Same-Day Discharge After Robotic Hysterectomy: A Resource Utilization and Quality Improvement Project

BACKGROUND

We implemented a low-cost education initiative to improve the rate of same-day discharge following hysterectomy performed for malignancy and assessed feasibility and impact on resource utilization.

METHODS

Development and implementation of faculty, patient, clinical, and perioperative staff education regarding the goal of same-day discharge for patients undergoing robotic hysterectomy and staging by gynecologic oncologists was started in July 2019. Chart review of 103 patients prior to the intervention and 112 patients after the start of the intervention was completed.

RESULTS

The rate of same-day discharge increased from 5% to 32% following the low-cost process change initiative, and a total of approximately 682 inpatient care hours were saved per 31 patients.

DISCUSSION

The rate of same-day discharges after hysterectomy and staging performed by gynecologic oncologists can be safely increased with a simple educational intervention, which can save significant patient care resources.

Abstract D039: Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): A new program to increase underrepresented minorities in clinical cancer research careers

An eight-week intensive pipeline training program was designed to recruit and prepare underrepresented minority undergraduate students to pursue careers as clinical research professionals and obtain advanced degrees in cancer research to improve diversity and culturally responsive care in clinical cancer research. Cancer clinical trials are imperative to advance therapies and improve patient survival rates, yet barriers exist preventing underrepresented minorities (URM) from participating. There is a need to foster a diverse healthcare workforce who mirror the larger population, yet national statistics report sluggish growth in the recruitment of underrepresented minorities (URM) to scientific occupations. Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) is a newly funded five-year National Cancer Institute R25 education program recruiting URM, to become clinical research professionals (CRPs) or seek advanced degrees in clinical cancer research. The eight-week program immerses students in hands-on experiences framed by the Joint Task Force for Clinical Trials Competency Domains. Grounded in theory of experiential learning and culturally responsive teaching, 35 faculty and CRPs taught and served as student champions, spanning pediatric oncology, oncology pharmacy, surgical oncology, gynecologic oncology, genetics, palliative care and medical oncology. Scholars experienced first-hand the methods in which complex trials provide innovative precision cancer treatments. Scholars completed a ‘Wicked Problems’ research project on cancer health disparities. Analysis of SPARCC evaluation data and one-on-one exit interviews utilizes both qualitative and quantitative methods. Of 39 applications received, 62% (24/39) identified as URM and 77% (30/39) were females. All applicants were enrolled in undergraduate programs or recently graduated with a bachelor’s degree. Most were pursuing biomedical science majors (30/39) with interest to seek careers in healthcare (34/39). In June 2019, ten scholars were accepted (9 females, 1 male), 90% of the matriculating cohort identified as URM. Over 84 different workshops were facilitated, and Scholars participated in three, two-week practicum rotations. Workshop sessions were evaluated by students using free text, 5-point Likert scale questions rating efficacy, satisfaction, and skills of the facilitator and an overall ten-point rating. Wicked Problems projects focused on: stigma of prostate health among African American males, cervical cancer screening among Latinas, impact of food insecurities on cancer treatment, skin cancer prevention among African Americans, and improving enrollment of URMs in clinical trials. Evaluation data is forthcoming. SPARCC has paved the way as an innovative and pedagogically sound education training program for URM. By curating an experience integrating research methods, cancer epidemiology, and health disparities, Scholars have a passion for clinical cancer research.

Citation Format: Kristina Kaljo, Robert Treat, Janet Rader. Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): A new program to increase underrepresented minorities in clinical cancer research careers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D039.

The Immune Landscape of Cancer

We performed an extensive immunogenomic analysis of more than 10,000 tumors comprising 33 diverse cancer types by utilizing data compiled by TCGA. Across cancer types, we identified six immune subtypes-wound healing, IFN-γ dominant, inflammatory, lymphocyte depleted, immunologically quiet, and TGF-β dominant-characterized by differences in macrophage or lymphocyte signatures, Th1:Th2 cell ratio, extent of intratumoral heterogeneity, aneuploidy, extent of neoantigen load, overall cell proliferation, expression of immunomodulatory genes, and prognosis. Specific driver mutations correlated with lower (CTNNB1, NRAS, or IDH1) or higher (BRAF, TP53, or CASP8) leukocyte levels across all cancers. Multiple control modalities of the intracellular and extracellular networks (transcription, microRNAs, copy number, and epigenetic processes) were involved in tumor-immune cell interactions, both across and within immune subtypes. Our immunogenomics pipeline to characterize these heterogeneous tumors and the resulting data are intended to serve as a resource for future targeted studies to further advance the field.

