bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adult Granulosa Cell Tumor of the Ovary: A Clinico Pathologic Study of 35 Cases
Authors: Fontanelli Rosanna , Stefanon Bernardina , Raspagliesi Francesco , Kenda Rado , Tomasic Gorana , Spatti Giovanbattista , Riboldi Gianluca , Di Donato Patrizia , Pilotti Silvana , De Palo Giuseppe 
Published: April 2018

Aims and background Adult granulosa cell tumor has a low malignant potential but requires an extensive follow-up of more than 5 years to accurately assess tumor activity. The aim of the present study was to evaluate the clinical characteristics, the treatment and the outcome of this rare ovarian tumor. Study design A retrospective review of 35 cases treated at primary onset of disease during a 23-year period from 1971 to 1993. Results The disease-free survival rate for stages IA-B-C at 5 and 10 years was 90% and 84%, respectively; for stages III-IV the 5-year freedom from progression rate was 16%. Conclusions The most important prognostic factor appears to be the extent of tumor involvement outside of the ovary.
A Phase II Study of 5-AZA-2'Deoxycytidine (Decitabine) in Hormone Independent Metastatic (D2) Prostate Cancer
Authors: Thibault Alain , Figg William D. , Bergan Raymond C. , Lush Richard M. , Myers Charles E. , Tompkins Anne , Reed Eddie , Samid Dvorit 
Published: April 2018

Aims and Background Decitabine (5-aza-2′-deoxycytidine) is an S-phase-specific pyrimidine analog with hypomethylation properties. In laboratory models of prostate cancer (PC-3 and DU-145), decitabine induces cellular differentiation and enhanced expression of genes involved in tumor suppression, immunogenicity, and programmed cell death. Methods We conducted a phase II study of decitabine in 14 men with progressive, metastatic prostate cancer recurrent after total androgen blockade and flutamide withdrawal. Decitabine was administered at a dose of 75 mg/m2/dose IV as a 1 hour infusion every 8 hours for three doses. Cycles of therapy were repeated every 5 to 8 weeks to allow for resolution of toxicity. Results Two of 12 patients evaluable for response had stable disease with a time to progression of more than 10 weeks. This activity was seen in 2 of 3 African-American patients. Toxicity was similar to previously reported experience. No significant changes in urinary concentrations of the angiogenic factor bFGF, a potential biomarker of tumor activity, were identified over time in 7 unselected patients with progressive disease. Conclusions We conclude that decitabine is a well tolerated regimen with modest clinical activity against hormone-independent prostate cancer. Further investigations in patients of African-American origin may be warranted.
Radiobiological Models of Tissue Response to Radiation in Treatment Planning Systems
Authors: Niemierko Andrzej 
Published: April 2018

Aims To present several biological concepts and models of tissue response to fractionated radiotherapy. To describe practical implementation of these models in three-dimensional treatment planning systems. Methods Models of cell survival, Equivalent Uniform Dose (EUD) and Tumor Control Probability (TCP) are discussed. These models are based on the target-cell hypothesis which assumes that response of organs and tissues to radiation therapy can be explained and mathematically described in terms of survival of the specific target-cells. Results Several formulae for deriving and calculating EUD and TCP for a given three-dimensional dose distribution are presented and discussed. Conclusions Biological models of tissue response to radiation, when used wisely, have a potential to be useful in radiation therapy treatment planning. The models can advance our understanding of the underlying biological mechanisms, and may help in designing new and better treatment strategies. They should be particularly useful in modern conformai radiotherapy where treatment strategy for each patient can be individualized and optimized according to patient characteristics and available technology of delivering sophisticated treatment plans.
Tamoxifen as Adjuvant after Surgery for Breast Cancer and Tamoxifen or Placebo as Chemoprevention in Healthy Women: Different Compliance with Treatment
Authors: Veronesi Andrea , Pizzichetta Maria Antonietta , Ferlante Maria Annunziata , Zottar Maura , Magri Maria Donatella , Crivellari Diana , Foladore Silva 
Published: April 2018

