In this study, clonal hematopoiesis with somatic mutations was found in 10% of otherwise healthy people older than 65. The risk of hematologic cancer was substantially increased among these persons; ...in two cases, the subsequent cancer was related to the clone that predated the cancer.
The development of disease often involves dynamic processes that begin years or decades before the clinical onset. In many cases, however, the process of pathogenesis goes undetected until after the patient has symptoms and presents with clinically apparent disease.
Cancer arises owing to the combined effects of multiple somatic mutations, which are likely to be acquired at different times.
1
Early mutations may be present many years before disease develops. In some models of cancer development, early mutations lead to clonal expansions by stem cells or other progenitor cells.
2
Such clonal expansions greatly increase the likelihood that later, cooperating mutations would . . .
To effectively engage veterans with substance misuse services, nurses need to understand their unique needs and the potential barriers that prevent them from accessing care. Nurses need to have an ...understanding and awareness of the cultural sensitivities associated with having been a member of the armed forces.
The aim of this study was to investigate the perceived barriers to care amongst those planning, commissioning and delivering services for veterans with substance misuse problems, and to identify and explore subject areas which nurse educators should consider for inclusion in nursing and health education programmes.
The findings reported in this paper come from one phase of a larger three phase research project and used an applied qualitative research approached based on methods developed for applied social policy research.
The study was undertaken in the north-east of England.
The study consisted of a purposive sample of planners, commissioners of services, and service providers in the North East of England.
Data was collected using a semi-structured interview schedule. Framework analysis was used to analyse the data.
Complexity of services and care, complexity of need and a lack of understanding of veterans were identified as factors that made accessing substance misuse care difficult. To help nurses better understand the unique needs of veterans three educational topics were identified for consideration in pre-registration nurse education: understanding military and veteran culture and the nature of modern warfare, the military ‘veteran as institutionalised’ hypothesis and stigma.
Health and social services can struggle to truly understand the unique needs and experiences of the veteran community. We have identified three broad subject areas that should be considered as the theoretical basis for a veteran specific education programme within pre and post-registration nurse education.
•Complexity of services makes substance misuse care difficult for veterans to access.•Health and social services struggle to understand the unique needs of the veteran community.•Institutions educating nurses should consider veteran specific education within their programme.
Learn state-of-the-art MIS techniques from master spine surgeons! Significant advances have been made in minimally invasive spine (MIS) surgery approaches, techniques, and innovative technologies. By ...preserving normal anatomic integrity during spine surgery, MIS approaches enable spine surgeons to achieve improved patient outcomes, including faster return to normal active lifestyles and reduced revision rates. Exposing only the small portion of the spine responsible for symptoms via small ports or channels, requires a deep understanding of spinal anatomy and spinal pathophysiology. Building on the widely acclaimed first edition, An Anatomic Approach to Minimally Invasive Spine Surgery, Second Edition, provides an expanded foundation of knowledge to master minimally invasive spine surgery. World-renowned spine neurosurgeons Mick Perez-Cruet, Richard Fessler, Michael Wang, and a cadre of highly regarded spine surgery experts provide masterful tutorials on an impressive array of cutting-edge technologies. Organized by seven sections and 51 chapters, the book presents a diverse spectrum of current safe and efficacious MIS procedures and future innovations. Nonsurgical approaches include injection-based spine procedures and stereotactic radiosurgery. Surgical technique chapters discuss MIS anterior, posterior, and lateral approaches to the cervical, thoracic, and lumbar spine, with procedures such as endoscopic microdiscectomy, vertebroplasty and kyphoplasty, percutaneous instrumentation, and robotic spine surgery. Key Features * Step-by-step illustrations, including more than 400 depictions by master surgical and anatomic illustrator Anthony Pazos portray the surgeon's-eye-view of anatomy, intraoperative images, and surgical instruments, thereby aiding in the understanding of anatomy and procedures * 20 online videos feature real-time operative fluoroscopy, pertinent anatomy, operative set-up, and common cervical, thoracic, and lumbar approaches * Discussion of novel MIS techniques reflected in 16 new or expanded chapters, including Robotic Assisted Thoracic Spine Surgery and Stem-Cell Based Intervertebral Disc Restoration There is truly no better clinical reward for spine surgeons than giving patients suffering from debilitating spinal disorders their life back. This quintessential MIS surgery resource will help surgeons and clinicians accomplish that goal.
