RESUMEN
In temperate estuaries of the southern Gulf of St. Lawrence, intermittent seasonal anoxia coupled with phytoplankton blooms is a regular occurrence in watersheds dominated by agricultural land use. To examine the spatial relationship between dissolved oxygen and phytoplankton throughout the estuary to assist in designing monitoring programs, oxygen depth profiles and chlorophyll measurements were taken bi-weekly from May to December in 18 estuaries. In five of those estuaries, dissolved oxygen data loggers were set to measure oxygen at hourly intervals and at multiple locations within the estuary the subsequent year. The primary hypothesis was that dissolved oxygen in the upper estuary (first 10% of estuary area) is predictive of dissolved oxygen mid-estuary (50% of estuary area). The second hypothesis was that hypoxia/superoxia in the estuary is influenced by temperature and tidal flushing. Oxygen depth profiles conducted in the first year of study provided preliminary support that dissolved oxygen in the upper estuary was related to dissolved oxygen throughout the estuary. However, dissolved oxygen from loggers deployed at 10% and 50% of estuary area did not show as strong a correlation as expected (less than half the variance explained). The strength of the correlation declined towards the end of summer. Spatial decoupling of oxygen within the estuary suggested influence of local conditions. Chlorophyll concentration seemed also to be dependent on local conditions as it appeared to be coupled with the presence of sustained anoxia in the upper estuary with blooms typically occurring within 7 to 14 days of anoxia. The practical implication for oxygen monitoring is that one location within the most severely impacted part of the estuary is not sufficient to fully evaluate the severity of eutrophication effects.
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Estuarios , Oxígeno , Monitoreo del Ambiente , Eutrofización , Nutrientes , Oxígeno/análisis , Estaciones del AñoRESUMEN
The importance of angular resolution in EBSD analyses is discussed based on an Inconel 718 sample containing several populations of recrystallized grains, with subtle differences in dislocation contents. Classical EBSD analyses (with angular resolution in the range of 0.5-1°) do not allow for distinguishing recrystallized grains grown dynamically or post-dynamically. The angular resolution of EBSD orientation and misorientation data can be significantly improved (down to about 0.1-0.2°) either using more sophisticated Kikuchi pattern indexing methods and/or using the recently proposed LLASS denoising filter (Local Linear Automatic Smoothing Splines). Then the coexistence of both dynamically and post-dynamically recrystallized grains in the sample can be confirmed and quantified. ECCI images unambiguously confirm the conclusions drawn from the analysis of improved angular resolution EBSD data, and furthermore reveal the presence of thermal stress induced dislocations with typical patterns in water quenched Inconel 718 recrystallized grains. LAY DESCRIPTION: EBSD is widely used to study recrystallization phenomena. Conventional EBSD is nevertheless not able to distinguish dynamic recrystallized grains from post-dynamic recrystallized grains which differ by subtitle differences in dislocation contents. In this paper, we show that improving the orientation precision of EBSD data by means of different methods allows distinguishing these two recrystallized grains populations. Analyses and discussion are based on an Inconel 718, a famous Nickel-based superalloy in aeronautic.
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The reprecipitation mechanisms and kinetics of γ' particles during cooling from supersolvus and subsolvus temperatures were studied in AD730(TM) Ni-based superalloy using Differential Thermal Analysis (DTA). The evolution in the morphology and distribution of reprecipitated γ' particles was investigated using Field Emission Gun Scanning Electron Microscopy (FEG-SEM). Depending on the cooling rate, γ' particles showed multi or monomodal distribution. The irregularity growth characteristics observed at lower cooling rates were analyzed in the context of Mullins and Sekerka theory, and allowed the determination of a critical size of γ' particles above which morphological instability appears. Precipitation kinetics parameters were determined using a non-isothermal JMA model and DTA data. The Avrami exponent was determined to be in the 1.5-2.3 range, suggesting spherical or irregular growth. A methodology was developed to take into account the temperature dependence of the rate coefficient k(T) in the non-isothermal JMA equation. In that regard, a function for k(T) was developed. Based on the results obtained, reprecipitation kinetics models for low and high cooling rates are proposed to quantify and predict the volume fraction of reprecipitated γ' particles during the cooling process.
