Increasing survival gap between young and elderly gastric cancer patients

INTRODUCTION: This study investigates the treatment and survival of young versus elderly potentially curable gastric cancer patients in the Netherlands. PATIENTS AND METHODS: All noncardia gastric cancer patients with potentially curable gastric cancer according to stage (cTx-3, cNx-3, and cMx-0) diagnosed between 1989 and 2013 were selected from the Netherlands Cancer Registry. Trends in treatment and overall survival were compared between young patients (younger than 70 years) and elderly patients (70 years or older). Multivariable logistic regression analysis was used to examine the probability of patients undergoing surgery and chemotherapy in the most recent period. Multivariable Cox regression analysis was used to identify independent factors associated with survival. RESULTS: In total, 8107 young and 13,814 elderly gastric cancer patients were included. There was a major increase in the proportion of patients treated with resection and chemotherapy after 2004-2008. In young patients the increase was from 2.6% in 1999-2003 to 63% in 2009-2013 (p < 0.01). Also an increase was noticed among elderly patients, from 0.1% to 16% (p < 0.01). Median survival increased from 2004 to 2008 onward particularly in young patients and to a lesser extent in elderly patients (from 28 to 41 months vs from 11 to 13 months). Multivariable Cox regression analyses confirmed that overall survival improved for young and elderly patients. DISCUSSION: Young patients experienced a stronger improvement in survival than elderly patients, resulting in an increasing survival gap. The literature shows this is a problem not only in the Netherlands but also throughout Europe. The dissimilarity in treatment between young and elderly patients could be the reason for this difference

Isolated limb perfusion with actinomycin D and TNF-alpha results in improved tumour response in soft-tissue sarcoma-bearing rats but is accompanied by severe local toxicity

Previously we demonstrated that addition of Tumour Necrosis Factor-α to melphalan or doxorubicin in a so-called isolated limb perfusion results in synergistic antitumour responses of sarcomas in both animal models and patients. Yet, 20 to 30% of the treated tumours do not respond. Therefore agents that synergise with tumour necrosis factor alpha must be investigated. Actinomycin D is used in combination with melphalan in isolated limb perfusion in the treatment of patients with melanoma in-transit metastases and is well known to augment tumour cell sensitivity towards tumour necrosis factor alpha in vitro. Both agents are very toxic, which limits their systemic use. Their applicability may therefore be tested in the isolated limb perfusion setting, by which the tumours can be exposed to high concentrations in the absence of systemic exposure. To study the beneficial effect of the combination in vivo, BN-175 soft tissue sarcoma-bearing rats were perfused with various concentrations of actinomycin D and tumour necrosis factor alpha. When used alone the drugs had only little effect on the tumour. Only when actinomycin D and tumour necrosis factor alpha were combined a tumour response was achieved. However, these responses were accompanied by severe, dose limiting, local toxicity such as destruction of the muscle tissue and massive oedema. Our results show that isolated limb perfusion with actinomycin D in combination with tumour necrosis factor alpha leads to a synergistic anti-tumour response but also to idiosyncratic locoregional toxicity to the normal tissues. Actinomycin D, in combination with tumour necrosis factor alpha, should not be explored in the clinical setting because of this. The standard approach in the clinic remains isolated limb perfusion with tumour necrosis factor alpha in combination with melphalan

Local excision of rectal cancer afterchemoradiation: feasibility depends on the primary stage

Item does not contain fulltext1 september 201

Challenges and solutions for enhancing agriculture value chain decision-making. A short review

© IFIP International Federation for Information Processing 2017. Increasingly challenging global and environmental requirements have resulted in agricultural systems coming under increasing pressure to enhance their resilience capabilities. This in special to respond to the abrupt changes in resource quality, quantity and availability, especially during unexpected environmental circumstances, such as uncertain weather, pests and diseases, volatile market conditions and commodity prices. Therefore, integrated solutions are necessary to support the knowledge-management, collaborative ICT solution, risk management and regulation management across agriculture stakeholders. Therefore, and based on the on-going work under the H2020 RUC-APS project research network, this book chapter is oriented to contribute to agriculture value chain decision-making field to cover the current need on gathering a common understanding and appreciation of new trends in agriculture value chain, in special the multi-disciplinary challenges. For this, a short a literature review is conducted to summarise the main findings on real application and current research trends. This within the objective to propose an integrated framework based on better use of communication ways, standardised structures, development of training and awareness, regulation based initiatives and vertical Integration

