Comorbidity and survival in advanced non-small cell lung cancer (NSCLC) veteran patients

e20675

Background: Prognostic value of comorbidity at diagnosis has received increasing attention. We studied whether the Charlson Comorbidity Index (CMI), Cumulative Illness Rating Scale (CIRS), Kaplan Feinstein Index (KFI), and/or VA Comorbidity Scale (VA) independently predicted survival for NSCLC patients Methods: In an IRB approved protocol, the charts of 101 patients with Stage IIIA, IIIB or IV Non small cell lung cancer seen from 2004 through 2006 at a VA medical center were reviewed of whom 94 have already died. Comorbidity scores ECOG performance status (PS), stage, number of treatments, serum LDH, and albumin levels were obtained or coded from medical records. Survival analyses were performed using proportional hazards models. Results: Median (M) patient age was 69 years (range 51–88), the M ECOG PS was 1 (range 0–4); 13 (13%) had stage IIIA, 27 (26%) IIB and 62 (61%) IV. The M number of treatments was 1 (range 0–6). Histologies were adenocarcinoma in 48 (48%) pts, squamous cell in 37 (37%) pts, and other 17 (15%) pts. The M survival was 207 days (range 4–1785 days). The Median (and ranges) were: 4.2 (1.2–12.8) for CMI, 3 (0–6) for CIRS15, 5(0–11) for CIRS16, 1.8 (0–4) for CIRS17, 0(0–1) for CIRS18, 2 (0–3) for KFI, and 4 (0–8) for VA. The M albumin was 3.7 (range 1.9–5.3) and LDH 201 (range 104–1036). In univariate survival analyses, the stage (p<0.001), ECOG PS (p<0.001), albumin (p<0.003), and the CIRS 17 (p <0.052) were predictive of survival; when, however, bisected by median values, the VA scale (p<0.027), ECOG PS (p<0.052) and albumin (p<.0017) were significantly related to survival but age, LDH, CMI, KFI and subscales of the CIRS (CIRS 16, CIRS 17, CIRS18) were not related to survival. In multivariate proportional hazards analyses that included stage and a comorbidity index, the CIRS16 (p<.032) was an independent predictor of survival; the combinations of stage (p<0.008), ECOG PS (p<.004), stage (p<.006) and albumin (p<.002) were independent predictors of survival. Conclusions: In this small sample, current comorbidity indices did not add to determinations of survival of veterans with advanced NSCLC. Further research is needed in a larger sample. Supported in part by the New Jersey Commission for Cancer Research 09–1133-CCR-EO and VA HSRD IIR 02–103.

No significant financial relationships to disclose.

Process characteristics and products of olive kernel high temperature steam gasification (HTSG)

Exploitation of olive kernel for bioenergy production, with respect to the green house gases (GHGs) mitigation, is the main aim of this work. In this study, olive kernels were used as a solid biofuel, and high temperature steam gasification (HTSG) was investigated, in the fixed bed unit at KTH Sweden, with regard to hydrogen maximization in the produced gasification gas. Experiments were carried out in a temperature range of 750-1050 degrees C, with steam as the gasifying agent. The behaviour of olive kernels, under residence times from 120 up to 960 s, has been studied. At 1050 degrees C, a medium to high calorific value gas was obtained (LHVgas=13.62 MJ/Nm3), while an acquired H2/CO molar ratio equal to four proved that olive kernel HTSG gasification could be an effective technology for a hydrogen-rich gas production (approximately 40%vv H2 in the produced gasification gas at 1050 degrees C). The produced char contained 79%ww of fixed carbon, low chlorine and sulphur content, which enables it for further re-use for energetic purposes. Tar content in the produced gas at 750 degrees C was 124.07 g/Nm3, while a 1050 degrees C at 79.64% reduction was observed and reached the value of 25.26 g/Nm3.