Aim The aim of this study was to investigate whether tamoxifen toxicity and treatment discontinuations differred in the adjuvant versus chemopreventive setting. Methods At our Institutions 119 postmenopausal breast cancer patients were randomized from August 1987 to March 1995 to tamoxifen only within adjuvant studies (International Breast Cancer Study Group studies VII and IX) and 202 healthy hysterectomized women aged 35-70 years were randomized from November 1993 to May 1996 in a multicenter, double-blind, placebo-controlled chemoprevention study (Italian Tamoxifen Prevention Study). The tamoxifen dose was 20 mg/day for 5 years in all studies. Median age was 66 years (54-85) in the adjuvant studies and 53 years (37-69) in the chemoprevention study. Median treatment duration was 238 and 120 weeks, respectively. Results Patients treated within adjuvant studies experienced more hot flashes, vaginal discharge and/or bleeding, bone marrow depression and weight gain than those treated in the chemoprevention study, consistent with the fact that a proportion of women in the latter study were receiving placebo. Temporary discontinuation occurred in 2.5% of patients in the adjuvant studies and in 5.4% of women in the chemoprevention study (difference not statistically significant). Permanent discontinuation was more frequent in the chemoprevention study than in the adjuvant ones (26.7% vs 15.1% - P < 0.05). Conclusions In summary, our data show that, although the toxicity of tamoxifen is superimposable in the two settings, a larger proportion of women treated as chemoprevention discontinue treatment spontaneously. Due to the double-blind nature of the chemoprevention study, the impact of the toxicity of tamoxifen upon compliance in the chemopreventive setting cannot be ascertained.
Complete Response to Chemotherapy in Intra-Abdominal Desmoplastic Small round Cell Carcinoma. A Case Report
Authors: De Lena Mario , Caruso Maria Lucia , Marzullo Franco , Mancarella Sergio , Armentano Raffaele , Ventrella Vincenzo , Guida Michele 
Published: April 2018

Aims and background The authors report the case of a 23-year-old woman affected by intra-abdominal desmoplastic small round cell tumor (DSRCT) who obtained a complete response to multiagent chemotherapy. DSRCT is a rare, highly aggressive neoplasm generally arising in young people and seldom in females (about 20 cases described in the literature). Methods The patient underwent surgical resection of a large 15 × 15 cm mass located in the right lower abdominal quadrant, but after only 2 months later, two liver metastasis were noted. Thus, she was subjected to an aggressive antineoplastic treatment consisting of three groups of alternating non-cross resistant multiagent regimens administered every 21 days (cis-platin-etoposide-adriamycin-bleomicin; gemcitabine-ifosfamide-dacarbazine; methotrexate-5-fluorouracilfolinic acid) for a total of 9 administrations. Results After one cycle of treatment including the administration of all the three alternated schemes of chemotherapy, a complete disappearance of liver disease was noted. The treatment was relatively well-tolerated and the toxicity was acceptable. At present, after 15 months from diagnosis and 12 months after starting chemotherapy, the patient is disease-free and in good health. Conclusions Even though this study regards only a single patient, it is noteworthy because of the rarity of this neoplasm and because of the infrequent complete responses reported in the literature. The efficacy and manageability of the treatment, suggests that both the timing and schedule used could constitute an important therapeutical option for this aggressive and poorly chemo-responsive tumor.
La Gastroprotezione Nel Paziente Oncologico: Approccio Razionale, Ruolo Dei Farmaci Antisecretori Ed Eventuali Ulteriori Prospettive in Oncologia
Authors: Mustacchi Giorgio , Ceccherini Rita 
Published: April 2018

