Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.

Africa as an evolutionary arena for large fruits

Strong paleoclimatic change and few Late Quaternary megafauna extinctions make mainland Africa unique among continents. Here, we hypothesize that, compared with elsewhere, these conditions created the ecological opportunity for the macroevolution and geographic distribution of large fruits. We assembled global phylogenetic, distribution and fruit size data for palms (Arecaceae), a pantropical, vertebrate-dispersed family with > 2600 species, and integrated these with data on extinction-driven body size reduction in mammalian frugivore assemblages since the Late Quaternary. We applied evolutionary trait, linear and null models to identify the selective pressures that have shaped fruit sizes. We show that African palm lineages have evolved towards larger fruit sizes and exhibited faster trait evolutionary rates than lineages elsewhere. Furthermore, the global distribution of the largest palm fruits across species assemblages was explained by occurrence in Africa, especially under low canopies, and extant megafauna, but not by mammalian downsizing. These patterns strongly deviated from expectations under a null model of stochastic (Brownian motion) evolution. Our results suggest that Africa provided a distinct evolutionary arena for palm fruit size evolution. We argue that megafaunal abundance and the expansion of savanna habitat since the Miocene provided selective advantages for the persistence of African plants with large fruits.

Response Evaluation after Neoadjuvant Chemotherapy for Resectable Gastric Cancer

BACKGROUND

The method of response evaluation following neoadjuvant chemotherapy (NAC) in resectable gastric cancer has been widely debated. An essential prerequisite is the ability to stratify patients into subsets of different long-term survival rates based on the response mode. Histopathological measures of regression have their limitations, and interest resides in CT-based methods that can be used in everyday settings.

METHODS

We conducted a population-based study (2007-2016) on 171 consecutive patients with gastric adenocarcinoma who were receiving NAC. Two methods of response evaluation were investigated: a strict radiological procedure using RECIST (downsizing), and a composite radiological/pathological procedure comparing the initial radiological TNM stage to the pathological ypTNM stage (downstaging). Clinicopathological variables that could predict the response were searched for, and correlations between the response mode and long-term survival rates were assessed.

RESULTS

RECIST failed to identify half of the patients progressing to metastatic disease, and it was unable to assign patients to subsets with different long-term survival rates based on the response mode. However, the TNM stage response mode did achieve this objective. Following re-staging, 48% (78/164) were downstaged, 15% (25/164) had an unchanged stage, and 37% (61/164) were upstaged. A total of 9% (15/164) showed a histopathological complete response. The 5-year overall survival rate was 65.3% (95% CI 54.7-75.9%) for TNM downstaged cases, 40.0% (95% CI 20.8-59.2%) for stable disease, and 14.8% (95% CI 6.0-23.6%) for patients with TNM progression, p < 0.001. In a multivariable ordinal regression model, the Lauren classification and tumor site were the only significant determinants of the response mode.

CONCLUSIONS

Downsizing, as a method for evaluating the response to NAC in gastric cancer, is discouraged. TNM re-staging by comparing the baseline radiological CT stage to the pathological stage following NAC is suggested as a useful method that may be used in everyday situations.

A Study on the Psychological Attributes of Survivors Who Experienced Downsizing in China

This study aims to examine how perceived justice affects downsizing survivors' attitudes, from the psychological contract perspective. By using data collected through surveys from employees of the Industrial and Commercial Bank of China (ICBC) who have recently survived layoffs, we examine the relationships between perceived justice, the survivors' psychological status, and their attitudes after downsizing. The hypothesis was verified through path analysis using SPSS 26.0 and Amos 23.0. Our findings are as follows. Perceived justice has a negative effect on psychological contract violation and a positive effect on trust. Psychological contract violation influences affective commitment negatively and influences turnover intention positively. Trust is positively related to affective commitment and negatively related to turnover intention. We hope that this study will be a useful piece of data that can provide guidelines for inducing positive behavior of members in downsized organizations.

