A new modified biased estimator for Zero inflated Poisson regression model

Zero-inflated Poisson (ZIP) model is widely used for counting data with excessive zeroes. The multicollinearity is the common factor in the explanatory variables of the count data. In this context, typically, maximum likelihood estimation (MLE) generates unsatisfactory results due to inflation of mean square error (MSE). In the solution of this problem usually, ridge parameters are used. In this study, we proposed a new modified zero-inflated Poisson ridge regression model to reduce the problem of multicollinearity. We experimented within the context of a specified simulation strategy and recorded the behavior of proposed estimators. We also apply our proposed estimator to the real-life data set and explore how our proposed estimators perform well in the presence of multicollinearity with the help of ZIP model for count data.

NCCN Guidelines® Insights: Merkel Cell Carcinoma, Version 1.2024

The NCCN Guidelines for Merkel Cell Carcinoma (MCC) provide recommendations for diagnostic workup, clinical stage, and treatment options for patients. The panel meets annually to discuss updates to the guidelines based on comments from expert review from panel members, institutional review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new page for locally advanced disease in the setting of clinical node negative status, entitled "Clinical N0 Disease, Locally Advanced MCC." This new algorithm page addresses locally advanced disease, and the panel clarifies the meaning behind the term "nonsurgical" by further defining locally advanced disease. In addition, the guideline includes the management of in-transit disease and updates to the systemic therapy options.

Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology

Basal cell carcinoma (BCC) is the most common form of skin cancer in the United States. Due to the high frequency, BCC occurrences are not typically recorded, and annual rates of incidence can only be estimated. Current estimated rates are 2 million Americans affected annually, and this continues to rise. Exposure to radiation, from either sunlight or previous medical therapy, is a key player in BCC development. BCC is not as aggressive as other skin cancers because it is less likely to metastasize. However, surgery and radiation are prevalent treatment options, therefore disfigurement and limitation of function are significant considerations. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) outline an updated risk stratification and treatment options available for BCC.

Enhancing mean estimators in median ranked set sampling with dual auxiliary information

When measuring the research variable is complicated, expensive, or problematic, median ranked set sampling (MRSS) is often utilized since it is straightforward to rank the components using a low-cost sorting criterion. Using this sampling scheme, many authors considered the problem of population mean estimation with a single auxiliary variable in order to obtain more precised estimators than the traditional ratio type regression estimators. In this article, we extend their ideas based on regression approach using two auxiliary variables and introduce a new regression-type estimator along with its theoretical expression of minimum mean square error (MSE). The suggested estimator's applicability is demonstrated using both simulated and real-world data sets.

A novel proposed class of estimators under ranked set sampling: Simulation and diverse applications

This study presents a novel enhanced exponential class of estimators for population mean under RSS by employing data on an auxiliary variable. The suggested estimators' mean square error (MSE) is calculated approximately at order one. The efficiency conditions that make the suggested enhanced exponential class of estimators superior to the traditional estimators are found. A simulation study using hypothetically drawn normal and exponential populations evaluates the execution of the suggested estimators. The findings demonstrate that the suggested estimators outperform their traditional equivalents. In addition, real data examples are examined to show how the proposed estimators can be implemented in various real life problems.

Demographic variations and time to initiation of adjunct treatment following surgical resection of anaplastic astrocytoma in the United States: a National Cancer Database analysis

BACKGROUND AND AIMS

The aim of this study was to analyze the trends, demographic differences in the type and time to initiation (TTI) of adjunct treatment AT following surgery for anaplastic astrocytoma (AA).

MATERIAL AND METHODS

The National Cancer Database (NCDB) was queried for patients diagnosed with AA from 2004 to 2016. Cox proportional hazards and modeling was used to determine factors influencing survival, including the impact of time to initiation (TTI) of adjuvant therapy.

RESULTS

Overall, 5890 patients were identified from the database. The use of combined RT + CT temporally increased from 66.3% (2004-2007) to 79% (2014-2016), p < 0001. Patients more likely to receive no treatment following surgical resection included elderly (> 60 years old), hispanic patients, those with either no or government insurance, those living > 20 miles from the cancer facility, those treated at low volume centers (< 2 cases/year). AT was received following surgical resection within 0-4 weeks, 4.1-8 weeks, and > 8 weeks in 41%, 48%, and 3%, respectively. Compared to patients who received RT + CT, patients were likely to receive RT only as AT either at 4-8 weeks or > 8 weeks after the surgical procedure. Patients who received AT within 0-4 weeks had the 3-year OS of 46% compared to 56.7% for patients who received treatment at 4.1-8 weeks.

CONCLUSION

We found significant variation in the type and timing of adjunct treatment following surgical resection of AA in the United States. A considerable number of patients (15%) received no AT following surgery.

Edukasi Bahaya Narkoba Perspektif Hukum Pidana dan Maqashid Syariah

Pendampingan edukasi bahaya narkoba ditinjau dari sisi hukum pidana dan maqashid syariah sangat perlu dilakukan di kalangan pemuda agar pengetahuan dan wawasan mereka semakin luas dan bisa menjadi self control dalam menghindari penggunaan narkoba, kegiatan ini menyasar pada sekumpulan remaja yang tergabung dalam Paguyuban Pemuda Dingin (PPD) Ngronggot Nganjuk. Secara umum, pengetahuan mereka tentang bahaya narkoba dari sisi kesehatan telah dimengerti, Namun. pengetahuan dan wawasan bahaya narkoba perspektif hukum pidana dan maqashid syariah masih banyak yang belum mengerti. Hasil yang diharapkan dari pendampingan ini adalah para pemuda di sasaran dampingan lebih semangat dalam beraktivitas serta terbebas dari narkoba dan memiliki mentalitas kuat dalam menghadapi tantangan zaman globalisasi, karena hal ini sangat diperlukan bagi paguyuban pemuda Dingin desa Ngronggot ketika bergaul dengan sesama di masyarakat. Metode pelatihan dilaksanakan dengan cara diskusi dan interaktif dalam menyampaikan pengetahuan kepada peserta pelatihan. Berdasarkan dari hasil pelatihan, adanya besar peningkatan pengetahuan yang diperoleh mitra dengan baik dengan perolehan hasil rata-rata pretest nilainya adalah 36,84 %, sedangkan hasil rata-rata posttest  adalah 54,74 %.

Neurological manifestation with special reference to HIV-associated neurocognitive disorder (HAND) among people on anti-retroviral treatment in India

OBJECTIVE

The neurological manifestations and their severity in patients on antiretroviral treatment (ART) are currently unexplained. ‎We aimed at studying the prevalence of HIV Associated Neurological Disorders (HAND) among people on antiretroviral treatment, using the International HIV Dementia Scale (IHDS).

PATIENTS AND METHODS

A predesigned and pretested proforma including the International HIV Dementia Scale (IHDS) was administered to 100 HIV patients attending to ART center of KIMS teaching Hospital (Koppal, Karnataka) from January 2020 to March 2020. The data was analyzed SPSS version 15 software. Descriptive statistics were used for demographic characteristics. The Student's t-test and chi-square test methods were applied to determine the relationship between qualitative characteristics.