Effects of room acoustics on the intelligibility of speech in classrooms for young children

This paper reports new measurements of the intelligibility of speech in conditions representative of elementary school classrooms. The speech test material was binaurally recorded in simulated classroom conditions and played back to subjects over headphones. Subjects included grade 1, 3, and 6 students (6, 8, and 11 year olds) as well as adults. Recognizing that reverberation time is not a complete descriptor of room acoustics conditions, simulated conditions included realistic early-to-late arriving sound ratios as well as varied reverberation time. For conditions of constant signal-to-noise ratio, intelligibility scores increased with decreasing reverberation time. However, for conditions including realistic increases in speech level with varied reverberation time for constant noise level, intelligibility scores were near maximum for a range of reverberation times. Young children's intelligibility scores benefited from added early reflections of speech sounds similar to adult listeners. The effect of varied reverberation time on the intelligibility of speech for young children was much less than the effect of varied signal-to-noise ratio. The results can be used to help to determine ideal conditions for speech communication in classrooms for younger listeners.

Luminal group may give more benefit for invasive micropapillary carcinoma component breast cancer patients: experience from Cancer Hospital Fudan University

Abstract #6152

Objective: Comparative studies on clinical features and outcomes of very rare invasive micropapillary carcinoma of breast cancer of 4 subtypes by immunohistochemistry staining.&#x2028; Methods: From Aug 2005 to Mar 2008, a total of 52 breast cancer patients(BCPs) with an invasive micropapillary component (IMPC) among 1951 Chinese BCPs with complete of clinicopathologic data in our institution were enrolled into a retrospective analysis. We characterized all these 52 patients and analyzed using various parameters.&#x2028; Results: The 52 cases of breast carcinoma with an IMPC all occurred in women. Mean age was 51 years (range from 26-82). All of these patients had breast masses; one also had metastasis to the supraclavicular lymph node at the time of diagnosis., mean tumor size was 2.83cm(T2), 23.08%(12/52) was pure invasive micropapillary carcinoma, and lymph node positive percentage was 75.59 %( 36/51).Fifty one patients received surgery, while one of them lost the chance of surgery. Forty of them received the modified mastectomy while one was performed lumpectomy due to old age. One was performed LAND alone and four were performed lumpectomy and sentinel lymph node biopsy.&#x2028; By using IHC staining, when we regard HER2/neu 0 and +as negative. The Luminal A group, Luminal B, trip-negative, HER2+ /ER- were 76.92% (40/52), 11.54 %( 6/52), 7.69 %( 4/52), 3.85 %( 2/52), respectively. Compared to the database of 2005 breast cancer carcinoma in our institution, there was more Luminal A group patients than the whole group (P=0.01, chi-square test.), more Luminal B (P=0.028, Fisher exact possibility test), less trip-negative group (P=0.001, chi-square test). The positive lymph node among the Luminal A group, Luminal B, trip-negative, HER2+ /ER- were 65%,80%, 100%, 100%, respectively, while the lymphvascular invasion were 55%,33.33%,50%,50%,respectively, Mulifocality in Luminal A was 25% , 16.67% in Luminal B , while 50% in both trip-negative and HER2+/ER-.&#x2028; Twenty-one of them received both anthracyclines and Taxane, while 27 only received anthracyclines, Four patients only were received only AIs due to old age. All the luminal group patients received endrocine therapy after chemo. After nearly 14 months (2∼34 months) follow up, thirty-six women were disease free, one had local recurrence, and 1 had lung metastasis, while 1 had ovary carcinoma when the diagnosis of breast malignant, one patient lost following up due to mental disorder. Among the luminal B, one had metastasis when diagnosis, others were disease free. One woman of the trip-negative died of non-breast cancer disease,the HER2+/ER- group was no recurrence or metastasis.&#x2028; Discussion: The prelimary results showed that more luminal group in the IMPC may get benefit from the endocrine therapy. However the number of these cases is small and follow-up time is not very long, further studies are necessary to explain these rare and unique pattern of invasive carcinoma.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6152.

