Sample records for a-bomb survived patients

  1. A comparison of clinicopathological features and prognosis in prostate cancer between atomic bomb survivors and control patients

    PubMed Central

    Shoji, Koichi; Teishima, Jun; Hayashi, Tetsutaro; Shinmei, Shunsuke; Akita, Tomoyuki; Sentani, Kazuhiro; Takeshima, Yukio; Arihiro, Koji; Tanaka, Junko; Yasui, Wataru; Matsubara, Akio

    2017-01-01

    An atomic bomb (A-bomb) was dropped on Hiroshima on 6th August 1945. Although numerous studies have investigated cancer incidence and mortality among A-bomb survivors, only a small number have addressed urological cancer in these survivors. The aim of the present study was to investigate the clinicopathological features of prostate cancer (PCa) in A-bomb survivors. The clinicopathological features and prognosis of PCa were retrospectively reviewed in 212 survivors and 595 control patients between November 1996 and December 2010. The histopathological and clinical outcomes of surgical treatment of PCa were also evaluated in 69 survivors and 162 control patients. Despite the higher age at diagnosis compared with the control group (P=0.0031), survivors were more likely to have been diagnosed with PCa from a health check compared with the control group (P<0.0001). As a consequence, the survivors were found to exhibit metastasis significantly less frequently (199/212, 93.9%) compared with the control patients (521/595, 87.6%; P=0.0076). Prognosis in the two groups was examined, subsequent to a mean length of follow-up of 44 months. Overall survival (OS) and PCa-specific survival (CS) were similar between the two groups (OS, P=0.2196; CS, P=0.1017). A-bomb exposure was not found to be an independent predictor for prognosis by multivariate analysis (OS, P=0.7800; CS, P=0.8688). The clinicopathological features of patients who underwent a prostatectomy were similar except for the diagnosis opportunity between the two groups. Progression-free survival rates were similar between the two groups (P=0.5630). A-bomb exposure was not a significant and independent predictor for worsening of progression-free prognosis by multivariate analysis (P=0.3763). A-bomb exposure does not appear to exert deleterious effects on the biological aggressiveness of PCa and the prognosis of patients with PCa. PMID:28693168

  2. A comparison of clinicopathological features and prognosis in prostate cancer between atomic bomb survivors and control patients.

    PubMed

    Shoji, Koichi; Teishima, Jun; Hayashi, Tetsutaro; Shinmei, Shunsuke; Akita, Tomoyuki; Sentani, Kazuhiro; Takeshima, Yukio; Arihiro, Koji; Tanaka, Junko; Yasui, Wataru; Matsubara, Akio

    2017-07-01

    An atomic bomb (A-bomb) was dropped on Hiroshima on 6th August 1945. Although numerous studies have investigated cancer incidence and mortality among A-bomb survivors, only a small number have addressed urological cancer in these survivors. The aim of the present study was to investigate the clinicopathological features of prostate cancer (PCa) in A-bomb survivors. The clinicopathological features and prognosis of PCa were retrospectively reviewed in 212 survivors and 595 control patients between November 1996 and December 2010. The histopathological and clinical outcomes of surgical treatment of PCa were also evaluated in 69 survivors and 162 control patients. Despite the higher age at diagnosis compared with the control group (P=0.0031), survivors were more likely to have been diagnosed with PCa from a health check compared with the control group (P<0.0001). As a consequence, the survivors were found to exhibit metastasis significantly less frequently (199/212, 93.9%) compared with the control patients (521/595, 87.6%; P=0.0076). Prognosis in the two groups was examined, subsequent to a mean length of follow-up of 44 months. Overall survival (OS) and PCa-specific survival (CS) were similar between the two groups (OS, P=0.2196; CS, P=0.1017). A-bomb exposure was not found to be an independent predictor for prognosis by multivariate analysis (OS, P=0.7800; CS, P=0.8688). The clinicopathological features of patients who underwent a prostatectomy were similar except for the diagnosis opportunity between the two groups. Progression-free survival rates were similar between the two groups (P=0.5630). A-bomb exposure was not a significant and independent predictor for worsening of progression-free prognosis by multivariate analysis (P=0.3763). A-bomb exposure does not appear to exert deleterious effects on the biological aggressiveness of PCa and the prognosis of patients with PCa.

  3. Impact of Nagasaki atomic bomb exposure on myelodysplastic syndrome patients who are treated with azacitidine.

    PubMed

    Jo, Tatsuro; Horio, Kensuke; Shigematsu, Kazuto

    2015-05-01

    High-dose radiation exposure greatly increases the risk of myelodysplastic syndromes (MDS), however the clinical characteristics of MDS among atomic bomb survivors have not been thoroughly investigated to date. We designed this study to identify these characteristics. We retrospectively evaluated data from 13 atomic bomb survivors with MDS and 15 elderly patients with de novo MDS who were diagnosed between April 2011 and April 2013 at the Nagasaki Genbaku Hospital. All patients were treated with azacitidine (AZA; a hypomethylating agent) and overall survival rates were estimated. No clear difference was observed in the clinical response to AZA between the two groups. However, atomic bomb survivors had a survival disadvantage, independent of their karyotype. Minute genetic alterations caused by exposure to atomic radiation can adversely affect the response to AZA, even 66 years after the exposure. Further studies are required to clarify the mechanisms underlying this phenomenon. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  4. Cluster bomb ocular injuries.

    PubMed

    Mansour, Ahmad M; Hamade, Haya; Ghaddar, Ayman; Mokadem, Ahmad Samih; El Hajj Ali, Mohamad; Awwad, Shady

    2012-01-01

    To present the visual outcomes and ocular sequelae of victims of cluster bombs. This retrospective, multicenter case series of ocular injury due to cluster bombs was conducted for 3 years after the war in South Lebanon (July 2006). Data were gathered from the reports to the Information Management System for Mine Action. There were 308 victims of clusters bombs; 36 individuals were killed, of which 2 received ocular lacerations and; 272 individuals were injured with 18 receiving ocular injury. These 18 surviving individuals were assessed by the authors. Ocular injury occurred in 6.5% (20/308) of cluster bomb victims. Trauma to multiple organs occurred in 12 of 18 cases (67%) with ocular injury. Ocular findings included corneal or scleral lacerations (16 eyes), corneal foreign bodies (9 eyes), corneal decompensation (2 eyes), ruptured cataract (6 eyes), and intravitreal foreign bodies (10 eyes). The corneas of one patient had extreme attenuation of the endothelium. Ocular injury occurred in 6.5% of cluster bomb victims and 67% of the patients with ocular injury sustained trauma to multiple organs. Visual morbidity in civilians is an additional reason for a global ban on the use of cluster bombs.

  5. Cluster Bomb Ocular Injuries

    PubMed Central

    Mansour, Ahmad M.; Hamade, Haya; Ghaddar, Ayman; Mokadem, Ahmad Samih; El Hajj Ali, Mohamad; Awwad, Shady

    2012-01-01

    Purpose: To present the visual outcomes and ocular sequelae of victims of cluster bombs. Materials and Methods: This retrospective, multicenter case series of ocular injury due to cluster bombs was conducted for 3 years after the war in South Lebanon (July 2006). Data were gathered from the reports to the Information Management System for Mine Action. Results: There were 308 victims of clusters bombs; 36 individuals were killed, of which 2 received ocular lacerations and; 272 individuals were injured with 18 receiving ocular injury. These 18 surviving individuals were assessed by the authors. Ocular injury occurred in 6.5% (20/308) of cluster bomb victims. Trauma to multiple organs occurred in 12 of 18 cases (67%) with ocular injury. Ocular findings included corneal or scleral lacerations (16 eyes), corneal foreign bodies (9 eyes), corneal decompensation (2 eyes), ruptured cataract (6 eyes), and intravitreal foreign bodies (10 eyes). The corneas of one patient had extreme attenuation of the endothelium. Conclusions: Ocular injury occurred in 6.5% of cluster bomb victims and 67% of the patients with ocular injury sustained trauma to multiple organs. Visual morbidity in civilians is an additional reason for a global ban on the use of cluster bombs. PMID:22346132

  6. Injury perceptions of bombing survivors--interviews from the Oklahoma City bombing.

    PubMed

    Glenshaw, Mary T; Vernick, Jon S; Frattaroli, Shannon; Brown, Sheryll; Mallonee, Sue

    2008-01-01

    Bombings, including the 1995 Oklahoma City bombing, remain an important public health threat. However, there has been little investigation into the impressions of injury risk or protective factors of bombing survivors. This study analyzes Oklahoma City bombing survivors' impressions of factors that influenced their risk of injury, and validates a hazard timeline outlining phases of injury risk in a building bombing. In-depth, semi-structured interviews were conducted within a sample of Oklahoma City bombing survivors. Participants included 15 injured and uninjured survivors, who were located in three buildings surrounding the detonation site during the attack. Risk factor themes included environmental glass, debris, and entrapment. Protective factors included knowledge of egress routes, shielding behaviors to deflect debris, and survival training. Building design and health status were reported as risk and protective factors. The hazard timeline was a useful tool, but should be modified to include a lay rescue phase. The combination of a narrative approach and direct questioning is an effective method of gathering the perceptions of survivors. Investigating survivors' impressions of building bombing hazards is critical to capture injury exposures, behavior patterns, and decision-making processes during actual events, and to identify interventions that will be supported by survivors.

  7. Resilience among Japanese atomic bomb survivors.

    PubMed

    Knowles, A

    2011-03-01

    The purpose of the study was to explore the experience of atomic bomb survivors from Hiroshima and Nagasaki. Never has the world experienced such extreme devastation as with the atomic bombings of Hiroshima and Nagasaki, Japan, in August 1945. Although significant quantitative research has been completed about the medical effects following radiation, the literature lacks qualitative exploration from a holistic health perspective. This was a qualitative descriptive study, using methods of narrative analysis, oral history and ethnography. The sample for this research included eight individuals who were exposed to the atomic bombings in Japan and currently reside in the United States. Findings provide insight to the resilience that the survivors exhibited immediately following the bomb, as well as throughout the 65 years following the event. From ethnographic data and interviews with survivors, a thematic structure was developed that depicts the essential elements of the atomic bomb experience. Two ways of being in the world followed the bombing: surviving and thriving, with resilience serving as a lever, allowing for fluid movement over time across the continuum. Individuals experiencing surviving exhibited anxiety about their personal and family members' health, expressed mistrust, and felt a stigma associated with being a survivor. For those who were thriving, peace activism, overcoming and forgiveness were typically displayed. Findings from this study add to the disaster nursing literature and highlight the role resilience plays in the atomic bomb survivors' life perspective. © 2011 The Author. International Nursing Review © 2011 International Council of Nurses.

  8. Outcome and status of microsatellite stability in Japanese atomic bomb survivors with early gastric carcinoma.

    PubMed

    Yamamoto, Manabu; Taguchi, Kenichi; Yamanaka, Takeharu; Matsuyama, Ayumi; Yoshinaga, Keiji; Tsutsui, Shinichi; Ishida, Teruyoshi

    2013-03-01

    In the decade after the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. However, the incidence of other cancers gradually increased, while that of leukemia decreased after this period. We evaluated the clinical outcome of early gastric cancer and microsatellite stability over a long-term period in atomic bomb survivors. The results of surgical treatment for early gastric cancer were reviewed for 117 atomic bomb survivors and 394 control patients between 1995 and 2006. In addition, immunohistochemical staining for hMSH2 and hMLH1 expression was performed to evaluate the status of microsatellite stability in 57 atomic bomb survivors and 82 control patients. The long-term survival rate for early gastric cancer in atomic bomb survivors was significantly lower than that in control patients (p < 0.01). Multivariable analysis revealed that age and sex were significant and independent prognostic factors for early gastric cancer. Defective hMSH2 and/or hMLH1 expression was also significantly higher in survivors than in control patients (p < 0.001). Logistic regression analysis revealed that atomic bomb survivorship was related to defective hMSH2 and/or hMLH1 expression. The prognosis of early gastric cancer in atomic bomb survivors was poor and was related to age and sex, rather than to being an atomic bomb survivor. Furthermore, a higher rate of defective hMSH2 and/or hMLH1 expression was observed in the survivors.

  9. Clinical features and prognosis of patients with myelodysplastic syndromes who were exposed to atomic bomb radiation in Nagasaki.

    PubMed

    Matsuo, Masatoshi; Iwanaga, Masako; Kondo, Hisayoshi; Soda, Midori; Jo, Tatsuro; Horio, Kensuke; Takasaki, Yumi; Kawaguchi, Yasuhisa; Tsushima, Hideki; Imaizumi, Yoshitaka; Imanishi, Daisuke; Taguchi, Jun; Sawayama, Yasushi; Hata, Tomoko; Miyazaki, Yasushi

    2016-10-01

    There is evidence that radiation exposure is a causative factor of myelodysplastic syndromes (MDS). However, little is known about whether radiation exposure is also a prognostic factor of MDS. We investigated the impact of radiation exposure on the prognosis of MDS in Nagasaki atomic bomb survivors using the International Prognostic Scoring System (IPSS) and the revised version (IPSS-R). Subjects were 140 patients with primary MDS diagnosed between 1985 and 2011 and evaluable for IPSS, IPSS-R, and exposure distance. Of those, 31 were exposed at <1.5 km, 35 at 1.5-2.99 km, and 74 at ≥3.0 km. By the end of March 2014, 47 patients (34%) progressed to overt leukemia and 106 (75.7%) died. By comparing with patients exposed at ≥3.0 km, those exposed at <1.5 km had significantly higher frequencies of abnormal chromosome (P = 0.02), intermediate/poor IPSS, and intermediate/poor/very poor IPSS-R cytogenetic category (P = 0.0001, and P < 0.0001, respectively). As with de novo MDS, multivariate Cox regression analyses revealed that cytogenetic abnormalities, IPSS karyotype, and IPSS-R cytogenetics were significantly associated with poor survival, and cumulative incidence of leukemic transformation in MDS among atomic bomb survivors, but exposure distance was not associated with any poor outcomes. These suggest that exposure to the greater dose of atomic bomb radiation is associated with developing poor cytogenetic abnormalities in MDS, which might consequently lead to overt leukemia among atomic bomb survivors. © 2016 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

  10. [A-bomb experience and Hibakushas' lives].

    PubMed

    Akiba, Tadatoshi

    2012-01-01

    The A-bomb experience of Hiroshima may shed light on the reconstruction plan of the Eastern Japan Earthquake and Tsunami and on implementing middle to long range care plans for the victims of the catastrophe. An important element in the success of Hiroshima's reconstruction was the understanding of the realities of everyday life of citizens and hibakusha by local and national government, and incorporation of those points of view into the reconstruction plan. Sharing of accurate and fair information about the disaster, restoration, and reconstruction with citizens was and still is a prerequisite for success. To convey learned lessons from the Hiroshima experience, three books are helpful: "A-bomb Mayor" by Shinzo Hamai, "The Meaning of Survival" compiled by the Chugoku Shimbun and "The Children of the A-bomb" compiled by Arata Osada. They help understand the history of hibakusha psychology from the point of view of their everyday lives and may help those affected by the Earthquake and Tsunami. To summarize the history of psychological changes among the hibakusha, three key transitional pairs of statements used widely by them over the span of 66 years help show the change in their attitude and emotional outlook. Each pair consists of an expression from the period immediately following the bombing and a second more recent expression: (1) Transition from "I would rather die." to "I am glad I am alive." (2) Transition from "I would rather forget." to "We should not forget." (3) Transition from "You will understand if you are a victim." to "No one else should ever suffer as we did".

  11. Bombs and Bomb Threats in the School

    ERIC Educational Resources Information Center

    Starkey, David J.; Starkey, John D.

    1977-01-01

    Bombs and the threat of bombing can leave school personnel faced by an explosive hazard without knowledge of what to do. Therefore, a preplanned response is necessary. Discusses four major stages of dealing with bombs and bomb threats. (Author/RK)

  12. Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data

    PubMed Central

    2015-01-01

    Background Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Methods Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. Results A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Conclusion Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging. PMID:26692453

  13. Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data.

    PubMed

    Khan, Irum; Khan, Nadeem; Naeem, Rubaba; Kerai, Salima; Allen, Kate; Zia, Nukhba; Shahbaz, Sana; Afridi, Shiraz; Siddiqui, Emaduddin; Khan, Uzma; Hyder, Adnan A; Razzak, Junaid A

    2015-01-01

    Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging.

  14. Prevalence of monoclonal gammopathy of undetermined significance in Asia: a viewpoint from nagasaki atomic bomb survivors.

    PubMed

    Iwanaga, Masako; Tomonaga, Masao

    2014-02-01

    Exposure to ionizing radiation is a known environmental risk factor for a variety of cancers including hematological malignancies, such as leukemia, myelodysplastic syndromes, and multiple myeloma. Therefore, for Hiroshima and Nagasaki atomic bomb survivors (surviving victims who were exposed to ionizing radiation emitted from the nuclear weapons), several cancer-screening tests have been provided annually, with government support, to detect the early stage of malignancies. An M-protein screening test has been used to detect multiple myeloma at an early stage among atomic bomb survivors. In the screening process, a number of patients with monoclonal gammopathy of undetermined significance (MGUS), in addition to multiple myeloma, have been identified. In 2009 and 2011, we reported the age- and sex-specific prevalence of MGUS between 1988 and 2004 and the possible role of radiation exposure in the development of MGUS using the screening data of more than 1000 patients with MGUS among approximately 52,000 Nagasaki atomic bomb survivors. The findings included: (1) a significant lower overall prevalence (2.1%) than that observed in Caucasian or African-origin populations; (2) a significantly higher prevalence in men than in women; (3) an age-related increase in the prevalence; (4) a significantly higher prevalence in people exposed to higher radiation doses only among those exposed at age 20 years or younger; and (5) a lower frequency of immunoglobulin M MGUS in Japanese patients than in patients in Western countries. The large study of MGUS among Nagasaki atomic bomb survivors has provided important findings for the etiology of MGUS, including a possible role of radiation exposure on the cause of MGUS and an ethnicity-related difference in the characteristics of MGUS. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Epidemiology of a thermonuclear bomb-burst over Nashville, Tennessee: a theoretic study.

    PubMed

    Quinn, R W

    1983-07-01

    A thermonuclear bomb explosion over any city in the world would have a devastating effect on the population and environment. For those who survive, with or without injuries, life would become primitive with little or no uncontaminated food or water, and with inadequate housing, fuel, and medical care, resulting in a breakdown of family and interpersonal relationships. This theoretic study of the potential outcome of a thermonuclear bomb-burst over Nashville, Tennessee, discusses epidemiologically the wide range of medical and psychologic effects from the direct trauma of blast and fire, widespread epidemics of otherwise controlled disease, long-term chronic illness, genetic damage, and catastrophic environmental havoc.

  16. Bomb Threats and Bomb Search Techniques.

    ERIC Educational Resources Information Center

    Department of the Treasury, Washington, DC.

    This pamphlet explains how to be prepared and plan for bomb threats and describes procedures to follow once a call has been received. The content covers (1) preparation for bomb threats, (2) evacuation procedures, (3) room search methods, (4) procedures to follow once a bomb has been located, and (5) typical problems that search teams will…

  17. Suicide Bombing Attacks

    PubMed Central

    Almogy, Gidon; Belzberg, Howard; Mintz, Yoaz; Pikarsky, Alon K.; Zamir, Gideon; Rivkind, Avraham I.

    2004-01-01

    Objective: To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks. Summary Background Data: The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects. Methods: The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003. Results: Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns. Conclusions: The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities. PMID:15075644

  18. Epidemiology of a thermonuclear bomb-burst over Nashville, Tennessee: a theoretic study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Quinn, R.W.

    1983-07-01

    A thermonuclear bomb explosion over any city in the world would have a devastating effect on the population and environment. For those who survive, with or without injuries, life would become primitive with little or no uncontaminated food or water, and with inadequate housing, fuel, and medical care, resulting in a breakdown of family and interpersonal relationships. This theoretic study of the potential outcome of a thermonuclear bomb-burst over Nashville, Tennessee, discusses epidemiologically the wide range of medical and psychologic effects from the direct trauma of blast and fire, widespread epidemics of otherwise controlled disease, long-term chronic illness, genetic damage,more » and catastrophic environmental havoc.« less

  19. Ophthalmologic survey of atomic bomb survivors in Japan, 1949. Atomic bomb radiation cataract case report with histopathologic study. Medical examination of Hiroshima patients with radiation cataracts (in Japanese and English)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cogan, D.G.; Martin, S.F.; Kimura, S.J.

    1959-01-01

    This document contains 3 reports dealing with the delayed effects of radiation on the eyes of survivors of the atomic explosions in Hiroshima and Nagasaki. In the first study, 1000 persons who were listed as having been in the open and within two kilometers of the hypocenter at the time of the explosion were selected at random from the census files of the Atomic Bomb Casualty Commission for study. In addition, 231 others, comprising the total available number of surviving persons listed at present in the census files as having been within one kilometer of the hypocenter, were examined, asmore » were several hundred others who were contacted through newspaper publicity, referrals from local ophthalmologists, or through hearsay. The survey resulted in bringing in persons having, or having had, a variety of ocular conditions. Those connected with the atomic bomb included the following diagnoses; multiple injuries of eyes and eyelids; keratoconjunctivitis from ultraviolet and ionizing radiations; thermal burn of the cornea and of the retina; retinitis proliferans; and radiation cataracts. The cataracts were the only delayed manifestations of ocular injury from the atomic bomb. The second paper is a case report of a histopathologic study of atomic bomb radiation cataract. The third paper presents the results of medical examinations of survivors having radiation induced cataracts. 32 references, 8 figures. (DMC)« less

  20. Emergency department impact of the Oklahoma City terrorist bombing.

    PubMed

    Hogan, D E; Waeckerle, J F; Dire, D J; Lillibridge, S R

    1999-08-01

    To collect descriptive epidemiologic injury data on patients who suffered acute injuries after the April 19, 1995, Oklahoma City bombing and to describe the effect on metropolitan emergency departments. A retrospective review of the medical records of victims seen for injury or illness related to the bombing at 1 of the 13 study hospitals from 9:02 AM to midnight April 19, 1995. Rescue workers and nontransported fatalities were excluded. Three hundred eighty-eight patients met inclusion criteria; 72 (18.6%) were admitted, 312 (80.4%) were treated and released, 3 (.7%) were dead on arrival, and 1 had undocumented disposition. Patients requiring admission took longer to arrive to EDs than patients treated and released (P =.0065). The EDs geographically closest to the blast site (1.5 radial miles) received significantly more victims than more distant EDs (P <.0001). Among the 90 patients with documented prehospital care, the most common interventions were spinal immobilization (964/90, 71.1%), field dressings (40/90, 44.4%), and intravenous fluids (32/90, 35.5%). No patients requiring prehospital CPR survived. Patients transported by EMS had higher admission rates than those arriving by any other mode (P <.0001). The most common procedures performed were wound care and intravenous infusion lines. The most common diagnoses were lacerations/contusion, fractures, strains, head injury, abrasions, and soft tissue foreign bodies. Tetanus toxoid, antibiotics, and analgesics were the most common pharmaceutical agents used. Plain radiology, computed tomographic radiology, and the hospital laboratory were the most significantly utilized ancillary services. EMS providers tended to transport the more seriously injured patients, who tended to arrive in a second wave at EDs. The closest hospitals received the greatest number of victims by all transport methods. The effects on pharmaceutical use and ancillary service were consistent with the care of penetrating and blunt trauma. The

  1. Terrorist bombings. Lessons learned from Belfast to Beirut.

    PubMed Central

    Frykberg, E R; Tepas, J J

    1988-01-01

    Experience in the management of mass casualties following a disaster is relatively sparse. The terrorist bombing serves as a timely and effective model for the analysis of patterns of injury and mortality and the determination of the factors influencing casualty survival in the wake of certain forms of disaster. For this purpose, a review of the published experience with terrorist bombings was carried out, providing a study population of 3357 casualties from 220 incidents worldwide. There were 2934 immediate survivors of these incidents (87%), of whom 881 (30%) were hospitalized. Forty deaths ultimately occurred among these survivors (1.4%), 39 of whom were among those hospitalized (4.4%). Injury severity was determined from available data for 1339 surviving casualties, 251 of whom were critically injured (18.7%). Of this population evaluable for injury severity, there were 31 late deaths, all of which occurred among those critically injured, accounting for an overall "critical mortality" rate of 12.4%. Overall triage efficiency was characterized by a mean overtriage rate (noncritically injured among those hospitalized or evacuated) of 59%, and a mean undertriage rate (critically injured among those not hospitalized or evacuated) of .05%. Multiple linear regression analysis of all major bombing incidents demonstrated a direct linear relationship between overtriage and critical mortality (r2 = .845), and an inversely proportional relationship between triage discrimination and critical mortality (r2 = 0.855). Although head injuries predominated in both immediate (71%) and late (52%) fatalities, injury to the abdomen carried the highest specific mortality rate (19%) of any single body system injury among immediate survivors. These data clearly document the importance of accurate triage as a survival determinant for critically injured casualties of these disasters. Furthermore, the data suggest that explosive force, time interval from injury to treatment, and anatomic

  2. Italian Bombs & Fuzes

    DTIC Science & Technology

    1948-06-01

    document states that the practice of galvanising aircraft bombs has ceased, and that a protective coat of paint is now used instead. These colourings...that the Italians are still in possession of large stocks of galvanised bombs. SECTION I CHEMICAL WARFARE BOMBS No. C.W. bombs have yet been

  3. The long-term outcome of atomic bomb survivors with gastric carcinoma.

    PubMed

    Yamamoto, Manabu; Matsuyama, Ayumi; Kameyama, Toshifumi; Okamoto, Masahiro; Okazaki, Jin; Utsunomiya, Tohru; Tsutsui, Shinichi; Ishida, Teruyoshi

    2009-12-01

    During the decade following the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. Subsequently, the incidence of other cancers gradually increased while that of leukemia decreased. We examined the long-term clinical outcome of gastric cancer and second primary cancer in atomic bomb survivors. Results of surgical treatment of gastric cancer were reviewed in 231 atomic bomb survivors and 759 control patients between 1995 and 2006. Long-term prognosis of gastric cancer in atomic bomb survivors was significantly poorer than that in control patients (P < 0.05). In a multivariate analysis, age, depth of tumor invasion, lymph node metastases, and curability were found to be significant and independent prognostic factors for gastric cancer. The incidence of second primary cancer after gastric cancer was significantly higher in survivors than in control patients (P < 0.01), because the number of elderly patients in the survivors was higher. Gastric cancer in survivors had a significantly poorer prognosis. Although the frequency of second primary cancer after gastric cancer in survivors was higher than that in control patients, it did not influence the prognosis.

  4. Mass casualties in the Oklahoma City bombing.

    PubMed

    Teague, David C

    2004-05-01

    The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources.

  5. Ocular injuries sustained by survivors of the Oklahoma City bombing.

    PubMed

    Mines, M; Thach, A; Mallonee, S; Hildebrand, L; Shariat, S

    2000-05-01

    The purpose of this study is to provide a review of the ocular injuries sustained by survivors of the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City. Retrospective, noncomparative case series. The authors retrospectively evaluated data collected on all surviving persons receiving ocular injuries during the bombing and on all at-risk occupants of the federal building and four adjacent buildings. Injury data from survivors were collected from multiple sources to include hospital medical records, a physician survey, emergency medical services run reports, written survivor accounts, building occupant survey, telephone interviews, and mail surveys. The types of ocular injuries, the associated systemic injuries, and the location of the injured at the time of the blast were evaluated. Fifty-five (8%) of the 684 injured bombing survivors sustained an ocular injury. Persons injured in the Murrah building were more than three times more likely to sustain an ocular injury than other injured persons. Seventy-one percent of ocular injuries occurred within 300 feet of the point of detonation. The most common serious ocular injuries included lid/brow lacerations (20 patients, 23 eyes), open globe injuries (12 eyes), orbital fractures (6 eyes), and retinal detachment (5 eyes). A retained intraocular foreign body accounted for only two of the injuries (4%). Glass accounted for nearly two thirds of the ocular injuries. Blasts involving explosions inflict severe ocular injury, mostly as a result of secondary blast effects from glass, debris, etc. Eye injuries in bombings can probably be prevented by increasing the distance from and orientation away from windows (i.e., by facing desks away from windows). Use of such products as laminated glass, toughened window glazing, and Mylar curtains may reduce glass projectiles in the blast vicinity.

  6. A man, a plan, a bomb

    NASA Astrophysics Data System (ADS)

    Harris, Margaret

    2015-03-01

    Was the atomic bombing of Hiroshima and Nagasaki justified? Was it necessary? Were there other - better - options available, either to the scientists who built the bombs or the generals who ordered them dropped? Nearly 70 years later, there are still no settled answers to these questions, and Tom Morton-Smith's new play Oppenheimer wisely avoids dwelling on the "what ifs" of atomic history.

  7. Genomic instability in the epidermis induced by atomic bomb (A-bomb) radiation: a long-lasting health effect in A-bomb survivors.

    PubMed

    Naruke, Yuki; Nakashima, Masahiro; Suzuki, Keiji; Kondo, Hisayoshi; Hayashi, Tomayoshi; Soda, Midori; Sekine, Ichiro

    2009-08-15

    Radiation etiology is suggested in the occurrence of basal cell carcinoma (BCC) of the skin among atomic bomb (A-bomb) survivors. Any genotoxicity, including ionizing radiation, can induce a DNA damage response (DDR), leading to genomic instability (GIN), which allows the accumulation of mutations during tumorigenesis. In this study, the authors evaluated the presence of GIN in the epidermis of survivors as a late effect of A-bomb radiation. In total, 146 BCCs, including 23 cases arising from nonexposed skin, were identified in survivors from 1968 to 1999. The incidence rate (IR) of BCC was calculated with stratification by distance in kilometers from the hypocenter (< or =1.5 km, 1.6-2.9 km, and > or =3 km). Nineteen epidermal samples surrounding BCC at the nonexposed sites were collected and tested for p53 binding protein 1 (53BP1) expression with immunofluorescence. 53BP1 rapidly forms nuclear foci at the sites of DNA double strand breaks (DSBs). Because 1 manifestation of GIN is the induction of endogenous DSBs, the level of 53BP1-focus formation (DDR type) can be considered as a marker for GIN. : The incidence rate of BCC increased significantly as exposure distance approached the hypocenter. Of the 7 epidermal samples from the proximal group (< or =1.5 km), 5 samples predominantly expressed DDR and an abnormal type of 53BP1 expression. In contrast, 4 of 5 samples from the distal group (> or =3 km) and all samples from the control group predominantly expressed the stable type of 53BP1 expression in the epidermis. : The current results demonstrated the endogenous activation of DDR in the epidermis surrounding BCC in the proximal group, suggesting the presence of a GIN in the survivors as a late effect of A-bomb radiation, which may indicate a predisposition to cancer.

  8. Bombs, flyin' high. In-flight dynamics of volcanic bombs from Strombolian to Vulcanian eruptions.

    NASA Astrophysics Data System (ADS)

    Taddeucci, Jacopo; Alatorre, Miguel; Cruz Vázquez, Omar; Del Bello, Elisabetta; Ricci, Tullio; Scarlato, Piergiorgio; Palladino, Danilo

    2016-04-01

    Bomb-sized (larger than 64 mm) pyroclasts are a common product of explosive eruptions and a considerable source of hazard, both from directly impacting on people and properties and from wildfires associated with their landing in vegetated areas. The dispersal of bombs is mostly modeled as purely ballistic trajectories controlled by gravity and drag forces associated with still air, and only recently other effects, such as the influence of eruption dynamics, the gas expansion, and in-flight collisions, are starting to be quantified both numerically and observationally. By using high-speed imaging of explosive volcanic eruptions here we attempt to calculate the drag coefficient of free-flying volcanic bombs during an eruption and at the same time we document a wide range of in-flight processes affecting bomb trajectories and introducing deviations from purely ballistic emplacement. High-speed (500 frames per second) videos of explosions at Stromboli and Etna (Italy), Fuego (Gatemala), Sakurajima (Japan), Yasur (Vanuatu), and Batu Tara (Indonesia) volcanoes provide a large assortment of free-flying bombs spanning Strombolian to Vulcanian source eruptions, basaltic to andesitic composition, centimeters to meters in size, and 10 to 300 m/s in fly velocity. By tracking the bombs during their flying trajectories we were able to: 1) measure their size, shape, and vertical component of velocity and related changes over time; and 2) measure the different interactions with the atmosphere and with other bombs. Quantitatively, these data allow us to provide the first direct measurement of the aerodynamic behavior and drag coefficient of volcanic bombs while settling, also including the effect of bomb rotation and changes in bomb shape and frontal section. We also show how our observations have the potential to parameterize a number of previously hypothesized and /or described but yet unquantified processes, including in-flight rotation, deformation, fragmentation, agglutination

  9. Rethinking suicide bombing.

    PubMed

    Aggarwal, Neil

    2009-01-01

    Current issues in the emerging psychiatric literature on suicide bombing tend to center around the pathologies of suicide bombers and the role of psychiatry as an adequate tool for analysis. Attention to broader social science research may allow mental health professionals to develop more accurate models of behavior to explain and possibly prevent future attacks. The psychiatric literature on suicide bombing was reviewed and compared to similar anthropological literature. A probe into the methodologies of researching suicide bombing, definitions of "war" and "terrorism", and beliefs on life, death, homicide, and suicide demonstrate that most of the psychiatric literature reflects a particular perspective which aspires towards a certain universalism. Anthropological approaches can disclose standpoints taken for granted since any interventions with respect to suicide bombing must eventually account for values which are ultimately culturally determined.

  10. Development of a Dirigible Bomb

    DTIC Science & Technology

    1943-04-15

    X - ¥ control for all future high-angle dirigible bombs in spite of the instrumental complications involved. /. two gyro system consisting of t...ts found thet the bomb wos in roll equilibrium £.t aero roll orientetion . Moreover, these roll equilibrium positions ire stt-ble ss indicated by...tirflow giving rise to voll torques in the seme direction fcs roll dis- placements from the «ero orientetion , the roll equilibrium found for equel pitch

  11. Endovascular Treatment of Carotid-Internal Jugular Venous Fistula in a Bomb Blast Victim.

    PubMed

    Ashraf, Tariq; Khan, Navedullah; Yousaf, K M; Yaqub, Maha Zainab Z.

    2017-02-01

    Carotid-internal jugular venous fistula is one of the rarest presentations among victims of bomb blast injuries. Treatment of such fistula is open surgery with high mortality and morbidity. Endovascular treatment with covered stent seems to have an optimal result with low complications. We present a case report of a bomb blast victim having carotid-jugular venous fistula with hemodynamic compromise. The patient was successfully managed with endovascular graft stent. There was an optimal result with no immediate and long-term complications.

  12. Exposure to an atomic bomb explosion is a risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

    PubMed

    Nakashima, Y; Takeishi, K; Guntani, A; Tsujita, E; Yoshinaga, K; Matsuyama, A; Hamatake, M; Maeda, T; Tsutsui, S; Matsuda, H; Ishida, T

    2015-01-01

    Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  13. Life-bombing-injury-life: a qualitative follow-up study of Oklahoma City bombing survivors with TBI.

    PubMed

    Sample, Pat L; Greene, David; Johns, Nikole R

    2012-01-01

    To learn about and come to an understanding of the recovery process and outcomes experienced by the survivors of the 1995 Oklahoma City bombing, who sustained a traumatic brain injury (TBI) along with other injuries in the blast. A phenomenological study was conducted using in-person interviews, document and video-tape review, internet communication and researcher journals as the primary data set. A total of 20 of the 46 bombing survivors with TBI (44%) agreed to be a part of the study. The data collection process focused on stories about service needs, services accessed and long-term outcomes of the participants. The researchers' data analysis yielded four themes (Trauma-Healing-Support; What TBI?; How I went back to work and life; Now I really need assistance!) that represented the content and meanings of the interviews and supplemental data. A common thread running through the interviews of survivors with TBI was their portrayal of life-long medical, emotional, vocational and residential needs since the bombing. What they experienced in the months--extending into years--after the bombing was beyond their own anticipation and that of their families and healthcare professionals.

  14. Population effects of the bombing of Oklahoma City.

    PubMed

    Smith, D W; Christiansen, E H; Vincent, R; Hann, N E

    1999-04-01

    The explosion at the Murrah Federal Building in Oklahoma City on April 19, 1995, affected many members of the community as well as direct victims. Our goal was to measure the exposure and effects among the general population. We conducted surveys of the Oklahoma City metropolitan area and a control area to measure exposure and impact, primarily stress and psychological distress. Of the adults in the Oklahoma City MSA, 61.5 percent (58.5 percent to 64.5 percent with 95 percent confidence) reported experiencing at least one direct result of the bombing. In population terms, about 433 thousand adults (between 412 thousand and 457 thousand, with 95 percent confidence) were exposed to one or more of the consequences of the bombing. Oklahomans reported higher rates (about double) of increased alcohol use, smoking more or starting smoking. They reported more stress (about double), psychological distress (about double), post-traumatic stress-disorder components, and intrusive thoughts (double) related to the bombing than in the control area. Oklahomans also reported higher rates of seeking help for their stress or taking steps to reduce stress. The differences persisted into 1996, more than a year after the bombing. The exposure to the bombing was widespread, including more than half the adults in the metropolitan area surrounding Oklahoma City. The psychological effects were high and, while decreasing, persisted more than a year after the bombing. Primary care practitioners should screen their patients, who may normally not be considered victims, for exposure to the effects of a terrorist disaster for an extended period of time.

  15. Time Variation of the Distance Separating Bomb and Dive Bomber Subsequent to Bomb Release

    NASA Technical Reports Server (NTRS)

    Mathews, Charles W.

    1952-01-01

    A study has been made of the variation of the distance separating bomb and aircraft with time after release as applied to dive-bombing operations, Separation distances determined from this study are presented in terms of two variables only, dive angle and maximum airplane accelerometer reading; the values of separation distance include the effects of delay in initiation of the pull-out and lag in attainment of the maximum normal acceleration.Contains analysis and calculations of the separation distances between bomb and dive bomber following bomb release, Separation distances as determined by the dive angle and the maximum airplane accelerometer reading are presented in a single chart.

  16. The role of radiology in the Oklahoma City bombing.

    PubMed

    Nye, P J; Tytle, T L; Jarman, R N; Eaton, B G

    1996-08-01

    To evaluate the role of radiologic services in the assessment of injuries and identification of deceased victims of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City, Okla. In cooperation with the Oklahoma University Health Sciences Center Disaster Studies Group, all victims of the Oklahoma City bombing who were treated in hospitals were evaluated. All radiologic studies performed in these patients during a 4-week period after the bombing were recorded. Major injuries incurred by the victims were noted but were not documented. In addition, assistance provided by radiologic services to the medical examiner's office for identification of deceased victims was assessed. On the day of the bombing, 99% (480 of 485) of the imaging studies performed were either plain radiography, primarily of the extremities and chest, or computed tomography (CT), half of which were of the head. Six deceased victims were identified solely by means of characteristics on radiographs. Almost all bombing-related radiologic studies were either plain radiography or CT. Other modalities had only limited roles. In deceased victims, plain radiography aided identification, and in many other victims it allowed localization of materials that were potential pieces of evidence.

  17. Bomb Cyclones Of The Western North Atlantic

    NASA Astrophysics Data System (ADS)

    Adams, Ryan E.

    "Bomb" cyclones represent a small subset of mid-latitude cyclones characterized by rapid intensification and frequently are associated with extreme weather conditions along the eastern coast of North America. Like other extreme phenomena, bomb cyclone predictions are prone to error leading to inadequate or untimely hazard warnings. The rare nature of bomb cyclones and the uniqueness of their evolutions has made it difficult for researchers to make meaningful generalizations on bomb cyclone events. This paper describes bomb cyclone climatology for the western North Atlantic, using data from the NCEP-NCAR Reanalysis for 1948-2016, and uses a synoptic climatological analysis to relate these bombs to their associated atmospheric environments. A self-organizing map (SOM) of 300-hPa geopotential height tendency is created to partition the regional atmospheric environment. Thermodynamic fields are contrasted by each 300-hPa geopotential height tendency pattern for both bomb and non-bomb events in composite difference maps. The SOM patterns most significantly associated with western North Atlantic bomb cyclogenesis are characterized by both strongly and weakly negative height tendencies along the eastern United States. In both cases, these patterns exhibit strong meridional flow, a distinction marked by the weakening and breaking down of the polar vortex in the boreal Winter. The composite maps for each pattern show the mean differences in low-mid level ascent and near surface thermodynamics for bomb environments contrasted with non-bomb environments, resulting in diverse spatiotemporal distributions of bombs in the western North Atlantic.

  18. Increased pediatric functional neurological symptom disorders after the Boston marathon bombings: a case series.

    PubMed

    Guerriero, Réjean M; Pier, Danielle B; de Gusmão, Claudio M; Bernson-Leung, Miya E; Maski, Kiran P; Urion, David K; Waugh, Jeff L

    2014-11-01

    Functional neurological symptom disorders are frequently the basis for acute neurological consultation. In children, they are often precipitated by high-frequency everyday stressors. The extent to which a severe traumatic experience may also precipitate functional neurological abnormalities is unknown. For the 2-week period after the Boston Marathon bombings, we prospectively collected data on patients whose presentation suggested a functional neurological symptom disorder. We assessed clinical and demographic variables, duration of symptoms, extent of educational impact, and degree of connection to the Marathon bombing. We contacted all patients at 6 months after presentation to determine the outcome and accuracy of the diagnosis. In a parallel study, we reported a baseline of 2.6 functional neurological presentations per week in our emergency room. In the week after the Marathon bombings, this frequency tripled. Ninety-one percent of presentations were delayed by 1 week, with onset around the first school day after a city-wide lockdown. Seventy-three percent had a history of a prior psychiatric diagnosis. At the 6 months follow-up, no functional neurological symptom disorder diagnoses were overturned and no new organic diagnosis was made. Pediatric functional neurological symptom disorder may be precipitated by both casual and high-intensity stressors. The 3.4-fold increase in incidence after the Boston Marathon bombings and city-wide lockdown demonstrates the marked effect that a community-wide tragedy can have on the mental health of children. Care providers must be aware of functional neurological symptom disorders after stressful community events in vulnerable patient populations, particularly those with prior psychiatric diagnoses. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital.

    PubMed

    Magaji, Bello Arkilla; Moy, Foong Ming; Roslani, April Camilla; Law, Chee Wei

    2017-05-18

    Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. It is the second most common cancer among both males and females in Malaysia. The economic burden of colorectal cancer is likely to increase over time owing to its current trend and aging population. Cancer survival analysis is an essential indicator for early detection and improvement in cancer treatment. However, there was a scarcity of studies concerning survival of colorectal cancer patients as well as its predictors. Therefore, we aimed to determine the 1-, 3- and 5-year survival rates, compare survival rates among ethnic groups and determine the predictors of survival among colorectal cancer patients. This was an ambidirectional cohort study conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia. All Malaysian citizens or permanent residents with histologically confirmed diagnosis of colorectal cancer seen at UMMC from 1 January 2001 to 31 December 2010 were included in the study. Demographic and clinical characteristics were extracted from the medical records. Patients were followed-up until death or censored at the end of the study (31st December 2010). Censored patients' vital status (whether alive or dead) were cross checked with the National Registration Department. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Log-rank test was used to compare the survival rates, while Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival. Among 1212 patients, the median survival for colorectal, colon and rectal cancers were 42.0, 42.0 and 41.0 months respectively; while the 1-, 3-, and 5-year relative survival rates ranged from 73.8 to 76.0%, 52.1 to 53.7% and 40.4 to 45.4% respectively. The Chinese patients had the lowest 5-year survival compared to Malay and Indian patients. Based on the 814

  20. Bombings specific triage (Bost Tool) tool and its application by healthcare professionals.

    PubMed

    Sanjay, Jaiswal; Ankur, Verma; Tamorish, Kole

    2015-01-01

    Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80%) with triage tool performed better in triaging the bomb blast victims than group A (50%) without the bombing specific triage tool performed. Development of bombing specific triage tool can reduce under triaging.

  1. Bombings specific triage (Bost Tool) tool and its application by healthcare professionals

    PubMed Central

    Sanjay, Jaiswal; Ankur, Verma; Tamorish, Kole

    2015-01-01

    BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to “wrong triage” in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. RESULTS: By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80%) with triage tool performed better in triaging the bomb blast victims than group A (50%) without the bombing specific triage tool performed. CONCLUSION: Development of bombing specific triage tool can reduce under triaging. PMID:26693264

  2. Are IRIS Bombs Connected to Ellerman Bombs?

    NASA Astrophysics Data System (ADS)

    Tian, Hui; Xu, Zhi; He, Jiansen; Madsen, Chad

    2016-06-01

    Recent observations by the Interface Region Imaging Spectrograph (IRIS) have revealed pockets of hot gas (˜2-8 × 104 K) potentially resulting from magnetic reconnection in the partially ionized lower solar atmosphere (IRIS bombs; IBs). Using joint observations between IRIS and the Chinese New Vacuum Solar Telescope, we have identified 10 IBs. We find that 3 are unambiguously and 3 others are possibly connected to Ellerman bombs (EBs), which show intense brightening of the extended {{{H}}}α wings without leaving an obvious signature in the {{{H}}}α core. These bombs generally reveal the following distinct properties: (1) the O IV 1401.156 Å and 1399.774 Å lines are absent or very weak; (2) the Mn I 2795.640 Å line manifests as an absorption feature superimposed on the greatly enhanced Mg II k line wing; (3) the Mg II k and h lines show intense brightening in the wings and no dramatic enhancement in the cores; (4) chromospheric absorption lines such as Ni II 1393.330 Å and 1335.203 Å are very strong; and (5) the 1700 Å images obtained with the Atmospheric Imaging Assembly on board the Solar Dynamics Observatory reveal intense and compact brightenings. These properties support the formation of these bombs in the photosphere, demonstrating that EBs can be heated much more efficiently than previously thought. We also demonstrate that the Mg II k and h lines can be used to investigate EBs similarly to {{{H}}}α , which opens a promising new window for EB studies. The remaining four IBs obviously have no connection to EBs and they do not have the properties mentioned above, suggesting a higher formation layer, possibly in the chromosphere.

  3. Atomic Bomb Health Benefits

    PubMed Central

    Luckey, T. D.

    2008-01-01

    Media reports of deaths and devastation produced by atomic bombs convinced people around the world that all ionizing radiation is harmful. This concentrated attention on fear of miniscule doses of radiation. Soon the linear no threshold (LNT) paradigm was converted into laws. Scientifically valid information about the health benefits from low dose irradiation was ignored. Here are studies which show increased health in Japanese survivors of atomic bombs. Parameters include decreased mutation, leukemia and solid tissue cancer mortality rates, and increased average lifespan. Each study exhibits a threshold that repudiates the LNT dogma. The average threshold for acute exposures to atomic bombs is about 100 cSv. Conclusions from these studies of atomic bomb survivors are: One burst of low dose irradiation elicits a lifetime of improved health.Improved health from low dose irradiation negates the LNT paradigm.Effective triage should include radiation hormesis for survivor treatment. PMID:19088902

  4. Atomic bomb health benefits.

    PubMed

    Luckey, T D

    2008-01-01

    Media reports of deaths and devastation produced by atomic bombs convinced people around the world that all ionizing radiation is harmful. This concentrated attention on fear of miniscule doses of radiation. Soon the linear no threshold (LNT) paradigm was converted into laws. Scientifically valid information about the health benefits from low dose irradiation was ignored. Here are studies which show increased health in Japanese survivors of atomic bombs. Parameters include decreased mutation, leukemia and solid tissue cancer mortality rates, and increased average lifespan. Each study exhibits a threshold that repudiates the LNT dogma. The average threshold for acute exposures to atomic bombs is about 100 cSv. Conclusions from these studies of atomic bomb survivors are: One burst of low dose irradiation elicits a lifetime of improved health.Improved health from low dose irradiation negates the LNT paradigm.Effective triage should include radiation hormesis for survivor treatment.

  5. Suicide bombing attacks: update and modifications to the protocol.

    PubMed

    Almogy, Gidon; Belzberg, Howard; Mintz, Yoaz; Pikarsky, Alon K; Zamir, Gideon; Rivkind, Avraham I

    2004-03-01

    To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks. The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects. The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003. Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns. The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities.

  6. Wind-Tunnel Investigation of the Effects on the Aerodynamic Characteristics of Modifications to a Model of a Bomb Mounted on a Wing-Fuselage Model and to a Model of the Bomb Alone

    NASA Technical Reports Server (NTRS)

    King, Thomas J., Jr.

    1954-01-01

    An investigation was conducted in the Langley high-speed 7- by 10-foot tunnel to determine effects of modifications to a bomb model (particularly with regard to drag) when mounted on a wing-fuselage model and tested at Mach numbers from 0.70 to 1.10. In addition, the static longitudinal stability characteristics of several configurations of a larger scale model of the bomb alone were obtained over a Mach number range from 0.50 to 0.95. The results obtained for the wing-fuselage-bomb model indicate that large reductions in installation drag were obtained for the wing-fuselage-bomb model when the flat nose of the basic bomb was replaced by rounded or pointed noses of various calibers. Shortening the mounting pylon gave further decreases in the installation drag. The tests of the bomb alone indicated that only the flat-nose configurations were stable over the greater part of the Mach number range. Nose-shape modifications which improved the drag also caused the bombs to become unstable at low angles of attack. The stability of the low-drag bomb configurations could be improved by lengthening the cylindrical portion of the body behind the center of gravity.

  7. Mortality in the Children of Atomic Bomb Survivors and Controls

    PubMed Central

    Neel, James V.; Kato, Hiroo; Schull, William J.

    1974-01-01

    A continuing study of mortality rates among children born to survivors of the atomic bombings and a suitable group of controls has been updated; the average interval between birth and verification of death or survival is 17 years. The mortality experience is now based on 18,946 children liveborn to parents one or both of whom were proximally exposed, receiving jointly an estimated dose of 117 rem; 16,516 children born to distally exposed parents receiving essentially no radiation; and 17,263 children born to parents not in Hiroshima or Nagasaki at the time of the bombings. No clearly significant effect of parental exposure on child's survival can be demonstrated either by a contingency χ2 type of analysis or regression analysis. On the basis of the regression data, the minimal gametic doubling dose of radiation of this type for mutations resulting in death during (on the average) the first 17 years of life among liveborn infants conceived 0–13 years after parental exposure is estimated at 46 rem for fathers and 125 rem for mothers. On the basis of experimental data, the gametic doubling dose for chronic, low-level radiation would be expected to be three to four times this value for males and as much as 1000 rem for females. PMID:4822470

  8. Korean atomic bomb victims.

    PubMed

    Sasamoto, Yukuo

    2009-01-01

    After colonizing Korea, Japan invaded China, and subsequently initiated the Pacific War against the United States, Britain, and their allies. Towards the end of the war, U.S. warplanes dropped atomic bombs on Hiroshima and Nagasaki, which resulted in a large number of Koreans who lived in Hiroshima and Nagasaki suffering from the effects of the bombs. The objective of this paper is to examine the history of Korea atomic bomb victims who were caught in between the U.S., Japan, the Republic of Korea (South Korea) and the Democratic People's Republic of Korea (North Korea).

  9. Thyroid Dysfunction and Autoimmune Thyroid Diseases Among Atomic Bomb Survivors Exposed in Childhood.

    PubMed

    Imaizumi, Misa; Ohishi, Waka; Nakashima, Eiji; Sera, Nobuko; Neriishi, Kazuo; Yamada, Michiko; Tatsukawa, Yoshimi; Takahashi, Ikuno; Fujiwara, Saeko; Sugino, Keizo; Ando, Takao; Usa, Toshiro; Kawakami, Atsushi; Akahoshi, Masazumi; Hida, Ayumi

    2017-07-01

    The risk of thyroid cancer increases and persists for decades among individuals exposed to ionizing radiation in childhood, although the long-term effects of childhood exposure to medium to low doses of radiation on thyroid dysfunction and autoimmune thyroid diseases have remained unclear. To evaluate radiation dose responses for the prevalence of thyroid dysfunction and autoimmune thyroid disease among atomic bomb survivors exposed in childhood. Hiroshima and Nagasaki atomic bomb survivors who were younger than 10 years old at exposure underwent thyroid examinations at the Radiation Effects Research Foundation between 2007 and 2011, which was 62 to 66 years after the bombing. Data from 2668 participants (mean age, 68.2 years; 1455 women) with known atomic bomb thyroid radiation doses (mean dose, 0.182 Gy; dose range, 0 to 4.040 Gy) were analyzed. Dose-response relationships between atomic bomb radiation dose and the prevalence of hypothyroidism, hyperthyroidism (Graves' disease), and positive for antithyroid antibodies. Prevalences were determined for hypothyroidism (129 cases, 7.8%), hyperthyroidism (32 cases of Graves' disease, 1.2%), and positive for antithyroid antibodies (573 cases, 21.5%). None of these was associated with thyroid radiation dose. Neither thyroid antibody-positive nor -negative hypothyroidism was associated with thyroid radiation dose. Additional analyses using alternative definitions of hypothyroidism and hyperthyroidism found that radiation dose responses were not significant. Radiation effects on thyroid dysfunction and autoimmune thyroid diseases were not observed among atomic bomb survivors exposed in childhood, at 62 to 66 years earlier. The cross-sectional design and survival bias were limitations of this study. Copyright © 2017 Endocrine Society

  10. Surgical resource utilization in urban terrorist bombing: a computer simulation.

    PubMed

    Hirshberg, A; Stein, M; Walden, R

    1999-09-01

    The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

  11. Reactions of Oklahoma City bombing survivors to media coverage of the September 11, 2001, attacks.

    PubMed

    Pfefferbaum, Betty; Nitiéma, Pascal; Pfefferbaum, Rose L; Houston, J Brian; Tucker, Phebe; Jeon-Slaughter, Haekyung; North, Carol S

    2016-02-01

    This study explored the effects of media coverage of a terrorist incident in individuals remote from the location of a major attack who had directly experienced a prior terrorist incident. Directly-exposed survivors of the 1995 Oklahoma City bombing, initially studied six months after the incident, and indirectly-affected Oklahoma City community residents were assessed two to seven months after the September 11, 2001, attacks. Survivors were assessed for a diagnosis of bombing-related posttraumatic stress disorder (PTSD) at index and follow up, and emotional reactions and September 11 media behavior were assessed in all participants. Among the three investigated forms of media (television, radio, and newspaper), only television viewing was associated with 9/11-related posttraumatic stress reactions. Exposure to the Oklahoma City bombing was associated with greater arousal in relation to the September 11 attacks, and among survivors, having developed bombing-related PTSD was associated with higher scores on all three September 11 posttraumatic stress response clusters (intrusion, avoidance, and arousal). Although time spent watching television coverage of the September 11 attacks and fear-related discontinuation of media contact were not associated with Oklahoma City bombing exposure, discontinuing September 11 media contact due to fear was associated with avoidance/numbing in the full sample and in the analysis restricted to the bombing survivors. Surviving a prior terrorist incident and developing PTSD in relation to that incident may predispose individuals to adverse reactions to media coverage of a future terrorist attack. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. The concept and science process skills analysis in bomb calorimeter experiment as a foundation for the development of virtual laboratory of bomb calorimeter

    NASA Astrophysics Data System (ADS)

    Kurniati, D. R.; Rohman, I.

    2018-05-01

    This study aims to analyze the concepts and science process skills in bomb calorimeter experiment as a basis for developing the virtual laboratory of bomb calorimeter. This study employed research and development method (R&D) to gain the answer to the proposed problems. This paper discussed the concepts and process skills analysis. The essential concepts and process skills associated with bomb calorimeter are analyze by optimizing the bomb calorimeter experiment. The concepts analysis found seven fundamental concepts to be concerned in developing the virtual laboratory that are internal energy, burning heat, perfect combustion, incomplete combustion, calorimeter constant, bomb calorimeter, and Black principle. Since the concept of bomb calorimeter, perfect and incomplete combustion created to figure out the real situation and contain controllable variables, in virtual the concepts displayed in the form of simulation. Meanwhile, the last four concepts presented in the form of animation because no variable found to be controlled. The process skills analysis detect four notable skills to be developed that are ability to observe, design experiment, interpretation, and communication skills.

  13. The Bali bombing: civilian aeromedical evacuation.

    PubMed

    Tran, Minh D; Garner, Alan A; Morrison, Ion; Sharley, Peter H; Griggs, William M; Xavier, Colin

    2003-10-06

    After the Bali bombing on 12 October 2002, many injured Australians required evacuation to Darwin, and then to burns units around Australia. Many patients were evacuated from Denpasar by Qantas, with assistance from staff of civilian medical retrieval services. The transport of patients from Darwin to specialist burns units involved a coordinated response of civilian and military services. Some issues in responding to such disasters were identified, and a national coordinating network could improve future responses.

  14. Age at exposure and attained age variations of cancer risk in the Japanese A-bomb and radiotherapy cohorts.

    PubMed

    Schneider, Uwe; Walsh, Linda

    2015-08-01

    Phenomenological risk models for radiation-induced cancer are frequently applied to estimate the risk of radiation-induced cancers at radiotherapy doses. Such models often include the effect modification, of the main risk to radiation dose response, by age at exposure and attained age. The aim of this paper is to compare the patterns in risk effect modification by age, between models obtained from the Japanese atomic-bomb (A-bomb) survivor data and models for cancer risks previously reported for radiotherapy patients. Patterns in risk effect modification by age from the epidemiological studies of radiotherapy patients were also used to refine and extend the risk effect modification by age obtained from the A-bomb survivor data, so that more universal models can be presented here. Simple log-linear and power functions of age for the risk effect modification applied in models of the A-bomb survivor data are compared to risks from epidemiological studies of second cancers after radiotherapy. These functions of age were also refined and fitted to radiotherapy risks. The resulting age models provide a refined and extended functional dependence of risk with age at exposure and attained age especially beyond 40 and 65 yr, respectively, and provide a better representation than the currently available simple age functions. It was found that the A-bomb models predict risk similarly to the outcomes of testicular cancer survivors. The survivors of Hodgkin's disease show steeper variations of risk with both age at exposure and attained age. The extended models predict solid cancer risk increase as a function of age at exposure beyond 40 yr and the risk decrease as a function of attained age beyond 65 yr better than the simple models. The standard functions for risk effect modification by age, based on the A-bomb survivor data, predict second cancer risk in radiotherapy patients for ages at exposure prior to 40 yr and attained ages before 55 yr reasonably well. However, for

  15. Survival of high-risk pediatric neuroblastoma patients in a developing country.

    PubMed

    Easton, Joseph C; Gomez, Sergio; Asdahl, Peter H; Conner, J Michael; Fynn, Alcira B; Ruiz, Claudia; Ojha, Rohit P

    2016-09-01

    Little information is available about survival of high-risk pediatric neuroblastoma patients in developing countries. We aimed to assess survival among high-risk pediatric neuroblastoma patients in La Plata, Argentina. Individuals eligible for our cohort were aged <20 yr when diagnosed with high-risk neuroblastoma and received cancer-directed therapy including stem cell transplantation at Hospital de Niños Sor Maria Ludovica between February 1999 and February 2015. We estimated overall survival probabilities using an extended Kaplan-Meier approach. Our study population comprised 39 high-risk neuroblastoma patients, of whom 39% were aged >4 yr at diagnosis, 54% were male, and 62% had adrenal neuroblastoma. We observed 18 deaths, and the median survival time of our study population was 1.7 yr. The five-yr overall survival probability was 24% (95% CL: 10%, 41%). In contrast, five-yr survival of high-risk neuroblastoma patients ranges between 23% and 76% in developed countries. Survival among high-risk neuroblastoma patients is generally poor regardless of geographic location, but our results illustrate dramatically worse survival for patients in a developing country. We speculate that the observed survival differences could be attenuated or eliminated with improvements in treatment and supportive care, but addressing these issues will require creative solutions because of resource limitations. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Red China’s Capitalist Bomb: Inside the Chinese Neutron Bomb Program

    DTIC Science & Technology

    2015-01-01

    developed an enhanced radiation weapon (ERW) but did not deploy it. ERWs, better known as “ neutron bombs,” are specialized nuclear weapons with...contemporary systems of concern. An ERW is a specialized nuclear weapon optimized to produce prompt radiation. Such a device emits neutrons with high...Council stated that China mastered “in succession the neutron bomb design technology and the nuclear weapon miniaturization technology.”10 This statement

  17. Automatic behavior sensing for a bomb-detecting dog

    NASA Astrophysics Data System (ADS)

    Nguyen, Hoa G.; Nans, Adam; Talke, Kurt; Candela, Paul; Everett, H. R.

    2015-05-01

    Bomb-detecting dogs are trained to detect explosives through their sense of smell and often perform a specific behavior to indicate a possible bomb detection. This behavior is noticed by the dog handler, who confirms the probable explosives, determines the location, and forwards the information to an explosive ordnance disposal (EOD) team. To improve the speed and accuracy of this process and better integrate it with the EOD team's robotic explosive disposal operation, SPAWAR Systems Center Pacific has designed and prototyped an electronic dog collar that automatically tracks the dog's location and attitude, detects the indicative behavior, and records the data. To account for the differences between dogs, a 5-minute training routine can be executed before the mission to establish initial values for the k-mean clustering algorithm that classifies a specific dog's behavior. The recorded data include GPS location of the suspected bomb, the path the dog took to approach this location, and a video clip covering the detection event. The dog handler reviews and confirms the data before it is packaged up and forwarded on to the EOD team. The EOD team uses the video clip to better identify the type of bomb and for awareness of the surrounding environment before they arrive at the scene. Before the robotic neutralization operation commences at the site, the location and path data (which are supplied in a format understandable by the next-generation EOD robots—the Advanced EOD Robotic System) can be loaded into the robotic controller to automatically guide the robot to the bomb site. This paper describes the project with emphasis on the dog-collar hardware, behavior-classification software, and feasibility testing.

  18. 68Ga/177Lu-NeoBOMB1, a Novel Radiolabeled GRPR Antagonist for Theranostic Use in Oncology.

    PubMed

    Dalm, Simone U; Bakker, Ingrid L; de Blois, Erik; Doeswijk, Gabriela N; Konijnenberg, Mark W; Orlandi, Francesca; Barbato, Donato; Tedesco, Mattia; Maina, Theodosia; Nock, Berthold A; de Jong, Marion

    2017-02-01

    Because overexpression of the gastrin-releasing peptide receptor (GRPR) has been reported on various cancer types, for example, prostate cancer and breast cancer, targeting this receptor with radioligands might have a significant impact on staging and treatment of GRPR-expressing tumors. NeoBOMB1 is a novel DOTA-coupled GRPR antagonist with high affinity for GRPR and excellent in vivo stability. The purpose of this preclinical study was to further explore the use of NeoBOMB1 for theranostic application by determining the biodistribution of 68 Ga-NeoBOMB1 and 177 Lu-NeoBOMB1. PC-3 tumor-xenografted BALB/c nu/nu mice were injected with either approximately 13 MBq/250 pmol 68 Ga-NeoBOMB1 or a low (∼1 MBq/200 pmol) versus high (∼1 MBq/10 pmol) peptide amount of 177 Lu-NeoBOMB1, after which biodistribution and imaging studies were performed. At 6 time points (15, 30, 60, 120, 240, and 360 min for 68 Ga-NeoBOMB1 and 1, 4, 24, 48, 96, and 168 h for 177 Lu-NeoBOMB1) postinjection tumor and organ uptake was determined. To assess receptor specificity, additional groups of animals were coinjected with an excess of unlabeled NeoBOMB1. Results of the biodistribution studies were used to determine pharmacokinetics and dosimetry. Furthermore, PET/CT and SPECT/MRI were performed. Injection of approximately 250 pmol 68 Ga-NeoBOMB1 resulted in a tumor and pancreas uptake of 12.4 ± 2.3 and 22.7 ± 3.3 percentage injected dose per gram (%ID/g) of tissue, respectively, at 120 min after injection. 177 Lu-NeoBOMB1 biodistribution studies revealed a higher tumor uptake (17.9 ± 3.3 vs. 11.6 ± 1.3 %ID/g of tissue at 240 min after injection) and a lower pancreatic uptake (19.8 ± 6.9 vs. 105 ± 13 %ID/g of tissue at 240 min after injection) with the higher peptide amount injected, leading to a significant increase in the absorbed dose to the tumor versus the pancreas (200 pmol, 570 vs. 265 mGy/MBq; 10 pmol, 435 vs. 1393 mGy/MBq). Using these data to predict patient dosimetry, we found

  19. Medical consequences of terrorist bombs containing spherical metal pellets: analysis of a suicide terrorism event.

    PubMed

    Kluger, Yoram; Mayo, Ami; Hiss, Jehuda; Ashkenazi, Eitamar; Bendahan, Jose; Blumenfeld, Amir; Michaelson, Moshe; Stein, Michael; Simon, Daniel; Schwartz, Ivan; Alfici, Ricardo

    2005-02-01

    Various metal objects added to explosives increase and diversify the wounding from bombing; especially favoured are spherical missiles for their special injuring characteristics. Our objective was to study the medical consequences and ballistic effects on human tissue of spherical metal pellets used in terrorist bombings. The clinical and forensic data of all bodily injured casualties of a suicide terrorist bombing in a crowded hotel dining room were analysed retrospectively. Of the 250 people at the scene, 164 were injured, with 91 (55.5%) suffering bodily injuries; 30 of them died. The immediately deceased had disseminated tissue damage and their bodies were saturated with steel spheres. Thirty-two immediate survivors sustained severe injuries (Injury Severity Score > or =16), and all suffered tissue penetration by the pellets. Twenty-three (32%) underwent surgery and 15 (21%) required intensive care. Metal pellets propelled by the explosion enhanced the secondary pattern of injury and injured even patients remote from the origin. Tissue destruction and specific organ injuries among survivors were limited. To evaluate and manage victims of terrorist bombings properly, medical teams should become familiar with these severe injuries.

  20. Prophylaxis for blood-borne diseases during the London 7/7 mass casualty terrorist bombing: a review and the role of bioethics.

    PubMed

    Edwards, Dafydd S; Barnett-Vanes, A; Narayan, N; Patel, H D L

    2016-10-01

    The suicide bombings in London on 7 July 2005 resulted in a mass casualty situation. Over 50% of casualties were treated at the Royal London Hospital where clinicians witnessed large numbers of severely injured patients. In some casualties human biological foreign material was found embedded in the soft tissue originating from the suicide bombers or other casualties. This had the potential of placing individuals at risk of transmission of blood-borne diseases. Advances in the fields of medicine and biology have led to increased survivorship in the context of trauma and mass casualty incidents. This has resulted in the emergence of ethical scenarios surrounding patient management. A systematic review of the literature of the 7/7 bombings, and suicide bombings reported globally, where biological implantation is noted, was performed to examine the medicolegal issues arising during such attack. Twelve casualties with human tissue implanted were recorded in the 7/7 bombings. While all patients at risk were given prophylaxis based on recommendations by the Health Protection Agency, several ethical considerations surfaced as a result. In this paper, we compare the sequence of events and the management process of the victims of the 7/7 bombings and the evidence-based research regarding blood-borne infection transmission. Furthermore, it explores the ethical dilemmas, experienced by the senior author on 7/7, surrounding prophylaxis for blood-borne diseases and protocols to avoid confusion over best practice in future bombing incidents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Systems, Shocks and Time Bombs

    NASA Astrophysics Data System (ADS)

    Winder, Nick

    The following sections are included: * Introduction * Modelling strategies * Are time-bomb phenomena important? * Heuristic approaches to time-bomb phenomena * Three rational approaches to TBP * Two irrational approaches * Conclusions * References

  2. A prospective study of long-term health outcomes among Oklahoma City bombing survivors.

    PubMed

    Shariat, S; Mallonee, S; Kruger, E; Farmer, K; North, C

    1999-04-01

    A follow-up study was conducted to identify long-term physical and emotional outcomes among Oklahoma City bombing survivors. Baseline data were gathered by the Oklahoma State Department of Health in 1995. Follow-up data were gathered by telephone interviews of survivors from 1-1/2 to 3 years after the bombing. The frequency of medical diagnoses, symptoms, medical cost, physical and social life changes, and services utilized since the bombing were assessed. A total of 494 persons were interviewed, 92 percent had been physically injured in the bombing. Seventy-nine percent of persons interviewed rated their general health status as "good," "very good," or "excellent." Overall, one-fourth to one-third of survivors reported being newly diagnosed with audiologic changes, anxiety, and depression since the bombing. One-third of persons reported preexisting medical conditions that had worsened since the bombing including depression (26%) and asthma/bronchitis (22%). The most frequently reported posttraumatic stress disorder symptoms were "being jumpy or easily startled" and "recurring distressful thoughts of the bombing." The most frequently utilized medical services were psychological counseling (63%) and audiology services (48%). Total costs were estimated of $ 5.7 million. Overall, persons who had been hospitalized with bombing injuries reported higher rates of diagnoses, symptoms, and services utilization. These findings suggest that a large proportion of survivors of a terrorist bombing, especially those seriously injured, will experience long-term physical and/or emotional outcomes and increased need for treatment for bombing-related medical conditions. All survivors should be carefully assessed over time for auditory damage, depression, anxiety, and posttraumatic stress disorder.

  3. Should We Let the Bomb Spread

    DTIC Science & Technology

    2016-11-01

    in national security policy formulation. iii v Strategic Studies Institute and U.S. Army War College Press SHOULD WE LET THE BOMB SPREAD? Henry D...the Bomb Don’t Think “More Is Better”..............25 W. Seth Carus 3. “At All Costs”: The Destructive Consequences of Anti-Proliferation Policy...In 1966, Leonard Beaton, a journalist and strategic scholar, published a short book that asked: Must the bomb spread?1 Mr. Beaton’s query

  4. Air pollution taking an intercontinental express highway in a bomb

    NASA Astrophysics Data System (ADS)

    Stohl, A.; Huntrieser, H.; Richter, A.; Beirle, S.; Cooper, O.; Eckhardt, S.; Forster, C.; James, P.; Spichtinger, N.; Wagner, T.

    2003-04-01

    Intercontinental transport (ICT) of trace substances normally occurs on timescales ranging from a few days to several weeks. In this paper we present an extraordinary episode, where pollution transport from North America to Europe took only one day. The transport mechanism in this case was exceptional, as it involved an explosively generated cyclone, a so-called meteorological bomb. To our knowledge, this is the first study describing pollution transport in a bomb. The discovery of this event was based on transport model calculations and satellite measurements of NO_2, a species with a relatively short lifetime in the atmosphere, which could be transported that far only because of the high wind speeds produced by the bomb. Since about 50 bomb events per year occur in the Northern Hemisphere, most of them downstream of Asia and North America, there is possibly some climatological relevance of this transport mechanism for the global re-distribution of air pollution, particularly of short-lived species.

  5. Age at exposure and attained age variations of cancer risk in the Japanese A-bomb and radiotherapy cohorts

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Schneider, Uwe, E-mail: uwe.schneider@uzh.ch; Walsh, Linda

    Purpose: Phenomenological risk models for radiation-induced cancer are frequently applied to estimate the risk of radiation-induced cancers at radiotherapy doses. Such models often include the effect modification, of the main risk to radiation dose response, by age at exposure and attained age. The aim of this paper is to compare the patterns in risk effect modification by age, between models obtained from the Japanese atomic-bomb (A-bomb) survivor data and models for cancer risks previously reported for radiotherapy patients. Patterns in risk effect modification by age from the epidemiological studies of radiotherapy patients were also used to refine and extend themore » risk effect modification by age obtained from the A-bomb survivor data, so that more universal models can be presented here. Methods: Simple log-linear and power functions of age for the risk effect modification applied in models of the A-bomb survivor data are compared to risks from epidemiological studies of second cancers after radiotherapy. These functions of age were also refined and fitted to radiotherapy risks. The resulting age models provide a refined and extended functional dependence of risk with age at exposure and attained age especially beyond 40 and 65 yr, respectively, and provide a better representation than the currently available simple age functions. Results: It was found that the A-bomb models predict risk similarly to the outcomes of testicular cancer survivors. The survivors of Hodgkin’s disease show steeper variations of risk with both age at exposure and attained age. The extended models predict solid cancer risk increase as a function of age at exposure beyond 40 yr and the risk decrease as a function of attained age beyond 65 yr better than the simple models. Conclusions: The standard functions for risk effect modification by age, based on the A-bomb survivor data, predict second cancer risk in radiotherapy patients for ages at exposure prior to 40 yr and attained

  6. Future population of atomic bomb survivors in Nagasaki.

    PubMed

    Yokota, Kenichi; Mine, Mariko; Shibata, Yoshisada

    2013-01-01

    The Nagasaki University Atomic Bomb Survivor Database, which was established in 1978 for elucidating the long-term health effects of the atomic bombing, has registered since 1970 about 120,000 atomic bomb survivors with a history of residence in Nagasaki city. Since the number of atomic bomb survivors has steadily been decreasing, prediction of future population is important for planning future epidemiologic studies, and we tried to predict the population of atomic bomb survivors in Nagasaki city from 2008 to 2030. In addition, we evaluated our estimated population comparing with the actual number from 2008 to 2011.

  7. Characteristic miR-24 Expression in Gastric Cancers among Atomic Bomb Survivors.

    PubMed

    Naito, Yutaka; Oue, Naohide; Pham, Trang T B; Yamamoto, Manabu; Fujihara, Megumu; Ishida, Teruyoshi; Mukai, Shoichiro; Sentani, Kazuhiro; Sakamoto, Naoya; Hida, Eisuke; Sasaki, Hiroki; Yasui, Wataru

    2015-01-01

    To elucidate the mechanism of radiation-induced cancers, we analyzed the expression profiles of microRNAs extracted from formalin-fixed paraffin-embedded (FFPE) gastric cancer (GC) tissue samples from atomic bomb survivors. The expression levels of miR-21, miR-24, miR-34a, miR-106a, miR-143, and miR-145 were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The expression of microRNAs was measured by qRT-PCR in a Hiroshima University Hospital cohort comprising 32 patients in the high-dose-exposed group and 18 patients in the low-dose-exposed group who developed GC after the bombing. The GC cases showing high expression of miR-24, miR-143, and miR-145 were more frequently found in the high-dose-exposed group than in the low-dose-exposed group. We next performed qRT-PCR of miR-24, miR-143, and miR-145 in a cohort from the Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital comprising 122 patients in the high-dose-exposed group and 48 patients in the low-dose-exposed group who developed GC after the bombing. High expressions of miR-24 and miR-143 were more frequently found in the high-dose-exposed group than in the low-dose-exposed group. Multivariate analysis demonstrated that only high expression of miR-24 was an independent predictor for the exposure status. These results suggest that the measurement of miR-24 expression from FFPE samples is useful to identify radiation-associated GC.

  8. The toxicology of zinc chloride smoke producing bombs and screens.

    PubMed

    El Idrissi, Ayman; van Berkel, Lisanne; Bonekamp, Nadia E; Dalemans, Diana J Z; van der Heyden, Marcel A G

    2017-03-01

    Zinc chloride (ZnCl 2 )-based smoke bombs and screens are in use since the Second World War (1939-1945). Many case descriptions on ZnCl 2 smoke inhalation incidents appeared since 1945. We provide a comprehensive overview of the clinical symptoms and underlying pathophysiology due to exposure to fumes from ZnCl 2 smoke producing bombs. In addition, we give a historical overview of treatment regimens and their outcomes. We performed a literature search on Medline, Scopus and Google Scholar databases using combinations of the following search terms "smoke bomb", "smoke screen", "ZnCl 2 ", "intoxication", "poisoning", "case report", "HE smoke", "hexachloroethane smoke", "smoke inhalation" and "white smoke". We retrieved additional reports based on the primary hits. We collected 30 case reports from the last seven decades encompassing 376 patients, 23 of whom died. Of all the patient descriptions, 31 were of sufficient detail for prudent analysis. Intoxication with clinical signs mainly took place in war situations and in military and fire emergency training sessions in enclosed spaces. Symptoms follow a biphasic course mainly characterised by dyspnoea, coughing and lacrimation, related to irritation of the airways in the first six hours, followed by reappearance of early signs complemented with inflammation related signs and tachycardia from 24 h onwards. Acute respiratory stress syndrome developed in severely affected individuals. Chest radiographs did not always correspond with clinical symptoms. Common therapy comprises corticosteroids, antibiotics and supplemental oxygen or positive pressure ventilation in 64% of the cases. Of the 31 patients included, eight died, three had permanent lung damage and 15 showed complete recovery, whereas in five patients outcome was not reported. Early signs likely relate to caustic reactions in the airway lining, whereas inhaled ZnCl 2 particles may trigger an inflammatory response and associated delayed fibrotic lung damage

  9. Researching the Oklahoma City bombing.

    PubMed

    Piotrowski, C; Perdue, B

    1995-12-01

    The authors present a literature retrieval strategy for investigators who plan to conduct research on the Oklahoma City bombing. To facilitate a comprehensive review of the scholarly research on disasters, mass emergencies, and terrorism, a multidatabase search strategy is strongly encouraged. Secondly, a wealth of current information and data on the bombing are available on "popular" and "news" files.

  10. Surgery Increases Survival in Patients With Gastrinoma

    PubMed Central

    Norton, Jeffrey A.; Fraker, Douglas L.; Alexander, H R.; Gibril, Fathia; Liewehr, David J.; Venzon, David J.; Jensen, Robert T.

    2006-01-01

    Objective: To determine whether the routine use of surgical exploration for gastrinoma resection/cure in 160 patients with Zollinger-Ellison syndrome (ZES) altered survival compared with 35 ZES patients who did not undergo surgery. Summary Background Data: The role of routine surgical exploration for resection/cure in patients with ZES has been controversial since the original description of this disease in 1955. This controversy continues today, not only because medical therapy for acid hypersecretion is so effective, but also in large part because no studies have shown an effect of tumor resection on survival. Methods: Long-term follow-up of 160 ZES patients who underwent routine surgery for gastrinoma/resection/cure was compared with 35 patients who had similar disease but did not undergo surgery for a variety of reasons. All patients had preoperative CT, MRI, ultrasound; if unclear, angiography and somatostatin receptor scintigraphy since 1994 to determine resectability. At surgery, all had the same standard ZES operation. All patients were evaluated yearly with imaging studies and disease activity studies. Results: The 35 nonsurgical patients did not differ from the 160 operated in clinical, laboratory, or tumor imaging results. The 2 groups did not differ in follow-up time since initial evaluation (range, 11.8–12 years). At surgery, 94% had a tumor removed, 51% were cured immediately, and 41% at last follow-up. Significantly more unoperated patients developed liver metastases (29% vs. 5%, P = 0.0002), died of any cause (54 vs. 21%, P = 0.0002), or died a disease-related death (23 vs. 1%, P < 0.00001). Survival plots showed operated patients had a better disease-related survival (P = 0.0012); however, there was no difference in non-disease-related survival. Fifteen-year disease-related survival was 98% for operated and 74% for unoperated (P = 0.0002). Conclusions: These results demonstrate that routine surgical exploration increases survival in patients with

  11. Triggering soft bombs at the LHC

    NASA Astrophysics Data System (ADS)

    Knapen, Simon; Griso, Simone Pagan; Papucci, Michele; Robinson, Dean J.

    2017-08-01

    Very high multiplicity, spherically-symmetric distributions of soft particles, with p T ˜ few×100 MeV, may be a signature of strongly-coupled hidden valleys that exhibit long, efficient showering windows. With traditional triggers, such `soft bomb' events closely resemble pile-up and are therefore only recorded with minimum bias triggers at a very low efficiency. We demonstrate a proof-of-concept for a high-level triggering strategy that efficiently separates soft bombs from pile-up by searching for a `belt of fire': a high density band of hits on the innermost layer of the tracker. Seeding our proposed high-level trigger with existing jet, missing transverse energy or lepton hardware-level triggers, we show that net trigger efficiencies of order 10% are possible for bombs of mass several × 100 GeV. We also consider the special case that soft bombs are the result of an exotic decay of the 125 GeV Higgs. The fiducial rate for `Higgs bombs' triggered in this manner is marginally higher than the rate achievable by triggering directly on a hard muon from associated Higgs production.

