Clinical Features and Outcomes Differ between Skeletal and Extraskeletal Osteosarcoma.

Background. Extraskeletal osteosarcoma (ESOS) is a rare subtype of osteosarcoma. We investigated patient characteristics, overall survival, and prognostic factors in ESOS. Methods. We identified cases of high-grade osteosarcoma with known tissue of origin in the Surveillance, Epidemiology, and End Results database from 1973 to 2009. Demographics were compared using univariate tests. Overall survival was compared with log-rank tests and multivariate analysis using Cox proportional hazards methods. Results. 256/4,173 (6%) patients with high-grade osteosarcoma had ESOS. Patients with ESOS were older, were more likely to have an axial tumor and regional lymph node involvement, and were female. Multivariate analysis showed ESOS to be favorable after controlling for stage, age, tumor site, gender, and year of diagnosis [hazard ratio 0.75 (95% CI 0.62 to 0.90); p = 0.002]. There was an interaction between age and tissue of origin such that older patients with ESOS had superior outcomes compared to older patients with skeletal osteosarcoma. Adverse prognostic factors in ESOS included metastatic disease, larger tumor size, older age, and axial tumor site. Conclusion. Patients with ESOS have distinct clinical features but similar prognostic factors compared to skeletal osteosarcoma. Older patients with ESOS have superior outcomes compared to older patients with skeletal osteosarcoma

Evaluation of person-level heterogeneity of treatment effects in published multiperson N-of-1 studies: systematic review and reanalysis.

OBJECTIVE:Individual patients with the same condition may respond differently to similar treatments. Our aim is to summarise the reporting of person-level heterogeneity of treatment effects (HTE) in multiperson N-of-1 studies and to examine the evidence for person-level HTE through reanalysis. STUDY DESIGN:Systematic review and reanalysis of multiperson N-of-1 studies. DATA SOURCES:Medline, Cochrane Controlled Trials, EMBASE, Web of Science and review of references through August 2017 for N-of-1 studies published in English. STUDY SELECTION:N-of-1 studies of pharmacological interventions with at least two subjects. DATA SYNTHESIS:Citation screening and data extractions were performed in duplicate. We performed statistical reanalysis testing for person-level HTE on all studies presenting person-level data. RESULTS:We identified 62 multiperson N-of-1 studies with at least two subjects. Statistical tests examining HTE were described in only 13 (21%), of which only two (3%) tested person-level HTE. Only 25 studies (40%) provided person-level data sufficient to reanalyse person-level HTE. Reanalysis using a fixed effect linear model identified statistically significant person-level HTE in 8 of the 13 studies (62%) reporting person-level treatment effects and in 8 of the 14 studies (57%) reporting person-level outcomes. CONCLUSIONS:Our analysis suggests that person-level HTE is common and often substantial. Reviewed studies had incomplete information on person-level treatment effects and their variation. Improved assessment and reporting of person-level treatment effects in multiperson N-of-1 studies are needed

Appropriateness of Upper Gastrointestinal Endoscopy: Comparison of American and Swiss Criteria

Objective: Examine the reproducibility of the RAND method for developing criteria for the appropriateness of medical procedures. Design: Comparison of two sets of explicit criteria for appropriateness of upper gastrointestinal (UGI) endoscopy, developed by separate expert panels from two countries.Setting: United States, Switzerland. Study participants: National experts from different medical specialties involved in the referral or application of UGI endoscopy.Interventions: Each panel was presented with about 500clinical scenarios (indications)that were rated on a nine-point scale as to the appropriateness of performing UGI endoscopy for a patient with that clinical presentation. Main outcome measurer: (1) distribution of appropriateness ratings and intrapanel agreement categories between the two panels, (2)between-panel agreement of assigning appropriateness for comparable indications and, (3) percentage of indications with major between-panel differences. Results: Ratings for 2/3 of indications could be compared. The Swiss panel showed higher intrapanel agreement (54.6% versus 46.2% p=0.002). Seventy-eight percent of comparable Indications were assigned to indentical categories of appropriateness by both panels (kappa=0.76,P <0.001). For 93% of the 376 comparable indications, there were no major interpanel differences. Conclusion: Separate expert panels in different countries, using a standardized methodology, produce criteria for appropriatenesof medical procedures that are similar. Given the resources being invested throught the world in devilping criteria and guidelines, international collaboration in seeking optimal use of limited health care resources should be intensifled. © 1997 Elsevier Science Ltd. All rights reserve

Cost-Effectiveness of Primary versus Secondary Prophylaxis with Pegfilgrastim in Women with Early-Stage Breast Cancer Receiving Chemotherapy

