Radiation therapy of breast cancer in the Nahe Breast Center: first results of an analysis in the context of health services research

BACKGROUND

The first evaluation of radiotherapy results in patients with breast cancer treated as part of a multimodal oncologic therapy in the Nahe Breast Center is presented. Analysis of the results was performed using an in-practice registry.

PATIENTS AND METHODS

From September 2016 to December 2017, 138 patients (median age 62.5 years; range 36-94 years) with breast cancer (right side, n = 67; left side, n = 71) received adjuvant radiation therapy. Of these, 103 patients received gyneco-oncologic care at the Nahe Breast Center, and 35 were referred from outside breast centers. The distribution into stages was as follows: stage I, n = 48; stage II, n = 68; stage III, n = 19; stage IV, n = 3. Neoadjuvant chemotherapy was given to 19 and adjuvant chemotherapy to 50 patients. Endocrine treatment was given to 120 patients. Both 3D conformal (n = 103) and intensity-modulated (n = 35) radiotherapy were performed with a modern linear accelerator.

RESULTS

With a median follow-up of 60 months (1-67), local recurrence occurred in 4/138 (2.9%) and distant metastasis in 8/138 (5.8%) patients; 7/138 (5.1%) patients died of their tumors during the follow-up period. The actuarial 5‑year local recurrence-free survival of all patients was 97.1%, and the actuarial 5‑year overall survival of all patients was 94.9%. We observed no grade 3 or 4 radiogenic side effects.

CONCLUSION

The results of radiotherapy for breast carcinoma at the Nahe Breast Center are comparable to published national and international results. In particular, the local recurrence rates in our study, determined absolutely and actuarially, are excellent, and demonstrate the usefulness of radiotherapy.

Counseling on Complementary Methods in the Treatment of Side Effects of Oncological Therapies: A Project of the Breast and Bowel Center Nahe at the Hospital Sankt Marienwoerth Bad Kreuznach

BACKGROUND

Increasingly, patients with cancer are asking for additional, complementary therapy options for treating the side effects of oncological therapy. Thus, the members of the Breast and Bowel Center Nahe at the Sankt Marienwörth Hospital Bad Kreuznach decided to define the content of this type of counseling for patients before treatment.

METHODS

In 2018, a team of internal oncologists, gynecological oncologists, radio-oncologists, nutritionists, psycho-oncologists, and study nurses met several times to define the content of counseling. To inform the team, an intensive literature review was conducted.

RESULTS

Counseling content was determined for complementary treatment options for the most frequent side effects of oncological therapies. Counseling sessions were formulated as frontal lectures (slide presentations), given at regular intervals for patients and relatives. These lectures were highly appreciated by patients.

CONCLUSION

These counseling sessions increased patient understanding of both useful complementary measures and harmful measures they should not use.

Maternal supplementation of seaweed-derived polysaccharides improves intestinal health and immune status of suckling piglets

The experiment investigated the effect of maternal dietary supplementation of seaweed-derived polysaccharides (SDP) (-SDP v. +SDP, n   20) from day 83 of gestation until weaning (day 28) on selected sow faeces and piglet digesta microbiota populations, piglet small-intestinal morphology, and intestinal nutrient transporter and inflammatory cytokine gene expression at birth, 48 h after birth and weaning. The effect of maternal dietary treatment on the piglet gene expression profile of inflammatory cytokines in the colon following a lipopolysaccharide (LPS) challenge was also investigated. Dietary SDP reduced sow faecal Enterobacteriaceae gene numbers at parturition. Small-intestinal morphology, nutrient transporter and cytokine gene expression in newborn piglets did not differ between maternal dietary treatments (P > 0·10). At 48 h after birth, sodium-glucose-linked transporter 1 gene expression was down-regulated in the ileum of piglets suckling the SDP-supplemented sows compared with those suckling the basal sows (P = 0·050). There was a SDP × LPS challenge interaction on IL-1 and IL-6 gene expression in the colon of piglets (P < 0·05). The gene expression of IL-1 and IL-6 was down-regulated in the LPS-challenged colon of piglets suckling the SDP sows compared with those suckling the basal sows (P < 0·05). However, there was no difference in IL-1 and IL-6 gene expression in the unchallenged colon between treatment groups. At weaning, piglets suckling the SDP-supplemented sows had increased villus height in the jejunum and ileum compared with those suckling the basal-fed sows (P < 0·05). In conclusion, maternal dietary SDP supplementation enhanced the immune response of suckling piglets and improved gut morphology, making them more immune competent to deal with post-weaning adversities.

