Significant understaging is seen in clinically staged T2N0 esophageal cancer patients undergoing esophagectomy.

This study aimed to determine the impact of preoperative staging on the treatment of clinical T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy. We reviewed a retrospective cohort of 27 patients treated at a single institution between 1999 and 2011. Clinical staging was performed with computed tomography, positron emission tomography, and endoscopic ultrasound. Patients were separated into two groups: neoadjuvant therapy followed by surgery (NEOSURG) and surgery alone (SURG). There were 11 patients (41%) in the NEOSURG group and 16 patients (59%) in the SURG group. In the NEOSURG group, three of 11 patients (27%) had a pathological complete response and eight (73%) were partial or nonresponders after neoadjuvant therapy. In the SURG group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged, and 1 (6%) was correctly staged. In the entire cohort, despite being clinically node negative, 14 of 27 patients (52%) had node-positive disease (5/11 [45%] in the NEOSURG group, and 9/16 [56%] in the SURG group). Overall survival rate was not statistically significant between the two groups (P = 0.96). Many cT2N0 patients are clinically understaged and show no preoperative evidence of node-positive disease. Consequently, neoadjuvant therapy may have a beneficial role in treatment.

Preoperative carboplatin and paclitaxel-based chemoradiotherapy for esophageal carcinoma: results of a modified CROSS regimen utilizing radiation doses greater than 41.4 Gy.

Trimodality therapy for resectable esophageal and gastroesophageal junction cancers utilizing preoperative radiotherapy with concurrent carboplatin and paclitaxel-based chemotherapy is being increasingly utilized secondary to the results of the phase III CROSS trial. However, there is a paucity of reports of this regimen as a component of chemoradiotherapy in North America. We aim to report on our clinical experience using a modified CROSS regimen with higher radiotherapy doses. Patients with advanced (cT2-cT4 or node positive) esophageal or gastroesophageal junction carcinoma who received preoperative carboplatin/paclitaxel-based chemoradiotherapy with radiation doses of greater than 41.4 Gray (Gy) followed by esophagectomy were identified from an institutional database. Patient, imaging, treatment, and tumor response characteristics were analyzed. Twenty-four patients were analyzed. All but one tumor had adenocarcinoma histology. The median radiation dose was 50.4 Gy. Pathologic complete response was achieved in 29% of patients, with all receiving 50.4 Gy. Three early postoperative deaths were seen, due in part to acute respiratory distress syndrome and all three patients received 50-50.4 Gy. With a median follow-up of 9.4 months (23 days-2 years), median survival was 24 months. Trimodality therapy utilizing concurrent carboplatin/paclitaxel with North American radiotherapy doses appeared to have similar pathologic complete response rates compared with the CROSS trial, but may be associated with higher toxicity. Although the sample size is small and further follow-up is necessary, radiation doses greater than 41.4 Gy may not be warranted secondary to a potentially increased risk of severe radiation-induced acute lung injury.

Diet characterisation of solitary bees on farmland: dietary specialisation predicts rarity.

Changes in agricultural practice across Europe and North America have been associated with declines in wild bee populations. Bee diet breadth has been associated with sensitivity to agricultural intensification, but much of this analysis has been conducted at the categorical level of generalist or specialist, and it is not clear to what extent the level of generalisation within generalist species is also associated with species persistence. We used pollen load analysis to quantify the pollen diets of wild solitary bees on 19 farms across southern England, UK. A total of 72 species of solitary bees were recorded, but only 31 species were abundant enough to allow for formal diet characterisation. The results broadly conformed to existing literature with the majority of species polylectic and collecting pollen from a wide range of plants. Pollen load analysis consistently identified pollens from more plant species and families from each bee species than direct observation of their foraging behaviour. After rarefaction to standardise pollen load sample sizes, diet breadth was significantly associated with frequency of occurrence, with more generalist bees present on more farms than less generalist bees. Our results show that the majority of bee species present on farmland in reasonable numbers are widely variable in their pollen choices, but that those with the broadest diet were present on the greatest number of farms. Increasing the diversity of plants included in agri-environment schemes may be necessary to provide a wider range of pollen resources in order to support a diverse bee community on farmland.

