Variability in the Treatment of Elderly Patients with Stage IIIA (N2) Non–Small-Cell Lung Cancer

INTRODUCTION: We evaluated treatment patterns of elderly patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC). METHODS: The use of surgery, chemotherapy, and radiation for patients with stage IIIA (T1-T3N2M0) NSCLC in the Surveillance, Epidemiology, and End Results-Medicare database from 2004 to 2007 was analyzed. Treatment variability was assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census track variables. Overall survival was analyzed using the Kaplan-Meier approach and Cox proportional hazard models. RESULTS: The most common treatments for 2958 patients with stage IIIA (N2) NSCLC were radiation with chemotherapy (n = 1065, 36%), no treatment (n = 534, 18%), and radiation alone (n = 383, 13%). Surgery was performed in 709 patients (24%): 235 patients (8%) had surgery alone, 40 patients (1%) had surgery with radiation, 222 patients had surgery with chemotherapy (8%), and 212 patients (7%) had surgery, chemotherapy, and radiation. Younger age (p < 0.0001), lower T-status (p < 0.0001), female sex (p = 0.04), and living in a census track with a higher median income (p = 0.03) predicted surgery use. Older age (p < 0.0001) was the only factor that predicted that patients did not get any therapy. The 3-year overall survival was 21.8 ± 1.5% for all patients, 42.1 ± 3.8% for patients that had surgery, and 15.4 ± 1.5% for patients that did not have surgery. Increasing age, higher T-stage and Charlson Comorbidity Index, and not having surgery, radiation, or chemotherapy were all risk factors for worse survival (all p values < 0.001). CONCLUSIONS: Treatment of elderly patients with stage IIIA (N2) NSCLC is highly variable and varies not only with specific patient and tumor characteristics but also with regional income level.

Search for WH production with a light Higgs boson decaying to prompt electron-jets in proton-proton collisions at sqrts=7 TeV with the ATLAS detector

A search is performed for WH production with a light Higgs boson decaying to hidden-sector particles resulting in clusters of collimated electrons, known as electron-jets. The search is performed with 2.04 fb(-1) of data collected in 2011 with the ATLAS detector at the Large Hadron Collider in proton-proton collisions at root s = 7 TeV. One event satisfying the signal selection criteria is observed, which is consistent with the expected background rate. Limits on the product of the WH production cross section and the branching ratio of a Higgs boson decaying to prompt electron-jets are calculated as a function of a Higgs boson mass in the range from 100 to 140 GeV.

Search for Extra Dimensions in diphoton events using proton-proton collisions recorded at sqrts=7 TeV with the ATLAS detector at the LHC

The large difference between the Planck scale and the electroweak scale, known as the hierarchy problem, is addressed in certain models through the postulate of extra spatial dimensions. A search for evidence of extra spatial dimensions in the diphoton channel has been performed using the full set of proton-proton collisions at root s = 7 TeV recorded in 2011 with the ATLAS detector at the CERN Large Hadron Collider. This dataset corresponds to an integrated luminosity of 4.9 fb(-1). The diphoton invariant mass spectrum is observed to be in good agreement with the Standard Model expectation. In the context of the model proposed by Arkani-Hamed, Dimopoulos and Dvali, 95% confidence level lower limits of between 2.52 and 3.92 TeV are set on the ultraviolet cutoff scale MS depending on the number of extra dimensions and the theoretical formalism used. In the context of the Randall-Sundrum model, a lower limit of 2.06 (1.00) TeV at 95% confidence level is set on the mass of the lightest graviton for couplings of k/(M) over bar (Pl) = 0.1(0.01). Combining with the ATLAS dilepton searches based on the 2011 data, the 95% confidence level lower limit on the Randall-Sundrum graviton mass is further tightened to 2.23 (1.03) TeV for k/(M) over bar (Pl) = 0.1(0.01).

Prevalence of paunch calf syndrome carriers in Italian Romagnola cattle.