RESULTS

The prevalence was found to be 59%. Out of 100, 57 HIV patients scored less than 10 whereas 43 HIV patients scored ≥10 on the IHDS scale. The mean age of the study population was 39.14 ±13.01 years; the total IHDS score was 9.96±1.53 and the CD4 count was 427.91±226.0. This study demonstrated that the patients with CD4 count more than 350 (i.e., 63.60%) had a better IHDS score.

CONCLUSIONS

Neurocognitive disorder was found to be more common than anticipated. All ICTC Centers need to consider assessing HIV-associated neurocognitive disability (HAND), and the International HIV Dementia Scale (IHDS) as one instrument for such assessment.

Stereotactic radiosurgery for melanoma brain metastases: dose-size response relationship in the era of immunotherapy

PURPOSE/OBJECTIVE(S)

To determine, for intact melanoma brain metastases (MBM) treated with single-fraction stereotactic radiosurgery (SRS), whether planning parameter peripheral dose per lesion diameter (PDLDm, Gy/mm) and lesion control (LC) differs with versus without immunotherapy (IO).

MATERIALS/METHODS

We performed a retrospective analysis of patients with intact MBM treated with SRS from 2008 to 2019. Cox-frailty models were constructed to include confounders selected by penalized Cox regression models with a LASSO selector. Interaction effect testing was used to determine whether a significant effect between IO and PDLDm could be demonstrated with respect to LC.

RESULTS

The study cohort comprised 67 patients with 244 MBMs treated with SRS (30 patients with 122 lesions treated with both SRS and IO) were included. The logarithm of PDLDm was selected as a predictor of LC (HR 0.307, 95% CI 0.098-0.441), adjusting for IO receipt (HR 0.363, 95% CI 0.108-1.224). Interaction effect testing demonstrated a differential effect of PDLDm by IO receipt, with respect to LC (p = 0.048). Twelve-month LC rates for a 7.5 mm lesion receiving SRS (18 Gy) with IO versus without IO were 87.8% (95% CI 69.0-98.3%) versus 79.8% (95% CI 55.1-93.8%) respectively.

CONCLUSION

PDLDm predicted LC in patients with small MBMs treated with single-fraction SRS. We found a differential effect of dose per lesion size and LC by immunotherapy receipt. Future studies are needed to determine whether lower doses of single-fraction SRS afford similarly effective LC for patients with small MBMs receiving immunotherapy.

Evaluation of reliability index and probability of failure for the improvement of the Nigerian empirical mechanistic flexible pavement analysis and design system (Nempads)

The aim of this work was to evaluate reliability index (RI) with respect to fatigue and rutting within the different seasons peculiar to Nigeria, in order to improve Empirical-Mechanistic flexible pavement design approach, using First Order Reliability Method (FORM). Flexible pavement design involves many uncertainties, variabilities, and approximations regarding the input parameters like material properties, traffic loads. Others include subgrade strength, drainage conditions, construction, compaction procedures and climatic factors such as temperature, rainfall, and snowfall, etc. The combination of the variances associated with input parameters contributes to components and system uncertainty, and this combination of variances can have a significant effect on the predicted performance of the pavement. Reliability in pavement design is introduced to consider these uncertainties. Layers thicknesses, material properties, and Equivalent Standard Axle Load (ESAL) were entered into a multi-layer elastic theory software, ELSYM-5, which in turn were used to calculate strains and stresses for different seasons. The results obtained were entered into Nigerian fitted transfer function distress models to compute allowable ESALS. Miner’s hypothesis theory equation was used to calculate the cumulative damage due to stress and strains generated. A Framework was generated for finding individual reliability index (RI), systemic reliability index (SRI), and probability of failure. The findings showed that Season I (Winter) recorded the highest component reliability index for fatigue (5.63 for Normal Distribution). Season II (Summer) recorded the lowest component reliability index (β) for rutting (5.4 for Normal Distribution). Season III (Spring) recorded the lowest component reliability index for fatigue (1.85 for Normal Distribution)

Association of indoor air pollution on cognitive dysfunction among elderly

OBJECTIVE

Cognitive dysfunction among the elderly is a devastating condition preceded by accumulation of neuropathology leading to accelerated cognitive decline. Many epidemiologic studies have reported the relation between indoor air pollution exposure and cognitive impairment. To clarify the nature of the association, a comprehensive systematic review and meta-analysis were performed.

MATERIALS AND METHODS

The analysis included all observational studies, including cross-sectional studies, prospective and retrospective cohort studies. Experimental studies, randomized controlled trials (RCTs), and controlled clinical trials were excluded. Studies on the relationships of indoor air pollution and cognition published before 30 April 2021 which are peer-reviewed scientific publications available in English were included after performing a structured literature search through electronic databases, including PubMed, Embase, Cochrane Library, and clinical trial.gov. A total of 146 articles were collected, and after screening thoroughly only, 9 studies were selected. Meta-analysis for the final set of selected studies was performed using the R software.

RESULTS

The quality of all the studies was adequate as almost all reported an association between at least one pollutant and cognitive dysfunction. However, relatively few studies considered outcomes that provide the most substantial evidence for a causal effect. In total, 5 studies have reported on cognitive function. The pooled mean of cognitive function was 12.16 (95% CI: 10.73 to 13.58). However, the heterogeneity was very high (I2=100%; chi-square test for heterogeneity = p<0.001). We used a modified JBI structured risk of the bias assessment tool, and it was minimal among the included studies as most of the studies have followed a random sampling method and explicitly mention it in their methods.

CONCLUSIONS

Exposure to indoor air pollution through fuels used for cooking and heating was significantly associated with cognitive dysfunction among elderly women. Given the limitations, a more extensive meta-analysis and longitudinal studies are recommended to investigate the biological mechanism behind the impact of indoor air pollution on cognitive health.

"LONG COVID": an insight

We aimed this systematic review to analyze and review the currently available published literature related to long COVID, understanding its pattern, and predicting the long-term effects on survivors. We thoroughly searched the databases for relevant articles till May 2021. The research articles that met our inclusion and exclusion criteria were assessed and reviewed by two independent researchers. After preliminary screening of the identified articles through title and abstract, 249 were selected. Consequently, 167 full-text articles were assessed and reviewed based on our inclusion criteria and thus 20 articles were regarded as eligible and analyzed in the present analysis. All the studies included adult population aged between 18 and above 60 years. The median length of hospital stay of the COVID-19 patients during the acute infection phase ranged from 8 days to 17 days. The most common prevalent long-term symptoms in COVID-19 patients included persistent fatigue and dyspnea in almost all of the studies. Other reported common symptoms included: shortness of breath, cough, joint pain, chest pain or tightness, headache, loss of smell/taste, sore throat, diarrhea, loss of memory, depression, anxiety. Associated cardiovascular events included arrhythmias, palpitations and hypotension, increased HR, venous thromboembolic diseases, myocarditis, and acute/decompensated heart failure as well. Among neurological manifestations headache, peripheral neuropathy symptoms, memory issues, concentration, and sleep disorders were most commonly observed with varying frequencies. Mental health issues affecting mental abilities, mood fluctuations namely anxiety and depression, and sleep disorders were commonly seen. Further, diarrhea, vomiting, digestive disorders, and Loss of appetite or weight loss are common gastrointestinal manifestations. Therefore, appropriate clinical evaluation is required in long COVID cases which in turn may help us to identify the risk factors, etiology, and to my help, we treat them early with appropriate management strategies.

