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A petroleum contaminant plume, Diesel No. 2 in this case, atop shallow groundwater had been under cleanup for more than two decades using traditional methods of bailing, skimmers, and other...

Background It is expected that about 65,000 new patients will be diagnosed with head and neck cancer in 2017 in the United States. Patients with recurrent or advanced or metastatic head and neck do not have good survival due to aggressive and recurrent nature of this cancer. Moreover, cumulative and residual toxicities from previous and ongoing treatments significantly impede quality of remaining part of their life. Currently available chemotherapeutic regimens for this group are derived from the treatments used for the potentially curable disease. These regimens and associated toxicity are obviously not the best matches for the treatment with palliative intent. We here present a retrospective study where we used dose-adjusted chemotherapy specifically for palliative treatment this sub-group of head and neck cancer patients. Methods Study population was identified from the University of Florida, and IRB approval was obtained. We used currently available and approved chemotherapeutic agents (including Taxols, Platins, 5-Fluorouracil and Epidermal Growth Factor Receptor inhibitors) for treatment of head and neck cancer but dose-adjusted at approximate 50% dose of currently recommended doses. We then gave personalized doses for a prolonged period by titrating doses based on response and tolerability of each patient. Data was collected for treatment, response, side effects, and outcomes. KM analysis was performed for survival data. Results Total of 32 patients were included in this study with a median age of 65.2 years and a median follow-up of 10.1 months. 62.5% (n = 20) had locally advanced disease and rest had metastatic disease. 37.5% (n = 12) had new disease while rest had recurrent cancer. Of 32 patients, 14 patients received TPF based while 18 patients received PFE based chemotherapy. Total of 270 chemotherapy cycles were delivered among these 32 patients. They received a median of 9 cycles (range 3–14) over a median of 6.2 months (range 1.8–21.1). With this treatment approach, we noted median progression-free survival of 14.0 months and median overall survival of 15.7 months. Notable grade 3 toxicities were generalized fatigue in 12.5% (n = 4), nausea/vomiting in 6.3% (n = 2), diarrhea in in 6.3% (n = 2), mouth soreness in 6.3% (n = 2), rash in 3.1% (n = 1), neutropenia in 18% (n = 6) and anemia in 15.6% (n = 5) while notable grade 4 toxicities were neutropenia and anaphylaxis in 3.1% (n = 1) patient each. Conclusion With this personalized approach, we noticed minimal side effects, able to deliver prolonged therapy and obtained comparable results to previous studies.

Inoperable or metastatic head and neck squamous cell cancer (HNSCC) is known to be associated with a poor patient prognosis. First line therapies include a Taxol, platinum-based antineoplastic and fluorouracil (FU) treatment regimen (TPF) or a platinum-based antineoplastic, FU and EGFR inhibitor treatment regimen (PFE). The toxicity of these regimens is one of the major limiting factors, particularly for palliative treatment. The present study is a retrospective study of 15 patients with HNSCC, where the treatment goal was palliative. Of the 15 patients, 8 received a TPF, while 7 received a PFE. A total of 129 treatment cycles were administered with a median of 9 cycles (range, 3-14). Chemotherapy began with low doses and was subsequently titrated up based on tolerance and response. Positive responses were noted with the lower doses compared with the conventional doses, and maximal doses were not required. The median dose of cisplatin, paclitaxel and 5-FU administered was 40 mg/m2, 80 mg/m2 and 360 mg/m2/day for 5 days, respectively. Cetuximab was used at a standard dose. At the initial follow-up (mean, 64 days; 3 cycles), a 100% disease control rate (DCR) and 80% overall response rate (ORR) was achieved. A positive response, 60% DCR and 60% ORR, was maintained until the late stages of the study (mean, 217 days; 9 cycles). Following termination of chemotherapy after >9 cycles, 4 patients remained disease free for ~1 year. A total of 3 patients exhibited a pathologic complete response despite radiologically exhibiting residual disease. The median progression-free survival time was 10.03 months and the overall survival time was 15.77 months. The only grade 3 hematologic toxicity noted was neutropenia in 3 (20%) patients. Grade 3 vomiting was noted in 1 (6.67%) patient and grade 3 stomatitis was noted in 1 (6.67%) patient. Due to low toxicity patients exhibited improved tolerance to this approach, particularly in terms of palliative care. Furthermore, these results are in contrast to the axiom that increased doses are more effective.

