Incorporation of monovalent cations in sulfate green rust

Green rust is a naturally occurring layered mixed-valent ferrous-ferric hydroxide, which can react with a range of redox-active compounds. Sulfate-bearing green rust is generally thought to have interlayers composed of sulfate and water. Here, we provide evidence that the interlayers also contain monovalent cations, using X-ray photoelectron spectroscopy and synchrotron X-ray scattering. For material synthesized with Na(+), K(+), Rb(+), or Cs(+), interlayer thickness derived from basal plane spacings correlates with the radius of the monovalent cation. In addition, sequential washing of the materials with water showed that Na(+) and K(+) were structurally fixed in the interlayer, whereas Rb(+) and Cs(+) could be removed, resulting in a decrease in the basal layer spacing. The incorporation of cations in the interlayer opens up new possibilities for the use of sulfate green rust for exchange reactions with both anions and cations: e.g., radioactive Cs.

Gastric and endobronchial metastases in a case of lobular breast cancer

Background

Invasive lobular carcinoma (ILC) is the second most common histological type of invasive breast carcinoma, preceded only by infiltrating ductal carcinoma, which has clinical, biological and molecular distinctions. These distinctions imply a different metastatic behavior between the histology of these 2 types of breast cancer.

Case Presentation

We report the case of a 51-year-old woman with breast cancer with ILC histology, diagnosed at an early stage. In the course of her disease, recurrences in the gastric mucosa and endobronchial area occurred. The treatment she received is described herein.

Conclusion

This is a case of ILC with unusual metastases. The absence of E-cadherin is related to the carcinogenesis of ILC and probably to these patterns of metastasis as well.

Effective method for emergency fertility preservation: random-start controlled ovarian stimulation

OBJECTIVE

To determine whether random-start controlled ovarian stimulation (COS), in which a patient is stimulated on presentation regardless of her menstrual-cycle phase, has outcomes similar to conventional early follicular phase-start COS for fertility preservation in cancer patients.

DESIGN

Retrospective cohort study.

SETTING

Academic medical center.

PATIENT(S)

Women recently diagnosed with cancer and in preparation for gonadotoxic therapy.

INTERVENTION(S)

Random- versus conventional-start COS.

MAIN OUTCOME MEASURE(S)

PRIMARY OUTCOME

number of mature oocytes retrieved; secondary outcomes: pattern of follicular development, oocyte yield, and fertilization rate.

RESULT(S)

The number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield, and fertilization rates were similar in random- (n = 35) and conventional-start (n = 93) COS cycles. No superiority was noted when comparing COS started in the late follicular (n = 13) or luteal phase (n = 22). The addition of letrozole, in the case of estrogen-sensitive cancers, did not adversely affect COS outcomes or oocyte maturity and competence in either random- or conventional-start protocols.

CONCLUSION(S)

Random-start COS is as effective as conventional-start COS in fertility preservation. This protocol would minimize delays and allow more patients to undergo fertility preservation and still proceed with cancer treatment within 2-3 weeks.

The utility of repeat enzyme immunoassay testing for the diagnosis of Clostridium difficile infection: a systematic review of the literature

Over the last 20 years, the prevalence of healthcare-associated Clostridium difficile (C. diff) disease has increased. While multiple tests are available for the diagnosis of C. diff infection, enzyme immunoassay (EIA) testing for toxin is the most used. Repeat EIA testing, although of limited utility, is common in medical practice. To assess the utility of repeat EIA testing to diagnose C. diff infections. Systematic literature review. Eligible studies performed >1 EIA test for C. diff toxin and were published in English. Electronic searches of MEDLINE and EMBASE were performed and bibliographies of review articles and conference abstracts were hand searched. Of 805 citations identified, 32 were reviewed in detail and nine were included in the final review. All studies except one were retrospective chart reviews. Seven studies had data on number of participants (32,526), and the overall reporting of test setting and patient characteristics was poor. The prevalence of C. diff infection ranged from 9.1% to 18.5%. The yield of the first EIA test ranged from 8.4% to 16.6%, dropping to 1.5-4.7% with a second test. The utility of repeat testing was evident in outbreak settings, where the yield of repeat testing was 5%. Repeat C. diff testing for hospitalized patients has low clinical utility and may be considered in outbreak settings or when the pre-test probability of disease is high. Future studies should aim to identify patients with a likelihood of disease and determine the utility of repeat testing compared with empiric treatment.