Immune status in merkel cell carcinoma: Relationships with clinical factors and independent prognostic value

e21509

Background: Immunosuppression (IS) is not currently considered in staging for Merkel cell carcinoma (MCC). We performed an analysis of the National Cancer Database (NCDB) to investigate immune status as an independent predictor of overall survival (OS) for patients with MCC and describe the relationship between immune status and other prognostic factors. Methods: The NCDB was queried for patients diagnosed with MCC from 2010 to 2016 with known immune status. Multivariable Cox proportional hazards models were used to define factors associated with OS. Adjuvant radiation and chemotherapy were treated as time-dependent predictors to limit immortal time bias. Secondary models were constructed to assess the association between IS etiology and OS. Multivariable logistic regression models were used to characterize relationships between immune status and other factors. Multiple imputation was used to minimize missing data bias. Results: The overall cohort included 3,882 patients (3,470 patients with known immunocompetence and 412 patients with known immunosuppression). Etiologies for profound IS included chronic lymphocytic leukemia (CLL, n = 118), Other including HIV/AIDS (n = 116), solid-organ transplant (n = 106), and Non-Hodgkin Lymphoma (NHL, n = 72). 2,864 patients (73.8%) underwent surgical nodal examination. The median follow-up time was 33 months (Interquartile Range: 18 to 55 months). The 3-year OS was lower for patients with IS (44.6%, CI 39.8-49.9%) compared to immunocompetent (IC) patients (68.7%, CI 67.1-70.4%, p < .0001). IS was associated with increased adjusted mortality hazard (HR 2.36, 95% CI 2.03-2.75). Etiology of IS was associated with OS ( p = .0015) with lowest 3-year OS (32.7%, CI 24.6%-43.5%) for patients with solid-organ transplantation. IS was associated with increased odds of greater nodal burden (OR 1.70, CI 1.37-2.11) and lymphovascular invasion (OR 1.58, CI 1.23-2.03). Conclusions: Immune status was independently prognostic for OS for patients with localized MCC. Etiology of IS may be associated with differential survival outcomes. Multiple adverse prognostic factors were associated with increased likelihood of IS. Immune status and potentially etiology of IS may be useful prognostic factors to consider for future MCC staging systems.

The effect of cleaning and repainting on the ship drag penalty

Although the hull of a recently dry-docked large ship is expected to be relatively smooth, surface scanning and experimentation reveal that it can exhibit an "orange-peel" roughness pattern with an equivalent sand-grain roughness height ks = 0. 101 mm. Using the known ks value and integral boundary layer evolution, a recently cleaned and coated full-scale ship was predicted to experience a significant increase in the average coefficient of friction %ΔC¯f and total hydrodynamic resistance %ΔR¯T during operation. Here the report also discusses two recently reported empirical estimations that can estimate k_s directly from measured surface topographical parameters, by-passing the need for experiments on replicated surfaces. The empirical estimations are found to have an accuracy of 4.5 - 5 percentage points in %ΔC¯f.

Contribution of advanced fluorescence nano microscopy towards revealing mitotic chromosome structure

The organization of chromatin into higher-order structures and its condensation process represent one of the key challenges in structural biology. This is important for elucidating several disease states. To address this long-standing problem, development of advanced imaging methods has played an essential role in providing understanding into mitotic chromosome structure and compaction. Amongst these are two fast evolving fluorescence imaging technologies, specifically fluorescence lifetime imaging (FLIM) and super-resolution microscopy (SRM). FLIM in particular has been lacking in the application of chromosome research while SRM has been successfully applied although not widely. Both these techniques are capable of providing fluorescence imaging with nanometer information. SRM or "nanoscopy" is capable of generating images of DNA with less than 50 nm resolution while FLIM when coupled with energy transfer may provide less than 20 nm information. Here, we discuss the advantages and limitations of both methods followed by their contribution to mitotic chromosome studies. Furthermore, we highlight the future prospects of how advancements in new technologies can contribute in the field of chromosome science.

Tradisi “Mbeleh Wedhus Kendhit” Sebagai Sarana Tolak Balak di Masa Pandemi Covid-19

Penelitian ini bertujuan untuk mendeskripsikan tradisi mbeleh wedhus kendhit sebagai sarana tolak bala di masa pandemi covid-19, juga untuk mengetahui bagaimana konstruksi pemahaman masyarakat mengenai tradisi mbeleh wedhus kendhit sebagai sarana tolak bala di masa pandemi covid-19, dan terakhir, untuk mengetahui nilai yang terkandung dalam tradisi mbeleh wedhus kendhit sebagai sarana tolak bala di masa pandemi covid-19. Untuk menjawab tujuan penelitian tersebut, penulis menggunakan pendekatan kualititatif  dengan jenis fenomenologis. Setelah data terkumpul, untuk mencari konstruksi pemahaman, dianalisis dengan menggunakan teori konstriuksi sosial Berger dan Luckman tentang subjective reality, symbolic reality, dan objective reality, juga tentang eksteralisasi, objektifikasi, dan iternalisasi. Sedangkan untuk mencari nilai yang terkandung dalam tradisi, menggunakan analisis descriptive-eksplorative. Dari hasil penelitian tersebut diketahui bahwa, tradisi ini merupakan rangkaian acara yang dimulai dari penyembelihan wedhus kendhit hingga doa bersama di lapangan dusun, dilaksanakan secara tentatif ketika terjadi pagebluk, seperti pagebluk covid-19. Masyarakat memahami bahwa tradisi mbeleh wedhus kendhit adalah sumber segala nilai, lanjut melaksanakan, kemudian mereka mendapatkan suatu kebenaran kolektif tentang adanya khasiat sebagai sarana tolak bala. Nilai yang terkandung dalam tradisi “mbeleh wedhus kendhit” ada dua, yakni nilai ilahiyah dan nilai insaniyah.

