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BACKGROUND: Olaparib is a poly(ADP-ribose) polymerase inhibitor and cediranib is an oral anti-angiogenic. In the primary analysis of this phase II study, combination cediranib/olaparib improved progression-free survival (PFS) compared with olaparib alone in relapsed platinum-sensitive ovarian cancer. This updated analysis was conducted to characterize overall survival (OS) and update PFS outcomes. PATIENTS AND METHODS: Ninety patients were enrolled to this randomized, open-label, phase II study between October 2011 and June 2013 across nine United States-based academic centers. Data cut-off was 21 December 2016, with a median follow-up of 46 months. Participants had relapsed platinum-sensitive ovarian cancer of high-grade serous or endometrioid histology or had a deleterious germline BRCA1/2 mutation (gBRCAm). Participants were randomized to receive olaparib capsules 400 mg twice daily or cediranib 30 mg daily and olaparib capsules 200 mg twice daily until disease progression. RESULTS: In this updated analysis, median PFS remained significantly longer with cediranib/olaparib compared with olaparib alone (16.5 versus 8.2 months, hazard ratio 0.50; P = 0.007). Subset analyses within stratum defined by BRCA status demonstrated statistically significant improvement in PFS (23.7 versus 5.7 months, P = 0.002) and OS (37.8 versus 23.0 months, P = 0.047) in gBRCA wild-type/unknown patients, although OS was not statistically different in the overall study population (44.2 versus 33.3 months, hazard ratio 0.64; P = 0.11). PFS and OS appeared similar between the two arms in gBRCAm patients. The most common CTCAE grade 3/4 adverse events with cediranib/olaparib remained fatigue, diarrhea, and hypertension. CONCLUSIONS: Combination cediranib/olaparib significantly extends PFS compared with olaparib alone in relapsed platinum-sensitive ovarian cancer. Subset analyses suggest this margin of benefit is driven by PFS prolongation in patients without gBRCAm. OS was also significantly increased by the cediranib/olaparib combination in this subset of patients. Additional studies of this combination are ongoing and should incorporate analyses based upon BRCA status. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT0111648.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Ftalazinas/administración & dosificación , Piperazinas/administración & dosificación , Quinazolinas/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Proteína BRCA1/genética , Proteína BRCA2/genética , Diarrea/inducido químicamente , Diarrea/epidemiología , Esquema de Medicación , Resistencia a Antineoplásicos/genética , Fatiga/inducido químicamente , Fatiga/epidemiología , Femenino , Estudios de Seguimiento , Mutación de Línea Germinal , Humanos , Hipertensión/inducido químicamente , Hipertensión/epidemiología , Estimación de Kaplan-Meier , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/mortalidad , Neoplasias Ováricas/genética , Neoplasias Ováricas/mortalidad , Ftalazinas/efectos adversos , Piperazinas/efectos adversos , Compuestos de Platino/farmacología , Compuestos de Platino/uso terapéutico , Supervivencia sin Progresión , Quinazolinas/efectos adversos , Criterios de Evaluación de Respuesta en Tumores Sólidos , Factores de TiempoRESUMEN
Borrelia burgdorferi and Anaplasma phagocytophilum are obligate intracellular parasites that maintain their life cycles in enzoonotic vector-host cycles with Ixodes scapularis as a vector. In addition to ticks, the hosts are commonly infested with insects from the Hippoboscidae family. This study confirms the presence of B. burgdorferi and A. phagocytophilum in deer keds (Lipoptena cervi) removed from white-tailed deer using PCR. Detection of these pathogens in deer ked represents a potential novel susceptibility of wildlife and also suggests the risk of transmission of these pathogens to humans and animals alike through the bite of an infected ectoparasite. This study represents the first instance in the U.S. of detection of tick-borne pathogens in a member of the Hippoboscid family.
