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Background and Aims: Determining if a person with dementia should be referred for a driver assessment, at what stage of the illness and how often to repeat this are difficult decisions for health professionals. The aims of this study were to develop criteria for driver assessment referral and to explore the value of routine reassessment for drivers with dementia.Methods and Results: Twenty participants with a diagnosis of dementia were recruited from a memory clinic and underwent a standard occupational therapy driver assessment and reassessment 6 months later. Fifteen failed the initial assessment but 10 went on to pass local area assessments. Some participants in the early stages of the disease failed. Five of the nine participants suitable for reassessment at 6 months also failed.Conclusion: The results confirmed that routine referral following the diagnosis of dementia is appropriate. Change in performance was noted at reassessment, confirming that 6 months between assessments is an appropriate timeframe. [ABSTRACT FROM AUTHOR]

Purpose: We assessed characteristics of patients at a pediatric gender clinic and investigated if reports of mental health concerns provided by transgender and gender diverse (TGD) youth patients differed from reports provided by a parent informant on their behalf. Methods: This cross-sectional study included 259 TGD patients 8 to 22 years of age attending a pediatric gender clinic in the southeast United States from 2015 to 2020. Pearson correlations and paired sample t -tests compared patient-reported mental health concerns at patient intake with those provided by a parent informant. Clinical symptom severity was assessed with standardized T-scores. Level 2 Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression Scale and Level 2 PROMIS Emotional Distress-Anxiety Scale assessed depression and anxiety symptoms of patients. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure was used with parents. Results: Patients had a mean age of 14.9 at first visit, with most identifying as White (85.5%), non-Hispanic (91.1%), and as a boy or man (63.6%). Half had moderate-to-severe depression (51.2%) or anxiety (47.9%) symptoms. There was a moderate, positive correlation between patient-reported and parent-reported depression symptoms, with no correlation for anxiety symptoms. Informant type differences were statistically significant (patients reporting greater depression and anxiety symptoms). Conclusions: TGD youth patients reported more severe depression and anxiety symptoms compared with parent informants. Despite moderate agreement on depression symptoms, parents did not accurately detect their child's anxiety symptoms. These discrepancies highlight a need for interventions which increase parental recognition of child mental health status.

Purpose: Our purpose was to compare dosimetric parameters and late gastrointestinal outcomes between patients treated with proton beam therapy (PBT) for localized prostate cancer with rectal balloon immobilization versus a hydrogel rectal spacer., Methods and Materials: Patients with localized, clinical stage T1-4 prostate adenocarcinoma were treated at a single institution using conventionally fractionated, dose-escalated PBT from 2013 to 2018. Patient-reported gastrointestinal toxicity was prospectively collected, and the incidence of rectal bleeding was retrospectively reviewed from patient records., Results: One hundred ninety-two patients were treated with rectal balloon immobilization, and 75 were treated with a rectal spacer. Rectal hydrogel spacer significantly improved rectal dosimetry while maintaining excellent target coverage. The 2-year actuarial rate of grade 2+ late rectal bleeding was 19% and 3% in the rectal balloon and hydrogel spacer groups, respectively (P = .003). In univariable analysis, the probability of grade 2+ rectal bleeding was significantly correlated with increasing rectal dose. In multivariable analysis, only receipt of spacer hydrogel (hazard ratio, 0.145; P = .010) and anticoagulation use (hazard ratio, 5.019; P < .001) were significantly associated with grade 2+ bleeding. At 2-year follow-up, patient-reported Expanded Prostate Cancer Index Composite bowel quality of life composite scores were less diminished in the hydrogel spacer group (absolute mean difference, 5.5; P = .030)., Conclusions: Use of rectal hydrogel spacer for prostate PBT is associated with a significantly lower incidence of clinically relevant, late rectal bleeding and lower decrement in long-term, patient-reported bowel quality of life compared with rectal balloon immobilization. Our results suggest that hydrogel spacer may improve rectal sparing compared with rectal balloon immobilization during PBT for prostate cancer., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: We report prospectively captured clinical toxicity and patient reported outcomes in a single institutional cohort of patients treated for prostate cancer with proton beam therapy (PBT). This is the largest reported series of patients treated mostly with pencil beam scanning PBT., Methods: We reviewed 231 patients treated on an IRB approved institutional registry from 2013 to 2016; final analysis included 192 patients with > 1-year of follow-up. Toxicity incidence was prospectively captured and scored using CTCAE v4.0. International Prostate Symptoms Score (IPSS), Sexual Health Inventory for Men (SHIM) score, and Expanded Prostate Cancer Index Composite (EPIC) bowel domain questionnaires were collected at each visit. Univariate Cox regression was used to explore associations of grade 2+ toxicity with clinical, treatment, and dosimetric variables., Results: Median follow-up was 1.7 years. Grade 3 toxicity was seen in 5/192 patients. No grade 4 or 5 toxicity was seen. Patient reported quality-of-life showed no change in urinary function post-radiation by IPSS scores. Median SHIM scores declined by 3.7 points at 1-year post-treatment without further decrease beyond year 1. On univariate analysis, only younger age (HR = 0.61, p = 0.022) was associated with decreased sexual toxicity. EPIC bowel domain scores declined from 96 at baseline (median) by an average of 5.4 points at 1-year post-treatment (95% CI: 2.5-8.2 points, p < 0.001), with no further decrease over time. Bowel toxicity was mostly in the form of transient rectal bleeding and was associated with anticoagulation use (HR = 3.45, p = 0.002)., Conclusions: Grade 3 or higher toxicity was rare at 2-years after treatment with PBT for localized prostate cancer. Longer follow-up is needed to further characterize late toxicity and biochemical control., Trial Registration: NCT, NCT01255748 . Registered 1 January 2013.