  12. Low dose radiation risks for women surviving the a-bombs in Japan: generalized additive model.

    PubMed

    Dropkin, Greg

    2016-11-24

    Analyses of cancer mortality and incidence in Japanese A-bomb survivors have been used to estimate radiation risks, which are generally higher for women. Relative Risk (RR) is usually modelled as a linear function of dose. Extrapolation from data including high doses predicts small risks at low doses. Generalized Additive Models (GAMs) are flexible methods for modelling non-linear behaviour. GAMs are applied to cancer incidence in female low dose subcohorts, using anonymous public data for the 1958 - 1998 Life Span Study, to test for linearity, explore interactions, adjust for the skewed dose distribution, examine significance below 100 mGy, and estimate risks at 10 mGy. For all solid cancer incidence, RR estimated from 0 - 100 mGy and 0 - 20 mGy subcohorts is significantly raised. The response tapers above 150 mGy. At low doses, RR increases with age-at-exposure and decreases with time-since-exposure, the preferred covariate. Using the empirical cumulative distribution of dose improves model fit, and capacity to detect non-linear responses. RR is elevated over wide ranges of covariate values. Results are stable under simulation, or when removing exceptional data cells, or adjusting neutron RBE. Estimates of Excess RR at 10 mGy using the cumulative dose distribution are 10 - 45 times higher than extrapolations from a linear model fitted to the full cohort. Below 100 mGy, quasipoisson models find significant effects for all solid, squamous, uterus, corpus, and thyroid cancers, and for respiratory cancers when age-at-exposure > 35 yrs. Results for the thyroid are compatible with studies of children treated for tinea capitis, and Chernobyl survivors. Results for the uterus are compatible with studies of UK nuclear workers and the Techa River cohort. Non-linear models find large, significant cancer risks for Japanese women exposed to low dose radiation from the atomic bombings. The risks should be reflected in protection standards.

  13. Atmospheric rivers and bombs

    NASA Astrophysics Data System (ADS)

    Zhu, Yong; Newell, Reginald E.

    1994-09-01

    Filamentary structure is a common feature of atmospheric water vapor transport; the filaments may be termed “atmospheric rivers” because some carry as much water as the Amazon [Newell et al., 1992]. An extratropical cyclone whose central pressure fall averages at least 1 hPa hr-1 for 24 hours is known in meteorology as a “bomb” [Sanders and Gyakum, 1980]. We report here an association between rivers and bombs. When a cyclonic system is penetrated by a river, the cyclonic center moves to be close to the position occupied by the leading edge of the river twelve hours previously and the central pressure falls. If the river then moves away from the cyclone, the central pressure rises. Based on a pilot study of pressure fall and water vapor flux convergence for two winter months, the cause of the explosive deepening appears to be latent heat liberation. This is substantiated by composite maps of seven Atlantic and seven Pacific bombs which show that the flux convergence near the bomb center has a comma cloud signature. The observed association may be useful in forecasting 12-hour direction of motion and pressure change of rapidly developing cyclonic systems; the incorporation of better moisture data into numerical forecasting models may be the reason for the reported increase of skill in the prediction of bombs in recent years.

  14. Seismogram offers insight into Oklahoma City bombing

    NASA Astrophysics Data System (ADS)

    Holzer, Thomas L.; Fletcher, Joe B.; Fuis, Gary S.; Ryberg, Trond; Brocher, Thomas M.; Dietel, Christopher M.

    The terrorist bombing of the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995, generated seismic waves that were recorded on two permanent seismographs about 7 and 26 km away from the bombing. The seismogram recorded at 26 km shows two low-frequency wave trains, discrete sets of oscillatory signals, that begin about 10 s apart. Public release of this record prompted speculation that each wave train was caused by a different energy source. On May 23, 1995, the U.S. Geological Survey monitored the demolition of the bomb-ravaged Federal Building with portable seismographs (Figure 1). Two wave trains were picked up again. The recordings indicate that the wave trains during both the bombing and demolition represent seismic waves traveling at different velocities. We conclude that the two wave trains recorded during the bombing are consistent with a single impulsive energy source.

  15. Multiple neoplasms, single primaries, and patient survival

    PubMed Central

    Amer, Magid H

    2014-01-01

    Background Multiple primary neoplasms in surviving cancer patients are relatively common, with an increasing incidence. Their impact on survival has not been clearly defined. Methods This was a retrospective review of clinical data for all consecutive patients with histologically confirmed cancer, with emphasis on single versus multiple primary neoplasms. Second primaries discovered at the workup of the index (first) primary were termed simultaneous, if discovered within 6 months of the index primary were called synchronous, and if discovered after 6 months were termed metachronous. Results Between 2005 and 2012, of 1,873 cancer patients, 322 developed second malignancies; these included two primaries (n=284), and three or more primaries (n=38). Forty-seven patients had synchronous primaries and 275 had metachronous primaries. Patients with multiple primaries were predominantly of Caucasian ancestry (91.0%), with a tendency to develop thrombosis (20.2%), had a strong family history of similar cancer (22.3%), and usually presented with earlier stage 0 through stage II disease (78.9%). When compared with 1,551 patients with a single primary, these figures were 8.9%, 15.6%, 18.3%, and 50.9%, respectively (P≤0.001). Five-year survival rates were higher for metachronous cancers (95%) than for synchronous primaries (59%) and single primaries (59%). The worst survival rate was for simultaneous concomitant multiple primaries, being a median of 1.9 years. The best survival was for patients with three or more primaries (median 10.9 years) and was similar to the expected survival for the age-matched and sex-matched general population (P=0.06991). Conclusion Patients with multiple primaries are usually of Caucasian ancestry, have less aggressive malignancies, present at earlier stages, frequently have a strong family history of similar cancer, and their cancers tend to have indolent clinical behavior with longer survival rates, possibly related to genetic predisposition

  16. Survival is not enough: reflections of a long-term renal patient.

    PubMed

    Eady, Robin A J

    2008-01-01

    A kidney patient recalls his experience of almost 45 years of renal replacement therapy covering nearly 25 years of dialysis and 20 years with a transplant. At the beginning, patient or graft survival was a major goal and symbol of successful treatment. But for the patient, what really matters is the quality of his life, assuming he can survive.

  17. Emotional intelligence in the operating room: analysis from the Boston Marathon bombing.

    PubMed

    Chang, Beverly P; Vacanti, Joshua C; Michaud, Yvonne; Flanagan, Hugh; Urman, Richard D

    2014-01-01

    The Boston Marathon terrorist bombing that occurred on April 15, 2013 illustrates the importance of a cohesive, efficient management for the operating room and perioperative services. Conceptually, emotional intelligence (EI) is a form of social intelligence used by individuals in leadership positions to monitor the feelings and emotions of their team while implementing a strategic plan. To describe the experience of caring for victims of the bombing at a large tertiary care center and provide examples demonstrating the importance of EI and its role in the management of patient flow and overall care. A retrospective review of trauma data was performed. Data regarding patient flow, treatment types, treatment times, and outcomes were gathered from the hospital's electronic tracking system and subsequently analyzed. Analyses were performed to aggregate the data, identify trends, and describe the medical care. Immediately following the bombing, a total of 35 patients were brought to the emergency department (ED) with injuries requiring immediate medical attention. 10 of these patients went directly to the operating room on arrival to the hospital. The first victim was in an operating room within 21 minutes after arrival to the ED. The application of EI in managerial decisions helped to ensure smooth transitions for victims throughout all stages of their perioperative care. EI provided the fundamental groundwork that allowed the operating room manager and nurse leaders to establish the calm and coordinated leadership that facilitated patient care and teamwork.

  18. Survival analysis of heart failure patients: A case study.

    PubMed

    Ahmad, Tanvir; Munir, Assia; Bhatti, Sajjad Haider; Aftab, Muhammad; Raza, Muhammad Ali

    2017-01-01

    This study was focused on survival analysis of heart failure patients who were admitted to Institute of Cardiology and Allied hospital Faisalabad-Pakistan during April-December (2015). All the patients were aged 40 years or above, having left ventricular systolic dysfunction, belonging to NYHA class III and IV. Cox regression was used to model mortality considering age, ejection fraction, serum creatinine, serum sodium, anemia, platelets, creatinine phosphokinase, blood pressure, gender, diabetes and smoking status as potentially contributing for mortality. Kaplan Meier plot was used to study the general pattern of survival which showed high intensity of mortality in the initial days and then a gradual increase up to the end of study. Martingale residuals were used to assess functional form of variables. Results were validated computing calibration slope and discrimination ability of model via bootstrapping. For graphical prediction of survival probability, a nomogram was constructed. Age, renal dysfunction, blood pressure, ejection fraction and anemia were found as significant risk factors for mortality among heart failure patients.

  19. Characteristic expression of fukutin in gastric cancer among atomic bomb survivors.

    PubMed

    Pham, Trang T B; Oue, Naohide; Yamamoto, Manabu; Fujihara, Megumu; Ishida, Teruyoshi; Mukai, Shoichiro; Sakamoto, Naoya; Sentani, Kazuhiro; Yasui, Wataru

    2017-02-01

    Approximately 70 years have passed since the atomic bombs were dropped on Nagasaki and Hiroshima. To elucidate potential biomarkers and possible mechanisms of radiation-induced cancer, the expression of FKTN , which encodes fukutin protein and causes Fukuyama-type congenital muscular dystrophy, was analyzed in gastric cancer (GC) tissue samples from atomic bomb survivors. Expression of cluster of differentiation (CD) 10 was also evaluated, as it has previously been observed that positive fukutin expression was frequently noted in CD10-positive GC cases. In the first cohort from Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital (Hiroshima, Japan; n=92), 102 (53%) of the GC cases were positive for fukutin. Expression of fukutin was not associated with exposure status, but was associated with CD10 expression (P=0.0001). The second cohort was from Hiroshima University Hospital (Hiroshima, Japan; n=86), and these patients were also in the Life Span Study cohort, in which atomic bomb radiation doses were precisely estimated using the DS02 system. Expression of fukutin was detected in 58 (67%) of GC cases. GC cases positive for fukutin were observed more frequently in the low dose-exposed group than in the high dose-exposed group (P=0.0001). Further studies with a larger cohort, including precise radiation dose estimation, may aid in clarifying whether fukutin could serve as a potential biomarker to define radiation-induced GC in atomic-bomb survivors.

  20. Characteristic expression of fukutin in gastric cancer among atomic bomb survivors

    PubMed Central

    Pham, Trang T.B.; Oue, Naohide; Yamamoto, Manabu; Fujihara, Megumu; Ishida, Teruyoshi; Mukai, Shoichiro; Sakamoto, Naoya; Sentani, Kazuhiro; Yasui, Wataru

    2017-01-01

    Approximately 70 years have passed since the atomic bombs were dropped on Nagasaki and Hiroshima. To elucidate potential biomarkers and possible mechanisms of radiation-induced cancer, the expression of FKTN, which encodes fukutin protein and causes Fukuyama-type congenital muscular dystrophy, was analyzed in gastric cancer (GC) tissue samples from atomic bomb survivors. Expression of cluster of differentiation (CD) 10 was also evaluated, as it has previously been observed that positive fukutin expression was frequently noted in CD10-positive GC cases. In the first cohort from Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital (Hiroshima, Japan; n=92), 102 (53%) of the GC cases were positive for fukutin. Expression of fukutin was not associated with exposure status, but was associated with CD10 expression (P=0.0001). The second cohort was from Hiroshima University Hospital (Hiroshima, Japan; n=86), and these patients were also in the Life Span Study cohort, in which atomic bomb radiation doses were precisely estimated using the DS02 system. Expression of fukutin was detected in 58 (67%) of GC cases. GC cases positive for fukutin were observed more frequently in the low dose-exposed group than in the high dose-exposed group (P=0.0001). Further studies with a larger cohort, including precise radiation dose estimation, may aid in clarifying whether fukutin could serve as a potential biomarker to define radiation-induced GC in atomic-bomb survivors. PMID:28356981

  1. Improving identification of traumatic brain injury after nonmilitary bomb blasts.

    PubMed

    Rutland-Brown, Wesley; Langlois, Jean A; Bazarian, Jeffrey J; Warden, Deborah

    2008-01-01

    To improve identification of traumatic brain injury (TBI) in survivors of nonmilitary bomb blasts during the acute care phase. The Centers for Disease Control and Prevention convened a meeting of experts in TBI, emergency medicine, and disaster response to review the recent literature and make recommendations. Seven key recommendations were proposed: (1) increase TBI awareness among medical professionals; (2) encourage use of standard definitions and consistent terminology; (3) improve screening methods for TBI in the acute care setting; (4) clarify the distinction between TBI and acute stress disorder; (5) encourage routine screening of hospitalized trauma patients for TBI; (6) improve identification of nonhospitalized TBI patients; and (7) integrate the appropriate level of TBI identification into all-hazards mass casualty preparedness. By adopting these recommendations, the United States could be better prepared to identify and respond to TBI following future bombing events.

  2. Risk of myelodysplastic syndromes in people exposed to ionizing radiation: a retrospective cohort study of Nagasaki atomic bomb survivors.

    PubMed

    Iwanaga, Masako; Hsu, Wan-Ling; Soda, Midori; Takasaki, Yumi; Tawara, Masayuki; Joh, Tatsuro; Amenomori, Tatsuhiko; Yamamura, Masaomi; Yoshida, Yoshiharu; Koba, Takashi; Miyazaki, Yasushi; Matsuo, Tatsuki; Preston, Dale L; Suyama, Akihiko; Kodama, Kazunori; Tomonaga, Masao

    2011-02-01

    The risk of myelodysplastic syndromes (MDS) has not been fully investigated among people exposed to ionizing radiation. We investigate MDS risk and radiation dose-response in Japanese atomic bomb survivors. We conducted a retrospective cohort study by using two databases of Nagasaki atomic bomb survivors: 64,026 people with known exposure distance in the database of Nagasaki University Atomic-Bomb Disease Institute (ABDI) and 22,245 people with estimated radiation dose in the Radiation Effects Research Foundation Life Span Study (LSS). Patients with MDS diagnosed from 1985 to 2004 were identified by record linkage between the cohorts and the Nagasaki Prefecture Cancer Registry. Cox and Poisson regression models were used to estimate relationships between exposure distance or dose and MDS risk. There were 151 patients with MDS in the ABDI cohort and 47 patients with MDS in the LSS cohort. MDS rate increased inversely with exposure distance, with an excess relative risk (ERR) decay per km of 1.2 (95% CI, 0.4 to 3.0; P < .001) for ABDI. MDS risk also showed a significant linear response to exposure dose level (P < .001) with an ERR per Gy of 4.3 (95% CI, 1.6 to 9.5; P < .001). After adjustment for sex, attained age, and birth year, the MDS risk was significantly greater in those exposed when young. A significant linear radiation dose-response for MDS exists in atomic bomb survivors 40 to 60 years after radiation exposure. Clinicians should perform careful long-term follow-up of irradiated people to detect MDS as early as possible.

  3. Ookinete-induced midgut peroxidases detonate the time bomb in anopheline mosquitoes.

    PubMed

    Kumar, Sanjeev; Barillas-Mury, Carolina

    2005-07-01

    Previous analysis of the temporal-spatial relationship between ookinete migration and the cellular localization of genes mediating midgut immune defense responses suggested that, in order to survive, parasites must complete invasion before toxic chemicals ("a bomb") are generated by the invaded cell. Recent studies indicate that ookinete invasion induces tyrosine nitration as a two-step reaction, in which NOS induction is followed by a localized increase in peroxidase activity. Peroxidases utilize nitrite and hydrogen peroxide as substrates, and detonate the time bomb by generating reactive nitrogen intermediates, such as nitrogen dioxide, which mediate nitration. There is evidence that peroxidases also mediate antimicrobial responses to bacteria, fungi and parasites in a broad range of biological systems including humans and plants. Defense reactions that generate toxic chemicals are also potentially harmful to the host mounting the response and often results in apoptosis. The two-step nitration pathway is probably an ancient response, as it has also been described in vertebrate leukocytes and probably evolved as a mechanism to circumscribe the toxic products generated during defense responses involving protein nitration.

  4. Selenium impacts on fish: an insidious time bomb

    Treesearch

    A. Dennis Lemly

    1999-01-01

    A selenium time bomb situation is developing in the United States and elsewhere that may result in substantial impacts on fish populations. The selenium time bomb has three components: (1) high food-chain bioaccumulation; (2) steep toxic response curve for fish; and (3) insidious mode of toxicity. If the threshold for selenium toxicity is exceeded, the time bomb...

  5. Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey.

    PubMed

    Yazgan, Cisel; Aksu, Nalan M

    2016-06-01

    To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.

  6. Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

    PubMed Central

    Aksu, Nalan M

    2016-01-01

    Objective: To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. PMID:26959613

  7. Prognostic Factors for Survival in Patients with Gastric Cancer using a Random Survival Forest

    PubMed

    Adham, Davoud; Abbasgholizadeh, Nategh; Abazari, Malek

    2017-01-01

    Background: Gastric cancer is the fifth most common cancer and the third top cause of cancer related death with about 1 million new cases and 700,000 deaths in 2012. The aim of this investigation was to identify important factors for outcome using a random survival forest (RSF) approach. Materials and Methods: Data were collected from 128 gastric cancer patients through a historical cohort study in Hamedan-Iran from 2007 to 2013. The event under consideration was death due to gastric cancer. The random survival forest model in R software was applied to determine the key factors affecting survival. Four split criteria were used to determine importance of the variables in the model including log-rank, conversation?? of events, log-rank score, and randomization. Efficiency of the model was confirmed in terms of Harrell’s concordance index. Results: The mean age of diagnosis was 63 ±12.57 and mean and median survival times were 15.2 (95%CI: 13.3, 17.0) and 12.3 (95%CI: 11.0, 13.4) months, respectively. The one-year, two-year, and three-year rates for survival were 51%, 13%, and 5%, respectively. Each RSF approach showed a slightly different ranking order. Very important covariates in nearly all the 4 RSF approaches were metastatic status, age at diagnosis and tumor size. The performance of each RSF approach was in the range of 0.29-0.32 and the best error rate was obtained by the log-rank splitting rule; second, third, and fourth ranks were log-rank score, conservation of events, and the random splitting rule, respectively. Conclusion: Low survival rate of gastric cancer patients is an indication of absence of a screening program for early diagnosis of the disease. Timely diagnosis in early phases increases survival and decreases mortality. Creative Commons Attribution License

  8. Marital Status and Survival in Patients with Carcinoid Tumors.

    PubMed

    Greenleaf, Erin K; Cooper, Amanda B; Hollenbeak, Christopher S

    2016-01-01

    Marital status is a known prognostic factor in overall and disease-specific survival in several types of cancer. The impact of marital status on survival in patients with carcinoid tumors remains unknown. We hypothesized that married patients have higher rates of survival than similar unmarried patients with carcinoid tumors. Using the Surveillance, Epidemiology, and End Results database, we identified 23,126 people diagnosed with a carcinoid tumor between 2000 and 2011 and stratified them according to marital status. Univariate and multivariable analyses were performed to compare the characteristics and outcomes between patient cohorts. Overall and cancer-related survival were analyzed using the Kaplan-Meier method. Multivariable survival analyses were performed using Cox proportional hazards models (hazards ratio [HR]), controlling for demographics and tumor-related and treatment-related variables. Propensity score analysis was performed to determine surgical intervention distributions among married and unmarried (ie, single, separated, divorced, widowed) patients. Marital status was significantly related to both overall and cancer-related survival in patients with carcinoid tumors. Divorced and widowed patients had worse overall survival (HR, 1.33 [95% confidence interval {CI}, 1.08-1.33] and 1.34 [95% CI, 1.22-1.46], respectively) and cancer-related survival (HR, 1.15 [95% CI, 1.00-1.31] and 1.15 [95% CI, 1.03-1.29], respectively) than married patients over five years. Single and separated patients had worse overall survival (HR, 1.20 [95% CI, 1.08-1.33] and 1.62 [95% CI, 1.25-2.11], respectively) than married patients over five years, but not worse cancer-related survival. Unmarried patients were more likely than matched married patients to undergo definitive surgical intervention (62.67% vs 53.11%, respectively, P < 0.0001). Even after controlling for other prognostic factors, married patients have a survival advantage after diagnosis of any carcinoid tumor

  9. Yale and the Atomic Bomb Casualty Commission.

    PubMed Central

    Bowers, J. Z.

    1983-01-01

    This is a description, based largely on personal discussions, of the contributions of men from the Yale University School of Medicine to the saga of the immediate and long-term studies on the medical effects of the atomic bombs at Hiroshima and Nagasaki. They played key roles in the immediate studies of bomb effects, in the creation of long-term studies of delayed effects, and in elevating the Atomic Bomb Casualty Commission after 1955 to a position of excellence in its studies and relations with the Japanese. The accumulation of the information presented in this paper derives from research for the preparation of the history of the Atomic Bomb Casualty Commission. In 1975, the commission was passed to Japanese leadership as the Radiation Effects Research Foundation. PMID:6349145

  10. Preventing fatalities in building bombings: what can we learn from the Oklahoma City bombing?

    PubMed

    Glenshaw, Mary T; Vernick, Jon S; Li, Guohua; Sorock, Gary S; Brown, Sheryll; Mallonee, Sue

    2007-07-01

    Bombings are an increasing threat to the public's health. Descriptive studies of blast injuries have been published, but these injuries have not been studied using analytical epidemiological methods. This study assesses factors associated with fatality risk among individuals exposed to the 1995 Oklahoma City bombing. Retrospective case-control analysis using multivariable logistic regression. Odds ratios (OR) of fatality are calculated among occupants of the Alfred P. Murrah Federal Building on April 19, 1995. Of the 348 occupants exposed, 163 (46.8%) were fatally injured. Fatality risk was greatest in the collapsed region of the building (adjusted OR 176.7, 95% confidence interval [CI] 65.9-474.2). Age > or =40 was also associated with a significantly increased risk of fatality (OR 3.7, 95% CI 1.4-9.8). Among people found in the noncollapsed region of the building, employees' status compared to a visitor's or child's status was protective (OR 0.13, 95% CI 0.01-1.3). Structural collapse is the most important risk factor for fatality in a building bombing. Progressive collapse may be prevented through more supportive building design. Protection of vulnerable building occupants can be improved by placement of relevant facilities in more structurally reinforced areas. Regular evacuation training of personnel and clear egress routes may also reduce fatality in a building bombing.

  11. Bomb Threats Taking Financial Toll

    ERIC Educational Resources Information Center

    Bowman, Darcia Harris

    2004-01-01

    Despite all its efforts to crack down on the bomb scares that disrupted classes again and again in 2003, North Carolina's Orange County district fell victim to yet another false alarm this school year, 2004. For some schools, bomb threats have become more routine than fire drills, with each incident ringing up multi-thousand-dollar tabs for…

  12. Forensic Seismology: constraints on terrorist bombings

    NASA Astrophysics Data System (ADS)

    Wallace, T. C.; Koper, K. D.

    2002-05-01

    Seismology has long been used as a tool to monitor and investigate explosions, both accidental and intentional. Seismic records can be used to provide a precise chronology of events, estimate the energy release in explosions and produce constraints to test various scenarios for the explosions. Truck bombs are a popular tool of terrorists, and at least two such attacks have been recorded seismically. On August 7, 1998 a truck bomb was detonated near the US embassy in Nairobi, Kenya. The bomb seriously damaging a dozen buildings, injuring more than 4000 people and causing 220 fatalities. The explosion was recorded on a short-period seismometer located north of the blast site; the blast seismogram contained body waves, Rayleigh waves and vibrations associated with the air blast. Modeling of the body and surfaces wave allowed an estimate of the origin time of the bombing, which it turn could be used as a constraint the timing of the air blasts. The speed of the air waves from an explosion depend on the air temperature and the size, or yield, of the explosion. In an effort to fully utilize the seismic recordings from such attacks, we analyzed the seismic records from a series of controlled truck bomb explosions carried out at White Sand Missile Range in New Mexico. We developed a new set of scaling laws that relate seismic and acoustic observations directly to the explosive mass (yield). These relationships give a yield of approximately 3000 kg of TNT equivalent for the Nairobi bomb. The terrorist bombing of the Murrah Federal Building in Oklahoma City in 1995 was also recorded on seismometers. One of these records showed 2 discrete surface wavetrains separated by approximately 10 seconds. Some groups seized on the seismic recordings as evidence that there were 2 explosions, and that the US government was actually behind the bombing. However, the USGS monitored the demolition of the remainder of the Murrah Building and showed that the collapse also produced 2 surface

  13. Theranostic Perspectives in Prostate Cancer with the Gastrin-Releasing Peptide Receptor Antagonist NeoBOMB1: Preclinical and First Clinical Results.

    PubMed

    Nock, Berthold A; Kaloudi, Aikaterini; Lymperis, Emmanouil; Giarika, Athina; Kulkarni, Harshad R; Klette, Ingo; Singh, Aviral; Krenning, Eric P; de Jong, Marion; Maina, Theodosia; Baum, Richard P

    2017-01-01

    We recently introduced the potent gastrin-releasing peptide receptor (GRPR) antagonist 68 Ga-SB3 ( 68 Ga-DOTA-p-aminomethylaniline-diglycolic acid-DPhe-Gln-Trp-Ala-Val-Gly-His-Leu-NHEt), showing excellent tumor localizing efficacy in animal models and in patients. By replacement of the C-terminal Leu 13 -Met 14 -NH 2 dipeptide of SB3 by Sta 13 -Leu 14 -NH 2 , the novel GRPR antagonist NeoBOMB1 was generated and labeled with different radiometals for theranostic use. We herein report on the biologic profile of resulting 67/68 Ga-, 111 In-, and 177 Lu-NeoBOMB1 radioligands in GRPR-expressing cells and mouse models. The first evidence of prostate cancer lesion visualization in men using 68 Ga-NeoBOMB1 and PET/CT is also presented. NeoBOMB1 was radiolabeled with 67/68 Ga, 111 In, and 177 Lu according to published protocols. The respective metalated species nat Ga-, nat In-, and nat Lu-NeoBOMB1 were also synthesized and used in competition binding experiments against [ 125 I-Tyr 4 ]BBN in GRPR-positive PC-3 cell membranes. Internalization of 67 Ga-, 111 In-, and 177 Lu-NeoBOMB1 radioligands was studied in PC-3 cells at 37°C, and their metabolic stability in peripheral mouse blood was determined by high-performance liquid chromatography analysis of blood samples. Biodistribution was performed by injecting a 67 Ga-, 111 In-, or 177 Lu-NeoBOMB1 bolus (74, 74, or 370 kBq, respectively, 100 μL, 10 pmol total peptide ± 40 nmol Tyr 4 -BBN: for in vivo GRPR blockade) in severe combined immunodeficiency mice bearing PC-3 xenografts. PET/CT images with 68 Ga-NeoBOMB1 were acquired in prostate cancer patients. NeoBOMB1 and nat Ga-, nat In-, and nat Lu-NeoBOMB1 bound to GRPR with high affinity (half maximal inhibitory concentration, 1-2 nM). 67 Ga-, 111 In-, and 177 Lu-NeoBOMB1 specifically and strongly bound on the cell membrane of PC-3 cells displaying low internalization, as expected for receptor antagonists. They showed excellent metabolic stability in peripheral mouse blood

  14. Volcanic plume and bomb field masses from thermal infrared camera imagery

    NASA Astrophysics Data System (ADS)

    Harris, A. J. L.; Delle Donne, D.; Dehn, J.; Ripepe, M.; Worden, A. K.

    2013-03-01

    Masses erupted during normal explosions at Stromboli volcano (Italy) are notoriously difficult to measure. We present a method that uses thermal infrared video for cooling bomb fields to obtain the total power emitted by all hot particles emitted during an explosion. A given mass of magma (M) will emit a finite amount of thermal power, defined by M cp(Te-T0), cp and Te being magma specific heat capacity and temperature, and T0 being ambient temperature. We use this relation to convert the total power emitted by the bomb field to the mass required to generate that power. To do this we extract power flux curves for the field and integrate this through time to obtain total power (E). This is used to estimate mass (Q) in Q=E/cp(Te-T0). When applied to individual bombs we obtain masses of between 1 and 9 kg per bomb, or a volume of 970 and 6500 cm3. These volumes equate to spheres with diameters 12 and 27 cm. For the entire bomb field we obtain volumes of 7-28 m3. We calculate masses for 32 eruptions and obtain typical bomb masses of between 103 and 104 kg per eruption. In addition, we estimate that between 102 and 103 kg of gas and ash are emitted as part of a mixed plume of bombs, gas and ash. We identify two types of eruption on the basis of the erupted bomb masses and the ratio of the plume's gas-and-ash component to the bomb component. The first type is bomb-dominated, is characterized by bomb masses of 104 kg and has ash-gas/ bomb ratios of ˜0.02. The second type is ash-and-gas dominated, is characterized by erupted bomb masses of 103 kg and has ash-gas/bomb ratios of around one, and as high as two. There is no correlation between the quantity of bombs and quantity of gas-ash erupted. In addition, while source pressure for each explosion correlates with the quantity of gas and ash erupted, the mass of bombs emitted varies independently of pressure.

  15. Bigeye Bomb: Unresolved Development Issues

    DTIC Science & Technology

    1989-08-11

    the lethal agent formed inside the Bigeye bomb) at the purity or equivalent- biotoxicity level required by the Test and Eval- uation Master Plan (TEMP...during the 5 through 30-second period after mixing starts, with- out specifying either wheit the required purity or equivalent biotoxicity level should...revision of the purity or equivalent biotoxicity requirement. However, we believe that a bomb that produces lethal agent at the required purity level for 1

  16. Physician Agency and Patient Survival*

    PubMed Central

    Jacobson, Mireille G.; Chang, Tom Y.; Earle, Craig C.; Newhouse, Joseph P.

    2017-01-01

    We investigate the role of physician agency in determining health care supply and patient outcomes. We show that an increase in health care supply due to a change in private physician incentives has a theoretically ambiguous impact on patient welfare. The increase can reflect either induced demand for ineffective care or a reduction in prior rationing of effective care. Furthermore, physician market structure matters in determining the welfare effects of changes in private physician incentives. We then analyze a change to Medicare fees that caused physicians to increase their provision of chemotherapy. We find that this increase in treatment improved patient survival, extending median life expectancy for lung cancer patients by about 18%. Consistent with the model, we find that while the treatment response was larger in less concentrated markets, survival improvements were larger in more concentrated markets. PMID:28133401

  17. 49 CFR 1544.303 - Bomb or air piracy threats.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Bomb or air piracy threats. 1544.303 Section 1544... AND COMMERCIAL OPERATORS Threat and Threat Response § 1544.303 Bomb or air piracy threats. (a) Flight.... (d) Notification. Upon receipt of any bomb threat against the security of a flight or facility, or...

  18. 49 CFR 1544.303 - Bomb or air piracy threats.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 false Bomb or air piracy threats. 1544.303 Section 1544... AND COMMERCIAL OPERATORS Threat and Threat Response § 1544.303 Bomb or air piracy threats. (a) Flight.... (d) Notification. Upon receipt of any bomb threat against the security of a flight or facility, or...

  19. 49 CFR 1544.303 - Bomb or air piracy threats.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 false Bomb or air piracy threats. 1544.303 Section 1544... AND COMMERCIAL OPERATORS Threat and Threat Response § 1544.303 Bomb or air piracy threats. (a) Flight.... (d) Notification. Upon receipt of any bomb threat against the security of a flight or facility, or...

  20. 49 CFR 1544.303 - Bomb or air piracy threats.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 false Bomb or air piracy threats. 1544.303 Section 1544... AND COMMERCIAL OPERATORS Threat and Threat Response § 1544.303 Bomb or air piracy threats. (a) Flight.... (d) Notification. Upon receipt of any bomb threat against the security of a flight or facility, or...

  1. 49 CFR 1544.303 - Bomb or air piracy threats.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 false Bomb or air piracy threats. 1544.303 Section 1544... AND COMMERCIAL OPERATORS Threat and Threat Response § 1544.303 Bomb or air piracy threats. (a) Flight.... (d) Notification. Upon receipt of any bomb threat against the security of a flight or facility, or...

  2. Hiroshima: Perspectives on the Atomic Bombing.

    ERIC Educational Resources Information Center

    Cheng, Amy

    In this curriculum module students analyze both U.S. and Japanese perspectives of the atomic bombing of Hiroshima. The activities integrate Howard Gardner's work on multiple intelligences. The module is recommended as a supplement to textbook coverage of the war in the Pacific and of the atomic bombing of Hiroshima. It can be used to support both…

  3. Conditional survival is greater than overall survival at diagnosis in patients with osteosarcoma and Ewing's sarcoma.

    PubMed

    Miller, Benjamin J; Lynch, Charles F; Buckwalter, Joseph A

    2013-11-01

    Conditional survival is a measure of the risk of mortality given that a patient has survived a defined period of time. These estimates are clinically helpful, but have not been reported previously for osteosarcoma or Ewing's sarcoma. We determined the conditional survival of patients with osteosarcoma and Ewing's sarcoma given survival of 1 or more years. We used the Surveillance, Epidemiology, and End Results (SEER) Program database to investigate cases of osteosarcoma and Ewing's sarcoma in patients younger than 40 years from 1973 to 2009. The SEER Program is managed by the National Cancer Institute and provides survival data gathered from population-based cancer registries. We used an actuarial life table analysis to determine any cancer cause-specific 5-year survival estimates conditional on 1 to 5 years of survival after diagnosis. We performed a similar analysis to determine 20-year survival from the time of diagnosis. The estimated 5-year survival improved each year after diagnosis. For local/regional osteosarcoma, the 5-year survival improved from 74.8% at baseline to 91.4% at 5 years-meaning that if a patient with localized osteosarcoma lives for 5 years, the chance of living for another 5 years is 91.4%. Similarly, the 5-year survivals for local/regional Ewing's sarcoma improved from 72.9% at baseline to 92.5% at 5 years, for metastatic osteosarcoma 35.5% at baseline to 85.4% at 5 years, and for metastatic Ewing's sarcoma 31.7% at baseline to 83.6% at 5 years. The likelihood of 20-year cause-specific survival from the time of diagnosis in osteosarcoma and Ewing's sarcoma was almost 90% or greater after 10 years of survival, suggesting that while most patients will remain disease-free indefinitely, some experience cancer-related complications years after presumed eradication. The 5-year survival estimates of osteosarcoma and Ewing's sarcoma improve with each additional year of patient survival. Knowledge of a changing risk profile is useful in counseling

  4. An Investigation of Bomb Cyclogenesis in NCEP's CFS Model

    NASA Astrophysics Data System (ADS)

    Alvarez, F. M.; Eichler, T.; Gottschalck, J.

    2008-12-01

    With the concerns, impacts and consequences of climate change increasing, the need for climate models to simulate daily weather is very important. Given the improvements in resolution and physical parameterizations, climate models are becoming capable of resolving extreme weather events. A particular type of extreme event which has large impacts on transportation, industry and the general public is a rapidly intensifying cyclone referred to as a "bomb." In this study, bombs are investigated using the National Center for Environmental Prediction's (NCEP) Climate Forecast System (CFS) model. We generate storm tracks based on 6-hourly sea-level pressure (SLP) from long-term climate runs of the CFS model. Investigation of this dataset has revealed that the CFS model is capable of producing bombs. We show a case study of a bomb in the CFS model and demonstrate that it has characteristics similar to the observed. Since the CFS model is capable of producing bombs, future work will focus on trends in their frequency and intensity so that an assessment of the potential role of the bomb in climate change can be assessed.

  5. Impact on the Japanese atomic bomb survivors of radiation received from the bombs.

    PubMed

    Cullings, Harry M

    2014-02-01

    The Radiation Effects Research Foundation (RERF) studies various cohorts of Japanese atomic bomb survivors, the largest being the Life Span Study (LSS), which includes 93,741 persons who were in Hiroshima or Nagasaki at the times of the bombings; there are also cohorts of persons who were exposed in utero and survivors' children. This presentation attempts to summarize the total impact of the radiation from the bombs on the survivors from both an individual perspective (both age-specific and integrated lifetime risk, along with a measure of life expectancy that describes how the risk affects the individual given age at exposure) and a group perspective (estimated numbers of excess occurrences in the cohort), including both early and late effects. As survivors' doses ranged well into the acutely lethal range at closer distances, some of them experienced acute signs and symptoms of radiation exposure in addition to being at risk of late effects. Although cancer has always been a primary concern among late effects, estimated numbers of excess cancers and hematopoietic malignancies in the LSS are a small fraction of the total due to the highly skewed dose distribution, with most survivors receiving small doses. For example, in the latest report on cancer incidence, 853 of 17,448 incident solid cancers were estimated to be attributable to radiation from the bombs. RERF research indicates that risk of radiation-associated cancer varies among sites and that some benign tumors such as uterine myoma are also associated with radiation. Noncancer late effects appear to be in excess in proportion to radiation dose but with an excess relative risk about one-third that of solid cancer and a correspondingly small overall fraction of cases attributable to radiation. Specific risks were found for some subcategories, particularly circulatory disease, including stroke and precedent conditions such as hypertension. Radiation-related cataract in the atomic bomb survivors is well known

  6. A Blast of Mistakes: Undiagnosed Cervical Spondylolisthesis Following a Bomb Explosion.

    PubMed

    Caruso, Riccardo; Marrocco, Luigi; Piccione, Emanuele; Wierzbicki, Venceslao

    2017-03-30

    BACKGROUND A case of spinal trauma had an unusual clinical course due to medical mistakes, from which we can learn some important lessons. CASE REPORT We report a case of spondylolisthesis following a bomb explosion, which went undiagnosed for a long time because of a series of mistakes that are highlighted in this article. What makes this case unique is that the spondylolisthesis developed during hospital stay, but the patient had no loss of mobility, strength, or sensitivity. CONCLUSIONS This case shows that establishing the conditions of an organ or a body part upon admission to hospital may not be enough when a patient has suffered extensive and serious trauma, and that it is necessary to carry out more checkups over time, especially if there are new clues and symptoms.

  7. Game of thrown bombs in 3D: using high speed cameras and photogrammetry techniques to reconstruct bomb trajectories at Stromboli (Italy)

    NASA Astrophysics Data System (ADS)

    Gaudin, D.; Taddeucci, J.; Scarlato, P.; Del Bello, E.; Houghton, B. F.; Orr, T. R.; Andronico, D.; Kueppers, U.

    2015-12-01

    Large juvenile bombs and lithic clasts, produced and ejected during explosive volcanic eruptions, follow ballistic trajectories. Of particular interest are: 1) the determination of ejection velocity and launch angle, which give insights into shallow conduit conditions and geometry; 2) particle trajectories, with an eye on trajectory evolution caused by collisions between bombs, as well as the interaction between bombs and ash/gas plumes; and 3) the computation of the final emplacement of bomb-sized clasts, which is important for hazard assessment and risk management. Ground-based imagery from a single camera only allows the reconstruction of bomb trajectories in a plan perpendicular to the line of sight, which may lead to underestimation of bomb velocities and does not allow the directionality of the ejections to be studied. To overcome this limitation, we adapted photogrammetry techniques to reconstruct 3D bomb trajectories from two or three synchronized high-speed video cameras. In particular, we modified existing algorithms to consider the errors that may arise from the very high velocity of the particles and the impossibility of measuring tie points close to the scene. Our method was tested during two field campaigns at Stromboli. In 2014, two high-speed cameras with a 500 Hz frame rate and a ~2 cm resolution were set up ~350m from the crater, 10° apart and synchronized. The experiment was repeated with similar parameters in 2015, but using three high-speed cameras in order to significantly reduce uncertainties and allow their estimation. Trajectory analyses for tens of bombs at various times allowed for the identification of shifts in the mean directivity and dispersal angle of the jets during the explosions. These time evolutions are also visible on the permanent video-camera monitoring system, demonstrating the applicability of our method to all kinds of explosive volcanoes.

  8. Transthoracic versus transhiatal esophagectomy - influence on patient survival.

    PubMed

    Łochowski, Mariusz; Łochowska, Barbara; Kozak, Józef

    2017-01-01

    To evaluate the survival of patients after surgery of the esophagus/cardia using the transthoracic and transhiatal methods. In the years 2007-2011, 102 patients were radically treated for cancer of the esophagus/cardia: 24 women and 78 men at the average age of 59.5. There were 38 transthoracic procedures and 64 transhiatal procedures. All patients had a conduit made from the stomach, led through lodges in the esophagus and combined with the stump of the esophagus in the neck following the Collard method. Two-pole lymphadenectomies were performed in all patients. Patients after transthoracic procedures had statistically more ( p < 0.05) lymph nodes removed than patients after transhiatal procedures. The 5-year survival rates in transhiatal and transthoracic procedures did not statistically differ, being 8% and 0% respectively. The length of patient survival was influenced by metastases in the nearby lymph nodes ( p < 0.0001) and the presence of adenocarcinoma. Surgical access (transhiatal and transthoracic surgery) does not affect the 5-year survival rates. Transhiatal surgery allows a greater number of lymph nodes to be removed. The main factor influencing the 5-year survival rate is the presence of metastases in the nearby lymph nodes.

  9. Quality improvement program for the B83 bomb hand truck

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Loll, M.B.; Buck, S.A.

    1998-04-01

    This report describes the problems, issues, and history of the H1347 bomb hand truck for the B83 bomb after the bomb was put into stockpile in the mid-1980s. Major issues that were reported in Unsatisfactory Reports (URs) were cracking problems on stacking fixture welds, cracked welds on the caster bracket receptacles on the cradle, cracked caster mounting brackets, casters unlocking from the swivel lock position, and caster tires rubbing and binding on the stacking frame. Resolution of these and other problems is described. The introduction of the H695B storage-only bomb hand truck to alleviate a shortage of bomb hand trucksmore » in the mid-1990s is described. The development and qualification of the H1347A bomb hand truck as a replacement for the H695 B is covered. The results from load test evaluations on the stacking fixture, cradle, and casters for the H1347 are described along with towing results on one and two-high stack configurations of B83 bombs in bomb hand trucks. New towing and truck/trailer transport procedures are described. Development, evaluation, and production recommendations for a stronger caster mounting bracket are described.« less

  10. Aerodynamic Simulation Analysis of Unmanned Airborne Electronic Bomb

    NASA Astrophysics Data System (ADS)

    Yang, Jiaoying; Guo, Yachao

    2017-10-01

    For microelectronic bombs for UAVs, on the basis of the use of rotors to lift the insurance on the basis of ammunition, increased tail to increase stability. The aerodynamic simulation of the outer structure of the ammunition was carried out by FLUENT software. The resistance coefficient, the lift coefficient and the pitch moment coefficient under different angle of attack and Mach number were obtained, and the aerodynamic characteristics of the electronic bomb were studied. The pressure line diagram and the velocity line diagram of the flow around the bomb are further analyzed, and the rationality of the external structure is verified, which provides a reference for the subsequent design of the electronic bomb.

  11. [Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters].

    PubMed

    Golubović, Zoran; Stanić, Vojkan; Trenkić, Srbobran; Stojiljković, Predrag; Stevanović, Goran; Lesić, Aleksandar; Golubović, Ivan; Milić, Dragan; Visnjić, Aleksandar; Najman, Stevo

    2010-08-01

    Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite

  12. Rapid intercontinental air pollution transport associated with a meteorological bomb

    NASA Astrophysics Data System (ADS)

    Stohl, A.; Huntrieser, H.; Richter, A.; Beirle, S.; Cooper, O.; Eckhardt, S.; Forster, C.; James, P.; Spichtinger, N.; Wenig, M.; Wagner, T.; Burrows, J.; Platt, U.

    2003-04-01

    Intercontinental transport (ICT) of trace substances normally occurs on timescales ranging from a few days to several weeks. In this paper an extraordinary episode in November 2001 is presented, where pollution transport across the North Atlantic took only about one day. The transport mechanism, termed here an intercontinental pollution express highway, was exceptional, as it involved an explosively generated cyclone, a so-called meteorological "bomb". To the authors' knowledge, this is the first study describing pollution transport in a bomb. The discovery of this event was based on transport model calculations and satellite measurements of NO2, a species with a relatively short lifetime in the atmosphere, which could be transported that far only because of the high wind speeds produced by the bomb. A 15-year transport climatology shows that intercontinental express highways are about four times more frequent in winter than in summer, in agreement with bomb climatologies. The climatology furthermore reveals that intercontinental express highways may be important for the budget of short-lived substances in the remote troposphere. For instance, for a substance with a lifetime of 1 day, express highways may be responsible for about two thirds of the total ICT. A rough calculation suggests that express highways connecting North America with Europe enhance the average NOx mixing ratios over Europe, due to North American emissions, by about 2-3 pptv in winter.

  13. Review of Injuries from Terrorist Bombings and Earthquakes

    DTIC Science & Technology

    2016-08-31

    distribution is unlimited. August 2016 Review of Injuries from Terrorist Bombings and Earthquakes DTRA-TR-16-064 T E C H N IC A L R E P...08-16 Technical Report 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Review of Injuries Types from Terrorist Bombings and Earthquakes HDTRA1-14-D-0003...Terrorist bombings and earthquakes provide valuable insight on the types of injuries that may occur in an improvised nuclear device (IND) scenario

  14. Deconstructing The Bomb: Confessions of a Nuclear Archeologist

    NASA Astrophysics Data System (ADS)

    Coster-Mullen, John

    2017-01-01

    I am the author of the groundbreaking book Atom Bombs: The Top Secret Inside Story of Little Boy and Fat Man. I will be sharing some of my quarter century of research and methodology that has allowed me to be the first researcher ever to unravel with an unprecedented level of accuracy, the most closely-guarded secrets of the first two Atomic Bombs (``Little Boy'' and ``Fat Man'') created by the Manhattan Project that were used to end WWII. I refer to this methodology as ``Nuclear Archeology'' and will demonstrate that this was done using entirely ``Open Sources'' of information.

  15. Survival of Patients with Oral Cavity Cancer in Germany

    PubMed Central

    Listl, Stefan; Jansen, Lina; Stenzinger, Albrecht; Freier, Kolja; Emrich, Katharina; Holleczek, Bernd; Katalinic, Alexander; Gondos, Adam; Brenner, Hermann

    2013-01-01

    The purpose of the present study was to describe the survival of patients diagnosed with oral cavity cancer in Germany. The analyses relied on data from eleven population-based cancer registries in Germany covering a population of 33 million inhabitants. Patients with a diagnosis of oral cavity cancer (ICD-10: C00-06) between 1997 and 2006 are included. Period analysis for 2002–2006 was applied to estimate five-year age-standardized relative survival, taking into account patients' sex as well as grade and tumor stage. Overall five-year relative survival for oral cavity cancer patients was 54.6%. According to tumor localization, five-year survival was 86.5% for lip cancer, 48.1% for tongue cancer and 51.7% for other regions of the oral cavity. Differences in survival were identified with respect to age, sex, tumor grade and stage. The present study is the first to provide a comprehensive overview on survival of oral cavity cancer patients in Germany. PMID:23349710

  16. Awful face of the war-impacted smoke bomb capsule in the face and systemic toxicity: reports from the conflict in Syria.

    PubMed

    Yilmaz, Bahar; Yeşiloğlu, Nebil; Firincioğullari, Remzi; Gökkaya, Ali; Özbey, Rafet; Özgür, Mustafa

    2015-01-01

    In this study, a rare kind of injury due to smoke bomb capsule impaction to midface and under the cranial base is presented, and maneuvers to reduce mortality are discussed. Three male patients were presented with impacted smoke bomb capsules into the midface and under the cranial base structures. Midface structures, anterior cranial base, and, in 2 patients, unilateral eye were severely damaged. Two patients died after the initial emergency operations because their lung disease progressed to acute respiratory distress syndrome. One of the patients lived, and soft tissue reconstruction was achieved by using temporal transposition and cheek advancement skin flaps with split-thickness skin graft from donor site. However, craniofacial destruction is important in these patients; a multidisciplinary approach is needed for the treatment of direct smoke bomb injuries because the patients experienced chemical burn and acute trauma. The timing of maxillofacial reconstruction is also a question in these specific patients.

  17. 49 CFR 1546.301 - Bomb or air piracy threats.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Bomb or air piracy threats. 1546.301 Section 1546... Threat Response § 1546.301 Bomb or air piracy threats. No foreign air carrier may land or take off an airplane in the United States after receiving a bomb or air piracy threat against that airplane, unless the...

  18. 49 CFR 1546.301 - Bomb or air piracy threats.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 false Bomb or air piracy threats. 1546.301 Section 1546... Threat Response § 1546.301 Bomb or air piracy threats. No foreign air carrier may land or take off an airplane in the United States after receiving a bomb or air piracy threat against that airplane, unless the...

  19. 49 CFR 1546.301 - Bomb or air piracy threats.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 false Bomb or air piracy threats. 1546.301 Section 1546... Threat Response § 1546.301 Bomb or air piracy threats. No foreign air carrier may land or take off an airplane in the United States after receiving a bomb or air piracy threat against that airplane, unless the...

  20. 49 CFR 1546.301 - Bomb or air piracy threats.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 false Bomb or air piracy threats. 1546.301 Section 1546... Threat Response § 1546.301 Bomb or air piracy threats. No foreign air carrier may land or take off an airplane in the United States after receiving a bomb or air piracy threat against that airplane, unless the...

  1. 49 CFR 1546.301 - Bomb or air piracy threats.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 false Bomb or air piracy threats. 1546.301 Section 1546... Threat Response § 1546.301 Bomb or air piracy threats. No foreign air carrier may land or take off an airplane in the United States after receiving a bomb or air piracy threat against that airplane, unless the...

  2. Mesothelioma: treatment and survival of a patient population and review of the literature.

    PubMed

    Stathopoulos, John; Antoniou, Dimosthenis; Stathopoulos, George P; Rigatos, Sotiris K; Dimitroulis, John; Koutandos, John; Michalopoulou, Pinelopi; Athanasiades, Athanasios; Veslemes, Marinos

    2005-01-01

    Our purpose was to evaluate the survival of patients with pleural and intraperitoneal malignant mesothelioma and, particularly, to estimate the efficacy of chemotherapy as well as radiotherapy and surgery. A review of the literature with respect to these parameters is included. Thirty-five patients with malignant mesothelioma (28 with pleural and 7 with intraperitoneal) were enrolled. Twenty-eight patients underwent chemotherapy, 7/35 radiation and 9/35 surgery (2 with pleural and 7 with abdominal disease). Combination chemotherapy included cisplatin-gemcitabine, cisplatin (or carboplatin) with premetrexed and doxorubicin-cyclophosphamide. In 2/28 patients with pleural mesothelioma the tumor was excised and in 7 with intraperitoneal disease, surgical therapy was palliative and there was survival prolongation. Radiotherapy was only palliative. Chemotherapy produced a very low response: 2/28 (7.14%) patients achieved a partial response. The median survival was 17 months, 4-year survival, 24.4% and 5-year survival, 12.12%. No serious toxicity was observed. Malignant mesothelioma of the pleura and intraperitoneum is a slow-growing disease which is indicated by the long survival, despite the failure of chemotherapy, radiation therapy and surgery.

  3. Hα features with hot onsets. I. Ellerman bombs

    NASA Astrophysics Data System (ADS)

    Rutten, R. J.

    2016-05-01

    Ellerman bombs are transient brightenings of the wings of the Balmer lines that uniquely mark reconnection in the solar photosphere. They are also bright in strong Ca II and ultraviolet lines and in ultraviolet continua, but they are not visible in the optical continuum and the Na I D and Mg I b lines. These discordant visibilities invalidate all published Ellerman bomb modeling. I argue that the assumption of Saha-Boltzmann lower-level populations is informative to estimate bomb-onset opacities for these diverse diagnostics, even and especially for Hα, and employ such estimates to gauge the visibilities of Ellerman bomb onsets in all of them. They constrain Ellerman bomb formation to temperatures 10 000-20 000 K and hydrogen densities around 1015 cm-3. Similar arguments likely hold for Hα visibility in other transient phenomena with hot and dense onsets.

  4. Survival period after tube feeding in bedridden older patients.

    PubMed

    Kosaka, Yoichi; Nakagawa-Satoh, Takuma; Ohrui, Takashi; Fujii, Masahiko; Arai, Hiroyuki; Sasaki, Hidetada

    2012-04-01

    We prospectively studied survival periods after tube feeding. Participants were 163 bedridden older patients suffering from dysphagia. A wide range of survival periods after tube feeding were observed within half a year without tube feeding after being bedridden. After this initial period, survival periods after tube feeding were limited to approximately half a year. Survival periods after tube feeding were positively proportional to the length of time patients were free from pneumonia after tube feeding. After tube feeding, patients died from pneumonia within half a year, and the frequency of pneumonia was 3.1 ± 2.7 times (mean ± SD) before death. Survival periods after tube feeding for less than 1 year were primarily determined by being bedridden for more than half a year without tube feeding and once pneumonia occurred; patients who were tube fed did not survive for more than half a year. © 2012 Japan Geriatrics Society.

  5. The secret of the Soviet hydrogen bomb

    NASA Astrophysics Data System (ADS)

    Wellerstein, Alex; Geist, Edward

    2017-11-01

    Was the first Soviet thermonuclear device really a step in the wrong direction? No bomb design has been as much maligned or otherwise disparaged as the first Soviet thermonuclear weapon. Detonated in August 1953, the bomb, officially tested under the name RDS-6s but usually known as Sloika or "layer cake" (the name Andrei Sakharov coined for it), was nothing to sneeze at. Shown in Figure 1 and able to be dropped from aircraft, it released the explosive equivalent, or yield, of almost half a megaton of TNT. The result was a blazing fireball with 20 times the power of the bomb that leveled Nagasaki, Japan.

  6. Management and Survival Patterns of Patients with Gliomatosis Cerebri: A SEER-Based Analysis.

    PubMed

    Carroll, Kate T; Hirshman, Brian; Ali, Mir Amaan; Alattar, Ali A; Brandel, Michael G; Lochte, Bryson; Lanman, Tyler; Carter, Bob; Chen, Clark C

    2017-07-01

    We used the SEER (Surveillance Epidemiology and End Results) database (1999-2010) to analyze the clinical practice patterns and overall survival in patients with gliomatosis cerebri (GC), or glioma involving 3 or more lobes of the cerebrum. We identified 111 patients (age ≥18 years) with clinically or microscopically diagnosed GC in the SEER database. Analyses were performed to determine clinical practice patterns for these patients and whether these practices were associated with survival. Fifty-eight percent of the 111 patients with GC received microscopic confirmation of their diagnosis. Of the remaining patients, 40% were diagnosed via imaging or laboratory tests, and 2% had unknown methods of diagnosis. Seven percent of patients who did not have microscopic confirmation of their diagnosis received radiation therapy. Radiation therapy and surgery were not associated with survival. The only variable significantly associated with overall survival was age at diagnosis. Patients aged 18-50 years showed improved survival relative to patients aged >50 years (median survival, 11 and 6 months, respectively; P = 0.03). For patients aged >50 years, improved overall survival was observed in the post-temozolomide era (2005-2010) relative to those treated in the pre-temozolomide era (1999-2004) (median survival, 9 and 4 months, respectively; P = 0.005). In the SEER database, ∼40% of the patients with glioma with imaging findings of GC do not receive microscopic confirmation of their diagnosis. We propose that tissue confirmation is warranted in patients with GC, because genomic analysis of these specimens may provide insights that will contribute to meaningful therapeutic intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. An autopsy case related to a terrorist attack using a ball-bearing bomb.

    PubMed

    Takamiya, Masataka; Biwasaka, Hitoshi; Niitsu, Hisae; Saigusa, Kiyoshi; Aoki, Yasuhiro

    2009-03-01

    We encountered an autopsy case related to a terrorist attack using a ball-bearing bomb. The decedent was a 51-year-old male without significant medical histories. During dinner in a restaurant, the perpetrator suddenly exploded a ball-bearing bomb, the blast from which blew the victim off his chair. The victim was found to be unresponsive, and pronounced dead. X-ray photographs taken before autopsy revealed six spherical shadows. Three penetrating wounds in the head, one in the neck and chest, and two in the left upper arm were observed in vivo. Six projectiles recovered from the body were identified as ball-bearings, one of which traveled through the midbrain, diencephalon, and left temporal lobe. Although blast injuries and penetrating wounds are often combined in bomb attack victims, penetrating brain injury would be the cause of death in this case. Lethal injuries to major organs can thus occur even though the destructive force of a ball-bearing bomb is weak. X-ray films were informative for detecting the ball-bearings in this case, suggesting that autopsy imaging is essential in cases of terrorism victims.

  8. Predictive model for survival in patients with gastric cancer.

    PubMed

    Goshayeshi, Ladan; Hoseini, Benyamin; Yousefli, Zahra; Khooie, Alireza; Etminani, Kobra; Esmaeilzadeh, Abbas; Golabpour, Amin

    2017-12-01

    Gastric cancer is one of the most prevalent cancers in the world. Characterized by poor prognosis, it is a frequent cause of cancer in Iran. The aim of the study was to design a predictive model of survival time for patients suffering from gastric cancer. This was a historical cohort conducted between 2011 and 2016. Study population were 277 patients suffering from gastric cancer. Data were gathered from the Iranian Cancer Registry and the laboratory of Emam Reza Hospital in Mashhad, Iran. Patients or their relatives underwent interviews where it was needed. Missing values were imputed by data mining techniques. Fifteen factors were analyzed. Survival was addressed as a dependent variable. Then, the predictive model was designed by combining both genetic algorithm and logistic regression. Matlab 2014 software was used to combine them. Of the 277 patients, only survival of 80 patients was available whose data were used for designing the predictive model. Mean ?SD of missing values for each patient was 4.43?.41 combined predictive model achieved 72.57% accuracy. Sex, birth year, age at diagnosis time, age at diagnosis time of patients' family, family history of gastric cancer, and family history of other gastrointestinal cancers were six parameters associated with patient survival. The study revealed that imputing missing values by data mining techniques have a good accuracy. And it also revealed six parameters extracted by genetic algorithm effect on the survival of patients with gastric cancer. Our combined predictive model, with a good accuracy, is appropriate to forecast the survival of patients suffering from Gastric cancer. So, we suggest policy makers and specialists to apply it for prediction of patients' survival.

  9. Britain's bomb

    NASA Astrophysics Data System (ADS)

    Corfield, Richard

    2012-10-01

    On the 60th anniversary of Britain's first nuclear test, Richard Corfield explores how Operation Hurricane - the British effort to develop the atomic bomb in the 1940s and 1950s - compares with states such as Iran that today wish to have such devices.

  10. Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003-10: a descriptive study.

    PubMed

    Hicks, Madelyn Hsiao-Rei; Dardagan, Hamit; Bagnall, Peter M; Spagat, Michael; Sloboda, John A

    2011-09-03

    Suicide bombs in Iraq are a major public health problem. We aimed to describe documented casualties from suicide bombs in Iraq during 2003-10 in Iraqi civilians and coalition soldiers. In this descriptive study, we analysed and compared suicide bomb casualties in Iraq that were documented in two datasets covering March 20, 2003, to Dec 31, 2010--one reporting coalition-soldier deaths from suicide bombs, the other reporting deaths and injuries of Iraqi civilians from armed violence. We analysed deaths and injuries over time, by bomb subtype and victim demographics. In 2003-10, 1003 documented suicide bomb events caused 19% (42,928 of 225,789) of all Iraqi civilian casualties in our dataset, 26% (30,644 of 117,165) of injured civilians, and 11% (12,284 of 108,624) of civilian deaths. The injured-to-killed ratio for civilians was 2·5 people injured to one person killed from suicide bombs. Suicide bombers on foot caused 43% (5314 of 12,284) of documented suicide bomb deaths. Suicide bombers who used cars caused 40% (12,224 of 30,644) of civilian injuries. Of 3963 demographically identifiable suicide bomb fatalities, 2981 (75%) were men, 428 (11%) were women, and 554 (14%) were children. Children made up a higher proportion of demographically identifiable deaths from suicide bombings than from general armed violence (9%, 3669 of 40,276 deaths; p<0·0001). The injured-to-killed ratio for all suicide bombings was slightly higher for women than it was for men (p=0·02), but the ratio for children was lower than it was for both women (p<0·0001) and men (p=0·0002). 200 coalition soldiers were killed in 79 suicide bomb events during 2003-10. More Iraqi civilians per lethal event were killed than were coalition soldiers (12 vs 3; p=0·004). Suicide bombers in Iraq kill significantly more Iraqi civilians than coalition soldiers. Among civilians, children are more likely to die than adults when injured by suicide bombs. None. Copyright © 2011 Elsevier Ltd. All rights

  11. Profiles of referrals to a psychiatric service: a descriptive study of survivors of the Nairobi US Embassy terrorist bomb blast.

    PubMed

    Ndetei, D M; Omar, A; Mutiso, V N; Ongecha, F A; Kokonya, D A

    2009-11-01

    To document the socio-demographic characteristics and psychiatric profiles of the survivors of the Nairobi United States Embassy terrorist bomb blast referred to a psychiatric and psychotherapy (counselling) service. This was a descriptive cross-sectional study. Clinical interviews and structured questionnaires for post-traumatic stress disorder (PTSD) and stress were administered. Survivors of the bomb blast referred to a psychiatric and psychotherapy service one year or more after the bombing were included in the study. These survivors had been treated using psychopharmacotherapy and individualised (not group) therapy/counselling. Eighty-three consecutive referrals to a psychiatric service participated in this study. There were more males and the sample was generally well educated. The referrals made contact with the referring agency for a number of reasons including seeking psychological, financial and medical assistance. All the patients reported varying degrees of psychiatric symptoms and functional impairment on various aspects of social occupational functioning. High scores for PTSD and other related stress were recorded one or more years after the bombing. Although the survivors indicated that initial counselling following the blast had helped them, they still scored high on PTSD suggesting that clinically, the initial counselling had little, if any impact on the development of PTSD. There is need for a holistic approach to the management of psychotrauma in individuals.

  12. Long-term follow-up of atomic bomb survivors.

    PubMed

    Sakata, Ritsu; Grant, Eric J; Ozasa, Kotaro

    2012-06-01

    The Life Span Study (LSS) is a follow-up study of atomic bomb (A-bomb) survivors to investigate the radiation effects on human health and has collected data for over 60 years. The LSS cohort consists of 93,741 A-bomb survivors and another 26,580 age and sex-matched subjects who were not in either city at the time of the bombing. Radiation doses have been computed based on individual location and shielding status at the time of the bombings. Age at death and cause of death are gathered through the Japanese national family registry system and cancer incidence data have been collected through the Hiroshima and Nagasaki cancer registries. Noncancer disease incidence and health information are collected through biannual medical examinations among a subset of the LSS. Radiation significantly increases the risks of death (22% at 1 Gy), cancer incidence (47% at 1 Gy), death due to leukemia (310% at 1 Gy), as well as the incidence of several noncancer diseases (e.g. thyroid nodules, chronic liver disease and cirrhosis, uterine myoma, and hypertension). Significant effects on maturity (e.g. growth reduction and early menopause) were also observed. Long-term follow-up studies of the A-bomb survivors have provided reliable information on health risks for the survivors and form the basis for radiation protection standards for workers and the public. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  13. Rapid intercontinental air pollution transport associated with a meteorological bomb

    NASA Astrophysics Data System (ADS)

    Stohl, A.; Huntrieser, H.; Richter, A.; Beirle, S.; Cooper, O. R.; Eckhardt, S.; Forster, C.; James, P.; Spichtinger, N.; Wenig, M.; Wagner, T.; Burrows, J. P.; Platt, U.

    2003-07-01

    Intercontinental transport (ICT) of trace substances normally occurs on timescales ranging from a few days to several weeks. In this paper an extraordinary episode in November 2001 is presented, where pollution transport across the North Atlantic took only about one day. The transport mechanism, termed here an intercontinental pollution express highway because of the high wind speeds, was exceptional, as it involved an explosively generated cyclone, a so-called meteorological "bomb''. To the authors' knowledge, this is the first study describing pollution transport in a bomb. The discovery of this event was based on tracer transport model calculations and satellite measurements of NO2, a species with a relatively short lifetime in the atmosphere, which could be transported that far only because of the high wind speeds produced by the bomb. A 15-year transport climatology shows that intercontinental express highways are about four times more frequent in winter than in summer, in agreement with bomb climatologies. The climatology furthermore suggests that intercontinental express highways may be important for the budget of short-lived substances in the remote troposphere. For instance, for a substance with a lifetime of 1 day, express highways may be responsible for about two thirds of the total ICT. We roughly estimate that express highways connecting North America with Europe enhance the average NOx mixing ratios over Europe, due to North American emissions, by about 2-3 pptv in winter.

  14. 49 CFR 173.160 - Bombs, smoke, non-explosive (corrosive).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Bombs, smoke, non-explosive (corrosive). 173.160 Section 173.160 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS... Class 1 and Class 7 § 173.160 Bombs, smoke, non-explosive (corrosive). Bombs, smoke, non-explosive may...

  15. 49 CFR 173.160 - Bombs, smoke, non-explosive (corrosive).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Bombs, smoke, non-explosive (corrosive). 173.160 Section 173.160 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS... Class 1 and Class 7 § 173.160 Bombs, smoke, non-explosive (corrosive). Bombs, smoke, non-explosive may...

  16. 49 CFR 173.160 - Bombs, smoke, non-explosive (corrosive).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Bombs, smoke, non-explosive (corrosive). 173.160 Section 173.160 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS... Class 1 and Class 7 § 173.160 Bombs, smoke, non-explosive (corrosive). Bombs, smoke, non-explosive may...

  17. 49 CFR 173.160 - Bombs, smoke, non-explosive (corrosive).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 2 2014-10-01 2014-10-01 false Bombs, smoke, non-explosive (corrosive). 173.160 Section 173.160 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS... Class 1 and Class 7 § 173.160 Bombs, smoke, non-explosive (corrosive). Bombs, smoke, non-explosive may...

  18. 49 CFR 173.160 - Bombs, smoke, non-explosive (corrosive).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Bombs, smoke, non-explosive (corrosive). 173.160 Section 173.160 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS... Class 1 and Class 7 § 173.160 Bombs, smoke, non-explosive (corrosive). Bombs, smoke, non-explosive may...

  19. Survival of Alzheimer's disease patients in Korea.

    PubMed

    Go, Seok Min; Lee, Kang Soo; Seo, Sang Won; Chin, Juhee; Kang, Sue J; Moon, So Young; Na, Duk L; Cheong, Hae-Kwan

    2013-01-01

    The natural history of Alzheimer's disease (AD) has rarely been studied in the Korean population. Our study on survival analyses in Korean AD patients potentially provides a basis for cross-cultural comparisons. We studied 724 consecutive patients from a memory disorder clinic in a tertiary hospital in Seoul, who were diagnosed as having AD between April 1995 and December 2005. Deaths were identified by the Statistics Korea database. The Kaplan-Meier method was used for survival analysis, and a Cox proportional hazard model was used to assess factors related to patient survival. The overall median survival from the onset of first symptoms and from the time of diagnosis was 12.6 years (95% confidence interval 11.7-13.4) and 9.3 years (95% confidence interval 8.7-9.9), respectively. The age of onset, male gender, history of diabetes mellitus, lower Mini-Mental State Examination score, and higher Clinical Dementia Rating score were negatively associated with survival. There was a reversal of risk of AD between early-onset and later-onset AD, 9.1 years after onset. The results of our study show a different pattern of survival compared to those studies carried out with western AD populations. Mortality risk of early-onset AD varied depending on the duration of follow-up. Copyright © 2013 S. Karger AG, Basel.

  20. Long-Term Survival in Patients Receiving a Continuous-Flow Left Ventricular Assist Device.

    PubMed

    Gosev, Igor; Kiernan, Michael S; Eckman, Peter; Soleimani, Behzad; Kilic, Ahmet; Uriel, Nir; Rich, Jonathan D; Katz, Jason N; Cowger, Jennifer; Lima, Brian; McGurk, Siobhan; Brisco-Bacik, Meredith A; Lee, Sanjin; Joseph, Susan M; Patel, Chetan B

    2018-03-01

    Long-term survivors after implantation of left ventricular assist devices (LVADs) are increasing in prevalence. We describe the characteristics and outcomes in patients surviving longer than 4 years on LVAD support. We performed a multicenter, retrospective analysis of patients surviving at least 4 years on continuous-flow LVAD (CF-LVAD) support with a HeartMate II at centers participating in the Evolving Mechanical support Research Group. Between 2005 and 2010, 156 long-term survivors were identified with a mean survival of 7.1 years (95% confidence interval: 6.7 to 7.5 years). The mean age was 58.2 ± 15.2 years and 30.1% were women. Readmission rate was low at 1.1 events per patient per year with the most common reasons leading to readmission being infection (0.10 readmissions per patient per year) and gastrointestinal bleeding (0.07 readmissions per patient per year). Two years after implantation, 97% of patients were either New York Heart Association functional class I or II, with 92% at 4 years. Patients surviving 4 years on CF-LVAD support can anticipate ongoing long-term survival with sustained improvements in functionality and low rates of rehospitalization. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Postoperative venous thromboembolism predicts survival in cancer patients.

    PubMed

    Auer, Rebecca Ann C; Scheer, Adena Sarah; McSparron, Jakob I; Schulman, Allison R; Tuorto, Scott; Doucette, Steve; Gonsalves, Jamie; Fong, Yuman

    2012-05-01

    To determine whether a postoperative venous thromboembolism (VTE) is associated with a worse prognosis and/or a more advanced cancer stage and to evaluate the association between a postoperative VTE and cancer-specific survival when known prognostic factors, such as age, stage, cancer type, and type of surgery, are controlled. It is unknown whether oncology patients who develop a venous thromboembolism after a complete curative resection are at the same survival disadvantage as oncology patients with a spontaneous VTE. A retrospective case control study was conducted at Memorial Sloan-Kettering Cancer Center. Years of study: January 1, 2000, to December 31, 2005. Median follow-up: 24.9 months (Interquartile range 13.0, 43.0). All cancer patients who underwent abdominal, pelvic, thoracic, or soft tissue procedures and those who developed a VTE within 30 days of the procedure were identified from a prospective morbidity and mortality database. Overall survival (OS) was calculated for the entire cohort. In the matched cohort, OS and disease-specific survival (DSS) were calculated for stages 0 to 3 and stages 0 to 2. A total of 23,541 cancer patients underwent an invasive procedure and 474 (2%) had a postoperative VTE. VTE patients had a significantly worse 5-year OS compared to no-VTE patients (43.8% vs 61.2%; P < 0.0001); 205 VTE patients (stages 0-3) were matched to 2050 controls by age, sex, cancer type, stage, and surgical procedure. In this matched analysis, VTE patients continued to demonstrate a significantly worse prognosis with an inferior 5-year OS (54.7% vs 66.3%; P < 0.0001) and DSS (67.8% vs 79.5%; P = 0.0007) as compared to controls. The survival difference persisted in early stage disease (stage 0-2), with 5-year DSS of 82.9% versus 87.3% (P = 0.01). Postoperative VTE in oncology patients with limited disease and a complete surgical resection is associated with an inferior cancer survival. A postoperative VTE remains a poor prognostic factor, even when

  2. Serum albumin predicts survival in patients with hilar cholangiocarcinoma.

    PubMed

    Waghray, Abhijeet; Sobotka, Anastasia; Marrero, Carlos Romero; Estfan, Bassam; Aucejo, Federico; Narayanan Menon, K V

    2017-02-01

    Hilar cholangiocarcinoma is a devastating malignancy with incidence varying by geography and other risk factors. Rapid progression of disease and delays in diagnosis restrict the number of patients eligible for curative therapy. The objective of this study was to determine prognostic factors of overall survival in all patients presenting with hilar cholangiocarcinoma. All adult patients with histologically confirmed hilar cholangiocarcinoma from 2003 to 2013 were evaluated for predictors of survival using demographic factors, laboratory data, symptoms and radiological characteristics at presentation. A total of 116 patients were identified to have pathological diagnosis of hilar cholangiocarcinoma and were included in the analysis. Patients with a serum albumin level >3.0 g/dL (P < 0.01), cancer antigen 19-9 ≤200 U/mL (P = 0.03), carcinoembryonic antigen ≤10 ìg/L (P < 0.01) or patients without a history of cirrhosis (P < 0.01) or diabetes (P = 0.02) were associated with a greater length of overall survival. A serum albumin level >3.0 g/dL was identified as an independent predictor of overall survival (hazard ratio 0.31; 95% confidence interval 0.14-0.70) with a survival benefit of 44 weeks. This study was the largest analysis to date of prognostic factors in patients with hilar cholangiocarcinoma. A serum albumin level >3.0 g/dL conferred an independent survival advantage with a significantly greater length of survival. © The Author(s) 2016. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University.

  3. Serum albumin predicts survival in patients with hilar cholangiocarcinoma

    PubMed Central

    Waghray, Abhijeet; Sobotka, Anastasia; Marrero, Carlos Romero; Estfan, Bassam; Aucejo, Federico

    2017-01-01

    Background and aims: Hilar cholangiocarcinoma is a devastating malignancy with incidence varying by geography and other risk factors. Rapid progression of disease and delays in diagnosis restrict the number of patients eligible for curative therapy. The objective of this study was to determine prognostic factors of overall survival in all patients presenting with hilar cholangiocarcinoma. Methods: All adult patients with histologically confirmed hilar cholangiocarcinoma from 2003 to 2013 were evaluated for predictors of survival using demographic factors, laboratory data, symptoms and radiological characteristics at presentation. Results: A total of 116 patients were identified to have pathological diagnosis of hilar cholangiocarcinoma and were included in the analysis. Patients with a serum albumin level >3.0 g/dL (P < 0.01), cancer antigen 19‐9 ≤200 U/mL (P = 0.03), carcinoembryonic antigen ≤10 ìg/L (P < 0.01) or patients without a history of cirrhosis (P < 0.01) or diabetes (P = 0.02) were associated with a greater length of overall survival. A serum albumin level >3.0 g/dL was identified as an independent predictor of overall survival (hazard ratio 0.31; 95% confidence interval 0.14–0.70) with a survival benefit of 44 weeks. Conclusion: This study was the largest analysis to date of prognostic factors in patients with hilar cholangiocarcinoma. A serum albumin level >3.0 g/dL conferred an independent survival advantage with a significantly greater length of survival. PMID:27389416

  4. Sticky bomb detection with other implications for vehicle security.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Johnston, R. G.; Vetrone, J.; Warner, J. S.

    2010-01-01

    A 'sticky bomb' is a type of improvised explosive device (IED) placed on a motor vehicle by (for example) a terrorist. The bomb is typically attached with adhesive ('duct') tape, or with magnets. This paper reports some preliminary results for a very rudimentary demonstration of two techniques for detecting the placement of a sticky bomb on a motor vehicle. The two techniques are tire pressure and magnetic measurements. There are other possible security applications for these techniques as well.

  5. [Diary of a hospital evacuation. Discovery of a 5 hundredweight bomb from World War II].

    PubMed

    Katter, I; Kunitz, O; Deller, A

    2008-07-01

    The discovery of an aircraft bomb from World War II made the complete evacuation of a tertiary care hospital with 629 beds and 17 specialist departments including a neonatal intensive care unit necessary. Some months before an alarm plan had been issued and a fire practice had been carried out which made it obvious to all concerned how important such measures are. Nevertheless, more room for improvement could be learned from the evacuation, in particular the rapid classification of the patients into categories and the fact that 20-30% of the patients needed stretcher-based transport for evacuation.

  6. Particle Detectors Subatomic Bomb Squad

    ScienceCinema

    Lincoln, Don

    2018-01-16

    The manner in which particle physicists investigate collisions in particle accelerators is a puzzling process. Using vaguely-defined “detectors,” scientists are able to somehow reconstruct the collisions and convert that information into physics measurements. In this video, Fermilab’s Dr. Don Lincoln sheds light on this mysterious technique. In a surprising analogy, he draws a parallel between experimental particle physics and bomb squad investigators and uses an explosive example to illustrate his points. Be sure to watch this video… it’s totally the bomb.

  7. Long-term survival and conditional survival of cancer patients in Japan using population-based cancer registry data

    PubMed Central

    Ito, Yuri; Miyashiro, Isao; Ito, Hidemi; Hosono, Satoyo; Chihara, Dai; Nakata-Yamada, Kayo; Nakayama, Masashi; Matsuzaka, Masashi; Hattori, Masakazu; Sugiyama, Hiromi; Oze, Isao; Tanaka, Rina; Nomura, Etsuko; Nishino, Yoshikazu; Matsuda, Tomohiro; Ioka, Akiko; Tsukuma, Hideaki; Nakayama, Tomio

    2014-01-01

    Although we usually report 5-year cancer survival using population-based cancer registry data, nowadays many cancer patients survive longer and need to be followed-up for more than 5 years. Long-term cancer survival figures are scarce in Japan. Here we report 10-year cancer survival and conditional survival using an established statistical approach. We received data on 1 387 489 cancer cases from six prefectural population-based cancer registries in Japan, diagnosed between 1993 and 2009 and followed-up for at least 5 years. We estimated the 10-year relative survival of patients who were followed-up between 2002 and 2006 using period analysis. Using this 10-year survival, we also calculated the conditional 5-year survival for cancer survivors who lived for some years after diagnosis. We reported 10-year survival and conditional survival of 23 types of cancer for 15–99-year-old patients and four types of cancer for children (0–14 years old) and adolescent and young adults (15–29 years old) patients by sex. Variation in 10-year cancer survival by site was wide, from 5% for pancreatic cancer to 95% for female thyroid cancer. Approximately 70–80% of children and adolescent and young adult cancer patients survived for more than 10 years. Conditional 5-year survival for most cancer sites increased according to years, whereas those for liver cancer and multiple myeloma did not increase. We reported 10-year cancer survival and conditional survival using population-based cancer registries in Japan. It is important for patients and clinicians to report these relevant figures using population-based data. PMID:25183551

  8. Suicide bombing attacks: Can external signs predict internal injuries?

    PubMed

    Almogy, Gidon; Mintz, Yoav; Zamir, Gideon; Bdolah-Abram, Tali; Elazary, Ram; Dotan, Livnat; Faruga, Mohammed; Rivkind, Avraham I

    2006-04-01

    To report the distribution and types of injuries in victims of suicide bombing attacks and to identify external signs that would guide triage and initial management. There is a need for information on the degree to which external injuries indicate internal injuries requiring emergency triage. The medical charts and the trauma registry database of all patients who were admitted to the Hadassah Hospital in Jerusalem from August 2001 to August 2004 following a suicide bombing attack were reviewed and analyzed for injury characteristics, number of body areas injured, presence of blast lung injury (BLI), and need for therapeutic laparotomy. Logistic analysis was performed to identify predictors of BLI and intra-abdominal injury. The study population consisted of 154 patients who were injured as a result of 17 attacks. Twenty-eight patients suffered from BLI (18.2%) and 13 patients (8.4%) underwent therapeutic laparotomy. Patients with penetrating head injury and those with > or =4 body areas injured were significantly more likely to suffer from BLI (odds ratio, 3.47 and 4.12, respectively, P < 0.05). Patients with penetrating torso injury and those with > or =4 body areas injured were significantly more likely to suffer from intra-abdominal injury (odds ratio, 22.27 and 4.89, respectively, P < 0.05). Easily recognizable external signs of trauma can be used to predict the occurrence of BLI and intra-abdominal injury. The importance of these signs needs to be incorporated into triage protocols and used to direct victims to the appropriate level of care both from the scene and in the hospital.

  9. 33 CFR 334.520 - Lake George, Fla.; naval bombing area.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Lake George, Fla.; naval bombing....; naval bombing area. (a) The danger zone. An area in the eastern part of Lake George described as follows.... (2) Prior to each bombing operation the danger zone will be patrolled by naval aircraft which will...

  10. 33 CFR 334.520 - Lake George, Fla.; naval bombing area.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Lake George, Fla.; naval bombing....; naval bombing area. (a) The danger zone. An area in the eastern part of Lake George described as follows.... (2) Prior to each bombing operation the danger zone will be patrolled by naval aircraft which will...

  11. New bomb, no mission

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mello, G.

