Dipeptidyl peptidase IV in two human glioma cell lines

Directory of Open Access Journals (Sweden)

A Sedo

2009-12-01

Full Text Available There is growing evidence that dipeptidyl peptidase IV [DPP-IV, EC 3.4.14.5] takes part in the metabolism of biologically active peptides participating in the regulation of growth and transformation of glial cells. However, the knowledge on the DPP-IV expression in human glial and glioma cells is still very limited. In this study, using histochemical and biochemical techniques, the DPP-IV activity was demonstrated in two commercially available human glioma cell lines of different transformation degree, as represented by U373 astrocytoma (Grade III and U87 glioblastoma multiforme (Grade IV lines. Higher total activity of the enzyme, as well as its preferential localisation in the plasma membrane, was observed in U87 cells. Compared to U373 population, U87 cells were morphologically more pleiomorphic, they were cycling at lower rate and expressing less Glial Fibrillary Acidic Protein. The data revealed positive correlation between the degree of transformation of cells and activity of DPP-IV. Great difference in expression of this enzyme, together with the phenotypic differences of cells, makes these lines a suitable standard model for further 57 studies of function of this enzyme in human glioma cells.

The cost of unresectable stage III or stage IV melanoma in Italy

Directory of Open Access Journals (Sweden)

Maio Michele

2012-11-01

Full Text Available Abstract Background In recent decades, melanoma incidence has been increasing in European countries; in 2006, there were approximately 60,000 cases leading to 13,000 deaths. Within Europe there is some geographical variation in the incidence of melanoma, with the highest rates reported in Scandinavia (15 cases per 100,000 inhabitants per year and the lowest in the Mediterranean countries (5 to 7 cases per 100,000 inhabitants per year. Methods The present article is based on the information collected in the MELODY study (MELanoma treatment patterns and Outcomes among patients with unresectable stage III or stage IV Disease: a retrospective longitudinal survey. In that study, the medical charts of patients were reviewed to document current treatment patterns and to analyse information on patients, disease characteristics and healthcare resource utilization related to the treatment of advanced melanoma regarding patients who presented with a diagnosis of malignant melanoma (stage I to IV at participating sites between 01 July, 2005 and 30 June, 2006. Results Summarizing, though the length of the follow-up period varies among sample patients, an amount of the yearly cost per patient can be estimated, dividing the average per patient total cost (€ 5.040 by the average follow-up duration (17.5 months and reporting to one year; on these grounds, unresectable stage III or stage IV melanoma in Italy would cost € 3,456 per patient per year.

Stark broadening of Ca IV spectral lines of astrophysical interest

Science.gov (United States)

Alonso-Medina, A.; Colón, C.

2014-12-01

Ca IV emission lines are under the preview of Solar Ultraviolet Measurements of Emitted Radiation device aboard the Solar and Heliospheric Observatory. Also, lines of the Ca IV in planetary nebulae NGC 7027 were detected with the Short Wavelength Spectrometer on board the Infrared Space Observatory. These facts justify an attempt to provide new spectroscopic parameters of Ca IV. There are no theoretical or experimental Stark broadening data for Ca IV. Using the Griem semi-empirical approach and the COWAN code, we report in this paper calculated values of the Stark broadening parameters for 467 lines of Ca IV. They were calculated using a set of wavefunctions obtained by using Hartree-Fock relativistic calculations. These lines arising from 3s23p4ns (n = 4, 5), 3s23p44p, 3s23p4nd (n = 3, 4) configurations. Stark widths and shifts are presented for an electron density of 1017 cm-3 and temperatures T = 10 000, 20 000 and 50 200 K. As these data cannot be compared to others in the literature, we present an analysis of the different regularities of the values presented in this work.

Metastatic melanoma: results of 'classical' second-line treatment with cytotoxic chemotherapies.

Science.gov (United States)

Perrin, Christophe; Pracht, Marc; Talour, Karen; Adamski, Henri; Cumin, Isabelle; Porneuf, Marc; Talarmin, Marie; Mesbah, Habiba; Audrain, Odile; Moignet, Aline; Lefeuvre-Plesse, Claudia; Lesimple, Thierry

2014-10-01

Metastatic melanoma is one of the most aggressive tumours, with a median survival that does not exceed 12 months. None of the cytotoxic first-line therapies have shown survival benefit in randomised clinical trials. To describe clinical benefit of second-line cytotoxic chemotherapy in the second line of treatment for metastatic melanoma. In a retrospective study, we analyse the outcome of patients with metastatic melanoma who had received two lines or more of cytotoxic treatments in four French dermato-oncology departments between 1999 and 2009. We describe the outcomes for 109 patients. Most of these patients received dacarbazine for the first line of chemotherapy and fotemustine for the second line of chemotherapy (67.0 and 64.2%, respectively). A clinical benefit was observed in 24.1% of the patients and overall survival was 4.1 months after the second-line treatment. At least 23.8% of patients suffered from grade 3 or 4 toxicities. The presence of more than two sites of metastasis and an M1c staging according to the AJCC classification represented negative predictive factors of clinical benefit. This study shows the modest benefit of a second line of cytotoxic chemotherapy in a nonselected population. If eligible, these patients should be proposed for ongoing clinical trials or for targeted therapies.

Aflibercept and FOLFOX6 Treatment for Previously Untreated Stage IV Colorectal Cancer

Science.gov (United States)

2018-04-03

Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Stage IV Colon Cancer; Stage IV Rectal Cancer

Should CA-125 response criteria be preferred to response evaluation criteria in solid tumors (RECIST) for prognostication during second-line chemotherapy of ovarian carcinoma?

DEFF Research Database (Denmark)

Gronlund, Bo; Høgdall, Claus; Hilden, Jørgen

2004-01-01

-line chemotherapy. PATIENTS AND METHODS: From a single-institution registry of 527 consecutive patients with primary ovarian carcinoma, 131 records satisfied the inclusion criteria: ovarian carcinoma of International Federation of Gynecology and Obstetrics stage IC to IV, first-line chemotherapy with paclitaxel...... and a platinum compound, refractory or recurrent disease, and second-line chemotherapy consisting of topotecan or paclitaxel plus carboplatin. Univariate and multivariate analyses of survival were performed using the landmark method. RESULTS: In patients with measurable disease by RECIST and with assessable...... sites (solitary v multiple; hazard ratio, 0.47; P = .020) were identified as contributory prognostic factors for survival, whereas the parameters of RECIST (responders v nonresponders), as well as the remaining variables, had nonsignificant prognostic impact. CONCLUSION: The GCIG CA-125 response...

Stage IV work-hardening related to disorientations in dislocation structures

DEFF Research Database (Denmark)

Pantleon, W.

2004-01-01

The effect of deformation-induced disorientations on the work-hardening of metals is modelled based on dislocation dynamics. Essentially, Kocks’ dislocation model describing stage III hardening is extended to stage IV by incorporation of excess dislocations related to the disorientations....... Disorientations evolving from purely statistical reasons — leading to a square root dependence of the average disorientation angle on strain — affect the initial work-hardening rate (and the saturation stress) of stage III only slightly. On the other hand, deterministic contributions to the development...... of disorientations, as differences in the activated slip systems across boundaries, cause a linear increase of the flow stress at large strains. Such a constant work-hardening rate is characteristic for stage IV....

Second stage gasifier in staged gasification and integrated process

Science.gov (United States)

Liu, Guohai; Vimalchand, Pannalal; Peng, Wan Wang

2015-10-06

A second stage gasification unit in a staged gasification integrated process flow scheme and operating methods are disclosed to gasify a wide range of low reactivity fuels. The inclusion of second stage gasification unit operating at high temperatures closer to ash fusion temperatures in the bed provides sufficient flexibility in unit configurations, operating conditions and methods to achieve an overall carbon conversion of over 95% for low reactivity materials such as bituminous and anthracite coals, petroleum residues and coke. The second stage gasification unit includes a stationary fluidized bed gasifier operating with a sufficiently turbulent bed of predefined inert bed material with lean char carbon content. The second stage gasifier fluidized bed is operated at relatively high temperatures up to 1400.degree. C. Steam and oxidant mixture can be injected to further increase the freeboard region operating temperature in the range of approximately from 50 to 100.degree. C. above the bed temperature.

Coefficient of work-hardening in stage-IV

CSIR Research Space (South Africa)

Nabarro, FRN

1994-04-15

Full Text Available The theory of work hardening in stage IV depends on the relation between the relative misorientation Psi of neighbouring subgrains and the plastic strain gamma (Psi = B gamma exp). The value of the constant B is suggested to be better related...

Transoral Robotic Surgery in Treating Patients With Benign or Stage I-IV Head and Neck Cancer

Science.gov (United States)

2014-11-07

III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Lymphoepithelioma of the Oropharynx; Stage IV Mucoepidermoid Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity

On the Importance of the Nonequilibrium Ionization of Si IV and O IV and the Line of Sight in Solar Surges

Science.gov (United States)

Nóbrega-Siverio, D.; Moreno-Insertis, F.; Martínez-Sykora, J.

2018-05-01

Surges are ubiquitous cool ejections in the solar atmosphere that often appear associated with transient phenomena like UV bursts or coronal jets. Recent observations from the Interface Region Imaging Spectrograph show that surges, although traditionally related to chromospheric lines, can exhibit enhanced emission in Si IV with brighter spectral profiles than for the average transition region (TR). In this paper, we explain why surges are natural sites to show enhanced emissivity in TR lines. We performed 2.5D radiative-MHD numerical experiments using the Bifrost code including the nonequilibrium (NEQ) ionization of silicon and oxygen. A surge is obtained as a by-product of magnetic flux emergence; the TR enveloping the emerged domain is strongly affected by NEQ effects: assuming statistical equilibrium would produce an absence of Si IV and O IV ions in most of the region. Studying the properties of the surge plasma emitting in the Si IV λ1402.77 and O IV λ1401.16 lines, we find that (a) the timescales for the optically thin losses and heat conduction are very short, leading to departures from statistical equilibrium, and (b) the surge emits in Si IV more and has an emissivity ratio of Si IV to O IV larger than a standard TR. Using synthetic spectra, we conclude the importance of line-of-sight effects: given the involved geometry of the surge, the line of sight can cut the emitting layer at small angles and/or cross it multiple times, causing prominent, spatially intermittent brightenings in both Si IV and O IV.

Stationary nonimaging concentrator as a second stage element in tracking systems

Energy Technology Data Exchange (ETDEWEB)

Kritchman, E.M.; O' Gallagher, J.; Snail, K.A.; Winston, R.

1983-06-01

The University of Chicago solar energy group and GTE Research have developed an Integrated Stationary Evacuated Concentration (ISEC) collector tube. In this paper the increase in concentration of line focus concentrators that can be achieved using the evacuated CPC collector tube as a second stage element is examined. Three primary elements of the overall concentration are analyzed: a flat parabolic absorber trough, a flat Fresnel lens, and a color and coma corrected Fresnel lens. The three examples demonstrate that high concentration ratios may be achieved by using the already fabricated ISEC as a second stage element. The ISEC also suppresses thermal losses due to conduction, convection, and infrared radiation.

Second-Line Therapy for Advanced NSCLC.

Science.gov (United States)

Weiss, Jared M; Stinchcombe, Thomas E

2013-01-01

Most patients with lung cancer have non-small cell lung cancer (NSCLC) subtype and have advanced disease at the time of diagnosis. Improvements in both first-line and subsequent therapies are allowing longer survival and enhanced quality of life for these patients. The median overall survival observed in many second-line trials is approximately 9 months, and many patients receive further therapy after second-line therapy. The cytotoxic agents pemetrexed and docetaxel and the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib are standard second-line therapies. For patients with EGFR mutation, a TKI is the favored second-line therapy if not already used in first-line therapy. For patients without the EGFR mutation, TKIs are an option, but many oncologists favor cytotoxic therapy. The inhibitor of the EML4/ALK fusion protein, crizotinib, has recently become a standard second-line treatment for patients with the gene rearrangement and has promise for patients with the ROS1 rearrangement.

Maintenance based Bevacizumab versus complete stop or continuous therapy after induction therapy in first line treatment of stage IV colorectal cancer: A meta-analysis of randomized clinical trials.

Science.gov (United States)

Tamburini, Emiliano; Rudnas, Britt; Santelmo, Carlotta; Drudi, Fabrizio; Gianni, Lorenzo; Nicoletti, Stefania V L; Ridolfi, Claudio; Tassinari, Davide

2016-08-01

In stage IV colorectal cancer, bevacizumab-based maintenance therapy, complete stop therapy and continuous therapy are considered all possible approaches after first line induction chemotherapy. However, there are no clear data about which approach is preferable. All randomized phase III trials comparing bevacizumab-based maintenance therapy (MB) with complete stop therapy (ST) or with continuous therapy (CT) were considered eligible and included into the analysis. Primary endpoint was the Time to failure strategies (TFS). Secondary endpoints were Overall Survival (OS) and Progression free survival (PFS). Meta-analysis was performed in line with the PRISMA statement. 1892 patients of five trials were included into the analysis. A significant improvement in TFS (HR 0.79; CI 95% 0.7-0.9 p=0.0005) and PFS (HR 0.56; CI 95% 0.44-0.71 p<0.00001) were observed in favour of MB versus ST. A trend, but not statistically significant, in favour of MB versus ST was also observed for OS (HR 0.88; CI 95% 0.77-1.01, p=0.08). Comparing maintenance therapy versus continuous therapy no statistically differences were observed in the outcomes evaluated (OS 12 months OR 1.1 p=0.62, OS 24 months OR 1 p=1, OS 36 months OR 0.54 p=0.3, TFS 12 months OR 0.76 p=0.65). Our meta-analysis suggests that use of MB approach increases TFS, PFS compared to ST. Although without observing any statistically advantage, it should be highlighted that MB versus ST showed a trend in favour of MB. We observed no difference between MB and CT. MB should be considered the standard regimen in patients with stage IV colorectal cancer after first line induction therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Performance on a Stage IV Object-Permanence Task with Standard and Nonstandard Covers.

Science.gov (United States)

And Others; Rader, Nancy

1979-01-01

Examined the role of perceptual-motor development in a typical Stage IV task. The performance of ten infants was compared on a Stage IV object permanence task when a cloth cover was used and when a small card cover was used. (JMB)

Afatinib versus erlotinib as second-line treatment of patients with advanced squamous cell carcinoma of the lung (LUX-Lung 8)

DEFF Research Database (Denmark)

Soria, Jean-Charles; Felip, Enriqueta; Cobo, Manuel

2015-01-01

BACKGROUND: There is a major unmet need for effective treatments in patients with squamous cell carcinoma of the lung. LUX-Lung 8 compared afatinib (an irreversible ErbB family blocker) with erlotinib (a reversible EGFR tyrosine kinase inhibitor), as second-line treatment for patients with advanced...... squamous cell carcinoma of the lung. METHODS: We did this open-label, phase 3 randomised controlled trial at 183 cancer centres in 23 countries worldwide. We enrolled adults with stage IIIB or IV squamous cell carcinoma of the lung who had progressed after at least four cycles of platinum...... be an additional option for the treatment of patients with squamous cell carcinoma of the lung. FUNDING: Boehringer Ingelheim....

Stark broadening of several Bi IV spectral lines of astrophysical interest

Science.gov (United States)

Colón, C.; Moreno-Díaz, C.; de Andrés-García, I.; Alonso-Medina, A.

2017-09-01

The presence of spectral lines of bismuth in stellar atmospheres has been reported in different stars. The anomalous values of the spectral intensities of Bi II and Bi III, compared to the theoretical Local Termodinamic Equilibrium (LTE) standards of Bi I/Bi II/Bi III, have been reported in the spectra obtained with the High Resolution Spectrograph of the Hubble/Goddard Space Telescope in the chemically peculiar stars HgMn stars χ Lupi and HR 7775. Spectral lines of 1436.8, 1902.3, 2630.9 and 2936.7 Å of Bi II and 1423.4 Å of Bi III were reported and their relative intensities were measured in these studies Litzén & Wahlgren 2002. These lines are overlapped with spectral lines of 1437.65, 2630.1 and 2937.1 Å of Bi IV. A study of the Stark broadening parameters of Bi IV spectral lines can help to study these overlaps. In this paper, using the Griem semi-empirical approach, we report calculated values of the Stark parameters for 64 spectral lines of Bi IV. The matrix elements used in these calculations have been determined from 17 configurations of Bi IV. They were calculated using the cowan code including core polarization effects. Data are displayed for an electron density of 1017 cm-3 and temperatures T = 10 000-160 000 K. Also calculated radiative lifetimes for 12 levels with experimental lifetime are presented, in order to test the goodness of our calculations. Theoretical trends of the Stark width and shift parameters versus the temperature for spectral lines of astrophysical interest are displayed.

Investigating the reasons of variability in Si IV and C IV broad absorption line troughs of quasars

Science.gov (United States)

Stathopoulos, Dimitrios; Lyratzi, Evangelia; Danezis, Emmanuel; Antoniou, Antonios; Tzimeas, Dimitrios

2017-09-01

In this paper we analyze the C IV and Si IV broad absorption troughs of two BALQSOs (J101056.69+355833.3, J114548.38+393746.6) to the individual components they consist of. By analyzing a BAL trough to its components we have the advantage to study the variations of the individual absorbing systems in the line of sight and not just the variations of the whole absorption trough or the variations of selected portions of BAL troughs exhibiting changes. We find that the velocity shifts and FWHMs (Full Width at Half Maximum) of the individual components do not vary between an interval of six years. All variable components show changes in the optical depths at line centers which are manifested as variations in the EW (Equivalent Width) of the components. In both BALQSOs, over corresponding velocities, Si IV has higher incidence of variability than C IV. From our analysis, evidence is in favour of different covering fractions between C IV and Si IV. Finally, although most of our results favour the crossing cloud scenario as the cause of variability, there is also strong piece of evidence indicating changing ionization as the source of variability. Thus, a mixed situation where both physical mechanisms contribute to BAL variability is the most possible scenario.

Combined effect of angioinfarction with immunotherapy in patients with stage IV renal cell carcinoma

International Nuclear Information System (INIS)

Oh, Joo Hyeong; Yoon, Yup; Jeong, Yu Mee; Ko, Young Tae; Chang, Sung Goo

1994-01-01

To assess the combined effectiveness of angioinfarction and immunotherapy for improving survival in patients with stage IV renal cell carcinoma. During the past 3 years, 13 patients of stage IV renal cell carcinoma were treated with angioinfarction and immunotherapy. Angioinfarction was performed on these 13 patients using absolute ethanol and occlusive balloon catheter. After angioinfarction, Interferon alpha was used for immunotherapy. For our analysis, 12 control patients of stage IV renal cell carcinoma without treatment were included in the study. Survival has been calculated according to the Kaplan and Meier method. The 1 year survival rate and median survival time in patients treated with angioinfarction and immunotherapy, were 46% and 13 months and in patients without treatment, 16% and 4 months, respectively. The combined treatment of angioinfarction and immunotherapy is of considerable value for improving survival in patients with stage IV renal cell carcinoma

Prognostic impact of tumor MET expression among patients with stage IV gastric cancer

DEFF Research Database (Denmark)

Erichsen, Rune; Kelsh, Michael A; Oliner, Kelly S

2016-01-01

PURPOSE: We aimed to investigate the prevalence and prognostic impact of tumor mesenchymal epithelial transition factor (MET) expression in stage IV gastric cancers in a real-world clinical setting because existing evidence is sparse. METHODS: The study included archived cancer specimens from 103...... stage IV gastric cancer patients (2003-2010). We analyzed MET-protein expression by immunohistochemistry (MET-positive if ≥25% of tumor cells showed MET expression). We calculated overall survival using the Kaplan-Meier method and hazard ratios comparing mortality among MET-positive and MET.......6 months), corresponding to an adjusted hazard ratio of 2.2 (95% confidence interval, 1.3-3.7). CONCLUSIONS: Tumor MET expression is prevalent and has substantial prognostic impact in stage IV gastric cancer patients....

Palliative Care in Improving Quality of Life and Symptoms in Patients With Stage III-IV Pancreatic or Ovarian Cancer

Science.gov (United States)

2014-12-18

Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Pancreatic Cancer; Stage III Pancreatic Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer

Clinical experience with radiation enhancement by hyperbaric oxygen in children with recurrent neuroblastoma stage IV

International Nuclear Information System (INIS)

Voute, P.A.; Kleij, A.J. van der; De Kraker, J.; Hoefnagel, C.A.; Tiel-van Buul, M.M.C.; Gennip, H. van

1995-01-01

The high risk group of patients with neuroblastoma are children over 1 year with stage IV disease. Most series report a maximum of 20% survival at 5 years. For recurrent neuroblastoma stage IV, cure rates are not reported in the literature, but they are nil. Any treatment for recurrent neuroblastoma stage IV remains a therapeutic dilemma. The outcome of radiation therapy is variable. A very important factor in tumour treatment remains tumour hypoxia, and others, such as metabolic factors, also play a role. Combined application of radiation modifiers may influence the final survival rate. In an attempt to improve the survival of recurrent neuroblastoma stage IV, hyperbaric oxygen and radioionated meta-Iodobenzylguanidine (MIBG) was used in a clinical setting. Although survival may not be used as a determinant of the usefulness of a treatment for stage IV neuroblastoma disease, a better one is not available. In this study, at 28 months, a cumulative probability of survival of 32% was recorded for patients treated with [ 131 I]MIBG and hyperbaric oxygen compared to 12% for [ 131 I]MIBG treatment alone. These preliminary results are promising but further studies are needed to reveal substantial therapeutic gain. (Author)

Concepts to meet non-road stage IV / Tier 4 emission legislation; Konzepte fuer die Emissionsgesetzgebung. Non-Road Stage IV / Tier 4

Energy Technology Data Exchange (ETDEWEB)

Cartus, T.; Herrmuth, H.; Stein, G. [AVL List GmbH, Graz (Austria); Scherm, P. [Euromot - European Association of Internal Combustion Engine Mfrs., Frankfurt am Main (Germany)

2007-12-15

By December 2007, the EC will have to submit a new proposal for Stage IV emissions limits for Non-Road Mobile Machinery. Industry is committed to contributing to this process and has asked AVL to carry out a study as a neutral engineering company. The main topics of this study are described in this article. (orig.)

Cost analysis of surgically treated pressure sores stage III and IV.

Science.gov (United States)

Filius, A; Damen, T H C; Schuijer-Maaskant, K P; Polinder, S; Hovius, S E R; Walbeehm, E T

2013-11-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Influence of {sup 18}F-FDG PET/CT on therapy management in patients with stage III/IV malignant melanoma

Energy Technology Data Exchange (ETDEWEB)

Schuele, Susann-Cathrin; Nikolaou, Konstantin; Pfannenberg, Christina [Eberhard-Karls-University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Eigentler, Thomas Kurt; Garbe, Claus [Eberhard-Karls-University Tuebingen, Skin Cancer Programme, Department of Dermatology, Tuebingen (Germany); Fougere, Christian la [Eberhard-Karls-University Tuebingen, Department of Nuclear Medicine, Tuebingen (Germany)

2016-03-15

To evaluate the influence of {sup 18}F-FDG PET/CT in comparison to CT alone on treatment decisions in patients with advanced melanoma and to analyse the 5-year survival data in comparison to literature data. Therapy management in 64 consecutive patients (primary staging n = 52; surveillance n = 12) with stage III/IV melanoma who underwent {sup 18}F-FDG PET/CT between 2004 and 2005 in our department was retrospectively analysed. Treatment decisions were made by two dermatooncologists for each patient twice, first based on the CT results and then based on the PET/CT results. Therapy changes based on the PET/CT results were classified as ''major'' (e.g. change from metastasectomy to systemic therapy) or ''minor'' (e.g. change from first to second line chemotherapy). The 5-year survival data of different patient cohorts were calculated. In the 52 patients in the primary staging group, the results of {sup 18}F-FDG PET/CT led to therapy change in 59 % and a major therapy change in 52 %. {sup 18}F-FDG PET/CT led to the avoidance of futile operations in 13 patients with suspicious lesions on CT that were deemed nontumorous on PET/CT. In the 12 patients in the surveillance group, the results of {sup 18}F-FDG PET/CT led to therapy change in 33 % and a major change in 17 %. The 5-year survival rates were 30 % in the entire cohort, 34 % in the primary staging group, and 17 % in the surveillance group. A significant overall survival benefit was observed in patients in whom {sup 18}F-FDG PET/CT excluded metastases or in whom metastases could be completely removed compared with patients who were not eligible for surgery (41 % vs. 10 %). Primary staging of patients with stage III/IV melanoma should be performed with {sup 18}F-FDG PET/CT, leading to higher diagnostic accuracy and enabling individualized therapeutic management, especially optimal patient selection for metastasectomy. This strategy may extend long-term survival even in patients

Fosaprepitant Dimeglumine, Palonosetron Hydrochloride, and Dexamethasone in Preventing Nausea and Vomiting Caused by Cisplatin in Patients With Stage III or Stage IV Head and Neck Cancer Undergoing Chemotherapy and Radiation Therapy

Science.gov (United States)

2017-04-13

Nausea and Vomiting; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx

Primary Tumor Thickness is a Prognostic Factor in Stage IV Melanoma: A Retrospective Study of Primary Tumor Characteristics.

Science.gov (United States)

Luen, Stephen; Wong, Siew Wei; Mar, Victoria; Kelly, John W; McLean, Catriona; McArthur, Grant A; Haydon, Andrew

2018-01-01

Stage IV melanoma exhibits a diverse range of tumor biology from indolent to aggressive disease. Many important prognostic factors have already been identified. Despite this, the behavior of metastatic melanoma remains difficult to predict. We sought to determine if any primary tumor characteristics affect survival following the diagnosis of stage IV melanoma. All patients diagnosed with stage IV melanoma between January 2003 and December 2012 were identified from the Victorian Melanoma Service database. Retrospective chart review was performed to collect data on primary tumor characteristics (thickness, ulceration, mitotic rate, melanoma subtype, or occult primary). Known and suspected prognostic factors were additionally collected (time to diagnosis of stage IV disease, age, sex, stage, receipt of chemotherapy, and era of recurrence). The effect of primary tumor characteristics on overall survival from the date of diagnosis of stage IV disease was assessed. A total of 227 patients with a median follow-up of 5 years from diagnosis of stage IV disease were identified. Median overall survival of the cohort was 250 days.Of the primary tumor characteristics assessed, only tumor thickness affected survival from diagnosis of stage IV disease, hazard ratio=1.09 (1.02 to 1.16), P=0.008. This remained significant in multivariate analysis, P=0.007. Other primary tumor characteristics did not significantly influence survival. Primary tumor thickness is a significant prognostic factor in stage IV melanoma. Our data suggest that the biology of the primary melanoma may persist to influence the behavior of metastatic disease.

Stage IV in electrical resistivity return to alpha-iron

International Nuclear Information System (INIS)

Poltavtseva, V.P.

2004-01-01

Full text: In compliance with the model of two interstitial atoms, in returning the electrical resistivity increment, the stage IV, related to migration of mono vacancies, should exist. Unfortunately, for alpha-iron there is no any reliable proof of existence of the stage IV (450-630 K) up to now. As a rule, the annealing stages revealed within this temperature range are considered as related to impurity effects. This paper is aimed at detection of the stage IV in returning the electrical resistivity increment in alpha-iron by means of irradiation of the materials differing in purity degree (99.99 and 99.8 %) by 30 MeV protons capable to create large amount of point defects and small clusters in BCC metals. By author opinion, it will make it possible to reach the radiation defect/vacancy concentrations comparable with contents of impurities (C and N) and, thus, to obtain an information about their migration. As a result of irradiation by protons at 270 K up to the fluence comprising 2.3·10 21 m -2 (0.001 dpa), the following has been found: - an increase in the electrical resistivity at 330 K is 0.84 and 0.61 nΩ·m for the alpha-iron purity degree 99.99 and 99.8 % respectively; - in the 99.99 % purity degree alpha-iron the process of electrical resistivity restoration comes to an end completely at 563 K, whereas in alpha-iron with larger content of impurity - at nearly 600 K; - in the 99.99% purity degree alpha iron electrical resistivity return spectrum a single wide peak centered at 445 K and two smeared peaks below 400 and higher than 490 K are revealed. As the impurity content increases, the 464 K peak changes the 445 K peak, which is about twice lower. Besides, a peak at 377 K occurs, and the peak at a temperature higher than 500 K, in contrast to the 99.99 % purity degree alpha-iron, has a point of inflection at 590 K. On a base of the data obtained, one may conclude that the stage centered around 445 K is of intrinsic nature, and the 99.99 % purity degree

Is complete resection of high-risk stage IV neuroblastoma associated with better survival?

Science.gov (United States)

Yeung, Fanny; Chung, Patrick Ho Yu; Tam, Paul Kwong Hang; Wong, Kenneth Kak Yuen

2015-12-01

The role of surgery in the management of stage IV neuroblastoma is controversial. In this study, we attempted to study if complete tumor resection had any impact on event-free survival (EFS) and overall survival (OS). A retrospective analysis of patients with stage IV neuroblastoma between November 2000 and July 2014 in a tertiary referral center was performed. Demographics data, extent of surgical resection, and outcomes were analyzed. A total of 34 patients with stage IV neuroblastoma according to International Neuroblastoma Staging System (INSS) were identified. The median age at diagnosis and operation was 3.5 (±1.9) years and 3.8 (±2.0) years, respectively. Complete gross tumor resection (CTR) was achieved in twenty-four patients (70.1%), in which one of the patients had nephrectomy and another had distal pancreatectomy. Gross total resection (GTR) with removal of >95% of tumor was performed in six patients (17.6%) and subtotal tumor resection (STR) with removal of >50%, but <95% of tumor was performed in four patients (11.8%). There was no statistical significance in terms of 5-year EFS and OS among the 3 groups. There was no surgery-related mortality or morbidity. From our center's experience, as there was no substantial survival benefit in stage IV neuroblastoma patients undergoing complete tumor resection, organ preservation and minimalization of morbidity should also be taken into consideration. Copyright © 2015. Published by Elsevier Inc.

SINGLE AGENT DOCETAXEL AS SECOND- LINE CHEMOTHERAPY FOR PRETREATED PATIENTS WITH RECURRENT NON- SMALL CELL LUNG CANCER

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Deyan N. Davidov

2013-04-01

Full Text Available Objective: Single agent Docetaxel is a standard therapy for patients with non- small cell lung cancer after the failure of platinum- containing regimens. The aim of this study was to explore the efficacy and safety of Docetaxel monotherapy as second- line chemotherapy in pretreated patient with inoperable non- small cell lung cancer. Methods: From January 2005 to May 2008 thirty- six consecutive patients with locally advanced or metastatic morphologically proven stage IIIB/ IV non- small cell lung cancer entered the study after failure of previous platinum- based regimens. Treatment schedule consist of Docetaxel 75 mg/m2 administered every three weeks with repetition after 21 days with Dexamethasone premedication. Results: Overall response rate, median time to progression and median survival was 16,6 %, 4,5 months and 5,6 months respectively. The main hematological toxicity was neutropenia. Conclusions: That data suggest that single agent Docetaxel remain reasonable choices for the chemotherapy in pretreated patients with non- small cell lung cancer.

False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

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Kwang-Soon Song

2013-01-01

Full Text Available Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER stage IV (Lauge-Hansen ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59% patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS and tibiofibular overlapping (TFO on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.

Can children undergoing ophthalmologic examinations under anesthesia be safely anesthetized without using an IV line?

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Vigoda M

2011-04-01

Full Text Available Michael M Vigoda, Azeema Latiff, Timothy G Murray, Jacqueline L Tutiven, Audina M Berrocal, Steven GayerBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USAPurpose: To document that with proper patient and procedure selection, children undergoing general inhalational anesthesia for ophthalmologic exams (with or without photos, ultrasound, laser treatment, peri-ocular injection of chemotherapy, suture removal, and/or replacement of ocular prosthesis can be safely anesthetized without the use of an intravenous (IV line. Children are rarely anesthetized without IV access placement. We performed a retrospective study to determine our incidence of IV access placement during examinations under anesthesia (EUA and the incidence of adverse events that required intraoperative IV access placement.Methods: Data collected from our operating room (OR information system includes but is not limited to diagnosis, anesthesiologist, surgeon, and location of IV catheter (if applicable, patient’s date of birth, actual procedure, and anesthesia/procedure times. We reviewed the OR and anesthetic records of children (>1 month and <10 years who underwent EUAs between January 1, 2003 and May 31, 2009. We determined the percentage of children who were anesthetized without IV access placement, as well as the incidence of any adverse events that required IV access placement, intraoperatively.Results: We analyzed data from 3196 procedures performed during a 77-month period. Patients’ ages ranged from 1 month to 9 years. Overall, 92% of procedures were performed without IV access placement. Procedure duration ranged from 1–39 minutes. Reasons for IV access placement included parental preference for antinausea medication and/or attending preference for IV access placement. No child who underwent anesthesia without an IV line had an intraoperative adverse event requiring insertion of an IV line.Conclusion: Our data suggest that for

The dependence of C IV broad absorption line properties on accompanying Si IV and Al III absorption: relating quasar-wind ionization levels, kinematics, and column densities

Energy Technology Data Exchange (ETDEWEB)

Filiz Ak, N.; Brandt, W. N.; Schneider, D. P.; Trump, J. R. [Department of Astronomy and Astrophysics, Pennsylvania State University, University Park, PA 16802 (United States); Hall, P. B. [Department of Physics and Astronomy, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3 (Canada); Anderson, S. F. [Astronomy Department, University of Washington, Seattle, WA 98195 (United States); Hamann, F. [Department of Astronomy, University of Florida, Gainesville, FL 32611-2055 (United States); Myers, Adam D. [Department of Physics and Astronomy, University of Wyoming, Laramie, WY 82071 (United States); Pâris, I. [Departamento de Astronomía, Universidad de Chile, Casilla 36-D, Santiago (Chile); Petitjean, P. [Institut d' Astrophysique de Paris, Universite Paris 6, F-75014 Paris (France); Ross, Nicholas P. [Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, CA 94720 (United States); Shen, Yue [Carnegie Observatories, 813 Santa Barbara Street, Pasadena, CA 91101 (United States); York, Don, E-mail: nfilizak@astro.psu.edu [Department of Astronomy and Astrophysics, The University of Chicago, Chicago, IL 60637 (United States)

2014-08-20

We consider how the profile and multi-year variability properties of a large sample of C IV Broad Absorption Line (BAL) troughs change when BALs from Si IV and/or Al III are present at corresponding velocities, indicating that the line of sight intercepts at least some lower ionization gas. We derive a number of observational results for C IV BALs separated according to the presence or absence of accompanying lower ionization transitions, including measurements of composite profile shapes, equivalent width (EW), characteristic velocities, composite variation profiles, and EW variability. We also measure the correlations between EW and fractional-EW variability for C IV, Si IV, and Al III. Our measurements reveal the basic correlated changes between ionization level, kinematics, and column density expected in accretion-disk wind models; e.g., lines of sight including lower ionization material generally show deeper and broader C IV troughs that have smaller minimum velocities and that are less variable. Many C IV BALs with no accompanying Si IV or Al III BALs may have only mild or no saturation.

Men and women show similar survival outcome in stage IV breast cancer.

Science.gov (United States)

Wu, San-Gang; Zhang, Wen-Wen; Liao, Xu-Lin; Sun, Jia-Yuan; Li, Feng-Yan; Su, Jing-Jun; He, Zhen-Yu

2017-08-01

To evaluate the clinicopathological features, patterns of distant metastases, and survival outcome between stage IV male breast cancer (MBC) and female breast cancer (FBC). Patients diagnosed with stage IV MBC and FBC between 2010 and 2013 were included using the Surveillance, Epidemiology, and End Results program. Univariate and multivariate Cox regression analyses were used to analyze risk factors for overall survival (OS). A total of 4997 patients were identified, including 60 MBC and 4937 FBC. Compared with FBC, patients with MBC were associated with a significantly higher rate of estrogen receptor-positive, progesterone receptor-positive, unmarried, lung metastases, and a lower frequency of liver metastases. Univariate and multivariate analyses showed no significant difference in OS between MBC and FBC. In the propensity score-matched population, there was also no difference in survival between MBC and FBC. Multivariate analysis of MBC showed that OS was longer for patients aged 50-69 years and with estrogen receptor-positive disease. There was no significant difference in survival outcome between stage IV MBC and FBC, but significant differences in clinicopathological features and patterns of metastases between the genders. Copyright © 2017 Elsevier Ltd. All rights reserved.

Second-stage turbine bucket airfoil

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Wang, John Zhiqiang; By, Robert Romany; Sims, Calvin L.; Hyde, Susan Marie

2002-01-01

The second-stage buckets have airfoil profiles substantially in accordance with Cartesian coordinate values of X, Y and Z set forth in inches in Table I wherein Z is a perpendicular distance from a plane normal to a radius of the turbine centerline and containing the X and Y values with the Z value commencing at zero in the X, Y plane at the radially innermost aerodynamic section of the airfoil and X and Y are coordinate values defining the airfoil profile at each distance Z. The X and Y values may be scaled as a function of the same constant or number to provide a scaled-up or scaled-down airfoil section for the bucket. The second-stage wheel has sixty buckets.

Differential Impact of Anastomotic Leak in Patients With Stage IV Colonic or Rectal Cancer

DEFF Research Database (Denmark)

Nordholm-Carstensen, Andreas; Rolff, Hans Christian; Krarup, Peter-Martin

2017-01-01

BACKGROUND: Anastomotic leak has a negative impact on the prognosis of patients who undergo colorectal cancer resection. However, data on anastomotic leak are limited for stage IV colorectal cancers. OBJECTIVE: The purpose of this study was to investigate the impact of anastomotic leak on survival....... PATIENTS: Patients who were diagnosed with stage IV colorectal cancer between 2009 and 2013 and underwent elective resection of their primary tumors were included. MAIN OUTCOME MEASURES: The primary outcome was all-cause mortality depending on the occurrence of anastomotic leak. Secondary outcomes were...... the administration of and time to adjuvant chemotherapy, metastasectomy rate, and risk factors for leak. RESULTS: Of the 774 patients with stage IV colorectal cancer who were included, 71 (9.2%) developed anastomotic leaks. Anastomotic leak had a significant impact on the long-term survival of patients with colon...

A novel technique for the treatment of stages III to IV hemorrhoids

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Lin, Guoqiang; Ge, Qiongxiang; He, Xiaokang; Qi, Haixin; Xu, Li

2017-01-01

Abstract To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan–Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P hemorrhoids. PMID:28658138

Papillary cystadenoma of the epididymis in a 12-year-old survivor of stage IV neuroblastoma

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Nnenaya Agochukwu

2018-04-01

Full Text Available Papillary cystadenoma of the epididymis (PCE is the second most common benign neoplasm of the epididymis [1]. It is very uncommon and has never been reported in a prepubertal male. It may occur sporadically, but more often occurs in association with von Hippel- Lindau (VHL disease [2]. There have been over 60 reports of patients with such tumors, with the youngest patient being 16 years old.We present the case of a 12- year old male with a history of stage IV neuroblastoma. He presented with a left paratesticular mass that was discovered on routine follow up physical exam with his pediatric oncologist. He was asymptomatic at the time of presentation with no signs or symptoms of hypoandrogenism. A computed tomography scan of the abdomen and pelvis was negative for lymphadenopathy and additional disease sites. Given the patient's history of stage IV neuroblastoma, there was suspicion of yolk sac tumor or metastases; he underwent an open radical left orchiectomy. Frozen section was consistent with yolk sac tumor, however final pathology revealed normal testicle with PCE.To date, this patient is the youngest reported patient with this diagnosis; furthermore papillary cystadenoma of the epididymis has never been reported in a patient with neuroblastoma. Keywords: Papillary cystadenoma, Epididymis, Prepubertal male, Neuroblastoma

Disorientations and their role on the work-hardening in stage IV

DEFF Research Database (Denmark)

Pantleon, W.

2005-01-01

statistical reasons still lead to stage III behavior and a saturation of the ow stress, but deterministic contributions to the development of disorienta- tions, as dierences in activated slip systems across boundaries, cause a linear increase of the flow stress at large strains. Such a constant work......The eect of deformation-induced disorientations on work-hardening of metals is modelled by dislocation dynamics. By incorporating excess dislocations related to disori- entations, Kocks' dislocation model describing stage III hardening is extended to stage IV. Disorientations evolving from purely...

Metastasis features of 546 patients with stage IV non-small cell lung cancer at first visit and the significance in radiotherapy

International Nuclear Information System (INIS)

Li Fenghu; Lu Bing; Fu Heyi; Han Lei; Li Qingsong; Li Huiqin

2012-01-01

Objective: To investigate the clinical metastasis features and the possibility of 3 dimensional radiotherapy of stage IV non-small cell lung cancer (NSCLC). Methods: The clinical materials of 546 patients with stage IV NSCLC and the relationship b T and N stage and metastasis were retrospectively analyzed. Results In 546 patients with stage IV NSCLC, the number with bone metastasis was 294, the number with brain metastasis was 167, the number with lung metastasis was 137, the number with liver metastasis was 79, the number with adrenal gland metastasis was 66, 37 with lymph node metastasis, 35 with subcutaneous metastasis and 10 with other organ metastasis. The number with single organ metastasis was 379 (69.4%) ,in which 37.7% with bone metastasis, 19.8% with brain metastasis, 16.9% with lung metastasis, 7.4% with liver metastasis, 7.4% with adrenal gland metastasis, 4.5% with lymph node metastasis, 5.5% with subcutaneous metastasis and 0.8% with other organ metastasis. The bone metastasis probability of T 3+4 patient was similar with T 1+2 (69.4%, 30.6%, χ 2 = 7.65, P = 0.067), but N 2+3 patient was more than N 0+1 (69.7%, 30.3%, χ 2 = 7.89, P = 0.044). The brain metastasis probability of T 3+4 patient was more than T 1+2 (70.7%, 29.3%, χ 2 = 10.64, P = 0.018), but N 2+3 patient was similar with N 0+1 (54.5%, 45.5%, χ 2 = 7.14, P = 0.079), and N 1+3+3 patient was more than N 0 (86.8%, 13.2%, χ 2 = 10.26, P = 0.024). Conclusions: In 546 patients with stage IV NSCLC, the most common metastatic organ is bone, the second is brain, the third is lung, the forth is liver, followed by adrenal gland; single organ metastasis is more common than multiple organ metastasis. The later the T stage is, the more severe is the metastasis. Through 3 dimensional radiotherapy, not only the quality of life of some stage IV patients is improved, but also the survival time was prolonged observably. (authors)

Family Caregiver Palliative Care Intervention in Supporting Caregivers of Patients With Stage II-IV Gastrointestinal, Gynecologic, Urologic and Lung Cancers

Science.gov (United States)

2018-02-12

Uterine Sarcoma; Stage IV Bladder Cancer; Stage IV Gastric Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer; Stage IV Renal Cell Cancer; Stage IV Urethral Cancer; Stage IVA Cervical Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVA Uterine Sarcoma; Stage IVB Cervical Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer; Stage IVB Uterine Sarcoma; Ureter Cancer; Stage IIA Lung Carcinoma; Stage IIB Lung Carcinoma; Stage IIIA Lung Carcinoma; Stage IIIB Lung Carcinoma

Cyclophosphamide-hydroxycamptothecin as second-line chemotherapy for advanced Ewing's sarcoma: experience of a single institution.

Science.gov (United States)

Han, Kun; Sun, Yuanjue; Zhang, Jianjun; He, Aina; Zheng, Shui'er; Shen, Zan; Yao, Yang

2014-06-01

To investigate the feasibility and efficacy of cyclophosphamide (CTX)-hydroxycamptothecin (HCPT) as second-line chemotherapy on advanced Ewing's sarcoma. From April 2009 to November 2010, 27 patients with advanced Ewing's sarcoma who had progressive disease after the first-line chemotherapy regimen of vincristine, dactinomycin and cyclophosphamide and ifosfamide and etoposide were retrospectively reviewed in this analysis. CTX was given (0.6 g/m(2), i.v. push day 1) and HCPT (6 mg/m(2), i.v. drip days 1-5) as second-line chemotherapy every 3 weeks. The primary end-point was overall response rate, the secondary end-point included progression-free, overall survival, disease control rate and toxicities. A total of 134 cycles were given, median four cycles per patient (range 2-6). Overall response rate was 30% and disease control rate was 82%, with two complete response (8%), six partial remission (22%) and 14 stable disease (52%). The median time to progression and overall survival time were 7 months (95% CI 3-10) and 11 months (95% CI 5-18), respectively. Major severe toxicities (grade 3 and 4) were: nausea/vomiting (17%), alopecia (17%); leukopenia (27%) in total cycles. Mild toxicities (grade 1 or 2) were leukopenia (73%), nausea/vomiting (83%), hepatic lesion (14%) and anemia (44%). A CTX-HCPT regimen can control disease progression effectively and the side effects can be tolerable for Chinese advanced Ewing's sarcoma patients. Further assessment is necessary to confirm the safety and efficacy of this treatment. © 2012 Wiley Publishing Asia Pty Ltd.

Nutrient Changes and in Vitro Digestibility in Generative Stage of M10-BMR Sorghum Mutant Lines

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R. Sriagtula

2017-08-01

Full Text Available The objective of this research was to investigate the influences of generative stage on crude protein, crude fiber, ash, and crude fat contents as well as in-vitro dry matter and organic matter digestibilities of M-10 BMR sorghum mutant lines. This research was arranged into a randomized block design with 2 factors. The first factor was M-10 BMR sorghum mutant lines (Patir 3.1, Patir 3.2 and Patir 3.7 and the second factor was generative stages (flowering, soft dough and hard dough phase. The observed variables were proximate contents of stem, leaves and panicle of sorghum plant and in-vitro digestibility of whole plant. The results showed that leaves crude protein (CP was more influenced by M-10 BMR sorghum mutant lines. Stems and panicles CP were influenced by the interaction between M-10 BMR sorghum mutant lines and generative stages. Further generative stage reduced stems CP but increased panicles CP. Crude fiber (CF, ash, and ether extract (EE in leaves were not influenced by generative stages. Stems CF was influenced by M-10 BMR sorghum mutant lines and generative stages, while stems EE was more influenced by generative stages. Stems ash content was influenced by the interaction between M-10 BMR sorghum mutant lines and generative stages while panicles ash content was more influenced by generative stages. M-10 BMR sorghum mutant lines and hard dough phase increased in-vitro dry matter and organic matter digestibilities. Based on those findings, it can be concluded that the increased maturity reduces CP and CF contents so it increases in-vitro digestibilities.

Second-Line Intraperitoneal Chemotherapy for Recurrent Epithelial Ovarian, Tubal and Peritoneal Cancer: A Propensity Score-Matching Study.

Science.gov (United States)

Lu, Chien-Hsing; Chang, Yen-Hou; Lee, Wai-Hou; Chang, Yi; Peng, Chia-Wen; Chuang, Chi-Mu

2016-01-01

The superiority of frontline intraperitoneal (IP) over intravenous (IV) chemotherapy is well established in the treatment of epithelial ovarian cancer. However, the role of IP chemotherapy in the second-line setting has rarely been investigated. Consecutive patients diagnosed with recurrent epithelial, tubal and peritoneal cancers between January 2000 and December 2012 were recruited using a propensity score-matching technique to adjust relevant risk factors. In total, 310 patients were included in the final analysis (94 for platinum-refractory/resistant disease and 216 for platinum-sensitive disease). IP chemotherapy demonstrated significantly longer median progression-free survival than IV chemotherapy (4.9 vs. 2.4 months, p chemotherapy confers longer progression-free survival than IV chemotherapy. Large-scale clinical trials should be conducted to validate the true efficacy. © 2016 S. Karger AG, Basel.

Second-line failure and first experience with third-line antiretroviral therapy in Mumbai, India

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Samsuddin Khan

2014-07-01

Full Text Available Background: There are limited data on the failure of second-line antiretroviral therapy (ART and the use of third-line ART in people living with HIV in resource-limited settings. Since 2011, the Médecins Sans Frontières (MSF HIV/tuberculosis programme in Mumbai, India, has been providing third-line ART to patients in care. Objective: To describe the experiences and programmatic challenges during management of suspected second-line ART failure and third-line ART therapy for patients living with HIV, including the use of HIV viral load (VL testing. Design: This was a retrospective, observational cohort study of patients with suspected second-line ART treatment failure, who were followed for at least 12 months between January 2011 and March 2014. Results: A total of 47 patients with suspected second-line failure met the inclusion criteria during the study period. Twenty-nine of them (62% responded to enhanced adherence support, had a subsequent undetectable VL after a median duration of 3 months and remained on second-line ART. The other 18 patients had to be initiated on a third-line ART regimen, which consisted of darunavir–ritonavir, raltegravir, and one or more appropriate nucleoside or nucleotide reverse transcriptase inhibitors, based on the results of HIV genotype testing. Of the 13 patients for whom follow-up VL results were available, 11 achieved virological suppression after a median duration of 3 months on third-line ART (interquartile range: 2.5–3.0. No serious treatment-related adverse events were recorded. Conclusions: With intensive counselling and adherence support in those suspected of failing second-line ART, unnecessary switching to more expensive third-line ART can be averted in the majority of cases. However, there is an increasing need for access to third-line ART medications such as darunavir and raltegravir, for which national ART programmes should be prepared. The cost of such medications and inadequate access to VL

Granisetron, Aprepitant, and Dexamethasone in Preventing Nausea and Vomiting in Patients Receiving Chemotherapy for Stage II, III, or IV Ovarian Cancer

Science.gov (United States)

2018-04-24

Nausea and Vomiting; Ovarian Brenner Tumor; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Seromucinous Carcinoma; Ovarian Serous Cystadenocarcinoma; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Primary Peritoneal Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer; Undifferentiated Ovarian Carcinoma

Intravital Microscopy in Evaluating Patients With Primary Peritoneal, Fallopian Tube, or Stage IA-IV Ovarian Cancer

Science.gov (United States)

2018-06-04

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

Delayed versus immediate pushing in second stage of labor.

Science.gov (United States)

Kelly, Mary; Johnson, Eileen; Lee, Vickie; Massey, Liz; Purser, Debbie; Ring, Karen; Sanderson, Stephanye; Styles, Juanita; Wood, Deb

2010-01-01

Comparison of two different methods for management of second stage of labor: immediate pushing at complete cervical dilation of 10 cm and delayed pushing 90 minutes after complete cervical dilation. This study was a randomized clinical trial in a labor and delivery unit of a not-for-profit community hospital. A sample of 44 nulliparous mothers with continuous epidural anesthesia were studied after random assignment to treatment groups. Subjects were managed with either immediate or delayed pushing during the second stage of labor at the time cervical dilation was complete. The primary outcome measure was the length of pushing during second stage of labor. Secondary outcomes included length of second stage of labor, maternal fatigue and perineal injuries, and fetal heart rate decelerations. Two-tailed, unpaired Student's t-tests and Chi-square analysis were used for data analysis. Level of significance was set at p pushing; N = 16 delayed pushing). The delayed pushing group had significantly shorter amount of time spent in pushing compared with the immediate pushing group (38.9 +/- 6.9 vs. 78.7 +/- 7.9 minutes, respectively, p = .002). Maternal fatigue scores, perineal injuries, and fetal heart rate decelerations were similar for both groups. Delaying pushing for up to 90 minutes after complete cervical dilation resulted in a significant decrease in the time mothers spent pushing without a significant increase in total time in second stage of labor.In clinical practice, healthcare providers sometimes resist delaying the onset of pushing after second stage of labor has begun because of a belief it will increase labor time. This study's finding of a 51% reduction in pushing time when mothers delay pushing for up to 90 minutes, with no significant increase in overall time for second stage of labor, disputes that concern.

Long-lasting complete response status of advanced stage IV gall bladder cancer and colon cancer after combined treatment including autologous formalin-fixed tumor vaccine: two case reports.

Science.gov (United States)

Imaoka, Yuki; Kuranishi, Fumito; Miyazaki, Tsubasa; Yasuda, Hiroko; Ohno, Tadao

2017-09-11

The prognosis of advanced (stage IV) cancer of the digestive organs is very poor. We have previously reported a case of advanced breast cancer with bone metastasis that was successfully treated with combined treatments including autologous formalin-fixed tumor vaccine (AFTV). Herein, we report the success of this approach in advanced stage IV (heavily metastasized) cases of gall bladder cancer and colon cancer. Case 1: A 61-year-old woman with stage IV gall bladder cancer (liver metastasis and lymph node metastasis) underwent surgery in May 2011, including partial resection of the liver. She was treated with AFTV as the first-line adjuvant therapy, followed by conventional chemotherapy. This patient is still alive without any recurrence, as confirmed with computed tomography, for more than 5 years. Case 2: A 64-year-old man with stage IV colon cancer (multiple para-aortic lymph node metastases and direct abdominal wall invasion) underwent non-curative surgery in May 2006. Following conventional chemotherapy, two courses of AFTV and radiation therapy were administered sequentially. This patient has had no recurrence for more than 5 years. We report the success of combination therapy including AFTV in cases of liver-metastasized gall bladder cancer and abdominal wall-metastasized colon cancer. Both patients experienced long-lasting, complete remission. Therefore, combination therapies including AFTV should be considered in patients with advanced cancer of the digestive organs.

Theoretical Atomic Physics code development IV: LINES, A code for computing atomic line spectra

International Nuclear Information System (INIS)

Abdallah, J. Jr.; Clark, R.E.H.

1988-12-01

A new computer program, LINES, has been developed for simulating atomic line emission and absorption spectra using the accurate fine structure energy levels and transition strengths calculated by the (CATS) Cowan Atomic Structure code. Population distributions for the ion stages are obtained in LINES by using the Local Thermodynamic Equilibrium (LTE) model. LINES is also useful for displaying the pertinent atomic data generated by CATS. This report describes the use of LINES. Both CATS and LINES are part of the Theoretical Atomic PhysicS (TAPS) code development effort at Los Alamos. 11 refs., 9 figs., 1 tab

Cost analysis of surgically treated pressure sores stage III and IV.

NARCIS (Netherlands)

Filius, A.; Damen, T.H.; Schuijer-Maaskant, K.P.; Polinder, S.; Hovius, S.E.R.; Walbeehm, E.T.

2013-01-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart

Second-stage primary Caesarean deliveries: Are maternal ...

African Journals Online (AJOL)

variables were nonsignificant. None of the women or their babies needed readmission to hospital or transfer to an intensive care unit. Table I: Demographic data of mother and neonate following Caesarean delivery in the first and second stages of labour. Demographics. Caesarean delivery 2nd stage (n = 53). Caesarean.

Stationary nonimaging concentrator as a second stage element in tracking systems

Science.gov (United States)

Kritchman, E. M.; Snail, K. A.; Ogallagher, J.; Winston, R.

1983-01-01

An increase in the concentration in line focus solar concentrators is shown to be available using an evacuated compound parabolic concentrator (CPC) tube as a second stage element. The absorber is integrated into an evacuated tube with a transparent upper section and a reflective lower section, with a selective coating on the absorber surface. The overall concentration is calculated in consideration of a parabolic mirror in a trough configuration, a flat Fresnel lens over the top, or a color and coma corrected Fresnel lens. The resulting apparatus is noted to also suppress thermal losses due to conduction, convection, and IR radiation.

Cetuximab and Radiation Therapy in Treating Patients With Stage III-IV Head and Neck Cancer

Science.gov (United States)

2017-11-15

Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Tongue Cancer

Second stage of Saturn V being assembled with the first stage.

Science.gov (United States)

1965-01-01

The hydrogen-powered second stage is being lowered into place during the final phase of fabrication of the Saturn V moon rocket at North American's Seal Beach, California facility. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

Second-order quadrupolar line shapes under molecular dynamics: An additional transition in the extremely fast regime.

Science.gov (United States)

Hung, Ivan; Wu, Gang; Gan, Zhehong

NMR spectroscopy is a powerful tool for probing molecular dynamics. For the classic case of two-site exchange, NMR spectra go through the transition from exchange broadening through coalescence and then motional narrowing as the exchange rate increases passing through the difference between the resonance frequencies of the two sites. For central-transition spectra of half-integer quadrupolar nuclei in solids, line shape change due to molecular dynamics occurs in two stages. The first stage occurs when the exchange rate is comparable to the second-order quadrupolar interaction. The second spectral transition comes at a faster exchange rate which approaches the Larmor frequency and generally reduces the isotropic quadrupolar shift. Such a two-stage transition phenomenon is unique to half-integer quadrupolar nuclei. A quantum mechanical formalism in full Liouville space is presented to explain the physical origin of the two-stage phenomenon and for use in spectral simulations. Variable-temperature 17 O NMR of solid NaNO 3 in which the NO 3 - ion undergoes 3-fold jumps confirms the two-stage transition process. The spectra of NaNO 3 acquired in the temperature range of 173-413K agree well with simulations using the quantum mechanical formalism. The rate constants for the 3-fold NO 3 - ion jumps span eight orders of magnitude (10 2 -10 10 s -1 ) covering both transitions of the dynamic 17 O line shape. Copyright © 2016 Elsevier Inc. All rights reserved.

The second stage of labour.

Science.gov (United States)

Baston, Helen

2004-03-01

This is the third 'midwifery basics' series aimed at student midwives, and focuses on midwifery care during labour. This month, we look at care during the second stage of labour. Students are encouraged to seek further information through a series of activities, and to link theory with practice by considering the issues relating to the care of the woman described in the vignette.

Efficacy and Safety of First-line Avelumab Treatment in Patients With Stage IV Metastatic Merkel Cell Carcinoma

Science.gov (United States)

Russell, Jeffery; Lebbé, Céleste; Chmielowski, Bartosz; Gambichler, Thilo; Grob, Jean-Jacques; Kiecker, Felix; Rabinowits, Guilherme; Terheyden, Patrick; Zwiener, Isabella; Bajars, Marcis; Hennessy, Meliessa; Kaufman, Howard L.

