Cancer by Sfakianakis Alexandros: 11/24/16

Πέμπτη 24 Νοεμβρίου 2016

Erste Normalstationen mit Frühwarnsystem ausgestattet

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 713-713
DOI: 10.1055/s-0042-119932

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Postzosterneuralgie: transkranielle Magnetstimulation

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 652-652
DOI: 10.1055/s-0042-115504

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Neue S3-Leitlinie zu Polytrauma

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 712-713
DOI: 10.1055/s-0042-119929

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Mikrovaskulärer Blutfluss bei Sepsis

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 652-653
DOI: 10.1055/s-0042-115505

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Akute Nierenschädigung - Postoperatives Begleitphänomen oder kausaler Risikofaktor für das operative Behandlungsergebnis?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 682-688
DOI: 10.1055/s-0042-101446

Der demografische Wandel und die Zunahme der Komplexität diagnostischer und chirurgischer Eingriffe haben dazu geführt, dass akute Nierenschädigung eine postoperative Komplikation mit zunehmender Relevanz ist. Postoperative akute Nierenschädigung ist mit höherer Mortalität und Morbidität sowie mit erhöhten Behandlungskosten assoziiert. Ob postoperative akute Nierenschädigung tatsächlich kausal mit einem schlechteren chirurgischen Behandlungsergebnis verknüpft ist, ist bisher nicht zweifelsfrei bewiesen. Dieser Artikel soll einen Überblick über das Phänomen postoperative akute Nierenschädigung geben, die Schwierigkeiten bei der Führung des Kausalbeweises in biomedizinscher Forschung erörtern und letztlich Argumente für und gegen den kausalen Zusammenhang zwischen posto-perativer akuter Nierenschädigung und dem chirurgischem Behandlungsergebnis diskutieren.
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Intraoperative EEG-Suppression assoziiert mit späterem Delir

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 653-654
DOI: 10.1055/s-0042-115506

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Bildgebung bei Rückenschmerzen oft sinnlos

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 712-712
DOI: 10.1055/s-0042-119927

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MikroRNA im septischen Schock verändert

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 654-654
DOI: 10.1055/s-0042-115507

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Thieme unterzeichnet „Sharing Principles“

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 712-712
DOI: 10.1055/s-0042-119933

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Schlaganfallbehandlung: schneller vor Ort als im Krankenhaus?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 654-655
DOI: 10.1055/s-0042-115508

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Akute Nierenschädigung - Aus Sicht des Nachwuchses

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 680-681
DOI: 10.1055/s-0042-101451

Die perioperative Nierenfunktionschädigung (acute kidney injury, AKI) wird typischerweise immer noch als primär intensivmedizinische denn als perioperative Komplikation wahrgenommen. Dabei bringen neben der Sepsis gerade große chirurgische Eingriffe viele Faktoren mit sich, die zu einer perioperativen AKI beitragen können. In diesem Kontext wird v. a. bei Elektiveingriffen das Risiko einer AKI immer noch erheblich unterschätzt.
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Kochsalzbolus nach Rocuronium verlängert Wirkdauer

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 655-655
DOI: 10.1055/s-0042-115509

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Akute Nierenschädigung - Ischämische Fernpräkonditionierung: ein Therapiekonzept für die Niere?

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 690-696
DOI: 10.1055/s-0042-101445

Die akute Nierenschädigung ist eine häufige und schwerwiegende Komplikation, die mit einer erhöhten Morbidität und Mortalität einhergeht. Sepsis und große chirurgische Eingriffe, insbesondere herzchirurgische Operationen, sind die häufigsten Ursachen für die Entwicklung einer akuten Nierenschädigung. Bereits geringgradige Serumkreatininwert-Erhöhungen sind mit einer erhöhten Mortalitätsrate assoziiert, sodass effektive Strategien zur Verhinderung einer akuten Nierenschädigung essenziell sind. Die ischämische Fernpräkonditionierung ist eine Intervention, die gekennzeichnet ist durch kurze Ischämie- und Reperfusionsphasen eines entfernten Gewebes oder Organs, bevor der eigentliche Schaden am Zielorgan stattfindet. Diese einfache und komplikationslose Maßnahme ist möglicherweise ein renoprotektiver Ansatz.
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Wache Videolaryngoskopie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 656-663
DOI: 10.1055/s-0042-102798

