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The interface reaction and its effect on the mechanical properties have been experimentally studied for aluminum-based composites reinforced with titanium dioxide nanoparticles (TiO2). Aluminum-based composites containing TiO2 nanoparticles (20 nm in size) are developed by hot-rolling the ball-milled powder. High chemical potential energy of the nanoparticles induces the fast formation of the interface layer during the heat treatment process, and high yield stress of 514 MPa in a composite containing 5 vol.% TiO2 nanoparticles can be achieved. Furthermore, dislocations are emitted at the nanoparticle/matrix interface during deformation due to the high stress concentration. This study can provide useful insights for the design of metal-matrix composites. [ABSTRACT FROM PUBLISHER]

Aluminum-based composites containing multi-walled carbon nanotubes are produced by a powder metallurgy route involving a ball-milling technique. Effects of processing parameters on the dispersion of multi-walled carbon nanotubes and resulting properties are investigated. Multi-walled carbon nanotubes, initially located on the powder surface with maintaining their connectivity, become dispersed individually and embedded progressively in the aluminum powder during a milling process. The composite with individually dispersed multi-walled carbon nanotubes shows a good strength but poor electrical and thermal conductivities. On the other hand, the composite with a network structure of MWCNTs reveals much enhanced electrical conductivity of 3.316 × 107 Sm−1 and thermal conductivity of 172 W/m K. [ABSTRACT FROM AUTHOR]

Background: Multidetector computed tomography (MDCT) is widely accepted as an effective imaging modality in monitoring for bladder cancer recurrence after radical cystectomy. Elucidating the pattern of bladder cancer recurrence on CT can increase the diagnostic accuracy. Purpose: To evaluate the recurrence patterns of transitional cell carcinoma of the bladder and the factors associated with cancer recurrence. Material and Methods: One hundred and forty-nine consecutive patients (mean age, 66.55 years; range, 32-86 years) who underwent preoperative contrast-enhanced CT and radical cystectomy were included in this study. The presence, site, and time of tumor recurrence were recorded retrospectively by two radiologists in a consensus fashion. The association of tumor recurrence and tumor factors (T stage, lymph node metastasis, nuclear grade, and tumor diameter) were also evaluated using multiple logistic regression analysis and Kaplan-Meier statistics. Results: Tumor recurrence occurred in 60 patients (40.3%) with a mean time of 14 months (range, 1-64 months). The sites of recurrence included the operation site (n = 20), lymph node (n = 20), bone (n = 11), liver (n = 6), lung (n = 5), upper urinary tract (n = 4), colon (n = 3), adrenal gland (n = 2), peritoneum (n = 1), abdominal wall (n = 1), psoas muscle (n = 1), and penile skin (n = 1). Tumor recurrence was found to be associated with advanced T stage (P = 0.002) and lymph node metastasis (P < 0.001). Conclusion: Transitional cell carcinomas of the bladder recur more frequently at the operation site and lymph node, and T-stage and lymph node metastasis are closely associated with tumor recurrence. [ABSTRACT FROM AUTHOR]

Curcumin, a naturally occurring polyphenolic compound from Curcuma longa, has long been used in folk medicine as an antiinflammatory remedy in Asian countries. Endometriosis is a chronic gynecological inflammatory disorder in which immune system deregulation may play a role in its initiation and progression. A number of mediators, including cell adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1); proinflammatory cytokines such as tumour necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-6 and IL-8; and chemokines such as monocyte chemotactic protein-1 (MCP-1), play key roles in the pathogenesis of endometriosis. The aim of our study was to explore the effect of curcumin on the expression of these critical molecules in human ectopic endometriotic stromal cells isolated from women with endometriosis. Endometriotic stromal cells treated with curcumin showed marked suppression of TNF-α-induced mRNA expression of ICAM-1 and VCAM-1. Curcumin treatment also significantly decreased the TNF-α-induced cell surface and total protein expression of ICAM-1 and VCAM-1 in a dose-dependent manner. In addition, treatment of endometriotic stromal cells with curcumin markedly inhibited TNF-α-induced secretion of IL-6, IL-8 and MCP-1. Furthermore, curcumin inhibited the activation of transcription factor NF-κB, a key regulator of inflammation, in human endometriotic stromal cells. These findings suggest that curcumin may have potential therapeutic uses in the prevention and treatment of endometriosis. [ABSTRACT FROM AUTHOR]

