Health-related quality of life and morbidity in patients receiving brachytherapy for clinically localized prostate cancer

Health-related quality of life must be a factor when treatment options are discussed with a patient. Quality of life is measured by validated questionnaires that include generic and disease-targeted measures. Urinary and rectal symptoms and sexual function are evaluated after treatment for prostate cancer. Quality of life is adversely affected in the early post-brachytherapy period primarily by the urinary morbidity. Urinary symptoms peak 2 months after treatment and decline thereafter, although severe long-term urinary toxicity occurs in 3% to 12% of patients. Urinary symptoms are generally treated with alpha-blocker and anticholinergic drugs, but 2% to 5% of patients require transurethral resection of the prostate to relieve persistent obstruction. However, 6 months after treatment, overall satisfaction is excellent, and the majority of patients would recommend the procedure to a friend.     

Soft tissue sarcomas of adults: state of the translational science.

Sarcomas--like leukemias, which are also mesodermal malignancies--carry biological significance disproportionate to their clinical frequency. Identification of mutations and translocations associated with these tumors has illuminated aberrant signaling pathways that cause these diseases, determine their behavior, and are therapeutic targets. Activated receptor-associated tyrosine kinase c-kit, mutated in most gastrointestinal stromal tumors, has proven a clinically effective target for enzyme inhibition. A translocation involving a single gene family, consisting of EWS and related genes, has been identified in five different sarcomas, and its chimeric protein products could prove similarly amenable to inhibitors. Resolution of the histopathological complexity is being aided by data from molecular and chromosomal characterization. Improvements in imaging, definition of prognostic factors, and surgical and radiotherapeutic treatment have resulted in improved local control. Continued progress will depend on further adapting the rapidly evolving technologies of genomics and proteomics. It will also depend upon accurate histopathological diagnosis based on validated reagents and consistent methodologies applied to adequate tissue samples derived from patients with complete clinical data. Finally, multicenter, coordinated trials, such as those that occurred with assessment of imatinib mesylate in metastatic gastrointestinal stromal tumors, will assure the most rapid reductions in morbidity and mortality.     

Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer.

PURPOSE: This randomized, controlled, multicenter, open-label, phase III study compared docetaxel versus paclitaxel in patients with advanced breast cancer that had progressed after an anthracycline-containing chemotherapy regimen. PATIENTS AND METHODS: Patients (n = 449) were randomly assigned to receive either docetaxel 100 mg/m2 (n = 225) or paclitaxel 175 mg/m2 (n = 224) on day 1, every 21 days until tumor progression, unacceptable toxicity, or withdrawal of consent. RESULTS: In the intent-to-treat population, both the median overall survival (OS, 15.4 v 12.7 months; hazard ratio [HR], 1.41; 95% CI, 1.15 to 1.73; P = .03) and the median time to progression (TTP, 5.7 months v 3.6 months; HR, 1.64; 95% CI, 1.33 to 2.02; P < .0001) for docetaxel were significantly longer than for paclitaxel, and the overall response rate (ORR, 32% v 25%; P = .10) was higher for docetaxel. These results were confirmed by multivariate analyses. The incidence of treatment-related hematologic and nonhematologic toxicities was greater for docetaxel than for paclitaxel; however, quality-of-life scores were not statistically different between treatment groups over time. CONCLUSION: Docetaxel was superior to paclitaxel in terms of OS and TTP. ORR was higher for docetaxel. Hematologic and nonhematologic toxicities occurred more frequently in the docetaxel group. The global quality-of-life scores were similar for both agents over time.     

Predictors of all‐cause mortality among patients hospitalized with influenza,respiratory syncytial virus,or SARS‐CoV‐2