Attention to detail: A photo-elicitation study of salience and packaging design for portion control and healthy eating

Evidence demonstrates that food packaging attracts consumers to purchase and has the potential to nudge consumers towards healthy choices, including reducing portion size. However, food purchasing decisions are often automatic and packaging features may go unnoticed. Therefore, it is important to understand what consumers identify as most salient about packaging: what they notice and why, and which elements might nudge consumers towards healthy options and smaller portions of high-energy-density foods. This study explored consumer perception of food packaging, investigated specific features associated with portion control and elicited design ideas to improve packaging for healthy eating and downsizing. A qualitative approach was adopted applying a participant-driven photo-elicitation (PDPE) task with in-depth interviews. Participants were 25 adults living in the UK (aged 20-32 years; 17 females, 8 males, x ¯ BMI = 23 kg/m² ). Participants took photographs of 10 food packages according to salience (n = 5) and portion control (n = 5). These were uploaded to a secure site and then discussed at the interview, which was transcribed and analysed. The salience of packaging was described in terms of trust building, stimulating appetite and relating to self-identity, whereas for portion control, themes included structural reminders, healthy prompts and portion awareness. Packaging can be designed to make health value or serving size more salient by prompting portion control and increasing the attractiveness of packaging. While food purchase decisions happen with little deliberation, when probed, consumers provide useful insights for packaging design to assist portion control.

Impact of Preoperative Chemotherapy Features on Patient Outcomes after Hepatectomy for Initially Unresectable Colorectal Cancer Liver Metastases: A LiverMetSurvey Analysis

Background: Prognostic factors have been extensively reported after resection of colorectal liver metastases (CLM); however, specific analyses of the impact of preoperative systemic anticancer therapy (PO-SACT) features on outcomes is lacking. Methods: For this real-world evidence study, we used prospectively collected data within the international surgical LiverMetSurvey database from all patients with initially-irresectable CLM. The main outcome was Overall Survival (OS) after surgery. Disease-free (DFS) and hepatic-specific relapse-free survival (HS-RFS) were secondary outcomes. PO-SACT features included duration (cumulative number of cycles), choice of the cytotoxic backbone (oxaliplatin- or irinotecan-based), fluoropyrimidine (infusional or oral) and addition or not of targeted monoclonal antibodies (anti-EGFR or anti-VEGF). Results: A total of 2793 patients in the database had received PO-SACT for initially irresectable diseases. Short (<7 or <13 cycles in 1st or 2nd line) PO-SACT duration was independently associated with longer OS (HR: 0.85 p = 0.046), DFS (HR: 0.81; p = 0.016) and HS-RFS (HR: 0.80; p = 0.05). All other PO-SACT features yielded basically comparable results. Conclusions: In this international cohort, provided that PO-SACT allowed conversion to resectability in initially irresectable CLM, surgery performed as soon as technically feasible resulted in the best outcomes. When resection was achieved, our findings indicate that the choice of PO-SACT regimen had a marginal if any, impact on outcomes.

The Effect of Downsizing Packages of Energy-Dense, Nutrient-Poor Snacks and Drinks on Consumption, Intentions, and Perceptions-A Scoping Review

The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

Super-Resolution Nanolithography of Two-Dimensional Materials by Anisotropic Etching

Nanostructuring allows altering of the electronic and photonic properties of two-dimensional (2D) materials. The efficiency, flexibility, and convenience of top-down lithography processes are, however, compromised by nanometer-scale edge roughness and resolution variability issues, which especially affect the performance of 2D materials. Here, we study how dry anisotropic etching of multilayer 2D materials with sulfur hexafluoride (SF₆) may overcome some of these issues, showing results for hexagonal boron nitride (hBN), tungsten disulfide (WS₂), tungsten diselenide (WSe₂), molybdenum disulfide (MoS₂), and molybdenum ditelluride (MoTe₂). Scanning electron microscopy and transmission electron microscopy reveal that etching leads to anisotropic hexagonal features in the studied transition metal dichalcogenides, with the relative degree of anisotropy ranked as: WS₂ > WSe₂ > MoTe₂ ∼ MoS₂. Etched holes are terminated by zigzag edges while etched dots (protrusions) are terminated by armchair edges. This can be explained by Wulff constructions, taking the relative stabilities of the edges and the AA' stacking order into account. Patterns in WS₂ are transferred to an underlying graphite layer, demonstrating a possible use for creating sub-10 nm features. In contrast, multilayer hBN exhibits no lateral anisotropy but shows consistent vertical etch angles, independent of crystal orientation. Using an hBN crystal as the base, ultrasharp corners can be created in lithographic patterns, which are then transferred to a graphite crystal underneath. We find that the anisotropic SF₆ reactive ion etching process makes it possible to downsize nanostructures and obtain smooth edges, sharp corners, and feature sizes significantly below the resolution limit of electron beam lithography. The nanostructured 2D materials can be used themselves or as etch masks to pattern other nanomaterials.

