Surgical Treatment of Recurrent Endometrial Cancer: Time for a Paradigm Shift.

BACKGROUND Although surgery represents the cornerstone treatment of endometrial cancer at initial diagnosis, scarce data are available in recurrent setting. The purpose of this study was to review the outcome of surgery in these patients. METHODS Medical records of all patients undergoing surgery for recurrent endometrial cancer at NCI Milano between January 2003 and January 2014 were reviewed. Survival was determined from the time of surgery for recurrence to last follow-up. Survival was estimated using Kaplan-Meier methods. Differences in survival were analyzed using the log-rank test. The Fisher's exact test was used to compare optimal versus suboptimal cytoreduction against possible predictive factors. RESULTS Sixty-four patients were identified. Median age was 66 years. Recurrences were multiple in 38 % of the cases. Optimal cytoreduction was achieved in 65.6 %. Median OR time was 165 min, median postoperative hemoglobin drop was 2.4 g/dl, and median length hospital stay was 5.5 days. Eleven patients developed postoperative complications, but only four required surgical management. Estimated 5-year progression-free survival (PFS) was 42 and 19 % in optimally and suboptimally cytoreduced patients, respectively. At multivariate analysis, only residual disease was associated with PFS. Estimated 5-year overall survival (OS) was 60 and 30 % in optimally and suboptimally cytoreduced patients, respectively. At multivariate analysis, residual disease and histotype were associated with OS. At multivariate analysis, only performance status was associated with optimal cytoreduction. CONCLUSIONS Secondary cytoreduction in endometrial cancer is associated with long PFS and OS. The only factors associated with improved long-term outcome are the absence of residual disease at the end of surgical resection and histotype.

A multifactorial analysis of explicitation in translation

The search for translation universals has been an important topic in translation studies over the past decades. In this paper, we focus on the notion of explicitation through a multifaceted study of causal connectives, integrating four different variables: the role of the source and the target languages, the influence of specific connectives and the role of the discourse relation they convey. Our results indicate that while source and target languages do not globally influence explicitation, specific connectives have a significant impact on this phenomenon. We also show that in English and French, the most frequently used connectives for explicitation share a similar semantic profile. Finally, we demonstrate that explicitation also varies across different discourse relations, even when they are conveyed by a single connective.

Do Exposure Suits Produce a 'Race to File'? An Economic Analysis of a Tort for Risk

Conventional tort law does not allow victims of exposure to a toxic substance to seek compensation until they develop actual symptoms of illness. This may effectively bar recovery because at the time the illness arises, injurers may be judgment proof. One possible response is to allow a tort for risk that allows victims to seek expected damages at the time of exposure. However, critics charge that this could create a 'race to file' wherein victims rush to file suit to ensure that they will get a share of the injurer's limited assets. We show that such a race may or may not occur in equilibrium, and that when it does occur, not all victims choose to file at exposure if bankruptcy is an inevitable result. If bankruptcy is not inevitable, it is possible that a tort for risk will trigger bankruptcy, although a no-bankruptcy equilibrium always exists and Paretodominates the bankruptcy equilibrium. We examine the consequences of the various tort-for-risk equilibria on the compensation of exposure victims, litigation costs, and injurer care.

Analysis of the LIFO inventory valuation method during the onset of IFRS

I propose that the Last in, First out (LIFO) inventory valuation method needs to be reevaluated. I will evaluate the impact of the LIFO method on earnings of publically traded companies with a LIFO reserve over the past 10 years. I will begin my proposal with the history of how the LIFO method became an acceptable valuation method and discuss the significance of LIFO within the accounting profession Next I will provide a description of LIFO, the First in, First out (FIFO), and the weighted average inventory valuation methods and explore the differences among each. More specifically, I will explore the arguments for and against the use of the LIFO method and the potential shift towards financial standards that do not allow LIFO (a standard adopted and influenced by the International Financial Accounting Standards Board). Data will be collected from Compustat for publicly traded companies (with a LIFO Reserve) for the past 10 years. I will document which firms use LIFO, analyze trends relating to LIFO usage and LIFO reserves (the difference in the cost of inventory between using LIFO and FIFO), and evaluate the effect on earnings. The purpose of this research is to evaluate the accuracy of LIFO in portraying earnings and to see how much tax has gone uncollected over the years because of the use of LIFO. Moreover, I will provide an opinion as to whether U.S. GAAP should adopt a standard similar to IFRS and ban the LIFO method.

