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Sample records for clinical stage ia

  1. Cervical Cancer Stage IA

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    ... hyphen, e.g. -historical Searches are case-insensitive Cervical Cancer Stage IA Add to My Pictures View /Download : ... 1500x1200 View Download Large: 3000x2400 View Download Title: Cervical Cancer Stage IA Description: Stage IA1 and IA2 cervical ...

  2. Clinical significance of preoperative carcinoembryonic antigen level in patients with clinical stage IA non-small cell lung cancer

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    Suda, Takashi; Hachimaru, Ayumi; Tochii, Daisuke; Tochii, Sachiko; Takagi, Yasushi

    2017-01-01

    Background The objective of this study was to assess the preoperative serum carcinoembryonic antigen (CEA) level in patients with clinical stage IA non-small cell lung cancer (NSCLC) and to evaluate its clinical significance. Methods Between January 2005 and December 2014, a total of 378 patients with clinical stage IA NSCLC underwent complete resection with systematic node dissection. The survival rate was estimated starting from the date of surgery to the date of either death or the last follow-up by the Kaplan-Meier method. Univariate analyses by log-rank tests were used to determine prognostic factors. Cox proportional hazards ratios were used to identify independent predictors of poor prognosis. Clinicopathological predictors of lymph node metastases were evaluated by logistic regression analyses. Results The 5-year survival rate of patients with an elevated preoperative serum CEA level was significantly lower than that of patients with a normal CEA level (75.5% vs. 87.7%; P=0.02). However, multivariate analysis did not show the preoperative serum CEA level to be an independent predictor of poor prognosis. Postoperative pathological factors, including lymphatic permeation, visceral pleural invasion, and lymph node metastases, tended to be positive in patients with an elevated preoperative serum CEA level. In addition, the CEA level was a statistically significant independent clinical predictor of lymph node metastases. Conclusions The preoperative serum CEA level was not an independent predictor of poor prognosis in patients with pathological stage IA NSCLC but was an important clinical predictor of tumor invasiveness and lymph node metastases in patients with clinical stage IA NSCLC. Therefore, measurement of the preoperative serum CEA level should be considered even for patients with early-stage NSCLC.

  3. Clinical Outcomes in International Federation of Gynecology and Obstetrics Stage IA Endometrial Cancer With Myometrial Invasion Treated With or Without Postoperative Vaginal Brachytherapy

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    Diavolitsis, V. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Rademaker, A. [Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Lurain, J.; Hoekstra, A. [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Strauss, J. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Small, W., E-mail: wsmall@nmff.org [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)

    2012-10-01

    Purpose: To assess the clinical outcomes of patients with Stage IA endometrial cancer with myometrial invasion treated with postoperative vaginal brachytherapy (VBT) with those who received no adjuvant therapy (NAT). Methods and Materials: All patients treated with hysterectomy for endometrial cancer at Northwestern Memorial Hospital between 1978 and 2005 were identified. Those patients with Stage IA disease with myometrial invasion who were treated with VBT alone or NAT were identified and included in the present analysis. Results: Of 252 patients with Stage IA endometrial cancer with superficial (<50%) myometrial invasion who met the inclusion criteria, 169 underwent VBT and 83 received NAT. The median follow-up in the VBT and NAT groups was 103 and 61 months, respectively. In the VBT group, 56.8% had Grade 1, 37.9% had Grade 2, and 5.3% had Grade 3 tumors. In the NAT group, 75.9%, 20.5%, and 3.6% had Grade 1, 2, and 3 tumors, respectively. Lymphatic or vascular space invasion was noted in 12.4% of the VBT patients and 5.6% of the NAT patients. The 5-year overall survival rate was 95.5%. The 5-year recurrence-free survival rate was 92.4% for all patients, 94.4% for the VBT group, and 87.4% for the NAT group (p = NS). Of the 169 VBT patients and 83 NAT patients, 8 (4.7%) and 6 (7.2%) developed recurrent disease. One vaginal recurrence occurred in the VBT group (0.6%) and three in the NAT group (3.8%). Recurrences developed 2-102 months after surgical treatment. Two of the four vaginal recurrences were salvaged. No Grade 3 or higher acute or late radiation toxicity was noted. Conclusions: The use of postoperative VBT in patients with Stage I endometrial cancer with <50% myometrial invasion yielded excellent vaginal disease control and disease-free survival, with minimal toxicity.

  4. Radiologic Predictors for Clinical Stage IA Lung Adenocarcinoma with Ground Glass Components: A Multi-Center Study of Long-Term Outcomes.

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    Zhao Li

    Full Text Available This study was to define preoperative predictors from radiologic findings for the pathologic risk groups based on long-term surgical outcomes, in the aim to help guide individualized patient management.We retrospectively reviewed 321 consecutive patients with clinical stage IA lung adenocarcinoma with ground glass component on computed tomography (CT scanning. Pathologic diagnosis for resection specimens was based on the 2011 IASLC/ATS/ERS classification of lung adenocarcinoma. Patients were classified into different pathologic risk grading groups based on their lymph node status, local regional recurrence and overall survival. Radiologic characteristics of the pulmonary nodules were re-evaluated by reconstructed three-dimension CT (3D-CT. Univariate and multivariate analysis identifies independent radiologic predictors from tumor diameter, total volume (TV, average CT value (AVG, and solid-to-tumor (S/T ratio. Receiver operating characteristic curves (ROC studies were carried out to determine the cutoff value(s for the predictor(s. Univariate cox regression model was used to determine the clinical significance of the above findings.A total of 321 patients with clinical stage IA lung adenocarcinoma with ground glass components were included in our study. Patients were classified into two pathologic low- and high- risk groups based on their distinguished surgical outcomes. A total of 134 patients fell into the low-risk group. Univariate and multivariate analyses identified AVG (HR: 32.210, 95% CI: 3.020-79.689, P<0.001 and S/T ratio (HR: 12.212, 95% CI: 5.441-27.408, P<0.001 as independent predictors for pathologic risk grading. ROC curves studies suggested the optimal cut-off values for AVG and S/T ratio were-198 (area under the curve [AUC] 0.921, 2.9 (AUC 0.996 and 54% (AUC 0.907, respectively. The tumor diameter and TV were excluded for the low AUCs (0.778 and 0.767. Both the cutoff values of AVG and S/T ratio were correlated with pathologic

  5. Intravital Microscopy for Identifying Tumor Vessels in Patients With Stage IA-IV Melanoma That is Being Removed by Surgery

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    2016-01-13

    Recurrent Melanoma; Stage IA Skin Melanoma; Stage IB Skin Melanoma; Stage IIA Skin Melanoma; Stage IIB Skin Melanoma; Stage IIC Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma; Stage IV Skin Melanoma

  6. Clinical description of hemodialysis headache in end-stage renal disease patients Caracterização clínica da cefaléia da diálise em pacientes renais crônicos

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    Alan Chester Feitosa de Jesus

    2009-12-01

    Full Text Available BACKGROUND: Hemodialysis (HD-related headaches are a common complaint of patients undergoing this procedure. OBJECTIVE: To determine the frequency and clinical characteristics of headache in patients undergoing HD and to discuss their diagnostic criteria. METHOD: The present study assessed, in a prospective manner, a series of patients consulting at a HD center in Aracaju, Sergipe, Brazil, from November 2007 to January 2008. Only patients with HD-related headaches without previous history of primary headache were diagnosed as isolated HD headache (HDH. RESULTS: Headache was reported by 76.1% of the patients studied. Prior to beginning dialysis, 47.9% had migraine without aura, 6.7% migraine with aura, 0.6% hemiplegic migraine, 5% episodic tension-type headache, and 2.5% migraine and tension-type headache. HDH was diagnosed in 6.7% of the patients, the most prevalent features being diffuse or temporal region location, bilateral headache, throbbing nature, and moderate severity. Seven patients with headaches between the sessions were not classified. CONCLUSION: While the pathophysiology of HDH is unknown, to diagnose patients with HDH or other possible HD-related headaches remains a challenge.Cefaléias relacionadas ao programa de hemodiálise é uma queixa comum. OBJETIVO: Determinar freqüência e características clínicas das cefaléias em pacientes em regime de hemodiálise e discutir critérios diagnósticos. MÉTODO: Foi feita uma avaliação clínica prospectiva de pacientes cefalêicos em um serviço de hemodiálise em Aracaju, Sergipe, Brasil, de novembro de 2007 a janeiro de 2008. Apenas pacientes sem antecedente de cefaléia primária receberam diagnóstico de cefaléia da diálise isolada. RESULTADOS: Cefaléia esteve presente em 76,1% dos pacientes estudados. Como antecedente de cefaléia, 47,9% tinham migrânea sem aura, 6,7% migrânea com aura, 0,6% migrânea hemiplégica, 5,5% cefaléia tensional episódica, e 2,5% associação de

  7. Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2-IIA cervical cancer

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    Park, Jung Jae; Kim, Chan Kyo; Park, Sung Yoon; Park, Byung Kwan [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea, Republic of); Kim, Bohyun [Mayo Clinic College of Medicine, Department of Radiology, Rochester, MN (United States)

    2014-05-15

    To investigate the value of diffusion-weighted imaging (DWI) in evaluating parametrial invasion (PMI) in stage IA2-IIA cervical cancer. A total of 117 patients with stage IA2-IIA cervical cancer who underwent preoperative MRI and radical hysterectomy were included in this study. Preoperative clinical variables and MRI variables were analysed and compared between the groups with and without pathologically proven PMI. All variables except age were significantly different between patients with and without pathologic PMI (P < 0.05). All variables except squamous cell carcinoma (SCC) antigen were also significantly correlated with pathologic PMI on univariate analysis (P < 0.05). Multivariate analysis indicated that PMI on MRI (P < 0.001) and tumour apparent diffusion coefficient (ADC) (P = 0.029) were independent predictors of pathologic PMI. Area under the curve of PMI on MRI increased significantly from 0.793 to 0.872 when combined with tumour ADC (P = 0.002). When PMI on MRI was further stratified by tumour ADC, the false negative rate was 2.0 % (1/49). In stage IA2-IIA cervical cancer, tumour ADC and PMI on MRI seem to be independent predictors of pathologic PMI. Combining the two predictors improved the diagnostic performance of identifying patients at low risk of pathologic PMI. (orig.)

  8. The value of loop electrosurgical conization in the treatment of stage IA1 microinvasive carcinoma of the uterine cervix.

    NARCIS (Netherlands)

    Bekkers, R.L.M.; Keijser, K.G.G.; Bulten, J.; Hanselaar, A.G.J.M.; Schijf, C.P.T.; Boonstra, H.; Massuger, L.F.A.G.

    2002-01-01

    The objective of this study is to assess the value of Loop Electrosurgical Conization (LEC) in the treatment of stage IA1 microinvasive squamous cell carcinoma (MIC) of the uterine cervix. Retrospectively, 82 patients with FIGO stage IA1 MIC, primarily treated with LEC on see and treat basis, were a

  9. Survival after stage IA endometrial cancer; can follow-up be altered?

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    Lajer, Henrik; Elnegaard, Sandra; Christensen, René D;

    2012-01-01

    IA (1988 classification) endometrial cancer patients prospectively included between 1986 and 1999. All patients had total abdominal hysterectomy and bilateral salpingo-oophorectomy without adjuvant therapy. Methods. The patient and the disease characteristics were drawn from the DEMCA database....... Of these recurrences, 15 of 23 (65%) were vaginal. Death from recurrence was observed in nine of 23 (39%) patients, and five of these nine had vaginal recurrences. Conclusions. Women with FIGO stage IA endometrial cancer have a very high disease-specific five year survival. Survival was related to histopathology...

  10. The chimeric transcript RUNX1-GLRX5: a biomarker for good postoperative prognosis in Stage IA non-small-cell lung cancer.

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    Ishikawa, Rie; Amano, Yosuke; Kawakami, Masanori; Sunohara, Mitsuhiro; Watanabe, Kousuke; Kage, Hidenori; Ohishi, Nobuya; Yatomi, Yutaka; Nakajima, Jun; Fukayama, Masashi; Nagase, Takahide; Takai, Daiya

    2016-02-01

    Stage IA non-small-cell lung cancer cases have been recognized as having a low risk of relapse; however, occasionally, relapse may occur. To predict clinical outcome in Stage IA non-small-cell lung cancer patients, we searched for chimeric transcripts that can be used as biomarkers and identified a novel chimeric transcript, RUNX1-GLRX5, comprising RUNX1, a transcription factor, and GLRX5. This chimera was detected in approximately half of the investigated Stage IA non-small-cell lung cancer patients (44/104 cases, 42.3%). Although there was no significant difference in the overall survival rate between RUNX1-GLRX5-positive and -negative cases (P = 0.088), a significantly lower relapse rate was observed in the RUNX1-GLRX5-positive cases (P = 0.039), indicating that this chimera can be used as a biomarker for good prognosis in Stage IA patients. Detection of the RUNX1-GLRX5 chimeric transcript may therefore be useful for the determination of a postoperative treatment plan for Stage IA non-small-cell lung cancer patients.

  11. Use of high-resolution computed tomography and positron emission tomography/computed tomography in the management of stage IA adenocarcinoma.

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    Miyata, Yoshihiro; Tsutani, Yasuhiro; Okada, Morihito

    2012-01-01

    Preoperative determination of malignant behavior is critical in choosing suitable therapeutic strategies such as sublobar resection for patients with small lung cancers. The aim of present review was to evaluate high-resolution computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography as tools for management of clinical stage IA adenocarcinoma.

  12. Silicon Phthalocyanine 4 and Photodynamic Therapy in Stage IA-IIA Cutaneous T-Cell Non-Hodgkin Lymphoma

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    2015-12-03

    Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Stage I Cutaneous T-cell Non-Hodgkin Lymphoma; Stage IA Mycosis Fungoides/Sezary Syndrome; Stage IB Mycosis Fungoides/Sezary Syndrome; Stage II Cutaneous T-cell Non-Hodgkin Lymphoma; Stage IIA Mycosis Fungoides/Sezary Syndrome

  13. Tamaño del tumor y supervivencia en carcinoma de pulmón, estadio IA Tumor size and survival in lung cancer, stage IA

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    Gustavo Lyons

    2008-02-01

    (NSCLC. Clinical records of 79 patients with stage IA NSCLC were reviewed. In 34.4% of patients (n = 28 size was ≤ 1.5 cm. Surgical mortality was 1.3%. Disease recurrence was noted in 19%. Patients with tumors ≤ 15 mm had a significantly higher 5-year survival (95% CI:0.05 vs. 77% CI: 0.07 in > 15mm group. Disease-free survival was 95% for tumors less than 15 mm vs. 72% in larger tumors. Using Cox Multivariate analysis, the most determinant factor for higher risk of mortality was size >15 mm (relative risk 25.9, IC: 2.3-292, p = 0.004. The independent influence of tumor size in stage IA NSCLC may have practical implications with regards to proposals for screening asymptomatic individuals at high risk for lung cancer.

  14. Presentation and management of a stage Ia lung cancer patient with a paraneoplastic factor VIII inhibitor.

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    Laselle, Brooks T; Boggio, Lisa N; Blum, Matthew G

    2006-01-01

    Acquired inhibitors to clotting factors most commonly involve factor VIII and are associated with autoimmune disease. Factor VIII inhibitors can cause severe spontaneous and iatrogenic bleeding that is difficult to manage. Factor VIII inhibitors are rarely associated with solid tumors and only three cases of adenocarcinoma of the lung have been reported. This report describes the multidisciplinary management of a factor VIII inhibitor-producing stage Ia lung adenocarcinoma that ultimately resulted in complete resectability.

  15. Implementing the IA stage and developing an instrument to assess the fidelity of critical time interventional: task shifting

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    Tatiana Fernandes Carpinteiro Silva

    2014-10-01

    Full Text Available One strategy that has been used for treat patients with mental health disorder is the implementation of psychosocial interventions. Like the development of a new drug, which requires safety studies before efficacy assessment, the psychosocial interventions should be implemented following defined stages, with the objective of increase the validity and reliability of such interventions. These stages are IA (pre-pilot, IB (pilot study, II (randomized clinical trial and III (additional studies. This study proposes a description of all activities carried out in implementation of the pre-pilot (IA Critical Time Intervention – Task Shifting (CTI-TS, including the development of manuals and the development of an instrument to assess fidelity to the original protocol. As a result, were performed the adaptation of instruments to be used in the pilot study, the adaptation of CTI-TS manual to Brazilian context, the adaptation of the agents CTI-TS training manual, as well the development of the CTI-TS assessment scale fidelity and its instruction manual. This allows multicentric studies conducted in different contexts could be performed avoiding biases. Considering that Brazil is a country that lacks resources allocated to mental care, it is expected that more psychosocial interventions can be implemented, since it was possible to develop the implementation process according to the methods recommended by the international scientific literature.

  16. Predictive value of 18F-FDG PET and CT morphologic features for recurrence in pathological stage IA non-small cell lung cancer.

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    Ko, Kai-Hsiung; Hsu, Hsian-He; Huang, Tsai-Wang; Gao, Hong-Wei; Cheng, Cheng-Yi; Hsu, Yi-Chih; Chang, Wei-Chou; Chu, Chi-Ming; Chen, Jia-Hong; Lee, Shih-Chun

    2015-01-01

    Patients with pathological stage IA non-small cell lung cancer (NSCLC) may relapse despite complete surgical resection without lymphovascular invasion. A method of selecting a high-risk group for adjuvant therapy is necessary. The aim of this study was to assess the predictive value of F-fluorodeoxyglucose (FDG) uptake and the morphologic features of computed tomography (CT) for recurrence in pathological stage IA NSCLC.One hundred forty-five patients with pathological stage IA NSCLC who underwent pretreatment with FDG positron emission tomography and CT evaluations were retrospectively enrolled. The associations among tumor recurrence and patient characteristics, maximal standard uptake value (SUVmax) of primary tumors, and CT imaging features were investigated using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of these factors.Tumor recurrence developed in 21 (14.5%) of the 145 patients, and the 5-year recurrence-free survival rate was 77%. The univariate analysis demonstrated that SUVmax, the grade of histological differentiation, tumor size, and the presence of bronchovascular bundle thickening were significant predictive factors (P recurrence in the multivariate analysis. The use of this predictive model yielded a greater area under the ROC curve (0.877), which suggests good discrimination.The combined evaluation of FDG uptake and CT morphologic features may be helpful in the prediction of recurrence in patients with pathological stage IA NSCLC and in the stratification of a high-risk group for postoperative adjuvant therapy or prospective clinical trials.

  17. The Influence of Cyst Emptying, Lymph Node Resection and Chemotherapy on Survival in Stage IA and IC1 Epithelial Ovarian Cancer

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    Rosendahl, Mikkel; Mosgaard, Berit Jul; Høgdall, Claus

    2016-01-01

    AIM: To determine if survival in stage I ovarian cancer is influenced by cyst emptying, lymph node resection and chemotherapy. PATIENTS AND METHODS: A survival analysis of 607 patients with ovarian cancer in stage IA, IA with cyst emptying (IAempty) and IC1 was performed. RESULTS......: There was no difference in five-year survival between IA (87%) and IC1 (87%) (p=0.899), between IA and IAempty (86%) (p=0.500) nor between IA+IAempty (87%) and IC1 without IAempty (84%) (p=0.527). Five-year survival rate (5YSR) was significantly higher after lymph node resection in stage IA (94% vs. 85%; p=0.01) and IA......+IC1 (93% vs. 85%; p=0.004). In multivariate analysis, lymph node resection improved prognosis significantly for all sub-stages, whereas stage and chemotherapy did not affect survival. CONCLUSION: In stage IA ovarian cancer, controlled cyst emptying without spill does not worsen prognosis. Lymph node...

  18. Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer.

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    Hwang, Ji Young; Kim, Da Hee; Bae, Hyo Sook; Kim, Mi-La; Jung, Yong Wook; Yun, Bo Seong; Seong, Seok Ju; Shin, Eunah; Kim, Mi Kyoung

    2017-05-01

    The aim of this study was to evaluate the oncologic and pregnancy outcomes of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with grade 2-differentiated stage IA endometrial adenocarcinoma who wish to preserve fertility. We retrospectively reviewed the medical records of patients with grade 2 stage IA endometrial adenocarcinoma who had received fertility-sparing treatment at CHA Gangnam Medical Center between 2011 and 2015. All of the patients were treated with combined oral MPA (500 mg/d)/LNG-IUS, and follow-up dilatation and curettage were performed every 3 months. A total of 5 patients were included in the study. The mean age was 30.4 ± 5.3 years (range, 25-39 years). After a mean treatment duration of 11.0 ± 6.2 months (range, 6-18 months), complete response (CR) was shown in 3 of the 5 patients, with partial response (PR) in the other 2 patients. One case of recurrence was reported 14 months after achieving CR. This patient was treated again with combined oral MPA/LNG-IUS and achieved CR by 6 months. The average follow-up period was 44.4 ± 26.2 months (range, 12-71 months). There were no cases of progressive disease. No treatment-related complications arose. Combined oral MPA/LNG-IUS treatment is considered to be a reasonably effective fertility-sparing treatment of grade 2 stage IA endometrial cancer. Although our results are encouraging, it is preliminary and should be considered with experienced oncologists in well-defined protocol and with close follow-up.

  19. Treatment preferences in stage IA and IB testicular seminoma: multicenter study of Anatolian Society of Medical Oncology.

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    Bilici, Ahmet; Ozturk, Turkan; Turkmen, Esma; Odabas, Hatice; Cihan, Sener; Selcukbiricik, Fatih; Erdogan, Bulent; Urakci, Zurat; Kandemir, Nurten; Bayoglu, Ibrahim Vedat; Demirci, Umut; Duran, Ayse Ocak; Sendur, Mehmet Ali Nahit; Yavuzer, Dilek; Harputluoglu, Hakan; Kavgaci, Halil; Gumus, Mahmut

    2015-10-01

    Approximately 75 % of patients with testicular seminoma present with stage I disease, and the probability of long-term survival approaches 100 %. However, the standard adjuvant treatment for stage I seminoma patients remains controversial, and there is no uniform consensus in the literature. The present study was performed to evaluate treatment preference and outcomes for men with stage I testicular seminoma. From 1997 to 2013, 282 patients with histologically confirmed stage IA and IB testicular seminoma who underwent orchiectomy were included. The outcomes of three management options and survivals were retrospectively analyzed. The prognostic significance of risk factors for relapse on survival was evaluated by univariate and multivariate analysis; in addition, the factors predicting relapse were also evaluated by logistic regression analysis. Of the 282 patients with stage I seminoma, 130 (46.1) received adjuvant radiotherapy (RT), 80 (28.4 %) were treated with adjuvant carboplatin, while the remaining 72 patients (25.5 %) underwent surveillance. At the time of analysis, the median follow-up period of 38.5 months; relapses were observed in 16 patients (22.3 %) on surveillance, in one patient (1.2 %) treated with adjuvant carboplatin and in ten patients (%7.7) who received adjuvant RT. The 5-year disease-free survival (DFS) rate for patients who underwent surveillance was worse than those of patients treated with adjuvant carboplatin and RT (64.2 vs. 97.7 vs. 91.9 %, respectively; p seminoma after orchiectomy. Moreover, the treatment strategy is an important prognostic indicator for DFS and a predictive factor for relapse. Although adjuvant treatment, especially carboplatin, seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still feasible and the preferred management option after radical orchiectomy in men with stage I seminoma. More reliable predictive factors are needed to make treatment decisions.

  20. Clinical TNM staging of gastrointestinal cancer

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    Castrup, W.

    1987-08-01

    Computed tomography has decisively improved determination of clinical stage of esophagus- and rectumtumors. This method enables to diagnose and localize tumorextension to adjacent organs and metastatic lymphnode involvement in most cases without additional invasive imaging procedure. In tumors of the stomach, small bowel and colon CT is rarely used.

  1. Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives.

    Science.gov (United States)

    Vitale, Salvatore Giovanni; Rossetti, Diego; Tropea, Alessandro; Biondi, Antonio; Laganà, Antonio Simone

    2017-02-10

    Fertility-sparing surgery (FSS) in reproductive-age patients affected by endometrial cancer (EC) gained growing attention in the last decade, although the first reports were already published in 1990-2000s. Nevertheless, only few patients undergoing FSS for stage I, type I EC had been reported in each case series, without a robust multicenter study. In the available literature there are even fewer reported cases of conservative treatment of Stage IA and G2 EC. Considering these important gaps in our current knowledge, the purpose of this review was to summarize the available evidence about conservative treatments for stage IA type I and G2 EC, to improve the pretreatment counseling for reproductive-age patients. According to our overview, women who have low-risk disease (G1 or G2, endometrioid histotype confined to the endometrium) are candidates for progestin therapy. In addition, FSS could be considered a valid option for reproductive-aged patients with stage IA type I and G2 EC. Nevertheless, we solicit new trials to clarify the medium- and long-term outcomes in this kind of patients.

  2. The Number of Positive Pelvic Lymph Nodes and Multiple Groups of Pelvic Lymph Node Metastasis Influence Prognosis in Stage IA-IIB Cervical Squamous Cell Carcinoma

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    Yu Liu

    2015-01-01

    Full Text Available Background: Pelvic lymph node metastasis (LNM is an important prognostic factor in cervical cancer. Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers. Analyses of the effects of the number of positive lymph nodes (LNs, unilateral versus bilateral pelvic LNM and a single group versus multiple groups of pelvic LNM on survival and recurrence of cervical squamous cell carcinoma are still lacking. The study aimed to analyze the effects of the number of positive pelvic LNs and a single group versus multiple groups of pelvic LNM on survival and recurrence. Methods: We performed a retrospective review of 296 patients diagnosed with Stage IA-IIB cervical squamous cell carcinoma who received extensive/sub-extensive hysterectomy with pelvic lymphadenectomy/pelvic LN sampling at Peking University People′s Hospital from November 2004 to July 2013. Ten clinicopathological variables were evaluated as risk factors for pelvic LNM: Age at diagnosis, gravidity, clinical stage, histological grade, tumor diameter, lymph-vascular space involvement (LVSI, depth of cervical stromal invasion, uterine invasion, parametrial invasion, and neoadjuvant chemotherapy. Results: The incidence of pelvic LNM was 20.27% (60/296 cases. Pelvic LNM (P = 0.00 was significantly correlated with recurrence. Pelvic LNM (P = 0.00, the number of positive pelvic LNs (P = 0.04 and a single group versus multiple groups of pelvic LNM (P = 0.03 had a significant influence on survival. Multivariate analysis revealed that LVSI (P = 0.00, depth of cervical stromal invasion (P = 0.00 and parametrial invasion (P = 0.03 were independently associated with pelvic LNM. Conclusions: Patients with pelvic LNM had a higher recurrence rate and poor survival outcomes. Furthermore, more than 2 positive pelvic LNs and multiple groups of pelvic LNM appeared to identify patients with worse survival outcomes in node-positive IA-IIB cervical squamous cell carcinoma. LVSI

  3. Predictive Impact for Postoperative Recurrence of Preoperative Serum Krebs von den Lungen-6 Concentration in Pathologic Stage IA Non-Small Cell Lung Cancer.

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    Shoji, Fumihiro; Yamazaki, Koji; Kouso, Hidenori; Mori, Ryo; Takeo, Sadanori

    2016-05-01

    Although stage IA non-small cell lung cancer has an optimistic survival rate, up to 10% of these patients relapse after surgical procedures and die. We retrospectively analyzed clinicopathologic features of patients with stage IA non-small cell lung cancer to identify recurrence predictors and to investigate effects of preoperative serum Krebs von den Lungen-6 (PS-KL-6) concentrations. We selected 204 consecutive patients with stage IA non-small cell lung cancer treated from December 2003 to December 2009 for this study and tested their PS-KL-6 concentrations in univariate and multivariate Cox regression analyses of recurrence-free survival (RFS). High PS-KL-6 concentration (PS-KL6(High)) was significantly associated with sex (p = 0.0006), smoking status (p = 0.0438), histology (p = 0.0049), and postoperative recurrence (p = 0.0058). Both intratumoral blood vessel invasion (p = 0.0345) and PS-KL6(High) (p = 0.0021) were identified as independent predictors of shorter RFS. Relative risk of patients with PS-KL6(High) was 3.478 compared with patients with low PS-KL-6 concentration (PS-KL6(Low); 95% confidence interval: 1.576 to 8.013). Among patients with tumors larger than 2 cm (T1b), the PS-KL6(High) group had significantly shorter RFS than the PS-KL6(Low) group (p = 0.0040). PS-KL-6 concentration is a simple and novel predictor of recurrence in patients with stage IA non-small cell lung cancer and might help to identify patients who will need more careful follow-up among T1bN0M0 series. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Clinical challenges in the management of isolated GH deficiency type IA in adulthood.

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    Casteràs, Anna; Kratzsch, Jürgen; Ferrández, Angel; Zafón, Carles; Carrascosa, Antonio; Mesa, Jordi

    2014-01-01

    Isolated GH deficiency type IA (IGHDIA) is an infrequent cause of severe congenital GHD, often managed by pediatric endocrinologists, and hence few cases in adulthood have been reported. Herein, we describe the clinical status of a 56-year-old male with IGHDIA due to a 6.7 kb deletion in GH1 gene that encodes GH, located on chromosome 17. We also describe phenotypic and biochemical parameters, as well as characterization of anti-GH antibodies after a new attempt made to treat with GH. The height of the adult patient was 123 cm. He presented with type 2 diabetes mellitus, dyslipidemia, osteoporosis, and low physical and psychological performance, compatible with GHD symptomatology. Anti-GH antibodies in high titers and with binding activity (>101 IU/ml) were found 50 years after exposure to exogenous GH, and their levels increased significantly (>200 U/ml) after a 3-month course of 0.2 mg/day recombinant human GH (rhGH) treatment. Higher doses of rhGH (1 mg daily) did not overcome the blockade, and no change in undetectable IGF1 levels was observed (time, as well as pituitary hormones periodically assessed.

  5. Molecular typing of MRSA and of clinical Staphylococcus aureus isolates from Iaşi, Romania.

    Science.gov (United States)

    Monecke, Stefan; Müller, Elke; Dorneanu, Olivia Simona; Vremeră, Teodora; Ehricht, Ralf

    2014-01-01

    Romania is one of the countries with the highest prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the world. To obtain data on affiliation of MRSA to strains and clonal complexes and on the population of methicillin susceptible S. aureus (MSSA), clinical isolates from bloodstream infections, skin and soft tissue infections as well as from screening swabs were collected at hospitals in Ia?i, a city in the North-Eastern part of Romania. Isolates were characterised by microarray hybridisation. Nearly half of all isolates (47%), and about one third (34%) of bloodstream isolates were MRSA. The prevalence of the Panton-Valentine leukocidin (PVL) was also high (31% among MRSA, 14% among MSSA). The most common MRSA strain was a PVL-negative CC1-MRSA-IV that might have emerged locally, as a related MSSA was also common. PVL-positive CC8-MRSA-IV ("USA300") and PVL-negative ST239-like MRSA-III were also frequently found while other MRSA strains were only sporadically detected. Among MSSA, PVL-positive CC121 as well as PVL-negative CC1, CC22 and CC45 predominated. Although this study provides only a snapshot of S. aureus/MRSA epidemiology in Romania, it confirms the high burden of MRSA and PVL on Romanian healthcare settings.

  6. Clinical presentation and staging of Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Gallamini, Andrea; Hutchings, Martin; Ramadan, Safaa

    2016-01-01

    . The main body of the review will be dedicated to the recently published guidelines for lymphoma staging (including HL) agreed by the experts during the 12th International Congress for Malignant Lymphoma in Lugano. The recommendations of the panel on how to integrate flurodeoxyglucose positron emission......, sometimes HL is a subtle disease, difficult to diagnose for the paucity of symptoms, the absence of physical findings, or for concomitant immunologic disorders: a compete overview of the common and rare patterns of HL clinical presentation will be also offered. The future perspective of PET scan use...

  7. Trachelectomy for cancer of the cervix: dargent's operation. Vaginal hysterectomy for early cancer of the cervix stage IA1 and CIN III

    DEFF Research Database (Denmark)

    Ottosen, Christian

    2011-01-01

    Radical vaginal trachelectomy is today an established method of treating selected women with cervical cancer stage IA2 and IB1, with tumour size less than 2cm without precluding future childbearing. This technique has been used for more than 20 years with reassuring oncological safety and excellent...... obstetrical outcomes. The procedure is a combination of laparoscopy for pelvic lymphadenectomy and challenging classic vaginal surgery to resect the tumour, part of the parametrium and upper vagina. Complications are in the range of 8-13%. Recurrence and death occur in 5 and 3%, respectively, as good...

  8. Hereditary neuropathies: systematization and diagnostics (clinical case of hereditary motor and sensor neuropathy of the IA type

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    Kolokolova A.M.

    2016-09-01

    Full Text Available Aim: to study the value of routine methods (clinical symptoms, electrophysiological findings and results of DNA analysis in diagnostics of hereditary motor sensory neuropathy type IA in outpatient clinics. Material and Methods. The review of foreign literature is represented. The phenotypic polymorphism, genetic heterogeneity and the difficulties of diagnostics are identified. A family with hereditary motor sensory neuropathy of lAtype is presented, which was diagnosed on the base of available methods in outpatient practice (clinical symptoms, genealogical method, electro-physiological findings and DNA analysis results. Results. Routine algorithm (consistent valuation of clinical symptoms, neurophysiologic findings and the results of DNA analysis helped to verify the diagnosis of hereditary motor sensory neuropathy of lAtype in outpatient practice after more than 20 years of the onset of the disease. Conclusion. The neurologists of outpatient clinics and other specialists must be informed about the availability of diagnostics of hereditary diseases of nervous system.

  9. Application of CK19mRNA in Evaluating Sentinel Lymph Node Micrometastasis in Patients with Stage IA2-IB2 Cervical Cancer%CK19mRNA检测在判断IA2-IB2期宫颈癌前哨淋巴结微转移中的作用

    Institute of Scientific and Technical Information of China (English)

    马永静; 熊英; 刘瑞

    2012-01-01

    Objective To detect expression of CK19mRNA in sentinel lymph nodes in patients with stage IA2 - IB2 cervical cancer, and to explore if CK19mRNA play an important role in judging lymph node micro-metastasis in early stage cervical cancer. Methods CK19mRNA was detected in sentinel lymph nodes and no - sentinel lymph nodes of stage IA2 - IB2 squamous cell cervical carcinoma by FQ - PC R( fluorescent quanti-tation - polymerase chain reaction). The positive rate in sentinel lymph nodes by FQ - PCR was compared with histopathologic diagnosis rate. The relation between CK19mRNA and the patients clinical and pathological parameter was analysed. The positive rate of CK19mRNA was compared in sentinel lymph nodes and no -sentinel lymph nodes. Results 86 sentinel lymph nodes were detected in 30 stage IA2 - IB2 cervical cancer. The positive rate of CK19mRNA in sentinel lymph nodes by FQ - PCR(32. 6% ) was significantly higher than the diagnosis rate of histopathology ( 12. 8% ) . Expression of CK19mRNA in sentinel lymph nodes was concerned with clinical stage, deep infiltration of interstitial substance, tumor size and lymph vascular space involvement (P >0.05). The positive rate of CK19mRNA in sentinel lymph nodes(32.6% ) was significantly higher than that in no - sentinel lymph nodes(4.5% ) (P < 0. 05). Conclusion CK19mRNA is better than histopathology in detecting sentinel lymph node micrometastasis of IA2 - IB2 cervical cancer. Therefore, it can evaluate prognosis of patients more exactly and guide adjunctive treatment.%目的 检测CK19mRNA在IA2-IB2期宫颈癌前哨淋巴结中的表达,探讨其在判断早期宫颈癌淋巴结微转移中的作用.方法 应用荧光定量PCR检测CK19mRNA在IA2-IB2期宫颈鳞癌前哨及非前哨淋巴结中的表达,比较CK19mRNA检测与常规组织病理学检查检出前哨淋巴结微转移的阳性率;分析前哨淋巴结中CK19mRNA的阳性表达与宫颈癌患者临床、病理参数的关系;比较CK19mRNA在前哨与非

  10. CyberKnife radiosurgery for inoperable stage IA non-small cell lung cancer: 18F-fluorodeoxyglucose positron emission tomography/computed tomography serial tumor response assessment

    Directory of Open Access Journals (Sweden)

    Chang Thomas

    2010-02-01

    Full Text Available Abstract Objective To report serial 18F-fluorodeoxyglucose (18F-FDG positron emission tomography (PET/computed tomography (CT tumor response following CyberKnife radiosurgery for stage IA non-small cell lung cancer (NSCLC. Methods Patients with biopsy-proven inoperable stage IA NSCLC were enrolled into this IRB-approved study. Targeting was based on 3-5 gold fiducial markers implanted in or near tumors. Gross tumor volumes (GTVs were contoured using lung windows; margins were expanded by 5 mm to establish the planning treatment volumes (PTVs. Doses ranged from 42-60 Gy in 3 equal fractions. 18F-FDG PET/CT was performed prior to and at 3-6-month, 9-15 months and 18-24 months following treatment. The tumor maximum standardized uptake value (SUVmax was recorded for each time point. Results Twenty patients with an average maximum tumor diameter of 2.2 cm were treated over a 3-year period. A mean dose of 51 Gy was delivered to the PTV in 3 to 11 days (mean, 7 days. The 30-Gy isodose contour extended an average of 2 cm from the GTV. At a median follow-up of 43 months, the 2-year Kaplan-Meier overall survival estimate was 90% and the local control estimate was 95%. Mean tumor SUVmax before treatment was 6.2 (range, 2.0 to 10.7. During early follow-up the mean tumor SUVmax remained at 2.3 (range, 1.0 to 5.7, despite transient elevations in individual tumor SUVmax levels attributed to peritumoral radiation-induced pneumonitis visible on CT imaging. At 18-24 months the mean tumor SUVmax for controlled tumors was 2.0, with a narrow range of values (range, 1.5 to 2.8. A single local failure was confirmed at 24 months in a patient with an elevated tumor SUVmax of 8.4. Conclusion Local control and survival following CyberKnife radiosurgery for stage IA NSCLC is exceptional. Early transient increases in tumor SUVmax are likely related to radiation-induced pneumonitis. Tumor SUVmaxvalues return to background levels at 18-24 months, enhancing 18F-FDG PET

  11. Promoter hypermethylation of the p16 and Wif-1 genes as an independent prognostic marker in stage IA non-small cell lung cancers.

    Science.gov (United States)

    Yoshino, Mitsuru; Suzuki, Makoto; Tian, Lei; Moriya, Yasumitsu; Hoshino, Hidehisa; Okamoto, Tatsuro; Yoshida, Shigetoshi; Shibuya, Kiyoshi; Yoshino, Ichiro

    2009-11-01

    Hypermethylation of promoter CpG islands is a major inactivation mechanism of tumor suppressor genes, some of which are thought to be related to the prognosis of patients with non-small cell lung cancer (NSCLC). Therefore, hypermethylation of the specific genes may be expected to serve as a prognostic biomarker for NSCLC. In this study, the methylation status of 14 genes was analyzed in 44 stage IA NSCLC cases using methylation-specific PCR. Hypermethylation was detected in PTGER2 (70% of cases), DRM/Gremlin (66%), sFRP-2 (57%), IL-12Rbeta2 (48%), Reprimo (41%), APC (39%), CXCL12 (39%), HPP1 (30%), SPARC (30%), sFRP-5 (30%), p16 (25%), RUNX3 (20%), sFRP-1 (20%) and Wif-1 (16%). Patients with p16, sFRP-5, Wif-1 or CXCL12 methylation had a significantly shorter duration of relapse-free survival than their counterparts with an unmethylated gene (p16, P=0.011; sFRP-5, P=0.030, Wif-1, P=0.036; CXCL12, P=0.026). Also, those with methylated HPP1, p16 or Wif-1 had a significantly shorter duration of overall survival (HPP1, P=0.031; p16, P=0.026; Wif-1, P=0.008). Multivariate analysis revealed that p16 methylation in relapse-free survival and Wif-1 methylation in overall survival were the strongest independent prognostic factors (p16, P=0.036; Wif-1, P=0.035). In conclusion, the hypermethylation of the p16 and Wif-1 genes has potential as biomarkers that may be used to predict the prognosis of stage IA NSCLC.

  12. Clinical prognostic markers in stage IIIC melanoma.

    Science.gov (United States)

    Madu, Max F; Schopman, Jaap H H; Berger, Danique M S; Klop, Willem M C; Jóźwiak, Katarzyna; Wouters, Michel W J M; van der Hage, Jos A; van Akkooi, Alexander C J

    2017-08-01

    Although the EORTC 18071-trial has shown a clear survival benefit for adjuvant ipilimumab, accurately selecting patients for this toxic adjuvant therapy is important. We aimed to identify prognostic factors for death and disease recurrence in AJCC stage IIIC melanoma patients. Retrospective analysis of patients who underwent lymph node dissection (LND) for stage IIIC melanoma in our institution between 2000 and 2016. Baseline characteristics, melanoma-specific survival (MSS), and disease-free survival (DFS) were assessed, and prognostic factors for recurrence and survival were analyzed using uni- and multivariable analysis. A total of 205 patients were included. Median follow-up was 20 months (interquartile range 11-43 months), median MSS was 28 months, and median DFS was 11 months. Five-year MSS was 33% and 5-year DFS was 23%. N3 (≥4 involved lymph nodes) and extracapsular extension (ECE) carried an increased risk of disease recurrence after LND and death by melanoma. Patients with both N3 and ECE had virtually no long-term survival. Although survival for patients with stage IIIC is poor in general, patients with both N3 disease and ECE constitute the group with the worst prognosis and should be considered for adjuvant therapy with ipilimumab or any other future effective adjuvant therapy (study). © 2017 Wiley Periodicals, Inc.

  13. [Performing madness: the clinic as stage].

    Science.gov (United States)

    Herrn, Rainer; Friedland, Alexander

    2014-12-01

    In the second half of the nine- teenth century, clinical demonstrations became the dominant teaching method in psychiatry, playing a key role in medical-professional disputes, as well. This paper traces this widely used though historiographically neglected practice of knowledge implementation and mediation, as demonstrated in the psychiatric clinic of the Berlin Charité (Psychiatrische und Nervenklinik der Berliner Charité) from 1881 to 1927. Documentation of this practice, found within individual medical records, forms the basis of this research. The concept of 'theatricality' assists in uncovering the dramatic quality of the clinical demonstration: Psychiatric knowledge was not simply disseminated through such a practice; rather, such knowledge was first performatively created through the very logic of its presentation of exemplary patient histories, as well as through the examination and diagnostic positioning of its patients. The 'success' of such presentations depended on many variables, related to staff, time, place, and other situational factors. These include the presence of appropriate lecture halls, the availability and calculated selection of patients, and the employment of specific performative techniques by doctors for the sake of producing desired results. As one effect, clinical demonstrations also encouraged patients to both learn and rehearse behavior considered relevant to the particular diagnosis that was to be demonstrated.

  14. Stage IA non-Hodgkin's lymphoma of the Waldeyer's ring; Limited chemotherapy and radiation therapy versus radiation therapy alone

    Energy Technology Data Exchange (ETDEWEB)

    Uematsu, Minoru (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology Dept. of Radiology, National Defense Medical College, Saitama (Japan)); Kondo, Makoto (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology); Hiramatsu, Hideko (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology); Ikeda, Yasuo (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Hematology); Mikata, Sumio (Chiba Univ. (Japan). School of Medicine); Katayama, Michiaki (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology); Ito, Hisao (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology); Kusano, Shoichi (Dept. of Radiology, National Defense Medical College, Saitama (Japan)); Kubo, Asuchishi (Keio Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology)

    1993-01-01

    Seventeen patients with stage IA non-Hodgkin's lymphoma of the Waldeyer's ring were treated with radiation therapy with or without chemotherapy. All lesions were judged as having intermediate grade malignancy in the Working Formulation. Eight patients received combined treatment with three cycles of cylcophosphamide, doxorubicin, vincristine and prednison (CHOP) and radiation therapy with 30 to 40 Gy. Another 9 patients were treated with radiation therapy 40 to 60 Gy alone. After a median follow-up of 69 months, all 8 patients, treated with combined modality were alive and relapse-free whereas 4 of the 9 treated with irradiation alone had relapsed. All relapses occurred transdiaphragmatically. Two of the 4 relapsing patients were saved, but the other two died of the disease. The 5-year relapse-free and cause-specific survival rates were 100% and 100% in the combined modality group, and 56% and 76% in the radiation therapy alone group (relapse-free: p=0.04, cause-specific: p=0.16). There were no serious complications related to treatment, although most patients complained of mouth dryness and most patients given CHOP had paresthesia. Our opinion was that the total impact of these two side-effects on quality of life was less pronounced after combined modality than after radiation therapy alone. Limited chemotherapy and radiation therapy seemed to be more beneficial than radiation therapy alone not only in relapse-free survival but also in quality of life after treatment. (orig.).

  15. On Two-stage Seamless Adaptive Design in Clinical Trials

    Directory of Open Access Journals (Sweden)

    Shein-Chung Chow

    2008-12-01

    Full Text Available In recent years, the use of adaptive design methods in clinical research and development based on accrued data has become very popular because of its efficiency and flexibility in modifying trial and/or statistical procedures of ongoing clinical trials. One of the most commonly considered adaptive designs is probably a two-stage seamless adaptive trial design that combines two separate studies into one single study. In many cases, study endpoints considered in a two-stage seamless adaptive design may be similar but different (e.g. a biomarker versus a regular clinical endpoint or the same study endpoint with different treatment durations. In this case, it is important to determine how the data collected from both stages should be combined for the final analysis. It is also of interest to know how the sample size calculation/allocation should be done for achieving the study objectives originally set for the two stages (separate studies. In this article, formulas for sample size calculation/allocation are derived for cases in which the study endpoints are continuous, discrete (e.g. binary responses, and contain time-to-event data assuming that there is a well-established relationship between the study endpoints at different stages, and that the study objectives at different stages are the same. In cases in which the study objectives at different stages are different (e.g. dose finding at the first stage and efficacy confirmation at the second stage and when there is a shift in patient population caused by protocol amendments, the derived test statistics and formulas for sample size calculation and allocation are necessarily modified for controlling the overall type I error at the prespecified level.

  16. Staging in bipolar disorder: from theoretical framework to clinical utility.

    Science.gov (United States)

    Berk, Michael; Post, Robert; Ratheesh, Aswin; Gliddon, Emma; Singh, Ajeet; Vieta, Eduard; Carvalho, Andre F; Ashton, Melanie M; Berk, Lesley; Cotton, Susan M; McGorry, Patrick D; Fernandes, Brisa S; Yatham, Lakshmi N; Dodd, Seetal

    2017-10-01

    Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a

  17. Clinical stage EGFR inhibitors irreversibly alkylate Bmx kinase.

    Science.gov (United States)

    Hur, Wooyoung; Velentza, Anastasia; Kim, Sungjoon; Flatauer, Laura; Jiang, Xinnong; Valente, David; Mason, Daniel E; Suzuki, Melissa; Larson, Brad; Zhang, Jianming; Zagorska, Anna; Didonato, Michael; Nagle, Advait; Warmuth, Markus; Balk, Steven P; Peters, Eric C; Gray, Nathanael S

    2008-11-15

    Irreversible HER/erbB inhibitors selectively inhibit HER-family kinases by targeting a unique cysteine residue located within the ATP-binding pocket. Sequence alignment reveals that this rare cysteine is also present in ten other protein kinases including all five Tec-family members. We demonstrate that the Tec-family kinase Bmx is potently inhibited by irreversible modification at Cys496 by clinical stage EGFR inhibitors such as CI-1033. This cross-reactivity may have significant clinical implications.

  18. Changing Management of Clinical Low-Stage Testicular Cancer

    Directory of Open Access Journals (Sweden)

    Timothy Gilligan

    2005-01-01

    Full Text Available Stage I and II testicular germ cell tumors (GCTs are almost always cured with appropriate treatment and most ongoing research regarding these tumors focuses on minimizing treatment toxicity. The management of clinical stage I testicular GCTs has grown more complicated due to the emergence of a brief course of chemotherapy as an additional treatment option for stage I seminomas and stage I nonseminomas. In addition, growing concern about radiation-induced cancers and other late toxicity has dulled enthusiasm for radiotherapy as a treatment for stage I seminomas. However, recent randomized trials have shown that radiotherapy doses and field sizes can be lowered without compromising cure rates and it is possible that this reduction in radiation exposure will reduce the rate of secondary cancers. At this point in history, stage I patients have three treatment options following radical orchiectomy: adjuvant (sometimes called “primary” chemotherapy (carboplatin for seminomas and the combined regimen of bleomycin, etoposide, and cisplatin for nonseminomas, surveillance, and either retroperitoneal lymph node dissection (for nonseminomas or radiotherapy (for pure seminomas. Clinical studies have made it possible to identify subgroups of patients at high and low risk for relapse and this has made it possible to tailor treatment decisions to the individual patient's postorchiectomy relapse risk.

  19. Consolidative Involved-Node Proton Therapy for Stage IA-IIIB Mediastinal Hodgkin Lymphoma: Preliminary Dosimetric Outcomes From a Phase II Study

    Energy Technology Data Exchange (ETDEWEB)

    Hoppe, Bradford S., E-mail: bhoppe@floridaproton.org [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Flampouri, Stella; Su Zhong; Morris, Christopher G. [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Latif, Naeem [University of Florida Hematology/Oncology, Jacksonville, FL (United States); Dang, Nam H.; Lynch, James [University of Florida Hematology/Oncology, Gainesville, FL (United States); Li Zuofeng; Mendenhall, Nancy P. [University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2012-05-01

    Purpose: To compare the dose reduction to organs at risk (OARs) with proton therapy (PT) versus three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in patients with mediastinal Hodgkin lymphoma (HL) enrolled on a Phase II study of involved-node radiotherapy (INRT). Methods and Materials: Between June 2009 and October 2010, 10 patients were enrolled on a University of Florida institutional review board-approved protocol for de novo 'classical' Stage IA-IIIB HL with mediastinal (bulky or nonbulky) involvement after chemotherapy. INRT was planned per European Organization for Research and Treatment of Cancer guidelines. Three separate optimized plans were developed for each patient: 3D-CRT, IMRT, and PT. The primary end point was a 50% reduction in the body V4 with PT compared with 3D-CRT or IMRT. Results: The median relative reduction with PT in the primary end point, body V4, was 51% compared with 3D-CRT (p = 0.0098) and 59% compared with IMRT (p = 0.0020), thus all patients were offered treatment with PT. PT provided the lowest mean dose to the heart, lungs, and breasts for all 10 patients compared with either 3D-CRT or IMRT. The median difference in the OAR mean dose reduction with PT compared with 3D-CRT were 10.4 Gy/CGE for heart; 5.5 Gy/CGE for lung; 0.9 Gy/CGE for breast; 8.3 Gy/CGE for esophagus; and 4.1 Gy/CGE for thyroid. The median differences for mean OAR dose reduction for PT compared with IMRT were 4.3 Gy/CGE for heart, 3.1 Gy/CGE for lung, 1.4 Gy/CGE for breast, 2.8 Gy/CGE for esophagus, and 2.7 Gy/CGE for thyroid. Conclusions: All 10 patients benefitted from dose reductions to OARs with PT compared with either 3D-CRT or IMRT. It is anticipated that these reductions in dose to OAR will translate into lower rates of late complications, but long-term follow-up on this Phase II INRT study is needed.

  20. Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Yan Xiao

    2015-01-01

    Full Text Available Background: End-stage hypertrophic cardiomyopathy (HCM is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM. Methods: End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality. Results: End-stage HCM was identified in 99 (5.4% patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05-3.80; P = 0.036, left bundle branch block (LBBB (HR: 2.80; 95% CI: 1.47-5.31; P = 0.002, and an abnormal Q wave (HR: 2.21; 95% CI: 1.16-4.23; P = 0.016 as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death. Conclusions: LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.

  1. Mentoring in Clinical Geropsychology: Across the Stages of Professional Development.

    Science.gov (United States)

    Zimmerman, Jennifer A; Fiske, Amy; Scogin, Forrest

    Projected growth in demand for clinical geropsychologists will require expanding the number of qualified geropsychology mentors at all stages of professional development. This special section provides information on mentoring from expert geropsychology mentors who offer their perspectives, and summarize relevant research, on mentoring graduate students, interns and postdoctoral fellows, junior faculty and members of special populations. The present paper provides an introduction to the special section by establishing the need for increased mentoring within clinical geropsychology, presenting results of a survey of mentoring practices and needs, and discussing ways in which the field is responding to the challenge.

  2. Chorea: clinical correlates of 119 cases Coréia: análise clínica de 119 casos

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    Maria Fernanda Mendes

    1996-09-01

    Full Text Available Chorea is a clinical syndrome characterized by abnormal involuntary arrhythmic movements, randomly distributed in time, affecting mainly the distal parts of the limbs. There are many diseases associated with chorea but the distribution of the etiologies vary too much in different parts of the world. We intended to study the etiologies of chorea in a Movement Disorders Unit of a university hospital-based outpatient clinic in Brazil. We studied the records of 119 patients with chorea based in the diagnostic criteria of the World Federation of Neurology. Sydenham's chorea (SC was the most frequent cause of chorea (51.3% of our sample. Other common causes were Huntington's chorea (18.5% and chorea post-stroke (9.2%. SC is not commonly seen in developed countries nowadays but is not rare in Brazil. SC patients generally have the clinical manifestation of it in the first 20 years of age and girls are more affected than boys and this feature was observed in our sample. Based on our own experience and in the review of the literature we propose an etiological classification of chorea.Coréia é uma síndrome caracterizada por movimentos involuntários arrítmicos, rápidos, abruptos, não repetitivos no tempo e com distribuição variável, preferentemente distal. O número de entidades clínicas reconhecidamente associadas a movimentos coréicos tem se tornado cada vez maior com o passar do tempo. Propusemo-nos estudar a frequência e algumas características epidemiológicas das coréias atendidas em um ambulatório especializado em distúrbios do movimento. Foram estudados os prontuários de 119 pacientes com o diagnóstico sindrômico de coréia. O predomínio absoluto foi de coréia de Sydenham (CS com 51,3% do total da amostra. Outras causas frequentes foram doença de Huntington (DH presente em 18,5% e a coréia secundária a doença cerebrovascular em 9,2% dos pacientes. O sexo feminino predominou em todas as faixas etárias, mas principalmente

  3. Evaluation of Clinical and MRI Staging for Prostate Cancer before Radical Prostatectomy

    Institute of Scientific and Technical Information of China (English)

    ZHONGChenyang; ZOUEnze; CHENMin; WANGWenchao; ZHAOWeifeng; WANBen; DENGShuming; YANGJianye

    2004-01-01

    To evaluate the clinical significance of clinical staging and magnetic resonance imaging (MRI) staging for prostate cancer before radical prostatectomy. Methods: Thirty-two patients with organ confined prostate cancer were reviewed to assess the accuracy of clinical staging and MRI staging to correlate with pathological staging results after radical prostatectomy. Results: 33.3% (10/30) prostate cancer patients with staging C and 3.3% (1/30) prostate cancer patients with staging D were diagnosed by pathology after radical prostatectomy in 30 patients with prostate cancer with clinical staging B, and 36.7% (11/30) under staging; Only one patient was over staging in clinical staging C. 19.1% (4/21) prostate cancer patients with staging C were diagnosed in 21 patients with prostate cancer and under staging with MRI staging B; 11.1% (1/9) was over staging with MRI staging C. The clinical staging and MRI staging had more correlation with pathological staging results (P=0.002), and PPV of the organ confined prostate cancer by clinical staging and MRI staging were 63.3% and 80.9% respectively, and NPV of nonorgan confined prostate cancer by clinical staging and MRI staging were 50% and 88.9% respectively. MRI staging was more specificity and accuracy than that of clinical staging to predict pathological staging results before radical prostatectomy (P=0.023). Conclusion: The MRI staging was more accuracy than that of clinical staging to predict pathological staging results in organ confined and nonorgan confined prostate cancer before radical prostatectomy.

  4. New dilemmas in small-cell lung cancer TNM clinical staging

    Science.gov (United States)

    Zarogoulidis, Konstantinos; Latsios, Dimitrios; Porpodis, Konstantinos; Zarogoulidis, Paul; Darwiche, Kaid; Antoniou, Nick; Hohenforst-Schmidt, Wolfgang; Eleftheriadou, Ellada; Boutsikou, Efimia; Kontakiotis, Theodoros

    2013-01-01

    Background Many patients with limited disease (LD) behave similarly to those with extensive disease (ED) from a prognostic point of view. On the other hand, a proportion of patients with ED small-cell lung cancer (SCLC) behave similarly to those with LD. Patients and methods In this retrospective study analysis, 764 patients with proven SCLC were included and managed with the same therapeutic protocols. Of these patients, 278 (36.4%) had LD, while 486 (63.6%) had ED. Results No statistically significant difference was observed for survival for IA and IB disease stages (P = 0.254) and between IIA and IIB stages (P = 0.256) according to the new tumor, node, metastasis (TNM) staging classification classification. In addition, no statistical significant difference was observed for survival between patients with (IIA + IIB) and IIIA (P = 0.951), (IIA + IIIA, P = 0.658), and (IIB + IIIA, P = 0.573) stages. Statistical significant difference was observed for survival among the LD SCLC patients with (IA + IB), (IIA + IIB + IIIA), and IIIB stages (P TNM staging system is recommended for more detailed prognostic information and treatment evaluation in these patients. PMID:23700372

  5. Potential Biomarkers of the Earliest Clinical Stages of Parkinson's Disease.

    Science.gov (United States)

    Alieva, Anelya Kh; Filatova, Elena V; Karabanov, Aleksey V; Illarioshkin, Sergey N; Slominsky, Petr A; Shadrina, Maria I

    2015-01-01

    Parkinson's disease (PD) is a widespread neurodegenerative disorder. Despite the intensive studies of this pathology, in general, the picture of the etiopathogenesis has still not been clarified fully. To understand better the mechanisms underlying the pathogenesis of PD, we analyzed the expression of 10 genes in the peripheral blood of treated and untreated patients with PD. 35 untreated patients with PD and 12 treated patients with Parkinson's disease (Hoehn and Yahr scores 1-2) were studied. An analysis of the mRNA levels of ATP13A2, PARK2, PARK7, PINK1, LRRK2, SNCA, ALDH1A1, PDHB, PPARGC1A, and ZNF746 genes in the peripheral blood of patients was carried out using reverse transcription followed by real-time PCR. A statistically significant and specific increase by more than 1.5-fold in the expression of the ATP13A2, PARK7, and ZNF746 genes was observed in patients with PD. Based on these results, it can be suggested that the upregulation of the mRNA levels of ATP13A2, PARK7, and ZNF746 in untreated patients in the earliest clinical stages can also be observed in the preclinical stages of PD, and that these genes can be considered as potential biomarkers of the preclinical stage of PD.

  6. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    NARCIS (Netherlands)

    Olde Rikkert, M.G.M.; Tona, K.D.; Janssen, L.; Burns, A.; Lobo, A.; Robert, P.; Sartorius, N.; Stoppe, G.; Waldemar, G.

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles describ

  7. The 2-stage liver transplant: 3 clinical scenarios.

    Science.gov (United States)

    Gedik, Ender; Bıçakçıoğlu, Murat; Otan, Emrah; İlksen Toprak, Hüseyin; Işık, Burak; Aydın, Cemalettin; Kayaalp, Cüneyt; Yılmaz, Sezai

    2015-04-01

    The main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.

  8. Biophysical properties of the clinical-stage antibody landscape

    Science.gov (United States)

    Jain, Tushar; Sun, Tingwan; Durand, Stéphanie; Hall, Amy; Houston, Nga Rewa; Nett, Juergen H.; Sharkey, Beth; Bobrowicz, Beata; Caffry, Isabelle; Yu, Yao; Cao, Yuan; Lynaugh, Heather; Brown, Michael; Baruah, Hemanta; Gray, Laura T.; Krauland, Eric M.; Xu, Yingda; Vásquez, Maximiliano; Wittrup, K. Dane

    2017-01-01

    Antibodies are a highly successful class of biological drugs, with over 50 such molecules approved for therapeutic use and hundreds more currently in clinical development. Improvements in technology for the discovery and optimization of high-potency antibodies have greatly increased the chances for finding binding molecules with desired biological properties; however, achieving drug-like properties at the same time is an additional requirement that is receiving increased attention. In this work, we attempt to quantify the historical limits of acceptability for multiple biophysical metrics of “developability.” Amino acid sequences from 137 antibodies in advanced clinical stages, including 48 approved for therapeutic use, were collected and used to construct isotype-matched IgG1 antibodies, which were then expressed in mammalian cells. The resulting material for each source antibody was evaluated in a dozen biophysical property assays. The distributions of the observed metrics are used to empirically define boundaries of drug-like behavior that can represent practical guidelines for future antibody drug candidates. PMID:28096333

  9. Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy

    Science.gov (United States)

    2016-02-09

    Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer

  10. [Clinical stages of patients with Alzheimer disease treated in specialist clinics in Spain. The EACE study].

    Science.gov (United States)

    Alom Poveda, J; Baquero, M; González-Adalid Guerreiro, M

    2013-10-01

    The diagnostic paradigm of Alzheimer disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. Multicentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). Participants in this study included 437 specialists representing all of Spain's autonomous communities and a total of 1,707 patients, of whom 1,694 were included in the analysis. Mean MMSE score was 17.6±4.8 (95% CI:17.4-17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSE<10) in 6%. The mean interval between symptom onset and the initial primary care visit was 10.9±17.2 months (95% CI:9.9-11.8), and the interval between symptom onset and diagnosis with AD was 28.4±21.3 months. Results from the EACE show that most AD patients in our area have reached a moderate clinical stage by the time they are evaluated in a specialist clinic. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  11. 糖尿病患者 GAD-Ab、IA2-Ab 和 ICA 联合检测的临床意义%Clinical significance of the combined detection of GAD-Ab, IA2-Ab and ICA in patients with diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    周厚清; 吴行贵

    2015-01-01

    目的:探讨抗谷氨酸脱羧酶抗体(GAD-Ab)、抗酪氨酸磷酸酶抗体(IA2-Ab)和抗胰岛细胞抗体(ICA)联合检测在糖尿病中的临床意义。方法选择糖尿病患者136例,其中1型糖尿病54例、2型糖尿病82例,同时选择健康对照者(正常对照组)65名,采用酶联免疫吸附试验(ELISA)检测 GAD-Ab 和 IA2-Ab,并采用间接免疫荧光法检测 ICA。结果1型糖尿病组 ICA、GAD-Ab 和 IA2-Ab 的阳性率分别为22.2%、61.1%和11.1%,明显高于2型糖尿病组(2.4%、4.9%、1.2%)及正常对照组(0%、0%、0%)(P 均<0.05)。1型糖尿病组 GAD-Ab阳性率明显高于 ICA 和 IA2-Ab(P <0.001)。 GAD-Ab 诊断1型糖尿病的敏感性和诊断符合率均高于 ICA 和IA2-Ab(P <0.05);GAD-Ab +ICA、GAD-Ab +IA2-Ab、ICA +GAD-Ab +IA2-Ab 联合检测的敏感性和诊断符合率亦均高于 ICA 和 IA2-Ab 单项检测(P <0.05)。结论 GAD-Ab、IA2-Ab 和 ICA 联合检测对糖尿病的诊断分型具有一定的意义。%Objective To investigate the clinical significance of the combined detection of anti-glutamic acid decarboxylase antibody (GAD-Ab), anti-protein tyrosine phosphatase antibody (IA2-Ab) and anti-islet cell antibody (ICA) in the diagnosis of diabetes mellitus.Methods A total of 136 patients with diabetes mellitus were enrolled, including 54 cases of type 1 diabetes mellitus and 82 cases of type 2 diabetes mellitus, and 65 healthy controls were enrolled as healthy control group.GAD-Ab and IA2-Ab were determined by enzyme-linked immunosorbent assay (ELISA), and ICA was determined by indirect immunofluorescence assay.Results The positive rates of ICA, GAD-Ab and IA2-Ab in patients with type 1 diabetes mellitus(22.2%, 61.1% and 11.1%) were significantly higher than those in patients with type 2 diabetes mellitus (2.4%, 4.9% and 1.2%) and control group (0%, 0% and

  12. Clinical outcome and imaging changes after intraarticular (IA) application of etanercept or methylprednisolone in rheumatoid arthritis: Magnetic resonance imaging and ultrasound-Doppler show no effect of IA injections in the wrist after 4 weeks

    DEFF Research Database (Denmark)

    Boesen, M.; Boesen, L.; Jensen, K.E.

    2008-01-01

    Objective. To assess the magnetic resonance imaging (MRI) and ultrasound (US) changes in the wrist of patients with rheumatoid arthritis (RA) 4 weeks after an US guided intraarticular (IA) injection. Methods. Contrast enhanced MRI and US-Doppler were performed at baseline and 4 weeks after IA...... injection of either 40 mg methylprednisolone (n = 12) or 25 mg etanercept (n = 13) in 25 patients with RA taking disease modifying antirheumatic drugs with a therapy-resistant wrist joint. All injections were US guided. Results. There was an improvement in swollen target joint score (p ...-29) in the total group was unchanged after 4 weeks (p = 0.13), whereas MRI erosion score increased in the total group from baseline, 17.88 (range 7-40), to 4 weeks, 18.25 (range 7-40) (p

  13. A study of mode of transmission, clinical presentations, WHO and immunological staging among HIV infected children

    Directory of Open Access Journals (Sweden)

    Durgesh Kumar

    2014-08-01

    Results: Predominant mode of transmission in our study was vertical and it was present in 95% cases. Fever was the most common presenting complaint and was present in 28 (59.57% cases. The most common clinical sign was pallor in our study, present in 37 cases (78.72% followed by lymphadenopathy 34 (72.34%. On the basis of WHO clinical staging, most of the patients in our study were found in stage 2 .On the basis of immunological staging, 51% had no evidence of immunosuppression (stage1, 18 (38.3% had mild to advanced immunosuppression (stage 2 and 3 and 5 (10.63% patients were severely immunosuppressed (stage 4. Conclusion: In HIV infected children predominant mode of transmission is vertical. Fever and pallor are common clinical manifestations. Most of the patients are found in WHO clinical stage 2 and immunological stage 1. [Int J Res Med Sci 2014; 2(4.000: 1541-1544

  14. Treatment results in women with clinical stage I and pathologic stage II endometrial carcinoma.

    Science.gov (United States)

    Jobsen, J J; Schutter, E M; Meerwaldt, J H; Van Der Palen, J; Van Der Sijde, R; Ten Cate, L N

    2001-01-01

    The aim of this study is to report survival and results of therapy and possible prognostic factors in women with pathologic stage II endometrial carcinoma. Forty-two patients with pathologic stage II endometrial carcinoma were treated at the department of Radiation Oncology of the Medisch Spectrum Twente between 1987 and 1998. All patients received external radiotherapy following standard surgical procedures and no adjuvant systemic therapy was given. From the 42 patients 21 had a pathologic stage IIA and 21 stage IIB. The median follow-up was 62 months. The overall recurrence rate was 21.5% (9/42). Seven patients had distant metastasis, of which three also had locoregional recurrence, vaginal vault and/or pelvic. The presence of myometrial invasion (> (1/2)) and/or lymph-angioinvasion showed a significant relation with distant metastasis (P = 0.017). Stage IIB showed more recurrences, 33% (7/21). There was a significant different 5-year disease specific survival for stage IIA and IIB, respectively, 95% and 74% (P = 0.0311). Patients with a differentiation grade 3 and stage IIB showed a significantly poorer (P = 0.003) 5-year survival of 48.6% (P = 0.003). Results obtained in the present series of patients are in accordance with the literature. The present treatment policy seems justified, except for patients with pathologic stage IIB and grade 3, in which a more aggressive treatment should be considered.

  15. Clinical outcome of fiducial-less CyberKnife radiosurgery for stage I non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jung, In Hye; Song, Si Yeol; Cho, Byung Chul; Kwak, Jung Won; Jung, Nuri Hyun; Kim, Su Ssan; Choi, Eun Kyung [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Jung, Jin Hong [Dept. of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul (Korea, Republic of); Je, Hyoung Uk [Dept. of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of); Choi, Won Sik [Dept. of Radiation Oncology, Gangneung Asan Hospital, Uiversity of Ulsan College of Medicine, Gangneung (Korea, Republic of)

    2015-06-15

    To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS). From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21. The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression. The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

  16. [Comparison between clinical and surgical-pathological TNM staging in patients with lung cancer].

    Science.gov (United States)

    Wei, Bo; Wang, Tianyou; Gong, Min; Lv, Kejie; Tian, Feng; Wang, Zhicheng

    2005-02-20

    The accuracy of clinical TNM staging correlates with appropriate treatment in patients with lung cancer. The aim of this study is to evaluate the agreement between clinical and surgical-pathological staging in patients with lung cancer and analyze its cause in detail. One hundred and fifty patients with lung cancer treated surgically from 2000 were enrolled randomly. Clinical and surgical-pathological staging of them were made respectively according to the International System for Staging Lung Cancer newly revised by UICC. Then concordance was determined between the two staging results with Kappa value, and difference in coincident rate was analyzed among subgroups of T staging. For T staging, the agreement was excellent (Kappa value=0.729), however, the coincident rate of T3 or T4 was significantly lower than that in T1 or T2 group (P conformity of TNM staging (Kappa value=0.287). Clinical T staging based on CT can indicate the location and size of primary tumor precisely. But the borderline may be difficult to estimate when tumor site is near chest wall or mediastinum, so some patients with clinical T4 still have chances to receive complete resection. The conformity of N staging is rather poor. The key point to improve the accuracy of clinical TNM staging should be to seek more reliable techniques for evaluating N status.

  17. Esophageal motion characteristics in thoracic esophageal cancer: Impact of clinical stage T4 versus stages T1-T3

    Directory of Open Access Journals (Sweden)

    Yuta Kobayashi, MS

    2016-10-01

    Conclusions: The EM and the ITV margins in cT4 were significantly smaller than those in cT1-T3. The NM and the ITV margins of abdominal LNs were much larger than those of cervicothoracic LNs and the esophagus. In clinical radiation therapy planning for esophageal cancer, we should take cT stage into consideration.