Purpose: We characterized both physician- and patient-reported rates of gastrointestinal (GI) toxicity in patients treated with proton beam therapy (PBT) at our institution for prostate adenocarcinoma and identified factors associated with toxicity., Methods and Materials: We treated 192 patients with PBT between July 2013 and July 2016. Included patients had ≥1 year of follow-up. Potential preexisting clinical and treatment-related risk factors for GI toxicity were recorded. Common Terminology Criteria for Adverse Events version 4.0 was used to score toxicity. Expanded Prostate Cancer Index Composite (EPIC) bowel domain questionnaires assessed patient-reported quality of life. Associations between grade (GR) 2+ toxicity and clinical, treatment, and dosimetric factors were assessed using Cox models and corresponding hazard ratios., Results: The median follow-up was 1.7 years. Most of the observed GI toxicity (>90%) was in the form of rectal bleeding (RB). GR2+ GI toxicity and RB actuarial rates specifically at 2 years were 21.3% and 20.4%, respectively. GR3 toxicity was rare, with only 1 observed RB event. No GR4/5 toxicity was seen. The EPIC bowel domain median score was 96 (range, 61-100) pretreatment, 93 (range, 41-100) at 1 year, 89 (range, 57-100) at 1.5 years, and 89 (range, 50-100) at 2 years. Anticoagulation use was the only factor selected during multivariate analysis for predicting GR2+ RB, with a resulting concordance index of 0.59 (95% confidence interval, 0.48-0.68; P = .088). Type of proton technology (pencil beam scanning vs uniform scanning) and number of fields treated per day (1 vs 2) showed no significant difference in toxicity rate., Conclusions: PBT was associated with acceptable rates of GR2+ transient GI toxicity, mostly in the form of RB, which correlated with anticoagulation use. High EPIC bowel domain quality of life was maintained in the 2 years after treatment.

The purpose of this study was to evaluate the dosimetric and practical effects of the Monaco treatment planning system "max arcs-per-beam" optimization parameter in pelvic radiotherapy treatments. We selected for this study a total of 17 previously treated patients with a range of pelvic disease sites including prostate (9), bladder (1), uterus (3), rectum (3), and cervix (1). For each patient, 2 plans were generated, one using an arc-per-beam setting of "1" and another with an arc-per-beam setting of "2" using the volumes and constraints established from the initial clinical treatments. All constraints and dose coverage objects were kept the same between plans, and all plans were normalized to 99.7% to ensure 100% of the planning target volume (PTV) received 95% of the prescription dose. Plans were evaluated for PTV conformity, homogeneity, number of monitor units, number of control points, and overall plan acceptability. Treatment delivery time, patient-specific quality assurance procedures, and the impact on clinical workflow were also assessed. We found that for complex-shaped target volumes (small central volumes with extending arms to cover nodal regions), the use of 2 arc-per-beam (2APB) parameter setting achieved significantly lower average dose-volume histogram values for the rectum V 20 (p = 0.0012) and bladder V 30 (p = 0.0036) while meeting the high dose target constraints. For simple PTV shapes, we found reduced monitor units (13.47%, p = 0.0009) and control points (8.77%, p = 0.0004) using 2APB planning. In addition, we found a beam delivery time reduction of approximately 25%. In summary, the dosimetric benefit, although moderate, was improved over a 1APB setting for complex PTV, and equivalent in other cases. The overall reduced delivery time suggests that the use of mulitple arcs per beam could lead to reduced patient-on-table time, increased clinical throughput, and reduced medical physics quality assurance effort., (Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to describe how patient information needs change over the course of receiving radiation therapy for prostate cancer. Convenience sampling was utilized to recruit men with stage I-III prostate cancer. A longitudinal repeated measures design was implemented for this pilot study. Patients were presented with 36 paired comparisons, each asking the participant to choose the most important information topic(s) for today. Following completion of the survey instruments, the clinic nurse delivered the four top-ranked information topic handouts to each patient with brief instruction on how to use the handouts. Over the course of 6 months, we were able to recruit 35 men. The four highest priority topics across all four sessions were prognosis, stage of disease, treatment options, and side effects. Our results suggest trends in the information priorities that men hold over the course of radiation treatment. The information priorities do appear to shift over time, notably prognosis concerns and risk for family members continued to rise over time, while side effect information declined. These findings will extend an already strong foundation of evidence for preparatory information in radiation therapy. Furthermore, these findings will strengthen current evidence that computerized assessment of patient self-report information is feasible and an important adjunct to clinical practice.

