External beam radiation therapy for locally advanced and metastatic gastrointestinal stromal tumors

BACKGROUND: The role of radiation therapy (RT) in the management of gastrointestinal stromal tumors (GIST) is not well described. Here we report our institutional experience for patients with locally advanced or metastatic GIST treated with RT. METHODS: Between 1997 and 2012, 15 patients with 22 GISTs were treated with RT at our center. The median age was 68 (range, 41–86). Fourteen patients had stage IV disease and 1 patient had stage IIIB disease, per the American Joint Committee on Cancer (AJCC), 7th Edition staging. Tumors were in a variety of locations, and were most commonly referred for palliative treatment. Eighteen of 22 tumors were symptomatic. Prior to RT, 14 of 15 patients received systemic therapy in the form of tyrosine kinase inhibitors (TKIs) (n = 11), chemotherapy (n = 4), or both (n = 1). TKIs were used concurrently for nine tumors (40.9%). No tumors were treated with concurrent chemotherapy. Several fractionation schemes were used, most commonly 3 Gy × 10 (n = 8). Local progression-free survival and overall survival were estimated using the Kaplan-Meier method. Acute toxicity was graded per Common Terminology Criteria for Adverse Events (CTCAE) v4.0. RESULTS: The median follow-up was 5.1 months (range, 1.3-28.3). At the time of analysis, 12 patients have died (80%). The estimated 6-month local progression-free survival and overall survival were 57.0% and 57.8%, respectively. Among the 18 symptomatic tumors, at least partial palliation was achieved in 17 (94.4%), and symptoms were completely palliated in eight (44.4%). Treatment was well tolerated, with no Grade 4 or 5 toxicities. There was no Grade ≥3 toxicity associated with concurrent TKI use. CONCLUSIONS: In this largest series to date of GISTs treated with RT, a high rate of palliation was achieved for symptomatic tumors in a cohort of advanced stage, heavily pretreated patients. Treatment was well tolerated, and concurrent use of tyrosine kinase inhibitor therapy was not associated with additional toxicity. While follow-up was short, durable control is possible for some patients, providing evidence that GIST is not universally radioresistant and that RT can provide an important benefit in patients with progressive or metastatic disease

Enfermedad de Hodgkin variedad esclerosis nodular, hallazgo clínico: Presentación atípica de un caso

Resumen La Enfermedad de Hodgkin (EH) es una entidad neoplásica que se presenta de forma más frecuente en pacientes femeninos, mayores de 16 años, está relacionada a una infección anterior por virus de Epstein-Barr. La presentación de este caso clínico tiene como objetivo describir este padecimiento de la variedad esclerosis nodular en un paciente pediátrico masculino de 12 años de edad, el cual se presentó al servicio de urgencias del Hospital General de Ciudad Juárez con cefalea intensa de un año de evolución. La hospitalización posterior, para el estudio integral del paciente, arrojó la presencia de un ganglio supraclavicular derecho, aumentado de tamaño y asintomático. El diagnóstico arrojado por los estudios clínicos y paraclínicos indica claramente la presencia de EH tipo esclerosis nodular, entidad rara para el tipo de paciente que se presenta. La descripción de este cuadro debe hacernos pensar en la posibilidad de esta patología en pacientes hasta cierto punto atípicos, y poder diagnosticar a estos pacientes en estadio I y II, ya que la EH es asintomática en la mayoría de los casos. Palabras clave: Linfoma de Hodgkin, esclerosis nodular, diagnóstico. Abstract Hodgking’s disease (HD) is a neoplasic entity more often presented in female patients, age 16 and above. It is related to a previous infection by Epstein – Barr virus. The presentation of this clinic case aims to describe this disease of nodular sclerotic variety in a male paediatric patient, age 12, who came to the Ciudad de Juarez General Hospital urgency services with a one-year-evolution intense migraine. The further hospitalization for the patient whole study showed the presence of a right supra-clavicle ganglion, increased in size and asymptomatic. The diagnosis obtained by clinical and paraclinic study clearly indicates the presence of HD type nodular sclerosis, strange entity for the type of patient presented. The description of this picture should make us think in the possibility of this pathology in some atypical patients, and be able to diagnose them in I and II stages, because HD is asymptomatic in most of the cases. Key words: Hodgkin Lymphoma, Nodular sclerosis, diagnosis

Cooperative Fabrication Methodology for Embedding Wireon Corved Surfaces

In conventional additive manufacturing (AM), an object is fabricated by depositing material in a layer by layer fashion. Typically, this process is retained so that deposition can occur on flat surfaces and motion can be constrained to requiring only three degrees of freedom (DOF) in a Cartesian coordinate system. When incorporating wire in three-dimensional (3D) objects, there is sometimes a need for placement along curved surfaces on which positions are defined not only by 3D Cartesian coordinates but also angular ones. Therefore, a minimum of two additional DOFs are required allowing movement to be generated at the build platform as well as of the extrusion head. This paper addresses a method for trajectory planning of both systems, that is, the extrusion head and the movable build platform, allowing for cooperative and harmonic motion between the two.Mechanical Engineerin

Conservation of the endemic dwarf carnivores of Cozumel Island, Mexico.

Cozumel Island, Mexico, harbours two endemic species of dwarf procyonids: the Pygmy Raccoon Procyon pygmaeus and the Dwarf Coati Nasua nelsoni. Both species are Critically Endangered, and are among the world&rsquo;s most threatened Carnivora. Here we summarise the research we have been conducting on their ecology, evolution, genetics, and conservation. We also summarise the conservation initiatives we have been undertaking and promoting in order to advance the conservation of these unique species and their habitats. This effort illustrates the importance of an interdisciplinary approach in conservation science and action in maximising effectiveness. Nevertheless, the precarious status of the species make it imperative to continue and expand the work we have carried out in Cozumel to prevent two imminent global extinctions.<br /

An employment program for ex-offenders with a substance use disorder: A grant proposal project

Obtaining gainful employment is demonstrated to be a strong contributing factor toward successful reintegration among ex-offenders. As substance use disorders and criminal behavior often intersect in this population and are left unmet by employment programs that do not address these elements simultaneously, the goal of this project is to fill this unmet need. This project served to develop a comprehensive employment program for ex-offenders diagnosed with substance use disorders and to identify a funding source and write a grant proposal to fund an employment program. Submission of this grant proposal was not a requirement for the successful completion of the project