AbstractObjectiveProphylaxis with granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. We estimated the incremental cost-effectiveness of G-CSF pegfilgrastim primary (starting in cycle 1 and continuing in subsequent cycles of chemotherapy) versus secondary (only after an FN event) prophylaxis in women with early-stage breast cancer receiving myelosuppressive chemotherapy with a ≥20% FN risk.MethodsA decision-analytic model was constructed from a health insurer's perspective with a lifetime study horizon. The model considers direct medical costs and outcomes related to reduced FN and potential survival benefits because of reduced FN-related mortality. Inputs for the model were obtained from the medical literature. Sensitivity analyses were conducted across plausible ranges in parameter values.ResultsThe incremental cost-effectiveness ratio (ICER) of pegfilgrastim as primary versus secondary prophylaxis was $48,000/FN episode avoided. Adding survival benefit from avoiding FN mortality yielded an ICER of$110,000/life-year gained (LYG) or $116,000/quality-adjusted life-year (QALY) gained. The most influential factors included FN case-fatality, FN relative risk reduction from primary prophylaxis, and age at diagnosis.ConclusionsCompared with secondary prophylaxis, the cost-effectiveness of pegfilgrastim as primary prophylaxis may be equivalent or superior to other commonly used supportive care interventions for women with breast cancer. Further assessment of the direct impact of G-CSF on short- and long-term survival is needed to substantiate these findings

Clinical Features and Outcomes Differ between Skeletal and Extraskeletal Osteosarcoma

Background. Extraskeletal osteosarcoma (ESOS) is a rare subtype of osteosarcoma. We investigated patient characteristics, overall survival, and prognostic factors in ESOS. Methods. We identified cases of high-grade osteosarcoma with known tissue of origin in the Surveillance, Epidemiology, and End Results database from 1973 to 2009. Demographics were compared using univariate tests. Overall survival was compared with log-rank tests and multivariate analysis using Cox proportional hazards methods. Results. 256/4,173 (6%) patients with high-grade osteosarcoma had ESOS. Patients with ESOS were older, were more likely to have an axial tumor and regional lymph node involvement, and were female. Multivariate analysis showed ESOS to be favorable after controlling for stage, age, tumor site, gender, and year of diagnosis [hazard ratio 0.75 (95% CI 0.62 to 0.90); p=0.002]. There was an interaction between age and tissue of origin such that older patients with ESOS had superior outcomes compared to older patients with skeletal osteosarcoma. Adverse prognostic factors in ESOS included metastatic disease, larger tumor size, older age, and axial tumor site. Conclusion. Patients with ESOS have distinct clinical features but similar prognostic factors compared to skeletal osteosarcoma. Older patients with ESOS have superior outcomes compared to older patients with skeletal osteosarcoma

Strong Continuum-continuum Couplings In The Direct Ionization Of Ar And He Atoms By 6-MeV/u U38+ And Th38+ Projectiles

Doubly differential cross sections have been measured as a function of the electron energy and observation angle for electron emission following collisions of 6-MeV/u U38+ and Th38+ on He and Ar. The electron-emission data show an enhancement at forward angles and a decrease at backward angles with respect to scaled-cross-section results based on the Born approximation. Comparison with classical-trajectory Monte Carlo calculations suggests that the deviation from the Born approximation can be explained by continuum-continuum couplings. By comparing with previously published data, we found that the forward enhancement as well as the backward decrease follow a q/vp (q,vp are the projectile charge and velocity) scaling. © 1989 The American Physical Society

When is it appropriate to prescribe postmenopausal hormone therapy?

OBJECTIVE: To develop evidence and consensus-based recommendations for the use of hormone therapy (HT) in postmenopausal women. DESIGN: Using evidence from clinical trials and other publications, a multidisciplinary group of women's health experts developed consensus-based recommendations for HT use in more than 300 clinical scenarios. These panelists utilized the RAND Appropriateness Method and a quantitative scale to rate the appropriateness of treatment options for women with various risk factors and clinical scenarios. RESULTS: The panel judged it appropriate to prescribe all forms of HT to women with intolerable menopause symptoms and usual (age-expected) risks of cardiovascular disease (CVD), venous thromboembolism (VTE), or stroke. Use of HT was judged not appropriate for the clinical scenarios of bone preservation, cosmetic appearance, current memory loss, loss of libido, or CVD protection. For a woman still using HT after 5 or more years, it was considered appropriate to recommend the options of stopping or lowering the dose even if stopping was previously attempted. In treating intolerable symptoms in the presence of some elevated risk for diseases related to HT, route of administration may affect appropriateness but prior stroke or TIA# risk is a contraindication. CONCLUSIONS: Standard HT is appropriate for women with intolerable menopausal symptoms in the absence of HT-related risk factors (eg, CVD, stroke, VTE, breast cancer). Panelists judged it appropriate to repeatedly present the option of stopping or reducing the dose. In most cases, presence of risk factors makes standard-dose oral HT not appropriate; however, some women may be candidates for a different dose or route of administration. [Authors]]]> Estrogen Replacement Therapy ; Gynecology ; Menopause ; Physician's Practice Patterns ; Practice Guidelines as Topic oai:serval.unil.ch:BIB_F6BBBCACCC3A 2022-05-07T01:30:17Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_F6BBBCACCC3A Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes. info:doi:10.1093/eurheartj/ehv289 info:eu-repo/semantics/altIdentifier/doi/10.1093/eurheartj/ehv289 info:eu-repo/semantics/altIdentifier/pmid/26142466 Nanchen, D. Gencer, B. Auer, R. Räber, L. Stefanini, G.G. Klingenberg, R. Schmied, C.M. Cornuz, J. Muller, O. Vogt, P. Jüni, P. Matter, C.M. Windecker, S. Lüscher, T.F. Mach, F. Rodondi, N. info:eu-repo/semantics/article article 2015 European Heart Journal, vol. 36, no. 36, pp. 2438-2445 info:eu-repo/semantics/altIdentifier/eissn/1522-9645 urn:issn:0195-668X <![CDATA[AIMS: We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS: We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (&gt;5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION: A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required

