Satisfaction with information and unmet information needs in men and women with cancer

Abstract

Purpose

Information needs in cancer patients are high but often not fulfilled. This study aimed to examine the level of perceived information, information satisfaction, and unmet needs in a large sample of cancer patients. Further, we explored associations with emotional distress and quality of life accounting for gender.

Methods

In a multicenter, cross-sectional study in Germany, 4020 cancer patients (mean age 58 years, 51 % women) were evaluated. We obtained self-reports of information level, information satisfaction, and unmet needs, measured depressive symptoms with the Patient Health Questionnaire (PHQ-9), symptoms of anxiety with the Generalized Anxiety Disorder Scale (GAD-7), and health-related quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30).

Results

Seventy-two to 88 % of participants reported to be well informed regarding various aspects of their disease, except of psychological support (38 %). However, unmet information needs were also prevalent in 36 to 48 %. Gender differences found were generally small. Although men felt less informed about psychological support, they expressed fewer needs for further information regarding this topic. Irrespective of gender, patients who were less satisfied with information received and had more unmet needs reported more anxiety, depression, and lower quality of life. Up to three quarters of those classified as most severely distressed reported unmet needs for information about psychological support.

Conclusions

In this largest study to date, we found high levels of both information received and satisfaction with information, but also considerable amounts of unmet needs, particularly regarding psychological support.

Implications for Cancer Survivors

Provision of information about psychosocial support seems important to increase utilization of support offers among distressed cancer survivors.

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Physical inactivity and risk of poor quality of life among elderly cancer survivors compared to women without cancer: the Iowa Women’s Health Study

Abstract

Purpose

Few studies have examined lifestyle factors and quality of life (QOL) in cancer survivors compared to a cancer-free group. Compared to active cancer-free women, we examined the association between physical inactivity and QOL in elderly cancer survivors and similar-aged women without cancer.

Methods

Participants included 1776 cancer survivors and 12,599 cancer-free women enrolled in the Iowa Women's Health Study in 1986 who completed the SF36 QOL assessment in 2004 (ages 73–88 years). The odds of poor QOL were computed for each SF36 subscale (>0.5 SD below mean score of cancer-free women) associated with physical inactivity (moderate-vigorous activity <once/week) between four groups based on the cross-classification of cancer history (no/yes) and physical inactivity (no/yes) (referent group = active cancer-free women).

Results

Compared with the referent group, inactive cancer survivors were significantly more likely to report poor QOL for each SF36 subscale (odds ratios 1.8 to 4.7), independent of age, comorbidity, body mass index (BMI), and diet quality. The greatest odds for poor QOL occurred for general health, vitality, and physical function. These increased odds occurred regardless of whether survivors were inactive at both baseline (1986) and follow-up or became inactive sometime after baseline. Among physically active women, cancer survivors had similar QOL as cancer-free women.

Conclusion

These findings provide evidence on the importance of leisure-time physical activity in older women and support the need for interventions to help older women maintain or regain a physically active lifestyle.

Implications for Cancer Survivors

Survivors who remain or become physically active as they age report better mental and physical QOL.

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Survivorship care plan preferences of cancer survivors and health care providers: a systematic review and quality appraisal of the evidence

Abstract

Purpose

The purpose of this systematic review was to describe and examine the current use of treatment summaries and survivorship care plans (TSs/SCPs) for cancer survivors, as well as to summarize and critically assess relevant literature regarding their preferences and usefulness. There is a knowledge gap regarding the preferences of stakeholders as to what is useful on a treatment summary or survivorship care plan.

Methods

A systematic review of eligible manuscripts was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies were identified via PubMed, CINAHL Plus, and the Cochrane Library from 2005 through 2013. Eligible studies were critically appraised with qualitative and quantitative appraisal tools.

Results

There were 29 studies included in this review; 19 were quantitative. Survivors and primary care physicians preferred a printable format delivered 0 to 6 months posttreatment and highlighting signs and symptoms of recurrence, late, and long-term effects, and recommendations for healthy living. Oncology providers supported the concept of treatment summary and survivorship care plan but reported significant barriers to their provision. No studies incorporated caregiver perspectives of treatment summary and survivorship care plan.

Conclusion

This systematic review did not reveal conclusive evidence regarding the needs of survivors or providers regarding treatment summaries and survivorship care plans. A lack of rigorous studies contributed to this.

Implications for cancer survivors

Treatment summaries and survivorship care plans are useful for cancer survivors; however, future rigorous studies should be conducted to identify and prioritize the preferences of survivors regarding these.

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What are the barriers of quality survivorship care for haematology cancer patients? Qualitative insights from cancer nurses

Abstract

Purpose

Many haematological cancer survivors report long-term physiological and psychosocial effects beyond treatment completion. These survivors continue to experience impaired quality of life (QoL) as a result of their disease and aggressive treatment. As key members of the multidisciplinary team, the purpose of this study is to examine the insights of cancer nurses to inform future developments in survivorship care provision.

Methods

Open text qualitative responses from two prospective Australian cross-sectional surveys of nurses (n = 136) caring for patients with haematological cancer. Data were analysed thematically, using an inductive approach to identify themes.

Results

This study has identified a number of issues that nurses perceive as barriers to quality survivorship care provision. Two main themes were identified: the first relating to the challenges nurses face in providing care ('care challenges') and the second relating to the challenges of providing survivorship care within contemporary health care systems ('system challenges').

Conclusions

Cancer nurses perceive the nature of haematological cancer and its treatment and of the health care system itself, as barriers to the provision of quality survivorship care. Care challenges such as the lack of a standard treatment path and the relapsing or remitting nature of haematological cancers may be somewhat intractable, but system challenges relating to clearly defining and delineating professional responsibilities and exchanging information with other clinicians are not.

Implications for cancer survivors

Addressing the issues identified will facilitate cancer nurses' provision of survivorship care and help address haematological survivors' needs with regard to the physical and psychosocial consequences of their cancer and treatment.

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Cultural considerations for South Asian women with breast cancer

Abstract

Purpose

Cultural values shape a woman's experience of disease and introduce novel stressors that influence psychosocial needs and adaptation. This literature review examines the psychosocial impact of breast cancer in South Asian women, a large group that has received little attention in this regard.

