Search

This study aimed to identify the demographic/socioeconomic factors associated with disparities in time to breast cancer treatment.We conducted an analysis of breast cancer patients from the National Cancer Database, 2008-2019. Time intervals from diagnosis to surgery, radiation, and chemotherapy were compared based on age, sex, race, and socioeconomic status.A total of 715,210 patients with breast cancer were included. Overall, Hispanic patients had the longest times to surgery, radiation, and chemotherapy compared to non-Hispanic patients (surgery 73.3 vs. 53.8 days, radiation 177.2 vs. 136.9 days, chemotherapy 83.0 vs. 66.5 days, all p0.01). Similarly, black patients, those who were uninsured, and those with lower income ($63,000) had the longest times to treatment.We identified several racial/socioeconomic disparities in time to treatment. Further investigation into the causes of these disparities is of increasing importance to address inequities in breast cancer care.

Various diseases associated with oxidative stress have necessitated the need to investigate plants for antioxidant agents. This study aims to investigate the antioxidant potential of the extract and fractions of C. pulcherrima and estimate the quantum chemical properties of polyphenolic compounds isolated from its most active antioxidant fraction. Methanolic extract and partition fractions of the pods of the plant were assayed for their antioxidant activity using four models: 1,1-diphenyl-2-dipicrylhydrazyl radical scavenging, ferric reducing antioxidant power, total antioxidant capacity and hydroxyl radical scavenging activity. Total phenolic and flavonoid contents of the extract and fractions were also investigated. Furthermore, the quantum chemical properties of two polyphenolic compounds were calculated to predict the antioxidant potential. The extract exhibited good antioxidant activity with IC50 = 45.63 µg/ml comparable to ascorbic acid of IC50 = 37.94 µg/ml, high reducing power with value at 376.74 ± 6.78, total antioxidant capacity obtained at ascorbic acid equivalence of 383 ± 8.16 mgAAE/g and potent hydroxyl radical scavenging activity with value at 580.97 µg/ml with ascorbic acid at 30.7 µg/ml. The total phenol and flavonoid contents values at 540.53 ± 3.71 and 347.87 ± 7.13 respectively. Furthermore, the results obtained from the quantum chemical calculations reveals polyphenolic compounds; 5(4-hydroxyphenyl)-3-hydroxy-2-methoxyphenol and 3(4-methanetriiol-2,6-dihydroxyphenoxy)-3’, 4’, 5’, 5, 7-pentahydroxy flavonol as promising antioxidant agents. The study concluded that C. pulcherrima pods have good antioxidant activity. Also, the polyphenolic compounds are among the chemical constituents responsible for the antioxidant activity obtained for the extract and ethyl acetate fraction.

The situation of residential buildings in urban areas must be assessed to ascertain their form and age, functions, convenience, and liveability. As a result, this paper evaluates selected aspects of the condition of residential buildings in Akure, Nigeria. The study's objectives include examining the types of housing units, plot coverage, the number of rooms, and building setbacks. Other factors include housing tenure, the condition of the in-house tap, the type of toilet facilities, and the age of the buildings. The study drew on both primary and secondary data sources. A total of 1,369 people were polled, with 684, 480, and 205 representing the core, transition, and peripheral zones. According to the findings, tenement buildings accounted for 62.3 percent of Akure's residential buildings. In the city core, 88.6 percent of the respondents developed their lands above 50 percent, while 20.0 percent developed their lands above 50 percent on the outskirts. The paper suggests that the relevant stakeholders should enforce the subsisting building regulations, introduce environmental inspectors and mobile courts, and the Ondo State government should invest in urban infrastructure.