Natural Orbitals and BEC in traps, a diffusion Monte Carlo analysis

We investigate the properties of hard core Bosons in harmonic traps over a wide range of densities. Bose-Einstein condensation is formulated using the one-body Density Matrix (OBDM) which is equally valid at low and high densities. The OBDM is calculated using diffusion Monte Carlo methods and it is diagonalized to obtain the "natural" single particle orbitals and their occupation, including the condensate fraction. At low Boson density, $na^3 < 10^{-5}$, where $n = N/V$ and $a$ is the hard core diameter, the condensate is localized at the center of the trap. As $na^3$ increases, the condensate moves to the edges of the trap. At high density it is localized at the edges of the trap. At $na^3 \leq 10^{-4}$ the Gross-Pitaevskii theory of the condensate describes the whole system within 1%. At $na^3 \approx 10^{-3}$ corrections are 3% to the GP energy but 30% to the Bogoliubov prediction of the condensate depletion. At $na^3 \gtrsim 10^{-2}$, mean field theory fails. At $na^3 \gtrsim 0.1$, the Bosons behave more like a liquid $^4$He droplet than a trapped Boson gas.Comment: 13 pages, 14 figures, submitted Phys. Rev.

Conspicuous consumption of the elite: Social and self-congruity in tourism choices

This paper relies on social and economic psychology to explore how the travel choices of Portuguese citizens, with different status levels in their daily lives, perceive and adopt different conspicuous travel patterns because of public exposure. To account for the moderated role of public exposure on conspicuous travel patterns, 36 Portuguese citizens were interviewed. Q-methods were applied to explore the varying senses of conspicuous travel choices among citizens with different levels of public exposure, both individually and relative to each other. Complementary qualitative methods were applied, in order to explore how the interviewees construct tourism conspicuous meanings that match their social or self-representations. The results suggest that social contexts moderate the ways in which individuals perceive and experience conspicuous travel. Further, the results show that public groups with higher exposure tend to prefer subtle signals of conspicuousness, in order to differentiate themselves from the mainstream

In vivo anti-tumor activity of the organometallic ruthenium(II)-arene complex [Ru(eta(6)-p-cymene)-Cl-2(pta)] (RAPTA-C) in human ovarian and colorectal carcinomas

Based on the clinical success of platinum-based anti-cancer drugs such as cisplatin, carboplatin and oxaliplatin, a variety of other metal-based anti-cancer compounds are being investigated. In particular, a number of ruthenium-based compounds have been identified which exhibit unique biochemical properties and reduced toxicity profiles compared to the clinically used platinum-based drugs. We have developed a series of organometallic ruthenium(II)-arene complexes that were shown to exert anti-metastatic activity with relatively minor activity on primary tumor growth. Here, we show that the prototype compound, [Ru(eta(6)-p-cymene)Cl-2(pta)], where pta = 1,3,5-triaza-7-phosphaadamantane (RAPTA-C), reduces the growth of primary tumors in preclinical models for ovarian and colorectal carcinomas. When administered daily at relatively low doses (0.2 mg kg(-1)), RAPTA-C was shown to significantly reduce the growth of the A2780 ovarian carcinoma transplanted onto the chicken chorioallantoic membrane model. Similar activity was observed in LS174T colorectal carcinoma in athymic mice, albeit at a higher dose. In both models, a clear inhibition of microvessel density was observed, confirming the previously discovered anti-angiogenic mechanism of RAPTA-C. Biodistribution studies with radiolabeled (Ru-103) RAPTA-C indicate that the compound is rapidly cleared from the organs and the bloodstream through excretion by the kidneys. As such, RAPTA-C is a promising compound for translation to clinical evaluation