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We assessed the impact of lymphoedema (defined as ≥ 10% limb volume change) on quality of life (QOL), ability to perform activities of daily living (ADLs) and coping in 277 melanoma patients. Limb volume was measured prospectively, pre-operatively and every 3-6 months for 18 months post-operatively using a perometer. Three questionnaires were administered to measure QOL, coping and impact on ADLs. Statistical analyses were conducted using longitudinal logistic regression models. At 18 months, the cumulative incidence of lymphoedema was 31% in patients with upper extremity nodal basin treatment and 40% in lower extremity nodal basin treatment patients. Patients with lower extremity lymphoedema reported lower QOL scores than those with upper extremity lymphoedema. Over 18 months, both groups with mild and moderate lymphoedema showed improvement in coping [odds ratio (OR): 6.67, 95% confidence interval (CI): 3.30-13.47] and performance of ADLs (OR: 7.46, CI: 3.38-16.47). Over the course of 18 months, men were found to have poorer coping scores than women (OR: 2.91, CI: 1.35-6.27). Lymphoedema was associated with improvement in coping over time (P = 0.08) and a higher reported interference with ADLs (OR: 2.53, CI: 1.29-4.97). Patient education about lymphoedema at the time of surgical consent may improve self-efficacy and coping ability. Effective management of lymphoedema may improve patient QOL and reduce interference with ADLs.
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Actividades Cotidianas , Adaptación Psicológica , Linfedema , Melanoma/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Linfedema/etiología , Linfedema/fisiopatología , Linfedema/psicología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Calidad de Vida , Análisis de Regresión , Autoeficacia , Encuestas y CuestionariosRESUMEN
A project of the American Lymphedema Framework Project (ALFP), this review seeks to examine the policy and economic impact of caring for patients with lymphedema, a common side effect of cancer treatment. This review is the first of its kind undertaken to investigate, coordinate, and streamline lymphedema policy initiatives in the United States with potential applicability worldwide. As part of a large scale literature review aiming to systematically evaluate the level of evidence of contemporary peer-reviewed lymphedema literature (2004 to 2011), publications on care delivery models, health policy, and economic impact were retrieved, summarized, and evaluated by a team of investigators and clinical experts. The review substantiates lymphedema education models and clinical models implemented at the community, health care provider, and individual level that improve delivery of care. The review exposes the lack of economic analysis related to lymphedema. Despite a dearth of evidence, efforts towards policy initiatives at the federal and state level are underway. These initiatives and the evidence to support them are examined and recommendations for translating these findings into clinical practice are made. Medical and community-based disease management interventions, taking on a public approach, are effective delivery models for lymphedema care and demonstrate great potential to improve cancer survivorship care. Efforts to create policy at the federal, state, and local level should target implementation of these models. More research is needed to identify costs associated with the treatment of lymphedema and to model the cost outlays and potential cost savings associated with comprehensive management of chronic lymphedema.
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Atención a la Salud/economía , Atención a la Salud/organización & administración , Política de Salud , Linfedema/terapia , Humanos , Linfedema/economía , Estados UnidosRESUMEN
INTRODUCTION: Motor imagery can be defined as a dynamic state during which the representation of a movement is internally rehearsed in the absence of voluntary movements. There are two strategies to mentally simulate the movements, either a visual representation of the movements (visual imagery), or kinesthetic feeling of the movement (kinetic imagery). In stroke rehabilitation, studies indicate that motor imagery associated with physical therapy results in cortical reorganization and correlative functional improvements. AIM: The aim of this study is to provide to the French-speaking community a valid and reliable version of the Movement Imagery Questionnaire - Revised Second Version (MIQ-RS). METHOD: We examined the test-retest, inter-rate reliability and the internal consistency of the visual and kinesthetic items of our French version of MIQ-RS in 153 healthy subjects. RESULTS: Results showed the internal consistency (Cronbach α=0.90) and test-retest reliability (intraclass correlation coefficient for visual items=0.68 and for kinesthetic items=0.78) of the French version of MIQ-RS were satisfactory; the two-factor structure was supported by confirmatory factor analysis. CONCLUSION: The French version of MIQ-RS is a valid and reliable instrument in French-speaking population and therefore useful as a measure for motor imagery ability.