Background: Tumor vascularity is a potential predictor of treatment outcomes in metastatic renal cell carcinoma (mRCC), and contrast enhancement of tumors in computed tomography (CT) is correlated significantly with microvessel density. In this study, the authors investigated whether tumor enhancement in contrast-enhanced CT (CECT) is useful for predicting outcomes in patients with mRCC who are receiving antiangiogenic therapy. Methods: Attenuation values were reviewed retrospectively on CECT images of all metastatic lesions in 66 patients from February 2007 to November 2008. All patients received a tyrosine kinase inhibitor (either sunitinib or sorafenib). Tumor response was evaluated on CECT studies every 12 weeks. The authors analyzed the association between contrast enhancement and treatment outcomes, including objective response, tumor size reduction rate, time to response, and time to progression. Results: In 46 patients, 198 metastatic lesions were assessed. Tumor size was reduced in 140 lesions (70.7%) and was increased in 58 lesions (29.3%). The mean reduction in size was 23.8%. The overall mean time to response and the time to progression were 8.6 months and 16.4 months, respectively. In multivariate analyses, tumor enhancement and enhancement pattern were associated with objective responses (P = .003 and P = .028, respectively). In addition, tumor enhancement was associated with tumor size reduction (P = .004). In Cox proportional hazards models, only tumor enhancement was associated significantly with the time to size reduction and progression-free survival (P = .03 and P = .015, respectively). Conclusions: Tumor enhancement on CECT images was associated with treatment outcomes and was identified as a potential predictor of treatment outcomes after antiangiogenic therapy in patients with mRCC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Self-expandable metal stents (SEMSs) are an effective palliative treatment for malignant biliary or duodenal strictures, but endoscopic stenting for combined malignant biliary and duodenal obstruction remains technically difficult. OBJECTIVE: To evaluate the feasibility and clinical success rate of endoscopic double stent-in-stent placement by using a new duodenal metallic stent for the management of malignant biliary and duodenal obstructions. DESIGN: Prospective, observational clinical feasibility study. SETTING: Tertiary referral center. MAIN OUTCOME MEASUREMENT: Technical and clinical success, complications, midterm outcome. PATIENTS AND METHODS: Eight patients with inoperable malignant biliary and duodenal strictures were enrolled. Endoscopic placement of a biliary SEMS was performed through the mesh of the duodenal stent. RESULTS: The duodenal strictures were in the first part of the duodenum in 3 patients (type 1) and in the second part in 5 patients (type 2). Duodenal stents were successfully deployed in all patients. Endoscopic placement of a biliary SEMS through the mesh of the duodenal stent was successful in 7 (87.5%) of 8 patients. In 2 of 3 patients with type 2 duodenal strictures with failed bile duct cannulation, biliary stenting was successful by using the rendezvous procedure. Early complications occurred in 1 patient. The overall median survival after combined stenting was 91 days (range 36-314 days). LIMITATIONS: Small number of patients and no comparison with other enteral stents. CONCLUSIONS: Biliary stenting through the new duodenal metallic stent is technically feasible and has a high success rate. Combined endoscopic biliary and duodenal stent-in-stent placement is a promising solution for the palliation of malignant biliary and duodenal obstruction. [ABSTRACT FROM AUTHOR]

Background: Peroral cholangioscopy (POC) provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother-baby endoscope system is not widely used because of several limitations. Although direct cholangioscopy with an ultraslim upper endoscope with a guidewire has been reported, success is not always guaranteed. Objective: To evaluate the feasibility and success rate of direct POC using an ultraslim endoscope with an intraductal balloon to maintain access compared with the guidewire method. Design: Prospective, observational clinical feasibility study. Setting: Tertiary referral center. Main Outcome Measurements: We compared overall procedure success rates and complications. A successful procedure was defined as one in which the endoscope was advanced into the bifurcation or stenotic segment of the biliary system. Patients and Methods: Twenty-nine patients with biliary disease underwent direct POC. All patients had previously undergone an endoscopic sphincterotomy or papillary balloon dilation with a large balloon. Eleven patients underwent wire-guided direct POC. Intraductal balloon-guided direct POC was performed in 21 patients. The balloon catheter was used to maintain access while an ultraslim upper endoscope was advanced over the balloon catheter, through the ampulla of Vater, and directly into the bile duct. Results: Wire-guided direct POC was successful in 5 of 11 (45.5%) patients. In contrast, the success rate of intraductal balloon-guided direct POC was 95.2% (20/21 patients, P < .05). Forceps biopsies under direct visualization of the intraductal lesion and therapeutic intervention, including laser lithotripsy or electrohydraulic lithotripsy, were performed successfully. Procedure-related complications were not observed. Limitations: A small number of patients and no comparison with conventional cholangioscopy. Conclusions: Intraductal balloon-guided direct POC with an ultraslim upper endoscope allows the direct visual examination and therapeutic intervention of bile ducts in patients with biliary disease. Further development of the endoscopic apparatus and specialized accessories are expected to facilitate this procedure. [ABSTRACT FROM AUTHOR]