  18. Clinical applicability of staging small cell lung cancer according to the seventh edition of the TNM staging system.

    Science.gov (United States)

    Jhun, Byung Woo; Lee, Kyung-Jong; Jeon, Kyeongman; Suh, Gee Young; Chung, Man Pyo; Kim, Hojoong; Kwon, O Jung; Sun, Jong-Mu; Ahn, Jin Seok; Ahn, Myung-Ju; Park, Keunchil; Choi, Joon Young; Lee, Kyung Soo; Han, Joungho; Um, Sang-Won

    2013-07-01

    The two-stage system of limited and extensive disease has been widely employed for small cell lung cancer (SCLC). However, the International Association for the Study of Lung Cancer has proposed that the TNM classification should be incorporated into clinical practice. The purpose of this study was to evaluate the applicability of the Union for International Cancer Control (UICC) 7th TNM staging system to SCLC. We retrospectively reviewed the medical records of consecutive patients with newly diagnosed histologically proven SCLC between March 2005 and January 2010. Patients who had other concurrent malignancies or had combined-type SCLC were excluded. We assessed overall survival (OS) according to the T descriptor, N descriptor, M descriptor, and TNM stage grouping. In total, 320 SCLC patients were included. Median age was 65 years and 286 patients (89.4%) were male. Median OS was 12.7 months. There were no significant differences in OS according to the T descriptor (P = 0.880). However, there were significant differences in OS according to the N (P TNM stage grouping (P TNM stage grouping, but not according to the T descriptors. The UICC 7th TNM staging system may contribute to a more precise prognosis in SCLC patients. Further studies are required to evaluate the applicability of the TNM staging system to SCLC. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke;

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles desc......, and is available in 14 languages. Taking into account the increasing differentiation of Alzheimer's disease in preclinical and predementia stages, there is an urgent need for global rating scales to be refined as well.......New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...... describing 12 staging instruments were identified (N = 6109 participants, age 65-87). Reliability was studied in most (91%) of the articles and was judged moderate to good. Approximately 78% of the articles evaluated concurrent validity, which was good to very good, while discriminant validity was assessed...

  20. Comparison of optimised endovaginal vs external array coil T2-weighted and diffusion-weighted imaging techniques for detecting suspected early stage (IA/IB1) uterine cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Downey, Kate; Morgan, Veronica A.; Giles, Sharon L.; MacDonald, A.; DeSouza, Nandita M. [The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, CRUK Cancer Imaging Centre, Surrey (United Kingdom); Attygalle, Ayoma D. [The Royal Marsden NHS Foundation Trust, Department of Histopathology, London (United Kingdom); Davis, M. [Kingston Hospital, Department of Gynaecology, Kingston-upon-Thames, Surrey (United Kingdom); Ind, Thomas E.J.; Shepherd, John H. [The Royal Marsden NHS Foundation Trust, Gynecology Unit, London (United Kingdom)

    2016-04-15

    To compare sensitivity and specificity of endovaginal versus external-array coil T2-W and T2-W + DWI for detecting and staging small cervical tumours. Optimised endovaginal and external array coil MRI at 3.0-T was done prospectively in 48 consecutive patients with stage Ia/Ib1 cervical cancer. Sensitivity/specificity for detecting tumour and parametrial extension against histopathology for a reading radiologist were determined on coronal T2-W and T2W + DW images. An independent radiologist also scored T2-W images without and with addition of DWI for the external-array and endovaginal coils on separate occasions >2 weeks apart. Cohen's kappa assessed inter- and intra-observer agreement. Median tumour volume in 19/38 cases positive on subsequent histology was 1.75 cm{sup 3}. Sensitivity, specificity, PPV, NPV were: reading radiologist 91.3 %, 89.5 %, 91.3 %, 89.5 %, respectively; independent radiologist T2-W 82.6 %, 73.7 %, 79.1 %, 77.8 % for endovaginal, 73.9 %, 89.5 %, 89.5 %, 73.9 % for external-array coil. Adding DWI improved sensitivity and specificity of endovaginal imaging (78.2 %, 89.5 %); adding DWI to external-array imaging improved specificity (94.7 %) but reduced sensitivity (66.7 %). Inter- and intra-observer agreement on T2-W + DWI was good (kappa = 0.67 and 0.62, respectively). Endovaginal coil T2-W MRI is more sensitive than external-array coil for detecting tumours <2 cm{sup 3}; adding DWI improves specificity of endovaginal imaging but reduces sensitivity of external-array imaging. (orig.)

  1. Analysis of antibiotic resistance pattern of S. aureus strains isolated from the Orthopedics-Traumatology Section of "Sf. Spiridon" Clinical Emergency Hospital, Iaşi.

    Science.gov (United States)

    Tucaliuc, D; Alexa, O; Tuchiluş, Cristina Gabriela; Ursu, Ramona Gabriela; Tucaliuc, Elena Simona; Iancu, Luminiţa Smaranda

    2014-01-01

    The retrospective analysis of antibiotic sensibility of S. aureus strains isolated from infected patients from the Orthopedics-Traumatology Clinic of "Sf. Spiridon" Clinical Emergency Hospital, Iaşi during January 2003-December 2013, in view of determining the evolution trend of the resistance phenomenon and of pinpointing the most useful treatment for these strains. The antibiotic sensitivity test was carried out using two methods: diffusimetric-Kirby-Bauer and the MIC determination by E-test (for the strains isolated in 2013); the interpretation of the sensitivity was made in a standardized manner, in compliance with the CLSI (Clinical and Laboratory Standards Institute) standard for antibiotics testing in force. The sensitivity testing for beta-lactams proved that during the 11 years of the study, the average value of the frequency of resistant strains was of 41.59% +/- 8.68. The highest frequency of MRSA (Methicillin Restant S. aureus) strains was noticed in 2012 (58.6%), followed by 2004 (50.7%). Even if in 2013 it dropped to 38.9%, the trend calculated for 2003-2013 is slightly rising (y = 0.0073x + 0.372). Out of the total of 495 S. aureus strains that were isolated, 164 (33.13%) were completely sensitive to the tested antibiotics and 26 (5.25%) were resistant only to beta-lactams. The other MRSA strains associated multiple resistance and MIC for vancomycin varied between 0.5-2 mg/ml. Two strains whose MIC was of 0.5 mg/ml were sensitive to most classes of tested antibiotics, including beta-lactams, except for macrolides (erythromycin), and the strain whose MIC was of 2 mg/ml, was resistant to all classes of tested antibiotics, except for glycopeptides and oxazolidiones. The other tested strains had a MIC for vancomycin equal to 1 mg/ml. Due to the fact that there are infections with SAMR strains in a rather worrying percentage (53.9%) that are resistant to the other classes of antibiotics, the only therapeutic solution being the vancomycin treatment, its

  2. Stages of Esophageal Cancer

    Science.gov (United States)

    ... stage 0 , abnormal cells are found in the mucosa or submucosa layer of the esophagus wall. These ... found. Stage IA : Cancer has formed in the mucosa or submucosa layer of the esophagus wall. The ...

  3. A modified varying-stage adaptive phase II/III clinical trial design.

    Science.gov (United States)

    Dong, Gaohong; Vandemeulebroecke, Marc

    2016-07-01

    Conventionally, adaptive phase II/III clinical trials are carried out with a strict two-stage design. Recently, a varying-stage adaptive phase II/III clinical trial design has been developed. In this design, following the first stage, an intermediate stage can be adaptively added to obtain more data, so that a more informative decision can be made. Therefore, the number of further investigational stages is determined based upon data accumulated to the interim analysis. This design considers two plausible study endpoints, with one of them initially designated as the primary endpoint. Based on interim results, another endpoint can be switched as the primary endpoint. However, in many therapeutic areas, the primary study endpoint is well established. Therefore, we modify this design to consider one study endpoint only so that it may be more readily applicable in real clinical trial designs. Our simulations show that, the same as the original design, this modified design controls the Type I error rate, and the design parameters such as the threshold probability for the two-stage setting and the alpha allocation ratio in the two-stage setting versus the three-stage setting have a great impact on the design characteristics. However, this modified design requires a larger sample size for the initial stage, and the probability of futility becomes much higher when the threshold probability for the two-stage setting gets smaller. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Clinical variants, stages, and management of basal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Lyubomir A Dourmishev

    2013-01-01

    Full Text Available Basal cell carcinoma (BCC is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in the head and seldom appears on genitalia and perigenital region. BCC progresses slowly and metastases are found in less than 0.5% of the cases; however, a considerable local destruction and mutilation could be observed when treatment is neglected or inadequate. Different variants as nodular, cystic, micronodular, superficial, pigment BCC are described in literature and the differential diagnosis in some cases could be difficult. The staging of BCC is made according to Tumor, Node, Metastasis (TNM classification and is essential for performing the adequate treatment. Numerous therapeutic methods established for treatment of BCC, having their advantages or disadvantages, do not absolutely dissolve the risk of relapses. The early diagnostics based on the good knowledge and timely organized and adequate treatment is a precondition for better prognosis. Despite the slow progress and numerous therapeutic methods, the basal cell carcinoma should not be underestimated.

  5. Late-stage disease at presentation to an HIV clinic in eastern ...

    African Journals Online (AJOL)

    Late-stage disease at presentation to an HIV clinic in eastern Tanzania: A retrospective cross-sectional study. ... Alternatively, you can download the PDF file directly to your computer, from where it can be opened using a PDF reader.

  6. Correlation of CliniCal data, anatomiCal site and disease stage in ...

    African Journals Online (AJOL)

    2008-06-01

    Jun 1, 2008 ... Objective: to evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of ... important prognostic factor in crc, early symptom investigation and .... colorectal and lung cancer. Brit. J. Cancer.

  7. Long-term results of patients with clinical stage C prostate cancer treated by photontherapy and early orchiectomy

    Energy Technology Data Exchange (ETDEWEB)

    Wiegel, T. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy]|[Dept. of Radiotherapy, Univ. Hospital Benjamin Franklin, Freie Univ. Berlin (Germany); Tepel, J. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy; Schmidt, R. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy; Klosterhalfen, H. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Urology; Arps, H. [General Hospital Fulda (Germany). Inst. of Pathology; Berger, P. [Univ. Hospital Eppendorf, Hamburg (Germany). Inst. of Medical Statistics; Franke, H.D. [Univ. Hospital Eppendorf, Hamburg (Germany). Dept. of Radiotherapy

    1996-11-01

    Background: To evaluate the value of radiotherapy and immediate hormonal therapy in the treatment of stage C prostate cancer. Patients and Method: From 1977 to 1986, 169 patients with clinically stage C prostate cancer underwent irradiation with curative intent following early orchiectomy. Sixty-four patients had a transurethral resection, 22 patients a prostatectomy and 83 patients had only a biopsy. In 38 patients a grade Ia/b tumor was found, in 78 patients a grade IIa/b tumor and in 43 patients a grade IIIa/b tumor using the German grade of malignancy. Treatment fields included the prostate, the seminal vesicles and the locoregional lymphatics. Until 1979 the dose was 60 Gy for the tumor encompassing isodose and from then on 65 Gy with a single dose of 2 Gy. Results: With a median follow-up of 98 months, the overall survival rate for 8 and 10 years was 51% and 37% and the cause-specific survival rate was 84% and 77%, respectively. Thirty-two patients (19%) developed distant metastases. Patients with local tumor control (n=148) had a significantly better overall survival rate of 45% for 10 years compared to patients with clinical local progression of disease (n=21) of 22% (p<0.05). Multivariate analysis showed the grade of malignancy and local control as independent factors for overall survival and cause-specific survival (p<0.05). Twenty-three patients (14%) had at least one late side effect for the rectum or the bladder, in almost all cases grade I or II. Five patients (3%) showed severe late side effects RTOG grade III (n=2) or IV (n=3). One patient had a colostomy, in 2 patients a severe haemorrhagic cystitis was seen. Conclusions: Radiotherapy with photons and early orchiectomy for patients with stage C prostate cancer achieves high local control rates and a 30% to 40% 10-year survival rate with a low incidence of late side effects. The value of the radiotherapy of the locoregional lymphatics remains controversial. (orig.) [Deutsch] Zwischen 1977 und 1986

  8. Clinical outcomes of end stage renal disease and adequacy of adult maintenance hemodialysis patients

    OpenAIRE

    Ismail Mahmud Ali, Amirthalingam R

    2014-01-01

    Background & Aim: End stage renal disease (ESRD) is an irreversible loss of kidney function caused by various risk factors and affected persons of lives mainly depending on the technology of renal replacement therapy (RRT) or renal transplantation (RT) to sustain the life. Aim of this study is to overview the clinical outcomes of ESRD and adequacy of maintenance hemodialysis among the patients. Materials & Methods: Currently, there are sixty two end stage renal disease patient’s clinical data...

  9. Health utility decreases with increasing clinical stage in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Jones, Ashley R; Jivraj, Naheed; Balendra, Rubika; Murphy, Caroline; Kelly, Joanna; Thornhill, Marie; Young, Carolyn; Shaw, Pamela J; Leigh, P Nigel; Turner, Martin R; Steen, I Nick; McCrone, Paul; Al-Chalabi, Ammar

    2014-06-01

    Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease typically causing death within three years. Understanding the impact of disease on patients using health utility at different stages of ALS would allow meaningful cost-benefit analysis of new potential therapies. A common health-related quality of life measurement, developed and validated for the UK, is the EQ-5D. Using clinical trial data from the LiCALS study, we calculated health utility using the EQ-5D for each King's ALS clinical stage from 214 patients. We analysed whether health utility, and other health-related measures, significantly changed between each of the clinical stages. Results showed that mean health utility decreased by 0.487 (the scale runs from 1 to - 0.594) between clinical stages 2A and 4. Emotional states, measured using the Hospital Anxiety and Depression Scale (HADS), showed worsening depression and anxiety scores as ALS progressed. Age of onset, disease onset, gender and treatment group were not predictors of EQ-5D, depression or anxiety. In conclusion, increasing severity of King's ALS Clinical Stage is associated with a progressive decrease in EQ-5D health utility. This is useful for cost-benefit analysis of new therapies and validates this ALS clinical staging system.

  10. COPD, stage and treatment in a large outpatient clinic

    Science.gov (United States)

    Holm, Claire Præst; Holm, Jakob; Nørgaard, Annette; Godtfredsen, Nina

    2017-01-01

    ABSTRACT Some COPD patients suffer from frequent exacerbations despite triple inhalation treatment. These frequent exacerbators should be identified, as exacerbations often lead to decreasing lung function and increasing mortality. Roflumilast reduces exacerbations in patients with a previous history of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62 patients (11.3%) met the criteria for treatment with roflumilast. Among the patients eligible for roflumilast treatment, only 14 patients (22.6%) were receiving treatment. There were no significant differences in FEV1, number of exacerbations, hospitalization due to exacerbation, MRC grade, age, smoking status and medication use between patients receiving roflumilast and not treated eligible patients. Our study documents low use of roflumilast treatment. In view of the established effect of roflumilast we think that this treatment should be considered more consistently as an option among COPD patients fulfilling the criteria for this therapy. PMID:28326174

  11. Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages

    Directory of Open Access Journals (Sweden)

    S Wijetunge

    2015-01-01

    Full Text Available Chronic kidney disease of unknown etiology (CKDU is endemic among the rural farming communities in several localities in and around the North Central region of Sri Lanka. This is an interstitial type renal disease and typically has an insidious onset and slow progression. This study was conducted to identify the pathological features in the different clinical stages of CKDU. This is a retrospective study of 251 renal biopsies identified to have a primary interstitial disease from regions endemic for CKDU. Pathological features were assessed and graded in relation to the clinical stage. The mean age of those affected by endemic CKDU was 37.3 ± 12.5 years and the male to female ratio was 3.3:1. The predominant feature of stage I disease was mild and moderate interstitial fibrosis; most did not have interstitial inflammation. The typical stage II disease had moderate interstitial fibrosis with or without mild interstitial inflammation. Stage III disease had moderate and severe interstitial fibrosis, moderate interstitial inflammation, tubular atrophy and some glomerulosclerosis. Stage IV disease typically had severe interstitial fibrosis and inflammation, tubular atrophy and glomerulosclerosis. The mean age of patients with stage I disease (27 ± 10.8 years was significantly lower than those of the other stages. About 79.2%, 55%, 49.1% and 50% in stage I, II, III and IV disease respectively were asymptomatic at the time of biopsy.

  12. Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages.

    Science.gov (United States)

    Wijetunge, S; Ratnatunga, N V I; Abeysekera, T D J; Wazil, A W M; Selvarajah, M

    2015-01-01

    Chronic kidney disease of unknown etiology (CKDU) is endemic among the rural farming communities in several localities in and around the North Central region of Sri Lanka. This is an interstitial type renal disease and typically has an insidious onset and slow progression. This study was conducted to identify the pathological features in the different clinical stages of CKDU. This is a retrospective study of 251 renal biopsies identified to have a primary interstitial disease from regions endemic for CKDU. Pathological features were assessed and graded in relation to the clinical stage. The mean age of those affected by endemic CKDU was 37.3 ± 12.5 years and the male to female ratio was 3.3:1. The predominant feature of stage I disease was mild and moderate interstitial fibrosis; most did not have interstitial inflammation. The typical stage II disease had moderate interstitial fibrosis with or without mild interstitial inflammation. Stage III disease had moderate and severe interstitial fibrosis, moderate interstitial inflammation, tubular atrophy and some glomerulosclerosis. Stage IV disease typically had severe interstitial fibrosis and inflammation, tubular atrophy and glomerulosclerosis. The mean age of patients with stage I disease (27 ± 10.8 years) was significantly lower than those of the other stages. About 79.2%, 55%, 49.1% and 50% in stage I, II, III and IV disease respectively were asymptomatic at the time of biopsy.

  13. IA, I AM

    DEFF Research Database (Denmark)

    Munk, Timme Bisgaard; Mørk, Kristian

    2004-01-01

    Hvad er informationsarkitektur? Mørk & Munk gennemgår de forskellige metaforiske konstruktioner af begrebet og kommer med deres helt egen selvstændige definition. Informationsarkitektur er en samtale, strukturation, en klassifikationskamp og et konceptuelt blend. Læs hvorfor i dette working paper...... om et af de meste centrale begreber videnssamfundet. For nu er vi alle informationsarkitekter: IA, I AM....

  14. Interval estimation of binomial proportion in clinical trials with a two-stage design.

    Science.gov (United States)

    Tsai, Wei-Yann; Chi, Yunchan; Chen, Chia-Min

    2008-01-15

    Generally, a two-stage design is employed in Phase II clinical trials to avoid giving patients an ineffective drug. If the number of patients with significant improvement, which is a binomial response, is greater than a pre-specified value at the first stage, then another binomial response at the second stage is also observed. This paper considers interval estimation of the response probability when the second stage is allowed to continue. Two asymptotic interval estimators, Wald and score, as well as two exact interval estimators, Clopper-Pearson and Sterne, are constructed according to the two binomial responses from this two-stage design, where the binomial response at the first stage follows a truncated binomial distribution. The mean actual coverage probability and expected interval width are employed to evaluate the performance of these interval estimators. According to the comparison results, the score interval is recommended for both Simon's optimal and minimax designs.

  15. Cefaléia crônica diária primária: apresentação clínica Chronic daily headache: clinical presentation

    Directory of Open Access Journals (Sweden)

    ABOUCH V. KRYMCHANTOWSKI

    2000-06-01

    Full Text Available As cefaléias crônicas diárias (CCD representam um grupo de cefaléias com frequência diária ou quase diária, por mais de 6 meses. Embora de ocorrência comum, não é bem definida levando a controvérsias quanto a sua identificação, nomenclatura e abordagem. Foram estudados retrospectivamente 300 pacientes (232 mulheres e 68 homens, com idades entre 16 e 86 anos (média de 38 para as mulheres e 42 para os homens de um centro especializado em cefaléias, que preencheram os critérios propostos por Silberstein e col.1,2 para as CCD primárias e apresentavam cefaléia 28 dias por mês. Os aspectos clínicos permitiram os diagnósticos das cefaléias primárias, antes da evolução para CCD como: migrânea transformada (MT em 271 pacientes (90,3%, cefaléia do tipo tensional crônica (CTTC em 26 pacientes (8,7% e cefaléia persistente diária de início súbito (CPDIS em 3 pacientes (1%. Entre os pacientes com MT, cefaléia fronto-temporal bilateral em peso ou pressão moderada, com duração não contínua e reinicio leve e progressivo foi o mais observado. A dor era associada a náusea em aproximadamente 60% dos pacientes e a fonofobia em 32%. Fotofobia, associação com distúrbios do sono e a ocorrência de crises intermitentes, variaram entre homens e mulheres. Entre os pacientes com CTTC, predominou dor fronto-temporal em peso ou pressão moderada, não contínua e sem sintomas associados, porém com distúrbios do sono na maioria dos pacientes.Chronic daily headache (CDH represents a group of any headache disorder that occurs on a daily or near daily basis, for longer than 6 months. Even though it is a common problem, it is not a well defined disorder, resulting in controversies regarding its identification, description and approach. Three hundred patients, 232 women and 68 men, ages 16 to 86 (mean 38 years old for the women and 42 for the men, attending a headache center and fulfilling the proposed criteria for CDH (Silberstein et al

  16. Study of aac(6'Ie-aph(2″Ia Gene in Clinical Strain of Enterococci and Identification of High-Level Gentamicin Resistante Enterococci

    Directory of Open Access Journals (Sweden)

    N. Dadfarma

    2010-10-01

    Full Text Available Introduction & Objective: Enterococci have emerged as the leading nosocomial pathogens. In addition to natural resistance to many agents, enterococci have also developed plasmid- and transposon-mediated resistance to high concentrations of aminoglycosides. High-level gentamicin resistance (HLGR of enterococci results in the failure of drug synergism with an aminoglycoside plus cell-wall-active agents. HLGR (MIC=500μg/ml strains is usually due to the presence of the aac(6'Ie-aph(2″Ia gene . Materials & Methods: In the present experimental study 142 enterococci were isolated from the patients’ species. Identification was done by using standard methods and antimicrobial susceptibility test was performed by disc diffusion technique. MIC of Gentamicin was determined by a broth micro dilution method (NCCLS. PCR was performed to detect the aac(6'Ie-aph(2″Ia gene .Presence of the gene aac(6'-Ie-aph(2″-Ia was confirmed by digest with Sca1 enzyme. A PCR product was sequenced and BLAST analyzed at the NCBI database to be confirmed. Results: 62(43.7% out of the 142 isolates, were found to exhibit HLGR phenotype. MIC ranging from 512 to >1024 μg/ml in 55 HLGR isolates. All resistant isolates except one, were found to harbor the aac(6'Ie-aph(2″Ia gene. In our strain collection, 42% of E. faecalis and 44% of E. faecium were HLGR. In the HLGR isolates the prevalence of resistance to other antibiotics and Multi Drug Resistance (MDR was higher than non–HLGR.This prevalence in E.faecium was higher than E.faecalis. The sequence was compared with a published sequence and confirmed. Conclusion: Our results indicate that high prevalence of MDR and HLGR enterococcal colonization is an important problem in our medical centers.Spread of the aac(6'-Ie-aph(2″-Ia gene was responsible for HLGR among enterococci isolated from the patients in Tehran. (Sci J Hamadan Univ Med Sci 2010;17(3:25-32

  17. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...... describing 12 staging instruments were identified (N = 6109 participants, age 65-87). Reliability was studied in most (91%) of the articles and was judged moderate to good. Approximately 78% of the articles evaluated concurrent validity, which was good to very good, while discriminant validity was assessed......, and is available in 14 languages. Taking into account the increasing differentiation of Alzheimer's disease in preclinical and predementia stages, there is an urgent need for global rating scales to be refined as well....

  18. Progenitors of type Ia supernovae

    CERN Document Server

    Maeda, Keiichi

    2016-01-01

    Natures of progenitors of type Ia Supernovae (SNe Ia) have not yet been clarified. There has been long and intensive discussion on whether the so-called single degenerate (SD) scenario or the double degenerate (DD) scenario, or anything else, could explain a major population of SNe Ia, but the conclusion has not yet been reached. With rapidly increasing observational data and new theoretical ideas, the field of studying the SN Ia progenitors has been quickly developing, and various new insights have been obtained in recent years. This article aims at providing a summary of the current situation regarding the SN Ia progenitors, both in theory and observations. It seems difficult to explain the emerging diversity seen in observations of SNe Ia by a single population, and we emphasize that it is important to clarify links between different progenitor scenarios and different sub-classes of SNe Ia.

  19. Improvement in clinical TNM staging documentation within a prostate cancer quality improvement collaborative.

    Science.gov (United States)

    Filson, Christopher P; Boer, Brooke; Curry, Jon; Linsell, Susan; Ye, Zaojun; Montie, James E; Miller, David C

    2014-04-01

    To assess the effectiveness of a feedback and educational intervention to increase documentation of clinical tumor-node-metastasis (TNM) stage among urologists in a statewide quality improvement collaborative. The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of urology practices that aims to improve the quality and cost-efficiency of prostate cancer care. In pilot data collection activities, trained abstractors recorded medical record documentation of clinical TNM stage by participating urologists. We compared levels of TNM stage documentation in 12 MUSIC practices at baseline and after performance feedback and a collaborative-wide educational intervention. We examined patient and practice characteristics associated with documentation of TNM stage. We accrued 491 and 581 men with newly diagnosed prostate cancer during the baseline and postfeedback phases of data collection, respectively. At baseline, 58% of patients had clinical TNM staging in the medical record, ranging from 19% to 96% across 12 practices (P TNM stage. This finding underscores the behavioral change possible with the collaborative quality improvement model and ensures the necessary risk stratification data for our ongoing efforts to improve care. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Optimizing IA-64 performance

    CERN Document Server

    Jarp, S

    2001-01-01

    Examines key features of the Itanium processor architecture and microarchitecture. The Itanium, originally known as the IA-64, is a 64-bit processor designed by Hewlett-Packard and Intel. In addition to the obvious performance gains that 64-bit addressing brings, the Itanium also supports performance-enhancing techniques such as predication, speculation, rotating registers, a wide parallel execution core, high clock speed, fast bus architecture, multiple execution units, and the like. Moreover, the Itanium is designed from the ground up around parallelism and uses a new kind of instruction set based on the Explicit Parallel Instruction Computing (EPIC) specification, which allows the processing of Windows-based and UNIX- based applications, among other features. Operating-system support for the IA-64 has been announced for 64-bit Windows, HP-UX, varieties of Linux, and AIX 51. The author shows how to achieve optimal code generation by a compiler or generate optimized sequences ofIA-64 assembly code to ensure ...

  1. Staging practice for prostate cancer varies and is not in line with clinical guidelines

    DEFF Research Database (Denmark)

    Petersen, Lars J; Shuytsky, Yuliya; Zacho, Helle D

    2016-01-01

    INTRODUCTION: The objective was to describe regional variations in M-staging in patients with newly diagnosed prostate cancer within a Danish county and to compare clinical practice with guideline recommendations. METHODS: Data were as captured from 1) a prospective, non-interventional study......" to "mandatory" head-to-thigh imaging. There were notable variations between clinical practice and guidelines in 2008, and this was even more evident in 2015. CONCLUSION: Considerable variations existed with respect to the M-staging imaging practices in prostate cancer within a single Danish county...

  2. Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer

    Science.gov (United States)

    2016-02-09

    Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IB Fallopian Tube Cancer; Stage IC Fallopian Tube Cancer; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIB Fallopian Tube Cancer; Stage IIC Fallopian Tube Cancer; Stage III Ovarian Cancer; Stage III Primary Peritoneal Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIC Fallopian Tube Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer

  3. Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

    NARCIS (Netherlands)

    Heijdenrijk, Kees

    2002-01-01

    The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

  4. Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

    NARCIS (Netherlands)

    Heijdenrijk, Kees

    2002-01-01

    The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

  5. A study of mode of transmission, clinical presentations, WHO and immunological staging among HIV infected children

    OpenAIRE

    Durgesh Kumar; Mukesh V. Singh; Dinesh Kumar; K. M. Shukla; Singh, D. K.; Singh, Dharmendra K.

    2014-01-01

    Background: The clinical manifestations of HIV infection vary widely among infants, children, and adolescent. So there is a need to study the mode of transmission, clinical presentations, WHO and immunological staging among HIV infected children. Methods: Observational analytic cross sectional study. The children who were HIV positive (confirmed by ELISA for HIV-1 and HIV-2), and attending the OPD of ART Centre and SN Children Hospital, Allahabad during period of one year. The study popula...

  6. DNA COPY PROFILE IN NASOPHARYNGEAL CARCINOMA AND ITS CORRELATION WITH CLINICAL STAGING

    Institute of Scientific and Technical Information of China (English)

    鄢践; 方嬿; 梁启万; 曾益新

    2001-01-01

    To detect genetic alterations in nasopharyngeal carcinoma (NPC) in Cantonese, the population with the highest incidence of NPC, and to correlate the findings with clinical staging. Methods: Comparative genomic hybridization (CGH) was performed on 35 primary nasopharyngeal carcinomas and a nonparametric χ2 test was used to analyze relationship between chromosome changes and clinical staging. Results: The identified common chromosomal alterations in NPC included gain of chromosomes 12q (21 cases, 60%), 4q (19cases, 43%), 3q (18 cases, 51%), 1q (15 cases, 43%),8q (14 cases, 40%), and 2q (12 cases, 30%). The most frequently detected loss of chromosomal materials involved chromosome 1p (24 cases, 69%), chromosome 3p (21 cases, 60%), 11q (20 cases, 57%), 14q (18 cases, 51%), 16q (14 cases, 40%), 13(12 cases, 34%), and 9p(11 cases, 31%). The high frequency (>50%) 4q gain and 1p loss were novel findings. Compared by nonparametric χ2 test, gains on 12q and 8q were found mainly in stages Ⅲ/Ⅳ and there were significant differences between two clinical stage groups ( stagesⅠ/Ⅱvs stages Ⅲ/Ⅳ). Conclusions: Current analysis has revealed a comprehensive profile of the chromosomal regions showing DNA copy number changes, which may harbor oncogenes or tumor suppressor genes involved in the development of primary NPC.

  7. Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil Aspectos clínicos e diagnósticos da microsporidiose intestinal em pacientes com infecção pelo HIV e diarréia crônica, no Rio de Janeiro, Brasil

    Directory of Open Access Journals (Sweden)

    Patrícia BRASIL

    2000-12-01

    Full Text Available The objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5% either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3 or polymerase chain reaction (n=6 confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.Os objetivos deste estudo foram determinar a prevalência e o prognóstico clínico da infecção por microsporídios em uma coorte de 40 pacientes com infecção pelo HIV e diarréia crônica na cidade do Rio de Janeiro, Brasil. Cada paciente teve suas fezes e fragmentos de intestino examinados para a pesquisa de CMV, bactérias e parasitos. A prevalência de microsporidiose foi de 27,5% (n=11. Esporos de microsporídios foram encontrados com maior frequência no exame direto das fezes do que em biópsias de intestino delgado. A microscopia eletrônica de transmissão e a reação de polimerase em cadeia (PCR identificaram Enterocytozoon bieneusi, respectivamente, em 3 e 6 amostras examinadas, confirmando a espécie como único agente causal. Nenhum outro microrganismo patogênico, além dos microsporídios, foi detectada em 5 dos pacientes com diarréia. Outros parasitos foram encontrados

  8. Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

    NARCIS (Netherlands)

    Frielink, L.M.; Pijlman, B.M.; Ezendam, N.P.; Pijnenborg, J.M.A.

    2016-01-01

    BACKGROUND: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. METHODS: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The perc

  9. Photoacoustic intra-operative nodal staging using clinically approved superparamagnetic iron oxide nanoparticles

    Science.gov (United States)

    Grootendorst, Diederik J.; Fratila, Raluca M.; Visscher, Martijn; Ten Haken, Bennie; van Wezel, Richard; Steenbergen, Wiendelt; Manohar, Srirang; Ruers, Theo J. M.

    2013-02-01

    Detection of tumor metastases in the lymphatic system is essential for accurate staging of various malignancies, however fast, accurate and cost-effective intra-operative evaluation of the nodal status remains difficult to perform with common available medical imaging techniques. In recent years, numerous studies have confirmed the additional value of superparamagnetic iron oxide dispersions (SPIOs) for nodal staging purposes, prompting the clearance of different SPIO dispersions for clinical practice. We evaluate whether a combination of photoacoustic (PA) imaging and a clinically approved SPIO dispersion, could be applied for intra-operative nodal staging. Metastatic adenocarcinoma was inoculated in Copenhagen rats for 5 or 8 days. After SPIO injection, the lymph nodes were photoacoustically imaged both in vivo and ex vivo whereafter imaging results were correlated with MR and histology. Results were compared to a control group without tumor inoculation. In the tumor groups clear irregularities, as small as 1 mm, were observed in the PA contrast pattern of the nodes together with an decrease of PA response. These irregularities could be correlated to the absence of contrast in the MR images and could be linked to metastatic deposits seen in the histological slides. The PA and MR images of the control animals did not show these features. We conclude that the combination of photoacoustic imaging with a clinically approved iron oxide nanoparticle dispersion is able to detect lymph node metastases in an animal model. This approach opens up new possibilities for fast intra-operative nodal staging in a clinical setting.

  10. Phased array magnetic resonance imaging for staging clinically localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Borre, Michael; Langkilde, Niels Christian; Wolf, Hans [Aarhus Univ. Hospital (Denmark). Dept. of Urology; Lundorf, Erik [Aarhus Univ. Hospital (Denmark). Center of MRI; Marcussen, Niels [Aarhus Univ. Hospital (Denmark). Inst. of Pathology

    2005-09-01

    Patients suffering from intra-capsular prostate cancer (T1-2, N0, M0) are potential candidates for curative treatment by radical prostatectomy or radiation therapy. Curative intended therapy is frequently associated with substantial side effects, which makes accuracy of preoperative staging important. However, up to 40% of the patients with clinically localized disease turn out to be under-staged and should not have been subjected to curative surgery. The aim of this study was to assess the value of preoperative phased array MRI staging in patients who are candidates for radical prostatectomy. Ninety-five potential candidates for radical prostatectomy suspected of suffering from clinical prostate cancer underwent pre-diagnostic and pre-operative staging by magnetic resonance imaging (MRI). The results were compared with the postoperative pathological findings including evidence of extra-capsular extension (ECE) of the tumor. The MRI results were not taken into consideration when staging the patients preoperatively or offering treatment. Radical prostatectomy was performed within a few weeks after MRI. In 48 patients the diagnostic biopsy did not detect carcinoma but benign hyperplasia of the prostate (BPH), while 9 patients had T3 disease. Thirty-eight patients had clinically localized prostate cancer and underwent radical prostatectomy. In 16 cases (42%) ECE was postoperatively proven by the pathologist, while only 22 (58%) of the patients suffered from true localized prostate cancer. The sensitivity and specificity of MRI detecting ECE were 24% and 86% respectively, while the positive and negative predictive value of MRI with regard to ECE were only 57% and 61% respectively. Phased array MRI did not in its present form provide the necessary accuracy in preoperative staging in clinically localized prostate cancer patients.

  11. The core-degenerate scenario for the progenitors of Type Ia supernovae

    Science.gov (United States)

    Wang, B.; Zhou, W.-H.; Zuo, Z.-Y.; Li, Y.-B.; Luo, X.; Zhang, J.-J.; Liu, D.-D.; Wu, C.-Y.

    2017-02-01

    The origin of the progenitors of Type Ia supernovae (SNe Ia) is still uncertain. The core-degenerate (CD) scenario has been proposed as an alternative way for the production of SNe Ia. In this scenario, SNe Ia are formed at the final stage of common-envelope evolution from a merger of a carbon-oxygen white dwarf (CO WD) with the CO core of an asymptotic giant branch companion. However, the birthrates of SNe Ia from this scenario are still not well determined. In this work, we performed a detailed investigation on the CD scenario based on a binary population synthesis approach. The SN Ia delay times from this scenario are basically in the range of 90-2500 Myr, mainly contributing to the observed SNe Ia with short and intermediate delay times, although this scenario can also produce some old SNe Ia. Meanwhile, our work indicates that the Galactic birthrates of SNe Ia from this scenario are not more than 20 per cent of total SNe Ia due to more careful treatment of mass transfer. Although the SN Ia birthrates in this work are lower than those in Ilkov & Soker, the CD scenario cannot be ruled out as a viable mechanism for the formation of SNe Ia. Especially, SNe Ia with circumstellar material from this scenario contribute to 0.7-10 per cent of total SNe Ia, which means that the CD scenario can reproduce the observed birthrates of SNe Ia like PTF 11kx. We also found that SNe Ia happen systemically earlier for a high value of metallicity and their birthrates increase with metallicity.

  12. Estudo comparativo da história clínica e da polissonografia na síndrome da apnéia/ hipopnéia obstrutiva do sono Comparative study between clinical history and polysomnogram in the obstructive sleep apnea/ hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Lys Maria Allenstein Gondim

    2007-12-01

    Full Text Available O reconhecimento dos distúrbios respiratórios do sono tem aumentado a cada ano. Manifestações, como o ronco, consideradas meros incômodos vêm adquirindo importância no que diz respeito à qualidade de vida e seu impacto social. OBJETIVO: Comparar a história clínica com os resultados da polissonografia (PSG, na Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS, é o principal objetivo deste trabalho. MATERIAL E MÉTODOS: Foi realizado um estudo retrospectivo, com 125 pacientes, através da análise de questionários específicos, IMC e Escala de Epworth. RESULTADOS: Dentre os pacientes, 75 eram do sexo masculino e 50 do feminino. O principal sintoma foi a roncopatia. 46% apresentaram PSG normais, 30% SAHOS leve, 15% moderada e 9% severa, não se evidenciando correlação estatística entre a clínica e a PSG. Dentre as queixas, somente a insônia foi relevante, em análise univariada e em pacientes normais e com SAHOS leve (pRecognizing sleep-disordered breathing is on the rise every year. Manifestations, such as snoring, that were earlier considered mere inconvenients are now acquiring greater importance concerning life quality and social impact. AIM OF THE STUDY: To compare the clinical history to polysomnogram (PSG results in the Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS. MATERIALS AND METHODS: 125 patients were analyzed, in a retrospective study. Specific questionnaires, avaliations of Body Mass Index and Epworth Scale were carried out. RESULTS: Among the patients, 75 were males and 50 were females. The main symptom was snoring. 46% had normal PSG, 30% had light OSAHS, 15% moderate and 9% severe OSAHS and it was not observed a correlation between clinical data and PSG results. Concerning clinical symptoms, only insomnia has shown relevance when univariably analyzed in normal and light OSAHS patients (p<0,05 compared to patients with moderate and severe OSAHS, losing its importance when analyzed together with other

  13. The cachexia clinic: from staging to managing nutritional and functional problems in advanced cancer patients.

    Science.gov (United States)

    Vigano, Antonio; Del Fabbro, Egidio; Bruera, Eduardo; Borod, Manuel

    2012-01-01

    Panels of experts have agreed on the definition of cancer cachexia stages (CCS). We evaluated the clinical relevance of these stages and proposed ways to apply the CCSs to the clinical practice via standardized methods. The CCS were applied to 207 patients with advanced non-small-cell lung or gastrointestinal cancers from the Human Cancer Cachexia Database via consensus among the coauthors. Patients were categorized as noncachectic, precachectic, cachectic, and in refractory cachexia. Through analysis of variance, χ2, and Kaplan-Meier analyses, we tested the relationships between CCSs and selected outcomes. The CCS were significantly correlated (P model for diagnosing more precisely the pathophysiology and severity of precachectic and cachectic conditions. The cachexia clinic, by working closely with palliative care programs, may offer the best environment for a comprehensive and personalized approach to the nutritional and functional problems in advanced cancer patients.

  14. Microscopic Omental Metastasis in Clinical Stage I Endometrial Cancer: A Meta-analysis.

    Science.gov (United States)

    Joo, Won Duk; Schwartz, Peter E; Rutherford, Thomas J; Seong, Seok Ju; Ku, Junbeom; Park, Hyun; Jung, Sang Geun; Choi, Min Chul; Lee, Chan

    2015-10-01

    A patient with early-stage endometrial cancer may possibly have microscopic metastasis in the omentum, which is associated with a poor prognosis. The purpose of this study was to identify risk factors for microscopic omental metastasis in patients with clinical stage I endometrial cancer to establish the indications for selective omentectomy. We searched the PubMed, EMBASE, and Cochrane Library databases for published studies from inception to August 2014, using terms such as 'endometrial cancer' or 'uterine cancer' for disease, 'omentectomy' or 'omental biopsy' for intervention, and 'metastasis' for outcome. Two reviewers independently identified the studies that matched the selection criteria. We calculated the pooled risk ratios (RRs) with 95 % confidence intervals (CI) of each surgicopathologic finding for microscopic omental metastases in clinical stage I endometrial cancer. We also calculated the prevalence of microscopic omental metastases. Among 1163 patients from ten studies, 22 cases (1.9 %) of microscopic omental metastases were found, which accounted for 26.5 % of all omental metastases. Positive lymph nodes (RR 8.71, 95 % CI 1.38-54.95), adnexal metastases (RR 16.76, 95 % CI 2.60-107.97), and appendiceal implants (RR 161.67, 95 % CI 5.16-5061.03) were highly associated with microscopic omental metastases. Microscopic omental metastases were not negligible in patients with clinical stage I endometrial cancer. Those with a risk factor of microscopic omental metastases were recommended for selective omentectomy.

  15. Low Level of Microsatellite Instability Correlates with Poor Clinical Prognosis in Stage II Colorectal Cancer Patients

    Directory of Open Access Journals (Sweden)

    Ehsan Nazemalhosseini Mojarad

    2016-01-01

    Full Text Available The influence of microsatellite instability (MSI on the prognosis of colorectal cancer (CRC requires more investigation. We assessed the role of MSI status in survival of individuals diagnosed with primary colorectal cancer. In this retrospective cross-sectional study the MSI status was determined in 158 formalin-fixed paraffin-embedded tumors and their matched normal tissues from patients who underwent curative surgery. Cox proportional hazard modeling was performed to assess the clinical prognostic significance. In this study we found that MSI-H tumors were predominantly located in the colon versus rectum (p=0.03, associated with poorer differentiation (p=0.003 and TNM stage II/III of tumors (p=0.02. In CRC patients with stage II, MSI-L cases showed significantly poorer survival compared with patients who had MSI-H or MSS tumors (p=0.04. This study indicates that MSI-L tumors correlate with poorer clinical outcome in patients with stage II tumors (p=0.04 or in tumors located in the colon (p=0.02. MSI-L characterizes a distinct subgroup of CRC patients who have a poorer outcome. This study suggests that MSI status in CRC, as a clinical prognostic marker, is dependent on other factors, such as tumor stage and location.

  16. Mindfulness Meditation or Survivorship Education in Improving Behavioral Symptoms in Younger Stage 0-III Breast Cancer Survivors (Pathways to Wellness)

    Science.gov (United States)

    2017-03-21

    Cancer Survivor; Early-Stage Breast Carcinoma; Stage 0 Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  17. Clinical potentials of methylator phenotype in stage 4 high-risk neuroblastoma: an open challenge.

    Directory of Open Access Journals (Sweden)

    Barbara Banelli

    Full Text Available Approximately 20% of stage 4 high-risk neuroblastoma patients are alive and disease-free 5 years after disease onset while the remaining experience rapid and fatal progression. Numerous findings underline the prognostic role of methylation of defined target genes in neuroblastoma without taking into account the clinical and biological heterogeneity of this disease. In this report we have investigated the methylation of the PCDHB cluster, the most informative member of the "Methylator Phenotype" in neuroblastoma, hypothesizing that if this epigenetic mark can predict overall and progression free survival in high-risk stage 4 neuroblastoma, it could be utilized to improve the risk stratification of the patients, alone or in conjunction with the previously identified methylation of the SFN gene (14.3.3sigma that can accurately predict outcome in these patients. We have utilized univariate and multivariate models to compare the prognostic power of PCDHB methylation in terms of overall and progression free survival, quantitatively determined by pyrosequencing, with that of other markers utilized for the patients' stratification utilizing methylation thresholds calculated on neuroblastoma at stage 1-4 and only on stage 4, high-risk patients. Our results indicate that PCDHB accurately distinguishes between high- and intermediate/low risk stage 4 neuroblastoma in agreement with the established risk stratification criteria. However PCDHB cannot predict outcome in the subgroup of stage 4 patients at high-risk whereas methylation levels of SFN are suggestive of a "methylation gradient" associated with tumor aggressiveness as suggested by the finding of a higher threshold that defines a subset of patients with an extremely severe disease (OS <24 months. Because of the heterogeneity of neuroblastoma we believe that clinically relevant methylation markers should be selected and tested on homogeneous groups of patients rather than on patients at all stages.

  18. Analysis of clinical features, serologic and cerebrospinal fluid tests in patients with neurosyphilis at different stages

    Directory of Open Access Journals (Sweden)

    Bao-jie WANG

    2016-08-01

    Full Text Available Objective To summarize the clinical features, serologic, cerebrospinal fluid (CSF tests in patients with neurosyphilis at different stages.  Methods A retrospective analysis was made on the clinical features, imaging, serologic and CSF tests, treatment and prognosis of 12 cases diagnosed as neurosyphilis. In those cases, 5 cases were early-stage neurosyphilis, including 4 syphilitic meningitis (meningomyelitis and one meningovascular syphilis; 7 cases were late-stage neurosyphilis, all of whom were general paresis.  Results The serum Treponema pallidum antibody (TP-Ab and rapid plasma regain (RPR tests were positive in all 12 cases. The CSF TP-Ab tests of 12 cases were all positive and CSF RPR tests were positive in 9 cases. In 5 cases of early-stage neurosyphilis, one case had elevated intracranial pressure (ICP, 3 cases presented with elevated white blood cell (WBC, 4 cases had elevated protein concentration. In 7 cases of late-stage neurosyphilis, one case had elevated ICP, 7 cases presented with elevated WBC and protein concentration. CSF cytology showed lymphocyte reaction, mainly small lymphocytes. All cases were treated with different doses of intravenous penicillin or ceftriaxone sodium by intramuscular injection, among whom 8 cases presented improved neuropsychiatric symptoms, while 4 cases had no significant improvement.  Conclusions Neurosyphilis is easy to be misdiagnosed because of various styles of onset and nontypical clinical manifestations. A definite diagnosis depends on clinical manifestations and serologic and CSF examinations. Early diagnosis and standard treatment is essential for improving prognosis and reducing complications. DOI: 10.3969/j.issn.1672-6731.2016.07.005

  19. Atrophy patterns in early clinical stages across distinct phenotypes of Alzheimer's disease.

    Science.gov (United States)

    Ossenkoppele, Rik; Cohn-Sheehy, Brendan I; La Joie, Renaud; Vogel, Jacob W; Möller, Christiane; Lehmann, Manja; van Berckel, Bart N M; Seeley, William W; Pijnenburg, Yolande A; Gorno-Tempini, Maria L; Kramer, Joel H; Barkhof, Frederik; Rosen, Howard J; van der Flier, Wiesje M; Jagust, William J; Miller, Bruce L; Scheltens, Philip; Rabinovici, Gil D

    2015-11-01

    Alzheimer's disease (AD) can present with distinct clinical variants. Identifying the earliest neurodegenerative changes associated with each variant has implications for early diagnosis, and for understanding the mechanisms that underlie regional vulnerability and disease progression in AD. We performed voxel-based morphometry to detect atrophy patterns in early clinical stages of four AD phenotypes: Posterior cortical atrophy (PCA, "visual variant," n=93), logopenic variant primary progressive aphasia (lvPPA, "language variant," n=74), and memory-predominant AD categorized as early age-of-onset (EOAD, 65 years, n=114). Patients with each syndrome were stratified based on: (1) degree of functional impairment, as measured by the clinical dementia rating (CDR) scale, and (2) overall extent of brain atrophy, as measured by a neuroimaging approach that sums the number of brain voxels showing significantly lower gray matter volume than cognitively normal controls (n=80). Even at the earliest clinical stage (CDR=0.5 or bottom quartile of overall atrophy), patients with each syndrome showed both common and variant-specific atrophy. Common atrophy across variants was found in temporoparietal regions that comprise the posterior default mode network (DMN). Early syndrome-specific atrophy mirrored functional brain networks underlying functions that are uniquely affected in each variant: Language network in lvPPA, posterior cingulate cortex-hippocampal circuit in amnestic EOAD and LOAD, and visual networks in PCA. At more advanced stages, atrophy patterns largely converged across AD variants. These findings support a model in which neurodegeneration selectively targets both the DMN and syndrome-specific vulnerable networks at the earliest clinical stages of AD.

  20. The clinical significance of axillary sentinel lymph node biopsy in different clinical stages breast cancer patients after neoadjuvant chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Juan Xu; Xinhong Wu; Yaojun Feng; Feng Yuan; Wei Fan

    2013-01-01

    Objective:We aimed to study the success and false negative rate of sentinel lymph node biopsy (SLNB) in dif-ferent clinical stages breast cancer patients being carried out with neoadjuvant chemotherapy (NAC), and the clinical signifi-cance of SLNB, we conducting this trial. Methods:One hunderd and thirty-seven cases were enrol ed in this clinical research from March 2003 to March 2007. Al of the patients’ sentinel lymph nodes were detected with 99mTc-Dx and methylene blue. There were 61 patients with stage T1-2N0M0 carried SLNB without NAC (group A), 76 cases were carried out NAC 3-4 cycles before SLNB, including 39 T2-4N0-1M0 cases (group B) and 27 T2-4N2-3M0 cases (group C). The success and false negative rate of SLNB were analysed with chi-square test. Results:In group A, the successful and false negative rate of SLNB were 92.31%(36/39), 8.57%(3/35), and in group B and C were 92.31%(36/39), 8.57%(3/35) and 74.07%(20/27), 18.52%(5/27), respectively. The successful rate of group C decreased and false negative rate increased significantly compared with group A and B (P0.05). Conclusion:The SLNB can accurately predict lymph node status of axil ary lymph node in N0-1 stage patients with NAC, but in N2-3 stage patients the success rate decreased and false rate increased negative significantly.

  1. TDP-43 stage, mixed pathologies, and clinical Alzheimer's-type dementia.

    Science.gov (United States)

    James, Bryan D; Wilson, Robert S; Boyle, Patricia A; Trojanowski, John Q; Bennett, David A; Schneider, Julie A

    2016-09-30

    Hyperphosphorylated transactive response DNA-binding protein 43 (TDP-43, encoded by TARDBP) proteinopathy has recently been described in ageing and in association with cognitive impairment, especially in the context of Alzheimer's disease pathology. To explore the role of mixed Alzheimer's disease and TDP-43 pathologies in clinical Alzheimer's-type dementia, we performed a comprehensive investigation of TDP-43, mixed pathologies, and clinical Alzheimer's-type dementia in a large cohort of community-dwelling older subjects. We tested the hypotheses that TDP-43 with Alzheimer's disease pathology is a common mixed pathology; is related to increased likelihood of expressing clinical Alzheimer's-type dementia; and that TDP-43 pathologic stage is an important determinant of clinical Alzheimer's-type dementia. Data came from 946 older adults with (n = 398) and without dementia (n = 548) from the Rush Memory and Aging Project and Religious Orders Study. TDP-43 proteinopathy (cytoplasmic inclusions) was present in 496 (52%) subjects, and the pattern of deposition was classified as stage 0 (none; 48%), stage 1 (amygdala; 18%), stage 2 (extension to hippocampus/entorhinal; 21%), or stage 3 (extension to neocortex; 14%). TDP-43 pathology combined with a pathologic diagnosis of Alzheimer's disease was a common mixed pathology (37% of all participants), and the proportion of subjects with clinical Alzheimer's-type dementia formerly labelled 'pure pathologic diagnosis of Alzheimer's disease' was halved when TDP-43 was considered. In logistic regression models adjusted for age, sex, and education, TDP-43 pathology was associated with clinical Alzheimer's-type dementia (odds ratio = 1.51, 95% confidence interval = 1.11, 2.05) independent of pathological Alzheimer's disease (odds ratio = 4.30, 95% confidence interval = 3.08, 6.01) or other pathologies (infarcts, arteriolosclerosis, Lewy bodies, and hippocampal sclerosis). Mixed Alzheimer's disease and TDP-43 pathologies were

  2. [Ways to improve efficiency of patient clinical examinations during early stage of cholelithiasis].

    Science.gov (United States)

    Khokhlacheva, N A; Suchkova, E V; Vakhrushev, Ia M

    2013-01-01

    The aim of the work was to improve the organization and conduct of clinical examination of patients with gallstone disease (GSD). An integrated study of 396 patients with different pathologies of the hepatobiliary system and the medical check-up for three years for 101 patients. Built logistic model to predict the likelihood of developing gallstone disease and developed a predictive scoring table it possible to distinguish patients at risk of developing gall stones. The result of follow-up of the proposed method was prevented economic losses due to the lack of need for a cholecystectomy, which is made up of one patient 6766.22 rubles., The entire group of 1,004,966.63 rubles. Obtained to diagnose cholelithiasis at an early stage dokamennoy. Developed a screening questionnaire, predictive scoring table, the scheme of follow-up also improves clinical examination of patients with cholelithiasis dokamennoy stage.

  3. Imaging vascular function for early stage clinical trials using dynamic contrast-enhanced magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Leach, M.O.; Orton, M. [Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Research UK and EPSRC Cancer Imaging Centre, Sutton, Surrey (United Kingdom); Morgan, B. [Univ. of Leicester, College of Medicine, Biological Sciences and Psychology, Leicester (United Kingdom); Tofts, P.S. [Brighton and Sussex Medical School, Univ. of Sussex, Clinical Imaging Sciences Centre, Sussex (United Kingdom); Buckley, D.L. [University of Leeds, Division of Medical Physics, Leeds (United Kingdom); Huang, W. [Oregon Health and Science Univ., Advanced Imaging Research Centre, Portland, OR (United States); Horsfield, M.A. [Medical Physics Section, Leicester Royal Infirmary, Dept. of Cardiovascular Sciences, Leicester (United Kingdom); Chenevert, T.L. [Univ. of Michigan Health System, Ann Arbor, MI (United States); Collins, D.J. [Royal Marsden Hospital NHS Foundation Trust, Cancer Research UK and EPSRC Cancer Imaging Centre, Sutton, Surrey (United Kingdom); Jackson, A. [Univ. of Manchester, Wolfson Molecular Imaging Centre, Withington, Manchester, M20 3LJ (United Kingdom); Lomas, D. [Univ. of Cambridge, Dept. of Radiology, Cambridge (United Kingdom); Whitcher, B. [Unit 2 Greenways Business Park, Mango Solutions, Chippenham (United Kingdom); Clarke, L. [Cancer Imaging Program, Imaging Technology Development Branch, Rockville, MD (United States); Plummer, R. [Univ. of Newcastle Upon Tyne, The Medical School, Medical Oncology, Northern Inst. for Cancer Research, Newcastle Upon Tyne (United Kingdom); Judson, I. [Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Jones, R. [Beatson West of Scotland Cancer Centre, Glasgow (United Kingdom); Alonzi, R. [Mount Vernon Cancer Centre, Northwood (United Kingdom); Brunner, T. [Gray Inst. for Radiation, Oncology and Biology, Oxford (United Kingdom); Koh, D.M. [Royal Marsden NHS Foundation Trust, Diagnostic Radiology, Sutton, Surrey (United Kingdom)] [and others

    2012-07-15

    Many therapeutic approaches to cancer affect the tumour vasculature, either indirectly or as a direct target. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become an important means of investigating this action, both pre-clinically and in early stage clinical trials. For such trials, it is essential that the measurement process (i.e. image acquisition and analysis) can be performed effectively and with consistency among contributing centres. As the technique continues to develop in order to provide potential improvements in sensitivity and physiological relevance, there is considerable scope for between-centre variation in techniques. A workshop was convened by the Imaging Committee of the Experimental Cancer Medicine Centres (ECMC) to review the current status of DCE-MRI and to provide recommendations on how the technique can best be used for early stage trials. This review and the consequent recommendations are summarised here. (orig.)

  4. Pediatróia

    OpenAIRE

    Carmona da Mota, Henrique

    2014-01-01

    Os pediatras deram-se conta que tinham perdido o seu “ponto da situação”, o seu “estado da arte”, a sua rainha, a estrela polar por que se guiavam. Na lufa-lufa do trabalho diário não lhe tinham dado a atenção indispensável e ela teria ido para o outro lado do mar Egeu.Decidiram ir lá buscá-la; todos colaboraram na organização da empresa e, tendo sacrificado aos deuses e escolhido o dia fasto, rumaram a Tróia. Nem todos que alguns espartanos teriam que ficar para assegurar a defesa das suas c...

  5. The core-degenerate scenario for the progenitors of type Ia supernovae

    CERN Document Server

    Wang, Bo; Zuo, Zhaoyu; Li, Yinbi; Luo, Xia; Zhang, Jujia; Liu, Dongdong; Wu, Chengyuan

    2016-01-01

    The origin of the progenitors of type Ia supernovae (SNe Ia) is still uncertain. The core-degenerate (CD) scenario has been proposed as an alternative way for the production of SNe Ia. In this scenario, SNe Ia are formed at the final stage of common-envelope evolution from a merger of a carbon-oxygen white dwarf (CO WD) with the CO core of an asymptotic giant branch companion. However, the birthrates of SNe Ia from this scenario are still not well determined. In this work, we performed a detailed investigation on the CD scenario based on a binary population synthesis approach. The SN Ia delay times from this scenario are basically in the range of 90Myr-2500Myr, mainly contributing to the observed SNe Ia with short and intermediate delay times although this scenario can also produce some old SNe Ia. Meanwhile, our work indicates that the Galactic birthrates of SNe Ia from this scenario are no more than 20% of total SNe Ia due to more careful treatment of mass transfer. Although the SN Ia birthrates in the pres...

  6. Clinical heterogeneity in patients with early-stage Parkinson's disease: a cluster analysis

    Institute of Scientific and Technical Information of China (English)

    Ping LIU; Tao FENG; Yong-jun WANG; Xuan ZHANG; Biao CHEN

    2011-01-01

    The aim of this study was to investigate the clinical heterogeneity of Parkinson's disease (PD) among a cohort of Chinese patients in early stages.Clinical data on demographics,motor variables,motor phenotypes,disease progression,global cognitive function,depression,apathy,sleep quality,constipation,fatigue,and L-dopa complications were collected from 138 Chinese PD subjects in early stages (Hoehn and Yahr stages 1-3).The PD subject subtypes were classified using k-means cluster analysis according to the clinical data from five- to three-cluster consecutively.Kappa statistical analysis was performed to evaluate the consistency among different subtype solutions.The cluster analysis indicated four main subtypes:the non-tremor dominant subtype (NTD,n=28,20.3%),rapid disease progression subtype (RDP,n=7,5.1%),young-onset subtype (YO,n=50,36.2%),and tremor dominant subtype (TD,n=53,38.4%).Overall,78.3% (108/138) of subjects were always classified between the same three groups (52 always in TD,7 in RDP,and 49 in NTD),and 98.6% (136/138) between five- and four-cluster solutions.However,subjects classified as NTD in the four-cluster analysis were dispersed into different subtypes in the three-cluster analysis,with low concordance between four- and three-cluster solutions (kappa value=-0.139,P=0.001 ).This study defines clinical heterogeneity of PD patients in early stages using a data-driven approach.The subtypes generated by the four-cluster solution appear to exhibit ideal internal cohesion and external isolation.

  7. CLINICAL STAGING OF CANCER OF THE PROSTATE DURING ITS PRIMARY BIOPSY

    Directory of Open Access Journals (Sweden)

    S. B. Petrov

    2010-01-01

    Full Text Available Clinical staging of cancer is the important element of a diagnostic process that determines the nature and scope of therapeutic measures required for a patient. Objective: to assess the role of clinical, clinical laboratory, and morphological findings in the diagnosis of prostate cancer (PC and to analyze the pattern of its clinical stages in patients having different levels of serum prostate-specific antigen (PSA and the results of digital rectal examination (DRE and ultrasound study (USS of the gland. Subjects and methods. The examination and follow-up records were analyzed in 2579 males aged 38-88 years who had indications for primary puncture biopsy of the prostate. Results. PC was detected in 997 (38.66% patients. Clinically localized adenocarcinoma was diagnosed in 50.85% of cases, locally advanced one being in 49.15%, including that with its invasion into the seminal vesicles in 8.73%. The findings of DRE and transrectal USS and serum PSA values allow one to substantially define the likely extent of cancer.

  8. Clinical and laboratory characteristics of chronic hepatitis C on the early stages of development

    Directory of Open Access Journals (Sweden)

    N. S. Zhevnerova

    2016-01-01

    Full Text Available Aim of the research – to assess the clinical and laboratory parameters in patients with chronic hepatitis C (CHC on the early stages of development and their comparison with the level of galectin3. The study included 78 patients with oligosymptomatic course of the disease and minimal liver fibrosis in the most cases. In the most patients with stages of the disease exceeding 8 years, viral load was over a million copies/ml. In 10 % of patients on the early stages of the disease, changes corresponding to severe liver fibrosis and cirrhosis F3 and F4 were detected. Moderate correlation of ALT activity, viral load and low severity with the duration of the disease was identified. There is a trend towards a higher level of galectin3 in a long course of CHC in comparison with earlier stages of its development, with significantly higher average level of galectin-3 in patients with minimal liver fibrosis (F0–F1 as compared to advanced stages, suggesting its importance in the launching and initial mechanisms of fibrogenesis.

  9. The relationship between clinical phenotype and early staged bilateral deep brain stimulation in Parkinson disease.

    Science.gov (United States)

    Sung, Victor W; Watts, Ray L; Schrandt, Christian J; Guthrie, Stephanie; Wang, Deli; Amara, Amy W; Guthrie, Barton L; Walker, Harrison C

    2013-12-01

    While many centers place bilateral deep brain stimulation (DBS) systems simultaneously, unilateral subthalamic nucleus (STN) DBS followed by a staged contralateral procedure has emerged as a treatment option for many patients. However, little is known about whether the preoperative phenotype predicts when staged placement of a DBS electrode in the opposite STN will be required. The authors aimed to determine whether preoperative clinical phenotype predicts early staged placement of a second STN DBS electrode in patients who undergo unilateral STN DBS for Parkinson disease (PD). Eighty-two consecutive patients with advanced PD underwent unilateral STN DBS contralateral to the most affected hemibody and had at least 2 years of follow-up. Multivariate logistic regression analysis determined preoperative characteristics that predicted staged placement of a second electrode in the opposite STN. Preoperative measurements included aspects of the Unified Parkinson's Disease Rating Scale (UPDRS), motor asymmetry index, and body weight. At 2-year follow-up, 28 (34%) of the 82 patients had undergone staged placement of a contralateral electrode while the remainder chose to continue with unilateral stimulation. Statistically significant improvements in UPDRS total and Part 3 scores were retained at the end of the 2-year follow-up period in both subsets of patients. Multivariate logistic regression analysis showed that the most important predictors for early staged placement of a second subthalamic stimulator were low asymmetry index (OR 13.4, 95% CI 2.8-64.9), high tremor subscore (OR 7.2, CI 1.5-35.0), and low body weight (OR 5.5, 95% CI 1.4-22.3). This single-center study provides evidence that elements of the preoperative PD phenotype predict whether patients will require early staged bilateral STN DBS. These data may aid in the management of patients with advanced PD who undergo STN DBS.

  10. Dissection of the sentry ganglion by laparoscopic boarding in patients with cervix uterine cancer clinical stages IA2 at IIB; Diseccion de ganglio centinela por abordaje laparoscopico en pacientes con cancer cervicouterino etapas clinicas IA2 a IIB

    Energy Technology Data Exchange (ETDEWEB)

    Valdez U, J.J.; Pichardo M, P.A.; Cortes M, G.; Escudero de los Rios, P. [Hospital de Oncologia. Centro Medico Nacional Siglo XXI. IMSS, Mexico D.F. (Mexico)

    2005-07-01

    The obtained results in presently study demonstrate that the feasibility of the detection of the sentry ganglion in cervix uterine cancer using a boarding by laparoscopic via, being necessary the use of twice labelled as much with patent blue and radioisotope (colloid of labelled rhenium with {sup 99m}Tc, total dose of 3 MCi) to achieve the identification of the ganglion. (Author)

  11. Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma.

    Science.gov (United States)

    Fischer, Stefanie; Tandstad, Torgrim; Wheater, Matthew; Porfiri, Emilio; Fléchon, Aude; Aparicio, Jorge; Klingbiel, Dirk; Skrbinc, Breda; Basso, Umberto; Shamash, Jonathan; Lorch, Anja; Dieckmann, Klaus-Peter; Cohn-Cedermark, Gabriella; Ståhl, Olof; Chau, Caroline; Arriola, Edurne; Marti, Kalena; Hutton, Paul; Laguerre, Brigitte; Maroto, Pablo; Beyer, Jörg; Gillessen, Silke

    2017-01-10

    Purpose Adjuvant carboplatin is one of three management strategies that may follow inguinal orchiectomy in clinical stage I seminoma. However, little is known about the outcome of patients who experience a relapse after such treatment. Patients and Methods Data from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 centers/groups from 20 countries were collected and retrospectively analyzed. Primary outcomes were disease-free survival and overall survival. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. Results With a median follow-up of 53 months (95% CI, 48 to 60 months) the 5-year disease-free survival was 82% (95% CI, 77% to 89%), and the 5-year overall survival was 98% (95% CI, 95% to 100%). The median time from orchiectomy to relapse was 19 months (95% CI, 17 to 23 months); 15% (95% CI, 10% to 21%) of relapses occurred > 3 years after treatment. The majority of relapses were detected by computed tomography scan during routine follow-up, 98% in the International Germ Cell Cancer Collaborative Group good prognosis group. Chemotherapy was administered to 92% of patients, mostly as standard first-line treatment corresponding to stage; 8% of patients had additional local treatments. Only 28 patients experienced a second relapse. At last follow-up, 174 (94%) of 185 patients were alive without disease, and four patients with disease. Seven patients died, three of whom due to progressive disease. Conclusion Within the limitations of a retrospective analysis, the results suggest that the majority of patients who experience a relapse after adjuvant carboplatin for clinical stage I seminoma can be successfully treated with a cisplatin-based chemotherapy regimen adequate for stage. Because 15% of the relapses occurred > 3 years after adjuvant treatment, a minimum of 5 years follow-up is recommended.

  12. Interobserver consistency of digital rectal examination in clinical staging of localized prostatic carcinoma.

    Science.gov (United States)

    Angulo, J C; Montie, J E; Bukowsky, T; Chakrabarty, A; Grignon, D J; Sakr, W; Shamsa, F H; Edson Pontes, J

    1995-01-01

    A prospective study was undertaken to determine the reproducibility of clinical staging based on digital rectal examination (DRE) in prostate carcinoma. We evaluated 48 consecutive patients diagnosed with localized prostatic cancer. Four urologists performed DRE and sorted the patients according to the 1992 American Joint Committee on Cancer Classification for prostate cancer. Both the percentage observed total agreement among each couple of two different observers and the interobserver variability (Kappa index) were analyzed. The percentage observed total agreement among observers in distinguishing five clinical subcategories (T1c, T2a, T2b, T2c, and T3a) ranged between 38-60% (mean 49%) and the Kappa index showed interobserver agreement was poor (overall Kappa = 0.3 1). All four examiners agreed in assigning the same subcategory in only 21 % of cases, and 90% of them were T I. If only categories are distinguished (T I, T2, or T3), the percentage observed total agreement rises to 60-71% (mean 66%) and the interexaminer agreement improves to good (overall Kappa = 0.4 1). Accurate pathologic staging was obtained in every patient and the percentage observed agreement between every examiner and the pathologist was calculated, excluding cases interpreted as T I c. Regarding subcategories, clinicopathologic agreement ranges between 17-46%. If only categories T2 and9T3 are distinguished, agreement rises to 57-69%. In summary, the ability to reproduce clinical staging based on DRE among multiple examiners is disappointingly low and understandably correlates poorly with pathologic stage.

  13. Functional Magnetic Resonance Imaging in Assessing Affect Reactivity and Regulation in Patients With Stage 0-III Breast Cancer

    Science.gov (United States)

    2017-02-27

    Healthy Subject; Stage 0 Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  14. Clinical staging and survival in refractory celiac disease: a single center experience.

    Science.gov (United States)

    Rubio-Tapia, Alberto; Kelly, Darlene G; Lahr, Brian D; Dogan, Ahmet; Wu, Tsung-Teh; Murray, Joseph A

    2009-01-01

    Refractory celiac disease (RCD) occurs when both symptoms and intestinal damage persist or recur despite strict adherence to a gluten-free diet. In RCD, the immunophenotype of intraepithelial lymphocytes may be normal and polyclonal (RCD I) or abnormal and monoclonal (RCD II). The aim is to describe the clinical characteristics, treatment, and long-term outcome in a large single-center cohort of patients with RCD. We compared the clinical characteristics and outcome in 57 patients with RCD: 42 with RCD I and 15 with RCD II. Fifteen of 57 patients died during follow-up (n=8 with RCD I and n=7 with RCD II), each within the first 2 years after RCD diagnosis. The overall 5-year cumulative survival is 70%, 80%, and 45% for the entire cohort, RCD I, and RCD II, respectively. The refractory state itself and enteropathy-associated T-cell lymphoma (EATL) were the most common causes of death, respectively. A new staging system is proposed based on the cumulative effect of 5 prognostic factors investigated at the time of the refractory state diagnosis: for patients in stages I, II, and III, the 5-year cumulative survival rate was 96%, 71%, and 19%, respectively (PRCD is associated with high mortality with RCD II having an especially poor prognosis because of the development of EATL. A new staging model is proposed that may improve the precision of prognosis in patients with RCD.

  15. [Congenital disorder of glycosylation type Ia (CDG Ia) - underdiagnosed entity?].

    Science.gov (United States)

    Sätilä, Heli; Kuusela, Anna-Leena; Pietilä, Kati; Niinikoski, Harri; Keskinen, Päivi

    2016-01-01

    Congenital disorders of glycosylation (CDG) are a relatively recently identified group of multisystem disorders caused by defective glycosylation of N-glycosylated proteins. They mainly involve the central and peripheral nervous system, but other organ systems are involved as well. Type CDG Ia accounts for over 80% of cases, characterized by decreased activity of the enzyme phosphomannomutase caused by mutations in chromosome 16 PMM2 gene. Treatment of CDG Ia remains symptomatic.

  16. Standardization of type Ia supernovae

    CERN Document Server

    Coelho, Rodrigo C V; Reis, Ribamar R R; Siffert, Beatriz B

    2014-01-01

    Type Ia supernovae (SNe Ia) have been intensively investigated due to its great homogeneity and high luminosity, which make it possible to use them as standardizable candles for the determination of cosmological parameters. In 2011, the physics Nobel prize was awarded for the discovery of the accelerating expansion of the Universe through observations of distant supernovae. This is a pedagogical article, aimed at those starting their study of that subject, in which we dwell on some topics related to the analysis of SNe Ia and their use in luminosity distance estimators. Here we investigate their spectral properties and light curve standardization, paying careful attention to the fundamental quantities directly related to the SNe Ia observables. Finally, we describe our own step-by-step implementation of a classical light curve fi?tter, the stretch, applying it to real data from the Carnegie Supernova Project.

  17. Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer

    Science.gov (United States)

    2017-08-23

    Endometrial Clear Cell Adenocarcinoma; Endometrial Serous Adenocarcinoma; Stage IA Uterine Corpus Cancer; Stage IB Uterine Corpus Cancer; Stage II Uterine Corpus Cancer; Stage IIIA Uterine Corpus Cancer; Stage IIIB Uterine Corpus Cancer; Stage IIIC Uterine Corpus Cancer; Stage IVA Uterine Corpus Cancer

  18. Current Situation and Evaluation of Clinical Studies on Acupuncture and Moxibustion Treatment of Peripheral Facial Paralysis at Selected Stages

    Institute of Scientific and Technical Information of China (English)

    LI Ying; WU Xi; HU Ka-ming; CHEN Xiao-qin

    2010-01-01

    @@ Peripheral facial paralysis is a frequently encountered disease with a high incidence, and it is one of the most common diseases in acupuncture and moxibustion treatment. Because there are rich literatures in clinical studies on acupuncture and moxibustion treatment for this disease, and clinically, it is divided into different stages, in the present paper the current situation of clinical studies about acupuncture and moxibustion treatment for peripheral facial paralysis according to different stages in resent years are analyzed and evaluated including the stage division,the optimal time for treatment, location of injured nerves and assessment of the therapeutic effect, etc.

