Referent Values for Commonly Used Clinical Mobility Tests in Black and White Adults Aged 50-95 Years.

OBJECTIVE: To estimate referent values for performance on clinical mobility tests conducted amongst racially diverse adults aged 50-95 years in the Southeast US. DESIGN: This is an observational study of community-dwelling older adults from diverse racial groups who participated in observational and rehabilitative studies conducted from 2011-2019. SETTING: Rehabilitation clinics around the greater metropolitan Atlanta, Georgia, region. PARTICIPANTS: A total of 314 adults (N=314; 222 women). Individuals were predominantly Black (n=121) or White (n=164), with some participants from other racial groups (n=29). INTERVENTIONS: Clinical and demographic data were collected at individual visits for each participant. MAIN OUTCOME MEASURES: Four Square Step Test (FSST), timed Up and Go (TUG) test, dual TUG test, 6-minute walk test (6MWT), 30-second chair stand, and gait speed were all used as assessments in each cohort. RESULTS: Performance slowly declines with increasing age, with a sharp drop in the ninth decade for preferred forward, backward, and fast gait speed; backward gait cadence; 6MWT, TUG test, dual-task TUG-Cognitive, and the 360° turn test. Declines were also seen in the eighth and ninth decades in the FSST. Among White participants, there were significant overall differences across age groups except in the assessment variable, preferred gait cadence. For Black individuals, there were significant overall differences across age groups for backward gait speed, fast gait speed, TUG-Cognitive, dual task, 6MWT, FSST, and 30-second chair stand. CONCLUSIONS: These data enrich current referent values for brief, commonly used clinical tests in a diverse, older Southeast US cohort. These data include representatives of the oldest old cohort. This study will support race- and age-specific fall prevention and mobility-enhancing therapeutic application among older patients in clinical practice.

The efficacy and safety of Padexol (paclitaxel) and cisplatin for treating advanced non-small cell lung cancer.

PURPOSE: The authors conducted a multicenter study to evaluate the efficacy and safety of combination chemotherapy with Padexol and cisplatin for treating patients with advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From November 2003 to April 2005, 42 chemo-naive patients with advanced NSCLC were enrolled into this study from 4 hospitals. The treatment consisted of Padexol 175 mg/m(2) as a 3-hr infusion, and this was followed by cisplatin 75 mg/m(2) administered as an intravenous infusion with standard premedication. The treatment was repeated every 3 weeks. RESULTS: Among the 42 patients (pts), 33 pts were evaluable for response. On the per protocol analysis, 1 patient (pt) (3.0%) achieved complete response (CR), 17 pts (51.5%) achieved partial response (PR), 6 pts (18.2%) achieved stable disease (SD), and 9 pts (27.3%) progressed; therefore, the overall response rate was 54.6% (95% CI: 37.6 approximately 71.5%). On the intention-to-treat analysis, 1 pt (2.4%) achieved CR, 18 pts (42.9%) achieved PR, 11 pts (26.2%) achieved SD, and 9 pts (21.4%) progressed; therefore, the overall response rate was 45.2% (95% CI: 30.2 approximately 60.3%). The response, as evaluated by the investigators, was independently reviewed by 2 external radiologists and it was as follows; 13 PR (43.3%), 14 SD (46.7%) and 3 progressive disease (10%). The median duration of response was 5.9 months. The median follow-up duration was 10.3 months (range: 1.3 to 22.1 months). The median time to progression was 5.8 months (95% CI: 4.7 to 7.4 months). The median survival time on the intention-to-treat analysis was 10.5 months (95% CI: 8.1 to 18.8 months). The most common grade 3 or 4 hematologic toxicities were neutropenia (26/180 cycles, 14.4%), anemia (7/180 cycles, 3.9%) and febrile neutropenia (2/180 cycles, 1.1%). The most frequent grade 3 or 4 non-hematologic toxicities were nausea (14/42 patients, 14.3%), anorexia (3/42 patients, 7.1%) and myalgia (3/42 patients, 7.1%). CONCLUSION: The authors observed that Padexol was as good as the other paclitaxel (Taxol or Genexol) formulations when combined with cisplatin for treating patients with advanced NSCLC.

Prognostic significance of bcl-2, bax, and p53 expression in diffuse large B-cell lymphoma.

Diffuse large B-cell lymphoma (DLCL) exhibits heterogeneous clinical features and varies markedly in response to treatment and prognosis. Because apoptosis-related proteins may play an important role in predicting the prognosis of DLCL, the current study investigated the prognostic significance of a high level of bcl-2, bax, and p53 expression in relation to clinical characteristics in patients with DLCL. Paraffin-embedded specimens from 94 patients with de novo DLCL were analyzed immunohistochemically for bcl-2, bax, and p53 gene expression. Cases with a positive immunohistological stain in more than 50% of the tumor cells were considered to have DLCL-positive expression. Patients were treated optimally, i.e., with radiotherapy including brief cycles of CHOP or CHOP-like regimens for patients with stage 1-2A diseases and with at least 6 cycles of CHOP or CHOP-like regimens for stage 2B-4 diseases. The responses to therapy and survival were then analyzed in 94 uniformly staged patients. bcl-2 expression was identified in 24 patients (26.4%), bax expression in 35 patients (37.6 %), and p53 expression in 21 patients (22.6%). bax expression proved to be a statistically significant prognostic factor in predicting the overall survival (OS) (P = 0.0015) and disease-free survival (DFS) (P = 0.0052), regardless of other clinical factors or immunohistological results. There was no significant difference in the OS (P = 0.0682) or DFS (P = 0.088) between the bcl-2-positive (n = 24) and bcl-2-negative (n = 67) groups. However, bcl-2 expression was found to be unfavorably associated with the OS (P = 0.0054) in a confined group with low (n = 51) or low intermediate (n = 22) IPI scores. The expression of p53 exhibited no statistical correlation with the OS or DFS. A multivariate analysis revealed that IPI score, bulky mass, and bax expression were all significantly associated with the DFS or OS. bax and bcl-2 should be considered as independent biologic prognostic parameters in DLCL, thereby aiding in the identification of patient risk groups. As such, bcl-2-positive patients with a low or low intermediate IPI score, or without a high level of bax expression could be candidates for more intensive therapy or alternative therapeutic approaches.

Pain and its treatment in patients with cancer in Korea.

Substantial pain is experienced by a lot of patients with cancer, and undertreated pain significantly undermines their quality of life. Despite international and national guidelines on cancer pain management, the practical effectiveness of management is still problematic. We did a prospective cross-sectional survey on pain prevalence, pain intensity, its impact on daily activity, and adequacy of pain management in 823 patients treated by medical oncologists and radiologic oncologists. At the time of the survey, 29.7% of the patients had pain that was moderate or severe. Performance status and tumor extent were significant predictors of pain presence and its intensity. Pain severity and the proportion of the patients whose function is impaired are highly associated. Among the patients with pain, only 37% rated pain relief as satisfactory. Forty-one percent of the patients with pain received inadequate pain management. Physicians did not adjust the analgesic prescription in about 53% of the patients who reported severe pain. These results demonstrate the alarming degree of undertreatment of pain in patients with cancer in Korea, and indicate the need to improve the management of cancer-related pain. Future research should elucidate the factors that impede adequate pain management in order to overcome obstacles to adequate treatment.