Einleitung: Derzeit rückt eine neue, faszinierende Technik als Alternative zur wachen flexiblen Intubationsendoskopie in den Fokus der klinischen Anästhesie: Wache Videolaryngoskopie.Hauptthemen: Die Intubation unter Erhaltung der Spontanatmung ist das Verfahren mit dem geringsten Risiko für Patienten mit erwartet schwierigem Atemweg. Im direkten Vergleich zur wachen, flexiblen Intubationsendoskopie erreicht die wache Videolaryngoskopie akzeptable Intubationszeiten bei gleichzeitig hoher Akzeptanz durch Patient und Anästhesist. In speziellen Fällen, insbesondere bei stark limitierter Mundöffnung und einer veränderten Anatomie des Halses, hervorgerufen durch Strahlentherapie, chirurgische Eingriffe und große Tumormassen, ist die Durchführung einer wachen Videolaryngoskopie schwierig oder unmöglich. Obligatorisch für die Umsetzung einer erfolgreichen, wachen Videolaryngoskopie sind suffiziente topische Anästhesie und eine differenzierte Sedierung. Die Herausforderung hier ist die Balance zwischen dem Erhalt der Spontanatmung und dem Erreichen möglichst optimaler Intubationsbedingungen ohne den Verlust der Kontaktfähigkeit des Patienten.Fazit: Wache Videolaryngoskopie kann die flexible Intubationsendoskopie nicht ersetzen. Nicht jeder Patient (und jeder Atemweg!) ist für eine wache Videolaryngoskopie geeignet. Eine sorgfältige Planung, die richtige Wahl des Spatels und genügend Expertise sind für den Erfolg einer wachen Videolaryngoskopie entscheidend.
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Auf Knopfdruck Notfall - Gelebtes Risikomanagement im Simulationszentrum

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 708-711
DOI: 10.1055/s-0042-118114

Kinderreanimation, anästhesiologische Zwischenfälle oder Komplikationen während der Geburt – gerade in Ausnahmesituationen fällt es schwer, einen kühlen Kopf zu bewahren. Trainiert werden solche brenzligen Szenarien immer öfter als „Trockenübung" im Patientensimulator. Denn was in der Luftfahrt schon zur Routine gehört, findet auch bei vielen Klinikchefs immer mehr Beachtung. Schließlich ist das Prinzip ganz einfach: den Ernstfall proben, bevor er eintrifft.
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Intensivtransport - Grundlagen und Voraussetzungen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 664-669
DOI: 10.1055/s-0042-106135

Bedingt durch die zunehmend veränderte Kliniklandschaft, die zu einer Reduktion der klinischen Einrichtungen v.a. in ländlichen Regionen und damit neben eingeschränkter Versorgungsoptionen in der Peripherie auch zu einer zentralisierten klinischen Versorgung führt, kommt dem Interhospitaltransfer eine immer grösser werdende Bedeutung zu. Spezialisierte Zentren haben durch diese Zentralisierung der klinischen Versorgung immer größere Einzugsgebiete. Dabei nehmen nicht nur die Anzahl der Transporte, sondern auch die Transportstrecken in den letzten Jahren kontinuierlich zu. Man unterscheidet zentripetale Transporte in die Zentren der Maximal- und Schwerpunktversorgung von zentrifugalen Transporten zurück in periphere Kliniken, Weaningeinrichtungen oder (Früh-) Rehabilitationseinrichtungen. Insbesondere bei Letzteren ist die Anzahl der noch unter intensivmedizinischen Bedingungen zu transportierenden Patienten deutlich angestiegen.
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Levosimendan bei septischem Schock ohne Vorteile

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 712-712
DOI: 10.1055/s-0042-119928

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Quiz intensiv - Stellen Sie die Diagnose!

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 676-679
DOI: 10.1055/s-0042-116623

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Telemedizin bei Herzschwäche: Patienten fühlen sich besser

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 712-712
DOI: 10.1055/s-0042-119930

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Evaluation of daily patient positioning for radiotherapy with a commercial 3D surface-imaging system (Catalyst™)

Abstract

Background

To report our initial clinical experience with the novel surface imaging system Catalyst™ (C-RAD AB, Sweden) in connection with an Elekta Synergy linear accelerator for daily patient positioning in patients undergoing radiation therapy.

Methods

We retrospectively analyzed the patient positioning of 154 fractions in 25 patients applied to thoracic, abdominal, and pelvic body regions. Patients were routinely positioned based on skin marks, shifted to the calculated isocenter position and treated after correction via cone beam CT which served as gold standard. Prior to CBCT an additional surface scan by the Catalyst™ system was performed and compared to a reference surface image cropped from the planning CT to obtain shift vectors for an optimal surface match. These shift vectors were subtracted from the vectors obtained by CBCT correction to assess the theoretical setup error that would have occurred if the patients had been positioned using solely the Catalyst™ system. The mean theoretical set up-error and its standard deviation were calculated for all measured fractions and the results were compared to patient positioning based on skin marks only.