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Anaplasma phagocytophilum/aislamiento & purificación , Borrelia burgdorferi/aislamiento & purificación , Ciervos/parasitología , Dípteros/parasitología , Anaplasmosis , Animales , Insectos Vectores/parasitología , Enfermedad de Lyme , Pennsylvania , Reacción en Cadena de la PolimerasaRESUMEN
High-level amplification of the protein phosphatase PPM1D (WIP1) is present in a subset of medulloblastomas (MBs) that have an expression profile consistent with active Sonic Hedgehog (SHH) signaling. We found that WIP1 overexpression increased expression of Shh target genes and cell proliferation in response to Shh stimulation in NIH3T3 and cerebellar granule neuron precursor cells in a p53-independent manner. Thus, we developed a mouse in which WIP1 is expressed in the developing brain under control of the Neurod2 promoter (ND2:WIP1). The external granule layer (EGL) in early postnatal ND2:WIP1 mice exhibited increased proliferation and expression of Shh downstream targets. MB incidence increased and survival decreased when ND2:WIP1 mice were crossed with an Shh-activated MB mouse model. Conversely, Wip1 knockout significantly suppressed MB formation in two independent mouse models of Shh-activated MB. Furthermore, Wip1 knockdown or treatment with a WIP1 inhibitor suppressed the effects of Shh stimulation and potentiated the growth inhibitory effects of SHH pathway-inhibiting drugs in Shh-activated MB cells in vitro. This suggests an important cross-talk between SHH and WIP1 pathways that accelerates tumorigenesis and supports WIP1 inhibition as a potential treatment strategy for MB.
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Neoplasias Cerebelosas/metabolismo , Proteínas Hedgehog/metabolismo , Meduloblastoma/metabolismo , Células-Madre Neurales/metabolismo , Proteína Fosfatasa 2C/metabolismo , Transducción de Señal , Animales , Biomarcadores , Ciclo Celular/genética , Línea Celular Tumoral , Proliferación Celular , Transformación Celular Neoplásica/metabolismo , Técnicas de Silenciamiento del Gen , Humanos , Ratones , Ratones Transgénicos , Células 3T3 NIH , Proteína Fosfatasa 2C/genética , Proteína p53 Supresora de Tumor/metabolismoRESUMEN
Recent studies suggest that medulloblastoma, the most common malignant brain tumor of childhood, is comprised of four disease variants. The WIP1 oncogene is overexpressed in Group 3 and 4 tumors, which contain medulloblastomas with the most aggressive clinical behavior. Our data demonstrate increased WIP1 expression in metastatic medulloblastomas, and inferior progression-free and overall survival of patients with WIP1 high-expressing medulloblastoma. Microarray analysis identified upregulation of genes involved in tumor metastasis, including the G protein-coupled receptor CXCR4, in medulloblastoma cells with high WIP1 expression. Stimulation with the CXCR4 ligand SDF1α activated PI-3 kinase signaling, and promoted growth and invasion of WIP1 high-expressing medulloblastoma cells in a p53-dependent manner. When xenografted into the cerebellum of immunodeficient mice, medulloblastoma cells with stable or endogenous high WIP1 expression exhibited strong expression of CXCR4 and activated AKT in primary and invasive tumor cells. WIP1 or CXCR4 knockdown inhibited medulloblastoma growth and invasion. WIP1 knockdown also improved the survival of mice xenografted with WIP1 high-expressing medulloblastoma cells. WIP1 knockdown inhibited cell surface localization of CXCR4 by suppressing expression of the G protein receptor kinase 5, GRK5. Restoration of wild-type GRK5 promoted Ser339 phosphorylation of CXCR4 and inhibited the growth of WIP1-stable medulloblastoma cells. Conversely, GRK5 knockdown inhibited Ser339 phosphorylation of CXCR4, increased cell surface localization of CXCR4 and promoted the growth of medulloblastoma cells with low WIP1 expression. These results demonstrate crosstalk among WIP1, CXCR4 and GRK5, which may be important for the aggressive phenotype of a subclass of medulloblastomas in children.
