The Development and Evaluation of an Educational Video for Breast Cancer Patients Requiring Adjuvant Radiation Therapy.

Patient education and informed consent are required prior to adjuvant radiation therapy (RT) for early breast cancer (EBC), and include the role, rationale, potential toxicities and practicalities of the treatment process. Current education of patients about RT is verbal, in the form of a consultation by a radiation oncologist, often supplemented with print or online materials. This approach is limited by its doctor-dependency and non-standardised nature. Video education is being recognised increasingly as an opportunity to remediate this and appeal to patients' preference for visual learning. The purpose of this study was to design and produce a video as an educational adjunct for EBC patients' viewing prior to adjuvant RT, and to evaluate its acceptability through content analysis of three online focus group discussions, among ten participants with EBC requiring RT. After qualitative content analysis of the focus group transcripts, data were summarised into three main categories: (1) understanding of RT, (2) ease of engagement with the video and (3) anxiety and preparedness for RT. The 18-min video was positively received by all participants, and discussion feedback was used to inform improvements to the video. This focus group study demonstrated that the video was well understood, informative and acceptable to EBC patients in preparing them for RT. The effectiveness of the video in improving knowledge and alleviating distress in preparation for therapy will be further evaluated in an ethics-approved biphasic quasi-experimental study.

Assessment of the environmental perceptions, attitudes, and awareness of city dwellers regarding sustainable urban environmental management: a case study of Dhaka, Bangladesh.

Environmental problems are very concerning, particularly in many cities of developing countries, because they obstruct the creation of a sustainable urban environment. Dhaka, Bangladesh was chosen as the research area of this study, as Bangladesh is a developing country with pollution; moreover, the level of residents' environmental perception was assessed, and their environmental attitudes and awareness were examined in relation to their demographic characteristics. A face-to-face questionnaire survey involving 400 respondents was conducted across various zones of the study area. The mean score, standard deviation, and p value of each respondent's answer were calculated separately using a one-way analysis of variance (ANOVA). Then, a grand mean, average standard deviation, and combined p values for environmental perception and attitude themes were computed theme-wise. Descriptive statistics were produced to illustrate the respondents' level of environmental awareness. The study results revealed that the respondents had a moderate to high level of perceived knowledge about the causes and effects of environmental pollution. They also had an intention to reduce the environmental pollution in their surroundings. The score differences (p < .05) across the age groups, education levels, occupation types, and income groups were nearly all significant, except for those pertaining to the gender of the respondents. Surprisingly, only 18% of the respondents were aware of their home's and neighborhood's garbage management procedures. It is urgent to influence citizens' environmental behaviors to ensure the city's long-term sustainability. This study's findings can be used in decision-making processes regarding sustainable urban environments worldwide.

Radiation therapy in the prevention and management of brain metastases in patients with small cell lung cancer: a narrative review.

OBJECTIVE: The purpose of this narrative review is to survey the current literature and provide treatment recommendations for the management of patients with brain metastases (BMs) from small cell lung cancer (SCLC). BACKGROUND: BMs are very common in patients with SCLC and management has changed significantly in recent years. Radiation techniques and systemic therapies have evolved and this review will highlight these recent studies and implications on clinical practice. METHODS: This narrative review covers prophylaxis and treatment of established BMs in patients with SCLC. Studies included are based on Medline, PubMed, Google scholar searches, abstracts from conference proceedings and references from published papers. CONCLUSIONS: Radiation therapy continue to have an important role in the prophylaxis and treatment of patients with BMs. Radiation technologies have resulted in significant reduction of toxicities and improved quality of life (QoL). There continues to be many unanswered questions and results of currently accruing trials will hopefully fill some of these gaps and refine the role of radiation therapy in the management of this condition.

FISH analysis of brain smears obtained at intraoperative diagnosis - An accurate and fast method to detect 1p/19q-codeletion in gliomas.