A comparison of techniques for assessing farmland bumblebee populations.

Agri-environment schemes have been implemented across the European Union in order to reverse declines in farmland biodiversity. To assess the impact of these schemes for bumblebees, accurate measures of their populations are required. Here, we compared bumblebee population estimates on 16 farms using three commonly used techniques: standardised line transects, coloured pan traps and molecular estimates of nest abundance. There was no significant correlation between the estimates obtained by the three techniques, suggesting that each technique captured a different aspect of local bumblebee population size and distribution in the landscape. Bumblebee abundance as observed on the transects was positively influenced by the number of flowers present on the transect. The number of bumblebees caught in pan traps was positively influenced by the density of flowers surrounding the trapping location and negatively influenced by wider landscape heterogeneity. Molecular estimates of the number of nests of Bombus terrestris and B. hortorum were positively associated with the proportion of the landscape covered in oilseed rape and field beans. Both direct survey techniques are strongly affected by floral abundance immediately around the survey site, potentially leading to misleading results if attempting to infer overall abundance in an area or on a farm. In contrast, whilst the molecular method suffers from an inability to detect sister pairs at low sample sizes, it appears to be unaffected by the abundance of forage and thus is the preferred survey technique.

Coping trajectories in later life: a 20-year predictive study.

OBJECTIVES AND METHOD: Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults' (n = 719; baseline M = 61 years) 20-year, intraindividual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories. RESULTS: Over the 20-year study interval, participants declined in the use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms, and fewer financial resources were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant. CONCLUSION: Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults' stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle-age.

Spatio-temporal distribution and emergence of beetles in arable fields in relation to soil moisture.

Predatory beetles contribute to the control of crop pests and are an important food resource for farmland birds. Many of these beetle species overwinter as larvae within agricultural soils, however, their spatio-temporal emergence patterns are poorly understood, even though such knowledge can assist with their management for biocontrol. Soil moisture is considered to be a key factor influencing oviposition site selection and larval survival. The time, density and spatial pattern of Carabidae and Staphylidae emergence was therefore measured across two fields and compared to soil moisture levels in the previous winter and adult distribution in the previous July. The mean density of Carabidae and Staphylidae that emerged between April and harvest within each field was 157 and 86 m-2, indicating that soils are an important over-wintering habitat for beneficial invertebrates and should be managed sympathetically if numbers are to be increased. Of the species that were sufficiently numerous to allow their spatial pattern to be analysed, all showed a heterogeneous emergence pattern, although patches with high emergence were stable over the sampling period. The distribution of eight species was influenced by soil moisture levels in the previous winter and eight species, although not the same, were spatially associated with the distribution of adults in the previous summer suggesting that the females selected oviposition areas with the appropriate soil wetness.

The role of large-scale spatially explicit and small-scale localized processes on the population dynamics of cereal aphids.

A field-scale study of the spatially explicit interaction between the carabid Poecilus cupreus Linnaeus, and two common aphid species (Sitobion avenae (Fabricius) and Metopolophium dirhodum (Walker)) in winter wheat was conducted. All three species showed considerable spatial pattern at the field scale. Activity-density of P. cupreus was an order of magnitude higher in the central part of the field compared to its periphery. Where P. cupreus activity-density was highest, S. avenae and M. dirhodum population peaks were delayed. Additionally, in the case of M. dirhodum, lower maximum counts were evident where P. cupreus activity-density was highest. An analysis of the movement of individual P. cupreus using release-recapture indicated that those beetles within the centre of the field exhibited reduced displacement, which may have caused the generation or maintenance of spatial pattern. Crop density was also measured throughout the field. Although crop density had no large-scale spatial pattern, its variability at the small-scale was consistent with an influence on aphid population dynamics. This study demonstrates empirically that both large-scale spatially explicit and small-scale localized processes influenced aphid population dynamics simultaneously.

