bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet-to-Lymphocyte Ratio and Use of NSAIDs during the Perioperative Period as Prognostic Indicators in Patients with NSCLC Undergoing Surgery
Authors: Lee Brenda M. , Rodríguez Andrea , Mena Gabriel , Gottumukkala Vijaya , Mehran Reza J. , Rice David C. , Feng Lei , Yu Jun , Cata Juan P. 
Published: August 2017

Background Hematological biomarkers of inflammation such as the neutrophil-to-lymphocytic rate have been reported as predictors of survival in a variety of cancers. The aim of the present study was to investigate the prognostic value of the perioperative platelet-to-lymphocyte ratio in patients with non–small-cell lung cancer (NSCLC) and to elucidate the effects of the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) on tumor recurrence and survival in patients undergoing surgical resection for NSCLC. Methods This retrospective study included data from 1,637 patients who underwent surgical resection for stage I, II, or III NSCLC. Perioperative data and tumor-related variables were included. Univariate and multivariable Cox proportional hazard ratio (HR) models were used to evaluate the association between perioperative platelet-to-lymphocyte ratio and NSAID use on recurrence-free survival (RFS) and overall survival (OS). Results Multivariate analysis showed that a preoperative platelet-to-lymphocyte ratio of at least 180 was associated with reduced rates of RFS (HR = 1.22; 95% confidence interval [CI], 1.03–1.45; P = .019) and OS (HR = 1.33; 95% CI, 1.10–1.62; P = .004). Perioperative use of NSAIDs showed no statistically significant changes in RFS and OS rates (P = .72 and P = .44, respectively). Conclusions A higher preoperative inflammatory status is associated with decreased rates of RFS and OS in patients with NSCLC undergoing curative surgery. Perioperative use of NSAIDs was not found to be an independent predictor of survival.
Skeletal Scintigraphy
Authors: Montilla-Soler Jaime L. , Makanji Rikesh 
Published: August 2017

Background Skeletal scintigraphy remains a valuable tool in the initial and subsequent evaluation of the skeletal system in patients with a diagnosis of primary or metastatic neoplasms. Methods We discuss radiopharmaceuticals, nuclear medicine imaging techniques, and current as well as future oncological applications in the adult population. Pertinent literature was reviewed to describe the advantages and limitations of available technologies for the evaluation of skeletal metastatic disease. Evaluation of primary and metastatic skeletal disease using nuclear medicine and positron emission tomography techniques is discussed. Results Skeletal scintigraphy provides valuable information in the initial evaluation for the presence of osteoblastic skeletal metastases. Incremental advances on available radiopharmaceuticals (fludeoxyglucose F 18, sodium fluoride F 18), coupled with advances in imaging techniques and imaging devices (single photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging), have had a significant impact on sensitivity, specificity, and accuracy rates for the detection of skeletal metastases. Conclusions Skeletal scintigraphy has a significant role in the initial diagnosis, staging, restaging, and treatment monitoring of patients with cancer and primary skeletal or metastatic disease. The coupling of diagnostic and therapeutic nuclear medicine agents in the setting of osteoblastic skeletal metastases is a valuable tool for the treatment for certain cancer types, including prostate cancer, and may become more widely used to treat other histologies as more data on other tumor types (eg, breast cancer, osteosarcoma) become available.
Pain and Symptom Management in Palliative Care
Authors: Ripamonti Carla , Bruera Eduardo 
Published: August 2017

Background Pain, dyspnea, and anorexia are common symptoms experienced by patients with cancer and often are poorly managed. Methods The incidence and causes of these symptoms are described, as well as factors that exacerbate or ameliorate their impact. Results Pharmacologic management of cancer pain is based on the use of a sequential “ladder” that incorporates nonopioid, opioid, and adjuvant drugs, depending on the severity of the pain. This approach usually is effective. Other symptoms of advanced disease may be more difficult to control. Conclusions Adherence to an adequate pain-control strategy will significantly enhance palliation of pain in patients with cancer.
Localization of Neuroendrocrine Tumors Using Somatostatin Receptor Imaging with Indium-111-Pentetreotide (OctreoScan)
Authors: Ellison E. Christopher , Schirmer William J. , Olsen John O. , Pozderac Rodney V. , Hinkle George , Hill Tom , O'Dorisio Thomas M. , O'Dorisio M. Sue 
Published: August 2017

