Access to Cancer Specialist Care and Treatment in Patients With Advanced Stage Lung Cancer

Background

Access to specialty care is critical for patients with advanced stage lung cancer. This study assessed access to cancer specialists and cancer treatment in a broad population of patients with advanced stage lung cancer.

Neuroblastoma among children in Southern and Eastern European cancer registries: Variations in incidence and temporal trends compared to US

Neuroblastoma comprises the most common neoplasm during infancy (first year of life). Our study describes incidence of neuroblastoma in Southern–Eastern Europe (SEE), including – for the first time – the Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM‐ST)/Greece, compared to the US population, while controlling for human development index (HDI). Age‐adjusted incidence rates (AIR) were calculated for 1,859 childhood (0–14 years) neuroblastoma cases, retrieved from 13 collaborating SEE registries (1990–2016), and were compared to those of SEER/US (N = 3,166; 1990–2012); temporal trends were assessed using Poisson regression and Joinpoint analyses. The overall AIR was significantly lower in SEE (10.1/million) compared to SEER (11.7 per million); the difference was maximum during infancy (43.7 vs. 53.3 per million, respectively), when approximately one‐third of cases were diagnosed. Incidence rates of neuroblastoma at ages <1 and 1–4 years were positively associated with HDI, whereas lower median age at diagnosis was correlated with higher overall AIR. Distribution of primary site and histology was similar in SEE and SEER. Neuroblastoma was slightly more common among males compared to females (male‐to‐female ratio: 1.1), mainly among SEE infants. Incidence trends decreased in infants in Slovenia, Cyprus and SEER and increased in Ukraine and Belarus. The lower incidence in SEE compared to SEER, especially in infants living in low HDI countries possibly indicates a lower level of overdiagnosis in SEE. Hence, increases in incidence rates in infancy noted in some subpopulations should be carefully monitored to avoid the unnecessary costs health impacts of tumors that could potentially spontaneously regress.     

An unsupervised approach to identify molecular phenotypic components influencing breast cancer features

To discover a biological basis for clinical subgroupings within breast cancers, we applied principal components (PCs) analysis to cDNA microarray data from 36 breast cancers. We correlated the resulting PCs with clinical features. The 35 PCs discovered were ranked in order of their impact on gene expression patterns. Interestingly, PC 7 identified a unique subgroup consisting of estrogen receptor (ER); (+) African-American patients. This group exhibited global molecular phenotypes significantly different from both ER (-) African-American women and ER (+) or ER (-) Caucasian women (P < 0.001). Additional significant PCs included PC 4, correlating with lymph node metastasis (P = 0.04), and PC 10, with tumor stage (stage 2 versus stage 3; P = 0.007). These results provide a molecular phenotypic basis for the existence of a biologically unique subgroup comprising ER (+) breast cancers from African-American patients. Moreover, these findings illustrate the potential of PCs analysis to detect molecular phenotypic bases for relevant clinical or biological features of human tumors in general.     

The lateral incisive canals of the adult hard palate - aberrant anatomy of a minor form of clefting?

Except the oral clefts and their associated dental development disturbances, no other discrete morphologies are reported in the literature as related to altered fusions of the fetal maxilla and premaxilla. We report here two cases related by the persistence in adult of an aberrant canal at the fusion site of the fetal premaxilla and maxilla. The first case presents an anastomosis of the superior anterior alveolar and greater palatine nerves, encountered during the dissection of a human adult male cadaver; that anastomosis, bilaterally present, projected on the aforementioned fusion site and traversed the hard palate to continue within the maxillary sinus wall. The second case evidenced on CT the unilateral presence of aberrant lateral incisive canals (LIC) at the level of the fetal premaxilla and maxilla fusion site; those canals, external (1.5 mm diameter) and internal (1.07 mm diameter), were corresponding as location to that one traversed by the aberrant anastomosis in the first case. Both LIC opened inferiorly but not superiorly, rather seeming to communicate with the bony canals within the nasal fossa floor at that level. We consider that such aberrant canals and nerves may represent very rare forms of clefting, previously undescribed; the possible anastomoses of the superior anterior alveolar and greater palatine nerves can be altered during a Le Fort I fracture and may be the morphology that can explain aberrant clinical nervous distributions at the level of the upper dentoalveolar arch and hard palate.     