  19. Potential Biomarkers of the Earliest Clinical Stages of Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Anelya Kh. Alieva

    2015-01-01

    Full Text Available Parkinson’s disease (PD is a widespread neurodegenerative disorder. Despite the intensive studies of this pathology, in general, the picture of the etiopathogenesis has still not been clarified fully. To understand better the mechanisms underlying the pathogenesis of PD, we analyzed the expression of 10 genes in the peripheral blood of treated and untreated patients with PD. 35 untreated patients with PD and 12 treated patients with Parkinson’s disease (Hoehn and Yahr scores 1-2 were studied. An analysis of the mRNA levels of ATP13A2, PARK2, PARK7, PINK1, LRRK2, SNCA, ALDH1A1, PDHB, PPARGC1A, and ZNF746 genes in the peripheral blood of patients was carried out using reverse transcription followed by real-time PCR. A statistically significant and specific increase by more than 1.5-fold in the expression of the ATP13A2, PARK7, and ZNF746 genes was observed in patients with PD. Based on these results, it can be suggested that the upregulation of the mRNA levels of ATP13A2, PARK7, and ZNF746 in untreated patients in the earliest clinical stages can also be observed in the preclinical stages of PD, and that these genes can be considered as potential biomarkers of the preclinical stage of PD.

  20. Analysis of Clinical Treatment Efficiency for 179 Geriatric Women with Stage I or II Cervical Carcinoma

    Institute of Scientific and Technical Information of China (English)

    YongwenHuang; MengdaLi; FuyuanLiu; YanfangLi

    2004-01-01

    OBJECTIVE To evaluate the efficiency of surgery plus radiotherapy and chemotherapy versus radiotherapy plus chemotherapy in the treatment of older patients with stage I or II cervical carcinoma and to seek suitable treatment for such patients. METHODS The clinical data of 179 elderly women with stage la or lib cervical cancer were analyzed retrospectively. One hundred and thirty-four cases underwent radical hysterectomy followed by adjuvant radiotherapy and/or chemotherapy (Group 1). Forty-five cases underwent radiation therapy plus adjuvant chemotherapy (Group 2). RESULTS The 5-year survival rates in group 1 and group 2 were 78.3% and 49.1%(P=0.04), respectively. The incidence of complications in group1 was 47.0%. Three patients died of complications after radical hysterectomy. The incidence of complications in group 2 was 75.6%. CONCLUSION Elderly patients with stage I or II cervical carcinoma should receive an operation if possible. In addition they should receive adjuvant treatments according to their personal conditions, and be treated with appropriate adjuvant chemo-and/or radiotherapy.

  1. [The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

    Science.gov (United States)

    Grande, M; Danza, F M

    1999-01-01

    The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

  2. Correlating animal and human phase Ia/Ib clinical data with CALAA-01, a targeted, polymer-based nanoparticle containing siRNA

    OpenAIRE

    Zuckerman, Jonathan E.; Gritli, Ismael; Tolcher, Anthony; Heidel, Jeremy D.; Lim, Dean; Morgan, Robert; Chmielowski, Bartosz; Ribas, Antoni; Davis, Mark E.; Yen, Yun

    2014-01-01

    Nanoparticle-based experimental therapeutics are currently being investigated in numerous human clinical trials. CALAA-01 is a targeted, polymer-based nanoparticle containing small interfering RNA (siRNA) and, to our knowledge, was the first RNA interference (RNAi)–based, experimental therapeutic to be administered to cancer patients. Here, we report the results from the initial phase I clinical trial where 24 patients with different cancers were treated with CALAA-01 and...

  3. Clinical Study on Treatment of Mid-Late Stage Gastric Carcinoma by Compound Xiansu Capsule (

    Institute of Scientific and Technical Information of China (English)

    HUA; Bao-jin

    2001-01-01

    [1]National Tumor Prevention and Treatment Office, National Association of Anti-Cancer Co-edited. “Chinese common malignant tumor standard of diagnosis and treatment”, the fourth fascicle, 2nd edition. Beijing: Beijing Medical University and Chinese Union Medical University United Press, 1991∶14-50.[2]SUN Y, ZHOU JC, chief edited. Clinical tumor medical handbook. 3rd edition. Beijing: People's Health Publishing House, 1996∶24.[3]Jiangsu New Medical College, chief edited. Chinese drugs dictionary. Shanghai: Shanghai Science and Technology Press, 1986∶34.[4]SHEN ZQ, SUN JX, HUANG LX. Astragalus in treating selective immunoglobin A deficiency. New Drug and Clinical 1997;16(4)∶246.[5]DING HZ, YANG LY. Application of Ginseng Astragalus decoction in the hepatic artery ligation and embolization in treating mid-late stage liver cancer. CJITWM 1994;14(suppl)∶302.[6]Berghella AM, Barni S, Robin T, et al. Progression mechanisms in gastric or colon cancer: soluble interleukin-2 (IL-2) receptor, IL-2 plus anti-CD3 proliferative response and tumor stage correlation. Cancer Immunol 1994;38(3)∶160.[7]Rosenberg SA, Kusugamik, Kawase T, et al. The development of new immunotherapies for the treatment of cancer using interleukin-2. Ann Surg 1990;208∶121.

  4. Long-term outcomes of radiotherapy for stage II testicular seminoma--the Mayo Clinic experience.

    Science.gov (United States)

    Hallemeier, Christopher L; Pisansky, Thomas M; Davis, Brian J; Choo, Richard

    2013-11-01

    To report long-term outcomes of patients with stage II testicular seminoma treated with radiotherapy (RT). A retrospective review was performed of 52 patients who received megavoltage RT for stage II testicular seminoma at Mayo Clinic between 1974 and 2007. Forty-eight patients (92%) had computed tomography staging. Overall survival (OS), relapse-free survival (RFS), and cause-specific survival (CSS) were determined using the Kaplan-Meier method. Major cardiac event (MCE) was defined as myocardial infarction, coronary artery bypass grafting or stenting, or valve replacement. Second malignancy (SM) was defined as biopsy-confirmed malignancy occurring in the RT field. The median patient age at diagnosis was 36 years. Stage was IIA (n = 24), IIB (n = 7), IIC (n = 17), and II not otherwise specified (NOS, n = 4). The median infradiaphragmatic RT dose was 30.7 Gy. Twenty-six patients (50%) received prophylactic mediastinal/supraclavicular (MSCV) RT. The median follow-up was 19 years. Estimates of OS, RFS, and CSS were 94%, 80%, and 96% at 10 years, and 83%, 72%, and 96% at 20 years, respectively. RFS at 10 years for stage IIA, IIB, IIC, and II NOS were 83%, 54%, 81%, and 100%, respectively (log-rank P = 0.21). Ten patients (19%) experienced disease relapse in the MSCV region (n = 7), para-aortic lymph nodes (n = 1), lung (n = 1), or peritoneal cavity (n = 1). Eight patients were successfully salvaged with chemotherapy and/or surgery, while 2 died of seminoma. Risk of MSCV relapse was significantly lower in patients who received MSCV RT vs. those who did not (10-year estimates: 4% vs. 21%, respectively, log-rank P = 0.01). MCE occurred in 10 patients (19%) at a median of 18 years (range 7-30) after RT. SM occurred in 5 patients (10%) at a median of 27 years (range 20-34) after RT. In patients with stage II testicular seminoma treated with RT, relapse in the irradiated site was uncommon. Infradiaphragmatic RT alone was associated with a significant risk of MSCV failure

  5. [Clinical application of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery].

    Science.gov (United States)

    Ren, C L; Jiang, S L; Xiao, C S; Wang, R; Gao, C Q

    2017-04-25

    Objective: To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. Methods: From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker (n=10) and dual chamber pacemaker (n=5) permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery. Results: All 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up. Conclusions: For patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.

  6. Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial

    DEFF Research Database (Denmark)

    Christensen, U C; Krøyer, K; Sander, B

    2009-01-01

    AIM: To determine the effect of internal limiting membrane (ILM) peeling on anatomical and functional success rates in stage 2 and 3 idiopathic macular hole surgery (MHS). METHODS: Randomised clinical trial of stage 2 and 3 idiopathic macular hole without visible epiretinal fibrosis and with less...

  7. Stage of change behavioral assessment tool fails to predict the prevalence of chlamydia in an urban adolescent health clinic.

    Science.gov (United States)

    Kasowitz, Andrea R; McCusker, Mark; Coury-Doniger, Patricia; Neal, Wendy P; Indyk, Debbie; Burk, Robert D; Jenkins, Stephen G; Rickert, Vaughn I; Herold, Betsy C

    2006-08-01

    Strategies to reduce STI among adolescents and young adults have failed to consistently demonstrate effectiveness. A universal approach may not be appropriate because individuals are at different stages with respect to self-management behaviors. Thus, the Stage of Change Transtheoretical Model has been advocated. This study was conducted to determine whether staging could be accomplished in an urban adolescent clinic and whether it provides a tool to predict STI risk. Participants were interviewed and staged according to a standardized instrument with respect to sexual risk behaviors and contraceptive use. Urban adolescent health clinic. 103 females (ages 18-24). A physical examination and diagnostic tests for syphilis, HSV, HCV, chlamydia, gonorrhea and HPV were performed. Stages for behaviors to reduce STI risk and to utilize contraception and STI prevalence. 78% of the participants were in the three earliest stages of behavior (precontemplative, contemplative, and ready for action) with respect to condom use for STI prevention; conversely only 47% were in early stages with respect to birth control practices. Of the participants tested, 12/81 (15%) had chlamydial infection detected by molecular techniques, whereas no participants had gonorrhoeae. Among the subset tested for HPV DNA, 18/45 (40%) were positive. The diagnostic behavior stage for STI prevention did not correlate with the presence of chlamydia. A staging instrument can be implemented into adolescent health clinic practice, but cannot be used as a risk assessment tool for the presence of chlamydia. Additionally females are more likely to protect themselves against pregnancy than against an STI.

  8. Alternative Dosing of Exemestane Before Surgery in Treating Postmenopausal Patients With Stage 0-II Estrogen Positive Breast Cancer

    Science.gov (United States)

    2017-02-17

    Estrogen Receptor Positive; Postmenopausal; Stage 0 Breast Cancer; Stage I Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer

  9. Mucocutaneous Manifestations of HIV and the Correlation with WHO Clinical Staging in a Tertiary Hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Olumayowa Abimbola Oninla

    2014-01-01

    Full Text Available Skin diseases are indicators of HIV/AIDS which correlates with WHO clinical stages. In resource limited environment where CD4 count is not readily available, they can be used in assessing HIV patients. The study aims to determine the mucocutaneous manifestations in HIV positive patients and their correlation with WHO clinical stages. A prospective cross-sectional study of mucocutaneous conditions was done among 215 newly diagnosed HIV patients from June 2008 to May 2012 at adult ART clinic, Wesley Guild Hospital Unit, OAU Teaching Hospitals Complex, Ilesha, Osun State, Nigeria. There were 156 dermatoses with oral/oesophageal/vaginal candidiasis (41.1%, PPE (24.4%, dermatophytic infections (8.9%, and herpes zoster (3.8% as the most common dermatoses. The proportions of dermatoses were 4.5%, 21.8%, 53.2%, and 20.5% in stages 1–4, respectively. A significant relationship (using Pearson’s Chi square with P value <0.05 was obtained between dermatoses and WHO clinical stages. Pearson’s correlation coefficient showed a positive correlation between the number of dermatoses and the WHO clinical stages. Dermatoses can therefore serve as diagnostic and prognostic markers in resource limited settings to initiate HAART in clinical stages 3 and 4.

  10. Clinical management of restless legs syndrome in end-stage renal disease patients.

    Science.gov (United States)

    Sahli, Zeyad T; Jo, Jae; Mousa, Shaker A; Tarazi, Frank I

    2017-02-01

    Restless legs syndrome (RLS) is a common neurological movement disorder, characterized by restless and unpleasant sensations in the deep inside of legs. The symptoms of RLS are less noticeable during daytime, but more prevalent at night. Therefore, the disorder can induce low quality of life, insomnia, and impairment of daytime activity. RLS in end-stage renal disease (ESRD) patients is especially problematic due to premature discontinuation of dialysis and increased mortality. The prevalence of RLS among dialysis patients is much higher compared to the prevalence of the same disorder in patients with normal renal functions. Even though there are recommended treatment guidelines for the general population established by Medical Advisory Board of the RLS foundation, which include the use of dopamine agonists, levodopa, gabapentin, benzodiazepines, and opioids, limited information is available on the effects of these therapies in ESRD patients. Since the existing clinical data were extrapolated from small sample sizes in short-term clinical trials, further clinical studies are still needed to better assess the efficacy, safety, and tolerability of these medications in patients with ESRD.

  11. Correlating animal and human phase Ia/Ib clinical data with CALAA-01, a targeted, polymer-based nanoparticle containing siRNA

    Science.gov (United States)

    Zuckerman, Jonathan E.; Gritli, Ismael; Tolcher, Anthony; Heidel, Jeremy D.; Lim, Dean; Morgan, Robert; Chmielowski, Bartosz; Ribas, Antoni; Davis, Mark E.; Yen, Yun

    2014-01-01

    Nanoparticle-based experimental therapeutics are currently being investigated in numerous human clinical trials. CALAA-01 is a targeted, polymer-based nanoparticle containing small interfering RNA (siRNA) and, to our knowledge, was the first RNA interference (RNAi)–based, experimental therapeutic to be administered to cancer patients. Here, we report the results from the initial phase I clinical trial where 24 patients with different cancers were treated with CALAA-01 and compare those results to data obtained from multispecies animal studies to provide a detailed example of translating this class of nanoparticles from animals to humans. The pharmacokinetics of CALAA-01 in mice, rats, monkeys, and humans show fast elimination and reveal that the maximum concentration obtained in the blood after i.v. administration correlates with body weight across all species. The safety profile of CALAA-01 in animals is similarly obtained in humans except that animal kidney toxicities are not observed in humans; this could be due to the use of a predosing hydration protocol used in the clinic. Taken in total, the animal models do appear to predict the behavior of CALAA-01 in humans. PMID:25049380

  12. Evaluation of Eight Different Clinical Staging Systems Associated with Overall Survival of Chinese Patients with Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Jian-Jun Zhao

    2015-01-01

    Full Text Available Background: Hepatocellular carcinoma (HCC is a common cancer in China, an area of high hepatitis B virus (HBV infection. Although several staging systems are available, there is no consensus on the best classification to use because multiple factors, such as etiology, clinical treatment and populations could affect the survival of HCC patients. Methods: This study analyzed 743 HBV-related Chinese HCC patients who received surgery first and evaluated the predictive values of eight different commonly used staging systems in the clinic. Results: The overall 1-, 3-, 5-year survival rates and a median survival were 91.5%, 70.3%, 55.3% and 72 months respectively. Barcelona Clinic Liver Cancer (BCLC staging systems had the best stratification ability and showed the lowest Akaike information criterion (AIC values (2896.577, followed by tumor-node-metastasis 7 th (TNM 7 th (AIC = 2899.980, TNM 6 th (AIC = 2902.17, Japan integrated staging score (AIC = 2918.085, Tokyo (AIC = 2938.822, Cancer of the Liver Italian Program score (AIC = 2941.950, Chinese University Prognostic Index grade (AIC = 2962.027, and Okuda (AIC = 2979.389. Conclusions: BCLC staging system is a better staging model for HBV infection patients with HCC in Chinese population among the eight currently used staging systems. These identifications afford a large group of Chinese HCC patients with HBV infection and could be helpful to design a new staging system for a certain population.

  13. Foot drop caused by lumbar degenerative disease: clinical features, prognostic factors of surgical outcome and clinical stage.

    Directory of Open Access Journals (Sweden)

    Kun Liu

    Full Text Available OBJECTIVE: The purpose of this study was to analyze the clinical features and prognostic factors of surgical outcome of foot drop caused by lumbar degenerative disease and put forward the clinical stage. METHODS: We retrospectively reviewed 135 patients with foot drop due to lumbar degenerative disease. The clinical features and mechanism were analyzed. Age, sex, duration of palsy, preoperative muscle strength of tibialis anterior (TA, sensation defect of affected lower limb, affected foot, diagnosis and compressed nerve roots were recorded and compared with surgical outcome. RESULTS: Foot drop was observed in 8.1% of all inpatients of lumbar degenerative disease. L5 nerve root compression was observed in 126 of all 135 patients (93.3%. Single, double and triple roots compression was observed respectively in 43, 83, and 9 patients (31.9%, 61.5%, and 6.6%. But there was no significant relationship between preoperative muscle strength of TA and the number of compressed roots. The muscle strength of TA was improved in 113 (83.7% patients after surgery, but it reached to >=4 in only 21 (15.6% patients. Improvement of the muscle strength of TA was almost stable at the 6-month follow-up. At the last follow-up, the muscle strength of TA was 1, 2, 3, 4, 5 respectively in 28, 24, 62, 13, 8 patients. Multivariate logistic regression showed duration of palsy (p=0.0360, OR=2.543, preoperative muscle strength of TA (p=0.0064, OR=5.528 and age (p=0.0309, OR=3.208 were factors that influenced recovery following an operation. CONCLUSIONS: L5 nerve root was most frequently affected. The muscle strength of TA improved in most patients after surgery, but few patients can get a good recovery from foot drop. Patients of shorter duration of palsy, better preoperative muscle strength of TA and younger age showed a better surgical outcome.

  14. Progenitors of Supernovae Type Ia

    CERN Document Server

    Toonen, S; Bours, M; Zwart, S Portegies; Claeys, J; Mennekens, N; Ruiter, A

    2013-01-01

    Despite the significance of Type Ia supernovae (SNeIa) in many fields in astrophysics, SNeIa lack a theoretical explanation. The standard scenarios involve thermonuclear explosions of carbon/oxygen white dwarfs approaching the Chandrasekhar mass; either by accretion from a companion or by a merger of two white dwarfs. We investigate the contribution from both channels to the SNIa rate with the binary population synthesis (BPS) code SeBa in order to constrain binary processes such as the mass retention efficiency of WD accretion and common envelope evolution. We determine the theoretical rates and delay time distribution of SNIa progenitors and in particular study how assumptions affect the predicted rates.

  15. [Clinical efficacy on peripheral facial paralysis at acute stage treated with opposing needling technique].

    Science.gov (United States)

    Li, Ying; Zhang, Zhongyi; Chen, Yuelai; Zong, Lei; Li, Jing; Tao, Ying; Zeng, Liang; Hou, Wenguang

    2015-01-01

    To compare the differences in clinical efficacy on peripheral facial paralysis at acute stage between the opposing needling technique and routine acupuncture at the affected side so as to provide the evidence on the acupuncture treatment for peripheral facial paralysis at acute stage. Forty patients were rando- mized into an opposing needling technique group (19 cases) and an affected side needling technique group (21 cases). The basic medication was same in the two groups. The acupoints were Fengchi (GB 20), Yangbai (GB 14) to Yuyao (EX-HN 4) (penetrating needling method), Jingming (BL 1), Chengqi (ST 1), Xiaguan (ST 7), Jiache (ST 6) to Dicang (ST 4), Hegu (LI 4) and Zusanli (ST 36). In supplementation, in the opposing needling technique group, the acupoints were stimulated on the face of healthy side. In the affected side needling technique group, the acupoints were stimulated on the face of the affected side. The treatment was given three times a week, for 4 weeks. House-Brackmann (H-B) facial nerve function assessment was used to evaluate facial nerve function before and after treatment in the patients of the two groups. The efficacy was compared between the two groups. The facial nerve function was recovered in the two groups and the total effective rate was 100.0% in the two groups (P>0.05). The curative rate was 68.4% (13/19) in the opposing needling technique group and better than 47.6% (10/21) in the affected side needling technique group (Pfacial nerve function in peripheral facial paralysis at acute stage and apparently shortens the curative time. The efficacy is better than that in acupuncture on the affect- ed side of the face.

  16. Clinical Observation in 31 Cases of Chronic Bronchitis at Remission Stage Treated with Bufei Keli

    Institute of Scientific and Technical Information of China (English)

    刘杨春; 王乃红; 王娜; 刘冠萍; 阎惠芳

    2003-01-01

    To observe the therapeutic effects of a Chinese drug Bufei Keli (补肺颗粒 granules for invigorating thelung) in the treatment of chronic bronchitis at remission stage, 62 cases were randomly divided into aThe results turned out to be that the short-term clinically controlled and markedly effective rate was77.42% and the long-term relapse-resisting markedly effective rate was 74.2% in the treatment group,which were obviously higher than 45.16% and 38.71% respectively in the control group (P<0.05). And theincrease in contents of SOD and CD3 and the decrease in LPO content in the treatment group were alsobigger than that in the control group (P<0.01). It is therefore concluded that Bufei Keli can improve qideficiency syndrome and raise the immunity of patients with chronic bronchitis, hence its effect ofresisting relapse of chronic bronchitis.

  17. Computed tomography in suppurative meningitis. CT and clinical findings in the acute stage

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Akira; Fujiwara, Katsuhiko; Iino, Shigeru (Kyoto Prefectural Univ. of Medicine (Japan))

    1982-06-01

    Computed tomography abnormalities revealed in 18 of 29 patients (62%) with infantile supprative meningitis. The abnormalities included ventricular dilatation (12 cases), subdural edema (8), cerebral infarction (4), cerebral atrophy (3), encephalitis (2), and cerebral herniation (1). The comparative study of CT pictures and clinical findings in the acute stage of the disease showed that the high incidence of these abnormalities occurred in the following conditions: 1) The age was less than 1 year, 2) establishment of the diagnosis took more than 5 days, 3) glucose of the cerebrospinal fluid was less than 200 mg/dl, 4) protein of the cerebrospinal fluid was more than 200 mg/dl, and 5) convulsion occurred 24 hrs after institution of the treatment.

  18. Management of clinical stage I testicular seminoma: active surveillance versus adjuvant chemotherapy.

    Science.gov (United States)

    Ondrusova, M; Ondrus, D; Miskovska, V; Kajo, K; Szoldova, K; Usakova, V; Stastna, V

    2015-07-01

    Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT), and adjuvant chemotherapy has been accepted in high-risk CSI NSGCTT. Because of the late toxicity of standard radiotherapy in CSI testicular seminoma (SGCTT), this therapeutic approach has been accepted also in the management of CSI SGCTT. In the current study, we analyzed single-center experience with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy) in patients with CSI SGCTT. The study analyzed a total of 90 patients collected at a single center from April 2008 to March 2015 with CSI SGCTT who were stratified into two groups according to risk-adapted therapeutic approaches. In the group A (low-risk CSI SGCTT-no rete testis invasion, tumor size 4 cm or pT ≥ 2 stage), which consisted of 16 patients who were treated with adjuvant chemotherapy, relapse occurred in two (12.5 %) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100 %. The statistically significant difference in progression-free survival between these two groups was not found. Radiotherapy is currently not recommended as an adjuvant treatment in CSI SGCTT patients. The benefit of using risk-adapted therapeutic approaches in CSI SGCTTs patients is evident.

  19. Clinical outcomes in patients with stage Ⅰ non-seminomatous germ cell cancer

    Institute of Scientific and Technical Information of China (English)

    Zhao-Jie Lv; Song Wu; Pei Dong; Kai Yao; Yin-Yin He; Yao-Ting Gui; Fang-Jian Zhou

    2013-01-01

    This study assesses the long-term outcomes in Han Chinese patients with clinical stage Ⅰ non-seminomatous germ cell testicular cancer (CSI NSGCT) treated with surveillance,retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy.We retrospectively evaluated 89 patients with a mean age of 26.5 years.After orchiectomy,37 patients were treated with surveillance,34 underwent RPLND and 18 were managed with chemotherapy.The overall survival rate,the recurrence-free survival rate and the risk factors were evaluated.The median follow-up length was 92 months (range:6-149 months).Thirteen of the 89 patients (14.6%) had relapses,and one died by the evaluation date.The overall survival rate was 98.9%.The cumulative 4-year recurrence-free rates were 80.2%,92.0% and 100% for the surveillance,RPLND and chemotherapy groups,respectively.The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is.Therefore,surveillance,RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT.Surveillance should be recommended for patients with the lowest recurrence rate,especially those without lymphovascular invasion.This study might aid the establishment of a standard therapy for CSI NSGCT in China.

  20. TYPE Ia SUPERNOVA CARBON FOOTPRINTS

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, R. C.; Nugent, P. [Computational Cosmology Center, Computational Research Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road MS 50B-4206, Berkeley, CA 94611 (United States); Aldering, G.; Aragon, C.; Bailey, S.; Childress, M.; Fakhouri, H. K.; Hsiao, E. Y.; Loken, S. [Physics Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, CA 94720 (United States); Antilogus, P.; Bongard, S.; Canto, A. [Laboratoire de Physique Nucleaire et des Hautes Energies, Universite Pierre et Marie Curie Paris 6, Universite Paris Diderot Paris 7, CNRS-IN2P3, 4 place Jussieu, 75252 Paris Cedex 05 (France); Baltay, C. [Department of Physics, Yale University, New Haven, CT 06250-8121 (United States); Buton, C.; Kerschhaggl, M.; Kowalski, M.; Paech, K. [Physikalisches Institut, Universitaet Bonn, Nussallee 12, 53115 Bonn (Germany); Chotard, N.; Copin, Y.; Gangler, E. [Universite de Lyon, F-69622 Lyon (France); and others

    2011-12-10

    We present convincing evidence of unburned carbon at photospheric velocities in new observations of five Type Ia supernovae (SNe Ia) obtained by the Nearby Supernova Factory. These SNe are identified by examining 346 spectra from 124 SNe obtained before +2.5 days relative to maximum. Detections are based on the presence of relatively strong C II {lambda}6580 absorption 'notches' in multiple spectra of each SN, aided by automated fitting with the SYNAPPS code. Four of the five SNe in question are otherwise spectroscopically unremarkable, with ions and ejection velocities typical of SNe Ia, but spectra of the fifth exhibit high-velocity (v > 20, 000 km s{sup -1}) Si II and Ca II features. On the other hand, the light curve properties are preferentially grouped, strongly suggesting a connection between carbon-positivity and broadband light curve/color behavior: three of the five have relatively narrow light curves but also blue colors and a fourth may be a dust-reddened member of this family. Accounting for signal to noise and phase, we estimate that 22{sup +10}{sub -6%} of SNe Ia exhibit spectroscopic C II signatures as late as -5 days with respect to maximum. We place these new objects in the context of previously recognized carbon-positive SNe Ia and consider reasonable scenarios seeking to explain a physical connection between light curve properties and the presence of photospheric carbon. We also examine the detailed evolution of the detected carbon signatures and the surrounding wavelength regions to shed light on the distribution of carbon in the ejecta. Our ability to reconstruct the C II {lambda}6580 feature in detail under the assumption of purely spherical symmetry casts doubt on a 'carbon blobs' hypothesis, but does not rule out all asymmetric models. A low volume filling factor for carbon, combined with line-of-sight effects, seems unlikely to explain the scarcity of detected carbon in SNe Ia by itself.

  1. Clinical outcomes of end stage renal disease and adequacy of adult maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ismail Mahmud Ali, Amirthalingam R

    2014-07-01

    Full Text Available Background & Aim: End stage renal disease (ESRD is an irreversible loss of kidney function caused by various risk factors and affected persons of lives mainly depending on the technology of renal replacement therapy (RRT or renal transplantation (RT to sustain the life. Aim of this study is to overview the clinical outcomes of ESRD and adequacy of maintenance hemodialysis among the patients. Materials & Methods: Currently, there are sixty two end stage renal disease patient’s clinical data’s were collected and included in the study. For all patients, pre and post hemodialysis samples were collected and processed through biochemical and hematology auto analyzer. The hemodialysis modalities 4008 H/S and high-flux & low flux ultra filter dialyzers had utilized to three dialysis sessions per week, 4 hrs per session for each individuals. Blood flow rates differed from 150 to 350ml min-1 dependingon conditions and standard dialysate flow was 500ml/ min-1. Results: Of total sixty two patients, 51.62% females and 48.38% males with mean age of 47.76 (18-72 years; gradually increased at the ages of 55 to 72 years then adult age. Concerning overall risk factors in ESRD, 61.30% of hypertension as a leading risk factor followed by 21% NIDDM, 11.30% other kidney diseases and 6.40% cardiac related diseases. Although, there are others clinical signs such as hypothyroidisms; extra-pulmonary infection, retinitis pigmentosa and infertility have been diagnosed. In addition, nearly 33.87%% of HCV, 6.45% HBV and 3.22% of co-infection have been prevalence in ESRD hemodialysis population. Relating to hepatitis C, B and co-infection during dialysis exposure were 29.41%, 2.94% and 2.94% in that order. In relation to overall adequacy of maintenance hemodialysis in this study nearly 75.80% (≥ 1.3 to 2.5 Kt/V and 24.20% (1.05 to 1.3 Kt/V were been analyzed through Kt/V formula for wastage clearance. Conclusion: The present study highlighted that the co morbidity of

  2. Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer disease.

    Science.gov (United States)

    Donovan, Nancy J; Amariglio, Rebecca E; Zoller, Amy S; Rudel, Rebecca K; Gomez-Isla, Teresa; Blacker, Deborah; Hyman, Bradley T; Locascio, Joseph J; Johnson, Keith A; Sperling, Reisa A; Marshall, Gad A; Rentz, Dorene M

    2014-12-01

    To examine neuropsychiatric and neuropsychological predictors of progression from normal to early clinical stages of Alzheimer disease (AD). From a total sample of 559 older adults from the Massachusetts Alzheimer's Disease Research Center longitudinal cohort, 454 were included in the primary analysis: 283 with clinically normal cognition (CN), 115 with mild cognitive impairment (MCI), and 56 with subjective cognitive concerns (SCC) but no objective impairment, a proposed transitional group between CN and MCI. Two latent cognitive factors (memory-semantic, attention-executive) and two neuropsychiatric factors (affective, psychotic) were derived from the Alzheimer's Disease Centers' Uniform Data Set neuropsychological battery and Neuropsychiatric Inventory brief questionnaire. Factors were analyzed as predictors of time to progression to a worse diagnosis using a Cox proportional hazards regression model with backward elimination. Covariates included baseline diagnosis, gender, age, education, prior depression, antidepressant medication, symptom duration, and interaction terms. Higher/better memory-semantic factor score predicted lower hazard of progression (hazard ratio [HR] = 0.4 for 1 standard deviation [SD] increase, p <0.0001), and higher/worse affective factor score predicted higher hazard (HR = 1.3 for one SD increase, p = 0.01). No other predictors were significant in adjusted analyses. Using diagnosis as a sole predictor of transition to MCI, the SCC diagnosis carried a fourfold risk of progression compared with CN (HR = 4.1, p <0.0001). These results identify affective and memory-semantic factors as significant predictors of more rapid progression from normal to early stages of cognitive decline and highlight the subgroup of cognitively normal elderly with SCC as those with elevated risk of progression to MCI. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  3. Early clinical characteristics according to developmental stage in children with definite moyamoya disease.

    Science.gov (United States)

    Kim, Young Ok; Joo, Sung-Pil; Seo, Bo-Ra; Rho, Young Il; Yoon, Woong; Woo, Young Jong

    2013-06-01

    The objective is to clarify the early clinical characteristics in childhood moyamoya disease (MD). Epidemiologic characteristics, symptoms and diagnostic rates were assessed in 64 children (0-18 years) with definite MD according to developmental stage: infancy (5; 0-1 years); toddlerhood/preschool age (22; 2-5 years); school age (29; 6-10 years); and adolescence (8; 11-18 years). The median ages at onset was 6.25 years and the female to male ratio was 1.9 (~2.5 in toddlerhood/preschool age and in adolescence, P=0.71). Previous headache was observed in 23% (14/64): frequently in school age (38%, P=0.02) and within 6 months before main symptoms (6/11). As an initial symptom, weakness was observed in 78% (50/64) mainly as transient ischemic attack (TIA, 61%) in limbs (90%) and unilaterally (82%). TIA was less frequent in infancy (40%, P=0.04). Seizure was observed in 27% (17/64): frequently in infancy (100%, Pchildren ~5 years (P<0.01). Severe headache associated with MD was observed in 14% (9/64). Provoking events were positive in 42% (27/64): in school age, frequently during eating (28%); and in toddlerhood/preschool age, during crying (27%). The diagnostic rates at 3 and 12 months from symptom-onset were 39% (80% during infancy vs. 28% in school age, P=0.14) and 67%, respectively. Symptomatic progression at diagnosis was observed in 38% (24/64). Initial clinical characteristics in childhood definite MD differed according to developmental stage and from at diagnosis.

  4. Validation of World Health Organisation HIV/AIDS clinical staging in predicting initiation of antiretroviral therapy and clinical predictors of low CD4 cell count in Uganda.

    Directory of Open Access Journals (Sweden)

    Steven Baveewo

    Full Text Available INTRODUCTION: The WHO clinical guidelines for HIV/AIDS are widely used in resource limited settings to represent the gold standard of CD4 counts for antiviral therapy initiation. The utility of the WHO-defined stage 1 and 2 clinical factors used in WHO HIV/AIDS clinical staging in predicting low CD4 cell count has not been established in Uganda. Although the WHO staging has shown low sensitivity for predicting CD4<200 cells/mm(3, it has not been evaluated at for CD4 cut-offs of <250 cells/mm(3 or <350 cells/mm(3. OBJECTIVE: To validate the World Health Organisation HIV/AIDS clinical staging in predicting initiation of antiretroviral therapy in a low-resource setting and to determine the clinical predictors of low CD4 cell count in Uganda. RESULTS: Data was collected on 395 participants from the Joint Clinical Research Centre, of whom 242 (61.3% were classified as in stages 1 and 2 and 262 (68% were females. Participants had a mean age of 36.8 years (SD 8.5. We found a significant inverse correlation between the CD4 lymphocyte count and WHO clinical stages. The sensitivity the WHO clinical staging at CD4 cell count of 250 cells/mm(3 and 350 cells/mm(3 was 53.5% and 49.1% respectively. Angular cheilitis, papular pruritic eruptions and recurrent upper respiratory tract infections were found to be significant predictors of low CD4 cell count among participants in WHO stage 1 and 2. CONCLUSION: The WHO HIV/AIDS clinical staging guidelines have a low sensitivity and about half of the participants in stages 1 and 2 would be eligible for ART initiation if they had been tested for CD4 count. Angular cheilitis and papular pruritic eruptions and recurrent upper respiratory tract infections may be used, in addition to the WHO staging, to improve sensitivity in the interim, as access to CD4 machines increases in Uganda.

  5. Dust around Type Ia supernovae

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Lifan

    2005-10-20

    An explanation is given of the low value of R lambda triple bond A lambda/E(B - V), the ratio of absolute to selective extinction deduced from Type Ia supernova observations. The idea involves scattering by dust clouds located in the circumstellar environment, or at the highest velocity shells of the supernova ejecta. The scattered light tends to reduce the effective R lambda in the optical, but has an opposite effect in the ultraviolet. The presence of circumstellar dust can be tested by ultraviolet to near infrared observations and by multi-epoch spectropolarimetry of SNe Ia.

  6. A prospective, randomized, multisite clinical evaluation of a transparent absorbent acrylic dressing and a hydrocolloid dressing in the management of Stage II and shallow Stage III pressure ulcers.

    Science.gov (United States)

    Brown-Etris, Marie; Milne, Catherine; Orsted, Heather; Gates, Judy L; Netsch, Debra; Punchello, Marion; Couture, Nancy; Albert, Martine; Attrell, Edie; Freyberg, Julie

    2008-04-01

    To compare clinical performance of a transparent absorbent acrylic dressing (3M Tegaderm Absorbent Clear Acrylic Dressing ]TAAD[; 3M Company, St Paul, MN) and a hydrocolloid dressing (HD ]DuoDERM CGF, ConvaTec, ER Squibb & Sons, Princeton, NJ[) in the management of Stage II and shallow Stage III pressure ulcers. Prospective, open-label, randomized, comparative, multisite clinical evaluation. Patients were followed up for a maximum of 56 days or until their ulcer healed. At weekly intervals, investigators conducted wound assessments and dressing performance evaluations. Wound care clinics, home care, and long-term care. Thirty-five patients received the TAAD, and 37 received the HD. Dressing performance assessments, patient comfort, dressing wear time, and wound healing were measured. The majority of investigator assessments favored the TAAD. Considerations given included the ability to center dressings over the ulcer (P = .005), ability to assess the ulcer before (P < .001) and after (P < .001) absorption, barrier properties (P = .039), patient comfort during removal (P < .001), overall patient comfort (P = .048), conformability before (P = .026) and after (P = .001) absorption, ease of removal (P < .001), nonadherence to wound bed (P < .001), residue in the wound (P = .002), residue on periwound skin (P < .001), and odor after absorption (P = .016). Overall satisfaction favored the TAAD (P < .001), and a high value was placed on its transparent feature (P < .001). Mean (SD) wear time for the TAAD was 5.7 (2.55) days compared with 4.7 (2.29) days for the HD (P = .086). This 1-day difference in wear time was clinically noticeable by the investigators (P = .035). Wound closure for the 2 dressing groups was nearly identical (P = .9627). Performance results favored the TAAD over the HD as standard treatment for Stage II and shallow Stage III pressure ulcers.

  7. Psychosexual Intervention in Patients With Stage I-III Gynecologic or Breast Cancer

    Science.gov (United States)

    2016-05-02

    Ovarian Sarcoma; Ovarian Stromal Cancer; Stage I Uterine Sarcoma; Stage I Vaginal Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IA Endometrial Carcinoma; Stage IA Fallopian Tube Cancer; Stage IA Ovarian Epithelial Cancer; Stage IA Ovarian Germ Cell Tumor; Stage IA Primary Peritoneal Cavity Cancer; Stage IB Cervical Cancer; Stage IB Endometrial Carcinoma; Stage IB Fallopian Tube Cancer; Stage IB Ovarian Epithelial Cancer; Stage IB Ovarian Germ Cell Tumor; Stage IB Primary Peritoneal Cavity Cancer; Stage IC Fallopian Tube Cancer; Stage IC Ovarian Epithelial Cancer; Stage IC Ovarian Germ Cell Tumor; Stage IC Primary Peritoneal Cavity Cancer; Stage II Endometrial Carcinoma; Stage II Gestational Trophoblastic Tumor; Stage II Uterine Sarcoma; Stage II Vaginal Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIA Ovarian Germ Cell Tumor; Stage IIA Primary Peritoneal Cavity Cancer; Stage IIB Cervical Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIB Ovarian Germ Cell Tumor; Stage IIB Primary Peritoneal Cavity Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Ovarian Germ Cell Tumor; Stage IIC Primary Peritoneal Cavity Cancer; Stage III Gestational Trophoblastic Tumor; Stage III Uterine Sarcoma; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IIIA Cervical Cancer; Stage IIIA Endometrial Carcinoma; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Cervical Cancer; Stage IIIB Endometrial Carcinoma; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Endometrial Carcinoma; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell

  8. Salvage of relapse of patients with Hodgkin's disease in clinical stages I or II who were staged with laparotomy and initially treated with radiotherapy alone. A report from the international database on Hodgkin's disease

    DEFF Research Database (Denmark)

    Specht, L; Horwich, A; Ashley, S

    1994-01-01

    To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy....

  9. [Statistical data on head trauma with frontal sinus involvement at the Emergency Hospital Clinic "Prof. Dr. Nicolae Oblu", Iaşi, Romania].

    Science.gov (United States)

    Dobrin, Irina; Dobrin, N; Poeata, I; Ianovici, N

    2011-01-01

    We present here some interesting points of view concerning head and brain injury with frontal sinus involvement. In general neurosurgical practice the frontal sinus traumatic involvement is about 3-5 per cent from all head trauma; we proposed to realise a extensive 5 years study to finnaly sumarise the characteristical elements for our geographical area. The amount of patients hospitalized in our clinic was about 80 000 in five years. Concerning our statistical data, there are 677 patients with frontal sinus injury, 490 from this were complicated with brain pathology. We concluded there are differences between our series and the other studies from developed countries, in our region the domestical (agricultural works) causes are about 10% higher.

  10. Cognitive reserve in granulin-related frontotemporal dementia: from preclinical to clinical stages.

    Directory of Open Access Journals (Sweden)

    Enrico Premi

    Full Text Available OBJECTIVE: Consistent with the cognitive reserve hypothesis, higher education and occupation attainments may help persons with neurodegenerative dementias to better withstand neuropathology before developing cognitive impairment. We tested here the cognitive reserve hypothesis in patients with frontotemporal dementia (FTD, with or without pathogenetic granulin mutations (GRN+ and GRN-, and in presymptomatic GRN mutation carriers (aGRN+. METHODS: Education and occupation attainments were assessed and combined to define Reserve Index (RI in 32 FTD patients, i.e. 12 GRN+ and 20 GRN-, and in 17 aGRN+. Changes in functional connectivity were estimated by resting state fMRI, focusing on the salience network (SN, executive network (EN and bilateral frontoparietal networks (FPNs. Cognitive status was measured by FTD-modified Clinical Dementia Rating Scale. RESULTS: In FTD patients higher level of premorbid cognitive reserve was associated with reduced connectivity within the SN and the EN. EN was more involved in FTD patients without GRN mutations, while SN was more affected in GRN pathology. In aGRN+, cognitive reserve was associated with reduced SN. CONCLUSIONS: This study suggests that cognitive reserve modulates functional connectivity in patients with FTD, even in monogenic disease. In GRN inherited FTD, cognitive reserve mechanisms operate even in presymptomatic to clinical stages.

  11. Intestinal microsporidiosis in HIV-positive patients with chronic unexplained diarrhea in Rio de Janeiro, Brazil: diagnosis, clinical presentation and follow-up Microsporidiose intestinal em pacientes HIV-positivos com diarréia crônica no Rio de Janeiro, Brasil: diagnóstico, clínica e acompanhamento

    Directory of Open Access Journals (Sweden)

    Patrícia Brasil

    1996-04-01

    Full Text Available After the diagnosis of two cases of microsporidial intestinal infection in 1992, in Rio de Janeiro, we have started looking for this parasite in HIV-infected patients with chronic unexplained diarrhea. We have studied 13 patients from Hospital Evandro Chagas, IOC-FIOCRUZ. Fecal specimens from these patients were examined for the presence of Cryptosporidia and Microsporidia, in addition to routine examination. Spores of Microsporidia were found in the stools of 6 (46.1% of the 13 patients studied, with 2 histological jejunal confirmations. The Microsporidia-infected patients presented chronic diarrhea with about 6 loose to watery bowel movements a day. Five infected patients were treated with Metronidazole (1.5 g/day. They initially showed a good clinical response, but they never stopped eliminating spores. After about the 4th week of therapy, their diarrhea returned. Two patients utilized Albendazole (400 mg/day-4 weeks with a similar initial improvement and recurrence of the diarrhea. Intestinal Microsporidiosis seems to be a marker of advanced stages of AIDS, since 5 of our 6 infected patients were dead after a 6 month period of follow-up. The present study indicates that intestinal microsporidiosis may be a burgeoning problem in HIV-infected patients with chronic diarrhea in Brazil, which deserves further investigation.Após o diagnóstico, em 1992, de 2 pacientes eliminando esporos de microsporídeos, o presente estudo foi realizado com o objetivo de determinar a ocorrência destes organismos em pacientes HIV-positivos com diarréia crônica sem etiologia definida. O grupo estudado era constituído de 13 pacientes acompanhados no Hospital Evandro Chagas, IOC, FIOCRUZ. Amostras fecais de cada paciente foram examinadas pelos métodos de rotina, além de colorações especiais para a pesquisa de Cryptosporidium e de microsporídeos. Esporos de microsporídeos foram observados nas fezes de 6 (46,1% dos 13 pacientes. Em 2 a confirmação foi

  12. The 'grey' assessment practice of IA screening

    DEFF Research Database (Denmark)

    Bidstrup, Morten

    2017-01-01

    ’ in Denmark. This article explores the prevalence, influence and applied rationale of grey IA. Through a questionnaire, data was collected from 121 IA practitioners working within the fields of environmental impact assessment and strategic environmental assessment. It was found that grey IA is a common......Research focusing on the practices surrounding screening in Impact Assessment (IA) is limited. Yet, it has been found that development proposals sometimes are adjusted through an informal dialog with IA practitioners prior to or during screening. Such practice is often referred to as ‘grey IA...... practice, which influences the outcomes of formal screening procedures through consideration of impacts on neighbours and spatial zones of protection. Grey IA is to some extent motivated by the opportunity to save the resources required for full-scale IA, but an additional ‘green’ rationale also exists...

  13. Defining Photometric Peculiar Type Ia Supernovae

    CERN Document Server

    Gonzalez-Gaitan, S; Pignata, G; Forster, F; Gutierrez, C P; Bufano, F; Galbany, L; Folatelli, G; Phillips, M M; Hamuy, M; Anderson, J P; de Jaeger, T

    2014-01-01

    We present a new photometric identification technique for SN 1991bg-like type Ia supernovae (SNe Ia), i.e. objects with light-curve characteristics such as later primary maxima and absence of secondary peak in redder filters. This method is capable of selecting out this sub-group from the normal type Ia population. Furthermore, we find that recently identified peculiar sub-types such as SNe Iax and super-Chandrasekhar SNe Ia have similar photometric characteristics as 91bg-like SNe Ia, namely the absence of secondary maxima and shoulders at longer wavelengths, and can also be classified with our technique. The similarity of these different SN Ia sub-groups perhaps suggests common physical conditions. This typing methodology permits the photometric identification of peculiar SNe Ia in large up-coming wide field surveys either to study them further or to obtain a pure sample of normal SNe Ia for cosmological studies.

  14. Defining photometric peculiar type Ia supernovae

    Energy Technology Data Exchange (ETDEWEB)

    González-Gaitán, S.; Pignata, G.; Förster, F.; Gutiérrez, C. P.; Bufano, F.; Galbany, L.; Hamuy, M.; De Jaeger, T. [Millennium Institute of Astrophysics, Casilla 36-D, Santiago (Chile); Hsiao, E. Y.; Phillips, M. M. [Carnegie Observatories, Las Campanas Observatory, Casilla 601, La Serena (Chile); Folatelli, G. [Kavli Institute for the Physics and Mathematics of the Universe, the University of Tokyo, Kashiwa 277-8583 (Kavli IPMU, WPI) (Japan); Anderson, J. P., E-mail: sgonzale@das.uchile.cl [European Southern Observatory, Alonso de Córdova 3107, Casilla 19, Santiago (Chile)

    2014-11-10

    We present a new photometric identification technique for SN 1991bg-like type Ia supernovae (SNe Ia), i.e., objects with light curve characteristics such as later primary maxima and the absence of a secondary peak in redder filters. This method is capable of selecting this sub-group from the normal type Ia population. Furthermore, we find that recently identified peculiar sub-types such as SNe Iax and super-Chandrasekhar SNe Ia have photometric characteristics similar to 91bg-like SNe Ia, namely, the absence of secondary maxima and shoulders at longer wavelengths, and can also be classified with our technique. The similarity of these different SN Ia sub-groups perhaps suggests common physical conditions. This typing methodology permits the photometric identification of peculiar SNe Ia in large upcoming wide-field surveys either to study them further or to obtain a pure sample of normal SNe Ia for cosmological studies.

  15. SBRT for early-stage glottic larynx cancer—Initial clinical outcomes from a phase I clinical trial

    Science.gov (United States)

    Schwartz, David L.; Sosa, Alan; Chun, Stephen G.; Ding, Chiuxiong; Xie, Xian-Jin; Nedzi, Lucien A.

    2017-01-01

    Purpose To confirm safety and feasibility of hypofractionated SBRT for early-stage glottic laryngeal cancer. Methods Twenty consecutive patients with cTis-T2N0M0 carcinoma of glottic larynx were enrolled. Patients entered dose-fractionation cohorts of incrementally shorter bio-equivalent schedules starting with 50 Gy in 15 fractions (fx), followed by 45 Gy/10 fx and, finally, 42.5 Gy/5 fx. Maximum combined CTV-PTV expansion was limited to 5 mm. Patients were treated on a Model G5 Cyberknife (Accuray, Sunnyvale, CA). Results Median follow-up is 13.4 months (range: 5.6–24.6 months), with 12 patients followed for at least one year. Maximum acute toxicity consisted of grade 2 hoarseness and dysphagia. Maximum chronic toxicity was seen in one patient treated with 45 Gy/10 fx who continued to smoke >1 pack/day and ultimately required protective tracheostomy. At 1-year follow-up, estimated local disease free survival for the full cohort was 82%. Overall survival is 100% at last follow-up. Conclusions We were able to reduce equipotent total fractions of SBRT from 15 to 5 without exceeding protocol-defined acute/subacute toxicity limits. With limited follow-up, disease control appears comparable to standard treatment. We continue to enroll to the 42.5 Gy/5 fx cohort and follow patients for late toxicity. Trial registration ClinicalTrials.gov NCT01984502 PMID:28253270

  16. IAS 12 needs methodical approach

    NARCIS (Netherlands)

    Hafkenscheid, R.P.F.M.; Janssen, C.M.L.

    2009-01-01

    The article describes a methodology used to establish the expected value of uncertain tax positions. The Project Update on Income Taxes released by the International Accounting Standards Board (IASB) in September 2008 aims to reduce the differences between IAS 12 Income Taxes and the SFAS 109 Accoun

  17. A two-stage algorithm for designing phase I cancer clinical trials for two new molecular entities.

    Science.gov (United States)

    Su, Zheng

    2010-01-01

    The continual reassessment method (CRM) and subsequent developments of the Bayesian approach provide important tools for the design of Phase I cancer clinical trials for a new molecular entity. In recent years the idea of developing a treatment composed of two molecular entities has been proposed. For example, for some tumor types there may be two signaling pathways, both of which need to be blocked simultaneously using two molecules to achieve therapeutic benefit. A two-stage Bayesian and likelihood based algorithm is introduced herein for designing Phase I cancer clinical trials for two new molecular entities. It starts with a modified CRM approach in the first stage and makes use of the accumulated data from the first stage to provide likelihood estimates of model parameters for use in the second stage. Copyright (c) 2009 Elsevier Inc. All rights reserved.

  18. Clinical Outcomes and Risks of Single-stage Bilateral Unicompartmental Knee Arthroplasty via Oxford Phase Ⅲ

    Institute of Scientific and Technical Information of China (English)

    Tong Ma; Yi-Hui Tu; Hua-Ming Xue; Tao Wen; Min-Wei Cai

    2015-01-01

    Background:Osteoarthritis often affects the joint bilaterally,and the single-stage (SS) unicompartmental knee arthroplasty (UKA) is advantageous in terms of a single anesthesia administration,a short hospital stay,lower medical costs,and enhanced patient convenience.However,the complication risk of SS UKA continues to be debated.The aim of this article was to evaluate the clinical effectiveness,complications,and functional recovery of SS and two-stage (TS) UKA.Methods:From January 2008 to December 2013,we compared a series of 36 SS UKA with 45 TS UKA for osteoarthritis.The mean age was 65.4 years (range:55-75 years).The mean body mass index was 25.2 kg/m2 (range:22-29 kg/m2).The pre-and post-operative Oxford Knee Scores (OKSs),complications,operative times,tourniquet times,the amount of drainage,and hemoglobin (Hb) were evaluated.The Chi-square test,Fisher's exact test,and paired and grouped t-tests were used in this study.Results:The mean follow-up was 50 months.No complications of death,fat embolism,deep vein thrombosis,and prosthetic infection were reported.Patients who underwent SS UKA had a shorter cumulative anesthesia time (113.5 vs.133.0 min,P < 0.01).There were no significant variations between the values of the mean tourniquet time,the amount of drainage,pre-and post-operative Hb in the different groups.No patient required a blood transfusion.No statistical differences were found in the complications between two groups (P > 0.05).At the final follow-up,the mean OKS improved from 39.48 ± 5.69 to 18.83 ± 3.82 (P < 0.01),with no statistical differences between the two groups (P > 0.05).Patients who underwent SS UKA had a faster recovery.Conclusions:The single-staged UKA offers the benefits of a single anesthesia administration,reduced total anesthetic time,decreased overall rehabilitation time,and absence of an increase in perioperative mortality or complications compared with the TS bilateral UKA.

  19. Ultraviolet diversity of Type Ia Supernovae

    DEFF Research Database (Denmark)

    Foley, Ryan J.; Pan, Yen-Chen; Brown, P.;

    2016-01-01

    Ultraviolet (UV) observations of Type Ia supernovae (SNe Ia) probe the outermost layers of the explosion, and UV spectra of SNe Ia are expected to be extremely sensitive to differences in progenitor composition and the details of the explosion. Here, we present the first study of a sample of high...

  20. Pregnancies in glycogen storage disease type Ia

    NARCIS (Netherlands)

    Martens, Danielle H. J.; Rake, Jan Peter; Schwarz, Martin; Ullrich, Kurt; Weinstein, David A.; Merkel, Martin; Sauer, Pieter J. J.; Smit, G. Peter A.

    2008-01-01

    OBJECTIVE: Reports on pregnancies in women with glycogen storage disease type Ia (GSD-Ia) are scarce. Because of improved life expectancy, pregnancy is becoming an important issue. We describe 15 pregnancies by focusing on dietary treatment, biochemical parameters, and GSD-Ia complications. STUDY DE

  1. Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer.

    Science.gov (United States)

    Canaz, Emel; Ozyurek, Eser Sefik; Erdem, Baki; Aldikactioglu Talmac, Merve; Yildiz Ozaydin, Ipek; Akbayir, Ozgur; Numanoglu, Ceyhun; Ulker, Volkan

    2017-06-14

    Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic

  2. Heavy Metal Exposure in Predicting Peripheral Neuropathy in Patients With Stage I-III Breast Cancer Undergoing Chemotherapy

    Science.gov (United States)

    2015-05-01

    Male Breast Cancer; Neurotoxicity; Peripheral Neuropathy; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  3. Interactive Gentle Yoga in Improving Quality of Life in Patients With Stage I-III Breast Cancer Undergoing Radiation Therapy

    Science.gov (United States)

    2017-07-28

    Anxiety Disorder; Depression; Ductal Breast Carcinoma in Situ; Fatigue; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  4. Phases of a Type Ia supernova explosion

    CERN Document Server

    Niemeyer, J C

    1998-01-01

    In the framework of the Chandrasekhar mass white dwarf model for Type Ia supernovae, various stages of the explosion are described in terms of the burning regimes of the thermonuclear flame front. In the early flamelet regime following the ``smoldering'' phase prior to the explosion, the flame is sufficiently thin and fast to remain laminar on small scales. As the white dwarf density declines, the thermal flame structure becomes subject to penetration by turbulent eddies, and it enters the ``distributed burning'' regime. A specific control parameter for this transition is proposed. Furthermore, we outline an argument for the coincidence of the transition between burning regimes with the onset of a deflagration-detonation-transition (DDT) in the late phase of the explosion.

  5. Endometrial cancer: results of clinical and histopathological staging compared to magnetic resonance imaging using an endorectal surface coil.

    Science.gov (United States)

    Brocker, Kerstin A; Alt, Céline D; Breyer, Ulrike; Hallscheidt, Peter; Sohn, Christof

    2014-04-01

    The aim of this study was to evaluate the staging accuracy of magnetic resonance imaging (MRI) with an endorectal surface coil on patients with endometrial cancer compared to results obtained using the International Federation of Gynecology and Obstetrics (FIGO) classification and histopathology. In this prospective study, patients with biopsy-proven endometrial cancer were staged clinically using the FIGO classification before undergoing 1.5 T MRI with an endorectal surface coil (eMRI). The staging results from the FIGO classification and from eMRI were compared with the histopathological results after surgery. Furthermore, each patient was given a questionnaire designed by the authors to evaluate the patients' opinions on eMRI. The responses were examined using the methods of descriptive analysis. A total of 33 consecutive patients were recruited and clinically staged before undergoing eMRI. Subsequently, 21 patients underwent primary surgery and 12 patients primary radiochemotherapy. The FIGO stages were identical to the histopathological results in 17 (81 %) cases, and those of eMRI were identical in 15 (71 %). In 13 (62 %) cases, FIGO and eMRI staged identically. In 12 (57 %) of the 21 cases, all three staging modalities diagnosed the same tumor stage. eMRI overstaged the tumor in four patients and understaged it in two. All T1a tumors were staged correctly by eMRI. Eighteen patients answered the questionnaire, of whom 11 (61 %) patients stated that their experience with eMRI was overall positive. It seems feasible in principle to employ eMRI for diagnosing patients with endometrial cancer stage T1a. Yet, the results of eMRI for our study population were not better than the results obtained using the FIGO classification or than those from using MRI without an endorectal surface coil. eMRI thus does not meet the expectations based on its use in other pelvic tumor entities.

  6. Testicular seminoma clinical stage 1: treatment outcome on a routine care level.

    Science.gov (United States)

    Dieckmann, Klaus-Peter; Dralle-Filiz, Inken; Matthies, Cord; Heinzelbecker, Julia; Bedke, Jens; Ellinger, Jörg; Anheuser, Petra; Souchon, Rainer; Pichlmeier, Uwe

    2016-07-01

    Clinical stage 1 (CS1) testicular seminoma involves an almost 100 % disease-specific survival in controlled clinical trials. We aimed to find out whether these results can be matched in patients managed on the routine care level. In total, 725 patients with seminoma CS1 were prospectively enrolled from 130 institutions. Adjuvant management as decided by local physicians involved surveillance (n = 256), radiotherapy (41), 1× Carboplatin (362), and 2× Carboplatin (66). We registered type of management, age, duration of follow-up (F/U), relapse, rete testis invasion (RTI), and tumor size. Actuarial relapse-free survival curves were calculated for treatment modalities and stratified for tumor sizes and RTI. A Cox regression model was calculated to explore for factors influencing relapses. Disease-specific survival was 100 %. Crude relapse rates were 8.2, 2.4, 5.0, and 1.5 % for surveillance, radiotherapy, 1× Carboplatin, and 2× Carboplatin after a median F/U of 30 months. RTI and tumor size were not associated with progression in surveillance patients. One course Carboplatin caused relapses in 6.8 % in tumor sizes >4 cm and 9.3 % (actuarial 13 %) in sizes >5 cm. The Cox model revealed the association of tumor size with recurrence in the entire seminoma population (Hazard ratio 1.17; 95 % confidence intervals 1.03-1.33). The overall outcome of CS1 seminoma managed on the routine care level mirrors that of controlled trials. Unexpectedly, the risk factors in surveillance patients were not confirmed, but tumor size proved to be a risk indicator in the entire group of seminoma. Importantly, one course Carboplatin involved low efficacy to control the disease in large tumors.

  7. Changes in clinical presentation and staging of lung cancer over two decades.

    Science.gov (United States)

    Leiro-Fernández, Virginia; Mouronte-Roibás, Cecilia; Ramos-Hernández, Cristina; Botana-Rial, Maribel; González-Piñeiro, Ana; García-Rodríguez, Esmeralda; Represas-Represas, Cristina; Fernández-Villar, Alberto

    2014-10-01

    Important clinical and epidemiological changes have been observed in lung cancer (LC) in our healthcare area compared to the previous decade. In the last 10 years, specific LC care circuits have been implemented and the active search for cases has been stepped up. The aim of this study was to analyze the progress of these changes over the last 20 years. This is a retrospective study comparing clinical and epidemiological changes between 2 historical cohorts of LC patients (1992-1994 [group 1, 164 patients] and 2004-2006 [group 2, 250 patients]) and a current group from the period 2011-2012 (group 3, 209 patients) Two hundred and nine (209) LC patients were included in group 3 (2011-2012 period). After comparing groups 3 and 2, a non-significant rise in smoking was observed in women (59% vs 41%, p=.25), while the prevalence of adenocarcinoma was unchanged (45% vs 44%, p=.9). The main changes observed were the increase in cases with previous malignancies (23% vs 16%, p=.04), the rise in patients with no associated LC symptoms (33% vs 16%, p<.001), and an increased number of localized NSCLC (non-small cell LC) diagnoses (42% vs 24% in series 2, p<.001 and 14.2% in series 1, p<.001). The number of LC patients diagnosed in localized stages has increased significantly. Furthermore, the number of patients with no symptoms associated with LC and with a history of previous malignancy were significantly increased. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. FLT PET in Measuring Treatment Response in Patients With Newly Diagnosed Estrogen Receptor-Positive, HER2-Negative Stage I-III Breast Cancer

    Science.gov (United States)

    2016-06-02

    Estrogen Receptor Positive; HER2/Neu Negative; Male Breast Carcinoma; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  9. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer.

    Science.gov (United States)

    Azzoli, Christopher G; Baker, Sherman; Temin, Sarah; Pao, William; Aliff, Timothy; Brahmer, Julie; Johnson, David H; Laskin, Janessa L; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pfister, David G; Piantadosi, Steven; Schiller, Joan H; Smith, Reily; Smith, Thomas J; Strawn, John R; Trent, David; Giaccone, Giuseppe

    2009-12-20

    The purpose of this article is to provide updated recommendations for the treatment of patients with stage IV non-small-cell lung cancer. A literature search identified relevant randomized trials published since 2002. The scope of the guideline was narrowed to chemotherapy and biologic therapy. An Update Committee reviewed the literature and made updated recommendations. One hundred sixty-two publications met the inclusion criteria. Recommendations were based on treatment strategies that improve overall survival. Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life. For first-line therapy in patients with performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For patients with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with carboplatin-paclitaxel, except for patients with certain clinical characteristics. Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs. Data are insufficient to recommend routine use of molecular markers to select chemotherapy.

  10. HPV16 variant lineage, clinical stage, and survival in women with invasive cervical cancer

    Directory of Open Access Journals (Sweden)

    Zuna Rosemary E

    2011-10-01

    Full Text Available Abstract Background HPV16 variants are associated with different risks for development of CIN3 and invasive cancer, although all are carcinogenic. The relationship of HPV 16 variants to cancer survival has not been studied. Methods 155 HPV16-positive cervical cancers were categorized according to European and non-European variant patterns by DNA sequencing of the E6 open reading frame. Clinico-pathologic parameters and clinical outcome were collected by chart review and death registry data. Results Of the 155 women (mean age 44.7 years; median follow-up 26.7 months, 85.2% harbored European variants while 14.8% had non-European sequences. HPV16 variants differed by histologic cell type (p = 0.03 and stage (1 vs. 2+; p = 0.03. Overall, 107 women (68.0% were alive with no evidence of cancer, 42 (27.1% died from cervical cancer, 2 (1.3% were alive with cervical cancer, and 4 (2.6% died of other causes. Death due to cervical cancer was associated with European variant status (p Conclusions Overall, invasive cervical cancers with non-European variants showed a less aggressive behavior than those with European variants. These findings should be replicated in a population with more non-European cases.

  11. An education and motivation intervention to change clinical management of the third stage of labor - the GIRMMAHP Initiative.

    Science.gov (United States)

    Figueras, Albert; Narváez, Edgar; Valsecia, Mabel; Vásquez, Susana; Rojas, Germán; Camilo, Angiolina; del Valle, José-María; Aguilera, Cristina

    2008-12-01

    Hemorrhage and hypertensive disorders are major contributors to death after delivery in developing countries. The GIRMMAHP Initiative was designed to describe the actual delivery care in five Latin American countries and to educate and motivate clinical staff at 17 hospitals with the purpose of implementing their own clinical practice guidelines to prevent postpartum hemorrhage. A multicountry education intervention was developed in four consecutive stages, using two analyses: (a) an observational study of the clinical records in eight teaching and nine nonteaching hospitals and (b) a study of the long-term changes measured 12 months after completion of an education intervention and writing a local clinical guideline. Data from 2,247 pregnant women showed that only 23.3 percent had an active management of the third stage of labor and that 22.7 percent received no prenatal care visit. These data were used to prepare local clinical practice guidelines in each participant hospital. The proportion of active management increased to 72.6 percent of deliveries at 3 months and 58.7 percent 1 year later. Use of oxytocin during the third stage of labor increased to 85.9 percent of included deliveries. The proportion of women who had postpartum hemorrhage decreased from 12.7 percent at baseline to 5 percent at 1 year after the intervention. An education intervention and discussion of actual clinical practice problems with health professionals and their involvement in drafting clinical guidelines helped improve health care quality and practitioners' adherence to these guidelines.

  12. Neoadjuvant therapy for early-stage breast cancer: the clinical utility of pertuzumab

    Directory of Open Access Journals (Sweden)

    Gollamudi J

    2016-02-01

    Full Text Available Jahnavi Gollamudi,1,* Jenny G Parvani,2,* William P Schiemann,3 Shaveta Vinayak3,4 1Department of Internal Medicine, 2Department of Biomedical Engineering, 3Case Comprehensive Cancer Center, Case Western Reserve University, 4Department of Hematology and Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA *These authors contributed equally to this work Abstract: Approximately 20% of breast cancer patients harbor tumors that overexpress human epidermal growth factor receptor 2 (HER2; also known as ErbB2, a receptor tyrosine kinase that belongs to the epidermal growth factor receptor family of receptor tyrosine kinases. HER2 amplification and hyperactivation drive the growth and survival of breast cancers through the aberrant activation of proto-oncogenic signaling systems, particularly the Ras/MAP kinase and PI3K/AKT pathways. Although HER2-positive (HER2+ breast cancer was originally considered to be a highly aggressive form of the disease, the clinical landscape of HER2+ breast cancers has literally been transformed by the approval of anti-HER2 agents for adjuvant and neoadjuvant settings. Indeed, pertuzumab is a novel monoclonal antibody that functions as an anti-HER2 agent by targeting the extracellular dimerization domain of the HER2 receptor; it is also the first drug to receive an accelerated approval by the US Food and Drug Administration for use in neoadjuvant settings in early-stage HER2+ breast cancer. Here, we review the molecular and cellular factors that contribute to the pathophysiology of HER2 in breast cancer, as well as summarize the landmark preclinical and clinical findings underlying the approval and use of pertuzumab in the neoadjuvant setting. Finally, the molecular mechanisms operant in mediating resistance to anti-HER2 agents, and perhaps to pertuzumab as well, will be discussed, as will the anticipated clinical impact and future directions of pertuzumab in breast cancer patients. Keywords: breast cancer

  13. Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

    Science.gov (United States)

    Salerno, Jennifer; Finelli, Antonio; Morash, Chris; Morgan, Scott C.; Power, Nicholas; Schieda, Nichola; Haider, Masoom A.

    2016-01-01

    Introduction: The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. Results: The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11–85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. Conclusions: Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.

  14. 老年糖尿病患者血清GAD-Ab、ICA、IAA和IA-2-Ab联合检测的临床应用价值%Clinical Value of Combined Detection of GAD-Ab, ICA, IAA and IA-2-Ab in Elderly Patients with Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    周细国; 杨一波; 杨伟平

    2011-01-01

    [目的]探讨谷氨酸脱羧酶抗体(GAD-Ab)、胰岛细胞抗体(ICA)、胰岛自身抗体(IAA)和蛋白酪氨酸磷酸酶抗体(IA-2-Ab)联合检测对老年糖尿病患者的应用价值.[方法]采用免疫印迹法检测330例老年糖尿病患者和40例正常人血清中GAD-Ab、ICA、IAA和IA-2-Ab,并对四项自身抗体全阴患者与有一项以上阳性患者的空腹血糖(FBG)、餐后两小时血糖(2hPBG)和糖化血红蛋白(HbA1c)等血液生化指标进行比较.[结果]430例老年糖尿病患者GAD-Ab、ICA、IAA和IA-2-Ab的阳性率分别为39.7%、28.5%、17.0%和16.4%,四项自身抗体全阴患者124例,占37.6%,与有一项以上阳性患者比较,其FPG、2hPBG和HbA1c水平无显著差异(P>0.05).[结论]四项联合检测对老年糖尿病患者的诊断及治疗方案的制定有重要意义.%[Objective] To explore the value of combined detection of glutamic acid decarboxylase antibody (GAD-Ab) , islet cell antibody(ICA) , insulin autoantibody(IAA) and protein-tyrosine phosphatase antibody (IA-2-Ab) in elderly patients with diabetes mellitus(DM). [Methods] Western blotting was used to detect serum GAD-Ab, ICA, IAA and IA-2-Ab in 430 elderly patients with DM and 40 healthy people. Biochemical indicators such as fasting plasma glucose (FPG) , postprandial 2h-blood glucose (PBG) and HbA1c were compared between patients with all 4 negative autoantibodies and patients with one or more positive autoantibod-ies. [Results]The positive rate of GAD-Ab, ICA, IAA and IA-2-Ab in 430 elderly patients with DM was 39. 7 %, 28. 5%, 17. 0% and 16. 4%, respectively. There were 124 patients(37. 6%) with all 4 negative autoantibodies. There was no difference in FPG, PBG and HbAlc between patients with all 4 negative autoantibodies and patients with one or more positive autoantibodies. [Conclusion] The combined detection of GAD-Ab, ICA, IAA and IA-2-Ab in serum have the important significance for the diagnosis and treatment protocol of elderly patients

  15. Salvage of relapse of patients with Hodgkin's disease in clinical stages I or II who were staged with laparotomy and initially treated with radiotherapy alone. A report from the international database on Hodgkin's disease

    DEFF Research Database (Denmark)

    Specht, L.; Horwich, A.; Ashley, S.

    1994-01-01

    PURPOSE: To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy. METHODS AND MATERIALS: Data were analyzed on 681...... patients in the International Database on Hodgkin's Disease who were initially in clinical Stages I or II, who were staged with laparotomy, and who relapsed after initial treatment with irradiation alone. Factors analyzed for outcome after first relapse included initial stage, age, sex, histology...

  16. Type Ia Supernova Carbon Footprints

    CERN Document Server

    Thomas, R C; Aragon, C; Antilogus, P; Bailey, S; Baltay, C; Bongard, S; Buton, C; Canto, A; Childress, M; Chotard, N; Copin, Y; Fakhouri, H K; Gangler, E; Hsiao, E Y; Kerschhaggl, M; Kowalski, M; Loken, S; Nugent, P; Paech, K; Pain, R; Pecontal, E; Pereira, R; Perlmutter, S; Rabinowitz, D; Rigault, M; Rubin, D; Runge, K; Scalzo, R; Smadja, G; Tao, C; Weaver, B A; Wu, C; Brown, P J; Milne, P A

    2011-01-01

    We present convincing evidence of unburned carbon at photospheric velocities in new observations of 5 Type Ia supernovae (SNe Ia) obtained by the Nearby Supernova Factory. These SNe are identified by examining 346 spectra from 124 SNe obtained before +2.5 d relative to maximum. Detections are based on the presence of relatively strong C II 6580 absorption "notches" in multiple spectra of each SN, aided by automated fitting with the SYNAPPS code. Four of the 5 SNe in question are otherwise spectroscopically unremarkable, with ions and ejection velocities typical of SNe Ia, but spectra of the fifth exhibits high-velocity (v > 20,000 km/s) Si II and Ca II features. On the other hand, the light curve properties are preferentially grouped, strongly suggesting a connection between carbon-positivity and broad band light curve/color behavior: Three of the 5 have relatively narrow light curves but also blue colors, and a fourth may be a dust-reddened member of this family. Accounting for signal-to-noise and phase, we ...