Methods

We conducted a comprehensive review of the literature published before April 2014 using Ovid MEDLINE, PsychINFO, PubMED, CINHAL, EMBASE, and Sociological Abstracts. We searched for articles about the psychosocial impact of breast cancer in South Asian women. We retained 23 studies for review.

Results

The literature concerning South Asian women's experiences identified culturally linked themes that play significant roles in shaping the illness experience; e.g., stigma and breast cancer, low priority of women's health, collective experience of disease, and religion and spirituality.

Conclusion

There is a growing need for culturally sensitive care for South Asian women. By understanding the core cultural values and integrating them into clinical practice, Western healthcare providers may improve the quality of care they deliver and help women to extract the maximum benefit.

Implications for Cancer Survivors

Developing culturally competent support services may enhance effectiveness in addressing the healthcare needs of South Asian women and may serve other ethnic minorities in North America.

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Active transportation in adult survivors of childhood cancer and neighborhood controls

Abstract

Purpose

Childhood cancer survivors (CCS) are at high risk of treatment-related late effects, including cardiovascular disease and diabetes, which can be exacerbated by inadequate physical activity (PA). Previous PA interventions targeting CCS have focused on the domain of leisure-time/recreational PA. Active transportation, another domain of PA, has not been described in CCS. Therefore, this study aimed to identify active transportation behaviors, barriers, and correlates in adult CCS.

Methods

We recruited 158 adult CCS and 153 controls matched on age, sex, and neighborhood for a survey regarding active transportation behaviors and perceptions. Linear and logistic regression models accounting for correlation among matched participants were used.

Results

Adult CCS engaged in similar levels of active transportation as controls (2.72 vs. 2.32 h/week, P = 0.40) despite perceiving greater health-related barriers (1.88 vs. 1.65 (measured on four-point Likert scale), P = 0.01). Marital/relationship status (odds ratio (OR) = 0.30, 95 % confidence interval (CI) = 0.11–0.81), planning/psychosocial barriers (OR = 0.15, 95 % CI = 0.04–0.53), and perceived neighborhood walkability (OR = 2.55, 95 % CI = 1.14–5.66) were correlates of active transportation among adult CCS, while objective neighborhood walkability (OR = 1.03, 95 % CI = 1.01–1.05) was a correlate among controls.

Conclusions

Results suggest adult CCS and controls utilize active transportation at approximately equal levels. Factors other than health, including perceived neighborhood walkability, are related to active transportation behaviors to a greater degree in adult CCS.

Implications for Cancer Survivors

Interventions might consider promoting active transportation as a way to incorporate more PA into the daily lives of adult CCS. Such interventions will not be likely successful, however, without existing or improved neighborhood walkability/bikeability.

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MicroRNA-378-mediated suppression of Runx1 alleviates the aggressive phenotype of triple-negative MDA-MB-231 human breast cancer cells

Abstract

The Runx1 transcription factor, known for its essential role in normal hematopoiesis, was reported in limited studies to be mutated or associated with human breast tumor tissues. Runx1 increases concomitantly with disease progression in the MMTV-PyMT transgenic mouse model of breast cancer. Compelling questions relate to mechanisms that regulate Runx1 expression in breast cancer. Here, we tested the hypothesis that dysregulation of Runx1-targeting microRNAs (miRNAs) allows for pathologic increase of Runx1 during breast cancer progression. Microarray profiling of the MMTV-PyMT model revealed significant downregulation of numerous miRNAs predicted to target Runx1. One of these, miR-378, was inversely correlated with Runx1 expression during breast cancer progression in mice and in human breast cancer cell lines MCF7 and triple-negative MDA-MB-231 that represent early- and late-stage diseases, respectively. MiR-378 is nearly absent in MDA-MB-231 cells. Luciferase reporter assays revealed that miR-378 binds the Runx1 3′ untranslated region (3′UTR) and inhibits Runx1 expression. Functionally, we demonstrated that ectopic expression of miR-378 in MDA-MB-231 cells inhibited Runx1 and suppressed migration and invasion, while inhibition of miR-378 in MCF7 cells increased Runx1 levels and cell migration. Depletion of Runx1 in late-stage breast cancer cells resulted in increased expression of both the miR-378 host gene PPARGC1B and pre-miR-378, suggesting a feedback loop. Taken together, our study identifies a novel and clinically relevant mechanism for regulation of Runx1 in breast cancer that is mediated by a PPARGC1B-miR-378-Runx1 regulatory pathway. Our results highlight the translational potential of miRNA replacement therapy for inhibiting Runx1 in breast cancer.

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Erratum to: Promyelocytic leukemia protein enhances apoptosis of gastric cancer cells through Yes-associated protein

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Upregulation of CD44v6 contributes to acquired chemoresistance via the modulation of autophagy in colon cancer SW480 cells

Abstract

The CD44 isoform containing variant exon v6 (CD44v6) plays an important role in the progression, metastasis, and prognosis of colorectal cancer (CRC). Recently, it was found that CD44v6 is involved in acquired drug resistance. This study aimed to investigate the molecular mechanism of CD44v6 in the resistance of CRC cells to chemotherapy. A stable CD44v6 overexpression model in SW480 cells was established via lentiviral transduction. The chemosensitivity of cells to 5-fluorouracil (5-FU) and oxaliplatin (L-OHP) was determined by cell counting kit (CCK)-8, lactate dehydrogenase (LDH) release, and colony formation assays. Immunohistochemical staining of CD44v6 was performed in human CRC tissues. The key components in cell apoptosis, drug efflux and metabolism, mismatch repair, autophagy, epithelial–mesenchymal transition (EMT), and the PI3K–Akt and MAPK–Ras–Erk1/2 pathways were assessed using flow cytometry, quantitative real-time polymerase chain reaction (PCR), and western blot assays. The CD44v6 overexpression cells showed a higher viability, a lower LDH release rate, and an increased clonogenicity than the control cells under drug treatment. Moreover, overexpression of CD44v6 resulted in enhanced autophagy flux, EMT, and phosphorylation of Akt and Erk in the presence of drugs. Furthermore, high CD44v6 expression in the primary tumor was closely associated with an early recurrence in CRC patients who underwent curative surgery and adjuvant chemotherapy. In conclusion, overexpression of CD44v6 contributes to chemoresistance in SW480 cells under cytotoxic stress via the modulation of autophagy, EMT, and activation of the PI3K–Akt and MAPK–Ras–Erk pathways.

