Purpose
We evaluated the efficacy and safety of capecitabine and temozolomide (CAPTEM) in patients with metastatic neuroendocrine tumors (NETs) to the liver. This regimen was based on our studies ...with carcinoid cell lines that showed synergistic cytotoxicity with sequence-specific dosing of 5-fluorouracil preceding temozolomide (TMZ).
Methods
A retrospective review was conducted of 18 patients with NETs metastatic to the liver who had failed 60 mg/month of Sandostatin LAR™ (100 %), chemotherapy (61 %), and hepatic chemoembolization (50 %). Patients received capecitabine at 600 mg/m
2
orally twice daily on days 1–14 (maximum 1,000 mg orally twice daily) and TMZ 150–200 mg/m
2
divided into two doses daily on days 10–14 of a 28-day cycle. Imaging was performed every 2 cycles, and serum tumor markers were measured every cycle.
Results
Using RECIST parameters, 1 patient (5.5 %) with midgut carcinoid achieved a surgically proven complete pathological response (CR), 10 patients (55.5 %) achieved a partial response (PR), and 4 patients (22.2 %) had stable disease (SD). Total response rate was 61 %, and clinical benefit (responders and SD) was 83.2 %. Of four carcinoid cases treated with CAPTEM, there was 1 CR, 1 PR, 1 SD, and 1 progressive disease. Median progression-free survival was 14.0 months (11.3–18.0 months). Median overall survival from diagnosis of liver metastases was 83 months (28–140 months). The only grade 3 toxicity was thrombocytopenia (11 %). There were no grade 4 toxicities, hospitalizations, opportunistic infections, febrile neutropenias, or deaths.
Conclusions
CAPTEM is highly active, well tolerated and may prolong survival in patients with well-differentiated, metastatic NET who have progressed on previous therapies.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
One of the hypotheses that may help explain the loss of honey bee colonies worldwide is the increasing potential for exposure of honey bees to complex mixtures of pesticides. To better understand ...this phenomenon, two multi-residue methods based on different extraction and cleanup procedures have been developed, and compared for the determination of 11 relevant pesticides in honey bees, pollen, and wax by gas chromatography–quadrupole mass spectrometry. Sample preparatory methods included solvent extraction followed by gel permeation chromatography (GPC) cleanup and cleanup using a dispersive solid-phase extraction with zirconium-based sorbents (Z-Sep). Matrix effects, method detection limits, recoveries, and reproducibility were evaluated and compared. Method detection limits (MDL) of the pesticides for the GPC method in honey bees, pollen, and wax ranged from 0.65 to 5.92ng/g dw, 0.56 to 6.61ng/g dw, and 0.40 to 8.30ng/g dw, respectively, while MDLs for the Z-Sep method were from 0.33 to 4.47ng/g dw, 0.42 to 5.37ng/g dw, and 0.51 to 5.34ng/g dw, respectively. The mean recoveries in all matrices and at three spiking concentrations ranged from 64.4% to 149.5% and 71.9% to 126.2% for the GPC and Z-Sep methods, with relative standard deviation between 1.5–25.3% and 1.3–15.9%, respectively. The results showed that the Z-Sep method was more suitable for the determination of the target pesticides, especially chlorothalonil, in bee hive samples. The Z-Sep method was then validated using a series of field-collected bee hive samples taken from honey bee colonies in Virginia.