Background Determining the best approach for esophageal cancer and predicting accurate prognosis are critical. Multiple studies evaluated characteristics associated with overall survival, and several prediction models have been developed. This study aimed to evaluate existing models and perform external validation of selected models. Methods A retrospective investigation of a multi-site institutional enterprise for patients with a diagnosis of esophageal cancer between 2013-2014 was performed. Selected survival prediction models included the Roswell Park Comprehensive Cancer Center (RPCCC) calculator, Oregon Health & Science University (OHSU) calculator, and two nomograms published by Shapiro et al. and Sun et al. One-year overall survival, level of agreement, and performance for each model were evaluated. Results A total of 104 patients were included and used to assess the prediction models. One-year overall survival was 0.76. Different calculators tended to rank patients similarly; however, they did not agree on predicted overall survival. The least disparity in correlation was observed between OHSU and Shapiro calculators. Shapiro's model achieved the highest performance [area under the curve (AUC) =0.63]. Conclusions Selected models showed fair results in estimating individual overall survival, although none achieved a high performance. While these tools may support the decision-making process for esophageal cancer patients, their implementation in clinical practice requires improved refinement to optimize their clinical utility.

Invasive tubular carcinoma (ITC) and invasive mucinous carcinoma (IMC) of the breast are rare histologic subtypes of breast cancer associated with favorable prognoses. The aim of our study was to investigate the outcomes for these rare subtypes using the National Cancer Database. Female patients diagnosed with ITC or IMC between 2005 and 2014 were analyzed. The primary outcome was overall survival (OS), and we analyzed its association with adjuvant therapy. 2735 patients with ITC and 5602 patients with IMC were identified. ITC presented in younger patients (57 vs. 67 years), had smaller tumors (size

Background Invasive papillary carcinoma (IPC) of the breast is thought to carry a more favorable prognosis than invasive ductal carcinoma (IDC). The aim of this study is to investigate the clinicopathological characteristics between IPC and IDC and their prognosis using a large nationwide data set. Methods Female patients diagnosed with malignant IPC and IDC between 2005 and 2014 were analyzed. Patients with incomplete survival data, stage 0/IV, unknown stage, or recurrent disease were excluded. Five-year overall survival was compared between IPC and IDC. Results Among 308,426 patients, 1147 had IPC and 307,279 had IDC. IPC presented more in older postmenopausal women, black Americans, and people who had government insurance. IPC had larger tumor size, lower-grade, and earlier-stage disease, less node-positive disease, higher hormone positivity, and lower human epidermal growth factor receptor 2 amplification. Adjuvant radiation and chemotherapy rates were lower in IPC than those in IDC. IPC had a similar 5-year overall survival as compared with IDC overall (86.8% versus 88.7%) (P = 0.06). Age, pathologic stage, and radiation treatment were shown to be independent prognostic factors of IPC. Conclusions IPC has a similar prognosis as IDC, suggesting that these patients should follow the same treatment protocols.

Background/aim Inflammatory pseudotumors are complex entities given that they carry varying characteristics with a multitude of behaviors that can resemble a malignancy clinically, radiographically, and histologically. Patients and methods Our case report presents a 65-year-old-female with a history of fever, abdominal pain, and anemia with imaging suggestive of a malignant disease process involving an ill-defined soft tissue mass between the left adrenal gland and pancreatic tail. Results Following diagnostic laparoscopy with abdominal washings and subsequent open resection of the mass, final pathology revealed multiple specimens demonstrating dense fibrosis with admixed spindled cells and inflammatory cells, an overarching morphology, and an immunohistochemical staining profile consistent with pancreatic inflammatory pseudotumor. Conclusion Inflammatory pseudotumor is a challenging diagnosis and should be included in the differential diagnosis for a patient who presents with nonspecific symptoms and an ill-defined mass on imaging.

