A qualitative study to explore the acceptability and usefulness of personalized biofeedback to motivate physical activity in cancer survivors.

Objective: Many cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and acceptability of a remotely delivered physical activity intervention utilizing wearable sensors and personalized feedback messages. Methods: In-person and virtual small group interviews were conducted engaging overweight/obese cancer survivors (n = 16, 94% female, 94% breast cancer survivors) in discussions resulting in 314 pages of transcribed data analyzed by multiple coders. Results: All participants expressed needing to increase physical activity, identifying lack of motivation centering on survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., continuous glucose monitors [CGMs]) as CGMs show biological metrics in real-time. Participants reported (1) personalized feedback messages can improve motivation and accountability; (2) CGM acceptability is high given survivors' medical history; and (3) glucose data is a relevant health indicator and they appreciated integrated messages (between Fitbit and CGM) in demonstrating how behaviors immediately affect one's body. Conclusions: This study supports the use of wearable biosensors and m-health interventions to promote physical activity in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of physical activity. Integrating biofeedback into physical activity interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.

Assessment of magnetic resonance imaging (MRI)-fusion prostate biopsy with concurrent standard systematic ultrasound-guided biopsy among men requiring repeat biopsy.

INTRODUCTION: The role of magnetic resonance imaging (MRI)-fusion biopsy (FB) remains unclear in men with prior negative prostate biopsies. This study aimed to compare the diagnostic accuracy of FB with concurrent systematic biopsy (SB) in patients requiring repeat prostate biopsies. METHODS: Patients with previous negative prostate biopsies requiring repeat biopsies were included. Those without suspicious lesions (≥Prostate Imaging-Reporting and Data System [PI-RADS] 3) on MRI were excluded. All patients underwent FB followed by SB. The primary outcome was the sensitivity for clinically significant prostate cancer (Gleason score ≥7). The secondary objective was identification of potential predictive factors of biopsy performance. RESULTS: A total of 53 patients were included; 41 (77%) patients were found to have clinically significant prostate cancer. FB had a higher detection rate of significant cancer compared to SB (85% vs. 76%, respectively, p=0.20) and lower diagnosis of indolent (Gleason score 3+3=6) cancer (10% vs. 27%, respectively, p=0.05). FB alone missed six (15%) clinically significant cancers, compared to 10 (24%) with SB. SB performance was significantly impaired in patients with anterior lesions and high prostate volumes (p<0.05). There was high degree of pathological discordance between the two approaches, with concordance seen in only 34% of patients. CONCLUSIONS: In patients with prior negative biopsies and ongoing suspicion for prostate cancer, a combined approach of FB with SB is needed for optimal detection and risk classification of clinically significant disease. Anterior tumors and large prostates were significant predictors of poor SB performance and an MRI-fusion alone approach in these settings could be considered.

The dosimetric quality of brachytherapy implants in patients with small prostate volume depends on the experience of the brachytherapy team.

PURPOSE: To investigate the dosimetric outcome of brachytherapy in patients with small prostate volume (PV). METHODS AND MATERIALS: Forty-three patients with small PV (<25 cm(3)) as determined using transrectal ultrasound and 120 patients with non-small PV (>25 cm(3)) that had received (125)I seed implants were reviewed in a retrospective cohort study. Implantations were performed under transrectal ultrasound guidance, and the prescription dose was 145 Gy. A CT and MRI scan of the pelvis were performed 1 month after implantation for dosimetric study. RESULTS: Compared with non-small PV patients, patients with small PV experienced larger 1-month edema (p<0.001); lower dose to 90% (the isodose enclosing 90% of PV and representing a minimum dose to that volume of the prostate [D(90)]) of the prostate (p=0.03); higher intracapsular seed density (p<0.001); and were less likely to achieve D(90)>or=140 Gy (p=0.013) in a postimplant dosimetric study. The number of patients with D(90)<140 Gy decreased steadily in both subsets of patients as the implant program matured (odds ratio=0.56 per year, p<0.001), but the small prostate group exhibited more improvement compared with the non-small prostate patients over the same time period. Multivariate analysis revealed that brachytherapy team experience rather than the size of prostate was a more important predictive factor of implant quality (p<0.001). CONCLUSIONS: This single institution experience demonstrated a significant learning curve in the initial years of a prostate brachytherapy program, especially for patients with small prostates. A small prostate itself is not a contraindication of brachytherapy. The quality of implant for patients with small prostates depends more on the skill of the brachytherapy team.

Diagnosis of Alzheimer's disease in an exhumed decomposed brain after twenty months of burial in a deep grave.

After 20 months of interment in a deep grave, the decomposed body of the 81-year old testator of a will was exhumed to sustain the burden of proof that he lacked testamentary capacity when the will was rewritten two days prior to his death. The brain was mushy and pulverized with complete disappearance of the brainstem, cerebellum and subcortical ganglia. Small foci of relatively intact dorsal frontal neocortex were identified. Sections from these foci were stained with hematoxylin and eosin, bielchowsky silver stain and immunostains for beta amyloid peptide (betaA4), tau and alpha-synuclein. Despite severe autolysis and decomposition, the bielchowsky stain and the betaA4 immunostains showed preserved frequent neuritic amyloid plaques with very few residual neurofibrillary tangles. Cerebral Amyloid Angiopathy was present. At the present time this case represents the first documented and reported case of direct tissue diagnosis of Alzheimer's Disease pathology in a decomposed brain following long term burial in a deep grave.

