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Branching pattern in the evolutionary tree for human mitochondrial DNA.

Eighty-eight types of mitochondrial (mt) DNA were found by sequencing the most variable part of the control region from 117 Caucasians. In the tree relating those types, most of the branching events occur about two-thirds of the way from the root of the tree to the tips of the branches. Moreover, the distribution of sequence differences between all possible pairs of individuals is approximately Poisson. Other non-African populations show a similar pattern. Assuming a neutral model, these findings imply that the probability of survival of new lineages has undergone dramatic changes, probably due to population expansion. Conversely, African populations show multimodal distributions fitting with a model of constant population size.

Animals↗

Modification of DiFrancesco-Noble equations to simulate the effects of vagal stimulation on in vivo mammalian sinoatrial node electrical activity.

We present a new mathematical model for vagal control of rabbit sinoatrial (SA) node electrical activity based on the DiFrancesco-Noble equations. The original equations were found to be unstable, resulting in progressive cycle by cycle depletion or accumulation of ions in intra- and extracellular compartments. This problem was overcome by modifying the maximum Na-K pump current and the time constant for uptake of intracellular calcium. We also included a formulation for the acetylcholine (ACh)-activated potassium current which was consistent with experimental data. This formulation was based on kinetics first proposed by Osterrieder and later modified by Yanagihara. The resulting model exhibits cycle-cycle ionic stability, and includes an ACh-activated potassium current which accurately reproduces experimentally observed effects of vagal stimulation on both the membrane potential and its time-derivative. Simulations were performed for both brief-burst and prolonged vagal stimulation using simplified square wave profiles for the concentration of ACh in the synaptic cleft space. This protocol permits the isolation of cardiac period dynamics caused by changes in membrane potential and intra- and extracellular ionic concentrations from those caused by other mechanisms including the dynamics of ACh release, diffusion, hydrolysis and washout. Simulation results for the effects of brief-burst single cycle stimulation on the cardiac period agree closely with experimental data reported in the literature, accurately reproducing changes in membrane potential and the phasic dependency of the response to the position of vagal stimulus bursts within the cycle. Simulation of the effects of prolonged vagal stimulation accurately reproduced the steady-state characteristics of heart period response, but did not yield the complex multimodal dynamics of the recovery phase, or the pronounced post vagal tachycardia observed experimentally at the termination of the stimulus. Our results show that the major chronotropic effects of vagal stimulation on the SA cell membrane can be explained in terms of the ACh-activated potassium current. The effects of this membrane current however are generally fast acting and cannot contribute to any long lasting dynamics of the cardiac period response. The modified DiFrancesco-Noble model presented in this article provides a valuable theoretical tool for further analysis of the dynamics of vagal control of the cardiac pacemaker.

Acetylcholine↗

A one‑year snapshot of pediatric regional anesthesia at a French Tertiary University Hospital.

BACKGROUND: Regional anesthesia (RA) is a major component of multimodal perioperative analgesia in children. Despite proven benefits, pediatric RA practice shows marked inter-institutional and international variability, with global practice patterns remaining largely underreported. This study aimed to characterize current RA practices in a pediatric anesthesia department of a French tertiary university hospital. METHODS: This retrospective observational study of prospectively collected data over one year included all children aged 0-18 years receiving at least one RA procedure. The data analyzed comprised demographics, surgical characteristics, RA techniques, guidance methods, and pharmacologic agents. Each RA procedure was considered an independent event, and patients were stratified into five age groups. RESULTS: Over the study period, 907 patients (6.0 [1.0; 12.0] years) underwent 1073 RA procedures: 894 peripheral blocks (83%) and 179 neuraxial blocks (17%). Peripheral blocks predominated in children >6 months (90%), while 59% of neuraxial RA were in infants <6 months. RA was conducted under general anesthesia in 90% of cases; awake spinal anesthesia in small infants comprised most neuraxial procedures. Ultrasound guidance was used in 98% of peripheral blocks, and pre-puncture scanning preceded 22% of neuraxial procedures. Clonidine was used as an adjuvant in >60% of cases. CONCLUSIONS: This single-center cohort reports one year of pediatric RA practice, characterized by high RA implementation rates. While ultrasound guidance was standard for peripheral blocks, pre-puncture scanning remains infrequently used for neuraxial techniques, highlighting a potential margin for improvement based on current practice. Results highlight selective neuraxial strategies in vulnerable infants and routine adjuvant use to optimize postoperative analgesia. Findings confirm RA feasibility in daily pediatric anesthesia and support multicenter studies evaluating inter-institutional variability and outcomes impact.