  17. New clinical staging for pharyngeal surgery in obstructive sleep apnea patients,

    Directory of Open Access Journals (Sweden)

    Tatiana Aguiar Vidigal

    2014-12-01

    Full Text Available Introduction: The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. Objective: To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. Methods: A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m2 with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. Results: The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I–V. Conclusion: The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V, regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II, the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III.

  18. Cefaléia do tipo tensional episódica: avaliação clínica de 50 pacientes Episodic tension-type headache: clinical evaluation of 50 patients

    Directory of Open Access Journals (Sweden)

    André Palma da Cunha Matta

    2006-03-01

    Full Text Available Com o objetivo de estudar os aspectos clínicos, a história familiar e o impacto da dor nas atividades laborativas, foi conduzido estudo de série de casos de 50 pacientes portadores de cefaléia do tipo tensional episódica (CTTE. Foram avaliados 40 mulheres e 10 homens, com idade média de 30 (±12 anos. Dor constrictiva esteve presente em 40 pacientes (80%. O enjôo foi o principal fenômeno acompanhante (20%. A dor bilateral predominou; entretanto, a localização unilateral também esteve presente (10%. Embora classicamente descrita como uma dor leve, observou-se que a CTTE pode se manifestar como crises de forte intensidade (16%. A história familiar foi positiva em 12 pacientes (24%. O impacto nas atividades laborativas foi detectado em 14% da amostra. Os achados a respeito das características da dor estão de acordo com a literatura. O impacto representado pela CTTE a nível individual e na sociedade deve, entretanto, ser reconsiderado.A case series study of 50 consecutive patients with episodic tension type headache (ETTH was conducted. Clinical aspects, family history and impact on work activities were studied. The casuistry was made up of 40 women and 10 men. The average age was 30 (±12 years. Constrictive pain was present in 40 patients (80%. Sickness was the most commonly reported related phenomenon (20%. As expected, bilateral pain predominated; however, unilateral location was also present (10%. Although classically described as a mild pain, we observed that ETTH can come in intense crisis (16%. Family history of tension type headache was positive in 12 patients. The impact on work activities was substantial (14%. Our findings regarding to clinical aspects are in agreement with the literature. It is important to mention that the impact of ETTH on the individual and society should be reconsidered, and is more substantial than has been reported to date.

  19. Improving Medical Residents' Attitudes toward HIV-Infected Persons through Training in an HIV Staging and Triage Clinic.

    Science.gov (United States)

    Orlander, Jay D.; And Others

    1994-01-01

    A study assessed the effectiveness of a weekly outpatient clinic for staging and triage of newly identified human-immunodeficiency-virus (HIV)-infected patients on 21 medical residents' attitudes and knowledge regarding HIV patient care, as compared with 20 control students. Results indicated that the experience positively affected student…

  20. Detection of virus level in tissues of rainbow trout, Oncoryhinchus mykiss in clinical stage of viral hemorrhagic septicemia

    DEFF Research Database (Denmark)

    Ghiasi, Farzad; Olesen, Niels Jørgen

    2014-01-01

    In order to detecting VHS virus titer in various tissues in clinical stage of VHS disease, rainbow trout, Oncorhynchus mykiss, were exposed to virus by bath. The experiments were carried out with 140 fish obtained from rainbow trout farm. The fish were divided into two equal groups in 120 Liter t...

  1. Does Clinical Staging and Histological Grading Show Parallelism In Oral Submucous Fibrosis? A Retrospective Study from an Indian City

    Directory of Open Access Journals (Sweden)

    Manish Narayan

    2014-06-01

    Conclusions: There was no correlation between clinical staging and histopathological grading of oral submucous fibrosis. The test results were statistically not significant. (p=0.635 This may be due to difference in severity and extent of fibrosis in different parts of the oral mucosa. [J Interdiscipl Histopathol 2014; 2(3.000: 145-149

  2. Management of the clinically negative neck in early-stage head and neck cancers after transoral resection

    NARCIS (Netherlands)

    Rodrigo, J.P.; Shah, J.P.; Silver, C.E.; Medina, J.E.; Takes, R.P.; Robbins, K.T.; Rinaldo, A.; Werner, J.A.; Ferlito, A.

    2011-01-01

    The decision regarding treatment of the clinically negative neck has been debated extensively. This is particularly true with early-stage tumors for which surgery is the treatment of choice, and the tumor has been resected transorally without a cervical incision. Elective neck dissection in this

  3. Serum lactate dehydrogenase isoenzyme 1 and relapse in patients with nonseminomatous testicular germ cell tumors clinical stage I

    DEFF Research Database (Denmark)

    von Eyben, F E; Madsen, E L; Blaabjerg, O

    2001-01-01

    Serum lactate dehydrogenase isoenzyme 1 catalytic concentration (S-LD-1) was measured at the time of orchiectomy in 104 patients with nonseminomatous testicular germ cell tumors (NSTGCT) clinical stage I who participated in a randomized study comparing surveillance after orchiectomy (group I...

  4. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient

    Directory of Open Access Journals (Sweden)

    M. A. C. Onuigbo

    2014-01-01

    Full Text Available Despite decades of research, a full understanding of chronic kidney disease (CKD-end stage renal disease (ESRD progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34% patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92 years. Precipitating AKI followed pneumonia (8, acutely decompensated heart failure (7, pyelonephritis (4, post-operative (5, sepsis (3, contrast-induced nephropathy (2, and others (2. Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

  5. Value of 18F-FDG PET in Clinical Staging of Non-Small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    Suwen Liu; Jinming Yu; Ligang Xing

    2005-01-01

    OBJECTIVE To evaluate the feasibility of 18F-deoxyglucose positron emission tomography (18F-FDG PET) in the staging of non-small cell lung cancer(NSCLC).METHODS 105 patients with NSCLC had been examined by 18F-FDG PET before radiotherapy. The results of the 18F-FDG PET examination were compared with those of CT:RESULTS The staging was changed in 38 patients because of 18F-FDG PET findings, with PET resulting in upstaging in 31 patients and downstaging in seven patients. Because of distant metastasis detected by PET, 21 patients received palliative treatment. Six of the seven downstaged patients underwent radical surgery, among which the PET findings were concordant with the pathological findings in five patients. Distant metastasis detected by PET elevated the pre-PET stage: at stage 110.0% (2/20), stage Ⅱ 14.3% (3/21 ) and stage Ⅲ 25.0% (16/64), respectively.CONCLUSION 18F-FDG PET, by changing clinical staging in 36.2% (38/105)of NSCLC patients, has an impact on treatment strategy in NSCLC patients.

  6. Expression and role of CXCL10 during the encephalitic stage of experimental and clinical African trypanosomiasis

    DEFF Research Database (Denmark)

    Amin, Daniel N; Rottenberg, Martin E; Thomsen, Allan R;

    2009-01-01

    BACKGROUND: Human African trypanosomiasis, caused by Trypanosoma brucei, involves an early hemolymphatic stage followed by a late encephalitic stage. METHODS: We studied the expression of chemokines with use of microarray and enzyme-linked immunosorbent assay in T. brucei brucei-infected mice...

  7. Analysis of clinical factors associating with improvement of TNM staging accuracy in pancreatic head adenocarcinoma%胰头癌肿瘤分期影响因素分析

    Institute of Scientific and Technical Information of China (English)

    徐威; 李敬东; 赵国刚; 田云鸿

    2011-01-01

    Objective To explore possible clinical factors contributing to improvement of TNM staging accuracy in pancreatic head adenocarcinoma (PHA). Methods The retrospective study was conducted on 121 consecutive cases of PHA surgically treated from January 2004 to December 2010 in Affiliated Hospital of North Sichuan Medical College. Univariate and multivariate analysis using ordinal logistic regression explored clinical factors relating to postoperative tumor staging (Ptnm staging). Cross-validation was done to test discriminant accuracy of multivariate analysis results when compared with preoperatively radiologically TNM staging evaluation. Results Altogether 121 cases of potentially-resectable PHA entered the study. Preoperatively radiologically TNM staging evaluation revealed as followed: unidentified: 28 cases (23.1%), IA 9 cases (7.4%),IB 45 cases (37.2%), HA 18 cases (14.9%),IIB 15 cases (12.4%) and HI 6 cases (5.0%), respectively. Simple radiological TNM staging accuracy was frustrating, since Ptnm staging results as followed: IA 2 cases (1.7%) , IB 7 cases (5.8%), HA 14 cases (11.6%), IIB 6 cases (5.0%), III 63 cases (52.1%) and IV 29 cases (24.0%) , respectively. Multivariate analysis demonstrated that radiologically TNM staging, tumor diameters, ALT≥84.6U/L, neutrophil-lymphocyte ratio and serum CA19-9 values contributed to improvement of accurate TNM staging. Cross-validation based on multivariate results exhibited better discriminant performance, demonstrating the number of observations correctly classified as 71.7% and 66.7% of cross-validated grouped cases correctly classified. When Ptnm staging reclassified three categories as IA + IB + IIA + IIB.III and IV, 78.6% of original grouped cases correctly classified and 74.6% of cross-validated grouped cases correctly classified. Conclusion Clinical factors associating with TNM staging could improve accuracy of PHA TNM staging and may be incorporated into current management strategy for PHA.%目的

  8. Dark Matter Ignition of Type Ia Supernovae.

    Science.gov (United States)

    Bramante, Joseph

    2015-10-02

    Recent studies of low redshift type Ia supernovae (SN Ia) indicate that half explode from less than Chandrasekhar mass white dwarfs, implying ignition must proceed from something besides the canonical criticality of Chandrasekhar mass SN Ia progenitors. We show that 1-100 PeV mass asymmetric dark matter, with imminently detectable nucleon scattering interactions, can accumulate to the point of self-gravitation in a white dwarf and collapse, shedding gravitational potential energy by scattering off nuclei, thereby heating the white dwarf and igniting the flame front that precedes SN Ia. We combine data on SN Ia masses with data on the ages of SN Ia-adjacent stars. This combination reveals a 2.8σ inverse correlation between SN Ia masses and ignition ages, which could result from increased capture of dark matter in 1.4 vs 1.1 solar mass white dwarfs. Future studies of SN Ia in galactic centers will provide additional tests of dark-matter-induced type Ia ignition. Remarkably, both bosonic and fermionic SN Ia-igniting dark matter also resolve the missing pulsar problem by forming black holes in ≳10  Myr old pulsars at the center of the Milky Way.

  9. Immunocytochemical stem cell markers can predict clinical stage of breast cancer.

    Science.gov (United States)

    Gutiérrez Diez, Pedro J; Su, Yanrong; Russo, Jose

    2017-09-01

    We present a computational-statistical algorithm that, from data on the staining degree of immunocytochemical markers: i) evaluates the ability of the considered immuno-panel in predicting the breast cancer stage; ii) makes the accurate identification of breast cancer stage possible; iii) provides the best stage prognosis compatible with the considered sample; and iv) does so through the use of the minimum number of markers minimizing time and resource costs. After running the algorithm on two data sets [triple-negative breast cancer, (TNBC), and estrogen receptor-negative breast cancer, (ERNBC)], we conclude that EpCAM and β1 integrin are enough to accurately predict TNBC stage, being ALDH1, CD24, CD61, and CK5 the necessary markers to exactly predict ERNBC stage.

  10. Clinical presentation of T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda.

    Directory of Open Access Journals (Sweden)

    Irene Kuepfer

    Full Text Available BACKGROUND: A wide spectrum of disease severity has been described for Human African Trypanosomiasis (HAT due to Trypanosoma brucei rhodesiense (T.b. rhodesiense, ranging from chronic disease patterns in southern countries of East Africa to an increase in virulence towards the north. However, only limited data on the clinical presentation of T.b. rhodesiense HAT is available. From 2006-2009 we conducted the first clinical trial program (Impamel III in T.b. rhodesiense endemic areas of Tanzania and Uganda in accordance with international standards (ICH-GCP. The primary and secondary outcome measures were safety and efficacy of an abridged melarsoprol schedule for treatment of second stage disease. Based on diagnostic findings and clinical examinations at baseline we describe the clinical presentation of T.b. rhodesiense HAT in second stage patients from two distinct geographical settings in East Africa. METHODOLOGY/PRINCIPAL FINDINGS: 138 second stage patients from Tanzania and Uganda were enrolled. Blood samples were collected for diagnosis and molecular identification of the infective trypanosomes, and T.b. rhodesiense infection was confirmed in all trial subjects. Significant differences in diagnostic parameters and clinical signs and symptoms were observed: the median white blood cell (WBC count in the cerebrospinal fluid (CSF was significantly higher in Tanzania (134 cells/mm(3 than in Uganda (20 cells/mm(3; p<0.0001. Unspecific signs of infection were more commonly seen in Uganda, whereas neurological signs and symptoms specific for HAT dominated the clinical presentation of the disease in Tanzania. Co-infections with malaria and HIV did not influence the clinical presentation nor treatment outcomes in the Tanzanian study population. CONCLUSIONS/SIGNIFICANCE: We describe a different clinical presentation of second stage T.b. rhodesiense HAT in two distinct geographical settings in East Africa. In the ongoing absence of sensitive diagnostic

  11. Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Duong, Cuong P.; Demitriou, Helen; Thompson, Anne; Williams, David; Thomas, Robert J.S. [Peter MacCallum Cancer Centre, Division of Surgical Oncology, Melbourne (Australia); Weih, LeAnn [Peter MacCallum Cancer Centre, Statistical Center, Melbourne (Australia); Hicks, Rodney J. [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia)

    2006-07-15

    To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p<0.001). Conventional stage was not able to clearly stratify this population. The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations. (orig.)

  12. Comparative effectiveness studies to improve clinical outcomes in end stage renal disease: the DEcIDE patient outcomes in end stage renal disease study

    Directory of Open Access Journals (Sweden)

    Boulware Ebony L

    2012-12-01

    Full Text Available Abstract Background Evidence is lacking to inform providers’ and patients’ decisions about many common treatment strategies for patients with end stage renal disease (ESRD. Methods/design The DEcIDE Patient Outcomes in ESRD Study is funded by the United States (US Agency for Health Care Research and Quality to study the comparative effectiveness of: 1 antihypertensive therapies, 2 early versus later initiation of dialysis, and 3 intravenous iron therapies on clinical outcomes in patients with ESRD. Ongoing studies utilize four existing, nationally representative cohorts of patients with ESRD, including (1 the Choices for Healthy Outcomes in Caring for ESRD study (1041 incident dialysis patients recruited from October 1995 to June 1999 with complete outcome ascertainment through 2009, (2 the Dialysis Clinic Inc (45,124 incident dialysis patients initiating and receiving their care from 2003–2010 with complete outcome ascertainment through 2010, (3 the United States Renal Data System (333,308 incident dialysis patients from 2006–2009 with complete outcome ascertainment through 2010, and (4 the Cleveland Clinic Foundation Chronic Kidney Disease Registry (53,399 patients with chronic kidney disease with outcome ascertainment from 2005 through 2009. We ascertain patient reported outcomes (i.e., health-related quality of life, morbidity, and mortality using clinical and administrative data, and data obtained from national death indices. We use advanced statistical methods (e.g., propensity scoring and marginal structural modeling to account for potential biases of our study designs. All data are de-identified for analyses. The conduct of studies and dissemination of findings are guided by input from Stakeholders in the ESRD community. Discussion The DEcIDE Patient Outcomes in ESRD Study will provide needed evidence regarding the effectiveness of common treatments employed for dialysis patients. Carefully planned dissemination strategies to the

  13. Type Ia supernova science 2010-2020

    CERN Document Server

    Howell, D A; Della Valle, M; Nugent, P E; Perlmutter, S; Marion, G H; Krisciunas, K; Badenes, C; Mazzali, P; Aldering, G; Antilogus, P; Baron, E; Becker, A; Baltay, C; Benetti, S; Blondin, S; Branch, D; Brown, E F; Deustua, S; Ealet, A; Ellis, Richard S; Fouchez, D; Freedman, W; Gal-Yam, A; Jha, S; Kasen, D; Kessler, R; Kim, A G; Leonard, D C; Li, W; Livio, M; Maoz, D; Mannucci, F; Matheson, T; Neill, J D; Nomoto, K; Panagia, N; Perrett, K; Phillips, M; Poznanski, D; Quimby, R; Rest, A; Riess, A; Sako, M; Soderberg, A M; Strolger, L; Thomas, R; Turatto, M; van Dyk, S; Wood-Vasey, W M

    2009-01-01

    In the next decade Type Ia supernovae (SNe Ia) will be used to test theories predicting changes in the Dark Energy equation of state with time. Ultimately this requires a dedicated space mission like JDEM. SNe Ia are mature cosmological probes --- their limitations are well characterized, and a path to improvement is clear. Dominant systematic errors include photometric calibration, selection effects, reddening, and population-dependent differences. Building on past lessons, well-controlled new surveys are poised to make strides in these areas: the Palomar Transient Factory, Skymapper, La Silla QUEST, Pan-STARRS, the Dark Energy Survey, LSST, and JDEM. They will obviate historical calibrations and selection biases, and allow comparisons via large subsamples. Some systematics follow from our ignorance of SN Ia progenitors, which there is hope of determining with SN Ia rate studies from 0Ia regulate galactic and cluster chemical evolution, inform stellar evolution, and are ...

  14. Interactive Tailored Website to Promote Sun Protection and Skin Self-Check Behaviors in Patients With Stage 0-III Melanoma

    Science.gov (United States)

    2017-02-15

    Stage 0 Skin Melanoma; Stage I Skin Melanoma; Stage IA Skin Melanoma; Stage IB Skin Melanoma; Stage II Skin Melanoma; Stage IIA Skin Melanoma; Stage IIB Skin Melanoma; Stage IIC Skin Melanoma; Stage III Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma

  15. Typhoid Vaccine in Testing Response to Immune Stress in Patients With Stage I-IIIA Breast Cancer Who Received Chemotherapy

    Science.gov (United States)

    2016-11-29

    Cognitive Side Effects of Cancer Therapy; Depression; Recurrent Breast Carcinoma; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer

  16. KeraStat Skin Therapy in Treating Radiation Dermatitis in Patients With Newly Diagnosed Stage 0-IIIA Breast Cancer

    Science.gov (United States)

    2017-05-25

    Ductal Breast Carcinoma in Situ; Skin Reactions Secondary to Radiation Therapy; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer

  17. Exercise in Targeting Metabolic Dysregulation in Stage I-III Breast or Prostate Cancer Survivors

    Science.gov (United States)

    2017-09-12

    Cancer Survivor; No Evidence of Disease; Obesity; Overweight; Prostate Carcinoma; Sedentary Lifestyle; Stage I Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage III Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  18. Gonorréia Gonorrhea

    Directory of Open Access Journals (Sweden)

    Gerson Oliveira Penna

    2000-10-01

    Full Text Available A gonorréia é uma infecção bacteriana freqüente, causada pela Neisseria gonorrhoeae, um diplococo Gram-negativo de transmissão quase que exclusiva através de contato sexual ou perinatal. Primariamente afeta membranas mucosas do trato genital inferior, e mais raramente, as mucosas do reto, orofaringe e conjuntiva. A infecção genital ascendente na mulher leva a uma complicação séria, a salpingite aguda, uma das principais causas de infertilidade feminina. A partir dos anos 90, deu-se início a um novo tempo no que se refere a descobertas sobre a patogenia da gonorréia e seu agente etiológico. O controle da gonorréia tem sido difícil na maioria das populações, e essa permanece um exemplo da influência que os fatores sociais, comportamentais e demográficos exercem na epidemiologia de uma doença infecciosa. O manejo da gonorréia e de outras doenças sexualmente transmissíveis requer tanto o tratamento do paciente e de seu parceiro sexual como medidas de saúde pública para interromper a transmissão da infecção e evitar complicações a longo prazo.Gonorrhea is a common bacterial infection caused by Neisseria gonorrhoeae, a Gram-negative diplococcus that is transmitted almost exclusively by sexual contact or perinatally. It primarily affects the mucous membranes of the lower genital tract and less frequently those of the rectum, oropharynx, and conjunctivae. Ascending genital infection in women leads to the predominant complication, acute salpingitis, one of the most common causes of female infertility in the world. Since the 1990s, a remarkable surge of information ensued regarding the pathogenesis of gonorrhea and its agent. Gonorrohea has proven difficult to control in most populations and remains a prime example of the influence that social, behavioral, and demographic factors can have on the epidemiology of an infectious disease. The management of gonorrhea and other sexually transmitted infections requires both

  19. Chemoradiotherapy for superficial (sm{sub 2}/sm{sub 3}) esophageal cancer. Chemoradiotherapy for clinical stage I esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Muro, Kei; Arai, Tatsuhiro; Hamanaka, Hisanao [National Cancer Center, Tokyo (Japan). Hospital

    2002-09-01

    We studied the clinical outcome of chemoradiotherapy for clinical Stage I squamous cell carcinoma of the esophagus. Seventy-one patients without possibility of cure by endoscopic mucosal resection (EMR) were analyzed. Patients received continuous infusion of 5FU at a dose of 700 mg/m{sup 2}/24 hours on days 1 to 4, combined with CDDP at a dose of 70 mg/m{sup 2} on day 1, and concurrent radiation therapy at a dose of 30 Gy in 15 fractions over 3 weeks. This schedule was repeated twice every 4 weeks, for a total radiation dose of 60 Gy. The 66 patients (93%) achieved a complete response. Toxicities were generally mild, but late radiation morbidity was relatively frequent. However, no toxicities interfering with function were seen. With a median follow-up duration of 23 months, the 1, 2 and 3-year survival rates were 97%, 90% and 80%, respectively. This survival rate compared with that obtained by ordinary surgery with three-field lymph node dissection. Chemoradiotherapy for clinical Stage I esophageal cancer is a promising method, because of its safety and its being a curative therapy. We should present this therapy as well as surgery as an option of possibly curative therapy to patients with clinical Stage I esophageal cancer. (author)

  20. Data of evolutionary structure change: 1C7IA-1P0IA [Confc[Archive

    Lifescience Database Archive (English)

    Full Text Available 1C7IA-1P0IA 1C7I 1P0I A A THQIVTTQYGKVKGT--TE--NGVHKWKGIPYAKPPVGQ...GPFGFMHLSSFDEAYSDNLGLLDQAAALKWVRENISAFGGDPDNVTVFGESAGGMSIAALLAMPAAKGLFQKAIMESGAS----RTMTKEQAASTAAAFLQVLGINES...QLDRLHTVAAEDLLKA-----ADQLRIAE-----KENIFQLFFQPALDPKTLPEEPEKSIAEGAASGIPLLIGTTRDEGYF...TLELPFVFGNLDELERMAKAEITDEVKQLSHTIQSAWTTFAKTGNPST---EAVNWPAYHEESRETVILDS-EITIENDPESEKRQKLF------ --IIIA...WNPNTDLSEDCLYLNVWIPAPKPKNATVLIWIYGGGFQTGTSSLHVYDGKFLARVERVIVVSMNYRVGALGFLALPG-NPEAPGNMGLFDQQLALQWVQKNIAAFGGN

  1. Bayesian Analysis of Type Ia Supernova Data

    Institute of Scientific and Technical Information of China (English)

    王晓峰; 周旭; 李宗伟; 陈黎

    2003-01-01

    Recently, the distances to type Ia supernova (SN Ia) at z ~ 0.5 have been measured with the motivation of estimating cosmological parameters. However, different sleuthing techniques tend to give inconsistent measurements for SN Ia distances (~0.3 mag), which significantly affects the determination of cosmological parameters.A Bayesian "hyper-parameter" procedure is used to analyse jointly the current SN Ia data, which considers the relative weights of different datasets. For a flat Universe, the combining analysis yields ΩM = 0.20 ± 0.07.

  2. Diarréia por parasitas Parasites induced diarrheas

    Directory of Open Access Journals (Sweden)

    Maria Eugênia Farias Almeida Motta

    2002-08-01

    Full Text Available A diarréia é uma causa importante de morbimortalidade nos países em desenvolvimento. Os agentes etiológicos mais comuns são os vírus e as bactérias. Este artigo tem o objetivo de analisar a ocorrência de diarréia como manifestação clínica de parasitose. Discute-se quais os protozoários e os helmintos que podem causar diarréia, as bases científicas atuais que explicam os mecanismos fisiopatológicos que desencadeiam a diarréia, bem como os exames complementares e o tratamento adequado para cada parasita implicado.Diarrhea is an important cause of morbidity and mortality in developing countries. The most common etiological agents are viruses and bacteria. This article has the objective of analyzing diarrhea as a clinical symptom of parasitosis. Protozoa and helminthes that may cause diarrhea are discussed, current scientific basis clarifying the pathological and physiological mechanisms causing diarrhea as well as supplementary tests and adequate treatment for each parasite involved are focused.

  3. Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence? Características clínicas, diagnóstico e tratamento das cefaléias primárias agudas em um serviço de emergência: por que ainda negligenciamos as evidências?

    Directory of Open Access Journals (Sweden)

    Facundo Burgos Ruiz Jr

    2007-12-01

    Full Text Available In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%, followed by probable tension-type headache (37.6%, unspecified headache (11.9%, and headache not elsewhere classified (2.8%. As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%, tenoxicam (31.8%, diazepam (20.9%, dimenhydrate (10.9%, and metochlopramide (9.9%. The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.Com o objetivo de avaliar as características clínicas, abordagem e tratamento das cefaléias agudas primárias atendidas no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU no ano de 2005, 109 prontuários foram analisados através de questionário padronizado, segundo idade, sexo, diagnóstico principal, características das crises, propedêutica e tratamento. A distribuição dos pacientes quanto ao tipo de cefaléia foi a seguinte: provável enxaqueca 47,7%, provável cefaléia tensional 37,6%, cefaléia não classificada 11,9% e cefaléia não classificada em outro local 2,8%. No que tange às características da crise, a localização da dor foi descrita em 86,2% dos pacientes. No tratamento dos pacientes com crise

  4. Sequence variations of Env signal peptide alleles in different clinical stages of HIV infection.

    Science.gov (United States)

    da Silva, Joaquim Xavier; Franco, Octávio Luiz; Lemos, Mikael Araújo Guimarães; Gondim, Marcos Vinícius Pereira; Prosdocimi, Francisco; Argañaraz, Enrique Roberto

    2011-09-01

    The human immunodeficiency virus has been shown to increase its infectivity throughout the course of infection. This virus selection property has been associated with genome mutations and recombinations among virus variants, causing amino acid residue alterations in important viral proteins. In order to explore the contribution of Env signal peptide (Env-sp) to Env glycoprotein expression and its possible relationship to increased virus infectivity observed at late stages of infection, we characterized Env-sp sequences derived from twelve patients at "early" and "late" stages of HIV infection without antiretroviral therapy use. In spite of the remarkable overall similarity between both stages, we observed the deletion of a sequence of neutral and basic residues at the Env-sp amino terminus in virus from early stage specimens and the insertion of basic residues in the hydrophobic region on late-stage viral isolates. The Env-sp sequence alterations may have viral adaptive functions during HIV infection. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Adjuvant systemic chemotherapy for stages II and III colon cancer after complete resection: a clinical practice guideline

    Science.gov (United States)

    Meyers, B.M.; Cosby, R.; Quereshy, F.; Jonker, D.

    2016-01-01

    Background Updated practice guidelines on adjuvant chemotherapy for completely resected colon cancer are lacking. In 2008, Cancer Care Ontario’s Program in Evidence-Based Care developed a guideline on adjuvant therapy for stages ii and iii colon cancer. With newer regimens being assessed in this patient population and older agents being either abandoned because of non-effectiveness or replaced by agents that are more efficacious, a full update of the original guideline was undertaken. Methods Literature searches (January 1987 to August 2015) of medline, embase, and the Cochrane Library were conducted; in addition, abstracts from the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Cancer Congress were reviewed (the latter for January 2007 to August 2015). A practice guideline was drafted that was then scrutinized by internal and external reviewers whose comments were incorporated into the final guideline. Results Twenty-six unique reports of eighteen randomized controlled trials and thirteen unique reports of twelve meta-analyses or pooled analyses were included in the evidence base. The 5 recommendations developed included 3 for stage ii colon cancer and 2 for stage iii colon cancer. Conclusions Patients with completely resected stage iii colon cancer should be offered adjuvant 5-fluorouracil (5fu)–based chemotherapy with or without oxaliplatin (based on definitive data for improvements in survival and disease-free survival). Patients with resected stage ii colon cancer without “high-risk” features should not receive adjuvant chemotherapy. For patients with “high-risk” features, 5fu-based chemotherapy with or without oxaliplatin should be offered, although no clinical trials have been conducted to conclusively demonstrate the same benefits seen in stage iii colon cancer. PMID:28050138

  6. History of the IAS-Society and the IAS-conferences

    NARCIS (Netherlands)

    Hertzberger, B.; Kanade, T.; Groen, F.

    2017-01-01

    This paper describes the development of the IAS-Society and the trends in the Intelligent Autonomous Systems conferences. The first IAS conference was held in 1986 and was the first conference on this topic. The Society, founded in 1994, laid the basis for the organization of the IAS conferences. Th

  7. History of the IAS-Society and the IAS-conferences

    NARCIS (Netherlands)

    Hertzberger, B.; Kanade, T.; Groen, F.

    This paper describes the development of the IAS-Society and the trends in the Intelligent Autonomous Systems conferences. The first IAS conference was held in 1986 and was the first conference on this topic. The Society, founded in 1994, laid the basis for the organization of the IAS conferences.

  8. Sclerosis in bisphosphonate-related osteonecrosis of the jaws and its correlation with the clinical stages: study of 43 cases.

    Science.gov (United States)

    Bagan, J V; Cibrian, R M; Lopez, J; Leopoldo-Rodado, M; Carbonell, E; Bagán, L; Utrilla, J; Scully, C

    2015-03-01

    We analysed the degree of sclerosis in the different stages of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and studied the relation between the grade of sclerosis, the clinical symptoms, and the depth of lucency. We compared 43 patients with mandibular BRONJ with a control group of 40 cases with no bony lesions. The presence of sclerotic bone, cortical irregularities, radiolucency, fragmentation or sequestration, periostitis, and narrowing of the mandibular canal were studied from computed tomographic (CT) scans using the program ImageJ 1.47v (National Institute of Health, Bethesda, USA) to measure the radiolucency, width of the cortices, and degree of sclerosis. Patients with BRONJ had more severe sclerosis than controls (p0.05). We conclude that the degree of sclerosis increases with the clinical stage of BRONJ, and is correlated with the depth of lucency.

  9. Could the clinical interpretability of subgroups detected using clustering methods be improved by using a novel two-stage approach?

    DEFF Research Database (Denmark)

    Kent, Peter; Stochkendahl, Mette Jensen; Wulff Christensen, Henrik

    2015-01-01

    is to use statistical clustering techniques, such as Cluster Analysis or Latent Class Analysis, to detect latent relationships between patient characteristics. Influential patient characteristics can come from diverse domains of health, such as pain, activity limitation, physical impairment, social role...... participation, psychological factors, biomarkers and imaging. However, such ‘whole person’ research may result in data-driven subgroups that are complex, difficult to interpret and challenging to recognise clinically. This paper describes a novel approach to applying statistical clustering techniques that may...... improve the clinical interpretability of derived subgroups and reduce sample size requirements. Methods This approach involves clustering in two sequential stages. The first stage involves clustering within health domains and therefore requires creating as many clustering models as there are health...

  10. Echinococcus granulosus-specific T-cell lines derived from patients at various clinical stages of cystic echinococcosis.

    Science.gov (United States)

    Riganò, R; Buttari, B; De Falco, E; Profumo, E; Ortona, E; Margutti, P; Scottà, C; Teggi, A; Siracusano, A

    2004-01-01

    To investigate the role of T lymphocytes in the immune response to Echinococcus granulosus, using sheep hydatid fluid (SHF) and antigen B (AgB), we generated T-cell lines from patients with active, transitional and inactive hydatid cysts. We established 16 T-cell lines, eight specific to SHF and eight specific to AgB. At surface phenotyping 88-98% of cells displayed the helper/inducer CD4 antigen. In all patients, at all clinical stages of hydatid cyst disease, T-cell stimulation with SHF and AgB invariably amplified a large number of almost identical Vbeta subfamily fragments. Irrespective of antigen-specificity, the two cell lines from the patient with an inactive cyst had a Th1 profile, because they exclusively expressed and produced IFN-gamma. Conversely, the T-cell lines derived from the seven patients with active and transitional hydatid cysts had mixed Th1/Th2 and Th0 clones. The functional characteristics of the 16 T-cell lines differed markedly in the various clinical stages of cystic echinococcosis, thus providing new in vitro evidence that Th1 lymphocytes contribute decisively to the inactive stage of hydatid disease, Th2 lymphocytes in the active and transitional stages. The parasite-specific T-cell lines, especially the two Th1 lines from the patient with an inactive cyst, may help identify Th1 protective epitopes on SHF and AgB.

  11. Comparative analysis of therapeutic efficacy of 131I in different clinical stages postoperative patients with papillary thyroid carcinoma

    Institute of Scientific and Technical Information of China (English)

    Li Zhao; Shuyao Zuo; Guoming Wang

    2012-01-01

    Objective: The aim of this study was to compare the effect of 131I therapy of different clinical stages in postopera-tive patients with papillary thyroid carcinoma (PTC). Methods: Eighty-seven PTC patients after surgery ablated with high doses of 131I from 2004 to 2010 were retrospectively reviewed. The efficacy of 131I therapy was assessed by three diagnostics that serum thyroglobulin (Tg) was normal or significantly reduced, 131I whole body scan (131I-WBS) was negative or the metas-tases shrank or the number of them decreased and new metastases was not found in cervical ultrasound examination. The χ2 test was used to analyze 3 factors which might affect the therapeutic efficacy of 131I in patients of different clinical period, including different surgical ways (total or subtotal thyroidectomy along with half or double sides neck lymph node dissection), age ( 0.25, P < 0.005, P < 0.01). The effective rate was 91.67% (44) in 48 cases undergoing total thyroidectomy; the effective rate was 53.85% (21) in 39 patients undergoing subtotal thyroidectomy. There was a significant difference between the two groups above by χ2 test (χ2 = 16.291; P < 0.005). Conclusion: The efficacy of 131I ablation of stage I and stage III in postoperative PTC patients was almost alike, while the efficacy of stage IV descended markedly. The results was mainly determined by residual thyroid tissue size because of different surgical modus.

  12. Relationship between season, lactation number and incidence of clinical mastitis in different stages of lactation in a Holstein dairy farm

    OpenAIRE

    Maede Moosavi; Abdolah Mirzaei; Mohsen Ghavami; Amin Tamadoد

    2014-01-01

    The aim of the present study was to compare the occurrence and duration of clinical mastitis in different seasons, stages of lactation period and parities in a Holstein dairy farm in Iran. A retrospective epidemiological survey from April 2005 to March 2008 was conducted on 884 clinical mastitis cases of 7437 lactations. Data of each case including calendar-date of mastitis onset, days in milk (DIM) of mastitis onset (early: 0-74 DIM; middle: 75-150 DIM, and late ≥ 150 DIM), duration of masti...

  13. USE OF EXTENDED-RELEASE PRAMIPEXOLE IN EARLY-STAGE PARKINSON’S DISEASE: DESCRIPTION OF A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    N. V. Fedorova

    2014-11-01

    Full Text Available The paper considers a clinical case of early-stage mixed Parkinson’s disease (PD with significant affective disorders and restless legs syndrome. Once-daily extended-release pramipexole 3 mg significantly improved a patient’s status and led to regression of movement and affective disorders. The paper gives data on the efficacy of dopamine receptor agonists in treating PD and the benefits of their extended-release formulations.

  14. lncRNA profiling in early-stage chronic lymphocytic leukemia identifies transcriptional fingerprints with relevance in clinical outcome

    OpenAIRE

    Ronchetti, D.; Manzoni, M; Agnelli, L; Vinci, C; Fabris, S; Cutrona, G; Matis, S.; Colombo,M.; Galletti, S.; Taiana, E.; Recchia, A.G.; Bossio, S.; Gentile, M; Musolino, C.; Di Raimondo, F

    2016-01-01

    Long non-coding RNAs (lncRNAs) represent a novel class of functional RNA molecules with an important emerging role in cancer. To elucidate their potential pathogenetic role in chronic lymphocytic leukemia (CLL), a biologically and clinically heterogeneous neoplasia, we investigated lncRNAs expression in a prospective series of 217 early-stage Binet A CLL patients and 26 different subpopulations of normal B-cells, through a custom annotation pipeline of microarray data. Our study identified a ...

  15. Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy.

    OpenAIRE

    Wattmo, Carina; Minthon, Lennart; Wallin, Åsa

    2016-01-01

    BACKGROUND: There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer's disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of cholinesterase inhibitor (ChEI) therapy. METHODS: This 3-year, prospective, observational, multicentre study included 1021 participants. Of the...

  16. Immunodiagnostic identification of dairy cows infected with Prototheca zopfii at various clinical stages and discrimination between infected and uninfected cows.

    Science.gov (United States)

    Roesler, U; Scholz, H; Hensel, A

    2001-02-01

    Protothecosis is a severe form of mastitis in cattle that is caused by colorless algae of the genus Prototheca. So far, no suitable serological test for the identification of infected animals is available for routine diagnosis. In this study an indirect enzyme-linked immunosorbent assay (ELISA) for the identification of infected cows and for discriminating among infected cows at various clinical stages was developed. Immunoglobulin G (IgG) in serum and IgA and IgG1 in whey were used as antibody isotypes. The ELISA was evaluated using serum and whey from animals at different clinical stages of infection. A total of 12 cows with acute clinical manifestation of protothecal mastitis, 22 cows with clinical signs of chronic mastitis, 40 Prototheca zopfii-negative cows, and 18 cows with chronic clinical signs and earlier cultures positive for P. zopfii but with presently negative culturing results were investigated. A sensitivity of 96% and a specificity of 94% were calculated for the ELISA based on IgA levels. Intra-assay and interassay variations were calculated to be 6.08 and 6.32%, respectively. Based on these data, this ELISA was found to be suitable for discrimination between infected and uninfected animals and might therefore be useful for screening affected herds.

  17. Clinical trials and late-stage drug development for Alzheimer’s disease: an appraisal from 1984 to 2014

    Science.gov (United States)

    Schneider, Lon S.; Mangialasche, Francesca; Andreasen, Niels; Feldman, Howard; Giacobini, Ezio; Jones, Roy; Mantua, Valentina; Mecocci, Patrizia; Pani, Luca; Winblad, Bengt; Kivipelto, Miia

    2014-01-01

    The modern era of drug development for Alzheimer’s disease began with the proposal of the cholinergic hypothesis of memory impairment and the 1984 research criteria for Alzheimer’s disease. Since then, despite the evaluation of numerous potential treatments in clinical trials, only four cholinesterase inhibitors and memantine have shown sufficient safety and efficacy to allow marketing approval at an international level. Although this is probably because the other drugs tested were ineffective, inadequate clinical development methods have also been blamed for the failures. Here we review the development of treatments for Alzheimer’s disease during the past 30 years, considering the drugs, potential targets, late-stage clinical trials, development methods, emerging use of biomarkers and evolution of regulatory considerations in order to summarize advances and anticipate future developments. We have considered late-stage Alzheimer’s disease drug development from 1984 to 2013, including individual clinical trials, systematic and qualitative reviews, meta-analyses, methods, commentaries, position papers and guidelines. We then review the evolution of drugs in late clinical development, methods, biomarkers and regulatory issues. Although a range of small molecules and biological products against many targets have been investigated in clinical trials, the predominant drug targets have been the cholinergic system and the amyloid cascade. Trial methods have evolved incrementally: inclusion criteria have largely remained focused on mild to moderate Alzheimer’s disease criteria, recently extending to early or prodromal Alzheimer disease or ‘mild cognitive impairment due to Alzheimer’s disease’, for drugs considered to be disease modifying. The duration of trials has remained at 6 to 12 months for drugs intended to improve symptoms; 18- to 24-month trials have been established for drugs expected to attenuate clinical course. Cognitive performance, activities

  18. Clinical trials and late-stage drug development for Alzheimer's disease: an appraisal from 1984 to 2014.

    Science.gov (United States)

    Schneider, L S; Mangialasche, F; Andreasen, N; Feldman, H; Giacobini, E; Jones, R; Mantua, V; Mecocci, P; Pani, L; Winblad, B; Kivipelto, M

    2014-03-01

    The modern era of drug development for Alzheimer's disease began with the proposal of the cholinergic hypothesis of memory impairment and the 1984 research criteria for Alzheimer's disease. Since then, despite the evaluation of numerous potential treatments in clinical trials, only four cholinesterase inhibitors and memantine have shown sufficient safety and efficacy to allow marketing approval at an international level. Although this is probably because the other drugs tested were ineffective, inadequate clinical development methods have also been blamed for the failures. Here, we review the development of treatments for Alzheimer's disease during the past 30 years, considering the drugs, potential targets, late-stage clinical trials, development methods, emerging use of biomarkers and evolution of regulatory considerations in order to summarize advances and anticipate future developments. We have considered late-stage Alzheimer's disease drug development from 1984 to 2013, including individual clinical trials, systematic and qualitative reviews, meta-analyses, methods, commentaries, position papers and guidelines. We then review the evolution of drugs in late clinical development, methods, biomarkers and regulatory issues. Although a range of small molecules and biological products against many targets have been investigated in clinical trials, the predominant drug targets have been the cholinergic system and the amyloid cascade. Trial methods have evolved incrementally: inclusion criteria have largely remained focused on mild-to-moderate Alzheimer's disease criteria, recently extending to early or prodromal Alzheimer disease or 'mild cognitive impairment due to Alzheimer's disease', for drugs considered to be disease modifying. The duration of trials has remained at 6-12 months for drugs intended to improve symptoms; 18- to 24-month trials have been established for drugs expected to attenuate clinical course. Cognitive performance, activities of daily living

  19. Artificial neural network for predicting pathological stage of clinically localized prostate cancer in a Taiwanese population

    Directory of Open Access Journals (Sweden)

    Chih-Wei Tsao

    2014-10-01

    Conclusion: ANN was superior to LR at predicting OCD in prostate cancer. Compared with the validation of current Partin Tables for the Taiwanese population, the ANN model resulted in larger AUCs and more accurate prediction of the pathologic stage of prostate cancer.

  20. Isolated port site recurrence of node-negative clinical stage IB1 cervical adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Uma Deshmukh

    2017-05-01

    Conclusion: This is the first case report describing an isolated port site recurrence in a patient who underwent robotic-assisted laparoscopic surgery for early-stage cervical adenocarcinoma with negative margins and negative lymph nodes. The mechanism underlying this isolated recurrence remains unknown.

  1. IGF-IEc expression is associated with advanced clinical and pathological stage of prostate cancer.

    Science.gov (United States)

    Savvani, Argyro; Petraki, Constantina; Msaouel, Pavlos; Diamanti, Evangelia; Xoxakos, Ioannis; Koutsilieris, Michael

    2013-06-01

    Recent evidence suggests a role for the insulin-like growth factor-1Ec (IGF-IEc) transcript variant in cancer biology. The aim of the present study was to investigate whether IGF-IEc expression is associated with prostate cancer stage. Formalin-fixed and paraffin-embedded prostate cancer surgical specimens from 83 patients were assessed by immunohistochemistry for IGF-IEc expression. Normal prostate epithelium was negative or demonstrated mild IGF-IEc cytoplasmic expression whereas prostate cancer exhibited mild to strong cytoplasmic immunoexpression. The mean IGF-1Ec expression, was significantly lower (p=0.004) in localized (stage ≤ IIb) prostate cancer, compared to locally advanced tumors (stage ≥ III). Only one out of 83 (1.2%) prostate cancer samples was completely negative for IGF-IEc. A weak-positive correlation was also observed between IGF-IEc expression levels and Gleason score (r=0.247; p=0.024). The present data demonstrate that the expression of IGF-IEc is positively-associated with more advanced stage and higher Gleason score of prostate carcinomas.

  2. Evaluation of Clinical and MRI Staging for Prostate Cancer before Radical Prostatectomy%磁共振成像(MRI)对前列腺癌分期的临床意义

    Institute of Scientific and Technical Information of China (English)

    钟晨阳; ZHONG Chenyang; 邹恩泽; ZOU Enze; 陈敏; CHEN Min; WANG Wenchao; ZHAO Weifeng; WAN Ben; DENG Shuming; WANG Jianye

    2004-01-01

    Objective: To evaluate the clinical significance of clinical staging and magnetic resonance imaging (MRI) staging for prostate cancer before radical prostatectomy. Methods: Thirty-two patients with organ confined prostate cancer were reviewed to assess the accuracy of clinical staging and MRI staging to correlate with pathological staging results after radical prostatectomy. Results: 33.3% (10/30) prostate cancer patients with staging C and 3.3% (1/30) prostate cancer patients with staging D were diagnosed by pathology after radical prostatectomy in 30 patients with prostate cancer with clinical staging B, and 36.7% (11/30) under staging; Only one patient was over staging in clinical staging C. 19.1% (4/21) prostate cancer patients with staging C were diagnosed in 21 patients with prostate cancer and under staging with MRI staging B; 11.1% (1/9) was over staging with MRI staging C. The clinical staging and MRI staging had more correlation with pathological staging results (P=0.002), and PPV of the organ confined prostate cancer by clinical staging and MRI staging were 63.3% and 80.9% respectively, and NPV of nonorgan confined prostate cancer by clinical staging and MRI staging were 50% and 88.9% respectively. MRI staging was more specificity and accuracy than that of clinical staging to predict pathological staging results before radical prostatectomy (P=0.023). Conclusion: The MRI staging was more accuracy than that of clinical staging to predict pathological staging results in organ confined and nonorgan confined prostate cancer before radical prostatectomy.

  3. Intelligent Autonomous Systems 11: IAS-11

    NARCIS (Netherlands)

    Christensen, H.I.; Groen, F.; Petriu, E.

    2010-01-01

    This volume contains the proceedings of the eleventh International Conference on Intelligent Autonomous Systems (IAS-11) at the University of Ottawa in Canada. As ever, the purpose of the IAS conference is to bring together leading international researchers with an interest in all aspects of the

  4. The Local Hosts of Type Ia Supernovae

    CERN Document Server

    Neill, James D; Howell, D Andy; Conley, Alex; Seibert, Mark; Martin, D Christopher; Barlow, Tom A; Foster, Karl; Friedman, Peter G; Morrissey, Patrick; Neff, Susan G; Schiminovich, David; Wyder, Ted K; Bianchi, Luciana; Donas, José; Heckman, Timothy M; Lee, Young-Wook; Madore, Barry F; Milliard, Bruno; Rich, R Michael; Szalay, A S

    2009-01-01

    We use multi-wavelength, matched aperture, integrated photometry from GALEX, SDSS and the RC3 to estimate the physical properties of 166 nearby galaxies hosting 168 well-observed Type Ia supernovae (SNe Ia). Our data corroborate well-known features that have been seen in other SN Ia samples. Specifically, hosts with active star formation produce brighter and slower SNe Ia on average, and hosts with luminosity-weighted ages older than 1 Gyr produce on average more faint, fast and fewer bright, slow SNe Ia than younger hosts. New results include that in our sample, the faintest and fastest SNe Ia occur only in galaxies exceeding a stellar mass threshhold of ~10^10 M_sun, indicating that their progenitors must arise in populations that are older and/or more metal rich than the general SN Ia population. A low host extinction sub-sample hints at a residual trend in peak luminosity with host age, after correcting for light-curve shape, giving the appearance that older hosts produce less-extincted SNe Ia on average....

  5. A comparative analysis of clinical and molecular factors with the stage of cervical cancer in a Brazilian cohort.

    Directory of Open Access Journals (Sweden)

    Sergio M Amaro-Filho

    Full Text Available UNLABELLED: Cell cycle protein expression plays an important role in the pathophysiology of cervical cancer. However, few studies have attempted to correlate the use of these biomarkers with the clinical progression of the tumor. OBJECTIVES: 1 To analyze the expression of Ki-67, p53 and p16(INK4a in cervical cancer, 2 to correlate the relative expression of these proteins as well as clinical parameters with the stage of disease, and 3 to determine the HPV DNA prevalence and subtype distribution. METHODS: Tissue Micro-Arrays (TMA from patients with invasive cervical cancer (ICC and controls were analyzed. HPV DNA detection was done by PCR and in situ hybridization. Ki-67, p53 and p16(INK4a were analyzed by immunohistochemistry; clinical data was derived from the chart review. RESULTS: Advanced tumor stage (III and IV was strongly associated (p55 years old, with more than four pregnancies and with the lack of formal education. HPV DNA was found in 94.3% of cases with the most prevalent types being HPV16 (67.5%, followed by HPV33 (12.0% and HPV35 (3.6%. High expression of Ki-67 and p16 was more common in the advanced FIGO stages (p = 0.023. Women with HPV16 tended to be younger (50.9 years; SE 1.9 compared to women with other types (59.9 years; SE 2.8. CONCLUSION: We found that Ki-67 and p16 expression were independently associated with the tumor stage. We also noted that about 1/3 of the cervical cancers in this Brazilian cohort were not associated with HPV types directly targeted by the current HPV vaccines.

  6. The percentage of iNKT cells among other immune cells at various clinical stages of laryngeal cancer

    Directory of Open Access Journals (Sweden)

    Janusz Klatka

    2016-04-01

    Full Text Available Introduction: Invariant natural killer T (iNKT cells constitute a small population of immune cells that share functional and phenotypic characteristics of T lymphocytes and NK cells. Due to their involvement in specific and non-specific immune responses, iNKT cells may represent an important component of antitumor and anti-infectious immunity. Material and methods: Using flow cytometry, we analyzed the percentages of iNKT cells as well as T and B lymphocytes in peripheral blood of 50 laryngeal cancer patients at various clinical stages in comparison to healthy controls (n=15. Moreover, we determined the expression of CD25, CD69 and CD95 antigens on T lymphocytes.Results: The percentage of CD4+/CD3+ T lymphocytes in the controls was higher than in laryngeal cancer patients, both with early and late stages of the disease. The percentage of CD8+/CD3+ T lymphocytes in healthy controls was lower than in patients with early and late clinical stages of laryngeal cancer. Patients with advanced laryngeal cancer showed a lower percentage of iNKT cells and higher frequencies of T regulatory cells (Tregs than the controls. Advanced clinical stages of laryngeal cancer are associated with impaired activation of lymphocytes.Conclusions: Our study confirmed that laryngeal cancer cells exert a strong suppressor effect on the immune system of the host. This is reflected by a decrease in the percentage of iNKT cells that are capable of cancer cell elimination, and a concomitant increase in the percentage of Tregs. However, further studies are needed in order to explain the underlying mechanisms of immunosuppression and understand interactions between immune and cancer cells.

  7. Diagnosis, clinical staging, and treatment of breast cancer: a retrospective multiyear study of a large controlled population.

    Science.gov (United States)

    Legorreta, Antonio P; Chernicoff, Helen O; Trinh, Jennifer B; Parker, Robert G

    2004-04-01

    This study compares diagnosis, staging, and treatment of newly diagnosed breast cancer cases over a several-year period. The study design was a retrospective, multiyear comparison between new breast cancer cases diagnosed in 1995 (n = 827) and 1997 (n = 815). Cases were identified through claims data, and medical record abstraction was used to verify each case and to identify clinical staging and type of treatment. All medical records were reviewed by one physician to maximize internal reliability. Both cohorts were predominantly 40 and older, white, married, and postmenopausal. The latter cohort (1997) had a higher proportion of women aged 70 to 79 and a lower proportion of women aged 40 to 49. In both cohorts, women age 40 and older were likely to be diagnosed with breast cancer at the time of mammographic screening, while women younger than 40 were more likely to be diagnosed by clinical breast examination. In logistic regression analyses, controlling for confounding factors such as age, undergoing mammographic screening increased the likelihood of having a low cancer stage at diagnosis by more than three and a half times. Mammographic screening was statistically significantly positively associated with having eligibility for breast-conserving treatment (BCT); however, although an increase in BCT eligibility was observed, actual use of BCT did not change. Mammography leads to a lower clinical stage as well as a greater likelihood of BCT eligibility at time of breast cancer diagnosis, but may not have a substantial effect on treatment choice (lumpectomy vs. mastectomy). Between 1995 and 1997, a trend was observed toward downstaging of disease at diagnosis; further research is warranted to observe whether this trend continues over time.

  8. Diagnostic Accuracy and Confidence in the Clinical Detection of Cognitive Impairment in Early-Stage Parkinson Disease.

    Science.gov (United States)

    Wyman-Chick, Kathryn A; Martin, Phillip K; Barrett, Matthew J; Manning, Carol A; Sperling, Scott A

    2017-05-01

    Mild cognitive impairment (MCI) is present in up to 34% of patients with early-stage Parkinson disease (PD); however, it is difficult to detect subtle impairment without objective cognitive testing. Data were obtained from the Parkinson Progression Marker Initiative. All 341 participants were administered the Montreal Cognitive Assessment (MoCA) and a brief neuropsychological battery. Participants were classified as PD-MCI if MoCA was <26 or if they scored ≥1 standard deviation below the normative mean in 2 or more domains, based upon established criteria. The sensitivity/specificity for the clinical detection of PD-MCI was determined. Overall accuracy for clinical detection of PD-MCI was 67.4%. Although clinical determination was highly specific (96.3%; 95% confidence interval [CI]: 0.92-0.98), sensitivity was poor (32.0%; 95% CI: 0.25-0.40). Identifying MCI in early-stage PD based on clinical interview alone appears to be insufficient. The inclusion of objective cognitive tests allowing for normative sample comparisons is needed to increase the detection of cognitive impairment in this population.

  9. [Significance and contemplation of clinical diagnosis and therapy on the renewal of the eighth edition of gastric cancer TNM staging system].

    Science.gov (United States)

    Xi, Hongqing; Zhang, Kecheng; Wei, Bo; Chen, Lin

    2017-02-25

    TNM staging is essential for clinical decision-making and prognostic prediction for patients with gastric cancer. The 7th TNM staging manual was formulated in 2009 and implemented in 2010. However, it was published that there were some deficiencies of the 7th edition of gastric cancer TNM staging system in clinical application process, and this old staging system could not meet the clinical needs. With the cooperation and promotion of the American Joint Committee on Cancer (AJCC), the International Union for Cancer Control (UICC) and the International Gastric Cancer Association (IGCA), and through the accumulation and analysis of gastric cancer big data, the 8th TNM staging system was published at the end of 2016. The updated staging system has defined the selection of staging system for esophagogastric junction cancer. It also has divided N3 into N3a and N3b, which has been incorporated into the new staging system, leading to more accurate risk stratification. Moreover, the cTNM staging system and ypTNM staging system have been added in the new staging manual. Overall, the 8th TNM staging system can facilitate more reasonable decision-making, more accurate prognostic prediction and better evaluation of therapeutic strategy. It is of high value to promote diagnostic and therapeutic standard for gastric cancer.

  10. Aspectos clínico-patológicos do carcinoma bronquioloalveolar e sobrevida em pacientes no estágio clínico I Clinicopathological aspects of and survival in patients with clinical stage I bronchioloalveolar carcinoma

    Directory of Open Access Journals (Sweden)

    Daniel Sammartino Brandão

    2010-04-01

    Full Text Available OBJETIVO: Analisar os aspectos clínico-patológicos do carcinoma bronquioloalveolar (CBA e a sobrevida em uma amostra de pacientes com estadiamento clínico I. MÉTODOS: Foram estudados retrospectivamente 26 pacientes com diagnóstico de CBA e estágio clínico I, , segundo a classificação tumor-node-metastasis (TNM, tumor-linfonodo-metástase,(15operados no Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, na cidade do Rio de Janeiro, RJ, entre 1987 e 2007, quanto a variáveis clínico-patológicas e radiológicas, mortalidade e sobrevida. Os dados foram colhidos dos prontuários médicos dos pacientes e analisados estatisticamente. RESULTADOS: Houve predomínio de mulheres (n = 16. A idade média ao diagnóstico foi de 68,5 anos. Houve predomínio de tabagistas (69,2%. As formas de apresentação assintomática (84,6% e nodular (88,5% foram as mais comuns. Houve predileção pelos lobos superiores (57,7%. O estágio patológico IB foi o mais comum, seguido pelos estágios IA e IIB (46,2%, 38,4% e 15,4%, respectivamente. Não houve óbitos hospitalares. Quatro pacientes faleceram durante o seguimento pós-operatório, com tempo livre de doença médio de 21,3 meses. A taxa de sobrevida global em cinco anos foi 83%. A probabilidade de sobrevida para os pacientes diagnosticados depois de 1999 tendeu a ser maior do que para aqueles diagnosticados até 1999 (taxa de sobrevida em três anos: 92% vs. 68%; p = 0,07. CONCLUSÕES: Os aspectos clínico-patológicos da amostra estudada foram semelhantes àqueles de estudos anteriores em pacientes com CBA.OBJECTIVE: To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC and the survival in a sample of patients at clinical stage I. METHODS: A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro

  11. A covariate adjusted two-stage allocation design for binary responses in randomized clinical trials.

    Science.gov (United States)

    Bandyopadhyay, Uttam; Biswas, Atanu; Bhattacharya, Rahul

    2007-10-30

    In the present work, we develop a two-stage allocation rule for binary response using the log-odds ratio within the Bayesian framework allowing the current allocation to depend on the covariate value of the current subject. We study, both numerically and theoretically, several exact and limiting properties of this design. The applicability of the proposed methodology is illustrated by using some data set. We compare this rule with some of the existing rules by computing various performance measures.

  12. Early-Stage Breast Cancer in the Octogenarian: Tumor Characteristics, Treatment Choices, and Clinical Outcomes

    Science.gov (United States)

    Mamtani, Anita; Gonzalez, Julie J.; Neo, Dayna; Slanetz, Priscilla J.; Houlihan, Mary Jane; Herold, Christina I.; Recht, Abram; Hacker, Michele R.; Sharma, Ranjna

    2016-01-01

    Background Nodal staging with sentinel node biopsy (SLNB), post-lumpectomy radiotherapy (RT), and endocrine therapy (ET) for estrogen receptor-positive (ER+) tumors is valuable in the treatment of early-stage (stages 1 or 2) breast cancer but used less often for elderly women. Methods This retrospective study investigated women referred for surgical evaluation of biopsy-proven primary early-stage invasive breast cancer from January 2001 to December 2010. Clinicopathologic features, treatment course, and outcomes for women ages 80–89 years and 50–59 years were compared. Results The study identified 178 eligible women ages 80–89 years and 169 women ages 50–59 years. The elderly women more often had grade 1 or 2 disease (p = 0.003) and ER+ tumors (p = 0.007) and less frequently had undergone adjuvant therapies (all p ≤ 0.001). Lumpectomy was performed more commonly for the elderly (92 vs. 83 %, p = 0.02), and axillary surgery was less commonly performed (46 vs. 96 %; p < 0.001). Fewer elderly women had undergone post-lumpectomy RT (42 vs. 89 %; p < 0.001) and ET for ER+ tumors (72 vs. 95 %; p < 0.001). During the median follow-up period of 56 months for the 80- to 89-year old group and 98 months for the 50- to 59-year-old group, death from breast cancer was similar (4 vs. 5 %; p = 0.5). The two groups respectively experienced 7 versus 6 locoregional recurrences and 11 versus 13 distant recurrences. Conclusions The octogenarians had disease survivorship similar to that of the younger women despite less frequent use of adjuvant therapies, likely reflecting lower-risk disease features. Whether increased use of axillary surgery, post-lumpectomy RT, and/or ET for ER+ tumors would further improve outcomes is an important area for further study, but treatment should not be deferred solely on the basis of age. PMID:27364507

  13. Clinical Scenarios in Chronic Kidney Disease: Kidneys' Structural Changes in End-Stage Renal Disease.

    Science.gov (United States)

    Meola, Mario; Samoni, Sara; Petrucci, Ilaria

    2016-01-01

    Acquired cystic kidney disease (ACKD) and renal cell carcinoma (RCC) are the most important manifestations of end-stage kidneys' structural changes. ACKD is caused by kidney damage or scarring and it is characterized by the presence of small, multiple cortical and medullary cysts filled with a fluid similar to preurine. ACKD prevalence varies according to predialysis and dialysis age and its pathogenesis is unknown, although it is stated that progressive destruction of renal tissue induces hypertrophy/compensatory hyperplasia of residual nephrons and may trigger the degenerative process. ACKD is almost asymptomatic, but it can lead to several complications (bleeding, rupture, infections, RCC). Ultrasound (US) is the first level imaging technique in ACKD, because of its sensitivity and reliability. The most serious complication of ACKD is RCC, which is stimulated by the same growth factors and proto-oncogenes that lead to the genesis of cysts. Two different histological types of RCC have been identified: (1) RCC associated with ACKD and (2) papillary renal clear cell carcinoma. Tumors in end-stage kidneys are mainly small, multifocal and bilateral, with a papillary structure and a low degree of malignancy. At US, RCC appears as a small inhomogeneous nodule (<3 cm), clearly outlined from the renal profile and hypoechoic if compared with sclerotic parenchyma. In some cases, tumor appears as a homogeneous and hyperechoic multifocal mass. The most specific US sign of a small tumor in end-stage kidney is the important arterial vascularization, in contrast with renal parenchymal vascular sclerosis.

  14. Clinical and microbiological evaluation of one-stage full-mouth disinfection: a short-term study

    Directory of Open Access Journals (Sweden)

    José Roberto Cortelli

    Full Text Available INTRODUCTION: Patients seem to adhere better to short-term periodontal treatment schemes. Besides, time-reduced treatments are more cost-effective. However, the degree of benefits related to this type of treatment still requires additional investigations. AIM: The present short-term study evaluated clinical and microbiological outcomes, from baseline to 3-months, of chronic periodontitis subjects treated by the one-stage full-mouth disinfection protocol. MATERIAL AND METHOD: Sixteen chronic periodontitis subjects (mean-age 49.87 ± 8.22 who met inclusion/exclusion criteria were included. A calibrated examiner measured whole-mouth plaque and gingival indices, periodontal pocket depth and clinical attachment level at baseline and at 3-months. Subgingival samples were also collected from the 5 most diseased periodontal sites to determine total bacterial load and levels of P. gingivalis and S. oralis by real time qPCR. Periodontal treatment consisted of full-mouth manual debridement plus wide intraoral use of chlorhexidine in gel and solution. Additionally, after debridement, individuals rinsed 0.12% chlorhexidine at home twice a day for the following 2 months. Data monitored were compared by paired Student-t test (p<0.05. RESULT: Statistical analysis revealed that, in general, one-stage full-mouth disinfection treatment provided significant clinical and microbiological improvements at 3-months. Total bacterial load showed one of the most pronounced reductions from baseline to 3-months (p=0.0001. Also, subgingival levels P. gingivalis and S. oralis reduced overtime. CONCLUSION: After a short period of monitoring, chronic periodontitis subjects showed clinical and microbial improvements following one-stage full-mouth disinfection treatment.

  15. Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

    Science.gov (United States)

    Harris, Lyndsay N.; McShane, Lisa M.; Andre, Fabrice; Collyar, Deborah E.; Gonzalez-Angulo, Ana M.; Hammond, Elizabeth H.; Kuderer, Nicole M.; Liu, Minetta C.; Mennel, Robert G.; Van Poznak, Catherine; Bast, Robert C.; Hayes, Daniel F.

    2016-01-01

    Purpose To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. Methods A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. Recommendations In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences. PMID:26858339

  16. THE ROLE OF MRI IN THE ILLUSTRATION OF METASTATIC LYMPHATIC PATHWAYS AND CLINICAL N-STAGING OF NASOPHARYNGEAL CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    Wei Xiong; Li Jianjun; Tang Qixin

    1998-01-01

    Subject: To study the role of MRI in the illustration of metastatic lymphatic pathways and clinical N-staging of nasopharyngeal carcinoma (NPC). Methods: Eighty NPC patients were examined with MRI before radiotherapy from Mar. 1994 to Jun. 1996. MRI were performed using T1 weighted image (T1WI) and T2 weighted image (T2WI) in transverse, and using T1WI in sagittal and coronal sections. Results: 1. NpC chief metastatic lymphatic pathways are: primary foci → Rouviere's node (RN), or retrostyloid space nodes (RSN) secondarily →deep cervical nodes; 2. The superior border of neck fields should be moved upward to the level of external acoustic meatus; 3. The authors suggested that in Nstaging for NPC, N0 and N1 be divided into N0a and N0b,and N1a and N1b. Conclusion: MRI is very useful in clinical N-staging of NPC, especially for the reflection of the influance of RN and/or RSN tumefaction on N-staging.

  17. Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance--protocol for a systematic review.

    Science.gov (United States)

    Kunath, Frank; Spek, Annabel; Jensen, Katrin; Zengerling, Friedemann; Schmidt, Stefanie

    2015-12-18

    Testicular cancer is primarily treated with the surgical removal of the affected testis. About 50% of testicular cancer patients present with a stage I seminoma. If no chemo- or radiotherapy as adjuvant treatment is initiated after orchiectomy, 15-20% of these patients will develop metastases. Although adjuvant treatment is effective in reducing the relapse risk, there is rising concern about overtreatment of these patients. Prognostic factors at primary diagnosis might have the potential to identify patients at higher risk of tumor relapse, allowing to guide individual therapy and to avoid overtreatment. Therefore, we aim to synthesize the available evidence on tumor or patient characteristics as possible prognostic factors for cancer recurrence in patients with clinical stage I seminoma. We will conduct a broad systematic review to analyze what prognostic factors predict cancer recurrence in patients with a first time diagnosis of clinical stage I seminoma, who received no adjuvant chemo- or radiotherapy after orchiectomy. The literature search will comprise MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and the conference proceedings of the American Society of Clinical Oncology (ASCO), American Urologic Association (AUA), and European Urologic Association (EAU) Annual Meetings. Prospective and retrospective longitudinal studies reporting on prognostic factors for cancer recurrence will be considered. We will consider the wealth of any candidate clinical or pathological prognostic factor reported in the literature. Our outcome of interest will be tumor recurrence at a minimum of 2 years follow-up. Study screening, data extraction, and quality assessment will be done by two reviewers independently. Hazard ratios will be used to measure the relationship between the potential prognostic factor and tumor recurrence. Meta-analyses will be conducted with sufficiently homogeneous studies and separately with respect to study design

  18. Patient Perspectives on Deep Brain Stimulation Clinical Research in Early Stage Parkinson's Disease.

    Science.gov (United States)

    Heusinkveld, Lauren; Hacker, Mallory; Turchan, Maxim; Bollig, Madelyn; Tamargo, Christina; Fisher, William; McLaughlin, Lauren; Martig, Adria; Charles, David

    2017-01-01

    The FDA has approved a multicenter, double-blind, Phase III, pivotal trial testing deep brain stimulation (DBS) in 280 people with very early stage Parkinson's disease (PD; IDE#G050016). In partnership with The Michael J. Fox Foundation for Parkinson's Research, we conducted a survey to investigate motivating factors, barriers, and gender differences among potentially eligible patients for participation in a trial testing DBS in early PD compared to standard medical treatment. The majority of survey respondents (72%) indicated they would consider learning more about participating. Early PD patients are therefore likely to consider enrolling in trials of invasive therapies that may slow symptom progression and help future patients.

  19. Endosalpingiosis of Axillary Lymph Nodes: A Rare Histopathologic Pitfall with Clinical Relevance for Breast Cancer Staging

    Directory of Open Access Journals (Sweden)

    Laila Nomani

    2016-01-01

    Full Text Available Establishment of accurate axillary lymph node status is of essential importance in determining both prognosis and the potential need for adjuvant therapy in patients with invasive breast cancer. Axillary lymph node heterotopias can in some cases result in overdiagnosis of metastatic disease. Nodal endosalpingiosis is perhaps the least commonly reported type of axially lymph node heterotopia. We herein illustrate a case in which second opinion pathologic interpretation combined with ancillary immunohistochemical studies allowed for a specific diagnosis of axillary nodal müllerian-type inclusions, confirming ypN0 staging and resulting in appropriate disease management and prognostication.

  20. Endosalpingiosis of Axillary Lymph Nodes: A Rare Histopathologic Pitfall with Clinical Relevance for Breast Cancer Staging

    Science.gov (United States)

    Nomani, Laila; Calhoun, Benjamin C.; Biscotti, Charles V.; Grobmyer, Stephen R.; Sturgis, Charles D.

    2016-01-01

    Establishment of accurate axillary lymph node status is of essential importance in determining both prognosis and the potential need for adjuvant therapy in patients with invasive breast cancer. Axillary lymph node heterotopias can in some cases result in overdiagnosis of metastatic disease. Nodal endosalpingiosis is perhaps the least commonly reported type of axially lymph node heterotopia. We herein illustrate a case in which second opinion pathologic interpretation combined with ancillary immunohistochemical studies allowed for a specific diagnosis of axillary nodal müllerian-type inclusions, confirming ypN0 staging and resulting in appropriate disease management and prognostication. PMID:27088025

  1. Clinical Characteristics and Outcomes of Late Relapse in Stage I Testicular Seminoma.

    Science.gov (United States)

    Hosni, A; Warde, P; Jewett, M; Bedard, P; Hamilton, R; Moore, M; Nayan, M; Huang, R; Atenafu, E G; O'Malley, M; Sweet, J; Chung, P

    2016-10-01

    To identify the characteristics and outcomes associated with late relapse in stage I seminoma. A retrospective review was carried out of all patients with stage I seminoma managed at our institution between 1981 and 2011. Data were obtained from a prospectively maintained database. Late relapse was defined as tumour recurrence > 2 years after orchiectomy. Overall, 1060 stage I seminoma patients were managed with active surveillance (n=766) or adjuvant radiotherapy (n=294). At a median follow-up of 10.6 years (range 1.2-30), 142 patients relapsed at a median (range) of 14 (3-129) months; 128 on active surveillance and 14 after adjuvant radiotherapy. The late relapse rate for the active surveillance and adjuvant radiotherapy groups was 4% and 1%, respectively. There was no specific clinicopathological factor associated with late relapse. Isolated para-aortic node(s) was the most common relapse site in active surveillance patients either in late (88%) or early relapse (82%). Among the active surveillance group, no patients with late relapse subsequently developed a second relapse after either salvage radiotherapy (n=25) or chemotherapy (n=6), whereas in early relapse patients a second relapse was reported in seven (10%) of 72 patients treated with salvage radiotherapy and one (4%) of 23 patients who received chemotherapy; all second relapses were subsequently salvaged with chemotherapy. No patient in the adjuvant radiotherapy group developed a second relapse after salvage chemotherapy (n=10) or inguinal radiotherapy/surgery (n=4). Of seven deaths, only one was related to seminoma. Among active surveillance patients, the 10 year overall survival for late and early relapse groups were 100% and 96% (P = 0.2), whereas the 10 year cancer-specific survival rates were 100% and 99% (P = 0.3), respectively. In stage I seminoma, the extent and pattern of late relapse is similar to that for early relapse. For active surveillance patients, selective use of salvage

  2. Relationship of Clinical and Pathologic Nodal Staging in Locally Advanced Breast Cancer: Current Controversies in Daily Practice?