Performance tiers: Implementing comparative effectiveness analysis in the health care setting through operations research and spatial methods

This dissertation develops and tests a comparative effectiveness methodology utilizing a novel approach to the application of Data Envelopment Analysis (DEA) in health studies. The concept of performance tiers (PerT) is introduced as terminology to express a relative risk class for individuals within a peer group and the PerT calculation is implemented with operations research (DEA) and spatial algorithms. The analysis results in the discrimination of the individual data observations into a relative risk classification by the DEA-PerT methodology. The performance of two distance measures, kNN (k-nearest neighbor) and Mahalanobis, was subsequently tested to classify new entrants into the appropriate tier. The methods were applied to subject data for the 14 year old cohort in the Project HeartBeat! study.^ The concepts presented herein represent a paradigm shift in the potential for public health applications to identify and respond to individual health status. The resultant classification scheme provides descriptive, and potentially prescriptive, guidance to assess and implement treatments and strategies to improve the delivery and performance of health systems. ^

Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

Analysis of p53 function and regulation

p53 is a tumor suppressor gene that is the most frequent target inactivated in cancers. Overexpression of wild-type p53 in rat embryo fibroblasts suppresses foci formation by other cooperating oncogenes. Introduction of wild-type p53 into cells that lack p53 arrests them at the G1/S boundary and reverses the transformed phenotype of some cells. The function of p53 in normal cells is illustrated by the ability of p53 to arrest cells at G1 phase of the cell cycle upon exposure to DNA-damaging agents including UV-irradiation and biosynthesis inhibitors.^ Since the amino acid sequence of p53 suggested that it may function as a transcription factor, we used GAL4 fusion assays to test that possibility. We found that wild-type p53 could specifically activate transcription when anchored by the GAL4 DNA binding domain. Mutant p53s, which have lost the ability to suppress foci formation by other oncogenes, were not able to activate transcription in this assay. Thus, we established a direct correlation between the tumor suppression and transactivation functions of p53.^ Having learned that p53 was a transcriptional activator, we next sought targets of p53 activation. Because many transcription factors regulate their own expression, we tested whether p53 had this autoregulatory property. Transient expression of wild-type p53 in cells increased the levels of endogenous p53 mRNA. Cotransfection of p53 together with a reporter bearing the p53 promoter confirmed that wild-type p53 specifically activates its own promoter. Deletion analysis from both the 5$\sp\prime$ and 3$\sp\prime$ ends of the promoter minimized the region responsible for p53 autoregulation to 45 bp. Methylation interference identified nucleotides involved in protein-DNA interaction. Mutations within this protected site specifically eliminated the response of the promoter to p53. In addition, multiple copies of this element confer responsiveness to wild-type p53 expression. Thus, we identified a F53 responsive element within the p53 promoter.^ The presence of a consensus NF-$\kappa$B site in the p53 promoter suggested that NF-KB may regulate p53 expression. Gel-shift experiments showed that both the p50 homodimer and the p50/p65 heterodimer bind to the p53 promoter. In addition, the p65 subunit of NF-$\kappa$B activates the p53 promoter in transient transfection experiments. TNF $\alpha$, a natural NF-$\kappa$B inducer, also activates the p53 promoter. Both p65 activation and TNF $\alpha$ induction require an intact NF-$\kappa$B site in the p53 promoter. Since NF-$\kappa$B activation occurs as a response to stress and p53 arrests cells in G1/S, where DNA repair occurs, activation of p53 by NF-$\kappa$B could be a mechanism by which cells recover from stress.^ In conclusion, we provided the first data that wild-type p53 functions as a transcriptional activator, whereas mutant p53 cannot. The correlation between growth suppression and transcriptional activation by p53 implies a pathway of tumor suppression. We have analyzed upstream components of the pathway by the identification of both p53 and NF-$\kappa$B as regulators of the p53 promoter. ^

NMR structural analysis of cardiac troponin C: Monitoring conformational changes induced by binding calcium, troponin I, and calcium -sensitizing drugs