Konstruksi Pemahaman Jamaah Majelis Zikir Al-Khidmah Terhadap Sakralitas Banyu Mana>qib

Abstract: This article aims to describe how the construction of the congregation's understanding of the al-Khidmah zikir assembly about the sacredness of banyu mana> qib so that it influences and moves the congregation to put water around the assembly. To answer these questions, the author uses a qualitative research methodology with analysis using the theory of Peter L. Berger and Thomas Luckman about social construction. The construction of the understanding of the congregation of the Al-Khidmah zikir assembly when viewed with Berger and Luckman's theory will take place through dialegical interactions of subjective reality, symbolic reality, and objective reality. Subjective reality in this theory, each individual believes that the reading of mana>qib is a source of value. After that, it is symbolically represented - symbolic reality - by placing water around the qib. Then the combination of each individual raises an objective reality about banyu mana>qib. Simultaneously there is also a process of externalization, objectification, and iternalization. The externalization process occurs when the congregation adjusts to the values that have developed among the congregation. Then the objectification is marked by the congregation who has the same understanding and perception, namely, banyu mana> qib which is able to provide properties as a healing medium. Finally, the congregation identifies itself (internalization) about the needs they want to fulfill through / because of the water, so that an action appears.الملخص: يهدف هذا المقال إلى دراسة كيفية بناء فهم مجمع ذكر الخدمت على قدسية مياه المناقب وبالتالي التأثير على المصلين وتحريكهم لوضع الماء حول التجمع. للإجابة على هذا السؤال ، يستخدم المؤلف منهجية بحث نوعي مع التحليل باستخدام نظرية بيتر ل.بيرجر وتوماس لاكمان في البناء الاجتماعي. إن بناء فهم مجمع ذكرى الخدمتة ، إذا ما نظر إليه بنظرية بيرغر ولوكمان ، سيتم من خلال التفاعل الديالكتيكي للواقع الذاتي والواقع الرمزي والواقع الموضوعي. الحقيقة الذاتية في هذه النظرية ، يعتقد كل فرد أن قراءة المناقب مصدر قيمة. بعد ذلك يتم تمثيلها رمزياً - الواقع الرمزي - بوضع الماء حول مكان قراءة المناقب. ثم يؤدي الجمع بين كل فرد إلى إحضار حقيقة موضوعية حول مناقب المياه. في الوقت نفسه ، هناك أيضًا عملية المبالغة والتشكيل والإمالة. تحدث عملية التخارج عندما تتكيف الجماعة مع القيم التي نشأت بين المصلين. ثم يتم تمييز التشيؤ من قبل المصلين الذين لديهم نفس الفهم والإدراك ، أي مياه المناقب القادرة على توفير الفعالية كوسيلة للشفاء. أخيرًا ، يعرّف المصلين أنفسهم (مستوطنين) حول الاحتياجات التي يريدون تلبيتها من خلال / بسبب الماء ، بحيث ينشأ فعل ما.Abstrak: Artikel ini bertujuan untuk mengungkapkan bagaimana konstruksi pemahaman jamaah majelis zikir Al-Khidmah tentang sakralitas banyu mana>qib sehingga mempengaruhi dan menggerakan jamaah untuk meletakkan air di sekitar majelis. Untuk menjawab pertanyaan tersebut, penulis menggunakan metodologi penelitian kualitatif dengan analisis menggunakan teori Peter L. Berger dan Thomas Luckman tentang konstruksi sosial. Konstruksi pemahaman jamaah majelis zikir Al-Khidmah jika dilihat dengan teori Berger dan Luckman maka akan berlangsung melalui interaksi dialegtis dari subjective reality, symbolic reality, dan objective reality. Subjective reality dalam teori ini, masing-masing individu meyakini bahwa bacaan manaqib adalah sumber nilai. Setelah itu direpresentasikan secara simbolis –symbolic reality- dengan meletakkan air di sekitar tempat pembacaan mana>qib. Kemudian gabungan masing-masing individu memunculkan satu objective reality tentang banyu mana>qib. Secara simultan juga terjadi proses eksteralisasi, objektifikasi, dan iternalisasi. Proses eksternalisasi terjadi ketika jamaah menyesuaikan diri dengan nilai yang sudah berkembang di kalangan jamaah. Kemudian objektifikasi ditandai dengan jamaah yang memiliki pemahaman dan presepsi yang sama, yakni, banyu mana>qib yang mampu memberikan khasiat sebagai media penyembuhan. Terakhir, jamaah mengidentifikasi dirinya (internalisasi) tentang kebutuhan yang hendak mereka penuhi melalui/lantaran air tersebut, sehingga muncul suatu tindakan.

Tumor infiltrating lymphocyte grade in Merkel cell carcinoma: relationships with clinical factors and independent prognostic value

INTRODUCTION

Surrogate markers of the host immune response are not currently included in AJCC staging for Merkel cell carcinoma (MCC), and have not been consistently associated with clinical outcomes. We performed an analysis of a large national database to investigate tumor infiltrating lymphocyte (TIL) grade as an independent predictor of overall survival (OS) for patients with MCC and to characterize the relationship between TIL grade and other clinical prognostic factors.

MATERIAL AND METHODS

The NCDB was queried for patients with resected, non-metastatic MCC with known TIL grade (absent, non-brisk and brisk). Multivariable Cox regression modeling was performed to define TIL grade as a predictor of OS adjusting for other relevant clinical factors. Multinomial, multivariable logistic regression was performed to characterize the relationship between TIL grade and other clinical prognostic factors. Multiple imputation was performed to account for missing data bias.

RESULTS

Both brisk (HR 0.55, CI 0.36-0.83) and non-brisk (HR 0.77, CI 0.60-0.98) were associated with decreased adjusted hazard of death relative to absent TIL grade. Adverse clinical factors such as 1-3 positive lymph nodes, lymphovascular invasion (LVI) and immunosuppression were associated with increased likelihood of non-brisk TIL relative to absent TIL grade (p values <.05). Extracapsular extension (ECS) was associated with decreased likelihood of brisk TIL relative to absent TIL grade (p<.05).

DISCUSSION

Histopathologic TIL grade was independently predictive for OS in this large national cohort. Significant differences in the likelihood of non-brisk or brisk TIL relative to absent grade were present with regards to LVI, ECS and immune status. TIL grade may be a useful prognostic factor to consider in addition to more granular characterization of TIL morphology and immunophenotype.

Physicochemical, antioxidant and sensory properties of chocolate spread fortified with jackfruit (Artocarpus heterophyllus) flour

Chocolate spread is often considered as an unhealthy product with low antioxidant activity and phenolic content since it does not contain cocoa liquor. This research aimed to investigate the potential on the physicochemical composition and antioxidant activity of jackfruit (Artocarpus heterophyllus) flour and red palm olein in the chocolate spread formulations. The effect of the jack fruit and red palm olein incorporation on the quality attributes and high nutritional value of chocolate spread was also examined. Physicochemical properties of the fortified chocolate spread, as well as the evaluation of physical parameters in the chocolate spread, were investigated. Melting points were analyzed by DSC (Differential scanning calorimeter) method, colour lightness was analyzed by chromameter hunter method, profile bioactive compound was analyzed by gas chromatography-mass spectrometry (GC-MS), and whilst for viscosity by Brookfield Viscometer method. The analysis results obtained that the sample code F5 (10% jackfruit flour: 26% sugar) contains of 43.47% fat, 0,88% free fatty acids, polyphenol 127 mg/g, 160.16 mg/g carotenoids, 42.75 μg/mL antioxidant activity IC50, and 6.19 degree of acidity per 100 g chocolate spreads and high panelists preference. However, the fortified chocolate spread had different characteristics from each other either in the chemical, physical or sensory properties. The best formulation code is F5 with 10% jackfruit flour, fortification significantly increased the antioxidant activity, carotenoid, polyphenols, viscosity, colour and melting points. Additionally, chocolate spread with 10% of jackfruit flour by-product presented the highest-ranking test rate of the three sensory attributes of aroma, taste and texture. Therefore, the use of jackfruit by-products in the development of chocolate spread is a viable alternative which can be explored for nutritional, technological and sensory purposes by the food industry.

