WorldWideScience

Sample records for cancer current evidence

  1. Preventing skin cancer through reduction of indoor tanning: current evidence.

    Science.gov (United States)

    Watson, Meg; Holman, Dawn M; Fox, Kathleen A; Guy, Gery P; Seidenberg, Andrew B; Sampson, Blake P; Sinclair, Craig; Lazovich, DeAnn

    2013-06-01

    Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices.

  2. Preventing skin cancer through reduction of indoor tanning: current evidence.

    Science.gov (United States)

    Watson, Meg; Holman, Dawn M; Fox, Kathleen A; Guy, Gery P; Seidenberg, Andrew B; Sampson, Blake P; Sinclair, Craig; Lazovich, DeAnn

    2013-06-01

    Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices. PMID:23683987

  3. Cancer and OSA: Current Evidence From Human Studies.

    Science.gov (United States)

    Martínez-García, Miguel Ángel; Campos-Rodriguez, Francisco; Barbé, Ferrán

    2016-08-01

    Despite the undeniable medical advances achieved in recent decades, cancer remains one of the main causes of mortality. It is thus extremely important to make every effort to discover new risk factors for this disease, particularly ones that can be treated or modified. Various pathophysiologic pathways have been postulated as possible causes of cancer or its increased aggressiveness, and also of greater resistance to antitumoral treatment, in the presence of both intermittent hypoxia and sleep fragmentation (both inherent to sleep apnea). Thus far, these biological hypotheses have been supported by various experimental studies in animals. Meanwhile, recent human studies drawing on preexisting databases have observed an increase in cancer incidence and mortality in patients with a greater severity of sleep-disordered breathing. However, the methodologic limitations of these studies (which are mostly retrospective and lack any measurement of direct markers of intermittent hypoxia or sleep fragmentation) highlight the need for controlled, prospective studies that would provide stronger scientific evidence regarding the existence of this association and its main characteristics, as well as explore its nature and origin in greater depth. The great epidemiologic impact of both cancer and sleep apnea and the potential for clinical treatment make this field of research an exciting challenge. PMID:27164292

  4. Radiation and breast cancer: a review of current evidence

    International Nuclear Information System (INIS)

    This paper summarizes current knowledge on ionizing radiation-associated breast cancer in the context of established breast cancer risk factors, the radiation dose–response relationship, and modifiers of dose response, taking into account epidemiological studies and animal experiments. Available epidemiological data support a linear dose–response relationship down to doses as low as about 100 mSv. However, the magnitude of risk per unit dose depends strongly on when radiation exposure occurs: exposure before the age of 20 years carries the greatest risk. Other characteristics that may influence the magnitude of dose-specific risk include attained age (that is, age at observation for risk), age at first full-term birth, parity, and possibly a history of benign breast disease, exposure to radiation while pregnant, and genetic factors

  5. Immunotherapy in prostate cancer: review of the current evidence.

    Science.gov (United States)

    Fernández-García, E M; Vera-Badillo, F E; Perez-Valderrama, B; Matos-Pita, A S; Duran, I

    2015-05-01

    Prostate cancer is the most common male malignancy in the Western world. Once it metastasizes, it is incurable. The current gold standard for metastatic disease is the combined docetaxel/prednisone regimen. Prostate cancer shows several characteristics that make it a suitable candidate for immunotherapy, as recently exemplified by the approval of sipuleucel-T, the first vaccine to treat any malignancy. Here, we review different tumor-associated antigen immunotherapy strategies currently being investigated, from a humanized radiolabeled monoclonal antibody (J-591) that targets radiation into tumor cells, moving on to vaccines and through to immunomodulator agents such as anti-CPLA-4 and anti-PD-1 monoclonal antibodies that activate T-cell responses via immune checkpoint inhibition. We explore different opinions on the best approach to integrate immunotherapy into existing standard therapies, such as androgen-deprivation therapy, radiotherapy or chemotherapy, and review different combination sequences, patient types and time points during the course of the disease to achieve a lasting immune response. We present data from recent phase III clinical trials that call for a change in trial endpoint design with immunotherapy agents, from the traditional tumor progression to overall survival and how such trials should include immune response measurements as secondary or intermediate endpoints to help identify patient clinical benefit in the earlier phases of treatment. Finally, we join in the recent questioning on the validity of RECIST criteria to measure response to immunotherapeutic agents, as initial increases in the size of tumors/lymph nodes, which are part of a normal immune response, could be categorized as disease progression under RECIST.

  6. Anesthesia and cancer recurrences: The current knowledge and evidence

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2015-01-01

    Full Text Available Surgical removal of solid tumors is of utmost importance as total resection can be curative. The surgical insult however itself may result in tumor micrometastasis coupled with depression of cell-mediated immunity culminating in tumor recurrence. Recent research suggests that few anesthetic agents or procedures can influence pathophysiology of metastasis in the postoperative period. Whereas opioids and volatile anesthetics have been implicated in angiogenesis and immunosuppression, evidences accumulated over the recent years have undoubtedly highlighted the attenuation of immunosuppression by regional anesthetic agents thereby making it superior over general anesthesia in preventing cancer recurrence. As anesthetic drugs are given at that time when patient is at the maximum risk of spread of metastasis, thus an understanding of the effect of anesthesia drugs and their impact on tumor metastasis is important so that appropriate anesthetic strategy can be made to improve long term survival in these patients. The purpose of the present review is therefore to emphasize the pivotal role of various anesthetic agents and anesthesia techniques in preventing tumor recurrence after surgery.

  7. Prognostic factors in ovarian cancer : current evidence and future prospects

    NARCIS (Netherlands)

    Crijns, APG; Boezen, HM; Schouten, JP; Arts, HJG; Hofstra, RMW; Willemse, PHB; de Vries, EGE; van der Zee, AGJ

    2003-01-01

    In ovarian cancer, translational research on the prognostic impact of molecular biological factors has until now not led to clinical implementation of any of these factors. This is partly due to the often conflicting results of different prognostic factor studies on the same molecular biological fac

  8. Recent evidence, advances, and current practices in surgical treatment of lung cancer.

    Science.gov (United States)

    Suda, Kenichi; Sato, Katsuaki; Mizuuchi, Hiroshi; Kobayashi, Yoshihisa; Shimoji, Masaki; Tomizawa, Kenji; Takemoto, Toshiki; Iwasaki, Takuya; Sakaguchi, Masahiro; Mitsudomi, Tetsuya

    2014-11-01

    In the last 10-15 years, strategies and modalities of lung cancer treatment have changed dramatically. Meanwhile, the treatment objectives, the lung cancers themselves, have also changed, probably owing to early detection by computed tomography and aging of the population. In particular, the proportions of smaller lung cancers, lung adenocarcinomas with ground-glass opacity, and lung cancers in older patients are increasing. Along with these changes, surgeons have innovated and evaluated novel procedures for pulmonary resection. These include the application of minimally invasive surgical techniques, such as video-assisted thoracoscopic surgery (VATS) and robotic surgery, and sub-lobar resection, such as wedge resection and segmentectomy, for small peripheral lung cancers. Currently, VATS has gained wide acceptance and several institutions in Japan have started using robotic surgery for lung cancers. Two important clinical trials of sub-lobar resection for small peripheral lung cancers are now underway in Japan. In addition, surgery itself is of growing importance in lung cancer treatment. In particular, recent evidence supports the use of surgery in strictly selected patients with locally advanced disease, lung cancers with N2 lymph node metastases, small cell lung cancers, recurrent oligo-metastasis after pulmonary resection, or relapsed tumors after drug treatment. Surgical treatment also provides abundant tumor samples for molecular analysis, which can be used for drug selection in the adjuvant setting or after disease relapse. In the era of personalized treatment, surgery is still one of the most important treatment modalities to combat lung cancer. PMID:25453375

  9. Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

    LENUS (Irish Health Repository)

    Duffy, Michael J

    2012-02-01

    Although widely used, the value of prostate-specific antigen (PSA) in screening asymptomatic men for prostate cancer is controversial. Reasons for the controversy relate to PSA being less than an ideal marker in detecting early prostate cancer, the possibility that screening for prostate cancer may result in the overdetection and thus overtreatment of indolent disease and the lack of clarity as to the definitive or best treatment for men diagnosed with localized prostate cancer. Although the results from some randomized prospective trials suggest that screening with PSA reduces mortality from prostate cancer, the overall benefit was modest. It is thus currently unclear as to whether the modest benefit of reduced mortality outweighs the harms of overdetection and overtreatment. Thus, prior to undergoing screening for prostate cancer, men should be informed of the risks and benefits of early detection. Newly emerging markers that may complement PSA in the early detection of prostate cancer include specific isoforms of PSA and PCA3.

  10. Extended Lymphadenectomy and "Mesopancreas" Excision during Pancreatoduodenectomy for Cancer; is it worth it? Review of Current Evidence

    Directory of Open Access Journals (Sweden)

    Elissaios Kontis

    2016-03-01

    Full Text Available Pancreatic cancer is a malignancy with overall poor prognosis. Surgery is the only treatment modality, which could provide cure. Therefore every effort possible should be made for pancreatectomy to achieve R0 resection. However, even after R0 resection, the survival outcomes are still far behind from other solid intrabdominal tumors. Extended lymphadenectomy and “mesopancreas” excision are the two main factors where focus has been given, in order to improve the outcomes of pancreatectomy for pancreatic head cancer. We present an up to date comprehensive review of the current evidence on the topics of extended lymphadenectomy and “mesopancreas” excision during pancreatoduodenectomy for cancer.

  11. Oleanane triterpenoids in the prevention and therapy of breast cancer: current evidence and future perspectives

    Science.gov (United States)

    Parikh, Nisha R.; Mandal, Animesh; Bhatia, Deepak; Siveen, Kodappully Sivaraman; Sethi, Gautam

    2014-01-01

    Breast cancer is one of the most frequently diagnosed cancers and major cause of death in women in the world. Emerging evidence underscores the value of dietary and non-dietary phytochemicals, including triterpenoids, in the prevention and treatment of breast cancer. Oleanolic acid, an oleanane-type pentacyclic triterpenoid, is present in a large number of dietary and medicinal plants. Oleanolic acid and its derivatives exhibit several promising pharmacological activities, including antioxidant, anti-inflammatory, hepatoprotective, cardioprotective, antipruritic, spasmolytic, antiallergic, antimicrobial and antiviral effects. Numerous studies indicate that oleanolic acid and other oleanane triterpenoids modulate multiple intracellular signaling pathways and exert chemopreventive and antitumor activities in various in vitro and in vivo model systems. A series of novel synthetic oleanane triterpenoids have been prepared by chemical modifications of oleanolic acid and some of these compounds are considered to be the most potent anti-inflammatory and anticarcinogenic triterpenoids. Accumulating studies provide extensive evidence that synthetic oleanane derivatives inhibit proliferation and induce apoptosis of various cancer cells in vitro and demonstrate cancer preventive or antitumor efficacy in animal models of blood, breast, colon, connective tissue, liver, lung, pancreas, prostate and skin cancer. This review critically examines the potential role of oleanolic acid, oleanane triterpenoids and related synthetic compounds in the chemoprevention and treatment of mammary neoplasia. Both in vitro and in vivo studies on these agents and related molecular mechanisms are presented. Several challenges and future directions of research to translate already available impressive preclinical knowledge to clinical practice of breast cancer prevention and therapy are also presented. PMID:25395898

  12. Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research

    Science.gov (United States)

    Magnuson, Allison; Allore, Heather; Cohen, Harvey Jay; Mohile, Supriya G.; Williams, Grant R.; Chapman, Andrew; Extermann, Martine; Olin, Rebecca L.; Targia, Valerie; Mackenzie, Amy; Holmes, Holly M.; Hurria, Arti

    2016-01-01

    Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. “GA with management” is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, “Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer,” a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research. PMID:27197915

  13. Geriatric assessment with management in cancer care: Current evidence and potential mechanisms for future research.

    Science.gov (United States)

    Magnuson, Allison; Allore, Heather; Cohen, Harvey Jay; Mohile, Supriya G; Williams, Grant R; Chapman, Andrew; Extermann, Martine; Olin, Rebecca L; Targia, Valerie; Mackenzie, Amy; Holmes, Holly M; Hurria, Arti

    2016-07-01

    Older adults with cancer represent a complex patient population. Geriatric assessment (GA) is recommended to evaluate the medical and supportive care needs of this group. "GA with management" is a term encompassing the resultant medical decisions and interventions implemented in response to vulnerabilities identified on GA. In older, non-cancer patients, GA with management has been shown to improve a variety of outcomes, such as reducing functional decline and health care utilization. However, the role of GA with management in the older adult with cancer is less well established. Rigorous clinical trials of GA with management are necessary to develop an evidence base and support its use in the routine oncology care of older adults. At the recent U-13 conference, "Design and Implementation of Intervention Studies to Improve or Maintain Quality of Survivorship in Older and/or Frail Adults with Cancer," a session was dedicated to developing research priorities in GA with management. Here we summarize identified knowledge gaps in GA with management studies for older patients with cancer and propose areas for future research. PMID:27197915

  14. Using opioids in general practice for chronic non-cancer pain: an overview of current evidence.

    Science.gov (United States)

    Currow, David C; Phillips, Jane; Clark, Katherine

    2016-05-01

    Chronic non-cancer pain (lasting more than 3 months) is highly prevalent in Australia (17% of males and 20% of females) and its optimal management is crucial to the health and wellbeing of the community. For 5% of the population, such pain interferes markedly with daily function. Part of the treatment for acute non-cancer pain for many people will include opioid analgesics at least for days to weeks. However, as pain becomes chronic, evidence to support ongoing prescription of opioids is lacking. There is increasing pressure to ensure that prescribing opioid analgesics is minimised to reduce not only the risk of dependence and illicit diversion but also the potential harms associated with tolerance, side effects and complications. Frameworks for considering opioid prescribing include assessing suitability of the patient for opioids; initiating a trial of therapy; and monitoring long term use. There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction. Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain: only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; consider referral to specialist services for assessment if doses are above 100 mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; limit prescribing to only one practitioner; seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective. PMID:27125804

  15. Functional magnetic resonance imaging in cervical cancer: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Sayan Kundu

    2012-01-01

    Full Text Available Carcinoma cervix is one of the most common cancers amongst Indian women. Though treatment strategies continue to evolve, there are no established predictive biomarkers of prognosis or therapeutic response. Novel imaging techniques using magnetic resonance (MR and positron emission tomography (PET can facilitate time resolved spatial evaluation of biological characteristics (perfusion, permeability, cellularity, proliferation, oxygenation, and apoptosis thereby serving as early surrogate biomarkers for prognosis and therapeutic response. Several of these imaging modalities such as dynamic contrast-enhanced MRI (DCE-MRI, diffusion-weighted MRI (DW-MRI, MR spectroscopy (MRS and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET are now being evaluated for gynecological oncology, with the majority of work being performed on cervical tumors. PUBMED database was searched for this review from January 1966 till February 2011. This review examines the basic principles of functional MR imaging for cervical cancer and its current status as a diagnostic and predictive biomarker for cervical cancer.

  16. The relationship between the nucleolus and cancer: Current evidence and emerging paradigms.

    Science.gov (United States)

    Orsolic, Ines; Jurada, Deana; Pullen, Nick; Oren, Moshe; Eliopoulos, Aristides G; Volarevic, Sinisa

    2016-06-01

    The nucleolus is the most prominent nuclear substructure assigned to produce ribosomes; molecular machines that are responsible for carrying out protein synthesis. To meet the increased demand for proteins during cell growth and proliferation the cell must increase protein synthetic capacity by upregulating ribosome biogenesis. While larger nucleolar size and number have been recognized as hallmark features of many tumor types, recent evidence has suggested that, in addition to overproduction of ribosomes, decreased ribosome biogenesis as well as qualitative changes in this process could also contribute to tumor initiation and cancer progression. Furthermore, the nucleolus has become the focus of intense attention for its involvement in processes that are clearly unrelated to ribosome biogenesis such as sensing and responding to endogenous and exogenous stressors, maintenance of genome stability, regulation of cell-cycle progression, cellular senescence, telomere function, chromatin structure, establishment of nuclear architecture, global regulation of gene expression and biogenesis of multiple ribonucleoprotein particles. The fact that dysregulation of many of these fundamental cellular processes may contribute to the malignant phenotype suggests that normal functioning of the nucleolus safeguards against the development of cancer and indicates its potential as a therapeutic approach. Here we review the recent advances made toward understanding these newly-recognized nucleolar functions and their roles in normal and cancer cells, and discuss possible future research directions.

  17. Current status of radiation therapy. Evidence-based medicine (EBM) of radiation therapy. Current management of patients with esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nemoto, Kenji [Tohoku Univ., Sendai (Japan). School of Medicine

    2002-03-01

    The best management for small mucosal esophageal cancer is generally endoscopic mucosal resection. However, for submucosal cancer and extensive mucosal caner, either radical surgery or radiation seems to be an equally efficacious option. Radiation therapy concurrent with chemotherapy is more effective than radiation therapy alone for patients with unresectable esophageal cancer. The key drugs are cisplatin and 5-fluorouracil. However, for patients with poor performance status or for aged patients, radiation therapy alone is still a choice of treatment. Surgery has generally been indicated for patients with resectable esophageal cancer. However, outcomes of concurrent chemoradiation therapy may be comparable with those of surgery. Therefore, a prospective randomized study should be performed to determine the best management for patients with resectable esophageal cancer. The usefulness of intra-cavitary irradiation for esophageal cancer has not been clarified. A prospective randomized trial with a large number of patients is necessary to determine the effectiveness of intra-cavitary irradiation. The best management for patients with loco-regionally recurrent esophageal cancer after surgery has not been determined. Intensive therapy should be considered if the site of recurrence is limited and the time interval from surgery to recurrence is long. Chemotherapy is essential in the management of patients with small cell esophageal cancer. However, the best local therapy has not been determined. (author)

  18. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    Energy Technology Data Exchange (ETDEWEB)

    Berman, Abigail T., E-mail: abigail.berman@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104 (United States); James, Sara St.; Rengan, Ramesh [Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA 98195 (United States)

    2015-07-02

    Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT), through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC), as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning.

  19. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    Directory of Open Access Journals (Sweden)

    Abigail T. Berman

    2015-07-01

    Full Text Available Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT, through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC, as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning.

  20. Proton Beam Therapy for Non-Small Cell Lung Cancer: Current Clinical Evidence and Future Directions

    International Nuclear Information System (INIS)

    Lung cancer is the leading cancer cause of death in the United States. Radiotherapy is an essential component of the definitive treatment of early-stage and locally-advanced lung cancer, and the palliative treatment of metastatic lung cancer. Proton beam therapy (PBT), through its characteristic Bragg peak, has the potential to decrease the toxicity of radiotherapy, and, subsequently improve the therapeutic ratio. Herein, we provide a primer on the physics of proton beam therapy for lung cancer, present the existing data in early-stage and locally-advanced non-small cell lung cancer (NSCLC), as well as in special situations such as re-irradiation and post-operative radiation therapy. We then present the technical challenges, such as anatomic changes and motion management, and future directions for PBT in lung cancer, including pencil beam scanning

  1. Current evidence of effects of Helicobacter pylori eradication on prevention of gastric cancer

    OpenAIRE

    Choi, Il Ju

    2013-01-01

    Gastric cancer is the second most common cause of cancer death worldwide and is usually detected at a late stage, except in Korea and Japan where early screening is in effect. Results from animal and epidemiological studies suggest that Helicobacter pylori infection, and subsequent gastritis, promote development of gastric cancer in the infected mucosa. Relatively effective treatment regimens are available to treat H. pylori infection, and in general, mass eradication of the organism is not c...

  2. Vitamin B6 and colorectal cancer: Current evidence and future directions

    OpenAIRE

    Zhang, Xue-Hong; Ma, Jing; Smith-Warner, Stephanie A.; Lee, Jung Eun; Giovannucci, Edward

    2013-01-01

    Colorectal cancer remains the third most common cancer in both women and men worldwide. Identifying modifiable dietary factors is crucial in developing primary prevention strategies. Vitamin B6 is involved in more than 100 coenzyme reactions, and may influence colorectal cancer risk in multiple ways including through its role in one-carbon metabolism related DNA synthesis and methylation and by reducing inflammation, cell proliferation, and oxidative stress. Observational studies of dietary o...

  3. Active surveillance for prostate cancer: current evidence and contemporary state of practice.

    Science.gov (United States)

    Tosoian, Jeffrey J; Carter, H Ballentine; Lepor, Abbey; Loeb, Stacy

    2016-04-01

    Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with unfavourable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favourable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate-cancer-specific mortality are exceedingly low in the intermediate term (5-10 years). Such outcomes seem to be closely associated with programme-specific criteria for selection, monitoring, and intervention, suggesting that AS--like other management strategies--could be individualized based on the level of risk acceptable to patients in light of their personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.

  4. Osteoradionecrosis in cancer patients : the evidence base for treatment-dependent frequency, current management strategies, and future studies

    NARCIS (Netherlands)

    Peterson, Douglas E.; Doerr, Wolfgang; Hovan, Allan; Pinto, Andres; Saunders, Debbie; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    2010-01-01

    The purpose of this study is to review the evidence base from 1990 to 2008 to (1) clarify the impact of cancer therapies on prevalence of osteoradionecrosis (ORN) in head and neck cancer patients, and to (2) evaluate management strategies and their consequences on quality of life and cost of care. A

  5. Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence

    Science.gov (United States)

    Liao, Guixiang; Li, Yan-Bing; Zhao, Zhihong; Li, Xianming; Deng, Haijun; Li, Gang

    2016-01-01

    The aim of this meta-analysis was to comprehensively compare the safety and efficacy of robotic-assisted rectal cancer surgery (RRCS) and open rectal cancer surgery (ORCS). Electronic database (PubMed, EMBASE, Web of Knowledge, and the Cochrane Library) searches were conducted for all relevant studies that compared the short-term and long-term outcomes between RRCS and ORCS. Odds ratios (ORs), mean differences, and hazard ratios were calculated. Seven studies involving 1074 patients with rectal cancer were identified for this meta-analysis. Compared with ORCS, RRCS is associated with a lower estimated blood loss (mean difference [MD]: −139.98, 95% confidence interval [CI]: −159.11 to −120.86; P < 0.00001), shorter hospital stay length (MD: −2.10, 95% CI: −3.47 to −0.73; P = 0.003), lower intraoperative transfusion requirements (OR: 0.52, 95% CI: 0.28 to 0.99, P = 0.05), shorter time to flatus passage (MD: −0.97, 95% CI = −1.06 to −0.88, P < 0.00001), and shorter time to resume a normal diet (MD: −1.71.95% CI = −3.31 to −0.12, P = 0.04). There were no significant differences in surgery-related complications, oncologic clearance, disease-free survival, and overall survival between the two groups. However, RRCS was associated with a longer operative time. RRCS is safe and effective. PMID:27228906

  6. Breast cancer prevention with anti-estrogens: review of the current evidence and future directions.

    Science.gov (United States)

    Mallick, Supriya; Benson, Rony; Julka, P K

    2016-03-01

    There is a potential for reducing the incidence of breast cancer by modifying or changing the reversible risk factors like dietary modifications, modifications in the sedentary life habits, etc. One of such methods which has gained popularity now is chemoprevention. Many agents have been evaluated in the chemoprevention setting in females with increased risk of breast cancers. Metformin, NSAIDS, Bisphosphonates, and statins were evaluated by various investigators with variable results. One of the agents that have been proven to be beneficial in this setting is the anti-estrogens. A major disadvantage of chemoprevention is that unlike prophylactic mastectomy it can never reduce the risk to near zero although it reduces the risk significantly. Another issue is the compliance as chemoprevention with anti-estrogens will need to be continued for 5 years while surgery is a one-time procedure. Another disadvantage is the possible side effects peculiar to each drug used which may not be a significant concern in prophylactic mastectomy group. All these factors must also be kept in mind and properly explained to the patient before starting chemoprevention using anti-estrogens. Here in this review we intend to look into the large randomized controlled trials to quantify the present status of chemoprevention with anti-estrogens. PMID:26439380

  7. Current practice of gastric cancer treatment

    Institute of Scientific and Technical Information of China (English)

    Yoon Young Choi; Ji Yeong An; Hyung-Il Kim; Jae-Ho Cheong; Woo Jin Hyung; Sung Hoon Noh

    2014-01-01

    Objective The aim of this review was to overview the current practice of gastric cancer treatment including surgery and other adjuvant modalities.Data sources The review was based on data obtained from the published articles and main guidelines in the East and West.Study selection Articles with high level of evidence or current best evidence in each issue were selected to be reviewed.Results Although varied adjuvant modalities have been proved to be benefit for treating gastric cancer,surgery is still the most important treatment strategy against gastric cancer.Actively adapting to new technology is important but it should be balanced with an effort to establish sound scientific rationale that adheres to oncologic principles.Conclusions Future treatment of gastric cancer will be focused on tailored,personalized therapy.For achieving it,collaboration across disciplines is essential.Also the philosophy of caring for the patients with gastric cancer should be rooted in the realization of true patient benefit regardless of who is providing the care.With these philosophies,we can shift the scientific and technological advances toward triumph over gastric cancer.

  8. Current management of oral cancer

    Institute of Scientific and Technical Information of China (English)

    Robert Ord

    2008-01-01

    @@ This presentation will summarize some of the current areas of interest in the management of oral cancer. The presentation will be divided into a brief review of epidemiology and diagnosis, with a more extensive discussion regarding the controversial areas in surgery and a review of the adjuvant roles of radiation and chemotherapy.

  9. [Current Approaches in Cancer Immunotherapy].

    Science.gov (United States)

    Otáhal, P; Trněný, M

    2015-01-01

    Methods of cancer immunotherapy have finally entered clinical medicine after years of preclinical research. Currently, there are several methods, which have proven to be very effective even in cases of incurable cancer. Antitumor monoclonal antibodies are among major therapeutic anti-cancer drugs and have been successfully used for many ears. Novel group of antibodies are immunomodulatory antibodies which can break tumor -specific immune tolerance and induce regression of tumors by nonspecific activation of immune system. Bispecific antibodies represent a novel class of anticancer agents which can induce expansion of T cells in vivo, blinatumomab is an example of such agents and is currently available for the treatment of acute B -cell leukemia. Cellular immunotherapy is also very effective, especially the use of Chimeric receptor modified T-cells for the therapy of B- cell lymphoproliferative diseases. Although it is a very complicated and expensive method, it is highly effective approach which can induce remission even in previously hopeless conditions. The goal of this article is to explain the basic principles of cancer immunotherapy and summarize the newest findings in this field.

  10. Pleiotropic Actions of Peroxisome Proliferator-Activated Receptors (PPARs in Dysregulated Metabolic Homeostasis, Inflammation and Cancer: Current Evidence and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Antonio Simone Laganà

    2016-06-01

    Full Text Available Background: Peroxisome proliferator-activated receptors (PPARs have demonstrated a lot of important effects in the regulation of glucose and lipid metabolism and in the correct functioning of adipose tissue. Recently, many studies have evaluated a possible effect of PPARs on tumor cells. The purpose of this review is to describe the effects of PPARs, their action and their future prospective; Methods: Narrative review aimed to synthesize cutting-edge evidence retrieved from searches of computerized databases; Results: PPARs play a key role in metabolic diseases, which include several cardiovascular diseases, insulin resistance, type 2 diabetes, metabolic syndrome, impaired immunity and the increasing risk of cancer; in particular, PPARα and PPARβ/δ mainly enable energy combustion, while PPARγ contributes to energy storage by enhancing adipogenesis; Conclusion: PPAR agonists could represent interesting types of molecules that can treat not only metabolic diseases, but also inflammation and cancer. Additional research is needed for the identification of high-affinity, high-specificity agonists for the treatment of obesity, type 2 diabetes (T2DM and other metabolic diseases. Further studies are needed also to elucidate the role of PPARs in cancer.

  11. More Evidence Linking Obesity to Liver Cancer

    Science.gov (United States)

    ... fullstory_161494.html More Evidence Linking Obesity to Liver Cancer And type 2 diabetes more than doubles the ... type 2 diabetes, may raise your risk for liver cancer, a new study suggests. "We found that each ...

  12. Evidence of peripheral nerve blocks for cancer-related pain

    DEFF Research Database (Denmark)

    Klepstad, P; Kurita, G P; Mercadante, S;

    2015-01-01

    The European Association for Palliative Care has initiated a comprehensive program to achieve an over-all review of the evidence of multiple cancer pain management strategies in order to extend the current guideline for treatment of cancer pain. The present systematic review analyzed the existing...

  13. Evidence based radiation oncology: Breast cancer

    International Nuclear Information System (INIS)

    Purpose: Radiotherapy is, similar to surgery, a local treatment. In the case of breast cancer, it is generally given after conservative or after more extensive, tumour and patient adapted, surgery. The target volumes can be the breast and/or the thoracic wall and/or the regional lymph node areas. The integration and the extent of radiotherapy as part of the comprehensive treatment of the breast cancer patient, including the amount of surgery and the sequencing with the systemic treatments, has to be well discussed with all medical specialists involved in treating breast cancer on a multidisciplinary basis. Guidelines for the appropriate prescription and execution of radiotherapy are of utmost importance. However, individualisation based on the individual patients' and tumours' characteristics should always be envisaged. Materials and methods: Based on a review of the literature the level of evidence that is available for the indications for radiotherapy is summarised, as well as the main clinical questions that are unanswered today. An overview of the recent and ongoing clinical trails in breast cancer will highlight some of the current ongoing debates. Conclusions: In the case of breast cancer, radiotherapy, given after as well conservative as extensive risk-adapted surgery, significantly reduces the risk of local and regional recurrences. Especially for patients with an intermediate to high absolute risk for local recurrences, a positive influence on overall survival has been shown, notably when appropriate radiotherapy techniques are used. Most important is that the best results that we can offer to our breast cancer patients for all clinical endpoints (local and regional control; quality of life; cosmetic results; survival) can be obtained by a multidisciplinary and patient-oriented approach, involving all those involved in the treatment of breast cancer patients

  14. Cancer immunotherapy: moving beyond current vaccines

    OpenAIRE

    Rosenberg, Steven A.; Yang, James C.; Restifo, Nicholas P

    2004-01-01

    Great progress has been made in the field of tumor immunology in the past decade, but optimism about the clinical application of currently available cancer vaccine approaches is based more on surrogate endpoints than on clinical tumor regression. In our cancer vaccine trials of 440 patients, the objective response rate was low (2.6%), and comparable to the results obtained by others. We consider here results in cancer vaccine trials and highlight alternate strategies that mediate cancer regre...

  15. Micronutrients and cancer aetiology: the epidemiological evidence.

    Science.gov (United States)

    Key, T

    1994-11-01

    Micronutrient deficiencies occur most commonly in poor countries and, therefore, are most likely to be associated with cancers common in these countries. Epidemiological studies are hampered by inaccurate measurement of micronutrient intake and by the correlations between intakes of many nutrients. The strongest evidence for a protective effect of micronutrients is for oesophageal cancer. The identity of the micronutrients is not certain, but may include retinol, riboflavin, ascorbic acid and Zn; alcohol, smoking and dietary nitrosamines increase the risk for oesophageal cancer. For stomach cancer there is good evidence that fruit and vegetables are protective. The protective effect of these foods might be largely due to ascorbic acid, but other nutrients and non-nutrients may also be important; the risk for stomach cancer is increased by salt, some types of preserved foods, and by infection of the stomach with the bacterium Helicobacter pylori. The risk for lung cancer appears to be reduced by a high intake of fruit and vegetables, but it is not clear which agents are responsible and the major cause of lung cancer is cigarette smoking. Diet is probably the major determinant of the risk for colo-rectal cancer; there is evidence that fruit and vegetables and fibre reduce risk and that meat and animal fat increase risk, but there is no convincing evidence that these relationships are mediated by micronutrients. The risk for cervical cancer is inversely related to fruit and vegetable consumption and, therefore, to consumption of carotenoids and ascorbic acid, but the major cause of this cancer is human papillomavirus and it is not yet clear whether the dietary associations indicate a true protective effect or whether they are due to confounding by other variables. The evidence that micronutrients are important in the aetiology of either breast cancer or prostate cancer is weak, but the possible roles of 1,25-dihydroxycholecalciferol and alpha-tocopherol in prostate

  16. Current treatment for colorectal cancer metastatic to the liver

    NARCIS (Netherlands)

    Cromheecke, M; de Jong, KP; Hoekstra, HJ

    1999-01-01

    Surgery is currently the only available treatment option which offers the potential for cure for patients with liver metastases from colorectal cancer. Of those who undergo a potentially curative operation for their primary tumour but subsequently recur, almost 80% will develop evidence of metastati

  17. Current clinical evidence on pioglitazone pharmacogenomics

    Directory of Open Access Journals (Sweden)

    Marina eKawaguchi-Suzuki

    2013-11-01

    Full Text Available Pioglitazone is the most widely used thiazolidinedione and acts as an insulin-sensitizer through activation of the Peroxisome Proliferator-Activated Receptor-γ (PPARγ. Pioglitazone is approved for use in the management of type 2 diabetes mellitus, but its use in other therapeutic areas is increasing due to pleiotropic effects. In this hypothesis article, the current clinical evidence on pioglitazone pharmacogenomics is summarized and related to variability in pioglitazone response. How genetic variation in the human genome affects the pharmacokinetics and pharmacodynamics of pioglitazone was examined. For pharmacodynamic effects, hypoglycemic and anti-atherosclerotic effects, risks of fracture or edema, and the increase in body mass index in response to pioglitazone based on genotype were examined. The genes CYP2C8 and PPARG are the most extensively studied to date and selected polymorphisms contribute to respective variability in pioglitazone pharmacokinetics and pharmacodynamics. We hypothesized that genetic variation in pioglitazone pathway genes contributes meaningfully to the clinically observed variability in drug response. To test the hypothesis that genetic variation in PPARG associates with variability in pioglitazone response, we conducted a meta-analysis to synthesize the currently available data on the PPARG p.Pro12Ala polymorphism. The results showed that PPARG 12Ala carriers had a more favorable change in fasting blood glucose from baseline as compared to patients with the wild-type Pro12Pro genotype (p=0.018. Unfortunately, findings for many other genes lack replication in independent cohorts to confirm association; further studies are needed. Also, the biological functionality of these polymorphisms is unknown. Based on current evidence, we propose that pharmacogenomics may provide an important tool to individualize pioglitazone therapy and better optimize therapy in patients with T2DM or other conditions for which pioglitazone

  18. Breast cancer stem cells: current advances and clinical implications.

    Science.gov (United States)

    Luo, Ming; Clouthier, Shawn G; Deol, Yadwinder; Liu, Suling; Nagrath, Sunitha; Azizi, Ebrahim; Wicha, Max S

    2015-01-01

    There is substantial evidence that many cancers, including breast cancer, are driven by a population of cells that display stem cell properties. These cells, termed cancer stem cells (CSCs) or tumor initiating cells, not only drive tumor initiation and growth but also mediate tumor metastasis and therapeutic resistance. In this chapter, we summarize current advances in CSC research with a major focus on breast CSCs (BCSCs). We review the prevailing methods to isolate and characterize BCSCs and recent evidence documenting their cellular origins and phenotypic plasticity that enables them to transition between mesenchymal and epithelial-like states. We describe in vitro and clinical evidence that these cells mediate metastasis and treatment resistance in breast cancer, the development of novel strategies to isolate circulating tumor cells (CTCs) that contain CSCs and the use of patient-derived xenograft (PDX) models in preclinical breast cancer research. Lastly, we highlight several signaling pathways that regulate BCSC self-renewal and describe clinical implications of targeting these cells for breast cancer treatment. The development of strategies to effectively target BCSCs has the potential to significantly improve the outcomes for patients with breast cancer.

  19. Prostate Cancer: Current Treatment and Prevention Strategies

    OpenAIRE

    Chen, Fang-zhi; Zhao, Xiao-kun

    2013-01-01

    Abstract Prostate cancer is one of the life threatening disorders of male. Although, over the last two decades, a high rate of overdiagnosis, and overtreatment has lowered the incidence rate of prostate cancer, the treatment or prevention strategies are not enough to control the high rate of disease related mortality. Current medical treatment approaches include surgery, radiation therapy, chemotherapy, hormonal therapy, cryosurgery and other methods. These approaches are more or less effecti...

  20. Phytoestrogens and human health effects: weighing up the current evidence.

    Science.gov (United States)

    Humfrey, C D

    1998-01-01

    Phytoestrogens are naturally occurring plant compounds which have oestrogenic and/or anti-oestrogenic activity. They are present in many human foodstuffs including beans, sprouts, cabbage, spinach, soyabean, grains and hops. The main classes are the isoflavones, coumestans and lignans. This review assesses the evidence that these substances may have adverse and/or beneficial impacts on the risk of several hormone-dependent diseases in humans. Evidence from studies of various animal species has demonstrated that ingestion of high levels of phytoestrogens can produce adverse effects on reproductive endpoints including fertility. Studies in laboratory animals have also shown that exposure to high doses of phytoestrogens during development can adversely affect brain differentiation and reproductive development in rodents, but may also have possible beneficial effects. In humans, there is a lack of information concerning the possible effects of high doses of phytoestrogens in infants and this should be addressed as a matter of priority so that any risks (or benefits) can be established. In adults, no current data exist to suggest that consumption of phytoestrogens at the levels normally encountered in the diet is likely to be harmful. Epidemiological studies suggest that foodstuffs containing phytoestrogens may have a beneficial role in protecting against a number of chronic diseases and conditions. For cancer of the prostate, colon, rectum, stomach and lung, the evidence is most consistent for a protective effect resulting from a high intake of grains, legumes, fruits and vegetables; it is not possible to identify particular food types or components that may be responsible. Dietary intervention studies indicate that in women soya and linseed may have beneficial effects on the risk of breast cancer and may help to alleviate postmenopausal symptoms. For osteoporosis, tentative evidence suggests phytoestrogens may have similar effects in maintaining bone density to those

  1. Exercise after breast cancer treatment: current perspectives

    Directory of Open Access Journals (Sweden)

    Dieli-Conwright CM

    2015-10-01

    Full Text Available Christina M Dieli-Conwright, Breanna Z Orozco Division of Biokinesiology and Physical Therapy, Women's Health and Exercise Laboratory, University of Southern California, Los Angeles, CA, USA Abstract: Over the past 2 decades, great strides have been made in the field of exercise-oncology research, particularly with breast cancer. This area of research is particularly important since there are >2.8 million breast cancer survivors who are in need of an intervention that can offset treatment-related side effects. Noticeable reductions in physical fitness (ie, cardiopulmonary fitness and muscular strength, negative changes in body composition (ie, increase in body mass, decrease in lean body mass, and increase in fat mass, increased fatigue, depression, or anxiety are some of the common side effects of cancer treatments that negatively impact overall quality of life and increase the risk for the development of comorbidities. Exercise plays a vital role in improving cardiopulmonary function, psychological events, muscular strength, and endurance in breast cancer survivors, and thus should be considered as a key factor of lifestyle intervention to reverse negative treatment-related side effects. The purpose of this review is to address current perspectives on the benefits of aerobic and resistance exercise after breast cancer treatments. This review is focused on the well-established benefits of exercise on physical and emotional well-being, bone health, lymphedema management, and the postulated benefits of exercise on risk reduction for recurrence of breast cancer. Keywords: breast cancer, exercise, physical well-being

  2. Exercise after breast cancer treatment: current perspectives.

    Science.gov (United States)

    Dieli-Conwright, Christina M; Orozco, Breanna Z

    2015-01-01

    Over the past 2 decades, great strides have been made in the field of exercise-oncology research, particularly with breast cancer. This area of research is particularly important since there are >2.8 million breast cancer survivors who are in need of an intervention that can offset treatment-related side effects. Noticeable reductions in physical fitness (ie, cardiopulmonary fitness and muscular strength), negative changes in body composition (ie, increase in body mass, decrease in lean body mass, and increase in fat mass), increased fatigue, depression, or anxiety are some of the common side effects of cancer treatments that negatively impact overall quality of life and increase the risk for the development of comorbidities. Exercise plays a vital role in improving cardiopulmonary function, psychological events, muscular strength, and endurance in breast cancer survivors, and thus should be considered as a key factor of lifestyle intervention to reverse negative treatment-related side effects. The purpose of this review is to address current perspectives on the benefits of aerobic and resistance exercise after breast cancer treatments. This review is focused on the well-established benefits of exercise on physical and emotional well-being, bone health, lymphedema management, and the postulated benefits of exercise on risk reduction for recurrence of breast cancer.

  3. Association between cancer literacy and cancer-related behaviour: evidence from Ticino, Switzerland

    Directory of Open Access Journals (Sweden)

    Nicola Diviani

    2014-07-01

    Full Text Available Background. This paper details the role of different dimensions of health literacy in the relationship between health literacy and cancer-related health behaviours. In particular, Cancer Literacy is studied as an exemplar of a dimension of health literacy beyond basic reading and writing skills. The link between functional health literacy, Cancer Literacy and cancer-related health behaviours is investigated in a sample of Ticino (Switzerland residents (n=639. Design and methods. Detailed data is collected about respondents’ functional health literacy, Cancer Literacy, cancer information seeking behaviour, engagement in cancer preventive behaviours, participation to cancer screenings, and intention to adhere to current screening recommendations. Results. Results confirm the added value of Cancer Literacy – compared to functional health literacy – in explaining people’s cancer information seeking behaviour, their participation to several cancer screenings and their screening intention, underscoring the need to take into account dimensions of health literacy beyond basic functional skills. Conclusions. From a public health perspective, findings provide further evidence on the importance of adapting informational and educational communication intervention designed to improve cancer prevention and screening to different audiences.

  4. Current strategies for the prevention of breast cancer

    Directory of Open Access Journals (Sweden)

    Advani P

    2014-05-01

    Full Text Available Pooja Advani, Alvaro Moreno-AspitiaDepartment of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USAAbstract: Due to the high incidence of breast cancer in the United States, optimal strategies for its prevention are imperative. This entails identification of women who are at an increased risk for breast cancer and an integrative approach that includes effective screening methods as well as nutritional, pharmacologic, and surgical management. Several breast cancer risk-assessment tools, such as the Gail and Claus models, can help clinicians determine the quantitative risk of breast cancer. The role of selective estrogen receptor modulators, such as tamoxifen and raloxifene, for the prevention of breast cancer has been well established. Several other agents, such as aromatase inhibitors, are currently being investigated. The potential adverse effects of these chemopreventive agents, which include an impact on the quality of life, must be discussed with the patient before deciding on this approach. Additionally, breast cancer risk factors have been identified over the years; some of them are modifiable, but others are not. Although there is no conclusive evidence to suggest the protective role of specific dietary components, alcohol consumption and obesity are associated with an increased breast cancer risk; thus lifestyle changes can lead to a lower risk of developing breast cancer. Surgical approaches, including bilateral risk-reduction mastectomy and salpingo-oophorectomy, are usually limited to women with a hereditary predisposition to development of breast cancer. The objective of this review is to summarize the various approaches directed at reducing the incidence of breast cancer.Keywords: chemoprevention, tamoxifen, raloxifene, prophylactic surgery

  5. Current Stem Cell Biomarkers and Their Functional Mechanisms in Prostate Cancer

    Science.gov (United States)

    Zhang, Kaile; Zhou, Shukui; Wang, Leilei; Wang, Jianlong; Zou, Qingsong; Zhao, Weixin; Fu, Qiang; Fang, Xiaolan

    2016-01-01

    Currently there is little effective treatment available for castration resistant prostate cancer, which is responsible for the majority of prostate cancer related deaths. Emerging evidence suggested that cancer stem cells might play an important role in resistance to traditional cancer therapies, and the studies of cancer stem cells (including specific isolation and targeting on those cells) might benefit the discovery of novel treatment of prostate cancer, especially castration resistant disease. In this review, we summarized major biomarkers for prostate cancer stem cells, as well as their functional mechanisms and potential application in clinical diagnosis and treatment of patients. PMID:27447616

  6. Genetic evidence linking lung cancer and COPD: a new perspective

    Directory of Open Access Journals (Sweden)

    Crapo JD

    2011-07-01

    Full Text Available Robert P Young1,4, Raewyn J Hopkins1, Gregory D Gamble1, Carol Etzel2, Randa El-Zein2, James D Crapo31Department of Medicine and School of Biological Sciences, University of Auckland, Auckland, New Zealand; 2Department of Epidemiology, UT MD Anderson Cancer Center, Houston, TX, USA; 3National Jewish Health, Denver, CO, USA; 4Synergenz Biosciences Ltd, Auckland, New ZealandAbstract: Epidemiological studies indicate that tobacco smoke exposure accounts for nearly 90% of cases of chronic obstructive pulmonary disease (COPD and lung cancer. However, genetic factors may explain why 10%–30% of smokers develop these complications. This perspective reviews the evidence suggesting that COPD is closely linked to susceptibility to lung cancer and outlines the potential relevance of this observation. Epidemiological studies show that COPD is the single most important risk factor for lung cancer among smokers and predates lung cancer in up to 80% of cases. Genome-wide association studies of lung cancer, lung function, and COPD have identified a number of overlapping “susceptibility” loci. With stringent phenotyping, it has recently been shown that several of these overlapping loci are independently associated with both COPD and lung cancer. These loci implicate genes underlying pulmonary inflammation and apoptotic processes mediated by the bronchial epithelium, and link COPD with lung cancer at a molecular genetic level. It is currently possible to derive risk models for lung cancer that incorporate lung cancer-specific genetic variants, recently identified “COPD-related” genetic variants, and clinical variables. Early studies suggest that single nucleotide polymorphism-based risk stratification of smokers might help better target novel prevention and early diagnostic strategies in lung cancer.Keywords: lung cancer, chronic obstructive pulmonary disease, association study, single nucleotide polymorphism, risk model

  7. Evidence and research in rectal cancer

    International Nuclear Information System (INIS)

    The main evidences of epidemiology, diagnostic imaging, pathology, surgery, radiotherapy, chemotherapy and follow-up are reviewed to optimize the routine treatment of rectal cancer according to a multidisciplinary approach. This paper reports on the knowledge shared between different specialists involved in the design and management of the multidisciplinary ESTRO Teaching Course on Rectal Cancer. The scenario of ongoing research is also addressed. In this time of changing treatments, it clearly appears that a common standard for large heterogeneous patient groups have to be substituted by more individualised therapies based on clinical-pathological features and very soon on molecular and genetic markers. Only trained multidisciplinary teams can face this new challenge and tailor the treatments according to the best scientific evidence for each patient

  8. Colonoscopy in Colorectal Cancer Screening: Current Aspects.

    Science.gov (United States)

    Triantafillidis, John K; Vagianos, Constantine; Malgarinos, George

    2015-09-01

    Colonoscopy represents a very important diagnostic modality for screening for colorectal cancer, because it has the ability to both detect and effectively remove pro-malignant and malignant lesions. It is recommended by almost all international and national gastroenterology and cancer societies, as an initial screening modality or, following a positive fecal occult blood test, to be performed every 10 years in individuals of average risk starting from the age of 50. However, a significant problem is the so-called post-screening (interval) polyps and cancers found some years after the index colonoscopy. In order to reduce the rate of interval cancers it is extremely necessary to optimize the quality and effectiveness of colonoscopy. Bowel preparation is of paramount importance for both accurate diagnosis and subsequent treatment of lesions found on colonoscopy. The quality of bowel preparation could be significantly improved by splitting the dose regimens, a strategy that has been shown to be superior to single-dose regimen. A good endoscopic technique and optimal withdrawal time offering adequate time for inspection, would further optimize the rate of cecal intubation and the number of lesions detected. During the last years, sophisticated devices have been introduced that would further facilitate cecal intubation. The percentage of total colonoscopies is now super-passing the level of 95 % allowing the adenoma detection rate to be greater than the suggestive level of 25 % in men and 15 % in women. This review aims to provide the reader with the current knowledge concerning indications, usefulness, limitations and future perspectives of this probably most important screening technique for colorectal cancer available today. PMID:27217671

  9. The evidence for low-dose CT screening of lung cancer.

    Science.gov (United States)

    Ruchalski, Kathleen; Gutierrez, Antonio; Genshaft, Scott; Abtin, Fereidoun; Suh, Robert

    2016-01-01

    Lung cancer remains the leading cause of cancer-related death in the United States. An effective screening tool for early lung cancer detection has long been sought. Early chest radiograph and low-dose computed tomography (LDCT) screening trials were promising and demonstrated increased cancer detection. However, these studies were not able to improve lung cancer mortality. The National Lung Screening Trial resulted in decreased lung cancer mortality with LDCT screening in a high-risk population. Similar trials are currently underway in Europe. With LDCT now being widely implemented, it is paramount for radiologists to understand the evidence for lung cancer screening.

  10. MRI for breast cancer: Current indications

    International Nuclear Information System (INIS)

    Mammography is the only imaging study that has been proven in multiple large randomized trials to decrease breast cancer mortality. Mammography, however, has its limitations and, as such, other modalities that can complement it are being studied. One of these is dynamic contrast-enhanced breast MRI, which has emerged as an important adjunctive modality and is at present the most sensitive modality that we have to evaluate the breast. The American College of Radiology, in its 2004 practice guidelines, has outlined the 12 current indications for breast MRI. This manuscript reviews and provides examples of each of these

  11. Clinical utility of eslicarbazepine: current evidence.

    Science.gov (United States)

    Zaccara, Gaetano; Giovannelli, Fabio; Cincotta, Massimo; Carelli, Alessia; Verrotti, Alberto

    2015-01-01

    Eslicarbazepine acetate (ESL) is a new antiepileptic drug whose mechanism of action is blockade of the voltage-gated sodium channel (VGSC). However, in respect to carbamazepine and oxcarbazepine, the active ESL metabolite (eslicarbazepine) affects slow inactivation of VGSC and has a similar affinity for the inactivated state and a lower affinity for the resting state of the channel. This new antiepileptic drug has been recently approved in Europe (trade name Zebinix) and in the United States (trade name Stedesa) for adjunctive treatment in adult subjects with partial-onset seizures, with or without secondary generalization. Following oral administration, ESL is rapidly and extensively metabolized by hepatic esterases to eslicarbazepine. This active metabolite has a linear pharmacokinetic profile, a low binding to plasma proteins (<40%), and a half-life of 20-24 hours and is mainly excreted by kidneys in an unchanged form or as glucuronide conjugates. ESL is administered once a day and has a low potential for drug-drug interactions. Efficacy and safety of this drug in patients with focal seizures have been assessed in four randomized clinical trials, and responder rates (percentage of patients with a ≥50% improvement of their seizures) ranged between 17% and 43%. Adverse events were usually mild to moderate, and the most common were dizziness, somnolence, diplopia, abnormal coordination, blurred vision, vertigo, headache, fatigue, nausea, and vomiting. ESL may be considered an interesting alternative to current antiepileptic drugs for the treatment of drug-resistant focal epilepsies. Additionally, it is under investigation in children with focal epilepsies, in patients with newly diagnosed focal epilepsies, and also in other neurological and psychiatric disorders. PMID:25709402

  12. Clinical utility of eslicarbazepine: current evidence

    Directory of Open Access Journals (Sweden)

    Zaccara G

    2015-02-01

    Full Text Available Gaetano Zaccara,1 Fabio Giovannelli,1,2 Massimo Cincotta,1 Alessia Carelli,3 Alberto Verrotti31Department of Medicine, Unit of Neurology, Florence Health Authority, Florence, Italy; 2Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA, University of Florence, Florence, Italy; 3Department of Pediatrics, University of Perugia, Perugia, ItalyAbstract: Eslicarbazepine acetate (ESL is a new antiepileptic drug whose mechanism of action is blockade of the voltage-gated sodium channel (VGSC. However, in respect to carbamazepine and oxcarbazepine, the active ESL metabolite (eslicarbazepine affects slow inactivation of VGSC and has a similar affinity for the inactivated state and a lower affinity for the resting state of the channel. This new antiepileptic drug has been recently approved in Europe (trade name Zebinix and in the United States (trade name Stedesa for adjunctive treatment in adult subjects with partial-onset seizures, with or without secondary generalization. Following oral administration, ESL is rapidly and extensively metabolized by hepatic esterases to eslicarbazepine. This active metabolite has a linear pharmacokinetic profile, a low binding to plasma proteins (<40%, and a half-life of 20–24 hours and is mainly excreted by kidneys in an unchanged form or as glucuronide conjugates. ESL is administered once a day and has a low potential for drug–drug interactions. Efficacy and safety of this drug in patients with focal seizures have been assessed in four randomized clinical trials, and responder rates (percentage of patients with a ≥50% improvement of their seizures ranged between 17% and 43%. Adverse events were usually mild to moderate, and the most common were dizziness, somnolence, diplopia, abnormal coordination, blurred vision, vertigo, headache, fatigue, nausea, and vomiting. ESL may be considered an interesting alternative to current antiepileptic drugs for the treatment of drug-resistant focal

  13. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    Energy Technology Data Exchange (ETDEWEB)

    Geinitz, Hans [Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Dept. of Radiation Oncology; Linz Univ. (Austria). Medical Faculty; Roach, Mack III [California Univ., San Francisco, CA (United States). Dept. of Radiation Oncology; Van As, Nicholas (ed.) [The Institute of Cancer Research, Sutton Surrey (United Kingdom)

    2015-04-01

    Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

  14. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Andrews, Kimberly; Brooks, Durado; DeSantis, Carol E; Fedewa, Stacey A; Lortet-Tieulent, Joannie; Manassaram-Baptiste, Deana; Brawley, Otis W; Wender, Richard C

    2016-01-01

    Each year the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines, including the update of the breast cancer screening guideline, discuss quality issues in colorectal cancer screening and new developments in lung cancer screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey.

  15. Current trends in staging rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Abdus Samee; Chelliah Ramachandran Selvasekar

    2011-01-01

    Management of rectal cancer has evolved over the years.In this condition preoperative investigations assist in deciding the optimal treatment.The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis.Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection.Endoanal ultrasound (EUS) is useful for tumor (T) staging;hence EUS is a useful imaging modality for early rectal cancer.Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence.Computerized tomography (CT) of the chest,abdomen and pelvis is used to rule out distant metastasis.Identification of the malignant nodes using EUS,CT and MRI is based on the size,morphology and internal characteristics but has drawbacks.Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor.In this situation,EUS and MRI may provide complementary information to decide further treatment.Functional imaging using positron emission tomography (PET) is useful,particularly PET/CT fusion scans to identify areas of the functionally hot spots.In the current state,imaging has enabled the multidisciplinary team of surgeons,oncologists,radiologists and pathologists to decide on the patient centered management of rectal cancer.In future,functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.

  16. Current role of surgical therapy in gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ryan Swan; Thomas J Miner

    2006-01-01

    Surgery is currently the only potentially curative treatment for gastric cancer. Since the inception of the gastrectomy for cancer of the stomach, there has been debate over the bounds of surgical therapy, balancing potential long-term survival with perioperative morbidity and mortality. This review delineates the current role of surgery in preoperative staging, curative resection, and palliative treatment for gastric cancer.

  17. Current progress in immunotherapy for pancreatic cancer.

    Science.gov (United States)

    Foley, Kelly; Kim, Victoria; Jaffee, Elizabeth; Zheng, Lei

    2016-10-10

    Pancreatic cancer remains one of the most lethal cancers with few treatment options. Immune-based strategies to treat pancreatic cancer, such as immune checkpoint inhibitors, therapeutic vaccines, and combination immunotherapies, are showing promise where other approaches have failed. Immune checkpoint inhibitors, including anti-CTLA4, anti-PD-1, and anti-PD-L1 antibodies, are effective as single agents in immune sensitive cancers like melanoma, but lack efficacy in immune insensitive cancers including pancreatic cancer. However, these inhibitors are showing clinical activity, even in traditionally non-immunogenic cancers, when combined with other interventions, including chemotherapy, radiation therapy, and therapeutic vaccines. Therapeutic vaccines given together with immune modulating agents are of particular interest because vaccines are the most efficient way to induce effective anti-tumor T cell responses, which is required for immunotherapies to be effective. In pancreatic cancer, early studies suggest that vaccines can induce T cells that have the potential to recognize and kill pancreatic cancer cells, but the tumor microenvironment inhibits effective T cell trafficking and function. While progress has been made in the development of immunotherapies for pancreatic cancer over the last several years, additional trials are needed to better understand the signals within the tumor microenvironment that are formidable barriers to T cell infiltration and function. Additionally, as more pancreatic specific antigens are identified, immunotherapies will continue to be refined to provide the most significant clinical benefit.

  18. Current and emerging treatments for pancreatic cancer.

    Science.gov (United States)

    Regine, W F; John, W J; Mohiuddin, M

    1997-10-01

    The worldwide annual pancreatic cancer death rate equals its estimated annual incidence. Surgery has been considered the only curative modality for this disease, but only 5 to 15% of patients are candidates for potentially curative resection. Evidence that postoperative adjuvant treatment improves outcome has been limited to a single randomised trial of a well tolerated split-course chemoradiation regimen. More intensive regimens have since been developed and are associated with, at best, a modest improvement in patient outcome. The potentially significant morbidity associated with pancreaticoduodenectomy, which can compromise the delivery of postoperative adjuvant chemoradiation, has led to the development of preoperative adjuvant ('neoadjuvant') chemoradiation in these patients. Although experience suggests that such an approach is feasible, its ultimate impact awaits further evaluation. Combined modality therapy has produced the most promising results in patients with unresectable or locally advanced disease. However, only modest improvements in median survival and minimal increases in long term survival have so far been achieved. This observation has encouraged many investigators to devise innovative methods of delivering therapy, including radioisotope implantation and intraoperative radiation therapy (IORT). Combined modality therapy with radioisotope implantation appears to have the greatest potential for improving local control and survival in these patients. IORT may be associated with lower morbidity than radioisotope implantation, but its impact may be limited by the radiobiological disadvantage associated with single dose boost therapy. Although new radiosensitising drugs are being tested, the problem of distant metastasis remains significant. New chemotherapeutic agents such as gemcitabine appear to have the potential to produce better results than those achieved over the last 35 years with fluorouracil. Investigations into the optimal integration of

  19. Age appropriate screening for cancer: Evidence-based practice in the United States of America

    Directory of Open Access Journals (Sweden)

    T S Pandey

    2014-01-01

    Full Text Available Cancer screening is a well established and integral part of routine care in the Western world including United States. Men and women are recommended to get age-specific screening for common cancers like breast, cervical, prostate, and colon. The goal of screening is primary and secondary prevention. Cancer prevention and early detection of cancers has been shown to improve survival rates and decrease mortality by prompt appropriate treatment. This article serves to outline the current guidelines in the United States for cancer screening and the evidence for them as well as discusses the possibility of a similar model of care in India as well as barriers to such a screening program for cancer. The evidence was mostly obtained from systematic reviews done by the United States Preventive Services Task Force guidelines and other peer institutions like American Cancer Society and Agency for Healthcare Research and Quality.

  20. Nanomedicines as cancer therapeutics: Current status

    NARCIS (Netherlands)

    Akhter, S.; Ahmad, M; Ramzani, F.; Singh, A..; Ahmad, I.; Rahman, Z.; Ahmad, F.J.; Storm, G.; Kok, R.J.

    2013-01-01

    As of 21st century, cancer is arguably the most complex and challenging disease known to mankind and an inevitable public health concern of this millennium. Nanotechnology, suitably amalgamated with cancer research, has ushered an era of highly personalized and safer medicines which can improve canc

  1. Focal therapy for prostate cancer: The current status

    OpenAIRE

    Marshall, Susan; Taneja, Samir

    2015-01-01

    Purpose In an era of increasing prostate cancer incidence and earlier detection, the assessment of clinical significance of prostate cancer is critical. Minimally invasive therapies are increasingly being investigated in localized prostate cancer. Methods and results In this review, we discuss the current status of magnetic resonance imaging targeted fusion prostate biopsy and focal therapy for prostate cancer, its rationale, and techniques. Conclusion Focal therapy offers a promising outlook...

  2. Current Research and Management of Ovarian Cancer in China

    Institute of Scientific and Technical Information of China (English)

    GUMeijiao; SHIWei

    2002-01-01

    Ovarian cancer is ne of the most lethal malignant tumors in China,represents the third most common cancer after cervical cancer and endometrial cancer,and the first leading cause of death from hynaecological cancers.Due to the lack of effective screening strategies and the absence of symptoms in early-stage of disease,over 70% of patients present at an advanced stage.Despite the advances in surgical techniques and conventional chemotheraphy,the prognosis of ovarian cancer has not been improved significantly,and indeed the long-term survival for patients with advanced disease does not exceed 20%.The aetiology of ovarian cancer temains poorly understood.In China,the major focus of research is to clarify the mechanism underlying ovarian cancer,develop more effective life-saving diagnostic and therapeutic measures,and undertake more population-based studies.This article summarizes current research,diagnosis and management of ovarian cancer in China.

  3. Chemoprevention of gastric cancer: current status

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    The development of gastric cancer is a multi-factor process. In addition to genetic factors, environmental factors including smoking, low gastric acidity, excessive intake of salt or salty food and low consumption of fresh fruits and vegetables all contribute to the development of gastric cancer. Of particular interest, epidemiological and experimental studies have demonstrated that Helicobacter pylori (H. pylori) infection is causally linked to gastric cancer. Most studies using micronutrient supplementation have failed to demonstrate any preventive effect against the development of gastric cancer. The use of non-steroidal anti-inflammatory drugs has been consistently observed to protect against the development of gastric cancer. Recently, eradication of H. pylori infection by a chemopreventative approach is being studied in a number of trials. Studies using precancerous lesions as an end point of the treatment have produced conflicting and mostly negative results. Trials using cancer as an end point are being cautiously carried out in high-risk populations, and will provide the definitive answer to this important question. In the end, vaccination may be proven to be the optimal strategy in human for the management of H. pylori infection and prevention of gastric cancer.

  4. Cancer Treatment Using Peptides: Current Therapies and Future Prospects

    OpenAIRE

    Jyothi Thundimadathil

    2012-01-01

    This paper discusses the role of peptides in cancer therapy with special emphasis on peptide drugs which are already approved and those in clinical trials. The potential of peptides in cancer treatment is evident from a variety of different strategies that are available to address the progression of tumor growth and propagation of the disease. Use of peptides that can directly target cancer cells without affecting normal cells (targeted therapy) is evolving as an alternate strategy to convent...

  5. Smoking behaviours of current cancer patients in Canada

    OpenAIRE

    Liu, J; Chadder, J.; S Fung; Lockwood, G.; Rahal, R.; Halligan, M.; Mowat, D.; Bryant, H.

    2016-01-01

    Evidence shows that continued smoking by cancer patients leads to adverse treatment outcomes and affects survival. Smoking diminishes treatment effectiveness, exacerbates side effects, and increases the risk of developing additional complications. Patients who continue to smoke also have a higher risk of developing a second primary cancer or experiencing a cancer recurrence, both of which ultimately contribute to poorer quality of life and poorer survival. Here, we present a snapshot of smoki...

  6. Current Immunotherapeutic Approaches in Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Shigeo Koido

    2011-01-01

    Full Text Available Pancreatic cancer is a highly aggressive and notoriously difficult to treat. As the vast majority of patients are diagnosed at advanced stage of the disease, only a small population is curative by surgical resection. Although gemcitabine-based chemotherapy is typically offered as standard of care, most patients do not survive longer than 6 months. Thus, new therapeutic approaches are needed. Pancreatic cancer cells that develop gemcitabine resistance would still be suitable targets for immunotherapy. Therefore, one promising treatment approach may be immunotherapy that is designed to target pancreatic-cancer-associated antigens. In this paper, we detail recent work in immunotherapy and the advances in concept of combination therapy of immunotherapy and chemotherapy. We offer our perspective on how to increase the clinical efficacy of immunotherapies for pancreatic cancer.

  7. Current status of oral cancer chemoprevention

    Institute of Scientific and Technical Information of China (English)

    Moni Abraham Kuriakose

    2008-01-01

    @@ Chemoprevention is the administration of agents to block or reverse carcinogenesis. Chemoprevention in oral cancer has been directed towards reversal of premalignant lesion and prevention of second primary tumor.

  8. LIFESTYLE AS RISK FACTOR FOR CANCER: EVIDENCE FROM HUMAN STUDIES

    OpenAIRE

    Khan, Naghma; Afaq, Farrukh; Mukhtar, Hasan

    2010-01-01

    It is increasingly appreciated that the chances of developing cancer are significantly affected by the choice of our lifestyle. There are several uncontrollable risk factors which account for the majority of cancers, but we can modify our lifestyle to reduce enhanced threat of cancer. Healthy lifestyle behaviors for cancer risk reduction include a healthy diet, weight management, regular exercise, reduction in alcohol consumption and smoking cessation. In this article, we present evidences on...