Histological effects of tazarotene 0.1% cream vs. vehicle on photodamaged skin: a 6-month, multicentre, double-blind, randomized, vehicle-controlled study in patients with photodamaged facial skin.

BACKGROUND: Topical tazarotene has been shown to offer efficacy in ameliorating multiple effects of photodamage. OBJECTIVES: To evaluate the histological effects of tazarotene cream on photodamaged skin. METHODS: In this multicentre, double-blind, randomized, vehicle-controlled study, 50 patients with photodamaged facial skin (at least mild fine wrinkling and mottled hyperpigmentation, with at least one of these being moderate) were randomized to apply tazarotene 0.1% cream or vehicle cream to their face, once daily for 24 weeks. RESULTS: Blinded assessments showed that tazarotene was less likely than vehicle to be associated with an increase in keratinocytic and melanocytic atypia, and more likely than vehicle to be associated with a reduction in atypia. Between-group comparisons in distribution of change from baseline categories of severity were in favour of tazarotene (P = 0.055 for keratinocytic atypia, P = 0.034 for melanocytic atypia, and P < 0.001 for the number of granular cell layers). Compared with vehicle, tazarotene was associated with an increase in epidermal polarity (P = 0.008) and epidermal thickness (P = 0.012), and a tendency for stratum corneum compaction. Tazarotene was also associated with widened intercellular spaces (reported as epidermal oedema) relative to vehicle (P < 0.001). CONCLUSIONS: Treatment of photodamaged skin with tazarotene is associated with an amelioration of keratinocytic and melanocytic atypia, an improvement in epidermal polarity, and an increase in epidermal thickness.

The spatial dynamics of crop and ground active predatory arthropods and their aphid prey in winter wheat.

The distribution of aphid predators within arable fields has been previously examined using pitfall traps. With this technique predominantly larger invertebrate species are captured, especially Carabidae, but the technique provides no estimate of density unless mark-recapture is used. However, many other numerically important aphid predators occur in arable fields and relatively little is known about their distribution patterns nor whether they exhibit a density-dependent response to patches of cereal aphids. Identification of the most effective predators can allow management practices to be developed accordingly. In this study, the distribution of cereal aphids and their predators was examined by suction sampling within a field of winter wheat in Devon, UK, along with visual estimates of weed patchiness. Sampling was conducted on four occasions in 1999 across a grid of 128 sample locations. The distribution of 11 predatory taxa from the Carabidae, Staphylinidae and Linyphiidae was examined. Additionally, the total number of aphid predators and a predation index were used in these analyses. Carabid adults and larvae, along with staphylinid larvae showed the strongest aggregation into patches and the most temporal stability in their distribution. Other taxa had more ephemeral distributions as did the cereal aphids. The distribution of carabid larvae was disassociated from the distribution of cereal aphids for the first two sampling occasions indicating biocontrol was occurring. Other predatory groups showed both association and disassociation. Carabid larvae, Bathyphantes and total numbers of Linyphiidae showed a strong correlation with weed cover for two of the sample dates. Cereal aphids were disassociated from weed cover on three sampling occasions.

A comparison of the effect of new and established insecticides on nontarget invertebrates of winter wheat fields.

Six insecticides, a carbamate (pirimicarb), four pyrethroid/mixtures (tao-fluvalinate, zeta-cypermethrin, deltamethrin, and pirimcarb+deltamethrin), and an organophosphate (dimethoate), registered for use within cereals, were field-tested for toxicity to beneficial nontarget invertebrate groups important as food for farmland birds. Compared to the control and the other compounds, pirimicarb was the least toxic for most invertebrate groups examined. The pyrethroids and pyrethroid mixture significantly reduced numbers of many of the nontarget groups compared to the control and pirimicarb. Tao-fluvalinate was the least toxic pyrethroid tested when compared to the other compounds. Toxicity was further tested on larvae of graminivorous sawflies, an important chick- food group, using field-sprayed plants in laboratory and semifield trials. None of the pyrethroid and carbamate compounds and mixtures was as toxic as the organophosphate, but all were more toxic than the control. The semifield experiments provided a useful way of determining potential insecticide impact on this nontarget group where field populations are often too low for field trials to have statistically conclusive results.