Purpose: Optimizing androgen suppression may provide better control of localized prostate cancer (PCa). Numerous trials have supported the benefit of combining androgen deprivation therapy with definitive radiation therapy in men with locally advanced or high-grade disease. Addition of abiraterone to luteinizing hormone-releasing hormone agonist (LHRHa) with radiation has not been reported. We examined the safety of this combination as well as its impact on androgen suppression., Methods and Materials: A prospective, phase 2 study was conducted in men with localized PCa treated with 6 months of neoadjuvant and concurrent abiraterone with LHRHa and radiation. Duration of adjuvant LHRHa was at the discretion of the treating clinician. Prostate biopsy assays were obtained prior to the start of therapy and prior to radiation. Sera and tissue androgen levels were measured by liquid chromatography-tandem mass spectrometry., Results: A total of 22 men with intermediate- (n=3) and high-risk PCa (n=19) received study therapy. Sixteen men completed the intended course of abiraterone, and 19 men completed planned radiation to 77.4 to 81 Gy. Radiation to pelvic nodes was administered in 20 men. The following grade 3 toxicities were reported: lymphopenia (14 patients), fatigue (1 patient), transaminitis (2 patients), hypertension (2 patients), and hypokalemia (1 patient). There were no grade 4 toxicities. All 21 men who complied with at least 3 months of abiraterone therapy had a preradiation prostate-specific antigen (PSA) concentration nadir of <0.3 ng/mL. Median levels of tissue androgen downstream of CYP17A were significantly suppressed after treatment with abiraterone, and upstream steroids were increased. At median follow-up of 21 months (range: 3-37 months), only 1 patient (who had discontinued abiraterone at 3 months) had biochemical relapse., Conclusions: Addition of abiraterone to LHRHa with radiation is safe and achieves effective prostatic androgen suppression. Preliminary analysis of the clinical data is also promising, with excellent PSA nadir and no relapse to date in this high-risk population., (Copyright © 2015 Elsevier Inc. All rights reserved.)

We present a 2-D plasmonic crystal design with visible band-gap by combining a 2-D photonic crystal with TM band-gap and a silver surface. Simulations show that the presence of the silver surface gives rise to an expanded band-gap. A plasmonic crystal defect cavity with Q ~300 and mode volume ~1.9x10(-2) (λ/n) (3) can be formed using our design. The total Q of such a cavity is determined by both the radiative loss of the dielectric component, as well as absorption loss to the metal. We provide design criteria for the optimization of the total Q to allow high radiative or extraction efficiency.

We present a design of plasmonic cavities that consists of two sets of 1-D plasmonic crystal reflectors on a plasmonic trench waveguide. A 'reverse image mold' (RIM) technique was developed to pattern high-resolution silver trenches and to embed emitters at the cavity field maximum, and FDTD simulations were performed to analyze the frequency response of the fabricated devices. Distinct cavity modes were observed from the photoluminescence spectra of the organic dye embedded within these cavities. The cavity geometry facilitates tuning of the modes through a change in cavity dimensions. Both the design and the fabrication technique presented could be extended to making trench waveguide-based plasmonic devices and circuits.