Supercritical carbon dioxide (sCO2) can be utilized as a working fluid in various thermal systems including large scale power cycles; portable power production units, centralized coolant systems and standalone cooling devices. However,the lack of accurate prediction tools such as heat transfer coefficient correlations, and insufficient research studies about the mechanisms controlling heat transfer processes, are hindering its practical realization for key energy and cooling systems. The overall objective of this study is to extend fundamental knowledge about heat transfer and fluid dynamic processes in conduits pertinent to sCO2 with an emphasis on flow inclination and directional effects. This paper present the a study on effects of gravity, buoyancy on sCO2 flow at temperature near and away from the pseudocritical temperature. The experimental setup consists of a high temperature and pressure sCO2 heat transfer loop and flow testing facility. Recently researched sCO2 heat exchangers can have tubes oriented at different angles such as 45° or 90° to horizontal. For optimized design of efficient and cost-effective turbo-machinery components utilizing sCO2 as the heat transfer fluid, an understanding of convective heat transfer inside a tube/pipe is equally as important as external heat transfer. This paper presents an experimental and numerical study on sCO2 heat transfer at various inclinations with angles ranging from 0° (horizontal) to 90° (vertical) along with upward and downward flow direction with different inlet temperature. Thermocouple based temperature measurement is utilized at multiple locations within the test section axially and circumferentially to study the temperature distributions on the tube surface. Computational Fluid dynamics (CFD) simulations have been performed using ANSYS Fluent to complement experimental data. The CFD and experiment have been analysed against known Gnielinski nusselt number correlation.

BACKGROUND/AIM Asian Americans (AA) are one of the largest and fastest growing minority groups in the United States consisting of 18 million people. This population is an ethnically diverse group that tends to be classified as one cohort resulting in hidden survival disparities among AA subgroups. PATIENTS AND METHODS The National Cancer Data Base was queried for patients of Korean, Japanese or Filipino ancestry with gastric adenocarcinoma or esophageal adenocarcinoma between 2004 and 2013. RESULTS A total of 28,213 patients met the inclusion criteria: 1,542 with gastric adenocarcinoma and 26,671 with esophageal adenocarcinoma. The Korean group with gastric cancer (0.42) showed improved 5-year survival over the Japanese (0.31) and Filipino (0.21; p

Despite advances in therapy for melanoma, heterogeneous responses with limited durability represent a major gap in treatment outcomes. The purpose of this study was to determine whether alteration in tumor blood flow could augment drug delivery and improve antitumor responses in a regional model of melanoma. This approach to altering tumor blood flow was termed “dynamic control.” Dynamic control of tumor vessels in C57BL/6 mice bearing B16 melanoma was performed using volume expansion (saline bolus) followed by phenylephrine. Intravital microscopy (IVM) was used to observe changes directly in real time. Our approach restored blood flow in non-functional tumor vessels. It also resulted in increased chemotherapy (melphalan) activity, as measured by formation of DNA adducts. The combination of dynamic control and melphalan resulted in superior outcomes compared to melphalan alone (median time to event 40.0 vs 25.0 days, respectively, p = 0.041). Moreover, 25% (3/12) of the mice treated with the combination approach showed complete tumor response. Importantly, dynamic control plus melphalan did not result in increased adverse events. In summary, we showed that dynamic control was feasible, directly observable, and augmented antitumor responses in a regional model of melanoma. Early clinical trials to determine the translational feasibility of dynamic control are ongoing.

Background Recent studies have shown an increase in the incidence of gastric cancer (GC) among young adults in Asia and Latin America. However, it is unknown if a similar trend is happening in the United States. Methods A retrospective review of the National Cancer Database was conducted to identify patients diagnosed with gastric adenocarcinoma between the years of 2004 and 2013. Results A total of 93 734 patients were included. The two age groups below 40 did not see a change in GC incidence; however, age groups above 40 had increasing incidence. Patients aged 18 to 25 had the largest proportion of stage 4 disease and a poor survival (median 11.5 months), compared to older patients. Conclusion Despite the increasing trend of GC among individuals, the incidence of GC among young adults is not increasing. However, this subpopulation presents at more advanced stages (clinical stage 4) and thus has worse survival.