2018-01-01

Importance Merkel cell carcinoma (MCC) is an aggressive skin cancer that is associated with poor survival outcomes in patients with distant metastatic disease. Results of part A of the JAVELIN Merkel 200 trial (avelumab in patients with Merkel cell carcinoma) showed that avelumab, an anti–programmed cell death ligand 1 (PD-L1) antibody, demonstrated efficacy in second-line or later treatment of patients with metastatic MCC (mMCC). Objective To evaluate the efficacy and safety of avelumab as first-line treatment for patients with distant mMCC. Design, Setting, and Participants JAVELIN Merkel 200 part B is an international, multicenter, single-arm, open-label clinical trial of first-line avelumab monotherapy. Eligible patients were adults with mMCC who had not received prior systemic treatment for metastatic disease. Patients were not selected for PD-L1 expression or Merkel cell polyomavirus status. Data were collected from April 15, 2016, to March 24, 2017, and enrollment is ongoing. Interventions Patients received avelumab, 10 mg/kg, by 1-hour intravenous infusion every 2 weeks until confirmed disease progression, unacceptable toxic effects, or withdrawal occurred. Main Outcomes and Measures Tumor status was assessed every 6 weeks and evaluated by independent review committee per Response Evaluation Criteria in Solid Tumors version 1.1. The primary end point was durable response, defined as an objective response with a duration of at least 6 months. Secondary end points include best overall response, duration of response, progression-free survival, safety, and tolerability. Results As of March 24, 2017, 39 patients were enrolled (30 men and 9 women; median age, 75 years [range, 47-88 years]), with a median follow-up of 5.1 months (range, 0.3-11.3 months). In a preplanned analysis, efficacy was assessed in 29 patients with at least 3 months of follow-up; the confirmed objective response rate was 62.1% (95% CI, 42.3%-79.3%), with 14 of 18 responses (77.8%) ongoing

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

Science.gov (United States)

2017-06-05

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

Incidence and severity of stage IV bronchopulmonary dysplasia in infants of very low birth weight

International Nuclear Information System (INIS)

Parker, B.R.; Stevens, S.K.; Northway, W.H.

1989-01-01

To evaluate the incidence and severity of stage IV bronchopulmonary dysplasia (BPD) in infants of very low birth weight, the authors reviewed the clinical course and chest radiographs of 138 such infants. In the lowest weight group ( 1500 g, 10%). However, the severity of BPD (graded by the Toce-Edwards Scale) was highest (6.3) in the < 1500-g group (< 900 g, 5.4; 1200-1500 g, 5.9). These data showed that, although the incidence of stage IV BVD significantly decreased as birth weight increased, the severity of chronic changes was independent of birth weight

ACTOplus Met XR in Treating Patients With Stage I-IV Oral Cavity or Oropharynx Cancer Undergoing Definitive Treatment

Science.gov (United States)

2018-03-02

Oral Cavity Neoplasm; Oropharyngeal Neoplasm; Stage I Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage I Oropharyngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage II Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage II Oropharyngeal Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage III Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IV Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IV Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVA Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVB Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVB Oropharyngeal Squamous Cell Carcinoma AJCC v7; Stage IVC Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7; Stage IVC Oropharyngeal Squamous Cell Carcinoma AJCC v7

Survival outcome of women with stage IV uterine carcinosarcoma who received neoadjuvant chemotherapy followed by surgery.

Science.gov (United States)

Matsuo, Koji; Johnson, Marian S; Im, Dwight D; Ross, Malcolm S; Bush, Stephen H; Yunokawa, Mayu; Blake, Erin A; Takano, Tadao; Klobocista, Merieme M; Hasegawa, Kosei; Ueda, Yutaka; Shida, Masako; Baba, Tsukasa; Satoh, Shinya; Yokoyama, Takuhei; Machida, Hiroko; Ikeda, Yuji; Adachi, Sosuke; Miyake, Takahito M; Iwasaki, Keita; Yanai, Shiori; Takeuchi, Satoshi; Nishimura, Masato; Nagano, Tadayoshi; Takekuma, Munetaka; Shahzad, Mian M K; Pejovic, Tanja; Omatsu, Kohei; Kelley, Joseph L; Ueland, Frederick R; Roman, Lynda D

2018-03-01

To examine survival of women with stage IV uterine carcinosarcoma (UCS) who received neoadjuvant chemotherapy followed by hysterectomy. This is a nested case-control study within a retrospective cohort of 1192 UCS cases. Women who received neoadjuvant chemotherapy followed by hysterectomy based-surgery for stage IV UCS (n = 26) were compared to those who had primary hysterectomy-based surgery without neoadjuvant chemotherapy for stage IV UCS (n = 120). Progression-free survival (PFS) and cause-specific survival (CSS) were examined. The most common regimen for neoadjuvant chemotherapy was carboplatin/paclitaxel (53.8%). Median number of neoadjuvant chemotherapy cycles was 4. PFS was similar between the neoadjuvant chemotherapy group and the primary surgery group (unadjusted-hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.75-1.89, P = 0.45). Similarly, CSS was comparable between the two groups (unadjusted-HR 1.13, 95%CI 0.68-1.90, P = 0.64). When the types of neoadjuvant chemotherapy regimens were compared, women who received a carboplatin/paclitaxel regimen had better survival outcomes compared to those who received other regimens: PFS, unadjusted-HR 0.38, 95%CI 0.15-0.93, P = 0.027; and CSS, unadjusted-HR 0.21, 95%CI 0.07-0.61, P = 0.002. Our study found that there is no statistically significant difference in survival between women with stage IV UCS who are tolerated neoadjuvant chemotherapy and those who undergo primary surgery. © 2017 Wiley Periodicals, Inc.

Vitamin D Status in Patients With Stage IV Colorectal Cancer: Findings From Intergroup Trial N9741

Science.gov (United States)

Ng, Kimmie; Sargent, Daniel J.; Goldberg, Richard M.; Meyerhardt, Jeffrey A.; Green, Erin M.; Pitot, Henry C.; Hollis, Bruce W.; Pollak, Michael N.; Fuchs, Charles S.

2011-01-01

Purpose Previous studies have suggested that higher plasma 25-hydroxyvitamin D3 [25(OH)D] levels are associated with decreased colorectal cancer risk and improved survival, but the prevalence of vitamin D deficiency in advanced colorectal cancer and its influence on outcomes are unknown. Patients and Methods We prospectively measured plasma 25(OH)D levels in 515 patients with stage IV colorectal cancer participating in a randomized trial of chemotherapy. Vitamin D deficiency was defined as 25(OH)D lower than 20 ng/mL, insufficiency as 20 to 29 ng/mL, and sufficiency as ≥ 30 ng/mL. We examined the association between baseline 25(OH)D level and selected patient characteristics. Cox proportional hazards models were used to calculate hazard ratios (HR) for death, disease progression, and tumor response, adjusted for prognostic factors. Results Among 515 eligible patients, 50% of the study population was vitamin D deficient, and 82% were vitamin D insufficient. Plasma 25(OH)D levels were lower in black patients compared to white patients and patients of other race (median, 10.7 v 21.1 v 19.3 ng/mL, respectively; P < .001), and females compared to males (median, 18.3 v 21.7 ng/mL, respectively; P = .0005). Baseline plasma 25(OH)D levels were not associated with patient outcome, although given the distribution of plasma levels in this cohort, statistical power for survival analyses were limited. Conclusion Vitamin D deficiency is highly prevalent among patients with stage IV colorectal cancer receiving first-line chemotherapy, particularly in black and female patients. PMID:21422438

BLACK HOLE MASS ESTIMATES BASED ON C IV ARE CONSISTENT WITH THOSE BASED ON THE BALMER LINES

Energy Technology Data Exchange (ETDEWEB)

Assef, R. J.; Denney, K. D.; Kochanek, C. S.; Peterson, B. M.; Kozlowski, S.; Dietrich, M.; Grier, C. J.; Khan, R. [Department of Astronomy, The Ohio State University, 140 W. 18th Ave., Columbus, OH 43210 (United States); Ageorges, N.; Buschkamp, P.; Gemperlein, H.; Hofmann, R. [Max-Planck-Institut fuer Extraterrestrische Physik, Giessenbachstr., D-85748 Garching (Germany); Barrows, R. S. [Arkansas Center for Space and Planetary Sciences, University of Arkansas, Fayetteville, AR 72701 (United States); Falco, E.; Kilic, M. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Feiz, C.; Germeroth, A. [Landessternwarte, ZAH, Koenigstuhl 12, D-69117 Heidelberg (Germany); Juette, M.; Knierim, V. [Astron. Institut der Ruhr Univ. Bochum, Universitaetsstr. 150, D-44780 Bochum (Germany); Laun, W., E-mail: rjassef@astronomy.ohio-state.edu [Max-Planck-Institut fuer Astronomie, Koenigstuhl 17, D-69117 Heidelberg (Germany); and others

2011-12-01

Using a sample of high-redshift lensed quasars from the CASTLES project with observed-frame ultraviolet or optical and near-infrared spectra, we have searched for possible biases between supermassive black hole (BH) mass estimates based on the C IV, H{alpha}, and H{beta} broad emission lines. Our sample is based upon that of Greene, Peng, and Ludwig, expanded with new near-IR spectroscopic observations, consistently analyzed high signal-to-noise ratio (S/N) optical spectra, and consistent continuum luminosity estimates at 5100 A. We find that BH mass estimates based on the full width at half-maximum (FWHM) of C IV show a systematic offset with respect to those obtained from the line dispersion, {sigma}{sub l}, of the same emission line, but not with those obtained from the FWHM of H{alpha} and H{beta}. The magnitude of the offset depends on the treatment of the He II and Fe II emission blended with C IV, but there is little scatter for any fixed measurement prescription. While we otherwise find no systematic offsets between C IV and Balmer line mass estimates, we do find that the residuals between them are strongly correlated with the ratio of the UV and optical continuum luminosities. This means that much of the dispersion in previous comparisons of C IV and H{beta} BH mass estimates are due to the continuum luminosities rather than to any properties of the lines. Removing this dependency reduces the scatter between the UV- and optical-based BH mass estimates by a factor of approximately two, from roughly 0.35 to 0.18 dex. The dispersion is smallest when comparing the C IV {sigma}{sub l} mass estimate, after removing the offset from the FWHM estimates, and either Balmer line mass estimate. The correlation with the continuum slope is likely due to a combination of reddening, host contamination, and object-dependent SED shapes. When we add additional heterogeneous measurements from the literature, the results are unchanged. Moreover, in a trial observation of a

A prognostic scoring model for survival after locoregional therapy in de novo stage IV breast cancer.

Science.gov (United States)

Kommalapati, Anuhya; Tella, Sri Harsha; Goyal, Gaurav; Ganti, Apar Kishor; Krishnamurthy, Jairam; Tandra, Pavan Kumar

2018-05-02

The role of locoregional treatment (LRT) remains controversial in de novo stage IV breast cancer (BC). We sought to analyze the role of LRT and prognostic factors of overall survival (OS) in de novo stage IV BC patients treated with LRT utilizing the National Cancer Data Base (NCDB). The objective of the current study is to create and internally validate a prognostic scoring model to predict the long-term OS for de novo stage IV BC patients treated with LRT. We included de novo stage IV BC patients reported to NCDB between 2004 and 2015. Patients were divided into LRT and no-LRT subsets. We randomized LRT subset to training and validation cohorts. In the training cohort, a seventeen-point prognostic scoring system was developed based on the hazard ratios calculated using Cox-proportional method. We stratified both training and validation cohorts into two "groups" [group 1 (0-7 points) and group 2 (7-17 points)]. Kaplan-Meier method and log-rank test were used to compare OS between the two groups. Our prognostic score was validated internally by comparing the OS between the respective groups in both the training and validation cohorts. Among 67,978 patients, LRT subset (21,200) had better median OS as compared to that of no-LRT (45 vs. 24 months; p < 0.0001). The group 1 and group 2 in the training cohort showed a significant difference in the 3-year OS (p < 0.0001) (68 vs. 26%). On internal validation, comparable OS was seen between the respective groups in each cohort (p = 0.77). Our prognostic scoring system will help oncologists to predict the prognosis in de novo stage IV BC patients treated with LRT. Although firm treatment-related conclusions cannot be made due to the retrospective nature of the study, LRT appears to be associated with a better OS in specific subgroups.

Comparison of Efficacy and Safety of Different Therapeutic Regimens as 
Second-line Treatment for Small Cell Lung Cancer

Directory of Open Access Journals (Sweden)

Zhihua LI

2015-05-01

.400. The median PFS from second-line chemotherapy of the two groups were 4.0 mo and 3.0 mo, and the second-line median OS were 6.5 mo and 4.5 mo. There was no statistic difference (P=0.432; P=0.508. The resistance/refractory disease patients were divided into group B2 (CPT-11-based regimen, group C (PTX/DXL-based regimen and group D (TPT-based regimen. There was no statistic difference in second-line ORR, DCR and median PFS among the three groups (P value is 0.521, 0.528 and 0.775, respectively; The median OS from second-line chemotherapy of the group D is longer than that of group B2 and group C, with statistical difference (P=0.043; P=0.030. The differences of grade III-IV hematologic toxicities among the four subgroups were not statistically different. The incidence of diarrhea in non-hematologic toxicities in patients who received irinotecan as second-line chemotherapy was higher than other three subgroups (P=0.029. Conclusion Patients who progressed after the completion of first-line chemotherapy can gain survival benefit. The response and the PFS of the different second-line chemotherapies were similar. The patients who received the TPT-based regimen may gain longer overall survival than other resistance/refractory disease patients.

Evidence of redshifts in the average solar line profiles of C IV and Si IV from OSO-8 observations

Science.gov (United States)

Roussel-Dupre, D.; Shine, R. A.

1982-01-01

Line profiles of C IV and Si V obtained by the Colorado spectrometer on OSO-8 are presented. It is shown that the mean profiles are redshifted with a magnitude varying from 6-20 km/s, and with a mean of 12 km/s. An apparent average downflow of material in the 50,000-100,000 K temperature range is measured. The redshifts are observed in the line center positions of spatially and temporally averaged profiles and are measured either relative to chromospheric Si I lines or from a comparison of sun center and limb profiles. The observations of 6-20 km/s redshifts place constraints on the mechanisms that dominate EUV line emission since it requires a strong weighting of the emission in regions of downward moving material, and since there is little evidence for corresponding upward moving materials in these lines.

A Si IV/O IV Electron Density Diagnostic for the Analysis of IRIS Solar Spectra

Science.gov (United States)

Young, P. R.; Keenan, F. P.; Milligan, R. O.; Peter, H.

2018-04-01

Solar spectra of ultraviolet bursts and flare ribbons from the Interface Region Imaging Spectrograph (IRIS) have suggested high electron densities of > {10}12 cm‑3 at transition region temperatures of 0.1 MK, based on large intensity ratios of Si IV λ1402.77 to O IV λ1401.16. In this work, a rare observation of the weak O IV λ1343.51 line is reported from an X-class flare that peaked at 21:41 UT on 2014 October 24. This line is used to develop a theoretical prediction of the Si IV λ1402.77 to O IV λ1401.16 ratio as a function of density that is recommended to be used in the high-density regime. The method makes use of new pressure-dependent ionization fractions that take account of the suppression of dielectronic recombination at high densities. It is applied to two sequences of flare kernel observations from the October 24 flare. The first shows densities that vary between 3× {10}12 and 3× {10}13 cm‑3 over a seven-minute period, while the second location shows stable density values of around 2× {10}12 cm‑3 over a three-minute period.

The ARIES-II and ARIES-IV second-stability tokamak reactors

International Nuclear Information System (INIS)

Najmabadi, F.; Conn, R.W.; Hasan, M.Z.; Mau, T.-K.; Sharafat, S.; Baxi, C.B.; Leuer, J.A.; McQuillan, B.W.; Puhn, F.A.; Schultz, K.R.; Wong, C.P.C.; Brooks, J.; Ehst, D.A.; Hassanein, A.; Hua, T.; Hull, A.; Mattis, R.; Picologlou, B.; Sze, D.-K.; Dolan, T.J.; Herring, J.S.; Bathke, C.G.; Krakowski, R.A.; Werley, K.A.; Bromberg, L.; Schultz, J.; Davis, F.; Holmes, J.A.; Lousteau, D.C.; Strickler, D.J.; Jardin, S.C.; Kessel, C.; Snead, L.; Steiner, D.; Valenti, M.; El-Guebaly, L.A.; Emmert, G.A.; Khater, H.Y.; Santarius, J.F.; Sawan, M.; Sviatoslavsky, I.N.; Cheng, E.T.

1992-01-01

The ARIES research program is a multi-institutional effort to develop several visions of tokamak reactors with enhanced economic, safety, and environmental features. Four ARIES visions are currently planned for the ARIES program. The ARIES-I design is a DT-burning reactor based on modest extrapolations from the present tokamak physics database and relies on either existing technology or technology for which trends are already in place, often in programs outside fusion. The ARIES-III study focuses on the potential of tokamaks to operate with D- 3 He fuel system as an alternative to deuterium and tritium. The ARIES-II and ARIES-IV designs have the same fusion plasma but different fusion-power-core designs. The ARIES-II reactor uses liquid lithium as the coolant and tritium breeder and vanadium alloy as the structural material in order to study the potential of low-activation metallic blankets. The ARIES-IV reactor uses helium as the coolant, a solid tritium-breeding material, and silicon carbide composite as the structural material in order to achieve the safety and environmental characteristic of fusion. In this paper the authors describe the trade-off leading to the optimum regime of operation for the ARIES-II and ARIES-IV second-stability reactors and review the engineering design of the fusion power cores

Contemporary second stage labor patterns in Taiwanese women with normal neonatal outcomes.

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Hung, Tai-Ho; Chen, Szu-Fu; Lo, Liang-Ming; Hsieh, T'sang-T'ang

2015-08-01

To compare the duration of second stage labor among modern Taiwanese women who achieved vaginal delivery without adverse neonatal outcomes and women who delivered during the early 1990 s. Data were collected from women who underwent spontaneous labor and vaginally delivered cephalic singleton fetuses with normal neonatal outcomes at the Taipei Chang Gung Memorial Hospital, Taipei, Taiwan from 1991-1995 (Cohort 1, n = 10,721) and 2010-2014 (Cohort 2, n = 3734). We calculated the median duration and 95th percentiles of second stage labor. The women were stratified according to analgesia and parity. Multiple linear regression analysis was used to determine the association between the maternal/pregnancy characteristics and second stage labor duration. The median second stage labor duration was significantly longer for Cohort 2 than for Cohort 1. For nulliparous women, the 95th percentile second stage labor thresholds were 255 minutes and 152 minutes (Cohort 2) and 165 minutes and 107 minutes (Cohort 1) for women with and without epidural analgesia, respectively. For multiparous women, the 95th percentile second stage labor thresholds were 136 minutes and 43 minutes (Cohort 2) and 125 minutes and 39 minutes (Cohort 1) for women with and without epidural analgesia, respectively. Birth weight, maternal age at delivery, and time period (2010-2014 vs. 1991-1995) were significant factors associated with the duration of second stage labor. Modern Taiwanese women who achieved vaginal delivery without adverse neonatal outcomes experienced longer second stage labors than women 25 years ago. The 95th percentile thresholds differed between nulliparous and multiparous women with and without epidural analgesia. Copyright © 2015. Published by Elsevier B.V.

Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer.

Science.gov (United States)

Chikaishi, Yasuhiro; Shinohara, Shinji; Kuwata, Taiji; Takenaka, Masaru; Oka, Soichi; Hirai, Ayako; Yoneda, Kazue; Kuroda, Kouji; Imanishi, Naoko; Ichiki, Yoshinobu; Tanaka, Fumihiro

2017-12-01

The standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) is systemic chemotherapy. However, certain patients, such as those with oligometastasis or M1a disease undergo resection of the primary lesion. We conducted a retrospective review of the records of 1,471 consecutive patients with NSCLC who underwent resection of the primary lesion for between June 2005 and May 2016. The present study included 38 patients with stage IV NSCLC who underwent complete resection of the primary lesion as first-line treatment. The median follow-up duration for the 38 patients (27 men) was 17.7 months (range, 1-82.3 months). The T factors were T1/T2/T3/T4 in 4/16/12/6 patients, respectively. The N factors were N0/N1/N2/N3 in 16/8/12/2 patients, respectively. The M factors were M1a/M1b/M1c in 19/13/6 patients, respectively. Of the 19 M1a patients, 11 were classified as cM0. We introduced the novel classification M-better/M-worse. M-better includes cM0 patients and M1b and M1c patients in whom all lesions have been locally controlled. M-worse includes cM1a patients and M1b and M1c patients in whom lesions cannot be locally controlled. The new M-better/M-worse statuses were 24/14 patients, respectively. The histology of NSCLC was adenocarcinoma/squamous cell carcinoma/others in 30/5/3 patients, respectively. The 5-year overall survival rate was 29%, and the median survival time was 725 days. Squamous cell carcinoma and M-worse were significant factors predicting poor outcomes (P=0.0017, P=0.0007, respectively). Even for stage IV NSCLC patients, resection of the primary lesion may be beneficial, especially for those with M-better status and those not diagnosed with squamous-cell carcinoma (SCC).

Differential Impact of Anastomotic Leak in Patients With Stage IV Colonic or Rectal Cancer: A Nationwide Cohort Study.

Science.gov (United States)

Nordholm-Carstensen, Andreas; Rolff, Hans Christian; Krarup, Peter-Martin

2017-05-01

Anastomotic leak has a negative impact on the prognosis of patients who undergo colorectal cancer resection. However, data on anastomotic leak are limited for stage IV colorectal cancers. The purpose of this study was to investigate the impact of anastomotic leak on survival and the decision to administer chemotherapy and/or metastasectomy after elective surgery for stage IV colorectal cancer. This was a nationwide, retrospective cohort study. Data were obtained from the Danish Colorectal Cancer Group, the Danish Pathology Registry, and the National Patient Registry. Patients who were diagnosed with stage IV colorectal cancer between 2009 and 2013 and underwent elective resection of their primary tumors were included. The primary outcome was all-cause mortality depending on the occurrence of anastomotic leak. Secondary outcomes were the administration of and time to adjuvant chemotherapy, metastasectomy rate, and risk factors for leak. Of the 774 patients with stage IV colorectal cancer who were included, 71 (9.2%) developed anastomotic leaks. Anastomotic leak had a significant impact on the long-term survival of patients with colon cancer (p = 0.04) but not on those with rectal cancer (p = 0.91). Anastomotic leak was followed by the decreased administration of adjuvant chemotherapy in patients with colon cancer (p = 0.007) but not in patients with rectal cancer (p = 0.47). Finally, anastomotic leak had a detrimental impact on metastasectomy rates after colon cancer but not on resection rates of rectal cancer. Retrospective data on the selection criteria for primary tumor resection and metastatic tumor load were unavailable. The impact of anastomotic leak on patients differed between stage IV colon and rectal cancers. Survival and eligibility to receive chemotherapy and metastasectomy differed between patients with colon and rectal cancers. When planning for primary tumor resection, these factors should be considered.

A system for customer feedback: the InterVention (IV) Line.

Science.gov (United States)

Wood, K E; Barker, J R; Stump, J W

2001-01-01

Healthcare organizations use a number of data collection methodologies to identify opportunities for improving customer satisfaction. One methodology used at the 665-bed University Hospitals and Clinics of the University of Mississippi Medical Center is a customer service telephone hotline. Patients, visitors, and staff members call in their compliments and concerns to the InterVention (IV) Line, which provides customized problem solving. This article provides an overview of the customer hotline and presents lessons learned from its implementation.

Assessment of skeletal maturation using mandibular second molar maturation stages.

Science.gov (United States)

Goyal, S; Goyal, S; Gugnani, N

2014-01-01

To investigate the relationship between cervical vertebrae maturation and mandibular second molar calcification stages. The study was designed as a retrospective, descriptive and crosssectional research project. Pre-treatment lateral cephalograms and panoramic radiographs of 99 males and 110 females in the age range of 7 to 18 years 7 months were evaluated with Demirjian Index (DI) and cervical vertebrae maturation indicators (CVMI) of Hassel and Farman. A null hypothesis was proposed that there is no relation between CVMI and DI. A highly significant association (Pearson's contingency coefficient 0.713 for males and 0.863 for females) was found between DI and CVMI. In males, the DI stage E corresponded to stage 2 of CVMI (pre-peak of pubertal growth spurt) and DI stages F and G corresponded to stages 3 and 4 of CVMI (peak of pubertal growth spurt). DI stage H was associated with stages 5 and 6 of CVMI (end of pubertal growth spurt). In females, the DI stages C, D corresponded to CVMI stages 1, 2; DI stages E, F with CVMI stages 3, 4; DI stages G, H with CVMI stages 5, 6. Mandibular second molar calcification stages can be used as indicators for assessment of skeletal maturity.

Title of the paper goes here second line

Indian Academy of Sciences (India)

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Features and prognostic impact of distant metastases in 45 dogs with de novo stage IV cutaneous mast cell tumours: A prospective study.

Science.gov (United States)

Pizzoni, S; Sabattini, S; Stefanello, D; Dentini, A; Ferrari, R; Dacasto, M; Giantin, M; Laganga, P; Amati, M; Tortorella, G; Marconato, L

2018-03-01

Distant metastases in dogs with cutaneous mast cell tumors (cMCT) are rare and incurable. The aims of this prospective study were to clarify the clinico-pathological features of stage IV cMCTs and to identify possible prognostic factors for progression-free interval (PFI) and survival time (ST). Dogs were eligible for recruitment if they had a previously untreated, histologically confirmed cMCT and if they underwent complete staging demonstrating stage IV disease. Dogs were uniformly followed-up, whereas treatment was not standardized and included no therapy, surgery, radiation therapy, chemotherapy, tyrosine-kinase inhibitors or a combination of these. 45 dogs with stage IV cMCT were enrolled. All dogs had distant metastatic disease, and 41 (91.1%) dogs had also metastasis in the regional lymph node. Histopathological grade and mutational status greatly varied among dogs. Median ST was 110 days. Notably, PFI and ST were independent of well-known prognostic factors, including anatomic site, histological grade, and mutational status. Conversely, tumor diameter >3 cm, more than 2 metastatic sites, bone marrow infiltration, and lack of tumor control at the primary site were confirmed to be negative prognostic factors by multivariate analysis. Currently, there is no satisfactory treatment for stage IV cMCT. Asymptomatic dogs with tumor diameter <3 cm and a low tumor burden, without bone marrow infiltration may be candidates for multimodal treatment. Stage IV dogs without lymph node metastasis may enjoy a surprisingly prolonged survival. The achievement of local tumor control seems to predict a better outcome in dogs with stage IV cMCT. © 2017 John Wiley & Sons Ltd.

On the line intensity ratios of prominent Si II, Si III, and Si IV multiplets

International Nuclear Information System (INIS)

Djenize, S.; Sreckovic, A.; Bukvic, S.

2010-01-01

Line intensities of singly, doubly and triply ionized silicon (Si II, Si III, and Si IV, respectively) belonging to the prominent higher multiplets, are of interest in laboratory and astrophysical plasma diagnostics. We measured these line intensities in the emission spectra of pulsed helium discharge. The Si II line intensity ratios in the 3s3p 22 D-3s 2 4p 2 P o , 3s 2 3d 2 D-3s 2 4f 2 F o , and 3s 2 4p 2 P o -3s 2 4d 2 D transitions, the Si III line intensity ratios in the 3s3d 3 D-3s4p 3 P o , 3s4p 3 P o -3s4d 3 D, 3s4p 3 P o -3s5s 3 S, 3s4s 3 S-3s4p 3 P o , and 3s4f 3 F o -3s5g 3 G transitions, and the Si IV line intensity ratios in the 4p 2 P o -4d 2 D and 4p 2 P o -5s 2 S transitions were obtained in a helium plasma at an electron temperature of about 17,000 ± 2000 K. Line shapes were recorded using a spectrograph and an ICCD camera as a highly-sensitive detection system. The silicon atoms were evaporated from a Pyrex discharge tube designed for the purpose. They represent impurities in the optically thin helium plasma at the silicon ionic wavelengths investigated. The line intensity ratios obtained were compared with those available in the literature, and with values calculated on the basis of available transition probabilities. The experimental data corresponded well with line intensity ratios calculated using the transition probabilities obtained from a Multi Configuration Hartree-Fock approximation for Si III and Si IV spectra. We recommend corrections of some Si II transition probabilities.

Combined therapy for 129 patients with second primary lung cancer

International Nuclear Information System (INIS)

Liang Jun; Feng Qinfu; Wang Luhua; Zhang Yaohong; Zhao Hongfa; Weng Xinran

2004-01-01

Objective: To analyze the clinical characteristics and prognosis of the second primary lung cancer. Methods: The interval between the second primary lung cancer and the previous primary cancer ranged from 10 days to 317 months (median 49 months). Of the 129 patients treated from 1971 to 1997 by surgery only, radiotherapy only and chemotherapy only or combined therapy, 11 (8.5%) patients had stage I, 29 (22.5%) stage II, 75 (58.1%) stage III and 14 (10.9%) stage IV; 30 patients received surgery alone, 54 radiotherapy alone, 8 chemotherapy alone, 12 surgery plus radiotherapy, 20 radiotherapy plus chemotherapy, 4 surgery plus chemotherapy and 1 surgery plus radiotherapy plus chemotherapy. Results: The overall 2-, 3- and 5-year survival rates were 40.2%, 27.2% and 15.3%. The stage I, II, III and IV 2-year survival rates were 71.6%, 60.7%, 32.9% and 0%, respectively (P 49 and ≤49 months of the interval between the second primary lung cancer and the previous primary cancer (P>0.05). Conclusions: Second primary lung cancer are similar to the first primary lung cancer in clinical characteristics and prognosis. The main cause of failure is lung cancer perse. Stage and being able to operation are prognostic factors

A proteomics panel for predicting optimal primary cytoreduction in stage III/IV ovarian cancer

DEFF Research Database (Denmark)

Risum, Signe; Høgdall, Estrid; Engelholm, Svend A

2009-01-01

for CA-125. In addition, serum was analyzed for 7 biomarkers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. These biomarkers were combined into a single-valued ovarian-cancer-risk index (OvaRI). CA-125 and OvaRI were evaluated as predictors of cytoreduction in 75......The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed...... stage III/IV patients using receiver operating characteristic curves. Complete primary cytoreduction (no macroscopic residual disease) was achieved in 31% (23/75) of the patients. The area under the receiver operating characteristic curve was 0.66 for CA-125 and 0.75 for OvaRI. The sensitivity...

[Outcome of operative treatment for supination-external rotation Lauge-Hansen stage IV ankle fractures].

Science.gov (United States)

Kołodziej, Łukasz; Boczar, Tomasz; Bohatyrewicz, Andrzej; Zietek, Paweł

2010-01-01

Ankle fractures are among the most common musculoskeletal injures. These fractures occur with an overall age- and sex-adjusted incidence rate around 180 per 100 000 person-years. The most frequent mechanism is considered to be supination-external rotation (60 to 80% of all ankle fractures) consisting of pathologic external rotation of the foot initially placed in some degree of supination. According to Lauge-Hansen classification, ankle joint structures are damaged in a sequence where the final, stage IV injuries, represents transverse fracture of the medial malleolus or its equivalent-rupture of the deltoid ligament. The aim of this study is to compare the results of two subtypes of supination-external rotation stage IV fractures. 43 patients treated surgically in 2006 to 2007 at Authors institution because of stage IV supination-external rotation ankle fracture were submitted to retrospective analysis. There were 25 patients with bimalleolar fracture (type 1) and in 18 patients with lateral malleolar fracture with accompanying rupture of the deltoid ligament (type 2). The mean age was 46 years (from 20 to 82 years). Average follow up period was 37 months (from 24 to 46 months). For the evaluation of treatment AOFAS hind-foot score (American Orthopedic Foot and Ankle Society) was used. The mean AOFAS score scale for Type 1 fractures was 85 points and for type 2 was significantly higher and amounted to 91 points (p ankle fractures with medial malleolar fracture, requires the implementation of additional diagnostic and therapeutic strategies and procedures in order to improve the outcome of results.

First- and Second-Line Targeted Systemic Therapy in Hepatocellular Carcinoma—An Update on Patient Selection and Response Evaluation

Directory of Open Access Journals (Sweden)

Johann von Felden

2016-11-01

Full Text Available Advanced hepatocellular carcinoma (HCC with vascular invasion and/or extrahepatic spread and preserved liver function, according to stage C of the Barcelona Clinic Liver Cancer (BCLC classification, has a dismal prognosis. The multi-targeted tyrosine-kinase receptor inhibitor (TKI sorafenib is the only proven active substance in systemic HCC therapy for first-line treatment. In this review, we summarize current aspects in patient selection and management of side effects, and provide an update on response evaluation during first-line sorafenib therapy. Since second-line treatment options have been improved with the successful completion of the RESORCE trial, demonstrating a survival benefit for second-line treatment with the TKI regorafenib, response monitoring during first-line therapy will be critical to deliver optimal systemic therapy in HCC. To this regard, specific side effects, in particular worsening of arterial hypertension and diarrhea, might suggest treatment response during first-line sorafenib therapy; however, clear predictive clinical markers, as well as laboratory test or serum markers, are not established. Assessment of radiologic response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST is helpful to identify patients who do not benefit from sorafenib treatment.

A second stage homogenization method

International Nuclear Information System (INIS)

Makai, M.

1981-01-01

A second homogenization is needed before the diffusion calculation of the core of large reactors. Such a second stage homogenization is outlined here. Our starting point is the Floquet theorem for it states that the diffusion equation for a periodic core always has a particular solution of the form esup(j)sup(B)sup(x) u (x). It is pointed out that the perturbation series expansion of function u can be derived by solving eigenvalue problems and the eigenvalues serve to define homogenized cross sections. With the help of these eigenvalues a homogenized diffusion equation can be derived the solution of which is cos Bx, the macroflux. It is shown that the flux can be expressed as a series of buckling. The leading term in this series is the well known Wigner-Seitz formula. Finally three examples are given: periodic absorption, a cell with an absorber pin in the cell centre, and a cell of three regions. (orig.)

Labour outcome in patients admitted in the second stage of labour at ...

African Journals Online (AJOL)

Outcome in patients of labour at Jos University Teaching Hospital. 166. Tropical Journal of ... consequences of patients arriving in the second stage of labour to the ..... this study showed that arrival in the second stage is a risk factor for vaginal/.

Two technicians apply insulation to S-II second stage

Science.gov (United States)

1964-01-01

Two technicians apply insulation to the outer surface of the S-II second stage booster for the Saturn V moon rocket. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

Stage line diagram: an age-conditional reference diagram for tracking development.

Science.gov (United States)

van Buuren, Stef; Ooms, Jeroen C L

2009-05-15

This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and disease staging), psychology (stages of cognitive development), human development (pubertal stages) and chronic diseases (stages of dementia). Transition probabilities between successive stages are modeled as smoothly varying functions of age. Age-conditional references are calculated from the modeled probabilities by the mid-P value. It is possible to eliminate the influence of age by calculating standard deviation scores (SDS). The method is applied to the empirical data to produce reference charts on secondary sexual maturation. The mean of the empirical SDS in the reference population is close to zero, whereas the variance depends on age. The stage line diagram provides quick insight into both status (in SDS) and tempo (in SDS/year) of development of an individual child. Other measures (e.g. height SDS, body mass index SDS) from the same child can be added to the chart. Diagrams for sexual maturation are available as a web application at http://vps.stefvanbuuren.nl/puberty. The stage line diagram expresses status and tempo of discrete changes on a continuous scale. Wider application of these measures scores opens up new analytic possibilities. (c) 2009 John Wiley & Sons, Ltd.

Weak instruments and the first stage F-statistic in IV models with a nonscalar error covariance structure

NARCIS (Netherlands)

Bun, M.; de Haan, M.

2010-01-01

We analyze the usefulness of the first stage F-statistic for detecting weak instruments in the IV model with a nonscalar error covariance structure. More in particular, we question the validity of the rule of thumb of a first stage F-statistic of 10 or higher for models with correlated errors

Multidisciplinary management of very advanced stage III and IV melanoma: Proof-of-principle.

Science.gov (United States)

Gutman, Haim; Ben-Ami, Eytan; Shapira-Frommer, Roni; Schachter, Jacob

2012-08-01

Patients with potentially resectable advanced stage III and IV melanoma are a selected subgroup that gain maximal advantage if treated in a melanoma center. Surgery combined with chemo/chemobiotherapy may yield durable remission and long-term palliation. Thirty-seven non-randomly selected patients underwent systemic therapy with the aim of consolidating treatment by surgery. Data were collected prospectively, and analyzed retrospectively. The median follow-up from diagnosis was 50 (3-307) months and 15 (1-156) months when calculated from the last intervention. Twenty-two males and 15 females, with a median age at diagnosis of 44 (20-71) years, with 13 trunk, 13 extremity, 3 head and neck and 8 unknown primary melanomas were included. There were 17 stage III and 20 stage IV patients with a median Breslow thickness of 3.7 (0.45-26) mm. Chemo/chemobiotherapy achieved 7 clinical complete responses (cCRs), 28 partial responses (PRs) and 2 instances of stable disease. Six of the 7 cCRs were operated on, securing pathological complete response in 5 and PR in one. Four of these five and the PR patient still have no evidence of disease (NED). Twenty-one of 30 PR patients were rendered NED by surgery; 14 of these 21 patients succumbed to melanoma, and one is alive with stable disease. Overall, 11 of 37 patients have not succumbed to melanoma, with a median of 72 (14-156) months survival following the last intervention. Of the eight patients with unknown primary melanomas, five have not succumbed to melanoma, with a median of 89 (30-156) months survival following the last intervention. Patients with marginally resectable stage III and IV melanoma have a significant 30% chance, according to this series, for durable remission if treated by a multidisciplinary team in a melanoma center using induction chemobiotherapy and surgery. Results are more favorable for patients with an unknown primary lesion. In view of the currently approved new effective treatments for melanoma, this

Effects of an Interdisciplinary Practice Bundle for Second-Stage Labor on Clinical Outcomes.

Science.gov (United States)

Garpiel, Susan J

2018-04-09

There is renewed interest in second-stage labor practices as recent evidence has challenged historical perspectives on safe duration of secondstage labor. Traditional practices and routine interventions during second-stage have uncertain benefit for low-risk women and may result in cesarean birth. The purpose of this quality improvement project was to implement an interdisciplinary second-stage practice bundle to promote safe outcomes including method of birth and women's birth experience. Standardized second-stage labor evidence-based practice recommendations structured into a 5 Ps practice bundle (patience, positioning, physiologic resuscitation, progress, preventing urinary harm) were implemented across 34 birthing hospitals in Trinity Health system. Significant improvements were observed in second-stage practices. Association of Women's Health, Obstetric and Neonatal Nurses' perinatal nursing care quality measure Second-Stage of Labor: Mother-Initiated Spontaneous Pushing significantly improved [pre-implementation 43% (510/1,195), post-implementation 76% (1,541/2,028), p labor practices derived from the Association of Women's Health, Obstetric and Neonatal Nurses and American College of Nurse-Midwives professional guidelines achieved our goals of safely reducing primary cesarean birth among low-risk nulliparous women, and optimizing maternal and fetal outcomes associated with labor and birth. By minimizing routine interventions, nurses support physiologic birth and improve women's birth satisfaction.

[Surgical treatment of the primary tumor in stage IV breast cancer].

Science.gov (United States)

Jiménez Anula, Juan; Sánchez Andújar, Belén; Machuca Chiriboga, Pablo; Navarro Cecilia, Joaquín; Dueñas Rodríguez, Basilio

2015-01-01

The aim of the study was to analyze the impact of loco-regional surgery on survival of patients with stage IV breast cancer. Retrospective study that included patients with breast cancer and synchronous metastases. Patients with ECOG above 2 and high-risk patients were excluded. The following variables were evaluated: age, tumor size, nodal involvement, histological type, histological grade, hormone receptor status, HER2 overexpression, number of affected organs, location of metastases and surgical treatment. The impact of surgery and several clinical and pathologic variables on survival was analyzed by Cox regression model. A total of 69 patients, of whom 36 (52.2%) underwent surgery (study group) were included. After a mean follow-up of 34 months, the median survival of the series was 55 months and no significant differences between the study group and the group of patients without surgery (P=0.187) were found. Two factors associated with worse survival were identified: the number of organs with metastases (HR=1.69, IC 95%: 1.05-2.71) and triple negative breast cancer (HR=3.49, IC 95%: 1.39-8.74). Loco-regional surgery, however, was not associated with survival. Loco-regional surgical treatment was not associated with improved survival inpacientes with stage IV breast cancer. The number of organs with metastases and tumors were triple negative prognostic factors for survival. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Labour outcome in patients admitted in the second stage of labour at ...

African Journals Online (AJOL)

Conclusions: This study identified transportation problems, fast progress of labour, absence of husband at home when labour starts as major reasons for presenting in second stage of labour. Presenting in second stage of labour was associated with worse labour outcome. Keywords: Maternal complications; perinatal ...

Metastatic volume: an old oncologic concept and a new prognostic factor for stage IV melanoma patients.

Science.gov (United States)

Panasiti, V; Curzio, M; Roberti, V; Lieto, P; Devirgiliis, V; Gobbi, S; Naspi, A; Coppola, R; Lopez, T; di Meo, N; Gatti, A; Trevisan, G; Londei, P; Calvieri, S

2013-01-01

The last melanoma staging system of the 2009 American Joint Committee on Cancer takes into account, for stage IV disease, the serum levels of lactate dehydrogenase (LDH) and the site of distant metastases. Our aim was to compare the significance of metastatic volume, as evaluated at the time of stage IV melanoma diagnosis, with other clinical predictors of prognosis. We conducted a retrospective multicentric study. To establish which variables were statistically correlated both with death and survival time, contingency tables were evaluated. The overall survival curves were compared using the Kaplan-Meier method. Metastatic volume and number of affected organs were statistically related to death. In detail, patients with a metastatic volume >15 cm(3) had a worse prognosis than those with a volume lower than this value (survival probability at 60 months: 6.8 vs. 40.9%, respectively). The Kaplan-Meier method confirmed that survival time was significantly related to the site(s) of metastases, to elevated LDH serum levels and to melanoma stage according to the latest system. Our results suggest that metastatic volume may be considered as a useful prognostic factor for survival among melanoma patients.

Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy.

Science.gov (United States)

Suaysod, Rapeepan; Ngo-Giang-Huong, Nicole; Salvadori, Nicolas; Cressey, Tim R; Kanjanavanit, Suparat; Techakunakorn, Pornchai; Krikajornkitti, Sawitree; Srirojana, Sakulrat; Laomanit, Laddawan; Chalermpantmetagul, Suwalai; Lallemant, Marc; Le Cœur, Sophie; McIntosh, Kenneth; Traisathit, Patrinee; Jourdain, Gonzague

2015-07-01

Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure. HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure. A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age >13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001). Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Reemergence of Splenectomy for ITP Second-line Treatment?

Science.gov (United States)

Chater, Charbel; Terriou, Louis; Duhamel, Alain; Launay, David; Chambon, Jean P; Pruvot, François R; Rogosnitzky, Moshe; Zerbib, Philippe

2016-11-01

Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients. Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy. The distinction between open (OS) and laparoscopic splenectomy (LS) was analyzed. Primary outcome was composite: hospitalization for bleeding and/or thrombocytopenia and death from hemorrhage or infection. Secondary outcomes were based on response (R) and complete response (CR) rates as defined by the American Society of Hematology. Ninety-six patients were included: 30 patients received Rituximab, 37 underwent OS, and 29 underwent LS. The follow-up was 30, 60, and 120 months in Rituximab, LS, and OS groups, respectively. At 30 month, the primary outcome-free survival rate was higher in splenectomy groups (84% for OS, 86% for LS) than Rituximab group (47%) (P = 0.0002). Similarly, at 30 month, R and CR rates were higher for OS (86.5% and 75.7%, respectively) and LS groups (93.1% and 89.7%) than Rituximab (46.7% and 30%) (P = 0.0001). Moreover, R rates remained elevated at 60 month for OS and LS groups (83.7% and 89.6% respectively) and 78.4% at 120 month for OS group. We observed that splenectomy for ITP second-line treatment was more effective than Rituximab regarding maintenance of R, CR, and overall response rates. OS and LS had similar efficacy.

Phase II trial of the regulatory T cell-depleting agent, denileukin diftitox, in patients with unresectable stage IV melanoma

International Nuclear Information System (INIS)

Telang, Sucheta; Gragg, Hana; Clem, Brian F; McMasters, Kelly M; Miller, Donald M; Chesney, Jason; Rasku, Mary Ann; Clem, Amy L; Carter, Karen; Klarer, Alden C; Badger, Wesley R; Milam, Rebecca A; Rai, Shesh N; Pan, Jianmin

2011-01-01

We previously found that administration of an interleukin 2/diphtheria toxin conjugate (DAB/IL2; Denileukin Diftitox; ONTAK) to stage IV melanoma patients depleted CD4 + CD25 HI Foxp3 + regulatory T cells and expanded melanoma-specific CD8 + T cells. The goal of this study was to assess the clinical efficacy of DAB/IL2 in an expanded cohort of stage IV melanoma patients. In a single-center, phase II trial, DAB/IL2 (12 μg/kg; 4 daily doses; 21 day cycles) was administered to 60 unresectable stage IV melanoma patients and response rates were assessed using a combination of 2-[ 18 F]-fluoro-2-deoxy-glucose (FDG)-positron emission tomography (PET) and computed tomography (CT) imaging. After DAB/IL2 administration, 16.7% of the 60 patients had partial responses, 5% stable disease and 15% mixed responses. Importantly, 45.5% of the chemo/immuno-naïve sub-population (11/60 patients) experienced partial responses. One year survival was markedly higher in partial responders (80 ± 11.9%) relative to patients with progressive disease (23.7 ± 6.5%; p value < 0.001) and 40 ± 6.2% of the total DAB/IL2-treated population were alive at 1 year. These data support the development of multi-center, randomized trials of DAB/IL2 as a monotherapy and in combination with other immunotherapeutic agents for the treatment of stage IV melanoma. http://www.clinicaltrials.gov/ct2/show/NCT00299689

Perceived adherence barriers among patients failing second-line ...

African Journals Online (AJOL)

Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa. W Barnett, G Patten, B Kerschberger, K Conradie, DB Garone, G van Cutsem, CJ Colvin ...

Second Stage (S-II) Arrives at Marshall Space Flight Center For Testing

Science.gov (United States)

2004-01-01

The business end of a Second Stage (S-II) slowly emerges from the shipping container as workers prepare to transport the Saturn V component to the testing facility at MSFC. The Second Stage (S-II) underwent vibration and engine firing tests. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

Phase II study of ipilimumab in adolescents with unresectable stage III or IV malignant melanoma

DEFF Research Database (Denmark)

Geoerger, Birgit; Bergeron, Christophe; Gore, Lia

2017-01-01

BACKGROUND: Ipilimumab is approved for the treatment of advanced melanoma in adults; however, little information on the efficacy and safety of ipilimumab in younger patients is available. METHODS: Patients aged 12 to <18 years with previously treated or untreated, unresectable stage III or IV mal...

Adverse obstetric outcomes in women with previous cesarean for dystocia in second stage of labor.

Science.gov (United States)

Jastrow, Nicole; Demers, Suzanne; Gauthier, Robert J; Chaillet, Nils; Brassard, Normand; Bujold, Emmanuel

2013-03-01

To evaluate obstetric outcomes in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor. A retrospective cohort study of women with one previous low transverse cesarean undergoing a first TOL was performed. Women with previous cesarean for dystocia in first stage and those with previous dystocia in second stage were compared with those with previous cesarean for nonrecurrent reasons (controls). Multivariable regressions analyses were performed. Of 1655 women, those with previous dystocia in second stage of labor (n = 204) had greater risks than controls (n = 880) to have an operative delivery [odds ratio (OR): 1.5; 95% confidence intervals (CI) 1.1 to 2.2], shoulder dystocia (OR: 2.9; 95% CI 1.1 to 8.0), and uterine rupture in the second stage of labor (OR: 4.9; 95% CI 1.1 to 23), and especially in case of fetal macrosomia (OR: 29.6; 95% CI 4.4 to 202). The median second stage of labor duration before uterine rupture was 2.5 hours (interquartile range: 1.5 to 3.2 hours) in these women. Previous cesarean for dystocia in the second stage of labor is associated with second-stage uterine rupture at next delivery, especially in cases of suspected fetal macrosomia and prolonged second stage of labor. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Second Stage (S-II) Plays Key Role in Apollo missions

Science.gov (United States)

1970-01-01

This photograph of the Saturn V Second Stage (S-II) clearly shows the cluster of five powerful J-2 engines needed to boost the Apollo spacecraft into earth orbit following first stage separation. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

Anti-SEMA4D Monoclonal Antibody VX15/2503 With Nivolumab or Ipilimumab in Treating Patients With Stage III or IV Melanoma

Science.gov (United States)

2018-04-26

Metastatic Melanoma; Stage III Cutaneous Melanoma AJCC v7; Stage IIIA Cutaneous Melanoma AJCC v7; Stage IIIB Cutaneous Melanoma AJCC v7; Stage IIIC Cutaneous Melanoma AJCC v7; Stage IV Cutaneous Melanoma AJCC v6 and v7

Delays in switching patients onto second-line antiretroviral treatment ...

African Journals Online (AJOL)

Background: South Africa has one of the largest antiretroviral treatment (ART) programmes globally. In addition to increasing access to ART, it is important that the health system also focuses on the appropriate management of patients who fail first-line ART. Delays in switching patients onto second-line ART can adversely ...

BigBOSS: The Ground-Based Stage IV BAO Experiment

Energy Technology Data Exchange (ETDEWEB)

Schlegel, David; Bebek, Chris; Heetderks, Henry; Ho, Shirley; Lampton, Michael; Levi, Michael; Mostek, Nick; Padmanabhan, Nikhil; Perlmutter, Saul; Roe, Natalie; Sholl, Michael; Smoot, George; White, Martin; Dey, Arjun; Abraham, Tony; Jannuzi, Buell; Joyce, Dick; Liang, Ming; Merrill, Mike; Olsen, Knut; Salim, Samir

2009-04-01

The BigBOSS experiment is a proposed DOE-NSF Stage IV ground-based dark energy experiment to study baryon acoustic oscillations (BAO) and the growth of structure with an all-sky galaxy redshift survey. The project is designed to unlock the mystery of dark energy using existing ground-based facilities operated by NOAO. A new 4000-fiber R=5000 spectrograph covering a 3-degree diameter field will measure BAO and redshift space distortions in the distribution of galaxies and hydrogen gas spanning redshifts from 0.2< z< 3.5. The Dark Energy Task Force figure of merit (DETF FoM) for this experiment is expected to be equal to that of a JDEM mission for BAO with the lower risk and cost typical of a ground-based experiment.

Determinants of durability of first-line antiretroviral therapy regimen and time from first-line failure to second-line antiretroviral therapy initiation

DEFF Research Database (Denmark)

Desmonde, Sophie; Eboua, François T; Malateste, Karen

2015-01-01

BACKGROUND: We described reasons for switching to second-line antiretroviral treatment (ART) and time to switch in HIV-infected children failing first-line ART in West Africa. METHODS: We included all children aged 15 years or less, starting ART (at least three drugs) in the paediatric Ie...... post-ART initiation, 188 (7%) had switched to second-line. The most frequent reasons were drug stock outs (20%), toxicity (18%), treatment failure (16%) and poor adherence (8%). Over the 24-month follow-up period, 322 (12%) children failed first-line ART after a median time of 7 months...... rare and switches after an immunological failure were insufficient. These gaps reveal that it is crucial to advocate for both sustainable access to first-line and alternative regimens to provide adequate roll-out of paediatric ART programmes....

Second-stage transsphenoidal approach (TSA) for highly vascular pituicytomas in children.

Science.gov (United States)

Kim, Young Gyu; Park, Young Seok

2015-06-01

A pituicytoma in the sellar area is extremely rare in children and, due to its highly vascularized nature, can be difficult to address using the transsphenoid approach (TSA) to surgery. Here, we report a rare case of a pituicytoma that was completely removed from a child through a staged operation using the TSA. A 13-year-old girl was admitted with a 1-year history of visual disturbance and amenorrhea. Visual field examination showed left total blindness and right temporal hemianopsia. Laboratory results revealed hormonal levels all within normal ranges. Brain magnetic resonance imaging (MRI) showed a homogeneous, highly enhancing sellar and suprasellar mass, typically suggestive of a pituitary adenoma. TSA surgery revealed the tumor had a rubbery-firm consistency, hypervascularity, and profuse bleeding. We removed the tumor partially and planned a second-stage operation. Gross total removal is the treatment of choice for this type of tumor. Attempted resection of these presumed adenomas or meningiomas using the TSA often results in unexpectedly heavy intraoperative bleeding due to the high vascularity of this rare tumor, making surgery challenging, especially in children where the tumor is within a relatively narrow corridor. While pituicytomas are a rare differential diagnosis for sellar or parasellar tumors in children, total removal by second-stage TSA surgery is indicated in the case of profuse bleeding or uncertainty of biopsy. Following first-stage TSA surgery and pathologic confirmation of pituicytoma, the strategy is typically gross total removal during second-stage TSA surgery. Although very rare in children, a pituicytoma should be included in the differential diagnosis of a mass in the sellar area if the tumor is highly enhancing or very vascular. Second-stage TSA surgery is another strategy when the pathology is not clear during the first-stage TSA surgery.

Blood flow and glucose metabolism in stage IV breast cancer: Heterogeneity of response during chemotherapy

NARCIS (Netherlands)

N.C. Krak (Nanda); J. van der Hoeven (John); O.S. Hoekstra (Otto); J.W.R. Twisk (Jos); E.E. van der Wall (Ernst); A.A. Lammertsma (Adriaan)

2008-01-01

textabstractObjective: The purpose of the study was to compare early changes in blood flow (BF) and glucose metabolism (MRglu) in metastatic breast cancer lesions of patients treated with chemotherapy. Methods: Eleven women with stage IV cancer and lesions in breast, lymph nodes, liver, and bone

Title IV Quality Control Project, Stage II. Management Option II: Delivery System Quality Improvements.

Science.gov (United States)

Advanced Technology, Inc., Reston, VA.

Stage Two of the Title IV Quality Control Project is an integrated study of quality in five related Federal financial aid programs for postsecondary students. Section 1 of the paper establishes a framework for defining quality improvements, in order to identify the types of changes that would tend to improve quality across all facets of the…

Randomized, phase III study of gemcitabine or erlotinib maintenance therapy versus observation, with predefined second-line treatment, after cisplatin-gemcitabine induction chemotherapy in advanced non-small-cell lung cancer.

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Pérol, Maurice; Chouaid, Christos; Pérol, David; Barlési, Fabrice; Gervais, Radj; Westeel, Virginie; Crequit, Jacky; Léna, Hervé; Vergnenègre, Alain; Zalcman, Gérard; Monnet, Isabelle; Le Caer, Hervé; Fournel, Pierre; Falchero, Lionel; Poudenx, Michel; Vaylet, Fabien; Ségura-Ferlay, Céline; Devouassoux-Shisheboran, Mojgan; Taron, Miquel; Milleron, Bernard

2012-10-01

This phase III study investigated whether continuation maintenance with gemcitabine or switch maintenance with erlotinib improves clinical outcome compared with observation in patients with advanced non-small-cell lung cancer (NSCLC) whose disease was controlled after cisplatin-gemcitabine induction chemotherapy. Four hundred sixty-four patients with stage IIIB/IV NSCLC without tumor progression after four cycles of cisplatin-gemcitabine were randomly assigned to observation or to gemcitabine (1,250 mg/m(2) days 1 and 8 of a 3-week cycle) or daily erlotinib (150 mg/day) study arms. On disease progression, patients in all three arms received pemetrexed (500 mg/m(2) once every 21 days) as predefined second-line therapy. The primary end point was progression-free survival (PFS). PFS was significantly prolonged by gemcitabine (median, 3.8 v 1.9 months; hazard ratio [HR], 0.56; 95% CI, 0.44 to 0.72; log-rank P benefit was consistent across all clinical subgroups. Both maintenance strategies resulted in a nonsignificant improvement in overall survival (OS); patients who received second-line pemetrexed or with a performance status of 0 appeared to derive greater benefit. Exploratory analysis showed that magnitude of response to induction chemotherapy may affect the OS benefit as a result of gemcitabine maintenance. Maintenance gemcitabine and erlotinib were well tolerated with no unexpected adverse events. Gemcitabine continuation maintenance or erlotinib switch maintenance significantly reduces disease progression in patients with advanced NSCLC treated with cisplatin-gemcitabine as first-line chemotherapy. Response to induction chemotherapy may affect OS only for continuation maintenance.

Effects of cardiac resynchronization therapy in patients with inotrope-dependent class IV end-stage heart failure

Directory of Open Access Journals (Sweden)

Ikutaro Nakajima

2013-12-01

Conclusion: CRT did not result in significant reverse remodeling in patients with inotrope-dependent class IV end-stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short-term period in some patients.

Advanced-stage III/IV follicular lymphoma. Treatment strategies for individual patients

Energy Technology Data Exchange (ETDEWEB)

Heinzelmann, Frank; Bamberg, Michael; Weinmann, Martin [Dept. of Radiation Oncology, Univ. of Tuebingen (Germany); Ottinger, Hellmut [Dept. of Bone Marrow Transplantation, Univ. of Essen (Germany); Engelhard, Marianne [Dept. of Radiation Oncology, Univ. of Essen (Germany); Soekler, Martin [Dept. of Internal Medicine II, Univ. of Tuebingen (Germany)

2010-05-15

Background: in patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient. Methods: the literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank. Results: in advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response. Conclusion: in case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab {+-} single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes. (orig.)

Fundal pressure during the second stage of labour.