Humans↗

Outcomes for endoscopic resection of sinonasal squamous cell carcinoma.

OBJECTIVES: Preliminary data suggest efficacy for the endoscopic approach for sinonasal malignancy. The purpose of this study is to evaluate the effectiveness of the endoscopic approach for the resection of sinonasal squamous cell carcinoma (SCC). STUDY DESIGN: Retrospective analysis of patients undergoing endoscopic resection of sinonasal SCC from August 1996 to May 2004. METHODS: Eleven patients were treated with curative intent. Demographic data, histopathology, extent of tumor involvement, and need for adjunctive radiation or chemotherapy were determined. Local recurrence (LR), distant metastasis, overall survival (OS), and disease-free survival (DFS) rates were calculated. RESULTS: The mean age for the patient population was 62.5 (52-85) years with a male:female ratio of 8:3. Multimodality therapy including radiation or chemotherapy was used in 8 of 11 (73%) patients. Seven patients were resected using strictly an endoscopic approach, whereas four required combined endoscopic and neurosurgical resection. LR and distant metastatic rates were 20% and 0%, respectively. OS and DFS were both 91%, with mean follow-up of 31.5 (range 6-88) months. CONCLUSIONS: Endoscopic resection in combination with multimodality therapy is an effective method for curative resection of sinonasal SCC. In this preliminary study, it facilitated complete resection with acceptable LR and DFS rates.

Aged↗

Factor analysis of clinical data from asbestos workers: implications for diagnosis and screening.

Clinical data from 624 asbestos exposed workers were analysed by factor analysis. Fifteen clinical variables were found to reflect several underlying factors: "obstruction," "interstitial disorder," "x ray change," "air tapping," and "age/exposure." Scoring individual subjects along these axes can facilitate identifying early cases and avoiding false diagnosis. The analysis suggests that screening should be multimodal and that radiographic abnormality need not imply physiological impairment.

Asbestosis↗

[Local tumor control and (disease-free) survival after surgery with pre- and intraoperative radiotherapy for primary non-resectable rectal carcinoma and local recurrence].

OBJECTIVE: Survey of the results of multimodality treatment for primary irresectable rectum carcinoma and local recurrence of rectal cancer. DESIGN: Retrospective. METHODS: During the period 1 February 1994 to 31 August 1999, 43 patients with locally advanced primary rectal cancer (25 men and 18 women; mean age: 64 years (range: 36-86)) and 53 patients with a local recurrence (33 men and 20 women; mean age: 61 years (39-82)) were treated with a multimodality treatment: i.e. preoperative radiotherapy (doses 50.4 Gy, or 30.0 Gy in the case of reirradiation), extensive surgery and intraoperative radiotherapy (doses 10-17.5 Gy). This treatment took place at two hospitals in the Netherlands, the Catharina Hospital in Eindhoven and, since 1997, the Daniel den Hoed Cancer Centre in Rotterdam. In 2000 data were collected for the local control and (disease-free) survival; these were analysed using the Kaplan-Meier method. Patients also completed a questionnaire about the quality of life at a median period of 14 months (range: 4-60) after the operation; the response level was 96% (76/79). RESULTS: After 3 years, the local control, disease-free survival and survival rates for the locally advanced primary rectal cancer group were 74%, 60% and 55% respectively, and for the locally recurrent rectal cancer group 64%, 34% and 50% respectively. Tumour resection with microscopically negative margins had a statistically significant positive effect on the local control and disease-free survival in both groups as well as on the survival in the locally advanced primary patient group. Seven of the 96 patients (7%) died as a result of complications. Of the patients with a primary irresectable carcinoma or a local recurrent tumour who completed the questionnaire the results were as follows: 56% and 63% respectively had been able to resume employment, 53% and 59% respectively had been able to resume their previous lifestyle, 15% and 27% respectively indicated radicular pain as a new symptom, 26% and 46% respectively stated problems with walking, 42% and 44% respectively stated problems with urinating and 59% and 52% respectively a reduction in sexual activity.