Epistaxis is a common problem in children that typically is not severe and seldom requires hospitalization. The nose is a highly vascular structure with a large surface area; subsequently, it is highly predisposed to bleeding. Childhood vasculitides are very rare and are commonly diagnosed by characteristic lesions on imaging studies along with syndrome recognition by clinicians. We present a case of recurrent epistaxis that persisted over 3 months due to Wegener's granulomatosis in an adolescent that was misdiagnosed as a benign hemorrhage from Kiesselbach's plexus.

Current management of neuromyelitis optica (NMO) is noncurative and only partially effective. Immunosuppressive or immunomodulatory agents are the mainstays of maintenance treatment. Safer, better-tolerated, and proven effective treatments are needed. The perceived rarity of NMO has impeded clinical trials for this disease. However, a diagnostic biomarker and recognition of a wider spectrum of NMO presentations has expanded the patient population from which study candidates might be recruited. Emerging insights into the pathogenesis of NMO have provided rationale for exploring new therapeutic targets. Academic, pharmaceutical, and regulatory communities are increasingly interested in meeting the unmet needs of patients with NMO. Clinical trials powered to yield unambiguous outcomes and designed to facilitate rapid evaluation of an expanding pipeline of experimental agents are needed. NMO-related disability occurs incrementally as a result of attacks; thus, limiting attack frequency and severity are critical treatment goals. Yet, the severity of NMO and perception that currently available agents are effective pose challenges to study design. We propose strategies for NMO clinical trials to evaluate agents targeting recovery from acute attacks and prevention of relapses, the 2 primary goals of NMO treatment. Aligning the interests of all stakeholders is an essential step to this end. journal article research support, non-u.s. gov't review 2015 Apr 28 2015 04 03 imported

e17515 Background: Toxicity of the standard regimens is a major limitation in treatment of head/neck cancer which impacted about 61,000 persons in 2016 in USA of which 13,000 died. We present data herein with low dose chemotherapy (metronomic) using commonly used drugs Taxols, Platins, 5-Flurouracil and EGFR inhibitors. We achieved equal or better outcomes as compared to standard dosing with minimal side effects (level 3/4). Methods: This is a retrospective study on squamous cell head and neck cancer patients where standard first line therapies were started at ½ normal dosing and was increased until the emergence of side effects and titrated thereafter. Results: Patient population consisted of 32 patients with 87% males and with median age 65.2 years where 59% had recurrent disease, 71% locally advanced and 28% had metastatic disease. Total 270 chemotherapy cycles were delivered among these 32 patients with median of 9 cycles. Median dose for Cispatin was 45mg/m2, Paclitaxol was 80mg/m2, 5-FU was 360mg/m2/day. Cetuximab was used at standard doses. 6 patients who achieved long-term disease control were then placed on immunotherapy with either Nivolumab (median dose of 3mg/kg) or Pembrolizumab (median dose of 2mg/kg) and got median of 7 cyles. Out of 32, 9 patients (28%) achieved complete remission, 3 patients (9%) achieved near-complete remission with more than 95% reduction in tumor size. Overall disease control rate was 68% and overall response rate was 59%. Out of 9 patients who achieved complete remission 5 underwent surgical exploration and 1 went for cryo-ablation and no residual tumor was found. Measuring tumor volume in patients who achieved disease control showed volume reduction of 53%, 62% and 78% in 1st, 2nd and 3rdfollow up surveillance studies at mean interval of 101 , 186 and 331 days showing steady response. Median Progression free survival was 17.8 months and overall survival at 40 months was 54%. Notable high-grade toxicities were generalized fatigue in 12.5% (n = 4), grade 3 neutropenia in 18% (n = 6) and grade 4 neutropenia in 1 patient. Conclusions: These excellent results, low toxicity and subsequent good quality of life encourage patient tailored approach rather than one-size fits all approach.