Background Many imaging methods have been used to detect neuroendocrine tumors of the gastrointestinal system. There is no gold standard for identifying the location of primary tumors and their potential metastases, and most conventional imaging techniques cannot detect tumors less than 1.0 cm in size. Methods The authors have investigated the use of 111In-pentetreotide as an imaging agent for abdominal neuroendocrine tumors. Results The agent is cleared rapidly by the kidneys and is primarily excreted intact with a biologic half-life of six hours. The largest radiation burden is to the spleen and kidneys. A nine-center study conducted in Europe involved 365 patients with gastroenteropancreatic neuroendocrine tumors that were also imaged by other methods. The results of 111In-pentetreotide were in agreement with those obtained by other methods for 79% of tumor locations. An additional 110 tumor localizations were detected that were not seen with conventional methods. The smallest gastrinoma imaged by 111In-pentetreotide was a 4-mm duodenal tumor. Conclusions Scintigraphy with 111In-pentetreotide is effective in visualizing various somatostatin receptors characteristic of neuroendocrine tumors of the gastrointestinal tract. Insulinomas, however, are not well imaged. Concurrent computed tomography scanning is advised to minimize the risk of missing liver metastases.
Cancer Prevention: The Roles of Diet and Chemoprevention
Authors: Greenwald Peter , Mcdonald Sharon S. 
Published: August 2017

Background Reduction of cancer risk by either preventing carcinogenesis or stopping carcinogenesis in its early stages is a logical approach for reducing the cancer burden, both for high-risk individuals and for the general population. The areas of dietary modification and chemoprevention show considerable promise as effective approaches for cancer prevention and are a focus of research efforts. Results Diet and cancer studies show that, generally, vegetables and fruits, dietary fiber, and certain nutrients seem to be protective against cancer, whereas fat, excessive calories, and alcohol seem to increase cancer risk. Chemoprevention research is closely linked to diet and cancer research and represents a logical research progression. Conclusions Dietary epidemiologic studies have helped to identify many naturally occurring chemopreventive agents. Currently, randomized clinical prevention trials sponsored by the NCI include dietary interventions (eg, low-fat and/or high-fiber vegetables and fruits) targeting breast and colorectal cancer, chemoprevention trials using micronutrients (eg, vitamin E, calcium, vitamin D) aimed at lung and colorectal cancer, and chemoprevention trials testing the effectiveness of pharmaceutical agents (eg, tamoxofen, finasteride, aspirin) for breast, prostate, and colorectal cancer.
Head and Neck Chemoprevention: Recent Advances
Authors: Lippman Scott M. 
Published: August 2017

BackgroundHead and neck cancers are important to human life and health in both developed and underdeveloped countries. Management of established cancers is difficult, and there is great interest in evaluating methods to prevent these tumors from developing.MethodsThe biology of carcinogenesis, including field carcinogenesis, is reviewed, together with the biology and pharmacology of the retinoids. Intervention studies of premalignant lesions have led to prospective clinical trials of the capability of various retinoids to reduce the incidence of new second cancers.ResultsHigh-dose 13-cis-retinoic acid (13cRA) has significant activity in reversing oral leukoplakia but at a cost of substantial toxicity, and relapses occur early. An ongoing intergroup trial is underway to evaluate the capacity of low-dose (30 mg/d) 13cRA given for three years to reduce the incidence of second primary tumors in patients with “cured” squamous head and neck cancers.ConclusionsMolecular studies of loss of heterozygosity and p53 gene mutations are advancing our understanding of field carcinogenesis and the biology, pharmacology, and effects of the retinoids used in cancer prevention. Translation of early clinical trials into large-scale intervention trials to prevent
Polypharmacy in the Older Patient with Cancer
Authors: Corcoran Mary E. 
Published: August 2017