Background and aim of the work: Breast cancer is the most common cancer in women in the United States. National Cancer Database (NCDB) is one of the largest tumor databases of the United States. This study aimed to evaluate the features of breast cancer in women from a large updated database. Methods: We describe and analyze the frequencies and percentages of the clinical and pathological features of women diagnosed with breast cancer registered in NCDB, in a period from 2004 to 2015. Results: A total of 2,423,875 women were diagnosed with breast cancer between 2004 and 2015. The nationally representative analysis demonstrated that the incidence of breast cancer among women increased over the years. Upper-outer quadrant was the most frequent primary tumor site, and the intraductal carcinoma was the most frequent histology. The prevalence of breast cancer increased with age. The most frequent grade at diagnosis was grade II. Broadly, invasive characteristics were noted more frequently in younger patients. Left and right breast were affected with almost the same frequency, with a slight predominance of the left breast. The most frequent surgical treatment was a partial mastectomy. Reconstruction with implant was the most frequent choice. Post-mastectomy radiation therapy was administered in the majority of patients. Conclusions: To the authors’ knowledge, the current study is the largest descriptive analysis to date on the clinical and pathological features of breast cancer in a population-based database. The increase in incidence over the years indicates an important need for etiologic research and innovative approaches to improve breast cancer prevention. (www.actabiomedica.it)

BACKGROUND/AIM The surgical management of invasive melanoma has been debated for many years and recommended excisional margins have been established. We aimed to describe the factors and survival related to the presence of residual tumor in patients with invasive melanoma lymph nodes negative. PATIENTS AND METHODS We performed a retrospective study by querying the National Cancer Database from 2004 to 2015. Associations were tested using a multivariate analysis. Overall survival was compared using the Kaplan-Meier method. RESULTS A total of 26,440 patients met the inclusion criteria. For Breslow depth groups ≤1 mm and >2 mm, older age and location in the head and neck were factors associated to residual tumor in margins (p

In buildings, natural ventilation is for human comfort; for odour removal, body and the structure cooling. A previous study revealed that libraries in Nigeria could not function efficiently without artificial ventilation and lighting. Artificial ventilation, aside from economic disadvantages, it is not reliable and anti-sustainability while natural ventilation is reliable, consume less energy, and in other words, it is more efficient when compared with other types of ventilation. The research evaluates the application of passive architectural strategies for natural ventilation in libraries within the hot-humid climate of Nigeria, intending to recommend natural ventilation strategies in libraries. Ten (10) libraries were selected randomly in the study area from both institutional and public libraries. The research conducted using observation schedule, the variables in the research are; Window types, Clerestory windows availability, Door openings, Screen walls, Courtyard, Other openings, use of external shading devices and orientation of the library. The data analysed using descriptive statistic; the results presented using tables, bar charts and pie charts. The research revealed that 29% of the cases studied use external vertical structural shading devices, 36% use horizontal shading devices, 21% use both vertical and horizontal shading devices to deflect solar radiation and 14% do not use any external shading devices. 80% of the libraries studied was oriented toward north-south (NS) direction, while 20% oriented toward east-west (EW) direction. Therefore, the majority of the libraries studied have desired orientation; however, each lacks one of the passive cooling strategies. Adequate natural ventilation in the libraries is achievable by the proper synthesis of the building orientation, proper design of building internal spaces, the proper position of window openings and use of projected window as well as clearstory. More so, further study to enhance natural ventilation configuration for the study area is desirable.

Background and objectives Omission of routine axillary staging and adjuvant radiation (XRT) in women ≥ 70 years old with early stage, hormone receptor-positive, clinically node-negative breast cancer has been endorsed based on several landmark studies. We sought to determine how much omission of axillary staging/XRT has been adopted. Methods Using the National Cancer Data Base, we selected malignant breast cancer cases in women ≥ 70 with ER + tumors, ≤2 cm with clinically negative lymph nodes who underwent breast conservation and had known XRT status in 2005-2015. The use of sentinel lymph node biopsy (SNB) and XRT status was summarized by year to determine trends over time. Results In total, 57 230/69 982 patients underwent SNB. Of the 12 752 patients in whom SNB was omitted, 6296 were treated at comprehensive community cancer programs. Regarding XRT, 33 891/70 114 received adjuvant XRT. There were no significant trends with regards to patients receiving SNB or those receiving XRT. Conclusion Since 2005, there has been no change in SNB or XRT for early stage ER + breast tumors. However, there was a difference in omission of SNB based on facility type and setting. Future monitoring is needed to determine if these trends persist following the recently released Choosing Wisely® recommendations.