Science.gov (United States)

Hofmeyr, G Justus; Vogel, Joshua P; Cuthbert, Anna; Singata, Mandisa

2017-03-07

Fundal pressure during the second stage of labour (also known as the 'Kristeller manoeuvre') involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal, in an attempt to assist spontaneous vaginal birth and avoid prolonged second stage or the need for operative birth. Fundal pressure has also been applied using an inflatable belt. Fundal pressure is widely used, however methods of its use vary widely. Despite strongly held opinions in favour of and against the use of fundal pressure, there is limited evidence regarding its maternal and neonatal benefits and harms. There is a need for objective evaluation of the effectiveness and safety of fundal pressure in the second stage of labour. To determine if fundal pressure is effective in achieving spontaneous vaginal birth, and preventing prolonged second stage or the need for operative birth, and to explore maternal and neonatal adverse effects related to fundal pressure. We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies. Randomised and quasi-randomised controlled trials of fundal pressure (manual or by inflatable belt) versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation. Two or more review authors independently assessed potential studies for inclusion and quality. We extracted data using a pre-designed form. We entered data into Review Manager 5 software and checked for accuracy. Nine trials are included in this updated review. Five trials (3057 women) compared manual fundal pressure versus no fundal pressure. Four trials (891 women) compared fundal pressure by means of an inflatable belt versus no fundal pressure. It was not possible to blind women and staff to this intervention. We assessed two trials as being at high risk of attrition bias and another at high risk of reporting bias. All other trials were low or unclear for other risk of bias

Hypofractionated Image Guided Radiation Therapy in Treating Patients With Stage IV Breast Cancer

Science.gov (United States)

2017-06-26

Central Nervous System Metastases; Invasive Ductal Breast Carcinoma; Invasive Ductal Breast Carcinoma With Predominant Intraductal Component; Invasive Lobular Breast Carcinoma; Invasive Lobular Breast Carcinoma With Predominant in Situ Component; Liver Metastases; Lobular Breast Carcinoma in Situ; Lung Metastases; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Recurrent Breast Cancer; Stage IV Breast Cancer; Tubular Ductal Breast Carcinoma; Tumors Metastatic to Brain

Second Stage Turbine Bucket Airfoil.

Science.gov (United States)

Xu, Liming; Ahmadi, Majid; Humanchuk, David John; Moretto, Nicholas; Delehanty, Richard Edward

2003-05-06

The second-stage buckets have airfoil profiles substantially in accordance with Cartesian coordinate values of X, Y and Z set forth in inches in Table I wherein Z is a perpendicular distance from a plane normal to a radius of the turbine centerline and containing the X and Y values with the Z value commencing at zero in the X, Y plane at the radially innermost aerodynamic section of the airfoil and X and Y are coordinate values defining the airfoil profile at each distance Z. The X, Y and Z values may be scaled as a function of the same constant or number to provide a scaled-up or scaled-down airfoil section for the bucket.

Cabazitaxel as second-line or third-line therapy in patients with metastatic castration-resistant prostate cancer

DEFF Research Database (Denmark)

Kongsted, Per; Svane, Inge M; Lindberg, Henriette

2016-01-01

To compare treatment outcomes in patients with metastatic castration-resistant prostate cancer treated with cabazitaxel (CA) as second-line or third-line therapy in the everyday clinical setting. Charts from 94 patients treated with CA as second-line (n=28) or third-line therapy (n=66) were...... evaluated. Common Terminology Criteria for Adverse Events were used to register grade 3-4 nonhematological toxicity during treatment with CA. Baseline metastatic castration-resistant prostate cancer-related prognostic factors, duration of therapy, and maximum prostate-specific antigen (PSA) percentage...... change were registered during treatment with CA and previous/subsequent novel androgen receptor targeting therapies. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. A median of 6 versus 5 treatment cycles was administered in patients treated...

First-Line Nivolumab in Stage IV or Recurrent Non-Small-Cell Lung Cancer.

NARCIS (Netherlands)

Carbone, D.P.; Reck, M.; Paz-Ares, L.; Creelan, B.; Horn, L.; Steins, M.; Felip, E.; Heuvel, M. van den; Ciuleanu, T.E.; Badin, F.; Ready, N.; Hiltermann, T.J.N.; Nair, S.; Juergens, R.; Peters, S.; Minenza, E.; Wrangle, J.M.; Rodriguez-Abreu, D.; Borghaei, H.; umenschein GR, J.r. Bl; Villaruz, L.C.; Havel, L.; Krejci, J.; rral Jaime, J. Co; Chang, H.; Geese, W.J.; Bhagavatheeswaran, P.; Chen, A.C.; Socinski, M.A.

2017-01-01

BACKGROUND: Nivolumab has been associated with longer overall survival than docetaxel among patients with previously treated non-small-cell lung cancer (NSCLC). In an open-label phase 3 trial, we compared first-line nivolumab with chemotherapy in patients with programmed death ligand 1

First-Line Nivolumab in Stage IV or Recurrent Non-Small-Cell Lung Cancer

NARCIS (Netherlands)

Carbone, D. P.; Reck, M.; Paz-Ares, L.; Creelan, B.; Horn, L.; Steins, M.; Felip, E.; van den Heuvel, M. M.; Ciuleanu, T. -E.; Badin, F.; Ready, N.; Hiltermann, T. J. N.; Nair, S; Juergens, R.; Peters, S.; Minenza, E.; Wrangle, J. M.; Rodriguez-Abreu, D.; Borghaei, H.; Blumenschein, G. R.; Villaruz, L. C.; Havel, L.; Krejci, J.; Corral Jaime, J.; Chang, C. -H.; Geese, W. J.; Bhagavatheeswaran, P.; Chen, Alexander C.; Socinski, M. A.

2017-01-01

BACKGROUND Nivolumab has been associated with longer overall survival than docetaxel among patients with previously treated non-small-cell lung cancer (NSCLC). In an open-label phase 3 trial, we compared first-line nivolumab with chemotherapy in patients with programmed death ligand 1

Two-stage hepatectomy: who will not jump over the second hurdle?

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Turrini, O; Ewald, J; Viret, F; Sarran, A; Goncalves, A; Delpero, J-R

2012-03-01

Two-stage hepatectomy uses compensatory liver regeneration after a first noncurative hepatectomy to enable a second curative resection in patients with bilobar colorectal liver metastasis (CLM). To determine the predictive factors of failure of two-stage hepatectomy. Between 2000 and 2010, 48 patients with irresectable CLM were eligible for two-stage hepatectomy. The planned strategy was a) cleaning of the left hepatic lobe (first hepatectomy), b) right portal vein embolisation and c) right hepatectomy (second hepatectomy). Six patients had occult CLM (n = 5) or extra-hepatic disease (n = 1), which was discovered during the first hepatectomy. Thus, 42 patients completed the first hepatectomy and underwent portal vein embolisation in order to receive the second hepatectomy. Eight patients did not undergo a second hepatectomy due to disease progression. Upon univariate analysis, two factors were identified that precluded patients from having the second hepatectomy: the combined resection of a primary tumour during the first hepatectomy (p = 0.01) and administration of chemotherapy between the two hepatectomies (p = 0.03). An independent association with impairment to perform the two-stage strategy was demonstrated by multivariate analysis for only the combined resection of the primary colorectal cancer during the first hepatectomy (p = 0.04). Due to the small number of patients and the absence of equivalent conclusions in other studies, we cannot recommend performance of an isolated colorectal resection prior to chemotherapy. However, resection of an asymptomatic primary tumour before chemotherapy should not be considered as an outdated procedure. Copyright © 2011 Elsevier Ltd. All rights reserved.

Paclitaxel/carboplatin with or without sorafenib in the first-line treatment of patients with stage III/IV epithelial ovarian cancer: a randomized phase II study of the Sarah Cannon Research Institute

International Nuclear Information System (INIS)

Hainsworth, John D; Thompson, Dana S; Bismayer, John A; Gian, Victor G; Merritt, William M; Whorf, Robert C; Finney, Lindsey H; Dudley, B Stephens

2015-01-01

This trial compared the efficacy and toxicity of standard first-line treatment with paclitaxel/carboplatin versus paclitaxel/carboplatin plus sorafenib in patients with advanced ovarian carcinoma. Patients with stage 3 or 4 epithelial ovarian cancer with residual measurable disease or elevated CA-125 levels after maximal surgical cytoreduction were randomized (1:1) to receive treatment with paclitaxel (175 mg/m 2 , 3 h infusion, day 1) and carboplatin (AUC 6.0, IV, day 1) with or without sorafenib 400 mg orally twice daily (PO BID). Patients were reevaluated for response after completing 6 weeks of treatment (two cycles); responding or stable patients received six cycles of paclitaxel/carboplatin. Patients receiving the sorafenib-containing regimen continued sorafenib (400 PO BID) for a total of 52 weeks. Eighty-five patients were randomized and received treatment.Efficacy was similar for patients receiving paclitaxel/carboplatin/sorafenib versus paclitaxel/carboplatin: overall response rates 69% versus 74%; median progression-free survival 15.4 versus 16.3 months; 2 year survival 76% versus 81%. The addition of sorafenib added substantially to the toxicity of the regimen; rash, hand–foot syndrome, mucositis, and hypertension were significantly more common in patients treated with sorafenib. The addition of sorafenib to standard paclitaxel/carboplatin did not improve efficacy and substantially increased toxicity in the first-line treatment of advanced epithelial ovarian cancer. Based on evidence from this study and other completed trials, sorafenib is unlikely to have a role in the treatment of ovarian cancer

Enriched enteral nutrition may improve short-term survival in stage IV gastric cancer patients: A randomized, controlled trial.

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Klek, Stanislaw; Scislo, Lucyna; Walewska, Elzbieta; Choruz, Ryszard; Galas, Aleksander

2017-04-01

The aim of the study was to determine whether the postoperative use of enteral nutrition enriched with arginine, glutamine, and omega-3 fatty acids influences survival in patients diagnosed with stomach cancer. For the purpose of the study, the second wave of the trial performed in 2003 to 2009 was done. Ninety-nine patients who underwent surgery for gastric cancer (27 F, 72 M, mean age: 62.9 y) met the inclusion criteria. Of those, 54 were randomized to standard and 45 to enriched enteral nutrition (EEN). In all patients, short- and long-term (5 y) survival was analyzed. Analysis of the overall survival time did not reveal differences between groups (P = 0.663). Until the end of the third month, however, there were nine deaths in the standard enteral nutrition group and no deaths in the EEN group (16.7% versus 0.0%, P = 0.004). The univariate analyses suggested that the EEN group may have lower risk, especially during the first year after intervention. A significant reduction in the risk of death was seen during the early period after surgery (first 6 mo) in the EEN group in stage IV patients (hazard ratio = 0.25, P = 0.049). The use of enriched enteral diet did not influence, however, the risk of dying when patients were analyzed together. The study does not support the beneficial effect of enriched enteral nutrition in long-term survival; however, the positive impact on the stage IV patients suggests the need for further, more detailed studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Concentration and the second stage of labor: outcomes associated with the interactive metronome.

Science.gov (United States)

McGowan, Meghan L; Lin, Alexander; Ou-Yang, Robin; Zei, Markus; Grobman, William

2012-11-01

To analyze the association between concentration, as measured by the Interactive Metronome, and a prolonged second stage of labor in nulliparous patients. From September 2008 to November 2009, nulliparous women at ≥34 weeks' gestation who were planning to use an epidural were asked to perform a 1-minute Interactive Metronome clapping test. Scores and demographic information were recorded. Data were then abstracted regarding each patient's labor course. The main outcome measure was the frequency of the second stage of labor exceeding 2 hours. Only patients with epidural anesthesia who completed the second stage of labor and did not require operative delivery performed for fetal indications prior to 2 full hours of pushing were included. Of the patients whose Interactive Metronome test scores were in the last quartile, which we associated with poor concentration, 52.9% (18/34) had a second stage of labor exceeding 2 hours compared with only 31.7% (33/104) of patients whose scores placed them in the first three quartiles (p = 0.026). Nulliparous patients with poor concentration scores, as measured by the Interactive Metronome, were more likely to push greater than 2 hours in the second stage of labor. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical and nonmedical factors influencing utilization of delayed pushing in the second stage.

Science.gov (United States)

Frey, Heather A; Tuuli, Methodius G; Cortez, Sarah; Odibo, Anthony O; Roehl, Kimberly A; Shanks, Anthony L; Macones, George A; Cahill, Alison G

2013-08-01

To evaluate factors impacting selection to delayed pushing in the second stage of labor. This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modeling was used to identify factors independently associated with delayed pushing. We identified 471 women who delayed pushing and 4819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second-stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing. We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second-stage labor management. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perceived adherence barriers among patients failing second-line ...

African Journals Online (AJOL)

1 School of Public Health and Family Medicine, University of Cape Town, South Africa ... To examine factors affecting adherence to second-line ART from the perspective of clinic staff and .... because she did not realise her VL would go up.

Qualitative study of patients’ decision-making when accepting second-line treatment after failure of first-line chemotherapy

Science.gov (United States)

Roch, Benoît; Roth, Caroline; Mérel, Jean-Pierre

2018-01-01

Objective Treatment failures in advanced lung cancer are frequent events affecting patients during or after first-line chemotherapy. International guidelines recommend second-line chemotherapy. However, around one half of patients who experience disease progression enter a systemic second-line therapy. In the herein qualitative study, we investigated patients' thoughts and attitudes determining the decision to undergo a second-line chemotherapy. Methods Thirty-three purposively selected patients who recently accepted second-line or palliative chemotherapy were invited to participate in this survey consisting of semi-structured in-depth interviews. Grounded theory was applied to investigate participants’ perceptions of the context that have surrounded their decision to undergo palliative chemotherapy. Results For most patients, tumor burden and reduced quality of life in relation with lung cancer itself were major drivers of the decision-making process. There was a balance between two different attitudes: making a decision to undergo a new line of chemotherapy or starting a psychological process in order to accept end of life. Choosing between these two attitudes allowed the patient to keep the matter of palliative care at a distance. Even in case of low chance of success, many patients who worried about their life partner's future would accept a new chemotherapy line. Some patients experienced ambivalent thoughts regarding social network, particularly about their family as daily function impairment required an increased need for relative's support. The initial "Worrying about others" thoughts left place to in an increasing self-need of care as those provided by relatives; this phenomenon might increase patients' self- perception of being a burden for others. Confidence previously established with formal caregiver support was another major decision driver: some patients with sustained confidence in their medical staff may have privileged this formal support rather

Visual Biofeedback using trans-perineal ultrasound during the second stage of labor.

Science.gov (United States)

Gilboa, Yinon; Frenkel, Tahl I; Schlesinger, Yael; Rousseau, Sofie; Hamiel, Daniel; Achiron, Reuven; Perlman, Sharon

2017-11-20

to assess the obstetrical and psychological effect of visual biofeedback using trans-perineal ultrasound (TPU) during the second stage of labor. Visual biofeedback using TPU was performed prospectively during the second stage of labor in twenty-six low risk nulliparous women. Pushing efficacy was assessed by the angle of progression at rest and during pushing efforts before and after observing the ultrasound screen. Obstetrical outcomes included level of perineal tearing, mode of delivery and length of the second stage. Psychological outcomes were assessed via self-report measures during the postnatal hospital stay. These included measures of perceived control and maternal satisfaction with childbirth as well as level of maternal feelings of connectedness toward her newborn. Obstetrical and psychological results were compared to a control group (n=69) who received standard obstetrical coaching by midwifes. Pushing efficacy significantly increased following visual biofeedback by TPU (p = 0.01). A significant association was found between the visual biofeedback and an intact perineum following delivery (p = 0.03). No significant differences were found in regard to mode of delivery or the length of the second stage. Feelings of maternal connectedness towards the newborn were significantly higher in the visual biofeedback group relative to non-biofeedback controls (p = 0.003). The results of this pilot study implicate that TPU may serve as a complementary tool to coached maternal pushing during the second stage of labor with obstetrical as well as psychological benefits. Further studies are required to confirm our findings and define the exact timing for optimal results. This article is protected by copyright. All rights reserved.

Cesarean delivery in the second stage of labor and the risk of subsequent premature birth.

Science.gov (United States)

Wood, Stephen L; Tang, Selphee; Crawford, Susan

2017-07-01

Cesarean delivery is being increasingly used by obstetricians for indicated deliveries in the second stage of labor. Unplanned extension of the uterine incision involving the cervix often occurs with these surgeries. Therefore, we hypothesized that cesarean delivery in the second stage of labor may increase the rate of subsequent spontaneous premature birth. We sought to determine if cesarean delivery in the late first stage of labor or in the second stage of labor increases the risk of a subsequent spontaneous preterm birth. We conducted a retrospective cohort study of matched first and second births from a large Canadian perinatal database. The primary outcomes were spontaneous premature birth cesarean delivery. The protocol and analysis plan was registered prior to obtaining data at Open Science Foundation. In total, 189,021 paired first and second births were identified. The risk of spontaneous preterm delivery cesarean delivery in the second stage of labor (relative risk, 1.57; 95% confidence interval, 1.43-1.73 and relative risk, 2.12; 95% confidence interval, 1.67-2.68, respectively). The risk of perinatal death in the second birth, excluding congenital anomalies, was also correspondingly increased (relative risk, 1.44; 95% confidence interval, 1.05-1.96). Cesarean delivery in second stage of labor was associated with a 2-fold increase in the risk of spontaneous preterm birth <32 weeks of gestation in a subsequent birth. This information may inform management of operative delivery in the second stage. Copyright © 2017 Elsevier Inc. All rights reserved.

LONG-TERM RESULTS OF TARGET THERAPY WITH FIRST AND * SECOND-LINE TYROSINE KINASE INHIBITORS IN PATIENTS WITH CHRONIC MYELOID LEUKEMIA

Directory of Open Access Journals (Sweden)

L. L. Vysotskaya

2015-01-01

Full Text Available Aim: To assess long-term efficacy of firstand second-line tyrosine kinase inhibitors in non-selected patients with chronic myeloid leukemia in a real-life clinical setting.Materials and methods: The assessment is based on long-term results of a prospective single center comparative clinical trial that was based on non-selected groups of 116 patients with various stages of chronic myeloid leukemia being treated with a first generation tyrosine kinase inhibitor imatinib, and of 44 patients being treated with a second generation tyrosine kinase inhibitor nilotinib. We analyzed all-cause mortality, progression-free survival from April 2005 to April 2013, with a median of the follow-up of 128 months.Results: In 116 patients with chronic myeloid leukemia treated with imatinib, the Kaplan-Meier survival estimate was 120 months. In 44 patients at an early chronic phase, 5-year overall survival and progression-free survival was 93.2% and 8-year overall and progression-free survival was 79.5%. In 44 patients at a late chronic stage, 5-year overall and progression-free survival was 95.5%, 8-year overall and progression-free survival, 72.7%. In 28 patients at acceleration phase, 5-years overall survival was 78.6% and 8-year overall survival, 46%. Median of overall survival in patients treated with nilotinib was not reached. During 78.6 months of combination treatment with cytotoxic agents, tyrosine kinase inhibitors of the first (imatinib and second line (nilotinib, overall survival was 100%.Conclusion: In clinical practice, inclusion of patients with chronic myeloid leukemia and imatinib resistance (disease relapse or imatinib intolerance into the treatment program with frontline therapy with general cytotoxic agents and thereafter with firstand second-line tyrosine kinase inhibitors significantly improves overall survival.

A Case Series of Survival Outcomes in Patients with Advanced-stage IIIb/IV Non-small-cell Lung Cancer Treated with HangAm-Plus

Directory of Open Access Journals (Sweden)

Bang Sun-Hwi

2012-06-01

Full Text Available Background and Objectives: Non-small-cell lung cancer (NSCLC represents approximately 80% of all lung cancers. Unfortunately, at their time of diagnosis, most patients have advanced to unresectable disease with a very poor prognosis. The oriental herbal medicine HangAm-Plus (HAP has been developed for antitumor purposes, and several previous studies have reported its therapeutic effects. In this study, the efficacy of HAP was evaluated as a third-line treatment for advanced-stage IIIb/IV NSCLC. Methods: The study involved six patients treated at the East- West Cancer Center (EWCC from April 2010 to October 2011. Inoperable advanced-stage IIIb/IV NSCLC patients received 3,000 or 6,000 mg of HAP on a daily basis over a 12-week period. Computed tomography (CT scans were obtained from the patients at the time of the initial administration and after 12 weeks of treatment. We observed and analyzed the patients overall survival (OS and progression-free survival (PFS. Results: Of the six patients, three expired during the study, and the three remaining patients were alive as of October 31, 2011. The OS ranged from 234 to 512 days, with a median survival of 397 days and a one-year survival rate of 66.7%. In the 12-week-interval chest CT assessment, three patients showed stable disease (SD, and the other three showed progressive disease (PD. The PFS of patients ranged from 88 to 512 days, the median PFS being 96 days. Longer OS and PFS were correlated with SD. Although not directly comparable, the OS and the PFS of this study were greater than those of the docetaxel or the best supportive care group in other studies. Conclusion: HAP may prolong the OS and the PFS of inoperable stage IIIb/IV NSCLC patients without significant adverse effects. In the future, more controlled clinical trials with larger samples from multi-centers should be conducted to evaluate the efficacy and the safety of HAP.

Improved survival with combined modality treatment for Stage IV breast cancer

International Nuclear Information System (INIS)

Nervi, C.; Arcangeli, G.; Concolino, F.; Cortese, M.

1979-01-01

Between 1974 and 1977, 85 patients with breast cancer at first postmastectomy relapse were irradiated (Radiation 3500 to 6000 rad--3/5 weeks) to all clinically evident lesions. Radiation fields were properly shaped to include a maximum 40% active bone marrow. After 3 to 4 weeks rest, chemotherapy was started as adjuvant therapy for residual or subclinical disease (ADR 30 mg/M 2 Day 1 and 8, 5-FU 400 mg/M 2 Day 1 and 8, CY 100 mg/M 2 Day 1 through 14: repeated after 14 days). ADR was discontinued at 500/M 2 and substituted by MTX 30 mg/M 2 Day 1 and 8 for a total of 2 years. Irradiated sites were chest wall in 35, supraclavicular and internal mammary nodes in 22, bone in 56, single lung lesions in 12, brain in 24. Controls were 52 comparable but non-randomized patients treated with chemotherapy only. Forty days after x-irradiation 68 patients (80%) were free of disease (NED) while in 17 cases (20%) some residual was still present (RED). In 28 of 68 cases (41%) NED after x-irradiation and 13 of 17 (76%) in RED group developed second relapse after a median interval of 26 and 20 mos., respectively. Four of 52 patients (8%) in the control group had complete regression with a median interval to second relapse of 7 mos. Median survival was 30 mos., 24 mos., and 13 mos., respectively, for NED, RED and chemotherapy only. Eighteen patients (26%) are free of disease after 36 to 48 mos. in the combined modality group; none in the chemotherapy group. Combined treatment cases did not show untolerable myelodepression. In 10 long-surviving patients a marked subcutaneous and skin fibrosis developed because of drug additive effect. Stage IV breast cancers rendered clinically free of disease with x-irradiation and subsequently treated with chemotherapy survive significantly longer than with chemotherapy alone

Effect of therapy switch on time to second-line antiretroviral treatment failure in HIV-infected patients.

Science.gov (United States)

Häggblom, Amanda; Santacatterina, Michele; Neogi, Ujjwal; Gisslen, Magnus; Hejdeman, Bo; Flamholc, Leo; Sönnerborg, Anders

2017-01-01

Switch from first line antiretroviral therapy (ART) to second-line ART is common in clinical practice. However, there is limited knowledge of to which extent different reason for therapy switch are associated with differences in long-term consequences and sustainability of the second line ART. Data from 869 patients with 14601 clinical visits between 1999-2014 were derived from the national cohort database. Reason for therapy switch and viral load (VL) levels at first-line ART failure were compared with regard to outcome of second line ART. Using the Laplace regression model we analyzed the median, 10th, 20th, 30th and 40th percentile of time to viral failure (VF). Most patients (n = 495; 57.0%) switched from first-line to second-line ART without VF. Patients switching due to detectable VL with (n = 124; 14.2%) or without drug resistance mutations (DRM) (n = 250; 28.8%) experienced VF to their second line regimen sooner (median time, years: 3.43 (95% CI 2.90-3.96) and 3.20 (95% 2.65-3.75), respectively) compared with those who switched without VF (4.53 years). Furthermore level of VL at first-line ART failure had a significant impact on failure of second-line ART starting after 2.5 years of second-line ART. In the context of life-long therapy, a median time on second line ART of 4.53 years for these patients is short. To prolong time on second-line ART, further studies are needed on the reasons for therapy changes. Additionally patients with a high VL at first-line VF should be more frequently monitored the period after the therapy switch.

Effect of therapy switch on time to second-line antiretroviral treatment failure in HIV-infected patients.

Directory of Open Access Journals (Sweden)

Amanda Häggblom

Full Text Available Switch from first line antiretroviral therapy (ART to second-line ART is common in clinical practice. However, there is limited knowledge of to which extent different reason for therapy switch are associated with differences in long-term consequences and sustainability of the second line ART.Data from 869 patients with 14601 clinical visits between 1999-2014 were derived from the national cohort database. Reason for therapy switch and viral load (VL levels at first-line ART failure were compared with regard to outcome of second line ART. Using the Laplace regression model we analyzed the median, 10th, 20th, 30th and 40th percentile of time to viral failure (VF.Most patients (n = 495; 57.0% switched from first-line to second-line ART without VF. Patients switching due to detectable VL with (n = 124; 14.2% or without drug resistance mutations (DRM (n = 250; 28.8% experienced VF to their second line regimen sooner (median time, years: 3.43 (95% CI 2.90-3.96 and 3.20 (95% 2.65-3.75, respectively compared with those who switched without VF (4.53 years. Furthermore level of VL at first-line ART failure had a significant impact on failure of second-line ART starting after 2.5 years of second-line ART.In the context of life-long therapy, a median time on second line ART of 4.53 years for these patients is short. To prolong time on second-line ART, further studies are needed on the reasons for therapy changes. Additionally patients with a high VL at first-line VF should be more frequently monitored the period after the therapy switch.

Survival Impact of Adjuvant Radiation Therapy in Masaoka Stage II to IV Thymomas: A Systematic Review and Meta-analysis

International Nuclear Information System (INIS)

Lim, Yu Jin; Kim, Eunji; Kim, Hak Jae; Wu, Hong-Gyun; Yan, Jinchun; Liu, Qin; Patel, Shilpen

2016-01-01

Purpose: To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis. Methods and Materials: A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis. Results: Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses. Conclusions: From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications.

Survival Impact of Adjuvant Radiation Therapy in Masaoka Stage II to IV Thymomas: A Systematic Review and Meta-analysis

Energy Technology Data Exchange (ETDEWEB)

Lim, Yu Jin; Kim, Eunji [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Hak Jae, E-mail: khjae@snu.ac.kr [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Wu, Hong-Gyun [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cancer Research Institute, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul (Korea, Republic of); Yan, Jinchun [Department of Radiation Oncology, Dalian Medical University, Liaoning (China); Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Liu, Qin [The Wistar Institute, Philadelphia, Pennsylvania (United States); Patel, Shilpen [Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington (United States)

2016-04-01

Purpose: To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis. Methods and Materials: A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis. Results: Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses. Conclusions: From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications.

The use of first stage bone augmentation screws to stabilize the surgical template in the second stage.

NARCIS (Netherlands)

Verhamme, L.M.; Meijer, G.J.; Berge, S.J.; Maal, T.J.J.

2015-01-01

A new method is presented in which the osteosynthesis screws from a first stage bone augmentation of the maxilla are used to stabilize the surgical template during implant placement in the second stage. This method was evaluated in one patient and the results compared to those of previous studies.

The use of first stage bone augmentation screws to stabilize the surgical template in the second stage

NARCIS (Netherlands)

Verhamme, L. M.; Meijer, G. J.; Bergé, S. J.; Maal, T. J J

2015-01-01

A new method is presented in which the osteosynthesis screws from a first stage bone augmentation of the maxilla are used to stabilize the surgical template during implant placement in the second stage. This method was evaluated in one patient and the results compared to those of previous studies.

Stage line diagram: An age-conditional reference diagram for tracking development

NARCIS (Netherlands)

Buuren, S. van; Ooms, J.C.L.

2009-01-01

This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and

Stage line diagram: an age-conditional reference diagram for tracking development.

NARCIS (Netherlands)

Van Buuren, S.; Ooms, J.C.L.

2009-01-01

This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and

Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer

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Grutsch James F

2009-01-01

Full Text Available Abstract Background A frequent manifestation of advanced lung cancer is malnutrition, timely identification and treatment of which can lead to improved patient outcomes. Bioelectrical impedance analysis (BIA is an easy-to-use and non-invasive technique to evaluate changes in body composition and nutritional status. We investigated the prognostic role of BIA-derived phase angle in advanced non-small cell lung cancer (NSCLC. Methods A case series of 165 stages IIIB and IV NSCLC patients treated at our center. The Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle, independent of stage at diagnosis and prior treatment history. Results 93 were males and 72 females. 61 had stage IIIB disease at diagnosis while 104 had stage IV. The median phase angle was 5.3 degrees (range = 2.9 – 8. Patients with phase angle 5.3 had 12.4 months (95% CI: 10.5 to 18.7; n = 84; (p = 0.02. After adjusting for age, stage at diagnosis and prior treatment history we found that every one degree increase in phase angle was associated with a relative risk of 0.79 (95% CI: 0.64 to 0.97, P = 0.02. Conclusion We found BIA-derived phase angle to be an independent prognostic indicator in patients with stage IIIB and IV NSCLC. Nutritional interventions targeted at improving phase angle could potentially lead to an improved survival in patients with advanced NSCLC.

Hypofractionated stereotactic body radiation therapy for elderly patients with stage IIB–IV nonsmall cell lung cancer who are ineligible for or refuse other treatment modalities

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Karam SD

2014-10-01

Full Text Available Sana D Karam,1 Zachary D Horne,2 Robert L Hong,2 Don McRae,2 David Duhamel,3 Nadim M Nasr2 1Department of Radiation Oncology, University of Colorado, Denver, CO, USA; 2Department of Radiation Oncology, 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA Objective: In elderly patients with stage IIB–IV nonsmall cell lung cancer who cannot tolerate chemotherapy, conventionally fractionated radiotherapy is the treatment of choice. We present our experience with hypofractionated stereotactic body radiation therapy (SBRT in the treatment of this patient population. Methods: Thirty-three patients with a median age of 80 years treated with fractionated SBRT were retrospectively analyzed. Most patients were smokers and had preexisting lung disease and either refused treatment or were ineligible. A median prescribed dose of 40 Gy was delivered to the prescription isodose line over a median of five treatments. The majority of patients (70% did not receive chemotherapy. Results: With a median follow-up of 9 months (range: 4–40 months, the actuarial median overall survival (OS and progression-free survival were 12 months for both. One year actuarial survival outcomes were 75%, 58%, 44%, and 48% for local control, regional control, progression-free survival, and OS, respectively. Increased volume of disease was a statistically significant predictor of worse OS. Three patients developed a grade 1 cough that peaked 3 weeks after treatment and resolved within 1 month. One patient developed grade 1 tracheal mucositis and three patients developed grade 1 pneumonitis. Both resolved 6 weeks after treatment. Three patients died within the first month of treatment, but the cause of death did not appear to be related to the treatment. Conclusion: Hypofractionated SBRT is a relatively safe and convenient treatment option for elderly patients with inoperable stage IIB–IV nonsmall cell lung cancer. However, given the small

A RISC/UNIX workstation second stage trigger

International Nuclear Information System (INIS)

Foreman, W.M.; Amann, J.F.; Fu, S.; Kozlowski, T.; Naivar, F.J.; Oothoudt, M.A.; Shelley, F.

1992-01-01

Recent advances in Reduced Instruction Set Computer (RISC) workstations have greatly altered the economics of processing power available for experiments. In addition VME interfaces available for many of these workstations make it possible to use them in experiment frontends for filtering and compressing data. Such a second stage trigger has been implemented at LAMPF using a commercially available workstation and VME interface. The implementation is described and measurements of data transfer speeds are presented in this paper

Medical and Non-Medical Factors Influencing Utilization of Delayed Pushing in the Second Stage

Science.gov (United States)

FREY, Heather A.; TUULI, Methodius G.; CORTEZ, Sarah; ODIBO, Anthony O.; ROEHL, Kimberly A.; SHANKS, Anthony L.; MACONES, George A.; CAHILL, Alison G.

2014-01-01

Objective To evaluate factors impacting selection to delayed pushing in the second stage of labor. Study design This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modelling was used to identify factors independently associated with delayed pushing. Results We identified 471 women who delayed pushing and 4,819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing. Conclusion We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second stage labor management. PMID:23208765

Second line drug susceptibility testing to inform the treatment of rifampin-resistant tuberculosis: a quantitative perspective

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Emily A. Kendall

2017-03-01

Full Text Available Treatment failure and resistance amplification are common among patients with rifampin-resistant tuberculosis (TB. Drug susceptibility testing (DST for second-line drugs is recommended for these patients, but logistical difficulties have impeded widespread implementation of second-line DST in many settings. To provide a quantitative perspective on the decision to scale up second-line DST, we synthesize literature on the prevalence of second-line drug resistance, the expected clinical and epidemiologic benefits of using second-line DST to ensure that patients with rifampin-resistant TB receive effective regimens, and the costs of implementing (or not implementing second-line DST for all individuals diagnosed with rifampin-resistant TB. We conclude that, in most settings, second-line DST could substantially improve treatment outcomes for patients with rifampin-resistant TB, reduce transmission of drug-resistant TB, prevent amplification of drug resistance, and be affordable or even cost-saving. Given the large investment made in each patient treated for rifampin-resistant TB, these payoffs would come at relatively small incremental cost. These anticipated benefits likely justify addressing the real challenges faced in implementing second-line DST in most high-burden settings.

Detection of EGFR mutations with mutation-specific antibodies in stage IV non-small-cell lung cancer

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Viteri Santiago

2010-12-01

Full Text Available Abstract Background Immunohistochemistry (IHC with mutation-specific antibodies may be an ancillary method of detecting EGFR mutations in lung cancer patients. Methods EGFR mutation status was analyzed by DNA assays, and compared with IHC results in five non-small-cell lung cancer (NSCLC cell lines and tumor samples from 78 stage IV NSCLC patients. Results IHC correctly identified del 19 in the H1650 and PC9 cell lines, L858R in H1975, and wild-type EGFR in H460 and A549, as well as wild-type EGFR in tumor samples from 22 patients. IHC with the mAb against EGFR with del 19 was highly positive for the protein in all 17 patients with a 15-bp (ELREA deletion in exon 19, whereas in patients with other deletions, IHC was weakly positive in 3 cases and negative in 9 cases. IHC with the mAb against the L858R mutation showed high positivity for the protein in 25/27 (93% patients with exon 21 EGFR mutations (all with L858R but did not identify the L861Q mutation in the remaining two patients. Conclusions IHC with mutation-specific mAbs against EGFR is a promising method for detecting EGFR mutations in NSCLC patients. However these mAbs should be validated with additional studies to clarify their possible role in routine clinical practice for screening EGFR mutations in NSCLC patients.

Second molar calcification stages to evaluate skeletal maturation: A cross-sectional radiographic study

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U H Vijayashree

2014-01-01

Conclusion: A highly positive correlation exists between DI of mandibular second molars and CVMI. Stage F of Demirjian index, with the root length equal to or greater than the crown height corresponds to stage 3 of CVMI indicating the start of peak in mandibular growth which would be appropriate time to plan for functional appliances. Therefore, mandibular second molar calcification stages are reliable skeletal maturity indicator, which can be used to predict the growth status in determining the optimal treatment timing.

A germline mutation in the BRCA1 3'UTR predicts Stage IV breast cancer.

Science.gov (United States)

Dorairaj, Jemima J; Salzman, David W; Wall, Deirdre; Rounds, Tiffany; Preskill, Carina; Sullivan, Catherine A W; Lindner, Robert; Curran, Catherine; Lezon-Geyda, Kim; McVeigh, Terri; Harris, Lyndsay; Newell, John; Kerin, Michael J; Wood, Marie; Miller, Nicola; Weidhaas, Joanne B

2014-06-10

A germline, variant in the BRCA1 3'UTR (rs8176318) was previously shown to predict breast and ovarian cancer risk in women from high-risk families, as well as increased risk of triple negative breast cancer. Here, we tested the hypothesis that this variant predicts tumor biology, like other 3'UTR mutations in cancer. The impact of the BRCA1-3'UTR-variant on BRCA1 gene expression, and altered response to external stimuli was tested in vitro using a luciferase reporter assay. Gene expression was further tested in vivo by immunoflourescence staining on breast tumor tissue, comparing triple negative patient samples with the variant (TG or TT) or non-variant (GG) BRCA1 3'UTR. To determine the significance of the variant on clinically relevant endpoints, a comprehensive collection of West-Irish breast cancer patients were tested for the variant. Finally, an association of the variant with breast screening clinical phenotypes was evaluated using a cohort of women from the High Risk Breast Program at the University of Vermont. Luciferase reporters with the BRCA1-3'UTR-variant (T allele) displayed significantly lower gene expression, as well as altered response to external hormonal stimuli, compared to the non-variant 3'UTR (G allele) in breast cancer cell lines. This was confirmed clinically by the finding of reduced BRCA1 gene expression in triple negative samples from patients carrying the homozygous TT variant, compared to non-variant patients. The BRCA1-3'UTR-variant (TG or TT) also associated with a modest increased risk for developing breast cancer in the West-Irish cohort (OR=1.4, 95% CI 1.1-1.8, p=0.033). More importantly, patients with the BRCA1-3'UTR-variant had a 4-fold increased risk of presenting with Stage IV disease (p=0.018, OR=3.37, 95% CI 1.3-11.0). Supporting that this finding is due to tumor biology, and not difficulty screening, obese women with the BRCA1-3'UTR-variant had significantly less dense breasts (p=0.0398) in the Vermont cohort. A variant in

Design of nonimaging concentrators as second stages in tandem with image-forming first-stage concentrators

Science.gov (United States)

Winston, R.; Welford, W. T.

1980-02-01

The paper discusses the paraboloidal mirror as a tracking solar concentrator, fitting a nonimaging second stage to the paraboloidal mirror, other image-forming systems as first stages, and tracking systems in two-dimensional geometry. Because of inherent aberrations, the paraboloidal mirror cannot achieve the thermodynamic limit. It is shown how paraboloidal mirrors of short focal ratio and similar systems can have their flux concentration enhanced to near the thermodynamic limit by the addition of nonimaging compound elliptical concentrators.

Design of nonimaging concentrators as second stages in tandem with image-forming first-stage concentrators

Science.gov (United States)

Winston, R.; Welford, W. T.

1980-01-01

The paper discusses the paraboloidal mirror as a tracking solar concentrator, fitting a nonimaging second stage to the paraboloidal mirror, other image-forming systems as first stages, and tracking systems in two-dimensional geometry. Because of inherent aberrations, the paraboloidal mirror cannot achieve the thermodynamic limit. It is shown how paraboloidal mirrors of short focal ratio and similar systems can have their flux concentration enhanced to near the thermodynamic limit by the addition of nonimaging compound elliptical concentrators.

Aflibercept as a second-line therapy in metastatic colorectal cancer: A limited Indian experience

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Govind Babu

2016-01-01

Full Text Available Introduction: Aflibercept in combination with FOLFIRI has been shown to improve overall survival in the pivotal VELOUR study. Aflibercept has not yet been marketed in India. Sanofi has made available this drug for Indian patients under a program called Named Patient Access Program (NPP. We present a limited clinical experience with the use of aflibercept at our center. Materials and Methods: We analyzed the data of the patients who received aflibercept under NPP. Aflibercept was given in combination with FOLFIRI as second-line for patients who progressed on oxaliplatin based therapy. Aflibercept was given at 4 mg/kg intravenous (IV every 15 days. Chemotoxicities were assessed as per CTCAE. Response evaluation was done every four cycles. Results: Five patients were enrolled. The median age was 34 years. The median number of aflibercept cycles administered was 12. Common grade 2/3 toxicities were mucositis, diarrhea, neutropenia thrombocytopenia, and hypertension seen in three (60%, three (60%, two (40%, two (40%, and one patient respectively. After four cycles, the response was assessed as: One complete remission (CR, three partial remissions (PR, and one progressive disease (PD. Three patients completed 12 cycles of chemotherapy and aflibercept. At the end of 12 cycles, one patient still in CR and two patients were in PR. Four patients were alive till date. Conclusion: As we had very less number of patients, it was very difficult to compare it with VELOUR data. It is one of option as second-line in metastatic colorectal cancer (mCRC who progressed on oxaliplatin chemotherapy. Mucositis, diarrhea, and hematological toxicity were the most common toxicity in our patient.

Clinical Predictors of Survival for Patients with Stage IV Cancer Referred to Radiation Oncology.

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Johnny Kao

Full Text Available There is an urgent need for a robust, clinically useful predictive model for survival in a heterogeneous group of patients with metastatic cancer referred to radiation oncology.From May 2012 to August 2013, 143 consecutive patients with stage IV cancer were prospectively evaluated by a single radiation oncologist. We retrospectively analyzed the effect of 29 patient, laboratory and tumor-related prognostic factors on overall survival using univariate analysis. Variables that were statistically significant on univariate analysis were entered into a multivariable Cox regression to identify independent predictors of overall survival.The median overall survival was 5.5 months. Four prognostic factors significantly predicted survival on multivariable analysis including ECOG performance status (0-1 vs. 2 vs. 3-4, number of active tumors (1 to 5 vs. ≥ 6, albumin levels (≥ 3.4 vs. 2.4 to 3.3 vs. 31.4 months for very low risk patients compared to 14.5 months for low risk, 4.1 months for intermediate risk and 1.2 months for high risk (p < 0.001.These data suggest that a model that considers performance status, extent of disease, primary tumor site and serum albumin represents a simple model to accurately predict survival for patients with stage IV cancer who are potential candidates for radiation therapy.

Non-equilibrium ionization by a periodic electron beam. II. Synthetic Si IV and O IV transition region spectra

Science.gov (United States)

Dzifčáková, Elena; Dudík, Jaroslav

2018-03-01

Context. Transition region (TR) spectra typically show the Si IV 1402.8 Å line to be enhanced by a factor of 5 or more compared to the neighboring O IV 1401.2 Å, contrary to predictions of ionization equilibrium models and the Maxwellian distribution of particle energies. Non-equilibrium effects in TR spectra are therefore expected. Aims: To investigate the combination of non-equilibrium ionization and high-energy particles, we apply the model of the periodic electron beam, represented by a κ-distribution that recurs at periods of several seconds, to plasma at chromospheric temperatures of 104 K. This simple model can approximate a burst of energy release involving accelerated particles. Methods: Instantaneous time-dependent charge states of silicon and oxygen were calculated and used to synthesize the instantaneous and period-averaged spectra of Si IV and O IV. Results: The electron beam drives the plasma out of equilibrium. At electron densities of Ne = 1010 cm-3, the plasma is out of ionization equilibrium at all times in all cases we considered, while for a higher density of Ne = 1011 cm-3, ionization equilibrium can be reached toward the end of each period, depending on the conditions. In turn, the character of the period-averaged synthetic spectra also depends on the properties of the beam. While the case of κ = 2 results in spectra with strong or even dominant O IV, higher values of κ can approximate a range of observed TR spectra. Spectra similar to typically observed spectra, with the Si IV 1402.8 Å line about a factor 5 higher than O IV 1401.2 Å, are obtained for κ = 3. An even higher value of κ = 5 results in spectra that are exclusively dominated by Si IV, with negligible O IV emission. This is a possible interpretation of the TR spectra of UV (Ellerman) bursts, although an interpretation that requires a density that is 1-3 orders of magnitude lower than for equilibrium estimates. Movies associated to Fig. A.1 are available at http://https://www.aanda.org

The Second Stage of a Saturn V Ready For Test

Science.gov (United States)

1970-01-01

This Saturn V S-II (second) stage is being lifted into position for a test at the Vehicle Assembly Building at the Kennedy Space Center. When the Saturn V booster stage (S-IC) burned out and dropped away, power for the Saturn was provided by the 82-foot-long and 33-foot-diameter S-II stage. Developed by the Space Division of North American Aviation under the direction of the Marshall Space Flight Center, the stage utilized five J-2 engines, each producing 200,000 pounds of thrust. The engines used liquid oxygen and liquid hydrogen as propellants. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

Survival predictors for second-line chemotherapy in Caucasian patients with metastatic gastric cancer

OpenAIRE

Bohanes, Pierre; Courvoisier, Delphine; Perneger, Thomas; Morel, Philippe; Huber, Olivier; Roth, Arnaud

2011-01-01

There are very limited data suggesting a benefit for second-line chemotherapy in advanced gastric cancer. Therefore, the number of patients who receive further treatment after failure of first-line chemotherapy varies considerably, ranging from 14% to 75%. In the absence of a demonstrated survival benefit of second-line chemotherapy, appropriate selection of patients based on survival predictors is essential. However, no clinico-pathologic parameters are currently widely adopted in clinical p...

Second-line afatinib administration in an elderly patient with squamous cell carcinoma

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Hohenforst-Schmidt W

2017-03-01

Full Text Available Wolfgang Hohenforst-Schmidt,1 Paul Zarogoulidis,2 Michael Steinheimer,1 Naim Benhassen,3 Chrysanthi Sardeli,4 Nikos Stalikas,2 Melpomeni Toitou,2 Haidong Huang5 1Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany; 2Pulmonary Department – Oncology Unit, “G Papanikolaou” General Hospital, Thessaloniki, Greece; 3Medical Clinic I, “Fuerth” Hospital, University of Erlangen, Fuerth, Germany; 4Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; 5Department of Respiratory and Critical Care Medicine, Changhai Hospital/First Affiliated Hospital of the Secondary Military Medical University, Shanghai, China Introduction: The majority of cases of lung cancer are still diagnosed at a late stage. At this stage, palliative therapeutic options including nonspecific cytotoxic drugs, targeted therapy, or immunotherapy can be utilized. In 2016, immunotherapy was approved in Europe for squamous cell carcinoma and adenocarcinoma. Moreover, afatinib was also approved as second-line therapy for squamous cell carcinoma. Case report: This article presents a case of a 76-year-old male with squamous cell carcinoma who received nab-paclitaxel as first-line therapy, and his treatment was switched to the tyrosine kinase inhibitor afatinib (40 mg after disease progression with left lung atelectasis. After receiving afatinib for only 28 days, the atelectasis resolved. No adverse effects were observed from the afatinib therapy. Discussion: In this case, afatinib 40 mg proved to be an effective alternative treatment for an elderly patient. Treatment choice should be based on the performance status of the patient, cost-effectiveness, and drug treatment guidelines. Keywords: lung cancer, EGFR, afatinib

Social-emotional instability in individuals with Rett syndrome: parents' experiences with second stage behaviour.

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Munde, V; Vlaskamp, C; Ter Haar, A

2016-01-01

While the medical profession often terms behaviours in individuals with Rett syndrome (RTT) in the second stage as 'autistic-like', parents disagree with this description. The present study focuses on a comparison of parents' experiences with the social-emotional behaviour of the child with RTT in the second and subsequent stages. In collaboration with the Dutch Rett Syndrome Organization, 51 parents of children with RTT in the Netherlands took part in the present study. Parents completed an online questionnaire to clarify their experiences of the social-emotional behaviour of their children during and after the second stage of RTT. Both quantitative and qualitative analysis techniques have been used. The results of the paired-samples t-test show that parents see significantly less social-emotional behaviour in the children during the second stage of RTT than in the subsequent stages. Parents reported that their children did not seek as much interaction. From the parents' descriptions, it would seem that the children are willing but unable to interact with their environment. Like previous research, our study leads to doubts about the appropriateness of the label 'autistic-like' for the behaviour of individuals in the second stage of RTT. While behaviours of individuals with autism and individuals with RTT may resemble each other, quality and intentions may differ. Still, future studies are needed for further clarification. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Steered molecular dynamics simulations of a type IV pilus probe initial stages of a force-induced conformational transition.

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Joseph L Baker

2013-04-01

Full Text Available Type IV pili are long, protein filaments built from a repeating subunit that protrudes from the surface of a wide variety of infectious bacteria. They are implicated in a vast array of functions, ranging from bacterial motility to microcolony formation to infection. One of the most well-studied type IV filaments is the gonococcal type IV pilus (GC-T4P from Neisseria gonorrhoeae, the causative agent of gonorrhea. Cryo-electron microscopy has been used to construct a model of this filament, offering insights into the structure of type IV pili. In addition, experiments have demonstrated that GC-T4P can withstand very large tension forces, and transition to a force-induced conformation. However, the details of force-generation, and the atomic-level characteristics of the force-induced conformation, are unknown. Here, steered molecular dynamics (SMD simulation was used to exert a force in silico on an 18 subunit segment of GC-T4P to address questions regarding the nature of the interactions that lead to the extraordinary strength of bacterial pili. SMD simulations revealed that the buried pilin α1 domains maintain hydrophobic contacts with one another within the core of the filament, leading to GC-T4P's structural stability. At the filament surface, gaps between pilin globular head domains in both the native and pulled states provide water accessible routes between the external environment and the interior of the filament, allowing water to access the pilin α1 domains as reported for VC-T4P in deuterium exchange experiments. Results were also compared to the experimentally observed force-induced conformation. In particular, an exposed amino acid sequence in the experimentally stretched filament was also found to become exposed during the SMD simulations, suggesting that initial stages of the force induced transition are well captured. Furthermore, a second sequence was shown to be initially hidden in the native filament and became exposed upon

Steered molecular dynamics simulations of a type IV pilus probe initial stages of a force-induced conformational transition.

Science.gov (United States)

Baker, Joseph L; Biais, Nicolas; Tama, Florence

2013-04-01

Type IV pili are long, protein filaments built from a repeating subunit that protrudes from the surface of a wide variety of infectious bacteria. They are implicated in a vast array of functions, ranging from bacterial motility to microcolony formation to infection. One of the most well-studied type IV filaments is the gonococcal type IV pilus (GC-T4P) from Neisseria gonorrhoeae, the causative agent of gonorrhea. Cryo-electron microscopy has been used to construct a model of this filament, offering insights into the structure of type IV pili. In addition, experiments have demonstrated that GC-T4P can withstand very large tension forces, and transition to a force-induced conformation. However, the details of force-generation, and the atomic-level characteristics of the force-induced conformation, are unknown. Here, steered molecular dynamics (SMD) simulation was used to exert a force in silico on an 18 subunit segment of GC-T4P to address questions regarding the nature of the interactions that lead to the extraordinary strength of bacterial pili. SMD simulations revealed that the buried pilin α1 domains maintain hydrophobic contacts with one another within the core of the filament, leading to GC-T4P's structural stability. At the filament surface, gaps between pilin globular head domains in both the native and pulled states provide water accessible routes between the external environment and the interior of the filament, allowing water to access the pilin α1 domains as reported for VC-T4P in deuterium exchange experiments. Results were also compared to the experimentally observed force-induced conformation. In particular, an exposed amino acid sequence in the experimentally stretched filament was also found to become exposed during the SMD simulations, suggesting that initial stages of the force induced transition are well captured. Furthermore, a second sequence was shown to be initially hidden in the native filament and became exposed upon stretching.

Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in Endocrine Therapy for Stage IV Breast Cancer.

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Iimori, Nozomi; Kashiwagi, Shinichiro; Asano, Yuka; Goto, Wataru; Takada, Koji; Takahashi, Katsuyuki; Hatano, Takaharu; Takashima, Tsutomu; Tomita, Shuhei; Motomura, Hisashi; Hirakawa, Kosei; Ohira, Masaichi

2018-01-01

Studies have found that patients with cancer exhibit abnormal leukocyte fractions, such as elevated neutrophil count and diminished lymphocyte count, and that the neutrophil-to-lymphocyte ratio (NLR) provides a surrogate marker for prognosis and response to treatment of patients after radical surgery for several different types of cancer. However, few reports have addressed the association between the NLR and response to endocrine therapy. In this study, we carried out a clinical investigation to confirm whether or not the NLR predicted the response to endocrine therapy of stage IV breast cancer. The study subjects were 34 patients who underwent endocrine therapy as initial drug therapy for stage IV breast cancer. The correlation between NLR and prognosis, including the efficacy of endocrine therapy, was evaluated retrospectively. Among the 34 patients, the NLR was high in 10 (29.4%) and low in 24 (70.6%). In analysis of outcomes, the group with low NLR had a significant prolongation of progression-free survival (p=0.003), time to treatment failure (p=0.031), and overall survival (p=0.013) compared to the group with high NLR. Univariate analysis of progression-free survival found that responding to treatment [hazard ratio (HR)=4.310, p=0.004] and low NLR (HR=3.940, p=0.016) were factors associated with a favorable prognosis. Multivariate analysis also showed that responding to treatment (HR=4.329, p=0.006) and low NLR (HR=3.930, p=0.008) were independent factors associated with a favorable prognosis. Our results suggested that the NLR may represent a predictive marker for response to endocrine therapy in stage IV breast cancer. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

International Nuclear Information System (INIS)

Thompson, Scott M.; Callstrom, Matthew R.; McKusick, Michael A.; Woodrum, David A.

2015-01-01

PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA

Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

Energy Technology Data Exchange (ETDEWEB)

Thompson, Scott M., E-mail: Thompson.scott@mayo.edu [Mayo Clinic, Mayo Graduate School, Mayo Medical School and the Mayo Clinic Medical Scientist Training Program, College of Medicine (United States); Callstrom, Matthew R., E-mail: callstrom.matthew@mayo.edu; McKusick, Michael A., E-mail: mckusick.michael@mayo.edu; Woodrum, David A., E-mail: woodrum.david@mayo.edu [Mayo Clinic, Department of Radiology, College of Medicine (United States)

2015-10-15

PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA.

Pretreatment Red Blood Cell Total Folate Concentration Is Associated With Response to Pemetrexed in Stage IV Nonsquamous Non-Small-cell Lung Cancer.

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Bagley, Stephen J; Vitale, Steven; Zhang, Suhong; Aggarwal, Charu; Evans, Tracey L; Alley, Evan W; Cohen, Roger B; Langer, Corey J; Blair, Ian A; Vachani, Anil; Whitehead, Alexander S

2017-03-01

Pemetrexed inhibits folate-dependent enzymes involved in pyrimidine and purine synthesis. Previous studies of genetic variation in these enzymes as predictors of pemetrexed efficacy have yielded inconsistent results. We investigated whether red blood cell (RBC) total folate, a phenotypic rather than genotypic, marker of cellular folate status was associated with the response to pemetrexed-based chemotherapy in advanced nonsquamous non-small-cell lung cancer (NSCLC). We conducted a prospective cohort study of patients with stage IV nonsquamous NSCLC receiving first-line chemotherapy containing pemetrexed. The pretreatment RBC total folate level was quantified using liquid chromatography mass spectrometry. We then compared the objective response rate (ORR) between patients with RBC total folate concentrations greater than and less than an optimal cutoff value determined from the receiver operating characteristic curve. A logistic regression model was used to adjust for age, sex, and the use of bevacizumab. The ORR was 62% (32 of 52 patients). Receiver operating characteristic analysis was used to establish that a RBC total folate cutoff value of 364.6 nM optimally discriminated between pemetrexed responders and nonresponders. Patients with RBC total folate  364.5 nM (P = .01). This difference persisted after adjusting for age, sex, and the use of bevacizumab (odds ratio, 0.07; 95% confidence interval, 0.01-0.57; P = .01). A low pretreatment RBC total folate was associated with an inferior response to pemetrexed-based chemotherapy in stage IV nonsquamous NSCLC. Larger, multicenter studies are needed to validate RBC total folate as a predictive marker of pemetrexed response. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain.

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Hansen, Ryan N; Pham, An T; Lovelace, Belinda; Balaban, Stela; Wan, George J

2017-10-01

Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07). Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

Title of the paper goes here second line

Indian Academy of Sciences (India)

Title of the paper goes here second line. AUTHOR11, AUTHOR21 and AUTHOR32,*. 1 Department of P, University X. 2 Department of Q, University Z. Abstract. Abstract text goes here. Abstract text goes here. Abstract text goes here. Abstract text goes here. Abstract text goes here. Abstract text goes here. Abstract text goes ...

On the astronomical orientation of the IV dynasty Egyptian pyramids and the dating of the second Giza pyramid

OpenAIRE

Magli, Giulio

2003-01-01

The data on the astronomical orientation of the IV dynasty Egyptian pyramids are re-analyzed and it is shown that such data suggest an inverse chronology between the `first` and the `second` Giza pyramid.

Traditionally vs sonographically coached pushing in second stage of labor: a pilot randomized controlled trial.

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Bellussi, F; Alcamisi, L; Guizzardi, G; Parma, D; Pilu, G

2018-03-13

To investigate the usefulness of visual biofeedback using transperineal ultrasound to improve coached pushing during the active second stage of labor in nulliparous women. This was a randomized controlled trial of low-risk nulliparous women in the active second stage of labor. Patients were allocated to either coached pushing aided by visual demonstration on transperineal ultrasound of the progress of the fetal head (sonographic coaching) or traditional coaching. Patients in both groups were coached by an obstetrician for the first 20 min of the active second stage of labor and, subsequently, the labor was supervised by a midwife. Primary outcomes were duration of the active second stage and increase in the angle of progression at the end of the coaching process. Secondary outcomes included the incidence of operative delivery and complications of labor. Forty women were recruited into the study. Those who received sonographic coaching had a shorter active phase of the second stage (30 min (interquartile range (IQR), 24-42 min) vs 45 min (IQR, 39-55 min); P = 0.01) and a greater increase in the angle of progression (13.5° (IQR, 9-20°) vs 5° (IQR, 3-9.5°); P = 0.01) in the first 20 min of the active second stage of labor than did those who had traditional coaching. No differences were found in the secondary outcomes between the two groups. Our preliminary data suggest that transperineal ultrasound may be a useful adjunct to coached pushing during the active second stage of labor. Further studies are required to confirm these findings and better define the benefits of this approach. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Cetuximab as second-line therapy in patients with metastatic esophageal adenocarcinoma: A phase II Southwest Oncology Group Study (S0415)

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Gold, Philip J.; Goldman, Bryan; Iqbal, Syma; Leichman, Lawrence P.; Zhang, Wu; Lenz, Heinz-Josef; Blanke, Charles D.