Adult↗

[Guidelines for surgical and multimodal therapy of malignant soft tissue tumors].

An optimal treatment of soft tissue sarcomas is influenced by multiple factors. The high local recurrence rate is often based on inadequate surgical primary therapy. An improvement of prognosis which is still unfavourable in some patients can be achieved only if guidelines described in this paper gain increasing influence in practice. A treatment concept for soft tissue sarcomas must be worked out interdisciplinary within the knowledge of all relevant data. Surgery is just one but an essential component of therapy to be placed at the right time. To achieve a R0-resection is an important requirement for survival free of recurrence. However, the influence of a local recurrence on overall survival remains controversial. Amputations should be taken into consideration only after exhaustion of all reconstructive procedures available.

Combined Modality Therapy↗

Multivariate analysis of survival in inflammatory breast cancer: impact of intensity of chemotherapy in multimodality treatment.

The prognosis of inflammatory breast cancer (IBC) is poor. We evaluated clinical and biopathological characteristics that could affect survival in 74 women with nonmetastatic IBC consecutively treated in our institution between 1976 and 2000. Patients received primary anthracycline-based chemotherapy at conventional doses (n=20) or high-dose chemotherapy (HDC) with haematopoietic stem cell support (HSCS) (n=54). After chemotherapy, 84% of patients underwent mastectomy, 95% were given radiotherapy and 55% tamoxifen. Immunohistochemistry data (ER, PR, ERBB2, P53) on pre-chemotherapy specimens suggested strong differences between IBC and non-IBC. The rate of pathological complete response to chemotherapy was 26% (27% with HDC and 17% with conventional doses, not significant). No single factor was found predictive of response. With a median follow-up of 48 months after diagnosis, the 5-year projected disease-free survival (DFS) was 24% and overall survival (OS) 41%. In multivariate analysis, the strongest independent prognostic factor was the delivery of HDC. The 5-year DFS and OS of patients were respectively 28 and 50% with HDC and 15 and 18% with conventional chemotherapy. These results and comparisons with other series of patients suggest a role for HDC with HSCS as part of the therapeutic approach in IBC. Further prospective studies are required to confirm it.

Adult↗

Small cell carcinoma of the gallbladder.

BACKGROUND AND OBJECTIVES: Small cell carcinoma of the gallbladder is rare with only 36 cases reported in the literature. Early reports demonstrated an extremely poor prognosis for this histologic type. Five new cases are reported and the previous experience in the literature is reviewed to further clarify the clinical behavior of this malignancy. METHODS: A retrospective analysis is performed on 5 new cases. An extensive review of the literature is also performed. RESULTS: Twenty-eight pure small cell carcinomas and 8 combined small cell carcinomas with adenocarcinoma are reported in the literature. Conclusions from the literature review reveal that small cell carcinoma of the gallbladder affects an elderly patient population (median age 65 years), has a female preponderance (76%), is associated with cholelithiasis (72%), metastasizes to nodes (88%), liver (88%), lung (23%), and peritoneum (19%), and has a median survival of 4 months. Pure tumors had median survivals of 9 months and combined tumors had median survivals of 4.5 months. The 5 patients in the literature treated with surgery and chemotherapy had improved median survival of 13 months. The 5 newly reported cases had similar epidemiological characteristics to the literature data, however, these cases were managed aggressively with surgery and chemotherapy, demonstrating a median survival of 31 months. CONCLUSIONS: Although small cell carcinoma of the gallbladder is a distinct histologic and clinical entity, it has many clinical characteristics similar to adenocarcinoma of the gallbladder including comparable natural history and tendency for locoregional spread. Aggressive multimodality therapy, especially the combination of surgery and chemotherapy, may improve survival.

