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BACKGROUND: Chemotherapy is the most distressing form of cancer treatment in oncology, but listening to music can be an adjuvant during chemotherapy. Monochord (MC) sounds are used in music therapy for the alleviation of pain, enhanced body perception, and relaxation. This study investigated the relaxation effect of MC sounds for patients during chemotherapy compared with progressive muscle relaxation (PMR), an established relaxation technique. METHODOLOGY/PRINCIPAL FINDINGS: Two randomized groups of patients were observed during chemotherapy. One group listened to recorded MC sounds (n=20) and the other group listened to recorded PMR (n=20). Each session was investigated pre and post using Spielberger's State Anxiety Inventory (SAI) and a questionnaire about the patient's physical and psychological states. Further, for the first and the last session, multivariate electroencephalogram (EEG) signals were recorded. Patients in both MC and PMR groups showed significant improvement in their physical and psychological states and in state anxiety. The EEG data showed that the MC and the PMR groups were associated with an increase of posterior theta (3.5-7.5Hz) and a decrease of midfrontal beta-2 band (20-29.5Hz) activity during the end phase of relaxation treatment. Further, the MC group was associated with decreased alpha band (8-12Hz) activity in comparison with PMR group. CONCLUSIONS: This study shows that both listening to recorded MC sounds and practising PMR have a useful and comparable effect on gynaecologic oncological patients during chemotherapy, with partially overlapping but also notably divergent neural correlates. Future research should establish the systematic use of MC in oncological contexts. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Evaluation of oncological outcome and prognostic factors of patients with primary breast cancer treated at a certified academic breast unit. Patients and methods: We prospectively collected data of 3338 patients, diagnosed with primary breast cancer between 01.01.2003 and 31.12.2010 and treated at the Breast Unit Heidelberg, Germany, in order to analyze outcome in clinical practice. We evaluated local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), observed overall survival (OS) and age-adjusted relative overall survival (ROS). In addition, the impact of known prognostic factors on these outcome variables was examined in univariate and multivariate analyses. Results: Of all patients, 368 (11.0%) had carcinoma in situ (CIS) and 197 (5.9%) had bilateral cancers. For the 2970 patients with invasive cancer, of which 49 patients (1.7%) had metastastic disease at time of diagnosis, DFS, LCR, DDFS, OS and ROS at 5 years were 79.8%, 84.7%, 81.2%, 86.3%, and 89.8%, respectively. In multivariate analysis age, pT category, nodal status, hormone receptor status and grading were identified as independent prognostic factors for OS. Conclusion: Compared with recent population-based reports from Germany, more favourable patient characteristics and nominally higher survival was found among this large cohort of patients with primary breast cancer treated at a single certified breast unit. [Copyright &y& Elsevier]

Aim: To determine what disease entities show accentuated grey–white differentiation of the cerebral hemisphere on diffusion-weighted images (DWI) or apparent diffusion coefficient (ADC) maps, and whether there is a correlation between the different patterns and the cause of the brain injury. Methods and materials: The DWI and ADC maps of 19 patients with global brain injury were reviewed and evaluated to investigate whether there was a correlation between the different patterns seen on the DWI and ADC maps and the cause of global brain injury. The ADC values were measured for quantitative analysis. Results: There were three different patterns of ADC decrease: a predominant ADC decrease in only the cerebral cortex (n =8; pattern I); an ADC decrease in both the cerebral cortex and white matter (WM) and a predominant decrease in the WM (n =9; pattern II); and a predominant ADC decrease in only the WM (n =3; pattern III). Conclusion: Pattern I is cerebral cortical injury, suggesting cortical laminar necrosis in hypoxic brain injury. Pattern II is cerebral cortical and WM injury, frequently seen in brain death, while pattern 3 is mainly WM injury, especially found in hypoglycaemic brain injury. It is likely that pattern I is decorticate injury and pattern II is decerebrate injury in hypoxic ischaemic encephalopathy.Patterns I and II are found in severe hypoxic brain injury, and pattern II is frequently shown in brain death, whereas pattern III was found in severe hypoglycaemic injury. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: We analyzed changes in aesthetic and functional outcome over time after breast conserving therapy. Our special interest resides in the question of whether these aspects gain or loose their influence on quality of life (QoL) with temporal progress. Patients and methods: This prospective single centre cohort study included 138 patients, treated with breast conserving surgery and consecutive radiotherapy. Patients completed two questionnaires one week and one year after surgery: the BCTOS (Breast Cancer Treatment Outcome Scale) to measure Functional, Aesthetic, and Breast Sensitivity Status and the EORTC (European Organisation for Research and Treatment of Cancer) C30-BR23 to assess QoL. We applied correlation and multiple regression analysis as statistical methods. Results: Aesthetic and Functional Status did not change significantly over one year, whereas Breast Sensitivity Status and several QoL subscales showed significant improvement (p < 0.0001). Correlations between BCTOS scales and EORTC subscales remain similar over time. Functional and Aesthetic Status kept a strong impact on global health (Spearman’s Rho = −0.28 to −0.45 depending on time of assessment). Increasing age and poorer Functional Status shortly after surgery are predictors of a decline in global health over one year (p < 0.001). Conclusion: Functional and aesthetic outcome after breast conserving surgery maintain their impact on QoL over a one year follow-up period and are valuable predictors of QoL. [Copyright &y& Elsevier]