Unemployment from stable, downsized and closed workplaces and alcohol-related mortality

AIMS

To assess the importance of health selection in the association between unemployment and alcohol-related mortality by comparing mortalities of those unemployed from workplaces experiencing different levels of downsizing. The more severe the downsizing, the less dependent unemployment would be on personal characteristics and the weaker the role of health selection.

DESIGN

We estimated hazards models of unemployment on alcohol-related diseases and poisonings and external causes with alcohol as a contributing cause over follow-ups of 0-5, 6-10 and 11-20 years and at different levels of downsizing (stable, downsized or closed).

SETTING

Finland, 1990 to 2009.

PARTICIPANTS

A register-based random sample of employees aged 25-63 in privately owned workplaces (n = 275 738).

MEASUREMENTS

The outcome was alcohol-related death and the exposure was unemployment. We adjusted for age, sex, year, education, marital status, health status, workplace tenure, industry, region and unemployment rate.

FINDINGS

Alcohol-disease mortality was elevated among the unemployed throughout the follow-up, regardless of the level of downsizing. At 11-20 years after baseline, those unemployed from stable workplaces had a 2.46 hazard ratio (HR) (95% confidence interval [CI] = 2.14-2.82), those from downsized workplaces 1.94 (95% CI = 1.64-2.30) and those from closed workplaces 2.13 (95% CI = 1.75-2.59), when compared with the controls. Alcohol-related external-cause mortality at 0-5 years follow-up was only associated with unemployment from stable workplaces (HR = 1.39, 95% CI = 1.22-1.58), but over time, an association emerged among those unemployed following downsizing and closure. At 11-20-year follow-up, the HR following downsizing was 1.83 (CI 95% = 1.37-2.45) and 1.54 (95% CI = 1.03-2.28) following closure.

CONCLUSIONS

There is some indication that alcohol-related ill-health may lead to unemployment in Finland. However, the persistent long-term association between unemployment and alcohol-related mortality even after workplace closure may imply a causal relation.

Systolic Nanofabrication of Super-Resolved Photonics and Biomimetics

Systolic nanofabrication is demonstrated via conformal downsizing of three-dimensional micropatterned monolithic master-casts made of extremely nanoporous aerogel and xerogel materials. The porous solid skeleton collapses by thermal treatment, generating miniaturized replicas, which preserve the original stereometric forms and incorporate minified nanoscale patterns. Paradigmatic holographic and biomimetic nanoarchitectures are conformally downsized by ~4×, yielding subwavelength surface features of less than ~150 nm. The operations demonstrate the super-resolution capabilities of this alternative concept and its potential evolution to an innovative nanotechnology of the future.

Predictors of managers' mental health during the COVID-19 pandemic

This study reports early evidence of managers' mental health and its predictors during the Coronavirus disease 2019 (COVID-19) pandemic in May 2020. In a sample of 646 managers from 49 countries, 5.3% (32) of managers reached the cut-off levels for disorders in distress (Kessler Psychological Distress Scale-6; K-6), 7.3% (38) experienced anxiety (General Anxiety Disorder-7; GAD-7), and 10.7% (56) had depression (Patient Health Questionnaire-9; PHQ-9). Age, relative income, and work status each predicted at least one of the conditions. Managers' 'illegitimate tasks' caused by COVID-19 predicted all three. Particularly noteworthy is the finding that the degree of downsizing an organization experienced during COVID-19 significantly predicted distress, anxiety, and depression for managers at the highest level (board members) only. This study helps identify managers in need of healthcare services as the COVID-19 pandemic affects organizations and their managers around the world.

Bullying and Harassment in Downsized Workplaces: What Can We Learn from the 2008 Icelandic Economic Collapse?