  9. Current Immunotherapeutic Approaches in Pancreatic Cancer

    OpenAIRE

    Jianlin Gong; Shigeo Koido; Hisao Tajiri; Hideo Komita; Masaki Ito; Kan Uchiyama; Kenichi Satoh; Keisuke Nagatsuma; Hiroshi Matsudaira; Toyokazu Yukawa; Shunichi Odahara; Jimi Mitobe; Yoshihisa Namiki; Shintaro Tsukinaga; Akitaka Takahara

    2011-01-01

    Pancreatic cancer is a highly aggressive and notoriously difficult to treat. As the vast majority of patients are diagnosed at advanced stage of the disease, only a small population is curative by surgical resection. Although gemcitabine-based chemotherapy is typically offered as standard of care, most patients do not survive longer than 6 months. Thus, new therapeutic approaches are needed. Pancreatic cancer cells that develop gemcitabine resistance would still be suitable targets for immuno...

  10. Exercise after breast cancer treatment: current perspectives

    OpenAIRE

    Dieli-Conwright CM; Orozco BZ

    2015-01-01

    Christina M Dieli-Conwright, Breanna Z Orozco Division of Biokinesiology and Physical Therapy, Women's Health and Exercise Laboratory, University of Southern California, Los Angeles, CA, USA Abstract: Over the past 2 decades, great strides have been made in the field of exercise-oncology research, particularly with breast cancer. This area of research is particularly important since there are >2.8 million breast cancer survivors who are in need of an intervention that can offs...

  11. [Cervical cancer screening in Switzerland - current practice and future challenges].

    Science.gov (United States)

    Untiet, Sarah; Schmidt, Nicole; Low, Nicola; Petignat, Patrick

    2013-04-01

    At the beginning of the 20th Century, cervical cancer was the leading cause of death from cancer in women. A marked decline in cervical cancer has been observed since the 1960s, in parallel with the introduction of the Papanicolau (Pap) test as a cytological screening method. Today, Pap smear screening is still the most widely used tool for cervical cancer prevention. Testing for human papillomavirus (HPV) in cervical specimens or a combination of Pap and HPV testing are also now available. In this article we compare current guidelines for cervical cancer screening in Switzerland with those in other European countries. In view of the opportunities offered by HPV testing and, since 2008, HPV vaccination, current guidelines for cervical cancer screening should be updated. Both the choice of screening tests and general organization of cervical cancer screening should be reviewed.

  12. Diet and colorectal cancer: current evidence for etiology and prevention Dieta y cáncer colorrectal: evidencia actual sobre la etiología y la prevención

    Directory of Open Access Journals (Sweden)

    F. G. Campos

    2005-02-01

    Full Text Available The etiology of colorectal cancer (CRC involves the interaction of cell molecular changes and environmental factors, with a great emphasis on diet components. But the paths connecting lifestyle characteristicas and the colorectal carcinogenesis remain unclear. Several risk factors are commonly found in western diets, such as high concentrations of fat and animal protein, as well as low amounts of fiber, fruits and vegetables. A large number of experimental studies have found a counteractive effect of fiber on neoplasia induction, especially in relation to fermentable fiber (wheat bran and cellulose. Epidemiological correlation studies have also indicated that a greater ingestion of vegetables, fruit, cereal and seeds is associated to a lower risk for colorectal neoplasia. Moreover, beneficial properties of fiber (especially from vegetable sources were documented in more than half of case-control studies. Nevertheless, recent epidemiological data from longitudinal and randomized trials tended not to support this influence. Future research should evaluate what sources of fiber provide effective anti-neoplasic protection, carrying out interventional studies with specific fibers for longer periods. Red meat, processed meats, and perhaps refines carbohydrates are also implicated in CRC risk. Recommendantions to decrease red meat intake are well accepted, although the total amount and composition of specific fatty acids may have distinct roles in this setting. Current evidence favors the substitution of long and medium-chain fatty acids and arachidonic acid for short-chain fatty acids and eicosapentaenoic acid. Excess boy weight and excess energy intake inducing hyperinsulinemia have been also associated to CRC, as well as personal habits such as physical inactivy, high alcohol consumption, smoking and low consumption of folate and methionine. Thus, current recommendations for decreasing the risk of CRC include dietary measures such as increased plant

  13. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

    Science.gov (United States)

    Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

    2016-01-01

    This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. PMID:27372845

  14. Emerging Breast Cancer Epidemic: Evidence from Africa

    OpenAIRE

    Ogundiran, Temidayo O; Akarolo-Anthony, Sally Nneoma Sarah; Adebamowo, Clement Adebayo

    2010-01-01

    Cancer is an increasingly important public health problem in developing countries, including Africa [1]. As public and professional awareness of the cancer problem has grown, so has interest in the pattern of disease presentation, its epidemiology and treatment outcome. To date, however, there has been limited research about breast cancer in Africa. In the absence of systematic population-based cancer registration, most information has come from small clinical and pathology case series and th...

  15. [Current status of robotic surgery for gastric cancer].

    Science.gov (United States)

    Suda, Koichi; Ishida, Yoshinori; Uyama, Ichiro

    2014-11-01

    Robotic surgery was launched in Japan in 2000.In particular, the development of the da Vinci S Surgical System was a major breakthrough. It was introduced in Japan for the first time through our hospital in January 2009. Since then, the number of surgical robots used has been dramatically increasing, with up to approximately 160 robots all over the country. To date, we have performed more than 500 robotic surgeries, including 180 gastrectomies, at our hospital. Our data suggest that compared with the conventional laparoscopic approach, the use of the da Vinci Surgical System in minimally invasive gastrectomy for gastric cancer might improve short-term outcomes, particularly in terms of preventing postoperative local complications. Thus, we believe that use of surgical robots become increasingly beneficial for more extensive resections and operations that require more advanced skills, even though a couple of issues remain to be solved, such as long operative time, high cost, and limited experience and evidence. In this article, the current status and future perspectives regarding robotic gastrectomy for gastric cancer are presented based on our experience and a review of the literature. PMID:25434438

  16. Current management of locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Nielsen, Mette Bak; Laurberg, Søren; Holm, Thorbjörn

    2011-01-01

    ABSTRACT Objective: A review of the literature was undertaken to provide an overview of the surgical management of locally recurrent rectal cancer (LRRC) after the introduction of total mesorectal excision (TME). Method: A systematic literature search was undertaken using PubMed, Embase, Web...

  17. Current and emerging breast cancer biomarkers

    Directory of Open Access Journals (Sweden)

    Maryam Sana

    2015-01-01

    Full Text Available Breast cancer treatment has experienced several advancements in the past few decades with the discovery of specific predictive and prognostic biomarkers that make possible the application of individualized therapies. In addition to traditional prognostic factors of breast carcinoma, molecular biomarkers have played a significant role in tumor prediction and treatment. The most frequent genetic alterations of breast cancer are gained along chromosome 1q, 8q, 17q, 20q, and 11q and losses along 8p, 13q, 16q, 18q, and 11q. Interestingly, many of these chromosomal fragments harbor known proto oncogenes or tumor suppressor genes such as BRCA1, BRCA2, p53, HER2-neu, cyclin D1, and cyclin E, which are briefly described in this review.

  18. Oral cancer, HPV infection and evidence of sexual transmission

    OpenAIRE

    Martín Hernán, Fátima; Sánchez Hernández, Juan Manuel; Cano Sánchez, Jorge; Campo, Julián; Romero, Jorge del

    2013-01-01

    The incidence of oropharyngeal cancer and oral cancer is growing worldwide, both in young non-smokers and in young non-drinkers (smoking and drinking are considered the main risk factors). Epidemiologic studies suggest a strong association between the infection by human papillomavirus (HPV), especially types 16 and 18 (high oncological risk) which have already demonstrated their etiological role in anal tumours as well as in cervix cancer. There is clear epidemiologic evidence that both types...

  19. Current therapy of small cell lung cancer

    DEFF Research Database (Denmark)

    Sorensen, M; Lassen, U; Hansen, H H

    1998-01-01

    This article reviews the most important recent clinical trials on the treatment of small cell lung cancer (SCLC). Two randomized studies addressing the timing of thoracic radiotherapy in limited stage SCLC are discussed. In the smaller of the two studies (n = 103), a survival benefit was associated...... with initial versus delayed radiotherapy. No survival differences in the larger study of the two studies were detected, which compared alternating with sequential delivery of radiotherapy (n = 335). The optimal way to deliver radiotherapy still must be defined. Two small, randomized studies on dose intensity...

  20. Evidence for current diagnostic criteria of diabetes mellitus

    Science.gov (United States)

    Kumar, Ritesh; Nandhini, Lakshmana Perumal; Kamalanathan, Sadishkumar; Sahoo, Jayaprakash; Vivekanadan, Muthupillai

    2016-01-01

    Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications. PMID:27660696

  1. Current Treatment of Toxoplasma Retinochoroiditis: An Evidence-Based Review

    Directory of Open Access Journals (Sweden)

    Meredith Harrell

    2014-01-01

    Full Text Available Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC. Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014 using the keyword ‘‘ocular toxoplasmosis’’. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.

  2. Evidence for current diagnostic criteria of diabetes mellitus.

    Science.gov (United States)

    Kumar, Ritesh; Nandhini, Lakshmana Perumal; Kamalanathan, Sadishkumar; Sahoo, Jayaprakash; Vivekanadan, Muthupillai

    2016-09-15

    Diabetes mellitus is a non-communicable metabolic derangement afflicting several millions of individuals globally. It is associated with several micro and macrovascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Association (ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of evidence.This review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose (FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications. PMID:27660696

  3. Current perspectives and emerging issues on cancer rehabilitation.

    Science.gov (United States)

    Stubblefield, Michael D; Hubbard, Gill; Cheville, Andrea; Koch, Uwe; Schmitz, Kathryn H; Dalton, Susanne Oksbjerg

    2013-06-01

    Cancer rehabilitation is a rapidly emerging and evolving medical field in both Europe and the United States, in large part because of increases in the number of cancer survivors. Although few argue with the need to restore function and quality of life to patients affected by cancer and its treatments, differences exist between European countries with regard to the funding, accessibility, and even the definition of cancer rehabilitation services. In the United States, there is tremendous variability in the provision of rehabilitation services resulting from a variety of factors, including a lack of highly trained cancer rehabilitation physicians and therapists as well as a lack of comprehensive cancer rehabilitation programs, even at the majority of top cancer centers. Although studies evaluating the effectiveness of rehabilitation programs in the cancer setting, particularly exercise, have influenced clinical decision-making in both Europe and the United States for some time, this emerging evidence base also is now starting to influence guideline and policy making. Coordinated research efforts are essential to establish a robust framework to support future investigation and establish shared initiatives. Determining the best way forward for cancer survivors will require investment in large-scale prospective cohort studies that sufficiently describe their rehabilitation needs through the continuum of the survivorship experience.

  4. Current Evidence and Insights about Genetics in Thoracic Aorta Disease

    Directory of Open Access Journals (Sweden)

    Gianluigi Bisleri

    2013-01-01

    Full Text Available Thoracic aortic aneurysms have been historically considered to be caused by etiologic factors similar to those implied in abdominal aortic aneurysms. However, during the past decade, there has been increasing evidence that almost 20% of thoracic aortic aneurysms may be associated with a genetic disease, often within a syndromic or familial disorder. Moreover, the presence of congenital anomalies, such as bicuspid aortic valve, may have a unique common genetic underlying cause. Finally, also sporadic forms have been found to be potentially associated with genetic disorders, as highlighted by the analysis of rare variants and expression of specific microRNAs. We therefore sought to perform a comprehensive review of the role of genetic causes in the development of thoracic aortic aneurysms, by analyzing in detail the current evidence of genetic alterations in syndromes such as Marfan, Loeys-Dietz, and Ehler-Danlos, familial or sporadic forms, or forms associated with bicuspid aortic valve.

  5. Clinical Practice Guidelines for Gastric Cancer in Korea: An Evidence-Based Approach

    OpenAIRE

    Lee, Jun Haeng; Kim, Jae G; Jung, Hye-Kyung; Kim, Jung Hoon; Jeong, Woo Kyoung; Jeon, Tae Joo; Kim, Joon Mee; Kim, Young Il; Ryu, Keun Won; Kong, Seong-Ho; Kim, Hyoung-Il; Jung, Hwoon-Yong; Kim, Yong Sik; Zang, Dae Young; Cho, Jae Yong

    2014-01-01

    Although gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to those in western countries. However, there are currently no Korean multidisciplinary guidelines for gastric cancer. Experts from related societies developed guidelines de novo to meet Korean circumstances and requirements, including 23 recommendation statements for diagnosis (n=9) and treatment (n=14) based on relevant key questions. The quality of the evidence was rated according to th...

  6. [Breast cancer screening in Austria: Key figures, age limits, screening intervals and evidence].

    Science.gov (United States)

    Jeitler, Klaus; Semlitsch, Thomas; Posch, Nicole; Siebenhofer, Andrea; Horvath, Karl

    2015-01-01

    In January 2014, the first nationwide quality-assured breast cancer screening program addressing women aged ≥ 40 years was introduced in Austria. As part of the process of developing a patient information leaflet, the Evidence Based Medicine (EBM) Review Center of the Medical University of Graz was charged with the task of assessing the potential benefits and harms of breast cancer screening from the available evidence. Based on these results, key figures were derived for mortality, false-positive and false-negative mammography results, and overdiagnosis, considering Austria-specific incidence rates for breast cancer and breast cancer mortality. Furthermore, the current evidence regarding age limits and screening interval, which were the subjects of controversial public discussions, was analyzed. A systematic search for primary and secondary literature was performed and additional evidence was screened, e. g., evaluation reports of European breast cancer screening programs. On the basis of the available evidence and of the Austrian breast cancer mortality and incidence rates, it can be assumed that - depending on the age group - 1 to 4 breast cancer deaths can be avoided per 1,000 women screened in a structured breast cancer screening program, while the overall mortality remains unchanged. On the other hand, 150 to 200 of these 1,000 women will be affected by false-positive results and 1 to 9 women by overdiagnosis due to the structured breast cancer screening. Therefore, the overall benefit-harm balance is uncertain. If women from 40 to 44 or above 70 years of age are considered, who can also participate in the Austrian screening program, even a negative benefit-harm balance seems possible. However, with the implementation of quality standards in breast cancer screening and the dissemination of a patient information leaflet, an improvement in the medical treatment situation, specifically in terms of informed decision-making, can be expected.

  7. [Breast cancer screening in Austria: Key figures, age limits, screening intervals and evidence].

    Science.gov (United States)

    Jeitler, Klaus; Semlitsch, Thomas; Posch, Nicole; Siebenhofer, Andrea; Horvath, Karl

    2015-01-01

    In January 2014, the first nationwide quality-assured breast cancer screening program addressing women aged ≥ 40 years was introduced in Austria. As part of the process of developing a patient information leaflet, the Evidence Based Medicine (EBM) Review Center of the Medical University of Graz was charged with the task of assessing the potential benefits and harms of breast cancer screening from the available evidence. Based on these results, key figures were derived for mortality, false-positive and false-negative mammography results, and overdiagnosis, considering Austria-specific incidence rates for breast cancer and breast cancer mortality. Furthermore, the current evidence regarding age limits and screening interval, which were the subjects of controversial public discussions, was analyzed. A systematic search for primary and secondary literature was performed and additional evidence was screened, e. g., evaluation reports of European breast cancer screening programs. On the basis of the available evidence and of the Austrian breast cancer mortality and incidence rates, it can be assumed that - depending on the age group - 1 to 4 breast cancer deaths can be avoided per 1,000 women screened in a structured breast cancer screening program, while the overall mortality remains unchanged. On the other hand, 150 to 200 of these 1,000 women will be affected by false-positive results and 1 to 9 women by overdiagnosis due to the structured breast cancer screening. Therefore, the overall benefit-harm balance is uncertain. If women from 40 to 44 or above 70 years of age are considered, who can also participate in the Austrian screening program, even a negative benefit-harm balance seems possible. However, with the implementation of quality standards in breast cancer screening and the dissemination of a patient information leaflet, an improvement in the medical treatment situation, specifically in terms of informed decision-making, can be expected. PMID:26354136

  8. Oral cancer public policies: is there any evidence of impact?

    Directory of Open Access Journals (Sweden)

    Cassius Torres-Pereira

    2010-01-01

    Full Text Available Investigation in oral cancer comprises many different fields such as epidemiology, risk factors, biological markers, diagnostic testing, screening, treatment and prognosis. Although many researchers have dealt with the oral cancer problem, it is unknown if any public policy is capable of reducing its incidence around the world under the scrutiny of the scientific method. This paper aims to briefly review and discuss the literature regarding oral cancer public policies and to screen the evidence of controlled implementations of oral health policies that have been able to diminish oral cancer incidence around the globe.

  9. Treatment of gastric outlet obstruction that results fromunresectable gastric cancer: Current evidence

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Malignant gastric outlet obstruction (GOO) is a commoncondition that results from locally advanced malignanciesin the upper gastrointestinal tract, such aspancreatic, gastric, and other carcinomas. Two typesof procedures for malignant GOO, namely, gastrojejunostomy(GJ) with laparotomy or a laparoscopicapproach and endoscopic stenting (ES), are currentlyavailable. Although numerous previous reports haveclarified the benefits and drawbacks of each procedure,whether GJ or ES should be used in patients with GOOthat results from gastric cancer who may have a longerlife expectancy than patients with other malignancieshas not been determined. In this review, which focuseson gastric cancer-induced GOO, we analyzed the twosystematic reviews and a meta-analysis that comparedGJ and ES and outlined the current status of GOOtreatment. We also provide an updated review thatincludes laparoscopic GJ. Various data from 13 studiesin one review and 6 studies in another review wereanalyzed. Although the main results of the presentreview indicated that both GJ and ES were efficacioustreatments in patients with GOO that resulted fromgastric cancer, current evidence suggests that GJ maybe the preferable procedure given its good performancestatus and improved prognosis in gastric cancer patients.

  10. A current global view of environmental and occupational cancers.

    Science.gov (United States)

    Yang, Mihi

    2011-07-01

    This review is focused on current information of avoidable environmental pollution and occupational exposure as causes of cancer. Approximately 2% to 8% of all cancers are thought to be due to occupation. In addition, occupational and environmental cancers have their own characteristics, e.g., specific chemicals and cancers, multiple factors, multiple causation and interaction, or latency period. Concerning carcinogens, asbestos/silica/wood dust, soot/polycyclic aromatic hydrocarbons [benzo(a) pyrene], heavy metals (arsenic, chromium, nickel), aromatic amines (4-aminobiphenyl, benzidine), organic solvents (benzene or vinyl chloride), radiation/radon, or indoor pollutants (formaldehyde, tobacco smoking) are mentioned with their specific cancers, e.g., lung, skin, and bladder cancers, mesothelioma or leukemia, and exposure routes, rubber or pigment manufacturing, textile, painting, insulation, mining, and so on. In addition, nanoparticles, electromagnetic waves, and climate changes are suspected as future carcinogenic sources. Moreover, the aspects of environmental and occupational cancers are quite different between developing and developed countries. The recent follow-up of occupational cancers in Nordic countries shows a good example for developed countries. On the other hand, newly industrializing countries face an increased burden of occupational and environmental cancers. Developing countries are particularly suffering from preventable cancers in mining, agriculture, or industries without proper implication of safety regulations. Therefore, industrialized countries are expected to educate and provide support for developing countries. In addition, citizens can encounter new environmental and occupational carcinogen nominators such as nanomaterials, electromagnetic wave, and climate exchanges. As their carcinogenicity or involvement in carcinogenesis is not clearly unknown, proper consideration for them should be taken into account. For these purposes, new

  11. Current medical treatment of estrogen receptor-positive breast cancer

    Institute of Scientific and Technical Information of China (English)

    Franco; Lumachi; Davide; A; Santeufemia; Stefano; MM; Basso

    2015-01-01

    Approximately 80% of breast cancers(BC) are estrogen receptor(ER)-positive and thus endocrine therapy(ET) should be considered complementary to surgery in the majority of patients. The advantages of oophorectomy, adrenalectomy and hypophysectomy in women with advanced BC have been demonstrated many years ago, and currently ET consist of(1) ovarian function suppression(OFS), usually obtained using gonadotropinreleasing hormone agonists(Gn RHa);(2) selective estrogen receptor modulators or down-regulators(SERMs or SERDs); and(3) aromatase inhibitors(AIs), or a combination of two or more drugs. For patients aged less than 50 years and ER+ BC, there is no conclusive evidence that the combination of OFS and SERMs(i.e., tamoxifen) or chemotherapy is superior to OFS alone. Tamoxifen users exhibit a reduced risk of BC, both invasive and in situ, especially during the first 5 years of therapy, and extending the treatment to 10 years further reduced the risk of recurrences. SERDs(i.e., fulvestrant) are especially useful in the neoadjuvant treatment of advanced BC, alone or in combination with either cytotoxic agents or AIs. There are two types of AIs: type Ⅰ are permanent steroidal inhibitors of aromatase, while type Ⅱ are reversible nonsteroidal inhibitors. Several studies demonstrated the superiority of the third-generation AIs(i.e., anastrozole and letrozole) compared with tamoxifen, and adjuvant therapy with AIs reduces the recurrence risk especially in patients with advanced BC. Unfortunately, some cancers are or became ET-resistant, and thus other drugs have been suggested in combination with SERMs or AIs, including cyclin-dependent kinase 4/6 inhibitors(palbociclib) and mammalian target of rapamycin(m TOR) inhibitors, such as everolimus. Further studies are required to confirm their real usefulness.

  12. Optimal breast cancer screening strategies for older women: current perspectives

    Directory of Open Access Journals (Sweden)

    Braithwaite D

    2016-02-01

    Full Text Available Dejana Braithwaite,1 Joshua Demb,1 Louise M Henderson2 1Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 2Department of Radiology, University of North Carolina, Chapel Hill, NC, USA Abstract: Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models. Keywords: aging, breast cancer, precision cancer screening

  13. Current Status and Challenges of Cancer Clinical Trials in Korea

    OpenAIRE

    Shim, Byoung Yong; Park, Se Hoon; Lee, Soonil; Kim, Jin-Soo; Lee, Kyoung Eun; Kang, Yoon-Koo; Ahn, Myung-Ju

    2015-01-01

    Purpose Cancer clinical trials in Korea have rapidly progressed in terms of quantity and quality during the last decade. This study evaluates the current status of cancer clinical trials in Korea and their associated problems. Materials and Methods We analyzed the clinical trials approved by the Korea Food and Drug Administration (KFDA) between 2007 and 2013. A nationwide on-line survey containing 22 questions was also performed with several cooperative study groups and individual researchers...

  14. Cancer screening in the United States, 2015: a review of current American cancer society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Manassaram-Baptiste, Deana; Brooks, Durado; Doroshenk, Mary; Fedewa, Stacey; Saslow, Debbie; Brawley, Otis W; Wender, Richard

    2015-01-01

    Each year, the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection along with a report on data and trends in cancer screening rates and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines. The latest data on utilization of cancer screening from the National Health Interview Survey (NHIS) also is described, as are several issues related to screening coverage under the Affordable Care Act, including the expansion of the Medicaid program.

  15. Dietary copper and human health: Current evidence and unresolved issues.

    Science.gov (United States)

    Bost, Muriel; Houdart, Sabine; Oberli, Marion; Kalonji, Esther; Huneau, Jean-François; Margaritis, Irène

    2016-05-01

    Although copper (Cu) is recognized as an essential trace element, uncertainties remain regarding Cu reference values for humans, as illustrated by discrepancies between recommendations issued by different national authorities. This review examines human studies published since 1990 on relationships between Cu intake, Cu balance, biomarkers of Cu status, and health. It points out several gaps and unresolved issues which make it difficult to assess Cu requirements. Results from balance studies suggest that daily intakes below 0.8 mg/day lead to net Cu losses, while net gains are consistently observed above 2.4 mg/day. However, because of an incomplete collection of losses in all studies, a precise estimation of Cu requirements cannot be derived from available data. Data regarding the relationship between Cu intake and potential biomarkers are either too preliminary or inconclusive because of low specificity or low sensitivity to change in dietary Cu over a wide range of intakes. Results from observation and intervention studies do not support a link between Cu and a risk of cardiovascular disease, cognitive decline, arthritis or cancer for intakes ranging from 0.6 to 3mg/day, and limited evidence exists for impaired immune function in healthy subjects with a very low (0.38 mg/day) Cu intake. However, data from observation studies should be regarded with caution because of uncertainties regarding Cu concentration in various foods and water. Further studies that accurately evaluate Cu exposure based on reliable biomarkers of Cu status are needed.

  16. [Immunooncology in Urologic Cancers: Current Status].

    Science.gov (United States)

    Grimm, M-O

    2016-09-01

    Immune checkpoint inhibitors are establishing itselves as a new systemic treatment option (in addition to chemotherapy and targeted therapy) for metastatic tumours. (Re)activating the immune system, these antibodies may lead to impressive remissions lasting for a long time in some patients. Regarding urological tumours, the anti-PD-1 antibody Nivolumab (Opdivo(®)) has been approved this year for advanced, previously treated renal cell carcinoma. In the United States, Atezolizumab (Tecentriq(®)) has been approved for metastatic urothelial carcinoma after platinum-based chemotherapy. In patients pre-treated with antiangiogenic drugs, Nivolumab has achieved a higher rate of remission (25 vs. 5%) and a 5.4-month increase in overall survival compared with Everolimus. An indirect comparison with chemotherapy demonstrates an increased remission rate (15%) and an increased 1-year survival rate (37%) for urothelial carcinoma after platinum-based chemotherapy with Atezolizumab. The frequency of side-effects resulting from these treatments is comparatively low. However, some patients experience what is called immune-mediated side-effects, which must be recognised and treated in a timely manner. Immune checkpoint inhibitors are being tested in numerous ongoing phase III clinical trials and have the potential to replace current first-line treatment options for metastatic tumours such as urothelial and renal cell carcinoma. These trials are also investigating anti-PD-1/anti-PD-L1 antibodies in combination with CTLA4 immune checkpoint inhibitors or antiangiogenic treatments. Approval trials are also investigating the role of immune checkpoint inhibitors in the adjuvant setting. PMID:27680188

  17. DNA evidence: current perspective and future challenges in India.

    Science.gov (United States)

    Verma, Sunil K; Goswami, Gajendra K

    2014-08-01

    Since the discovery of DNA fingerprinting technology in 1985 it has been used extensively as evidence in the court of law world-wide to establish the individual identity both in civil and criminal matters. In India, the first case of parentage dispute solved by the use of DNA fingerprinting technology was in 1989. Since then till date, the DNA technology has been used not only to resolve the cases of paternity and maternity disputes, but also for the establishment of individual identity in various criminal cases and for wildlife forensic identification. Since last half a decade, India is exercising to enact legislation on the use of DNA in the judicial realm and the draft 'Human DNA Bill-2012' is pending in the parliament. Largely, the promoters of forensic DNA testing have anticipated that DNA tests are nearly infallible and DNA technology could be the greatest single advance step in search for truth, conviction of the perpetrator, and acquittal of the innocent. The current article provides a comprehensive review on the status of DNA testing in India and elucidates the consequences of the admissibility of DNA as 'evidence' in the judicial dominion. In this backdrop of civil and criminal laws and changing ethical and societal attitudes, it is concluded that the DNA legislation in India and world-wide needs to be designed with utmost care.

  18. DNA evidence: current perspective and future challenges in India.

    Science.gov (United States)

    Verma, Sunil K; Goswami, Gajendra K

    2014-08-01

    Since the discovery of DNA fingerprinting technology in 1985 it has been used extensively as evidence in the court of law world-wide to establish the individual identity both in civil and criminal matters. In India, the first case of parentage dispute solved by the use of DNA fingerprinting technology was in 1989. Since then till date, the DNA technology has been used not only to resolve the cases of paternity and maternity disputes, but also for the establishment of individual identity in various criminal cases and for wildlife forensic identification. Since last half a decade, India is exercising to enact legislation on the use of DNA in the judicial realm and the draft 'Human DNA Bill-2012' is pending in the parliament. Largely, the promoters of forensic DNA testing have anticipated that DNA tests are nearly infallible and DNA technology could be the greatest single advance step in search for truth, conviction of the perpetrator, and acquittal of the innocent. The current article provides a comprehensive review on the status of DNA testing in India and elucidates the consequences of the admissibility of DNA as 'evidence' in the judicial dominion. In this backdrop of civil and criminal laws and changing ethical and societal attitudes, it is concluded that the DNA legislation in India and world-wide needs to be designed with utmost care. PMID:24967868

  19. Vascular interventional radiology. Current evidence in endovascular surgery. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Cowling, Mark G. (ed.) [Univ. Hospital North Staffordshire, Stoke-on-Trent (United Kingdom). Dept. of Radiology

    2012-11-01

    Succinct chapters that will allow readers to identify quickly the information that they need. Ideally sized book for storage and use in the interventional suite. Contains sufficient detail for trainees in endovascular therapy/interventional radiology to gain a thorough grasp of the relevant issues. Fully updated to reflect recent advances. This new edition of Vascular Interventional Radiology: Current Evidence in Endovascular Surgery provides a thorough yet succinct and accessible review of the latest knowledge in the field of endovascular surgery. All chapters have been updated to reflect the advances that have occurred during the past five years, and new chapters are included on carotid artery stenting and day case intervention. The chapter on lower limb veno-occlusive disease has been expanded to include management of deep venous thrombosis. Among the other topics considered are the endovascular treatment options in different arterial territories, aneurysm repair techniques, and the management of venous stenosis and venous insufficiency. The aim throughout is to tackle issues of evidence-based practice in order to assist trainees and experienced practitioners in making and implementing treatment decisions. This book will be an invaluable source of information for both interventional radiologists and vascular surgeons with an interest in endovascular techniques.

  20. Cancer survivorship research: a review of the literature and summary of current NCI-designated cancer center projects.

    Science.gov (United States)

    Harrop, J Phil; Dean, Julie A; Paskett, Electra D

    2011-10-01

    The number of cancer survivors and the amount of cancer survivorship research have grown substantially during the past three decades. This article provides a review of interventional and observational cancer survivorship research efforts as well as a summary of current cancer survivorship research projects being conducted by National Cancer Institute-designated cancer centers in an effort to identify areas that need further attention.

  1. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening.

    Science.gov (United States)

    Smith, Robert A; Brooks, Durado; Cokkinides, Vilma; Saslow, Debbie; Brawley, Otis W

    2013-01-01

    Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, current ACS cancer screening guidelines are summarized, as are updated guidelines on cervical cancer screening and lung cancer screening with low-dose helical computed tomography. The latest data on the use of cancer screening from the National Health Interview Survey also are described, as are several issues related to screening coverage under the Patient Protection and Affordable Care Act of 2010.

  2. Diet and colorectal cancer: current evidence for etiology and prevention Dieta y cáncer colorrectal: evidencia actual sobre la etiología y la prevención

    OpenAIRE

    F. G. Campos; A. G. Logullo Waitzberg; D. R. Kiss; D. L. Waitzberg; Habr-Gama, A.; Gama-Rodrigues, J.

    2005-01-01

    The etiology of colorectal cancer (CRC) involves the interaction of cell molecular changes and environmental factors, with a great emphasis on diet components. But the paths connecting lifestyle characteristicas and the colorectal carcinogenesis remain unclear. Several risk factors are commonly found in western diets, such as high concentrations of fat and animal protein, as well as low amounts of fiber, fruits and vegetables. A large number of experimental studies have found a counteractive ...

  3. Current issues in the targeted therapy of advanced colorectal cancer.

    NARCIS (Netherlands)

    Knijn, N.; Tol, J.; Punt, C.J.A.

    2010-01-01

    Currently used cytotoxic drugs in the treatment of advanced colorectal cancer (ACC) are primarily the fluoropyrimidines, irinotecan, and oxaliplatin. The introduction of targeted therapy has increased the therapeutic arsenal. Two classes of monoclonal antibodies have been approved for clinical use i

  4. Alcohol Intake and Breast Cancer Risk: Weighing the Overall Evidence

    OpenAIRE

    McDonald, Jasmine A; Goyal, Abhishek; Terry, Mary Beth

    2013-01-01

    Moderate alcohol consumption has been linked to an approximate 30-50% increased risk in breast cancer. Case-control and cohort studies have consistently observed this modest increase. We highlight recent evidence from molecular epidemiologic studies and studies of intermediate markers like mammographic density that provide additional evidence that this association is real and not solely explained by factors/correlates of the exposure and outcome present in non-randomized studies. We also revi...

  5. [Medicinal plants in cancer patients: current practices and evaluation data].

    Science.gov (United States)

    Huet, Matthieu

    2013-05-01

    Many complementary and alternatives medicines are offered to patients with cancer. Among them, herbal medicines have a substantial place. These plants are mainly used to reduce adverse effects of anticancer treatments and for specific anticancer properties. Our review shows that only few clinical data support medicinal plants effectiveness in cancer patients. Arguments rely mainly on usual indications and pharmacological data for minimization of treatments toxicity while for the anticancer properties, on epidemiological and preclinical data. To inform and counsel patients and people around, healthcare professionals need to evaluate benefit-risk balance on evidence-based information. Because the medical decision should be shared with the patient, his beliefs and preferences have to be considered. When no adverse effect or drug interaction is associated with herbal medicine, we state that their use is acceptable. This paper discuss of potential risk and benefit of the most used medicinal plants by cancer patients.

  6. Contrary to Evidence, Some Doctors Recommend Ovarian Cancer Screening | Division of Cancer Prevention

    Science.gov (United States)

    One in three doctors believes that screening for ovarian cancer is effective, according to a recently published survey of practicing physicians, even though substantial evidence to the contrary exists. |

  7. [Hierarchy of evidence: levels of evidence and grades of recommendation from current use].

    Science.gov (United States)

    Manterola, Carlos; Asenjo-Lobos, Claudla; Otzen, Tamara

    2014-12-01

    There are multiple proposals and classifications that hierarchize evidence, which may confuse those who are dedicated to generate it both in health technology assessments, as for the development of clinical guidelines, etc. The aim of this manuscript is to describe the most commonly used classifications of levels of evidence and grades of recommendation, analyzing their main differences and applications so that the user can choose the one that better suits your needs and take this health decisions basing their practice on the best available evidence. A systematic literature search was performed in PubMed and MEDLINE databases and in Google, Yahoo and Ixquick search engines. A wealth of information concerning levels of evidence and degrees recommendation was obtained. It was summarized the information of the 11 proposals more currently used (CTFPHC, Sackett, USPSTF, CEBM, GRADE, SIGN, NICE, NHMRC, PCCRP, ADA y ACCF/AHA), between which it emphasizes the GRADE WORKING GROUP, incorporated by around 90 national and international organizations such as the World Health Organization, The Cochrane Library, American College of Physicians, American Thoracic Society, UpToDate, etc.; and locally by the Ministry of Health to create clinical practice guidelines.

  8. Prostate Cancer Registries: Current Status and Future Directions

    OpenAIRE

    Gandaglia, G; Bray, F.; Cooperberg, MR; Karnes, RJ; Leveridge, MJ; Moretti, K; Murphy, DG; Penson, DF; Miller, DC

    2016-01-01

    © 2015 European Association of Urology. Context: Disease-specific registries that enroll a considerable number of patients play a major role in prostate cancer (PCa) research. Objective: To evaluate available registries, describe their strengths and limitations, and discuss the potential future role of PCa registries in outcomes research. Evidence acquisition: We performed a literature review of the Medline, Embase, and Web of Science databases. The search strategy included the terms prostate...

  9. Breast cancer pain management - A review of current & novel therapies

    Directory of Open Access Journals (Sweden)

    Aanchal Satija

    2014-01-01

    Full Text Available Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients′ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO′s three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients.

  10. Infant Nutrition and Later Health: A Review of Current Evidence

    Directory of Open Access Journals (Sweden)

    Caroline Fall

    2012-07-01

    Full Text Available There is a growing recognition of the need for a lifecourse approach to understanding the aetiology of adult disease, and there is now significant evidence that links patterns of infant feeding to differences in health outcomes, both in the short and longer term. Breastfeeding is associated with lower rates of infection in infancy; in high-income populations, it is associated with reductions in blood pressure and total blood cholesterol, and lower risks of obesity and diabetes in adult life. Breastfeeding rates are suboptimal in many countries, and strategies to promote breastfeeding could therefore confer important benefits for health at a population level. However, there are particular challenges in defining nutritional exposures in infancy, including marked social gradients in initiation and duration of breastfeeding. In recent studies of low and middle-income populations of children and young adults, where the influences on infant feeding practice differ, beneficial effects of breastfeeding on blood pressure, BMI and risk of diabetes have not been confirmed, and further information is needed. Little is currently known about the long-term consequences of differences in the timing and nature of the weaning diet. Future progress will depend on new studies that provide detailed prospective data on duration and exclusivity of breastfeeding together with appropriate characterisation of the weaning diet.

  11. Targeted temperature management: Current evidence and practices in critical care

    Directory of Open Access Journals (Sweden)

    Saurabh Saigal

    2015-01-01

    Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.

  12. Targeted temperature management: Current evidence and practices in critical care.

    Science.gov (United States)

    Saigal, Saurabh; Sharma, Jai Prakash; Dhurwe, Ritika; Kumar, Sanjay; Gurjar, Mohan

    2015-09-01

    Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI), meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios. PMID:26430341

  13. [Overview of current modalities of colorectal cancer screening].

    Science.gov (United States)

    Kajzrlíková, Ivana Mikoviny; Vítek, Petr

    2016-04-01

    There are one-step and two-steps programs for colorectal cancer screening. The aim of all screening examinations is to detect early stage of the disease in asymptomatic patient. The aim of this article is actual review of current screening modalities such as fecal occult blood test, flexible sigmoideoscopy, colonoscopy, CT colonography, capsule endoscopy, blood-based tests and stool DNA tests. Colonoscopy still remains the gold standard for detection of colorectal neoplasias. In majority of countries worldwide programs for colorectal cancer screening are based on immunochemical fecal occult blood test followed by colonoscopy when positive.

  14. Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline

    Directory of Open Access Journals (Sweden)

    Alexander H. G. Paterson

    2013-12-01

    Full Text Available Bone loss is common in patients with breast cancer. Bone modifying agents (BMAs, such as bisphosphonates and denosumab, have been shown to reverse or stabilize bone loss and may be useful in the primary and metastatic settings. The purpose of this review is to provide clear evidence-based strategies for the management of bone loss and its symptoms in breast cancer. A systematic review of clinical trials and meta-analyses published between 1996 and 2012 was conducted of MEDLINE and EMBASE. Reference lists were hand-searched for additional publications. Recommendations were developed based on the best available evidence. Zoledronate, pamidronate, clodronate, and denosumab are recommended for metastatic breast cancer patients; however, no one agent can be recommended over another. Zoledronate or any oral bisphosphonate and denosumab should be considered in primary breast cancer patients who are postmenopausal on aromatase inhibitor therapy and have a high risk of fracture and/or a low bone mineral density and in premenopausal primary breast cancer patients who become amenorrheic after therapy. No one agent can be recommended over another. BMAs are not currently recommended as adjuvant therapy in primary breast cancer for the purpose of improving survival, although a major Early Breast Cancer Cooperative Trialists’ Group meta-analysis is underway which may impact future practice. Adverse events can be managed with appropriate supportive care.

  15. Surgery for gastric cancer: An evidence-based perspective

    Directory of Open Access Journals (Sweden)

    D'souza Melroy

    2009-01-01

    Full Text Available Despite a decreasing incidence, stomach cancer is the second leading cause of cancer mortality worldwide. Surgical resection offers the only chance for cure in this aggressive cancer. The surgical management of gastric cancer has witnessed numerous debates in the past decades. These include the extent of lymphadenectomy, extent of surgery, role of laparoscopic gastrectomy, and the impact of high volume of centers, on the outcome of surgery. This review attempts to address these controversies with an evidence-based perspective. A literature search in MEDLINE (www.pubmed.org has been performed with the relevant key words and corresponding MeSH terms. The search has been limited to English publications on human subjects. A manual search of the bibliographies has also been carried out, to identify the relevant publications for possible inclusion.

  16. Brain Cancer Stem Cells: Current Status on Glioblastoma Multiforme

    International Nuclear Information System (INIS)

    Glioblastoma multiforme (GBM), an aggressive brain tumor of astrocytic/neural stem cell origin, represents one of the most incurable cancers. GBM tumors are highly heterogeneous. However, most tumors contain a subpopulation of cells that display neural stem cell characteristics in vitro and that can generate a new brain tumor upon transplantation in mice. Hence, previously identified molecular pathways regulating neural stem cell biology were found to represent the cornerstone of GBM stem cell self-renewal mechanism. GBM tumors are also notorious for their resistance to radiation therapy. Notably, GBM “cancer stem cells” were also found to be responsible for this radioresistance. Herein, we will analyze the data supporting or not the cancer stem cell model in GBM, overview the current knowledge regarding GBM stem cell self-renewal and radioresistance molecular mechanisms, and discuss the potential therapeutic application of these findings

  17. A-bomb radiation and evidence of late effects other than cancer.

    Science.gov (United States)

    Stewart, A M; Kneale, G W

    1990-06-01

    Cancer risk coefficients for ionizing radiation are currently based on the assumption that, after the bombing of Hiroshima and Nagasaki, there were no late effects of early selection (survival of the fittest) or acute marrow damage. These negative findings were the result of applying a linear model of relative risk to the deaths of 5-y survivors. By applying a linear-quadratic model to these deaths (i.e., a model with more than one degree of freedom), we have obtained evidence of longstanding competition between selection effects of the early deaths and other radiation effects, and also evidence that late effects of radiation include marrow damage as well as cancer. Consequently, the present method of risk estimation--by linear extrapolation of high dose effects--should no longer be used for estimating the cancer effects of occupational exposures or background radiation. PMID:2345104

  18. Current status of bevacizumab in advanced ovarian cancer

    Directory of Open Access Journals (Sweden)

    Tomao F

    2013-07-01

    Full Text Available Federica Tomao,1,* Anselmo Papa,2,* Luigi Rossi,2 Davide Caruso,2 Pierluigi Benedetti Panici,1 Martina Venezia,2 Silverio Tomao21Department of Gynaecology and Obstetrics, "Sapienza" University of Rome, Policlinico "Umberto I," Rome, Italy; 2Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Oncology Unit, "ICOT," Latina, Italy*Authors contributed equally to this workAbstract: Ovarian cancer is the most lethal gynecological cancer, mainly because of the delay in diagnosis. Recently, much effort has been put into investigating and introducing novel targeted agents into clinical practice, with the aim of improving prognosis and quality of life. Angiogenesis is a possible target. The aim of this review is to investigate the most common molecular pathways of angiogenesis, which have provided novel targets for tailored therapy in patients with ovarian cancer. These therapeutic strategies include monoclonal antibodies and tyrosine-kinase inhibitors. These drugs have as molecular targets vascular endothelial growth factor, vascular endothelial growth factor receptors, platelet-derived growth factor, fibroblast growth factor, and angiopoietin. Bevacizumab was investigated in several Phase III studies, with interesting results. Today, there is strong evidence for introducing bevacizumab in the treatment of patients with advanced and recurrent ovarian cancer. Nevertheless, further investigations and large clinical trials are needed to understand the safety and effectiveness of bevacizumab, the optimal duration and timing of treatment, and activity in association with other chemotherapeutic and targeted agents. It also is necessary to identify biologic factors predictive of efficacy to choose the most appropriate antiangiogenic agent in the integrated treatment of epithelial ovarian cancer.Keywords: epithelial ovarian cancer, angiogenesis, bevacizumab, vascular endothelial growth factor, chemotherapy

  19. [Surgery for pancreatic cancer: Evidence-based surgical strategies].

    Science.gov (United States)

    Sánchez Cabús, Santiago; Fernández-Cruz, Laureano

    2015-01-01

    Pancreatic cancer surgery represents a challenge for surgeons due to its technical complexity, the potential complications that may appear, and ultimately because of its poor survival. The aim of this article is to summarize the scientific evidence regarding the surgical treatment of pancreatic cancer in order to help surgeons in the decision making process in the management of these patients .Here we will review such fundamental issues as the need for a biopsy before surgery, the type of pancreatic anastomosis leading to better results, and the need for placement of drains after pancreatic surgery will be discussed.

  20. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer

    Directory of Open Access Journals (Sweden)

    Palesh O

    2012-12-01

    Full Text Available Oxana Palesh,1 Luke Peppone,2 Pasquale F Innominato,3–5 Michelle Janelsins,2 Monica Jeong,1 Lisa Sprod,7 Josee Savard,6 Max Rotatori,1 Shelli Kesler,1 Melinda Telli,1 Karen Mustian21Stanford University School of Medicine, Stanford, CA, USA; 2University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; 3INSERM, UMRS 776, Biological Rhythms and Cancers, Villejuif, France; 4Faculty of Medicine, Universite Paris Sud, le Kremlin-Bicêtre, France; 5APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse Hospital, Villejuif, France; 6Laval University, Quebec, Canada; 7University of North Carolina, Wilmington, NC, USAAbstract: Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients

  1. Bursectomy for gastric cancer: What does the evidence indicate?

    Directory of Open Access Journals (Sweden)

    S G Barreto

    2015-01-01

    Full Text Available Radical resection of the bursa omentalis (radical bursectomy as part of a curative resection for gastric cancer has been advised for close to a century. However, the postulated associated morbidity and lack of a clear benefit in terms of survival preclude its routine use. To objectively review the available evidence on the role of bursectomy as part of a curative resection for gastric cancer. A systematic search of the scientific literature was carried out using Embase, PubMed, MedLine and the Cochrane central register of controlled trials for the years 1965-2013 to obtain access to all publications, especially randomized controlled trials (RCTs, systematic reviews and meta-analyses involving bursectomy in gastric cancer with the appropriate specific search terms, namely, “bursectomy,” “stomach cancer,” “gastric cancer,” “survival,” “morbidity,” “outcomes” and “RCTs”. Using the above search strategy, a total of 29 publications was retrieved of which five publications were identified describing bursectomy and its outcomes in gastric cancer. These included three retrospective cohort studies and two publications from a single RCT. Bursectomy do not appear to add the morbidity or mortality of the overall surgery. However, it did not appear to significantly improve overall survival neither in the retrospective cohort studies nor in the only RCT. The evidence to date is insufficient to suggest any additional benefit of routine bursectomy to a radical gastrectomy with D2 lymphadenectomy for gastric cancer. Results of an on-going RCT are awaited to determine if bursectomy may further improve overall survival in patients with advanced T-stage of disease.

  2. Complementary and integrative medicine for breast cancer patients - Evidence based practical recommendations.

    Science.gov (United States)

    Witt, C M; Cardoso, M J

    2016-08-01

    On average half of the breast cancer patients' population uses complementary and integrative medicine (CIM) therapies and many of them would like to receive information on CIM from their conventional treatment team. However, often they don't feel comfortable in discussing CIM related questions, with their conventional treatment team, because they think they don't have enough expertise and available time to deal with this topic. Furthermore, information on the evidence of CIM is not easily accessible and the available information is not always reliable. The purpose of the current paper is to provide: 1) an overview about the CIM interventions that have shown positive effects in breast cancer patients and might be useful in supportive cancer care, 2) practical guidance on how to choose and find a qualified referral to a CIM treatment: 3) recommendations on how these interventions could be integrated into Breast Cancer Centers and which factors should be taken into consideration in this setting. This paper takes available CIM practice guidelines for cancer patients and previous research on CIM implementation models into account. There are CIM interventions that have shown a potential to reduce symptoms of cancer or cancer treatments in breast cancer patients and the vast majority uses a non-pharmacological approach and have a good potential for implementation. Nevertheless, further and more rigorous research is still needed. PMID:27203402

  3. Barrett’s oesophagus: Evidence from the current metaanalyses

    Institute of Scientific and Technical Information of China (English)

    Piers; Gatenby; Yuen; Soon

    2014-01-01

    Guidelines have been published regarding the management of Barrett’s oesophagus(columnar-lined oesophagus). These have examined the role of surveillance in an effort to detect dysplasia and early cancer. The guidelines have provided criteria for enrolment into surveillance and some risk stratification with regard to surveillance interval. The research basis for the decisions reached with regard to cancer risk is weak and this manuscript has examined the available data published from meta-analyses up to 25 th April 2013(much of which has been published since the guidelines and their most recent updates have been written). There were 9 meta-analyses comparing patients with Barrett’s oesophagus to control populations. These have demonstrated that Barrett’s oesophagus is more common in males than females, in subjects who have ever smoked, in subjects with obesity, in subjects with prolonged symptoms of gastro-oesophageal reflux disease, in subjects who do not have infection with Helicobacter pylori and in subjects with hiatus hernia. These findings should inform public health measures in reducing the risk of Barrett’s oesophagus and subsequent surveillance burden and cancer risk. There were 8 meta-analyses comparing different groups of patients with Barrett’s oesophagus with regard to cancer risk. These have demonstrated that there was no statistically significant benefit of antireflux surgery over medical therapy, that endoscopic ablative therapy was effective in reducing cancer risk that there was similar cancer risk in patients with Barrett’s oesophagus independent of geographic origin, that the adenocarcinoma incidence in males is twice the rate in females, that the cancer risk in long segment disease showed a trend to be higher than in short segment disease, that there was a trend for higher cancer risk in low-grade dysplasia over non-dysplastic Barrett’s oesophagus, that there is a lower risk in patients with Helicobacter pylori infection and that

  4. Barrett's oesophagus: Evidence from the current meta-analyses.

    Science.gov (United States)

    Gatenby, Piers; Soon, Yuen

    2014-08-15

    Guidelines have been published regarding the management of Barrett's oesophagus (columnar-lined oesophagus). These have examined the role of surveillance in an effort to detect dysplasia and early cancer. The guidelines have provided criteria for enrolment into surveillance and some risk stratification with regard to surveillance interval. The research basis for the decisions reached with regard to cancer risk is weak and this manuscript has examined the available data published from meta-analyses up to 25(th) April 2013 (much of which has been published since the guidelines and their most recent updates have been written). There were 9 meta-analyses comparing patients with Barrett's oesophagus to control populations. These have demonstrated that Barrett's oesophagus is more common in males than females, in subjects who have ever smoked, in subjects with obesity, in subjects with prolonged symptoms of gastro-oesophageal reflux disease, in subjects who do not have infection with Helicobacter pylori and in subjects with hiatus hernia. These findings should inform public health measures in reducing the risk of Barrett's oesophagus and subsequent surveillance burden and cancer risk. There were 8 meta-analyses comparing different groups of patients with Barrett's oesophagus with regard to cancer risk. These have demonstrated that there was no statistically significant benefit of antireflux surgery over medical therapy, that endoscopic ablative therapy was effective in reducing cancer risk that there was similar cancer risk in patients with Barrett's oesophagus independent of geographic origin, that the adenocarcinoma incidence in males is twice the rate in females, that the cancer risk in long segment disease showed a trend to be higher than in short segment disease, that there was a trend for higher cancer risk in low-grade dysplasia over non-dysplastic Barrett's oesophagus, that there is a lower risk in patients with Helicobacter pylori infection and that there is a

  5. No biological evidence of XMRV in blood or prostatic fluid from prostate cancer patients.

    Directory of Open Access Journals (Sweden)

    Ramon Mendoza

    Full Text Available BACKGROUND: XMRV (xenotropic murine leukemia virus-related virus was initially discovered in association with prostate cancer and later with chronic fatigue syndrome (CFS. Its association with CFS is now largely discredited, and current results support a laboratory origin for XMRV with no reproducible evidence for infection of humans. However, some results indicating the presence of XMRV in prostate cancer are difficult to attribute to sample contamination. Here we have sought biological evidence that might confirm the presence of XMRV in prostate cancer samples previously having tested positive. METHODS AND RESULTS: We have tested for infectious XMRV and neutralizing antibodies against XMRV in blood plasma from 29 subjects with prostate cancer, and for infectious XMRV in prostate secretions from another five prostate cancer subjects. Nine of these subjects had previously tested positive for XMRV by PCR or by virus assay. We did not detect XMRV or related retroviruses in any sample, and the neutralizing activities of the plasma samples were all very low, a result inconsistent with XMRV infection of the plasma donors. CONCLUSIONS: We find no evidence for XMRV infection of any human subject tested, either by assay for infectious virus or for neutralizing antibodies. Our results are consistent with the majority of published studies on XMRV, which find that XMRV is not present in humans. The observed low to undetectable XMRV neutralization by human plasma indicates a lack of innate restriction of XMRV replication by soluble factors in human blood.

  6. Genetic-epidemiological evidence for the role of acetaldehyde in cancers related to alcohol drinking.

    Science.gov (United States)

    Eriksson, C J Peter

    2015-01-01

    Alcohol drinking increases the risk for a number of cancers. Currently, the highest risk (Group 1) concerns oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast, as assessed by the International Agency for Research on Cancer (IARC). Alcohol and other beverage constituents, their metabolic effects, and alcohol-related unhealthy lifestyles have been suggested as etiological factors. The aim of the present survey is to evaluate the carcinogenic role of acetaldehyde in alcohol-related cancers, with special emphasis on the genetic-epidemiological evidence. Acetaldehyde, as a constituent of alcoholic beverages, and microbial and endogenous alcohol oxidation well explain why alcohol-related cancers primarily occur in the digestive tracts and other tissues with active alcohol and acetaldehyde metabolism. Genetic-epidemiological research has brought compelling evidence for the causality of acetaldehyde in alcohol-related cancers. Thus, IARC recently categorized alcohol-drinking-related acetaldehyde to Group 1 for head and neck and esophageal cancers. This is probably just the tip of the iceberg, since more recent epidemiological studies have also shown significant positive associations between the aldehyde dehydrogenase ALDH2 (rs671)*2 allele (encoding inactive enzyme causing high acetaldehyde elevations) and gastric, colorectal, lung, and hepatocellular cancers. However, a number of the current studies lack the appropriate matching or stratification of alcohol drinking in the case-control comparisons, which has led to erroneous interpretations of the data. Future studies should consider these aspects more thoroughly. The polymorphism phenotypes (flushing and nausea) may provide valuable tools for future successful health education in the prevention of alcohol-drinking-related cancers.

  7. Defining the level of evidence for technology adoption in the localized prostate cancer pathway.

    Science.gov (United States)

    Valerio, Massimo; El-Shater Bosaily, Ahmed; Emberton, Mark; Ahmed, Hashim U

    2014-08-01

    New technologies in prostate cancer are attempting to change the current prostate cancer pathway by aiming to reduce harms while maintaining the benefits associated with screening, diagnosis, and treatment. In this article, we discuss the optimal evaluation that new technologies should undergo to provide level 1 evidence typically required to change the practice. With this in mind, we focus on feasible and pragmatic trials that could be delivered in a timely fashion by many centers while retaining primary outcomes that focus on clinically meaningful outcomes. PMID:24332638

  8. Vulvar cancer: initial management and systematic review of literature on currently applied treatment approaches.

    Science.gov (United States)

    Sznurkowski, Jacek Jan

    2016-07-01

    This review provides guidelines and aims to estimate utilisation rates of treatment modalities applied in vulvar cancer. Current standards of treatment are as follows: wide local excision instead of radical vulvectomy in the case of small tumour (T cancer', 'treatment' identified seven full-text manuscripts, including data on 1114 patients. Utilisation rates of neoadjuvant radiochemotherapy, chemotherapy alone, surgery, adjuvant radiotherapy and adjuvant radiochemotherapy were 5.9%, 0.3%, 89.3%, 22.6% and 0.2% respectively. An evidence-based estimation of appropriate rates of surgery, radiotherapy and chemotherapy for vulvar cancer is needed to compare management reflecting guidelines with presented here real frequency of applied modalities. PMID:26880231

  9. Prognostic stratification of colorectal cancer patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Schneider NI

    2014-07-01

    Full Text Available Nora I Schneider, Cord LangnerInstitute of Pathology, Medical University of Graz, Graz, AustriaAbstract: Tumor staging according to the American Joint Committee on Cancer/Union for International Cancer Control tumor, node, metastasis (TNM system is currently regarded as the standard for staging of patients with colorectal cancer. This system provides the strongest prognostic information for patients with early stage disease and those with advanced disease. For patients with intermediate levels of disease, it is less able to predict disease outcome. Therefore, additional prognostic markers are needed to improve the management of affected patients. Ideal markers are readily assessable on hematoxylin and eosin-stained tumor slides, and in this way are easily applicable worldwide. This review summarizes the histological features of colorectal cancer that can be used for prognostic stratification. Specifically, we refer to the different histological variants of colorectal cancer that have been identified, each of these variants carrying distinct prognostic significance. Established markers of adverse outcomes are lymphatic and venous invasion, as well as perineural invasion, but underreporting still occurs in the routine setting. Tumor budding and tumor necrosis are recent advances that may help to identify patients at high risk for recurrence. The prognostic significance of the antitumor inflammatory response has been known for quite a long time, but a lack of standardization prevented its application in routine pathology. However, scales to assess intra- and peritumoral inflammation have recently emerged, and can be expected to strengthen the prognostic significance of the pathology report.Keywords: colorectal cancer, lymphatic invasion, blood-vessel invasion, perineural invasion, tumor budding, tumor necrosis

  10. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  11. Cancer therapy with phytochemicals: evidence from clinical studies

    Directory of Open Access Journals (Sweden)

    Ahmad Ghorbani

    2015-02-01

    Full Text Available Cancer is still one of the major causes of mortality in both developing and developed countries. At this time, in spite of intensive interventions, a large number of patients have poor prognosis. Therefore, the effort for finding new anticancer agents with better efficacy and lesser side effects has continued. According to the traditional recommendations and experimental studies, numerous medicinal plants have been reported to have anticancer effect. Also antiproliferative, proapoptotic, antimetastatic and antiangiogenic effects of several phytochemicals have been shown with in vitro experiments or animal studies. However, only a small number of them were tested in cancerous patients and limited evidence exists on their clinical effectiveness. Also, regarding some phytochemicals, only beneficial effects on cancer-related symptoms or on quality of life have been reported and no positive results exist on their antitumor actions. In this review we focus on phytochemicals that their beneficial effects on various types of cancer are supported by clinical trials. Based our literature search, curcumin, green tea, resveratrol and Viscum album had satisfactory instances of clinical evidence for supporting their anticancer effects. The main findings on these phytochemicals are summarized and discussed.

  12. Current imaging strategies for the evaluation of uterine cervical cancer.

    Science.gov (United States)

    Bourgioti, Charis; Chatoupis, Konstantinos; Moulopoulos, Lia Angela

    2016-04-28

    Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.

  13. Current status of radiation therapy for prostate cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Radiotherapy for the treatment of prostate cancer has been extensively explored in the past. Along with the comprehensive understanding of the biology of prostate cancer and rapid advances in terms of technology, the outcome of treatment for the patients with prostate cancer has improved. The authors review radiotherapy as the primary treatment for the disease, with particular emphasis on the technological advances from both the radiobiological and radiophysics aspects. Nonconventional fractionated irradiation like hyper- or hypo-fractionation has been implemented in the clinic, the final results still need to be confirmed in the future. Technological advances like IMRT, IGRT,in the last two decades have significantly improved the delivery of external radiotherapy to the prostate. This has resulted in an overall increase in the total dose that can be safely delivered to the prostate, which has led to modest improvements in the biochemical outcome. However, establishing the standard therapy for prostate cancer remains controversial. It is hoped that the next decades will bring continued advances in the development of biologicals that will further improve current clinical outcomes.

  14. Postpartum family planning: current evidence on successful interventions

    Directory of Open Access Journals (Sweden)

    Blazer C

    2016-04-01

    Full Text Available Cassandra Blazer, Ndola Prata Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, CA, USA Abstract: We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations. Keywords: postpartum period, family planning, birth spacing, interventions, systematic review, contraception, less developed countries

  15. Asbestos and colon cancer: a weight-of-the-evidence review.

    OpenAIRE

    Gamble, J F

    1994-01-01

    What is the evidence that exposure to asbestos causes colon cancer? This weight-of-evidence review considers epidemiologic evidence from cohort studies of asbestos-exposed workers, case-control studies of colon cancer, animal bioassays, and other corroborative evidence. The major evidence for a causal association at high exposure is a combined colorectal standardized mortality ratio (SMR) of 1.5 for asbestos cohorts where the lung cancer SMR was greater than twofold. However, misdiagnosis may...

  16. [Evidence-Based Review of Laryngeal Cancer Surgery].

    Science.gov (United States)

    Wiegand, S

    2016-04-01

    Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number of organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery and transoral robotic surgery, have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the U.S.. Improving the evidence base in laryngeal cancer surgery by successful establishment of surgical trials should be the future goal. PMID:27128401

  17. Current nutrition promotion, beliefs and barriers among cancer nurses in Australia and New Zealand.

    Science.gov (United States)

    Puhringer, Petra G; Olsen, Alicia; Climstein, Mike; Sargeant, Sally; Jones, Lynnette M; Keogh, Justin W L

    2015-01-01

    Rationale. Many cancer patients and survivors do not meet nutritional and physical activity guidelines, thus healthier eating and greater levels of physical activity could have considerable benefits for these individuals. While research has investigated cancer survivors' perspective on their challenges in meeting the nutrition and physical guidelines, little research has examined how health professionals may assist their patients meet these guidelines. Cancer nurses are ideally placed to promote healthy behaviours to their patients, especially if access to dieticians or dietary resources is limited. However, little is known about cancer nurses' healthy eating promotion practices to their patients. The primary aim of this study was to examine current healthy eating promotion practices, beliefs and barriers of cancer nurses in Australia and New Zealand. A secondary aim was to gain insight into whether these practices, beliefs and barriers were influenced by the nurses' hospital or years of work experience. Patients and Methods. An online questionnaire was used to obtain data. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (eating prior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses felt that healthy eating had positive effects on the cancer patients' quality of life (85.4%), weight management (82.9%), mental health (80.5%), activities of daily living (79.7%) and risk of other chronic diseases (79.7%), although only 75.5% agreed or strongly agreed that this is due to a strong evidence base. Lack of time (25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited by the cancer nurses as the most common barriers to promoting healthy eating to their patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses' healthy eating promotion practices

  18. Targeting breast cancer through its microenvironment : Current status of preclinical and clinical research in finding relevant targets

    NARCIS (Netherlands)

    Nienhuis, H. H.; Gaykema, S. B. M.; Timmer-Bosscha, H.; Jalving, M.; Brouwers, A. H.; Lub-de Hooge, M. N.; van der Vegt, B.; Overmoyer, B.; de Vries, E. G. E.; Schroder, C. P.

    2015-01-01

    It is increasingly evident that not only breast cancer cells, but also the tissue embedding these cells: the tumor microenvironment, plays an important role in tumor progression, metastasis formation and treatment sensitivity. This review focuses on the current knowledge of processes by which the mi

  19. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    OpenAIRE

    Bhavani Shankar Kodali; Urman, Richard D.

    2014-01-01

    Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 ). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlat...

  20. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  1. Evidence for current sheet acceleration in the geomagnetic tail

    International Nuclear Information System (INIS)

    The existence of the current sheet and the dawn to dusk electric field in the geomagnetic tail implies there is particle energization in the tail current sheet of the order 2--10% of the total solar wind energy incident upon the dayside magnetopause. In this paper we determine that ion acceleration in a current sheet with a small magnetic field across the sheet, via single-particle motion which violates the guiding center approximation, can account for this large energization in the tail. We calculate the distribution of accelerated ions which result from the urrent sheet acceleration and compare the results with distributions of accelerated ions frequently observed flowing earthwards along the outer boundary of the plasma sheet. The comparison indicates that the observed earthward flowing ions result from current sheet acceleration. Comparison with measurements of auroral ion predictions at low precipitation at low altitudes implies that the accelerated ions ejected from the current sheet are also an important source of auroral ion precipitation. In addition, these acceletated ions may be an important source of plasma sheet ions

  2. Diet, H pylori infection and gastric cancer: Evidence and controversies

    Institute of Scientific and Technical Information of China (English)

    Alba Rocco; Gerardo Nardone

    2007-01-01

    Despite decreasing incidence and mortality rates, gastric cancer (GC) still remains the fourth most common cancer and the second most common cause of cancer-related deaths worldwide. Due to the limited treatment options,at present, prevention is likely to be the only effective means of controlling this disease. The success of a prevention strategy depends upon the understanding of etiological and pathogenic mechanisms underlying gastric carcinogenesis. The etiology of GC is multi-factorial,however, in the recent years, mounting evidence suggests that environmental factors play a key role. The most important environmental factors implicated in the pathogenesis of GC are diet and H pylori infection. Thus,modifications in lifestyle and dietary habit associated with eradication of H pylori infection could hypothetically represent the most promising potential targets for GC prevention. In this review we will address the evidence and the controversies on the role of these agents in noncardia GC by focusing on retrospective and prospective observational studies and interventional trials.

  3. Evidence of Branching Phenomena in Current-Driven Ionization Waves

    Science.gov (United States)

    Loebner, Keith T. K.; Underwood, Thomas C.; Cappelli, Mark A.