2010-01-01

Introduction Esophageal adenocarcinomas commonly express the Epidermal Growth Factor Receptor (EGFR). This trial assessed the six month overall survival probability in metastatic esophageal cancer patients treated with cetuximab as second line therapy. Methods This was a multicenter, open-label phase II study of single agent cetuximab for metastatic esophageal adenocarcinoma patients who failed one prior chemotherapy regimen. Adequate organ function and Zubrod performance status of 0-2 were required. Patients received cetuximab 400mg/m2 IV on week one, and 250 mg/m2 IV weekly thereafter. The primary objective was to determine 6 month overall survival. Secondary endpoints included progression-free survival, response rate, and toxicity. Tumor tissue was collected for correlative studies. Results Sixty-three patients were registered, with 8 ineligible or never treated. Fifty-five eligible patients (male=49, female=6; median age=61.2 years [range 30.7-88.5]) were enrolled. Twenty patients survived > 6 months for a 6-month overall survival rate of 36% (95% CI: 24%, 50%). The median overall survival was 4.0 months (95% CI: 3.2, 5.9). Median progression-free survival was 1.8 months (95% CI: 1.7, 1.9). One partial response and 2 unconfirmed partial responses were observed. Two patients experienced grade 4 fatigue. There was one treatment-related death due to pneumonitis. Germline polymorphisms of EGFR, EGF, IL-8, COX-2, VEGF, CCND1, NRP1 and Kras mutational status were not associated with response or survival. Conclusions The 6-month overall survival rate of 36% observed on this study failed to meet the primary survival objective. Thus, cetuximab alone cannot be recommended in the second-line treatment of metastatic esophageal cancer. PMID:20631636

Evaluation of concomitant use of non-specific immunopotentiator on 172 cases of primary lung cancer (Stage III, IV) treated with radiation combined with chemotherapy

International Nuclear Information System (INIS)

Ogawa, Yasuhiro; Kimura, Shuji; Imajo, Yoshinari; Hamada, Fumio; Miyaji, Chihiro

1982-01-01

The clinical effect of concomitant use of non-specific immunopotentiator OK-432 and/or PSK was studied about 172 cases of primary lung cancer (Stage III, IV). In 91 cases in stage III, fifty percent survival period was found to be 11.5 months for 63 cases with OK-432 and/or PSK, and 7.5 months for 28 cases without immunotherapy, respectively. In 81 cases in stage IV, fifty percent survival period was found to be 6.7 months for 45 cases with OK-432 and/or PSK, and 3.3 months for 36 cases without immunotherapy, respectively. (author)

Predicting for activity of second-line trastuzumab-based therapy in her2-positive advanced breast cancer

Directory of Open Access Journals (Sweden)

Rottenfusser Andrea

2009-10-01

Full Text Available Abstract Background In Her2-positive advanced breast cancer, the upfront use of trastuzumab is well established. Upon progression on first-line therapy, patients may be switched to lapatinib. Others however remain candidates for continued antibody treatment (treatment beyond progression. Here, we aimed to identify factors predicting for activity of second-line trastuzumab-based therapy. Methods Ninety-seven patients treated with > 1 line of trastuzumab-containing therapy were available for this analysis. Her2-status was determined by immunohistochemistry and re-analyzed by FISH if a score of 2+ was gained. Time to progression (TTP on second-line therapy was defined as primary study endpoint. TTP and overall survival (OS were estimated using the Kaplan-Meier product limit method. Multivariate analyses (Cox proportional hazards model, multinomial logistic regression were applied in order to identify factors associated with TTP, response, OS, and incidence of brain metastases. p values Results Median TTP on second-line trastuzumab-based therapy was 7 months (95% CI 5.74-8.26, and 8 months (95% CI 6.25-9.74 on first-line, respectively (n.s.. In the multivariate models, none of the clinical or histopthological features could reliably predict for activity of second-line trastuzumab-based treatment. OS was 43 months suggesting improved survival in patients treated with trastuzumab in multiple-lines. A significant deterioration of cardiac function was observed in three patients; 40.2% developed brain metastases while on second-line trastuzumab or thereafter. Conclusion Trastuzumab beyond progression showed considerable activity. None of the variables investigated correlated with activity of second-line therapy. In order to predict for activity of second-line trastuzumab, it appears necessary to evaluate factors known to confer trastuzumab-resistance.

Second-line salvage treatment of AIDS-associated Pneumocystis jirovecii pneumonia: a case series and systematic review

DEFF Research Database (Denmark)

Benfield, T.; Atzori, C.; Miller, R.F.

2008-01-01

BACKGROUND: Limited clinical data exist to guide the choice of second-line salvage treatment for AIDS-associated Pneumocystis jirovecii pneumonia (PCP). METHODS: We did a systematic search of MEDLINE for all randomized and observational studies of PCP treatment published up to August 2007...... and included individual treatment data of AIDS-associated PCP from a tricenter study. We calculated pooled estimates of reported outcome of second-line treatment using averaged odds ratios (ORs). RESULTS: Twenty-nine studies with sufficient detail of second-line treatment and outcome, including data from 82...... individual cases from the tricenter study, yielded a total of 468 PCP second-line treatment episodes. Response rates to second-line treatment were comparable for trimethoprim-sulfamethoxazole (TMP-SMX; 68%) and clindamycin-primaquine (73%) (OR for response = 2.1 [95% confidence interval (CI): 1.1 to 3...

Symptom burden & quality of life among patients receiving second-line treatment of metastatic colorectal cancer

Directory of Open Access Journals (Sweden)

Walker Mark S

2012-06-01

Full Text Available Abstract Background Bevacizumab (B and cetuximab (C are both approved for use in the treatment of metastatic colorectal cancer (mCRC in the second-line. We examined patient reported symptom burden during second-line treatment of mCRC. Methods Adult mCRC patients treated in the second-line setting with a regimen that included B, C, or chemotherapy only (O and who had completed ≥ 1 Patient Care Monitor (PCM surveys as part of routine clinical care were drawn from the ACORN Data Warehouse. Primary endpoints were rash, dry skin, itching, nail changes, nausea, vomiting, fatigue, burning in hands/feet, and diarrhea. Linear mixed models examined change in PCM scores across B, C and O (B = reference. Results 182 patients were enrolled (B: n = 106, C: n = 38, O: n = 38. Patients were 51% female, 67% Caucasian, with mean age of 62.0 (SD = 12.6. Groups did not differ on demographic or clinical characteristics. The most common second-line regimens were FOLFIRI ± B or C (23.1% and FOLFOX ± B or C (22.5%. Results showed baseline scores to be strongly predictive of second-line symptoms across all PCM items (all p’s  Conclusions Patients receiving second-line treatment for mCRC with B report less symptom burden, especially dermatologic, compared to patients treated with C.

THE SLOAN DIGITAL SKY SURVEY REVERBERATION MAPPING PROJECT: RAPID C iv BROAD ABSORPTION LINE VARIABILITY

International Nuclear Information System (INIS)

Grier, C. J.; Brandt, W. N.; Trump, J. R.; Schneider, D. P.; Hall, P. B.; Shen, Yue; Vivek, M.; Dawson, K. S.; Ak, N. Filiz; Chen, Yuguang; Denney, K. D.; Kochanek, C. S.; Peterson, B. M.; Green, Paul J.; Jiang, Linhua; McGreer, Ian D.; Pâris, I.; Tao, Charling; Wood-Vasey, W. M.; Bizyaev, Dmitry

2015-01-01

We report the discovery of rapid variations of a high-velocity C iv broad absorption line trough in the quasar SDSS J141007.74+541203.3. This object was intensively observed in 2014 as a part of the Sloan Digital Sky Survey Reverberation Mapping Project, during which 32 epochs of spectroscopy were obtained with the Baryon Oscillation Spectroscopic Survey spectrograph. We observe significant (>4σ) variability in the equivalent width (EW) of the broad (∼4000 km s −1 wide) C iv trough on rest-frame timescales as short as 1.20 days (∼29 hr), the shortest broad absorption line variability timescale yet reported. The EW varied by ∼10% on these short timescales, and by about a factor of two over the duration of the campaign. We evaluate several potential causes of the variability, concluding that the most likely cause is a rapid response to changes in the incident ionizing continuum. If the outflow is at a radius where the recombination rate is higher than the ionization rate, the timescale of variability places a lower limit on the density of the absorbing gas of n e ≳ 3.9 × 10 5 cm −3 . The broad absorption line variability characteristics of this quasar are consistent with those observed in previous studies of quasars, indicating that such short-term variability may in fact be common and thus can be used to learn about outflow characteristics and contributions to quasar/host-galaxy feedback scenarios

Saturn V Second Stage (S-II) Ready for Static Test

Science.gov (United States)

1965-01-01

Two workers are dwarfed by the five J-2 engines of the Saturn V second stage (S-II) as they make final inspections prior to a static test firing by North American Space Division. These five hydrogen -fueled engines produced one million pounds of thrust, and placed the Apollo spacecraft into earth orbit before departing for the moon. The towering 363-foot Saturn V was a multi-stage, multi-engine launch vehicle standing taller than the Statue of Liberty. Altogether, the Saturn V engines produced as much power as 85 Hoover Dams.

Utility of Inflammatory Marker- and Nutritional Status-based Prognostic Factors for Predicting the Prognosis of Stage IV Gastric Cancer Patients Undergoing Non-curative Surgery.

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Mimatsu, Kenji; Fukino, Nobutada; Ogasawara, Yasuo; Saino, Yoko; Oida, Takatsugu

2017-08-01

The present study aimed to compare the utility of various inflammatory marker- and nutritional status-based prognostic factors, including many previous established prognostic factors, for predicting the prognosis of stage IV gastric cancer patients undergoing non-curative surgery. A total of 33 patients with stage IV gastric cancer who had undergone palliative gastrectomy and gastrojejunostomy were included in the study. Univariate and multivariate analyses were performed to evaluate the relationships between the mGPS, PNI, NLR, PLR, the CONUT, various clinicopathological factors and cancer-specific survival (CS). Among patients who received non-curative surgery, univariate analysis of CS identified the following significant risk factors: chemotherapy, mGPS and NLR, and multivariate analysis revealed that the mGPS was independently associated with CS. The mGPS was a more useful prognostic factor than the PNI, NLR, PLR and CONUT in patients undergoing non-curative surgery for stage IV gastric cancer. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Metronomic capecitabine as second-line treatment for hepatocellular carcinoma after sorafenib discontinuation.

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Trevisani, Franco; Brandi, Giovanni; Garuti, Francesca; Barbera, Maria Aurelia; Tortora, Raffaella; Casadei Gardini, Andrea; Granito, Alessandro; Tovoli, Francesco; De Lorenzo, Stefania; Inghilesi, Andrea Lorenzo; Foschi, Francesco Giuseppe; Bernardi, Mauro; Marra, Fabio; Sacco, Rodolfo; Di Costanzo, Giovan Giuseppe

2018-02-01

Metronomic capecitabine (MC) is a well-tolerated systemic treatment showing promising results in one retrospective study, as second-line therapy after sorafenib failure, in patients with hepatocellular carcinoma (HCC). 117 patients undergoing MC were compared to 112 patients, eligible for this treatment, but undergoing best supportive care (BSC) after sorafenib discontinuation for toxicity or HCC progression. The two groups were compared for demographic and clinical features. A multivariate regression analysis was conducted to detect independent prognostic factors. To balance confounding factors between the two groups, a propensity score model based on independent prognosticators (performance status, neoplastic thrombosis, causes of sorafenib discontinuation and pre-sorafenib treatment) was performed. Patients undergoing MC showed better performance status, lower tumor burden, lower prevalence of portal vein thrombosis, and better cancer stage. Median (95% CI) post-sorafenib survival (PSS) was longer in MC than in BSC patients [9.5 (7.5-11.6) vs 5.0 (4.2-5.7) months (p < 0.001)]. Neoplastic thrombosis, cause of sorafenib discontinuation, pre-sorafenib treatment and MC were independent prognosticators. The benefit of capecitabine was confirmed in patients after matching with propensity score [PSS: 9.9 (6.8-12.9) vs. 5.8 (4.8-6.8) months, (p = 0.001)]. MC lowered the mortality risk by about 40%. MC achieved better results in patients who stopped sorafenib for adverse events than in those who progressed during it [PSS: 17.3 (10.5-24.1) vs. 7.8 (5.2-10.1) months, (p = 0.035)]. Treatment toxicity was low and easily manageable with dose modulation. MC may be an efficient and safe second-line systemic therapy for HCC patients who discontinued sorafenib for toxicity or tumor progression.

Pretreatment red blood cell total folate is associated with response to pemetrexed in stage IV non-squamous non-small-cell lung cancer

Science.gov (United States)

Bagley, Stephen J.; Vitale, Steven; Zhang, Suhong; Aggarwal, Charu; Evans, Tracey L.; Alley, Evan W.; Cohen, Roger B.; Langer, Corey J.; Blair, Ian A.; Vachani, Anil; Whitehead, Alexander S.

2016-01-01

Objectives Pemetrexed inhibits folate-dependent enzymes involved in pyrimidine and purine synthesis. Prior studies of genetic variation in these enzymes as predictors of pemetrexed efficacy have yielded inconsistent results. We investigated whether red blood cell (RBC) total folate, a phenotypic rather than genotypic marker of cellular folate status, was associated with response to pemetrexed-based chemotherapy in advanced non-squamous non-small-cell lung cancer (NSCLC). Materials and methods We conducted a prospective cohort study of patients with stage IV non-squamous NSCLC receiving first-line chemotherapy containing pemetrexed. Pretreatment RBC total folate was quantified using liquid chromatography/mass spectrometry. We then compared objective response rate (ORR) between patients with RBC total folate concentrations above and below an optimal cut-off value determined from the receiver operating characteristic (ROC) curve. A logistic regression model was used to adjust for age, sex, and use of bevacizumab. Results The ORR was 62% (32 of 52 patients). ROC analysis was used to establish that a RBC total folate cutoff value of 364.6 nM optimally discriminated between pemetrexed responders and non-responders. Patients with RBC total folate below 364.5 nM had an ORR of 27%, compared to 71% in patients with RBC total folate above this value (p=0.01). This difference persisted after adjusting for age, sex, and use of bevacizumab (OR 0.07, 95% CI 0.01 - 0.57, p=0.01). Conclusions Low pretreatment RBC total folate is associated with inferior response to pemetrexed-based chemotherapy in stage IV non-squamous NSCLC. Larger, multicenter studies are needed to validate RBC total folate as a predictive marker of pemetrexed response. PMID:27863923

Prognostic Impact of 21-Gene Recurrence Score in Patients With Stage IV Breast Cancer: TBCRC 013.

Science.gov (United States)

King, Tari A; Lyman, Jaclyn P; Gonen, Mithat; Voci, Amy; De Brot, Marina; Boafo, Camilla; Sing, Amy Pratt; Hwang, E Shelley; Alvarado, Michael D; Liu, Minetta C; Boughey, Judy C; McGuire, Kandace P; Van Poznak, Catherine H; Jacobs, Lisa K; Meszoely, Ingrid M; Krontiras, Helen; Babiera, Gildy V; Norton, Larry; Morrow, Monica; Hudis, Clifford A

2016-07-10

The objective of this study was to determine whether the 21-gene Recurrence Score (RS) provides clinically meaningful information in patients with de novo stage IV breast cancer enrolled in the Translational Breast Cancer Research Consortium (TBCRC) 013. TBCRC 013 was a multicenter prospective registry that evaluated the role of surgery of the primary tumor in patients with de novo stage IV breast cancer. From July 2009 to April 2012, 127 patients from 14 sites were enrolled; 109 (86%) patients had pretreatment primary tumor samples suitable for 21-gene RS analysis. Clinical variables, time to first progression (TTP), and 2-year overall survival (OS) were correlated with the 21-gene RS by using log-rank, Kaplan-Meier, and Cox regression. Median patient age was 52 years (21 to 79 years); the majority had hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative (72 [66%]) or hormone receptor-positive/HER2-positive (20 [18%]) breast cancer. At a median follow-up of 29 months, median TTP was 20 months (95% CI, 16 to 26 months), and median survival was 49 months (95% CI, 40 months to not reached). An RS was generated for 101 (93%) primary tumor samples: 22 (23%) low risk (< 18), 29 (28%) intermediate risk (18 to 30); and 50 (49%) high risk (≥ 31). For all patients, RS was associated with TTP (P = .01) and 2-year OS (P = .04). In multivariable Cox regression models among 69 patients with estrogen receptor (ER)-positive/HER2-negative cancer, RS was independently prognostic for TTP (hazard ratio, 1.40; 95% CI, 1.05 to 1.86; P = .02) and 2-year OS (hazard ratio, 1.83; 95% CI, 1.14 to 2.95; P = .013). The 21-gene RS is independently prognostic for both TTP and 2-year OS in ER-positive/HER2-negative de novo stage IV breast cancer. Prospective validation is needed to determine the potential role for this assay in the clinical management of this patient subset. © 2016 by American Society of Clinical Oncology.

Narrow absorption lines complex I: one form of broad absorption line

Science.gov (United States)

Lu, Wei-Jian; Lin, Ying-Ru

2018-03-01

We discover that some of the broad absorption lines (BALs) are actually a complex of narrow absorption lines (NALs). As a pilot study of this type of BAL, we show this discovery through a typical example in this paper. Utilizing the two-epoch observations of J002710.06-094435.3 (hereafter J0027-0944) from the Sloan Digital Sky Survey (SDSS), we find that each of the C IV and Si IV BAL troughs contains at least four NAL doublets. By resolving the Si IV BAL into multiple NALs, we present the following main results and conclusions. First, all these NALs show coordinated variations between the two-epoch SDSS observations, suggesting that they all originate in the quasar outflow, and that their variations are due to global changes in the ionization condition of the absorbing gas. Secondly, a BAL consisting of a number of NAL components indicates that this type of BAL is basically the same as the intrinsic NAL, which tends to support the inclination model rather than the evolution model. Thirdly, although both the C IV and Si IV BALs originate from the same clumpy substructures of the outflow, they show different profile shapes: multiple absorption troughs for the Si IV BAL in a wider velocity range, while P-Cygni for the C IV BAL in a narrower velocity range. This can be interpreted by the substantial differences in fine structure and oscillator strength between the Si IVλλ1393, 1402 and C IVλλ1548, 1551 doublets. Based on the above conclusions, we consider that the decomposition of a BAL into NALs can serve as a way to resolve the clumpy structure for outflows, and it can be used to learn more about characteristics of the clumpy structure and to test the outflow model, when utilizing high-resolution spectra and photoionization model.

Palliative Care Intervention in Improving Symptom Control and Quality of Life in Patients With Stage II-IV Non-small Cell Lung Cancer and Their Family Caregivers

Science.gov (United States)

2017-10-16

Caregiver; Psychological Impact of Cancer and Its Treatment; Recurrent 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; Stage IV Non-small Cell Lung Cancer

Staged membrane oxidation reactor system

Science.gov (United States)

Repasky, John Michael; Carolan, Michael Francis; Stein, VanEric Edward; Chen, Christopher Ming-Poh

2012-09-11

Ion transport membrane oxidation system comprising (a) two or more membrane oxidation stages, each stage comprising a reactant zone, an oxidant zone, one or more ion transport membranes separating the reactant zone from the oxidant zone, a reactant gas inlet region, a reactant gas outlet region, an oxidant gas inlet region, and an oxidant gas outlet region; (b) an interstage reactant gas flow path disposed between each pair of membrane oxidation stages and adapted to place the reactant gas outlet region of a first stage of the pair in flow communication with the reactant gas inlet region of a second stage of the pair; and (c) one or more reactant interstage feed gas lines, each line being in flow communication with any interstage reactant gas flow path or with the reactant zone of any membrane oxidation stage receiving interstage reactant gas.

Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis.

Science.gov (United States)

Leone, Bernardo Amadeo; Vallejo, Carlos Teodoro; Romero, Alberto Omar; Machiavelli, Mario Raúl; Pérez, Juan Eduardo; Leone, Julieta; Leone, José Pablo

2017-02-01

To analyze the prognostic influence of metastatic pattern (MP) compared with other biologic and clinical factors in stage IV breast cancer at initial diagnosis (BCID) and evaluate factors associated with specific sites of metastases (SSM). We evaluated women with stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results program from 2010 to 2013. MP was categorized as bone-only, visceral, bone and visceral (BV), and other. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with SSM. We included 9143 patients. Bone represented 37.5% of patients, visceral 21.9%, BV 28.8%, and other 11.9%. Median OS by MP was as follows: bone 38 months, visceral 21 months, BV 19 months, and other 33 months (P < 0.0001). Univariate analysis showed that higher number of metastatic sites had worse prognosis. In multivariate analysis, older age (hazard ratio 1.9), black race (hazard ratio 1.17), grade 3/4 tumors (hazard ratio 1.6), triple-negative (hazard ratio 2.24), BV MP (hazard ratio 2.07), and unmarried patients (hazard ratio 1.25) had significantly shorter OS. As compared with HR+/HER2- tumors, triple-negative and HR-/HER2+ had higher odds of brain, liver, lung, and other metastases. HR+/HER2+ had higher odds of liver metastases. All three subtypes had lower odds of bone metastases. There were substantial differences in OS according to MP. Tumor subtypes have a clear influence among other factors on SSM. We identified several prognostic factors that could guide therapy selection in treatment naïve patients.

Clinical Benefit of Second-Line Palliative Chemotherapy in Advanced Soft-Tissue Sarcoma

Directory of Open Access Journals (Sweden)

Anna Minchom

2010-01-01

Full Text Available Background. This paper aimed to assess the utility of second-line chemotherapy in patients with advanced soft-tissue sarcoma. Materials and Methods. A retrospective search of a prospectively maintained database identified patients treated between 1991 and 2005. Patients with gastrointestinal stromal tumours, small round cell tumours, and Ewing's sarcoma were excluded. Response was assessed using WHO and RECIST. Patients who achieved stable disease for 6 months or more were classified as having disease control. Results. Three hundred and seventy-nine patients received second-line chemotherapy. Eighty-six (22.7% achieved disease control. Median duration of response was 11 months (95% CI: 9–13. On multivariate analysis, pathological subtype, absence of lung metastases, and the use of combination chemotherapy were independent predictors of disease control. Twenty-eight (16.1% patients who failed to respond to first-line therapy achieved disease control. Eight (2.1% patients had sufficient downstaging to enable complete surgical resection. Progression-free survival was 23% at 6 months. Median overall survival was 8 months (95% CI: 7–10 months. On multivariate analysis, synovial histology and absence of lung metastases were associated with improved survival. Conclusion. Second-line chemotherapy can provide clinical benefit in over 20% of soft-tissue sarcoma patients.

A cross-sectional study exploring the incidence of and indications for second-stage cesarean delivery over three decades.

Science.gov (United States)

Pearson, Greg A; MacKenzie, Ian Z

2017-09-01

To observe the incidence of, indications for, and complications associated with second-stage cesarean delivery in 10-year intervals over 30 years. The present analysis of prospectively collected data compared cesarean deliveries during 1976, 1986, 1996, and 2006 at John Radcliffe Hospital in Oxford, UK (n=3222). Pregnancy, delivery, and neonatal details were reviewed. The proportion of deliveries by cesarean in the second stage of labor increased from 0.5% (22/4464) in 1976 to 2.1% (124/5998) in 2006 (Pcesarean deliveries during the second stage because of failed instrumental delivery also increased over the study period from 59.1% (13/22) in 1976 to 71.0% (88/124) in 2006. Compared with cesareans at other stages, uterine trauma (Pcesarean delivery. Neonates delivered by second-stage cesarean had lower Apgar scores (Pcesarean earlier in labor. A trend towards an increase in neonatal trauma with second-stage cesarean compared with cesarean delivery before labor or during the first stage did not reach statistical significance. The proportion of deliveries by cesarean in the second stage of labor increased; these deliveries were associated with greater maternal and neonatal morbidity, but were not influenced by the indication for cesarean. © 2017 International Federation of Gynecology and Obstetrics.

Current Treatments for Surgically Resectable, Limited-Stage, and Extensive-Stage Small Cell Lung Cancer.

Science.gov (United States)

Stinchcombe, Thomas E

2017-12-01

The prevalence of small cell lung cancer (SCLC) has declined in the U.S. as the prevalence of tobacco use has declined. However, a significant number of people in the U.S. are current or former smokers and are at risk of developing SCLC. Routine histological or cytological evaluation can reliably make the diagnosis of SCLC, and immunohistochemistry stains (thyroid transcription factor-1, chromogranin, synaptophysin, and CD56) can be used if there is uncertainty about the diagnosis. Rarely do patients present with SCLC amendable to surgical resection, and evaluation requires a meticulous workup for extra-thoracic metastases and invasive staging of the mediastinum. Resected patients require adjuvant chemotherapy and/or thoracic radiation therapy (TRT), and prophylactic cranial radiation (PCI) should be considered depending on the stage. For limited-stage disease, concurrent platinum-etoposide and TRT followed by PCI is the standard. Thoracic radiation therapy should be started early in treatment, and can be given twice daily to 45 Gy or once daily to 60-70 Gy. For extensive-stage disease, platinum-etoposide remains the standard first-line therapy, and the standard second-line therapy is topotecan. Preliminary studies have demonstrated the activity of immunotherapy, and the response rate is approximately 10-30% with some durable responses observed. Rovalpituzumab tesirine, an antibody drug conjugate, has shown promising activity in patients with high delta-like protein 3 tumor expression (approximately 70% of patients with SCLC). The emergence of these and other promising agents has rekindled interest in drug development in SCLC. Several ongoing trials are investigating novel agents in the first-line, maintenance, and second-line settings. This review will provide an update on the standard therapies for surgically resected limited-stage small cell lung cancer and extensive-stage small cell lung cancer that have been investigated in recent clinical trials. © Alpha

Efficacy of Icotinib treatment in patients with stage IIIb/IV non-small cell lung cancer.

Science.gov (United States)

Qin, Na; Yang, Xinjie; Zhang, Quan; Li, Xi; Zhang, Hui; Lv, Jialin; Wu, Yuhua; Wang, Jinghui; Zhang, Shucai

2014-05-01

To evaluate the efficacy and safety of Icotinib - an orally administered, highly potent selective inhibitor of epidermal growth factor receptor (EGFR) and its active mutations, in the treatment of patients with advanced non-small cell lung cancer (NSCLC). A total of 101 patients with stage IIIb/IV NSCLC were treated with 125 mg Icotinib three times a day until disease progression or intolerable toxicity. Response rate was evaluated using response evaluation criteria in solid tumors and progression-free survival (PFS) was collected. The overall response rate (ORR) and disease control rate (DCR) were 37.6% (38/101) and 79.2% (80/101), respectively. The median PFS was 6.5 months. Multivariate analysis showed that female gender (P= 0.048, 95% confidence interval [CI] 1.010-6.016) and occurrence of rash (P= 0.002, 95% CI 1.667-9.809) were the independent predictive factors for ORR, while a performance status (PS) score of 0-1 (P= 0.001, 95% CI 0.024-0.402) and rash (P= 0.042, 95% CI 1.089-76.557) were the independent predictive factors for DCR. In addition, PS scores of 0-1 (P Icotinib were rash (35.6%) and diarrhea (17.8%), which was tolerable. Treatment of stage IIIb/IV NSCLC patients with Icotinib was effective and tolerable, specifically in patients with EGFR mutation.

Infantile tibia vara: Treatment of Langenskiold stage IV

Directory of Open Access Journals (Sweden)

Umrani Salil

2008-01-01

Full Text Available An eight year old girl presented with a progressively increasing deformity of the left proximal tibia since last 2 years. She had no history of trauma, fever and swelling of left knee. There were no obvious signs of rickets/muscular dystrophy. She had 25 degrees of tibia vara clinically with lateral thrust and a prominent fibular head. The radiograph of left knee revealed tibia vara with medial beaking and a significant depression of the medial tibial epiphysis and metaphysis. A computed tomography (CTscan revealed significant depression of the medial tibial epiphysis but no bony bar in the physis or fusion of the medical tibial epiphysis. There was a posterior slope in addition to the medial one. She was treated with elevation of the medial tibial hemiplateau with subtuberosity valgus derotation dome osteotomy. She also underwent a lateral proximal tibial hemiphysiodesis (temporary stapling. A prophylactic subcutaneons anterolateral compartment fasciotomy was also performed. All osteotomies united in 2 months. All deformities were corrected and she regained a knee range of 0 to 130 degrees. At final followup (4 years, there was no recurrence of varus deformity, knee was stable, with 1cm of leg length discrepancy. In Langenskiold stage IV tibia vara, elevation of medial tibial plateau, a subtuberosity valgus derotation osteotomy and a concomitant lateral hemiephiphysiodesis has given good results.

THE SLOAN DIGITAL SKY SURVEY REVERBERATION MAPPING PROJECT: RAPID C iv BROAD ABSORPTION LINE VARIABILITY

Energy Technology Data Exchange (ETDEWEB)

Grier, C. J.; Brandt, W. N.; Trump, J. R.; Schneider, D. P. [Department of Astronomy and Astrophysics and Institute for Gravitation and the Cosmos, The Pennsylvania State University, 525 Davey Laboratory, University Park, PA 16802 (United States); Hall, P. B. [Department of Physics and Astronomy, York University, Toronto, ON M3J 1P3 (Canada); Shen, Yue [Carnegie Observatories, 813 Santa Barbara Street, Pasadena, CA 91101 (United States); Vivek, M.; Dawson, K. S. [Department of Physics and Astronomy, University of Utah, Salt Lake City, UT 84112 (United States); Ak, N. Filiz [Faculty of Sciences, Department of Astronomy and Space Sciences, Erciyes University, 38039 Kayseri (Turkey); Chen, Yuguang [Department of Astronomy, School of Physics, Peking University, Beijing 100871 (China); Denney, K. D.; Kochanek, C. S.; Peterson, B. M. [Department of Astronomy, The Ohio State University, 140 West 18th Avenue, Columbus, OH 43210 (United States); Green, Paul J. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Jiang, Linhua [Kavli Institute for Astronomy and Astrophysics, Peking University, Beijing 100871 (China); McGreer, Ian D. [Steward Observatory, The University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721-0065 (United States); Pâris, I. [INAF-Osservatorio Astronomico di Trieste, Via G. B. Tiepolo 11, I-34131 Trieste (Italy); Tao, Charling [Centre de Physique des Particules de Marseille, Aix-Marseille Universite, CNRS /IN2P3, 163, avenue de Luminy, Case 902, F-13288 Marseille Cedex 09 (France); Wood-Vasey, W. M. [PITT PACC, Department of Physics and Astronomy, University of Pittsburgh, 3941 O’Hara Street, Pittsburgh, PA 15260 (United States); Bizyaev, Dmitry, E-mail: grier@psu.edu [Apache Point Observatory and New Mexico State University, P.O. Box 59, Sunspot, NM, 88349-0059 (United States); and others

2015-06-10

We report the discovery of rapid variations of a high-velocity C iv broad absorption line trough in the quasar SDSS J141007.74+541203.3. This object was intensively observed in 2014 as a part of the Sloan Digital Sky Survey Reverberation Mapping Project, during which 32 epochs of spectroscopy were obtained with the Baryon Oscillation Spectroscopic Survey spectrograph. We observe significant (>4σ) variability in the equivalent width (EW) of the broad (∼4000 km s{sup −1} wide) C iv trough on rest-frame timescales as short as 1.20 days (∼29 hr), the shortest broad absorption line variability timescale yet reported. The EW varied by ∼10% on these short timescales, and by about a factor of two over the duration of the campaign. We evaluate several potential causes of the variability, concluding that the most likely cause is a rapid response to changes in the incident ionizing continuum. If the outflow is at a radius where the recombination rate is higher than the ionization rate, the timescale of variability places a lower limit on the density of the absorbing gas of n{sub e} ≳ 3.9 × 10{sup 5} cm{sup −3}. The broad absorption line variability characteristics of this quasar are consistent with those observed in previous studies of quasars, indicating that such short-term variability may in fact be common and thus can be used to learn about outflow characteristics and contributions to quasar/host-galaxy feedback scenarios.

Directions for attractive tokamak reactors: The ARIES-II and ARIES-IV second-stability designs

International Nuclear Information System (INIS)

Najmabadi, F.; Conn, R.W.

1993-01-01

ARIES is a research program to develop several visions of tokamak reactors with enhanced economic, safety, and environmental features. The ARIES study has developed four visions for tokamaks. All four designs are steady-state, 1000-MWe (net) power reactors. The ARIES-II and ARIES-IV designs assume potential advances in plasma physics (such as second-stability operation) predicted by theory but not yet established experimentally. The two designs have the same fusion plasma but different fusion-power-core. There are only minor differences between the ARIES-II and ARIES-IV plasma parameters. ARIES-IV is a 1000-MWe reactor with an average neutron wall loading of 3 MW/m 2 , and a mass power density of about 120 kWe/tonne of fusion power core. The reactor major radius is 6.1 m, the plasma minor radius is 1.5 m and the plasma elongation is 2, and the plasma triangularity is 0.67. The plasma current is low (6.8 MA), B on-axis is 7.7 T (corresponding to a maximum field at the coil of 16T), and the toroidal beta is 3.4% (Troyon coefficient = 6). The operating regime is optimized such that most of the plasma current (∼ 90%) is provided by the bootstrap current. ARIES-II uses liquid lithium as the coolant and tritium breeder. V-5Cr-5Ti is used as the structural material so that the potential of low-activation metallic blankets can be studied. ARIES-IV uses helium as the coolant, a solid tritium-breeding material (Li 2 O), and silicon carbide composite as structural material. The waste produced by neutron activation in both designs is found to meet the criteria allowing shallow-land burial under U.S. regulations. The cost of electricity for the ARIES-II-IV class of reactors is estimated to be about 20% lower than comparable, steady-state first-stability reactors (e.g. ARIES-I). 25 refs, 2 figs, 1 tab

Spectrum of bone marrow changes in patients of chronic kidney disease (stage iii, iv and v)

International Nuclear Information System (INIS)

Latif, R.K.; Khan, S.A.; Ahmad, S.Q.; Arshad, U.

2017-01-01

To see the various hematological changes in the bone marrow of patients with chronic kidney disease (CKD) stage III, IV and V. Study Design: Cross sectional observational study.Place and Duration of Study: Study was conducted in the department of haematology (Pathology), Army Medical College, Rawalpindi and duration was one year, from Mar 2015 to Feb 2016. Material and Methods: Patients of both sexes and all age groups with CKD stage III, IV and V were included in this study. Patients' histories were recorded. Complete blood counts, bone marrow aspiration and trephine biopsy were done and evaluated microscopically. Mean blood counts of the patients in three groups of CKD were compared. Frequencies of various bone marrow (BM) findings in patients of CKD were calculated. Results: Out of 57 patients, 41 (71.9%) were males while 16 (28%) were females. Mean age was 60 years. There was no statistically significant difference between the mean hemoglobin, mean white cell count and mean platelets count of the patients in three groups of CKD. Reactive changes due to underlying CKD and inflammation were the most frequent findings in the BM of the patients. Conclusion: Anaemia of mild to moderate severity and reactive changes in the BM are the most frequent haematological findings encountered in patients suffering from advanced stage CKD. Since CKD is predominantly a disease of the elderly so it is not rare to find the co-morbidities including plasmacytosis, malignancies and their effects on the BM in patients of CKD. (author)

Effectiveness of the second-stage rehabilitation in stroke patients with cognitive impairment.

Science.gov (United States)

Milinavičienė, Eglė; Rastenytė, Daiva; Kriščiūnas, Aleksandras

2011-01-01

The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients. The study sample comprised 226 stroke patients at the Viršužiglis Hospital of rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment. More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (Prehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment.

viking: identification and characterization of a second type IV collagen in Drosophila.

Science.gov (United States)

Yasothornsrikul, S; Davis, W J; Cramer, G; Kimbrell, D A; Dearolf, C R

1997-10-01

We have taken an enhancer trap approach to identify genes that are expressed in hematopoietic cells and tissues of Drosophila. We conducted a molecular analysis of two P-element insertion strains that have reporter gene expression in embryonic hemocytes, strain 197 and vikingICO. This analysis has determined that viking encodes a collagen type IV gene, alpha2(IV). The viking locus is located adjacent to the previously described DCg1, which encodes collagen alpha1(IV), and in the opposite orientation. The alpha2(IV) and alpha1(IV) collagens are structurally very similar to one another, and to vertebrate type IV collagens. In early development, viking and DCg1 are transcribed in the same tissue-specific pattern, primarily in the hemocytes and fat body cells. Our results suggest that both the alpha1 and alpha2 collagen IV chains may contribute to basement membranes in Drosophila. This work also provides the foundation for a more complete genetic dissection of collagen type IV molecules and their developmental function in Drosophila.

Capecitabine and oxaliplatin as second-line treatment in patients with carcinoma of unknown primary site

DEFF Research Database (Denmark)

Møller, Anne Kirstine Hundahl; Pedersen, Karen Damgaard; Abildgaard, Julie Rafn

2010-01-01

tumours may be overrepresented. These patients could be candidates for GI tract-directed therapy. We here report the results obtained with oxaliplatin and capecitabine as second-line therapy in 25 recurrent/refractory CUP patients following first-line treatment with paclitaxel, cisplatin and gemcitabine.......Treatment of patients with carcinoma of unknown primary site (CUP) remains a challenge, and no effective second-line treatment has been identified. In CUP patients who are non-responsive or relapse early after first-line platinum/taxane-based regimens, it is likely that gastrointestinal (GI) tract...

Superselective intra-arterial infusion chemotherapy for stage III/IV squamous cell carcinomas of the oral cavity: Midterm results

International Nuclear Information System (INIS)

Ikushima, I.; Korogi, Y.; Ishii, A.; Hirai, T.; Yamura, M.; Nishimura, R.; Baba, Y.; Yamashita, Y.; Shinohara, M.

2008-01-01

Purpose: We performed superselective intra-arterial infusion chemotherapy (SIC) according to a protocol in which drug distribution is evaluated by the use of interventional radiology (IVR)-computed tomography (CT) system, and the chemotherapy is combined with medium-dose conformal radiation therapy (CRT). We analyzed retrospectively the factors that affect the midterm survival ratio, including local response, for stage III and IV squamous cell carcinomas of the oral cavity. Materials and methods: Forty consecutive patients with stage III and IV squamous cell carcinomas of the oral cavity and who had undergone both SIC and CRT were enrolled. A microcatheter was placed in the appropriate feeding artery of the tumor and cisplatin (50 mg/body) was infused twice. CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Histopathologic effects were classified into five grades: grade 0 or 1 was defined as a poor response, and grade II or higher as a good response. Age, sex, stage, local response to treatment, mode of invasion and lymph node metastasis were analyzed, and differences in the midterm survival ratio were assessed. Results: The 3-year survival ratio of the 40 cases was 67%. A good local response (III or IV) was achieved in 75% of the cases. The survival ratio of the good local response group was significantly better than that of the poor response group (p = 0.04). Mode of invasion (p = 0.03) and lymph node metastasis (p = 0.01) were also predictive of survival. In the multivariable analysis of survival, however, no variables including good local response (p = 0.12), were predictive. Conslusion: Our new protocol improved local response, but it did not contribute to the survival ratio

Diet and Physical Activity Change or Usual Care in Improving Progression-Free Survival in Patients With Previously Treated Stage II, III, or IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Science.gov (United States)

2018-02-14

Fallopian Tube Clear Cell Adenocarcinoma; Fallopian Tube Endometrioid Adenocarcinoma; Fallopian Tube Mucinous Adenocarcinoma; Fallopian Tube Serous Adenocarcinoma; Fallopian Tube Transitional Cell Carcinoma; Malignant Ovarian Brenner Tumor; Ovarian Clear Cell Adenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Adenocarcinoma; Ovarian Seromucinous Carcinoma; Ovarian Serous Adenocarcinoma; Ovarian Transitional Cell Carcinoma; Primary Peritoneal Serous Adenocarcinoma; Stage IIA Fallopian Tube Cancer AJCC v6 and v7; Stage IIA Ovarian Cancer AJCC V6 and v7; Stage IIB Fallopian Tube Cancer AJCC v6 and v7; Stage IIB Ovarian Cancer AJCC v6 and v7; Stage IIC Fallopian Tube Cancer AJCC v6 and v7; Stage IIC Ovarian Cancer AJCC v6 and v7; Stage IIIA Fallopian Tube Cancer AJCC v7; Stage IIIA Ovarian Cancer AJCC v6 and v7; Stage IIIA Primary Peritoneal Cancer AJCC v7; Stage IIIB Fallopian Tube Cancer AJCC v7; Stage IIIB Ovarian Cancer AJCC v6 and v7; Stage IIIB Primary Peritoneal Cancer AJCC v7; Stage IIIC Fallopian Tube Cancer AJCC v7; Stage IIIC Ovarian Cancer AJCC v6 and v7; Stage IIIC Primary Peritoneal Cancer AJCC v7; Stage IV Fallopian Tube Cancer AJCC v6 and v7; Stage IV Ovarian Cancer AJCC v6 and v7; Stage IV Primary Peritoneal Cancer AJCC v7; Undifferentiated Fallopian Tube Carcinoma; Undifferentiated Ovarian Carcinoma

Effects of pushing techniques during the second stage of labor: A randomized controlled trial.

Science.gov (United States)

Koyucu, Refika Genç; Demirci, Nurdan

2017-10-01

Spontaneous pushing is a method that is used in the management of the second stage of labor and suggested to be more physiological for the mother and infant. The present study aims to evaluate the effects of pushing techniques on the mother and newborn. This randomized prospective study was performed between June 2013-March 2014 in a tertiary maternity clinic in Istanbul. 80 low risk, nulliparous cases were randomized to pushing groups. Valsalva pushing group was told to hold their breath while pushing. No visual-verbal instructions were given to spontaneous pushing group and they were encouraged to push without preventing respiration. Demographic data, second stage period, perineal laceration rates, fetal heart rate patterns, presence of meconium stained amniotic liquid, newborn APGAR scores, POP-Q examination and Q-tip test results were evaluated in these cases. The second stage of labor was significantly longer with spontaneous pushing. Decrease in Hb levels in valsalva pushing group was determined to be higher than spontaneous pushing group. An increased urethral mobility was observed in valsalva pushing group. Although the duration of the second stage of labor was longer compared to valsalva pushing technique, women were able to give birth without requiring any verbal or visual instruction, without exceeding the limit value of two hours and without affecting fetal wellness and neonatal results. Copyright © 2017. Published by Elsevier B.V.

A budget-impact and cost-effectiveness model for second-line treatment of major depression.

Science.gov (United States)

Malone, Daniel C

2007-07-01

Depressed patients who initially fail to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. The purpose of this study was to evaluate the effectiveness, cost, cost-effectiveness, and budget impact of second-line pharmacologic treatment for major depressive disorder (MDD). A cost-effectiveness analysis was conducted to evaluate second-line therapies (citalopram, escitalopram, fluoxetine, paroxetine, paroxetine controlled release [CR], sertraline, and venlafaxine extended release [XR]) for the treatment of depression. Effectiveness data were obtained from published clinical studies. The primary outcome was remission defined as a score of 7 or less on the Hamilton Rating Scale for Depression (HAM-D) or a score of 10 or less on the montgomery-Asberg Depression Rating Scale (MADRS) depression rating scales. The wholesale acquisition cost (WAC) for medications and medical treatment costs for depression were included. The perspective was derived from a managed care organization (MCO) with 500,000 members, a 1.9% annual incidence of depression, and treatment duration of 6 months. Assumptions included: second-line treatment is not as effective as first-line treatment, WAC price reflects MCO costs, and side effects were identical. Sensitivity analyses were conducted to determine variables that influenced the results. Second-line remission rates were 20.4% for venlafaxine XR, 16.9% for sertraline, 16.4% for escitalopram, 15.1% for generic SSRIs (weighted average), and 13.6% for paroxetine CR. Pharmacy costs ranged from $163 for generic SSRIs to $319 for venlafaxine SR. Total cost per patient achieving remission was $14,275 for venlafaxine SR, followed by $16,100 for escitalopram. The incremental cost-effectiveness ratio (ICER) for venlafaxine SR compared with generic SSRIs was $2,073 per patient achieving remission, followed by escitalopram with an ICER of $3,566. The model was most sensitive to other therapies

Calculated Resonance Line Profiles of [Mg II], [C II], and [Si IV] in the Solar Atmosphere

Science.gov (United States)

Avrett, E.; Landi, E.; McKillop, S.

2013-12-01

NASA's Interface Region Imaging Spectrograph space mission, launched 2013 June 27, is intended to study the structure of the solar chromosphere and the transition region between the chromosphere and corona. The spectral lines to be observed include the Mg II k line at 2796.5 Å, the C II 1334.5 Å line, and the Si IV line at 1393.8 Å, which are formed in the middle chromosphere, the upper chromosphere, and the lower transition region, respectively. Here we calculate the profiles of these lines from four models of the solar atmosphere, intended to represent the faint and mean internetwork, a network lane, and bright network. We show how the profiles change from the center of the solar disk toward the limb of the Sun and in response to outflows and inflows. These results are intended to cover the range of expected quiet-Sun observations and assist in their interpretation. We expect that the observations will lead to improvements in the models, which can then be used to estimate the required non-radiative heating in the different regions.

Calculated resonance line profiles of [Mg II], [C II], and [Si IV] in the solar atmosphere

International Nuclear Information System (INIS)

Avrett, E.; McKillop, S.; Landi, E.

2013-01-01

NASA's Interface Region Imaging Spectrograph space mission, launched 2013 June 27, is intended to study the structure of the solar chromosphere and the transition region between the chromosphere and corona. The spectral lines to be observed include the Mg II k line at 2796.5 Å, the C II 1334.5 Å line, and the Si IV line at 1393.8 Å, which are formed in the middle chromosphere, the upper chromosphere, and the lower transition region, respectively. Here we calculate the profiles of these lines from four models of the solar atmosphere, intended to represent the faint and mean internetwork, a network lane, and bright network. We show how the profiles change from the center of the solar disk toward the limb of the Sun and in response to outflows and inflows. These results are intended to cover the range of expected quiet-Sun observations and assist in their interpretation. We expect that the observations will lead to improvements in the models, which can then be used to estimate the required non-radiative heating in the different regions.

Prediction of survival in patients with Stage IV kidney cancer

Directory of Open Access Journals (Sweden)

L. V. Mirilenko

2015-01-01

Full Text Available The efficiency of treatment was evaluated and the predictors of adjusted survival (AS were identified in patients with disseminated kidney cancer treated at the Republican Research and Practical Center for Oncology and Medical Radiology in 1999 to 2011 (A.E. Okeanov, P.I. Moiseev, L.F. Levin. Malignant tumors in Belarus, 2001–2012. Edited by O.G. Sukonko. Seven factors (regional lymph node metastases; distant bone metastases; a high-grade tumor; sarcomatous tumor differentiation; hemoglobin levels of < 125 g/l in women and < 150 g/l in men; an erythrocyte sedimentation rate of 40 mm/h; palliative surgery were found to have an independent, unfavorable impact on AS. A multidimensional model was built to define what risk group low (no more than 2 poor factors, moderate (3–4 poor factors, and high (more than 4 poor factors the patients with Stage IV kidney cancer belonged to. In these groups, the median survival was 34.7, 17.2, and 4.0 months and 3-year AS rates were 48.6, 24.6, and 3.2 %, respectively. 

Metronomic capecitabine as second-line treatment in hepatocellular carcinoma after sorafenib failure.

Science.gov (United States)

Granito, Alessandro; Marinelli, Sara; Terzi, Eleonora; Piscaglia, Fabio; Renzulli, Matteo; Venerandi, Laura; Benevento, Francesca; Bolondi, Luigi

2015-06-01

No standard second-line treatments are available for hepatocellular carcinoma patients who fail sorafenib therapy. We assessed the safety and efficacy of metronomic capecitabine after first-line sorafenib failure. Retrospective analysis of consecutive hepatocellular carcinoma patients receiving metronomic capecitabine between January 2012 and November 2014. The primary end-point was safety, secondary end-point was efficacy, including time-to-progression and overall survival. Twenty-six patients (80% Child-Pugh A, 80% Barcelona Clinic Liver Cancer stage C) received metronomic capecitabine (500 mg/bid). Median treatment duration was 3.2 months (range 0.6-31). Fourteen (53%) patients experienced at least one adverse event. The most frequent drug-related adverse events were bilirubin elevation (23%), fatigue (15%), anaemia (11%), lymphoedema (11%), and hand-foot syndrome (7.6%). Treatment was interrupted in 19 (73%) for disease progression, in 4 (15%) for liver deterioration, and in 1 (3.8%) for adverse event. Disease control was achieved in 6 (23%) patients. Median time-to-progression was 4 months (95% confidence interval 3.2-4.7). Median overall survival was 8 months (95% confidence interval 3.7-12.3). Metronomic capecitabine was well tolerated in hepatocellular carcinoma patients who had been treated with sorafenib. Preliminary data show potential anti-tumour activity with long-lasting disease control in a subgroup of patients that warrants further evaluation in a phase III study. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Magnetic resonance imaging of the active second stage of labour: Proof of principle

International Nuclear Information System (INIS)

Guettler, F.V.; Heinrich, A.; Rump, J.; Bucourt, M. de; Hamm, B.; Teichgraeber, U.K.; Schnackenburg, B.; Bamberg, C.

2012-01-01

To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible. Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour. Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts. CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications. (orig.)

Factors associated with a poor prognosis for the IVF-ICSI live birth rate in women with rAFS stage III and IV endometriosis.

Science.gov (United States)

Roux, Pauline; Perrin, Jeanne; Mancini, Julien; Agostini, Aubert; Boubli, Léon; Courbiere, Blandine

2017-07-01

To assess the factors associated with a poor prognosis for a cumulative IVF live birth rate (LBR) in women with stage III and IV endometriosis according to the revised classification of the American Fertility Society (rAFS). A retrospective cohort study was conducted between January 1, 2010, and December 31, 2014, in our Reproductive Medicine Center. We analyzed different factors associated with a poor prognosis for a cumulative IVF LBR in women with rAFS stage III and IV endometriosis. A total of 101 patients were included, representing 232 IVF-ICSI cycles and 212 embryo transfers. The primary endpoint was the cumulative LBR per cycle and per patient. The cumulative LBR per cycle was 14.7% (n = 34) and that per patient was 31.7% (n = 32). The cumulative LBR was significantly decreased by active smoking [ adj OR = 3.4, 95% CI (1.12-10.60), p = 0.031], poor ovarian response (POR) according to the Bologna criteria [ adj OR = 11.5, 95% CI (1.37-96.83), p = 0.024], and rAFS stage IV [ adj OR = 3.2, 95% CI (1.13-8.95), p = 0.024]. The cumulative LBR per women was 59.4% without factors associated with a poor prognosis and 25.6% in the case of one factor, and it decreased to 7.7% in the case of two or three factors (p endometriosis had a negative impact on the IVF-ICSI cumulative LBR for women with rAFS stage III and IV endometriosis. Because smoking dramatically decreases the LBR with endometriosis, stopping smoking before IVF-ICSI should be strongly advised.

INDIRECT EVIDENCE: MILD ALZHEIMER’S DISEASE & CANNABIS AFFECT THE SECOND STAGE OF FREE RECALL SUGGESTING LOCALIZATION IN HIPPOCAMPAL CA1

Directory of Open Access Journals (Sweden)

Eugen Tarnow

2016-12-01

Full Text Available Recently it was shown explicitly that free recall consists of two stages: the first few recalls empty working memory and a second stage, a reactivation stage, concludes the recall ([20]; for a review of the theoretical prediction see [15]. Here it is shown that the serial position curve changes in mild Alzheimer’s disease (AD and acute cannabis usage - lowered total recall and lessened primacy - are similar to second stage recall and different from working memory recall.Since cannabis and AD affect the second stage of free recall, the intersection of the two localizes the second stage of free recall to the CA1 area of the hippocampus. Since the second stage of recall uses a retrieval process that is accompanied by a linear rise in the error rate [18] this error generating mechanism should give clues to the structure of the corresponding neural network.

Locally Advanced Stage IV Squamous Cell Carcinoma of the Head and Neck: Impact of Pre-Radiotherapy Hemoglobin Level and Interruptions During Radiotherapy

International Nuclear Information System (INIS)

Rades, Dirk; Stoehr, Monika; Kazic, Nadja; Hakim, Samer G.; Walz, Annette; Schild, Steven E.; Dunst, Juergen

2008-01-01

Purpose: Stage IV head and neck cancer patients carry a poor prognosis. Clear understanding of prognostic factors can help to optimize care for the individual patient. This study investigated 11 potential prognostic factors including pre-radiotherapy hemoglobin level and interruptions during radiotherapy for overall survival (OS), metastases-free survival (MFS), and locoregional control (LC) after radiochemotherapy. Methods and Materials: Eleven factors were investigated in 153 patients receiving radiochemotherapy for Stage IV squamous cell head and neck cancer: age, gender, Karnofsky performance score (KPS), tumor site, grading, T stage, N stage, pre-radiotherapy hemoglobin level, surgery, chemotherapy type, and interruptions during radiotherapy >1 week. Results: On multivariate analysis, improved OS was associated with KPS 90-100 (relative risk [RR], 2.36; 95% confidence interval [CI], 1.20-4.93; p = .012), hemoglobin ≥12 g/dL (RR, 1.88; 95% CI, 1.01-3.53; p = .048), and no radiotherapy interruptions (RR, 2.59; 95% CI, 1.15-5.78; p = .021). Improved LC was significantly associated with lower T stage (RR, 2.17; 95% CI, 1.16-4.63; p = .013), hemoglobin ≥12 g/dL (RR, 4.12; 95% CI, 1.92-9.09; p 1 week. It appears important to avoid anemia and radiotherapy interruptions to achieve the best treatment results

Preoperative chemoradiotherapy using superselective intraarterial infusion via superficial temporal artery for stage III, IV oral cancer

Energy Technology Data Exchange (ETDEWEB)

Tohnai, Iwai; Shigetomi, Toshio [Nagoya Univ. (Japan). Graduate School of Medicine; Hayashi, Yasushi [Nagoya Second Red Cross Hospital (Japan)] (and others)

2002-03-01

Thirty-eight patients with stage III, IV oral cancer were treated by preoperative chemoradiotherapy using superselective intraarterial infusion via the superficial temporal artery. Radiotherapy (total dose: 40 Gy) and chemotherapy using CBDCA (total dose: 460 mg/m{sup 2}) were performed daily, followed by surgery. Catheter-insertion of 34 patients was done successfully. Four catheter insertions were not done successfully because of the anomaly of the artery such as common trunk of the lingual artery and the facial artery. The clinical effects were CR in 9 patients (26.5%) and PR in 25 (73.5%), and histopathological effects after surgery were grade III, IV in 10 (29.4%), grade IIb in 23 (67.6%), and grade IIa in 2 (5.8%). The 5-year cumulative survival rate was 67.8%. This superselective intra arterial infusion method could be the technique of choice for the treatment of oral cancer. (author)

Preoperative chemoradiotherapy using superselective intraarterial infusion via superficial temporal artery for stage III, IV oral cancer

International Nuclear Information System (INIS)

Tohnai, Iwai; Shigetomi, Toshio

2002-01-01

Thirty-eight patients with stage III, IV oral cancer were treated by preoperative chemoradiotherapy using superselective intraarterial infusion via the superficial temporal artery. Radiotherapy (total dose: 40 Gy) and chemotherapy using CBDCA (total dose: 460 mg/m 2 ) were performed daily, followed by surgery. Catheter-insertion of 34 patients was done successfully. Four catheter insertions were not done successfully because of the anomaly of the artery such as common trunk of the lingual artery and the facial artery. The clinical effects were CR in 9 patients (26.5%) and PR in 25 (73.5%), and histopathological effects after surgery were grade III, IV in 10 (29.4%), grade IIb in 23 (67.6%), and grade IIa in 2 (5.8%). The 5-year cumulative survival rate was 67.8%. This superselective intra arterial infusion method could be the technique of choice for the treatment of oral cancer. (author)

Radiotherapy for stage IV oropharyngeal cancer

International Nuclear Information System (INIS)

Nakamura, Kaori; Akimoto, Tetsuo; Motegi, Atsushi

2008-01-01

Fifty-seven patients with stage IVA-B oropharyngeal cancer treated by definitive radiotherapy in our facility from January 1993 to August 2005 were retrospectively analyzed. The age of the patients was 34-84 (median 62) years old. Thirty-four were male and 14 were female. Subsite of the tumor was anterior: 16, lateral: 39, posterior: 1, and superior: 1. Forty-nine patients were treated with chemotherapy. Induction chemotherapy (ICT) was done in 25 patients, ICT+concurrent chemoradiotherapy (CCRT) in 15 patients, and CCRT in 9 patients. A dose of 60-82 Gy (median 72 Gy) by hyperfractionated radiotherapy, at 1.2 Gy/fraction twice a day, was delivered in 37 patients, and 60-72 Gy (median 66 Gy) with a conventional daily fractionation in 20 patients. Salvage surgery was performed in 5 patients as a part of primary treatment after radiotherapy. The 5-year cause-specific survival rate and disease-free survival rate were 52.9% and 51.4%, respectively. By univariate analysis, the impact of age, sex, T-stage, N-stage, histological differentiation, chemotherapy and fractionation of radiation therapy on survivals were evaluated. T-stage, N-stage and histological differentiation were significantly covariate correlated with survival. The treatment results were not satisfactory. Further investigation of the treatment strategy to improve the treatment outcome of advanced oropharyngeal cancer is desired. (author)

Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis.