The purpose of the study was to perform a node-by-node comparison of an ADC-based diagnosis and various size-based criteria on T2-weighted imaging (T2WI) with regard to their correlation with PET/CT findings in patients with uterine cervical cancer. In 163 patients with 339 pelvic lymph nodes (LNs) with short-axis diameter >5 mm, the minimum apparent diffusion coefficient (ADC), mean ADC, short- and long-axis diameters, and ratio of long- to short-axis diameters (L/S ratio) were compared in PET/CT-positive and -negative LNs. On PET/CT, 118 (35%) LNs in 58 patients were positive. The mean value of minimum and mean ADCs, short- and long-axis diameters, and L/S ratio were different in PET/CT-positive (0.6436 x 10(-3) mm(2)/s, 0.756 x 10(-3) mm(2)/s, 10.3 mm, 13.2 mm, 1.32, respectively) and PET/CT-negative LNs (0.8893 x 10(-3) mm(2)/s, 1.019 x 10(-3) mm(2)/s, 7.4 mm, 11.0 mm, 1.49, respectively) (P < 0.05). The Az value of the minimum ADC (0.864) was greater than those of mean ADC (0.836), short-axis diameter (0.764), long-axis diameter (0.640) and L/S ratio (0.652) (P < 0.05). The sensitivity and accuracy of the minimum ADC (86%, 82%) were greater than those of the short-axis diameter (55%, 74%), long-axis diameter (73%, 58%) and L/S ratio (52%, 66%) (P < 0.05). ADC showed superior correlation with PET/CT compared with conventional size-based criteria on T2WI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Endoscopic management of malignant hilar biliary strictures is difficult even for an experienced endoscopist. Moreover, endoscopic placement of bilateral metal stents is considered very difficult and complicated. OBJECTIVE: We explored the feasibility and efficacy of the placement of a newly designed metal stent for an endoscopic bilateral stent-in-stent procedure for the management of malignant hilar biliary strictures. DESIGN: Multicenter prospective feasibility study. SETTING: Five academic tertiary referral centers. PATIENTS: Thirty-five patients with malignant hilar biliary strictures of Bismuth type II or higher were enrolled. INTERVENTIONS: Bilateral stent placement by an endoscopic stent-in-stent procedure. MAIN OUTCOME MEASUREMENTS: Technical success, functional success, early and late complications, stent patency. RESULTS: The overall technical success rate of the newly designed metal stent was 94.3% (33/35). The success rate of the stent-in-stent procedure in a single session was 82% (27/33) per protocol and 77% (27/35) as intent to treat. In cases in which the initial stent-in-stent procedure failed, patients underwent the endoscopic stent-in-stent procedure for contralateral stent placement at 2 days (6%, 2/33) or 4 days (12%, 4/33) after the initial stent placement. There was no percutaneous insertion of a contralateral stent in these patients. There was no stent-related early or late complication in any enrolled patient. Functional success was 100% (33/33). Reintervention because of stent malfunction was 6% (2/33). These 2 patients showed sludge formation in the stent. During follow-up, there was no stent tumor ingrowth or overgrowth in the placed stent in any enrolled patient. According to the Kaplan-Meier analysis, median survival and stent patency were 180 days and 150 days, respectively. LIMITATIONS: An uncontrolled feasibility study with a small patient population and a limited follow-up period. CONCLUSION: The newly designed metal stent for the endoscopic bilateral stent-in-stent procedure may be feasible and effective for malignant hilar biliary strictures. [ABSTRACT FROM AUTHOR]

