bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization Of Obstetric Assistance At Labor And Childbirth In Low-Risk Women On A Maternity Of Reference To Maternal And Child Health
Authors: Medeiros Maxsuenia Queiroz , Feitosa Francisco Edson Lucena , Pinheiro Ana Karina Bezerra , Neto Raimundo Homero Carvalho , Firmiano Mariana Luisa Veras , Mesquita Debora Rodrigues , Augusto Lucas Costa Carvalho , Carvalho Francisco Herlanio Costa
Published: April 2017

Objectives: To describe the prevalence of the implementation of obstetric interventions for labor and birth in normal-risk women in reference to maternity Stork Network.

Methodology: cross-sectional study was performed from April 2014 to January 2015, with 421 participants in the Maternity School Assis Chateaubriand - UFC, admitted during spontaneous or induced labor with a live fetus and single pregnancy term and their fetuses weighing between 2,500 and 4.499g. The data collection instrument was divided into blocks with sociodemographic and clinical characteristics, obstetric, data care during labor, delivery and birth, maternal morbidity, maternal outcome and obstetric practices in categories A and B from WHO and perinatal outcomes. The values ​​are presented as mean ± standard deviation.

Results: The age ranged from 13 to 44; the average gestational age at admission was 38.9 ± 1.1 weeks; 52.2% with only one child; 8.6% had a previous cesarean section. There was 96.2% of pre-natal coverage with an average of 6.4 consultations. 76.2% had vaginal delivery. Obstetric practices in category A were more prevalent oxytocin in the third stage (97.1%), partograph (95%), non-invasive methods for pain relief (87.2%), companion (84.6%). While in section B were more of a vaginal examination at 2 hours (50.4%) and intravenous infusion (44.9%) and oxytocin in the expansion phase (28.8%). The present study had as limitations the loss of some data, which depended on the filling of third parties, which are characteristic of searches in medical records, or any documentary archive because it is a collection of secondary data.

Conclusions: It was possible to identify that the "Good labor assistance practices" has been developed in a good proportion considered; however some practices that should be discouraged are still performed relatively frequently.
Characterization of People with Diabetes Mellitus Assisted in an Outpatient Follow-up Clinic
Authors: Oliveira Patrícia Simplício de , Lima Carla Lidiane Jácome de , Ferreira Josefa Danielma Lopes , Ferreira Thalys Maynnard Costa , Lucena Adriana Lira Rufino de , Acioly Cizone Maria Carneiro , Agra Glenda , Cruz Ronny Anderson de Oliveira , Silva Maryjane Alves Oliveira da , Costa Marta Miriam Lopes
Published: April 2017

Objective: To characterize the profile of people with diabetes, according to sociodemographic, clinical and laboratory variables.

Method: Cross-sectional study with a quantitative approach, conducted with 110 people with diabetes mellitus treated at outpatient follow-up of a teaching hospital in João Pessoa - PB, Brazil, during February-June 2015. To collect data, we used a form contemplating sociodemographic, clinical and laboratory variables. For the analysis, we used descriptive statistics often measures for categorical variables, mean and standard deviation for numeric variables.

Results: The study revealed that the socio-demographic, clinical and laboratory characteristics increase the risk of morbidity and mortality for people studied, as well as being impediments to the realization of self-care.

Conclusion: The importance of achieving education for self-care was evident, for many of these identified factors can be modified when the person with diabetes has knowledge about their health-disease process, promoting positive attitudes in their care.
Bifidobacterium animalis subsp. lactis 420 mitigates the pathological impact of myocardial infarction in the mouse
Authors: Danilo C.A. , Constantopoulos E. , McKee L.A. , Chen H. , Regan J.A. , Lipovka Y. , Lahtinen S. , Stenman L.K. , Nguyen T.-V.V. , Doyle K.P. , Slepian M.J. , Khalpey Z.I. , Konhilas J.P.
Published: April 2017

There is a growing appreciation that our microbial environment in the gut plays a critical role in the maintenance of health and the pathogenesis of disease. Probiotic, beneficial gut microbes, administration can directly attenuate cardiac injury and post-myocardial infarction (MI) remodelling, yet the mechanisms of cardioprotection are unknown. We hypothesised that administration of Bifidobacterium animalis subsp. lactis 420 (B420), a probiotic with known anti-inflammatory properties, to mice will mitigate the pathological impact of MI, and that anti-inflammatory T regulatory (Treg) immune cells are necessary to impart protection against MI as a result of B420 administration. Wild-type male mice were administered B420, saline or Lactobacillus salivarius 33 (Ls-33) by gavage daily for 14 or 35 days, and underwent ischemia/reperfusion (I/R). Pretreatment with B420 for 10 or 28 days attenuated cardiac injury from I/R and reduced levels of inflammatory markers. Depletion of Treg cells by administration of anti-CD25 monoclonal antibodies eliminated B420-mediated cardio-protection. Further cytokine analysis revealed a shift from a pro-inflammatory to an anti-inflammatory environment in the probiotic treated post-MI hearts compared to controls. To summarise, B420 administration mitigates the pathological impact of MI. Next, we show that Treg immune cells are necessary to mediate B420-mediated protection against MI. Finally, we identify putative cellular, epigenetic and/or post-translational mechanisms of B420-mediated protection against MI.
Factors Influencing Citizens' Intention to Use E-Government Services
Authors: Mensah Isaac Kofi , Jianing Mi , Durrani Dilawar Khan
Published: April 2017

