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Purpose: To determine the ability of image-guided high-dose rate brachytherapy (IG-HDR) to provide local control (LC) of lesions in non-traditional locations for patients with heavily pre-treated malignancies. Material and methods: This retrospective series included 18 patients treated between 2012 and 2014 with IG-HDR, either in combination with external beam radiotherapy (EBRT; n = 9) or as monotherapy (n = 9). Lesions were located in the pelvis (n = 5), extremity (n = 2), abdomen/retroperitoneum (n = 9), and head/neck (n = 2). All cases were performed in conjunction between interventional radiology and radiation oncology. Toxicity was graded based on CTCAE v4.0 and local failure was determined by RECIST criteria. Kaplan-Meier analysis was performed for LC and overall survival. Results: The median follow-up was 11.9 months. Two patients had localized disease at presentation; the remainder had recurrent and/or metastatic disease. Seven patients had prior EBRT, with a median equivalent dose in two Gy fractions (EQD2) of 47.0 Gy. The median total EQD2s were 34 Gy and 60.9 Gy for patients treated with monotherapy or combination therapy, respectively. Image-guided high-dose rate brachytherapy was delivered in one to six fractions. Six patients had local failures at a median interval of 5.27 months with a one-year LC rate of 59.3% and a one-year overall survival of 40.7%. Six patients died from their disease at a median interval of 6.85 months from the end of treatment. There were no grade = 3 acute toxicities but two patients had serious long term toxicities. Conclusions: We demonstrate a good one year LC rate of nearly 60%, and a favorable toxicity profile when utilizing IG-HDR to deliver high doses of radiation with high precision into targets not readily accessible by other forms of local therapy. These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC. [ABSTRACT FROM AUTHOR]

Background. Physical activity is associated with better physical health, possibly by changing biological markers of health such as waist circumference and inflammation, but these relationships are unclear and even less understood among older Latinos--a group with high rates of sedentary lifestyle. Methods. Participantswere 120 sedentary older Latino adults fromsenior centers. Communitypartnered research methods were used to recruit participants. Inflammatory (C-reactive protein) and metabolic markers of health (waist circumference, HDL-cholesterol, triglycerides, insulin, and glucose), physical activity (Yale physical activity survey), and physical performance (short physical performance NIA battery) were measured at baseline and 6-month followup. Results. Eighty percent of the sample was female. In final adjusted cross-sectional models, better physical activity indices were associated with faster gait speed (P < 0.05). In adjusted longitudinal analyses, change in self-reported physical activity level correlated inversely with change in CRP (β = -0.05; P = 0.03) and change in waist circumference (β = -0.16; P = 0.02). Biological markers of health did not mediate the relationship between physical activity and physical performance. Conclusion. In this community-partnered study, higher physical activity was associated with better physical performance in cross-sectional analyses. In longitudinal analysis, increased physical activity was associated with improvements in some metabolic and inflammatory markers of health. [ABSTRACT FROM AUTHOR]

Background: Ki-67 is a robust predictive/prognostic marker in prostate cancer; however, tumor heterogeneity in prostate biopsy samples is not well studied. Methods: Using an MRI/US fusion device, biopsy cores were obtained systematically and by targeting when indicated by MRI. Prostate cores containing cancer from 77 consecutive men were analyzed. The highest Ki-67 was used to determine interprostatic variation. Ki-67 range (highest minus lowest) was used to determine intraprostatic and intralesion variation. Apparent diffusion coefficient (ADC) values were evaluated in relation to Ki-67. Results: Interprostatic Ki-67 mean ± standard deviation (SD) values for NCCN low (L), intermediate (I), and high (H) risk patients were 5.1 ± 3.8%, 7.4 ± 6.8%, and 12.0 ± 12.4% (ANOVA P = 0.013). Intraprostatic mean ± SDKi-67 ranges in L, I, and H risk patients were 2.6 ± 3.6%, 5.3 ± 6.8%, and 10.9 ± 12.3% (ANOVA P = 0.027). Intralesion mean ± SDKi-67 ranges in L, I, and H risk patients were 1.1 ± 0.9%, 5.2 ± 7.9%, and 8.1 ± 10.8% (ANOVA P = 0.22). ADC values at Ki-67 > and <7.1% were 860 ± 203 and 1036 ± 217, respectively (P = 0.0029). Conclusions: High risk patients have significantly higher inter- and intraprostatic Ki-67 heterogeneity. This needs to be considered when utilizing Ki-67 clinically. [ABSTRACT FROM AUTHOR]