Science.gov (United States)

Birolo, Carolina; Zannin, Maria Elisabetta; Arsenyeva, Svetlana; Cimaz, Rolando; Miserocchi, Elisabetta; Dubko, Margarita; Deslandre, Chantal Job; Falcini, Fernanda; Alessio, Maria; La Torre, Francesco; Denisova, Ekaterina; Martini, Giorgia; Nikishina, Irina; Zulian, Francesco

2016-11-01

Abatacept (ABA) has recently been proposed as second-line treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis refractory to anti-tumor necrosis factor-α (anti-TNF) agents, but little is known about its efficacy as a first-line approach. The aim of the present study was to compare the safety and efficacy of ABA as a first-line biological agent (ABA-1) with that of ABA as a second-line treatment after 1 or more anti-TNF agents (ABA-2), in patients with severe JIA-related uveitis. In this multicenter study, we collected data on patients with severe JIA-related uveitis treated with ABA as a first-line or second-line biological agent. Changes in frequency of uveitis flares/year and ocular complications before and after ABA treatment, clinical remission, and side effects were recorded. Thirty-five patients with a mean age of 10.8 years were treated with ABA for a mean period of 19.6 months. In 4 patients, ABA administration was discontinued, owing to inefficacy on arthritis in 3 cases and allergic reaction in 1. Thirty-one patients, 14 in the ABA-1 group and 17 in the ABA-2 group, completed the 12-month followup period; of these, 17 (54.8%) had clinical remission. The mean frequency of uveitis flares decreased from 4.1 to 1.2 in the ABA-1 group (p = 0.002) and from 3.7 to 1.2 in the ABA-2 group (p = 0.004). Preexisting ocular complications improved or remained stable in all but 5 patients, all in the ABA-2 group. No significant difference was found between the efficacy of the 2 treatment modalities. ABA confirmed its good safety profile. ABA, used as first-line biological treatment or after 1 or more anti-TNF agents, induces a comparable improvement in severe refractory JIA-related uveitis.

CONCEPTS OF IMPROVING CURRENT PROTECTION OF POWER-GRID LINES

Directory of Open Access Journals (Sweden)

F. A. Romaniuk

2015-01-01

Full Text Available The  6–35  kV  power-grid  current  protection  serves  to  protect  the  transmission  lines against phase-to-phase short-circuits. The major disadvantage of it lies in the relatively large time delays of the last stages especially in the main sections of the grid owing to the stepped relay characteristics as well as a large number of the steps. A full-fledged protection of the 6–35 kV lines against inter-phase short circuits can be provided by the two-stage current protection: the first stage being the current cutoff without any time delay and the second stage – the maximum current protection where the time delay is linear contingent on the distance between the protection placement and the fault-point location. The article introduces the rating formulae for the time delays of the second-stage and their exemplary graphic presentation. The authors offer a variant for solving the problem with computation of the second-stage time delays in those instances where several feeders diverge from the bus bars of the substation located in the end of the protected line.Improving current protections for the 6–35 kV transmission lines with one-end power supply against interphase short-circuits can be based on the collective application of the following principles: accounting for the type and location of the short-circuit which provides for the high-performance cutoff zone instantaneous expansion and its independence on the mode of failure and the grid operation mode. It also allows increase of the last stage sensitiveness towards asymmetrical short-circuits; detection of the short-circuit location only on the results of fault currents measurement which simplifies the protection implementation; realization of the last (second protection stage with linear-dependent time delay which ensures potentiality of its operation speed increase.

Micro-mechanical modelling of ductile failure in 6005A aluminium using a physics based strain hardening larw including stage IV

DEFF Research Database (Denmark)

Simar, Aude; Nielsen, Kim Lau; de Meester, Bruno

2010-01-01

The strain hardening and damage behaviour of isothermally heat treated 6005A aluminium is investigated in order to link the thermal treatment conditions, microstructure and fracture strain. The need for a plastic flow rule involving a stage IV hardening at large strain was found essential to gene...

Systematic review, meta-analysis, and meta-regression: Successful second-line treatment for Helicobacter pylori.

Science.gov (United States)

Muñoz, Neus; Sánchez-Delgado, Jordi; Baylina, Mireia; Puig, Ignasi; López-Góngora, Sheila; Suarez, David; Calvet, Xavier

2018-06-01

Multiple Helicobacter pylori second-line schedules have been described as potentially useful. It remains unclear, however, which are the best combinations, and which features of second-line treatments are related to better cure rates. The aim of this study was to determine that second-line treatments achieved excellent (>90%) cure rates by performing a systematic review and when possible a meta-analysis. A meta-regression was planned to determine the characteristics of treatments achieving excellent cure rates. A systematic review for studies evaluating second-line Helicobacter pylori treatment was carried out in multiple databases. A formal meta-analysis was performed when an adequate number of comparative studies was found, using RevMan5.3. A meta-regression for evaluating factors predicting cure rates >90% was performed using Stata Statistical Software. The systematic review identified 115 eligible studies, including 203 evaluable treatment arms. The results were extremely heterogeneous, with 61 treatment arms (30%) achieving optimal (>90%) cure rates. The meta-analysis favored quadruple therapies over triple (83.2% vs 76.1%, OR: 0.59:0.38-0.93; P = .02) and 14-day quadruple treatments over 7-day treatments (91.2% vs 81.5%, OR; 95% CI: 0.42:0.24-0.73; P = .002), although the differences were significant only in the per-protocol analysis. The meta-regression did not find any particular characteristics of the studies to be associated with excellent cure rates. Second-line Helicobacter pylori treatments achieving>90% cure rates are extremely heterogeneous. Quadruple therapy and 14-day treatments seem better than triple therapies and 7-day ones. No single characteristic of the treatments was related to excellent cure rates. Future approaches suitable for infectious diseases-thus considering antibiotic resistances-are needed to design rescue treatments that consistently achieve excellent cure rates. © 2018 John Wiley & Sons Ltd.

Efficacy and Safety of First-line Avelumab Treatment in Patients With Stage IV Metastatic Merkel Cell Carcinoma: A Preplanned Interim Analysis of a Clinical Trial.

Science.gov (United States)

D'Angelo, Sandra P; Russell, Jeffery; Lebbé, Céleste; Chmielowski, Bartosz; Gambichler, Thilo; Grob, Jean-Jacques; Kiecker, Felix; Rabinowits, Guilherme; Terheyden, Patrick; Zwiener, Isabella; Bajars, Marcis; Hennessy, Meliessa; Kaufman, Howard L

2018-03-22

Merkel cell carcinoma (MCC) is an aggressive skin cancer that is associated with poor survival outcomes in patients with distant metastatic disease. Results of part A of the JAVELIN Merkel 200 trial (avelumab in patients with Merkel cell carcinoma) showed that avelumab, an anti-programmed cell death ligand 1 (PD-L1) antibody, demonstrated efficacy in second-line or later treatment of patients with metastatic MCC (mMCC). To evaluate the efficacy and safety of avelumab as first-line treatment for patients with distant mMCC. JAVELIN Merkel 200 part B is an international, multicenter, single-arm, open-label clinical trial of first-line avelumab monotherapy. Eligible patients were adults with mMCC who had not received prior systemic treatment for metastatic disease. Patients were not selected for PD-L1 expression or Merkel cell polyomavirus status. Data were collected from April 15, 2016, to March 24, 2017, and enrollment is ongoing. Patients received avelumab, 10 mg/kg, by 1-hour intravenous infusion every 2 weeks until confirmed disease progression, unacceptable toxic effects, or withdrawal occurred. Tumor status was assessed every 6 weeks and evaluated by independent review committee per Response Evaluation Criteria in Solid Tumors version 1.1. The primary end point was durable response, defined as an objective response with a duration of at least 6 months. Secondary end points include best overall response, duration of response, progression-free survival, safety, and tolerability. As of March 24, 2017, 39 patients were enrolled (30 men and 9 women; median age, 75 years [range, 47-88 years]), with a median follow-up of 5.1 months (range, 0.3-11.3 months). In a preplanned analysis, efficacy was assessed in 29 patients with at least 3 months of follow-up; the confirmed objective response rate was 62.1% (95% CI, 42.3%-79.3%), with 14 of 18 responses (77.8%) ongoing at the time of analysis. In responding patients, the estimated proportion with duration of response of at

Contemporary second stage labor patterns in Taiwanese women with normal neonatal outcomes

Directory of Open Access Journals (Sweden)

Tai-Ho Hung

2015-08-01

Conclusion: Modern Taiwanese women who achieved vaginal delivery without adverse neonatal outcomes experienced longer second stage labors than women 25 years ago. The 95th percentile thresholds differed between nulliparous and multiparous women with and without epidural analgesia.

Determination of uranium (IV) by flow voltammetry

International Nuclear Information System (INIS)

Ding Anqing

1987-01-01

According to the quantitative reaction of U(IV) and Fe(III) in H 2 SO 4 as well as the relation between current and concentration of substance detected, U(IV) has been determined indirectly by measurement of the electrolysis current of residual Fe(III). The columniform electrode used is made of glass carbon particles. At the range of U(IV) from a few micrograms to 40 μg, the linear relation is excellent. The relative standard deviation is within ±4%. The interference of Fe(II), Ti(IV) and U(VI) is negligible but of Ti(III) is serious. This method has been successfully applied in the determination of actual samples (both out line and on line). Main advantages of this procedure are rapid, simple, small amount of sample (only at microgram level) and easy to realize automation, able to use for on line or process analysis

Bone radioisotope scanning: usefulness in the evaluation and observation of patients with breast cancer in clinical stage II, III, IV

International Nuclear Information System (INIS)

Cano P, R.A.

1995-01-01

The clinical records of 420 patients with diagnosis of breast cancer well documented by the pathological anatomy in clinical stage II, III and IV were reviewed. In each one of them has been done at least a bone scanning during the diagnosis. In 52 cases carried out sericeous dosages of CA 15-3 and in some cases it was necessary to administer Samarium-153 EDTMP as palliative therapy of bone pain. The presence of secondary gamma-graphic focuses was 0/84 cases (0%) in clinical stage II, 54/265 cases (20%) in III and 41/91 cases (45%) in IV. The one focus appeared in 6.7% of the cases. In 7 of the 52 cases that received sericeous dosages of CA 15-3 were detected secondary osseous lesions, and 5 of them presented a marker elevation. The bone scanning has shown in many cases the presence of getters focuses in singular places of skeleton, urinary excretory system or mammary tissue. The gamma rays from Sm-153 allowed us to get some appropriate basal views post-therapy of the secondary lesions. The results show that the great incidence of secondary lesions in the skeleton occurred in cases of stages III and IV unlike other countries. The serial repetition of the radioisotope scanning. The presence of one focus in the skeleton of a patient with a well-known neoplasia makes us to do a careful evaluation of the focus nature. The presence of tracer accumulation in the kidney, ureter and bladder allows us to infer the pathology of excretory system that is the first evidence of its presence in many cases. (author). 71 refs., 7 figs., 6 tabs

Lung-MAP: Talazoparib in Treating Patients With HRRD Positive Recurrent Stage IV Squamous Cell Lung Cancer

Science.gov (United States)

2018-05-31

ATM Gene Mutation; ATR Gene Mutation; BARD1 Gene Mutation; BRCA1 Gene Mutation; BRCA2 Gene Mutation; BRIP1 Gene Mutation; CHEK1 Gene Mutation; CHEK2 Gene Mutation; FANCA Gene Mutation; FANCC Gene Mutation; FANCD2 Gene Mutation; FANCF Gene Mutation; FANCM Gene Mutation; NBN Gene Mutation; PALB2 Gene Mutation; RAD51 Gene Mutation; RAD51B Gene Mutation; RAD54L Gene Mutation; Recurrent Squamous Cell Lung Carcinoma; RPA1 Gene Mutation; Stage IV Squamous Cell Lung Carcinoma AJCC v7

Splenectomy vs. rituximab as a second-line therapy in immune thrombocytopenic purpura: a single center experience.

Science.gov (United States)

Al Askar, Ahmed S; Shaheen, Naila A; Al Zahrani, Mohsen; Al Otaibi, Mohammed G; Al Qahtani, Bader S; Ahmed, Faris; Al Zughaibi, Mohand; Kamran, Ismat; Mendoza, May Anne; Khan, Altaf

2018-01-01

Immune thrombocytopenic purpura (ITP) is a common hematological disease treated primarily by corticosteroids. The aim of the present study was to compare response rate between patients, underwent splenectomy vs. rituximab as second-line therapy. Adult patients diagnosed with ITP who did not respond to corticosteroids or relapsed during the period 1990-2014 were included in a quasi-experimental study. Categorical variables were compared using Fisher exact test. Response to treatment was compared using logistic regression. Data were analyzed using SAS V9.2. One-hundred and forty-three patients with ITP were identified through medical records. Of 62 patients treated, 30 (48.38%) required second-line therapy. 19 (63%) patients received rituximab, and 11 (37%) underwent splenectomy. Platelets at diagnosis were not different between study groups (p = 0.062). Splenectomy group patients were younger (p = 0.011). Response to second-line therapy showed no significant difference between two groups (OR 2.03, 95% CI (0.21-22.09), p = 0.549). Results did not show a statistically significant difference in platelet counts over time between treatment groups (p = 0.101). When used exclusively as a second-line therapy for steroid-refractory ITP, the response rate was not statistically different between rituximab and splenectomy. However, further large studies are needed to assess the response rates for these treatment modalities as a second-line therapy.

Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.

Science.gov (United States)

Gillesby, Erica; Burns, Suzan; Dempsey, Amy; Kirby, Shirley; Mogensen, Kami; Naylor, Kelly; Petrella, Joann; Vanicelli, Rebecca; Whelan, Breon

2010-01-01

To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue. Randomized clinical trial. Labor and delivery unit of a not-for-profit community hospital. Convenience sample of nulliparous laboring women with epidural anesthesia. Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation. The length of pushing, total length of the second stage, and maternal fatigue. A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05). We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Second-line systemic therapy for metastatic colorectal cancer.

Science.gov (United States)

Mocellin, Simone; Baretta, Zora; Roqué I Figuls, Marta; Solà, Ivan; Martin-Richard, Marta; Hallum, Sara; Bonfill Cosp, Xavier

2017-01-27

The therapeutic management of people with metastatic colorectal cancer (CRC) who did not respond to first-line treatment represents a formidable challenge. To determine the efficacy and toxicity of second-line systemic therapy in people with metastatic CRC. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 4), Ovid MEDLINE (1950 to May 2016), Ovid MEDLINE In-process & Other Non-Indexed Citations (1946 to May 2016) and Ovid Embase (1974 to May 2016). There were no language or date of publication restrictions. Randomized controlled trials (RCTs) assessing the efficacy (survival, tumour response) and toxicity (incidence of severe adverse effects (SAEs)) of second-line systemic therapy (single or combined treatment with any anticancer drug, at any dose and number of cycles) in people with metastatic CRC that progressed, recurred or did not respond to first-line systemic therapy. Authors performed a descriptive analysis of each included RCT in terms of primary (survival) and secondary (tumour response, toxicity) endpoints. In the light of the variety of drug regimens tested in the included trials, we could carry out meta-analysis considering classes of (rather than single) anticancer regimens; to this aim, we applied the random-effects model to pool the data. We used hazard ratios (HRs) and risk ratios (RRs) to describe the strength of the association for survival (overall (OS) and progression-free survival (PFS)) and dichotomous (overall response rate (ORR) and SAE rate) data, respectively, with 95% confidence intervals (CI). Thirty-four RCTs (enrolling 13,787 participants) fulfilled the eligibility criteria. Available evidence enabled us to address multiple clinical issues regarding the survival effects of second-line systemic therapy of people with metastatic CRC.1. Chemotherapy (irinotecan) was more effective than best supportive care (HR for OS: 0.58, 95% CI 0.43 to 0.80; 1 RCT; moderate-quality evidence); 2

Technical area status report for second-stage destruction and offgas treatment

International Nuclear Information System (INIS)

French, N.B.; Dalton, J.D.; Vavruska, J.

1994-08-01

This report was sponsored by the Mixed Waste Integrated Program (MWIP), which was established by the Department of Energy (DOE), Office of Environmental Restoration and Waste Management (EM), Office of Technology Development (OTD). DOE/EM carries the charter to direct and coordinate waste management and site remediation throughout the DOE complex. Within EM, the OTD established the MWIP to identify and develop new technologies for treatment of DOE low-level mixed waste. This report represents the second TASR for the Second-Stage Destruction and Offgas Treatment technical area. This TASR updates technology information, a design methodology for air pollution control systems for mixed waste treatment, and technology development needs for DOE/EM. The TASRs form the basis of a technology development program that addresses the highest priority DOE environmental needs and is coordinated with other technology development efforts both inside and outside DOE. The main functions of the second-stage destruction and offgas treatment system are to treat the gaseous effluent from the primary treatment process to acceptable levels for release to the atmosphere. Specific functions include (1) destruction of volatile organics; (2) capture of particulate matter; (3) capture of volatile metals; (4) capture and control of volatile, condensed-phase, and solid-phase radionuclides; (5) control of acid gases; (6) NO x abatement; and (7) gas cooling and reheating as required to perform these functions

Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: Analysis of therapeutic results in 112 cases

International Nuclear Information System (INIS)

Mitsudo, Kenji; Koizumi, Toshiyuki; Iida, Masaki; Iwai, Toshinori; Nakashima, Hideyuki; Oguri, Senri; Kioi, Mitomu; Hirota, Makoto; Koike, Izumi; Hata, Masaharu; Tohnai, Iwai

2014-01-01

Purpose: To evaluate the therapeutic results and rate of organ preservation in patients with stage III or IV oral cancer treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy. Materials and methods: One hundred and twelve patients with stage III and IV oral squamous cell carcinoma underwent intra-arterial chemoradiotherapy. Catheterization from the superficial temporal and occipital arteries was performed. Treatment consisted of superselective intra-arterial chemotherapy (docetaxel, total 60 mg/m 2 , cisplatin, total 150 mg/m 2 ) and daily concurrent radiotherapy (total of 60 Gy) for 6 weeks. Results: The median follow-up for all patients was 46.2 months (range, 10–76 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 98 (87.5%) of 112 cases. Five-year survival and local control rates were 71.3% and 79.3%, respectively. Grade 3 or 4 toxicities included mucositis in 92.0%, neutropenia in 30.4%, dermatitis in 28.6%, anemia in 26.8%, and thrombocytopenia in 7.1% of patients. Grade 3 toxicities included dysphagia in 72.3%, nausea/vomiting in 21.4%, fever in 8.0%, and renal failure in 0.9% of patients. Conclusion: Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer provided good overall survival and local control

Cost-Effectiveness Analysis of Second-Line Chemotherapy Agents for Advanced Gastric Cancer.

Science.gov (United States)

Lam, Simon W; Wai, Maya; Lau, Jessica E; McNamara, Michael; Earl, Marc; Udeh, Belinda

2017-01-01

Gastric cancer is the fifth most common malignancy and second leading cause of cancer-related mortality. Chemotherapy options for patients who fail first-line treatment are limited. Thus the objective of this study was to assess the cost-effectiveness of second-line treatment options for patients with advanced or metastatic gastric cancer. Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care. The model was performed from a third-party payer's perspective to compare lifetime costs and health benefits associated with studied second-line therapies. Costs included only relevant direct medical costs. The model assumed chemotherapy cycle lengths of 30 days and a maximum number of 24 cycles. Systematic review of literature was performed to identify clinical data sources and utility and cost data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. The primary outcome measure for this analysis was the ICER between different therapies, where the incremental cost was divided by the number of QALYs saved. The ICER was compared with a willingness-to-pay (WTP) threshold that was set at $50,000/QALY gained, and an exploratory analysis using $160,000/QALY gained was also used. The model's robustness was tested by using 1-way sensitivity analyses and a 10,000 Monte Carlo simulation probabilistic sensitivity analysis (PSA). Irinotecan had the lowest lifetime cost and was associated with a QALY gain of 0.35 year. Docetaxel, ramucirumab alone, and palliative care were dominated strategies. Paclitaxel and the combination of paclitaxel plus ramucirumab led to higher QALYs gained, at an incremental cost of $86,815 and $1,056,125 per QALY gained, respectively. Based on our prespecified

THE DIFFERENCES IN SEXUAL FUNCTION BETWEEN WOMEN AFTER CESAREAN SECTION WITH INDICATION OF SECOND STAGE DISTOCIA AND ELECTIVE INDICATION

Directory of Open Access Journals (Sweden)

Ricvan Dana Nindrea

2018-03-01

Full Text Available This research want to know the difference between a woman's sexual function after childbirth with Caesarean section on indications second stage dystocia and elective.This study is observational analytic with cross sectional design using comparative in M. Djamil General Hospital and Networking Hospital. Obtained samples are 26 women after childbirth cesarean section for second stage dystocia and 26 women after elective Caesarean section were spawned from term pregnancies that meet the inclusion and exclusion criteria. Data analysis was performed using univariate and bivariate using independent T test. The average female sexual function after cesarean section indication of second stage dystocia is 27,70 ± 8,53 and female sexual function after elective Caesarean section indications are 33,55 ± 3,18. Statistical test results are known there is a difference in sexual function between women after Caesarean section indication of second stage dystocia and elective p = 0,003 (p ≤ 0,05. There is a difference between a woman's sexual function after childbirth Caesarean section on indications second stage dystocia and elective.

The hyperfractionation in the oropharynx carcinomas treatment: stages III and IV

International Nuclear Information System (INIS)

Pinto, L.H.J.

1990-01-01

From April 1986 until May 1989. 112 patients with stages III and IV oropharynx carcinomas were included in a protocol comparing the use of Hyperfractionation and Conventional Fractionation. The doses were 6600 rad in 33 fractions of 200 rad for the conventional fractionation and 7040 rad in 64 fractions, two fractions of 110 rad per day for the hyperfractionation. As of January 1990 an analysis was performed in 98 patients, with a median follow-up of 14 months. The probability of complete responses in the oropharynx was 74%, with 84% for the hyperfractionation and 64% for the conventional fractionation ( p < 0,05). Survival was improved in 42 months for those patients treated with hyperfractionation: 27% versus 8% (p < 0,05). In patients with lesions out of the base of the tongue and in those with Karnofsky performance status of 50%, 60% and 70%, survival was improved with the use of hyperfractionation (p = 0,02 and p 0,006 respectively. The study demonstrates the superiority of hyperfractionation over the classical fractionation in the treatment of patients with carcinoma of the oropharynx. (author)

Immediate compared with delayed pushing in the second stage of labor: a systematic review and meta-analysis.

Science.gov (United States)

Tuuli, Methodius G; Frey, Heather A; Odibo, Anthony O; Macones, George A; Cahill, Alison G

2012-09-01

To estimate whether immediate or delayed pushing in the second stage of labor optimizes spontaneous vaginal delivery and other perinatal outcomes. We searched electronic databases MEDLINE and CINHAL through August 2011 without restrictions. The search terms used were MeSH headings, text words, and word variations of the words or phrases labor, laboring down, passive descent, passive second stage, physiologic second stage, spontaneous pushing, pushing, or bearing down. We searched for randomized controlled trials comparing immediate with delayed pushing in the second stage of labor. The primary outcome was spontaneous vaginal delivery. Secondary outcomes were instrumental delivery, cesarean delivery, duration of the second stage, duration of active pushing, and other maternal and neonatal outcomes. Heterogeneity was assessed using the Q test and I2. Pooled relative risks (RRs) and weighted mean differences were calculated using random-effects models. Twelve randomized controlled trials (1,584 immediate and 1,531 delayed pushing) met inclusion criteria. Overall, delayed pushing was associated with an increased rate of spontaneous vaginal delivery compared with immediate pushing (61.5% compared with 56.9%, pooled RR 1.09, 95% confidence interval [CI] 1.03-1.15). This increase was smaller and not statistically significant among high-quality studies (59.0% compared with 54.9%, pooled RR 1.07, 95% CI 0.98-1.26) but larger and statistically significant in lower-quality studies (81.0% compared with 71.0%%, pooled RR 1.13, 95% CI 1.02-1.24). Operative vaginal delivery rates were high in most studies and not significantly different between the two groups (33.7% compared with 37.4%, pooled RR 0.89, 95% CI 0.76-1.06). Delayed pushing was associated with prolongation of the second stage (weighted mean difference 56.92 minutes, 95% CI 42.19-71.64) and shortened duration of active pushing (weighted mean difference -21.98 minutes, 95% CI -31.29 to -12.68). Studies to date suggest

Virologic failure of protease inhibitor-based second-line antiretroviral therapy without resistance in a large HIV treatment program in South Africa.

Directory of Open Access Journals (Sweden)

Julie H Levison

Full Text Available We investigated the prevalence of wild-type virus (no major drug resistance and drug resistance mutations at second-line antiretroviral treatment (ART failure in a large HIV treatment program in South Africa.HIV-infected patients ≥ 15 years of age who had failed protease inhibitor (PI-based second-line ART (2 consecutive HIV RNA tests >1000 copies/ml on lopinavir/ritonavir, didanosine, and zidovudine were identified retrospectively. Patients with virologic failure were continued on second-line ART. Genotypic testing for drug resistance was performed on frozen plasma samples obtained closest to and after the date of laboratory confirmed second-line ART failure. Of 322 HIV-infected patients on second-line ART, 43 were adults with confirmed virologic failure, and 33 had available plasma for viral sequencing. HIV-1 RNA subtype C predominated (n = 32, 97%. Mean duration on ART (SD prior to initiation of second-line ART was 23 (17 months, and time from second-line ART initiation to failure was 10 (9 months. Plasma samples were obtained 7(9 months from confirmed failure. At second-line failure, 22 patients (67% had wild-type virus. There was no major resistance to PIs found. Eleven of 33 patients had a second plasma sample taken 8 (5.5 months after the first. Median HIV-1 RNA and the genotypic resistance profile were unchanged.Most patients who failed second-line ART had wild-type virus. We did not observe evolution of resistance despite continuation of PI-based ART after failure. Interventions that successfully improve adherence could allow patients to continue to benefit from second-line ART therapy even after initial failure.

Biomodulation with sequential intravenous IFN-alpha2b and 5-fluorouracil as second-line treatment in patients with advanced colorectal cancer.

Science.gov (United States)

Pérez, J E; Lacava, J A; Domínguez, M E; Rodríguez, R; Barbieri, M R; Romero Acuña, L A; Romero Acuña, J M; Langhi, M J; Amato, S; Marrone, N; Ortiz, E H; Leone, B A; Vallejo, C T; Machiavelli, M R; Romero, A O

1998-08-01

A phase II trial was carried out by the Grupo Oncologico Cooperativo del Sur (G.O.C.S.) to assess the efficacy and toxicity of a biochemical modulation of 5-fluorouracil (5-FU) by i.v. pretreatment with interferon (IFN)-alpha2b in patients with advanced colorectal carcinoma refractory to previous therapy with 5-FU modulated by methotrexate (MTX) or leucovorin (LV) or both. Between January 1993 and October 1995, 34 patients were entered on the study. The treatment was IFN-alpha2b 5 x 10(6)/m2 IU in a 1-h i.v. infusion, followed immediately by 5-FU 600 mg/m2 i.v. bolus injection. Courses were repeated weekly until observation of progressive disease or severe toxicity. One patient could not be assessed for response. Objective regression was observed in 2 of 33 patients (6%, 95% confidence interval, 0%-14%). No patient achieved a complete response. Two patients had partial responses (6%). No change was recorded in 14 patients (41%), and progressive disease occurred in 17 (52%). The median time to treatment failure was 3 months, and the median survival was 5 months. Toxicity was within acceptable limits. The main side effects were mucositis and diarrhea. Four episodes of grade 2 stomatitis were observed, causing dosage modifications. The most frequent toxic effects attributable to IFN-alpha2b were mild fatigue and fever. In conclusion, second-line therapy with i.v. IFN-alpha2b preceding 5-FU has shown an interesting profile of activity in a patient population with clearly unfavorable characteristics. From this perspective, further appropriately designed studies are needed to identify the greatest potential of IFN-alpha2b as a modulator of 5-FU.

Structural assessment procedure of corroding submarine gas pipelines using on-line inspection data

International Nuclear Information System (INIS)

Nordin Yahaya

2000-01-01

This paper presents 'the alternative approach of overall procedure in the assessment of corroded pipelines using data gathered by the on-line inspection device. The methodology adopts a generalised approach of analysing pipeline inspection data and a prediction of the structural reliability due to the deteriorating corrosion environment. The whole assessment methodology is divided into four separate stages; 1 to IV. Stages 1 and 11 are the initial procedure prior to the actual analysis of the inspection data. The scope of this paper is concerted into the procedure to be taken in Stage 111 where the stage is sub-divided into 3 major steps; Part A, B and C. These procedures are Part A (statistical and probabilistic analysis of the inspection data) and Part B (the application of extreme value statistics) and C (reliability assessment). Stage IV (risk assessment) is the final step in the procedure where the consequences of failure are evaluated. The proposed risk-based assessment procedure is more systematic and reliable to account for a huge amount of collected data usually obtained in an on-line inspection using the intelligent devices. The outcomes of this risk-based methodology can be very useful in the decision-making process by the operation management. This in turn will produce an efficient inspection, repair and maintenance program and enhanced the optimised return in investment. (author)

Can we improve C IV-based single epoch black hole mass estimations?

Science.gov (United States)

Mejía-Restrepo, J. E.; Trakhtenbrot, B.; Lira, P.; Netzer, H.

2018-05-01

In large optical surveys at high redshifts (z > 2), the C IV broad emission line is the most practical alternative to estimate the mass (MBH) of active super-massive black holes (SMBHs). However, mass determinations obtained with this line are known to be highly uncertain. In this work we use the Sloan Digital Sky Survey Data Release 7 and 12 quasar catalogues to statistically test three alternative methods put forward in the literature to improve C IV-based MBH estimations. These methods are constructed from correlations between the ratio of the C IV line-width to the low ionization line-widths (Hα, Hβ and Mg II) and several other properties of rest-frame UV emission lines. Our analysis suggests that these correction methods are of limited applicability, mostly because all of them depend on correlations that are driven by the linewidth of the C IV profile itself and not by an interconnection between the linewidth of the C IV line with the linewidth of the low ionization lines. Our results show that optical C IV-based mass estimates at high redshift cannot be a proper replacement for estimates based on IR spectroscopy of low ionization lines like Hα, Hβ and Mg II.

Does delayed pushing in the second stage of labor impact perinatal outcomes?

Science.gov (United States)

Frey, Heather A; Tuuli, Methodius G; Cortez, Sarah; Odibo, Anthony O; Roehl, Kimberly A; Shanks, Anthony L; Macones, George A; Cahill, Alison G

2012-11-01

To estimate maternal, neonatal, and labor outcomes associated with delayed pushing. A retrospective cohort study of all consecutive women admitted to a single institution in labor at term who reached the second stage of labor. Pregnancies with multiple fetuses or major anomalies were excluded. Delayed pushing was defined as initiation of pushing ≥60 minutes after complete dilatation. Primary outcome was mode of delivery. Multivariable logistic regression was used to control for confounding. Of the 5290 women who met inclusion criteria, 471 (8.9%) employed delayed pushing, and 4819 (91.1%) pushed immediately. Delayed pushing was associated with increased rates of cesarean, operative vaginal delivery, maternal fever, and lower arterial cord pH. Duration of the second stage and length of time spent pushing were significantly longer with delayed pushing. Delayed pushing is associated with lower rates of spontaneous vaginal delivery and increased adverse maternal and neonatal outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Second cancers following radiotherapy for early stage head and neck cancer

International Nuclear Information System (INIS)

Shibuya, Hitoshi; Yoshimura, Ryo-ichi; Oota, Sayako; Watanabe, Hiroshi; Miura, Masahiko

2005-01-01

Different site specificity of second primary cancer following treatment for early stage squamous cell carcinoma of the head and neck was found in the analysis of post-treatment long-term follow up cases. The highest risk of second primary cancer was observed in the oro-hypo-pharynx cancer groups, and the lowest risks were observed in the epi-pharynx cancer and maxillary sinus cancer groups. Squamous cell carcinoma in the irradiated head and neck region with long latency periods could be included in the radiation induced cancer from comparison with post-irradiation cases for malignant lymphoma, benign diseases as well as breast cancers. (author)

"To look at death another way": Black teenage males' perspectives on second-lines and regular funerals in New Orleans.

Science.gov (United States)

Bordere, Tashel C

The purpose of this study was to describe how Black adolescent males understand "second-line" (musical processions) and "regular"/traditional funeral rituals in New Orleans following the violent deaths of significant persons in their lives. In-depth interviews were conducted with 10 Black males between the ages of 12 and 15 using descriptive phenomenology methodology. Findings revealed that these participants understood death as a cause for celebration, remembrance, and unity related to their experiences with the second-line ritual. Three elements of the life world of Black teenage males were descriptive of second lines, including: a) observed locations of second lines; b) dancing to good music; and c) observed messages conveyed through t-shirts. Participants provided gender-based descriptions of perceived spoken and unspoken rights in grieving at the two distinct rituals. Related to their second-line experience, the teens reflect on ways in which they wish to have their deaths ritualized.

Second Line of Defense Spares Program Assessment

Energy Technology Data Exchange (ETDEWEB)

Henderson, Dale L.; Muller, George; Mercier, Theresa M.; Brigantic, Robert T.; Perkins, Casey J.; Cooley, Scott K.

2012-11-20

The Office of the Second Line of Defense (SLD) is part of the Department of Energy‘s (DOE) National Nuclear Security Administration (NNSA). The SLD Program accomplishes its critical global security mission by forming cooperative relationships with partner countries to install passive radiation detection systems that augment traditional inspection and law enforcement measures by alerting border officials to the presence of special nuclear or other radiological materials in cross-border traffic. An important tenet of the program is to work collaboratively with these countries to establish the necessary processes, procedures, infrastructure and conditions that will enable them to fully assume the financial and technical responsibilities for operating the equipment. As the number of operational deployments grows, the SLD Program faces an increasingly complex logistics process to promote the timely and efficient supply of spare parts.

The need for second-line antiretroviral therapy in adults in sub-Saharan Africa up to 2030: a mathematical modelling study.

Science.gov (United States)

Estill, Janne; Ford, Nathan; Salazar-Vizcaya, Luisa; Haas, Andreas D; Blaser, Nello; Habiyambere, Vincent; Keiser, Olivia

2016-03-01

The number of patients in need of second-line antiretroviral drugs is increasing in sub-Saharan Africa. We aimed to project the need of second-line antiretroviral therapy in adults in sub-Saharan Africa up to 2030. We developed a simulation model for HIV and applied it to each sub-Saharan African country. We used the WHO country intelligence database to estimate the number of adult patients receiving antiretroviral therapy from 2005 to 2014. We fitted the number of adult patients receiving antiretroviral therapy to observed estimates, and predicted first-line and second-line needs between 2015 and 2030. We present results for sub-Saharan Africa, and eight selected countries. We present 18 scenarios, combining the availability of viral load monitoring, speed of antiretroviral scale-up, and rates of retention and switching to second-line. HIV transmission was not included. Depending on the scenario, 8·7-25·6 million people are expected to receive antiretroviral therapy in 2020, of whom 0·5-3·0 million will be receiving second-line antiretroviral therapy. The proportion of patients on treatment receiving second-line therapy was highest (15·6%) in the scenario with perfect retention and immediate switching, no further scale-up, and universal routine viral load monitoring. In 2030, the estimated range of patients receiving antiretroviral therapy will remain constant, but the number of patients receiving second-line antiretroviral therapy will increase to 0·8-4·6 million (6·6-19·6%). The need for second-line antiretroviral therapy was two to three times higher if routine viral load monitoring was implemented throughout the region, compared with a scenario of no further viral load monitoring scale-up. For each monitoring strategy, the future proportion of patients receiving second-line antiretroviral therapy differed only minimally between countries. Donors and countries in sub-Saharan Africa should prepare for a substantial increase in the need for second-line

HOT GAS LINES IN T TAURI STARS

International Nuclear Information System (INIS)

Ardila, David R.; Herczeg, Gregory J.; Gregory, Scott G.; Hillenbrand, Lynne A.; Ingleby, Laura; Bergin, Edwin; Bethell, Thomas; Calvet, Nuria; France, Kevin; Brown, Alexander; Edwards, Suzan; Johns-Krull, Christopher; Linsky, Jeffrey L.; Yang, Hao; Valenti, Jeff A.; Abgrall, Hervé; Alexander, Richard D.; Brown, Joanna M.; Espaillat, Catherine; Hussain, Gaitee

2013-01-01

For Classical T Tauri Stars (CTTSs), the resonance doublets of N V, Si IV, and C IV, as well as the He II 1640 Å line, trace hot gas flows and act as diagnostics of the accretion process. In this paper we assemble a large high-resolution, high-sensitivity data set of these lines in CTTSs and Weak T Tauri Stars (WTTSs). The sample comprises 35 stars: 1 Herbig Ae star, 28 CTTSs, and 6 WTTSs. We find that the C IV, Si IV, and N V lines in CTTSs all have similar shapes. We decompose the C IV and He II lines into broad and narrow Gaussian components (BC and NC). The most common (50%) C IV line morphology in CTTSs is that of a low-velocity NC together with a redshifted BC. For CTTSs, a strong BC is the result of the accretion process. The contribution fraction of the NC to the C IV line flux in CTTSs increases with accretion rate, from ∼20% to up to ∼80%. The velocity centroids of the BCs and NCs are such that V BC ∼> 4 V NC , consistent with the predictions of the accretion shock model, in at most 12 out of 22 CTTSs. We do not find evidence of the post-shock becoming buried in the stellar photosphere due to the pressure of the accretion flow. The He II CTTSs lines are generally symmetric and narrow, with FWHM and redshifts comparable to those of WTTSs. They are less redshifted than the CTTSs C IV lines, by ∼10 km s –1 . The amount of flux in the BC of the He II line is small compared to that of the C IV line, and we show that this is consistent with models of the pre-shock column emission. Overall, the observations are consistent with the presence of multiple accretion columns with different densities or with accretion models that predict a slow-moving, low-density region in the periphery of the accretion column. For HN Tau A and RW Aur A, most of the C IV line is blueshifted suggesting that the C IV emission is produced by shocks within outflow jets. In our sample, the Herbig Ae star DX Cha is the only object for which we find a P-Cygni profile in the C IV

The effect of uterine fundal pressure on the duration of the second stage of labor: a randomized controlled trial.

Science.gov (United States)

Api, Olus; Balcin, Muge Emeksiz; Ugurel, Vedat; Api, Murat; Turan, Cem; Unal, Orhan

2009-01-01

To determine the effect of uterine fundal pressure on shortening the second stage of labor and on the fetal outcome. Randomized controlled trial. Teaching and research hospital. One hundred ninety-seven women between 37 and 42 gestational weeks with singleton cephalic presentation admitted to the delivery unit. Random allocation into groups with or without manual fundal pressure during the second stage of labor. The primary outcome measure was the duration of the second stage of labor. Secondary outcome measures were umbilical artery pH, HCO3-, base excess, pO2, pCO2 values and the rate of instrumental delivery, severe maternal morbidity/mortality, neonatal trauma, admission to neonatal intensive care unit, and neonatal death. There were no significant differences in the mean duration of the second stage of labor and secondary outcome measures except for mean pO2 which was lower and mean pCO2 which was higher in the fundal pressure group. Nevertheless, the values still remained within normal ranges and there were no neonates with an Apgar score <7 in either of the groups. Application of fundal pressure on a delivering woman was ineffective in shortening the second stage of labor.

Epirubicin plus paclitaxel regimen as second-line treatment of patients with small-cell lung cancer.

Science.gov (United States)

Pasello, Giulia; Carli, Paolo; Canova, Fabio; Bonanno, Laura; Polo, Valentina; Zago, Giulia; Urso, Loredana; Conte, Pierfranco; Favaretto, Adolfo

2015-04-01

Most patients with small cell lung cancer (SCLC) experience relapse within one year after first-line treatment. The aim of this study was to describe activity and safety of second-line with epirubicin at 70 mg/m(2) followed by paclitaxel at 135 mg/m(2) on day 1 every three weeks for a maximum of six cycles. This is a retrospective review of all patients with SCLC evaluated for second-line treatment between 2003 and 2013 at our Institution. Sixty-eight patients received the study regimen of epirubicin with paclitaxel. We observed partial response in 19 (30%), stable disease in 22 (34%) and total early failure rate in 23 (36%) patients. Median progression free and overall survival were 21.8 and 26.5 weeks, respectively. Haematological toxicities were as follows: grade 3-4 leukopenia and neutropenia in 18 (31%) and 30 (22%) of patients, respectively; grade 3 anaemia and grade 4 thrombocytopenia were reported in 2 (3%) and 5 (9%) of patients, respectively. Epirubicin with paclitaxel is an active and tolerable second-line regimen in patients with SCLC. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

The Relationship Between the Childhood Autism Rating Scale: Second Edition and Clinical Diagnosis Utilizing the DSM-IV-TR and the DSM-5.

Science.gov (United States)

Dawkins, Tamara; Meyer, Allison T; Van Bourgondien, Mary E

2016-10-01

The Childhood Autism Rating Scale, Second Edition (CARS2; 2010) includes two rating scales; the CARS2-Standard Version (CARS2-ST) and the newly developed CARS2-High Functioning Version (CARS2-HF). To assess the diagnostic agreement between the CARS2 and DSM-IV-TR versus DSM-5 criteria for Autism Spectrum Disorder (ASD), clinicians at community based centers of the University of North Carolina TEACCH Autism Program rated participants seen for a diagnostic evaluation on symptoms of autism using both the DSM-IV-TR and DSM-5 criteria and either the CARS2-HF or the CARS2-ST. Findings suggest that overall, the diagnostic agreement of the CARS2 remains high across DSM-IV and DSM-5 criteria for autism.

Optics of two-stage photovoltaic concentrators with dielectric second stages

Science.gov (United States)

Ning, Xiaohui; O'Gallagher, Joseph; Winston, Roland

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Optics of two-stage photovoltaic concentrators with dielectric second stages.

Science.gov (United States)

Ning, X; O'Gallagher, J; Winston, R

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

The efficacy and safety of inflatable obstetric belts for management of the second stage of labor.

Science.gov (United States)

Kang, Jin Hee; Lee, Gun Ho; Park, Young Bae; Jun, Hye Sun; Lee, Kyoung Jin; Hahn, Won Bo; Park, Sang Won; Park, Hee Jin; Cha, Dong Hyun

2009-10-01

This study was designed to assess the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. One hundred twenty-three nulliparas with a singleton cephalic pregnancy at term were randomized. Standard care was performed in the control group, and uterine fundal pressure by the Labor Assister (Baidy M-420/Curexo, Inc., Seoul, Korea) was utilized in addition to standard care in the active group. The Labor Assister is an inflatable obstetric belts that synchronized to apply uniform fundal pressure during a uterine contraction. The 62 women in the active group spent less time in the second stage of labor when compared to the 61 women in the control group (41.55+/-30.39 min vs. 62.11+/-35.99 min). There was no significant difference in perinatal outcomes between the two groups. In conclusion, the uterine fundal pressure exerted by the Labor Assister reduces the duration of the second stage of labor without attendant complications.

Duration of Second Stage of Labour at Term and Pushing Time: Risk Factors for Postpartum Haemorrhage.

Science.gov (United States)

Looft, Emelie; Simic, Marija; Ahlberg, Mia; Snowden, Jonathan M; Cheng, Yvonne W; Stephansson, Olof

2017-03-01

Prolonged labour is associated with increased risk of postpartum haemorrhage (PPH), but the role of active pushing time and the relation with management during labour remains poorly understood. A population-based cohort study from electronic medical record data in the Stockholm-Gotland Region, Sweden. We included 57 267 primiparous women with singleton, term gestation, livebirths delivered vaginally in cephalic presentation in 2008-14. We performed multivariable Poisson regression to estimate the association between length of second stage, pushing time, and PPH (estimated blood loss >500 mL during delivery), adjusting for maternal, delivery, and fetal characteristics as potential confounders. The incidence of PPH was 28.9%. The risk of PPH increased with each passing hour of second stage: compared with a second stage pushing time exceeding 30 min. Compared to pushing time between 15 and 29 min, the RR for PPH were for pushing time during labour are both associated with increased risk of PPH. © 2017 John Wiley & Sons Ltd.

Nintedanib plus docetaxel as second-line therapy in patients with non-small-cell lung cancer

DEFF Research Database (Denmark)

Popat, Sanjay; Mellemgaard, Anders; Fahrbach, Kyle

2015-01-01

BACKGROUND: Nintedanib plus docetaxel has proven an overall survival benefit over docetaxel monotherapy in second-line treatment of non-small-cell lung cancer of adenocarcinoma histology in the LUME-Lung 1 pivotal trial. No published trials have previously compared nintedanib plus docetaxel...... with advanced non-small-cell lung cancer of adenocarcinoma histology, results suggest that nintedanib plus docetaxel offers clinical benefit compared with docetaxel alone, when used as second-line treatment, and suggests that this combination may also add clinical benefit compared with erlotinib in this patient...

Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer.

Science.gov (United States)

Kleespies, Axel; Füessl, Kathrin E; Seeliger, Hendrik; Eichhorn, Martin E; Müller, Mario H; Rentsch, Markus; Thasler, Wolfgang E; Angele, Martin K; Kreis, Martin E; Jauch, Karl-Walter

2009-09-01

The benefit of elective primary tumor resection for non-curable stage IV colorectal cancer (CRC) remains largely undefined. We wanted to identify risk factors for postoperative complications and short survival. Using a prospective database, we analyzed potential risk factors in 233 patients, who were electively operated for non-curable stage IV CRC between 1996 and 2002. Patients with recurrent tumors, resectable metastases, emergency operations, and non-resective surgery were excluded. Risk factors for increased postoperative morbidity and limited postoperative survival were identified by multivariate analyses. Patients with colon cancer (CC = 156) and rectal cancer (RC = 77) were comparable with regard to age, sex, comorbidity, American Society of Anesthesiologists score, carcinoembryonic antigen levels, hepatic spread, tumor grade, resection margins, 30-day mortality (CC 5.1%, RC 3.9%) and postoperative chemotherapy. pT4 tumors, carcinomatosis, and non-anatomical resections were more common in colon cancer patients, whereas enterostomies (CC 1.3%, RC 67.5%, p 50%, and comorbidity >1 organ. Prognostic factors for limited postoperative survival were hepatic tumor load >50%, pT4 tumors, lymphatic spread, R1-2 resection, and lack of chemotherapy. Palliative resection is associated with a particularly unfavorable outcome in rectal cancer patients presenting with a locally advanced tumor (pT4, expected R2 resection) or an extensive comorbidity, and in all CRC patients who show a hepatic tumor load >50%. For such patients, surgery might be contraindicated unless the tumor is immediately life-threatening.

C IV BROAD ABSORPTION LINE ACCELERATION IN SLOAN DIGITAL SKY SURVEY QUASARS

Energy Technology Data Exchange (ETDEWEB)

Grier, C. J.; Brandt, W. N.; Trump, J. R.; Schneider, D. P.; Sun, M.; Beatty, T. G. [Department of Astronomy and Astrophysics, The Pennsylvania State University, 525 Davey Laboratory, University Park, PA 16802 (United States); Hall, P. B. [Department of Physics and Astronomy, York University, Toronto, ON M3J 1P3 (Canada); Filiz Ak, N. [Faculty of Sciences, Department of Astronomy and Space Sciences, Erciyes University, 38039 Kayseri (Turkey); Anderson, S. F. [Department of Astronomy, University of Washington, Box 351580, Seattle, WA 98195 (United States); Green, Paul J. [Harvard Smithsonian Center for Astrophysics, 60 Garden St, Cambridge, MA 02138 (United States); Vivek, M.; Brownstein, Joel R. [Department of Physics and Astronomy, University of Utah, 115 S. 1400 E., Salt Lake City, UT 84112 (United States); Roman-Lopes, Alexandre, E-mail: grier@psu.edu [Departamento de Fisica, Facultad de Ciencias, Universidad de La Serena, Cisternas 1200, La Serena (Chile)

2016-06-20

We present results from the largest systematic investigation of broad absorption line (BAL) acceleration to date. We use spectra of 140 quasars from three Sloan Digital Sky Survey programs to search for global velocity offsets in BALs over timescales of ≈2.5–5.5 years in the quasar rest frame. We carefully select acceleration candidates by requiring monolithic velocity shifts over the entire BAL trough, avoiding BALs with velocity shifts that might be caused by profile variability. The C iv BALs of two quasars show velocity shifts consistent with the expected signatures of BAL acceleration, and the BAL of one quasar shows a velocity-shift signature of deceleration. In our two acceleration candidates, we see evidence that the magnitude of the acceleration is not constant over time; the magnitudes of the change in acceleration for both acceleration candidates are difficult to produce with a standard disk-wind model or via geometric projection effects. We measure upper limits to acceleration and deceleration for 76 additional BAL troughs and find that the majority of BALs are stable to within about 3% of their mean velocities. The lack of widespread acceleration/deceleration could indicate that the gas producing most BALs is located at large radii from the central black hole and/or is not currently strongly interacting with ambient material within the host galaxy along our line of sight.

Second Line of Defense Spares Program

Energy Technology Data Exchange (ETDEWEB)

Henderson, Dale L.; Holmes, Aimee E.; Muller, George; Mercier, Theresa M.; Brigantic, Robert T.; Perkins, Casey J.; Cooley, Scott K.; Thorsen, Darlene E.

2012-11-20

During Fiscal Year 2012, a team from the Pacific Northwest National Laboratory (PNNL) conducted an assessment and analysis of the Second Line of Defense (SLD) Sustainability spare parts program. Spare parts management touches many aspects of the SLD Sustainability Program including contracting and integration of Local Maintenance Providers (LMP), equipment vendors, analyses and metrics on program performance, system state of health, and maintenance practices. Standardized spares management will provide better data for decisions during site transition phase and will facilitate transition to host country sustainability ownership. The effort was coordinated with related SLD Sustainability Program initiatives, including a configuration items baselining initiative, a metrics initiative, and a maintenance initiative. The spares study has also led to pilot programs for sourcing alternatives that include regional intermediate inventories and partnering agreements that leverage existing supply chains. Many partners from the SLD Sustainability program contributed to and were consulted in the course of the study. This document provides a description of the findings, recommendations, and implemented solutions that have resulted from the study.

The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women.

Science.gov (United States)

Moraloglu, Ozlem; Kansu-Celik, Hatice; Tasci, Yasemin; Karakaya, Burcu Kısa; Yilmaz, Yasar; Cakir, Ebru; Yakut, Halil Ibrahim

2017-01-01

To assess the effects on neonatal and maternal outcomes of different pushing positions during the second stage of labor in nulliparous women. This prospective study included 102 healthy, pregnant, nulliparous women who were randomly allocated to either of two positions: a squatting using bars (n = 51), or a supine position modified to 45 degree of semi-fowler (n = 51) during the second stage of labor. Duration of the second stage of labor, maternal pain, postpartum blood loss, abnormal fetal heart rate patterns that required intervention, and newborn outcomes were compared between the two groups. The trial showed that women who adopted the squatting position using bars experienced a significant reduction in the duration of the second stage of labor; they were less likely to be induced, and their Visual Analog Scale score was lower than those who were allocated the supine position modified to 45 degree of semi-fowler during second stage of labor (p < 0.05). There were no significant differences with regard to postpartum blood loss, neonatal birth weight, Apgar score at one and five minutes, or admission to the Neonatal Intensive Care Unit. In healthy nulliparous women, adopting a squatting position using bars was associated with a shorter second stage of labor, lower Visual Analog Scale score, more satisfaction, and a reduction in oxytocin requirements compared with adopting the supine position. For Turkish women, the squatting position is easy to adopt as it is more appropriate in terms of Turkish social habits and traditions.

Phase II Study of HER-2/neu Intracellular Domain Peptide-Based Vaccine Administered to Stage IV HER2 Positive Breast Cancer Patients Receiving Trastuzumab

National Research Council Canada - National Science Library

Disis, Mary L

2007-01-01

The primary purpose of this grant is to determine the overall survival benefit in Stage IV HER2 positive breast cancer patients vaccinated with a HER2 ICD peptide-based vaccine while receiving maintenance trastuzumab...

Phase II Study of HER-2/neu Intracellular Domain Peptide-Based Vaccine Administered to Stage IV HER2 Positive Breast Cancer Patients Receiving Trastuzumab

National Research Council Canada - National Science Library

Disis, Mary L

2006-01-01

The primary purpose of this grant is to determine the overall survival benefit in Stage IV HER2 positive breast cancer patients vaccinated with a HER2 ICD peptide-based vaccine while receiving maintenance trastuzumab...

Trends in prescribing systemic treatment and overall survival for non-small cell lung cancer stage IIIB/IV in the Netherlands : 2008-2012

NARCIS (Netherlands)

Peters, Bas J M; Cramer-Vd Welle, Christine M; Smit, Arthur A J; Schramel, Franz M N H; van de Garde, Ewoudt M W

2017-01-01

BACKGROUND: The present study aims to give a detailed overview of day-to-day practice in the systemic treatment of NSCLC stage IIIB/IV and its clinical outcomes in six large teaching hospitals in the Netherlands in the period 2008-2012. METHODS: A retrospective observational cohort study was

A randomized phase II trial of first-line treatment with gemcitabine, erlotinib, or gemcitabine and erlotinib in elderly patients (age ≥70 years) with stage IIIB/IV non-small cell lung cancer.

Science.gov (United States)

Stinchcombe, Thomas E; Peterman, Amy H; Lee, Carrie B; Moore, Dominic T; Beaumont, Jennifer L; Bradford, Daniel S; Bakri, Kamal; Taylor, Mark; Crane, Jeffrey M; Schwartz, Garry; Hensing, Thomas A; McElroy, Edwin; Niell, Harvey B; Harper, Harry D; Pal, Sridhar; Socinski, Mark A

2011-09-01

Single-agent gemcitabine is a standard of care for elderly patients with advanced non-small cell lung cancer, but novel therapies are needed for this patient population. We performed a noncomparative randomized phase II trial of gemcitabine, erlotinib, or the combination in elderly patients (age ≥70 years) with stage IIIB or IV non-small cell lung cancer. Patients were randomized to arms: A (gemcitabine 1200 mg/m on days 1 and 8 every 21 days), B (erlotinib 150 mg daily), or C (gemcitabine 1000 mg/m on days 1 and 8 every 21 days and erlotinib 100 mg daily). Arms B and C were considered investigational; the primary objective was 6-month progression-free survival. Between March 2006 and May 2010, 146 eligible patients received protocol therapy. The majority of the patients (82%) had stage IV disease, 64% reported adenocarcinoma histology, 90% reported current or previous tobacco use, and 28% had a performance status of 2. The 6-month progression-free survival rate observed in arms A, B, and C was 22% (95% confidence interval [CI] 11-35), 24% (95% CI 13-36), and 25% (95% CI 15-38), respectively; the median overall survival observed was 6.8 months (95% CI 4.8-8.5), 5.8 months (95% CI 3.0-8.3), and 5.6 months (95% CI 3.5-8.4), respectively. The rate of grade ≥3 hematological and nonhematological toxicity observed was similar in all three arms. The best overall health-related quality of life response did not differ between treatment arms. Erlotinib or erlotinib and gemcitabine do not warrant further investigation in an unselected elderly patient population.

C IV LINE-WIDTH ANOMALIES

DEFF Research Database (Denmark)

Denney, Kelly Dianne; Pogge, R.W.; Assef, R.J.

2013-01-01

Comparison of six high-redshift quasar spectra obtained with the Large Binocular Telescope with previous observations from the Sloan Digital Sky Survey shows that failure to correctly identify absorption and other problems with accurate characterization of the CIV emission line profile in low S/N...

Sapanisertib and Osimertinib in Treating Patients With Stage IV EGFR Mutation Positive Non-small Cell Lung Cancer After Progression on a Previous EGFR Tyrosine Kinase Inhibitor

Science.gov (United States)

2018-04-25

EGFR Activating Mutation; EGFR Exon 19 Deletion Mutation; EGFR NP_005219.2:p.G719X; EGFR NP_005219.2:p.L858R; EGFR NP_005219.2:p.L861Q; EGFR T790M Mutation Negative; Recurrent Non-Small Cell Lung Carcinoma; Stage III Non-Small Cell Lung Cancer AJCC v7; Stage IIIA Non-Small Cell Lung Cancer AJCC v7; Stage IIIB Non-Small Cell Lung Cancer AJCC v7; Stage IV Non-Small Cell Lung Cancer AJCC v7

Final report of the cooperative study on seismic isolation design. The second stage

Energy Technology Data Exchange (ETDEWEB)

Uryu, Mitsuru; Terada, Syuji; Shioya, Tsutomu (and others)

1999-05-01

The applicability of the seismic isolation design onto the nuclear fuel facilities, which must clear severe criteria of integrity, has been examined. Following the first stage of the cooperative study, conducted from 1988 to 1991, the second stage included critical vibration testing, seismic observation of seismic isolation building and founded buildings of non-isolation, with the objectives of clarifying the policies on critical design of seismic isolation building. Integrity of the seismic isolation piping system was tested by means of static deformation test, with variable inner water pressure and relative deformation. (Yamamoto, A.)

Efficacy and Safety of Capecitabine, Irinotecan, Gemcitabine, and Bevacizumab as Second-Line Treatment in Advanced Biliary Tract Cancer

DEFF Research Database (Denmark)

Larsen, Finn Ole; Markussen, Alice; Diness, Laura V

2018-01-01

, there are no phase III trials supporting second-line treatment, and the phase II trials with chemotherapy do not show any clear benefit. In this study, we investigated the effect of adding bevacizumab to chemotherapy in second-line treatment. METHODS: From November 2013 to January 2016, 50 patients with advanced...

ROSA-IV Large Scale Test Facility (LSTF) system description for second simulated fuel assembly

International Nuclear Information System (INIS)

1990-10-01

The ROSA-IV Program's Large Scale Test Facility (LSTF) is a test facility for integral simulation of thermal-hydraulic response of a pressurized water reactor (PWR) during small break loss-of-coolant accidents (LOCAs) and transients. In this facility, the PWR core nuclear fuel rods are simulated using electric heater rods. The simulated fuel assembly which was installed during the facility construction was replaced with a new one in 1988. The first test with this second simulated fuel assembly was conducted in December 1988. This report describes the facility configuration and characteristics as of this date (December 1988) including the new simulated fuel assembly design and the facility changes which were made during the testing with the first assembly as well as during the renewal of the simulated fuel assembly. (author)

Disease-related mortality exceeds treatment-related mortality in patients with chronic myeloid leukemia on second-line or later therapy.