Abstract LB-215: Astrocytes promote brain metastasis of triple-negative great cancer through TGF-β2/ANGPTL4 axis

Breast cancer has a high propensity for brain metastasis (BM), especially in triple negative (ER-/PR-/Her2-) breast cancer (TNBC) subsets. To date, the underlying mechanism for BM is poorly understood, and no targeted therapies have been developed. Metastatic outcome depends on the interactions of metastatic cells with a specific organ microenvironment. Astrocyte is the most abundant cell type in the brain microenvironment. Previous observations suggest a role for astrocytes in tumor BM, but the underlying mechanism is unknown. Our goal is to determine how astrocytes promote TNBC cell BM and to develop novel therapeutic strategies to treat this deadly disease

To investigate the effect of astrocyte on BM formation of TNBC cells, we passaged TNBC cells in astrocyte-cultured medium (ACM), and compared these cells to DMEM passaged cells (control) for their genetic and functional difference. Next, we determined the role of a significant ACM up-regulated gene, angiopoietin-like 4 (Angptl4), in BM formation in a mouse model. Furthermore, we investigated the mechanisms for how TNBC cells and astrocytes interaction to up-regulate the ANGPTL4 expression, and how ANGPTL4 contributes to BM formation. Finally, we analyzed the ANGPTL4 expression in brain metastatic tumors and plasma from TNBC patients.

We found that 1) ACM-conditioned MDA-MB-231 cell facilitated BM formation and up-regulated ANGPTL4 expression. In addition to 231 cells, other TNBC cells (MDA-MB-468 and HCC1937) showed similar up-regulation of ANGPTL4 expression; 2) knockdown of Angptl4 by shRNA reduced ACM-induced BM formation and mortality; 3) astrocytes produced transforming growth factor-beta2 (TGF-β2), which was enhanced by tumor cell-derived IL-1β and TNF-α. The TGF-β2 through Smad signaling in part is responsible for the up-regulation of ANGPTL4 in TNBCs; 4) passaging TNBC cells in ACM led to a large amount of cells died, but cells survived in ACM revealed cancer stem cell like phenotype with CD44+/CD24-, α-SMA high and ID1 low. They started to gradually grow when extended to passage them in ACM. However, knockdown of ANGPTL4 resulted to a contrary consequence; and 5) the higher ANGPTL4 level was observed in brain mets compared to primary tumors, and the higher ANGPTL4 level in plasma was also identified in TNBC patients with BM compared to without BM.

Collectively, our results suggest that TNBC cells interact with astrocytes to promote astrocytes secrete TGF-β2, which in turn up-regulates ANGPTL4 expression in TNBC cells. This up-regulation of ANGPTL4 attributes to the survival and activation of a small population of breast cancer stem like cells from TNBC to facilitate BM formation. This work presents a novel mechanism of how astrocytes and tumor cells communicate in a paracrine and autocrine manner to facilitate BM of TNBC. Our work suggests that ANGPTL4 is a potential therapeutic molecule that can be targeted for the treatment of BM of TNBCs.

Note: This abstract was not presented at the meeting.

Citation Format: Ling Wang, Zhimin Hou, Emily Gronseth, Janet Rader, David Harder, Ramani Ramchandran. Astrocytes promote brain metastasis of triple-negative great cancer through TGF-β2/ANGPTL4 axis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-215. doi:10.1158/1538-7445.AM2017-LB-215

Abstract 1214: Single nucleotide polymorphism in HER family members increases susceptibility to human invasive cervical cancer

Cervical cancer is the second-most common cancer among women worldwide (Parkin et al. 1999). Some studies address prognostic roles that different genes play after the development of cervical cancer. However, there is a lack of studies addressing polymorphisms in genes of normal tissues that influence susceptibility to cervical cancer prior to malignant transformation. Such studies could be pivotal in prevention and timely diagnosis. It is well-known that Human Papillomavirus (HPV) infection appears to be the primary causative factor for cervical cancer, but host factors must be crucial since only a fraction of HPV-infected women develop cervical cancer. HPV antigens are the ligands of HER family members, and the E5 protein may play a role in the early stage of HPV infection before transformation. Thus, we studied whether there are excessive parent-to-offspring transmissions of specific HER SNP variants in EGFR, ERBB2, ERBB3 and ERBB4, in cases of invasive cervical cancer (ICC) or cervical intraepithelial neoplasia grade 3 (CIN3). Based on single SNP TDT tests, we identified a significant association between ICC/CIN3 and rs11770506, which is located at intron1 of EGFR and in high linkage disequilibrium (LD) with multiple enhancers. Our study provides clues for the identification of vulnerable populations and will advance the development of early detection of ICC in appropriate populations.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1214. doi:10.1158/1538-7445.AM2011-1214