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Neoplasias Cerebelosas/patología , Quimiocina CXCL2/metabolismo , Quinasa 5 del Receptor Acoplado a Proteína-G/metabolismo , Meduloblastoma/patología , Fosfoproteínas Fosfatasas/genética , Receptores CXCR4/genética , Adolescente , Animales , Línea Celular Tumoral , Neoplasias Cerebelosas/genética , Niño , Preescolar , Femenino , Quinasa 5 del Receptor Acoplado a Proteína-G/genética , Humanos , Lactante , Masculino , Meduloblastoma/genética , Ratones , Ratones SCID , Invasividad Neoplásica , Trasplante de Neoplasias , Fosfoproteínas Fosfatasas/metabolismo , Proteína Fosfatasa 2C , Receptores CXCR4/metabolismo , Transducción de Señal , Adulto JovenRESUMEN
INTRODUCTION: Gynecologic oncologists regularly care for patients at the end of life, yet little is known about their training or preparedness to deal with issues of palliative care. We sought to examine the training provided to gynecologic oncology fellows as well as their perceived preparedness to provide palliative care. METHODS: A self-administered survey was distributed to all fellows enrolled in all gynecologic oncology fellowships during the 2009 academic year. The instrument assessed attitudes, training, experience, and preparedness regarding caring for patients at the end of life. Descriptive, bivariate and multivariable analyses were performed. RESULTS: Sixty-one percent (103/168) of fellows completed the survey. Most (89%) feel that palliative care is integral to their training, but few (11%) have had any palliative care training, including either a rotation or fellowship. Using a scale of 1-10, fellows rated teaching quality on two common training opportunities, specifically managing postoperative complications (7.8) and endometrial cancer patients (8.7), as significantly higher than teaching on managing patients at the end of life (5.5; p<0.001). Fellows rated the quality of end of life teaching as significantly lower than overall teaching (55% vs. 92%; p=0.001). Their self-assessment regarding overall preparedness to deal with end of life issues was associated with higher end of life teaching quality and experience caring for more than 10 dying patients. CONCLUSIONS: The quantity and quality of training in palliative care are lower compared to other common procedural and oncological issues. Gynecologic oncology fellowship programs need to incorporate a palliative care training curriculum.
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Becas , Ginecología/educación , Oncología Médica/educación , Cuidados Paliativos , Cuidado Terminal , Adulto , Actitud del Personal de Salud , Competencia Clínica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Encuestas y CuestionariosRESUMEN
The standard targeted therapy for HER2-overexpressing breast cancer is the HER2 monoclonal antibody, trastuzumab. Although effective, many patients eventually develop trastuzumab resistance. The dual EGFR/HER2 small molecule tyrosine kinase inhibitor lapatinib is approved for use in trastuzumab-refractory metastatic HER2-positive breast cancer. However, lapatinib resistance is a problem as most patients with trastuzumab-refractory disease do not benefit from lapatinib. Understanding the mechanisms underlying lapatinib resistance may ultimately facilitate development of new therapeutic strategies for HER2-overexpressing breast cancer. Our current results indicate that MEK inhibition increases lapatinib-mediated cytotoxicity in resistant HER2-overexpressing breast cancer cells. We genetically and pharmacologically blocked MEK/ERK signaling and evaluated lapatinib response by trypan blue exclusion, anchorage-independent growth assays, flow cytometric cell cycle and apoptosis analysis, and in tumor xenografts. Combined MEK inhibition and lapatinib treatment reduced phosphorylated ERK more than single agent treatment. In addition, Western blots, immunofluorescence, and immunohistochemistry demonstrated that the combination of MEK inhibitor plus lapatinib reduced nuclear expression of the MEK/ERK downstream proto-oncogene FOXM1. Genetic knockdown of MEK was tested for the ability to increase lapatinib-mediated cell cycle arrest or apoptosis in JIMT-1 and MDA361 cells. Finally, xenograft studies demonstrated that combined pharmacological inhibition of MEK plus lapatinib suppressed tumor growth and reduced expression of FOXM1 in HER2-overexpressing breast cancers that are resistant to trastuzumab and lapatinib. Our results suggest that FoxM1 contributes to lapatinib resistance downstream of MEK signaling, and supports further study of pharmacological MEK inhibition to improve response to lapatinib in HER2-overexpressing trastuzumab-resistant breast cancer.