Using mathematical models to understand the time dependence of the growth of ductal carcinoma in situ

Abstract #1165

Background: Models of cancer growth have been developed that predict tumor size and growth dynamics for invasive tumors. However, it has been difficult to model ductal carcinoma in situ (DCIS) because of the constraints introduced by its containment within the duct system.&#x2028; Materials and Methods: We have developed a spherical model of growth of solid type DCIS using chemical engineering models of reaction and diffusion in porous media to represent the spread of DCIS in the duct systems. The model predicts tumor diameter based on four input parameters: the ratio of the apoptosis rate to the proliferation rate (A), the diffusion penetration length for nutrient to sustain the tumor growth (L), the volume fraction that tumor cells occupied within the involved breast tissue (V), and the time taken for a cell to complete mitosis(T). We have estimated L, V, and T from the literature, and then back-calcuated A for a range of diameters. We have used these four parameters as inputs and studied the time dependence of the evolution of DCIS.&#x2028; Results: We have found that the range of the values of A that we determined are within an adeqaute physiological range based on rates of proliferation and apoptosis taken from the literature. Using the model, the time to reach at least 95% of the maximum size ranges from less than 30 days for DCIS measuring 0.5 cm to almost 80 days for DCIS measuring 6 cm in diameter.&#x2028; &#x2028; Discussion: There has been little understanding of how long it takes for DCIS to grow, and whether it reaches a steady state size. Our simulations show that DCIS can grow to sizes as large as 6 cm in less than 3 months if it has the correct properties, including a high proliferation rate relative to the apoptosis rate and appropriate access to nutrients. This finding may help to explain why many cases of DCIS are not diagnosed before they progress to invasive carcinoma.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1165.

Survival among women with triple receptor-negative breast cancer and brain metastases

Abstract #6077

Background&#x2028; The purpose of this study was to determine the incidence of brain metastases in a cohort of women with early stage triple-receptor negative breast cancer and to evaluate the survival outcomes of these patients.&#x2028; Method&#x2028; Six hundred and seventy nine patients with early stage triple-receptor negative breast cancer diagnosed between 1980 and 2006 were identified. Cumulative incidence of brain metastases at 2- and 5-years following a diagnosis of early-stage triple receptor-negative breast cancer considering death as a competing risk was computed. Time to brain metastases was computed from the date of breast cancer diagnosis to the date of development of brain metastases. Cox proportional hazards models, adjusted for various patient and tumor characteristics, were then fitted to explore factors that could predict for the subsequent development of brain metastases in this cohort. Survival following a diagnosis of brain metastases was measured from the date of brain metastases diagnosis to the date of death from any cause. All survival outcomes were computed using the Kaplan – Meier product limit method and compared across groups using log rank statistic.&#x2028; Results&#x2028; Median age was 50 years (range 22 to 97 years) and median follow-up was 26.9 months (range 1.1 to 321.3 months. Overall 42 (6.2%) patients developed brain metastases of whom 16 (38.1%) had 3 brain lesions or less, 19 (45.2%) had more than 3 brain lesions and number of brain lesions was unknown in 7 (16.7%) patients. Overall cumulative incidence at 2- and 5-years was 5.6% (95% CI 3.8%-7.9%) and 9.6% (95% CI 6.8% - 13%) respectively. Twenty –four (3.5%) patients developed brain metastases as the first site of recurrence with cumulative incidence at 2- and 5-years observed to be 2.0% (95% CI 2.6% -6.0%) and 4.9% (95% CI 3.2%-7.0%) respectively. In the multivariable model factors such as age at primary tumor diagnosis, initial clinical stage, histological tumor grade, number of lymph nodes examined and tumor lymph-vascular invasion were not significantly associated with time to brain metastases. For the whole group of patients who developed brain metastases median survival was 2.9 months (95% CI 2.0 – 7.6 months). Among those who developed brain metastases as the first site of recurrence median survival was 5.8 months (95% CI 1.7 – 11.0 months).&#x2028; Conclusion&#x2028; Data from published studies have reported a 5-year cumulative incidence of brain metastases of approximately 5 % in an unselected breast cancer population. In our large single institutional study patients with triple-receptor-negative breast tumors we report higher early cumulative incidence compared to historical controls associated with poor survival. Patients with triple-receptor negative breast tumors may be an ideal cohort to target brain metastases preventive strategies.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6077.

