Are serial CA 19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin?

Background: Serial kinetics of serum CA 19-9 levels have been reported to reflect response and survival in patients with pancreatic cancer undergoing surgery, radiotherapy, and chemotherapy. We prospectively studied serial kinetics of serum CA 19-9 levels of patients with locally advanced or metastatic disease treated with gemcitabine and cisplatin. Patients and Methods: Enrolled in the study were 87 patients (female/male = 26/61; stage III/IV disease = 24/63). Patients received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 plus cisplatin 50 mg/m(2) on days 1 and 15, every 4 weeks. Serum samples were collected at the onset of chemotherapy and before the start of a new treatment cycle (day 28). Results: 77 of 87 patients (88.5%) with initially elevated CA 19-9 levels were included for evaluation. According to imaging criteria, 4 (5.2%) achieved a complete remission and 11 (14.3%) achieved partial remission, yielding an overall response rate of 19.5%. 43 (55.8%) patients were CA 19-9 responders, defined by greater than or equal to50% decrease in CA 19-9 serum levels within 2 months after treatment initiation. Except for one, all patients who had responded by imaging criteria (n = 14) fulfilled the criterion of a CA 19-9 responder. Despite being characterized as non-responders by CT-imaging criteria (stable/progressive disease), 29 patients were classified as CA 19-9 responders (positive predictive value 32.5%). Independent of the response evaluation by CT, CA 19-9 responders survived significantly longer than CA 19-9 non-responders (295 d; 95% CI: 285-445 vs. 174 d; 95% CI: 134-198; p = 0.022). Conclusion: CA 19-9 kinetics in serum serve as an early and reliable indicator of response and help to predict survival in patients with advanced pancreatic cancer receiving effective treatment with gemcitabine and cisplatin

Large-Scale Magnetic-Field Generation by Randomly Forced Shearing Waves

A rigorous theory for the generation of a large-scale magnetic field by random non-helically forced motions of a conducting fluid combined with a linear shear is presented in the analytically tractable limit of low Rm and weak shear. The dynamo is kinematic and due to fluctuations in the net (volume-averaged) electromotive force. This is a minimal proof-of-concept quasilinear calculation aiming to put the shear dynamo, a new effect recently found in numerical experiments, on a firm theoretical footing. Numerically observed scalings of the wavenumber and growth rate of the fastest growing mode, previously not understood, are derived analytically. The simplicity of the model suggests that shear dynamo action may be a generic property of sheared magnetohydrodynamic turbulence.Comment: Paper substantially rewritten, results changed (relative to v1). Revised versio

The geomorphological setting of some of Scotland's east coast freshwater mills: a comment on Downward and Skinner (2005) ‘Working rivers: the geomorphological legacy...’

Many of the water mills on Scotland's east coast streams, unlike those discussed recently by Downward and Skinner (2005 Area 37 138–47), are found in predominantly bedrock reaches immediately downstream of knickpoints (i.e. bedrock steps). Bedrock knickpoints in the lower reaches of Scottish rivers are a widespread fluvial response to the glacio-isostatic rebound of northern Britain. These steps in the river profile propagate headward over time, but for intervals of a few centuries or so they are sufficiently stable to be exploited for the elevational fall necessary to power the mill wheel. Many of these mills were apparently powered by ‘run-of-the-river’, as are some today that formerly had mill dams. The typical lack of sediment storage along the erosional lower reaches of many Scottish rivers means that failure of mill structures in Scotland will probably have less dramatic geomorphological and management implications than those suggested by Downward and Skinner for southern English rivers

Nonlinear growth of firehose and mirror fluctuations in turbulent galaxy-cluster plasmas

In turbulent high-beta astrophysical plasmas (exemplified by the galaxy cluster plasmas), pressure-anisotropy-driven firehose and mirror fluctuations grow nonlinearly to large amplitudes, dB/B ~ 1, on a timescale comparable to the turnover time of the turbulent motions. The principle of their nonlinear evolution is to generate secularly growing small-scale magnetic fluctuations that on average cancel the temporal change in the large-scale magnetic field responsible for the pressure anisotropies. The presence of small-scale magnetic fluctuations may dramatically affect the transport properties and, thereby, the large-scale dynamics of the high-beta astrophysical plasmas.Comment: revtex, 4 pages, 1 figure; replaced to match published versio

