bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Applications of Radioimmunoscintigraphy with Prostate-Specific Antibodies for Prostate Cancer
Authors: Manyak Michael J. 
Published: August 2017

Background The presence of metastasis is the most important prognostic indicator in patients with prostate carcinoma and is the predominant determinant of therapeutic choices. Current tools for detection of recurrence or metastasis are less than optimal. Recent clinical trials with radiolabeled monoclonal antibodies appear to provide more precise localization of prostate cancer in these clinical circumstances Methods Multicenter national trials of patients at relatively high risk for metastasis at diagnosis and patients with biochemical evidence of recurrence after prostatectomy underwent radioimmunoscintigraphy with capromab pendetide. Results Tissue confirmation of scan results demonstrated a 15-fold and 4-fold increase in sensitivity over computed tomography and magnetic resonance imaging, respectively, for newly diagnosed patients. Preliminary data have shown a 3- to 4-fold increase in durable complete response to radiation therapy in patients with biochemical failure following radical prostatectomy. Conclusions Patients at relatively high risk for metastasis at diagnosis and those with biochemical evidence of recurrence after prostatectomy may benefit from radioimmunoscintigraphy.
The Current Status of Gene Therapy for Prostate Cancer
Authors: Nowroozi Mohammad R. , Pisters Louis L. 
Published: August 2017

Background Due to limitations of local and systemic therapies for prostate cancer, interest has continued in the development of new treatment modalities. Gene therapy has emerged as a new approach that may prevent or treat disease by using the therapeutic information encoded in DNA sequences. Several institutions are actively experimenting with this approach. Methods The authors review the most common genetic alterations in prostate cancer, the principles of gene therapy, and gene delivery including both viral and nonviral vectors. Treatment strategies for both cytoreductive gene therapy as well as corrective gene therapy are described, and the available protocols to date with gene therapy for the treatment of prostate cancer are presented. Results and Conclusions More than 150 active protocols are ongoing to evaluate gene therapy in the treatment of cancer, with 13 of these open for patients with prostate cancer. The future of gene therapy as applicable to prostate cancer depends on additional development of vector systems and a better understanding of the genes involved in tumor induction and proliferation. Although gene therapy is clearly in its infancy, it is in an explosive growth phase and holds tremendous promise as a treatment modality for prostate cancer.
Reforming the Care System to Support those Coming to the End of Life
Authors: Lynn Joanne 
Published: August 2017

Background: Health care has shifted its focus regarding dying patients toward improving care rather than striving for cure. Methods: The Center to Improve Care of the Dying and the Institute for Healthcare Improvement sponsored a quality improvement collaborative from July 1997 through July 1998 to learn how to accomplish this. Results: (1) Classifying persons as “dying” or “not dying” does not help to ensure quality care at the end of life. The impossibility of predicting time of death in many illnesses demands not only a shift to asking whether a patient is sick enough to die of the current illness, but also targeting special services to those patients. (2) Quality improvement strategies in this arena regularly yield important gains in such fields as pain control, bereavement support, and advance planning. (3) Serious reform probably must originate in system design and routine practice rather than in exhortations to customize decision making. The Study to Understand Prognoses and Preferences in Outcomes and Risks of Treatment (SUPPORT) found that 80% of the substantial variation in the rate of death at home correlated with hospital bed supply. Conclusions: Based on the inadequacy of the current classification system and on the unpredictability of the timing of death, a conceptual model is proposed for many patients that mixes conventional “aggressive” care with palliative care and is triggered by illness severity rather than by prognosis. High leverage reform in end-of-life care is available now through quality improvement strategies.
Advanced Cancer and Comorbid Conditions: Prognosis and Treatment
Authors: Stuart Brad 
Published: August 2017