Adult↗

Improved prognosis of children with osteosarcoma metastatic to the lung(s) at the time of diagnosis.

BACKGROUND: A poor outcome is traditionally ascribed to osteosarcoma metastatic to the lungs, but data have been unavailable regarding the outcome of such patients after systematic treatment on clinical trials. METHODS: The clinical course and outcome of 31 patients who had osteosarcoma metastatic to the lungs diagnosed between 1962 and 1990 at St. Jude Children's Research Hospital were reviewed to determine whether the use of increasingly aggressive multimodality therapy has improved their outcome. The patients were grouped by treatment eras, based on major changes in therapy (i.e., single-agent or two-agent era, 1962-1972; standard multiagent era, 1972-1982; and intensive multiagent era, 1982-1990). RESULTS: With increasingly intensive chemotherapy, more aggressive efforts to resect metastatic disease, and earlier detection of pulmonary metastases by computed tomography, the survival of these patients has improved significantly over the 28-year study period. Those treated since 1982 have a 50% estimated probability of survival at 3 years, whereas there were no survivors at 3 years in the two earlier eras. Survival for the former group reached a plateau of 30% at 4 years. CONCLUSIONS: The use of aggressive multimodality therapy, coupled with modern pediatric imaging techniques to detect pulmonary disease, has improved the traditionally dismal outlook in pediatric patients with osteosarcoma and synchronous pulmonary metastases.

Adolescent↗

Multimodal evaluation of therapy versus consultation components in a large inner-city early intervention program.

Cincinnati's Social Skills Development Program (SSDP) used a social competence model to direct its interventions for children. Systematic screening identified 15-25% of the primary grade children who showed behavioral problems and deficits in social skills at seven elementary schools. Multimodal evaluations comparing therapy and consultation interventions included three types of assessments over a 1 year period. Tests of social skills revealed that children who received both therapy and consultation services, compared to those who received only consultation, improved in a basic empathy skill and increased their externality in locus of control. School record data showed that therapy and consultation children improved in grades; but, consultation children improved most. Finally, trained observers found that therapy children, compared to children in consultation only, increased cooperative interactions with teachers and maintained appropriate solitary behaviors. The data are discussed as providing some support for the hypothesis that therapy produced increased benefits for children compared to the less costly consultation intervention. However, since therapy and consultation conditions were not differentiated on many assessments (e.g., tests of interpersonal problem-solving and advanced empathy skills; lateness; achievement), more intense behaviorally oriented interventions may be warranted.

Child↗

Neoadjuvant strategies for non-small cell lung cancer.

During the last 15-20 years, several phase II trials have investigated the use of chemotherapy and chemoradiation prior to surgery in the management of stage IIIA non-small cell lung cancer (NSCLC). The results of these studies, in contrast to insignificant outcomes of comparative studies with chemotherapy in the postoperative setting, have been encouraging. Moreover, phase III trials comparing surgery alone with chemotherapy plus surgery have confirmed the efficacy of this multimodality approach. In recent years, newer and more effective chemotherapy combinations have become available and are now being used prior to surgery. One focus of ongoing research is to confirm that preoperative chemotherapy followed by complete resection is a better treatment approach than surgery alone, even for patients with early-stage NSCLC. Recent data suggest that induction chemotherapy in this category of patients yields high response rates and does not compromise the outcome of surgery. Given the systemic nature of lung cancer it is estimated that systemic therapy before local treatment will play an increasingly important role for patients with early-stage NSCLC.

Antineoplastic Combined Chemotherapy Protocols↗

Optimal therapy for oesophageal cancer.