Objective: The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice., Methods: A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored., Results: A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated., Conclusion: The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Low-grade alimentary lymphoma (LGAL) requires histological assessment of biopsies for diagnosis whereas intermediate- (IGAL) and high-grade (HGAL) alimentary lymphoma (AL) can be diagnosed by cytology of intestinal or mesenteric lymph node aspirates. Assessment of the relative frequency of subtypes of AL using histology alone may be skewed towards an increased frequency of LGAL as cases of IGAL or HGAL diagnosed cytologically may not progress to biopsy. We investigated the relative prevalence of AL subtypes diagnosed by both histopathology and cytology among primary accession cases across Australia during a 5-year period. Clinicopathological features of LGAL were compared with those of IGAL/HGAL. Fifty-three cases of AL were identified, including 30 diagnosed by histology (15 LGAL, 13 HGAL, two IGAL) and 23 IGAL/HGAL diagnosed by cytology. LGAL cases comprised 50% of histological diagnoses, but only 28% of all AL. A palpable abdominal mass was more common in IGAL/HGAL (43%) than in LGAL (7%) [odds ratio (OR) 7.6, P = 0.01]. Anaemia was more common in IGAL/HGAL (41%) compared with LGAL (7%) (OR 9.6, P = 0.02). On abdominal ultrasound, a gastrointestinal mural mass was visualised in 41% of IGAL/HGAL and 0% of LGAL (P = 0.01). Where a detailed abdominal ultrasound report was provided, gastric/intestinal wall thickening was the most commonly reported abnormality (82%). In cats with intestinal thickening, a loss of normal layering was more common (P = 0.02) in cats with IGAL/HGAL (71%) compared with those with LGAL (20%). The relative prevalence of LGAL was lower when cases diagnosed by cytology were included in addition to those diagnosed by histology in the study population. The relative frequency with which LGAL is diagnosed has increased since initial reports from this region. A number of significant clinicopathological findings are useful to distinguish LGAL from IGAL/HGAL.

Development of the yolk sac of squamate reptiles (lizards and snakes) differs from other amniote lineages in the pattern of growth of extraembryonic mesoderm, which produces a cavity, the yolk cleft, within the yolk. The structure of the yolk cleft and the accompanying isolated yolk mass influence development of the allantois and chorioallantoic membrane. The yolk cleft of viviparous species of the Eugongylus group of scincid lizards is the foundation for an elaborate yolk sac placenta; development of the yolk cleft of oviparous species has not been studied. We used light microscopy to describe the yolk sac and chorioallantoic membrane in a developmental series of an oviparous member of this species group, Oligosoma lichenigerum. Topology of the extraembryonic membranes of late stage embryos differs from viviparous species as a result of differences in development of the yolk sac. The chorioallantoic membrane encircles the egg of O. lichenigerum but is confined to the embryonic hemisphere of the egg in viviparous species. Early development of the yolk cleft is similar for both modes of parity, but in contrast to viviparous species, the yolk cleft of O. lichenigerum is transformed into a tube-like structure, which fills with cells. The yolk cleft originates as extraembryonic mesoderm is diverted from the periphery of the egg into the yolk sac cavity. As a result, a bilaminar omphalopleure persists over the abembryonic surface of the yolk. The bilaminar omphalopleure is ultimately displaced by intrusion of allantoic mesoderm between ectodermal and endodermal layers. The resulting chorioallantoic membrane has a similar structure but different developmental history to the chorioallantoic membrane of the embryonic hemisphere of the egg., (Copyright © 2012 Wiley Periodicals, Inc.)

Introduction: Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity., Methods: Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy - Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness-to-drive as the outcome., Results: Twenty-one physical, 13 sensory and seven assessments of cognition/perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy - Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations., Conclusion: This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy - Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the off-road driving capacity of clients., (© 2011 The Authors. Australian Occupational Therapy Journal © 2011 Occupational Therapy Australia.)

Copy number variation (CNV) is a highly topical area of research in schizophrenia, but the clinical relevance is uncertain and the translation to clinical practice is under-studied. There is a paucity of research involving truly community-based samples of schizophrenia and widely available laboratory techniques. Our objective was to determine the prevalence of clinically detectable CNVs in a community sample of schizophrenia, while mimicking typical clinical practice conditions. We used a brief clinical screening protocol for developmental features in adults with schizophrenia for identifying individuals with 22q11.2 deletions and karyotypically detectable chromosomal anomalies in 204 consecutive patients with schizophrenia from a single Canadian catchment area. Twenty-seven (13.2%) subjects met clinical criteria for a possible syndrome, and 26 of these individuals received clinical genetic testing. Five of these, representing 2.5% of the total sample (95% CI: 0.3%-4.6%), including two of ten patients with mental retardation, had clinically detectable anomalies: two 22q11.2 deletions (1.0%), one 47, XYY, and two other novel CNVs--an 8p23.3-p23.1 deletion and a de novo 19p13.3-p13.2 duplication. The results support the utility of screening and genetic testing to identify genetic syndromes in adults with schizophrenia in clinical practice. Identifying large, rare CNVs (particularly 22q11.2 deletions) can lead to significant changes in management, follow-up, and genetic counselling that are helpful to the patient, family, and clinicians., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