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Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Mama/efectos de los fármacos , Factores de Transcripción Forkhead/metabolismo , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Inhibidores de Proteínas Quinasas/uso terapéutico , Quinazolinas/uso terapéutico , Animales , Antineoplásicos/farmacología , Apoptosis/efectos de los fármacos , Bencimidazoles/farmacología , Bencimidazoles/uso terapéutico , Mama/metabolismo , Mama/patología , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Línea Celular Tumoral , Femenino , Proteína Forkhead Box M1 , Factores de Transcripción Forkhead/análisis , Factores de Transcripción Forkhead/genética , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Lapatinib , Ratones , Ratones Desnudos , Inhibidores de Proteínas Quinasas/farmacología , Proto-Oncogenes Mas , Quinazolinas/farmacologíaRESUMEN
Actuated car doors are a promising way to increase the convenience of access to cars. We propose an advanced actuation and control concept which can easily be integrated into conventional car doors. By utilizing a linear, nonbackdrivable actuator and various sensors, both automatic and manual door operations are enabled. A discrete state controller ensures a safe operation of the door, including automatic opening and closing. The realization of a supportive, high-quality haptic interaction with the car door for the manual operation is the principal part of our work. Due to the impracticality of a direct measurement of the user interaction force at a car door, we chose impedance control to render the desired dynamics. The impedance was designed to provide a convenient, intuitive, and safe manual handling of the door. We implemented and tested four different impedance control schemes, of which impedance control with actuator force feedback performed best. Two experimental evaluations with 16 and 27 participants revealed a predominant approval of the actuated car door.
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OBJECTIVE: This study investigated the influence of mutual information (MI) on temporal and dipole reconstruction based on independent components (ICs) derived from independent component analysis (ICA). METHOD: Artificial electroencephalogram (EEG) datasets were created by means of a neural mass model simulating cortical activity of two neural sources within a four-shell spherical head model. Mutual information between neural sources was systematicallyvaried. RESULTS: Increasing spatial error for reconstructed locations of ICs with increasing MI was observed. By contrast, the reconstruction error for the time course of source activity was largely independent of MI but varied systematically with Gaussianity of the sources. CONCLUSION: Independent component analysis is a viable tool for analyzing the temporal activity of EEG/MEG (magnetoencephalography) sources even if the underlying neural sources are mutually dependent. However, if ICA is used as a preprocessing algorithm for source localization, mutual information between sources introduces a bias in the reconstructed locations of the sources. SIGNIFICANCE: Studies using ICA-algorithms based on MI have to be aware of possible errors in the spatial reconstruction of sources if these are coupled with other neural sources.
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Mapeo Encefálico/métodos , Simulación por Computador , Electroencefalografía/métodos , Magnetoencefalografía/métodos , Análisis de Componente Principal , Procesamiento de Señales Asistido por Computador , Potenciales de Acción/fisiología , Algoritmos , Corteza Cerebral/anatomía & histología , Corteza Cerebral/fisiología , Sincronización Cortical , Potenciales Evocados/fisiología , Humanos , Modelos Estadísticos , Redes Neurales de la Computación , Neuronas/fisiología , Dinámicas no Lineales , Distribución Normal , Factores de TiempoRESUMEN
Due to limited simultaneous access to a greater pool of patients an effective training of medical students or young orthopedic physicians is difficult. A knee joint simulator that comprises the properties of a healthy or pathological knee can support medical education and training. In this paper a mechatronic system is presented that provides visual, acoustic, and haptic (force) feedback so that it allows a user to touch and move a virtual shank, bones or muscles within the leg, and simultaneously observe the generated movement, feel the contact force, and hear sounds. These and further features enable the user to study and assess the properties of the knee, e.g. by testing the joint laxity and end-point stiffness in six degrees-of-motion (DOF) and by grasping and pulling at muscles, rupturing ligaments or changing muscle/ligament paths. Such a tool can support training of physical knee evaluation required for diagnosis and therapeutic planning, since any kind of pathology of any subject type can be tested at any time. Furthermore, it can provide a better understanding of functional anatomy, e.g. for the education of medical students.