Science.gov (United States)

Pearson, Edward; McGarry, Lisa; Gala, Smeet; Nieset, Christopher; Nanavaty, Merena; Mwamburi, Mkaya; Levy, Yair

2016-04-01

Treatment of newly-diagnosed patients with chronic-phase chronic myeloid leukemia (CP-CML) with tyrosine kinase inhibitors (TKIs) results in near-normal life expectancy. However, CP-CML patients resistant to initial TKIs face a poorer prognosis and significantly higher CML-related mortality. We conducted a systematic literature review to evaluate the specific causes of deaths (diseases progression versus drug-related) in CP-CML patients receiving second- or third-line therapy. We identified eight studies based on our criteria that reported causes of death. Overall, 5% of second-line and 10% of third-line patients died during the study follow-up period. For second-line, (7 studies, n=1926), mortality was attributed to disease progression for 41% of deaths, 2% to treatment-related causes, 3% were treatment-unrelated, and 50% were unspecified adverse events (AEs), not likely related to study drug. In third-line, (2 studies, n=144), 71% deaths were attributed to disease progression, 7% treatment-related AEs, 14% treatment-unrelated and 7% unspecified AEs. Annual death rates for second- and third-line therapy were significantly higher than for general population in similar age group. Our findings suggest death attributed to disease progression is approximately 10 times that due to treatment-related AEs in patients with CP-CML receiving second- or third-line therapy. Therefore, the potential benefits of effective treatment for these patients with the currently available TKIs outweigh the risks of treatment-induced AEs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enhanced Design Alternative IV

International Nuclear Information System (INIS)

Kramer, N.E.

1999-01-01

This report evaluates Enhanced Design Alternative (EDA) IV as part of the second phase of the License Application Design Selection (LADS) effort. The EDA IV concept was compared to the VA reference design using criteria from the Design Input Request for LADS Phase II EDA Evaluations (CRWMS M and O 1999b) and (CRWMS M and O 1999f). Briefly, the EDA IV concept arranges the waste packages close together in an emplacement configuration known as line load. Continuous pre-closure ventilation keeps the waste packages from exceeding their 350 C cladding and 200 C (4.3.6) drift wall temperature limits. This EDA concept keeps relatively high, uniform emplacement drift temperatures (post-closure) to drive water away from the repository and thus dry out the pillars between emplacement drifts. The waste package is shielded to permit human access to emplacement drifts and includes an integral filler inside the package to reduce the amount of water that can contact the waste form. Closure of the repository is desired 50 years after first waste is emplaced. Both backfill and drip shields will be emplaced at closure to improve post-closure performance. The EDA IV concept includes more defense-in-depth layers than the VA reference design because of its backfill, drip shield, waste package shielding, and integral filler features. These features contribute to the low dose-rate to the public achieved during the first 10,000 years of repository life as shown in Figure 3. Investigation of the EDA IV concept has led to the following general conclusions: (1) The total life cycle cost for EDA IV is about $21.7 billion which equates to a $11.3 billion net present value (both figures rounded up). (2) The incidence of design basis events for EDA IV is similar to the VA reference design. (3) The emplacement of the waste packages in drifts will be similar to the VA reference design. However, heavier equipment may be required because the shielded waste package will be heavier. (4) The heavier

Treatment paradigms for advanced stage non-small cell lung cancer in the era of multiple lines of therapy.

Science.gov (United States)

Stinchcombe, Thomas E; Socinski, Mark A

2009-02-01

The duration of first-line and the timing of second-line therapy for advanced non-small cell lung cancer has been an area of recent investigation. Five trials have been performed that have investigated shorter (3-4 cycles) versus longer duration of platinum-based therapy; four trials revealed an equivalent overall survival with the shorter duration of therapy, and one trial revealed superior survival with the longer duration of therapy. The toxicity and quality of life data has either been equivalent or favored the shorter duration of therapy. Two trials have investigated the timing of a second-line therapy after completion of four cycles of platinum-based therapy versus the standard treatment paradigm of initiating second-line therapy upon disease progression. Both of these trials have revealed a statistically significant improvement in the progression-free survival, and a trend towards improved survival for the earlier use of second-line therapy. Only 50 to 60% of patients on the standard treatment arm initiated second-line therapy, and the promising results observed are most likely related to the fact that a higher percentage of patients received second-line therapy on the experimental arm. Several trials have investigated maintenance chemotherapy, and these trials have not revealed a survival benefit probably due to the fact that many patients experience disease progression or unacceptable toxicity during the initial or maintenance therapy. The addition of a targeted agent (bevacizumab or cetuximab) to the initial chemotherapy and the continuation of the targeted agent after completion of the chemotherapy have yielded superior overall survival in comparison to chemotherapy alone. The incremental benefit of the maintenance therapy with the targeted agent is unknown.

Results of paclitaxel (day 1 and 8 and carboplatin given on every three weeks in advanced (stage III-IV non-small cell lung cancer

Directory of Open Access Journals (Sweden)

Salepci Taflan

2005-01-01

Full Text Available Abstract Background Both paclitaxel (P and carboplatin (C have significant activity in non-small cell lung cancer (NSCLC. The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT regimen in advanced stage NSCLC to evaluate the efficacy and toxicity. Methods Patients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS ECOG 0–2 were given P 112.5 mg/m2 intravenously (IV over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles. Results Median age was 58 (age range 39–77 and 41 patients (80% were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 (1–6. Seven patients (14% did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR in 45% and stable disease (SD in 18%. Twelve patients (24% received local RT. Thirteen patients (25% received 2nd line CT at progression. At a median follow-up of 7 months (range, 1–20, 25 (49% patients died and 35 patients (69% progressed. Median overall survival (OS was 11 ± 2 months (95% CI; 6 to 16, 1-year OS ratio was 44%. Median time to progression (TTP was 6 ± 1 months (95% CI; 4 to 8, 1-year progression free survival (PFS ratio was 20%. We observed following grade 3 toxicities: asthenia (10%, neuropathy (4%, anorexia (4%, anemia (4%, hypersensitivity to P (2%, nausea/vomiting (2%, diarrhea (2% and neutropenia (2%. Two patients (4% died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%. Conclusions P on day 1 and 8 and C every three weeks is practical and fairly

Using Five Stage Model to Design of Collaborative Learning Environments in Second Life

Science.gov (United States)

Orhan, Sevil; Karaman, M. Kemal

2014-01-01

Specifically Second Life (SL) among virtual worlds draws attention of researchers to form collaborative learning environments (Sutcliffe & Alrayes, 2012) since it could be used as a rich platform to simulate a real environment containing many collaborative learning characteristics and interaction tools within itself. Five Stage Model (FSM)…

Hazardous Waste Code Determination for First/Second-Stage Sludge Waste Stream (IDCs 001, 002, 800)

International Nuclear Information System (INIS)

Arbon, R.E.

2001-01-01

This document, Hazardous Waste Code Determination for the First/Second-Stage Sludge Waste Stream, summarizes the efforts performed at the Idaho National Engineering and Environmental Laboratory (INEEL) to make a hazardous waste code determination on Item Description Codes (IDCs) 001, 002, and 800 drums. This characterization effort included a thorough review of acceptable knowledge (AK), physical characterization, waste form sampling, chemical analyses, and headspace gas data. This effort included an assessment of pre-Waste Analysis Plan (WAP) solidified sampling and analysis data (referred to as preliminary data). Seventy-five First/Second-Stage Sludge Drums, provided in Table 1-1, have been subjected to core sampling and analysis using the requirements defined in the Quality Assurance Program Plan (QAPP). Based on WAP defined statistical reduction, of preliminary data, a sample size of five was calculated. That is, five additional drums should be core sampled and analyzed. A total of seven drums were sampled, analyzed, and validated in compliance with the WAP criteria. The pre-WAP data (taken under the QAPP) correlated very well with the WAP compliant drum data. As a result, no additional sampling is required. Based upon the information summarized in this document, an accurate hazardous waste determination has been made for the First/Second-Stage Sludge Waste Stream

Durations of second stage of labor and pushing, and adverse neonatal outcomes: a population-based cohort study.

Science.gov (United States)

Sandström, A; Altman, M; Cnattingius, S; Johansson, S; Ahlberg, M; Stephansson, O

2017-03-01

The associations between duration of second stage of labor, pushing time and risk of adverse neonatal outcomes are not fully established. Therefore, we aimed to examine such relationships. A population-based cohort study including 42 539 nulliparous women with singleton infants born in cephalic presentation at ⩾37 gestational weeks, using the Stockholm-Gotland Obstetric Cohort, Sweden, and the Swedish Neonatal Quality Register, 2008 to 2013. Poisson regression was used to analyze estimated adjusted relative risks (RRs), with 95% confidence intervals (CIs). Outcome measures were umbilical artery acidosis (pH pushing pushing ⩾60 min increased rates of acidosis from 0.57 to 1.69% (adjusted RR 2.55 (95% CI 1.51 to 4.30)). Prolonged durations of second stage of labor and pushing are associated with increased RRs of adverse neonatal outcomes. Clinical assessment of fetal well-being is essential when durations of second stage and pushing increases.

Second-line combination therapies in nonsmall cell lung cancer without known driver mutations

Directory of Open Access Journals (Sweden)

Maria-Virginia Bluthgen

2015-12-01

Full Text Available In advanced nonsmall cell lung cancer (NSCLC patients, platinum-based combination chemotherapy is standard treatment in the first-line setting; however, the large majority of patients ultimately progress. For more than a decade, single-agent therapy with docetaxel, pemetrexed or erlotinib has been the standard of care after failure with platinum salts, showing some benefit over best supportive care. Nonetheless, prognosis remains poor and new second-line strategies are urgently needed. Combinations of cytotoxic agents, including rechallenge with platinum salts, do not offer clear benefit over single-agent therapy for the majority of patients. In patients without a known tumoural oncogenic driver mutation, regimens based on combinations of targeted agents have shown promising results; however, a clear role in therapeutic management is yet to be established. Some success has been reported in recent research combining a cytotoxic agent with targeted therapies. In this review, we summarise published data for the various strategies evaluated over the past decade in second-line treatment of NSCLC patients without a known driver mutation. We focus on combination treatments and consider future perspectives, including the need to identify predictive markers to support personalised therapeutic strategies.

Predictors of cervical cancer being at an advanced stage at diagnosis in Sudan

DEFF Research Database (Denmark)

Ibrahim, Ahmed; Rasch, Vibeke; Pukkala, Eero

2011-01-01

Cervical cancer is the second most common cancer among women in Sudan, with more than two-thirds of all women with invasive cervical cancer being diagnosed at an advanced stage (stages III and IV). The lack of a screening program for cervical cancer in Sudan may contribute to the late presentation...... of this cancer, but other factors potentially associated with advanced stages of cervical cancer at diagnosis are unknown. The purpose of this research was to investigate the relationship between age, marital status, ethnicity, health insurance coverage, residence in an urban vs a rural setting, and stage (at...... diagnosis) of cervical cancer in Sudan....

The number of cycles of neoadjuvant chemotherapy is associated with prognosis of stage IIIc-IV high-grade serous ovarian cancer.

Science.gov (United States)

Xu, Xia; Deng, Fei; Lv, Mengmeng; Chen, Xiaoxiang

2017-02-01

No consensus exists on the number of chemotherapy cycles to be administered before and after interval debulking surgery (IDS) in patients with advanced stage epithelial ovarian cancer. The present study aims to explore the optimal number of cycles of neoadjuvant chemotherapy (NAC) and post-operation chemotherapy to treat the International Federation of Gynecology and Obstetrics stage IIIc-IV high-grade serous ovarian cancer (HG-SOC). A total of 129 IIIc-IV stage HG-SOC cases were retrospectively analyzed. Cases were comprised of patients who underwent NAC followed by IDS and who achieved clinical complete response (CCR) at the end of primary therapy. Patients were recruited from the Jiangsu Institute of Cancer Research between 1993 and 2013. Optimal IDS-associated factors were explored with logistic regression. The association between progression-free survival (PFS), overall survival (OS) duration, and covariates was assessed by Cox proportional hazards model and log-rank test. The median number of NAC cycle was 3 (range 1-8). CA-125 decreasing kinetics (p = 0.01) was independently associated with optimal IDS. CA-125 decreasing kinetics, optimal IDS, and NAC cycles was independently associated with OS (p cycles was shorter than those of patients who underwent cycles (12.3 versus 17.2 months). The PFS and OS of patients who underwent cycles of adjuvant chemotherapy post-IDS were shorter than those of patients who underwent ≥5 cycles (14.2 and 20.3 versus 21.2 and 28.8 months). NAC cycles, CA-125 decreasing kinetics, and optimal debulking are independently associated with the prognosis of patients with advanced stage HG-SOC who underwent NAC/IDS and achieved CCR. The number of administered NAC cycles should not exceed 4.

Pharmacoeconomic analysis of the use of first- and second-line drugs in the treatment of multiple sclerosis

Directory of Open Access Journals (Sweden)

V. R. Mkrtchyan

2015-01-01

Full Text Available Objective: to make a pharmacoeconomic comparison of the administration of first- and second-line drugs in the treatment of multiple sclerosis through cost, cost-effectiveness, and budget impact analyses using the 2015 state prices.Material and methods. A pharmacoeconomic analysis was carried out on the basis of the data available in the literature on trials of the effects of the drugs on the rates of exacerbations and disability. On calculating, the authors took into account the current standards for the out- and inpatient management of patients with this nosological entity in accordance with the compulsory health insurance (CHI program; prices for state drug purchases in March 2015; prices for medical services in compliance with the CHI standards in Moscow in 2015; the average sizes of minimum wage, salary, and disability grants with consideration for a discount rate of 3%. The cost-effectiveness and budget impact analyses were performed for intramuscular interferon (INF-β1a (avonex, 30 μg, subcutaneous INF-β1a (rebif, 44 μg, subcutaneous INF-β1b (ronbetal, 8,000,000 IU, subcutaneous INF-β1b (betaferon, 9,600,000 IU, subcutaneous glatiramer acetate (copaxone, 20 mg, intravenous natalizumab (tyzabri, 300 mg, and oral fingolimod (gilenya, 0.5 mg.Results and discussion. The second-line drug tyzabri outperforms the first-line agents for cost-effectiveness. The first-line drugs betaferon and copaxone is slightly exceeded in this indicator by tyzabri; the other both first- and second-line agents compared are all the more inferior in this indicator. The budget impact analysis has shown that the cost of the second-line drugs was higher than that of the first-line ones.

First and second line mechanisms of cadmium detoxification in the lichen photobiont Trebouxia impressa (Chlorophyta)

International Nuclear Information System (INIS)

Sanita di Toppi, L.; Pawlik-Skowronska, B.; Vurro, E.; Vattuone, Z.; Kalinowska, R.; Restivo, F.M.; Musetti, R.; Skowronski, T.

2008-01-01

'First line' defence mechanisms, such as phytochelatin biosynthesis, and 'second line' mechanisms, such as stress protein induction, were investigated in cadmium-exposed cells of Trebouxia impressa Ahmadjian, a green microalgal species that is a common photobiont of the lichen Physcia adscendens (Fr.) H. Olivier. When T. impressa cells were exposed to 0, 9 and 18 μM Cd for 6, 18 and 48 h, glutathione and phytochelatins efficiently protected the cells against Cd damage. By contrast, the highest Cd concentration (36 μM) at the longest exposure-time (48 h) caused marked drops in glutathione and phytochelatin content, several types of ultrastructural damage, and decreases in cell density and total chlorophyll concentration. In this case, induction of stress proteins was observed, but only long after the induction of phytochelatins. Thus, stress proteins could represent a 'second line' mechanism to counteract Cd stress, activated when there is a decline in the 'first line' mechanism of Cd detoxification given by phytochelatins. - Trebouxia impressa photobionts protect themselves against cadmium stress by means of phytochelatins and stress proteins

First and second line mechanisms of cadmium detoxification in the lichen photobiont Trebouxia impressa (Chlorophyta)

Energy Technology Data Exchange (ETDEWEB)

Sanita di Toppi, L. [Dipartimento di Biologia Evolutiva e Funzionale, viale G.P. Usberti 11/A, Universita di Parma, 43100 Parma (Italy)], E-mail: luigi.sanitaditoppi@unipr.it; Pawlik-Skowronska, B. [Centre for Ecological Research, Polish Academy of Sciences, Experimental Station, Niecala 18/3, 20080 Lublin (Poland); Vurro, E. [Dipartimento di Biologia Evolutiva e Funzionale, viale G.P. Usberti 11/A, Universita di Parma, 43100 Parma (Italy); Vattuone, Z. [Dipartimento di Biologia Evolutiva e Funzionale, viale G.P. Usberti 11/A, Universita di Parma, 43100 Parma (Italy); Centre for Ecological Research, Polish Academy of Sciences, Experimental Station, Niecala 18/3, 20080 Lublin (Poland); Kalinowska, R. [Centre for Ecological Research, Polish Academy of Sciences, Experimental Station, Niecala 18/3, 20080 Lublin (Poland); Restivo, F.M. [Dipartimento di Genetica, Biologia dei Microrganismi, Antropologia, Evoluzione, viale G.P. Usberti 11/A, Universita di Parma, 43100 Parma (Italy); Musetti, R. [Dipartimento di Biologia Applicata alla Difesa delle Piante, via delle Scienze 208, Universita di Udine, 33100 Udine (Italy); Skowronski, T. [Centre for Ecological Research, Polish Academy of Sciences, Experimental Station, Niecala 18/3, 20080 Lublin (Poland)

2008-01-15

'First line' defence mechanisms, such as phytochelatin biosynthesis, and 'second line' mechanisms, such as stress protein induction, were investigated in cadmium-exposed cells of Trebouxia impressa Ahmadjian, a green microalgal species that is a common photobiont of the lichen Physcia adscendens (Fr.) H. Olivier. When T. impressa cells were exposed to 0, 9 and 18 {mu}M Cd for 6, 18 and 48 h, glutathione and phytochelatins efficiently protected the cells against Cd damage. By contrast, the highest Cd concentration (36 {mu}M) at the longest exposure-time (48 h) caused marked drops in glutathione and phytochelatin content, several types of ultrastructural damage, and decreases in cell density and total chlorophyll concentration. In this case, induction of stress proteins was observed, but only long after the induction of phytochelatins. Thus, stress proteins could represent a 'second line' mechanism to counteract Cd stress, activated when there is a decline in the 'first line' mechanism of Cd detoxification given by phytochelatins. - Trebouxia impressa photobionts protect themselves against cadmium stress by means of phytochelatins and stress proteins.

Artificial induction of third-stage dispersal juveniles of Bursaphelenchus xylophilus using newly established inbred lines.

Directory of Open Access Journals (Sweden)

Suguru E Tanaka

Full Text Available The pine wood nematode, Bursaphelenchus xylophilus, is the causal agent of pine wilt disease. This nematode has two developmental forms in its life cycle; i.e., the propagative and dispersal forms. The former is the form that builds up its population inside the host pine. The latter is specialized for transport by the vector. This form is separated into two dispersal stages (third and fourth; the third-stage dispersal juvenile (JIII is specialized for survival under unfavorable conditions, whereas the fourth-stage juvenile (JIV, which is induced by a chemical signal from the carrier Monochamus beetle, is transported to new host pines and invades them. Because of its importance in the disease cycle, molecular and chemical aspects of the JIV have been investigated, while the mechanism of JIII induction has not been sufficiently investigated. In an effort to clarify the JIII induction process, we established inbred lines of B. xylophilus and compared their biological features. We found that the total number of nematodes (propagation proportion was negatively correlated with the JIII emergence proportion, likely because nematode development was arrested at JIII; i.e., they could not develop to adults via the reproductive stage. In addition, JIII induction seemed to be regulated by a small number of genes because the JIII induction proportion varied among inbred lines despite the high homozygosity of the parental line. We also demonstrated that JIII can be artificially induced by the nematode's secreted substances. This is the first report of artificial induction of JIII in B. xylophilus. The dauer (dispersal juvenile of the model organism Caenorhabditis elegans corresponds functionally to JIII of B. xylophilus, and this stage is known to be induced by a chemical signal referred to as daumone, derived from the nematodes' secretion. The artificial induction of JIII suggests the presence of daumone-like material in B. xylophilus.

Risk of second malignancies in patients with early-stage classical Hodgkin's lymphoma treated in a modern era

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LeMieux, Melissa H; Solanki, Abhishek A; Mahmood, Usama; Chmura, Steven J; Koshy, Matthew

2015-01-01

Second malignancies remain an issue affecting morbidity and mortality in long-term survivors of early stage Hodgkin's lymphoma (HL). We undertook this study to determine if treatment in the modern era resulted in decreased second malignancies. Patients diagnosed with stage I–II cHL between 1988 and 2009 who received radiation therapy (RT) were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Freedom from second malignancy (FFSM) was estimated using the Kaplan–Meier method. Univariate analysis (UVA) was performed using the Log-Rank test, and included age, gender, year of diagnosis, and stage. Multivariable analysis (MVA) was performed using Cox Proportional Hazards modeling. The study cohort included 8807 patients. The median age at diagnosis was 32 years (range: 2–85). The majority of patients had stage II disease (n = 6044, 69%), 597 (7%) had extranodal involvement (ENI), and 1925 (22%) had B symptoms. Median follow-up for the entire cohort was 7.2 years (range: 0–22). Five hundred twenty-three (6%) patients developed a second malignancy. Median latency to second malignancy was 5.8 years (range: 0.1–21.5). Of the 523 patients that developed a second malignancy, 228 (44%) occurred in the first 5 years, 139 (27%) were diagnosed between years 5–10, and 156 (30%) beyond 10 years. The 10 year FFSM for patients treated between 1988 and 1999 was 93.0% versus 95.1% for patients treated between 2000 and 2009 (P = 0.04), On MVA, treatment between 2000 and 2009 was associated with a HR for second malignancy of 0.77 (95% Confidence Interval: 0.62–0.96, P = 0.02) compared to the treatment between 1988 and 1999. Our analysis suggests that in patients treated with RT for stage I or II cHL, treatment prior to 2000 had a slightly higher risk of second malignancy compared to treatment in 2000 and later. Further studies, with longer follow-up of patients treated in the modern era are needed to confirm these findings

Recent TWOQUICK particle simulations of one- and two- stage transmission lines and diodes on PBFA and SABRE

International Nuclear Information System (INIS)

Poukey, J.W.; Cuneo, M.E.; Lockner, T.R.

1993-01-01

This paper presents recent particle simulation studies of the pulsed-power machines PBFA and SABRE. The code used is the 2-D electromagnetic TWOQUICK. For SABRE we emphasize the single-stage case and compare with experiment. Here the voltage adder, magnetically-insulated-transmission-line (MITL), and proton applied-B extraction diode are all included in the fully time-dependent simulations. Results include vacuum wave precursor effects vs. cathode turn-on threshold, and the sheath-retrapping benefits of diode undermatching. For PBFA we emphasize the 2-stage case and compare with experiments using lithium ions. Here we include the transmission lines and MITLs feeding the 2-stage barrel diode. Results show that good operation is critically dependent on careful B-field shaping in the feeds and diode

High-dose chemotherapy and auto-SCT for relapsed and refractory Hodgkin's lymphoma patients refractory to first-line salvage chemotherapy but responsive to second-line salvage chemotherapy.

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Rauf, Muhammad Shahzad; Maghfoor, Irfan; Elhassan, Tusneem Ahmed M; Akhtar, Saad

2015-01-01

Relapsed or primary refractory Hodgkin's lymphoma (HL) patients refractory to first-line salvage chemotherapy (first salvage) and unable to undergo high-dose chemotherapy (HDC) and autologous stem cell transplant (auto-SCT) have very poor outcome. Some patients are offered second-line salvage chemotherapy (second salvage), if they are responsive and may receive HDC auto-SCT. We identified 31 patients (18 males, 13 females) from 1996-2012 who received second salvage prior to auto-SCT. Median age at auto-SCT is 22 years. Patients were grouped as (1) relapsed-refractory (Rel:Ref): patients with prior complete response (CR) and on relapse found refractory to first salvage and received second salvage and (2) refractory-refractory (Ref:Ref): patients refractory to both primary treatment and first salvage and received second salvage. Median follow-up is 63 months (18-170). Disease status after second salvage prior to HDC was CR 16 %, partial response (PR) 71 % and stable disease 13 %. After HDC auto-SCT, CR:PR: progressive disease was observed in 18 (58 %): four (12 %): nine (29 %) patients, respectively. Five-year overall survival (OS) for whole group is 57 % (Rel:Ref vs. Ref:Ref, 73 % vs. 48 %, p = 0.48). Progression-free survival (PFS) for whole group is 52 % (Rel:Ref vs. Ref:Ref, 73 % vs. 40 % respectively, p = 0.11). Second-line salvage is a valid approach with no long-term side effects for those HL patients who do not respond to first-line salvage chemotherapy and they can be candidate of HDC and stem cell transplant with a high ORR, the PFS and OS in relapse-refractory and refractory-refractory group of patients.

Inspection logistics planning for multi-stage production systems with applications to semiconductor fabrication lines

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Chen, Kyle Dakai

Since the market for semiconductor products has become more lucrative and competitive, research into improving yields for semiconductor fabrication lines has lately received a tremendous amount of attention. One of the most critical tasks in achieving such yield improvements is to plan the in-line inspection sampling efficiently so that any potential yield problems can be detected early and eliminated quickly. We formulate a multi-stage inspection planning model based on configurations in actual semiconductor fabrication lines, specifically taking into account both the capacity constraint and the congestion effects at the inspection station. We propose a new mixed First-Come-First-Serve (FCFS) and Last-Come-First-Serve (LCFS) discipline for serving the inspection samples to expedite the detection of potential yield problems. Employing this mixed FCFS and LCFS discipline, we derive approximate expressions for the queueing delays in yield problem detection time and develop near-optimal algorithms to obtain the inspection logistics planning policies. We also investigate the queueing performance with this mixed type of service discipline under different assumptions and configurations. In addition, we conduct numerical tests and generate managerial insights based on input data from actual semiconductor fabrication lines. To the best of our knowledge, this research is novel in developing, for the first time in the literature, near-optimal results for inspection logistics planning in multi-stage production systems with congestion effects explicitly considered.

A randomized, double-blind, phase III study comparing two doses of erlotinib for second-line treatment of current smokers with advanced non-small-cell lung cancer (CurrentS).

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Smit, Egbert F; Wu, Yi-Long; Gervais, Radj; Zhou, Caicun; Felip, Enriqueta; Feng, Jifeng; Guclu, Salih Zeki; Hoiczyk, Mathias; Dorokhova, Elena; Freudensprung, Ulrich; Grange, Susan; Perez-Moreno, Pablo Diego; Mitchell, Lada; Reck, Martin

2016-09-01

Active smokers with non-small-cell lung cancer (NSCLC) have increased erlotinib metabolism versus non-smoking patients, which reduces exposure. Therefore, an increased erlotinib dose may be beneficial. The CurrentS study (NCT01183858) assessed efficacy and safety of 300mg erlotinib (E300) as second-line therapy in current smokers with locally advanced or metastatic NSCLC versus the standard 150mg dose (E150). Patients with stage IIIB/IV NSCLC (current smokers who failed first-line platinum-based chemotherapy) were randomized to receive E150 or E300 until progression/death/unacceptable toxicity. progression-free survival (PFS). Secondary endpoints: overall survival (OS), disease control rate and safety. A total of 342 patients were screened; the intent-to-treat population comprised 159 E300 patients and 154 E150 patients. Median PFS was 7.0 versus 6.9 weeks with E300 versus E150, respectively (unstratified hazard ratio [HR]=1.05, 95% confidence interval [CI]: 0.83-1.33; unstratified log-rank P=0.671). Median OS was 6.8 months in both arms (unstratified HR=1.03, 95% CI: 0.80-1.32; unstratified log-rank P=0.846). Overall, 89.2% (E300 arm) and 84.4% (E150 arm) experienced ≥1 adverse event (AE) of any grade (44.3% and 37%, respectively, experienced grade ≥3 AEs); AEs of special interest were reported in 67.7% and 47.4% of patients, respectively. E300 resulted in higher mean plasma concentrations versus E150, however, this did not improve efficacy. Despite the difference in erlotinib exposure, there was no evidence of an incremental efficacy benefit of a higher erlotinib dose versus the standard dose in this population of highly active smokers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Correlation between clinical fetal head station and sonographic angle of progression during the second stage of labor.

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Perlman, Sharon; Kivilevitch, Zvi; Moran, Orit; Katorza, Eldad; Kees, Salim; Achiron, Reuven; Gilboa, Yinon

2017-08-04

To investigate the correlation between the angle of progression and the clinical fetal head station (FHS) during the second stage of labor, and to build reference range. A prospective, observational study was conducted. Women carrying singleton term pregnancies were enrolled during the second stage of labor. FHS was assessed manually by a senior obstetrician, while the angle of progression (AOP) was assessed by transperineal ultrasound (TPU). Both examiners were blinded to each others results. The correlation between the sonographic AOP and the clinical FHS was analyzed. Seventy patients comprised the study group. Clinical FHS demonstrated an excellent correlation with the sonographic measurement of AOP (Pearson's Correlation 0.642, p correlation was best described by a cubic regression according to the formula: 123.800 + 10.290 × FHS -2.889 * FHS +0.910, (r 2  = 0.423, p correlation between the clinical FHS and the TPU measured AOP. These standardized sonographic values may serve the obstetrician as a reliable, objective auxiliary tool for the evaluation of the FHS during the second stage of labor.

[Clinic significance of nm23, collage IV and PCNA expression in non-small cell lung cancer].

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Yu, Q; Ma, L; Jing, S; Xu, Y; Geng, D

2001-12-20

To study the significance of nm23, collagen IV and PCNA expressions in non-small cell lung cancer. Expressions of the nm23, collagen IV and PCNA in 84 cases of non-small cell lung cancer were examined with SP immunohistochemical technique. Of the 84 cases, there were squamous cell carcinoma 42, adenocarcinoma 42, stage I 27, stage II 24, stage III 24, and stage IV 9. Statistical analysis was performed with Chi-Square test. Expressions of the nm23, collagen IV and PCNA in 84 cases of non-small cell lung cancer were 60. 7% ( 51/ 84) , 75. 0% ( 63/ 84) and 53. 6% ( 45/ 84) respectively. There was negative correlation between the lymph node metastasis and the expressions of nm23 and collagen IV in squamous cell carcinoma, and the expressions of collagen IV and PCNA were associated with tumor differentiation. No correlation was found between TNM stage and expressions of nm23, collagen IV and PCNA. The results indicate that nm23, collagen IV and PCNA participate the modulation of metastasis of non-small cell lung cancer and that they may be used to evaluate the potential of metastasis.

Hyperfractionated radiotherapy and simultaneous cisplatin for stage-III and -IV carcinomas of the head and neck. Long-term results including functional outcome

International Nuclear Information System (INIS)

Huguenin, P.; Glanzmann, C.; Taussky, D.; Luetolf, U.M.; Schmid, S.; Moe, K.

1998-01-01

Purpose: To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck. Methods: From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m 2 daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H and N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%). Results: Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of ≥grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects. Conclusions: Hyperfractionated RT with concomitant CDDP is well tolerated and highly

Staging of Lung Cancer

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... LUNG CANCER MINI-SERIES #2 Staging of Lung Cancer Once your lung cancer is diagnosed, staging tells you and your health care provider about ... at it under a microscope. The stages of lung cancer are listed as I, II, III, and IV ...

The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma

International Nuclear Information System (INIS)

Higginson, Daniel S.; Chen, Ronald C.; Tracton, Gregg; Morris, David E.; Halle, Jan; Rosenman, Julian G.; Stefanescu, Mihaela; Pham, Erica; Socinski, Mark A.; Marks, Lawrence B.

2012-01-01

Purpose: Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials: We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results: On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation (P=.0046), total volume of intrathoracic disease (P=.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography (P<.0001). When partitioned into central and peripheral volumes, central (P<.0001) but not peripheral (P=.74) disease was associated with worse survival. On multivariate analysis with known factors, pulmonary symptoms (hazard ratio, 1.46; P=.042), central disease volume (hazard ratio, 1.47; P=.042), and bronchial/vascular compression (hazard ratio, 1

Prevalence of resistance to second-line tuberculosis drug among multidrug-resistant tuberculosis patients in Viet Nam, 2011.

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Nguyen, Hoa Binh; Nguyen, Nhung Viet; Tran, Huong Thi Giang; Nguyen, Hai Viet; Bui, Quyen Thi Tu

2016-01-01

Extensively drug-resistant tuberculosis (XDR-TB) represents an emerging public health problem worldwide. According to the World Health Organization, an estimated 9.7% of multidrug-resistant TB (MDR-TB) cases are defined as XDR-TB globally. The objective of this study was to determine the prevalence of drug resistance to second-line TB drugs among MDR-TB cases detected in the Fourth National Anti-Tuberculosis Drug Resistance Survey in Viet Nam. Eighty clusters of TB cases were selected using a probability-proportion-to-size approach. To identify MDR-TB cases, drug susceptibility testing (DST) was performed for the four major first-line TB drugs. DST of second-line drugs (ofloxacin, amikacin, kanamycin, capreomycin) was performed on isolates from MDR-TB cases to identify pre-XDR and XDR cases. A total of 1629 smear-positive TB cases were eligible for culture and DST. Of those, DST results for first-line drugs were available for 1312 cases, and 91 (6.9%) had MDR-TB. Second-line DST results were available for 84 of these cases. Of those, 15 cases (17.9%) had ofloxacin resistance and 6.0% were resistant to kanamycin and capreomycin. Five MDR-TB cases (6.0%) met the criteria of XDR-TB. This survey provides the first estimates of the proportion of XDR-TB among MDR-TB cases in Viet Nam and provides important information for local policies regarding second-line DST. Local policies and programmes that are geared towards TB prevention, early diagnosis and treatment with effective regimens are of high importance.

[A case of a geriatric patient with stage IV anal canal cancer showing complete response to chemoradiation therapy].

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Kuroda, Masatoshi; Hirai, Ryuji; Ikeda, Eiji; Tsuji, Hisashi; Takagi, Shoji; Yamano, Toshihisa; Yoshitomi, Seiji

2012-11-01

We present a case in which chemoradiation therapy was effective in a geriatric patient with Stage IV anal canal cancer. The patient is an 81-year-old woman who complained of proctorrhagia and anal pain. She was referred to us by her family doctor who suspected rectal cancer. Tumors as large as 6.5 cm in diameter mainly on the right side of the rectum as well as 2 palpable enlarged lymph nodes on the right inguinal area, were found during the initial physical examination. Squamous cell carcinoma was elevated to 16 ng/mL. A CT scan revealed that irregularly shaped masses as large as 7 cm in diameter were externally exposed on the right side of the rectum along with enlarged lymph nodes on the right inguinal area and metastasis at S7 lesion in the liver. Squamous cell carcinoma was diagnosed from biopsy results. Due to her age, the chemotherapy regimen was S-1+CDDP with radiation therapy and 4-port irradiation (50.4 Gy) of the primary tumor, interior of the pelvis, and inguinal lymph nodes. Partial response was observed upon completion of treatment, and complete response was obtained after 6 months. She is currently an outpatient taking S-1: 60 mg/day orally. There is no indication of cancer recurrence after 1 year and 3 months, and she continues to visit an outpatient clinic for regular follow-ups. These results demonstrate the effectiveness of chemoradiation therapy for geriatric patients with Stage IV anal canal cancer.

On the use of dental ceramics as a possible second-line approach to accident irradiation dosimetry

International Nuclear Information System (INIS)

Davies, J.E.

1979-01-01

Recent development in dental ceramic production has resulted in natural or depleted uranium, used for over half a century to mimic the fluorescence of natural teeth, being substituted in such ceramics by non-radioactive fluorescent materials. This creates the possibility of using dental ceramics incorporating the latter as second-line dosimeters in cases of accidental irradiation. This pilot study shows the feasbility of such an approach using both thermally stimulated exoelectron and thermoluminescent techniques. In conclusion, it is considered that it would be of interest to continue this investigation of dental ceramic materials as second-line accident dosimeters

Advanced colorectal cancer, refractory to infusional fluorouracil treatment: efficacy of second line fluorouracil in combination with a different biochemical modulation

NARCIS (Netherlands)

van Halteren, H. K.; Wagener, D. J.; Vreugdenhil, G.; Punt, C. J.

1997-01-01

Currently there is no standard second line treatment for patients with advanced colorectal cancer (ACC). Previous reports have demonstrated that some patients may benefit from second line infusional 5-fluorouracil (5-FU) after failing 5-FU bolus treatment. We retrospectively studied the efficacy and

Effects of pushing techniques during the second stage of labor: A randomized controlled trial

Directory of Open Access Journals (Sweden)

Refika Genç Koyucu

2017-10-01

Conclusions: Although the duration of the second stage of labor was longer compared to valsalva pushing technique, women were able to give birth without requiring any verbal or visual instruction, without exceeding the limit value of two hours and without affecting fetal wellness and neonatal results.

The Cox-maze IV procedure in its second decade: still the gold standard?

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Ruaengsri, Chawannuch; Schill, Matthew R; Khiabani, Ali J; Schuessler, Richard B; Melby, Spencer J; Damiano, Ralph J

2018-04-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia and the treatment options include medical treatment and catheter-based or surgical interventions. AF is a major cause of stroke, and its prevalence is increasing. The surgical treatment of AF has been revolutionized over the past 2 decades through surgical innovation and improvements in endoscopic imaging, ablation technology and surgical instrumentation. The Cox-maze (CM) procedure, which was developed by James Cox and introduced clinically in 1987, is a procedure in which multiple incisions are created in both the left and the right atria to eliminate AF while allowing the sinus impulse to reach the atrioventricular node. This procedure became the gold standard for the surgical treatment of AF. Its latest iteration is termed the CM IV and was introduced in 2002. The CM IV replaced the previous cut-and-sew method (CM III) by replacing most of the incisions with a combination of bipolar radiofrequency and cryoablation. The use of ablation technologies, made the CM IV technically easier, faster and more amenable to minimally invasive approaches. The aims of this article are to review the indications and preoperative planning for the CM IV, to describe the operative technique and to review the literature including comparisons of the CM IV with the previous cut-and-sew method. Finally, this review explores future directions for the surgical treatment of patients with AF.

Colorectal cancer stages transcriptome analysis.

Directory of Open Access Journals (Sweden)

Tianyao Huo

Full Text Available Colorectal cancer (CRC is the third most common cancer and the second leading cause of cancer-related deaths in the United States. The purpose of this study was to evaluate the gene expression differences in different stages of CRC. Gene expression data on 433 CRC patient samples were obtained from The Cancer Genome Atlas (TCGA. Gene expression differences were evaluated across CRC stages using linear regression. Genes with p≤0.001 in expression differences were evaluated further in principal component analysis and genes with p≤0.0001 were evaluated further in gene set enrichment analysis. A total of 377 patients with gene expression data in 20,532 genes were included in the final analysis. The numbers of patients in stage I through IV were 59, 147, 116 and 55, respectively. NEK4 gene, which encodes for NIMA related kinase 4, was differentially expressed across the four stages of CRC. The stage I patients had the highest expression of NEK4 genes, while the stage IV patients had the lowest expressions (p = 9*10-6. Ten other genes (RNF34, HIST3H2BB, NUDT6, LRCh4, GLB1L, HIST2H4A, TMEM79, AMIGO2, C20orf135 and SPSB3 had p value of 0.0001 in the differential expression analysis. Principal component analysis indicated that the patients from the 4 clinical stages do not appear to have distinct gene expression pattern. Network-based and pathway-based gene set enrichment analyses showed that these 11 genes map to multiple pathways such as meiotic synapsis and packaging of telomere ends, etc. Ten of these 11 genes were linked to Gene Ontology terms such as nucleosome, DNA packaging complex and protein-DNA interactions. The protein complex-based gene set analysis showed that four genes were involved in H2AX complex II. This study identified a small number of genes that might be associated with clinical stages of CRC. Our analysis was not able to find a molecular basis for the current clinical staging for CRC based on the gene expression patterns.

Metabolic tumor volume measured by F 18 FDG PET/CT can further stratify the prognosis of patients with stage IV Non Small Cell Lung Cancer

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Yoo, Su Woong; Kim, Ja Hae; Chong, Ar I; Kwon, Seong Young; Min, Jung Joon; Song, Ho Chun; Bom, Hee Seung [Chonnam National Univ. Hwasun Hospital, Gwangju (Korea, Republic of)

2012-12-15

This study aimed to further stratify prognostic factors in patients with stage IV non small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). The subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F 18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were mea measured by receiver operating characteristic (ROC) curve anal analysis. Kaplan Meier survival (PET). The univariate and multivariate cox proportional hazards models were used to select the significant prognostic factors. Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV lung and TLG lung) were significant factors for prediction of PFS ( <0.001 =0.038, respectively). Patients showing lower values of MTV lung and TLG lung than the cutoff values had significantly longer mean PFS than those with higher values. hazard ratios (95% confidence interval) of MTV lung and TLG lung measured by univariate analysis were 6.4 (2.5 16.3) and 2.4 (1.0 5.5), respectively. multivariate analysis revealed that MTV lung was the only significant factor for prediction of prognosis. Hazard ratio was 13,5 (1.6 111.1, =0,016). patients with stage IV NSCLC could be further stratified into subgroups of significantly better and worse prognosis by MTV of primary lung lesion.

Metabolic tumor volume measured by F 18 FDG PET/CT can further stratify the prognosis of patients with stage IV Non Small Cell Lung Cancer

International Nuclear Information System (INIS)

Yoo, Su Woong; Kim, Ja Hae; Chong, Ar I; Kwon, Seong Young; Min, Jung Joon; Song, Ho Chun; Bom, Hee Seung

2012-01-01

This study aimed to further stratify prognostic factors in patients with stage IV non small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). The subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F 18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were mea measured by receiver operating characteristic (ROC) curve anal analysis. Kaplan Meier survival (PET). The univariate and multivariate cox proportional hazards models were used to select the significant prognostic factors. Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV lung and TLG lung) were significant factors for prediction of PFS ( <0.001 =0.038, respectively). Patients showing lower values of MTV lung and TLG lung than the cutoff values had significantly longer mean PFS than those with higher values. hazard ratios (95% confidence interval) of MTV lung and TLG lung measured by univariate analysis were 6.4 (2.5 16.3) and 2.4 (1.0 5.5), respectively. multivariate analysis revealed that MTV lung was the only significant factor for prediction of prognosis. Hazard ratio was 13,5 (1.6 111.1, =0,016). patients with stage IV NSCLC could be further stratified into subgroups of significantly better and worse prognosis by MTV of primary lung lesion

Human metastatic melanoma cell lines express high levels of growth hormone receptor and respond to GH treatment

Energy Technology Data Exchange (ETDEWEB)

Sustarsic, Elahu G. [Edison Biotechnology Institute, 1 Watertower Drive, Athens, OH (United States); Department of Biological Sciences, Ohio University, Athens, OH (United States); Junnila, Riia K. [Edison Biotechnology Institute, 1 Watertower Drive, Athens, OH (United States); Kopchick, John J., E-mail: kopchick@ohio.edu [Edison Biotechnology Institute, 1 Watertower Drive, Athens, OH (United States); Department of Biological Sciences, Ohio University, Athens, OH (United States); Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH (United States)

2013-11-08

Highlights: •Most cancer types of the NCI60 have sub-sets of cell lines with high GHR expression. •GHR is highly expressed in melanoma cell lines. •GHR is elevated in advanced stage IV metastatic tumors vs. stage III. •GH treatment of metastatic melanoma cell lines alters growth and cell signaling. -- Abstract: Accumulating evidence implicates the growth hormone receptor (GHR) in carcinogenesis. While multiple studies show evidence for expression of growth hormone (GH) and GHR mRNA in human cancer tissue, there is a lack of quantification and only a few cancer types have been investigated. The National Cancer Institute’s NCI60 panel includes 60 cancer cell lines from nine types of human cancer: breast, CNS, colon, leukemia, melanoma, non-small cell lung, ovarian, prostate and renal. We utilized this panel to quantify expression of GHR, GH, prolactin receptor (PRLR) and prolactin (PRL) mRNA with real-time RT qPCR. Both GHR and PRLR show a broad range of expression within and among most cancer types. Strikingly, GHR expression is nearly 50-fold higher in melanoma than in the panel as a whole. Analysis of human metastatic melanoma biopsies confirmed GHR gene expression in melanoma tissue. In these human biopsies, the level of GHR mRNA is elevated in advanced stage IV tumor samples compared to stage III. Due to the novel finding of high GHR in melanoma, we examined the effect of GH treatment on three NCI60 melanoma lines (MDA-MB-435, UACC-62 and SK-MEL-5). GH increased proliferation in two out of three cell lines tested. Further analysis revealed GH-induced activation of STAT5 and mTOR in a cell line dependent manner. In conclusion, we have identified cell lines and cancer types that are ideal to study the role of GH and PRL in cancer, yet have been largely overlooked. Furthermore, we found that human metastatic melanoma tumors express GHR and cell lines possess active GHRs that can modulate multiple signaling pathways and alter cell proliferation. Based on

The Relationship between the "Childhood Autism Rating Scale: Second Edition" and Clinical Diagnosis Utilizing the DSM-IV-TR and the DSM-5

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Dawkins, Tamara; Meyer, Allison T.; Van Bourgondien, Mary E.

2016-01-01

"The Childhood Autism Rating Scale, Second Edition" (CARS2; 2010) includes two rating scales; the CARS2-Standard Version (CARS2-ST) and the newly developed CARS2-High Functioning Version (CARS2-HF). To assess the diagnostic agreement between the CARS2 and DSM-IV-TR versus DSM-5 criteria for Autism Spectrum Disorder (ASD), clinicians at…

Second-line therapy in diffuse large B-cell lymphoma (DLBCL): treatment patterns and outcomes in older patients receiving outpatient chemotherapy.

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Danese, Mark D; Griffiths, Robert I; Gleeson, Michelle L; Dalvi, Tapashi; Li, Jingyi; Mikhael, Joseph R; Deeter, Robert; Dreyling, Martin

2017-05-01

Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33.1% received palliative therapy. There were no differences in survival by type of therapy received, either for relapsed or refractory patients, although the patient risk profile differed significantly. However, duration of remission, male gender, and anemia at diagnosis were important predictors in relapsed patients, and male gender, B-symptoms, comorbidity burden, and poverty status were important predictors in refractory patients. Survival in elderly patients receiving second-line therapy remains poor, and the 24-month cost of all care exceeds $97,000. Patients would benefit from improved treatment options.

Assessment of skeletal maturation with permanent mandibular second molar calcification stages among a group of Nepalese orthodontic patients

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Giri J

2016-03-01

Full Text Available Jamal Giri,1 Basanta Kumar Shrestha,2 Rajiv Yadav,2 Tika Ram Ghimire21Department of Orthodontics, BP Koirala Institute of Health Sciences, Dharan, 2Department of Dentistry, Institute of Medicine, Kathmandu, Nepal Background: Assessment of growth status of a patient is a key component in orthodontic diagnosis and treatment planning for growing patients with skeletal discrepancy. Skeletal maturation based on hand-wrist radiograph and cervical vertebral maturation (CVM are commonly used methods of growth assessment. Studies have shown that stages of dental calcification can also be used to assess skeletal maturation status of an individual, whereas other studies have suggested that the relationship between dental calcification and skeletal maturation should be interpreted with caution owing to racial variation. Objective: To evaluate the relationship between permanent mandibular second molar calcification stages and skeletal maturity assessed by CVM among a group of Nepalese orthodontic patients. Materials and methods: One hundred and sixty-eight digital radiographs (84 orthopantomograms and 84 lateral cephalograms were obtained from the records of 84 patients who sought orthodontic treatment in Orthodontic and Dentofacial Orthopaedic Unit, Department of Dentistry, Institute of Medicine, Kathmandu. Two parameters were used in this study, namely, CVM stages from lateral cephalogram and Demirjian index (DI stages from orthopantomogram. The evaluation of digital radiographs was carried out on a computer screen with a resolution of 1,280×800 pixels. The association between DI stages of permanent mandibular second molar and CVM stages was assessed. Results: A statistically significant association was found between DI and CVM stages for both male and female subjects with Pearson's contingency coefficient value of 0.751 and 0.766 for male and female subjects, respectively. Conclusion: Skeletal maturation can be reliably assessed with dental calcification

Interpretation of electrocardiographic, echocardiographic and biochemical findings during different stages of Canine Visceral Leishmaniasis

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Ural K

2017-09-01

Full Text Available Objective. The purpose of the present study was to test the hypothesis that cardiac alterations participate within different stages of CVL. Materials and methods. Twenty-eight dogs were diagnosed with CVL, were classified [based on clinical signs, rapid ELISA/IFAT, hematological and serum biochemical tests, urinary protein/creatinine ratio, ECG and ECHO]. as follows; group I (mild disease, group II (moderate disease, group III (severe disease, group IV (very severe disease and group V included healthy controls. Results. Ig G antibodies against leishmaniasis as tested by IFAT, were deemed 1/64 to 1/16000 among infected groups. There were statistical significance regarding mean values for WBC [among healthy control group (V. and other groups (p=0.049], RBC [among stage III-stage IV and other groups (p=0.001], Hb [between stage I and stage III-stage IV (p=0.008, HCT [between stage I and other groups (p = 0.001] MCHC [between stage I and stage II- stage IV (p=0.046], serum creatinine [(p=0.008 stage IV and stage I-II within group V], serum protein [(p=0.002 among stage IV and stage I-III- healthy control groups] and serum albumine [(p=0.004 among stage IV and stage I-II]. There was no alteration in CTnI concentrations,among groups. UPC analysis revealed statistical difference among control group and stage II to IV dogs (p=0.000. Moderate or severe ECG abnormalities were detected in 6/28 of diseased dogs. Regarding ECHO examination LA/ Ao value presented significant difference (p=0.003 among stage IV and other groups. Conclusions. It may be suggested that establishing Leishvet Working Group to those of dogs classified into stage I to IV, ECG [left atrial/ventricular enlargement, myocardial hypoxia] and ECHO [left atrial dilation, decrased/increased LVIDs, decrased/increased LVIDd, shortened FS and EF (systolic dysfunction] alterations must be taken into account along with hematological and serum biochemical analysis.

New spectroscopic results in Xe II, Xe III, and Xe IV

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Reyna Almandos, Jorge Guillermo; Gallardo, Mario; Garavaglia, Mario J.

1982-01-01

New results obtained in spontaneous xenon spectrum employing a conventional pulsed gaseous laser tube as light source, are presented in this work. A total of 626 spectral lines has been ionically assigned as follows: 50 to Xe II spectrum, 103 to Xe III spectrum, arid 222 to Xe IV spectrum. 30 Lines previously assigned to Xe II were reassigned as belonging to Xe III, 94 lines were assigned with some doubts to Xe II-III spectrum and 84 lines to Xe Ill-IV spectrum. Also there were clas...

ACTOplus Met XR in Treating Patients With Stage I-IV Oral Cavity or Oropharynx Cancer Undergoing Definitive Treatment | Division of Cancer Prevention

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This randomized phase IIb trial studies how well ACTOplus met XR works in treating in patients with stage I-IV oral cavity or oropharynx cancer that are undergoing definitive treatment. Chemoprevention is the use of drugs to keep oral cavity or oropharynx cancer from forming or coming back. The use of ACTOplus met XR may slow disease progression in patients with oral cavity or

Is there a progression-free survival benefit of first-line crizotinib versus standard chemotherapy and second-line crizotinib in ALK-positive advanced lung adenocarcinoma? A retrospective study of Chinese patients.

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Cui, Shaohua; Zhao, Yizhuo; Dong, Lili; Gu, Aiqin; Xiong, Liwen; Qian, Jialin; Zhang, Wei; Niu, Yanjie; Pan, Feng; Jiang, Liyan

2016-06-01

Although crizotinib has demonstrated promising efficacy and acceptable toxicity in patients with advanced non-small cell lung cancer (NSCLC), the available evidence in Chinese populations is currently limited. This study compared the progression-free survival (PFS) of Chinese patients with anaplastic lymphoma kinase (ALK)-positive, advanced lung adenocarcinoma who received first-line crizotinib therapy with that of patients who received first-line standard chemotherapy, and also the PFS benefit of first-line versus second-line crizotinib treatment. Data on 80 patients with ALK-positive, advanced lung adenocarcinoma who received crizotinib or standard chemotherapy as first-line treatments between June 2013 and December 2014 were retrospectively collected; 26 of the patients received crizotinib as second-line therapy after progressive disease (PD) occurred on first-line chemotherapy. Tumor responses were assessed using Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. The median PFS was 13.3 months (95% CI: 6.5-20.0 months) in patients who received first-line crizotinib as compared with 5.4 months (95% CI: 4.4-6.5 months) in patients who received first-line standard chemotherapy (adjusted hazard ratio for progression or death with crizotinib, 0.20; 95% CI: 0.11-0.36; P benefit of first-line crizotinib versus first-line standard chemotherapy in Chinese patients with ALK-positive lung adenocarcinoma. Additionally, crizotinib showed promising efficacy in patients who received it as second-line therapy after PD had occurred on first-line chemotherapy. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Early stage second-language learning improves executive control: evidence from ERP.

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Sullivan, Margot D; Janus, Monika; Moreno, Sylvain; Astheimer, Lori; Bialystok, Ellen

2014-12-01

A growing body of research has reported a bilingual advantage in performance on executive control tasks, but it is not known at what point in emerging bilingualism these advantages first appear. The present study investigated the effect of early stage second-language training on executive control. Monolingual English-speaking students were tested on a go-nogo task, sentence judgment task, and verbal fluency, before and after 6 months of Spanish instruction. The training group (n = 25) consisted of students enrolled in introductory Spanish and the control group (n = 30) consisted of students enrolled in introductory Psychology. After training, the Spanish group showed larger P3 amplitude on the go-nogo task and smaller P600 amplitude on the judgment task, indicating enhanced performance, with no changes for the control group and no differences between groups on behavioral measures. Results are discussed in terms of neural changes underlying executive control after brief second-language learning. Copyright © 2014 Elsevier Inc. All rights reserved.

Second Line of Defense Virtual Private Network Guidance for Deployed and New CAS Systems

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Singh, Surya V.; Thronas, Aaron I.

2010-01-01

This paper discusses the importance of remote access via virtual private network (VPN) for the Second Line of Defense (SLD) Central Alarm System (CAS) sites, the requirements for maintaining secure channels while using VPN and implementation requirements for current and future sites.

Resistance to fluoroquinolones and second-line injectable drugs: impact on multidrug-resistant TB outcomes

NARCIS (Netherlands)

Falzon, Dennis; Gandhi, Neel; Migliori, Giovanni B.; Sotgiu, Giovanni; Cox, Helen S.; Holtz, Timothy H.; Hollm-Delgado, Maria-Graciela; Keshavjee, Salmaan; Deriemer, Kathryn; Centis, Rosella; D'Ambrosio, Lia; Lange, Christoph G.; Bauer, Melissa; Menzies, Dick; Ahuja, S. D.; Ashkin, D.; Avendaño, M.; Banerjee, R.; Bauer, M.; Becerra, M. C.; Benedetti, A.; Burgos, M.; Centis, R.; Chan, E. D.; Chiang, C. Y.; Cobelens, F.; Cox, H.; D'Ambrosio, L.; de Lange, W. C. M.; DeRiemer, K.; Enarson, D.; Falzon, D.; Flanagan, K. L.; Flood, J.; Gandhi, N.; Garcia-Garcia, M. L.; Granich, R. M.; Hollm-Delgado, M. G.; Holtz, T. H.; Hopewell, P.; Iseman, M. D.; Jarlsberg, L. G.; Keshavjee, S.; Kim, H. R.; Koh, W. J.; Lancaster, J. L.; Lange, C.; Leimane, V.; Leung, C. C.; Li, J.

2013-01-01

A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable

Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?

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Rustum, Saad; Beckmann, Erik; Wilhelmi, Mathias; Krueger, Heike; Kaufeld, Tim; Umminger, Julia; Haverich, Axel; Martens, Andreas; Shrestha, Malakh

2017-10-01

Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease. Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure. The median times to the second-stage procedure were 7 (0-78) months in the ET group and 8 (0-66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4-10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11). We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Evaluation of MGIT 960 System for the Second-Line Drugs Susceptibility Testing of Mycobacterium tuberculosis

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Hyejin Kim

2013-01-01

Full Text Available Many laboratories validate DST of the second-line drugs by BACTEC MGIT 960 system. The objective of this study is to evaluate the critical concentration and perform DST for the 2nd line drugs. We evaluated 193 clinical strains of M. tuberculosis isolated from patients in South Korea. Testing the critical concentration of six second-line drugs was performed by MGIT 960 and compared with L-J proportion method. The critical concentration was determined to establish the most one that gave the difference between drug resistance and susceptibility in MGIT960 system. Good agreement of the following concentrations was found: Concordance was 95% for 0.5 μg/mL of moxifloxacin; 93.6%, 1.0 μg/mL of levofloxacin; 97.5%, 2.5 μg/mL of kanamycin; 90.6%, 2.5 μg/mL of capreomycin; 86.2%, 5.0 μg/mL of ethionamide; and 90.8%, 2.0 μg/mL of ρ-aminosalicylic acid. The critical concentrations of the four drugs, moxifloxacin, levofloxacin, kanamycin, and capreomycin, were concordant and reliable for testing 2nd line drug resistance. Further study of ethionamide and ρ-aminosalicylic acid is required.

Primary colectomy in patients with stage IV colon cancer and unresectable distant metastases improves overall survival: results of a multicentric study.