Introduction Contiguous non-mass enhancement (NME) often coexists with a solid tumor component on MRI, but it can be challenging to predict whether NME represents invasive breast cancer, ductal carcinoma in situ (DCIS), benign disease, or biopsy site reaction. The purpose of this study was to determine the association between the size/extent of NME and the presence of invasive cancer and/or DCIS on final pathology. Methods This was a single institution retrospective analysis of a prospectively maintained breast cancer registry (2010-2020). Female patients who underwent surgical resection were included if they had a diagnosis of invasive breast cancer (with or without DCIS) and had an MRI showing both a solid mass and contiguous NME. The size of NME on MRI was compared with the size of invasive cancer and/or DCIS on the final pathology. Results From a total of 3443 patients, 225 patients were included. 86.2% had invasive ductal carcinoma (IDC), and 12.0% had invasive lobular carcinoma 76.9% were ER+, 16.4% were HER2+, and 13.3% were triple negative breast cancer (TNBC). 18.7% received neoadjuvant chemotherapy (NCT) of whom 31% achieved a complete radiographic/pathologic response. Pearson correlation coefficients (r) between the size of NME and invasive cancer/DCIS showed a strong and positive correlation of MRI NME with DCIS on pathology in patients without NCT. Subgroup analysis showed the strongest correlations for NME and DCIS among non-white (r = .70) and HER2 + patients (r = .74) who did not receive NCT. Conclusions Strong correlations between NME and DCIS were found for HER2 + disease and non-white patients, but only modest correlations were found for other patient/disease characteristics. These correlations may impact decisions in surgical approach.

Background/Aim: Pancreatic cancer has a very poor prognosis, though outcomes based on age are not well characterized. The aim of current study was to analyze the survival of patients with pancreatic cancer based on age. Patients and Methods: Using National Cancer Data Base (NCDB), we determined survival outcome based on age among patients with pancreatic cancer. Results: A total of 423,482 patients between 2004 and 2017 were included in the study. Patients aged between 18 and 40-years-old had the worst 3-year survival rate among stage 1 disease. Conversely, patients over 65-years-old had the worst 3-year survival rate and presented with more advanced disease (clinical stages 3 and 4). Conclusion: Older patients with more advanced disease had worse survival.

Glucokinase activators are considered as new therapeutic arsenals that bind to the allosteric activator sites of glucokinase enzymes, thereby maximizing its catalytic rate and increasing its affinity to glucose. This study was designed to identify potent glucokinase activators from prenylated flavonoids isolated from medicinal plants using molecular docking, molecular dynamics simulation, density functional theory, and ADMET analysis. Virtual screening was carried out on glucokinase enzymes using 221 naturally occurring prenylated flavonoids, followed by molecular dynamics simulation (100 ns), density functional theory (B3LYP model), and ADMET (admeSar 2 online server) studies. The result obtained from the virtual screening with the glucokinase revealed arcommunol B (−10.1 kcal/mol), kuwanon S (−9.6 kcal/mol), manuifolin H (−9.5 kcal/mol), and kuwanon F (−9.4 kcal/mol) as the top-ranked molecules. Additionally, the molecular dynamics simulation and MM/GBSA calculations showed that the hit molecules were stable at the active site of the glucokinase enzyme. Furthermore, the DFT and ADMET studies revealed the hit molecules as potential glucokinase activators and drug-like candidates. Our findings suggested further evaluation of the top-ranked prenylated flavonoids for their in vitro and in vivo glucokinase activating potentials.