This paper describes a strategy for the fabrication of functional electronic components (transistors, capacitors, resistors, conductors, and logic gates but not, at present, inductors) that combines a single layer of lithography with angle-dependent physical vapor deposition; this approach is named topographically encoded microlithography (abbreviated as TEMIL). This strategy extends the simple concept of 'shadow evaporation' to reduce the number and complexity of the steps required to produce isolated devices and arrays of devices, and eliminates the need for registration (the sequential stacking of patterns with correct alignment) entirely. The defining advantage of this strategy is that it extracts information from the 3D topography of features in photoresist, and combines this information with the 3D information from the angle-dependent deposition (the angle and orientation used for deposition from a collimated source of material), to create 'shadowed' and 'illuminated' regions on the underlying substrate. It also takes advantage of the ability of replica molding techniques to produce 3D topography in polymeric resists. A single layer of patterned resist can thus direct the fabrication of a nearly unlimited number of possible shapes, composed of layers of any materials that can be deposited by vapor deposition. The sequential deposition of various shapes (by changing orientation and material source) makes it possible to fabricate complex structures-including interconnected transistors-using a single layer of topography. The complexity of structures that can be fabricated using simple lithographic features distinguishes this procedure from other techniques based on shadow evaporation.

Purpose: This was an exploratory analysis of a trial of intermittent androgen deprivation (IAD) in men with biochemical relapse (BR) to establish first cycle characteristics prognostic for progression to castration-resistant prostate cancer (CRPC) and death., Patients and Methods: Men with BR of prostate cancer after radical prostatectomy (RP) or radiation (RT) were treated with androgen deprivation therapy (ADT) comprised of leuprolide and flutamide. After 9 months on treatment, ADT was stopped, and monthly prostate-specific antigen (PSA) levels were observed during the off-treatment interval. When the PSA reached a threshold value (1 ng/mL for RP, 4 ng/mL for RT), ADT was resumed in a new cycle. Patients were treated intermittently in this manner until CRPC, which was defined as > or = two consecutive increasing PSA values while on ADT with castrate testosterone levels., Results: Seventy-two of 100 patients enrolled onto the study met criteria for this analysis. The duration of the first off-treatment interval (< or = v > 40 weeks) was associated with shorter time to CRPC (hazard ratio = 2.9; 95% CI, 1.1 to 7.7; P = .03) and death (hazard ratio = 3.8; 95% CI, 1.1 to 13.6; P = .04) after adjusting for age, stage, grade, and PSA at diagnosis., Conclusion: In patients who completed the first cycle of IAD, a duration of the first off-treatment interval of < or = 40 weeks defines a subset of patients at higher risk of CRPC and death. Conversely, patients with an off-treatment interval of more than 40 weeks have a significantly better long-term prognosis.

Objective: The number of functionally impaired drivers being assessed is increasing the urgency to develop a standardized off-road driver assessment battery. We examined the validity of the Road Law and Road Craft Test (RLRCT) and a version of the Melbourne Slide Test to determine whether they should be included in the Occupational Therapy Driver Off-Road Assessment (OT-DORA) battery, which is under development., Method: We conducted a file audit of 118 data sets with individual item scores for the RLRCT and Melbourne Slide Test., Results: The RLRCT test with one item removed provides clinicians with a valid indication of clients' off-road driving skills. The Melbourne Slide Test added no new information over that provided by the RLRCT and can be excluded from the battery., Conclusion: The revised 14-item RLRCT should be included in the OT-DORA battery. Further research is required to develop the OT-DORA battery as a valid and reliable measure of off-road driver skill.

Adult bone marrow (BM) contributes to neovascularization in some but not all settings, and reasons for these discordant results have remained unexplored. We conducted novel comparative studies in which multiple neovascularization models were established in single mice to reduce variations in experimental methodology. In different combinations, BM contribution was detected in ischemic retinas and, to a lesser extent, Lewis lung carcinoma cells, whereas B16 melanomas showed little to no BM contribution. Using this spectrum of BM contribution, we demonstrate the necessity for site-specific expression of stromal-derived factor-1alpha (SDF-1alpha) and its mobilizing effects on BM. Blocking SDF-1alpha activity with neutralizing antibodies abrogated BM-derived neovascularization in lung cancer and retinopathy. Furthermore, secondary transplantation of single hematopoietic stem cells (HSCs) showed that HSCs are a long-term source of neovasculogenesis and that CD133(+)CXCR4(+) myeloid progenitor cells directly participate in new blood vessel formation in response to SDF-1alpha. The varied BM contribution seen in different model systems is suggestive of redundant mechanisms governing postnatal neovasculogenesis and provides an explanation for contradictory results observed in the field.

