Stem Cell Transplantation
Authors: Messina Giuseppe , Quartarone Eugenia , Console Giuseppe , Irrera Giuseppe , Martino Massimo , Pucci Giulia , Le Piane Emilio , Branca Damiano , Cafarelli Francesco , Gangemi Antonio , Iacopino Pasquale
Published: February 2018

Wernicke's encephalopathy is an acute neuropsychiatric condition due to thiamine deficiency frequently associated with chronic alcohol abuse. We describe 2 cases of patients who experienced acute Wernicke's encephalopathy after allogeneic stem cell transplantation associated with the use of commercial total parental nutrition. Early diagnosis with magnetic resonance imaging and timely treatment with thiamine resulted in rapid resolution of clinical and radiological signs. In conclusion, the prolonged use of commercial total parental nutrition formulas must be supplemented with thiamine in the form of intramuscularly administered multivitamins.
Primary Osteosarcoma of the Kidney with Retroperitoneal Hemorrhage. Case Report and Review of the Literature
Authors: Cioppa Tommaso , Marrelli Daniele , Neri Alessandro , Malagnino Valeria , Caruso Stefano , Pinto Enrico , Roviello Franco
Published: February 2018

Primary osteosarcoma of the kidney is a very rare neoplasm with a very poor prognosis and unclear histogenesis. Only 20 cases have been reported in the literature. It has a strong tendency to recur locally and spread to distant sites. We present the clinical case of a 79-year-old man affected by a primary osteosarcoma of the kidney presenting with substantial retroperitoneal tumor hemorrhage. Laparotomy revealed a massive retroperitoneal hematoma due to a bleeding large stony renal mass with multiple bizarre calcifications. The diagnosis of primary renal osteosarcoma was made on the basis of hematoxylin-eosin staining and confirmed by electron microscopy. Hematoma drainage and radical nephrectomy were performed. To our knowledge this is the first case of bleeding renal osteosarcoma reported in the literature. The most important clinical findings, the pathogenesis and the treatment modalities of this rare neoplasm are discussed.
Myoepithelial Hamartoma of the Stomach Simulating a Gastric Carcinoma. A Case Report
Authors: Portale Teresa Rosanna , Mosca Francesco , Vicari Salvatore , Pulvirenti Giuseppa , Fichera Simona , Salomone Edvige , Puleo Stefano
Published: February 2018

Myoepithelial hamartoma is a very rare submucosal tumor of the stomach. Magnus-Alsleben first described 5 cases of this tumor in 1903. More recently (1993) Vandelli et al. published a review of the literature comprising only 33 cases. Histologically, the tumor is characterized by hypertrophic smooth muscle bands surrounding diverse epithelial elements that can be arranged in different ways: as a simple glandular structure, Brunner's gland, pancreatic ducts and occasionally pancreatic acinus. We report a case of myoepithelial hamartoma of the stomach simulating a gastric carcinoma.
Incidence of Multiple Primary Bladder and Prostate Cancer in a Central Region of Italy. Umbria, 1994-2004
Authors: Cassetti Tiziana , Scheibel Massimo , Stracci Fabrizio , Minelli Liliana , La Rosa Francesco
Published: February 2018

The aim of this study was to determine the incidence of multiple bladder-prostate cancers in the population of the Italian region of Umbria and to clarify some diagnostic aspects. Prostate and bladder cancer incidence data in Umbria were obtained from cancer registry records. In the period from 1994 to 2004, 3,470 new patients with bladder cancer and 5,430 new patients with prostate cancer were registered. Among these patients there were 238 who presented multiple bladder and prostate cancers.

Synchronous cancers were detected in 74 of these patients. Fifty-four of them had simultaneous tumors (diagnosed during the same hospitalization), while in 16 patients bladder cancer was detected earlier than prostate cancer and in 4 patients the opposite occurred. This study confirmed an increase in prostate cancer diagnoses in patients with bladder cancer. The increase was mainly accounted for by the detection of prostate cancers during cystectomies performed for bladder carcinoma.