Primary chemo-radiotherapy in the treatment of locally advanced and inflammatory breast cancer

BACKGROUND: The best management of large, diffuse or inflammatory breast cancers is uncertain and the place of radiotherapy and/or surgery is not clearly defined. METHODS: A cohort of 123 patients with non-metastatic locally advanced or inflammatory breast cancer 3 cm or more in diameter or T4, was treated between 1989 and 2006. All patients received primary chemotherapy followed by radiotherapy, 40 Gy in 15 fractions with 10 Gy boost. Patients with ER positive tumours received Tamoxifen. Assessment was carried out 8 weeks post-treatment and surgery was reserved for residual or recurrent disease. RESULTS: For each stage there were T2/3: 63, T4b: 31 and T4d: 29 patients. 80 had complete clinical response (65%) but 18 patients were never free of inoperable local disease. 25 patients had residual operable disease at assessment and 12 patients who initially had a complete response developed operable local recurrence (LR). 37 Patients (30%) had surgery at a mean of 15 months post diagnosis. At 5 years, overall survival (OS) of the two surgical groups was not significantly different from those 68 patients who had complete remission without surgery, p=0.218, HR 1.46 (0.80-2.55). Surgery as an independent variable to predict survival was not significant on a Cox proportional hazards model (p=0.97). LR in the surgical groups was 13.5% vs 17.5% in the non-surgical patients. The median OS was 64.5 months and disease-free survival (DFS) was 52.5 months. 5-Year OS was 54% and DFS survival 43%. CONCLUSION: In patients with a complete or partial response to chemo-radiotherapy for locally advanced or inflammatory breast cancer, reserving surgery for those with residual or recurrent local disease did not appear to compromise survival. This finding would support examination of this treatment strategy by a randomised controlled trial

The Changing Management of Oesophageal Carcinoma: Survival in a Population Cohort 1985-1994

Background: The management of esophageal carcinoma is changing but before the introduction of chemotherapy and multidisciplinary teams, surgery became more selective. The aim of this study was to confirm this trend and to examine survival in a total population cohort 1985-94. Results: Only a quarter of 413 patients had surgery but from 1989 even fewer were operated on but there were more longterm survivors: 1/51 v. 7/58 (p<0.05). Operative mortality fell from 12% to 6.9 % in the later period (N.S.) and survival post surgery was marginally improved, 15 v. 11 months p = 0.0502. The five year survival rate doubled from 7.8% to 17.2%. Conclusion: Few studies of esophageal cancer include all cases in a defined population. This carries a very poor prognosis but the present cohort shows a slight improvement with more selective surgery and this may serve as a benchmark against which modern multidisciplinary management might be compared

Bayesian discrimination with longitudinal data

The motivation for the methodological development is a double-blind clinical trial designed to estimate the effect of regular injection of growth hormone, with the purpose of identifying growth hormone abusers in sport. The data formed part of a multicentre investigation jointly sponsored by the European Union and the International Olympic Committee. The data are such that for each individual there is a matrix of marker variables by time point (nominally 8 markers at each of 7 time points). Data arise out of a double-blind trial in which individuals are given growth hormone at one of two dose levels or placebo daily for 28 days. Monitoring by means of blood samples is at 0, 21, 28, 30, 33, 42 and 84 days. We give a new method of Bayesian discrimination for multivariate longitudinal data. This involves a Kronecker product covariance structure for the time by measurement (markers) data on each individual. This structure is estimated by an empirical Bayes approach, using an ECM algorithm, within a Bayesian Gaussian discrimination model. In future one may have markers for an individual at one or more time points. The method gives probabilities that an individual is on placebo or on one of the two dose regimes

A 10-Year Follow-up of a Longitudinal Study of Gallstone Prevalence at Necropsy in South East England

The purpose of this study was to examine a previous increase in male gallstone disease and to consider the burden of gallstones in a necropsy study with matched controls over a decade. Gallstone prevalence in 5,050 males fell from 20.2% to 19.1% (P = 0.022) and in 4,125 females fell from 30.4% to 29.0% (P = 0.03). Female gallstone subjects had a higher BMI than controls 24.5 vs. 23.3 (P\0.01), but males did not. Gallstones were twice as common in diabetics, but not with coronary heart disease (CHD). A third of elderly patients of both sexes had gallstones, but cholecystectomy was more common in females, 17:10%. Gallstone-related mortality was 0.7%. The prevalence of gallstones fell slightly. The association between gallstones and diabetes was confirmed, but not for CHD, and for BMI this was confined to females. Gallstones are very common in the elderly, but most are unoperated and seldom cause death

