The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable.

OBJECTIVES: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24-40% of hormone receptor+/HER2- patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. METHODS: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. RESULTS: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%. Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)-more likely if lower grade and if ER and/or PR > 10%. Fourteen percent of patients with pre-ODX TR for HT added CT-more likely if ER and/or PR ≤10% and if Ki67 > 15% Overall, TR for CT decreased from 47% to 24%. CONCLUSION: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.

Humour experience in schizophrenia: relationship with executive dysfunction and psychosocial impairment.

BACKGROUND: The ability to appreciate humour is essential to successful human interactions. In this study, we hypothesized that individuals with schizophrenia would have diminished ability to recognize and appreciate humour. The relationship between humour experience and clinical symptoms, cognitive and social functioning was examined. METHOD: Thirty patients with a DSM-IV diagnosis of schizophrenia were compared with 30 age-, gender-, IQ- and ethnicity-matched healthy controls. Humour recognition was measured by identification of humorous moments in four silent slapstick comedy film clips and calculated as d-prime (d') according to signal detection theory. Humour appreciation was measured by self-report mood state and funniness ratings. Patients were assessed for clinical symptoms, theory of mind ability, executive function [using the Wisconsin Card Sorting Test (WCST)] and social functioning [using the Life Skills Profile (LSP)]. RESULTS: Patient and control groups did not differ in the funniness ratings they attributed to the video clips. Patients with schizophrenia had a lower d' (humour) compared to the controls, after controlling for (1) the performance of a baseline recognition task with a non-humorous video clip and (2) severity of depressive symptoms. In patients, d' (humour) had significant negative correlation with delusion and depression scores, the perseverative error score of the WCST and the total scores of the LSP. CONCLUSIONS: Compared with controls, patients with schizophrenia were less sensitive at detecting humour but similarly able to appreciate humour. The degree of humour recognition difficulty may be associated with the extent of executive dysfunction and thus contribute to the psychosocial impairment in patients with schizophrenia.

Percutaneous excimer laser coronary angioplasty.

To determine the efficacy of percutaneous excimer laser coronary angioplasty as an adjunct or alternative to conventional balloon angioplasty, 55 patients were studied in a multicenter trial. These patients underwent the procedure using a modification of conventional balloon angioplasty technique. A first-generation, 1.6-mm diameter catheter constructed of 12 individual silica fibers concentrically arranged around a guidewire lumen was used. Catheter tip energy density varied from 35 to 50 mJ/mm2. The mean number of pulses delivered at 20 Hz was 1,272 +/- 1,345. Acute success was defined as a greater than or equal to 20% increase in stenotic diameter and a lumen of greater than or equal to 1 mm in diameter after laser treatment. Acute success was achieved in 46 of 55 (84%) patients. Adjunctive balloon angioplasty was performed on 41 patients (75%). The percent diameter stenosis as determined by quantitative angiography decreased from a baseline of 83 +/- 14 to 49 +/- 11% after laser treatment and to 38 +/- 12% in patients undergoing adjunctive balloon angioplasty. The mean minimal stenotic diameter increased from a baseline of 0.5 +/- 0.4 to 1.6 +/- 0.5 mm after laser treatment and to 2.1 +/- 0.5 mm after balloon angioplasty. There were no deaths and no vascular perforations. One patient (1.8%) required emergency coronary bypass surgery. These data suggest that excimer laser energy delivered percutaneously by specially constructed catheters can safely ablate atheroma and reduce coronary stenoses.

Differential photoabsorption using argon laser radiation on atherosclerotic plaque in non-hemolyzed and hemolyzed blood.

Since argon laser radiation (488 to 514 nm) can vaporize human atherosclerotic plaque, we determined whether different blood media--hemolyzed versus non-hemolyzed blood--can alter photoabsorption of atherosclerotic plaque. Forty cadaveric aortic fibrous plaque samples were fitted onto small vials containing 0.02 ml of either non-hemolyzed blood or hemolyzed blood over the surface of the plaque. The distal end of a 400-mu core diameter quartz fiber was directed onto the surface of the plaque and the proximal end of the fiber was connected to an argon laser. The vaporized area and depth of plaque penetration were measured and the estimated volume of crater formation was derived. Following 2.5, 5, 10 and 20 J of laser energies, vaporized volumes were 0.12, 0.72, 0.97 and 4.09 mm3, respectively, for hemolyzed blood and were 0 (p less than 0.01), 0 (p less than 0.01), 0.92 (NS) and 4.39 mm3 (NS), respectively, for non-hemolyzed blood. Laser radiation destroys red blood cells; the higher the energies, the greater the hemolysis. Thus, different blood media such as hemolyzed and non-hemolyzed blood can alter photoabsorption of atherosclerotic plaque. Low level argon laser absorption upon plaque can occur under hemolyzed blood but not under non-hemolyzed blood. Since higher levels of argon laser energies cause greater lysis of red blood cells, comparable degrees of plaque ablation are observed under either blood medium.

Results of using the serological method of epidemiological investigation of plague foci in the Muyunkum and Eastern Kyzylkum deserts in 1978-1982.

Results of serological examination of 81,853 mammals from the Muyunkum and 26,303 from the Eastern Kyzylkum deserts were compared with results of a corresponding bacteriological examination for plague. In both foci and in all phases throughout the epizootic of plague, the serological method made it possible to detect infected animals 6-10 times more frequently in comparison with the bacteriological method. The big meriones mice, i.e., the basic carriers of plague in natural foci, were found to be infected considerably more (in percentage) frequently than the meridian meriones. Differences in the reactivity of meriones to the invasion of plague microbe were observed in both foci (the indices of titres in the antigen neutralization reaction were considerably higher in the Eastern Kyzylkums). The serological method of investigation is highly informative in evaluating both the present state of epizootic activity of a plague focus and its activity in the past.

Epidemiological studies of Q fever in the area of Dzhambul in the Kazakh SSR.

The frequency of Q fever in the area of Dzhabmul varies from 1.0 [district of Kurdayi, 1968] to 18.1 [district of Talass, 1972] for 100,000 inhabitants. The lower incidence of Q fever in the rural population, compared to that of inhabitants of towns, is closely associated with the development of early immunity. Farm animals are the main source of infection. The persistent circulation of Rickettsia burneti among wild life is maintained by wild mammallans and ticks Ixodes.