Effect of maternal supplementation with seaweed extracts on growth performance and aspects of gastrointestinal health of newly weaned piglets after challenge with enterotoxigenic Escherichia coli K88

In the present study, a 2 × 2 factorial arrangement was conducted to investigate the effect of maternal supplementation with seaweed extracts ( - SWE v. +SWE, n 20) from day 83 of gestation until weaning (day 28) on post-weaning (PW) growth performance, faecal score, faecal enterotoxigenic Escherichia coli (ETEC) toxin quantification, intestinal histology and cytokine mRNA of unchallenged and ETEC-challenged pigs. Pigs were ETEC challenged on day 9 PW. There was a maternal treatment × challenge (SWE × ETEC) interaction effect on growth performance and faecal score (P< 0.05). Pigs from SWE-supplemented sows and ETEC-challenged (SE) had higher average daily gain (ADG) during 0-13 d PW and reduced faecal score during 0-72 h post-challenge than those from basal-fed sows and ETEC-challenged (BE) (P< 0.05). However, there was no difference between unchallenged pigs from the SWE-supplemented sows (SC) and basal-fed sows (BC) (P>0.10). Pigs from the SWE-supplemented sows had reduced heat-labile enterotoxin gene copy numbers than those from the basal-fed sows (P< 0.05). Maternal SWE supplementation increased the villus height in the ileum of pigs (P< 0.05). There was a SWE × ETEC interaction effect (P< 0.05) on IL-6 mRNA and a SWE × gastrointestinal (GI) region interaction effect (P< 0.05) on transforming growth factor-β1 (TGF-β1) and TNF-α mRNA. IL-6 mRNA was down-regulated in SC pigs than BC pigs (P< 0.05). However, there was no difference in IL-6 mRNA between SE and BE pigs. The mRNA of TGF-β1 and TNF-α was down-regulated in the colon of pigs from the SWE-supplemented sows compared with those from the basal-fed sows (P< 0.05). However, there was no difference in TGF-β1 and TNF-α mRNA in the ileum between the pigs from the SWE-supplemented sows and basal-fed sows. In conclusion, maternal SWE supplementation improves ADG and the aspects of GI health of weaned pigs following an ETEC challenge.

Effect of seaweed-derived laminarin and fucoidan and zinc oxide on gut morphology, nutrient transporters, nutrient digestibility, growth performance and selected microbial populations in weaned pigs

In the present study, two experiments were conducted to (1) evaluate the effect of laminarin and/or fucoidan on ileal morphology, nutrient transporter gene expression and coefficient of total tract apparent digestibility (CTTAD) of nutrients and (2) determine whether laminarin inclusion could be used as an alternative to ZnO supplementation in weaned pig diets. Expt 1 was designed as a 2 × 2 factorial arrangement, comprising four dietary treatments (n 7 replicates, weaning age 24 d, live weight 6·9 kg). The dietary treatments were as follows: (1) basal diet; (2) basal diet+300 ppm laminarin; (3) basal diet+240 ppm fucoidan; (4) basal diet+300 ppm laminarin and 240 ppm fucoidan. There was an interaction between laminarin and fucoidan on the CTTAD of gross energy (GE) (P< 0·05) and the expression of sodium-glucose-linked transporter 1 (SGLT1/SLC5A1) and GLUT1/SLC2A1 and GLUT2/SLC2A2 (P< 0·05) in the ileum. The laminarin diet increased the CTTAD of GE and increased the expression of SGLT1, GLUT1 and GLUT2 compared with the basal diet. However, there was no effect of laminarin supplementation on these variables when combined with fucoidan. Expt 2 was designed as a complete randomised design (n 8 replicates/treatment, weaning age 24 d, live weight 7·0 kg), and the treatments were (1) basal diet, (2) basal diet and laminarin (300 ppm), and (3) basal diet and ZnO (3100 ppm, 0-14 d, and 2600 ppm, 15-32 d post-weaning). The laminarin diet increased average daily gain and gain:feed ratio compared with the basal diet during days 0-32 post-weaning (P< 0·01) and had an effect similar to the ZnO diet. These results demonstrate that laminarin provides a dietary means to improve gut health and growth performance post-weaning.