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•Pesticide exposure has been linked with honey bee population losses.•Reliable multi-residue analytical methods are needed for trace pesticide analysis.•Two sample preparation methods were tested: GPC and d-SPE with Z-Sep.•Z-Sep cleanup was the preferred method and was successful with field-collected media.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Fe K-edge X-ray absorption near-edge structure (XANES) and Mössbauer spectra were collected on natural basaltic glasses equilibrated over a range of oxygen fugacity (QFM −
3.5 to QFM +
4.5). The ...basalt compositions and
fO
2 conditions were chosen to bracket the natural range of redox conditions expected for basalts from mid-ocean ridge, ocean island, back-arc basin, and arc settings, in order to develop a high-precision calibration for the determination of Fe
3+/∑Fe in natural basalts. The pre-edge centroid energy, corresponding to the 1s
→
3d transition, was determined to be the most robust proxy for Fe oxidation state, affording significant advantages compared to the use of other spectral features. A second-order polynomial models the correlation between the centroid and Fe
3+/∑Fe, yielding a precision of ±
0.0045 in Fe
3+/∑Fe for glasses with Fe
3+/∑Fe
>
8%, which is comparable to the precision of wet chemistry. This high precision relies on a Si (311) monochromator to better define the Fe
2+ and Fe
3+ transitions, accurate and robust modeling of the pre-edge feature, dense
fO
2-coverage and compositional appropriateness of reference glasses, and application of a non-linear drift correction. Through re-analysis of the reference glasses across three synchrotron beam sessions, we show that the quoted precision can be achieved (i.e., analyses are reproducible) across multiple synchrotron beam sessions, even when spectral collection conditions (detector parameters or sample geometry) change. Rhyolitic glasses were also analyzed and yield a higher centroid energy at a given Fe
3+/∑Fe than basalts, implying that major variations in melt structure affect the relationship between centroid position and Fe
3+/∑Fe, and that separate calibrations are needed for the determination of oxidation state in basalts and rhyolites.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Intraoperative errors are inevitable, and how surgeons respond impacts patient outcomes. Although previous research has queried surgeons on their responses to errors, no research to our knowledge has ...considered how surgeons respond to operative errors from a contemporary first-hand source: the operating room staff. This study evaluated how surgeons react to intraoperative errors and the effectiveness of employed strategies as witnessed by operating room staff.
A survey was distributed to operating room staff at 4 academic hospitals. Items included multiple-choice and open-ended questions assessing surgeon behaviors observed after intraoperative error. Participants reported the perceived effectiveness of the surgeon’s actions.
Of 294 respondents, 234 (79.6%) reported being in the operating room when an error or adverse event occurred. Strategies positively associated with effective surgeon coping included the surgeon telling the team about the event and announcing a plan. Themes emerged regarding the importance of the surgeon remaining calm, communicating, and not blaming others for the error. Evidence of poor coping also emerged: “Yelling, feet stomping and throwing objects onto the field. The surgeon cannot articulate needs well because of anger.”
These data from operating room staff corroborates previous research presenting a framework for effective coping while shedding light on new, often poor, behaviors that have not emerged in prior research. Surgical trainees will benefit from the now-enhanced empirical foundation on which coping curricula and interventions can be built.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To provide updated information on the distribution of histopathologic types of primary pulmonary neoplasia in dogs and evaluate the effect of postoperative adjuvant chemotherapy in dogs with ...pulmonary carcinoma.
340 dogs.
Medical records of dogs that underwent lung lobectomy for removal of a primary pulmonary mass were reviewed, and histopathologic type of lesions was determined. The canine lung carcinoma stage classification system was used to determine clinical stage for dogs with pulmonary carcinoma.
Pulmonary carcinoma was the most frequently encountered tumor type (296/340 87.1%), followed by sarcoma (26 7.6%), adenoma (11 3.2%), and pulmonary neuroendocrine tumor (5 1.5%); there was also 1 plasmacytoma and 1 carcinosarcoma. Twenty (5.9%) sarcomas were classified as primary pulmonary histiocytic sarcoma. There was a significant difference in median survival time between dogs with pulmonary carcinomas (399 days), dogs with histiocytic sarcomas (300 days), and dogs with neuroendocrine tumors (498 days). When dogs with pulmonary carcinomas were grouped on the basis of clinical stage, there were no significant differences in median survival time between dogs that did and did not receive adjuvant chemotherapy.
Results indicated that pulmonary carcinoma is the most common cause of primary pulmonary neoplasia in dogs; however, nonepithelial tumors can occur. Survival times were significantly different between dogs with pulmonary carcinoma, histiocytic sarcoma, and neuroendocrine tumor, emphasizing the importance of recognizing the relative incidence of these various histologic diagnoses. The therapeutic effect of adjuvant chemotherapy in dogs with pulmonary carcinoma remains unclear and warrants further investigation.
To compare bacteriologic culture results for superficial swab and tissue biopsy specimens obtained from dogs with open skin wounds.