BACKGROUND: The 'mother-baby' endoscope system currently used for peroral cholangioscopy (POC) has several limitations. Endoscopic direct cholangioscopy when using an ultra-slim upper endoscope with a guidewire to maintain access has been reported, but appropriate accessories are required to increase the success rate. Herein, we describe a novel method, overtube-balloon-assisted endoscopy, for direct POC. OBJECTIVE: To evaluate the feasibility and usefulness of direct POC when using an ultra-slim upper endoscope with an overtube balloon to maintain access. SETTING: A single center. DESIGN: Case series. PATIENTS: Twelve patients with biliary disease. INTERVENTIONS: Direct POC by using an ultra-slim upper endoscope and diagnostic and/or therapeutic procedures. MAIN OUTCOME MEASUREMENTS: Success rate of this technique, diagnostic or therapeutic feasibility, and complications. RESULTS: Overtube-balloon-assisted direct POC was performed successfully in 10 of 12 patients (83.3%). The procedure revealed 4 common bile duct (CBD) stones, 4 benign biliary strictures, 1 polypoid tumor, and 1 cholangiocarcinoma. Five patients underwent forceps biopsy under direct visualization of the intraductal lesion. Laser lithotripsy was successfully performed in 1 patient. No procedure-related complication occurred. LIMITATIONS: A small number of patients and no comparison with conventional cholangioscopy. CONCLUSIONS: The overtube balloon appears to be a useful accessory in direct POC when using an ultra-slim upper endoscope. However, further development of a slim overtube or other accessories is necessary to improve the success rate of direct POC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Selective cannulation in patients with a Billroth II gastrectomy is still challenging. OBJECTIVE: To evaluate the usefulness of a multibending, forward-viewing endoscope (M-scope) for selective cannulation during diagnostic or therapeutic ERCP in patients with a Billroth II gastrectomy. DESIGN: Case series. SETTING: Tertiary center. PATIENTS: Fourteen patients having biliary disease with a Billroth II gastrectomy in whom selective cannulation failed when using a conventional forward-viewing endoscope. INTERVENTIONS: In all cases, we attempted selective biliary cannulation for ERCP with a single-bending, forward-viewing endoscope for 10 minutes. After failure with the conventional endoscope, we retried selective cannulation with the M-scope for 10 minutes. After cannulation, the diagnostic or therapeutic endoscopic procedures were performed. MAIN OUTCOME MEASUREMENTS: We assessed the success rate of selective cannulation, the possibility of therapeutic approaches, and procedure-related complications. RESULTS: In all cases, we successfully reached the ampulla of Vater with the M-scope. The overall success rate of selective cannulation with the M-scope was 92.9% (13/14). One patient developed mild pancreatitis. Therapeutic procedures such as sphincterotomy, balloon dilatation, stone removal, and biliary drainage were all possible. LIMITATIONS: Small number of patients; uncontrolled, single-center study. CONCLUSIONS: The M-scope seems to be helpful for selective cannulation during ERCP in patients with a Billroth II gastrectomy. All diagnostic and therapeutic procedures were possible through the M-scope. [ABSTRACT FROM AUTHOR]

