bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maintenance and Consolidation Therapy in Patients with Unresectable Stage III/IV Non-Small Cell Lung Cancer
Authors: Thatcher Nicholas , Heighway Jim 
Published: October 2010

Abstract
Globally, lung cancer is the leading cause of cancer-related mortality. Current chemotherapy combinations for the first-line treatment of advanced disease (stage IIIB with malignant pleural effusion/stage IV) and chemoradiotherapy regimens for the treatment of unresectable locally advanced disease (stage IIIA and IIIB without malignant pleural effusion) appear to have reached an efficacy plateau. The addition of new compounds including targeted agents to standard first-line cytotoxic doublets, administered concurrently and/or as maintenance therapy in patients who have not experienced disease progression after such treatment, has been shown to improve efficacy beyond this plateau in patients with advanced disease. However, to date, such approaches have been less successful in the treatment of patients with unresectable locally advanced stage III disease. The purpose of this review is to summarize the data from recent randomized phase III studies involving agents administered as maintenance or consolidation therapy in the treatment of unresectable stage III/IV non-small cell lung cancer (NSCLC). A possible alternative approach to the use of cytotoxic or molecularly targeted agents in this setting is the administration of therapeutic anticancer vaccines, which are designed to stimulate a host immunological response against the tumor. Current data in relation to the potential of vaccine therapy for NSCLC are therefore also reviewed, with a particular focus on belagenpumatucel-L and L-BLP25 vaccines, which are currently undergoing phase III evaluation as maintenance therapies in patients with unresectable stage III/IV NSCLC who have tumor control following first-line therapy.
Tolerability, Efficacy, and Safety of Pegylated Liposomal Doxorubicin in Combination with Carboplatin Versus Gemcitabine–Carboplatin for the Treatment of Platinum-Sensitive Recurrent Ovarian Cancer: A Systematic Review
Authors: Holloway Robert W. , Grendys Edward C. , Lefebvre Patrick , Vekeman Francis , McMeekin Scott 
Published: October 2010

Abstract

Objective.
To compare the tolerability, efficacy, and safety profiles of pegylated liposomal doxorubicin in combination with carboplatin (PLD–Carbo) with those of gemcitabine–carboplatin (Gem–Carbo) for the treatment of patients with platinum-sensitive recurrent ovarian cancer (PSROC) by reviewing the published literature.

Methods.
Using the PubMed database, a systematic review of peer-reviewed literature published between January 2000 and September 2009 was undertaken to identify studies related to the treatment of patients with PSROC with PLD–Carbo or Gem–Carbo. Studies reporting either response rate, progression-free survival (PFS), and/or overall survival (OS) were included. Treatment regimens, efficacy endpoints, and safety profiles were compared between the two combination therapies.

Results.
Ten studies evaluating 608 patients (PLD–Carbo: 5 studies, 278 patients; Gem–Carbo: 5 studies, 330 patients) were identified. The mean planned doses were: PLD, 34.8 mg/m2 and Gem, 993 mg/m2. The dose intensity reported in Gem trials was lower (75% of the planned dose) than the dose intensity reported in PLD trials (93.7% of the planned dose), suggesting better tolerability for the PLD–Carbo regimen. Among patients receiving PLD–Carbo, 60.2% achieved a response (complete, 27.0%; partial, 33.2%), versus 51.4% of patients treated with Gem–Carbo (complete, 19.2%; partial, 32.2%). The median PFS times were 10.6 months and 8.9 months in the PLD–Carbo and the Gem–Carbo populations, respectively. The median OS was longer for the PLD–Carbo regimen (27.1 months) than for the Gem–Carbo regimen (19.7 months). The hematological safety profiles were comparable in the two groups, although grade III or IV anemia (PLD–Carbo, 13.6%; Gem–Carbo, 24.5%) and neutropenia (PLD–Carbo, 45.5%; Gem–Carbo, 62.9%) were more common in patients receiving Gem–Carbo.