52 client-owned dogs.
For each dog, 1 wound underwent routine ...preparation prior to collection of 2 specimens, 1 by superficial swab (Levine) technique and 1 by tissue biopsy. Specimens were processed for bacteriologic culture. Two observers determined whether any detected difference in culture results for the 2 types of specimen would have resulted in differing treatment plans.
Culture results of swab and tissue biopsy specimens were identical in 11/52 (21.2%) cases. Tissue biopsy specimen and swab cultures yielded positive results for 44 (84.6%) and 40 (76.9%) wounds, respectively. With regard to mean recovery rates of bacteria from wounds with positive culture results, both the biopsy specimens and swabs yielded 3.4 bacterial species/wound. All wounds for which swab cultures yielded no growth also had negative culture results for biopsy specimens. Biopsy specimen and swab culture results were in agreement with regard to the most common bacteria cultured. In 7/52 (13%) wounds, the observers would have treated the patient differently on the basis of the results of the 2 cultures.
Results indicated that culture of a swab collected by the Levine technique is an appropriate noninvasive alternative to culture of a tissue biopsy specimen. A negative result obtained from culture of a swab is likely to be reliable. Disagreement between the results of swab and tissue biopsy specimen cultures is likely of low clinical importance.
Researchers have found that former collegiate athletes (FCAs) exhibit unfavorable changes in physical and mental health later in life, which may be exacerbated by physical inactivity following ...retirement from college sport. Despite past sports training, FCAs are as active or less active than non-athlete alumni, with some not meeting the current Physical Activity (PA) Guidelines for Adults. Researchers suggest promoting PA in FCAs to prevent future health concerns (e.g., worsening body composition, physical function, depression). Prior to intervention development, a deeper understanding of FCAs' experiences with PA post-sport and program characteristics they consider effective is warranted. Seventeen insufficiently active former National Collegiate Athletic Association Division I athletes participated in semi-structured interviews exploring their experiences with post-sport PA and perceptions of effective program characteristics. Using Consensual Qualitative Research Procedures, five domains were constructed. This manuscript overviews the first three of these domains, which pertain to participants' experiences with post-sport PA: (a) transitional lifestyle shifts that affected PA behavior; (b) barriers affecting PA choices and behavior post-sport; and (c) enablers affecting PA choices and behavior post-sport. All FCAs discussed needing a break to physically and mentally recover following sports retirement. Participants identified similar barriers to being active (e.g., time constraints, resource availability) following this break to those reported by non-athletic populations. Furthermore, FCAs prioritized activities they enjoyed, were influenced by past sports participation, and made them "feel" healthy and included in a group. Translating cognitive-behavioral strategies utilized to enhance sports performance may be viable in promoting PA maintenance in this population post-sport-retirement.
Lay summary: Seventeen former college athletes (FCAs) participated in semi-structured interviews exploring their experiences with physical activity (PA) post-sport and perceptions of PA promotional factors. Recognizing barriers, enablers, and transitional experiences regarding PA represents a critical step in developing effective PA interventions for FCAs.
IMPLICATIONS FOR PRACTICE
Former Division I college athletes indicated their population is susceptible to similar PA barriers faced by non-athletic adult populations. Cognitive behavioral strategies demonstrated to be efficacious in other adult populations may benefit FCAs.
Many cognitive behavioral strategies used to enhance sports performance for athletes in college are applicable to PA promotion outside of sport. Mental performance consultants (MPCs) who work with this population may consider transferring the use of these strategies to focus on PA promotion in athletes transitioning out of sport.
Former Division I athletes indicated completing exercise over general PA to attain long-term health benefits, but lacked solid goals that could guide their behavior. Focusing on cognitive-behavioral strategies that maintain exercise behavior may be the most viable way to improve long-term health and activity levels. As such, multi-disciplinary teams involving MPCs and exercise professionals may be warranted.