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Erratum to: Separation and Characterization of Epithelial and Mesenchymal-like Murine Mammary Tumor Cells Reveals Epithelial Cell Differentiation Plasticity and Enhanced Tumorigenicity of Epithelial-enriched Tumor Cells

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Re: "A Vaccine Study Design Selection Framework for the Postlicensure Rapid Immunization Safety Monitoring Program"

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Age- and Sex-Specific Social Contact Patterns and Incidence of Mycobacterium tuberculosis Infection

We aimed to model the incidence of infection with Mycobacterium tuberculosis among adults using data on infection incidence in children, disease prevalence in adults, and social contact patterns. We conducted a cross-sectional face-to-face survey of adults in 2011, enumerating "close" (shared conversation) and "casual" (shared indoor space) social contacts in 16 Zambian communities and 8 South African communities. We modeled the incidence of M. tuberculosis infection in all age groups using these contact patterns, as well as the observed incidence of M. tuberculosis infection in children and the prevalence of tuberculosis disease in adults. A total of 3,528 adults participated in the study. The reported rates of close and casual contact were 4.9 per adult per day (95% confidence interval: 4.6, 5.2) and 10.4 per adult per day (95% confidence interval: 9.3, 11.6), respectively. Rates of close contact were higher for adults in larger households and rural areas. There was preferential mixing of close contacts within age groups and within sexes. The estimated incidence of M. tuberculosis infection in adults was 1.5–6 times higher (2.5%–10% per year) than that in children. More than 50% of infections in men, women, and children were estimated to be due to contact with adult men. We conclude that estimates of infection incidence based on surveys in children might underestimate incidence in adults. Most infections may be due to contact with adult men. Treatment and control of tuberculosis in men is critical to protecting men, women, and children from tuberculosis.

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Two Authors Reply

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Diabetes Pathology and Risk of Primary Open-Angle Glaucoma: Evaluating Causal Mechanisms by Using Genetic Information

Although type 2 diabetes (T2D) predicts glaucoma, the potential for unmeasured confounding has hampered causal conclusions. We performed separate sample genetic instrumental variable analyses using the Genetic Epidemiology Research Study on Adult Health and Aging cohort (n = 69,685; 1995–2013) to estimate effects of T2D on primary open-angle glaucoma (POAG; 3,554 cases). Genetic instrumental variables for overall and mechanism-specific (i.e., linked to T2D via influences on adiposity, β-cell function, insulin regulation, or other metabolic processes) T2D risk were constructed by using 39 genetic polymorphisms established to predict T2D in other samples. Instrumental variable estimates indicated that T2D increased POAG risk (odds ratio = 2.53, 95% confidence interval: 1.04, 6.11). The instrumental variable for β-cell dysregulation also significantly predicted POAG (odds ratio_β-cell = 5.26, 95% confidence interval: 1.75, 15.85), even among individuals without diagnosed T2D, suggesting that metabolic dysregulation may increase POAG risk prior to T2D diagnosis. The T2D risk variant in the melatonin receptor 1B gene (MTNR1B) predicted risk of POAG independently of T2D status, indicating possible pleiotropic physiological functions of melatonin, but instrumental variable effect estimates were significant even excluding MTNR1B variants. To our knowledge, this is the first genetic instrumental variable study of T2D and glaucoma, providing a novel approach to evaluating this hypothesized relationship. Our findings substantially bolster observational evidence that T2D increases POAG risk.

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The Glioma International Case-Control Study: A Report From the Genetic Epidemiology of Glioma International Consortium

Decades of research have established only a few etiological factors for glioma, which is a rare and highly fatal brain cancer. Common methodological challenges among glioma studies include small sample sizes, heterogeneity of tumor subtypes, and retrospective exposure assessment. Here, we briefly describe the Glioma International Case-Control (GICC) Study (recruitment, 2010–2013), a study being conducted by the Genetic Epidemiology of Glioma International Consortium that integrates data from multiple data collection sites, uses a common protocol and questionnaire, and includes biospecimen collection. To our knowledge, the GICC Study is the largest glioma study to date that includes collection of blood samples, which will allow for genetic analysis and interrogation of gene-environment interactions.

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The Association Between Alcohol Consumption and Lung Carcinoma by Histological Subtype

Alcohol is a carcinogen suspected of increasing lung cancer risk. Therefore, we prospectively evaluated the relationship between alcohol consumption and lung carcinoma in 492,902 persons from the National Institutes of Health-AARP Diet and Health Study. We used Cox models to calculate hazard ratios and 95% confidence intervals, adjusting for tobacco smoking and other potential confounders. Between 1995/1996 and December 31, 2006, there were 10,227 incident cases of lung carcinoma, classified as adenocarcinoma (n = 4,036), squamous cell carcinoma (n = 1,998), small cell carcinoma (n = 1,524), undifferentiated carcinoma (n = 559), and other (n = 2,110). Compared with nondrinking, alcohol consumption was associated with a modest nonlinear reduction in total lung carcinoma risk at lower levels of consumption (for 0.5–<1 drink/day, HR = 0.89, 95% confidence interval: 0.82, 0.96) but a modest increase in risk in the highest category (for ≥7 drinks/day, HR = 1.11, 95% confidence interval: 1.00, 1.24). Regarding histological type, alcohol was associated with a nonlinear reduction in squamous cell carcinoma that became attenuated as consumption increased and a modest increase in adenocarcinoma among heavier drinkers. Cubic spline models confirmed these findings. Our data suggest that the relationship between alcohol consumption and lung carcinoma differs by histological subtype.