Key Points Question Is preoperative chemosensitivity associated with increased survival among patients with resectable gastric adenocarcinoma who undergo postoperative chemotherapy? Findings In this national cohort study of 2382 patients, postoperative chemotherapy was significantly associated with longer postoperative survival in patients with chemosensitive disease but not in those with very sensitive or refractory disease. Meaning These findings suggest that preoperative chemosensitivity may be helpful in making the decision regarding postoperative chemotherapy for patients with resectable gastric adenocarcinoma., This cohort study examines whether preoperative chemosensitivity is associated with postoperative survival among patients with resectable gastric adenocarcinoma who receive postoperative chemotherapy., Importance Considering its low completion rate, the survival benefit associated with postoperative chemotherapy (PC) is unclear in patients with resectable gastric adenocarcinoma who received preoperative chemotherapy. Objective To determine whether preoperative chemosensitivity is associated with postoperative survival among patients with resectable gastric adenocarcinoma who receive PC. Design, Setting, and Participants This national, hospital-based cohort study used data from the National Cancer Database, which covers more than 70% newly diagnosed gastric adenocarcinomas in the US, between 2006 and 2017. Participants included patients with clinical stage II or III disease treated with preoperative chemotherapy and curative-intent resection, excluding radiotherapy. Preoperative chemosensitivity was defined as very sensitive (ypT0N0), sensitive (pathological TNM stage less than clinical, excluding ypT0N0), and refractory (pathological greater than or equal to clinical). Data were analyzed in April 2021. Exposures Receipt of PC or not. Main Outcomes and Measures Overall survival from surgical discharge. Results This study included 2382 patients (1599 men [67%]; median [IQR] age, 63 [54-70] years). Most patients (1524 patients [64%]) received no PC. Most patients (1483 patients [62%]) had refractory disease, followed by sensitive disease (727 patients [31%]) and very sensitive disease (172 patients [7%]). Patients with older age (odds ratio [OR], 0.99; 95% CI, 0.97-1.00), comorbidity (OR, 0.71; 95% CI, 0.57-0.90), longer time from chemotherapy initiation to surgery (OR, 0.99; 95% CI, 0.97-1.00), less sensitivity to preoperative chemotherapy (very sensitive vs refractory OR, 0.58; 95% CI, 0.37-0.89; sensitive vs refractory OR, 0.96; 95% CI, 0.76-1.20), and longer surgical hospitalization (OR, 0.95; 95% CI, 0.93-0.97) had a significantly lower likelihood of receiving PC. PC was not associated with improved survival in the whole group (hazard ratio [HR], 0.88; 95% CI, 0.75-1.02). Patients with refractory disease had the worst survival compared with patients with sensitive disease (HR, 0.39; 95% CI, 0.32-0.46) and those with very sensitive disease (HR, 0.12; 95% CI, 0.07-0.20). Preoperative chemosensitivity was significantly associated with the survival benefit from PC (P for interaction = .03). PC was significantly associated with longer survival in patients with sensitive disease (5-year survival rate, 73.8% in the PC group vs 65.0% in the no PC group; HR, 0.64; 95% CI, 0.46-0.91), but not in those with very sensitive disease (5-year survival rate, 80.0% in the PC group vs 90.8% in the no PC group; HR, 2.45; 95% CI, 0.81-7.43) and those with refractory disease (5-year survival rate, 41.8% in the PC group vs 40.7% in the no PC group; HR, 0.93; 95% CI, 0.79-1.10). Conclusions and Relevance In this cohort study, preoperative chemosensitivity was associated with survival among patients with resectable gastric adenocarcinoma who received PC. These findings may help inform future studies to personalize postoperative therapy.

BACKGROUND External ear melanoma (EEM) is a rare condition with controversies in the literature. We analyzed patients with EEM in the United States compared to other head and neck melanomas (OHNMs). METHODS The National Cancer Database (NCDB) was used to select patients with head and neck melanoma from January 1, 2004 to December 31, 2015. Mann-Whitney and χ tests were used to estimate statistical significance, and multivariate logistic regression to identify independent associations adjusted for confounders. RESULTS A total of 137,233 patients met the study criteria. Among them, 16,991 (12.4%) had EEM and 120,242 (87.6%) had OHNM. For patients with EEM, the mean (standard deviation) age was 66.26 (15.798) years. Most of the patients with EEM were men (85.5%), insured by Medicare (52.4%), and treated in Academic/Research Programs (47.7%) or Comprehensive Community Cancer Programs (32.3%). Most of the EEM tumors had invasive behavior (68.0%) were Stages 0 (30.3%) or I (40.3%), and were without ulceration (76.9%). Mean time to receive any treatment was 14.1 days for EEM compared with 14.6 days for OHNM (P

BACKGROUND Eyelid melanoma (EM) is a rare condition that accounts for