To determine survival rates and the pattern of failure in head and neck cancer patients treated with induction chemotherapy, limited surgery and concomitant chemoradiotherapy.
Three cycles of ...induction chemotherapy with cisplatin, fluorouracil (5-FU), leucovorin, and interferon alfa-2b (PFL-IFN) were followed by optional surgery, and seven or eight cycles of 5-FU, hydroxyurea, and concurrent radiation for 5 days (FHX) for a total radiation dose of 65 to 75 Gy. Surgical resection was performed with the intent to spare organ function.
Seventy-one patients were treated at three institutions. Sixty-five patients (91%) had stage IV disease with N2/3 in 46. Thirty-three patients (51%; 95% confidence interval, 39% to 63%) achieved a clinical complete response (CR) to PFL-IFN. Local therapy consisted of surgery in 37 and/or FHX in 55 patients. With a median follow-up duration of 37 months, there have been 20 recurrences (15 local, four distant, and one both local and distant), and 29 deaths, 15 in patients with disease progression and 14 not directly related to the primary tumor. Four patients have developed second malignancies. At 3 years, 69% (+/- 6%) are progression-free and the overall survival rate is 60% (+/- 6%). Toxicity of PFL-IFN included severe or life-threatening mucositis (54%) and myelosuppression (60%). Five patients died of toxicity. During FHX, 70% of patients had grade 3 or 4 mucositis.
PFL-IFN is highly active, producing clinical CRs in 51% of patients, and, when followed by FHX, resulting in high local and distant control and overall survival rates. Second malignancies and intercurrent medical disease emerge as major risks to long-term survival. In view of the high toxicity and long treatment duration, further modifications of this approach are required.
The biological stabilization process of cattle and poultry manure was studied using thermogravimetric analysis and (13)C nuclear magnetic resonance. The stabilization processes carried out were ...composting, anaerobic digestion and a mixed process (partly aerobic, partly anaerobic). It was observed from the analyzed samples that the biological stabilization processes reduce the volatile content of the bio-wastes and increase the degree of aromaticity. The stabilization of cattle manure by means of aerobic processes was able to further oxidize and enriched in aromatic compounds the bio-waste when compared with the digestion process. On the other hand, the stabilization of poultry manure resulted in a greater aromatization under the digestion process. Stabilized samples with a high degree of aromaticity presented a lower volatile content accompanied by a reduction in the intensity of the differential thermogravimetry peak registered under an inert atmosphere, indicative of the thermal decomposition of the organic matter. The thermal decomposition of all the analyzed materials (fresh and stabilized samples) commenced at around 200 degrees C but for the digested poultry manure, which decomposition initiated close to 250 degrees C. All stabilized samples yielded a lower degree of volatilization to that one observed in fresh samples.
Study of biological stabilization process of cattle and poultry manure by thermogravimetric analysis and super(13)C NMR was conducted. The stabilization process carried out were namely, composting, ...anaerobic digestion and a mixed process. The stabilization of cattle manure by means of aerobic processes was able to further oxidize and enriched in aromatic compounds the bio-waste when compared with the digestion process. Stabilized samples with a high degree of aromaticity presented a lower volatile content accompanied by a reduction in the intensity of the differential thermogravimetry peak registered under an inert atmosphere, indicative of the thermal decomposition of the organic matter. It was observed that all stabilized samples yielded a lower degree of volatilization to that one observed in fresh samples.