Background: Nonmalignant comorbid medical conditions, such as heart failure and emphysema, may complicate cancer treatment. Methods: Guidelines from the National Hospice Organization for cancer and selected nonmalignant diseases are outlined, and treatment principles for end-stage heart failure and emphysema are reviewed. Results: Estimates by clinicians of survivability in advanced cancer and nonmalignant disease are important in order to allow patients and family members to begin realistic advance planning. As disease progresses through its end stages to death, optimal management may include both disease-modifying and symptom-relieving interventions. Conclusions: A well-managed end of life is an important therapeutic option in informed consent discussions with seriously ill patients and their families.
Bisphosphonates in the Management of Breast Cancer
Authors: Cristofanilli Massimo , Hortobagyi Gabriel N. 
Published: August 2017

Background: Bone is the most frequent site of metastasis in patients with breast cancer. Bone metastasis, particularly osteolytic bone destruction, is usually associated with significant morbidity and deterioration of quality of life. Bisphosphonates are specific inhibitors of osteoclast activity used in the treatment of hypercalcemia of malignancy and osteolytic bone disease. Methods: We reviewed pertinent literature on the use of bisphosphonates therapy to treat metastatic breast cancer. Results: The use of bisphosphonates in the management of osteolytic bone metastases results in improved palliation of symptoms. Use of these agents in the adjuvant setting may help to prevent bone metastases. Conclusions: Bisphosphonates represent an effective palliative treatment when combined with chemotherapy and hormonal therapy for the management of osteolytic bone metastases. Identifying the exact mechanism of action requires further investigation to better define the possibility of a direct antitumor effect. The role of bisphosphonates in the adjuvant setting is still controversial, pending the results of large randomized trials.
New Hormonal Therapies for Breast Cancer
Authors: Minton Susan E. 
Published: August 2017

Background: There has been an explosion in the development of hormonal therapies for the treatment of breast cancer. Several new agents have been approved for the treatment of breast cancer in the metastatic setting, and trials are ongoing in the adjuvant and prevention setting to improve hormonal therapy for the prevention and treatment of breast cancer. Methods: The literature on new hormonal therapies for the treatment of breast cancer is reviewed, with an emphasis on newer agents. Results: Two antiestrogens are now approved in the United States for the treatment of metastatic breast cancer. Other antiestrogens have activity in metastatic breast cancer as well as in osteoporosis. Newer pure antiestrogens may overcome resistance to tamoxifen. Several aromatase inhibitors are available for the treatment of metastatic breast cancer. Conclusions: Many hormonal agents are now available for both adjuvant and advanced disease settings. Developments will depend on clarifying mechanisms of resistance to antiestrogens and identifying new classes of agents that lack cross-resistance to standard therapy.
Is Fatigue a Long-term Side Effect of Breast Cancer Treatment?
Authors: Jacobsen Paul B. , Stein Kevin 
Published: August 2017

Background: Fatigue is one of the most common and distressing symptoms experienced by breast cancer survivors. Despite its prevalence, relatively little is known about the characteristics, etiology, or treatment of fatigue in breast cancer survivors. Methods: This report reviews studies that assessed fatigue in breast cancer patients previously treated with adjuvant radiotherapy, adjuvant chemotherapy, or autologous bone marrow transplantation. Results: A review of the literature suggests that breast cancer patients who undergo adjuvant chemotherapy or autologous bone marrow transplantation experience clinically significant levels of fatigue for months or even years following the completion of active treatment. In contrast, there is little evidence that patients who receive only regional therapy (ie, surgery plus adjuvant radiotherapy) experience clinically significant fatigue as a long-term treatment side effect. Conclusions: A growing body of evidence indicates that persistent fatigue can be a long-term side effect of certain forms of breast cancer treatment. The challenges for the future will be to determine the etiology of fatigue among breast cancer survivors and to develop interventions that are effective in preventing or reducing fatigue following breast cancer treatment.
Vaccines for Ovarian Carcinoma
Authors: Butts Cherie , Freedman Ralph S. 
Published: August 2017

