Erythema nodosum as a result of estrogen patch therapy for prostate cancer: a case report.

© 2015 Coyle et al.Introduction: Erythema nodosum is often associated with a distressing symptomatology, including painful subcutaneous nodules, polyarthropathy, and significant fatigue. Whilst it is a well-documented side-effect of estrogen therapy in females, we describe what we believe to be the first report in the literature of erythema nodosum as a result of estrogen therapy in a male. Case presentation: A 64-year-old Afro-Caribbean man with locally advanced carcinoma of the prostate agreed to participate in a randomized controlled trial comparing estrogen patches with luteinizing hormone-releasing hormone analogs to achieve androgen deprivation, and was allocated to the group receiving estrogen patches. One month later he presented with tender lesions on his shins and painful swelling of his ankles, wrists, and left shoulder. This was followed by progressive severe fatigue that required hospital admission, where he was diagnosed with erythema nodosum by a rheumatologist. Two months after discontinuing the estrogen patches the erythema nodosum, and associated symptoms, had fully resolved, and to date he remains well with no further recurrence. Conclusion: Trial results may establish transdermal estrogen as an alternative to luteinizing hormone-releasing hormone analogs in the management of prostate cancer, and has already been established as a therapy for male to female transsexuals. It is essential to record the toxicity profile of transdermal estrogen in men to ensure accurate safety information. This case report highlights a previously undocumented toxicity of estrogen therapy in men, of which oncologists, urologists, and endocrinologists need to be aware. Rheumatologists and dermatologists should add estrogen therapy to their differential diagnosis of men presenting with erythema nodosum

A thermal-fluid analysis of piping dead-legs in high purity water systems

Purified water forms an integral part of pharmaceutical production. The consistency of water quality produced by purrficatron processes and distributed to points-of-use is of utmost importance Tee-sectlons Installed in distribution loops are commonly used to divert fluid flow at take-off points. However fluid flow restriction at teesection branches can cause piping dead-legs. Dead-legs consist of reglons of stagnant fluid where harmful organisms can proliferate unaffected by the scounng effects of distribution loop flow. This thesis presents a thermo-fluld analysis focusmg upon the fluid dynamics and heat transfer mechanisms occurrmg wthin dead-leg branches A literature review of high purity water system designed etails sanitization methods currently employed in industry with reference to the detrimental effects of dead-legs. Experimentation was performed using a single-loop fluid rig complete with capped 90' tee-section representmg a piplng dead-leg. Analysis of the thermal conditions for various dead-leg configurations was performed mcludmg variations of branch length and diameter. The effect of varying loop velocity was also investigated. The application of non-intrusive analysis techniques was considered. Infrared thermography and surface-mounted thermocouples were used to map surface temperature distribution across a dead-leg branch. Increased temperatures were noted at the base of the dead-leg branch for increasing loop velocities. Comparison of reduced and equal diameter dead-legs for varying branch lengths suggested dead-leg temperature is strongly related to mlet loop velocity. Acceptable thermal responses were noted m 4d dead-legs for loop velocity > 0.94m/s, 2d reduced diameter dead-legs at 1 50m/s and in 2d equal diameter deadlegs throughout the examined velocity range. Although all dead-leg configurations used in analysis adhered to industry recommendations; unsatisfactory thermo-fluid conditions recorded for remalnlng dead-legs suggests revision of accepted regulations. Non-intrusive analyses illustrated greater temperatures at branch md-pomnt compared with base measurements. However the application of techniques was deemed limited due to pipe wall conduction effects

The relationship among knowledge of, attitudes toward, and use of portfolios for assessment by teacher education professors

The major purpose of this study was to examine the evaluation of portfolios as an alternative assessment tool along with those factors which influence the implementation practices of portfolios by faculty in colleges of education. The specific goals of this study were to determine the relationship between college and university professors\u27 knowledge of portfolio assessment and their attitudes toward using portfolios as an alternative to traditional assessment practices, as well as college and university professors\u27 knowledge of portfolio assessment and use of portfolios in the courses that they teach, and professors\u27 attitudes and use of portfolios. Other areas of investigation included professors, attitudes toward using portfolios and use of portfolios in their courses, gender and knowledge of portfolios, gender and attitude toward portfolio assessment, years of teaching experience and knowledge of portfolios, and years of experience and attitudes toward portfolio assessment. Data for this study were collected by e-mailing and mailing a questionnaire and demographic data form concerning portfolio assessment to all Louisiana professors involved in undergraduate teacher education courses in both public and private colleges and universities (N = 342). Analysis of the 98 responses utilizing Pearson Product-Moment correlation revealed a significant relationship between the professors\u27 knowledge of portfolio assessment and their attitudes toward using portfolios as an alternative to traditional assessment. In addition, a significant relationship was found using a Triserial correlation between professors, portfolio knowledge and the use of portfolios in the courses that they teach. A Triserial correlation also found that there was no significant relationship between professors\u27 attitudes toward portfolio assessment and their use of portfolios in the courses that they teach. An analysis using t tests revealed that a significant difference between gender and portfolio knowledge and gender and attitudes toward portfolio assessment does exist. A significant difference between years of experience and portfolio knowledge and between years of experience and attitudes toward portfolio assessment was not revealed using t tests