Prevention of local recurrence after surgical debulking of nodal and subcutaneous melanoma deposits by hypofractionated radiation.

BACKGROUND: Local recurrence (LR) after surgical debulking of nodal or subcutaneous melanoma deposits defeats the purpose of operation and may worsen prognosis if the procedure was performed for stage III disease. To decrease LR rates in this setting, we extended the previously described role of hypofractionated radiation for melanoma deposits of the neck to all situations where the patient was felt to be at high risk for postoperative relapse after resection of bulky disease. METHODS: Hypofractionated external beam radiation was administered in 6-Gy doses for 5 fractions (total dose 30 Gy, given over a median of 15 elapsed days) to 42 resected melanoma deposit sites in 41 patients. RESULTS: Stages of the 41 patients at the time of treatment were: 22 stage III and 19 stage IV. All patients had complete gross resection of disease at the radiation site before radiation. Mean time between operation and initiation of radiation was 4 weeks. The 42 sites of treatment included 27 neck, 9 axilla, 3 groin, and 3 subcutaneous deposits. There were no treatment-related deaths; side effects were minimal and self-limited. Transient erythema, desquamation, fibrosis, telangiectasias, and mucositis, parotiditis, and xerostomia (for head and neck radiation) were reported, but no patient required interruption of therapy for these events. Of the 42 treated sites, only 2 recurred in the treatment field (one neck, one axilla) during the mean follow-up time of 22.4 months, for a treatment failure rate of 4.8%. This represents improved local control compared with patients treated with surgery alone at our institution and with published recurrence rates. CONCLUSIONS: The addition of hypofractionated radiation therapy after resection of nodal and subcutaneous melanoma deposits at a variety of sites is a rapid and well-tolerated method of providing excellent local control.

Cranial neuropathy following curative chemotherapy and radiotherapy for carcinoma of the nasopharynx.

Cranial nerve damage following head and neck radiotherapy is an unusual event. Cranial neuropathy following concurrent chemotherapy and radiotherapy is unreported. The authors report a case of a 54-year-old man treated with curative chemotherapy and radiotherapy for a stage III nasopharyngeal carcinoma who developed an unilateral hypoglossal nerve palsy five years after therapy. Follow-up examination and magnetic resonance imaging (MRI) show no evidence of recurrent disease. Hypoglossal nerve injury occurring after head and neck radiotherapy is an indirect effect due to progressive soft tissue fibrosis and loss of vascularity. This process develops over years leading to nerve entrapment and permanent damage. Cranial nerve palsies, including damage to the hypoglossal nerve, can develop years after therapy with no evidence of tumour recurrence. Chemotherapy and radiotherapy have improved progression-free and overall survival in advanced nasopharyngeal cancer. As more patients achieve long-term tumour control following chemotherapy and radiotherapy, we must be cognizant of potential late injury to cranial nerves.

Molecular detection of prostate epithelial cells from the surgical field and peripheral circulation during radical prostatectomy.

PURPOSE: Prostate cancer progression despite organ confined pathological assessment has been reported in a variable number of men after radical retropubic prostatectomy. To study this phenomenon, we used the prostate specific antigen (PSA) reverse transcriptase-polymerase chain reaction assay. MATERIALS AND METHODS: We prospectively assayed the peripheral venous blood before, during and after surgical manipulation as well as the intraoperative field blood for PSA reverse transcriptase-polymerase chain reaction-positive cells in 22 men undergoing radical retropubic prostatectomy. RESULTS: PSA reverse transcriptase-polymerase chain reaction-positive cells were identified in 20 of the 22 operative field samples (91%) and 4 of 16 (25%) had evidence of intraoperative hematogenous dissemination (p = 0.046). No significant association was identified among Gleason score, pathological stage and the PSA reverse transcriptase-polymerase chain reaction result. CONCLUSIONS: Our results suggest that tumor cell spillage and less frequently hematogenous dissemination may be associated with operative manipulation of the prostate during radical retropubic prostatectomy and may potentially represent mechanisms of failure after radical retropubic prostatectomy.