18F-fluorodeoxyglucose-positron emission tomography and pathologic tumor size in early-stage invasive cervical cancer

PURPOSE

Cervical cancer tumor size determined by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) thresholding of the maximum standardized uptake value (SUVMax) has been correlated with the determined tumor size by computed tomography and magnetic resonance imaging. The purpose of this study was to evaluate the relationship between preoperative FDG-PET tumor size and pathologic tumor diameter in patients with early-stage cervical cancer who were undergoing radical hysterectomy.

PATIENTS AND METHODS

Forty patients with early-stage cervical cancer underwent pretreatment FDG-PET/computed tomography before radical hysterectomy and lymph node dissection. Primary tumor diameter was defined on FDG-PET as the largest diameter of the 3-dimensional volumetric isocontour of the 40% threshold of the SUVMax. The FDG-PET measurements were compared with the tumor diameter and the histological diameter of the pathologic specimen using regression analysis, paired t test, and unpaired t test.

RESULTS

The FDG-PET tumor diameter measurements were correlated to the pathologic tumor diameter in the surgical specimen with a coefficient of determination (R2) of 0.951 and a correlation coefficient of 0.757 (P < 0.0001).

CONCLUSION

There is a high level of correlation in the FDG-PET and the pathologic tumor measurements in the early-stage cervical cancer.

Effects of cancer treatment on ovarian function

Causes of primary ovarian failure are reviewed, focusing specifically on cancer treatment-related modalities. Strategies and future directions for protection of the ovaries during cancer therapy, including ovarian transposition, and conformal radiation techniques are presented.

Human papillomaviruses target the double-stranded RNA protein kinase pathway

The double-stranded RNA protein kinase (PKR) pathway plays a vital role in the innate immune response to viral infection. Activation of PKR following virus entry can lead to a shutdown in translation, thereby inhibiting viral protein synthesis and replication. Little is currently known about whether human papillomaviruses (HPVs) modulate PKR expression and activity. In this study, normal human foreskin keratinocytes (NHKs) transfected stably with the HPV 31 or 16 genomes and cell lines expressing the HPV 16 E6 and E7 oncoproteins were used to examine effects on the PKR pathway. HPV gene products were found to modulate PKR phosphorylation, activity and localization. The levels of total PKR protein were reduced modestly in cells that maintained HPV 16 or 31 episomes through a reduction in PKR transcription. However, levels of phosphorylated PKR were decreased 4-fold through a post-transcriptional mechanism mediated by E6 and E7 that was independent of the transcriptional downregulation mediated by HPV. In response to infection by vesicular stomatitis virus, phosphorylation of eIF2alpha was blocked in cells expressing HPV oncoproteins, but not in NHKs. Finally, it was observed that the cellular localization of PKR was altered by HPV gene products in HPV raft cultures, as well as HPV-positive patient biopsies. This effect was mediated by the HPV E6 oncoprotein and leads to the co-localization of PKR with P-bodies. These studies demonstrate that high-risk HPVs target the PKR pathway by multiple mechanisms.

Lack of benefit of concurrent chemotherapy in patients with cervical cancer and negative lymph nodes by FDG-PET

PURPOSE

To compare the outcome of patients with cervical cancer and negative lymph nodes by fluorodeoxyglucose-positron emission tomography (FDG-PET) treated with irradiation (RT) and concurrent chemotherapy or RT alone.

METHODS AND MATERIALS

This was a prospective data registry of 65 patients with cervical cancer and negative lymph nodes by whole-body FDG-PET. The tumor stage was IB2 in 11, IIB in 37, and IIIB in 17 patients. RT alone was administered to 15 and RT with concurrent weekly cisplatin to 50 patients.