MINITAB multivariate macros

MINITAB macros are an invaluable teaching aid for multivariate analysis. Specific examples are provided to illustrate the use of the MINITAB Multivariate Macro Library produced by the authors, and available via anonymous file transfer protocol and the World Wide Web. The components of this library are described, together with a collection of useful data sets. We discuss how the library may be used to teach a multivariate analysis course

Exploring the linkages between land management institutions, land degradation and acid mine drainage: The case of the West Rand Goldfield.

From the beginning of time, land has been an important asset to man: it provides shelter and serves as a source of livelihood for man (through farming, mining, etc.), which are important for human survival. However, these activities, if unmanaged, can contribute to the destruction of the quality of land and the environment. This study adopted a qualitative approach to understanding the dynamics of and logic behind government institutions’ response(s) to the issue of AMD The most prominent effect of mining activities that can negatively affect the quality of land is acid mine drainage, which is generated through mining activities and after mines closure. AMD formation takes longer to generate but its effects can persist even after mines have been shut down. It also results in the pollution of water, soil and air, and through these media, presents health problems to man, in this research report, a qualitative study was undertaken on the West Rand Goldfield. It explored the extent to which institutions responsible for the land and environmental management respond to the challenging issue of AMD in the West Rand Gold Field. The approach used to analyse government intervention in the study area is theoretically based. The report draws from different academic literature, policy documents, news articles related to AMD and how it been managed in the West Rand goldfield The findings from the study were that most government interventions came into being only after AMD had started decanting from the mines in 2002. There is a lack of collaboration among different government institutions and other stakeholders for the management of the AMD problem. Furthermore, the land management policy is also not clear as to which arm of government should take the lead in AMD management, and there is a lack of enforcement of environmental laws and directives from by the Department of Environmental Affairs and Tourism (DEAT). In order to rectify these problems, some of the measures recommended include policy reform to clarify roles and responsibilities of land management institutions, reducing the number of institutions involve in the management of AMD establishing a joint task force for land rehabilitations after mine closure

Silicon nanowires, carbon nanotubes, and magnetic nanocrystals: synthesis, properties, and applications

textCentral to the practical use of nanoscale materials is the controlled growth in technologically meaningful quantities. Many of the proposed applications of the nanomaterials potentially require inexpensive production of the building blocks. Solution-based synthetic approach offers controllability, high throughput, and scalability, which make the process attractive for the potential scale-up. Growth kinetics could be readily influenced by chemical interactions between the precursor and the solvent. In order to fully utilize its benefits, it is therefore pivotal to understand the decomposition chemistry of the precursors used in the reactions. Supercritical fluids were used as solvent in which high temperature reactions could take place. Silicon nanowires with diameters of 20~30 nm was synthesized in supercritical fluids with metal nanocrystals as seeds for the nanowire growth. To unravel the effect of silicon precursors, several silicon precursors were reacted and the resulting products were investigated. The scalability of the system is discussed based on the experimental data. The nanowires were characterized with various characterization tools, including high-resolution transmission electron microscopy and electron energy loss spectroscopy. The crystallographic signatures were analyzed through the transmission electron microscopic study, and fundamental electrical and optical properties were probed by electron energy loss spectroscopy. Carbon nanotubes were prepared by reacting carbon-containing chemicals in supercritical fluids with organometallic compounds that form metal seed particles in-situ. A batch reaction, in which the temperature control was relatively poor, yielded a mixture of multiwall nanotubes and amorphous carbon nanofilaments with a low selectivity of nanotubes in the product. When reaction parameters were translated into a continuous flow-through reaction, nanotube selectivity as well as the throughput of the total product significantly improved. Magnetic properties of various metal nanocrystals were also studied. Colloidal synthesis enables the growth of FePt and MnPt3 nanocrystals with size uniformity. The as-synthesized nanocrystals, however, had compositionally disordered soft-magnetic phases. To obtain hard magnetic layered phase, the nanocrystals must be annealed at high temperatures, which led to sintering of the inorganic cores. To prevent sintering, the nanocrystals were encapsulated with silica layer prior to annealing. Interparticle magnetic interactions were also explored using particles with varying silica thickness.Chemical Engineerin