    2015-10-01

    This Letter reports the first fully consistent experimental observations of current-driven ionization waves conforming to the magnetohydrodynamic Rankine-Hugoniot model for hydromagnetic shocks. Detailed measurements of the thermodynamic and electrodynamic plasma state variables across the ionization region confirm the existence of two types of waves, corresponding to the upper and lower solution branches of the Hugoniot curve. These waves are generated by pulsed currents in a coaxial gas-fed plasma accelerator. The coupling between the state variables of this complex, transient, three-dimensional system shows a remarkable quantitative agreement of less than 8% deviation from the quasisteady, one-dimensional theoretical model.

  4. The Intertemporal Approach to the Current Account: Evidence for Chile

    Directory of Open Access Journals (Sweden)

    Sergio A. Salas Landeau

    2002-03-01

    Full Text Available This paper studies the existence of "excess" current-account imbalances in Chile in the 1960-1999 period. This phenomenon is modelled using present value tests that allow for variable interest rates and exchange rate fluctuations. Despite its simplicity, most of the observed imbalances in the current account are accounted for by the model. Results suggest that using models where agents behave as forward-looking rational agents, is a valid framework. Moreover, the analysis highlights the rel-evance of variable interest rates and exchange rates. Results also imply that capital controls, that were widely used in the period under study, were not effective.

  5. [Cancer].

    Science.gov (United States)

    de la Peña-López, Roberto; Remolina-Bonilla, Yuly Andrea

    2016-09-01

    Cancer is a group of diseases which represents a significant public health problem in Mexico and worldwide. In Mexico neoplasms are the second leading cause of death. An increased morbidity and mortality are expected in the next decades. Several preventable risk factors for cancer development have been identified, the most relevant including tobacco use, which accounts for 30% of the cancer cases; and obesity, associated to another 30%. These factors, in turn, are related to sedentarism, alcohol abuse and imbalanced diets. Some agents are well knokn to cause cancer such as ionizing radiation, viruses such as the papilloma virus (HPV) and hepatitis virus (B and C), and more recently environmental pollution exposure and red meat consumption have been pointed out as carcinogens by the International Agency for Research in Cancer (IARC). The scientific evidence currently available is insufficient to consider milk either as a risk factor or protective factor against different types of cancer. PMID:27603890

  6. Glycemic control in cardiac surgery: Rationale and current evidence

    Directory of Open Access Journals (Sweden)

    G Girish

    2014-01-01

    Full Text Available Studies in cardiac surgical patients have shown an association of hyperglycemia with increased incidences of sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias and longer intensive care and hospital stay. There is considerable controversy regarding appropriate glycemic management in these patients and in the definition of hyperglycemia and hypoglycemia or the blood sugar levels at which therapy should be initiated. There is also dilemma regarding the usage of "tight glycemic control" with studies showing conflicting evidences. Part of the controversy can be explained by the differing designs of these studies and the variable definitions of hyperglycemia and hypoglycemia.

  7. Omega-3 Fatty Acids in Modern Parenteral Nutrition: A Review of the Current Evidence

    Directory of Open Access Journals (Sweden)

    Stanislaw Klek

    2016-03-01

    Full Text Available Intravenous lipid emulsions are an essential component of parenteral nutrition regimens. Originally employed as an efficient non-glucose energy source to reduce the adverse effects of high glucose intake and provide essential fatty acids, lipid emulsions have assumed a larger therapeutic role due to research demonstrating the effects of omega-3 and omega-6 polyunsaturated fatty acids (PUFA on key metabolic functions, including inflammatory and immune response, coagulation, and cell signaling. Indeed, emerging evidence suggests that the effects of omega-3 PUFA on inflammation and immune response result in meaningful therapeutic benefits in surgical, cancer, and critically ill patients as well as patients requiring long-term parenteral nutrition. The present review provides an overview of the mechanisms of action through which omega-3 and omega-6 PUFA modulate the immune-inflammatory response and summarizes the current body of evidence regarding the clinical and pharmacoeconomic benefits of intravenous n-3 fatty acid-containing lipid emulsions in patients requiring parenteral nutrition.

  8. Revisiting reflexology: Concept, evidence, current practice, and practitioner training.

    Science.gov (United States)

    Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

    2015-10-01

    Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided. PMID:26587391

  9. Value of Travel Time Reliability: A review of current evidence

    OpenAIRE

    Carlos Carrion; David Levinson

    2010-01-01

    Travel time reliability is a fundamental factor in travel behavior. It represents the temporal uncertainty experienced by users in their movement between any two nodes in a network. The importance of the time reliability depends on the penalties incurred by the users. In road networks, travelers consider the existence of a trip travel time uncertainty in different choice situations (departure time, route, mode, and others). In this paper, a systematic review of the current state of research i...

  10. Berry fruits for cancer prevention: current status and future prospects.

    Science.gov (United States)

    Seeram, Navindra P

    2008-02-13

    Overwhelming evidence suggests that edible small and soft-fleshed berry fruits may have beneficial effects against several types of human cancers. The anticancer potential of berries has been related, at least in part, to a multitude of bioactive phytochemicals that these colorful fruits contain, including polyphenols (flavonoids, proanthocyanidins, ellagitannins, gallotannins, phenolic acids), stilbenoids, lignans, and triterpenoids. Studies show that the anticancer effects of berry bioactives are partially mediated through their abilities to counteract, reduce, and also repair damage resulting from oxidative stress and inflammation. In addition, berry bioactives also regulate carcinogen and xenobiotic metabolizing enzymes, various transcription and growth factors, inflammatory cytokines, and subcellular signaling pathways of cancer cell proliferation, apoptosis, and tumor angiogenesis. Berry phytochemicals may also potentially sensitize tumor cells to chemotherapeutic agents by inhibiting pathways that lead to treatment resistance, and berry fruit consumption may provide protection from therapy-associated toxicities. Although a wide variety of berry fruits are consumed worldwide, this paper focuses on those commonly consumed in North America, namely, blackberries, black raspberries, blueberries, cranberries, red raspberries, and strawberries. In addition, a large body of studies on singly purified berry bioactives is available, but this paper focuses on studies of "whole berries" per se, that is, as berry extracts and purified fractions, juices, and freeze-dried powders. Potential mechanisms of anticancer action and bioavailability of berry phenolics, as well as gaps in knowledge and recommendations for future berry research, are also briefly discussed. PMID:18211019

  11. Cellular phones and their hazards: the current evidence.

    Science.gov (United States)

    Munshi, Anusheel; Jalali, Rakesh

    2002-01-01

    The past decade has seen an exponential increase globally in the use of cellular phones (popularly known as mobile or cell phones). These phones are convenient and trendy. Discarding the wire means that the communication is through electromagnetic waves, which could have potential hazards. Alarmist reports in the lay press and high profile lawsuits, particularly in the West, have attracted attention to the possible harmful effects of cellular phones. Adverse effects investigated by various clinical trials include the possible link to increased risk of vehicular accidents, leukaemias, sleep disturbances and the more serious brain tumours. Available level II evidence suggests that the only proven side-effect is an increased risk of vehicular accidents. So far, all studies have consistently negated any association between cellular phones and brain tumours. Yet, the final word remains to be said.

  12. Interventions to address maternal and childhood undernutrition: current evidence.

    Science.gov (United States)

    Bhutta, Zulfiqar A; Das, Jai K

    2014-01-01

    The global burden of undernutrition remains high with little evidence of change in many countries. We reviewed the evidence of the potential nutritional interventions and estimated their effect on nutrition-related outcomes of women and children. Among the maternal interventions, daily iron supplementation results in a 69% reduction in incidence of anemia, 20% in incidence of low birthweight (LBW) and improves mean birthweight. MMN supplementation during pregnancy has been shown to significantly decrease the number of LBW infants by 14% and small for gestational age (SGA) by 13%. Balanced protein-energy supplementation reduces the incidence of SGA by 32% and risk of stillbirths by 38%. Antimalarials when given to pregnant women increase the mean birthweight significantly and were associated with a 43% reduction in LBW and severe antenatal anemia by 38%. Among the neonatal and child interventions, educational/counseling interventions increased exclusive breastfeeding by 43% at 4-6 weeks and 137% at 6 months. Vitamin A supplementation (VAS) reduces all-cause mortality by 24% and results in a 14% reduction in the risk of infant mortality at 6 months. Intermittent iron supplementation in children reduces the risk of anemia by 49% and iron deficiency by 76%, and significantly improves hemoglobin and ferritin concentration. Preventive zinc supplementation in populations at risk of zinc deficiency decreases morbidity from childhood diarrhea and acute lower respiratory infections, and increases linear growth and weight gain among infants and young children. Among the supportive interventions, hand washing with soap significantly reduces diarrhea morbidity by 48%, though it depends on access to water. The effect of water treatment on diarrhea morbidity also appears similarly large with a 17% reduction. Recent research has established linkages of preconception interventions with improved maternal, perinatal and neonatal health outcomes, and it has been suggested that several

  13. Evidence to Support the Anti-Cancer Effect of Olive Leaf Extract and Future Directions.

    Science.gov (United States)

    Boss, Anna; Bishop, Karen S; Marlow, Gareth; Barnett, Matthew P G; Ferguson, Lynnette R

    2016-08-19

    The traditional Mediterranean diet (MD) is associated with long life and lower prevalence of cardiovascular disease and cancers. The main components of this diet include high intake of fruit, vegetables, red wine, extra virgin olive oil (EVOO) and fish, low intake of dairy and red meat. Olive oil has gained support as a key effector of health benefits and there is evidence that this relates to the polyphenol content. Olive leaf extract (OLE) contains a higher quantity and variety of polyphenols than those found in EVOO. There are also important structural differences between polyphenols from olive leaf and those from olive fruit that may improve the capacity of OLE to enhance health outcomes. Olive polyphenols have been claimed to play an important protective role in cancer and other inflammation-related diseases. Both inflammatory and cancer cell models have shown that olive leaf polyphenols are anti-inflammatory and protect against DNA damage initiated by free radicals. The various bioactive properties of olive leaf polyphenols are a plausible explanation for the inhibition of progression and development of cancers. The pathways and signaling cascades manipulated include the NF-κB inflammatory response and the oxidative stress response, but the effects of these bioactive components may also result from their action as a phytoestrogen. Due to the similar structure of the olive polyphenols to oestrogens, these have been hypothesized to interact with oestrogen receptors, thereby reducing the prevalence and progression of hormone related cancers. Evidence for the protective effect of olive polyphenols for cancer in humans remains anecdotal and clinical trials are required to substantiate these claims idea. This review aims to amalgamate the current literature regarding bioavailability and mechanisms involved in the potential anti-cancer action of olive leaf polyphenols.

  14. Evidence to Support the Anti-Cancer Effect of Olive Leaf Extract and Future Directions

    Science.gov (United States)

    Boss, Anna; Bishop, Karen S.; Marlow, Gareth; Barnett, Matthew P. G.; Ferguson, Lynnette R.

    2016-01-01

    The traditional Mediterranean diet (MD) is associated with long life and lower prevalence of cardiovascular disease and cancers. The main components of this diet include high intake of fruit, vegetables, red wine, extra virgin olive oil (EVOO) and fish, low intake of dairy and red meat. Olive oil has gained support as a key effector of health benefits and there is evidence that this relates to the polyphenol content. Olive leaf extract (OLE) contains a higher quantity and variety of polyphenols than those found in EVOO. There are also important structural differences between polyphenols from olive leaf and those from olive fruit that may improve the capacity of OLE to enhance health outcomes. Olive polyphenols have been claimed to play an important protective role in cancer and other inflammation-related diseases. Both inflammatory and cancer cell models have shown that olive leaf polyphenols are anti-inflammatory and protect against DNA damage initiated by free radicals. The various bioactive properties of olive leaf polyphenols are a plausible explanation for the inhibition of progression and development of cancers. The pathways and signaling cascades manipulated include the NF-κB inflammatory response and the oxidative stress response, but the effects of these bioactive components may also result from their action as a phytoestrogen. Due to the similar structure of the olive polyphenols to oestrogens, these have been hypothesized to interact with oestrogen receptors, thereby reducing the prevalence and progression of hormone related cancers. Evidence for the protective effect of olive polyphenols for cancer in humans remains anecdotal and clinical trials are required to substantiate these claims idea. This review aims to amalgamate the current literature regarding bioavailability and mechanisms involved in the potential anti-cancer action of olive leaf polyphenols. PMID:27548217

  15. Evidence to Support the Anti-Cancer Effect of Olive Leaf Extract and Future Directions.

    Science.gov (United States)

    Boss, Anna; Bishop, Karen S; Marlow, Gareth; Barnett, Matthew P G; Ferguson, Lynnette R

    2016-01-01

    The traditional Mediterranean diet (MD) is associated with long life and lower prevalence of cardiovascular disease and cancers. The main components of this diet include high intake of fruit, vegetables, red wine, extra virgin olive oil (EVOO) and fish, low intake of dairy and red meat. Olive oil has gained support as a key effector of health benefits and there is evidence that this relates to the polyphenol content. Olive leaf extract (OLE) contains a higher quantity and variety of polyphenols than those found in EVOO. There are also important structural differences between polyphenols from olive leaf and those from olive fruit that may improve the capacity of OLE to enhance health outcomes. Olive polyphenols have been claimed to play an important protective role in cancer and other inflammation-related diseases. Both inflammatory and cancer cell models have shown that olive leaf polyphenols are anti-inflammatory and protect against DNA damage initiated by free radicals. The various bioactive properties of olive leaf polyphenols are a plausible explanation for the inhibition of progression and development of cancers. The pathways and signaling cascades manipulated include the NF-κB inflammatory response and the oxidative stress response, but the effects of these bioactive components may also result from their action as a phytoestrogen. Due to the similar structure of the olive polyphenols to oestrogens, these have been hypothesized to interact with oestrogen receptors, thereby reducing the prevalence and progression of hormone related cancers. Evidence for the protective effect of olive polyphenols for cancer in humans remains anecdotal and clinical trials are required to substantiate these claims idea. This review aims to amalgamate the current literature regarding bioavailability and mechanisms involved in the potential anti-cancer action of olive leaf polyphenols. PMID:27548217

  16. Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective

    Science.gov (United States)

    Fiore, Marco; Leone, Sebastiano

    2016-01-01

    Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease (ESLD); spontaneous fungal peritonitis (SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients, not even the antifungals used for the prophylaxis, neither optimal treatment. We reviewed, in order to focus the epidemiology, characteristics, and, considering the high mortality rate of SFP, the use of optimal empirical antifungal therapy the current literature. PMID:27678356

  17. Enteral nutrition formula selection: current evidence and implications for practice.

    Science.gov (United States)

    Brown, Britta; Roehl, Kelly; Betz, Melanie

    2015-02-01

    Many new enteral nutrition (EN) formulas have been created over the past several decades with a variety of intended uses. Although each is intended to promote improved outcomes, research is often unclear and, in many cases, conflicting. It is important to note that EN products are considered medical foods by the U.S. Food and Drug Administration and therefore do not have to complete premarket review or approval and are not regulated to the same extent as pharmaceuticals. While standard EN formulas are designed to meet the basic macro- and micronutrient requirements of individuals who cannot meet nutrition needs orally, specialty EN products have been developed to exhibit pharmacologic properties, such as immune-enhancing formulas containing arginine, glutamine, nucleotides, and ω-3 fatty acids. With the vast number of products available, rising costs of healthcare, and the drive toward evidence-based practice, it is imperative that clinicians carefully consider research regarding use of specialty formulas, paying close attention to the quality, patient population, clinical end points, and cost to patient and/or facility. PMID:25516537

  18. Micronutrients and Leptospirosis: A Review of the Current Evidence

    Science.gov (United States)

    Herman, Heather S.; Mehta, Saurabh; Cárdenas, Washington B.; Stewart-Ibarra, Anna M.

    2016-01-01

    Background Leptospirosis is one of the most widespread zoonoses and represents a major threat to human health. Due to the high burden of disease, limitations in diagnostics, and limited coverage and availability of effective human and veterinary vaccines, leptospirosis remains an important neglected zoonotic disease. Improved surveillance and identification of modifiable risk factors for leptospirosis are urgently needed to inform preventive interventions and reduce the risk and severity of Leptospira infection. Methodology/Principal Findings This review was conducted to examine the evidence that links micronutrient status and Leptospira infection. A total of 56 studies were included in this review: 28 in vitro, 17 animal, and 11 observational human studies. Findings indicated that Leptospira infection is associated with higher iron and calcium concentrations and hypomagnesemia. Conclusions/Significance Few prospective studies and no randomized trials have been conducted to date to examine the potential role of micronutrients in Leptospira infection. The limited literature in this area constrains our ability to make specific recommendations; however, the roles of iron, calcium, and magnesium in leptospirosis represent important areas for future research. The role of micronutrients in leptospirosis risk and severity needs to be elucidated in larger prospective human studies to inform public health interventions. PMID:27387046

  19. Finding current evidence: search strategies and common databases.

    Science.gov (United States)

    Gillespie, Lesley Diane; Gillespie, William John

    2003-08-01

    With more than 100 orthopaedic, sports medicine, or hand surgery journals indexed in MEDLINE, it is no longer possible to keep abreast of developments in orthopaedic surgery by reading a few journals each month. Electronic resources are easier to search and more current than most print sources. We provide a practical approach to finding useful information to guide orthopaedic practice. We focus first on where to find the information by providing details about many useful databases and web links. Sources for identifying guidelines, systematic reviews, and randomized controlled trials are identified. The second section discusses how to find the information, from the first stage of formulating a question and identifying the concepts of interest, through to writing a simple strategy. Sources for additional self-directed learning are provided.

  20. The current role of radiotherapy in colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Aleman, B.M.P.; Bartelink, H. [Nederlands Kanker Inst. `Antoni van Leeuwenhoekhuis`, Amsterdam (Netherlands); Gunderson, L.L. [Mayo Clinic, Rochester, MN (United States)

    1995-07-01

    During the last two decades, radiotherapy has become an integral part of the multidisciplinary approach in the treatment of patients with colorectal cancer. Currently, radiotherapy is seen mainly as an adjuvant therapy, sometimes in combination with chemotherapy, in a pre- or post-operative setting. Adjuvant radiotherapy alone leads to a significant reduction of local recurrence rates, but an impact on survival is seen only in subset analyses. Combined modality treatment can reduce local recurrence rates even further, and can also reduce the rate of distant relapses and increase survival. The acute toxicity of combined modality is considerably higher. Local radiation can also be used as a component of organ conserving local treatment for selected early lesions. Radiotherapy has been an important palliative treatment modality, diminishing symptoms in cases of inoperable primary rectal cancers or pelvic recurrences. The timing of radiation, surgery and chemotherapy has been under evaluation for years. For patients with locally advanced primary or recurrent malignancies (unresectable due to fixation), the preferred sequence is pre-operative irradiation with or without chemotherapy, followed by surgical resection. For mobile resectable lesions, sequencing issues are being tested in phase III randomised trials. (author).

  1. Collaborative Research in Childhood Cancer Survivorship: The Current Landscape.

    Science.gov (United States)

    Bhatia, Smita; Armenian, Saro H; Armstrong, Gregory T; van Dulmen-den Broeder, Eline; Hawkins, Michael M; Kremer, Leontien C M; Kuehni, Claudia E; Olsen, Jørgen H; Robison, Leslie L; Hudson, Melissa M

    2015-09-20

    Survivors of childhood cancer carry a substantial burden of morbidity and are at increased risk for premature death. Furthermore, clear associations exist between specific therapeutic exposures and the risk for a variety of long-term complications. The entire landscape of health issues encountered for decades after successful completion of treatment is currently being explored in various collaborative research settings. These settings include large population-based or multi-institutional cohorts and single-institution studies. The ascertainment of outcomes has depended on self-reporting, linkage to registries, or clinical assessments. Survivorship research in the cooperative group setting, such as the Children's Oncology Group, has leveraged the clinical trials infrastructure to explore the molecular underpinnings of treatment-related adverse events, and to understand specific complications in the setting of randomized risk-reduction strategies. This review highlights the salient findings from these large collaborative initiatives, emphasizing the need for life-long follow-up of survivors of childhood cancer, and describing the development of several guidelines and efforts toward harmonization. Finally, the review reinforces the need to identify populations at highest risk, facilitating the development of risk prediction models that would allow for targeted interventions across the entire trajectory of survivorship.

  2. Current lifestyle of young adults treated for cancer in childhood.

    Science.gov (United States)

    Evans, S E; Radford, M

    1995-05-01

    The aim of this study was to look at the current lifestyle of young adult survivors of childhood cancer between the ages of 16 and 30 years to document their achievements and expose any psychosocial problems. Sixty six young adult survivors were contacted and asked if they and their siblings (16-30 years) would take part in a lifestyle study; 48 patients and 38 sibling controls were interviewed. This took the form of a structured lifestyle questionnaire, a self esteem questionnaire (Oxford Psychologists Press), and an unstructured interview. Fifty five per cent of patients achieved five or more A-C grades at 'O' level/GCSE compared with 62% of siblings and a national average of 30%. Despite that these patients were significantly less likely to go on to higher education than their siblings. The two groups were equally employable and earning similar salaries. There were three cases of known employer prejudice. A slightly higher percentage of patients than siblings had their driving licence. Seventeen patients felt their appearance had changed and eight felt that they had a residual physical mobility problem. Both groups were socially active and equally likely to partake in competitive sports. There was no overall difference in the self esteem of the two groups. In general the survivors of childhood cancer were coping well in their young adult life and achieving the same lifestyle goals as their siblings. However, significant problems have been identified. PMID:7618909

  3. Current status and perspectives of brachytherapy for cervical cancer.

    Science.gov (United States)

    Toita, Takafumi

    2009-02-01

    Standard definitive radiotherapy for cervical cancer consists of whole pelvic external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). In Japan, high-dose-rate ICBT (HDR-ICBT) has been utilized in clinical practice for more than 40 years. Several randomized clinical trials demonstrated that HDR-ICBT achieved comparative outcomes, both for pelvic control and incidences of late complications, to low-dose-rate (LDR) ICBT. In addition, HDR-ICBT has some potential advantages over LDR-ICBT, leading to further improvement in treatment results. Prior to the current computer planning systems, some excellent treatment planning concepts were established. At present, systems modified from these concepts, or novel approaches, such as image-guided brachytherapy (IGBT) are under investigation. One serious problem to be solved in HDR-ICBT for cervical cancer is that of the discrepancy in standard treatment schedules for combination HDR-ICBT and EBRT between the United States and Japan. Prospective studies are ongoing to assess the efficacy and toxicity of the Japanese schedule. PMID:19225920

  4. [Current status and perspectives of radiotherapy for esophageal cancer].

    Science.gov (United States)

    Wu, S X; Wang, L H

    2016-09-23

    Esophageal cancer is one of the most common cancers in China. More than 80% of esophageal cancer patients are diagnosed at a late stage and are not eligible for surgery. Radiotherapy is one of the most important modalities in esophageal cancer treatment. Here we reviewed the advances in esophageal cancer radiotherapy and radiotherapy-based combined-modality therapy, such as optimization of radiation dose and target volume, application of precise radiotherapy technique and the integration of radiotherapy with chemotherapy and targeted therapy.

  5. Current impediments to acceptance of the ultraviolet-B-vitamin D-cancer hypothesis.

    Science.gov (United States)

    Grant, William B; Boucher, Barbara J

    2009-09-01

    The ultraviolet-B (UVB)-vitamin D-cancer hypothesis was proposed in 1980. There have been numerous ecological, observational and other studies of the hypothesis. There are about 14 types of cancer for which it seems to apply: bladder, breast, colon, endometrial, esophageal, gallbladder, gastric, ovarian, pancreatic, rectal, renal and vulvar cancer and both Hodgkin's and non-Hodgkin's lymphoma. Nonetheless, the hypothesis has not yet been accepted by public health agencies. Some of the reasons for this include a distrust of ecological studies, some mistrust of observational studies, and the existence of just one positive randomized controlled trial, an analysis of a vitamin D and calcium supplementation study involving post-menopausal women in Nebraska. Paradigm shifts such as this generally take time, in part due to opposition from those content with the status quo. In this paper, results of ecological studies in the United States using summertime solar UVB as the index of vitamin D production, which is highly asymmetrical with respect to latitude, and indices for other cancer risk-modifying factors (air pollution, alcohol consumption, dietary iron and zinc, ethnic background, socioeconomic status, smoking and urban/rural residence) are discussed in terms of supporting the hypothesis. These studies were not considered while other ecological studies were examined in recent critiques of the hypothesis. While additional randomized controlled trials would, of course, be helpful, the current evidence seems to satisfy the criteria for causality as outlined by A. Bradford Hill. PMID:19667154

  6. CT screening for lung cancer: Is the evidence strong enough?

    Science.gov (United States)

    Field, J K; Devaraj, A; Duffy, S W; Baldwin, D R

    2016-01-01

    The prevailing questions at this time in both the public mind and the clinical establishment is, do we have sufficient evidence to implement lung cancer Computed Tomography (CT) screening in Europe? If not, what is outstanding? This review addresses the twelve major areas, which are critical to any decision to implement CT screening and where we need to assess whether we have sufficient evidence to proceed to a recommendation for implementation in Europe. The readiness level of these twelve categories in 2015 have been with colour coded, where green indicates we have sufficient evidence, amber is borderline evidence and red requires further evidence. Recruitment from the 'Hard to Reach' community still remains at red, while mortality data, cost effectiveness and screening interval are all categorised as amber. The integration of smoking cessation into CT screening programmes is still considered to be category amber. The US Preventive Services Task Force have recommended that CT screening is implemented in the USA utilising the NLST criteria, apart from continuing screening to 80 years of age. The cost effectiveness of the NLST was calculated to be $81,000/QALY, however, its well recognised that the costs of medical care in the USA, is far higher than that of Europe. Medicare have agreed to cover the cost of screening but have stipulated a number of stringent requirements for inclusion. To date we do not have good CT screening mortality data available in Europe and eagerly await the publication of the NELSON trial data in 2016 and then the pooled UKLS and NELSON data thereafter. However in the meantime we should start planning for implementation in Europe, especially in the areas of the radiological service provision and accreditation, as well as identifying novel mechanisms to recruit from the hardest to reach communities. PMID:26711931

  7. HPV and Cervical Cancer Epidemiology - Current Status of HPV Vaccination in India.

    Science.gov (United States)

    Chatterjee, Sharmila; Chattopadhyay, Amit; Samanta, Luna; Panigrahi, Pinaki

    2016-01-01

    Cervical cancer (CaCx) is the second most fatal cancer contributing to 14% of cancers in Indian females, which account for 25.4% and 26.5% of the global burden of CaCx prevalence and mortality, respectively. Persistent infection with high-risk human papilloma virus (HPV- strains 16 and 18) is the most important risk factor for precursors of invasive CaCx. Comprehensive prevention strategies for CaCx should include screening and HPV vaccination. Three screening modalities for CaCx are cytology, visual inspection with acetic acid, and HPV testing. There is no Indian national policy on CaCx prevention, and screening of asymptomatic females against CaCx is practically non-existent. HPV vaccines can make a major breakthrough in the control of CaCx in India which has high disease load and no organized screening program. Despite the Indian Government's effort to introduce HPV vaccination in the National Immunization Program and bring down vaccine cost, challenges to implementing vaccination in India are strong such as: inadequate epidemiological evidence for disease prioritization, duration of vaccine use, parental attitudes, and vaccine acceptance. This paper reviews the current epidemiology of CaCx and HPV in India, and the current status of HPV vaccination in the country. This article stresses the need for more research in the Indian context, to evaluate interventions for CaCx and assess their applicability, success, scalability and sustainability within the constraints of the Indian health care system. PMID:27644600

  8. Human endogenous retroviruses and cancer prevention: evidence and prospects

    Directory of Open Access Journals (Sweden)

    Cegolon Luca

    2013-01-01

    as other tumors like sarcoma, lymphoma, bladder and breast cancer. An amino acid sequence similar to HERV-K-MEL, recognized to cause a significant protective effect against melanoma, is shared by the antigenic determinants expressed by some vaccines such as BCG, vaccinia virus and the yellow fever virus. HERV-K are also reactivated in the majority of human breast cancers. Monoclonal and single-chain antibodies against the HERV-K Env protein recently proved capable of blocking the proliferation of human breast cancer cells in vitro, inhibiting tumor growth in mice bearing xenograft tumors. Summary A recent epidemiological study provided provisional evidence of how melanoma risk could possibly be reduced if the yellow fever virus vaccine (YFV were received at least 10 years before, possibly preventing tumor initiation rather than culling melanoma cells already compromised. Further research is recommended to confirm the temporal pattern of this protection and eliminate/attenuate the potential role of relevant confounders as socio-economic status and other vaccinations. It appears also appropriate to examine the potential protective effect of YFV against other malignancies expressing high levels of HERV-K antigens, namely breast cancer, sarcoma, lymphoma and bladder cancer. Tumor immune-therapy, as described for the monoclonal antibodies against breast cancer, is indeed considered more complex and less advantageous than immune-prevention. Cellular immunity possibly triggered by vaccines as for YFV might also be involved in anti-cancer response, in addition to humoral immunity.

  9. Research on cancer diagnosis in Malaysia: current status.

    Science.gov (United States)

    Looi, L M; Zubaidah, Z; Cheah, P L; Cheong, S K; Gudum, H R; Iekhsan, O; Ikram, S I; Jamal, R; Mak, J W; Othman, N H; Puteri, J N; Rosline, H; Sabariah, A R; Seow, H F; Sharifah, N A

    2004-06-01

    Cancer is a major morbidity and mortality concern in Malaysia. Based on National Cancer Registry data, the Malaysian population is estimated to bear a cancer burden of about 40,000 new cases per year, and a cumulative lifetime risk of about 1:4. Cancer research in Malaysia has to consider needs relevant to our population, and resources constraints. Hence, funding bodies prioritise cancers of high prevalence, unique to our community and posing specific clinical problems. Cancer diagnosis is crucial to cancer management. While cancer diagnosis research largely aims at improvements in diagnostic information towards more appropriate therapy, it also impacts upon policy development and other areas of cancer management. The scope of cancer diagnosis upon which this paper is based, and their possible impact on other R&D areas, has been broadly categorized into: (1) identification of aetiological agents and their linkages to the development of precancer and cancer (impact on policy development, cancer prevention and treatment), (2) cancer biology and pathogenesis (impact on cancer prevention, treatment strategies and product development), (3) improvements in accuracy, sensitivity and specificity in cancer detection, monitoring and classification (impact on technology development) and (4) prognostic and predictive parameters (impact on treatment strategies). This paper is based on data collected by the Working Group on Cancer Diagnosis Research for the First National Conference on Cancer Research Coordination in April 2004. Data was collated from the databases of Institutions/Universities where the authors are employed, the Ministry of Science, Technology and Innovation (MOSTI) and targeted survey feedback from key cancer researchers. Under the 7th Malaysia Plan, 76 cancer projects were funded through the Intensified Research in Priority Areas (IRPA) scheme of MOSTI, amounting to almost RM15 million of grant money. 47(61.8%) of these projects were substantially in cancer

  10. The current status of imaging diagnosis of breast cancer

    International Nuclear Information System (INIS)

    In recent years, the incidence and the mortality rate of female breast cancer in our country is increasing, Early diagnosis of breast cancer is particularly important. Precious preoperative staging in the breast cancer is advantageous for the treatment planning. Evaluating the efficacy of chemotherapy is beneficial for adjusting the follow-up plan. Imaging examination has become an important role in breast cancer management. At present, commonly used equipment include mammography, ultrasound, CT, and MRI, etc. This article reviews the present study status of these tools in diagnosis of breast cancer. A reasonable and effective choice of those tools can facilitate clinic diagnosis and treatment. (authors)

  11. Current state of prostate cancer treatment in Jamaica.

    Science.gov (United States)

    Morrison, Belinda F; Aiken, William D; Mayhew, Richard

    2014-01-01

    Prostate cancer is the commonest cancer in Jamaica as well as the leading cause of cancer-related deaths. One report suggested that Jamaica has the highest incidence rate of prostate cancer in the world, with an age-standardised rate of 304/100,000 per year. The Caribbean region is reported to have the highest mortality rate of prostate cancer worldwide. Prostate cancer accounts for a large portion of the clinical practice for health-care practitioners in Jamaica. The Jamaica Urological Society is a professional body comprising 19 urologists in Jamaica who provide most of the care for men with prostate cancer in collaboration with medical oncologists, radiation oncologists, and a palliative care physician. The health-care system is structured in two tiers in Jamaica: public and private. The urologist-to-patient ratio is high, and this limits adequate urological care. Screening for prostate cancer is not a national policy in Jamaica. However, the Jamaica Urological Society and the Jamaica Cancer Society work synergistically to promote screening as well as to provide patient education for prostate cancer. Adequate treatment for localised prostate cancer is available in Jamaica in the forms of active surveillance, nerve-sparing radical retropubic prostatectomy, external beam radiation, and brachytherapy. However, there is a geographic maldistribution of centres that provide prostate cancer treatment, which leads to treatment delays. Also, there is difficulty in affording some treatment options in the private health-care sectors. Androgen deprivation therapy is available for treatment of locally advanced and metastatic prostate cancer and is subsidised through a programme called the National Health Fund. Second-line hormonal agents and chemotherapeutic agents are available but are costly to most of the population. The infrastructure for treatment of prostate cancer in Jamaica is good, but it requires additional technological advances as well as additional specialist

  12. Cancer Treatment-Related Cardiotoxicity: Understanding the Current State of Knowledge and Developing Future Research Priorities

    Science.gov (United States)

    Cancer Treatment-Related Cardiotoxicity: Understanding the Current State of Knowledge and Developing Future Research Priorities, a 2013 workshop sponsored by the Epidemiology and Genomics Research Program.

  13. Current concepts on posterior meniscal root lesion: A treatment algorithm based on the currently available evidence

    Directory of Open Access Journals (Sweden)

    Guan-Yang Song

    2014-07-01

    Full Text Available Meniscal root lesion is defined as an avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion, which is commonly observed at the posterior region in the clinical practice. Although a number of biomechanical and clinical studies have shown the importance of the integrity of the posterior meniscal roots, the appropriate treatment is still controversial. The purposes of this review are to develop a current understanding of how the posterior meniscal root functions and to review the available treatment options for posterior meniscal root lesion.

  14. Quick evidence reviews using Epistemonikos: a thorough, friendly and current approach to evidence in health

    Directory of Open Access Journals (Sweden)

    Gabriel Rada

    2014-07-01

    Full Text Available Those who make decisions on healthcare should do so informed by the best scientific evidence at one’s disposal. During the last few years, it has become undeniable that identifying and synthesizing all scientific studies that respond a question constitutes an unapproachable challenge for a clinician. The quantity of information has increased excessively, some facts are not available, investigations are of either bad quality or even fraudulent, and the methods for achieving a combination and synthesis of all studies are each time more sophisticated. Moreover, if this inaccurate process is carried out, there exists a high risk of arriving at a biased conclusion.

  15. Cancer of the Pancreas: Molecular Pathways and Current Advancement in Treatment

    Science.gov (United States)

    Polireddy, Kishore; Chen, Qi

    2016-01-01

    Pancreatic cancer is one of the most lethal cancers among all malignances, with a median overall survival of cancers harbor a variety of genetic alternations that render it difficult to treat even with targeted therapy. Recent studies revealed that pancreatic cancers are highly enriched with a cancer stem cell (CSC) population, which is resistant to chemotherapeutic drugs, and therefore escapes chemotherapy and promotes tumor recurrence. Cancer cell epithelial to mesenchymal transition (EMT) is highly associated with metastasis, generation of CSCs, and treatment resistance in pancreatic cancer. Reviewed here are the molecular biology of pancreatic cancer, the major signaling pathways regulating pancreatic cancer EMT and CSCs, and the advancement in current clinical and experimental treatments for pancreatic cancer.

  16. New advances in genitourinary cancer: evidence gathered in 2014.

    Science.gov (United States)

    Suárez, C; Puente, J; Gallardo, E; Méndez-Vidal, M J; Climent, M A; León, L; Olmos, D; García del Muro, X; González-Billalabeitia, E; Grande, E; Bellmunt, J; Mellado, B; Maroto, P; González del Alba, A

    2015-09-01

    This review provides updated information published in 2014 regarding advances and major achievements in genitourinary cancer. Sections include the best in prostate cancer, renal cancer, bladder cancer, and germ cell tumors. In the field of prostate cancer, data related to treatment approach of hormone-sensitive disease, castrate-resistant prostate cancer, mechanisms of resistance, new drugs, and molecular research are presented. In relation to renal cancer, relevant aspects in the treatment of advanced renal cell carcinoma, immunotherapy, and molecular research, including angiogenesis and von Hippel-Lindau gene, molecular biology of non-clear cell histologies, and epigenetics of clear renal cell cancer are described. New strategies in the management of muscle-invasive localized bladder cancer and metastatic disease are reported as well as salient findings of biomolecular research in urothelial cancer. Some approaches intended to improve outcomes in poor prognosis patients with metastatic germ cell cancer are also reported. Results of clinical trials in these areas are discussed. PMID:26227584

  17. Educating physicians in evidence based medicine: current practices and curricular strategies

    NARCIS (Netherlands)

    Maggio, L.A.

    2015-01-01

    Evidence based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM is an expectation of professional healthcare and requisite component in many medical school curricula. Yet, despite

  18. Evidence-based estimate of appropriate radiotherapy utilization rate for prostate cancer

    International Nuclear Information System (INIS)

    Purpose: Current estimates of the proportion of cancer patients who will require radiotherapy (RT) are based almost entirely on expert opinion. The objective of this study was to use an evidence-based approach to estimate the proportion of incident cases of prostate cancer that should receive RT at any point in the evolution of the illness. Methods and Materials: A systematic review of the literature was undertaken to identify indications for RT for prostate cancer and to ascertain the level of evidence that supported each indication. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of prostate cancer patients. The effect of sampling error on the estimated appropriate rate of RT was calculated mathematically, and the effect of systematic error using alternative sources of information was estimated by sensitivity analysis. Results: It was estimated that 61.2% ±5.6% of prostate cancer cases develop one or more indications for RT at some point in the course of the illness. The plausible range for this rate was 57.3%-69.8% on sensitivity analysis. Of all prostate cancer patients, 32.2%±3.8% should receive RT in their initial treatment and 29.0% ± 4.1% later for recurrence or progression. The proportion of cases that ever require RT is risk grouping dependent; 43.9%±2.2% in low-risk disease, 68.7%± .5% in intermediate-risk disease; and 79.0% ± 3.8% in high-risk locoregional disease. For metastatic disease, the predicted rate was 66.4%±0.3%. Conclusion: This method provides a rational starting point for the long-term planning of radiation services and for the audit of access to RT at the population level. By completing such evaluations in major cancer sites, it will be possible to estimate the appropriate RT rate for the cancer population as a whole

  19. An evidence-based estimate of appropriate radiotherapy utilization rate for breast cancer

    International Nuclear Information System (INIS)

    Purpose: Current estimates of the proportion of cancer patients who will require radiotherapy (RT) are based almost entirely on expert opinion. We sought to use an evidence-based approach to estimate the proportion of incident cases of breast cancer that will require RT at any point in the evolution of the illness. Methods and Materials: We undertook a systematic review of the literature to identify indications for RT for breast cancer and to ascertain the level of evidence that supported each indication. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of breast cancer patients. The effect of sampling error on the estimated appropriate rate of RT was calculated mathematically, and the effect of systematic error was estimated by sensitivity analysis. Results: It was estimated that 66.4% ± 4.8% of breast cancer patients develop one or more indications for RT at some point in the course of the illness. The plausible range for this rate was 56.3%-72.4% on sensitivity analysis. Of all breast cancer patients, 57.3% ± 4.7% require RT in their initial treatment and 9.1% ± 1.0% do so later for recurrence or progression. The proportion of patients who ever require RT is stage dependent: 39.8% ± 1.1% in ductal carcinoma in situ; 68.6% ± 4.1% in Stage I invasive carcinoma; 81.5% ± 2.3% in Stage II; 95.3% ± 0.3% in Stage III; and 63.7% ± 0.3% in Stage IV. Conclusion: This method provides a rational starting point for the long-term planning of RT services and for the audit of access to RT at the population level. By completing such evaluations in the major cancer sites, it will be possible to estimate the appropriate RT treatment rate for the cancer population as a whole

  20. Gastric cancer: Current status of lymph node dissection.

    Science.gov (United States)

    Degiuli, Maurizio; De Manzoni, Giovanni; Di Leo, Alberto; D'Ugo, Domenico; Galasso, Erica; Marrelli, Daniele; Petrioli, Roberto; Polom, Karol; Roviello, Franco; Santullo, Francesco; Morino, Mario

    2016-03-14

    D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC. PMID:26973384

  1. Current Understanding of the Role of PPARγ in Gastrointestinal Cancers

    Directory of Open Access Journals (Sweden)

    Bing Zou

    2009-01-01

    Full Text Available Numerous studies have indicated that PPARγ plays multiple roles such as in inflammation, cell cycle control, cell proliferation, apoptosis, and carcinogenesis, thus PPARγ contributes to the homeostasis. Many in vitro studies have showed that ligand-induced activation of PPARγ possess antitumor effect in many cancers including CRC. However, the role of PPARγ in gastrointestinal cancers, especially in colorectal cancer, is rather controversial. Nevertheless, some recent studies with the positive results on the possible application of PPARγ ligands, such as Bezafibrate or Rosiglitazone in gastrointestinal cancers, have suggested a potential usefulness of PPARγ agonists in cancer prevention and therapy. In this review, the authors discuss the recent developments in the role of PPARγ in gastrointestinal cancers.

  2. Current Status and Future Perspectives in Differentiated Thyroid Cancer

    OpenAIRE

    Kim, Tae Yong; Kim, Won Gu; Kim, Won Bae; Shong, Young Kee

    2014-01-01

    Thyroid cancer is increasing all over the world. The exact cause of this increase is still debated and there are conflicting reports. Sophisticated molecular studies suggest that environmental chemicals may have effects of thyroid carcinogenesis. The development of powerful molecular biology techniques has enabled targeted next-generation sequencing for detection of mutations in thyroid cancer, and this technique can make a specific diagnosis of thyroid cancer in cytologically indeterminate c...

  3. Adjuvant Therapy of Colon Cancer: Current Status and Future Developments

    OpenAIRE

    Morse, Michael A.

    2005-01-01

    Options for the adjuvant therapy of resected stage III colon cancer have expanded beyond the previously well-accepted standard of 5-fluorouracil (5-FU) combined with leucovorin. The Xeloda in Adjuvant Colon Cancer Therapy (X-ACT) study confirmed that capecitabine (Xeloda) is at least as effective and is less toxic than a bolus 5-FU and leucovorin regimen for patients with stage III colon cancer. This study, in addition to National Surgical Adjuvant Breast and Bowel Project (NSABP) C-06, which...

  4. Personalizing medicine for metastatic colorectal cancer: Current developments

    OpenAIRE

    Marques, Andrea Marin; Turner, Alice; de Mello, Ramon Andrade

    2014-01-01

    Metastatic colorectal cancer (mCRC) is still one of the tumor types with the highest incidence and mortality. In 2012, colorectal cancer was the second most prevalence cancer among males (9%) and the third among females (8%). In this disease, early diagnosis is important to improve treatment outcomes. However, at the time of diagnosis, about one quarter of patients already have metastases, and overall survival of these patients at 5-years survival is very low. Because of these poor statistics...

  5. Current Guidelines for the Diagnosis and Treatment of Breast Cancer

    OpenAIRE

    Hayes, Teresa G.; Peterson, Leif E; Weinberg, Armin D.

    1998-01-01

    The management of breast cancer is a significant public health issue. Early detection of breast cancer through screening mammography, physician clinical examination and breast self-examination can reduce breast cancer mortality by approximately 30%. Most major health organisations agree that yearly mammographic screening should begin at the age of 40 years, although there is some controversy about the need for mammography between the ages of 40 and 49 years. The use of mammographic screening ...

  6. Current Evidence for a Role of the Kynurenine Pathway of Tryptophan Metabolism in Multiple Sclerosis

    Science.gov (United States)

    Lovelace, Michael D.; Varney, Bianca; Sundaram, Gayathri; Franco, Nunzio F.; Ng, Mei Li; Pai, Saparna; Lim, Chai K.; Guillemin, Gilles J.; Brew, Bruce J.

    2016-01-01

    The kynurenine pathway (KP) is the major metabolic pathway of the essential amino acid tryptophan (TRP). Stimulation by inflammatory molecules, such as interferon-γ (IFN-γ), is the trigger for induction of the KP, driving a complex cascade of production of both neuroprotective and neurotoxic metabolites, and in turn, regulation of the immune response and responses of brain cells to the KP metabolites. Consequently, substantial evidence has accumulated over the past couple of decades that dysregulation of the KP and the production of neurotoxic metabolites are associated with many neuroinflammatory and neurodegenerative diseases, including Parkinson’s disease, AIDS-related dementia, motor neurone disease, schizophrenia, Huntington’s disease, and brain cancers. In the past decade, evidence of the link between the KP and multiple sclerosis (MS) has rapidly grown and has implicated the KP in MS pathogenesis. KP enzymes, indoleamine 2,3-dioxygenase (IDO-1) and tryptophan dioxygenase (highest expression in hepatic cells), are the principal enzymes triggering activation of the KP to produce kynurenine from TRP. This is in preference to other routes such as serotonin and melatonin production. In neurological disease, degradation of the blood–brain barrier, even if transient, allows the entry of blood monocytes into the brain parenchyma. Similar to microglia and macrophages, these cells are highly responsive to IFN-γ, which upregulates the expression of enzymes, including IDO-1, producing neurotoxic KP metabolites such as quinolinic acid. These metabolites circulate systemically or are released locally in the brain and can contribute to the excitotoxic death of oligodendrocytes and neurons in neurological disease principally by virtue of their agonist activity at N-methyl-d-aspartic acid receptors. The latest evidence is presented and discussed. The enzymes that control the checkpoints in the KP represent an attractive therapeutic target, and consequently several

  7. From Evidence to Decision Support in Cancer Screening; Application of Miscan Models

    NARCIS (Netherlands)

    R. Boer (Rob)

    2000-01-01

    textabstractMaking decisions to introduce or change cancer screening that are based on observed evidence is not straight forward. Even if there is evidence available from randomised controlled trials that clearly proves a reduction in mortality from the cancer in question, there are still several is

  8. A methodological framework for evaluating the evidence for Complementary and Alternative Medicine (CAM) for cancer

    DEFF Research Database (Denmark)

    Zachariae, Robert; Johannesen, Helle

    2011-01-01

    In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning...

  9. Pioglitazone (Actos) and bladder cancer: Legal system triumphs over the evidence.

    Science.gov (United States)

    Davidson, Mayer B

    2016-08-01

    In preclinical studies, pioglitazone was associated with bladder cancer in male rats (but not in female rats, mice dogs or monkeys). Because of this association, the Federal Drug Administration requested a large 10year epidemiological study to evaluate whether there was an association between bladder cancer and exposure to pioglitazone in patients. A 5-year interim report published in 2011 showed no significant association between ever vs never exposure to the drug but a significant association in patients exposed to pioglitazone for >2years. Importantly, the final 10year report did not confirm the 5year interim report finding no association between bladder cancer and pioglitazone, even after >4years of exposure to the drug. However, as would be expected, following the 5-year interim report, many epidemiological studies were carried out and civil litigation lawsuits began to be filed. Of the 23 epidemiological studies that have been published to date, 18 showed no association between bladder cancer and pioglitazone (5 with a combination of rosiglitazone and pioglitazone). Of the five that did show a significant association with pioglitazone, three could not be confirmed in the same population and in one of them there were significantly more risk factors for bladder cancer in the patients exposed to pioglitazone. In the fourth one, a significant association became non-significant when patients >79years were included. In the fifth one, detection bias was a major flaw. Currently, >11,000 legal cases have been filed, many of which claim emotional distress due to the fear of bladder cancer. To limit their legal costs, the pharmaceutical company has established a 2.4 billion dollar settlement pool. So much for evidence-based medicine. PMID:27133452

  10. Pioglitazone (Actos) and bladder cancer: Legal system triumphs over the evidence.

    Science.gov (United States)

    Davidson, Mayer B

    2016-08-01

    In preclinical studies, pioglitazone was associated with bladder cancer in male rats (but not in female rats, mice dogs or monkeys). Because of this association, the Federal Drug Administration requested a large 10year epidemiological study to evaluate whether there was an association between bladder cancer and exposure to pioglitazone in patients. A 5-year interim report published in 2011 showed no significant association between ever vs never exposure to the drug but a significant association in patients exposed to pioglitazone for >2years. Importantly, the final 10year report did not confirm the 5year interim report finding no association between bladder cancer and pioglitazone, even after >4years of exposure to the drug. However, as would be expected, following the 5-year interim report, many epidemiological studies were carried out and civil litigation lawsuits began to be filed. Of the 23 epidemiological studies that have been published to date, 18 showed no association between bladder cancer and pioglitazone (5 with a combination of rosiglitazone and pioglitazone). Of the five that did show a significant association with pioglitazone, three could not be confirmed in the same population and in one of them there were significantly more risk factors for bladder cancer in the patients exposed to pioglitazone. In the fourth one, a significant association became non-significant when patients >79years were included. In the fifth one, detection bias was a major flaw. Currently, >11,000 legal cases have been filed, many of which claim emotional distress due to the fear of bladder cancer. To limit their legal costs, the pharmaceutical company has established a 2.4 billion dollar settlement pool. So much for evidence-based medicine.

  11. Psychological Issues in Cancer Genetics: Current Research and Future Priorities.

    Science.gov (United States)

    Hopwood, Penelope

    1997-01-01

    Data concerning the psychological impact of high risk of cancer are reviewed, including implications of genetic testing, breast screening,and accuracy of women's risk estimates. Work in progress on prophylactic mastectomy and chemoprevention is reviewed. Research on cancer families, and interventions and prevention strategies for high-risk…

  12. Research on cancer diagnosis in Malaysia: current status.

    Science.gov (United States)

    Looi, L M; Zubaidah, Z; Cheah, P L; Cheong, S K; Gudum, H R; Iekhsan, O; Ikram, S I; Jamal, R; Mak, J W; Othman, N H; Puteri, J N; Rosline, H; Sabariah, A R; Seow, H F; Sharifah, N A

    2004-06-01

    Cancer is a major morbidity and mortality concern in Malaysia. Based on National Cancer Registry data, the Malaysian population is estimated to bear a cancer burden of about 40,000 new cases per year, and a cumulative lifetime risk of about 1:4. Cancer research in Malaysia has to consider needs relevant to our population, and resources constraints. Hence, funding bodies prioritise cancers of high prevalence, unique to our community and posing specific clinical problems. Cancer diagnosis is crucial to cancer management. While cancer diagnosis research largely aims at improvements in diagnostic information towards more appropriate therapy, it also impacts upon policy development and other areas of cancer management. The scope of cancer diagnosis upon which this paper is based, and their possible impact on other R&D areas, has been broadly categorized into: (1) identification of aetiological agents and their linkages to the development of precancer and cancer (impact on policy development, cancer prevention and treatment), (2) cancer biology and pathogenesis (impact on cancer prevention, treatment strategies and product development), (3) improvements in accuracy, sensitivity and specificity in cancer detection, monitoring and classification (impact on technology development) and (4) prognostic and predictive parameters (impact on treatment strategies). This paper is based on data collected by the Working Group on Cancer Diagnosis Research for the First National Conference on Cancer Research Coordination in April 2004. Data was collated from the databases of Institutions/Universities where the authors are employed, the Ministry of Science, Technology and Innovation (MOSTI) and targeted survey feedback from key cancer researchers. Under the 7th Malaysia Plan, 76 cancer projects were funded through the Intensified Research in Priority Areas (IRPA) scheme of MOSTI, amounting to almost RM15 million of grant money. 47(61.8%) of these projects were substantially in cancer

  13. Psychoneuroimmunology and cancer: historical perspectives and current research.

    Science.gov (United States)

    Fife, A; Beasley, P J; Fertig, D L

    1996-01-01

    The belief that cancer might be related to temperament or distress has been emphasized throughout the history of medicine. The field of psychoneuroimmunology has its origins in psychosomatic medicine, and has evolved to the investigations of complex interactions between the psyche and the nervous, immune, and endocrine systems. Such interactions may have implications in both cancer risk and survival.

  14. Cancer and Radiation Therapy: Current Advances and Future Directions

    Directory of Open Access Journals (Sweden)

    Rajamanickam Baskar, Kuo Ann Lee, Richard Yeo, Kheng-Wei Yeoh

    2012-01-01

    Full Text Available In recent years remarkable progress has been made towards the understanding of proposed hallmarks of cancer development and treatment. However with its increasing incidence, the clinical management of cancer continues to be a challenge for the 21st century. Treatment modalities comprise of radiation therapy, surgery, chemotherapy, immunotherapy and hormonal therapy. Radiation therapy remains an important component of cancer treatment with approximately 50% of all cancer patients receiving radiation therapy during their course of illness; it contributes towards 40% of curative treatment for cancer. The main goal of radiation therapy is to deprive cancer cells of their multiplication (cell division potential. Celebrating a century of advances since Marie Curie won her second Nobel Prize for her research into radium, 2011 has been designated the Year of Radiation therapy in the UK. Over the last 100 years, ongoing advances in the techniques of radiation treatment and progress made in understanding the biology of cancer cell responses to radiation will endeavor to increase the survival and reduce treatment side effects for cancer patients. In this review, principles, application and advances in radiation therapy with their biological end points are discussed.

  15. Aspirin and Zileuton and Biomarker Expression in Nasal Tissue of Current Smokers | Division of Cancer Prevention

    Science.gov (United States)

    This randomized phase II trial studies the effects of aspirin and zileuton on genes related to tobacco use in current smokers. Smokers are at increased risk for developing lung and other cancers. Aspirin and zileuton may interfere with genes related to tobacco use and may be useful in preventing lung cancer in current smokers. |

  16. Current cancer incidence and trends in Yaounde, Cameroon

    Directory of Open Access Journals (Sweden)

    Enow Orock GE

    2014-05-01

    Full Text Available Background: Except for some information on relative frequencies of different cancers in selected areas, the epidemiology of cancer in Cameroon is relatively unknown. Though there is no reliable data on its incidence and pattern, with an estimated 15,000 new cases diagnosed annually and a prevalence of about 25.000 cases throughout the country, cancer is being increasingly recognized as a public health problem in Cameroon. The Yaounde Cancer Registry is a population registry physically located at the General Hospital Yaounde that has been operating since 2004. It collects data from about 20 sources that cover the entire population of Yaounde estimated in 2010 at about 1,299,369. Objectives: The objective of this study was to find out the incidence and trends of cancer in the Yaounde population in the period 2004 – 2006/2010 – 2011. It is hoped that this will enable policy makers, health providers and other stake holders plan appropriate health management policy in this population. Materials and Methods: This report presents the cancer incidence for 5 years, 2004 – 2006/2010 – 2011 in the Yaounde population estimated at 1,299,369. Data of the Yaounde Cancer Registry was reviewed for the period under study using Canreg5 software. Only malignant cases registered during the period under study were used in the analysis while benign and other uncertain tumours were excluded. The 2010 census estimates by the National Institute of Statistics was employed to calculate the incidence, age-standardized and crude rates. Other software like excel, epi info were also used for analysis. Survival studies were not carried out in this study. Results: A total of 4,689 new malignant cases were reported, of which 2,901 (68% were females and 1,788 (32% were males. The incidence showed an average of 358 for men and 580 for women. The average age of cancer patients in Yaounde is 44.8 years. Morphologically confirmed cases accounted for 89% .The annual number of

  17. Therapies targeting cancer stem cells: Current trends and future challenges

    Institute of Scientific and Technical Information of China (English)

    Denisa; L; Dragu; Laura; G; Necula; Coralia; Bleotu; Carmen; C; Diaconu; Mihaela; Chivu-Economescu

    2015-01-01

    Traditional therapies against cancer, chemo- and radiotherapy, have multiple limitations that lead to treatment failure and cancer recurrence. These limitations are related to systemic and local toxicity, while treatment failure and cancer relapse are due to drug resistance and self-renewal, properties of a small population of tumor cells called cancer stem cells(CSCs). These cells are involved in cancer initiation, maintenance, metastasis and recurrence. Therefore, in order to develop efficient treatments that can induce a longlasting clinical response preventing tumor relapse it is important to develop drugs that can specifically target and eliminate CSCs. Recent identification of surface markers and understanding of molecular feature associated with CSC phenotype helped with the design of effective treatments. In this review we discuss targeting surface biomarkers, signaling pathways that regulate CSCs self-renewal and differentiation, drug-efflux pumps involved in apoptosis resistance, microenvironmental signals that sustain CSCs growth, manipulation of mi RNA expression, and induction of CSCs apoptosis and differentiation, with specific aim to hamper CSCs regeneration and cancer relapse. Some of these agents are under evaluation in preclinical and clinical studies, most of them for using in combination with traditional therapies. The combined therapy using conventional anticancer drugs with CSCs-targeting agents, may offer a promising strategy for management and eradication of different types of cancers.

  18. Colorectal cancer management in Poland: current improvements and future challenges.

    Science.gov (United States)

    Ruszkowski, Jacek

    2010-01-01

    Colorectal cancer (CRC) is the second most commonly identified malignant neoplasm diagnosed in men (12% of total cancers) and women (11%) in Poland, while CRC mortality is second in men (10.1%) and third in women (11.2%). The main reasons for increasing incidence and mortality are an aging population and an increase in environmental and lifestyle factors which may lead to cancer. In Poland there is a lack of historical (regularly published and accessible) data on cancer morbidity and survival rates. The Oncology Centre published cancer data for the first time in February 2009 the 2006, which, also for the first time, embraced the entire country. Oncology data collection in Poland is based on a network of 16 Regional Cancer Registries reporting to the Polish National Cancer Registry in Warsaw. An additional source of oncology data is the National Health Fund and the Central Statistical Office. The National Cancer Programme (2005) provides funding at ca 780 million euro, which includes amongst others the Early CRC Detection Programme to promote a free screening colonoscopy. Oncology services in Poland are funded almost entirely by public resources--the national budget as sustained by tax revenues (Ministry of Health) and the National Health Fund as sustained by the obligatory public health insurance contribution. Oncology expenditure covered by the national budget (Ministry of Health) and the National Cancer Programme in 2006 amounted to 44.8 million euro and 105.2 million euro, respectively. All these preventive, curative and organizational efforts have significantly improved access to efficient therapies (including radiotherapy) and diagnostic procedures in recent years in Poland, although, clearly, a lot remains to be done.

  19. Obtaining evidence beyond the current "special arrangement sources." Interim final rule with request for comments.

    Science.gov (United States)

    2014-06-12

    We are amending our regulations to state that we will obtain evidence from any appropriate source. Our current regulations provide that we will obtain information from "special arrangement sources'' for those infrequent situations when we are in a better position than our State agency partners to obtain evidence. Due to improved evidence collection through our increased use of health information technology (health IT), we are obtaining evidence electronically with increasing frequency. We expect that, over time, the electronic exchange of medical records will become our primary means for obtaining medical evidence. As we increase our use of health IT, the designation of "special arrangement sources'' will no longer adequately describe from whom we collect evidence.

  20. Early Gastric Cancer: Current Advances of Endoscopic Diagnosis and Treatment.

    Science.gov (United States)

    Zhu, Linlin; Qin, Jinyu; Wang, Jin; Guo, Tianjiao; Wang, Zijing; Yang, Jinlin

    2016-01-01

    Endoscopy is a major method for early gastric cancer screening because of its high detection rate, but its diagnostic accuracy depends heavily on the availability of endoscopic instruments. Many novel endoscopic techniques have been shown to increase the diagnostic yield of early gastric cancer. With the improved detection rate of EGC, the endoscopic treatment has become widespread due to advances in the instruments available and endoscopist's experience. The aim of this review is to summarize frequently-used endoscopic diagnosis and treatment in early gastric cancer (EGC). PMID:26884753

  1. Early Gastric Cancer: Current Advances of Endoscopic Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Linlin Zhu

    2016-01-01

    Full Text Available Endoscopy is a major method for early gastric cancer screening because of its high detection rate, but its diagnostic accuracy depends heavily on the availability of endoscopic instruments. Many novel endoscopic techniques have been shown to increase the diagnostic yield of early gastric cancer. With the improved detection rate of EGC, the endoscopic treatment has become widespread due to advances in the instruments available and endoscopist’s experience. The aim of this review is to summarize frequently-used endoscopic diagnosis and treatment in early gastric cancer (EGC.

  2. [Prostate cancer stem cells: advances in current research].

    Science.gov (United States)

    Wu, Gang; Wu, Deng-long

    2015-02-01

    Prostate cancer is one of the most common malignancies threatening men's health, and the mechanisms underlying its initiation and progression are poorly understood. Last decade has witnessed encouraging progress in the studies of prostate cancer stem cells (PCSCs), which are considered to play important roles in tumor initiation, recurrence and metastasis, castration resistance, and drug resistance. Therefore, a deeper insight into PCSCs is of great significance for the successful management of prostate cancer. This article presents an overview on the location, origin, and markers of PCSCs as well as their potential correlation with tumor metastasis and castration resistance.

  3. Angiogenesis Inhibition in Prostate Cancer: Current Uses and Future Promises

    Directory of Open Access Journals (Sweden)

    Jeanny B. Aragon-Ching

    2010-01-01

    Full Text Available Angiogenesis has been well recognized as a fundamental part of a multistep process in the evolution of cancer progression, invasion, and metastasis. Strategies for inhibiting angiogenesis have been one of the most robust fields of cancer investigation, focusing on the vascular endothelial growth factor (VEGF family and its receptors. There are numerous regulatory drug approvals to date for the use of these agents in treating a variety of solid tumors. While therapeutic efficacy has been established, challenges remain with regards to overcoming resistance and assessing response to antiangiogenic therapies. Prostate cancer is the most common noncutaneous malignancy among American men and angiogenesis plays a role in disease progression. The use of antiangiogenesis agents in prostate cancer has been promising and is hereby explored.

  4. A Current Review of Targeted Therapeutics for Ovarian Cancer

    Directory of Open Access Journals (Sweden)

    Susana M. Campos

    2010-01-01

    Full Text Available Difficult to detect, ovarian cancer typically presents at an advanced stage. Significant progress has been achieved in the treatment of ovarian cancer with therapeutics focused on DNA replication or cell division. However, despite sensitivity to induction chemotherapy the majority of patients will develop recurrent disease. Conventional agents for recurrent disease offer little in terms of long-term responses. Various targeted therapeutics have been explored in the management of ovarian cancer. These include monoclonal antibodies to epidermal growth factor receptors, small molecule tyrosine kinase inhibitors, monoclonal antibodies directed at the vascular endothelial growth factor (bevacizumab, and the small tyrosine kinase inhibitors that target the vascular endothelial growth factor receptor. Recently, several other agents have come forth as potential therapeutic agents in the management of ovarian cancer. These include monoclonal antibodies to the folate receptor, triple angiokinase inhibitors, PARP inhibitors, aurora kinase inhibitors, inhibitors of the Hedgehog pathway, folate receptor antagonists, and MTOR inhibitors.

  5. Predicting Pelvic Lymph Node Involvement in Current-Era Prostate Cancer

    International Nuclear Information System (INIS)

    Purpose: The Roach formula [2/3 × prostate-specific antigen + (Gleason score – 6) × 10], derived in 1993 during the early prostate specific antigen (PSA) screening era, has been used to predict the risk of pelvic lymph node involvement in patients with prostate cancer. In the current era of widespread PSA screening with a shift to earlier disease stages, there is evidence to suggest that the Roach score overestimates risk of nodal metastasis. This study retrospectively reviews the validity of this formula as a prediction tool. Methods and Materials: We conducted a retrospective institutional review including men with clinical T1c–T3 prostate cancer, with baseline PSA levels and biopsy-obtained Gleason scores who underwent radical prostatectomy with pelvic node dissection from 2001 through 2009 (N = 1,022). The predicted risk of nodal involvement was calculated for each patient using the Roach formula and then compared with actual rates following surgery. Results: The study included 1,022 patients; 99.6% had clinical T1c/T2 disease, with a mean of 10.3 lymph nodes surgically evaluated. Overall, 42 patients (4.1%) had nodal metastasis. For every range of scores, the Roach formula overestimates the risk of nodal involvement. Observed nodal positivity was 1%, 6.3%, 10%, 15.2%, and 16.7% for Roach scores ≤10%, >10%–20%, >20%–30%, >30%–40%, and >40%, respectively. The Roach score overestimates the risk by approximately 4.5-fold in patients with scores ≤10%, by 2.5-fold for all scores between 10% and 40%, and by 4-fold for scores >40%. Conclusion: The Roach formula overpredicts the risk of pelvic nodal involvement in current-era prostate cancer patients undergoing regular PSA screening and with mainly T1c/T2 disease. Contemporary patients are much less likely to have nodal involvement for a given PSA and Gleason score.