    1997-05-01

    The cold war may be over, but the nuclear arms race has not quite ended. The United States is fielding a new nuclear weapon-a bomb that was used to threaten Libya, a non-nuclear nation, even before it was deployed. The B61 {open_quotes}mod-11{close_quotes} gravity bomb is the first nuclear capability added to the US arsenal since 1989. It was developed and deployed secretly, without public or congressional debate, and in apparent contradiction to official domestic and international assurances that no new nuclear weapons were being developed in the United States. The B61-11`s unique earth-penetrating characteristic and wide range of yields allowmore » it to threaten otherwide indestructible targets from the air-or, in Pentagonese, to hold such targets {open_quotes}at risk.{close_quotes} That makes the B61-11 a uniquely useful warfighting tool. The 1,200-pound B61-11 replaces the B53, a 8,900-pound, nine-megaton bomb that was developed as a {open_quotes}city buster{close_quotes} and was later designated as a substitute for an earth-penetrating weapon. The B53 was deliverable only by vulnerable B-52s; in contrast, the smaller and lighter B61-11 can be delivered the the stealthier B-2A bomber, or even by F16 fighters.« less

  12. Bomb Blast and Its Consequences: Successful Intensive Care Management of Massive Pulmonary Embolsim.

    PubMed

    Shamim, Faisal; Rizwan, Muhammad; Aziz, Adil

    2016-06-01

    A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit. Based on history, echocardiography findings and patient parameters, a clinical diagnosis of massive pulmonary embolism was made and immediate thrombolytic therapy with alteplase was started. The immediate improvement in hemodynamic status was evident following 2 hours of alteplase infusion. This case also highlights the aggressiveness of resuscitation, decision making in initiating thrombolytic therapy on clinical grounds, importance of deep venous thrombosis prophylaxis, and exhaustion of health resources due to blast related mass destruction.

  13. Going back to home to die: does it make a difference to patient survival?

    PubMed

    Murakami, Nozomu; Tanabe, Kouichi; Morita, Tatsuya; Kadoya, Shinichi; Shimada, Masanari; Ishiguro, Kaname; Endo, Naoki; Sawada, Koichiro; Fujikawa, Yasunaga; Takashima, Rumi; Amemiya, Yoko; Iida, Hiroyuki; Koseki, Shiro; Yasuda, Hatsuna; Kashii, Tatsuhiko

    2015-01-01

    Many patients wish to stay at home during the terminal stage of cancer. However, there is concern that medical care provided at home may negatively affect survival. This study therefore explored whether the survival duration differed between cancer patients who received inpatient care and those who received home care. We retrospectively investigated the place of care/death and survival duration of 190 cancer patients after their referral to a palliative care consultation team in a Japanese general hospital between 2007 and 2012. The patients were classified into a hospital care group consisting of those who received palliative care in the hospital until death, and a home care group including patients who received palliative care at home from doctors in collaboration with the palliative care consultation team. Details of the place of care, survival duration, and patient characteristics (primary site, gender, age, history of chemotherapy, and performance status) were obtained from electronic medical records, and analyzed after propensity score matching in the place of care. Median survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013). Cox's proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status. This study suggests that the general concern that home care shortens the survival duration of patients is not based on evidence. A cohort study including more known prognostic factors is necessary to confirm the results.

  14. Survival in patients with metachronous second primary lung cancer.

    PubMed

    Ha, Duc; Choi, Humberto; Chevalier, Cory; Zell, Katrina; Wang, Xiao-Feng; Mazzone, Peter J

    2015-01-01

    Four to 10% of patients with non-small cell lung cancer subsequently develop a metachronous second primary lung cancer. The decision to perform surveillance or screening imaging for patients with potentially cured lung cancer must take into account the outcomes expected when detecting metachronous second primaries. To assess potential survival differences between patients with metachronous second primary lung cancer compared to matched patients with first primary lung cancer. We retrospectively reviewed patients diagnosed with lung cancer at the Cleveland Clinic (2006-2010). Metachronous second primary lung cancer was defined as lung cancer diagnosed after a 4-year, disease-free interval from the first lung cancer, or if there were two different histologic subtypes diagnosed at different times. Patients with first primary lung cancer diagnosed in the same time period served as control subjects. Propensity score matching was performed using age, sex, smoking history, histologic subtype, and collaborative stage, with a 1:3 case-control ratio. Survival analyses were performed by Cox proportional hazards modeling and Kaplan-Meier estimates. Forty-four patients met criteria for having a metachronous second primary lung cancer. There were no statistically significant differences between case subjects and control subjects in prognostic variables. The median survival time and 2-year overall survival rate for the metachronous second primary group, compared with control subjects, were as follows: 11.8 versus 18.4 months (P = 0.18) and 31.0 versus 40.9% (P = 0.28). The survival difference was largest in those with stage I metachronous second primaries (median survival time, 26.8 vs. 60.4 mo, P = 0.09; 2-year overall survival, 56.3 vs. 71.2%, P = 0.28). Patients with stage I metachronous second primary lung cancer may have worse survival than those who present with a first primary lung cancer. This could influence the benefit-risk balance of screening the high-risk cohort with

  15. Investigation on circular asymmetry of geographical distribution in cancer mortality of Hiroshima atomic bomb survivors based on risk maps: analysis of spatial survival data.

    PubMed

    Tonda, Tetsuji; Satoh, Kenichi; Otani, Keiko; Sato, Yuya; Maruyama, Hirofumi; Kawakami, Hideshi; Tashiro, Satoshi; Hoshi, Masaharu; Ohtaki, Megu

    2012-05-01

    While there is a considerable number of studies on the relationship between the risk of disease or death and direct exposure from the atomic bomb in Hiroshima, the risk for indirect exposure caused by residual radioactivity has not yet been fully evaluated. One of the reasons is that risk assessments have utilized estimated radiation doses, but that it is difficult to estimate indirect exposure. To evaluate risks for other causes, including indirect radiation exposure, as well as direct exposure, a statistical method is described here that evaluates risk with respect to individual location at the time of atomic bomb exposure instead of radiation dose. In addition, it is also considered to split the risks into separate risks due to direct exposure and other causes using radiation dose. The proposed method is applied to a cohort study of Hiroshima atomic bomb survivors. The resultant contour map suggests that the region west to the hypocenter has a higher risk compared to other areas. This in turn suggests that there exists an impact on risk that cannot be explained by direct exposure.

  16. Cardiovascular disease among atomic bomb survivors.

    PubMed

    Ozasa, Kotaro; Takahashi, Ikuno; Grant, Eric J; Kodama, Kazunori

    2017-10-01

    The profile of cardiovascular disease in Japan has been different from that in Western countries. Hypertension was the major cause not only for hemorrhagic stroke but also for ischemic stroke and heart disease in the past, and the influence of hypertension has decreased with calendar years because of reduced salt intake and westernization of lifestyle, and also improved medical care. The health status of atomic bomb survivors has reflected this profile as well as radiation effects. It is also likely that this cohort has been affected by the difficult conditions experienced in the aftermath of the war and atomic bombings. In this article, we tried to make a consistent interpretation of epidemiological findings of atomic bomb radiation effects on cardiovascular disease. Among the atomic bomb survivors, radiation exposure was associated with some cardiovascular diseases that are often associated with hypertension, and dose response appeared to be primarily non-linear among those who were exposed at younger ages. These effects are thought to reflect the nature of whole body irradiation. But, some findings remain inconsistent, possibly because of possible misclassification in death certificate diagnoses in the Life Span Study as well as selected information from the Adult Health Study which was limited to participants, focused on specific outcomes, and gathered in selected periods of follow-up. Therefore, a comprehensive and balanced interpretation of the results from both groups is necessary.

  17. [Survival pronostic factors in Mexican patients with multiforme glioblastoma].

    PubMed

    Hernández-Reyna, Ricardo; Medellín-Sánchez, Roberto; Cerda-Flores, Ricardo M; Calderón-Garcidueñas, Ana Laura

    2010-01-01

    To study the pre- and transoperative factors that influence patients' survival with GM. Clinical and pathological records of all confirmed cases of GM diagnosed between 2000 and 2006 were included. Postoperative survival was divided in less or more than 8 months. χ2 test was used. One hundred and twenty patients (45 women and 75 men) were studied. Age range was from 7 to 85 years, 3.3% were 16 years old or younger and 12.5% were 70 years old or older. Headache was the most frequent complain, 40 patients developed hemiparesia and 6 had parestesias. Predominance of white matter hemispheric lesions was observed: right hemispheric tumors 65 (54%), left lesions 30 (25%) and bilateral tumors 7%. Histologically, 1.6% of GM had a sarcomatous component; 35% of patients survived less than 8 months. A difference between patients survival was the preoperative Karnofsky Performance Scale Score and the degree of cerebral edema during the surgical procedure. Pre-operative Karnofsky evaluation and edema during the surgical procedure were significant prognostic factors for survival.

  18. Biomarkers of Radiosensitivity in A-Bomb Survivors Pregnant at the Time of Bombings in Hiroshima and Nagasaki

    DOE PAGES

    Miles, Edward F.; Tatsukawa, Yoshimi; Funamoto, Sachiyo; ...

    2011-01-01

    Purpose . There is evidence in the literature of increased maternal radiosensitivity during pregnancy. Materials and Methods . We tested this hypothesis using information from the atomic-bomb survivor cohort, that is, the Adult Health Study database at the Radiation Effects Research Foundation, which contains data from a cohort of women who were pregnant at the time of the bombings of Hiroshima and Nagasaki. Previous evaluation has demonstrated long-term radiation dose-response effects. Results/Conclusions . Data on approximately 250 women were available to assess dose-response rates for serum cholesterol, white blood cell count, erythrocyte sedimentation rate, and serum hemoglobin, and on approximatelymore » 85 women for stable chromosome aberrations, glycophorin A locus mutations, and naïve CD4 T-cell counts. Although there is no statistically significant evidence of increased radiosensitivity in pregnant women, the increased slope of the linear trend line in the third trimester with respect to stable chromosome aberrations is suggestive of an increased radiosensitivity.« less

  19. Improved survival among older acute myeloid leukemia patients - a population-based study.

    PubMed

    Shah, Binay Kumar; Ghimire, Krishna Bilas

    2014-07-01

    Survival in acute myeloid leukemia (AML) has improved in younger patients over the last decade. This study was conducted to evaluate the relative survival rates in older AML patients over two decades in the US. We analyzed Surveillance, Epidemiology, and End Results (SEER) registry database to evaluate relative survival rate in older (≥ 75 years) AML population diagnosed during 1992-2009. We selected AML patients from 13 registries of SEER 18 database to compare RS during 1992-2000 and 2001-2009. The relative survival rates improved significantly during 2001-2009 compared to 1992-2000 for all age groups and sex. For young elderly patients (75-84 years) RS increased from 13.1 ± 0.8% to 17.4 ± 0.9% at one year Z-value = 3.98, p < 0.0001 and from 2.0 ± 0.4 to 2.6 ± 0.5%, Z-value = 3.61, p < 0.0005 at five years. Similarly, for very elderly (≥ 85 years) patients RS increased from 5.3 ± 1.0% to 8.0 ± 1.0%, Z-value = 3.03, p < 0.005 at one year, but no improvement seen at five years. The relative survival in elderly AML has increased significantly during 2001-2009 compared to 1992-2000.

  20. Simultaneous observations of Ellerman bombs by NST and IRIS

    NASA Astrophysics Data System (ADS)

    Kim, Y. H.; Yurchyshyn, V.; Cho, I. H.; Lee, J.; Park, Y. D.; Yang, H.; Ahn, K.; Goode, P.

    2015-12-01

    In this study, we present the simultaneous observations of Ellerman bombs made by New Solar Telescope (NST) of Big Bear Solar Observatory (BBSO) and Interface Region Imaging Spectrograph (IRIS) in space. The data obtained during joint NST-IRIS observations on 30 and 31 in July 2014. We observed two representative events on both days. The first one was a relatively weak Ellerman bomb occurred around 19:20 UT on 30 July 2014. IRIS observed this event by sit-and-stare mode thus we analyzed high cadence spectral data and slit-jaw data simultaneously. We found that this event was a hot explosion that occurred by magnetic reconnection in the lower atmosphere of the Sun. The second event was quite strong Ellerman bomb (20:20 UT on 31 July 2014) that is well observed by NST FISS (Fast Imaging Solar Spectrograph), while there was no IRIS spectral data. We had IRIS slit-jaw data only. The Ellerman bomb was clearly coincident with the IRIS brightening at the same location. Since the Ellerman bombs are usually believed to occur in the photosphere with no coronal emission, it should be explained its higher atmospheric emission in IRIS data. We will present the result of simultaneous observations by IRIS and NST instruments and discuss physical connection between Ellerman bombs and IRIS brightenings.

  1. Significance of genomic instability in breast cancer in atomic bomb survivors: analysis of microarray-comparative genomic hybridization.

    PubMed

    Oikawa, Masahiro; Yoshiura, Koh-ichiro; Kondo, Hisayoshi; Miura, Shiro; Nagayasu, Takeshi; Nakashima, Masahiro

    2011-12-07

    It has been postulated that ionizing radiation induces breast cancers among atomic bomb (A-bomb) survivors. We have reported a higher incidence of HER2 and C-MYC oncogene amplification in breast cancers from A-bomb survivors. The purpose of this study was to clarify the effect of A-bomb radiation exposure on genomic instability (GIN), which is an important hallmark of carcinogenesis, in archival formalin-fixed paraffin-embedded (FFPE) tissues of breast cancer by using microarray-comparative genomic hybridization (aCGH). Tumor DNA was extracted from FFPE tissues of invasive ductal cancers from 15 survivors who were exposed at 1.5 km or less from the hypocenter and 13 calendar year-matched non-exposed patients followed by aCGH analysis using a high-density oligonucleotide microarray. The total length of copy number aberrations (CNA) was used as an indicator of GIN, and correlation with clinicopathological factors were statistically tested. The mean of the derivative log ratio spread (DLRSpread), which estimates the noise by calculating the spread of log ratio differences between consecutive probes for all chromosomes, was 0.54 (range, 0.26 to 1.05). The concordance of results between aCGH and fluorescence in situ hybridization (FISH) for HER2 gene amplification was 88%. The incidence of HER2 amplification and histological grade was significantly higher in the A-bomb survivors than control group (P = 0.04, respectively). The total length of CNA tended to be larger in the A-bomb survivors (P = 0.15). Correlation analysis of CNA and clinicopathological factors revealed that DLRSpread was negatively correlated with that significantly (P = 0.034, r = -0.40). Multivariate analysis with covariance revealed that the exposure to A-bomb was a significant (P = 0.005) independent factor which was associated with larger total length of CNA of breast cancers. Thus, archival FFPE tissues from A-bomb survivors are useful for genome-wide aCGH analysis. Our results suggested that A-bomb

  2. Significance of genomic instability in breast cancer in atomic bomb survivors: analysis of microarray-comparative genomic hybridization

    PubMed Central

    2011-01-01

    Background It has been postulated that ionizing radiation induces breast cancers among atomic bomb (A-bomb) survivors. We have reported a higher incidence of HER2 and C-MYC oncogene amplification in breast cancers from A-bomb survivors. The purpose of this study was to clarify the effect of A-bomb radiation exposure on genomic instability (GIN), which is an important hallmark of carcinogenesis, in archival formalin-fixed paraffin-embedded (FFPE) tissues of breast cancer by using microarray-comparative genomic hybridization (aCGH). Methods Tumor DNA was extracted from FFPE tissues of invasive ductal cancers from 15 survivors who were exposed at 1.5 km or less from the hypocenter and 13 calendar year-matched non-exposed patients followed by aCGH analysis using a high-density oligonucleotide microarray. The total length of copy number aberrations (CNA) was used as an indicator of GIN, and correlation with clinicopathological factors were statistically tested. Results The mean of the derivative log ratio spread (DLRSpread), which estimates the noise by calculating the spread of log ratio differences between consecutive probes for all chromosomes, was 0.54 (range, 0.26 to 1.05). The concordance of results between aCGH and fluorescence in situ hybridization (FISH) for HER2 gene amplification was 88%. The incidence of HER2 amplification and histological grade was significantly higher in the A-bomb survivors than control group (P = 0.04, respectively). The total length of CNA tended to be larger in the A-bomb survivors (P = 0.15). Correlation analysis of CNA and clinicopathological factors revealed that DLRSpread was negatively correlated with that significantly (P = 0.034, r = -0.40). Multivariate analysis with covariance revealed that the exposure to A-bomb was a significant (P = 0.005) independent factor which was associated with larger total length of CNA of breast cancers. Conclusions Thus, archival FFPE tissues from A-bomb survivors are useful for genome-wide a

  3. Algebraically special resonances of the Kerr-black-hole-mirror bomb

    NASA Astrophysics Data System (ADS)

    Hod, Shahar

    2013-12-01

    A corotating bosonic field interacting with a spinning Kerr black hole can extract rotational energy and angular momentum from the hole. This intriguing phenomenon is known as superradiant scattering. As pointed out by Press and Teukolsky, the black-hole-field system can be made unstable (explosive) by placing a reflecting mirror around the black hole, which prevents the extracted energy from escaping to infinity. This composed black-hole-mirror-field bomb has been studied extensively by many researchers. It is worth noting, however, that most former studies of the black-hole bomb phenomenon have focused on the specific case of confined scalar (spin-0) fields. In the present study we explore the physical properties of the higher-spin (electromagnetic and gravitational) black-hole bombs. It is shown that this composed system is amenable to an analytic treatment in the physically interesting regime of rapidly rotating black holes. In particular, we prove that the composed black-hole-mirror-field bomb is characterized by the unstable resonance frequency ω=mΩH+is·2πTBH (here s and m are, respectively, the spin parameter and the azimuthal harmonic index of the field, and ΩH and TBH are, respectively, the angular-velocity and the temperature of the rapidly spinning black hole). Our results provide evidence that the higher-spin (electromagnetic and gravitational) black-hole-mirror bombs are much more explosive than the extensively studied scalar black-hole-mirror bomb. In particular, it is shown here that the instability growth rates that characterize the higher-spin black-hole bombs are 2 orders of magnitude larger than the instability growth rate of the scalar black-hole bomb.

  4. Imaginary Savior: the image of the nuclear bomb in Korea, 1945-1960.

    PubMed

    Kim, Dong-Won

    2009-01-01

    Two atomic bombs dropped on Hiroshima and Nagasaki in August 1945 brought the unexpected liberation of Korea from the 35-year Japanese occupation. Koreans therefore had a very favorable and positive image of the nuclear bomb and nuclear energy from the beginning. The image of the nuclear bomb as "savior" was strengthened during the Korean War when the United States openly mentioned the possible use of the nuclear bomb against North Korean and Chinese military. After the end of the Korean War in July 1953 South Koreans strongly supported the development of the nuclear bomb in order to deter another North Korean invasion. When the US government provided South Korea with a research nuclear reactor in the late 1950s, most South Koreans hailed it as the first step to developing their own nuclear bomb. This paper will analyze how and why the savior image of the nuclear bomb originated and spread in Korea during the 1950s.

  5. Increased survival and decreased recurrence in colorectal cancer patients diagnosed in a screening programme.

    PubMed

    Mengual-Ballester, Mónica; Pellicer-Franco, Enrique; Valero-Navarro, Graciela; Soria-Aledo, Victoriano; García-Marín, José Andrés; Aguayo-Albasini, José Luis

    2016-08-01

    Population-based screening programmes for colorectal cancer (CRC) allow an early diagnosis, even before the onset of symptoms, but there are few studies and none in Spain on the influence they have on patient survival. The aim of the present study is to show that patients receiving surgery for CRC following diagnosis via a screening programme have a higher survival and disease-free survival rate than those diagnosed in the symptomatic stage. Prospective study of all the patients undergoing programmed surgery for CRC at the JM Morales Meseguer Hospital in Murcia (Spain) between 2004 and 2010. The patients were divided into two groups: (a) those diagnosed through screening (125 cases); and (b) those diagnosed in the symptomatic stage (565 cases). Survival and disease-free survival were analysed and compared for both groups using the Mantel method. The screen-detected CRC patients show a higher rate of survival (86.3% versus 72.1% at 5 years, p<0.05) and a lower rate of tumour recurrence (73.4% versus 88.3% at 5 years, p<0.05). Population-based screening for CRC is an effective strategic measure for reducing mortality specific to this neoplasia. Copyright © 2016. Published by Elsevier Ltd.

  6. The Freezing Bomb

    ERIC Educational Resources Information Center

    Mills, Allan

    2010-01-01

    The extreme pressures that are generated when water freezes were traditionally demonstrated by sealing a small volume in a massive cast iron "bomb" and then surrounding it with a freezing mixture of ice and salt. This vessel would dramatically fail by brittle fracture, but no quantitative measurement of bursting pressure was available. Calculation…

  7. Important risk factors of allograft survival in cadaveric renal transplantation. A study of 426 patients.

    PubMed Central

    Diethelm, A G; Blackstone, E H; Naftel, D C; Hudson, S L; Barber, W H; Deierhoi, M H; Barger, B O; Curtis, J J; Luke, R G

    1988-01-01

    Multiple risk factors contribute to the allograft survival of patients who have cadaveric renal transplantation. A retrospective review of 19 such factors in 426 patients identified race, DR match, B + DR match, number of transplants, and preservation time to have a significant influence. The parametric analysis confirmed the effect to be primarily in the early phase, i.e., first 6 months. All patients received cyclosporine with other methods of immunosuppression resulting in an overall 1-year graft survival rate of 66%. The overall 1-year graft survival rate in the white race was 73% and in the black race was 57% (p = 0.002). Allograft survival and DR match showed white recipients with a 1 DR match to have 75% survival at 1 year compared with 57% in the black patient (p = 0.009). If HLA B + DR match was considered, the white recipient allograft survival increased to 76%, 84%, and 88% for 1, 2, and 3 match kidneys by parametric analysis. Patients receiving first grafts had better graft survival (68%) than those undergoing retransplantation (58%) (p = 0.05). Organ preservation less than 12 hours influenced allograft survival with a 78% 1-year survival rate compared with 63% for kidneys with 12-18 hours of preservation. Despite the benefits of B + DR typing, short preservation time, and first transplants to the white recipient, the allograft survival in the black recipient remained uninfluenced by these parameters. PMID:3288138

  8. Factors associated with injury severity in Oklahoma City bombing survivors.

    PubMed

    Glenshaw, Mary T; Vernick, Jon S; Li, Guohua; Sorock, Gary S; Brown, Sheryll; Mallonee, Sue

    2009-02-01

    Terrorist bombings are an increasing source of violent death and injury worldwide. Injuries in building bombings have been previously reported in descriptive studies, but no comparative analyses have quantitatively assessed factors influencing the severity of nonfatal bombing injuries. The objective of this study was to identify personal and environmental risk factors for injury severity in the Oklahoma City bombing, on April 19, 1995. We conducted a retrospective comparative analysis of 509 nonfatally injured occupants of four buildings surrounding the detonation site. The source of data was the 1995 Oklahoma City Bombing database, a registry of all injuries and fatalities related to the bombing. Multivariable logistic regression was used to assess two outcomes: (1) medically-attended injury among injured occupants; and (2) hospital admission among occupants with medically attended injuries. Increased odds of sustaining medically attended injuries were associated with being struck by flying glass (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI], 1.9-14.8) and location above the first floor of buildings (OR, 4.0; 95% CI, 1.4-11.7) after adjustment for other factors. Adjusted odds of hospital admission were associated with location in the collapsed region (AOR, 43.4; 95% CI, 4.4-434.1), being blown by the blast wind (AOR, 5.3; 95% CI, 2.1-13.8), and being trapped (AOR, 3.1; 95% CI, 1.2-7.7). The severity of nonfatal injury in the Oklahoma bombing was primarily associated with structural and environmental factors. Improved architectural design may prevent many injuries in building bombings. These finding provide evidence for future injury prevention activities.

  9. Estimate of survival of patients admitted to a palliative care unit: a prospective study.

    PubMed

    Bruera, E; Miller, M J; Kuehn, N; MacEachern, T; Hanson, J

    1992-02-01

    In a prospective open study, 61 consecutive patients with advanced cancer admitted to a Palliative Care Unit underwent survival estimation by two independent physicians after a complete medical exam performed during the first day of admission. An independent research nurse also assessed each patient during the first day of admission. The assessment included activity, pain, nausea, depression, anxiety, anorexia, dry mouth, dyspnea, dysphagia, weight loss, and cognitive status. After the assessment was completed, patients were followed until discharge or death. In 47 evaluable patients, logistic regression showed a significant correlation between survival and dysphagia, cognitive failure, and weight loss. Accordingly, an "indicator of poor prognosis" was considered to exist in any patient who demonstrated weight loss of 10 kg or more plus cognitive failure (Mini-Mental State Questionnaire less than 24) plus dysphagia to solids or liquids. This indicator had a similar level of sensitivity, specificity, and overall accuracy, and a higher level of significance as compared with the assessment by physician #1 and physician #2, respectively. Our data suggest that three simple determinations, which may be performed by a nurse, can predict survival more or less than 4 wk as well as the assessments of two skilled physicians. These results need to be confirmed in other trials with large numbers of patients. Perhaps confirmation of these results and identification of other prognostic factors will result in staging systems for survival estimation of terminally ill cancer patients.

  10. Tobacco Cessation May Improve Lung Cancer Patient Survival.

    PubMed

    Dobson Amato, Katharine A; Hyland, Andrew; Reed, Robert; Mahoney, Martin C; Marshall, James; Giovino, Gary; Bansal-Travers, Maansi; Ochs-Balcom, Heather M; Zevon, Michael A; Cummings, K Michael; Nwogu, Chukwumere; Singh, Anurag K; Chen, Hongbin; Warren, Graham W; Reid, Mary

    2015-07-01

    This study characterizes tobacco cessation patterns and the association of cessation with survival among lung cancer patients at Roswell Park Cancer Institute: an NCI Designated Comprehensive Cancer Center. Lung cancer patients presenting at this institution were screened with a standardized tobacco assessment, and those who had used tobacco within the past 30 days were automatically referred to a telephone-based cessation service. Demographic, clinical information, and self-reported tobacco use at last contact were obtained via electronic medical records and the Roswell Park Cancer Institute tumor registry for all lung cancer patients referred to the service between October 2010 and October 2012. Descriptive statistics and Cox proportional hazards models were used to assess whether tobacco cessation and other factors were associated with lung cancer survival through May 2014. Calls were attempted to 313 of 388 lung cancer patients referred to the cessation service. Eighty percent of patients (250 of 313) were successfully contacted and participated in at least one telephone-based cessation call; 40.8% (102 of 250) of persons contacted reported having quit at the last contact. After controlling for age, pack year history, sex, Eastern Cooperative Oncology Group performance status, time between diagnosis and last contact, tumor histology, and clinical stage, a statistically significant increase in survival was associated with quitting compared with continued tobacco use at last contact (HR = 1.79; 95% confidence interval: 1.14-2.82) with a median 9 month improvement in overall survival. Tobacco cessation among lung cancer patients after diagnosis may increase overall survival.

  11. Tobacco Cessation May Improve Lung Cancer Patient Survival

    PubMed Central

    Dobson Amato, Katharine A.; Hyland, Andrew; Reed, Robert; Mahoney, Martin C.; Marshall, James; Giovino, Gary; Bansal-Travers, Maansi; Ochs-Balcom, Heather M.; Zevon, Michael A.; Cummings, K. Michael; Nwogu, Chukwumere; Singh, Anurag K.; Chen, Hongbin; Warren, Graham W.; Reid, Mary

    2015-01-01

    Introduction This study characterizes tobacco cessation patterns and the association of cessation with survival among lung cancer patients at Roswell Park Cancer Institute: an NCI Designated Comprehensive Cancer Center. Methods Lung cancer patients presenting at this institution were screened with a standardized tobacco assessment, and those who had used tobacco within the past 30 days were automatically referred to a telephone-based cessation service. Demographic, clinical information and self-reported tobacco use at last contact were obtained via electronic medical records and the RPCI tumor registry for all lung cancer patients referred to the service between October 2010 and October 2012. Descriptive statistics and Cox proportional hazards models were used to assess whether tobacco cessation and other factors were associated with lung cancer survival through May 2014. Results Calls were attempted to 313 of 388 lung cancer patients referred to the cessation service. Eighty percent of patients (250/313) were successfully contacted and participated in at least one telephone-based cessation call; 40.8% (102/250) of persons contacted reported having quit at the last contact. After controlling for age, pack year history, sex, ECOG performance status, time between diagnosis and last contact, tumor histology, and clinical stage, a statistically significant increase in survival was associated with quitting compared to continued tobacco use at last contact (HR=1.79; 95% CI: 1.14-2.82) with a median 9 month improvement in overall survival. Conclusions Tobacco cessation among lung cancer patients after diagnosis may increase overall survival. PMID:26102442

  12. Illness perceptions predict survival in haemodialysis patients.

    PubMed

    Chilcot, Joseph; Wellsted, David; Farrington, Ken

    2011-01-01

    Illness perceptions have been shown to be important determinants of functional and psychosocial outcomes, including quality of life and treatment adherence in end-stage renal disease patients. The aim of this prospective study was to determine whether haemodialysis patients' illness perceptions impact upon survival. Haemodialysis patients from a UK renal service completed the Revised Illness Perception Questionnaire. Over the study period (May 2007 to December 2010), all-cause mortality was recorded as the endpoint. 223 patients were followed up for a median of 15.9 months (min. 10 days, max. 42.7 months). The median dialysis vintage was 17.6 months (min. 4 days, max. 391.3 months). Treatment control perceptions demonstrated a significant association with mortality (HR = 0.91, 95% CI: 0.83-0.99, p = 0.03). After controlling for covariates, including age, albumin, extra renal comorbidity and depression scores, perception of treatment control remained a significant predictor of mortality (HR = 0.89, 95% CI: 0.80-0.99, p = 0.03). Patients' perceptions of treatment control (dialysis therapy) predict survival independently of survival risk factors, including comorbidity. Studies are required to test whether psychological interventions designed to modify maladaptive illness perceptions influence clinical outcomes in this patient setting. Copyright © 2011 S. Karger AG, Basel.

  13. Survival factors of hospitalized out-of-hospital cardiac arrest patients in Taiwan: A retrospective study.

    PubMed

    Lai, Chung-Yu; Lin, Fu-Huang; Chu, Hsin; Ku, Chih-Hung; Tsai, Shih-Hung; Chung, Chi-Hsiang; Chien, Wu-Chien; Wu, Chun-Hsien; Chu, Chi-Ming; Chang, Chi-Wen

    2018-01-01

    The chain of survival has been shown to improve the chances of survival for victims of cardiac arrest. Post-cardiac arrest care has been demonstrated to significantly impact the survival of out-of-hospital cardiac arrest (OHCA). How post-cardiac arrest care influences the survival of OHCA patients has been a main concern in recent years. The objective of this study was to assess the survival outcome of hospitalized OHCA patients and determine the factors associated with improved survival in terms of survival to discharge. We conducted a retrospective observational study by analyzing records from the National Health Insurance Research Database of Taiwan from 2007 to 2013. We collected cases with an International Classification of Disease Clinical Modification, 9th revision primary diagnosis codes of 427.41 (ventricular fibrillation, VF) or 427.5 (cardiac arrest) and excluded patients less than 18 years old, as well as cases with an unknown outcome or a combination of traumatic comorbidities. We then calculated the proportion of survival to discharge among hospitalized OHCA patients. Factors associated with the dependent variable were examined by logistic regression. Statistical analysis was conducted using SPSS 22 (IBM, Armonk, NY). Of the 11,000 cases, 2,499 patients (22.7%) survived to hospital discharge. The mean age of subjects who survived to hospital discharge and those who did not was 66.7±16.7 and 71.7±15.2 years, respectively. After adjusting for covariates, neurological failure, cardiac comorbidities, hospital level, intensive care unit beds, transfer to another hospital, and length of hospital stay were independent predictors of improved survival. Cardiac rhythm on admission was a strong factor associated with survival to discharge (VF vs. non-VF: adjusted odds ratio: 3.51; 95% confidence interval: 3.06-4.01). In conclusion, cardiac comorbidities, hospital volume, cardiac rhythm on admission, transfer to another hospital and length of hospital stay had

  14. Survival and predictors of death among primary immunodeficient patients: a registry-based study.

    PubMed

    Al-Herz, Waleed; Moussa, Mohamed A A

    2012-06-01

    The aims of this study were to investigate survival among patients with primary immunodeficiency disorders (PID) in Kuwait and to determine whether certain variables were associated with increased risk of death. The data of 176 patients (98 males and 78 females) were extracted from the Kuwait National Primary Immunodeficiency Disorders Registry and the observation period was from January 2004 to July 2011. The distribution of the reported patients was combined T- and B-cell immunodeficiencies (30.1%), predominantly antibody immunodeficiency (19.9%), other well-defined immunodeficiencies (25%), diseases of immune dysregulation (14.8%), congenital defects of phagocyte number, function or both (6.25%), and complement deficiencies (4.0%). In a total of 619.1 patient-years at risk, 48 patients died (mortality incidence rate 77.53 per 1,000 person-years). The overall survival in the studied cohort was 72.7% (72.4% for males and 73.1% for females). The most common cause of death was sepsis (46%) followed by pneumonia (29%). The probabilities that a patient survived 2, 4, and 6 years after onset of symptoms were 76%, 73%, and 69%, respectively. The variables that were found to be predictors for death are parental consanguinity, sepsis, adenovirus and CMV infections, failure to thrive, PID category, and onset age <6 months. Patients with PID have decreased probabilities of survival that are variable between PID categories. Early diagnosis and aggressive therapeutic interventions specifically of patients with history of the variables associated with increased risk of death may help increase their chance of survival.

  15. Environmental Composites for Bomb Cyclones of the Western North Atlantic in Reanalysis, 1948-2016.

    NASA Astrophysics Data System (ADS)

    Adams, R.; Sheridan, S. C.

    2017-12-01

    "Bomb" cyclones represent a small subset of mid-latitude cyclones characterized by rapid intensification and frequently are associated with extreme weather conditions along the eastern coast of North America. Like other extreme phenomena, bomb cyclone predictions are prone to error leading to inadequate or untimely hazard warnings. The rare nature of bomb cyclones and the uniqueness of their evolutions has made it difficult for researchers to make meaningful generalizations on bomb cyclone events. This paper describes bomb cyclone climatology for the western North Atlantic, using data from the NCEP-NCAR Reanalysis for 1948-2016, and uses a synoptic climatological analysis to relate these bombs to their associated atmospheric environments. A self-organizing map (SOM) of 300-hPa geopotential height tendency is created to partition the regional atmospheric environment. Thermodynamic fields are contrasted by each 300-hPa geopotential height tendency pattern for both bomb and non-bomb events in composite difference maps. The SOM patterns most significantly associated with western North Atlantic bomb cyclogenesis are characterized by both strongly and weakly negative height tendencies along the eastern United States. In both cases, these patterns exhibit strong meridional flow, a distinction marked by the weakening and breaking down of the polar vortex in the boreal Winter. The composite maps for each pattern show the mean differences in low-mid level ascent and near surface thermodynamics for bomb environments contrasted with non-bomb environments, resulting in diverse spatiotemporal distributions of bombs in the western North Atlantic.

  16. A toy model for the yield of a tamped fission bomb

    NASA Astrophysics Data System (ADS)

    Reed, B. Cameron

    2018-02-01

    A simple expression is developed for estimating the yield of a tamped fission bomb, that is, a basic nuclear weapon comprising a fissile core jacketed by a surrounding neutron-reflecting tamper. This expression is based on modeling the nuclear chain reaction as a geometric progression in combination with a previously published expression for the threshold-criticality condition for such a core. The derivation is especially straightforward, as it requires no knowledge of diffusion theory and should be accessible to students of both physics and policy. The calculation can be set up as a single page spreadsheet. Application to the Little Boy and Fat Man bombs of World War II gives results in reasonable accord with published yield estimates for these weapons.

  17. Recipient age as a determinant factor of patient and graft survival.

    PubMed

    Moreso, Francesc; Ortega, Francisco; Mendiluce, Alicia

    2004-06-01

    Age of renal transplants has been related to death, alloimmune response and graft outcome. We reviewed the influence of patient age on transplant outcome in three cohorts of patients transplanted in Spain during the 1990 s. Patient age was categorized into four groups (I, 18-40; II, 41-50; III, 51-60; and IV, > 60 years). Risks factors for acute rejection were evaluated by logistic regression adjusting for transplant centre and transplantation year, while a Cox proportional hazard model was employed for analysing patient and graft survival. Older patients had a higher death rate (I, 3.5%; II, 7.7%; III, 13.2%; and IV, 16.9%; P<0.001), but a lower standardized mortality index (I, 7.6; II, 7.0; III, 5.8; and IV, 4.1; P = 0.0019). Older patients had the lowest risk of acute rejection [odds ratio (OR) 0.79 and 95% confidence interval (CI) 0.66-0.97 for group II; OR 0.75 and 95% CI 0.62-0.91 for group III; OR 0.43 and 95% CI 0.33-0.56 for group IV). Death-censored graft survival was poorer in patients older than 60 years (relative risk 1.40; 95% CI 1.09-1.80), but this result was not explained by any combination of patient age with donor age, delayed graft function or immunosuppression. Patient age is a main determinant of transplant outcome. Although death rate is higher for older patients, standardized mortality was not. Thus, the efforts to reduce mortality should be also implemented in younger patients. Old patients have a low risk of acute rejection but a poorer death-censored graft survival. This last result was not explained by any controlled variable in our study.

  18. Marital status and survival in patients with renal cell carcinoma.

    PubMed

    Li, Yan; Zhu, Ming-Xi; Qi, Si-Hua

    2018-04-01

    Previous studies have shown that marital status is an independent prognostic factor for survival in several types of cancer. In this study, we investigated the effects of marital status on survival outcomes among renal cell carcinoma (RCC) patients.We identified patients diagnosed with RCC between 1973 and 2013 from the Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier analysis and Cox regression were used to identify the effects of marital status on overall survival (OS) and cancer-specific survival (CSS).We enrolled 97,662 eligible RCC patients, including 64,884 married patients, and 32,778 unmarried (9831 divorced/separated, 9692 widowed, and 13,255 single) patients at diagnosis. The 5-year OS and CSS rates of the married, separated/divorced, widowed, and single patients were 73.7%, 69.5%, 58.3%, and 73.2% (OS), and 82.2%, 80.7%, 75.7%, and 83.3% (CSS), respectively. Multivariate Cox regression showed that, compared with married patients, widowed individuals showed poorer OS (hazard ratio, 1.419; 95% confidence interval, 1.370-1.469) and CSS (hazard ratio, 1.210; 95% confidence interval, 1.144-1.279). Stratified analyses and multivariate Cox regression showed that, in the insured and uninsured groups, married patients had better survival outcomes while widowed patients suffered worse OS outcomes; however, this trend was not significant for CSS.In RCC patients, married patients had better survival outcomes while widowed patients tended to suffer worse survival outcomes in terms of both OS and CSS.

  19. PSYCHIATRIC MORBIDITY AMONG VICTIMS OF BOMB BLAST

    PubMed Central

    Gautam, Shiv; Gupta, I.D.; Batra, Lalit; Sharma, Himanshiu; Khandelwal, Rakesh; Pant, Anshuman

    1998-01-01

    Thirty one victims of bomb blast in a bus caused by terrorist activity in Dausa district, Rajasthan on 22.5.96, were evaluated for psychological reactions 3 days & 2 weeks after the incident. All hospitalized & non hospitalised bomb blast victims were assessed within 3 days of injury by objective predictors (percent of burnt area, facial disfigurement, limb amputations, fractures etc.) and subjective predictors (emotional distress and perceived social support). Detailed history, physical and mental state examination of all patients was carried out and for those having scores more then 17 on GHQ-60 (Hindi version), IPIS was administered. Diagnosis was made by 3 senior consultant psychiatrists of Psychiatric Centre, Jaipur, on the basis oflCD-10. At day 3 of 31 patients studied 11 (35.45%) had psychiatric morbidity. Out of which 6 (19.35%) had acute stress reaction, 3 (9.68%) had depression and 2 (6.45%) dissociative amnesia. Most commonly reported symptoms on IPIS were depersonalisation, derealisation, sleep disturbances specially generalised sleep loss, loss of appetite, nightmares, situational anxiety, depression, mental irritability, dulness of feelings, self blame, guilt, loss of interest, suicidal ideas, and worry about money, spouse, work and children. Most common physical injury was burns, followed by hearing disturbances, wounds received due to glass <& metal pieces and non specific pains and aches. Findings of follow up have been discussed and battery of tests for evaluation of victims of acute trauma has been suggested. PMID:21494441

  20. The bomb 14C transient in the Pacific Ocean

    NASA Astrophysics Data System (ADS)

    Rodgers, Keith B.; Schrag, Daniel P.; Cane, Mark A.; Naik, Naomi H.

    2000-04-01

    A modeling study of the bomb 14C transient is presented for the Pacific Ocean. A primitive equation ocean circulation model has been configured for a high-resolution domain that accounts for the Indonesian Throughflow (ITF). Four separate runs were performed: (1) seasonal forcing with 20 Sv of ITF transport, (2) seasonal forcing with 10 Sv of ITF transport, (3) seasonal forcing with no ITF transport, and (4) interannual forcing with 15 Sv of ITF transport. This study has two main objectives. First, it is intended to describe the time evolution of the bomb 14C transient. This serves as a tool with which one can identify the physical processes controlling the evolving bomb 14C distribution in the Pacific thermocline and thus provides an interpretive framework for the database of Δ14C measurements in the Pacific. Second, transient tracers are applied to the physical oceanographic problem of intergyre exchange. This is of importance in furthering our understanding of the potential role of the upper Pacific Ocean in climate variability. We use bomb 14C as a dye tracer of intergyre exchange between the subtropical gyres and the equatorial upwelling regions of the equatorial Pacific. Observations show that while the atmospheric Δ14C signal peaked in the early to mid-1960s, the Δ14C levels in the surface water waters of the subtropical gyres peaked near 1970, and the Δ14C of surface waters in the equatorial Pacific continued to rise through the 1980s. It is shown that the model exhibits skill in representing the large-scale observed features observed for the bomb 14C transient in the Pacific Ocean. The model successfully captures the basin-scale inventories of bomb 14C in the tropics as well as in the extratropics of the North Pacific. For the equatorial Pacific this is attributed to the model's high meridional resolution. The discrepancies in the three-dimensional distribution of bomb 14C between the model and data are discussed within the context of the dynamical

  1. Slow fuze on the neutron bomb

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Frye, A.

    The U.S. government has wrestled with the neutron bomb's production and its potential bargaining powers for years. President Carter's decision not to decide about the neutron bomb has now provoked a furor. The alarm focuses more on the politics of the decision than on its moral, military, and strategic aspects. The political reaction to Carter's deferring production may virtually compel him to produce neutron warheads eventually, unless the Soviet Union displays compensating restraint in the coming months. While the Kremlin has indicated a willingness to forgo production of similar weapons of its own, it is unlikely to accept American demandsmore » for other concessions, such as a limit on Soviet SS-20 missile deployments. Since the issue has not been settled, but merely postponed, further thought should be given to the potential costs and benefits of an eventual deployment. Following a lengthy discussion of all aspects of the issue, the answers for the use of the neutron bomb and as to whether it will make Europe and America more secure remain unanswered. (MCW)« less

  2. Captives of Their Fantasies: The German Atomic Bomb Scientists

    NASA Astrophysics Data System (ADS)

    Klotz, Irving M.

    1997-02-01

    When the Nazi government collapsed in May, 1945, an Allied intelligence mission took into custody nine of the German scientists who played key roles in the German atomic bomb project. Under great secrecy these men were confined in a large country house, Farm Hall, near Cambridge (England), and their conversations were recorded surreptitiously by hidden microphones in every room. The transcripts were kept TOP SECRET for 47 years and were finally released recently. They give fascinating insights into the personalities of the guests and invaluable information on what the Germans really understood about the physics and chemistry of a nuclear reactor and an atomic bomb. The Farm Hall transcripts clearly establish that (a) the Germans on August 6, 1945 did not believe that the Allies had exploded an atomic bomb over Hiroshima that day; (b) they never succeeded in constructing a self-sustaining nuclear reactor; (c) they were confused about the differences between an atomic bomb and a reactor; (d) they did not know how to correctly calculate the critical mass of a bomb; (e) they thought that "plutonium" was probably element 91. The Farm Hall transcripts contradict the self-serving and sensationalist writings about German efforts that have appeared during the past fifty years.

  3. Proposal and validation of a new model to estimate survival for hepatocellular carcinoma patients.

    PubMed

    Liu, Po-Hong; Hsu, Chia-Yang; Hsia, Cheng-Yuan; Lee, Yun-Hsuan; Huang, Yi-Hsiang; Su, Chien-Wei; Lee, Fa-Yauh; Lin, Han-Chieh; Huo, Teh-Ia

    2016-08-01

    The survival of hepatocellular carcinoma (HCC) patients is heterogeneous. We aim to develop and validate a simple prognostic model to estimate survival for HCC patients (MESH score). A total of 3182 patients were randomised into derivation and validation cohort. Multivariate analysis was used to identify independent predictors of survival in the derivation cohort. The validation cohort was employed to examine the prognostic capabilities. The MESH score allocated 1 point for each of the following parameters: large tumour (beyond Milan criteria), presence of vascular invasion or metastasis, Child-Turcotte-Pugh score ≥6, performance status ≥2, serum alpha-fetoprotein level ≥20 ng/ml, and serum alkaline phosphatase ≥200 IU/L, with a maximal of 6 points. In the validation cohort, significant survival differences were found across all MESH scores from 0 to 6 (all p < 0.01). The MESH system was associated with the highest homogeneity and lowest corrected Akaike information criterion compared with Barcelona Clínic Liver Cancer, Hong Kong Liver Cancer (HKLC), Cancer of the Liver Italian Program, Taipei Integrated Scoring and model to estimate survival in ambulatory HCC Patients systems. The prognostic accuracy of the MESH scores remained constant in patients with hepatitis B- or hepatitis C-related HCC. The MESH score can also discriminate survival for patients from early to advanced stages of HCC. This newly proposed simple and accurate survival model provides enhanced prognostic accuracy for HCC. The MESH system is a useful supplement to the BCLC and HKLC classification schemes in refining treatment strategies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis.

    PubMed

    Poorolajal, J; Hooshmand, E; Mahjub, H; Esmailnasab, N; Jenabi, E

    2016-10-01

    The life expectancy of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) reported by several epidemiological studies is inconsistent. This meta-analysis was conducted to estimate the survival rate from HIV diagnosis to AIDS onset and from AIDS onset to death. The electronic databases PubMed, Web of Science and Scopus were searched to February 2016. In addition, the reference lists of included studies were checked to identify further references, and the database of the International AIDS Society was also searched. Cohort studies addressing the survival rate in patients diagnosed with HIV/AIDS were included in this meta-analysis. The outcomes of interest were the survival rate of patients diagnosed with HIV progressing to AIDS, and the survival rate of patients with AIDS dying from AIDS-related causes with or without highly active antiretroviral therapy (HAART). The survival rate (P) was estimated with 95% confidence intervals based on random-effects models. In total, 27,862 references were identified, and 57 studies involving 294,662 participants were included in this meta-analysis. Two, 4-, 6-, 8-, 10- and 12-year survival probabilities of progression from HIV diagnosis to AIDS onset were estimated to be 82%, 72%, 64%, 57%, 26% and 19%, respectively. Two, 4-, 6-, 8- and 10-year survival probabilities of progression from AIDS onset to AIDS-related death in patients who received HAART were estimated to be 87%, 86%, 78%, 78%, and 61%, respectively, and 2-, 4- and 6-year survival probabilities of progression from AIDS onset to AIDS-related death in patients who did not receive HAART were estimated to be 48%, 26% and 18%, respectively. Evidence of considerable heterogeneity was found. The majority of the studies had a moderate to high risk of bias. The majority of HIV-positive patients progress to AIDS within the first decade of diagnosis. Most patients who receive HAART will survive for >10 years after the onset of AIDS, whereas

  5. A Community Study of the Psychological Effects of the Omagh Car Bomb on Adults

    PubMed Central

    Duffy, Michael; Bolton, David; Gillespie, Kate; Ehlers, Anke; Clark, David M.

    2013-01-01

    Background The main aims of the study were to assess psychological morbidity among adults nine months after a car bomb explosion in the town of Omagh, Northern Ireland and to identify predictors of chronic posttraumatic stress disorder symptoms. Method A questionnaire was sent to all adults in households in The Omagh District Council area. The questionnaire comprised established predictors of PTSD (such as pre-trauma personal characteristics, type of exposure, initial emotional response and long-term adverse physical or financial problems), predictors derived from the Ehlers and Clark (2000) cognitive model, a measure of PTSD symptoms and the General Health Questionnaire. Results Among respondents (n = 3131) the highest rates of PTSD symptoms and probable casesness (58.5%) were observed among people who were present in the street when the bomb exploded but elevated rates were also observed in people who subsequently attended the scene (21.8% probable caseness) and among people for whom someone close died (11.9%). People with a near miss (left the scene before the explosion) did not show elevated rates. Exposure to the bombing increased PTSD symptoms to a greater extent than general psychiatric symptoms. Previously established predictors accounted for 42% of the variance in PTSD symptoms among people directly exposed to the bombing. Predictors derived from the cognitive model accounted for 63%. Conclusions High rates of chronic PTSD were observed in individuals exposed to the bombing. Psychological variables that are in principle amenable to treatment were the best predictors of PTSD symptoms. Teams planning treatment interventions for victims of future bombings and other traumas may wish to take these results into account. PMID:24098795

  6. Uganda: Perfection of Post-Conflict Stability or Ticking Time Bomb

    DTIC Science & Technology

    2016-01-01

    1 UGANDA: PERFECTION OF POST-CONFLICT STABILITY OR TICKING TIME BOMB ? By Kristin M. Pearson and Alex S. Pedersen, United States Air...Force Academy 2015 INSS RESEARCH PAPER 2016 2 UGANDA: PERFECTION OF POST-CONFLICT STABILITY OR TICKING TIME BOMB ? By Kristin M. Pearson and Alex...likely. “The area is a ticking time bomb without ongoing efforts. There’s an entire group of young men trained in military tactics that have said

  7. Survival of patients with multiple primary malignancies: a study of 783 patients with gastrointestinal stromal tumor

    PubMed Central

    Pandurengan, R. K.; Dumont, A. G.; Araujo, D. M.; Ludwig, J. A.; Ravi, V.; Patel, S.; Garber, J.; Benjamin, R. S.; Strom, S. S.; Trent, J. C.

    2010-01-01

    Background: We sought to investigate the characteristics and survival rate of patients with gastrointestinal stromal tumor (GIST) associated with other primary malignancies. Patients and methods: A total of 783 patients with GIST were identified from 1995 to 2007. Additional primaries included tumors not considered metastasis, invasion, or recurrence of GIST, nor non-melanoma skin cancer. Data on gender, age at diagnosis, follow-up time after diagnosis, and death were collected. Results: Of the 783 patients with GIST, 153(20%) were identified with at least one additional primary. Patients with additional primaries were more often men (M : F 1.5 versus 1.3) and older (66 versus 53 years). More patients had another cancer diagnosed before (134) than after (52) GIST. Primaries observed before GIST were cancers of the prostate (25), breast (12), esophagus (9), and kidney (7) and melanoma (6). Lung (5) and kidney (5) primaries were the most frequent after GIST. The 5-year survival was 68% for patients with primaries before GIST, 61% for patients with primaries after GIST, 58% for patients with GIST only, and 49% for patients with two or more primaries in addition to GIST (P = 0.002). Conclusions: Approximately 20% of patients with GIST develop other cancers. Inferior median 5-year survival was observed in patients with GIST with two or more other cancers. The etiology and clinical implications of other malignancies in patients with GIST should be investigated. PMID:20348145

  8. Rising threat of terrorist bomb blasts in Karachi--a 5-year study.

    PubMed

    Mirza, Farhat Hussain; Parhyar, Hamid Ali; Tirmizi, Syed Zubair Ahmed

    2013-08-01

    This study aims to determine the frequency of injuries and fatalities associated with terrorist bomb explosions in the city of Karachi from 1 January 2007 to 31 December 2011. Moreover, this study is aimed to determine age and sex vulnerability among the victims of blast explosion. A descriptive cross-sectional study was conducted. The study was carried out at mortuaries and medicolegal sections at Jinnah Postgraduate Medical Center, Civil Hospital and Abbasi-Shaheed Hospital Karachi, the three main hospitals, which cater to all these cases of Karachi. The study included all bomb blast victims examined and autopsied from January 2007 to December 2011 at Jinnah Postgraduate Medical Center, Civil Hospital and Abbassi Shaheed Hospital Karachi. Details of 1142 cases were collected for those medicolegal deaths and injured persons, identified to be the victims of bomb blasts from January 2007 to December 2011. Data were collected on a preformed proforma from the mortuaries and medicolegal sections of these three public sector hospitals. The variables investigated include age, gender, year-wise distribution of the injured and the dead along with the cause of death and body parts injured in survivors. Out of the total 11,109 autopsies during the study period, 249 (2.24%) were carried out on deaths due to bomb blasts. Similarly, 135,065 injury cases were reported during the study period out of which 893 (0.66%) cases were due to bomb blasts. An initial peak in the year 2007, followed by a decline in 2008 and since then a steady rise of bomb blast incidences with casualties and fatalities, has been observed. The highest numbers of injured victims were reported in the year 2010 and fatalities in 2007. Among 1142 cases, 95.18% were male and 4.82% female with a male to female ratio of 19.76:1. Persons of ages between 15 and 45 years were chiefly involved. Shock due to multiple injuries was the leading cause of death, followed by head injury with or without haemorrhage. The

  9. Is Einstein the Father of the Atomic Bomb

    NASA Astrophysics Data System (ADS)

    Lustig, Harry

    2009-05-01

    Soon after the American atomic bombs were dropped on Hiroshima and Nagasaki, the notion took hold in the popular mind that Albert Einstein was ``the father of the bomb.'' The claim of paternity rests on the belief that E=mc2 is what makes the release of enormous amounts of energy in the fission process possible and that the atomic bomb could not have been built without it. This is a misapprehension. Most physicists have known that all along. Nevertheless in his reaction to the opera Dr. Atomic, a prominent physicist claimed that Einstein's discovery that matter can be transformed into energy ``is precisely what made the bomb possible.'' In fact what makes the fission reaction and one of its applications,the atomic bomb, possible is the smaller binding energies of fission products compared to the binding energies of the nuclei that undergo fission.The binding energies of nuclei are a well understood consequence of the numbers and arrangements of protons and neutrons in the nucleus and of quantum-mechanical effects. The realization that composite systems have binding energies predates relativity. In the 19th century they were ascribed to potential and other forms of energy that reside in the system. With Einstein they became rest mass energy. While E=mc2 is not the cause of fission, measuring the masses of the participants in the reaction does permit an easy calculation of the kinetic energy that is released.

  10. Survival probabilities of patients with childhood spinal muscle atrophy.

    PubMed

    Mannaa, Mohannad M; Kalra, Maninder; Wong, Brenda; Cohen, Aliza P; Amin, Raouf S

    2009-03-01

    Medical and technological advances over the past 2 decades have resulted in improved patient care for children with spinal muscular atrophy (SMA). The objective of the present study was to describe changes in the life expectancy of pediatric patients with SMA over time and to compare these findings with previously reported survival patterns. Medical records of all patients diagnosed with SMA over a 16-year period (1989-2005) at Cincinnati Children's Hospital Medical Center were reviewed. Data pertaining to date of birth, type of SMA, medical and surgical interventions, pulmonary complications, and date of death were obtained. Kaplan-Meier survival analyses showed a significant improvement in survival probabilities in the severest form of SMA. We found a positive trend in the survival of patients with severe SMA. Although we cannot attribute this trend to any single factor, it is likely that advances in pulmonary care and aggressive nutritional support have played a significant role.

  11. Clinical outcomes and survival in AA amyloidosis patients.

    PubMed

    Ayar, Yavuz; Ersoy, Alparslan; Oksuz, Mustafa Ferhat; Ocakoglu, Gokhan; Vuruskan, Berna Aytac; Yildiz, Abdülmecit; Isiktas, Emel; Oruc, Aysegül; Celikci, Sedat; Arslan, Ismail; Sahin, Ahmet Bilgehan; Güllülü, Mustafa

    Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis. A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results. Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65±3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1-1.06, p=0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07-1.46, p=0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01-1.16, p=0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3±16 months. Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients

  12. Sinonasal mucosal melanoma: retrospective survival study of 25 patients.

    PubMed

    Vandenhende, C; Leroy, X; Chevalier, D; Mortuaire, G

    2012-02-01

    To determine potential prognostic factors for survival in patients with mucosal malignant melanoma of the sinonasal tract. Patients managed between 1991 and 2008 were assessed retrospectively. The seventh edition Union for International Cancer Control (7th UICC) tumour-node-metastasis classification was used for tumour staging. Kaplan-Meier and log rank tests were used for survival analysis. Twenty-five patients were studied (six were tumour stage three, eight tumour stage four(a) and 11 tumour stage four(b)). Surgery was performed on 23 patients (92 per cent). Fifteen received post-operative radiotherapy. Mean follow up was 31.3 months (range, two to 99 months). Three-year disease-free survival was improved in patients with stage four tumour arising from the nasal fossa, versus other sites, and in those with stage four tumour treated with surgery plus adjuvant radiotherapy, versus other treatments. Patients with melanoma of the nasal cavity have very poor survival rates. Treatment is still based on adequate surgical resection with safe margins. In this study, post-operative radiotherapy improved local control only for stage four tumours.

  13. Marital status and survival in patients with renal cell carcinoma

    PubMed Central

    Li, Yan; Zhu, Ming-xi; Qi, Si-hua

    2018-01-01

    Abstract Previous studies have shown that marital status is an independent prognostic factor for survival in several types of cancer. In this study, we investigated the effects of marital status on survival outcomes among renal cell carcinoma (RCC) patients. We identified patients diagnosed with RCC between 1973 and 2013 from the Surveillance, Epidemiology and End Results (SEER) database. Kaplan–Meier analysis and Cox regression were used to identify the effects of marital status on overall survival (OS) and cancer-specific survival (CSS). We enrolled 97,662 eligible RCC patients, including 64,884 married patients, and 32,778 unmarried (9831 divorced/separated, 9692 widowed, and 13,255 single) patients at diagnosis. The 5-year OS and CSS rates of the married, separated/divorced, widowed, and single patients were 73.7%, 69.5%, 58.3%, and 73.2% (OS), and 82.2%, 80.7%, 75.7%, and 83.3% (CSS), respectively. Multivariate Cox regression showed that, compared with married patients, widowed individuals showed poorer OS (hazard ratio, 1.419; 95% confidence interval, 1.370–1.469) and CSS (hazard ratio, 1.210; 95% confidence interval, 1.144–1.279). Stratified analyses and multivariate Cox regression showed that, in the insured and uninsured groups, married patients had better survival outcomes while widowed patients suffered worse OS outcomes; however, this trend was not significant for CSS. In RCC patients, married patients had better survival outcomes while widowed patients tended to suffer worse survival outcomes in terms of both OS and CSS. PMID:29668592

  14. Improved Survival in Male Melanoma Patients in the Era of Sentinel Node Biopsy.

    PubMed

    Koskivuo, I; Vihinen, P; Mäki, M; Talve, L; Vahlberg, T; Suominen, E

    2017-03-01

    Sentinel node biopsy is a standard method for nodal staging in patients with clinically localized cutaneous melanoma, but the survival advantage of sentinel node biopsy remains unsolved. The aim of this case-control study was to investigate the survival benefit of sentinel node biopsy. A total of 305 prospective melanoma patients undergoing sentinel node biopsy were compared with 616 retrospective control patients with clinically localized melanoma whom have not undergone sentinel node biopsy. Survival differences were calculated with the median follow-up time of 71 months in sentinel node biopsy patients and 74 months in control patients. Analyses were calculated overall and separately in males and females. Overall, there were no differences in relapse-free survival or cancer-specific survival between sentinel node biopsy patients and control patients. Male sentinel node biopsy patients had significantly higher relapse-free survival ( P = 0.021) and cancer-specific survival ( P = 0.024) than control patients. In females, no differences were found. Cancer-specific survival rates at 5 years were 87.8% in sentinel node biopsy patients and 85.2% in controls overall with 88.3% in male sentinel node biopsy patients and 80.6% in male controls and 87.3% in female sentinel node biopsy patients and 89.8% in female controls. Sentinel node biopsy did not improve survival in melanoma patients overall. While females had no differences in survival, males had significantly improved relapse-free survival and cancer-specific survival following sentinel node biopsy.

  15. Design and use of a servo-controlled high pressure window bomb in spectroscopic studies of solid propellant combustion

    NASA Technical Reports Server (NTRS)

    Goetz, F.; Mann, D. M.

    1980-01-01

    The feasibility of using a high pressure window bomb as a laboratory scale model of actual motor conditions. The design and operation of a modified high pressure window bomb is discussed. An optical servocontrol mechanism has been designed to hold the burning surface of a propellant strand at a fixed position within the bomb chamber. This mechanism permits the recording of visible and infrared emission spectra from various propellants. Preliminary visible emission spectra of a nonmetalized and metalized propellant are compared with spectra recorded using the modified bomb.

  16. Media exposure in children one hundred miles from a terrorist bombing.

    PubMed

    Pfefferbaum, Betty; Seale, Thomas W; Brandt, Edward N; Pfefferbaum, Rose L; Doughty, Debby E; Rainwater, Scott M

    2003-03-01

    This study assessed indirect interpersonal exposure to the 1995 Oklahoma City bombing, broadcast and print media exposure in the aftermath of the explosion, emotional reactions to media coverage, and posttraumatic stress reactions in children distant from the explosion. A survey was administered to 88 sixth-grade students in the public middle school in a community 100 miles from Oklahoma City 2 years after the bombing. Many children reported indirect interpersonal exposure and most reported bomb-related media exposure. Print media exposure was more strongly associated with enduring posttraumatic stress than broadcast exposure. Indirect interpersonal exposure and the interaction of media exposure with emotional reaction to media coverage in the aftermath of the explosion each predicted ongoing posttraumatic stress. The results suggest that children may have lingering reactions to highly publicized terrorist incidents. Concern about the influence of television viewing has long been proclaimed. This study implicates print media exposure as well. Media exposure to terrorist incidents, therefore, should be monitored and those working with children should assess exposure and stress even in children not directly impacted.

  17. Pulmonary function test findings in patients with acute inhalation injury caused by smoke bombs

    PubMed Central

    Cao, Lu; Zhang, Xin-Gang; Wang, Jian-Guo; Wang, Han-Bin; Chen, Yi-Bing; Zhao, Da-Hui; Shi, Wen-Fang

    2016-01-01

    Background This study aimed to determine the effects of smoke bomb-induced acute inhalation injury on pulmonary function at different stages of lung injury. Methods We performed pulmonary function tests (PFTs) in 15 patients with acute inhalation injury from days 3 to 180 after smoke inhalation. We measured the trace element zinc in whole blood on days 4 and 17, and correlations of zinc levels with PFTs were performed. Results In the acute stage of lung injury (day 3), 3 of 11 patients with mild symptoms had normal pulmonary function and 8 patients with restrictive ventilatory dysfunction and reduced diffusing capacity. Some patients also had mild obstructive ventilatory dysfunction (5 patients) and a decline in small airway function (6 patients). For patients with severe symptoms, PFT results showed moderate to severe restrictive ventilatory dysfunction and reduced diffusing capacity. PaCO2 was significantly higher (P=0.047) in patients with reduced small airway function compared with those with normal small airway function. Whole blood zinc levels in the convalescence stage (day 17) were significantly lower than those in the acute stage (day 4). Zinc in the acute stage was negatively correlated with DLCO/VA on days 3, 10, and 46 (r=−0.633, −0.676, and −0.675 respectively, P<0.05). Conclusions Smoke inhalation injury mainly causes restrictive ventilatory dysfunction and reduced diffusing capacity, and causes mild obstructive ventilatory dysfunction and small airway function decline in some patients. Zinc is negatively correlated with DLCO/VA. Zinc levels may be able to predict prognosis and indicate the degree of lung injury. PMID:28066595

  18. Survival Analysis of Patients with End Stage Renal Disease

    NASA Astrophysics Data System (ADS)

    Urrutia, J. D.; Gayo, W. S.; Bautista, L. A.; Baccay, E. B.

    2015-06-01

    This paper provides a survival analysis of End Stage Renal Disease (ESRD) under Kaplan-Meier Estimates and Weibull Distribution. The data were obtained from the records of V. L. MakabaliMemorial Hospital with respect to time t (patient's age), covariates such as developed secondary disease (Pulmonary Congestion and Cardiovascular Disease), gender, and the event of interest: the death of ESRD patients. Survival and hazard rates were estimated using NCSS for Weibull Distribution and SPSS for Kaplan-Meier Estimates. These lead to the same conclusion that hazard rate increases and survival rate decreases of ESRD patient diagnosed with Pulmonary Congestion, Cardiovascular Disease and both diseases with respect to time. It also shows that female patients have a greater risk of death compared to males. The probability risk was given the equation R = 1 — e-H(t) where e-H(t) is the survival function, H(t) the cumulative hazard function which was created using Cox-Regression.

  19. Incident-related television viewing and psychiatric disorders in Oklahoma City bombing survivors.

    PubMed

    Pfefferbaum, Betty; North, Carol S; Pfefferbaum, Rose L; Jeon-Slaughter, Haekyung; Houston, J Brian; Regens, James L

    2012-01-01

    The objective of this study was to examine terrorism media coverage and psychiatric outcomes in directly-exposed terrorism survivors. The study used (1) self-report questionnaires to retrospectively assess event-related media behaviors and reactions in a cross sectional design and (2) longitudinal structured diagnostic interviews to assess psychopathologic outcomes. The participants were 99 directly-exposed Oklahoma City bombing survivors who were initially studied six months after the 1995 incident. Though a fear reaction to bombing-related television coverage and fear-driven discontinuation of bombing-related media contact were associated with diagnostic outcomes, the number of hours viewing bombing-related television coverage in the first week after the event was not associated with the prevalence of bombing-related posttraumatic stress disorder or post-bombing major depressive disorder during the seven years post event. The results raise doubt about the effects of quantified incident-related television viewing on clinically-significant emotional outcomes in directly-exposed terrorism survivors.

  20. Addition of Androgens Improves Survival in Elderly Patients With Acute Myeloid Leukemia: A GOELAMS Study.

    PubMed

    Pigneux, Arnaud; Béné, Marie C; Guardiola, Philippe; Recher, Christian; Hamel, Jean-Francois; Sauvezie, Mathieu; Harousseau, Jean-Luc; Tournilhac, Olivier; Witz, Francis; Berthou, Christian; Escoffre-Barbe, Martine; Guyotat, Denis; Fegueux, Nathalie; Himberlin, Chantal; Hunault, Mathilde; Delain, Martine; Lioure, Bruno; Jourdan, Eric; Bauduer, Frederic; Dreyfus, Francois; Cahn, Jean-Yves; Sotto, Jean-Jacques; Ifrah, Norbert

    2017-02-01

    Purpose Elderly patients with acute myeloid leukemia (AML) have a poor prognosis, and innovative maintenance therapy could improve their outcomes. Androgens, used in the treatment of aplastic anemia, have been reported to block proliferation of and initiate differentiation in AML cells. We report the results of a multicenter, phase III, randomized open-label trial exploring the benefit of adding androgens to maintenance therapy in patients 60 years of age or older. Patients and Methods A total of 330 patients with AML de novo or secondary to chemotherapy or radiotherapy were enrolled in the study. Induction therapy included idarubicin 8 mg/m 2 on days 1 to 5, cytarabine 100 mg/m 2 on days 1 to 7, and lomustine 200 mg/m 2 on day 1. Patients in complete remission or partial remission received six reinduction courses, alternating idarubicin 8 mg/m 2 on day 1, cytarabine 100 mg/m 2 on days 1 to 5, and a regimen of methotrexate and mercaptopurine. Patients were randomly assigned to receive norethandrolone 10 or 20 mg/day, according to body weight, or no norethandrolone for a 2-year maintenance therapy regimen. The primary end point was disease-free survival by intention to treat. Secondary end points were event-free survival, overall survival, and safety. This trial was registered at www.ClinicalTrials.gov identifier NCT00700544. Results Random assignment allotted 165 patients to each arm; arm A received norethandrolone, and arm B did not receive norethandrolone. Complete remission or partial remission was achieved in 247 patients (76%). The Schoenfeld time-dependent model showed that norethandrolone significantly improved survival for patients still in remission at 1 year after induction. In arms A and B, respectively, 5-year disease-free survival was 31.2% and 16.2%, event-free survival was 21.5% and 12.9%, and overall survival was 26.3% and 17.2%. Norethandrolone improved outcomes irrelevant to all prognosis factors. Only patients with baseline leukocytes > 30 × 10

  1. Survival of patients with Ewing's sarcoma in Yazd-Iran.

    PubMed

    Akhavan, Ali; Binesh, Fariba; Shamshiri, Hadi; Ghanadi, Fazllolah

    2014-01-01

    The Ewing's sarcoma family is a group of small round cell tumors which accounts for 10-15% of all primary bone neoplasms. The aim of this study was to evaluate the survival of Ewing's sarcoma patients in our province and to determine of influencing factors. All patients with documented Ewing's sarcoma/ primitive neuroectodermal tumor(PNET) family pathology were enrolled in this study during a period of eight years. For all of them local and systemic therapy were carried out. Overall and event free survival and prognostic factors were evaluated. Thirty two patients were enrolled in the study. The median age was 17.5 years. Twenty (65.2%) were male and 9 (28.1%) were aged 14 years or less. Mean disease free survival was 26.8 (95%CI; 13.8-39.9) months and five year disease free survival was 26%. Mean overall survival was 38.7 months (95%CI; 25.9-50.6) and median overall survival was 24 months. Five year overall survival was 25%. From the variables evaluated , only presence of metastatic disease at presentation (p value=0. 028) and complete response (p value =0. 006) had significant relations to overall survival. Survival of Ewing's sarcoma in our province is disappointing. It seems to be mostly due to less effective treatment. Administration of adequate chemotherapy dosage, resection of tumor with negative margins and precise assessment of irradiation volume may prove helpful.

  2. BAD phosphorylation determines ovarian cancer chemo-sensitivity and patient survival

    PubMed Central

    Marchion, Douglas C.; Cottrill, Hope M.; Xiong, Yin; Chen, Ning; Bicaku, Elona; Fulp, William J.; Bansal, Nisha; Chon, Hye Sook; Stickles, Xiaomang B.; Kamath, Siddharth G.; Hakam, Ardeshir; Li, Lihua; Su, Dan; Moreno, Carolina; Judson, Patricia L.; Berchuck, Andrew; Wenham, Robert M.; Apte, Sachin M.; Gonzalez-Bosquet, Jesus; Bloom, Gregory C.; Eschrich, Steven A.; Sebti, Said; Chen, Dung-Tsa; Lancaster, Johnathan M.

    2011-01-01

    Purpose Despite initial sensitivity to chemotherapy, ovarian cancers (OVCA) often develop drug-resistance, which limits patient survival. Using specimens and/or genomic data from 289 patients and a panel of cancer cell lines, we explored genome-wide expression changes that underlie the evolution of OVCA chemo-resistance and characterized the BCL2 antagonist of cell death (BAD) apoptosis pathway as a determinant of chemo-sensitivity and patient survival. Experimental Design Serial OVCA cell cisplatin treatments were performed in parallel with measurements of genome-wide expression changes. Pathway analysis was performed on genes associated with increasing cisplatin-resistance (EC50). BAD-pathway expression and BAD-protein phosphorylation were evaluated in patient samples and cell lines as determinants of chemo-sensitivity and/or clinical outcome and as therapeutic targets. Results Induced in vitro OVCA cisplatin-resistance was associated with BAD-pathway expression (P < 0.001). In OVCA cell lines and primary specimens, BAD-protein phosphorylation was associated with platinum-resistance (n = 147, P < 0.0001) and also with overall patient survival (n = 134, P = 0.0007). Targeted modulation of BAD-phosphorylation levels influenced cisplatin sensitivity. A 47-gene BAD-pathway score was associated with in vitro phosphorylated-BAD levels and with survival in 142 patients with advanced-stage (III/IV) serous OVCA. Integration of BAD-phosphorylation or BAD-pathway score with OVCA surgical cytoreductive status was significantly associated with overall survival by log-rank test (P = 0.004 and <0.0001, respectively). Conclusion The BAD apoptosis pathway influences OVCA chemo-sensitivity and overall survival, likely via modulation of BAD-phosphorylation. The pathway has clinical relevance as a biomarker of therapeutic response, patient survival, and as a promising therapeutic target. PMID:21849418

  3. A-BOMB SURVIVOR SITE-SPECIFIC RADIOGENIC CANCER RISKS ESTIMATES

    EPA Science Inventory

    A draft manuscript is being prepared that describes ways to improve estimates of risk from radiation that have been derived from A-bomb survivors. The work has been published in the journal Radiation Research volume 169, pages 87-98.

  4. Higher platelet cytochrome oxidase specific activity in surviving than in non-surviving septic patients

    PubMed Central

    2014-01-01

    Introduction In a previous study with 96 septic patients, we found that circulating platelets in 6-months surviving septic patients showed higher activity and quantity of cytochrome c oxidase (COX) normalized by citrate synthase (CS) activity at moment of severe sepsis diagnosis than non-surviving septic patients. The objective of this study was to estimate whether COX specific activity during the first week predicts 1-month sepsis survival in a larger cohort of patients. Methods Using a prospective, multicenter, observational study carried out in six Spanish intensive care units with 198 severe septic patients, we determined COX activity per proteins (COXact/Prot) in circulating platelets at day 1, 4 and 8 of the severe sepsis diagnosis. Endpoints were 1-month and 6-months mortality. Results Survivor patients (n = 130) showed higher COXact/Prot (P < 0.001) than non-survivors (n = 68) at day 1, 4 and 8 of severe sepsis diagnosis. More than a half of the 6-months survivor patients showed an increase in their COXact/Prot from day 1 to 8. However, most of the 1-month non-survivors exhibited a decrease in their COXact/Prot from day 1 to 8. Multiple logistic regression analyses showed that of platelet COXact/Prot > 0.30 mOD/min/mg at day 1 (P = 0.002), 4 (P = 0.006) and 8 (P = 0.02) was associated independently with 1-month mortality. Area under the curve of COXact/Prot at day 1, 4 and 8 to predict 30-day survival were 0.70 (95% CI = 0.63-0.76; P < 0.001), 0.71 (95% CI = 0.64-0.77; P < 0.001) and 0.71 (95% CI = 0.64-0.78; P < 0.001), respectively. Conclusions The new findings of our study, to our knowledge the largest series reporting data about mitochondrial function during follow-up in septic patients, were that septic patients that survive 1-month have a higher platelet cytochrome oxidase activity at moment of sepsis diagnosis and during the first week than non-survivors, and that platelet cytochrome oxidase

  5. ESR dosimetry for atomic bomb survivors and radiologic technologists

    NASA Astrophysics Data System (ADS)

    Tatsumi-Miyajima, Junko

    1987-06-01

    An individual absorbed dose for atomic bomb (A-bomb) survivors and radiologic technologists has been estimated using a new personal dosimetry. This dosimetry is based on the electron spin resonance (ESR) spectroscopy of the CO 33- radicals, which are produced in their teeth by radiation. Measurements were carried out to study the characteristics of the dosimetry; the ESR signals of the CO 33- radicals were stable and increased linearly with the radiation dose. In the evaluation of the absorbed dose, the ESR signals were considered to be a function of photon energy. The absorbed doses in ten cases of A-bomb victims and eight cases of radiologic technologists were determined. For A-bomb survivors, the adsorbed doses, which were estimated using the ESR dosimetry, were consistent with the ones obtained using the calculations of the tissue dose in air of A-bomb, and also with the ones obtained using the chromosome measurements. For radiologic technologists, the absorbed doses, which were estimated using the ESR dosimetry, agreed with the ones calculated using the information on the occupational history and conditions. The advantages of this method are that the absorbed dose can be directly estimated by measuring the ESR signals obtained from the teeth of persons, who are exposed to radiation. Therefore, the ESR dosimetry is useful to estimate the accidental exposure and the long term cumulative dose.

  6. Triggering soft bombs at the LHC

    DOE PAGES

    Knapen, Simon; Griso, Simone Pagan; Papucci, Michele; ...

    2017-08-18

    Very high multiplicity, spherically-symmetric distributions of soft particles, with p T ~ few×100 MeV, may be a signature of strongly-coupled hidden valleys that exhibit long, efficient showering windows. With traditional triggers, such ‘soft bomb’ events closely resemble pile-up and are therefore only recorded with minimum bias triggers at a very low efficiency. We demonstrate a proof-of-concept for a high-level triggering strategy that efficiently separates soft bombs from pile-up by searching for a ‘belt of fire’: a high density band of hits on the innermost layer of the tracker. Seeding our proposed high-level trigger with existing jet, missing transverse energy ormore » lepton hardware-level triggers, we show that net trigger efficiencies of order 10% are possible for bombs of mass several × 100 GeV. We also consider the special case that soft bombs are the result of an exotic decay of the 125 GeV Higgs. The fiducial rate for ‘Higgs bombs’ triggered in this manner is marginally higher than the rate achievable by triggering directly on a hard muon from associated Higgs production.« less

  7. Triggering soft bombs at the LHC

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Knapen, Simon; Griso, Simone Pagan; Papucci, Michele

    Very high multiplicity, spherically-symmetric distributions of soft particles, with p T ~ few×100 MeV, may be a signature of strongly-coupled hidden valleys that exhibit long, efficient showering windows. With traditional triggers, such ‘soft bomb’ events closely resemble pile-up and are therefore only recorded with minimum bias triggers at a very low efficiency. We demonstrate a proof-of-concept for a high-level triggering strategy that efficiently separates soft bombs from pile-up by searching for a ‘belt of fire’: a high density band of hits on the innermost layer of the tracker. Seeding our proposed high-level trigger with existing jet, missing transverse energy ormore » lepton hardware-level triggers, we show that net trigger efficiencies of order 10% are possible for bombs of mass several × 100 GeV. We also consider the special case that soft bombs are the result of an exotic decay of the 125 GeV Higgs. The fiducial rate for ‘Higgs bombs’ triggered in this manner is marginally higher than the rate achievable by triggering directly on a hard muon from associated Higgs production.« less

  8. Trastuzumab and survival of patients with metastatic breast cancer.

    PubMed

    Kast, Karin; Schoffer, Olaf; Link, Theresa; Forberger, Almuth; Petzold, Andrea; Niedostatek, Antje; Werner, Carmen; Klug, Stefanie J; Werner, Andreas; Gatzweiler, Axel; Richter, Barbara; Baretton, Gustavo; Wimberger, Pauline

    2017-08-01

    Prognosis of Her2-positive breast cancer has changed since the introduction of trastuzumab for treatment in metastatic and early breast cancer. It was described to be even better compared to prognosis of Her2-negative metastatic breast cancer. The purpose of this study was to evaluate the effect of trastuzumab in our cohort. Besides the effect of adjuvant pretreatment with trastuzumab on survival of patients with metastatic Her2-positive breast cancer was analyzed. All patients with primary breast cancer of the Regional Breast Cancer Center Dresden diagnosed during the years 2001-2013 were analyzed for treatment with or without trastuzumab in the adjuvant and in the metastatic treatment setting using Kaplan-Meier survival estimation and Cox regression. Age and tumor stage at time of first diagnosis of breast cancer as well as hormone receptor status, grading, time, and site of metastasis at first diagnosis of distant metastatic disease were analyzed. Of 4.481 female patients with primary breast cancer, 643 presented with metastatic disease. Her2-positive status was documented in 465 patients, including 116 patients with primary or secondary metastases. Median survival of patients with Her2-positive primary metastatic disease was 3.0 years (95% CI 2.3-4.0). After adjustment for other factors, survival was better in patients with Her2-positive breast cancer with trastuzumab therapy compared to Her2-negative metastatic disease (HR 2.10; 95% CI 1.58-2.79). Analysis of influence of adjuvant therapy with and without trastuzumab by Kaplan-Meier showed a trend for better survival in not pretreated patients. Median survival was highest in hormone receptor-positive Her2-positive (triple-positive) primary metastatic breast cancer patients with 3.3 years (95% CI 2.3-4.6). Prognosis of patients with Her2-positive metastatic breast cancer after trastuzumab treatment is more favorable than for Her2-negative breast cancer. The role of adjuvant chemotherapy with or without

  9. Ultrasonic Device Would Open Pipe Bombs

    NASA Technical Reports Server (NTRS)

    El-Raheb, Michael S.; Adams, Marc A.; Zwissler, James G.

    1991-01-01

    Piezoelectric ultrasonic transducer, energized by frequency generator and power supply, vibrates shell of pipe bomb while hardly disturbing explosive inner material. Frequency-control circuitry senses resonance in shell and holds generator at that frequency to induce fatigue cracking in threads of end cap. In addition to disarming bombs, ultrasonically induced fatigue may have other applications. In manufacturing, replaces some machining and cutting operations. In repair of equipment, cleanly and quickly disassembles corroded parts. In demolition of buildings used to dismember steel framework safely and controllably.