RESULTS

The 5-year overall survival estimate was 85% with RT and 81% with RT and concurrent chemotherapy (p = 0.91). The corresponding 5-year cause-specific survival estimates were 78% and 74% (p = 0.98). The differences in the sites of recurrence (pelvis vs. distant metastasis) were not statistically significant between the two groups (p = 0.77). A Cox proportional hazards model of survival outcome did not identify chemotherapy, overall treatment time, or radiation dose as statistically significant prognostic factors. Severe complications included one rectovaginal fistula, one rectal stricture requiring colostomy (both in the concurrent chemotherapy group), and one death from chemotherapy-related complications.

CONCLUSION

Irradiation with concurrent cisplatin was not advantageous compared with RT alone in patients with negative lymph nodes on FDG-PET.

A randomized phase II evaluation of bryostatin-1 (NSC #339555) in persistent or recurrent squamous cell carcinoma of the cervix: A Gynecologic Oncology Group Study

OBJECTIVES

The Gynecologic Oncology Group performed a randomized phase II study to determine the antitumor activity and toxicity of two different schedules of administration of bryostatin-1 in patients with persistent or recurrent squamous cell carcinoma of the cervix.

METHODS

Eligible patients were randomized to receive either bryostatin-1 25 mug/m(2) as a 1-h infusion weekly for 3 weeks followed by a 1-week rest (Regimen I) or bryostatin-1 120 mug/m(2) as a 72-h continuous infusion every 2 weeks (Regimen II).

RESULTS

A total of 70 patients were enrolled on this study. There were 32 eligible patients on Regimen I and 33 eligible patients on Regimen II; all but 4 had had prior chemotherapy. There were two partial responses (one on each treatment arm) among the 65 eligible patients (response rates = 3.1 and 3.0%, respectively). Ten patients on each regimen had stable disease. The most common adverse event was myalgia; 8 of 32 patients (25%) on Regimen I and 16 of 33 patients (48%) on Regimen II had any grade of myalgia. There was no significant myelosuppression on either treatment arm.

CONCLUSIONS

Both of these schedules and doses of bryostatin-1 are inactive as single agents in the second-line treatment of squamous cell carcinoma of the cervix.

Lymph node control in cervical cancer

PURPOSE

The aim was to evaluate pretreatment lymph node size, irradiation dose, and failure patterns.

METHODS

Pretreatment PET and CT were performed in 208 patients. Lymph nodes were scored as either positive or negative by PET and lymph node size was measured by CT. Lymph node irradiation dose and sites of failure were recorded.

RESULTS

The mean pelvic lymph node doses were: PET negative nodes, < or =1 cm, 66.8 Gy, and 0/76 failures; PET positive nodes, < or =1 cm, 66.8 Gy, and 3/89 failures; 1.1-< or =2 cm, 66.9 Gy, and 0/21 failures; 2.1-< or =3 cm, 69.4 Gy, and 2/15 failures; and 3.1 to < or =4 cm, 74.1 Gy, and 0/5 failures. The mean paraaortic lymph node dose was 43.3 Gy and there were no paraaortic failures for 24 patients with PET positive < or =1 cm nodes, 0/5 failures for 1.1 to < or =2 cm, and 0/4 failures for 2.1 to < or =3 cm. The most common site of failure was distant metastases.

CONCLUSIONS

The irradiation doses given in this study were adequate to control most lymph node metastases. Positive lymph nodes of any size at diagnosis were the most significant predictor for developing distant metastases.

Spindle cell ossifying amyloidotic tumor of the fallopian tube

We report a unique tumor of the fallopian tube that was an incidental finding in a 60-year-old woman. The tumor was characterized by nests of spindle cells embedded in a partially ossified, hyalinized stroma, that also contained amyloid and basement membrane-like material. The histologic appearance of the tumor cells suggested an epithelial nature, but no immunohistochemical or ultrastructural evidence of such was found. The circumscription of the tumor and its lack of mitotic activity and cytologic atypia suggest a benign nature, but the histogenesis and appropriate classification of the tumor remain unclear.

Posttherapy [18F] Fluorodeoxyglucose Positron Emission Tomography in Carcinoma of the Cervix: Response and Outcome

Purpose

The aim of this study was to evaluate response to therapy using posttherapy molecular imaging with [18F] fluorodeoxyglucose (FDG), and to compare the response with patient outcome.

Patients and Methods

This was a retrospective medical record review of 152 patients with carcinoma of the cervix. All patients underwent a pre- and posttreatment whole-body positron emission tomography (PET) imaging scan with FDG. Patients were treated with external irradiation and intracavitary brachytherapy, and most received concurrent weekly cisplatin. Posttherapy whole-body FDG-PET was performed 1 to 12 months (mean, 3 months) after completion of treatment.