Results

Integration of the surface scan into the clinical workflow did not result in a significant time delay. Regarding the entire group, the mean setup error by using skin marks only was 0.0 ± 2.1 mm in lateral, −0.4 ± 2.4 mm in longitudinal, and 1.1 ± 2.6 mm vertical direction. The mean theoretical setup error that would have occurred using solely the Catalyst™ was −0.1 ± 2.1 mm laterally, −1.8 ± 5.4 mm longitudinally, and 1.4 ± 3.2 mm vertically. No significant difference was found in any direction. For thoracic targets the mean setup error based on the Catalyst™ was 0.6 ± 2.6 mm laterally, −5.0 ± 7.9 mm longitudinally, and 0.5 ± 3.2 mm vertically. For abdominal targets, the mean setup error was 0.3 ± 2.2 mm laterally, 2.6 ± 1.8 mm longitudinally, and 2.1 ± 5.5 mm vertically. For pelvic targets, the setup error was −0.9 ± 1.5 mm laterally, −1.7 ± 2.8 mm longitudinally, and 1.6 ± 2.2 mm vertically. A significant difference between Catalyst™ and skin mark based positioning was only observed in longitudinal direction of pelvic targets.

Conclusion

Optical surface scanning using Catalyst™ seems potentially useful for daily positioning at least to complement usual imaging modalities in most patients with acceptable accuracy, although a significant improvement compared to skin mark based positioning could not be derived from the evaluated data. However, this effect seemed to be rather caused by the unexpected high accuracy of skin mark based positioning than by inaccuracy using the Catalyst™. Further on, surface registration in longitudinal axis seemed less reliable especially in pelvic localization. Therefore further prospective evaluation based on strictly predefined protocols is needed to determine the optimal scanning approaches and parameters.

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Class solutions for SABR-VMAT for high-risk prostate cancer with and without elective nodal irradiation

Abstract

Background

The purpose of this study is to find the optimal planning settings for prostate SABR-VMAT for high-risk prostate cancer patients irradiated to prostate only (PO) or prostate and pelvic lymph nodes (PPLN).

Methods

For 10 patients, plans using 6MV flattened, flattening-filter-free (FFF) 6MV (6 F) and FFF 10MV (10 F) photon beams with full and partial arc arrangements were generated and compared. The prescribed dose was 40Gy to the prostate with 25Gy to the PLN in 5 fractions. Plans were then evaluated for PTV coverage, dose fall-off, and OAR doses. The number of monitor units and the treatment delivery times were also compared. Statistical differences were evaluated using a paired sample Wilcoxon signed rank test with a significance level of 0.05%.

Results

A total of 150 plans were generated for this study. Acceptable PO plans were obtained using single arcs, while two arcs were necessary for PPLN. All plans were highly conformal (CI ≥1.3 and CN ≥0.90) with no significant differences in the PTV dose coverage. 6MV plans required significantly longer treatment time and had higher dose spillage compared to FFF plans. Superior plans were obtained using 10 F 300° partial arcs for PO with the lowest rectal dose, dose spillage and the shortest treatment times. For PPLN, 6 F and 10 F plans were equivalent.

Conclusions

SABR-VMAT with FFF photon beams offers a clear benefit with respect to shorter treatment delivery times and reduced dose spillage. Class solutions using a single 10 F 300° arc for PO and two 10 F or 6 F partial 300° arcs for PPLN are proposed.

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Evaluation of daily patient positioning for radiotherapy with a commercial 3D surface-imaging system (Catalyst™)

Abstract

Background

Methods

Results

Conclusion

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Class solutions for SABR-VMAT for high-risk prostate cancer with and without elective nodal irradiation

Abstract

Background

Methods

Results

Conclusions

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Predictive biomarkers and effectiveness of MUC1-targeted dendritic-cell-based vaccine in patients with refractory non-small cell lung cancer

Background:

The dendritic cell (DC)-based vaccine targeting the highly immunogenic tumor antigen, MUC1, has been promising for a cancer immunotherapy; however, predictive biomarkers for beneficial clinical responses of the vaccine remain to be determined.

Methods:

DCs loaded with MUC1-derived peptide were subcutaneously administered to patients with MUC1-positive non-small cell lung cancer (NSCLC) that was refractory to standard anticancer therapies, every 2 weeks. The effectiveness and tolerability of the vaccine were evaluated, and predictive biomarkers of clinical responses were explored.