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Health Selection into Neighborhoods Among Families in the Moving to Opportunity Program

Moving to Opportunity for Fair Housing was a randomized experiment that moved very low-income US families from high-poverty neighborhoods to low-poverty neighborhoods starting in the early 1990s. We modeled report of a child's baseline health problem as a predictor of neighborhood outcomes for households randomly assigned to move from high- to low-poverty neighborhoods. We explored associations between baseline health problems and odds of moving with the program upon randomization (1994–1997), neighborhood poverty rate at follow-up (2002), and total time spent in affluent neighborhoods and duration-weighted poverty. Among 1,550 households randomized to low-poverty neighborhoods, a smaller share of households reporting baseline child health problems (P = 0.004) took up the intervention (38%) than those not reporting a health problem (50%). In weighted and covariate-adjusted models, a child health problem predicted nearly 40% lower odds of complying with the experimental condition (odds ratio = 0.62, 95% confidence interval: 0.42, 0.91; P = 0.015). Among compliers, a baseline child health problem predicted 2.5 percentage points' higher neighborhood poverty at take-up (95% confidence interval: 0.90, 4.07; P = 0.002). We conclude that child health problems in a household prior to randomization predicted lower likelihood of using the program voucher to move to a low-poverty neighborhood within the experiment's low-poverty treatment arm and predicted selection into poorer neighborhoods among experimental compliers. Child morbidity may constrain families attempting to improve their life circumstances.

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Invited Commentary: E Pluribus Unum for Epidemiology

In this issue of the Journal, Amirian et al. (Am J Epidemiol. 2016;183(2):85–91) present a report from the Genetic Epidemiology of Glioma International Consortium (GLIOGENE Consortium), a new international consortium of glioma case-control studies. This report is noteworthy, because the GLIOGENE Consortium represents a new generation of epidemiologic consortia. GLIOGENE investigators have created an infrastructure that addresses important limitations of first-generation consortia efforts, which comprised a posteriori harmonization of exposure data and the inclusion of studies that did not include the same—or any—exposure data. As with these first-generation consortia efforts, the GLIOGENE Consortium embraces the primary importance of sample size, and to achieve that, the consortium tolerates different study designs that permit heterogeneity in case and control ascertainment. In contrast, however, the consortium's Glioma International Case-Control (GICC) Study incorporates systematic collection of exposure data from both cases and controls to facilitate downstream evaluation of exposure associations and gene-environment interactions. The described GICC Study thus serves as a model for future epidemiologic efforts that reflects a paradigm shift whereby studies are now being conducted with the expectation of downstream collaboration, thus demanding coordination and harmonization of apparently independent efforts at the time of study initiation rather than at study completion.

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Editorial Board

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Estimating the Time-Varying Joint Effects of Obesity and Smoking on All-Cause Mortality Using Marginal Structural Models

Obesity and smoking are independently associated with a higher mortality risk, but previous studies have reported conflicting results about the relationship between these 2 time-varying exposures. Using prospective longitudinal data (1987–2007) from the Atherosclerosis Risk in Communities Study, our objective in the present study was to estimate the joint effects of obesity and smoking on all-cause mortality and investigate whether there were additive or multiplicative interactions. We fit a joint marginal structural Poisson model to account for time-varying confounding affected by prior exposure to obesity and smoking. The incidence rate ratios from the joint model were 2.00 (95% confidence interval (CI): 1.79, 2.24) for the effect of smoking on mortality among nonobese persons, 1.31 (95% CI: 1.13, 1.51) for the effect of obesity on mortality among nonsmokers, and 1.97 (95% CI: 1.73, 2.22) for the joint effect of smoking and obesity on mortality. The negative product term from the exponential model revealed a submultiplicative interaction between obesity and smoking (β = –0.28, 95% CI: –0.45, –0.11; P < 0.001). The relative excess risk of interaction was –0.34 (95% CI: –0.60, –0.07), indicating the presence of subadditive interaction. These results provide important information for epidemiologists, clinicians, and public health practitioners about the harmful impact of smoking and obesity.

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Contents Page

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Correlates of Peripheral Blood Mitochondrial DNA Content in a General Population

Accumulation of mitochondrial DNA (mtDNA) mutations leads to alterations of mitochondrial biogenesis and function that might produce a decrease in mtDNA content within cells. This implies that mtDNA content might be a potential biomarker associated with oxidative stress and inflammation. However, data on correlates of mtDNA content in a general population are sparse. Our goal in the present study was to describe in a randomly recruited population sample the distribution and determinants of peripheral blood mtDNA content. From 2009 to 2013, we examined 689 persons (50.4% women; mean age = 54.4 years) randomly selected from a Flemish population (Flemish Study on Environment, Genes, and Health Outcomes). Relative mtDNA copy number as compared with nuclear DNA was measured by quantitative real-time polymerase chain reaction in peripheral blood. There was a curvilinear relationship between relative mtDNA copy number and age. mtDNA content slightly increased until the fifth decade of life and declined in older subjects (P_age² = 0.0002). mtDNA content was significantly higher in women (P = 0.007) and increased with platelet count (P < 0.0001), whereas it was inversely associated with white blood cell count (P < 0.0001). We also observed lower mtDNA content in women using estroprogestogens (P = 0.044). This study demonstrated in a general population that peripheral blood mtDNA content is significantly associated with sex and age. Blood mtDNA content is also influenced by platelet and white blood cell counts and estroprogestogen intake. Further studies are required to clarify the impact of chronic inflammation and hormone therapy on mitochondrial function.

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Subscription Page

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Melin and Bondy Respond to "E Pluribus Unum for Epidemiology"

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Cover Page

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Genome-Wide Epigenetic Studies in Human Disease: A Primer on -Omic Technologies

Epigenetic information encoded in covalent modifications of DNA and histone proteins regulates fundamental biological processes through the action of chromatin regulators, transcription factors, and noncoding RNA species. Epigenetic plasticity enables an organism to respond to developmental and environmental signals without genetic changes. However, aberrant epigenetic control plays a key role in pathogenesis of disease. Normal epigenetic states could be disrupted by detrimental mutations and expression alteration of chromatin regulators or by environmental factors. In this primer, we briefly review the epigenetic basis of human disease and discuss how recent discoveries in this field could be translated into clinical diagnosis, prevention, and treatment. We introduce platforms for mapping genome-wide chromatin accessibility, nucleosome occupancy, DNA-binding proteins, and DNA methylation, primarily focusing on the integration of DNA methylation and chromatin immunoprecipitation–sequencing technologies into disease association studies. We highlight practical considerations in applying high-throughput epigenetic assays and formulating analytical strategies. Finally, we summarize current challenges in sample acquisition, experimental procedures, data analysis, and interpretation and make recommendations on further refinement in these areas. Incorporating epigenomic testing into the clinical research arsenal will greatly facilitate our understanding of the epigenetic basis of disease and help identify novel therapeutic targets.