Background Elderly patients – those aged 65 years and over – use more medications than their younger counterparts and experience higher risks for polypharmacy, drug interactions, adverse drug reactions, and noncompliance for this age-group. Methods The data on polypharmacy in the aged is reviewed, supplemented with preliminary information from studies performed on elderly patients with cancer at our institution. Results Polypharmacy occurs in ambulatory, extended care, and institutional settings. Over-the-counter medications are underreported. The number of potential drug-related problems is related to the total number of prescriptions. Methods for evaluating the extent of polypharmacy include the “brown-bag” technique and careful medication histories. Conclusions The risks of polypharmacy may be reduced with patient and physician education, intervention, and drug monitoring. Further pharmacokinetic investigations of anticancer medications are needed to recognize the potential for harmful drug interactions, to understand their toxicity profiles, and to avoid the clinical implications of drug interactions.
Radioisotope-Guided Surgical Biopsy of Suspected Osseous Metastases
Authors: Robinson Lary A. 
Published: August 2017

Background Radioisotope bone scanning is frequently used to stage patients with suspected or proven malignancies. Since false-positive results are common, especially in the ribs, open biopsy is often necessary. The conventional approach of visual inspection of the bone scan image to guide the surgeon usually requires excision of a large area of one or two ribs to assure that the biopsy was performed on the correct rib. A more precise method to guide the biopsy is desirable. Methods One technique to localize the suspicious area of bone intraoperatively for accurate biopsy involves percutaneous injection of the bone abnormality with a radioisotope followed by injection of methylene blue into the periosteum and subsequent open surgical biopsy. A more recent technique uses a hand-held gamma probe in a sterile sleeve in the operating room to locate the bone “hot spot” directly in the wound to guide the biopsy. Results Both techniques are effective in pinpointing the bone scan abnormality, but use of the gamma probe is less cumbersome and consumes less time and fewer resources. In one series of 10 patients undergoing gamma probe-guided biopsies of 13 rib and 1 sternal bone scan lesions, this technique showed a sensitivity of 100% in locating the area of abnormal radioisotope uptake. All biopsies yielded an abnormal diagnosis to account for the bone scan abnormality, but only 4 of 14 (29%) demonstrated metastatic tumor. Conclusions Techniques described for radioisotope-guided localization of areas of increased tracer uptake in asymptomatic suspected bone metastases are accurate, sensitive guides to the open biopsy of these bony abnormalities. Due to the high false-positive rates in these asymptomatic but suspicious bone scan abnormalities, a diagnosis should be histologically confirmed.
Perfusion Magnetic Resonance Imaging to Assess Brain Tumor Responses to New Therapies
Authors: Lev Michael H. , Hochberg Fred 
Published: August 2017

Background: Although magnetic resonance imaging (MRI) is effective in detecting the location of intracranial tumors, new imaging techniques have been studied that may enhance the specificity for the prediction of histologic grade of tumor and for the distinction between recurrence and tumor necrosis associated with cancer therapy. Methods: The authors review their experience and that of others on the use of perfusion magnetic resonance imaging to evaluate responses of brain tumors to new therapies. Results: Functional imaging techniques that can distinguish tumor from normal brain tissue using physiological parameters. These new approaches provide maps of tumor perfusion to monitor the effects of novel compounds that restrict tumor angiogenesis. Conclusions: Perfusion MRI not only may be as effective as radionuclide-based techniques in sensitivity and specificity in assessing brain tumor responses to new therapies, but also may offer higher resolution and convenient co-registration with conventional MRI, as well as time- and cost-effectiveness. Further study is needed to determine the role of perfusion MRI in assessing brain tumor responses to new therapies.
Manipulating the Immunologic Characteristics of Both Graft and Host to Improve Transplant Outcome
Authors: Noga Stephen J. , O'donnell Paul V. 
Published: August 2017