  10. Treatment and survival among 1594 patients with ATL.

    PubMed

    Katsuya, Hiroo; Ishitsuka, Kenji; Utsunomiya, Atae; Hanada, Shuichi; Eto, Tetsuya; Moriuchi, Yukiyoshi; Saburi, Yoshio; Miyahara, Masaharu; Sueoka, Eisaburo; Uike, Naokuni; Yoshida, Shinichiro; Yamashita, Kiyoshi; Tsukasaki, Kunihiro; Suzushima, Hitoshi; Ohno, Yuju; Matsuoka, Hitoshi; Jo, Tatsuro; Amano, Masahiro; Hino, Ryosuke; Shimokawa, Mototsugu; Kawai, Kazuhiro; Suzumiya, Junji; Tamura, Kazuo

    2015-12-10

    Adult T-cell leukemia/lymphoma (ATL) is a malignancy of mature T lymphocytes caused by human T-lymphotropic virus type I. Intensive combination chemotherapy and allogeneic hematopoietic stem cell transplantation have been introduced since the previous Japanese nationwide survey was performed in the late 1980s. In this study, we delineated the current features and management of ATL in Japan. The clinical data were collected retrospectively from the medical records of patients diagnosed with ATL between 2000 and 2009, and a total of 1665 patients' records were submitted to the central office from 84 institutions in Japan. Seventy-one patients were excluded; 895, 355, 187, and 157 patients with acute, lymphoma, chronic, and smoldering types, respectively, remained. The median survival times were 8.3, 10.6, 31.5, and 55.0 months, and 4-year overall survival (OS) rates were 11%, 16%, 36%, and 52%, respectively, for acute, lymphoma, chronic, and smoldering types. The number of patients with allogeneic hematopoietic stem cell transplantation was 227, and their median survival time and OS at 4 years after allogeneic hematopoietic stem cell transplantation was 5.9 months and 26%, respectively. This study revealed that the prognoses of the patients with acute and lymphoma types were still unsatisfactory, despite the recent progress in treatment modalities, but an improvement of 4-year OS was observed in comparison with the previous survey. Of note, one-quarter of patients who could undergo transplantation experienced long survival. It is also noted that the prognosis of the smoldering type was worse than expected. © 2015 by The American Society of Hematology.

  11. Survival in Patients with Degenerative Mitral Stenosis: Results from a Large Retrospective Cohort Study.

    PubMed

    Pasca, Ioana; Dang, Patricia; Tyagi, Gaurav; Pai, Ramdas G

    2016-05-01

    Severe mitral annular calcification causing degenerative mitral stenosis (DMS) is increasingly encountered in patients undergoing mitral and aortic valve interventions. However, its clinical profile and natural history and the factors affecting survival remain poorly characterized. The goal of this study was to characterize the factors affecting survival in patients with DMS. An institutional echocardiographic database was searched for patients with DMS, defined as severe mitral annular calcification without commissural fusion and a mean transmitral diastolic gradient of ≥2 mm Hg. This resulted in a cohort of 1,004 patients. Survival was analyzed as a function of clinical, pharmacologic, and echocardiographic variables. The patient characteristics were as follows: mean age, 73 ± 14 years; 73% women; coronary artery disease in 49%; and diabetes mellitus in 50%. The 1- and 5-year survival rates were 78% and 47%, respectively, and were slightly worse with higher DMS grades (P = .02). Risk factors for higher mortality included greater age (P < .0001), atrial fibrillation (P = .0009), renal insufficiency (P = .004), mitral regurgitation (P < .0001), tricuspid regurgitation (P < .0001), elevated right atrial pressure (P < .0001), concomitant aortic stenosis (P = .02), and low serum albumin level (P < .0001). Adjusted for propensity scores, use of renin-angiotensin system blockers (P = .02) or statins (P = .04) was associated with better survival, and use of digoxin was associated with higher mortality (P = .007). Prognosis in patients with DMS is poor, being worse in the aged and those with renal insufficiency, atrial fibrillation, and other concomitant valvular lesions. Renin-angiotensin system blockers and statins may confer a survival benefit, and digoxin use may be associated with higher mortality in these patients. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  12. Glaucoma in atomic bomb survivors.

    PubMed

    Kiuchi, Yoshiaki; Yokoyama, Tomoko; Takamatsu, Michiya; Tsuiki, Eiko; Uematsu, Masafumi; Kinoshita, Hirofumi; Kumagami, Takeshi; Kitaoka, Takashi; Minamoto, Atsushi; Neriishi, Kazuo; Nakashima, Eiji; Khattree, Ravindra; Hida, Ayumi; Fujiwara, Saeko; Akahoshi, Masazumi

    2013-10-01

    Radiation has been associated with increases in noncancerous diseases. An effect of low-dose radiation on the prevalence of clinically detected glaucoma has not been previously reported. We therefore investigated the prevalence of glaucoma in A-bomb survivors and its possible association with radiation dose. A total of 1,589 people who participated in the clinical examination program for A-bomb survivors at the Radiation Effects Research Foundation (RERF) between October 2006 and September 2008 and who had reconstructed radiation doses, were recruited into this cross-sectional screening study. The prevalence of glaucoma and its dose-response relationship to A-bomb radiation were measured. Each subject underwent an initial screening consisting of an interview and ophthalmological examination. Questionable cases with any indication of ocular disease, including glaucoma, were referred to local hospitals for more comprehensive evaluation. A diagnosis of glaucoma was made based on specific optic disc appearance, perimetric results and other ocular findings. Of 1,589 eligible people, we detected 284 (17.9%) cases of glaucoma overall, including 36 (2.3%) cases of primary open-angle glaucoma with intraocular pressure levels greater than 21 mmHg, 226 (14.2%) cases of normal-tension glaucoma and 25 (1.6%) cases of primary angle-closure glaucoma. Seven glaucoma risk factors were examined as potential confounders but only two needed to be included in the final model. Binary regression using a generalized estimating equation method, with adjustment for gender, age, city, cataract surgery or diabetes mellitus, revealed an odds ratio at 1 Gy of 1.31 (95% confidence interval 1.11-1.53, P = 0.001) in the case of normal-tension glaucoma, but no association for other types of glaucoma. The prevalence of normal-tension glaucoma may increase with A-bomb radiation dose, but uncertainties associated with nonparticipation (59% participation) suggest caution in the interpretation of these

  13. Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups

    PubMed Central

    Pulte, Dianne; Redaniel, Maria Theresa; Jansen, Lina; Brenner, Hermann; Jeffreys, Mona

    2013-01-01

    The survival of younger patients with acute leukemia has improved in the early 21st century, but it is unknown whether people of all ethnic and racial backgrounds have benefited equally. Using cancer registry data from the Surveillance, Epidemiology and End Results Program, we assessed trends in 5-year relative survival for patients aged 15 years or more with acute lymphoblastic leukemia and acute myeloblastic leukemia divided by racial and ethnic group, including non-Hispanic whites, African-Americans, Hispanics, and Asian-Pacific Islanders in the 1990s and the early 21st century. Modeled period analysis was used to obtain the most up-to-date estimates of survival. Overall, the 5-year survival increased from 31.6% in 1997-2002 to 39.0% in 2003-2008 for patients with acute lymphoblastic leukemia and from 15.5% in 1991-1996 to 22.5% in 2003-2008 for those with acute myeloblastic leukemia. Nevertheless, among patients with acute lymphoblastic leukemia, age-adjusted 5-year relative survival rates remained lower for African-Americans and Hispanics than for non-Hispanic whites. Among patients with acute myeloblastic leukemia, the increase in survival was greatest (from 32.6% in 1991-1996 to 47.1% in 2003-2008) for younger patients (15-54 years), and was more pronounced for non-Hispanic whites (+16.4% units) than for other patients (+10.8% units). Increases in survival are observed in all ethnic or racial groups. Nevertheless, among patients with acute leukemias, disparities in survival persist between non-Hispanic white people and people of other ethnic or racial groups. Disparities are increasing in younger patients with acute myeloblastic leukemia. Improvements in access to treatment, especially for minority patients, may improve outcomes. PMID:22929974

  14. Effects of percutaneous endoscopic gastrostomy on survival of patients in a persistent vegetative state after stroke.

    PubMed

    Wu, Kunpeng; Chen, Ying; Yan, Caihong; Huang, Zhijia; Wang, Deming; Gui, Peigen; Bao, Juan

    2017-10-01

    To assess the effect of percutaneous endoscopic gastrostomy on short- and long-term survival of patients in a persistent vegetative state after stroke and determine the relevant prognostic factors. Stroke may lead to a persistent vegetative state, and the effect of percutaneous endoscopic gastrostomy on survival of stroke patients in a persistent vegetative state remains unclear. Prospective study. A total of 97 stroke patients in a persistent vegetative state hospitalised from January 2009 to December 2011 at the Second Hospital, University of South China, were assessed in this study. Percutaneous endoscopic gastrostomy was performed in 55 patients, and mean follow-up time was 18 months. Survival rate and risk factors were analysed. Median survival in the 55 percutaneous endoscopic gastrostomy-treated patients was 17·6 months, higher compared with 8·2 months obtained for the remaining 42 patients without percutaneous endoscopic gastrostomy treatment. Univariate analyses revealed that age, hospitalisation time, percutaneous endoscopic gastrostomy treatment status, family financial situation, family care, pulmonary infection and nutrition were significantly associated with survival. Multivariate analysis indicated that older age, no gastrostomy, poor family care, pulmonary infection and poor nutritional status were independent risk factors affecting survival. Indeed, percutaneous endoscopic gastrostomy significantly improved the nutritional status and decreased pulmonary infection rate in patients with persistent vegetative state after stroke. Interestingly, median survival time was 20·3 months in patients with no or one independent risk factors of poor prognosis (n = 38), longer compared with 8·7 months found for patients with two or more independent risk factors (n = 59). Percutaneous endoscopic gastrostomy significantly improves long-term survival of stroke patients in a persistent vegetative state and is associated with improved nutritional status

  15. [Effect of Fuzheng Huayu capsules on survival rate of patients with liver cirrhosis].

    PubMed

    Ge, X J; Zhao, C Q; Xu, L M

    2017-11-20

    Objective: To investigate the effect of Fuzheng Huayu capsules on the survival rate of patients with liver cirrhosis. Methods: A retrospective analysis was performed for the clinical data of the patients with various types of liver cirrhosis who were hospitalized in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 1, 2006 to December 31, 2008. The data collected for these patients included their basic information, diagnosis and treatment, and results of laboratory examination. The Kaplan-Meier method was used to analyze the effect of Fuzheng Huayu capsules on the survival rate of patients with liver cancer. The starting point of observation was the first day of the patient's admission and the ending point of follow-up observation was the date of death or the end of follow-up April 1, 2014. The cut-off value was obtained if the patient did not experience any outcome event (death) at the end of follow-up. With reference to the outcome, the time when the outcome occurred, and the cut-off value, the life-table method was used to calculate survival rates and survival curves were plotted. The Kaplan-Meier product-limit method was used to calculate the arithmetic mean of survival time and median survival time, and the log-rank test was used to compare the survival data. Results: A total of 430 patients with liver cirrhosis were enrolled, among whom 191 died and 239 survived or were censored. The average constituent ratio of death was 55.6% and the average constituent ratio of survival was 44.4%. The life-table method showed that the half-, 1-, 2-, and 5-year survival rates were 70%, 64%, 58%, and 48%, respectively. The median survival time was 112.1 weeks for the patients who did not take Fuzheng Huayu capsules and 351.6 weeks for those who did, and there was a significant difference in survival rate between the two groups ( P = 0.000). Among 313 patients who had an etiology of hepatitis B, 164 did not take Fuzheng Huayu

  16. Home parenteral nutrition for advanced cancer patients: Contributes to survival?

    PubMed

    Theilla, Miriam; Cohen, Johnathan; Kagan, Ilia; Attal-Singer, Joelle; Lev, Shaul; Singer, Pierre

    2017-03-24

    Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN. All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality. Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population. These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Self-rated health as a predictor of survival among patients with advanced cancer.

    PubMed

    Shadbolt, Bruce; Barresi, Jane; Craft, Paul

    2002-05-15

    Evidence is emerging about the strong predictive relationship between self-rated health (SRH) and survival, although there is little evidence on palliative populations where an accurate prediction of survival is valuable. Thus, the relative importance of SRH in predicting the survival of ambulatory patients with advanced cancer was examined. SRH was compared to clinical assessments of performance status, as well as to quality-of-life measures. By use of a prospective cohort design, 181 patients (76% response rate) with advanced cancer were recruited into the study, resurveyed at 18 weeks, and observed to record deaths. The average age of patients was 62 years (SD = 12). The median survival time was 10 months. SRH was the strongest predictor of survival from baseline. Also, a Cox regression comparing changes in SRH over time yielded hazard ratios suggesting the relative risk (RR) of dying was greater for fair ratings at 18 weeks (approximately 3 times) compared with consistent good or better ratings; the RR was even greater (4.2 and 6.2 times) for poor ratings, especially when ratings were poor at baseline and 18 weeks (31 times). Improvement in SRH over time yielded the lowest RR. SRH is valid, reliable, and responsive to change as a predictor of survival of advanced cancer. These qualities suggest that SRH should be considered as an additional tool by oncologists to assess patients. Similarly, health managers could use SRH as an indicator of disease severity in palliative care case mix. Finally, SRH could provide a key to help us understand the human side of disease and its relationship with medicine.

  18. Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair.

    PubMed

    Sasabuchi, Yusuke; Kimura, Naoyuki; Shiotsuka, Junji; Komuro, Tetsuya; Mouri, Hideyuki; Ohnuma, Tetsu; Asaka, Kayo; Lefor, Alan K; Yasunaga, Hideo; Yamaguchi, Atsushi; Adachi, Hideo; Sanui, Masamitsu

    2016-12-01

    Although acute kidney injury (AKI) is known as a serious complication after operation for acute type A aortic dissection (AAAD), the long-term impact of AKI remains unclear. The aim of the present study is to investigate the long-term survival in patients with AKI after operation for AAAD. This study included 403 patients who underwent operation for AAAD from 1990 to 2011 at Jichi Medical University, Saitama Medical Center. Postoperative AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Kaplan-Meier survival analysis and Cox proportional hazards regression were modeled to analyze the association between the AKI stage and postoperative long-term survival. Of 403 patients, 181 (44.9%) experienced postoperative AKI. Kaplan-Meier estimates for long-term survival were significantly different among patients without AKI and patients with stage 1, 2, and 3 AKI (p < 0.001). Hazard ratios of long-term survival for patients with stages 1, 2, and 3 AKI compared with patients without AKI were 1.38 (95% confidence interval [CI]: 0.84 to 2.26), 1.82 (95% CI: 0.95 to 3.51), and 3.79 (95% CI: 1.95 to 7.37), respectively. More patients with AKI died because of cardiovascular disease after discharge than patients without AKI (1.8% versus 6.0%, p = 0.03). Stage 3 AKI is significantly associated with lower long-term survival after operation for AAAD. Patient follow-up after discharge that focuses on cardiovascular issues may benefit patients who survive AKI after AAAD operation. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Marital status as a predictor of survival in patients with human papilloma virus-positive oropharyngeal cancer.

    PubMed

    Rubin, Samuel J; Kirke, Diana N; Ezzat, Waleed H; Truong, Minh T; Salama, Andrew R; Jalisi, Scharukh

    Determine whether marital status is a significant predictor of survival in human papillomavirus-positive oropharyngeal cancer. A single center retrospective study included patients diagnosed with human papilloma virus-positive oropharyngeal cancer at Boston Medical Center between January 1, 2010 and December 30, 2015, and initiated treatment with curative intent at Boston Medical Center. Demographic data and tumor-related variables were recorded. Univariate analysis was performed using a two-sample t-test, chi-squared test, Fisher's exact test, and Kaplan Meier curves with a log rank test. Multivariate survival analysis was performed using a Cox regression model. A total of 65 patients were included in the study with 24 patients described as married and 41 patients described as single. There was no significant difference in most demographic variables or tumor related variables between the two study groups, except single patients were significantly more likely to have government insurance (p=0.0431). Furthermore, there was no significant difference in 3-year overall survival between married patients and single patients (married=91.67% vs single=87.80%; p=0.6532) or 3-year progression free survival (married=79.17% vs single=85.37%; p=0.8136). After adjusting for confounders including age, sex, race, insurance type, smoking status, treatment, and AJCC combined pathologic stage, marital status was not a significant predictor of survival [HR=0.903; 95% CI (0.126,6.489); p=0.9192]. Although previous literature has demonstrated that married patients with head and neck cancer have a survival benefit compared to single patients with head and neck cancer, we were unable to demonstrate the same survival benefit in a cohort of patients with human papilloma virus-positive oropharyngeal cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Fatalities associated with home-made pipe bombs in Northern Ireland.

    PubMed

    Lucas, James; Crane, Jack

    2008-06-01

    Pipe bombs are crudely constructed improvized explosive devices which are easily made at home. They are increasingly used by terrorists and others, and may inflict serious injuries and cause death. Four fatalities have occurred in association with their use in Northern Ireland between 1998 and 2002. In 2 cases, death was due to penetrating shrapnel injuries to the chest causing laceration of the great vessels, and a third fatality occurred due to a bomb fragment penetrating the cranial cavity. A pipe bomb exploded close to the back of the head of a fourth victim and this was associated with a severe brain injury. The pathologist was able to determine the position of the victim in relation to the explosion by interpreting the pattern of injuries. It seems likely that 2 of the victims had been involved in the construction, transport, or use of the devices. A third victim was entirely innocent and had been in the process of removing a pipe bomb, which had been thrown through the window of her home, when it exploded. The fourth victim was a member of the security forces who had been struck by a bomb fragment, in the region of the right eye, during a period of sectarian unrest.

  1. Self injury of extremities leading to amputation while handling local bomb.

    PubMed

    Bhadani, Umesh Kumar

    2013-05-01

    Self injury while making material which has a tendency to blast is dangerous- whether it is fire cracker or local bomb. Some villagers living nearby forest make bomb to scare wild animals to protect their pet animals. A 22-year old girl while making this kind of local bomb, got injured badly. The injury was sustained while making bomb in a sitting position with face down as it is evident form type of injury. There was lacerated injury of both hands leading to amputation of both hands above wrists. Lacerated injury was present on medial sides of both thighs and gun powder marks on face. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  2. How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations.

    PubMed

    Piccioli, Andrea; Spinelli, M Silvia; Forsberg, Jonathan A; Wedin, Rikard; Healey, John H; Ippolito, Vincenzo; Daolio, Primo Andrea; Ruggieri, Pietro; Maccauro, Giulio; Gasbarrini, Alessandro; Biagini, Roberto; Piana, Raimondo; Fazioli, Flavio; Luzzati, Alessandro; Di Martino, Alberto; Nicolosi, Francesco; Camnasio, Francesco; Rosa, Michele Attilio; Campanacci, Domenico Andrea; Denaro, Vincenzo; Capanna, Rodolfo

    2015-05-22

    We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.org , we attempted to externally validate it using independent, international data. We collected data from patients treated at 13 Italian orthopaedic oncology referral centers between 2010 and 2013, then applied to PATHFx, which generated a probability of survival at three and 12-months for each patient. We assessed accuracy using the area under the receiver-operating characteristic curve (AUC), clinical utility using Decision Curve Analysis (DCA), and compared the Italian patient data to the training set (United States) and first external validation set (Scandinavia). The Italian dataset contained 287 records with at least 12 months follow-up information. The AUCs for the three-month and 12-month estimates was 0.80 and 0.77, respectively. There were missing data, including the surgeon's estimate of survival that was missing in the majority of records. Physiologically, Italian patients were similar to patients in the training and first validation sets. However notable differences were observed in the proportion of those surviving three and 12-months, suggesting differences in referral patterns and perhaps indications for surgery. PATHFx was successfully validated in an Italian dataset containing missing data. This study demonstrates its broad applicability to European patients, even in centers with differing treatment philosophies from those previously studied.

  3. Chromosome aberration analysis in atomic bomb survivors and Thorotrast patients using two- and three-colour chromosome painting of chromosomal subsets.

    PubMed

    Tanaka, K; Popp, S; Fischer, C; Van Kaick, G; Kamada, N; Cremer, T; Cremer, C

    1996-07-01

    Chromosomal translocations in peripheral lymphocytes of three healthy Hiroshima atomic (A)-bomb survivors, as well as three Thorotrast patients and two non-irradiated age-matched control persons from the German Thorotrast study were studied by two- and three-colour fluorescence in situ hybridization (chromosome painting) with various combinations of whole chromosome composite probes, including chromosomes 1, 2, 3, 4, 6, 7, 8, 9 and 12. Translocation frequencies detected by chromosome painting in cells of the A-bomb survivors were compared with results obtained by G-banding. A direct comparison was made, i.e. only those cells with simple translocations or complex aberrations detected by G-banding were taken into consideration which in principle could be detected also with the respective painting combination. The statistical analysis revealed no significant differences from a 1:1 relationship between the frequencies of aberrant cells obtained by both methods. The use of genomic translocation frequencies estimated from subsets of chromosomes for biological dosimetry is discussed in the light of evidence that chromosomes occupy distinct territories and are variably arranged in human lymphocyte nuclei. This territorial organization of interphase chromosomes implies that translocations will be restricted to chromatin located at the periphery of adjacent chromosome territories.

  4. BOMB STABILIZING STRUCTURE

    DOEpatents

    Kelley, J.L.; Runyan, C.E.

    1963-12-10

    A stabilizinig structure capable of minimizing deviations of a falling body such as a bomb from desired trajectory is described. The structure comprises a fin or shroud arrangement of double-wedge configuration, the feeding portion being of narrow wedge shape and the after portion being of a wider wedge shape. The structure provides a force component for keeping the body on essentially desired trajectory throughout its fall. (AEC)

  5. [The survivability of patients with cervical cancer of IIB stage].

    PubMed

    Kryzhanivs'ka, A Ie; Diakiv, I B

    2014-01-01

    To the present tense finally mine-out not tactic of treatment of patients with the cervical cancer (CC) of IIB stage, but in the standards of diagnostics and treatment there are different variants of treatment of this pathology, and choice, most optimum, as a rule, depends on subjective opinion of doctor. Consequently, purpose of our work--to promote efficiency of treatment of patients on CC IIB the stage, by application of neoadjuvant chemotherapy in the combined treatment. The results of treatment are analysed 291 patients on CC IIB stages which got radical treatment in Ivano-Frankivsk OKOD from 1998 to 2013 years. At the use of neoadjuvant chemotherapy index of general 5-years-survival and nonrecurrence survivability made 74.4% and 70.8%, and to preoperative chemotherapy--70.8% and 68.3% accordingly. At application of independent chemoradial therapy, to the index of general 5-years-survival and nonrecurrence survivability was 51.1% and 49.3%, accordingly. It is not exposed reliable difference (P < 0.05) at comparison of indexes of 5-years-survivability of patients which have got the combined methods of treatment, but a reliable difference is exposed when compared to patients which have got independent chemoradial therapy (P > 0.05). Consequently, application of the combined methods of treatment of patients of CC IIB stages were improved by indexes general 5-years and to nonrecurrence survivability by comparison to independent cheradial therapy. .

  6. Etiology impacts survival in patients with severe aortic regurgitation: results from a cohort of 756 patients.

    PubMed

    Varadarajan, Padmini; Patel, Reena; Turk, Rami; Kamath, Ashvin R; Sampath, Unnati; Khandhar, Sumit; Pai, Ramdas G

    2013-01-01

    Severe aortic regurgitation (AR) is caused by a variety of mechanisms, which include the degenerative process, bicuspid aortic valve (BAV), aortic root dilation, endocarditis or a combination of these. Their frequency in a contemporary clinical series, and their impact on survival, are currently unknown. The authors' echocardiographic database between 1993 and 2007 was screened for patients with severe AR, and yielded 756 patients. Detailed chart reviews were performed to acquire clinical and demographic data. Mortality data were obtained from the social security death index and analyzed as a function of the condition's etiology. The probable etiologies for AR were: degenerative in 29% of patients, BAV in 10%, aortic root pathology in 11%, endocarditis in 10%, and mixed or unclear mechanism in 40%. Survival was a function of the etiology (p < 0.0001), with degenerative mechanism having the worst prognosis and BAV the best. This differential impact on mortality remained significant after adjusting for age, gender, coronary artery disease, diabetes mellitus, renal insufficiency, left ventricular ejection fraction and aortic valve replacement, using the Cox regression model (p < 0.0001). Etiology has a significant independent impact on mortality in patients with severe AR, with the worst survival being seen in degenerative AR.

  7. Did Divorces Decline after the Oklahoma City Bombing?

    ERIC Educational Resources Information Center

    Nakonezny, Paul A.; Reddick, Rebecca; Rodgers, Joseph Lee

    2004-01-01

    The Oklahoma City bombing in April 1995 was an act of terrorism that had many potential influences on the city and state, including influences on families. We analyzed divorce data from 1985 to 2000 for all 77 counties in Oklahoma to assess the divorce response to the Oklahoma City bombing. Our prediction was that divorce rates in Oklahoma would…

  8. Hostility as a predictor of survival in patients with coronary artery disease.

    PubMed

    Boyle, Stephen H; Williams, Redford B; Mark, Daniel B; Brummett, Beverly H; Siegler, Ilene C; Helms, Michael J; Barefoot, John C

    2004-01-01

    This article presents a reanalysis of an earlier study that reported a nonsignificant relation between the 50-item Cook-Medley Hostility Scale (CMHS) and survival in a sample of coronary patients. Since publication of those results, there have been significant developments in the measurement of hostility that suggest that an abbreviated scale may be a better predictor of health outcomes. This study examined the ability of the total CMHS and an abbreviated form of the CMHS (ACM) to predict survival in a sample of patients with documented coronary artery disease (CAD) with increased statistical power. Nine hundred thirty-six patients (83% were male; mean age = 51.48) with CAD who were followed for an average of 14.9 years. The ACM consisted of the combination of the cynicism, hostile attribution, hostile affect, and aggressive responding subscales that were identified in an earlier study (Barefoot et al. [1989]) by a rational analysis of the item content. The relation between hostility and survival was examined with Cox proportional hazard models (hazard ratios [HRs] based on a two standard deviation difference). Controlling for disease severity, the ACM was a significant predictor for both CHD mortality (HR = 1.33, p <.009) and total mortality (HR = 1.28, p <.02). The total CMHS was only a marginally significant predictor of either outcome (p values < 0.06). The results of this study suggest that hostility is associated with poorer survival in CAD patients, and it may be possible to refine measures of hostility in order to improve prediction of health outcomes.

  9. Improving patient survival with the colorectal cancer multi-disciplinary team.

    PubMed

    MacDermid, E; Hooton, G; MacDonald, M; McKay, G; Grose, D; Mohammed, N; Porteous, C

    2009-03-01

    There is little information on the impact of the colorectal multi-disciplinary team (MDT) in the United Kingdom. Our single operator presented his patients before and after the inception of an MDT meeting in June 2002. The aim of this study was to assess the effect of this on his patients' survival, and trends in the use of adjuvant chemotherapy. Data were collected on all patients (n = 310) undergoing colectomy for colorectal cancer by one surgeon. Excluding patients with Dukes A stage, the pre-MDT cohort from January 1997 to May 2002 was 176 and the post-MDT cohort from June 2002 to December 2005 was 134. Three-year survival rates were calculated using Kaplan-Meier life table analysis. Prognostic factors were analysed using Cox-proportional hazard regression, and chemotherapy data analysed using the chi-squared test. Independent prognostic indicators of chemotherapy prescription were examined using binary logistic testing. MDT status was shown to be an independent predictor of survival on hazard regression analysis (P = 0.044). A significantly greater number of patients were prescribed adjuvant chemotherapy in the post-MDT cohort (P = 0.0002). MDT status was shown to be a significant prognostic indicator of chemotherapy prescription (P < 0.0001). Three-year survival for Dukes C patients was 58% in the pre-MDT group, and 66% in the post-MDT group (P = 0.023). There was a significant increase in patients undergoing adjuvant postoperative chemotherapy after the inception of the MDT. This was associated with a significant survival benefit in patients with Dukes C disease. The data suggest that the MDT process has resulted in an increase in the prescription of adjuvant chemotherapy, with 3-year survival being greater after its inception.

  10. Clinical features and overall survival among elderly cancer patients in a tertiary cancer center

    PubMed Central

    Antunes, Yuri Philippe Pimentel Vieira; Bugano, Diogo Diniz Gomes; del Giglio, Auro; Kaliks, Rafael Aliosha; Karnakis, Theodora; Pontes, Lucíola de Barros

    2015-01-01

    ABSTRACT Objective To evaluate the epidemiological profile and overall survival of a large population of elderly individuals diagnosed with solid tumors in a tertiary hospital. Methods This retrospective study included patients aged >65 years, diagnosed with solid tumors between January 2007 and December 2011, at Hospital Israelita Albert Einstein, São Paulo, Brazil. The medical records were reviewed to obtain information about clinical variables and overall survival. Results A total of 806 patients were identified, and 58.4% were male. Mean age was 74 years (65 to 99 years). The most common types were prostate (22%), colorectal (21%), breast (19%), and lung cancer (13%), followed by bladder (8%), pancreas (6%), and other types (11%). The majority of patients were diagnosed at early stage disease. After a median follow-up of 27 months (15 to 45 months), 29% of the patients (234/806) died, predominantly in the group older than 70 years. For the entire cohort, the median 2-year survival rate was 71%. Median overall survival was not reached within the study period. In a multivariate analysis, age (HR: 1.35; 95%CI: 1.25-1.45; p<0.001) and disease stage (HR: 1.93; 95%CI: 1.75-2.14; p<0.001) were independent negative predictors of poor survival. Conclusion The most prevalent tumors were prostate, colorectal, breast, and lung cancer, with the larger proportion diagnosed at initial stages, reflecting the great number of patients alive at last follow-up. PMID:26676269

  11. Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients.

    PubMed

    Erhunmwunsee, Loretta; Gulack, Brian C; Rushing, Christel; Niedzwiecki, Donna; Berry, Mark F; Hartwig, Matthew G

    2017-07-01

    Black patients with esophageal cancer have worse survival than white patients. This study examines this racial disparity in conjunction with socioeconomic status (SES) and explores whether race-based outcome differences exist using a national database. The associations between race and SES with overall survival of patients treated with esophagectomy for stages I to III esophageal cancer between 2003 and 2011 in the National Cancer Data Base were investigated using the Kaplan-Meier method and proportional hazards analyses. Median income by zip code and proportion of the zip code residents without a high school diploma were grouped into income and education quartiles, respectively and used as surrogates for SES. The association between race and overall survival stratified by SES is explored. Of 11,599 esophagectomy patients who met study criteria, 3,503 (30.2%) were in the highest income quartile, 2,847 (24.5%) were in the highest education quartile, and 610 patients (5%) were black. Before adjustment for SES, black patients had worse overall survival than white patients (median survival 23.0 versus 34.7 months, log rank p < 0.001), and overall, survival times improved with increasing income and education (p < 0.001 for both). After adjustment for putative prognostic factors, SES was associated with overall survival, whereas race was not. Prior studies have suggested that survival of esophageal cancer patients after esophagectomy is associated with race. Our study suggests that race is not significantly related to overall survival when adjusted for other prognostic variables. Socioeconomic status, however, remains significantly related to overall survival in our model. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Survival of Patients with Cystic Fibrosis Depending on Mutation Type and Nutritional Status.

    PubMed

    Szwed, A; John, A; Goździk-Spychalska, J; Czaiński, W; Czerniak, W; Ratajczak, J; Batura-Gabryel, H

    2018-01-01

    The purpose of the study was to evaluate the influence of nutrition and of the severity of mutation type on survival rate in cystic fibrosis (CF) patients. Data were longitudinally collected from 60 hospitalized adult CF patients, aged 18-50. The variables consisted of body mass index (BMI) ratio, Cole's BMI cut-off points, severity of mutation type, and survival rate of CF patients. We found that the mean BMI was strongly associated with the severity of mutation type and was significantly lower in patients with severe mutations of grade I and II. The mutation type significantly affected the patients' survival rate; survival was greater in patients with mild and undefined mutation types. The BMI and Cole's cut-off points also had a significant influence on survival rate. CF patients, who suffered from malnutrition and emaciation, had a shorter survival rate than those with proper nutritional status. In conclusion, the study findings confirmed a significant effect of nutritional status and of mutation type on survival rate of CF patients.

  13. Bomb Threat Becomes Real News.

    ERIC Educational Resources Information Center

    Gastaldo, Evann

    1999-01-01

    Discusses how the staff of the newspaper at Camarillo High School (California) covered a bomb threat at their school. Describes how they, overnight, conducted interviews, took and developed photographs, produced the layout, and published the newspaper. (RS)

  14. Unusual Long Survival with a Giant Invasive Pheochromocytoma of an Incompatible Patient.

    PubMed

    Nar, Asli

    2018-03-13

    Pheochromocytomas (PHEOs) are rare neuroendocrine tumors and about 2-13% of PHEOs are malignant. Predicting malignancy in PHEO cases with invasion but without metastasis is still controversial in the literature. This study presents an unusual long survival with a giant invasive PHEO in an incompatible patient and a review of the literature. In 1989, a 23-year-old female patient was operated for a giant adrenal mass with a pathological final diagnosis of PHEO. Information to the patient's family was provided about the short life span of the patient in the postoperative period because the tumor could not be totally resected. The patient started using regular antihypertensive drugs only after 1994. In 1994, 3700 mBq 131-I-metaiodobenzylguanidine (MIBG) treatment was given. Since then, no specific treatment was administered for PHEO due to patient incompatibility. She was diagnosed with type 2 diabetes mellitus at the age of 40 years and had a cerebrovascular accident due to hypertension at the age of 42. New abdominal computed tomography (CT) showed a right-sided 75 x 37 mm irregular and heterogeneous mass lesion extending inferiorly from the diaphragmatic crus level located in the right adrenal locus compatible with local recurrence. There was no I-123-MIBG uptake. She refused to have advanced workup and further treatment options. Malignant PHEOs reduce overall survival as a consequence of excessive catecholamine release, large tumor burden, and malignancy-related complications. Currently, the treatment of a malignant PHEO still has difficulties for both patients and doctors. Main treatment options for malignant PHEOs are primarily surgical excision. The effect of radionuclide therapy on survival time still remains to be determined. Efforts should be made to identify clinical, biochemical, and pathological criteria for malignancy and to develop new therapies in these patients with malignancy. The clinical course of malignant PHEOs is remarkably variable. Disease

  15. Marital status, treatment, and survival in patients with glioblastoma multiforme: a population based study.

    PubMed

    Chang, Susan M; Barker, Fred G

    2005-11-01

    Social factors influence cancer treatment choices, potentially affecting patient survival. In the current study, the authors studied the interrelations between marital status, treatment received, and survival in patients with glioblastoma multiforme (GM), using population-based data. The data source was the Surveillance, Epidemiology, and End Results (SEER) Public Use Database, 1988-2001, 2004 release, all registries. Multivariate logistic, ordinal, and Cox regression analyses adjusted for demographic and clinical variables were used. Of 10,987 patients with GM, 67% were married, 31% were unmarried, and 2% were of unknown marital status. Tumors were slightly larger at the time of diagnosis in unmarried patients (49% of unmarried patients had tumors larger than 45 mm vs. 45% of married patients; P = 0.004, multivariate analysis). Unmarried patients were less likely to undergo surgical resection (vs. biopsy; 75% of unmarried patients vs. 78% of married patients) and were less likely to receive postoperative radiation therapy (RT) (70% of unmarried patients vs. 79% of married patients). On multivariate analysis, the odds ratio (OR) for resection (vs. biopsy) in unmarried patients was 0.88 (95% confidence interval [95% CI], 0.79-0.98; P = 0.02), and the OR for RT in unmarried patients was 0.69 (95% CI, 0.62-0.77; P < 0.001). Unmarried patients more often refused both surgical resection and RT. Unmarried patients who underwent surgical resection and RT were found to have a shorter survival than similarly treated married patients (hazard ratio for unmarried patients, 1.10; P = 0.003). Unmarried patients with GM presented with larger tumors, were less likely to undergo both surgical resection and postoperative RT, and had a shorter survival after diagnosis when compared with married patients, even after adjustment for treatment and other prognostic factors. (c) 2005 American Cancer Society.

  16. Post-relapse survival in patients with Ewing sarcoma.

    PubMed

    Ferrari, Stefano; Luksch, Roberto; Hall, Kirsten Sundby; Fagioli, Franca; Prete, Arcangelo; Tamburini, Angela; Tienghi, Amelia; DiGirolamo, Stefania; Paioli, Anna; Abate, Massimo Eraldo; Podda, Marta; Cammelli, Silvia; Eriksson, Mikael; Brach del Prever, Adalberto

    2015-06-01

    Post-relapse survival (PRS) was evaluated in patients with Ewing sarcoma (EWS) enrolled in chemotherapy protocols based on the use of high-dose chemotherapy with busulfan and melfalan (HDT) as a first-line consolidation treatment in high-risk patients. EWS patients enrolled in ISG/SSG III and IV trials who relapsed after complete remission were included in the analysis. At recurrence, chemotherapy based on high-dose ifosfamide was foreseen, and patients who responded but had not received HDT underwent consolidation therapy with HDT. Data from 107 EWS patients were included in the analysis. Median time to recurrence (RFI) was 18 months, and 45 (42%) patients had multiple sites of recurrence. Patients who had previously been treated with HDT had a significantly (P = 0.02) shorter RFI and were less likely to achieve a second complete remission (CR2). CR2 status was achieved by 42 (39%) patients. Fifty patients received high-dose IFO (20 went to consolidation HDT). The 5-year PRS was 19% (95% CI 11 to 27%). With CR2, the 5-year PRS was 48% (95% CI 31 to 64%). Without CR2, median time to death was six months (range 1-45 months). According to the multivariate analysis, patients younger than 15 years, recurrence to the lung only, and RFI longer than 24 months significantly influenced the probability of PRS. Age, pattern of recurrence, RFI, and response to second-line chemotherapy influence post-relapse survival in patients with recurrent Ewing sarcoma. No survival advantage was observed from chemotherapy consolidation with HDT. © 2015 Wiley Periodicals, Inc.

  17. Factors affecting 30-month survival in lung cancer patients.

    PubMed

    Mahesh, P A; Archana, S; Jayaraj, B S; Patil, Shekar; Chaya, S K; Shashidhar, H P; Sunitha, B S; Prabhakar, A K

    2012-10-01

    Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.

  18. Factors affecting 30-month survival in lung cancer patients

    PubMed Central

    Mahesh, P.A.; Archana, S.; Jayaraj, B.S.; Patil, Shekar; Chaya, S.K.; Shashidhar, H.P.; Sunitha, B.S.; Prabhakar, A.K.

    2012-01-01

    Background & objectives: Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Methods: Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. Results: A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Interpretation & conclusions: Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients. PMID:23168702

  19. Marital status and survival in patients with rectal cancer: A population-based STROBE cohort study.

    PubMed

    Li, Zhuyue; Wang, Kang; Zhang, Xuemei; Wen, Jin

    2018-05-01

    To examine the impact of marital status on overall survival (OS) and rectal cancer-specific survival (RCSS) for aged patients.We used the Surveillance, Epidemiology and End Results database to identify aged patients (>65 years) with early stage rectal cancer (RC) (T1-T4, N0, M0) in the United States from 2004 to 2010. Propensity score matching was conducted to avoid potential confounding factors with ratio at 1:1. We used Kaplan-Meier to compare OS and RCSS between the married patients and the unmarried, respectively. We used cox proportion hazard regressions to obtain hazard rates for OS, and proportional subdistribution hazard model was performed to calculate hazard rates for RCSS.Totally, 5196 patients were included. The married (2598 [50%]) aged patients had better crude 5-year overall survival rate (64.2% vs 57.3%, P < .001) and higher crude 5-year cancer-specific survival rate (80% vs 75.9%, P < .001) than the unmarried (2598 (50%)), respectively. In multivariate analyses, married patients had significantly lower overall death than unmarried patients (HR = 0.77, 95% CI = 0.71-0.83, P < .001), while aged married patients had no cancer-specific survival benefit versus the unmarried aged patients (HR = 0.92, 95% CI = 0.81-1.04, P = .17).Among old population, married patients with early stage RC had better OS than the unmarried, while current evidence showed that marital status might have no protective effect on cancer-specific survival.

  20. Physical Parameters of Vulcanian Eruptions at Pichincha Volcano, Ecuador: Bomb Morphologies and Textures

    NASA Astrophysics Data System (ADS)

    Wright, H. M.; Cashman, K.; Rosi, M.; Cioni, R.

    2003-12-01

    Vulcanian eruptions are common at many volcanoes around the world. These eruptions occur in energetic pulses and eject relatively small amounts of material. Each blast event (vulcanian eruption) has been inferred to represent a "throat-clearing" process that ejects a conduit plug. As such, we can examine the ejected material to reconstruct the conduit stratigraphy. The recent sequence of vulcanian eruptions at Guagua Pichincha volcano provides an opportunity to learn more about the dynamics of and pressurization conditions preceding vulcanian eruptions. From late 1999 - mid 2000, Pichincha experienced a series of vulcanian eruptions that ejected ballistic bombs, which now cover the surface of the crater. Bomb types range from dense to highly vesicular, with many exhibiting the breadcrusting that is ubiquitous in vulcanian deposits. Clast morphology varies with clast density, with slightly vesicular bombs having thick, glassy crusts and widely spaced cracks, whereas more vesicular bombs have thinner crusts and more closely spaced, regular crack patterns. The wide range of clast types appears to represent the stratigraphy of the conduit prior to each eruptive event, with denser blocks formed from more degassed magma near the top of the pre-eruptive conduit plug and more vesicular blocks representing deeper, less degassed levels in the conduit. This study uses the ballistic bombs, including the abundant breadcrust bombs, to learn more about conduit processes during a typical vulcanian eruption. In particular, we use the rapidly quenched crusts of breadcrust bombs, which preserve pre-eruptive conduit material, to determine gradients in volatile and crystal content in the conduit. The volatile content (both H2O and CO2) of the pre-eruptive melt was determined from FTIR spectroscopic analysis of bomb rind matrix glass. These values reach up to 1.2 wt% water and 10 ppm CO2, equivalent to 15 MPa maximum recorded presusure, or approximately 600 meters maximum depth

  1. The Oklahoma bombing. Lessons learned.

    PubMed

    Anteau, C M; Williams, L A

    1997-06-01

    The Oklahoma City bombing experience in April of 1995 provided a unique opportunity to test the effectiveness of an existing disaster plan. The critical care nurses at Columbia Presbyterian Hospital learned valuable lessons about managing intense activity, equipment and supplies, staffing resources, and visitor issues. The degree to which the bombing affected the emotional state of personnel was unanticipated, and leaders learned that critical stress management interventions should be included in every emergency preparedness plan. Additionally, recommendations include using runners for communication; assigning specific roles (supplies, staffing, triage); keeping additional staff in reserve for shift relief; ensuring ample hospital staff members are available to coordinate visitors and media; and setting up record systems to preserve continuity. The unique lessons learned as a result of this terrorist attack can be used by other critical care nurses to understand and refine disaster plans.

  2. Determinants of survival in patients receiving dialysis in Libya.

    PubMed

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2013-04-01

    Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

  3. Effect of smoking on survival of patients with hepatocellular carcinoma.

    PubMed

    Kolly, Philippe; Knöpfli, Marina; Dufour, Jean-François

    2017-11-01

    Lifestyle factors such as smoking, obesity and physical activity have gained interest in the field of hepatocellular carcinoma. These factors play a significant role in the development of hepatocellular carcinoma. Several studies revealed the impact of tobacco consumption on the development of hepatocellular carcinoma and its synergistic effects with viral etiologies (hepatitis B and C). The effects of smoking on survival in patients with a diagnosed hepatocellular carcinoma have not yet been investigated in a Western cohort where hepatitis C infection is a major risk factor. Using data from a prospective cohort of patients with hepatocellular carcinoma who were followed at the University Hospital of Bern, Switzerland, survival was compared by Kaplan-Meier analysis in smokers and nonsmokers, and multivariate Cox regression was applied to control for confounding variables. Of 238 eligible hepatocellular carcinoma patients, 64 were smokers at the time of inclusion and 174 were nonsmokers. Smokers had a significant worse overall survival than nonsmokers (hazard ratio 1.77, 95% confidence interval: 1.22-2.58, P=.003). Analysis of patients according to their underlying liver disease, revealed that smoking, and not nonsmoking, affected survival of hepatitis B virus and C virus-infected patients only. In this subgroup, smoking was an independent predictor for survival (hazard ratio 2.99, 95% confidence interval: 1.7-5.23, P<.001) and remained independently predictive when adjusted for confounding variables. This study shows that smoking is an independent predictor of survival in hepatitis B virus/hepatitis C virus-infected patients with hepatocellular carcinoma. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Determinants of 1-year survival in critically ill acute leukemia patients: a GRRR-OH study.

    PubMed

    Tavares, Márcio; Lemiale, Virginie; Mokart, Djamel; Pène, Frédéric; Lengliné, Etienne; Kouatchet, Achille; Mayaux, Julien; Vincent, François; Nyunga, Martine; Bruneel, Fabrice; Rabbat, Antoine; Lebert, Christine; Perez, Pierre; Meert, Anne-Pascale; Benoit, Dominique; Darmon, Michael; Azoulay, Elie

    2018-06-01

    Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (ICU) management. Data on long-term survival are limited. This is a post hoc analysis of the prospective multicenter data from France and Belgium: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique [A Research Group on Acute Respiratory Failure in Onco-Hematological Patients (French)] Study, to identify determinants of 1-year survival in critically ill AL patients. A total of 278 patients were admitted in the 17 participating ICUs. Median age was 58 years and 70% had newly diagnosed leukemia. ICU mortality rate was 28.6 and 39.6% of the patients alive at 1 year. Admission for intensive monitoring was independently associated with better 1-year survival by multivariate analysis. Conversely, relapsed/refractory disease, secondary leukemia, mechanical ventilation and renal replacement therapy were independently associated with 1-year mortality. This study confirms the impact of organ dysfunction on long-term survival in ICU patients with AL. Follow-up studies to assess respiratory and renal recovery are warranted.

  5. A new survival score for patients with brain metastases who received whole-brain radiotherapy (WBRT) alone.

    PubMed

    Rades, Dirk; Dziggel, Liesa; Nagy, Viorica; Segedin, Barbara; Lohynska, Radka; Veninga, Theo; Khoa, Mai T; Trang, Ngo T; Schild, Steven E

    2013-07-01

    Survival scores for patients with brain metastasis exist. However, the treatment regimens used to create these scores were heterogeneous. This study aimed to develop and validate a survival score in homogeneously treated patients. Eight-hundred-and-eighty-two patients receiving 10 × 3Gy of WBRT alone were randomly assigned to a test group (N=441) or a validation group (N=441). In the multivariate analysis of the test group, age, performance status, extracranial metastasis, and systemic treatment prior to WBRT were independent predictors of survival. The score for each factor was determined by dividing the 6-month survival rate (in %) by 10. Scores were summed and total scores ranged from 6 to 19 points. Patients were divided into four prognostic groups. The 6-month survival rates were 4% for 6-9 points, 29% for 10-14 points, 62% for 15-17 points, and 93% for 17-18 points (p<0.001) in the test group. The survival rates were 3%, 28%, 54% and 96%, respectively (p<0.001) in the validation group. Since the 6-month survival rates in the validation group were very similar to the test group, this new score (WBRT-30) appears valid and reproducible. It can help making treatment choices and stratifying patients in future trials. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Psychiatric disorders in rescue workers after the Oklahoma City bombing.

    PubMed

    North, Carol S; Tivis, Laura; McMillen, J Curtis; Pfefferbaum, Betty; Spitznagel, Edward L; Cox, Jann; Nixon, Sara; Bunch, Kenneth P; Smith, Elizabeth M

    2002-05-01

    Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. The prevalence of posttraumatic stress disorder related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem.

  7. Posttraumatic stress among young children after the death of a friend or acquaintance in a terrorist bombing.

    PubMed

    Pfefferbaum, B; Gurwitch, R H; McDonald, N B; Leftwich, M J; Sconzo, G M; Messenbaugh, A K; Schultz, R A

    2000-03-01

    The effects of traumatic loss on children who reported a friend or acquaintance killed in the 1995 Oklahoma City bombing of a federal office building were examined. Twenty-seven children who lost a friend or acquaintance and 27 demographically matched controls were assessed eight to ten months after the bombing. All but three of the children continued to experience posttraumatic stress symptoms. Those who lost a friend watched significantly more bombing-related television coverage than those without losses. Those who lost a friend had significantly more posttraumatic stress symptoms at the time of the assessment than those who lost an acquaintance. Parents and those working with children should be alert to the impact of loss even when it involves nonrelatives.

  8. Dealing with "The Bomb"

    ERIC Educational Resources Information Center

    Caruso, Nicholas D., Jr.

    2004-01-01

    Every superintendent eventually has to deal with "The Bomb." This refers to a loaded question from a board member dropped at an inopportune moment in a public meeting when the superintendent has been given no time to prepare an informed response. The superintendent's typical reactions include the "deer in the headlights" look, a big gulp or even a…

  9. Forensic applications of 14C bomb-pulse dating

    NASA Astrophysics Data System (ADS)

    Zoppi, U.; Skopec, Z.; Skopec, J.; Jones, G.; Fink, D.; Hua, Q.; Jacobsen, G.; Tuniz, C.; Williams, A.

    2004-08-01

    After a brief review of the basics of 14C bomb-pulse dating, this paper presents two unique forensic applications. Particular attention is dedicated to the use of the 14C bomb-pulse to establish the time of harvest of illicit drugs such as heroin and opium. Preliminary measurements of 14C concentrations in milligram samples taken from seized drugs are presented. 14C bomb-pulse dating can determine whether drug distribution originates from stockpiles or recent manufacture, and support the action of law enforcement authorities against criminal organisations involved in drug trafficking. In addition, we describe the dating of wine vintages for a number of authenticated single label vintage red wines from the Barossa Valley - South Australia. Our results show that radiocarbon dating can be used to accurately determine wine vintages and therefore reveal the addition of unrelated materials of natural and synthetic origin.

  10. Survival after in-hospital cardiac arrest among cerebrovascular disease patients.

    PubMed

    Fehnel, Corey R; Trepman, Alissa; Steele, Dale; Khan, Muhib A; Silver, Brian; Mitchell, Susan L

    2018-05-19

    Stroke is a leading cause of death and disability, and while preferences for cardiopulmonary resuscitation (CPR) are frequently discussed, there is limited evidence detailing outcomes after CPR among acute cerebrovascular neurology (inclusive of stroke, subarachnoid hemorrhage (SAH)) patients. Systematic review and meta-analysis of PubMed and Cochrane libraries from January 1990 to December 2016 was conducted among stroke patients undergoing in-hospital CPR. Primary data from studies meeting inclusion criteria at two levels were extracted: 1) studies reporting survival to hospital discharge after CPR with cerebrovascular primary admitting diagnosis, and 2) studies reporting survival to hospital discharge after CPR with cerebrovascular comorbidity. Meta-analysis generated weighted, pooled survival estimates for each population. Of 818 articles screened, there were 176 articles (22%) that underwent full review. Three articles met primary inclusion criteria, with an estimated 8% (95% Confidence Interval (CI) 0.01, 0.14) rate of survival to hospital discharge from a pooled sample of 561 cerebrovascular patients after in-hospital CPR. Twenty articles met secondary inclusion criteria, listing a cerebrovascular comorbidity, with an estimated rate of survival to hospital discharge of 16% (95% CI 0.14, 0.19). All studies demonstrated wide variability in adherence to Utstein guidelines, and neurological outcomes were detailed in only 6 (26%) studies. Among the few studies reporting survival to hospital discharge after CPR among acute cerebrovascular patients, survival is lower than general inpatient populations. These findings synthesize the limited empirical basis for discussions about resuscitation among stroke patients, and highlight the need for more disease stratified reporting of outcomes after inpatient CPR. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Sulfur activation at the Little Boy-Comet Critical Assembly: a replica of the Hiroshima bomb

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kerr, G.D.; Emery, J.F.; Pace, J.V. III

    1985-04-01

    Studies have been completed on the activation of sulfur by fast neutrons from the Little Boy-Comet Critical Assembly which replicates the general features of the Hiroshima bomb. The complex effects of the bomb's design and construction on leakage of sulfur-activation neutrons were investigated both experimentally and theoretically. Our sulfur activation studies were performed as part of a larger program to provide benchmark data for testing of methods used in recent source-term calculations for the Hiroshima bomb. Source neutrons capable of activating sulfur play an important role in determining neutron doses in Hiroshima at a kilometer or more from the pointmore » of explosion. 37 refs., 5 figs., 6 tabs.« less

  12. Neutron relative biological effectiveness in Hiroshima and Nagasaki atomic bomb survivors: a critical review

    PubMed Central

    Sasaki, Masao S.; Endo, Satoru; Hoshi, Masaharu; Nomura, Taisei

    2016-01-01

    The calculated risk of cancer in humans due to radiation exposure is based primarily on long-term follow-up studies, e.g. the life-span study (LSS) on atomic bomb (A-bomb) survivors in Hiroshima and Nagasaki. Since A-bomb radiation consists of a mixture of γ-rays and neutrons, it is essential that the relative biological effectiveness (RBE) of neutrons is adequately evaluated if a study is to serve as a reference for cancer risk. However, the relatively small neutron component hampered the direct estimation of RBE in LSS data. To circumvent this problem, several strategies have been attempted, including dose-independent constant RBE, dose-dependent variable RBE, and dependence on the degrees of dominance of intermingled γ-rays. By surveying the available literature, we tested the chromosomal RBE of neutrons as the biological endpoint for its equivalence to the microdosimetric quantities obtained using a tissue-equivalent proportional counter (TEPC) in various neutron fields. The radiation weighting factor, or quality factor, Qn, of neutrons as expressed in terms of the energy dependence of the maximum RBE, RBEm, was consistent with that predicted by the TEPC data, indicating that the chromosomally measured RBE was independent of the magnitude of coexisting γ-rays. The obtained neutron RBE, which varied with neutron dose, was confirmed to be the most adequate RBE system in terms of agreement with the cancer incidence in A-bomb survivors, using chromosome aberrations as surrogate markers. With this RBE system, the cancer risk in A-bomb survivors as expressed in unit dose of reference radiation is equally compatible with Hiroshima and Nagasaki cities, and may be potentially applicable in other cases of human radiation exposure. PMID:27614201

  13. Risk factors affecting survival in heart transplant patients.

    PubMed

    Almenar, L; Cardo, M L; Martínez-Dolz, L; García-Palomar, C; Rueda, J; Zorio, E; Arnau, M A; Osa, A; Palencia, M

    2005-11-01

    Certain cardiovascular risk factors have been linked to morbidity and mortality in heart transplant (HT) patients. The sum of various risk factors may have a large cumulative negative effect, leading to a substantially worse prognosis and the need to consider whether HT is contraindicated. The objective of this study was to determine whether the risk factors usually available prior to HT result in an excess mortality in our setting that contraindicates transplantation. Consecutive patients who underwent heart transplantation from November 1987 to January 2004 were included. Heart-lung transplants, retransplants, and pediatric transplants were excluded. Of the 384 patients, 89% were men. Mean age was 52 years (range, 12 to 67). Underlying disease included ischemic heart disease (52%), idiopathic dilated cardiomyopathy (36%), valvular disease (8%), and other (4%). Variables considered risk factors were obesity (BMI >25), dyslipidemia, hypertension, prior thoracic surgery, diabetes, and history of ischemic heart disease. Survival curves by number of risk factors using Kaplan-Meier and log-rank for comparison of curves. Overall patient survival at 1, 5, 10, and 13 years was 76%, 68%, 54%, and 47%, respectively. Survival at 10 years, if fewer than two risk factors were present, was 69%; 59% if two or three factors were present; and 37% if more than three associated risk factors were present (P = .04). The presence of certain risk factors in patients undergoing HT resulted in lower survival rates. The combination of various risk factors clearly worsened outcomes. However, we do not believe this should be an absolute contraindication for transplantation.

  14. A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients.

    PubMed

    Oberije, Cary; De Ruysscher, Dirk; Houben, Ruud; van de Heuvel, Michel; Uyterlinde, Wilma; Deasy, Joseph O; Belderbos, Jose; Dingemans, Anne-Marie C; Rimner, Andreas; Din, Shaun; Lambin, Philippe

    2015-07-15

    Although patients with stage III non-small cell lung cancer (NSCLC) are homogeneous according to the TNM staging system, they form a heterogeneous group, which is reflected in the survival outcome. The increasing amount of information for an individual patient and the growing number of treatment options facilitate personalized treatment, but they also complicate treatment decision making. Decision support systems (DSS), which provide individualized prognostic information, can overcome this but are currently lacking. A DSS for stage III NSCLC requires the development and integration of multiple models. The current study takes the first step in this process by developing and validating a model that can provide physicians with a survival probability for an individual NSCLC patient. Data from 548 patients with stage III NSCLC were available to enable the development of a prediction model, using stratified Cox regression. Variables were selected by using a bootstrap procedure. Performance of the model was expressed as the c statistic, assessed internally and on 2 external data sets (n=174 and n=130). The final multivariate model, stratified for treatment, consisted of age, gender, World Health Organization performance status, overall treatment time, equivalent radiation dose, number of positive lymph node stations, and gross tumor volume. The bootstrapped c statistic was 0.62. The model could identify risk groups in external data sets. Nomograms were constructed to predict an individual patient's survival probability (www.predictcancer.org). The data set can be downloaded at https://www.cancerdata.org/10.1016/j.ijrobp.2015.02.048. The prediction model for overall survival of patients with stage III NSCLC highlights the importance of combining patient, clinical, and treatment variables. Nomograms were developed and validated. This tool could be used as a first building block for a decision support system. Copyright © 2015 The Authors. Published by Elsevier Inc. All

  15. Survival of Patients Receiving a Primary Prevention Implantable Cardioverter-Defibrillator in Clinical Practice vs Clinical Trials

    PubMed Central

    Al-Khatib, Sana M.; Hellkamp, Anne; Bardy, Gust H.; Hammill, Stephen; Jackson Hall, W.; Mark, Daniel B.; Anstrom, Kevin J.; Curtis, Jeptha; Al-Khalidi, Hussein; Curtis, Lesley H.; Heidenreich, Paul; Peterson, Eric D.; Sanders, Gillian; Clapp-Channing, Nancy; Lee, Kerry L.; Moss, Arthur J.

    2013-01-01

    Importance Randomized clinical trials have shown that implantable cardioverter-defibrillator (ICD) therapy saves lives. Whether the survival of patients who received an ICD in primary prevention clinical trials differs from that of trial-eligible patients receiving a primary prevention ICD in clinical practice is unknown. Objective To determine whether trial-eligible patients who received a primary prevention ICD as documented in a large national registry have a survival rate that differs from the survival rate of similar patients who received an ICD in the 2 largest primary prevention clinical trials, MADIT-II (n=742) and SCD-HeFT (n=829). Design, Setting, and Patients Retrospective analysis of data for patients enrolled in the National Cardiovascular Data Registry ICD Registry between January 1, 2006, and December 31, 2007, meeting the MADIT-II criteria (2464 propensity score–matched patients) or the SCD-HeFT criteria (3352 propensity score–matched patients). Mortality data for the registry patients were collected through December 31, 2009. Main Outcome Measures Cox proportional hazards models were used to compare mortality from any cause. Results The median follow-up time in MADIT-II, SCD-HeFT, and the ICD Registry was 19.5, 46.1, and 35.2 months, respectively. Compared with patients enrolled in the clinical trials, patients in the ICD Registry were significantly older and had a higher burden of comorbidities. In the matched cohorts, there was no significant difference in survival between MADIT-II–like patients in the registry and MADIT-II patients randomized to receive an ICD (2-year mortality rates: 13.9% and 15.6%, respectively; adjusted ICD Registry vs trial hazard ratio, 1.06; 95% CI, 0.85–1.31; P=.62). Likewise, the survival among SCD-HeFT–like patients in the registry was not significantly different from survival among patients randomized to receive ICD therapy in SCD-HeFT (3-year mortality rates: 17.3% and 17.4%, respectively; adjusted registry

  16. Epidemiological research on radiation-induced cancer in atomic bomb survivors

    PubMed Central

    Ozasa, Kotaro

    2016-01-01

    The late effects of exposure to atomic bomb radiation on cancer occurrence have been evaluated by epidemiological studies on three cohorts: a cohort of atomic bomb survivors (Life Span Study; LSS), survivors exposed in utero, and children of atomic bomb survivors (F1). The risk of leukemia among the survivors increased remarkably in the early period after the bombings, especially among children. Increased risks of solid cancers have been evident since around 10 years after the bombings and are still present today. The LSS has clarified the dose–response relationships of radiation exposure and risk of various cancers, taking into account important risk modifiers such as sex, age at exposure, and attained age. Confounding by conventional risk factors including lifestyle differences is not considered substantial because people were non-selectively exposed to the atomic bomb radiation. Uncertainty in risk estimates at low-dose levels is thought to be derived from various sources, including different estimates of risk at background levels, uncertainty in dose estimates, residual confounding and interaction, strong risk factors, and exposure to residual radiation and/or medical radiation. The risk of cancer in subjects exposed in utero is similar to that in LSS subjects who were exposed in childhood. Regarding hereditary effects of radiation exposure, no increased risk of cancers associated with parental exposure to radiation have been observed in the F1 cohort to date. In addition to biological and pathogenetic interpretations of the present results, epidemiological investigations using advanced technology should be used to further analyze these cohorts. PMID:26976124

  17. Pre- and post-bomb radiocarbon in fish otoliths

    NASA Astrophysics Data System (ADS)

    Kalish, John M.

    1993-02-01

    Measurements of radiocarbon in seawater dissolved inorganic carbon (DIC), or suitable proxies such as hermatypic corals, are a valuable source of information on carbon flux and ocean circulation. However, knowledge of the global distribution of both pre- and post-bomb radiocarbon is limited due to the sources of these data. Suitable hermatypic corals are restricted to shallow tropical and subtropical waters and oceanographic collections of seawater are prohibitively expensive. What is needed is a proxy for ocean radiocarbon that can be collected at most latitudes and depths, and which can be reliably aged. Here I report accelerator mass spectrometry analyses of radiocarbon from selected regions of fish otoliths and show that such measurements are suitable for determining both pre- and post-bomb radiocarbon in all oceans and at most depths. Radiocarbon data obtained from otoliths can extend our knowledge of carbon flux in the oceans and atmosphere and help to develop further understanding of the fate of atmospheric CO 2 and ocean circulation. The data presented here represent the first pre- and post-bomb time series of radiocarbon levels from temperate waters. Furthermore, I demonstrate that the dramatic increase in radiocarbon in the atmosphere and oceans, attributable to the atmospheric testing of thermonuclear bombs during the 1950's and 1960's, provides a chemical mark on fish otoliths that is suitable for the validation of age in fishes.

  18. Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb--case report.

    PubMed

    Golubović, Zoran; Vidić, Goran; Trenkić, Srbobran; Vukasinović, Zoran; Lesić, Aleksandar; Stojiljković, Predrag; Stevanović, Goran; Golubović, Ivan; Visnjić, Aleksandar; Najman, Stevo

    2010-01-01

    Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.

  19. 26. BOMBS IN CRATE IN BUILDING 1607. VIEW TO NORTHWEST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    26. BOMBS IN CRATE IN BUILDING 1607. VIEW TO NORTHWEST. - Rocky Mountain Arsenal, Cluster Bomb Assembly-Filling-Storage Building, 3500 feet South of Ninth Avenue; 2870 feet East of D Street, Commerce City, Adams County, CO

  20. Associations between advanced cancer patients' survival and family caregiver presence and burden.

    PubMed

    Dionne-Odom, J Nicholas; Hull, Jay G; Martin, Michelle Y; Lyons, Kathleen Doyle; Prescott, Anna T; Tosteson, Tor; Li, Zhongze; Akyar, Imatullah; Raju, Dheeraj; Bakitas, Marie A

    2016-05-01

    We conducted a randomized controlled trial (RCT) of an early palliative care intervention (ENABLE: Educate, Nurture, Advise, Before Life Ends) for persons with advanced cancer and their family caregivers. Not all patient participants had a caregiver coparticipant; hence, we explored whether there were relationships between patient survival, having an enrolled caregiver, and caregiver outcomes prior to death. One hundred and twenty-three patient-caregiver dyads and 84 patients without a caregiver coparticipant participated in the ENABLE early versus delayed (12 weeks later) RCT. We collected caregiver quality-of-life (QOL), depression, and burden (objective, stress, and demand) measures every 6 weeks for 24 weeks and every 3 months thereafter until the patient's death or study completion. We conducted survival analyses using log-rank and Cox proportional hazards models. Patients with a caregiver coparticipant had significantly shorter survival (Wald = 4.31, HR = 1.52, CI: 1.02-2.25, P = 0.04). After including caregiver status, marital status (married/unmarried), their interaction, and relevant covariates, caregiver status (Wald = 6.25, HR = 2.62, CI: 1.23-5.59, P = 0.01), being married (Wald = 8.79, HR = 2.92, CI: 1.44-5.91, P = 0.003), and their interaction (Wald = 5.18, HR = 0.35, CI: 0.14-0.87, P = 0.02) were significant predictors of lower patient survival. Lower survival in patients with a caregiver was significantly related to higher caregiver demand burden (Wald = 4.87, CI: 1.01-1.20, P = 0.03) but not caregiver QOL, depression, and objective and stress burden. Advanced cancer patients with caregivers enrolled in a clinical trial had lower survival than patients without caregivers; however, this mortality risk was mostly attributable to higher survival by unmarried patients without caregivers. Higher caregiver demand burden was also associated with decreased patient survival. © 2016 The Authors. Cancer Medicine published by

  1. Ten-Year Survival in Patients with Idiopathic Pulmonary Fibrosis After Lung Transplantation.

    PubMed

    ten Klooster, Liesbeth; Nossent, George D; Kwakkel-van Erp, Johanna M; van Kessel, Diana A; Oudijk, Erik J; van de Graaf, Ed A; Luijk, Bart; Hoek, Rogier A; van den Blink, Bernt; van Hal, Peter Th; Verschuuren, Erik A; van der Bij, Wim; van Moorsel, Coline H; Grutters, Jan C

    2015-12-01

    Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal fibrosing lung disease with a median survival of approximately 3 years after diagnosis. The only medical option to improve survival in IPF is lung transplantation (LTX). The purpose of this study was to evaluate trajectory data of IPF patients listed for LTX and to investigate the survival after LTX. Data were retrospectively collected from September 1989 until July 2011 of all IPF patients registered for LTX in the Netherlands. Patients were included after revision of the diagnosis based on the criteria set by the ATS/ERS/JRS/ALAT. Trajectory data, clinical data at time of screening, and donor data were collected. In total, 98 IPF patients were listed for LTX. During the waiting list period, 30 % of the patients died. Mean pulmonary artery pressure, 6-min walking distance, and the use of supplemental oxygen were significant predictors of mortality on the waiting list. Fifty-two patients received LTX with a median overall survival after transplantation of 10 years. This study demonstrated a 10-year survival time after LTX in IPF. Furthermore, our study demonstrated a significantly better survival after bilateral LTX in IPF compared to single LTX although bilateral LTX patients were significantly younger.

  2. Description and Survival of Stage I and II Lung Cancer Patients.

    PubMed

    Pérez-Martínez, Olaia; Vidal-García, Iria; Montero-Martínez, Carmen; Provencio, Mariano; Ruano-Ravina, Alberto

    2018-03-16

    The objective of our study was to describe the characteristics of patients diagnosed with stage I and II lung cancer in the health area of A Coruña (Galicia) and to determine their overall survival according to certain variables. Retrospective case series in patients diagnosed between January 2011 and December 2015 with stage I and II primary lung cancer with a minimum follow-up of 18 months. 158 patients were included, 99 at stage I, with a median age of 69 years [range 20-90], predominantly men (81%). Adenocarcinoma was the most common histology (52.9%), followed by epidermoid carcinoma (33.1%). Asymptomatic patients (35.9%) presented more frequently in stage I. Median survival was 57 months (95% CI 48.1-65.9), with higher survival among women, patients under 70 years of age, and those who received surgical treatment. Early stage lung cancer in the health area of A Coruña occurs predominantly in men, in advanced age, and with adenocarcinoma histology. Survival was greater among patients with stage I disease, women, individuals aged under 70 years, and those treated surgically. Despite early diagnosis, median survival was less than 5 years. Copyright © 2018 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Survival of patients treated for end-stage renal disease by dialysis and transplantation.

    PubMed Central

    Higgins, M. R.; Grace, M.; Dossetor, J. B.

    1977-01-01

    The results of treatment in 213 patients with end-stage renal disease who underwent hemodialysis, peritoneal dialysis or transplantation, or a combination, between 1962 and 1975 were analysed. Comparison by censored survival analysis showed significantly better (P less than 0.01) patient survival with the integrated therapy of dialysis and transplantation than with either form of dialysis alone. There was no significant difference in survival of males and females but survival at the extremes of age was poorer. Analysis of survival by major cause of renal failure indicated best survival in patients with congenital renal disease. Graft and patient survival rates at 1 year after the first transplantation were 42% and 69%. The major cause of death in this series was vascular disease but infection was responsible for 50% of deaths after transplantation. While integration of dialysis with transplantation produces best patient survival, this course is possible only when sufficient cadaver kidneys are available. PMID:334354

  4. Survival Rate of Dental Implants in Patients with History of Periodontal Disease: A Retrospective Cohort Study.

    PubMed

    Correia, Francisco; Gouveia, Sónia; Felino, António Campos; Costa, Ana Lemos; Almeida, Ricardo Faria

    To evaluate the differences between the survival rates of implants placed in patients with no history of periodontal disease (NP) and in patients with a history of chronic periodontal disease (CP). A retrospective cohort study was conducted in which all consenting patients treated with dental implants in a private clinic in Oporto, Portugal, from November 2, 2002 through February 11, 2011 were included. All patients were treated consecutively by the same experimental operator. This study aimed to analyze how the primary outcomes (presence of disease, time of placement, and time of loading) and the secondary outcomes (severity-generalized periodontitis, brand, implant length, prosthesis type, prosthesis metal-ceramic extension) influence the survival rate of dental implants. The survival analysis was performed through the Kaplan-Meier method, and the equality of survival distributions for all groups was tested with the log-rank test with a significance level of .05 for all comparisons. The sample consisted of 202 patients (47% NP and 53% CP) and 689 implants (31% NP and 69% CP). The survival rate in the NP and CP groups showed no statistically significant differences (95.8% versus 93.1%; P ≥ .05). Implants were lost before loading in 54.9% of the cases. The majority of the implants were lost in the first year and stabilized after the second year. Survival rates in the NP and CP patients showed no statistically significant differences when comparing the following factors: subclassification of the disease, implant brands, implant length (short/standard), type of prosthesis, extension of the prosthesis metal-ceramic, and time of placement and loading (P ≥ .05). This work disclosed no statistically significant differences in terms of survival rates when compared with the control group. Placing implants in patients with a history of periodontal disease appears to be viable and safe.

  5. How a School Coped with the Oklahoma City Bombing.

    ERIC Educational Resources Information Center

    Aspy, David N.; Aspy, Cheryl B.

    1996-01-01

    Following the Oklahoma City bombing, fifth graders at a nearby elementary school coped with ensuing uncertainty, pain, and loss. They wrote appreciative letters to fire and rescue workers; shared personal stories with classmates; compiled an anthology of poems, prayers, and stories; attended an assembly to honor parents participating in rescue…

  6. Prognostic and survival analysis of 837 Chinese colorectal cancer patients.

    PubMed

    Yuan, Ying; Li, Mo-Dan; Hu, Han-Guang; Dong, Cai-Xia; Chen, Jia-Qi; Li, Xiao-Fen; Li, Jing-Jing; Shen, Hong

    2013-05-07

    To develop a prognostic model to predict survival of patients with colorectal cancer (CRC). Survival data of 837 CRC patients undergoing surgery between 1996 and 2006 were collected and analyzed by univariate analysis and Cox proportional hazard regression model to reveal the prognostic factors for CRC. All data were recorded using a standard data form and analyzed using SPSS version 18.0 (SPSS, Chicago, IL, United States). Survival curves were calculated by the Kaplan-Meier method. The log rank test was used to assess differences in survival. Univariate hazard ratios and significant and independent predictors of disease-specific survival and were identified by Cox proportional hazard analysis. The stepwise procedure was set to a threshold of 0.05. Statistical significance was defined as P < 0.05. The survival rate was 74% at 3 years and 68% at 5 years. The results of univariate analysis suggested age, preoperative obstruction, serum carcinoembryonic antigen level at diagnosis, status of resection, tumor size, histological grade, pathological type, lymphovascular invasion, invasion of adjacent organs, and tumor node metastasis (TNM) staging were positive prognostic factors (P < 0.05). Lymph node ratio (LNR) was also a strong prognostic factor in stage III CRC (P < 0.0001). We divided 341 stage III patients into three groups according to LNR values (LNR1, LNR ≤ 0.33, n = 211; LNR2, LNR 0.34-0.66, n = 76; and LNR3, LNR ≥ 0.67, n = 54). Univariate analysis showed a significant statistical difference in 3-year survival among these groups: LNR1, 73%; LNR2, 55%; and LNR3, 42% (P < 0.0001). The multivariate analysis results showed that histological grade, depth of bowel wall invasion, and number of metastatic lymph nodes were the most important prognostic factors for CRC if we did not consider the interaction of the TNM staging system (P < 0.05). When the TNM staging was taken into account, histological grade lost its statistical significance, while the specific TNM

  7. 24. INTERIOR DETAIL OF BUILDING 1607, SHOWING BOMBS AND CRATES. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. INTERIOR DETAIL OF BUILDING 1607, SHOWING BOMBS AND CRATES. VIEW TO SOUTHWEST. - Rocky Mountain Arsenal, Cluster Bomb Assembly-Filling-Storage Building, 3500 feet South of Ninth Avenue; 2870 feet East of D Street, Commerce City, Adams County, CO

  8. [Survival in patients with liver cirrhosis at the Durango, IMSS Regional General Hospital].

    PubMed

    Rodríguez-Hernández, Heriberto; Jacobo-Karam, Janett S; Castañón-Santillán, María del Carmen; Arámbula-Chávez, Mayela; Martínez-Aguilar, Gerardo

    2002-01-01

    In Mexico, hepatic cirrhosis mortality exhibits important regional differences. To analyze global survival of cirrhotic patients, according to etiology and functional status. Between March 1990 to August 1998, newly diagnosed patients with hepatic cirrhosis were included in a follow-up study. Subjects were analyzed monthly. Information on clinical evolution, complications, and dates of events (death) and complications were registered. Survival was estimated using Kaplan-Meier method. Ninety nine subjects were included in the survival analysis, 66 with alcoholic and 33 with viral cirrhosis (HCV and HBV in 24 and nine patients, respectively). Ninety seven percent of patients were decompensated at diagnosis, and 81% had ascites. Probabilities for survival in the entire series were 69.7, 37.6 and 23.6% at 24, 48, and 60 months, respectively. There were no significant differences in the survival of patients grouped according to etiology. When survival was analyzed by Child-Pugh score, it was slightly higher in the alcoholic cirrhosis group. In this study survival probability of patients with viral cirrhosis was lower than in patients with alcohol cirrhosis.

  9. Was Nazi Germany on the Road to an Atomic Bomb after all?

    NASA Astrophysics Data System (ADS)

    Lustig, Harry

    2006-04-01

    The story of Germany's efforts to develop a nuclear weapon during World War II is a much written about and contentious subject. However there has been agreement on one thing: by the end of the War the Germans had not achieved and were nowhere near to building a bomb. The dispute therefore has been about why Germany did not succeed. Now, from Germany, comes a challenge to this truth, in the provocative book Hitlers Bombe by Rainer Karlsch. The bombshell in Hitler's Bombe is the assertion that German scientists developed and tested a primitive fission and fusion nuclear weapon in March 1945. Karlsch bases this claim on testimony of witnesses in 1962, previously secret Russian documents, and the results of soil tests carried out in 2004 and 2005. However the physics is very murky and it seems out of the question that Germany had enough Uranium 235 or produced any Plutonium for a bomb. Hitlers Bombe also makes other, better documented and more credible revisionist assertions. These include the claim that the Nazis did continue to try to build a bomb after 1942 and that not Werner Heisenberg, but Kurt Diebner and Walther Gerlach were then the leaders of the German Uranium project. Karlsch's book therefore deserves more attention from physicists and historians than it has received in the United States.

  10. Association of Acute Radiation Syndrome and Rain after the Bombings in Atomic Bomb Survivors.

    PubMed

    Ozasa, K; Sakata, R; Cullings, H M; Grant, E J

    2016-06-01

    Acute radiation-induced symptoms reported in survivors after the atomic bombings in Hiroshima and Nagasaki have been suspected to be associated with rain that fell after the explosions, but this association has not been evaluated in an epidemiological study that considers the effects of the direct dose from the atomic bombs and other factors. The aim of this study was to evaluate this association using information from a fixed cohort, comprised of 93,741 members of the Life Span Study who were in the city at the time of the bombing. Information on acute symptoms and exposure to rain was collected in surveys conducted by interviewers, primarily in the 1950s. The proportion of survivors developing severe epilation was around 60% at levels of direct radiation doses of 3 Gy or higher and less than 0.2% at levels <0.005 Gy regardless of reported rain exposure status. The low prevalence of acute symptoms at low direct doses indicates that the reported fallout rain was not homogeneously radioactive at a level sufficient to cause a substantial probability of acute symptoms. We observed that the proportion of reported acute symptoms was slightly higher among those who reported rain exposure in some subgroups, however, suggestions that rain was the cause of these reported symptoms are not supported by analyses specific to the known areas of radioactive fallout. Misclassification of exposure and outcome, including symptoms due to other causes and recall bias, appears to be a more plausible explanation. However, the insufficient and retrospective nature of the available data limited our ability to quantify the attribution to those possible causes.

  11. Is Dialysis Modality a Factor in the Survival of Patients Initiating Dialysis After Kidney Transplant Failure?

    PubMed Central

    Perl, Jeffrey; Dong, James; Rose, Caren; Jassal, Sarbjit Vanita; Gill, John S.

    2013-01-01

    ♦ Background: Kidney transplant failure (TF) is among the leading causes of dialysis initiation. Whether survival is similar for patients treated with peritoneal dialysis (PD) and with hemodialysis (HD) after TF is unclear and may inform decisions concerning dialysis modality selection. ♦ Methods: Between 1995 and 2007, 16 113 adult dialysis patients identified from the US Renal Data System initiated dialysis after TF. A multivariable Cox proportional hazards model was used to evaluate the impact of initial dialysis modality (1 865 PD, 14 248 HD) on early (1-year) and overall mortality in an intention-to-treat approach. ♦ Results: Compared with HD patients, PD patients were younger (46.1 years vs 49.4 years, p < 0.0001) with fewer comorbidities such as diabetes mellitus (23.1% vs 25.7%, p < 0.0001). After adjustment, survival among PD patients was greater within the first year after dialysis initiation [adjusted hazard ratio (AHR): 0.85; 95% confidence interval (CI): 0.74 to 0.97], but lower after 2 years (AHR: 1.15; 95% CI: 1.02 to 1.29). During the entire period of observation, survival in both groups was similar (AHR for PD compared with HD: 1.09; 95% CI: 1.0 to 1.20). In a sensitivity analysis restricted to a cohort of 1865 propensity-matched pairs of HD and PD patients, results were similar (AHR: 1.03; 95% CI: 0.93 to 1.14). Subgroups of patients with a body mass index exceeding 30 kg/m2 [AHR: 1.26; 95% CI: 1.05 to 1.52) and with a baseline estimated glomerular filtration rate (eGFR) less than 5 mL/min/1.73 m2 (AHR: 1.45; 95% CI: 1.05 to 1.98) experienced inferior overall survival when treated with PD. ♦ Conclusions: Compared with HD, PD is associated with an early survival advantage, inferior late survival, and similar overall survival in patients initiating dialysis after TF. Those data suggest that increased initial use of PD among patients returning to dialysis after TF may be associated with improved outcomes, except among patients with a higher

  12. The image of the atomic bomb in Japan before Hiroshima.

    PubMed

    Nakao, Maika

    2009-01-01

    This paper traces the roots of the image of the atomic bomb in Japan by investigating the various discourses on atomic energy and atomic weapons in Japanese literature prior to the bombing of Hiroshima in August 1945. Japan is a country that suffered an atomic attack and, at the same time, one of the countries that was engaged in atomic weapons research during the Second World War. During the war, the discourses on atomic weapons were not limited to the military or scientific communities, but included the general public, thus facilitating the creation of a shared image of the atomic bomb as an ultimate weapon. This paper examines how this image was created. This special issue deals with the comparison among different countries, but the purpose of my paper is to deepen this subject by illustrating the differences within a single country in different periods. This research aims to extend the historical perspective concerning the atomic bomb in Japan, and offers another way of looking at this both historical and contemporary issue.