Background Metastasis to the abdominal cavity is the primary cause of morbidity and mortality in patients with ovarian cancer. Beyond surgery and chemotherapy combinations, strategies that target tumor cells in vivo are being investigated, such as the use of recombinant cytokines to up-regulate or modulate the cell-mediated or humoral immune response. Methods The authors report on their experience with tumor vaccines, including first-generation vaccines, peptide vaccines, and polynucleotide vaccines, in the treatment of ovarian cancer Results Cytokines may stimulate proliferation or activation of effector cells that mediate either major histocompatibility restricted cytotoxicity (adaptive immunity) or natural (innate) immunity. Cytokines are often pleiotropic, and their effects may depend on concentration, scheduling, and responsiveness of the cell populations to which they are directed. They also have been used to enhance the efficacy of tumor vaccines that have reached a higher level of sophistication. Recently designed tumor vaccines are capable of stimulating antitumor immune responses that recognize tumor cell epitopes or that have the potential to act synergistically with cytokines such as interleukin-2 and interleukin-12. Conclusions Enthusiasm for antitumor vaccine strategies is supported by accumulating clinical reports of responses following treatments using a variety of vaccines. Additional research is needed to determine optimum vaccine approaches for the treatment or prevention of ovarian cancer.
Modification of the Radiation Response of Patients with Carcinoma of the Uterine Cervix
Authors: Grigsby Perry W. 
Published: August 2017

Background The purpose of this review is to summarize clinical trials for patients with cervical cancer treated with irradiation and modifiers of the irradiation response. Methods The Medline database was used to identify clinical studies that evaluated modifiers of the irradiation response for patients with carcinoma of the uterine cervix from 1970 through 1998. The studies included were prospective, randomized phase III clinical trials comparing irradiation alone to irradiation plus a chemical modifier for carcinoma of the uterine cervix. Results Various chemical agents have been combined with irradiation in the treatment of patients with carcinoma of the uterine cervix. These agents include hyperbaric oxygen, hydroxyurea, nitroimidazoles, neoadjuvant chemotherapy, and concurrent chemotherapy. Conclusions Many prospective, randomized studies evaluating the use of chemical agents to modify the irradiation response in patients with carcinoma of the uterine cervix indicate no improvement over radiation therapy alone. However, the February 1999 NCI clinical announcement describes a survival advantage for cisplatin-based therapy and concurrent irradiation.
Angiogenesis and Cancer Control: From Concept to Therapeutic Trial
Authors: Brem Steven 
Published: August 2017

Background There is extraordinary interest in developing angiosuppressive agents for cancer treatment. Several new agents appear promising for the treatment of a variety of human cancers. Current concepts and new agents in clinical trials are the focus of this article. In particular, the introduction of a new treatment for human brain tumors is presented in detail, using an antiangiogenic agent, penicillamine, and depletion of an obligatory cofactor of angiogenesis, copper. Methods The explosive increase in literature on antiangiogenesis is reviewed using computerized search, findings presented at the recent national cancer and angiogenesis meetings. A specific protocol, NABTT 97-04, “Penicillamine and Copper Reduction for Newly Diagnosed Glioblastoma,” is presented as an example of angiotherapeutic drug discovery. Results A number of promising molecular approaches are being introduced to suppress tumor angiogenesis. Major categories of angiogenesis antagonists include protease inhibitors, direct inhibitors of endothelial cell proliferation and migration, suppression of angiogenic growth factors, inhibition of endothelial-specific integrin/survival signaling, chelators of copper, and inhibitors with specific other mechanisms. The preliminary results of early trials offer a glimpse into how antiangiogenesis therapy will be integrated into future care of the patient with cancer. Conclusions Thirty-five antiangiogenesis therapies are currently being evaluated in clinical trials. As we learn more about the fundamental mechanisms of angiogenesis, eg, the role of copper in growth factor activation, effective methods of cancer control will be implemented.
Chemotherapy of Testis Cancer
Authors: Benedetto Pasquale 
Published: August 2017