Background Several critical outcomes of allogeneic stem cell transplantation for hematologic malignancies such as engraftment, incidence of graft-vs-host disease (GVHD) and disease-free survival depend on a balance between residual host and infused donor T cells and on chemosensitivity of the underlying disorder. Manipulating cell compartments of the allograft does affect long-term outcome. Methods The authors review investigations on the effect of blood and marrow graft components, treatment regimens, and immunologic interventions on eventual transplant outcome, an approach termed “graft engineering.” Results Major advances in graft engineering over the last decade are presented as a series of related developments or levels that derive from the goals of reducing GVHD and minimal residual disease. Conclusions Morbidity and mortality of GVHD have decreased markedly by methods of T-cell depletion but at the expense of recurrent disease. Cellular therapy and immunotherapy show promise in potentially eradicating residual disease posttransplant.
The Current Status of the Pathology of Prostate Cancer
Authors: Murphy William M. 
Published: August 2017

Background The pathology of prostate cancer in modern day medicine cannot be understood simply in terms of tissue patterns or genetic abnormalities. Efforts to accommodate changes in patient care delivery and reimbursement, combined with an explosion in information, have wrought major changes in pathology. Methods The author summarizes the current status of the pathology of prostate cancer in light of these influences. The detection of prostate cancer in needle biopsies, the diagnostic interpretations that tend to confuse clinicians, the prognostic factors in prostate cancer, and the effects of radiotherapy and hormone therapy on prostatic tissue are discussed. Results Collegial associations are difficult to maintain when consultants are spatially separated and patients are shuttled between primary care and specialty centers. Economic forces cannot be ignored, regardless of the level of altruism of individual practitioners. A medical environment governed by judgment and wisdom is difficult to maintain when external forces and even patients themselves demand application of the latest information to each case. Conclusions Current trends in medicine offer almost as many pitfalls as promises. Information gathering and transfer tend to marginalize anatomic pathologists from patient care. Current pathology is affected by the influences of medicolegal and economic forces.
Trends in Cancer Pain Management
Authors: Lesage Pauline , Portenoy Russell K. 
Published: August 2017

Background: Pain is a prevalent symptom in cancer patients, affecting up to 50% of patients undergoing active cancer treatment and up to 90% of those with advanced disease. Although adequate relief can be achieved in the majority of cancer patients, pain is often treated inadequately in traditional settings. Methods: The authors use their experience and that of others to review the evaluation and diagnosis of pain syndromes and the principles of management. Results: The World Health Organization and other governmental agencies have recognized the importance of pain management as part of routine cancer care. Conducting a comprehensive assessment, competently providing analgesic drugs, and communicating with the patient and family allow effective management of pain in the cancer patient. Conclusions: Several approaches can promote adequate management of cancer pain, such as enhancing clinician knowledge of pain syndromes, improving pain assessment, and updating medical information related to pain and symptom control.
Ethical Issues in End-of-Life Care
Authors: Walker Robert M. 
Published: August 2017

Background: Physicians who treat patients approaching the end of life often face moral, ethical, and legal issues involving shared decision making, futility, the right to refuse medical treatment, euthanasia, and physician-assisted suicide. Methods: The author examines cases that involve these issues and also reviews the ethical principles that guide current medical practice. Issues such as end-of-life ethical questions, the right to life-sustaining therapy, medical futility, the distinction between killing and allowing to die, and physician-assisted suicide are discussed. Results: The principal problem involves the appropriate use of technology at the end of life. While developments in technology have enhanced our ability to prolong life, issues have also arisen regarding the resulting quality of life, the sometimes marginal benefits to our patients, and the burdens that this technology imposes on patients, families, and society. Conclusions: Legal and ethical issues continue to confront patients, courts, and physicians. A better understanding of these issues and an awareness of the availability of effective palliative care will help physicians, patients, and families adequately address the end-of-life issues that are an intrinsic part of medical care.
Nutrients in the Chemoprevention of Prostate Cancer: Current and Future Prospects
Authors: Kumar Nagi B. , Besterman-Dahan Karen 
Published: August 2017