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High CYP2C19 phenotypic variability in gastrointestinal cancer patients

Abstract

Purpose

CYP2C19 contributes to the metabolism of several chemotherapeutic agents. The CYP2C19 homozygous null function genotype strongly predicts activity phenotype in healthy populations. An additional acquired loss of function has been reported in up to one-third of cancer patients. It is not known whether this phenomenon also occurs in patients with earlier stage or in resected disease.

Methods

This study investigated whether acquired loss of CYP2C19 function was detectable in patients with stage III–IV or resected gastrointestinal cancer. CYP2C19 genotype was determined in 49 patients, and subjects were probed for CYP2C19 activity on three test occasions.

Results

An acquired loss of CYP2C19 activity was observed in 20 % of stage III–IV and 17 % of resected patients at the first test. Significant (p < 0.01) genotype–phenotype discordance was observed in both groups. There were no direct associations between this discordance and inflammatory markers, tumour burden or chemotherapeutic history. Notably, hepatic CYP2C19 function was not stable over time and phenotype conversion occurred in 23 patients over the period of testing.

Conclusion

Reliance on germ-line genotype to infer a poor metaboliser status could substantially underestimate the number of patients with deficient CYP2C19 function. This could compromise the interpretation of genotype-based clinical association studies.

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Elevated circulating monocyte chemoattractant protein 1 (MCP-1/CCL-2) level may be an unfavorable predictive factor to platinum- and taxane-based combination chemotherapy in patients with gastric cancer

Abstract

Purpose

Monocyte chemoattractant protein 1 (MCP-1/CCL-2) is a member of the CC chemokine family and a potent chemotactic factor for monocytes that regulate migration and infiltration of monocytes and macrophages. It plays an important role in the pathogenesis of multiple malignancies, and its expression strongly also affects the outcomes of cancer patients. The objective of this study was to determine the clinical significance of the serum levels of MCP-1/CCL-2 in gastric cancer patients.

Materials and methods

A total of 78 patients diagnosed with gastric cancer were enrolled in this study. Serum MCP-1/CCL-2 concentrations were determined by the solid-phase sandwich ELISA method. Age- and sex-matched 30 healthy controls were included in the analysis.

Results

The median age at diagnosis was 60 years, range 21–84 years. The baseline serum MCP-1/CCL-2 concentrations of the gastric cancer patients were significantly higher than of healthy subjects (p < 0.001). The known clinical variables including gender, age, site of lesion, histopathology, tumor size, lymph node involvement, and stage of disease were not found to be correlated with serum MCP-1/CCL-2 concentrations (p > 0.05). However, a significant relationship was shown between serum MCP-1/CCL-2 levels and response to chemotherapy (p = 0.05). Chemotherapy non-responsive patients had higher serum MCP-1/CCL-2 concentrations. Serum MCP-1/CCL-2 concentrations were not associated with prognosis on both progression-free and overall survival (p = 0.53 and p = 0.39, respectively).

Conclusion

Elevated circulating MCP-1/CCL-2 level may be an unfavorable predictive factor to chemotherapy based on platinum and taxane in patients with gastric cancer. However, serum MCP-1/CCL-2 concentrations were not associated with prognosis on both progression-free and overall survival.

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A phase II trial of modified FOLFOX6 as first-line therapy for adenocarcinoma of an unknown primary site

Abstract

Purpose

The aim of the study was to assess the clinical activity and toxicity of oxaliplatin and leucovorin in combination with bolus and continuous infusional 5-fluorouracil administered every 2 weeks (modified FOLFOX-6 regimen) to patients with adenocarcinoma of an unknown primary site (ACUP).

Methods

Previously untreated ACUP patients were treated with oxaliplatin (100 mg/m²) and leucovorin (200 mg/m²) as a 2-h infusion followed by bolus administration of 5-fluorouracil (400 mg/m²) and continuous infusion of 5-fluorouracil (2400 mg/m²) every 2 weeks.

Results

A total of 23 patients were enrolled and treated with a modified FOLFOX-6 regimen between May 2009 and November 2014. This trial was terminated before the scheduled enrollment due to poor accrual. A total of 134 cycles of mFOLFOX-6 were administered to 23 patients. The median number of cycles of mFOLFOX-6 was 5 (range 1–12). Among 20 patients whose tumor responses were evaluable, seven patients showed a partial response (no complete response), with an objective response rate of 35.0 %. The median duration of response was 3.9 months (range 3.0–19.8). The median progression-free survival and overall survival were 3.0 and 9.5 months, respectively (95 % confidence interval 1.4–6.7 months and 4.8–26.4 months, respectively). Treatment-related toxicity was manageable.

Conclusions

mFOLFOX-6 showed modest activity in treatment-naïve patients with ACUP. A future, prospective large-scale study incorporating a parallel molecular prediction marker study is warranted.

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The ability of mannitol to decrease cisplatin-induced nephrotoxicity in children: real or not?

Abstract

Purpose

Platinum compounds are very effective drugs for the treatment of childhood malignancies, and their use has contributed to an increase in the long-term survival of children with cancer. Unfortunately, the risk of severe disabling effects such as nephrotoxicity is well known among children receiving cisplatin-based chemotherapy.

Methods

The main pharmacodynamics and clinical characteristics of cisplatin nephrotoxicity are described in order to explore the real ability of mannitol to prevent cisplatin-related nephrotoxicity.

Results

Currently, the choice of hydration alone or hydration plus mannitol to prevent nephrotoxicity is controversial. No guidelines are available to provide recommendations on this issue either in adults or in children.

Conclusions

Appropriate hydration remains the main fundamental strategy for reducing the risk of cisplatin-induced nephrotoxicity. In conventional treatment regimens employing doses of cisplatin of less than 100 mg/m² in patients with normal renal function, pre- and post-hydration (3 l/m² at least 12 h pre-cisplatin and 24 h post-cisplatin) alone should be routinely used. In higher doses, pre- and post-hydration plus mannitol should be considered in order to ensure a valid diuresis.

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First-in-human multicenter phase I study of BMS-936561 (MDX-1203), an antibody-drug conjugate targeting CD70

Abstract

Purpose

The study evaluated the safety, tolerability, and pharmacokinetics of BMS-936561, a fully human monoclonal antibody-drug conjugate targeting CD70 cell-surface protein.