Conclusion.
Results from this systematic analysis of peer-reviewed literature suggest that PLD–Carbo therapy is a rational alternative to Gem–Carbo for the treatment of patients with PSROC.
Prognosis and Outcome of Small (≤1 cm), Node-Negative Breast Cancer on the Basis of Hormonal and HER-2 Status
Authors: Amar Surabhi , McCullough Ann E. , Tan Winston , Geiger Xochiquetzal J. , Boughey Judy C. , McNeil Rebecca B. , Coppola Kyle E. , McLaughlin Sarah A. , Palmieri Frances M. , Perez Edith A. 
Published: October 2010

Abstract
Long-term outcomes and hence the role of adjuvant therapy in patients with small (≤1 cm), node-negative breast cancer remain unclear. This study's objective was to evaluate whether human epidermal growth factor receptor (HER)-2 status is an independent, poor prognostic marker in patients with these tumors and to identify a subgroup of patients with these small tumors who might benefit from adjuvant systemic therapy. All patients with a diagnosis of a node-negative breast tumor measuring ≤1 cm and available HER-2 test results between January 1, 2001, and December 31, 2005, at the three Mayo Clinic sites were identified. Clinicopathologic data were compared in three groups: HER-2−, HER-2+, and triple-negative (TN) tumors. Of the 421 tumors identified, 364 (86.5%) were HER-2−, 28 (6.7%) were HER-2+, and 29 (6.9%) were TN. The median follow-up time was 1,015 days (range, 1–2,549 days). Groups were balanced in terms of patient age and tumor histology. Eleven patients with HER-2− tumors (3.0%), seven with HER-2+ tumors (25.0%), and eight with TN tumors (27.6%) received adjuvant chemotherapy. Follow-up data were available for 357, 28, and 28 patients in the three groups, respectively. Death rates in the three groups were 6.4% (23 of 357) (one recurrence-related death), 0% (0 of 28), and 7.1% (2 of 28) (one recurrence-related death), respectively. During follow-up, the tumor recurred in nine patients: four were HER-2− tumors (1.1%), two were HER-2+ tumors (7.1%), and three were TN tumors (10.7%). Patients with small, node-negative breast tumors have an excellent prognosis, but HER-2+ and TN tumors appear to have a higher recurrence rate, warranting consideration for broad use and optimization of systemic adjuvant treatments.
Age and Axillary Lymph Node Ratio in Postmenopausal Women with T1-T2 Node Positive Breast Cancer
Authors: Vinh-Hung Vincent , Joseph Sue A. , Coutty Nadege , Ly Bevan Hong , Vlastos Georges , Nguyen Nam Phong 
Published: October 2010

Abstract

Learning Objectives
After completing this course, the reader will be able to: Identify changes in medical/surgical practice that can affect the prognostic performance of established prognostic factors such as lymph node involvement in breast cancer.Explain how the lymph node ratio can help to adjust against practice-related changes.Use the lymph node ratio as a measure of tumor burden in order to weigh the risk of breast cancer death against other causes of death in elderly patients.
This article is available for continuing medical education credit at CME.TheOncologist.com

Purpose.
The purpose of this article was to examine the relationship between age and lymph node ratio (LNR, number of positive nodes divided by number of examined nodes), and to determine their effects on breast cancer (BC) and overall mortality.

Methods.
Women aged ≥50 years, diagnosed in 1988–1997 with a unilateral histologically confirmed T1-T2 node positive surgically treated primary nonmetastatic BC, were selected from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER). Generalized Additive Models for Location Scale and Shape (GAMLSS) were used to evaluate the age-LNR relationship. Cumulative incidence functions and multivariate competing risks analysis based on model selection by the Bayesian Information Criterion (BIC) were used to examine the effect of age and LNR on mortality. Low LNR was defined as ≤0.20, mid-LNR 0.21–0.65, and high LNR &gt;0.65.