Results:

Between August 2005 and May 2015, 40 patients received the vaccines. The median survival time (MST) after the initial vaccination was 7.4 months, and the 1-year survival rate was 25.0%. The MST for patients who received more than six vaccinations was 9.5 months, and the 1-year survival rate was 39.3%. In this cohort, patients who experienced immune-related adverse events, including skin reactions at the vaccination site and fever, had significantly longer survival times compared with patients without those immune-related adverse events (12.6 versus 6.7 months, p = 0.042). Longer survival times were also observed in patients whose peripheral white blood cells contained >20.0% lymphocytes (12.6 versus 4.5 months; p = 0.014). MUC1-specific cytotoxic immune responses were achieved in all of seven patients analyzed who received six vaccinations.

Conclusion:

The MUC1-targeted DC-based vaccine induced an antitumor immune response that promoted prolonged survival of patients with refractory NSCLC. The occurrence of immune-related adverse events and having a higher percentage of peripheral lymphocytes were predictive biomarkers of a beneficial clinical response during cancer immunotherapy for NSCLC.

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Volumetric image-guided highly conformal radiotherapy of the prostate bed: Toxicity analysis

Publication date: January–February 2017
Source:Reports of Practical Oncology & Radiotherapy, Volume 22, Issue 1
Author(s): Gianluca Ingrosso, Alessandra Carosi, Daniela di Cristino, Elisabetta Ponti, Andrea Lancia, Alessandra Murgia, Claudia Bruni, Pasquale Morelli, Franca Pietrasanta, Riccardo Santoni
AimTo evaluate toxicity of high conformal image-guided radiotherapy of the prostate bed.BackgroundRadiotherapy of the prostate bed has a pivotal role in the post-operative and salvage settings, but few clinical data are available on the use of daily image guidance in combination with highly conformal techniques, and data on long-term results are lacking.Materials and methodsWe analyzed 118 patients irradiated on the prostate bed using conformal plans processed with a micro-multileaf collimator, and daily checking treatment set-up with a cone-beam CT system. Correlation between toxicity and clinical-dosimetric parameters was assessed by the Cox regression model and log-rank test. Survival analyses were performed with the Kaplan–Meier method.ResultsMedian follow-up was 54.08 months. Late grade ≥2 gastro-intestinal (GI) and genito-urinary (GU) toxicity were 3.4% and 4.2%, respectively. Actuarial 4-year late grade ≥2 GI and GU toxicities were 4% and 6%, respectively. Four-year relapse-free survival was 87%. At log-rank test, acute grade ≥2 GI toxicity is associated with the use of antihypertensives (p=0.03), and there is a trend toward significance between the use of anticoagulants and late grade ≥2 GI toxicity (p=0.07). At Cox analysis, acute grade ≥2 GU toxicity is correlated with the percentage of bladder volume receiving more than 65Gy (p=0.02, HR 1.87 CI 1.25–2.8), and the maximal dose to the rectum is correlated to the development of late grade ≥2 GI toxicity (p=0.03, HR 2.75 CI 1.10–6.9).ConclusionsConformal volumetric image-guided radiotherapy of the prostate bed leads to low toxicity rates.

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Histopathologic diagnosis of brain metastases: current trends in management and future considerations

Abstract

Confronted with brain metastases (BM), pathologists aim to rule out a primary central nervous system (CNS) tumor and to identify or verify the primary tumor site to guide the clinician to specific therapies. Apart from morphological features, ancillary immunohistochemical analysis is the most effective tool for characterizing a metastatic neoplasm of unknown origin. A limited array of antibodies is used, taking into account relevant clinical information and the known brain tropism of lung cancer, breast cancer and melanoma. Recently, targeted therapies have enriched the therapeutic arsenal, in particular for patients with non-small cell lung cancer or melanoma and for patients carrying molecular anomalies. These therapies can lead to a substantial tumor response, brain metastases included, which justifies rapid determination of a molecular profile. To combine different tools and provide timely results, good tumor sample management and careful attention at the pre-analytical phase are critical. Appropriate strategies for molecular and immunohistochemical analysis are needed to identify theranostic markers. This article aims to review the anatomopathological diagnostic approach for BM in the age of targeted therapies.

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High expression of long non-coding RNA ATB indicates a poor prognosis and regulates cell proliferation and metastasis in non-small cell lung cancer

Abstract

Background and aim

Long non-coding RNAs (lncRNAs) have been demonstrated to act as a critical regulator in the processes of tumor biology. In this study, whether lncRNA-ATB is a potential indicator for non-small cell lung cancer (NSCLC) was investigated and its biological function in NSCLC was also determined.