Mutations in the ACTN4 gene cause focal segmental glomerulosclerosis (FSGS), which shows autosomal dominant inheritance (Online Mendelian Inheritance in Man No. 603278, FSGS1). Most patients with a diagnosis of FSGS1 show a mild to moderate degree of proteinuria during adolescence or later, and some patients gradually progress to end-stage renal disease. Here, we report a familial case of FSGS1 in which 2 affected siblings showed unusual clinical, pathological, and genetic features. Both patients presented with full-blown rapidly progressing nephrotic syndrome in early childhood. Renal pathological findings were of an FSGS collapsing variant and FSGS not otherwise specified. A novel ACTN4 mutation, p.Ser262Phe, was detected in the patients, and their father was found to have a germline mosaicism for the mutation. In addition, these siblings also had a heterozygous p.Thr5Met substitution in NPHS1, which encodes nephrin, although the functional significance of this substitution is unclear. This is the third clinical report of FSGS1 and the first case report of germline mosaicism confirmed in patients with hereditary podocyte disorders. FSGS1 may have widely variable clinical and pathological phenotypes and therefore should be considered in young children with full-blown and rapidly progressing nephrotic syndrome. The possibility of germline mosaicism makes interpretation of molecular diagnoses and genetic counseling more difficult. Copyright © 2008 National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the activity and the safety of a combination regimen of capecitabine and doxorubicin as salvage chemotherapy in advanced gastric cancer patients who had undergone one or two prior chemotherapy regimens. Patients received capecitabine, 2,500 mg/m2/day PO for 14 days (D1–14) and doxorubicin, 30 mg/m2 IV on day 1 every 3 weeks until disease progression. The response was evaluated according to RECIST criteria, and the toxicity was evaluated by NCI-CTC (version 2.0). Forty-five patients were enrolled. Twenty-six patients were treated as second-line chemotherapy and the remaining patients as third-line chemotherapy. A total of 152 cycles of chemotherapy (median 2, range 1–12) were administered. Median dose intensities of capecitabine and doxorubicin were 11,326 and 9.6 mg/m2/week, respectively. The overall response rate was 6.7% (95% CI, 4.1–12.5%) and the disease control rate was 46.7% (95% CI, 28.6–87.1%) according to an intent-to-treat analysis. The median progression-free survival was 11.3 weeks (95% CI, 5.6–16.7 weeks). The median overall survival was 29.1 weeks (95% CI, 18.3–39.9 weeks) with one-year survival rate of 24%. Severe (grade III/IV) hematologic and non-hematologic toxicity was uncommon and included nausea/vomiting in five (11.1%), neutropenia in two (4.4%), anemia in one (2.2%), and hand-foot syndrome in one patient (2.2%). The combination of capecitabine and doxorubicin is a feasible salvage regimen in advanced pre-treated gastric cancer. [ABSTRACT FROM AUTHOR]

Purpose: Since the combination of capecitabine and irinotecan has successfully been used as a first-line treatment in metastatic colorectal cancer (MCRC), we expected promising results when given as a second-line treatment to metastatic colorectal patients who had been pretreated with 5-Fluorouracil and Oxaliplatin.Methods: Thirty-three MCRC patients participated in this study and received an oral dose of 1,000 mg/m(2 )capecitabine twice daily on days 1-14 and a dose of 100 mg/m(2) irinotecan infused over 90 min on days 1 and 8, every 3 weeks.Results: The overall response rate in intent-to-treat was 33.3% (95% CI, 21.5-58.3%), including one complete response (3.0%) and ten partial responses (30.3%); 12 patients (36.4%) had disease stabilization and only 9 (27.3%) progressed. The median time to progression was 6.7 months (95% CI, 4.8-8.6 months). After a median follow-up time of 12 months, nine patients (27.3%) were still alive with metastatic disease. The median response duration for all patients was 6.7 months (95% CI, 3.9-9.5 months) and the median overall survival was 13.4 months (95% CI, 11.0-15.8 months) with a 1-year survival rate of 55.4%. Myelosuppression was commonly observed; NCI-CTC (v 2.0) grade 3/4 neutropenia, however, occurred in eight (24%) patients and grade 3 anemia was seen in one patient (3%). The most common (grade 3/4) non-hematological toxicity was diarrhea (15%) and the other severe grade 3/4 toxicities included nausea/vomiting in one patient (3%), stomatitis in one patient (3%), hand-foot syndrome in one patient (3%).Conclusions: The combination of capecitabine and irinotecan is an effective and well-tolerated regimen for second-line treatment of metastatic colorectal cancer. However, further phase III trials are required to clarify its use in the treatment of metastastic colorectal cancer patients who have been pretreated with 5-fluorouracil and oxaliplatin. [ABSTRACT FROM AUTHOR]