Regulated river restoration through planned flooding involves trade-offs be- tween aquatic and terrestrial components, between relict pre-dam and novel post-dam re- sources and processes, and between management of individual resources and ecosystem characteristics. We review the terrestrial (wetland and riparian) impacts of a 1274 m 3 /s test flood conducted by the U.S. Bureau of Reclamation in March/April 1996, which was designed to improve understanding of sediment transport and management downstream from Glen Canyon Dam in the Colorado River ecosystem. The test flood successfully restored sandbars throughout the river corridor and was timed to prevent direct impacts to species of concern. A total of 1275 endangered Kanab ambersnail (Oxyloma haydeni kan- abensis) were translocated above the flood zone at Vaseys Paradise spring, and an estimated 10.7% of the total snail habitat and 7.7% of the total snail population were lost to the flood. The test flood scoured channel margin wetlands, including potential foraging habitats of endangered Southwestern Willow Flycatcher (Empidonax traillii extimus). It also buried ground-covering riparian vegetation under .1 m of fine sand but only slightly altered woody sandbar vegetation and some return-current channel marshes. Pre-flood control ef- forts and appropriate flood timing limited recruitment of four common nonnative perennial plant species. Slight impacts on ethnobotanical resources were detected .430 km down- stream, but those plant assemblages recovered rapidly. Careful design of planned flood hydrograph shape and seasonal timing is required to mitigate terrestrial impacts during efforts to restore essential fluvial geomorphic and aquatic habitats in regulated river eco- systems.

e17501Background: Inoperable or metastatic HNSCC is known to have poor prognosis. Regimens TPF (Taxol, Platin and FU) or PFE (Platin, FU and EGFR inhibitors) are among first line therapies. Due to ...

Introduction There have been recent reports of high vascular complication rates after the use of the Mynx vascular closure device (VCD). At our institution, vascular complications due to these devices have rarely been encountered. A study was undertaken to retrospectively compare angiographic abnormalities seen after femoral artery closure by both the Mynx and AngioSeal VCDs to provide further insight into the risks associated with VCDs. Methods All adult patients who underwent deployment of either a Mynx or AngioSeal VCD and subsequently underwent repeat angiography within the next 30 days between 1 July 2010 and 1 April 2011 were reviewed. Two independent blinded radiologists compared blinded pre-procedure and follow-up femoral angiograms for the presence of pseudoaneurysm or other vascular abnormality. Hospital records were reviewed for major or minor complications of the groin site or femoral artery. Results Thirty patients (31 angiograms) underwent vascular closure with a Mynx and 57 patients (69 angiograms) received an AngioSeal. The average time elapse until repeat femoral angiography was 6.2 days (range 1–21, median 5.5 days) in the Mynx group and 6.3 days (range 0–30, median 5 days) in the AngioSeal group. Two pseudoaneurysms and one minor stenosis were identified in the AngioSeal group. No angiographic abnormalities were seen in the Mynx group. No intraluminal filling defects were demonstrated on any of the follow-up femoral angiograms. One patient who received an AngioSeal developed a delayed minor groin site hematoma that did not require surgical intervention. Conclusions Angiographic complications were seen in only 3% of patients after closure with Mynx or AngioSeal VCDs. There were no clinically significant groin site or vascular complications. These data suggest that both VCDs are safe for use after angiography with a low rate of femoral artery complications.

Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines.