  13. Survival Comparison of Patients With Cystic Fibrosis in Canada and the United States: A Population-Based Cohort Study.

    PubMed

    Stephenson, Anne L; Sykes, Jenna; Stanojevic, Sanja; Quon, Bradley S; Marshall, Bruce C; Petren, Kristofer; Ostrenga, Josh; Fink, Aliza K; Elbert, Alexander; Goss, Christopher H

    2017-04-18

    In 2011, the median age of survival of patients with cystic fibrosis reported in the United States was 36.8 years, compared with 48.5 years in Canada. Direct comparison of survival estimates between national registries is challenging because of inherent differences in methodologies used, data processing techniques, and ascertainment bias. To use a standardized approach to calculate cystic fibrosis survival estimates and to explore differences between Canada and the United States. Population-based study. 42 Canadian cystic fibrosis clinics and 110 U.S. cystic fibrosis care centers. Patients followed in the Canadian Cystic Fibrosis Registry (CCFR) and U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR) between 1990 and 2013. Cox proportional hazards models were used to compare survival between patients followed in the CCFR (n = 5941) and those in the CFFPR (n = 45 448). Multivariable models were used to adjust for factors known to be associated with survival. Median age of survival in patients with cystic fibrosis increased in both countries between 1990 and 2013; however, in 1995 and 2005, survival in Canada increased at a faster rate than in the United States (P < 0.001). On the basis of contemporary data from 2009 to 2013, the median age of survival in Canada was 10 years greater than in the United States (50.9 vs. 40.6 years, respectively). The adjusted risk for death was 34% lower in Canada than the United States (hazard ratio, 0.66 [95% CI, 0.54 to 0.81]). A greater proportion of patients in Canada received transplants (10.3% vs. 6.5%, respectively [standardized difference, 13.7]). Differences in survival between U.S. and Canadian patients varied according to U.S. patients' insurance status. Ascertainment bias due to missing data or nonrandom loss to follow-up might affect the results. Differences in cystic fibrosis survival between Canada and the United States persisted after adjustment for risk factors associated with survival, except for private

  14. Relationship between physician and patient assessment of performance status and survival in a large cohort of patients with haematologic malignancies.

    PubMed

    Liu, Michael A; Hshieh, Tammy; Condron, Nolan; Wadleigh, Martha; Abel, Gregory A; Driver, Jane A

    2016-09-27

    Few studies have investigated the relationship between physician and patient-assessed performance status (PS) in blood cancers. Retrospective analysis among 1418 patients with haematologic malignancies seen at Dana-Farber Cancer Institute between 2007 and 2014. We analysed physician-patient agreement of Eastern Cooperative Oncology Group PS using weighted κ-statistics and survival analysis. Mean age was 58.6 years and average follow-up was 38 months. Agreement in PS was fair/moderate (weighted κ=0.41, 95% CI 0.37-0.44). Physicians assigned a better functional status (lower score) than patients (mean 0.60 vs 0.81), particularly when patients were young and the disease was aggressive. Both scores independently predicted survival, but physician scores were more accurate. Disagreements in score were associated with poorer survival when physicians rated PS better than patients, and were modified by age, sex and severity of disease. Physician-patient disagreements in PS score are common and have prognostic significance.

  15. 25. INTERIOR DETAIL OF BUILDING 1607, SHOWING BOMB CRATES AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    25. INTERIOR DETAIL OF BUILDING 1607, SHOWING BOMB CRATES AND SCALE. VIEW TO WEST. - Rocky Mountain Arsenal, Cluster Bomb Assembly-Filling-Storage Building, 3500 feet South of Ninth Avenue; 2870 feet East of D Street, Commerce City, Adams County, CO

  16. Neutron relative biological effectiveness in Hiroshima and Nagasaki atomic bomb survivors: a critical review.

    PubMed

    Sasaki, Masao S; Endo, Satoru; Hoshi, Masaharu; Nomura, Taisei

    2016-11-01

    The calculated risk of cancer in humans due to radiation exposure is based primarily on long-term follow-up studies, e.g. the life-span study (LSS) on atomic bomb (A-bomb) survivors in Hiroshima and Nagasaki. Since A-bomb radiation consists of a mixture of γ-rays and neutrons, it is essential that the relative biological effectiveness (RBE) of neutrons is adequately evaluated if a study is to serve as a reference for cancer risk. However, the relatively small neutron component hampered the direct estimation of RBE in LSS data. To circumvent this problem, several strategies have been attempted, including dose-independent constant RBE, dose-dependent variable RBE, and dependence on the degrees of dominance of intermingled γ-rays. By surveying the available literature, we tested the chromosomal RBE of neutrons as the biological endpoint for its equivalence to the microdosimetric quantities obtained using a tissue-equivalent proportional counter (TEPC) in various neutron fields. The radiation weighting factor, or quality factor, Q n , of neutrons as expressed in terms of the energy dependence of the maximum RBE, RBE m , was consistent with that predicted by the TEPC data, indicating that the chromosomally measured RBE was independent of the magnitude of coexisting γ-rays. The obtained neutron RBE, which varied with neutron dose, was confirmed to be the most adequate RBE system in terms of agreement with the cancer incidence in A-bomb survivors, using chromosome aberrations as surrogate markers. With this RBE system, the cancer risk in A-bomb survivors as expressed in unit dose of reference radiation is equally compatible with Hiroshima and Nagasaki cities, and may be potentially applicable in other cases of human radiation exposure. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  17. Self-rated health supersedes patient satisfaction with service quality as a predictor of survival in prostate cancer.

    PubMed

    Gupta, Digant; Patel, Kamal; Lis, Christopher G

    2015-09-04

    We have previously reported that higher patient satisfaction (PS) with service quality is associated with favorable survival outcomes in a variety of cancers. However, we argued that patients with greater satisfaction might be the ones with better self-rated health (SRH), a recognized predictor of cancer survival. We therefore investigated whether SRH can supersede patient satisfaction as a predictor of survival in prostate cancer. Nine hundred seventeen prostate cancer treated at four Cancer Treatment Centers of America(®) hospitals between July 2011 and March 2013. PS was measured on a 7-point scale ranging from "completely dissatisfied" to "completely satisfied". SRH was measured on a 7-point scale ranging from "very poor" to "excellent". Both were dichotomized into two categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between PS and survival controlling for covariates. The response rate for this study was 72%. Majority of patients (n = 517) had stage II disease. Seven hundred eighty-seven (85.8%) patients were "completely satisfied". Three hundred nineteen (34.8%) patients had "excellent" SRH. There was a weak but significant correlation between satisfaction and SRH (Kendall's tau b = 0.18; p < 0.001). On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality (HR = 0.46; 95% CI: 0.25-0.85; p = 0.01). Similarly, patients with "excellent" SRH had a significantly lower risk of mortality (HR = 0.25; 95% CI: 0.11-0.58; p = 0.001). On multivariate analysis, SRH was found to be a significant predictor of survival (HR = 0.31; 95% CI: 0.12-0.79; p = 0.01) while patient satisfaction was not (HR = 0.76; 95% CI: 0.40-1.5; p = 0.40). SRH supersedes patient satisfaction with service quality as a predictor of survival in prostate cancer. SRH should be used as a control variable in analyses involving patient satisfaction as a

  18. Psychologic Intervention Improves Survival for Breast Cancer Patients

    PubMed Central

    Andersen, Barbara L.; Yang, Hae-Chung; Farrar, William B.; Golden-Kreutz, Deanna M.; Emery, Charles F.; Thornton, Lisa M.; Young, Donn C.; Carson, William E.

    2009-01-01

    BACKGROUND The question of whether stress poses a risk for cancer progression has been difficult to answer. A randomized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention would have improved survival compared with patients who were only assessed. METHODS A total of 227 patients who were surgically treated for regional breast cancer participated. Before beginning adjuvant cancer therapies, patients were assessed with psychologic and behavioral measures and had a health evaluation, and a 60-mL blood sample was drawn. Patients were randomized to Psychologic Intervention plus assessment or Assessment only study arms. The intervention was psychologist led; conducted in small groups; and included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care. Earlier articles demonstrated that, compared with the Assessment arm, the Intervention arm improved across all of the latter secondary outcomes. Immunity was also enhanced. RESULTS After a median of 11 years of follow-up, disease recurrence was reported to occur in 62 of 212 (29%) women and death was reported for 54 of 227 (24%) women. Using Cox proportional hazards analysis, multivariate comparison of survival was conducted. As predicted, patients in the Intervention arm were found to have a reduced risk of breast cancer recurrence (hazards ratio [HR] of 0.55; P=.034) and death from breast cancer (HR of 0.44; P=.016) compared with patients in the Assessment only arm. Follow-up analyses also demonstrated that Intervention patients had a reduced risk of death from all causes (HR of 0.51; P=.028). CONCLUSIONS Psychologic interventions as delivered and studied here can improve survival. PMID:19016270

  19. Education, survival and avoidable deaths in cancer patients in Finland.

    PubMed

    Pokhrel, A; Martikainen, P; Pukkala, E; Rautalahti, M; Seppä, K; Hakulinen, T

    2010-09-28

    Relative survival after cancer in Finland is at the highest level observed in Europe and has, in general, been on a steady increase. The aim of this study is to assess whether the high survival is equally shared by different population subgroups and to estimate the possible gains that might be achieved if equity prevailed. The educational level and occupation before the cancer diagnosis of patients diagnosed in Finland in 1971-2005 was derived from an antecedent population census. The cancers were divided into 27 site categories. Cancer (cause)-specific 5-year survival proportions were calculated for three patient categories based on the educational level and for an occupational group of potentially health-conscious patients (physicians, nurses, teachers etc.). Proportions of avoidable deaths were derived by assuming that the patients from the two lower education categories would have the same mortality owing to cancer, as those from the highest educational category. Estimates were also made by additionally assuming that even the mortalities owing to other causes of death were all equal to those in the highest category. For almost all the sites considered, survival was consistently highest for patients with the highest education and lowest for those with only basic education. The potentially health-conscious patients had an even higher survival. The differences were, in part, attributable to less favourable distributions of tumour stages in the lower education categories. In 1996-2005, 4-7% of the deaths in Finnish cancer patients could have potentially been avoided during the first 5-year period after diagnosis, if all the patients had the same cancer mortality as the patients with the highest educational background. The proportion would have also been much higher, 8-11%, if, in addition, the mortality from other causes had been the same as that in the highest educational category. Even in a potentially equitable society with high health care standards, marked

  20. A Constant Pressure Bomb

    NASA Technical Reports Server (NTRS)

    Stevens, F W

    1924-01-01

    This report describes a new optical method of unusual simplicity and of good accuracy suitable to study the kinetics of gaseous reactions. The device is the complement of the spherical bomb of constant volume, and extends the applicability of the relationship, pv=rt for gaseous equilibrium conditions, to the use of both factors p and v. The method substitutes for the mechanical complications of a manometer placed at some distance from the seat of reaction the possibility of allowing the radiant effects of reaction to record themselves directly upon a sensitive film. It is possible the device may be of use in the study of the photoelectric effects of radiation. The method makes possible a greater precision in the measurement of normal flame velocities than was previously possible. An approximate analysis shows that the increase of pressure and density ahead of the flame is negligible until the velocity of the flame approaches that of sound.

  1. Epidemiological research on radiation-induced cancer in atomic bomb survivors.

    PubMed

    Ozasa, Kotaro

    2016-08-01

    The late effects of exposure to atomic bomb radiation on cancer occurrence have been evaluated by epidemiological studies on three cohorts: a cohort of atomic bomb survivors (Life Span Study; LSS), survivors exposed IN UTERO : , and children of atomic bomb survivors (F1). The risk of leukemia among the survivors increased remarkably in the early period after the bombings, especially among children. Increased risks of solid cancers have been evident since around 10 years after the bombings and are still present today. The LSS has clarified the dose-response relationships of radiation exposure and risk of various cancers, taking into account important risk modifiers such as sex, age at exposure, and attained age. Confounding by conventional risk factors including lifestyle differences is not considered substantial because people were non-selectively exposed to the atomic bomb radiation. Uncertainty in risk estimates at low-dose levels is thought to be derived from various sources, including different estimates of risk at background levels, uncertainty in dose estimates, residual confounding and interaction, strong risk factors, and exposure to residual radiation and/or medical radiation. The risk of cancer in subjects exposed IN UTERO : is similar to that in LSS subjects who were exposed in childhood. Regarding hereditary effects of radiation exposure, no increased risk of cancers associated with parental exposure to radiation have been observed in the F1 cohort to date. In addition to biological and pathogenetic interpretations of the present results, epidemiological investigations using advanced technology should be used to further analyze these cohorts. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  2. Risk of death among children of atomic bomb survivors after 62 years of follow-up: a cohort study.

    PubMed

    Grant, Eric J; Furukawa, Kyoji; Sakata, Ritsu; Sugiyama, Hiromi; Sadakane, Atsuko; Takahashi, Ikuno; Utada, Mai; Shimizu, Yukiko; Ozasa, Kotaro

    2015-10-01

    No clear epidemiological hereditary effects of radiation exposure in human beings have been reported. However, no previous studies have investigated mortality into middle age in a population whose parents were exposed to substantial amounts of radiation before conception. We assessed mortality in children of the atomic bomb survivors after 62 years of follow-up. In this prospective cohort study, we assessed 75 327 singleton children of atomic bomb survivors in Hiroshima and Nagasaki and unexposed controls, born between 1946 and 1984, and followed up to Dec 31, 2009. Parental gonadal doses of radiation from the atomic bombings were the primary exposures. The primary endpoint was death due to cancer or non-cancer disease, based on death certificates. Median follow-up was 54·3 years (IQR 45·4-59·3). 5183 participants died from disease. The mean age of the 68 689 surviving children at the end of follow-up was 53·1 years (SD 7·9) with 15 623 (23%) older than age 60 years. For parents who were exposed to a non-zero gonadal dose of radiation, the mean dose was 264 mGy (SD 463). We detected no association between maternal gonadal radiation exposure and risk of death caused by cancer (hazard ratio [HR] for 1 Gy change in exposure 0·891 [95% CI 0·693-1·145]; p=0·36) or risk of death caused by non-cancer diseases (0·973 [0·849-1·115]; p=0·69). Likewise, paternal exposure had no effect on deaths caused by cancer (0·815 [0·614-1·083]; p=0·14) or deaths caused by non-cancer disease (1·103 [0·979-1·241]; p=0·12). Age or time between parental exposure and delivery had no effect on risk of death. Late effects of ionising radiation exposure include increased mortality risks, and models of the transgenerational effects of radiation exposure predict more genetic disease in the children of people exposed to radiation. However, children of people exposed to the atomic bombs in Hiroshima and Nagasaki had no indications of deleterious health effects after 62

  3. Lunar phases and survival of breast cancer patients--a statistical analysis of 3,757 cases.

    PubMed

    Peters-Engl, C; Frank, W; Kerschbaum, F; Denison, U; Medl, M; Sevelda, P

    2001-11-01

    The potential influence of lunar phases on human life has been widely discussed by the lay press. The purpose of this study was to find out whether the timing of surgery during particular lunar phases influences the survival of breast cancer patients. It has been postulated that breast cancer surgery performed during the waxing moon, or particularly at full moon, is associated with a poorer outcome. We tested this hypothesis by evaluating the overall survival for 3,757 consecutive patients with invasive breast cancer. All patients underwent either modified radical mastectomy or breast conserving surgery plus radiotherapy, followed by adjuvant cytotoxic or hormonal therapy. The date of definitive surgery was allocated to the lunar phases. 1,904 (50.7%) patients were operated on during the waxing moon and 1,853 (47.3%) during the waning moon. The median follow-up was 74 months (range 1-372 months). The mean age at primary surgery did not differ significantly in the two groups 58.39 (SD 13.14) versus 58.34 (12.75) (p >0.05, t-test). Breast cancer stages at initial diagnosis were evenly distributed according to the lunar phases (p = 0.325; chi-square). Survival curves were plotted according to the method of Kaplan-Meier. No significant differences were observed when timing of surgery was allocated to the lunar phases (p = 0.4841, log-rank). Subgroup analysis of premenopausal patients revealed similar results (p = 0.2950, log-rank; n = 1072). Using multivariate Cox modelling, we found a significant association between the patient's age, stage of disease and survival, whereas no association with survival was observed for the timing of surgery (RR= 1.062; 95% CI, 0.970-1.163; p = 0.1937). No significant differences in overall survival of breast cancer patients were observed when timing of breast cancer surgery during the lunar cycle was considered. Although this was not a prospective randomized trial, the statistical magnitude of the results do not support any

  4. Nature and results of treatment of war wounds caused by cluster bombs.

    PubMed

    Mitković, Milorad; Bumbasirević, Marko; Grubor, Predrag; Milenković, Sasa; Micić, Ivan; Stojiljković, Predrag; Kostić, Igor; Karaleić, Sasa; Stamenić, Sonja; Pavlović, Predrag; Stanojlović, Milos; Jovanović, Vladimir; Radovanović, Zoran; Cirić, Tamara; Kutlesić-Stojanović, Katarina; Mitković, Milan

    2013-01-01

    The aim of this study is to describe the nature of war wounds with fracture caused by cluster bombs and to suggest treatment options for such injuries. The nature of wounds caused by cluster bombs differs from those caused by conventional arms (they are more severe). The sides of the wounds are represented by conquasated soft tissues (such as fat and muscle) with thick dead tissues, ordinarily with a thickness of 0.5-4.5 cm. Another main characteristic of such injuries is the high percentage of amputations needed due to the high rate of neurovascular damage. This paper investigates the cases of 81 patients who sustained a total of 99 war wounds with fractures. The average age of the patients was 32.7 years while the youngest was 20 and the oldest, 77. According to The International Committee of the Red Cross (ICRC) classification of war wounds, 14 patients had grade I injuries, 48 patients grade II, and 29 patients, grade III. Mitkovic external fixation system, known also as the "War Fixator" was used for all fractures fixation. One protocol, which was a modification of the ICRC's protocol adapted to our specific conditions, was used throughout the study. For solving soft tissue defects, a rotator fasciocutan flap was the most frequently used. For solving of bones defect Mitkovic reconstructive external fixation device was used. All fractures we treated healed. We concluded that shortening the procedural time and being a very simple, immediate using of Mitkovic versatile external fixator ("War Fixator") is, leads to desirable results.

  5. Increased survival of cirrhotic patients with septic shock.

    PubMed

    Sauneuf, Bertrand; Champigneulle, Benoit; Soummer, Alexis; Mongardon, Nicolas; Charpentier, Julien; Cariou, Alain; Chiche, Jean-Daniel; Mallet, Vincent; Mira, Jean-Paul; Pène, Frédéric

    2013-04-19

    The overall outcome of septic shock has been recently improved. We sought to determine whether this survival gain extends to the high-risk subgroup of patients with cirrhosis. Cirrhotic patients with septic shock admitted to a medical intensive care unit (ICU) during two consecutive periods (1997-2004 and 2005-2010) were retrospectively studied. Forty-seven and 42 cirrhotic patients presented with septic shock in 1997-2004 and 2005-2010, respectively. The recent period differed from the previous one by implementation of adjuvant treatments of septic shock including albumin infusion as fluid volume therapy, low-dose glucocorticoids, and intensive insulin therapy. ICU and hospital survival markedly improved over time (40% in 2005-2010 vs. 17% in 1997-2004, P = 0.02 and 29% in 2005-2010 vs. 6% in 1997-2004, P = 0.009, respectively). Furthermore, this survival gain in the latter period was sustained for 6 months (survival rate 24% in 2005-2010 vs. 6% in 1997-2004, P = 0.06). After adjustment with age, the liver disease stage (Child-Pugh score), and the critical illness severity score (SOFA score), ICU admission between 2005 and 2010 remained an independent favorable prognostic factor (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02-0.4, P = 0.004). The stage of the underlying liver disease was also independently associated with hospital mortality (Child-Pugh score: OR 1.42 per point, 95% CI 1.06-1.9, P = 0.018). In the light of advances in management of both cirrhosis and septic shock, survival of such patients substantially increased over recent years. The stage of the underlying liver disease and the related therapeutic options should be included in the decision-making process for ICU admission.

  6. Effect of pravastatin on survival in patients with advanced hepatocellular carcinoma. A randomized controlled trial

    PubMed Central

    Kawata, S; Yamasaki, E; Nagase, T; Inui, Y; Ito, N; Matsuda, Y; Inada, M; Tamura, S; Noda, S; Imai, Y; Matsuzawa, Y

    2001-01-01

    Chemotherapy is not effective for hepatocellular carcinoma (HCC). HMG-CoA redutase inhibitors have cytostatic activity for cancer cells, but their clinical usefulness is unknown. To investigate whether pravastatin, a potent HMG-CoA reductase inhibitor, prolongs survival in patients with advanced HCC, this randomized controlled trial was conducted between February 1990 and February 1998 at Osaka University Hospital. 91 consecutive patients <71 years old (mean age 62) with unresectable HCC were enroled in this study. 8 patients were withdrawn because of progressive liver dysfunction; 83 patients were randomized to standard treatment with or without pravastatin. All patients underwent transcatheter arterial embolization (TAE) followed by oral 5-FU 200 mg−1d for 2 months. Patients were then randomly assigned to control (n = 42) and pravastatin (n = 41) groups. Pravastatin was administered at a daily dose of 40 mg. The effect of pravastatin on tumour growth was assessed by ultrasonography. Primary endpoint was death due to progression of HCC. The duration of pravastatin administration was 16.5 ± 9.8 months (mean ± SD). No patients in either group were lost to follow-up. Median survival was 18 months in the pravastatin group versus 9 months in controls (P = 0.006). The Cox proportional hazards model showed that pravastatin was a significant factor contributing to survival. Pravastatin prolonged the survival of patients with advanced HCC, suggesting its value for adjuvant treatment. © 2001 Cancer Research Campaign http://www.bjcancer.com PMID:11286466

  7. Application of a Non-Mixture Cure Rate Model for Analyzing Survival of Patients with Breast Cancer.

    PubMed

    Baghestani, Ahmad Reza; Moghaddam, Sahar Saeedi; Majd, Hamid Alavi; Akbari, Mohammad Esmaeil; Nafissi, Nahid; Gohari, Kimiya

    2015-01-01

    As a result of significant progress made in treatment of many types of cancers during the last few decades, there have been an increased number of patients who do not experience mortality. We refer to these observations as cure or immune and models for survival data which include cure fraction are known as cure rate models or long-term survival models. In this study we used the data collected from 438 female patients with breast cancer registered in the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients had been diagnosed from 1992 to 2012 and were followed up until October 2014. We had to exclude some because of incomplete information. Phone calls were made to confirm whether the patients were still alive or not. Deaths due to breast cancer were regarded as failure. To identify clinical, pathological, and biological characteristics of patients that might have had an effect on survival of the patients we used a non-mixture cure rate model; in addition, a Weibull distribution was proposed for the survival time. Analyses were performed using STATA version 14. The significance level was set at P ≤ 0.05. A total of 75 patients (17.1%) died due to breast cancer during the study, up to the last follow-up. Numbers of metastatic lymph nodes and histologic grade were significant factors. The cure fraction was estimated to be 58%. When a cure fraction is not available, the analysis will be changed to standard approaches of survival analysis; however when the data indicate that the cure fraction is available, we suggest analysis of survival data via cure models.

  8. Survival of Patients with Stomach Cancer and its Determinants in Kurdistan.

    PubMed

    Moradi, Ghobad; Karimi, Kohsar; Esmailnasab, Nader; Roshani, Daem

    2016-01-01

    Stomach cancer is the fourth most common cancer and the second leading cause of death from cancer in the world. In Iran, this type of cancer has high rates of incidence and mortality. This study aimed to assess the survival rate of patients with stomach cancer and its determinants in Kurdistan, a province with one of the highest incidence rates of stomach cancer in the country. We studied a total of 202 patients with stomach cancer who were admitted to Tohid Hospital in Sanandaj from 2009 to 2013. Using KaplanMeier nonparametric methods the survival rate of patients was calculated in terms of different levels of age at diagnosis, gender, education, residential area, occupation, underweight, and clinical variables including tumor histology, site of tumor, disease stage, and type of treatment. In addition, we compared the survival rates using the logrank test. Finally, Cox proportional hazards regression was applied using Stata 12 and R 3.1.0 software. The significance level was set at 0.05. The mean age at diagnosis was 64.7 ± 12.0 years. The survival rate of patients with stomach cancer was 43.9% and 7% at the first and the fifth year after diagnosis, respectively. The results of logrank test showed significant relationships between survival and age at diagnosis, education, disease stage, type of treatment, and degree of being underweight (P<0.05). Moreover, according to the results of Cox proportional hazards regression model, the variables of education, disease stage, and type of treatment were associated with patient survival (P<0.05). The survival rate of patients with stomach cancer is low and the prognosis is very poor. Given the poor prognosis of the patients, it is critical to find ways for early diagnosis and facilitating timely access to effective treatment methods.

  9. Obesity adversely affects survival in pancreatic cancer patients.

    PubMed

    McWilliams, Robert R; Matsumoto, Martha E; Burch, Patrick A; Kim, George P; Halfdanarson, Thorvardur R; de Andrade, Mariza; Reid-Lombardo, Kaye; Bamlet, William R

    2010-11-01

    Higher body-mass index (BMI) has been implicated as a risk factor for developing pancreatic cancer, but its effect on survival has not been thoroughly investigated. The authors assessed the association of BMI with survival in a sample of pancreatic cancer patients and used epidemiologic and clinical information to understand the contribution of diabetes and hyperglycemia. A survival analysis using Cox proportional hazards by usual adult BMI was performed on 1861 unselected patients with pancreatic adenocarcinoma; analyses were adjusted for covariates that included clinical stage, age, and sex. Secondary analyses incorporated self-reported diabetes and fasting blood glucose in the survival model. BMI as a continuous variable was inversely associated with survival from pancreatic adenocarcinoma (hazard ratio [HR], 1.019 for each increased unit of BMI [kg/m2], P<.001) after adjustment for age, stage, and sex. In analysis by National Institutes of Health BMI category, BMIs of 30 to 34.99 kg/m2 (HR, 1.14; 95% confidence interval [CI], 0.98-1.33), 35 to 39.99 kg/m2 (HR 1.32, 95% CI 1.08-1.62), and ≥40 (HR 1.60, 95% CI 1.26-2.04) were associated with decreased survival compared with normal BMI of 18.5 to 24.99 kg/m2 (overall trend test P<.001). Fasting blood glucose and diabetes did not affect the results. Higher BMI is associated with decreased survival in pancreatic cancer. Although the mechanism of this association remains undetermined, diabetes and hyperglycemia do not appear to account for the observed association. Copyright © 2010 American Cancer Society.

  10. Bomb Threat Assessments. Fact Sheet

    ERIC Educational Resources Information Center

    Tunkel, Ronald F.

    2010-01-01

    This information provides a brief, summary outline of how investigators should assess anonymous bomb threats at schools. Applying these principles may help administrators and law enforcement personnel accurately assess the viability and credibility of a threat and appropriately gauge their response. Any credible evidence provided by teachers or…

  11. The Last Act: The Atomic Bomb and the End of World War II.

    ERIC Educational Resources Information Center

    Smithsonian Institution, Washington, DC. National Air And Space Museum.

    This text was to have been the script for the National Air and Space Museum's exhibition of the Enola Gay, focusing on the end of World War II and the decision of the United States to use of the atomic bomb. The Enola Gay was a B-29 aircraft that carried the atomic bomb dropped on Hiroshima, Japan, on August 6, 1945. The atomic bomb brought a…

  12. Exposure to Atomic Bomb Radiation and Age-Related Macular Degeneration in Later Life: The Hiroshima-Nagasaki Atomic Bomb Survivor Study.

    PubMed

    Itakura, Katsumasa; Takahashi, Ikuno; Nakashima, Eiji; Yanagi, Masahide; Kawasaki, Ryo; Neriishi, Kazuo; Wang, Jie Jin; Wong, Tien Yin; Hida, Ayumi; Ohishi, Waka; Kiuchi, Yoshiaki

    2015-08-01

    To investigate the association between radiation exposure from the atomic bombings and the prevalence of age-related macular degeneration (AMD) among older residents of Hiroshima and Nagasaki. The Adult Health Study is a cohort study of atomic bomb survivors living in Hiroshima and Nagasaki, comprising 2153 participants who underwent examinations with retinal fundus photographs in 2006-2008. The radiation dose to the eye for the analysis was estimated with the revised dosimetry system (DS02). The retinal photographs were graded according to the Wisconsin Age-Related Maculopathy Grading System modified for nonstereoscopic retinal images. Early and late AMD were defined according to the type of lesion detected in the worse eye of the participants. Person-specific data were analyzed by using a logistic regression model to assess the association between radiation dose and AMD. Among the 1824 subjects with gradable retinal images (84.7% of the overall participants), the estimated eye dose was widely distributed, with a mean of 0.45 Gy and standard deviation of 0.74 Gy. The prevalence of early and late AMD was 10.5% and 0.3%, respectively. There were no significant associations between radiation dose and AMD, with each 1-Gy increase in exposure, adjusted odds ratio was 0.93 (95% confidence interval [CI], 0.75-1.15) for early AMD and 0.79 (95% CI, 0.21-2.94) for late AMD. No significant associations were found between atomic bomb irradiation early in life and the prevalence of early or late AMD later in life among Japanese atomic bomb survivors.

  13. Pseudoaneurysm of head and neck vessels has been frequently observed in road side bomb blast victims.

    PubMed

    Yousuf, Kamal Muhammad; Khan, Fahad Hanif

    2016-06-01

    Due to recent war situation in neighboring country we have witnessed large number of victims with post-traumatic false (pseudo) aneurysms of head and neck in roadside bomb blast victims in Pakistan. Thus through this observational retrospective study we aim to share our experience of managing these patients. 5 years patients' case records, from June 2008-June 2013, were reviewed from the hospital's records. 14 cases of roadside bomb blast victims, developing false aneurysms of major or minor vessels of head and neck, were studied. We excluded the post-traumatic pseudoaneurysms involving other sites and vessels of the body. We observed the mechanism, the duration of presentation, symptoms/signs, vessels involved, complications and the management done. All 14 cases presented with a localized pulsatile swelling with tenderness in the course of a known artery and with an overlying entry site wound from bomb blast sharp nails. Men were affected more as compared to women. All (14) cases had 2-12 weeks of duration between the injury and presentation. Temporal artery (4) was involved in most cases followed by common carotid artery (3). Open surgery was treatment of choice in 12 (85.7%) of cases; however 2 (14.3%) patients had endovascular intervention to correct the pathology. Post-operatively all patients recovered completely, without any major or minor complications. Surgical intervention remains the management of choice for post-traumatic false aneurysms of head and neck in Pakistan. Despite the benefits of endovascular procedures, improvements must be weighed against the added costs on the patients. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  14. Prognostic value of lymph nodes count on survival of patients with distal cholangiocarcinomas

    PubMed Central

    Lin, Hua-Peng; Li, Sheng-Wei; Liu, Ye; Zhou, Shi-Ji

    2018-01-01

    AIM To evaluate the prognostic value of the number of retrieved lymph nodes (LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number. METHODS The Surveillance, Epidemiology and End Results database was used to screen for patients with distal cholangiocarcinoma. Patients with different numbers of retrieved LNs were divided into three groups by the X-tile program. X-tile from Yale University is a useful tool for outcome-based cut-point optimization. The Kaplan-Meier method and Cox regression analysis were utilized for survival analysis. RESULTS A total of 449 patients with distal cholangiocarcinoma met the inclusion criteria. The Kaplan-Meier survival analysis for all patients and for N1 patients revealed no significant differences among patients with different retrieved LN counts in terms of overall and cancer-specific survival. In patients with node-negative distal cholangiocarcinoma, patients with four to nine retrieved LNs had a significantly better overall (P = 0.026) and cancer-specific survival (P = 0.039) than others. In the subsequent multivariate analysis, the number of retrieved LNs was evaluated to be independently associated with survival. Additionally, patients with four to nine retrieved LNs had a significantly lower overall mortality risk [hazard ratio (HR) = 0.39; 95% confidence interval (CI): 0.20-0.74] and cancer cause-specific mortality risk (HR = 0.32; 95%CI: 0.15-0.66) than other patients. Additionally, stratified survival analyses showed persistently better overall and cancer-specific survival when retrieving four to nine LNs in patients with any T stage of tumor, a tumor between 20 and 50 mm in diameter, or a poorly differentiated or undifferentiated tumor, and in patients who were ≤ 70-years-old. CONCLUSION The number of retrieved LNs was an important independent prognostic factor for patients with node-negative distal cholangiocarcinoma. Additionally

  15. Bomb blast imaging: bringing order to chaos.

    PubMed

    Dick, E A; Ballard, M; Alwan-Walker, H; Kashef, E; Batrick, N; Hettiaratchy, S; Moran, C G

    2018-06-01

    Blast injuries are complex, severe, and outside of our everyday clinical practice, but every radiologist needs to understand them. By their nature, bomb blasts are unpredictable and affect multiple victims, yet require an immediate, coordinated, and whole-hearted response from all members of the clinical team, including all radiology staff. This article will help you gain the requisite expertise in blast imaging including recognising primary, secondary, and tertiary blast injuries. It will also help you understand the fundamental role that imaging plays during mass casualty attacks and how to avoid radiology becoming a bottleneck to the forward flow of severely injured patients as they are triaged and treated. Copyright © 2018. Published by Elsevier Ltd.

  16. Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study.

    PubMed

    Raspagliesi, Francesco; Maltese, Giuseppa; Bogani, Giorgio; Fucà, Giovanni; Lepori, Stefano; De Iaco, Pierandrea; Perrone, Myriam; Scambia, Giovanni; Cormio, Gennaro; Bogliolo, Stefano; Bergamini, Alice; Bifulco, Giuseppe; Casali, Paolo Giovanni; Lorusso, Domenica

    2017-01-01

    To investigate the impact of morcellation on survival outcomes of patients affected by undiagnosed uterine sarcoma. This is a retrospective study performed in 8 referral centers of MITO group. Data of women undergoing morcellation for apparent benign uterine myomas who were ultimately diagnosed with stage I uterine sarcoma on final pathology were compared with data of women who did not undergo morcellation. Uterine sarcoma included: leiomyosarcomas (LMS), smooth muscle tumors of uncertain malignant potential (STUMP), low-grade endometrial stromal sarcomas (LG-ESS) and undifferentiated uterine sarcomas (UUS). Two-year survival outcomes were evaluated using Kaplan-Meir and Cox models. Overall 125 patients were identified: 31(24.8%), 21(16.8%) and 73(58.4%) patients had power morcellation during laparoscopy, non power morcellation during open surgery and non morcellation during open procedures, respectively. Considering patients affected by LMS, morcellation did not correlated with disease-free survival. However, patients undergoing either morcellation or power morcellation experienced a 3-fold increase risk of death in comparison to patients who had not morcellation (p=0.02). A trend towards an increase of recurrence was observed for patients undergoing morcellation for STUMP (HR 7.7, p=0.09); while no differences in survival outcomes were observed for patients with LG-ESS and UUS. Our data suggest that morcellation increase the risk of death in patients affected by undiagnosed LMS. Further prospective studies are warranted in order to assess the risk to benefit ratio of power morcellator utilization in patients with apparent benign uterine myomas. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Rapid learning in practice: A lung cancer survival decision support system in routine patient care data

    PubMed Central

    Dekker, Andre; Vinod, Shalini; Holloway, Lois; Oberije, Cary; George, Armia; Goozee, Gary; Delaney, Geoff P.; Lambin, Philippe; Thwaites, David

    2016-01-01

    Background and purpose A rapid learning approach has been proposed to extract and apply knowledge from routine care data rather than solely relying on clinical trial evidence. To validate this in practice we deployed a previously developed decision support system (DSS) in a typical, busy clinic for non-small cell lung cancer (NSCLC) patients. Material and methods Gender, age, performance status, lung function, lymph node status, tumor volume and survival were extracted without review from clinical data sources for lung cancer patients. With these data the DSS was tested to predict overall survival. Results 3919 lung cancer patients were identified with 159 eligible for inclusion, due to ineligible histology or stage, non-radical dose, missing tumor volume or survival. The DSS successfully identified a good prognosis group and a medium/poor prognosis group (2 year OS 69% vs. 27/30%, p < 0.001). Stage was less discriminatory (2 year OS 47% for stage I–II vs. 36% for stage IIIA–IIIB, p = 0.12) with most good prognosis patients having higher stage disease. The DSS predicted a large absolute overall survival benefit (~40%) for a radical dose compared to a non-radical dose in patients with a good prognosis, while no survival benefit of radical radiotherapy was predicted for patients with a poor prognosis. Conclusions A rapid learning environment is possible with the quality of clinical data sufficient to validate a DSS. It uses patient and tumor features to identify prognostic groups in whom therapy can be individualized based on predicted outcomes. Especially the survival benefit of a radical versus non-radical dose predicted by the DSS for various prognostic groups has clinical relevance, but needs to be prospectively validated. PMID:25241994

  18. Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.

    PubMed

    Tsai, Jaw-Shiun; Chen, Chao-Hsien; Wu, Chih-Hsun; Chiu, Tai-Yuan; Morita, Tatsuya; Chang, Chin-Hao; Hung, Shou-Hung; Lee, Ya-Ping; Chen, Ching-Yu

    2015-02-01

    Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored. This study evaluated changes in consciousness after admission to a palliative care unit and their correlation with prognosis in terminal cancer patients. This is a prospective observational study. From a palliative care unit in Taiwan, 531 cancer patients (51.8% male) were recruited. Consciousness status was assessed at admission and one week afterwards and recorded as normal or impaired. The mean age was 65.28±13.59 years, and the average survival time was 23.41±37.69 days. Patients with normal consciousness at admission (n=317) had better survival than those with impaired consciousness at admission (n=214): (17.0 days versus 6.0 days, p<0.001). In the analysis on survival within one week after admission, those with normal consciousness at admission had a higher percentage of survival than the impaired (78.9% versus 44.3%, p<0.001). Patients were further classified into four groups according to consciousness levels: (1) normal at admission and one week afterwards, (2) impaired at admission but normal one week afterwards, (3) normal at admission but impaired one week afterwards, and (4) impaired both at admission and one week afterwards. The former two groups had significantly better survival than the latter two groups: (median survival counted from day 7 after admission), 25.5, 27.0, 7.0, and 7.0 days, respectively. Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.

  19. Re-analysis of survival data of cancer patients utilizing additive homeopathy.

    PubMed

    Gleiss, Andreas; Frass, Michael; Gaertner, Katharina

    2016-08-01

    In this short communication we present a re-analysis of homeopathic patient data in comparison to control patient data from the same Outpatient´s Unit "Homeopathy in malignant diseases" of the Medical University of Vienna. In this analysis we took account of a probable immortal time bias. For patients suffering from advanced stages of cancer and surviving the first 6 or 12 months after diagnosis, respectively, the results show that utilizing homeopathy gives a statistically significant (p<0.001) advantage over control patients regarding survival time. In conclusion, bearing in mind all limitations, the results of this retrospective study suggest that patients with advanced stages of cancer might benefit from additional homeopathic treatment until a survival time of up to 12 months after diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Pulmonary arterial enlargement predicts long-term survival in COPD patients.

    PubMed

    de-Torres, Juan P; Ezponda, Ana; Alcaide, Ana B; Campo, Arantza; Berto, Juan; Gonzalez, Jessica; Zulueta, Javier J; Casanova, Ciro; Rodriguez-Delgado, Luisa Elena; Celli, Bartolome R; Bastarrika, Gorka

    2018-01-01

    Pulmonary artery enlargement (PAE) is associated with exacerbations in Chronic Obstructive Pulmonary Disease (COPD) and with survival in moderate to severe patients. The potential role of PAE in survival prediction has not been compared with other clinical and physiological prognostic markers. In 188 patients with COPD, PA diameter was measured on a chest CT and the following clinical and physiological parameters registered: age, gender, smoking status, pack-years history, dyspnea, lung function, exercise capacity, Body Mass Index, BODE index and history of exacerbations in year prior to enrolment. Proportional Cox regression analysis determined the best predictor of all cause survival. During 83 months (±42), 43 patients died. Age, pack-years history, smoking status, BMI, FEV1%, six minute walking distance, Modified Medical Research Council dyspnea scale, BODE index, exacerbation rate prior to enrollment, PA diameter and PAE (diameter≥30mm) were associated with survival. In the multivariable analysis, age (HR: 1.08; 95%CI: 1.03-1.12, p<0.001) and PAE (HR: 2.78; 95%CI: 1.35-5.75, p = 0.006) were the most powerful parameters associated with all-cause mortality. In this prospective observational study of COPD patients with mild to moderate airflow limitation, PAE was the best predictor of long-term survival along with age.

  1. [Five-year survival analysis in patients with penile cancer].

    PubMed

    Montiel-Jarquín, Álvaro José; Contreras-Díaz, Antonio Jesús; Vázquez-Cruz, Eduardo; Chopin-Gazga, Marco Antonio; Romero-Figueroa, María Socorro; Etchegaray-Morales, Ivet; Alvarado-Ortega, Ivan

    2017-01-01

    Short-term survival of penile cancer is poor. The objective was to describe the 5-years penile cancer survival. Retrospective cohort study. We included patients with penile cancer managed surgically from 2010 to 2014. Descriptive statistics were used for socio-demographic variables and the Kaplan-Meier estimator for survival function. We studied 22 patients with a mean age of 64.95 years and a time of evolution of 25 months after the diagnosis. 68.2% of patients smoked or had human papillomavirus (HPV); they all presented phimosis; 72.7% had pain in the penis and the groin area; 81.8% had palpable lymph nodes and 45.5% lesions ≥ 3 cm; 86.3% were diagnosed in clinical stage IIIa. 59.1% underwent partial penectomy and 86.4% had squamous cell variety. 40.9% of patients died six months after the surgery. 66% of the smokers presented metastasis; all of the patients that smoked and had HPV infection had neurovascular invasion and died; 83.3% of the patients (n = 6) who underwent partial penectomy and positive lymph node dissection due to metastases died. The 5-years mortality of patients with penile cancer was 40.9%. Tobacco use and HPV increase morbidity and mortality in patients with penile cancer; lesions greater than 5 cm are more common in smokers. The size of the lesion increases with the delay in treatment.

  2. The impact of the 1995 Oklahoma City bombing on the partners of firefighters.

    PubMed

    Pfefferbaum, Betty; North, Carol S; Bunch, Kenneth; Wilson, Teddy G; Tucker, Phebe; Schorr, John K

    2002-09-01

    This study explored the impact of the 1995 Oklahoma City, Oklahoma, bombing on the spouses and significant others of a volunteer sample of Oklahoma City firefighters who participated in the bombing rescue effort. Twenty-seven partners of Oklahoma City firefighters participated in this study, conducted 42 to 44 months after the bombing. These partners were assessed using a structured diagnostic interview and a companion interview to examine exposure, rates of psychiatric disorders and symptoms, functioning, health, and relationships. Coping and perception of the firefighter partner's response were also examined. Some of the women were exposed directly; most knew someone who had been involved in the disaster, and all reported exposure through the media. The rate of psychiatric disorders in the women following the disaster was 22%, essentially unchanged from before the incident. One developed bomb-related posttraumatic stress disorder (PTSD). Most were satisfied with their work performance; 15% reported that their health had worsened since the bombing, and more than one third reported permanent changes in relationships as a result of the bombing. Most coped by turning to friends or relatives, with less than 10% seeking professional help. Many described symptoms in their firefighter mate; all reported that their mate had been affected by the experience, and one half said their mate had fully recovered. The mates of these firefighters fared relatively well in terms of psychiatric disorders, symptoms, and ability to function. The prevalence of bomb-related posttraumatic stress disorder was considerably lower in this sample than in samples of individuals more directly exposed to the bombing, although some reported changes in relationships and health. The results suggest the need for further study of the impact of interpersonal exposure in those who provide support for rescue-and-recovery workers in major terrorist incidents.

  3. The recovery and analysis of mitochondrial DNA from exploded pipe bombs.

    PubMed

    Foran, David R; Gehring, Michael E; Stallworth, Shawn E

    2009-01-01

    Improvised explosive devices (IEDs) represent one of the most common modes of arbitrarily injuring or killing human beings. Because of the heat generated by, and destruction to, an IED postconflagration, most methods for identifying who assembled the device are ineffective. In the research presented, steel pipe bombs were mock-assembled by volunteers, and the bombs detonated under controlled conditions. The resultant shrapnel was collected and swabbed for residual cellular material. Mitochondrial DNA profiles were generated and compared blind to the pool of individuals who assembled the bombs. Assemblers were correctly identified 50% of the time, while another 19% could be placed into a group of three individuals with shared haplotypes. Only one bomb was assigned incorrectly. In some instances a contaminating profile (mixture) was also observed. Taken together, the results speak to the extreme sensitivity the methods have for identifying those who assemble IEDs, along with precautions needed when collecting and processing such evidence.

  4. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation.

    PubMed

    Ozcan, C; Jahangir, A; Friedman, P A; Patel, P J; Munger, T M; Rea, R F; Lloyd, M A; Packer, D L; Hodge, D O; Gersh, B J; Hammill, S C; Shen, W K

    2001-04-05

    In patients with atrial fibrillation that is refractory to drug therapy, radio-frequency ablation of the atrioventricular node and implantation of a permanent pacemaker are an alternative therapeutic approach. The effect of this procedure on long-term survival is unknown. We studied all patients who underwent ablation of the atrioventricular node and implantation of a permanent pacemaker at the Mayo Clinic between 1990 and 1998. Observed survival was compared with the survival rates in two control populations: age- and sex-matched members of the Minnesota population between 1970 and 1990 and consecutive patients with atrial fibrillation who received drug therapy in 1993. A total of 350 patients (mean [+/-SD] age, 68+/-11 years) were studied. During a mean of 36+/-26 months of follow-up, 78 patients died. The observed survival rate was significantly lower than the expected survival rate based on the general Minnesota population (P<0.001). Previous myocardial infarction (P<0.001), a history of congestive heart failure (P=0.02), and treatment with cardiac drugs after ablation (P=0.03) were independent predictors of death. Observed survival among patients without these three risk factors was similar to expected survival (P=0.43). None of the 26 patients with lone atrial fibrillation died during follow-up (37+/-27 months). The observed survival rate among patients who underwent ablation was similar to that among 229 controls with atrial fibrillation (mean age, 67+/-12 years) who received drug therapy (P=0.44). In the absence of underlying heart disease, survival among patients with atrial fibrillation after ablation of the atrioventricular node is similar to expected survival in the general population. Long-term survival is similar for patients with atrial fibrillation, whether they receive ablation or drug therapy. Control of the ventricular rate by ablation of the atrioventricular node and permanent pacing does not adversely affect long-term survival.

  5. After the bomb. Oklahoma City rescuers talk about their experiences.

    PubMed

    Robinson, M; Kernes, R; Lindsay, W; Webster, M

    1995-06-01

    Rather than trying to write a second-hand description of the response to the April 19 bombing of the Federal Building in Oklahoma City, we thought we'd let some of the people who were there caring for patients and searching for victims share their experiences in their own words. Marion Angell Garza, JEMS editorial/news coordinator, spoke at length with six responders, including paramedics, the triage and treatment officer, a firefighter/EMT-1 and an emergency physician. The following excerpts are from those interviews.

  6. 1. EAST SIDE OF OVERHEAD BOMB TRANSPORT RACK, WITH BUILDING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. EAST SIDE OF OVERHEAD BOMB TRANSPORT RACK, WITH BUILDING 343 AT LEFT AND BUILDING 328 AT RIGHT. VIEW TO WEST. - Rocky Mountain Arsenal, Overhead Bomb Transport Rack, 1580 feet South of December Seventh Avenue; 860 feet West of D Street, Commerce City, Adams County, CO

  7. Patient satisfaction with service quality as a predictor of survival outcomes in breast cancer.

    PubMed

    Gupta, Digant; Rodeghier, Mark; Lis, Christopher G

    2014-01-01

    Despite the recognized relevance of symptom burden in breast cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality of care received might influence outcome. We therefore evaluated the relationship between patient-reported satisfaction with service quality and survival in breast cancer. A random sample of 1,521 breast cancer patients treated at Cancer Treatment Centers of America. A questionnaire which covered several dimensions of patient satisfaction was administered. Items were measured on a seven-point Likert scale ranging from "completely dissatisfied" to "completely satisfied". Univariate and multivariate Cox regression was used to evaluate the association between patient satisfaction and survival. Of 1,521 patients, 836 were newly diagnosed, and 685 had previously been treated. A number of 409, 611, 323, and 178 patients had stage I, II, III, and IV disease, respectively. A total of 1,106 (72.7 %) patients were completely satisfied with the overall service quality, while 415 (27.3 %) were not. On univariate analysis, completely satisfied patients had a significantly lower risk of mortality compared to those not completely satisfied (HR = 0.62; 95 % CI 0.50-0.76; p < 0.001). On multivariate analysis, completely satisfied patients demonstrated significantly lower mortality (HR = 0.71; 95 % CI 0.57-0.87; p = 0.001) compared to those not completely satisfied. Patient satisfaction with service quality was an independent predictor of survival in breast cancer. Further exploration of a possible meaningful relationship between patient satisfaction with the care they receive and outcomes in breast cancer is indicated.

  8. The Impact of Chemoembolization Endpoints on Survival in Hepatocellular Carcinoma Patients

    PubMed Central

    Jin, Brian; Wang, Dingxin; Lewandowski, Robert J.; Riaz, Ahsun; Ryu, Robert K.; Sato, Kent T.; Larson, Andrew C.; Salem, Riad; Omary, Reed A.

    2010-01-01

    OBJECTIVE To investigate the relationship between angiographic embolic endpoints of transarterial chemoembolization (TACE) and survival in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study retrospectively assessed 105 patients with surgically unresectable HCC who underwent TACE. Patients were classified according to a previously established subjective angiographic chemoembolization endpoint (SACE) scale. Only one patient was classified as SACE level 1 and thus excluded from all subsequent analysis. Survival was evaluated with Kaplan-Meier analysis. Multivariate analysis with Cox’s proportional hazard regression model was used to determine independent prognostic risk factors of survival. RESULTS Overall median survival was 21.1 months (95% confidence interval [CI], 15.9–26.4). Patients embolized to SACE levels 2 and 3 were aggregated and had a significantly higher median survival (25.6 months; 95% CI, 16.2–35.0) than patients embolized to SACE level 4 (17.1 months; 95% CI, 13.3–20.9) (p = 0.035). Multivariate analysis indicated that SACE level 4 (Hazard ratio [HR], 2.49; 95% CI, 1.41–4.42; p = 0.002), European Cooperative Oncology Group performance status > 0 (HR, 1.97; 95% CI, 1.15–3.37; p = 0.013), American Joint Committee on Cancer stage 3 or 4 (HR, 2.42; 95% CI, 1.27–4.60; p = 0.007), and Child-Pugh class B (HR, 1.94; 95% CI, 1.09–3.46; p = 0.025) were all independent negative prognostic indicators of survival. CONCLUSION Embolization to an intermediate, sub-stasis endpoint (SACE levels 2 and 3) during TACE improves survival compared to embolization to a higher, stasis endpoint (SACE level 4). Interventional oncologists should consider targeting these intermediate, sub-stasis angiographic endpoints during TACE. PMID:21427346

  9. A gene expression inflammatory signature specifically predicts multiple myeloma evolution and patients survival.

    PubMed

    Botta, C; Di Martino, M T; Ciliberto, D; Cucè, M; Correale, P; Rossi, M; Tagliaferri, P; Tassone, P

    2016-12-16

    Multiple myeloma (MM) is closely dependent on cross-talk between malignant plasma cells and cellular components of the inflammatory/immunosuppressive bone marrow milieu, which promotes disease progression, drug resistance, neo-angiogenesis, bone destruction and immune-impairment. We investigated the relevance of inflammatory genes in predicting disease evolution and patient survival. A bioinformatics study by Ingenuity Pathway Analysis on gene expression profiling dataset of monoclonal gammopathy of undetermined significance, smoldering and symptomatic-MM, identified inflammatory and cytokine/chemokine pathways as the most progressively affected during disease evolution. We then selected 20 candidate genes involved in B-cell inflammation and we investigated their role in predicting clinical outcome, through univariate and multivariate analyses (log-rank test, logistic regression and Cox-regression model). We defined an 8-genes signature (IL8, IL10, IL17A, CCL3, CCL5, VEGFA, EBI3 and NOS2) identifying each condition (MGUS/smoldering/symptomatic-MM) with 84% accuracy. Moreover, six genes (IFNG, IL2, LTA, CCL2, VEGFA, CCL3) were found independently correlated with patients' survival. Patients whose MM cells expressed high levels of Th1 cytokines (IFNG/LTA/IL2/CCL2) and low levels of CCL3 and VEGFA, experienced the longest survival. On these six genes, we built a prognostic risk score that was validated in three additional independent datasets. In this study, we provide proof-of-concept that inflammation has a critical role in MM patient progression and survival. The inflammatory-gene prognostic signature validated in different datasets clearly indicates novel opportunities for personalized anti-MM treatment.

  10. Relation between delay and survival in 596 patients with breast cancer.

    PubMed

    Machiavelli, M; Leone, B; Romero, A; Perez, J; Vallejo, C; Bianco, A; Rodriguez, R; Estevez, R; Chacon, R; Dansky, C

    1989-01-01

    To evaluate the influence of delay between first symptom and first treatment upon survival the medical records of 596 patients with breast cancer were reviewed. The following intervals were considered: less than 3 months; 3-6 months and greater than 6 months. Patients in the less than 3 months delay group had a better distribution by clinical stages and a 10-year survival rate higher than those in the longer delay groups (p = 0.034). However, within each stage no statistically significant difference in survival according to delay was observed. A Cox multivariate analysis revealed that performance status and stage of disease were independent predictors of survival, but not delay. Assuming the best prognosis for patients with clinical stages I and II and less than 3 months delay, the group with longer delay times had 15 deaths over what would have been predicted. This adverse effect was observed almost exclusively among patients over age 50 (14/15).

  11. Timing of chemotherapy and survival in patients with resectable gastric adenocarcinoma

    PubMed Central

    Arrington, Amanda K; Nelson, Rebecca; Patel, Supriya S; Luu, Carrie; Ko, Michelle; Garcia-Aguilar, Julio; Kim, Joseph

    2013-01-01

    AIM: To evaluate the timing of chemotherapy in gastric cancer by comparing survival outcomes in treatment groups. METHODS: Patients with surgically resected gastric adenocarcinoma from 1988 to 2006 were identified from the Los Angeles County Cancer Surveillance Program. To evaluate the population most likely to receive and/or benefit from adjunct chemotherapy, inclusion criteria consisted of Stage II or III gastric cancer patients > 18 years of age who underwent curative-intent surgical resection. Patients were categorized into three groups according to the receipt of chemotherapy: (1) no chemotherapy; (2) preoperative chemotherapy; or (3) postoperative chemotherapy. Clinical and pathologic characteristics were compared across the different treatment arms. RESULTS: Of 1518 patients with surgically resected gastric cancer, 327 (21.5%) received perioperative chemotherapy. The majority of these 327 patients were male (68%) with a mean age of 61.5 years; and they were significantly younger than non-chemotherapy patients (mean age, 70.7; P < 0.001). Most patients had tumors frequently located in the distal stomach (34.5%). Preoperative chemotherapy was administered to 11.3% of patients (n = 37) and postoperative therapy to 88.7% of patients (n = 290). An overall survival benefit according to timing of chemotherapy was not observed on univariate or multivariate analysis. Similar results were observed with stage-specific survival analyses (5-year overall survival: Stage II, 25% vs 30%, respectively; Stage III, 14% vs 11%, respectively). Therefore, our results do not identify a survival advantage for specific timing of chemotherapy in locally advanced gastric cancer. CONCLUSION: This study supports the implementation of a randomized trial comparing the timing of perioperative therapy in patients with locally advanced gastric cancer. PMID:24392183

  12. Predicting survival time in noncurative patients with advanced cancer: a prospective study in China.

    PubMed

    Cui, Jing; Zhou, Lingjun; Wee, B; Shen, Fengping; Ma, Xiuqiang; Zhao, Jijun

    2014-05-01

    Accurate prediction of prognosis for cancer patients is important for good clinical decision making in therapeutic and care strategies. The application of prognostic tools and indicators could improve prediction accuracy. This study aimed to develop a new prognostic scale to predict survival time of advanced cancer patients in China. We prospectively collected items that we anticipated might influence survival time of advanced cancer patients. Participants were recruited from 12 hospitals in Shanghai, China. We collected data including demographic information, clinical symptoms and signs, and biochemical test results. Log-rank tests, Cox regression, and linear regression were performed to develop a prognostic scale. Three hundred twenty patients with advanced cancer were recruited. Fourteen prognostic factors were included in the prognostic scale: Karnofsky Performance Scale (KPS) score, pain, ascites, hydrothorax, edema, delirium, cachexia, white blood cell (WBC) count, hemoglobin, sodium, total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP) values. The score was calculated by summing the partial scores, ranging from 0 to 30. When using the cutoff points of 7-day, 30-day, 90-day, and 180-day survival time, the scores were calculated as 12, 10, 8, and 6, respectively. We propose a new prognostic scale including KPS, pain, ascites, hydrothorax, edema, delirium, cachexia, WBC count, hemoglobin, sodium, total bilirubin, direct bilirubin, AST, and ALP values, which may help guide physicians in predicting the likely survival time of cancer patients more accurately. More studies are needed to validate this scale in the future.

  13. Early Seizure Freedom Is a Prognostic Factor for Survival in Patients with West Syndrome.

    PubMed

    Krijgh, E J C; Catsman-Berrevoets, C E; Neuteboom, R F

    2018-05-21

     West syndrome (WS) is a devastating epileptic encephalopathy with substantial mortality. After a study by Riikonen in 1996, further data on mortality and prognostic factors for survival has been scarce. We aimed to study mortality in patients with WS and identify prognostic factors for survival.  We performed a single-center retrospective study in a tertiary referral clinic (Erasmus University Hospital/Sophia Children's Hospital). This study obtained data from deceased patients regarding the age of death and cause of death. Seizure outcome was assessed at 8 weeks after the start of treatment and at 1 year after the onset of WS. At 1 year of follow-up seizure frequency, number of antiepileptic drugs and seizure type were evaluated.  With a mean follow-up of 60 months (range 8-314 months), 162 patients met the inclusion criteria. At 8 weeks and 1 year of follow-up, 64 patients (40%) were seizure free. Overall, 37 patients (23%) died. The cumulative mortality percentage was 31%. Seizure freedom was an independent predictor of survival ( p  = 0.01).  In this study, remission of seizures at 8 weeks of follow-up was significantly associated with reduced mortality in patients with WS. Georg Thieme Verlag KG Stuttgart · New York.

  14. Ultrasonic Acoustic Emissions from the Sapwood of Thuja occidentalis Measured inside a Pressure Bomb 1

    PubMed Central

    Tyree, Melvin T.; Dixon, Michael A.; Thompson, Robert G.

    1984-01-01

    An improved method of counting acoustic emission (AE) events from water-stressed stems of cedar (Thuja occidentalis L.) is presented. Amplified AEs are analyzed on a real time basis by a microcomputer. The instrumentation counts AE events in a fashion nearly analogous to scintillation counting of radioactive materials. The technique was applied to measuring ultrasonic AEs from the stems of cedar inside a pressure bomb. The shoots were originally fully hydrated. When the shoots are dehydrated in the bomb by application of an overpressure very few AEs were detected. When the bomb pressure is reduced after dehydration of the shoot, AE events could be detected. We conclude that ultrasonic AEs are caused by cavitation events (= structural breakdown of water columns in the tracheids of cedar) and not by the breaking of cellulose fibers in the wood. PMID:16663501

  15. Personality and Major Depression among Directly Exposed Survivors of the Oklahoma City Bombing

    PubMed Central

    North, Carol S.; Cloninger, C. Robert

    2012-01-01

    Background. Few disaster studies have specifically examined personality and resilience in association with disaster exposure, posttraumatic stress disorder (PTSD), and major depression. Methods. 151 directly-exposed survivors of the Oklahoma City bombing randomly selected from a bombing survivor registry completed PTSD, major depression, and personality assessments using the Diagnostic Interview Schedule for DSM-IV and the Temperament and Character Inventory, respectively. Results. The most prevalent postdisaster psychiatric disorder was bombing-related PTSD (32%); major depression was second in prevalence (21%). Bombing-related PTSD was associated with the combination of low self-directedness and low cooperativeness and also with high self-transcendence and high harm avoidance in most configurations. Postdisaster major depression was significantly more prevalent among those with (56%) than without (5%) bombing-related PTSD (P < .001) and those with (72%) than without (14%) predisaster major depression (P < .001). Incident major depression was not associated with the combination of low self-directedness and low cooperativeness. Conclusions. Personality features can distinguish resilience to a specific life-threatening stressor from general indicators of well-being. Unlike bombing-related PTSD, major depression was not a robust marker of low resilience. Development and validation of measures of resilience should utilize well-defined diagnoses whenever possible, rather than relying on nonspecific measures of psychological distress. PMID:23008763

  16. Personality and Major Depression among Directly Exposed Survivors of the Oklahoma City Bombing.

    PubMed

    North, Carol S; Cloninger, C Robert

    2012-01-01

    Background. Few disaster studies have specifically examined personality and resilience in association with disaster exposure, posttraumatic stress disorder (PTSD), and major depression. Methods. 151 directly-exposed survivors of the Oklahoma City bombing randomly selected from a bombing survivor registry completed PTSD, major depression, and personality assessments using the Diagnostic Interview Schedule for DSM-IV and the Temperament and Character Inventory, respectively. Results. The most prevalent postdisaster psychiatric disorder was bombing-related PTSD (32%); major depression was second in prevalence (21%). Bombing-related PTSD was associated with the combination of low self-directedness and low cooperativeness and also with high self-transcendence and high harm avoidance in most configurations. Postdisaster major depression was significantly more prevalent among those with (56%) than without (5%) bombing-related PTSD (P < .001) and those with (72%) than without (14%) predisaster major depression (P < .001). Incident major depression was not associated with the combination of low self-directedness and low cooperativeness. Conclusions. Personality features can distinguish resilience to a specific life-threatening stressor from general indicators of well-being. Unlike bombing-related PTSD, major depression was not a robust marker of low resilience. Development and validation of measures of resilience should utilize well-defined diagnoses whenever possible, rather than relying on nonspecific measures of psychological distress.

  17. Improvement in High-Grade Osteosarcoma Survival: Results from 202 Patients Treated at a Single Institution in Taiwan.

    PubMed

    Hung, Giun-Yi; Yen, Hsiu-Ju; Yen, Chueh-Chuan; Wu, Po-Kuei; Chen, Cheng-Fong; Chen, Paul C-H; Wu, Hung-Ta H; Chiou, Hong-Jen; Chen, Wei-Ming

    2016-04-01

    The aim of this study was to compare survival before and after 2004 and define the prognostic factors for high-grade osteosarcomas beyond those of typical young patients with localized extremity disease. Few studies have reported the long-term treatment outcomes of high-grade osteosarcoma in Taiwan. A total of 202 patients with primary high-grade osteosarcoma who received primary chemotherapy at Taipei Veterans General Hospital between January 1995 and December 2011 were retrospectively evaluated and compared by period (1995-2003 vs 2004-2011). Patients of all ages and tumor sites and those following or not following controlled protocols were included in analysis of demographic, tumor-related, and treatment-related variables and survival. Overall survival and progression-free survival at 5 years were, respectively, 67.7% and 48% for all patients (n = 202), 77.3% and 57.1% for patients without metastasis (n = 157), and 33.9% and 14.8% for patients with metastasis (n = 45). The survival rates of patients treated after 2004 were significantly higher (by 13%-16%) compared with those of patients treated before 2004, with an accompanying 30% increase in histological good response rate (P = .002). Factors significantly contributing to inferior survival in univariate and multivariate analyses were diagnosis before 2004, metastasis at diagnosis, and being a noncandidate for a controlled treatment protocol. By comparison with the regimens used at our institution before 2004, the current results support the effectiveness of the post-2004 regimens, which consisted of substantially reduced cycles of high-dose methotrexate and a higher dosage of ifosfamide per cycle, cisplatin, and doxorubicin, for treating high-grade osteosarcoma in Asian patients.

  18. A Confusion of Signals: James Franck, the Chicago Scientists and Early Efforts to Stop the Bomb

    ERIC Educational Resources Information Center

    Villa, Brian Loring

    1975-01-01

    If the scientists working on the Manhattan Project had realized the consequences of the atomic bomb earlier, formulated their recommendations more precisely, and approached the statesmen in time, American policy on use and control of the bomb might well have been different. (Author/BT)

  19. [Prognostic factors for survival in patients with resectable advanced gastric adenocarcinoma].

    PubMed

    Medrano-Guzmán, Rafael; Valencia-Mercado, Daniel; Luna-Castillo, Marisol; García-Ríos, Luis Enrique; González-Rodríguez, Domingo

    Patients under 45 years with gastric cancer are associated with a poor prognosis. Recent studies report that the 5-year survival is better in younger patients after curative resection. To determine if prognostic factors such as age under 45 years old, anaemia, weight loss, tumour differentiation, histological sub-type, depth of invasion, and lymph node involvement, reduce the survival of patients with resectable advanced gastric adenocarcinoma undergoing gastrectomy with limited and extended lymphadenectomy. This study included a cohort of consecutive cases treated in the Sarcomas Department of the Oncology Hospital of the Centro Médico Nacional Siglo XXI, of the Instituto Mexicano del Seguro Social, during the period between January 2000 and December 2006. Of the total of 588 patients evaluated, 112 (19%) were under 45 years, 43% classified as Borrmann IV, and 36% as Borrmann III. Metastatic disease was present in 39.3%, localised diffuse in 12.5%; lower resectability 52.7 vs. 61.3% in older than 45 years. At the end of the study 29.5% of patients under 45 years were alive; no recurrence in 26.8%, with an overall survival of 58.6±4.3 months, compared with 18.3% of patients alive over 45 years, 17.9% disease-free, and with overall survival 35.2±4.3 months resectable disease. Patients under 45 years have a better survival after a two-year disease-free period. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Effects of radiation on the incidence of prostate cancer among Nagasaki atomic bomb survivors.

    PubMed

    Kondo, Hisayoshi; Soda, Midori; Mine, Mariko; Yokota, Kenichi

    2013-10-01

    Atomic bomb survivors have been reported to have an increased risk of some cancers, especially leukemia. However, the risk of prostate cancer in atomic bomb survivors is not known to have been examined previously. This study examined the association between atomic bomb radiation and the incidence of prostate cancer among male Nagasaki atomic bomb survivors. The subjects were classified by distance from the hypocenter into a proximal group (<2 km), a distal group (≥2 km), and an early entrance group (those who entered the region <2 km from the hypocenter within 2 weeks after the explosion). Between 1996 and 2009, 631 new cases of prostate cancer were identified among approximately 18 400 male Nagasaki atomic bomb survivors who were alive in 1996. The Cox proportional hazard model was used to estimate the risk of prostate cancer development, with adjustment for age at atomic bomb explosion, attained age, smoking status, and alcohol consumption. Compared with the distal group, the proximal group had significant increased risks of total, localized, and high-grade prostate cancer (relative risk and 95% confidence interval: 1.51 [1.21-1.89]; 1.80 [1.26-2.57]; and 1.88 [1.20-2.94], respectively). This report is the first known to reveal a significant relationship between atomic bomb radiation and prostate cancer. © 2013 Japanese Cancer Association.

  1. Post-listing survival for highly sensitised patients on the UK kidney transplant waiting list: a matched cohort analysis.

    PubMed

    Manook, Miriam; Koeser, Leonardo; Ahmed, Zubir; Robb, Matthew; Johnson, Rachel; Shaw, Olivia; Kessaris, Nicos; Dorling, Anthony; Mamode, Nizam

    2017-02-18

    More than 40% of patients awaiting a kidney transplant in the UK are sensitised with human leucocyte antigen (HLA) antibodies. Median time to transplantation for such patients is double that of unsensitised patients at about 74 months. Removing antibody to perform an HLA-incompatible (HLAi) living donor transplantation is perceived to be high risk, although patient survival data are limited. We compared survival of patients opting for an HLAi kidney transplant with that of similarly sensitised patients awaiting a compatible organ. From the UK adult kidney transplant waiting list, we selected crossmatch positive living donor HLAi kidney transplant recipients who received their transplant between Jan 1, 2007, and Dec 31, 2013, and were followed up to Dec 31, 2014 (end of study). These patients were matched in a 1:4 ratio with similarly sensitised patients cases listed for a deceased-donor transplant during that period. Data were censored both at the time of transplantation (listed only), and at the end of the study period (listed or transplant). We used Kaplan-Meier curves to compare patient survival between HLAi and the matched cohort. Of 25 518 patient listings, 213 (1%) underwent HLAi transplantation during the study period. 852 matched controls were identified, of whom 41% (95% CI 32-50) remained without a transplant at 58 months after matching. We noted no difference in survival between patients who were in the HLAi group compared with the listed only group (log rank p=0·446), or listed or transplant group (log rank p=0·984). Survival of sensitised patients undergoing HLAi in the UK is comparable with those on dialysis awaiting a compatible organ, many of whom are unlikely to be have a transplant. Choosing a direct HLAi transplant has no detrimental effect on survival, but offers no survival benefit, by contrast with similar patients studied in a North American multicentre cohort. UK National Health Service Blood & Transplant and Guy's & St Thomas' National

  2. Survival of selected patients with ovarian cancer treated with fertility-sparing surgery.

    PubMed

    Hedbäck, Nora Elisabeth; Karlsen, Mona Aarenstrup; Høgdall, Claus Kim; Rosendahl, Mikkel

    2018-04-11

    How many patients in Denmark were treated with fertility-sparing surgery (FSS) for epithelial ovarian cancer (EOC) and what was their prognosis compared with patients treated with radical surgery (RS)? This study was a retrospective Danish nationwide study, evaluating the effect of FSS compared with RS in patients with EOC, age ≤45 years and International Federation of Gynecology and Obstetrics (FIGO) stage ≤IC3 from 2005 to 2016. A total of 106 patients were included. Of these, 13 were treated with FSS and 93 were treated with RS. Median age was 27 versus 42 years (P < 0.0001). Overall survival did not differ significantly between the two groups. Overall survival rate in the FSS group was 100%, while the overall survival in the RS group was 87%. Disease-specific survival was 100% in the FSS group and 91% in the RS group. This study shows that patients treated with FSS for FIGO stage I EOC do not have an impaired survival compared with patients treated with RS. Nevertheless, the conclusion must be interpreted with caution due to the limited number of patients and the retrospective nature of the study. Larger studies are needed before conclusions can be drawn. Copyright © 2018. Published by Elsevier Ltd.

  3. Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures.

    PubMed

    Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart

    2013-01-01

    Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age <75 years and male sex were risk factors for subsequent fracture. This study found that survival times did not differ significantly between patients with and without subsequent major

  4. Atomic bomb: Ultimate faith of diplomacy. Research report, August 1992-April 1993

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Frank, S.

    1993-04-01

    This paper examines the development and use of the atomic bombs as the means of achieving a grand strategy formulated by United States President Franklin Roosevelt and British Prime Minister Winston Churchill as early as 1943. This grand strategy consisted of two main goals. First, if necessary, the atomic bombs would be used to end World War II as soon as they were ready. Second, the existence of the atomic bombs would be used as a diplomatic hammer to shape the political landscape of the postwar world - a direct warning to Soviet dictator Joseph Stalin not to attempt tomore » hegemonize Eastern Europe and the Far East. Was the grand strategy successfully accomplished. Could newly sworn President Harry Truman have employed diplomatic means to quickly and successfully end World War II without resorting to the use of the atomic bombs against Japan.« less

  5. Five-Year Survival Rates for Treatment-Naive Patients With Advanced Melanoma Who Received Ipilimumab Plus Dacarbazine in a Phase III Trial

    PubMed Central

    Maio, Michele; Grob, Jean-Jacques; Aamdal, Steinar; Bondarenko, Igor; Robert, Caroline; Thomas, Luc; Garbe, Claus; Chiarion-Sileni, Vanna; Testori, Alessandro; Chen, Tai-Tsang; Tschaika, Marina; Wolchok, Jedd D.

    2015-01-01

    Purpose There is evidence from nonrandomized studies that a proportion of ipilimumab-treated patients with advanced melanoma experience long-term survival. To demonstrate a long-term survival benefit with ipilimumab, we evaluated the 5-year survival rates of patients treated in a randomized, controlled phase III trial. Patients and Methods A milestone survival analysis was conducted to capture the 5-year survival rate of treatment-naive patients with advanced melanoma who received ipilimumab in a phase III trial. Patients were randomly assigned 1:1 to receive ipilimumab at 10 mg/kg plus dacarbazine (n = 250) or placebo plus dacarbazine (n = 252) at weeks 1, 4, 7, and 10 followed by dacarbazine alone every 3 weeks through week 22. Eligible patients could receive maintenance ipilimumab or placebo every 12 weeks beginning at week 24. A safety analysis was conducted on patients who survived at least 5 years and continued to receive ipilimumab as maintenance therapy. Results The 5-year survival rate was 18.2% (95% CI, 13.6% to 23.4%) for patients treated with ipilimumab plus dacarbazine versus 8.8% (95% CI, 5.7% to 12.8%) for patients treated with placebo plus dacarbazine (P = .002). A plateau in the survival curve began at approximately 3 years. In patients who survived at least 5 years and continued to receive ipilimumab, grade 3 or 4 immune-related adverse events were observed exclusively in the skin. Conclusion The additional survival benefit of ipilimumab plus dacarbazine is maintained with twice as many patients alive at 5 years compared with those who initially received placebo plus dacarbazine. These results demonstrate a durable survival benefit with ipilimumab in advanced melanoma. PMID:25713437

  6. Comparison of Survival Outcomes Among Cancer Patients Treated In and Out of Clinical Trials

    PubMed Central

    2014-01-01

    Background Clinical trials test the efficacy of a treatment in a select patient population. We examined whether cancer clinical trial patients were similar to nontrial, “real-world” patients with respect to presenting characteristics and survival. Methods We reviewed the SWOG national clinical trials consortium database to identify candidate trials. Demographic factors, stage, and overall survival for patients in the standard arms were compared with nontrial control subjects selected from the Surveillance, Epidemiology, and End Results program. Multivariable survival analyses using Cox regression were conducted. The survival functions from aggregate data across all studies were compared separately by prognosis (≥50% vs <50% average 2-year survival). All statistical tests were two-sided. Results We analyzed 21 SWOG studies (11 good prognosis and 10 poor prognosis) comprising 5190 patients enrolled from 1987 to 2007. Trial patients were younger than nontrial patients (P < .001). In multivariable analysis, trial participation was not associated with improved overall survival for all 11 good-prognosis studies but was associated with better survival for nine of 10 poor-prognosis studies (P < .001). The impact of trial participation on overall survival endured for only 1 year. Conclusions Trial participation was associated with better survival in the first year after diagnosis, likely because of eligibility criteria that excluded higher comorbidity patients from trials. Similar survival patterns between trial and nontrial patients after the first year suggest that trial standard arm outcomes are generalizable over the long term and may improve confidence that trial treatment effects will translate to the real-world setting. Reducing eligibility criteria would improve access to clinical trials. PMID:24627276

  7. Long-term survival in patients with metastatic melanoma treated with DTIC or temozolomide.

    PubMed

    Kim, Christina; Lee, Christopher W; Kovacic, Laurel; Shah, Amil; Klasa, Richard; Savage, Kerry J

    2010-01-01

    Patients with metastatic melanoma typically have a poor outcome; however, a small proportion of patients achieve long-term survival (LTS). It is unclear how often LTS is related to sensitivity to chemotherapy. All patients with metastatic melanoma treated with either dacarbazine (DTIC) or temozolomide (TMZ) at the British Columbia Cancer Agency (BCCA) from January 1, 1988 to February 1, 2006 were identified through the BCCA pharmacy electronic database, which was then linked to the surveillance and outcomes unit to identify patients with LTS, defined as survival > or =18 months following chemotherapy. In total, 397 patients were treated with either DTIC (n = 349) or TMZ (n = 48) and 43 patients (10.8%) were identified with LTS. Two additional patients with LTS were added prior to 1988 for a total of 45 patients. The 5-year overall and progression-free survival rates for patients with LTS were 33% and 16%, respectively. In total, 16% had a complete response (CR) to chemotherapy, which was the only factor identified that correlated with survival in the multivariate analysis. However, most patients with LTS had an incomplete response to chemotherapy. LTS occurs in select patients who achieve a CR to chemotherapy. However, this occurs in only a minority of patients and, in most cases, the longer survival is likely the result of indolent disease biology or host factors.

  8. Long-Term Survival in Patients with Metastatic Melanoma Treated with DTIC or Temozolomide

    PubMed Central

    Kim, Christina; Lee, Christopher W.; Kovacic, Laurel; Shah, Amil; Klasa, Richard

    2010-01-01

    Background. Patients with metastatic melanoma typically have a poor outcome; however, a small proportion of patients achieve long-term survival (LTS). It is unclear how often LTS is related to sensitivity to chemotherapy. Methods. All patients with metastatic melanoma treated with either dacarbazine (DTIC) or temozolomide (TMZ) at the British Columbia Cancer Agency (BCCA) from January 1, 1988 to February 1, 2006 were identified through the BCCA pharmacy electronic database, which was then linked to the surveillance and outcomes unit to identify patients with LTS, defined as survival ≥18 months following chemotherapy. Results. In total, 397 patients were treated with either DTIC (n = 349) or TMZ (n = 48) and 43 patients (10.8%) were identified with LTS. Two additional patients with LTS were added prior to 1988 for a total of 45 patients. The 5-year overall and progression-free survival rates for patients with LTS were 33% and 16%, respectively. In total, 16% had a complete response (CR) to chemotherapy, which was the only factor identified that correlated with survival in the multivariate analysis. However, most patients with LTS had an incomplete response to chemotherapy. Conclusions. LTS occurs in select patients who achieve a CR to chemotherapy. However, this occurs in only a minority of patients and, in most cases, the longer survival is likely the result of indolent disease biology or host factors. PMID:20538743

  9. 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile.

    PubMed

    Edwards, D S; McMenemy, L; Stapley, S A; Patel, H D L; Clasper, J C

    2016-03-01

    Terrorists have used the explosive device successfully globally, with their effects extending beyond the resulting injuries. Suicide bombings, in particular, are being increasingly deployed due to the devastating effect of a combination of high lethality and target accuracy. The aim of this study was to identify trends and analyse the demographics and casualty figures of terrorist bombings worldwide. Analysis of the Global Terrorism Database (GTD) and a PubMed/Embase literature search (keywords "terrorist", and/or "suicide", and/or "bombing") from 1970 to 2014 was performed. 58,095 terrorist explosions worldwide were identified in the GTD. 5.08% were suicide bombings. Incidents per year are increasing (P<0.01). Mean casualty statistics per incidents was 1.14 deaths and 3.45 wounded from non-suicide incidents, and 10.16 and 24.16 from suicide bombings (p<0.05). The kill:wounded ratio was statistically higher in suicide attacks than non-suicide attacks, 1:1.3 and 1:1.24 respectively (p<0.05). The Middle East witnessed the most incidents (26.9%), with Europe (13.2%) ranked 4th. The literature search identified 41 publications reporting 167 incidents of which 3.9% detailed building collapse (BC), 60.8% confined space (CS), 23.5% open space (OS) and 11.8% semi-confined space (SC) attacks. 60.4% reported on suicide terrorist attacks. Overall 32 deaths and 180 injuries per incident were seen, however significantly more deaths occurred in explosions associated with a BC. Comparing OS and CS no difference in the deaths per incident was seen, 14.2(SD±17.828) and 15.63 (SD±10.071) respectively. However OS explosions resulted in significantly more injuries, 192.7 (SD±141.147), compared to CS, 79.20 (SD±59.8). Extremity related wounds were the commonest injuries seen (32%). Terrorist bombings continue to be a threat and are increasing particularly in the Middle East. Initial reports, generated immediately at the scene by experienced coordination, on the type of detonation

  10. Survival of patients with hepatocellular carcinoma in the San Joaquin Valley: a comparison with California Cancer Registry data.