Research shows that bullying is a significant workplace issue. A previous study showed increased sickness-related absences among municipality employees during the Icelandic economic crisis in 2008. This led to the following research questions: has bullying and/or harassment increased between the time points of the study up to seven years after the crisis? Did bullying and/or harassment change depending on downsizing? Are quantitative job demands, role conflicts and social support connected to bullying and/or harassment at work and if so, how? The study is based on a four-wave longitudinal balanced panel dataset consisting of those who work within the education and care services operated by Icelandic municipalities. It was seen that bullying and harassment had increased between the time points of the study. Furthermore, employees in downsized workplaces, workplaces with higher quantitative job demands, more role conflicts and less support were more likely to experience bullying and/or harassment than employees in other workplaces. Since the effects may prevail for several years, the study demonstrates that the consequences of downsizing need to be carefully considered and that managers must be supported in that role. As economic crises tend to occur periodically, presently due to COVID-19, the knowledge is both of theoretical and practical importance.

Changes in area and number of nature reserves in China

Nature reserves (NR) are the cornerstone of biodiversity conservation. Over the past 60 years, the rapid expansion of NRs in China, one of the world's megadiverse countries, has played a critical role in slowing biodiversity loss. We examined the changes in the number and area of China's NRs from 1956 to 2014 and analyzed the effect of economic development on the expansion of China's NRs from 2005 to 2014 with linear models. Despite a continuing increase in the number of NRs, the total area of China's NRs decreased by 3% from 2007 to 2014. This loss resulted from downsizing and degazettement of existing NRs and a slowdown in the establishment of new ones. Nature reserves in regions with rapid economic development exhibited a greater decrease in area, suggesting that downsizing and degazettement of NRs are closely related to the intensifying competition between economic growth and conservation. For example, boundary adjustments to national NRs, the most strictly protected NRs, along the coast of China's Yellow Sea, a global biodiversity hotspot with a fast-growing economy, resulted in the loss of one-third of the total area. One of the most important ecosystems in these NRs, tidal wetlands, decreased by 27.8% because of boundary adjustments and by 25.2% because of land reclamation. Our results suggest conservation achievement, in terms of both area and quality, are declining at least in some regions in the Chinese NR estate. Although the designation of protected areas that are primarily managed for sustainable use has increased rapidly in recent years in China, we propose that NRs with biodiversity conservation as their main function should not be replaced or weakened.

Homes Too Large for Household Needs? Under-Occupancy as Policy Problem and Lived Experience among Older Social Housing Tenants

Rising demand for social housing has induced housing authorities to find ways to increase the utilisation of existing housing stock, including targeting households thought to be living in homes that are larger than they need. This "under-occupation" of social housing is common among older tenants who, as with other under-occupiers, have been subject to unpopular measures designed to encourage downsizing. Yet little attention has been given to the housing needs of under-occupying older tenants and the ability of the social housing sector to meet those needs. In reviewing a new housing initiative for older under-occupying social housing tenants in Brisbane, Australia, this paper explores the housing needs and experience of this cohort. It shows that under-occupancy is a lived experience for some tenants and that downsizing to a smaller property is an attractive, albeit limited option. This suggests that policy prescriptions about the problem of older under-occupiers in the social housing sector should be reframed around the issue of tenants housing needs as they age.

The association between job insecurity and engagement of employees at work

This study examined the association between employees' perceived job insecurity and employee engagement. Using Gallup-Sharecare Well-Being Index (2008-2014) data, we applied logistic regressions to examine the association between job insecurity and engagement, controlling for covariates. The job insecurity variable was also interacted with the supervisor support variable. We found that perceived job insecurity was associated with reduced engagement and that this may be moderated by supervisor support. This is the first study using nationally representative data to examine the role of supervisor support in mitigating the negative impact of job insecurity on engagement.

Use of 5-alpha-reductase inhibitors as alternatives to luteinizing-hormone releasing hormone (LHRH) analogs or anti-androgens for prostate downsizing before brachytherapy

INTRODUCTION

Prostate hypertrophy, median lobe hypertrophy, and pubic arch interference (PAI) are relative contraindications to brachytherapy because of potential morbidity and technical considerations. GnRH analogs or non-steroidal anti-androgens are currently utilized to achieve prostatic downsizing prior to brachytherapy. However, such agents have been associated with effects on body habitus, metabolism, and quality of life. In contrast, 5-alpha reductase inhibitors (5-ARI) are far less frequently associated with these morbidities.