Science.gov (United States)

Karoui, Mehdi; Roudot-Thoraval, Françoise; Mesli, Farida; Mitry, Emmanuel; Aparicio, Thomas; Des Guetz, Gaetan; DesGuetz, Gaetan; Louvet, Christophe; Landi, Bruno; Tiret, Emmanuel; Sobhani, Iradj

2011-08-01

Whether patients with stage IV colon cancer and unresectable distant metastases should be managed by primary colectomy followed by chemotherapy or immediate chemotherapy without resection of the primary tumor is still controversial. This study aimed to evaluate predictive factors associated with survival in patients with stage IV colon cancer and unresectable distant metastases. This large retrospective multicentric study included 6 academic hospitals. This study was conducted at 6 Paris University Hospitals (Assistance Publique-Hôpitaux de Paris; Saint Antoine, Henri Mondor, Ambroise Paré, Hôpital Europeen Gorges Pompidou, Bichat, and Avicenne). Between 1998 and 2007, 208 patients with good performance status and stage IV colon cancer with unresectable distant metastases received chemotherapy, either as initial management or after primary tumor resection. Survival was estimated by use of the Kaplan-Meier method. Factors associated with survival were tested by means of a log-rank test. Results were expressed as median values with 95% confidence intervals. Factors independently related to survival were tested using a Cox regression model adjusted for a propensity score. Of the 208 patients, 85 underwent colectomy before chemotherapy, whereas 123 were treated with use of primary chemotherapy with or without biotherapy. At univariate analysis, the following factors were significantly associated with survival: primary colectomy (P = .031), secondary curative surgery (P < .001), well-differentiated primary tumor (P < .001), exclusive liver metastases (P < .027), absence of need for colonic stent (P = .009), and addition of antiangiogenic (P = .001) or anti-epidermal growth factor receptor (P = .013) drugs to chemotherapy. After Cox multivariate analysis and after adjusting for the propensity score, all of these factors, with the exception of two, colonic stent and anti-epidermal growth factor receptor drug, were found to be independently associated with overall

Comparison of abdominopelvic CT results and findings at second-look laparotomy in ovarian carcinoma patients

International Nuclear Information System (INIS)

Reuter, K.L.; Griffin, T.; Hunter, R.E.

1987-01-01

Restaging in epithelial ovarian carcinoma after primary therapy has proven difficult by standard noninvasive methods and commonly requires second-look laparotomy. In the authors' study to date preoperative abdominopelvic CT (CBT) results and operative findings have been compared in 24 patients (25 studies) with ovarian adenocarcinoma currently clinically free of disease originally graded as FIGO stage III or IV, except for one patient with stage IC, undergoing second-look laparotomy to determine tumor status. There were ten true-negative, three false-negative, 12 true-positive, and no false-positive CBTs. Negative studies were associated with positive findings at laparotomy, including microscopic foci, in only 12% of all cases; thus, CBT in the series has shown a better correlation with surgery than in previous studies. Currently the authors are combining monoclonal antibody scanning with the CBT results with the goal of possibly avoiding second-look surgery in certain patients

Bone radioisotope scanning: usefulness in the evaluation and observation of patients with breast cancer in clinical stage II, III, IV; Gammagrafia osea: utilidad en la evaluacion y seguimiento de pacientes con cancer de mama en estadio clinico II, III, IV

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Cano P, R A

1996-12-31

The clinical records of 420 patients with diagnosis of breast cancer well documented by the pathological anatomy in clinical stage II, III and IV were reviewed. In each one of them has been done at least a bone scanning during the diagnosis. In 52 cases carried out sericeous dosages of CA 15-3 and in some cases it was necessary to administer Samarium-153 EDTMP as palliative therapy of bone pain. The presence of secondary gamma-graphic focuses was 0/84 cases (0%) in clinical stage II, 54/265 cases (20%) in III and 41/91 cases (45%) in IV. The one focus appeared in 6.7% of the cases. In 7 of the 52 cases that received sericeous dosages of CA 15-3 were detected secondary osseous lesions, and 5 of them presented a marker elevation. The bone scanning has shown in many cases the presence of getters focuses in singular places of skeleton, urinary excretory system or mammary tissue. The gamma rays from Sm-153 allowed us to get some appropriate basal views post-therapy of the secondary lesions. The results show that the great incidence of secondary lesions in the skeleton occurred in cases of stages III and IV unlike other countries. The serial repetition of the radioisotope scanning. The presence of one focus in the skeleton of a patient with a well-known neoplasia makes us to do a careful evaluation of the focus nature. The presence of tracer accumulation in the kidney, ureter and bladder allows us to infer the pathology of excretory system that is the first evidence of its presence in many cases. (author). 71 refs., 7 figs., 6 tabs.

Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB-IV lung cancer patients.

Science.gov (United States)

Kim, Yu Jung; Kim, Mi-Jung; Cho, Young-Jae; Park, Jong Sun; Kim, Jin Won; Chang, Hyun; Lee, Jeong-Ok; Lee, Keun-Wook; Kim, Jee Hyun; Yoon, Ho Il; Bang, Soo-Mee; Lee, Jae Ho; Lee, Choon-Taek; Lee, Jong Seok

2014-03-01

Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS)≥2, and 79 (84%) had non-small-cell lung cancer. In total, 28 patients (30%) were newly diagnosed or were receiving first-line treatment, and 22 (23%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90%), and ICU mortality and hospital mortality were 57 and 78%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratiobedridden patients (n=22) showed significantly poorer overall survival (11.0 vs. 29.0 days, p=0.005). Among 21 patients who were discharged from the hospital, 11 (52%) received further chemotherapy. Certain advanced lung cancer patients may benefit from ICU management. However, refractory patients and patients with a poor PS do not seem to benefit from ICU care. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.

Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa

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W Barnett

2013-11-01

Full Text Available Background. The recent scale-up of antiretroviral therapy (ART coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART. Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers. Methods. Research was conducted at a large primary care tuberculosis (TB/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11, in-depth interviews with patients (n=10 and a Photovoice workshop (n=11. Responses and photographs were coded by content; data were transformed into variables and analysed accordingly. Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic. Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.

Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol

International Nuclear Information System (INIS)

Ritter, M.; Teudt, I. U.; Meyer, J. E.; Schröder, U.; Kovács, G.; Wollenberg, B.

2016-01-01

After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol. From January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data. DFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed. Pre-treated patients with a further relapse benefit from the ‘cetuximab-taxane recurrency scheme’. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity. The online version of this article (doi:10.1186/s13014-016-0583-0) contains supplementary material, which is available to authorized users

Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

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Jegadeesh, Naresh; Rajpara, Raj; Esiashvili, Natia; Shi, Zheng [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Liu, Yuan [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia (United States); Okwan-Duodu, Derrick [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Flowers, Christopher R. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Medical Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

2015-05-01

Purpose: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (DLBCL) in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. Methods and Materials: Two hundred eleven patients with stage III and IV DLBCL treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed, with local recurrence (LR) as the primary outcome. Results: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV≥15 (P=.10). Conclusions: Advanced-stage DLBCL patients with stage III disease or with disease ≥5 cm appear to be at an increased risk for LR. Patients with <5-cm disease and SUVmax ≥15 may be at higher risk for LR. These patients may benefit from consolidative RT after chemoimmunotherapy.

Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

International Nuclear Information System (INIS)

Jegadeesh, Naresh; Rajpara, Raj; Esiashvili, Natia; Shi, Zheng; Liu, Yuan; Okwan-Duodu, Derrick; Flowers, Christopher R.; Khan, Mohammad K.

2015-01-01

Purpose: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (DLBCL) in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. Methods and Materials: Two hundred eleven patients with stage III and IV DLBCL treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed, with local recurrence (LR) as the primary outcome. Results: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV≥15 (P=.10). Conclusions: Advanced-stage DLBCL patients with stage III disease or with disease ≥5 cm appear to be at an increased risk for LR. Patients with <5-cm disease and SUVmax ≥15 may be at higher risk for LR. These patients may benefit from consolidative RT after chemoimmunotherapy

Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma

Science.gov (United States)

Horwich, A; Fossa, S D; Huddart, R; Dearnaley, D P; Stenning, S; Aresu, M; Bliss, J M; Hall, E

2014-01-01

Background: Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant. Methods: We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51 151 person-years of follow-up. Results: Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47–1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39–1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic–abdominal sites the SIR was 1.62 (95% CI: 1.43–1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98–1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30–1.65, P<0.0001). Conclusion: The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers. PMID:24263066

A Phase II Study of Weekly Docetaxel as Second-Line Chemotherapy in Patients With Metastatic Urothelial Carcinoma.

Science.gov (United States)

Kim, Young Saing; Lee, Soon Il; Park, Se Hoon; Park, Silvia; Hwang, In Gyu; Lee, Sang-Cheol; Sun, Jong-Mu; Lee, Jeeyun; Lim, Ho Yeong

2016-02-01

The present multicenter phase II study evaluated the efficacy and safety of weekly docetaxel as second-line chemotherapy for metastatic urothelial carcinoma. Weekly docetaxel was well tolerated but demonstrated modest activity, with a response rate of 6%, a median progression-free survival (PFS) of 1.4 months, and a median overall survival (OS) of 8.3 months. The dichotomy between PFS and OS was likely associated with subsequent platinum-based chemotherapy received by 58% of the patients. Docetaxel is commonly used for second-line therapy for metastatic urothelial carcinoma (UC). However, myelosuppression is a substantial concern when the traditional 3-week docetaxel cycle is used. The present multicenter phase II study evaluated the efficacy and safety of weekly docetaxel as second-line chemotherapy for metastatic UC. Patients with progression after previous platinum-based chemotherapy for advanced or metastatic disease were treated with docetaxel 30 mg/m(2) on days 1 and 8 every 21 days. The primary endpoint was the response rate. The study enrolled 31 patients. Their median age was 64 years (range, 40-79 years). An Eastern Cooperative Oncology Group performance status of 1, liver metastasis, and a hemoglobin level chemotherapy had been administered for metastatic disease in 29 patients (94%). Although fatigue (13%) and anorexia (6%) were the most frequently observed grade 3 to 4 toxicities, the safety profiles were generally mild and manageable. Two patients (6%) achieved an objective response, which was maintained for 3.0 to 7.8 months. Eight patients experienced disease stabilization (disease control rate, 32%). The median progression-free survival (PFS) and overall survival (OS) were 1.4 months (95% confidence interval [CI], 1.3-1.6) and 8.3 months (95% CI, 5.9-10.6), respectively. A relatively long OS was associated with further salvage platinum-based chemotherapy (n = 18, 58%) showing an encouraging activity (response rate, 44%; median PFS, 4.0 months

Transfer line tests take centre stage

CERN Multimedia

Katarina Anthony

2014-01-01

Last weekend, proton beams came knocking on the LHC's door. Shooting from the SPS and into the two LHC transfer lines, the proton beams were dumped just short of entering the accelerator.   The upper plot shows the trajectory of the first TI2 beam, which reached the end of the transfer line in a single attempt after 18 months of technical stop. Below, a smoother beam trajectory in TI2 after some corrections. For the first time since Run 1, the SPS to LHC transfer lines (TI8 and TI2) transported proton beams just short of the LHC. "We tested the beam instrumentation, the devices that measure the beam intensity, transverse beam profile, position and losses, as well as the beam collimators along the transfer lines," says Reyes Alemany Fernandez, the engineer in charge of the LHC. "We were also able to spot possible bottle necks in the beam trajectory and to perform the first optics measurements." Once the beams arrived at the transfer line beam dumps...

Can Locoregional Treatment of the Primary Tumor Improve Outcomes for Women With Stage IV Breast Cancer at Diagnosis?

International Nuclear Information System (INIS)

Nguyen, David H.A.; Truong, Pauline T.; Alexander, Cheryl; Walter, Caroline V.; Hayashi, Emily; Christie, Jennifer; Lesperance, Mary

2012-01-01

Purpose: To examine the effect of locoregional treatment (LRT) of the primary tumor on survival in patients with Stage IV breast cancer at diagnosis. Methods and Materials: The study cohort comprised 733 women referred to the British Columbia Cancer Agency between 1996 and 2005 with newly diagnosed clinical or pathologic M1 breast cancer. Tumor and treatment characteristics, overall survival (OS), and locoregional progression-free survival were compared between patients treated with (n = 378) and without (n = 355) LRT of the primary disease. Multivariable analysis was performed with Cox regression modeling. Results: The median follow-up time was 1.9 years. LRT consisted of surgery alone in 67% of patients, radiotherapy alone in 22%, and both in 11%. LRT was used more commonly in women with age <50 years, Eastern Cooperative Oncology Group (ECOG) performance status 0–1, Stage T1–2 tumors, N0–1 disease, limited M1 burden, and asymptomatic M1 disease (all p < 0.05). Systemic therapy was used in 92% of patients who underwent LRT and 85% of patients who did not. In patients treated with LRT compared with those without LRT, the 5-year OS rates were 21% vs. 14% (p < 0.001), and the rates of locoregional progression-free survival were 72% vs. 46% (p < 0.001). Among 378 patients treated with LRT, the rates of 5-year OS were higher in patients with age <50, ECOG performance status 0–1, estrogen receptor–positive disease, clear surgical margins, single subsite, bone-only metastasis, and one to four metastatic lesions (all p < 0.003). On multivariable analysis, LRT was associated with improved OS (hazard ratio, 0.78; 95% confidence interval, 0.64–0.94, p = 0.009). Conclusion: Locoregional treatment of the primary disease is associated with improved survival in some women with Stage IV breast cancer at diagnosis. Among those treated with LRT, the most favorable rates of survival were observed in subsets with young age, good performance status, estrogen receptor�

Phase II trial of second-line erlotinib and digoxin for nonsmall cell lung cancer (NSCLC

Directory of Open Access Journals (Sweden)

Fadi Kayali

2011-02-01

Full Text Available Fadi Kayali, Muhamad A Janjua, Damian A Laber, Donald Miller, Goetz H KloeckerUniversity of Louisville, James Graham Brown Cancer Center, Louisville, KY, USABackground: In vitro digoxin sensitizes cancer cells to the induction of apoptosis by chemotherapy. Inhibition of the Na/K-ATPase enzyme by ouabain disturbs the intracellular ion composition of cancer cells, altering cellular homeostasis. This suggests that inhibition of the Na/K pump results in cellular sensitization of malignant but not benign cells to the induction of apoptosis. Epidemiologic studies have also shown beneficial effects of digitalis in breast cancer incidence. At ASCO (American Society of Clinical Oncology 2007 our group presented a Phase II study showing encouraging results by adding digoxin to biochemotherapy for melanoma. Erlotinib is one of the standard second-line treatments for nonsmall cell lung cancer (NSCLC, with a response rate (RR of 10%. This study's hypothesis was that adding digoxin to erlotinib will improve the RR and time to progression (TTP in NSCLC.Methods: Patients with progressive disease (PD after chemotherapy were enrolled if they had an ECOG (Eastern Cooperative Oncology Group score from 0 to 2 and good organ function. Daily erlotinib 150 mg and digoxin 0.25 mg were taken by mouth. The digoxin dose was adjusted to keep levels between 1 and 2 ng/mL. Computed tomography scans were done every 6 weeks. Treatment continued until PD or significant toxicity occurred.Results: Patient accrual lasted from March 2006 until August 2008 and was stopped early at the time of interim analysis. Twenty-eight patients were enrolled, and 24 who completed at least 6 weeks of therapy are presented here. All patients had unresectable NSCLC stage III/IV at diagnosis. Median age was 61 (34–78, 14 were female, 17 had prior radiation (not involving the target lesions, 23 had one prior chemotherapy, and one subject had two. Only one patient was a never-smoker. Histologies were

Second-Line Treatment Options in Non-Small-Cell Lung Cancer: Report From an International Experts Panel Meeting of the Italian Association of Thoracic Oncology

NARCIS (Netherlands)

Gridelli, Cesare; Baas, Paul; Barlesi, Fabrice; Ciardiello, Fortunato; Crinò, Lucio; Felip, Enriqueta; Gadgeel, Shirish; Papadimitrakopoulou, Vali; Paz-Ares, Luis; Planchard, David; Perol, Maurice; Hanna, Nasser; Sgambato, Assunta; Casaluce, Francesca; de Marinis, Filippo

2017-01-01

Non-small-cell lung cancer (NSCLC) patients inevitably progress to first-line therapy and further active treatments are warranted. In the past few years, new second-line therapies, beyond chemotherapy agents, have become available in clinical practice. To date, several options for the second-line

Pushing/bearing down methods for the second stage of labour.

Science.gov (United States)

Lemos, Andrea; Amorim, Melania Mr; Dornelas de Andrade, Armele; de Souza, Ariani I; Cabral Filho, José Eulálio; Correia, Jailson B

2017-03-26

Maternal pushing during the second stage of labour is an important and indispensable contributor to the involuntary expulsive force developed by uterine contraction. There is no consensus on an ideal strategy to facilitate these expulsive efforts and there are contradictory results about the influence on the mother and fetus. To evaluate the benefits and possible disadvantages of different kinds of techniques regarding maternal pushing/breathing during the expulsive stage of labour on maternal and fetal outcomes. We searched Cochrane Pregnancy and Childbirth's Trials Register (19 September 2016) and reference lists of retrieved studies. Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of pushing/bearing down techniques (type and/or timing) performed during the second stage of labour on maternal and neonatal outcomes. Cluster-RCTs were eligible for inclusion, but none were identified. Studies using a cross-over design and those published in abstract form only were not eligible for inclusion in this review. Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. Data were checked for accuracy. In this updated review, we included 21 studies in total, eight (884 women) comparing spontaneous pushing versus directed pushing, with or without epidural analgesia and 13 (2879 women) comparing delayed pushing versus immediate pushing with epidural analgesia. Our GRADE assessments of evidence ranged from moderate to very low quality; the main reasons for downgrading were study design limitations and imprecision of effect estimates. Overall, the included studies varied in their risk of bias; most were judged to be at unclear risk of bias. Comparison 1: types of pushing: spontaneous pushing versus directed pushingThere was no clear difference in the duration of the second stage of labour (mean difference (MD) 10.26 minutes; 95% confidence interval (CI) -1.12 to 21.64 minutes, six studies, 667 women, random

An original accelerated radiotherapy schedule in stage III to IV head and neck cancers. Results in a multicenter setting

International Nuclear Information System (INIS)

Allal, A.S.

2000-01-01

Background: Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting. Patients and Methods: Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.9 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days). Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2x1.6 Gy to 1.66 Gy/day) to a larger head and neck volume. Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles). Results: Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%). Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases. The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71). The 5-year overall actuarial survival was 32% (95% CI: 18 to 46). Induction chemotherapy was not associated with a more favorable outcome. Conclusions: This study demonstrates the feasibility of this schedule in a multicenter setting. The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable. Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials. (orig.) [de

Cost effectiveness of regorafenib as second-line therapy for patients with advanced hepatocellular carcinoma.

Science.gov (United States)

Parikh, Neehar D; Singal, Amit G; Hutton, David W

2017-10-01

Regorafenib, a multikinase inhibitor, has demonstrated prolonged survival by 2.8 months as a second-line agent in patients with hepatocellular carcinoma (HCC) who progress on sorafenib therapy. The objective of the current study was to examine the cost effectiveness of regorafenib for the treatment of HCC. The authors constructed a Markov simulation model of patients with unresectable HCC and Child-Pugh A cirrhosis who received treatment with regorafenib versus best supportive care. Model inputs for regorafenib effectiveness and rates of adverse events in patients with HCC were based on published clinical trial data and literature review. Quality-adjusted life years (QALYs) were calculated along with the incremental cost-effectiveness ratio (ICER) of regorafenib therapy. One-way sensitivity analyses also were conducted simultaneously on all model parameters and on various Monte-Carlo simulation parameters, and the regorafenib cost threshold at which cost effectiveness would be achieved was determined. Regorafenib provided an increase of 0.18 QALYs at a cost of $47,112. The ICER for regorafenib, compared with best supportive care, was $224,362. In 1-way sensitivity analyses, there were no scenarios in which regorafenib was cost effective. In cost threshold analysis, regorafenib would have to be priced at or below $67 per pill to be cost effective at an ICER of $100,000. Regorafenib is not cost effective as a second-line agent in the treatment of HCC, with a marginal increase in QALYs at a high cost. Lowering the cost of regorafenib or improving the selection of patients who can achieve maximal survival benefit would improve its value as a second-line treatment option for patients with HCC. Cancer 2017;123:3725-3731. © 2017 American Cancer Society. © 2017 American Cancer Society.

A Bayesian network meta-analysis on second-line systemic therapy in advanced gastric cancer.

Science.gov (United States)

Zhu, Xiaofu; Ko, Yoo-Joung; Berry, Scott; Shah, Keya; Lee, Esther; Chan, Kelvin

2017-07-01

It is unclear which regimen is the most efficacious among the available therapies for advanced gastric cancer in the second-line setting. We performed a network meta-analysis to determine their relative benefits. We conducted a systematic review of randomized controlled trials (RCTs) through the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and American Society of Clinical Oncology abstracts up to June 2014 to identify phase III RCTs on advanced gastric cancer in the second-line setting. Overall survival (OS) data were the primary outcome of interest. Hazard ratios (HRs) were extracted from the publications on the basis of reported values or were extracted from survival curves by established methods. A Bayesian network meta-analysis was performed with WinBUGS to compare all regimens simultaneously. Eight RCTs (2439 patients) were identified and contained extractable data for quantitative analysis. Network meta-analysis showed that paclitaxel plus ramucirumab was superior to single-agent ramucirumab [OS HR 0.51, 95 % credible region (CR) 0.30-0.86], paclitaxel (OS HR 0.81, 95 % CR 0.68-0.96), docetaxel (OS HR 0.56, 95 % CR 0.33-0.94), and irinotecan (OS HR 0.71, 95 % CR 0.52-0.99). Paclitaxel plus ramucirumab also had an 89 % probability of being the best regimen among all these regimens. Single-agent ramucirumab, paclitaxel, docetaxel, and irinotecan were comparable to each other with respect to OS and were superior to best supportive care. This is the first network meta-analysis to compare all second-line regimens reported in phase III gastric cancer trials. The results suggest the paclitaxel plus ramucirumab combination is the most effective therapy and should be the reference regimen for future comparative trials.

Stage III & IV colon and rectal cancers share a similar genetic profile: a review of the Oregon Colorectal Cancer Registry.

Science.gov (United States)

Gawlick, Ute; Lu, Kim C; Douthit, Miriam A; Diggs, Brian S; Schuff, Kathryn G; Herzig, Daniel O; Tsikitis, Vassiliki L

2013-05-01

Determining the molecular profile of colon and rectal cancers offers the possibility of personalized cancer treatment. The purpose of this study was to determine whether known genetic mutations associated with colorectal carcinogenesis differ between colon and rectal cancers and whether they are associated with survival. The Oregon Colorectal Cancer Registry is a prospectively maintained, institutional review board-approved tissue repository with associated demographic and clinical information. The registry was queried for any patient with molecular analysis paired with clinical data. Patient demographics, tumor characteristics, microsatellite instability status, and mutational analysis for p53, AKT, BRAF, KRAS, MET, NRAS, and PIK3CA were analyzed. Categorical variables were compared using chi-square tests. Continuous variables between groups were analyzed using Mann-Whitney U tests. Kaplan-Meier analysis was used for survival studies. Comparisons of survival were made using log-rank tests. The registry included 370 patients: 69% with colon cancer and 31% with rectal cancer. Eighty percent of colon cancers and 68% of rectal cancers were stages III and IV. Mutational analysis found no significant differences in detected mutations between colon and rectal cancers, except that there were significantly more BRAF mutations in colon cancers compared with rectal cancers (10% vs 0%, P colon versus rectal cancers when stratified by the presence of KRAS, PIK3CA, and BRAF mutations. Stage III and IV colon and rectal cancers share similar molecular profiles, except that there were significantly more BRAF mutations in colon cancers compared with rectal cancers. Copyright © 2013 Elsevier Inc. All rights reserved.

Response of the primary tumor in symptomatic and asymptomatic stage IV colorectal cancer to combined interventional endoscopy and palliative chemotherapy

International Nuclear Information System (INIS)

Cameron, Silke; Hünerbein, Diana; Mansuroglu, Tümen; Armbrust, Thomas; Scharf, Jens-Gerd; Schwörer, Harald; Füzesi, László; Ramadori, Giuliano

2009-01-01

The treatment of the primary tumor in advanced metastatic colorectal cancer (CRC) is still a matter of discussion. Little attention has thus far been paid to the endoscopically observable changes of the primary in non-curatively resectable stage IV disease. 20 patients [14 men, 6 women, median age 67 (39–82) years] were observed after initial diagnosis of non-curatively resectable metastasized symptomatic (83%) or asymptomatic (17%) CRC, from June 2002 to April 2009. If necessary, endoscopic tumor debulking was performed. 5-FU based chemotherapy was given immediately thereafter. In 10 patients, chemotherapy was combined with antibody therapy. Response of the primary was observed in all patients. Local symptoms were treated endoscopically whenever necessary (obstruction or bleeding), and further improved after chemotherapy was started: Four patients showed initial complete endoscopic disappearance of the primary. In an additional 6 patients, only adenomatous tissue was histologically detected. In both these groups, two patients revealed local tumor relapse after interruption of therapy. Local tumor regression or stable disease was achieved in the remaining 10 patients. 15 patients died during the observation time. In 13 cases, death was related to metastatic disease progression. The mean overall survival time was 19.6 (3–71) months. No complications due to the primary were observed. This study shows that modern anti-cancer drugs combined with endoscopic therapy are an effective and safe treatment of the symptomatic primary and ameliorate local complaints without the need for surgical intervention in advanced UICC stage IV CRC

C IV EMISSION AND THE ULTRAVIOLET THROUGH X-RAY SPECTRAL ENERGY DISTRIBUTION OF RADIO-QUIET QUASARS

International Nuclear Information System (INIS)

Kruczek, Nicholas E.; Richards, Gordon T.; Deo, Rajesh P.; Krawczyk, Coleman M.; Gallagher, S. C.; Hall, Patrick B.; Hewett, Paul C.; Leighly, Karen M.; Proga, Daniel

2011-01-01

In the rest-frame ultraviolet (UV), two of the parameters that best characterize the range of emission-line properties in quasar broad emission-line regions are the equivalent width and the blueshift of the C IV λ1549 line relative to the quasar rest frame. We explore the connection between these emission-line properties and the UV through X-ray spectral energy distribution (SED) for radio-quiet (RQ) quasars. Our sample consists of a heterogeneous compilation of 406 quasars from the Sloan Digital Sky Survey (at z > 1.54) and Palomar-Green survey (at z < 0.4) that have well-measured C IV emission-line and X-ray properties (including 164 objects with measured Γ). We find that RQ quasars with both strong C IV emission and small C IV blueshifts can be classified as 'hard-spectrum' sources that are (relatively) strong in the X-ray as compared to the UV. On the other hand, RQ quasars with both weak C IV emission and large C IV blueshifts are instead 'soft-spectrum' sources that are (relatively) weak in the X-ray as compared to the UV. This work helps to further bridge optical/soft X-ray 'eigenvector 1' relationships to the UV and hard X-ray. Based on these findings, we argue that future work should consider systematic errors in bolometric corrections (and thus accretion rates) that are derived from a single mean SED. Detailed analysis of the C IV emission line may allow for SED-dependent corrections to these quantities.

Impact of TBI on late effects in children treated by megatherapy for Stage IV neuroblastoma. A study of the French Society of Pediatric oncology

International Nuclear Information System (INIS)

Flandin, Isabelle; Hartmann, Olivier; Michon, Jean; Pinkerton, Ross; Coze, Carole; Stephan, Jean Louis; Fourquet, Bernard; Valteau-Couanet, Dominique; Bergeron, Christophe; Philip, Thierry; Carrie, Christian

2006-01-01

Purpose: To determine the contribution of total body irradiation (TBI) to late sequelae in children treated with high-dose chemotherapy and autologous bone marrow transplantation for Stage IV neuroblastoma. Patients and Methods: We compared two populations that were similar with regard to age, stage, pre-autologous bone marrow transplantation chemotherapy (CT) regimen, period of treatment, and follow-up (12 years). The TBI group (n = 32) received TBI as part of the megatherapy procedure (1982-1993), whereas the CT group (n 30) received conditioning without TBI (1985-1992). Analysis 12 years later focused on growth, weight and corpulence (body mass index) delay; hormonal deficiencies; liver, kidney, heart, ear, eye, and dental sequelae; school performance; and the incidence of secondary tumors. Results: Impact of TBI was most marked in relation to growth and weight delay, although the mean delay was not severe, probably because of treatment with growth hormones. Other consequences of TBI were thyroid insufficiency, cataracts, and a high incidence of secondary tumors. Hearing loss and dental agenesis were more prominent in the group treated with CT alone. No differences were observed in school performance. Conclusion: The most frequent side effects of TBI were cataracts, thyroid insufficiency, and growth delay, but more worrying is the risk of secondary tumors. Because of the young mean age of patients and the toxicity of TBI regimens without any survival advantage, regimens without TBI are preferable in the management of Stage IV neuroblastoma

Release of fission products from irradiated SRP fuels at elevated temperatures: Data report on the second stage of the SRP source term study

International Nuclear Information System (INIS)

Woodley, R.E.

1987-03-01

The measurements of the release of fission products from irradiated Savannah River Plant (SRP) fuels at elevated temperatures reported herein extend the results of the first stage of the investigation to two additional fuel temperatures. In the first stage, two types of SRP fuels, a uranium-aluminum alloy designated MK-16 and a U 3 O 8 -aluminum cermet designated OX-2, were exposed to one of three different atmospheres, argon, air, or 80% steam-20% argon, at either of two different temperatures, 700 or 1100 0 C. In the second stage, the two fuels and three atmospheres remained the same, but the fuel temperatures, 850 and 1000 0 C, were intermediate to those previously employed. For each set of conditions, the measurements were repeated and, thus, the second stage of the study, like the first, consisted of 24 separate runs. This report presents the results of the 24 second-stage measurements

Single Ion transient-IBIC analyses of semiconductor devices using a cryogenic temperature stage

International Nuclear Information System (INIS)

Laird, J.S.; Bardos, R.; Legge, G.J.F.; Jagadish, C.

1998-01-01

A new Transient - IBIC data acquisition and analysis system at MARC is described. A discussion on the need for single ion control and temperature control is also given. The recorded signal is used as the trigger for beam pulsing. The new cryostatic temperature control stage is introduced. Data is presented on line profiles across the edge of a Au-Si junction collected over the temperature range of 25-300K using a developed C-V and I-V variable temperature stage incorporating a liquid helium cryostat. It demonstrates the potential improvements in spatial resolution in materials of long lifetime by mapping on timing windows around the prompt charge component in the charge transient

Establishing the accuracy and acceptability of abdominal ultrasound to define the foetal head position in the second stage of labour: a validation study.

LENUS (Irish Health Repository)

Ramphul, Meenakshi

2012-09-01

To compare the diagnosis of the foetal head position in the second stage of labour by ultrasound scan performed by a novice sonographer and by clinical assessment, to that of an expert sonographer (gold standard); and to evaluate the acceptability of ultrasound in the second stage of labour to women and clinicians.

Surgery for patients with gastric cancer in the terminal stage of the illness - TNM stage IV.

Science.gov (United States)

Budisin, N I; Majdevac, I Z; Budisin, E S; Manic, D; Patrnogic, A; Radovanovic, Z

2009-01-01

To assess any survival advantage in patients with incurable gastric cancer who had undergone resection, bypass or exploratory surgery. In nonresectable patients with pain, the effect of celiac plexus neurolysis was assessed. We retrospectively analysed data of 330 patients, operated between 1992 and 2006. The patients were followed until death or last examination. Incurable gastric cancer was defined as TNM stage IV disease: locally advanced (LA), with solitary distant metastasis (SM) or with multiple metastases and/or peritoneal carcinomatosis (MMC). The patients were divided into these 3 groups. Their postoperative survival was calculated and compared in relation to the surgical technique used. Factors which influenced mortality and survival were identified. 131 patients (39.7%) had locally LA cancer, 98 (29.7%) SM, and 101 (30.6%) belonged to the MMC group. The surgical procedures included 138 (41.8%) exploratory laparotomies, 84 (25.5%) bypass procedures and 108 (32.7%) resections. Thirty-three (10%) unresectable patients with pain underwent celiac plexus neurolysis. The mean survival was 21.8 months after resections, 7 months after by-passes and 4.8 after exploratory laparotomies (p = 0.0001). It was 14.57 months (p=0.001) in the LA group, 12.53 (p = 0.005) in the SM group, and 5.2 in the MMC group. Survival was shorter in patients with preoperative weight loss of more than 20 kg (3.2 months, p 0.05), while significantly increased mortality occurred in patients with weight loss of over 20 kg (32%, p=0.03). Celiac plexus neurolysis was immediately effective in 30 out of 33 (91%) patients (p=0.0001), while 3 months later it was still effective in 15 (45.5%) patients (p=0.08). Resections are suggested in the LA and SM groups, and neurolysis in all nonresected patients with pain.

Staging of intestinal- and diffuse-type gastric cancers with the OLGA and OLGIM staging systems.

Science.gov (United States)

Cho, S-J; Choi, I J; Kook, M-C; Nam, B-H; Kim, C G; Lee, J Y; Ryu, K W; Kim, Y-W

2013-11-01

Operative link on gastritis assessment (OLGA) and Operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems have been proposed for gastric cancer (GC) risk estimation. To validate the OLGA and OLGIM staging systems in a region with high risk of GC. This retrospective study included 474 GC patients and age- and sex-matched health screening control persons in a cancer centre hospital. We classified gastritis patterns according to the OLGA and OLGIM systems using the histological database that a pathologist prospectively evaluated using the updated Sydney system. GC risk according to the OLGA and OLGIM stages was evaluated using logistic regression analysis. More GC patients had OLGA stages III-IV (46.2%) than controls (26.6%, P diffuse-type GCs (30.9%). OLGA stages III and IV were significantly associated with increased risk of GC [odds ratios (ORs), 2.09; P = 0.008 and 2.04; P = 0.014 respectively] in multivariate analysis. The association was more significant for intestinal-type (ORs, 4.76; P = 0.001 and 4.19; P = 0.002 respectively), but not diffuse-type GC. OLGIM stages from I to IV were significantly associated with increased risk of both intestinal-type (ORs, 3.64, 5.15, 7.89 and 13.20 respectively) and diffuse-type GC (ORs, 1.84, 2.59, 5.08 and 6.32 respectively) with a significantly increasing trend. As high OLGA and OLGIM stages are independent risk factors for gastric cancer, the staging systems may be useful for risk assessment in high-risk regions, especially for intestinal-type gastric cancer. © 2013 John Wiley & Sons Ltd.

Internet Economics IV

Science.gov (United States)

2004-08-01

edts.): Internet Economics IV Technical Report No. 2004-04, August 2004 Information Systems Laboratory IIS, Departement of Computer Science University of...level agreements (SLA), Information technology (IT), Internet address, Internet service provider 16. PRICE CODE 17. SECURITY CLASSIFICATION 18... technology and its economic impacts in the Internet world today. The second talk addresses the area of AAA protocol, summarizing authentication

Birthing positions during second stage of labor and long-term psychological outcomes in low-risk women

NARCIS (Netherlands)

Jonge, A. de; Rijnders, M.E.B.; Diem, M.T. van; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

2011-01-01

PURPOSE: To examine the long-term influence of birthing positions during the second stage of labor, as well as other factors, on birth satisfaction, self-esteem (based on the Rosenberg Self-esteem Scale [RSE]) and emotional well-being (based on the Edinburgh Postnatal Depression Scale [EPDS]). STUDY

APOGEE-2: The Second Phase of the Apache Point Observatory Galactic Evolution Experiment in SDSS-IV

Science.gov (United States)

Sobeck, Jennifer; Majewski, S.; Hearty, F.; Schiavon, R. P.; Holtzman, J. A.; Johnson, J.; Frinchaboy, P. M.; Skrutskie, M. F.; Munoz, R.; Pinsonneault, M. H.; Nidever, D. L.; Zasowski, G.; Garcia Perez, A.; Fabbian, D.; Meza Cofre, A.; Cunha, K. M.; Smith, V. V.; Chiappini, C.; Beers, T. C.; Steinmetz, M.; Anders, F.; Bizyaev, D.; Roman, A.; Fleming, S. W.; Crane, J. D.; SDSS-IV/APOGEE-2 Collaboration

2014-01-01

The second phase of the Apache Point Observatory Galactic Evolution Experiment (APOGEE-2), a part of the Sloan Digital Sky Survey IV (SDSS-IV), will commence operations in 2014. APOGEE-2 represents a significant expansion over APOGEE-1, not only in the size of the stellar sample, but also in the coverage of the sky through observations in both the Northern and Southern Hemispheres. Observations on the 2.5m Sloan Foundation Telescope of the Apache Point Observatory (APOGEE-2N) will continue immediately after the conclusion of APOGEE-1, to be followed by observations with the 2.5m du Pont Telescope of the Las Campanas Observatory (APOGEE-2S) within three years. Over the six-year lifetime of the project, high resolution (R˜22,500), high signal-to-noise (≥100) spectroscopic data in the H-band wavelength regime (1.51-1.69 μm) will be obtained for several hundred thousand stars, more than tripling the total APOGEE-1 sample. Accurate radial velocities and detailed chemical compositions will be generated for target stars in the main Galactic components (bulge, disk, and halo), open/globular clusters, and satellite dwarf galaxies. The spectroscopic follow-up program of Kepler targets with the APOGEE-2N instrument will be continued and expanded. APOGEE-2 will significantly extend and enhance the APOGEE-1 legacy of scientific contributions to understanding the origin and evolution of the elements, the assembly and formation history of galaxies like the Milky Way, and fundamental stellar astrophysics.

Characterization of HIV-1 antiretroviral drug resistance after second-line treatment failure in Mali, a limited-resources setting

Science.gov (United States)

Maiga, Almoustapha Issiaka; Fofana, Djeneba Bocar; Cisse, Mamadou; Diallo, Fodié; Maiga, Moussa Youssoufa; Traore, Hamar Alassane; Maiga, Issouf Alassane; Sylla, Aliou; Fofana, Dionke; Taiwo, Babafemi; Murphy, Robert; Katlama, Christine; Tounkara, Anatole; Calvez, Vincent; Marcelin, Anne-Geneviève

2012-01-01

Objectives We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing. Methods We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm. Results Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm3. Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P < 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P < 0.0001) and darunavir (P = 0.06). Conclusion Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings. PMID:22888273

Learning from experience: development of a cognitive task-list to assess the second stage of labour for operative delivery.

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Hodges, Ryan; Simpson, Andrea; Gurau, David; Secter, Michael; Mocarski, Eva; Pittini, Richard; Snelgrove, John; Windrim, Rory; Higgins, Mary

2015-04-01

Ensuring the availability of operative vaginal delivery is one strategy for reducing the rising Caesarean section rate. However, current training programs appear inadequate. We sought to systematically identify the core steps in assessing women in the second stage of labour for safe operative delivery, and to produce an expert task-list to assist residents and obstetricians in deciding on the safest mode of delivery for their patients. Labour and delivery nursing staff of three large university-associated hospitals identified clinicians they considered to be skilled in operative vaginal deliveries. Obstetricians who were identified consistently were invited to participate in the study. Participants were filmed performing their normal assessment of the second stage of labour on a model. Two clinicians reviewed all videos and documented all verbal and non-verbal components of the assessment; these components were grouped into overarching themes and combined into an integrated expert task-list. The task-list was then circulated to all participants for additional comments, checked against SOGC guidelines, and redrafted, allowing production of a final expert task-list. Thirty clinicians were identified by this process and 20 agreed to participate. Themes identified were assessment of suitability, focused history, physical examination including importance of an abdominal examination, strategies to accurately assess fetal position, station, and the likelihood of success, cautionary signs to prompt reassessment in the operating room, and warning signs to abandon operative delivery for Caesarean section. Communication strategies were emphasized. Having expert clinicians teach assessment in the second stage of labour is an important step in the education of residents and junior obstetricians to improve confidence in managing the second stage of labour.

[Ultrasound in monitoring of the second stage of labour].

Science.gov (United States)

Fouché, C J; Simon, E G; Potin, J; Perrotin, F

2012-11-01

In the second stage of labor, fetal head rotation and fetal head position are determinant for the management of labor to attempt a vaginal delivery or a cesarean section. However, digital examination is highly subjective. Nowadays, delivery rooms are often equipped with compact and high performance ultrasound systems. The clinical examination can be easily completed by quantified and reproducible methods. Transabdominal ultrasonography is a well-known and efficient way to determine the fetal head position. Nevertheless, ultrasound approach to assess fetal head descent is less widespread. We can use translabial or transperineal way to evaluate fetal head position. We describe precisely two different types of methods: the linear methods (3 different types) and the angles of progression (4 different types of measurement). Among all those methods, the main pelvic landmarks are the symphysis pubis and the fetal skull. The angle of progression appears promising but the assessment was restricted to occipitoanterior fetal position cases. In the coming years, ultrasound will likely play a greater role in the management of labor. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Reg IV is a direct target of intestinal transcriptional factor CDX2 in gastric cancer.

Directory of Open Access Journals (Sweden)

Yutaka Naito

Full Text Available REG4, which encodes Reg IV protein, is a member of the calcium-dependent lectin superfamily and potent activator of the epidermal growth factor receptor/Akt/activator protein-1 signaling pathway. Several human cancers overexpress Reg IV, and Reg IV expression is associated with intestinal phenotype differentiation. However, regulation of REG4 transcription remains unclear. In the present study, we investigated whether CDX2 regulates Reg IV expression in gastric cancer (GC cells. Expression of Reg IV and CDX2 was analyzed by Western blot and quantitative reverse transcription-polymerase chain reaction in 9 GC cell lines and 2 colon cancer cell lines. The function of the 5'-flanking region of the REG4 gene was characterized by luciferase assay. In 9 GC cell lines, endogenous Reg IV and CDX2 expression were well correlated. Using an estrogen receptor-regulated form of CDX2, rapid induction of Reg IV expression was observed in HT-29 cells. Reporter gene assays revealed an important role in transcription for consensus CDX2 DNA binding elements in the 5'-flanking region of the REG4 gene. Chromatin immunoprecipitation assays showed that CDX2 binds directly to the 5'-flanking region of REG4. These results indicate that CDX2 protein directly regulates Reg IV expression.

Dense electro-optic frequency comb generated by two-stage modulation for dual-comb spectroscopy.

Science.gov (United States)

Wang, Shuai; Fan, Xinyu; Xu, Bingxin; He, Zuyuan

2017-10-01

An electro-optic frequency comb enables frequency-agile comb-based spectroscopy without using sophisticated phase-locking electronics. Nevertheless, dense electro-optic frequency combs over broad spans have yet to be developed. In this Letter, we propose a straightforward and efficient method for electro-optic frequency comb generation with a small line spacing and a large span. This method is based on two-stage modulation: generating an 18 GHz line-spacing comb at the first stage and a 250 MHz line-spacing comb at the second stage. After generating an electro-optic frequency comb covering 1500 lines, we set up an easily established mutually coherent hybrid dual-comb interferometer, which combines the generated electro-optic frequency comb and a free-running mode-locked laser. As a proof of concept, this hybrid dual-comb interferometer is used to measure the absorption and dispersion profiles of the molecular transition of H 13 CN with a spectral resolution of 250 MHz.

The effect of inflatable obstetric belts in nulliparous pregnant women receiving patient-controlled epidural analgesia during the second stage of labor.

Science.gov (United States)

Kim, Jong-Woon; Kim, Yoon Ha; Cho, Hye Yon; Shin, Hee-Young; Shin, Jong Chul; Choi, Sea Kyung; Lee, Keun-Young; Song, Ji-Eun; Lee, Pil-Ryang

2013-11-01

The aim of this study was to evaluate the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. Between July 2009 and December 2010, 188 nulliparous women with a singleton pregnancy at term were enrolled and only one dropped. The participants were randomized to receive either standard care (control group, n = 91) or uterine fundal pressure by the Labor Assister (Baidy M-520/Curexo, Inc., Seoul, Korea; active group, n = 97) during the second stage of labor in addition to standard care. The Labor Assister is an inflatable obstetric belt that is synchronized to apply constant fundal pressure during a uterine contraction. The primary endpoint was duration of the second stage of labor in women who delivered vaginally (control, n = 80 versus active, n = 93). It was not analyzed in women who delivered by cesarean section (n = 14) and delivered precipitously (n = 1). The secondary outcomes are perinatal outcomes and perineal laceration. Participants received patient-controlled epidural analgesia. The 93 women in the active group spent less time in the second stage of labor when compared to the 80 women in the control group (46.51 ± 28.01 min versus 75.02 ± 37.48 min, p labor without complications in nulliparous women who receive patient-controlled epidural analgesia.

Enhancement MRI evaluation of neuroblastoma staging in children

International Nuclear Information System (INIS)

Li Xin; Wang Chunxiang; Zhao Bin; Liu Peifang

2002-01-01

Objective: To evaluate the value and limitation of Gd-DTPA enhanced MRI for neuroblastoma staging in children. Methods: Twelve cases of neuroblastoma proved by operation or bone marrow aspiration were examined by gadolinium-enhanced MRI. The age ranged from seven months to five years, mean 3.7 years. Eight tumors originated from adrenal, and four from posterior mediastinum. Conventional sequences, double dose gadolinium-enhanced MRI, and 3D CEMRA were used in all patients. Six cases were examined by CT in same time. Imaging staging on surgic-histopathological-based International Neuroblastoma Staging System (INSS) was performed. Results: Six patients were staged by CT, including stage I-II in 2 cases, stage III in 4 cases, and stage IV in none. Twelve patients were staged by conventional MRI, including stage I-II in 2 cases, stage III in 9 cases, and stage IV in 1 case. Twelve patients were staged by double dose gadolinium-enhanced MRI, including stage I-II in 1 case, stage III in 1 case, and stage IV in 10 cases. Conclusion: Gadolinium-enhanced MRI was a single best imaging modality for neuroblastoma, most useful for distal to diaphragm metastasis, dumbbell tumor intraspinal extension, and bone marrow metastasis that was not detected by aspirate examination. Enhancement MRI was important in evaluating the therapy and was also helpful in assessing the therapeutic efficacy and relapse. 3D CEMRA helps demonstrate large vascular encasement and tumor erosion into important organs, and it is useful in assessing the respectability. Long examination time and lack in showing the characteristic calcium were the limitations

Phase II study of biweekly cetuximab in combination with irinotecan as second-line treatment in patients with platinum-resistant gastro-oesophageal cancer

DEFF Research Database (Denmark)

Schønnemann, K R; Yilmaz, Mette Karen; Bjerregaard, J K

2012-01-01

The purpose of this phase II trial was to evaluate the efficacy and safety of cetuximab and irinotecan as second-line treatment in patients with gastro-oesophageal adenocarcinoma.......The purpose of this phase II trial was to evaluate the efficacy and safety of cetuximab and irinotecan as second-line treatment in patients with gastro-oesophageal adenocarcinoma....

Second malignancy in young early-stage breast cancer patients with modern radiotherapy: A long-term population-based study (A STROBE-compliant study).

Science.gov (United States)

Xie, Liyi; Lin, Chen; Zhang, Huan; Bao, Xuhui

2018-04-01

Second cancer is a leading cause of death in long-term survivors of younger early-stage breast cancer patients. To date, relationship of age, receipt of radiotherapy (RT), and estimated doses received by target organs have not yet been well elucidated. Using Surveillance, Epidemiology, and End Results database, patients aged 20 to 44, diagnosed with a first primary staging I-IIIA ipsilateral breast invasive ductal carcinoma, underwent surgery during 1988 to 2009 were identified, and those with a second malignancy at ≥1-year follow-up were analyzed to calculate cumulative incidences (CIs) of second malignancy in whole group and each subgroup. Subgroups were dichotomized by surgery type, axillary dissection, and axillary lymph node status. With a median follow-up of 11.8 years, 22,628 women including 1495 patients (6.6%) developing second malignancies (3.7% contralateral breast cancer, 2.9% non-breast second malignancies, and 0.7% high-dose site second malignancies) were identified. Three-dimensional coordinate systems with age at primary diagnosis, time after primary breast cancer diagnosis, and CI of second malignancy as 3 axes, for endpoints including all second malignancy, second primary contralateral breast cancer, and non-breast second malignancy were presented, along with the risk in RT and non-RT groups in overall group and subgroups. Five-, 10-, 15-, and 20-year all second malignancy-free survivals in RT and non-RT groups were 89.5% versus 85.4%, 80.1% versus 75.0%, 72.9% versus 67.9%, and 65.6% versus 61.8% (P < .0001). From the large national dataset, a broad visualized overview of second malignancy risk, including second contralateral breast cancer and non-breast second cancer, suggests generally beneficial therapeutic ratio for radiotherapy in young women with early-stage breast cancer.

Operative shortening of the sling as a second-line treatment after TVT failure

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Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz

2011-01-01

Introduction Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. Materials and methods Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. Results All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. Conclusions The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure. PMID:24578885

Safety assessment for Generation IV nuclear systems

International Nuclear Information System (INIS)

Leahy, T.J.

2012-01-01

The Generation IV International Forum (GIF) Risk and Safety Working Group (RSWG) was created to develop an effective approach for the safety of Generation IV advanced nuclear energy systems. Recent RSWG work has focused on the definition of an integrated safety assessment methodology (ISAM) for evaluating the safety of Generation IV systems. ISAM is an integrated 'tool-kit' consisting of 5 analytical techniques that are available and matched to appropriate stages of Generation IV system concept development: 1) qualitative safety features review - QSR, 2) phenomena identification and ranking table - PIRT, 3) objective provision tree - OPT, 4) deterministic and phenomenological analyses - DPA, and 5) probabilistic safety analysis - PSA. The integrated methodology is intended to yield safety-related insights that help actively drive the evolving design throughout the technology development cycle, potentially resulting in enhanced safety, reduced costs, and shortened development time

[Comparison of the Efficacy and Safety of Icotinib with Standard Second-line 
Chemotherapy in Previously Treated Advanced Non-small Cell Lung Cancer].

Science.gov (United States)

Yao, Shuyang; Qian, Kun; Wang, Ruotian; Li, Yuanbo; Zhang, Yi

2015-06-01

This study compared the efficacy and safety of icotinib with standard second-line chemotherapy (single-agent docetaxel or pemetrexed) in previously treated advanced non-small cell lung cancer (NSCLC). Thirty-two consecutive patients treated with icotinib and 33 consecutive patients treated with standard second-line chemotherapy in Xuanwu Hospital from January 2012 to July 2013 were enrolled in our retrospective research. The Response Evaluation Criteria in Solid Tumors were used to evaluate the tumor responses, and the progression-free survival (PFS) was evaluated by Kaplan-Meier method. Icotinib was comparable with standard second-line chemotherapy for advanced NSCLC in terms of overall response rate (ORR) (28.1% vs 18.2%, P=0.341), disease control rate (DFS)(43.8% vs 45.5%, P=0.890), and PFS (4.3 months vs 3.8 months, P=0.506). In the icotinib group, the ORR of epidermal growth factor receptor (EGFR) mutant was significantly higher than that of EGFR unknown or wild type (P=0.017). In multivariate analysis, age, gender, histology, and the optimum first-line treatment response were dependent prognostic factors based on the PFS of the icotinib group. The incidence of adverse events was significantly fewer in the icotinib group than in the chemotherapy group (P=0.001). Compared with the standard second-line chemotherapy, icotinib is active in the treatment of advanced NSCLC patients, especially with EGFR unknown in the second line, with an acceptable adverse event profile.

Arrival in the labour ward in second stage of labour--any prognostic significance?

Science.gov (United States)

Nkyekyer, K

1998-05-01

A comparative descriptive study was carried out to determine whether, in uncomplicated term pregnancies with the foetus in vertex presentation, there were any differences in maternal or foetal outcome between women who arrived in the labour ward in second stage of labour and those who arrived in early active phase. There were two hundred and seventeen women each in the study and comparison groups. There were no significant differences between the two groups as regards age, parity, marital status and level of education. Women in the comparison group were better antenatal clinic attendants. Those in the study group were more likely to have indicated that they had problems with transportation. They also had considerably shorter labours and all achieved spontaneous vaginal deliveries; a significant proportion (10.6%) of the comparison group had interventional deliveries. The incidence of episiotomies, lower genital tract injuries, manual removal of placenta and postpartum haemorrhage after vaginal delivery were not different between the two groups. Babies born to mothers in the study group were significantly lighter, by about 170 gms, and had a lower incidence of low one-minute Apgar scores. There were no significant differences in the rates of admission to the neonatal intensive care unit or in early neonatal deaths. Arrival in the labour ward in second stage of labour prognosticates non-interventional delivery without any increased risk of adverse outcome to the mother or her baby.

A review of the stages of work hardening

Energy Technology Data Exchange (ETDEWEB)

Rollett, A.D.; Kocks, U.F.

1993-07-01

Stages of work hardening are reviewed with emphasis on links between each stage. Simple quantitative descriptions are given for each stage. Similarities between stage I, easy glide, and stage IV, large strain hardening, are pointed out both in terms of magnitude of the hardening rate and of the underlying mechanism of dislocation debris accumulation. Stage II is described as an athermal hardening stage that occurs when statistical variations in the dislocation ``forest`` lead to geometrical storage of dislocations. The steadily decreasing hardening rate observed in stage III is characterized by the increasing rate of loss of dislocation density due to dynamic recovery. Stage III appears to have an asymptote to a saturation stress which is determined by the characteristics of the dislocation tangles, or cell walls. The imperfect nature of the dynamic recovery process, however, leads to the accumulation of dislocation debris and this, by analogy with stage 1, causes the apparent saturation stress to rise, thus causing stage IV.

The [NeIV] Lines in High Excitation Gaseous Nebulae.

Science.gov (United States)

Aller, L H

1970-04-01

The "forbidden" lines of three times ionized neon are among the most precious indicators of electron temperature and excitation. They are also predicted to be among the strongest lines observed in the far ultraviolet spectra of high excitation nebulae.

Efficacy and safety of a diode laser in second-stage implant surgery: a comparative study.

Science.gov (United States)

El-Kholey, K E

2014-05-01

For more than a decade, peri-implant tissues have been treated with soft tissue lasers to create a bloodless flap for implant placement and to uncover implants with minimal bleeding, trauma, and anaesthesia. This study was designed to assess if dental implant uncovering is possible with a diode laser without anaesthesia, and to compare its performance with traditional cold scalpel surgery. Thirty patients with a total of 45 completely osseointegrated implants participated in this study. Patients were divided into two groups. For the study group, second-stage implant surgery was done with a 970nm diode laser. For the control group, the implants were exposed with a surgical blade. Certain parameters were used for evaluation of the two techniques. The use of the diode laser obviated the need for local anaesthesia; there was a significant difference between the two groups regarding the need for anaesthesia (Pdiode laser can be used effectively for second-stage implant surgery, providing both the dentist and the patient with additional advantages over the conventional methods used for implant exposure. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Staging and treatment of ovarian carcinoma

International Nuclear Information System (INIS)

De Palo, G.; Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan

1989-01-01

The staging and treatment of ovarian cancer is reviewed with special attention to developments during the last decade. Pathways of spread, presurgical and surgical staging are described and discussed, as are the biologic characters of the different histologic subtypes. Principles of surgery, endoperitoneal and external radiotherapy, single-drug and multiple-drug systemic chemotherapy (therapeutic and adjuvant), intraperitoneal chemotherapy, second-line chemotherapy, hormone therapy and the use of biologic response modifiers are reported and discussed with background of recent clinical trials. It is concluded that considerable progress has been made concerning diagnosis, staging and treatment of ovarian cancer. The proportion of cases in advanced stages has thus decreased and the survival rate increased. However, it is also obvious that the long-term prognosis for patients with advanced disease has not significantly improved over the last 10 years, despite introduction of multiple-drug regimens with high initial response rates. Ovarian cancer remains the most important gynecologic cause of death in the Western countries. (orig.)

Ripple Mitigation with Improved Line-Load Transients Response in Two-Stage DC-DC-AC Converter

DEFF Research Database (Denmark)

Gautam, Aditya R.; Gaurav, Kumar; Guerrero, Josep M.

2018-01-01

. The front-end boost converter in the considered two-stage converter interfaces a battery bank and single phase inverter fed loads. The control shapes the output impedance of boost converter to reduce the ripple component at battery input. Secondly, the proposed controller achieves good dynamic performance...

Comparison of the Efficacy and Safety of Icotinib with Standard Second-line 
Chemotherapy in Previously Treated Advanced Non-small Cell Lung Cancer

Directory of Open Access Journals (Sweden)

Shuyang YAO

2015-06-01

Full Text Available Background and objective This study compared the efficacy and safety of icotinib with standard second-line chemotherapy (single-agent docetaxel or pemetrexed in previously treated advanced non-small cell lung cancer (NSCLC. Methods Thirty-two consecutive patients treated with icotinib and 33 consecutive patients treated with standard second-line chemotherapy in Xuanwu Hospital from January 2012 to July 2013 were enrolled in our retrospective research. The Response Evaluation Criteria in Solid Tumors were used to evaluate the tumor responses, and the progression-free survival (PFS was evaluated by Kaplan-Meier method. Results Icotinib was comparable with standard second-line chemotherapy for advanced NSCLC in terms of overall response rate (ORR (28.1% vs 18.2%, P=0.341, disease control rate (DFS(43.8% vs 45.5%, P=0.890, and PFS (4.3 months vs 3.8 months, P=0.506. In the icotinib group, the ORR of epidermal growth factor receptor (EGFR mutant was significantly higher than that of EGFR unknown or wild type (P=0.017. In multivariate analysis, age, gender, histology, and the optimum first-line treatment response were dependent prognostic factors based on the PFS of the icotinib group. The incidence of adverse events was significantly fewer in the icotinib group than in the chemotherapy group (P=0.001. Conclusion Compared with the standard second-line chemotherapy, icotinib is active in the treatment of advanced NSCLC patients, especially with EGFR unknown in the second line, with an acceptable adverse event profile.

Continued efficacy of sulfadoxine-pyrimethamine as second line treatment for malaria in children in Guinea-Bissau

DEFF Research Database (Denmark)

Kofoed, Poul-Erik; Rodrigues, Amabelia; Aaby, Peter

2006-01-01

BACKGROUND: Sulfadoxine-pyrimethamine (S/P) is widely used for treatment of failures following the first line treatment for malaria in Africa. In Guinea-Bissau, it has been recommended as second line therapy by the National Malaria Programme since 1996. In order to monitor any change of the in vivo...... sensitivity, the efficacy of S/P was studied immediately before the introduction of the drug and 6-9 years later. METHODS: Children participating in clinical in vivo studies were given S/P if having late clinical treatment failure following the treatment with quinine, chloroquine, or amodiaquine...