    Science.gov (United States)

    De Felice, Francesca; Musio, Daniela; Bulzonetti, Nadia; Raffetto, Nicola; Tombolini, Vincenzo

    2014-01-01

    Systemic neo-adjuvant therapy plays a primary role in the management of locally advanced breast cancer. Without having any negative effect in overall survival, induction chemotherapy potentially assures a surgery approach in unresectable disease or a conservative treatment in technically resectable disease and acts on a well-vascularized tumor bed, without the modifications induced by surgery. A specific issue has a central function in the neo-adjuvant setting: lymph nodes status. It still represents one of the strongest predictors of long-term prognosis in breast cancer. The discussion of regional radiation therapy should be a matter of debate, especially in a pathological complete response. Currently, the indication for radiotherapy is based on the clinical stage before the surgery, even for the irradiation of the loco-regional lymph nodes. Regardless of pathological down-staging, radiation therapy is accepted as standard adjuvant treatment in locally advanced breast cancer. PMID:25247013

  3. ENTEROVIRUS INFECTION IN CHILDREN: CLINICAL AND EPIDEMIOLOGICAL FEATURES AT THE CURRENT STAGE

    Directory of Open Access Journals (Sweden)

    G. P. Martynova

    2016-01-01

    Full Text Available The article presents the current clinical and epidemiological features of enterovirus infection in children of Krasnoyarsk Territory. A retrospective analysis of the incidence of enterovirus infection and enterovirus meningitis in the period 2014—2015 according to the forms of state statistical reporting №2 «Information on infectious and parasitic diseases». Clinical and epidemiological analysis of enterovirus infection in 454 children who were treated at MBUZ «City Children's Infectious Hospital №1» in the period of seasonal rise of morbidity in 2014 revealed a prevalence of etiological structure of enteroviruses Coxsackie B, Coxsackie B5, Coxsackie B3, Coxsackie B4. The region recorded the different clinical forms of enterovirus infection (rash, myalgia, diarrhea, gerpangina, the structure of which is still, aseptic meningitis prevails.

  4. The progenitors of supernovae Type Ia

    Science.gov (United States)

    Toonen, Silvia

    2014-09-01

    Despite the significance of Type Ia supernovae (SNeIa) in many fields in astrophysics, SNeIa lack a theoretical explanation. SNeIa are generally thought to be thermonuclear explosions of carbon/oxygen (CO) white dwarfs (WDs). The canonical scenarios involve white dwarfs reaching the Chandrasekhar mass, either by accretion from a non-degenerate companion (single-degenerate channel, SD) or by a merger of two CO WDs (double-degenerate channel, DD). The study of SNeIa progenitors is a very active field of research for binary population synthesis (BPS) studies. The strength of the BPS approach is to study the effect of uncertainties in binary evolution on the macroscopic properties of a binary population, in order to constrain binary evolutionary processes. I will discuss the expected SNeIa rate from the BPS approach and the uncertainties in their progenitor evolution, and compare with current observations. I will also discuss the results of the POPCORN project in which four BPS codes were compared to better understand the differences in the predicted SNeIa rate of the SD channel. The goal of this project is to investigate whether differences in the simulated populations are due to numerical effects or whether they can be explained by differences in the input physics. I will show which assumptions in BPS codes affect the results most and hence should be studied in more detail.

  5. Ultraviolet Diversity of Type Ia Supernovae

    CERN Document Server

    Foley, Ryan J; Brown, P; Filippenko, A V; Fox, O D; Hillebrandt, W; Kirshner, R P; Marion, G H; Milne, P A; Parrent, J T; Pignata, G; Stritzinger, M D

    2016-01-01

    Ultraviolet (UV) observations of Type Ia supernovae (SNe Ia) probe the outermost layers of the explosion, and UV spectra of SNe Ia are expected to be extremely sensitive to differences in progenitor composition and the details of the explosion. Here we present the first study of a sample of high signal-to-noise ratio SN Ia spectra that extend blueward of 2900 A. We focus on spectra taken within 5 days of maximum brightness. Our sample of ten SNe Ia spans the majority of the parameter space of SN Ia optical diversity. We find that SNe Ia have significantly more diversity in the UV than in the optical, with the spectral variance continuing to increase with decreasing wavelengths until at least 1800 A (the limit of our data). The majority of the UV variance correlates with optical light-curve shape, while there are no obvious and unique correlations between spectral shape and either ejecta velocity or host-galaxy morphology. Using light-curve shape as the primary variable, we create a UV spectral model for SNe I...

  6. Constraining cosmological parameter with SN Ia

    Science.gov (United States)

    Indra Putri, A. N.; Wulandari, H. R. Tri

    2016-11-01

    A type I supemovae (SN Ia) is an exploding white dwarf, whose mass exceeds Chandrasekar limit (1.44 solar mass). If a white dwarf is in a binary system, it may accrete matter from the companion, resulting in an excess mass that cannot be balanced by the pressure of degenerated electrons in the core. SNe Ia are highly luminous objects, that they are visible from very high distances. After some corrections (stretch (s), colour (c), K-corrections, etc.), the variations in the light curves of SNe Ia can be suppressed to be no more than 10%. Their high luminosity and almost uniform intrinsic brightness at the peak light, i.e. MB ∼ -19, make SNe Ia ideal standard candle. Because of their visibility from large distances, SNe Ia can be employed as a cosmological measuring tool. It was analysis of SNe Ia data that indicated for the first time, that the universe is not only expanding, but also accelerating. This work analyzed a compilation of SNe Ia data to determine several cosmological parameters (H0, Ωm, Ωa, and w). It can be concluded from the analysis, that our universe is a flat, dark energy dominated universe, and that the cosmological constant A is a suitable candidate for dark energy.

  7. Luminosity distributions of Type Ia Supernovae

    CERN Document Server

    Ashall, Chris; Sasdelli, Michele; Prentice, Simon

    2016-01-01

    We have assembled a dataset of 165 low redshift, $z<$0.06, publicly available type Ia supernovae (SNe Ia). We produce maximum light magnitude ($M_{B}$ and $M_{V}$) distributions of SNe Ia to explore the diversity of parameter space that they can fill. Before correction for host galaxy extinction we find that the mean $M_{B}$ and $M_{V}$ of SNe Ia are $-18.58\\pm0.07$mag and $-18.72\\pm0.05$mag respectively. Host galaxy extinction is corrected using a new method based on the SN spectrum. After correction, the mean values of $M_{B}$ and $M_{V}$ of SNe Ia are $-19.10\\pm0.06$ and $-19.10\\pm0.05$mag respectively. After correction for host galaxy extinction, `normal' SNeIa ($\\Delta m_{15}(B)<1.6$mag) fill a larger parameter space in the Width-Luminosity Relation (WLR) than previously suggested, and there is evidence for luminous SNe Ia with large $\\Delta m_{15}(B)$. We find a bimodal distribution in $\\Delta m_{15}(B)$, with a pronounced lack of transitional events at $\\Delta m_{15}(B)$=1.6 mag. We confirm that ...

  8. Primary early-stage intestinal and colonic non-Hodgkin's lymphoma: Clinical features, management, and outcome of 37 patients

    Institute of Scientific and Technical Information of China (English)

    Shu-Lian Wang; Ye-Xiong Li; Zhong-Xing Liao; Xin-Fan Liu; Zi-Hao Yu; Da-Zhong Gu; Tu-Nan Qian; Yong-Wen Song; Jing Jin; Wei-Hu Wang

    2005-01-01

    AIM: To analyze the clinical features, management, and outcome of treatment of patients with primary intestinal and colonic non-Hodgkin's lymphoma (PICL).METHODS: A retrospective study was performed in 37 patients with early-stage PICL who were treated in our hospital from 1958 to 1998. Their clinical features,management, and outcome were assessed. Prognostic factors for survival were analyzed by univariate analysis using the Kaplan-Meier product-limit method and log-rank test.RESULTS: Twenty-five patients presented with Ann Arbor stage I PICL and 12 with Ann Arbor stage Ⅱ PICL. Thirty-five patients underwent surgery (including 31 with complete resection), 22 received postoperative chemotherapy or radiotherapy or both. Two patients with rectal tumors underwent biopsy and chemotherapy with or without radiotherapy. The 5- and 10-year overall survival (OS) rates were 51.9% and 44.5%. The corresponding diseasefree survival (DFS) rates were 42.4% and 37.7%. In univariate analysis, multiple-modality treatment was associated with a better DFS rate compared to single treatment (P = 0.001).While age, tumor size, tumor site, stage, histology, or extent of surgery were not associated with OS and DFS,use of adjuvant chemotherapy significantly improved DFS (P = 0.031) for the 31 patients who underwent complete resection. Additional radiotherapy combined with chemotherapy led to a longer survival than chemotherapy alone in six patients with gross residual disease after surgery or biopsy.CONCLUSION: Combined surgery and chemotherapy is recommended for treatment of patients with PICL.Additional radiotherapy is needed to improve the outcome of patients who have gross residual disease after surgery.

  9. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Stemer Gunar

    2011-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD and end-stage renal disease (ESRD represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations. Methods A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems. Results Among a total of 21 studies, only four (19% were controlled trials. The majority of studies were descriptive (67% and before-after studies (14%. Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional

  10. Significance of supraclavicular lymph node involvement on determination of clinical staging for thoracic esophageal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Hong Gyun; Park, Charn II; Ha, Sung Whan; Kim, Il Han [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-06-01

    Involvement of supraclavicular lymph nodes (SCL) is considered distant metastasis for thoracic esophageal carcinoma in AJCC staging system revised in 1997. We investigated significance of SCL involvement compared to other regional lymph node involvement. Two- hundred eighty-nine patients with unresectable esophageal carcinoma were treated with radiation therapy from June of 1979 through December 1992. of these patients, 25 were identified having SCL involvement. Survival rate and relapse patterns were compared with that of mediastinal and perigastric lymph node positive patients to evaluate prognostic significance of SCL involvement. Median survival for patients with SCL involvement was 7 months and 2- and 5-year overall survival rates were 12.0% and 4.0% respectably. Corresponding features for regional node positive patients were 9 month, 17.0% and 3.8%. There was no significant difference between two groups. There was also no difference in patterns of recurrence. Results of this analysis showed that SCL involvement should be staged as nodal disease in contrast to present classification of metastatic disease.

  11. Lumbar extracavitary corpectomy with a single stage circumferential arthrodesis: surgical technique and clinical series.

    Science.gov (United States)

    Singh, Kern; Park, Daniel K

    2012-07-01

    Circumferential arthrodesis and reconstruction is necessary after a lumbar corpectomy in the setting of malignancy and infection. The advent of expandable cage technology now allows for safe anterior column reconstruction via a posterior approach with no transection and minimal retraction of the lumbar spinal nerve roots. Fifteen patients underwent a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach. Posterior segmental pedicle screw fixation and iliac crest bone graft was used in all cases. Fifteen lumbar extracavitary corpectomy nerve root-sparing procedures have been performed to date, with at least 1-year follow-up (12 tumors/3 infections). No patient suffered any neurological complications. One patient suffered from a postoperative myocardial infarction 10 days after the procedure. Two patients had medical complications that were treated without sequelae. We present a technical description and case series of patients undergoing a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach with at least 1-year follow-up. The technique is safe, technically feasible, and obviates an anterior approach in this oftentimes critically ill patient population.

  12. Validação de questionário para diagnóstico de cefaléia em ambulatório de hospital universitário Validation of a headache questionnaire in an outpatient clinic of an universitary hospital

    Directory of Open Access Journals (Sweden)

    Isabela J. M. Benseñor

    1997-09-01

    Full Text Available A cefaléia é sintoma de alta prevalência na população, sendo queixa freqüente na prática clínica. Cursa geralmente com exame físico geral e neurológico normais. A triagem de pacientes com cefaléia facilitaria o atendimento em centros médicos não especializados. No presente estudo utilizou-se um questionário baseado nos critérios da Sociedade Internacional de Cefaléias modificado pelos autores em 204 pacientes de ambulatório do Hospital das Clínicas da FMUSP. Metade destes pacientes foi submetida a consulta clínica. Os resultados do questionário foram então comparados com os resultados da consulta clínica (padrão-ouro. As cefaléias encontradas eram primárias (89,6% na sua maioria. O questionário demonstrou sensibilidade de 90,2% para detecção das enxaquecas e especificidade de 57,9%, com coeficiente de comparação (kappa de 0,47, e valor preditivo positivo (VPP de 65,7% e um valor preditivo negativo (VPN de 86,8 . A sensibilidade para detecção de cefaléia do tipotensional foi 60,8% e a especificidade foi 87,1% comkappa de 0,49, e VPP de 77,8% e VPN de 75,9. Concluímos que esse questionário pode ser utilizado como um método de triagem para o diagnóstico de cefaléias, podendo ser aplicado por pessoal não médico. Futuramente, ele poderá ser utilizado em estudos populacionais.Headache is a common complaint with a high prevalence in ambulatory settings. The physical and neurological examinations are frequently normal. The use of questionnaires as a screening method for patients with primary headache could facilitate the diagnosis in non specialized medical centers. In the present study, we used a questionnaire , based on the IHS criteria and modified by the authors, applied to 204 patients from the outpatient clinic of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Half of the patients were submitted to a clinical interview. We compared the results of the questionnaire with

  13. Infrared Light Curves of Type Ia Supernovae

    Science.gov (United States)

    Friedman, Andrew Samuel

    2012-05-01

    This thesis presents the CfAIR2 data set, which includes over 4000 near-Infrared (NIR) JHK8-band measurements of 104 Type Ia Supernovae (SN Ia) observed from 2005-2011 using PAIRITEL, the 1.3-m Peters Automated InfraRed Imaging TELescope at the Fred Lawrence Whipple Observatory (FLWO) on Mount Hopkins, Arizona. While the discovery of dark energy and most subsequent supernova cosmology has been performed using optical and Ultraviolet wavelength observations of SN Ia, a growing body of evidence suggests that NIR SN Ia observations will be crucial for future cosmological studies. Whereas SN Ia observed at optical wavelengths have been shown to be excellent standardizeable candles, using empirical correlations between luminosity, light curve shape, and color, the CfAIR2 data set strengthens the evidence that SN Ia at NIR wavelengths are essentially standard candles, even without correction for light-curve shape or for reddening. CfAIR2 was obtained as part of the CfA Supernova Program, an ongoing multi-wavelength follow-up effort at FLWO designed to observe high-quality, densely sampled light curves and spectra of hundreds of low-redshift SN Ia. CfAIR2 is the largest homogeneously observed and processed NIR data set of its kind to date, nearly tripling the number of individual JHK8-band observations and nearly doubling the set of SN Ia with published NIR light curves in the literature. Matched only by the recently published Carnegie Supernova Project sample, CfAIR2 complements the large and growing set of low-redshift optical and NIR SN Ia observations obtained by the CfA and other programs, making this data set a unique and particularly valuable local universe anchor for future supernova cosmology.

  14. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

  15. Management of Endometrial Cancer at Mayo Clinic: Intensive Surgical Staging and Disease-based Postoperative Treatment

    NARCIS (Netherlands)

    Mariani, A.

    2006-01-01

    Chapter 1 is a general introduction, while chapter 8 is the final discussion and conclusions. The remaining chapters (from 2 to 7) are composed by a brief introduction, followed by the published article(s) that form(s) the structure of the chapter. Management of Endometrial Cancer at Mayo Clinic: I

  16. Art Therapy for an Individual with Late Stage Dementia: A Clinical Case Description

    Science.gov (United States)

    Tucknott-Cohen, Tisah; Ehresman, Crystal

    2016-01-01

    This article describes the healing benefits of art therapy for an individual with dementia of the Alzheimer's type. In this clinical case description, a woman diagnosed with Alzheimer's disease received individual art therapy for 17 weeks. The treatment concerns that arose, altered view of reality, agitation, and retrogenesis provide insight on…

  17. Cytogenetic abnormalities and clinical stage in testicular nonseminomatous germ cell tumors

    NARCIS (Netherlands)

    de Graaff, W E; van Echten-Arends, J; Oosterhuis, J W; de Jong, B; te Meerman, G J; Wiersema-Buist, J; Sleijfer, D T; Schraffordt Koops, H

    1993-01-01

    To study the impact of chromosomal abnormalities on the clinical behavior of testicular nonseminomatous germ cell tumors (TNSGCTs), we compared the chromosomal constitution of primary tumors of patients who initially presented and remained without metastases to those with metastatic disease. Further

  18. Art Therapy for an Individual with Late Stage Dementia: A Clinical Case Description

    Science.gov (United States)

    Tucknott-Cohen, Tisah; Ehresman, Crystal

    2016-01-01

    This article describes the healing benefits of art therapy for an individual with dementia of the Alzheimer's type. In this clinical case description, a woman diagnosed with Alzheimer's disease received individual art therapy for 17 weeks. The treatment concerns that arose, altered view of reality, agitation, and retrogenesis provide insight on…

  19. Management of Endometrial Cancer at Mayo Clinic: Intensive Surgical Staging and Disease-based Postoperative Treatment

    NARCIS (Netherlands)

    Mariani, A.

    2006-01-01

    Chapter 1 is a general introduction, while chapter 8 is the final discussion and conclusions. The remaining chapters (from 2 to 7) are composed by a brief introduction, followed by the published article(s) that form(s) the structure of the chapter. Management of Endometrial Cancer at Mayo Clinic: I

  20. Leidos Biomed Supports Clinical Trials for Vaccine Against Mosquito-borne Chikungunya | FNLCR Staging

    Science.gov (United States)

    An experimental vaccine for mosquito-borne chikungunya is being tested at sites in the Caribbean as part of a phase II clinical trial being managed by the Frederick National Lab. No vaccine or treatment currently exists for the viral disease, which c

  1. 22nd IAS Meeting of Sedimentology

    Institute of Scientific and Technical Information of China (English)

    DavorPavelic; IgorVlahovic; JosipHalamic

    2004-01-01

    The 22nd IAS Meeting of Sedimentology was held in the Convention Centre of the Grand Hotel Adriatic, in a small touristic town Opatija, located on the eastern Adriatic coast where Central Europe and the Mediterranean meet. It was the second IAS Meeting held in Croatia--the first one, 4th IAS Regional Meeting of Sedimentology, was held in Split in 1983. The Meeting in Opatija was organized by the Institute of Geology (Zagreb) and the Croatian Geological Society. The sponsor was Ministry of Science and Technology of the Reoublic of Croatia.

  2. SNe Ia as a cosmological probe

    CERN Document Server

    Meng, Xiangcun; Han, Zhanwen

    2015-01-01

    Type Ia supernovae luminosities can be corrected to render them useful as standard candles able to probe the expansion history of the universe. This technique was successful applied to discover the present acceleration of the universe. As the number of SNe Ia observed at high redshift increases and analysis techniques are perfected, people aim to use this technique to probe the equation of state of the dark energy. Nevertheless, the nature of SNe Ia progenitors remains controversial and concerns persist about possible evolution effects that may be larger and harder to characterize than the more obvious statistical uncertainties.

  3. Multiple stage MS in analysis of plasma, serum, urine and in vitro samples relevant to clinical and forensic toxicology.

    Science.gov (United States)

    Meyer, Golo M; Maurer, Hans H; Meyer, Markus R

    2016-01-01

    This paper reviews MS approaches applied to metabolism studies, structure elucidation and qualitative or quantitative screening of drugs (of abuse) and/or their metabolites. Applications in clinical and forensic toxicology were included using blood plasma or serum, urine, in vitro samples, liquids, solids or plant material. Techniques covered are liquid chromatography coupled to low-resolution and high-resolution multiple stage mass analyzers. Only PubMed listed studies published in English between January 2008 and January 2015 were considered. Approaches are discussed focusing on sample preparation and mass spectral settings. Comments on advantages and limitations of these techniques complete the review.

  4. Association between in vivo iododeoxyuridine labeling, MIB-1 expression, malignancy grade and clinical stage in human prostate cancer

    DEFF Research Database (Denmark)

    Borre, M; Høyer, M; Sørensen, Flemming Brandt

    1998-01-01

    labeled in vivo with IdUrd (a thymidine analogue incorporated into DNA in S-phase cells) by intravenous infusion before transurethral resection. IdUrd-labeled cells and MIB-1-positive cells were detected by immunohistochemistry. We found statistically significant associations between the tumor cell...... proliferation rates measured by in vivo IdUrd labeling and MIB-1 expression in formalin-fixed paraffin-embedded tumors. Good correlations were also found between S-phase fraction, MIB-1 expression, clinical stage and malignancy grade. These results make larger retrospective studies on archival tissue meaningful....

  5. In search of proof-of-concept: gene therapy for glycogen storage disease type Ia.

    Science.gov (United States)

    Koeberl, Dwight D

    2012-07-01

    The emergence of life threatening long-term complications in glycogen storage disease type Ia (GSD-Ia) has emphasized the need for new therapies, such as gene therapy, which could achieve biochemical correction of glucose-6-phosphatase deficiency and reverse clinical involvement. We have developed gene therapy with a novel adeno-associated virus (AAV) vector that: 1) prevented mortality and corrected glycogen storage in the liver, 2) corrected hypoglycemia during fasting, and 3) achieved efficacy with a low number of vector particles in G6Pase-deficient mice and dogs. However, the gradual loss of transgene expression from episomal AAV vector genomes eventually necessitated the administration of a different pseudotype of the AAV vector to sustain dogs with GSD-Ia. Further preclinical development of AAV vector-mediated gene therapy is therefore warranted in GSD-Ia.

  6. Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial.

    Science.gov (United States)

    Kahn, Elyne; D'Haese, Pierre-Francois; Dawant, Benoit; Allen, Laura; Kao, Chris; Charles, P David; Konrad, Peter

    2012-02-01

    Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior -1.1±1.7 mm, lateral 10.7±1.7 mm and superior -3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.

  7. Clinical applications of the Model for End-Stage Liver Disease (MELD in hepatic medicine

    Directory of Open Access Journals (Sweden)

    Lau T

    2013-02-01

    Full Text Available Tsang Lau, Jawad AhmadDivision of Liver Diseases, Mount Sinai School of Medicine, New York, USAAbstract: The Model for End-Stage Liver Disease (MELD score incorporates serum bilirubin, creatinine, and the international normalized ratio (INR into a formula that provides a continuous variable that is a very accurate predictor of 90-day mortality in patients with cirrhosis. It is currently utilized in the United States to prioritize deceased donor organ allocation for patients listed for liver transplantation. The MELD score is superior to other prognostic models in patients with end-stage liver disease, such as the Child–Turcotte–Pugh score, since it uses only objective criteria, and its implementation in 2002 led to a sharp reduction in the number of people waiting for liver transplant and reduced mortality on the waiting list without affecting posttransplant survival. Although mainly adopted for use in patients waiting for liver transplant, the MELD score has also proved to be an effective predictor of outcome in other situations, such as patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis. Several variations of the original MELD score, involving the addition of serum sodium or looking at the change in MELD over time, have been examined, and these may slightly improve its accuracy. The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation. The application of the MELD score in prioritizing patients for liver transplantation has been successful, but further studies and legislation are required to ensure a fair and equitable system.Keywords: MELD score, liver transplantation

  8. [RNASEL study of genetics of prostate cancer and its relation to clinical staging].

    Science.gov (United States)

    Alvarez-Cubero, M J; Saiz, M; Martínez-González, L J; Alvarez, J C; Lorente, J A; Cozar, J M

    2012-05-01

    This study has aimed to find a possible genetic relationship between sporadic prostate cancers. An attempt is made to establish population subgroups in patients based on the genotype found and the aggressiveness of the cancer. A total of 231 patients with sporadic prostate cancer and 68 controls were selected. The subjects were selected by an urologist using clinical parameters such as PSA level and Gleason score. Both groups (patients and controls) were genotyped in RNASEL gene by sequencing the exons 1 and 3. Statistically significant differences were found between controls and patients in some of the genotyped regions of the RNASEL gene (I97L, D541E and R462Q). Thanks to the genetic profile in some regions of the genoma, such as the RNASEL gene, together with the combination of the clinical and environmental parameters, we can suggest a care and more personalized follow-up of each patient. Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.

  9. [Classification and staging systems for hilar cholangio-carcinoma (Klatskin tumors): clinical application and practical relevance].

    Science.gov (United States)

    Gavrilovici, V; Grecu, F; Seripcariu, V; Dragomir, Cr

    2011-01-01

    Hilar cholangiocarcinomas or Klatskin tumors have been classified in 1975 by French surgeons Henri Bismuth and Marvin B. Corlette and this remains largely used in clinical practice. The authors present the TNM classification and the changes introduced by the sixth and seventh edition of Union for International Cancer Control regarding the tumors of the proximal bile duct and describe Blumgart classification for tumors of this site. The usefulness of these systems is assessed considering the last six years experience of the service.

  10. Superficial and deep lymph node dissection for stage III cutaneous melanoma: clinical outcome and prognostic factors

    Directory of Open Access Journals (Sweden)

    Mozzillo Nicola

    2013-02-01

    Full Text Available Abstract Background The aims of this retrospective analysis were to evaluate the effect of combined superficial and deep groin dissection on disease-free and melanoma-specific survival, and to identify the most important factors for predicting the involvement of deep nodes according to clinically or microscopically detected nodal metastases. Methods Between January 1996 and December 2005, 133 consecutive patients with groin lymph node metastases underwent superficial and deep dissection at the National Cancer Institute, Naples. Lymph node involvement was clinically evident in 84 patients and detected by sentinel node biopsy in 49 cases. Results The 5-year disease-free survival was significantly better for patients with superficial lymph node metastases than for patients with involvement of both superficial and deep lymph nodes (34.9% vs. 19.0%; P = 0.001. The 5-year melanoma-specific survival was also significantly better for patients with superficial node metastases only (55.6% vs. 33.3%; P = 0.001. Conclusions Metastasis in the deep nodes is the strongest predictor of both disease-free and melanoma-specific survival. Deep groin dissection should be considered for all patients with groin clinical nodal involvement, but might be spared in patients with a positive sentinel node. Prospective studies will clarify the issue further.

  11. Clinical and economic outcomes in Medicare beneficiaries with stage 3 or stage 4 chronic kidney disease and anemia: the role of intravenous iron therapy.

    Science.gov (United States)

    Knight, Tyler G; Ryan, Kellie; Schaefer, Caroline P; D'Sylva, Lynell; Durden, Emily D

    2010-10-01

    Anemia in patients with chronic kidney disease (CKD) is associated with increased morbidity and mortality, decreased quality of life, and substantial health care costs. Iron therapy is recommended, usually in combination with an erythropoiesis-stimulating agent (ESA), in many CKD patients with anemia and low iron levels to raise hemoglobin levels to a range of 10 to 12 grams per deciliter; iron deficiency is defined by a ferritin score less than 100 micrograms (mcg) per liter and transferrin saturation (TSAT) less than 20%. To examine the use of intravenous (IV) iron and its associated economic and clinical outcomes in Medicare beneficiaries with stage 3 or stage 4 CKD and anemia. This was a retrospective cohort analysis using 2006 and 2007 Medicare 5% Standard Analytic Files (SAF). Use of therapy with IV iron and/or ESAs was identified among patients diagnosed with CKD and anemia. The study index quarter was the first quarter in 2006 during which the patient had primary or secondary diagnoses of both CKD and anemia. Based on the receipt of IV iron or ESA treatment in the index quarter, patients were classified into 1 of 4 treatment groups: IV iron and ESA; IV iron without ESA; ESA without IV iron; neither IV iron nor ESA. Therapy with oral iron was not measurable with this database. Clinical and economic outcomes, including the progression to advanced CKD stages, development of anemia, mortality, hospitalization, and net Medicare reimbursement (i.e., not including patient or supplemental plan contribution) for all-cause health care services, were examined for 1 year following the index quarter. Between-group differences were tested using Pearson chi-square for categorical variables and the Kruskal-Wallis nonparametric test for reimbursement. Multivariate logistic regression models were estimated to assess the associations of mortality, inpatient hospitalization, skilled nursing facility (SNF) admission, and hospice care with treatment regimen, controlling for

  12. Microbial landscape features in patients with generalized periodontitis at pre-clinical and radiological stage of its development

    Directory of Open Access Journals (Sweden)

    Vatamanyuk N.V.

    2014-11-01

    Full Text Available The paper presents the results of a comparative study of microbial landscape features in patients with generalized periodontitis at pre-clinical and radiological stage of its development in 42 patients. The purpose of the study is a comparative study of the composition of microbiocenosis of periodontal tissues in patients with chronic catarrhal gingivitis (CCG and chronic generalized periodontitis (CGP at an early stage of development and development studies of microbiological criteria for early emergence of the destructive process in periodontal structures. We found that the microflora isolated from dento-gingival grooves is of importance in diagnostics to identify the etiology of chronic generalized catarrhal gingivitis (CGCG and chronic generalized periodontitis in the early stages of its development. It was established that the presence of two or more types of fixed parodonto-pathogenic microorganisms in microbial association increases the likelihood of inflammatory and destructive events in periodontal tissues in patients with GCCG and is one of the reasons of is becoming CGP.

  13. The Relationship between Apoptosis and the Expression of Proliferating Cell Nuclear Antigen and the Clinical Stages in Gastric Carcinoma

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The relationship between the apoptosis and the expression of proliferating cell nuclear antigen (PCNA) and the clinical stages in gastric cancers was studied. By using terminal deoxynucleotidyl transferase-mediated nick end labelling (TUNEL) technique and PCNA immunohistochemical staining, the apoptosis and the expression of PCNA in tissue of gastric carcinoma were assayed in situ, the index of apoptosis (AI), index of PCNA (PI) and the rate of AI/PI were calculated. AI and PI in gastric cancer tissues were (6.5±3.7) % and (49.8±15.9) % respectively, and the rate of AI/PI was 0.13±0.05, which were obviously different from those of normal gastric mucosa in paragastric cancer (P<0.01). With the advanced TNM stages of gastric carcinoma, the AI was decreased, PI was increased and the rate of AI/PI decreased in gastric carcinoma. There was significant difference in them between the gastric cancer tissues and normal gastric mucosa in pericarcinoma in TNM stage Ⅱ to Ⅳ (P<0.05). It was suggested that the decreased apoptotic cells and the increased proliferating cells were obviously related to the tumor genesis and tumor progression in gastric carcinoma. The AI, PI and the rate of AI/PI would become the prognostic factors in advanced gastric carcinoma.

  14. On Simon's two-stage design for single-arm phase IIA cancer clinical trials under beta-binomial distribution.

    Science.gov (United States)

    Liu, Junfeng; Lin, Yong; Shih, Weichung Joe

    2010-05-10

    Simon (Control. Clin. Trials 1989; 10:1-10)'s two-stage design has been broadly applied to single-arm phase IIA cancer clinical trials in order to minimize either the expected or the maximum sample size under the null hypothesis of drug inefficacy, i.e. when the pre-specified amount of improvement in response rate (RR) is not expected to be observed. This paper studies a realistic scenario where the standard and experimental treatment RRs follow two continuous distributions (e.g. beta distribution) rather than two single values. The binomial probabilities in Simon's (Control. Clin. Trials 1989; 10:1-10) design are replaced by prior predictive Beta-binomial probabilities that are the ratios of two beta functions and domain-restricted RRs involve incomplete beta functions to induce the null hypothesis acceptance probability. We illustrate that Beta-binomial mixture model based two-stage design retains certain desirable properties for hypothesis testing purpose. However, numerical results show that such designs may not exist under certain hypothesis and error rate (type I and II) setups within maximal sample size approximately 130. Furthermore, we give theoretical conditions for asymptotic two-stage design non-existence (sample size goes to infinity) in order to improve the efficiency of design search and to avoid needless searching.

  15. Bioengineered human IAS reconstructs with functional and molecular properties similar to intact IAS

    OpenAIRE

    Singh, Jagmohan; Rattan, Satish

    2012-01-01

    Because of its critical importance in rectoanal incontinence, we determined the feasibility to reconstruct internal anal sphincter (IAS) from human IAS smooth muscle cells (SMCs) with functional and molecular attributes similar to the intact sphincter. The reconstructs were developed using SMCs from the circular smooth muscle layer of the human IAS, grown in smooth muscle differentiation media under sterile conditions in Sylgard-coated tissue culture plates with central Sylgard posts. The bas...

  16. A review of type Ia supernova spectra

    CERN Document Server

    Parrent, J; Parthasarathy, M

    2014-01-01

    SN 2011fe was the nearest and best-observed type Ia supernova in a generation, and brought previous incomplete datasets into sharp contrast with the detailed new data. In retrospect, documenting spectroscopic behaviors of type Ia supernovae has been more often limited by sparse and incomplete temporal sampling than by consequences of signal-to-noise ratios, telluric features, or small sample sizes. As a result, type Ia supernovae have been primarily studied insofar as parameters discretized by relative epochs and incomplete temporal snapshots near maximum light. Here we discuss a necessary next step toward consistently modeling and directly measuring spectroscopic observables of type Ia supernova spectra. In addition, we analyze current spectroscopic data in the parameter space defined by empirical metrics, which will be relevant even after progenitors are observed and detailed models are refined.

  17. Improvements to type Ia supernova models

    Science.gov (United States)

    Saunders, Clare M.

    Type Ia Supernovae provided the first strong evidence of dark energy and are still an important tool for measuring the accelerated expansion of the universe. However, future improvements will be limited by systematic uncertainties in our use of Type Ia supernovae as standard candles. Using Type Ia supernovae for cosmology relies on our ability to standardize their absolute magnitudes, but this relies on imperfect models of supernova spectra time series. This thesis is focused on using data from the Nearby Supernova Factory both to understand current sources of uncertainty in standardizing Type Ia supernovae and to develop techniques that can be used to limit uncertainty in future analyses. (Abstract shortened by ProQuest.).

  18. Lymphadenectomy in locally advanced cervical cancer study (LiLACS): Phase III clinical trial comparing surgical with radiologic staging in patients with stages IB2-IVA cervical cancer.

    Science.gov (United States)

    Frumovitz, Michael; Querleu, Denis; Gil-Moreno, Antonio; Morice, Philippe; Jhingran, Anuja; Munsell, Mark F; Macapinlac, Homer A; Leblanc, Eric; Martinez, Alejandra; Ramirez, Pedro T

    2014-01-01

    Radiation treatment planning for women with locally advanced cervical cancer (stages IB2-IVA) is often based on positron emission tomography (PET). PET, however, has poor sensitivity in detecting metastases in aortocaval nodes. We have initiated a study with the objective of determining whether pre-therapeutic laparoscopic surgical staging followed by tailored chemoradiation improves survival as compared with PET/computed tomography (CT) radiologic staging alone followed by chemoradiation. This international, multicenter phase III trial will enroll 600 women with stages IB2-IVA cervical cancer and PET/CT findings showing fluorodeoxyglucose-avid pelvic nodes and fluorodeoxyglucose-negative para-aortic nodes. Eligible patients will be randomized to undergo either pelvic radiotherapy with chemotherapy (standard-of-care arm) or surgical staging via a minimally invasive extraperitoneal approach followed by tailored radiotherapy with chemotherapy (experimental arm). The primary end point is overall survival. Secondary end points are disease-free survival, short- and long-term morbidity with pre-therapeutic surgical staging, and determination of anatomic locations of metastatic para-aortic nodes in relationship to the inferior mesenteric artery. We believe this study will show that tailored chemoradiation after pre-therapeutic surgical staging improves survival as compared with chemoradiation based on PET/CT in women with stages IB2-IVA cervical cancer.

  19. Clinical and radiologic evaluation of 2-stage IMZ implants placed in a single-stage procedure : 2-year results of a prospective comparative study

    NARCIS (Netherlands)

    Heydenrijk, K; Raghoebar, GM; Meijer, HJA; Stegenga, B

    2003-01-01

    Purpose: The aim of this study was to evaluate the feasibility of using a 2-stage implant system in a single-stage procedure and to study the impact of the microgap between the implant and the abutment. Materials and Methods: Sixty edentulous patients (Cawood class V or VI) participated in this stud

  20. Norovirus infection: features of epidemiology and clinical and laboratory manifestations at the present stage

    Directory of Open Access Journals (Sweden)

    N.V. Pronko

    2017-04-01

    Full Text Available Background. Among most significant for practical medicine infections, acute intestinal infections of viral etiology are becoming increasingly topical [2, 4]. According to domestic and foreign literature, up to 70 % of gastroenteritis occur during cold seasons of the year and are induced by viruses [3, 5]. The range of the factors producing viral diarrheas is rather wide. One of the comparatively new acute intestinal infections (AII producing factors is noroviruses [5, 6]. The prevalence of noroviruses has been little studied, and the clinical picture has been characterized insufficiently. This can be explained by insufficient diagnostics and registration of this infection [3, 6, 7]. Aim of the work: analysis of the morbidity and determination of clinical laboratory features of noroviral infection (NVI in children according to the data of the Regional Clinical Infectious Di­seases Hospital in Grodno. Materials and methods. A comprehensive clinical laboratory analysis of 1,105 case histories of children aged 1 month to 14 years with verified viral intestinal infection, who were admitted to Grodno Regional Clinical Infectious Diseases Hospital from January 2013 to December 2016, was carried out. The patients were divided according to the final clinical diagnosis in the following way: rotaviral infection (RVI was found in 676 (61.2 % individuals, adenoviral intestinal infection (AVI — in 212 (19.2 %, NVI was detected in 156 (14.1 % and enteroviral infection — in 61 (5.5 % persons. The examination was carried out according to the protocols approved by the Ministry of Health of the Republic of Belarus. Results. As our study showed, at the period analyzed the viral intestinal diseases amounted to 70.4 % of all the cases of diseases in the structure of AII in children. Patients hospitalized with viral diarrhea showed prevalence of RVI (61.2 %. NVI was the third by the incidence among viral diarrheas, and it was registered in 14.1 % of the cases

  1. Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan clinical trial.

    Science.gov (United States)

    Chu, K C; Smart, C R; Tarone, R E

    1988-09-21

    The Health Insurance Plan (HIP) of Greater New York conducted a clinical trial to determine if screening for breast cancer with mammography and clinical examination would decrease breast cancer mortality. The extent of disease at diagnosis among breast cancers detected by screening and the effect of screening on breast cancer mortality have been evaluated in the cohort of all HIP women diagnosed with breast cancer within 6 years of entry into the trial and followed at least 18 years after trial entry. Six years was the earliest time at which the number of cases diagnosed in the control group was equal to the number of cases diagnosed in the study group. In the cohorts of women 40-49 and 50-64 years of age at entry, shifts were significant to lower stages for screen-detected cases. As a result, the study group women in each age cohort had significantly lower breast cancer mortality than control group women when statistical analyses were restricted to data from cases only. In the 40-49 age-at-entry cohort, the reduced breast cancer mortality in the study group appears to result from lower mortality in stage I cases as well as from earlier case detection, and this may explain differences between the two age-at-entry cohorts in the length of follow-up time required to demonstrate a mortality reduction due to screening.

  2. T4/T8 ratio and absolute T4 cell numbers in different clinical stages of Kaposi's sarcoma in AIDS.

    Science.gov (United States)

    Spornraft, P; Fröschl, M; Ring, J; Meurer, M; Goebel, F D; Ziegler-Heitbrock, H W; Riethmüller, G; Braun-Falco, O

    1988-07-01

    Thirty-seven men (36 homosexual or bisexual and one heterosexual) with epidemic Kaposi's sarcoma and underlying HIV infection were followed up over a period of up to 32 months. Fourteen patients (38%) died, with a median survival time of 7.2 months after the diagnosis of AIDS. Seventeen patients (46%) presented with one or more opportunistic infections, mostly Pneumocystis carinii pneumonia. Eighteen patients (49%) had lymphadenopathy syndrome according to the definition of the CDC. Using the Laubenstein-classification of Kaposi's sarcoma, all patients either remained stable or deteriorated, improvement was never observed. Absolute T4 lymphocyte counts and the T4/T8 ratio were not related to the disease stage. With the onset of B symptoms (systemic symptoms), however, the absolute T4 numbers and the T4/T8 ratio markedly decreased. Delayed type hypersensitivity also showed no relationship to the clinical stages of Kaposi's sarcoma. Thus, the clinical progression of Kaposi's sarcoma lesions seems to be largely independent of the immunological parameters investigated. However, the onset of B symptoms was observed to be related to changes in immune status.

  3. Expression and its clinical significance of HLA-G in HCMV-infected placental villi at early pregnant stage

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xin-wen; LI Fen; SHENG Qiu; YU Xue-wen; REN Yong-hui; LI Xue-cheng

    2007-01-01

    Objective: To study the expression and its clinical significance of HLA-G in HCMV intrauterine infected placental villi at early pregnant stage. Methods: PCR (polymerase chain reaction) was used to screen the peripheral blood for HCMV-DNA in 462 women who had willingly undergone induced abortion.Then immunohistochemistry was also used to detect expressions of mouse anti-HCMV early antigen (HCMV-EA) and mouse anti-HLA-G in HCMV-DNA positive cases' placental villi. The difference of HLA-G expressions between the intrauterine infection group(HCMV EA positives), the intrauterine infection-free group (HCMV-EA negatives) and the normal control group (50 cases of healthy early placental villi) was compared. Results: Of the 78 cases,which were detected HCMV DNA positive, 11 (14.10%)were HCMV-EA positive. Compared with the other two groups, HLA-G expressions in the intrauterine infection group were both obviously decreased(both P<0.001). HLA-G expression positions in all three groups were mainly located in the cytotrophoblast. Conclusion: Intrauterine HCMV infection at early pregnant stage is closely related to HLA-G expression at the maternal-fetal interface. The virogenetic products may affect the expression of HLA-G at the maternal-fetal interface and that of its immunological function,thus leading to different clinical outcomes.

  4. Close binary white dwarfs and supernovae IA

    Directory of Open Access Journals (Sweden)

    R. Napiwotzki

    2004-01-01

    Full Text Available Informamos sobre el estado actual de los \\surveys" de velocidades radiales para binarias de enanas blancas (degeneradas dobles - DDs incluyendo SPY (Exploraci on ESO de progenitoras de supernovas Ia que recien- temente se llevaron a cabo en el VLT. Una amplia muestra de DDs nos permitir a poner fuertes restricciones sobre las fases evolutivas de los sistemas progenitores de binarias cercanas y tambi en llevar a cabo pruebas observacionales del escenario DD para supernovas de tipo Ia.

  5. The Impact on Clinical Practice of Endoscopic Ultrasonography Used for the Diagnosis and Staging of Pancreatic Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Queneau PE

    2001-05-01

    Full Text Available CONTEXT: Endoscopic ultrasonography is considered a highly accurate procedure for diagnosing small pancreatic tumors and assessing their locoregional extension. OBJECTIVE: To evaluate the impact of endoscopic ultrasonography on the management of pancreatic adenocarcinoma in clinical practice. PATIENTS: Sixty-four consecutive patients (mean age 70.5 plus/minus 11.9 years hospitalized for staging or diagnosis of pancreatic adenocarcinoma were retrospectively (from January 1995 to November 1997 or prospectively studied (from December 1997 to August 1999. SETTING: Group 1 consisted of 52 patients with pancreatic adenocarcinoma which was discovered using computerized tomography scanning and/or ultrasound. Endoscopic ultrasonography was utilized for staging purposes only in patients who were considered to be operable and the tumor to be resectable based on computerized tomography scanning criteria. Group 2 consisted of 12 patients who were diagnosed as having a pancreatic adenocarcinoma using endoscopic ultrasonography whereas computerized tomography scanning and ultrasound was negative. MAIN OUTCOME MEASURES: The impact of endoscopic ultrasonography was analyzed on the basis of the number of patients requiring endoscopic ultrasonography as a staging procedure (Group 1 and by evaluating the performance of endoscopic ultrasonography in determining resectability (Groups 1 and 2 based on the surgical and anatomopathological results. RESULTS: Endoscopic ultrasonography was performed in 20 out of 64 patients (31.3%: 8/52 in Group 1 (15.4% and all 12 patients of Group 2. Endoscopic ultrasonography correctly assessed an absolute contraindication to resection in 11 cases. Resection was confirmed in 8 of the 9 cases selected by endoscopic ultrasonography. The positive predictive value, negative predictive value and overall accuracy of endoscopic ultrasonography for determining resection were 89%, 100%, and 95%, respectively. CONCLUSIONS: The impact of

  6. Type Ia Supernovae: Colors, Rates, and Progenitors

    CERN Document Server

    Heringer, Epson; Kezwer, Jason; Graham, Melissa L; Sand, David; Bildfell, Chris

    2016-01-01

    The rate of type Ia supernovae (SNe Ia) in a galaxy depends not only on stellar mass, but also on star formation history. Here we show that two simple observational quantities ($g-r$ or $u-r$ host galaxy color, and $r$-band luminosity), coupled with an assumed delay time distribution (the rate of SNe Ia as a function of time for an instantaneous burst of star formation), are sufficient to accurately determine a galaxy's SN Ia rate, with very little sensitivity to the precise details of the star formation history. Using this result, we compare observed and predicted color distributions of SN Ia hosts for the MENeaCS cluster supernova survey, and for the SDSS Stripe 82 supernova survey. The observations are consistent with a continuous delay time distribution (DTD), without any cutoff. For old progenitor systems the power-law slope for the DTD is found to be $-1.50 ^{+0.19} _{-0.15}$. This result favours the double degenerate scenario for SN Ia, though other interpretations are possible. We find that the late-t...

  7. Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit.

    Science.gov (United States)

    Videhult, P; Smedh, K; Lundin, P; Kraaz, W

    2007-06-01

    The aims were to determine agreement between staging of rectal cancer made by magnetic resonance imaging (MRI) and histopathological examination and the influence of MRI on choice of radiotherapy (RT) and surgical procedure. In this retrospective audit, preoperative MRI was performed on 91 patients who underwent bowel resection, with 93% having total mesorectal excision. Tumour stage according to mural penetration, nodal status and circumferential resection margin (mCRM) involvement was assessed and compared with histopathology. Five radiologists interpreted the images. Overall agreement between MRI and histopathology for T stage was 66%. The greatest difficulty was in distinguishing between T1, T2 and minimal T3 tumours. The accuracy for mCRM (MRI) was 86% (78/91),with an interobserver variation between 80% and 100%. In the 13 cases with no agreement between mCRM and pCRM (pathological), seven had long-term RT and nine en bloc resections, indicating that the margins initially were involved with an even higher accuracy for mCRM. Preoperative short-term RT was routine, but based on MRI findings, choice of RT was affected in 29 cases (32%); 17 patients had no RT and 12 long-term RT. The surgical procedure was affected in 17 cases (19%) with planned perirectal en bloc resections in all. CRM was involved (CRM with high accuracy in rectal cancer. MRI could be used as a clinical guidance with high reliability as indicated by the low figures of histopathologically involved CRM.

  8. Diarréia em bezerros da raça Nelore criados extensivamente: estudo clínico e etiológico Diarrhea in Nelore calves: Clinical and etiologic study

    Directory of Open Access Journals (Sweden)

    José P. Oliveira Filho

    2007-10-01

    Full Text Available A diarréia é considerada uma das principais causas de morbidade e mortalidade de bezerros neonatos. Foram colhidas 100 amostras fecais diarréicas e 30 amostras não diarréicas (grupo controle, de bezerros Nelore com até nove semanas de idade com o objetivo de detectar os enteropatógenos Salmonella spp., Escherichia coli, rotavírus, coronavírus, Cryptosporidium spp. e ovos de helmintos. Enteropatógenos foram detectados em 79,0% das amostras diarréicas e em 70,0% das amostras não-diarréicas. No grupo de bezerros com diarréia, E. coli (69,0% foi o agente mais freqüentemente isolado, seguido de Cryptosporidium spp. (30,0%, coronavírus (16,0% e rotavírus (11,0%. No grupo controle, E. coli, Cryptosporidium spp. e coronavírus foram detectados, respectivamente, em 66,7%, 10,0% e 3,3% das amostras. Salmonella spp. e ovos de estrongilídeos não foram encontrados nos dois grupos avaliados. A fímbria K99 foi identificada exclusivamente nas linhagens de E. coli isoladas de bezerros com diarréia (5,8%. Entre os antimicrobianos avaliados "in vitro" a enrofloxacina, a norfloxacina e a gentamicina foram os mais efetivos. O peso dos bezerros aos 210 dias de idade não apresentou diferença significativa entre os animais com e sem diarréia.Diarrhea is considered as one of the main causes of morbidity and mortality in neonates calves. Fecal samples from 100 diarrheic and 30 non-diarrheic (control group Nelore calves less than 9 weeks old were collected for Salmonella spp., Escherichia coli, rotavirus, coronavirus, Cryptosporidium spp., and for helminth eggs investigation. Enteropathogens were detected in 79.0% diarrheic samples and 70.0% non-diarrheic samples. Among diarrheic calves, Escherichia coli (69.0% was the most common agent found, following by Cryptosporidium spp. (30.0%, coronavirus (16.0%, and rotavirus (11.0%. In the control group, E. coli, Cryptosporidium spp. and coronavirus were detected in 66.7%, 10.0% and 3.3% of the samples

  9. Line scan diffusion tensor MRI at low magnetic field strength: Feasibility study of cervical spondylotic myelopathy in an early clinical stage

    National Research Council Canada - National Science Library

    Hori, Masaaki; Okubo, Toshiyuki; Aoki, Shigeki; Kumagai, Hiroshi; Araki, Tsutomu

    2006-01-01

    To implement line scan diffusion tensor MR imaging (LSDTI) on a 0.2 Tesla MR imager, and investigate the findings in the spinal cord of patients with cervical spondylotic myelopathy in an early clinical stage...

  10. Assessment of quality of life for the patients with cervical cancer at different clinical stages

    Institute of Scientific and Technical Information of China (English)

    Yao Xie; Fang-Hui Zhao; Si-Han Lu; He Huang; Xiong-Fei Pan; Chun-Xia Yang; You-Lin Qiao

    2013-01-01

    With improved overall survival of cervical cancer patients,the importance of the quality of life (QOL)is increasingly recognized.This study was conducted to compare the QOL of women with different stage cervical cancer before and after treatment to facilitate improved cervical cancer prevention and treatment.We used the generic Medical Outcomes Study Short Form-36 (MOS SF-36) to collect QOL information.Based on SF-36,we interviewed cervical cancer patients at West China Second Affiliated Hospital and Sichuan Cancer Hospital between May 2010 and January 2011.A total of 92 patients with precancerous lesions,93 with early cancer,and 35 with advanced cancer responded to our survey.Average physical component summary (PCS) scores were significantly different between the three groups at every time point (P < 0.05).Average mental component summary (MCS) scores were significantly different between the three groups after treatment (P < 0.05).Average PCS and MCS scores increased gradually from the pretreatment to posttreatment period for patients with precancerous lesions.However,they reached the lowest at 1 month after treatment for patients with early and advanced cancers and rebounded between 1and 6 months after treatment.Our results indicate that patients with precancerous lesions and early cervical cancer show better overall QOL than do those with advanced cervical cancer.Additionally,patients with early cancer recover more quickly than do those with advanced cancer in terms of both physical and mental functions.Thus,early detection and treatment initiatives may improve the QOL for patients with precancerous lesions and cervical cancer.

  11. Private portraits or suffering on stage: curating clinical photographic collections in the museum context

    Directory of Open Access Journals (Sweden)

    Dr Mieneke te Hennepe

    2016-03-01

    Full Text Available Medical photography collections often remind us of the inescapable reality of human suffering and pain, and at the same time they oblige us to deal with questions of ownership and privacy. Medical photography collections are thus considered ‘sensitive’ collections within the museum context. This essay investigates privacy issues involved in the curating of historical photographic collections in museum spaces. When medical photography entered into non-medical domains privacy issues emerged. It is these privacy issues that cast a shadow of sensitivity on the medical material. But the relationship between clinical photograph collections and museums is not as straightforward as it may seem. Personal pictures involve power and privacy, and both aspects play a role in the public display of historical medical photographs, often in unexpected ways.

  12. ACCESS TO HEALTH CARE IN THE OUTPATIENT CLINICS OF ST. PETERSBURG AT THE PRESENT STAGE

    Directory of Open Access Journals (Sweden)

    M. G. Karaylanov

    2016-01-01

    Full Text Available The brief analysis of the organization of primary health care on an outpatient basis in the case ofSt. Petersburgis reflected. The structure of primary health care is described, namely healthcare organizations that provide outpatient care; the standards and the level of availability of primary health care, as well as the capacity of outpatient clinics are defined. An important criterion for the quality of care is its accessibility, taking into account the number of attached population. Reforming the ambulatory network in a large city is one of the most difficult health management problems, due to many factors, first of all determined by the needs of the population in primary health care, a variety of organizational forms of outpatient care, intensive changing residential area of the city, the need to ensure effective interactions with other social institutions.

  13. Imaging as component of clinical tumor staging; Bildgebung als Teil des klinischen Tumorstagings

    Energy Technology Data Exchange (ETDEWEB)

    Brodowicz, T. [Klinische Abt. fuer Onkologie, Universitaetskliniken Wien (Austria); Zielinski, C.C. [Klinische Abt. fuer Onkologie, Universitaetskliniken Wien (Austria)]|[Extraordinariat fuer Internistisch-Experimentelle Onkologie, Universitaetskliniken Wien (Austria)]|[Ludwig Boltzmann Inst. fuer Klinisch Experimentelle Onkologie, Wien (Austria)

    1999-07-01

    In order to evaluate the anatomic extension of neoplastic disease according to the TNM system sufficiently, inclusion of imaging techniques is absolutely necessary. In addition, decisions on further clinical processing are based on precise identification of primary tumor extent (T), condition of regional nodes (N) and possible presence of distant metastases (M). Breast cancer, lung cancer, colorectal cancer and prostate cancer represent the most common tumor entities. Within this context the importance of imaging techniques for diagnosis, prognosis, therapy and follow-up of patients with these malignancies is presented in this report. (orig.) [Deutsch] Ein adaequates, das weitere klinische Procedere bestimmende Tumorstaging nach dem TNM-System, sprich die Evaluierung der Primaertumorgroesse (T), des Ausmasses des Lymphknotenbefalls (N) sowie einer eventuell vorhandenen Fernmetastasierung (M) ist nur durch Inkludierung der Bildgebung moeglich. Anhand der haeufigsten Tumorentitaeten - dem Mammakarzinom, Bronchialkarzinom, Prostatakarzinom sowie dem kolorektalen Karzinom - wird die Bedeutung der BBildgebung fuer Diagnose, Prognose, Therapie und letztendlich Nachsorge erlaeutert. (orig.)

  14. [Helicobacter pylori infection in the gastric mucosa of patients with HIV/AIDS in different clinical stages].

    Science.gov (United States)

    Luo, Hong-Bin; Hu, Zhong-Wei; Guo, Jia-Wei

    2009-07-01

    To analyze Helicobacter pylori infection in the gastric mucosa of patients with HIV/AIDS in different clinical stages. This study involved 170 patients with HIV/AIDS and 34 HIV-negative patients. All the patients underwent upper endoscopy and antral gastric biopsy to determine the status of Helicobacter pylori infection using aniline red staining and rapid urease test. The patients with HIV/AIDS were stratified based on CD4(+)T lymphocyte counts and clinical setting into asymptomatic HIV infection (A1, A2) group, symptomatic HIV infection (B1, B2) group and AIDS (A3, B3, C1-3) group. The prevalence of Helicobacter pylori infection in HIV/AIDS patients was 16.5% (28/170), and in the 3 groups classified, the infection rates were 23.4% (11/47), 14.0% (8/57), and 13.6% (9/66), respectively; the infection rate was 47.1% (16/34) in the control group. Helicobacter pylori infection rate in the gastric mucosa of the patients with HIV/AIDS in different clinical stages was significantly lower than that of the control group (P<0.05); the infection rates in symptomatic HIV-infected (B1, B2) group and AIDS (A3, B3, C1-3) group were significantly lower than that in asymptomatic HIV-infected (A1, A2) group (P<0.05). The low Helicobacter pylori infection rate in HIV/AIDS patients may result from severe immunodeficiency in the gastric mucosa.

  15. Rates and progenitors of type Ia supernovae

    Energy Technology Data Exchange (ETDEWEB)

    Wood-Vasey, William Michael [Univ. of California, Berkeley, CA (United States)

    2004-01-01

    The remarkable uniformity of Type Ia supernovae has allowed astronomers to use them as distance indicators to measure the properties and expansion history of the Universe. However, Type Ia supernovae exhibit intrinsic variation in both their spectra and observed brightness. The brightness variations have been approximately corrected by various methods, but there remain intrinsic variations that limit the statistical power of current and future observations of distant supernovae for cosmological purposes. There may be systematic effects in this residual variation that evolve with redshift and thus limit the cosmological power of SN Ia luminosity-distance experiments. To reduce these systematic uncertainties, we need a deeper understanding of the observed variations in Type Ia supernovae. Toward this end, the Nearby Supernova Factory has been designed to discover hundreds of Type Ia supernovae in a systematic and automated fashion and study them in detail. This project will observe these supernovae spectrophotometrically to provide the homogeneous high-quality data set necessary to improve the understanding and calibration of these vital cosmological yardsticks. From 1998 to 2003, in collaboration with the Near-Earth Asteroid Tracking group at the Jet Propulsion Laboratory, a systematic and automated searching program was conceived and executed using the computing facilities at Lawrence Berkeley National Laboratory and the National Energy Research Supercomputing Center. An automated search had never been attempted on this scale. A number of planned future large supernovae projects are predicated on the ability to find supernovae quickly, reliably, and efficiently in large datasets. A prototype run of the SNfactory search pipeline conducted from 2002 to 2003 discovered 83 SNe at a final rate of 12 SNe/month. A large, homogeneous search of this scale offers an excellent opportunity to measure the rate of Type Ia supernovae. This thesis presents a new method for

  16. Clinical and economic aspects of sevelamer therapy in end-stage renal disease patients

    Directory of Open Access Journals (Sweden)

    Ossareh S

    2014-05-01

    Full Text Available Shahrzad OssarehDepartment of Medicine, Nephrology Section, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, IranAbstract: Phosphate control is still a great challenge in chronic kidney disease (CKD, and in spite of the great improvements in dialysis techniques, achievement of the goals for mineral metabolism control is still far from ideal. Aluminum hydroxide has been largely abandoned due to the high risk of aluminum toxicity, while the use of calcium-based phosphate binders may cause hypercalcemia, overzealous parathyroid suppression, and extraskeletal calcification. Sevelamer hydrochloride has been introduced as an efficient medication for phosphate control, with a lower risk of hypercalcemia and parathyroid suppression. Various clinical trials have compared the risk of vascular calcification between sevelamer and calcium salts with inconsistent results. In spite of these inconsistencies, the Kidney Disease Outcomes Quality Initiative (KDOQI suggests non-calcium phosphate binders as the preferred phosphate binder in dialysis patients with severe vascular and/or other soft-tissue calcifications and in those with hypercalcemia or parathyroid hormone (PTH <150 mg/dL. The Kidney Disease Improving Global Outcome (KDIGO limits the use of non-calcium phosphate binders to patients with hypercalcemia. Regarding the effect on mortality, the results of clinical trials are again inconsistent. The other important aspect of using sevelamer is the issue of price, which is substantially higher than calcium-based phosphate binders. Reviewing the studies on economic aspects shows that sevelamer increases quality-adjusted life-years (QALY and possibly life years, with a higher cost compared to calcium-based phosphate binders. In conclusion, sevelamer is a very useful drug for phosphate control, reduction of hypercalcemia, and lessening the risk of adynamic bone disease, with probable reduction in vascular calcification and possible

  17. [Active management of the third stage of labor: Three schemes of oxytocin: randomised clinical trial].

    Science.gov (United States)

    Neri-Mejía, M; Pedraza-Avilés, A G

    2016-05-01

    To compare the effectiveness of intramuscular oxytocin against intravenous oxytocin against intravenous traditional oxytocin infusion, in the active management of the third period of the delayed impingement labor work and controlled cord traction. Randomized controlled blinded clinical trial. In women age 14 to 40 with full term pregnancy, childbirth attended by ISSSTE's Regional Hospital "Gral. Ignacio Zaragoza", in the period from August to December 2015. 152 deliveries were attended, from which 66 fulfill with selection criteria. Group 1 = 22 patients, group 2 = 21 patients and Group 3 = 23 patients. The total age average was 26.92 + 5.8. For blood volume, statistical differences were significant among the three groups (p = 0.000). Adverse reactions were presented in 1 .5%, without difference between the groups. (P = 0.337). The differences in hemoglobin values and final and initial hematocrit presented differences with statistical significance (p = 0.000 for both). Nonetheless, the differences obtained in the analysis of the diverse variables among the three types of treatment, the three schemes are effective on the obstetrical hemorrhage prevention.

  18. Effects of laser immunotherapy on late-stage, metastatic breast cancer patients in a Phase II clinical trial

    Science.gov (United States)

    Ferrel, Gabriela L.; Zhou, Feifan; Li, Xiaosong; Hode, Tomas; Nordquist, Robert E.; Alleruzzo, Luciano; Chen, Wei R.

    2014-03-01

    Laser immunotherapy (LIT), a novel technique with a local intervention to induce systemic antitumor effects, was developed to treat metastatic cancers. The pre-clinical studies of LIT have shown its unique characteristics in generating a specific antitumor immunity in treating metastatic tumors in rats and mice. For late-stage, metastatic breast cancer patients, who were considered to be out of other available treatment options, we conducted a small Phase II clinical trial using LIT starting in 2009 in Lima, Peru. This Phase II study was closed in December of 2012, as acknowldged by the Ministry of Health (MOH) of Peur letter 438-2014-OGITT/INS dated March 5th, 2014. Ten patients were enrolled and received LIT in one or multiple 4-week treatment cycles. At the study closing date, four patients were alive and two of them remained cancer free. Here, following the successful conclusion of our Phase II study, we report the clinical effects of LIT on metastatic breast cancer patients. Specifically, we present the overall status of all the patients three years after the treatment and also the outcomes of two long-term surviving patients.

  19. Using CD4 counts to evaluate the stages and epidemiology of HIV infection in South Carolina public clinic patients.

    Science.gov (United States)

    Luby, S; Jones, J; Horan, J

    1994-01-01

    OBJECTIVES. CD4 lymphocyte counts decrease with the duration of human immunodeficiency virus (HIV) infection. We used CD4 counts collected for clinical reasons to evaluate the stage of HIV infection and the epidemiology of recent HIV infections among attendees of South Carolina's public health clinics. METHODS. We measured the CD4 T-lymphocyte counts of persons newly diagnosed with HIV infection April 1989 through June 1990 at South Carolina public health clinics who returned for follow-up. RESULTS. Of 812 newly diagnosed HIV-infected health department patients, 420 (52%) had their CD4 lymphocyte counts measured. Of these 420, 51 (12%) had CD4 counts of or = 900), which are associated with more recent HIV infection, were more common in females. CONCLUSIONS. In South Carolina, almost half of newly reported HIV-infected persons who agreed to CD4 testing at the health department might benefit from immediate drug therapy. Within this population, women may be an emerging risk group that requires specifically directed HIV prevention efforts. PMID:7907458

  20. Plasma viscosity: a potential predictor of both medical treatment response and clinical stage of ulcerative colitis.

    Science.gov (United States)

    Tolga, Yakar; Mansur, Cosar Arif; Savas, Gokturk Hu Seyin; Gulhan, Unler Kanat Ayse; Alper, Parlakgumus; Ilknur, Kozanoglu; Ender, Serin

    2016-01-01

    La colite ulcerosa (UC) è una delle maggiori forme di colonpatia infiammatoria cronica recidivante. La capacità di identificare tipo, gravità e sensibilità alla terapia su parametri di laboratorio è da tempo oggetto di ricerca degli studi clinici. Lo scopo di questo studio è quello di accertare la relazione tra la viscosità del plasma (PV), l’attività della malattia e la risposta al trattamento medico. Lo studio si è svolto su 105 pazienti con UC e 42 volontari sani. I prelievi di sangue sono stati utilizzati per valutare la viscosità del plasma (PV), la velocità di eritrosedimentazione (ESR), la proteina C-reattiva ultrasensibile (hs-CRP), il D-dimero e il fibrinogeno. I pazienti con UC sono stati raggruppati in relazione al grado di attività flogistica (cioè 59 attivi e 46 in remissione). La PV è risultata più elevata in quelli con UC attiva rispetto a quella dei soggetti in remissione o nei soggetti sani. È risultata significativamente più elevata sia nei casi di UC refrattaria al trattamento steroideo rispetto a quelli sensibili (p< 0.001), e nelle UC rafrattarie alla ciclosrporina rispetto a quelli sensibili (p= 0.003). Con l’aumento della PV nei pazienti affetti da UC sono risultati significativamente associati il punteggio del SCCAI (Increased Simple Clinical Colitis Activity Index), dell’EGS (Endoscopic Grading Scale) e del HAD (Histological Disease Activity (HAD). Si conclude che la PV è un marker utile per la previsione di sensibilità al trattamento sterorideo e con ciclosporina nei pazienti con UC attiva. Potrebbe essere rimpiazzata dalla ESR e dalla hs-CRP come misura della risposta in fase acuta in quanto sufficientemente sensibile. Questi risultati possono essere utili per l’identificazione dei pazienti con UC attiva da destinare alla colectomia.

  1. Optimization of the extent of surgical treatment in patients with stage I in cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chernyshova, A. L.; Lyapunov, A. Yu., E-mail: Lyapunov1720.90@mail.ru [Tomsk Cancer Research Institute, Kooperativny Street 5, Tomsk, 634050 (Russian Federation); Kolomiets, L. A. [Tomsk Cancer Research Institute, Kooperativny Street 5, Tomsk, 634050 (Russian Federation); Siberian State Medical University, Moskovsky Trakt 2, Tomsk, 634050 (Russian Federation); Sinilkin, I. G.; Chernov, V. I. [Tomsk Cancer Research Institute, Kooperativny Street 5, Tomsk, 634050 (Russian Federation); Tomsk Polytechnic University, Lenin Avenue 30, Tomsk, 634050 (Russian Federation)

    2016-08-02

    The study included 26 patients with FIGO stage Ia1–Ib1 cervical cancer who underwent fertility-sparing surgery (transabdominaltrachelectomy). To visualize sentinel lymph nodes, lymphoscintigraphy with injection of 99mTc-labelled nanocolloid was performed the day before surgery. Intraoperative identification of sentinel lymph nodes using hand-held gamma probe was carried out to determine the radioactive counts over the draining lymph node basin. The sentinel lymph node detection in cervical cancer patients contributes to the accurate clinical assessment of the pelvic lymph node status, precise staging of the disease and tailoring of surgical treatment to individual patient.

  2. Optimization of the extent of surgical treatment in patients with stage I in cervical cancer

    Science.gov (United States)

    Chernyshova, A. L.; Kolomiets, L. A.; Sinilkin, I. G.; Chernov, V. I.; Lyapunov, A. Yu.

    2016-08-01

    The study included 26 patients with FIGO stage Ia1-Ib1 cervical cancer who underwent fertility-sparing surgery (transabdominaltrachelectomy). To visualize sentinel lymph nodes, lymphoscintigraphy with injection of 99mTc-labelled nanocolloid was performed the day before surgery. Intraoperative identification of sentinel lymph nodes using hand-held gamma probe was carried out to determine the radioactive counts over the draining lymph node basin. The sentinel lymph node detection in cervical cancer patients contributes to the accurate clinical assessment of the pelvic lymph node status, precise staging of the disease and tailoring of surgical treatment to individual patient.

  3. Merging white dwarfs and Type Ia supernovae

    Science.gov (United States)

    Yungelson, L. R.; Kuranov, A. G.

    2017-01-01

    Using population synthesis, we study a double-degenerate (DD) scenario for Type Ia supernovae (SNe Ia), aiming to estimate the maximum possible contribution to the rate of SNe from this scenario and the dependence of the delay-time distribution (DTD) on it. We make an extreme assumption that all mergers of super-Chandrasekhar pairs of CO white dwarfs (WDs) and mergers of CO WDs more massive than 0.47 M⊙ with hybrid or helium WDs more massive than 0.37 M⊙ produce SNe Ia. The models are parametrized by the product of the common envelope efficiency and the parameter of binding energy of stellar envelopes, αce λ, which we vary between 0.25 and 2. The best agreement with observations is obtained for αce λ = 2. A substantial contribution to the rate of SNe Ia is provided by the pairs with a hybrid WD. The estimated Galactic rate of SNe Ia is 6.5 × 10-3 yr-1 (for the mass of the bulge and thin disc equal to 7.2 × 1010 M⊙), which is comparable to the observational estimate (5.4 ± 0.12) × 10-3 yr-1. The model DTD for 1 ≤ t ≤ 8 Gyr satisfactorily fits the DTD for SNe Ia in the field galaxies (Maoz, Mannucci & Brandt). For this epoch, the model DTD is ∝t-1.64. At earlier and later epochs, our DTD has a deficit of events, as in other studies. Marginal agreement with the observational DTD is achieved even if only CO+CO WDs with M1 ≥ 0.8 M⊙ and M2 ≥ 0.6 M⊙ produce SNe Ia. A better agreement of observed and modelled DTD may be obtained if tidal effects are weaker than assumed and/or the metallicity of the population is much lower than solar.

  4. Toward comprehensive management tailored to prognostic factors of patients with clinical stages I and II in Hodgkin's disease. The EORTC Lymphoma Group controlled clinical trials: 1964-1987.