Survival among women with triple receptor-negative breast cancer and brain metastases

BACKGROUND

The purpose of this study was to determine the incidence of and survival following brain metastases among women with triple receptor-negative breast cancer.

PATIENTS AND METHODS

In all, 679 patients with nonmetastatic triple receptor-negative breast cancer diagnosed from 1980 to 2006 were identified. Cumulative incidence of brain metastases was computed. Cox proportional hazards models were fitted to explore factors that predict for development of brain metastases. Survival was computed using the Kaplan-Meier product limit method.

RESULTS

Median follow-up was 26.9 months. In all, 42 (6.2%) patients developed brain metastases with a cumulative incidence at 2 and 5 years of 5.6% [95% confidence interval (CI) 3.8% to 7.9%] and 9.6% (95% CI 6.8% to 13%), respectively. A total of 24 (3.5%) patients developed brain metastases as the first site of recurrence with cumulative incidence at 2 and 5 years of 2.0% (95% CI 2.6% to 6.0%) and 4.9% (95% CI 3.2% to 7.0%), respectively. In the multivariable model, no specific factor was observed to be significantly associated with time to brain metastases. Median survival for all patients who developed brain metastases and those who developed brain metastases as the first site of recurrence was 2.9 months (95% CI 2.0-7.6 months) and 5.8 months (95% CI 1.7-11.0 months), respectively.

CONCLUSION

In this single-institutional study, patients with nonmetastatic triple receptor-negative breast tumors have a high early incidence of brain metastases associated with poor survival and maybe an ideal cohort to target brain metastases preventive strategies.

Induced sputum improves the diagnosis of pulmonary tuberculosis in hospitalized patients in Gaborone, Botswana

SETTING

Low sensitivity of acid-fast bacilli (AFB) sputum smears and absence of productive cough are obstacles to the diagnosis of pulmonary tuberculosis (PTB) in hospitals that lack access to bronchoscopy.

OBJECTIVES

To evaluate induced sputum, gastric content, blood and urine specimens to improve PTB diagnosis in patients not diagnosed by expectorated sputum AFB smears.

DESIGN

Patients admitted to the medical wards of a large public hospital in Gaborone, Botswana, were prospectively enrolled if they had symptoms consistent with PTB, an abnormal chest radiograph, were treated empirically with anti-tuberculosis chemotherapy or had no improvement on antibiotics, and had a non-productive cough or AFB smear-negative sputum. Induced sputum was stained for AFB and Mycobacterium tuberculosis cultures were performed on induced sputum, gastric contents, urine and blood.

RESULTS

Of 140 patients meeting the enrollment criteria, 113 (81%) were human immunodeficiency virus (HIV) positive. Fifty-seven (41%) had PTB based on positive cultures from one or more sites, including 48 (84%) from induced sputum, 17 (30%) urine, 13 (23%) gastric contents and 7 (12%) blood. AFB smears were positive in only 18 (32%) culture-proven PTB cases.

CONCLUSION

Induced sputum cultures greatly enhanced M. tuberculosis detection in patients with a high prevalence of HIV/AIDS in a hospital without access to bronchoscopy.

Combustion characteristics of simulated gas fuel in a 30 kg/h scale pyrolysis-melting incinerator

Combustion characteristics of gas fuel in a pyrolysis-melting incinerator having a 30 kg/h capacity were investigated. Pyrolyzed gas from waste was simulated by propane that was injected in the combustion chamber, and burnt through multi-staged combustion by distributing the combustion air to primary, secondary, and tertiary air nozzles. Temperatures and the concentrations of gas components in the combustion chamber were measured. Combustion performance was evaluated with respect to the temperature distribution and combustion gas concentrations of O2, CO and NOx. Using secondary air and/or tertiary air, the combustion performance was improved, and, in particular, NOx concentration decreased significantly following the tertiary air injection.