The article presents a study on factors which affect neck and shoulder pain experienced by operators of sewing machines. It examines the influence of factors both individual and work related in regards to neck and shoulder pain. It reveals that operators who worked longer or harder experienced less reduction to pain, therefore having less workloads and overtime should be considered in the management of work-related musculoskeletal disorders.

Reports of pain and physical exam findings for musculoskeletal disorders (MSDs) are two common outcome measures independently used to assess work-related MSDs in the scientific literature. How these measures correlate with each other, however, is largely unknown. We recruited 520 sewing machine operators to describe the correlation between subjective self-reported pain and physical findings of MSDs in three upper body regions including the neck/shoulder, elbow/forearm, and hand/wrist. Self-reports of pain and physical findings resulted in different and partly non-overlapping classifications of subjects as MSD cases in our study. Both outcome measures were found to be consistently associated with 'having a medical history of MSDs', 'perceived physical exertion', 'perceived job insecurity' (neck/shoulder), being of older age (arm/forearm), and female gender (arm/forearm and hand/wrist); however, we observed inconsistency for the measures for a number of other job related factors such as 'operating a single machine' and 'number of work hours per week'. Because to date no agreed upon "gold standard" for diagnosing MSDs exists, our findings suggest that research results can be very different when using self-reported measures versus physical exam findings. Also, in order to evaluate the success of an intervention, screening, or surveillance program for work related MSDs, it is important to define clearly which outcome measure best to employ. [ABSTRACT FROM AUTHOR]

This study used a modified version of the Behavioral Model for Vulnerable Populations to examine the predisposing, enabling, and need factors associated with detectable viral load (VL). HIV status was measured using saliva and confirmed by blood. Of 797 persons enrolled, 193 were HIV positive and provided VL counts. A hierarchical multivariate logistic regression approach demonstrated that the predisposing factors of homelessness and recent substance abuse, particularly methamphetamine abuse, had a negative association with VL. The negative association of homelessness on VL was weakened with the introduction of enabling and need utilization factors. Mediation analysis indicated homelessness and HIV medication taking significantly associated with methamphetamine use as a predictor of detectable viral load. Guided policy to address substance abuse among those who are HIV positive is needed to improve biological outcomes. [ABSTRACT FROM AUTHOR]

The article presents a randomized controlled trial which determines whether an adjustable chair improved back and hip pain of sewing machine operators in the garment industry in Los Angeles, California. It revealed that in 2000, the industry employed 11 million workers worldwide with approximately 350,000 workers wherein most of them were minimum wage earners, nonunion, immigrant women. Researchers found out that neck and shoulder pain were their most common complaints. These operators perform precision tasks while seated at a relatively fast pace with work cycles of 30 to 60 seconds which is performed on nonadjustable workstations and chairs. To address the problems, researchers suggested that workers should have an adjustable chair with a curved or a flat seat pan.