Methods

The expression levels of lncRNA-ATB in NSCLC tissues and cell lines were measured. A549 cell line was explored to investigate the functions of lncRNA-ATB in NSCLC.

Results

Real-time PCR results showed that lncRNA-ATB expression was up-regulated in both in NSCLC tissues and cell lines. High lncRNA-ATB expression in tumor tissue was associated with larger tumor size, lymph node metastasis, and distant metastasis in patients with NSCLC, respectively. In addition, the patients with high expression of lncRNA-ATB presented a lower survival probability. In vitro experiments showed that down-regulation of lncRNA-ATB promoted the cell apoptosis, whereas inhibited the cell viability, cell migration, and cell invasion.

Conclusion

High expression of lncRNA-ATB indicated a poor prognosis and led to the cell proliferation and metastasis in NSCLC.

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High expression of long non-coding RNA ATB indicates a poor prognosis and regulates cell proliferation and metastasis in non-small cell lung cancer

Abstract

Background and aim

Methods

The expression levels of lncRNA-ATB in NSCLC tissues and cell lines were measured. A549 cell line was explored to investigate the functions of lncRNA-ATB in NSCLC.

Results

Conclusion

High expression of lncRNA-ATB indicated a poor prognosis and led to the cell proliferation and metastasis in NSCLC.

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“I sleep better at night”: How Peer Review of Radiation Treatment Plans Indirectly Improves Quality of Care Across Radiation Treatment Programs

Publication date: Available online 24 November 2016
Source:Practical Radiation Oncology
Author(s): M Brundage, M Hart, J O'Donnell, L Reddeman, E Gutierrez, S Foxcroft, P Warde
PurposePeer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans, and can also have indirect impacts on radiation treatment programs. We undertook a systematic qualitative approach to describing the indirect benefits of peer review, factors which were seen to facilitate or be barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs).Methods and MaterialsSemi-structured qualitative interviews were held with Radiation Oncology Heads and Radiation Therapy Managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by two independent reviewers, and any discordance was resolved by consensus.ResultsA total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n=3), process (n=9), or outcome (n=10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs.ConclusionsAlthough challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans.

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“I sleep better at night”: How Peer Review of Radiation Treatment Plans Indirectly Improves Quality of Care Across Radiation Treatment Programs

Antitumor immunity and advances in cancer immunotherapy

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NFκBP65 transcription factor modulates resistance to doxorubicin through ABC transporters in breast cancer

Abstract

Background

Shedding light on chemoresistance biology of breast cancer could contribute to enhance the clinical outcome. Intrinsic or acquired resistance to chemotherapy is a major problem in breast cancer treatment.

Methods and materials

The NFκB pathway by siRNAP65 and JSH-23 as a translocational inhibitor of NFκBP65 in the doxorubicin-resistant MCF-7 (MCF-7/Dox) and MCF-7 cells was blocked. Then, the ABC transporter expression and function were assessed by real-time qRT-PCR and flow cytometry, respectively. Induction of apoptosis was evaluated after inhibition of the NFΚB pathway as well.

Results

Our study underlined the upregulation of NFκBP65 and anti-apoptotic Bcl-2 and downregulation of pro-apoptotic Bax in the MCF-7/Dox cells compared with control MCF-7 cells. Here, we showed that interplay between nuclear factor kappa B P65 (NFkBP65) as a transcriptional regulator and ABC transporters in the MCF-7/Dox cancer cells. We found that inhibition of the elevated expression of NFκBP65 in the resistant breast cancer, whether translocational inhibition or silencing by siRNA, decreased the expression and function of MDR1 and MRP1 efflux pumps. Furthermore, the blockade of NFκBP65 promoted apoptosis via modulating Bcl-2 and BAX expression. After inhibition of the NFκBP65 signaling pathway, elevated baseline expression of survival Bcl-2 gene in the resistant breast cells significantly decreased.

Conclusion

Suppression of the NFκB pathway has a profound dual impact on promoting the intrinsic apoptotic pathway and reducing ABC transporter function and expression, which are some of the chemoresistance features. It was speculated that the NFκB pathway directly acts on doxorubicin-induced MDR1 and MRP1 expression in MCF-7/Dox cells.

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Accuracy assessment methods of tissue marker clip placement after 11-gauge vacuum-assisted stereotactic breast biopsy: comparison of measurements using direct and conventional methods

Abstract

Background

The objective of the study was to compare direct measurement with a conventional method for evaluation of clip placement in stereotactic vacuum-assisted breast biopsy (ST-VAB) and to evaluate the accuracy of clip placement using the direct method.

