Multidisciplinary treatment of olfactory neuroblastoma: Patterns of failure and management of recurrence.

PURPOSE: Esthesioneuroblastoma is an uncommon malignancy of the head and neck for which there is no defined treatment protocol. The purpose of this study is to report our experience with the treatment and patterns of failure of this disease. METHODS AND MATERIALS: From 1994 to 2012, 37 previously unreported patients with esthesioneuroblastoma were evaluated, and 32 eventually treated for cure at 2 academic medical centers. All patients were staged with Kadish criteria. The mean and median follow-ups were 96.1 and 76.5 months respectively (range 6-240 months). RESULTS: The Kadish stage was A in 6 patients, B in 13 patients, and C in 13 patients. Four patients were initially treated with concurrent chemo-radiation therapy. Twenty-eight patients were treated with primary surgery. Two (2) underwent open medial maxillectomy and 26 underwent craniofacial resection (open - 17, endoscopic - 9). Three patients received curative surgical resection only. Seven patients failed either within the cranial axis or distantly, 6 of the 7 are dead of disease, 10-194 months following initial treatment. Six patients had isolated neck recurrences, 4/6 were salvaged with neck dissection and additional chemo-radiation and remain alive 30-194 months following initial treatment. Estimated overall survival rate at 10 years was 78% based on Kadish and T stages. CONCLUSION: In this retrospective analysis of 32 patients, Kadish stage C and stage T3/T4 tumors were associated with worse outcome. Total radiation dose of 60 Gy, margin status, patient age, were not found to have significant prognostic value.

A candidate prostate cancer susceptibility gene at chromosome 17p.

It is difficult to identify genes that predispose to prostate cancer due to late age at diagnosis, presence of phenocopies within high-risk pedigrees and genetic complexity. A genome-wide scan of large, high-risk pedigrees from Utah has provided evidence for linkage to a locus on chromosome 17p. We carried out positional cloning and mutation screening within the refined interval, identifying a gene, ELAC2, harboring mutations (including a frameshift and a nonconservative missense change) that segregate with prostate cancer in two pedigrees. In addition, two common missense variants in the gene are associated with the occurrence of prostate cancer. ELAC2 is a member of an uncharacterized gene family predicted to encode a metal-dependent hydrolase domain that is conserved among eukaryotes, archaebacteria and eubacteria. The gene product bears amino acid sequence similarity to two better understood protein families, namely the PSO2 (SNM1) DNA interstrand crosslink repair proteins and the 73-kD subunit of mRNA 3' end cleavage and polyadenylation specificity factor (CPSF73).

Ethnic identity and mental health stigma among Black adults in the United States.

Objectives ­: Mental illness stigma is a barrier to engagement in mental health services. This study assesses our hypothesis that specific ethnic identity dimensions influences mental health behavior including stigma. Methods ­: We performed an online cross sectional observational study among Black adults (n = 248, ages 18-65). We examined the relationship between an individual's approach to their racial identity in the community and stigma behavior towards mental health; generalized linear models were performed. We assessed demographic characteristics as moderators of the primary association. Results ­: Black adults with higher centrality reported lower past stigma behavior (RR=1.57, CI: 1.11-2.21, P = 0.01), but higher future intended stigma behavior (RR=0.93, CI: 0.88-0.99, P = 0.02). Majority of respondents reported high centrality and high assimilation; however, assimilation did not appear to correlate with mental health stigma behavior. Age, education and ethnicity appeared to have a limited moderating effect on the association between centrality and stigma behavior. Conclusions ­: Centrality was associated with mental health stigma behavior. By understanding the intersecting characteristics that may increase the likelihood for mental illness stigma, we will be better able to reduce mental illness stigma and optimize engagement in mental health services.

Reporting of sex and gender in randomized controlled trials in Canada: a cross-sectional methods study.

BACKGROUND: Accurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants. METHODS: We searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second. RESULTS: The search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12-6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined "sex" and/or "gender." No publication carried out a comprehensive sex and gender analysis. CONCLUSIONS: Findings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research.

Patterns of death among suicide attempters, a psychiatric population and a general population.

This epidemeological study examines patterns of mortality for a population of suicide attempters, a psychiatric population without suicide attempts, and a general population without psychiatric histories in order to clarify earlier reports of differential risks of death associated with these groups. Mortality patterns were investigated over an 11-year period in terms of demographic characteristics and rates of death by various causes. Suicidal deaths were given special attention to identify variables that may have predictive validity for suicide. The results indicate that the suicide attempter group represents a distinctive demographic and mortality entity from either the psychiatric or general populations, and accounts for much of the increased risk of death previously attributed to the psychiatric population. Further, premature deaths due to suicide are strongly associated with the suicide attempter group. The psychiatric and general populations differ in relatively insignificant ways. These results suggest that a profitable approach to the prevention of suicide would be to focus on individuals who were at high risk within the suicide attempter population. Longer-term follow-up of these individuals is necessary if deaths due to suicide are to be prevented. Difficulties associated with implementation of preventive follow-up programs are also discussed.