The term 'paunch calf syndrome' encompasses the multi-organic lethal developmental dysplasia reported in the Romagnola breed of cattle and is characterised by facial deformities, an enlarged and floating abdomen containing considerable abdominal effusion, and hepatic fibrosis. Paunch calf syndrome is caused by a missense mutation in the KDM2B gene (c.2503G>A) that is thought to lead to an amino acid exchange (p.D835N). In this study, the prevalence of carriers of the mutant KDM2B allele (and thus the frequency of the allele) was assessed in selected subpopulations of Romagnola cattle. The prevalence of carriers within top-ranked Romagnola sires over the years 2007-2012 was 29.3% (allele frequency 14.6%). In young bull calves, 30.9% were carriers with an allele frequency of 15.4%.

Mid-term results of aortic root replacement using a self-assembled biological composite graft.

OBJECTIVES To report the mid-term results of aortic root replacement using a self-assembled biological composite graft, consisting of a vascular tube graft and a stented tissue valve. METHODS Between January 2005 and December 2011, 201 consecutive patients [median age 66 (interquartile range, IQR, 55-77) years, 31 female patients (15.4%), median logistic EuroSCORE 10 (IQR 6.8-23.2)] underwent aortic root replacement using a stented tissue valve for the following indications: annulo-aortic ectasia or ascending aortic aneurysm with aortic valve disease in 162 (76.8%) patients, active infective endocarditis in 18 (9.0%) and acute aortic dissection Stanford type A in 21 (10.4%). All patients underwent clinical and echocardiographic follow-up. We analysed survival and valve-related events. RESULTS The overall in-hospital mortality rate was 4.5%. One- and 5-year cardiac-related mortality rates were 3 and 6%, and overall survival was 95 ± 1.5 and 75 ± 3.6%, respectively. The rate of freedom from structural valve failure was 99% and 97 ± 0.4% at the 1- and 5-year follow-up, respectively. The incidence rates of prosthetic valve endocarditis were 3 and 4%, respectively. During a median follow-up of 28 (IQR 14-51) months, only 2 (1%) patients required valve-related redo surgery due to prosthetic valvular endocarditis and none suffered from thromboembolic events. One percent of patients showed structural valve deterioration without any clinical symptoms; none of the patients suffered greater than mild aortic regurgitation. CONCLUSIONS Aortic root replacement using a self-assembled biological composite graft is an interesting option. Haemodynamic results are excellent, with freedom from structured valve failure. Need for reoperation is extremely low, but long-term results are necessary to prove the durability of this concept.

Sportmotorische Leistungsfähigkeit und schulische Leistung – Zum mediierenden Effekt der exekutiven Funktionen