The purpose of this research paper is to investigate the determinates of Korean students in China to use e-government services. A total of 400 structured research questionnaire instruments was designed and administered to potential respondents of which 93.75% responded. The Technology Acceptance Mode (TAM) was used as a theoretical framework for this study. The data gathered was analyzed with SPSS version 20. The results show that all the predictors (Perceived Usefulness, Perceived Ease of Use, Perceived Service Quality, and Citizen Trust) investigated are significant positive determiners of Korean students' intention to adopt and use e-government services. The results further indicated that Citizen Trust positively and significantly moderated the positive relationship between perceived ease of use, perceived service quality and intention to use e-government services but failed to show any positive moderation effect on perceived usefulness and intention to use e-government services. The implications of these findings are further discussed.
Hydraulic Flanged Tube, Pipe, and Hose Connections, 4-Screw Flange Connection Part 2: 42 MPa (Code 62)
Authors:   Hydraulic Hose and Hose Fittings Committee
Published: April 2017

This SAE Standard covers general and dimensional specifications for the Code 62 metric (type 1) and inch (type 2) flanged heads, flange clamps (FC and FCM), and split flange clamps (FCS and FCSM) applicable to four-screw flange type tube, pipe, and hose connections. Also included are the recommended port dimensions and port design considerations. Type 2 (inch) flange clamps and split flanges are not for new design.

The flanged heads specified are incorporated into fittings having suitable means for attachment of tubes, pipes, or hoses to provide connection ends. These connections are intended for application in hydraulic systems, on industrial and commercial products, where it is desired to avoid the use of threaded connections.

The rated working pressure of an assembly shall not exceed the least of all the component working pressure rated values.

THE FOLLOWING GENERAL SPECIFICATIONS SUPPLEMENT THE DIMENSIONAL DATA CONTAINED IN THE TABLES WITH RESPECT TO ALL UNSPECIFIED DETAIL. PARTS MANUFACTURED TO THIS STANDARD ARE INTERCHANGEABLE WITH ISO 6162-2 AND CONNECTORS TO EITHER STANDARD CAN BE SUPPLIED WITH THE EXCEPTION OF THE -40 AND -48 TYPE 2 CONNECTIONS THAT ARE INCLUDED IN J518-2, BUT NOT ISO 6162-2.
The Realization of Kinship Terms in Persian and Filipino
Authors: Azodi Nazli , Karimi Fateme
Published: April 2017

Sociolinguistics studies of language forms and functions should be an indispensable part of second/foreign language learning. Family or kinship address terms as an important feature of interface between language and society, can provide valuable sociolinguistic information about the interlocutors and their relationships. In line with the studies of these terms during the past few decades, this paper focuses on collecting and explaining different types of kinship terminology that Persian and Filipino interlocutors use in their conversations. The relevant terms have been collected by observation and interview. The study also highlights the differences between the two languages in using such terms based on social and cultural status. The findings of the study show that Persian is a gender sensitive and a dynamic language while Filipino is a sex-neutral and respect oriented language.
A 22nd case report of extrauterine adenomyoma of the abdominal wall
Authors: Sampaio Rita , Palla Garcia José , Macedo Carlos Sampaio , Vizcaíno José Ramón
Published: April 2017

An adenomyoma of the uterus is a nodular tumor-like mass of benign endometrial glands, endometrioid stroma and smooth muscle tissue. Extra-uterine adenomyoma is an extremely rare tumor. The majority of the cases described was from ovary and located in the pelvis. We present a case of a 70 years old woman with clinical and radiological suspicious of disseminated malignancy. In the abdominal wall, a 5-cm nodule of larger dimension detected by computed tomography-scan was biopsied for accessibility reasons. The morphological and immunohistochemical features of the biopsy led us to propose the diagnosis of an extrauterine adenomyoma. This article reports the 22nd case of extrauterine adenomyoma, a rare and poorly understood tumor that could be imagiologically and clinically indistinguishable from a metastasis.
Development the Food Safety and Sanitation Competences Indicators for Foodservice Employees
Authors: Ko Wen-Hwa , Hsiao I-Fan
Published: April 2017

This study investigates the competence indicators for managers and kitchen staff of food safety and hygiene from anew perspective in order to establish competence indicators in further compliance with the existing requirements forfood safety and hygiene. After a three-round Delphi method questionnaire, this study integrated the opinions of 20experts and established the indicators of food safety and sanitation competences for foodservice employees. Theresults show that, for managers, management competence is more important than professional or core competences,while professional competence is the most important for kitchen staff. For managers, the most important corecompetence is professional ethics, the most important management competence is leadership; and the most importantprofessional competence is knowledge of food safety and hygiene. In terms of kitchen staff, the most important corecompetence is professional ethics. Professional competence ensures hand washing and disinfection.
PROVENANCE STUDIES IN POLAND (PART 2)
Authors: Romanowska-Zadrożna Maria
Published: April 2017