Results.
GAMLSS showed a nonlinear LNR-age relationship, increasing from mean LNR 0.26–0.28 at age 50–70 years to 0.30 at 80 years and 0.40 at 90 years. Compared with a 9.8% [95% confidence interval (CI) 8.8%–10.8%] risk of BC death at 5 years in women aged 50–59 years with low LNR, the risk in women ≥80 years with low LNR was 12.6% [95% CI 10.1%–15.0%], mid-LNR 18.1% [13.9%–22.1%], high LNR 29.8% [22.7%–36.1%]. Five-years overall risk of death increased from 40.8% [37.5%–43.9%] by low LNR to 67.4% [61.4%–72.4%] by high LNR. The overall mortality hazard ratio for age ≥80 years with high LNR was 7.49 [6.54–8.59], as compared with women aged 50–59 years with low LNR.

Conclusion.
High LNR combined with older age was associated with a threefold increased risk of BC death and a sevenfold increased hazard ratio of overall mortality.
Is Increasing Physical Activity Necessary to Diminish Fatigue During Cancer Treatment? Comparing Cognitive Behavior Therapy and a Brief Nursing Intervention with Usual Care in a Multicenter Randomized Controlled Trial
Authors: Goedendorp Martine M. , Peters Marlies E.W.J. , Gielissen Marieke F.M. , Witjes J. Alfred , Leer Jan Willem , Verhagen Constans A.H.H.V.M. , Bleijenberg Gijs 
Published: October 2010

Abstract

Background.
Two interventions for fatigue were given during curative cancer treatment. The aim of this multicenter randomized controlled trial (RCT) with three conditions was to demonstrate the efficacy and to determine the contribution of physical activity.

Methods.
Recruited from seven hospitals, 220 patients with various malignancies participated in a RCT. The brief nursing intervention (BNI) consisted of two 1-hour sessions, 3 months apart, given by 12 trained nurses, focusing only on physical activity. Cognitive behavior therapy (CBT) consisted of up to ten 1-hour sessions, within 6 months, provided by two therapists, focusing on physical activity and psychosocial elements. The control group received only usual care (UC). Assessments took place before and at least 2 months after cancer treatment, when patients had recovered from acute fatigue. Fatigue was the primary outcome. Efficacy was tested using analyses of covariance. A nonparametric bootstrap approach was used to test whether the effect on fatigue was mediated by physical activity.

Results.
The CBT group was significantly less fatigued than the UC group. Between the BNI and the UC groups, no significant difference was found in fatigue. The mediation hypothesis was rejected.

Discussion.
CBT given during curative cancer treatment proved to be an effective intervention to reduce fatigue at least 2 months after cancer treatment. The BNI was not effective. Contrary to what was expected, physical activity did not mediate the effect of CBT on fatigue. Thus, the reduction in fatigue elicited by CBT was realized without a lasting increase in physical activity.
Obesity and the Risk for a Hematological Malignancy: Leukemia, Lymphoma, or Myeloma
Authors: Lichtman Marshall A. 
Published: October 2010

Abstract
The aggregate of epidemiological studies indicates a significantly elevated risk for cancer in people with a high body mass index (BMI); a “dose–response” effect exists with increasing risk as BMI increases from the normal to overweight to obese categories. Successful sustained weight loss decreases future risk. The relationship of being overweight to the risk for leukemia in the aggregate has been supported in several large cohort studies and two meta-analyses of cohort and case–control studies. One meta-analysis found an elevated risk for each of the four major subtypes of leukemia. A significant association between the risk for non-Hodgkin's lymphoma and elevated BMI was supported by a meta-analysis of 13 cohort and nine case–control studies. The risk for diffuse large B-cell lymphoma may be especially significant. A high BMI increases the risk for myeloma, as judged by a meta-analysis of 11 cohort and four case–control studies. The biological relationship of obesity to the risk for cancer (biological plausibility) is unresolved. The two major causal final pathways could be “inductive” or “selective.” The metabolic, endocrinologic, immunologic, and inflammatory-like changes resulting from obesity may increase the cell mutation rate, dysregulate gene function, disturb DNA repair, or induce epigenetic changes, favoring the induction of neoplastic transformation (inductive). Alternatively, obesity may create an environment in which pre-existing clones that are dormant are permitted (selected) to emerge.
Clarithromycin Accumulation by Phagocytes and Its Effect on Killing of Aggregatibacter actinomycetemcomitans
Authors: Iskandar Irma , Walters John D. 
Published: October 2010