Contraction of cardiac muscle is regulated through the Ca2+ dependent protein-protein interactions of the troponin complex (Tn). The critical role cardiac troponin C (cTnC) plays as the Ca2+ receptor in this complex makes it an attractive target for positive inotropic compounds. In this study, the ten Met methyl groups in cTnC, [98% 13C ϵ]-Met cTnC, are used as structural markers to monitor conformational changes in cTnC and identify sites of interaction between cTnC and cardiac troponin I (cTnI) responsible for the Ca2+ dependent interactions. In addition the structural consequences that a number of Ca2+-sensitizing compounds have on free cTnC and the cTnC·cTnI complex were characterized. Using heteronuclear NMR experiments and monitoring chemical shift changes in the ten Met methyl 1H-13C correlations in 3Ca2+ cTnC when bound to cTnI revealed an anti-parallel arrangement for the two proteins such that the N-domain of cTnI interacts with the C-domain of cTnC. The large chemical shifts in Mets-81, -120, and -157 identified points of contact between the proteins that include the C-domain hydrophobic surface in cTnC and the A, B, and D helical interface located in the regulatory N-domain of cTnC. TnI association [cTnI(33–80), cTnI(86–211), or cTnI(33–211)] was found also to dramatically reduce flexibility in the D/E central linker of cTnC as monitored by line broadening in the Met 1H- 13C correlations of cTnC induced by a nitroxide spin label, MTSSL, covalently attached to cTnC at Cys 84. TnI association resulted in an extended cTnC that is unlike the compact structure observed for free cTnC. The Met 1H-13C correlations also allowed the binding characteristics of bepridil, TFP, levosimendan, and EMD 57033 to the apo, 2Ca2+, and Ca2+ saturated forms of cTnC to be determined. In addition, the location of drug binding on the 3Ca2+cTnC·cTnI complex was identified for bepridil and TFP. Use of a novel spin-labeled phenothiazine, and detection of isotope filtered NOEs, allowed identification of drug binding sites in the shallow hydrophobic cup in the C-terminal domain, and on two hydrophobic surfaces on N-regulatory domain in free 3Ca2+ cTnC. In contrast, only one N-domain drug binding site exists in 3Ca2+ cTnC·cTnI complex. The methyl groups of Met 45, 60 and 80, which are grouped in a hydrophobic patch near site II in cTnC, showed the greatest change upon titration with bepridil or TFP, suggesting that this is a critical site of drug binding in both free cTnC and when associated with cTnI. The strongest NOEs were seen for Met-60 and -80, which are located on helices C and D, respectively, of Ca2+ binding site II. These results support the conclusion that the small hydrophobic patch which includes Met-45, -60, and -80 constitutes a drug binding site, and that binding drugs to this site will lead to an increase in Ca2+ binding affinity of site II while preserving maximal cTnC activity. Thus, the subregion in cTnC makes a likely target against which to design new and selective Ca2+-sensitizing compounds. ^

(Data S1) Palynological analysis of IODP and ODP sediment cores around the Antarctic margin

The circum-Antarctic Southern Ocean is an important region for global marine food webs and carbon cycling because of sea-ice formation and its unique plankton ecosystem. However, the mechanisms underlying the installation of this distinct ecosystem and the geological timing of its development remain unknown. Here, we show, on the basis of fossil marine dinoflagellate cyst records, that a major restructuring of the Southern Ocean plankton ecosystem occurred abruptly and concomitant with the first major Antarctic glaciation in the earliest Oligocene (~33.6 million years ago). This turnover marks a regime shift in zooplankton-phytoplankton interactions and community structure, which indicates the appearance of eutrophic and seasonally productive environments on the Antarctic margin. We conclude that earliest Oligocene cooling, ice-sheet expansion, and subsequent sea-ice formation were important drivers of biotic evolution in the Southern Ocean.