Racial differences in neurocognitive outcomes post-stroke: The impact of healthcare variables

AbstractObjectives:The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.Methods:One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age:M=56.4;SD=12.6; education:M=13.7;SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.Results:An independent samplesttest indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score:M=37.63;SD=11.67) than Whites (Fluid T-score:M=42.59,SD=11.54;p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p&lt;.001 andp=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.Conclusions:We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017,23, 640–652)</jats:p

Magneto-centrifugally driven winds: comparison of MHD simulations with theory

Stationary magnetohydrodynamic (MHD) outflows from a rotating, conducting Keplerian accretion disk threaded by B-field are investigated numerically by time-dependent, axisymmetric (2.5D) simulations using a Godunov-type code. A large class of stationary magneto-centrifugally driven winds are found where matter is accelerated from a thermal speed at the disk to much larger velocity, greater than the fast magnetosonic speed and larger than the escape speed. The flows are approximately spherical outflows with only small collimation within the simulation region. Numerical results are shown to coincide with the theoretical predictions of ideal, axisymmetric MHD to high accuracy. Investigation of the influence of outer boundary conditions, particularly that on the toroidal component of magnetic field shows that the commonly used ``free'' boundary condition leads to artificial magnetic forces which can act to give spurious collimation. New boundary conditions are proposed which do not generate artificial forces. Artificial results may also arise for cases where the Mach cones on the outer boundaries are partially directed into the simulation region.Comment: 19 pages, 18 figures, emulapj.sty is use

Self-Similar Magnetocentrifugal Disk Winds with Cylindrical Asymptotics

We construct a two-parameter family of models for self-collimated, radially self-similar magnetized outflows from accretion disks. A flow at zero initial poloidal speed leaves the surface of a rotating disk and is accelerated and redirected toward the pole by helical magnetic fields threading the disk. At large distances from the disk, the flow streamlines asymptote to wrap around the surfaces of nested cylinders. In constrast to previous disk wind modeling, we have explicitly implemented the cylindrical asymptotic boundary condition to examine the consequences for flow dynamics. The solutions are characterized by the logarithmic gradient of the magnetic field strength and the ratios between the footpoint radius R_0 and asymptotic radius R_1 of streamlines; the Alfven radius must be found as an eigenvalue. Cylindrical solutions require the magnetic field to drop less steeply than 1/R. We find that the asymptotic poloidal speed on any streamline is typically just a few tenths of the Kepler speed at the corresponding disk footpoint. The asymptotic toroidal Alfven speed is, however, a few times the footpoint Kepler speed. We discuss the implications of the models for interpretations of observed optical jets and molecular outflows from young stellar systems. We suggest that the difficulty of achieving strong collimation in vector velocity simultaneously with a final speed comparable to the disk rotation rate argues against isolated jets and in favor of models with broader winds.Comment: 39 pages, Latex (uses AAS Latex macros), 6 eps figures, postscript preprint with embedded figures available from http://www.astro.umd.edu/~ostriker/professional/publications.html , to appear in ApJ 9/1/9

Generation of Magnetic Field by Combined Action of Turbulence and Shear

The feasibility of a mean-field dynamo in nonhelical turbulence with superimposed linear shear is studied numerically in elongated shearing boxes. Exponential growth of magnetic field at scales much larger than the outer scale of the turbulence is found. The charateristic scale of the field is l_B ~ S^{-1/2} and growth rate is gamma ~ S, where S is the shearing rate. This newly discovered shear dynamo effect potentially represents a very generic mechanism for generating large-scale magnetic fields in a broad class of astrophysical systems with spatially coherent mean flows.Comment: 4 pages, 5 figures; replaced with revised version that matches the published PR