Results

The posttherapy PET did not show any abnormal FDG uptake in 114 patients, and their 5-year cause-specific survival estimate was 80%. There was persistent (in the irradiated region) abnormal FDG uptake in the cervix or lymph nodes in 20 patients. Their 5-year cause-specific survival estimate was 32%. New anatomic sites (in unirradiated regions) of abnormal FDG uptake were present in 18 patients, and none were alive at 5 years. A Cox proportional hazards model of survival outcome indicated that any abnormal posttherapy FDG uptake (persistent or new) was the most significant prognostic factor for developing metastatic disease and death from cervical cancer when compared with pretreatment- and treatment-related prognostic factors (P < .0001).

Conclusion

Posttherapy abnormal FDG uptake (persistent or new) as detected by whole-body PET measures tumor response and might be predictive of tumor recurrence and death from cervical cancer. Prospective validation of these results is warranted.

MSI in endometrial carcinoma: absence of MLH1 promoter methylation is associated with increased familial risk for cancers

Loss of DNA mismatch repair occurs in a variety of malignancies and is associated with genome-wide instability of microsatellite repeats, a molecular phenotype referred to as microsatellite instability (MSI). MSI is a consistent feature of colorectal and endometrial tumors from patients with hereditary non-polyposis colorectal cancer (HNPCC). Sporadic colorectal and endometrial cancers that exhibit MSI frequently have methylation of the MLH1 promoter. We undertook a detailed family and medical history study to compare family cancer risk for women with MSI-positive and -negative endometrial cancers. The MLH1 promoter methylation status was determined for all cancers. Family histories were developed for 80 probands (40 with MSI-positive and 40 with MSI-negative tumors). The numbers of reported cancers in first- and second-degree relatives of the 2 groups were similar. There was a modest increase in familial cancer clustering for MSI-positive probands. When MSI-positive tumors were subclassified according to MLH1 promoter methylation, a clear association between methylation status and familial cancer risk was evident. Women with MSI-positive endometrial cancers in which the MLH1 promoter was unmethylated had a 7-fold relative risk (RR) of demonstrating familial clustering of cancers [RR 7.07 (95% confidence interval 2.29-21.81)]. The women with MSI-positive, MLH1-unmethylated tumors were significantly younger than the rest of the study population (56.1 years vs. 65.4, p < or = 0.01). Age of onset and tumor MSI not associated with MLH1 promoter methylation may point to women with a genetic susceptibility to malignancies.

Evaluation of the family history collection process and the accuracy of cancer reporting among a series of women with endometrial cancer

Family history data are critical in the study of hereditary cancer syndromes and the identification of cancer modifier genes.

PURPOSE

The purpose of this study was to analyze the process for collecting and verifying reported cancer family histories and identify reporting inaccuracies among a series of women with endometrial cancer.

EXPERIMENTAL DESIGN

Detailed family histories were obtained from 80 women enrolled in a research study. Medical records were collected to verify cancer reporting.

RESULTS

Participants reported 289 cancers among themselves and 2925 first-, second-, and third-degree relatives. There was a significant relationship between the number of telephone contacts made with each participant and the fraction of records retrieved from hospitals (chi(2) = 23.68, d.f. = 7, P = 0.001). Medical records were retrieved for 102 of 289 (35%) reported cancers and 10 additional cancers, not initially reported by participants. Medical records were more likely to be retrieved if the relative with cancer was living, closely related to the study participant, and the cancer type was known. The success in retrieving medical records declined with increasing record age (chi(2) = 35.07, d.f. = 5, P < 0.001). Thirty-two of the 112 (28.6%) verified cancers were identified to be inaccurately reported, with a significantly higher number of inaccurate reports among second- and third-degree relatives than first-degree relatives (P = 0.02). Two participants, who did not accurately report their cancer family history, had an increase in their family-based risk assessment after medical record collection.

CONCLUSIONS

Additional studies to improve record collection efficiency and identify cancer reporting accuracy are needed among general research populations.