Zircon U-Pb and Hf-O analysis of porphyries from the Duolong porphyry Cu-Au deposit in the Bangongco copper belt, central Tibet

The Duolong porphyry Cu-Au deposit (5.4 Mt at 0.72% Cu, 41 t at 0.23 g/t Au), which is related to the granodiorite porphyry and the quartz-diorite porphyry from the Bangongco copper belt in central Tibet, formed in a continental arc setting. Here, we present the zircon U-Pb ages, geochemical whole-rock, Sr-Nd whole-rock and zircon in-situ Hf-O isotopic data for the Duolong porphyries. Secondary ion mass spectrometry (SIMS) zircon U-Pb analyses for six samples yielded consistent ages of ~118 Ma, indicating a Cretaceous formation age. The Duolong porphyries (SiO2 of 58.81-68.81 wt.%, K2O of 2.90-5.17 wt.%) belong to the high-K calc-alkaline series. They show light rare earth element (LREE)-enriched distribution patterns with (La/Yb)N = 6.1-11.7, enrichment in large ion lithophile elements (e.g., Cs, Rb, and Ba) and depletion of high field strength elements (e.g., Nb), with negative Ti anomalies. All zircons from the Duolong porphyries share relatively similar Hf-O isotopic compositions (d18O=5.88-7.27 per mil; eHf(t)=3.6-7.3), indicating that they crystallized from a series of cogenetic melts with various degrees of fractional crystallization. This, along with the general absence of older inherited zircons, rules out significant crustal contamination during zircon growth. The zircons are mostly enriched in d18O relative to mantle values, indicating the involvement of an 18O-enriched crustal source in the generation of the Duolong porphyries. Together with the presence of syn-mineralization basaltic andesite, the mixing between silicic melts derived from the lower crust and evolved H2O-rich mafic melts derived from the metsomatizied mantle wedge, followed by subsequent fractional crystallization (FC) and minor crustal contamination in the shallow crust, could well explain the petrogenesis of the Duolong porphyries. Significantly, the hybrid melts possibly inherited the arc magma characteristics of abundant F, Cl, Cu, and Au elements and high oxidation state, which contributed to the formation of the Duolong porphyry Cu-Au deposit.

Pollen analysis of sediment cores from the mouth of the river Congo to Walvis Bay and Lüderitz

The distribution of pollen in marine sediments is used to record vegetation changes over the past 30,000 years on the adjacent continent. A transect of marine pollen sequences from the mouth of the river Congo (~5°S) to Walvis Bay and Lüderitz (~25°S) shows vegetation changes in Congo, Angola and Namibia from the last glacial period into the Holocene. The comparison of pollen records from different latitudes provides information about the latitudinal shift of open forest and savannahs (Poaceae pollen), the extension of lowland forest (rain forest pollen) and Afromontane forest (Podocarpus pollen), and the position of the desert fringe (pollen of Caryophyllaceae, Chenopodiaceae and Amaranthaceae). High Cyperaceae pollen percentages in sediments from the last glacial period off the mouth of the river Congo suggest the presence of open swamps rather than savannah vegetation in the Congo Basin. Pollen from Restionaceae in combination with Stoebe-type pollen (probably from Elytropappus) indicates a possible northwards extension of winter rain vegetation during the last glacial period. The record of Rhizophora (mangrove) pollen is linked to erosion of the continental shelf and sea-level rise. Pollen influx is highest off river mouths (10-2000 grains year**-1 cm**-2), close to the coast (300-6000 grains year**-1 cm**-2), but is an order of magnitude lower at sites situated far from the continent (<10 grains year**-1 cm**-2).

Diatom and hydrocarbon analysis of sediment core NBP00-03-JPC38

In this study, we present a unique high-resolution Holocene record of oceanographic and climatic change based on analyses of diatom assemblages combined with biomarker data from a sediment core collected from the Vega Drift, eastern Antarctic Peninsula (EAP). These data add to the climate framework already established by high-resolution marine sedimentary records from the Palmer Deep, western Antarctic Peninsula (WAP). Heavy sea ice conditions and reduced primary productivity were observed prior to 7.4 ka B.P. in relation with the proximity of the glacial ice melt and calving. Subsequent Holocene oceanographic conditions were controlled by the interactions between the Westerlies-Antarctic Circumpolar Current (ACC)-Weddell Gyre dynamics. A warm period characterized by short seasonal sea ice duration associated with a southern shift of both ACC and Westerlies field persisted until 5 ka B.P. This warm episode was then followed by climate deterioration during the middle-to-late Holocene (5 to 1.9 ka B.P.) with a gradual increase in annual sea ice duration triggered by the expansion of the Weddell Gyre and a strong oceanic connection from the EAP to the WAP. Increase of benthic diatom species during this period was indicative of more summer/autumn storms, which was consistent with changes in synoptic atmospheric circulation and the establishment of low- to high-latitude teleconnections. Finally, the multicentennial scale variability of the Weddell Gyre intensity and storm frequency during the late Holocene appeared to be associated with the increased El Niño-Southern Oscillation frequency.