In vitro antibacterial activity and potential applications in food of sea urchin (Diadema setosum) from Cape of Palette, South Sulawesi

Marine invertebrates in support of his life's defence of sea predatory use an innate immune mechanism, namely the cellular component hemocytes by secreting the dissolved antimicrobial and cytotoxic substances. It shows that marine invertebrates are potential sources and promising antimicrobial compounds. This research was aimed at determining the antibacterial activity of sea urchin (Diadema setosum) extract against some bacterial isolates and its application to foodstuffs. The gonad and shell of sea urchin extracted by methanol and ethyl acetate and then separated by ultrasound-assisted extraction. Screening of antibacterial compound use gas chromatography-mass spectrometry (GC-MS), and disc diffusion method was followed to determine the antimicrobial activity against Salmonella, Escherichia coli and Staphylococcus aureus. The results of this study showed antibacterial activity against one or more strains. The gonad of sea urchin from methanol extract exhibited significant inhibitory effect and effective against Salmonella, E. coli and S. aureus. Majority of gonad and shell of sea urchin extract showed antibacterial activity against the tested strains. However, gonad of methanol extract was found to be inhibiting microorganisms gram-negative (E. coli) and gram-positive (Salmonella and S. aureus). Gonad extract can be a good source of antibacterial agents.

Management trends for anaplastic meningioma with adjuvant radiotherapy and predictors of long-term survival

OBJECTIVEThe purpose of this study was to describe effects of adjuvant radiotherapy (RT) for anaplastic meningiomas (AMs) on long-term survival, and to analyze patient and RT characteristics associated with long-term survival.METHODSThe authors queried a retrospective cohort of patients with AM from the National Cancer Database (NCDB) diagnosed between 2004 and 2015 to describe treatment trends. For outcome analysis, patients with at least 10 years of follow-up were included, and they were stratified based on adjuvant RT status and propensity matched to controls for covariates. Survival curves were compared. A data-driven approach was used to find a biologically effective dose (BED) of RT with the largest difference between survival curves. Factors associated with long-term survival were quantified.RESULTSThe authors identified 2170 cases of AM in the NCDB between 2004 and 2015. They observed increased use of adjuvant RT in patients treated with higher doses. A total of 178 cases met the inclusion criteria for outcome analysis. Forty-five percent (n = 80) received adjuvant RT. Patients received a BED of 80.23 ± 16.6 Gy (mean ± IQR). The median survival time was not significantly different (32.8 months for adjuvant RT vs 38.5 months for no RT; p = 0.57, log-rank test). Dichotomizing the patients at a BED of 81 Gy showed maximal difference in survival distribution with a decrease in median survival in favor of no adjuvant RT (31.2 months for adjuvant RT vs 49.7 months for no RT; p = 0.03, log-rank test), but this difference was not significant after false discovery rate correction. Age was a significant predictor for long-term survival.CONCLUSIONSAMs are aggressive tumors that carry a poor prognosis. Conventional adjuvant RT improves local control. However, the effect of adjuvant radiation on overall survival is unclear. Further investigation into this area is warranted.

Phytochemical and antibacterial properties of sea cucumber (Muelleria lecanora) from Barrang Lompo Islands, Makassar South Sulawesi

Barrang Lompo Island Waters is home for different species of marine biota of sea cucumber (Muelleria lecanora). Many sea cucumber species have been used as health supplements because they contain bioactive compounds that are beneficial to people in Indonesia. Given this, our study was designed to investigate the phytochemical, and antibacterial properties of crude acetone, methanol and hexane extract of sea cucumber using maceration extraction methods. The sea cucumber extract was prepared and the phytochemical profile was studied by analysing Gas Chromatography-Mass Spectrometry (GC-MS). Results showed that the extracts were a complex mixture of numerous compounds; many of which were present in trace amounts antioxidants and antimicrobial; hexadecanoic acid, methyl ester, 9-octadecenoic acid (z) -, methyl ester (stearic acid methyl ester), octadecanoic acid, methyl ester, 2-[(hexadecyloxy)methyl]oxirane, cholest5-en-3-yl acetate, ergosta-14,22-dien-3-ol, acetate,(3.beta.,5.alpha.,22e), 5,8,11,14- eicosatetraenoic acid, methyl ester, (all-z) epa/omega 3, pentacosane, hexatriacontane, and 9-hexadecenoic acid, methyl ester, (Z). The extract was also evaluated for activity against three pathogenic bacterial strains (Escherichia coli, Staphylococcus aureus and Salmonella) using the disc diffusion method. The extract exhibited clear zones of inhibition against the tested bacteria. Maximum inhibitory zone concentration values were demonstrated to be: Escherichia coli = 6.84 mm , Staphylococcus aureus = 7.22 mm, and Salmonella = 7.87 mm. These results revealed the significant potential of sea cucumber as a source of antioxidants and antimicrobial agents and also highlight the necessity of further purification and characterisation of solitary bioactive compounds for their prospective applications in pharmaceutical industries, food, and nutraceutical (food functional)

Optimal adjuvant radiotherapy dose for stage I, II or III Merkel cell carcinoma: an analysis of the National Cancer Database

BACKGROUND

We performed an analysis of the National Cancer Database to determine optimal doses of conventionally-fractionated adjuvant radiotherapy for patients with stage I/II or III Merkel cell carcinoma.

METHODS

The cohort included 2735 patients with resected Merkel cell carcinoma of the head and neck, trunk or extremities receiving radiotherapy. Exclusion criteria included doses of radiotherapy <30 or >80 Gy, or dose per fraction >200 or <180 cGy. Recursive partitioning analysis and spline models were used to select dose thresholds. Multivariable Cox regression was performed to validate thresholds with respect to overall survival.

RESULTS

Recursive partitioning analysis models defined a threshold of 57 Gy for stage I/II Merkel cell carcinoma, above which 3-year overall survival rate was decreased (P < 0.0001). The 3-year overall survival rate for patients receiving 50.0-57.0 Gy (81.2%) was greater compared to doses of 30.0-49.9 Gy (75.3%) or >57.0 Gy (70%, P < 0.0001). Doses > 57.0 Gy were associated with an increased hazard of death (1.31, confidence interval 1.07-1.60) with respect to doses of 50.0-57.0 Gy. Doses < 50.0 Gy for stage III Merkel cell carcinoma were associated with worsened 3-year overall survival (P < 0.0001) and increased hazard of death (2.01, confidence interval 1.43-2.82) with respect to doses between 50.0 and 57.0 Gy.