Methods

Accuracy of clip placement was assessed by measuring the distance from a residual calcification of a targeted calcification clustered to a clip on a mammogram after ST-VAB. Distances in the craniocaudal (CC) and mediolateral oblique (MLO) views were measured in 28 subjects with mammograms recorded twice or more after ST-VAB. The difference in the distance between the first and second measurements was defined as the reproducibility and was compared with that from a conventional method using a mask system with overlap of transparent film on the mammogram. The 3D clip-to-calcification distance was measured using the direct method in 71 subjects.

Results

The reproducibility of the direct method was higher than that of the conventional method in CC and MLO views (P = 0.002, P < 0.001). The median 3D clip-to-calcification distance was 2.8 mm, with an interquartile range of 2.0–4.8 mm and a range of 1.1–36.3 mm.

Conclusion

The direct method used in this study was more accurate than the conventional method, and gave a median 3D distance of 2.8 mm between the calcification and clip.

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Outcomes of retesting BRCA negative patients using multigene panels

Abstract

The utility of multigene panels in retesting patients who previously tested negative for a pathogenic mutation by BRCA1/2 testing is not well established. Patients who previously tested negative for a pathogenic BRCA1/2 mutation by standard sequencing, and who were seen in cancer genetics center between November 1, 2012 and June 30, 2015 for additional testing utilizing multigene panels, were identified using our genetic testing registry. Data on demographics, personal and family history of cancer, results of panel testing and the impact on patient management was collected retrospectively. A total of 122 patients underwent retesting during the study period. Thirteen (11%) pathogenic mutations were identified in the following genes: CHEK2(4), PALB2(3), ATM(2), CDH1, APC, BARD1 and MRE11A. Eleven out of these thirteen mutations were deemed actionable based on published guidelines. Of these eleven, seven patients had an actual change in clinical management as a result of retesting. Furthermore, retesting also led to a change in clinical management in the two patients with mutations in genes (BARD1 and MRE11A) which do not have clear guidelines for management. There were no significant differences in demographics and personal and family history of cancer between patients who tested positive and those who tested negative on retesting. This study demonstrates the clinical utility of multigene panels in a group of high risk individuals who previously tested negative for a BRCA1/2 mutation. This retesting approach revealed a pathogenic mutation in 11% of cases. Retesting led to significant change in clinical management in a majority of patients with actionable mutations (7 out of 11), as well as in those with mutations in genes which do not have specific management guidelines.

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HSP90 is a promising target in gemcitabine and 5-fluorouracil resistant pancreatic cancer

Abstract

Chemotherapy (CT) options in pancreatic cancer (PC) are limited to gemcitabine and 5-fluorouracil (5-FU). Several identified molecular targets in PC represent client proteins of HSP90. HSP90 is a promising target since it interferes with many oncogenic signaling pathways simultaneously. The aim of this study was to evaluate the efficacy of different HSP90 inhibitors in gemcitabine and 5-FU resistant PC. PC cell lines 5061, 5072 and 5156 were isolated and brought in to culture from patients being operated at our institution. L3.6pl cell line served as a control. Anti-proliferative efficacy of three different HSP90 inhibitors (17-AAG, 17-DMAG and 17-AEPGA) was evaluated by the MTT assay. Alterations in signaling pathway effectors and apoptosis upon HSP90 inhibition were determined by western blot analysis and annexin V/PI staining. The cell lines 5061, 5072 and 5156 were resistant to gemcitabine and 5-FU. In contrast 17-AAG and the water-soluble derivates 17-DMAG and 17-AEPGA displayed high anti-proliferative activity in all tested cell lines. The calculated IC₅₀ was below 1 µM. Highly significant down regulation of epidermal-growth-factor-receptor, insulin-like-growth-factor-receptor-1, AKT and MAPK reflected the intracellular molecular signaling-network disruption. Furthermore, besides HSP70 also HSP27 was upregulated in all cell lines. Apoptosis occurred early under HSP90 inhibition and was determined by annexin V/PI staining and CASPASE-3 and PARP assay. In contrast, gemcitabine treated cells did not show any apoptosis. HSP90 inhibition disrupts multiple signaling cascades in gemcitabine and 5-FU resistant PC simultaneously and promotes cancer cell apoptosis. Watersoluble 17-DMAG is equally effective as 17-AAG. HSP27, besides HSP70, may represent an effective response marker of successful HSP90 inhibition.

http://ift.tt/2greFCk

The changing landscape in radiotherapy for breast cancer: Lessons from long term follow-up in some European breast cancer trials