The association between Helicobacter Pylori chronic gastritis, psychological trauma and somatization disorder. A case report

Helicobacter Pylori is considered to be the agent responsible for peptic ulcers and gastritis, and its eradication represents a main objective in the treatment of digestive diseases. We present the case report of a female patient diagnosed with chronic Helicobacter Pylori infection, where symptoms manifested after the patient was raped. In the context of psychological trauma, digestive manifestations such as ulcer and gastritis were identified, greatly exacerbated as compared with the endoscopic and histological aspect of the gastric mucosa. The patient simultaneously developed a complex psychiatric pathology. The association between Helicobacter Pylori chronic gastritis, somatization and trauma is discussed.     

Neurodegeneration: An early event of diabetic retinopathy

Diabetic retinopathy (DR) has been classically considered to be a microcirculatory disease of the retina caused by the deleterious metabolic effects of hyperglycemia per se and the metabolic pathways triggered by hyperglycemia. However, retinal neurodegeneration is already present before any microcirculatory abnormalities can be detected in ophthalmoscopic examination. In other words, retinal neurodegeneration is an early event in the pathogenesis of DR which predates and participates in the microcirculatory abnormalities that occur in DR. Therefore, the study of the mechanisms that lead to neurodegeneration will be essential to identify new therapeutic targets in the early stages of DR. Elevated levels of glutamate and the overexpression of the renin- angiotensin-system play an essential role in the neurodegenerative process that occurs in diabetic retina. Among neuroprotective factors, pigment epithelial derived factor, somatostatin and erythropoietin seem to be the most relevant and these will be considered in this review. Nevertheless, it should be noted that the balance between neurotoxic and neuroprotective factors rather than levels of neurotoxic factors alone will determine the presence or absence of retinal neurodegeneration in the diabetic eye. New strategies, based on either the delivery of neuroprotective agents or the blockade of neurotoxic factors, are currently being tested in experimental models and in clinical pilot studies. Whether these novel therapies will eventually supplement or prevent the need for laser photocoagulation or vitrectomy awaits the results of additional clinical research.     

Reliability and validity of the Romanian version of a scale to measure infant feeding attitudes and knowledge

AIM: To describe the development and testing of the Romanian version of the Iowa Infant Feeding Attitude Scale (IIFAS-R). The original instrument has well-established psychometrics for use in English-speaking countries. METHODS: Questionnaires including demographics and items about prior pregnancy and opinions about breastfeeding in public were administered to women in Cluj-Napoca, Romania, attending antenatal clinic (n = 336) and to a separate cohort of mothers within 24 h of delivery (n = 276). Postpartum follow-up was conducted with a sample of maternity cohort subjects who initiated breastfeeding in the hospital (n = 52). RESULTS: Internal consistency was adequate in both cohorts (antenatal alpha= 0.50; maternity alpha= 0.63), with improved reliability for antenatal multigravid (alpha= 0.60) and university-educated women (alpha= 0.57). Score distributions were comparable and item means were approximately central across cohorts. Among pregnant women, higher scores (more positive towards breastfeeding) were associated with longer planned maternity leave (chi2= 17.8; p = 0.02). Higher maternity cohort scores were associated with age (r = 0.31, p = 0.003), urban residence (chi2= 10.2, p = 0.04), breastfeeding a prior infant for at least 6 weeks (chi2= 6.4, p = 0.04), and with intending to breastfeed for at least 6 weeks (chi2= 4.7, p = 0.03). Postpartum women still breastfeeding at follow-up also scored higher (chi2= 9.3, p = 0.009). CONCLUSION: This is the first study to report on use of the IIFAS in Eastern Europe. The IIFAS-R is easy to administer, reliable and valid in Romania. The IIFAS-R can support data collection to promote and assess breastfeeding initiatives consistent with World Health Organization recommendations.