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Imaginación , Movimiento , Encuestas y Cuestionarios , Adulto , Anciano , Femenino , Francia , Humanos , Cinestesia , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Traducciones , Adulto JovenRESUMEN
Currently, a limited number of studies have been conducted that examine sources of information and knowledge level in individuals with lymphedema. This study aimed (1) to examine self-reported information sources and perceived lymphedema knowledge among individuals with lymphedema; and (2) to examine differences in self-reported information sources and perceived lymphedema knowledge among individuals with primary or secondary lymphedema; and with upper or lower extremity lymphedema. The National Lymphedema Network (NLN) conducted a survey to collect self-report data from March 2006 to January 2010. Overall, participants preferred a variety of sources of information. Participants reported low levels of knowledge about the types of lymphedema, treatment approaches and methods, and self-administrated therapies. In comparison to participants with secondary or upper extremity lymphedema, participants with primary or lower extremity lymphedema reported lower knowledge level regarding causes of lymphedema, risks for and complications of lymphedema, treatment approaches and methods for lymphedema, and self-administered therapies. Opportunities exist to expand lymphedema information sources. Healthcare professionals should focus on delivering high quality information about treatment and self-care management to individuals with lymphedema.
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Conocimientos, Actitudes y Práctica en Salud , Linfedema/psicología , Femenino , Humanos , Difusión de la Información , Extremidad Inferior , Linfedema/etiología , Linfedema/terapia , Masculino , Autocuidado , Autoinforme , Extremidad SuperiorRESUMEN
Intermittent pneumatic compression (IPC) therapy is an effective modality to reduce the volume of the lymphedematous limbs alone or in conjunction with other modalities of therapy such as decongestive therapy. However, there is no consensus on the frequency or treatment parameters for IPC devices. We undertook a systematic review of contemporary peer-reviewed literature (2004-2011) to evaluate the evidence for use of IPC in the treatment of lymphedema. In select patients, IPC use may provide an acceptable home-based treatment modality in addition to wearing compression garments.
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Aparatos de Compresión Neumática Intermitente , Sistema Linfático/fisiopatología , Linfedema/terapia , Medicina Basada en la Evidencia , Humanos , Aparatos de Compresión Neumática Intermitente/efectos adversos , Linfedema/fisiopatología , Presión , Resultado del TratamientoRESUMEN
Currently, there is a lack of data related to differences in symptoms and infection across different types and anatomical sites of lymphedema. The objective of this study was to examine differences in symptoms and infection status among individuals with lymphedema of the upper or lower extremities. The National Lymphedema Network initiated an online survey of self-report lymphedema data from March 2006 through January 2010. Descriptive statistics, Mann-Whitney tests, and Chi-square tests were used to analyze data. 723 individuals with upper extremity lymphedema and 1114 individuals with lower extremity lymphedema completed the survey. Individuals with extremity lymphedema experienced high symptom burden and infectious complications. Compared with individuals with upper extremity lymphedema, individuals with lower extremity lymphedema experienced more frequent and more severe symptoms (p<.001), infection episodes (p<.001), and infection-related hospitalizations (p<.001). No statistically significant differences of symptom burden and infection status were identified between individuals with lower extremity primary and secondary lymphedema. Individuals with extremity lymphedema experience substantial symptom burden and infectious complications; however, those with lower extremity lymphedema have more severe symptoms and more infections than those with upper extremity lymphedema.
