Adjuvant therapy for breast cancer with positive axillary nodes designed according to estrogen receptor status

This is a preliminary report of the Southwest Oncology Group in which therapy is randomized by estrogen receptor (ER) data. Estrogen receptor-negative patients receive either 1 or 2 years of cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone (CMFVP). The ER-positive group receive CMFVP for 1 year and/or hormonal therapy. The findings to date include: (a) Estrogen receptor-positive patients have a significantly longer disease-free interval compared to ER-negative patients (p =0.004); (b) there is no significant difference in diseasefree interval for ER-negative patients who receive either 1 or 2 years of CMFVP; (c) the data for ER-positive patients is too preliminary to report for disease-free or total survival; and (d) toxicity is acceptable because of frequent monitoring and examinations which result in the low percentage of life-threatening toxicity.

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Resumen Este es un informe preliminar del Southwest Oncology Group de los Estados Unidos, grupo en el cual la terapia fue realizada en forma aleatorizada de acuerdo a los datos sobre receptores de estrógeno. Los pacientes con receptores de estrógeno negativos recibieron 1 o 2 años de CMFVP (ciclofosfamida, metotrexato, 5-fluorouracil, vincristina, y prednisona). Los pacientes con receptores de estrógeno positivos recibieron CMFVP por un año y/o terapia hormonal. 1. Los pacientes con receptores de estrógeno positivos presentaron un intervalo libre de enfermedad significativamente más largo que el de los pacientes con receptores de estrógeno negativos (p=0.004). 2. No se encontre una diferencia significativa en el intervalo libre de enfermedad entre los pacientes con receptores de estrógeno negativos que recibieron CMFVP por uno o por dos años. 3. Los datos sobre los pacientes con ER positivo son demasiado preliminares para poder informar sobre el estado libre de enfermedad o la supervivencia. 4. La toxicidad es aceptable en gracia a la monitoría mediante controles y exámenes frecuentes, lo cual resulta en una baja incidencia de toxicidad que pueda hacer peligrar la vida del paciente.

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Résumé Cet article constitue un rapport préliminaire provenant du Groupe Oncologique du Sud-Ouest des Etats-Unis. Il concerne les effets obtenus par la chimiothérapie associée à l'exérèse du cancer du sein qui s'accompagne d'un envahissement des ganglions axillaires. L'étude est randomisée en fonction du paramètre récepteur oestrogénique. Les malades qui appartiennent au groupe oestrogène récepteur négatif sont soumis pendant 1 an ou 2 ans à une chimiothérapie CMFVP (cyclophosphamide, methotrexate, 5-FU, vincristine, prédnisone). Le groupe oestrogène récepteur positif est soumis à la même chimiothérapie pendant un an et/ou à un traitement hormonal. 1. Les malades du groupe oestrogène récepteur positif présentent une récidive plus tardive que celle des malades qui appartiennent au groupe oestrogène récepteur négatif (p=0.004). 2. Il n'y a pas de différence significative en ce qui concerne ce fait pour les malades du groupe oestrogène récepteur négatif qui sont traités un an ou deux ans par le CMFVP. 3. Les données pour les malades du groupe oestrogène récepteur positif sont trop récentes pour apprécier avec précision la durée de la survie totale ou celle de l'intervalle libre entre le traitement et la récidive. 4. La toxicité du traitement chimiothérapique est acceptable dès lors que le traitement est bien conduit sous une surveillance effectuée à intervalles réguliers et fréquents qui permet de dépister les signes avant-coureurs de la toxicité.

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Supported by grant CA 20319-09.     

Prospective associations between parental feeding practices and children's oral processing behaviours

Previous research demonstrated that faster eating rates are linked with increased intake of energy during a meal. Here, we examined whether within‐meal parental feeding practices show cross‐sectional and prospective associations with children's oral processing behaviours and whether the previously demonstrated association between faster eating rates and higher energy intakes varies by parental feeding practices. A subset (n = 155) of children and their mothers from the Growing Up in Singapore Towards healthy Outcomes cohort participated in an ad libitum meal at age 4.5 years. Children's oral processing behaviours (eating rate, bite size, chews per gram, oral exposure time, and meal duration) and parental feeding practices (autonomy‐supporting and coercive prompts, restrictions, hurrying, and slowing) were recorded during the meal. Subsequently, 94 of the children participated in a follow‐up meal without their mothers at age 6 years. Parental feeding practices were not consistently associated with child oral processing behaviours overall. However, exploratory post hoc analyses revealed some sex differences. The mothers of girls with faster eating rates, larger bite sizes, and fewer chews were more likely to use hurrying, slowing, and restrictions, but similar associations were not observed among boys. Children who had the most problematic eating style and were eating fast and for long experienced more restrictions, instructions to slow down, and prompts. Faster eating rates were linked with the highest energy intakes if children were additionally prompted to eat. Prospective analyses showed that children who were more often prompted using coercive techniques and less frequently hurried at age 4.5 years had faster eating rates at 6 years and a larger increase in eating rates between ages 4.5 and 6 years but did not consume more energy. Although the direction of these associations cannot be assumed, these exploratory analyses suggest sex differences in the associations between feeding practices and oral processing behaviours and highlight the potential role of parents in the development of children's oral processing behaviours.     

Nutrients or nursing? Understanding how breast milk feeding affects child cognition

European Journal of Nutrition - To explore the associations between type of milk feeding (the “nutrients”) and mode of breast milk feeding (the “nursing”) with child...     

Social learning in a longitudinal integrated clinical placement

Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes; connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of integration in the wider community. Preparedness for practice, reflected students’ perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students’ agentic engagement, collaboration, and learning within an LIC. It is related to student perceptions of preparedness for practice. These findings provide insight for institutions wishing to develop similar programmes, by encouraging health professional educators to consider all of the potential elements of the placements, which most promote connectivity.     

The Subtemporal Approach to the Lateral Midbrain with and without Zygomatic Osteotomy: An Anatomical Study

The subtemporal approach provides a narrow operative corridor to the crus cerebrum and adjacent structures of the crural, interpeduncular, and ambient cistern. Addition of a zygomatic osteotomy widens this narrow corridor and spares retraction of the temporal lobe. We investigate and compare the morphometric parameters of the subtemporal approach with versus without zygomatic osteotomy. On each side of four cadaveric heads, a temporal craniotomy was performed to gain access to the crus cerebrum and adjacent subarachnoid cisterns using a subtemporal approach. Operative corridor width and corridor working angle were measured with and without brain retraction on each specimen side. Next, a zygomatic osteotomy was performed followed by full downward reflection of the temporalis muscle and further drilling of the squamous part of the temporal bone. Lastly, operative corridor width and corridor working angle were measured again for comparison. The subtemporal operating corridor was (mean/SD): 5.8/2.6 mm without retraction, 11.4/4.3 mm with retraction, and 13.5/6.5° working angle. After addition of a zygomatic osteotomy, the operative corridor was 8/9.2/4.3 mm without retraction, 14.7/4.5 mm with retraction, 31.8/3.1° working angle. Zygomatic osteotomy significantly increased the operative corridor working angle of the subtemporal approach. Furthermore, we demonstrate a direct approach into the interpeduncular fossa. Clin. Anat. 32:710–714, 2019. © 2019 Wiley Periodicals, Inc.