The importance of molecular testing of gliomas is highlighted in the 2016 revised 4th edition of the WHO Classification of Tumours of the Central Nervous System, which applies an integrated diagnosis of histological and molecular features. In this classification system, oligodendrogliomas (ODG) are defined as IDH-mutant and 1p/19q-codeleted. Fluorescence in situ hybridization (FISH) analysis of formalin-fixed paraffin-embedded (FFPE) tissue is a standard method of determining 1p/19q-codeletion. However, it has several disadvantages, including requiring lengthy pretreatment, truncation artefact and lack of on-site access in many centers. In an effort to address these issues, we analysed FISH performed on smears obtained at intraoperative frozen section on 51 gliomas and compared this to FISH performed on subsequent FFPE sections. Four cases were excluded due to uninterpretable FISH results. Of the remaining 47 cases, 17 were concordant for 1p/19q-codeletion, 29 were concordant for lack of 1p/19q-codeletion, and 1 was discordant with 1p/19q-codeletion found on FFPE tissue but not on intraoperative smears. The discordant case was most likely due to sampling error, as the frozen section had not shown definite tumor. The FISH results on intraoperative smears were received within 24-48 h after the sample was collected, compared with 3-4 days for FFPE tissue. FISH on smears obtained at intraoperative frozen section is an accurate and fast method for determining 1p/19q-codeletion.

Pomacentrus bangladeshius, a new species of damselfish (Perciformes, Pomacentridae) from Saint Martin's Island, Bangladesh.

A new species of damselfish, Pomacentrus bangladeshius, is described from 3 specimens, 67-77 mm standard length (SL), collected from Saint Martin's Island, Bangladesh. The new species is distinguished from congeners in having the following combination of characters: XIV, 13 dorsal-fin elements; II, 14 anal-fin elements; 19 pectoral-fin rays; 18-19 lateral-line scales; 17-19 gill rakers on first arch; body depth 1.68-1.88 (1.88) in SL; snout 4.17-4.60 (4.17) in head length; head 2.91-3.09 (3.08) in SL; a prominent notch present between preorbital and suborbital; olive to dark brown body color, dark brown premaxilla, and yellow iris with a narrow bronze eye ring. The new species inhabits shallow reef flats around rock and coral outcrops. Phylogenetic analysis also shows the clear divergence of P. bangladeshius from other genetically closely related congeneric species retrieved from GenBank and that it represents a separate lineage.

Occult metastatic thyroid cancer diagnosed during breast cancer axillary sentinel node biopsy.

SUMMARY: In most developed countries, breast carcinoma is the most common malignancy in women and while thyroid cancer is less common, its incidence is almost three to five times greater in women than in men. Since 1966, studies have demonstrated an association between thyroid and breast cancer and despite these studies, the mechanism/s by which they are related, remains unclear. We present a case of a 56-year-old lady who initially presented in 2014 with a screen detected left breast carcinoma but was subsequently found to have occult metastatic thyroid cancer to the axilla, diagnosed from a sentinel node biopsy from the primary breast procedure. The patient underwent a left mastectomy, left axillary dissection and total thyroidectomy followed by three courses of radioactive iodine ablation. Despite this, her thyroglobulin level continued to increase, which was secondary to a metastatic thyroid cancer parasternal metastasis. Breast and thyroid cancer presents metachronously or synchronously more often than by chance. With improving mortality in primary cancers, such as breast and differentiated thyroid cancer, it is likely that as clinicians, we will continue to encounter this association in practice. LEARNING POINTS: There has been a long-standing observation of an association between breast and thyroid cancer although the exact mechanism of this association remains unclear. Our patient presented with thyroid cancer with an incidental diagnosis from a sentinel node biopsy during her primary breast operation for breast cancer and was also found to have a parasternal distant bony metastasis. Thyroid axillary metastases are generally rare. The interesting nature in which this patient's metastatic thyroid carcinoma behaved more like a breast carcinoma highlights a correlation between these two cancers. With improving mortality in these primary cancers, clinicians are likely to encounter this association in clinical practice. Systemic therapy for metastatic breast and thyroid cancers differ and therefore a clear diagnosis of metastasis is crucial.