This article continues the first part of
Provenance studies in Poland published in issue 57 of the
“Muzealnictwo” Annual in 2016, and complements the text
published two years ago, which was more general and focused
on the situation in the USA and Europe. It presents diverse
aspects of the topic, through statistical analysis of the
situation in our museums and discussing works by Polish
authors who tackled the problem of methodology, including
first texts on library science and war losses, so-called
orphaned works and property of Holocaust victims, and
the post-war situation which contributed to the work’s loss
of its origin. The article also draws attention to the legal
aspects of purchasing artworks without due diligence, as
well as to the verification of museum exhibits’ origin before
obtaining legal protection for those works which are to be
placed under so-called museum immunity. In the literature
on provenance studies when examining the provenance of
artworks, the increasing role of digital tools, such as the
internet or digitisation, has been noted. Attention has also
been drawn to the contribution of conservators and their
innovative methods which may help determine the origin
of an object. Another aspect raised in the text is the issue of
the theoretical preparation to conduct provenance studies
as well as the education which is already standard in library
science faculties, but still a long-awaited subject for students
of art history and archiving. Although NIMOZ has already organised
day-long workshops for museum professionals, and
the University of Warsaw has conducted academic seminars
lasting several hours, there is still a long way before reaching
the two-term studies offered at the Berlin Open University.
A Smooth Test of Goodness-of-Fit for the Weibull Distribution: An Application to an HIV Retention Data
Authors: Odhiambo Collins , Odhiambo John , Omolo Bernard
Published: April 2017

In this study, we fit the two-parameter Weibull distribution to an HIV retention data and assess the fit using a smooth test of goodness-of-fit. The smooth test described here is a score test and is derived as an extension of the Neyman’s smooth test. Simulations are conducted to compare the power of the smooth test with the power of each of three empirical goodness-of-fit tests for the Weibull distribution. Results show that the smooth tests of order three and four are more powerful than the three empirical goodness-of-fit tests. For validation, we used retention data from an HIV care setting in Kenya.
Allelopathic effects of curly dock (Rumex crispus) on spring barley seed germination and early growth
Authors: Malinauskaitė Regina
Published: April 2017

The experiment was carried out at Aleksandras Stulgins­kis University in 2015. The goal of the experiment was to set the allelopathic interaction and influence of Rumex crispus seeds (unsoaked and soaked for 168 hours) and ionized water on spring barley grain germination. The following experiment variants with different proportions of barley grains and R. crispus fruits were used: a) control – 30 barley grains; other variants: b) 20 barley grains and 10 R. crispus fruits, c) 15:15 and d) 10:20. During the germination in distilled water, unsoaked R. crispus fruits inhibited the barley grain germination. In alkaline ionized water, unsoaked fruits did not affect the barley grain germination, which amounted to 100%. Soaked Rumex crispus fruits stimulated the germination. The lowest germination energy (83%) and viability (92%) were determined in the case of ratio 20:10. In distilled water, unsoaked fruits increased barley root and coleoptile elongation. The longest roots (140.00 mm) and coleoptiles (108.26 mm) were in the variant 15:15. Soaked fruits increased barley root elongation, but did not have any effect on the coleoptile length. In ionized alkaline water, in the experiment variants 20:10 and 15:15, R. crispus fruits suppressed barley root and coleoptile elongation. In the case of ratio 10:20 barley formed the longest roots and coleoptiles. Soaked fruits increased barley root elongation, especially in the case of ratio 10:20, and coleoptile elongation. R. crispus fruits had no significant effect on the number of roots.
Controversies in the Surgical Management of Gastric Cancer
Authors: Kooby David A. , Coit Daniel G.
Published: April 2017

Although the incidence of gastric adenocarcinoma in the United States has declined steadily since the early 1900s, it remains a significant health problem. Progress has been made during the past few decades in several areas: Lymph node staging has been refined, perioperative mortality has fallen, and plausible adjuvant therapy has emerged. Currently, complete surgical resection is the mainstay of therapy because it is the only potentially curative option; however, considerable controversy remains regarding the specifics of a surgical approach. This article examines 4 major controversies in the management of gastric cancer: extent of gastric resection, role of extended lymph node dissection, value of elective splenectomy for proximal gastric lesions, and current state of adjuvant therapy. Pertinent retrospective and prospective studies are reviewed to help formulate meaningful conclusions.
Taxanes in the Adjuvant Treatment of Breast Cancer
Authors: Trauth Donna , Goldstein Lori J.
Published: April 2017

Adjuvant chemotherapy clearly demonstrates a reduction in mortality in breast cancer. However, the added benefit from the addition of taxanes remains uncertain. Paclitaxel and its cousin docetaxel have proven activity in the treatment of metastatic breast cancer. Toxicity has been tolerable when taxanes are used as single agents or in combination with anthracyclines. Several clinical trials are currently underway evaluating the role of taxanes in the adjuvant setting. Preliminary results from large phase III studies are promising; however, mature data are required before conclusions can be drawn. This article reviews the trials currently underway, evaluating the efficacy, dosage, scheduling, and regimens of taxanes in the adjuvant treatment of breast cancer.
New Technologies in Breast Imaging
Authors: Patterson Stephanie K.
Published: April 2017