BackgroundShared and divergent predictors of clinical severity across respiratory viruses may support clinical and community responses in the context of a novel respiratory pathogen.MethodsWe conducted a retrospective cohort study to identify predictors of 30‐day all‐cause mortality following hospitalization with influenza (N = 45,749; 2010‐09 to 2019‐05), respiratory syncytial virus (RSV; N = 24 345; 2010‐09 to 2019‐04), or severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2; N = 8988; 2020‐03 to 2020‐12; pre‐vaccine) using population‐based health administrative data from Ontario, Canada. Multivariable modified Poisson regression was used to assess associations between potential predictors and mortality. We compared the direction, magnitude, and confidence intervals of risk ratios to identify shared and divergent predictors of mortality.ResultsA total of 3186 (7.0%), 697 (2.9%), and 1880 (20.9%) patients died within 30 days of hospital admission with influenza, RSV, and SARS‐CoV‐2, respectively. Shared predictors of increased mortality included older age, male sex, residence in a long‐term care home, and chronic kidney disease. Positive associations between age and mortality were largest for patients with SARS‐CoV‐2. Few comorbidities were associated with mortality among patients with SARS‐CoV‐2 as compared with those with influenza or RSV.ConclusionsOur findings may help identify patients at greatest risk of illness secondary to a respiratory virus, anticipate hospital resource needs, and prioritize local prevention and therapeutic strategies to communities with higher prevalence of risk factors.     

Impact Strength of Preplaced Aggregate Concrete Comprising Glass Fibre Mesh and Steel Fibres: Experiments and Modeling

Concrete is the most widely used and most affordable construction material. The structural damage that concrete cracks and fractures may cause can be severe. These concerns have lately been alleviated by new developments in fibre concretes. Recent advancements in fibrous concrete and its evolution have been rapidly drawing researchers’ attentions worldwide, which motivates the development of a new type of composite with superior impact resistance. Preplaced aggregate fibrous concrete (PAFC) is a revolutionary composite comprising a higher dosage of fibres. It has outstanding impact resistance that surpasses those of traditional fibrous concrete. The impact behaviour of PAFC in addition to glass fibre mesh (GFM) has not been investigated thoroughly. To fill this research gap, this study investigates the impact performance of three-layered PAFC comprising steel fibres and GFM insertion. Eight different mixtures were prepared and can be divided into two groups. In the first group, specimens were made with 4% fibres and two single, double and triple layers of GFM insertion between the three-layered concrete. The second group of specimens was reinforced with 5, 2 and 5% steel fibres at the top, middle and bottom layers, respectively. However, the GFM insertion scheme for the second group was the same as the first. Rectangular specimens of size 500 × 100 × 100 mm were cast and tested against drop weight impact. The parameters studied were cracking impact numbers, failure impact number, ductility index and failure patterns. In addition, an analytical model was used to evaluate the impact failure energies. Results indicate that the combined action of steel fibre and GFM exhibited an excellent impact resistance. Increasing the number of GFM insertions between the specimen layer led to increased impact strength. The dose of the fibres utilized in the outer layer of the PAFC was increased, resulting in the material having a higher impact resistance. The cracking impact numbers improved from 28 to 40%, and failure impact numbers ranged from 58.8 to 92.2% when the GFM insertion numbers increased from one to three.     

Drop Weight Impact Test on Prepacked Aggregate Fibrous Concrete—An Experimental Study

In recent years, prepacked aggregate fibrous concrete (PAFC) is a new composite that has earned immense popularity and attracted researchers globally. The preparation procedure consists of two steps: the coarse aggregate is initially piled into a mold to create a natural skeleton and then filled with flowable grout. In this instance, the skeleton was completely filled with grout and bonded into an integrated body due to cement hydration, yielding a solid concrete material. In this research, experimental tests were performed to introduce five simple alterations to the ACI 544 drop weight impact test setup, intending to decrease result dispersion. The first alteration was replacing the steel ball with a steel bar to apply a line impact instead of a single point impact. The second and third introduced line and cross notched specimens at the specimen’s top surface and the load applied through a steel plate of cross knife-like or line load types. These modifications distributed impact load over a broader area and decrease dispersion of results. The fourth and fifth were bedding with sand and coarse aggregate as an alternate to the solid base plate. One-hundred-and-eight cylindrical specimens were prepared and tested in 12 groups to evaluate the suggested alteration methods. Steel and polypropylene fibers were utilized with a dosage of 2.4% to produce PAFC. The findings indicated that the line notched specimens and sand bedding significantly decreased the coefficient of variation (COV) of the test results suggesting some alterations. Using a cross-line notched specimen and line of impact with coarse bedding also effectively reduced COV for all mixtures.