  6. Management of locally advanced breast cancer: Evolution and current practice

    OpenAIRE

    Rustogi Ashish; Budrukkar Ashwini; Dinshaw Ketayun; Jalali Rakesh

    2005-01-01

    Locally advanced breast cancer (LABC) accounts for a sizeable number (30-60%) of breast cancer cases and is a common clinical scenario in developing countries. The treatment of LABC has evolved from single modality treatment, consisting of radical mutilating surgery or higher doses of radiotherapy in inoperable disease to multimodality management, which along with the above two included systemic therapy. Neoadjuvant chemotherapy (NACT) has made a tremendous impact on the management of ...

  7. Current and emerging therapies for the treatment of pancreatic cancer

    OpenAIRE

    Moss, Rebecca

    2010-01-01

    Rebecca A Moss, Clifton LeeThe Cancer Institute of New Jersey, New Brunswick, NJ, USAAbstract: Pancreatic adenocarcinoma carries a dismal prognosis and remains a significant cause of cancer morbidity and mortality. Most patients survive less than 1 year; chemotherapeutic options prolong life minimally. The best chance for long-term survival is complete resection, which offers a 3-year survival of only 15%. Most patients who do undergo resection will go on to die of their disease. Research in ...

  8. Use of bisphosphonates in prostate cancer: Current status

    OpenAIRE

    Nayyar, Rishi; Gupta, Narmada P

    2007-01-01

    Bisphosphonates are a relatively newer class of drugs which have been used for the prevention of skeletal related complications of age related osteoporosis or metastatic disease from carcinoma breast or multiple myeloma. Their role in the management of prostate cancer is still under evolution. We hereby review the ongoing and some published randomized trials to define the role of bisphosphonates in various stages of prostate cancer.

  9. [Current Status and Perspective of Chemoradiotherapy for Uterine Cervical Cancer].

    Science.gov (United States)

    Toita, Takafumi; Ariga, Takuro; Kasuya, Goro; Hashimoto, Seiji; Maemoto, Hitoshi; Heianna, Joichi; Kakinohana, Yasumasa; Murayama, Sadayuki

    2015-10-01

    Fifteen years has passed since the NCI announced the clinical importance of concurrent chemoradiotherapy (CCRT) in radiotherapy for patients with locoregionally advanced uterine cervical cancer. Numerous clinical trials have been performed to further improve the outcomes of CCRT. In addition to investigations of chemotherapeutic regimens and schedules, adaptation of novel radiotherapy methods such as image-guided brachytherapy (IGBT) and intensity-modulated radiotherapy (IMRT) is encouraged in CCRT for cervical cancer. PMID:26489545

  10. Lung cancer screening: history, current perspectives, and future directions

    Science.gov (United States)

    Sharma, Divakar; Newman, Thomas G.

    2015-01-01

    Lung cancer has remained the leading cause of death worldwide among all cancers. The dismal 5-year survival rate of 16% is in part due to the lack of symptoms during early stages and lack of an effective screening test until recently. Chest X-ray and sputum cytology were studied extensively as potential screening tests for lung cancer and were conclusively proven to be of no value. Subsequently, a number of studies compared computed tomography (CT) with the chest X-ray. These studies did identify lung cancer in earlier stages. However, they were not designed to prove a reduction in mortality. Later trials have focused on low-dose CT (LDCT) as a screening tool. The largest US trial – the National Lung Screening Trial (NLST) – enrolled approximately 54,000 patients and revealed a 20% reduction in mortality. While a role for LDCT in lung cancer screening has been established, the issues of high false positive rates, radiation risk, and cost effectiveness still need to be addressed. The guidelines of the international organizations that now include LDCT in lung cancer screening are reviewed. Other methods that may improve earlier detection such as positron emission tomography, autofluorescence bronchoscopy, and molecular biomarkers are also discussed. PMID:26528348

  11. Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement.

    Science.gov (United States)

    Hurria, Arti; Levit, Laura A; Dale, William; Mohile, Supriya G; Muss, Hyman B; Fehrenbacher, Louis; Magnuson, Allison; Lichtman, Stuart M; Bruinooge, Suanna S; Soto-Perez-de-Celis, Enrique; Tew, William P; Postow, Michael A; Cohen, Harvey J

    2015-11-10

    The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.

  12. Helicobacter pylori and peptic ulcer disease. Current evidence for management strategies.

    OpenAIRE

    Chiba, N; Lahaie, R; Fedorak, R N; Bailey, R.; Veldhuyzen van Zanten, S J; Bernucci, B.

    1998-01-01

    OBJECTIVE: To review current evidence for primary care physicians who manage Helicobacter pylori in peptic ulcer disease. QUALITY OF EVIDENCE: MEDLINE was searched to August 1997 for randomized controlled trials, systematic overviews, and consensus reports. High-quality recent reviews were often found. Randomized controlled trials presented as abstracts at recent meetings were reviewed. MAIN FINDINGS: Helicobacter pylori is found in most case of duodental and gastric ulcer, and eradication of...

  13. Cognitive behavioral therapy in anxiety disorders: current state of the evidence

    OpenAIRE

    Otte, Christian

    2011-01-01

    A plethora of studies have examined the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for adult anxiety disorders. In recent years, several meta-analyses have been conducted to quantitatively review the evidence of CBT for anxiety disorders, each using different inclusion criteria for studies, such as use of control conditions or type of study environment. This review aims to summarize and to discuss the current state of the evidence regarding CBT treatment for panic disord...

  14. Evidence for breathing modes in direct current, pulsed, and high power impulse magnetron sputtering plasmas

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Yuchen [State Key Lab for Materials Processing and Die & Mold Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074 (China); Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720 (United States); Zhou, Xue [Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720 (United States); Department of Electrical Engineering, Harbin Institute of Technology, Harbin 150000 (China); Liu, Jason X. [Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720 (United States); Department of Physics, University of California, Berkeley, Berkeley, California 94720 (United States); Anders, André, E-mail: aanders@lbl.gov [Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720 (United States)

    2016-01-18

    We present evidence for breathing modes in magnetron sputtering plasmas: periodic axial variations of plasma parameters with characteristic frequencies between 10 and 100 kHz. A set of azimuthally distributed probes shows synchronous oscillations of the floating potential. They appear most clearly when considering the intermediate current regime in which the direction of azimuthal spoke motion changes. Breathing oscillations were found to be superimposed on azimuthal spoke motion. Depending on pressure and current, one can also find a regime of chaotic fluctuations and one of stable discharges, the latter at high current. A pressure-current phase diagram for the different situations is proposed.

  15. Evidence for breathing modes in direct current, pulsed, and high power impulse magnetron sputtering plasmas

    International Nuclear Information System (INIS)

    We present evidence for breathing modes in magnetron sputtering plasmas: periodic axial variations of plasma parameters with characteristic frequencies between 10 and 100 kHz. A set of azimuthally distributed probes shows synchronous oscillations of the floating potential. They appear most clearly when considering the intermediate current regime in which the direction of azimuthal spoke motion changes. Breathing oscillations were found to be superimposed on azimuthal spoke motion. Depending on pressure and current, one can also find a regime of chaotic fluctuations and one of stable discharges, the latter at high current. A pressure-current phase diagram for the different situations is proposed

  16. Pharmacogenomics and Pancreatic Cancer Treatment. Optimizing Current Therapy and Individualizing Future Therapy

    Directory of Open Access Journals (Sweden)

    Soonmo Peter Kang

    2008-05-01

    Full Text Available Each year, more than 30,000 Americans are diagnosed with pancreatic cancer. We have only made incremental advancements in treatment of pancreatic cancer despite our best efforts. Research has revealed that pancreatic cancer is a genetic disease which is associated with various forms of cancer associated genetic alterations. Identification and understanding of these carcinogenic gene alterations is the base upon which we can overcome drug resistance and develop novel treatment approaches. In this paper, we review current understanding of pharmacogenomics of pancreatic cancer treatment and address future direction of the field.

  17. [Cancer-related Cognitive Impairment: Current Knowledge and Future Challenges].

    Science.gov (United States)

    Tanimukai, Hitoshi

    2015-01-01

    Cancer patients often suffer from various distresses, including cognitive impairment. Cognitive impairment during and after cancer diagnosis and treatment are collectively called "Cancer-related cognitive impairment (CRCI)". The number of publications about cognitive impairment due to cancer therapy, especially chemotherapy, hormonal therapy, and radiotherapy, has been growing. Patients often worry not only about their disease condition and therapies, but also experience concerns regarding their memory, attention, and ability to concentrate. Even subtle CRCI can have a significant impact on social relationships, the ability to work, undergo treatment, accomplish meaningful goals, and the quality of life. Longitudinal studies of cancer patients indicated that up to 75% experience CRCI during treatment. Furthermore, CRCI may persist for many years following treatment. However, it is not well understood by most physicians and medical staff. CRCI can be mediated through increased inflammatory cytokines and hormonal changes. In addition, the biology of the cancer, stress, and attentional fatigue can also contribute to CRCI. Genetic factors and co-occurring symptoms may explain some of the inter-individual variability in CRCI. Researchers and patients are actively trying to identify effective interventional methods and useful coping strategies. Many patients are willing to discuss their disease condition and future treatment with medical staff and/or their families. Some patients also hope to discuss their end-of-life care. However, it is difficult to express their will after developing cognitive impairment. Advance care planning (ACP) can help in such situations. This process involves discussion between a patient, their family, and clinicians to clarify and reflect on values, treatment preferences, and goals to develop a shared understanding of how end-of-life care should proceed. The number of cancer patients with cognitive impairment has been increasing owing to the

  18. Current trends in the chemotherapy of colorectal cancer.

    Science.gov (United States)

    Berciano-Guerrero, M A; Villa-Guzmán, J C; Acosta-Guerrero, R; Castañeda-Peñalvo, G; Rodríguez-Flores, J

    2012-01-01

    The increase in the therapeutic arsenal in the last 20 years, has given rise to changes in treating colorectal cancer (CRC) with only pyrimidines to combine several cytotoxic drugs. However, the present question is to determine the optimal sequence of this combination. This review presents an update of data on chemical and clinical features of chemotherapy used for colorectal cancer and the mechanisms of cellular resistance and potential predictive and prognostic biomarkers, which may contribute to a better selection of a therapeutic strategy. PMID:22830343

  19. The current pattern of reconstructive surgery for breast cancer

    OpenAIRE

    A. Kh. Ismagilov; A. R. Khamitov; A. S. Vanesyan

    2015-01-01

    In Russia, breast cancer (BC) occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %). While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in referen...

  20. Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Karapanos, Konstantinos, E-mail: dr.kostaskarapanos@gmail.com; Nomikos, Iakovos N. [Department of Surgery (B' Unit), METAXA Cancer Memorial Hospital, Piraeus (Greece)

    2011-02-11

    Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.

  1. Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

    International Nuclear Information System (INIS)

    Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results

  2. Diabetes and Cancer: a Review of Current Knowledge.

    Science.gov (United States)

    Wojciechowska, J; Krajewski, W; Bolanowski, M; Kręcicki, T; Zatoński, T

    2016-05-01

    Diabetes mellitus (DM), one of the most common life-threatening illnesses worldwide, is a group of metabolic diseases, characterized by sustained hyperglycemia. The global prevalence of diabetes mellitus among adults reached 387 millions in 2014 and is still rising. It is suggested there is a strong association between diabetes mellitus (especially type 2 diabetes mellitus) and carcinogenesis. The possible biological links between diabetes mellitus and cancer comprise hyperinsulinemia, hyperglycemia and fat-induced chronic inflammation. Although, the strongest association refers to pancreas and liver, there are many other organs involved in carcinogenesis in diabetic patients including breast, endometrium, bladder and kidney.Recent studies suggest that there is also association between cancer incidence and anti-diabetic medications. It was observed that some medications decrease the risk of carcinogenesis and some increase that risk. The majority of studies concern metformin, a drug of choice in type 2 diabetes mellitus, and its anti-neoplastic and tumor-suppressing activity. The positive effect of metformin was found in numerous researches investigating breast, pancreas, liver, colon, ovaries and prostate tumors.Because a variety of studies have suggested that diabetes mellitus and cancer are frequently coexisting diseases, recently published studies try to explain the influence of diabetes mellitus and anti-diabetic medications on carcinogenesis in different organs.We present the review of the latest studies investigating the association between both diabetes mellitus and anti-diabetic medications and cancer incidence and prognosis.Particularly we highlight the problem of concomitant head and neck cancers in diabetics, rarely analysed and often omitted in studies. PMID:27219686

  3. An Overview of Current Screening and Management Approaches for Prostate Cancer.

    Science.gov (United States)

    Akram, Omar N; Mushtaq, Gohar; Kamal, Mohammad Amjad

    2015-01-01

    Prostate cancer is the fourth leading cause of mortality in Australian men. The prevalence and incidence is increasing in both developed and developing nations, thus there is a need for better screening and management of this disorder. While there is no direct known cause of prostate cancer, management is largely focused on early detection and treatment strategies. Of particular concern is advanced prostate cancer which can manifest as castrate resistant prostate cancer characterized by therapy resistance. This short review outlines the global epidemiology of prostate cancer, clinical manifestations, risk factors, current screening strategies including first line clinical screening as well as the use of circulating biomarkers, and treatment of prostate cancer through mainstream therapeutics as well as the cutting edge peptide and nano-technology based therapeutics that are being implemented or in the process of development to overcome therapeutic obstacles in the treatment of prostate cancer.

  4. Evidence of current impact of climate change on life : a walk from genes to the biosphere

    NARCIS (Netherlands)

    Penuelas, Josep; Sardans, Jordi; Estiarte, Marc; Ogaya, Roma; Carnicer, Jofre; Coll, Marta; Barbeta, Adria; Rivas-Ubach, Albert; Llusia, Joan; Garbulsky, Martin; Filella, Iolanda; Jump, Alistair S.

    2013-01-01

    We review the evidence of how organisms and populations are currently responding to climate change through phenotypic plasticity, genotypic evolution, changes in distribution and, in some cases, local extinction. Organisms alter their gene expression and metabolism to increase the concentrations of

  5. Patterns of care study and evidence based medicine for radiation therapy. Prostate cancer

    International Nuclear Information System (INIS)

    In Japan, where the mortality rate of prostate cancer is lower than in Western countries, there is little evidence of radiation therapy for prostate cancer. Therefore, we have to refer to the evidence of radiation therapy from Western countries, but we should pay attention to the differences of cultural, racial, or social background between Japan and Western countries. The Patterns of Care Study (PCS) was conducted in Japan and extramural audits were performed for 50 randomly selected institutions. Detailed information of 311 prostate cancer patients without distant metastases and other cancers, who were treated with radiation therapy in 1996-1998, was collected. In this article, the results of PCS for primary prostate cancer were shown, with a review of literature for the appropriate choice of radiation therapy. This study was supported by the Grantin-Aid for Cancer Research from Ministry of Health, Labor and Welfare (10-17). (author)

  6. Current trends in cancer vaccines--a bioinformatics perspective.

    Science.gov (United States)

    Sankar, Shanju; Nayanar, Sangeetha K; Balasubramanian, Satheesan

    2013-01-01

    Cancer vaccine development is in the process of becoming reality in future, due to successful phase II/III clinical trials. However, there are still problems due to the specificity of tumor antigens and weakness of tumor associated antigens in eliciting an effective immune response. Computational models to assess the vaccine efficacy have helped to improve and understand what is necessary for personalized treatment. Further research is needed to elucidate the mechanisms of activation of antigen specific cytotoxic T lymphocytes, decreased TREG number functionality and antigen cascade, so that overall improvement in vaccine efficacy and disease free survival can be attained. T cell epitomic based in sillico approaches might be very effective for the design and development of novel cancer vaccines.

  7. Current status and prospect of therapy with advanced cancer

    International Nuclear Information System (INIS)

    Symtomatic or palliative therapy of the patients with advanced cancer must be directed to the relief of specific distressing symptoms caused by or associated with neoplasm. The radiotherapy must have a clear concepts of the potential accomplishments of other treatment modalities, such as neurosurgery, anesthesiology, chemotherapy, pharmacology and psychotherapy, so that he may use his own method in proper perspective. I discussed following is an list of contents in this papers. Relief of pain, Psychotherapy, SVC obstruction, Obstructive jaundice, Brain and lung metastasis, prevention of fracture, Skin metastasis, Liver metastasis and treatment of advanced pediaric tumor etc. For the future: 1) Establishment of Stage and Grade of advanced cancer. 2) Development of new chemotherapeutic drug and immunotherapy. 3) Combination of multidisciplinary team and multidisciplinary treatment. (author)

  8. CURRENT TREATMENTS FOR UROTHELIAL CANCER OF THE UPPER URINARY TRACT

    OpenAIRE

    S. V. Afonin; M. I. Volkova; V. B. Matveev

    2014-01-01

    TNephroureterectomy is by right considered to be the gold standard for treatment in patients with urothelial cancer of the upper urinary tract. Nevertheless, various surgical treatments are now being intensively developed and introduced into clinical practice and a possibility of using adjuvant and neoadjuvant chemotherapy is also being studied. The review summarizes data on various methods of treatment, its efficiency, long-term results and prognosis.

  9. Ambulatory surgery for the patient with breast cancer: current perspectives

    OpenAIRE

    Tan, Ern Yu; Pek, Chong Han; Tey,Boon Lim, John

    2016-01-01

    Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefit...

  10. Review of new evidence regarding the relationship of gasoline exposure to kidney cancer and leukemia.

    OpenAIRE

    Enterline, P E

    1993-01-01

    Four new or updated epidemiologic studies were presented at a meeting on the health effects of gasoline exposure held in Miami, Florida, November 5-8, 1991. A focus of these studies was whether there is a relationship between gasoline exposure and kidney cancer and leukemia. For gasoline distribution workers, who have a relatively high exposure, there was some evidence for a kidney cancer relationship in three studies but none in the fourth. There was evidence for an acute myelocytic leukemia...

  11. Imaging in primary penile cancer: current status and future directions

    Energy Technology Data Exchange (ETDEWEB)

    Kochhar, Rohit; Taylor, Ben [Christie, NHS Foundation Trust, Department of Radiology, Manchester (United Kingdom); Sangar, Vijay [Christie, NHS Foundation Trust, Department of Urology, Manchester (United Kingdom)

    2010-01-15

    Penile cancer is a rare neoplasm in the developed world. Clinical assessment often results in inaccurate staging and radiological techniques have a key role in staging and postoperative assessment. Magnetic resonance imaging (MRI) depicts penile anatomy in detail and is the most accurate technique for local staging and postoperative follow-up. MRI and ultrasound (US), although helpful for assessment of lymph nodes, are not reliable enough for accurate nodal staging. US-guided fine needle aspiration cytology (FNAC), however, remains a valuable tool to confirm metastases in suspicious inguinal nodes. Lymphoscintigraphy with dynamic sentinel node biopsy (DSNB) is a promising technique used to predict occult lymph node metastases. Novel imaging techniques such as positron emission tomography/computed tomography (PET-CT) and nanoparticle enhanced MRI have high sensitivity and specificity for lymph node metastases but their availability is limited and clinical utility is not fully established. The radiologist needs to be familiar with the normal penile anatomy, imaging appearances of pre- and post-treatment penile cancer, and the advantages and limitations of the available imaging techniques. This review highlights the above points and presents a systematic approach to make the best use of imaging in the management of patients with penile cancer. (orig.)

  12. Current and emerging therapies for the treatment of pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Rebecca A Moss

    2010-07-01

    Full Text Available Rebecca A Moss, Clifton LeeThe Cancer Institute of New Jersey, New Brunswick, NJ, USAAbstract: Pancreatic adenocarcinoma carries a dismal prognosis and remains a significant cause of cancer morbidity and mortality. Most patients survive less than 1 year; chemotherapeutic options prolong life minimally. The best chance for long-term survival is complete resection, which offers a 3-year survival of only 15%. Most patients who do undergo resection will go on to die of their disease. Research in chemotherapy for metastatic disease has made only modest progress and the standard of care remains the purine analog gemcitabine. For resectable pancreatic cancer, presumed micrometastases provide the rationale for adjuvant chemotherapy and chemoradiation (CRT to supplement surgical management. Numerous randomized control trials, none definitive, of adjuvant chemotherapy and CRT have been conducted and are summarized in this review, along with recent developments in how unresectable disease can be subcategorized according to the potential for eventual curative resection. This review will also emphasize palliative care and discuss some avenues of research that show early promise.Keywords: neoadjuvant therapy, palliative care adeno carcinoma, mortality

  13. Biology of cancer: current issues and future prospects.

    Science.gov (United States)

    Jenkins, J

    1992-02-01

    The future of cancer treatment is limited only by the rate of progress made in understanding the biology of cancer. The future will present a considerable challenge to health care professionals to learn new theories, understand new terms, and expect different toxicities. The explosion of information and technology is exciting, yet frightening. The willingness of scientists, health care professionals, and consumers to deal with the ethical, financial, and political issues generated by this progress is gratifying. Because science has created such advances, the effort to deal with the outcomes is worthwhile but still difficult. The challenge to rapidly facilitate the sharing of the scientific and clinical advances has been recognized by the nation. A legislative mandate to create a way to store and analyze the vast data related to molecular biology, biochemistry, and genetics resulted in the National Center for Biotechnology Information. The development of automated systems to analyze genetic, environmental, biological, and chemistry information can only enhance future progress in the management of cancer.

  14. Nutrition support and dietary interventions for patients with lung cancer: current insights

    Directory of Open Access Journals (Sweden)

    Kiss N

    2016-01-01

    Full Text Available Nicole Kiss1,2 1Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; 2Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Abstract: Malnutrition and weight loss are prevalent in patients with lung cancer. The impact of malnutrition on patients with cancer, and specifically in patients with lung cancer, has been demonstrated in a large number of studies. Malnutrition has been shown to negatively affect treatment completion, survival, quality of life, physical function, and health care costs. Emerging evidence is providing some insight into which lung cancer patients are at higher nutritional risk. In lung cancer patients treated with radiotherapy, stage III or more disease, treatment with concurrent chemotherapy and the extent of radiotherapy delivered to the esophagus appear to confer a higher risk of weight loss during and post-treatment. Studies investigating nutrition interventions for lung cancer patients have examined intensive dietary counseling, supplementation with fish oils, and interdisciplinary models of nutrition and exercise interventions and show promise for improved outcomes from these interventions. However, further research utilizing these interventions in large clinical trials is required to definitively establish effective interventions in this patient group. Keywords: lung cancer, nutrition, malnutrition

  15. Current status and implications of microRNAs in ovarian cancer diagnosis and therapy

    Directory of Open Access Journals (Sweden)

    Zaman Mohd Saif

    2012-12-01

    Full Text Available Abstract Ovarian cancer is the fifth most common cancer among women and causes more deaths than any other type of female reproductive cancer. Currently, treatment of ovarian cancer is based on the combination of surgery and chemotherapy. While recurrent ovarian cancer responds to additional chemotherapy treatments, the progression-free interval becomes shorter after each cycle, as chemo-resistance increases until the disease becomes incurable. There is, therefore, a strong need for prognostic and predictive markers to help optimize and personalize treatment in order to improve the outcome of ovarian cancer. An increasing number of studies indicate an essential role for microRNAs in ovarian cancer progression and chemo-resistance. MicroRNAs (miRNAs are small endogenous non-coding RNAs (~22bp which are frequently dysregulated in cancer. Typically, miRNAs are involved in crucial biological processes, including development, differentiation, apoptosis and proliferation. Two families of miRNAs, miR-200 and let-7, are frequently dysregulated in ovarian cancer and have been associated with poor prognosis. Both have been implicated in the regulation of epithelial-to-mesenchymal transition, a cellular transition associated with tumor aggressiveness, tumor invasion and chemo-resistance. Moreover, miRNAs also have possible implications for improving cancer diagnosis; for example miR-200 family, let-7 family, miR-21 and miR-214 may be useful in diagnostic tests to help detect ovarian cancer at an early stage. Additionally, the use of multiple target O-modified antagomirs (MTG-AMO to inhibit oncogenic miRNAs and miRNA replacement therapy for tumor suppressor miRNAs are essential tools for miRNA based cancer therapeutics. In this review we describe the current status of the role miRNAs play in ovarian cancer and focus on the possibilities of microRNA-based therapies and the use of microRNAs as diagnostic tools.

  16. Lapatinib: the evidence for its therapeutic value in metastatic breast cancer

    Directory of Open Access Journals (Sweden)

    Andrew Thomson

    2005-06-01

    Full Text Available Andrew ThomsonCore Medical Publishing, Knutsford, UKIntroduction: Breast cancer is the most common cancer affecting women. Many patients ultimately progress to metastatic disease and optimal management of this disease remains a significant therapeutic challenge. Lapatinib, a dual tyrosine kinase inhibitor, is in clinical development for treatment of this disease. Aims: The objective of this article is to review the published evidence for the treatment of metastatic breast cancer with lapatinib, and assess its therapeutic potential.Evidence review: Most evidence has appeared in meeting abstract reports of phase I and II studies in healthy volunteers and cancer patients. Four studies have included patients with exclusively breast cancer. Complete and partial responses and stable disease has been reported in some patients. Emerging evidence indicates that complete and partial responses can be achieved in some patients with metastatic breast cancer. Lapatinib appears to be well tolerated in cancer patients and the maximum tolerated dose is in the region of 1800 mg/day. In addition, it has been used in combination with other cancer treatments. Five ongoing or planned phase II monotherapy and three phase III combination-therapy studies with lapatinib have been identified.Outcomes summary: The phase I and II studies reported to date have provided safety data and preliminary indications regarding efficacy. There is preliminary evidence that lapatinib can achieve objective response rates of 10–38% in patients with metastatic breast cancer. Patients with tumors overexpressing ErbB1 and/or ErbB2 are likely to benefit from lapatinib treatment. Key words: lapatinib, GW572016, metastatic breast cancer, signal transduction, tyrosine kinase inhibition

  17. Role of von Willebrand factor levels in the prognosis of stage Ⅳ colorectal cancer: Do we have enough evidence?

    Institute of Scientific and Technical Information of China (English)

    I. Gil-Bazo; J. A Díaz-González; J. Rodríguez; J. Cortés; E. Calvo; J. A. Páramo; J. García-Foncillas

    2005-01-01

    @@ TO THE EDITOR Cancer patients usually present a prothrombotic condition.Several clotting-related proteins, such as yon Willebrand factor (vWF), presenting higher plasma concentrations in these patients, may play a key role in this process. Moreover,some of those proteins are currently being characterized as response rate and overall survival markers in metastatic colorectal cancer (MCRC). In this comment article, we discuss the last piece of evidence that supports the use of vWF as a prognostic indicator in MCRC patients, provided by a paper recently published by Wang et al., in the World Journal of Gastroenterology. Summarizing, although vWF should be seriously considered as potential future prognostic and predictive indicator in colorectal cancer, more dynamic and better designed studies in longer series of patients should be conducted before standardizing its universal use among these patients.

  18. The treatment of metastatic non-small cell lung cancer in the elderly: an evidence-based approach

    Directory of Open Access Journals (Sweden)

    David E Dawe

    2014-07-01

    Full Text Available An increasing proportion of patients with advanced NSCLC are over 70 years old, raising unique challenges for treatment decision-making. While these patients are underrepresented in clinical trials, there is an emerging body of evidence associated with this group. The lesson of comprehensive geriatric assessment is that chronological age does not always correlate with physiological age and a variety of important comorbidities and geriatric syndromes can go undetected in a typical history and physical. These comorbidities and expected physiologic changes due to aging complicate decision-making around appropriate treatment. This review discusses geriatric assessment in elderly cancer patients and evaluates the current evidence for chemotherapy and targeted therapy for patients with advanced non-small cell lung cancer aged ≥70 years.

  19. Radionuclide liver cancer therapies: from concept to current clinical status.

    Science.gov (United States)

    Vente, Maarten A D; Hobbelink, Monique G G; van Het Schip, Alfred D; Zonnenberg, Bernard A; Nijsen, Johannes F W

    2007-07-01

    Primary and secondary liver cancer have longtime been characterized by an overall poor prognosis since the majority of patients are not candidates for surgical resection with curative intent, systemic chemotherapy alone has rarely resulted in long-term survival, and the role of conventional external beam radiation therapy has traditionally been limited due to the relative sensitivity of the liver parenchyma to radiation. Therefore, a host of new treatment options have been developed and clinically introduced, including radioembolization techniques, which are the main topic of this paper. In these locoregional treatments liver malignancies are passively targeted because, unlike the normal liver, the blood supply of intrahepatic tumors is almost uniquely derived from the hepatic artery. These internal radiation techniques consist of injecting either yttrium-90 ((90)Y) microspheres, or iodine-131 ((131)I) or rhenium-188 ((188)Re) labeled lipiodol into the hepatic artery. Radioactive lipiodol is used exclusively for treatment of primary liver cancer, whereas (90)Y microsphere therapy is applied for treatment of both primary and metastatic liver cancers. Favorable clinical results have been achieved, particularly when (90)Y microspheres were used in conjunction with systemic chemotherapy. The main advantages of radiolabeled lipiodol treatment are that it is relatively inexpensive (especially (188)Re-HDD-lipiodol) and that the administration procedure is somewhat less complex than that of the microspheres. Holmium-166 ((166)Ho) loaded poly(L-lactic acid) microspheres have also been developed and are about to be clinically introduced. Since (166)Ho is a combined beta-gamma emitter and highly paramagnetic as well, it allows for both (quantitative) scintigraphic and magnetic resonance imaging. PMID:17630919

  20. Epidemiological evidence on environmental tobacco smoke and cancers other than lung or breast.

    Science.gov (United States)

    Lee, Peter N; Thornton, Alison J; Hamling, Janette S

    2016-10-01

    We reviewed 87 epidemiological studies relating environmental tobacco smoke (ETS) exposure to risk of cancer other than lung or breast in never smoking adults. This updates a 2002 review which also considered breast cancer. Meta-analysis showed no significant relationship with ETS for nasopharynx cancer, head and neck cancer, various digestive cancers (stomach, rectum, colorectal, liver, pancreas), or cancers of endometrium, ovary, bladder and brain. For some cancers (including oesophagus, colon, gall bladder and lymphoma) more limited data did not suggest a relationship. An increased cervix cancer risk (RR 1.58, 95%CI 1.29-1.93, n = 17 independent estimates), reducing to 1.29 (95%CI 1.01-1.65) after restriction to five estimates adjusting for HPV infection or sexual activity suggests a causal relationship, as do associations with nasosinus cancer observed in 2002 (no new studies since), and less so kidney cancer (RR 1.33, 95%CI 1.04-1.70, n = 6). A weaker association with total cancer (RR 1.13, 95%CI 1.03-1.35, n = 19) based on heterogeneous data is inconclusive. Inadequate confounder control, recall bias, publication bias, and occasional reports of implausibly large RRs in individual studies contribute to our conclusion that the epidemiological evidence does not convincingly demonstrate that ETS exposure causes any of the cancers studied. PMID:27321059

  1. Cannabinoids for Symptom Management and Cancer Therapy: The Evidence.

    Science.gov (United States)

    Davis, Mellar P

    2016-07-01

    Cannabinoids bind not only to classical receptors (CB1 and CB2) but also to certain orphan receptors (GPR55 and GPR119), ion channels (transient receptor potential vanilloid), and peroxisome proliferator-activated receptors. Cannabinoids are known to modulate a multitude of monoamine receptors. Structurally, there are 3 groups of cannabinoids. Multiple studies, most of which are of moderate to low quality, demonstrate that tetrahydrocannabinol (THC) and oromucosal cannabinoid combinations of THC and cannabidiol (CBD) modestly reduce cancer pain. Dronabinol and nabilone are better antiemetics for chemotherapy-induced nausea and vomiting (CINV) than certain neuroleptics, but are not better than serotonin receptor antagonists in reducing delayed emesis, and cannabinoids have largely been superseded by neurokinin-1 receptor antagonists and olanzapine; both cannabinoids have been recommended for breakthrough nausea and vomiting among other antiemetics. Dronabinol is ineffective in ameliorating cancer anorexia but does improve associated cancer-related dysgeusia. Multiple cancers express cannabinoid receptors directly related to the degree of anaplasia and grade of tumor. Preclinical in vitro and in vivo studies suggest that cannabinoids may have anticancer activity. Paradoxically, cannabinoid receptor antagonists also have antitumor activity. There are few randomized smoked or vaporized cannabis trials in cancer on which to judge the benefits of these forms of cannabinoids on symptoms and the clinical course of cancer. Smoked cannabis has been found to contain Aspergillosis. Immunosuppressed patients should be advised of the risks of using "medical marijuana" in this regard. PMID:27407130

  2. Intensity-modulated radiotherapy for lung cancer: current status and future developments

    OpenAIRE

    Chan, C; Lang, S.; Rowbottom, C; Guckenberger, M.; Faivre-Finn, C

    2014-01-01

    Radiotherapy plays an important role in the management of lung cancer, with over 50% of patients receiving this modality at some point during their treatment. Intensity-modulated radiotherapy (IMRT) is a technique that adds fluence modulation to beam shaping, which improves radiotherapy dose conformity around the tumor and spares surrounding normal structures. Treatment with IMRT is becoming more widely available for the treatment of lung cancer, despite the paucity of high level evidence sup...

  3. Management of locally advanced breast cancer: Evolution and current practice

    Directory of Open Access Journals (Sweden)

    Rustogi Ashish

    2005-01-01

    Full Text Available Locally advanced breast cancer (LABC accounts for a sizeable number (30-60% of breast cancer cases and is a common clinical scenario in developing countries. The treatment of LABC has evolved from single modality treatment, consisting of radical mutilating surgery or higher doses of radiotherapy in inoperable disease to multimodality management, which along with the above two included systemic therapy. Neoadjuvant chemotherapy (NACT has made a tremendous impact on the management of LABC. NACT was initiated to institute systemic therapy upfront at the earliest in this group of patients with a high risk of micrometastasis burden. While NACT did not yield a survival advantage, it has however made breast conservation possible in selected group of cases. Large number of studies and many randomised trials have been done in women with LABC in order to improve the therapeutic decisions and also the local control and survival. With this background we have reviewed various treatment options in patients with LABC which should possibly help in guiding the clinicians for optimal management of LABC.

  4. Targeting cancer testis antigens for biomarkers and immunotherapy in colorectal cancer: Current status and challenges

    Institute of Scientific and Technical Information of China (English)

    Anil; Suri; Nirmala; Jagadish; Shikha; Saini; Namita; Gupta

    2015-01-01

    Colorectal cancer ranks third among the estimatedcancer cases and cancer related mortalities in United States in 2014. Early detection and efficient therapy remains a significant clinical challenge for this disease. Therefore, there is a need to identify novel tumor asso-ciated molecules to target for biomarker development and immunotherapy. In this regard, cancer testis antigens have emerged as a potential targets for developing novel clinical biomarkers and immunotherapy for various malignancies. These germ cell specific proteins exhibit aberrant expression in cancer cells and contribute in tumorigenesis. Owing to their unique expression profile and immunogenicity in cancer patients, cancer testis antigens are clinically referred as the most promising tumor associated antigens. Several cancer testis antigens have been studied in colorectal cancer but none of them could be used in clinical practice. This review is an attempt to address the promising cancer testis antigens in colorectal cancer and their possible clinical implications as biomarkers and immunotherapeutic targets with particular focus on challenges and future interventions.

  5. Current situation of interventional treatment for non-small cell lung cancer

    International Nuclear Information System (INIS)

    Primary bronchogenic carcinoma, which referred to as lung cancer, is one of the most common malignant tumors in china. The 2010 China Health Statistical Yearbook indicates that in 2005 the mortality of lung cancer was at the first place of all cancers. Non-small-cell lung cancer (NSCLC) accounts for 8.5% of all the lung cancers, most of the patents are diagnosed in their late stages and have lost the chance of operation resection, and the 5-year survival rate is only about 15%. Being of technical simplicity, mild side reaction, satisfactory local effect and reliable reproducibility, interventional therapy has become an important and non-surgical method for advanced NSCLC, and has been widely applied in clinical practice. This paper aims to make a review about the current situation of interventional treatment for non-small cell lung cancer. (authors)

  6. Weight of evidence analysis of lung cancer in Colorado Plateau uranium miners

    International Nuclear Information System (INIS)

    The authors use a Bayesian contingency table analysis to assess lung cancer in the Colorado plateau uranium miners. This population is studied by Whittemore, Hornung and BEIR-IV, but none of these includes the radiation dose from hard rock mining that about 38% of the miners have accumulated. The analysis uses 'weight of evidence' which Good applied to the analysis of lung cancer many years ago. The analysis indicates that only in those exposed for a long period and at high exposure rates is the weight of evidence positive with a coefficient of variation less than unity that radiation is associated with the lung cancers. The coefficient of variation is a criterion of the significance of the weight of evidence for the association of the radon exposure in the miners with lung cancer. In the subsequent discussion it is suggested that this approach is similar to the probability of causation, which it is not. (author)

  7. Free testosterone drives cancer aggressiveness: evidence from US population studies.

    Directory of Open Access Journals (Sweden)

    Shohreh Shahabi

    Full Text Available Cancer incidence and mortality are higher in males than in females, suggesting that some gender-related factors are behind such a difference. To analyze this phenomenon the most recent Surveillance, Epidemiology and End Results (SEER database served to access cancer survival data for the US population. Patients with gender-specific cancer and with limited information were excluded and this fact limited the sample size to 1,194,490 patients. NHANES III provided the distribution of physiologic variables in US population (n = 29,314. Cox model and Kaplan-Meier method were used to test the impact of gender on survival across age, and to calculate the gender-specific hazard ratio of dying from cancer five years following diagnosis. The distribution of the hazard ratio across age was then compared with the distribution of 65 physiological variables assessed in NHANES III. Spearman and Kolmogorov-Smirnov test assessed the homology. Cancer survival was lower in males than in females in the age range 17 to 61 years. The risk of death from cancer in males was about 30% higher than that of females of the same age. This effect was present only in sarcomas and epithelial solid tumors with distant disease and the effect was more prominent in African-Americans than Caucasians. When compared to the variables assessed in the NHANES III study, the hazard ratio almost exactly matched the distribution of free testosterone in males; none of the other analyzed variables exhibited a similar homology. Our findings suggest that male sex hormones give rise to cancer aggressiveness in patients younger than 61 years.

  8. Preserving fertility in young patients with endometrial cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    Kalogera E

    2014-07-01

    Full Text Available Eleftheria Kalogera, Sean C Dowdy, Jamie N Bakkum-Gamez Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA Abstract: Endometrial cancer (EC is the most common gynecologic malignancy in developed countries and affects predominantly postmenopausal women. It is estimated, however, that 15%–25% of women will be diagnosed before menopause. As more women choose to defer childbearing until later in life, the feasibility and safety of fertility-sparing EC management have been increasingly studied. Definitive treatment of total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by women who wish to maintain their reproductive potential. However, the consideration of conservative management carries the oncologic risks of unstaged EC and the risk of missing a synchronous ovarian cancer. It is further complicated by the lack of consensus regarding the initial assessment, treatment, and surveillance. Conservative treatment with progestins has been shown to be a feasible and safe fertility-sparing approach for women with low grade, early stage EC with no myometrial invasion. The two most commonly adopted regimens are medroxyprogesterone acetate at 500–600 mg daily and megestrol acetate at 160 mg daily for a minimum of 6–9 months, with initial response rates commonly reported between 60% and 80% and recurrence rates between 25% and 40%. Photodynamic therapy and hysteroscopic EC excision have recently been reported as alternative approaches to progestin therapy alone. However, limited efficacy and safety data exist. Live birth rates after progestin therapy have typically been reported around 30%; however, when focusing only on those who do pursue fertility after successful treatment, the live birth rates were found to be higher than 60%. Assisted reproductive technology has been associated with a higher live birth rate compared with spontaneous conception, most likely reflecting the

  9. Current principles of effective therapy for ovarian cancer

    Directory of Open Access Journals (Sweden)

    L. A. Ashrafyan

    2015-01-01

    Full Text Available In spite of all of modern medicine»s advances, ovarian cancer (OC mortality remains to be incommensurably high and to hold the lead among gynecological cancers. The initial cause of this deplorable statistics is the absence of a clear concept of the pathogenesis of OC and hence the justified prevention and methodology of early diagnosis of the disease; in this connection, therapy that proves to be ineffective is frequently used by medical oncologists in their daily practice. As a consequence, there is a high proportion of its further progression: the rates of early and late recurrences were about 30 and 60–65 %, respectively; most of which are drug resistant to further chemotherapy cycles. By taking into account these strikingly modest statistics, it becomes apparent that oncologists desire to make changes in the existing treatment regimen to achieve meaningful results. To use target drugs is one of these promising areas owing to new views on the concept of the pathogenesis of OC.Nevertheless, considering a wide variety of the signaling cascades and molecules, which are involved in the process of carcinogenesis, even target compounds, if they have only one point of application, cannot always produce their desirable therapeutic effect and their co-administration is responsible for high toxicity. In this light, the most effective drugs are indole-3-carbinol and epigallocathechin-3-gallate, which virtually cause no adverse reactions and can block various molecular targets at different levels of the mechanism of malignant transformation. Based on L. A. Ashrafyan, s concept of two pathogenetic variants of sporadic OC (2009 and on the recent findings in molecular biology and epigenetics, the incorporation of the above medications into the standard treatment regimen for OC should increase survival rates and change the nature of recurrence by that of more locally advanced forms. On this basis, a clinical trial was carried out to study

  10. Evidence for Anomalous Effects on the Current Evolution in Tokamak Operating Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Casper, T; Jayakumar, R; Allen, S; Holcomb, C; Makowski, M; Pearlstein, L; Berk, H; Greenfield, C; Luce, T; Petty, C; Politzer, P; Wade, M; Murakami, M; Kessel, C

    2006-10-03

    Alternatives to the usual picture of advanced tokamak (AT) discharges are those that form when anomalous effects alter the plasma current and pressure profiles and those that achieve stationary characteristics through mechanisms so that a measure of desired AT features is maintained without external current-profile control. Regimes exhibiting these characteristics are those where the safety factor (q) evolves to a stationary profile with the on-axis and minimum q {approx} 1 and those with a deeply hollow current channel and high values of q. Operating scenarios with high fusion performance at low current and where the inductively driven current density achieves a stationary configuration with either small or non-existing sawteeth may enhance the neutron fluence per pulse on ITER and future burning plasmas. Hollow current profile discharges exhibit high confinement and a strong ''box-like'' internal transport barrier (ITB). We present results providing evidence for current profile formation and evolution exhibiting features consistent with anomalous effects or with self-organizing mechanisms. Determination of the underlying physical processes leading to these anomalous effects is important for scaling of current experiments for application in future burning plasmas.

  11. Cytochrome P450-based cancer gene therapy: current status.

    Science.gov (United States)

    Kan, On; Kingsman, Susan; Naylor, Stuart

    2002-12-01

    Results from a number of preclinical studies have demonstrated that a P450-based gene-directed enzyme prodrug therapy (GDEPT) strategy for the treatment of cancer is both safe and efficacious. This strategy has now moved forward into the clinic. At least two different approaches using different delivery methods (retroviral vector MetXia [Oxford BioMedica] and encapsulated P450 expressing cells), different cytochrome P450 isoforms (human CYP2B6 versus rat CYP2B1) and different prodrugs (cyclophosphamide [CPA] versus ifosfamide [IFA]) have concluded Phase I/II clinical trial with encouraging results. In the future, P450-based GDEPT can potentially be further enhanced by improved vectors for P450 gene delivery and disease-targeted promoters for focused gene expression at the target site. In addition, there is scope for developing synthetic P450s and their respective prodrugs to improve both enzyme kinetics and the profile of the active moiety. PMID:12517265

  12. Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment.

    Science.gov (United States)

    Klumpp, Raymond; Trevisan, Carlo

    2015-01-01

    Treatment of Avascular Osteonecrosis (AVN) of the femoral head to prevent progression to an arthritic hip is a challenging subject. Many conservative treatment options have been proposed in the literature. Weight bearing restriction as a stand-alone therapy is insufficient in preventing disease progression but it may be useful when combined with pharmacological agents or surgery. Bisphosphonate treatment in AVN might be efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage and, considered the limited evidence and potential side effects of treatment, it could be considered in a pre-collapse stage in selected cases. Current literature suggests that low molecular weight heparin could lower disease progression in idiopathic AVN with quality of evidence being very low. Also the evidence to support the use of statins or vasodilators in the treatment of osteonecrosis is very low and their use cannot be recommended. Extracorporeal shock wave therapy may improve pain and function in early stages of disease with a low evidence, but there doesn't seem to be a significant change in time to the occurrence of femoral head collapse. Only one study has been conducted with pulsed electromagnetic fields therefore no recommendation can be given on clinical use of PEF in AVN. Evidence on hyperbaric oxygen therapy in the treatment of AVN is very limited and the high cost of treatment and the limited availability of structures that can provide the service poses other concerns about its feasibility. Based on current evidence, conservative treatment may be considered in early stages of asymptomatic AVN instead of observation only. PMID:27134631

  13. Current Evidence on the Use of Antifilarial Agents in the Management of Bancroftian Filariasis

    OpenAIRE

    Sumadhya Deepika Fernando; Chaturaka Rodrigo; Senaka Rajapakse

    2010-01-01

    Many trials have explored the efficacy of individual drugs and drug combinations to treat bancroftian filariasis. This narrative review summarizes the current evidence for drug management of bancroftian filariasis. Diethylcarbamazine (DEC) remains the prime antifilarial agent with a well-established microfilaricidal and some macrofilaricidal effects. Ivermectin (IVM) is highly microfilaricidal but minimally macrofilaricidal. The role of albendazole (ALB) in treatment regimens is not well esta...

  14. Quantized current blockade and hydrodynamic correlations in biopolymer translocation through nanopores: evidence from multiscale simulations

    CERN Document Server

    Bernaschi, Massimo; Succi, Sauro; Fyta, Maria; Kaxiras, Efthimios

    2008-01-01

    We present a detailed description of biopolymer translocation through a nanopore in the presence of a solvent, using an innovative multi-scale methodology which treats the biopolymer at the microscopic scale as combined with a self-consistent mesoscopic description for the solvent fluid dynamics. We report evidence for quantized current blockade depending on the folding configuration and offer detailed information on the role of hydrodynamic correlations in speeding-up the translocation process.

  15. Enteral nutrition in acute pancreatitis: A review of the current evidence

    OpenAIRE

    Oláh, Attila; Romics Jr, Laszlo

    2014-01-01

    The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data. A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis. Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding, early vs delayed...

  16. Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues.

    Science.gov (United States)

    Korantzopoulos, Panagiotis; Sideris, Skevos; Dilaveris, Polychronis; Gatzoulis, Konstantinos; Goudevenos, John A

    2016-04-01

    A significant increase in the implantation of cardiac implantable electronic devices (CIEDs) is evident over the past years, while there is evidence for a disproportionate increase in CIED-related infections. The cumulative probability of device infection seems to be higher in implantable cardioverter defibrillator and in cardiac resynchronization therapy patients compared with permanent pacemaker patients. Given that more than a half of CIED infections are possibly related to the operative procedure, there is a need for effective periprocedural infection control. However, many of the current recommendations are empirical and not evidence-based, while questions, unresolved issues, and conflicting evidence arise. The perioperative systemic use of antibiotics confers significant benefit in prevention of CIED infections. However, there are no conclusive data regarding the specific value of each agent in different clinical settings, the value of post-operative antibiotic treatment as well as the optimal duration of therapy. The merit of local pocket irrigation with antibiotic and/or antiseptic agents remains unproved. Of note, recent evidence indicates that the application of antibacterial envelopes into the device pocket markedly decreases the infection risk. In addition, limited reports on strict integrated infection control protocols show a dramatic reduction in infection rates in this setting and therefore deserve further attention. Finally, the relative impact of particular factors on the infection risk, including the type of the CIED, patients' individual characteristics and comorbidities, should be further examined since it may facilitate the development of tailored prophylactic interventions for each patient. PMID:26516219

  17. Calcium and Cancer Prevention: Strengths and Limits of the Evidence

    Science.gov (United States)

    ... calcium carbonate has about 40 percent elemental calcium, meaning that 500 mg of calcium carbonate actually contains ... in this trial also contained vitamin D (400 international units [ IU ]). During ... and calcium in relation to prostate cancer risk among more than 142, ...

  18. Immunotherapy of Head and Neck Cancer: Current and Future Considerations

    Directory of Open Access Journals (Sweden)

    Alexander D. Rapidis

    2009-01-01

    Full Text Available Patients with head and neck squamous cell carcinoma (HNSCC are at considerable risk for death, with 5-year relative survival rates of approximately 60%. The profound multifaceted deficiencies in cell-mediated immunity that persist in most patients after treatment may be related to the high rates of treatment failure and second primary malignancies. Radiotherapy and chemoradiotherapy commonly have severe acute and long-term side effects on immune responses. The development of immunotherapies reflects growing awareness that certain immune system deficiencies specific to HNSCC and some other cancers may contribute to the poor long-term outcomes. Systemic cell-mediated immunotherapy is intended to activate the entire immune system and mount a systemic and/or locoregional antitumor response. The delivery of cytokines, either by single cytokines, for example, interleukin-2, interleukin-12, interferon-, interferon-, or by a biologic mix of multiple cytokines, such as IRX-2, may result in tumor rejection and durable immune responses. Targeted immunotherapy makes use of monoclonal antibodies or vaccines. All immunotherapies for HNSCC except cetuximab remain investigational, but a number of agents whose efficacy and tolerability are promising have entered phase 2 or phase 3 development.

  19. Current opinion on lymphadenectomy in pancreatic cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Theodoros E Pavlidis; Efstathios T Pavlidis; Athanasios K Sakantamis

    2011-01-01

    BACKGROUND: Adenocarcinoma of the pancreas exhibits aggressive behavior in growth, inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%. Curative resection is the only potential therapeutic opportunity. DATA  SOURCES: A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS: Despite recent advances in chemotherapy, radio-therapy or even immunotherapy, surgery still remains the major factor that affects the outcome. The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy;it has failed to prove beneficial. Four prospective, randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection. The exact lymph node status, including malignant spread and the total number retrieved as well as the lymph node ratio, is the most important prognostic factor. Positive lymph nodes after pancreatectomy are present in 70%. Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS: Undoubtedly, a standard lymphadenectomy including >15 lymph nodes must be no longer preferred in patients with the usual head location. The extended lymphadenectomy does not have any place, unless in randomized trials. In cases with body or tail location, the radical antegrade modular pancreatosplenectomy gives promising results. Nevertheless, accurate localization and detailed examination of the resected specimen are required for better staging.

  20. Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk.

    Science.gov (United States)

    Michaud, Jason E; Billups, Kevin L; Partin, Alan W

    2015-12-01

    Testosterone plays a central role in male development and health. Likewise, androgen deficiency, or hypogonadism, is associated with a variety of symptoms including decreased energy, diminished libido and erectile dysfunction, among others. Male androgen levels steadily decline with age, and, in a subset of symptomatic older men, can result in late-onset hypogonadism (LOH). Over the last decade, increased awareness of hypogonadism among patients and providers has led to a significant rise in the use of testosterone replacement therapy (TRT) for hypogonadism, and especially in LOH. Accompanying the rise in TRT are concerns of potential adverse effects, including cardiovascular risks and the promotion of prostate cancer. The 'androgen hypothesis' asserts that prostate cancer development and progression is driven by androgens, and thus TRT has the theoretical potential to drive prostate cancer development and progression. In this review, we examine existing data surrounding testosterone and prostate cancer. There is significant evidence that androgens promote prostate cancer in experimental systems. However, there is no clear evidence that elevations in endogenous testosterone levels promote the development of prostate cancer in humans. As a result of experimental and historical data on the progression of prostate cancer following TRT, there has been widespread belief that TRT will promote disease progression in prostate cancer patients. Despite these fears, there are a growing number of studies demonstrating no increase in prostate cancer incidence among men on TRT. Furthermore, in studies involving a small number of patients, there has been no discernable increase in disease progression in prostate cancer patients on TRT. While data from large, prospective, randomized, controlled trials are absent, TRT in select prostate cancer patients is likely safe. In the end, the use of TRT in prostate cancer patients is still considered experimental and should only be offered

  1. Can UGT1A1 genotyping reduce morbidity and mortality in patients with metastatic colorectal cancer treated with irinotecan? An evidence-based review

    OpenAIRE

    Palomaki, Glenn E; Bradley, Linda A.; Douglas, Michael P.; Kolor, Katherine; Dotson, W. David

    2009-01-01

    This evidence-based review addresses the question of whether testing for UGT1A1 mutations in patients with metastatic colorectal cancer treated with irinotecan leads to improvement in outcomes (e.g., irinotecan toxicity, response to treatment, morbidity, and mortality), when compared with no testing. No studies were identified that addressed this question directly. The quality of evidence on the analytic validity of current UGT1A1 genetic testing methods is adequate (scale: convincing, adequa...

  2. Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

    Directory of Open Access Journals (Sweden)

    Alpesh N. Amin

    2011-09-01

    Full Text Available Venous thromboembolism (VTE, a common complication in patients with cancer, is associated with increased risk of morbidity, mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities, age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated. Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis across the patient continuum.

  3. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

    Directory of Open Access Journals (Sweden)

    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  4. Association between Cancer Literacy and Cancer-Related Behaviour: Evidence from Ticino, Switzerland

    OpenAIRE

    Nicola Diviani; Schulz, Peter J

    2014-01-01

    Background This paper details the role of different dimensions of health literacy in the relationship between health literacy and cancer-related health behaviours. In particular, Cancer Literacy is studied as an exemplar of a dimension of health literacy beyond basic reading and writing skills. The link between functional health literacy, Cancer Literacy and cancer-related health behaviours is investigated in a sample of Ticino (Switzerland) residents (n=639). Design and methods Detailed data...

  5. Direct Evidence for Neutrino Flavor Transformation from Neutral-Current Interactions in the Sudbury Neutrino Observatory

    CERN Document Server

    Ahmad, Q R; Andersen, T C; Anglin, J D; Barton, J C; Beier, E W; Bercovitch, M; Bigu, J; Biller, S D; Black, R A; Blevis, I; Boardman, R J; Boger, J; Bonvin, E; Boulay, M G; Bowler, M G; Bowles, T J; Brice, S J; Browne, M C; Bullard, T V; Buhler, G; Cameron, J; Chan, Y D; Chen, H H; Chen, M; Chen, X; Cleveland, B T; Clifford, E T H; Cowan, J H M; Cowen, D F; Cox, G A; Dai, X; Dalnoki-Veress, F; Davidson, W F; Doe, P J; Doucas, G; Dragowsky, M R; Duba, C A; Duncan, F A; Dunford, M; Dunmore, J A; Earle, E D; Elliott, S R; Evans, H C; Ewan, G T; Farine, J; Fergani, H; Ferraris, A P; Ford, R J; Formaggio, J A; Fowler, M M; Frame, K; Frank, E D; Frati, W; Gagnon, N; Germani, J V; Gil, S; Graham, K; Grant, D R; Hahn, R L; Hallin, A L; Hallman, E D; Hamer, A S; Hamian, A A; Handler, W B; Haq, R U; Hargrove, C K; Harvey, P J; Hazama, R; Heeger, K M; Heintzelman, W J; Heise, J; Helmer, R L; Hepburn, J D; Heron, H; Hewett, J L; Hime, A; Howe, M; Hykawy, J G; Isaac, M C P; Jagam, P; Jelley, N A; Jillings, C; Jonkmans, G; Kazkaz, K; Keener, P T; Klein, J R; Knox, A B; Komar, R J; Kouzes, R; Kutter, T; Kyba, C C M; Law, J; Lawson, I T; Lay, M; Lee, H W; Lesko, K T; Leslie, J R; Levine, I; Locke, W; Luoma, S; Lyon, J; Majerus, S; Mak, H B; Maneira, J; Manor, J; Marino, A D; McCauley, N; McDonald, A B; McDonald, D S; McFarlane, K; McGregor, G; Meijer-Drees, R; Miin, C; Miller, G G; Milton, G; Moffat, B A; Moorhead, M E; Nally, C W; Neubauer, M S; Newcomer, F M; Ng, H S; Noble, A J; Norman, E B; Novikov, V M; O'Neill, M; Okada, C E; Ollerhead, R W; Omori, Mamoru; Orrell, J L; Oser, S M; Poon, A W P; Radcliffe, T J; Roberge, A; Robertson, B C; Robertson, R G H; Rosendahl, S S E; Rowley, J K; Rusu, V L; Saettler, E; Schaffer, K K; Schwendener, M H; Schülke, A; Seifert, H; Shatkay, M; Simpson, J J; Sims, C J; Sinclair, D; Skensved, P; Smith, A R; Smith, M W E; Spreitzer, T; Starinsky, N; Steiger, T D; Stokstad, R G; Stonehill, L C; Storey, R S; Sur, B; Tafirout, R; Tagg, N; Tanner, N W; Taplin, R K; Thorman, M; Thornewell, P M; Trent, P T; Tserkovnyak, Y; Van Berg, R; Van de Water, R G; Virtue, C J; Waltham, C E; Wang, J X; Wark, D L; West, N; Wilhelmy, J B; Wilkerson, J F; Wilson, J R; Wittich, P; Wouters, J M; Yeh, M

    2002-01-01

    Observations of neutral current neutrino interactions on deuterium in the Sudbury Neutrino Observatory are reported. Using the neutral current, elastic scattering, and charged current reactions and assuming the standard 8B shape, the electron-neutrino component of the 8B solar flux is 1.76 +/-0.05(stat.)+/-0.09(syst.) x10^6/(cm^2 s), for a kinetic energy threshold of 5 MeV. The non-electron neutrino component is 3.41+/-0.45(stat.)+0.48,-0.45(syst.) x10^6/(cm^2 s), 5.3 standard deviations greater than zero, providing strong evidence for solar electron neutrino flavor transformation. The total flux measured with the NC reaction is 5.09 +0.44,-0.43(stat.)+0.46,-0.43(syst.)x10^6/(cm^2 s), consistent with solar models.

  6. Genetic Evidence for XPC-KRAS Interactions During Lung Cancer Development.

    Science.gov (United States)

    Zhang, Xiaoli; He, Nonggao; Gu, Dongsheng; Wickliffe, Jeff; Salazar, James; Boldogh, Istavan; Xie, Jingwu

    2015-10-20

    Lung cancer causes more deaths than breast, colorectal and prostate cancers combined. Despite major advances in targeted therapy in a subset of lung adenocarcinomas, the overall 5-year survival rate for lung cancer worldwide has not significantly changed for the last few decades. DNA repair deficiency is known to contribute to lung cancer development. In fact, human polymorphisms in DNA repair genes such as xeroderma pigmentosum group C (XPC) are highly associated with lung cancer incidence. However, the direct genetic evidence for the role of XPC for lung cancer development is still lacking. Mutations of the Kirsten rat sarcoma viral oncogene homolog (Kras) or its downstream effector genes occur in almost all lung cancer cells, and there are a number of mouse models for lung cancer with these mutations. Using activated Kras, Kras(LA1), as a driver for lung cancer development in mice, we showed for the first time that mice with Kras(LA1) and Xpc knockout had worst outcomes in lung cancer development, and this phenotype was associated with accumulated DNA damage. Using cultured cells, we demonstrated that induced expression of oncogenic KRAS(G12V) led to increased levels of reactive oxygen species (ROS) as well as DNA damage, and both can be suppressed by anti-oxidants. Our results suggest that XPC may help repair DNA damage caused by KRAS-mediated production of ROS. PMID:26554912

  7. Review of salt consumption and stomach cancer risk:Epidemiological and biological evidence

    Institute of Scientific and Technical Information of China (English)

    Xiao-Qin Wang; Paul D Terry; Hong Yan

    2009-01-01

    Stomach cancer is still the fourth most common cancer; thus, it remains an important public health burden worldwide, especially in developing countries. The remarkable geographic variations in the rates of stomach cancer indicate that dietary factors, including a range of food groups to which salt and/or nitrates have been added, may affect stomach cancer risk. In this paper, we review the results from ecologic, case-control and cohort studies on the relationship between salt or salted foods and stomach cancer risk. The majority of ecological studies indicated that the average salt intake in each population was closely correlated with gastric cancer mortality. Most casecontrol studies showed similar results, indicating a moderate to high increase in risk for the highest level of salt or salted food consumption. The overall results from cohort studies are not totally consistent, but are suggestive of a moderate direct association. Since salt intake has been correlated with Helicobacter pylori ( H pylori) infection, it is possible that these two factors may synergize to promote the development of stomach cancer. Additionally, salt may also cause stomach cancer through directly damaging gastric mucus, improving temporary epithelial proliferation and the incidence of endogenous mutations, and inducing hypergastrinemia that leads to eventual parietal cell loss and progression to gastric cancer. Based on the considerable evidence from ecological, case-control and cohort studies worldwide and the mechanistic plausibility, limitation on salt and salted food consumption is a practical strategy for preventing gastric cancer.

  8. The current pattern of reconstructive surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    A. Kh. Ismagilov

    2015-01-01

    Full Text Available In Russia, breast cancer (BC occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %. While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in reference to the lower rate of the manifestation of lymphedemas. However, patients who have undergone this or that mastectomy are observed to have lower self-appraisal scores, a change in their professional sphere, irritability and apprehensiveness Thus, the decreased rate of the manifestation of lymphedema and obvious postoperative traumatization are not the only components of quality of life in patients with BC. According to the data obtained by E. Frank et al. (1978, G.P. Maguire et al. (1978, and F. Meerwein (1981, removal of the breast itself leads to a woman’s loss of femininity, attractiveness, and sexiness, which was also confirmed and reported by L. Aerts et al. (2014. In this connection, classical radical mastectomy begins to give way to organ-sparing treatment. Taking into account that psychotherapy and external prosthetics do not alleviate the above problems and that there are always women with established BC who have contraindications to organ-sparing treatment, breast reconstructive plastic operations arouse more and more interest. Reconstruction of the breast implies restoration of both its shape and contours to be maximally brought closer to its preoperative level. However, with regard to cancer alertness to breast reconstructive surgery, not only aesthetic requirements are imposed. The next step in improving quality of life in patients with BC was the emergence and development of breast-sparing mastectomies, the first point of these

  9. Axitinib: The evidence of its potential in the treatment of advanced thyroid cancer

    Directory of Open Access Journals (Sweden)

    Hari A Deshpande, Scott Gettinger

    2009-06-01

    Full Text Available Hari A Deshpande1, Scott Gettinger1, Julie Ann Sosa21Yale Cancer Center, Department of Medical Oncology, 2Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USAIntroduction: Thyroid cancer is a rare disease with an incidence of around 37,000 cases per year. However, its incidence is rising faster than many other cancers and for men this disease ranks highest overall in the rate of increase (2.4% annual increase in cancer deaths. As the number of radioactive iodine-resistant thyroid cancers increases, the need for newer treatments has become more important. Axitinib is one of many new small molecule inhibitors of growth factor receptors that have shown promise in the treatment of many cancers. It targets the vascular endothelial growth factor receptors 1, 2 and 3.Aims: The goal of this article is to review the published evidence for the use of axitinib in the treatment of thyroid cancer and define its therapeutic potential. Evidence review: The major evidence of axitinib activity has appeared in meeting report abstracts. One phase II study has been published. This included patients with any histological type of thyroid cancer that was not amenable to treatment with radioactive iodine. Clinical potential: To date, in phase II clinical studies axitinib has demonstrated antitumor activity in advanced refractory thyroid cancer. As a monotherapy it resulted in a 30% response rate with another 38% of patients having stable disease. Axitinib appears to have a good tolerability profile, with hypertension being the most common grade 3 or greater side effect. Keywords: axitinib, thyroid cancer, vascular endothelial growth factor receptor

  10. Targeted therapies with companion diagnostics in the management of breast cancer: current perspectives.

    Science.gov (United States)

    Myers, Meagan B

    2016-01-01

    Breast cancer is a multifaceted disease exhibiting both intertumoral and intratumoral heterogeneity as well as variable disease course. Over 2 decades of research has advanced the understanding of the molecular substructure of breast cancer, directing the development of new therapeutic strategies against these actionable targets. In vitro diagnostics, and specifically companion diagnostics, have been integral in the successful development and implementation of these targeted therapies, such as those directed against the human epidermal growth factor receptor 2. Lately, there has been a surge in the development, commercialization, and marketing of diagnostic assays to assist in breast cancer patient care. More recently, multigene signature assays, such as Oncotype DX, MammaPrint, and Prosigna, have been integrated in the clinical setting in order to tailor decisions on adjuvant endocrine and chemotherapy treatment. This review provides an overview of the current state of breast cancer management and the use of companion diagnostics to direct personalized approaches in the treatment of breast cancer. PMID:26858530

  11. Non-small cell lung cancer: current treatment and future advances.

    Science.gov (United States)

    Zappa, Cecilia; Mousa, Shaker A

    2016-06-01

    Lung cancer has a poor prognosis; over half of people diagnosed with lung cancer die within one year of diagnosis and the 5-year survival is less than 18%. Non-small cell lung cancer (NSCLC) accounts for the majority of all lung cancer cases. Risk factors for developing NSCLC have been identified, with cigarette smoking being a major factor along with other environmental and genetic risk factors. Depending on the staging of lung cancer, patients are eligible for certain treatments ranging from surgery to radiation to chemotherapy as well as targeted therapy. With the advancement of genetics and biomarkers testing, specific mutations have been identified to better target treatment for individual patients. This review discusses current treatments including surgery, chemotherapy, radiotherapy, and immunotherapy as well as how biomarker testing has helped improve survival in patients with NSCLC. PMID:27413711

  12. Neoadjuvant Chemotherapy Use in Bladder Cancer: A Survey of Current Practice and Opinions

    Directory of Open Access Journals (Sweden)

    N. G. Cowan

    2014-01-01

    Full Text Available Objectives. Level 1 evidence supports the use of neoadjuvant chemotherapy (NAC to improve overall survival in muscle invasive bladder cancer; however utilization rates remain low. The aims of our study were to determine factors associated with NAC use, to more clearly define reasons for low utilization, and to determine the current rate of NAC use among urologic oncologists. Materials and Methods. Active members of the Society for Urologic Oncology were provided a 20-question survey. Descriptive statistical analysis was conducted for each question and univariate analysis was performed. Results. We achieved a response rate of 21%. Clinical T3/T4 disease was the most often selected reason for recommending NAC (87%. Concerns with recommending NAC were age and comorbidities (54% followed by delay in surgery (35%. An association was identified between urologic oncologists who discussed NAC with >90% of their patients and medical oncologists “always” recommending NAC (P=0.0009. NAC utilization rate was between 30 and 57%. Conclusions. Amongst this highly specialized group of respondents, clinical T3-T4 disease was the most common reason for implementation of NAC. Respondents who frequently discussed NAC were more likely to report their medical oncologist always recommending NAC. Reported NAC use was higher in this surveyed group (30–57% compared with recently published rates.