In view of the large number of cancer patients treated with FANS and/or corticosteroids for long periods of time, Authors discuss how the use of antisecretory drugs for gastroprotection has become common practice in spite of the lack of clear scientific evidence. The paper analyses the principal mechanisms of gastrotoxicity of FANS, essentially associated with the inhibition of prostaglandins and consequent reduction of the secretion of mucous and bicarbonate. It also discusses the numerous controlled trials evaluating the efficacy of ranitidine for gastroprotection versus placebo and versus the analogous synthetic substance, misoprostole, derived from prostaglandin E1. This analysis shows that misoprostole provides significant protection against both gastric and duodenal ulcers, whilst the antisecretory drug protects only against localised duodenal ulcer. The conclusion is that optimum protection against FANS is provided by misoprostole. In any case more than 30% of patients are destined to develop ulcerous or minor lesions for which treatment with antisecretory drugs is correct. After analysis of the available literature on the gastrotoxicity of corticosteroids, it is clear that this risk is real only for a small sub-population of patients (treated in dual therapy with FANS, for long periods, with high doses or in presence of ulcer anamnesis). It is not known in these cases whether prophylactic treatment is suitable, nor which would be the best prophylactic treatment. In other cases the problem does not arise since the number of patients developing ulcers is similar with corticosteroids treatment or with placebo. Some further interesting features of ranitidine compared to cimetidine (its better pharmacological profile due to the lack of side effects, lack of medullary depression, lack of interference with the immunological system, lack of antiandrogen effects) are also discussed. Particularly interesting is the lack of interference with cyclophosphamide metabolism, such interference having shown for cimetidine. Studies involving ranitidine treatment in association with Interleukin-2 for renal carcinoma and metastatic melanoma are also of interest although no statistically significant results are available as yet.
EPOETIN A ALFA IN RADIOTERAPIA
Authors: Trodella Lucio , Balducci Mario , Gambacorta Maria Antonietta , Mantini Giovanna 
Published: April 2018

Sixty per cent of oncologic patients need radiation therapy for cure or palliation. In fact, in most neoplastic diseases, a better local control positively impacts on disease-free survival and overall survival. The efficacy of radiotherapy depends on several factors: while some are tumor-related, others are host-related. Radiobiological phenomena are also important: ionizing radiation is responsible for cell damage (double rupture of DNA chains), mostly an indirect mechanism with the formation of free radicals. Their toxic action is enhanced by the oxygen partial pressure at the cellular level. A number of studies have confirmed that good tissue oxygenation is a function of a high hemoglobin level in the peripheral blood (Hb≥13g/dL). Unfortunately, these values are rarely present in oncologic patients due to the disease-related toxicosis as well as to the therapy induced hematologic toxicity. The treatment of anemia is free of risk for the recent developments in technology which with gene cloning and the technique of recombinant DNA has allowed the production of human recombinant erythropoietin. Erythropoietin is produced by the interstitial cells of renal tubules in response to hypoxia. It prevents apoptosis and promotes erythroid proliferation and differentiation with consequent reticulocyte release and hemoglobin synthesis. It is not completely understood whether the efficacy of radiotherapy depends on hemoglobin values present at the start of irradiation (often less than 12-13 g/dL) or on the higher ones observed during and at the end of radiotherapy. Therefore, preventive systemic erythropoietin therapy in non anemic patients in terms of costs/benefits is at present non sustainable. To the contrary, in patients undergoing radiotherapy to extended fields or aggressive multimodal treatments, for the higher risk of anemia, the early use of this treatment can be hypothesized in case of initial anemia to improve therapy compliance and prevent negative conditioning of results. Keeping in mind that grade 1 minimum toxicity for red cells, according to the Radiation Therapy Oncology Group (RTOG) is equal to 11gHb/dL we think that this value can be considered as cutoff to start erythropoietin therapy.
Timing and Outcomes of Tracheostomy Performed by Pulmonary and/or Critical Care Physicians
Authors: Nishi Shawn P. E. , Shah Shiwan K. , Zhang Wei , Kuo Yong-Fang , Sharma Gulshan 
Published: April 2018