    Science.gov (United States)

    Tubiana, M; Henry-Amar, M; Carde, P; Burgers, J M; Hayat, M; Van der Schueren, E; Noordijk, E M; Tanguy, A; Meerwaldt, J H; Thomas, J

    1989-01-01

    From 1964 to 1987, the EORTC Lymphoma Group conducted four consecutive controlled clinical trials on clinical stages I and II Hodgkin's disease in which 1,579 patients were entered. From the onset the main aim of these trials was to identify the subsets of patients who could be treated safely by regional radiotherapy (RT). Therefore, several prognostic indicators were prospectively registered and progressively used in the trial protocols for the delineation of the favorable and unfavorable subgroups as soon as they were recognized of high predictive value. In the H2 trial (1972 to 1976), the histologic subtype was the only variable taken into account for the therapeutic strategy and the staging laparotomy findings were found to be of prognostic value only in patients with favorable prognostic indicators. In the H5 trial (1977 to 1982), patients were subdivided into two subgroups according to six prognostic indicators. Patients with favorable features were submitted to a staging laparotomy (lap); lap negative patients were randomized between mantle field RT and mantle field plus paraaortic RT. Disease free survival (DFS) and total survival (S) were similar in the two arms. Among patients with unfavorable features, DFS and S were significantly higher in the arm treated by combination of mechlorethamine, vincristine, procarbazine, prednisone (MOPP) chemotherapy (CT) and RT than in the arm treated by total nodal irradiation. Nevertheless, in patients below the age of 40, the overall survival rates were equivalent in the two arms. In the H6 trial, the delineation of the favorable subgroup was based on (a) absence of systemic symptoms and elevated ESR, (b) no more than one or two lymph node areas involved. The aim of the study was to assess the impact on survival of a therapeutic strategy including staging laparotomy. At a 4-year follow-up, no difference in survival was evidenced. In patients with unfavorable prognostic indicators, 3 MOPP-RT-3 MOPP were compared with 3

  5. One-stage urethral reconstruction using colonic mucosa graft:an experimental and clinical study

    Institute of Scientific and Technical Information of China (English)

    Yue-Min Xu; Yong Qiao; Ying-Long Sa; Jiong Zhang; Hui-Zhen Zhang; Xin-Ru Zhang; Deng-Long Wu; Rong Chen

    2003-01-01

    AIM: To investigate the possibility of urethral reconstructionwith a free colonic mucosa graft and to present ourpreliminary experience with urethral substitution using a freegraft of colonic mucosa for treatment of 7 patients withcomplex urethral stricture of a long segment.METHODS: Ten female dogs underwent a procedure inwhich the urethral mucosa was totally removed andreplaced with a free graft of colonic mucosa. A urodynamicstudy was performed before the operation and sacrifice.The dogs were sacrificed 8 to 16 weeks after the operationfor histological examination of urethra. Besides, 7 patientswith complex urethral stricture of a long segment weretreated by urethroplasty with the use of a colonic mucosalgraft. The cases had undergone an average of 3 previousunsuccessful repairs. Urethral reconstruction with a freegraft of colonic mucosa ranged from 10 to 17 cm (mean13.1 cm). Follow-up included urethrography, urethroscopyand uroflowmetry.RESULTS: Urethral stricture developed in 1 dog. The resultsof urodynamic studies showed that the difference in themaximum urethral pressure between the pre-operation andpre-sacrifice in the remaining 9 dogs was not of significance(P>0.05). Histological examination revealed that the colonicfree mucosa survived inside the urethral lumen of the 10experimental dogs. Plicae surface and unilaminar cylindricepithelium of the colonic mucosa was observed in dogssacrificed 8 weeks after the operation. The plicae surfaceand unilaminar cylindric epithelium of the colonic mucosawas not observed, and metaplastic transitional epitheliumcovered a large proportion of the urethral mucosa in dogssacrificed 12 weeks after the operation. Clinically, the patientswere followed up for 3-18 months postoperatively (mean8.5 months). Meetal stenosis was developed in 1 patient 3months postoperatively and needed reoperation. The patientwas voiding very well with urinary peak flow 28.7 ml/s duringthe follow-up of 9 months after reoperation. The

  6. Survival analysis of patients with clinical stages I or II Hodgkin's disease who have relapsed after initial treatment with radiotherapy alone

    DEFF Research Database (Denmark)

    Horwich, A; Specht, L; Ashley, S

    1997-01-01

    To aid treatment choice in early stage of Hodgkin's disease, we analysed patients registered in the IDHD Database with clinical stages I or II Hodgkin's disease who were not staged with laparotomy and whose initial treatment was with radiotherapy alone. The factors analysed for outcome after first...... relapse included initial stage, age, sex, histology, number of involved areas, mediastinal involvement, E-lesions, B-symptoms, erythrocyte sedimentation rate, alkaline phosphatase, serum albumin and haemoglobin. As well as presentation variables, we analysed the disease-free interval after initial...... radiotherapy and the extent of disease at relapse. A total of 1364 patients with clinical stage I or II Hodgkin's disease were treated with initial radiotherapy, of whom 473 relapsed. The probability of survival 10 years after relapse was 63%. For cause-specific survival (CSS), both multivariate and univariate...

  7. HIV treatments reduce malaria liver stage burden in a non-human primate model of malaria infection at clinically relevant concentrations in vivo.

    Directory of Open Access Journals (Sweden)

    Charlotte V Hobbs

    Full Text Available We have previously shown that the HIV protease inhibitor lopinavir-ritonavir (LPV-RTV and the antibiotic trimethoprim sulfamethoxazole (TMP-SMX inhibit Plasmodium liver stages in rodent malarias and in vitro in P. falciparum. Since clinically relevant levels are better achieved in the non-human-primate model, and since Plasmodium knowlesi is an accepted animal model for the study of liver stages of malaria as a surrogate for P. falciparum infection, we investigated the antimalarial activity of these drugs on Plasmodium knowlesi liver stages in rhesus macaques. We demonstrate that TMP-SMX and TMP-SMX+LPV-RTV (in combination, but not LPV-RTV alone, inhibit liver stage parasite development. Because drugs that inhibit the clinically silent liver stages target parasites when they are present in lower numbers, these results may have implications for eradication efforts.

  8. Clinical significance of a proposed lymphoscintigrpahic functional grade system in patients with extremity lymphedema of stage i

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joan Young; Hwang, Ji Hye; Kim, Dong Ik; Cho, Young Seok; Lee, Su Jin; Choi, Yong; Choe, Yeam Seong; Lee, Kyung Han; Kim, Byung Tae [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-07-01

    We proposed a new lymphoscintigrpahic functional grade (LGr) system in extremity lymphedema, and investigated the association between the LGr and a long-term response to physical therapy in patients with extremity lymphedema of stage I. The subjects were 20 patients with unilateral extremity lymphedema of stage I, who underwent pre-treatment extremity lymphoscintigraphy using Tc-99m antimony sulfur colloid, and were treated by complex decongestive physical therapy (CDPT). A proposed lymphoscintigrpahic functional grade system consisted of LGr 0 to LGr 4 according to the ilioinguinal nodal uptake, amount of dermal backflow, and uptake pattern of main and collateral lymphatics : LGr 0 = normal, LGr 1 = decreased lymphatic function without dermal backflow, LGr 2 = decreased lymphatic function with dermal backflow, LGr 3 = non - visualization of main lymphatics with dermal backflow, and LGr 4 = no significant lymphatic transport from injection site. LGr 2 was divided into 2A and 2B based on the amount of dermal backflow. A physician who is a lymphedema specialist determined the long-term outcome to CDPT with normalized response (NR), good response (GR) and poor response (PR) based on the change of edema volume reduction, skin status and occurrence of dermatolymphangioadenitis after the clinical follow-up for more than 1 year. Therapeutic responses were NR in 2 patients. GR in 9 patients and PR in 9 patients. Baseline LGrs were 1 in 7 patients, 2A in 4 patients, 2B in 5 patients, 3 in 2 patients, and 4 in 2 patients. There was a significant relationship between therapeutic response and LGr (p=0.003). In other words, 10 of 11 patients (91%) with LGr 1 or 2A showed NR. or GR. On the contrary, 8 of 9 patients (89%) with LGr 2B, 3 or 4 showed PR. Patients with unilateral extremity lymphedema of stage I had different lymphoscintigrpahic functional grades. This grade system may be useful to predict the response to physical therapy in such patients.

  9. Pre-clinical grades predict clinical performance in the MBBS stage II examination at the University of the West Indies, Mona Campus.

    Science.gov (United States)

    Pepple, Dagogo J; Young, Lauriann E; Gordon-Strachan, Georgiana M; Carroll, Robert G

    2013-12-20

    In the preclinical sciences, statistically significant predictive values have been reported between the performances in one discipline and the others, supporting the hypothesis that students who perform well in one discipline were likely to perform well in the other disciplines. We therefore decided to conduct a retrospective study to investigate the predictive effects of preclinical subjects on clinical subjects from 87 students of The University of the West Indies (UWI), Mona Campus who took the MBBS Stage II examination at various times between May 2000 and May 2002. The grade in Pathology was significantly predicted by scores in Anatomy and Pharmacology; Medicine by Physiology and Pharmacology scores; Surgery by Anatomy and Social and Preventive Medicine scores; while, the Obstetrics and Gynecology grade was predicted by the Anatomy score. The results support the hypothesis that the scores in some preclinical subjects can predict the performance in specific clinical subjects, which could be interpreted to suggest that poor performance in specific preclinical disciplines could be a warning sign of future poor performance in the related clinical disciplines.

  10. Radiotherapy or chemotherapy for clinical stage IIA and IIB seminoma: a systematic review and meta-analysis of patient outcomes.

    Science.gov (United States)

    Giannatempo, P; Greco, T; Mariani, L; Nicolai, N; Tana, S; Farè, E; Raggi, D; Piva, L; Catanzaro, M; Biasoni, D; Torelli, T; Stagni, S; Avuzzi, B; Maffezzini, M; Landoni, G; De Braud, F; Gianni, A M; Sonpavde, G; Salvioni, R; Necchi, A

    2015-04-01

    Outcomes of radiotherapy (RT) compared with chemotherapy (CT) remain poorly defined for clinical stage (CS) IIA and IIB seminoma. We aimed to evaluate the current role of the two treatment modalities in this setting of testicular seminoma. A systematic review and meta-analysis (MA) was carried out to identify all evaluable studies. Search was limited to studies published after 1990 and included the Medline, Embase databases, and abstracts from ASCO (GU), ESMO, AUA, and ASTRO meetings up to April 2014. Sensitivity analyses were applied including the following: CSIIA and CSIIB, paraortic + iliac RT only in both stages, RT dose (≥30 versus seminoma, a trend in favor of CT for a lower incidence of side-effects and RR in CSIIB was found. This evidence is limited by the retrospective quality of studies and their small sample size. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  11. IgG subclass response to HIV in relation to antibody-dependent cellular cytotoxicity at different clinical stages.

    Science.gov (United States)

    Ljunggren, K; Broliden, P A; Morfeldt-Månson, L; Jondal, M; Wahren, B

    1988-01-01

    The anti-HIV IgG subclass response was analysed in sera from different clinical stages and related to virus specific antibody-dependent cellular cytotoxicity (ADCC). IgG1 was found to be the dominant subclass, present in all sera and with similar mean titres at different stages. The number of anti-HIV IgG3 positive sera, measured on whole viral lysate antigen plates, decreased during disease progression from 38% in symptom-free to 7% in AIDS patients. IgG2 and IgG4 subclasses were less prevalent although a slight increase of IgG4 frequency was found in AIDS patients. High IgG1 titres correlated with a positive ADCC reaction but there was no correlation between anti-HIV IgG1 and ADCC titres. Some sera which contained HIV IgG1 as the only subclass were able to mediate an ADCC reaction. In addition, when anti-HIV IgG3 was isolated, by protein A chromatography, no ADCC killing was induced by these antibodies. It is concluded that IgG1 is the major ADCC-active IgG subclass in HIV infected individuals. The lack of correlation between IgG1 and ADCC titres may be explained by a relatively small fraction of IgG1 antibodies mediating ADCC. PMID:3208446

  12. Clinically different stages of Alzheimer's disease associated by amyloid deposition with [11C]-PIB PET imaging.

    Science.gov (United States)

    Hatashita, Shizuo; Yamasaki, Hidetomo

    2010-01-01

    We investigated whether [11C]-PIB PET detects underlying amyloid deposition at clinically different stages of Alzheimer's disease (AD) and preclinical dementia. The Japanese cohort of 214 subjects underwent cognitive testing and 60-min dynamic [11C]-PIB PET. [11C]-PIB data were acquired from 35-60 min after injection. Regions of interest were defined on co-registered MRI. Distribution volume ratios (DVR) of PIB retention were determined using Logan graphical analysis. All 56 patients with AD showed a robust increase in PIB retention in cortical areas (typical PIB AD-pattern). A mean DVR value in 11 patients with moderate AD (CDR: 2.1 ± 0.4) showed significantly higher PIB retention (2.38 ± 0.42, p differ from very mild AD. The prevalence of AD among the 53 amyloid positive patients aged 75 years or older increased greatly to 74% whereas that of amyloid positive HC decreased by only 9% and amyloid positive MCI by 17%. Prodromal AD and AD dementia is identified, based on cognitive function and amyloid deposition by PIB PET imaging. Further, the cortical amyloid deposition could be detected at preclinical stage of AD.

  13. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms

    Directory of Open Access Journals (Sweden)

    Ramakrishnan K

    2013-12-01

    Full Text Available Karthik Ramakrishnan,1 T Christopher Bond,1 Ami Claxton,1 Vipan C Sood,2 Maria Kootsikas,2 Wendy Agnese,2 Scott Sibbel11DaVita Clinical Research, Minneapolis, MN, USA; 2Mitsubishi Tanabe Pharma Corporation, Jersey City, NJ, USAAbstract: One of the most common conditions affecting end-stage renal disease (ESRD patients undergoing hemodialysis (HD is pruritus. Studies report that itchy and dry skin, symptoms of pruritus, affect 40%–90% of ESRD patients. Yet, in clinical practice the condition is often underdiagnosed resulting in inadequate management and an underappreciated impact on patient outcomes. Two retrospective analyses were conducted: a preliminary analysis of ESRD patients with pruritus symptoms (n=73,124 undergoing HD or peritoneal dialysis at a large dialysis provider and a subsequent detailed analysis of a homogenous subset of patients undergoing in-center HD (n=38,315. The goal was to better understand the clinical burden of pruritus as it relates to patient characteristics, quality of life, medication use, and HD compliance. This population is commonly burdened by multiple comorbidities and related polypharmaceutical management; identifying the relationship of pruritus to these ailments can help guide future research and resource allocation. The detailed analysis confirmed trends observed in the preliminary analysis: 30% reported being "moderately" to "extremely bothered" by itchiness. The HD patient population with the highest severity of self-reported pruritus also had a consistent trend in overall increased resource utilization – higher monthly doses of erythropoietin-stimulating agents (53,397.1 to 63,405.4 units and intravenous (IV iron (237.2 to 247.6 units and higher use of IV antibiotics (14.1% to 20.7%, as well as poorer quality-of-life measures (25-point reductions in Burden of Disease Score and Effects on Daily Life subscales of the Kidney Disease Quality of Life-36 survey. These results highlight the need to better

  14. Early report of randomized double blind clinical trial of hormonal therapy of carcinoma of prostate (CAP stage D2

    Directory of Open Access Journals (Sweden)

    Jagdeesh N Kulkarni

    2003-01-01

    Full Text Available Objectives: We herein report our experience of double blind randomized clinical trial comparing combined an-drogen blockade vs monotherapy in stage D2 CaP. Patients and Methods: Through June 1999 and May 2001, 100 patients of stage D2 CaP were randomized into placebo (44 and flutamide (42 group after orchiectomy in double blind fashion using the strictest criteria. All men and histological proof of CaP with bone metastasis dem-onstrated on imaging: bone scan and skeletal survey. These patients were further substratified according to number o f bony metastases into high volume disease (HVD>5 sites and low volume disease (LVD< 5 sites. The follow-up was at 3 month intervals. Criteria for decoding were clinical or serological progression and serious adverse effects. Results: Of the 100 patients recruited in the trial, 48 had HVD and 52 LVD. Treatmentwise they were almost equally distributed in flutamide group and placebo group. In the follow-up ranging front 6 to 24 months, 30 out of 100 patients (30% required decoding, reasons for decod-ing were progression of disease in 25 and serious adverse effects in remaining 5. These 25 patients were further analyzed according to treatment group, volume of metas-tasis pre -orchiectomy PSA and Gleason score. We observed that number of bony metastases had impact over the dura-tion of response to hormonal therapy. Discussion: We initiated this simple trial to address the issue of benefit of total androgen blockade over monotherapy in Indian population. In the initial analysis, we observed that treatment group did not make any impact over the response. While subset of prostate cancer with large number of bony metastases has higher propensity to convert into hormone refractory cancer Conclusions: Addition of flutamide did not provide ben-efit. We observed that large number of bony metastases had poor response to hormonal therapy, hence it requires large trial to substantiate this initial observation.

  15. Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer’s disease

    Science.gov (United States)

    Donovan, Nancy J.; Amariglio, Rebecca E.; Zoller, Amy S.; Rudel, Rebecca K.; Gomez-Isla, Teresa; Blacker, Deborah; Hyman, Bradley T.; Locascio, Joseph J.; Johnson, Keith A.; Sperling, Reisa A.; Marshall, Gad A.; Rentz, Dorene M.

    2014-01-01

    Objectives To examine neuropsychiatric and neuropsychological predictors of progression from normal to early clinical stages of Alzheimer’s disease (AD). Design Longitudinal study Setting Massachusetts Alzheimer’s Disease Research Center longitudinal cohort Participants From a total sample of 559 older adults, 454 were included in the primary analysis: 283 with clinically normal cognition (CN), 115 with mild cognitive impairment (MCI) and 56 with subjective cognitive concerns (SCC) but no objective impairment, a proposed transitional group between CN and MCI. Measurements Two latent cognitive factors (Memory-Semantic, Attention-Executive) and two neuropsychiatric factors (Affective, Psychotic) were derived from the Alzheimer’s Disease Centers’ Uniform Data Set neuropsychological battery and Neuropsychiatric Inventory brief questionnaire. Factors were analyzed as predictors of time to progression to a worse diagnosis using a Cox proportional-hazards regression model with backward elimination. Covariates included baseline diagnosis, gender, age, education, prior depression, antidepressant medication, symptom duration, and interaction terms. Results Higher/better Memory-Semantic factor score predicted lower hazard of progression (HR=0.4 for one SD increase, p<0.0001), and higher/worse Affective factor score predicted higher hazard (HR=1.3 for one SD increase, p=0.01). No other predictors were significant in adjusted analyses. Using diagnosis as a sole predictor of transition to MCI, the SCC diagnosis carried a 4-fold risk of progression compared to CN (HR=4.1, p<0.0001). Conclusions These results identify affective and memory-semantic factors as significant predictors of more rapid progression from normal to early stages of cognitive decline and highlight the subgroup of cognitively normal elderly with SCC as those with elevated risk of progression to MCI. PMID:24698445

  16. A predictive genetic signature for response to fluoropyrimidine-based neoadjuvant chemoradiation in clinical Stage II and III rectal cancer

    Directory of Open Access Journals (Sweden)

    Jason eChan

    2013-11-01

    Full Text Available PurposePreoperative chemoradiation is currently the standard of care for patients with clinical stage II and III rectal cancer but only about 45% of patients achieve tumor downstaging and less than 20% of patients achieve a pathologic complete response. Better methods to stratify patients according to potential neoadjuvant treatment response are needed. We used microarray analysis to identify a genetic signature that correlates with a pathological complete response to neoadjuvant chemoradiation. We performed a gene network analysis to identify potential signaling pathways involved in determining response to neoadjuvant treatment.Patients and MethodsWe identified 31 T3-4 N0-1 rectal cancer patients who were treated with neoadjuvant fluorouracil-based chemoradiation. 8 patients were identified to have achieved a pathological complete response to treatment while 23 patients did not. mRNA expression was analyzed using cDNA microarrays. The correlation between mRNA expression and pathological complete response from pre-treatment tumor biopsies was determined. Gene network analysis was performed for the genes represented by the predictive signature.ResultsA genetic signature represented by expression levels of the 3 genes EHBP1, STAT1, and GAPDH was found to correlate with a pathological complete response to neoadjuvant treatment. The difference in expression levels between patients who achieved a pathological complete response and those who did not was greatest for EHBP1. Gene network analysis showed that the 3 genes can be connected by the gene UBC. ConclusionThis study identifies a 3-gene signature expressed in pre-treatment tumor biopsies that correlates with a pathological complete response to neoadjuvant chemoradiation in patients with clinical stage II and III rectal cancer. These 3 genes can be connected by the gene UBC, suggesting that ubiquination is a molecular mechanism involved in determining response to treatment. Validating this genet

  17. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

    Science.gov (United States)

    Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David

    2015-10-01

    The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

    Institute of Scientific and Technical Information of China (English)

    Eduardo Vilar Gomez; Luis Calzadilla Bertot; Bienvenido Gra Oramas; Enrique Arus Soler; Raimundo Llanio Navarro; Javier Diaz Elias; Oscar Villa Jiménez; Maria del Rosario Abreu Vazquez

    2009-01-01

    AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was constructed using clinical (ascites,encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model.It was applied to estimate 12-,52- and 104-wk survival.The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset.Finally,the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk ≤8 and high risk>8).RESULTS:In the validation cohort,all measures of fit,discrimination and calibration were improved when the biochemical and clinical model was used.The proposed model had better predictive values (c-statistic:0.90,0.91,0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-,52- and 104-wk mortality,respectively.In addition,the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L,4.69) is better calibrated than MELD (H-L,17.06) and CP (H-L,14.23).There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk,P=0.61;high risk,P=0.77).CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

  19. Type Ia Supernovae and the Hubble Constant

    CERN Document Server

    Branch, D

    1998-01-01

    The focus of this review is the work that has been done during the 1990s on using Type Ia supernovae (SNe Ia) to measure the Hubble constant ($H_0$). SNe Ia are well suited for measuring $H_0$. A straightforward maximum-light color criterion can weed out the minority of observed events that are either intrinsically subluminous or substantially extinguished by dust, leaving a majority subsample that has observational absolute-magnitude dispersions of less than $\\sigma_{obs}(M_B) \\simeq \\sigma_{obs}(M_V) \\simeq 0.3$ mag. Correlations between absolute magnitude and one or more distance-independent SN Ia or parent-galaxy observables can be used to further standardize the absolute magnitudes to better than 0.2 mag. The absolute magnitudes can be calibrated in two independent ways --- empirically, using Cepheid-based distances to parent galaxies of SNe Ia, and physically, by light curve and spectrum fitting. At present the empirical and physical calibrations are in agreement at $M_B \\simeq M_V \\simeq -19.4$ or -19....

  20. The Spectroscopic Diversity of Type Ia Supernovae

    CERN Document Server

    Blondin, S; Kirshner, R P; Mandel, K S; Berlind, P; Calkins, M; Challis, P; Garnavich, P M; Jha, S W; Modjaz, M; Riess, A G; Schmidt, B P

    2012-01-01

    We present 2603 spectra of 462 nearby Type Ia supernovae (SN Ia) obtained during 1993-2008 through the Center for Astrophysics Supernova Program. Most of the spectra were obtained with the FAST spectrograph at the FLWO 1.5m telescope and reduced in a consistent manner, making data set well suited for studies of SN Ia spectroscopic diversity. We study the spectroscopic and photometric properties of SN Ia as a function of spectroscopic class using the classification schemes of Branch et al. and Wang et al. The width-luminosity relation appears to be steeper for SN Ia with broader lines. Based on the evolution of the characteristic Si II 6355 line, we propose improved methods for measuring velocity gradients, revealing a larger range than previously suspected, from ~0 to ~400 km/s/day considering the instantaneous velocity decline rate at maximum light. We find a weaker and less significant correlation between Si II velocity and intrinsic B-V color at maximum light than reported by Foley et al., owing to a more ...

  1. Diagnostic value of magnetic resonance lymphography in preoperative staging of clinically negative necks in squamous cell carcinoma of the oral cavity: A pilot study

    NARCIS (Netherlands)

    Wensing, B.M.; Deserno, W.M.L.L.G.; Bondt, R.B. de; Marres, H.A.M.; Merkx, M.A.W.; Barentsz, J.O.; Hoogen, F.J. van den

    2011-01-01

    Pilot study evaluating the diagnostic value of magnetic resonance lymphography (MRL) compared with conventional imaging techniques in the preoperative staging of the clinically (palpable) negative neck (cN0) in squamous cell carcinoma of the oral cavity (SCCOC). Patients with SCCOC without clinical

  2. Avaliação clínica da eficácia da combinação paracetamol e cafeína no tratamento da cefaléia tipo tensão Clinical evaluation of the efficacy of the acetaminophen and caffeine combination in the treatment of tension headache

    Directory of Open Access Journals (Sweden)

    GETÚLIO DARÉ RABELLO

    2000-03-01

    Full Text Available A cefaléia tipo tensão em suas duas modalidades, episódica e crônica, é a forma mais comum de dor de cabeça na população. O tratamento é feito com medidas não farmacológicas e farmacológicas, tanto para o ataque como profilaxia das crises. Este estudo foi realizado com 5490 pacientes, que procuraram ambulatórios e consultórios médicos em várias regiões do Brasil. Cerca de 95% apresentavam cefaléia tipo tensão episódica e 5% cefaléia tipo tensão crônica. A maioria dos pacientes apresentou crises de intensidade moderada (62,19%. Em 5419 pacientes uma crise de cefaléia tipo tensão foi tratada com 1000 mg de paracetamol e 130 mg de cafeína. Em 93,98% início de melhora foi observado em até 2 horas após a ingestão da medicação. Em 77,61% houve reversão completa da crise em até 2 horas. Avaliação da eficácia boa/excelente foi observada em 51,93%/37,80% dos casos quando feita pelos médicos e em 48,51%/40,29 quando pelos pacientes. Efeitos adversos, em geral manifestações gastrointestinais, foram observados em 5,57%. Este estudo representa uma experiência brasileira no tratamento de ataque da cefaléia tipo tensão, demonstrando eficácia e segurança no uso da combinação paracetamol-cafeína.Tension type headache in both its forms, episodic and chronic, is the most common type of headache experienced by the population. The headache attack or the prevention of new crises may be treated with pharmacological as well as non-pharmacological measures. This study included 5,490 patients from out-patient clinics and medical offices covering various regions of Brazil. Approximately 95% of the subjects had episodic tension type headache, while 5% had chronic tension type headache. The majority of the patients presented with crisis of moderate intensity (62.19%. In 5,419 patients a tension type headache crisis was treated with acetaminophen 1000 mg and caffeine 130 mg. In 93.98%, onset of relief occurred within 2 hours of

  3. Management and outcomes of clinical stage IIA/B seminoma: Results from the National Cancer Data Base 1998-2012.

    Science.gov (United States)

    Paly, Jonathan J; Lin, Chun Chieh; Gray, Phillip J; Hallemeier, Christopher L; Beard, Clair; Sineshaw, Helmneh; Jemal, Ahmedin; Efstathiou, Jason A

    Disease-specific survival for testicular seminoma approaches 100%, even for those with node-positive disease. We sought to describe modern practice patterns, survival outcomes, and factors associated with postoperative therapy for patients with clinical stage (CS) IIA/B disease. Data on patients diagnosed with CS IIA/B seminoma from 1998 to 2012 were extracted from the National Cancer Data Base. Demographic, clinical, treatment, and payer characteristics were evaluated using multivariate regression to identify factors associated with receipt of chemotherapy or radiation therapy (RT) within 6 months of orchiectomy. Five-year Kaplan-Meier overall survival (OS) by CS and treatment was calculated. A Cox proportional hazards regression for 5-year OS was performed. A total of 1885 patients were included; 38.5% received chemotherapy and 61.5% received RT. On multivariate analysis, factors associated with receipt of postorchiectomy RT rather than chemotherapy included CS IIA (odds ratio [OR], 3.04; P < .01) and community treatment setting (OR, 1.81-2.76; P < .01). Reduced likelihood of receiving RT was associated with Medicaid insurance (OR, 0.50; P < .01), more recent year of diagnosis (continuous OR, 0.93; P < .01), and primary pathologic tumor 3/4 stage (OR, 0.47; P < .01). On multivariate Cox regression, decreased 5-year OS was associated with receipt of chemotherapy in CS IIA patients (hazard ratio, 13.33; P < .01) but not in CS IIB patients (hazard ratio, 1.39; P = .45). For CS IIA, 5-year OS was 99.4% for orchiectomy and RT versus 91.2% for orchiectomy and chemotherapy (log-rank P < .01). For CS IIB, 5-year OS was 96.1% for orchiectomy and RT versus 92.8% for orchiectomy and chemotherapy (log-rank P = .08). Consistent with national guideline recommendations, our analysis supports preferred status for RT in CS IIA. In addition, these data also support use of RT for CS IIB. CS, treatment year, primary pathologic tumor stage, insurance, and facility type were

  4. Photometric classification of type Ia supernovae in the SuperNova Legacy Survey with supervised learning

    CERN Document Server

    Möller, A; Leloup, C; Neveu, J; Palanque-Delabrouille, N; Rich, J; Carlberg, R; Lidman, C; Pritchet, C

    2016-01-01

    In the era of large astronomical surveys, photometric classification of supernovae (SNe) has become an important research field due to limited spectroscopic resources for candidate follow-up and classification. In this work, we present a method to photometrically classify type Ia supernovae based on machine learning with redshifts that are derived from the SN light-curves. This method is implemented on real data from the SNLS deferred pipeline, a purely photometric pipeline that identifies SNe Ia at high-redshifts ($0.2stages: feature extraction (obtaining the SN redshift from photometry and estimating light-curve shape parameters) and machine learning classification. We study the performance of different algorithms such as Random Forest and Boosted Decision Trees. We evaluate the performance using SN simulations and real data from the first 3 years of the Supernova Legacy Survey (SNLS), which contains large spectroscopically and photometrically classified type Ia sa...

  5. Tratamento das cefaléias Treatment of headaches

    Directory of Open Access Journals (Sweden)

    José Luiz Dias Gherpelli

    2002-08-01

    Full Text Available Objetivo: realizar revisão bibliográfica sobre o tema tratamento da cefaléia na infância e adolescência. Fontes dos dados: revisão bibliográfica através do banco de dados Medline, utilizando os termos: cefaléia, enxaqueca ou migrânea, infância ou adolescência e tratamento, no período de 1966 a 2001, excluindo artigos de revisão e registros de casos. Foram selecionados artigos científicos que relataram estudos sobre a eficácia da terapêutica farmacológica e não farmacológica no tratamento das cefaléias primárias. Síntese dos dados: foram encontrados 104 artigos científicos, sendo selecionados aqueles que relataram estudos do tipo caso-controle, ou droga versus placebo, cegos ou abertos, e que estudassem crianças ou adolescentes. Conclusões: é digna de nota a pobreza de estudos controlados sobre o tema na faixa etária pediátrica, apesar da importância que as cefaléias primárias apresentam na prática clínica. Apenas algumas drogas foram estudadas de forma cientificamente adequada e, mesmo assim, o número de estudos é pequeno. Tanto o tratamento da crise álgica aguda quanto a profilaxia da cefaléia foram abordados.Objective: to perform a bibliographic review about headache treatment in childhood and adolescence. Sources: articles were searched through Medline database using the terms: migraine, or headache, childhood, or adolescence, and treatment, during the period between 1966 and 2001. Review articles and case reports were excluded. Only articles dealing with pharmacological, and non-pharmacological treatment of primary headaches were selected. Summary of the findings: a total of 104 articles were found; only those reporting results of the case-control studies, or drug vs. placebo, either blind, or open, and that included children, or adolescents were selected. Conclusions: only a few controlled studies about the headache treatment were found in the pediatric age group, although primary headaches are

  6. Analysis of stage and clinical/prognostic factors for colon and rectal cancer from SEER registries: AJCC and collaborative stage data collection system.

    Science.gov (United States)

    Chen, Vivien W; Hsieh, Mei-Chin; Charlton, Mary E; Ruiz, Bernardo A; Karlitz, Jordan; Altekruse, Sean F; Ries, Lynn A G; Jessup, J Milburn

    2014-12-01

    The Collaborative Stage (CS) Data Collection System enables multiple cancer registration programs to document anatomic and molecular pathology features that contribute to the Tumor (T), Node (N), Metastasis (M) - TNM - system of the American Joint Committee on Cancer (AJCC). This article highlights changes in CS for colon and rectal carcinomas as TNM moved from the AJCC 6th to the 7th editions. Data from 18 Surveillance, Epidemiology, and End Results (SEER) population-based registries were analyzed for the years 2004-2010, which included 191,361colon and 73,341 rectal carcinomas. Overall, the incidence of colon and rectal cancers declined, with the greatest decrease in stage 0. The AJCC's 7th edition introduction of changes in the subcategorization of T4, N1, and N2 caused shifting within stage groups in 25,577 colon and 10,150 rectal cancers diagnosed in 2010. Several site-specific factors (SSFs) introduced in the 7th edition had interesting findings: 1) approximately 10% of colon and rectal cancers had tumor deposits - about 30%-40% occurred without lymph node metastases, which resulted in 2.5% of colon and 3.3% of rectal cases becoming N1c (stage III A/B) in the AJCC 7th edition; 2) 10% of colon and 12% of rectal cases had circumferential radial margins Cancer Society.

  7. Bioinformatics Analysis Reveals Distinct Molecular Characteristics of Hepatitis B-Related Hepatocellular Carcinomas from Very Early to Advanced Barcelona Clinic Liver Cancer Stages.

    Directory of Open Access Journals (Sweden)

    Fan-Yun Kong

    Full Text Available Hepatocellular carcinoma (HCCis the fifth most common malignancy associated with high mortality. One of the risk factors for HCC is chronic hepatitis B virus (HBV infection. The treatment strategy for the disease is dependent on the stage of HCC, and the Barcelona clinic liver cancer (BCLC staging system is used in most HCC cases. However, the molecular characteristics of HBV-related HCC in different BCLC stages are still unknown. Using GSE14520 microarray data from HBV-related HCC cases with BCLC stages from 0 (very early stage to C (advanced stage in the gene expression omnibus (GEO database, differentially expressed genes (DEGs, including common DEGs and unique DEGs in different BCLC stages, were identified. These DEGs were located on different chromosomes. The molecular functions and biology pathways of DEGs were identified by gene ontology (GO analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG pathway analysis, and the interactome networks of DEGs were constructed using the NetVenn online tool. The results revealed that both common DEGs and stage-specific DEGs were associated with various molecular functions and were involved in special biological pathways. In addition, several hub genes were found in the interactome networks of DEGs. The identified DEGs and hub genes promote our understanding of the molecular mechanisms underlying the development of HBV-related HCC through the different BCLC stages, and might be used as staging biomarkers or molecular targets for the treatment of HCC with HBV infection.

  8. Bioinformatics Analysis Reveals Distinct Molecular Characteristics of Hepatitis B-Related Hepatocellular Carcinomas from Very Early to Advanced Barcelona Clinic Liver Cancer Stages

    Science.gov (United States)

    Hu, Wei; Kou, Yan-Bo; You, Hong-Juan; Liu, Xiao-Mei; Zheng, Kui-Yang; Tang, Ren-Xian

    2016-01-01

    Hepatocellular carcinoma (HCC)is the fifth most common malignancy associated with high mortality. One of the risk factors for HCC is chronic hepatitis B virus (HBV) infection. The treatment strategy for the disease is dependent on the stage of HCC, and the Barcelona clinic liver cancer (BCLC) staging system is used in most HCC cases. However, the molecular characteristics of HBV-related HCC in different BCLC stages are still unknown. Using GSE14520 microarray data from HBV-related HCC cases with BCLC stages from 0 (very early stage) to C (advanced stage) in the gene expression omnibus (GEO) database, differentially expressed genes (DEGs), including common DEGs and unique DEGs in different BCLC stages, were identified. These DEGs were located on different chromosomes. The molecular functions and biology pathways of DEGs were identified by gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and the interactome networks of DEGs were constructed using the NetVenn online tool. The results revealed that both common DEGs and stage-specific DEGs were associated with various molecular functions and were involved in special biological pathways. In addition, several hub genes were found in the interactome networks of DEGs. The identified DEGs and hub genes promote our understanding of the molecular mechanisms underlying the development of HBV-related HCC through the different BCLC stages, and might be used as staging biomarkers or molecular targets for the treatment of HCC with HBV infection. PMID:27454179

  9. IAS 41 Agriculture: Fair Value Accounting

    Directory of Open Access Journals (Sweden)

    Viorel Lefter

    2007-05-01

    Full Text Available Issuing this standard that had to be applied for the first time for the financial statements started after 1.01.2003 meant a change of direction from two points of view: on one hand, through IAS 41 was issued for the first time an extensive standard typical for this sector and, on the other hand, for the first time were included in the income statement, independently from the sales transactions, incomes from variations of the fair value of an asset. Because of this last aspect, IAS 41 can be considered an important standard, because it represents the starting point of a consistent transition from the purchase cost principle towards a fair value accounting. IASC has dedicated to the thematic field of agriculture a specific standard, because this economic branch has a great importance for the developing countries. On the other hand, IAS 41 is also applied for the agricultural activities of the enterprises from other sectors.

  10. New approaches to SNe Ia progenitors

    CERN Document Server

    Ruiz-Lapuente, Pilar

    2014-01-01

    Although Type Ia supernovae (SNe Ia) are a major tool in cosmology and play a key role in the chemical evolution of galaxies, the nature of their progenitor systems (apart from the fact that they must be close binaries containing at least one white dwarf) remains largely unknown. In the last decade, considerable efforts have been made, both observationally and theoretically, to solve this problem. Observations have, however, revealed a previously unsuspected variety of events, ranging from very underluminous outbursts to clearly overluminous ones, and spanning a range well outside the peak luminosity--decline rate of the light curve relationship, used to make calibrated candles of the SNe Ia. On the theoretical side, new explosion scenarios, such as violent mergings of pairs of white dwarfs, have been explored. We review those recent developments, emphasizing the new observational findings, but also trying to tie them to the different scenarios and explosion mechanisms proposed thus far.

  11. RSIADB, a collective resource for genome and transcriptome analyses in Rhizoctonia solani AG1 IA.

    Science.gov (United States)

    Chen, Lei; Ai, Peng; Zhang, Jinfeng; Deng, Qiming; Wang, Shiquan; Li, Shuangcheng; Zhu, Jun; Li, Ping; Zheng, Aiping

    2016-01-01

    Rice [Oryza sativa (L.)] feeds more than half of the world's population. Rhizoctonia solaniis a major fungal pathogen of rice causing extreme crop losses in all rice-growing regions of the world. R. solani AG1 IA is a major cause of sheath blight in rice. In this study, we constructed a comprehensive and user-friendly web-based database, RSIADB, to analyse its draft genome and transcriptome. The database was built using the genome sequence (10,489 genes) and annotation information for R. solani AG1 IA. A total of six RNAseq samples of R. solani AG1 IA were also analysed, corresponding to 10, 18, 24, 32, 48 and 72 h after infection of rice leaves. The RSIADB database enables users to search, browse, and download gene sequences for R. solani AG1 IA, and mine the data using BLAST, Sequence Extractor, Browse and Construction Diagram tools that were integrated into the database. RSIADB is an important genomic resource for scientists working with R. solani AG1 IA and will assist researchers in analysing the annotated genome and transcriptome of this pathogen. This resource will facilitate studies on gene function, pathogenesis factors and secreted proteins, as well as provide an avenue for comparative analyses of genes expressed during different stages of infection. Database URL:http://genedenovoweb.ticp.net:81/rsia/index.php.

  12. [From classification medicine to clinical medicine (the end of the XVIII century--1870s). Communication 2. The first stage of clinical medicine development: introduction of the method of clinico-anatomic correlations].

    Science.gov (United States)

    2011-01-01

    The first stage of clinical medicine development is analysed which covers the period from early 1800s to middle 1870s. Considered are basic research achievements associated with introduction of the method of clinico-anatomic correlations into practical medicine.

  13. Clinical characteristics and outcomes of end-stage renal disease patients with self-reported pruritus symptoms.

    Science.gov (United States)

    Ramakrishnan, Karthik; Bond, T Christopher; Claxton, Ami; Sood, Vipan C; Kootsikas, Maria; Agnese, Wendy; Sibbel, Scott

    2013-01-01

    One of the most common conditions affecting end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) is pruritus. Studies report that itchy and dry skin, symptoms of pruritus, affect 40%-90% of ESRD patients. Yet, in clinical practice the condition is often underdiagnosed resulting in inadequate management and an underappreciated impact on patient outcomes. Two retrospective analyses were conducted: a preliminary analysis of ESRD patients with pruritus symptoms (n=73,124) undergoing HD or peritoneal dialysis at a large dialysis provider and a subsequent detailed analysis of a homogenous subset of patients undergoing in-center HD (n=38,315). The goal was to better understand the clinical burden of pruritus as it relates to patient characteristics, quality of life, medication use, and HD compliance. This population is commonly burdened by multiple comorbidities and related polypharmaceutical management; identifying the relationship of pruritus to these ailments can help guide future research and resource allocation. The detailed analysis confirmed trends observed in the preliminary analysis: 30% reported being "moderately" to "extremely bothered" by itchiness. The HD patient population with the highest severity of self-reported pruritus also had a consistent trend in overall increased resource utilization - higher monthly doses of erythropoietin-stimulating agents (53,397.1 to 63,405.4 units) and intravenous (IV) iron (237.2 to 247.6 units) and higher use of IV antibiotics (14.1% to 20.7%), as well as poorer quality-of-life measures (25-point reductions in Burden of Disease Score and Effects on Daily Life subscales of the Kidney Disease Quality of Life-36 survey). These results highlight the need to better identify and manage ESRD patients impacted by pruritus, as this symptom is associated with negative clinical outcomes and increased resource utilization. Further studies are needed to evaluate the current economic burden of pruritus in ESRD patients and

  14. Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Pandey, Vivek; Khanna, Vikrant; Madi, Sandesh; Tripathi, Anshul; Acharya, Kiran

    2017-06-01

    Medial collateral ligament (MCL) is a prime valgus stabilizer of the knee, and MCL tears are currently managed conservatively. However, posteromedial corner (PMC) injury along with MCL tear is not same as isolated MCL tear and the former is more serious injury and requires operative attention. However, literature is scarce about the management and outcome of PMC-MCL tear alongside anterior cruciate ligament (ACL) tear. The purpose of this study is to report the clinical outcome of primary repair of MCL and PMC with or without staged ACL reconstruction. A retrospective evaluation was performed on patients with MCL-PMC complex injury with ACL tear who underwent primary repair of MCL-PMC tear followed by rehabilitation. Further, several of them chose to undergo ACL reconstruction whereas rest opted conservative treatment for the ACL tear. A total of 35 patients of two groups [Group 1 (n=15): MCL-PMC repaired and ACL conserved; Group 2 (n=20): MCL-PMC repaired and ACL reconstructed] met the inclusion criteria with a minimum follow-up of two years. Clinical outcome measures included grade of valgus medial opening (0° extension and 30° flexion), Lysholm and International knee documentation committee (IKDC) scores, KT-1000 measurement, subjective feeling of instability, range of motion (ROM) assessment and complications. While comparing group 2 versus group 1, mean Lysholm (94.6 vs. 91.06; p=0.017) and IKDC scores (86.3 vs. 77.6; p=0.011) of group 2 were significantly higher than group 1. 60% patients of group 1 complained of instability against none in the group 2 (p<0.0001). All the knees of both the groups were valgus stable with none requiring late reconstruction. The mean loss of flexion ROM in group 1 and 2 was 12° and 9° respectively which was not statistically different (p=0.41). However while considering the loss of motion, two groups did not show any significant difference in clinical scores. Primary MCL-PMC repair renders the knee stable in coronal plane in

  15. Correlation between the preoperative serum prostate specific antigen, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy: An Indian experience

    Directory of Open Access Journals (Sweden)

    P Singh

    2011-01-01

    Full Text Available Objectives: To correlate the preoperative serum prostate specific antigen (PSA, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy (RARP in Indian men with clinically localized cancer prostate. Materials and Methods: A prospective study analysis was done for 166 consecutive patients of prostate cancer who underwent RARP at our center from June 2006 to October 2009. Preoperative workup included serum PSA, biopsy Gleason score, and clinical staging. The preoperative parameters were correlated with final Gleason score, capsular penetration, seminal vesicle involvement, and lymph node status on final histopathology. Results: The mean age was 64 years (range: 50-76 years with mean and median PSA of 17.98 ng/ml (range: 0.3-68.3 ng/ml and 12.1 ng/ml, respectively. With increase in preoperative Gleason score, chance of organ confinement decreases (P=0.002 and capsular penetration increases (P=0.004 linearly. With increasing serum PSA, there is linear decrease in trend of organ-confined disease (P=0.03 and increased chances of seminal vesicle involvement (P=0.02. Patients with higher clinical stage have less probability of localized disease (P=0.007 and more chances of capsular penetration (P=0.04 and seminal vesicle involvement (P=0.004. Conclusion: Our data suggest that patients with higher preoperative serum PSA, Gleason score, and clinical stage have more chances of advanced pathological stage following RARP.

  16. The Impact of Clinical Stage on Radiation Doses to Organs at Risk Following Intensity-modulated Radiotherapy in Nasopharyngeal Carcinoma: A Prospective Analysis.

    Science.gov (United States)

    Xu, Lin; Yao, Ji-Jin; Zhou, Guan-Qun; Zhang, Wang-Jian; Liu, Guo-Long; Liu, Li-Zhi; Ma, Jun; Sun, Ying

    2016-01-01

    Background: The development of intensity-modulated radiotherapy (IMRT) has revolutionized the management of nasopharyngeal carcinoma (NPC). The purpose of this study was to investigate the impact of clinical stage on radiation doses to organs at risk (OARs) in NPC. Material and Methods: One hundred and forty-eight patients with newly diagnosed and untreated NPC were prospectively enrolled. Based on the anatomic definition and pathogenesis of radiation induced injury, a total of 28 OARs surrounding the nasopharynx were contoured on axial computed tomography (CT) planning images in each patient. Dose-volume histograms, as well as the mean and maximal doses for each structure, were calculated. Results: Radiation doses to 15 OARs (including the brain stem, temporal lobe and eye) were positively correlated with T stage, the radiation doses to 13 OARs (including the brachial plexus, parotid and thyroid) increased significantly with N stage, and the radiation doses to the spinal cord and mandible had no association with T or N stage. Based on the characteristic of excess rates, 9 OARs (e.g. spinal cord, eye, trachea, and et al.) met tolerance doses easily in all stages, 9 OARs (e.g. brain stem, temporal lobe, brachial plexus, and et al.) easily in early stages but with difficulty in advanced stages, and 10 OARs (e.g. cochlea, parotid, thyroid, and et al.) with difficulty in all stages. Conclusions: The radiation doses to most of OARs are associated with T or N stage, and there are three kinds of patterns for them: 1) meet tolerance doses easily in all stages; 2) meet tolerance doses easily in early stages but with difficulty in advanced stages; and 3) meet tolerance doses with difficulty in all stages.

  17. The surgical management of early-stage cervical cancer.

    Science.gov (United States)

    Salicrú, Sabina R; de la Torre, Javier F V; Gil-Moreno, Antonio

    2013-08-01

    The main objective is to update the literature data in the last year which may support a surgical approach to early cervical cancer [ECC; Stage International Federation of Gynecology and Obstetrics (FIGO) IA-IB1-IIA1]. Radical hysterectomy remains the gold standard by most international guidelines because surgical treatment has hardly changed in recent decades, except for stage IA1. Trends in clinical research in the past 12-18 months involve minimal invasive surgery (with laparoscopic surgery or robotic-assisted surgery), fertility preservation (in the initial stages and in the absence of bad prognostic factors), nerve-sparing and sentinel node techniques. Some institutions have published studies in specific groups such as older, obese or pregnant women. There is a growing trend to practice less aggressive surgery in order to preserve fertility in young women and avoid an excess of treatment in some selected patients. Therefore, nerve-sparing techniques can help to improve the quality of life. More studies are needed to demonstrate oncologic results of the sentinel node technique. Laparoscopic and robotic-assisted surgery can substitute open surgical treatment.

  18. Bioengineered human IAS reconstructs with functional and molecular properties similar to intact IAS.

    Science.gov (United States)

    Singh, Jagmohan; Rattan, Satish

    2012-09-15

    Because of its critical importance in rectoanal incontinence, we determined the feasibility to reconstruct internal anal sphincter (IAS) from human IAS smooth muscle cells (SMCs) with functional and molecular attributes similar to the intact sphincter. The reconstructs were developed using SMCs from the circular smooth muscle layer of the human IAS, grown in smooth muscle differentiation media under sterile conditions in Sylgard-coated tissue culture plates with central Sylgard posts. The basal tone in the reconstructs and its changes were recorded following 0 Ca(2+), KCl, bethanechol, isoproterenol, protein kinase C (PKC) activator phorbol 12,13-dibutyrate, and Rho kinase (ROCK) and PKC inhibitors Y-27632 and Gö-6850, respectively. Western blot (WB), immunofluorescence (IF), and immunocytochemical (IC) analyses were also performed. The reconstructs developed spontaneous tone (0.68 ± 0.26 mN). Bethanechol (a muscarinic agonist) and K(+) depolarization produced contraction, whereas isoproterenol (β-adrenoceptor agonist) and Y-27632 produced a concentration-dependent decrease in the tone. Maximal decrease in basal tone with Y-27632 and Gö-6850 (each 10(-5) M) was 80.45 ± 3.29 and 17.76 ± 3.50%, respectively. WB data with the IAS constructs' SMCs revealed higher levels of RhoA/ROCK, protein kinase C-potentiated inhibitor or inhibitory phosphoprotein for myosin phosphatase (CPI-17), phospho-CPI-17, MYPT1, and 20-kDa myosin light chain vs. rectal smooth muscle. WB, IF, and IC studies of original SMCs and redispersed from the reconstructs for the relative distribution of different signal transduction proteins confirmed the feasibility of reconstruction of IAS with functional properties similar to intact IAS and demonstrated the development of myogenic tone with critical dependence on RhoA/ROCK. We conclude that it is feasible to bioengineer IAS constructs using human IAS SMCs that behave like intact IAS.

  19. Postactivation depression of the Ia EPSP in motoneurons is reduced in both the G127X SOD1 model of amyotrophic lateral sclerosis and in aged mice

    DEFF Research Database (Denmark)

    Hedegaard, Anne; Lehnhoff, Janna; Moldovan, Mihai

    2015-01-01

    Post Activation Depression (PActD) of Ia afferent EPSPs in spinal motoneurons results in a long lasting depression of the stretch reflex. PActD is of clinical interest as it has been shown to be reduced in a number of spastic disorders. Using in vivo intracellular recordings of Ia EPSPs in adult ...

  20. Survival rates according to barcelona clinic liver cancersub-staging system after transarterial embolization forintermediate hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Leandro Armani Scaffaro; Steffan Frosi Stella; Mario Reis Alvares-Da-Silva; Cleber Dario Pinto Kruel

    2015-01-01

    AIM To investigate the survival rates after transarterialembolization (TAE).METHODS: One hundred third six hepatocellularcarcinoma (HCC) patients [90 barcelona clinic livercancer (BCLC) B] were submitted to TAE betweenAugust 2008 and December 2013 in a single centerwere retrospectively studied. TAE was performed viasuperselective catheterization followed by embolizationwith polyvinyl alcohol or microspheres. The date of thefirst embolization until death or the last follow-up datewas used for the assessment of survival. The survivalrates were calculated using the Kaplan-Meier method,and the groups were compared using the log-rank test.RESULTS: The overall mean survival was 35.8 mo(95%CI: 25.1-52.0). The survival rates of the BCLC Apatients (33.7%) were 98.9%, 79.0% and 58.0% at12, 24 and 36 mo, respectively, and the mean survivalwas 38.1 mo (95%CI: 27.5-52.0). The survival rates ofthe BCLC B patients (66.2%) were 89.0%, 69.0% and49.5% at 12, 24 and 36 mo, respectively, and the meansurvival was 29.0 mo (95%CI: 17.2-34). The survivalrates according to the BCLC B sub-staging showedsignificant differences between the groups, with meansurvival rates in the B1, B2, B3 and B4 groups of 33.5mo (95%CI: 32.8-34.3), 28.6 mo (95%CI: 27.5-29.8),19.0 mo (95%CI: 17.2-20.9) and 13 mo, respectively (P= 0.013).CONCLUSION: The BCLC sub-staging systemcould add additional prognosis information for postembolizationsurvival rates in HCC patients.

  1. Radiofrequency ablation versus resection for Barcelona clinic liver cancer very early/early stage hepatocellular carcinoma: a systematic review

    Directory of Open Access Journals (Sweden)

    He ZX

    2016-02-01

    Full Text Available Zhen-Xin He,1 Pu Xiang,2 Jian-Ping Gong,1 Nan-Sheng Cheng,3 Wei Zhang4 1Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 2State Key Laboratory of Biotherapy and Cancer Center, 3Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, 4Department of Hepatobiliary Surgery, Yue Bei People’s Hospital, Shaoguan, Guangdong, People’s Republic of China Aim: To compare the long-term survival outcomes of radiofrequency ablation and liver resection for single very early/early stage hepatocellular carcinoma (HCC. Methods: The Cochrane Library (Issue 3, 2015, Embase (1974 to March 15, 2015, PubMed (1950 to March 15, 2015, Web of Science (1900 to March 15, 2015, and Chinese Biomedical Literature Database (1978 to March 15, 2015 were searched to identify relevant trials. Only trials that compared radiofrequency ablation and liver resection for single very early stage (≤2 cm or early stage (≤3 cm HCC according to the Barcelona clinic liver cancer (BCLC staging system were considered for inclusion in this review. The primary outcomes that we analyzed were the 3-year and 5-year overall survival (OS rates, and the secondary outcomes that we analyzed were the 3-year and 5-year disease-free survival (DFS rates. Review Manager 5.3 was used to perform a cumulative meta-analysis. Possible publication bias was examined using a funnel plot. A random-effects model was applied to summarize the various outcomes. Results: Six studies involving 947 patients were identified that compared radiofrequency ablation (n=528 to liver resection (n=419 for single BCLC very early HCC. In these six studies, the rates of 3-year OS, 5-year OS, 3-year DFS, and 5-year DFS were significantly lower in the radiofrequency ablation group than in the liver resection group (risk ratio [RR] =0.90, 95% confidence interval [CI]: 0.83–0.98, P=0.01; RR =0.84, 95% CI: 0.75–0.95, P=0.004; RR =0.77, 95% CI

  2. Differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer

    Directory of Open Access Journals (Sweden)

    Kim IY

    2015-11-01

    Full Text Available Ik Yong Kim,1,* Bo Ra Kim,2,* Hyun Soo Kim,2 Young Wan Kim1 1Department of Surgery, Division of Colorectal Surgery, 2Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea *These authors contributed equally to this work Purpose: To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery.Methods: A total of 100 consecutive stage IV patients undergoing open (n=61 or laparoscopic (n=39 major resection were analyzed. There were four cases (10% of conversion to laparotomy in the laparoscopy group.Results: Pathological T4 tumors (56% vs 26%, primary colon cancers (74% vs 51%, and larger tumor diameter (6 vs 5 cm were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39% and low anterior resection was more common in the laparoscopy group (39%, P=0.002. Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100% than with open surgery (56%, although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups.Conclusion: Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage

  3. Risk of nodal metastases at laparoscopic pelvic lymphadenectomy using PSA, Gleason score, and clinical stage in men with localized prostate cancer.

    Science.gov (United States)

    Hoenig, D M; Chi, S; Porter, C; Tackett, L; Smith, D S; Cohen, S I; Stein, B S

    1997-08-01

    Laparoscopic pelvic lymph node dissection (LPLND) is a low-morbidity procedure used to stage prostate cancer accurately prior to definitive local therapy. To better select patients for LPLND, we reviewed the clinical features of 120 patients with clinically localized prostate cancer who underwent LPLND to define significant risk factors for nodal metastases. The age ranged from 43 to 79 years (mean 68). Serum prostate specific antigen (PSA) concentration ranged from 1.3 to 329 ng/mL, Gleason score ranged from 2 to 9, and clinical stage ranged from T1b to T3c. Nodal metastases were discovered in 15 patients (13%). Among men with a Gleason score > or = 7, 21% had nodal metastases (P = 0.004). A serum PSA > 20 ng/mL and clinical stage T1b, T2b, or greater also were statistically significant predictors of lymph node metastases (20% and 19%, respectively). In multivariate analysis, Gleason score significantly predicted nodal metastases when controlling for all other clinical measures. Therefore, LPLND is indicated for any patient with a Gleason score > or = 7, PSA > 20 ng/mL, and advanced clinical T stage, independently or in combination.

  4. Clinical Association of Thyroid Stimulating Hormone Receptor Antibody Levels with Disease Severity in the Chronic Inactive Stage of Graves' Orbitopathy.

    Science.gov (United States)

    Woo, Young Jae; Jang, Sun Young; Lim, Tyler Hyung Taek; Yoon, Jin Sook

    2015-08-01

    To investigate associations between serum thyroid stimulating hormone (TSH) receptor antibody (TRAb) levels and Graves' orbitopathy (GO) activity/severity in chronic-stage GO and compare the performance of two newly-developed TRAb assays (third-generation TSH-binding inhibition immunoglobulin [TBII] assay versus Mc4 thyroid-stimulating immunoglobulin [TSI] bioassay). This study is a retrospective review of medical charts and blood tests from Korean GO patients who first visited the departments of ophthalmology and endocrinology, Yonsei University College of Medicine from January 2008 to December 2011, were diagnosed with GO and Graves' hyperthyroidism, and were followed up for ≥18 months. Third-generation M22-TBII and Mc4-TSI assays were performed in the chronic-inactive GO patients in whom euthyroidism status was restored. Patients' GO activity/severity clinical activity scores (CAS), and modified NOSPECS scores were examined for a correlation with TRAb assays. Fifty patients (mean age, 41.3 years; 41 females) were analyzed. The mean duration of Graves' hyperthyroidism symptom was 63 months (range, 18 to 401 months) and that of GO was 46 months (range, 18 to 240 months). All patients had been treated previously with anti-thyroid drugs for a median period of 52.3 months, and two patients underwent either radioiodine therapy or total thyroidectomy. Mean CAS and NOSPECS scores were 0.5 ± 0.9 (standard deviation) and 4.8 ± 3.1, respectively. Mean M22-TBII and Mc4-TSI values were 7.5 ± 10.2 IL/L and 325.9 ± 210.1 specimen-to-reference control ratio. TSI was significantly correlated with NOSPECS score (R = 0.479, p 0.05), because GO inflammatory activity subsided in the chronic stages of GO. In chronic-inactive GO after euthyroid restoration, GO activity score did not associate with serum levels of TRAb or TBII. However, levels of the functional antibody Mc4-TSI did correlate with GO severity. Therefore, the TSI bioassay is a clinically relevant measure of disease

  5. Evaluation of angiographic delayed vasospasm due to ruptured aneurysm in comparison with cerebral circulation time measured by IA-DSA

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Yoshikazu; Shima, Takeshi; Nishida, Masahiro; Yamane, Kanji; Okita, Shinji; Hatayama, Takashi; Yoshida, Akira; Naoe, Yasutaka; Shiga, Naoko (Chugoku Rosai Hospital, Hiroshima (Japan))

    1994-05-01

    Delayed vasospasm due to ruptured aneurysm has been basically evaluated by angiographic changes in contrast to clinical features such as delayed ischemic neurological deficits (DIND). However, the discrepancies between angiographic and clinical findings have been pointed out. In this study, angiographic changes and cerebral circulation time in ruptured aneurysms were simultaneously investigated with IA-DSA. Thirty-two patients, who had ruptured aneurysms at the anterior circle of Willis and neck clippings at the acute stage, were investigated. Carotid angiogram was performed with IA-DSA on the 7-13th day after the attack. Angiographic changes were evaluated by Fischer's classification and circulation time was calculated in the following way. A time-density curve was obtained at the two ROI's: the C3-C4 portion and the rolandic vein. Circulation time was defined by the difference between the time showing peak optical density at the carotid and the venous portion. The control value of this circulation time obtained from 20 cases with non-rupture aneurysm and epilepsy was 3.4 sec (53 year old) on the average. X-ray CT scan examination was performed at the same time and clinical features were observed every day. Angiographically, 3 cases were free from vasospasm, 18 cases were found to present slight to moderate vasospasm, and 11 cases showed severe vasospasm. Circulation time in patients with no spasm was 3.6 seconds, in patients with slight to moderate vasospasm it was 4.3 seconds and in patients with severe vasospasm it was 6.8 seconds. Ten patients showing cerebral infarction on CT scans demonstrated significantly long circulation time, 7.0 seconds on the average. And all patients having severe vasospasm with circulation time more than 6 seconds presented DIND such as hemiparesis. (author).

  6. Penerapan PSAK Adopsi IAS 41 Agriculture

    Directory of Open Access Journals (Sweden)

    Stefanus Ariyanto

    2014-05-01

    Full Text Available This study aims to determine whether the application of PSAK adopted from IAS 41: Agriculture should be applied to State-Owned Enterprises, especially the plantation SOE. So that the SOE financial information produced becomes more useful for decision-making. Furthermore, this study wants to answer what benefits can be obtained from the implementation of this standard on the plantation-based SOE. The main characteristic of IAS is the use of fair value model for biological assets owned by the agriculture-based entity. The use of this model raises a lot of controversy, primarily, associated with relevant quality and reliability of the information it produces. Research used qualitative method with data collection through literature study, survey, interview, and observation. Survey and interview were divided into two major parts, which were: on the compilers of financial statements and the stakeholders. From this study it can be concluded that the PSAK based on IAS 41 have not to be implemented yet in the near future due to IAS 41 will undergo quite significant revision. Currently, the State-Owned Enterprises could use the PSAK plantation SOE that has been issued.

  7. 75 FR 11582 - IOWA Disaster # IA-00023

    Science.gov (United States)

    2010-03-11

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION IOWA Disaster IA-00023 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  8. 78 FR 28939 - Iowa Disaster #IA-00050

    Science.gov (United States)

    2013-05-16

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00050 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  9. 78 FR 36010 - Iowa Disaster #IA-00052

    Science.gov (United States)

    2013-06-14

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00052 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  10. 76 FR 66768 - Iowa Disaster #IA-00033

    Science.gov (United States)

    2011-10-27

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00033 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for the State of Iowa...

  11. 75 FR 51507 - Iowa Disaster #IA-00024

    Science.gov (United States)

    2010-08-20

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00024 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for the State of Iowa...

  12. 75 FR 53006 - Iowa Disaster #IA-00026

    Science.gov (United States)

    2010-08-30

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00026 AGENCY: U.S. Small Business Administration. ACTION: Amendment 2. SUMMARY: This is an amendment of the Presidential declaration of a major disaster for Public Assistance Only...

  13. 76 FR 55721 - Iowa Disaster #IA-00038

    Science.gov (United States)

    2011-09-08

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00038 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  14. 76 FR 54522 - Iowa Disaster #IA-00037

    Science.gov (United States)

    2011-09-01

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00037 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  15. 76 FR 54521 - Iowa Disaster #IA-00036

    Science.gov (United States)

    2011-09-01

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00036 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major ] disaster for Public Assistance Only for...

  16. 76 FR 29284 - Iowa Disaster #IA-00031

    Science.gov (United States)

    2011-05-20

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00031 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  17. 76 FR 27738 - Iowa Disaster #IA-00030

    Science.gov (United States)

    2011-05-12

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00030 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the State of Iowa dated...

  18. 78 FR 42147 - Iowa Disaster #IA-00054

    Science.gov (United States)

    2013-07-15

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00054 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance only for...

  19. 75 FR 45681 - Iowa Disaster #IA-00025

    Science.gov (United States)

    2010-08-03

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00025 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  20. 75 FR 47035 - Iowa Disaster # IA-00026

    Science.gov (United States)

    2010-08-04

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00026 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance only for...

  1. 76 FR 52042 - Iowa Disaster #IA-00035

    Science.gov (United States)

    2011-08-19

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00035 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the State of Iowa Dated....

  2. 75 FR 10329 - Iowa Disaster #IA-00022

    Science.gov (United States)

    2010-03-05

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Iowa Disaster IA-00022 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for...

  3. Single Degenerate Progenitors of Type Ia Supernovae

    Science.gov (United States)

    Bours, Madelon; Toonen, Silvia; Nelemans, Gijs

    2013-01-01

    There is a general agreement that Type Ia supernovae correspond to the thermonuclear runaway of a white dwarf (WD) in a compact binary. The details of these progenitor systems are still unclear. Using the population synthesis code SeBa and several assumption for the WD retention efficiency, we estimate the delay times and supernova rates for the single degenerate scenario.

  4. 78 FR 48762 - Iowa Disaster #IA-00053

    Science.gov (United States)

    2013-08-09

    ... ADMINISTRATION Iowa Disaster IA-00053 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This...: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement... of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW., Suite...

  5. Probing Cosmological Isotropy With Type IA Supernovae

    CERN Document Server

    Bengaly, C A P; Alcaniz, J S

    2015-01-01

    We investigate the validity of the Cosmological Principle by mapping the cosmological parameters $H_0$ and $q_0$ through the celestial sphere. In our analysis, performed in a low-redshift regime to follow a model-independent approach, we use two compilations of type Ia Supernovae (SNe Ia), namely the Union2.1 and the JLA datasets. Firstly, we show that the angular distributions for both SNe Ia datasets are statistically anisotropic at high confidence level ($p$-value $<$ 0.0001), in particular the JLA sample. Then we find that the cosmic expansion and acceleration are mainly of dipolar type, with maximal anisotropic expansion [acceleration] pointing towards $(l,b) \\simeq (326^{\\circ},12^{\\circ})$ [$(l,b) \\simeq (174^{\\circ},27^{\\circ})$], and $(l,b) \\simeq (58^{\\circ},-60^{\\circ})$ [$(l,b) \\simeq (225^{\\circ},51^{\\circ})$] for the Union2.1 and JLA data, respectively. Secondly, we use a geometrical method to test the hypothesis that the non-uniformly distributed SNe Ia events could introduce anisotropic imp...

  6. Merging white dwarfs and SN Ia

    CERN Document Server

    Yungelson, L R

    2016-01-01

    Using population synthesis, we study a double-degenerate (DD) scenario for SNe Ia, aiming to estimate the maximum possible contribution to the rate of SNe from this scenario and the dependence of the delay-time distribution (DTD) on it. We make an extreme assumption that all mergers of super-Chandrasekhar pairs of CO white dwarfs (WDs) and mergers of CO WDs more massive than 0.47 $M_\\odot$ with hybrid or helium WDs more massive than 0.37$M_\\odot$ produce SNe Ia. The models are parametrized by the product of the common envelope efficiency and the parameter of binding energy of stellar envelopes $\\alpha_{ce}\\lambda$, which we vary between 0.25 and 2. The best agreement with observations is obtained for $\\alpha_{ce}\\lambda$=2. A substantial contribution to the rate of SNe Ia is provided by the pairs with a hybrid WD. The estimated Galactic rate of SNe Ia is $6.5 10^{-3}$ per yr (for the mass of the bulge and thin disk equal to $7.2 10^{10} M_\\odot$), which is comparable to the observational estimate $(5.4\\pm0.12...

  7. IAS 17 Leases - A Closer Look

    OpenAIRE

    Muthupandian, K S

    2009-01-01

    The International Accounting Standards Committee issued the the International Accounting Standard 17, Leases. The objective of IAS 17 is to prescribe, for lessees and lessors, the appropriate accounting treatment and disclosures to apply in relation to leases. This article presents a closer look of standard (objective, scope, definitions, accounting treatment, recognition, presentation and disclosures).

  8. A comparative study between cleavage stage embryo transfer at day 3 and blastocyst stage transfer at day 5 in in-vitro fertilization/intra-cytoplasmic sperm injection on clinical pregnancy rates.

    Science.gov (United States)

    Kaur, Prabhleen; Swarankar, M L; Maheshwari, Manju; Acharya, Veena

    2014-07-01

    To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage transfer. A randomized, prospective study was conducted in Infertility clinic, Department of Obstetrics and Gynecology, Mahatma Gandhi Hospital, Jaipur on 300 patients aged 25-40 years undergoing in-vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) cycle from May 2010-April 2011. When three or more Grade-I embryos were observed on day 2 of culture, patients were divided randomly into two study groups, cleavage stage transfer and blastocyst transfer group having 150 patients each. Primary outcomes evaluated were, Clinical pregnancy rate and Implantation rate. The results were analyzed using proportions, standard deviation and Chi-square test. Both the groups were similar for age, indication and number of embryos transferred. Clinical pregnancies after blastocyst transfer were significantly higher 66 (44.0%) compared to cleavage stage embryo transfer 44 (29.33%) (P < 0.01). Implantation rate for blastocyst transfer group was also significantly higher (P < 0.001). Blastocyst transfer having higher implantation rate and clinical pregnancy rate lead to reduction in multiple pregnancies.

  9. A comparative study between cleavage stage embryo transfer at day 3 and blastocyst stage transfer at day 5 in in-vitro fertilization/intra-cytoplasmic sperm injection on clinical pregnancy rates

    Directory of Open Access Journals (Sweden)

    Prabhleen Kaur

    2014-01-01

    Full Text Available Objective: To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage transfer. Study Design: A randomized, prospective study was conducted in Infertility clinic, Department of Obstetrics and Gynecology, Mahatma Gandhi Hospital, Jaipur on 300 patients aged 25-40 years undergoing in-vitro fertilization (IVF/intra-cytoplasmic sperm injection (ICSI cycle from May 2010-April 2011. When three or more Grade-I embryos were observed on day 2 of culture, patients were divided randomly into two study groups, cleavage stage transfer and blastocyst transfer group having 150 patients each. Primary outcomes evaluated were, Clinical pregnancy rate and Implantation rate. The results were analyzed using proportions, standard deviation and Chi-square test. Results: Both the groups were similar for age, indication and number of embryos transferred. Clinical pregnancies after blastocyst transfer were significantly higher 66 (44.0% compared to cleavage stage embryo transfer 44 (29.33% (P < 0.01.Implantation rate for blastocyst transfer group was also significantly higher (P < 0.001. Conclusion: Blastocyst transfer having higher implantation rate and clinical pregnancy rate lead to reduction in multiple pregnancies.

  10. IA-2及IA-2β与1型糖尿病

    Institute of Scientific and Technical Information of China (English)

    宗阳; 罗敏

    2000-01-01

    IA-2和IA-2β是近年来发现的两种重要胰岛细胞自身抗原,是引发1型糖尿病胰岛自身免疫反应的重要因素.针对两者的自身抗体存在于半数以上的新诊1型糖尿病患者血清中.IA-2、IA-2β及其抗体检测在1型糖尿病的发病机制研究、诊断、预测和早期防治中具有重要作用.

  11. Barcelona clinic liver cancer nomogram and others staging/scoring systems in a French hepatocellular carcinoma cohort

    Science.gov (United States)

    Adhoute, Xavier; Pénaranda, Guillaume; Raoul, Jean Luc; Edeline, Julien; Blanc, Jean-Frédéric; Pol, Bernard; Campanile, Manuela; Perrier, Hervé; Bayle, Olivier; Monnet, Olivier; Beaurain, Patrick; Muller, Cyril; Castellani, Paul; Le Treut, Yves Patrice; Bronowicki, Jean Pierre; Bourlière, Marc

    2017-01-01

    AIM To compare the performances of the Barcelona clinic liver cancer (BCLC) nomogram and others systems (BCLC, HKLC, CLIP, NIACE) for survival prediction in a large hepatocellular carcinoma (HCC) French cohort. METHODS Data were collected retrospectively from 01/2007 to 12/2013 in five French centers. Newly diagnosed HCC patients were analyzed. The discriminatory ability, homogeneity ability, prognostic stratification ability Akaike information criterion (AIC) and C-index were compared among scoring systems. RESULTS The cohort included 1102 patients, mostly men, median age 68 [60-74] years with cirrhosis (81%), child-Pugh A (73%), alcohol-related (41%), HCV-related (27%). HCC were multinodular (59%) and vascular invasion was present in 41% of cases. At time of HCC diagnosis BCLC stages were A (17%), B (16%), C (60%) and D (7%). First line HCC treatment was curative in 23.5%, palliative in 59.5%, BSC in 17% of our population. Median OS was 10.8 mo [4.9-28.0]. Each system distinguished different survival prognosis groups (P < 0.0001). The nomogram had the highest discriminatory ability, the highest C-index value. NIACE score had the lowest AIC value. The nomogram distinguished sixteen different prognosis groups. By classifying unifocal large HCC into tumor burden 1, the nomogram was less powerful. CONCLUSION In this French cohort, the BCLC nomogram and the NIACE score provided the best prognostic information, but the NIACE could even help treatment strategies. PMID:28465639

  12. Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC

    Directory of Open Access Journals (Sweden)

    Marcio Aurelio Aita

    Full Text Available ABSTRACT OBJECTIVE: To compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC or four-corner fusion (FCF. METHOD: Twenty-seven patients aged 18-59 years (mean 37.52 years were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM; pain assessment with a visual analog scale (VAS; grip strength; disability of the arm, shoulder, and hand (DASH; and return to work were evaluated. RESULTS: Group A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23% and in Group B, 8/14 (57.14% patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B. CONCLUSION: The clinical and functional results do not present statistically significant differences for both analyzed methods.