No evidence for BCL10 mutation in endometrial cancers with microsatellite instability

Previous reports have suggested that the mononucleotide repeats in BCL10 frequently are mutated in both hematologic malignancies and solid tumors. We set out to determine whether these repeats, like simple repeat sequences in other genes, are a target for mutation in endometrial cancers with defective DNA mismatch repair. Primary endometrial cancers (n = 42) and endometrial cancer cell lines (n=5) with microsatellite instability (MSI) were investigated. BCL10 exons 2 and 3 were amplified by PCR and evaluated for mutation using denaturing high-performance liquid chromatography (DHPLC) and single stand conformational variant (SSCV) analysis. Variants were directly sequenced. No BCL10 mutations were detected in exons 2 or 3 by DHPLC or SSCV. A polymorphism in exon 3 (638G-->A) was seen in 4/42 (9.5%) MSI-positive endometrial cancers and 0/5 MSI-positive endometrial cancer cell lines. Thus, mutation in the mononucleotide repeat tracts of BCL10 is not a feature of endometrial cancers with defective DNA mismatch repair.

Methylation associated inactivation of RASSF1A from region 3p21.3 in lung, breast and ovarian tumours

Previously we analysed overlapping homozygous deletions in lung and breast tumours/tumour lines and defined a small region of 120 kb (part of LCTSGR1) at 3p21.3 that contained putative lung and breast cancer tumour suppressor gene(s) (TSG). Eight genes including RASSF1 were isolated from the minimal region. However, extensive mutation analysis in lung tumours and tumour lines revealed only rare inactivating mutations. Recently, de novo methylation at a CpG island associated with isoform A of RASSF1 (RASSF1A) was reported in lung tumours and tumour lines. To investigate RASSF1A as a candidate TSG for various cancers, we investigated: (a) RASSF1A methylation status in a large series of primary tumour and tumour lines; (b) chromosome 3p allele loss in lung tumours and (c) RASSF1 mutation analysis in breast tumours. RASSF1A promoter region CpG island methylation was detected in 72% of SCLC, 34% of NSCLC, 9% of breast, 10% of ovarian and 0% of primary cervical tumours and in 72% SCLC, 36% NSCLC, 80% of breast and 40% of ovarian tumour lines. In view of the lower frequency of RASSF1 methylation in primary breast cancers we proceeded to RASSF1 mutation analysis in 40 breast cancers. No mutations were detected, but six single nucleotide polymorphisms were identified. Twenty of 26 SCLC tumours with 3p21.3 allelic loss had RASSF1A methylation, while only six out of 22 NSCLC with 3p21.3 allele loss had RASSF1A methylation (P=0.0012), one out of five ovarian and none out of six cervical tumours with 3p21.3 loss had RASSF1A methylation. These results suggest that (a) RASSF1A inactivation by two hits (methylation and loss) is a critical step in SCLC tumourigenesis and (b) RASSF1A inactivation is of lesser importance in NSCLC, breast, ovarian and cervical cancers in which other genes within LCTSGR1 are likely to be implicated.

Radiation therapy for carcinoma of the cervix with biopsy-proven positive para-aortic lymph nodes

PURPOSE

To evaluate local tumor control, cause-specific survival, patterns of relapse, and toxicity in patients with cervical cancer and positive para-aortic lymph nodes treated with radiation therapy alone.

METHODS

This is a retrospective chart review of 43 patients with cervical cancer and biopsy-proven positive para-aortic lymph nodes treated with radiation therapy treated from 1965 to 1993. There were 15 patients with clinical Stage I disease, 12 with Stage II, and 16 with Stage III. Patients were treated with external irradiation to the pelvis and para-aortic regions combined with brachytherapy. None received chemotherapy.

RESULTS

The 5-year overall survival rate was 32% and the median overall survival was 2.2 years. The 5-year cause-specific survival rate was 49% and the median cause-specific survival was 2.7 years. The cause-specific survivals at 5 years were 47% for Stage I, 64% for Stage II, and 46% for Stage III. Tumor recurrence occurred in 20 patients. The sites of recurrence were in the pelvis only in 3, the pelvis and distant metastasis in 9, and distant metastasis only in 8 patients. Severe, grade 3 complications occurred in 2 patients. One patient developed an enterovaginal fistulas and 1 developed radiation myelitis.

CONCLUSION

Pelvic and para-aortic irradiation and brachytherapy resulted in a 49%, 5-year, cause-specific survival. Clinical tumor stage did not effect outcome. The majority of relapses occurred at distant sites. Toxicity was acceptable. Systemic chemotherapy should be considered as adjunctive therapy for these patients.