Large, randomized controlled trials have proven the efficacy of mammography in reducing breast cancer mortality. However, the known deficiencies of mammography have led to the development of new technologies. Magnetic resonance imaging (MRI), digital mammography, computer-assisted diagnosis, positron-emission tomography (PET), technetium 99m sestamibi, and expanding roles for breast ultrasound have been explored as tools in breast cancer detection and evaluation. This article discusses these modalities and their current uses.
Breast Cancer Risk Assessment: A Guide for Clinicians Using the NCCN Breast Cancer Risk Reduction Guidelines
Authors: Merajver Sofia D. , Milliron Kara
Published: April 2017

Breast cancer, a complex and heterogeneous disease, is the most common malignancy diagnosed in women in the United States, with over 180,000 new cases and approximately 44,000 deaths per year. Breast cancer risk is influenced by a large number of factors, including age, family history, reproductive and hormonal history, proliferative breast conditions, physical activity, diet, and environmental exposures. These factors all interact in a complex manner to contribute to the risk of developing breast cancer. Because the interactions between risk factors are poorly understood at the molecular level, it is difficult to accurately evaluate the breast cancer risk of a given person presenting with an individual constellation of factors. To better define the population at increased risk that may warrant specific intervention, several models exist to estimate a woman's risk for developing breast cancer and for harboring a germline mutation in a cancer susceptibility gene. This article summarizes these models and gives brief guidelines about which model may be preferable given a specific family history.
A Cancer-Related Fatigue Clinic: Opportunities and Challenges
Authors: Escalante Carmen P. , Manzullo Ellen , Valdres Rosalie
Published: April 2017

Cancer-related fatigue (CRF) is the most prevalent symptom of cancer, occurring in 60% to 90% of patients and surpassing pain in frequency. CRF may increase patients' anxieties and hamper their quality of life. We developed a CRF clinic in 1998 because we believed there needed to be a more focused effort on the education, evaluation, and treatment of CRF for our patients. Since then, we have gained clinical insights into the planning, development, and evolution of this endeavor. Our objective is to share our experiences and provide preliminary analysis of the first 123 patients evaluated in this clinic.
Psychological Issues in Geriatric Oncology
Authors: Sarwal Archna , Roth Andrew J.
Published: April 2017

Optimism about improved survival from cancer has increased. However, even with tremendous improvements in screening techniques and treatment, a cancer diagnosis may shatter the dream of a dignified old age for elderly patients. Cancer diagnosis and treatment often produce psychological stresses resulting from the actual symptoms of the disease, as well as the patient and family's perceptions of the disease and its stigma. Concerns related to cancer have particular meaning for aging individuals who undergo these situations in the context of retirement, widowhood, other medical disabilities, and other losses. Today, patients and families are more interested in treatment issues and quality of life, both during and after treatment. In this article we discuss late life depression, anxiety, and delirium and treatments related to elderly patients coping with cancer.
Novel Biospecific Agents for the Treatment of Myelodysplastic Syndromes
Authors: Gotlib Jason , Greenberg Peter L.
Published: April 2017

Levels of treatment for patients with myelodysplastic syndromes (MDS) fall within 3 broad categories: supportive care, low- and high-intensity therapy. Most approaches remain experimental, and supportive care remains the standard of treatment in MDS. In parallel with the growing knowledge of the multiple pathobiologic abnormalities in MDS, increasing numbers of low-intensity, biospecific agents that target these pathogenetic lesions have entered clinical trial testing. Although the term “biospecific” has been applied to many of these investigational drugs, they often exert pleiotropic effects, many of which remain to be identified. An ongoing challenge will be to more fully characterize the mechanisms of action of these drugs and to characterize biologic correlates of response. With these data in hand, it will be increasingly feasible to treat patients with combinations of biospecific drugs with non-overlapping actions and toxicities, a therapeutic approach that is likely required to effectively overcome the barriers posed by the biologic heterogeneity of MDS. This review focuses on recent therapeutic approaches using such biologic response modifiers to treat MDS.
How to Monitor Patients with Chronic Myelogenous Leukemia
Authors: O'Dwyer Michael E
Published: April 2017

The introduction of imatinib has radically altered the treatment options and, perhaps, prognosis for patients with newly diagnosed chronic myelogenous leukemia (CML). However, although the majority of patients appear to benefit from this agent, it is important to recognize as early as possible the patients who experience a sub-optimal response and those who may be at risk of disease progression. This article reviews current available methods of monitoring and provides recommendations for appropriate follow up of imatinib-treated patients.
Prostate Biopsy Strategies: Current State of the Art
Authors: Mian Badar M.
Published: April 2017