Background: Although pulmonary and/or critical care (P/CC) physicians perform percutaneous tracheostomy in mechanically ventilated patients, the trends, timing, and outcomes of this procedure have not been well described. This study aims to describe the trends, timing, and outcomes of this procedure. Methods: Using 5% medicare data, we retrospectively examined a cohort who had tracheostomy performed after initiation of mechanical ventilation during acute hospitalization to describe the timing of tracheostomy placement by pulmonary and/or critical care (P/CC) physicians and associated outcomes. Results: There were 4864 participants in the study cohort from 2007 to 2014. We examined the timing of tracheostomy (in days from initiation of mechanical ventilation), length of hospital stay, in-hospital death, and death within 30 days after hospital discharge. The percentage of tracheostomies performed by P/CC physicians increased significantly, from 7.2% in 2007 to 14.1% in 2014 (Cochran-Armitage test for trend, P = .001). Tracheostomies performed by P/CC physicians were more common in larger hospitals and major academic medical centers. After adjustment for baseline characteristics, the following parameters did not differ by provider: time to tracheostomy, length of hospital stay (days), in-hospital death, and death within 30 days after discharge. A tracheostomy was more likely to be performed by a P/CC physician at a larger (≥500 beds) hospital (adjusted odds ratio: 1.85, 95% confidence interval: 1.47-2.34). Conclusions: Tracheostomies are increasingly performed by P/CC physicians with similar outcomes, likely related to patient selection.
A quantitative method for the detection of muscle functional active and passive behavior recovery in models of damage-regeneration
Authors: Grasa Jorge , Pérez-Ruíz Ana , Muñoz María Jesús , Soteras Fernando , Bobadilla Muñoz Miriam , Baraibar Churio Arantxa , Prósper Felipe , Calvo Begoña 
Published: April 2018

Unlike other organs, skeletal muscle is endowed with a remarkable potential for regeneration that depends on the presence of satellite cells. Histological and functional (force generation) recoveries after muscle damage are not parallel processes. The aim of this study is to examine the in vivo contractile properties and in vitro passive stress–stretch behavior of muscle during degeneration–regeneration processes. Notexin was injected into rat tibialis anterior muscle, and functional recovery and histological changes were compared. We found that histological improvement of damaged muscle is delayed in comparison with its capacity to generate force. The elastic properties of muscle were not altered in agreement with the unchanged cross-linking index, probably as a consequence of the unaltered deposition of total collagen during degeneration–regeneration processes together with the maintenance of the ratio of collagens type I and III.
Saving the girl: A creative reading of Alice Sebold’s Lucky and The Lovely Bones
Authors: Kilby Jane 
Published: April 2018

In the late 1990s, Alice Sebold is writing what will become her phenomenally successful novel The Lovely Bones (2002), but she finds herself having to abandon it in order to write her critically acclaimed rape memoir Lucky (1999). She did not want, she says years later, Susie Salmon (the novel’s dead narrator) doing “work for her”, but wanted Susie free “to tell her own story”. Lucky would be the “real deal” about rape, while The Lovely Bones would be a fantasy. And yet, the memoir and novel are similar in many respects; and nearly identical to begin with. The Lovely Bones opens with the rape, murder and mutilation of a young girl – Susie – while Lucky opens with reference to the girl who was raped, murdered and mutilated in the tunnel Sebold was also raped in. This girl, Sebold maintains, always haunts her. Thus, I will argue, it is not possible to read her novel, which some critics have dismissed as “timid and sentimental”, without reading her gritty autobiography; and vice versa it is not possible to read Sebold’s rape memoir without reading her novel, which in a complex way bears witness to that unnamed girl, if not for all dead, unnamed girls. The question is, then, how does the intertextuality of Sebold’s novel and memoir, and, more broadly, the interrelationship of truth and fantasy, impact on our reading of Sebold’s work, especially her memoir? Keywords Rape, fact, fiction, truth, lie, reading, writing, creative witnessing, wishful thinking, utopia
Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
Authors: Ranson William A. , Cheung Zoe B. , Di Capua John , Lee Nathan J. , Ukogu Chierika , Jacobs Samantha , Vig Khushdeep S. , Kim Jun S. , White Samuel J. W. , Cho Samuel K. 
Published: April 2018