  13. Observational Study Designs for Comparative Effectiveness Research: An Alternative Approach to Close Evidence Gaps in Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Comparative effectiveness research (CER) has emerged as an approach to improve quality of care and patient outcomes while reducing healthcare costs by providing evidence to guide healthcare decisions. Randomized controlled trials (RCTs) have represented the ideal study design to support treatment decisions in head-and-neck (H and N) cancers. In RCTs, formal chance (randomization) determines treatment allocation, which prevents selection bias from distorting the measure of treatment effects. Despite this advantage, only a minority of patients qualify for inclusion in H and N RCTs, which limits the validity of their results to the broader H and N cancer patient population seen in clinical practice. Randomized controlled trials often do not address other knowledge gaps in the management of H and N cancer, including treatment comparisons for rare types of H and N cancers, monitoring of rare or late toxicity events (eg, osteoradionecrosis), or in some instances an RCT is simply not feasible. Observational studies, or studies in which treatment allocation occurs independently of investigators' choice or randomization, may address several of these gaps in knowledge, thereby complementing the role of RCTs. This critical review discusses how observational CER studies complement RCTs in generating the evidence to inform healthcare decisions and improve the quality of care and outcomes of H and N cancer patients. Review topics include a balanced discussion about the strengths and limitations of both RCT and observational CER study designs; a brief description of design and analytic techniques to handle selection bias in observational studies; examples of observational studies that inform current clinical practices and management of H and N cancers; and suggestions for relevant CER questions that could be addressed by an observational study design

  14. Current Studies of Acupuncture in Cancer-Induced Bone Pain Animal Models

    OpenAIRE

    Hee Kyoung Ryu; Yong-Hyeon Baek; Yeon-Cheol Park; Byung-Kwan Seo

    2014-01-01

    Acupuncture is generally accepted as a safe and harmless treatment option for alleviating pain. To explore the pain mechanism, numerous animal models have been developed to simulate specific human pain conditions, including cancer-induced bone pain (CIBP). In this study, we analyzed the current research methodology of acupuncture for the treatment of CIBP. We electronically searched the PubMed database for animal studies published from 2000 onward using these search terms: (bone cancer OR can...

  15. ASWAGANDHA (WITHANIA SOMNIFERA) – AYURVEDIC BEQUEST FOR THE PATIENTS OF CANCER: AN UPDATE ON CURRENT RESEARCH

    OpenAIRE

    Rao Paramkusha Madupu; Khemani Naresh

    2010-01-01

    Aswagandha (Withania somnifera) is a popularly known medicinal plant said in Ayurveda. It has been used to promote vigor and strength. The current ongoing researches are approving the plant can be useful in malignacies at various levels and with different mechanisms. An effort has been made in this paper to review such results focused at cancer therapy and management. Aswagandha (Withania somnifera) is also known as Indian ginseng proves to be a beacon for blinded minds of cancer sufferers.

  16. Estrogen receptor of primary breast cancers: evidence for intracellular proteolysis

    OpenAIRE

    Maaroufi, Younes; Lacroix, Marc; Lespagnard, Laurence; Journé, Fabrice; Larsimont, Denis; Leclercq, Guy

    2000-01-01

    Introduction: We previously reported that about two-thirds of [125I]oestradiol-labelled cytosolic ERs from breast cancer samples eluted as low-molecular-weight isoforms (≤ 37 kDa, size-exclusion fast pressure liquid chromatography [FPLC]). These isoforms failed to adsorb strongly to hydroxylapatite at high ionic strength, a property that was ascribed to receptors devoid of amino-terminal ABC domains. In view of recent data concerning intracellular proteolysis of several transcriptional regula...

  17. Screening for cancer: when to stop?: A practical guide and review of the evidence.

    Science.gov (United States)

    Soung, Michael C

    2015-03-01

    Deciding when to stop cancer screening in older adults is a complex challenge that involves multiple factors: individual health status and life expectancy; risks and benefits of screening, which vary with age and comorbidity; and individual preferences and values. This article examines current cancer screening practices and reviews the risks and benefits of cancer screening for colorectal, breast, lung, prostate, and cervical cancer, particularly in older individuals and those with multiple comorbidities. Tools for estimating life expectancy are reviewed, and a practical framework is presented to guide discussions on when the harms of screening likely outweigh the benefits.

  18. Lung Cancer and Human Papilloma Viruses (HPVs: Examining the Molecular Evidence

    Directory of Open Access Journals (Sweden)

    Priya R. Prabhu

    2012-01-01

    Full Text Available Human papilloma virus (HPV, known to be an etiological agent for genital cancers, has been suggested also to be a possible contributory agent for lung cancer. Alternatively, lung cancer, formerly considered to be solely a smoker's disease, may now be more appropriately categorised into never smoker's and smoker's lung cancer. Through this paper we attempt to bring forth the current knowledge regarding mechanisms of HPV gaining access into the lung tissue, various strategies involved in HPV-associated tumorigenesis in lung tissue.

  19. Ionizing radiation and cancer risk: evidence from epidemiology.

    Science.gov (United States)

    Ron, E

    1998-11-01

    Epidemiological studies provide the primary data on the carcinogenic effects of radiation in humans. Much of what is known has come from studies of the atomic bomb survivors, and to a lesser extent from patients receiving radiotherapy. These studies demonstrate that exposure to moderate to high doses of radiation increases the risk of cancer in most organs. For all solid cancers combined, cancers of the thyroid, breast and lung, and leukemia, risk estimates are fairly precise, and associations have been found at relatively low doses (bomb survivors, a linear-quadratic dose response seems to fit the data better than a pure linear model. Radiation does not act entirely in isolation. It can interact with other carcinogens, e.g. tobacco or chemotherapeutic agents, and with host factors such as age at exposure, gender or reproductive history. Interactions with medical interventions or with certain heritable mutations have also been suggested. While the studies of high-dose exposures are essential for understanding the overall biological consequences of radiation exposure, the public is more concerned about the long-term health effects from protracted exposures at low doses. Unfortunately, the inherent limitations of epidemiology make it extremely difficult to directly quantify health risks from these exposures. While most epidemiological data are compatible with linear extrapolations from exposures at high doses or high dose rates, they cannot entirely exclude other possibilities. As the field of epidemiology advances, understanding more about the health effects of prolonged and low-dose exposures will be the next challenge. PMID:9806607

  20. Current Challenges in Prostate Cancer Management and the Rationale behind Targeted Focal Therapy

    Directory of Open Access Journals (Sweden)

    Al B. Barqawi

    2012-01-01

    Full Text Available Among men, prostate cancer has a high prevalence, with relatively lower cancer-specific mortality risk compared to lung and colon cancer. Prostate-specific antigen (PSA screening has increased prostate cancer awareness since its implementation as a screening tool almost 25 years ago, but, due to the largely indolent course of this disease and the unspecific nature of the PSA test, increased incidence has largely been associated with cancers that would not go on to cause death (clinically insignificant, leading to an overdiagnosis challenge and an ensuing overtreatment consequences. The overtreatment problem is exacerbated by the high risk of side effects that current treatment techniques have, putting patients’ quality of life at risk with little or no survival benefit. The goals of this paper are to evaluate the rise, prevalence, and impact of the overdiagnosis and ensuing overtreatment problems, as well as highlight potential solutions. In this effort, a review of major epidemiological and screening studies, cancer statistics from the advent of prostate-specific antigen screening to the present, and reports on patient concerns and treatment outcomes was conducted to present the dominant factors that underlie current challenges in prostate cancer treatment and illuminate potential solutions.

  1. The genetics of neuroendocrine prostate cancers: a review of current and emerging candidates

    Directory of Open Access Journals (Sweden)

    Ather MH

    2012-11-01

    devising novel therapeutic strategies to develop targeted therapies. CgA has the potential to become an important marker of advanced castration-resistant PC in cases where prostate-specific antigen can no longer be relied upon. Aberrant androgen-receptor signaling at various levels provides evidence of the importance of this pathway for the development of castration-resistant PC. Many epigenetic influences – in particular, the role of changing miRNA expression – provide valuable insights. Currently, massive sequencing efforts are underway to define important somatic genetic alterations (amplifications, deletions, point mutations, translocations in PC, and these alterations hold great promise as prognostic markers and for predicting response to therapy.Keywords: prostate cancer, epigenetic, genetic, neuroendocrine differentiation

  2. [Evidence and recommendations for oncologic clinical exercise - a personalized treatment concept for cancer patients].

    Science.gov (United States)

    Baumann, Freerk Theeagnus; Hallek, Michael; Meyer, Janika; Galvão, Daniel Abido; Bloch, Wilhelm; Elter, Thomas

    2015-09-01

    Oncological treatments can lead to acute and chronic cancer related toxicities. In recent years, a large number of clinical studies have reported positive effects of exercise to the bio-psycho-social regeneration of cancer patients. However, very few evidence-based programs have been implemented into practice with little opportunity for cancer patients to engage in such programs. Reviews and RCT studies on exercise and cancer are showing that specific exercise programs have a positive impact on fatigue syndrome, urinary incontinence, lymphedema, polyneuropathy, arthralgia, and androgen deprivation related toxicities. With the increasing evidence for exercise oncology interventions, recommendations arising from clinical trials should be translated into clinical practice and this should be viewed as an important next step in this fast moving field of exercise oncology. For that the personalized treatment concept "Oncologic clinical exercise" (OTT) was developed. PMID:26402184

  3. Complementary Medicine, Exercise, Meditation, Diet, and Lifestyle Modification for Anxiety Disorders: A Review of Current Evidence

    Directory of Open Access Journals (Sweden)

    J. Sarris

    2012-01-01

    Full Text Available Use of complementary medicines and therapies (CAM and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.

  4. Fish, Mercury, Selenium and Cardiovascular Risk: Current Evidence and Unanswered Questions

    Directory of Open Access Journals (Sweden)

    Dariush Mozaffarian

    2009-06-01

    Full Text Available Controversy has arisen among the public and in the media regarding the health effects of fish intake in adults. Substantial evidence indicates that fish consumption reduces coronary heart disease mortality, the leading cause of death in developed and most developing nations. Conversely, concerns have grown regarding potential effects of exposure to mercury found in some fish. Seafood species are also rich in selenium, an essential trace element that may protect against both cardiovascular disease and toxic effects of mercury. Such protective effects would have direct implications for recommendations regarding optimal selenium intake and for assessing the potential impact of mercury exposure from fish intake in different populations. Because fish consumption appears to have important health benefits in adults, elucidating the relationships between fish intake, mercury and selenium exposure, and health risk is of considerable scientific and public health relevance. The evidence for health effects of fish consumption in adults is reviewed, focusing on the strength and consistency of evidence and relative magnitudes of effects of omega-3 fatty acids, mercury, and selenium. Given the preponderance of evidence, the focus is on cardiovascular effects, but other potential health effects, as well as potential effects of polychlorinated biphenyls and dioxins in fish, are also briefly reviewed. The relevant current unanswered questions and directions of further research are summarized.

  5. Fasting therapy for treating and preventing disease - current state of evidence.

    Science.gov (United States)

    Michalsen, Andreas; Li, Chenying

    2013-01-01

    Periods of deliberate fasting with restriction of solid food intake are practiced worldwide, mostly based on traditional, cultural or religious reasons. There is large empirical and observational evidence that medically supervised modified fasting (fasting cure, 200-500 kcal nutritional intake per day) with periods of 7-21 days is efficacious in the treatment of rheumatic diseases, chronic pain syndromes, hypertension, and metabolic syndrome. The beneficial effects of fasting followed by vegetarian diet in rheumatoid arthritis are confirmed by randomized controlled trials. Further beneficial effects of fasting are supported by observational data and abundant evidence from experimental research which found caloric restriction and intermittent fasting being associated with deceleration or prevention of most chronic degenerative and chronic inflammatory diseases. Intermittent fasting may also be useful as an accompanying treatment during chemotherapy of cancer. A further beneficial effect of fasting relates to improvements in sustainable lifestyle modification and adoption of a healthy diet, possibly mediated by fasting-induced mood enhancement. Various identified mechanisms of fasting point to its potential health-promoting effects, e.g., fasting-induced neuroendocrine activation and hormetic stress response, increased production of neurotrophic factors, reduced mitochondrial oxidative stress, general decrease of signals associated with aging, and promotion of autophagy. Fasting therapy might contribute to the prevention and treatment of chronic diseases and should be further evaluated in controlled clinical trials and observational studies. PMID:24434759

  6. Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment.

    Science.gov (United States)

    Mitchell, Sandra A; Hoffman, Amy J; Clark, Jane C; DeGennaro, Regina M; Poirier, Patricia; Robinson, Carolene B; Weisbrod, Breanna L

    2014-01-01

    Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research. PMID:25427608

  7. An evidence-based estimate of the appropriate rate of utilization of radiotherapy for cancer of the cervix

    International Nuclear Information System (INIS)

    Purpose: Current estimates of the proportion of cancer patients who will require radiotherapy (RT) are based almost entirely on expert opinion. The objective of this study was to calculate the proportion of incident cases of cervical cancer that should receive RT by application of an evidence-based approach. Methods and Materials: A systematic review of the literature was done to identify indications for RT for cervical cancer and to ascertain the level of evidence that supported each indication. A survey of Canadian gynecologic oncologists and radiation oncologists who treat cervical cancer was done to determine the level of acceptance of each indication among doctors who practice in the field. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of patients with cervical cancer. Results: The systematic review of the literature identified 29 different indications for RT for cervical cancer. The majority of the 75 experts who responded to the mail survey stated that they 'usually' or 'always' recommended RT in all but one of the clinical situations that were identified as indications for RT on the basis of the systematic review. The analysis of epidemiologic data revealed that, in a typical North American population, 65.4% ± 2.5% of cervical cancer cases will develop one or more indications for RT at some point in the course of the illness, 63.4% ± 2.3% will develop indications for RT as part of their initial management, and 2.0% ± 0.9% will develop indications for RT for progressive or recurrent disease. The effects of variations in case mix on the need for RT was examined by sensitivity analysis, which suggested that the maximum plausible range for the appropriate rate of utilization of RT was 54.3% to 67.9%. The proportion of cases that required RT was stage dependent: 10.6% ± 1.2% in Stage IA, 74.9% ± 1.3% in Stage IB, 100% in Stages II and III, and 97.2% ± 1.1% in Stage IV

  8. Obesity and pancreatic cancer: overview of epidemiologic evidence and biologic mechanisms

    OpenAIRE

    Paige M Bracci

    2012-01-01

    In the U.S. pancreatic cancer is characterized by a low 5-year survival rate of approximately 6%, fewer than 10% of patients diagnosed with localized disease and thus candidates for “curative” surgical resection, increasing incidence and few established risk factors. Similar statistics are observed for other industrialized nations. With new evidence to suggest that pancreatic cancer develops over a number of years, markers that can better identify high risk patients and are applicable to earl...

  9. How to identify patients with cancer at risk of falling: a review of the evidence.

    LENUS (Irish Health Repository)

    Stone, Carol A

    2011-02-01

    Clinical experience and a limited number of studies suggest that a cancer diagnosis confers a high risk of accidental falls. The negative sequelae of falls in older persons are well documented; risk factors for falls in this population have been extensively investigated and evidence for the efficacy of interventions to reduce falls is steadily emerging. It is not known whether the risk factors for falls and effective interventions for falls risk reduction in patients with cancer are different from those in older persons.

  10. Clinical evidence for the use of aspirin in the treatment of cancer

    OpenAIRE

    Langley, Ruth E

    2013-01-01

    Although the anti-cancer effects of aspirin were first identified in pre-clinical models four decades ago, a clear role for the drug in either the prevention or treatment of cancer has not been established. Concerns about toxicity, particularly major haemorrhage, and a lack of randomised evidence demonstrating efficacy have limited its use in primary prevention; there was also doubt that a simple aspirin could have a significant therapeutic effect against established malignancy. Three new pie...

  11. Sentinel Node Mapping for Breast Cancer: Current Situation

    Directory of Open Access Journals (Sweden)

    Sergi Vidal-Sicart

    2012-01-01

    Full Text Available Axillary node status is a major prognostic factor in early-stage disease. Traditional staging needs levels I and II axillary lymph node dissection. Axillary involvement is found in 10%–30% of patients with T1 (<2 cm tumours. Sentinel lymph node biopsy is a minimal invasive method of checking the potential nodal involvement. It is based on the assumption of an orderly progression of lymph node invasion by metastatic cells from tumour site. Thus, when sentinel node is free of metastases the remaining nodes are free, too (with a false negative rate lesser than 5%. Moreover, Randomized trials demonstrated a marked reduction of complications associated with the sentinel lymph node biopsy when compared with axillary lymph node dissection. Currently, the sentinel node biopsy procedure is recognized as the standard treatment for stages I and II. In these stages, this approach has a positive node rate similar to those observed after lymphadenectomy, a significant decrease in morbidity and similar nodal relapse rates at 5 years. In this review, the indications and contraindications of the sentinel node biopsy are summarized and the methodological aspects discussed. Finally, the new technologic and histologic developments allow to develop a more accurate and refinate technique that can achieve virtually the identification of 100% of sentinel nodes and reduce the false negative rate.

  12. Current and Potential Uses of Immunocytokines as Cancer Immunotherapy

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    Paul M. Sondel

    2012-07-01

    Full Text Available Immunocytokines (ICs are a class of molecules created by linking tumor-reactive monoclonal antibodies to cytokines that are able to activate immune cells. Tumor selective localization is provided by the ability of the mAb component to bind to molecules found on the tumor cell surface or molecules found selectively in the tumor microenvronment. In this way the cytokine component of the immunocytokine is selectively localized to sites of tumor and can activate immune cells with appropriate receptors for the cytokine. Immunocytokines have been made and tested by us, and others, using a variety of tumor-reactive mAbs linked to distinct cytokines. To date, the majority of clinical progress has been made with ICs that have linked human interleukin-2 (IL2 to a select number of tumor reactive mAbs that had already been in prior clinical testing as non-modified mAbs. Here we briefly review the background for the creation of ICs, summarize current clinical progress, emphasize mechanisms of action for ICs that are distinct from those of their constituent components, and present some directions for future development and testing.

  13. Fried Food Consumption and Cardiovascular Health: A Review of Current Evidence

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    Taraka V. Gadiraju

    2015-10-01

    Full Text Available Fried food consumption and its effects on cardiovascular disease are still subjects of debate. The objective of this review was to summarize current evidence on the association between fried food consumption and cardiovascular disease, diabetes, hypertension and obesity and to recommend directions for future research. We used PubMed, Google Scholar and Medline searches to retrieve pertinent publications. Most available data were based on questionnaires as a tool to capture fried food intakes, and study design was limited to case-control and cohort studies. While few studies have reported a positive association between frequencies of fried food intake and risk of coronary artery disease, heart failure, diabetes or hypertension, other investigators have failed to confirm such an association. There is strong evidence suggesting a higher risk of developing chronic disease when fried foods are consumed more frequently (i.e., four or more times per week. Major gaps in the current literature include a lack of detailed information on the type of oils used for frying foods, stratification of the different types of fried food, frying procedure (deep and pan frying, temperature and duration of frying, how often oils were reused and a lack of consideration of overall dietary patterns. Besides addressing these gaps, future research should also develop tools to better define fried food consumption at home versus away from home and to assess their effects on chronic diseases. In summary, the current review provides enough evidence to suggest adverse health effects with higher frequency of fried food consumption. While awaiting confirmation from future studies, it may be advisable to the public to consume fried foods in moderation while emphasizing an overall healthy diet.

  14. Emerging Evidence for MicroRNAs as Regulators of Cancer Stem Cells

    International Nuclear Information System (INIS)

    Cancer stem cells are defined as a subpopulation of cells within a tumor that are capable of self-renewal and differentiation into the heterogeneous cell lineages that comprise the tumor. Many studies indicate that cancer stem cells may be responsible for treatment failure and relapse in cancer patients. The factors that regulate cancer stem cells are not well defined. MicroRNAs (miRNAs) are small non-coding RNAs that regulate translational repression and transcript degradation. miRNAs play a critical role in embryonic and inducible pluripotent stem cell regulation and emerging evidence supports their role in cancer stem cell evolution. To date, miRNAs have been shown to act either as tumor suppressor genes or oncogenes in driving critical gene expression pathways in cancer stem cells in a wide range of human malignancies, including hematopoietic and epithelial tumors and sarcomas. miRNAs involved in cancer stem cell regulation provide attractive, novel therapeutic targets for cancer treatment. This review attempts to summarize progress to date in defining the role of miRNAs in cancer stem cells

  15. Emerging Evidence for MicroRNAs as Regulators of Cancer Stem Cells

    Energy Technology Data Exchange (ETDEWEB)

    Sethi, Aisha [Department of Pathology, Henry Ford Hospital, Detroit, MI 48202 (United States); Sholl, Lynette M., E-mail: lmsholl@partners.org [Department of Pathology, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA 02115 (United States)

    2011-10-24

    Cancer stem cells are defined as a subpopulation of cells within a tumor that are capable of self-renewal and differentiation into the heterogeneous cell lineages that comprise the tumor. Many studies indicate that cancer stem cells may be responsible for treatment failure and relapse in cancer patients. The factors that regulate cancer stem cells are not well defined. MicroRNAs (miRNAs) are small non-coding RNAs that regulate translational repression and transcript degradation. miRNAs play a critical role in embryonic and inducible pluripotent stem cell regulation and emerging evidence supports their role in cancer stem cell evolution. To date, miRNAs have been shown to act either as tumor suppressor genes or oncogenes in driving critical gene expression pathways in cancer stem cells in a wide range of human malignancies, including hematopoietic and epithelial tumors and sarcomas. miRNAs involved in cancer stem cell regulation provide attractive, novel therapeutic targets for cancer treatment. This review attempts to summarize progress to date in defining the role of miRNAs in cancer stem cells.

  16. Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence.

    Science.gov (United States)

    Block, G; Patterson, B; Subar, A

    1992-01-01

    Approximately 200 studies that examined the relationship between fruit and vegetable intake and cancers of the lung, colon, breast, cervix, esophagus, oral cavity, stomach, bladder, pancreas, and ovary are reviewed. A statistically significant protective effect of fruit and vegetable consumption was found in 128 of 156 dietary studies in which results were expressed in terms of relative risk. For most cancer sites, persons with low fruit and vegetable intake (at least the lower one-fourth of the population) experience about twice the risk of cancer compared with those with high intake, even after control for potentially confounding factors. For lung cancer, significant protection was found in 24 of 25 studies after control for smoking in most instances. Fruits, in particular, were significantly protective in cancers of the esophagus, oral cavity, and larynx, for which 28 of 29 studies were significant. Strong evidence of a protective effect of fruit and vegetable consumption was seen in cancers of the pancreas and stomach (26 of 30 studies), as well as in colorectal and bladder cancers (23 of 38 studies). For cancers of the cervix, ovary, and endometrium, a significant protective effect was shown in 11 of 13 studies, and for breast cancer a protective effect was found to be strong and consistent in a meta analysis. It would appear that major public health benefits could be achieved by substantially increasing consumption of these foods.

  17. Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions.

    Science.gov (United States)

    Silver, Julie K; Gilchrist, Laura S

    2011-05-01

    Cancer rehabilitation is an important part of survivorship as a distinct phase of treatment. Although cancer rehabilitation may involve many disciplines, this article specifically covers evidence-based treatment in physical and occupational therapy. Patients may need physical and occupational therapy services for a variety of cancer-related or cancer-treatment-related problems, including pain, fatigue, deconditioning, and difficulty with gait. They may also have problems resuming their previous level of function, which can impact on activities of daily living, instrumental activities of daily living, return to previous home and community activity levels, and return to work. This review discusses the role of physical and occupational therapy in helping cancer patients improve pain and musculoskeletal issues, deconditioning and endurance effects, fatigue, balance and falls, and lymphedema and psychosocial problems. PMID:21765263

  18. Current Evidence Supporting the Link Between Dietary Fatty Acids and Cardiovascular Disease.

    Science.gov (United States)

    Hammad, Shatha; Pu, Shuaihua; Jones, Peter J

    2016-05-01

    Lack of consensus exists pertaining to the scientific evidence regarding effects of various dietary fatty acids on cardiovascular disease (CVD) risk. The objective of this article is to review current evidence concerning cardiovascular health effects of the main dietary fatty acid types; namely, trans (TFA), saturated (SFA), polyunsaturated (PUFA; n-3 PUFA and n-6 PUFA), and monounsaturated fatty acids (MUFA). Accumulating evidence shows negative health impacts of TFA and SFA; both may increase CVD risk. Policies have been proposed to reduce TFA and SFA consumption to less than 1 and 7 % of energy intake, respectively. Cardiovascular health might be promoted by replacing SFA and TFA with n-6 PUFA, n-3 PUFA, or MUFA; however, the optimal amount of PUFA or MUFA that can be used to replace SFA and TFA has not been defined yet. Evidence suggests of the potential importance of restricting n-6 PUFA up to 10 % of energy and obtaining an n-6/n-3 ratio as close as possible to unity, along with a particular emphasis on consuming adequate amounts of essential fatty acids. The latest evidence shows cardioprotective effects of MUFA-rich diets, especially when MUFA are supplemented with essential fatty acids; namely, docosahexaenoic acid. MUFA has been newly suggested to be involved in regulating fat oxidation, energy metabolism, appetite sensations, weight maintenance, and cholesterol metabolism. These favorable effects might implicate MUFA as the preferable choice to substitute for other fatty acids, especially given the declaration of its safety for up to 20 % of total energy. PMID:26719191

  19. Nutrition and cancer: A review of the evidence for an anti-cancer diet

    Directory of Open Access Journals (Sweden)

    Donaldson Michael S

    2004-10-01

    Full Text Available Abstract It has been estimated that 30–40 percent of all cancers can be prevented by lifestyle and dietary measures alone. Obesity, nutrient sparse foods such as concentrated sugars and refined flour products that contribute to impaired glucose metabolism (which leads to diabetes, low fiber intake, consumption of red meat, and imbalance of omega 3 and omega 6 fats all contribute to excess cancer risk. Intake of flax seed, especially its lignan fraction, and abundant portions of fruits and vegetables will lower cancer risk. Allium and cruciferous vegetables are especially beneficial, with broccoli sprouts being the densest source of sulforophane. Protective elements in a cancer prevention diet include selenium, folic acid, vitamin B-12, vitamin D, chlorophyll, and antioxidants such as the carotenoids (α-carotene, β-carotene, lycopene, lutein, cryptoxanthin. Ascorbic acid has limited benefits orally, but could be very beneficial intravenously. Supplementary use of oral digestive enzymes and probiotics also has merit as anticancer dietary measures. When a diet is compiled according to the guidelines here it is likely that there would be at least a 60–70 percent decrease in breast, colorectal, and prostate cancers, and even a 40–50 percent decrease in lung cancer, along with similar reductions in cancers at other sites. Such a diet would be conducive to preventing cancer and would favor recovery from cancer as well.

  20. Estimation of an optimal chemotherapy utilisation rate for cancer: setting an evidence-based benchmark for quality cancer care.

    Science.gov (United States)

    Jacob, S A; Ng, W L; Do, V

    2015-02-01

    There is wide variation in the proportion of newly diagnosed cancer patients who receive chemotherapy, indicating the need for a benchmark rate of chemotherapy utilisation. This study describes an evidence-based model that estimates the proportion of new cancer patients in whom chemotherapy is indicated at least once (defined as the optimal chemotherapy utilisation rate). The optimal chemotherapy utilisation rate can act as a benchmark for measuring and improving the quality of care. Models of optimal chemotherapy utilisation were constructed for each cancer site based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient- and tumour-related attributes for which chemotherapy was indicated were obtained, using population-based data where possible. Treatment indications and epidemiological data were merged to calculate the optimal chemotherapy utilisation rate. Monte Carlo simulations and sensitivity analyses were used to assess the effect of controversial chemotherapy indications and variations in epidemiological data on our model. Chemotherapy is indicated at least once in 49.1% (95% confidence interval 48.8-49.6%) of all new cancer patients in Australia. The optimal chemotherapy utilisation rates for individual tumour sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. The optimal chemotherapy utilisation rate can serve as a benchmark for planning chemotherapy services on a population basis. The model can be used to evaluate service delivery by comparing the benchmark rate with patterns of care data. The overall estimate for other countries can be obtained by substituting the relevant distribution of cancer types. It can also be used to predict future chemotherapy workload and can be easily modified to take into account future changes in cancer incidence, presentation stage or chemotherapy indications.

  1. [Current situation and confusion of sublobar resection for early stage lung cancer].

    Science.gov (United States)

    Yang, Fan; Wang, Jun

    2015-10-01

    Lobectomy with lymph node dissection has long been the standard surgical procedure for non-small cell lung cancer. However, the increased identification of smaller and smaller and even more indolent tumors by advanced imaging screening rekindled the interest of sublobar resection. Still, existing evidence only supports sublobar resection for radiologically or pathologically "very-early" stage tumors or high-risk patients. Ongoing randomized controlled trials in America, Japan and Europe will address the issue of "radical" application of sublobar resection, as well as an elderly patient trial for "compromized" application initiated by us. These efforts will delineate the utility of sublobar resection in patients with non-small cell lung cancer.

  2. Colorectal Cancer Screening in Average Risk Populations: Evidence Summary.

    Science.gov (United States)

    Tinmouth, Jill; Vella, Emily T; Baxter, Nancy N; Dubé, Catherine; Gould, Michael; Hey, Amanda; Ismaila, Nofisat; McCurdy, Bronwen R; Paszat, Lawrence

    2016-01-01

    Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program. PMID:27597935

  3. The Built Environment and Child Health: An Overview of Current Evidence.

    Science.gov (United States)

    Gascon, Mireia; Vrijheid, Martine; Nieuwenhuijsen, Mark J

    2016-09-01

    Urbanization and the shaping of the built environment have provided a number of socioeconomic benefits, but they have also brought unwanted side effects on health. We aimed to review the current epidemiological evidence of the associations between the built environment, closely related exposures, and child health. We focused on growth and obesity, neuropsychological development, and respiratory and immune health. We used existing review articles and supplemented these with relevant work published and not included in existing reviews. The present review shows that there is good evidence for an association between air pollution and fetal growth restriction and respiratory health, whereas for other exposure and outcome combinations, further evidence is needed. Future studies should make efforts to integrate the different built environment features and to include the evaluation of environments other than home, as well as accessibility, qualitative and perception assessment of the built environment, and, if possible, with improved and standardized tools to facilitate comparability between studies. Efforts are also needed to conduct longitudinal and intervention studies and to understand potential mechanisms behind the associations observed. Finally, studies in low- and middle-income countries are needed. PMID:27220615

  4. Probiotics for the Treatment of Symptomatic Uncomplicated Diverticular Disease: Rationale and Current Evidence.

    Science.gov (United States)

    Scarpignato, Carmelo; Bertelé, Anna; Tursi, Antonio

    2016-10-01

    Changes in the colonic microbiota are critical to the pathogenesis of diverticular complications such as diverticulitis and peridiverticular abscesses. However, more subtle changes in microbiota composition may well be important to the more chronic manifestations of diverticulosis. Some studies have shown the presence of bacterial overgrowth in subgroups of patients with diverticular disease and recent studies, using molecular biology techniques, found an increase of proteobacteria and actinobacteria in patients with symptomatic uncomplicated diverticular disease (SUDD), compared with healthy controls. The use of probiotics to modulate intestinal microecology in SUDD appears therefore rational. Although several investigations evaluating the clinical efficacy of probiotics have been performed, no definitive results have yet been achieved, mainly due to the heterogeneity of the available studies. Most of the studies used probiotics in combination with poorly absorbed antimicrobials or anti-inflammatory drugs. In only 4 studies, there was a harm using probiotics alone, but only 1 was a placebo-controlled, double-blind trial. The analysis of the available evidence reveals a poor quality of the published studies, whose design was heterogeneous, with only 2 out of 11 trials being double-blind and randomized. Therefore, available data can only suggest a benefit of probiotics in SUDD, but do not allow any evidence-based definite conclusion. As a consequence, current guidelines state that there is insufficient evidence to recommend probiotics for symptom relief in patients with diverticular disease. PMID:27622371

  5. Vitamin E in Sarcopenia: Current Evidences on Its Role in Prevention and Treatment

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    Shy Cian Khor

    2014-01-01

    Full Text Available Sarcopenia is a geriatric syndrome that is characterized by gradual loss of muscle mass and strength with increasing age. Although the underlying mechanism is still unknown, the contribution of increased oxidative stress in advanced age has been recognized as one of the risk factors of sarcopenia. Thus, eliminating reactive oxygen species (ROS can be a strategy to combat sarcopenia. In this review, we discuss the potential role of vitamin E in the prevention and treatment of sarcopenia. Vitamin E is a lipid soluble vitamin, with potent antioxidant properties and current evidence suggesting a role in the modulation of signaling pathways. Previous studies have shown its possible beneficial effects on aging and age-related diseases. Although there are evidences suggesting an association between vitamin E and muscle health, they are still inconclusive compared to other more extensively studied chronic diseases such as neurodegenerative diseases and cardiovascular diseases. Therefore, we reviewed the role of vitamin E and its potential protective mechanisms on muscle health based on previous and current in vitro and in vivo studies.

  6. Panitumumab: the evidence of its therapeutic potential in metastatic colorectal cancer care

    Directory of Open Access Journals (Sweden)

    Erika Martinelli

    2007-11-01

    Full Text Available Erika Martinelli1, Floriana Morgillo1, Teresa Troiani1, Giampaolo Tortora2, Fortunato Ciardiello11Cattedra di Oncologia Medica, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale “F. Magrassi e A. Lanzara”, Seconda Università degli Studi di Napoli, Napoli, Italy; 2Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinina, Università di Napoli Federico II, Napoli, ItalyIntroduction: Colorectal cancer is the fourth most common malignant disease. Of newly diagnosed patients, 40% have metastatic disease at diagnosis, and approximately 25% of patients with localized disease at diagnosis will ultimately develop metastatic disease. The benefits of systemic chemotherapy in the treatment of metastatic colorectal cancer over best supportive care have been established. Panitumumab (ABX-EGF is the first fully human monoclonal antibody developed for use in colorectal cancer that targets the extracellular domains of epidermal growth factor receptor.Aims: The goal of this article is to review the published evidence for the use of panitumumab in the treatment of metastatic colorectal cancer to define its therapeutic potential.Evidence review: The major evidence of panitumumab activity in colorectal cancer has appeared in meeting report abstracts. One phase II study in monotherapy, one in combination with chemotherapy, and one phase III study have included only patients with metastatic colorectal cancer.Clinical potential: To date, in phase II clinical studies panitumumab has demonstrated antitumor activity in advanced, refractory colorectal cancer. As monotherapy it resulted in a 10% response rate with 38% of patients having stable disease, and a 36% response rate with 46% stable disease when combined with chemotherapy. A phase III study indicates a clinically significant advantage of panitumumab as third-line monotherapy over best supportive care. Panitumumab appears to have a good tolerability profile, with no maximum tolerated

  7. Evidence supporting the conceptual framework of cancer chemoprevention in canines.

    Science.gov (United States)

    Kondratyuk, Tamara P; Adrian, Julie Ann Luiz; Wright, Brian; Park, Eun-Jung; van Breemen, Richard B; Morris, Kenneth R; Pezzuto, John M

    2016-01-01

    As with human beings, dogs suffer from the consequences of cancer. We investigated the potential of a formulation comprised of resveratrol, ellagic acid, genistein, curcumin and quercetin to modulate biomarkers indicative of disease prevention. Dog biscuits were evaluated for palatability and ability to deliver the chemopreventive agents. The extent of endogenous DNA damage in peripheral blood lymphocytes from dogs given the dietary supplement or placebo showed no change. However, H2O2-inducible DNA damage was significantly decreased after consumption of the supplement. The expression of 11 of 84 genes related to oxidative stress was altered. Hematological parameters remained in the reference range. The concept of chemoprevention for the explicit benefit of the canine is compelling since dogs are an important part of our culture. Our results establish a proof-of-principle and provide a framework for improving the health and well-being of "man's best friend". PMID:27216246

  8. Preserving fertility in patients undergoing treatment for breast cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    Moffat R

    2014-07-01

    Full Text Available Rebecca Moffat,1 Uwe Güth2 1Women’s Hospital, Clinic for Gynecologic Endocrinology and Reproductive Medicine, University Hospital Basel, Basel, 2Department of Gynecology and Obstetrics, Breast Center, SenoSuisse, Cantonal Hospital Winterthur, Winterthur, Switzerland Abstract: Invasive breast cancer (BC is the most frequent cancer of young women. Considering the trend toward postponing childbearing until the later reproductive years, the number of childless women at diagnosis of BC will continue to increase. The American Society of Clinical Oncology and the American Society for Reproductive Medicine have recommended that the impact of cancer treatments on fertility should be addressed with all cancer patients of reproductive age and that options for fertility preservation, such as cryopreservation of embryos and oocytes, ovarian tissue, in vitro maturation of immature oocytes, and ovarian suppression with gonadotropin-releasing hormone analogs, should be discussed routinely. To optimally counsel patients on how to best weigh the risks and benefits of fertility preservation, both the health care provider and the patient must know about the options, their risks, and their likelihood of success. The aim of this review is to summarize current knowledge on fertility preservation options for young BC patients, surrogates of ovarian function, psychosocial aspects of infertility after cancer treatment, women’s attitudes towards childbearing after cancer treatment, and health care providers’ attitudes towards fertility preservation. Keywords: breast cancer, fertility preservation, oncofertility, chemotherapy

  9. Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review

    Directory of Open Access Journals (Sweden)

    Patrícia do Carmo Silva Parreira

    2014-03-01

    Full Text Available Questions: Is Kinesio Taping more effective than a sham taping/placebo, no treatment or other interventions in people with musculoskeletal conditions? Is the addition of Kinesio Taping to other interventions more effective than other interventions alone in people with musculoskeletal conditions? Design: Systematic review of randomised trials. Participants: People with musculoskeletal conditions. Intervention: Kinesio Taping was compared with sham taping/placebo, no treatment, exercises, manual therapy and conventional physiotherapy. Outcome measures: Pain intensity, disability, quality of life, return to work, and global impression of recovery. Results: Twelve randomised trials involving 495 participants were included in the review. The effectiveness of the Kinesio Taping was tested in participants with: shoulder pain in two trials; knee pain in three trials; chronic low back pain in two trials; neck pain in three trials; plantar fasciitis in one trial; and multiple musculoskeletal conditions in one trial. The methodological quality of eligible trials was moderate, with a mean of 6.1 points on the 10-point PEDro Scale score. Overall, Kinesio Taping was no better than sham taping/placebo and active comparison groups. In all comparisons where Kinesio Taping was better than an active or a sham control group, the effect sizes were small and probably not clinically significant or the trials were of low quality. Conclusion: This review provides the most updated evidence on the effectiveness of the Kinesio Taping for musculoskeletal conditions. The current evidence does not support the use of this intervention in these clinical populations. PROSPERO registration: CRD42012003436. [Parreira PdCS, Costa LdCM, Hespanhol Junior LC, Lopes AD, Costa LOP (2014 Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of Physiotherapy 60: 31–39

  10. German second-opinion network for testicular cancer: Sealing the leaky pipe between evidence and clinical practice

    Science.gov (United States)

    ZENGERLING, FRIEDEMANN; HARTMANN, MICHAEL; HEIDENREICH, AXEL; KREGE, SUSANNE; ALBERS, PETER; KARL, ALEXANDER; WEISSBACH, LOTHAR; WAGNER, WALTER; BEDKE, JENS; RETZ, MARGITTA; SCHMELZ, HANS U.; KLIESCH, SABINE; KUCZYK, MARKUS; WINTER, EVA; POTTEK, TOBIAS; DIECKMANN, KLAUS-PETER; SCHRADER, ANDRES JAN; SCHRADER, MARK

    2014-01-01

    In 2006, the German Testicular Cancer Study Group initiated an extensive evidence-based national second-opinion network to improve the care of testicular cancer patients. The primary aims were to reflect the current state of testicular cancer treatment in Germany and to analyze the project’s effect on the quality of care delivered to testicular cancer patients. A freely available internet-based platform was developed for the exchange of data between the urologists seeking advice and the 31 second-opinion givers. After providing all data relevant to the primary treatment decision, urologists received a second opinion on their therapy plan within h. Endpoints were congruence between the first and second opinion, conformity of applied therapy with the corresponding recommendation and progression-free survival rate of the introduced patients. Significance was determined by two-sided Pearson’s χ2 test. A total of 1,284 second-opinion requests were submitted from November 2006 to October 2011, and 926 of these cases were eligible for further analysis. A discrepancy was found between first and second opinion in 39.5% of the cases. Discrepant second opinions led to less extensive treatment in 28.1% and to more extensive treatment in 15.6%. Patients treated within the framework of the second-opinion project had an overall 2-year progression-free survival rate of 90.4%. Approximately every 6th second opinion led to a relevant change in therapy. Despite the lack of financial incentives, data from every 8th testicular cancer patient in Germany were submitted to second-opinion centers. Second-opinion centers can help to improve the implementation of evidence into clinical practice. PMID:24788853

  11. Helicobacter pylori and gastric cancer: current status of the Austrian-Czech-German gastric cancer prevention trial (PRISMA-Study)

    Institute of Scientific and Technical Information of China (English)

    S. Miehlke; A. Leodolter; P. Malfertheiner; A. Neubauer; G. Ehninger; M. Stolte; E, Bayerdorffer; C. Kirsch; B. Dragosics; M. Gschwantler; G. Oberhuber; D. Antos; P. Dite; J. Lauter; J. Labenz

    2001-01-01

    AIM To test the hypothesis that Helicobacter pylori eradication alone can reduce the incidence of gastric cancer in a subgroup of individuals with an increased risk for this fatal disease.METHODS It is a prospective, randomized,double-blind, placebo-controlled multinational multicenter trial. Men between 55 and 65 years of age with a gastric cancer phenotype of Helicobacterpylori gastritis are randomized to receive a 7-day course of omeprazole 2 × 20 mg,clarithromycin 2 × 500 mg, and amoxicillin 2 ×lg for 7 days, or omeprazole2 × 20mg plusplacebo. Follow - up endoscopy is scheduled 3months after therapy, and thereafter in one-year intervals. Predefined study endpoints are gastric cancer, precancerous lesions (dysplasia, adenoma), other cancers, anddeath.RESULTS Since March 1998, 1524 target patients have been screened, 279 patients (18.3%) had a corpus-dominant type of H.pylori gastritis, and 167 of those were randomized (58.8%). In the active treatment group (n -- 86), H. pylori infection infection was cured in 88.9% of patients. Currently, thecumulative follow-up time is 3046 months (253.8patient-years, median follow-up 16 months). So far, none of the patients developed gastric cancer or any precancerous lesion. Three(1.8%) patients reached study endpoints other than gastric cancer.CONCLUSION Among men between 55 and 65years of age, the gastric cancer phenotype of H.pylori gastritis appears to be more common than expected. Further follow- up and continuing recruitment are necessary to fulfil the main aim of the study.

  12. Systematic review of the epidemiological evidence comparing lung cancer risk in smokers of mentholated and unmentholated cigarettes

    Directory of Open Access Journals (Sweden)

    Lee Peter N

    2011-04-01

    Full Text Available Abstract Background US mentholated cigarette sales have increased considerably over 50 years. Preference for mentholated cigarettes is markedly higher in Black people. While menthol itself is not genotoxic or carcinogenic, its acute respiratory effects might affect inhalation of cigarette smoke. This possibility seems consistent with the higher lung cancer risk in Black men, despite Black people smoking less and starting smoking later than White people. Despite experimental data suggesting similar carcinogenicity of mentholated and non-mentholated cigarettes, the lack of convincing evidence that mentholation increases puffing, inhalation or smoke uptake, and the similarity of lung cancer rates in Black and White females, a review of cigarette mentholation and lung cancer is timely given current regulatory interest in the topic. Methods Epidemiological studies comparing lung cancer risk in mentholated and non-mentholated cigarette smokers were identified from MedLine and other sources. Study details were extracted and strengths and weaknesses assessed. Relative risk estimates were extracted, or derived, for ever mentholated use and for long-term use, overall and by gender, race, and current/ever smoking, and meta-analyses conducted. Results Eight generally good quality studies were identified, with valid cases and controls, and appropriate adjustment for age, gender, race and smoking. The studies afforded good power to detect possible effects. However, only one study presented results by histological type, none adjusted for occupation or diet, and some provided no results by length of mentholated cigarette use. The data do not suggest any effect of mentholation on lung cancer risk. Adjusted relative risk estimates for ever use vary from 0.81 to 1.12, giving a combined estimate of 0.93 (95% confidence interval 0.84-1.02, n = 8, with no increase in males (1.01, 0.84-1.22, n = 5, females (0.80, 0.67-0.95, n = 5, White people (0.87, 0.75-1.03, n = 4

  13. The association between type 2 diabetes mellitus and women cancer: the epidemiological evidences and putative mechanisms.

    Science.gov (United States)

    Joung, Kyong Hye; Jeong, Jae-Wook; Ku, Bon Jeong

    2015-01-01

    Type 2 diabetes mellitus (T2DM), a chronic disease increasing rapidly worldwide, is well established as an important risk factor for various types of cancer. Although many factors impact the development of T2DM and cancer including sex, age, ethnicity, obesity, diet, physical activity levels, and environmental exposure, many epidemiological and experimental studies are gradually contributing to knowledge regarding the interrelationship between DM and cancer. The insulin resistance, hyperinsulinemia, and chronic inflammation associated with diabetes mellitus are all associated strongly with cancer. The changes in bioavailable ovarian steroid hormone that occur in diabetes mellitus (the increasing levels of estrogen and androgen and the decreasing level of progesterone) are also considered potentially carcinogenic conditions for the breast, endometrium, and ovaries in women. In addition, the interaction among insulin, insulin-like growth factors (IGFs), and ovarian steroid hormones, such as estrogen and progesterone, could act synergistically during cancer development. Here, we review the cancer-related mechanisms in T2DM, the epidemiological evidence linking T2DM and cancers in women, and the role of antidiabetic medication in these cancers.

  14. How the risk of liver cancer changes after alcohol cessation: A review and meta-analysis of the current literature

    Directory of Open Access Journals (Sweden)

    Heckley Gawain A

    2011-10-01

    Full Text Available Abstract Background It is well established that drinking alcohol raises the risk of liver cancer (hepatocellular carcinoma. However, it has not been sufficiently established as to whether or not drinking cessation subsequently reduces the risk of liver cancer and if it does reduce the risk how long it takes for this heightened risk to fall to that of never drinkers. This question is important for effective policy design and evaluation, to establish causality and for motivational treatments. Methods A systematic review and meta-analysis using the current available evidence and a specific form of Generalised Least Squares is performed to assess how the risk of liver cancer changes with time for former drinkers. Results Four studies are found to have quantified the effect of drinking cessation on the risk of liver cancer. The meta-analysis suggests that the risk of liver cancer does indeed fall after cessation by 6-7% a year, but there remains a large uncertainty around this estimate both statistically and in its interpretation. As an illustration it is estimated that a time period of 23 years is required after drinking cessation, with a correspondingly large 95% confidence interval of 14 to 70 years, for the risk of liver cancer to be equal to that of never drinkers. Conclusion This is a relatively under researched area and this is reflected in the uncertainty of the findings. It is our view that it is not possible to extrapolate the results found here to the general population. Too few studies have addressed this question and of the studies that have, all have significant limitations. The key issue amongst the relevant studies is that it appears that current drinkers, abstainers and former drinkers are not composed of, or effectively adjusted to be, similar populations making inferences about risk changes impossible. This is a very difficult area to study effectively, but it is an important topic. More work is required to reduce both statistical

  15. Plantar fasciitis – to jab or to support? A systematic review of the current best evidence

    Directory of Open Access Journals (Sweden)

    Uden H

    2011-05-01

    Full Text Available Hayley Uden1, Eva Boesch1, Saravana Kumar1,21Division of Health Sciences, 2International Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, South Australia, AustraliaBackground: Plantar fasciitis is a common condition routinely managed by podiatrists in the community and is widely treated conservatively. Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and corticosteroid injections. While common to clinical practice, the evidence base underpinning these treatment strategies is unknown. Therefore, the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis.Methods: A systematic literature search was conducted. Experimental studies, in English, from 1998 to 2010 were accepted for inclusion in this review. The PEDro quality assessment tool and the National Health and Medical Research Council's hierarchy of evidence were used to assess the quality of the included studies.Results: Six randomized controlled trials which met the selection criteria were included in this review. Four reported on customized functional foot orthoses and 2 on corticosteroid injections. Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis. Additionally, customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis. Corticosteroid injections may have side effects, especially pain (from the injection.Conclusion: Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis. While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis

  16. Current and upcoming approaches to exploit the reversibility of epigenetic mutations in breast cancer.

    Science.gov (United States)

    Falahi, Fahimeh; van Kruchten, Michel; Martinet, Nadine; Hospers, Geke A P; Rots, Marianne G

    2014-07-29

    DNA methylation and histone modifications are important epigenetic modifications associated with gene (dys)regulation. The epigenetic modifications are balanced by epigenetic enzymes, so-called writers and erasers, such as DNA (de)methylases and histone (de)acetylases. Aberrant epigenetic alterations have been associated with various diseases, including breast cancer. Since aberrant epigenetic modifications are potentially reversible, they might represent targets for breast cancer therapy. Indeed, several drugs have been designed to inhibit epigenetic enzymes (epi-drugs), thereby reversing epigenetic modifications. US Food and Drug Administration approval has been obtained for some epi-drugs for hematological malignancies. However, these drugs have had very modest anti-tumor efficacy in phase I and II clinical trials in breast cancer patients as monotherapy. Therefore, current clinical trials focus on the combination of epi-drugs with other therapies to enhance or restore the sensitivity to such therapies. This approach has yielded some promising results in early phase II trials. The disadvantage of epi-drugs, however, is genome-wide effects, which may cause unwanted upregulation of, for example, pro-metastatic genes. Development of gene-targeted epigenetic modifications (epigenetic editing) in breast cancer can provide a novel approach to prevent such unwanted events. In this context, identification of crucial epigenetic modifications regulating key genes in breast cancer is of critical importance. In this review, we first describe aberrant DNA methylation and histone modifications as two important classes of epigenetic mutations in breast cancer. Then we focus on the preclinical and clinical epigenetic-based therapies currently being explored for breast cancer. Finally, we describe epigenetic editing as a promising new approach for possible applications towards more targeted breast cancer treatment.

  17. The status of current epidemiological knowledge of radiocarcinogenecity: other, miscellaneous cancers

    International Nuclear Information System (INIS)

    Currently available epidemiological data indicate low or intermediate levels of sensitivity for radiation-induced cancers of most tissues and organ systems other than lung, thyroid and female breast, and leukaemia. However, the estimated risks for these ''other, miscellaneous'' cancers may reflect deficiencies in the data as a result of small study populations, insufficient population dose to detect an effect, uncertainties in dosimetry or the confounding or modifying effects of unknown or unevaluated risk factors. Additional information is necessary to improve existing risk estimates for the malignancies in the other, miscellaneous category. This may be obtained by continued follow-up of the populations currently under study, application of new and developing molecular technologies to identify and quantify radiation exposures for individuals, and pooled or parallel analyses of multiple populations. Cancers of the following tissues are briefly discussed:- digestive system, genito-urinary system, brain or central nervous system, lymphoma, multiple myeloma, bone and skin. (Author)

  18. Clinical utility of brain stimulation modalities following traumatic brain injury: current evidence

    Directory of Open Access Journals (Sweden)

    Li S

    2015-06-01

    Full Text Available Shasha Li,1,2 Ana Luiza Zaninotto,2,3 Iuri Santana Neville,4 Wellingson Silva Paiva,4 Danuza Nunn,2 Felipe Fregni21Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA, USA; 3Division of Psychology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; 4Division of Neurosurgery, University of São Paulo Medical School, São Paulo, São Paulo, BrazilAbstract: Traumatic brain injury (TBI remains the main cause of disability and a major public health problem worldwide. This review focuses on the neurophysiology of TBI, and the rationale and current state of evidence of clinical application of brain stimulation to promote TBI recovery, particularly on consciousness, cognitive function, motor impairments, and psychiatric conditions. We discuss the mechanisms of different brain stimulation techniques including major noninvasive and invasive stimulations. Thus far, most noninvasive brain stimulation interventions have been nontargeted and focused on the chronic phase of recovery after TBI. In the acute stages, there is limited available evidence of the efficacy and safety of brain stimulation to improve functional outcomes. Comparing the studies across different techniques, transcranial direct current stimulation is the intervention that currently has the higher number of properly designed clinical trials, though total number is still small. We recognize the need for larger studies with target neuroplasticity modulation to fully explore the benefits of brain stimulation to effect TBI recovery during different stages of recovery.Keywords: traumatic brain injury, brain stimulation, neuroplasticity

  19. [The level of evidence for the use of biomarkers in the early detection of prostate cancer].

    Science.gov (United States)

    Lamy, Pierre-Jean; Gauchez, Anne-Sophie; Salomon, Laurent; Haugh, Margaret; Ceraline, Jocelyn; Fulla, Yvonne; Georges, Agnès; Larré, Stéphane; Loric, Sylvain; Luporsi, Elisabeth; Martin, Pierre-Marie; Mazerolles, Catherine; Molinié, Vincent; Mongiat-Artus, Pierre; Piffret, Jacques; Thuillier, François; Perrin, Paul; Rebillard, Xavier

    2016-01-01

    To systematically review the evidence for the use of PSA and other biomarkers in the early detection of prostate cancer, we searched PubMed for clinical trials and studies assessing PSA and other biomarkers in the early detection of prostate cancer, published between 2000 and May 2013 that included >200 subjects. The level of evidence (LOE) for clinical utility was evaluated using the tumor marker utility grading system. A total of 84 publications, corresponding to 70 trials and studies were selected for inclusion in this review. We attributed a level of evidence (LoE) of IA to PSA for early PCa detection, but we do not recommend its use in mass screening. Emerging biomarkers were assessed in prospective case-control and cohort studies: PCA3 (n=3); kallikreins (n=3); [-2]proPSA (n=5); fusion oncogenes (n=2). These studies used biopsy results for prostate cancer to determine specificity and sensitivity, but they did not assess the effect on PCa mortality. The LoE attributed was III-C. PSA can be used for early prostate cancer detection but mass screening is not recommended. Studies on other biomarkers suggest that they could be used, individually or in combination, to improve the selection of patients with elevated PSA levels for biopsy, but RCTs assessing their impact on prostate cancer management and mortality are needed. A better use of available tests is possible for men at risk in order to maximize the risk-benefit ratio.

  20. ORGAN-SPARING SURGERY FOR RECTAL CANCER: EVOLUTION, CURRENT TRENDS, AND PROSPECTS

    Directory of Open Access Journals (Sweden)

    R. I. Tamrazov

    2013-01-01

    Full Text Available The article describes the main stages of the development of sphincter-saving surgery for rectal cancer. An historical look at this issue from the standpoint of research of past years in our country and abroad, as well as analysis of current sphincter-preserving surgery and future directions in this area.

  1. Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction

    NARCIS (Netherlands)

    Schreurs, Liesbeth; Verhoef, C.C.; van der Jagt, E.J.; van Dam, G.M.; Groen, H.; Plukker, J.T.

    2008-01-01

    Purpose: To evaluate the value of external ultrasonography (US) of the neck in current dedicated preoperative staging of patients with cancer of the esophagus and gastroesophageal junction (GEJ). Materials and methods: We analyzed 180 consecutive patients (154 men, 26 women, and mean age 63 (38-84)

  2. Anti EGFR therapy in the treatment of non-metastatic head and neck squamous cell carcinoma: The current evidence

    Directory of Open Access Journals (Sweden)

    Rony Benson

    2016-09-01

    Full Text Available Head and neck squamous cell carcinoma (HNSCC accounts for a large oncologic burden in the developing countries. In patients with locally advanced head and neck cancer multimodality treatment is warranted. Radiation therapy with concurrent chemotherapy has long been considered the standard for patients with disease involving the oropharynx, larynx and hypopharynx. However, addition of chemotherapy to radiotherapy increases treatment related toxicity by many folds and compliance rates decrease. In this context a systemic therapy, which when used concurrent with radiation with favorable toxicity profile is of great importance for improving disease control in locally advanced HNSCC. Anti-epithelial growth factor receptor targeted therapy emerged as a potential treatment option. In recent years many trials were conducted to find the optimum treatment option with the combination of these targeted agents. The initial trials showed excellent results with minimal morbidity and led to great enthusiasm across the globe to incorporate these regimens as a standard of care. However, subsequently many trials failed to maintain such results and now there is little agreement to the initial results achieved with these drugs. Based on the current evidence we cannot recommend the replacement of cisplatin with targeted therapy in concurrent setting. It may be considered in patients with altered renal parameters, hypersensitivity or intolerance to cisplatin. The addition of targeted therapy in addition to chemotherapy in the concurrent setting can’t also be recommended as the benefit is doubtful and is associated with a significant increase in toxicity.

  3. TP53 mutations as biomarkers for cancer epidemiology in Latin America: current knowledge and perspectives.

    Science.gov (United States)

    de Moura Gallo, Claudia Vitória; Azevedo E Silva Mendonça, Gulnar; de Moraes, Emanuela; Olivier, Magali; Hainaut, Pierre

    2005-05-01

    Due to particular social and economical development, and to the impact of globalization of lifestyles, Latin America shows a superposition of cancers that are frequent in low resource countries (gastric, oesophageal squamous cell and cervical cancers) and high resource countries (cancers of breast, colon and rectum, lung and prostate). Latin America thus offers opportunities for investigating the impact on changing lifestyle patterns on the occurrence of cancer. At the molecular level, mutations in the tumor suppressor gene TP53 are common in many cancers and their distribution can be informative of the nature of the mutagenic mechanisms, thus giving clues to cancer etiology and molecular pathogenesis. However most of the data available are derived from studies in industrialized countries. In this review, we discuss current trends on cancer occurrence in Latin American countries, and we review the literature available on TP53 mutations and polymorphisms in patients from Latin America. Overall, a total of 285 mutations have been described in 1213 patients in 20 publications, representing 1.5% of the total number of mutations reported world-wide. Except for hematological cancers, TP53 mutation frequencies are similar to those reported in other regions of the world. The only tumor site presenting significant differences in mutation pattern as compared to other parts of the world is colon and rectum. However, this difference is based on a single study with 35 patients. Recently, a characteristic TP53 mutation at codon 337 (R337H) has been identified in the germline of children with adrenocortical carcinoma in Southern Brazil. Further and better focused analyses of TP53 mutation patterns in the context of epidemiological studies, should help to improve our understanding of cancer etiology in order to develop appropriate health policies and public health programs in Latin America. PMID:15878142

  4. Current Advances in the Application of Raman Spectroscopy for Molecular Diagnosis of Cervical Cancer

    Directory of Open Access Journals (Sweden)

    Inês Raquel Martins Ramos

    2015-01-01

    Full Text Available Raman spectroscopy provides a unique biochemical fingerprint capable of identifying and characterizing the structure of molecules, cells, and tissues. In cervical cancer, it is acknowledged as a promising biochemical tool due to its ability to detect premalignancy and early malignancy stages. This review summarizes the key research in the area and the evidence compiled is very encouraging for ongoing and further research. In addition to the diagnostic potential, promising results for HPV detection and monitoring treatment response suggest more than just a diagnosis prospective. A greater body of evidence is however necessary before Raman spectroscopy is fully validated for clinical use and larger comprehensive studies are required to fully establish the role of Raman spectroscopy in the molecular diagnostics of cervical cancer.

  5. Update on Edoxaban for the Prevention and Treatment of Thromboembolism: Clinical Applications Based on Current Evidence.

    Science.gov (United States)

    Zalpour, Ali; Oo, Thein Hlaing

    2015-01-01

    Vitamin K antagonists (VKA) and heparins have been utilized for the prevention and treatment of thromboembolism (arterial and venous) for decades. Targeting and inhibiting specific coagulation factors have led to new discoveries in the pharmacotherapy of thromboembolism management. These targeted anticoagulants are known as direct oral anticoagulants (DOACs). Two pharmacologically distinct classes of targeted agents are dabigatran etexilate (Direct Thrombin Inhibitor (DTI)) and rivaroxaban, apixaban, and edoxaban (direct oral factor Xa inhibitors (OFXaIs)). Emerging evidence from the clinical trials has shown that DOACs are noninferior to VKA or low-molecular-weight heparins in the prevention and treatment of thromboembolism. This review examines the role of edoxaban, a recently approved OFXaI, in the prevention and treatment of thromboembolism based on the available published literature. The management of edoxaban in the perioperative setting, reversibility in bleeding cases, its role in cancer patients, the relevance of drug-drug interactions, patient satisfaction, financial impacts, and patient education will be discussed. PMID:26351456

  6. Update on Edoxaban for the Prevention and Treatment of Thromboembolism: Clinical Applications Based on Current Evidence

    Directory of Open Access Journals (Sweden)

    Ali Zalpour

    2015-01-01

    Full Text Available Vitamin K antagonists (VKA and heparins have been utilized for the prevention and treatment of thromboembolism (arterial and venous for decades. Targeting and inhibiting specific coagulation factors have led to new discoveries in the pharmacotherapy of thromboembolism management. These targeted anticoagulants are known as direct oral anticoagulants (DOACs. Two pharmacologically distinct classes of targeted agents are dabigatran etexilate (Direct Thrombin Inhibitor (DTI and rivaroxaban, apixaban, and edoxaban (direct oral factor Xa inhibitors (OFXaIs. Emerging evidence from the clinical trials has shown that DOACs are noninferior to VKA or low-molecular-weight heparins in the prevention and treatment of thromboembolism. This review examines the role of edoxaban, a recently approved OFXaI, in the prevention and treatment of thromboembolism based on the available published literature. The management of edoxaban in the perioperative setting, reversibility in bleeding cases, its role in cancer patients, the relevance of drug-drug interactions, patient satisfaction, financial impacts, and patient education will be discussed.

  7. Contemporary evidence for robot-assisted radical cystectomy for treating bladder cancer.

    Science.gov (United States)

    Satkunasivam, Raj; Wallis, Christopher J D; Nam, Robert K; Desai, Mihir; Gill, Inderbir S

    2016-09-01

    Robot-assisted radical cystectomy (RARC) is an evolving technique for the treatment of muscle-invasive bladder cancer (MIBC); however, its effectiveness compared with open radical cystectomy (ORC) - the established modality - is debated. Six specific areas of evidence are critically important for supporting the continuing use of RARC for MIBC, including technical aspects of surgery, perioperative outcomes, complications, oncological outcomes, functional outcomes, and financial costs. Considerable progress has been made regarding these aspects and data show that RARC replicates the technical benchmarks of ORC in terms of success of cystectomy, lymph node dissection, and urinary diversion, and could offer advantages over the more-established technique. Despite some clear benefits of RARC (such as reduced blood loss) other perioperative outcomes, including duration of inpatient stay and 30-90 day complication rates, seem to be similar to those of ORC. Current data on oncological and functional outcomes are promising, but robust data from prospective studies will help determine the indications for use of RARC for treating MIBC in the future. PMID:27502548

  8. Direct evidence for neutrino flavor transformation from neutral-current interactions in the Sudbury Neutrino Observatory.