METHODS AND MATERIALS

Patients with large gland size, median lobe hypertrophy, or PAI were offered 5-ARI therapy. Repeat transrectal ultrasound was performed at 3 or 4 months, followed by brachytherapy if resolution was achieved. If downsizing was inadequate, patients were offered continuation of 5-ARI for additional 3 months, gonadotropin-releasing hormone analog (GnRH) agonist or antiandrogen therapy, or other curative treatment.

RESULTS

Of 59 patients with follow-up available, 42 (71%) were deemed to have adequate downsizing; 37 (63%) after 3 to 4 months of 5-ARI and 5 (8%) after 7 to 8 months. Seventeen patients (29%) received other treatments because of inadequate effect. Median volume reduction was 20%. Of 41 patients undergoing brachytherapy, 4 (9.7%) required temporary catheterization because of obstruction. Median follow-up after implantation was 25 months (range, 1-64). Median time for return to International Prostate Symptom Score ≤5 of baseline score was 7 months (interquartile ratio, 6-13). All but 1 patient who received brachytherapy remain biochemically controlled.

CONCLUSION

5-ARI monotherapy is an alternative for downsizing in patients with hypertrophy or PAI, with more than 70% achieving adequate downsizing without use of GnRH analogs or antiandrogens. Patients who received brachytherapy experienced typical rates of postimplant urinary morbidity.

Stereotactic body radiotherapy used as a bridge to liver transplant in patients with hepatocellular carcinoma and Child-Pugh score ≥8 cirrhosis

INTRODUCTION

To report on SBRT as a bridge to OLT for patients with HCC and Child-Pugh ≥8 cirrhosis.

METHODS

Retrospective review of 15 patients, treated from 2010-2017. Three patients excluded secondary to delisting from prohibitive substance. Twelve patients (17 lesions) included for final analysis. Hepatic SPECT functional treatment planning utilized.

RESULTS

The median age of 60 years with a median CP 9 and MELD 14. The median SBRT dose was 40 Gy in 5 fractions, and median tumor size was 2.3cm (1.2-5.3cm). Median follow-up and survival was 40-months and 46-months, respectively. One patient succumbed to renal/hepatic failure before OLT. Radiographic response was 80%. pCR at explant was 46%. No grade ≥ 3 acute toxicities. Median time to progression of CP ≥ 2 was 9.7-months and MELD progression was not met before OLT.

CONCLUSION

SBRT with functional treatment planning can be used safely as a bridge to OLT in select patients with CP ≥8 cirrhosis.

Facilitating a Major Staffing Transition in a State Psychiatric Hospital With Changes to Nursing Orientation

BACKGROUND

A large state psychiatric hospital experienced a state-mandated Reduction in Force that resulted in the abrupt loss and rapid turnover of more than 40% of its nursing and paraprofessional staff. The change exemplified current national trends toward downsizing and facility closure.

OBJECTIVE

This article describes revisions to the nursing orientation program that supported cost containment and fidelity to mission and clinical practices during the transition.

DESIGN

An existing nursing orientation program was reconfigured in alignment with principles of rational instructional design and a core-competencies model of curriculum development, evidence-based practices that provided tactical clarity and commonality of purpose during a complex and emotionally charged transition period.

RESULTS

Program redesign enabled efficiencies that facilitated the transition, with no evidence of associated negative effects.

CONCLUSION

The process described here offers an example for hospitals facing similar workforce reorganization in an era of public sector downsizing.

Goodbye or Identify: Detrimental Effects of Downsizing on Identification and Survivor Performance

Research shows that after layoffs, employees often report decreased commitment and performance which has been coined the survivor syndrome. However, the mechanisms underlying this effect remain underexplored. The purpose of the paper is to show that reduced organizational identification can serve as an explanation for the survivor syndrome. We conducted a laboratory experiment, in which participants work as a group of employees for another participant who acts as employer. In the course of the experiment, the employer decides whether one of his or her employees should be laid off or not. Mediation analysis supports a social identity-based explanation for the emergence of the survivor syndrome: downsizing causes lower identification with the employer which in turn relates to lower performance of employees.