Behaviour and growth performance of low-birth-weight piglets cross-fostered in multiparous sows with piglets of higher birth weights

The aim of the study was to evaluate the behaviour, pre-weaning survival rate and growth performance of low birth weight (BW) piglets cross-fostered with piglets of higher weights. Piglets were transferred to 60 foster sows, and divided in three groups (G; n=20): G1- 12 low BW piglets (0.80 - 1.25kg); G2- six low BW piglets and six intermediate BW piglets (1.40 - 1.60kg), and G3- six low BW piglets and six high BW piglets (>1.70kg). For the analysis, groups G2 and G3 were subdivided in LG2 (six G2 light piglets); IG2 (six G2 intermediate piglets), LG3 (six G3 light piglets), and HG3 (six G3 heavy piglets). Behavioural observations were carried out on days 1, 2, 4 and 6 (visual direct observation) and on days 3 and 5 (video recording) after birth. The percentage of missed nursings was higher in LG3 piglets than in LG1, IG2 and HG3 piglets, on days 1 and 2. On day 4, light piglets (LG1, LG2 and LG3) missed more nursings than IG2 and HG3 piglets. On day 3, video recording showed a higher percentage of missed nursings in LG1, LG2, and LG3 piglets as compared to HG3 piglets. On day 1, the number of fights during nursing was higher in IG2 than in LG1 and LG3 piglets. Also on day 1, number of fights and percentage of piglets engaged in fights, during 15min after nursing, were higher in LG1, LG3 and HG3 than in LG2 piglets. More playful behaviours were observed on day 2 in IG2 and HG3 piglets compared to LG1, LG2 and LG3 piglets. Light piglets (LG1, LG2, and LG3) presented similar body weight on days 4, 8, 12 and 16 after birth, regardless of being mixed with piglets of higher weights or not; however, the survival rate until day 16 was most compromised in LG3 piglets compared to the other groups. Despite the lack of influence of littermates' weight on the growth of low BW piglets, their survival rate indicates that they should not be mixed with high BW piglets.

Absorção de IgG via colostro em leitões biológicos e adotados após a uniformização da leitegada

Nove fêmeas de quinto parto (OP5) foram imunizadas com 4mg e 2mg de albumina sérica bovina (BSA) aos 70 e 100 dias de gestação, respectivamente. A uniformização da leitegada foi realizada 4,9±1,9h após o nascimento, antes de os leitões efetuarem a primeira mamada. As leitegadas foram compostas por cinco leitões biológicos (LB) e cinco leitões adotados (LA), com pesos semelhantes ao nascimento. Foram coletadas amostras de sangue dos leitões ao nascimento e 24h após, das fêmeas ao pós-parto e de colostro de cada grupo de tetos ao parto e 24h após. As amostras de soro e colostro foram quantificadas para IgG pelo ELISA indireto. A densidade ótica de IgG anti-BSA (DOIgG-BSA) dos leitões (24h de vida) foi correlacionada com a das fêmeas. A DOIgG-BSA entre LB e LA foi semelhante, assim como entre os grupos de tetos, ao parto e 24h após. Entretanto, ocorreu redução na DOIgG-BSA do parto até 24h após. LB e LA absorveram a mesma quantidade de IgG via colostro, quando a uniformização foi realizada até 5h pós-parto, independentemente do teto em que os leitões mamaram, uma vez que esses possuem a mesma concentração de IgG.

Dynamic interactions of p53 with DNA in solution by time-lapse atomic force microscopy

Dynamic interactions of the tumor suppressor protein p53 with a DNA fragment containing a p53-specific recognition sequence were directly observed by time-lapse tapping mode atomic force microscopy (AFM) in liquid. The divalent cation Mg(2+) was used to loosely attach both DNA and p53 to a mica surface so they could be imaged by the AFM while interacting with each other. Various interactions of p53 with DNA were observed, including dissociation/re-association, sliding and possibly direct binding to the specific sequence. Two modes of target recognition of p53 were detected: (a) direct binding, and (b) initial non-specific binding with subsequent translocation by one-dimensional diffusion of the protein along the DNA to the specific site.