We present a general approach to growing ZnO nanowires on arbitrary, high melting point (above 970 degrees C) substrates using the vapor-liquid-solid (VLS) growth mechanism. Our approach utilizes the melting point reduction of sufficiently small (5 nm diameter) Au particles to provide a liquid catalyst without substrate interaction. Using this size-dependent melting effect, we demonstrate catalytic VLS growth of ZnO nanowires on both Ti and Mo foil substrates with aspect ratios in excess of 1000:1. Transmission electron microscopy shows the nanowires to be single-crystalline, and photoluminescence spectra show high-quality optical properties. We believe this growth technique to be widely applicable to a variety of substrates and material systems.

Background: Many patients with invasive urothelial cell cancer are poor candidates for cisplatin-based chemotherapy, and many are high risk for cystectomy. Southwest Oncology Group Trial 8733 was designed to address treatment for such patients., Methods: Eligible patients had primary or recurrent muscle-invasive disease with transitional cell or squamous cell histology, a performance status from 0 to 2, no extrapelvic disease, a life expectancy >3 months, and adequate hematologic function. The treating clinician assigned patients to operable or inoperable groups. All patients received 2 cycles of 5-fluorouracil (5-FU) at a dose of 1000 mg/m(2) per day x 4 starting concurrently with radiation at a dose of 200 centigrays per day x 10 each cycle. After 2 cycles, operable patients with positive biopsies underwent cystectomy, and patients with negative biopsies received a third cycle of chemoradiotherapy. Patients in the inoperable group received 3 cycles without interim biopsy., Results: Eighteen of 24 eligible patients in the operable group were evaluable for response. Five patients had a complete response (CR), 9 patients had stable disease, 1 patient had progressive disease, and 3 patients were not assessable. The median progression-free survival was 10 months (95% confidence interval [95% CI], 4-14 months), and the median overall survival was 18 months (95% CI, 7-28 months). In the inoperable group, 35 of 37 eligible patients were evaluable for response with 17 CRs (49%; 95% CI, 31%-66%). The median progression-free survival was 13 months (95% CI, 10-17 months), and the median overall survival was 20 months (95% CI, 11-53 months). There were no episodes of grade 4 toxicity., Conclusions: In the current study, the combination of 5-FU and radiation was found to be tolerated well by patients with numerous comorbidities who could not tolerate cisplatin-based therapy or cystectomy., ((c) 2008 American Cancer Society.)

Purpose: Men diagnosed with localized prostate cancer (LPC) often have the opportunity to participate in the treatment choice. The purpose of this study was to evaluate relationships between influential factors on treatment choice and the decision-related outcomes of decisional conflict and satisfaction., Patients and Methods: This report presents data from 260 men diagnosed with LPC who were identified by their clinicians as having a choice of treatments. Men completed questionnaires at home within 2 weeks of the informational clinic visit with the clinician, but before treatment. The respondent sample had a mean age of 63.2 years (standard deviation, 8.1 years); the majority were married/partnered (82.7%), working (51.5%), white (93.8%), and educated at the collegiate level (83.8%). Personal factors (information, influential people, and outcomes), treatment choice, and decisional conflict and satisfaction with the decision (SWD) were queried. Relationships between all variables and the outcomes, SWD, and treatment choice were explored using exhaustive chi(2) automatic interaction detector., Results: The strongest predictor partition variable for SWD was the subscale "factors contributing to uncertainty" (adjusted P < 0.0001) followed by the Trait Anxiety score (adjusted P = 0.0388). The strongest predictive partition for the actual treatment choice was age group (adjusted P < 0.0001), followed by interacting marital status (adjusted P = 0.0003), influence of the urologist (adjusted P = 0.0008), and use of the Internet (adjusted P = 0.0479). Men with LPC were more satisfied with their treatment choice when they reported fewer uncertainty factors; these are factors mainly relevant to information needed to understand the pros and cons and to make a decision. Consistent with this finding for treatment choice is the use of the Internet, though this factor interacted with age, the influence of their surgeon, and marital status., Conclusion: This study suggests that personally meaningful information communicated between patients and clinicians is paramount.

