To report interim cosmetic and toxicity results of a multicenter randomized trial comparing accelerated partial-breast irradiation (APBI) using three-dimensional conformal external beam radiation ...therapy (3D-CRT) with whole-breast irradiation (WBI).
Women age > 40 years with invasive or in situ breast cancer ≤ 3 cm were randomly assigned after breast-conserving surgery to 3D-CRT APBI (38.5 Gy in 10 fractions twice daily) or WBI (42.5 Gy in 16 or 50 Gy in 25 daily fractions ± boost irradiation). The primary outcome was ipsilateral breast tumor recurrence (IBTR). Secondary outcomes were cosmesis and toxicity. Adverse cosmesis was defined as a fair or poor global cosmetic score. After a planned interim cosmetic analysis, the data, safety, and monitoring committee recommended release of results. There have been too few IBTR events to trigger an efficacy analysis.
Between 2006 and 2011, 2,135 women were randomly assigned to 3D-CRT APBI or WBI. Median follow-up was 36 months. Adverse cosmesis at 3 years was increased among those treated with APBI compared with WBI as assessed by trained nurses (29% v 17%; P < .001), by patients (26% v 18%; P = .0022), and by physicians reviewing digital photographs (35% v 17%; P < .001). Grade 3 toxicities were rare in both treatment arms (1.4% v 0%), but grade 1 and 2 toxicities were increased among those who received APBI compared with WBI (P < .001).
3D-CRT APBI increased rates of adverse cosmesis and late radiation toxicity compared with standard WBI. Clinicians and patients are cautioned against the use of 3D-CRT APBI outside the context of a controlled trial.
ABSTRACT
The choice of a celebrity endorser for a brand is an important topic in advertising and marketing, as considerable time and effort resources are dedicated to finding the right celebrity to ...represent a given organization. Celebrities used as endorsers in advertisements are often very popular ones. However, from a cognitive point of view (and a more academic one), congruence between brand and celebrity seems to be very important too. Based on affective and cognitive theories to explain endorsement effectiveness, congruence between brand and celebrity is shown to be as effective as celebrity likability. Moreover, congruence between brand and celebrity as well as celebrity likability have an impact on the predisposition toward the ad, which in turn influences brand beliefs and purchase intention.
To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or ...whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial.
Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only.
Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients.
In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment volume was not independently associated with an adverse cosmetic outcome, and a useful clinical threshold could not be identified.
This article presents a technique designed to extend the scanning range of a probe-fed patch array whose performances are limited by scan blindness, due to a strong surface wave coupling. The current ...framework relates to the context of radar applications requiring a large scanning range (up to 60°) and where no inter-element spacing modification is possible as a result of strong T/R modules integration constraints. The proposed solution is based on the introduction of an additional correcting coupling within the array, by means of microstrip lines connecting the sources two by two. A thorough step-by-step description of the design methodology is introduced. It is then implemented in the case of a single-polarized ten-element patch array operating in X-band. Simulation results as well as an experimental validation of the concept are presented. They assess the effective improvement of the active impedance matching and realized gain resulting from the use of connecting lines.
This paper addresses the distribution of Genitives and PPs in deverbal nominalizations with a particular focus on Romanian -tor nominals that express agents, e.g., vânzător ‘seller’, and instruments, ...e.g., tocător ‘shredder’. The issue of the distribution of Genitives is central to understanding the argumental structure properties of deverbal nominalizations in Romanian, and cross-linguistically. Derived nominals expressing agents and instruments have been and continue to be the subject of much controversy in the literature with respect to whether they (or at least some of them) involve an argument structure. We argue that the existence of an argumental Genitive in Romanian provides strong support for views that propose that (at least a subclass of) agent nominals have argument-structure properties. However, we also show that a proper understanding of the distribution of Genitive case-marked complements and PPs bears upon their interpretive nature, and more particularly on their specific vs. non-specific interpretation.
Childhood trauma has been suggested to be involved in the susceptibility to bipolar disorder. However, case‐control studies are lacking, and the preferential implication and the dose‐effect of ...different trauma subtypes remain poorly investigated. Two hundred six bipolar patients and 94 controls completed the Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994). The CTQ total score was higher for bipolar patients than for controls. The presence of multiple trauma was significantly more frequent in bipolar patients than in controls (63% vs. 33%). Multiple logistic regression suggested that only emotional abuse was associated with bipolar disorder with a suggestive dose‐effect. Clinical practice should include systematic assessment of childhood trauma among bipolar patients with a particular focus on emotional abuse.