Background: Clarithromycin inhibits several periodontal pathogens and is concentrated inside gingival fibroblasts and epithelial cells by an active transporter. We hypothesized that polymorphonuclear leukocytes (PMNs) and less mature myeloid cells possess a similar transporter for clarithromycin. It is feasible that clarithromycin accumulation inside PMNs could enhance their ability to kill Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans).Methods: To test the first hypothesis, purified PMNs and cultured HL‐60 cells were incubated with [3H]‐clarithromycin. Clarithromycin transport was assayed by measuring changes in cell‐associated radioactivity over time. The second hypothesis was examined with PMNs loaded by incubation with clarithromycin (5 μg/ml). Opsonized bacteria were incubated at 37°C with control and clarithromycin‐loaded PMNs.Results: Mature human PMNs, HL‐60 cells differentiated into granulocytes, and undifferentiated HL‐60 cells all took up clarithromycin in a saturable manner. The kinetics of uptake by all yielded linear Lineweaver‐Burk plots. HL‐60 granulocytes transported clarithromycin with a Km of ≈250 μg/ml and a Vmax of 473 ng/min/106 cells, which were not significantly different from the values obtained with PMNs. At steady state, clarithromycin levels inside HL‐60 granulocytes and PMNs were 28‐ to 71‐fold higher than extracellular levels. Clarithromycin‐loaded PMNs killed significantly more A. actinomycetemcomitans and achieved shorter half‐times for killing than control PMNs when assayed at a bacteria‐to‐PMN ratio of 100:1 (P <0.04). At a ratio of 30:1, these differences were not consistently significant.Conclusions: PMNs and less mature myeloid cells possess a transporter that takes up and concentrates clarithromycin. This system could help PMNs cope with an overwhelming infection by A. actinomycetemcomitans.
Periodontitis Prevalence and Severity in Indonesians With Type 2 Diabetes
Authors: Susanto Hendri , Nesse Willem , Dijkstra Pieter U. , Agustina Dewi , Vissink Arjan , Abbas Frank 
Published: October 2010

Background: The prevalence of diabetes mellitus type 2 (DM2) in Indonesia is high and still rising. Periodontitis is associated with DM2. No study has investigated this association in Indonesia, nor has any study investigated this association using a variety of methods to operationalize periodontitis. The present study compares prevalence and severity of periodontitis in patients with DM2 to healthy controls, using different methods to operationalize periodontitis.Methods: A total of 78 subjects with DM2 and 65 healthy control subjects underwent a full‐mouth periodontal screening assessing probing depth, gingival recession, plaque index, and bleeding on probing. Using these measurements, the prevalence and severity of periodontitis was operationalized in various ways. Differences in the prevalence and severity of periodontitis between subjects with DM2 and healthy subjects were analyzed using univariate analyses. In regression analyses, the prevalence and severity of periodontitis were predicted on the basis of DM2 presence, controlling for confounders and effect modification.Results: Prevalence of periodontitis was significantly higher in subjects with DM2 compared to healthy subjects, showing odds ratios of 5.0 and 6.1. Likewise, periodontitis severity was significantly higher in subjects with DM2.Conclusion: Indonesian subjects with DM2 had more prevalent and more severe periodontitis than healthy Indonesian subjects, independent of confounding factors or the methods used to operationalize periodontitis.
Implant Stability and Peri‐Implant Parameters in Free Vascularized Iliac Graft Transplantation Patients: Report of Three Ameloblastoma Cases
Authors: Tözüm Tolga F. , Sönmez Erhan , Askin Sezen B. , Tulunoglu Ibrahim , Safak Tunc 
Published: October 2010