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Simulación por Computador , Instrucción por Computador , Articulación de la Rodilla/fisiopatología , Modelos Anatómicos , Ortopedia/educación , Interfaz Usuario-Computador , Retroalimentación , Humanos , Imagenología Tridimensional , Artropatías/diagnóstico , Artropatías/fisiopatologíaRESUMEN
This study evaluated the clinical utility of a commercially available chemosensitivity assay. In the first part of the study, tumor tissues from dogs with various malignancies were tested, and the dogs were treated with a mitoxantrone/cyclophosphamide combination protocol. Tumor response was evaluated and compared to the predicted response. Assay results were not a significant predictor of clinical response to chemotherapy or of survival time. In the second part of the study, assay results were used to direct therapy in dogs with refractory lymphoma. There was no significant correlation (p equals 0.323) between predicted response and case outcome.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Ensayos de Selección de Medicamentos Antitumorales/veterinaria , Linfoma/veterinaria , Animales , Ciclofosfamida/administración & dosificación , Enfermedades de los Perros/mortalidad , Perros , Ensayos de Selección de Medicamentos Antitumorales/métodos , Modelos Lineales , Linfoma/tratamiento farmacológico , Mitoxantrona/administración & dosificación , Valor Predictivo de las Pruebas , Estudios Prospectivos , Método Simple Ciego , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: To investigate the incidence of adverse events during hemodialysis treatments as a function of calories and fluid intake. METHODS: The study period was August 3-26, 1999. Hemodialysis visits were studied. Twenty-three patients receiving hemodialysis during the 2nd shift on Tuesday, Thursday, and Saturday were studied. A total of 166 hemodialysis patient visits were studied. Data collected included: amount of fluid and food consumed, blood pressure levels, and mannitol use during each hemodialysis treatment; and any symptoms that occurred either during or after the dialysis treatment (hypotension, nausea, vomiting, diarrhea, cramping, and access problems). RESULTS: Using regression analysis, calories and fluids were strong predictors of both hypotension (P =.003) and mannitol use (P =.000), but not of cramping or access problems. Patients were 3 times more likely to have hypotension if taking any fluids (P =.011). Patients consuming >200 calories were 2 times as likely to have hypotension (P =.058). Patients were 5 times more likely to use mannitol if taking any fluids (P =.005). Mannitol use increased significantly (P =.001) with those patients consuming >200 calories. CONCLUSION: Patients who ate more than 200 calories and consumed more than 200 mL of fluid during hemodialysis had an increased incident of hypotensive events and increased use of mannitol.
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Ingestión de Líquidos , Ingestión de Energía , Hipotensión/epidemiología , Manitol/administración & dosificación , Diálisis Renal/efectos adversos , Anciano , Humanos , Hipotensión/etiología , Incidencia , Análisis de RegresiónRESUMEN
Thirteen dogs with histopathologically confirmed malignancies were treated with mitoxantrone and cyclophosphamide combination therapy. One to four doses were administered at 21-day intervals. Recombinant human granulocyte colony-stimulating factor was administered to ameliorate myelosuppression in dogs with neutrophil nadirs less than 1,000/microl. While the protocol appears to be safe for use in tumor-bearing dogs, an advantage over mitoxantrone single-agent protocols in terms of tumor response was not demonstrated in this initial pilot study.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Neoplasias/veterinaria , Animales , Ciclofosfamida/administración & dosificación , Perros , Quimioterapia Combinada , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Mitoxantrona/administración & dosificación , Neoplasias/tratamiento farmacológico , Neutropenia/inducido químicamente , Neutropenia/tratamiento farmacológico , Resultado del TratamientoRESUMEN
OBJECTIVES: To determine systemic and local platinum concentrations released from subcutaneously implanted cis-diamminedichloroplatinum (cisplatin) -impregnated polymethylmethacrylate (PMMA) and to evaluate systemic or local adverse reactions. ANIMALS: 6 healthy dogs. PROCEDURE: Cisplatin (20 mg) was inserted into PMMA that was fashioned into cylinders and placed into subcutaneous tissue chambers overlying the thorax (treated site). An empty tissue chamber was placed over the opposite side (control site). Plasma samples were obtained for platinum determination before implantation, at 3, 6, and 12 hours after implantation on day 0, and once daily on days 1, 2, 3, 7, 14, 21, and 29. At similar times on similar days, tissue chamber fluid samples also were obtained for platinum determination. Complete blood count, serum urea nitrogen and creatinine concentration determinations, and urinalyses were performed on days 1, 2, 3, 7, 14, 21, and 29. Complete necropsy was performed at conclusion of the study. RESULTS: Tissue chamber platinum concentrations at the treated site were significantly greater than plasma and control site tissue chamber concentrations on days 2, 3, 7, 10. Mean plasma platinum concentration at 3 (0.735 microg/ml), 6 (0.691 microg/ml), 12 (0.534 microg/ml), 24 (0.131 microg/ml), 48 (0.2 microg/ml), 72 (0.1 microg/ml), and 158 (0.014 microg/ml) hours was significantly greater than pretreatment values (0.0 microg/ml). Plasma platinum concentration 10 days after treatment (0.011 microg/ml) did not significantly differ from pretreatment values. Local or systemic adverse reactions were not apparent. CONCLUSIONS: The route of cisplatin administration was safe. Greater concentration of platinum was released locally relative to plasma concentration for an extended period.