Methods

Eligible patients had ECOG performance status 0–2 and received ≤3 prior chemotherapy regimens. An initial accelerated titration design enrolling one patient per dose level was followed by 3 + 3 dose escalation with the first observation of a grade ≥2 adverse event (AE). We tested escalating doses of BMS-936561 (0.5, 1, 2, 4, 8, 15 mg/kg) administered every 21 days in a 42 day cycle for a maximum of 17 cycles. Pharmacokinetic samples were collected in cycle 1.

Results

A total of 26 patients enrolled; 16 and 10 for the escalation and expansion cohorts, respectively. Median age was 63 years (48–74); 18 males and 25 Caucasians. There was no defined MTD per protocol, but a DLT of grade 3 hypersensitivity was recorded in 2 of 16 (13 %) subjects at the highest dose of 15 mg/kg. The most frequent AEs were: fatigue (85 %), nausea (54 %), and decreased appetite (39 %). Delayed toxicities (facial edema and pleural/pericardial effusions) occurred in 6 of 16 (38 %) subjects at the 15 mg/kg dose. PK analysis showed a dose-proportional increase in active drug levels with increasing doses. There was disease stabilization in 18 of 26 patients (69 %) without correlation with received dose.

Conclusions

BMS-936561 is well tolerated over a wide range of doses in patients with advanced ccRCC and B-NHL. The 8 mg/kg dose was the highest best tolerated dose and the recommended dose for future studies.

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Identification of polymorphic variants associated with erlotinib-related skin toxicity in advanced non-small cell lung cancer patients by DMET microarray analysis

Abstract

Purpose

Erlotinib is a targeted agent commonly used in advanced non-small cell lung cancer (aNSCLC). However, drug-related skin toxicity often may affect the quality of life of cancer patients and lead to treatment discontinuation. Genetic polymorphisms in drug transporters and metabolizing enzymes play a major role in the interindividual variability in terms of efficacy and toxicity of erlotinib treatment. The aim of our study was to identify genetic determinants in adsorption, distribution, metabolism, and excretion genes influencing skin rash (SR) by the novel drug-metabolizing enzyme and transporter (DMET) microarray Affymetrix platform in aNSCLC patients.

Methods

In a retrospective study, 34 erlotinib-treated aNSCLC patients were genotyped by DMET Plus chip: 23 patients experienced SR (cases), while 11 patients did not (controls). Peripheral blood DNA was genotyped. Genotype association was analyzed by Fisher's exact test, and the toxicity-associated gene sets underwent Ingenuity Pathway Analysis (IPA)^®.

Results

Seven SNPs in six genes (CYP27B1, MAT1A1, CHST1, CYP4B1, ADH6, and SLC22A1) were associated with the occurrence of SR or with a protective effect. Specifically, the rs8176345 in CYP27B1 gene was significantly correlated with SR (p = 0.0003, OR 55.55, 95 % CI 2.7036–1141.1707). The IPA on SR-related genes highlighted the role of a variety of canonical pathways including 1,25-dihydroxyvitamin D3 biosynthesis, S-adenosyl-l-methionine biosynthesis, and methionine degradation I (to homocysteine) in SR development.

Conclusion

Although exploratory, this study indicates rs8176345 in CYP27B1 gene as significantly correlated with erlotinib-induced SR in aNSCLC patients probably through a mechanism mediated by vitamin D3 and inflammation at skin level.

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Disparities in melanoma incidence and mortality in South-Eastern Europe: Increasing incidence and divergent mortality patterns. Is progress around the corner?

Publication date: March 2016
Source:European Journal of Cancer, Volume 55
Author(s): Jelena Barbaric, Mario Sekerija, Dominic Agius, Daniela Coza, Nadya Dimitrova, Anna Demetriou, Chakameh Safaei Diba, Sultan Eser, Zivana Gavric, Maja Primic-Zakelj, Snezana Zivkovic, Miroslav Zvolsky, Freddie Bray, Jan Willem Coebergh, Ariana Znaor
IntroductionMost countries in South-Eastern Europe (SEE) have lower incidence, but higher mortality rates of malignant melanoma (MM) of the skin compared to North-Western Europe (NWE). We explored trends in MM incidence and mortality in SEE countries by sex and age and compared them with the trends in NWE.MethodsWe obtained data on incident cases and deaths from MM (ICD-10 code C43) from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. We calculated age-specific rates for 25–49 ('young'), 50–69 ('middle aged') and 70+ years ('older') and estimated the average annual percent of change in incidence and mortality trends 2000–2010 according to age group and sex, using joinpoint regression analysis.FindingsThe incidence rates of MM across the region were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia.InterpretationWhile MM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in MM control. In the context of prevention of melanoma, disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budgets.



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GANP protein encoded on human chromosome 21/mouse chromosome 10 is associated with resistance to mammary tumor development

Summary

Human chromosome 21 is known to be associated with the high risk of hematological malignancy but with resistance to breast cancer in the study of Down syndrome. In human cancers, we previously observed the significant alterations of the protein expression encoded by the ganp/MCM3AP gene on human chromosome 21q22.3. Here, we investigated GANP protein alterations in human breast cancer samples (416 cases) at various stages by immunohistochemical analysis. This cohort study clearly demonstrated that the GANP expression is significantly decreased in human breast cancer cases with poor prognosis as an independent risk factor [relapse-free survival; hazard ratio=2.37, 95% confidence interval=1.27 to 4.42, p=0.007 (univariate analysis) and hazard ratio=2.70, 95% confidence interval=1.42 to 5.13, p=0.002 (multivariate analysis)]. To investigate whether the altered GANP expression is associated with mammary tumorigenesis, we created mutant mice that were conditionally deficient in the ganp/MCM3AP gene using wap-cre recombinase transgenic mice. Mammary gland tumors occurred at a very high incidence in female mammary gland-specific GANP-deficient mice after severe impairment of mammary gland development during pregnancy. Moreover, tumor development also occurred in female post parous GANP-heterodeficient mice. GANP has a significant role in the suppression of DNA damage caused by estrogen in human breast cancer cell lines. These results indicated that the GANP protein is associated with breast cancer resistance.

This article is protected by copyright. All rights reserved.