Prostate-specific antigen testing and prostate biopsy have revolutionized our ability to detect prostate cancer at an early stage. The transrectal ultrasound-guided biopsy procedure has undergone a number of modifications over the past 10 years to meet our goal of early detection of cancer at a curable stage. Biopsy schemes have evolved from lesion-directed biopsies to systematic mapping of the peripheral zone of the prostate, which harbors almost all of the significant tumor foci. An increase in the number of biopsy cores from 6 to 10 (or 12) has resulted in a significant improvement in the detection of clinically localized cancer, without any appreciable increase in the number of indolent cancers. Current biopsy schemes also have enhanced our ability to determine the true prognostic value of pathologic lesions such as high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation which have been associated with cancer detection in repeat biopsies. I discuss the rationale behind, and the outcomes of, various biopsy strategies. More than 15 years after PSA testing was popularized for early detection, a number of men are presenting for evaluation regarding repeat prostate biopsy for various clinical indications. The indications, biopsy scheme, and cancer detection rates for repeat prostate biopsy are discussed in detail.
Biochemical Relapse After Primary Treatment for Prostate Cancer: Studies on Natural History and Therapeutic Considerations
Authors: Rosenbaum Eli , Partin Alan , Eisenberger Mario A.
Published: April 2017

After local treatment, a substantial proportion of patients with prostate cancer present with rising prostate specific antigen (PSA) serum levels as the only indication of disease activity. Evolving data derived from large databases that were predominantly retrospectively evaluated show that the natural history of these patients is quite variable. Various clinical and pathologic parameters have been shown to predict for the probability of development of distant metastasis, including the surgical Gleason score, time of PSA relapse after primary treatment, and PSA doubling time (PSADT). The PSADT appears to be the most important predictor of development of distant metastasis and prostate cancer-specific mortality. At present, no data support a standard management approach for these patients, and clinical trials pose a major challenge in view of the methodologic complexities involved. Patients and treating physicians should make major efforts to participate in clinical trials in this patient population.
Biobehavioral Factors in Chemotherapy-Induced Nausea and Vomiting
Authors: Roscoe Joseph A. , Morrow Gary R. , Hickok Jane T. , Mustian Karen M. , Shelke Abhay R.
Published: April 2017

Although emesis can be considered a reflex to clear toxins from the body and involves mostly lower brain structures, nausea's purpose appears to be a warning signal to the individual to not engage in behaviors that he or she was doing at the time. As such, it involves the functioning of cognition and memory from higher developed neural structures. Given this, it should not be surprising that biobehavioral factors are important in predicting and controlling nausea. This article reviews the individual characteristics that are clinically useful in predicting which patients will have an increased probability of experiencing nausea or emesis during chemotherapy treatment, and also briefly review psychologic and biobehavioral treatments that can be useful in managing chemotherapy-related nausea.
Relationship Between Hemoglobin Levels and Quality of Life During Radiation Therapy Plus Concomitant or Sequential Chemotherapy in Patients With Cancer and Anemia Treated With Epoetin Alfa
Authors: Shasha Daniel , Cremieux Pierre , Harrison Louis
Published: April 2017

This study in patients with cancer and anemia, who were receiving chemoradiation and were treated with epoetin alfa, examined the relationship between hemoglobin level and quality of life (QOL), change in hemoglobin and change in QOL, and incremental (1 g/dL) increase in hemoglobin and related incremental improvement in QOL. Data from a multicenter, open-label, prospective study of once-weekly epoetin alfa therapy in anemic cancer patients receiving chemoradiation were used to retrospectively evaluate the relationship between hemoglobin changes and QOL changes via correlation and longitudinal analyses. A sample selection correction method was used to ensure unbiased results. QOL (energy, activity, overall QOL) was measured using the Linear Analog Scale Assessment. An incremental analysis determined the greatest incremental increase in QOL associated with a 1 g/dL increase in hemoglobin level. Of the 777 patients enrolled, 464 met chemotherapy and radiotherapy eligibility criteria. Of these, 359 (77%) underwent two QOL assessments and were eligible for analysis. A nonlinear and statistically significant positive correlation was found between hemoglobin levels and Linear Analog Scale Assessment QOL scores (r = 0.32 [energy], 0.33 [activity], and 0.29 [overall QOL]; P < .0001). An incremental analysis used regression methods to characterize the changes in hemoglobin levels and QOL scores. Hemoglobin change was found to be a statistically significant determinant of QOL changes (P < .05). The greatest incremental QOL gain associated with a 1-g/dL change in hemoglobin occurred around hemoglobin 12 g/dL (range, 11–13 g/dL). A direct relationship exists between hemoglobin increases and corresponding QOL increases. Maximal incremental gain in QOL occurred when hemoglobin was approximately 12 g/dL (range, 11–13 g/dL).
Liquid-Based Cytology: Evaluation of Effectiveness, Cost-Effectiveness, and Application to Present Practice
Authors: Cox J. Thomas
Published: April 2017