CONCLUSIONS

Our results support doses of 50-57 Gy for most patients with stage I/II Merkel cell carcinoma receiving conventionally-fractionated adjuvant radiotherapy. In contrast to a prior National Cancer Database analysis, our results suggest doses ≥ 50 Gy should be strongly considered for patients with stage III Merkel cell carcinoma regardless of anatomic subsite.

Immune status and the efficacy of adjuvant radiotherapy for patients with localized Merkel cell carcinoma of the head and neck

PURPOSE

Immunosuppressed (IS) patients are at increased risk for developing Merkel cell carcinoma (MCC) with worsened outcomes compared to immunocompetent (IC) patients. We sought to determine the effects of immune status on the efficacy of adjuvant RT regarding OS for patients with stage I, II or III (localized) MCC of the head and neck.

METHODS/PATIENTS

The National Cancer Database was queried for patients with resected, localized MCC of the head and neck with known immune status. Kaplan-Meier methods were used to describe OS. Log-rank tests, multivariable Cox regression models and interaction effect testing were used to compare OS by subgroup categorized by patient and treatment factors including immune status and adjuvant RT receipt.

RESULTS

A total of 892 (89.6%) IC and 104 (10.4%) IS patients with MCC of the head and neck were included. Adjuvant RT was associated with improved 3-year OS rate for both IS patients (49.4% vs. 35.5%, p = 0.0467) and stage I/II IC patients (72.4% vs. 62.9%, p = 0.0092). Adjuvant RT was associated with decreased hazard of death (HR 0.77, 95% CI 0.62-0.95). Interaction effect testing did not demonstrate a difference in the efficacy of adjuvant RT on OS between IC and IS status (p = 0.157).

CONCLUSIONS

In this NCDB analysis, adjuvant RT was associated with decreased hazard of death for patients with localized MCC of the head and neck regardless of immune status and should be considered for both IS and IC patients.

Phase-contrast 3D tomography of HeLa cells grown in PLLA polymer electrospun scaffolds using synchrotron X-rays

Advanced imaging is useful for understanding the three-dimensional (3D) growth of cells. X-ray tomography serves as a powerful noninvasive, nondestructive technique that can fulfill these purposes by providing information about cell growth within 3D platforms. There are a limited number of studies taking advantage of synchrotron X-rays, which provides a large field of view and suitable resolution to image cells within specific biomaterials. In this study, X-ray synchrotron radiation microtomography at Diamond Light Source and advanced image processing were used to investigate cellular infiltration of HeLa cells within poly L-lactide (PLLA) scaffolds. This study demonstrates that synchrotron X-rays using phase contrast is a useful method to understand the 3D growth of cells in PLLA electrospun scaffolds. Two different fiber diameter (2 and 4 µm) scaffolds with different pore sizes, grown over 2, 5 and 8 days in vitro, were examined for infiltration and cell connectivity. After performing visualization by segmentation of the cells from the fibers, the results clearly show deeper cell growth and higher cellular interconnectivity in the 4 µm fiber diameter scaffold. This indicates the potential for using such 3D technology to study cell-scaffold interactions for future medical use.

ACTR-03. FINAL RESULTS OF A PHASE II STUDY OF HYPOFRACTIONATED RADIOTHERAPY WITH CONCURRENT AND ADJUVANT TEMOZOLOMIDE IN PATIENTS OVER 70 YEARS OLD WITH NEWLY DIAGNOSED GLIOBLASTOMA

BACKGROUND

We sought to determine the efficacy and tolerability of hypofractionated radiotherapy (HFRT), 34Gy given over two weeks with concurrent and adjuvant temozolomide, in patients over 70 years old with newly diagnosed GBM.

METHODS

Patients ≥ 70 years of age with newly diagnosed GBM received HFRT to a dose of 34 Gy in 10 fractions over 2 weeks, delivered with concurrent and adjuvant TMZ. Quality of life (QOL) data using the validated functional assessment of cancer therapy-brain (FACT-BR) questionnaire was collected. Kaplan-Meier methods and log-rank tests were used for survival analyses. A random intercepts growth model with baseline and linear effect in time terms was used to assess QOL with relation to protocol treatment.

RESULTS

Eleven patients were enrolled from 12/1/2015 to 2/5/2018. Median age and KPS of the cohort was 74 years (range 70 -81) and 80 (range 60–100). Eight patients have died. Median follow-up of the cohort was 13.8 months (range 3 – 26 months). The median progression free survival (PFS) was 6.0 months (CI 4.7 months -not achieved (NA) and the median overall survival (OS) was 24.5 months (CI 10.2 months –NA). MGMT methylation status was significantly associated with both PFS (p =0.02) and OS (p =0.02). All patients completed HFRT with no patients developing ≥ grade 3 adverse treatment events. QOL did not significantly worsen over time with therapy (p =0.75).

CONCLUSIONS

This completed phase II trial suggest a HFRT schedule of 34Gy delivered over 2 weeks with concomitant and adjuvant TMZ is well tolerated in elderly GBM patients without compromising clinical outcomes. This result compares favorably to the longer HFRT regimen of 40Gy over 3 weeks. ClinicalTrials.gov identifier: NCT01985087

RTHP-08. FAILURE TO COMPLETE STANDARD RADIATION THERAPY IN GLIOBLASTOMA PATIENTS: PATTERNS FROM A NATIONAL DATABASE WITH IMPLICATIONS FOR SURVIVAL AND THERAPEUTIC DECISION MAKING

BACKGROUND

Approximately 5%-10% of patients with newly diagnosed glioblastoma (GBM) will fail to complete standard radiotherapy (SRT). We sought to determine the impact on survival and to identify risk factors for failure to complete SRT.

METHODS

A cohort of 17,451 adults with GBM were identified from the National Cancer Database. The cohort was restricted to patients diagnosed between 2005 to 2012 that were started on conventionally fractionated RT of 1.8 to 2.0 Gy per fraction to a dose of < 66Gy and. Patients were stratified by RT dose achieved: (a.) completed RT > 58Gy, (b.) nearly completed RT > 50Gy - < 58Gy, and (c.) did not complete RT < 50Gy.

RESULTS

Radiotherapy completion rates correlated with survival, 87% of patients completed RT and had a median OS of 13.5 months, 4% were near completers (median OS 5.7 months), and 9% did not complete RT (median OS 1.9 months). Risk factors for not completing SRT were: older age, biopsy alone, government insurance, high comorbidity score and lower income zip code (all OR > 1 and p-values < 0.05). Twenty-eight percent of patients > 80 yrs did not complete SRT (OR 2.99, 95% CI 2.36–3.80, relative to 40–49 yrs) and 19% of 70-79-yrs did not complete SRT (OR 1.99, 95% CI 1.63–2.42).