Extinction of ants' feeding and social foraging on myrmecochorous seeds

BACKGROUND/AIMS: Fibrocaps is a dry powder fibrin sealant containing human plasma-derived fibrinogen and thrombin. The safety, efficacy, and application methods for Fibrocaps were evaluated in an exploratory, first-in-human, noncomparative, clinical study. METHODS: Patients with minor bleeding/oozing after elective partial hepatic resection had Fibrocaps applied to the bleeding site either directly from the vial or from a spray device, with manual pressure applied using a cellulose, collagen, or gelatin sponge, if needed. Safety was evaluated at screening and postoperative days 1, 2, and 5, and weeks 4 and 12. The formation of anti-thrombin antibodies was assessed at baseline, and after 4 and 12 weeks. Time to hemostasis (TTH) within 10 min was determined. RESULTS: Twenty-nine patients were treated with Fibrocaps; 6 experienced serious adverse events that were not related to the course of treatment. Adverse events occurring in >10% of patients were nausea, constipation, hypotension, obstipation, hypokalemia, and postoperative pain. Most adverse events were mild or moderate in severity. No patient developed anti-thrombin antibodies. The percentage of patients who achieved hemostasis was 93%; the median TTH was 3.8 min (range 0.3-10.3). Manual pressure was applied with Fibrocaps in 19 patients and considered beneficial in most. CONCLUSION: Fibrocaps was well tolerated in patients undergoing elective hepatic resection and resulted in rapid hemostasis. These safety and efficacy results support further clinical testing of this ready-to-use fibrin sealant as an adjunct to surgical hemostasis. (c) 2015 S. Karger AG, Basel

Liver Resection for Hepatic Metastases from Soft Tissue Sarcoma:A Nationwide Study

Contains fulltext : 209467pub.pdf (publisher's version ) (Open Access

Dense molecular gas at 12 mm towards Galactic TeV gamma-ray sources

The High Energy Stereoscopic System has revealed many TeV (1012 eV) gamma-ray sources along the Galactic plane, and around 30 per cent of these sources remain unidentified. The morphology and dynamics of dense gas coincident and surrounding the gamma-ray emission can provide clues about the nature of the TeV emission. The H2O Southern Galactic Plane Survey (HOPS) undertaken with the Mopra radio telescope includes several dense gas tracers, such as NH3 (n,n) transitions and HC3N (3–2), star formation tracers including H2O masers and radio recombination lines that trace ionized gas. A search for dense gas, traced by NH3 (1,1) emission seen in HOPS and additional observations, towards Galactic TeV sources has been undertaken. Of the 49 Galactic TeV sources covered by 12 mm observations, NH3 (1,1) is detected towards or adjacent to 38 of them. Dense gas counterparts have been detected near several unidentified Galactic TeV sources that display morphology pointing to a hadronic origin to the TeV gamma-rays. The dense gas detected towards some TeV sources displays unusual emission characteristics, including very broad linewidths and enhanced ortho-to-para NH3 abundance ratios towards HESS J1745−303 and HESS J1801−233, which reflects previous shock activity within the gas

Investigation of Dense Gas Towards Relativistic Outflow Sources

We probe the interstellar medium towards the objects Circinus X-1, a low-mass X-ray binary with relativistic jets; and the highly energetic Westerlund 2 stellar cluster, which is located towards TeV gamma-ray emission and interesting arc- and jet-like features seen in Nanten 12CO data. We have mapped both regions with the Mopra radio telescope, in 7 mm and 12 mm wavebands, looking for evidence of disrupted/dense gas caused by the interaction between high energy outflows and the ISM. Towards Westerlund 2, peaks in CS(J=1-0) emission indicate high density gas towards the middle of the arc and the endpoint of the jet; and radio recombination line emission is seen overlapping the coincident HII region RCW49. Towards Circinus X-1, 12CO(J = 1-0) Nanten data reveals three molecular clouds that lie in the region of Cir X-1. Gas parameters for each cloud are presented here

Lay and professional stakeholder involvement in scoping palliative care issues: Methods used in seven European countries

BACKGROUND: Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. AIMS: To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. DESIGN: Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. SETTING/PARTICIPANTS: A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ⩾18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. RESULTS: Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. CONCLUSION: Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development