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Antineoplásicos/farmacocinética , Cisplatino/farmacocinética , Perros/metabolismo , Polimetil Metacrilato , Animales , Antineoplásicos/administración & dosificación , Cisplatino/administración & dosificación , Preparaciones de Acción Retardada , Femenino , MasculinoRESUMEN
A 5-month-old boy with a VACTERL syndrome underwent cardiac surgery for correction of a common arterial trunk and closure of an atrial septal defect. A prominent Eustachian valve was mistaken for the atrial septum and surgically closed. Thirty months later, after gradual shrinking of the foramen ovale with associated reduction of the right-to-left shunt, the boy presented with acute symptoms of a lower inflow obstruction, characterized by hepatomegaly and engorged abdominal vein pattern (Medusa's head). The boy was reoperated successfully after the condition had been recognized.
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Atrios Cardíacos/cirugía , Defectos del Tabique Interatrial/cirugía , Complicaciones Posoperatorias/etiología , Vena Cava Inferior/cirugía , Anomalías Múltiples/cirugía , Humanos , Enfermedad Iatrogénica , Lactante , Masculino , Complicaciones Posoperatorias/cirugía , Reoperación , SíndromeRESUMEN
A 14-month-old, intact male Labrador retriever was referred for evaluation of vomiting and regurgitation. A diagnosis of gastroesophageal intussusception with aspiration pneumonia was made. The patient responded favorably to aggressive surgical and medical management. The guarded to poor prognosis for gastroesophageal intussusception makes the successful outcome of this case unique.
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Enfermedades de los Perros , Enfermedades del Esófago/veterinaria , Intususcepción/veterinaria , Neumonía por Aspiración/veterinaria , Animales , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/terapia , Perros , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/diagnóstico por imagen , Masculino , Neumonía por Aspiración/complicaciones , Neumonía por Aspiración/diagnóstico por imagen , Pronóstico , Radiografía , Gastropatías/complicaciones , Gastropatías/diagnóstico por imagen , Gastropatías/veterinariaRESUMEN
Case records of 32 cats with cutaneous mast cell tumors (CMCTs) were reviewed. Using the Patnaik system for grading canine mast cell tumors, the relationships between histopathological grade and patient survival time and tumor recurrence were examined. Tumor histopathological grade had no prognostic significance. One-, two-, and three-year tumor recurrence rates following surgical excision were 16%, 19%, and 13%, respectively. Incomplete excision was not associated with a higher rate of tumor recurrence.
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Enfermedades de los Gatos/mortalidad , Sarcoma de Mastocitos/veterinaria , Neoplasias Cutáneas/veterinaria , Animales , Enfermedades de los Gatos/patología , Enfermedades de los Gatos/cirugía , Gatos , Femenino , Estudios de Seguimiento , Masculino , Sarcoma de Mastocitos/mortalidad , Sarcoma de Mastocitos/patología , Recurrencia Local de Neoplasia/veterinaria , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Análisis de Supervivencia , Factores de TiempoRESUMEN
PURPOSE: To explore how well medical schools prepare students to address end-of-life issues with their patients. METHOD: In 1997, the authors surveyed 226 fourth-year students at Georgetown University School of Medicine and Mayo Medical School, assessing relevant knowledge, experiences, and attitudes, and the students' sense of preparedness to address end-of-life issues. RESULTS: Seventy-two percent (162) of the eligible students responded. Almost all (99%) recognized the importance of advance directives and anticipated discussing end-of-life issues with patients in their practices (84%). However, only 41% thought their education regarding end-of-life issues had been adequate, only 27% had ever discussed end-of-life issues with a patient themselves, and only 35% thought they had had adequate exposure and education regarding advance directives. Eighty percent favored more education about end-of-life issues. Educational exposure to end-of-life issues and to role models, ability to correctly define an advance directive, number of end-of-life discussions witnessed, and age all were associated the students' sense of preparedness to discuss advance directives with patients. CONCLUSION: Most of the students felt unprepared to discuss end-of-life issues with their patients, but wanted to learn more. The factors associated with a sense of preparedness suggest several possible, easily made, educational interventions, but further research is required to understand the scope of the problem and to implement curricular modifications.