Definition of An Optimal First-line Chemotherapy in Metastatic Breast Cancer

Single-agent chemotherapy of metastatic breast cancer is the treatment of choice in patients with slow tumor progression and asymptomatic disease. In this patient group, the choice of drugs is based more on good tolerability than on efficacy. By contrast, symptomatic or rapidly progressing disease requires the use of highly active regimens where more weight is put on reliable antitumor activity. While anthraycline-based combination regimens have set the standard of effective treatment, the addition of docetaxel (and to a lesser extent paclitaxel) has improved tumor response, but failed to induce a consistent prolongation of survival. Based on retrospective analyses, it is hypothesised that the combined use of anthracyclines and taxanes in first-line therapy may be most beneficial in defined subgroups: after adjuvant chemotherapy, in patients with HER-2 gene amplification, possibly also in patients with rapidly progressing visceral disease.     

The influence of stigma on the sexual risk behavior of rural men who have sex with men.

Research investigating predictors of risky sexual behavior of rural MSM is sparse, even though the prevalence of HIV in rural areas has increased. This study explored two sets of predictors of 93 rural MSM's levels of risky sexual behavior: mental health variables and stigma emanating from men's family members, health care professionals, and people in the rural communities in which they live. Over 47% of the men were found to be at modified high to high risk. Logistic regression using a continuation logit model was used to test the relationship of the predictor variables and the four levels of risk. Findings indicate that self-esteem was predictive of the highest sexual risk behavior but not lower levels of risk. Stigma was predictive of modified high sexual risk when compared to low and no risk categories. No variables differentiated men at low risk from men at no risk.     

How we do it: Reinsertion of the stylet into the nucleus contour cochlear implant to facilitate second insertion. A helpful technique salvaging the cochlear implant device

• There are several causes for failure of appropriate position of the electrode array of the nucleus cochlear implant, e.g. incomplete insertion, extrusion, luxation, curling of the device, deviation, or false route. • If the position of the electrode array in relation to the modiolus is unsatisfactory, in order to salvage the cochlear implant one can reload the cochlear implant array with its stylet. • In order to reload the electrode array, primarily it needs to be removed from the cochlea and inserted into a small size suction tube (lubricated with just water). Then the stylet needs to be carefully straightened and inserted into the lumen of the array. • This technique is a relatively simple solution for unsatisfactory placement of the electrode array and can prevent discarding the precious cochlear implant.     

Gastrointestinal dysfunction among intensive care unit patients

This study used the Acute Physiological and Chronic Health Evaluation (APACHE II) system to select two groups of ICU patients with comparable risk of hospital death to evaluate the importance of GI dysfunction, defined as failure to tolerate enteral nutrition (EN), as a prognostic factor. In our ICU, patients who have not undergone recent bowel surgery are treated by EN. Those patients who cannot tolerate EN are treated by total parenteral nutrition (TPN). One hundred and eleven patients who tolerated EN (functioning gut) and 97 TPN patients who failed to tolerate EN (GI dysfunction) were studied. The mean APACHE II scores of the two groups were 17.7 +/- 6.5 (SD) and 17.7 +/- 5.1, respectively. The observed mortality of patients with GI dysfunction (51%) was significantly higher (p less than .0005) than that of patients with a functioning gut (25%). This was associated with significantly poorer APACHE II mean BP, oxygenation, and creatinine scores among the GI dysfunction patients. Our results suggest that shock, ischemia, and hypoxemia, in addition to causing impairment of renal function, may bring about changes in the GI tract, evident clinically only as a failure to tolerate EN, which have an adverse effect on the prognosis of ICU patients so affected.     

Object attachment, thumbsucking, and the passage to sleep

Cross-cultural studies suggest that children who sleep in the same room as their parents and who are breast-fed are less likely to use an attachment object. The present study examined childrearing practices that emphasize physical proximity of parent and child and use of an attachment object and thumbsucking at bedtime with 126 healthy U.S. infants. Four child-rearing practices were focused on: presence or absence of a caregiver when the child actually fell asleep; mode of feeding; location of the child's bed or sleeping place; whether or not the child slept with the parents during the night. Children who had an adult present as they fell asleep were less likely to use an attachment object or suck their thumbs. In contrast to cross-cultural research, the results of the present study suggest that where a child sleeps during the night or how the child is fed is not as important an influence on the bedtime use of an attachment object or thumbsucking as whether an adult is present as the child actually falls asleep.     

Personality of patients with pseudoseizures

We studied personality features of 19 patients with pseudoseizures (PS) only. Scores on a personality inventory (MMPI) were compared with those of adults with generalized seizures and correlated to cognitive measures (Halstead-Reitan). Mean MMPI scores did not differ significantly, and no profile distinguished PS and epilepsy patients. MMPI abnormalities of PS patients were diverse and seldom characteristic of hysteria. Eight PS patients had cognitive impairment, two without MMPI evidence of personality disorder. These findings suggest that the etiology of pseudoseizures is multifactorial, involving different psychopathologies and sometimes cerebral dysfunction.