Background Prior to the use of cisplatin, durable complete remissions of metastatic testis cancer were rare. In 1977, a treatment program including a chemotherapy program of cisplatin, vinblastine, and bleomycin (PVB) led to high response rates and acceptable toxicities in patients with disseminated testis cancer. Since then, the BEP (bleomycin, etoposide, and cisplatin) regimen has been established as standard therapy for good- and poor-risk disease and ifosfamide-based regimens or high-dose chemotherapy with stem cell rescue as salvage therapy. Methods The results of those prospective, randomized clinical trials that have markedly improved the outlook of patients with this type of cancer have been reviewed. Results Categories of risk have been defined. Standard therapy for both good-risk and poor-risk disease remains BEP therapy. High-dose chemotherapy with autologous bone marrow or peripheral stem cell rescue transplantation is being investigated to overcome chemotherapy resistance. Conclusions While the present state of the art for treating metastatic testicular cancer is promising, approximately one third of patients with “poor-risk” disease will not achieve a remission. Trials of new agents and approaches are needed to increase patient survival.
Grip strength feigning is hard to detect: an exploratory study
Authors: Vollert Jan , Pasqualicchio Carina , Papenhoff Mike , Heitmann Burkhard , Müller Frank , Maier Christoph 
Published: August 2017

Detecting submaximal effort when testing grip strength is difficult. Research so far has focused on the discrimination between sincere and feigning healthy participants, whereas the clinically relevant distinction is between injured patients and feigning participants. The aim of our study was to compare rapid exchange grip and isometric grip strength testing in 41 participants feigning weakness with 39 patients with decreased hand function. Various parameters that describe grip strength were recorded and tested for differences between the groups. Only the maximum grip strength during rapid exchange grip was found to be significantly higher in feigning participants compared with patients, but this cannot be used for decision-making on an individual basis. We found no parameters that are useful for the detection of feigned weakness in an individual case. Level of evidence: III
Immunomodulatory effects of heat-killed Mycobacterium obuense on human blood dendritic cells
Authors: Bazzi Samer , Modjtahedi Helmout , Mudan Satvinder , Achkar Marcel , Akle Charles , Bahr Georges M. 
Published: August 2017

Heat-killed (HK) Mycobacterium obuense is a novel immunomodulator, currently undergoing clinical evaluation as an immunotherapeutic agent in the treatment of cancer. Here, we examined the effect of in vitro exposure to HK M. obuense on the expression of different categories of surface receptors on human blood myeloid (m) and plasmacytoid (p) DCs. Moreover, we have characterized the cytokine and chemokine secretion patterns of purified total blood DCs stimulated with HK M. obuense. HK M. obuense significantly up-regulated the expression of CD11c, CD80, CD83, CD86, CD274 and MHC class II in whole-blood mDCs and CD80, CD123 and MHC class II in whole-blood pDCs. Down-regulation of CD195 expression in both DC subpopulations was also noted. Further analysis showed that HK M. obuense up-regulated the expression of CD80, CD83 and MHC class II on purified blood DC subpopulations. TLR2 and TLR1 were also identified to be engaged in mediating the HK M. obuense-induced up-regulation of surface receptor expression on whole blood mDCs. In addition, our data demonstrated that HK M. obuense augmented the secretion of CCL4, CCL5, CCL22, CXCL8, IL-6, IL-12p40 and TNF-α by purified total blood DCs. Taken together, our data suggest that HK M. obuense exerts potent differential immunomodulatory effects on human DC subpopulations.
Promoting smoking cessation in China: a foot-in-the-door approach to tobacco control advocacy
Authors: Chan Sophia Siu Chee , Cheung Yee Tak Derek , Wong David Chung Ngor , Jiang Chao Qiang , He Yao , Yang Li , Jiang Bin , Wu Lei , Tan Shou Yong , Cheng Kar Keung , Lam Tai-hing 
Published: August 2017