Oesophageal carcinoma is one of the commonest cancers in the world and has an increasing incidence in Western civilisation. As the epidemiology of the disease has changed so too has our treatment strategies. The present standard of care is surgery but this is associated with disappointing survival figures. The role of chemotherapy and radiation is now established in inoperable disease. How best to deliver these modes of therapy has yet to be defined. Extrapolation of data from previous trials is difficult as these trials have many deficiencies and do not account for recent advances in therapeutics or techniques of delivery. The role of chemo-radiotherapy in operable disease is even more controversial. A number of prospective randomised trials of trimodality therapy versus surgery alone suggests a benefit for multimodal therapy. These trials also reveal evidence to support the use of chemo-radiotherapy alone in a subset of patients with resectable disease. The appropriate application of these varied therapeutic interventions remains unanswered. Further progress in diagnostic techniques and predictive markers may allow us to stratify patients into different treatment groups. Continued investigation is required to keep pace with the evolution of oesophageal cancer and its therapy. This will facilitate a better understanding of the disease and optimise the treatment offered to patients.

Adenocarcinoma↗

Global spectral-kinetic analysis of room temperature chlorophyll a fluorescence from light-harvesting antenna mutants of barley.

This study presents a novel measurement, and simulation, of the time-resolved room temperature chlorophyll a fluorescence emission spectra from leaves of the barley wild-type and chlorophyll-b-deficient chlorina (clo) f2 and f104 mutants. The primary data were collected with a streak-camera-based picosecond-pulsed fluorometer that simultaneously records the spectral distribution and time dependence of the fluorescence decay. A new global spectral-kinetic analysis programme method, termed the double convolution integral (DCI) method, was developed to convolve the exciting laser pulse shape with a multimodal-distributed decay profile function that is again convolved with the spectral emission band amplitude functions. We report several key results obtained by the simultaneous spectral-kinetic acquisition and DCI methods. First, under conditions of dark-level fluorescence, when photosystem II (PS II) photochemistry is at a maximum at room temperature, both the clo f2 and clo f104 mutants exhibit very similar PS II spectral-decay contours as the wild-type (wt), with the main band centred around 685 nm. Second, dark-level fluorescence is strongly influenced beyond 700 nm by broad emission bands from PS I, and its associated antennae proteins, which exhibit much more rapid decay kinetics and strong integrated amplitudes. In particular a 705-720 nm band is present in all three samples, with a 710 nm band predominating in the clo f2 leaves. When the PS II photochemistry becomes inhibited, maximizing the fluorescence yield, both the clo f104 mutant and the wt exhibit lifetime increases for their major distribution modes from the minimal 205-500 ps range to the maximal 1500-2500 ps range for both the 685 nm and 740 nm bands. The clo f2 mutant, however, exhibits several unique spectral-kinetic properties, attributed to its unique PS I antennae and thylakoid structure, indicating changes in both PS II fluorescence reabsorption and PS II to PS I energy transfer pathways compared to the wt and clo f104. Photoprotective energy dissipation mediated by the xanthophyll cycle pigments and the PsbS protein was uninhibited in the clo f104 mutant but, as commonly reported in the literature, significantly inhibited in the clo f2; the inhibited energy dissipation is partly attributed to its thylakoid structure and PS II to PS I energy transfer properties. It is concluded that it is imperative with steady-state fluorometers, especially for in vivo studies of PS II efficiency or photoprotective energy dissipation, to quantify the influence of the PS I spectral emission.

Chlorophyll↗

A qualitative evaluation of a faith-based breast and cervical cancer screening intervention for African American women.