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Infecciones/epidemiología , Linfedema/complicaciones , Femenino , Humanos , Extremidad Inferior , Masculino , Extremidad SuperiorRESUMEN
BACKGROUND: The study's objective was to investigate the risks of developing cardiac disorders following the administration of chemotherapy and radiation therapy in patients with non-small-cell lung cancer (NSCLC). METHODS: The study consisted of 34 209 patients aged > or =65 years with American Joint Committee on Cancer stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Result-Medicare linked database (1991-2002) who were free of cardiac disorders at NSCLC diagnosis. RESULTS: There were significant associations between the use of chemotherapy/radiation and the risks of developing ischemic heart disease, conduction disorders, cardiac dysfunction, and heart failure. The absolute risks for cardiac dysfunction increased with the administration of chemotherapy-only and radiation-only, and incrementally with chemoradiation. Men, blacks, older patients, those with higher comorbidity scores, and advanced disease were at higher risk. The risk for ischemic heart disease increased when radiation/chemoradiation were rendered to the left lung and both lungs and for cardiac dysfunction, radiation administered to the left lung. CONCLUSIONS: There were significant associations especially for cardiac dysfunction with use of chemotherapy/radiation therapy and risks of developing cardiac toxicity in NSCLC patients. The risks of treatment-associated cardiac toxicity, specifically ischemic heart disease and cardiac dysfunction, were greatest among those with left-sided lung tumors.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/terapia , Cardiopatías/inducido químicamente , Corazón/efectos de la radiación , Neoplasias Pulmonares/terapia , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Terapia Combinada , Femenino , Cardiopatías/diagnóstico , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Masculino , Estadificación de Neoplasias , Traumatismos por Radiación/diagnóstico , Programa de VERF , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Current American Joint Committee on Cancer retroperitoneal sarcoma (RPS) staging is not representative of patients with RPS specifically and has limited discriminative power. Our objective was to develop a RPS disease-specific nomogram capable of stratifying patients based on probability of overall survival (OS) after resection. PATIENTS AND METHODS: In all, 1118 RPS patients were evaluated at our institution (1996-2006). Patients with resectable, nonmetastatic disease were selected (n = 343) and baseline, treatment and outcome variables were retrieved. A nomogram was created and its performance was evaluated by calculating its discrimination (concordance index) and calibration and by subsequent internal validation. RESULTS: Median follow-up and OS were 50 and 59 months, respectively. Independent predictors of OS were included in the nomogram: age (> or = 65), tumor size (> or = 15 cm), type of presentation (primary versus recurrent), multifocality, completeness of resection and histology. The concordance index was 0.73 [95% confidence interval (CI) 0.71-0.75] and the calibration was excellent, with all observed outcomes within the 95% CI of each predicted survival probability. CONCLUSIONS: A RPS-specific postoperative nomogram was developed. It improves RPS staging by allowing a more dynamic and robust disease-specific risk stratification. This prognostic tool can help in patient counseling and for selection of high-risk patients that may benefit from adjuvant therapies or inclusion into clinical trials.
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Nomogramas , Neoplasias Retroperitoneales/diagnóstico , Sarcoma/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Periodo Posoperatorio , Neoplasias Retroperitoneales/mortalidad , Neoplasias Retroperitoneales/cirugía , Sarcoma/mortalidad , Sarcoma/cirugía , Análisis de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Decreased performance status, comorbidities, and disease natural history may erode enthusiasm for soft tissue sarcoma (STS) resection in elderly patients. Consequently, we evaluated the outcome of elderly patients amenable to complete surgical resection treated at a single institution. METHODS: Prospectively accrued data were used to identify patients with primary STS age >or=65 years (n = 325) who underwent complete macroscopic resection at our institution (1996-2007). Univariable and multivariable analyses were performed to identify prognostic factors. RESULTS: Median age at presentation was 72 years; 179 patients (55.1%) had associated comorbidities with an ASA score of >or=3. Extremity was the most common site (57.1%; n = 186), undifferentiated pleomorphic sarcoma the most common histology (60.4%; n = 197); 232 (71.2%) were high grade, 222 (68.3%) were >5 cm. Thirty-day postoperative mortality was 0.9% (n = 3); overall complication rate was 30.7% (n = 100), and mean postoperative hospital stay was 9 days (range, 1-84). Estimated median survival was 96 months, 5-year disease-specific survival (DSS) was 63%. Multivariable analysis identified age >or=75 year (HR = 2.03), tumor size: 5-15 vs <5 cm (HR = 3.54), or >15 vs <5 cm (HR = 10.33), and high-grade (HR = 5.53) as significant independent adverse prognostic factors. Compared with patients aged 65-74 years, older patients had more high grade tumors (P = .04), received chemotherapy less often (P < .0001), developed different patterns of recurrence (P < .05), and exhibited a shorter median survival (70 months; P = .05). CONCLUSIONS: Properly selected elderly patients can safely undergo extensive STS resections. Until more effective therapies become available, surgery in the elderly is indicated and remains the best means for STS control.