The purpose of this pilot study was to develop and test the Personal Patient Profile-Prostate (P4), a customized, Internet-based decision support system for men with localized prostate cancer. In a sample of 30 men, the P4 program was successfully implemented in a clinical setting. Men reported the program useful and web-logs documented a high use rate of menu-driven components of the intervention.

Advanced mycosis fungoides (MF) is incurable with conventional treatments. High-dose chemoradiotherapy with autologous bone marrow transplantation has induced remissions in a small number of patients with MF, but this modality is limited by a high relapse rate. We report induction of complete remission in a 37-year-old woman with rapidly progressive stage IV MF with allogeneic stem cell transplantation (Allo SCT). She remains in continuous complete remission 2 years after transplant. Allo SCT for MF is theoretically attractive, because there is no contamination of the graft by malignant cells, and because of the possibility of graft-versus-tumor effect. Although the results in this patient are encouraging, more patients and longer follow-up are needed to define the usefulness of Allo SCT in the treatment of MF.

Neutrophil extravasation during inflammation can occur either by a mechanism that requires the neutrophil integrin complex, CD18, or by an alternative CD18-independent route. Which of the two pathways is used has been shown to depend on the site and nature of the inflammatory insult. More recent evidence suggests that selection may also depend on whether inflammation is chronic or acute, but why this is the case remains unknown. Using an in vitro model that supports both migratory mechanisms, we examined the CD18 dependency of migration of neutrophils isolated from patients with either chronic or acute pulmonary infection. Chronic neutrophils were found to behave like normal neutrophils by migrating to IL-8 and leukotriene B(4) using the CD18-independent pathway, but to the bacterial product, FMLP, using the CD18-dependent route. In contrast, migration of acute neutrophils to all of these stimuli was CD18 dependent. Normal neutrophils could be manipulated to resemble acute neutrophils by exposing them to FMLP before migration, which resulted in a "switch" from the CD18-independent to -dependent mechanism during migration to IL-8 or leukotriene B(4). Although treatment of normal neutrophils with FMLP caused selective down-regulation of the IL-8 receptor, CXCR2, and acute neutrophils were found to have less CXCR2 than normal, a functional relationship between decreased CXCR2 and selection of CD18-dependent migration was not demonstrated. Results indicate that selection of the CD18-dependent or -independent migration mechanism can be controlled by the neutrophil and suggest that the altered CD18 requirements of acute neutrophils may be due to priming in the circulation during acute infection.

The Eugongylus species group of Australian lygosomine skinks provides an unparalleled opportunity to study the evolution of placentotrophy. Viviparity and placentotrophy have evolved in two lineages, currently recognised as the genera Pseudemoia and Niveoscincus. The genus Niveoscincus is important because it is the only lineage of squamates in which variation in placental morphology and in the pattern of embryonic nutrition is known. Niveoscincus coventryi has the least complex placental morphology among species currently assigned to the genus. We quantified the net uptake of nutrients across the placenta of N. coventryi for comparison with other species in the genus and with other viviparous and oviparous lizards. The pattern of embryonic nutrition of N. coventryi is similar to other viviparous lizards with simple placentae in that there is no net uptake of dry matter during development but there is a net uptake of water, calcium, potassium, and sodium. There is no net uptake of lipid, nitrogen (an index of protein), or magnesium. We conclude that N. coventryi is predominantly lecithotrophic. Further, if N. coventryi is the sister taxon to Tasmanian Niveoscincus, then the distribution of patterns of embryonic nutrition among members of this clade suggests that the evolution of placentotrophy occurred during radiation of this lineage in Tasmania., (Copyright 2001 Wiley-Liss, Inc.)

Eulamprus tympanum is a high-altitude viviparous lizard that was probably used to help define a Type I chorioallantoic placenta. In this article, we (1) describe the net transport of nutrients across the placenta of E. tympanum, and (2) compare placental uptake in E. tympanum with a previous study of Eulamprus quoyii, which occurs in warmer environments, to assess the potential importance of thermal regime on placentotrophy. Freshly ovulated eggs are 387.3+/-19.7 mg. There is a significant net uptake of water and a net loss of dry matter during development, so the dry neonate is only 84% the size of the dry egg. There is no significant change in the total ash or nitrogen in eggs during embryonic development, with the entire loss of dry matter being lipid. Almost the entire loss of lipid occurs in the triacylglycerol fraction, with no net change in phospholipids. A net increase in total cholesterol suggests that cholesterol is synthesised by the developing embryo. The lipid profile of eggs of E. tympanum reflects that of other species with simple placentae in having a relatively high proportion of triacylglycerol and little cholesterol. The fatty acid composition of eggs reflects that expected in the diet of E. tympanum. There is a preservation and some synthesis of arachidonic (20:4n-6) and docosahexaenoic (22:6n-3) acids in the phospholipid fraction during embryonic development. Despite there being no net uptake of ash, there is a net increase in calcium, potassium, sodium, and magnesium in the neonate compared with the egg. We conclude that E. tympanum, like E. quoyii, is predominantly lecithotrophic with little, if any, uptake of organic molecules but with significant uptake of some inorganic ions and water. In addition, there is no difference in placentotrophy correlated with differences in the environments inhabited by each species.