    PubMed

    Atla, Pradeep R; Sheikh, Muhammad Y; Mascarenhas, Ranjan; Choudhury, Jayanta; Mills, Paul

    2012-01-01

    Variation in the survival of patients with hepatocellular carcinoma (HCC) is related to racial differences, socioeconomic disparities and treatment options among different populations. A retrospective review of the data from medical records of patients diagnosed with HCC were analyzed at an urban tertiary referral teaching hospital and compared to patients in the California Cancer Registry (CCR) - a participant in the Survival Epidemiology and End Results (SEER)program of the National Cancer Institute (NCI). The main outcome measure was overall survival rates. 160 patients with the diagnosis of HCC (M/F=127/33), mean age 59.7±10 years, 32% white, 49% Hispanic, 12% Asian and 6% African American. Multivariate analysis identified tumor size, model for end-stage liver disease (MELD) score, portal vein invasion and treatment offered as the independent predictors of survival (p <0.05). Survival rates across racial groups were not statistically significant. 5.6% received curative treatments (orthotopic liver transplantation, resection, rediofrequency ablation) (median survival 69 months), 34.4% received nonsurgical treatments (trans-arterial chemoembolization, systemic chemotherapy) (median survival 9 months), while 60% received palliative or no treatment (median survival 3 months) (p <0.001). There was decreased survival in our patient population with HCC beyond 2 years. 60% of our study population received only palliative or no treatment suggesting a possible lack of awareness of chronic liver disease as well as access to appropriate surveillance modalities. Ethnic disparities such as Hispanic predominance in this study in contrast to the CCR/SEER database may have been a contributing factor for poorer outcome.

  11. Survival of patients with hepatocellular carcinoma in the San Joaquin Valley: a comparison with California Cancer Registry data

    PubMed Central

    Atla, Pradeep R.; Sheikh, Muhammad Y.; Mascarenhas, Ranjan; Choudhury, Jayanta; Mills, Paul

    2012-01-01

    Background Variation in the survival of patients with hepatocellular carcinoma (HCC) is related to racial differences, socioeconomic disparities and treatment options among different populations. Methods A retrospective review of the data from medical records of patients diagnosed with HCC were analyzed at an urban tertiary referral teaching hospital and compared to patients in the California Cancer Registry (CCR) – a participant in the Survival Epidemiology and End Results (SEER)program of the National Cancer Institute (NCI). The main outcome measure was overall survival rates. Results 160 patients with the diagnosis of HCC (M/F=127/33), mean age 59.7±10 years, 32% white, 49% Hispanic, 12% Asian and 6% African American. Multivariate analysis identified tumor size, model for end-stage liver disease (MELD) score, portal vein invasion and treatment offered as the independent predictors of survival (p <0.05). Survival rates across racial groups were not statistically significant. 5.6% received curative treatments (orthotopic liver transplantation, resection, rediofrequency ablation) (median survival 69 months), 34.4% received nonsurgical treatments (trans-arterial chemoembolization, systemic chemotherapy) (median survival 9 months), while 60% received palliative or no treatment (median survival 3 months) (p <0.001). Conclusion There was decreased survival in our patient population with HCC beyond 2 years. 60% of our study population received only palliative or no treatment suggesting a possible lack of awareness of chronic liver disease as well as access to appropriate surveillance modalities. Ethnic disparities such as Hispanic predominance in this study in contrast to the CCR/SEER database may have been a contributing factor for poorer outcome. PMID:24714222

  12. Conditional survival of pediatric, adolescent, and young adult soft tissue sarcoma and bone tumor patients.

    PubMed

    Ou, Judy Y; Spraker-Perlman, Holly; Dietz, Andrew C; Smits-Seemann, Rochelle R; Kaul, Sapna; Kirchhoff, Anne C

    2017-10-01

    Survival estimates for soft tissue sarcomas (STS) and malignant bone tumors (BT) diagnosed in pediatric, adolescent, and young adult patients are not easily available. We present survival estimates based on a patient having survived a defined period of time (conditional survival). Conditional survival estimates for the short-term were calculated for patients from diagnosis to the first five years after diagnosis and for patients surviving in the long-term (up to 20 years after diagnosis). We identified 703 patients who were diagnosed with a STS or BT at age ≤25 years from January 1, 1986 to December 31, 2012 at a large pediatric oncology center in Salt Lake City, Utah, United States. We obtained cancer type, age at diagnosis, primary site, and demographic data from medical records, and vital status through the National Death Index. Cancer stage was available for a subset of the cohort through the Utah Cancer Registry. Cox proportional hazards models, adjusted for age and sex, calculated survival estimates for all analyses. Short-term survival improves over time for both sarcomas. Short-term survival for STS from diagnosis (Year 0) did not differ by sex, but short-term survival starting from 1-year post diagnosis was significantly worse for male patients (Survival probability 1-year post-diagnosis [SP1]:77% [95% CI:71-83]) than female patients (SP1:86% [81-92]). Survival for patients who were diagnosed at age ≤10 years (Survival probability at diagnosis [SP0]:85% [79-91]) compared to diagnosis at ages 16-25 years (SP0:67% [59-75]) was significantly better at all time-points from diagnosis to 5-years post-diagnosis. Survival for axial sites (SP0:69% [63-75]) compared to extremities (SP0:84% [79-90]) was significantly worse from diagnosis to 1-year post-diagnosis. Survival for axial BT (SP0: 64% [54-74] was significantly worse than BT in the extremities (SP0:73% [68-79]) from diagnosis to 3-years post diagnosis. Relapsed patients of both sarcoma types had

  13. Dr. Lytle Adams' incendiary "bat bomb" of World War II.

    PubMed

    Christen, Arden G; Christen, Joan A

    2004-11-01

    On December 7, 1941, a 60-year old dentist from Irwin, Pennsylvania, Dr. Lytle S. Adams, was driving home from a vacation at Carlsbad Caverns in New Mexico. Hours earlier, he had been gripped with amazement as he witnessed millions of bats exiting the caves of Carlsbad. Listening to his car radio on his return trip, he was shocked to hear that Japan had just attacked Pearl Harbor. Dr. Adams, outraged over this travesty, began to mentally construct a plan for U.S. retaliation. As his thoughts returned to the countless bats that had awed him, he formed a tentative plan: millions of these small, flying mammals could be connected to tiny, time-fused incendiary bombs, and then released to land on the flimsily constructed structures which dotted the cities of Japan. Within a few minutes, the bombs would explode and enflame the entire urban areas. He postulated that these immeasurable numbers of fires, spreading their devastation over such vast areas within Japanese cities would result in the enemy's speedy surrender. This article documents the futile efforts of Dr. Adams, his team and the U.S. government to develop and employ an effective, incendiary bat bomb. The recently developed atom bomb, a far more deadly weapon was used in its place.

  14. Impact of delay to treatment upon survival in 1067 patients with breast-cancer.

    PubMed

    Rabinovich, M; Vallejo, C; Perez, J; Rodriguez, R; Cuevas, M; Machiavelli, M; Lacava, J; Leone, B; Romero, A; Mickiewicz, E; Chacon, R; Estevez, R

    1993-02-01

    The medical records of 1067 patients with breast cancer were reviewed to evaluate the influence of delay between first symptom and first treatment upon survival. Three delay intervals were considered: <3 months; 3-6 months and >6 months. At a follow-up of 120 months, survival analyses identified a statistically significant difference (p=0.029) favoring patients with <3 months delay in the whole cohort, and in the group of women aged 50 or older (p=0.001). No differences were found when survival according to delay was considered within each clinical stage. A Cox multivariate analysis revealed that performance status, stage, age and menopausal status were significant predictors of survival for the whole group of patients. However, delay was an independent prognostic factor in patients with age greater-than-or-equal-to 50. In summary, 38/1067 patients (3.1%) could have been adversely affected by a >3 months delay between first symptom and first treatment. Better survival rate for patients with a short delay would obey to a greater number of patients in favorable stages and a higher proportion of women aged 50 or older in this group.

  15. Nuclear shadows on silvered walls: Atomic Bomb Cinema, from 1935 to 1991

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Shapiro, J.F.

    1991-01-01

    The cinema and the atomic bomb are two of the most significant technological innovations of the past-century - their influence on culture has provoked tremendous political, academic, and popular debate. The point at which these two technologies intersect is what the author calls Atomic Bomb Cinema.' Since 1945 almost six hundred films with images of nuclear weapons have been released in the US, and they have been virtually ignored by everyone but the film going public. This study shows how Bomb films' use recurring themes and formal structures, and therefore must be treated as a coherent body of films; identifiesmore » historical, mythological, and contemporary motifs; and analyzes these films from two points of view: interdisciplinary (history, politics, economics, sociology, and aesthetics) and cross-cultural (American, Japanese, British, and Australian). The most important element of Atomic Bomb Cinema is the Apocalyptic Imagination; film makers use it to structure their narratives and explore a wide range of ideological issues. In contrast to commonly held beliefs, Atomic Bomb Cinema is undeniably part of a process that helps people to understand the threat of nuclear war. In this instance, the cinema is one cultural institution that contributes to a healthy society.« less

  16. Therapeutic effect of apatinib on overall survival is mediated by prolonged progression-free survival in advanced gastric cancer patients

    PubMed Central

    Shen, Sipeng; Shi, Qianwen; Bai, Jianling; Li, Jin; Qin, Shukui; Yu, Hao; Chen, Feng

    2017-01-01

    Apatinib is reported to significantly improve the overall survival (OS) of patients with advanced gastric cancer who have previously failed second-line chemotherapy. However, it is not well understood whether apatinib acts by improving progression or by prolonging post-progression survival. Here, based on phase III clinical trial data, the mediating effect of apatinib on patient overall survival was systematically quantified, through progression-free survival (PFS), post-progression survival (PPS), and the disease control rate (DCR). PFS was the primary mediator of the association between apatinib treatment and OS, with an indirect-effect mean survival time ratio of 1.63 (95%CI 1.35-1.97), which mediated 93.5% of the treatment effect. The DCR was also a significant mediator among secondary efficacy endpoints, and had an indirect-effect mean survival time ratio of 1.47 (95%CI 1.20-1.79, 50.9% mediated). Both primary and other targets of the DCR had similar results. The results indicated that apatinib treatment prolongs progression-free survival rather than post-progression survival, and in turn, leads to improved overall survival. Additionally, our study highlights the value of mediation analysis in clinical trials in providing additional information to build upon traditional primary analysis. PMID:27793017

  17. Therapeutic effect of apatinib on overall survival is mediated by prolonged progression-free survival in advanced gastric cancer patients.

    PubMed

    Huang, Lihong; Wei, Yongyue; Shen, Sipeng; Shi, Qianwen; Bai, Jianling; Li, Jin; Qin, Shukui; Yu, Hao; Chen, Feng

    2017-04-25

    Apatinib is reported to significantly improve the overall survival (OS) of patients with advanced gastric cancer who have previously failed second-line chemotherapy. However, it is not well understood whether apatinib acts by improving progression or by prolonging post-progression survival. Here, based on phase III clinical trial data, the mediating effect of apatinib on patient overall survival was systematically quantified, through progression-free survival (PFS), post-progression survival (PPS), and the disease control rate (DCR). PFS was the primary mediator of the association between apatinib treatment and OS, with an indirect-effect mean survival time ratio of 1.63 (95%CI 1.35-1.97), which mediated 93.5% of the treatment effect. The DCR was also a significant mediator among secondary efficacy endpoints, and had an indirect-effect mean survival time ratio of 1.47 (95%CI 1.20-1.79, 50.9% mediated). Both primary and other targets of the DCR had similar results. The results indicated that apatinib treatment prolongs progression-free survival rather than post-progression survival, and in turn, leads to improved overall survival. Additionally, our study highlights the value of mediation analysis in clinical trials in providing additional information to build upon traditional primary analysis.

  18. Marital status and survival of patients with oral cavity squamous cell carcinoma: a population-based study.

    PubMed

    Shi, Xiao; Zhang, Ting-Ting; Hu, Wei-Ping; Ji, Qing-Hai

    2017-04-25

    The relationship between marital status and oral cavity squamous cell carcinoma (OCSCC) survival has not been explored. The objective of our study was to evaluate the impact of marital status on OCSCC survival and investigate the potential mechanisms. Married patients had better 5-year cancer-specific survival (CSS) (66.7% vs 54.9%) and 5-year overall survival (OS) (56.0% vs 41.1%). In multivariate Cox regression models, unmarried patients also showed higher mortality risk for both CSS (Hazard Ratio [HR]: 1.260, 95% confidence interval (CI): 1.187-1.339, P < 0.001) and OS (HR: 1.328, 95% CI: 1.266-1.392, P < 0.001). Multivariate logistic regression showed married patients were more likely to be diagnosed at earlier stage (P < 0.001) and receive surgery (P < 0.001). Married patients still demonstrated better prognosis in the 1:1 matched group analysis (CSS: 62.9% vs 60.8%, OS: 52.3% vs 46.5%). 11022 eligible OCSCC patients were identified from Surveillance, Epidemiology, and End Results (SEER) database, including 5902 married and 5120 unmarried individuals. Kaplan-Meier analysis, Log-rank test and Cox proportional hazards regression model were used to analyze survival and mortality risk. Influence of marital status on stage, age at diagnosis and selection of treatment was determined by binomial and multinomial logistic regression. Propensity score matching method was adopted to perform a 1:1 matched cohort. Marriage has an independently protective effect on OCSCC survival. Earlier diagnosis and more sufficient treatment are possible explanations. Besides, even after 1:1 matching, survival advantage of married group still exists, indicating that spousal support from other aspects may also play an important role.

  19. Survival trends among patients with advanced renal cell carcinoma in the United States.

    PubMed

    Shah, Binay Kumar; Ghimire, Krishna Bilas

    2015-01-01

    Since the approval of sorafenib in December 2005, several targeted therapeutic agents have been approved by the FDA for the treatment of advanced renal cell carcinoma (RCC). This study was conducted to find out whether the improvements in survival of advanced RCC patients with targeted agents have translated into a survival benefit in a population-based cohort. We analyzed the SEER 18 (Surveillance, Epidemiology and End RESULTS) registry database to calculate the relative survival rates for advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009. We also evaluated the survival rates by age (<65 and ≥65 years) and sex. The total number of advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009 were 7,047, 4,059, 1,548 and 1,440, respectively. During 2001-2009, the 1- and 3-year relative survival rates were 26.7±0.6 and 10.0±0.4%, respectively. There was no significant difference in 1-year relative survival rates for patients diagnosed during 2006-2007 and 2008-2009 compared to those diagnosed during 2001-2005. Similarly, the 3-year survival rates for patients diagnosed during 2006-2007 were similar to those diagnosed during 2001-2005. This population-based study showed that there was no significant improvement in relative survival rates among advanced RCC patients in the era of targeted agents. © 2014 S. Karger AG, Basel.

  20. Impact of socioeconomic status on survival of colorectal cancer patients.

    PubMed

    Zhang, Qian; Wang, Yufu; Hu, Hanqing; Huang, Rui; Xie, Lei; Liu, Enrui; Chen, Ying-Gang; Wang, Guiyu; Wang, Xishan

    2017-12-01

    Socioeconomic status (SES) has an impact on the survival of various cancers, but it has not been fully understood in colorectal cancer (CRC). The Surveillance, Epidemiology and End Results database was adopted to detect the role of SES in the survival outcomes of CRC. A total of 184,322 eligible patients were included and SES status was analyzed. The multivariable analysis showed that Non-Hispanic Black (HR, 1.20; 95% CI, 1.15-1.24), being widowed (HR, 1.04; 95% CI, 1.01-1.07), any Medicaid (HR, 1.36; 95% CI, 1.33-1.39) and the lowest education level group patients had relative poorer prognosis. Besides, sex, tumor location, age, differentiation level and American Joint Committee on Cancer stage also had significant effects on overall survival of CRC. The individuals were further divided into five groups according to the number of survival-adverse factors. All of the four groups containing adverse factors showed impaired survival outcomes compared with the group containing no adverse factor.

  1. Five-year survival rates for treatment-naive patients with advanced melanoma who received ipilimumab plus dacarbazine in a phase III trial.

    PubMed

    Maio, Michele; Grob, Jean-Jacques; Aamdal, Steinar; Bondarenko, Igor; Robert, Caroline; Thomas, Luc; Garbe, Claus; Chiarion-Sileni, Vanna; Testori, Alessandro; Chen, Tai-Tsang; Tschaika, Marina; Wolchok, Jedd D

    2015-04-01

    There is evidence from nonrandomized studies that a proportion of ipilimumab-treated patients with advanced melanoma experience long-term survival. To demonstrate a long-term survival benefit with ipilimumab, we evaluated the 5-year survival rates of patients treated in a randomized, controlled phase III trial. A milestone survival analysis was conducted to capture the 5-year survival rate of treatment-naive patients with advanced melanoma who received ipilimumab in a phase III trial. Patients were randomly assigned 1:1 to receive ipilimumab at 10 mg/kg plus dacarbazine (n = 250) or placebo plus dacarbazine (n = 252) at weeks 1, 4, 7, and 10 followed by dacarbazine alone every 3 weeks through week 22. Eligible patients could receive maintenance ipilimumab or placebo every 12 weeks beginning at week 24. A safety analysis was conducted on patients who survived at least 5 years and continued to receive ipilimumab as maintenance therapy. The 5-year survival rate was 18.2% (95% CI, 13.6% to 23.4%) for patients treated with ipilimumab plus dacarbazine versus 8.8% (95% CI, 5.7% to 12.8%) for patients treated with placebo plus dacarbazine (P = .002). A plateau in the survival curve began at approximately 3 years. In patients who survived at least 5 years and continued to receive ipilimumab, grade 3 or 4 immune-related adverse events were observed exclusively in the skin. The additional survival benefit of ipilimumab plus dacarbazine is maintained with twice as many patients alive at 5 years compared with those who initially received placebo plus dacarbazine. These results demonstrate a durable survival benefit with ipilimumab in advanced melanoma. © 2015 by American Society of Clinical Oncology.

  2. Ensuring the safety of surgical teams when managing casualties of a radiological dirty bomb.

    PubMed

    Williams, Geraint; O'Malley, Michael; Nocera, Antony

    2010-09-01

    The capacity for surgical teams to ensure their own safety when dealing with the consequences caused by the detonation of a radiological dirty bomb is primarily determined by prior knowledge, familiarity and training for this type of event. This review article defines the associated radiological terminology with an emphasis on the personal safety of surgical team members in respect to the principles of radiological protection. The article also describes a technique for use of hand held radiation monitors and will discuss the identification and management of radiologically contaminated patients who may pose a significant danger to the surgical team. 2010 Elsevier Ltd. All rights reserved.

  3. The TP53 gene polymorphisms and survival of sporadic breast cancer patients.

    PubMed

    Bišof, V; Salihović, M Peričić; Narančić, N Smolej; Skarić-Jurić, T; Jakić-Razumović, J; Janićijević, B; Rudan, P

    2012-06-01

    The TP53 gene polymorphisms, Arg72Pro and PIN3 (+16 bp), can have prognostic and predictive value in different cancers including breast cancer. The aim of the present study is to investigate a potential association between different genotypes of these polymorphisms and clinicopathological variables with survival of breast cancer patients in Croatian population. Ninety-four women with sporadic breast cancer were retrospectively analyzed. Median follow-up period was 67.9 months. The effects of basic clinical and histopathological characteristics of tumor on survival were tested by Cox's proportional hazards regression analysis. The TNM stage was associated with overall survival by Kaplan-Meier analysis, univariate, and multivariate Cox's proportional hazards regression analysis, while grade was associated with survival by Kaplan-Meier analysis and univariate Cox's proportional hazards regression analysis. Different genotypes of the Arg72Pro and PIN3 (+16 bp) polymorphisms had no significant impact on survival in breast cancer patients. However, in subgroup of patients treated with chemotherapy without anthracycline, the A2A2 genotype of the PIN3 (+16 bp) polymorphism was associated with poorer overall survival than other genotypes by Kaplan-Meier analysis (P = 0.048). The TP53 polymorphisms, Arg72Pro and PIN3 (+16 bp), had no impact on survival in unselected sporadic breast cancer patients in Croatian population. However, the results support the role of the A2A2 genotype of the PIN3 (+16 bp) polymorphism as a marker for identification of patients that may benefit from anthracycline-containing chemotherapy.

  4. Absenteeism among survivors of the atomic bombing of Hiroshima.

    PubMed Central

    Meigs, J W; Blot, W J; Inoue, S; Meigs, C R

    1975-01-01

    Atomic bomb survivors who worked at the Atomic Bomb Casualty Commission in Hiroshima during the years 1968-71 and held handbooks identifying them as survivors took significantly more days of both annual leave and sick leave than did matched and paired control subjects. These differences in leave-taking patterns are considered to be due to behavioural causes as they could not be attributed to radiation dose-response effects. PMID:1156567

  5. Survival from breast cancer in patients with CHEK2 mutations.

    PubMed

    Huzarski, T; Cybulski, C; Wokolorczyk, D; Jakubowska, A; Byrski, T; Gronwald, J; Domagała, P; Szwiec, M; Godlewski, D; Kilar, E; Marczyk, E; Siołek, M; Wiśniowski, R; Janiszewska, H; Surdyka, D; Sibilski, R; Sun, P; Lubiński, J; Narod, S A

    2014-04-01

    The purpose of this study is to estimate 10-year survival rates for patients with early onset breast cancer, with and without a CHEK2 mutation and to identify prognostic factors among CHEK2-positive breast cancer patients. 3,592 women with stage I to stage III breast cancer, diagnosed at or below age 50, were tested for four founder mutations in the CHEK2 gene. Information on tumor characteristics and on treatments received was retrieved from medical records. Dates of death were obtained from the Poland Vital Statistics Registry. Survival curves were generated for the mutation-positive and -negative sub-cohorts. Predictors of survival were determined among CHEK2 carriers using the Cox proportional hazards model. 3,592 patients were eligible for the study, of whom 140 (3.9 %) carried a CHEK2-truncating mutation and 347 (9.7 %) carried a missense mutation. The mean follow-up was 8.9 years. The 10-year survival for all CHEK2 mutation carriers was 78.8 % (95 % CI 74.6-83.2 %) and for non-carriers was 80.1 % (95 % CI 78.5-81.8 %). Among women with a CHEK2-positive breast cancer, the adjusted hazard ratio associated with ER-positive status was 0.88 (95 % CI 0.48-1.62). Among women with an ER-positive breast cancer, the adjusted hazard ratio associated with a CHEK2 mutation was 1.31 (95 % CI 0.97-1.77). The survival of women with breast cancer and a CHEK2 mutation is similar to that of patients without a CHEK2 mutation.

  6. Impact of hypertension on early outcomes and long-term survival of patients undergoing aortic repair with Stanford A dissection.

    PubMed

    Merkle, Julia; Sabashnikov, Anton; Deppe, Antje-Christin; Zeriouh, Mohamed; Eghbalzadeh, Kaveh; Weber, Carolyn; Rahmanian, Parwis; Kuhn, Elmar; Madershahian, Navid; Kroener, Axel; Choi, Yeong-Hoon; Kuhn-Régnier, Ferdinand; Liakopoulos, Oliver; Wahlers, Thorsten

    2018-04-01

    Stanford A acute aortic dissection (AAD) is a life-threatening emergency, typically occurring in hypertensive patients, requiring immediate surgical repair. The aim of this study was to evaluate early outcomes and long-term survival of hypertensive patients in comparison to normotensive patients suffering from Stanford A AAD. In our center, 240 patients with Stanford A AAD underwent aortic surgical repair from January 2006 to April 2015. After statistical and logistic regression analysis, Kaplan-Meier survival estimation was performed, with up to 9-year follow-up. The proportion of hypertensive patients suffering from Stanford A AAD was 75.4% (n=181). There were only few statistically significant differences in terms of basic demographics, comorbidities, preoperative baseline and clinical characteristics of hypertensive patients in comparison to normotensive patients. Hypertensive patients were significantly older (p=0.008), more frequently received hemi-arch repair (p=0.028) and selective brain perfusion (p=0.001). Our study showed similar statistical results in terms of 30-day mortality (p=0.196), long-term overall cumulative survival of patients (Log-Rank p=0.506) and survival of patients free from cerebrovascular events (Log-Rank p=0.186). Furthermore, subgroup analysis for long-term survival in terms of men (Log-Rank p=0.853), women (Log-Rank p=0.227), patients under and above 65 years of age (Log-Rank p=0.188 and Log-Rank p=0.602, respectively) and patients undergoing one of the three types of aortic repair surgery showed similar results for normotensive and hypertensive patient groups. Subgroup analysis for long-term survival of patients free from cerebrovascular events for women, patients under 65 years of age and patients undergoing aortic arch repair showed significant differences between the two groups in favor of hypertensive patients. Hypertensive patients suffering from Stanford A AAD were older, more frequently received hemi-arch replacement and were

  7. Conditional survival analysis of hepatocellular carcinoma patients treated with radiofrequency ablation.

    PubMed

    Facciorusso, Antonio; Del Prete, Valentina; Antonino, Matteo; Neve, Viviana; Amoruso, Annabianca; Crucinio, Nicola; Di Leo, Alfredo; Barone, Michele

    2015-10-01

    Survival estimates are commonly reported as survival from the first observation, but future survival probability changes based on the survival time already accumulated after therapy, otherwise known as conditional survival (CS). The aim of the study was to describe CS according to different prognostic variables in hepatocellular carcinoma (HCC) patients treated with radiofrequency ablation (RFA). Data on 125 very early/early HCC patients treated with RFA between 1999 and 2007 were analyzed. Actuarial survival estimates were computed by means of Kaplan-Meier method and compared by log-rank test. The 5-year CS was calculated with stratification by several predictors for patients who had already survived up to 5 years from diagnosis. Median overall survival (OS) was 72 months (95% confidence interval [CI], 58-86). Age, Child-Pugh (CP), α-fetoprotein (AFP), Cancer of the Liver Italian Program (CLIP) score and type of recurrence (early vs late) were significant predictors of OS. The 5-year CS rates of the entire study cohort assessed at 1, 2, 3 and 5 years from the treatment were 49%, 48%, 30% and 34%, respectively. Subgroup analysis confirmed age and CP as significant predictors of CS at all time points, while the CS of subgroups stratified by AFP and CLIP did not differ significantly from the 3rd year after RFA onward, as more advanced patients had probably escaped early recurrence. CS analysis showed that the impact of different variables influencing OS is not linear over time after RFA. Information derived from the study can improve the current management of HCC patients. © 2014 The Japan Society of Hepatology.

  8. Future use of tritium in mapping pre-bomb groundwater volumes.

    PubMed

    Eastoe, C J; Watts, C J; Ploughe, M; Wright, W E

    2012-01-01

    The tritium input to groundwater, represented as volume-weighted mean tritium concentrations in precipitation, has been close to constant in Tucson and Albuquerque since 1992, and the decrease in tritium concentrations at the tail end of the bomb tritium pulse has ceased. To determine the future usefulness of tritium measurements in southwestern North America, volume-weighted mean tritium levels in seasonal aggregate precipitation samples have been gathered from 26 sites. The averages range from 2 to 9 tritium units (TU). Tritium concentrations increase with site latitude, and possibly with distance from the coast and with site altitude, reflecting local ratios of combination of low-tritium moisture advected from the oceans with high-tritium moisture originating near the tropopause. Tritium used alone as a tool for mapping aquifer volumes containing only pre-bomb recharge to groundwater will become ambiguous when the tritium in precipitation at the end of the bomb tritium pulse decays to levels close to the analytical detection limit. At such a time, tritium in precipitation from the last one to two decades of the bomb pulse will become indistinguishable from pre-bomb recharge. The threshold of ambiguity has already arrived in coastal areas with a mean of 2 TU in precipitation and will follow in the next three decades throughout the study region. Where the mean tritium level is near 5 TU, the threshold will occur between 2025 and 2030, given a detection limit of 0.6 TU. Similar thresholds of ambiguity, with different local timing possible, apply globally. © 2011, The Author(s). Ground Water © 2011, National Ground Water Association.

  9. Suicide in paradise: aftermath of the Bali bombings.

    PubMed

    Suryani, L K; Page, A; Lesmana, C B J; Jennaway, M; Basudewa, I D G; Taylor, R

    2009-08-01

    The relationship between the Bali (Indonesia) bombings of October 2002 and suicide has not previously been investigated, despite anecdotal evidence of the economic and psychological consequences of these attacks. Suicide rates were calculated over the period 1994-2006 in three Bali regencies to determine whether suicide increased in the period following the first Bali bombings. Poisson regression and time-series models were used to assess the change in suicide rates by sex, age and area in the periods before and after October 2002. Suicide rates (age-adjusted) increased in males from an average of 2.84 (per 100 000) in the period pre-2002 to 8.10 in the period post-2002, and for females from 1.51 to 3.68. The greatest increases in suicide in the post-2002 period were in the age groups 20-29 and 60 years, for both males and females. Tourist arrivals fell significantly after the bombings, and addition of tourism to models reduced relative risk estimates of suicide, suggesting that some of the increase may be attributable to the socio-economic effects of declines in tourism. There was an almost fourfold increase in male suicide risk and a threefold increase in female suicide risk in the period following the 2002 bombings in Bali. Trends in tourism did not account for most of the observed increases. Other factors such as indirect socio-economic effects and Balinese notions of collective guilt and anxieties relating to ritual neglect are important in understanding the rise in suicide in the post-2002 period.

  10. Factors predicting survival in amyotrophic lateral sclerosis patients on non-invasive ventilation.

    PubMed

    Gonzalez Calzada, Nuria; Prats Soro, Enric; Mateu Gomez, Lluis; Giro Bulta, Esther; Cordoba Izquierdo, Ana; Povedano Panades, Monica; Dorca Sargatal, Jordi; Farrero Muñoz, Eva

    2016-01-01

    Non invasive ventilation (NIV) improves quality of life and extends survival in amyotrophic lateral sclerosis (ALS) patients. However, few data exist about the factors related to survival. We intended to assess the predictive factors that influence survival in patients after NIV initiation. Patients who started NIV from 2000 to 2014 and were tolerant (compliance ≥ 4 hours) were included; demographic, disease related and respiratory variables at NIV initiation were analysed. Statistical analysis was performed using the Kaplan-Meier test and Cox proportional hazard models. 213 patients were included with median survival from NIV initiation of 13.5 months. In univariate analysis, the identified risk factors for mortality were severity of bulbar involvement (HR 2), Forced Vital Capacity (FVC) % (HR 0.99) and ALSFRS-R (HR 0.97). Multivariate analysis showed that bulbar involvement (HR 1.92) and ALSFRS-R (HR 0.97) were independent predictive factors of survival in patients on NIV. In our study, the two prognostic factors in ALS patients following NIV were the severity of bulbar involvement and ALSFRS-R at the time on NIV initiation. A better assessment of bulbar involvement, including evaluation of the upper airway, and a careful titration on NIV are necessary to optimize treatment efficacy.

  11. Survival of the first arteriovenous fistula in 96 patients on chronic hemodialysis.

    PubMed

    Radoui, Aicha; Lyoussfi, Zineb; Haddiya, Intissar; Skalli, Zoubair; El Idrissi, Redouane; Rhou, Hakima; Ezzaitouni, Fatima; Ouzeddoun, Naima; El Mesnaoui, Abbes; Bayahia, Rabea; Benamar, Loubna

    2011-07-01

    Native arteriovenous fistula (AVF) represents the best vascular approach for chronic hemodialysis. The aim of this study was to determine the survival of the first AVF and to identify the factors responsible for poor AVF survival. A retrospective study was conducted on 96 chronic hemodialysis patients benefiting from the creation and cannulation of their first AVF at our center, with a minimum follow-up period of 1 year. We collected demographic, clinical, and biological data, as well as analyzed the following AVF characteristics: anatomic site, cannulation time, survival, and complications. To identify the predictive factors of poor AVF survival, we defined and compared two groups of patients on the basis of whether they lost their first AVF during the evolution. Patients' mean age was 42.1 ± 13 years, with predominantly female patients. Mean AVF cannulation time was 17.5 ± 24 days. AVF loss was mainly related to thrombosis in 29% of the cases and stenosis in 9.4%. AVF survival was 87%, 77%, 71%, 67%, and 64% after 1, 3, 5, 8, and 10 years of hemodialysis, respectively. In our study, the main factors associated with AVF loss were lengthy jugular venous catheters placement (p = 0.004), short AVF cannulation time after its creation (p = 0.03), and hypotension episodes during dialysis (p = 0.03). Long-term survival and quality of life in hemodialysis depend on an appropriate dialysis carried out-thanks to a correct vascular approach! According to the previously published data, survival of the first AVF can vary between 10% and 36% at 10 years. In our study, survival of the first native AVF was satisfying because it reached 64% at 10 years. Early AVF creation and prevention and management of its complications remain the safest and most comfortable solution to ensure AVF survival and thus a satisfying survival and quality of life in chronic hemodialysis patients. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  12. Nitrosourea efficacy in high-grade glioma: a survival gain analysis summarizing 504 cohorts with 24193 patients.

    PubMed

    Wolff, Johannes E A; Berrak, Su; Koontz Webb, Susannah E; Zhang, Ming

    2008-05-01

    Even though past studies have suggested efficacy of nitrosourea drugs in patients with high-grade glioma and temozolomide has recently been shown significantly to be beneficial, no conclusive comparisons between these agents have been published. We performed a survival gain analysis of 364 studies describing 24,193 patients with high-grade glioma treated in 504 cohorts, and compared the effects of drugs. The most frequent diagnoses were glioblastoma multiforme (GBM) (72%) and anaplastic astrocytoma (22%). The mean overall survival (mOS) was 14.1 months. The outcome was influenced by several of the known prognostic factors including the histological grade, if the tumors were newly diagnosed or recurrent, the completeness of resection, patients' age, and gender. This information allowed the calculation of a predicted mOS for each cohort based on their prognostic factors independent of treatment. Survival gain to characterize the influence of treatment was subsequently defined and validated as the difference between the observed and the predicted mOS. In 62 CCNU-treated cohorts and 15 ACNU-treated cohorts the survival gain was 5.3 months and 8.9 months (P < 0.0005), respectively. No detectable survival gain for patients treated with various BCNU-containing regimens was found. Conclusion CCNU- and ACNU-containing regimens were superior to BCNU containing regiments.

  13. Survival of metastatic colorectal cancer patients treated with chemotherapy in Alberta (1995-2004).

    PubMed

    Chen, Yiqun; Qiu, Zhenguo; Kamruzzaman, Anmmd; Snodgrass, Tom; Scarfe, Andrew; Bryant, Heather E

    2010-02-01

    Clinical trials have suggested that advances in chemotherapy significantly improve the survival of patients with metastatic colorectal cancer. Comparable evidence from clinical practice is scarce. This study aims to investigate the survival of patients with metastatic colorectal cancer treated with chemotherapy in Alberta, Canada. Trends of relative survival of patients diagnosed in 1994-2003 were assessed using Alberta Cancer Registry (ACR) data. The median overall survival (OS) of patients diagnosed in 2004 was determined by linking Cancer Registry data with Electronic Medical Records (EMR). Cox regression models were fitted to calculate the hazard ratio for patients treated with chemotherapy. The 2-year relative survival for patients with metastatic colorectal cancer who received chemotherapy increased significantly from 29% to 41% over the 10 years (1994-2003, p < 0.015). A 69% reduction in the risk of mortality was observed in the 168 patients who received chemotherapy compared to the 87 patients who did not, after adjusting for age, gender, and number of metastases. The median OS of patients who received chemotherapy was 17.5 months. This is comparable to the 18-20 months seen in recently published clinical trials, considering the patients in this study were from the real clinical practice, nearly half of them were older than 70, and many of them might have important co-morbidities. The survival of patients diagnosed with metastatic colorectal cancer in Alberta has improved in recent years; this is most likely attributable in large part to the use of chemotherapy.

  14. Psychological response to the Oklahoma City bombing.

    PubMed

    Krug, R S; Nixon, S J; Vincent, R

    1996-01-01

    The bombing of the Alfred P. Murrah Federal Office Building in Oklahoma City was the most devastating terrorist activity that has occurred in America. Prevention of revictimization of persons seriously affected by the bombing was central to the planned response to this tragedy. Coordination and collaboration among local, state, and national agencies promoted effective clinical services provision, research facilitation, and prevention of revictimization. Information gathered from this cooperative effort will contribute to the effort to minimize the potential for such tragedies in the future as well as help to develop prevention and intervention strategies to reduce the effects when the next such disaster occurs.

  15. Are Londoners Prepared for an Emergency? A Longitudinal Study Following the London Bombings

    PubMed Central

    Rubin, James; Amlôt, Richard; Simpson, John; Wessely, Simon

    2008-01-01

    The UK government sees increasing individual preparedness as a priority, but the level of preparedness of people in the UK for a large-scale emergency is not known. The London bombings of July 7, 2005, affected many Londoners and may have altered their sense of vulnerability to a future terrorist attack. We used a longitudinal study design to assess individual preparedness within the same sample of Londoners at 2 points in time: immediately after the bombings (T1) and 7 to 8 months later (T2). A demographically representative sample of 1,010 Londoners participated in a phone interview at T1. Subsequently, at T2, 574 of the same people participated in a follow-up phone interview. At T1 51% of Londoners had made 4 or more relevant emergency plans; 48% had gathered 4 or more relevant supplies in case of emergency. There was evidence of increased preparedness at T2, by which time 90% had made 4 or more emergency plans. Ethnicity, low social status, and having felt a sense of threat during the bombings predicted increased preparedness between T1 and T2. Women in general, and women of low social status in particular, perceived themselves to be unprepared in the event of a future terrorist attack. In summary, Londoners show moderate levels of emergency preparedness, which increased following the London bombings. Although we cannot know whether this association is causal, the prospective nature of the study increases the likelihood that it is. However, preparedness is still patchy, and there are important demographic associations with levels of preparedness and perception of vulnerability. These findings have implications for future development of individual and community emergency preparedness policy. PMID:19117430

  16. Investigations of Lateral Stability of a Glide Bomb Using Automatic Control Having No Time Lag

    NASA Technical Reports Server (NTRS)

    Sponder, E. W.

    1950-01-01

    The investigation of the lateral stability of an automatically controlled glide bomb led also to the attempt of clarifying the influence of a phugoid oscillation or of any general longitudinal oscillation on the lateral stability of a glide bomb. Under the assumption that its period of oscillation considerably exceeds the rolling and yawing oscillation and that c(sub a) is, at least in sections, practically constant, the result of this test is quite simple. It becomes clear that the influence of the phugoid oscillation may be replaced by suitable variation of the rolling-yawing moment on a rectilinear flight path instead of the phugoid oscillation. If the flying weight of the glide bomb of unchanged dimensions is increased, an increase of the flight velocity will be more favorable than an increase of the lift coefficient. The arrangement of the control permits lateral stability to be achieved in every case; a minimum rolling moment due to sideslip proves of great help.

  17. Clinical characteristics and quality-of-life in patients surviving a decade of prostate cancer with bone metastases.

    PubMed

    Klaff, Rami; Berglund, Anders; Varenhorst, Eberhard; Hedlund, Per Olov; Jǿnler, Morten; Sandblom, Gabriel

    2016-06-01

    To describe characteristics and quality-of-life (QoL), and to define factors associated with long-term survival in a subgroup of patients with prostate cancer with M1b disease. The study was based on 915 patients from a prospective randomised multicentre trial (No. 5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade. Long-term survival was defined as patients having an overall survival of ≥10 years, and logistic regression models were constructed to identity clinical predictors of survival. QoL during follow-up was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire - C30 version 1 (EORTC-C30) ratings. In all, 40 (4.4%) of the 915 men survived for >10 years. Factors significantly associated with increased likelihood of surviving for >10 years in the univariate analyses were: absence of cancer-related pain; Eastern Cooperative Oncology Group (ECOG) performance status of <2; negligible analgesic consumption; T-category of 1-2; prostate-specific antigen (PSA) level of <231 μg/L; and a Soloway score of 1. In the multivariate analyses, ECOG performance status of <2, PSA level of <231 μg/L, and Soloway score of 1, were all independent predictors of long-term survival. All subscales of the EORTC-C30 were higher in this group than for patients with short survival, but slowly declined over the decade. A subgroup of patients with prostate cancer with M1b disease and certain characteristics showed a positive long-term response to androgen-deprivation therapy with an acceptable QoL over a decade or more. Independent predictors of long-term survival were identified as ECOG performance status of <2, limited extent of bone metastases (Soloway score of 1), and a PSA level of <231 μg/L at the time of enrolment. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  18. The Rhetoric of "Unconditional Surrender" and the Decision to Drop the Atomic Bomb.

    ERIC Educational Resources Information Center

    Hikins, James W.

    1983-01-01

    Analyzes the decision to drop the atomic bomb from a rhetorical point of view, arguing that the bombs were launched because of an American commitment to a particular rhetoric that focused on the propaganda slogan "unconditional surrender." (PD)

  19. Lessons from the atomic bomb about secondary MDS.

    PubMed

    Hata, Tomoko; Imanishi, Daisuke; Miyazaki, Yasushi

    2014-12-01

    Myelodysplastic syndromes (MDSs) is a hematological neoplasm defined by ineffective hematopoiesis, dysplasia of hematopoietic cells, and risk of progression to acute leukemia. MDS occurs as de novo or secondary, and chemoradiotherapy for cancers is thought to increase the risk of MDS among patients. Recently, an epidemiological study for MDS among A-bomb survivors was performed, and it clearly demonstrated that the exposure to external radiation significantly increased the risk of MDS. Precise epidemiological data among survivors have revealed important clinical factors related to the risk of leukemias. In this review, by comparing data for secondary MDS and leukemia/MDS among survivors, several factors which would affect the risk of MDS, especially secondary MDS, are discussed.

  20. The Organization of Hospital Services for Casualties due to the Bombing of Cities, Based on Experience Gained in Barcelona—with Special Reference to the Classification of Casualties

    PubMed Central

    Trueta, J.

    1939-01-01

    (1) Difference between modern “total population” war and old-fashioned war. Difference between bombing of (a) military objectives and (b) civilian population. (a) The heavy bomb, e.g. 750 lb., with large fragments, upward throw, great destruction of buildings. (b) The light bomb with finger nail fragments, horizontal throw, great velocity.There is in addition the incendiary bomb, little used in Barcelona because the buildings are built of stone and concrete. (2) Aerial bombing of a town produces injuries needing more immediate hospitalization than most front-line wounds. At the same time it is possible in a town to organize rapid collection of patients and their immediate transfer to hospital. (3) Experience shows that it is most desirable to make this transfer of patients to hospital a primary consideration. On arrival they are “sorted” and minor injuries are given First Aid treatment and sent home, others are fully examined, classified, and dispatched to the theatres on a priority list, to nearby wards for resuscitation, to wards for rest, or sent on to plaster rooms for splintage, or to a neurosurgical centre. (4) First-aid posts in a town should be in hospitals and treat superficial injuries, &c., after primary sorting in the hospital reception room. (5) First-aid posts in outlying areas should carry out the same function for the same type of cases; all the more seriously wounded, including those with tiny penetrating wounds, should be dispatched without first aid treatment direct to hospital. (6) Hospital arrangements, for circulation of ambulances, for sorting, undressing of patients, docketing of valuables, &c. (7) Classification must be carried out by surgeons of experience and judgment. They must regard not only a standard priority list but the particular clinical picture and prognosis in each case. (8) The surgeon will furthermore draft the cases with regard to the special abilities of the surgical units available, e.g. chest, abdomen, or limbs

  1. Cancer and non-cancer effects in Japanese atomic bomb survivors.

    PubMed

    Little, M P

    2009-06-01

    The survivors of the atomic bombings in Hiroshima and Nagasaki are a general population of all ages and sexes and, because of the wide and well characterised range of doses received, have been used by many scientific committees (International Commission on Radiological Protection (ICRP), United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), Biological Effects of Ionizing Radiations (BEIR)) as the basis of population cancer risk estimates following radiation exposure. Leukaemia was the first cancer to be associated with atomic bomb radiation exposure, with preliminary indications of an excess among the survivors within the first five years after the bombings. An excess of solid cancers became apparent approximately ten years after radiation exposure. With increasing follow-up, excess risks of most cancer types have been observed, the major exceptions being chronic lymphocytic leukaemia, and pancreatic, prostate and uterine cancer. For most solid cancer sites a linear dose response is observed, although in the latest follow-up of the mortality data there is evidence (p = 0.10) for an upward curvature in the dose response for all solid cancers. The only cancer sites which exhibit (upward) curvature in the dose response are leukaemia, and non-melanoma skin and bone cancer. For leukaemia the dose response is very markedly upward curving, indeed largely describable as a pure quadratic dose response, particularly in the low dose (0-2 Sv) range. Even 55 years after the bombings over 40% of the Life Span Study cohort remain alive, so continued follow-up of this group is vital for completing our understanding of long-term radiation effects in people. In general, the relative risks per unit dose among the Japanese atomic bomb survivors are greater than those among comparable subsets in studies of medically exposed individuals. Cell sterilisation largely accounts for the discrepancy in relative risks between these two populations, although other

  2. Fast neutrons measured in copper from the Hiroshima atomic bomb dome.

    PubMed

    Marchetti, A A; McAninch, J E; Rugel, G; Rühm, W; Korschinek, G; Martinelli, R E; Faestermann, T; Knie, K; Egbert, S D; Wallner, A; Wallner, C; Tanaka, K; Endo, S; Hoshi, M; Shizuma, K; Fujita, S; Hasai, H; Imanaka, T; Straume, T

    2009-01-01

    The first measurements of (63)Ni produced by A-bomb fast neutrons (above approximately 1 MeV) in copper samples from Hiroshima encompassed distances from approximately 380 to 5062 m from the hypocenter (the point on the ground directly under the bomb). They included the region of interest to survivor studies (approximately 900 to 1500 m) and provided the first direct validation of fast neutrons in that range. However, a significant measurement gap remained between the hypocenter and 380 m. Measurements close to the hypocenter are important as a high-value anchor for the slope of the curve for neutron activation as a function of distance. Here we report measurements of (63)Ni in copper samples from the historic Hiroshima Atomic Bomb Dome, which is located approximately 150 m from the hypocenter. These measurements extend the range of our previously published data for (63)Ni providing a more comprehensive and consistent A-bomb activation curve. The results are also in good agreement with calculations based on the current dosimetry system (DS02) and give further experimental support to the accuracy of this system that forms the basis for radiation risk estimates worldwide.

  3. Alterations of body mass index and body composition in atomic bomb survivors.

    PubMed

    Tatsukawa, Y; Misumi, M; Yamada, M; Masunari, N; Oyama, H; Nakanishi, S; Fukunaga, M; Fujiwara, S

    2013-08-01

    Obesity, underweight, sarcopenia and excess accumulation of abdominal fat are associated with a risk of death and adverse health outcomes. Our aim was to determine whether body mass index (BMI) and body composition, assessed with dual-energy X-ray absorptiometry (DXA), are associated with radiation exposure among atomic bomb (A-bomb) survivors. This was a cross-sectional study conducted in the Adult Health Study of the Radiation Effects Research Foundation. We examined 2686 subjects (834 men and 1852 women), aged 48-89 years (0-40 years at A-bomb exposure), for BMI analysis. Among them, 550 men and 1179 women underwent DXA in 1994-1996 and were eligible for a body composition study. After being adjusted for age and other potential confounding factors, A-bomb radiation dose was associated significantly and negatively with BMI in both sexes (P=0.01 in men, P=0.03 in women) and appendicular lean mass (P<0.001 in men, P=0.05 in women). It was positively associated with trunk-to-limb fat ratio in women who were less than 15 years old at the time of exposure (P=0.03). This is the first study to report a significant dose response for BMI and body composition 50 years after A-bomb radiation exposure. We will need to conduct further studies to evaluate whether these alterations affect health status.

  4. How training and experience affect the benefits of autonomy in a dirty-bomb experiment

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    David J. Bruemmer; Curtis W. Nielsen; David I. Gertman

    2008-03-01

    A dirty-bomb experiment conducted at the INL is used to evaluate the effectiveness and suitability of three different modes of robot control. The experiment uses three distinct user groups to understand how participants’ background and training affect the way in which they use and benefit from autonomy. The results show that the target mode, which involves automated mapping and plume tracing together with a point and click tasking tool, provides the best performance for each group. This is true for objective performance such as source detection and localization accuracy as well as subjective measures such as perceived workload, frustration andmore » preference. The best overall performance is achieved by the Explosive Ordinance Disposal group which has experience in both robot teleoperation and dirty bomb response. The user group that benefits least from autonomy is the Nuclear Engineers that have no experience with either robot operation or dirty bomb response. The group that benefits most from autonomy is the Weapons of Mass Destruction Civil Response Team that has extensive experience related to the task, but no robot training.« less

  5. Gutuo Jiejiu decoction improves survival of patients with severe alcoholic hepatitis: A retrospective cohort study.

    PubMed

    Mou, Hong-Yuan; Nie, Hong-Ming; Hu, Xiao-Yu

    2017-04-28

    To verify the value of Gutuo Jiejiu decoction in improving the survival of patients with severe alcoholic hepatitis (SAH). We performed a retrospective cohort study in consecutive patients diagnosed with SAH at the Teaching Hospital of Chengdu University of Traditional Chinese Medicine and Shuguang Hospital, Shanghai University of Traditional Chinese Medicine. The traditional Chinese medicine formula Gutuo Jiejiu decoction was employed as an exposure factor. Patients from the Teaching Hospital of Chengdu University of Traditional Chinese Medicine who had been treated with Gutuo Jiejiu decoction + prednisone were assigned to an observation group, and patients from Shuguang Hospital, Shanghai University of Traditional Chinese Medicine who had been treated with prednisone alone were selected as a control group. A retrospective analysis was performed by comparing age, alcohol intake, and clinical parameters of liver injury before and after treatment. Additionally, the 3- and 12-mo survival rates and the occurrence of complications were analyzed. One hundred and twenty-eight eligible patients were selected from 175 cases with SAH, of which 68 were assigned to the observation group and the other 60 to the control group. No significant difference was found in the patients' baseline characteristics ( P > 0.05). However, significant improvements of 90-d survival rate [56/68 (82.4%) vs 27/60 (45.0%), P = 0.0000] and 365-d survival rate [48/68 (70.6%) vs 13/60 (21.7%), P = 00000] were observed in the observation group after treatment. After the first 3 mo of treatment, more improvements in the clinical parameters and scoring systems related to liver injury occurred in the observation group than in the control group ( P < 0.05). After treatment for 12 mo, the differences in the clinical parameters and scoring systems related to liver injury between the two groups were more significant ( P < 0.05). No significant differences in complications and adverse effects were found

  6. Treatment patterns and survival in patients with ALK-positive non-small-cell lung cancer: a Canadian retrospective study.

    PubMed

    Kayaniyil, S; Hurry, M; Wilson, J; Wheatley-Price, P; Melosky, B; Rothenstein, J; Cohen, V; Koch, C; Zhang, J; Osenenko, K; Liu, G

    2016-12-01

    Crizotinib was the first agent approved for the treatment of anaplastic lymphoma kinase ( ALK )-positive (+) non-small-cell lung cancer (nsclc), followed by ceritinib. However, patients eventually progress or develop resistance to crizotinib. With limited real-world data available, the objective of the present work was to evaluate treatment patterns and survival after crizotinib in patients with locally advanced or metastatic ALK + nsclc in Canada. In this retrospective study at 6 oncology centres across Canada, medical records of patients with locally advanced or metastatic ALK + nsclc were reviewed. Demographic and clinical characteristics, treatments, and outcomes data were abstracted. Analyses focused on patients who discontinued crizotinib treatment. Of the 97 patients included, 9 were crizotinib-naïve, and 39 were still receiving crizotinib at study end. The 49 patients who discontinued crizotinib treatment were included in the analysis. Of those 49 patients, 43% received ceritinib at any time, 20% subsequently received systemic chemotherapy only (but never ceritinib), and 37% received no further treatment or died before receiving additional treatment. Median overall survival from crizotinib discontinuation was shorter in patients who did not receive ceritinib than in those who received ceritinib (1.7 months vs. 20.4 months, p < 0.001). In a multivariable analysis, factors associated with poorer survival included lack of additional therapies (particularly ceritinib), male sex, and younger age, but not smoking status; patients of Asian ethnicity showed a nonsignificant trend toward improved survival. A substantial proportion of patients with ALK + nsclc received no further treatment or died before receiving additional treatment after crizotinib. Treatment with systemic agents was associated with improved survival, with ceritinib use being associated with the longest survival.

  7. (41)Ca in tooth enamel. Part I: a biological signature of neutron exposure in atomic bomb survivors.

    PubMed

    Wallner, A; Rühm, W; Rugel, G; Nakamura, N; Arazi, A; Faestermann, T; Knie, K; Maier, H J; Korschinek, G

    2010-08-01

    The detection of (41)Ca atoms in tooth enamel using accelerator mass spectrometry is suggested as a method capable of reconstructing thermal neutron exposures from atomic bomb survivors in Hiroshima and Nagasaki. In general, (41)Ca atoms are produced via thermal neutron capture by stable (40)Ca. Thus any (41)Ca atoms present in the tooth enamel of the survivors would be due to neutron exposure from both natural sources and radiation from the bomb. Tooth samples from five survivors in a control group with negligible neutron exposure were used to investigate the natural (41)Ca content in tooth enamel, and 16 tooth samples from 13 survivors were used to estimate bomb-related neutron exposure. The results showed that the mean (41)Ca/Ca isotope ratio was (0.17 +/- 0.05) x 10(-14) in the control samples and increased to 2 x 10(-14) for survivors who were proximally exposed to the bomb. The (41)Ca/Ca ratios showed an inverse correlation with distance from the hypocenter at the time of the bombing, similar to values that have been derived from theoretical free-in-air thermal-neutron transport calculations. Given that gamma-ray doses were determined earlier for the same tooth samples by means of electron spin resonance (ESR, or electron paramagnetic resonance, EPR), these results can serve to validate neutron exposures that were calculated individually for the survivors but that had to incorporate a number of assumptions (e.g. shielding conditions for the survivors).

  8. Bomb blast mass casualty incidents: initial triage and management of injuries.

    PubMed

    Goh, S H

    2009-01-01

    Bomb blast injuries are no longer confined to battlefields. With the ever present threat of terrorism, we should always be prepared for bomb blasts. Bomb blast injuries tend to affect air-containing organs more, as the blast wave tends to exert a shearing force on air-tissue interfaces. Commonly-injured organs include the tympanic membranes, the sinuses, the lungs and the bowel. Of these, blast lung injury is the most challenging to treat. The clinical picture is a mix of acute respiratory distress syndrome and air embolism, and the institution of positive pressure ventilation in the presence of low venous pressures could cause systemic arterial air embolism. The presence of a tympanic membrane perforation is not a reliable indicator of the presence of a blast injury in the other air-containing organs elsewhere. Radiological imaging of the head, chest and abdomen help with the early identification of blast lung injury, head injury, abdominal injury, eye and sinus injuries, as well as any penetration by foreign bodies. In addition, it must be borne in mind that bomb blasts could also be used to disperse radiological and chemical agents.

  9. Medical Effects of Atomic Bombs. The Report of the Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan; Volume 1. Section 1. Introduction. Section 2. Physics. Section 3H. Hiroshima City. Section 3N. Nagasaki City

    DTIC Science & Technology

    1951-04-19

    cases. The patients complained of nausea and vomit- ing on the day of the bombing and this was followed by progressive fever , anorexia, severe diarrhea... Fever and diarrhea occurred frequently and at about this same time. In the more severely affected patients, all of these symptoms appeared after a...to those seen in aplastic anemia and agranulocytosis, ]ji the most severely affected patients, fever increased steadily and those who died usually

  10. Marital status and survival of patients with oral cavity squamous cell carcinoma: a population-based study

    PubMed Central

    Shi, Xiao; Zhang, Ting-ting; Hu, Wei-ping; Ji, Qing-hai

    2017-01-01

    Background The relationship between marital status and oral cavity squamous cell carcinoma (OCSCC) survival has not been explored. The objective of our study was to evaluate the impact of marital status on OCSCC survival and investigate the potential mechanisms. Results Married patients had better 5-year cancer-specific survival (CSS) (66.7% vs 54.9%) and 5-year overall survival (OS) (56.0% vs 41.1%). In multivariate Cox regression models, unmarried patients also showed higher mortality risk for both CSS (Hazard Ratio [HR]: 1.260, 95% confidence interval (CI): 1.187–1.339, P < 0.001) and OS (HR: 1.328, 95% CI: 1.266–1.392, P < 0.001). Multivariate logistic regression showed married patients were more likely to be diagnosed at earlier stage (P < 0.001) and receive surgery (P < 0.001). Married patients still demonstrated better prognosis in the 1:1 matched group analysis (CSS: 62.9% vs 60.8%, OS: 52.3% vs 46.5%). Materials and Methods 11022 eligible OCSCC patients were identified from Surveillance, Epidemiology, and End Results (SEER) database, including 5902 married and 5120 unmarried individuals. Kaplan-Meier analysis, Log-rank test and Cox proportional hazards regression model were used to analyze survival and mortality risk. Influence of marital status on stage, age at diagnosis and selection of treatment was determined by binomial and multinomial logistic regression. Propensity score matching method was adopted to perform a 1:1 matched cohort. Conclusions Marriage has an independently protective effect on OCSCC survival. Earlier diagnosis and more sufficient treatment are possible explanations. Besides, even after 1:1 matching, survival advantage of married group still exists, indicating that spousal support from other aspects may also play an important role. PMID:28415710

  11. Education, Income, and Support for Suicide Bombings: Evidence from Six Muslim Countries

    ERIC Educational Resources Information Center

    Shafiq, M. Najeeb; Sinno, Abdulkader H.

    2010-01-01

    The authors examine the effect of educational attainment and income on support for suicide bombing among Muslim publics in six predominantly Muslim countries that have experienced suicide bombings: Indonesia, Jordan, Lebanon, Morocco, Pakistan, and Turkey. The authors make two contributions. First, they present a conceptual model, which has been…

  12. Myth-building: The [open quotes]Islamic[close quotes] bomb

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hoodbhoy, P.

    1993-06-01

    The [open quotes]Islamic Bomb[close quotes] is roughly understood to be a nuclear weapon aquired for broad ideological reasons--a weapon that supposedly belongs to the Muslim [ital ummah] or community and, as such, is the ultimate expression of Islamic solidarity. Concern about the Islamic bomb is at the heart of the intense effort to prevent the spread of nuclear weapons to Muslim countries. The official justification is a general one: proliferation must be curbed globally. But unofficially, the Islamic bomb gets special attention. The reasons behind this special attention are described in this article. The reasons include fear of terrorism, ofmore » a [ital jihad] willing to indiscriminately use nuclear weapons in hope of a reward in the Hereafter, and of the transfer of nuclear arms from nuclear to non-nuclear Muslim countries in times of crisis. Possibilities for controlling the proliferation of nuclear weapons in Muslim countries are addressed. Reasons are cited as to why various Muslim countries wish to acquire nuclear weapons.« less

  13. Treatment Patterns, Survival, and Healthcare Costs of Patients with Malignant Gliomas in a Large US Commercially Insured Population

    PubMed Central

    Ray, Saurabh; Bonafede, Machaon M.; Mohile, Nimish A.

    2014-01-01

    Background Glioblastoma multiforme is the most common malignant primary brain tumor in adults and is associated with poor survival rates. Symptoms often include headaches; nausea and vomiting; and progressive memory, personality, or neurologic deficits. The treatment remains a challenge, and despite the approval of multiple new therapies in the past decade, survival has not improved. Objective To describe treatment patterns, survival, and healthcare costs of patients with incident glioblastoma in a large US population. Methods For this population-based study, adult patients (aged ≥18 years) with incident malignant brain neoplasm who had undergone brain surgery between January 1, 2006, and December 31, 2010, were identified in the Truven Health Analytics MarketScan Research Databases. The patients were stratified into 4 cohorts based on the use of temozolomide and/or external beam radiation therapy within 90 days after brain surgery (ie, the index event). Treatment patterns, survival, and healthcare costs were assessed until patient death, disenrollment, or the end-of-study period. Results A total of 2272 patients met the inclusion criteria; of these, 37% received temozolomide and radiation therapy, 13.8% received radiation alone, 3.9% received temozolomide alone, and 45.3% of patients received neither. The average patient age ranged from 55.3 years to 59.8 years across the study cohorts; between 29.8% and 44% of patients in each cohort were female. The duration of temozolomide use was similar between the temozolomide-only cohort and patients receiving temozolomide with external beam radiation; approximately 76% of patients received temozolomide at least 60 days, dropping to 48.1% and 23% at 180 days and 360 days of follow-up, respectively. The median survival was 456 days, ranging from 331 days in the temozolomide-only cohort to 529 days in the cohort that received neither temozolomide nor external beam radiation. The average total costs in the 6 months postindex

  14. Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia--results of a tertiary referral centre.

    PubMed

    Roembke, Felicitas; Heinzow, Hauke Sebastian; Gosseling, Thomas; Heinecke, Achim; Domagk, Dirk; Domschke, Wolfram; Meister, Tobias

    2014-01-01

    Pneumocystis jirovecii pneumonia also known as pneumocystis pneumonia (PCP) is an opportunistic respiratory infection in human immunodeficiency virus (HIV) patients that may also develop in non-HIV immunocompromised persons. The aim of our study was to evaluate mortality predictors of PCP patients in a tertiary referral centre. Fifty-one patients with symptomatic PCP were enrolled in the study. The patients had either HIV infection (n = 21) or other immunosuppressive conditions (n = 30). Baseline characteristics (e.g. age, sex and underlying disease) were retrieved. Kaplan-Meier analysis was employed to calculate survival. Comparisons were made by log-rank test. A multivariate analysis of factors influencing survival was carried out using the Cox regression model. Chi-squared test and Wilcoxon-Mann-Whitney test was applied as appropriate. The median survival time for the HIV group was >120 months compared with 3 months for the non-HIV group (P = 0.009). Three-month survival probability was also significantly greater in the HIV group compared with the non-HIV group (90% vs 41%, P = 0.002). In univariate log-rank test, intensive care unit (ICU) necessity, HIV negativity, age >50 years, haemoglobin <10g/dl, C-reactive protein >5 mg/dL and multiple comorbidities were significant negative predictors of survival. In the Cox regression model, ICU and HIV statuses turned out to be independent prognostic factors of survival. PCP is a serious problem in non-HIV immunocompromised patients in whom survival outcomes are worse than those in HIV patients. © 2013 John Wiley & Sons Ltd.

  15. The effect of lymphadenectomy on survival and recurrence in patients with ovarian cancer: a systematic review and meta-analysis.

    PubMed

    Zhou, Jinhong; Shan, Guoping; Chen, Yiwen

    2016-08-01

    Our objective was to perform a meta-analysis examining the effectiveness of lymphadenectomy in patients with ovarian cancer. PubMed and CENTRAL databases were searched on 15 November 2015 using the terms 'lymphadenectomy', 'ovarian cancer', 'dissection', 'para-aortic', 'pelvic' and survival. Prospective and retrospective studies comparing the outcomes of surgery with or without lymphadenectomy were included. Outcomes were 5-year overall survival, progression-free survival and recurrence rate. Of the 556 studies identified, 3 randomized controlled trials and 11 retrospective studies were included. Lymphadenectomy was associated with greater 5-year overall survival than no lymphadenectomy (pooled odds ratio = 1.58, 95% confidence interval: 1.41-1.77, p < 0.001). There was no difference in progression-free survival between the groups (pooled overall survival = 1.62, 95% confidence interval: 0.82-3.21, p = 0.168). Lymphadenectomy was associated with greater progression-free survival in randomized clinical trials (pooled overall survival = 1.57, 95% confidence interval: 1.11-2.21, p = 0.010), but not in retrospective studies. Lymphadenectomy was associated with a significantly lower recurrence rate (pooled overall survival = 0.51, 95% confidence interval: 0.30-0.85, p = 0.011). Lymphadenectomy was associated with greater 5-year overall survival in patients with both early and advanced stage cancer, but was associated with greater progression-free survival and lower recurrence rate only in patients with advanced stage cancer. Lymphadenectomy is associated with greater 5-year overall survival in patients with early and advanced stage ovarian cancer, but an effect on progression-free survival and recurrence rate was only found in patients with advanced stage ovarian cancer. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada.

    PubMed

    Kim, Chong S; Hannouf, Malek B; Sarma, Sisira; Rodrigues, George B; Rogan, Peter K; Mahmud, Salaheddin M; Winquist, Eric; Brackstone, Muriel; Zaric, Gregory S

    2015-11-01

    Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS). We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. We cross-validated CUP diagnosis and obtained additional information about metastasis through data linkage with the SDS/DAD database. OS was assessed using Cox regression models adjusting for histology and sites of metastases. We identified 3564 patients diagnosed with CUP. Patients without histologically confirmed disease (n = 1821) had a one-year OS of 10.9%, whereas patients with confirmed histology (n = 1743) had a one-year OS of 15.6%. The most common metastatic sites were in the respiratory or digestive systems (n = 1603), and the most common histology was adenocarcinoma (n = 939). Three-year survival rates were 3.5%, 5.3%, 41.6% and 3.6% among adenocarcinoma, unspecified carcinoma, squamous cell carcinoma and undifferentiated histology, respectively. Three-year survival rates were 40%, 2.4%, 8.0% and 4.6% among patients with metastases localised to lymph nodes, the respiratory or digestive systems, other specified sites, and unspecified sites, respectively. CUP patients in Ontario have a poor prognosis. Some subgroups may have better survival rates, such as patients with metastases localised to lymph nodes and patients with squamous cell histology.

  17. Infective endocarditis: outcome in surviving patients with intracardiac complications.

    PubMed

    Mocchegiani, Roberto; Pergolini, Martina; Nataloni, Maura

    2007-03-01

    The purpose of this study was to assess the outcome of 15 patients who survived infective endocarditis with abscesses and other intracardiac complications. Abscesses were associated with native valve endocarditis in seven patients and prosthetic valve endocarditis in eight patients; fistulas were observed in three patients, and subaortic perforation in three patients. Sensitivity for the detection of abscesses was 42.8% and 92.8% using transthoracic and transoesophageal echocardiography, respectively. Eleven patients underwent surgical treatment with no operative mortality, whereas four patients were only medically treated. During follow-up (mean 8.26 years), two patients died (13%) and six recurrences (five early and one late prosthetic valve endocarditis) required re-intervention for prosthesis dysfunction (40%); an improvement in New York Heart Association class in survivors and no changes in echocardiographic lesions were observed. Infective intracardiac complications do not seem to significantly reduce the overall survival (87%) of patients at long-term follow-up.

  18. Temporal trends in patient characteristics and survival of intensive care admissions with sepsis: a multicenter analysis*.

    PubMed

    Dreiher, Jacob; Almog, Yaniv; Sprung, Charles L; Codish, Shlomi; Klein, Moti; Einav, Sharon; Bar-Lavie, Yaron; Singer, Pierre P; Nimrod, Adi; Sachs, Jeffrey; Talmor, Daniel; Friger, Michael; Greenberg, Dan; Olsfanger, David; Hersch, Moshe; Novack, Victor

    2012-03-01

    To estimate in-hospital, 1-yr, and long-term mortality and to assess time trends in incidence and outcomes of sepsis admissions in the intensive care unit. A population-based, multicenter, retrospective cohort study. Patients hospitalized with sepsis in the intensive care unit in seven general hospitals in Israel during 2002-2008. None. Survival data were collected and analyzed according to demographic and background clinical characteristics, as well as features of the sepsis episode, using Kaplan-Meier approach for long-term survival. A total of 5,155 patients were included in the cohort (median age: 70, 56.3% males; median Charlson comorbidity index: 4). The mean number of intensive care unit admissions per month increased over time, while no change in in-hospital mortality was observed. The proportion of patients surviving to hospital discharge was 43.9%. The 1-, 2-, 5-, and 8-yr survival rates were 33.0%, 29.8%, 23.3%, and 19.8%, respectively. Mortality was higher in older patients, patients with a higher Charlson comorbidity index, and those with multiorgan failure, and similar in males and females. One-year age-standardized mortality ratio was 21-fold higher than expected, based on the general population rates. Mortality following intensive care unit sepsis admission remains high and is correlated with underlying patients' characteristics, including age, comorbidities, and the number of failing organ systems.

  19. Cartridge output testing - Methods to overcome closed-bomb shortcomings

    NASA Technical Reports Server (NTRS)

    Bement, Laurence J.; Schimmel, Morry L.

    1991-01-01

    Although the closed-bomb test has achieved virtually universal acceptance for measuring the output performance of pyrotechnic cartridges, there are serious shortcomings in its ability to quantify the performance of cartridges used as energy sources for pyrotechnic-activated mechanical devices. This paper presents several examples of cartridges (including the NASA Standard Initiator NSI) that successfully met closed-bomb performance requirements, but resulted in functional failures in mechanisms. To resolve these failures, test methods were developed to demonstrate a functional margin, based on comparing energy required to accomplish the function to energy deliverable by the cartridge.

  20. Vitamin D receptor polymorphisms and survival in patients with cutaneous melanoma: a population-based study

    PubMed Central

    Orlow, Irene; Reiner, Anne S.; Thomas, Nancy E.; Roy, Pampa; Kanetsky, Peter A.; Luo, Li; Paine, Susan; Armstrong, Bruce K.; Kricker, Anne; Marrett, Loraine D.; Rosso, Stefano; Zanetti, Roberto; Gruber, Stephen B.; Anton-Culver, Hoda; Gallagher, Richard P.; Dwyer, Terence; Busam, Klaus; Begg, Colin B.; Berwick, Marianne

    2016-01-01

    Factors known to affect melanoma survival include age at presentation, sex and tumor characteristics. Polymorphisms also appear to modulate survival following diagnosis. Result from other studies suggest that vitamin D receptor (VDR) polymorphisms (SNPs) impact survival in patients with glioma, renal cell carcinoma, lung, breast, prostate and other cancers; however, a comprehensive study of VDR polymorphisms and melanoma-specific survival is lacking. We aimed to investigate whether VDR genetic variation influences survival in patients with cutaneous melanoma. The analysis involved 3566 incident single and multiple primary melanoma cases enrolled in the international population-based Genes, Environment, and Melanoma Study. Melanoma-specific survival outcomes were calculated for each of 38 VDR SNPs using a competing risk analysis after adjustment for covariates. There were 254 (7.1%) deaths due to melanoma during the median 7.6 years follow-up period. VDR SNPs rs7299460, rs3782905, rs2239182, rs12370156, rs2238140, rs7305032, rs1544410 (BsmI) and rs731236 (TaqI) each had a statistically significant (trend P values < 0.05) association with melanoma-specific survival in multivariate analysis. One functional SNP (rs2239182) remained significant after adjustment for multiple testing using the Monte Carlo method. None of the SNPs associated with survival were significantly associated with Breslow thickness, ulceration or mitosis. These results suggest that the VDR gene may influence survival from melanoma, although the mechanism by which VDR exerts its effect does not seem driven by tumor aggressiveness. Further investigations are needed to confirm our results and to understand the relationship between VDR and survival in the combined context of tumor and host characteristics. PMID:26521212

  1. Why 159°?: a story about the dropping of the Hiroshima atom bomb

    NASA Astrophysics Data System (ADS)

    Prunty, Sean L.

    2015-04-01

    This paper presents an analysis of the evasive manoeuvre undertaken by the pilot of the Enola Gay aircraft following the dropping of the first uranium bomb. The pilot was instructed to make a 159° turn following the bomb’s release in order to acquire the greatest distance from the point at which the bomb explodes. Accordingly, the objective here is to investigate why the angle should be exactly 159°. The optimum flight-path to maximize the distance from the detonation point is analysed by considering the escape or exit angle taken by the aircraft following a turning-manoeuvre that points it directly away from the detonation site. A range of escape angles are predicted based on the requirement to exit the turning radius prior to detonation. By using information that appeared in a historical account of the event regarding the manoeuvre undertaken by the pilot following the release of the bomb, an estimate is made of the escape angle. Despite the fact that the result shows reasonable agreement with the value of 159°, some uncertainty is expressed as to the close coincidence obtained. In addition, the location of the aircraft and the time of arrival of the shock wave following detonation are also briefly discussed.

  2. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review

    PubMed Central

    2009-01-01

    Background In Europe, extracts from Viscum album (VA-E), the European white-berry mistletoe, are widely used to treat patients with cancer. Methods We searched several databases such as Cochrane, EMBASE, NCCAM, NLM, DIMDI, CAMbase, and Medline. Inclusion criteria were controlled clinical studies on parameters associated with survival in cancer patients treated with Iscador. Outcome data were extracted as they were given in the publication, and expressed as hazard ratios (HR), their logarithm, and the respective standard errors using standard formulas. Results We found 49 publications on the clinical effects of Iscador usage on survival of cancer patients which met our criteria. Among them, 41 studies and strata provided enough data to extract hazard ratios (HR) and their standard errors (Iscador versus no extra treatment). The majority of studies reported positive effects in favour of the Iscador application. Heterogeneity of study results was moderate (I2 = 38.3%, p < 0.0001). The funnel plots were considerably skewed, indicating a publication bias, a notion which is corroborated by statistical means (AC = -1.3, CI: -1.9 to -0.6, p <= 0.0001). A random effect meta-analysis estimated the overall hazard ratio at HR = 0.59 (CI: 0.53 to 0.66, p < 0.0001). Randomized studies showed less effects than non-randomized studies (ratio of HRs: 1.24, CI: 0.79 to 1.92, p = 0.35), and matched-pair studies gave significantly better results than others (ratio of HRs: 0.33; CI: 0.17 to 0.65, p = 0.0012). Conclusions Pooled analysis of clinical studies suggests that adjuvant treatment of cancer patients with the mistletoe extract Iscador is associated with a better survival. Despite obvious limitations, and strong hints for a publication bias which limits the evidence found in this meta-analysis, one can not ignore the fact that studies with positive effects of VA-E on survival of cancer patients are accumulating. Future studies evaluating the effects of Iscador should focus on a

  3. Education, Income and Support for Suicide Bombings: Evidence from Six Muslim Countries

    ERIC Educational Resources Information Center

    Shafiq, M. Najeeb; Sinno, Abdulkader H.

    2009-01-01

    We examine the effect of educational attainment and income on support for suicide bombing among Muslim publics in six predominantly Muslim countries that have experienced suicide bombings: Indonesia, Jordan, Lebanon, Morocco, Pakistan, and Turkey. We make two contributions. First, we present a conceptual model, which has been lacking in the…

  4. Human papilloma virus and survival of oropharyngeal cancer patients treated with surgery and adjuvant radiotherapy.

    PubMed

    Broglie, Martina A; Soltermann, Alex; Haile, Sarah R; Huber, Gerhard F; Stoeckli, Sandro J

    2015-07-01

    Impact of p16 protein, a surrogate marker for human papilloma virus induced cancer, p53 and EGFR as well as clinical factors on survival in a patient cohort with oropharyngeal squamous cell carcinoma (OPSCC) treated by surgical resection and adjuvant radiotherapy (RT) ± concomitant chemotherapy (CT). This is a retrospective analysis of patient's charts and tumor tissue. 57 patients were consecutively included and their tumor tissue assembled on a tissue microarray following immunohistochemical analysis. Survival times were estimated by means of Kaplan-Meier analysis. The importance of clinical and immunohistochemical factors for outcome was estimated by cox proportional hazard models. With 88% 5-year overall survival, 91% 5-year disease-specific survival and 91% 5-year disease-free survival, respectively, we found excellent survival rates in this surgically treated patient cohort of mainly advanced OPSCC (93% AJCC stage III or IV). The only factors positively influencing survival were p16 overexpression as well as p53 negativity and even more pronounced the combination of those biomarkers. Survival analysis of patients classified into three risk categories according to an algorithm based on p16, smoking, T- and N-category revealed a low, intermediate and high-risk group with significant survival differences between the low and the high-risk group. Patients with OPSCC can be successfully treated by surgery and adjuvant RT ± CT with a clear survival benefit of p16 positive, p53 negative patients. We recommend considering a combination of immunohistochemical (p16, p53) and clinical factors (smoking, T- and N-category) for risk stratification.

  5. The Tennis Ball Bomb Incident or the Safety Plan as "Shelf Document"

    ERIC Educational Resources Information Center

    Fast, Jonathan; Fanelli, Rossella

    2003-01-01

    This article presents a case study of a single incident involving a high school student who brought a "tennis ball" bomb to school. Although the district had recently created a safety plan, with a specific protocol for the discovery of a bomb in the building, the principal and the crises team ignored it. The principal did not refer to…

  6. Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna.

    PubMed

    Gaertner, Katharina; Müllner, Michael; Friehs, Helmut; Schuster, Ernst; Marosi, Christine; Muchitsch, Ilse; Frass, Michael; Kaye, Alan David

    2014-04-01

    Current literature suggests a positive influence of additive classical homeopathy on global health and well-being in cancer patients. Besides encouraging case reports, there is little if any research on long-term survival of patients who obtain homeopathic care during cancer treatment. Data from cancer patients who had undergone homeopathic treatment complementary to conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected, described and a retrospective subgroup-analysis with regard to survival time was performed. Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis of disease, quantitative and qualitative description of patient characteristics, and survival time. In four years, a total of 538 patients were recorded to have visited the Outpatient Unit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7% (n=287) who had undergone at least three homeopathic consultations within four years, 18.7% (n=54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblastoma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cell carcinoma. Median overall survival was compared to expert expectations of survival outcomes by specific cancer type and was prolonged across observed cancer entities (p<0.001). Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized

  7. Survival after Radiofrequency Ablation in 122 Patients with Inoperable Colorectal Lung Metastases

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gillams, Alice, E-mail: alliesorting@gmail.com; Khan, Zahid; Osborn, Peter

    2013-06-15

    Purpose. To analyze the factors associated with favorable survival in patients with inoperable colorectal lung metastases treated with percutaneous image-guided radiofrequency ablation. Methods. Between 2002 and 2011, a total of 398 metastases were ablated in 122 patients (87 male, median age 68 years, range 29-90 years) at 256 procedures. Percutaneous CT-guided cool-tip radiofrequency ablation was performed under sedation/general anesthesia. Maximum tumor size, number of tumors ablated, number of procedures, concurrent/prior liver ablation, previous liver or lung resection, systemic chemotherapy, disease-free interval from primary resection to lung metastasis, and survival from first ablation were recorded prospectively. Kaplan-Meier analysis was performed, andmore » factors were compared by log rank test. Results. The initial number of metastases ablated was 2.3 (range 1-8); the total number was 3.3 (range 1-15). The maximum tumor diameter was 1.7 (range 0.5-4) cm, and the number of procedures was 2 (range 1-10). The major complication rate was 3.9 %. Overall median and 3-year survival rate were 41 months and 57 %. Survival was better in patients with smaller tumors-a median of 51 months, with 3-year survival of 64 % for tumors 2 cm or smaller versus 31 months and 44 % for tumors 2.1-4 cm (p = 0.08). The number of metastases ablated and whether the tumors were unilateral or bilateral did not affect survival. The presence of treated liver metastases, systemic chemotherapy, or prior lung resection did not affect survival. Conclusion. Three-year survival of 57 % in patients with inoperable colorectal lung metastases is better than would be expected with chemotherapy alone. Patients with inoperable but small-volume colorectal lung metastases should be referred for ablation.« less

  8. A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival: A retrospective cohort study through data acquired from a prospectively maintained national database.