Matched-pair analysis to compare the outcomes of a second salvage auto-SCT to systemic chemotherapy alone in patients with multiple myeloma who relapsed after front-line auto-SCT.

Science.gov (United States)

Yhim, H-Y; Kim, K; Kim, J S; Kang, H J; Kim, J-A; Min, C-K; Bae, S H; Park, E; Yang, D-H; Suh, C; Kim, M K; Mun, Y-C; Eom, H S; Shin, H J; Yoon, H-J; Kwon, J H; Lee, J H; Kim, Y S; Yoon, S-S; Kwak, J-Y

2013-03-01

The aims of this study were to investigate the outcomes of second salvage auto-SCT and to identify the impacts of a second auto-SCT compared with systemic chemotherapy alone on disease outcome. Data from 48 patients who underwent second auto-SCT were matched to 144 patients (1:3) who received systemic chemotherapy alone from the Korean Myeloma Registry. Groups were matched for nine potential prognostic factors and compared for treatment outcomes. The median age of matching-pairs at relapse was 55.5 years. A total of 156 patients (81%) received vincristine, doxorubicin and dexamethasone induction therapy before the first auto-SCT. Thirty-five patients (73%) in the second auto-SCT group received novel agent-based therapies before the second auto-SCT, and similar proportion in both groups received novel therapies after relapse of front-line auto-SCT. With a median follow-up of 55.3 months, patients who underwent a second auto-SCT had significantly better median OS (55.5 vs 25.4 months, P=0.035). In multivariate analysis for OS, SCT, International Staging System III and salvage chemotherapy alone were independent predictors for worse OS. The outcomes of second auto-SCT appear to be superior to those of systemic chemotherapy alone. A randomized trial comparing both treatment strategies is required.

Metastatic non-small-cell lung cancer: consensus on pathology and molecular tests, first-line, second-line, and third-line therapy: 1st ESMO Consensus Conference in Lung Cancer; Lugano 2010

DEFF Research Database (Denmark)

Felip, E; Gridelli, C; Baas, P

2011-01-01

the conference, the expert panel prepared clinically relevant questions concerning five areas: early and locally advanced non-small-cell lung cancer (NSCLC), first-line metastatic NSCLC, second-/third-line NSCLC, NSCLC pathology and molecular testing, and small-cell lung cancer to be addressed through discussion......The 1st ESMO Consensus Conference on lung cancer was held in Lugano, Switzerland on 21 and 22 May 2010 with the participation of a multidisciplinary panel of leading professionals in pathology and molecular diagnostics, medical oncology, surgical oncology and radiation oncology. Before...... at the Consensus Conference. All relevant scientific literature for each question was reviewed in advance. During the Consensus Conference, the panel developed recommendations for each specific question. The consensus agreement on three of these areas: NSCLC pathology and molecular testing, the treatment of first-line...

Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial.

Science.gov (United States)

van Meurs, Hannah S; Tajik, Parvin; Hof, Michel H P; Vergote, Ignace; Kenter, Gemma G; Mol, Ben Willem J; Buist, Marrije R; Bossuyt, Patrick M

2013-10-01

To investigate whether biomarkers consisting of baseline characteristics of advanced stage ovarian cancer patients can help in identifying subgroups of patients who would benefit more from primary surgery or neoadjuvant chemotherapy. We used data of the European Organisation for Research and Treatment of Cancer (EORTC) 55971 trial in which 670 patients were randomly assigned to primary surgery or neoadjuvant chemotherapy. The primary outcome was overall survival. Ten baseline clinical and pathological characteristics were selected as potential biomarkers. Using Subpopulation Treatment Effect Pattern Plots (STEPP), biomarkers with a statistically significant qualitative additive interaction with treatment were considered as potentially informative for treatment selection. We also combined selected biomarkers to form a multimarker treatment selection rule. The size of the largest metastatic tumour and clinical stage were significantly associated with the magnitude of the benefit from treatment, in terms of five-year survival (p for interaction: 0.008 and 0.016, respectively). Stage IIIC patients with metastatic tumours ⩽45 mm benefited more from primary surgery while stage IV patients with metastatic tumours >45 mm benefited more from neoadjuvant chemotherapy. In stage IIIC patients with larger metastatic tumours and in stage IV patients with less extensive metastatic tumours both treatments were equally effective. We estimated that by selecting treatments for patients based on largest metastatic tumour and clinical stage, the potential five-year survival rate in the population of treated patients would be 27.3% (95% confidence interval (CI) 21.9-33.0), 7.8% higher than if all were treated with primary surgery, and 5.6% higher if all were treated with neoadjuvant chemotherapy. Although survival was comparable after primary surgery and neoadjuvant chemotherapy in the overall group of patients with ovarian cancer in the EORTC 55971 trial, we found in this exploratory

Proliferation of Endogenous Retroviruses in the Early Stages of a Host Germ Line Invasion

Science.gov (United States)

Ishida, Yasuko; Zhao, Kai; Greenwood, Alex D.; Roca, Alfred L.

2015-01-01

Endogenous retroviruses (ERVs) comprise 8% of the human genome and are common in all vertebrate genomes. The only retrovirus known to be currently transitioning from exogenous to endogenous form is the koala retrovirus (KoRV), making koalas (Phascolarctos cinereus) ideal for examining the early stages of retroviral endogenization. To distinguish endogenous from exogenous KoRV proviruses, we isolated koala genomic regions flanking KoRV integration sites. In three wild southern Australian koalas, there were fewer KoRV loci than in three captive Queensland koalas, consistent with reports that southern Australian koalas carry fewer KoRVs. Of 39 distinct KoRV proviral loci examined in a sire–dam–progeny triad, all proved to be vertically transmitted and endogenous; none was exogenous. Of the 39 endogenous KoRVs (enKoRVs), only one was present in the genomes of both the sire and the dam, suggesting that, at this early stage in the retroviral invasion of a host germ line, very large numbers of ERVs have proliferated at very low frequencies in the koala population. Sequence divergence between the 5′- and 3′-long terminal repeats (LTRs) of a provirus can be used as a molecular clock. Within each of ten enKoRVs, the 5′-LTR sequence was identical to the 3′-LTR sequence, suggesting a maximum age for enKoRV invasion of the koala germ line of approximately 22,200–49,900 years ago, although a much younger age is possible. Across the ten proviruses, seven LTR haplotypes were detected, indicating that at least seven different retroviral sequences had entered the koala germ line. PMID:25261407

Hemodiafiltration using pre-dilutional on-line citrate dialysate: A new technique for regional citrate anticoagulation: A feasibility study

Directory of Open Access Journals (Sweden)

Radhouane Bousselmi

2015-01-01

Full Text Available A prospective, observational, feasibility study was carried out on four patients with end-stage renal failure undergoing bicarbonate hemodialysis to study the feasibility of an on-line hemodiafiltration technique using a citrate dialysate with pre-dilutional infusion of citrate as a technique for regional citrate anticoagulation. All patients had contraindication to systemic heparin anticoagulation. The dialysis technique consisted of an on-line hemodiafiltration with a citrate dialysate without calcium using a Fresenius 4008S dialysis machine and Fresenius Polysulfone F60 dialyzers. The infusion solution was procured directly from the dialysate and was infused into the arterial line. To avoid the risk of hypocalcemia, calcium gluconate was infused to the venous return line. The study was carried out in two stages. During the first stage, the citrate infusion rate was 80 mL/min and the calcium infusion rate was 9 mmol/h. At the second stage, the rates were 100 mL/min and 11 mmol/h, respectively. The primary endpoint of this study was the incidence of thrombosis in the extracorporeal blood circuit and/or the dialyzer. A total of 78 sessions were conducted. All the sessions were well tolerated clinically and there were no major incidents in any of the four patients. At the first stage of the study, there were five incidences of small clots in the venous blood chamber, an incidence of extracorporeal blood circuit thrombosis of 12.5%. At the second stage of the study, no cases of extracorporeal blood circuit or dialyzer thrombosis were noted. Hemodiafiltration with on-line citrate dialysate infusion to the arterial line is safe and allows an effective regional anticoagulation of the extracorporeal blood circuit without the need for systemic anticoagulation.

Flow injection on-line spectrophotometric determination of thorium(IV) after preconcentration on XAD-4 resin impregnated with oxytetracycline

Energy Technology Data Exchange (ETDEWEB)

Shahida, Shabnam; Khan, Muhammad Haleem [Univ. of Azad Jammu and Kashmir, Muzaffarabad (Pakistan). Dept. of Chemistry; Ali, Akbar [Pakistan Institute of Nuclear Science and Technology, Islamabad (Pakistan). Chemistry Div.

2014-02-15

A very sensitive, selective and simple flow injection time-based method was developed for on-line preconcentration and determination of thorium(IV) at micro g L{sup -1} levels in environmental samples. The system operation was based on thorium(IV) ion retention at pH 4.0 in the minicolumn at a flow rate of 15.2 mL min{sup -1}. The trapped complex was then eluted with 3.6 mol L{sup -1} HCl at a flow rate of 4.9 mL min{sup -1}. The amount of thorium(IV) in the eluate was measured spectrophotometrically at 651 nm using arsenazo-III solution (0.05 % in 3.6 mol L{sup -1} HCl stabilized with 1 % triton X-100, 4.9 mL min{sup -1}) as colorimetric reagent. All chemical, and flow injection variables were optimized for the quantitative preconcentration of metal and a study of interference level of various ions was also carried out. The system offered low backpressure and improved sensitivity and selectivity. At a preconcentration time of 60 s and a sample frequency of 40 h{sup -1}, the enhancement factor was 97, the detection limit was 0.25 μg L{sup -1}, and the precision expressed as relative standard deviation was 1.08 % (at 50 μg L{sup -1}), whereas for 300 s of the preconcentration time and a sample frequency of 10 h{sup -1}, the enhancement factor of 357, the detection limit (3s) of 0.069 μg L{sup -1} and the precision of 1.32 % (at 10 μg L{sup -1}) was reported. The accuracy of the developed method was sufficient and evaluated by the analysis of certified reference material IAEA-SL-1 (Lake Sediment) and spiked water samples.

Flow injection on-line spectrophotometric determination of thorium(IV) after preconcentration on XAD-4 resin impregnated with oxytetracycline

International Nuclear Information System (INIS)

Shahida, Shabnam; Khan, Muhammad Haleem; Ali, Akbar

2014-01-01

A very sensitive, selective and simple flow injection time-based method was developed for on-line preconcentration and determination of thorium(IV) at micro g L"-"1 levels in environmental samples. The system operation was based on thorium(IV) ion retention at pH 4.0 in the minicolumn at a flow rate of 15.2 mL min"-"1. The trapped complex was then eluted with 3.6 mol L"-"1 HCl at a flow rate of 4.9 mL min"-"1. The amount of thorium(IV) in the eluate was measured spectrophotometrically at 651 nm using arsenazo-III solution (0.05 % in 3.6 mol L"-"1 HCl stabilized with 1 % triton X-100, 4.9 mL min"-"1) as colorimetric reagent. All chemical, and flow injection variables were optimized for the quantitative preconcentration of metal and a study of interference level of various ions was also carried out. The system offered low backpressure and improved sensitivity and selectivity. At a preconcentration time of 60 s and a sample frequency of 40 h"-"1, the enhancement factor was 97, the detection limit was 0.25 μg L"-"1, and the precision expressed as relative standard deviation was 1.08 % (at 50 μg L"-"1), whereas for 300 s of the preconcentration time and a sample frequency of 10 h"-"1, the enhancement factor of 357, the detection limit (3s) of 0.069 μg L"-"1 and the precision of 1.32 % (at 10 μg L"-"1) was reported. The accuracy of the developed method was sufficient and evaluated by the analysis of certified reference material IAEA-SL-1 (Lake Sediment) and spiked water samples.

Front-line intraperitoneal versus intravenous chemotherapy in stage III-IV epithelial ovarian, tubal, and peritoneal cancer with minimal residual disease: a competing risk analysis.

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Chang, Yen-Hou; Li, Wai-Hou; Chang, Yi; Peng, Chia-Wen; Cheng, Ching-Hsuan; Chang, Wei-Pin; Chuang, Chi-Mu

2016-03-17

In the analysis of survival data for cancer patients, the problem of competing risks is often ignored. Competing risks have been recognized as a special case of time-to-event analysis. The conventional techniques for time-to-event analysis applied in the presence of competing risks often give biased or uninterpretable results. Using a prospectively collected administrative health care database in a single institution, we identified patients diagnosed with stage III or IV primary epithelial ovarian, tubal, and peritoneal cancers with minimal residual disease after primary cytoreductive surgery between 1995 and 2012. Here, we sought to evaluate whether intraperitoneal chemotherapy outperforms intravenous chemotherapy in the presence of competing risks. Unadjusted and multivariable subdistribution hazards models were applied to this database with two types of competing risks (cancer-specific mortality and other-cause mortality) coded to measure the relative effects of intraperitoneal chemotherapy. A total of 1263 patients were recruited as the initial cohort. After propensity score matching, 381 patients in each arm entered into final competing risk analysis. Cumulative incidence estimates for cancer-specific mortality were statistically significantly lower (p = 0.017, Gray test) in patients receiving intraperitoneal chemotherapy (5-year estimates, 34.5%; 95% confidence interval [CI], 29.5-39.6%, and 10-year estimates, 60.7%; 95% CI, 52.2-68.0%) versus intravenous chemotherapy (5-year estimates, 41.3%; 95% CI, 36.2-46.3%, and 10-year estimates, 67.5%, 95% CI, 61.6-72.7%). In subdistribution hazards analysis, for cancer-specific mortality, intraperitoneal chemotherapy outperforms intravenous chemotherapy (Subdistribution hazard ratio, 0.82; 95% CI, 0.70-0.96) after correcting other covariates. In conclusion, results from this comparative effectiveness study provide supportive evidence for previous published randomized trials that intraperitoneal chemotherapy

Nondual Psychotherapy and Second Stage Sexual Addictions Recovery: Transforming "Master of the Universe" Narcissism into Nondual Being

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Nixon, Gary; Theriault, Brian

2012-01-01

This article describes the process of working through the "dry drunk" second stage of sexual addiction recovery through transforming the narcissistic "Master of the Universe" personality into the experience of nondual being using the Almaas Diamond Approach of self-realization. The Diamond Approach is a transpersonal informed psychology…

Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients.

Science.gov (United States)

Fink, Bernd; Schlumberger, Michael; Oremek, Damian

2017-08-01

patients were assessed before surgery, between stages, every 3 months during the first year after surgery, every 6 months during the second year postoperative, and at latest followup, and were retrospectively drawn from a longitudinally maintained institutional database. Thirty-four of 35 patients (97.2%; 95% CI, 85.4%-99.5%) appeared free of infection by criteria of Masri et al. and Zimmerli et al. at latest followup. The Harris hip score was 61 ± 13 points after the first operation and 82 ± 16 points 2 years after the second operation. This technique is a promising treatment option for periprosthetic infections of the hip in which substantial acetabular defects exclude implantation of a normal spacer and a two-stage revision of the femoral component is favored. Level IV, therapeutic study.

Use of spiral CT in demonstrating early carcinoma of the stomach - I stage

International Nuclear Information System (INIS)

Pomakov, P.

2009-01-01

Full text: The aim of this lecture is to provide practical information about the methodology and technique of spiral computed tomography, which provide maximum diagnostic efficiency in early gastric cancer - I stage, and to present the semiotics of CT images seen in early gastric cancer stage I - a own and literature data. Methodology of the study covers optimal drug muscle relaxation of the abdominal wall by injection of 2 sg buskolizin intravenous; maximum distension of the stomach lumen by ingestion of 3 effervescent disintegrated tablets Vit. C with 1-2 sips of water, necessarily using of non-ionic contrast media - 100 ml / 300 mg iodine / 1 ml liquid bolus introduced for 30 seconds. Start scanning - 30 seconds of the start of injection - to visualize the arterial phase, use of slices with a thickness of 3 mm and 2 mm interval; exponential data 120 kV, 160 mAc. Earlier form of gastric cancer have to be presented by 5 CT image: unequal unsmooth, scallop or polycyclic contours of the lining, thinning the complete disappearance of the lining; undulating thickening of the lining; nodal formation like a polyp on a broad basis with a 2-5 mm, double contour of the lining - like a wave. These amendments are localized only in a limited segment of the gastric mucosa. Spiral CT is an effective diagnostic performance in gastric cancer, including the early stage I of cancer development. This is realized only by using the specific methodology of the study as well as good knowledge of the CT images semiology for carcinoma, localized only within a certain perimeter of the stomach lining

A prospective study on concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage IV non-small cell lung cancer (1) -survival and toxicity

International Nuclear Information System (INIS)

Su Shengfa; Lu Bing; Zhang Bo; Hu Yinyang; Ouyang Weiwei; Li Huiqin; Wang Gang; Long Jinhua

2011-01-01

Objective: To evaluate the overall survival and safety among patients for stage IV non-small cell lung cancer (NSCLC) treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT). Methods: From Jan. 2003 to July 2010, 201 patients with stage IV NSCLC were included. All patients were treated with CCTTRT. Those patients who received only one cycle chemotherapy were not included in survival analysis,but analysis of toxicity. One hundred and eighty-two patients were eligible for survival analysis. All patients received platinum-based two-drug chemotherapy. The median number of cycles was 4. The median dose to planning target volume of primary tumor (DT PTV ) was 63 Gy. Treatment-related gastrointestinal and hematological toxicity were scored according to WHO criteria. Radiation-related pneumonitis and esophagitis were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTC) version 3.0. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression model was used to examine the effect of CCTTRT on overall survival. Results: The follow-up rate of 201 patients was 97.5%. with 201, 170 and 134 patients finished 2 =10.10, P =0.001). For patients eligible for survival analysis and received 4 - 5 cycles of systemic chemotherapy, MST of patients treated with DT PTV ≥63 Gy was significantly longer than those treated with DT PTV 2 =20.48, P =0.000) and 16.1 months vs.8.8 months (χ 2 =11.75, P =0.001)]. For patients with single organ metastasis, MST was 16 months for those treated with DT PTV ≥63 Gy and 9 months for those with DT PTV 2 =10.51, P=0.000); for patients with multiple organ metastasis, it was 11 months and 7 months, respectively (χ 2 =7.90, P =0.005). Multivariate analysis showed that concurrent 4 - 5 cycles chemotherapy and DTPTV ≥63 Gy (β =0.243, P=0.019) and improved KPS (β =1.268, P=0.000) were independent factors for survival. For the whole

Identifying Stages in a Learning Hierarchy for Use in Formative Assessment--The Example of Line Graphs

Science.gov (United States)

Stacey, Kaye; Price, Beth; Steinle, Vicki

2012-01-01

This paper discusses issues arising in the design of questions to use in an on-line computer-based formative assessment system, focussing on how best to identify the stages of a learning hierarchy for reporting to teachers. Data from several hundred students is used to illustrate how design decisions have been made for a test on interpreting line…

Current status of NPP generation IV

International Nuclear Information System (INIS)

Yohanes Dwi Anggoro; Dharu Dewi; Nurlaila; Arief Tris Yuliyanto

2013-01-01

Today development of nuclear technology has reached the stage of research and development of Generation IV nuclear power plants (advanced reactor systems) which is an innovative development from the previous generation of nuclear power plants. There are six types of power generation IV reactors, namely: Very High Temperature Reactor (VHTR), Sodium-cooled Fast Reactor (SFR), Gas-cooled Fast Reactor (GFR), Lead-cooled Fast Reactor (LFR), Molten Salt Reactor (MSR), and Super Critical Water-cooled Reactor (SCWR). The purpose of this study is to know the development of Generation IV nuclear power plants that have been done by the thirteen countries that are members of the Gen IV International Forum (GIF). The method used is review study and refers to various studies related to the current status of research and development of generation IV nuclear power. The result of this study showed that the systems and technology on Generation IV nuclear power plants offer significant advances in sustainability, safety and reliability, economics, and proliferation resistance and physical protection. In addition, based on the research and development experience is estimated that: SFR can be used optimally in 2015, VHTR in 2020, while NPP types GFR, LFR, MSR, and SCWR in 2025. Utilization of NPP generation IV said to be optimal if fulfill the goal of NPP generation IV, such as: capable to generate energy sustainability and promote long-term availability of nuclear fuel, minimize nuclear waste and reduce the long term stewardship burden, has an advantage in the field of safety and reliability compared to the previous generation of NPP and VHTR technology have a good prospects in Indonesia. (author)

Screening accuracy of the parent-completed Ages and Stages Questionnaires - second edition as a broadband screener for motor problems in preschoolers with autism spectrum disorders.

Science.gov (United States)

Vanvuchelen, Marleen; Van Schuerbeeck, Lise; Braeken, Marijke Aka

2017-01-01

Children with autism spectrum disorders are at risk for motor problems. However, this area is often overlooked in the developmental evaluation in autism diagnostic clinics. An alternative can be to identify children who should receive intensive motor assessment by using a parent-based screener. The aim of this study was to examine whether the Ages and Stages Questionnaires - second edition may be used to identify gross and fine motor problems in children. High-functioning children with autism spectrum disorder (n = 43, 22-54 m) participated in this study. Sensitivity, specificity, predictive values and areas under the receiver operating characteristic curve were calculated by comparing the Ages and Stages Questionnaires - second edition scores to the developmental evaluation of the Peabody Developmental Motor Scale - second edition. The results revealed that both the Ages and Stages Questionnaires - second edition gross and fine motor domain may be used to identify children without motor problems. In contrast, sensitivity analyses revealed the likelihood of under screening motor problems in this population. The Ages and Stages Questionnaires - second edition met only the criteria of a fair to good accuracy to identify poor gross motor (sensitivity = 100%) and below-average fine motor development (sensitivity = 71%) in this sample. Hence, the capacity of the Ages and Stages Questionnaires - second edition to identify motor problems in preschoolers with autism spectrum disorder appears to be limited. It is recommended to include a formal standardized motor test in the diagnostic procedure for all children with autism spectrum disorder. © The Author(s) 2016.

Proliferation of endogenous retroviruses in the early stages of a host germ line invasion.

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Ishida, Yasuko; Zhao, Kai; Greenwood, Alex D; Roca, Alfred L

2015-01-01

Endogenous retroviruses (ERVs) comprise 8% of the human genome and are common in all vertebrate genomes. The only retrovirus known to be currently transitioning from exogenous to endogenous form is the koala retrovirus (KoRV), making koalas (Phascolarctos cinereus) ideal for examining the early stages of retroviral endogenization. To distinguish endogenous from exogenous KoRV proviruses, we isolated koala genomic regions flanking KoRV integration sites. In three wild southern Australian koalas, there were fewer KoRV loci than in three captive Queensland koalas, consistent with reports that southern Australian koalas carry fewer KoRVs. Of 39 distinct KoRV proviral loci examined in a sire-dam-progeny triad, all proved to be vertically transmitted and endogenous; none was exogenous. Of the 39 endogenous KoRVs (enKoRVs), only one was present in the genomes of both the sire and the dam, suggesting that, at this early stage in the retroviral invasion of a host germ line, very large numbers of ERVs have proliferated at very low frequencies in the koala population. Sequence divergence between the 5'- and 3'-long terminal repeats (LTRs) of a provirus can be used as a molecular clock. Within each of ten enKoRVs, the 5'-LTR sequence was identical to the 3'-LTR sequence, suggesting a maximum age for enKoRV invasion of the koala germ line of approximately 22,200-49,900 years ago, although a much younger age is possible. Across the ten proviruses, seven LTR haplotypes were detected, indicating that at least seven different retroviral sequences had entered the koala germ line. © The Author 2014. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Non-LTE equivalent widths for Si II, III and IV

International Nuclear Information System (INIS)

Becker, S.R.; Butler, K.

1990-01-01

Equivalent widths for a set of Si II, III and IV lines reliable for the determination of temperatures in the B star parameter range are given. They are calculated on a fine grid of LTE line blanketed model atmospheres and lie in the wavelength region from 4070 A to 5070 A

Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour.

Science.gov (United States)

Chang, Su-Chuan; Chou, Min-Min; Lin, Kuan-Chia; Lin, Lie-Chu; Lin, Yu-Lan; Kuo, Su-Chen

2011-12-01

To evaluate maternal labour pain, fatigue, duration of the second stage of labour, the women's bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position. Quasi-experimental study. Medical centre in Taichung, Taiwan. 66 Women giving birth at the hospital, with 33 primigravidas assigned to each group. During the second stage of labour, the women in the experimental group pushed from an upright position and were given support to push spontaneously; the women in the control group pushed from a supine position and were supported via Valsalva pushing. Pain scores were recorded at two evaluation time points: at 10 cm of cervical dilation and one hour after the first pain score evaluation. One to four hours after childbirth, the trained nurses collected the fatigue and pushing experience scores. The women in the experimental group had a lower pain index (5.67 versus 7.15, p = 0.01), lower feelings of fatigue post birth (53.91 versus 69.39, p pushing intervention during the second stage of labour lessened pain and fatigue, shortened the pushing time and enhanced the pushing experience. Pushing interventions can yield increased satisfaction levels for women giving birth. Copyright © 2010 Elsevier Ltd. All rights reserved.

THROMBOCYTOSIS AS PROGNOSTIC FACTOR FOR SURVIVAL IN PATIENTS WITH ADVANCED NON SMALL CELL LUNG CANCER TREATED WITH FIRST- LINE CHEMOTHERAPY.

Directory of Open Access Journals (Sweden)

Deyan Davidov

2014-12-01

Full Text Available Objective: The aim of this study was to evaluate elevated platelet count as a prognostic factor for survival in patients with advanced (stage IIIB/ IV non- small cell lung cancer (NSCLC receiving first- line chemotherapy. Methods: From 2005 to 2009 three hundreds forty seven consecutive patients with stage IIIB or IV NSCLC, treated in Department of Medical Oncology, UMHAT "Dr Georgi Stranski" entered the study. The therapeutic regimens included intravenous administration of platinum- based doublets. Survival analysis was evaluated by Kaplan- Meier test. The influence of pretreatment thrombocytosis as prognostic factor for survival was analyzed using multivariate stepwise Cox regression analyses. Results: Elevated platelet counts were found in 78 patients. The overall survival for patients without elevated platelet counts was 9,6 months versus 6,9 months for these with thrombocytosis. In multivariate analysis as independent poor prognostic factors were identified: stage, performance status and elevated platelet counts. Conclusions: These results indicated that platelet counts as well as some clinical pathologic characteristics could be useful prognostic factors in patients with unresectable NSCLC.

Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting

NARCIS (Netherlands)

van Zyl, Gert Uves; van Mens, Thijs E.; McIlleron, Helen; Zeier, Michele; Nachega, Jean B.; Decloedt, Eric; Malavazzi, Carolina; Smith, Peter; Huang, Yong; van der Merwe, Lize; Gandhi, Monica; Maartens, Gary

2011-01-01

In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure. We conducted a cross-sectional survey to investigate the aetiology of virologic failure in 2 public

Atypical nuclear localization of VIP receptors in glioma cell lines and patients

Energy Technology Data Exchange (ETDEWEB)

Barbarin, Alice; Séité, Paule [Equipe Récepteurs, Régulations et Cellules Tumorales, Université de Poitiers, PBS bât 36, 1 rue Georges Bonnet, TSA 51106, 86073 Poitiers Cedex 9 (France); Godet, Julie [Laboratoire d’anatomie et de cytologie pathologiques, CHU de Poitiers, 2 rue de la Milétrie, 86000 Poitiers (France); Bensalma, Souheyla; Muller, Jean-Marc [Equipe Récepteurs, Régulations et Cellules Tumorales, Université de Poitiers, PBS bât 36, 1 rue Georges Bonnet, TSA 51106, 86073 Poitiers Cedex 9 (France); Chadéneau, Corinne, E-mail: corinne.chadeneau@univ-poitiers.fr [Equipe Récepteurs, Régulations et Cellules Tumorales, Université de Poitiers, PBS bât 36, 1 rue Georges Bonnet, TSA 51106, 86073 Poitiers Cedex 9 (France)

2014-11-28

Highlights: • The VIP receptor VPAC1 contains a putative NLS signal. • VPAC1 is predominantly nuclear in GBM cell lines but not VPAC2. • Non-nuclear VPAC1/2 protein expression is correlated with glioma grade. • Nuclear VPAC1 is observed in 50% of stage IV glioma (GBM). - Abstract: An increasing number of G protein-coupled receptors, like receptors for vasoactive intestinal peptide (VIP), are found in cell nucleus. As VIP receptors are involved in the regulation of glioma cell proliferation and migration, we investigated the expression and the nuclear localization of the VIP receptors VPAC1 and VPAC2 in this cancer. First, by applying Western blot and immunofluorescence detection in three human glioblastoma (GBM) cell lines, we observed a strong nuclear staining for the VPAC1 receptor and a weak nuclear VPAC2 receptor staining. Second, immunohistochemical staining of VPAC1 and VPAC2 on tissue microarrays (TMA) showed that the two receptors were expressed in normal brain and glioma tissues. Expression in the non-nuclear compartment of the two receptors significantly increased with the grade of the tumors. Analysis of nuclear staining revealed a significant increase of VPAC1 staining with glioma grade, with up to 50% of GBM displaying strong VPAC1 nuclear staining, whereas nuclear VPAC2 staining remained marginal. The increase in VPAC receptor expression with glioma grades and the enhanced nuclear localization of the VPAC1 receptors in GBM might be of importance for glioma progression.

Comparison of second molar eruption patterns in patients with skeletal Class II and skeletal Class I malocclusions.

Science.gov (United States)

Brin, Ilana; Camasuvi, Semin; Dali, Nasser; Aizenbud, Dror

2006-12-01

The eruptive positions of the second molars in Class I and Class II malocclusions were studied. Pretreatment records of 221 patients with a mean age of 11.3 years were evaluated. About 19% of them had skeletal Class I, 31% had skeletal maxillary Class II, and 50% had skeletal mandibular Class II malocclusions. The mean values of the dental and chronologic ages of the subjects were similar. The eruptive positions in relation to a reference line, the developmental stages of the patients' second molars and dental ages were recorded from the panoramic roentgenograms. The distribution of the various developmental stages in each malocclusion group was similar, and no association between skeletal malocclusion and dental developmental stage of the second molars was encountered. The eruptive position of the maxillary second molars was more occlusal only in the oldest maxillary Class II group, above 12 years of age (P = .02). These results support, in part, previous reports suggesting that the maxillary second molars may erupt earlier in patients with skeletal maxillary Class II malocclusions.

Stage IVN neuroblastoma: MRI diagnosis of left supraclavicular ''Virchow's'' nodal spread

International Nuclear Information System (INIS)

Abramson, S.J.; Berdon, W.E.; Stolar, C.; Ruzal-Shapiro, C.; Garvin, J.

1996-01-01

Stage IV neuroblastoma is associated with high mortality; an exception are patients whose stage IV status includes distant positive nodes, but no skeletal metastases - stage IVN neuroblastoma. We describe our experience with preoperative MRI in three patients with extensive abdominal neuroblastoma without cortical bony involvement but with unsuspected metastatic involvement to the left supraclavicular (Virchow's) node. We review findings of left supraclavicular nodal spread in five earlier cases of IVN neuroblastoma. (orig.). With 3 figs., 1 tab

Resonance transition array of Yb IV

International Nuclear Information System (INIS)

Kaufman, V.; Sugar, J.

1976-01-01

Nineteen pairs of lines in the wavelength range of 800--1300 A were identified as transitions to the two levels of the ground term of Yb IV, 4f 13 2 F. The 2 F 5 / 2 -- 2 F 7 / 2 interval is 10 214.0 cm -1 with an rms deviation of 0.4 cm -1

Second-line treatments: moving towards an opportunity to improve survival in advanced gastric cancer?

Science.gov (United States)

Salati, Massimiliano; Di Emidio, Katia; Tarantino, Vittoria; Cascinu, Stefano

2017-01-01

Gastric cancer is the third leading cause of cancer-related death globally with approximately 723 000 deaths every year. Most patients present with advanced unresectable or metastatic disease, only amenable to palliative systemic treatment and a median survival uncommonly exceeding 12 months. Over the last years, the efficacy of chemotherapy combination has plateaued and the introduction of the anti-human epidermal growth factor receptor 2 trastuzumab has resulted in a limited survival gain in the upfront setting. After this positive experience, first-line treatment with new targeted therapies failed to improve the outcome of advanced gastric cancer. On the contrary, second-line options, including monochemotherapy with taxanes or irinotecan and the anti-vascular endothelial growth factor receptor 2 ramucirumab, either alone or combined with paclitaxel, opened new therapeutic rooms for an ever-increasing number of patients who maintain an acceptable performance status across multiple lines. This article provides an updated overview on the current management of advanced gastric cancer and discusses how the different treatment options available may be best combined to favourably impact the outcome of patients following the logic of a treatment strategy.

Thyroid remnant ablation success and disease outcome in stage III or IV differentiated thyroid carcinoma: recombinant human thyrotropin versus thyroid hormone withdrawal.

Science.gov (United States)

Vallejo Casas, Juan A; Mena Bares, Luisa M; Gálvez Moreno, Maria A; Moreno Ortega, Estefanía; Marlowe, Robert J; Maza Muret, Francisco R; Albalá González, María D

2016-06-01

Most publications to date compare outcomes after post-surgical thyroid remnant ablation stimulated by recombinant human thyrotropin (rhTSH) versus thyroid hormone withholding/withdrawal (THW) in low-recurrence risk differentiated thyroid carcinoma (DTC) patients. We sought to perform this comparison in high-risk patients. We retrospectively analyzed ~9-year single-center experience in 70 consecutive adults with initial UICC (Union for International Cancer Control) stage III/IV, M0 DTC undergoing rhTSH-aided (N.=54) or THW-aided (N.=16) high-activity ablation. Endpoints included ablation success and DTC outcome. Assessed ≥1 year post-ablation, ablation success comprised a) no visible scintigraphic thyroid bed uptake or pathological extra-thyroidal uptake; b) undetectable stimulated serum thyroglobulin (Tg) without interfering autoantibodies; c) both criteria. DTC outcome, determined at the latest visit, comprised either 1) "no evidence of disease" (NED): undetectable Tg, negative Tg autoantibodies, negative most recent whole-body scan, no suspicious findings clinically, on neck ultrasonography, or on other imaging; 2) persistent disease: failure to attain NED; or 3) recurrence: loss of NED. After the first ablative activity, ablation success by scintigraphic plus biochemical criteria was 64.8% in rhTSH patients, 56.3% in THW patients (P=NS). After 3.5-year versus 6.2-year median follow-up (P<0.05), DTC outcomes were NED, 85.2%, persistent disease, 13.0%, recurrence, 1.9%, in the rhTSH group and NED, 87.5%, persistent or recurrent disease, 6.3% each, in the THW group (P=NS). In patients with initial stage III/IV, M0 DTC, rhTSH-aided and THW-assisted ablation were associated with comparable remnant eradication or DTC cure rates.

Retrospective analysis of third-line chemotherapy in advanced non-small cell lung cancer

Directory of Open Access Journals (Sweden)

Ali Murat Tatli

2015-01-01

Results: A total of 72 patients who had received third-line or higher chemotherapy were included in the analysis. The median age of patients was 49 years (range 41-76, and there were 13 (18.1% women and 59 (81.9% men. Estimated median survival was 26 months. Moreover, overall survival was significantly longer in patients for whom disease control was achieved after second-line chemotherapy compared to those with disease progression (34 vs. 17 months, respectively. Survival after third-line treatment was significantly longer in the group with Eastern Cooperative Oncology Group (ECOG performance status 0-1 at the beginning of third-line therapy compared to patients with a status of 2-3. Conclusions: In patients with advanced stage NSCLC, administration of third-line and higher systemic chemotherapy may be associated with increase in overall survival. Furthermore, greater increases in overall survival were also observed in patients for whom disease control was achieved after second-line therapy and in those with ECOG performance status of 0-1 before third-line treatment.

Sealing ability and thermal diffusivity of cavity lining materials: An in vitro study

Directory of Open Access Journals (Sweden)

Prabhakar A

2008-10-01

Full Text Available Aims: The purpose of this study was to evaluate and compare the sealing ability and the thermal insulating capability of four different cavity lining materials. Materials and Methods: Forty noncarious human mandibular second premolars that were extracted for orthodontic treatment were collected, cleaned, and stored in distilled water. These premolars were randomly divided into four groups of ten teeth each for treatment with the different cavity lining materials. Group I teeth were treated with cavity varnish, group II teeth with amorphous calcium phosphate (ACP, group III teeth with dentin bonding agent, and group IV teeth with resin-modified glass ionomer cement (RMGIC. Electrical resistance and the difference in the time-temperature curve of the external surface and the pulp side [A D -A P ] of each tooth following heat and cold application for 120 s were measured before and after cavity lining placement to determine the sealing ability and thermal insulating property, respectively. Data collected were subjected to statistical analysis. For paired data, paired t-test and Wilcoxon′s signed rank test were used. One-way ANOVA was used for comparisons between multiple groups and the Mann-Whitney U test for comparisons between pairs. Results: The mean difference in electrical resistance (in KΩ of different cavity lining materials were as follows: group I = +3.53, group II = −1.00, group III = +20.43, and group IV = +11.44. The mean differences in the area (A D -A P under the time-temperature curve following heat application were as follows: group I = 6.6 mm 2 , group II = 15.3 mm 2 , group III = 130.5 mm 2 , and group IV = 412.0 mm 2 . The mean differences in the area (A D -A P under the time-temperature curve following cold application were as follows: group I = 24.5 mm 2 , group II = 3.2 mm 2 , group III = 314.9 mm 2 , and group IV = 480.5 mm 2 . Conclusion: Dentin bonding agent and RMGIC provided effective sealing of the dentinal tubules

Synthesis and thermal decomposition kinetics of Th(IV) complex with unsymmetrical Schiff base ligand

International Nuclear Information System (INIS)

Fan Yuhua; Bi Caifeng; Liu Siquan; Yang Lirong; Liu Feng; Ai Xiaokang

2006-01-01

A new unsymmetrical Schiff base ligand (H 2 LLi) was synthesized using L-lysine, o-vanillin and salicylaladyde. Thorium(IV) complex of this ligand [Th(H 2 L)(NO 3 )](NO 3 ) 2 x 3H 2 O have been prepared and characterized by elemental analyses, IR, UV and molar conductance. The thermal decomposition kinetics of the complex for the second stage was studied under non-isothermal condition by TG and DTG methods. The kinetic equation may be expressed as: dα/dt = A x e -E/RT x 1/2 (1-α) x [-ln(1-α)] -1 . The kinetic parameters (E, A), activation entropy ΔS ≠ and activation free-energy ΔG ≠ were also calculated. (author)

X-Band Electron Paramagnetic Resonance Comparison of Mononuclear Mn(IV)-oxo and Mn(IV)-hydroxo Complexes and Quantum Chemical Investigation of Mn(IV) Zero-Field Splitting.

Science.gov (United States)

Leto, Domenick F; Massie, Allyssa A; Colmer, Hannah E; Jackson, Timothy A

2016-04-04

X-band electron paramagnetic resonance (EPR) spectroscopy was used to probe the ground-state electronic structures of mononuclear Mn(IV) complexes [Mn(IV)(OH)2(Me2EBC)](2+) and [Mn(IV)(O)(OH)(Me2EBC)](+). These compounds are known to effect C-H bond oxidation reactions by a hydrogen-atom transfer mechanism. They provide an ideal system for comparing Mn(IV)-hydroxo versus Mn(IV)-oxo motifs, as they differ by only a proton. Simulations of 5 K EPR data, along with analysis of variable-temperature EPR signal intensities, allowed for the estimation of ground-state zero-field splitting (ZFS) and (55)Mn hyperfine parameters for both complexes. From this analysis, it was concluded that the Mn(IV)-oxo complex [Mn(IV)(O)(OH)(Me2EBC)](+) has an axial ZFS parameter D (D = +1.2(0.4) cm(-1)) and rhombicity (E/D = 0.22(1)) perturbed relative to the Mn(IV)-hydroxo analogue [Mn(IV)(OH)2(Me2EBC)](2+) (|D| = 0.75(0.25) cm(-1); E/D = 0.15(2)), although the complexes have similar (55)Mn values (a = 7.7 and 7.5 mT, respectively). The ZFS parameters for [Mn(IV)(OH)2(Me2EBC)](2+) were compared with values obtained previously through variable-temperature, variable-field magnetic circular dichroism (VTVH MCD) experiments. While the VTVH MCD analysis can provide a reasonable estimate of the magnitude of D, the E/D values were poorly defined. Using the ZFS parameters reported for these complexes and five other mononuclear Mn(IV) complexes, we employed coupled-perturbed density functional theory (CP-DFT) and complete active space self-consistent field (CASSCF) calculations with second-order n-electron valence-state perturbation theory (NEVPT2) correction, to compare the ability of these two quantum chemical methods for reproducing experimental ZFS parameters for Mn(IV) centers. The CP-DFT approach was found to provide reasonably acceptable values for D, whereas the CASSCF/NEVPT2 method fared worse, considerably overestimating the magnitude of D in several cases. Both methods were poor in

Screening and staging for non-small cell lung cancer by serum laser Raman spectroscopy.

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Wang, Hong; Zhang, Shaohong; Wan, Limei; Sun, Hong; Tan, Jie; Su, Qiucheng

2018-08-05

Lung cancer is the leading cause of cancer-related death worldwide. Current clinical screening methods to detect lung cancer are expensive and associated with many complications. Raman spectroscopy is a spectroscopic technique that offers a convenient method to gain molecular information about biological samples. In this study, we measured the serum Raman spectral intensity of healthy volunteers and patients with different stages of non-small cell lung cancer. The purpose of this study was to evaluate the application of serum laser Raman spectroscopy as a low cost alternative method in the screening and staging of non-small cell lung cancer (NSCLC). The Raman spectra of the sera of peripheral venous blood were measured with a LabRAM HR 800 confocal Micro Raman spectrometer for individuals from five groups including 14 healthy volunteers (control group), 23 patients with stage I NSCLC (stage I group), 24 patients with stage II NSCLC (stage II group), 19 patients with stage III NSCLC (stage III group), 11 patients with stage IV NSCLC (stage IV group). Each serum sample was measured 3 times at different spots and the average spectra represented the signal of Raman spectra in each case. The Raman spectrum signal data of the five groups were statistically analyzed by analysis of variance (ANOVA), principal component analysis (PCA), linear discriminant analysis (LDA), and cross-validation. Raman spectral intensity was sequentially reduced in serum samples from control group, stage I group, stage II group and stage III/IV group. The strongest peak intensity was observed in the control group, and the weakest one was found in the stage III/IV group at bands of 848 cm -1 , 999 cm -1 , 1152 cm -1 , 1446 cm -1 and 1658 cm -1 (P Raman spectroscopy can effectively identify patients with stage I, stage II or stage III/IV Non-Small Cell Lung cancer using patient serum samples. Copyright © 2018 Elsevier B.V. All rights reserved.

Nintedanib plus docetaxel as second-line therapy in patients with non-small-cell lung cancer of adenocarcinoma histology

DEFF Research Database (Denmark)

Popat, Sanjay; Mellemgaard, Anders; Reck, Martin

2017-01-01

PATIENTS & METHODS: We provide an update to a network meta-analysis evaluating the relative efficacy of nintedanib + docetaxel versus other second-line agents in adenocarcinoma histology non-small-cell lung cancer. RESULTS: Overall similarity of nintedanib + docetaxel versus ramucirumab + docetaxel...

Identification of type IV collagen exposure as a molecular imaging target for early detection of thoracic aortic dissection

Science.gov (United States)

Xu, Ke; Xu, Chen; Zhang, Yanzhenzi; Qi, Feiran; Yu, Bingran; Li, Ping; Jia, Lixin; Li, Yulin; Xu, Fu-jian; Du, Jie

2018-01-01

Thoracic aortic dissection (TAD) is an aggressive and life-threatening vascular disease and there is no effective means of early diagnosis of dissection. Type IV collagen (Col-IV) is a major component of the sub-endothelial basement membrane, which is initially exposed followed by endothelial injury as early-stage event of TAD. So, we want to build a noninvasive diagnostic method to detect early dissection by identifying the exposed Col-IV via MRI. Methods: Col-IV-targeted magnetic resonance/ fluorescence dual probe (Col-IV-DOTA-Gd-rhodamine B; CDR) was synthesized by amide reaction and coordination reaction. Flow cytometry analysis was used to evaluate the cell viability of SMC treated with CDR and fluorescence assays were used to assess the Col-IV targeting ability of CDR in vitro. We then examined the sensitivity and specificity of CDR at different stages of TAD via MRI and bioluminescence imaging in vivo. Results: The localization of Col-IV (under the intima) was observed by histology images. CDR bound specifically to Col-IV-expressing vascular smooth muscle cells and BAPN-induced dissected aorta. The CDR signal was co-detected by magnetic resonance imaging (MRI) and bioluminescence imaging as early as 2 weeks after BAPN administration (pre-dissection stage). The ability to detect rupture of dissected aorta was indicated by a strong normalized signal enhancement (NSE) in vivo. Moreover, NSE was negatively correlated with the time of dissection rupture after BAPN administration (r2 = 0.8482). Conclusion: As confirmed by in vivo studies, the CDR can identify the exposed Col-IV in degenerated aorta to monitor the progress of aortic dissection from the early stage to the rupture via MRI. Thus, CDR-enhanced MRI proposes a potential method for dissection screening, and for monitoring disease progression and therapeutic response. PMID:29290819

Preliminary work for stage 2 decommissioning of B16 pile chimney

International Nuclear Information System (INIS)

Wright, E.M.; Mathews, R.F.

1991-01-01

Planning of the second stage of decommissioning of the two pile chimneys at Sellafield started while work was underway on the first stage, which involved removal of the sections above the filters. The second stage requires the removal of all radio-active parts and the dismantling of the filter and diffuser sections, and has to be completed by 1997. The planning involved studying the many possible options and their effects on both radiological and industrial safety. This decommissioning project employs a high proportion of civil engineering and construction techniques, which are then developed to eliminate the hazards from radioactive dusts, and to minimise the effect of radiation on operatives working on the project. Much of this equipment is modified forms of standard construction equipment and includes cutting equipment and remotely operated vehicles. The initial phases of the work involve: provision of a waste packaging and access building; provision of temporary ventilation systems to control the dust generated by the work, cutting of 3 m square access doorway through the 1.5 m thick reinforced concrete wall of the chimney; provision of Remotely Operated Vehicle (ROV) to act as a tool carrier for lining stripping work; removal of the thermal lining from the floor and lower walls of the chimney, and installation of precast concrete walls which separate the pile reactor core from the chimney flue. (author)

NEW PRECISION ORBITS OF BRIGHT DOUBLE-LINED SPECTROSCOPIC BINARIES. IV. 66 ANDROMEDAE, HR 6979, AND HR 9059

International Nuclear Information System (INIS)

Fekel, Francis C.; Williamson, Michael H.; Tomkin, Jocelyn

2010-01-01

We have determined improved spectroscopic orbits for three double-lined binaries, 66 And (F4 V), HR 6979 (Am), and HR 9059 (F5 IV) using radial velocities from the 2.1 m telescope at McDonald Observatory, the coude feed telescope at Kitt Peak National Observatory, and 2 m telescope at Fairborn Observatory. The orbital periods range from 11.0 to 14.3 days, and all three systems have eccentric orbits. The new orbital dimensions (a 1 sin i and a 2 sin i) and minimum masses (m 1 sin 3 i and m 2 sin 3 i) have accuracies of 0.2% or better. All six components of the three binary systems are rotating more slowly than their predicted pseudosynchronous rotational velocities. Hipparcos photometry of HR 9059 shows that this system has partial eclipses. Its components are nearly identical in mass and are at the very end of their main-sequence lifetimes or perhaps have just begun to traverse the Hertsprung gap.

Gene expression profiles in stages II and III colon cancers

DEFF Research Database (Denmark)

Thorsteinsson, Morten; Kirkeby, Lene T; Hansen, Raino

2012-01-01

PURPOSE: A 128-gene signature has been proposed to predict outcome in patients with stages II and III colorectal cancers. In the present study, we aimed to reproduce and validate the 128-gene signature in external and independent material. METHODS: Gene expression data from the original material...... were retrieved from the Gene Expression Omnibus (GEO) (n¿=¿111) in addition to a Danish data set (n¿=¿37). All patients had stages II and III colon cancers. A Prediction Analysis of Microarray classifier, based on the 128-gene signature and the original training set of stage I (n¿=¿65) and stage IV (n...... correctly predicted as stage IV-like, and the remaining patients were predicted as stage I-like and unclassifiable, respectively. Stage II patients could not be stratified. CONCLUSIONS: The 128-gene signature showed reproducibility in stage III colon cancer, but could not predict recurrence in stage II...

PREDICTORS OF OVERALL SURVIVAL IN PATIENTS WITH RECURRENT NON-SEMINOMATOUS GERMINAL TESTICULAR TUMORS ON CURRENT SECOND-LINE CHEMOTHERAPY

Directory of Open Access Journals (Sweden)

M. Yu. Fedyanin

2010-01-01

Full Text Available Objective: to define predictors that influence longevity in patients with recurrent non-seminomatous germinal testicular tumors (NGTT on standard second-line chemotherapy (CT including cisplatin and iphosphamide. Statistical analysis was performed using the statistical packages Graph Pad Prism 4.00 for Windows and SPSS 15.0 for Windows. Subjects and methods. Case history data were analyzed in 693 patients with disseminated NGTT who had received current CT and followed up at the Department of Clinical Pharmacology and CT, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences. The median follow-up was 32 (range 3-215 months. The disease progressed in 181 (26% patients. Detailed information was available on the nature of second-line CT in only 138 patients. Half (71 (51.7% of the 138 patients had second-line CT including iphosphamide. Uni- and multivariate analyses were made to identify predictors that influence longevity in patients with recurrent NGTT on standard secondline CT including cisplatin and iphosphamide. Results. Five-year overall survival (OS was 32% (95% confidence interval 25-41%. The multivariate analysis showed the morphological pattern of a primary tumor (a yolk sac tumor component, a pre-induction CT lactate dehydrogenase (LDH level of ?d1.5 units of the upper normal range, progression during induction CT, and a pre-second-line CT LDH level of ?d 1000 U/l to be negative predictors. According to the number of negative factors, the patients were classified into 3 groups: 1 good prognosis [n = 10 (14% of the 71 patients], 100% 3-year OS; 2 intermediate prognosis (one negative factor [n = 33 (46.5% of the 71 patients], 50.2% 3-year OS; 3 poor prognosis (?d 2 negative factors, 6.7% 3-year OS. Conclusion. Standard iphosphamide-containing therapy enables all patients to be treated in the good prognosis group of those with recurrent NGTT. That fails to achieve such striking results in the intermediate and

The unwound portion dividing helix IV of NhaA undergoes a conformational change at physiological pH and lines the cation passage.

Science.gov (United States)

Rimon, Abraham; Kozachkov-Magrisso, Lena; Padan, Etana

2012-11-27

pH and Na(+) homeostasis in all cells requires Na(+)/H(+) antiporters. The crystal structure of NhaA, the main antiporter of Escherichia coli, has provided general insights into antiporter mechanisms and their pH regulation. Functional studies of NhaA in the membrane have yielded valuable information regarding its functionality in situ at physiological pH. Here, we Cys-scanned the discontinuous transmembrane segment (TM) IV (helices IVp and IVc connected by an extended chain) of NhaA to explore its functionality at physiological pH. We then tested the accessibility of the Cys replacements to the positively charged SH reagent [2-(trimethylammonium)ethyl] methanethiosulfonate bromide (MTSET) and the negatively charged 2-sulfonatoethyl methanethiosulfonate (MTSES) in intact cells at pH 8.5 and 6.5 and in parallel tested their accessibility to MTSET in high-pressure membranes at both pH values. We found that the outer membrane of E. coli TA16 acts as a partially permeable barrier to MTSET. Overcoming this technical problem, we revealed that (a) Cys replacement of the most conserved residues of TM IV strongly increases the apparent K(m) of NhaA to both Na(+) and Li(+), (b) the cationic passage of NhaA at physiological pH is lined by the most conserved and functionally important residues of TM IV, and (c) a pH shift from 6.5 to 8.5 induces conformational changes in helix IVp and in the extended chain at physiological pH.

Osimertinib and Necitumumab in Treating Patients With EGFR-Mutant Stage IV or Recurrent Non-small Cell Lung Cancer Who Have Progressed on a Previous EGFR Tyrosine Kinase Inhibitor

Science.gov (United States)

2018-03-07

EGFR Exon 19 Deletion Mutation; EGFR Exon 20 Insertion Mutation; EGFR NP_005219.2:p.G719X; EGFR NP_005219.2:p.L858R; EGFR NP_005219.2:p.L861Q; EGFR NP_005219.2:p.T790M; EGFR T790M Mutation Negative; Recurrent Non-Small Cell Lung Carcinoma; Stage IV Non-Small Cell Lung Cancer AJCC v7

Second-Line Hormonal Therapy for Men With Chemotherapy-Naïve, Castration-Resistant Prostate Cancer: American Society of Clinical Oncology Provisional Clinical Opinion.

Science.gov (United States)

Virgo, Katherine S; Basch, Ethan; Loblaw, D Andrew; Oliver, Thomas K; Rumble, R Bryan; Carducci, Michael A; Nordquist, Luke; Taplin, Mary-Ellen; Winquist, Eric; Singer, Eric A

2017-06-10

Purpose ASCO provisional clinical opinions (PCOs) offer direction to the ASCO membership after publication or presentation of potential practice-changing data. This PCO addresses second-line hormonal therapy for chemotherapy-naïve men with castration-resistant prostate cancer (CRPC) who range from being asymptomatic with only biochemical evidence of CRPC to having documented metastases but minimal symptoms. Clinical Context The treatment goal for CRPC is palliation. Despite resistance to initial androgen deprivation therapy, most men respond to second-line hormonal therapies. However, guidelines have neither addressed second-line hormonal therapy for nonmetastatic CRPC nor provided specific guidance with regard to the chemotherapy-naïve population. Recent Data Six phase III randomized controlled trials and expert consensus opinion inform this PCO. Provisional Clinical Opinion For men with CRPC, a castrate state should be maintained indefinitely. Second-line hormonal therapy (eg, antiandrogens, CYP17 inhibitors) may be considered in patients with nonmetastatic CRPC at high risk for metastatic disease (rapid prostate-specific antigen doubling time or velocity) but otherwise is not suggested. In patients with radiographic evidence of metastases and minimal symptoms, enzalutamide or abiraterone plus prednisone should be offered after discussion with patients about potential harms, benefits, costs, and patient preferences. Radium-223 and sipuleucel-T also are options. No evidence provides guidance about the optimal order of hormonal therapies for CRPC beyond second-line treatment. Prostate-specific antigen testing every 4 to 6 months is reasonable for men without metastases. Routine radiographic restaging generally is not suggested but can be considered for patients at risk for metastases or who exhibit symptoms or other evidence of progression. Additional information is available at www.asco.org/genitourinary-cancer-guidelines and www.asco.org/guidelineswiki .

Treatment paradigms for patients with metastatic non small cell lung cancer (NSCLC, squamous lung cancer: first, second and third-line

Directory of Open Access Journals (Sweden)

Abdulaziz eAl Farsi

2014-06-01

Full Text Available Historically, the treatment algorithm applied to non small cell lung cancer (NSCLC was the same for all histologic subtypes. However, recent advances in our understanding of the molecular profiles of squamous and non-squamous NSCLC have changed this perspective. Histologic subtype and the presence of specific molecular abnormalities have predictive value for response to and toxicity from therapy, as well as overall survival. For patients with squamous NSCLC, a platinum agent plus gemcitabine, or paclitaxel is recommended as first-line therapy. The role of EGFR monoclonal antibodies is uncertain. Maintenance therapy is not widely recommended, although data exist for the use of erlotinib. The standard recommendation for second-line therapy is docetaxel and erlotinib should be considered as second or third-line therapy. There is ongoing research identifying molecular targets in squamous NSCLC and many agents are in early phase clinical trials. Immunotherapeutic approaches targeting programmed death 1 receptor (PD-1 and its ligand (PD-L1 appear promising.

The microstructural origin of work hardening stages

DEFF Research Database (Denmark)

Hughes, D. A.; Hansen, N.

2018-01-01

The strain evolution of the flow stress and work hardening rate in stages III and IV is explored by utilizing a fully described deformation microstructure. Extensive measurements by transmission electron microscopy reveal a hierarchical subdivision of grains by low angle incidental dislocation...... addition of the classical Taylor and Hall-Petch formulations. Model predictions agree closely with experimental values of flow stress and work hardening rate in stages III and IV. Strong connections between the evolutionary stages of the deformation microstructure and work hardening rates create a new...... (modern) basis for the classic problem of work hardening in metals and alloys. These connections lead the way for the future development of ultra high strength ductile metals produced via plastic deformation.(c) 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved....

Reversal of the decision for caesarean section in the second stage of labour on the basis of consultant vaginal assessment.

Science.gov (United States)

Oláh, K S

2005-02-01

During a 5-year period there were 32 cases where the vaginal assessment performed by a specialist registrar in the second stage of labour was re-assessed within 15 minutes by a consultant obstetrician. The examination was prompted by a request for permission to perform a caesarean section in the second stage of labour. The results suggest a significant discrepancy between the consultants and the specialist registrar's findings, with 44% of the cases indicating a difference in the position of the head, and 81% a difference in the station of the head. No comment was made about caput or moulding in the majority of cases (94%). The study findings suggest that vaginal examination, like instrumental delivery, is a skill that is being eroded and will require formal instruction to address this problem.

An Integrated Safety Assessment Methodology for Generation IV Nuclear Systems

International Nuclear Information System (INIS)