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Sarcoma/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Sarcoma/patología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
We sought to define the incidence, risk factors, symptoms, and quality of life (QOL) outcomes associated with various degrees of postoperative limb volume change (LVC). A prospective cohort study was performed obtaining serial limb volume measurements using a perometer on 269 women undergoing surgery for breast cancer. Four groups were created based on maximum LVC: none < 5.0%, mild 5.0-9.9%, moderate 10.0-14.9%, and severe 15.0%. Symptoms and QOL were assessed. 81 (30.1%), 70 (26.0%), and 14 (5.2%) women developed mild, moderate, and severe LVC, respectively. Increases in body mass index (p < 0.001) and post-operative complications (p = 0.002) were associated with increasing LVC. Lower QOL scores were associated with a moderate LVC (OR = 3.72, 95% CI, 1.29-10.73, p = 0.015) and postoperative infections (OR = 5.04, 95% CI, 1.73-14.70, p = 0.003). LVC at 5.0% occurs in up to 61.3% of breast cancer survivors and is associated with a significant increase in symptoms and a change in reported quality of life.
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Neoplasias de la Mama/complicaciones , Extremidades/patología , Calidad de Vida , Sobrevivientes/psicología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Encuestas y Cuestionarios , Tasa de SupervivenciaRESUMEN
The effect of a magnetic field on the steady-state and time-resolved optical emission of a custom fullerene-linked photosensitizer (PS) in liposome cell phantoms was studied at various oxygen concentrations (0.19-190 microM). Zeeman splitting of the triplet state and hyperfine coupling, which control intersystem crossing between singlet and triplet states, are altered in the presence of low magnetic fields (B < 320 mT), perturbing the luminescence intensity and lifetime as compared to the triplet state at B = 0. Measurements of the luminescence intensity and lifetime were performed using a time-domain apparatus integrated with a magnet. We propose that by probing magnet-affected optical emissions, one can monitor the state of oxygenation throughout the course of photodynamic therapy. Since the magnetic field effect (MFE) operates primarily by affecting the radical ion pairs related to type I photodynamic action, the enhancement or suppression of the MFE can be used as a measure of the dynamic equilibrium between the type I and II photodynamic pathways. The unique photo-initiated charge-transfer properties of the PS used in this study allow it to serve as both cytotoxic agent and oxygen probe that can provide in situ dosimetric information at close to real time.
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Sustancias Luminiscentes/química , Magnetismo , Oxígeno/análisis , Fotoquimioterapia , Fármacos Fotosensibilizantes/química , Fulerenos/química , Sustancias Luminiscentes/síntesis química , Fantasmas de Imagen , Fármacos Fotosensibilizantes/síntesis química , Factores de TiempoRESUMEN
Metastatic melanoma cells express a number of protein tyrosine kinases (PTKs) that are considered to be targets for imatinib. We conducted a phase II trial of imatinib in patients with metastatic melanoma expressing at least one of these PTKs. Twenty-one patients whose tumours expressed at least one PTK (c-kit, platelet-derived growth factor receptors, c-abl, or abl-related gene) were treated with 400 mg of imatinib twice daily. One patient with metastatic acral lentiginous melanoma, containing the highest c-kit expression among all patients, had dramatic improvement on positron emission tomographic scan at 6 weeks and had a partial response lasting 12.8 months. The responder had a substantial increase in tumour and endothelial cell apoptosis at 2 weeks of treatment. Imatinib was fairly well tolerated: no patient required treatment discontinuation because of toxicity. Fatigue and oedema were the only grade 3 or 4 toxicities that occurred in more than 10% of the patients. Imatinib at the studied dose had minimal clinical efficacy as a single-agent therapy for metastatic melanoma. However, based on the characteristics of the responding tumour in our study, clinical activity of imatinib, specifically in patients with melanoma with certain c-kit aberrations, should be examined.
