Locoregional therapy and systemic cetuximab to treat colorectal liver metastases

AIM: To investigate efficacy and safety of second-line treatment with irinotecan-loaded drug-eluting beads (DEBIRI) and cetuximab (DEBIRITUX) of unresectable colorectal liver metastases.METHODS: Patients with the following characteristics were included in the study: unresectable hepatic metastases from colorectal carcinoma (CRC-LM), progression after first line chemotherapy (any type of chemotherapeutic drug and combination was allowed), second line treatment (mandatory), which included for each patient (unregarding the KRas status) two cycles of DEBIRI (using 100-300 μm beads loaded with irinotecan at a total dose 200 mg) followed by 12 cycles of cetuximab that was administered weekly at a first dose of 400 mg/m² and then 250 mg/m²; good performance status (0-2) and liver functionality (alanine aminotransferase and gamma-glutamyl transferase not exceeding three times the upper limit of normal, total bilirubin not exceeding 2.5 mg/mL). Data were collected retrospectively and included: tumor response (evaluated monthly for 6 mo then every 3 mo), overall response rate (ORR), KRas status, type and intensity of adverse events (G according to the Common Terminology Criteria for Adverse Events v3.0, CTCAE), overall survival (OS) and progression free survival (PFS).RESULTS: Forty consecutive cases of CRC hepatic metastases were included in the study. Median duration of DEBIRITUX was 4.4 mo (range, 4.0-6.5). Sixteen patients (40%) received the planned 2 cycles of DEBIRI and an average of 10 cetuximab cycles. ORR of the whole sample was 50%, in particular 4 patients were complete responders (10%) and 16 (40%) partial responders. The most observed side effects (G2) were: post-embolization syndrome (30%), diarrhea (25%), skin rushes (38%) and asthenia (35%). The retrospective evaluation of KRas status (24 wild type, 16 mutated) showed that the group of patients with wild type KRas had ORR significantly higher than mutant KRas. Median follow-up was 29 mo (8-48 range); median PFS was 9.8 mo and OS was 20.4 mo. Future randomized trials are required in this setting to establish a role for DEBIRITUX compared with systemic chemotherapy.CONCLUSION: DEBIRITUX seems to be efficacious after first line chemotherapy for the treatment of unresectable CRC-LM.     

Measuring patient satisfaction following epilepsy surgery

Purpose: To systematically review primary research examining patient satisfaction with epilepsy surgery in order to obtain evidence‐based estimates of this surgical outcome; to assess methods used to measure epilepsy surgery satisfaction, overall epilepsy surgery satisfaction ratings, and predictors of epilepsy surgery satisfaction. Methods: Systematic review of published studies in English up to June 2009, focusing on patient satisfaction with all types of epilepsy surgery in patients of all ages. We excluded studies that focused on satisfaction with epilepsy treatment in general, on quality of life without specific exploration of patient satisfaction with surgery, and on satisfaction with the process of health care delivery, rather than with surgery and its outcomes. Key Findings: Eight studies met inclusion criteria. Satisfaction was assessed using one or more global questions. Four epilepsy surgery satisfaction question content patterns emerged: (1) satisfied or dissatisfied, (2) perceived success or failure, (3) overall positive or negative impact, and (4) willingness to repeat surgery or regretting surgery. Overall 71% were satisfied; 64% considered it a success; it had a positive effect for 78%; and 87% would repeat surgery. Seizure freedom was the most common predictor of epilepsy surgery satisfaction, whereas postoperative neurologic deficit predicted dissatisfaction. Significance: Patient satisfaction with interventions is an important aspect of patient‐centered care, but it has received little attention in epilepsy surgery. Future research is required to develop and validate epilepsy surgery satisfaction tools. We provide preliminary guiding principles for measuring satisfaction after epilepsy surgery.     

Wind-borne insects mediate directional pollen transfer between desert fig trees 160 kilometers apart

The question of how far pollen can move between plants has implications for topics as diverse as habitat fragmentation, conservation management, and the containment of genetically modified crops. The monoecious African fig tree Ficus sycomorus L. relies on the small, short-lived, night-flying, host-specific fig wasp Ceratosolen arabicus Mayr for pollination. We used microsatellite markers to characterize a geographically isolated riparian population of F. sycomorus growing along the Ugab River in the Namib Desert, Namibia, together with paternity analysis of seedlings from known mothers, to map pollen movement within this population. In this way we tracked insect movements between individually recognizable trees by means of their pollen cargo and documented the movement of C. arabicus between known trees separated by more than 160 km, with a mean distance for confirmed successful pollination events of 88.6 km. The predominant observed movement of pollinators was in a westerly direction, toward the sea, reflecting seasonal nighttime wind direction and the wind-borne dispersal of fig wasps. Our results suggest the existence of an extensive panmictic population of trees that are well suited to overcome the effects of geographical isolation.     

Cutaneous perforators of the peroneal artery: Cadaveric study with implications in the design of the osteocutaneous free fibular flap

Bilateral dissection of 15 formalin embalmed cadaver legs was performed in order to study the anatomic pattern of the peroneal artery (PA) and its cutaneous perforating vessels (CB). The total number of CB from the PA was 125 or an average of 4.17 branches per leg. CB were distributed in the superoinferior axis between 18.25 and 84.25% of the length of the fibula and their average length was 5 ± 1.8 cm. 86/125 (68.8%) of the CB were classified as myocutaneous branches (MC) that penetrated muscle before reaching the skin, whereas 39/125 (31.2%) were septocutaneous branches (SC) that passed through the intermuscular septum. The mean distance between the posterior border of the fibula and the site where the perforators emerged was 1.88 ± 0.79 cm for the SC and 1.21 ± 0.87 cm for the MC. These anatomic findings should encourage the surgeon to design the skin paddle in the boundary between the middle and the distal third of the fibular length about 2 cm behind the posterior fibular border on the posterolateral leg, where the number of CB is maximal. Clin. Anat. 22:826–833, 2009. © 2009 Wiley‐Liss, Inc.     

The impact of numeracy on reactions to different graphic risk presentation formats: An experimental analogue study

Objectives. Numeracy, the ability to process basic mathematical concepts, may affect responses to graphical displays of health risk information. Displays of probabilistic risk information using grouped dots are easier to understand than displays using dispersed dots. However, dispersed dots may better convey the randomness with which health threats occur, so increasing perceived susceptibility. We hypothesized that low numeracy participants would better understand risks presented using grouped dot displays, while high numeracy participants would have good understanding, regardless of display type. Moreover, we predicted that dispersed dot displays, in contrast to grouped dot displays, would increase risk perceptions and worry only for highly numerate individuals. Design and method. One hundred and forty smokers read vignettes asking them to imagine being at risk of Crohn's disease, in a 2(display type: dispersed/grouped dots)×3(risk magnitude: 3%/6%/50%)×2(numeracy: high/low) design. They completed measures of risk comprehension, perceived susceptibility and worry. Results. More numerate participants had better objective risk comprehension, but this effect was not moderated by display type. There was marginally significant support for the predicted numeracy × display type interaction for worry about Crohn's disease, but not for perceived susceptibility to the condition. Conclusions. Dispersed dot displays somewhat increase worry in highly numerate individuals, but only numeracy influenced objective risk comprehension. The most effective display type for communicating risk information will depend on the numeracy of the population and the goal(s) of the communication.