No evidence for BCL10 mutation in endometrial cancers with microsatellite instability

Previous reports have suggested that the mononucleotide repeats in BCL10 frequently are mutated in both hematologic malignancies and solid tumors. We set out to determine whether these repeats, like simple repeat sequences in other genes, are a target for mutation in endometrial cancers with defective DNA mismatch repair. Primary endometrial cancers (n = 42) and endometrial cancer cell lines (n=5) with microsatellite instability (MSI) were investigated. BCL10 exons 2 and 3 were amplified by PCR and evaluated for mutation using denaturing high-performance liquid chromatography (DHPLC) and single stand conformational variant (SSCV) analysis. Variants were directly sequenced. No BCL10 mutations were detected in exons 2 or 3 by DHPLC or SSCV. A polymorphism in exon 3 (638G-->A) was seen in 4/42 (9.5%) MSI-positive endometrial cancers and 0/5 MSI-positive endometrial cancer cell lines. Thus, mutation in the mononucleotide repeat tracts of BCL10 is not a feature of endometrial cancers with defective DNA mismatch repair.

Validation for MEDFICTS, a dietary assessment instrument for evaluating adherence to total and saturated fat recommendations of the National Cholesterol Education Program Step 1 and Step 2 diets

MEDFICTS is a dietary assessment instrument designed to evaluate patient adherence to the National Cholesterol Education Program Step 1 and Step 2 diets. It provides a quick way to record food intake, portion size, and frequency of intake while focusing on foods that are the primary contributors of total fat, saturated fat, and cholesterol in the average American diet (i.e., Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table and Snacks). MEDFICTS was validated in a pilot study using 16 computer-analyzed sets of 4-day food records randomly selected from 7-day food records collected in the Diet Modification Clinic at Baylor College of Medicine, Houston, Tex). MEDFICTS correctly identified the 11 patients consuming a Step 1 diet, the 2 patients consuming the Step 2 diet and the 3 patients consuming an average American diet. Pearson correlation coefficients between MEDFICTS and the 4-day records were significant for percent energy from total fat (r = 0.81, P < .0002), saturated fat (r = 0.79, P < .0003), and cholesterol (r = 0.52, P < .039). Pearson correlation coefficients from 2 follow-up validation studies (3-day diet records [n = 22] through the Mary Imogene Bassett Research Institute, Cooperstown, NY, and a second study at the Diet Modification Clinic [n = 26]) also correlated significantly with percent energy from total fat (r = 0.56, P < .006; r = 0.71, P < .0001), saturated fat (r = 0.60, P < .003; r = 0.71, P < .0001), and approached significance for cholesterol intake (r = 0.54, P < .009; r = 0.39, P < .051) respectively. MEDFICTS is a quick, efficient tool that can be used in cardiovascular health screening, clinical practice, or research for the assessment of adherence to Step 1 or 2 diets. It can be self administered, and when reviewed with a dietitian, can provide an opportunity for nutrition education.

Mapping an endometrial cancer tumor suppressor gene at 10q25 and development of a bacterial clone contig for the consensus deletion interval

Frequent loss of chromosome 10q sequences in endometrial cancers suggests the involvement of a tumor suppressor gene. Previous loss-of-heterozygosity (LOH)studies have pointed to the 10q25-q26 region as the likely site of a tumor suppressor involved in endometrial tumorigenesis (S. L. Peiffer et al., 1995, Cancer Res. 55: 1922-1926; S. Nagase et al., 1996, Br. J. Cancer 74: 1979-1983; S. Nagase et al.,1997, Cancer Res. 57: 1630-1633). In an attempt to define further the localization of a tumor suppressor gene at 10q25, we screened a panel of 123 endometrioid adenocarcinomas for loss of heterozygosity of 10q25.3 sequences. Forty-three (35%) revealed LOH at one or more loci. The observed patterns of allelic loss define a minimum consensus region of deletion between D10S221 and D10S610. A sequence-ready bacterial clone contig and a long-range restriction map for a 1-Mb interval spanning the deletion region were developed as the first step in experiments directed toward the discovery the 10q25 tumor suppressor.

Bathing persons with dementia

In the care of persons with Alzheimer's disease and related disorders, bathing frequently poses a formidable challenge for caregivers. This article reports the results of a consensus conference on techniques to reduce disruptive behaviors during bathing, and to make the process less stressful for persons with dementia.