Study Design: Retrospective cohort study. Objectives: The prevalence of obesity-related low back pain and degenerative disc disease is on the rise. Past studies have demonstrated that obesity is associated with higher perioperative complication rates, but there remains a gap in the literature regarding additional risk factors that further predispose this already high-risk patient population to poor surgical outcomes following elective posterior lumbar fusion (PLF). The aim of the study is to identify independent risk factors for poor 30-day perioperative outcomes in morbidly obese patients undergoing elective PLF. Methods: We identified 22 909 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective PLF. There were 1861 morbidly obese patients. Baseline patient demographics and medical comorbidities were collected. Univariate analysis was performed to compare perioperative complication rates between non-morbidly obese and morbidly obese patients. The 5 most common complications in the morbidly obese group were then selected for multivariate regression analysis to identify independent risk factors for poor 30-day outcomes. Results: Morbidly obese patients had a higher perioperative complication rate. The 5 most common complications were prolonged hospitalization, blood transfusion, readmission, wound complications, and reoperation. Independent risk factors for these complications were age ≥65 years, super obesity (ie, BMI > 48.6), chronic steroid use, American Society of Anesthesiology classification ≥3, poor functional status, long length of fusion ≥4 levels, and extended operative time (ie, operative time ≥318 minutes). Conclusions: Morbidly obese patients are at higher risk of perioperative complications following elective PLF. Modifiable risk factors for the most common complications are obesity and preoperative steroid use.
Mental health law in Cyprus
Authors: Palazidou Eleni , Polyniki Anna 
Published: April 2018

The current Law for Psychiatric Care in the Republic of Cyprus was enacted in 1997 with amendments made in 2003 and 2007. The mental health law makes provision for the development and function of Psychiatric Centres for the care of the mentally ill. In contrast to the old Mental Health Law there is a major shift from a custodial approach to community care. Compulsory admissions under the Act, which require a Court Order, are made to a designated secure psychiatric in-patient unit. The protection of patients' human rights is at the core of the Act.The Mental Health Commission, a Supervisory Committee and designated body for the Protection of the Rights of the Mentally Ill, assists in the correct implementation of the Mental Health Law. The Commission has a primarily advisory role but it is actively involved in monitoring the implementation of the Mental Health Law.
Heparan Sulfate Proteoglycan Sulfation Regulates Uterine Differentiation and Signaling During Embryo Implantation
Authors: Yin Yan , Wang Adam , Feng Li , Wang Yu , Zhang Hong , Zhang Ivy , Bany Brent M , Ma Liang 
Published: April 2018

AbstractTo prepare for embryo implantation, the uterus must undergo a series of reciprocal interactions between the uterine epithelium and the underlying stroma, which are orchestrated by ovarian hormones. During this process, multiple signaling pathways are activated to direct cell proliferation and differentiation, which render the uterus receptive to the implanting blastocysts. One important modulator of these signaling pathways is the cell surface and extracellular matrix macromolecules, heparan sulfate proteoglycans (HSPGs). HSPGs play crucial roles in signal transduction by regulating morphogen transport and ligand binding. In this study, we examine the role of HSPG sulfation in regulating uterine receptivity by conditionally deleting the N-deacetylase/N-sulfotransferase (NDST) 1 gene (Ndst1) in the mouse uterus using the Pgr-Cre driver, on an Ndst2- and Ndst3-null genetic background. Although development of the female reproductive tract and subsequent ovarian function appear normal in Ndst triple-knockout females, they are infertile due to implantation defects. Embryo attachment appears to occur but the uterine epithelium at the site of implantation persists rather than disintegrates in the mutant. Uterine epithelial cells continued to proliferate past day 4 of pregnancy, accompanied by elevated Fgf2 and Fgf9 expression, whereas uterine stroma failed to undergo decidualization, as evidenced by lack of Bmp2 induction. Despite normal Indian hedgehog expression, transcripts of Ptch1 and Gli1, both components as well as targets of the hedgehog (Hh) pathway, were detected only in the subepithelial stroma, indicating altered Hh signaling in the mutant uterus. Taken together, these data implicate an essential role for HSPGs in modulating signal transduction during mouse implantation.