The value of epithelial membrane antigen expression in separating benign mesothelial proliferation from malignant mesothelioma: a comparative study.

Differentiating reactive mesothelial (RM) proliferation from malignant mesothelioma (MM) can be cytologically challenging. There have been discordant studies reporting the value of epithelial membrane antigen (EMA) in differentiating RM from MM. In this study, we investigated the expression of two different clones of EMA in RM and MM. Twenty cases of pleural effusion smears of RM and 20 cases of MM with their corresponding cell blocks were retrieved from the hospital computer system. Diagnosis of MM was confirmed by surgical decortication or pneumonectomy with immunostaining studies and/or electron microscopy. Cases of RM were confirmed by clinical history and histology. Cell blocks were formalin-fixed, paraffin-embedded, and immunostained for EMA clone Mc5 and EMA clone E29. The positive rates for clone Mc5 were 14/20 (70%) for MM and 12/20 (60%) for RM and EMA clone E29 were 15/20 (75%) for MM and 0/20 (0%) for RM. The sensitivity and specificity for EMA clone Mc5 were 70 and 40%, respectively. For EMA clone E29, the sensitivity and specificity were 75 and 100%, respectively. In conclusion, both RM and MM immunostained for EMA clone Mc5, indicating that it is not a reliable immunocytochemical marker for differentiating RM from MM. EMA clone E29 was negative in all cases of RM and positive in 75% of MM and therefore is a reliable immunocytochemical marker for differentiating RM from MM.

Suicides following bariatric surgery for the treatment of obesity.

The proportion of the United States population living with bariatric surgery has increased exponentially since the mid 1990s. It is pertinent to study and understand the mortality patterns of this emergent population cohort and determine the role bariatric surgery may play in these mortality patterns. We present the forensic and clinical characteristics of three cases of suicide following bariatric surgery for the treatment of morbid obesity. The clinical history in each case included recurrent major depressive disorder before and after surgery. Surgery-suicide intervals were 12 months, 27 months and 26 months, respectively. Pre-surgery and pre-mortem body mass indices were 37.7 and 22.2 kg/m(2); 42.0 and 25.0 kg/m(2); 39.5 and 29.4 kg/m(2). Depressive disorder may persist in the bariatric surgery patient despite successful surgical control of obesity.

Usefulness of Cdx2 in separating mucinous bronchioloalveolar adenocarcinoma of the lung from metastatic mucinous colorectal adenocarcinoma.

We studied the diagnostic value of Cdx2 to distinguish mucinous bronchioloalveolar carcinoma from mucinous colorectal adenocarcinoma metastatic to the lung. We retrieved 92 via the hospital computer system, including 30 mucinous bronchioloalveolar carcinomas, 32 nonmucinous bronchioloalveolar carcinomas, and 30 mucinous colorectal adenocarcinomas metastatic to the lung. All cases were confirmed by clinical history and surgical resection with occasional immunohistochemical studies. Cases were stained with antibodies against Cdx2, thyroid transcription factor-1 (TTF-1), cytokeratin (CK) 7, and CK20. Bronchioloalveolar carcinoma, mucinous type, showed positive staining for Cdx2, TTF-1, CK7, and CK20 in 0 (0%), 5 (17%), 30 (100%), and 18 (60%) of 30 cases, respectively; nonmucinous tumors were positive in 0 (0%), 30 (94%), 32 (100%), and 0 (0%) of 32 cases, respectively. For colorectal adenocarcinoma, the positive staining for Cdx-2, TTF-1, CK7, and CK20 was 29 (97%), 0 (0%), 7 (23%), and 29 (97%) of 30 cases, respectively. Our results demonstrated Cdx2 as a sensitive and specific marker for differentiating metastatic colorectal adenocarcinoma from mucinous bronchioloalveolar adenocarcinoma.

Stability of the Bax (G)8 microsatellite in localized prostatic adenocarcinoma.

OBJECTIVES: Microsatellite instability has been found in a variety of tumors including prostate cancer. Bax, a pro-apoptotic protein from the Bcl-2 family of proteins, has a microsatellite composed of an eight deoxyguanine [(G)8] tract located in exon 3. Prostate carcinoma cells have increased proliferation indices and lower levels of apoptosis when compared to benign tissue. We investigated whether instability in the Bax (G)8 microsatellite contributes to loss of apoptotic control in localized prostate cancer. PATIENTS AND METHODS: Thirty-eight patients undergoing radical prostatectomy for localized prostate carcinoma participated in this study. Prostate carcinoma was microdissected, and polymerase chain reaction amplification of a region containing the (G)8 microsatellite was performed on DNA from peripheral blood leukocytes and tumors, followed by single strand conformational polymorphism (SSCP) analysis and direct DNA sequencing. RESULTS: SSCP analysis showed no alteration in the number of bands detected upon comparison of tumor tissue to leukocytes, suggesting no alterations in the microsatellite. This was confirmed by direct sequencing, which demonstrated a normal (G)8 sequence in each case. CONCLUSION: We conclude that the Bax (G)8 microsatellite is stable in localized stage T2 and T3 prostate cancer. Our findings argue against a mutator phenotype pathway leading to loss of apoptotic control in localized prostate cancer.

Treatment of cyclophosphamide induced hemorrhagic cystitis with hyperbaric oxygen: a case report.

Hemorrhagic cystitis is a well known complication of treatment with cyclophosphamide. We describe a case of refractory cyclophosphamide induced hemorrhagic cystitis treated successfully with hyperbaric oxygen.