    Science.gov (United States)

    Ahmad, Q R; Allen, R C; Andersen, T C; D Anglin, J; Barton, J C; Beier, E W; Bercovitch, M; Bigu, J; Biller, S D; Black, R A; Blevis, I; Boardman, R J; Boger, J; Bonvin, E; Boulay, M G; Bowler, M G; Bowles, T J; Brice, S J; Browne, M C; Bullard, T V; Bühler, G; Cameron, J; Chan, Y D; Chen, H H; Chen, M; Chen, X; Cleveland, B T; Clifford, E T H; Cowan, J H M; Cowen, D F; Cox, G A; Dai, X; Dalnoki-Veress, F; Davidson, W F; Doe, P J; Doucas, G; Dragowsky, M R; Duba, C A; Duncan, F A; Dunford, M; Dunmore, J A; Earle, E D; Elliott, S R; Evans, H C; Ewan, G T; Farine, J; Fergani, H; Ferraris, A P; Ford, R J; Formaggio, J A; Fowler, M M; Frame, K; Frank, E D; Frati, W; Gagnon, N; Germani, J V; Gil, S; Graham, K; Grant, D R; Hahn, R L; Hallin, A L; Hallman, E D; Hamer, A S; Hamian, A A; Handler, W B; Haq, R U; Hargrove, C K; Harvey, P J; Hazama, R; Heeger, K M; Heintzelman, W J; Heise, J; Helmer, R L; Hepburn, J D; Heron, H; Hewett, J; Hime, A; Howe, M; Hykawy, J G; Isaac, M C P; Jagam, P; Jelley, N A; Jillings, C; Jonkmans, G; Kazkaz, K; Keener, P T; Klein, J R; Knox, A B; Komar, R J; Kouzes, R; Kutter, T; Kyba, C C M; Law, J; Lawson, I T; Lay, M; Lee, H W; Lesko, K T; Leslie, J R; Levine, I; Locke, W; Luoma, S; Lyon, J; Majerus, S; Mak, H B; Maneira, J; Manor, J; Marino, A D; McCauley, N; McDonald, A B; McDonald, D S; McFarlane, K; McGregor, G; Meijer Drees, R; Mifflin, C; Miller, G G; Milton, G; Moffat, B A; Moorhead, M; Nally, C W; Neubauer, M S; Newcomer, F M; Ng, H S; Noble, A J; Norman, E B; Novikov, V M; O'Neill, M; Okada, C E; Ollerhead, R W; Omori, M; Orrell, J L; Oser, S M; Poon, A W P; Radcliffe, T J; Roberge, A; Robertson, B C; Robertson, R G H; Rosendahl, S S E; Rowley, J K; Rusu, V L; Saettler, E; Schaffer, K K; Schwendener, M H; Schülke, A; Seifert, H; Shatkay, M; Simpson, J J; Sims, C J; Sinclair, D; Skensved, P; Smith, A R; Smith, M W E; Spreitzer, T; Starinsky, N; Steiger, T D; Stokstad, R G; Stonehill, L C; Storey, R S; Sur, B; Tafirout, R; Tagg, N; Tanner, N W; Taplin, R K; Thorman, M; Thornewell, P M; Trent, P T; Tserkovnyak, Y I; Van Berg, R; Van de Water, R G; Virtue, C J; Waltham, C E; Wang, J-X; Wark, D L; West, N; Wilhelmy, J B; Wilkerson, J F; Wilson, J R; Wittich, P; Wouters, J M; Yeh, M

    2002-07-01

    Observations of neutral-current nu interactions on deuterium in the Sudbury Neutrino Observatory are reported. Using the neutral current (NC), elastic scattering, and charged current reactions and assuming the standard 8B shape, the nu(e) component of the 8B solar flux is phis(e) = 1.76(+0.05)(-0.05)(stat)(+0.09)(-0.09)(syst) x 10(6) cm(-2) s(-1) for a kinetic energy threshold of 5 MeV. The non-nu(e) component is phi(mu)(tau) = 3.41(+0.45)(-0.45)(stat)(+0.48)(-0.45)(syst) x 10(6) cm(-2) s(-1), 5.3sigma greater than zero, providing strong evidence for solar nu(e) flavor transformation. The total flux measured with the NC reaction is phi(NC) = 5.09(+0.44)(-0.43)(stat)(+0.46)(-0.43)(syst) x 10(6) cm(-2) s(-1), consistent with solar models.

  9. The genetics of neuroendocrine prostate cancers: a review of current and emerging candidates.

    Science.gov (United States)

    Ather, M Hammad; Siddiqui, Tahmeena

    2012-01-01

    -resistant PC in cases where prostate-specific antigen can no longer be relied upon. Aberrant androgen-receptor signaling at various levels provides evidence of the importance of this pathway for the development of castration-resistant PC. Many epigenetic influences - in particular, the role of changing miRNA expression - provide valuable insights. Currently, massive sequencing efforts are underway to define important somatic genetic alterations (amplifications, deletions, point mutations, translocations) in PC, and these alterations hold great promise as prognostic markers and for predicting response to therapy.

  10. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC.

    Science.gov (United States)

    Caraceni, Augusto; Hanks, Geoffrey; Kaasa, Stein; Bennett, Michael I; Brunelli, Cinzia; Cherny, Nathan; Dale, Ola; De Conno, Franco; Fallon, Marie; Hanna, Magdi; Haugen, Dagny Faksvåg; Juhl, Gitte; King, Samuel; Klepstad, Pål; Laugsand, Eivor A; Maltoni, Marco; Mercadante, Sebastiano; Nabal, Maria; Pigni, Alessandra; Radbruch, Lukas; Reid, Colette; Sjogren, Per; Stone, Patrick C; Tassinari, Davide; Zeppetella, Giovambattista

    2012-02-01

    Here we provide the updated version of the guidelines of the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. The update was undertaken by the European Palliative Care Research Collaborative. Previous EAPC guidelines were reviewed and compared with other currently available guidelines, and consensus recommendations were created by formal international expert panel. The content of the guidelines was defined according to several topics, each of which was assigned to collaborators who developed systematic literature reviews with a common methodology. The recommendations were developed by a writing committee that combined the evidence derived from the systematic reviews with the panellists' evaluations in a co-authored process, and were endorsed by the EAPC Board of Directors. The guidelines are presented as a list of 16 evidence-based recommendations developed according to the Grading of Recommendations Assessment, Development and Evaluation system.

  11. Human Papillomavirus: Current and Future RNAi Therapeutic Strategies for Cervical Cancer

    Directory of Open Access Journals (Sweden)

    Hun Soon Jung

    2015-05-01

    Full Text Available Human papillomaviruses (HPVs are small DNA viruses; some oncogenic ones can cause different types of cancer, in particular cervical cancer. HPV-associated carcinogenesis provides a classical model system for RNA interference (RNAi based cancer therapies, because the viral oncogenes E6 and E7 that cause cervical cancer are expressed only in cancerous cells. Previous studies on the development of therapeutic RNAi facilitated the advancement of therapeutic siRNAs and demonstrated its versatility by siRNA-mediated depletion of single or multiple cellular/viral targets. Sequence-specific gene silencing using RNAi shows promise as a novel therapeutic approach for the treatment of a variety of diseases that currently lack effective treatments. However, siRNA-based targeting requires further validation of its efficacy in vitro and in vivo, for its potential off-target effects, and of the design of conventional therapies to be used in combination with siRNAs and their drug delivery vehicles. In this review we discuss what is currently known about HPV-associated carcinogenesis and the potential for combining siRNA with other treatment strategies for the development of future therapies. Finally, we present our assessment of the most promising path to the development of RNAi therapeutic strategies for clinical settings.

  12. Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium

    OpenAIRE

    Olsen, C. M.; Nagle, C. M.; Whiteman, D C; Ness, R; C. L. Pearce; Pike, M. C.; Rossing, M A; Terry, Kathryn Lynne; Wu, A. H.; Risch, H A; Yu, H.; Doherty, J. A.; Chang-Claude, J; Hein, R.; Nickels, S

    2013-01-01

    Whilst previous studies have reported that higher body-mass index (BMI) increases a woman’s risk of developing ovarian cancer, associations for the different histological subtypes have not been well defined. As the prevalence of obesity has increased dramatically, and classification of ovarian histology has improved in the last decade, we sought to examine the association in a pooled analysis of recent studies participating in the Ovarian Cancer Association Consortium. We ev...

  13. Cervical cancer and human papillomavirus: Epidemiological evidence and perspectives for prevention

    Directory of Open Access Journals (Sweden)

    MUÑOZ NUBIA

    1997-01-01

    Full Text Available Cervical cancer is a major public health problem, as it is the second most common cancer in women world-wide after breast cancer. About 80% of the half a million cases estimated to occur annually in the world, occur in developing countries. The epidemiological evidence linking human papillomavirus (HPV to cervical cancer is reviewed. It is concluded that over 90% of cervical cancers can be attributed to certain HPV types. HPV 16 accounts for the highest proportion (50% followed by HPV 18 (12%, HPV 45 (8% and HPV 31 (5%. The associations with these HPV types are very b and consistent with odds ratios over 15 in all case-control studies in high- and low-risk countries for cervical cancer. However, HPV is not a sufficient cause of this malignancy; certain cofactors are necessary for a proportion of HPV persistent infections to eventually progress to cancer. These include host factors such as histocompatibilidad types and immunological response, hormonal influences and infections with other sexually transmitted agents such as Chlamydia trachomatis. In addition, results from our studies carried out in Spain and Colombia support the hypothesis that male carriers of HPV play an important role in the development of cervical cancer in their wives. The recognition of the central role of HPV in cervical cancer has far-reaching implications for the primary and secondary prevention of this malignancy. Prophylactic and therapeutic HPV vaccines are now under development and HPV typing is being integrated into screening programmes in pilot studies in a few developed countries. In developing countries, well conducted conventional screening programmes remain the best approach for the control of cervical cancer until a safe and efficient HPV vaccine can be used in the general population.

  14. Current Challenges in Volatile Organic Compounds Analysis as Potential Biomarkers of Cancer

    Directory of Open Access Journals (Sweden)

    Kamila Schmidt

    2015-01-01

    Full Text Available An early diagnosis and appropriate treatment are crucial in reducing mortality among people suffering from cancer. There is a lack of characteristic early clinical symptoms in most forms of cancer, which highlights the importance of investigating new methods for its early detection. One of the most promising methods is the analysis of volatile organic compounds (VOCs. VOCs are a diverse group of carbon-based chemicals that are present in exhaled breath and biofluids and may be collected from the headspace of these matrices. Different patterns of VOCs have been correlated with various diseases, cancer among them. Studies have also shown that cancer cells in vitro produce or consume specific VOCs that can serve as potential biomarkers that differentiate them from noncancerous cells. This review identifies the current challenges in the investigation of VOCs as potential cancer biomarkers, by the critical evaluation of available matrices for the in vivo and in vitro approaches in this field and by comparison of the main extraction and detection techniques that have been applied to date in this area of study. It also summarises complementary in vivo, ex vivo, and in vitro studies conducted to date in order to try to identify volatile biomarkers of cancer.

  15. Current status and prospects of clinical proteomics studies on detection of colorectal cancer: Hopes and fears

    Institute of Scientific and Technical Information of China (English)

    ME de Noo; RAEM Tollenaar; AM Deelder; LH Bouwman

    2006-01-01

    Colorectal adenocarcinoma (CRC) is the third most common type of cancer and the fourth most frequent cause of death due to cancer worldwide. Given the natural history of CRC, early diagnosis appears to be the most appropriate tool to reduce disease-related mortality. A field of recent interest is clinical proteomics, which was reported to lead to high sensitivity and specificities for early detection of several solid tumors. This emerging field uses mass spectrometry-based protein profiles/patterns of easy accessible body fluids to distinguish cancer from non-cancer patients. These discrepancies may be a result of: (1) proteins being abnormally produced or shed and added to the serum proteome, (2) proteins clipped or modified as a consequence of the disease process, or (3) proteins subtracted from the proteome owing to disease-related proteolytic degradation pathways. Therefore, protein pattern diagnostics would provide easy and reliable tools for detection of cancer. This paper focuses on the current status of clinical proteomics research in oncology and in colorectal cancer especially,and will reflect on pitfalls and fears in this relatively new area of clinical medicine, which are reproducibility issues and pre-analytical factors, statistical issues, and identification and nature of discriminating proteins/peptides.

  16. Aspirin use and lung cancer risk: a possible relationship? Evidence from an updated meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hai-yan Jiang

    Full Text Available Growing evidence has emerged and controversial results reported on possible relationship between aspirin use and lung cancer risk. We, therefore, conducted this updated and comprehensive meta-analysis to evaluate this issue, with focus on dose-risk and duration-risk relationships.We searched electronic databases including PUBMED, EMBASE and Cochrane library to identify eligible studies. Relative risk (RR and its 95% confidence interval (CI were used for cohort studies, while odds ratio (OR were employed for case-control studies. The random effects and fixed effects models were used for analyses.18 studies were identified including 19835 lung cancer cases, which were eligible for inclusion in the present meta-analysis. Pooled data from case-control studies showed a significant inverse association between regular aspirin use and lung cancer risk. But for cohort studies, insignificant association was detected with little evidence of heterogeneity (RR: 1.05, 95%CI: 0.95 - 1.16; I2: 10.3%, p value: 0.351. In case-control studies, standard aspirin use (>325mg was related to lower lung cancer incidence, compared with low-dose aspirin use (75-100mg. A similar trend was observed in cohort studies. Besides, when analysis was restricted to long time regular aspirin use (>5 years, insignificant results were reported in both cohort and case-control studies. Finally, regular aspirin use might result in higher reduction of non-small cell lung cancer incidence among men.Our findings do not support the protective effect of regular aspirin use on lung cancer risk. Long time aspirin use, sex, dose and type of lung cancer might alter the effect of aspirin use on lung cancer risk. More well-designed studies are needed to further clarify these associations.

  17. Combination Therapies for the Treatment of Advanced Melanoma: A Review of Current Evidence

    Directory of Open Access Journals (Sweden)

    Mark Voskoboynik

    2014-01-01

    Full Text Available The treatment of advanced melanoma has been revolutionised in recent years with the advent of a range of new therapies. BRAF inhibitors, such as vemurafenib, have demonstrated improvements in the overall survival of patients with advanced melanoma that harbour a BRAF V600 mutation. Alongside these targeted therapies, novel immune-checkpoint inhibitors, such as ipilimumab, have also been developed and have produced similarly improved outcomes for patients. For the first time in the history of melanoma, monotherapy with each of these drugs has produced improvements in the overall survival of patients with advanced disease. Building on this initial success, there has been intense interest in developing combination therapies predominantly with either dual blockade of the MAPK oncogenic pathway or dual immune-checkpoint blockade. The current evidence for the use of these combination therapies will be presented here.

  18. Evidence for enhancement of critical current by intergrain Ag in YBaCuO-Ag ceramics

    Energy Technology Data Exchange (ETDEWEB)

    Dwir, B.; Affronte, M.; Pavuna, D.

    1989-07-24

    We report the evidence for enhancement of critical current density /ital J//sub /ital c// by /similar to/50%, which occurs when /similar to/10 wt. % Ag is added to Y/sub 1/Ba/sub 2/Cu/sub 3/O/sub 7/minus//delta// ceramics. The maximal /ital J//sub /ital c// (/similar to/700 A/cm/sup 2/ at /ital T/=77 K) appears simultaneously with maximum YBaCuO compactness in the samples. The silver fills the intergranular space (holes) without Cu substitution, and the critical temperature /ital T//sub /ital c// is not reduced from the bulk value (/similar to/91 K). Normal-state resistivity of Ag-YBaCuO samples is decreased by an order of magnitude, and samples exhibit improved contact resistance and resistance to water. While the critical density is improved by adding /similar to/10 wt. % Ag, it decreases at higher Ag concentrations.

  19. Assessing competency in Evidence Based Practice: strengths and limitations of current tools in practice

    Directory of Open Access Journals (Sweden)

    Ilic Dragan

    2009-08-01

    Full Text Available Abstract Background Evidence Based Practice (EBP involves making clinical decisions informed by the most relevant and valid evidence available. Competence can broadly be defined as a concept that incorporates a variety of domains including knowledge, skills and attitudes. Adopting an evidence-based approach to practice requires differing competencies across various domains including literature searching, critical appraisal and communication. This paper examines the current tools available to assess EBP competence and compares their applicability to existing assessment techniques used in medicine, nursing and health sciences. Discussion Only two validated assessment tools have been developed to specifically assess all aspects of EBP competence. Of the two tools (Berlin and Fresno tools, only the Fresno tool comprehensively assesses EBP competency across all relevant domains. However, both tools focus on assessing EBP competency in medical students; therefore neither can be used for assessing EBP competency across different health disciplines. The Objective Structured Clinical Exam (OSCE has been demonstrated as a reliable and versatile tool to assess clinical competencies, practical and communication skills. The OSCE has scope as an alternate method for assessing EBP competency, since it combines assessment of cognitive skills including knowledge, reasoning and communication. However, further research is needed to develop the OSCE as a viable method for assessing EBP competency. Summary Demonstrating EBP competence is a complex task – therefore no single assessment method can adequately provide all of the necessary data to assess complete EBP competence. There is a need for further research to explore how EBP competence is best assessed; be it in written formats, such as the Fresno tool, or another format, such as the OSCE. Future tools must also incorporate measures of assessing how EBP competence affects clinician behaviour and attitudes as

  20. Effects of exercise training on chronic inflammation in obesity : current evidence and potential mechanisms.

    Science.gov (United States)

    You, Tongjian; Arsenis, Nicole C; Disanzo, Beth L; Lamonte, Michael J

    2013-04-01

    Chronic, systemic inflammation is an independent risk factor for several major clinical diseases. In obesity, circulating levels of inflammatory markers are elevated, possibly due to increased production of pro-inflammatory cytokines from several tissues/cells, including macrophages within adipose tissue, vascular endothelial cells and peripheral blood mononuclear cells. Recent evidence supports that adipose tissue hypoxia may be an important mechanism through which enlarged adipose tissue elicits local tissue inflammation and further contributes to systemic inflammation. Current evidence supports that exercise training, such as aerobic and resistance exercise, reduces chronic inflammation, especially in obese individuals with high levels of inflammatory biomarkers undergoing a longer-term intervention. Several studies have reported that this effect is independent of the exercise-induced weight loss. There are several mechanisms through which exercise training reduces chronic inflammation, including its effect on muscle tissue to generate muscle-derived, anti-inflammatory 'myokine', its effect on adipose tissue to improve hypoxia and reduce local adipose tissue inflammation, its effect on endothelial cells to reduce leukocyte adhesion and cytokine production systemically, and its effect on the immune system to lower the number of pro-inflammatory cells and reduce pro-inflammatory cytokine production per cell. Of these potential mechanisms, the effect of exercise training on adipose tissue oxygenation is worth further investigation, as it is very likely that exercise training stimulates adipose tissue angiogenesis and increases blood flow, thereby reducing hypoxia and the associated chronic inflammation in adipose tissue of obese individuals. PMID:23494259

  1. Smoke exposure as a risk factor for asthma in childhood: a review of current evidence.

    Science.gov (United States)

    Ferrante, Giuliana; Antona, Roberta; Malizia, Velia; Montalbano, Laura; Corsello, Giovanni; La Grutta, Stefania

    2014-01-01

    Asthma is a common chronic multifactorial disease that affects >300 million people worldwide. Outdoor and indoor pollution exposure has been associated with respiratory health effects in adults and children. Smoking still represents a huge public health problem and millions of children suffer the detrimental effects of passive smoke exposure. This study was designed to review the current evidences on exposure to passive smoke as a risk factor for asthma onset in childhood. A review of the most recent studies on this topic was undertaken to provide evidence about the magnitude of the effect of passive smoking on the risk of incidence of asthma in children. The effects of passive smoking are different depending on individual and environmental factors. Environmental tobacco smoke (ETS) is one of the most important indoor air pollutants and can interact with other air pollutants in eliciting respiratory outcomes during childhood. The increased risk of respiratory outcomes in children exposed to prenatal and early postnatal passive smoke might be caused by an adverse effect on both the immune system and the structural and functional development of the lung; this may explain the subsequent increased risk of incident asthma. The magnitude of the exposure is quite difficult to precisely quantify because it is significantly influenced by the child's daily activities. Because exposure to ETS is a likely cause for asthma onset in childhood, there is a strong need to prevent infants and children from breathing air contaminated with tobacco smoke.

  2. Evidence of current impact of climate change on life: a walk from genes to the biosphere.

    Science.gov (United States)

    Peñuelas, Josep; Sardans, Jordi; Estiarte, Marc; Ogaya, Romà; Carnicer, Jofre; Coll, Marta; Barbeta, Adria; Rivas-Ubach, Albert; Llusià, Joan; Garbulsky, Martin; Filella, Iolanda; Jump, Alistair S

    2013-08-01

    We review the evidence of how organisms and populations are currently responding to climate change through phenotypic plasticity, genotypic evolution, changes in distribution and, in some cases, local extinction. Organisms alter their gene expression and metabolism to increase the concentrations of several antistress compounds and to change their physiology, phenology, growth and reproduction in response to climate change. Rapid adaptation and microevolution occur at the population level. Together with these phenotypic and genotypic adaptations, the movement of organisms and the turnover of populations can lead to migration toward habitats with better conditions unless hindered by barriers. Both migration and local extinction of populations have occurred. However, many unknowns for all these processes remain. The roles of phenotypic plasticity and genotypic evolution and their possible trade-offs and links with population structure warrant further research. The application of omic techniques to ecological studies will greatly favor this research. It remains poorly understood how climate change will result in asymmetrical responses of species and how it will interact with other increasing global impacts, such as N eutrophication, changes in environmental N : P ratios and species invasion, among many others. The biogeochemical and biophysical feedbacks on climate of all these changes in vegetation are also poorly understood. We here review the evidence of responses to climate change and discuss the perspectives for increasing our knowledge of the interactions between climate change and life.

  3. Effects of exercise training on chronic inflammation in obesity : current evidence and potential mechanisms.

    Science.gov (United States)

    You, Tongjian; Arsenis, Nicole C; Disanzo, Beth L; Lamonte, Michael J

    2013-04-01

    Chronic, systemic inflammation is an independent risk factor for several major clinical diseases. In obesity, circulating levels of inflammatory markers are elevated, possibly due to increased production of pro-inflammatory cytokines from several tissues/cells, including macrophages within adipose tissue, vascular endothelial cells and peripheral blood mononuclear cells. Recent evidence supports that adipose tissue hypoxia may be an important mechanism through which enlarged adipose tissue elicits local tissue inflammation and further contributes to systemic inflammation. Current evidence supports that exercise training, such as aerobic and resistance exercise, reduces chronic inflammation, especially in obese individuals with high levels of inflammatory biomarkers undergoing a longer-term intervention. Several studies have reported that this effect is independent of the exercise-induced weight loss. There are several mechanisms through which exercise training reduces chronic inflammation, including its effect on muscle tissue to generate muscle-derived, anti-inflammatory 'myokine', its effect on adipose tissue to improve hypoxia and reduce local adipose tissue inflammation, its effect on endothelial cells to reduce leukocyte adhesion and cytokine production systemically, and its effect on the immune system to lower the number of pro-inflammatory cells and reduce pro-inflammatory cytokine production per cell. Of these potential mechanisms, the effect of exercise training on adipose tissue oxygenation is worth further investigation, as it is very likely that exercise training stimulates adipose tissue angiogenesis and increases blood flow, thereby reducing hypoxia and the associated chronic inflammation in adipose tissue of obese individuals.

  4. [Current problems and challenges in the diagnosis and treatment of colorectal cancer in China].

    Science.gov (United States)

    Wang, Jianping; Wang, Lei

    2014-06-01

    In the past 20 years, researches regarding colorectal cancer have experienced unprecedented boom in China. However, a seris problems have been exposed, including a rapid increase in morbility, the geographical limitations of tumor screening, nonstandard diagnosis and treatment, very limited mechanism researches, and lack of randomized controlled clinical trials with Chinese characteristics. This article puts forward some main emphases of the current work, based on the above problems and challenges, in order to improve the overall level of the diagnosis and treatment of colorectal cancer in China.

  5. Fatty acid and vitamin interventions in adults with schizophrenia: a systematic review of the current evidence.

    Science.gov (United States)

    Chia, Siok Ching; Henry, Jeyakumar; Mok, Yee Ming; Honer, William G; Sim, Kang

    2015-12-01

    Current psychopharmacological approaches to reduce psychotic phenomenology in schizophrenia are associated with adverse effects including extrapyramidal and metabolic side effects. In view of the emerging data on nutritional supplementation interventions in schizophrenia which are not entirely consistent, we aimed to review existent studies focusing on fatty acid and vitamin interventions and summarise current evidence on such nutritional supplementations in schizophrenia. We searched the digital databases (ScienceDirect, Scopus, SpringerLINK, PubMed/Medline) for relevant studies pertaining to fatty acid and vitamin supplementation interventions in the management of psychotic symptoms in schizophrenia up to February 2015. Overall, there were more studies conducted on fatty acid over vitamin supplementations in patients with schizophrenia. There were more positive findings in support of fatty acid supplementation compared with vitamin supplementation in the context of specific intervention features (dose of nutrient supplementation, single versus combination nutritional interventions, specific antipsychotic), subject features (older age, long duration of illness, baseline polyunsaturated fatty acid levels) and clinical outcomes (improvements of psychotic symptoms and/or extrapyramidal side effects from antipsychotics). However, investigations of both supplementation modalities were limited by relatively small study sample sizes, short study duration, which precluded further segmentation of impact on more diverse patient subtypes and symptom profiles. Future studies may consider examining larger samples over a longer time period, recruiting younger subjects with shorter duration of illness, examination of different clinical features including specific cognitive domains, and use of single versus combination nutritional interventions. PMID:26354100

  6. Fatty acid and vitamin interventions in adults with schizophrenia: a systematic review of the current evidence.

    Science.gov (United States)

    Chia, Siok Ching; Henry, Jeyakumar; Mok, Yee Ming; Honer, William G; Sim, Kang

    2015-12-01

    Current psychopharmacological approaches to reduce psychotic phenomenology in schizophrenia are associated with adverse effects including extrapyramidal and metabolic side effects. In view of the emerging data on nutritional supplementation interventions in schizophrenia which are not entirely consistent, we aimed to review existent studies focusing on fatty acid and vitamin interventions and summarise current evidence on such nutritional supplementations in schizophrenia. We searched the digital databases (ScienceDirect, Scopus, SpringerLINK, PubMed/Medline) for relevant studies pertaining to fatty acid and vitamin supplementation interventions in the management of psychotic symptoms in schizophrenia up to February 2015. Overall, there were more studies conducted on fatty acid over vitamin supplementations in patients with schizophrenia. There were more positive findings in support of fatty acid supplementation compared with vitamin supplementation in the context of specific intervention features (dose of nutrient supplementation, single versus combination nutritional interventions, specific antipsychotic), subject features (older age, long duration of illness, baseline polyunsaturated fatty acid levels) and clinical outcomes (improvements of psychotic symptoms and/or extrapyramidal side effects from antipsychotics). However, investigations of both supplementation modalities were limited by relatively small study sample sizes, short study duration, which precluded further segmentation of impact on more diverse patient subtypes and symptom profiles. Future studies may consider examining larger samples over a longer time period, recruiting younger subjects with shorter duration of illness, examination of different clinical features including specific cognitive domains, and use of single versus combination nutritional interventions.

  7. Cancer Multidisciplinary Team Meetings: Evidence, Challenges, and the Role of Clinical Decision Support Technology

    Directory of Open Access Journals (Sweden)

    Vivek Patkar

    2011-01-01

    Full Text Available Multidisciplinary team (MDT model in cancer care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence. Over the last few years, regular MDT meetings have become a standard practice in oncology and gained the status of the key decision-making forum for patient management. Despite the fact that cancer MDT meetings are well accepted by clinicians, concerns are raised over the paucity of good-quality evidence on their overall impact. There are also concerns over lack of the appropriate support for this important but overburdened decision-making platform. The growing acceptance by clinical community of the health information technology in recent years has created new opportunities and possibilities of using advanced clinical decision support (CDS systems to realise full potential of cancer MDT meetings. In this paper, we present targeted summary of the available evidence on the impact of cancer MDT meetings, discuss the reported challenges, and explore the role that a CDS technology could play in addressing some of these challenges.

  8. Cancer Multidisciplinary Team Meetings: Evidence, Challenges, and the Role of Clinical Decision Support Technology

    International Nuclear Information System (INIS)

    Multidisciplinary team (MDT) model in cancer care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence. Over the last few years, regular MDT meetings have become a standard practice in oncology and gained the status of the key decision-making forum for patient management. Despite the fact that cancer MDT meetings are well accepted by clinicians, concerns are raised over the paucity of good-quality evidence on their overall impact. There are also concerns over lack of the appropriate support for this important but overburdened decision-making platform. The growing acceptance by clinical community of the health information technology in recent years has created new opportunities and possibilities of using advanced clinical decision support (CDS) systems to realise full potential of cancer MDT meetings. In this paper, we present targeted summary of the available evidence on the impact of cancer MDT meetings, discuss the reported challenges, and explore the role that a CDS technology could play in addressing some of these challenges

  9. Anti-angiogenesis in hepatocellular carcinoma treatment: Current evidence and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Martin-Walter Welker; Joerg Trojan

    2011-01-01

    Hepatocellular carcinoma (HCC) is among the most common cancer diseases worldwide. Arterial hypervascularisation is an essential step for HCC tumorigenesis and can be targeted by transarterial chemoembolization (TACE). This interventional method is the standard treatment for patients with intermediate stage HCC, but is also applied as "bridging" therapy for patients awaiting liver transplantation in many centers worldwide. Usually the devascularization effect induced by TACE is transient, consequently resulting in repeated cycles of TACE every 4-8 wk. Despite documented survival benefits, TACE can also induce the up-regulation of proangiogenic and growth factors, which might contribute to accelerated progression in patients with incomplete response. In 2007, sorafenib, a multi-tyrosine kinase and angiogenesis inhibitor, was approved as the first systemic treatment for advanced stage HCC. Other active targeted compounds, either inhibitors of angiogenesis and/or growth factors, are currently being investigated in numerous clinical trials. To overcome revascularisation or tumor progression under TACE treatment it seems therefore attractive to combine TACE with systemic targeted agents, which might theoretically block the effects of proangiogenic and growth factors. Over the last 12 mo, several retrospective or prospective cohort studies combining TACE and sorafenib have been published. Nevertheless, robust results of the efficacy and tolerability of such combination strategies as proven by randomized, controlled trials are awaited in the next two years.

  10. Stem cells and cancer: Evidence for bone marrow stem cells in epithelial cancers

    Institute of Scientific and Technical Information of China (English)

    Han-Chen Li; Calin Stoicov; Arlin B Rogers; JeanMarie Houghton

    2006-01-01

    Cancer commonly arises at the sites of chronic inflammation and infection. Although this association has long been recognized, the reason has remained unclear. Within the gastrointestinal tract, there are many examples of inflammatory conditions associated with cancer, and these include reflux disease and Barrett's adenocarcinoma of the esophagus, Helicobacter infection and gastric cancer, inflammatory bowel disease and colorectal cancer and viral hepatitis leading to hepatocellular carcinoma.There are several mechanisms by which chronic inflammation has been postulated to lead to cancer which includes enhanced proliferation in an endless attempt to heal damage, the presence of a persistent inflammatory environment creating a pro-carcinogenic environment and more recently a role for engraftment of circulating marrow-derived stem cells which may contribute to the stromal components of the tumor as well as the tumor mass itself. Here we review the recent advances in our understanding of the contributions of circulating bone marrow-derived stem cells to the formation of tumors in animal models as well as in human beings.

  11. Adjuvant Cancer Biotherapy by Viscum Album Extract Isorel: Overview of Evidence Based Medicine Findings.

    Science.gov (United States)

    Sunjic, Suzana Borovic; Gasparovic, Ana Cipak; Vukovic, Tea; Weiss, Thomas; Weiss, Elisabeth Sussman; Soldo, Ivo; Djakovic, Nikola; Zarkovic, Tomislav; Zarkovic, Neven

    2015-09-01

    Within the integrative medicine one of the most frequently used adjuvant cancer biotherapies is based on aqueous mistletoe (Viscum album) extracts. Tumor growth inhibition, stimulation of host immune response and improvement of the quality of life are the positive effects of mistletoe therapy described in several preclinical and clinical studies. However, cumulative results of the evidence based medicine findings on such treatments are rarely given. Therefore, this paper evaluates the evidence based findings describing effects of the Viscum album extract Isorel in cancer therapy with respect to the type of therapy, stage and type of illness. This study presents cumulated data for 74 patients with different types and stages of cancer treated by Viscum album extract as adjuvant treatment to different conventional therapies, mostly combined surgery and radiotherapy. The biotherapy effectiveness was evaluated according to the outcome as (1) no major therapeutic improvement (15% of patients), (2) prevention of tumor recurrence (47% of patients) and (3) regression of cancer (38% of patients). Notably, there was no obvious health worsening during the follow up period at all. Thus, the results obtained for conventional anticancer therapies combined with adjuvant biotherapy based on Viscum album extract seem to be beneficial for the majority of cancer patients (85%) without serious side effects.

  12. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.

  13. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain.

    Science.gov (United States)

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. PMID:26009665

  14. Height and Breast Cancer Risk: Evidence From Prospective Studies and Mendelian Randomization

    Science.gov (United States)

    Zhang, Ben; Shu, Xiao-Ou; Delahanty, Ryan J.; Zeng, Chenjie; Michailidou, Kyriaki; Bolla, Manjeet K.; Wang, Qin; Dennis, Joe; Wen, Wanqing; Long, Jirong; Li, Chun; Dunning, Alison M.; Chang-Claude, Jenny; Shah, Mitul; Perkins, Barbara J.; Czene, Kamila; Darabi, Hatef; Eriksson, Mikael; Bojesen, Stig E.; Nordestgaard, Børge G.; Nielsen, Sune F.; Flyger, Henrik; Lambrechts, Diether; Neven, Patrick; Wildiers, Hans; Floris, Giuseppe; Schmidt, Marjanka K.; Rookus, Matti A.; van den Hurk, Katja; de Kort, Wim L. A. M.; Couch, Fergus J.; Olson, Janet E.; Hallberg, Emily; Vachon, Celine; Rudolph, Anja; Seibold, Petra; Flesch-Janys, Dieter; Peto, Julian; dos-Santos-Silva, Isabel; Fletcher, Olivia; Johnson, Nichola; Nevanlinna, Heli; Muranen, Taru A.; Aittomäki, Kristiina; Blomqvist, Carl; Li, Jingmei; Humphreys, Keith; Brand, Judith; Guénel, Pascal; Truong, Thérèse; Cordina-Duverger, Emilie; Menegaux, Florence; Burwinkel, Barbara; Marme, Frederik; Yang, Rongxi; Surowy, Harald; Benitez, Javier; Zamora, M. Pilar; Perez, Jose I. A.; Cox, Angela; Cross, Simon S.; Reed, Malcolm W. R.; Andrulis, Irene L.; Knight, Julia A.; Glendon, Gord; Tchatchou, Sandrine; Sawyer, Elinor J.; Tomlinson, Ian; Kerin, Michael J.; Miller, Nicola; Chenevix-Trench, Georgia; Haiman, Christopher A.; Henderson, Brian E.; Schumacher, Fredrick; Marchand, Loic Le; Lindblom, Annika; Margolin, Sara; Hooning, Maartje J.; Martens, John W. M.; Tilanus-Linthorst, Madeleine M. A.; Collée, J. Margriet; Hopper, John L.; Southey, Melissa C.; Tsimiklis, Helen; Apicella, Carmel; Slager, Susan; Toland, Amanda E.; Ambrosone, Christine B.; Yannoukakos, Drakoulis; Giles, Graham G.; Milne, Roger L.; McLean, Catriona; Fasching, Peter A.; Haeberle, Lothar; Ekici, Arif B.; Beckmann, Matthias W.; Brenner, Hermann; Dieffenbach, Aida Karina; Arndt, Volker; Stegmaier, Christa; Swerdlow, Anthony J.; Ashworth, Alan; Orr, Nick; Jones, Michael; Figueroa, Jonine; Garcia-Closas, Montserrat; Brinton, Louise; Lissowska, Jolanta; Dumont, Martine; Winqvist, Robert; Pylkäs, Katri; Jukkola-Vuorinen, Arja; Grip, Mervi; Brauch, Hiltrud; Brüning, Thomas; Ko, Yon-Dschun; Peterlongo, Paolo; Manoukian, Siranoush; Bonanni, Bernardo; Radice, Paolo; Bogdanova, Natalia; Antonenkova, Natalia; Dörk, Thilo; Mannermaa, Arto; Kataja, Vesa; Kosma, Veli-Matti; Hartikainen, Jaana M.; Devilee, Peter; Seynaeve, Caroline; Van Asperen, Christi J.; Jakubowska, Anna; Lubiński, Jan; Jaworska-Bieniek, Katarzyna; Durda, Katarzyna; Hamann, Ute; Torres, Diana; Schmutzler, Rita K.; Neuhausen, Susan L.; Anton-Culver, Hoda; Kristensen, Vessela N.; Grenaker Alnæs, Grethe I.; Pierce, Brandon L.; Kraft, Peter; Peters, Ulrike; Lindstrom, Sara; Seminara, Daniela; Burgess, Stephen; Ahsan, Habibul; Whittemore, Alice S.; John, Esther M.; Gammon, Marilie D.; Malone, Kathleen E.; Tessier, Daniel C.; Vincent, Daniel; Bacot, Francois; Luccarini, Craig; Baynes, Caroline; Ahmed, Shahana; Maranian, Mel; Healey, Catherine S.; González-Neira, Anna; Pita, Guillermo; Alonso, M. Rosario; Álvarez, Nuria; Herrero, Daniel; Pharoah, Paul D. P.; Simard, Jacques; Hall, Per; Hunter, David J.; Easton, Douglas F.

    2015-01-01

    Background: Epidemiological studies have linked adult height with breast cancer risk in women. However, the magnitude of the association, particularly by subtypes of breast cancer, has not been established. Furthermore, the mechanisms of the association remain unclear. Methods: We performed a meta-analysis to investigate associations between height and breast cancer risk using data from 159 prospective cohorts totaling 5216302 women, including 113178 events. In a consortium with individual-level data from 46325 case patients and 42482 control subjects, we conducted a Mendelian randomization analysis using a genetic score that comprised 168 height-associated variants as an instrument. This association was further evaluated in a second consortium using summary statistics data from 16003 case patients and 41335 control subjects. Results: The pooled relative risk of breast cancer was 1.17 (95% confidence interval [CI] = 1.15 to 1.19) per 10cm increase in height in the meta-analysis of prospective studies. In Mendelian randomization analysis, the odds ratio of breast cancer per 10cm increase in genetically predicted height was 1.22 (95% CI = 1.13 to 1.32) in the first consortium and 1.21 (95% CI = 1.05 to 1.39) in the second consortium. The association was found in both premenopausal and postmenopausal women but restricted to hormone receptor–positive breast cancer. Analyses of height-associated variants identified eight new loci associated with breast cancer risk after adjusting for multiple comparisons, including three loci at 1q21.2, DNAJC27, and CCDC91 at genome-wide significance level P < 5×10–8. Conclusions: Our study provides strong evidence that adult height is a risk factor for breast cancer in women and certain genetic factors and biological pathways affecting adult height have an important role in the etiology of breast cancer. PMID:26296642

  15. Green tea for the prevention of cancer: evidence of field epidemiology

    Directory of Open Access Journals (Sweden)

    Min Zhang

    2012-10-01

    Full Text Available Background: Tea is derived from the leaf of Camellia sinensis, a natural beverage widely consumed around the world. Geological and botanical evidence suggests that the tea plant originated from China. Varying methods of processing tea leaves lead to green tea, black tea, or Oolong tea, which differ in their concentrations of polyphenols. Green tea polyphenols appear to have anti-tumorigenic properties, and form 30-40% of the dry weight of green tea compared with only 3-10% of black tea. Numerous studies in multiple animal models and different cancer cell lines have demonstrated the anti-tumorigenesis by green tea polyphenols. Despite the consistency of laboratory results, evidence of this effect occuring in humans has been inconclusive to date.Objective: To investigate if green tea consumption was associated with longer survival rates in ovarian cancer patients, and a lower risk of ovarian, breast, and colorectal cancer, in addition toadult leukemiaMethods: We have conducted one prospective cohort study in ovarian cancer patients, and fivecase-control studies in ovarian, breast, and colorectal cancers, and leukemia over the past decade. Tea consumption was measured using a structured questionnaire by face-to-face interviews. The validity and reliability of the questionnaire was assessed in a preliminary study, and then evaluated by a test–retest. Cox proportional hazards regression models were used to obtain hazard ratios(HRs, 95% confidence intervals(95% CIs, and were adjusted for age at diagnosis, locality, body mass index(BMI, parity, International Federation of Gynecology and Obstetrics(IFGO stage, histologic grade of differentiation, cytology of ascites, residual tumour, and chemotherapeutic status. Odds ratios(ORs and 95% CIs were obtained using logistic regression analyses, which accounted for demographic, lifestyle, hormonal and family cancer factors, and potential confounders.Functional Foods in Health and Disease 2012, 2

  16. Current status of methodology research on nuclear medicine on sentinel lymph node biopsy in breast cancer

    International Nuclear Information System (INIS)

    Breast cancer is the most common malignancy of the female,and axillary lymph node dissection has been considered as the basic method in breast cancer surgery. Sentinel lymph node biopsy (SLNB) in recent years is accepted gradually both at home and abroad because it not only can avoid complications but also has the advantages of safe and simple operation, high accuracy, and slight trauma. It has taken the place of axillary lymph node dissection in the treatment of axillary node-negative patients. Nuclear medicine inspection has played a crucial role in SLNB, and radiotracers, injecting techniques,detecting methods and standards have great influence upon the accuracy and false-negative rate of axillary lymph nodes and internal mammary lymph nodes detection. In this review, the current methodology status of nuclear medicine is summarized on SLNB in breast cancer at home and abroad. (authors)

  17. Evolving Paradigm of Radiotherapy for High-Risk Prostate Cancer: Current Consensus and Continuing Controversies

    Science.gov (United States)

    Juloori, Aditya; Shah, Chirag; Stephans, Kevin; Vassil, Andrew; Tendulkar, Rahul

    2016-01-01

    High-risk prostate cancer is an aggressive form of the disease with an increased risk of distant metastasis and subsequent mortality. Multiple randomized trials have established that the combination of radiation therapy and long-term androgen deprivation therapy improves overall survival compared to either treatment alone. Standard of care for men with high-risk prostate cancer in the modern setting is dose-escalated radiotherapy along with 2-3 years of androgen deprivation therapy (ADT). There are research efforts directed towards assessing the efficacy of shorter ADT duration. Current research has been focused on assessing hypofractionated and stereotactic body radiation therapy (SBRT) techniques. Ongoing randomized trials will help assess the utility of pelvic lymph node irradiation. Research is also focused on multimodality therapy with addition of a brachytherapy boost to external beam radiation to help improve outcomes in men with high-risk prostate cancer. PMID:27313896

  18. Pegylated liposomal doxorubicin: appraisal of its current role in the management of epithelial ovarian cancer

    Directory of Open Access Journals (Sweden)

    Markman M

    2011-06-01

    Full Text Available Maurie MarkmanCancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, PA, USAAbstract: Pegylated liposomal doxorubicin (PLD has become a major component in the routine management of epithelial ovarian cancer. The drug is frequently employed as a single agent in the platinum-resistant setting, and recently reported data reveal the superiority of the combination of PLD plus carboplatin, compared with the platinum drug plus paclitaxel, in delaying the time to disease progression in women with recurrent (potentially platinum-sensitive disease. Current research efforts involving PLD in ovarian cancer are focusing on adding novel targeted drugs to this cytotoxic agent. The utility of such approaches in the platinum-resistant population, compared with the sequential administration of single agents active in this setting, remains to be determined.Keywords: PLD, carboplatin, paclitaxel, platinum-sensitive, platinum-resistant

  19. Evaluating Evidence for Association of Human Bladder Cancer with Drinking-Water Chlorination Disinfection By-Products.

    Science.gov (United States)

    Hrudey, Steve E; Backer, Lorraine C; Humpage, Andrew R; Krasner, Stuart W; Michaud, Dominique S; Moore, Lee E; Singer, Philip C; Stanford, Benjamin D

    2015-01-01

    Exposure to chlorination disinfection by-products (CxDBPs) is prevalent in populations using chlorination-based methods to disinfect public water supplies. Multifaceted research has been directed for decades to identify, characterize, and understand the toxicology of these compounds, control and minimize their formation, and conduct epidemiologic studies related to exposure. Urinary bladder cancer has been the health risk most consistently associated with CxDBPs in epidemiologic studies. An international workshop was held to (1) discuss the qualitative strengths and limitations that inform the association between bladder cancer and CxDBPs in the context of possible causation, (2) identify knowledge gaps for this topic in relation to chlorine/chloramine-based disinfection practice(s) in the United States, and (3) assess the evidence for informing risk management. Epidemiological evidence linking exposures to CxDBPs in drinking water to human bladder cancer risk provides insight into causality. However, because of imprecise, inaccurate, or incomplete estimation of CxDBPs levels in epidemiologic studies, translation from hazard identification directly to risk management and regulatory policy for CxDBPs can be challenging. Quantitative risk estimates derived from toxicological risk assessment for CxDBPs currently cannot be reconciled with those from epidemiologic studies, notwithstanding the complexities involved, making regulatory interpretation difficult. Evidence presented here has both strengths and limitations that require additional studies to resolve and improve the understanding of exposure response relationships. Replication of epidemiologic findings in independent populations with further elaboration of exposure assessment is needed to strengthen the knowledge base needed to better inform effective regulatory approaches.

  20. Histopathological, Molecular, and Genetic Profile of Hereditary Diffuse Gastric Cancer: Current Knowledge and Challenges for the Future.

    Science.gov (United States)

    van der Post, Rachel S; Gullo, Irene; Oliveira, Carla; Tang, Laura H; Grabsch, Heike I; O'Donovan, Maria; Fitzgerald, Rebecca C; van Krieken, Han; Carneiro, Fátima

    2016-01-01

    Familial clustering is seen in 10 % of gastric cancer cases and approximately 1-3 % of gastric cancer arises in the setting of hereditary diffuse gastric cancer (HDGC). In families with HDGC, gastric cancer presents at young age. HDGC is predominantly caused by germline mutations in CDH1 and in a minority by mutations in other genes, including CTNNA1. Early stage HDGC is characterized by a few, up to dozens of intramucosal foci of signet ring cell carcinoma and its precursor lesions. These include in situ signet ring cell carcinoma and pagetoid spread of signet ring cells. Advanced HDGC presents as poorly cohesive/diffuse type carcinoma, normally with very few typical signet ring cells, and has a poor prognosis. Currently, it is unknown which factors drive the progression towards aggressive disease, but it is clear that most intramucosal lesions will not have such progression.Immunohistochemical profile of early and advanced HDGC is often characterized by abnormal E-cadherin immunoexpression, including absent or reduced membranous expression, as well as "dotted" or cytoplasmic expression. However, membranous expression of E-cadherin does not exclude HDGC. Intramucosal HDGC (pT1a) presents with an "indolent" phenotype, characterized by typical signet ring cells without immunoexpression of Ki-67 and p53, while advanced carcinomas (pT > 1) display an "aggressive" phenotype with pleomorphic cells, that are immunoreactive for Ki-67 and p53. These features show that the IHC profile is different between intramucosal and more advanced HDGC, providing evidence of phenotypic heterogeneity, and may help to define predictive biomarkers of progression from indolent to aggressive, widely invasive carcinomas.

  1. Association of Smokeless Tobacco with Oral Cancer - Evidence From the South Asian Studies: A Systematic Review.

    Science.gov (United States)

    Awan, Kamran Habib; Patil, Shankargouda

    2016-09-01

    Smokeless tobacco (SLT) is associated with many heath hazards including oral cancer. Its use is more common in South Asian countries. The current paper aims to systematically review the South Asian studies to assess the association of SLT and oral cancer. Detailed automated literature searches of PubMed, Medline, EMBASE and ISI Web of Science from January 1980 to July 2015 were conducted using the key words "oral cancer", "oral precancer", "oral premalignant lesions", "oral squamous cell carcinoma", "smokeless tobacco", "betel quid", "areca nut", "Gutkha" in various combinations. Letters to the editor, review articles, and case-reports were excluded. Atotal of 21 studies were included. Three studies were of cohort design while the remaining were of case-control design. Nine studies reported betel quid as a risk factor for oral cancer, while fifteen studies reported data on other types of chewing tobacco. The odds ratio (OR) for betel quid and risk of oral cancer varied from 3.1 to 15.7 (11.0-22.1); and for chewable tobacco and risk of oral cancer varied from 1.2 (1.0-1.4) to 12.9 (7.5-22.3). Astrong association between different types of SLTand oral cancer was observed. Well-structured programmes should be employed in South Asian region, both in terms of educating the general public about the health hazards of SLTas well as providing cessation assistance. PMID:27671184

  2. Concurrent chemo-radiotherapy in the treatment of early breast cancer: Current status

    Directory of Open Access Journals (Sweden)

    Nabil Ismaili

    2013-01-01

    Full Text Available Concurrent chemo-radiotherapy (CCRT in early breast cancer was investigated by few authors and remains controversial. This treatment is more commonly used for locally advanced breast cancer and showed high rate of complete pathological response. A search of articles published in English literature, between 1980 and November 2012, was conducted on Medline using the following terms: "breast cancer", "chemotherapy", "concurrent radiotherapy", and "Trastuzumab". We identified five phase I/II trials and three randomized phase three trials evaluating concurrent chemoradiotherapy in the adjuvant of breast cancer. In patients with early breast cancer having positive lymph nodes, phases III clinical trials showed that CCRT improved local control after conservative breast surgery. However, these randomized trials used non-standard regimen: Cyclophosphamide, methotrexate and fluorouracil (CMF or fluorouracil, mitoxantrone and cyclophosphamide (FNC. In addition, in phases II clinical trials, concurrent use of taxanes and anthracycline with standard whole-breast irradiation showed high rate of toxicity: Pulmonary toxicity with taxane; and cardiac and skin toxicity with anthracycline. Consequentely, CCRT is not be used in practice because of concerns of toxicity with the standard drugs (anthracyclines and taxanes and radiation. Anthracyclines with partial breast irradiation (PBI was feasible according to one phase I clinical trial, and should be investigated in randomized clinical trials. Concurrent Trastuzumab plus radiotherapy is safe and can be used in HER2-positive breast cancer; in this case, cardiac volume sparing and patient selections for internal mammary chain irradiation are highly recommended. The present paper aimed to review the current data evaluating the efficacy and safety of CCRT in early breast cancer.

  3. Current dichotomy between traditional molecular biological and omic research in cancer biology and pharmacology.

    Science.gov (United States)

    Reinhold, William C

    2015-12-10

    There is currently a split within the cancer research community between traditional molecular biological hypothesis-driven and the more recent "omic" forms or research. While the molecular biological approach employs the tried and true single alteration-single response formulations of experimentation, the omic employs broad-based assay or sample collection approaches that generate large volumes of data. How to integrate the benefits of these two approaches in an efficient and productive fashion remains an outstanding issue. Ideally, one would merge the understandability, exactness, simplicity, and testability of the molecular biological approach, with the larger amounts of data, simultaneous consideration of multiple alterations, consideration of genes both of known interest along with the novel, cross-sample comparisons among cell lines and patient samples, and consideration of directed questions while simultaneously gaining exposure to the novel provided by the omic approach. While at the current time integration of the two disciplines remains problematic, attempts to do so are ongoing, and will be necessary for the understanding of the large cell line screens including the Developmental Therapeutics Program's NCI-60, the Broad Institute's Cancer Cell Line Encyclopedia, and the Wellcome Trust Sanger Institute's Cancer Genome Project, as well as the the Cancer Genome Atlas clinical samples project. Going forward there is significant benefit to be had from the integration of the molecular biological and the omic forms or research, with the desired goal being improved translational understanding and application. PMID:26677427

  4. Targeted therapies with companion diagnostics in the management of breast cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    Myers MB

    2016-01-01

    Full Text Available Meagan B Myers Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA Abstract: Breast cancer is a multifaceted disease exhibiting both intertumoral and intratumoral heterogeneity as well as variable disease course. Over 2 decades of research has advanced the understanding of the molecular substructure of breast cancer, directing the development of new therapeutic strategies against these actionable targets. In vitro diagnostics, and specifically companion diagnostics, have been integral in the successful development and implementation of these targeted therapies, such as those directed against the human epidermal growth factor receptor 2. Lately, there has been a surge in the development, commercialization, and marketing of diagnostic assays to assist in breast cancer patient care. More recently, multigene signature assays, such as Oncotype DX, MammaPrint, and Prosigna, have been integrated in the clinical setting in order to tailor decisions on adjuvant endocrine and chemotherapy treatment. This review provides an overview of the current state of breast cancer management and the use of companion diagnostics to direct personalized approaches in the treatment of breast cancer. Keywords: HER2, precision medicine, in vitro diagnostics, estrogen receptor, multigene assay

  5. Coffee consumption and the risk of endometrial cancer: Evidence from a case-control study of female hormone-related cancers in Japan.

    Science.gov (United States)

    Hirose, Kaoru; Niwa, Yoshimitsu; Wakai, Kenji; Matsuo, Keitaro; Nakanishi, Toru; Tajima, Kazuo

    2007-03-01

    Coffee has become a popular beverage worldwide. Caffeine, a major ingredient of coffee, has been proposed to have a favorable affect on the modulation of circulating estrogen levels and therefore may be of importance in developments on hormone-related cancers. However, epidemiological evidence is limited and inconsistent. We examined the relationship between intake of coffee and hormone-related cancer risk among Japanese women using data from the hospital-based epidemiological research program at Aichi Cancer Center (HERPACC). In total, 2122 breast, 229 endometrial and 166 ovarian cancer cases were included, and 12 425 women, confirmed as free of cancer, were recruited as the control group. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined by multiple logistic regression analysis. A statistically significant inverse association between risk of endometrial cancer and coffee consumption was noted in Japanese women, with no clear association evident for breast and ovarian cancer risk. Compared to non-drinker, the OR of daily drinking of 1-2 cups and 3 or more cups per day for endometrial cancer were 0.64 (95% CI: 0.43-0.94) and 0.41 (95% CI: 0.19-0.87), respectively, and the linear trend was also statistically significant (P cancer. In summary, the results of the present study suggest that coffee consumption reduces the risk of endometrial cancer in Japanese subjects. Given the scarcity of studies of coffee intake and endometrial cancer and other hormone-dependent cancer risk, additional investigations are warranted. PMID:17270030

  6. Current developments of coumarin-based anti-cancer agents in medicinal chemistry.

    Science.gov (United States)

    Emami, Saeed; Dadashpour, Sakineh

    2015-09-18

    Cancer is one of the leading health hazards and the prominent cause of death in the world. A number of anticancer agents are currently in clinical practice and used for treatment of various kinds of cancers. There is no doubt that the existing arsenal of anticancer agents is insufficient due to the high incidence of side effects and multidrug resistance. In the efforts to develop suitable anticancer drugs, medicinal chemists have focused on coumarin derivatives. Coumarin is a naturally occurring compound and a versatile synthetic scaffold possessing wide spectrum of biological effects including potential anticancer activity. This review article covers the current developments of coumarin-based anticancer agents and also discusses the structure-activity relationship of the most potent compounds. PMID:26318068

  7. Current developments of coumarin-based anti-cancer agents in medicinal chemistry.

    Science.gov (United States)

    Emami, Saeed; Dadashpour, Sakineh

    2015-09-18

    Cancer is one of the leading health hazards and the prominent cause of death in the world. A number of anticancer agents are currently in clinical practice and used for treatment of various kinds of cancers. There is no doubt that the existing arsenal of anticancer agents is insufficient due to the high incidence of side effects and multidrug resistance. In the efforts to develop suitable anticancer drugs, medicinal chemists have focused on coumarin derivatives. Coumarin is a naturally occurring compound and a versatile synthetic scaffold possessing wide spectrum of biological effects including potential anticancer activity. This review article covers the current developments of coumarin-based anticancer agents and also discusses the structure-activity relationship of the most potent compounds.

  8. [Current situation and outlook of transanal total mesorectum excision in rectal cancer].

    Science.gov (United States)

    Kang, Liang; Wang, Jianping

    2016-08-25

    Since the characteristics of metastasis and invasion of rectal cancer are confirmed gradually, the aim of surgical treatment in rectal cancer is to protect anal and reproductive function, and to minimize the damage of patients. With prominent advantages of identified lower tumor resection margin, enough circumference resection margin, more minimally invasive procedure and faster recovery, transanal total mesorectal excision(taTME) integrated with natural canal theory, transanal minimally invasive technique and TME can effectively solve the difficulties of transabdominal procedure and becomes the research hotspot in rectal cancer surgery worldwide. Though taTME is still at the initial stage and has certain problems, such as the definition of operational procedure, careful performance of standard operation, further summary of operational detail and skill, observation of long-term efficacy and optimization design of operational instruments, it will be supported by high-level evidence based on increasing cases, maturation of procedure, and clinical multicenter cohort researches. TaTME has a good application prospect and may become one of the main procedures of colorectal surgery to treat the middle or low rectal cancer. PMID:27545460

  9. Current status of treatment of metastatic colorectal cancer with special reference to cetuximab and elderly patients

    Directory of Open Access Journals (Sweden)

    Per Pfeiffer

    2008-12-01

    Full Text Available Per Pfeiffer, Camilla Qvortrup, Jon K BjerregaardDepartment of Oncology, Odense University Hospital. Institute of Clinical Research, University of Southern Denmark. Odense C, DenmarkPurpose: Elderly cancer patients often have co-morbidities and other characteristics that make the selection of optimal treatment more complex. The introduction of targeted therapies in colorectal cancer has further complicated this problem. This review will focus on the role of the EGFR antibody cetuximab in elderly patients.Methods: We have reviewed the available evidence in the literature to evaluate the results of therapy with cetuximab, alone or in combination with chemotherapy, with a focus on elderly patients with metastatic colorectal cancer (mCRC.Results: In patients with mCRC, combination chemotherapy prolongs median survival to more than 18 months and even around 24 months in combination with cetuximab in selected patients. No prospective studies have evaluated cetuximab in elderly patients. However, subgroup analyses from randomized trials and retrospective analysis suggest that the efficacy of chemotherapy and cetuximab is maintained in fit elderly patients, but with slightly increased but acceptable toxicity.Conclusion: No prospective cetuximab studies have been conducted solely in a population of elderly patients. However, available data suggest that outcomes in the fit elderly mirror results observed in younger patients.Keywords: metastatic colorectal cancer, cetuximab, elderly patients

  10. Developing national guidance on genetic testing for breast cancer predisposition: the role of economic evidence?

    NARCIS (Netherlands)

    Sullivan, W.; Evans, D.G.; Newman, W.G.; Ramsden, S.C.; Scheffer, H.; Payne, K.

    2012-01-01

    Advancements in genetic testing to identify predisposition for hereditary breast cancer (HBC) mean that it is important to understand the incremental costs and benefits of the new technologies compared with current testing strategies. This study aimed to (1) identify and critically appraise existing

  11. Neo-adjuvant chemo(radio)therapy in gastric cancer: Current status and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Alberto; Biondi; Maria; C; Lirosi; Domenico; D’Ugo; Valeria; Fico; Riccardo; Ricci; Francesco; Santullo; Antonia; Rizzuto; Ferdinando; CM; Cananzi; Roberto; Persiani

    2015-01-01

    In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.

  12. Interprofessional collaborative practice within cancer teams: Translating evidence into action. A mixed methods study protocol

    Directory of Open Access Journals (Sweden)

    Roberge Danièle

    2010-07-01

    Full Text Available Abstract Background A regional integrated cancer network has implemented a program (educational workshops, reflective and mentoring activities designed to support the uptake of evidence-informed interprofessional collaborative practices (referred to in this text as EIPCP within cancer teams. This research project, which relates to the Registered Nurses' Association of Ontario (RNAO Best Practice Guidelines and other sources of research evidence, represents a unique opportunity to learn more about the factors and processes involved in the translation of evidence-based recommendations into professional practices. The planned study seeks to address context-specific challenges and the concerns of nurses and other stakeholders regarding the uptake of evidence-based recommendations to effectively promote and support interprofessional collaborative practices. Aim This study aims to examine the uptake of evidence-based recommendations from best practice guidelines intended to enhance interprofessional collaborative practices within cancer teams. Design The planned study constitutes a practical trial, defined as a trial designed to provide comprehensive information that is grounded in real-world healthcare dynamics. An exploratory mixed methods study design will be used. It will involve collecting quantitative data to assess professionals' knowledge and attitudes, as well as practice environment factors associated with effective uptake of evidence-based recommendations. Semi-structured interviews will be conducted concurrently with care providers to gather qualitative data for describing the processes involved in the translation of evidence into action from both the users' (n = 12 and providers' (n = 24 perspectives. The Graham et al. Ottawa Model of Research Use will serve to construct operational definitions of concepts, and to establish the initial coding labels to be used in the thematic analysis of the qualitative data. Quantitative and qualitative

  13. Management of urogenital atrophy in breast cancer patients: a systematic review of available evidence from randomized trials.

    Science.gov (United States)

    Mazzarello, Sasha; Hutton, Brian; Ibrahim, Mohammed F K; Jacobs, Carmel; Shorr, Risa; Smith, Stephanie; Ng, Terry; Clemons, Mark

    2015-07-01

    Symptoms of urogenital atrophy are common in breast cancer survivors. Its optimal management is currently unknown. A systematic review of randomized controlled trials (RCTs) evaluating treatments for urogenital atrophy in breast cancer patients was performed. EMBASE, Ovid Medline and the Cochrane Library were searched from 1946 to November 2014. Outcomes included improvements in both vaginal symptoms (e.g., dryness, pain, dyspareunia and itching) and vaginal hormone response measured by validated scales [e.g., Vaginal Health Index (VHI) and Vaginal Maturation Index (VMI)]. Of 430 unique citations identified, 4 studies (n = 196) met inclusion criteria. Interventions included pH-balanced gel, Replens(®), lidocaine, Estring(®) and Vagifem(®). Sample sizes ranged from 7 to 98 patients. Given the heterogeneity of the studies, a narrative synthesis of results was performed. One study of 98 patients suggested that vaginal pH-balanced gel (mean VHI 5.00 ± 0.816, mean VMI 51.18 ± 3.753) was more efficient than placebo (VHI 16.98 ± 3.875, p VMI 47.87 ± 2.728, p VMI in a study of seven patients. Treatment of urogenital atrophy remains a challenging issue and there is a paucity of RCT evidence addressing this knowledge gap. It is evident that more prospective trials are needed. PMID:26003182

  14. Experimental Evidence of Persistent Androgen-Receptor-Dependency in Castration-Resistant Prostate Cancer

    OpenAIRE

    Osamu Ogawa; Tomomi Kamba; Takahiro Inoue; Takashi Kobayashi

    2013-01-01

    In the majority of castration-resistant prostate cancer (CRPC), prostate-specific antigen (PSA), product of a gene that is almost exclusively regulated by the androgen receptor (AR), still acts as a serum marker reflecting disease burden, indicating that AR signaling is activated even under castrate level of serum androgen. Accumulated evidence shows that transcriptional ability of AR is activated both in ligand-dependent and -independent manners in CRPC cells. Some androgen-independent subli...

  15. Aspirin Use and Lung Cancer Risk: A Possible Relationship? Evidence from an Updated Meta-Analysis

    OpenAIRE

    Hai-yan Jiang; Tian-bao Huang; Lei Xu; Jing Yu; Yan Wu; Jiang Geng; Xu-dong Yao

    2015-01-01

    Background and Purpose Growing evidence has emerged and controversial results reported on possible relationship between aspirin use and lung cancer risk. We, therefore, conducted this updated and comprehensive meta-analysis to evaluate this issue, with focus on dose-risk and duration-risk relationships. Methods We searched electronic databases including PUBMED, EMBASE and Cochrane library to identify eligible studies. Relative risk (RR) and its 95% confidence interval (CI) were used for cohor...

  16. Current Evidence for Developmental, Structural, and Functional Brain Defects following Prenatal Radiation Exposure

    Directory of Open Access Journals (Sweden)

    Tine Verreet

    2016-01-01

    Full Text Available Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic and man-made radiation sources, including those from industry but especially from the medical sector. The increasing use of medical radiation modalities, in particular those employing low-dose radiation such as CT scans, raises concerns regarding the effects of cumulative exposure doses and the inappropriate utilization of these imaging techniques. One of the major goals in the radioprotection field is to better understand the potential health risk posed to the unborn child after radiation exposure to the pregnant mother, of which the first convincing evidence came from epidemiological studies on in utero exposed atomic bomb survivors. In the following years, animal models have proven to be an essential tool to further characterize brain developmental defects and consequent functional deficits. However, the identification of a possible dose threshold is far from complete and a sound link between early defects and persistent anomalies has not yet been established. This review provides an overview of the current knowledge on brain developmental and persistent defects resulting from in utero radiation exposure and addresses the many questions that still remain to be answered.