Service coordinators in senior housing. An exploration of an emerging role in long-term care.

The evolving role of service coordinators in federally subsidized senior housing offers a new opportunity to enhance service delivery to older adults who are aging in place. Senior housing occupies an unrecognized but important niche in the long-term care continuum. The Department of Housing and Urban Development has acknowledged the need for housing-based social services by developing and funding service coordinator positions. Efforts by visionary agencies have demonstrated that an on-site social service professional improves access to needed supportive services and assists housing staff to understand age-related issues. Although the need and efficacy of housing-based services have been substantiated, the day-to-day practice has not been widely examined. This article offers a description of the unique dynamics of providing social services in a housing setting, based on the experiences of service coordinators in the San Francisco Bay area.

Phantom orchalgia.

Chronic scrotal pain is most commonly explained by the radiculitis that is caused by low back strain. The diagnosis is made chiefly by taking a careful history and by excluding other causes. Treatment directed to relieve sensory nerve root irritation at the T10 to L1 levels is often successful.

Emergency department patterns in psychiatric visits during the holiday season.

STUDY OBJECTIVE: To determine the prevalence of psychopathology during the holiday season and which subpopulations are at greatest risk for holiday decompensation. DESIGN: A retrospective analysis of emergency department records. SETTING: ED of a university-affiliated hospital located in a mixed urban-agricultural catchment area in North Carolina. PARTICIPANTS: Eight thousand seven hundred fifty-six patient visits to the ED, with subsequent triage for psychiatric evaluation, for a 6-year period (1987 to 1993), were analyzed. RESULTS: We observed seasonal patterns in visits, with a general decrease in visits preceding holidays followed by an increase afterward. Substance abusers, men, and black patients were more likely to visit the ED than expected, particularly during the weeks surrounding Christmas. CONCLUSION: These results support the existence of a "Christmas effect" on ED visitations by patients with psychiatric symptoms. Understanding of these patterns may help emergency physicians predict the seasonal variation of such patient visits and apply preventive measures accordingly.

Tolerance of patients with human immunodeficiency virus and anal carcinoma to treatment with combined chemotherapy and radiation therapy.

PURPOSE: To evaluate treatment tolerance in patients with and without the human immunodeficiency virus (HIV) who were undergoing treatment of anal cancer. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records of 62 patients with anal cancer who received radiation treatment. Seven patients had HIV, four of whom had acquired immunodeficiency syndrome. Fifty-five patients were HIV negative, including 11 patients identified as being at high risk for HIV infection whose status was unknown. RESULTS: Thirty of the 55 (55%) patients who were HIV negative required treatment breaks of a mean duration of 16.7 days. Four of those 55 (7%) patients required hospitalization. Three of 42 (7%) patients who were HIV negative receiving chemotherapy required chemotherapy dose reduction. All seven patients with HIV required treatment breaks of a mean duration of 21.7 days. Three of the seven (43%) patients required hospitalization. Four of the seven (57%) patients required chemotherapy dose reduction. CONCLUSION: Patients with HIV undergoing treatment of anal cancer have increased toxic reactions to chemoradiation. Treatment must be individually tailored on the basis of extent of disease and degree of compromise of the immune system.

Extragonadal seminoma involving urinary bladder and arising in the prostate.

The authors report the first instance of a patient with seminoma probably arising from the prostate but also involving the bladder. A 58-year-old man presented with symptoms and signs of prostatic enlargement. Cystoscopy revealed a fungating neoplasm, probably arising from the prostate and surrounding the bladder neck. The biopsy was consistent with the diagnosis of seminoma. The patient experienced complete remission after chemotherapy with bleomycin, cisplatin, and etoposide.