Background and Purpose: We present three patients with acute ischemic stroke who underwent computed tomography perfusion (CTP) imaging utilizing an Aquilion ONE (Toshiba Medical Systems, Nasu, Japan) 320-dectector row CT scanner using a Singular Value Decomposition Plus (SVD+) algorithm to generate perfusion maps. These MTT maps may prove to be a sensitive and specific predictor of ischemic penumbra (IP) and infarct core (IC). Methods: Patients, who presented with an acute ischemic stroke, received high quality whole-brain CTP scans and a follow up MRI or non-contrast CT (NCCT) scan, and underwent successful pharmacological and/ or interventional reperfusion procedures were selected for evaluation. A neuroradiologist utilizing Vitrea FX 3.1 software reviewed images, and the IC volumes were calculated. Results: A comparison was made between the volumes of infarct core utilizing SVD+ MTT maps and DWI MR sequences or a sub-acute NCCT. There was a correlation between the infarct core volume measured on MTT and final infarct volume on follow up imaging. However due to limitations associated with a small sample size, a statistical correlation cannot be definitively calculated from this data set. Conclusions: Utilization of the SVD+ MTT map may allow for a more accurate assessment of the infarct core and surrounding salvageable tissue as compared to cerebral blood flow/cerebral blood volume (CBF/CBV) mismatch though further studies are required to validate this observation.

Objective: MTT map is a sensitive and specific map differentiating ischemic penumbra (IP) from infarct core (IC) in acute stroke. Background We present eight patients with acute ischemic stroke who presented to our emergency department and underwent computed tomography perfusion (CTP) imaging utilizing the Toshiba Aquilion ONE 320-dectector row CT scanner running a Singular Value Decomposition Plus (SVD+) algorithm to generate perfusion maps. Design/Methods: A retrospective analysis of patients who presented with an acute ischemic stroke was performed. Patients receiving a high quality whole-brain CTP scan without evidence of hemorrhage on initial or follow-up CT who additionally underwent follow up MRI with DWI within 48 hours were included. Vitrea FX 3.1 software was utilized by a single, blinded neuroradiologist to process images. At risk territory was defined by the area of delayed perfusion on the time to peak map. The IC volume on the MTT map, as determined by values less than 3 seconds within this at risk territory, was measured on each slice. The total IC volumes were calculated by taking the sum of the IC on individual slices multiplied by the thickness of each slice. Pearson correlation was applied to assess for statistical correlation between IC on CTP and area of restriction on follow up DWI. Results: A comparison was made between the volumes of infarct core utilizing SVD+ MTT maps and DWI MR sequences. There was a significant correlation between infarct core volumes measured on MTT and infarct volumes on follow up DWI (r = 0.79). Conclusions: Although further studies are required to validate this observation, preliminary studies suggest that utilization of the SVD+ MTT map may allow for an accurate assessment of the infarct core and surrounding salvageable tissue. The additional information garnered from accurate interpretation of the SVD+ MTT maps may further guide clinicians in critical decision making during acute ischemic events. Disclosure: Dr. Dababneh has nothing to disclose. Dr. Guerrero has nothing to disclose. Dr. Wilson has nothing to disclose. Dr. Mocco has received personal compensation for activities with Concentric Inc as a consultant. Dr. Bennett has nothing to disclose. Dr. Hoh has received personal compensation for activities with Codman Neurovascular. Dr. Yuzeforich-Khanna has nothing to disclose. Dr. Peters has received personal compensation for activities with Toshiba as a speaker. Dr. Waters has nothing to disclose.

RNase MRP is a ribonucleoprotein endoribonuclease that has been shown to cleave mitochondrial primer RNA sequences from a variety of sources. The bulk of RNase MRP activity is found in the nucleus where its function remains unknown. Two different approaches have resulted in predictions of distinct secondary structures for RNase MRP RNA. In order to analyze more definitively the higher-order structure of RNase MRP RNA, we have conducted a phylogenetic comparison of the available RNase MRP RNA sequences from human, mouse, rat, cow, toad, and yeast. The resulting secondary structure shares features in common with previously described structures for prokaryotic and eukaryotic RNase P RNAs (1) and RNase MRP RNAs (2, 3). In addition, the phylogenetic structure is consistent with available chemical modification data on RNase MRP RNA and with the detailed analysis of the To antigen binding domain located near the 5' end of the RNase MRP RNA. The structure is not limited to RNase MRP RNAs, but can be expanded to cover both eukaryotic RNase P RNAs and RNase P/MRP RNAs from plants.