General introduction to the psychotherapy of Pierre Janet

This article deals with Pierre Janet's concept of "Psychological Analysis" (analyse psychologique). It brings out Janet's criticism of Sigmund Freud's ideas, and delineates the difference between psychological analysis (Janet) and psychoanalysis (Freud). Further it points out that Janet's theories on the pathogenesis of neurotic disorders rely on the concept of psychic trauma and associated fixed ideas. Mental force and mental tension, described in greater detail, are essential for the pathogenesis of mental disorders. According to Janet, a significant characteristic of the neurotically disturbed person is a feature that Von Gebsattel calls "Werdenshemmung" ("inhibition of becoming"), a state which impairs the life development of the ill person.

[Pierre Janet (1859-1947). "Physician-philosopher, psychologist and psychotherapist]

Today's efforts at the foundation of psychotherapy by psychology should consider the work of the French philosopher, physician and psychologist Pierre Janet. The article sketches some aspects of Janet's biography, work and influence and refers to a few of his progressive ideas about an empirically based psychotherapy.

Effects of dioxins and furans on liver enzymes, lipid parameters, and thyroid hormones in former thermal metal recycling workers

A cross-sectional study was performed to examine the internal exposure of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDF) in former workers in a nonferrous metal recycling facility. Liver enzymes, lipid parameters, and thyroid hormones were measured to check possible biologic effects. Compared to background levels, the international toxicity equivalent levels of exposed workers were slightly elevated (median 42 ppt, range 13-281 ppt). The workers also had higher total PCDF concentrations (median 128 ppt, range 30-1138 ppt). Correlation analyses demonstrate significant associations with only one liver enzyme, alanine aminotransferase. There were no such associations with serum cholesterol levels or with serum thyroid hormones. Because of the cross-sectional design of the study, firm conclusions cannot be drawn. For further evaluation, a follow-up examination appears necessary.

Neuropsychiatric aspects in Munchausen's syndrome

The case of a 27-year-old woman with Munchausen's syndrome is presented, in whom a history of cerebral palsy and pathological findings from electroencephalogram, cranial computed tomography, and neuropsychological assessment were prominent. It is argued that neuropsychiatric aspects may play a role in the development of Munchausen's syndrome in a subgroup of patients.

Sequence-specific labeling of superhelical DNA by triple helix formation and psoralen crosslinking

Site-specific labeling of covalently closed circular DNA was achieved by using triple helix-forming oligonucleotides 10, 11 and 27 nt in length. The sequences consisted exclusively of pyrimidines (C and T) with a reactive psoralen at the 5'-end and a biotin at the 3'-end. The probes were directed to different target sites on the plasmids pUC18 (2686 bp), pUC18/4A (2799 bp) and pUC1 8/4A-H 1 (2530 bp). After triple helix formation at acid pH the oligonucleotides were photocrosslinked to the target DNAs via the psoralen moiety, endowing the covalent adduct with unconditional stability, e.g. under conditions unfavorable for preservation of the triplex, such as neutral pH. Complex formation was monitored after polyacrylamide gel electrophoresis by streptavidin-alkaline phosphatase (SAP)-induced chemiluminescence. The yield of triple helix increased with the molar ratio of oligonucleotide to target and the length of the probe sequence (27mer > 11mer). The covalent adduct DNA were visualized by scanning force microscopy (SFM) using avidin or streptavidin as protein tags for the biotin group on the oligonucleotide probes. We discuss the versatility of triple helix DNA complexes for studying the conformation of superhelical DNA.

Somatic symptoms in Turkish and German depressed patients

We determined the pattern and severity of symptoms in Turkish and German depressed inpatients. Psychopathological and somatic symptoms were documented on standardized rating scales of the Association for Methodology and Documentation in Psychiatry (AMDP) System. Of a total sample of 6000 inpatients admitted to the Psychiatric Department of the Free University of Berlin from 1981 to 1989, 28 Turkish inpatients with diagnoses of depression, according to the International Classification of Diseases, ninth revision, were compared with a randomly selected group of matched German depressed inpatients. Turkish patients scored higher only on the Vegetative-somatic syndrome scale but did not differ on the Depressive or Apathetic syndrome scale of the AMDP System.