CONCLUSIONS

Failure to complete SRT was associated with decreased survival in our cohort. Risk factors for failure to complete SRT, include older age, biopsy alone and substantial comorbidities. Other studies have shown SRT is discontinued primarily due to clinical deterioration and/or disease progression. Therefore, these patients should be considered for alternative therapeutic management such as hypofractionated radiotherapy.

Trends in the Management Paradigms of Intracranial Meningioma

Objective  Intracranial meningiomas are the most common primary brain tumor. Treatment paradigms have evolved over time. There are limited number of population-based studies that examine this modern evolution. Here, we describe the trends of management of intracranial meningiomas using a national database. Methods  The data were obtained from the National Cancer Database for the years 2004 to 2015, the collected variables included: patients' age, gender, insurance type, income, comorbidity score, the tumor size and grade, and treatment modality (observation, surgery, radiotherapy, or combination therapy). We performed statistical analyses to detect association between unique variables and outcomes. In addition, we performed mortality analyses for various treatment modalities. Results  A total of 199,096 patients with a diagnosis of intracranial meningioma were included, the majority of patients were white females, mean age of 61 years, and half of the tumors were ≤ 3 cm. Observation was the most commonly used management modality followed by surgical resection, radiotherapy, and combination therapy. For the entire time period, there was an increased use of observation as a primary management method. Predictors of mortality included increased age, larger tumor size, higher tumor grade, treatment at a community hospital, and higher comorbidity scores. Conclusion  Population-based studies of intracranial meningiomas are uncommon; our study is one of the few reports that examine the changes in the modern management paradigms of meningioma in the United States over time. Additionally, we shed light on the factors that affected survival of patients with this condition.

Failure to complete standard radiation therapy in glioblastoma patients: Patterns from a national database with implications for survival and therapeutic decision making in older glioblastoma patients

INTRODUCTION

It is estimated that 5%-10% of patients with newly diagnosed glioblastoma (GBM) fail to complete standard chemoradiation (CRT). We sought to determine the impact of failure to complete CRT on survival and to identify risk factors.

METHODS

We queried the National Cancer Database and identified a cohort of 17,451 adults with GBM diagnosed from 2005 to 2012. The cohort was restricted to patients that started conventionally fractionated adjuvant chemoradiation of 1.8 to 2.0 Gy per fraction to a dose of ≤66Gy. Patients were stratified by RT dose: a) completed RT ≥ 58Gy, b) nearly completed RT ≥ 50Gy - <58Gy, and c) did not complete RT ≤ 50Gy.

RESULTS

The CRT completion rate correlated with survival, 87% of patients completed CRT and had a median OS of 13.5 months, 4% were near completers (median OS 5.7 months), and 9% did not complete RT (median OS 1.9 months). Older age was associated with a higher risk of non-completion. Twenty-eight percent of patients ≥80 years old did not complete standard CRT (OR 2.99) and 19% of 70-79-year olds did not complete CRT (OR 1.99). The adjusted mortality hazard ratio was greater for patients that did not complete CRT across all age categories and for nearly complete CRT patients older than 40 (non-significant for age < 40).

CONCLUSIONS

Failure to complete standard chemoradiation was associated with decreased survival in our cohort. Patients with risk factors for failure (like advanced age) should be considered for alternative treatments such as hypofractionated radiotherapy.

Effect of Adding Insulin Transferrin Selenium (ITS) in the Medium on Maturation and Fertilization Rates of Bali Cattle Oocytes

The aim of this study was to determine the effect of adding Insulin Transferrin Selenium (ITS) in the medium on maturation and fertilization rates of Bali cattle oocytes. The ovarium of Bali cows were sliced to produce oocytes, then the collected oocytes were subsequently selected based on their quality. Those oocytes were maturated for 24 hours and then fertilized for 18 hours in the incubators of 5% CO2 with temperature of 38.5ºC. Oocytes were stained using 2% of aceto orcein, and observed under a microscope. This study was divided into four treatments at different addition of ITS in the medium and replicated four times, and analized using a Factorial Complete Randomized Design (CRD)at each treatment. The treatments consisted of P0 as control, P1 (5 ng/ml), P2 (10 ng/ml), and P3 (15 ng/ml). Parameters observed in this study were the stages of oocytes maturation rate that consisted of germinal vesicle (GV), germinal vesicle break down (GVBD), metaphase I (M-I), and metaphase II (M-II), and fertilization rate that consisted of absence of pronucleus (P0), 1 pronucleus (PN1), 2 pronucleus (PN2), and more than two pronucleus (&gt;2PN). The results of this study showed that addition of ITS at 5-15 ng/ml did not effect maturation and fertilization rates of Bali cows oocytes.The conculision of the study is addition of ITS at 5 ng / ml produces the best level of maturation and for the best level of fertilization with addition ITS at 15 ng / ml.

How do office workers respond to media coverage of sitting?

BACKGROUND

Sitting time is associated with adverse physical and mental health outcomes, and premature mortality. Office workers sit for prolonged periods, so are at particular risk. Scientific advances in public health threats are predominantly communicated to the public through media reports.

AIMS

This study aimed to examine office workers' impromptu responses to media coverage of scientific evidence related to the health risks of sedentary behaviour.

METHODS

Semi-structured interviews were run with 26 office workers (mean age 35 years), recruited from four organizations in southern England. Within the interview, each participant provided a 'think-aloud' narrative as they read three real-world news reports relating to sedentary behaviour. Thematic analysis was conducted on verbatim transcripts.

RESULTS

Three themes were extracted from the data: gauging the personal relevance of the news reports; questioning their trustworthiness and challenging the feasibility of proposed sitting-reduction strategies. Participants voiced scepticism about the applicability of the reports to their personal circumstances, and the validity of the reports and the scientific evidence underpinning them.

CONCLUSIONS

Researchers, press officers and journalists should emphasise the ways in which participants in research studies represent the broader population of office workers, and offer greater transparency in reporting study methods, when reporting scientific advances in sedentary behaviour.

Effects of adjuvant radiation therapy on survival for patients with resected primary tracheal carcinoma: an analysis of the National Cancer Database

Objective(s)

To identify predictors for receiving adjuvant radiation therapy (RT) and investigate the impact of adjuvant RT on survival for patients with resected primary tracheal carcinoma (PTC).

Methods

The National Cancer database was queried for patients with PTC diagnosed from 2004 to 2014 undergoing resection. Patients who died within 30 days of resection were excluded to minimize immortal time bias. Kaplan–Meier methods, Cox regression modeling and propensity score weighted (PSW) log-rank tests were considered to assess the relationship between adjuvant RT and overall survival (OS). Logistic regression was performed to identify predictors associated with receiving adjuvant RT.