  13. 75 FR 37292 - Amendment of Class E Airspace; Cherokee, IA

    Science.gov (United States)

    2010-06-29

    ... Cherokee, IA. Decommissioning of the Pilot Rock non-directional beacon (NDB) at Cherokee County Regional Airport, Cherokee, IA has made this action necessary to enhance the safety and management of Instrument... Federal Aviation Administration 14 CFR Part 71 Amendment of Class E Airspace; Cherokee, IA AGENCY:...

  14. 76 FR 73501 - Amendment of Class E Airspace; Carroll, IA

    Science.gov (United States)

    2011-11-29

    ... Carroll, IA. Decommissioning of the Carroll non-directional beacon (NDB) at Arthur N. Neu Airport, Carroll, IA, has made this action necessary to enhance the safety and management of Instrument Flight Rule... Federal Aviation Administration 14 CFR Part 71 Amendment of Class E Airspace; Carroll, IA AGENCY:...

  15. Expression of I-A and I-E,C region-coded Ia antigens on functional B cell subpopulations.

    Science.gov (United States)

    Frelinger, J A; Hibbler, F J; Hill, S W

    1978-12-01

    Ia antigens from specific subregions have been examined on functional B cell populations. Expression of both I-A and I-E,C region antigens was demonstrated on cells required for both lipopolysaccharide mitogenesis and polyclonal activation. Similar I-A and I-E,C subregion expression was found on cells required for response to the T-independent antigen, polyvinylpyrrolidone. TNP-specific IgM and hen egg lysozyme-specific IgG plaque-forming cells also express I-A and I-E,C region antigens. No evidence was found for an Ia- population responsive in the systems tested. Further, no evidence of preferential expression of I-A or I-E,C region antigens was observed in any system examined. Therefore, it appears that B cells express both I-A and I-E,C region-coded Ia antigens.

  16. Outcomes of Positron Emission Tomography-Staged Clinical N3 Breast Cancer Treated With Neoadjuvant Chemotherapy, Surgery, and Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hae Jin [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Shin, Kyung Hwan, E-mail: radiat@ncc.re.kr [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Cho, Kwan Ho [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Park, In Hae; Lee, Keun Seok; Ro, Jungsil; Jung, So-Youn; Lee, Seeyoun; Kim, Seok Won; Kang, Han-Sung [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Chie, Eui Kyu; Ha, Sung Whan [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2011-12-01

    Purpose: To evaluate the treatment outcome and efficacy of regional lymph node irradiation after neoadjuvant chemotherapy (NCT) and surgery in positron emission tomography (PET)-positive clinical N3 (cN3) breast cancer patients. Methods and Materials: A total of 55 patients with ipsilateral infraclavicular (ICL), internal mammary (IMN), or supraclavicular (SCL) lymph node involvement in the absence of distant metastases, as revealed by an initial PET scan, were retrospectively analyzed. The clinical nodal stage at diagnosis (2002 AJCC) was cN3a in 14 patients (26%), cN3b in 12 patients (22%), and cN3c in 29 patients (53%). All patients were treated with NCT, followed by mastectomy or breast-conserving surgery and subsequent radiotherapy (RT) with curative intent. Results: At the median follow-up of 38 months (range, 9-80 months), 20 patients (36%) had developed treatment failures, including distant metastases either alone or combined with locoregional recurrences that included one ipsilateral breast recurrence (IBR), six regional failures (RF), and one case of combined IBR and RF. Only 3 patients (5.5%) exhibited treatment failure at the initial PET-positive clinical N3 lymph node. The 5-year locoregional relapse-free survival, disease-free survival (DFS), and overall survival rates were 80%, 60%, and 79%, respectively. RT delivered to PET-positive IMN regions in cN3b patients and at higher doses ({>=}55 Gy) to SCL regions in cN3c patients was not associated with improved 5-year IMN/SCL relapse-free survival or DFS. Conclusion: NCT followed by surgery and RT, including the regional lymph nodes, resulted in excellent locoregional control for patients with PET-positive cN3 breast cancer. The primary treatment failure in this group was due to distant metastasis rather than RF. Neither higher-dose RT directed at PET-positive SCL nodes nor coverage of PET-positive IMN nodes was associated with additional gains in locoregional control or DFS.

  17. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the Clinical and Pathologic Staging of Small Cell Lung Cancer in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer.

    Science.gov (United States)

    Nicholson, Andrew G; Chansky, Kari; Crowley, John; Beyruti, Ricardo; Kubota, Kaoru; Turrisi, Andrew; Eberhardt, Wilfried E E; van Meerbeeck, Jan; Rami-Porta, Ramón

    2016-03-01

    Small cell lung cancer (SCLC) is commonly classified as either limited or extensive, but the Union for International Cancer Control TNM Classification of Malignant Tumours seventh edition (2009) recommended tumor, node, and metastasis (TNM) staging based on analysis of the International Association for the Study of Lung Cancer (IASLC) database. Survival analyses were performed for clinically and pathologically staged patients presenting with SCLC from 1999 through 2010. Prognosis was compared in relation to the TNM seventh edition staging to serve as validation and analyzed in relation to proposed changes to the T descriptors found in the eighth edition. There were 5002 patients: 4848 patients with clinical and 582 with pathological stages. Among these, 428 had both. Survival differences were confirmed for T and N categories and maintained in relation to proposed revisions to T descriptors for seventh edition TNM categories and proposed changes in the eighth edition. There were also survival differences, notably at 12 months, in patients with brain-only single-site metastasis (SSM) compared to SSM at other sites, and SSM without a pleural effusion showed a better prognosis than other patients in the M1b category. We confirm the prognostic value of clinical and pathological TNM staging in patients with SCLC, and recommend continued usage for SCLC in relation to proposed changes to T, N, and M descriptors for NSCLC in the eighth edition. However, for M descriptors, it remains uncertain whether survival differences in patients with SSM in the brain simply reflect better treatment options rather than better survival based on anatomic extent of disease. Copyright © 2015 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  18. Evaluation of the appropriateness of the preclinical phase (stage A and stage B) of heart failure Management in Outpatient clinics in Italy rationale and design of the 'VASTISSIMO' study.

    Science.gov (United States)

    Mureddu, Gian F; Nistri, Stefano; Faggiano, Pompilio; Fimiani, Biagio; Misuraca, Gianfranco; Maggi, Antonio; Gori, Anna M; Uguccioni, Massimo; Tavazzi, Luigi; Zito, Giovanni B

    2016-07-01

    Early detection of heart failure, when still preclinical, is fundamental. Therefore, it is important to assess whether preclinical heart failure management by cardiologists is adequate. The VASTISSIMO study ('EValuation of the AppropriateneSs of The preclInical phase (Stage A and Stage B) of heart failure Management in Outpatient clinics in Italy') is a prospective nationwide study aimed to evaluate the appropriateness of diagnosis and management of preclinical heart failure (stages A and B) by cardiologists working in outpatient clinics in Italy. Secondary goals are to verify if an online educational course for cardiologists can improve management of preclinical heart failure, and evaluate how well cardiologists are aware of patients' adherence to medications. The study involves 80 outpatient cardiology clinics distributed throughout Italy, affiliated either to the Hospital Cardiologists Association or to the Regional Association of Outpatient Cardiologists, and is designed with two phases of consecutive outpatient enrolment each lasting 1 month. In phase 1, physicians' awareness of the risk of heart failure and their decision-making process are recorded. Subsequently, half of the cardiologists are randomized to undergo an online educational course aimed to improve preclinical heart failure management through implementation of guideline recommendations. At the end of the course, all cardiologists are evaluated (phase 2) to see whether changes in clinical management have occurred in those who underwent the educational program versus those who did not. Patients' adherence to prescribed medications will be assessed through the Morisky Self-report Questionnaire. This study should provide valuable information about cardiologists' awareness of preclinical heart failure and the appropriateness of clinical practice in outpatient cardiology clinics in Italy.

  19. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update.

    Science.gov (United States)

    Lyman, Gary H; Somerfield, Mark R; Bosserman, Linda D; Perkins, Cheryl L; Weaver, Donald L; Giuliano, Armando E

    2016-12-12

    Purpose To provide current recommendations on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer. Methods PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from 2012 through July 2016. An Update Panel reviewed the identified abstracts. Results Of the eight publications identified and reviewed, none prompted a change in the 2014 recommendations, which are reaffirmed by the updated literature review. Conclusion Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND (in most cases). Women with SLN metastases who will undergo mastectomy should be offered ALND. These three recommendations are based on randomized controlled trials. Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ, who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB. Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or are pregnant should not undergo SNB.

  20. A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b).

    Science.gov (United States)

    Saglam, Remzi; Muslumanoglu, Ahmet Yaser; Tokatlı, Zafer; Caşkurlu, Turhan; Sarica, Kemal; Taşçi, Ali İhsan; Erkurt, Bülent; Süer, Evren; Kabakci, Ahmet Sinan; Preminger, Glenn; Traxer, Olivier; Rassweiler, Jens J

    2014-12-01

    An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296±544 mm(3) [range: 432-3100 mm3]) in an observational study (IDEAL stage 2). Robotic FURS was performed with the Roboflex Avicenna robotic device. Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. Mean robot docking time was 59.6±45 s. Mean operative time was 74min (range: 40-182). Mean fragmentation speed was 29.1±6.1 mm3/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p<0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement

  1. 75 FR 16067 - Designation for the Champaign, IL; Emmett, MI; Davenport, IA; Enid, OK; Keokuk, IA; Marshall, MI...

    Science.gov (United States)

    2010-03-31

    ... Register (74 FR 45803), GIPSA requested applications for designation to provide official services in the...; Davenport, IA; Enid, OK; Keokuk, IA; Marshall, MI; and Omaha, NE Areas AGENCY: Grain Inspection, Packers and.... Detroit Emmett, MI (810-395-2105) 4/1/2010 3/31/2013 Eastern Iowa Davenport, IA (563-322-7149). 4/1/2010...

  2. FGFR4 Gly388Arg polymorphism may affect the clinical stage of patients with lung cancer by modulating the transcriptional profile of normal lung.

    Science.gov (United States)

    Falvella, Felicia S; Frullanti, Elisa; Galvan, Antonella; Spinola, Monica; Noci, Sara; De Cecco, Loris; Nosotti, Mario; Santambrogio, Luigi; Incarbone, Matteo; Alloisio, Marco; Calabrò, Elisa; Pastorino, Ugo; Skaug, Vidar; Haugen, Aage; Taioli, Emanuela; Dragani, Tommaso A

    2009-06-15

    The association of the fibroblast growth factor receptor 4 (FGFR4) Gly388Arg polymorphism with clinical stage and overall survival in a series of 541 Italian lung adenocarcinoma (ADCA) patients indicated a significantly decreased survival in patients carrying the rare Arg388 allele as compared to that in Gly/Gly homozygous patients [hazard ratio (HR) = 1.5; 95% confidence interval (CI) 1.1-1.9], with the decrease related to the association of the same polymorphism with clinical stage (HR = 1.8, 95% CI 1.3-2.6). By contrast, no significant association was detected in small series of either Norwegian lung ADCA patients or Italian lung squamous cell carcinoma (SQCC) patients. Single nucleotide polymorphisms of known FGFR4 ligands expressed in lung (FGF9, FGF18 and FGF19) were not associated with clinical stage or survival and showed no interaction with FGFR4. Analysis of gene expression profile in normal lungs according to FGFR4 genotype indicated a specific transcript pattern associated with the allele carrier status, suggesting a functional role for the FGFR4 polymorphism already detectable in normal lung. These findings confirm the significant association of the FGFR4 Gly388Arg polymorphism with clinical stage and overall survival in an Italian lung ADCA population and demonstrate a FGFR4 genotype-dependent transcriptional profile present in normal lung tissue.

  3. The value of pre operative S-100B and SUV in clinically stage III melanoma patients undergoing therapeutic lymph node dissection

    NARCIS (Netherlands)

    Kruijff, S.; Bastiaannet, E.; Speijers, M. J.; Kobold, A. C. M.; Brouwers, A. H.; Hoekstra, H. J.

    2011-01-01

    Introduction: High preoperative serum S-100B values and Standardized Uptake Values (SUV) of Fluorodeoxyglucose (FDG) in PET for clinically stage III melanoma patients could be indicators of recurrence after surgical treatment. Aim was to assess the correlation and the prognostic value of these marke

  4. Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients with Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study

    Science.gov (United States)

    Karupaiah, Tilakavati; Wong, Kimberly; Chinna, Karuthan; Arasu, Kanimolli; Chee, Winnie Siew Swee

    2015-01-01

    The CORFIS ("Community-Based Cardiovascular Risk Factors Intervention Strategies") program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in…

  5. Extended Cancer Education for Longer-Term Survivors in Primary Care for Patients With Stage I-II Breast or Prostate Cancer or Stage I-III Colorectal Cancer

    Science.gov (United States)

    2017-08-01

    Stage I Breast Cancer; Stage I Colorectal Cancer AJCC v6 and v7; Stage I Prostate Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage II Colorectal Cancer AJCC v7; Stage II Prostate Cancer; Stage IIA Breast Cancer; Stage IIA Colorectal Cancer AJCC v7; Stage IIA Prostate Cancer; Stage IIB Breast Cancer; Stage IIB Colorectal Cancer AJCC v7; Stage IIB Prostate Cancer; Stage IIC Colorectal Cancer AJCC v7; Stage III Colorectal Cancer AJCC v7; Stage IIIA Colorectal Cancer AJCC v7; Stage IIIB Colorectal Cancer AJCC v7; Stage IIIC Colorectal Cancer AJCC v7

  6. An analysis of meiotic stage of nondisjunction and clinical characteristics in 27 children with Down syndrome and leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Shugar, A. [New York General Hospital, Ontario (Canada); Soukup, S. [Children`s Hospital Medical Center, Cincinnati, OH (United States)

    1994-09-01

    The observation that children with Down syndrome experience a significantly increased risk for leukemia was made in the 1950`s. Recent research has revealed that two specific forms of leukemia, acute non-lymphoblastic leukemia (specifically the subtype M7) and transient leukemia (TL) are preferentially associated with trisomy 21. The specific association of these leukemias with trisomy 21 has suggested to others that there may be a gene on chromosome 21 which predisposes to TL and M7 leukemia. If a recessive gene for susceptibility existed, then trisomies arising as a duplication of one parental centromere through a mitotic or meiosis II error would be expected to have a higher frequency of TL and M7 leukemia. The purpose of this study was (i) To test the models which propose that disomic homozygosity is preponderant in cases of TL and M7 leukemia in a Down syndrome population (ii) To further characterize the clinical characteristics of leukemia in the Down syndrome population. We utilized a combination of cytogenetic and DNA polymorphism analyses to determine stage of non-disjunction and parental orgin of the extra chromosome in 18 children with Down syndrome and leukemia. The DNA analyses are reported elsewhere. Among 27 cases of Down Syndrome leukemics, meiosis II or mitotic errors were seen in 4 out of 5 informative TL and M7 cases and in only 1 out of 5 cases of other leukemias. Clinical analysis revealed that the frequency of M7 leukemia is significantly higher in DS-leukemics compared to non-Down syndrome-leukemics. A case of Down syndrome TL with subsequent development of M7 leukemia was anecdotal evidence that TL and M7 leukemia may be of common clonal origin. The fact that fewer than 100% of TL and M7 leukemia cases demonstrated meiosis II or mitotic errors indicates that disomic homozygosity is not necessary for the development of these leukemias, however it may be an important factor which predisposes to TL and M7 leukemia in Down syndrome.

  7. The Healthy Start Renal Clinic: Benefits of Tracking and Early Intervention in Pre-End Stage Renal Disease Patients

    Science.gov (United States)

    Self, Ida; Lindberg, Jill; Filangeri, Judith; Anderson, Shannon; Szerlip, Marjorie; Best, Julie; Sadler, Rebecca; Savoie, Judy; Jackson, Dina; James, Carla; Husserl, Fred; Copely, J. Brian

    1999-01-01

    Several studies have demonstrated a strong association between the benefits of pre-end stage renal disease (ESRD) education and decreased length of hospital stay (LOS) and hospital charges, delay of renal replacement therapy (RRT), and a smooth transition to RRT. The Ochsner Healthy Start Renal Clinic (HSRC) is a multidisciplinary early education and tracking program for pre-ESRD patients and their families. We identified and educated pre-ESRD patients about kidney disease, allowing them to discuss and make informed decisions about their treatment and be better prepared to cope with the transition to RRT and the changes in their lives resulting from kidney failure. HSRC patients demonstrated a significant decrease in length of hospital stay (p = 0.05), a trend towards decreased hospital episodes and charges, decreased use of temporary venous access, and a smooth transition to RRT. The control group was made up of patients who had either refused the structured education or had been referred to HSRC late and received only conventional instruction by a social worker at the point where dialysis was imminent. We compared the number of episodes of hospitalization, LOS, and overall hospital charges for the period immediately surrounding initiation of chronic dialysis (2 months before and 1 month following onset) of all 36 patients who began chronic hemodialysis in our facility between November 1997 and November 1998. HSRC patients had LOS half as long (p=0.05), fewer hospital episodes, and hospital charges of $5,000 less per patient than the non-HSRC group. Initial data strongly suggest that early education and intervention through the coordination of a multidisciplinary team maximize the continuity of patient care. PMID:21845139

  8. Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic 
Malignancies: Video-assisted Thoracoscopic Thymectomy versus Open Approaches

    Directory of Open Access Journals (Sweden)

    Hao WANG

    2016-07-01

    Full Text Available Background and objective Video-assisted thoracoscopic surgery (VATS theoretically offers advantages over open thymectomy for clinically early-stage (Masaoka-Koga stage I and II thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas (ChART. Methods Between 1994 and 2012, data of 1,117 patients having surgery for clinically early-stage (Masaoka-Koga stage I and II tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy (VATS group, while 876 cases underwent open thymectomy (Open group. Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival. Results Compared with the Open group, the VATS group had higher percentage of total thymectomy (80.5% vs 73.9%, P=0.028, resection rate (98.8% vs 88.7%, P<0.001 and less recurrence (2.9% vs 16.0%, P<0.001. Five-year overall survival was 92% after VATS and 92% after open thymectomy, with no significant difference between the two groups (P=0.15. However, 5-year disease free survival were 92% in VATS group and 83% in Open group (P=0.011. Cox proportional hazards model revealed that WHO classification, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no significant impact on long-term outcome. Conclusion This study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malignancies. And it may offer better perioperative outcomes, as well as equal oncological survival.

  9. Birthrates and delay times of Type Ia supernovae

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Type Ia supernovae (SNe Ia) play an important role in diverse areas of astrophysics, from the chemical evolution of galaxies to observational cosmology. However, the nature of the progenitors of SNe Ia is still unclear. In this paper, according to a detailed binary population synthesis study, we obtained SN Ia birthrates and delay times from different progenitor models, and compared them with observations. We find that the Galactic SN Ia birthrate from the double-degenerate (DD) model is close to those inferred from observations, while the birthrate from the single-degenerate (SD) model accounts for only about 1/2-2/3 of the observations. If a single starburst is assumed, the distribution of the delay times of SNe Ia from the SD model is a weak bimodality, where the WD + He channel contributes to the SNe Ia with delay times shorter than 100 Myr, and the WD + MS and WD + RG channels to those with age longer than 1 Gyr.

  10. Coréia aguda na gravidez

    Directory of Open Access Journals (Sweden)

    Walter C. Pereira

    1967-12-01

    Full Text Available São apresentados doze casos de coréia aguda observados entre 150.000 gestantes (1/12.500. A maioria dos surtos ocorreu no segundo trimestre da primeira gravidez. A duração média dos sintomas foi de três meses, não tendo sido registrado caso algum de óbito materno. Todos os partos foram espontâneos e normais. Houve apenas um óbito fetal conseqüente a choque hemorrágico. São tecidas considerações a propósito dos aspectos clínico, laboratorial e prognóstico da coréia gravídica, sendo focalizado mais pormenorizadamente o problema fisiopatogênico dessa afecção.

  11. Single degenerate supernova type Ia progenitors

    CERN Document Server

    Bours, M C P; Nelemans, G

    2013-01-01

    There is general agreement that supernovae Ia correspond to the thermonuclear runaway of a white dwarf that is part of a compact binary, but the details of the progenitor systems are still unknown and much debated. One of the proposed progenitor theories is the single-degenerate channel in which a white dwarf accretes from a companion, grows in mass, reaches a critical mass limit, and is then consumed after thermonuclear runaway sets in. However, there are major disagreements about the theoretical delay time distribution and the corresponding time-integrated supernova Ia rate from this channel. We investigate whether the differences are due to the uncertainty in the common envelope phase and the fraction of transferred mass that is retained by the white dwarf. This so-called retention efficiency may have a strong influence on the final amount and timing of supernovae Ia. Using the population synthesis code SeBa, we simulated large numbers of binaries for various assumptions on common envelopes and retention e...

  12. New mutation type in pseudohypoparathyroidism type Ia.

    Science.gov (United States)

    Fernandez-Rebollo, Eduardo; Barrio, Raquel; Pérez-Nanclares, Gustavo; Carcavilla, Atilano; Garin, Intza; Castaño, Luis; de Nanclares, Guiomar Pérez

    2008-11-01

    The GNAS gene encodes the alpha-subunit of the stimulatory G proteins, which play a crucial role in intracellular signal transduction of peptide and neurotransmitter receptors. Heterozygous inactivating maternally inherited mutations of GNAS (including translation initiation mutations, amino acid substitutions, nonsense mutations, splice site mutations and small insertions or deletions) lead to a phenotype in which Albright hereditary osteodystrophy is associated with pseudohypoparathyroidism type Ia. We sought to identify the molecular defect in a patient who was thought to have PHP-Ia. The GNAS gene of a 5-year-old boy with brachydactily, mental retardation, pseudohypoparathyroidism and congenital hypothyroidism was investigated. We found a heterozygous inversion of exon 2 and part of intron 1 of de novo origin. Molecular studies of cDNA from blood RNA demonstrated that both the normal and the mutant variants were stable and that new splice-sites were generated. This report demonstrates the first evidence for an inversion at the GNAS gene responsible of pseudohypoparathyroidism type Ia.

  13. Shock Breakout from Type Ia Supernova

    CERN Document Server

    Piro, Anthony L; Weinberg, Nevin N

    2009-01-01

    The mode of explosive burning in Type Ia SNe remains an outstanding problem. It is generally thought to begin as a subsonic deflagration, but this may transition into a supersonic detonation (the DDT). We argue that this transition leads to a breakout shock, which would provide the first unambiguous evidence that DDTs occur. Its main features are a hard X-ray flash (~20 keV) lasting ~0.01 s with a total radiated energy of ~10^{40} ergs, followed by a cooling tail. This creates a distinct feature in the visual light curve, which is separate from the nickel decay. This cooling tail has a maximum absolute visual magnitude of M_V = -9 to -10 at approximately 1 day, which depends most sensitively on the white dwarf radius at the time of the DDT. As the thermal diffusion wave moves in, the composition of these surface layers may be imprinted as spectral features, which would help to discern between SN Ia progenitor models. Since this feature should accompany every SNe Ia, future deep surveys (e.g., m=24) will see i...

  14. Simulation of multi-stage nonlinear bone remodeling induced by fixed partial dentures of different configurations: a comparative clinical and numerical study.

    Science.gov (United States)

    Liao, Zhipeng; Yoda, Nobuhiro; Chen, Junning; Zheng, Keke; Sasaki, Keiichi; Swain, Michael V; Li, Qing

    2017-04-01

    This paper aimed to develop a clinically validated bone remodeling algorithm by integrating bone's dynamic properties in a multi-stage fashion based on a four-year clinical follow-up of implant treatment. The configurational effects of fixed partial dentures (FPDs) were explored using a multi-stage remodeling rule. Three-dimensional real-time occlusal loads during maximum voluntary clenching were measured with a piezoelectric force transducer and were incorporated into a computerized tomography-based finite element mandibular model. Virtual X-ray images were generated based on simulation and statistically correlated with clinical data using linear regressions. The strain energy density-driven remodeling parameters were regulated over the time frame considered. A linear single-stage bone remodeling algorithm, with a single set of constant remodeling parameters, was found to poorly fit with clinical data through linear regression (low [Formula: see text] and R), whereas a time-dependent multi-stage algorithm better simulated the remodeling process (high [Formula: see text] and R) against the clinical results. The three-implant-supported and distally cantilevered FPDs presented noticeable and continuous bone apposition, mainly adjacent to the cervical and apical regions. The bridged and mesially cantilevered FPDs showed bone resorption or no visible bone formation in some areas. Time-dependent variation of bone remodeling parameters is recommended to better correlate remodeling simulation with clinical follow-up. The position of FPD pontics plays a critical role in mechanobiological functionality and bone remodeling. Caution should be exercised when selecting the cantilever FPD due to the risk of overloading bone resorption.

  15. Lymphography and computed tomography of abdominal nodes in newly diagnosed patients with Hodgkin's disease in clinical stage I-III

    Energy Technology Data Exchange (ETDEWEB)

    Neumann, C.H.

    1986-10-01

    Between 1978 and 1983, 80 patients with Hodgkin's disease (HD) in clinical Stage I-III had computed tomography (CT) of the abdomen and pelvis and lymphography (LAG) prior to staging laparatomy with multiple lymph node biopsies at Stanford University Medical Center. There were 224 biopsied nodal sites. The sensitivity and specificity for CT to determine the status of biopsied paraortic and iliac nodes was .61 and .91 vs. .94 and .90 for LAG. CT appeared of even lower sensitivity (.13) in evaluating splenic hilar, celiac axis and portal nodes. Including all biopsy proven subdiaphragmatic nodal sites, CT's sensitivity to diagnose the presence of subdiaphragmatic adenopathy was .38 vs. .52 in LAG. Assessment of the final pathological stage was more successful by LAG (.61) than by CT (.49). Positive and negative predictive values of both tests indicate higher reliability of LAG results as regards individual intraabdominal nodes (LAG .71, .98 vs. CT .58, .86), the entire subdiaphragmatic nodal area (LAG .79, .77 vs. CT .61, .71) and prediction of final pathological stage. LAG appeared to be the more useful test during initial staging of newly diagnosed and untreated patients with HD. None of the test for itself or in combination can replace laparatomy when exact information is necessary for further clinical decisions.

  16. Brief chemotherapy associated with extended field radiotherapy in Hodgkins disease. Long-term results in a series of 102 patients with clinical stages I-IIIA

    Energy Technology Data Exchange (ETDEWEB)

    Largarde, P.; Eghbali, H.; Bonichon, F.; Mascarel, I. de; Chauvergne, J.; Hoerni, B.

    1988-07-01

    From 1972 to 1976, 102 patients with stages I-IIIA Hodgkin's disease (HD) were treated by chemotherapy with cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP: two courses) associated with extended field radiotherapy. Staging included neither laparotomy nor splenectomy (clinical staging). Treatment included neither splenic irradiation nor maintenance therapy. Complete remission was achieved for 98 patients and 11 of them recurred up to 94 months after treatment. Median follow-up of this controlled study is 13 years. Disease free survival (DFS) is 87% at 6 years and 84% at 10 and 15 years. Overall survival is 77% at 10 and 74% at 15 years. Disease specific survival is better (91% at 10 and 87% at 15 years) since only 38% (10/26) deaths were due to HD. The other deaths (16/26) with no evidence of HD were due to second cancer and intercurrent disease. Prognostic analysis of DFS by log-rank test gives significance to the following factors: contiguous extra-nodal involvement (P = 0.008), more than 3 involved sites (P 0.01), signs of compression (P = 0.02), clinical stage IIIA (P = 0.03), infradiaphragmatic stages I-II (P 0.04). The potential risk of secondary cancer is difficult to assess.

  17. Comparative proteomic study of colorectal carcinoma with different clinical stages%不同临床分期大肠癌组织的蛋白质组学比较研究

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective: Colorectal carcinoma clinical stage associated proteins would be found by comparing differential expressed proteins from colorectal carcinoma tissues with different clinical stages. Methods: Total protein from colorectal carcinoma tissues were extracted; differential proteome profiles were established and analyzed by means of immobilized pH gradient-based two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Results: Well-resolved, reproducible 2-DE profiles of human colorectal carcinoma tissues were obtained. Average protein spots were 970±41,980±32,1010±43,1240±34 in stage Ⅰ, stage Ⅱ,stage Ⅲ, stage Ⅳ respectively; Compared to stage Ⅰ, differential expressed protein spots was 52.00 ± 12 in stage Ⅱ, 42.00± 11 in stage Ⅲ, 72.00 ± 15 in stage Ⅳ; Part of differential expressing proteins were analyzed by mass spectrometry and bioinformation, 19 of them were well characterized. Three proteins were overexpressed in stage Ⅰ, stage Ⅲ, stage Ⅳ, and one protein were overexpressed in stage Ⅳ exclusively. Conclusion: Differential expressed proteins exist in clinical stage of colorectal carcinoma, which would be biomarkers for diagnosis and prediction of prognosis.

  18. Analysis of Bone Mineral Density in Multiple Myeloma: A Comparison of Bone Mineral Density with Plain Radiography, Magnetic Resonance Imaging, and Clinical Staging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Na; Kwon, Soon Tae; Song, Ik Chan [Dept. of Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2013-01-15

    To analyze the bone mineral density (BMD) in multiple myeloma (MM) and to compare BMD with plain radiography, MRI and clinical stage. We reviewed 59 patients with MM and an age- and sex-matched control group, with measured BMD. The L-spine and femoral neck (FN) BMD were measured by dual-energy X-ray absorptiometry. Lateral plain radiographs of the L-spine were graded as 3 stages using the modified Saville index. Four bone marrow patterns were classified on sagittal T1- and T2-weighted magnetic resonance images of the L-spine. BMD in the MM and control group were analyzed. BMD in MM was compared with the modified Saville index, bone marrow patterns on MRI, and clinical stages. In MM, spine BMD was reduced and the difference between spine and FN BMD was larger than the control group (p < 0.001). The modified Saville index was negatively correlated with spine T scores (p < 0.01). The spine BMD in normal marrow pattern on the MRI was the most reduced. There was no statistical correlation between BMD and clinical stage. In MM, spine BMD was significantly reduced and the difference between spine and FN BMD was larger than the control group. The modified Saville index was significantly correlated with spine BMD in MM.

  19. Objective malignancy grading of squamous cell carcinoma of the lung. Stereologic estimates of mean nuclear size are of prognostic value, independent of clinical stage of disease

    DEFF Research Database (Denmark)

    Ladekarl, M; Bæk-Hansen, T; Henrik-Nielsen, R

    1995-01-01

    BACKGROUND: The prognostic value of quantitative histopathologic parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous (N = 39) and mixed, adenosquamous (N = 16) cell type. Patients alive were followed for at least 12 years. METHODS: Using a projec......BACKGROUND: The prognostic value of quantitative histopathologic parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous (N = 39) and mixed, adenosquamous (N = 16) cell type. Patients alive were followed for at least 12 years. METHODS: Using...... of nuclei to tissue, and the number of mitotic profiles per 10(3) nuclear profiles. For each patient, information was recorded regarding sex, age at diagnosis, and clinical stage of disease. RESULTS: Single-factor analyses showed that a favorable prognosis was associated with early clinical stages (Stages I...... volume were found to be parameters of significant, independent prognostic value. CONCLUSIONS: The present feasibility study indicates that estimates of the mean nuclear volume are of prognostic value, independent of the clinical stage of disease. This quantitative histopathologic variable is highly...

  20. Clinical Observation on Therapeutic Effect of Acupuncture and Moxibustion Treatment for Melanoderm's Peripheral Facial Paralysis at Remission Stage

    Institute of Scientific and Technical Information of China (English)

    MA Deng-shang; YANG Ling

    2007-01-01

    The traditional acupuncture and moxibustion therapies were adopted to treat 32cases of melanoderm's peripheral facial paralysis at remission stage, the effective rate was 93.8%, indicating that acupuncture and moxibustion therapies are effective for different races.

  1. Disruption of BMP Signaling in Osteoblasts Through Type IA Receptor (BMPRIA) Increases Bone Mass*

    Science.gov (United States)

    Kamiya, Nobuhiro; Ye, Ling; Kobayashi, Tatsuya; Lucas, Donald J; Mochida, Yoshiyuki; Yamauchi, Mitsuo; Kronenberg, Henry M; Feng, Jian Q; Mishina, Yuji

    2008-01-01

    Bone morphogenetic proteins (BMPs) are known as ectopic bone inducers. The FDA approved BMPs (BMP2 and BMP7) for clinical use. However, direct effects of BMPs on endogenous bone metabolism are not yet well known. We conditionally disrupted BMP receptor type IA (BMPRIA) in osteoblasts during weanling and adult stages to show the impact of BMP signaling on endogenous bone modeling and remodeling. Cre recombination was detected in immature osteoblasts in the periosteum, osteoblasts, and osteocytes but not in chondrocytes and osteoclasts after tamoxifen administration. Bmpr1a conditional knockout mice (cKO) showed increased bone mass primarily in trabecular bone at P21 and 22 wk as determined by H&E staining. Vertebrae, tails, and ribs showed increased radiodensity at 22 wk, consistent with a significant increase in BMD. Both μCT and histomorphometry showed an increase in trabecular BV/TV and thickness of cKO adult bones, whereas osteoclast number, bone formation rate, and mineral apposition rate were decreased. Expression levels of bone formation markers (Runx2 and Bsp), resorption markers (Mmp9, Ctsk, and Tracp), and Rankl were decreased, and Opg was increased in adult bones, resulting in a reduction in the ratio of Rankl to osteoprotegerin (Opg). The reduction in osteoclastogenesis through the RANKL–OPG pathway was also observed in weanling stages and reproduced in newborn calvaria culture. These results suggest that Bmpr1a cKO increased endogenous bone mass primarily in trabecular bone with decreased osteoclastogenesis through the RANKL–OPG pathway. We conclude that BMPRIA signaling in osteoblasts affects both bone formation and resorption to reduce endogenous bone mass in vivo. PMID:18684091

  2. Disruption of BMP signaling in osteoblasts through type IA receptor (BMPRIA) increases bone mass.

    Science.gov (United States)

    Kamiya, Nobuhiro; Ye, Ling; Kobayashi, Tatsuya; Lucas, Donald J; Mochida, Yoshiyuki; Yamauchi, Mitsuo; Kronenberg, Henry M; Feng, Jian Q; Mishina, Yuji

    2008-12-01

    Bone morphogenetic proteins (BMPs) are known as ectopic bone inducers. The FDA approved BMPs (BMP2 and BMP7) for clinical use. However, direct effects of BMPs on endogenous bone metabolism are not yet well known. We conditionally disrupted BMP receptor type IA (BMPRIA) in osteoblasts during weanling and adult stages to show the impact of BMP signaling on endogenous bone modeling and remodeling. Cre recombination was detected in immature osteoblasts in the periosteum, osteoblasts, and osteocytes but not in chondrocytes and osteoclasts after tamoxifen administration. Bmpr1a conditional knockout mice (cKO) showed increased bone mass primarily in trabecular bone at P21 and 22 wk as determined by H&E staining. Vertebrae, tails, and ribs showed increased radiodensity at 22 wk, consistent with a significant increase in BMD. Both muCT and histomorphometry showed an increase in trabecular BV/TV and thickness of cKO adult bones, whereas osteoclast number, bone formation rate, and mineral apposition rate were decreased. Expression levels of bone formation markers (Runx2 and Bsp), resorption markers (Mmp9, Ctsk, and Tracp), and Rankl were decreased, and Opg was increased in adult bones, resulting in a reduction in the ratio of Rankl to osteoprotegerin (Opg). The reduction in osteoclastogenesis through the RANKL-OPG pathway was also observed in weanling stages and reproduced in newborn calvaria culture. These results suggest that Bmpr1a cKO increased endogenous bone mass primarily in trabecular bone with decreased osteoclastogenesis through the RANKL-OPG pathway. We conclude that BMPRIA signaling in osteoblasts affects both bone formation and resorption to reduce endogenous bone mass in vivo.

  3. Tests of Environmental Effects on SN Ia Production

    Science.gov (United States)

    Strolger, Louis-Gregory; van Dyk, Schuyler; Wolff, Schuyler; Campbell, Lachlan; Sadler, Suzanna; Pease, April

    2011-02-01

    The largely unknown type Ia supernova mechanism remains one of the largest sources of possible systematic uncertainty in achieving precise measures of dark energy. The host galaxy environments of SNe Ia provide our best opportunity for constraining the mechanism(s) of the SN Ia progenitor system, i.e., the stars involved, the incubation times, and the sensitivity of SNe Ia to changes in the local gas-phase metallicity. The latter can affect the luminosity of the resultant Ia event, and possibly the success in ultimately yielding a SN Ia event. We seek to solidify possible environmental trends in SN Ia rates from direct measures of host galaxy properties, using the sample collected by the Nearby Galaxies Supernova Search project. This study will uncover which has the greatest influence on SN Ia production efficiency: parent population age, rate of star-formation, or metallicity. Here, we propose to continue our analysis using the Mayall 4m + RCSP to obtain broad SEDs, R_23 metallicities, and star formation rates for 18 of the 25 remaining host galaxies (all z≤0.15) from the NGSS sample (20 targets were obtained in the 2010 semesters). These data will be combined with the remaining sample to be completed in the 2011B semester. The sample will provide a validity test of the mostly indirect trends being established for SNe Ia from the LOSS, SDSS, SNfactory and other surveys, and ultimately steer future investigations towards more precise SN Ia cosmology.

  4. CfA Nearby Supernova Ia Light Curves

    Science.gov (United States)

    Hicken, Malcolm; Berlind, P.; Blondin, S.; Calkins, M.; Challis, P.; Esquerdo, G.; Everett, M.; Fernandez, J.; Jha, S.; Kirshner, R. P.; Latham, D.; Modjaz, M.; Rest, A.; Wood-Vasey, M.

    2007-12-01

    Type Ia supernovae (SN Ia) are central in measuring the accelerated expansion of the Universe and the properties of the underlying dark energy. Nearby SN Ia are compared with distant ones to establish the history of cosmic expansion. In fact, current efforts in SN Ia cosmology are constrained by the limited number of well-observed nearby SN Ia. A significantly improved sample of nearby SN Ia, fully covering the space of Ia properties, is needed to maximize the utility of high-redshift SN Ia. Our ongoing project at the CfA has collected such a set of 170 SN Ia. We have used the FLWO 1.2m telescope. About half of our objects were observed in UBVRI with the 4Shooter camera and have an average of 10 epochs each while the other half was taken in UBVr'i' with the Keplercam instrument and have an average of 17 epochs each. We have now reduced this sample of over 25000 images and present calibrated light curves of these SN Ia along with an analysis of their properties. The CfA Supernova program is supported in part by the National Science Foundation through grant AST-0606772 to Harvard University.

  5. CLINICAL SIGNIFICANCE OF THE LYMPH NODE MICRO-METASTASIS IN PATEINTS WITH EARLY STAGE NON-SMALL-CELL LUNG CANCER

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    @@ The postoperative 5-year survival rate is about 50-85% in the patient with the stage I non-small-cell lung cancer (NSCLC). It is remains unclear how we should give these patients adjuvant radiotherapy and chemotherapy after operation. We performed a postspective study to assess the prognostic and treatment guiding significance of lymph nodes micrometastasis (LMM) in patients with completely resected NSCLC at stage I.

  6. Correlation and discriminant analysis between clinical, endoscopic, thoracic X-ray and bronchoalveolar lavage fluid cytology scores, for staging horses with recurrent airway obstruction (RAO).

    Science.gov (United States)

    Tilley, P; Sales Luis, J P; Branco Ferreira, M

    2012-10-01

    As recurrent airway obstruction (RAO) is progressive and as medical history is frequently unknown by owners, it's important to suggest a score model to characterize RAO stages for a more accurate diagnosis and treatment. The authors correlated clinical (CS), endoscopic (ES), thoracic X-ray (XRS) and bronchoalveolar lavage fluid (BALFS) scores in horses with RAO, in an attempt to establish relevance of each factor's contribution for the characterization of RAO stages and to suggest a staging method. Thirty horses with RAO and ten healthy controls were studied. Pearson correlation coefficients were determined between CS, ES, XRS and BALFS. Only significant correlation coefficients (>0.60) were considered. One way variance analyses were used to compare the two groups. A discriminant analysis model was adjusted on the RAO staging method suggested. There was a significant correlation coefficient between the CS cough, nostril flare and abdominal lift, all the mucus ES (0.61-0.84), the XRS interstitial pattern, bronchial radiopacity and thickening and tracheal thickening (0.67-0.78) and the BALFS neutrophil percentages (0.63-0.84). These variables (e.g., cough) which presented a significant correlation coefficient were considered relevant and chosen for a score model to characterize RAO stages. The ten healthy controls were attributed stage 0 and the 30 RAO horses were attributed stages 1 (4 horses), 2 (7 horses), 3 (10 horses) and 4 (9 horses). There was also a significant correlation coefficient between all the relevant variables and the RAO stage (0.61-0.89). Furthermore, discriminant analysis of the RAO staging method showed 92.5% of original grouped cases and 85.0% of cross-validated grouped cases correctly classified, having confirmed major contribution of the same variables that had significant correlation coefficients. Even though further confirmation by lung functional testing is desirable, the significant correlation between relevant variables and RAO stage and

  7. Different survival of Barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

    Science.gov (United States)

    Sinn, Dong Hyun; Cho, Ju-Yeon; Gwak, Geum-Youn; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul

    2015-01-01

    Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

  8. Different survival of Barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

    Directory of Open Access Journals (Sweden)

    Dong Hyun Sinn

    Full Text Available Portal vein invasion (PVI and extrahepatic spread (ES are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC staging system (BCLC stage C, and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%, hepatitis B virus (458, 78.7%], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES, C2 (PVI-II/III without distant ES, C3 (PVI-0/I with distant ES, and C4 (PVI-II/III with distant ES, respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

  9. Advances in Lymph Node Metastasis and the Modes of Lymph Node 
Dissection in Early Stage Non-small Cell Lung Caner

    Directory of Open Access Journals (Sweden)

    Ningning DING

    2016-06-01

    Full Text Available Lung cancer ranks the first position in morbidity and mortality among all malignances in China. Non-small cell lung cancer (NSCLC accounts for nearly 80% of all lung malignancies. Surgical resection is still the current major treatment method for early stage NSCLC. Lymph node stages together with the extent of lymph node dissection directly affect the prognosis. Anatomical lobectomy with systematic mediastinal lymph node dissection have been the standard surgical treatment for NSCLC. However, it is controversial in the extent of lymph node dissection for early stage NSCLC. Accurate nodes stage and the extent of mediatinal nodes dissection affect the peri-operative complications and the prognosis of NSCLC greatly. In the past decade, more and more surgeons demostrated that lobe-specific or selective mediastinal lymph node dissection is suitable for clinical stage I NSCLC, especially the stage Ia lesions, and may become the standard lymph node dissection mode in the future.

  10. [Advances in Lymph Node Metastasis and the Modes of Lymph Node 
Dissection in Early Stage Non-small Cell Lung Caner].

    Science.gov (United States)

    Ding, Ningning; Mao, Yousheng

    2016-06-20

    Lung cancer ranks the first position in morbidity and mortality among all malignances in China. Non-small cell lung cancer (NSCLC) accounts for nearly 80% of all lung malignancies. Surgical resection is still the current major treatment method for early stage NSCLC. Lymph node stages together with the extent of lymph node dissection directly affect the prognosis. Anatomical lobectomy with systematic mediastinal lymph node dissection have been the standard surgical treatment for NSCLC. However, it is controversial in the extent of lymph node dissection for early stage NSCLC. Accurate nodes stage and the extent of mediatinal nodes dissection affect the peri-operative complications and the prognosis of NSCLC greatly. In the past decade, more and more surgeons demostrated that lobe-specific or selective mediastinal lymph node dissection is suitable for clinical stage I NSCLC, especially the stage Ia lesions, and may become the standard lymph node dissection mode in the future.

  11. Structure of the phosphotransferase domain of the bifunctional aminoglycoside-resistance enzyme AAC(6')-Ie-APH(2'')-Ia.

    Science.gov (United States)

    Smith, Clyde A; Toth, Marta; Bhattacharya, Monolekha; Frase, Hilary; Vakulenko, Sergei B

    2014-06-01

    The bifunctional acetyltransferase(6')-Ie-phosphotransferase(2'')-Ia [AAC(6')-Ie-APH(2'')-Ia] is the most important aminoglycoside-resistance enzyme in Gram-positive bacteria, conferring resistance to almost all known aminoglycoside antibiotics in clinical use. Owing to its importance, this enzyme has been the focus of intensive research since its isolation in the mid-1980s but, despite much effort, structural details of AAC(6')-Ie-APH(2'')-Ia have remained elusive. The structure of the Mg2GDP complex of the APH(2'')-Ia domain of the bifunctional enzyme has now been determined at 2.3 Å resolution. The structure of APH(2'')-Ia is reminiscent of the structures of other aminoglycoside phosphotransferases, having a two-domain architecture with the nucleotide-binding site located at the junction of the two domains. Unlike the previously characterized APH(2'')-IIa and APH(2'')-IVa enzymes, which are capable of utilizing both ATP and GTP as the phosphate donors, APH(2'')-Ia uses GTP exclusively in the phosphorylation of the aminoglycoside antibiotics, and in this regard closely resembles the GTP-dependent APH(2'')-IIIa enzyme. In APH(2'')-Ia this GTP selectivity is governed by the presence of a `gatekeeper' residue, Tyr100, the side chain of which projects into the active site and effectively blocks access to the adenine-binding template. Mutation of this tyrosine residue to a less bulky phenylalanine provides better access for ATP to the NTP-binding template and converts APH(2'')-Ia into a dual-specificity enzyme.

  12. Low-Dose Acetylsalicylic Acid in Treating Patients With Stage I-III Non-Small Cell Lung Cancer

    Science.gov (United States)

    2016-06-28

    Adenocarcinoma of the Lung; Recurrent Non-small Cell Lung Cancer; Stage IA Non-small Cell Lung Cancer; Stage IB Non-small Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer

  13. Spectroscopy of twelve Type Ia supernovae at intermediate redshift

    CERN Document Server

    Balland, C; Pain, R; Walton, N A; Amanullah, R; Astier, Pierre; Ellis, Richard S; Fabbro, S; Goobar, A; Hardin, D; Hook, I M; Irwin, M J; McMahon, R M; Mendez, J M; Ruiz-Lapuente, P; Sainton, G; Schahmaneche, K; Stanishev, V

    2005-01-01

    We present spectra of twelve Type Ia supernovae obtained in 1999 at the William Herschel Telescope and the Nordic Optical Telescope during a search for Type Ia supernovae (SN Ia) at intermediate redshift. The spectra range from z=0.178 to z=0.493, including five high signal-to-noise ratio SN Ia spectra in the still largely unexplored range 0.15 < z < 0.3. Most of the spectra were obtained before or around restframe B-band maximum light. None of them shows the peculiar spectral features found in low-redshift over- or under-luminous SN Ia. Expansion velocities of characteristic spectral absorption features such as SiII at 6355 angs., SII at 5640 angs. and CaII at 3945 angs. are found consistent with their low-z SN Ia counterparts.

  14. Validation of Transient Elastography and Comparison with Spleen Length Measurement for Staging of Fibrosis and Clinical Prognosis in Primary Sclerosing Cholangitis

    Science.gov (United States)

    Ehlken, Hanno; Wroblewski, Raluca; Corpechot, Christophe; Arrivé, Lionel; Rieger, Tim; Hartl, Johannes; Lezius, Susanne; Hübener, Peter; Schulze, Kornelius; Zenouzi, Roman; Sebode, Marcial; Peiseler, Moritz; Denzer, Ulrike W.; Quaas, Alexander; Weiler-Normann, Christina; Lohse, Ansgar W.; Chazouilleres, Olivier; Schramm, Christoph

    2016-01-01

    Background Patients with primary sclerosing cholangitis (PSC) develop progressive liver fibrosis and end-stage liver disease. Non-invasive and widely available parameters are urgently needed to assess disease stage and the risk of clinical progression. Transient elastography (TE) has been reported to predict fibrosis stage and disease progression. However, these results have not been confirmed in an independent cohort and comparison of TE measurement to other non-invasive means is missing. Methods In a retrospective study we collected data from consecutive PSC patients receiving TE measurements from 2006 to 2014 (n = 139). Data from 62 patients who also underwent a liver biopsy were used to assess the performance of TE and spleen length (SL) measurement for the staging of liver fibrosis. Follow-up data from this cohort (n = 130, Hamburg) and another independent cohort (n = 80, Paris) was used to compare TE and SL as predictors of clinical outcome applying Harrel’s C calculations. Results TE measurement had a very good performance for the diagnosis and exclusion of higher fibrosis stages (≥F3: AUROC 0.95) and an excellent performance for the diagnosis and exclusion of cirrhosis (F4 vs. < F4: AUROC 0.98). Single-point TE measurement had very similar predictive power for patient outcome as previously published. In a combined cohort of PSC patients (n = 210), SL measurements had a similar performance as TE for the prediction of patient outcome (5 x cross-validated Harrel’s C 0.76 and 0.72 for SL and TE, respectively). Conclusions Baseline TE measurement has an excellent performance to diagnose higher fibrosis stages in PSC. Baseline measurements of SL and TE have similar usefulness as predictive markers for disease progression in patients with PSC. PMID:27723798

  15. [From classificational medicine to clinical medicine (the end of the XVIII century to 1870s). Communication 3. The second stage of clinical medicine development: introduction of methods of laboratory experiment and chemical analysis].

    Science.gov (United States)

    Stochik, A M; Zatravkin, S N

    2011-01-01

    The article concerns the end stage of clinical medicine establishment covering the period from early 1840s to the middle 1870s of the XIX century. Basic scientific achievements related to introduction into practical medicine of the methods of laboratory experiment and chemical analysis are reviewed.

  16. Constraining Cosmic Evolution of Type Ia Supernovae

    Energy Technology Data Exchange (ETDEWEB)

    Foley, Ryan J.; Filippenko, Alexei V.; Aguilera, C.; Becker, A.C.; Blondin, S.; Challis, P.; Clocchiatti, A.; Covarrubias, R.; Davis, T.M.; Garnavich, P.M.; Jha, S.; Kirshner, R.P.; Krisciunas, K.; Leibundgut, B.; Li, W.; Matheson, T.; Miceli, A.; Miknaitis, G.; Pignata, G.; Rest, A.; Riess, A.G.; /UC, Berkeley, Astron. Dept. /Cerro-Tololo InterAmerican Obs. /Washington U., Seattle, Astron. Dept. /Harvard-Smithsonian Ctr. Astrophys. /Chile U., Catolica /Bohr Inst. /Notre Dame U. /KIPAC, Menlo Park /Texas A-M /European Southern Observ. /NOAO, Tucson /Fermilab /Chile U., Santiago /Harvard U., Phys. Dept. /Baltimore, Space Telescope Sci. /Johns Hopkins U. /Res. Sch. Astron. Astrophys., Weston Creek /Stockholm U. /Hawaii U. /Illinois U., Urbana, Astron. Dept.

    2008-02-13

    We present the first large-scale effort of creating composite spectra of high-redshift type Ia supernovae (SNe Ia) and comparing them to low-redshift counterparts. Through the ESSENCE project, we have obtained 107 spectra of 88 high-redshift SNe Ia with excellent light-curve information. In addition, we have obtained 397 spectra of low-redshift SNe through a multiple-decade effort at Lick and Keck Observatories, and we have used 45 ultraviolet spectra obtained by HST/IUE. The low-redshift spectra act as a control sample when comparing to the ESSENCE spectra. In all instances, the ESSENCE and Lick composite spectra appear very similar. The addition of galaxy light to the Lick composite spectra allows a nearly perfect match of the overall spectral-energy distribution with the ESSENCE composite spectra, indicating that the high-redshift SNe are more contaminated with host-galaxy light than their low-redshift counterparts. This is caused by observing objects at all redshifts with similar slit widths, which corresponds to different projected distances. After correcting for the galaxy-light contamination, subtle differences in the spectra remain. We have estimated the systematic errors when using current spectral templates for K-corrections to be {approx}0.02 mag. The variance in the composite spectra give an estimate of the intrinsic variance in low-redshift maximum-light SN spectra of {approx}3% in the optical and growing toward the ultraviolet. The difference between the maximum-light low and high-redshift spectra constrain SN evolution between our samples to be < 10% in the rest-frame optical.

  17. The influence of number of high risk factors on clinical outcomes in patients with early-stage cervical cancer after radical hysterectomy and adjuvant chemoradiation

    Science.gov (United States)

    Lim, Soyi; Lee, Seok-Ho; Park, Chan-Yong

    2016-01-01

    Objective The purpose of this study was to evaluate the prognosis according to the number of high risk factors in patients with high risk factors after radical hysterectomy and adjuvant chemoradiation therapy for early stage cervical cancer. Methods Clinicopathological variables and clinical outcomes of patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IIA cervical cancer who had one or more high risk factors after radical hysterectomy and adjuvant chemoradiation therapy were retrospectively analyzed. Patients were divided into two groups according to the number of high risk factors (group 1, single high risk factor; group 2, two or more high risk factors). Results A total of 93 patients were enrolled in the present study. Forty nine out of 93 (52.7%) patients had a single high risk factor, and 44 (47.3%) had two or more high risk factors. Statistically significant differences in stage and stromal invasion were observed between group 1 and group 2. However, age, histology, tumor size, and lymphovascular space invasion did not differ significantly between the groups. Distant recurrence occurred more frequently in group 2, and the probability of recurrence and death was higher in group 2. Conclusion Patients with two or more high risk factors had worse prognosis in early stage cervical cancer. For these patients, consideration of new strategies to improve survival may be worthwhile. Conduct of further clinical trials is warranted for development of adjuvant treatment strategies individualized to each risk group. PMID:27200308

  18. Use of WHO clinical stage for assessing patient eligibility to antiretroviral therapy in a routine health service setting in Jinja, Uganda

    Directory of Open Access Journals (Sweden)

    Namara Geoffrey

    2008-02-01

    Full Text Available Abstract In a routine service delivery setting in Uganda, we assessed the ability of the WHO clinical stage to accurately identify HIV-infected patients in whom antiretroviral therapy should be started. Among 4302 subjects screened for ART, the sensitivity and specificity (95% CI of WHO stage III, IV against a CD4 count 6/l were 52% (50, 54% and 68% (66, 70% respectively. Plasma viral load was tested in a subset of 1453 subjects in whom ART was initiated. Among 938 subjects with plasma viral load of 100,000 copies or more, 391 (42%, 95% CI 39, 45% were at WHO stage I or II. In this setting, a large number of individuals could have been denied access to antiretroviral therapy if eligibility to ART was assessed on the basis of WHO clinical stage. There is an urgent need for greater CD4 count testing and evaluation of the utility of plasma viral load prior to initiation of ART to accompany the roll-out of ART.

  19. Milton H. Erickson e o cavalo de tróia: a terapia não convencional no cenário da crise dos paradigmas em psicologia clínica Milton H. Erickson and the trojan horse: the nonconventional therapy in the paradigms crisis scenario in clinical psychology

    Directory of Open Access Journals (Sweden)

    Maurício S. Neubern

    2002-01-01

    Full Text Available O presente artigo busca situar a obra de Milton Erickson no cenário da transição de paradigmas científicos, particularmente da psicologia clínica. Destaca-se que as contribuições desse autor, ao mesmo tempo em que denunciam as limitações do paradigma dominante, apontam na direção de pressupostos distintos, muito afins com as perspectivas de um paradigma emergente. A metáfora do cavalo de Tróia busca retratar a influência sutil e intensa do trabalho desse autor sobre as perspectivas consagradas, de modo que, enquanto fascina e causa admiração, traz em si um potencial elevado de reflexão crítica e incisiva sobre essas mesmas perspectivas. Destacando três aspectos centrais desse processo - a impossibilidade teórica, o resgate da subjetividade complexa e a busca de novas racionalidades - o artigo é concluído delineando possíveis caminhos para a concepção e o uso do legado de Erickson.This article places Milton Erickson's work in the scenerio of transition of scientific paradigms, especially in clinical psychology. The text shows that Erickson' contribution denounces the limitations of the dominant paradigm and at the same time points to different assumptions that are very similar to the emergent paradigm's perspectives. The trojan horse metaphor aims at showing the powerful and subtle influence of Erickson's work on sacred perspectives. While Erickson's work cause fascination and wonder it simultaneously provoques critical and incisive reflections about the sacred perspectives. This paper makes salient three main aspects - the theorical impossibility, the rescue of a complex subjectivity and, at last, the search of new racionalities. As a conclusion, possible pathways for understanding and using Erickson's legacy in the field of clinical psychology are enphasized.

  20. THE FIRST EXPERIENCE IN CLINICAL APPLICATION OF DOMESTIC CIRCULATORY SUPPORT DEVICE ON BASIS OF IMPLANTABLE AXIAL PUMP FOR TWO STAGE HEART TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2013-01-01

    Full Text Available The paper describes the first clinical experience in RF of successful application of domestic circulatory support device based on implantable axial pump for two stage heart transplantation. This case demonstrate the effec- tiveness and safety of our device (АВК-Н for a longtime (270 days left ventricular bypass and the ability to perform a successful transplantation of donor,s heart after application of this system. 

  1. THE FIRST EXPERIENCE IN CLINICAL APPLICATION OF DOMESTIC CIRCULATORY SUPPORT DEVICE ON BASIS OF IMPLANTABLE AXIAL PUMP FOR TWO STAGE HEART TRANSPLANTATION

    OpenAIRE

    S. V. Gautier; G. P. Itkin; S. Yu. Shemakin; R. Sh. Saitgareev; V. N. Poptsov; V. M. Zakharevich; G. A. Akopov; A. Ya. Kormer; T. A. Khalilulin; O. P. Shevchenko; А. М. Nevzorov; I. А. Filatov; S. V. Selishev

    2013-01-01

    The paper describes the first clinical experience in RF of successful application of domestic circulatory support device based on implantable axial pump for two stage heart transplantation. This case demonstrate the effec- tiveness and safety of our device (АВК-Н) for a longtime (270 days) left ventricular bypass and the ability to perform a successful transplantation of donor,s heart after application of this system. 

  2. The Implementation of IAS 16 and IAS 41 at Andrew Peller Limited

    Science.gov (United States)

    Lapointe-Antunes, Pascale; Moore, James

    2013-01-01

    This case asks students to play the role of Doug Grodeckie, Manager of Financial Reporting at Andrew Peller Limited (APL). Doug was asked to prepare a report analyzing Andrew Peller Limited's current tangible long-lived assets disclosures and making recommendations on how best to comply with International Accounting Standard (IAS) 16 Property,…

  3. Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico.

    Science.gov (United States)

    Vladislavovna Doubova Dubova, Svetlana; Flores-Hernández, Sergio; Rodriguez-Aguilar, Leticia; Pérez-Cuevas, Ricardo

    2010-02-10

    1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women. The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR) by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155). The association between quality of care and HR-QoL was estimated through multiple linear regression analysis. The lowest mean of PRCR was for the health promotion component (24.1%) and the highest for the treatment component (86.6%). The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P < 0.0001). The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women.

  4. Search for Type Ia supernova NUV-optical subclasses

    Science.gov (United States)

    Cinabro, David; Scolnic, Daniel; Kessler, Richard; Li, Ashley; Miller, Jake

    2017-04-01

    In response to a recently reported observation of evidence for two classes of Type Ia supernovae (SNe Ia) distinguished by their brightness in the rest-frame near-ultraviolet (NUV), we search for the phenomenon in publicly available light-curve data. We use the SNANA supernova analysis package to simulate SN Ia light curves in the Sloan Digital Sky Survey (SDSS) Supernova Search and the Supernova Legacy Survey (SNLS) with a model of two distinct ultraviolet classes of SNe Ia and a conventional model with a single broad distribution of SN-Ia ultraviolet brightnesses. We compare simulated distributions of rest-frame colours with these two models to those observed in 158 SNe Ia in the SDSS and SNLS data. The SNLS sample of 99 SNe Ia is in clearly better agreement with a model with one class of SN Ia light curves and shows no evidence for distinct NUV sub-classes. The SDSS sample of 59 SNe Ia with poorer colour resolution does not distinguish between the two models.

  5. Search For Type Ia Supernova NUV-Optical Subclasses

    CERN Document Server

    Cinabro, David; Kessler, Richard; Li, Ashley; Miller, Jake

    2016-01-01

    In response to a recently reported observation of evidence for two classes of Type Ia Supernovae (SNe Ia) distinguished by their brightness in the rest-frame near ultraviolet (NUV), we search for the phenomenon in publicly available light-curve data. We use the SNANA supernova analysis package to simulate SN Ia-light curves in the Sloan Digital Sky Survey Supernova Search (SDSS) and the Supernova Legacy Survey (SNLS) with a model of two distinct ultraviolet classes of SNe Ia and a conventional model with a single broad distribution of SN-Ia ultraviolet brightnesses. We compare simulated distributions of rest-frame colors with these two models to those observed in 158 SNe Ia in the SDSS and SNLS data. The SNLS sample of 99 SNe Ia is in clearly better agreement with a model with one class of SN Ia light curves and shows no evidence for distinct NUV sub-classes. The SDSS sample of 59 SNe Ia with poorer color resolution does not distinguish between the two models.

  6. SNe Ia: Can Chandrasekhar Mass Explosions Reproduce the Observed Zoo?

    CERN Document Server

    Baron, E

    2014-01-01

    The question of the nature of the progenitor of Type Ia supernovae (SNe Ia) is important both for our detailed understanding of stellar evolution and for their use as cosmological probes of the dark energy. Much of the basic features of SNe Ia can be understood directly from the nuclear physics, a fact which Gerry would have appreciated. We present an overview of the current observational and theoretical situation and show that it not incompatible with most SNe Ia being the results of thermonuclear explosions near the Chandrasekhar mass.

  7. Tests of Environmental Effects on Type Ia Supernova Production

    Science.gov (United States)

    Sadler, Suzanna M.; Strolger, L.; Wolff, S.

    2011-01-01

    The host galaxy environments of type Ia supernovae (SNe Ia) provide our best opportunity for constraining the mechanism(s) of the SN Ia progenitor system, i.e., the stars involved, the incubation times, and the sensitivity of SNe Ia to changes in the local gas-phase metallicity. The latter can affect the luminosity of the resultant event, and possibly the success in ultimately yielding a SN Ia. We seek to solidify possible environmental trends in SN Ia rates from direct measures of host galaxy properties, using the sample collected by the Nearby Galaxies Supernova Search project. This study will uncover which has the greatest influence on SN Ia production efficiency: parent population age, rate of star-formation, or metallicity. Here, we will show some preliminary results from SSP model fitting (of age and [Fe/H]) to a selection of hosts obtained thus far from this study. The complete sample will provide a validity test of the mostly indirect trends being established for SNe Ia from the LOSS, SDSS, SNfactory and other surveys, and may ultimately steer future investigations towards more precise SN Ia cosmology.

  8. Near-Infrared Properties of Type Ia Supernovae

    Science.gov (United States)

    Phillips, M. M.

    2012-02-01

    The photometric properties of Type Ia supernovae (SNe Ia) in the near-infrared as garnered from observations made over the last 30 years are reviewed. During this period, light curves for more than 120 nearby SNe Ia have been published, revealing considerable homogeneity but also some fascinating differences. These data have confirmed that, for all but the fastest declining objects, SNe Ia are essentially perfect standard candles in the near-infrared, displaying only a slight dependence of peak luminosity on decline rate and color.

  9. Ages of Type Ia Supernovae Over Cosmic Time

    CERN Document Server

    Childress, Michael J; Zahid, H Jabran

    2014-01-01

    We derive empirical models for galaxy mass assembly histories, and convolve these with theoretical delay time distribution (DTD) models for Type Ia supernovae (SNe Ia) to derive the distribution of progenitor ages for all SNe Ia occurring at a given epoch of cosmic time. In actively star-forming galaxies, the progression of the star formation rate is shallower than a $t^{-1}$ SN Ia DTD, so mean SN Ia ages peak at the DTD peak in all star-forming galaxies at all epochs of cosmic history. In passive galaxies which have ceased star formation through some quenching process, the SN Ia age distribution peaks at the quenching epoch, which in passive galaxies evolves in redshift to track the past epoch of major star formation. Our models reproduce the SN Ia rate evolution in redshift, the relationship between SN Ia stretch and host mass, and the distribution of SN Ia host masses in a manner qualitatively consistent with observations. Our model naturally predicts that low-mass galaxies tend to be actively star-forming...

  10. Analytical Expressions For Light-curves of Supernovae Type Ia

    CERN Document Server

    Dado, Shlomo

    2013-01-01

    A simple analytical model is used to derive the main properties of supernovae type Ia (SNe Ia), which are produced by the thermonuclear explosion of accreting C-O white dwarfs that cross the Chandrasekhar mass limit. The few underlying physical assumptions of the model yield analytical expressions that reproduce quite well the observed bolometric light-curves of SNe Ia and the empirical brighter-slower and brighter-bluer relationships that were used to standardize SNe Ia for their use as distance indicators, which led to the discovery of the accelerating expansion of the universe.

  11. The violent white dwarf merger scenario for the progenitors of type Ia supernovae

    CERN Document Server

    Liu, Dongdong; Podsiadlowski, Philipp; Han, Zhanwen

    2016-01-01

    Recent observations suggest that some type Ia supernovae (SNe Ia) originate from the merging of two carbon-oxygen white dwarfs (CO WDs). Meanwhile, recent hydrodynamical simulations have indicated that the accretion-induced collapse may be avoided under certain conditions when double WDs merge violently. However, the properties of SNe Ia from this violent merger scenario are highly dependent on a particular mass-accretion stage, the so-called WD + He subgiant channel, during which the primary WD is able to increase its mass by accreting He-rich material from a He subgiant before the systems evolves into a double WD system. In this article, we aim to study this particular evolutionary stage systematically and give the properties of violent WD mergers. By employing the Eggleton stellar evolution code, we followed a large number of binary calculations and obtained the regions in parameter space for producing violent mergers based on the WD + He subgiant channel. According to these simulations, we found that the ...

  12. High-risk clinical target volume delineation in CT-guided cervical cancer brachytherapy - Impact of information from FIGO stage with or without systematic inclusion of 3D documentation of clinical gynecological examination

    Energy Technology Data Exchange (ETDEWEB)

    Hegazy, Neamat [Dept. of Radiotherapy, Comprehensive Cancer Centre Vienna, Medical Univ. of Vienna, Vienna (Austria); Dept. of Clinical Oncology, Medical Univ. of Alexandria, Alexandria (Egypt); Poetter Rickard; Kirisits, Christian [Dept. of Radiotherapy, Comprehensive Cancer Centre Vienna, Medical Univ. of Vienna, Vienna (Austria); Christian Doppler Lab. for Medical Radiation Research for Radiation Oncology, Medical Univ. Vienna (Austria); Berger, Daniel; Federico, Mario; Sturdza, Alina; Nesvacil, Nicole [Dept. of Radiotherapy, Comprehensive Cancer Centre Vienna, Medical Univ. of Vienna, Vienna (Austria)], e-mail: nicole.nesvacil@meduniwien.ac.at

    2013-10-15

    Purpose: The aim of the study was to improve computed tomography (CT)-based high-risk clinical target volume (HR CTV) delineation protocols for cervix cancer patients, in settings without any access to magnetic resonance imaging (MRI) at the time of brachytherapy. Therefore the value of a systematic integration of comprehensive three-dimensional (3D) documentation of repetitive gynecological examination for CT-based HR CTV delineation protocols, in addition to information from FIGO staging, was investigated. In addition to a comparison between reference MRI contours and two different CT-based contouring methods (using complementary information from FIGO staging with or without additional 3D clinical drawings), the use of standardized uterine heights was also investigated. Material and methods: Thirty-five cervix cancer patients with CT- and MR-images and 3D clinical drawings at time of diagnosis and brachytherapy were included. HR CTV{sub stage} was based on CT information and FIGO stage. HR CTV{sub stage} {sub +3Dclin} was contoured on CT using FIGO stage and 3D clinical drawing. Standardized HR CTV heights were: 1/1, 2/3 and 1/2 of uterine height. MRI-based HR CTV was delineated independently. Resulting widths, thicknesses, heights, and volumes of HR CTV{sub stage}, HR CTV{sub stage+3Dclin} and MRI-based HR CTV contours were compared. Results: The overall normalized volume ratios (mean{+-}SD of CT/MRI{sub ref} volume) of HR CTV{sub stage} and HR{sub stage+3Dclin} were 2.6 ({+-}0.6) and 2.1 ({+-}0.4) for 1/1 and 2.3 ({+-}0.5) and 1.8 ({+-}0.4), for 2/3, and 1.9 ({+-}0.5) and 1.5 ({+-}0.3), for 1/2 of uterine height. The mean normalized widths were 1.5{+-}0.2 and 1.2{+-}0.2 for HR CTV{sub stage} and HR CTV{sub stage+3Dclin}, respectively (p < 0.05). The mean normalized heights for HR CTV{sub stage} and HR CTV{sub stage+3Dclin} were both 1.7{+-}0.4 for 1/1 (p < 0.05.), 1.3{+-}0.3 for 2/3 (p < 0.05) and 1.1{+-}0.3 for 1/2 of uterine height. Conclusion: CT-based HR

  13. Clinical trials and late‐stage drug development for Alzheimer's disease: an appraisal from 1984 to 2014

    National Research Council Canada - National Science Library

    Schneider, L. S; Mangialasche, F; Andreasen, N; Feldman, H; Giacobini, E; Jones, R; Mantua, V; Mecocci, P; Pani, L; Winblad, B; Kivipelto, M

    2014-01-01

    .... Since then, despite the evaluation of numerous potential treatments in clinical trials, only four cholinesterase inhibitors and memantine have shown sufficient safety and efficacy to allow marketing...