Patient perceptions of reproductive health counseling at the time of cancer diagnosis: a qualitative study of female California cancer survivors

PURPOSE

We sought to determine what women recall about reproductive health risks (RHR) from cancer therapy at the time of cancer diagnosis in order to identify barriers to reproductive health counseling (RHC) and fertility preservation (FP).

METHODS

Data were obtained by surveying 1,041 female cancer survivors from the California Cancer Registry. Inclusion criteria included women age 18-40 with a diagnosis of leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, breast or GI cancer diagnosed between 1993 and 2007. Women were asked to respond to an open-ended question: "what did your doctor tell you about how cancer treatment could affect your ability to get pregnant?" Framework analysis was used to identify themes surrounding patient perceptions of RHC.

RESULTS

Of the patients, 51.8 % (361 out of 697) recalled receiving reproductive health counseling and 12.2 % (85 out of 697) recalled receiving FP counseling. Of the patients, 45.3 % (277 out of 612) reported that uncertain prognosis, risk of recurrence or vertical transmission, age, parity, or uncertain desire may have prevented them from receiving timely and essential information on RHRs. Communication barriers included omission of information, failure to disclose RHRs, and presentation of incorrect information on FP.

DISCUSSION

In a sample of women diagnosed with cancer of reproductive age, almost half did not recall counseling on RHRs and few recalled FP counseling. Communication barriers between physicians and patients regarding fertility may lead to uninformed (reproductive health) RH decisions.

IMPLICATIONS FOR CANCER SURVIVORS

Many women may not receive adequate information about RHRs or FP at the time of cancer diagnosis. Advancements in reproductive technology and emerging organizations that cover financial costs of FP have dramatically changed what options women have to preserve their fertility. Routine and thoughtful RHR and FP counseling, as well as collaborative cancer care will help ensure that women diagnosed with cancer are provided with the services and information they need to make an informed choice about their reproductive future.

Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer

BACKGROUND

The post-treatment quality of life (QOL) impacts of receiving precancer-treatment infertility counseling and of pursuing fertility preservation have not been described in large-scale studies of reproductive age women with cancer.

METHODS

In total, 1041 women who were diagnosed between ages 18 and 40 years responded to a retrospective survey and reported whether they received infertility counseling before cancer treatment and whether they took action to preserve fertility. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Validated QOL scales were used: the Decision Regret Score, the Satisfaction with Life Scale (SWLS), and the brief World Health Organization QOL questionnaire.

RESULTS

Overall, 560 women (61%) who received treatment that potentially could affect fertility were counseled by the oncology team, 45 (5%) were counseled by fertility specialists, and 36 (4%) took action to preserve fertility. Pretreatment infertility counseling by a fertility specialist and an oncologist resulted in lower regret than counseling by an oncologist alone (8.4 vs 11.0; P < .0001). The addition of fertility preservation (6.6 vs 11.0; P < .0001) also was associated with even lower regret scores than counseling by an oncologist alone. Further improvements also were observed in SWLS scores with the addition of fertility specialist counseling (23.0 vs 19.8; P = .09) or preserving fertility (24.0 vs 19.0; P = .05).

CONCLUSIONS

Receiving specialized counseling about reproductive loss and pursuing fertility preservation is associated with less regret and greater QOL for survivors, yet few patients are exposed to this potential benefit. Women of reproductive age should have expert counseling and should be given the opportunity to make active decisions about preserving fertility.