Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer

BACKGROUND: Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. OBJECTIVES: To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer. SEARCH STRATEGY: We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult women with advanced primary epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed. MAIN RESULTS: One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 women with stage IIIC advanced epithelial ovarian cancer who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among women receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 women with carcinomatosis, those who underwent ultra-radical surgery had significantly better disease specific survival than women who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias. AUTHORS' CONCLUSIONS: We found only low quality evidence comparing ultra-radical and standard surgery in women with advanced ovarian cancer and carcinomatosis. The evidence suggested that ultra-radical surgery may result in better survival. It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery.In order to determine the role of ultra-radical surgery in the management of advanced stage ovarian cancer, a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would be required.link_to_subscribed_fulltex

Childhood solid tumours in relation to population mixing around the time of birth

In a retrospective cohort study of 673 787 live births in the Northern Region of England, 1975 - 1994, we investigated whether a higher level of population mixing around birth was a risk factor for solid tumours, by diagnostic group (Hodgkin's disease, brain and spinal tumours, neuroblastoma, other solid tumours), diagnosed during 1975-2001 under age 15 years. Logistic regression was used to relate risk to population mixing, based on (i) all movers and (ii) incomers from outside the region. Both ward and county district level analyses were performed. There was a decreased risk of brain and spinal tumours with increasing population mixing based on incomers from outside the region (OR for trend across three categories = 0.79, 95% CI: 0.66-0.95, P = 0.01 in the ward level analysis). Although this may be because of chance, it is consistent with a role of exposure to infection and immunological response in the aetiology of these tumours. For other tumour groups, there was no consistent evidence of an association between risk and population mixing

Childhood solid tumours in relation to infections in the community in Cumbria during pregnancy and around thetime of birth

In a retrospective cohort study of all 99 976 live births in Cumbria, 1975–1992, we investigated whether higher levels of community infections during the mother's pregnancy and in early life were risk factors for solid tumours (brain/spinal and other tumours), diagnosed 1975–1993 under age 15 years. Logistic regression was used to relate risk to incidence of community infections in three prenatal and two postnatal quarters. There was an increased risk of brain/spinal tumours among children exposed around or soon after birth to higher levels of community infections, in particular measles (OR for trend=2.1, 95%CI : 1.3–3.6, P=0.008) and influenza (OR for exposure=3.3, 95%CI : 1.5–7.4, P=0.005). There was some evidence of an association between exposure to infections around and soon after birth and risk of other tumours, but this may have been a chance finding. The findings are consistent with other recent epidemiological studies suggesting brain tumours may be associated with perinatal exposure to infections

GOODS-Herschel: Separating High Redshift active galactic Nuclei and star forming galaxies Using Infrared Color Diagnostics

We have compiled a large sample of 151 high redshift (z=0.5-4) galaxies selected at 24 microns (S24>100 uJy) in the GOODS-N and ECDFS fields for which we have deep Spitzer IRS spectroscopy, allowing us to decompose the mid-infrared spectrum into contributions from star formation and activity in the galactic nuclei. In addition, we have a wealth of photometric data from Spitzer IRAC/MIPS and Herschel PACS/SPIRE. We explore how effective different infrared color combinations are at separating our mid-IR spectroscopically determined active galactic nuclei from our star forming galaxies. We look in depth at existing IRAC color diagnostics, and we explore new color-color diagnostics combining mid-IR, far-IR, and near-IR photometry, since these combinations provide the most detail about the shape of a source's IR spectrum. An added benefit of using a color that combines far-IR and mid-IR photometry is that it is indicative of the power source driving the IR luminosity. For our data set, the optimal color selections are S250/S24 vs. S8.0/S3.6 and S100/S24 vs. S8.0/S3.6; both diagnostics have ~10% contamination rate in the regions occupied primarily by star forming galaxies and active galactic nuclei, respectively. Based on the low contamination rate, these two new IR color-color diagnostics are ideal for estimating both the mid-IR power source of a galaxy when spectroscopy is unavailable and the dominant power source contributing to the IR luminosity. In the absence of far-IR data, we present color diagnostics using the WISE mid-IR bands which can efficiently select out high z (z~2) star forming galaxies.Comment: Accepted for publication in ApJ. 13 pages, 8 figure

Evidence for a wide range of UV obscuration in z ~ 2 dusty galaxies from the GOODS-Herschel survey