Results

A total of 549 patients were identified with 300 patients (55%) receiving adjuvant RT. Squamous cell carcinoma (SCC) was the most common histology with 234 patients (43%). Adenoid cystic carcinoma (ACC) was second most frequent with 180 patients (33%). Adjuvant RT was not associated with OS by multivariable Cox analysis or PSW log-rank test (P values > 0.05). Patients with positive surgical margins (odds ratio (OR) 1.80, confidence interval (CI) 1.06–3.07) were more likely to receive adjuvant RT than those with negative surgical margins. Patients with ACC (OR 6.53, CI 3.57–11.95) were more likely to receive adjuvant RT compared with SCC.

Conclusions

Adjuvant RT was not significantly associated with OS for patients with resected PTC in this analysis. Surgical margin status and tumor histology were associated with receiving adjuvant RT. Further investigations including prospective registry studies capturing radiation technique and treatment volumes are needed to better define which patients with resected PTC may benefit from adjuvant RT.

Survival Impact of Time to Initiation of Adjuvant Radiation for Merkel Cell Carcinoma: An Analysis of the National Cancer Database

PURPOSE

This study aimed to determine the impact of time to initiation (TTI) of adjuvant radiation therapy (RT) on overall survival (OS) for patients with stage I or II Merkel cell carcinoma (MCC).

METHODS AND MATERIALS

The National Cancer Database was queried for patients with MCC of the head and neck, trunk, or extremities diagnosed between 2006 and 2014. Patients who did not undergo resection or receive adjuvant RT within 180 days of surgery were excluded. TTI was defined as the time from resection to first RT fraction. Linear regression was used to define factors associated with TTI. Recursive partitioning analysis modeling was performed to determine an optimal threshold for TTI. Cox proportional hazards modeling was performed to define covariates associated with OS.

RESULTS

A total of 2293 patients were included in this study. The median TTI for the cohort was 62 days (interquartile range, 43-86 days). TTI was not associated with OS for the overall cohort by multivariable Cox modeling (P = .19). Age, treatment facility type, lymph node examination, anatomic subsite, and surgical margin were associated with TTI (P < .05). Age, sex, insurance status, Charlson-Deyo comorbidity score, lymph node examination status, tumor size, and surgical margin were associated with OS (all P < .05).

CONCLUSIONS

Increased TTI of adjuvant RT was not associated with OS for patients with early stage MCC in this analysis of the National Cancer Database. The median TTI of 62 days from resection to adjuvant RT initiation for our study cohort contextualizes TTI on a national level and may offer reassurance for patients with prolonged postoperative wound healing or intercurrent illness delaying immediate RT initiation. Despite the lack of a clear detriment to survival with increased TTI up to 180 days from surgery, unnecessary delays in initiating adjuvant therapy should continue to be minimized while ensuring optimal recovery from resection.

Interim Results of a Phase II Study of Hypofractionated Radiotherapy with Concurrent Temozolomide Followed by Adjuvant Temozolomide in Patients over 70 Years Old with Newly Diagnosed Glioblastoma

OBJECTIVE

In this phase II study, we investigate clinical outcomes and tolerability of hypofractionated radiotherapy (HRT) combined with temozolomide (TMZ) to treat elderly patients with glioblastoma (GBM).

METHODS

Patients 70 years of age or older with newly diagnosed GBM received HRT to a dose of 34 Gy given in ten fractions over 2 weeks, delivered with concurrent and adjuvant TMZ.

RESULTS

In this interim analysis, ten patients were enrolled on trial from 12/1/2015 to 4/5/2017. With a median follow-up of 9 months (range 3-12 months), median progression-free survival (PFS) was 6 months. The median overall survival (OS) has not been reached. Estimated 1-year OS and PFS rates were 53.3 and 44.4%, respectively. All patients completed the full course of RT, with no patients developing grade 3 or higher adverse events from treatment.

CONCLUSIONS

The preliminary results of our phase II trial suggest HRT delivered over 2 weeks with concurrent and adjuvant TMZ is well tolerated in elderly patients with GBM without compromising clinical outcomes.

Effect of Bali cattle ovarian status on oocytes nuclear maturation and in vitro fertilization rate

<p>The aim of this study was to investigate whether the reproductive status influences the nuclear maturation and fertilization rates of bali cattle oocytes in vitro. Several pairs of ovary were classified into four groups: 1) ovaries with Corpus Luteum (CL) and Dominant Follicle (DF), 2) ovaries without CL and with DF, 3) ovaries with CL and without DF, 4) ovaries without both CL and DF. In the first experiment, oocytes were collected by slicing method in Phosphate Buffer Saline (PBS) medium supplemented with 10% Fetal Bovine Serum (FBS) and 100 IU/ml penicillin streptomycin. Oocytes were matured in tissue culture medium (TCM)-199 supplemented with 10% Fetal Bovine Serum (FBS), 10 IU/ml Follicle Stimulating Hormone (FSH), 10 IU/ml Luteinizing Hormone (LH), and 50 μg/ml gentamycin. Oocytes were matured in 5% CO2 incubator, 38oC for 24 h. In the second experiment, oocytes were matured and then fertilized in vitro to observe pronuclear formation. The first experiment showed that the percentage of oocytes reached methaphase-II (MII) stage on ovaries with CL and without DF (89.47%) were higher (P&lt;0,01) compared to ovaries without both CL and DF (75,47%), ovaries without CL and with DF (74.,41%), or ovaries with CL and DF (65,52%). The result of second experiment showed that the ovarian reproductive status was not significantly different (P&gt;0.05) on fertilization rate.</p>

Neck dissection for unknown cancer of the head and neck in the era of chemoradiation

PURPOSE

To report outcomes for patients with cervical lymph node metastases from an unknown primary site of the head and neck treated with either non-operative therapy or neck dissection followed by adjuvant therapy.

MATERIALS AND METHODS

All patients with squamous cell carcinoma of an unknown primary site of the head or neck seen between 2003 and 2013 were reviewed. The Kaplan-Meier method was used to estimate overall survival, local recurrence free survival, loco-regional recurrence free survival, and progression free survival. The log-rank test and proportional hazards regression were used to analyze factors influencing outcomes.

RESULTS

Of 2258 patients with a new diagnosis of head and neck cancer, no primary site was identified in 66 patients. Twenty-nine patients were treated with definitive non-operative therapy (15 with chemoradiation and 14 with radiation alone). Thirty-seven patients received an upfront neck dissection followed by adjuvant radiation or chemoradiation. Three-year loco-regional recurrence free survival, progression free survival, and overall survival were 55.9%, 55.4%, and 69.4% respectively. Patients treated with preoperative neck dissection had improved local recurrence free survival (96.7% vs 54.1%, p=0.003) and loco-regional recurrence free survival (82.2% vs 46.4%, p=0.068) compared to patients treated with definitive chemoradiation with no difference in overall survival (p=0.641).

CONCLUSIONS

Neck dissection improved local and regional control but not overall survival in patients with unknown primary squamous cell carcinoma of the head and neck over non-operative therapy alone.