Conditional survival in patients treated for gastric cancer with a curative intent.

BACKGROUND AND OBJECTIVES: Conditional survival (CS) provides the probability that a patient who has already survived a certain number of years after treatment will survive an additional number of years. We aim to study the CS of patients with gastric cancer. METHODS: Patients who underwent curative intent treatment for gastric cancer in a single institution between 2007 and 2018 were included in the analysis. The probability (CS) that a patient who has already survived x years will survive an additional y year, was calculated as CS (y/x) = S(x + y)/S(x). RESULTS: The probability of surviving an additional 3 years if a patient had already survived 1, 2, 3, 4, and 5 years after treatment were 64.2%, 74.5%, 81.6%, 83.2%, and 88.2%, respectively whereas the 4-, 5-, 6-, 7-, and 8-year actuarial OS were only 47.2%, 43.2%, 41%, 39.4%, and 38.2%, respectively. The independent prognostic factors associated with poor survival were age >60 years, T stage ≥T3, N stage ≥N2, proximal tumor location, and lymph node ratio > 0.18. Patients with these high-risk features showed the greatest increase in CS3 over time. CONCLUSION: CS estimates provided a more dynamic prognostic information over time for patients treated for gastric cancer with curative intent.

Characteristics of Patients Involved in Physical Assault in an Acute Inpatient Psychiatric Setting.

BACKGROUND: Although aggressive behavior in psychiatric settings is a major concern, very few studies have focused exclusively on physical assault in a general inpatient psychiatric population. OBJECTIVES: This study had 3 main goals: (1) to evaluate the prevalence of assaultive behavior in an acute psychiatric hospital; (2) to identify the clinical and socio-demographic factors associated with assaultive behavior during hospitalization; and (3) to explore whether a diagnosis of schizophrenia spectrum disorder increases the risk of assaultive behavior. METHODS: We conducted a retrospective chart review of patients admitted to acute units in a psychiatric hospital between 2009 and 2012. A subset of occurrence reports identified by a multidisciplinary team as "physical assault" was included in the analysis. Using logistic multivariate regression analysis, these patients were compared with a randomly selected nonassaultive control group, matched for length of stay to identify factors associated with assaultive behavior. RESULTS: Of 757 occurrence reports, 613 met criteria for significant assault committed by 356 patients over 309,552 patient days. The assault incident density was 1.98 per 1000 patient days. In the logistic regression model of best fit, the factors significantly associated with assaultive behavior were age, legal status, and substance use. A diagnosis of schizophrenia spectrum disorder was not significantly associated with assaultive behavior. CONCLUSIONS: Clinicians should take extra precautions for involuntarily admitted young patients with a history of substance use, as they are more likely to exhibit assaultive behavior. A diagnosis of schizophrenia spectrum disorder in itself is not significantly associated with assaultive behavior. Screening instruments such as the Dynamic Appraisal of Situational Aggression may be useful in assessing risk of assault.

Metallothioneins and zinc dysregulation contribute to neurodevelopmental damage in a model of perinatal viral infection.