This paper examines normative and formative approaches toward describing normal work area. Squires' model of normal work area is an example of a normative approach, which prescribes the shape of normal work area. Squires' model has been taken as the starting point for more recent attempts to delineate reach boundaries in the workplace. However, his original paper does not present the derivation for his model or his claim that the distal boundary of his normal work area can be described by a prolate epicycloid. This paper presents the derivation for Squires' model and shows that the resulting curve is not a prolate epicycloid, but a related form, a hypotrochoid. It then identifies shortcomings of normative models, like Squires', notably the viability of the reach assumptions on which such normative models are based and their inability to deal with context-conditioned variability in the workplace. Finally, it examines the application of formative models, which attempt to identify constraints on the types of reach actions that people use. Data on how people actually reach may constitute a more appropriate foundation for constructing work area models needed to develop workplace standards. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the use and success rates of the GlideScope (GVL) by emergency physicians (EPs) during the initial two years after its introduction. METHODS: We performed an observational study using registry data of five emergency departments. The success rates in adult patients were evaluated and compared with those of conventional laryngoscope (CL). RESULTS: The GVL was used in 345 (10.7%) of 3233 intubation attempts by EPs. The overall success rate of the GVL was not higher than a CL (79.1% vs 77.6%, p=0.538). The success rate for the patients with difficult airway was higher in the GVL than a CL (80.0% vs 50.4%, p<0.001). CONCLUSION: The GVL was not used frequently by EPs during the initial two years after its introduction. Although the GVL provides a better glottic view, the overall success rates were similar to a CL. The GVL may be useful in patients with difficult airway. [ABSTRACT FROM AUTHOR]

BACKGROUND: Combination chemotherapy with gemcitabine and a platinum-based agent is regarded as a standard treatment for patients with advanced biliary-tract cancer. Results of phase 2 trials of single-agent erlotinib in biliary-tract cancer and of gemcitabine plus erlotinib in pancreatic cancer have shown modest benefits. Therefore, we aimed to investigate the efficacy of gemcitabine and oxaliplatin plus erlotinib versus chemotherapy alone for advanced biliary-tract cancer. METHODS: In this open label, randomised, phase 3 trial, we randomly assigned patients (in a 1:1 ratio) with metastatic biliary-tract cancer (cholangiocarcinoma, gallbladder cancer, or ampulla of Vater cancer) to receive either first-line treatment with chemotherapy alone (gemcitabine 1000 mg/m(2) on day 1 and oxaliplatin 100 mg/m(2) on day 2) or chemotherapy plus erlotinib (100 mg daily). Treatment was repeated every 2 weeks until disease progression or unacceptable toxic effects. Randomisation was done centrally (stratified by participating centre and presence of measurable lesion). The primary endpoint was progression-free survival. Analyses were by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT01149122. FINDINGS: 133 patients were randomly assigned to the chemotherapy alone group and 135 to the chemotherapy plus erlotinib group. The groups were balanced except for a higher proportion of patients with cholangiocarcinoma in the group given erlotinib than in the chemotherapy alone group (96 [71%] patients vs 84 [63%]). Median progression-free survival was 4·2 months (95% CI 2·7-5·7) in the chemotherapy alone group and 5·8 months (95% CI 4·6-7·0) in the chemotherapy plus erlotinib group (hazard ratio [HR] 0·80, 95% CI 0·61-1·03; p=0·087). Significantly more patients had an objective response in the chemotherapy plus erlotinib group than in the chemotherapy alone group (40 patients vs 21 patients; p=0·005), but median overall survival was the same in both groups (9·5 months [95% CI 7·5-11·5] in the chemotherapy alone group and 9·5 months [7·6-11·4] in the chemotherapy plus erlotinib group; HR 0·93, 0·69-1·25; p=0·611). All-cause deaths within 30 days of random assignment occurred in one (1%) of the patients in the chemotherapy alone group and in four (3%) of those in the chemotherapy plus erlotinib group. The most common grade 3-4 adverse event was febrile neutropenia (eight [6%] patients in the chemotherapy alone group and six [4%] in the chemotherapy plus erlotinib group). No patient died of treatment-related causes during the study. Subgroup analyses by primary site of disease showed that for patients with cholangiocarcinoma, the addition of erlotinib to chemotherapy significantly prolonged median progression-free survival (5·9 months [95% CI 4·7-7·1] for chemotherapy plus erlotinib vs 3·0 months [1·1-4·9] for chemotherapy alone; HR 0·73, 95% CI 0·53-1·00; p=0·049). INTERPRETATION: Although no significant difference in progression-free survival was noted between groups, the addition of erlotinib to gemcitabine and oxaliplatin showed antitumour activity and might be a treatment option for patients with cholangiocarcinoma. FUNDING: None. [ABSTRACT FROM AUTHOR]