The contents of eggs and neonates of the Australian skinks, Lampropholis guichenoti and L. delicata, are described and compared to allow interpretation of nutrient utilisation by the developing embryo. Even though the females are the same size, L. guichenoti lay smaller clutches of larger eggs (egg contents=41.6+/-1.2 mg dry mass) than L. delicata (26.6+/-2.8 mg). The energy density is the same for eggs (30.5+/-0.9 J/g ash-free dry mass for L. guichenoti and 29.9+/-1.1 J/mg for L. delicata) and neonates (22.5+/-1.3 J/mg for L. guichenoti and 23.5+/-0.4 J/mg for L. delicata) between species. The amount of nitrogen (protein) in neonates is only slightly lower than that in eggs, whereas there is a large and significant decline in total lipids. Thus, like some other skinks, protein is a source of metabolic energy during embryogenesis, although not as important as lipid. Triacylglycerol is the major lipid component of the eggs (80% of total lipid), with phospholipid forming only approximately 10% of the total lipid. The fatty acid profile of the phospholipid is distinguished by a high proportion of arachidonic acid (8%), a significant proportion of eicosapentaenoic acid (2-4%) and a relatively low proportion of docosahexaenoic acid (2-3%) compared to chickens. Eggs of both species have remarkably low concentrations of free cholesterol compared to other amniote eggs (0.7% for L. guichenoti and 1.3% for L. delicata). The loss of lipid during embryonic development is almost entirely due to the selective utilisation of yolk triacylglycerol, presumably for energy. By contrast, the amount of phospholipid recovered from the neonates was the same as that originally in the eggs. Moreover, significantly more total cholesterol was present in the neonates than in the eggs, suggesting that biosynthesis of additional cholesterol occurred during development. The phospholipids of the neonates contain higher proportions of arachidonic (11-12%) and docosahexaenoic (8%) acids than the phospholipids of the eggs. Eicosapentaenoic acid is less prevalent in phospholipids in neonates than in eggs. Neonates of both species contain significantly more calcium than the fresh egg contents (L. guichenoti, eggs 0.303+/-0.051 mg, neonates 0.641+/-0.047 mg; L. delicata, eggs 0.187+/-0.013 mg, neonates 0.435+/-0.033 mg), presumably as a result of resorption of calcium from the eggshell. Interestingly, there is also significantly more sodium in neonates than in the contents of fresh eggs (L. guichenoti, eggs 0.094+/-0.010 mg, neonates 0.184+/-0.011 mg; L. delicata, eggs 0.084+/-0.011 mg, neonates 0.151+/-0.010 mg). There is no significant difference in the content of potassium and magnesium in eggs and neonates of either species. Although the fresh eggs of L. delicata have a significantly higher sodium concentration than L. guichenoti, there is no difference in the concentrations of calcium, magnesium, potassium or sodium in the neonates of the two species.

Niveoscincus ocellatus is an important species in historical analyses of the evolution of viviparity because it is the species upon which the type II chorioallantoic placenta was based. Here we describe the net nutrient uptake across the placenta of N. ocellatus for comparison with other species of skinks with complex placentae. N. ocellatus is highly placentotrophic, with neonates being 1.68-times larger in dry matter than the fresh eggs. There is an increase of nitrogen from 6.3 +/- 0.2 mg to 9.2 +/- 0.6 mg, and ash from 3.8 +/- 0.3 mg to 6.7 +/- 0.6 mg. The increase in ash is made up by a more than two-fold increase in the amounts of calcium, potassium and sodium. There is no significant difference in lipids in the neonates compared to fresh eggs, so considerable lipid must have crossed the placenta to provide energy for embryonic development. N. ocellatus is significantly more placentotrophic than Niveoscincus metallicus, which also has a complex chorioallantoic placenta. Discovery of substantial placentotrophy in this genus confirms that two lineages of Australian lygosomine skinks (represented by the genera Pseudemoia and Niveoscincus) have evolved this pattern of embryonic nutrition and supports the hypothesis that the evolution of reptilian placentotrophy involves specialisations in addition to structural modifications of the chorioallantoic placenta.