Neoadjuvant chemotherapy improves survival in patients with oesophageal mucinous adenocarcinoma: Post-hoc analysis of the UK MRC OE02 and OE05 trials

Background: Adenocarcinoma with more than 50% extracellular mucin is a relatively rare histological subtype of gastrointestinal adenocarcinomas. The clinical impact of extracellular mucin in oesophageal adenocarcinoma (OeAC) has not been investigated in detail. We hypothesised that patients with mucinous OeAC (OeACmucin) do not benefit from neoadjuvant chemotherapy. Methods: OeAC patients either treated by surgery alone in the OE02 trial (S-patients) or by neoadjuvant chemotherapy followed by surgery (CS-patients) in OE02 or OE05 trials were included. Cancers from 1055 resection specimens (OE02 [test cohort]: 187 CS, 185 S; OE05 [validation cohort]: 683 CS) were classified as either mucinous (more than 50% of the tumour area consists of extracellular mucin, OeACmucin) or non-mucinous adenocarcinoma (OeACnon-mucin). The relationship between histological phenotype, clinicopathological characteristics, survival and treatment was analysed. Results: Overall, 7.3% and 9.6% OeAC were classified as OeACmucin in OE02 and OE05, respectively. In OE02, the frequency of OeACmucin was similar in S and CS-patients. Patients with OeACmucin treated with surgery alone had a poorer overall survival compared with OeACnon-mucin patients (hazard ratio: 2.222, 95% confidence interval: 1.08–4.56, P = 0.025). Patients with OeACmucin treated with neoadjuvant chemotherapy and surgery had similar survival as OeACnon-mucin patients in test and validation cohort. Conclusions: This is the first study to suggest in a post-hoc analysis of material from two independent phase III clinical trials that the poor survival of patients with mucinous OeAC can be improved by neoadjuvant chemotherapy. Future studies are warranted to identify potential underlying biological, biochemical or pharmacokinetic interactions between extracellular mucin and chemotherapy

Optimization of facade design based on the impact of interior obstructions to daylighting

Overcrowding in the perimeter zone is an inevitable issue in residential rooms with limited space. Obstructions, such as furniture and household items, may block the existing windows, and therefore affect interior daylight conditions. A facade design approach is needed that simultaneously takes into account daylighting and the volume of usable space for obstructions in the perimeter zone of such rooms. This study simulates daylight distributions in a typical small residential room with obstructions in front of windows. The simulation consists of two parts. First, the effects on horizontal illuminances caused by different positions and shapes of obstructions are examined under an overcast sky. Second, the maximum usable space volumes for obstructions of 51 optimized facade configurations are calculated in terms of four window-to-wall ratios (WWRs). The results of this study show that optimizing the forms of facade design can increase the usable interior space volume and meet the daylighting requirements of Chinese standards for small residential rooms. Additionally, by using the optimized facade forms, a facade with a WWR value of 50% provides the maximum usable space for obstructions. Based on the above results, this paper presents two matrices that can help architects in selecting the appropriate fenestration methods and confirming the size of usable space and allocation for residents

Prevalence of neural tube defects in economically and socially deprived area of China

Objective: This paper aims to understand the situation and epidemiology trend of neural tube defects in Guizhou province, China from 1996 to 2004. Study design: Pregnant women from 17 hospitals in Guizhou province were chosen for investigation of perinatal infants from January 1996 to December 2004. Results: Of 1,208 birth defect cases studied in this 9-year period, a total of 122 cases were identified as neural tube defects (NTD), making up a 10.10% of the total birth defects. The average prevalence rate of NTD was 12.21 per 10,000 births; however, there is no significant difference between the genders. In this study, the age of mothers during pregnancy was shown to be one of the major factors affecting the prevalence rate of NTD and the differences between infants with or without NTD and the usage of folic acid as a supplement during pregnancy were found to be statistical significant. Conclusion: NTD was found to be the most common and serious form of human birth defect in Guizhou province. For prevention, folic acid supplement is thought to be efficacious in inhibiting NTD, and thus, it is essential for people in socially deprived areas to effectively reduce the prevalence of NTD in China. © Springer-Verlag 2007.link_to_subscribed_fulltex

Neoadjuvant chemotherapy improves survival in patients with oesophageal mucinous adenocarcinoma: Post-hoc analysis of the UK MRC OE02 and OE05 trials.

BACKGROUND: Adenocarcinoma with more than 50% extracellular mucin is a relatively rare histological subtype of gastrointestinal adenocarcinomas. The clinical impact of extracellular mucin in oesophageal adenocarcinoma (OeAC) has not been investigated in detail. We hypothesised that patients with mucinous OeAC (OeACmucin) do not benefit from neoadjuvant chemotherapy. METHODS: OeAC patients either treated by surgery alone in the OE02 trial (S-patients) or by neoadjuvant chemotherapy followed by surgery (CS-patients) in OE02 or OE05 trials were included. Cancers from 1055 resection specimens (OE02 [test cohort]: 187 CS, 185 S; OE05 [validation cohort]: 683 CS) were classified as either mucinous (more than 50% of the tumour area consists of extracellular mucin, OeACmucin) or non-mucinous adenocarcinoma (OeACnon-mucin). The relationship between histological phenotype, clinicopathological characteristics, survival and treatment was analysed. RESULTS: Overall, 7.3% and 9.6% OeAC were classified as OeACmucin in OE02 and OE05, respectively. In OE02, the frequency of OeACmucin was similar in S and CS-patients. Patients with OeACmucin treated with surgery alone had a poorer overall survival compared with OeACnon-mucin patients (hazard ratio: 2.222, 95% confidence interval: 1.08-4.56, P = 0.025). Patients with OeACmucin treated with neoadjuvant chemotherapy and surgery had similar survival as OeACnon-mucin patients in test and validation cohort. CONCLUSIONS: This is the first study to suggest in a post-hoc analysis of material from two independent phase III clinical trials that the poor survival of patients with mucinous OeAC can be improved by neoadjuvant chemotherapy. Future studies are warranted to identify potential underlying biological, biochemical or pharmacokinetic interactions between extracellular mucin and chemotherapy