Hydroxyurea and fluorouracil (5-FU) are active cytotoxic drugs in head and neck cancer and have shown synergistic activity in vitro. Both drugs also act as radiosensitizers. Therefore, we ...administered radiotherapy at daily fractions of 180 to 200 cGy with simultaneous continuous infusion 5-FU at 800 mg/m2/d and escalating daily doses of hydroxyurea for five days. Cycles were repeated every other week until completion of radiotherapy. Thirty-nine inoperable patients were treated at six dose levels of hydroxyurea ranging from 500 mg to 3,000 mg orally daily. Little effect of hydroxyurea on the WBC or platelet count was noted in patients receiving less than 2,000 mg daily, whereas both parameters decreased progressively in patients receiving 2,000 mg daily or more. Mucositis occurred at all dose levels, requiring frequent dose reduction of 5-FU; however, in patients receiving a daily hydroxyurea dose of 2,000 mg or less, the median weekly 5-FU dose administered was 1,725 mg/m2 (86% of the intended 5-FU dose), whereas at daily hydroxyurea doses exceeding 2,000 mg, the median weekly 5-FU dose decreased to 1,133 mg/m2 (57%) (P = .001). Of 15 evaluable patients with recurrent disease after prior local therapy only one failed to respond; six had a complete response (CR), and eight a partial response (PR). Of 17 evaluable patients without prior local therapy, 12 had a CR, with no patient developing recurrence in the irradiated field to date; five patients had a PR. We conclude that the recommended dose of hydroxyurea in this regimen is 2,000 mg daily. That dose will cause mild to moderate myelosuppression and will allow for delivery of greater than 80% of the intended 5-FU dose. The activity of this regimen in poor-prognosis head and neck cancer exceeds 90%; its further investigation in previously untreated patients is warranted.
Semantically enabled service-oriented architecture focused on principles of service orientation, semantic modeling, intelligent and automated integration defines grounds for a cutting-edge technology ...which enables new means to integration of services, more adaptive to changes in business requirements which occur over systems’ lifetime. We define the architecture starting from a global perspective and through Web service modeling ontology as its semantic service model we narrow down to its services, processes and technology we use for the reference implementation. On a B2B integration scenario we demonstrate several aspects of the architecture and further describe the evaluation of the implementation according to a community-agreed standard evaluation methodology for semantic-based systems.
The biological stabilization process of cattle and poultry manure was studied using thermogravimetric analysis and
13C nuclear magnetic resonance. The stabilization processes carried out were ...composting, anaerobic digestion and a mixed process (partly aerobic, partly anaerobic). It was observed from the analyzed samples that the biological stabilization processes reduce the volatile content of the bio-wastes and increase the degree of aromaticity.
The stabilization of cattle manure by means of aerobic processes was able to further oxidize and enriched in aromatic compounds the bio-waste when compared with the digestion process. On the other hand, the stabilization of poultry manure resulted in a greater aromatization under the digestion process. Stabilized samples with a high degree of aromaticity presented a lower volatile content accompanied by a reduction in the intensity of the differential thermogravimetry peak registered under an inert atmosphere, indicative of the thermal decomposition of the organic matter.
The thermal decomposition of all the analyzed materials (fresh and stabilized samples) commenced at around 200
°C but for the digested poultry manure, which decomposition initiated close to 250
°C. All stabilized samples yielded a lower degree of volatilization to that one observed in fresh samples.
To increase the complete response (CR) rate of patients with locally advanced head and neck cancer after three cycles of neoadjuvant chemotherapy, we added sequential methotrexate to the combination ...of cisplatin and continuous infusion fluorouracil (5-FU). We also evaluated the feasibility of administering three additional cycles of the same regimen as adjuvant chemotherapy. Thirty-eight patients were treated; the median age was 53 years and 36 patients had stage IV disease. Chemotherapy consisted of methotrexate 120 mg/m2 followed 24 hours later by cisplatin 100 mg/m2 and a five-day continuous infusion of 5-FU at 1,000 mg/m2/d. Of 34 patients evaluable for response to neoadjuvant chemotherapy, nine had a CR, 21 a partial response (PR), two a minimal response (MR), and one patient each stable disease (SD) and no response (NR). Of 31 patients who received local therapy, 15 were treated with surgery and radiotherapy and 16 with radiotherapy alone. Of 25 patients eligible to receive adjuvant chemotherapy only ten received all three intended cycles, while 15 received less or no adjuvant chemotherapy because of patient refusal, cumulative toxicity, or early disease progression. With a median follow-up time of 39 months, the median survival is estimated to be 20 months. Of eight patients with nasopharyngeal or paranasal sinus cancer, none has had disease recurrence. Patients with good initial performance status and low N-stage also had a significant survival advantage. Chemotherapy-related toxicities consisted mainly of mucositis, requiring 5-FU dose reduction in the majority of patients; similar toxicities were exacerbated in the adjuvant setting. The addition of methotrexate did not increase the CR rate over what has been reported for the combination of cisplatin and 5-FU alone. Certain subsets of patients appear to have a good prognosis when treated in this fashion. The administration of adequate adjuvant chemotherapy in patients with head and neck cancer remains difficult due to toxicity and poor patient compliance.
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