[Effects of different vitamin D metabolites on the leg weakness syndrome of turkeys]

In two experiments the influence of vitamin D metabolites on leg weakness in turkeys belonging to the Big 6 line was studied. The metabolites were given orally or intravenously in different dosages. There are no differences in vitamin-D-dependent parameters between healthy turkeys and turkeys with leg weakness. Additional oral application of 1,25 (OH)2D3 in dosages of 2, 5 or 10 micrograms per animal day and of 400 micrograms 25 (OH)D3 per animal day had no influence on leg weakness. Even after intravenous application of 2 or 5 micrograms 1,25(OH)2D3 per animal day there were no changes concerning the degree of leg weakness nor were any signs of hypervitaminosis D observed (increase of serum calcium level or increase of the activity of duodenal calcium binding protein). Our results indicate that this form of leg weakness in turkeys is not connected to a disturbance of vitamin D metabolism.

[Anamnestic and psychopathologic studies of obsessive-compulsive patients]

Twenty-eight patients, that is 0.8% of all 3,225 patients admitted between 1981 and 1986 in the Free University of Berlin, Department of Psychiatry, had a primary diagnosis of obsessive-compulsive disorder (ICD-9: 300.3). These patients were compared with random samples of equal size (N = 28) of schizophrenic psychoses paranoid type (ICD 295.3), manic depressive psychoses depressed type (ICD 296.1) and neurotic depressions (ICD 300.4) using an AMDP-based multiaxial diagnostic description. It turned out, that although obsessive-compulsive patients were best discriminated from the other clinical groups by their typical symptoms, they were characterized likewise by other psychopathological, especially depressive symptoms. In view of the course of obsessive-compulsive disorder, the findings were compatible with those of other reports. Beyond it, a subgroup of patients with relatively unfavourable course could be described by AMPD-items.

Attentional functions in listening and schizophrenia. A selective review

Maintaining the focus on one sound object or shifting it to another are considered to be two important attentional functions in selective listening, which may serve to differentiate attentional deficits in schizophrenics with respect to their psychopathology. To avoid confounding attentional control with effects of cerebral organization (laterality) as in dichotic listening, it is suggested that spatial hearing is taken into account when testing these attentional operations.

Referent communication of chronic schizophrenics and chronic alcoholics under simultaneous and successive task presentation

Sixteen chronic schizophrenics and 16 chronic alcoholics were presented pairs of colors with the instruction to describe one of them (referent) so that an unknown listener could distinguish the referent from the other color (nonreferent). In one experimental condition patients were asked to name the nonreferent before they were instructed to describe the referent (successive presentation). In the other condition a parallel set of display colors was presented simultaneously with the instruction to describe the referent. Both groups of patients communicated equally well under both modes of presentation. In both groups communication accuracy decreased while response latency and references to the nonreferent increased, the more difficult the colors were to discriminate. Schizophrenics, but not alcoholics, referred more often to both the colors in a display if the successive mode of presentation was administered before the simultaneous mode. They showed a steeper slope of utterance length across levels of difficulty than the alcoholics. In the schizophrenic group, the degree of general psychopathology as well as paranoid and anergic tendencies correlated negatively with communication accuracy, utterance length, and the number of descriptions referring to both colors of an item in the simultaneous presentation condition. Results were discussed with respect to earlier work with Cohen's (1978a) referent communication task.

[Measurement of skin temperature in breast cancer--a new possibility of early diagnosis]

The local skin temperature was measured by infrared thermometry in 100 women suffering from malign neoplasms of the breast. After thermal stimulation the reaction of the skin temperature was determined in a repeated measurement. The results were compared with standard temperature values obtained in 100 healthy women. Statistical evaluation of the data using discriminant analysis resulted in a score, which allowed to classify 90% of the women with mamma carcinomas and 92% of the controls correctly. The possible application of this passive diagnostic method to the early detection of malign tumors in the breast is discussed.