Introduction: The Chinese government’s implementation of the MPOWER policies and compliance with the WHO Framework Convention on Tobacco Control requirements has been slow. We used the ‘foot-in-the-door’ approach to promote tobacco control advocacy through capacity building of healthcare leaders, and establishment of smoking cessation clinics in Guangzhou and Beijing (two of the largest cities in China). Methods: This collaborative pilot project involved the University of Hong Kong and three major hospitals in Guangzhou and Beijing. A steering committee conducted the smoking cessation training workshops starting from April 2006, and set up three smoking cessation model clinics during August 2006 to October 2008. We followed up the trained health care professionals (HCPs) in 2014 and 2015 to assess their impacts on tobacco control beyond smoking cessation. Results: We emphasized the importance of the general tobacco control atmosphere during smoking cessation training of 139 HCPs to motivate them to engage in tobacco control advocacy. In addition to enhancing their knowledge and skills in cessation, the HCPs were then involved in the establishment of three in-hospital smoking cessation clinics and served as smoking cessation counselors since June 2008. Moreover, they ventured outside the clinics and the community to publicize smoking cessation. Their effort has contributed to smoke-free legislation, better surveillance on smoking and media advocacy on tobacco control in China. Conclusions: The training and establishment of smoking cessation clinics could serve as a means to motivate and empower HCPs who could contribute to broaden tobacco control policy in China.
Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’
Authors: Ashley Blair , Spiegel David A , Cahill Patrick , Talwar Divya , Baldwin Keith D 
Published: August 2017

Background: Defining the appropriate threshold at which to initiate a fever workup is imperative to promote patient safety, appropriate resource utilization, and antibiotic stewardship. Our group performed a systematic review of the available literature on perioperative fever (POF) workups in orthopaedic patients to evaluate the frequency, timing and utility of blood cultures (BC) and other investigations in the POF workup, to determine the clinical relevance of any infections and to evaluate their cost effectiveness. Methods: Studies were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane and Google Scholar for articles through September 2016. Forty-nine articles were retrieved and 22 articles met the pre-determined inclusion criteria. Proportions of positive studies were noted and averaged using random effects analysis. Results: Post-operative pyrexia ranged in prevalence between 8.1% and 87.3%. The studies routinely performed during a fever workup had wide ranges of diagnostic yield, including chest X-rays from 0% to 40%, urinalyses from 8.2% to 38.7%, urine cultures from 0% to 22.4% and BC from 0% to 13.3%. Only two patients with positive BC developed clinical sepsis. Cost per fever evaluation ranged from $350 to $950. Conclusion: The findings of this review suggest that early post-operative fever is an expected event following orthopaedic surgery. Based on the available literature, any kind of workup in the absence of localizing symptoms in the third post-operative day or before is unwarranted and is an inappropriate use of hospital resources.
Improving Patient Experiences and Outcomes Through Personal Care Aide Training
Authors: Luz Clare C , Hanson Katherine V , Hao Yuning , Spurgeon Elizabeth 
Published: August 2017

Introduction: The rapidly aging US population is resulting in major challenges including delivering quality care at lower costs in the face of a critical health-care workforce shortage. The movement toward home care has dramatically increased the need for qualified, paid personal care aides (PCAs). Adequate PCA training that focuses on skills for person-centered, at home support is an imperative. This study provides evidence that clients of PCAs who have completed a comprehensive, evidence-based PCA training program, titled Building Training…Building Quality (BTBQ), report higher satisfaction and better health outcomes, compared to clients of PCAs with lesser or other training. Methods: A mixed-methods, quasi-experimental design was used to compare self-reported survey responses from clients of BTBQ-trained PCAs (treatment group) with responses from clients of non-BTBQ-trained PCAs (control group). Results: Clients of BTBQ-trained PCAs had significantly fewer falls and emergency department visits compared to clients whose PCAs had no BTBQ training ( P < .05). Conclusion: BTBQ-like PCA training reduces costly adverse events.
Uncovering the mystery of opposite circadian rhythms between mouse and human leukocytes in humanized mice
Authors: Zhao Yue , Liu Min , Chan Xue Ying , Tan Sue Yee , Subramaniam Sharrada , Fan Yong , Loh Eva , Chang Kenneth Tou En , Tan Thiam Chye , Chen Qingfeng 
Published: August 2017

Key PointsHuman circulating leukocytes in humanized mice reproduce similar circadian oscillations as seen in humans. A novel molecular clock network exhibiting opposite effects on regulating human and mouse leukocyte circadian rhythm is discovered.