Cut-point for Ki-67 proliferation index as a prognostic marker for glioblastoma.

INTRODUCTION: Ki-67 proliferation index (Ki-67 index) is used to quantify cell proliferation during histopathological assessment of various tumors including glioblastoma (GB). AIM: We aimed to assess correlation between Ki-67 index and overall survival in patients with GB and determine a cut-point for Ki-67 index that predicts for poorer survival. METHOD: Records of adult patients diagnosed with GB on histopathological specimens at a tertiary cancer center in Sydney between 1 January 2002 and 30 July 2012 were retrieved. Specimens of these patients were examined for quantification of Ki-67 staining by two independent pathologists. Patient, disease, treatment, and survival data were collected from hospital and cancer care service records. Statistical analysis was performed using proportional hazards models, Kaplan-Meier curves, and the minimum P-value approach. RESULT: Of the eligible 71 patients, 58% were males with median age of 58 (range 18-87). Seventy-three percent of patients were of ECOG performance status 0-1. There was a statistically significant correlation between Ki-67 index and overall survival. In patients with Ki-67 > 22% (n = 36), 5-year survival was approximately 30% compared to 5% in those with Ki-67 ≤ 22% (n = 35; log-rank P-value = 0.04; hazard ratio (HR) = 0.53; 95% confidence intervals (CI), 0.29-0.97). CONCLUSION: This study demonstrates a positive correlation between Ki-67 index and overall survival in patients with GB. Percentage staining of Ki-67 < 22% appears to predict for poorer survival in GB.

Contouring consensus guidelines in breast cancer radiotherapy: Comparison and systematic review of patterns of failure.

Adequate coverage of sites harbouring potential microscopic disease is paramount, where the clinical decision has been made to include regional lymph node radiotherapy for patients with breast cancer. This must be achieved in balance with minimising dose to normal tissues. Several international consensus guidelines detailing clinical target volumes (CTVs) are available, but there is currently no agreement as to which is most appropriate for a given clinical situation. Contouring guidelines are beneficial for routine practice and essential for clinical trial quality assurance. The aims of this study were as follows: to provide a single point of comparison of four commonly used contouring guidelines, including one used in a current Trans-Tasman Radiation Oncology Group trial; and to undertake a systematic review of existing studies which map sites of breast cancer recurrence against contouring guidelines. Two international consensus guidelines (European Society for Radiotherapy and Oncology, and Radiation Therapy Oncology Group) were compared with two clinical trial guidelines (TROG 12.02 PET LABRADOR and the Proton/Photon trial NCT02603341 RADCOMP). Comprehensive literature search for patterns of failure studies was undertaken using Embase and Pubmed. We detail the small but significant differences between the breast consensus guidelines, particularly the supraclavicular (SCF) and internal mammary chain CTVs. Seven series were found mapping recurrence patterns. These results are discussed in the context of the contouring guidelines. Several studies found the SCF CTV is the area at greatest risk of geographical 'miss'. This review will facilitate further discussion about guideline selection and modification, particularly for future clinical trials in Australia and New Zealand.

Changes in Brain Metastasis During Radiosurgical Planning.