Silt grain-size analysis of ODP holes from the western equatorial Atlantic

Grain-size records of the terrigenous and calcareous silt fraction, preservation of planktic foraminifera, and benthic foraminiferal stable-isotope data (delta13C, delta18O values of C. wuellerstorfi) at ODP Site 927 on the Ceará Rise (5°27.7'N, 44°28.8'W), are used to reconstruct variations in the history of bottom current strength, ventilation, and carbonate corrosiveness of deep waters during the time interval from 0.8 to 0.3 Ma. Glacial periods are characterized by generally smaller mean sizes of the terrigenous sortable silt fraction (mean(SS)), lower delta13C values, and poorer preservation of planktic foraminifera compared to interglacials. This indicates lower bottom current speeds, larger nutrient contents and more corrosive deep water. By contrast, larger mean(SS) sizes, higher delta13C values, and well preserved planktic foraminifera indicate strong circulation and a well ventilated deep-water mass during interglacials. The observed changes are most likely related to the weakening and strengthening of circulation of Lower North Atlantic Deep Water (LNADW). Cross-spectral analysis between the mean(SS) and benthic delta18O records reveals that minima in mean(SS) occur about 7.6 k.y. after the maximum in ice volume. This indicates a considerable lag time between ice-shield induced changes in LNADW production and subsequent changes in the velocity of LNADW flow in the western equatorial Atlantic. Striking changes in bottom current speed occur regularly during glacial to interglacial transitions. Extremely fine mean(SS) minima point to an almost complete shutdown of bottom current vigor in response to a cessation of LNADW production caused by an enhanced melt water release during the initial phases of deglaciation. However, each of the fine minima extremes is followed by a rapid shift to very high mean(SS) values that indicate strong bottom currents, and hence, vigorous LNADW flow during the early interglacials. After the onset of glacial Stage 12, generally poorer carbonate preservation and higher variability is registered. This coincides with a global decrease in carbonate preservation during the mid-Brunhes (mid-Brunhes dissolution event). Detailed grain-size analysis of the calcareous fine fraction (<63 µm) revealed a considerable reduction of particles in the fraction from 7 to 63 µm during periods of enhanced dissolution. This indicates a preferential dissolution of larger planktic foraminiferal fragments which leads to an enrichment of coccoliths in the calcareous fine fraction.

Stable isotope analysis of jellyfish in Kiel Fjord, Western Baltic Sea during POLARFUCHS cruises (June - October 2011)

A temporal change in stable isotope (SI) composition of jellyfish in the Kiel Fjord, Western Baltic Sea, was documented by analyzing delta13C, delta15N and delta34S of bell tissue of Aurelia aurita and Cyanea capillata in the period between June and October 2011. A strong and significant temporal change in all SI values of A. aurita was found, including an increase of ~3permille in delta13C, a decrease of ~4permille in delta15N and sharp decline of ~7permille in delta34S. Sampling from 18 m to surface.

(Table 1) Different age analysis from sediment cores XP98-PC-4 and XP98-PC-2

Sea-surface temperatures (SSTs) in the Sea of Okhotsk were reconstructed based on alkenone unsaturation indices in two sediment cores. Alkenone-SSTs were found to range from 3 to 9 °C over the last 85 kyr with higher SST values in warm periods: Holocene and the oxygen isotope stage (OIS) 5a. In the last glacial periods (OIS 4 and 3), average alkenone SST was estimated to be 4 °C, which was 4 °C lower than the Holocene on average. However, alkenone SSTs around the last glacial maximum (LGM) are as high as those of the Holocene. The variation patterns of U37K' in the Okhotsk Sea were found to be similar to those reported in the Sea of Japan [Org. Chem. 32 (2001) 57] over the last 30 kyr, although the SSTs were lower in the Sea of Okhotsk. The higher U37K' values around the LGM may be a rather common phenomenon in semi-closed marginal seas such as the Japan Sea and the Okhotsk Sea, which are both adjacent to the northwestern Pacific. Such an anomaly in the LGM may have been caused by either a seasonal shift of coccolith blooming or a contribution from a different strain or species that produces alkenones