This review describes the developments in the radiation treatment of breast cancer based on some randomized European trials during the past decades. It will focus on the relevance of long term follow-up in breast cancer patients, starting with the surprising and important change in treatment results during follow-up shown in a locally advanced breast cancer trial. Breast conserving therapy (BCT) in stage I and II breast cancer was explored and tested in a randomized trial to prove equivalence between BCT and mastectomy.

http://ift.tt/2fwvjSc

Internal and external generalizability of temporal dose–response relationships for xerostomia following IMRT for head and neck cancer

To study internal and external generalizability of temporal dose–response relationships for xerostomia after intensity-modulated radiotherapy (IMRT) for head and neck cancer, and to investigate potential amendments of the QUANTEC guidelines.

http://ift.tt/2g9JzP1

Patient-reported quality of life after stereotactic body radiation therapy versus moderate hypofractionation for clinically localized prostate cancer

Evaluate changes in bowel, urinary and sexual patient-reported quality of life following treatment with moderately hypofractionated radiotherapy (<5Gray/fraction) or stereotactic body radiation therapy (SBRT;5–10Gray/fraction) for prostate cancer.

http://ift.tt/2fwxDZc

A new anatomical classification of the bronchial arteries based on the spatial relationships to the esophagus and the tracheobronchus

Abstract

Purpose

To reveal the patterns of the mediastinal course of the bronchial arteries (BAs).

Methods

The BAs were dissected to determine the positional relationships of their mediastinal courses with the tracheobronchus and the esophagus in 72 adult cadavers.

Results

The mediastinal courses of the 227 BAs found in this study were classified into 4 types. There were 61 and 163 BAs passing the right side (Type I) and the left side (Type II reaching dorsal surface (n = 98), or Type III reaching ventral surface (n = 65) of the tracheobronchus) of the esophagus, respectively. Three BAs originated from the subclavian artery (Type IV). All Type I BAs were right BAs, whereas 91.8% of the Type II BAs were left BAs. However, 43.1 and 56.9% of the Type III BAs were the right and left BAs, respectively.

Conclusion

The classification of the mediastinal course of the BAs determined by the spatial relationships to the tracheobronchus and the esophagus may be clinically useful, because each category of this classification can be determined during esophagectomy and indicates whether the BA is a right or left BA.

http://ift.tt/2fWVNwI

A new anatomical classification of the bronchial arteries based on the spatial relationships to the esophagus and the tracheobronchus

Abstract

Purpose

To reveal the patterns of the mediastinal course of the bronchial arteries (BAs).

Methods

The BAs were dissected to determine the positional relationships of their mediastinal courses with the tracheobronchus and the esophagus in 72 adult cadavers.

Results

Conclusion

from Cancer via ola Kala on Inoreader http://ift.tt/2fWVNwI
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High expression of long non-coding RNA ATB indicates a poor prognosis and regulates cell proliferation and metastasis in non-small cell lung cancer

Abstract

Background and aim

Methods

The expression levels of lncRNA-ATB in NSCLC tissues and cell lines were measured. A549 cell line was explored to investigate the functions of lncRNA-ATB in NSCLC.

Results

Conclusion

High expression of lncRNA-ATB indicated a poor prognosis and led to the cell proliferation and metastasis in NSCLC.

http://ift.tt/2ftpykG

High expression of long non-coding RNA ATB indicates a poor prognosis and regulates cell proliferation and metastasis in non-small cell lung cancer

Abstract

Background and aim

Methods

The expression levels of lncRNA-ATB in NSCLC tissues and cell lines were measured. A549 cell line was explored to investigate the functions of lncRNA-ATB in NSCLC.

Results

Conclusion

High expression of lncRNA-ATB indicated a poor prognosis and led to the cell proliferation and metastasis in NSCLC.

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Sonoanatomic indices of lumbar facet joints in patients with facetogenic back pain in comparison to healthy subjects

Nowadays, ultrasound is increasingly used with a great accuracy in performing nerve blocks for facet joint disease.

http://ift.tt/2ftoayL

A case of central diabetes insipidus after ketamine infusion during an external to internal carotid artery bypass

We report the first teenage case of ketamine-induced transient central diabetes insipidus.

http://ift.tt/2gmgrH6

Imaging button battery ingestions and insertions in children: a 15-year single-center review

Abstract

Background

Recent studies have shown an increase in morbidity associated with button battery ingestions in children.

Objective

To perform a comprehensive, imaging-focused review of all patients with confirmed button battery ingestions/insertions imaged at our institution in the last 15 years.