PURPOSE: To determine whether there are any changes in brain metastases or resection cavity volumes between planning magnetic resonance imaging (MRI) and radiosurgery (RS) treatment and whether these led to a change in management or alteration in the RS plan. METHODS AND MATERIALS: Patients undergoing RS for brain metastasis or tumor resection cavities had a standardized planning MRI (MRI-1) performed and a repeat verification MRI (MRI-2) 24 hours before RS. Any change in management, including replanning based on MRI-2, was recorded. RESULTS: Thirty-four patients with a total of 59 lesions (44 metastases and 15 tumor resection cavities) were assessed with a median time between MRI-1 and MRI-2 of 7 days. Seventeen patients (50%) required a change in management based on the changes seen on MRI-2. For patients with 7 days or less between scans, 41% (9 of 22) required a change in management; among patients with 8 days or more between scans, 78% (7 of 9) required a change in management. Per lesion, 32 out of 59 lesions required replanning, including 7 of 15 (47%) cavities and 25 of 44 (57%) metastases, with the most common reason (23 lesions) being an increase in gross target volume (tumor) or clinical target volume (tumor cavity). CONCLUSIONS: Measurable changes occur in brain metastasis over a short amount of time, with a change in management required in 41% of patients with 7 days between MRI-1 and MRI-2 and in 78% of patients when there is a delay longer than 7 days. We therefore recommend that the time between planning MRI and RS treatment be as short as possible.

Cutaneous metastasis of prostate carcinoma treated with radiotherapy: a case presentation.

BACKGROUND: Prostate cancer is a commonly diagnosed and treated malignancy, although it rarely presents with cutaneous metastases. In this case presentation, we describe the diagnosis and treatment with radiotherapy of a patient who presented with cutaneous metastases on his chest wall secondary to prostate cancer. CASE PRESENTATION: In 2006, a 73-year-old Caucasian gentleman with metastatic castration resistant prostate cancer treated with mitoxantrone and prednisolone presented with cutaneous nodules on his chest wall. A punch biopsy diagnosed cutaneous metastases, with histological confirmation with positive staining for cytokeratin, PSA (prostate specific antigen) and PAP (prostatic acid phosphatise). Systemic treatment was ceased due to progressive disease; radiotherapy was used to treat these nodules with a durable clinical response. The patient died five months after initial diagnosis of cutaneous metastases. CONCLUSIONS: In this report, a rare metastatic manifestation of a common malignancy is presented. Whilst dermal metastases carries a poor prognosis from reported literature, this is the first report of radiotherapy providing a durable clinical response with relief from bleeding and pain.

Knowledge, Attitude and Practice Regarding Informed Consent in Medical Research among Resident Doctors of a Medical College of Eastern India

Informed consent remains an important ethical and legal document ensuring autonomy of the research participants. Objective: The present study was undertaken with the idea to find out the gap in respect to knowledge, attitude and practice in acquiring Informed Consent so that we can improve the procedure of acquiring consent in accordance with the present regulations. Methods: Questionnaire based close ended cross sectional study within 1 week time frame in Bankura Sammilani Medical college involving the resident doctors pursuing their post graduate degrees. Results: Though 83.4% had the knowledge but 68% do not feel necessary to take consent. The major limitation being excessive work load and lack of time. Conclusion: The study revealed that there was lot of lacunae in their knowledge giving rise to improper attitude and practice regarding Informed consent procedure in a research project.

Histiocytic sarcoma of the brain.

Histiocytic sarcoma is a rare malignant neoplasm of the lympho-hematopoietic system that usually occurs in the skin, lymph nodes and intestinal tract. We present a 36-year-old woman with a rare histiocytic sarcoma with isolated central nervous system (CNS) involvement of multifocal circumscribed lesions. Biopsy of the brain lesions showed diffuse proliferation of pleomorphic histiocytes that were immunopositive for CD45, CD68 and CD163. Various cytokeratins and markers of lymphoma, melanoma, germ cell tumours and primary CNS tumours were negative. Examination of bone marrow trephine and a whole-body positron emission tomography scan showed no evidence of involvement of any other organ systems, thus establishing the primary nature of the lesion. The neoplastic cells uniquely showed eosinophilic globules within the cytoplasm, which were positive for CD68. These globules were shown by electron microscopy to be collections of lysosomes. A thorough discussion of the differential diagnosis and literature review is included.