Introduction: Die sportmotorische Leistungsfähigkeit (SMLF) hängt nicht nur positiv mit der körperlichen Gesundheit zusammen, sondern gilt auch als Prädiktor für die schulische Leistung (SL) (van der Niet, Hartmann, Smith, & Visscher, 2014). Um die Frage zu beantworten, wie denn zwei auf den ersten Blick so distale Merkmale zusammenhängen sollen, werden unterschiedliche erklärende Variablen diskutiert, wobei die kognitive Stimulationshypothese die exekutiven Funktionen (EF) als mediierende Variable im Zusammenhang zwischen SMLF und SL postuliert. Die Annahme hierbei ist, dass die mit komplexen motorischen Kontrollprozessen einhergehende kognitive Beanspruchung bei einem wiederholten Ausführen von nicht-automatisierten sportbezogenen Handlungen zu einer Aktivierung und somit Förderung der EF führt (Best, 2010). EF, verstanden als höhere kognitive Prozesse, die ein zielorientiertes und situationsangepasstes Handeln erlauben, sind für den schulischen Erfolg von zentraler Bedeutung und gleichzeitig wichtige Prädiktoren der SL (Diamond, 2013). Obwohl diese Mediation seit einigen Jahren in der Literatur diskutiert wird, wurde sie bis heute noch nicht mit Hilfe längsschnittlicher Daten geprüft. Daher wird im Folgenden der mediierende Effekt der EF im Zusammenhang zwischen SMLF und SL getestet. Methods: Im Rahmen der Studie Sport und Kognition 5.0 wurden insgesamt 237 Primarschulkinder (52.3% ♀; 11.31 ± 0.62 Jahre) zu drei Messzeitpunkten in ihrer SMLF (T1) und ihren EF (T2) getestet. Zusätzlich wurde die SL (T3) mittels objektiver Schulleistungstests (Mathematik und Deutsch) erhoben. Um die Hauptfragestellung zu prüfen, ob die SL vorwiegend mediiert über die EF durch die SMLF vorhergesagt werden kann, wurde eine bootstrapping-basierte Mediationsanalyse in AMOS 22 durchgeführt. Results: Das theoretisch abgeleitete Strukturgleichungsmodell (2 (22, N = 237) = 30.357, p = .110; CFI = .978) weist eine zufriedenstellende Anpassungsgüte auf. Erwartungsgemäss zerfällt der Zusammenhang innerhalb des Mediationsmodells zwischen der SMLF und der SL, alsbald die EF ins Modell aufgenommen werden (β = .16, p = .634). Sowohl der Zusammenhang zwischen der SMLF und den EF (β = .38, p = .039), als auch der Zusammenhang zwischen den EF und der SL fallen signifikant aus (β = .91, p = .001) und ergeben dabei eine volle Mediation über den indirekten (p = .021) und totalen Effekt (p = .001). Discussion/Conclusion: Die erstmals vorliegenden längsschnittlichen Daten bestätigen den Zusammenhang zwischen SMLF und SL bei einer Mediation über die EF und decken sich mit den, aus einem querschnittlichen Design stammenden, Befunden von van der Niet et al. (2014). Zur Steigerung der schulischen Leistung sollten zukünftige Schulsportinterventionen die SMLF von Kindern erhöhen und dabei die EF bei der Auswahl von sportlichen Aufgaben mitberücksichtigen. References: Best, J. R. (2010). Effects of physical activity on children’s executive function: Contributions of experimental research on aerobic exercise. Developmental Review, 30, 331-351. Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. van der Niet, A. G., Hartmann, E., Smith, J. & Visscher, C. (2014). Modeling relationships between physical fitness, executive functioning, and academic achievement in primary school children. Psychology of Sport & Exercise, 15(4), 319-325.

Radiotherapy for renal-cell carcinoma

Renal-cell carcinoma is considered to be a radioresistant tumour, but this notion might be wrong. If given in a few (even single) fractions, but at a high fraction dose, stereotactic body radiotherapy becomes increasingly important in the management of renal-cell carcinoma, both in primary settings and in treatment of oligometastatic disease. There is an established biological rationale for the radiosensitivity of renal-cell carcinoma to stereotactic body radiotherapy based on the ceramide pathway, which is activated only when a high dose per fraction is given. Apart from the direct effect of stereotactic body radiotherapy on renal-cell carcinoma, stereotactic body radiotherapy can also induce an abscopal effect. This effect, caused by immunological processes, might be enhanced when targeted drugs and stereotactic body radiotherapy are combined. Therefore, rigorous, prospective randomised trials involving a multidisciplinary scientific panel are needed urgently.