Materials and methods

Radiology reports from Jan. 1, 2000, to July 12, 2015, were searched for the terms "battery" and "batteries." Confirmed cases of battery ingestion/insertion for which images were available were reviewed. Cases were reviewed for imaging studies performed, imaging findings, patient demographics, clinical history and management. Two pediatric gastroenterologists reviewed endoscopic images and graded mucosal injuries in selected cases.

Results

Two hundred seventy-six cases were reviewed. All patients were imaged with radiography, 19 with fluoroscopy (6.8%), and 4 with CT (1.4%). Batteries retained in the esophagus (n = 27, 9.8%) were larger in diameter on average than those that had passed distally (22.1 ± 3.3 mm vs. 13.7 ± 1.6 mm, P<0.0001). Battery diameter ≥20 mm was associated with esophageal impaction (P<0.0001) and higher grade esophageal injury (P<0.0001). Mean battery diameter was greater for patients with grade 1 or higher mucosal injury than for patients with no mucosal injury (22.1 ± 2.1 mm vs. 14.7 ± 4.5 mm, P<0.0001). Sixteen percent (4/25) of patients with grade ≥1 esophageal injury had batteries in the stomach on initial imaging. Five patients (1.8%) had serious clinical complications (e.g., esophageal perforation, tracheoesophageal fistula).

Conclusion

Button batteries >20mm in diameter warrant increased clinical scrutiny due to higher likelihood and severity of injury. Implementation of recent pediatric gastroenterology societal guidelines will likely lead to a substantial increase in the number of CT and MRI examinations.

http://ift.tt/2fcU4nC

Imaging button battery ingestions and insertions in children: a 15-year single-center review

Abstract

Background

Recent studies have shown an increase in morbidity associated with button battery ingestions in children.

Objective

To perform a comprehensive, imaging-focused review of all patients with confirmed button battery ingestions/insertions imaged at our institution in the last 15 years.

Materials and methods

Results

Conclusion

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Phenotype, biochemical features, genotype and treatment outcome of pyridoxine-dependent epilepsy

Abstract

We report treatment outcome of eleven patients with pyridoxine-dependent epilepsy caused by pathogenic variants in ALDH7A1 (PDE-ALDH7A1). We developed a clinical severity score to compare phenotype with biochemical features, genotype and delays in the initiation of pyridoxine. Clinical severity score included 1) global developmental delay/ intellectual disability; 2) age of seizure onset prior to pyridoxine; 3) current seizures on treatment. Phenotype scored 1–3 = mild; 4–6 = moderate; and 7–9 = severe. Five patients had mild, four patients had moderate, and two patients had severe phenotype. Phenotype ranged from mild to severe in eight patients (no lysine-restricted diet in the infantile period) with more than 10-fold elevated urine or plasma α-AASA levels. Phenotype ranged from mild to moderate in patients with homozygous truncating variants and from moderate to severe in patients with homozygous missense variants. There was no correlation between severity of the phenotype and the degree of α-AASA elevation in urine or genotype. All patients were on pyridoxine, nine patients were on arginine and five patients were on the lysine-restricted diet. 73% of the patients became seizure free on pyridoxine. 25% of the patients had a mild phenotype on pyridoxine monotherapy. Whereas, 100% of the patients, on the lysine-restricted diet initiated within their first 7 months of life, had a mild phenotype. Early initiation of lysine-restricted diet and/or arginine therapy likely improved neurodevelopmental outcome in young patients with PDE-ALDH7A1.

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Phenotype, biochemical features, genotype and treatment outcome of pyridoxine-dependent epilepsy

Abstract

http://ift.tt/2fWj7L3

Transanal approach for intersphincteric resection of rectal cancer in a patient with a huge prostatic hypertrophy

Abstract

The gold standard of surgical technique for rectal cancer is total mesorectal excision (TME). Laparoscopic TME has been proven to provide surgical safety and oncological outcomes equivalent to open TME. However, dissection of the lower rectum has some inherent difficulties related to a narrow pelvic space. The challenge of TME in the lower rectum was confirmed by the Colorectal Cancer Laparoscopic or Open Resection (COLOR) II trial showing a 9% positive circumferential margin (CRM) rate in laparoscopic TME and a 22% positive CRM rate in open TME. Recently, transanal TME has attracted intense attention as a promising alternative to laparoscopic TME. In this video article, we show the performance of a transanal approach for intersphincteric resection (ISR) of rectal cancer in a patient with a huge prostatic hypertrophy.

http://ift.tt/2gqvyNi

Transanal approach for intersphincteric resection of rectal cancer in a patient with a huge prostatic hypertrophy

Abstract

from Cancer via ola Kala on Inoreader http://ift.tt/2gqvyNi
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