This article reviews the data available as of 2004 on the effectiveness and cost-effectiveness of cervical screening with the two available cytologic methods, the conventional Papanicolaou (Pap; CP) smear and liquid-based cytology (LBC), and discusses the application of LBC to current practice. The majority of LBC studies are on the ThinPrep Pap Test (CYTYC, Boxsborough, MA) and the remainder are on SurePath (TriPath, Burlington, NC), which was previously known as AutoCyte Prep. LBC identified more low-grade squamous intraepithelial lesion (LSIL) Pap test results compared with paired conventional cytology in 17 of 21 ThinPrep and 9 of 12 SurePath “split-sample” studies considered to fulfill the criteria for inclusion in the British NHS Health Technology Assessment (HTA) evaluation of cervical cytology. In four of the six recent ThinPrep and one of two SurePath split-sample studies, more high-grade squamous intraepithelial lesion-positive (HSIL+) results were identified by LBC than by CP. All 15 “direct-to vial studies” meeting HTA criteria reported more LSIL+ results for LBC compared with CP, and all eight of the direct-to-vial studies reporting HSIL+ results separately showed increased detection of high-grade cytology interpretations. Fifteen studies met the criteria for evaluating sensitivity and specificity. Aggregate sensitivity for the CP was 71.5% and for LBC was 80.1%. Indirect comparisons of the two LBC methods did not detect a difference in sensitivity, and a meta-analysis of the six studies comparing specificity between CP and LBC found no difference. Other capabilities of LBC are improved specimen adequacy and the ability to do ancillary testing out of the liquid-based vial. In cost-effective analyses based on models of disease natural history and/or the clinical effectiveness of each screening modality, screening with CP was always dominated by screening with LBC. Primary cervical screening guidelines issued by the American Cancer Society in 2002 recommend repeating the cytology biannually if liquid-based and annually if conventional. The gain in sensitivity, apparent cost-effectiveness, and advantage of having a representative specimen for ancillary testing, support the use of LBC.
Combined Chemotherapy and Radiation Therapy for Cervical Cancer
Authors: Moore David H.
Published: April 2017

More than 50% of patients with newly diagnosed cervical cancer will undergo radiation therapy as a primary treatment modality. Results from five phase III trials conducted by National Cancer Institute (NCI)-sponsored cooperative groups showed significant survival advantages from the addition of cisplatin-based chemotherapy to primary radiation therapy, changing the standard of care for patients with bulky or locally advanced cervical carcinoma. The majority of patients for whom treatment fails, however, have persistent pelvic disease. Other agents (alone or in combination with cisplatin) with potential synergy with radiation therapy should be studied. Future trials should investigate potential interrelationships between anemia, tumor hypoxia, angiogenesis, and the effectiveness of radiation therapy. Therapies specific to tumor hypoxia (tirapazamine) or strategies to maintain higher nadir hemoglobin levels during treatment (aggressive transfusion policies; erythropoietin) should also be studied.
Management of Advanced Germ Cell Cancer in Patients With Unfavorable Prognosis
Authors: Margolin Kim
Published: April 2017

Advanced germ cell cancer can be cured in most patients using chemotherapy with or without surgery. A small fraction of patients with nonseminomatous tumors (NSGCT) and an even smaller percentage of seminoma patients are destined to have a less favorable outcome, due to an inadequate response to first-line chemotherapy (failure to achieve remission, finding of residual viable carcinoma at post-chemotherapy surgery, or relapse after achieving a remission). Despite the apparent salvage potential for regimens containing ifosfamide or paclitaxel, no proof exists that such combinations are superior to the standard regimen of four cycles of cisplatin, etoposide, and bleomycin (PEB) in the front-line therapy of patients with advanced NSGCT. Other modifications of first-line therapy, such as the addition of paclitaxel or the use of escalated doses of cisplatin, also have failed to increase the cure rate. The use of single or tandem cycles of high-dose chemotherapy (HDT with autologous hematopoietic cell transplant [aHCT]) in various settings (for selected patients with poor prognostic features before therapy, patients predicted to have a poor outcome based on the rate of serum tumor marker decline while on therapy, and patients in relapse or failure to achieve adequate response to standard therapy) has been evaluated in many phase II and a limited number of phase III trials, which are summarized in this review. Important questions that remain to be answered include the role of new agents and the use of more sophisticated techniques to understand prognostic and predictive factors in selecting therapy for GCT.
Grade 1 Chondrosarcoma of Bone: A Diagnostic and Treatment Dilemma
Authors: Randall R. Lor , Gowski William
Published: April 2017

Cartilaginous lesions of bone are relatively common and cover a large spectrum from latent enchondroma to aggressive dedifferentiated chondrosarcoma. Differentiating among these lesions, particularly benign enchondroma and low-grade chondrosarcoma, can be challenging. Differentiating involves assimilation and interpretation of clinical, radiographic, and histologic criteria. Molecular techniques to assist in distinguishing among the various subtypes are being developed, but these techniques have not yielded any clinically significant contribution. As a result of an imperfect diagnostic schema, a consensus on treatment algorithms has been elusive. This review highlights the specific clinical, radiographic, and histologic criteria currently used clinically to differentiate between benign enchondroma and low-grade chondrosarcoma. We discuss the promise of emerging molecular technologies. Finally, we provide a review of the available literature on treatment outcomes, along with a discussion of our own particular preferences.
Adjuvant Therapy for Soft Tissue Sarcoma
Authors: Schuetze Scott M. , Ray Michael E.
Published: April 2017