Patterns of Care in the Administration of Neo-adjuvant Chemotherapy for Breast Cancer. A Population-Based Study

Neo-adjuvant chemotherapy (NAC) is used to facilitate radical surgery for initially irresectable or locally advanced breast cancer. The indication for NAC has been extended to clinically node negative (cN0) patients in whom adjuvant systemic therapy is foreseen. A population-based study was conducted to evaluate the increasing use of NAC, breast conserving surgery (BCS) after NAC and timing of the sentinel node biopsy (SNB). All female breast cancer patients, treated in 10 hospitals in the Eindhoven Cancer Registry area in the Netherlands between January 2003 and June 2012 were included (N = 18,427). In total, 1,402 patients (7.6%) received NAC. The administration increased from 2.5% in 2003 to 13.0% in 2011 (p < 0.001). Use of NAC increased from 0.5% to 2.3% for cT1 tumors, from 2.8% to 27.0% for cT2, from 30.6% to 70.9% for cT3, and from 40.5% to 58.1% for cT4 tumors (p < 0.001). In cN0 patients, use of NAC increased from 1.0% to 4.4% and in clinically node positive patients from 12.0% to 57.5% (p < 0.001). Downsizing of the tumor and BCS are achieved increasingly. In 2011, in three hospitals NAC was administered in <10% of patients, in five hospitals in 10-15% and in two hospitals the proportion of patients receiving NAC was >20% (p < 0.001). Of the 1,402 patients with NAC, 495 patients underwent SNB, 91.5% of whom prior to NAC. In the Netherlands up to one in eight patients receive NAC. The administration of NAC and the percentage of BCS increased over the past decade, especially in cT2 tumors. Considerable hospital variation in the administration of NAC exists.

Association of pretreatment serum carcinoembryonic antigen levels with chemoradiation-induced downstaging and downsizing of rectal cancer

The aim of this study was to identify pretreatment clinical parameters associated with preoperative chemoradiotherapy (CRT)-induced downstaging and downsizing of locally advanced rectal cancer (LARC T3-4 or N+). Data from 51 LARC patients, who received preoperative CRT and radical surgery between 2010 and 2013, were retrospectively analyzed. Rectal adenocarcinoma was histologically confirmed in all patients, who ranged in age between 41 and 81 years (median, 64 years). CRT consisted of 50.4 Gy pelvic radiotherapy with concurrent chemotherapy using 5-fluorouracil and leucovorin. After a median interval of 7 weeks post-CRT, the patients underwent total mesorectal excision. Downstaging was defined as the transition from cStage II-III to ypStage 0-I. The longest tumor diameter was measured pre- and post-CRT using computed tomography or magnetic resonance imaging, and based on the surgical specimen, respectively. Downstaging was observed in 16 (31.4%) patients, including 5 (9.8%) with a pathological complete response. The median downsizing rate was 60%. The serum carcinoembryonic antigen (CEA) levels were 0.8-153.9 ng/ml (median, 4.4 ng/ml). The maximum standardized uptake value was 4.7-33.9 (median, 10.8). On univariate analysis, cT stage, tumor size and CEA level were associated with downstaging. On multivariate analysis, only CEA level (≤5 ng/ml) was a significant predictor of downstaging (odds ratio = 16.0; 95% confidence interval: 1.8-146.7; P=0.014). CEA level was the only factor significantly associated with downsizing (>60%) in the univariate analysis. These results demonstrated that pretreatment serum CEA levels are significantly associated with downstaging as well as downsizing of LARC following preoperative CRT. Therefore, this parameter may be useful in personalizing the management of LARC patients.

Approaching the downsizing limit of silicon for surface-controlled lithium storage

Graphene-sheet-supported uniform ultrasmall (≈3 nm) silicon quantum dots have been successfully synthesized by a simple and effective self-assembly strategy, exhibiting unprecedented fast, surface-controlled lithium-storage behavior and outstanding lithium-storage properties including extraordinary rate capability and remarkable cycling stability, attributable to the intrinsic role of approaching the downsizing limit of silicon.

Surgical treatment for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is an epithelial tumor derived from hepatocytes; it accounts for 80% of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related deaths. HCC treatment is a multidisciplinary and a multimodal task, with surgery in the form of liver resection and liver transplantation (LT) representing the only potentially curative modality. However, there are variable opinions and discussions about applying these surgical options and using other supporting treatments. This article is a narrative review that includes articles published from 1984 to 2013 located by searching scientific databases such as PubMed, SCOPUS, and Elsevier, with the main keyword of hepatocellular carcinoma in addition to other keywords such as liver transplantation, liver resection, transarterial chemoembolization, portal vein embolization, bridging therapy, and downstaging. In this review, we focus mainly on the surgical treatment options offered for HCC, in order to illustrate the current relevant data available in the literature to help in applying these surgical options and to use other supporting treatment modalities when appropriate.