Laparoscopic versus open end colostomy closure: a single-center experience

The aim of this study was to review our experience with laparoscopic end colostomy closure. A retrospective review of a prospectively entered database was performed. Proportions and continuous variables were compared using the Fisher's exact and the Mann-Whitney U tests, respectively. Within the study period, 53 patients underwent closure of end colostomies. The main reasons for the colonic resections were perforated diverticulitis (52.7%) and neoplasms (20.8%). In 28 patients (53%), laparoscopic closure (LC) was attempted. Demographics did not differ between the attempted LC and the primary open closure (OC) group. The conversion rate from an LC to an OC was 50 per cent (14 of 28), mostly as a result of adhesions (71.4%). Hospital length of stay (HLOS) was significantly longer for the OC than with the attempted LC group (15.4 ± 11.9 days vs 11.3 ± 8.5 days, P = 0.046). The overall complication rate was not different between the completed LC and the OC groups (43 vs 56%, P = 0.634). The majority of complications detected (91.1%) were minor and could be treated conservatively. The role of laparoscopy to close end colostomies is questionable, because the conversion rate is high. However, a shorter HLOS can be expected when laparoscopy is successful. To reduce morbidity resulting from prolonged operation times, it is crucial to convert early and pre-emptively if hostile adhesions are found.

Eigenvalue estimates for non-selfadjoint Dirac operators on the real line

We show that the non-embedded eigenvalues of the Dirac operator on the real line with complex mass and non-Hermitian potential V lie in the disjoint union of two disks, provided that the L1-norm of V is bounded from above by the speed of light times the reduced Planck constant. The result is sharp; moreover, the analogous sharp result for the Schrödinger operator, originally proved by Abramov, Aslanyan and Davies, emerges in the nonrelativistic limit. For massless Dirac operators, the condition on V implies the absence of non-real eigenvalues. Our results are further generalized to potentials with slower decay at infinity. As an application, we determine bounds on resonances and embedded eigenvalues of Dirac operators with Hermitian dilation-analytic potentials.

Evaluation of liver parenchyma and perfusion using dynamic contrast-enhanced computed tomography and contrast-enhanced ultrasonography in captive green iguanas (Iguana iguana) under general anesthesia.

BACKGROUND Contrast-enhanced diagnostic imaging techniques are considered useful in veterinary and human medicine to evaluate liver perfusion and focal hepatic lesions. Although hepatic diseases are a common occurrence in reptile medicine, there is no reference to the use of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) to evaluate the liver in lizards. Therefore, the aim of this study was to evaluate the pattern of change in echogenicity and attenuation of the liver in green iguanas (Iguana iguana) after administration of specific contrast media. RESULTS An increase in liver echogenicity and density was evident during CEUS and CECT, respectively. In CEUS, the mean ± SD (median; range) peak enhancement was 19.9% ± 7.5 (18.3; 11.7-34.6). Time to peak enhancement was 134.0 ± 125.1 (68.4; 59.6-364.5) seconds. During CECT, first visualization of the contrast medium was at 3.6 ± 0.5 (4; 3-4) seconds in the aorta, 10.7 ± 2.2 (10.5; 7-14) seconds in the hepatic arteries, and 15 ± 4.5 (14.5; 10-24) seconds in the liver parenchyma. Time to peak was 14.1 ± 3.4 (13; 11-21) and 31 ± 9.6 (29; 23-45) seconds in the aorta and the liver parenchyma, respectively. CONCLUSION CEUS and dynamic CECT are practical means to determine liver hemodynamics in green iguanas. Distribution of contrast medium in iguana differed from mammals. Specific reference ranges of hepatic perfusion for diagnostic evaluation of the liver in iguanas are necessary since the use of mammalian references may lead the clinician to formulate incorrect diagnostic suspicions.

Search for contact interactions and large extra dimensions in the dilepton channel using proton-proton collisions at s√ = 8 TeV with the ATLAS detector

A search is conducted for non-resonant new phenomena in dielectron and dimuon final states, originating from either contact interactions or large extra spatial dimensions. The LHC 2012 proton–proton collision dataset recorded by the ATLAS detector is used, corresponding to 20 fb−1 at √ s = 8 TeV. The dilepton invariant mass spectrum is a discriminating variable in both searches, with the contact interaction search additionally utilizing the dilepton forward-backward asymmetry. No significant deviations from the Standard Model expectation are observed. Lower limits are set on the ℓℓqq contact interaction scale ʌ between 15.4 TeVand 26.3 TeV, at the 95%credibility level. For large extra spatial dimensions, lower limits are set on the string scale MS between 3.2 TeV to 5.0 TeV.