Background External factors such as diet and lifestyle may be important in the etiology of invasive prostate cancer. Specific features of prostate cancer, including high prevalence, long latency, and significant mortality and morbidity, provide the opportunities for chemoprevention. Methods The authors examine the experimental and epidemiological data demonstrating the chemopreventive activity, safety, and toxicity of chronic administration of these specific nutrients as chemopreventive agents in prostate cancer. Results Several nutrients have been identified as agents that inhibit mutagenesis and hyperproliferation or induce apoptosis or differentiation, which are critical characteristics for chemoprevention. Successful chemopreventive strategies require well-characterized agents, suitable cohorts, and reliable intermediate biomarkers of cancer for evaluating efficacy. Phytoestrogens/isoflavones, vitamins D and E, selenium, and lycopene have been identified as promising nutrients in the role of chemoprevention of prostate cancer. Conclusions Clinical studies to evaluate the safety and effectiveness of these agents as future prospects in cancer chemoprevention, both individually and in combination, are warranted.
Arthroscopic debridement for primary elbow osteoarthritis with and without capsulectomy: a comparative cohort study
Authors: Isa Ahaoiza D , Athwal George S , King Graham J W , MacDermid Joy C , Faber Kenneth J 
Published: August 2017

Background Arthroscopic elbow debridement for primary osteoarthritis may be performed with or without a joint capsulectomy. The purpose of this comparative cohort study was to compare range of motion (ROM) and early complications between patients with and without anterior capsulectomy. Methods In total, 110 patients with primary osteoarthritis of the elbow who underwent an arthroscopic debridement for primary osteoarthritis were reviewed with a minimum of 3 months postoperative follow-up. The first group consisted of 51 patients who had a concomitant capsulectomy and the second group consisted of 59 patients who either had a capsulotomy or did not have the capsule addressed. Results There was significantly greater pre-operative stiffness in the group who had an anterior capsulectomy versus those who did not. A greater improvement in arc of ROM occurred in patients who had a concomitant capsulectomy compared to patients without (24° versus 12°) (p < 0.003); however, there were no significant differences in final ROM between groups. There were no statistically significant differences in the incidence of complications between the groups (16% capsulectomy versus 18% no capsulectomy). Conclusions Elbow arthroscopy and debridement for primary elbow osteoarthritis yields satisfactory motion at short-term follow-up with or without a capsulectomy. The incidence of early complications was low at this tertiary referral centre, with no significant differences between groups.
Comparison Between S2-Alar-Iliac Screw Fixation and Iliac Screw Fixation in Adult Deformity Surgery: Reoperation Rates and Spinopelvic Parameters
Authors: Ishida Wataru , Elder Benjamin D. , Holmes Christina , Lo Sheng-Fu L. , Goodwin C. Rory , Kosztowski Thomas A. , Bydon Ali , Gokaslan Ziya L. , Wolinsky Jean-Paul , Sciubba Daniel M. , Witham Timothy F. 
Published: August 2017

Study Design: Retrospective cohort study. Objective: The S2-alar-iliac (S2AI) technique has been described as an alternative method for pelvic fixation in place of iliac screws (ISs) in spinal deformity surgery. The objective of this study was to analyze the impact of S2AI screws on radiographical outcomes, including spinopelvic parameters. Methods: A retrospective review of 17 patients receiving ISs and 46 patients receiving S2AI screws for correction of adult spinal deformity between 2010 and 2015 with minimum 1-year follow-up was conducted. Patient data on postoperative complications, including reoperation rates and proximal junctional kyphosis (PJK), and radiographical parameters was collected and statistically analyzed. Results: With mean follow-up of 21.1 months, the overall reoperation rate was significantly lower in the S2AI group than in the IS group (21.7% vs 58.8%, P = .01), but the incidence of PJK was similar (32.6% vs 35.3%, P > .99). Moreover, the time to reoperation in the IS group was significantly shorter than in the S2AI group ( P = .001), and the S2AI group trended toward a longer time to reoperation due to PJK ( P = .08). There was a significantly higher change in pelvic incidence (PI) in the S2AI group (−6.0°) compared with the IS group ( P = .001). Conclusions: Compared with the IS technique, the S2AI technique demonstrated a lower rate of overall reoperation, a similar rate of PJK, longer time to reoperation, and possible reduction in PI. Future studies may be warranted to clarify the mechanism of these results and how they can be translated into improved patient care.