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Effects of Dietary Selenium Against Lead Toxicity Are Related to the Ion Profile in Chicken Muscle

Abstract

Complex antagonistic interactions between Selenium (Se) and heavy metals have been reported in previous studies. However, little is known regarding the effects of Se on lead (Pb)-induced toxicity and the ion profile in the muscles of chickens. In this present study, we fed chickens either Se or Pb or both Se and Pb supplement and later analyzed the concentrations of 26 ions in chicken muscle tissues. We determined that a Se- and Pb-containing diets significantly affected microelements in chicken muscle. Treatment with Se increased the content of Se but resulted in a reduced concentration of Cu, As, Cd, Sn, Hg, and Ba. Treatment with Pb increased concentrations of Ni while reducing those of B, V, Cr, Fe, Co, Cu, Zn, and Mo. Moreover, Se also reduced the concentration of Pb, Zn, Co, Fe, V, and Cr, which in contrast were induced by Pb. Additionally, we also found that synergistic and antagonistic interactions existed between Se and Pb supplementation. Our findings suggested that Se can exert a negative effect on Pb in chicken muscle tissues and may be related to changes in ion profiles.

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Selenium Deficiency Facilitates Inflammation Following S . aureus Infection by Regulating TLR2-Related Pathways in the Mouse Mammary Gland

Abstract

Selenium (Se) is an essential micronutrient affecting various aspects of health. Se deficiency has been associated with inflammation and immune responses. Mastitis poses a serious problem for humans and animals in the postpartum period. Staphylococcus aureus (S. aureus) is the most common infectious bacterial pathogen associated with mastitis. The present study sought to determine the effects and underlying mechanism of dietary Se on S. aureus-induced inflammation using a model of mouse mastitis. ELISA and Western blotting were performed to detect protein levels. Quantitative PCR (qPCR) was performed to detect messenger RNA (mRNA) levels. The histopathological changes indicated that Se deficiency resulted in increased inflammatory lesions in S. aureus mastitis, whereas Se deficiency did not induce inflammatory lesions in the mammary gland. Myeloperoxidase (MPO) activity was increased in Se-deficient mice with S. aureus mastitis. Analysis of cytokine mRNA and protein showed that Se deficiency leads to increased TNF-α, IL-1β, and IL-6 production in S. aureus mastitis. In addition, Se deficiency enhanced the mRNA and protein expressions of toll-like receptor 2 (TLR2), which were originally upregulated by S. aureus in the mammary gland tissues and human embryonic kidney 293 (HEK293)-mTLR2 cells. When Se-deficient mice were infected with S. aureus, the phosphorylation of IκB, nuclear factor-κB (NF-κB), extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 was greatly increased. The results indicate that Se deficiency could intensify the inflammatory reaction in S. aureus mastitis. This work contributes to the exploration of new methods of preventing or treating of S. aureus mastitis and other infectious diseases.

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Effect of Supplementing Organic Forms of Zinc, Selenium and Chromium on Performance, Anti-Oxidant and Immune Responses in Broiler Chicken Reared in Tropical Summer

Abstract

Two experiments were conducted to study the effect of supplementing organic forms of zinc (Zn), selenium (Se) and chromium (Cr) on performance, anti-oxidant activities and immune responses in broiler chickens from 1 to 21 days of age, which were reared in cyclic heat-stressed condition under tropical summer in open-sided poultry house. A total of 200 (experiment I) and 450-day-old (experiment II) broiler male chicks (Cobb 400) were randomly distributed in stainless steel battery brooders (610 mm × 762 mm × 475 mm) at the rate of five birds per pen. A maize-soybean meal-based control diet (CD) containing recommended (Vencobb 400, Broiler Management Guide) concentrations of inorganic trace minerals and other nutrients was prepared. The CD was supplemented individually with organic form of selenium (Se, 0.30 mg/kg), chromium (Cr, 2 mg/kg) and zinc (Zn, 40 mg/kg) in experiment I. In experiment II, two concentrations of each Zn (20 and 40 mg/kg), Se (0.15 and 0.30 mg/kg) and Cr (1 and 2 mg/kg) were supplemented to the basal diet in 2 × 2 × 2 factorial design. A group without supplementing inorganic trace minerals was maintained as control group in both experiments. Each diet was allotted randomly to ten replicates in both experiments and fed ad libitum from 1 to 21 days of age. At 19th day of age, blood samples were collected for estimation of anti-oxidant and immune responses. Supplementation of Se, Cr and Zn increased (P < 0.05) body mass gain (BMG) and feed intake compared to those fed the CD in experiment I. The feed efficiency (FE) in Cr-fed group was higher (P < 0.05) compared to the CD-fed group. Se or Cr supplementation reduced lipid peroxidation (LP) compared to broilers fed the CD. In experiment II, BMG was not affected (P > 0.05) by the interaction between levels of Zn, Se and Cr in broiler diet. The FE improved (P < 0.05) with supplementation of the trace minerals tested at both concentrations except in group fed 40 mg Zn, 0.5 mg Se and 1 mg Cr/kg. Reduction in lipid peroxidation (LP, P < 0.05) and increased (P < 0.05) activity of superoxide dismutase were observed in broiler fed organic Zn, Se and Cr compared to the CD-fed group. The dietary concentrations of Zn, Se and Cr did not influence (P > 0.05) the immune responses (Newcastle disease titre and cell-mediated immune response to phytohaemagglutinin-P) in both the experiments. Based on the results, it is concluded that supplementation of organic form of Se, Cr and Zn (0.30, 2 and 40 mg/kg, respectively) either alone or in combination significantly improved performance and anti-oxidant responses (reduced LP and increased superoxide dismutase) in commercial broiler chicks (21 days of age) reared in cyclic heat stress conditions in open-sided poultry house during summer.

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Antioxidant and Hepatoprotective Activities of Mycelia Selenium Polysaccharide by Hypsizigus marmoreus SK-02

Abstract

This work was designed to investigate the characteristic properties (bond types and monosaccharide compositions), and hepatoprotective effects on carbon tetrachloride (CCl₄)-induced liver damage of mycelia selenium polysaccharides (MSPS) separated and purified from Hypsizigus marmoreus SK-02. Characteristic analysis of MSPS showed the selenium content (70.15 μg/g) in mycelia. The antioxidant activities in vitro demonstrated that MSPS had potential effects on scavenging reactive oxygen species and enhancing the reducing power. The treatment of MSPS for CCl₄-induced animal experiment demonstrated that the MSPS could reduce the levels of malondiadehyde (MDA), lipid peroxide (LPO), glutamic oxalacetic transaminase (AST), and glutamic-pyruvic transaminase (ALT) activities and improve the levels of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), total cholesterol (TC), and triglyceride (TG) in serum/liver homogenate against CCl₄-induced injures. Findings presented in this study clearly demonstrated that MSPS might be suitable for functional foods and natural drugs in preventing the CCl₄-induced acute liver damage.