Breathing manoeuvre-dependent changes in myocardial oxygenation in healthy humans.

AIMS CO₂ is an intrinsic vasodilator for cerebral and myocardial blood vessels. Myocardial vasodilation without a parallel increase of the oxygen demand leads to changes in myocardial oxygenation. Because apnoea and hyperventilation modify blood CO₂, we hypothesized that voluntary breathing manoeuvres induce changes in myocardial oxygenation that can be measured by oxygenation-sensitive cardiovascular magnetic resonance (CMR). METHODS AND RESULTS Fourteen healthy volunteers were studied. Eight performed free long breath-hold as well as a 1- and 2-min hyperventilation, whereas six aquatic athletes were studied during a 60-s breath-hold and a free long breath-hold. Signal intensity (SI) changes in T₂*-weighted, steady-state free precession, gradient echo images at 1.5 T were monitored during breathing manoeuvres and compared with changes in capillary blood gases. Breath-holds lasted for 35, 58 and 117 s, and hyperventilation for 60 and 120 s. As expected, capillary pCO₂ decreased significantly during hyperventilation. Capillary pO₂ decreased significantly during the 117-s breath-hold. The breath-holds led to a SI decrease (deoxygenation) in the left ventricular blood pool, while the SI of the myocardium increased by 8.2% (P = 0.04), consistent with an increase in myocardial oxygenation. In contrast, hyperventilation for 120 s, however, resulted in a significant 7.5% decrease in myocardial SI/oxygenation (P = 0.02). Change in capillary pCO₂ was the only independently correlated variable predicting myocardial oxygenation changes during breathing manoeuvres (r = 0.58, P < 0.01). CONCLUSION In healthy individuals, breathing manoeuvres lead to changes in myocardial oxygenation, which appear to be mediated by CO₂. These changes can be monitored in vivo by oxygenation-sensitive CMR and thus, may have value as a diagnostic tool.

The deglaciation history of the Simplon region (southern Swiss Alps) constrained by 10Be exposure dating of ice-molded bedrock surfaces

The deglaciation history of the Swiss Alps after the Last Glacial Maximum involved the decay of several ice domes and the subsequent disintegration of valley glaciers at high altitude. Here we use bedrock exposure dating to reconstruct the temporal and spatial pattern of ice retreat at the Simplon Pass (altitude: ∼2000 m) located 40 km southwest of the ‘Rhône ice dome’. Eleven 10Be exposure ages from glacially polished quartz veins and ice-molded bedrock surfaces cluster tightly between 13.5 ± 0.6 ka and 15.4 ± 0.6 ka (internal errors) indicating that the Simplon Pass depression became ice-free at 14.1 ± 0.4 ka (external error of mean age). This age constraint is interpreted to record the melting of the high valley glaciers in the Simplon Pass region during the warm Bølling–Allerød interstadial shortly after the Oldest Dryas stadial. Two bedrock samples collected a few hundred meters above the pass depression yield older 10Be ages of 17.8 ± 0.6 ka and 18.0 ± 0.6 ka. These ages likely reflect the initial downwasting of the Rhône ice dome and the termination of the ice transfluence from the ice dome across the Simplon Pass toward the southern foreland. There, the retreat of the piedmont glacier in Val d’Ossola was roughly synchronous with the decay of the Rhône ice dome in the interior of the mountain belt, as shown by 10Be ages of 17.7 ± 0.9 ka and 16.1 ± 0.6 ka for a whaleback at ∼500 m elevation near Montecrestese in northern Italy. In combination with well-dated paleoclimate records derived from lake sediments, our new age data suggest that during the deglaciation of the European Alps the decay of ice domes was approximately synchronous with the retreat of piedmont glaciers in the foreland and was followed by the melting of high-altitude valley glaciers after the transition from the Oldest Dryas to the Bølling–Allerød, when mean annual temperatures rose rapidly by ∼3 °C.