This article presents a formative evaluation of a CDC Racial and Ethnic Approaches to Community Health (REACH) 2010 faith-based breast and cervical cancer early detection and prevention intervention for African American women living in urban communities. Focus groups were conducted with a sample of women (N=94) recruited from each church participating in the intervention. One focus group was conducted in each of the nine participating churches following completion of the 6-month REACH 2010 intervention. Transcribed data were coded to identify relevant themes. Key findings included (a) the acceptability of receiving cancer education within the context of a faith community, (b) the importance of pastoral input, (c) the effectiveness of personal testimonies and lay health advocates, (d) the saliency of biblical scripture in reinforcing health messages, (e) the effectiveness of multimodal learning aids, and (f) the relationship between cervical cancer and social stigma. Study findings have implications for enhancing faith-based breast and cervical cancer prevention efforts in African American communities.

Black or African American↗

[Effects of peptide factors from right and left brain hemispheres of rats on amplitude-time characteristics of projective and interhemispheric evoked responses].

Peptide extracts of the right and left hemispheres were applied to the projective (somatosensory and visual) and temporal associative regions of the left brain hemisphere in cats. In the zones of peptide application, evoked potentials (EP) in response to singular and coupled somatic, visual and transcallosal stimuli were registered. The data obtained showed that right and left peptide extracts had different effects on evoked potentials of the left hemisphere. Thus ipsilateral extract increased the amplitude of projective EP, decreased duration of their cycles and amplitude of transcallosal responses. Contralateral extract, on the contrary, activated interhemispheric inputs to brain cortex, suppressed thalamic inputs and increased multimodal properties of neurons. A differential approach to the problem of specific correction of pathological states of the right and left brain hemispheres is required. Right and left peptide extracts may be used in normalization of interhemispheric activity balance in compensatory-recovering processes.

Adaptation, Physiological↗

Avoiding Colostomy With Conservative Multimodality Management of Distal Rectal Cancer.

While abdominoperineal resection with permanent colostomy has been the surgical benchmark in the treatment of distal rectal carcinoma, different approaches to treatment have been sought for decades to decrease the morbidity and mortality associated with radical surgical procedures for this disease. The advent of alternative methods of sphincter preservation that afford excellent functional results has led to a decline in the incidence of abdominoperineal resection. With appropriate patient selection, accurate preoperative staging data, and the selection of a surgical approach appropriate to the tumor stage, conservative surgical approaches now can be considered in the treatment of cancer at every level of the rectum.

Journal Article↗

Hemithorax irradiation for Ewing tumors of the chest wall.

PURPOSE: In the Cooperative Ewing's Sarcoma Study 86 and the European Intergroup Cooperative Ewing's Sarcoma Study 92, hemithorax irradiation (RT) was performed in patients with Ewing tumors of the chest wall involving the pleura or contaminating the pleural cavity. In a retrospective analysis, the outcomes of these patients were evaluated and compared with those of patients with chest wall tumors who did not receive hemithorax RT. METHODS AND MATERIALS: Between 1985 and 1996, 138 patients presented with nonmetastatic Ewing tumors of the chest wall. They were treated in a multimodal treatment regimen that included polychemotherapy and local therapy depending on the tumor characteristics. Hemithorax RT was performed at a dose of 15 Gy for patients <14 years old and 20 Gy for patients >or=14 years old. Forty-two patients received hemithorax RT (Group 1) and 86 patients did not (Group 2). The data were insufficient for the other 10 patients. RESULTS: Comparing both groups, the initial pleural effusion, pleural infiltration, and intraoperative contamination of the pleural space were significantly more frequent in Group 1. The event-free survival rate after 7 years was 63% for patients in Group 1 and 46% for patients in Group 2 (not statistically significant). The 7-year local relapse rate (including combined local-systemic relapses) was 12% in Group 1 and 10% in Group 2; the corresponding systemic relapse rates were 22% and 39%. CONCLUSION: Patients with chest wall tumors who received hemithorax RT were negatively selected; yet the rate of event-free survival was better for patients who received hemithorax RT than for those who did not (although the difference was not statistically significant). This result was due to a reduction of metastases, mainly lung metastases. Local control was equivalent between the two groups. These favorable results have caused us to continue using hemithorax RT to treat high-risk patients with Ewing tumors of the chest wall.

Adolescent↗