  17. Current Evidence for Developmental, Structural, and Functional Brain Defects following Prenatal Radiation Exposure

    Science.gov (United States)

    Verreet, Tine; Quintens, Roel; Baatout, Sarah; Benotmane, Mohammed A.

    2016-01-01

    Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic) and man-made radiation sources, including those from industry but especially from the medical sector. The increasing use of medical radiation modalities, in particular those employing low-dose radiation such as CT scans, raises concerns regarding the effects of cumulative exposure doses and the inappropriate utilization of these imaging techniques. One of the major goals in the radioprotection field is to better understand the potential health risk posed to the unborn child after radiation exposure to the pregnant mother, of which the first convincing evidence came from epidemiological studies on in utero exposed atomic bomb survivors. In the following years, animal models have proven to be an essential tool to further characterize brain developmental defects and consequent functional deficits. However, the identification of a possible dose threshold is far from complete and a sound link between early defects and persistent anomalies has not yet been established. This review provides an overview of the current knowledge on brain developmental and persistent defects resulting from in utero radiation exposure and addresses the many questions that still remain to be answered. PMID:27382490

  18. Evidence for improvement of critical current by Ag in YBaCuO-Ag thick films

    Science.gov (United States)

    Dwir, B.; Kellett, B.; Mieville, L.; Pavuna, D.

    1991-04-01

    The evidence is reported for enhancement of critical current density J(c) in YBa2Cu3O(7-delta) thick films with the addition of Ag, which is correlated with improvements in structural properties. An improvement of 50 percent in J(c) (up to about 500 A/sq cm at T = 4.2 K) was obtained in films made from YBCO + 60 wt pct Ag powder, fabricated by the spin-on technique on (100) SrTiO3, which is correlated with improvements in structure. The resulting films are 10 microns thick, uniform, partially textured, and show good adherence. The critical temperature Tc is improved by the addition of Ag, and a reduction in the density of microcracks and in the amount of secondary phases in the sintered films was observed. Normal-state resistivity is reduced by almost three orders of magnitude, making these films potentially useful for electronic applications in interconnects and novel hybrid circuits.

  19. Evidence for improvement of critical current by Ag in YBaCuO-Ag thick films

    Energy Technology Data Exchange (ETDEWEB)

    Dwir, B.; Kellett, B.; Mieville, L.; Pavuna, D. (Institute of Micro- and Opto-electronics, Department of Physics, Swiss Federal Institute of Technology, CH-1015 Lausanne, Switzerland (CH))

    1991-04-15

    The evidence is reported for enhancement of critical current density {ital J}{sub {ital c}} in YBa{sub 2}Cu{sub 3}O{sub 7{minus}{delta}} thick films with the addition of Ag, which is correlated with improvements in structural properties. An improvement of 50% in {ital J}{sub {ital c}} (up to {similar to}500 A/cm{sup 2} at {ital T}=4.2 K) was obtained in films made from YBCO+60wt % Ag powder, fabricated by the spin-on technique on (100) SrTiO{sub 3}, which is correlated with improvements in structure. The resulting films are 10 {mu}m thick, uniform, partially textured, and show good adherence. The critical temperature {ital T}{sub {ital c}} is improved by the addition of Ag, and a reduction in the density of microcracks and in the amount of secondary phases in the sintered films was observed. Normal-state resistivity is reduced by almost three orders of magnitude, making these films potentially useful for electronic applications in interconnects and novel hybrid circuits.

  20. Current Evidence for Developmental, Structural, and Functional Brain Defects following Prenatal Radiation Exposure.

    Science.gov (United States)

    Verreet, Tine; Verslegers, Mieke; Quintens, Roel; Baatout, Sarah; Benotmane, Mohammed A

    2016-01-01

    Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic) and man-made radiation sources, including those from industry but especially from the medical sector. The increasing use of medical radiation modalities, in particular those employing low-dose radiation such as CT scans, raises concerns regarding the effects of cumulative exposure doses and the inappropriate utilization of these imaging techniques. One of the major goals in the radioprotection field is to better understand the potential health risk posed to the unborn child after radiation exposure to the pregnant mother, of which the first convincing evidence came from epidemiological studies on in utero exposed atomic bomb survivors. In the following years, animal models have proven to be an essential tool to further characterize brain developmental defects and consequent functional deficits. However, the identification of a possible dose threshold is far from complete and a sound link between early defects and persistent anomalies has not yet been established. This review provides an overview of the current knowledge on brain developmental and persistent defects resulting from in utero radiation exposure and addresses the many questions that still remain to be answered. PMID:27382490

  1. Twenty-Four-Hour Ambulatory Pulse Wave Analysis in Hypertension Management: Current Evidence and Perspectives.

    Science.gov (United States)

    Omboni, Stefano; Posokhov, Igor N; Kotovskaya, Yulia V; Protogerou, Athanase D; Blacher, Jacques

    2016-10-01

    The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. This allowed to make appropriate recommendations in clinical practice guidelines of several scientific societies. Due to advances in technologies, largely operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions, over the 24 h. According to the acceptable accuracy and reproducibility of 24-h ambulatory PWA, it appears to be a promising tool for evaluating vascular biomarkers in daily life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, concerning the clinical use of PWA over the 24 h in ambulatory conditions at the moment, there is no sufficient evidence to support its routine clinical use. In particular, long-term outcome studies are needed to show the predictive value of 24-h PWV, CAP, and AIx values, provided by these devices, over and beyond peripheral blood pressure, and to answer the many technical and clinical questions still open. To this regard, the VASOTENS Registry, an international observational prospective study recently started, will help providing answers on a large sample of hypertensive patients recruited worldwide. PMID:27659178

  2. Remote ischaemic conditioning and remodelling following myocardial infarction: current evidence and future perspectives.

    Science.gov (United States)

    Vanezis, A P; Rodrigo, G C; Squire, I B; Samani, N J

    2016-09-01

    Remote ischaemic conditioning (rIC) has demonstrated its effectiveness as a powerful cardioprotective tool in number of preclinical and limited clinical settings. More recently, ischaemic postconditioning given after an ischaemic event such as a myocardial infarction (MI) has shown not only to reduce infarct size but also to have beneficial effects on acute remodelling post-MI and to reduce the burden of heart failure and other detrimental outcomes. Building on this platform, repeated rIC over a number of days has the potential to augment the protective process even further. This review considers the current evidence base from which the concept of rIC in the setting of post-MI remodelling has grown. It also discusses the ongoing and planned clinical trials which are attempting to elucidate whether the protection imparted by rIC in the preclinical setting can be translated to the clinic and become a realistic weapon in the clinician's armoury to tackle acute remodelling and heart failure post-MI. PMID:27177446

  3. Incretin-based therapies in prediabetes: Current evidence and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Georgios; S; Papaetis

    2014-01-01

    The prevalence of type 2 diabetes(T2D) is evolving globally at an alarming rate. Prediabetes is an intermediate state of glucose metabolism that exists between normal glucose tolerance(NGT) and the clinical entity of T2 D. Relentless β-cell decline and failure is responsible for the progression from NGT to prediabetes and eventually T2 D. The huge burden resulting from the complications of T2 D created the need of therapeutic strategies in an effort to prevent or delay its development. The beneficial effects of incretin-based therapies, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1(GLP-1) receptor agonists, on β-cell function in patients with T2 D, together with their strictly glucose-depended mechanism of action, suggested their possible use in individuals with prediabetes when greater β-cell mass and function are preserved and the possibility of β-cell salvage is higher. The present paper summarizes the main molecular intracellular mechanisms through which GLP-1 exerts its activity on β-cells. It also explores the current evidence of incretin based therapies when administered in a prediabetic state, both in animal models and in humans. Finally it discusses the safety of incretin-based therapies as well as their possible role in order to delay or prevent T2 D.

  4. Screening women at high risk of breast cancer on the basis of evidence

    International Nuclear Information System (INIS)

    Geneticists are able to identify the risk of breast cancer. Strategies on offer include prevention, early diagnosis by screening, and prophylactic surgery. This paper analyses the evidence for offering screening. The radiation dose of mammography has been measured, but the risk is not fully known. Mammography screening of women of 40-50 years in the normal population has known effect. Little evidence is available for women under 40 years or for women with genetic susceptibility to breast cancer. Dense parenchymal pattern is associated with high grade cancers, and is both a risk factor and a reason for impaired screening sensitivity. Whether this applies to younger women or women at high risk is speculative. The pathological features of the cancers in gene carriers show differences from those occurring in normal women. This work should be correlated with imaging features. There is no literature to support the use of newer imaging methods in these women. Ultrasound and MRI avoid radiation and may be useful in dense breasts. SestaMIBI and PET scanning are not yet mature enough for screening, and may never have such a role. Any newer modality must be subjected to a formal randomised trial before being offered to screen women at high risk

  5. Current Perspectives on Percutaneous Vertebroplasty: Current Evidence/Controversies, Patient Selection and Assessment, and Technique and Complications

    Directory of Open Access Journals (Sweden)

    Robert James Nairn

    2011-01-01

    Full Text Available Osteoporotic-associated vertebral compression fractures are a major public health concern, dwarfing even hip fractures in incidence in the United States. These fractures carry a significant morbidity and mortality burden and also represent a major growing source of consumption of scarce heath resources. Percutaneous vertebroplasty remains a commonly used and safe technique for the symptomatic treatment of vertebral compression fractures, both osteoporotic- and neoplastic-induced. By carefully selecting appropriate patients who are referred promptly, vertebroplasty can provide significant and durable pain relief over traditional conservative therapy. Recent controversies surrounding the evidence for vertebroplasty in osteoporotic-associated vertebral compression fractures are reviewed. A comprehensive step-by-step practical guide to performing vertebroplasty is then described. A brief description of patient selection, workup, as well as complications is also provided.

  6. Cancer Stem Cells in Pancreatic Cancer

    International Nuclear Information System (INIS)

    Pancreatic cancer is an aggressive malignant solid tumor well-known by early metastasis, local invasion, resistance to standard chemo- and radiotherapy and poor prognosis. Increasing evidence indicates that pancreatic cancer is initiated and propagated by cancer stem cells (CSCs). Here we review the current research results regarding CSCs in pancreatic cancer and discuss the different markers identifying pancreatic CSCs. This review will focus on metastasis, microRNA regulation and anti-CSC therapy in pancreatic cancer

  7. Vitamin D and Breast Cancer

    OpenAIRE

    Shao, Theresa; Klein, Paula; Grossbard, Michael L.

    2012-01-01

    Vitamin D metabolism and its mechanism of action, the current evidence on the relationship between vitamin D and breast cancer, and the optimal dosing of vitamin D for breast cancer prevention are summarized.

  8. Trichloroethylene and Cancer: Systematic and Quantitative Review of Epidemiologic Evidence for Identifying Hazards

    Directory of Open Access Journals (Sweden)

    Cheryl Siegel Scott

    2011-11-01

    Full Text Available We conducted a meta-analysis focusing on studies with high potential for trichloroethylene (TCE exposure to provide quantitative evaluations of the evidence for associations between TCE exposure and kidney, liver, and non-Hodgkin lymphoma (NHL cancers. A systematic review documenting essential design features, exposure assessment approaches, statistical analyses, and potential sources of confounding and bias identified twenty-four cohort and case-control studies on TCE and the three cancers of interest with high potential for exposure, including five recently published case-control studies of kidney cancer or NHL. Fixed- and random-effects models were fitted to the data on overall exposure and on the highest exposure group. Sensitivity analyses examined the influence of individual studies and of alternative risk estimate selections. For overall TCE exposure and kidney cancer, the summary relative risk (RRm estimate from the random effects model was 1.27 (95% CI: 1.13, 1.43, with a higher RRm for the highest exposure groups (1.58, 95% CI: 1.28, 1.96. The RRm estimates were not overly sensitive to alternative risk estimate selections or to removal of an individual study. There was no apparent heterogeneity or publication bias. For NHL, RRm estimates for overall exposure and for the highest exposure group, respectively, were 1.23 (95% CI: 1.07, 1.42 and 1.43 (95% CI: 1.13, 1.82 and, for liver cancer, 1.29 (95% CI: 1.07, 1.56 and 1.28 (95% CI: 0.93, 1.77. Our findings provide strong support for a causal association between TCE exposure and kidney cancer. The support is strong but less robust for NHL, where issues of study heterogeneity, potential publication bias, and weaker exposure-response results contribute uncertainty, and more limited for liver cancer, where only cohort studies with small numbers of cases were available.

  9. Current Hypothesis for the Relationship between Dietary Rice Bran Intake, the Intestinal Microbiota and Colorectal Cancer Prevention.

    Science.gov (United States)

    So, Winnie K W; Law, Bernard M H; Law, Patrick T W; Chan, Carmen W H; Chair, Sek Ying

    2016-01-01

    Globally, colorectal cancer (CRC) is the third most common form of cancer. The development of effective chemopreventive strategies to reduce CRC incidence is therefore of paramount importance. Over the past decade, research has indicated the potential of rice bran, a byproduct of rice milling, in CRC chemoprevention. This was recently suggested to be partly attributable to modification in the composition of intestinal microbiota when rice bran was ingested. Indeed, previous studies have reported changes in the population size of certain bacterial species, or microbial dysbiosis, in the intestines of CRC patients and animal models. Rice bran intake was shown to reverse such changes through the manipulation of the population of health-promoting bacteria in the intestine. The present review first provides an overview of evidence on the link between microbial dysbiosis and CRC carcinogenesis and describes the molecular events associated with that link. Thereafter, there is a summary of current data on the effect of rice bran intake on the composition of intestinal microbiota in human and animal models. The article also highlights the need for further studies on the inter-relationship between rice bran intake, the composition of intestinal microbiota and CRC prevention. PMID:27649240

  10. Current Hypothesis for the Relationship between Dietary Rice Bran Intake, the Intestinal Microbiota and Colorectal Cancer Prevention

    Directory of Open Access Journals (Sweden)

    Winnie K. W. So

    2016-09-01

    Full Text Available Globally, colorectal cancer (CRC is the third most common form of cancer. The development of effective chemopreventive strategies to reduce CRC incidence is therefore of paramount importance. Over the past decade, research has indicated the potential of rice bran, a byproduct of rice milling, in CRC chemoprevention. This was recently suggested to be partly attributable to modification in the composition of intestinal microbiota when rice bran was ingested. Indeed, previous studies have reported changes in the population size of certain bacterial species, or microbial dysbiosis, in the intestines of CRC patients and animal models. Rice bran intake was shown to reverse such changes through the manipulation of the population of health-promoting bacteria in the intestine. The present review first provides an overview of evidence on the link between microbial dysbiosis and CRC carcinogenesis and describes the molecular events associated with that link. Thereafter, there is a summary of current data on the effect of rice bran intake on the composition of intestinal microbiota in human and animal models. The article also highlights the need for further studies on the inter-relationship between rice bran intake, the composition of intestinal microbiota and CRC prevention.

  11. Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future Directions

    Directory of Open Access Journals (Sweden)

    A. Sarvazyan

    2008-01-01

    Full Text Available Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicine in developing countries is inadequate for the majority of the population. There is a tremendous worldwide need to detect breast cancer at its earliest stage. These needs must be balanced by the ability of countries to provide breast cancer screening technology to their populations. We reviewed the diagnostic accuracy, procedure cost and cost-effectiveness of currently available technique for breast screening and diagnosis including clinical breast examination, mammography, ultrasound, magnetic resonance imaging, biopsy and a new modality for cancer diagnostics termed elasticity imaging that has emerged in the last decade. Clinical results demonstrate that elasticity imaging even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques. In view of many countries with limited resources, effective yet less expensive modes of screening must be considered worldwide. The tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.

  12. PI3K and Akt as molecular targets for cancer therapy: current clinical outcomes

    Institute of Scientific and Technical Information of China (English)

    Ipsita PAL; Mahitosh MANDAL

    2012-01-01

    The PI3K-Akt pathway is a vital regulator of cell proliferation and survival.Alterations in the PIK3CA gene that lead to enhanced PI3K kinase activity have been reported in many human cancer types,including cancers of the colon,breast,brain,liver,stomach and lung.Deregulation of PI3K causes aberrant Akt activity.Therefore targeting this pathway could have implications for cancer treatment.The first generation PI3K-Akt inhibitors were proven to be highly effective with a low IC50,but later,they were shown to have toxic side effects and poor pharmacological properties and selectivity.Thus,these inhibitors were only effective in preclinical models.However,derivatives of these first generation inhibitors are much more selective and are quite effective in targeting the PI3K-Akt pathway,either alone or in combination.These second-generation inhibitors are essentially a specific chemical moiety that helps to form a strong hydrogen bond interaction with the PI3K/Akt molecule.The goal of this review is to delineate the current efforts that have been undertaken to inhibit the various components of the PI3K and Akt pathway in different types of cancer both in vitro and in vivo.Our focus here is on these novel therapies and their inhibitory effects that depend upon their chemical nature,as well as their development towards clinical trials.

  13. Lymph node-positive prostate cancer: current issues, emerging technology and impact on clinical outcome.

    Science.gov (United States)

    Adams, Julia; Cheng, Liang

    2011-09-01

    Lymph node metastasis in patients with prostate cancer indicates a poorer prognosis compared with patients without lymph node metastasis; however, some patients with node-positive disease have long-term survival. Many studies have attempted to discern what characteristics of lymph node metastasis are prognostically significant. These characteristics include nodal tumor volume, number of positive lymph nodes, lymph node density, extranodal extension, lymphovascular invasion and tumor dedifferentiation. Favorable characteristics of regional lymph node involvement included a smaller tumor size and smaller tumor volume. However, the current staging system for prostate cancer does not provide different subclassifications for patients with node-positive prostate cancer. In recent years numerous advanced technologies for the detection of lymph node metastasis have been developed, including molecular imaging techniques and the CellSearch Circulating Tumor Cell System. With the increased detection of patients with prostate cancer, emergence of new technology to identify lymph node metastasis and the number of radical prostatectomies being performed on the rise, subclassifying patients with lymph node-positive disease is imperative. Subclassification would provide a better picture of patient prognosis and allow for a better understanding of targeted therapies to treat patients with lymph node metastasis.

  14. Targeting PD-1/PD-L1 in lung cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    González-Cao M

    2015-07-01

    Full Text Available María González-Cao,1 Niki Karachaliou,1 Santiago Viteri,1 Daniela Morales-Espinosa,1 Cristina Teixidó,2 Jesús Sánchez Ruiz,3 Miquel Ángel Molina-Vila,2 Mariacarmela Santarpia,4 Rafael Rosell1,2,5,61Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Quirón Dexeus University Hospital, Barcelona, Spain; 2Pangaea Biotech SL, Barcelona, Spain; 3Centro Nacional de Investigación Oncología (CNIO, Madrid, Spain; 4Medical Oncology Unit, Human Pathology Department, University of Messina, Messina, Italy; 5Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Barcelona, Spain; 6Fundación Molecular Oncology Research, Barcelona, SpainAbstract: Increased understanding of tumor immunology has led to the development of effective immunotherapy treatments. One of the most important advances in this field has been due to pharmacological design of antibodies against immune checkpoint inhibitors. Anti-PD-1/PD-L1 antibodies are currently in advanced phases of clinical development for several tumors, including lung cancer. Results from Phase I–III trials with anti-PD-1/PD-L1 antibodies in non-small-cell lung cancer have demonstrated response rates of around 20% (range, 16%–50%. More importantly, responses are long-lasting (median duration of response, 18 months and fast (50% of responses are detected at time of first tumor evaluation with very low grade 3–4 toxicity (less than 5%. Recently, the anti-PD-1 antibody pembrolizumab received US Food and Drug Administration (FDA breakthrough therapy designation for treatment of non-small-cell lung cancer, supported by data from a Phase Ib trial. Another anti-PD-1 antibody, nivolumab, has also been approved for lung cancer based on survival advantage demonstrated in recently released data from a Phase III trial in squamous cell lung cancer.Keywords: immunotherapy, immunoncology

  15. EGFR Targeting in Hormone-Refractory Prostate Cancer: Current Appraisal and Prospects for Treatment

    Directory of Open Access Journals (Sweden)

    Gerard Milano

    2010-07-01

    Full Text Available The incidence of prostate cancer increases with age and because of its high prevalence this disease has become a major public health concern. Despite advances in our understanding of the biological mechanisms responsible for the development of this cancer, the transition to the hormone refractory stage (HRPC and metastatic progression pose real problems of clinical management. Currently, docetaxel chemotherapy has been shown to have a slight but significant impact on survival, though the gain in median survival is still less than three months. Research is therefore continuing to improve treatment outcomes. The progression of prostate cancer is accompanied by the overexpression of EGFR (epidermal growth factor receptor in a very large majority of cases, suggesting that this may play a mechanistic role. Unfortunately, although preclinical findings seem to be promising for therapies targeting the EGFR in HRPC, current clinical results are disappointing. These results should however encourage us to look for different ways of using anti-EGFR agents or combining them with other targeted therapies.

  16. From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening.

    Science.gov (United States)

    Rovito, Michael J; Manjelievskaia, Janna; Leone, James E; Lutz, Michael J; Nangia, Ajay

    2016-06-01

    In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a 'D' recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the 'D' grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a 'D' grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current 'D' grade for TCa screening (i.e. discourage the use of said service) should be changed to an 'I' statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value. PMID:27419037

  17. From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening.

    Science.gov (United States)

    Rovito, Michael J; Manjelievskaia, Janna; Leone, James E; Lutz, Michael J; Nangia, Ajay

    2016-06-01

    In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a 'D' recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the 'D' grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a 'D' grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current 'D' grade for TCa screening (i.e. discourage the use of said service) should be changed to an 'I' statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value.

  18. Cancer: A Problem of Developmental Biology; Scientific Evidence for Reprogramming and Differentiation Therapy.

    Science.gov (United States)

    Sell, Stewart; Nicolini, Andrea; Ferrari, Paola; Biava, Pier M

    2016-01-01

    Current medical literature acknowledges that embryonic micro-environment is able to suppress tumor development. Administering carcinogenic substances during organogenesis in fact leads to embryonic malformations, but not to offspring tumor growth. Once organogenesis has ended, administration of carcinogenic substances causes a rise in offspring tumor development. These data indicate that cancer can be considered a deviation in normal development, which can be regulated by factors of the embryonic microenvironment. Furthermore, it has been demonstrated that teratoma differentiates into normal tissues once it is implanted in the embryo. Recently, it has been shown that implanting a melanoma in Zebrafish embryo did not result in a tumor development; however, it did in the adult specimen. This demonstrates that cancer cells can differentiate into normal tissues when implanted in the embryo. In addition, it was demonstrated that other tumors can revert into a normal phenotype and/or differentiate into normal tissue when implanted in the embryo. These studies led some authors to define cancer as a problem of developmental biology and to predict the present concept of "cancer stem cells theory". In this review, we record the most important researches about the reprogramming and differentiation treatments of cancer cells to better clarify how the substances taken from developing embryo or other biological substances can induce differentiation of malignant cells. Lastly, a model of cancer has been proposed here, conceived by one of us, which is consistent with the reality, as demonstrated by a great number of researches. This model integrates the theory of the "maturation arrest" of cancer cells as conceived by B. Pierce with the theory which describes cancer as a process of deterministic chaos determined by genetic and/or epigenetic alterations in differentiated cells, which leads a normal cell to become cancerous. All the researches here described demonstrated that cancer

  19. Evidence-based patient choice: a prostate cancer decision aid in plain language

    Directory of Open Access Journals (Sweden)

    Ohene-Frempong Janet

    2005-06-01

    Full Text Available Abstract Background Decision aids (DA to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. Methods Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape. Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4 and survey of a new sample of men newly diagnosed with prostate cancer (n = 60, compared with historical controls (n = 184. Results A transparent description of the development process and design elements is reported. Formative evaluation among newly diagnosed prostate cancer patients found the DA to be clear and useful in reaching a decision. Newly diagnosed patients reported more discussions with doctors about treatment options, and showed increases in knowledge of side effects of radiation therapy. Conclusion The plain language DA presenting medical evidence in text and numerical formats appears acceptable and useful in decision-making about localized prostate cancer treatment. Further testing should evaluate the impact of all three media on decisions made and quality of life in the survivorship period, especially among very low literacy men.

  20. Evolution of an Evidence Collaboration: From Initial Goals to Current Initiatives.

    Science.gov (United States)

    Giambra, Barbara K; Clark, Eloise; Busch, Melida D; Gerhardt, Wendy Engstrom

    2015-01-01

    Best practices based on evidence are needed by every clinician to provide safe, effective, patient-centered care. Determining best practice for a given situation can be difficult. Ideally, the clinician understands how to critically appraise the relevant research, and integrates high-quality research with interdisciplinary clinical expertise and patient and family values and preferences to choose best care for an individual or family. At our organization, we are taking the integration of research, clinical expertise, and patient/family preferences and values to the next level by aligning the evidence work of multiple functional areas and disciplines to improve the safety and effectiveness of clinical practice. The Evidence Collaboration, an interdisciplinary community of practice, has evolved to meet the challenges of helping novices and experts of all disciplines identify, critically appraise, synthesize, and disseminate evidence to inform best practices for patients and families, staff, and institutional processes. By creating a common language for evidence work, resources such as the Let Evidence Guide Every New Decision system, and templates for dissemination, the Evidence Collaboration has moved the organizational culture toward one that encourages the use of evidence in all decisions. Our progress continues as we strive to include patients and families in the decisions about best practices based on evidence.

  1. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

  2. Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: a review of the evidence.

    OpenAIRE

    Latino-Martel, Paule; Cottet, Vanessa; Druesne Pecollo, Nathalie; Pierre, Fabrice; Touillaud, Marina; Touvier, Mathilde; Vasson, Marie-Paule; Deschasaux, Mélanie; Le Merdy, Julie; Barrandon, Emilie; Ancellin, Raphaëlle

    2016-01-01

    Purpose : Prevention is a priority in the fight against cancers, especially nutritional prevention. To update the levels of evidence of relationships between 10 nutritional factors and cancer risk, the scientific literature published from 2006 to 2014 was reviewed by an expert group.[br/] Methods : Data from 133 meta-analyses, pooled analyses or intervention trials were examined. Nearly 150 relationships between nutritional factors and cancer at various sites were evaluated.[br/] Result...

  3. Prostate cancer - evidence of exercise and nutrition trial (PrEvENT):Study protocol for a randomised controlled feasibility trial

    OpenAIRE

    Hackshaw-McGeagh, Lucy; Lane, J. Athene; Persad, Raj; Gillatt, David; Holly, Jeff M P; Koupparis, Anthony; Rowe, Edward; Johnston, Lyndsey; Cloete, Jenny; Shiridzinomwa, Constance; Abrams, Paul; Penfold, Chris M; Bahl, Amit; Oxley, Jon; Perks, Claire M.

    2016-01-01

    Background: A growing body of observational evidence suggests that nutritional and physical activity interventions are associated with beneficial outcomes for men with prostate cancer, including brisk walking, lycopene intake, increased fruit and vegetable intake and reduced dairy consumption. However, randomised controlled trial data are limited. The 'Prostate Cancer: Evidence of Exercise and Nutrition Trial' investigates the feasibility of recruiting and randomising men diagnosed with local...

  4. Current standards and new innovative approaches for treatment of pancreatic cancer.

    Science.gov (United States)

    Conroy, Thierry; Bachet, Jean-Baptiste; Ayav, Ahmet; Huguet, Florence; Lambert, Aurélien; Caramella, Caroline; Maréchal, Raphaël; Van Laethem, Jean-Luc; Ducreux, Michel

    2016-04-01

    Pancreatic adenocarcinoma remains a devastating disease with a 5-year survival rate not exceeding 6%. Treatment of this disease remains a major challenge. This article reviews the state-of-the-art in the management of this disease and the new innovative approaches that may help to accelerate progress in treating its victims. After careful pre-therapeutic evaluation, only 15-20% of patients diagnosed with a pancreatic cancer (PC) are eligible for upfront radical surgery. After R0 or R1 resection in such patients, evidence suggests a significantly positive impact on survival of adjuvant chemotherapy comprising 6 months of gemcitabine or fluorouracil/folinic acid. Delayed adjuvant chemoradiation is considered as an option in cases of positive margins. Borderline resectable pancreatic cancer (BRPC) is defined as a tumour involving the mesenteric vasculature to a limited extend. Resection of these tumours is technically feasible, yet runs the high risk of a R1 resection. Neoadjuvant treatment probably offers the best chance of achieving successful R0 resection and long-term survival, but the best treatment options should be determined in prospective randomised studies. Gemcitabine has for 15 years been the only validated therapy for advanced PC. Following decades of negative phase III studies, increasing evidence now suggests that further significant improvements to overall survival can be achieved via either Folfirinox or gemcitabine + nab-paclitaxel regimens. Progress in systemic therapy may improve the chances of resection in borderline resectable pancreatic cancer (BRPC) or locally advanced PC. This requires first enhancing knowledge of the genetic events driving carcinogenesis, which may then be translated into clinical studies. PMID:26851397

  5. Current advances in biomarkers for targeted therapy in triple-negative breast cancer

    Directory of Open Access Journals (Sweden)

    Fleisher B

    2016-10-01

    Full Text Available Brett Fleisher,1 Charlotte Clarke,2 Sihem Ait-Oudhia1 1Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, 2Department of Translational Research, UT MD Anderson Cancer Center, Houston, TX, USA Abstract: Triple-negative breast cancer (TNBC is a complex heterogeneous disease characterized by the absence of three hallmark receptors: human epidermal growth factor receptor 2, estrogen receptor, and progesterone receptor. Compared to other breast cancer subtypes, TNBC is more aggressive, has a higher prevalence in African-Americans, and more frequently affects younger patients. Currently, TNBC lacks clinically accepted targets for tailored therapy, warranting the need for candidate biomarkers. BiomarkerBase, an online platform used to find biomarkers reported in clinical trials, was utilized to screen all potential biomarkers for TNBC and select only the ones registered in completed TNBC trials through clinicaltrials.gov. The selected candidate biomarkers were classified as surrogate, prognostic, predictive, or pharmacodynamic (PD and organized by location in the blood, on the cell surface, in the cytoplasm, or in the nucleus. Blood biomarkers include vascular endothelial growth factor/vascular endothelial growth factor receptor and interleukin-8 (IL-­8; cell surface biomarkers include EGFR, insulin-like growth factor binding protein, c-Kit, c-Met, and PD-L1; cytoplasm biomarkers include PIK3CA, pAKT/S6/p4E-BP1, PTEN, ALDH1, and the PIK3CA/AKT/mTOR-related metabolites; and nucleus biomarkers include BRCA1, the glucocorticoid receptor, TP53, and Ki67. Candidate biomarkers were further organized into a “cellular protein network” that demonstrates potential connectivity. This review provides an inventory and reference point for promising biomarkers for breakthrough targeted therapies in TNBC. Keywords: anti-cancer directed pharmacotherapy, difficult

  6. Towards Evidence-Based Initial Teacher Education in Singapore: A Review of Current Literature

    Science.gov (United States)

    Low, Ee-Ling; Hui, Chenri; Taylor, Peter G.; Ng, Pak Tee

    2012-01-01

    Initial teacher education (ITE) in Singapore is shifting towards evidence-based practice. Despite a clear policy orientation, ITE in Singapore has not yet produced the evidence base that it is anticipating. This paper presents an analytical review of previous research into ITE in Singapore and makes comparisons to the larger international context.…

  7. Evidence of Effectiveness of Current Therapies to Prevent and Treat Early Childhood Caries

    DEFF Research Database (Denmark)

    Twetman, Svante; Dhar, Vineet

    2015-01-01

    and Evaluation) system. RESULTS: There was moderate and limited quality of evidence in support of fluoride toothpaste and fluoride varnish for ECC prevention, while the evidence for fluoride tablets/drops was insufficient. The support for the use of silver diamine fluoride, xylitol, chlorhexidine varnish...

  8. Chemoprevention of prostate cancer: Natural compounds, antiandrogens, and antioxidants - In vivo evidence

    Directory of Open Access Journals (Sweden)

    Nur Özten-Kandas

    2011-01-01

    Full Text Available Prostate cancer is the leading non-skin malignancy detected in US males and the second cause of death due to male cancer, in the US. Interventions with drugs or diet supplements that slow down the growth and progression of prostate cancer are potentially very effective in reducing the burden of prostate cancer, particularly if these treatments also prevent the de novo development of new prostatic malignancies. Challenges to identify efficacious agents and develop them for chemopreventive application in men at risk for prostate cancer have included uncertainty about which preclinical models have the ability to predict efficacy in men and lack of consensus about which early phase clinical trial designs are the most appropriate and cost-effective to test promising agents. Efficacy studies in animal models have identified several agents with potential chemopreventive activity against prostate cancer, but few of these findings have been translated into clinical trials. This article identifies some of the major issues associated with prostate cancer chemoprevention research and summarizes the most significant current results from animal efficacy studies and human clinical prevention trials. This summary focuses on: (1 Naturally occurring agents and compounds derived from such agents, including green tea and its constituents, silibinin and milk thistle, and genistein and soy, (2 chemoprevention drugs including agents interfering with androgen action, and (3 antioxidants such as selenium, vitamin E, and lycopene. The general lack of activity of antioxidants is discussed, followed by considerations about translation of preclinical chemoprevention efficacy data, focusing on dose, form, bioavailability, and timing of administration of the agent, as well as discussion of study design of clinical trials and the predictive ability of preclinical models.

  9. The National Cancer Institute's PREVENT Cancer Preclinical Drug Development Program: overview, current projects, animal models, agent development strategies, and molecular targets.

    Science.gov (United States)

    Shoemaker, Robert H; Suen, Chen S; Holmes, Cathy A; Fay, Judith R; Steele, Vernon E

    2016-02-01

    The PREVENT Cancer Preclinical Drug Development Program (PREVENT) is a National Cancer Institute, Division of Cancer Prevention (NCI, DCP)-supported program whose primary goal is to bring new cancer preventive interventions (small molecules and vaccines) and biomarkers through preclinical development towards clinical trials by creating partnerships between the public sector (eg, academia, industry) and DCP. PREVENT has a formalized structure for moving interventions forward in the prevention pipeline using a stage-gate process with go/no go decision points along the critical path for development. This review describes the structure of the program, its focus areas, and provides examples of projects currently in the pipeline.

  10. The National Cancer Institute's PREVENT Cancer Preclinical Drug Development Program: overview, current projects, animal models, agent development strategies, and molecular targets.

    Science.gov (United States)

    Shoemaker, Robert H; Suen, Chen S; Holmes, Cathy A; Fay, Judith R; Steele, Vernon E

    2016-02-01

    The PREVENT Cancer Preclinical Drug Development Program (PREVENT) is a National Cancer Institute, Division of Cancer Prevention (NCI, DCP)-supported program whose primary goal is to bring new cancer preventive interventions (small molecules and vaccines) and biomarkers through preclinical development towards clinical trials by creating partnerships between the public sector (eg, academia, industry) and DCP. PREVENT has a formalized structure for moving interventions forward in the prevention pipeline using a stage-gate process with go/no go decision points along the critical path for development. This review describes the structure of the program, its focus areas, and provides examples of projects currently in the pipeline. PMID:26970137

  11. Current understandings and perspectives on non-cancer health effects of benzene: A global concern

    International Nuclear Information System (INIS)

    Objective: Benzene, as a volatile organic compound, is known as one of the main air pollutants in the environment. The aim of this review is to summarize all available evidences on non-cancerous health effects of benzene providing an overview of possible association of exposure to benzene with human chronic diseases, specially, in those regions of the world where benzene concentration is being poorly monitored. Methodology: A bibliographic search of scientific databases including PubMed, Google Scholar, and Scirus was conducted with key words of “benzene toxic health effects”, “environmental volatile organic compounds”, “diabetes mellitus and environmental pollutants”, “breast cancer and environmental pollution”, “prevalence of lung cancer”, and “diabetes prevalence”. More than 300 peer reviewed papers were examined. Experimental and epidemiologic studies reporting health effects of benzene and volatile organic compounds were included in the study. Results: Epidemiologic and experimental studies suggest that benzene exposure can lead to numerous non-cancerous health effects associated with functional aberration of vital systems in the body like reproductive, immune, nervous, endocrine, cardiovascular, and respiratory. Conclusion: Chronic diseases have become a health burden of global dimension with special emphasis in regions with poor monitoring over contents of benzene in petrochemicals. Benzene is a well known carcinogen of blood and its components, but the concern of benzene exposure is more than carcinogenicity of blood components and should be evaluated in both epidemiologic and experimental studies. Aspect of interactions and mechanism of toxicity in relation to human general health problems especially endocrine disturbances with particular reference to diabetes, breast and lung cancers should be followed up. - Highlights: • Benzene is a volatile organic compound and established blood carcinogen. • Exposure to benzene needs to be

  12. Current understandings and perspectives on non-cancer health effects of benzene: A global concern

    Energy Technology Data Exchange (ETDEWEB)

    Bahadar, Haji [International Campus, Tehran University of Medical Sciences (Iran, Islamic Republic of); Pharmaceutical Sciences Research Center and Faculty of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of); Mostafalou, Sara [Pharmaceutical Sciences Research Center and Faculty of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of); Abdollahi, Mohammad, E-mail: Mohammad.Abdollahi@UToronto.Ca [Pharmaceutical Sciences Research Center and Faculty of Pharmacy, Tehran University of Medical Sciences (Iran, Islamic Republic of)

    2014-04-15

    Objective: Benzene, as a volatile organic compound, is known as one of the main air pollutants in the environment. The aim of this review is to summarize all available evidences on non-cancerous health effects of benzene providing an overview of possible association of exposure to benzene with human chronic diseases, specially, in those regions of the world where benzene concentration is being poorly monitored. Methodology: A bibliographic search of scientific databases including PubMed, Google Scholar, and Scirus was conducted with key words of “benzene toxic health effects”, “environmental volatile organic compounds”, “diabetes mellitus and environmental pollutants”, “breast cancer and environmental pollution”, “prevalence of lung cancer”, and “diabetes prevalence”. More than 300 peer reviewed papers were examined. Experimental and epidemiologic studies reporting health effects of benzene and volatile organic compounds were included in the study. Results: Epidemiologic and experimental studies suggest that benzene exposure can lead to numerous non-cancerous health effects associated with functional aberration of vital systems in the body like reproductive, immune, nervous, endocrine, cardiovascular, and respiratory. Conclusion: Chronic diseases have become a health burden of global dimension with special emphasis in regions with poor monitoring over contents of benzene in petrochemicals. Benzene is a well known carcinogen of blood and its components, but the concern of benzene exposure is more than carcinogenicity of blood components and should be evaluated in both epidemiologic and experimental studies. Aspect of interactions and mechanism of toxicity in relation to human general health problems especially endocrine disturbances with particular reference to diabetes, breast and lung cancers should be followed up. - Highlights: • Benzene is a volatile organic compound and established blood carcinogen. • Exposure to benzene needs to be

  13. Barriers and facilitators to cervical cancer screening in high incidence populations: A synthesis of qualitative evidence.

    Science.gov (United States)

    Driscoll, Susan D

    2016-01-01

    Despite the efficacy and availability of screening and treatment for cervical cancer, it remains the leading cause of death for women in many low resource countries. The inability or reluctance of women to use screening and treatment is the largest contributor to cervical cancer morbidity and mortality. The aim of the author in this article is to determine knowledge, attitudes, and beliefs that facilitate or hinder women's use of screening in high incidence countries through a synthesis of qualitative research. CINAHL, Medline, AnthroSource, Sociological Abstracts, Social Service Abstracts, GenderWatch, Ethnic News Watch, and ASSIA databases were queried for qualitative research published from 2008 to 2013. Ten studies meeting inclusion criteria were reviewed and analyzed using constant comparative analysis. Barriers to cervical cancer screening included fatalism, mistrust of non-traditional healthcare providers, masculine/feminine beliefs, limited knowledge, and misunderstandings of causes of cervical cancer. Facilitators included knowledge of sexual risk factors, recognition of signs and symptoms, and community/social support. Pragmatic solutions suggested by this synthesis, that may decrease barriers and enhance facilitators, involved cultural humility (a continual commitment to cultural competence), promotion of gender equality, collaboration among stakeholders, and the translation of evidence-based practices from low to high incidence populations. PMID:26496628

  14. The public funding of expensive cancer therapies: synthesizing the "3Es"--evidence, economics, and ethics.

    Science.gov (United States)

    Kirby, Jeffrey; Somers, Emily; Simpson, Christy; McPhee, Judy

    2008-01-01

    The cost of new cancer therapies and drugs has risen sharply and somewhat alarmingly in the last five years. In those developed countries where healthcare systems are (primarily) publicly funded, this has caused legitimate concern among government administrators and politicians who must make decisions regarding funding. In the Canadian context, provincial Departments of Health are mandated to provide comprehensive healthcare services to all citizens out of a "fixed pot" of financial resources, which is determined annually as part of the provincial government's overall budget process. In recent years there has been increasing recognition among healthcare decision makers that the approval of funding for multiple new expensive cancer treatments is creating an "opportunity cost" for meeting the other legitimate healthcare needs of provincial citizens. In response to this reality, the Department of Health of the Canadian province of Nova Scotia created a Cancer Systemic Therapy Policy Committee (CSTPC) in 2005. The mandate of this committee is to make recommendations to the Nova Scotia Deputy Minister of Health regarding the public funding of new cancer therapies. In collaboration with consultants from the Dalhousie University Department of Bioethics, the committee developed a comprehensive and inclusive decision-making framework to promote and facilitate decision making that is explicitly informed by evidence, economics, and ethics--the "3Es"--in reaching and making recommendations. PMID:18839752

  15. CYP17 inhibitors in prostate cancer: latest evidence and clinical potential.

    Science.gov (United States)

    Alex, Anitha B; Pal, Sumanta K; Agarwal, Neeraj

    2016-07-01

    Since androgen signaling plays a pivotal role in the proliferation and metastasis of prostate cancer, androgen deprivation therapy (ADT) or castration therapy is considered the backbone of treatment for newly diagnosed metastatic prostate cancer. However, almost all men experience disease progression on ADT to a state known as metastatic castration-resistant prostate cancer (mCRPC), which continues to be driven by intratumoral androgen synthesis or androgen receptor signaling. Hence, the extragonadal ablation of androgen synthesis from pregnane precursors holds much promise. An inhibitor of cytochrome P450 17α-hydroxy/17,20-lyase (CYP17) enzymes, abiraterone acetate, has already been approved for men with mCRPC. Newer CYP17 inhibitors continue to be developed which are either more selective or have concomitant inhibitory actions on AR signaling. These include VT-464, orteronel, and galeterone. Herein, we focus on the molecular mechanism of action, efficacy, latest evidence, and clinical potential of CYP17 inhibitors in prostate cancer. PMID:27482286

  16. Anticoagulation in combination with antiangiogenesis and chemotherapy for cancer patients: evidence and hypothesis.

    Science.gov (United States)

    Wang, Ji; Zhu, Chengchu

    2016-01-01

    Hypercoagulable state and disorganized angiogenesis are two conspicuous characteristics during tumor progression. There are a considerable number of clinical trials focusing on the effects of anticoagulant and antiangiogenic drugs on the survival of cancer patients. Favorable outcomes have been observed. Excessive blood coagulation not only causes cancer-associated thrombosis, which is a common complication and is the second leading cause of death in patients, but also decreases intratumoral perfusion rates and drug delivery by reducing the effective cross-sectional area of blood vessels. Meanwhile, structural and functional abnormalities of the tumor microvasculature also compromise convective drug transport and create a hypoxic and acidic microenvironment. Vascular normalization strategy can temporarily recover the abnormal state of tumor vasculature by improving blood density, dilation, and leakiness, resulting in enhanced penetration of chemotherapies and oxygen within a short time window. In this article, we first review the evidence to support the opinion that anticoagulant and antiangiogenic therapy can improve cancer survival through several underlying mechanisms. Next, we speculate on the feasibility and value of the combined strategy and discuss whether such a combination has a synergistic antineoplastic effect in cancer patients by way of increasing blood vessel perfusion and drug distribution. PMID:27536135

  17. The 'Pokemon' (ZBTB7) Gene: No Evidence of Association with Sporadic Breast Cancer.

    Science.gov (United States)

    Salas, Antonio; Vega, Ana; Milne, Roger L; García-Magariños, Manuel; Ruibal, Alvaro; Benítez, Javier; Carracedo, Angel

    2008-01-01

    It has been proposed that the excess of familiar risk associated with breast cancer could be explained by the cumulative effect of multiple weakly predisposing alleles. The transcriptional repressor FBI1, also known as Pokemon, has recently been identified as a critical factor in oncogenesis. This protein is encoded by the ZBTB7 gene. Here we aimed to determine whether polymorphisms in ZBTB7 are associated with breast cancer risk in a sample of cases and controls collected in hospitals from North and Central Spanish patients. We genotyped 15 SNPs in ZBTB7, including the flanking regions, with an average coverage of 1 SNP/2.4 Kb, in 360 sporadic breast cancer cases and 402 controls. Comparison of allele, genotype and haplotype frequencies between cases and controls did not reveal associations using Pearson's chi-square test and a permutation procedure to correct for multiple test. In this, the first study of the ZBTB7 gene in relation to, sporadic breast cancer, we found no evidence of an association. PMID:21892298

  18. Bladder cancer risk in painters: a review of the epidemiological evidence, 1989-2004.

    Science.gov (United States)

    Bosetti, Cristina; Pira, Enrico; La Vecchia, Carlo

    2005-11-01

    Epidemiological studies on the potential association between painting and the risk of bladder cancer published after the Monograph of the International Agency for Research on Cancer N. 47 of 1989 have been systematically reviewed. These included four cohort studies on the incidence of bladder cancer among painters, with a pooled relative risk (RR) of 1.10 (95% confidence interval, CI, 1.03-1.18), based on 893 cases observed. The corresponding summary RR from four cohort studies on mortality was 1.23 (95% CI 1.11-1.37), based on 370 deaths. The pooled RR from 14 case-control studies and a pooled-analysis of other 11 case-control studies was 1.35 (95% CI 1.19-1.53), based on 465 cases exposed. Overall, the RR from all epidemiological studies was 1.17 (95% 1.11-1.27). Thus, recent epidemiological evidence indicates a moderate excess risk for bladder cancer in painters. Some studies, however, suggested that any such risk would have been greater for exposures in the distant past. Open issues for interpretation include residual confounding by social class and tobacco smoking, and understanding the time-risk relation. In particular, the potential residual risk related to exposure over the last two to three decades remains to be defined. PMID:16184465

  19. Anticoagulation in combination with antiangiogenesis and chemotherapy for cancer patients: evidence and hypothesis

    Directory of Open Access Journals (Sweden)

    Wang J

    2016-07-01

    Full Text Available Ji Wang, Chengchu Zhu Department of Cardiothoracic Surgery, Taizhou Hospital, Wenzhou Medical University, Linhai, Zhejiang, People’s Republic of China Abstract: Hypercoagulable state and disorganized angiogenesis are two conspicuous characteristics during tumor progression. There are a considerable number of clinical trials focusing on the effects of anticoagulant and antiangiogenic drugs on the survival of cancer patients. Favorable outcomes have been observed. Excessive blood coagulation not only causes cancer-associated thrombosis, which is a common complication and is the second leading cause of death in patients, but also decreases intratumoral perfusion rates and drug delivery by reducing the effective cross-sectional area of blood vessels. Meanwhile, structural and functional abnormalities of the tumor microvasculature also compromise convective drug transport and create a hypoxic and acidic microenvironment. Vascular normalization strategy can temporarily recover the abnormal state of tumor vasculature by improving blood density, dilation, and leakiness, resulting in enhanced penetration of chemotherapies and oxygen within a short time window. In this article, we first review the evidence to support the opinion that anticoagulant and antiangiogenic therapy can improve cancer survival through several underlying mechanisms. Next, we speculate on the feasibility and value of the combined strategy and discuss whether such a combination has a synergistic antineoplastic effect in cancer patients by way of increasing blood vessel perfusion and drug distribution. Keywords: tumor microenvironment, anticoagulation, antiangiogenesis, vascular normalization, tumor perfusion

  20. Targeted therapy for advanced gastric cancer: A review of current status and future prospects

    Institute of Scientific and Technical Information of China (English)

    Ozkan; Kanat; Bert; O’Neil; Safi; Shahda

    2015-01-01

    In the West in particular, the vast majority of gastric cancer(GC) patients present with advanced-stage disease. Although combination chemotherapy is stillthe most important component of treatment for these patients, it confers a modest survival advantage. Recently, increased knowledge of the key molecular signaling pathways involved in gastric carcinogenesis has led to the discovery of specific molecular-targeted therapeutic agents. Some of these agents such as trastuzumab and ramucirumab have changed the treatment paradigm for this disease. In this paper, we will summarize the current clinical status of targeted drug therapy in the management of GC.

  1. Targeting Head and Neck Cancer Stem Cells: Current Advances and Future Challenges.

    Science.gov (United States)

    Birkeland, A C; Owen, J H; Prince, M E

    2015-11-01

    Cancer stem cells (CSCs), or tumor-initiating cells, comprise a subset of tumor cells with demonstrated ability for tumor growth, invasion, metastasis, and resistance to chemotherapy and radiation. Targeting of CSCs remains an attractive yet elusive therapeutic option, with the goal of increasing specificity and effectiveness in tumor eradication, as well as decreasing off-target or systemic toxicity. Research into further characterization and targeted therapy toward head and neck CSCs is an active and rapidly evolving field. This review discusses the current state of research into therapy against head and neck CSCs and future directions for targeted therapy.

  2. Dietary supplementation in patients with alcoholic liver disease:a review on current evidence

    Institute of Scientific and Technical Information of China (English)

    Zeinab Ghorbani; Masoomeh Hajizadeh; Azita Hekmatdoost

    2016-01-01

    BACKGROUND: Alcoholic liver disease (ALD) is one of the main causes of liver disease worldwide. Although the patho-genesis of ALD has not yet been well elucidated, the oxidative metabolites of ethanol such as acetaldehyde and reactive oxy-gen species play a pivotal role in the clinical and pathological spectrum of the disease. This review summarizes the existing evidences on dietary supplements considered to have antioxi-dant, and/or anti-inlfammatory properties, and their role in the management of ALD and the proposed mechanisms. DATA SOURCES: The present study reviewed all studies pub-lished in PubMed, ScienceDirect and Scopus, from 1959 to 2015, indicating the role of different dietary supplementation in attenuation of many pathophysiological processes involved in development and progression of ALD. Full-texts of citations were used except for those that were published in languages other than English. RESULTS: Signiifcant progress has been made to understand the key events and molecular players for the onset and pro-gression of ALD from both experimental and clinical studies;however, there is no successful treatment currently available. The present review discussed the role of a variety of dietary supplements (e.g. vitamin A, carotenoids, vitamins B3, C and E, in addition to antioxidants and anti-inlfammatory agents) in treating ALD. It has been shown that supplementation with some carotenoids, vitamin B3, vitamin C, silymarin, curcumin, probiotics, zinc, S-adenosylmethionine and garlic may have potential beneifcial effects in animal models of ALD; however, the number of clinical studies is very limited. In addition, sup-plementation should be accompanied with alcohol cessation. CONCLUSIONS: Since oxidative stress and inlfammation are involved in the pathogenesis of ALD, dietary supplements that can modulate these pathologies could be useful in the treat-ment of ALD. In addition to alcohol cessation, these supple-ments have shown beneifcial effects on animal

  3. Epidemiologic evidence of cancer risk in textile industry workers: a review and update.

    Science.gov (United States)

    Mastrangelo, Giuseppe; Fedeli, Ugo; Fadda, Emanuela; Milan, Giovanni; Lange, John H

    2002-05-01

    A meta-analysis of epidemiologic studies for textile industry workers was undertaken in an attempt to evaluate whether the cancer risk varies within the textile industry in relation to the job held or the textile fiber used. We combined studies published up until 1990, when an ad hoc IARC Monograph was issued, and those published after 1990 with the aim of appreciating evidence of reversing trends in cancer risk. Observed and expected cases reported in the original studies were summed up and the totals were divided to obtain a pooled relative risk (PRR) with a 95% confidence interval (CI) estimated with a fixed-effect model. We calculated a chi-square test (chi2) of heterogeneity among studies. When PRR and chi2 were both significant, PRR and CI were calculated with a random-effect model and the source of heterogeneity was investigated. Lung cancer risk was around 0.4 in the first study on cotton workers published in 1936, around 0.7 in subsequent studies, mostly published in the 1970s and 1980s, and around 1.0 in the last studies published in the 1990s. Papers published in the 1970s and 1980s produced consistent risk estimates for lung cancer risk, which was significantly lower than 1.0 in workers exposed to cotton (PRR = 0.77; CI = 0.69-0.86) and wool dust (0.71; 0.50-0.92), as well as in carders and fiber preparers (0.73; 0.54-0.91), weavers (0.71; 0.56-0.85), and spinners and weavers (0.78; 0.66-0.91). Lung cancer PRRs did not significantly deviate from 1.0 in textile workers using synthetic fibers or silk, and in dyers. Increased PRRs were found for sinonasal cancer in workers exposed to cotton dust, and in workers involved in spinning or weaving (4.14; 1.80-6.49). PRR was 1.46 (1.10-1.82) for cancer of the digestive system in textile workers using synthetic fibers or silk, and 1.34 (1.10-1.59) for colorectal cancer in spinners and weavers. The increased bladder cancer PRR in dyers (1.39; 1.07-1.71) is generally attributed to textile dye exposure. In studies

  4. Current status of immunotherapy for non-small-cell lung cancer.

    Science.gov (United States)

    Imbimbo, Martina; Lo Russo, Giuseppe; Blackhall, Fiona

    2016-08-01

    In the last few years, the introduction of novel immunotherapeutic agents has represented a treatment shift for a subset of patients with non-small-cell lung cancer (NSCLC). Checkpoint inhibitors have been demonstrated to improve survival in advanced stage disease with very good tolerability. This success follows many years of scientific effort to manipulate the human immune system to attack cancer cells. With a variety of approaches ranging from vaccines to administration of interleukin or interferon-γ, the results in NSCLC were unsuccessful, with the view that it is a scarcely immunogenic cancer, unlike melanoma or renal cell carcinoma. The step change has come from understanding of immune checkpoints-cell surface molecules that regulate immune system activation and mediate coinhibitory signaling pathways that physiologically protect the body from autoimmunity. These pathways play an important role in tumors, including NSCLC, and are a mechanism of escape from immune surveillance. Several monoclonal antibodies have been developed in order to inhibit these molecules and unleash the brakes of the immune system. Currently in NSCLC, 7 different checkpoint inhibitors are under investigation: 2 anti-cytotoxic T-lymphocyte-associated antigen 4, 2 anti-programmed death (PD)-1, and 3 anti-PD-ligand 1 antibodies. Here we review the progress to date in developing immunotherapy for NSCLC, summarize results from published trials, highlight ongoing trials, and discuss progress in the question of how best to select patients for this treatment. PMID:27443896

  5. Current Role and Future Perspectives of Magnetic Resonance Spectroscopy in Radiation Oncology for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Aleksandra Zapotoczna

    2007-06-01

    Full Text Available Prostatic neoplasms are not uniformly distributed within the prostate volume. With recent developments in three-dimensional intensity-modulated and imageguided radiation therapy, it is possible to treat different volumes within the prostate to different thresholds of doses. This approach has the potential to adapt the dose to the biologic aggressiveness of various clusters of tumor cells within the gland. The definition of tumor burden volume in prostate cancer can be facilitated by the use of magnetic resonance spectroscopy (MRS. The increasing sensitivity and specificity of MRS to the prostate is causing new interest in its potential role in the definition of target subvolumes at higher risk of failure following radical radiotherapy. Prostate MRS might also play a role as a noninvasive predictive factor for tumor response and treatment outcome. We review the use of MRS in radiation therapy for prostate cancer by evaluating its accuracy in the classification of aggressive cancer regions and target definition; its current role in the radiotherapy planning process, with special interest in technical issues behind the successful inclusion of MRS in clinical use; and available early experiences as a prognostic tool.

  6. Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Raja, J. [Department of Radiology, St George' s Hospital, Tooting, London (United Kingdom)]. E-mail: jowadraja@gmail.com; Ramachandran, N. [Department of Radiology, St George' s Hospital, Tooting, London (United Kingdom); Munneke, G. [Department of Radiology, St George' s Hospital, Tooting, London (United Kingdom); Patel, U. [Department of Radiology, St George' s Hospital, Tooting, London (United Kingdom)

    2006-02-15

    In contemporary practice, most prostate cancers are either invisible on ultrasound or indistinguishable from concurrent benign prostatic hyperplasia. Diagnosis therefore rests on prostate biopsy. Biopsies are not simply directed at ultrasonically visible lesions, as these would miss many cancers; rather the whole gland is sampled. The sampling itself is systematic, using patterns based on prostate zonal anatomy and the geographical distribution and frequency of cancer. This review explains the evolution of the prostate biopsy technique, from the classical sextant biopsy method to the more recent extended biopsy protocols (8, 10, 12, >12 and saturation biopsy protocols). Extended protocols are increasingly being used to improve diagnostic accuracy, especially in those patients who require repeat biopsy. This trend has been facilitated by the ongoing improvement in safety and acceptability of the procedure, particularly with the use of antibiotic prophylaxis and local anaesthesia. The technical details of these extended protocols are discussed, as are the current data regarding procedure-related morbidity and how this may be minimized.

  7. Current status and evolution of preclinical drug development models of epithelial ovarian cancer

    Directory of Open Access Journals (Sweden)

    Panagiotis A Konstantinopoulos

    2013-12-01

    Full Text Available Epithelial ovarian cancer (EOC is the most lethal gynecologic malignancy and the fifth most common cause of female cancer death in the United States. Although important advances in surgical and chemotherapeutic strategies over the last three decades have significantly improved the median survival of EOC patients, the plateau of the survival curve has not changed appreciably. Given that EOC is a genetically and biologically heterogeneous disease, identification of specific molecular abnormalities that can be targeted in each individual ovarian cancer on the basis of predictive biomarkers promises to be an effective strategy to improve outcome in this disease. However, for this promise to materialize, appropriate preclinical experimental platforms that recapitulate the complexity of these neoplasms and reliably predict antitumor activity in the clinic are critically important. In this review, we will present the current status and evolution of preclinical models of EOC, including cell lines, immortalized normal cells, xenograft models, patient-derived xenografts and animal models, and will discuss their potential for oncology drug development.

  8. Difference of Sodium Currents between Pediatric and Adult Human Atrial Myocytes: Evidence for Developmental Changes of Sodium Channels

    Directory of Open Access Journals (Sweden)

    Benzhi Cai, Xiaoqin Mu, Dongmei Gong, Shulin Jiang, Jianping Li, Qingxin Meng, Yunlong Bai, Yanju Liu, Xinyue Wang, Xueying Tan, Baofeng Yang, Yanjie Lu

    2011-01-01

    Full Text Available Voltage-gated calcium currents and potassium currents were shown to undergo developmental changes in postnatal human and animal cardiomocytes. However, so far, there is no evidence whether sodium currents also presented the developmental changes in postnatal human atrial cells. The aim of this study was to observe age-related changes of sodium currents between pediatric and adult atrial myocytes. Human atrial myocytes were acutely isolated and the whole-cell patch clamp technique was used to record sodium currents isolated from pediatric and adult atrial cardiomocytes. The peak amplitude of sodium currents recorded in adult atrial cells was significantly larger than that in pediatric atrial myocytes. However, there was no significant difference of the activation voltage for peak sodium currents between two kinds of atrial myocytes. The time constants for the activation and inactivation of sodium currents were smaller in adult atria than pediatric atria. The further study revealed that the voltage-dependent inactivation of sodium currents were more slow in adult atrial cardiomyocytes than pediatric atrial cells. A significant difference was also observed in the recovery process of sodium channel from inactivation. In summary, a few significant differences were demonstrated in sodium currents characteristics between pediatric and adult atrial myocytes, which indicates that sodium currents in human atria also undergo developmental changes.

  9. Evidence-based practice in Occupational Health Psychology. Current status and further developments

    OpenAIRE

    Maricutoiu, Laurentiu P.; Florin A. Sava

    2012-01-01

    The present paper discusses the status of evidence-based practice in Occupational Health Psychology (OHP). After several searches on large online databases, we have found that OHP papers that discuss interventions are less than 10% of the overall literature. Furthermore, quantitative reviews research that reports interventions on major OHP topics are generally absent. In the last part of the paper, we formulate some reccomendations for increasing the number of papers relevant for evidence-bas...

  10. GSTM1 null genotype in COPD and lung cancer: evidence of a modifier or confounding effect?

    Directory of Open Access Journals (Sweden)

    Young RP

    2011-09-01

    Full Text Available Robert P Young1,2, Raewyn J Hopkins1, Bryan A Hay1, Gregory D Gamble11Schools of Biological Science and Health Sciences, University of Auckland, 2Department of Medicine, Auckland City Hospital, Auckland, New ZealandBackground: Studies over the past two decades have reported associations between GSTM1 (glutathione S-transferase mu 1 null genotype and chronic obstructive pulmonary disease (COPD or lung cancer. However, a modifier or confounding effect from COPD mediating the GSTM1 association with lung cancer has not been previously explored.Aim and methods: This variant was examined in a case-control study of current or former smokers with COPD (n = 669, lung cancer (n = 454, or normal lung function (n = 488. Sex, age, and smoking history were comparable between groups.Results: The GSTM1 null genotype was found to be more frequent in smokers with COPD alone (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.02–1.66, P = 0.031 and lung cancer (OR 1.26, 95% CI 0.96–1.65, P = 0.083 than in matched smokers with normal lung function (62%, 61%, and 56%, respectively. However, when smokers with lung cancer were subgrouped according to the presence of COPD, then the association with all COPD subjects (OR 1.34, 95% CI 1.07–1.70, P = 0.010 and with COPD and lung cancer (OR 1.50, 95% CI 1.06–2.12, P = 0.018 continued to be significant while that with lung cancer only was reduced (OR 1.11, 95% CI 0.78–1.56, P = 0.55. These associations were independent of age, sex, height, lung function, and smoking history.Conclusion: Findings suggest that COPD is an important subphenotype of lung cancer and may underlie previously reported associations with the GSTM1 null genotype.Keywords: lung cancer, chronic obstructive pulmonary disease, GSTM1, association study, polymorphism, copy number variant

  11. Overview of the evidence on digital breast tomosynthesis in breast cancer detection.

    Science.gov (United States)

    Houssami, Nehmat; Skaane, Per

    2013-04-01

    Digital breast tomosynthesis (DBT, or 3D-mammography), a three-dimensional derivative of digital mammography (DM), reduces the effect of tissue superimposition and may improve mammographic interpretation. In this review, we examined the evidence on the accuracy of DBT in clinical studies. Published studies of DBT were relatively small studies, mostly test-set observer (reader) studies or clinical series that included symptomatic and screen-recalled cases, and were generally enriched with cancers. With these limitations in mind, the evidence showed some consistent findings, summarized as follows: two-view DBT has at least equal or better accuracy than standard two-view DM, whereas one-view DBT does not have better accuracy than standard DM; the addition of DBT to standard mammography (for mammographic interpretation or for assessment or triage of screen-recalled abnormalities) increases accuracy; improved accuracy from using DBT (relative to, or added to, DM) may be due to increased cancer detection or due to reduced false positive recalls, or both; and subjective interpretation of cancer conspicuity consistently found that cancers were equally or more conspicuous on DBT relative to DM. Preliminary data from population screening trials suggest that the integration of DBT with conventional DM (screen-reading using combined 2D + 3D mammography) may substantially improve breast cancer detection, although final results are not yet available, and many logistical issues need further evaluation to determine the potential implications and cost of combined 2D + 3D mammographic screening. At present, there is insufficient evidence to justify a change from standard DM to DBT however the available data strongly support investment in new large-scale population screening trials. These trials need to avoid the 'double' acquisitions required for 2D + 3D mammograms, and should therefore focus on evaluating integrated 2Dsynthetic + 3D mammography (where 2D-images are

  12. Targeted Therapy Database (TTD: a model to match patient's molecular profile with current knowledge on cancer biology.