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.
Genomics-Based Prognosis and Therapeutic Prediction in Breast Cancer
Authors: Jeffrey Stefanie S. , Lønning Per Eystein , Hillner Bruce E.
Published: April 2017

Breast cancer is a heterogeneous disease. DNA microarray technology is being applied to breast cancer to identify new prognostic biomarkers, to predict response to therapy, and to discover targets for the development of novel therapies. New diagnostic assays based on global gene expression are being introduced into clinical practice or tested in large-scale clinical trials. This review focuses on translational studies using microarray analyses and discusses best practice features and pitfalls. We note that factors that predict metastatic disease are not necessarily the same factors that predict therapeutic response. We believe that the characterization and discernment of different systems among breast cancers is crucial for understanding drug sensitivity and resistance mechanisms and for guiding therapy.
Partial-Breast Radiation for Early Staged Breast Cancers: Hypothesis, Existing Data, and a Planned Phase III Trial
Authors: McCormick Beryl
Published: April 2017

This review of clinical data from partial-breast treatment studies discusses results from a single institution's experience using brachytherapy catheters, the MammoSite balloon (Proxima Company, Alpharetta, GA), and three-dimensional external beam partial-breast treatment. Rationale, techniques, dose schedules, and available results are presented. Intra-operative single-dose radiation to the lumpectomy site is also reviewed. The National Surgical Adjuvant Breast and Bowel Project (NSABP) and Radiation Therapy Oncology Group (RTOG) cooperative groups are opening a phase III trial to compare partial-breast treatment to the standard 5- to 6-week course of whole-breast radiation. The design of this study is also presented in this review.
Induction Chemotherapy for Head and Neck Cancer: Will History Repeat Itself?
Authors: Argiris Athanassios
Published: April 2017

Locally advanced squamous cell head and neck cancer remains a therapeutic challenge for multidisciplinary teams. Despite high objective response rates, induction chemotherapy has not resulted in tangible benefit in multiple randomized trials. In recent years, as most evidence solidified the role of concurrent chemotherapy and radiation as either primary or postoperative therapy for locally advanced head and neck cancer, induction chemotherapy fell out of scope and practice. The failure of older randomized trials to show a survival benefit from induction chemotherapy can be attributed to several factors. It is possible that the predominance of locoregional failure did not allow any added benefit from better systemic control to translate into a survival advantage. Alternatively, seemingly active chemotherapy regimens may have been suboptimal. Nevertheless, recent developments have altered our perception of head and neck cancer and its treatment. Locoregional control has dramatically improved with concurrent chemoradiotherapy. Of note is that none of the previously conducted randomized trials of induction chemotherapy used concurrent chemoradiotherapy in the control arm. Moreover, we witnessed the development of better combination regimens that improved efficacy in the induction setting. The previously standard cisplatin/5-fluoruracil (5-FU) combination is being replaced by the triple combination of taxane/cisplatin/5-FU. Randomized trials showed that increased activity with the triplet regimen resulted in improved long-term disease control and survival. Finally, cetuximab, an active epidermal growth factor receptor inhibitor, is entering clinical practice and is expected to change the standard of therapy. With the emergence of more efficacious systemic therapies, the role of induction therapy warrants reevaluation. A number of randomized trials are planned or currently ongoing to investigate concurrent chemoradiotherapy with or without induction. These trials are anticipated to redefine the role of induction chemotherapy for head and neck cancer.
Surgical Management of Colorectal Cancer in the Laparoscopic Era: A Review of Prospective Randomized Trials
Authors: Bloomston Mark , Kaufman Henry , Winston John , Arnold Mark , Martin Edward
Published: April 2017

The benefits of laparoscopy in benign diseases are quite clear. Patients generally can expect smaller incisions, less narcotic usage, quicker return of bowel function, and shorter hospitalizations. The benefits of laparoscopy in oncologic surgery are less clear, and laparoscopic oncology surgery has many critics. Early reports of long surgical times, high operating room costs, and alarming rates of port-site recurrences after laparoscopic colectomy for colorectal cancer all but stopped this less-invasive approach outside the confines of clinical protocols. As the results of larger retrospective studies began to refute these earlier detrimental claims, prospective randomized trials began to take a foothold. In this article, we review these randomized trials with particular attention to the perioperative effects of laparoscopic colectomy and the short-term oncologic outcomes.
Technologic Advances in Surgery for Brain Tumors: Tools of the Trade in the Modern Neurosurgical Operating Room
Authors: McPherson Christopher M. , Sawaya Raymond
Published: April 2017

Surgery is an essential part of the oncologic treatment of patients with brain tumors. Surgery is necessary for histologic diagnosis, and the cytoreduction of tumor mass has been shown to improve patient survival time and quality of life. Ultimately, the goal of any oncologic neurosurgery is to achieve maximal safe resection. Over the years, many technologic adjuncts have been developed to assist the surgeon in achieving this goal. In this article, we review the technologic advances of modern neurosurgery that are helping to reach this goal.
Resistance to Imatinib: Mechanisms and Management
Authors: Deininger Michael
Published: April 2017