Problematic Wandering Behavior in the Cognitively Impaired Elderly: A Single-Subject Case Study

Three psychosocial factors that may influence wandering behavior have been previously identified: lifelong patterns of coping with stress, previous work roles, and a need to search for persons or places associated with security. Strategies for managing wandering behavior include environmental modifications, planned activities, physical exercise, and attention to psychosocial history. However, limited attention has been given to testing psychosocial approaches that could be used by nursing home staff when interacting with residents who wander. The findings of this study suggest that providing sufficient staff time for interacting with residents, programs that address residents' needs for activity and rest, and appropriate environmental modifications should occur in conjunction with the decreased use of antipsychotic medications and physical restraints.

Use of siderails: rethinking a standard of practice

1. Policy and/or tradition is not adequate rationale for siderail use in light of current information indicating that siderails can be a hazard. 2. If a client is going to climb out over the siderail, the siderail increases risk for client injury. In such cases siderail use cannot be justified. 3. The nurses's goal is not to eliminate siderail use, but to individualize it--to use siderails only in cases in which they increase the safety, security, and mobility of clients.

Peripapillary vasoconstriction in the glaucomas and the anterior ischemic optic neuropathies

Proximal constriction (retinal arteries narrower near the disk than further down the stream in the retina) was present in 96 of 226 eyes (42%) with classic glaucoma or normal-tension glaucoma, but it was present in only 11 of 206 eyes (5%) that were normal, had ocular hypertension, or had retinal disease not affecting the optic nerve. In cases of glaucoma with proximal constriction over only part of the disk circumference, its location corresponded to the sector with the greatest cupping in 60 of 66 cases (91%) and likewise corresponded to the sector in which the peripapillary zone of absent retinal pigment epithelium was widest in 48 of 55 cases (87%). Proximal constriction was also present in 16 of 45 eyes (36%) with nonischemic types of non-glaucomatous optic atrophy. The nonarteritic form of anterior ischemic optic neuropathy had proximal constriction in 19 of 28 eyes (68%), which was more frequent than in those with glaucoma (P = .017). Only one of nine eyes with the arteritic form of anterior ischemic optic neuropathy had proximal constriction, which was lower prevalence than in those with glaucoma (P = .066). General arterial narrowing (throughout the retinal course) was present in 111 of 204 (54%) of those with moderate optic nerve damage and 100 of 128 (78%) of those with severe optic nerve damage in all categories, compared with 29 of 208 (14%) of the controls with no optic nerve damage. Unlike proximal constriction, the generalized narrowing was related to severity of optic nerve damage and not to the disease category.

French homologation for medical devices: past and future

The French approval procedure for medical devices, known as homologation, is considered to be one of the most complicated national approval processes in Europe. This article outlines some of the key elements of homologation and the major changes that have been introduced since 1991. In addition, homologation will not survive in its present form when the EC Directives come into force. The author outlines current expectations.

Biochemical and genetic basis for the ETS (enterotoxin sensitivity) phenotype in mice

Evidence has been accumulating that humans are genetically predisposed to cholera gravis. Using the sealed adult mouse model, we found that certain inbred mice were also hypersensitive to cholera toxin (CT). Such mice were designated ETS+ (enterotoxin sensitive), and the trait was linked to the K end of the mouse H-2 histocompatibility complex. Cells isolated from ETS+ mice bound more CT and accumulated more cyclic adenosine monophosphate (cAMP) after intoxication. Analysis of ETS+ cells showed that they express lesser amounts of the non-GM1 gangliosides that block or compete for relevant CT binding sites in ETS- cells. Conversion of ETS- non-GM1 gangliosides to GM1 with neuraminidase increased CT binding and cAMP responses. Reconstitution of nonreactive ganglioside-deficient cells with ETS+ or ETS- gangliosides caused them to bind CT like the original ETS+ or ETS- cells. Ganglioside expression genes known to map to the same H-2-linked region as the ETS phenotype seem to be involved in controlling murine susceptibility to CT.

Modifying the environment to decrease use of restraints

Because the majority of residents lack the skills and capacities to adapt to the nursing home environment, it is the staff's responsibility to modify the environment to reflect the residents' needs. In persons with dementia, anxious behavior occurs when the individual's environment provides too many stressors or no opportunities to relax or avoid stimuli, the stress threshold is exceeded, and dysfunctional or problem behaviors are manifested. Nurses must decrease their reliance on physical restraints, think creatively to solve problems, and look to theories to provide ideas and guidance. Administrators must encourage innovation and be willing to take calculated risks.