    PubMed

    Kjaer, D W; Nassar, M; Jensen, L S; Svendsen, L B; Mortensen, F V

    2017-02-01

    This study aimed to assess the impact of esophageal stenting on postoperative complications and survival in patients with obstructing esophageal and gastroesophageal junction (GEJ) cancer. All patients treated without neoadjuvant therapy that had an R0-resection performed for esophageal and GEJ cancer between January 2003 and December 2010 were identified from a prospectively maintained database. Data on stenting, postoperative mortality, morbidity, recurrence-free survival, complications, and length of hospital stay were collected. Kaplan-Meier plots for survival and recurrence-free survival curves were constructed for R0 resected patients. Data were compared between the stent and no-stent group by nonparametric tests. Two hundred seventy three consecutive R0 resected patients with esophageal or GEJ cancer were identified. Of these patients, 63 had a stent as a bridge to surgery. The male/female ratio was 2.64 (198/75) with a median age in the stent group (SG) of 65.1 versus 64.3 in the no stent group (NSG). Patients were comparable with respect to gender, age, smoking, TNM-classification, oncological treatment, hospital stay, tumor location, and histology. The median survival in the SG was 11.6 months compared with 21.3 months for patients treated without a bridging stent (P < 0.001). There were no statistically significant differences in 30-day mortality between the two groups, but NSG patients exhibited a significantly better two-year survival (P = 0.017). The median recurrence-free survival was 9.1 months for the SG compared with 15.2 months for the NSG. The use of a stent as a bridging procedure to surgery in patients treated without neaoadjuvant therapy for an esophageal or GEJ cancer that later underwent R0 resection decreased the two year survival and the recurrence-free survival. © 2016 International Society for Diseases of the Esophagus.

  9. Psychiatric disorders after terrorist bombings among rescue workers and bombing survivors in Nairobi and rescue workers in Oklahoma City.

    PubMed

    Zhang, Gus; Pfefferbaum, Betty; Narayanan, Pushpa; Lee, Sungkyu; Thielman, Samuel; North, Carol S

    2016-02-01

    To examine the prevalence of psychopathology in 52 male rescue workers responding to the 1998 U.S. Embassy bombing in Nairobi, Kenya, comparing them with 176 male rescue workers responding to the 1995 Oklahoma City, Oklahoma, bombing and with 105 directly exposed male civilian survivors of the Nairobi bombing. The Diagnostic Interview Schedule/Disaster Supplement assessed pre-disaster and post-disaster psychiatric disorders and variables related to demographics, exposure, disaster perceptions, and coping in all 3 disaster subgroups. The most prevalent post-disaster disorders were posttraumatic stress disorder (PTSD) (22%) and major depressive disorder (MDD) (27%) among Nairobi rescue workers, which were more than 2 and 4 times higher, respectively, than among Oklahoma City rescue workers. Alcohol use disorder was the most prevalent pre- and post-disaster disorder among Oklahoma City rescue workers. Nairobi rescue workers had a prevalence of PTSD and MDD not significantly different from Nairobi civilian survivors. Nairobi rescue workers were more symptomatic than Oklahoma City rescue workers and were as symptomatic as Nairobi civilian survivors. The vulnerability of Nairobi rescue workers to psychological sequelae may be a reflection of their volunteer, rather than professional, status. These findings contribute to understanding rescue worker mental health, especially among volunteer rescue workers, with potential implications for the importance of professional status of rescue workers in conferring protection from adverse mental health outcomes.

  10. Adjunctive traditional Chinese medicine therapy improves survival of liver cancer patients.

    PubMed

    Liao, Yueh-Hsiang; Lin, Cheng-Chieh; Lai, Hsueh-Chou; Chiang, Jen-Huai; Lin, Jaung-Geng; Li, Tsai-Chung

    2015-12-01

    Traditional Chinese medicine (TCM) is an alternative treatment for cancer with its effect by stimulating host immune response for cytotoxic activity against liver cancer. No studies evaluated TCM treatment on survival of liver cancer patients. This study determined whether the combination of TCM and conventional cancer treatment affects the survival of liver cancer patients. A retrospective cohort study was conducted in 127 237 newly diagnosed liver cancer patients from 2000 to 2009 in the National Health Insurance Program database. Among these patients, 30 992 (24.36%) used TCM for liver cancer care. All patients were followed up until 2011. The mean follow-up was 5.67 years (SD 1.47) for TCM users and 5.49 years (SD 3.64) for non-TCM users. Compared with patients without TCM use, patients with TCM use were significantly associated with a decreased risk of death [hazard ratio (HR) = 0.65, 95% confidence interval (CI) = 0.64-0.66] with multivariate adjustment. A similar significant protective effect of TCM use across various subgroups of chronic liver diseases was also observed. Jia Wei Xiao Yao San (HR = 0.89, 95% CI = 0.81-0.96) and Chai Hu Shu Gan Tang (HR = 0.86, 95% CI = 0.78-0.95) were the most effective TCM agents that improved survival. This cohort study provided information that adjunctive therapy with TCM may improve the survival in liver cancer patients. Further studies are needed to confirm the potential role of TCM in HCC. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. The cetene scale and the induction period preceding the spontaneous ignition of diesel fuels in bombs

    NASA Technical Reports Server (NTRS)

    Michailova, M N; Neumann, M B

    1936-01-01

    In the present report a comparison is made between the scale obtained with mixtures of cetane and l-methyl naphthalene in a bomb, and that obtained with the same fuels in a Waukesha engine. The tests were conducted in a metal bomb heated by a Nichrome spiral. The fuel was injected into the bomb from a Bosch jet by means of a specially constructed plunger pump. The instant injection and the pressure curve in the bomb were registered by a beam of light which was reflected from a mirror connected to the needle of the jet and to a membrane indicator.

  12. Factors affecting survival outcomes of patients with non-metastatic Ewing's sarcoma family tumors in the spine: a retrospective analysis of 63 patients in a single center.

    PubMed

    Wan, Wei; Lou, Yan; Hu, Zhiqi; Wang, Ting; Li, Jinsong; Tang, Yu; Wu, Zhipeng; Xu, Leqin; Yang, Xinghai; Song, Dianwen; Xiao, Jianru

    2017-01-01

    Little information has been published in the literature regarding survival outcomes of patients with Ewing's sarcoma family tumors (ESFTs) of the spine. The purpose of this study is to explore factors that may affect the prognosis of patients with non-metastatic spinal ESFTs. A retrospective analysis of survival outcomes was performed in patients with non-metastatic spinal ESFTs. Univariate and multivariate analyses were employed to identify prognostic factors for recurrence and survival. Recurrence-free survival (RFS) and overall survival (OS) were defined as the date of surgery to the date of local relapse and death. Kaplan-Meier methods were applied to estimate RFS and OS. Log-rank test was used to analyze single factors for RFS and OS. Factors with p values ≤0.1 were subjected to multivariate analysis. A total of 63 patients with non-metastatic spinal ESFTs were included in this study. The mean follow-up period was 35.1 months (range 1-155). Postoperative recurrence was detected in 25 patients, and distant metastasis and death occurred in 22 and 36 patients respectively. The result of multivariate analysis suggested that age older than 25 years and neoadjuvant chemotherapy were favorable independent prognostic factors for RFS and OS. In addition, total en-bloc resection, postoperative chemotherapy, radiotherapy and non-distant metastasis were favorable independent prognostic factors for OS. Age older than 25 years and neoadjuvant chemotherapy are favorable prognostic factors for both RFS and OS. In addition, total en-bloc resection, postoperative chemotherapy, radiotherapy and non-distant metastasis are closely associated with favorable survival.

  13. Predicting survival times for neuroblastoma patients using RNA-seq expression profiles.

    PubMed

    Grimes, Tyler; Walker, Alejandro R; Datta, Susmita; Datta, Somnath

    2018-05-30

    Neuroblastoma is the most common tumor of early childhood and is notorious for its high variability in clinical presentation. Accurate prognosis has remained a challenge for many patients. In this study, expression profiles from RNA-sequencing are used to predict survival times directly. Several models are investigated using various annotation levels of expression profiles (genes, transcripts, and introns), and an ensemble predictor is proposed as a heuristic for combining these different profiles. The use of RNA-seq data is shown to improve accuracy in comparison to using clinical data alone for predicting overall survival times. Furthermore, clinically high-risk patients can be subclassified based on their predicted overall survival times. In this effort, the best performing model was the elastic net using both transcripts and introns together. This model separated patients into two groups with 2-year overall survival rates of 0.40±0.11 (n=22) versus 0.80±0.05 (n=68). The ensemble approach gave similar results, with groups 0.42±0.10 (n=25) versus 0.82±0.05 (n=65). This suggests that the ensemble is able to effectively combine the individual RNA-seq datasets. Using predicted survival times based on RNA-seq data can provide improved prognosis by subclassifying clinically high-risk neuroblastoma patients. This article was reviewed by Subharup Guha and Isabel Nepomuceno.

  14. Radiation exposure and disease questionnaires of early entrants after the Hiroshima bombing.

    PubMed

    Imanaka, Tetsuji; Endo, Satoru; Kawano, Noriyuki; Tanaka, Kenichi

    2012-03-01

    It is popularly known that people who entered into the ground-zero area shortly after the atomic bombings in Hiroshima and Nagasaki suffered from various syndromes similar to acute radiation effects. External exposures from neutron-induced radionuclides in soil have recently been reassessed based on DS02 calculations as functions of both distance from the hypocentres and elapsed time after the explosions. Significant exposure due to induced radiation can be determined for those who entered the area within 1000 m from the hypocentres shortly after the bombing. Although it was impossible to track the action of each of the survivors over the days or weeks following the bombings in order to make reliable dose estimates for their exposures to soil activation or fallout, four individuals among those early entrants were investigated here to describe useful information of what happened shortly after the bombing.

  15. The course of post-traumatic stress disorder after the Oklahoma City bombing.

    PubMed

    North, C S

    2001-12-01

    Oklahoma City bombing survivors (N = 182) were studied 6 months post-bombing and reassessed approximately 1 year later (N = 141) to determine the longitudinal course of post-traumatic stress disorder (PTSD) and other psychiatric disorders. The Diagnostic Interview Schedule assessed lifetime, current, predisaster, and post-bombing psychiatric diagnoses at both assessment points. One-third of the Oklahoma City bombing survivors had PTSD at index, and similar rates were diagnosed at follow-up. More recovery from depression was apparent than from PTSD. No delayed onset PTSD was observed, and all PTSD was chronic. Avoidance and numbing symptoms were dominant in defining the development of PTSD. Early onset and chronicity of PTSD indicate need for prompt and long-term intervention after disasters. Focus on avoidance and numbing symptoms may aid in identification of individuals needing intervention and monitoring the course of PTSD.

  16. The Manhattan Project: Making the Atomic Bomb. 1999 edition.

    DOE R&D Accomplishments Database

    Gosling, F. G.

    1999-01-01

    "The Manhattan Project: Making the Atomic Bomb" is a short history of the origins and development of the American atomic bomb program during World War II. Beginning with the scientific developments of the pre-war years, the monograph details the role of the United States government in conducting a secret, nationwide enterprise that took science from the laboratory and into combat with an entirely new type of weapon. The monograph concludes with a discussion of the immediate postwar period, the debate over the Atomic Energy Act of 1946, and the founding of the Atomic Energy Commission.

  17. Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction.

    PubMed

    Martin, Lisa; Watanabe, Sharon; Fainsinger, Robin; Lau, Francis; Ghosh, Sunita; Quan, Hue; Atkins, Marlis; Fassbender, Konrad; Downing, G Michael; Baracos, Vickie

    2010-10-01

    To determine whether elements of a standard nutritional screening assessment are independently prognostic of survival in patients with advanced cancer. A prospective nested cohort of patients with metastatic cancer were accrued from different units of a Regional Palliative Care Program. Patients completed a nutritional screen on admission. Data included age, sex, cancer site, height, weight history, dietary intake, 13 nutrition impact symptoms, and patient- and physician-reported performance status (PS). Univariate and multivariate survival analyses were conducted. Concordance statistics (c-statistics) were used to test the predictive accuracy of models based on training and validation sets; a c-statistic of 0.5 indicates the model predicts the outcome as well as chance; perfect prediction has a c-statistic of 1.0. A training set of patients in palliative home care (n = 1,164) was used to identify prognostic variables. Primary disease site, PS, short-term weight change (either gain or loss), dietary intake, and dysphagia predicted survival in multivariate analysis (P < .05). A model including only patients separated by disease site and PS with high c-statistics between predicted and observed responses for survival in the training set (0.90) and validation set (0.88; n = 603). The addition of weight change, dietary intake, and dysphagia did not further improve the c-statistic of the model. The c-statistic was also not altered by substituting physician-rated palliative PS for patient-reported PS. We demonstrate a high probability of concordance between predicted and observed survival for patients in distinct palliative care settings (home care, tertiary inpatient, ambulatory outpatient) based on patient-reported information.

  18. Discussion: Reporting and calibration of post-bomb 14C data

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Reimer, P J; Brown, T A; Reimer, R W

    2004-10-11

    The definitive paper by Stuiver and Polach (1977) established the conventions for reporting of {sup 14}C data for chronological and geophysical studies based on the radioactive decay of {sup 14}C in the sample since the year of sample death or formation. Several ways of reporting {sup 14}C activity levels relative to a standard were also established, but no specific instructions were given for reporting nuclear weapons testing (post-bomb) {sup 14}C levels in samples. Because the use of post-bomb {sup 14}C is becoming more prevalent in forensics, biology, and geosciences, a convention needs to be adopted. We advocate the use ofmore » fraction modern with a new symbol F{sup 14}C to prevent confusion with the previously used Fm, which may or may not have been fractionation corrected. We also discuss the calibration of post-bomb {sup 14}C samples and the available datasets and compilations, but do not give a recommendation for a particular dataset.« less

  19. Factors associated with improved survival among older colorectal cancer patients in the US: a population-based analysis

    PubMed Central

    2009-01-01

    Background The purpose of this study was to estimate the relative impact of changes in demographics, stage at detection, treatment mix, and medical technology on 5-year survival among older colorectal cancer (CRC) patients. Methods We selected older patients diagnosed with CRC between 1992 and 2000 from the SEER-Medicare database and followed them through 2005. Trends in demographic characteristics, stage at detection and initial treatment mix were evaluated descriptively. Separate multivariate logistic regression models for colon (CC) and rectal cancer (RC) patients were estimated to isolate the independent effects of these factors along with technological change (proxied by cohort year) on 5-year survival. Results Our sample included 37,808 CC and 13,619 RC patients (combined mean ± SD age: 77.2 ± 7.0 years; 55% female; 87% white). In recent years, more CC patients were diagnosed at Stage I and fewer at Stages II and IV, and more RC patients were diagnosed at Stage I and fewer at Stages II and III. CC and RC patients diagnosed in later years were slightly older with somewhat better Charlson scores and were more likely to be female, from the Northeast, and from areas with higher average education levels. Surgery alone was more common in later years for CC patients while combined surgery, chemotherapy, and radiotherapy was more common for RC patients. Between 1992 and 2000, 5-year observed survival improved from 43.0% to 46.3% for CC patients and from 39.4% to 42.2% for RC patients. Multivariate logistic regressions indicate that patients diagnosed in 2000 had significantly greater odds of 5-year survival than those diagnosed in 1992 (OR: 1.35 for CC, 1.38 for RC). Our decomposition suggests that early detection had little impact on survival; rather, technological improvements (e.g., new medical technologies or more effective use of existing technologies) and changing demographics were responsible for the largest share of the change in 5-year survival in CC and

  20. Prehospital helicopter transport and survival of patients with traumatic brain injury.

    PubMed

    Bekelis, Kimon; Missios, Symeon; Mackenzie, Todd A

    2015-03-01

    To investigate the association of helicopter transport with survival of patients with traumatic brain injury (TBI), in comparison with ground emergency medical services (EMS). Helicopter utilization and its effect on the outcomes of TBI remain controversial. We performed a retrospective cohort study involving patients with TBI who were registered in the National Trauma Data Bank between 2009 and 2011. Regression techniques with propensity score matching were used to investigate the association of helicopter transport with survival of patients with TBI, in comparison with ground EMS. During the study period, there were 209,529 patients with TBI who were registered in the National Trauma Data Bank and met the inclusion criteria. Of these patients, 35,334 were transported via helicopters and 174,195 via ground EMS. For patients transported to level I trauma centers, 2797 deaths (12%) were recorded after helicopter transport and 8161 (7.8%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival [OR (odds ratio), 1.95; 95% confidence interval (CI), 1.81-2.10; absolute risk reduction (ARR), 6.37%]. This persisted after propensity score matching (OR, 1.88; 95% CI, 1.74-2.03; ARR, 5.93%). For patients transported to level II trauma centers, 1282 deaths (10.6%) were recorded after helicopter transport and 5097 (7.3%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival (OR, 1.81; 95% CI, 1.64-2.00; ARR 5.17%). This again persisted after propensity score matching (OR, 1.73; 95% CI, 1.55-1.94; ARR, 4.69). Helicopter transport of patients with TBI to level I and II trauma centers was associated with improved survival, in comparison with ground EMS.

  1. Prehospital Helicopter Transport and Survival of Patients With Traumatic Brain Injury

    PubMed Central

    Mackenzie, Todd A.

    2015-01-01

    Objective To investigate the association of helicopter transport with survival of patients with traumatic brain injury (TBI), in comparison with ground emergency medical services (EMS). Background Helicopter utilization and its effect on the outcomes of TBI remain controversial. Methods We performed a retrospective cohort study involving patients with TBI who were registered in the National Trauma Data Bank between 2009 and 2011. Regression techniques with propensity score matching were used to investigate the association of helicopter transport with survival of patients with TBI, in comparison with ground EMS. Results During the study period, there were 209,529 patients with TBI who were registered in the National Trauma Data Bank and met the inclusion criteria. Of these patients, 35,334 were transported via helicopters and 174,195 via ground EMS. For patients transported to level I trauma centers, 2797 deaths (12%) were recorded after helicopter transport and 8161 (7.8%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival [OR (odds ratio), 1.95; 95% confidence interval (CI), 1.81–2.10; absolute risk reduction (ARR), 6.37%]. This persisted after propensity score matching (OR, 1.88; 95% CI, 1.74–2.03; ARR, 5.93%). For patients transported to level II trauma centers, 1282 deaths (10.6%) were recorded after helicopter transport and 5097 (7.3%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival (OR, 1.81; 95% CI, 1.64–2.00; ARR 5.17%). This again persisted after propensity score matching (OR, 1.73; 95% CI, 1.55–1.94; ARR, 4.69). Conclusions Helicopter transport of patients with TBI to level I and II trauma centers was associated with improved survival, in comparison with ground EMS. PMID:24743624

  2. Significance of perioperative infection in survival of patients with ovarian cancer.

    PubMed

    Matsuo, Koji; Prather, Christina P; Ahn, Edward H; Eno, Michele L; Tierney, Katherine E; Yessaian, Annie A; Im, Dwight D; Rosenshein, Neil B; Roman, Lynda D

    2012-02-01

    Perioperative infectious diseases comprise some of the most common causes of surgical mortality in women with ovarian cancer. This study was aimed to evaluate the significance of perioperative infections in survival of patients with ovarian cancer. Patients who underwent primary cytoreductive surgery were included in the analysis (n = 276). The enumeration and speciation of pathogens, antimicrobial agents used, and sensitivity assay results were culled from medical records and correlated to clinicopathologic demographics and survival outcomes. Perioperative infection was determined as a positive microbiology result obtained within a 6-week postoperative period. The incidence of perioperative infection was 15.9% (common sites: urinary tract, 57.3%, and surgical wound, 21.4%). Commonly isolated pathogens were Enterococcus species (22.4%) and Escherichia coli (19.4%) in urinary tract infection, and Bacteroides fragilis, E. coli, and Klebsiella pneumoniae (all, 16%) in surgical wound infection. Imipenem represents one of the least resistant antimicrobial agents commonly seen in urinary tract and surgical wound infections in our institution. Perioperative infection was associated with diabetes, serous histology, lymph node metastasis, bowel resection, decreased bicarbonate, and elevated serum urea nitrogen in multivariate analysis. Perioperative infections were associated with increased surgical mortality, delay in chemotherapy treatment, decreased chemotherapy response, shorter progression-free survival (median time, 8.4 vs 17.6 months; P < 0.001), and decreased overall survival (29.0 vs 51.8 months; P = 0.011). Multivariate analysis showed that perioperative infections other than urinary tract infection remained a significant risk factor for decreased survival (progression-free survival, P = 0.02; and overall survival, P = 0.019). Perioperative infectious disease comprises an independent risk factor for survival of patients with ovarian cancer.

  3. Delivering More Than Bombs: The Utility of Long-Range Strike Platforms

    DTIC Science & Technology

    2012-06-01

    strategic in the consequences of their actions” in Colin S. Gray, Explorations in Strategy (New York: Praeger, 1998), 61. Strategic bombing does not...LRS-B 3 Air Force Priorities for a New Strategy with Constrained Budgets, Office of the Chief of Staff of the...17 to battle, the defensive nature of US air strategy all but disappeared. The proponents of long-range strategic bombing quickly gained support

  4. Survival prediction of trauma patients: a study on US National Trauma Data Bank.

    PubMed

    Sefrioui, I; Amadini, R; Mauro, J; El Fallahi, A; Gabbrielli, M

    2017-12-01

    Exceptional circumstances like major incidents or natural disasters may cause a huge number of victims that might not be immediately and simultaneously saved. In these cases it is important to define priorities avoiding to waste time and resources for not savable victims. Trauma and Injury Severity Score (TRISS) methodology is the well-known and standard system usually used by practitioners to predict the survival probability of trauma patients. However, practitioners have noted that the accuracy of TRISS predictions is unacceptable especially for severely injured patients. Thus, alternative methods should be proposed. In this work we evaluate different approaches for predicting whether a patient will survive or not according to simple and easily measurable observations. We conducted a rigorous, comparative study based on the most important prediction techniques using real clinical data of the US National Trauma Data Bank. Empirical results show that well-known Machine Learning classifiers can outperform the TRISS methodology. Based on our findings, we can say that the best approach we evaluated is Random Forest: it has the best accuracy, the best area under the curve, and k-statistic, as well as the second-best sensitivity and specificity. It has also a good calibration curve. Furthermore, its performance monotonically increases as the dataset size grows, meaning that it can be very effective to exploit incoming knowledge. Considering the whole dataset, it is always better than TRISS. Finally, we implemented a new tool to compute the survival of victims. This will help medical practitioners to obtain a better accuracy than the TRISS tools. Random Forests may be a good candidate solution for improving the predictions on survival upon the standard TRISS methodology.

  5. Discrete improvement in racial disparity in survival among patients with stage IV colorectal cancer: a 21-year population-based analysis.

    PubMed

    Castleberry, A W; Güller, U; Tarantino, I; Berry, M F; Brügger, L; Warschkow, R; Cerny, T; Mantyh, C R; Candinas, D; Worni, M

    2014-06-01

    Recently, multiple clinical trials have demonstrated improved outcomes in patients with metastatic colorectal cancer. This study investigated if the improved survival is race dependent. Overall and cancer-specific survival of 77,490 White and Black patients with metastatic colorectal cancer from the 1988-2008 Surveillance Epidemiology and End Results registry were compared using unadjusted and multivariable adjusted Cox proportional hazard regression as well as competing risk analyses. Median age was 69 years, 47.4 % were female and 86.0 % White. Median survival was 11 months overall, with an overall increase from 8 to 14 months between 1988 and 2008. Overall survival increased from 8 to 14 months for White, and from 6 to 13 months for Black patients. After multivariable adjustment, the following parameters were associated with better survival: White, female, younger, better educated and married patients, patients with higher income and living in urban areas, patients with rectosigmoid junction and rectal cancer, undergoing cancer-directed surgery, having well/moderately differentiated, and N0 tumors (p < 0.05 for all covariates). Discrepancies in overall survival based on race did not change significantly over time; however, there was a significant decrease of cancer-specific survival discrepancies over time between White and Black patients with a hazard ratio of 0.995 (95 % confidence interval 0.991-1.000) per year (p = 0.03). A clinically relevant overall survival increase was found from 1988 to 2008 in this population-based analysis for both White and Black patients with metastatic colorectal cancer. Although both White and Black patients benefitted from this improvement, a slight discrepancy between the two groups remained.

  6. A survival analysis of GBM patients in the West of Scotland pre- and post-introduction of the Stupp regime.

    PubMed

    Teo, Mario; Martin, Sean; Owusu-Agyemang, Kevin; Nowicki, Stefan; Clark, Brian; Mackinnon, Mairi; Stewart, Willie; Paul, James; St George, Jerome

    2014-06-01

    It is now accepted that the concomitant administration of temozolomide with radiotherapy (Stupp regime), in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM), significantly improves survival and this practice has been adopted locally since 2004. However, survival outcomes in cancer can vary in different population groups, and outcomes can be affected by a number of local factors including socioeconomic status. In the West of Scotland, we have one of the worse socioeconomic status and overall health record for a western European country. With the ongoing reorganisation and rationalisation in the National Health Service, the addition of prolonged courses of chemotherapy to patients' management significantly adds to the financial burden of a cash stripped NHS. A survival analysis in patients with GBM was therefore performed, comparing outcomes of pre- and post-introduction of the Stupp regime, to justify the current practice. Prospectively collected clinical data were analysed in 105 consecutive patients receiving concurrent chemoradiotherapy (Stupp regime) following surgical treatment of GBM between December 2004 and February 2009. This was compared to those of 106 consecutive GBM patients who had radical radiotherapy (pre-Stupp regime) post-surgery between January 2001 and February 2006. The median overall survival for the post-Stupp cohort was 15.3 months (range, 2.83-50.5 months), with 1-year and 2-year overall survival rates of 65.7% and 19%, respectively. This was in comparison with the median overall pre-Stupp survival of 10.7 months, with 1-year and 2-year survival rates of 42.6% and 12%, respectively (log-rank test, p < 0.001). Multivariate Cox regression analysis showed that independent prognostic factors for better survival were younger age, greater extent of surgical resection and a post-operative chemoradiotherapy regime. Significant survival benefit has been achieved, following the introduction of the Stupp regime, in GBM

  7. Survival benefit of pancreaticoduodenectomy in a Japanese fashion for a limited group of patients with pancreatic head cancer.

    PubMed

    Takao, Sonshin; Shinchi, Hiroyuki; Maemura, Kosei; Kurahara, Hiroshi; Natsugoe, Shoji; Aikou, Takashi

    2008-01-01

    To evaluate the clinical benefit of pancreaticoduodenectomy in a Japanese fashion for patients with pancreatic head cancer. One hundred and one patients underwent pancreatectomy for pancreatic head cancer between 1980 and 2001. Of these, 40 patients in the extended resection (ER) group had an extended lymphadenectomy and neural plexus dissection as a Japanese fashion, while 61 patients in the conventional resection (CR) group. Tumor status, morbidity, mortality, survival and pattern of recurrence were retrospectively studied. The incidence of R0 operations in the ER group was higher than that in the CR group (p<0.01). The actuarial 5-year survival rate (30.6%) of patients with pStage IIA or IIB in the ER group was significantly higher than that (8.2%) in the CR group (p=0.04) because local recurrence (47%) in the CR group was higher than that (25%) in the ER group (p=0.02). In an immunohistochemical study of isolated tumor cells (ITCs), 13 patients (57%) with lymph node ITCs were included in the 23 pN0 patients. Pancreaticoduodenectomy in a Japanese fashion with an adequate extended resection might bring a survival benefit for patients with pStage IIA or IIB pancreatic head cancer.

  8. Longitudinal Temporal and Probabilistic Prediction of Survival in a Cohort of Patients With Advanced Cancer

    PubMed Central

    Perez-Cruz, Pedro E.; dos Santos, Renata; Silva, Thiago Buosi; Crovador, Camila Souza; Nascimento, Maria Salete de Angelis; Hall, Stacy; Fajardo, Julieta; Bruera, Eduardo; Hui, David

    2014-01-01

    Context Survival prognostication is important during end-of-life. The accuracy of clinician prediction of survival (CPS) over time has not been well characterized. Objectives To examine changes in prognostication accuracy during the last 14 days of life in a cohort of patients with advanced cancer admitted to two acute palliative care units and to compare the accuracy between the temporal and probabilistic approaches. Methods Physicians and nurses prognosticated survival daily for cancer patients in two hospitals until death/discharge using two prognostic approaches: temporal and probabilistic. We assessed accuracy for each method daily during the last 14 days of life comparing accuracy at day −14 (baseline) with accuracy at each time point using a test of proportions. Results 6718 temporal and 6621 probabilistic estimations were provided by physicians and nurses for 311 patients, respectively. Median (interquartile range) survival was 8 (4, 20) days. Temporal CPS had low accuracy (10–40%) and did not change over time. In contrast, probabilistic CPS was significantly more accurate (p<.05 at each time point) but decreased close to death. Conclusion Probabilistic CPS was consistently more accurate than temporal CPS over the last 14 days of life; however, its accuracy decreased as patients approached death. Our findings suggest that better tools to predict impending death are necessary. PMID:24746583

  9. Overall survival and self-reported fatigue in patients with esophageal cancer.

    PubMed

    Stauder, M C; Romero, Y; Kabat, B; Atherton, P J; Geno, D; Deschamps, C; Jatoi, A; Sloan, J A; Botros, M; Jung, K W; Arora, A S; Miller, R C

    2013-02-01

    A prospective cohort study was conducted to analyze whether self-reported fatigue predicts overall survival in patients with esophageal cancer. Patients enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry between September 2001 and January 2009 who completed a baseline quality of life instrument were eligible for evaluation. The fatigue component was scored on a 0-10 scale, with 0 as extreme fatigue. Patients were categorized as having a decreased energy level if they reported a score of ≤ 5. Fatigue scores ≥ 6 reflect normal levels of energy. Data from a total of 659 enrolled patients were analyzed. A total of 392 (59 %) and 267 (41 %) patients reported decreased and normal energy, respectively. Univariate analysis indicates patients with normal energy had improved 5-year survival compared to patients with decreased energy (37 vs 28 %, hazard ratio (HR) 0.74, p = 0.006). Among the patients with locally advanced disease, the same relationship was seen (28 vs 17 %, HR = 0.67, p = 0.003); this remained significant on multivariate analysis (HR = 0.71, p = 0.015). A decreased energy level is associated with poor survival in patients with esophageal cancer. Thus, patients with high levels of fatigue should be referred for psychological support and be considered for therapy aimed at amelioration of fatigue symptoms.

  10. Association of a Locus in the CAMTA1 Gene With Survival in Patients With Sporadic Amyotrophic Lateral Sclerosis.

    PubMed

    Fogh, Isabella; Lin, Kuang; Tiloca, Cinzia; Rooney, James; Gellera, Cinzia; Diekstra, Frank P; Ratti, Antonia; Shatunov, Aleksey; van Es, Michael A; Proitsi, Petroula; Jones, Ashley; Sproviero, William; Chiò, Adriano; McLaughlin, Russell Lewis; Sorarù, Gianni; Corrado, Lucia; Stahl, Daniel; Del Bo, Roberto; Cereda, Cristina; Castellotti, Barbara; Glass, Jonathan D; Newhouse, Steven; Dobson, Richard; Smith, Bradley N; Topp, Simon; van Rheenen, Wouter; Meininger, Vincent; Melki, Judith; Morrison, Karen E; Shaw, Pamela J; Leigh, P Nigel; Andersen, Peter M; Comi, Giacomo P; Ticozzi, Nicola; Mazzini, Letizia; D'Alfonso, Sandra; Traynor, Bryan J; Van Damme, Philip; Robberecht, Wim; Brown, Robert H; Landers, John E; Hardiman, Orla; Lewis, Cathryn M; van den Berg, Leonard H; Shaw, Christopher E; Veldink, Jan H; Silani, Vincenzo; Al-Chalabi, Ammar; Powell, John

    2016-07-01

    Amyotrophic lateral sclerosis (ALS) is a devastating adult-onset neurodegenerative disorder with a poor prognosis and a median survival of 3 years. However, a significant proportion of patients survive more than 10 years from symptom onset. To identify gene variants influencing survival in ALS. This genome-wide association study (GWAS) analyzed survival in data sets from several European countries and the United States that were collected by the Italian Consortium for the Genetics of ALS and the International Consortium on Amyotrophic Lateral Sclerosis Genetics. The study population included 4256 patients with ALS (3125 [73.4%] deceased) with genotype data extended to 7 174 392 variants by imputation analysis. Samples of DNA were collected from January 1, 1993, to December 31, 2009, and analyzed from March 1, 2014, to February 28, 2015. Cox proportional hazards regression under an additive model with adjustment for age at onset, sex, and the first 4 principal components of ancestry, followed by meta-analysis, were used to analyze data. Survival distributions for the most associated genetic variants were assessed by Kaplan-Meier analysis. Among the 4256 patients included in the analysis (2589 male [60.8%] and 1667 female [39.2%]; mean [SD] age at onset, 59 [12] years), the following 2 novel loci were significantly associated with ALS survival: at 10q23 (rs139550538; P = 1.87 × 10-9) and in the CAMTA1 gene at 1p36 (rs2412208, P = 3.53 × 10-8). At locus 10q23, the adjusted hazard ratio for patients with the rs139550538 AA or AT genotype was 1.61 (95% CI, 1.38-1.89; P = 1.87 × 10-9), corresponding to an 8-month reduction in survival compared with TT carriers. For rs2412208 CAMTA1, the adjusted hazard ratio for patients with the GG or GT genotype was 1.17 (95% CI, 1.11-1.24; P = 3.53 × 10-8), corresponding to a 4-month reduction in survival compared with TT carriers. This GWAS robustly identified 2 loci at genome-wide levels of

  11. Role Playing: The Atomic Bomb and the End of World War II

    ERIC Educational Resources Information Center

    Eggleston, Noel C.

    1978-01-01

    Describes how a role playing exercise can be used to teach students in a college level history course about the use of the atomic bomb in World War II. Information is presented on general use of role playing in history courses, objectives, questions to consider about use of the atomic bomb, and course evaluation. For journal availability, see so…

  12. Mechanism of formation of volcanic bombs: insights from a pilot study of anisotropy of magnetic susceptibility and preliminary assessment of analytical models

    NASA Astrophysics Data System (ADS)

    Cañón-Tapia, Edgardo

    2017-07-01

    Volcanic bombs and achneliths are a special type of pyroclastic fragments formed by mildly explosive volcanic eruptions. Models explaining the general shapes of those particles can be divided in two broad categories. The most popular envisages the acquisition of shapes of volcanic bombs as the result of the rush of air acting on a fluid clot during flight, and it includes many variants. The less commonly quoted model envisages their shapes as the result of forces acting at the moment of ejection of liquid from the magma pool in the conduit, experiencing an almost negligible modification through its travel through air. Quantitative evidence supporting either of those two models is limited. In this work, I explore the extent to which the anisotropy of magnetic susceptibility (AMS) might be useful in the study of mechanisms of formation of volcanic bombs by comparing measurements made on two spindle and two bread-crusted bombs. The results of this pilot study reveal that the degree of anisotropy of spindle bombs is larger, and their principal susceptibility axes are better clustered than on bread-crusted bombs. Also, the orientation of the principal susceptibility axes is consistent with two specific models (one of the in-flight variants and the general ejection model). Consequently, the reported AMS measurements, albeit limited in number, indicate that it is reasonable to focus attention on only two specific models to explain the acquisition of the shapes of volcanic bombs. Based on a parallel theoretical assessment of analytical models, a third alternative is outlined, envisaging volcanic bomb formation as a two-stage process that involves the bursting of large ( m) gas bubbles on the surface of a magma pond. The new model advanced here is also consistent with the reported AMS results, and constitutes a working hypothesis that should be tested by future studies richer in data. Fortunately, since this work also establishes that AMS can be used to determine magnetic

  13. The effects of geography on survival in patients with oral cavity squamous cell carcinoma.

    PubMed

    Zhang, Han; Dziegielewski, Peter T; Jean Nguyen, T T; Jeffery, Caroline C; O'Connell, Daniel A; Harris, Jeffrey R; Seikaly, Hadi

    2015-06-01

    To assess the survival outcomes of oral cavity squamous cell carcinoma (OCSCC) by differing geographical location. Demographic, pathologic, treatment, and survival data was obtained from OCSCC patients from 1998-2010 in Alberta, Canada. 554 patients were included from 660 OCSCC patients. Overall, disease-specific, and disease-free survivals were estimated with Kaplan-Meier and Cox regression analyses. Patients were grouped by geographic locations. Patients from urban locations had improved overall, disease-specific, and disease-free survival compared to rural locations (p<0.05). Two and five year estimates of overall survival were significantly higher in the urban cohort at 84% and 78%, versus rural with 48% and 44%, respectively (p<0.05). Disease-specific and disease-free survival rates were also superior in the urban group (p<0.05). Diagnosis to treatment time for all 3 geographical groups was not found to be statistically significant (p>0.05). This study shows that patients with OCSCC living in urban settings have improved survival compared to rural groups. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Survival in Malnourished Older Patients Receiving Post-Discharge Nutritional Support; Long-Term Results of a Randomized Controlled Trial.

    PubMed

    Neelemaat, F; van Keeken, S; Langius, J A E; de van der Schueren, M A E; Thijs, A; Bosmans, J E

    2017-01-01

    Previous analyses have shown that a post-discharge individualized nutritional intervention had positive effects on body weight, lean body mass, functional limitations and fall incidents in malnourished older patients. However, the impact of this intervention on survival has not yet been studied. The objective of this randomized controlled study was to examine the effect of a post-discharge individualized nutritional intervention on survival in malnourished older patients. Malnourished older patients, aged ≥ 60 years, were randomized during hospitalization to a three-months post-discharge nutritional intervention group (protein and energy enriched diet, oral nutritional supplements, vitamin D3/calcium supplement and telephone counseling by a dietitian) or to a usual care regimen (control group). Survival data were collected 4 years after enrollment. Survival analyses were performed using intention-to-treat analysis by Log-rank tests and Cox regression adjusted for confounders. The study population consisted of 94 men (45%) and 116 women with a mean age of 74.5 (SD 9.5) years. There were no statistically significant differences in baseline characteristics. Survival data was available in 208 out of 210 patients. After 1 and 4 years of follow-up, survival rates were respectively 66% and 29% in the intervention group (n=104) and 73% and 30% in the control group (n=104). There were no statistically significant differences in survival between the two groups 1 year (HR= 0.933, 95% CI=0.675-1.289) and 4 years after enrollment (HR=0.928, 95% CI=0.671-1.283). The current study failed to show an effect of a three-months post-discharge multi-component nutritional intervention in malnourished older patients on long-term survival, despite the positive effects on short-term outcome such as functional limitations and falls.

  15. Vitamin D receptor polymorphisms and survival in patients with cutaneous melanoma: a population-based study.

    PubMed

    Orlow, Irene; Reiner, Anne S; Thomas, Nancy E; Roy, Pampa; Kanetsky, Peter A; Luo, Li; Paine, Susan; Armstrong, Bruce K; Kricker, Anne; Marrett, Loraine D; Rosso, Stefano; Zanetti, Roberto; Gruber, Stephen B; Anton-Culver, Hoda; Gallagher, Richard P; Dwyer, Terence; Busam, Klaus; Begg, Colin B; Berwick, Marianne

    2016-01-01

    Factors known to affect melanoma survival include age at presentation, sex and tumor characteristics. Polymorphisms also appear to modulate survival following diagnosis. Result from other studies suggest that vitamin D receptor (VDR) polymorphisms (SNPs) impact survival in patients with glioma, renal cell carcinoma, lung, breast, prostate and other cancers; however, a comprehensive study of VDR polymorphisms and melanoma-specific survival is lacking. We aimed to investigate whether VDR genetic variation influences survival in patients with cutaneous melanoma. The analysis involved 3566 incident single and multiple primary melanoma cases enrolled in the international population-based Genes, Environment, and Melanoma Study. Melanoma-specific survival outcomes were calculated for each of 38 VDR SNPs using a competing risk analysis after adjustment for covariates. There were 254 (7.1%) deaths due to melanoma during the median 7.6 years follow-up period. VDR SNPs rs7299460, rs3782905, rs2239182, rs12370156, rs2238140, rs7305032, rs1544410 (BsmI) and rs731236 (TaqI) each had a statistically significant (trend P values < 0.05) association with melanoma-specific survival in multivariate analysis. One functional SNP (rs2239182) remained significant after adjustment for multiple testing using the Monte Carlo method. None of the SNPs associated with survival were significantly associated with Breslow thickness, ulceration or mitosis. These results suggest that the VDR gene may influence survival from melanoma, although the mechanism by which VDR exerts its effect does not seem driven by tumor aggressiveness. Further investigations are needed to confirm our results and to understand the relationship between VDR and survival in the combined context of tumor and host characteristics. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Depressive Symptoms and Poor Social Support Have a Synergistic Effect on Event-Free Survival in Patients with Heart Failure

    PubMed Central

    Chung, Misook L.; Lennie, Terry A.; Dekker, Rebecca L; Wu, Jia-Rong; Moser, Debra K.

    2010-01-01

    Background Depressive symptoms and poor social support are predictors of increased morbidity and mortality in patients with heart failure (HF). However, the combined contribution of depressive symptoms and social support event-free survival of patients with HF has not been examined. Objective To compare event-free survival in four groups of patients with HF stratified by depressive symptoms and perceived social support. Method A total of 220 patients completed the Beck Depression Inventory-II and the Multidimensional Perceived Social Support Scale and were followed for up to 4 years to collect data on death and hospitalizations. Results Depressive symptoms (HR=1.73, P=.008) and perceived social support (PSS) (HR=1.51, P=.048) were independent predictors of event-free survival. Depressed patients with low PSS had 2.1 times higher risk of events than non-depressed patients with high PSS (P=.003). Conclusion Depressive symptoms and poor social support had a negative additive effect on event-free survival in patients with HF. PMID:21453972

  17. Depressive symptoms and poor social support have a synergistic effect on event-free survival in patients with heart failure.

    PubMed

    Chung, Misook L; Lennie, Terry A; Dekker, Rebecca L; Wu, Jia-Rong; Moser, Debra K

    2011-01-01

    Depressive symptoms and poor social support are predictors of increased morbidity and mortality in patients with heart failure (HF). However, the combined contribution of depressive symptoms and social support event-free survival of patients with HF has not been examined. To compare event-free survival in 4 groups of patients with HF stratified by depressive symptoms and perceived social support (PSS). A total of 220 patients completed the Beck Depression Inventory-II and the Multidimensional Perceived Social Support Scale and were followed for up to 4 years to collect data on death and hospitalizations. Depressive symptoms (hazard ratio = 1.73, P = .008) and PSS (hazard ratio = 1.51, P = .048) were independent predictors of event-free survival. Depressed patients with low PSS had 2.1 times higher risk of events than non-depressed patients with high PSS (P = .003). Depressive symptoms and poor social support had a negative additive effect on event-free survival in patients with HF. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Survival of ovarian cancer patients in Denmark: excess mortality risk analysis of five-year relative survival in the period 1978-2002.

    PubMed

    Hannibal, Charlotte Gerd; Cortes, Rikke; Engholm, Gerda; Kjaer, Susanne Krüger

    2008-01-01

    To explore the variation in ovarian cancer survival in Denmark in the period 1978-2002 in relation to time since diagnosis, age at diagnosis, period of diagnosis, stage and histology. Register-based cohort study. Denmark in the period 1978-2002. Using the nationwide Danish Cancer Registry, we included a total of 13,035 women diagnosed with invasive ovarian cancer in Denmark in the period 1978-2002. Excess mortality risk analyses of five-year relative survival of ovarian cancer patients diagnosed in the period 1978-2002 with follow-up through 2006 were made based on data from the NORDCAN database. Five-year relative survival, excess mortality rate (ER) and relative excess mortality risk (RER) after an ovarian cancer diagnosis. The relative survival of Danish ovarian cancer patients slightly increased in the period 1978-2002. The ERs were highest in the first year following diagnosis, in particular in the first three months, and among older patients, even for localized and regional tumors. The pattern remained the same when stratified by histological subgroup. Older age at diagnosis, earlier period of diagnosis, more advanced stage at diagnosis and being diagnosed with undifferentiated carcinoma predicted poorer survival among Danish ovarian cancer patients diagnosed in the period 1978-2002. The survival of Danish ovarian cancer patients has slightly increased from 1978 through 2002. Despite this, the mortality rate of ovarian cancer in Denmark is still higher than in the other Nordic countries. Explanations for these differences are still to be identified.

  19. Changes in survival patterns in urban Chinese patients with liver cancer

    PubMed Central

    Hao, Xi-Shan; Chen, Ke-Xin; Wang, Peizhong Peter; Rohan, Tom

    2003-01-01

    AIM: To examine the survival patterns and determinants of primary liver cancer in a geographically defined Chinese population. METHODS: Primary liver cancer cases (n = 13685) diagnosed between 1981 and 2000 were identified by the Tianjin Cancer Registry. Age-adjusted and age-specific incidence rates were examined in both males and females. Proportional hazards (Cox) regression was utilized to explore the effects of time of diagnosis, sex, age, occupation, residence, and hospital of diagnosis on survival. RESULTS: Crude and age-adjusted incidence rates in the study period were: 27.4/100000 and 26.3/100000 in males; and 11.5/100000 and 10.4/100000 in females, respectively. Cox regression analyses indicated that there was a significant improvement in survival rates over time. Industrial workers and older people had relatively poor survival rates. The hospital in which the liver cancer was diagnosed was a statistically significant predictor of survival; patients diagnosed in city hospitals were more likely to have better survival than those diagnosed in community/district hospitals. CONCLUSION: Patients diagnosed in recent years appeared to have a better outcome than those diagnosed in early times. There were also significant survival disparities with respect to occupation and hospital of diagnosis, which suggest that socioeconomic status may play an important role in determining prognosis. PMID:12800226

  20. Improved survival with an innovative approach to the treatment of severely burned patients: development of a burn treatment manual.

    PubMed

    Morisada, S; Nosaka, N; Tsukahara, K; Ugawa, T; Sato, K; Ujike, Y

    2015-09-30

    The management of severely burned patients remains a major issue worldwide as indicated by the high incidence of permanent debilitating complications and poor survival rates. In April 2012, the Advanced Emergency & Critical Care Medical Center of the Okayama University Hospital began implementing guidelines for severely burned patients, distributed as a standard burn treatment manual. The protocol, developed in-house, was validated by comparing the outcomes of patients with severe extensive burns (SEB) treated before and after implementation of these new guidelines at this institution. The patients included in this study had a burn index (BI) ≥30 or a prognostic burn index (PBI = BI + patient's age) ≥100. The survival rate of the patients with BI ≥30 was 65.2% with the traditional treatment and 100% with the new guidelines. Likewise, the survival rate of the patients with PBI ≥100 was 61.1% with the traditional treatment compared to 100% with the new guidelines. Together, these data demonstrate that the new treatment guidelines dramatically improved the treatment outcome and survival of SEB patients.

  1. Patterns of metastasis and survival in breast cancer patients: a preliminary study in an Iranian population.

    PubMed

    Ziaei, Jamal Eivazi; Pourzand, Ali; Bayat, Amrollah; Vaez, Jalil

    2012-01-01

    Due to lack of sufficient data on characteristics of breast cancer patients and risk factors for developing metastasis in Iran this study was designed to understand clinical aspects impacting on survival. A cross-sectional study on breast cancer patients was conducted in an oncology clinic of the university hospital between 1995 and 2010. Data were retrieved from medical records and included age, menopausal status, tumor diameter, number of involved nodes, histopathological type, estrogen and progesterone receptor expression, c-erbB-2, primary and secondary metastasis sites, overall survival, disease free interval and type of chemotherapy protocol. The results were analyzed with SPSS 13 software.The mean age of the patients was 49.2 (27-89) years. The primary tumors were mainly ER positive (48%) and PR negative (49.3%). The status of lymph nodes dissected and examined in these patients was unknown in 19 patients (25.3%) while 18 patients (24%) had positive lymph nodes with no report on the number of involved nodes. All of the patients had received antracyclin based chemotherapy in an adjuvant or metastatic setting. Adjuvant hormonal therapy was administered to receptor positive patients. In average, overall survival after recurrence was 30 months (95%CI 24.605-35.325) for non-skeletal versus 42 months (95%CI 31.211-52.789) for skeletal metastasis (P= 0.002). The median survival was also greater for receptor positive patients; 39 months (95%CI 33.716-44.284) for PR+ versus 26 months (95%CI 19.210-32.790) for PR- (P=0.047) and 38 months (95%CI 32.908-43.092) for ER+ versus 27 months (95%CI 18.780-35.220) for ER- patients (P=0.016). No relation was found between site of first metastasis and hormone receptor, age, tumor diameter, DFI and menopausal status. Sites of metastasis were independent of age, size of the tumor, menopausal and hormone receptor status in this study. Overall survival provided significant relations with respect to receptor status and bone

  2. Pets, depression and long term survival in community living patients following myocardial infarction

    PubMed Central

    Friedmann, Erika; Thomas, Sue A.; Son, Heesook

    2011-01-01

    Evidence supports the contribution of depression, anxiety, and poor social support to mortality of hospitalized myocardial infarction (MI) patients. The contribution of depression to survival is independent of disease severity. Pet ownership, a non-human form of social support, has also been associated with one year survival of post-MI patients. The current study addresses whether pet ownership contributes independently to long term survival beyond the contributions of depression, anxiety, or low social support in post-MI patients who have already survived at least 6 months. Data from patients (N = 460) enrolled in the “Psychosocial Responses in the Home Automated External Defibrillator Trial (PR-HAT)”were used. Seventeen patients died during a median follow-up of 2.8 years. In Cox proportional hazards regression model that included depression, lack of pet ownership, and the interaction between depression and lack of pet ownership, not owning a pet was the only significant independent predictor of mortality (p = 0.036). The interaction between pet ownership and depression tended to be significant indicating that the effect of pet ownership on survival in this group of people who have supportive spouses/companions living with them may relate to depression. PMID:21857770

  3. Modest overall survival improvements from 1998 to 2009 in metastatic gastric cancer patients: a population-based SEER analysis.

    PubMed

    Ebinger, Sabrina M; Warschkow, René; Tarantino, Ignazio; Schmied, Bruno M; Güller, Ulrich; Schiesser, Marc

    2016-07-01

    An increasing fraction of gastric cancer patients present with distant metastases at diagnosis. The objective of the present 11-year population-based trend analysis was to assess the survival rates in patients who underwent and in patients who did not undergo palliative gastrectomy. Patients with metastatic gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2009. Time trend and impact of palliative gastrectomy on survival were assessed by both a multivariate Cox proportional hazards model and propensity score matching. We identified 8249 patients with stage IV gastric cancer. The rate of metastatic disease increased from 31.0 % in 1998 to 37.5 % in 2009 (P < 0.001). The palliative gastrectomy rate dropped from 18.8 to 10.2 % (P = 0.004). The median survival for patients who underwent palliative gastrectomy (N = 1445, 17.4 %) and for patients who did not undergo palliative gastrectomy (N = 6804, 82.4 %) was 7 and 3 months, respectively. There was an increase in median overall survival from 2 months (1998) to 3 months (2009) in the no-gastrectomy group, and from 6.5 to 8 months in the gastrectomy group. The 3-year cancer-specific survival rates were 2.1 % (95 % confidence interval 1.7-2.5 %) for patients who did not undergo palliative gastrectomy and 9.4 % (95 % confidence interval 7.8-11.2 %) for patients who underwent palliative gastrectomy (P < 0.001). Palliative gastrectomy was associated with an increased cancer-specific survival in propensity-score-adjusted Cox regression analyses (hazard ratio 0.50, 95 % confidence interval 0.46-0.55, P < 0.001). On a population-based level, only modest improvements in prognosis for metastatic gastric cancer were observed in patients who underwent and in patients who did not undergo palliative gastrectomy. Considering the low rate of midterm survivors in both groups, only a small subgroup of patients benefits from palliative

  4. Systemic lupus erythematosus. I. Outcome and survival: Dutch experience with 110 patients studied prospectively.

    PubMed Central

    Swaak, A J; Nossent, J C; Bronsveld, W; Van Rooyen, A; Nieuwenhuys, E J; Theuns, L; Smeenk, R J

    1989-01-01

    This report presents an analysis of the cumulative survival in 110 well defined patients with systemic lupus erythematosus (SLE) who were followed up over a prolonged period of time. Special attention was paid to possible differences between patients who died and those who were still alive at the end of the study. Of the 110 patients with SLE, 96 (87%) were still alive after 10 years; the cumulative survival for men was 69% (11/16) and for women 90% (85/94). Patients who never developed a new exacerbation after the diagnosis for SLE had been established had a 10 year survival of 100%; for patients with one, two, or three exacerbations the 10 year survival was 91%, 69%, and 33% respectively. From these prospective studies it was found that the exacerbation frequency is most closely related to survival. Disease symptoms of renal involvement or neurological involvement, or both, present at the onset or at the moment the SLE diagnosis was established, were predominantly seen in patients who died during the follow up. PMID:2742399

  5. Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion.

    PubMed

    Terra, Ricardo Mingarini; Antonangelo, Leila; Mariani, Alessandro Wasum; de Oliveira, Ricardo Lopes Moraes; Teixeira, Lisete Ribeiro; Pego-Fernandes, Paulo Manuel

    2016-08-01

    Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion. Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival. 156 patients (out of 196 potentially eligible) were included in this study. Most were female (72 %) and breast cancer was the most common underlying malignancy (53 %). Pleural fluid ADA level was stratified as low (<15 U/L), normal (15 ≤ ADA < 40), and high (≥40). Low and high ADA levels were associated with worse survival when compared to normal ADA (logrank: 0.0024). In multivariable analysis, abnormal ADA (<15 or ADA ≥ 40) and underlying malignancies different from lymphoma, lung, or breast cancer were associated with worse survival. Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival. Pleural fluid Adenosine Deaminase levels (<15 or ≥40 U/L) and neoplasms other than lung, breast, or lymphoma are independent predictors of worse survival in patients with malignant pleural effusion who undergo pleurodesis.

  6. True survival benefit of lung transplantation for cystic fibrosis patients: the Zurich experience.

    PubMed

    Hofer, Markus; Benden, Christian; Inci, Ilhan; Schmid, Christoph; Irani, Sarosh; Speich, Rudolf; Weder, Walter; Boehler, Annette

    2009-04-01

    Lung transplantation is the ultimate therapy for end-stage cystic fibrosis (CF) lung disease; however, the debate continues as to whether lung transplantation improves survival. We report post-transplant outcome in CF at our institution by comparing 5-year post-transplant survival with a calculated 5-year survival without lung transplantation, using a predictive 5-year survivorship model, and describe pre-transplant parameters influencing transplant outcome. CF patients undergoing lung transplantation at our center were included (1992 to 2007). Survival rates were calculated and compared, and univariate and multivariate Cox regression analyses were used for statistical assessment. Eighty transplants were performed in CF patients, 11 (13.8%) of whom were children. Mean age at transplant was 26.2 years (95% confidence interval: 24.4 to 28.0). The Liou raw score at transplant was -20 (95% confidence interval: -16 to -24), resulting in an estimated 5-year survival without transplantation of 33 +/- 14%, compared with a 5-year post-transplant survival of 68.2 +/- 5.6%. Further improvement was noted in the recent transplant era (since 2000), with a 5-year survival of 72.7 +/- 7.3%. Univariate analysis revealed that later year of transplant and diagnosis of diabetes influenced survival positively. Pediatric age had no negative impact. In the multivariate analysis, only diabetes influenced survival, in a positive manner. Lung transplantation performed at centers having experience with the procedure can offer a true survival benefit to patients with end-stage CF lung disease.

  7. Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest.

    PubMed

    Jung, Julianna

    2016-10-01

    Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed.

  8. Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients.

    PubMed

    Fullerton, Brenna S; Sparks, Eric A; Hall, Amber M; Duggan, Christopher; Jaksic, Tom; Modi, Biren P

    2016-01-01

    Patient selection for transplant evaluation in pediatric intestinal failure is predicated on the ability to assess long-term transplant-free survival. In light of trends toward improved survival of intestinal failure patients in recent decades, we sought to determine if the presence of biopsy-proven hepatic cirrhosis or the eventual achievement of enteral autonomy were associated with transplant-free survival. After IRB approval, records of all pediatric intestinal failure patients (parenteral nutrition (PN) >90 days) treated at a single intestinal failure center from February 2002 to September 2014 were reviewed. Chi-squared, Mann-Whitney, and log-rank testing were performed as appropriate. Of 313 patients, 174 eventually weaned off PN. Liver biopsies were available in 126 patients (most common indication was intestinal failure associated liver disease, IFALD), and 23 met histologic criteria for cirrhosis. Transplant-free survival for the whole cohort of 313 patients was 94.7% at 1 year and 89.2% at 5 years. Among patients with liver biopsies, transplant-free survival in cirrhotics vs. noncirrhotics was 95.5% vs. 94.1% at one year and 95.5% vs. 86.7% at 5 years (P=0.29). Transplant-free survival in patients who achieved enteral autonomy compared with patients who remained PN dependent was 98.2% vs. 90.3% at one year and 98.2% vs. 76.9% at 5 years (P<0.001). There was no association between cirrhosis and eventual enteral autonomy (P=0.88). Achieving enteral autonomy was associated with improved transplant-free survival in pediatric intestinal failure patients. There was no association between histopathological diagnosis of cirrhosis and transplant-free survival in the cohort. These data suggest that automatic transplant referral may not be required for histopathological diagnosis of cirrhosis alone, and that ongoing efforts aimed at achievement of enteral autonomy remain paramount in pediatric intestinal failure. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Impact of educational differences as measure of socioeconomic status on survival for breast cancer patients.

    PubMed

    Nowara, Elżbieta; Suwiński, Rafał

    2012-01-01

    Breast cancer is the most frequent malignancy affecting women. Some reports suggest the influence of socioeconomic status, including education, on survival rates for cancer patients. This report analyzes the effect of patients' education level on their survival. A retrospective analysis of the group of 810 breast cancer patients treated in single center in Poland was performed. The analyzed group included women with elementary education (24%), vocational training (19%), secondary (38%) or higher education (16%). Overall, recurrence-free and metastasis free survival times were analyzed. The actuarial 5-year overall survival was 72% (median 4.7 years), 5-year local recurrence-free survival was 84%, whereas metastasis-free survival 76%. Multivariate Cox model has shown that lower education had independent significantly negative influence on local recurrence-free survival time (p = 0.024). The highest risk of recurrence was found for patients with elementary education (p = 0.009). The same was confirmed for distant metastasis-free survival (p = 0.001), with the highest risk of metastases in patients with vocational education and stage IIIB breast cancer (p < 0.001). Education level had significant impact on overall survival. The patients with higher-level education lived longer (p = 0.042). Shorter recurrence-free survival time among women attaining lowest education level and longer overall survival time for women with higher education level suggest the necessity for intensified cancer awareness educational effort and screening among less-educated healthy Polish women.

  10. Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus–Infected Patients

    PubMed Central

    Rosenke, Kyle; Adjemian, Jennifer; Munster, Vincent J.; Marzi, Andrea; Falzarano, Darryl; Onyango, Clayton O.; Ochieng, Melvin; Juma, Bonventure; Fischer, Robert J.; Prescott, Joseph B.; Safronetz, David; Omballa, Victor; Owuor, Collins; Hoenen, Thomas; Groseth, Allison; Martellaro, Cynthia; van Doremalen, Neeltje; Zemtsova, Galina; Self, Joshua; Bushmaker, Trenton; McNally, Kristin; Rowe, Thomas; Emery, Shannon L.; Feldmann, Friederike; Williamson, Brandi N.; Best, Sonja M.; Nyenswah, Tolbert G.; Grolla, Allen; Strong, James E.; Kobinger, Gary; Bolay, Fatorma K.; Zoon, Kathryn C.; Stassijns, Jorgen; Giuliani, Ruggero; de Smet, Martin; Nichol, Stuart T.; Fields, Barry; Sprecher, Armand; Massaquoi, Moses; Feldmann, Heinz; de Wit, Emmie

    2016-01-01

    Background. The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus. Methods. All blood samples from suspected Ebola virus–infected patients admitted to the Médecins Sans Frontières ELWA3 Ebola treatment unit in Monrovia were tested by quantitative real-time polymerase chain reaction for the presence of Ebola virus and Plasmodium species RNA. Clinical outcome in laboratory-confirmed Ebola virus–infected patients was analyzed as a function of age, sex, Ebola viremia, and Plasmodium species parasitemia. Results. The case fatality rate of 1182 patients with laboratory-confirmed Ebola virus infections was 52%. The probability of surviving decreased with increasing age and decreased with increasing Ebola viral load. Ebola virus–infected patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age; those with the highest levels of parasitemia had a survival rate of 83%. This effect was independent of treatment with antimalarials, as this was provided to all patients. Moreover, treatment with antimalarials did not affect survival in the Ebola virus mouse model. Conclusions. Plasmodium species parasitemia is associated with an increase in the probability of surviving Ebola virus infection. More research is needed to understand the molecular mechanism underlying this remarkable phenomenon and translate it into treatment options for Ebola virus infection. PMID:27531847

  11. Cancer mortality among atomic bomb survivors exposed as children.

    PubMed

    Goto, Hitomi; Watanabe, Tomoyuki; Miyao, Masaru; Fukuda, Hiromi; Sato, Yuzo; Oshida, Yoshiharu

    2012-05-01

    To compare cancer mortality among A-bomb survivors exposed as children with cancer mortality among an unexposed control group (the entire population of Japan, JPCG). The subjects were the Hiroshima and Nagasaki A-bomb survivor groups (0-14 years of age in 1945) reported in life span study report 12 (follow-up years were from 1950 to 1990), and a control group consisting of the JPCG. We estimated the expected number of deaths due to all causes and cancers of various causes among the exposed survivors who died in the follow-up interval, if they had died with the same mortality as the JPCG (0-14 years of age in 1945). We calculated the standardized mortality ratio (SMR) of A-bomb survivors in comparison with the JPCG. SMRs were significantly higher in exposed boys overall for all deaths, all cancers, leukemia, and liver cancer, and for exposed girls overall for all cancers, solid cancers, liver cancer, and breast cancer. In boys, SMRs were significantly higher for all deaths and liver cancer even in those exposed to very low doses, and for all cancers, solid cancers, and liver cancer in those exposed to low doses. In girls, SMRs were significantly higher for liver cancer and uterine cancer in those exposed to low doses, and for leukemia, solid cancers, stomach cancer, and breast cancer in those exposed to high doses. We calculated the SMRs for the A-bomb survivors versus JPCG in childhood and compared them with a true non-exposed group. A notable result was that SMRs in boys exposed to low doses were significantly higher for solid cancer.

  12. Survival benefit of zoledronic Acid in postmenopausal breast cancer patients receiving aromatase inhibitors.

    PubMed

    Ahn, Sung Gwe; Kim, Sung Hyun; Lee, Hak Min; Lee, Seung Ah; Jeong, Joon

    2014-12-01

    A growing body of evidence indicates that zoledronic acid (ZA) can improve the clinical outcome in patients with breast cancer and low estrogen levels. In the present study, we aimed to investigate the survival benefit of ZA administration in postmenopausal Korean women with breast cancer who were also receiving aromatase inhibitors. Between January 2004 and December 2010, 235 postmenopausal breast cancer patients undergoing aromatase inhibitor therapy were investigated. All patients were postmenopausal, as confirmed by laboratory tests. Of these patients, 77 received adjuvant upfront ZA for at least 1 year in addition to conventional adjuvant treatment. The remaining 158 patients never received ZA and were treated according to the St. Gallen guidelines. The baseline characteristics for ZA treatment were not different between the two groups. The median follow-up time was 62 months, and the patients who received ZA in addition to aromatase inhibitors showed a better recurrence-free survival compared to those who received aromatase inhibitors alone (p=0.035). On multivariate analysis, the patients who received ZA showed a better recurrence-free survival independent of the tumor size, nodal status, progesterone receptor, and histological grade. For this model, Harrell c index was 0.743. The hazard ratio of ZA use for recurrence-free survival was 0.12 (95% confidence interval, 0.01-0.99). Our findings suggest that upfront use of ZA as part of adjuvant treatment can offer a survival benefit to postmenopausal breast cancer patients receiving aromatase inhibitor treatment.

  13. Medical Effects of a Transuranic "Dirty Bomb".

    PubMed

    Durakovic, Asaf

    2017-03-01

    The modern military battlefields are characterized by the use of nonconventional weapons such as encountered in the conflicts of the Gulf War I and Gulf War II. Recent warfare in Iraq, Afghanistan, and the Balkans has introduced radioactive weapons to the modern war zone scenarios. This presents the military medicine with a new area of radioactive warfare with the potential large scale contamination of military and civilian targets with the variety of radioactive isotopes further enhanced by the clandestine use of radioactive materials in the terrorist radioactive warfare. Radioactive dispersal devices (RDDs), including the "dirty bomb," involve the use of organotropic radioisotopes such as iodine 131, cesium 137, strontium 90, and transuranic elements. Some of the current studies of RDDs involve large-scale medical effects, social and economic disruption of the society, logistics of casualty management, cleanup, and transportation preparedness, still insufficiently addressed by the environmental and mass casualty medicine. The consequences of a dirty bomb, particularly in the terrorist use in urban areas, are a subject of international studies of multiple agencies involved in the management of disaster medicine. The long-term somatic and genetic impact of some from among over 400 radioisotopes released in the nuclear fission include somatic and transgenerational genetic effects with the potential challenges of the genomic stability of the biosphere. The global contamination is additionally heightened by the presence of transuranic elements in the modern warzone, including depleted uranium recently found to contain plutonium 239, possibly the most dangerous substance known to man with one pound of plutonium capable of causing 8 billion cancers. The planning for the consequences of radioactive dirty bomb are being currently studied in reference to the alkaline earths, osteotropic, and stem cell hazards of internally deposited radioactive isotopes, in particular

  14. Survival of elderly patients with multiple myeloma-Effect of upfront autologous stem cell transplantation.

    PubMed

    Merz, Maximilian; Jansen, Lina; Castro, Felipe A; Hillengass, Jens; Salwender, Hans; Weisel, Katja; Scheid, Christof; Luttmann, Sabine; Emrich, Katharina; Holleczek, Bernd; Katalinic, Alexander; Nennecke, Alice; Straka, Christian; Langer, Christian; Engelhardt, Monika; Einsele, Hermann; Kröger, Nicolaus; Beelen, Dietrich; Dreger, Peter; Brenner, Hermann; Goldschmidt, Hartmut

    2016-07-01

    The aim of this study was to determine the value of upfront autologous transplantation (ASCT) in elderly patients (60-79 years) with myeloma. We analysed relative survival (RS) of patients diagnosed in 1998-2011 and treated with ASCT within 12 months after diagnosis in Germany (n = 3591; German Registry of Stem Cell Transplantation) and compare RS with survival of myeloma patients diagnosed in the same years in Germany (n = 13,903; population-based German Cancer Registries). Utilisation of ASCT has increased rapidly between 2000-2002 and 2009-2011 (60-64years: 7.0-43.0%; 65-69 years: 6.6-23.7%; 70-79 years: 0.4-4.0%). Comparison of 5-year RS of patients from the general German myeloma population who have survived the first year after diagnosis with 5-year RS of patients treated with ASCT revealed higher survival for transplanted patients among all age groups (60-64: 59.2% versus 66.1%; 65-69: 57.4% versus 61.7%; 70-79: 51.0% versus 56.6%). RS increased strongly between 2003-2005 and 2009-2011 for the general German myeloma population (+8.5%) and for patients treated with ASCT (+11.8%). Differences in RS between these groups increased over time from +1.9% higher age-standardised survival in transplanted patients in 2003-2005 to 5.2% higher survival in 2009-2011. We conclude that upfront ASCT might be a major contributor to improved survival for elderly myeloma patients in Germany. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression.

    PubMed

    Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E

    2018-07-01

    Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore or preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under institutional review board (IRB) waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from August 2008 to March 2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression because of metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre-, and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS]), and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed rank tests, Pearson correlation coefficient, Cox regression model, log-rank analysis, and Kaplan-Meier analysis. Forty patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21 of 40) survived and 43% (17 of 40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89 years, although Kaplan-Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=.0342, p=.0358, respectively) and postoperative KPS (p=.0221

  16. From classified to commonplace: the trajectory of the hydrogen bomb 'secret'.

    PubMed

    Wellerstein, Alex

    2008-06-01

    The secret of the hydrogen bomb went from being an icon of nuclear secrecy to something that could be widely reproduced on the Internet and in children's textbooks. The rise and fall of the H-bomb secret reveals both changing attitudes towards state secrecy in general and the contingent nature of secrecy, depending on an imagined threat as guidance.

  17. Longitudinal temporal and probabilistic prediction of survival in a cohort of patients with advanced cancer.

    PubMed

    Perez-Cruz, Pedro E; Dos Santos, Renata; Silva, Thiago Buosi; Crovador, Camila Souza; Nascimento, Maria Salete de Angelis; Hall, Stacy; Fajardo, Julieta; Bruera, Eduardo; Hui, David

    2014-11-01

    Survival prognostication is important during the end of life. The accuracy of clinician prediction of survival (CPS) over time has not been well characterized. The aims of the study were to examine changes in prognostication accuracy during the last 14 days of life in a cohort of patients with advanced cancer admitted to two acute palliative care units and to compare the accuracy between the temporal and probabilistic approaches. Physicians and nurses prognosticated survival daily for cancer patients in two hospitals until death/discharge using two prognostic approaches: temporal and probabilistic. We assessed accuracy for each method daily during the last 14 days of life comparing accuracy at Day -14 (baseline) with accuracy at each time point using a test of proportions. A total of 6718 temporal and 6621 probabilistic estimations were provided by physicians and nurses for 311 patients, respectively. Median (interquartile range) survival was 8 days (4-20 days). Temporal CPS had low accuracy (10%-40%) and did not change over time. In contrast, probabilistic CPS was significantly more accurate (P < .05 at each time point) but decreased close to death. Probabilistic CPS was consistently more accurate than temporal CPS over the last 14 days of life; however, its accuracy decreased as patients approached death. Our findings suggest that better tools to predict impending death are necessary. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. ATM and p53 combined analysis predicts survival in glioblastoma multiforme patients: A clinicopathologic study.

    PubMed

    Romano, Francesco Jacopo; Guadagno, Elia; Solari, Domenico; Borrelli, Giorgio; Pignatiello, Sara; Cappabianca, Paolo; Del Basso De Caro, Marialaura

    2018-06-01

    Glioblastoma is one of the most malignant cancers, with a distinguishing dismal prognosis: surgery followed by chemo- and radiotherapy represents the current standard of care, and chemo- and radioresistance underlie disease recurrence and short overall survival of patients suffering from this malignancy. ATM is a kinase activated by autophosphorylation upon DNA doublestrand breaks arising from errors during replication, byproducts of metabolism, chemotherapy or ionizing radiations; TP53 is one of the most popular tumor suppressor, with a preeminent role in DNA damage response and repair. To study the effects of the immunohistochemical expression of p-ATM and p53 in glioblastoma patients, 21 cases were retrospectively examined. In normal brain tissue, p-ATM was expressed only in neurons; conversely, in tumors cells, the protein showed a variable cytoplasmic expression (score: +,++,+++), with being completely undetectable in three cases. Statistical analysis revealed that high p-ATM score (++/+++) strongly correlated to shorter survival (P = 0.022). No difference in overall survival was registered between p53 normally expressed (NE) and overexpressed (OE) glioblastoma patients (P = 0.669). Survival analysis performed on the results from combined assessment of the two proteins showed that patients with NE p53 /low pATM score had longer overall survival than the NE p53/ high pATM score counterpart. Cox-regression analysis confirmed this finding (HR = 0.025; CI 95% = 0.002-0.284; P = 0.003). Our study outlined the immunohistochemical expression of p-ATM/p53 in glioblastomas and provided data on their possible prognostic/predictive of response role. A "non-oncogene addiction" to ATM for NEp53 glioblastoma could be postulated, strengthening the rationale for development of ATM inhibiting drugs. © 2018 Wiley Periodicals, Inc.

  19. Trauma, grief and depression in Nairobi children after the 1998 bombing of the American Embassy.

    PubMed

    Pfefferbaum, Betty; North, Carol S; Doughty, Debby E; Pfefferbaum, Rose L; Dumont, Cedric E; Pynoos, Robert S; Gurwitch, Robin H; Ndetei, David

    2006-01-01

    Despite the increasingly dangerous world where trauma and loss are common, relatively few studies have explored traumatic grief in children. The 1998 American Embassy bombing in Nairobi, Kenya, provided an unfortunate opportunity to examine this topic. This report describes findings in 156 children who knew someone killed in the incident, assessed 8 to 14 months after the explosion. Bomb-related posttraumatic stress was associated with physical exposure, acute response, posttraumatic stress related to other negative life events, type of bomb-related loss, and subsequent loss. Grief was associated with bomb-related posttraumatic stress, posttraumatic stress related to other negative life events, and type of bomb-related loss. The study supports the developing literature on traumatic grief and the need for studies exploring the potentially unique aspects of this construct.

  20. Monitoring exposure to atomic bomb radiation by somatic mutation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Akiyama, Mitoshi; Kyoizumi, Seishi; Kusunoki, Yoichiro

    Atomic bomb survivors are a population suitable for studying the relationship between somatic mutation and cancer risk because their exposure doses are relatively well known and their dose responses in terms of cancer risk have also been thoroughly studied. An analysis has been made of erythrocyte glycophorin A (GPA) gene mutations in 1,226 atomic bomb survivors in Hiroshima and Nagasaki. The GPA mutation frequency (Mf) increased slightly but significantly with age at the time of measurement and with the number of cigarettes smoked. After adjustment for the effect of smoking, the Mf was significantly higher in males than in femalesmore » and higher in Hiroshima than in Nagasaki. All of these characteristics of the background GPA Mf were in accord with those of solid tumor incidence obtained from an earlier epidemiological study of A-bomb survivors. Analysis of the dose effect on Mf revealed the doubling dose to be about 1.20 Sv and the minimum dose for detection of a significant increase to be about 0.24 Sv. No significant dose effect for difference in sex, city, or age at the time of bombing was observed. Interestingly, the doubling dose for the GPA Mf approximated that for solid cancer incidence (1.59 Sv). And the minimum dose for detection was not inconsistent with the data for solid cancer incidence. The dose effect was significantly higher in those diagnosed with cancer before or after measurement than in those without a history of cancer. These findings are consistent with the hypothesis that somatic mutations are the main cause of excess cancer risk from radiation exposure. 27 refs., 2 figs.« less

  1. SurvNet: a web server for identifying network-based biomarkers that most correlate with patient survival data.

    PubMed

    Li, Jun; Roebuck, Paul; Grünewald, Stefan; Liang, Han

    2012-07-01

    An important task in biomedical research is identifying biomarkers that correlate with patient clinical data, and these biomarkers then provide a critical foundation for the diagnosis and treatment of disease. Conventionally, such an analysis is based on individual genes, but the results are often noisy and difficult to interpret. Using a biological network as the searching platform, network-based biomarkers are expected to be more robust and provide deep insights into the molecular mechanisms of disease. We have developed a novel bioinformatics web server for identifying network-based biomarkers that most correlate with patient survival data, SurvNet. The web server takes three input files: one biological network file, representing a gene regulatory or protein interaction network; one molecular profiling file, containing any type of gene- or protein-centred high-throughput biological data (e.g. microarray expression data or DNA methylation data); and one patient survival data file (e.g. patients' progression-free survival data). Given user-defined parameters, SurvNet will automatically search for subnetworks that most correlate with the observed patient survival data. As the output, SurvNet will generate a list of network biomarkers and display them through a user-friendly interface. SurvNet can be accessed at http://bioinformatics.mdanderson.org/main/SurvNet.

  2. Is there any survival advantage of obesity in Southern European haemodialysis patients?

    PubMed

    Chazot, Charles; Gassia, Jean-Paul; Di Benedetto, Attilio; Cesare, Salvatore; Ponce, Pedro; Marcelli, Daniele

    2009-09-01

    In the general population, a high body mass index (BMI) is associated with increased cardiovascular disease and all-cause mortality. However, according to US epidemiological evaluation in maintenance haemodialysis (HD) patients, a reverse epidemiology is described and baseline obesity appears paradoxically associated with better survival. The aim of this study is to examine in a Southern European HD population the relationship between survival and BMI at the start of HD treatment, and how survival is influenced by the body weight (BW) variations during the first year of treatment. A total of 85 dialysis centres located in Portugal, France and Italy and belonging to the FME European dialysis chain were included. The current prospective analysis focuses on incident patients admitted to these centres between 1 January 2000 and 30 September 2005 with <1 month of previous follow-up on RRT. Data were gained from the FME EuCliD database. Patients were classified at baseline in four categories according to the BMI: underweight, normal range, overweight and obese. Also, the patient survival was analysed according to five quintiles of BW changes during the first year of HD treatment <-5.8%, -5.8 to -1.1%, -1.1 to 1.7% (reference category), +1.7 to +5.5% and >+5.5%. Survival analysis was adjusted for a set of demographic and comorbids using Kaplan-Meier curves and Cox model. Hazard ratios and their 95% confidence intervals were calculated with the use of the estimated regression coefficients and their standard errors. A total of 5592 patients were analysed (40.9% females), and the mean age at admission was 64.4 + 16.5 years. Of them, 27.7% were diabetic. The mean follow-up was 2.0 +/- 1.6 years. Almost half of the patients (46.4%) were in the normal range of BMI (20-24.9 kg/m(2)). When analysed with the Cox model, the categories of baseline BMI (underweight, normal range, overweight and obese) significantly influenced the survival with the respective hazard ratio (HR) and

  3. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

    PubMed Central

    Borghgraef, Cindy; Etienne, Anne-Marie; Merckaert, Isabelle; Paesmans, Marianne; Reynaert, Christine; Roos, Myriam; Slachmuylder, Jean-Louis; Vandenbossche, Sandrine; Bron, Dominique; Razavi, Darius

    2016-01-01

    Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying

  4. Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?

    PubMed

    Hamano, Jun; Yamaguchi, Takashi; Maeda, Isseki; Suga, Akihiko; Hisanaga, Takayuki; Ishihara, Tatsuhiko; Iwashita, Tomoyuki; Kaneishi, Keisuke; Kawagoe, Shohei; Kuriyama, Toshiyuki; Maeda, Takashi; Mori, Ichiro; Nakajima, Nobuhisa; Nishi, Tomohiro; Sakurai, Hiroki; Shimoyama, Satofumi; Shinjo, Takuya; Shirayama, Hiroto; Yamada, Takeshi; Morita, Tatsuya

    2016-05-01

    Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital. This multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services. Among the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days' prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P = .006) and in the weeks' prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P = .007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months' prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P < .01) and adjusted models (HR, 0.87; 95% CI, 0.77-0.97; P = .01). In comparison with cancer patients who died in a hospital, cancer patients who died at home had similar or longer survival. Cancer 2016;122:1453-1460. © 2016 American Cancer Society. © 2015 American Cancer Society.

  5. Bonebrake Theological Seminary - Most Secret A-Bomb Project Site

    NASA Astrophysics Data System (ADS)

    Sopka, Katherine R.; Sopka, Elisabeth M.

    2004-05-01

    In late 1943, a small number of nuclear scientists was urgently assembled in Dayton, Ohio by the U.S. Army Manhattan District Engineers and Monsanto Chemical Company Research Division to set up a top secret research project essential to counteract the German atomic bomb threat. The site chosen was an old stone building built in 1879 by the United Brethren Church in a residential area known locally as the Bonebrake Seminary. Centered on a sizeable open plot, the austere three story building was surrounded by a tall cyclone fence with a narrow gate and a minimal guard post - nothing revealed the site's intense research activity then or even in the post-WWII Cold War period. Bonebrake scientists would produce the highly radioactive polonium sources for the plutonium (Pu-239) bomb igniter used in August over Nagasaki just before the end of WWII against Japan. The existence of Bonebrake and its research/production work remained classified top secret throughout the Cold War. Only in recent times can any reference be found even to the existence of this project (unlike , for example, Los Alamos or Oak Ridge) and few, if any details, have ever been published. The primary source of information for this paper is Dr. John J. Sopka who was recruited from Princeton University by the Manhattan District in 1943 as physicist for this project.

  6. Palliative Sedation in Advanced Cancer Patients: Does it Shorten Survival Time? - A Systematic Review

    PubMed Central

    Barathi, B; Chandra, Prabha S

    2013-01-01

    Background: Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. Objectives: This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Materials and Methods: Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Results: Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST) was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. Conclusion: This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review. PMID:23766594

  7. Palliative Sedation in Advanced Cancer Patients: Does it Shorten Survival Time? - A Systematic Review.

    PubMed

    Barathi, B; Chandra, Prabha S

    2013-01-01

    Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST) was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review.