    Directory of Open Access Journals (Sweden)

    Simone Mocellin

    Full Text Available BACKGROUND: The efficacy of current anticancer treatments is far from satisfactory and many patients still die of their disease. A general agreement exists on the urgency of developing molecularly targeted therapies, although their implementation in the clinical setting is in its infancy. In fact, despite the wealth of preclinical studies addressing these issues, the difficulty of testing each targeted therapy hypothesis in the clinical arena represents an intrinsic obstacle. As a consequence, we are witnessing a paradoxical situation where most hypotheses about the molecular and cellular biology of cancer remain clinically untested and therefore do not translate into a therapeutic benefit for patients. OBJECTIVE: To present a computational method aimed to comprehensively exploit the scientific knowledge in order to foster the development of personalized cancer treatment by matching the patient's molecular profile with the available evidence on targeted therapy. METHODS: To this aim we focused on melanoma, an increasingly diagnosed malignancy for which the need for novel therapeutic approaches is paradigmatic since no effective treatment is available in the advanced setting. Relevant data were manually extracted from peer-reviewed full-text original articles describing any type of anti-melanoma targeted therapy tested in any type of experimental or clinical model. To this purpose, Medline, Embase, Cancerlit and the Cochrane databases were searched. RESULTS AND CONCLUSIONS: We created a manually annotated database (Targeted Therapy Database, TTD where the relevant data are gathered in a formal representation that can be computationally analyzed. Dedicated algorithms were set up for the identification of the prevalent therapeutic hypotheses based on the available evidence and for ranking treatments based on the molecular profile of individual patients. In this essay we describe the principles and computational algorithms of an original method

  13. The evidence of neuraxial administration of analgesics for cancer-related pain

    DEFF Research Database (Denmark)

    Kurita, G P; Benthien, K S; Nordly, M;

    2015-01-01

    clinical and methodological diversity that precluded a meta-analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences...... related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation. RESULTS: The number of abstracts...

  14. Work at night and breast cancer--report on evidence-based options for preventive actions

    DEFF Research Database (Denmark)

    Bonde, Jens Peter; Hansen, Johnni; Kolstad, Henrik Albert;

    2012-01-01

    is needed before definite recommendations can be made. Earlier or more intensive mammography screening among female night shift worker is not recommended because the harm-benefit ratio in this age group may not be beneficial. Preventive effects of melatonin supplementation on breast cancer risk have...... by suppression of melatonin secretion. Work during the night is widespread worldwide. To provide additional evidence-based recommendations on prevention of diseases related to night shift work, large studies on the impact of various shift schedules and type of light on circadian rhythms need to be conducted...

  15. A Novel Wide-Area Backup Protection Based on Fault Component Current Distribution and Improved Evidence Theory

    Directory of Open Access Journals (Sweden)

    Zhe Zhang

    2014-01-01

    Full Text Available In order to solve the problems of the existing wide-area backup protection (WABP algorithms, the paper proposes a novel WABP algorithm based on the distribution characteristics of fault component current and improved Dempster/Shafer (D-S evidence theory. When a fault occurs, slave substations transmit to master station the amplitudes of fault component currents of transmission lines which are the closest to fault element. Then master substation identifies suspicious faulty lines according to the distribution characteristics of fault component current. After that, the master substation will identify the actual faulty line with improved D-S evidence theory based on the action states of traditional protections and direction components of these suspicious faulty lines. The simulation examples based on IEEE 10-generator-39-bus system show that the proposed WABP algorithm has an excellent performance. The algorithm has low requirement of sampling synchronization, small wide-area communication flow, and high fault tolerance.

  16. Targeting bone metabolism in patients with advanced prostate cancer: current options and controversies.

    Science.gov (United States)

    Todenhöfer, Tilman; Stenzl, Arnulf; Hofbauer, Lorenz C; Rachner, Tilman D

    2015-01-01

    Maintaining bone health remains a clinical challenge in patients with prostate cancer (PC) who are at risk of developing metastatic bone disease and increased bone loss due to hormone ablation therapy. In patients with cancer-treatment induced bone loss (CTIBL), antiresorptive agents have been shown to improve bone mineral density (BMD) and to reduce the risk of fractures. For patients with bone metastases, both zoledronic acid and denosumab delay skeletal related events (SREs) in the castration resistant stage of disease. Novel agents targeting the Wnt inhibitors dickkopf-1 and sclerostin are currently under investigation for the treatment of osteoporosis and malignant bone disease. New antineoplastic drugs such as abiraterone, enzalutamide, and Radium-223 are capable of further delaying SREs in patients with advanced PC. The benefit of antiresorptive treatment for patients with castration sensitive PC appears to be limited. Recent trials on the use of zoledronic acid for the prevention of bone metastases failed to be successful, whereas denosumab delayed the occurrence of bone metastases by a median of 4.1 months. Currently, the use of antiresorptive drugs to prevent bone metastases still remains a field of controversies and further trials are needed to identify patient subgroups that may profit from early therapy. PMID:25802521

  17. Volumetric intensity modulated arc therapy in lung cancer: Current literature review

    Directory of Open Access Journals (Sweden)

    Suresh B Rana

    2013-01-01

    Full Text Available The volumetric intensity modulated arc therapy (VMAT is a novel radiation technique that delivers a highly conformal radiation dose to the target by allowing the simultaneous variation of gantry rotation speed, dose rate and multiple-leaf collimators leaf positions. The aim of this study was to review the current literature on two VMAT systems, RapidArc and SmartArc with main focus on planning studies of lung cancer. A systematic review of available data was conducted using MEDLINE/PubMed with the keywords ′′lung′′ and "VMAT". The published data show that VMAT techniques have clear superiority over three-dimensional conformal radiation therapy with regard to improving dose conformity and sparing of organs at risks (OARs. The data indicates that for lung tumor VMAT and intensity modulated radiation therapy (IMRT provide equivalent dose homogeneity, dose conformity and target volume coverage; however, contradictory results were obtained in terms of OARs sparing. The major advantages of VMAT over IMRT are the reduction in the number of monitor units and faster treatment delivery times without compromising the quality of the treatment plans. Moreover, faster delivery time is more patient-friendly and it minimizes intra-fractional patient motion allowing treatment volumes stay within their respective treatment margins. Current literature data shows that VMAT can be a good option to treat lung cancer; however, data on clinical trials are still lacking. The clinical trials are essential to confirm the safety and efficacy of VMAT techniques.

  18. Testing for her2 in breast cancer: current pathology challenges faced in Canada.

    Science.gov (United States)

    Hanna, W; Barnes, P; Berendt, R; Chang, M; Magliocco, A; Mulligan, A M; Rees, H; Miller, N; Elavathil, L; Gilks, B; Pettigrew, N; Pilavdzic, D; Sengupta, S

    2012-12-01

    This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (her2)-positive breast cancer currently faced by pathologists in Canada: Pre-analysis issues affecting the accuracy of her2 testing in non-excision sample types: core-needle biopsies, effusion samples, fine-needle aspirates, and bone metastasesher2 testing of core-needle biopsies compared with surgical specimensCriteria for retesting her2 status upon disease recurrenceLiterature searches for each topic were carried out using the medline, Embase, International Pharmaceutical Abstracts, and biosis databases. In addition, the congress databases of the American Society of Clinical Oncology (2005-2011) and the San Antonio Breast Cancer Symposium (2007-2011) were searched for relevant abstracts.All authors are expert breast pathologists with extensive experience of her2 testing, and several participated in the development of Canadian her2 testing guidelines. For each topic, the authors present an evaluation of the current data available for the guidance of pathology practice, with recommendations for the optimization or improvement of her2 testing practice. PMID:23300357

  19. Targeting Bone Metabolism in Patients with Advanced Prostate Cancer: Current Options and Controversies

    Directory of Open Access Journals (Sweden)

    Tilman Todenhöfer

    2015-01-01

    Full Text Available Maintaining bone health remains a clinical challenge in patients with prostate cancer (PC who are at risk of developing metastatic bone disease and increased bone loss due to hormone ablation therapy. In patients with cancer-treatment induced bone loss (CTIBL, antiresorptive agents have been shown to improve bone mineral density (BMD and to reduce the risk of fractures. For patients with bone metastases, both zoledronic acid and denosumab delay skeletal related events (SREs in the castration resistant stage of disease. Novel agents targeting the Wnt inhibitors dickkopf-1 and sclerostin are currently under investigation for the treatment of osteoporosis and malignant bone disease. New antineoplastic drugs such as abiraterone, enzalutamide, and Radium-223 are capable of further delaying SREs in patients with advanced PC. The benefit of antiresorptive treatment for patients with castration sensitive PC appears to be limited. Recent trials on the use of zoledronic acid for the prevention of bone metastases failed to be successful, whereas denosumab delayed the occurrence of bone metastases by a median of 4.1 months. Currently, the use of antiresorptive drugs to prevent bone metastases still remains a field of controversies and further trials are needed to identify patient subgroups that may profit from early therapy.

  20. Advanced gastric cancer: Is there enough evidence to call second-line therapy standard?

    Institute of Scientific and Technical Information of China (English)

    Hendrik-Tobias Arkenau; Matilde Saggese; Charlotte Lemech

    2012-01-01

    Gastric cancer and cancer of the gastro-oesophageal junction (GOJ) are the 4th most common cancer diagnoses worldwide with regional differences in incidence rates.The treatment of gastric and GOJ cancers is complex and requires multimodality treatment including chemotherapy treatment,surgery,and radiotherapy.During the past decade considerable improvements were achieved by advanced surgical techniques,tailored chemotherapies/radiotherapy and technical innovations in clinical diagnostics.In patients with advanced or metastatic gastric/GOJ cancer systemic chemotherapy with fluoropyrimidine/platinum-based regimens (+/-human epidermal growth factor receptor-2 antibody) is the mainstay of treatment.Despite these improvements,the clinical outcome for patients with advanced or metastatic disease is generally poor with 5-year survival rates ranging between 5%-15%.These poor survival rates may to some extent be related that standard therapies beyond first-line therapies have never been defined.Considering that this patient population is often not fit enough to receive further treatments there is an increasing body of evidence from phase-2 studies that in fact second-line therapies may have a positive impact in terms of overall survival.Moreover two recently published phase-3 studies support the use of second-line chemotherapy.A South Korean study compared either,irinotecan or docetaxel with best supportive care and a German study compared irinotecan with best supportive care-both studies met their primary endpoint overall survival.In this "Field of Vision" article,we review these recently published phase-3 studies and put them into the context of clinical prognostic factors helping to guide treatment decisions in patients who most likely benefit.

  1. Further evidence for increased macrophage migration inhibitory factor expression in prostate cancer

    Directory of Open Access Journals (Sweden)

    Iczkowski Kenneth A

    2005-07-01

    Full Text Available Abstract Background Macrophage migration inhibitory factor (MIF is a cytokine associated with prostate cancer, based on histologic evidence and circulating (serum levels. Recent studies from another laboratory failed to document these results. This study's aims were to extend and confirm our previous data, as well as to define possible mechanisms for the discrepant results. Additional aims were to examine MIF expression, as well as the location of MIF's receptor, CD74, in human prostatic adenocarcinoma compared to matched benign prostate. Methods MIF amounts were determined in random serum samples remaining following routine PSA screening by ELISA. Native, denaturing and reducing polyacrylamide gels and Western blot analyses determined the MIF form in serum. Prostate tissue arrays were processed for MIF in situ hybridization and immunohistochemistry for MIF and CD74. MIF released into culture medium from normal epithelial, LNCaP and PC-3 cells was detected by Western blot analysis. Results Median serum MIF amounts were significantly elevated in prostate cancer patients (5.87 ± 3.91 ng/ml; ± interquartile range; n = 115 compared with patients with no documented diagnosis of prostate cancer (2.19 ± 2.65 ng/ml; n = 158. ELISA diluent reagents that included bovine serum albumin (BSA significantly reduced MIF serum detection (p Conclusion Increased serum MIF was associated with prostate cancer. Diluent reagents that included BSA resulted in MIF serum immunoassay interference. In addition, significant amounts of complexed MIF (180 kDa under denaturing conditions by Western blot found in the serum do not bind to the MIF capture antibody. Increased MIF mRNA expression was observed in prostatic adenocarcinoma compared to benign tissue from matched samples, supporting our earlier finding of increased MIF gene expression in prostate cancer.

  2. Developing clinical strength-of-evidence approach to define HIV-associated malignancies for cancer registration in Kenya.

    Directory of Open Access Journals (Sweden)

    Anne Korir

    Full Text Available BACKGROUND: Sub-Saharan Africa cancer registries are beset by an increasing cancer burden further exacerbated by the AIDS epidemic where there are limited capabilities for cancer-AIDS match co-registration. We undertook a pilot study based on a "strength-of-evidence" approach using clinical data that is abstracted at the time of cancer registration for purposes of linking cancer diagnosis to AIDS diagnosis. METHODS/FINDINGS: The standard Nairobi Cancer Registry form was modified for registrars to abstract the following clinical data from medical records regarding HIV infection/AIDS in a hierarchal approach at time of cancer registration from highest-to-lowest strength-of-evidence: 1 documentation of positive HIV serology; 2 antiretroviral drug prescription; 3 CD4+ lymphocyte count; and 4 WHO HIV clinical stage or immune suppression syndrome (ISS, which is Kenyan terminology for AIDS. Between August 1 and October 31, 2011 a total of 1,200 cancer cases were registered. Of these, 171 cases (14.3% met clinical strength-of-evidence criteria for association with HIV infection/AIDS; 69% (118 cases were tumor types with known HIV association - Kaposi's sarcoma, cervical cancer, non-Hodgkin's and Hodgkin's lymphoma, and conjunctiva carcinoma and 31% (53 were consistent with non-AIDS defining cancers. Verifiable positive HIV serology was identified in 47 (27% cases for an absolute seroprevalence rate of 4% among the cancer registered cases with an upper boundary of 14% among those meeting at least one of strength-of-evidence criteria. CONCLUSIONS/SIGNIFICANCE: This pilot demonstration of a hierarchal, clinical strength-of-evidence approach for cancer-AIDS registration in Kenya establishes feasibility, is readily adaptable, pragmatic, and does not require additional resources for critically under staffed cancer registries. Cancer is an emerging public health challenge, and African nations need to develop well designed population-based studies in order to

  3. Current status of ultrasound-guided surgery in the treatment of breast cancer.

    Science.gov (United States)

    Volders, José H; Haloua, Max H; Krekel, Nicole Ma; Meijer, Sybren; van den Tol, Petrousjka M

    2016-02-10

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast

  4. CURRENT EVIDENCE REGARDING THE EFFICACY OF PROPHYLACTIC ANTIBIOTICS IN THE MANAGEMENT OF FACIAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Anilkumar

    2016-03-01

    Full Text Available Fractures of the facial region are commonly treated by surgeons operating in the head and neck. Antibiotic prophylaxis is used by these surgeons to decrease the rate of infections, however the role of prophylactic antibiotics remains controversial. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery and third molar surgeries. Unfortunately there is little evidence regarding the efficacy of prophylactic antibiotics in the management of facial fractures. In numerous cases no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. The aim of this paper is to present the available evidence regarding the efficacy of prophylactic antibiotics in the management of facial fractures.

  5. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    Science.gov (United States)

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy. PMID:26327530

  6. Nutrition support and dietary interventions for patients with lung cancer: current insights

    OpenAIRE

    Kiss N

    2016-01-01

    Nicole Kiss1,2 1Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; 2Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Abstract: Malnutrition and weight loss are prevalent in patients with lung cancer. The impact of malnutrition on patients with cancer, and specifically in patients with lung cancer, has been demonstrated in a large number of studies. Malnutrition has been shown to neg...

  7. Respiratory medicines for children: Current evidence, unlicensed use and research priorities

    NARCIS (Netherlands)

    A.R. Smyth; A. Barbato (A.); N. Beydon (Nicole); H. Bisgaard; K. de Boeck; P.L.P. Brand (Paul L.P.); A. Bush; B. Fauroux (Brigitte); J.C. de Jongste (Johan); M. Korppi; C. O'Callaghan; M.W.H. Pijnenburg (Mariëlle); F. Ratjen (Felix); K. Southern; D. Spencer; A. Thomson; H. Vyas; A. Warris (Adilia); P.J.F.M. Merkus (Peter)

    2010-01-01

    textabstractThis European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe off-licence use, research priorities and ongoing studies. Off-licence and off-label prescribing in children is widespread a

  8. Type 2 Endoleaks Post-EVAR: Current Evidence for Rupture Risk, Intervention and Outcomes of Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Raymond, E-mail: rchung@doctors.org.uk; Morgan, Robert A., E-mail: Robert.Morgan@stgeorges.nhs.uk [St. George’s Healthcare NHS Trust, Radiology, Ground Floor, St. James Wing (United Kingdom)

    2015-06-15

    Type 2 endoleaks (EL2) are the most commonly encountered endoleaks following EVAR. Despite two decades of experience, there remains considerable variation in the management of EL2 with controversies ranging from if to treat, when to treat and how to treat. Here, we summarise the available evidence, describe the treatment techniques available and offer guidelines for management.

  9. Type 2 Endoleaks Post-EVAR: Current Evidence for Rupture Risk, Intervention and Outcomes of Treatment

    International Nuclear Information System (INIS)

    Type 2 endoleaks (EL2) are the most commonly encountered endoleaks following EVAR. Despite two decades of experience, there remains considerable variation in the management of EL2 with controversies ranging from if to treat, when to treat and how to treat. Here, we summarise the available evidence, describe the treatment techniques available and offer guidelines for management

  10. Management of Child and Adolescent Eating Disorders: The Current Evidence Base and Future Directions

    Science.gov (United States)

    Gowers, Simon; Bryant-Waugh, Rachel

    2004-01-01

    Although eating disorders in children and adolescents remain a serious cause of morbidity and mortality, the evidence base for effective interventions is surprisingly weak. The adult literature is growing steadily, but this is mainly with regard to psychological therapies for bulimia nervosa and to some extent in the field of pharmacotherapy. This…

  11. Current Evidence on Treatment of Patients With Chronic Systolic Heart Failure and Renal Insufficiency

    NARCIS (Netherlands)

    Damman, Kevin; Tang, W. H. Wilson; Felker, G. Michael; Lassus, Johan; Zannad, Faiez; Krum, Henry; McMurray, John J. V.

    2014-01-01

    Chronic kidney disease (CKD) is increasingly prevalent in patients with chronic systolic heart failure. Therefore, evidence-based therapies are more and more being used in patients with some degree of renal dysfunction. However, most pivotal randomized clinical trials specifically excluded patients

  12. A review of current evidence for the causal impact of attentional bias on fear and anxiety

    NARCIS (Netherlands)

    B. van Bockstaele; B. Verschuere; H. Tibboel; J. de Houwer; G. Crombez; E.H.W. Koster

    2014-01-01

    Prominent cognitive theories postulate that an attentional bias toward threatening information contributes to the etiology, maintenance, or exacerbation of fear and anxiety. In this review, we investigate to what extent these causal claims are supported by sound empirical evidence. Although differen

  13. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials.

    Science.gov (United States)

    van la Parra, Raquel F D; Kuerer, Henry M

    2016-01-01

    With improvements in chemotherapy regimens, targeted therapies, and our fundamental understanding of the relationship of tumor subtype and pathologic complete response (pCR), there has been dramatic improvement in pCR rates in the past decade, especially among triple-negative and human epidermal growth factor receptor 2-positive breast cancers. Rates of pCR in these groups of patients can be in the 60 % range and thus question the paradigm for the necessity of breast and nodal surgery in all cases, particularly when the patient will be receiving adjuvant local therapy with radiotherapy. Current practice for patients who respond well to neoadjuvant chemotherapy (NCT) is often to proceed with the same breast and axillary procedures as would have been offered women who had not received NCT, regardless of the apparent clinical response. Given these high response rates in defined subgroups among exceptional responders it is appropriate to question whether surgery is now a redundant procedure in their overall management. Further, definitive radiation without surgical resection with or without systemic therapy has been proven effective for several other malignant disease sites including some stages of esophageal, anal, laryngeal, prostate, cervical, and lung carcinoma. The main impediments for potential elimination of surgery have been the fact that prior and current standard and functional breast imaging methods are incapable of accurate prediction of residual disease and that integrating percutaneous biopsy of the breast primary and nodes following NCT may circumvent this issue. This article highlights historical attempts at omission of surgery following NCT in an earlier era, the current status of breast and nodal imaging to predict residual carcinoma, and ongoing and planned trials designed to identify appropriate patients who might be selected for clinical trials designed to test the safety of selected elimination of breast cancer surgery in percutaneous image

  14. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials.

    Science.gov (United States)

    van la Parra, Raquel F D; Kuerer, Henry M

    2016-03-08

    With improvements in chemotherapy regimens, targeted therapies, and our fundamental understanding of the relationship of tumor subtype and pathologic complete response (pCR), there has been dramatic improvement in pCR rates in the past decade, especially among triple-negative and human epidermal growth factor receptor 2-positive breast cancers. Rates of pCR in these groups of patients can be in the 60 % range and thus question the paradigm for the necessity of breast and nodal surgery in all cases, particularly when the patient will be receiving adjuvant local therapy with radiotherapy. Current practice for patients who respond well to neoadjuvant chemotherapy (NCT) is often to proceed with the same breast and axillary procedures as would have been offered women who had not received NCT, regardless of the apparent clinical response. Given these high response rates in defined subgroups among exceptional responders it is appropriate to question whether surgery is now a redundant procedure in their overall management. Further, definitive radiation without surgical resection with or without systemic therapy has been proven effective for several other malignant disease sites including some stages of esophageal, anal, laryngeal, prostate, cervical, and lung carcinoma. The main impediments for potential elimination of surgery have been the fact that prior and current standard and functional breast imaging methods are incapable of accurate prediction of residual disease and that integrating percutaneous biopsy of the breast primary and nodes following NCT may circumvent this issue. This article highlights historical attempts at omission of surgery following NCT in an earlier era, the current status of breast and nodal imaging to predict residual carcinoma, and ongoing and planned trials designed to identify appropriate patients who might be selected for clinical trials designed to test the safety of selected elimination of breast cancer surgery in percutaneous image

  15. Outcome analysis of breast cancer patients who declined evidence-based treatment

    Directory of Open Access Journals (Sweden)

    Joseph Kurian

    2012-06-01

    Full Text Available Abstract Background To analyze the characteristics and outcomes of women with breast cancer in the Northern Alberta Health Region (NAHR who declined recommended primary standard treatments. Methods A chart review was performed of breast cancer patients who refused recommended treatments during the period 1980 to 2006. A matched pair analysis was performed to compare the survival data between those who refused or received standard treatments. Results A total of 185 (1.2% patients refused standard treatment. Eighty-seven (47% were below the age of 75 at diagnosis. The majority of those who refused standard treatments were married (50.6%, 50 years or older (60.9%, and from the urban area (65.5%. The 5-year overall survival rates were 43.2% (95% CI: 32.0 to 54.4% for those who refused standard treatments and 81.9% (95% CI: 76.9 to 86.9% for those who received them. The corresponding values for the disease-specific survival were 46.2% (95% CI: 34.9 to 57.6% vs. 84.7% (95% CI: 80.0 to 89.4%. Conclusions Women who declined primary standard treatment had significantly worse survival than those who received standard treatments. There is no evidence to support using Complementary and Alternative Medicine (CAM as primary cancer treatment.

  16. Is Current Account of Turkey Sustainable ? Evidence from Nonlinear Unit Root Tests

    Directory of Open Access Journals (Sweden)

    Serkan Taştan

    2015-09-01

    Full Text Available In this paper, current account sustainability of Turkey is analyzed in a nonlinear framework. Various nonlinear unit root tests have been used to test for structural break, sign and size nonlinearity. We have tested structural break and size nonlinearity separately and structural break-sign and size-sign nonlinearities simultaneously. Only considering the size nonlinearity, we have found that the current account of Turkey is sustainable. Thus, the size nonlinearity, in other words the speed of reversion to equilibrium, is essential for the current account sustainability of Turkey. We have also found that the speed of adjustment towards equilibrium is symmetric, while considering size and sign nonlinearities simultaneously.

  17. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

    Directory of Open Access Journals (Sweden)

    Stacey Dawn

    2012-11-01

    Full Text Available Abstract Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©. Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a establishing an advisory knowledge user team in each of three targeted settings; (b assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c adapting protocols for local use, ensuring fidelity of the content; (d selecting intervention strategies to overcome known barriers and implementing the protocols; (e conducting think-aloud usability testing; (f evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing

  18. Evidence for DNA Damage as a Biological Link Between Diabetes and Cancer

    Institute of Scientific and Technical Information of China (English)

    Shao Chin Lee; Juliana CN Chan

    2015-01-01

    Objective:This review examines the evidence that:Diabetes is a state of DNA damage;pathophysiological factors in diabetes can cause DNA damage;DNA damage can cause mutations;and DNA mutation is linked to carcinogenesis.Data Sources:We retrieved information from the PubMed database up to January,2014,using various search terms and their combinations including DNA damage,diabetes,cancer,high glucose,hyperglycemia,free fatty acids,palmitic acid,advanced glycation end products,mutation and carcinogenesis.Study Selection:We included data from peer-reviewed journals and a textbook printed in English on relationships between DNA damage and diabetes as well as pathophysiological factors in diabetes.Publications on relationships among DNA damage,mutagenesis,and carcinogenesis,were also reviewed.We organized this information into a conceptual framework to explain the possible causal relationship between DNA damage and carcinogenesis in diabetes.Results:There are a large amount of data supporting the view that DNA mutation is a typical feature in carcinogenesis.Patients with type 2 diabetes have increased production of reactive oxygen species,reduced levels of antioxidant capacity,and increased levels of DNA damage.The pathophysiological factors and metabolic milieu in diabetes can cause DNA damage such as DNA strand break and base modification (i.e.,oxidation).Emerging experimental data suggest that signal pathways (i.e.,Akt/tuberin) link diabetes to DNA damage.This collective evidence indicates that diabetes is a pathophysiological state of oxidative stress and DNA damage which can lead to various types of mutation to cause aberration in cells and thereby increased cancer risk.Conclusions:This review highlights the interrelationships amongst diabetes,DNA damage,DNA mutation and carcinogenesis,which suggests that DNA damage can be a biological link between diabetes and cancer.

  19. Perceptions of Radiation Oncologists and Urologists on Sources and Type of Evidence to Inform Prostate Cancer Treatment Decisions

    Energy Technology Data Exchange (ETDEWEB)

    Han, Leona C. [Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota (United States); Delpe, Sophia [Department of Urology, Yale University, New Haven, Connecticut (United States); Shah, Nilay D. [Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota (United States); Ziegenfuss, Jeanette Y. [HealthPartners, Minneapolis, Minnesota (United States); Tilburt, Jon C. [Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota (United States); Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota (United States); Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota (United States); Karnes, R. Jeffrey [Department of Urology, Mayo Clinic, Rochester, Minnesota (United States); Nguyen, Paul L. [Division of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Gross, Cary P. [Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut (United States); Department of Internal Medicine, Yale University, New Haven, Connecticut (United States); Yu, James B. [Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut (United States); Department of Radiation Oncology, Yale University, New Haven, Connecticut (United States); Trinh, Quoc-Dien [Division of Urology, Brigham and Women' s Hospital, Harvard University, Boston, Massachusetts (United States); Sun, Maxine [Cancer Prognostics and Health Outcomes, University of Montreal Health Center, Montreal, QC (Canada); Ranasinghe, Weranja K.B. [Division of Urology, Alfred Hospital, Prahran, Melbourne, Victoria (Australia); Kim, Simon P., E-mail: simkim@me.com [Department of Urology, Yale University, New Haven, Connecticut (United States); Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, Connecticut (United States)

    2014-06-01

    Purpose: To perform a national survey of radiation oncologists and urologists about the type of resources used and the level of evidence needed to change clinical practice in localized prostate cancer. Methods and Materials: From a random sample, 1422 physicians were mailed a survey assessing the types of information used and what level of evidence could alter their clinical practice in prostate cancer. Multivariable logistic regression models were used to identify differences in physician characteristics for each outcome. Results: Survey response rates were similar for radiation oncologists and urologists (44% vs 46%; P=.46). Specialty-specific journals represented the most commonly used resource for informing the clinical practice for radiation oncologists (65%) and urologists (70%). Relative to radiation oncologists, urologists were less likely to report utilizing top-tier medical journals (25% vs 39%; adjusted odds ratio [OR] 0.50; P=.01) or cancer journals (22% vs 51%; adjusted OR 0.50; P<.001) but more likely to rely on clinical guidelines (46% vs 38%; adjusted OR 1.6; P=.006). Both radiation oncologists and urologists most commonly reported large randomized, clinical trials as the level of evidence to change treatment recommendations for localized prostate cancer (85% vs 77%; P=.009). Conclusions: Both specialties rely on their own specialty-specific journals and view randomized, clinical trials as the level of evidence needed to change clinical practice. Our study provides a context on meaningful ways of disseminating evidence for localized prostate cancer.

  20. Perceptions of Radiation Oncologists and Urologists on Sources and Type of Evidence to Inform Prostate Cancer Treatment Decisions

    International Nuclear Information System (INIS)

    Purpose: To perform a national survey of radiation oncologists and urologists about the type of resources used and the level of evidence needed to change clinical practice in localized prostate cancer. Methods and Materials: From a random sample, 1422 physicians were mailed a survey assessing the types of information used and what level of evidence could alter their clinical practice in prostate cancer. Multivariable logistic regression models were used to identify differences in physician characteristics for each outcome. Results: Survey response rates were similar for radiation oncologists and urologists (44% vs 46%; P=.46). Specialty-specific journals represented the most commonly used resource for informing the clinical practice for radiation oncologists (65%) and urologists (70%). Relative to radiation oncologists, urologists were less likely to report utilizing top-tier medical journals (25% vs 39%; adjusted odds ratio [OR] 0.50; P=.01) or cancer journals (22% vs 51%; adjusted OR 0.50; P<.001) but more likely to rely on clinical guidelines (46% vs 38%; adjusted OR 1.6; P=.006). Both radiation oncologists and urologists most commonly reported large randomized, clinical trials as the level of evidence to change treatment recommendations for localized prostate cancer (85% vs 77%; P=.009). Conclusions: Both specialties rely on their own specialty-specific journals and view randomized, clinical trials as the level of evidence needed to change clinical practice. Our study provides a context on meaningful ways of disseminating evidence for localized prostate cancer

  1. Cancer Stem Cells in Pancreatic Cancer

    OpenAIRE

    Karl-Walter Jauch; Hendrik Seeliger; Hanno Niess; Qi Bao; Andrea Renner; Yue Zhao; Bruns, Christiane J.

    2010-01-01

    Pancreatic cancer is an aggressive malignant solid tumor well-known by early metastasis, local invasion, resistance to standard chemo- and radiotherapy and poor prognosis. Increasing evidence indicates that pancreatic cancer is initiated and propagated by cancer stem cells (CSCs). Here we review the current research results regarding CSCs in pancreatic cancer and discuss the different markers identifying pancreatic CSCs. This review will focus on metastasis, microRNA regulation and anti-CSC t...

  2. Antidepressants for older people: what can we learn from the current evidence base?

    Science.gov (United States)

    Katona, Cornelius; Bindman, Dorothea C; Katona, Cara P

    2014-10-01

    This paper updates our previous review of the evidence base for managing depression in old age while focusing more specifically on the use of antidepressants. Overall, recent systematic reviews and meta-analyses indicate that antidepressants are effective in the acute treatment of depression in old age but that the superiority of active drug over placebo is quite modest. The depression of Alzheimer's disease is probably not treated effectively with antidepressants. The most consistent evidence is for the effectiveness of continued antidepressant treatment in those depressed patients who respond well to acute treatment. There remains a clear need for more research to identify effective treatments for resistant depression though therapeutic nihilism should be avoided if first-line treatment fails. PMID:24975955

  3. Web 2.0 for health promotion: reviewing the current evidence.

    Science.gov (United States)

    Chou, Wen-ying Sylvia; Prestin, Abby; Lyons, Claire; Wen, Kuang-yi

    2013-01-01

    As Web 2.0 and social media make the communication landscape increasingly participatory, empirical evidence is needed regarding their impact on and utility for health promotion. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 4 medical and social science databases for literature (2004-present) on the intersection of Web 2.0 and health. A total of 514 unique publications matched our criteria. We classified references as commentaries and reviews (n = 267), descriptive studies (n = 213), and pilot intervention studies (n = 34). The scarcity of empirical evidence points to the need for more interventions with participatory and user-generated features. Innovative study designs and measurement methods are needed to understand the communication landscape and to critically assess intervention effectiveness. To address health disparities, interventions must consider accessibility for vulnerable populations.

  4. Panitumumab: the evidence for its use in the treatment of metastatic colorectal cancer

    Directory of Open Access Journals (Sweden)

    Rossana Berardi

    2010-09-01

    Full Text Available Rossana Berardi1, Azzurra Onofri2, Mirco Pistelli2, Elena Maccaroni2, Mario Scartozzi1, Chiara Pierantoni1, Stefano Cascinu11Clinica di Oncologia Medica, Università Politecnica delle Marche, Ospedali Riuniti Umberto I-GM Lancisi-G Salesi di Ancona, Italy; 2Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, ItalyAbstract: Panitumumab is the first fully human monoclonal antibody to Epidermal Growth Factor Receptor (EGFR to enter clinical trials for the treatment of solid tumors. The anti-tumor activity of panitumumab has been tested in vitro and in vivo, and inhibition of tumor growth has been observed in numerous cancer models, particularly lung, kidney and colorectal (CRC. Preclinical and clinical studies have established a role for panitumumab in metastatic colorectal cancer (mCRC refractory to multiple chemotherapeutic regimens. Based on these encouraging findings, panitumumab was approved by the US Food and Drug Administration for the treatment of patients with epidermal growth factor receptor-expressing mCRC refractory to fluoropyrimidine-, oxaliplatin-, and/or irinotecan-containing chemotherapeutic regimens. The improvement in progression free survival (PFS and response rate (RR produced by panitumumab monotherapy was significantly greater in patients with non mutated (wild-type K-RAS than in those with mutant K-RAS. Therefore implementing routine K-RAS screening and limiting the use of EGFR inhibitors to patients with wild-type K-RAS appears the better strategy for select only the patients who could benefit from the therapy with panitumumab and also may have the potential for cost savings. The purpose of this review was to evaluate the patient-related, disease-related and economic-related evidence for the use of panitumumab in the treatment of metastatic colorectal cancer in clinical practice.Keywords: colorectal cancer, EGFR; K-RAS, panitumumab 

  5. Local Unemployment and the Relative Wages of Immigrants: Evidence from the Current Population Surveys

    OpenAIRE

    Barth, Erling; Bratsberg, Bernt; Raaum, Oddbjørn

    2003-01-01

    We provide evidence on wage profiles of immigrants using CPS data from 1979 to 2001, taking into account that changes in labor market conditions impact natives and immigrants differently. High rates of immigrant wage assimilation in general, and relatively high wages of immigrant cohorts that arrived during the 1990s in particular, can largely be explained by a negative trend in unemployment in the data. Relating immigrant and native period effects to local labor market unemployment, we find ...

  6. Beyond hydrogeologic evidence: challenging the current assumptions about salinity processes in the Corangamite region, Australia

    Science.gov (United States)

    Dahlhaus, P. G.; Cox, J. W.; Simmons, C. T.; Smitt, C. M.

    2008-11-01

    In keeping with the standard scientific methods, investigations of salinity processes focus on the collection and interpretation of contemporary scientific data. However, using multiple lines of evidence from non-hydrogeologic sources such as geomorphic, archaeological and historical records can substantially add value to the scientific investigations. By using such evidence, the validity of the assumptions about salinity processes in Australian landscapes is challenged, especially the assumption that the clearing of native vegetation has resulted in rising saline groundwater in all landscapes. In the Corangamite region of south-west Victoria, salinity has been an episodic feature of the landscapes throughout the Quaternary and was present at the time of the Aboriginal inhabitants and the first pastoral settlement by Europeans. Although surface-water salinity has increased in some waterways and the area of salinised land has expanded in some landscapes, there is no recorded evidence found which supports significant rises in groundwater following widespread land-use change. In many areas, salinity is an inherent component of the region’s landscapes, and sustains world-class environmental assets that require appropriate salinity levels for their ecological health. Managing salinity requires understanding the specific salinity processes in each landscape.

  7. Current Evidence regarding Prophylactic Antibiotics in Head and Neck and Maxillofacial Surgery

    Directory of Open Access Journals (Sweden)

    Kilian Kreutzer

    2014-01-01

    Full Text Available Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base.

  8. Breast Cancer Screening in Women with Learning Disabilities: Current Knowledge and Considerations

    Science.gov (United States)

    Willis, Diane S.; Kennedy, Catriona M.; Kilbride, Lynn

    2008-01-01

    As people with learning disabilities now live longer, they will experience the same age-related illnesses as the general population and cancer is a prime example of this. In women, cancer screening is used to detect early on-set of cancer of the breast and abnormalities of the cervix which might, if left untreated, develop into cancer.…

  9. Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope.

    Science.gov (United States)

    Heptonstall, N B; Ali, T; Mankad, K

    2016-04-01

    This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial. PMID:26970390

  10. Evidence for the possible biological significance of the igf-1 gene alternative splicing in prostate cancer

    Directory of Open Access Journals (Sweden)

    Anastassios ePhilippou

    2013-03-01

    Full Text Available Insulin-like growth factor I (IGF-I has been implicated in the pathogenesis of prostate cancer (PCa, since it plays a key role in cell proliferation, differentiation and apoptosis. The IGF-I actions are mediated mainly via its binding to the type I IGF receptor (IGF-IR, however IGF-I signaling via insulin receptor (IR and hybrid IGF-I/IR is also evident. Different IGF-I mRNA splice variants, namely IGF-IEa, IGF-IEb and IGF-IEc, are expressed in human cells and tissues. These transcripts encode several IGF-I precursor proteins which contain the same bioactive product (mature IGF-I, however, they differ by the length of their signal peptides on the amino-terminal end and the structure of the extension peptides (E-peptides on the carboxy-terminal end. There is an increasing interest in the possible different role of the IGF-I transcripts and their respective non-(matureIGF-I products in the regulation of distinct biological activities. Moreover, there is strong evidence of a differential expression profile of the IGF-I splice variants in normal vs. PCa tissues and PCa cells, implying that the expression pattern of the various IGF-I transcripts and their respective protein products may possess different functions in cancer biology. Herein, the evidence that the IGF-IEc transcript regulates PCa growth via Ec-peptide specific and IGF-IR/IR-independent signaling is discussed.

  11. An overview of synthetic strategies and current applications of gold nanorods in cancer treatment

    Science.gov (United States)

    Manish Lakhani, Prit; Vishnu Kiran Rompicharla, Sri; Ghosh, Balaram; Biswas, Swati

    2015-10-01

    Photothermal therapy, also referred to as optical hyperthermia or photothermal ablation, is an emerging strategy for treating solid tumours. Colloidal gold converts the absorbed light into localized heat via a non-radiative mechanism, surface plasmon resonance, which ablates the solid tumours. Several plasmon resonating nanostructures, including gold nanoparticles (AuNPs), gold nanorods (AuNRs), gold nanoshells, gold nanocages, copper sulphide and carbon nanotubes, have shown potential for photo-activated cancer therapy. Generally, spherical AuNPs display absorption maxima between 500-550 nm, making them inefficient due to low tissue penetration. On the other hand, AuNRs absorb light in the near-infrared (NIR) region that penetrates deeper with higher spatial precision, and causes no damage to the surrounding healthy tissues due to the low energy absorption of NIR light by normal tissue. Moreover, the absorption range of light can be fine-tuned to the NIR region by adjusting the aspect ratios of AuNRs. However, large-scale synthesis and stability of this colloidal system still poses challenges for clinical translation. In this review, we discuss various strategies applied up to now for the synthesis of AuNRs. Current trends in the pre-clinical development of multifunctional AuNRs with emphasis on preparation and application strategies in cancer therapy have been delineated.

  12. [Current status and prospect of treatment for esophageal cancer in the era of precision medicine].

    Science.gov (United States)

    Guo, X T; He, J

    2016-09-23

    Esophageal cancer (EC) is one of the most common malignant tumors around the world and has a high incidence in China. Chinese EC patients account for more than 50% in the world. The pathological subtype of EC shows a geographic distribution. Adenocarcinoma is the main pathological type in western countries, while squamous cell carcinoma is the dominant subtype in China. Thus specific diagnosis and treatment of EC are needed for Chinese patients. Although early diagnosis, progress in surgery and comprehensive treatment of EC have made remarkable achievements in China in recent years, yet the prognosis for resectable EC patients remains poor, with a 5-year survival of 30%. In addition, as the level of treatment varies significantly in different regions and centers around China, the current status of treatment for EC needs further improvement. This article reviews the advances in the treatment for EC in recent years, analyzes the present problems, and explores the perspective of the progress in esophageal cancer treatment in the era of precision medicine.

  13. Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer [

    Directory of Open Access Journals (Sweden)

    Sadick, Haneen

    2012-12-01

    Full Text Available [english] The incidence of head and neck squamous cell carcinoma (HNSCC is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic options, HNSCC still represents a multidisciplinary challenge.One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome predicition in patients with HNSCC.This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRI are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning.

  14. Do you do Damon®? What is the current evidence base underlying the philosophy of this appliance system?

    Science.gov (United States)

    Wright, Natasha; Modarai, Faranak; Cobourne, Martyn T; Dibiase, Andrew T

    2011-09-01

    Self-ligating bracket systems are increasing in popularity amongst orthodontists. This reflects their high quality engineering, improved reliability and relative ease of use. However, it might also be related to claims of superior function made by the manufacturers of these appliances. In particular, the Damon(®) appliance system claims to offer significant advantages to both orthodontist and patient over conventional-ligation and other forms of self-ligated appliances. We have reviewed current literature relating to use of the Damon(®) appliance system. There is some evidence to suggest this appliance may lead to reductions in chairside time for the orthodontist, particularly those experienced with this system, in comparison to conventional-ligation. However, evidence that pain experience is reduced for the patient when using Damon(®) brackets is not conclusive. In the presence of identical archwire sequences, there is no evidence that Damon(®) brackets can align teeth faster or in a qualitatively differently manner, when compared with conventional-ligation. There is no high quality evidence that treatment with the Damon(®) appliance takes place more rapidly or leads to a superior occlusal or aesthetic result. Indeed, the best available evidence would suggest there is no difference in treatment outcome or time, at least in extraction cases. There is no evidence that treatment with the Damon(®) appliance is more stable. Claims relating to improved clinical performance of the Damon(®) appliance system are currently being made to orthodontists and patients that are not substantiated in the scientific literature. PMID:21875995

  15. Evidence of early bottom water current flow after the Messinian Salinity Crisis in the Gulf of Cadiz

    OpenAIRE

    van der Schee, Marlies; F. J. Sierro; Jiménez-Espejo, F.J.; Hernández-Molina, F.J.; R. Flecker; J. A. Flores; Acton, G; Gutjahr, Marcus; Grunert, P.; García-Gallardo, Á.; Andersen, Nils

    2016-01-01

    Highlights • Stratigraphic framework over the Miocene-Pliocene boundary at IODP Site U1387. • Abrupt sedimentary changes over the Miocene-Pliocene boundary. • Clear hints for onset of Mediterranean Outflow after the Messinian Salinity Crisis. • Evidence of bottom water currents in contouritic sedimentation and elevated Zr/Al. • Quiet, hemipelagic sediment deposition during the Messinian in the Gulf of Cadiz. Abstract Integrated Ocean Drilling Program (IO...

  16. The effectiveness of current approaches to workplace stress management in the nursing profession: an evidence based literature review

    OpenAIRE

    Mimura, C; Griffiths, P

    2003-01-01

    The effectiveness of current approaches to workplace stress management for nurses was assessed through a systematic review. Seven randomised controlled trials and three prospective cohort studies assessing the effectiveness of a stress management programmes were identified and reviewed. The quality of research identified was weak. There is more evidence for the effectiveness of programmes based on providing personal support than environmental management to reduce stressors. However, since the...

  17. Biological Activities and Bioavailability of Mangosteen Xanthones: A Critical Review of the Current Evidence

    Directory of Open Access Journals (Sweden)

    Mark L. Failla

    2013-08-01

    Full Text Available Mangosteen (Garcinia mangostana L. is a tropical tree native to Southeast Asia that produces a fruit whose pericarp contains a family of tricyclic isoprenylated polyphenols referred to as xanthones. Numerous in vitro studies have shown that these xanthones possess anti-oxidant, anti-proliferative, pro-apoptotic, anti-inflammatory and anti-carcinogenic activities. Aggressive marketing of such health promoting benefits has resulted in mangosteen’s classification as a “superfruit”. This has led to sales of mangosteen containing beverages in USA alone exceeding $200 million in 2008 despite very limited animal and human studies. This review will (a critically address recent reports of in vivo studies on the bioavailability and metabolism of mangosteen xanthones, (b update the in vitro and in vivo data on anti-cancer and anti-inflammatory activities of mangosteen xanthones, and (c suggest needed areas of inquiry regarding the absorption, metabolism and efficacy of mangosteen xanthones.

  18. Evidence for neutral-current diffractive neutral pion production from hydrogen in neutrino interactions on hydrocarbon

    CERN Document Server

    Wolcott, J; Altinok, O; Bercellie, A; Betancourt, M; Bodek, A; Bravar, A; Budd, H; Cai, T; Carneiro, M F; Chvojka, J; Devan, J; Dytman, S A; Diaz, G A; Eberly, B; Endress, E; Felix, J; Fields, L; Galindo, R; Gallagher, H; Golan, T; Gran, R; Harris, D A; Higuera, A; Hurtado, K; Kiveni, M; Kleykamp, J; Kordosky, M; Le, T; Maher, E; Manly, S; Mann, W A; Marshall, C M; Caicedo, D A Martinez; McFarland, K S; McGivern, C L; McGowan, A M; Messerly, B; Miller, J; Mislivec, A; Morfin, J G; Mousseau, J; Naples, D; Nelson, J K; Norrick, A; Nuruzzaman,; Paolone, V; Park, J; Patrick, C E; Perdue, G N; Rakotondravohitra, L; Ramirez, M A; Ray, H; Ren, L; Rimal, D; Rodrigues, P A; Ruterbories, D; Schellman, H; Schmitz, D W; Salinas, C J Solano; Sanchez, S F; Tagg, N; Tice, B G; Valencia, E; Walton, T; Wospakrik, M; Zhang, D

    2016-01-01

    The MINERvA experiment observes an excess of events containing electromagnetic showers relative to the expectation from Monte Carlo simulations in neutral-current neutrino interactions with mean beam energy of 4.5 GeV on a hydrocarbon target. The excess is characterized and found to be consistent with neutral-current neutral pion production with a broad energy distribution peaking at 7 GeV and a total cross section of 0.26 +- 0.02 (stat) +- 0.08 (sys) x 10^{-39} cm^{2}. The angular distribution, electromagnetic shower energy, and spatial distribution of the energy depositions of the excess are consistent with expectations from neutrino neutral-current diffractive neutral pion production from hydrogen in the hydrocarbon target. These data comprise the first direct experimental observation and constraint for a reaction that poses an important background process in neutrino oscillation experiments searching for muon neutrino to electron neutrino oscillations.

  19. The role of analgesic blocking in the management of cancer pain: current trends. a review article.

    Science.gov (United States)

    Lund, P C

    1982-01-01

    The significant role of reversible and neurolytic analgesic blocking in the management of cancer pain in general is presented. It is pointed out that this modality of therapy may play a very significant role in the management of many such patients. It is pointed out that blocks of the peripheral as well as the central nervous system should be considered early rather than late in these disease syndromes in order to prevent central fixation. It is obvious that these procedures should be employed much more extensively than is generally the case at the present time. The opinions expressed are based upon over 30 years of clinical experience and a review of the current literature dealing with the management of pain. PMID:6960118

  20. Current Status of Poly(ADP-ribose Polymerase Inhibitors as Novel Therapeutic Agents for Triple-Negative Breast Cancer

    Directory of Open Access Journals (Sweden)

    David J. Hiller

    2012-01-01

    Full Text Available Triple-negative breast cancer (TNBC is an aggressive type of breast cancer that is clinically defined as lacking estrogen and progesterone receptors, as well as being ERBB2 (HER-2 negative. Without specific therapeutic targets, TNBC carries a worse prognosis than other types of breast cancer in the absence of therapy. Research has now further differentiated breast cancer into subtypes based on genetic expression patterns. One of these subtypes, basal-like, frequently overlaps with the clinical picture of TNBC. Additionally, both TNBC and basal-like breast cancer link to BRCA mutations. Recent pharmaceutical advances have created a class of drugs, poly(ADP-ribose polymerase (PARP inhibitors, which are showing potential to effectively treat these patients. The aim of this paper is to summarize the basis behind PARP inhibitors and update the current status of their development in clinical trials for the treatment of TNBC.

  1. Candidate genes of Waldenström’s macroglobulinemia: current evidence and research

    Directory of Open Access Journals (Sweden)

    Bianchi G

    2013-07-01

    Full Text Available Giada Bianchi,1 Antonio Sacco,1 Shaji Kumar,2 Giuseppe Rossi,3 Irene Ghobrial,1 Aldo Roccaro11Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 2Division of Hematology, Mayo Clinic, Rochester, MN, USA; 3Department of Hematology, Spedali Civili di Brescia, Brescia, ItalyAbstract: Waldenström’s macroglobulinemia (WM is a relatively uncommon, indolent malignancy of immunoglobulin M-producing B cells. The World Health Organization classifies it as a lymphoplasmacytic lymphoma and patients typically present with anemia, hepatosplenomegaly and diffuse lymphadenopathies. Historically, the genetic characterization of the disease has been hampered by the relatively low proliferative rate of WM cells, thus making karyotyping challenging. The use of novel technologies such as fluorescence in situ hybridization, gene array, and whole genome sequencing has contributed greatly to establishing candidate genes in the pathophysiology of WM and to identifying potential treatment targets, such as L265P MYD88. The discovery of microRNAs and the recognition of epigenetics as a major modulatory mechanism of oncogene expression and/or oncosuppressor silencing have aided in further understanding the pathogenesis of WM. Once thought to closely resemble multiple myeloma, a cancer of terminally differentiated, immunoglobulin-secreting plasma cells, WM appears to genetically cluster with other indolent B-cell lymphomas such as chronic lymphocytic leukemia/small cell lymphoma. The relative high incidence of familial cases of WM and other B-cell malignancies has been helpful in identifying high-risk gene candidates. In this review, we focus on the established genes involved in the pathogenesis of WM, with special emphasis on the key role of derangement of the nuclear factor kappa B signaling pathway and epigenetic mechanisms.Keywords: genetics, familial cases, NF-κB, whole genome sequencing, MYD88

  2. Mammography - importance, possibilities, current screening situation of the breast cancer and further expansion possibilities

    International Nuclear Information System (INIS)

    Breast cancer still remains the most frequent cancer in women population. Incidence of breast cancer is increasing, but mortality is decreasing. The most important for decreasing of breast cancer mortality is early diagnostic, especially screening. Screening is a form of secondary prevention. Although many screening studies have shown that mammography decreases of the breast cancer death, there are still many controversies. The published recommendations for the breast screening are sometimes very different. (author)

  3. Current Issues of Targeted Therapy in Metastatic Triple-Negative Breast Cancer

    OpenAIRE

    Liedtke, Cornelia; Kiesel, Ludwig

    2011-01-01

    Patients with triple-negative breast cancer are characterized by a poor prognosis compared with patients with other breast cancer subtypes. The angiogenesis inhibitor bevacizumab is effective in the palliative treatment of patients with triple-negative breast cancer as well as in other breast cancer subtypes. PARP inhibitors represent the first group of targeted agents to be developed under the particular aspect of treating patients with hereditary and triple-negative breast cancer. In additi...

  4. Application of Quantum Dots-Based Biotechnology in Cancer Diagnosis: Current Status and Future Perspectives

    OpenAIRE

    Chun-Wei Peng; Yan Li

    2010-01-01

    The semiconductor nanocrystal quantum dots (QDs) have excellent photo-physical properties, and the QDs-based probes have achieved encouraging developments in cellular and in vivo molecular imaging. More and more researches showed that QDs-based technology may become a promising approach in cancer research. In this review, we focus on recent application of QDs in cancer diagnosis and treatment, including early detection of primary tumor such as ovarian cancer, breast cancer, prostate cancer an...

  5. Current Good Manufacturing Practice Production of an Oncolytic Recombinant Vesicular Stomatitis Viral Vector for Cancer Treatment

    Science.gov (United States)

    Meseck, M.; Derecho, I.; Lopez, P.; Knoblauch, C.; McMahon, R.; Anderson, J.; Dunphy, N.; Quezada, V.; Khan, R.; Huang, P.; Dang, W.; Luo, M.; Hsu, D.; Woo, S.L.C.; Couture, L.

    2011-01-01

    Abstract Vesicular stomatitis virus (VSV) is an oncolytic virus currently being investigated as a promising tool to treat cancer because of its ability to selectively replicate in cancer cells. To enhance the oncolytic property of the nonpathologic laboratory strain of VSV, we generated a recombinant vector [rVSV(MΔ51)-M3] expressing murine gammaherpesvirus M3, a secreted viral chemokine-binding protein that binds to a broad range of mammalian chemokines with high affinity. As previously reported, when rVSV(MΔ51)-M3 was used in an orthotopic model of hepatocellular carcinoma (HCC) in rats, it suppressed inflammatory cell migration to the virus-infected tumor site, which allowed for enhanced intratumoral virus replication leading to increased tumor necrosis and substantially prolonged survival. These encouraging results led to the development of this vector for clinical translation in patients with HCC. However, a scalable current Good Manufacturing Practice (cGMP)-compliant manufacturing process has not been described for this vector. To produce the quantities of high-titer virus required for clinical trials, a process that is amenable to GMP manufacturing and scale-up was developed. We describe here a large-scale (50-liter) vector production process capable of achieving crude titers on the order of 109 plaque-forming units (PFU)/ml under cGMP. This process was used to generate a master virus seed stock and a clinical lot of the clinical trial agent under cGMP with an infectious viral titer of approximately 2 × 1010 PFU/ml (total yield, 1 × 1013 PFU). The lot has passed all U.S. Food and Drug Administration-mandated release testing and will be used in a phase 1 clinical translational trial in patients with advanced HCC. PMID:21083425

  6. Current good manufacturing practice production of an oncolytic recombinant vesicular stomatitis viral vector for cancer treatment.

    Science.gov (United States)

    Ausubel, L J; Meseck, M; Derecho, I; Lopez, P; Knoblauch, C; McMahon, R; Anderson, J; Dunphy, N; Quezada, V; Khan, R; Huang, P; Dang, W; Luo, M; Hsu, D; Woo, S L C; Couture, L

    2011-04-01

    Vesicular stomatitis virus (VSV) is an oncolytic virus currently being investigated as a promising tool to treat cancer because of its ability to selectively replicate in cancer cells. To enhance the oncolytic property of the nonpathologic laboratory strain of VSV, we generated a recombinant vector [rVSV(MΔ51)-M3] expressing murine gammaherpesvirus M3, a secreted viral chemokine-binding protein that binds to a broad range of mammalian chemokines with high affinity. As previously reported, when rVSV(MΔ51)-M3 was used in an orthotopic model of hepatocellular carcinoma (HCC) in rats, it suppressed inflammatory cell migration to the virus-infected tumor site, which allowed for enhanced intratumoral virus replication leading to increased tumor necrosis and substantially prolonged survival. These encouraging results led to the development of this vector for clinical translation in patients with HCC. However, a scalable current Good Manufacturing Practice (cGMP)-compliant manufacturing process has not been described for this vector. To produce the quantities of high-titer virus required for clinical trials, a process that is amenable to GMP manufacturing and scale-up was developed. We describe here a large-scale (50-liter) vector production process capable of achieving crude titers on the order of 10(9) plaque-forming units (PFU)/ml under cGMP. This process was used to generate a master virus seed stock and a clinical lot of the clinical trial agent under cGMP with an infectious viral titer of approximately 2 × 10(10) PFU/ml (total yield, 1 × 10(13) PFU). The lot has passed all U.S. Food and Drug Administration-mandated release testing and will be used in a phase 1 clinical translational trial in patients with advanced HCC.

  7. Optimizing therapy for radioactive iodine-refractory differentiated thyroid cancer: Current state of the art and future directions

    OpenAIRE

    Dadu, R.; Cabanillas, M.E.

    2012-01-01

    The majority of patients with differentiated thyroid cancer are cured with standard primary treatments including surgery, radioactive iodine and TSH suppression. A small proportion of patients who develop radioactive iodine-refractory metastatic disease have few treatment options. Recent discovery of the molecular mechanisms that contribute to thyroid cancer tumorigenesis and its progression have revealed key targets that are currently being evaluated in clinical trials. In the last decade se...

  8. Manual therapy for chronic obstructive airways disease: a systematic review of current evidence.

    Science.gov (United States)

    Heneghan, Nicola R; Adab, Peymane; Balanos, George M; Jordan, Rachel E

    2012-12-01

    Chronic obstructive pulmonary disease (COPD) is a growing global problem. Despite mounting evidence of significant co morbidity including musculoskeletal changes, evidenced based non pharmacological management approaches are limited to smoking cessation and pulmonary rehabilitation. Existing evidence suggests manual therapy may be beneficial in the management of COPD. A systematic review was conducted of key databases up until May 2010. Studies were included if they were RCTs or pre/post study designs testing an MT intervention and included a physiological measure of lung function. Descriptive results were collated. Pooling of data and meta-analysis was not possible due to heterogeneity in key characteristics. From 3086 articles 24 full text articles were evaluated, resulting in 7 included studies (5 RCTs, 2 pre-post studies) from 2 countries. Of all COPD subjects (n = 131) interventions included; osteopathic manipulative therapy (OMT) (n = 100), massage (n = 5), muscle stretching (n = 14), and passive movements (n = 12). Of the 7 included studies, 6 had high risk of bias with many design/reporting faults, with only one OMT study (n = 25) being evaluated as low risk of bias. In this study, performance based measures of pulmonary function (FEV1, FVC) changed minimally (reported measures for 'improved health' and 'breathing difficulty' however did improve following OMT compared to the control. Evidence for MT as an adjunctive management approach for COPD is lacking. More exploratory research is first required to better understand the nature and extent of changes in the musculoskeletal system in patients with COPD and their possible relationship with pulmonary function. PMID:22703901

  9. Mindfulness-Based Cognitive Therapy: Further Issues in Current Evidence and Future Research

    Science.gov (United States)

    Williams, J. Mark G.; Russell, Ian; Russell, Daphne

    2008-01-01

    The authors respond to the article by H. F. Coelho, P. H. Canter, and E. Ernst (2007), which reviewed the current status of mindfulness-based cognitive therapy (MBCT). First, they clarify the randomization procedures in the 2 main MBCT trials. Second, they report posttreatment and follow-up data to show that trial participants allocated to…

  10. Income Inequality and Health Status in the United States: Evidence from the Current Population Survey.

    Science.gov (United States)

    Mellor, Jennifer M.; Milyo, Jeffrey

    2002-01-01

    Current Population Survey data on self-reported health status and income for the general population and those in poverty were analyzed. No consistent association was found between income inequality and individual health status. Previous findings of such an association were attributed to ecological fallacy or failure to control for individual…

  11. Dietary prevention of allergic disease in children : Are current recommendations really based on good evidence?

    NARCIS (Netherlands)

    Brand, Paul L. P.; Vlieg-Boerstra, Berber J.; Dubois, Anthony E. J. .

    2007-01-01

    We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (Such as the diagnosis of eczema). In addition,

  12. Non-front-fanged colubroid snakes: a current evidence-based analysis of medical significance.

    Science.gov (United States)

    Weinstein, Scott A; White, Julian; Keyler, Daniel E; Warrell, David A

    2013-07-01

    Non-front-fanged colubroid snakes (NFFC; formerly and artificially taxonomically assembled as "colubrids") comprise about 70% of extant snake species and include several taxa now known to cause lethal or life threatening envenoming in humans. Although the medical risks of bites by only a handful of species have been documented, a growing number of NFFC are implicated in medically significant bites. The majority of these snakes have oral products (Duvernoy's secretions, or venoms) with unknown biomedical properties and their potential for causing harm in humans is unknown. Increasingly, multiple NFFC species are entering the commercial snake trade posing an uncertain risk. Published case reports describing NFFC bites were assessed for evidence-based value, clinical detail and verified species identification. These data were subjected to meta-analysis and a hazard index was generated for select taxa. Cases on which we consulted or personally treated were included and subjected to the same assessment criteria. Cases involving approximately 120 species met the selection criteria, and a small subset designated Hazard Level 1 (most hazardous), contained 5 species with lethal potential. Recommended management of these cases included antivenom for 3 species, Dispholidus typus, Rhabdophis tiginis, Rhabdophis subminiatus, whereas others in this subset without commercially available antivenoms (Thelotornis spp.) were treated with plasma/erythrocyte replacement therapy and supportive care. Heparin, antifibrinolytics and/or plasmapheresis/exchange transfusion have been used in the management of some Hazard Level 1 envenomings, but evidence-based analysis positively contraindicates the use of any of these interventions. Hazard Level 2/3 species were involved in cases containing mixed quality data that implicated these taxa (e.g. Boiga irregularis, Philodryas olfersii, Malpolon monspessulanus) with bites that caused rare systemic effects. Recommended management may include use of

  13. Working conditions and health among employees at information technology - enabled services: A review of current evidence

    Directory of Open Access Journals (Sweden)

    Kesavachandran C

    2006-07-01

    Full Text Available Workers in information technology (IT - enabled services like business process outsourcing and call centers working with visual display units are reported to have various health and psycho social disorders. Evidence from previously published studies in peer- reviewed journals and internet sources were examined to explore health disorders and psycho-social problems among personnel employed in IT-based services, for a systematic review on the topic. In addition, authors executed a questionnaire- based pilot study. The available literature and the pilot study, both suggest health disorders and psychosocial problems among workers of Business Process Outsourcing. The details are discussed in the review.

  14. Epidemiological evidence of a relationship between type-1 diabetes mellitus and cancer: a review of the existing literature.

    OpenAIRE

    Gordon-Dseagu, V. L.; Shelton, N.; Mindell, J. S.

    2013-01-01

    This review explores the epidemiological evidence relating to type-1 diabetes (T1DM) and cancer incidence and mortality. Mortality rates among those with T1DM are higher in every age group compared with the general population; the majority of this mortality is due to factors related to the consequences of diabetes, such as cardiovascular and renal disease. For over 100 years, researchers have explored the relationships between diabetes and cancer and although there is now a large body of work...

  15. How to Treat a Signal? Current Basis for RET-Genotype-Oriented Choice of Kinase Inhibitors for the Treatment of Medullary Thyroid Cancer.

    Science.gov (United States)

    Prazeres, Hugo; Torres, Joana; Rodrigues, Fernando; Couto, Joana P; Vinagre, João; Sobrinho-Simões, Manuel; Soares, Paula

    2011-01-01

    The significance of RET in thyroid cancer comes from solid evidence that, when inherited, an RET activating mutation primes C-cells to transform into medullary carcinomas. Moreover, environmental exposure to radiation also induces rearranged transforming RET "isoforms" that are found in papillary thyroid cancer. The RET gene codes for a tyrosine kinase receptor that targets a diverse set of intracellular signaling pathways. The nature of RET point mutations predicts differences in the mechanisms by which the receptor becomes activated and correlates with different forms of clinical presentation, age of onset, and biological aggressiveness. A number of RET-targeting Tyrosine Kinase Inhibitors (TKIs) are currently undergoing clinical trials to evaluate their effectiveness in the treatment of thyroid cancer, and it is conceivable that the RET genotype may also influence response to these compounds. The question that now emerges is whether, in the future, the rational for treatment of refractory thyroid cancer will be based on the management of an abnormal RET signal. In this paper we address the RET-targeting TKIs and review studies about the signaling properties of distinct RET mutants as a means to predict response and design combinatorial therapies for the soon to be available TKIs. PMID:21765992

  16. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  17. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  18. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

    Science.gov (United States)

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-01-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  19. The Role of Adiponectin in Cancer: A Review of Current Evidence

    OpenAIRE

    Dalamaga, Maria; Diakopoulos, Kalliope N.; Mantzoros, Christos S.

    2012-01-01

    Excess body weight is associated not only with an increased risk of type 2 diabetes and cardiovascular disease (CVD) but also with various types of malignancies. Adiponectin, the most abundant protein secreted by adipose tissue, exhibits insulin-sensitizing, antiinflammatory, antiatherogenic, proapoptotic, and antiproliferative properties. Circulating adiponectin levels, which are determined predominantly by genetic factors, diet, physical activity, and abdominal adiposity, are decreased in p...

  20. Respiratory medicines for children: current evidence, unlicensed use and research priorities

    DEFF Research Database (Denmark)

    Smyth, A R; Barbato, A; Beydon, N;

    2010-01-01

    This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe off-licence use, research priorities and ongoing studies. Off-licence and off-label prescribing in children is widespread and potent......This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe off-licence use, research priorities and ongoing studies. Off-licence and off-label prescribing in children is widespread...... and potentially harmful. Research areas in asthma include novel formulations and regimens, and individualised prescribing. In cystic fibrosis, future studies will focus on screened infants and robust outcome measures are needed. Other areas include new enzyme and antibiotic formulations and the basic defect....... Research into pneumonia should include evaluation of new antibacterials and regimens, rapid diagnostic tests and, in pleural infection, antibiotic penetration, fibrinolytics and surveillance. In uncommon conditions, such as primary ciliary dyskinesia, congenital pulmonary abnormalities or neuromuscular...