Decreased nerve distribution in mixed venous-lymphatic malformation

In order to investigate the nerve distribution in mixed venous-lymphatic malformations (MVLMs), 57 postoperative patients diagnosed with MVLMs of the tongue were selected. Immunohistochemistry staining for neurofilament (NF) was used to detect sensory nerve fibers. Distribution of NF in samples from MVLMs was compared with distribution of NF in normal tongue tissue, venous malformations, lymphatic malformations and venular malformations. Results showed that the number of NF-positive nerve fibers in MVLMs was comparable to that in venous malformations and lymphatic malformations. The number of nerve fibers in MVLMs was significantly lower than in normal tissues. NF distribution in MVLMs was not affected by the patient's age or the coexistence of infection. These data suggest that the decreased distribution of sensory nerve fibers in MVLMs may be involved in the pathogenesis of MVLM of the tongue.

Effects of pulsed UV-light on peanut allergens in extracts and liquid peanut butter

Pulsed ultraviolet (PUV) light, a nonthermal technology, was used to treat both the peanut extracts and liquid peanut butter. The objective was to determine if such treatment would lead to a reduction in the allergenic properties of the peanut extract and butter. Peanut samples were PUV treated using a Xenon RS-3000C under the following conditions: 3 pulses/s, 14.6 cm from the central axis of the lamp, 4 min (extract) or 3 min (liquid peanut butter). After the treatment, the peanut samples were centrifuged and the supernatants analyzed by SDS-PAGE and competitive inhibition enzyme-linked immunosorbent assay (ciELISA). For comparison, boiling treatments were also performed. SDS-PAGE showed that while boiling treatment had little effect on the peanut allergens, PUV-light-treated samples displayed a reduced solubility or level of peanut allergens (63 kDa). Solubility of another allergen (18 to 20 kDa) was unaffected. Insoluble aggregates formed were responsible for the reduced level of allergens in PUV-light-treated samples. ciELISA showed that untreated samples exhibited an IgE binding 7-fold higher than the PUV-treated samples. It was concluded that PUV light was effective in reducing IgE binding of peanut extracts and liquid peanut butter. The current study provides an approach to the development of a possibly less allergenic peanut product. However, the reduction in actual allergenicity needs to be confirmed by clinical studies.

Giant congenital melanocytic nevus coexistent with Chiari II malformation

BACKGROUND

Giant congenital melanocytic nevus (GCMN) and Chiari II malformation (CM II) are distinct rare clinical entities. No previous report of this condition is to be found in the medical literature.

MATERIAL AND METHODS

We report the case of a male infant seen initially for a GCMN and an upper thoracic myelomeningocele. MRI incidentally revealed cerebellum and brain stem elongate via the foramen magnum. The infant's physical examination included spastic quadriparesis and hypotonia. An operation for myelomeningocele repair and suboccipital craniectomy with resection of C (1) and cerebellar tonsils was done. The signs and symptoms of the patient were improved after surgery. The GCMN was not treated according to the parents' wished, but a schedule of long-term monitoring was recommended.

CONCLUSION

This case report illustrates that CMNs can coexist with CM II. The clinician who diagnoses a patient with CMNs should remember that this entity can be associated with other pathologies of the central nervous system. Earlier diagnosis and surgical intervention improves the prognosis. Long-term monitoring and follow-up should be recommended for patients with CMNs.

Power Ultrasound

The use of ultrasound as a processing aid has been explored in various industrial sectors for over fifty years, but the application of this physical energy in food processing is relatively new. In this article, the current research and development activities of power ultrasound centered on food and bioprocessing applications are summarized. The mode of action of ultrasonication is attributed to several mechanical and chemical actions caused by cavitation, which include localized hot spots, formation of shock waves, microsteaming, and liquid jets, as well as the production of chemical species that will also impact the process kinetics and food quality attributes. Means to enhance cavitation activity is addressed. The research needs for the future development of ultrasound food processing are also discussed.