  14. De novo Transcriptome Analysis of Rhizoctonia solani AG1 IA Strain Early Invasion in Zoysia japonica Root.

    Science.gov (United States)

    Zhu, Chen; Ai, Lin; Wang, Li; Yin, Pingping; Liu, Chenglan; Li, Shanshan; Zeng, Huiming

    2016-01-01

    Zoysia japonica brown spot was caused by necrotrophic fungus Rhizoctonia solani invasion, which led to severe financial loss in city lawn and golf ground maintenance. However, little was known about the molecular mechanism of R. solani pathogenicity in Z. japonica. In this study we examined early stage interaction between R. solani AG1 IA strain and Z. japonica cultivar "Zenith" root by cell ultra-structure analysis, pathogenesis-related proteins assay and transcriptome analysis to explore molecular clues for AG1 IA strain pathogenicity in Z. japonica. No obvious cell structure damage was found in infected roots and most pathogenesis-related protein activities showedg a downward trend especially in 36 h post inoculation, which exhibits AG1 IA strain stealthy invasion characteristic. According to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) database classification, most DEGs in infected "Zenith" roots dynamically changed especially in three aspects, signal transduction, gene translation, and protein synthesis. Total 3422 unigenes of "Zenith" root were predicted into 14 kinds of resistance (R) gene class. Potential fungal resistance related unigenes of "Zenith" root were involved in ligin biosynthesis, phytoalexin synthesis, oxidative burst, wax biosynthesis, while two down-regulated unigenes encoding leucine-rich repeat receptor protein kinase and subtilisin-like protease might be important for host-derived signal perception to AG1 IA strain invasion. According to Pathogen Host Interaction (PHI) database annotation, 1508 unigenes of AG1 IA strain were predicted and classified into 37 known pathogen species, in addition, unigenes encoding virulence, signaling, host stress tolerance, and potential effector were also predicted. This research uncovered transcriptional profiling during the early phase interaction between R. solani AG1 IA strain and Z. japonica, and will greatly help identify key pathogenicity of AG1 IA strain.

  15. De novo Transcriptome Analysis of Rhizoctonia solani AG1 IA Strain Early Invasion in Zoysia japonica Root

    Science.gov (United States)

    Zhu, Chen; Ai, Lin; Wang, Li; Yin, Pingping; Liu, Chenglan; Li, Shanshan; Zeng, Huiming

    2016-01-01

    Zoysia japonica brown spot was caused by necrotrophic fungus Rhizoctonia solani invasion, which led to severe financial loss in city lawn and golf ground maintenance. However, little was known about the molecular mechanism of R. solani pathogenicity in Z. japonica. In this study we examined early stage interaction between R. solani AG1 IA strain and Z. japonica cultivar “Zenith” root by cell ultra-structure analysis, pathogenesis-related proteins assay and transcriptome analysis to explore molecular clues for AG1 IA strain pathogenicity in Z. japonica. No obvious cell structure damage was found in infected roots and most pathogenesis-related protein activities showedg a downward trend especially in 36 h post inoculation, which exhibits AG1 IA strain stealthy invasion characteristic. According to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) database classification, most DEGs in infected “Zenith” roots dynamically changed especially in three aspects, signal transduction, gene translation, and protein synthesis. Total 3422 unigenes of “Zenith” root were predicted into 14 kinds of resistance (R) gene class. Potential fungal resistance related unigenes of “Zenith” root were involved in ligin biosynthesis, phytoalexin synthesis, oxidative burst, wax biosynthesis, while two down-regulated unigenes encoding leucine-rich repeat receptor protein kinase and subtilisin-like protease might be important for host-derived signal perception to AG1 IA strain invasion. According to Pathogen Host Interaction (PHI) database annotation, 1508 unigenes of AG1 IA strain were predicted and classified into 37 known pathogen species, in addition, unigenes encoding virulence, signaling, host stress tolerance, and potential effector were also predicted. This research uncovered transcriptional profiling during the early phase interaction between R. solani AG1 IA strain and Z. japonica, and will greatly help identify key pathogenicity of AG1 IA strain

  16. Preoperative serum squamous cell carcinoma antigen levels in clinical decision making for patients with early-stage cervical cancer

    NARCIS (Netherlands)

    Reesink-Peters, N; van der Velden, J; ten Hoor, KA; Boezen, HM; de Vries, EGE; Schilthuis, MS; Mourits, MJE; Nijman, HW; Aalders, JG; Hollema, H; Pras, E; Duk, JM; van der Zee, AGJ

    2005-01-01

    PURPOSE: To prevent morbidity associated with double modality treatment, early-stage cervical cancer patients should only be offered surgery when there is a low likelihood for adjuvant radiotherapy. We analyzed whether serum squamous cell carcinoma antigen (SCC-ag) analysis allows better preoperativ

  17. Preoperative T-staging of prostate carcinoma: Endorectal MRI compared with other imaging and clinical methods; Praeoperatives T-Staging des Prostatakarzinoms: Endorektale Magnetresonanztomographie im Vergleich zu anderen bildgebenden und klinischen Methoden

    Energy Technology Data Exchange (ETDEWEB)

    Huch Boeni, R.A. [Inst. fuer Diagnostische Radiologie, Dept. fuer Medizinische Radiologie, Universitaetsspital Zurich (Switzerland); Hutter, B.E. [Inst. fuer Diagnostische Radiologie, Dept. fuer Medizinische Radiologie, Universitaetsspital Zurich (Switzerland); Trinkler, F. [Urologische Klinik, Universitaetsspital Zurich (Switzerland); Jochum, W. [Inst. fuer Klinische Pathologie, Dept. fuer Pathologie, Universitaetsspital Zurich (Switzerland); Pestalozzi, D. [Urologische Klinik, Limmattalspital, Schlieren (Switzerland); Krestin, G.P. [Inst. fuer Diagnostische Radiologie, Dept. fuer Medizinische Radiologie, Universitaetsspital Zurich (Switzerland)

    1996-08-01

    Purpose: The diagnostic value of endorectal magnetic resonance imaging (MRI) in comparison to clinical information and other imaging modalities was analysed in order to define the most accurate preoperative staging method. Methods: 54 patients with biopsy proven prostate carcinoma, who underwent subsequent prostatectomy, were examined with an endorectal surface coil. The results were compared to body coil MRI, digital rectal examination and prostate specific antigen levels. In 37 patients, results of endorectal ultrasound were available. Results: Staging accuracy, sensitivity and specificity of endorectal coil MRI were 83.3%. For body coil MRI, staging accuracy was 59.2%, sensitivity 43.3% and specificity 82.6%, for transrectal ultrasound 59.5%, 36.4% and 91.7% and for the digital rectal examination 55.6%, 26.7% and 91.7%, respectively. Staging accuracy of endorectal MRI was significantly (p<0.05) superior to that of the other imaging modalities. Conclusion: Endorectal coil MRI allows reliable distinction between localised and advanced tumour stages and is superior to other imaging techniques in this regard. It can thus be recommended for staging in patients with prostate carcinoma. (orig.) [Deutsch] Ziel: Beurteilung des Stellenwerts der endorektalen Magnetresonanztomographie (MRT) bei der praeoperativen Beurteilung des Prostatakarzinoms. Methodik: 54 Patienten mit bioptisch gesichertem Prostatakarzinom erhielten praeoperativ eine endorektale MR-Untersuchung. Die Ergebnisse wurden der digitalen Tastuntersuchung, dem prostataspezifischen Antigenwert (PSA) und der MRT mit Koerperspule gegenuebergestellt und mit der Histologie korreliert. Bei 37 Patienten stand zusaetzlich ein transrektaler Ultraschall zum Vergleich zur Verfuegung. Resultate: Treffsicherheit, Sensitivitaet und Spezifitaet der endorektalen MRT betrugen jeweils 83,3%. Die MRT mit Koerperspule hatte eine Treffsicherheit von 59,2% eine Sensitivitaet von 43,3% und eine Spezifitaet von 82,6%. Die

  18. Clinical Analysis of stereotactic body radiation therapy using extracranial gamma knife for patients with mainly bulky inoperable early stage non-small cell lung carcinoma

    Directory of Open Access Journals (Sweden)

    Tang Hanjun

    2011-07-01

    Full Text Available Abstract Purpose To evaluate the clinical efficacy and toxicity of stereotactic body radiation therapy (SBRT using extracranial gamma knife in patients with mainly bulky inoperable early stage non-small cell lung carcinoma (NSCLC. Materials and methods A total of 43 medically inoperable patients with mainly bulky Stage I/II NSCLC received SBRT using gamma knife were reviewed. The fraction dose and the total dose were determined by the radiation oncologist according to patients' general status, tumor location, tumor size and the relationship between tumor and nearby organ at risk (OAR. The total dose of 34~47.5 Gy was prescribed in 4~12 fractions, 3.5~10 Gy per fraction, one fraction per day or every other day. The therapeutic efficacy and toxicity were evaluated. Results The median follow-up was 22 months (range, 3-102 months. The local tumor response rate was 95.35%, with CR 18.60% (8/43 and PR 76.74% (33/43, respectively. The local control rates at 1, 2, 3, 5 years were 77.54%, 53.02%, 39.77%, and 15.46%, respectively, while the 1- and 2-year local control rates were 75% and 60% for tumor ≤3 cm; 84% and 71% for tumor sized 3~5 cm; 55% and 14.6% for tumor sized 5~7 cm; and 45%, 21% in those with tumor size of >7 cm. The overall survival rate at 1, 2, 3, 5 years were 92.04%, 78.04%, 62.76%, 42.61%, respectively. The toxicity of stereotactic radiation therapy was grade 1-2. Clinical stages were significantly important factor in local control of lung tumors (P = 0.000. Both clinical stages (P = 0.015 and chemotherapy (P = 0.042 were significantly important factors in overall survival of lung tumors. Conclusion SBRT is an effective and safe therapy for medically inoperable patients with early stage NSCLC. Clinical stage was the significant prognostic factors for both local tumor control and overall survival. The toxicity is mild. The overall local control for bulky tumors is poor. Tumor size is a poor prognostic factor, and the patients for

  19. CLINICAL OBSERVATION ON STAGE-AIDED TREATMENT OF 62 CASES OF PERIPHERAL FACIAL PARALYSIS WITH ACUPUNCTURE,MOXIBUSTION AND CUPPING

    Institute of Scientific and Technical Information of China (English)

    刘宜军; 周友龙

    2004-01-01

    Objective: To probe the best therapy for peripheral facial paralysis.Methods: A total of 122 cases of facial paralysis patients were randomized into treatment group (n=62, treating the disease by stages) and control group (n=60).For patients at the acute stage in treatment group, main point Yifeng (TE 17) was pricked first, followed by performing cupping and moxibustion, for patients at the resting stage, main point Hegu (LI 4) was punctured with reducing needling method, combined with other acupoints in the light of the concrete situations.For patients at the restoration stage, main point Zusanli (ST 36) was punctured with reinforcing method in combination with seven-star-needle tapping at the local affected region.Patients of control group were treated with routine method by puncturing Fengchi (GB 20), Yifeng (TE 17), Jiache (ST 6), Hegu (LI 4), Taichong (LR 3), etc..The treatment was conducted once daily, with 10 days being a therapeutic course.Results: Following 3 courses of treatment, of the 62 cases in treatment group, 44 (70.9%) were cured, 12 (19.4%) had remarkable improvement in their symptoms and signs, 6 (9.7%) had amelioration, with the cure plus markedly effective rate being 90.3%; of the 60 cases in control group, 30 (50.0%) were cured, 12 (20.0%) had apparent improvement, 16 (26.7%) had amelioration, and the rest 2 (3.3%) failed in the treatment, with the cure plus markedly effective rate being 70.0%.Ridit analysis showed that the cure rate and cure plus markedly effective rate of treatment group were significantly higher than those of control group (P<0.05).Conclusion: Stage-aided acupuncture treatment is superior to routine treatment for facial palsy.

  20. Prostate cancer incidence, clinical stage and survival in relation to obesity: a prospective cohort study in Denmark.

    Science.gov (United States)

    Møller, Henrik; Roswall, Nina; Van Hemelrijck, Mieke; Larsen, Signe Benzon; Cuzick, Jack; Holmberg, Lars; Overvad, Kim; Tjønneland, Anne

    2015-04-15

    There is no clear link between obesity and prostate cancer incidence but an association has been reported between obesity and fatal prostate cancer. We report on two prospective cohort analyses on (i) the incidence of prostate cancer in relation to obesity in a cohort of men with no previous cancer, and on (ii) the stage distribution and prostate cancer specific mortality in relation to obesity among men with prostate cancer. The "Diet, Cancer and Health" prospective cohort study was established in Denmark in 1993-1997 and accrued 26,944 men aged 50-64 years. Data were extracted on height, weight, body mass index (BMI), waist circumference and body fat percentage. Information on cancer incidence and deaths were obtained by record linkage with the Danish Cancer Register and the Danish Death Register. The incidence rate of prostate cancer was similar or slightly lower in obese men compared with nonobese men, but obese men tended to be diagnosed with more advanced prostate cancer. The proportion of Stage 3-4 cancers was 37% in the lowest BMI quartile and 48% in the highest (p = 0.006). Obese men with prostate cancer had higher prostate cancer specific mortality. The hazard ratio comparing the highest and the lowest quartiles of BMI was 1.48 (95% confidence interval: 1.06-2.05; p-value for trend: 0.002). The association was attenuated but not eliminated by statistical adjustment for stage, and the data are suggestive of a stage-independent causal pathway where prostate cancer in obese men has higher fatality, even in early-stage disease. © 2014 UICC.

  1. An Approach to Information Architecture(IA)%信息构建(Information Architecture,IA)探析

    Institute of Scientific and Technical Information of China (English)

    荣毅虹; 梁战平

    2003-01-01

    本文以Internet发展为背景,分前网络时期和网络时期两个阶段对IA进行了考察,提出了狭义IA(书本IA、网站IA)和广义IA,并对其含义、内容和作用进行了探讨和论述.

  2. The clinical significance of serum SCC-Ag combined with CD105 in patients with cervical cancer during the early stage diagnosis

    Institute of Scientific and Technical Information of China (English)

    Ru-Chan Ma; Hong Bi; Sen-Yang Cao

    2016-01-01

    Objective:To invest the clinical significance of serum SCC-Ag combined with CD105 in early diagnosis of cervical cancer to provide new ideas for early diagnosis and clinical treatment of cervical cancer.Methods: A total of 74 cases cervical cancer patients were selected as cervical cancer group, and 52 cases uterine fibroids patients were selected as normal cervical group, serum samples were collected in the early morning fasting condition, SCC-Ag and CD105 were checked by ELISA method, SCC-Ag and CD105 of two groups were analyzed by t-test, and to compare SCC-Ag and CD105 in different TMN staging, lymph gland metastasis and non-lymph gland metastasis in patients with cervical cancer, the correlation analysis was used by Pearson correlation analysis method.Results: These results came from ELISA method, comparing with normal cervical group, the SCC-Ag and CD105 of cervical cancer group increased, the difference was statistically significant. Comparing withⅠperiod of TMN staging, SCC-Ag and CD105 ofⅡ period increased,Ⅲ,Ⅳ period increased, the difference was statistically significant. Comparing withⅡ period, SCC-Ag and CD105 ofⅢ,Ⅳ period increased, the difference was statistically significant. Comparing with non-lymph gland metastasis, SCC-Ag and CD105 of lymph gland metastasis increased in cervical cancer with surgical treatment, the difference was statistically significant. According to Pearson correlation analysis, SCC-Ag and CD105 were positively correlated.Conclusion: SCC-Ag and CD105 in patients with cervical cancer increase highly, it has important clinical value that of serum SCC-Ag combined with CD105 in the early diagnosis of cervical cancer, especially it has clinical guiding significance to staging and lymph gland metastasis of cervical cancer, and it is worthy of clinical reference.

  3. The Distant Type Ia Supernova Rate

    Science.gov (United States)

    Pain, R.; Fabbro, S.; Sullivan, M.; Ellis, R. S.; Aldering, G.; Astier, P.; Deustua, S. E.; Fruchter, A. S.; Goldhaber, G.; Goobar, A.; Groom, D. E.; Hardin, D.; Hook, I. M.; Howell, D. A.; Irwin, M. J.; Kim, A. G.; Kim, M. Y.; Knop, R. A.; Lee, J. C.; Perlmutter, S.; Ruiz-Lapuente, P.; Schahmaneche, K.; Schaefer, B.; Walton, N. A.

    2002-05-28

    We present a measurement of the rate of distant Type Ia supernovae derived using 4 large subsets of data from the Supernova Cosmology Project. Within this fiducial sample, which surveyed about 12 square degrees, thirty-eight supernovae were detected at redshifts 0.25--0.85. In a spatially flat cosmological model consistent with the results obtained by the Supernova Cosmology Project, we derive a rest-frame Type Ia supernova rate at a mean red shift z {approx_equal} 0.55 of 1.53 {sub -0.25}{sub -0.31}{sup 0.28}{sup 0.32} x 10{sup -4} h{sup 3} Mpc{sup -3} yr{sup -1} or 0.58{sub -0.09}{sub -0.09}{sup +0.10}{sup +0.10} h{sup 2} SNu(1 SNu = 1 supernova per century per 10{sup 10} L{sub B}sun), where the first uncertainty is statistical and the second includes systematic effects. The dependence of the rate on the assumed cosmological parameters is studied and the redshift dependence of the rate per unit comoving volume is contrasted with local estimates in the context of possible cosmic star formation histories and progenitor models.

  4. Neutronization and Energetics of Type Ia Supernovae

    Science.gov (United States)

    Seitenzahl, I. R.; Peng, F.; Townsley, D. M.; Calder, A. C.

    2005-12-01

    Type Ia supernovae are critical distance indicators for cosmology. The lightcurves are powered by the decay of radioactive nickel and cobalt isotopes. The amount of nickel produced in the supernova event depends on the detailed trajectories of the hydrodynamic evolution of the explosion. A key ingredient in numerical simulations of the deflagration phase of Type Ia supernovae is the nuclear flame model. A realistic model must accurately describe the nuclear energy released, the timescale on which the energy release occurs, and the changes in composition that constitute the burning. Once the flame has passed, the hot products of the burning constitute a nuclear statistical equilibrium (NSE) abundance distribution. Since the NSE abundances, and hence derived quantities such as the mean binding energy per nucleon, are functions of the density, temperature and electron fraction, it is important to continuously adjust the NSE state of the ashes during the hydrodynamic evolution of the star. Weak interactions influence the energetics and evolution via the change in degeneracy pressure due to captured electrons, the energy losses carried away by neutrinos, and the readjustment of the NSE state following a change in the electron fraction. We have developed a NSE-based model, which implements these features for a hydrodynamical evolution code.

  5. Dark matter ignition of type Ia supernovae

    CERN Document Server

    Bramante, Joseph

    2015-01-01

    Recent studies of low redshift type Ia supernovae (SNIa) indicate that half explode from less than Chandrasekhar mass white dwarfs, implying ignition must proceed from something besides the canonical criticality of Chandrasekhar mass SNIa progenitors. We show that $0.1-10$ PeV mass asymmetric dark matter, with imminently detectable nucleon scattering interactions, can accumulate to the point of self-gravitation in a white dwarf and collapse, shedding gravitational potential energy by scattering off nuclei, thereby heating the white dwarf and igniting the flame front that precedes SNIa. We combine data on SNIa masses with data on the ages of SNIa-adjacent stars. This combination reveals a $ 3 \\sigma$ inverse correlation between SNIa masses and ignition ages, which could result from increased capture of dark matter in 1.4 versus 1.1 solar mass white dwarfs. Future studies of SNIa in galactic centers will provide additional tests of dark-matter-induced type Ia ignition. Remarkably, both bosonic and fermionic SNI...

  6. The distant Type Ia supernova rate

    CERN Document Server

    Pain, R; Sullivan, M; Ellis, Richard S; Aldering, G; Astier, Pierre; Duestua, S E; Fruchter, A S; Goldhaber, Gerson; Goobar, A; Groom, D E; Hardin, D; Hook, I M; Howell, D A; Irwin, M J; Kim, A G; Kim, M Y; Knop, R A; Lee, J C; Lidman, C E; McMahon, R G; Nugent, P; Panagia, N; Pennypacker, C R; Perlmutter, S; Ruiz-Lapuente, P; Schahmaneche, K; Schaefer, B; Walton, N A

    2001-01-01

    We present a measurement of the rate of distant Type Ia supernovae derived using 4 large subsets of data from the Supernova Cosmology Project. Within this fiducial sample, which surveyed about 12 square degrees, thirty-eight supernovae were detected at redshifts 0.25--0.85. In a spatially-flat cosmological model consistent with the results obtained by the Supernova Cosmology Project, we derive a rest-frame Type Ia supernova rate at a mean redshift $z\\simeq0.55$ of $1.53 {^{+0.28}_{-0.25}} {^{+0.32}_{-0.31}} 10^{-4} h^3 {\\rm Mpc}^{-3} {\\rm yr}^{-1}$ or $0.58 {^{+0.10}_{-0.09}} {^{+0.10}_{-0.09}} h^2 {\\rm SNu}$ (1 SNu = 1 supernova per century per $10^{10}$\\Lbsun), where the first uncertainty is statistical and the second includes systematic effects. The dependence of the rate on the assumed cosmological parameters is studied and the redshift dependence of the rate per unit comoving volume is contrasted with local estimates in the context of possible cosmic star formation histories and progenitor models.

  7. THE GEOMORPHOSITES OF ROŞIA MONTANĂ

    Directory of Open Access Journals (Sweden)

    Maria-Adina Jurj

    2016-06-01

    Full Text Available The geomorphosites of Roșia Montană. The volcanic relief of the Roșia Montană mining area is characterised by a significant number of geomorphosites, represented especially by necks and dykes, such as: Cârnic, Orlea, Jig-Văidoaia, Lety etc. Another category of geomorphosites is represented by those with hydrographic features, namely the ponds created for mining purposes since Roman period. We identified a number of 14 geomorphosites; 9 of these are the results of the Neogene volcanic activity, and 5 are the ponds which appeared as an indirect consequence of the volcanic specific of the area. The geomorphosites created by the volcanic activity have also a significant archaeological, historical and cultural value, due to the valuable mining galleries and another evidences of this ancient activity. Among all the geomorphosites of the area, the most important one is Cârnic Massif which has a complex system of underground mining galleries, some of them belonging to Roman period. We consider that capitalization through touristic activities of these landforms is the best utilization in terms of ecological, cultural and economic perspectives.

  8. Type Ia supernovae: explosions and progenitors

    Science.gov (United States)

    Kerzendorf, Wolfgang Eitel

    2011-08-01

    Supernovae are the brightest explosions in the universe. Supernovae in our Galaxy, rare and happening only every few centuries, have probably been observed since the beginnings of mankind. At first they were interpreted as religious omens but in the last half millennium they have increasingly been used to study the cosmos and our place in it. Tycho Brahe deduced from his observations of the famous supernova in 1572, that the stars, in contrast to the widely believe Aristotelian doctrine, were not immutable. More than 400 years after Tycho made his paradigm changing discovery using SN 1572, and some 60 years after supernovae had been identified as distant dying stars, two teams changed the view of the world again using supernovae. The found that the Universe was accelerating in its expansion, a conclusion that could most easily be explained if more than 70% of the Universe was some previously un-identified form of matter now often referred to as `Dark Energy'. Beyond their prominent role as tools to gauge our place in the Universe, supernovae themselves have been studied well over the past 75 years. We now know that there are two main physical causes of these cataclysmic events. One of these channels is the collapse of the core of a massive star. The observationally motivated classes Type II, Type Ib and Type Ic have been attributed to these events. This thesis, however is dedicated to the second group of supernovae, the thermonuclear explosions of degenerate carbon and oxygen rich material and lacking hydrogen - called Type Ia supernovae (SNe Ia). White dwarf stars are formed at the end of a typical star's life when nuclear burning ceases in the core, the outer envelope is ejected, with the degenerate core typically cooling for eternity. Theory predicts that such stars will self ignite when close to 1.38 Msun (called the Chandrasekhar Mass). Most stars however leave white dwarfs with 0.6 Msun, and no star leaves a remnant as heavy as 1.38 M! sun, which suggests

  9. Finding Distances to Type Ia Supernovae

    Science.gov (United States)

    Kohler, Susanna

    2016-03-01

    Type Ia supernovae are known as standard candles due to their consistency, allowing us to measure distances based on their brightness. But what if these explosions arent quite as consistent as we thought? Due scientific diligence requires careful checks, so a recent study investigates whether the metallicity of a supernovas environment affects the peak luminosity of the explosion.Metallicity Dependence?Type Ia supernovae are incredibly powerful tools for determining distances in our universe. Because these supernovae are formed by white dwarfs that explode when they reach a uniform accreted mass, the supernova peak luminosity is thought to be very consistent. This consistency allows these supernovae to be used as standard candles to measure distances to their host galaxies.But what if that peak luminosity is affected by a factor that we havent taken into account? Theorists have proposed that the luminosities of Type Ia supernovae might depend on the metallicity of their environments with high-metallicity environments suppressing supernova luminosities. If this is true, then we could be systematically mis-measuring cosmological distances using these supernovae.Testing AbundancesSupernova brightnesses vs. the metallicity of their environments. Low-metallicity supernovae (blue shading) and high-metallicity supernovae (red shading) have an average magnitude difference of ~0.14. [Adapted from Moreno-Raya et al. 2016]A team led by Manuel Moreno-Raya, of the Center for Energy, Environment and Technology (CIEMAT) in Spain, has observed 28 Type Ia supernovae in an effort to test for such a metallicity dependence. These supernovae each have independent distance measurements (e.g., from Cepheids or the Tully-Fisher relation).Moreno-Raya and collaborators used spectra from the 4.2-m William Herschel Telescope to estimate oxygen abundances in the region where each of these supernovae exploded. They then used these measurements to determine if metallicity of the local region

  10. Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Chigomezgo Munthali

    2014-06-01

    Full Text Available Introduction: The World Health Organization (WHO recommends that HIV-positive adults with CD4 count ≤500 cells/mm3 initiate antiretroviral therapy (ART. In many countries of sub-Saharan Africa, CD4 count is not widely available or consistently used and instead the WHO clinical staging system is used to determine ART eligibility. However, concerns have been raised regarding its discriminatory ability to identify patients eligible to start ART. We therefore reviewed the accuracy of WHO stage 3 or 4 assessment in identifying ART eligibility according to CD4 count thresholds for ART initiation. Methods: We systematically searched PubMed and Global Health databases and conference abstracts using a comprehensive strategy for studies that compared the results of WHO clinical staging with CD4 count thresholds. Studies performed in sub-Saharan Africa and published in English between 1998 and 2013 were eligible for inclusion according to our predefined study protocol. Two authors independently extracted data and assessed methodological quality and risk of bias using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2 tool. Summary estimates of sensitivity and specificity were derived for each CD4 count threshold and hierarchical summary receiver operator characteristic curves were plotted. Results: Fifteen studies met the inclusion criteria, including 25,032 participants from 14 countries. Most studies assessed individuals attending ART clinics prior to treatment initiation. WHO clinical stage 3 or 4 disease had a sensitivity of 60% (95% CI: 45–73%, Q=914.26, p<0.001 and specificity of 73% (95% CI: 60–83%, Q=1439.43, p<0.001 for a CD4 threshold of ≤200 cells/mm3 (11 studies; sensitivity and specificity for a threshold of CD4 count ≤350 cells/mm3 were 45% (95% CI: 26–66%, Q=1607.31, p<0.001 and 85% (95% CI: 69–93%, Q=896.70, p<0.001, respectively (six studies. For the threshold of CD4 count ≤500 cells/mm3 sensitivity was

  11. Prognostic Effect of Ultra-Staging Node-Negative Colon Cancer Without Adjuvant Chemotherapy: A Prospective National Cancer Institute-Sponsored Clinical Trial.

    Science.gov (United States)

    Protic, Mladjan; Stojadinovic, Alexander; Nissan, Aviram; Wainberg, Zev; Steele, Scott R; Chen, David C; Avital, Itzhak; Bilchik, Anton J

    2015-09-01

    We recently reported, in a prospective randomized trial, that ultra-staging of patients with colon cancer is associated with significantly improved disease-free survival (DFS) compared with conventional staging. That trial did not control for lymph node (LN) number or adjuvant chemotherapy use. The current international prospective multicenter cooperative group trial (ClinicalTrials.gov identifier NCT00949312; "Ultra-staging in Early Colon Cancer") evaluates the 12-LN quality measure and nodal ultra-staging impact on DFS in patients not receiving adjuvant chemotherapy. Eligibility criteria included biopsy-proven colon adenocarcinoma; absence of metastatic disease; >12 LNs staged pathologically; pan-cytokeratin immunohistochemistry (IHC) of hematoxylin and eosin (H&E)-negative LNs; and no adjuvant chemotherapy. Of 445 patients screened, 203 patients were eligible. The majority of patients had intermediate grade (57.7%) and T3 tumors (64.9%). At a mean follow-up of 36.8 ± 22.1 months (range 0 to 97 months), 94.3% remain disease free. Recurrence was least likely in patients with ≥12 LNs, H&E-negative LNs, and IHC-negative LNs (pN0i-): 2.6% vs 16.7% in the pN0i+ group (p negative colon cancer (≥12 LNs, pN0i-) are unlikely to benefit from adjuvant chemotherapy; 97% remain disease free after primary tumor resection. Both surgical and pathologic quality measures are imperative in planning clinical trials in nonmetastatic colon cancer. Copyright © 2015 American College of Surgeons. All rights reserved.

  12. Clinical impact of FDG-PET/CT in the planning of radiotherapy for early-stage Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Hutchings, Martin; Jakobsen, Annika Loft; Hansen, Mads

    2007-01-01

    BACKGROUND: Early-stage Hodgkin lymphoma (HL) has excellent survival rates but carries a high risk of late treatment-related adverse effects. Modern, individualised therapeutic strategies require an accurate determination of the extent of the disease. This study investigated the potential impact...... of 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computerised tomogrpahy (FDG-PET/CT) in the planning of involved field radiotherapy (IFRT). PATIENTS AND METHODS: Thirty patients received staging FDG-PET/CT before therapy, and IFRT after a short course of ABVD (adriamycin, bleomycin......, vinblastine, dacarbazine) chemotherapy. IFRT planning was performed using only the CT data from the FDG-PET/CT scan. Later, the IFRT planning was performed anew using the FDG-PET/CT data as basis for contouring. RESULTS: In 20 out of 30 patients, the radiotherapy (RT) course was unaffected by the addition...

  13. CLINICAL ANALYSIS ON INTEGRATED TREATMENT OF 2240 CASES OF PERIPHERAL FACIAL PARALYSIS BY STAGES IN PLATEAU REGION

    Institute of Scientific and Technical Information of China (English)

    JU Rui-quan; SU Li-qing; SUN Yong; ZHANG Jin-rong; LIU Su-chen

    2005-01-01

    Objective: To observe the therapeutic effect of integrated treatment of peripheral facial paralysis by stages in Qinghai plateau area. Methods: A total of 2 240 cases of peripheral facial paralysis treated with integrated approaches by stages were assigned to treatment group, and other 75 cases treated with acupuncture therapy assigned to control group. In treatment group, patients were treated with 1) medication (Prednisone, Dibazol, etc) and TDP ("special electromagnetic spectrum") plus ultrashort irradiation in the early stage; 2) TDP plus ultrasonic wave irradiation and acupuncture of Yangbai (阳白GB 14) to Yuyao (鱼腰EX-HN 4, penetration needling), etc in the medium stage; 3) medium-frequency irradiation and electroacupuncture (EA) of muscle motor joints and acupoints (GB-14, etc). Patients of control group were treated with conventional acupuncture therapy (GB-14, etc). Results: After treatment, of the 2 240 patients in treatment group, 2 072 (92.5%) were cured, 120 (5.3%) effective, 33 (1.5%) improved, and 15 (0.7%) failed. The total effective rate was 99.3%. Of the 75 cases in control group, 46 (61.3%) were cured, 16 (21.3%) effective, 9 (12.0%) improved, and 4 (5.4%) ineffective. The total effective rate was 94.6%. The cure rate and the total effective rate of treatment group were significantly higher than those of control group respectively (χ2=29.379, P<0.01; χ2=5.716, P<0.025). Conclusion: The therapeutic effect of integrated approaches (medication, acupuncture, electromagnetic+ultrashort wave+ultrasonic wave+ medium-frequency wave irradiation) is significantly superior to that of simple acupuncture therapy in treating peripheral facial paralysis.

  14. Clinical Application of Adjuvant Treatment after Operation in Patients with Stage IIIa Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yajie GAO

    2010-04-01

    Full Text Available Background and objective The efficacy of complete resection of the cancer for patients with stage IIIa non-small cell lung cancer (NSCLC is limited. Synthetic therapy is taken the lead in advocating at present. However, the value of post-operative radiotherapy is not still clear. The aim of this study is to evaluate the survival time and side effects of postoperative chemotherapy or chemoradiotherapy in the treatment of stage IIIa NSCLC. Methods Between December 2003 and June 2007, 52 cases that have completed followed-up data with stage IIIa of NSCLC received in the First Affiliated Hospital of Dalian Medical University. Twenty-three patients received postoperative chemoradiotherapy (group A and 29 patients received postoperative chemotherapy combined with radiotherapy (group B. Group A adopted platinum-based combination chemotherapy for 4-6 cycles. The chemotherapeutics included gemcitabine, vinorelbine and docetaxel. Group B used chemotherapy for 2-4 cycles and then received 3-dimensional conformal radiotherapy (3D-CRT. The prescribe dose of target volume was 50 Gy. The chemotherapy was same as for group A and needed 4 cycles in all. The impact of postoperative adjuvant treatment on survival and toxicity was observed in patients with stage IIIa NSCLC and the reason of disease progression was analyzed. Results The median survival was 32.5 months in group A and 31.9 months in group B (P=0.371. Progression-free survival extended about 6 months (P=0.044. The survival rate was 87% at 1 year, 0.1% at 2 year, 33% at 3 year for group A compared with 93%, 69%, 45% for group B. The major side effects were hematological and gastrointestinal toxicities, including nausea, vomiting and neutropenia. There was no significant difference in these toxicities between the two groups (P>0.05. Radioactiv esophageal infection occurred in 17.2% of the patients. Acute and late radioactive lung infection occurred in 13.8% and 27.6% of the patients. All these toxicities

  15. Does posterior cingulate hypometabolism result from disconnection or local pathology across preclinical and clinical stages of Alzheimer's disease?

    Energy Technology Data Exchange (ETDEWEB)

    Teipel, Stefan [University of Rostock, Department of Psychosomatic Medicine, Rostock (Germany); DZNE, German Center for Neurodegenerative Diseases, Rostock (Germany); Alzheimer' s Disease Neuroimaging Initiative (United States); Grothe, Michel J. [DZNE, German Center for Neurodegenerative Diseases, Rostock (Germany); Alzheimer' s Disease Neuroimaging Initiative (United States)

    2016-03-15

    Posterior cingulate cortex (PCC) hypometabolism as measured by FDG PET is an indicator of Alzheimer's disease (AD) in prodromal stages, such as in mild cognitive impairment (MCI), and has been found to be closely associated with hippocampus atrophy in AD dementia.We studied the effects of local and remote atrophy and of local amyloid load on the PCC metabolic signal in patients with different preclinical and clinical stages of AD. We determined the volume of the hippocampus and PCC grey matter based on volumetric MRI scans, PCC amyloid load based on AV45 PET, and PCC metabolism based on FDG PET in 667 subjects participating in the Alzheimer's Disease Neuroimaging Initiative spanning the range from cognitively normal ageing through prodromal AD to AD dementia. In cognitively normal individuals and those with early MCI, PCC hypometabolism was exclusively associated with hippocampus atrophy, whereas in subjects with late MCI it was associated with both local and remote effects of atrophy as well as local amyloid load. In subjects with AD dementia, PCC hypometabolism was exclusively related to local atrophy. Our findings suggest that the effects of remote pathology on PCC hypometabolism decrease and the effects of local pathology increase from preclinical to clinical stages of AD, consistent with a progressive disconnection of the PCC from downstream cortical and subcortical brain regions. (orig.)

  16. The VLT Measures the Shape of a Type Ia Supernova

    Science.gov (United States)

    2003-08-01

    First Polarimetric Detection of Explosion Asymmetry has Cosmological Implications Summary An international team of astronomers [2] has performed new and very detailed observations of a supernova in a distant galaxy with the ESO Very Large Telescope (VLT) at the Paranal Observatory (Chile). They show for the first time that a particular type of supernova, caused by the explosion of a "white dwarf", a dense star with a mass around that of the Sun, is asymmetric during the initial phases of expansion . The significance of this observation is much larger than may seem at a first glance . This particular kind of supernova, designated "Type Ia", plays a very important role in the current attempts to map the Universe. It has for long been assumed that Type Ia supernovae all have the same intrinsic brightness , earning them a nickname as "standard candles". If so, differences in the observed brightness between individual supernovae of this type simply reflect their different distances. This, and the fact that the peak brightness of these supernovae rivals that of their parent galaxy, has allowed to measure distances of even very remote galaxies . Some apparent discrepancies that were recently found have led to the discovery of cosmic acceleration . However, this first clearcut observation of explosion asymmetry in a Type Ia supernova means that the exact brightness of such an object will depend on the angle from which it is seen. Since this angle is unknown for any particular supernova, this obviously introduces an amount of uncertainty into this kind of basic distance measurements in the Universe which must be taken into account in the future. Fortunately, the VLT data also show that if you wait a little - which in observational terms makes it possible to look deeper into the expanding fireball - then it becomes more spherical. Distance determinations of supernovae that are performed at this later stage will therefore be more accurate. PR Photo 24a/03 : Spiral galaxy NGC

  17. Multidisciplinary management of non small cell lung cancer (NSCLC in stage III: clinical case description. Recommendations and state of the art

    Directory of Open Access Journals (Sweden)

    Simona Carnio

    2013-03-01

    Full Text Available Lung cancer is the leading cause of cancer death in industrialized countries with progressive increase of its mortality rate. Non Small Cell Lung Cancer (NSCLC is approximately 80-85% of all lung cancers, being adenocarcinoma and squamous cell carcinoma the most common histologies. The majority of the patients with stage III clinical stage, presents a mediastinal lymph node involvement described with computed tomography (TC and/or positron emission tomography (PET. The current approach to patients with NSCLC is multidisciplinary, especially for those staged as potentially operable, both for staging and for a correct definition of best treatment strategy. Updated international and national Guidelines and recommendations can provide valuable support to the clinician.The case described concerns the accidental detection of a tumour in the lung in a 58-year-old man with arterial hypertension controlled with ACE inhibitors. The treatments agreed after a multidisciplinary approach are cisplatin and docetaxel, the surgical resection, and the radiotherapy. After three months the patient has neither metastasis nor relapse.

  18. UBVRI Light Curves of 44 Type Ia Supernovae

    NARCIS (Netherlands)

    Jha, Saurabh; Groot, Paul J.

    2006-01-01

    We present UBVRI photometry of 44 Type Ia supernovae (SNe Ia) observed from 1997 to 2001 as part of a continuing monitoring campaign at the Fred Lawrence Whipple Observatory of the Harvard-Smithsonian Center for Astrophysics. The data set comprises 2190 observations and is the largest homogeneously

  19. The Connection between IAS/IFRS and Social Responsibility

    Directory of Open Access Journals (Sweden)

    Stefano AMELIO

    2016-05-01

    Full Text Available The aim of the paper is to evaluate the degree of social responsibility arising from the statement of comprehensive income prepared according to IAS/IFRS, to demonstrate whether the values obtained from prospects and from the calculation of the indicators are sufficient to analyze the Company's performance from the perspective of social responsibility and sustainable value or not. In order to achieve the objective of harmonization, the European Union adopted the IAS/IFRS developed by the International Accounting Standards Board (IASB. The research is divided into two sections and the approach used is mainly theoretical and qualitative. In the first part, the financial statements to be prepared according to IAS 1 and IAS 7 and, in particular, the so called statement of profit or loss and other comprehensive income for the period are analyzed by underling the function of the same and by presenting some financial performance indicators. Then, the research highlights how these values obtained are not useful to communicate the company's strategy in terms of social responsibility and sustainable value. In the second part the analyses exposes the concept of social balance. According to the social responsibility view the IAS/IFRS financial statements should be accompanied by the social balance. It becomes crucial to complete the set of financial statements stated from IAS 1 with a social balance as well as the same IAS 1 contemplates. For this reason it is possible to say that the connection between IAS/IFRS and social responsibility is weak.

  20. Autologous peptides constitutively occupy the antigen binding site on Ia

    DEFF Research Database (Denmark)

    Buus, S; Sette, A; Colon, S M;

    1988-01-01

    Low molecular weight material associated with affinity-purified class II major histocompatibility complex (MHC) molecules of mouse (Ia) had the expected properties of peptides bound to the antigen binding site of Ia. Thus, the low molecular weight material derived from the I-Ad isotype...

  1. 77 FR 66067 - Amendment of Class E Airspace; Boone, IA

    Science.gov (United States)

    2012-11-01

    ... Administration 14 CFR Part 71 Amendment of Class E Airspace; Boone, IA AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final rule. SUMMARY: This action amends Class E airspace at Boone, IA... necessary for standard instrument approach procedures and for the safety and management of Instrument...

  2. 77 FR 68682 - Amendment of Class E Airspace; Guthrie, IA

    Science.gov (United States)

    2012-11-16

    ... Federal Aviation Administration 14 CFR Part 71 Amendment of Class E Airspace; Guthrie, IA AGENCY: Federal... Guthrie, IA. Decommissioning of the Guthrie Center non-directional radio beacon (NDB) at Guthrie County... safety and management of Instrument Flight Rule (IFR) operations at the airport. Geographic...

  3. Intermediate-band Photometry of Type Ia Supernovae

    CERN Document Server

    Wang, X; Zhang, T; Li, Z; Wang, Xiaofeng; Zhou, Xu; Zhang, Tianmeng; Li, Zongwei

    2004-01-01

    We present optical light curves of five Type Ia supernovae (2002er, 2002fk, 2003cg, 2003du, 2003fk). The photometric observations were performed in a set of intermediate-band filters. SNe 2002er, 2003du appear to be normal SN Ia events with similar light curve shapes, while SN 2003kf shows the behavior of a brighter SN Ia with slower decline rate after maximum. The light curves of SN 2003cg is unusual; they show a fast rise and dramatic decline near maximum and do not display secondary peak at longer wavelengths during 15-30 days after maximum light. This suggests that SN 2003cg is likely to be an intrinsically subluminous, 91bg-like SN Ia. Exploration of SN Ia feature lines through intermediate-band photometry is briefly discussed.

  4. Theoretical considerations about implementation of IAS 41 in Romania

    Directory of Open Access Journals (Sweden)

    Liliana FELEAGĂ

    2012-02-01

    Full Text Available Although agriculture is an important part of the world economy, accounting in agriculture still has many shortcomings. The adoption of IAS 41 „Agricuture” has tried to improve this situation and increase the comparability of financial statements of entities in the agricultural sector. Although controversial, IAS 41 is the first step of a consistent transition to fair value assessment in the agricultural sector. The objective of our work is the analysis of IAS 41 and current accounting agricultural situation in Romania. Accounting regulations in Romania are in accordance with European directives and, in many respects, converged with IFRS referential. Provisions of IAS 41, however, are not reflected directly in Romanian regulations. With the increase of forest land transactions and foreign investments in animal farms, it is expected that recognition and measurement of biological assets under IAS 41 to become a necessity.

  5. Type Ia Supernova Remnants: Shaping by Iron Bullets

    CERN Document Server

    Tsebrenko, Danny

    2015-01-01

    Using 2D numerical hydrodynamical simulations of type Ia supernova remnants (SNR Ia) we show that iron clumps few times denser than the rest of the SN ejecta might form protrusions in an otherwise spherical SNR. Such protrusions exist in some SNR Ia, e.g., SNR 1885 and Tycho. Iron clumps are expected to form in the deflagration to detonation explosion model. In SNR Ia where there are two opposite protrusions, termed ears, such as Kepler's SNR and SNR G1.9+0.3, our scenario implies that the dense clumps, or iron bullets, were formed along an axis. Such a preferred axis can result from a rotating white dwarf progenitor. If our claim holds, this offers an important clue to the SN Ia explosion scenario.

  6. Human Ia-like antigens in non-lymphoid organs.

    Science.gov (United States)

    Koyama, K; Fukunishi, T; Barcos, M; Tanigaki, N; Pressman, D

    1979-01-01

    Human Ia-like antigens in liver and kidney were shown by the immunofluorescence assay to be present mostly in the endothelial-mesenchymal cells of these organs. The parenchymal cells apparently contained no human Ia-like antigens. The antigens in liver and kidney were purified and shown to have the same subunit structure as human Ia-like antigens of cultured B-lymphoid cells. The human Ia-like antigens in non-lymphoid organs, not only in liver and kidney but also in testis, heart, muscle and brain, carried all the xenoantigenic characteristics of human Ia-like antigens expressed on lymphoid cells of B-cell lineage. Images Figure 1 PMID:389786

  7. A metric space for type Ia supernova spectra

    CERN Document Server

    Sasdelli, Michele; Aldering, G; Antilogus, P; Aragon, C; Bailey, S; Baltay, C; Benitez-Herrera, S; Bongard, S; Buton, C; Canto, A; Cellier-Holzem, F; Chen, J; Childress, M; Chotard, N; Copin, Y; Fakhouri, H K; Feindt, U; Fink, M; Fleury, M; Fouchez, D; Gangler, E; Guy, J; Ishida, E E O; Kim, A G; Kowalski, M; Kromer, M; Lombardo, S; Mazzali, P A; Nordin, J; Pain, R; Pécontal, E; Pereira, R; Perlmutter, S; Rabinowitz, D; Rigault, M; Runge, K; Saunders, C; Scalzo, R; Smadja, G; Suzuki, N; Tao, C; Taubenberger, S; Thomas, R C; Tilquin, A; Weaver, B A

    2014-01-01

    We develop a new framework for use in exploring Type Ia Supernova (SN Ia) spectra. Combining Principal Component Analysis (PCA) and Partial Least Square analysis (PLS) we are able to establish correlations between the Principal Components (PCs) and spectroscopic/photometric SNe Ia features. The technique was applied to ~120 supernova and ~800 spectra from the Nearby Supernova Factory. The ability of PCA to group together SNe Ia with similar spectral features, already explored in previous studies, is greatly enhanced by two important modifications: (1) the initial data matrix is built using derivatives of spectra over the wavelength, which increases the weight of weak lines and discards extinction, and (2) we extract time evolution information through the use of entire spectral sequences concatenated in each line of the input data matrix. These allow us to define a stable PC parameter space which can be used to characterize synthetic SN Ia spectra by means of real SN features. Using PLS, we demonstrate that th...

  8. Adiponectin levels correlate with the severity of hypertriglyceridaemia in glycogen storage disease Ia

    NARCIS (Netherlands)

    Bandsma, R. H. J.; Smit, G. P. A.; Reijngoud, D. -J.; Kuipers, F.

    2009-01-01

    Glycogen storage disease type Ia (GSD Ia) is characterized by severe hypercholesterolaemia and hypertriglyceridaemia. Little is known about the aetiology of the hyperlipidaemia in GSD Ia. Adipokines play an important regulatory role in lipid metabolism. We investigated whether adipokine concentratio

  9. Neuropsychological effects of deep brain stimulation in subjects with early stage Parkinson's disease in a randomized clinical trial.

    Science.gov (United States)

    Tramontana, Michael G; Molinari, Anna L; Konrad, Peter E; Davis, Thomas L; Wylie, Scott A; Neimat, Joseph S; May, Alexandra T; Phibbs, Fenna T; Hedera, Peter; Gill, Chandler E; Salomon, Ronald M; Wang, Lily; Song, Yanna; Charles, David

    2015-01-01

    Deep brain stimulation (DBS) is an effective treatment for patients with advanced Parkinson's disease (PD) and motor symptom complications. Recently, attention has been focused on whether offering DBS earlier in the course of PD is beneficial. The purpose of this study was to determine the effects of DBS on neuropsychological functioning in subjects with early stage PD. Thirty subjects with early PD (Hoehn & Yahr Stage II off medication) were randomized to optimal drug therapy (ODT) (n = 15) or bilateral subthalamic nucleus (STN) DBS+ODT (n = 15) after completing an expanded informed consent process specially designed for the study and administered by a medical ethicist and the study team. Comprehensive neuropsychological testing was completed in the treatment-withdrawn state at baseline and at 12 month and 24 month follow-ups. Two serious adverse events occurred in the DBS+ODT group. One subject experienced a stroke and another developed infected hardware that contributed to specific declines in cognitive functioning. However, compared to the ODT group, the remaining subjects in the DBS+ODT group exhibited modest reductions on a few measures of attention, executive function, and word fluency at 12 months. These differences were largely diminished at 24 months, especially when those with the adverse events were excluded. The results of this trial provide novel data regarding the effects of DBS on cognitive function in early PD. We believe that the findings and insights from this trial can help guide the safety analysis and risk-benefit evaluations in future discussions of DBS in early stage PD.

  10. On the use of Disease Staging for clinical management: analysis of untimely admissions in the Abruzzo Region, Italy

    Directory of Open Access Journals (Sweden)

    Lamberto Manzoli

    2004-12-01

    Full Text Available

    Background and aims. The process of decentralization which recently occurred within the Italian National Health Service has transferred substantial responsibility and authority for health care administration to the individual regions. The project is aimed at developing regional benchmarks that can be used as a part of an ongoing system for analysis of resource use and quality of care in the Abruzzo Region of Italy.

    Methods. All 286 924 hospital admissions for the year 2001 in the region were analysed. Three diseases were chosen for in-depth review: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. There were a total of 9391 admissions for these diagnoses. Severity, length of hospital stay and hospital mortality were analysed using Disease Staging methodology. In addition, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely and late.

    Results. The rate of medically unnecessary admissions for diabetes mellitus was 72% throughout the region, and the percentage of late hospitalisations for cholelithiasis/cholecystitis was 43%. For both diseases, there were significant variations across Local Health Units in the proportion of late and early admissions. The rate of timely hospitalisations for bacterial pneumonia was higher than 86%.

    Conclusion. The analysis of discharge abstract data using Disease Staging revealed that in the Abruzzo region there are problems of inappropriate hospital admission, both early and late, for all diseases examined excepted bacterial pneumonia.

    Data confirmed the validity of Disease Staging to compare the performance of diverse hospitals in terms of length of stay and in-hospital mortality.

  11. [Postoperative Adjuvant Chemotherapy for Stage III Colon Cancer--Drug Selection, Tolerability, and Safety in Clinical Practice].

    Science.gov (United States)

    Okada, Kazutake; Sadahiro, Sotaro; Saito, Gota; Tanaka, Akira; Suzuki, Toshiyuki

    2016-05-01

    In the National Comprehensive Cancer Network (NCCN) guidelines, oxaliplatin (L-OHP)-based chemotherapeutic regimens, including 5-fluorouracil, Leucovorin (LV), and L-OHP (FOLFOX); capecitabine and L-OHP (CapeOX); and 5-fluorouracil, folinic acid, and L-OHP (FLOX) are designated as category 1 recommendations for postoperative adjuvant chemotherapy in Stage III colon cancer, followed by capecitabine and 5-fluorouracil plus LV as category 2A recommendations. We studied the selection of drugs for adjuvant chemotherapy and assessed the tolerability and safety of CapeOX and tegafur-uracil (UFT) plus LV (UFT/LV) in patients with Stage III colon cancer. The study group included 104 consecutive patients with Stage III colon cancer who underwent curative surgery. One patient changed hospitals immediately after surgery. Among the remaining 103 patients, 82 (80%) received adjuvant chemotherapy and 21 (20%) did not. CapeOX was administered to 32 patients (31%), UFT/LV to 49 patients (48%), and capecitabine to 1 patient (1%). In 59 patients, the treatment choice was determined according to the patient's preference; 32 patients (54%) selected CapeOX, 26 (44%) selected UFT/LV, and 1 (2%) selected no chemotherapy. The treatment completion rate was 80% for CapeOX and 84% for UFT/LV. Among patients who completed chemotherapy, dose reduction and drug withdrawal were not required in 22% of patients who received CapeOX and 80% of those who received UFT/LV. Neither CapeOX nor UFT/LV was associated with any serious adverse events. The tolerability and safety of CapeOX and UFT/LV were acceptable. However, CapeOX dose had to be carefully adjusted according to each patient's condition.

  12. Results of volume-staged fractionated Gamma Knife radiosurgery for large complex arteriovenous malformations: obliteration rates and clinical outcomes of an evolving treatment paradigm.

    Science.gov (United States)

    Franzin, Alberto; Panni, Pietro; Spatola, Giorgio; Vecchio, Antonella Del; Gallotti, Alberto L; Gigliotti, Carmen R; Cavalli, Andrea; Donofrio, Carmine A; Mortini, Pietro

    2016-12-01

    OBJECTIVE There are few reported series regarding volume-staged Gamma Knife radiosurgery (GKRS) for the treatment of large, complex, cerebral arteriovenous malformations (AVMs). The object of this study was to report the results of using volume-staged Gamma Knife radiosurgery for patients affected by large and complex AVMs. METHODS Data from 20 patients with large AVMs were prospectively included in the authors' AVM database between 2004 and 2012. A staging strategy was used when treating lesion volumes larger than 10 cm(3). Hemorrhage and seizures were the presenting clinical feature for 6 (30%) and 8 (40%) patients, respectively. The median AVM volume was 15.9 cm(3) (range 10.1-34.3 cm(3)). The mean interval between stages (± standard deviation) was 15 months (± 9 months). The median margin dose for each stage was 20 Gy (range 18-25 Gy). RESULTS Obliteration was confirmed in 8 (42%) patients after a mean follow-up of 45 months (range 19-87 months). A significant reduction (> 75%) of the original nidal volume was achieved in 4 (20%) patients. Engel Class I-II seizure status was reported by 75% of patients presenting with seizures (50% Engel Class I and 25% Engel Class II) after radiosurgery. After radiosurgery, 71.5% (5/7) of patients who had presented with a worsening neurological deficit reported a complete resolution or amelioration. None of the patients who presented acutely because of hemorrhage experienced a new bleeding episode during follow-up. One (5%) patient developed radionecrosis that caused sensorimotor hemisyndrome. Two (10%) patients sustained a bleeding episode after GKRS, although only 1 (5%) was symptomatic. High nidal flow rate and a time interval between stages of less than 11.7 months were factors significantly associated with AVM obliteration (p = 0.021 and p = 0.041, respectively). Patient age younger than 44 years was significantly associated with a greater than 75% reduction in AVM volume but not with AVM obliteration (p = 0

  13. Impact of MammaPrint on Clinical Decision-Making in South African Patients with Early-Stage Breast Cancer.

    Science.gov (United States)

    Pohl, Heinrich; Kotze, Maritha J; Grant, Kathleen A; van der Merwe, Lize; Pienaar, Fredrieka M; Apffelstaedt, Justus P; Myburgh, Ettienne J

    2016-07-01

    The aim of the study was to evaluate the impact of MammaPrint on treatment decision-making in patients with breast cancer. Clinicopathologic information of all breast cancer patients referred for MammaPrint testing in South Africa was collected from 2007 until 2014. A total of 107 patients (109 tumors) with estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor-2 negative tumors were selected with tumors ≥10 mm, or when 1-3 nodes were involved without extra-nodal extension. None of the clinical indicators correlated significantly with the MammaPrint risk classification, which changed the decision for adjuvant chemotherapy in 52% of patients. Of 60 patients who were clinically high risk, 62% had a low-risk MammaPrint result and of the 47 clinically low -risk patients 40% had a high-risk MammaPrint result. This study indicates that MammaPrint could reduce the need for adjuvant chemotherapy by 17% using the selection criteria stipulated. The significant impact on treatment decisions confirmed the clinical utility of MammaPrint independent of standard clinicopathologic risk factors as supported by long-term clinical outcome studies.

  14. Anastilosis Virtual de Felipéia

    Directory of Open Access Journals (Sweden)

    Hélio Costa Lima

    2011-04-01

    Full Text Available This text is about a virtual anastylosis of Felipéia, capital of Paraíba, the first city founded in Brazil under the Spanish Crown in 1585, during the Iberic Union. Recently, infographics resources enabled the reconstruction, with great precision, of the old city’s ground plans from Dutch maps from 1634-37, and establish the first hypothesis of a tridimensional configuration of the city. Now, measuring and studies are being done to make possible a piece by piece virtual anastylosis of the buildings and, after that, a tridimensional virtual reconstruction of the historical city, which will enable virtual walkabouts on the streets, squares and buildings.

  15. Type Ia Supernova Explosion: Gravitationally Confined Detonation

    CERN Document Server

    Plewa, T; Lamb, D

    2004-01-01

    We present a new mechanism for Type Ia supernova explosions in massive white dwarfs. The proposed scenario follows from relaxing the assumption of symmetry in the model and involves a detonation created in an unconfined environment. The explosion begins with an essentially central ignition of stellar material initiating a deflagration. This deflagration results in the formation of a buoyantly-driven bubble of hot material that reaches the stellar surface at supersonic speeds. The bubble breakout forms a strong pressure wave that laterally accelerates fuel-rich outer stellar layers. This material, confined by gravity to the white dwarf, races along the stellar surface and is focused at the location opposite to the point of the bubble breakout. These streams of nuclear fuel carry enough mass and energy to trigger a detonation just above the stellar surface. The flow conditions at that moment support a detonation that will incinerate the white dwarf and result in an energetic explosion. The stellar expansion fol...

  16. Type Ia supernovae and the DD scenario

    CERN Document Server

    Isern, J; Lorén-Aguilar, P

    2011-01-01

    Type Ia supernovae are thought to be the outcome of the thermonuclear explosion of a white dwarf in a close binary system. Two possible scenarios, not necessarily incompatible, have been advanced. One assumes a white dwarf that accretes matter from a nondegenerate companion (the single degenerate scenario), the other assumes two white dwarfs that merge as a consequence of the emission of gravitational waves (the double degenerate scenario). The delay time distribution of star formation bursts strongly suggests that the DD scenario should be responsible of the late time explosions, but this contradicts the common wisdom that the outcome of the merging of two white dwarfs is an accretion induced collapse to a neutron star. In this contribution we review some of the most controversial issues of this problem.

  17. 3IA Conference (3IA’2011)

    CERN Document Server

    Miaoulis, Georgios; Intelligent Computer Graphics 2011

    2012-01-01

    In Computer Graphics, the use of intelligent techniques started more recently than in other research areas. However, during these last two decades, the use of intelligent Computer Graphics techniques is growing up year after year and more and more interesting techniques are presented in this area.   The purpose of this volume is to present current work of the Intelligent Computer Graphics community, a community growing up year after year. This volume is a kind of continuation of the previously published Springer volumes “Artificial Intelligence Techniques for Computer Graphics” (2008), “Intelligent Computer Graphics 2009” (2009) and “Intelligent Computer Graphics 2010” (2010).   This volume contains selected extended papers from the last 3IA Conference (3IA’2011), which has been held in Athens (Greece) in May 2011. This year papers are particularly exciting and concern areas like virtual reality, artificial life, data visualization, games, global illumination, point cloud modelling, declarativ...

  18. Matrix Metalloproteinase-2 Promoter Genotype as a Marker of Cutaneous T-Cell Lymphoma Early Stage

    Directory of Open Access Journals (Sweden)

    Anna Vasku

    2010-01-01

    Full Text Available The aim of the study was to investigate the DNA polymorphic genotype in MMP-2 promoter gene as a potential candidate region for the development of the cutaneous T-cell lymphoma (CTCL and/or its progression. A total of 89 Czech patients with CTCL (including 23 patients with large plaque parapsoriasis were compared to 198 controls of similar age and sex distribution, without personal or family history of chronic skin diseases and without personal history of malignancy. The three selected polymorphisms in the promoter of MMP-2 gene (−1575G/A, −1306C/T, and −790T/G were determined using the PCR-based methodology with RFLP. In our cohort, the associated GGCCTT MMP-2 promoter genotype was highly significantly more frequent in CTCL-Ia stage patients compared to patients with parapsoriasis, the tests having high sensitivity and specificity (78%, 83%, resp.. To conclude, use of associated MMP-2 promoter genotype as a DNA marker might make it possible to distinguish between the patients with parapsoriasis and those with CTCL stage Ia, which could substantially improve possibilities of clinical diagnostics, therapy design, and prognosis of this serious condition in the early stages.

  19. Matrix metalloproteinase-2 promoter genotype as a marker of cutaneous T-cell lymphoma early stage.

    Science.gov (United States)

    Vasku, Anna; Vasku, Julie Bienertova; Necas, Miroslav; Vasku, Vladimir

    2010-01-01

    The aim of the study was to investigate the DNA polymorphic genotype in MMP-2 promoter gene as a potential candidate region for the development of the cutaneous T-cell lymphoma (CTCL) and/or its progression. A total of 89 Czech patients with CTCL (including 23 patients with large plaque parapsoriasis) were compared to 198 controls of similar age and sex distribution, without personal or family history of chronic skin diseases and without personal history of malignancy. The three selected polymorphisms in the promoter of MMP-2 gene (-1575G/A, -1306C/T, and -790T/G) were determined using the PCR-based methodology with RFLP. In our cohort, the associated GGCCTT MMP-2 promoter genotype was highly significantly more frequent in CTCL-Ia stage patients compared to patients with parapsoriasis, the tests having high sensitivity and specificity (78%, 83%, resp.). To conclude, use of associated MMP-2 promoter genotype as a DNA marker might make it possible to distinguish between the patients with parapsoriasis and those with CTCL stage Ia, which could substantially improve possibilities of clinical diagnostics, therapy design, and prognosis of this serious condition in the early stages.

  20. Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder

    DEFF Research Database (Denmark)

    Vinberg, Maj; Mikkelsen, Rie Lambaek; Kirkegaard, Thomas;

    2017-01-01

    level, the presence of comorbid personality disorders and coping strategies. METHODS: Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status...... using the Coping Inventory for Stressful Situations. RESULTS: In total, 344 patients were included (BD I (n=163) and BD II (n=181). Patients with BD II presented with significantly more depressive symptoms, more cognitive complaints, lower overall functioning, and a higher prevalence of comorbid...

  1. Use of Disease Staging and analysis of untimely admissions in the Abruzzo Region, Italy: implications for clinical management

    Directory of Open Access Journals (Sweden)

    Lamberto Manzoli

    2004-06-01

    Full Text Available

    Dear Sir;
    The Section of Epidemiology and Public Health of the University “G. d’Annunzio” of Chieti, in collaboration with the Centre for Research in Medical Education and Health Care of Jefferson Medical College, Philadelphia, PA, USA, has analysed 350,000 hospital admissions for the year 2001 in the Abruzzo region. Four diseases were chosen for an in-depth analysis. These were: diabetes mellitus;
    cholecystitis/cholelithiasis; cancer of the female breast and bacterial pneumonia.The total admissions for these conditions were 11,000.
    Using the Disease Staging methodology to control for severity, a number of variables were analysed:
    length of hospital stay, hospital mortality, complications and repeated admissions. In addition, the timeliness of hospitalisation was analysed by grouping admissions into three categories: premature or medically unnecessary, timely, and late.An example of the first type is a patient with an elevated blood sugar but no other complications (Stage 1 Diabetes Mellitus.

  2. The Clinical Research in Advanced Stage Gastric Cancer Accompanying Hemorrhage with EHLF Chemotherapy and Thrombin to Take Orally

    Institute of Scientific and Technical Information of China (English)

    Chen Huoguo

    2003-01-01

    Purpose:Study therapeutic effectiveness about EHLF chemotherapy and thrombin to take orally in advanced stage gastriccancer accompanying hemorrhage.Methods:76 cases were divided into two groups at random,that were diagnosed by pathology andclinical. Research group included medicine:(etoposide)VP-16,100 mg intravenous drip,d1~3;(hydroxycamptothecin)HCPT, 10mg,ivtravenous drip,d1~5;(calciumfolinate)CF, 100 mg,intravenous drip,d1~5;(fluorouracil)5-Fu,0.5,intravenous drip,d1~5;thrombin,5oou,oral administration,three times in a day, d1~7.Matched control:normal regulation to medicine in gastric hemorrhye.Results:Effective rate in research group was 78.4%,obvious better than one in matched control 28.2%(P<0.01),bad reaction wasslight, life quantity was obvious exaltation.Conclusion:EHLF chemotherapy and thrombin to take orally was used as treatment project inadranced stage gastric cancer accompanying hemorrhage,good result in research group. It is worthy to deserve further reseach.

  3. Scalpel or SABR for Treatment of Early-Stage Lung Cancer: Clinical Considerations for the Multidisciplinary Team

    Directory of Open Access Journals (Sweden)

    Joe Y. Chang

    2011-09-01

    Full Text Available Treatment options for early-stage (T1-2 N0 non-small cell lung cancer are often limited by the patient’s advanced age, poor performance status, and comorbidities. Despite these challenges, stereotactic ablative radiotherapy (SABR provides a highly effective and safe therapy for intrathoracic tumors and has become the standard of care for delivering definitive treatment in medically inoperable patients. High-quality treatment, which includes reliable immobilization, accurate tumor targeting, and precise verification of dose delivery, is essential both to achieve successful cure and to avoid debilitating toxicities. Generally, SABR is well tolerated in patients with peripherally located tumors, but even centrally or superiorly located lesions can be treated if there is adequate conformal avoidance of normal structures and/or modified fractionation to meet dose constraints. While several preliminary studies suggest that SABR is as efficacious as surgery in operable patients, results of randomized data will illuminate whether the indications for SABR can be expanded to include patients who are candidates for surgical resection. Herein, we review the rationale for using SABR and its application in treating different patient populations with early-stage lung cancer.

  4. 78 FR 13015 - Designation for the Sandusky, MI; Davenport, IA; Enid, OK; Keokuk, IA; Marshall, MI; and Omaha...

    Science.gov (United States)

    2013-02-26

    ... the September 13, 2012 Federal Register (77 FR 56608), GIPSA requested applications for designation to... Grain Inspection, Packers and Stockyards Administration Designation for the Sandusky, MI; Davenport, IA; Enid, OK; Keokuk, IA; Marshall, MI; and Omaha, NE Areas AGENCY: Grain Inspection, Packers...

  5. B3GNT3 Expression Is a Novel Marker Correlated with Pelvic Lymph Node Metastasis and Poor Clinical Outcome in Early-Stage Cervical Cancer

    Science.gov (United States)

    Niu, Chunhao; Song, Libing; Zhang, Yanna

    2015-01-01

    Background The β1,3-N-acetylglucosaminyltransferase-3 gene (B3GNT3) encodes a member of the B3GNT family that functions as the backbone structure of dimeric sialyl-Lewis A and is involved in L-selectin ligand biosynthesis, lymphocyte homing and lymphocyte trafficking. B3GNT3 has been implicated as an important element in the development of certain cancers. However, the characteristics of B3GNT3 in the development and progression of cancer remain largely unknown. Thus, our study aimed to investigate the expression pattern and the prognostic value of B3GNT3 in patients with early-stage cervical cancer. Methods The mRNA and protein levels of B3GNT3 expression were examined in eight cervical cancer cell lines and ten paired cervical cancer tumors, using real-time PCR and western blotting, respectively. Immunohistochemistry (IHC) was used to analyze B3GNT3 protein expression in paraffin-embedded tissues from 196 early-stage cervical cancer patients. Statistical analyses were applied to evaluate the association between B3GNT3 expression scores and clinical parameters, as well as patient survival. Results B3GNT3 expression was significantly upregulated in cervical cancer cell lines and lesions compared with normal cells and adjacent noncancerous cervical tissues. In the 196 cases of tested early-stage cervical cancer samples, the B3GNT3 protein level was positively correlated with high risk TYPES of human papillomavirus (HPV) infection (P = 0.026), FIGO stage (P cervical cancer patients. Conclusions Our study demonstrated that elevated B3GNT3 expression is associated with pelvic lymph node metastasis and poor outcome in early-stage cervical cancer patients. B3GNT3 may be a novel prognostic marker and therapeutic target for the treatment of cervical cancer. PMID:26709519

  6. Clinical analysis of early-stage misdiagnosis of Creutzfeldt-Jakob disease%克雅病早期误诊临床分析

    Institute of Scientific and Technical Information of China (English)

    吴杰贤; 梁颖茵; 姚晓黎

    2011-01-01

    目的 提高散发性克雅病临床诊断水平,降低其误诊率.方法 回顾性分析11例克雅病患者临床表现及早期误诊情况.结果 11例克雅病患者早期误诊为阿尔茨海默病4例,病毒性脑炎3例,脑梗死2例,路易体痴呆2例,脑脊液14-3-3蛋白阳性6例.结论 克雅病的早期临床表现极不典型,较易误诊;多次复查脑电图、磁共振弥散加权成像、脑脊液14-3-3蛋白是诊断本病的重要手段.%Objective To improve the clinical practical diagnosis of sporadic Creutzfeldt-Jakob disease and decrease the probability of misdiagnosis.Methods Clinical manifestations of 11 cases of Creutzfeldt-Jakob disease misdiagnosed in the early stage were reviewed.Results Eleven cases of Creutzfeldt-Jakob disease were misdiagnosed as Alzheimer' s disease (4 cases), viral encephalitis (3 cases),cerebral infarction (2 cases) and dementia with Lewy bodies (2 cases) in the early stage.Cerebrospinal fluid 14-3-3 protein was positive in 6 cases.Conclusions The clinical manifestations of Creutzfeldt- Jakob disease in the early stage are atypical and tend to be misdiagnosed;repetitive EEG,diffusion weighted imaging and cerebrospinal fluid 14-3-3 protein are essential to diagnosis.

  7. [Clinical safety research of penetrating acupuncture at the head points for cerebral hemorrhage at the acute stage].

    Science.gov (United States)

    Yuan, Ping; Bao, Chun-Ling; Dong, Gui-Rong

    2012-07-01

    To verify the safety of penetrating acupuncture at the head points for cerebral hemorrhage at the acute stage. Sixty cases of cerebral hemorrhage at the acute stage were selected and randomized into a western medication group and a head-point group, 30 cases in each one. In the western medication group, the anti-cranial pressure and anti-blood pressure program was administered with the conventional intravenous infusion of Sodium Nitroprusside, Mannite, etc. In the head-point group, on the basis of the treatment as the western medication group, the penetrating acupuncture at the head points was supplemented. For consciousness disturbance, Taiyang (EX-HN 5), Benshen (GB 13) and penetrating needling from Shenting (GV 24) to Shangxing (GV 23) were selected. For headache, the penetrating needling was adopted from Shangxing (GV 23) to Yintang (EX-HN 3) and from Fengchi (GB 20) to Fengchi (GB 20). For disturbance of urination and defecation, the penetrating needling was adopted from Baihui (GV 20) to Sishencong (EX-HN 1). For aphasia, the penetrating needling was adopted from Fengfu (GV 16) to Yamen (GV 15), etc. For facial paralysis, the penetrating needling from Dicang (ST 4) to Jiache (ST 6) and Xiaguan (ST 7) were selected. For paralysis, the penetrating needling was adopted from Baihui (GV 20) to Taiyang (EX-HN 5), etc. Before and after treatment, the changes in c