Justice by Luck: How Unclear Records Force Some Unlucky Prisoners to Serve Unconstitutional Sentences in the Wake of Johnson v. United States

The Armed Career Criminal Act (ACCA) imposes mandatory minimum sentences on individuals convicted of being a felon in possession of a firearm who have at least three prior convictions for “violent felon[ies].” “Violent felon[ies]” include those crimes contemplated by the ACCA’s “residual clause.” The Supreme Court ruled that the residual clause was unconstitutional in Johnson v. United States in 2015. As the decision in Johnson was retroactive, individuals whose sentences were enhanced on the basis of the residual clause may seek relief under Johnson. In affording such relief, however, the circuits disagree as to what standard of proof should apply to the question of whether a sentence enhancement was in fact based on the residual clause. Some circuits have held that a movant must show only that his sentence enhancement “may have” been based on the residual clause in order to have the sentence vacated. Other circuits, however, have held that a movant must meet the higher preponderance-of-the-evidence standard by showing that the judge more than likely relied on the residual clause in handing down the sentence. In 2019, the Fifth Circuit in United States v. Clay chose sides in the circuit split by adopting the harsher preponderance-of-the-evidence standard. This Note uses the Fifth Circuit’s decision in Clay as a springboard for analyzing the consequences of the preponderance-of-the evidence standard

Metformin as an adjuvant treatment for cancer: a systematic review and meta-analysis.

BACKGROUND: Metformin use has been associated with a reduced risk of developing cancer and an improvement in overall cancer survival rates in meta-analyses, but, to date, evidence to support the use of metformin as an adjuvant therapy in individual cancer types has not been presented. PATIENTS AND METHODS: We systematically searched research databases, conference abstracts and trial registries for any studies reporting cancer outcomes for individual tumour types in metformin users compared with non-users, and extracted data on patients with early-stage cancer. Studies were assessed for design and quality, and a meta-analysis was conducted to quantify the adjuvant effect of metformin on recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS), to inform future trial design. RESULTS: Of 7670 articles screened, 27 eligible studies were identified comprising 24 178 participants, all enrolled in observational studies. In those with early-stage colorectal cancer, metformin use was associated with a significant benefit in all outcomes [RFS hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.47-0.85; OS HR 0.69, CI 0.58-0.83; CSS HR 0.58, CI 0.39-0.86]. For men with early-stage prostate cancer, metformin was associated with significant, or borderline significant, benefits in all outcomes (RFS HR 0.83, CI 0.69-1.00; OS HR 0.82, CI 0.73-0.93; CSS HR 0.58, CI 0.37-0.93); however, there was significant heterogeneity between studies. The data suggest that prostate cancer patients treated with radical radiotherapy may benefit more from metformin (RFS HR 0.45, CI 0.29-0.70). In breast and urothelial cancer, no significant benefits were identified. Sufficient data were not available to conduct analyses on the impact of metformin dose and duration. CONCLUSIONS: Our findings suggest that metformin could be a useful adjuvant agent, with the greatest benefits seen in colorectal and prostate cancer, particularly in those receiving radical radiotherapy, and randomised, controlled trials which investigate dose and duration, alongside efficacy, are advocated

Aspirin and Colorectal Cancer Prevention and Treatment: Is It for Everyone?

There is now a considerable body of data supporting the hypothesis that aspirin could be effective in the prevention and treatment of colorectal cancer, and a number of phase III randomised controlled trials designed to evaluate the role of aspirin in the treatment of colorectal cancer are ongoing. Although generally well tolerated, aspirin can have adverse effects, including dyspepsia and, infrequently, bleeding. To ensure a favourable balance of benefits and risks from aspirin, a more personalised assessment of the advantages and disadvantages is required. Emerging data suggest that tumour PIK3CA mutation status, expression of cyclo-oxygenase-2 and human leukocyte antigen class I, along with certain germline polymorphisms, might all help to identify individuals who stand to gain most. We review both the underpinning evidence and current data, on clinical, molecular and genetic biomarkers for aspirin use in the prevention and treatment of colorectal cancer, and discuss the opportunities for further biomarker research provided by ongoing trials