Weight gain patterns during twin gestation.

Few data are available about desirable weight gain during twin gestation. The present study addresses this issue through retrospective evaluation of 217 women pregnant with twins who delivered at Swedish Hospital Medical Center, Seattle, between 1982 and 1986. The purpose of the study was to identify an optimum total weight gain and an optimum weight gain pattern for normal twin gestation. A mean prenatal weight gain of 20 kg (44 lb) was associated with "optimum" outcome; optimum outcome was defined as a pregnancy lasting at least 37 weeks with the delivery of two living infants weighing greater than or equal to 2,500 gm each with 5-minute Apgar scores greater than or equal to 7. A weight gain curve for twin gestation was generated and compared with the standard curve for singleton pregnancy. While the weight gain curve during twin gestation was similar to the standard curve during the first half of pregnancy, increased weight gain began in the second trimester and continued to term. The weight gain pattern of twin gestations with less-than-optimum outcome paralleled that of the optimum outcome group until about 30 weeks' gestation, at which time weight gain slowed in women in the former group, whose mean total weight gain was 16.8 kg (37 lb).

Building a methods bridge between public policy analysis and healthy public policy.

The literature has only begun to consider what research is needed to support the development and implementation of healthy public policy initiatives. To date, a consistent methodological approach is recommended: multiple methods (document analysis and key informant interviews supplemented by quantitative data) with an aim toward understanding the perspective of key policy stakeholders. Currently, these methods are not the mainstay of policy analysis which is often driven more by a preference for technique (e.g., cost-benefit analysis) than by underlying epistemology or theory. Yet the explicit values of healthy public policy (intersectoral policy-making, public participation, etc.) suggest the importance of paying greater attention to epistemological and theoretical principles when making methodological choices.

Healthier work environments through action research.

A team of nurses and a university-based nurse researcher describe a nursing theory-based action research plan to promote a healthier work environment. The process combines research and practice to achieve desired outcomes within an acute-care setting.

Risks of mortality of suicide attempters compared with psychiatric and general populations.

This study compares mortality risk among suicide attempters, psychiatric patients, and members of the general population using demographic data from the Monroe County (New York) Psychiatric Case Register for 1960 to 1970. During this 11-year period there were 172 deaths reported for the suicide attempt group, 6, 108 for the Psychiatric Register population, and 58,542 for the general population. The relative risk of death from all causes of the suicide attempt group was nearly twice that of the general population and slightly higher than that of the psychiatric group. High risks of mortality were differentially associated with several demographic and treatment variables. Implications for predictive criteria and interventive strategies are discussed.

Linking research and practice through discussion.

PURPOSE: To describe the process and outcomes of a researcher-initiated discussion group with nurses in clinical practice. DESIGN: Descriptive case study. The study, which began in 1991, included one group of four acute care nurses. Between 1992-1996, three other groups of nurses participated. METHODS: Nurses in practice read and discussed articles from a program of research on breast cancer during a series of group sessions. The semi-structured sessions were tape-recorded. RESULTS: Participants suggested how to make article content more understandable to clinicians; they affirmed findings relevant to practice; and identified ways to integrate research in practice. CONCLUSIONS: Discussion served as a means for the researcher and nurses to connect the research-practice gap through learning the practice perspective and the process and value of research. Discussion groups are recommended to enhance science-based clinical practice.

The identification and characterization of four laccases from the plant pathogenic fungus Rhizoctonia solani.

Four distinct laccase genes, lcc1, lcc2, lcc3 and lcc4, have been identified in the fungus Rhizoctonia solani. Both cDNA and genomic copies of these genes were isolated and characterized. Hybridization analyses indicate that each of the four laccase genes is present in a single copy in the genome. The R. solani laccases can be divided into two groups based on their protein size, intron/exon organization, and transcriptional regulation. Three of these enzymes have been expressed in the fungus Aspergillus oryzae. Two of the recombinant laccases, r-lcc1 and r-lcc4, as well as the native lcc4 enzyme were purified and characterized. The purified proteins are homodimeric, comprised of two subunits of approximately 66kDa for lcc4 and 50-100kDa for the recombinant lcc1 protein. These laccases have spectral properties that are consistent with other blue copper proteins. With syringaldazine as a substrate, lcc4 has optimal activity at pH7, whereas lcc1 has optimal activity at pH6.