Bupropion hydrochloride is a dopamine and norepinephrine reuptake inhibitor which may be an effective treatment for cocaine dependence due to its ability to reverse deficits in dopaminergic functioning that occur in chronic cocaine users. We performed a randomized, double-blind, placebo controlled trial comparing outpatient treatment with bupropion (N = 37) and placebo (N = 33) in combination with standard cognitive behavioral therapy. There were no statistically significant differences between bupropion and placebo in treatment outcomes, including aggregate measures of urine drug screen results (Joint Probability Index at 16 weeks: 0.43 for bupropion and 0.38 for placebo), treatment retention, cocaine craving ratings, and assessments of depressive symptoms. The failure to find an effect for bupropion relative to placebo, when combined with standard cognitive behavioral therapy, dampens enthusiasm for future development of bupropion as a cocaine pharmacotherapy. [ABSTRACT FROM AUTHOR]

The article discusses a study which assesses the effect of chair design on neck or shoulder pain among sewing machine operators. It aims to determine whether a chair with a curved seat pan leads to improved changes in neck or shoulder pain scores. Results reveal that participants who received the flat seat chair experienced a decline in pain. It is concluded that findings show that an adjustable height task chair with a curved seat pan can lessen neck and shoulder pain severity.

BACKGROUND: The optimal management of high-risk prostate cancer (CaP) remains controversial. We hypothesized that specialty-specific differences would manifest in treatment recommendations between radiation oncologists and urologists, regardless of the level of evidence supporting various strategies. METHODS: An online survey was offered to radiation oncologists and urologists, querying opinions about treating high-risk CaP in the upfront setting, postoperatively, or after biochemical recurrences (BCRs) following radiation therapy (RT). Multivariate logistic regression was used to analyze how specialty influenced responses, adjusted for practice setting, training level, percentage of consultation caseload consisting of CaP, and nationality. RESULTS: A total of 1,253 physicians (846 radiation oncologists and 407 urologists) completed the survey. Radiation oncologists were more likely to prefer adjuvant RT, feel that it is underutilized, and recommend salvage RT at lower PSA thresholds (P < .0001). Urologists were more likely to recommend salvage radical prostatectomy (RP) or cryoablation for local salvage after RT, while radiation oncologists were more likely to recommend RT-based modalities and feel that local salvage was underutilized after RT (P < .0001). Urologists were more likely to feel that upfront RP was a better definitive treatment (P < .0001), while radiation oncologists were more likely to have the opposite opinion (P = .005). CONCLUSIONS: Specialty-specific differences were identified for both upfront management and management after BCRs for high-risk CaP, with specialists more likely to recommend the treatments they could deliver for nearly all clinical scenarios, whether these recommendations were based on high-level evidence or not. These differences highlight the need for multidisciplinary clinics and improved cross-specialty education. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a single-institutional experience with the use of re-irradiation for recurrent and new primary cancers of the head and neck.Methods: The medical charts of 80 consecutive patients who underwent re-irradiation for local-regionally recurrent or second primary head and neck cancer between November 1998 and December 2015 were analyzed. Multivariate analysis was performed using Cox proportional hazard and logistic regression to determine predictors of clinical outcomes.Results: Seventy-six of the 80 patients were evaluable. The median age was 57.5 (range 26.6-84.9); Intensity-modulated radiotherapy (IMRT) was used in 71 (93.4%) patients with a median dose of 60Gy. Thirty-one patients (40.8%) underwent salvage surgery before re-irradiation and 47 (61.8%) received concurrent systemic therapy. The median time interval between radiation courses was 25.3months (range 2-322months). The 2-year estimates of overall survival, progression free survival, locoregional control, and distant control were 51.0%, 31.3%, 36.8% and 68.3%, respectively. Patients who underwent salvage surgery prior to re-irradiation had significantly improved locoregional control, progression free survival, and overall survival (p<0.05, for all). On multivariate analysis, gross tumor volume (GTV) at re-irradiation and interval between radiation courses were associated with improved overall survival. Severe (grade⩾3) late complications were observed in 25 patients (32.8%).Conclusions: Re-irradiation for recurrent or second primary head and neck cancer is feasible and effective in select patients with head and neck cancer. The high observed rate of treatment-related morbidity highlights the continue challenges that accompany this approach. [ABSTRACT FROM AUTHOR]