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Antineoplásicos/uso terapéutico , Melanoma/tratamiento farmacológico , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Secuencia de Bases , Benzamidas , Cartilla de ADN , Progresión de la Enfermedad , Femenino , Humanos , Mesilato de Imatinib , Masculino , Melanoma/irrigación sanguínea , Melanoma/diagnóstico por imagen , Melanoma/secundario , Persona de Mediana Edad , Piperazinas/efectos adversos , Tomografía de Emisión de Positrones , Pirimidinas/efectos adversos , Neoplasias Cutáneas/irrigación sanguínea , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Resultado del TratamientoRESUMEN
In embryonic stem (ES) cells, leukemia inhibitory factor (LIF)/STAT3, wnt and nodal/activin signaling are mainly active to control pluripotency during expansion. To maintain pluripotency, ES cells are typically cultured on feeder cells of varying origins. Murine ES cells are commonly cultured on murine embryonic fibroblasts (MEFs), which senesce early and must be frequently prepared. This process is laborious and leads to batch variation presenting a challenge for high-throughput ES cell expansion. Although some cell lines can be sustained by exogenous LIF, this method is costly. We present here a novel and inexpensive culture method for expanding murine ES cells on human foreskin fibroblast (HFF) feeders. After 20 passages on HFFs without LIF, ES cell lines showed normal expression levels of pluripotency markers, maintained a normal karyotype and retained the ability to contribute to the germline. As HFFs do not senesce for at least 62 passages, they present a vast supply of feeders.
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Células Madre Embrionarias/citología , Fibroblastos/citología , Prepucio/citología , Animales , Biomarcadores/metabolismo , Diferenciación Celular , Células Cultivadas , Técnicas de Cocultivo/métodos , Citocinas/genética , Femenino , Citometría de Flujo , Perfilación de la Expresión Génica , Humanos , Inmunohistoquímica , Cariotipificación , Factor Inhibidor de Leucemia , Masculino , Ratones , Ratones Endogámicos , Células Madre Pluripotentes/citología , ARN Mensajero/genética , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
BACKGROUND: This study examined the various approaches to the management of perforation and the associated outcomes in patients with bevacizumab-associated bowel perforation at a tertiary cancer center. PATIENTS AND METHODS: Our institutional pharmacy database was searched to identify all patients who had received bevacizumab over a 2-year period (January 2004 to October 2006). Medical records of these patients were examined for reports of confirmed bowel perforation or fistula, associated clinicopathological factors, treatment, and outcomes. RESULTS: We identified 1442 patients who had been treated with bevacizumab over the study period with perforation occurring in 24 (1.7%). The breakdown of these 24 patients by disease site was as follows: ovarian (3 of 50, 6%), gastroesophageal (2 of 38, 5.3%), pancreatic (7 of 141, 5%), unknown primary (1 of 60, 1.7%), lung (1 of 67, 1.5%), colorectal (6 of 478, 1.3%), and renal cell (4 of 269, 1.5%). The majority of patients (n = 19, 79%) were initially managed nonoperatively. Only five (21%) patients ultimately underwent surgical exploration, with a subsequent anastomotic leak developing in one patient. The overall 30-day mortality rate was 12.5%. CONCLUSIONS: Bevacizumab-associated bowel perforation occurs in patients with various malignancies, with an incidence of 1.7%. Nonoperative treatment is a viable approach to management in selected patients.