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Anti-tumor effects of pigment epithelium-derived factor (PEDF): implication for cancer therapy. A mini-review

Abstract

Pigment epithelium-derived factor (PEDF) is a secreted glycoprotein and a non-inhibitory member of the serine protease inhibitor (serpin) family. It is widely expressed in human fetal and adult tissues but its expression decreases with age and in malignant tissues. The main anti-cancer activities of PEDF derive from its dual effects, either indirectly on the tumor microenvironment (indirect antitumor action) or directly on the tumor itself (direct antitumor influence). The indirect antitumor activities of PEDF were uncovered from the early findings that it stimulates retinoblastoma cell differentiation and that additionally it possesses anti-angiogenic, anti-tumorigenic and anti-metastatic properties. The mechanisms of its direct antitumor effect, however, have not been fully elucidated. This review highlights recent progress in our understanding of the multifunctional activities of PEDF and, in particular, its anti-cancer signaling mechanisms. Additionally, we discuss the possibility of using novel phosphaplatin compounds that can upregulate PEDF expression as a chemotherapy for cancer treatment.

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Revisiting tumor angiogenesis: vessel co-option, vessel remodeling, and cancer cell-derived vasculature formation

Abstract

Tumor growth and metastasis depend on the establishment of tumor vasculature to provide oxygen, nutrients, and other essential factors. The well-known vascular endothelial growth factor (VEGF) signaling is crucial for sprouting angiogenesis as well as recruitment of circulating progenitor endothelial cells to tumor vasculature, which has become therapeutic targets in clinical practice. However, the survival benefits gained from targeting VEGF signaling have been very limited, with the inevitable development of treatment resistance. In this article, we discuss the most recent findings and understanding on how solid tumors evade VEGF-targeted therapy, with a special focus on vessel co-option, vessel remodeling, and tumor cell-derived vasculature establishment. Vessel co-option may occur in tumors independently of sprouting angiogenesis, and sprouting angiogenesis is not always required for tumor growth. The differences between vessel-like structure and tubule-like structure formed by tumor cells are also introduced. The exploration of the underlying mechanisms of these alternative angiogenic approaches would not only widen our knowledge of tumor angiogenesis but also provide novel therapeutic targets for better controlling cancer growth and metastasis.

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Erratum to: Preoperative predictive factors and further risk stratification of biochemical recurrence in clinically localized high-risk prostate cancer

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S-1 and irinotecan plus bevacizumab as second-line chemotherapy for patients with oxaliplatin-refractory metastatic colorectal cancer: a multicenter phase II study in Japan (KSCC1102)

Abstract

Background

Combination chemotherapy with S-1 and irinotecan is one of the standard treatments for metastatic colorectal cancer (mCRC) in Japan. However, there are few alternative practical second-line therapies. We conducted a phase II trial to evaluate the efficacy and safety of the combination of S-1 and irinotecan plus bevacizumab as a second-line treatment for oxaliplatin-refractory mCRC.

Methods

Patients with mCRC who were previously treated with oxaliplatin-containing regimens were enrolled. Oral S-1 at a dose of 80 mg/m² was administered twice daily for 2 weeks, followed by a 1-week drug-free interval. Irinotecan at a dose of 150 mg/m² and bevacizumab at a dose of 7.5 mg/kg were administered on day 1. The primary endpoint was progression-free survival (PFS).

Results

Thirty-seven patients were enrolled, and 34 and 36 patients were assessed for response and safety, respectively. The overall response rate was 20.6 % (95 % confidence interval [CI] 8.7–37.9), and the disease control rate was 76.5 % (95 % CI 58.8–89.3). The median PFS was 5.6 months (95 % CI 3.8–7.0). The median overall survival was 16.4 months (95 % CI 8.1–20.0). The most common grade 3/4 adverse events included neutropenia (25.0 %), anorexia (22.2 %), anemia (16.7 %), and fatigue/malaise (16.7 %). The most common grade 3/4 adverse event of special interest for bevacizumab was hypertension (30.6 %). One treatment-related death caused by gastrointestinal bleeding occurred.

Conclusions

The findings suggest that the combination of S-1 and irinotecan plus bevacizumab is effective and tolerable as second-line chemotherapy for patients with oxaliplatin-refractory mCRC.

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Pediatric Radiology editorial board — acknowledgments and updates

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Tribute to Professor Dr. Guy Sebag

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Pediatric Radiology Continuing Medical Education Activity

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Quantification of structural changes in the corpus callosumin children with profound hypoxic–ischaemic brain injury

Abstract

Background

Birth-related acute profound hypoxic–ischaemic brain injury has specific patterns of damage including the paracentral lobules.

Objective

To test the hypothesis that there is anatomically coherent regional volume loss of the corpus callosum as a result of this hemispheric abnormality.

Materials and methods

Study subjects included 13 children with proven acute profound hypoxic–ischaemic brain injury and 13 children with developmental delay but no brain abnormalities. A computerised system divided the corpus callosum into 100 segments, measuring each width. Principal component analysis grouped the widths into contiguous anatomical regions. We conducted analysis of variance of corpus callosum widths as well as support vector machine stratification into patient groups.

Results

There was statistically significant narrowing of the mid–posterior body and genu of the corpus callosum in children with hypoxic–ischaemic brain injury. Support vector machine analysis yielded over 95% accuracy in patient group stratification using the corpus callosum centile widths.

Conclusion

Focal volume loss is seen in the corpus callosum of children with hypoxic–ischaemic brain injury secondary to loss of commissural fibres arising in the paracentral lobules. Support vector machine stratification into the hypoxic–ischaemic brain injury group or the control group on the basis of corpus callosum width is highly accurate and points towards rapid clinical translation of this technique as a potential biomarker of hypoxic–ischaemic brain injury.

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Hermes

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Diagnosis of pediatric gastric, small-bowel and colonic volvulus

Abstract

Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

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