Financial crisis and collapsed banks: psychological distress and work related factors among surviving employees--a nation-wide study

AIM

The study considered psychological distress among surviving bank employees differently entangled in downsizing and restructuring following the financial crisis of 2008.

METHODS

A cross-sectional, nationwide study was conducted among surviving employees (N = 1880, response rate 68%). Multivariate analysis was conducted to assess factors associated with psychological distress.

RESULTS

In the banks, where all employees experienced rapid and unpredictable organizational changes, psychological distress was higher among employees most entangled in the downsizing and restructuring process. Being subjected to downsizing within own department, salary cut, and transfer to another department, was directly related to increased psychological distress, controlling for background factors. The associations between downsizing, restructuring, and distress were reduced somewhat by adding job demands, job control, and empowering leadership to the model, however, adding social support had little effect on these associations.

CONCLUSION

Employees most entangled in organizational changes are the most vulnerable and should be prioritized in workplace interventions during organizational changes.

Modified cisplatin/interferon α-2b/doxorubicin/5-fluorouracil (PIAF) chemotherapy in patients with no hepatitis or cirrhosis is associated with improved response rate, resectability, and survival of initially unresectable hepatocellular carcinoma

BACKGROUND

The purpose of this study was to evaluate the factors associated with response rate, resectability, and survival after cisplatin/interferon α-2b/doxorubicin/5-fluorouracil (PIAF) combination therapy in patients with initially unresectable hepatocellular carcinoma.

METHODS

The study included 2 groups of patients treated with conventional high-dose PIAF (n = 84) between 1994 and 2003 and those without hepatitis or cirrhosis treated with modified PIAF (n = 33) between 2003 and 2012. Tolerance of chemotherapy, best radiographic response, rate of conversion to curative surgery, and overall survival were analyzed and compared between the 2 groups, and multivariate and logistic regression analyses were applied to identify predictors of response and survival.

RESULTS

The modified PIAF group had a higher median number of PIAF cycles (4 versus 2, P = .049), higher objective response rate (36% versus 15%, P = .013), higher rate of conversion to curative surgery (33% versus 10%, P = .004), and longer median overall survival (21.3 versus 10.6 months, P = .002). Multivariate analyses confirmed that positive hepatitis B serology (hazard ratio [HR] = 1.68; 95% confidence interval [CI] = 1.08-2.59) and Eastern Cooperative Oncology Group performance status ≥ 2 (HR = 1.75; 95% CI = 1.04-2.93) were associated with worse survival whereas curative surgical resection after PIAF treatment (HR = 0.15; 95% CI = 0.07-0.35) was associated with improved survival.

CONCLUSIONS

In patients with initially unresectable hepatocellular carcinoma, the modified PIAF regimen in patients with no hepatitis or cirrhosis is associated with improved response, resectability, and survival.

Exploratory studies on development of the chemokine receptor CXCR4 antagonists toward downsizing

Seven transmembrane (7TM) G-protein-coupled receptor (GPCR) families are important targets for drug discovery, and specific antagonists for GPCR can accelerate research in the field of medicinal chemistry. The chemokine receptor CXCR4 is a GPCR that possesses a unique ligand CXCL12/stromal cell-derived factor-1 (SDF-1). The interaction between CXCL12 and CXCR4 is essential for the migration of progenitor cells during embryonic development of the cardiovascular, hemopoietic and central nervous systems, and also involved in several intractable disease processes, including HIV infection, cancer cell metastasis, progression of acute and chronic leukemias, rheumatoid arthritis and pulmonary fibrosis. Thus, CXCR4 may be an important therapeutic target in all of these diseases, and various CXCR4 antagonists have been proposed as potential drugs. Fourteen-mer peptides, T140 and its analogs, and downsized cyclic pentapeptides have been developed by us as potent CXCR4 antagonists. This article describes the development of a number of specific CXCR4 antagonists in our laboratory, including downsizing.