Background: Ameloblastoma, a benign but locally aggressive tumor, accounts for 9% to 11% of all odontogenic tumors. Radical procedures, including resection, are performed. To restore functions after resection, free vascularized iliac grafts followed by a dental implant–supported prosthesis are used as a successful treatment option. The aim of this case report is to evaluate the peri‐implant clinical status and stability of dental implants placed in patients with advanced‐stage mandibular ameloblastomas.Methods: Examinations of three patients revealed extensive ameloblastomas, and hemimandibulectomies were performed. Six months after surgeries, two to four dental implants were placed. After 6 months of healing, one fixed prosthesis and two removable prostheses were delivered. The stability of implants was evaluated at the surgical baseline and 1, 3, 6, 9, and 12 months after surgery by resonance‐frequency (RF) analysis. Peri‐implant clinical parameters (i.e., plaque index [PI], gingival index [GI], gingival bleeding time index [GBTI], and peri‐implant probing depth [PD]) were recorded at the delivery of the prosthesis and at follow‐ups at 1, 3, and 6 months.Results: Nine implants that supported one removable prosthesis and two fixed prostheses were placed. RF analysis revealed no significant changes in implant stability during 12 months of follow‐up. Peri‐implant clinical parameters (PI, GI, and GBTI) showed slight improvements during follow‐up. Although advancements were observed in 6 months, PDs were found to be deeper than optimal measurements for the whole observation time.Conclusion: The implant‐supported prosthetic rehabilitation of patients with ameloblastomas reconstructed with free vascularized iliac crest grafts can be a predictive alternative for improving the quality of life of patients in which a high implant stability and acceptable peri‐implant health may be achieved.
Recruiting and Retaining Primary Care Physicians in Urban Underserved Communities: The Importance of Having a Mission to Serve
Authors: Odom Walker Kara , Ryan Gery , Ramey Robin , Nunez Felix L. , Beltran Robert , Splawn Robert G. , Brown Arleen F. 
Published: October 2010

Objectives. We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. Methods. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Results. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Conclusions. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work–life balance.
Approaches to Measuring the Extent and Impact of Environmental Change in Three California Community-Level Obesity Prevention Initiatives
Authors: Cheadle Allen , Samuels Sarah E. , Rauzon Suzanne , Yoshida Sallie C. , Schwartz Pamela M. , Boyle Maria , Beery William L. , Craypo Lisa , Solomon Loel 
Published: October 2010

Despite growing support among public health researchers and practitioners for environmental approaches to obesity prevention, there is a lack of empirical evidence from intervention studies showing a favorable impact of either increased healthy food availability on healthy eating or changes in the built environment on physical activity. It is therefore critical that we carefully evaluate initiatives targeting the community environment to expand the evidence base for environmental interventions. We describe the approaches used to measure the extent and impact of environmental change in 3 community-level obesity-prevention initiatives in California. We focus on measuring changes in the community environment and assessing the impact of those changes on residents most directly exposed to the interventions.
Large Artery Calcification on Dialysis Patients Is Located in the Intima and Related to Atherosclerosis
Authors: Coll Blai , Betriu Angels , Martínez-Alonso Montserrat , Amoedo Maria Luisa , Arcidiacono Maria Vittoria , Borras Merce , Valdivielso Jose Manuel , Fernández Elvira 
Published: October 2010

Summary

Background and objectives
Vascular calcification (VC) has a significant effect in cardiovascular diseases on dialysis patients. However, VC is assessed with x-ray-based techniques, which do not inform about calcium localization (intima, media, atherosclerosis-related). The aim of this work is to study VC and its related factors using arterial ultrasound to report the exact location of calcium.

Design, setting, participants, & measurements
This was an observational, cross-sectional, case-control study that included 232 patients in dialysis and 208 age- and sex-matched controls with normal kidney function. Demographic data and laboratory values were collated. Carotid, femoral, and brachial ultrasounds were performed to assess VC and atherosclerosis burden using a standardized protocol.

Results
Cardiovascular risk factors were predominantly found in controls, although the burden of atherosclerosis was higher in the dialysis group. VC was significantly more prevalent in the group of patients on dialysis than control subjects, and in both groups the most prevalent pattern of VC was linear calcification located in the intima of the artery wall. Age and undergoing dialysis (with or without previous cardiovascular diseases) were positively and significantly associated with linear calcification. Conversely, the absence of atherosclerosis and low levels of C-reactive protein and phosphorus significantly impeded the development of linear calcification.

Conclusions
VC in large, conduit arteries is more prevalent in patients on dialysis than controls and is predominantly located in a linear fashion in the intima of the arteries.