Imatinib, a specific small molecule inhibitor of the Abl kinase, has become the standard drug therapy for chronic myelogenous leukemia in all phases. More than 80% of newly diagnosed patients with chronic phase attain a complete cytogenetic response (CCR). Although remissions in patients with early disease are generally durable, acquired resistance after an initial response is common in advanced disease. Reactivation of Bcr-Abl signaling is almost invariably present at the time of relapse, consistent with re-establishment of the initial pathogenetic mechanism. Mutations in the kinase domain (KD) of Bcr-Abl that impair drug binding and increased expression of Bcr-Abl have been identified as major mechanism of acquired drug resistance. The fact that Bcr-Abl remains central to disease pathogenesis at the time of relapse implies that it also remains the optimal drug target. Alternative Abl kinase inhibitors with increased potency and activity against most Bcr-Abl KD mutants are currently undergoing phase I/II clinical testing, with encouraging early results. Despite the high rates of CCR, persistence of residual leukemia as assessed by reverse transcription polymerase chain reaction is the rule even in patients with chronic phase, suggesting that even these patients may remain at risk of relapse. Understanding the mechanisms underlying disease persistence will be crucial for developing strategies to eradicate residual leukemia.
Parenteral Iron Therapy: A Single Institution's Experience Over a 5-Year Period
Authors: Laman Christopher A. , Silverstein Scott B. , Rodgers George M.
Published: April 2017

Many patients require parenteral iron therapy for optimal correction of anemia, including cancer patients who require erythropoietic drugs. Available parenteral iron therapy options include iron dextran, iron gluconate, and iron sucrose. The purpose of this study is to summarize our institution's experience with parenteral iron therapy over a 5-year period, with a focus on comparative safety profiles. All patients receiving parenteral iron therapy over this period were included in the analysis. Chi-squared test and Fisher's exact test were used to compare the adverse event rates of each product. A total of 121 patients received 444 infusions of parenteral iron over this period. Iron dextran was the most commonly used product (85 patients) and iron sucrose was the least used (2 patients). Iron gluconate was used by 34 patients. Overall adverse event rates per patient with iron dextran and iron gluconate were 16.5% and 5.8%, respectively (P = .024). Premedication with diphenhydramine and acetaminophen before infusions of iron dextran reduced adverse event rates per infusion from 12.3% to 4.4% (P = .054). Test doses of iron dextran were used 88% of the time for initial infusions of iron dextran. All adverse events for all parenteral iron products were mild or moderate. There were no serious adverse events and no anaphylaxis was observed. Our results suggest that, if test doses and premedications are used, iron dextran is an acceptable product to treat iron deficiency.
Cancer Patient Survival and Erythropoietin
Authors: Glaspy John A.
Published: April 2017

Cancer patients are frequently anemic. Treatment of anemic patients with erythropoiesis-stimulating proteins (ESPs) such as epoetin and darbepoetin is associated with benefits that include a reduced transfusion risk and improved quality of life. The recent reports of two randomized trials in which ESP treatment was associated with a decreased survival raised valid concerns regarding the safety of these agents in oncology practice. Reports of erythropoietin receptors on non-hematologic human tumor cells have increased the level of concern and provided a relatively simple model for the effects of ESPs on tumor progression and resistance to treatment. This article reviews available data, which lead to a number of conclusions: 1) the two trials suggesting a negative impact on survival have serious methodologic issues that may compromise interpretation; 2) when used to treat rather than prevent anemia in cancer patients, ESPs show no significant negative impact on survival outcomes; 3) with the exception of erythroleukemia cell lines, the presence of functional erythropoietin receptors on human tumor cells has not been conclusively shown; and 4) a sound theoretical basis exists, supported by preclinical evidence, that any effect of ESP therapy on tumor outcomes may depend on baseline hemoglobin levels, with different effects when anemic and non-anemic individuals are treated. For the present, it is prudent to withhold ESP therapy unless hemoglobin concentrations fall below 12 g/dL and to titrate treatment to maintain a target of 12 g/dL, with adjustments in therapy to insure that levels do not exceed 13 g/dL.
Acute Myeloid Leukemia Clinical Practice Guidelines in Oncology
Authors: _ _
Published: April 2017

Approximately 11,960 people will be diagnosed with acute myeloid leukemia (AML) in 2005, and 9,000 patients will die of the disease. As the population ages, the incidence of AML, along with myelodysplasia, appears to be rising. Equally disturbing is the increasing incidence of treatment-related myelodysplasia and leukemia in survivors of tumors of childhood and young adulthood such as Hodgkin's disease, sarcomas, breast and testicular cancers, and lymphomas. Recent large clinical trials have highlighted the need for new, innovative strategies because outcomes for AML patients, particularly older patients, have not substantially changed in the past 3 decades.

For the most recent version of the guidelines, please visit NCCN.org