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Anticuerpos Monoclonales/efectos adversos , Perforación Intestinal/inducido químicamente , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab , Humanos , Incidencia , Perforación Intestinal/mortalidad , Perforación Intestinal/terapia , Metástasis de la Neoplasia , Neoplasias/tratamiento farmacológico , Neoplasias/mortalidad , Tasa de SupervivenciaRESUMEN
Nematodes change their surface compositions in response to environmental signals, which may allow them to survive attacks from microbial pathogens or host immune systems. In the free-living species Caenorhabditis elegans, wild-type worms are induced to display an L1 (first larval stage) surface epitope at later larval stages when grown on an extract of spent culture medium (Inducible Larval Display or ILD). Before this study, it was not known whether ILD was regulated by the well-characterized, neurologically based chemical senses of C. elegans, which mediate other behavioural and developmental responses to environmental signals such as chemotaxis and formation of the facultatively arrested dauer larva stage. We show here that ILD requires the activities of three genes that are essential for the function of the C. elegans chemosensory neurons. ILD was abolished in chemotaxis-defective che-3, osm-3 and tax-4 mutants. In contrast, chemotaxis-defective mutants altered in a different gene, srf-6, show constitutive display of the L1 epitope on all four larval stages. The ILD-defective che-3, osm-3 and tax-4 mutations blocked the constitutive larval display of an srf-6 mutant. Combining srf-6 and certain dauer-constitutive mutations in double mutants enhanced constitutive dauer formation, consistent with the idea that srf-6 acts in parallel with specific components of the dauer formation pathway. These results taken together are consistent with the hypothesis that ILD is triggered by environmental signals detected by the nematode's chemosensory neurons.
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Proteínas de Caenorhabditis elegans/genética , Caenorhabditis elegans/genética , Células Quimiorreceptoras/fisiología , Factores Quimiotácticos/genética , Regulación del Desarrollo de la Expresión Génica/fisiología , Olfato/fisiología , Animales , Antígenos de Superficie/genética , Antígenos de Superficie/metabolismo , Caenorhabditis elegans/inmunología , Caenorhabditis elegans/metabolismo , Proteínas de Caenorhabditis elegans/inmunología , Proteínas de Caenorhabditis elegans/metabolismo , Factores Quimiotácticos/inmunología , Factores Quimiotácticos/metabolismo , Quimiotaxis/fisiología , Dineínas/genética , Dineínas/inmunología , Dineínas/metabolismo , Epítopos/genética , Epítopos/inmunología , Epítopos/metabolismo , Regulación del Desarrollo de la Expresión Génica/inmunología , Canales Iónicos/genética , Canales Iónicos/metabolismo , Cinesinas/genética , Cinesinas/metabolismo , Larva/crecimiento & desarrollo , Larva/inmunología , Larva/metabolismo , Proteínas Mutantes/genética , Proteínas Mutantes/inmunología , Proteínas Mutantes/metabolismo , Piel/inmunología , Piel/metabolismoRESUMEN
BACKGROUND: Women with breast cancer are more frequently being treated with preoperative neoadjuvant chemotherapy. The reliability of sentinel lymph node biopsy (SLNB) following chemotherapy has not been determined. This was a meta-analysis of studies that examined the results of SLNB after preoperative chemotherapy. METHODS: Included articles had to meet two criteria. First, patients had to have had operable breast cancer and to have undergone SLNB after preoperative chemotherapy and, second, patients had to have undergone subsequent axillary lymph node dissection. Meta-analyses were performed in which Bayesian hierarchical models were created to estimate the identification rate (IR) and sensitivity of SLNB in this setting. RESULTS: Twenty-one studies were identified that included a total of 1273 patients. The IRs reported ranged from 72 to 100 per cent, with a pooled estimate of 90 per cent. The sensitivity of SLNB ranged from 67 to 100 per cent, with a pooled estimate of 88 (95 per cent confidence interval 85 to 90) per cent. Meta-analyses performed using Bayesian modelling resulted in (posterior) estimates for IR and sensitivity of 91 (95 per cent credible interval 88 to 94) and 88 (95 per cent credible interval 84 to 91) per cent respectively. CONCLUSION: SLNB is a reliable tool for planning treatment after preoperative chemotherapy.