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BFBNIB, FSPLJ, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
The size and frequency of wildfires in the western United
States have been increasing, and this trend is projected to continue, with increasing adverse consequences for human health. Gas- and ...particle-phase
organic compounds are the main components of wildfire emissions. Some of the directly emitted compounds are hazardous air pollutants, while others can
react with oxidants to form secondary air pollutants such as ozone and
secondary organic aerosol (SOA). Further, compounds emitted in the particle
phase can volatize during smoke transport and can then serve as precursors for SOA. The extent of pollutant formation from wildfire emissions is
dependent in part on the speciation of organic compounds. The most detailed
speciation of organic compounds has been achieved in laboratory studies,
though recent field campaigns are leading to an increase in such
measurements in the field. In this study, we identified and quantified
hundreds of gas- and particle-phase organic compounds emitted from
conifer-dominated wildfires in the western US, using two two-dimensional gas
chromatography coupled with time-of-flight mass spectrometry (GC × GC ToF-MS) instruments. Observed emission factors (EFs) and emission ratios
are reported for four wildfires. As has been demonstrated previously,
modified combustion efficiency (MCE) was a good predictor of particle-phase EFs (e.g., R2=0.78 and 0.84 for sugars and terpenoids,
respectively), except for elemental carbon. Higher emissions of
diterpenoids, resin acids, and monoterpenes were observed in the field relative to laboratory studies, likely due to distillation from unburned
heated vegetation, which may be underrepresented in laboratory studies.
These diterpenoids and resin acids accounted for up to 45 % of total
quantified organic aerosol, higher than the contribution from sugar and
sugar derivatives. The low volatility of resin acids makes them ideal
markers for conifer fire smoke. The speciated measurements also show that
evaporation of semi-volatile organic compounds took place in smoke plumes,
which suggests that the evaporated primary organic aerosol can be a precursor of SOAs in wildfire smoke plumes.
To examine cross-sectional associations between farmers' market shopping behaviours and objectively measured and self-reported fruit and vegetable (FV) intake among rural North Carolina (NC) and New ...York City (NYC) shoppers.
Cross-sectional intercept surveys were used to assess self-reported FV intake and three measures of farmers' market shopping behaviour: (1) frequency of purchasing FV; (2) variety of FV purchased and (3) dollars spent on FV. Skin carotenoids, a non-invasive biomarker for FV intake, were objectively measured using pressure-mediated reflection spectroscopy. Associations between farmers' market shopping behaviours and FV intake were examined using regression models that controlled for demographic variables (e.g. age, sex, race, smoking status, education, income and state).
Farmers' markets (n 17 markets) in rural NC and NYC.
A convenience sample of 645 farmers' market shoppers.
Farmers' market shoppers in NYC purchased a greater variety of FV and had higher skin carotenoid scores compared with shoppers in rural NC. Among all shoppers, there was a positive, statistically significant association between self-reported frequency of shopping at farmers' markets and self-reported as well as objectively assessed FV intake. The variety of FV purchased and farmers' market spending on FV also were positively associated with self-reported FV intake, but not skin carotenoids.
Those who shop for FV more frequently at a farmers' markets, purchase a greater variety of FV and spend more money on FV have higher self-reported, and in some cases higher objectively measured FV intake. Further research is needed to understand these associations and test causality.
Prior work has identified intraoperative and postoperative coping strategies among surgeons and has demonstrated surgical errors to have a significant impact on patient outcomes and physicians. ...Little research has considered which coping strategies are most common among surgeons and if there exist coping strategy differences among sex or training level.
An electronic survey was distributed to surgical faculty and trainees at 3 institutions. Variables included coping techniques after making an error in the operating room. Participants were asked to report the effectiveness of their overall coping strategy.
A total of 168 participants (56% male, 45% faculty) experienced an operative error and answered questions regarding coping strategies. The only coping strategy significantly associated with positive ratings of coping effectiveness was, upon error, taking a step back and taking time to think and act (r = 0.17; P = .024). There were differences between men and women in both intra and postoperative coping strategies. Men (mean = 3.69/5, standard error = .09) viewed their overall coping strategy as more effective than women (mean = 3.38/5, standard error = .09), t(158.86) = 2.47; P = .015.
Although both male and female surgeons reported making errors in the operating room, differences exist in the strategies surgeons use to cope with these mistakes, and strategies differ in their ratings of effectiveness.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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