  8. Improved method for analysis of RNA present in long-term preserved thyroid cancer tissue of atomic bomb survivors.

    PubMed

    Hamatani, Kiyohiro; Eguchi, Hidetaka; Mukai, Mayumi; Koyama, Kazuaki; Taga, Masataka; Ito, Reiko; Hayashi, Yuzo; Nakachi, Kei

    2010-01-01

    Since many thyroid cancer tissue samples from atomic bomb (A-bomb) survivors have been preserved for several decades as unbuffered formalin-fixed, paraffin-embedded specimens, molecular oncological analysis of such archival specimens is indispensable for clarifying the mechanisms of thyroid carcinogenesis in A-bomb survivors. Although RET gene rearrangements are the most important targets, it is a difficult task to examine all of the 13 known types of RET gene rearrangements with the use of the limited quantity of RNA that has been extracted from invaluable paraffin-embedded tissue specimens of A-bomb survivors. In this study, we established an improved 5' rapid amplification of cDNA ends (RACE) method using a small amount of RNA extracted from archival thyroid cancer tissue specimens. Three archival thyroid cancer tissue specimens from three different patients were used as in-house controls to determine the conditions for an improved switching mechanism at 5' end of RNA transcript (SMART) RACE method; one tissue specimen with RET/PTC1 rearrangement and one with RET/PTC3 rearrangement were used as positive samples. One other specimen, used as a negative sample, revealed no detectable expression of the RET gene tyrosine kinase domain. We established a 5' RACE method using an amount of RNA as small as 10 ng extracted from long-term preserved, unbuffered formalin-fixed, paraffin-embedded thyroid cancer tissue by application of SMART technology. This improved SMART RACE method not only identified common RET gene rearrangements, but also isolated a clone containing a 93-bp insert of rare RTE/PTC8 in RNA extracted from formalin-fixed, paraffin-embedded thyroid cancer specimens from one A-bomb survivor who had been exposed to a high radiation dose. In addition, in the papillary thyroid cancer of another high-dose A-bomb survivor, this method detected one novel type of RET gene rearrangement whose partner gene is acyl coenzyme A binding domain 5, located on chromosome 10p

  9. Can patient experience with service quality predict survival in colorectal cancer?

    PubMed

    Gupta, Digant; Lis, Christopher G; Rodeghier, Mark

    2013-01-01

    Despite the recognized relevance of symptom burden in colorectal cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality-of-care received might influence outcome. We evaluated the relationship between patient-reported experience with service quality and survival in 702 returning colorectal cancer patients treated at our institution between July 2007 and December 2010. Overall patient experience "considering everything, how satisfied are you with your overall experience?" was measured on a 7-point Likert scale ranging from completely dissatisfied to completely satisfied. It was dichotomized into two categories: top box response (7) versus all others (1-6). Cox regression was used to evaluate the association between patient experience and survival. Of 702 patients, 506 were "completely satisfied" while 196 were not. On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality compared to those "not completely satisfied" (hazard ratio [HR] = 0.78; 95% confidence interval [CI]: 0.61-0.98; p = .04). Similarly, on multivariate analysis controlling for stage at diagnosis, treatment history, age, and gender, "completely satisfied" patients demonstrated significantly lower mortality (HR = 0.74; 95% CI: 0.58-0.95; p = .02). Patient experience with service quality was an independent predictor of survival in colorectal cancer, a novel finding in the literature. © 2012 National Association for Healthcare Quality.

  10. Impact of socioeconomic status on survival for patients with anal cancer.

    PubMed

    Lin, Daniel; Gold, Heather T; Schreiber, David; Leichman, Lawrence P; Sherman, Scott E; Becker, Daniel J

    2018-04-15

    Although outcomes for patients with squamous cell carcinoma of the anus (SCCA) have improved, the gains in benefit may not be shared uniformly among patients of disparate socioeconomic status. In the current study, the authors investigated whether area-based median household income (MHI) is predictive of survival among patients with SCCA. Patients diagnosed with SCCA from 2004 through 2013 in the Surveillance, Epidemiology, and End Results registry were included. Socioeconomic status was defined by census-tract MHI level and divided into quintiles. Multivariable Cox proportional hazards models and logistic regression were used to study predictors of survival and radiotherapy receipt. A total of 9550 cases of SCCA were included. The median age of the patients was 58 years, 63% were female, 85% were white, and 38% were married. In multivariable analyses, patients living in areas with lower MHI were found to have worse overall survival and cancer-specific survival (CSS) compared with those in the highest income areas. Mortality hazard ratios for lowest to highest income were 1.32 (95% confidence interval [95% CI], 1.18-1.49), 1.31 (95% CI, 1.16-1.48), 1.19 (95% CI, 1.06-1.34), and 1.16 (95% CI, 1.03-1.30). The hazard ratios for CSS similarly ranged from 1.34 to 1.22 for lowest to highest income. Older age, black race, male sex, unmarried marital status, an earlier year of diagnosis, higher tumor grade, and later American Joint Committee on Cancer stage of disease also were associated with worse CSS. Income was not found to be associated with the odds of initiating radiotherapy in multivariable analysis (odds ratio of 0.87 for lowest to highest income level; 95% CI, 0.63-1.20). MHI appears to independently predict CSS and overall survival in patients with SCCA. Black race was found to remain a predictor of SCCA survival despite controlling for income. Further study is needed to understand the mechanisms by which socioeconomic inequalities affect cancer care and

  11. Association of a Locus in the CAMTA1 Gene With Survival in Patients With Sporadic Amyotrophic Lateral Sclerosis

    PubMed Central

    Fogh, Isabella; Lin, Kuang; Tiloca, Cinzia; Rooney, James; Gellera, Cinzia; Diekstra, Frank P.; Ratti, Antonia; Shatunov, Aleksey; van Es, Michael A.; Proitsi, Petroula; Jones, Ashley; Sproviero, William; Chiò, Adriano; McLaughlin, Russell Lewis; Sorarù, Gianni; Corrado, Lucia; Stahl, Daniel; Bo, Roberto Del; Cereda, Cristina; Castellotti, Barbara; Glass, Jonathan D.; Newhouse, Steven; Dobson, Richard; Smith, Bradley N.; Topp, Simon; van Rheenen, Wouter; Meininger, Vincent; Melki, Judith; Morrison, Karen E.; Shaw, Pamela J.; Leigh, P. Nigel; Andersen, Peter M.; Comi, Giacomo P.; Ticozzi, Nicola; Mazzini, Letizia; D’Alfonso, Sandra; Traynor, Bryan J.; Van Damme, Philip; Robberecht, Wim; Brown, Robert H.; Landers, John E.; Hardiman, Orla; Lewis, Cathryn M.; van den Berg, Leonard H.; Shaw, Christopher E.; Veldink, Jan H.; Silani, Vincenzo; Al-Chalabi, Ammar; Powell, John

    2017-01-01

    IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a devastating adult-onset neurodegenerative disorder with a poor prognosis and a median survival of 3 years. However, a significant proportion of patients survive more than 10 years from symptom onset. OBJECTIVE To identify gene variants influencing survival in ALS. DESIGN, SETTING, AND PARTICIPANTS This genome-wide association study (GWAS) analyzed survival in data sets from several European countries and the United States that were collected by the Italian Consortium for the Genetics of ALS and the International Consortium on Amyotrophic Lateral Sclerosis Genetics. The study population included 4256 patients with ALS (3125 [73.4%] deceased) with genotype data extended to 7 174 392 variants by imputation analysis. Samples of DNA were collected from January 1, 1993, to December 31, 2009, and analyzed from March 1, 2014, to February 28, 2015. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression under an additive model with adjustment for age at onset, sex, and the first 4 principal components of ancestry, followed by meta-analysis, were used to analyze data. Survival distributions for the most associated genetic variants were assessed by Kaplan-Meier analysis. RESULTS Among the 4256 patients included in the analysis (2589 male [60.8%] and 1667 female [39.2%]; mean [SD] age at onset, 59 [12] years), the following 2 novel loci were significantly associated with ALS survival: at 10q23 (rs139550538; P = 1.87 × 10−9) and in the CAMTA1 gene at 1p36 (rs2412208, P = 3.53 × 10−8). At locus 10q23, the adjusted hazard ratio for patients with the rs139550538 AA or AT genotype was 1.61 (95% CI, 1.38–1.89; P = 1.87 × 10−9), corresponding to an 8-month reduction in survival compared with TT carriers. For rs2412208 CAMTA1, the adjusted hazard ratio for patients with the GG or GT genotype was 1.17 (95% CI, 1.11–1.24; P = 3.53 × 10−8), corresponding to a 4-month reduction in survival compared with TT carriers

  12. Intention-to-treat survival benefit of liver transplantation in patients with hepatocellular cancer.

    PubMed

    Lai, Quirino; Vitale, Alessandro; Iesari, Samuele; Finkenstedt, Armin; Mennini, Gianluca; Spoletini, Gabriele; Hoppe-Lotichius, Maria; Vennarecci, Giovanni; Manzia, Tommaso M; Nicolini, Daniele; Avolio, Alfonso W; Frigo, Anna Chiara; Graziadei, Ivo; Rossi, Massimo; Tsochatzis, Emmanouil; Otto, Gerd; Ettorre, Giuseppe M; Tisone, Giuseppe; Vivarelli, Marco; Agnes, Salvatore; Cillo, Umberto; Lerut, Jan

    2017-12-01

    The debate about the best approach to select patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT) is still ongoing. This study aims to identify the best variables allowing to discriminate between "high-" and "low-benefit" patients. To do so, the concept of intention-to-treat (ITT) survival benefit of LT has been created. Data of 2,103 adult HCC patients consecutively enlisted during the period 1987-2015 were analyzed. Three rigorous statistical steps were used in order to create the ITT survival benefit of LT: the development of an ITT LT and a non-LT survival model, and the individual prediction of the ITT survival benefit of LT defined as the difference between the median ITT survival with (based on the first model) and without LT (based on the second model) calculated for each enrolled patient. Four variables (Model for End-Stage Liver Disease, alpha-fetoprotein, Milan-Criteria status, and radiological response) displayed a high effect in terms of delta benefit. According to these risk factors, four benefit groups were identified. Patients with three to four factors ("no-benefit group"; n = 405 of 2,103; 19.2%) had no benefit of LT compared to alternative treatments. Conversely, patients without any risk factor ("large-benefit group"; n = 108; 5.1%) yielded the highest benefit from LT reaching 60 months. The ITT transplant survival benefit presented here allows physicians to better select HCC patients waiting for LT. The obtained stratification may lead to an improved and more equitable method of organ allocation. Patients without benefit should be de-listed, whereas patients with large benefit ratio should be prioritized for LT. (Hepatology 2017;66:1910-1919). © 2017 by the American Association for the Study of Liver Diseases.

  13. Smoking Adversely Affects Survival in Acute Myeloid Leukemia Patients

    PubMed Central

    Varadarajan, Ramya; Licht, Andrea S; Hyland, Andrew J; Ford, Laurie A.; Sait, Sheila N.J.; Block, Annemarie W.; Barcos, Maurice; Baer, Maria R.; Wang, Eunice S.; Wetzler, Meir

    2011-01-01

    Summary Smoking adversely affects hematopoietic stem cell transplantation outcome. We asked whether smoking affected outcome of newly diagnosed acute myeloid leukemia (AML) patients treated with chemotherapy. Data were collected on 280 AML patients treated with high-dose cytarabine and idarubicin-containing regimens at Roswell Park Cancer Institute who had smoking status data at diagnosis. Patients’ gender, age, AML presentation (de novo vs. secondary), white blood cell (WBC) count at diagnosis, karyotype and smoking status (never vs. ever) were analyzed. Among the 161 males and 119 females with a median follow-up of 12.9 months, 101 (36.1%) had never smoked and 179 (63.9%) were ever smokers. The proportion of patients between never and ever smokers was similar with respect to age, AML presentation, WBC count at diagnosis or karyotype based on univariate analysis of these categorical variables. Never smokers had a significantly longer overall survival (60.32 months) compared to ever smokers (30.89; p=0.005). In multivariate analysis incorporating gender, age, AML presentation, WBC count, karyotype, and smoking status as covariates, age, karyotype and smoking status retained prognostic value for overall survival. In summary, cigarette smoking has a deleterious effect on overall survival in AML. PMID:21520043

  14. Karnofsky Performance Status Before and After Liver Transplantation Predicts Graft and Patient Survival.

    PubMed

    Thuluvath, Paul J; Thuluvath, Avesh J; Savva, Yulia

    2018-06-05

    The Karnofsky Performance Status (KPS) has been used for almost 70 years for clinical assessment of patients. Our objective was to determine whether KPS is an independent predictor of post-liver transplant (LT) survival after adjusting for known confounders. Adult patients listed with UNOS from 2006 to 2016 were grouped patients into low (10-40%, n=15,103), intermediate (50-70%, n=22,183) and high (80-100%, n=13,131) KPS based on KPS scores at the time of LT after excluding those on ventilators or life support. We determined the trends in KPS before and after LT, and survival probabilities based on KPS. There was a decline in KPS scores between listing and LT and there was significant improvement after LT. The graft and patient survival differences were significantly lower (p<0.0001) in those with low KPS. After adjusting for other confounders, the hazard ratios (HR) for graft failure were 1.17 (1.12-1.22, p <0.01) for the intermediate and 1.38 (1.31-1.46, p <0.01) for the low group. Similarly, HR for patient failure were 1.18 (1.13-1.24, p <0.01) for the intermediate and 1.43 (1.35-1.52, p <0.01) for the low group. Other independent negative predictors for graft and patient survival were older age, Black ethnicity, presence of hepatic encephalopathy and donor risk index. Those who did not show significant improvements in post-LT KPS scores had poorer outcomes in all three KPS groups, but it was most obvious in the low KPS group with 1-year patient survival of 33%. The KPS, before and after LT, is an independent predictor of graft and patient survival after adjusting for other important predictors of survival. The overall health of liver transplant recipients could be assessed by a simple clinical assessment tool called Karnofsky Performance Status which assess an individual's overall functional status on 11-point scale, in increments of 10, where a score of 0 is considered dead and 100 is considered perfect health. In this study, using a large dataset, we show

  15. Survival after diagnosis of AIDS: a prospective observational study of 2625 patients. Royal Free/Chelsea and Westminster Hospitals Collaborative Group.

    PubMed Central

    Mocroft, A.; Youle, M.; Morcinek, J.; Sabin, C. A.; Gazzard, B.; Johnson, M. A.; Phillips, A. N.

    1997-01-01

    OBJECTIVE: To estimate median survival and changes in survival in patients diagnosed as having AIDS. DESIGN: Prospective observational study. SETTING: Clinics in two large London hospitals. SUBJECTS: 2625 patients with AIDS seen between 1982 and July 1995. MAIN OUTCOME MEASURES: Survival, estimated using lifetable analyses, and factors associated with survival, identified from Cox proportional hazards models. RESULTS: Median survival (20 months) was longer than previous estimates. The CD4 lymphocyte count at or before initial AIDS defining illness decreased significantly over time from 90 x 10(6)/1 during 1987 or earlier to 40 x 10(6)/1 during 1994 and 1995 (P < 0.0001). In the first three months after diagnosis, patients in whom AIDS was diagnosed after 1987 had a much lower risk of death (relative risk 0.44, 95% confidence interval 0.22 to 0.86; P = 0.017) than patients diagnosed before 1987. When the diagnosis was based on oesophageal candidiasis or Kaposi's sarcoma, patients had a lower risk of death than when the diagnosis was based on Pneumocystis carinii pneumonia (0.21 (0.07 to 0.59). P = 0.0030 and 0.37 (0.16 to 0.83), P = 0.016). Three months after AIDS diagnosis, the risk of death was similar in patients whose diagnosis was made after and before 1987 (1.02 (0.79 to 1.31), P = 0.91). There were no differences in survival between patients diagnosed during 1988-90, 1991-3, or 1994-5. CONCLUSIONS: In later years, patients were much more likely to survive their initial illness, but long term survival has remained poor. The decrease in CD4 lymphocyte count at AIDS diagnosis indicates that patients are being diagnosed as having AIDS at ever more advanced stages of immunodeficiency. PMID:9040386

  16. Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease.

    PubMed

    Yang, Fan; Khin, Lay-Wai; Lau, Titus; Chua, Horng-Ruey; Vathsala, A; Lee, Evan; Luo, Nan

    2015-01-01

    Studies comparing patient survival of hemodialysis (HD) and peritoneal dialysis (PD) have yielded conflicting results and no such study was from South-East Asia. This study aimed to compare the survival outcomes of patients with end-stage renal disease (ESRD) who started dialysis with HD and PD in Singapore. Survival data for a maximum of 5 years from a single-center cohort of 871 ESRD patients starting dialysis with HD (n = 641) or PD (n = 230) from 2005-2010 was analyzed using the flexible Royston-Parmar (RP) model. The model was also applied to a subsample of 225 propensity-score-matched patient pairs and subgroups defined by age, diabetes mellitus, and cardiovascular disease. After adjusting for the effect of socio-demographic and clinical characteristics, the risk of death was higher in patients initiating dialysis with PD than those initiating dialysis with HD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.67-2.59; p<0.001), although there was no significant difference in mortality between the two modalities in the first 12 months of treatment. Consistently, in the matched subsample, patients starting PD had a higher risk of death than those starting HD (HR: 1.73, 95% CI: 1.30-2.28, p<0.001). Subgroup analysis showed that PD may be similar to or better than HD in survival outcomes among young patients (≤65 years old) without diabetes or cardiovascular disease. ESRD patients who initiated dialysis with HD experienced better survival outcomes than those who initiated dialysis with PD in Singapore, although survival outcomes may not differ between the two dialysis modalities in young and healthier patients. These findings are potentially confounded by selection bias, as patients were not randomized to the two dialysis modalities in this cohort study.

  17. The association between chronic kidney disease and cardiovascular disease risk factors in atomic bomb survivors.

    PubMed

    Sera, Nobuko; Hida, Ayumi; Imaizumi, Misa; Nakashima, Eiji; Akahoshi, Masazumi

    2013-01-01

    Atomic bomb (A-bomb) radiation is associated with cardiovascular disease (CVD) and metabolic CVD risk factors. Chronic kidney disease (CKD) is also known to be a risk factor for CVD and little is known whether CKD is associated with A-bomb radiation. To examine whether CKD is associated with CVD risk factors or with A-bomb radiation in A-bomb survivors, we classified renal dysfunction in 1,040 A-bomb survivors who were examined in 2004-2007 as normal [n = 121; estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m(2)]; mild (n = 686; eGFR 60-89 ml/min/1.73 m(2)); moderate (n = 217; eGFR 30-59 ml/min/1.73 m(2)); or severe (n = 16; eGFR <30 ml/min/1.73 m(2)). Also, we diagnosed subjects in the moderate and severe renal dysfunction groups as having CKD (n = 233; eGFR <59 ml/min/1.73 m(2)). After adjusting for age, gender, and smoking and drinking habits, we looked for an association between renal dysfunction and hypertension, diabetes mellitus (DM), hyperlipidemia, and metabolic syndrome (MetS), and between renal dysfunction and A-bomb radiation. Hypertension [odds ratio (OR), 1.57; 95% confidence interval (CI), 1.12-2.20, P = 0.009]; DM (OR, 1.79; 95% CI, 1.23-2.61, P = 0.002); hyperlipidemia (OR, 1.55; 95% CI, 1.12-2.14, P = 0.008); and MetS (OR, 1.86; 95% CI, 1.32-2.63, P < 0.001) were associated with CKD (moderate/severe renal dysfunction), and hyperlipidemia and MetS were also associated with mild renal dysfunction. CKD (OR/Gy, 1.29; 95% CI, 1.01-1.63, P = 0.038) and severe renal dysfunction (OR/Gy, 3.19; 95% CI, 1.63-6.25, P < 0.001) were significantly associated with radiation dose. CKD associated with radiation may have played a role in the development of CVD among A-bomb survivors.

  18. Age validation of quillback rockfish (Sebastes maliger) using bomb radiocarbon

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kerr, L A; Andrews, A H; Munk, K

    2005-01-05

    Rockfishes (Sebastes spp.) support one of the most economically important fisheries of the Pacific Northwest and it is essential for sustainable management that age estimation procedures be validated for these species. Atmospheric testing of thermonuclear devices during the 1950s and 1960s created a global radiocarbon ({sup 14}C) signal in the ocean environment that scientists have identified as a useful tracer and chronological marker in natural systems. In this study, we first demonstrated that fewer samples are necessary for age validation using the bomb-generated {sup 14}C signal by emphasizing the utility of the time-specific marker created by the initial rise ofmore » bomb-{sup 14}C. Second, the bomb-generated {sup 14}C signal retained in fish otoliths was used to validate the age and age estimation methodology of the quillback rockfish (Sebastes maliger) in the waters of southeast Alaska. Radiocarbon values from the first year's growth of quillback rockfish otoliths were plotted against estimated birth year producing a {sup 14}C time series spanning 1950 to 1985. The initial rise of bomb-{sup 14}C from pre-bomb levels ({approx} -90 {per_thousand}) occurred in 1959 {+-} 1 year and {sup 14}C levels rose relatively rapidly to peak {Delta}{sup 14}C values in 1967 (+105.4 {per_thousand}), with a subsequent declining trend through the end of the record in 1985 (+15.4 {per_thousand}). The agreement between the year of initial rise of {sup 14}C levels from the quillback rockfish record and the chronometer determined for the waters of southeast Alaska from yelloweye rockfish (S. ruberrimus) otoliths validated the ageing methodology for the quillback rockfish. The concordance of the entire quillback rockfish {sup 14}C record with the yelloweye rockfish time series demonstrated the effectiveness of this age validation technique, confirmed the longevity of the quillback rockfish up to a minimum of 43 years, and strongly supports higher age estimates of up to 90 years.« less

  19. Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus-Infected Patients.

    PubMed

    Rosenke, Kyle; Adjemian, Jennifer; Munster, Vincent J; Marzi, Andrea; Falzarano, Darryl; Onyango, Clayton O; Ochieng, Melvin; Juma, Bonventure; Fischer, Robert J; Prescott, Joseph B; Safronetz, David; Omballa, Victor; Owuor, Collins; Hoenen, Thomas; Groseth, Allison; Martellaro, Cynthia; van Doremalen, Neeltje; Zemtsova, Galina; Self, Joshua; Bushmaker, Trenton; McNally, Kristin; Rowe, Thomas; Emery, Shannon L; Feldmann, Friederike; Williamson, Brandi N; Best, Sonja M; Nyenswah, Tolbert G; Grolla, Allen; Strong, James E; Kobinger, Gary; Bolay, Fatorma K; Zoon, Kathryn C; Stassijns, Jorgen; Giuliani, Ruggero; de Smet, Martin; Nichol, Stuart T; Fields, Barry; Sprecher, Armand; Massaquoi, Moses; Feldmann, Heinz; de Wit, Emmie

    2016-10-15

    The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus. All blood samples from suspected Ebola virus-infected patients admitted to the Médecins Sans Frontières ELWA3 Ebola treatment unit in Monrovia were tested by quantitative real-time polymerase chain reaction for the presence of Ebola virus and Plasmodium species RNA. Clinical outcome in laboratory-confirmed Ebola virus-infected patients was analyzed as a function of age, sex, Ebola viremia, and Plasmodium species parasitemia. The case fatality rate of 1182 patients with laboratory-confirmed Ebola virus infections was 52%. The probability of surviving decreased with increasing age and decreased with increasing Ebola viral load. Ebola virus-infected patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age; those with the highest levels of parasitemia had a survival rate of 83%. This effect was independent of treatment with antimalarials, as this was provided to all patients. Moreover, treatment with antimalarials did not affect survival in the Ebola virus mouse model. Plasmodium species parasitemia is associated with an increase in the probability of surviving Ebola virus infection. More research is needed to understand the molecular mechanism underlying this remarkable phenomenon and translate it into treatment options for Ebola virus infection. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  20. Prevalence, Risk Factors, and Survival of Patients with Intrahepatic Cholangiocarcinoma.

    PubMed

    Chinchilla-López, Paulina; Aguilar-Olivos, Nancy; García-Gómez, Jaime; Hernández-Alejandro, Karen; Chablé-Montero, Fredy; Motola-Kuba, Daniel; Patel, Tushar; Méndez-Sánchez, Nahum

    2017-01-01

    To investigate the prevalence, related risk factors, and survival of intrahepatic cholangiocarcinoma in a Mexican population. We conducted a cross-sectional study at Medica Sur Hospital in Mexico City with approval of the local research ethics committee. We found cases by reviewing all clinical records of in-patients between October 2005 and January 2016 who had been diagnosed with malignant liver tumors. Clinical characteristics and comorbidities were obtained to evaluate the probable risk factors and the Charlson index. The cases were staged based on the TNM staging system for bile duct tumors used by the American Joint Committee on Cancer and median patient survival rates were calculated using the Kaplan-Meier method. We reviewed 233 cases of hepatic cancer. Amongst these, hepatocellular carcinomas represented 19.3% (n = 45), followed by intrahepatic cholangiocarcinomas, which accounted for 7.7% (n = 18). The median age of patients with intrahepatic cholangiocarcinoma was 63 years, and most of them presented with cholestasis and intrahepatic biliary ductal dilation. Unfortunately, 89% (n = 16) of them were in an advanced stage and 80% had multicentric tumors. Median survival was 286 days among patients with advanced stage tumors (25th-75th interquartile range, 174-645 days). No correlation was found between the presence of comorbidities defined by the Charlson index, and survival. We evaluated the presence of definite and probable risk factors for the development of intrahepatic cholangiocarcinoma, that is, smoking, alcohol consumption, and primary sclerosing cholangitis. We found an overall prevalence of intrahepatic cholangiocarcinoma of 7.7%; unfortunately, these patients were diagnosed at advanced stages. Smoking and primary sclerosing cholangitis were the positive risk factors for its development in this population.

  1. Survival Analysis of Patients with Interval Cancer Undergoing Gastric Cancer Screening by Endoscopy

    PubMed Central

    Hamashima, Chisato; Shabana, Michiko; Okamoto, Mikizo; Osaki, Yoneatsu; Kishimoto, Takuji

    2015-01-01

    Aims Interval cancer is a key factor that influences the effectiveness of a cancer screening program. To evaluate the impact of interval cancer on the effectiveness of endoscopic screening, the survival rates of patients with interval cancer were analyzed. Methods We performed gastric cancer-specific and all-causes survival analyses of patients with screen-detected cancer and patients with interval cancer in the endoscopic screening group and radiographic screening group using the Kaplan-Meier method. Since the screening interval was 1 year, interval cancer was defined as gastric cancer detected within 1 year after a negative result. A Cox proportional hazards model was used to investigate the risk factors associated with gastric cancer-specific and all-causes death. Results A total of 1,493 gastric cancer patients (endoscopic screening group: n = 347; radiographic screening group: n = 166; outpatient group: n = 980) were identified from the Tottori Cancer Registry from 2001 to 2008. The gastric cancer-specific survival rates were higher in the endoscopic screening group than in the radiographic screening group and the outpatients group. In the endoscopic screening group, the gastric cancer-specific survival rate of the patients with screen-detected cancer and the patients with interval cancer were nearly equal (P = 0.869). In the radiographic screening group, the gastric cancer-specific survival rate of the patients with screen-detected cancer was higher than that of the patients with interval cancer (P = 0.009). For gastric cancer-specific death, the hazard ratio of interval cancer in the endoscopic screening group was 0.216 for gastric cancer death (95%CI: 0.054-0.868) compared with the outpatient group. Conclusion The survival rate and the risk of gastric cancer death among the patients with screen-detected cancer and patients with interval cancer were not significantly different in the annual endoscopic screening. These results suggest the potential of

  2. Precision closed bomb calorimeter for testing flame and gas producing initiators

    NASA Technical Reports Server (NTRS)

    Carpenter, D. R., Jr.; Taylor, A. C., Jr.

    1972-01-01

    A calorimeter has been developed under this study to help meet the needs of accurate performance monitoring of electrically or mechanically actuated flame and gas producing devices, such as squib-type initiators. A ten cubic centimeter closed bomb (closed volume) calorimeter was designed to provide a standard pressure trace and to measure a nominal 50 calorie output, using the basic components of a Parr Model 1411 calorimeter. Two prototype bombs were fabricated, pressure tested to 2600 psi, and extensively evaluated.

  3. Patenting the bomb: nuclear weapons, intellectual property, and technological control.

    PubMed

    Wellerstein, Alex

    2008-03-01

    During the course of the Manhattan Project, the U.S. government secretly attempted to acquire a monopoly on the patent rights for inventions used in the production of nuclear weapons and nuclear energy. The use of patents as a system of control, while common for more mundane technologies, would seem at first glance to conflict with the regimes of secrecy that have traditionally been associated with nuclear weapons. In explaining the origins and operations of the Manhattan Project patent system, though, this essay argues that the utilization of patents was an ad hoc attempt at legal control of the atomic bomb by Manhattan Project administrators, focused on the monopolistic aspects of the patent system and preexisting patent secrecy legislation. From the present perspective, using patents as a method of control for such weapons seems inadequate, if not unnecessary; but at the time, when the bomb was a new and essentially unregulated technology, patents played an important role in the thinking of project administrators concerned with meaningful postwar control of the bomb.

  4. Maintaining physical therapy standards in an emergency situation: solutions after the Bali bombing disaster.

    PubMed

    Edgar, D; Wood, F; Goodwin-Walters, A

    2005-08-01

    In a mass casualty event, treatment is traditionally provided in a 'best for the most' fashion. This paper examines the challenges encountered by physical therapists while providing rehabilitation to 28 survivors who suffered burns after the terrorist bombing in Bali, Indonesia. Individual patient input was achieved with routine outcome measures and workload statistics. Workforce expansion, maintenance of treatment quality, and other practical initiatives used in order to achieve this goal are discussed.

  5. Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients.

    PubMed

    Rymarz, Aleksandra; Gibińska, Julia; Zajbt, Maria; Piechota, Wiesław; Niemczyk, Stanisław

    2018-11-01

    Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients. Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session. Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p = .013) and higher IL-6 (p = .032) and hsCRP levels (p = .011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan-Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p = .055). LTI inversely correlated with age and IL-6 and positively with IGF-1. Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.

  6. Association of Adjuvant Chemotherapy With Survival in Patients With Stage II or III Gastric Cancer

    PubMed Central

    Jiang, Yuming; Li, Tuanjie; Liang, Xiaoling; Hu, Yanfeng; Huang, Lei; Liao, Zhenchen; Zhao, Liying; Han, Zhen; Zhu, Shuguang; Wang, Menglan; Xu, Yangwei; Qi, Xiaolong; Liu, Hao; Yang, Yang; Yu, Jiang; Liu, Wei; Cai, Shirong

    2017-01-01

    Importance The current staging system of gastric cancer is not adequate for defining a prognosis and predicting the patients most likely to benefit from chemotherapy. Objective To construct a survival prediction model based on specific tumor and patient characteristics that enables individualized predictions of the net survival benefit of adjuvant chemotherapy for patients with stage II or stage III gastric cancer. Design, Setting, and Participants In this multicenter retrospective analysis, a survival prediction model was constructed using data from a training cohort of 746 patients with stage II or stage III gastric cancer who satisfied the study’s inclusion criteria and underwent surgery between January 1, 2004, and December 31, 2012, at Nanfang Hospital in Guangzhou, China. Patient and tumor characteristics were included as covariates, and their association with overall survival and disease-free survival with and without adjuvant chemotherapy was assessed. The model was internally validated for discrimination and calibration using bootstrap resampling. To externally validate the model, data were included from a validation cohort of 973 patients with stage II or stage III gastric cancer who met the inclusion criteria and underwent surgery at First Affiliated Hospital in Guangzhou, China, and at West China Hospital of Sichuan Hospital in Chendu, China, between January 1, 2000, and June 30, 2009. Data were analyzed from July 10, 2016, to September 1, 2016. Main Outcomes and Measures Concordance index and decision curve analysis for each measure associated with postoperative overall survival and disease-free survival. Results Of the 1719 patients analyzed, 1183 (68.8%) were men and 536 (31.2%) were women and the median (interquartile range) age was 57 (49-66) years. Age, location, differentiation, carcinoembryonic antigen, cancer antigen 19-9, depth of invasion, lymph node metastasis, and adjuvant chemotherapy were significantly associated with overall survival

  7. Design, Development, and Innovation of an Interactive Multimedia Training Simulator for Responding to Air Transportation Bomb Threats

    NASA Technical Reports Server (NTRS)

    Chung, Christopher A.; Marwaha, Shweta

    2005-01-01

    This paper describes an interactive multimedia simulator for air transportation bomb threat training. The objective of this project is to improve the air transportation sector s capability to respond to bomb threats received by commercial airports and aircraft. The simulator provides realistic training on receiving and responding to a variety of bomb threats that might not otherwise be possible due to time, cost, or operational constraints. Validation analysis indicates that the use of the simulator resulted in statistically significant increases in individual ability to respond to these types of bomb threats.

  8. Combustion in a Bomb with a Fuel-Injection System

    NASA Technical Reports Server (NTRS)

    Cohn, Mildred; Spencer, Robert C

    1935-01-01

    Fuel injected into a spherical bomb filled with air at a desired density and temperature could be ignited with a spark a few thousandths of a second after injection, an interval comparable with the ignition lag in fuel-injection engines. The effect of several variables on the extent and rate of combustion was investigated: time intervals between injection and ignition of fuel of 0.003 to 0.06 second and one of 5 minutes; initial air temperatures of 100 degrees C. to 250 degrees C.; initial air densities equivalent to 5, 10, and 15 absolute atmospheres pressure at 100 degrees C.; and air-fuel ratios of 5 to 25.

  9. Survival analysis of high-intensity focused ultrasound ablation in patients with small hepatocellular carcinoma.

    PubMed

    Cheung, Tan To; Fan, Sheung Tat; Chu, Ferdinand S K; Jenkins, Caroline R; Chok, Kenneth S H; Tsang, Simon H Y; Dai, Wing Chiu; Chan, Albert C Y; Chan, See Ching; Yau, Thomas C C; Poon, Ronnie T P; Lo, Chung Mau

    2013-08-01

    High-intensity focused ultrasound (HIFU) ablation is a non-invasive treatment for hepatocellular carcinoma (HCC). At present, data on the treatment's long-term outcome are limited. This study analysed the survival outcome of HIFU ablation for HCCs smaller than 3 cm. Forty-seven patients with HCCs smaller than 3 cm received HIFU treatment between October 2006 and September 2010. Fifty-nine patients who received percutaneous radiofrequency ablation (RFA) were selected for comparison. The two groups of patients were compared in terms of pre-operative variables and survival. More patients in the HIFU group patients had Child-Pugh B cirrhosis (34% versus 8.5%; P = 0.001). The 1- and 3-year overall survival rates of patients whose tumours were completely ablated in the HIFU group compared with the RFA group were 97.4% versus 94.6% and 81.2% versus 79.8%, respectively (P = 0.530). The corresponding 1- and 3-year disease-free survival rates were 63.6% versus 62.4% and 25.9% versus 34.1% (P = 0.683). HIFU ablation is a safe and effective method for small HCCs. It can achieve survival outcomes comparable to those of percutaneous RFA and thus serves as a good alternative ablation treatment for patients with cirrhosis. © 2012 International Hepato-Pancreato-Biliary Association.

  10. FROM THE HISTORY OF PHYSICS: The development of the first Soviet atomic bomb

    NASA Astrophysics Data System (ADS)

    Goncharov, German A.; Ryabev, Lev D.

    2001-01-01

    In the late 1930s and early 1940s, two remarkable physical phenomena — the fission of heavy nuclei and the chain fission reaction — were discovered, implying that a new powerful source of energy (nuclear fission energy) might become a practical possibility for mankind. At that time, however, the political situation in the world made the development of the atomic bomb the main objective of nuclear energy research in the countries involved. The first atomic bombs, notoriously used in the war against Japan, were produced by the United States of America only six and a half years after the discovery of fission. Four years later, the first Soviet atomic bomb was tested. This was a major step toward the establishment of nuclear parity which led to stability and global peace and thus greatly influenced the destiny of human kind. Based on documentary materials covering the period from 1939 to 1949, this paper traces the origin and evolution of the physical ideas behind the first Soviet atomic bomb and discusses the most important events associated with the project.

  11. Impact of Different Aortic Entry Tear Sites on Early Outcomes and Long-Term Survival in Patients with Stanford A Acute Aortic Dissection.

    PubMed

    Merkle, Julia; Sabashnikov, Anton; Deppe, Antje Christin; Weber, Saskia; Mader, Navid; Choi, Yeong-Hoon; Liakopoulos, Oliver; Kuhn-Régnier, Ferdinand; Wahlers, Thorsten

    2018-06-13

     Stanford A acute aortic dissection (AAD) is a life-threatening emergency. The aim of this study was to compare the impact of three different aortic entry tear sites on early outcomes and long-term survival of patients with Stanford A AAD.  From January 2006 to April 2015, a total of 240 consecutive patients with diagnosed Stanford A AAD underwent emergent, isolated surgical aortic repair in our center. Patients were divided into three groups comprising isolated ascending aorta, proximal aortic arch, and distal aortic arch entry tear site and were followed up for up to 9 years.  Thirty-day mortality as well as major cerebrovascular events were significantly different between the three groups ( p  = 0.007 and p  = 0.048, respectively). Overall cumulative short- and long-term survival of all patients revealed significant differences (Log-Rank p  = 0.002), whereas survival of all patients free from major cerebrovascular events was similar (Log-Rank p  = 0.780). Subgroup analysis of short- and long-term survival of patients showed significant differences in terms of men (Log-Rank p  = 0.043), women (Log-Rank p  = 0.004), patients over 65 years of age (Log-Rank p  = 0.007), and hypertensive patients (Log-Rank p  = 0.003). Kaplan-Meier survival estimation plots significantly showed poorest survival for distal aortic arch entry tear site group.  The location of the primary entry tear in patients with Stanford A AAD significantly influences early outcomes, short- and long-term survival of patients, whereas survival of patients free from major cerebrovascular events showed similar results among the three groups. Distal aortic entry tear site showed poorest outcomes and survival. Georg Thieme Verlag KG Stuttgart · New York.

  12. Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival.

    PubMed

    Patel, Krishna; Foster, Nathan R; Kumar, Amanika; Grudem, Megan; Longenbach, Sherri; Bakkum-Gamez, Jamie; Haddock, Michael; Dowdy, Sean; Jatoi, Aminah

    2015-05-01

    Hydronephrosis is a frequently observed but understudied complication in patients with cervical cancer. To better characterize hydronephrosis in cervical cancer patients, the current study sought (1) to describe hydronephrosis-associated morbidity and (2) to analyze the prognostic effect of hydronephrosis in patients with a broad range of cancer stages over time. The Mayo Clinic Tumor Registry was interrogated for all invasive cervical cancer patients seen at the Mayo Clinic from 2008 through 2013 in Rochester, Minnesota; these patients' medical records were then reviewed in detail. Two hundred seventy-nine cervical cancer patients with a median age of 49 years and a range of cancer stages were included. Sixty-five patients (23 %) were diagnosed with hydronephrosis at some point during their disease course. In univariate analyses, hydronephrosis was associated with advanced cancer stage (p < 0.0001), squamous histology (p = 0.0079), and nonsurgical cancer treatment (p = 0.0039). In multivariate analyses, stage and tumor histology were associated with hydronephrosis. All but one patient underwent stent placement or urinary diversion; hydronephrosis-related morbidity included pain, urinary tract infections, nausea and vomiting, renal failure, and urinary tract bleeding. In landmark univariate survival analyses, hydronephrosis was associated with worse survival at all time points. In landmark multivariate analyses (adjusted for patient age, stage, cancer treatment, and tumor histology), hydronephrosis was associated with a trend toward worse survival over time (hazard ratios ranged from 1.47 to 4.69). Hydronephrosis in cervical cancer patients is associated with notable morbidity. It is also associated with trends toward worse survival-even if it occurs after the original cancer diagnosis.

  13. Media's role in broadcasting acute stress following the Boston Marathon bombings.

    PubMed

    Holman, E Alison; Garfin, Dana Rose; Silver, Roxane Cohen

    2014-01-07

    We compared the impact of media vs. direct exposure on acute stress response to collective trauma. We conducted an Internet-based survey following the Boston Marathon bombings between April 29 and May 13, 2013, with representative samples of residents from Boston (n = 846), New York City (n = 941), and the remainder of the United States (n = 2,888). Acute stress symptom scores were comparable in Boston and New York [regression coefficient (b) = 0.43; SE = 1.42; 95% confidence interval (CI), -2.36, 3.23], but lower nationwide when compared with Boston (b = -2.21; SE = 1.07; 95% CI, -4.31, -0.12). Adjusting for prebombing mental health (collected prospectively), demographics, and prior collective stress exposure, six or more daily hours of bombing-related media exposure in the week after the bombings was associated with higher acute stress than direct exposure to the bombings (continuous acute stress symptom total: media exposure b = 15.61 vs. direct exposure b = 5.69). Controlling for prospectively collected prebombing television-watching habits did not change the findings. In adjusted models, direct exposure to the 9/11 terrorist attacks and the Sandy Hook School shootings were both significantly associated with bombing-related acute stress; Superstorm Sandy exposure wasn't. Prior exposure to similar and/or violent events may render some individuals vulnerable to the negative effects of collective traumas. Repeatedly engaging with trauma-related media content for several hours daily shortly after collective trauma may prolong acute stress experiences and promote substantial stress-related symptomatology. Mass media may become a conduit that spreads negative consequences of community trauma beyond directly affected communities.

  14. Evaluation of adverse events in atomic bomb survivors receiving curative-intent radiation therapy from 2005 to 2010.

    PubMed

    Doi, Yoshiko; Murakami, Yuji; Kenjo, Masahiro; Imano, Nobuki; Kimura, Tomoki; Nagata, Yasushi

    2016-01-01

    To evaluate the safety of radiation therapy (RT) in atomic bomb (A-bomb) survivors (ABS), we evaluated the frequency of RT-associated adverse events (AEs) in ABS. We selected patients who underwent curative external-beam RT (EBRT) at Hiroshima University Hospital between January 2005 and December 2010 and were born before August 1946; the patients were divided into ABS and non-ABS groups, which groups received identical treatments without stratification. We retrospectively reviewed the medical records of 220 ABS and 753 non-ABS patients. The median age was 72 years. The median observation durations were 41 and 37 months for the ABS and non-ABS groups, respectively. The ABS group had higher frequencies of women, breast cancer patients, and concurrent chemotherapy and had a lower incidence of only acute hematological AEs. However this tendency disappeared when breast cancer patients were excluded, and no significant differences were observed between the ABS and non-ABS groups regarding Grade ⩾ 3 other acute and late AEs. The overall cumulative incidence of Grade ⩾ 3 late AEs did not significantly differ between the ABS and non-ABS groups. Notable increases in AEs were not observed during or after RT among ABS. This study clarified that stratification is not required when treating ABS with RT. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Analytic treatment of the black-hole bomb

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hod, Shahar; Hod, Oded; School of Chemistry, Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978

    2010-03-15

    A bosonic field impinging on a rotating black hole can be amplified as it scatters off the hole, a phenomenon known as superradiant scattering. If in addition the field has a nonzero rest mass {mu}, the mass term effectively works as a mirror, reflecting the scattered wave back towards the black hole. In this physical system, known as a black-hole bomb, the wave may bounce back and forth between the black hole and some turning point, amplifying itself each time. Consequently, the field grows exponentially over time and is unstable. In this paper we study analytically for the first timemore » the phenomenon of superradiant instability (the black-hole bomb mechanism) in the regime M{mu}=O(1) of greatest instability. We find a maximal instability growth rate of {tau}{sup -1}=1.7x10{sup -3}M{sup -1}. This instability is 4 orders of magnitude stronger than has been previously estimated.« less

  16. Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease.

    PubMed

    Sedlis, Steven P; Hartigan, Pamela M; Teo, Koon K; Maron, David J; Spertus, John A; Mancini, G B John; Kostuk, William; Chaitman, Bernard R; Berman, Daniel; Lorin, Jeffrey D; Dada, Marcin; Weintraub, William S; Boden, William E

    2015-11-12

    Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years. We obtained permission from the patients at the Department of Veterans Affairs (VA) sites and some non-VA sites in the United States to use their Social Security numbers to track their survival after the original trial period ended. We searched the VA national Corporate Data Warehouse and the National Death Index for survival information and the dates of death from any cause. We calculated survival according to the Kaplan-Meier method and used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics. Extended survival information was available for 1211 patients (53% of the original population). The median duration of follow-up for all patients was 6.2 years (range, 0 to 15); the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years (range, 0 to 15). A total of 561 deaths (180 during the follow-up period in the original trial and 381 during the extended follow-up period) occurred: 284 deaths (25%) in the PCI group and 277 (24%) in the medical-therapy group (adjusted hazard ratio, 1.03; 95% confidence interval, 0.83 to 1.21; P=0.76). During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA

  17. "US-detonated nano bombs" facilitate targeting treatment of resistant breast cancer.

    PubMed

    Shi, Jinjin; Liu, Wei; Fu, Yu; Yin, Na; Zhang, Hongling; Chang, Junbiao; Zhang, Zhenzhong

    2018-03-28

    Reversal of drug resistance and targeted therapy are the keys but remain challenging in resistant breast cancer treatment. Herein, low frequency ultrasound detonated "nano bombs" were rationally designed and used for treatment of resistant breast cancer. For the 'nano bombs', the ammunition (Doxorubicin, DOX) was loaded into the ammunition depot (hollow mesoporous TiO 2 , MTNs), and the safety device (dsDNA) was wrapped on the surface of MTNs to avoid the unexpected DOX release. We found the "US-detonated explosive" abilities of "nano bomb" MTNs (NBMTNs), including explosive generation of ROS, explosive release of DOX, US-triggered lysosome escape and mitochondrial targeting in the in vitro and in vivo studies. More importantly, the drug resistance of MCF-7/ADR cells could be reversed via the inhibition of mitochondrial energy supply approach caused by the "explosion" of NBMTNs. Furthermore, NBMTNs combined the superior chemotherapy efficacy of DOX and potent SDT efficacy in one single platform and significantly enhanced the anticancer efficacy. Our results demonstrate an approach for reversing resistance and specific targeting of tumors using 'US-detonated nano bombs'. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Analysis of Survival Rates Following Primary Surgery of 178 Consecutive Patients with Oral Cancer in a Large District General Hospital.

    PubMed

    Stathopoulos, Panagiotis; Smith, William P

    2017-06-01

    The aim of this study is to present the survival rates in patients treated for oral cancer with primary surgery in a large district general hospital. We discuss the influence of the most significant prognostic factors on survival and compare our results with larger centres specializing in the management of oral cancer. All patients diagnosed with oral cancer from 1995 to 2006 and were treated in the Department had their details entered prospectively onto a computerized database. Demographic details of patients, type of treatment, pathological stage of tumor (TNM), local and regional recurrence rate, overall survival, disease specific survival and incidence of involved margins were recorded and calculated. Of the 178 patients, 96 (54 %) were alive and free of oral cancer 5 years after surgery. Forty-four patients died of oral cancer (24.7 %) but 38 (21.3 %) died of other causes. The overall survival rate after primary surgery in relation to stage was: I 84 %, II 71 %, III 36 % and IV 28 %. As almost half of our patients presented with advanced cancer and had discouraging survival rates, we emphasize the need for early recognition of the disease. Advanced disease signifies difficulty in obtaining clear margins which actually indicates a higher recurrence rate. 25 % of our patients died of oral cancer within 5 years of surgery which highlights the poor prognosis that recurrence carries after treatment. Effective educational campaign with purpose to raise oral cancer awareness and earlier referral may result in improvement of survival.

  19. Neutrophil-lymphocyte ratio predicts survival in patients with advanced cholangiocarcinoma on chemotherapy.

    PubMed

    Lee, Ban Seok; Lee, Sang Hyub; Son, Jun Hyuk; Jang, Dong Kee; Chung, Kwang Hyun; Lee, Yoon Suk; Paik, Woo Hyun; Ryu, Ji Kon; Kim, Yong-Tae

    2016-02-01

    The blood neutrophil-to-lymphocyte ratio (NLR) is reported to be a prognostic marker in several cancers. However, the prognostic role of NLR in patients with advanced cholangiocarcinoma on chemotherapy is unknown. A total of 221 patients with pathologically confirmed locally advanced or metastatic cholangiocarcinoma receiving first-line palliative chemotherapy were enrolled. Associations between baseline clinical and laboratory variables including NLR and survival were investigated. Patients were classified into two groups according to the NLR level (≤ 5 vs. >5). Median overall survival (OS) and time to progression (TTP) in patients with NLR ≤ 5 were 10.9 and 6.7 months, respectively, and 6.8 and 4.1 months in patients with NLR > 5 (P < 0.001, P = 0.002, respectively). In multivariate analysis, number of cycles of chemotherapy was a significant predictor of longer OS (HR 0.86, P < 0.001), whereas adverse prognostic factors for OS were CA 19-9 > 300 (HR 1.43, P = 0.025), CEA > 5 (HR 1.44, P = 0.029), higher stage (HR 1.69, P = 0.004), and NLR > 5 (HR 1.87, P < 0.001). NLR > 5 was also associated with reduced TTP (HR 1.66, P = 0.007). Among 50 patients with initial NLR > 5, 33 patients had NLR ≤ 5 after two cycles of chemotherapy and they had significantly better survival than the others (HR 0.48, P = 0.015). NLR independently predicts survival in patients with advanced cholangiocarcinoma undergoing chemotherapy. Considering cost-effectiveness and easy availability, NLR may be a useful biomarker for prognosis prediction.

  20. Patient and implant survival following joint replacement because of metastatic bone disease

    PubMed Central

    2013-01-01

    Background Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint replacement as the treatment for bone metastasis or hematological diseases of the extremities. Patients and methods 130 patients (mean age 64 (30–85) years, 76 females) received 140 joint replacements due to skeletal metastases (n = 114) or hematological disease (n = 16) during the period 2003–2008. 21 replaced joints were located in the upper extremities and 119 in the lower extremities. Clinical and survival data were extracted from patient files and various registers. Results The probability of patient survival was 51% (95% CI: 42–59) after 6 months, 39% (CI: 31–48) after 12 months, and 29% (CI: 21–37) after 24 months. The following surgical complications were seen (8 of which led to additional surgery): 2–5 hip dislocations (n = 8), deep infection (n = 3), peroneal palsy (n = 2), a shoulder prosthesis penetrating the skin (n = 1), and disassembly of an elbow prosthesis (n = 1). The probability of avoiding all kinds of surgery related to the implanted prosthesis was 94% (CI: 89–99) after 1 year and 92% (CI: 85–98) after 2 years. Conclusion Joint replacement operations because of metastatic bone disease do not appear to have given a poorer rate of patient survival than other types of surgical treatment, and the reoperation rate was low. PMID:23530874

  1. A new biologic prognostic model based on immunohistochemistry predicts survival in patients with diffuse large B-cell lymphoma.

    PubMed

    Perry, Anamarija M; Cardesa-Salzmann, Teresa M; Meyer, Paul N; Colomo, Luis; Smith, Lynette M; Fu, Kai; Greiner, Timothy C; Delabie, Jan; Gascoyne, Randy D; Rimsza, Lisa; Jaffe, Elaine S; Ott, German; Rosenwald, Andreas; Braziel, Rita M; Tubbs, Raymond; Cook, James R; Staudt, Louis M; Connors, Joseph M; Sehn, Laurie H; Vose, Julie M; López-Guillermo, Armando; Campo, Elias; Chan, Wing C; Weisenburger, Dennis D

    2012-09-13

    Biologic factors that predict the survival of patients with a diffuse large B-cell lymphoma, such as cell of origin and stromal signatures, have been discovered by gene expression profiling. We attempted to simulate these gene expression profiling findings and create a new biologic prognostic model based on immunohistochemistry. We studied 199 patients (125 in the training set, 74 in the validation set) with de novo diffuse large B-cell lymphoma treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP-like therapies, and immunohistochemical stains were performed on paraffin-embedded tissue microarrays. In the model, 1 point was awarded for each adverse prognostic factor: nongerminal center B cell-like subtype, SPARC (secreted protein, acidic, and rich in cysteine) < 5%, and microvascular density quartile 4. The model using these 3 biologic markers was highly predictive of overall survival and event-free survival in multivariate analysis after adjusting for the International Prognostic Index in both the training and validation sets. This new model delineates 2 groups of patients, 1 with a low biologic score (0-1) and good survival and the other with a high score (2-3) and poor survival. This new biologic prognostic model could be used with the International Prognostic Index to stratify patients for novel or risk-adapted therapies.

  2. Resolution of severe hyponatraemia is associated with improved survival in patients with cancer.

    PubMed

    Balachandran, Kirsty; Okines, Alicia; Gunapala, Ranga; Morganstein, Daniel; Popat, Sanjay

    2015-03-22

    Hyponatraemia is a common finding in patients with cancer, and has been shown to be associated with poor prognosis in different settings. We have analysed the impact of severe hyponatraemia in patients with cancer. A retrospective review of all patients admitted to a specialist cancer hospital with a plasma sodium of less than 115 mmol/l and a diagnosis of malignancy was undertaken. Patient and tumour characteristics were analysed as well as impact of hyponatraemia management on overall survival and number of lines of cancer treatment received. 57 patients were identified. 84% had advanced Stage 3 or 4 cancer and approximately 85% with data available had symptoms attributable to hyponatraemia. Mean length of hospital stay was 12 days, and overall survival (OS) was 5.1 months. Plasma sodium level corrected in 56% of patients and here OS was 13.6 months compared to 16 days in those whose sodium did not correct (p < 0.001). Those whose sodium corrected were more likely to receive further lines of anti-cancer treatment. Severe hyponatraemia in cancer is associated with very poor survival, but correction of the sodium level leads to additional treatment and significantly greater overall survival (although it is not possible to determine if this is due to specific therapy of the hyponatraemia or the resolving hyponatraemia reflects an improvement in the clinical condition). Aggressive treatment of hyponatraemia may allow more anti-cancer treatment and improve survival.

  3. Cartel Car Bombings in Mexico

    DTIC Science & Technology

    2013-08-01

    English and Spanish language media reports, Borderland Beat, available from www.borderlandbeat.com, Blog Del Naco, avail- able from...Departamento Administradora de Seguridad en Proceso de Supresión) DEA Drug Enforcement Administration DHS Department of Homeland...the official said in Spanish . ‘Car bombs have been employed in Nuevo Laredo, Monterrey, Victoria and the Tamaulipas coast city of Tampico, which

  4. ELLERMAN BOMBS AT HIGH RESOLUTION. IV. VISIBILITY IN Na I AND Mg I

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rutten, R. J.; Rouppe van der Voort, L. H. M.; Vissers, G. J. M., E-mail: R.J.Rutten@uu.nl

    2015-08-01

    Ellerman bombs are transient brightenings of the wings of the solar Balmer lines that mark reconnection in the photosphere. Ellerman noted in 1917 that he did not observe such brightenings in the Na i D and Mg i b lines. This non-visibility should constrain EB interpretation, but has not been addressed in published bomb modeling. We therefore test Ellerman’s observation and confirm it using high-quality imaging spectrometry with the Swedish 1-m Solar Telescope. However, we find a diffuse brightness in these lines that seems to result from prior EBs. We tentatively suggest this is a post-bomb hot-cloud phenomenon also foundmore » in recent EB spectroscopy in the ultraviolet.« less

  5. Plasma Cytokines Correlated With Disease Characteristics, Progression-Free Survival, and Overall Survival in Testicular Germ-Cell Tumor Patients.

    PubMed

    Svetlovska, Daniela; Miskovska, Viera; Cholujova, Dana; Gronesova, Paulina; Cingelova, Silvia; Chovanec, Michal; Sycova-Mila, Zuzana; Obertova, Jana; Palacka, Patrik; Rajec, Jan; Kalavska, Katarina; Usakova, Vanda; Luha, Jan; Ondrus, Dalibor; Spanik, Stanislav; Mardiak, Jozef; Mego, Michal

    2017-06-01

    Cytokines are the communicators of immune system and are involved in all immune responses. The aim of this study was to assess the correlation among plasma cytokines, patient and tumor characteristics, and clinical outcome in chemonaive testicular germ-cell tumor (TGCT) patients. This study included 92 metastatic chemotherapy-naive TGCT patients treated with platinum-based chemotherapy from July 2010 to March 2014. Plasma was isolated before first administration of chemotherapy, and the concentration of 51 plasma cytokines were analyzed using multiplex bead arrays. At a median follow-up of 33.2 months (range, 0.1-54.8 months), 10.9% of patients experienced disease progression, and 7.6% died. Several cytokines were associated with different baseline clinicopathologic features. Elevated plasma levels of interferon (IFN)-α2, interleukin (IL)-2Rα, IL-16, hepatocyte growth factor (HGF), and monocyte chemotactic protein (MCP)-3 were significantly associated with worse progression-free survival and overall survival (OS). Moreover, elevated levels of stem-cell growth factor (SCGF)-β were also associated with worse OS. Patients with elevated levels of all 6 cytokines experienced significantly worse outcomes compared to patients who had fewer than 6 cytokines elevated (hazard ratio = 12.06; 95% confidence interval, 7.39-19.49; P = .002 for progression-free survival, and hazard ratio = 39.65; 95% confidence interval, 25.03-62.18; P < .00001 for OS, respectively). Results were independent of International Germ Cell Cancer Collaborative Group criteria. We found a correlation among progression free-survival, OS, and circulating cytokines in TGCT. This suggests the existence an association between plasma cytokines and baseline clinicopathologic features in TGCT. Plasma cytokines could be used for identification of high-risk patients who are candidates for new therapeutic approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Chemotherapy Regimen Extends Survival in Advanced Pancreatic Cancer Patients

    Cancer.gov

    A four-drug chemotherapy regimen has produced the longest improvement in survival ever seen in a phase III clinical trial of patients with metastatic pancreatic cancer, one of the deadliest types of cancer.

  7. Effect of previous history of cancer on survival of patients with a second cancer of the head and neck.

    PubMed

    Jégu, Jérémie; Belot, Aurélien; Borel, Christian; Daubisse-Marliac, Laetitia; Trétarre, Brigitte; Ganry, Olivier; Guizard, Anne-Valérie; Bara, Simona; Troussard, Xavier; Bouvier, Véronique; Woronoff, Anne-Sophie; Colonna, Marc; Velten, Michel

    2015-05-01

    To provide head and neck squamous cell carcinoma (HNSCC) survival estimates with respect to patient previous history of cancer. Data from ten French population-based cancer registries were used to establish a cohort of all male patients presenting with a HNSCC diagnosed between 1989 and 2004. Vital status was updated until December 31, 2007. The 5-year overall and net survival estimates were assessed using the Kaplan-Meier and Pohar-Perme estimators, respectively. Multivariate Cox regression models were used to assess the effect of cancer history adjusted for age and year of HNSCC diagnosis. Among the cases of HNSCC, 5553 were localized in the oral cavity, 3646 in the oropharynx, 3793 in the hypopharynx and 4550 in the larynx. From 11.0% to 16.8% of patients presented with a previous history of cancer according to HNSCC. Overall and net survival were closely tied to the presence, or not, of a previous cancer. For example, for carcinoma of the oral cavity, the five-year overall survival was 14.0%, 5.9% and 36.7% in case of previous lung cancer, oesophagus cancer or no cancer history, respectively. Multivariate analyses showed that previous history of cancer was a prognosis factor independent of age and year of diagnosis (p<.001). Previous history of cancer is strongly associated with survival among HNSCC patients. Survival estimates based on patients' previous history of cancer will enable clinicians to assess more precisely the prognosis of their patients with respect to this major comorbid condition. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Tumour cell dormancy as a contributor to the reduced survival of GBM patients who received standard therapy.

    PubMed

    Tong, Luqing; Yi, Li; Liu, Peidong; Abeysekera, Iruni Roshanie; Hai, Long; Li, Tao; Tao, Zhennan; Ma, Haiwen; Xie, Yang; Huang, Yubao; Yu, Shengping; Li, Jiabo; Yuan, Feng; Yang, Xuejun

    2018-07-01

    Glioblastoma multiforme (GBM) is a fatal cancer with varying life expectancy, even for patients undergoing the same standard therapy. Identification of differentially expressed genes in GBM patients with different survival rates may benefit the development of effective therapeutic strategies. In the present study, key pathways and genes correlated with survival in GBM patients were screened with bioinformatic analysis. Included in the study were 136 eligible patients who had undertaken surgical resection of GBM followed by temozolomide (TMZ) chemoradiation and long-term therapy with TMZ. A total of 383 differentially expressed genes (DEGs) related to GBM survival were identified. Gene Ontology and pathway enrichment analysis as well as hub gene screening and module analysis were performed. As expected, angiogenesis and migration of GBM cells were closely correlated with a poor prognosis. Importantly, the results also indicated that cell dormancy was an essential contributor to the reduced survival of GBM patients. Given the lack of specific targeted genes and pathways known to be involved in tumour cell dormancy, we proposed enriched candidate genes related to the negative regulation of cell proliferation, signalling pathways regulating pluripotency of stem cells and neuroactive ligand-receptor interaction, and 3 hub genes (FTH1, GRM1 and DDIT3). Maintaining persistent cell dormancy or preventing tumour cells from entering dormancy during chemoradiation should be a promising therapeutic strategy.

  9. Disease-Free Survival after Hepatic Resection in Hepatocellular Carcinoma Patients: A Prediction Approach Using Artificial Neural Network

    PubMed Central

    Ho, Wen-Hsien; Lee, King-Teh; Chen, Hong-Yaw; Ho, Te-Wei; Chiu, Herng-Chia

    2012-01-01

    Background A database for hepatocellular carcinoma (HCC) patients who had received hepatic resection was used to develop prediction models for 1-, 3- and 5-year disease-free survival based on a set of clinical parameters for this patient group. Methods The three prediction models included an artificial neural network (ANN) model, a logistic regression (LR) model, and a decision tree (DT) model. Data for 427, 354 and 297 HCC patients with histories of 1-, 3- and 5-year disease-free survival after hepatic resection, respectively, were extracted from the HCC patient database. From each of the three groups, 80% of the cases (342, 283 and 238 cases of 1-, 3- and 5-year disease-free survival, respectively) were selected to provide training data for the prediction models. The remaining 20% of cases in each group (85, 71 and 59 cases in the three respective groups) were assigned to validation groups for performance comparisons of the three models. Area under receiver operating characteristics curve (AUROC) was used as the performance index for evaluating the three models. Conclusions The ANN model outperformed the LR and DT models in terms of prediction accuracy. This study demonstrated the feasibility of using ANNs in medical decision support systems for predicting disease-free survival based on clinical databases in HCC patients who have received hepatic resection. PMID:22235270

  10. Tracheostomy mechanical ventilation in patients with amyotrophic lateral sclerosis: clinical features and survival analysis.

    PubMed

    Spataro, Rossella; Bono, Valeria; Marchese, Santino; La Bella, Vincenzo

    2012-12-15

    Tracheostomy mechanical ventilation (TMV) is performed in amyotrophic lateral sclerosis (ALS) patients with a respiratory failure or when the non-invasive ventilation (NIV) is no longer effective. We evaluated the clinical characteristics and survival of a cohort of tracheostomized ALS patients, followed in a single ALS Clinical Center. Between 2001 and 2010, 87 out of 279 ALS patients were submitted to TMV. Onset was spinal in 62 and bulbar in 25. After tracheostomy, most patients were followed up through telephone interviews to caregivers. A complete survival analysis could be performed in fifty-two TMV patients. 31.3% ALS patients underwent tracheostomy, with a male prevalence (M/F=1.69) and a median age of 61 years (interquartile range=47-66). After tracheostomy, nearly all patients were under home care. TMV ALS patients were more likely than non-tracheostomized (NT) patients to be implanted with a PEG device, although the bulbar-/spinal-onset ratio did not differ between the two groups. Kaplan-Meyer analysis showed that tracheostomy increases median survival (TMV, 47 months vs NT, 31 months, p=0.008), with the greatest effect in patients younger than 60 at onset (TMV ≤ 60 years, 57.5 months vs NT ≤ 60 years, 38.5 months, p=0.002). TMV is increasingly performed in ALS patients. Nearly all TMV patients live at home and most of them are fed through a PEG device. Survival after tracheostomy is generally increased, with the stronger effect in patients younger than 60. This survival advantage is apparently lost when TMV is performed in patients older than 60. The results of this study might be useful for the decision-making process of patients and their families about this advanced palliative care. Copyright © 2012. Published by Elsevier B.V.

  11. Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis.

    PubMed

    Calman, Lynn; Beaver, Kinta; Hind, Daniel; Lorigan, Paul; Roberts, Chris; Lloyd-Jones, Myfanwy

    2011-12-01

    The burden of lung cancer is high for patients and carers. Care after treatment may have the potential to impact on this. We reviewed the published literature on follow-up strategies intended to improve survival and quality of life. We systematically reviewed studies comparing follow-up regimes in lung cancer. Primary outcomes were overall survival (comparing more intensive versus less intensive follow-up) and survival comparing symptomatic with asymptomatic recurrence. Quality of life was identified as a secondary outcome measure. Hazard ratios (HRs) and 95% confidence intervals from eligible studies were synthesized. Nine studies that examined the role of more intensive follow-up for patients with lung cancer were included (eight observational studies and one randomized controlled trial). The studies of curative resection included patients with non-small cell lung cancer Stages I to III disease, and studies of palliative treatment follow-up included limited and extensive stage patients with small cell lung cancer. A total of 1669 patients were included in the studies. Follow-up programs were heterogeneous and multifaceted. A nonsignificant trend for intensive follow-up to improve survival was identified, for the curative intent treatment subgroup (HR: 0.83; 95% confidence interval: 0.66-1.05). Asymptomatic recurrence was associated with increased survival, which was statistically significant HR: 0.61 (0.50-0.74) (p < 0.01); quality of life was only assessed in one study. This meta-analysis must be interpreted with caution due to the potential for bias in the included studies: observed benefit may be due to systematic differences in outcomes rather than intervention effects. Some benefit was noted from intensive follow-up strategies. More robust data, in the form of randomized controlled trials, are needed to confirm these findings as the review is based primarily on observational studies. Future research should also include patient-centered outcomes to

  12. Long-Term Survival, Quality of Life, and Quality-Adjusted Survival in Critically Ill Patients With Cancer.

    PubMed

    Normilio-Silva, Karina; de Figueiredo, Adelaide Cristina; Pedroso-de-Lima, Antonio Carlos; Tunes-da-Silva, Gisela; Nunes da Silva, Adriana; Delgado Dias Levites, Andresa; de-Simone, Ana Tereza; Lopes Safra, Patrícia; Zancani, Roberta; Tonini, Paula Camilla; Vasconcelos de Andrade E Silva, Ulysses; Buosi Silva, Thiago; Martins Giorgi, Juliana; Eluf-Neto, José; Costa, Anderson; Abrahão Hajjar, Ludhmila; Biasi Cavalcanti, Alexandre

    2016-07-01

    To assess the long-term survival, health-related quality of life, and quality-adjusted life years of cancer patients admitted to ICUs. Prospective cohort. Two cancer specialized ICUs in Brazil. A total of 792 participants. None. The health-related quality of life before ICU admission; at 15 days; and at 3, 6, 12, and 18 months was assessed with the EQ-5D-3L. In addition, the vital status was assessed at 24 months. The mean age of the subjects was 61.6 ± 14.3 years, 42.5% were female subjects and half were admitted after elective surgery. The mean Simplified Acute Physiology Score 3 was 47.4 ± 15.6. Survival at 12 and 18 months was 42.4% and 38.1%, respectively. The mean EQ-5D-3L utility measure before admission to the ICU was 0.47 ± 0.43, at 15 days it was 0.41 ± 0.44, at 90 days 0.56 ± 0.42, at 6 months 0.60 ± 0.41, at 12 months 0.67 ± 0.35, and at 18 months 0.67 ± 0.35. The probabilities for attaining 12 and 18 months of quality-adjusted survival were 30.1% and 19.1%, respectively. There were statistically significant differences in survival time and quality-adjusted life years according to all assessed baseline characteristics (ICU admission after elective surgery, emergency surgery, or medical admission; Simplified Acute Physiology Score 3; cancer extension; cancer status; previous surgery; previous chemotherapy; previous radiotherapy; performance status; and previous health-related quality of life). Only the previous health-related quality of life and performance status were associated with the health-related quality of life during the 18-month follow-up. Long-term survival, health-related quality of life, and quality-adjusted life year expectancy of cancer patients admitted to the ICU are limited. Nevertheless, these clinical outcomes exhibit wide variability among patients and are associated with simple characteristics present at the time of ICU admission, which may help healthcare professionals estimate patients

  13. Inhibition of intestinal epithelial apoptosis improves survival in a murine model of radiation combined injury.

    PubMed

    Jung, Enjae; Perrone, Erin E; Brahmamdan, Pavan; McDonough, Jacquelyn S; Leathersich, Ann M; Dominguez, Jessica A; Clark, Andrew T; Fox, Amy C; Dunne, W Michael; Hotchkiss, Richard S; Coopersmith, Craig M

    2013-01-01

    World conditions place large populations at risk from ionizing radiation (IR) from detonation of dirty bombs or nuclear devices. In a subgroup of patients, ionizing radiation exposure would be followed by a secondary infection. The effects of radiation combined injury are potentially more lethal than either insult in isolation. The purpose of this study was to determine mechanisms of mortality and possible therapeutic targets in radiation combined injury. Mice were exposed to IR with 2.5 Gray (Gy) followed four days later by intratracheal methicillin-resistant Staphylococcus aureus (MRSA). While either IR or MRSA alone yielded 100% survival, animals with radiation combined injury had 53% survival (p = 0.01). Compared to IR or MRSA alone, mice with radiation combined injury had increased gut apoptosis, local and systemic bacterial burden, decreased splenic CD4 T cells, CD8 T cells, B cells, NK cells, and dendritic cells, and increased BAL and systemic IL-6 and G-CSF. In contrast, radiation combined injury did not alter lymphocyte apoptosis, pulmonary injury, or intestinal proliferation compared to IR or MRSA alone. In light of the synergistic increase in gut apoptosis following radiation combined injury, transgenic mice that overexpress Bcl-2 in their intestine and wild type mice were subjected to IR followed by MRSA. Bcl-2 mice had decreased gut apoptosis and improved survival compared to WT mice (92% vs. 42%; p<0.01). These data demonstrate that radiation combined injury results in significantly higher mortality than could be predicted based upon either IR or MRSA infection alone, and that preventing gut apoptosis may be a potential therapeutic target.

  14. Inhibition of Intestinal Epithelial Apoptosis Improves Survival in a Murine Model of Radiation Combined Injury

    PubMed Central

    Jung, Enjae; Perrone, Erin E.; Brahmamdan, Pavan; McDonough, Jacquelyn S.; Leathersich, Ann M.; Dominguez, Jessica A.; Clark, Andrew T.; Fox, Amy C.; Dunne, W. Michael; Hotchkiss, Richard S.; Coopersmith, Craig M.

    2013-01-01

    World conditions place large populations at risk from ionizing radiation (IR) from detonation of dirty bombs or nuclear devices. In a subgroup of patients, ionizing radiation exposure would be followed by a secondary infection. The effects of radiation combined injury are potentially more lethal than either insult in isolation. The purpose of this study was to determine mechanisms of mortality and possible therapeutic targets in radiation combined injury. Mice were exposed to IR with 2.5 Gray (Gy) followed four days later by intratracheal methicillin-resistant Staphylococcus aureus (MRSA). While either IR or MRSA alone yielded 100% survival, animals with radiation combined injury had 53% survival (p = 0.01). Compared to IR or MRSA alone, mice with radiation combined injury had increased gut apoptosis, local and systemic bacterial burden, decreased splenic CD4 T cells, CD8 T cells, B cells, NK cells, and dendritic cells, and increased BAL and systemic IL-6 and G-CSF. In contrast, radiation combined injury did not alter lymphocyte apoptosis, pulmonary injury, or intestinal proliferation compared to IR or MRSA alone. In light of the synergistic increase in gut apoptosis following radiation combined injury, transgenic mice that overexpress Bcl-2 in their intestine and wild type mice were subjected to IR followed by MRSA. Bcl-2 mice had decreased gut apoptosis and improved survival compared to WT mice (92% vs. 42%; p<0.01). These data demonstrate that radiation combined injury results in significantly higher mortality than could be predicted based upon either IR or MRSA infection alone, and that preventing gut apoptosis may be a potential therapeutic target. PMID:24204769

  15. Bronchoscopic management of patients with symptomatic airway stenosis and prognostic factors for survival.

    PubMed

    Okiror, Lawrence; Jiang, Li; Oswald, Nicola; Bille, Andrea; Rajesh, Pala; Bishay, Ehab; Steyn, Richard; Naidu, Babu; Kalkat, Maninder

    2015-05-01

    Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival. This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method. Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death. Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Relation between hypermetabolism, cachexia, and survival in cancer patients: a prospective study in 390 cancer patients before initiation of anticancer therapy.

    PubMed

    Vazeille, Clara; Jouinot, Anne; Durand, Jean-Philippe; Neveux, Nathalie; Boudou-Rouquette, Pascaline; Huillard, Olivier; Alexandre, Jérôme; Cynober, Luc; Goldwasser, François

    2017-05-01

    Background: Cachexia is a major cause of death in cancer patients. The role of hypermetabolism in cancer cachexia remains unclear. Objective: We studied the relation between resting energy expenditure (REE), the estimated energy balance, clinical and biological markers of cachexia, and survival. Design: REE was measured with the use of indirect calorimetry in cancer patients before the initiation of anticancer therapies. Hypermetabolic, normometabolic, and hypometabolic patients were identified with the use of Boothby's standard. Weight loss, performance status (PS), C-reactive protein (CRP), albumin, the nutritional risk index, daily energy intake, energy balance (equal to daily energy intakes minus the REE), and survival were recorded. Results: Of 390 enrolled patients, 49% of subjects were hypermetabolic, 30% of subjects were normometabolic, and 21% of subjects were hypometabolic. Mean daily energy intakes did not differ significantly between the 3 groups. Hypermetabolic patients, compared with normometabolic patients, were more likely to have a negative energy balance [45% compared with 32%, respectively; OR: 1.74 (95% CI: 1.05, 2.91); P = 0.024], weight loss >5% [48% compared with 34%, respectively; OR: 1.83 (95% CI: 1.11, 3.04); P = 0.013], PS ≥2 [40% compared with 29%, respectively; OR: 1.70 (95% CI: 1.01, 2.88); P = 0.038], and CRP concentrations ≥10 mg/L [52% compared with 33%, respectively; OR: 2.2 (95% CI: 1.33, 3.66); P = 0.001]. In metastatic patients, compared with normometabolism, hypermetabolism was associated with a reduced median survival [14.6 compared with 21.4 mo, respectively; OR: 1.48 (95% CI: 1.01, 2.17); P = 0.044]. Conclusions: Hypermetabolism is correlated with clinical and biological markers of cancer cachexia and is associated with a shorter survival in metastatic cancer patients. The development of therapeutic strategies that aim to blunt hypermetabolism appears warranted. This trial was registered at www.controlled-trials.com as

  17. Pancreatic cancer patient survival correlates with DNA methylation of pancreas development genes.

    PubMed

    Thompson, Michael J; Rubbi, Liudmilla; Dawson, David W; Donahue, Timothy R; Pellegrini, Matteo

    2015-01-01

    DNA methylation is an epigenetic mark associated with regulation of transcription and genome structure. These markers have been investigated in a variety of cancer settings for their utility in differentiating normal tissue from tumor tissue. Here, we examine the direct correlation between DNA methylation and patient survival. We find that changes in the DNA methylation of key pancreatic developmental genes are strongly associated with patient survival.

  18. Incidence of bone metastases and survival after a diagnosis of bone metastases in breast cancer patients.

    PubMed

    Harries, M; Taylor, A; Holmberg, L; Agbaje, O; Garmo, H; Kabilan, S; Purushotham, A

    2014-08-01

    Bone is the most common metastatic site associated with breast cancer. Using a database of women with breast cancer treated at Guy's Hospital, London 1976-2006 and followed until end 2010, we determined incidence of and survival after bone metastases. We calculated cumulative incidence of bone metastases considering death without prior bone metastases as a competing risk. Risk of bone metastases was modelled through Cox-regression. Survival after bone metastases diagnosis was calculated using Kaplan-Meier methodology. Of the 7064 women, 589 (22%) developed bone metastases during 8.4 years (mean). Incidence of bone metastases was significantly higher in younger women, tumour size >5 cm, higher tumour grade, lobular carcinoma and ≥ four positive nodes, but was not affected by hormone receptor status. Median survival after bone metastases diagnosis was 2.3 years in women with bone-only metastases compared with <1 year in women with visceral and bone metastases. There was a trend for decreased survival for patients who developed visceral metastases early, and proportionately fewer patients in this group. Incidence of bone metastases has decreased but bone metastases remain a highly relevant clinical problem due to the large number of patients being diagnosed with breast cancer. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Lean body mass predicts long-term survival in Chinese patients on peritoneal dialysis.

    PubMed

    Huang, Jenq-Wen; Lien, Yu-Chung; Wu, Hon-Yen; Yen, Chung-Jen; Pan, Chun-Chun; Hung, Tsai-Wei; Su, Chi-Ting; Chiang, Chih-Kang; Cheng, Hui-Teng; Hung, Kuan-Yu

    2013-01-01

    Reduced lean body mass (LBM) is one of the main indicators in malnutrition inflammation syndrome among patients on dialysis. However, the influence of LBM on peritoneal dialysis (PD) patients' outcomes and the factors related to increasing LBM are seldom reported. We enrolled 103 incident PD patients between 2002 and 2003, and followed them until December 2011. Clinical characteristics, PD-associated parameters, residual renal function, and serum chemistry profiles of each patient were collected at 1 month and 1 year after initiating PD. LBM was estimated using creatinine index corrected with body weight. Multiple linear regression analysis, Kaplan-Meier survival analysis, and Cox regression proportional hazard analysis were used to define independent variables and compare survival between groups. Using the median LBM value (70% for men and 64% for women), patients were divided into group 1 (n = 52; low LBM) and group 2 (n = 51; high LBM). Group 1 patients had higher rates of peritonitis (1.6 vs. 1.1/100 patient months; p<0.05) and hospitalization (14.6 vs. 9.7/100 patient months; p<0.05). Group 1 patients also had shorter overall survival and technique survival (p<0.01). Each percentage point increase in LBM reduced the hazard ratio for mortality by 8% after adjustment for diabetes, age, sex, and body mass index (BMI). Changes in residual renal function and protein catabolic rate were independently associated with changes in LBM in the first year of PD. LBM serves as a good parameter in addition to BMI to predict the survival of patients on PD. Preserving residual renal function and increasing protein intake can increase LBM.

  20. An Aggressive Surgical Approach Leads to Improved Survival in Patients With Gallbladder Cancer

    PubMed Central

    Dixon, Elijah; Vollmer, Charles M.; Sahajpal, Ajay; Cattral, Mark; Grant, David; Doig, Christopher; Hemming, Al; Taylor, Bryce; Langer, Bernard; Greig, Paul; Gallinger, Steven

    2005-01-01

    Objective: To determine if an aggressive surgical approach, with an increase in R0 resections, has resulted in improved survival for patients with gallbladder cancer. Summary Background Data: Many physicians express a relatively nihilistic approach to the treatment of gallbladder cancer; consensus among surgeons regarding the indications for a radical surgical approach has not been reached. Methods: A retrospective review of all patients with gallbladder cancer admitted during the past 12 years was conducted. Ninety-nine patients were identified. Cases treated during the 12-year period 1990 to 2002 were divided into 2 time-period (TP) cohorts, those treated in the first 6 years (TP1, N = 35) and those treated in the last 6 years (TP2, N = 64). Results: Disease stratification by stage and other demographic features were similar in the 2 time periods. An operation with curative intent was performed on 38 patients. Nine (26%) R0 resections were performed in TP1 and 24 (38%) in TP2. The number of liver resections, as well as the frequency of extrahepatic biliary resections, was greater in TP2 (P < 0.04). In both time periods, an R0 resection was associated with improved survival (P < 0.02 TP1, P < 0.0001 TP2). Overall survival of all patients in TP2 was significantly greater than in TP1 (P < 0.03), with a median survival of 9 months in TP1 and 17 months in TP2. The median 5-year survival in TP1 was 7%, and 35% in TP2. The surgical mortality rate for the entire cohort was 2%, with a 49% morbidity rate. Conclusions: A margin-negative, R0 resection leads to improved survival in patients with gallbladder cancer. PMID:15729060