Lung cancer is the second most diagnosed cancer and the leading cause of cancer-related mortality in Canada. Surgical resection is the treatment of choice for patients with stage I non–small-cell ...lung cancer (NSCLC). However, 20% to 30% of them are deemed medically inoperable and may be offered radiation therapy. Standard external-beam radiation therapy (EBRT) is associated with high rates of local recurrence and poor long-term survival. Stereotactic ablative radiation therapy (SABR) is increasingly being proposed for inoperable patients, and the use of this treatment modality for operable patients is also being contemplated. The objective of this guideline is to review the efficacy and safety of SABR in these two clinical situations and to develop evidence-based recommendations.
A review of the scientific literature published up to December 2013 was performed. A total of 44 publications were included.
Considering the evidence available to date, the Comité de l’évolution des pratiques en oncologie recommends the following: (1) for medically operable patients with stage T1-2N0M0 NSCLC, surgery remains the standard treatment because comparative data regarding the efficacy of SABR and surgery are currently insufficient for SABR to be considered an equivalent alternative to surgery for these patients; (2) for medically inoperable patients with stage T1-2N0M0 NSCLC or medically operable patients who refuse surgery, SABR should be preferred to standard EBRT (grade B recommendation); (3) the biological equivalent dose (BED10) used for SABR treatment should be at least 100 Gy (grade B recommendation); (4) for patients with a central tumor, a large-volume tumor (large planning target volume) or severe pulmonary comorbidity, a risk-adapted schedule should be used (dose reduction or increase in the number of fractions; grade B recommendation); (5) the choice of using SABR to treat NSCLC should be discussed within tumor boards; treatment with SABR (or with standard EBRT) should not be considered for patients whose life expectancy is very limited because of comorbidities (grade D recommendation).
Arterial stiffness, a major cardiovascular risk factor, develops within 2 months in mice fed a high-fat, high-sucrose (HFHS) diet, serving as a model of human metabolic syndrome, and it is associated ...with activation of proinflammatory and oxidant pathways in vascular smooth muscle (VSM) cells. Sirtuin-1 (SirT1) is an NAD(+)-dependent deacetylase regulated by the cellular metabolic status. Our goal was to study the effects of VSM SirT1 on arterial stiffness in the context of diet-induced metabolic syndrome. Overnight fasting acutely decreased arterial stiffness, measured in vivo by pulse wave velocity, in mice fed HFHS for 2 or 8 months, but not in mice lacking SirT1 in VSM (SMKO). Similarly, VSM-specific genetic SirT1 overexpression (SMTG) prevented pulse wave velocity increases induced by HFHS feeding, during 8 months. Administration of resveratrol or S17834, 2 polyphenolic compounds known to activate SirT1, prevented HFHS-induced arterial stiffness and were mimicked by global SirT1 overexpression (SirT1 bacterial artificial chromosome overexpressor), without evident metabolic improvements. In addition, HFHS-induced pulse wave velocity increases were reversed by 1-week treatment with a specific, small molecule SirT1 activator (SRT1720). These beneficial effects of pharmacological or genetic SirT1 activation, against HFHS-induced arterial stiffness, were associated with a decrease in nuclear factor kappa light chain enhancer of activated B cells (NFκB) activation and vascular cell adhesion molecule (VCAM-1) and p47phox protein expressions, in aorta and VSM cells. In conclusion, VSM SirT1 activation decreases arterial stiffness in the setting of obesity by stimulating anti-inflammatory and antioxidant pathways in the aorta. SirT1 activators may represent a novel therapeutic approach to prevent arterial stiffness and associated cardiovascular complications in overweight/obese individuals with metabolic syndrome.
This article presents a novel solution to extend the scanning range of a cavity‐backed stacked‐patch phased array whose performances are limited by scan blindness. Two main aspects are investigated. ...The first section is a thorough description of the scan blindness mechanism and the associated mutual coupling scheme occurring in the reported array. The second section introduces a revised array topology that allows extending the scanning range up to the blind angle. The article focuses on the proof of concept of the proposed solution, which is based on the switching between two operating modes of the structure, each one covering a part of a globally wider scanning range. In the present case, the scanning capability of the array has been extended by 10° in the scanning plane of interest. Besides, the restored impedance matching allows for a 2 dBi gain improvement at the scan blindness angle.
A series of 15 cinnamoyl triazole derivatives was prepared by Cu(I)-catalyzed azide/alkyne 3+2-cycloaddition reactions and examined as inhibitors of guinea-pig liver transglutaminase. Several ...compounds exhibited activity as reversible inhibitors that were competitive with acyl donor transglutaminase substrates. For example, triazole 4d has a Ki value of 174 n m and represents one of the most potent reversible transglutaminase inhibitors reported to date.
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