Dusty galaxies at z ~ 2 span a wide range of relative brightness between rest-frame mid-infrared (8um) and ultraviolet wavelengths. We attempt to determine the physical mechanism responsible for this diversity. Dust-obscured galaxies (DOGs), which have rest-frame mid-IR to UV flux density ratios > 1000, might be abnormally bright in the mid-IR, perhaps due to prominent AGN and/or PAH emission, or abnormally faint in the UV. We use far-infrared data from the GOODS-Herschel survey to show that most DOGs with 10^12 L_Sun < L_IR < 10^13 L_Sun are not abnormally bright in the mid-IR when compared to other dusty galaxies with similar IR (8--1000um) luminosities. We observe a relation between the median IR to UV luminosity ratios and the median UV continuum power-law indices for these galaxies, and we find that only 24% have specific star formation rates which indicate the dominance of compact star-forming regions. This circumstantial evidence supports the idea that the UV- and IR-emitting regions in these galaxies are spatially coincident, which implies a connection between the abnormal UV faintness of DOGs and dust obscuration. We conclude that the range in rest-frame mid-IR to UV flux density ratios spanned by dusty galaxies at z ~ 2 is due to differing amounts of UV obscuration. Of galaxies with these IR luminosities, DOGs are the most obscured. We attribute differences in UV obscuration to either: 1) differences in the degree of alignment between the spatial distributions of dust and massive stars, or 2) differences in the total dust content.Comment: 9 pages, 9 figures. Accepted by Ap

The Taiwan ECDFS Near-Infrared Survey: Very Bright End of the Luminosity Function at z>7

The primary goal of the Taiwan ECDFS Near-Infrared Survey (TENIS) is to find well screened galaxy candidates at z>7 (z' dropout) in the Extended Chandra Deep Field-South (ECDFS). To this end, TENIS provides relatively deep J and Ks data (~25.3 ABmag, 5-sigma) for an area of 0.5*0.5 degree. Leveraged with existing data at mid-infrared to optical wavelengths, this allows us to screen for the most luminous high-z objects, which are rare and thus require a survey over a large field to be found. We introduce new color selection criteria to select a z>7 sample with minimal contaminations from low-z galaxies and Galactic cool stars; to reduce confusion in the relatively low angular resolution IRAC images, we introduce a novel deconvolution method to measure the IRAC fluxes of individual sources. Illustrating perhaps the effectiveness at which we screen out interlopers, we find only one z>7 candidate, TENIS-ZD1. The candidate has a weighted z_phot of 7.8, and its colors and luminosity indicate a young (45M years old) starburst galaxy with a stellar mass of 3.2*10^10 M_sun. The result matches with the observational luminosity function analysis and the semi-analytic simulation result based on the Millennium Simulations, which may over predict the volume density for high-z massive galaxies. The existence of TENIS-ZD1, if confirmed spectroscopically to be at z>7, therefore poses a challenge to current theoretical models for how so much mass can accumulate in a galaxy at such a high redshift.Comment: 14 pages, 11 figures, ApJ accepte

Population mixing, socioeconomic status and incidence of childhood acute lymphoblastic leukaemia in England and Wales: analysis by census ward

In this population-based study of acute lymphoblastic leukaemia (ALL) diagnosed among children aged under 15 years in England and Wales during 1986–1995, we analysed incidence at census ward level in relation to a range of variables from the 1991 census, which could be relevant to theories of infectious aetiology. ‘Population-mixing' measures, used as surrogates for quantity and diversity of infections entering the community, were calculated from census data on the origins and destinations of migrants in the year before the census. Incidence at ages 1–4 years tended independently to be higher in rural wards, to increase with the diversity of origin wards from which in-migrants had moved during the year before the census, and to be lower in the most deprived areas as categorised by the Carstairs index. This last association was much weaker when urban/rural status and in-migrants' diversity were allowed for. There was no evidence of association with population mixing or deprivation for ALL diagnosed at ages 0 or 5–14 years. The apparent specificity to the young childhood age group suggests that these associations are particularly marked for precursor B-cell ALL, with the disease more likely to occur when delayed exposure to infection leads to increased immunological stress, as predicted by Greaves. The association with diversity of incomers, especially in rural areas, is also consistent with the higher incidence of leukaemia predicted by Kinlen, where population mixing results in below average herd immunity to an infectious agent

Separation and Purification of Sulforaphane from Broccoli by Solid Phase Extraction

A simple solid-phase extraction (SPE) method for the determination of sulforaphane in broccoli has been developed. The optimal conditions were found to be use of a silica SPE cartridge, and ethyl acetate and dichloromethane as washing and eluting solvents, respectively, which could eliminate interferences originating from the broccoli matrix. The extracts were sufficiently clean to be directly injected into high-performance liquid chromatography (HPLC) for further chromatographic analysis. Good linearity was obtained from 0.05 to 200 μg/mL (r = 0.998) for sulforaphane with the relative standard deviations less than 3.6%. The mean recoveries of sulforaphane from broccoli were more than 90.8% and the detection limit (S/N = 3:1) was 0.02 μg/mL. The SPE method provides a higher yield of sulforaphane from crude extracts compared to conventional liquid-liquid extraction