Neonatal Borna disease (NBD) virus infection in the Lewis rat results in life-long viral persistence and causes behavioral and neurodevelopmental abnormalities. A hallmark of the disorder is progressive loss of cerebellar Purkinje and dentate gyrus granule cells. Findings of increased brain metallothionein-I and -II (MT-I/-II) mRNA expression in cDNA microarray experiments led us to investigate MT isoforms and their relationship to brain zinc metabolism, cellular toxicity, and neurodevelopmental abnormalities in this model. Real-time PCR confirmed marked induction of MT-I/-II mRNA expression in the brains of NBD rats (40.5-fold increase in cerebellum, p<0.0001; 6.8-fold increase in hippocampus, p=0.003; and 9.5-fold increase in striatum, p=0.0012), whereas a trend toward decreased MT-III mRNA was found in hippocampus (1.25-fold decrease, p=0.0841). Double label immunofluorescence revealed prominent MT-I/-II expression in astrocytes throughout the brain; MT-III protein was decreased in granule cell neurons and increased in astrocytes, with differential subcellular distribution from cytoplasmic to nuclear compartments in NBD rat hippocampus. Modified Timm staining of hippocampus revealed reduced zinc in mossy fiber projections to the hilus and CA3, accumulation of zinc in glial cells and degenerating granule cell somata, and robust mossy fiber sprouting into the inner molecular layer of the dentate gyrus. Zinc Transporter 3 (ZnT-3) mRNA expression was decreased in hippocampus (2.3-fold decrease, p= 0.0065); staining for its correlate protein was reduced in hippocampal mossy fibers. Furthermore, 2 molecules implicated in axonal pathfinding and mossy fiber sprouting, the extracellular matrix glycoprotein, tenascin-R (TN-R), and the hyaluronan receptor CD44, were increased in NBD hippocampal neuropil. Abnormal zinc metabolism and mechanisms of neuroplasticity may contribute to the pathogenesis of disease in this model, raising more general implications for neurodevelopmental damage following viral infections in early life.

Regional patterns of pectoralis fascicle strain in the pigeon Columba livia during level flight.

Regional fascicle strains were recorded in vivo from the pectoralis of carneau pigeons using sonomicrometry during level slow flight, together with regional electromyography (EMG) and deltopectoral crest (DPC) strain measurements of whole muscle force. Fascicle strain measurements were obtained at four sites within the pectoralis: the anterior (Ant), middle (Mid) and posterior (Post) sternobrachium (SB), and the smaller thoracobrachium (TB). Strains were also recorded along the intramuscular aponeurosis of the pectoralis to assess its 'in-series' compliance with respect to strains of Post SB and TB fascicles. In-series segment strains were also obtained along Ant SB and Mid SB fascicles, which insert directly on the DPC without attaching to the intramuscular aponeurosis. In-series segment strains differed from 2% to 17.2%, averaging differences of 6.1% at the Ant SB site and 1.4% at the Mid SB site. Temporal patterns of in-series fascicle segment strain were similar at both sites. Regional fascicle strains also exhibited similar temporal patterns of lengthening and shortening and were most uniform in magnitude at the Ant SB, Mid SB and TB sites (total strain: 33.7%, 35.9% and 33.2% respectively), but were smaller at the Post SB site (24.4%). Strains measured along the aponeurosis tracked the patterns of contractile fascicle strain but were significantly lower in magnitude (19.1%). Fascicle lengthening strains (+25.4%) greatly exceeded net shortening strains (-6.5%) at all sites. Much of the variation in regional fascicle strain patterns resulted from variation of in vivo recording sites among individual animals, despite attempts to define consistent regions for obtaining in vivo recordings. No significant variation in EMG activation onset was found, but deactivation of the Ant SB occurred before the other muscle sites. Even so, the range of variation was small, with all muscle regions being activated midway through lengthening (upstroke) and turned off midway through shortening (downstroke). While subtle differences in the timing and rate of fascicle strain may relate to differing functional roles of the pectoralis, regional patterns of fascicle strain and activation suggest a generally uniform role for the muscle as a whole throughout the wingbeat cycle. Shorter fascicles located in more posterior regions of the muscle underwent generally similar strains as longer fascicles located in more anterior SB regions. The resulting differences in fiber length were accommodated by strain in the intramuscular aponeurosis and rotation of the pectoralis insertion with respect to the origin. As a result, longer Ant and Mid SB fascicles were estimated to contribute substantially more work per unit mass than shorter Post SB and TB fascicles. When the mass fractions of these regions are accounted for, our regional fascicle strain measurements show that the anterior regions of the pectoralis likely contribute 76%, and the posterior regions 24%, of the muscle's total work output. When adjusted for mass fraction and regional fascicle strain, pectoralis work averaged 24.7+/-5.1 J kg(-1) (206.6+/-43.5 W kg(-1)) during level slow (approximately 4-5 m s(-1)) flight.