Objective: We recently showed that both maternal and fetal erythroblast counts are elevated in the peripheral blood of pregnant women with preeclampsia. The purpose of this study was to examine whether this elevation actually occurs before the clinical onset of the disorder.Study Design: Erythroblasts were enriched and enumerated in 97 maternal blood samples obtained in the second trimester, and results were subsequently correlated with pregnancy outcomes.Results: Significantly higher quantities of erythroblasts (mean, 6041.7 vs 928.9; P =.008) were detected in blood samples obtained from women who later acquired preeclampsia (n = 15) than in blood samples from the control cohort (n = 72). Intrauterine growth restriction (n = 10) was not accompanied by a similar rise in erythroblast count.Conclusion: Because a large proportion of the erythroblasts in maternal blood are fetal, our data suggest that fetal-maternal cell traffic is affected early in pregnancies that are later complicated by preeclampsia but not in those affected only by intrauterine growth restriction. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine efficacy of Medical Nutrition Therapy (MNT) on diabetes control and inflammation. Methods: The study had a single-arm, pre- and posttest design. 107 type 2 diabetes patients (aged 60.1 ±10.7 years, 64 males and 43 females) participated for 6 month in individualized dietary intervention program based on MNT. Nutrient intakes based on 24hr dietary recall, blood glucose level, serum tumor necrosis factor (TNF-α), interleukin-6 (IL-6), and high sensitivity C-reactive protein (hsCRP) were evaluated at baseline, before and end of intervention (six month) follow-up. Statistical analyses performed paired t test and Pearson correlations, respectively, were used to assess changes in outcomes and associations between dietary variables and inflammatory markers. Results: Plasma HDL-cholesterol significantly increased (p<0.05) and TNF-α, HbAlC significantly decreased (p<0.01) pre- to post intervention. Dietary inflammatory potentials (DIP) improved from baseline to 6 month (P<0.05). Change in DIP score positively correlated with change in TNF-α (P<0.01; baseline to 6 month). Conclusions: We suggest that an improvement in nutrition resulting from a MNT for type 2 diabetes patients led to improvement in their inflammatory status. [ABSTRACT FROM AUTHOR]

Aim: To investigate magnetic resonance imaging (MRI) findings that could be used to differentiate intramedullary spinal ependymoma from astrocytoma, and to determine predictors for this differentiation. Materials and methods: MRI images of 43 consecutive patients with pathologically proven intramedullary spinal ependymoma (n = 24) and astrocytoma (n = 19) were comparatively evaluated with regard to size, location, margin, signal intensity, contrast enhancement, presence of syringohydromyelia, tumoural cyst, non-tumoural cyst, and haemorrhage. MRI findings and demographic data were compared between the two tumour groups using univariate and multivariate logistic regression analyses. Results: In patients with ependymoma, older age and a larger solid component were more often observed than in astrocytoma. Central location, presence of enhancement, diffuse enhancement, syringohydromyelia, haemorrhage, and cap sign were more frequently observed in ependymoma. However, multivariate analysis revealed that syringohydromyelia was the only variable able to independently differentiate ependymoma from astrocytoma, with an odds ratio of 62.9 (95% CI: 4.38–903.22; p = 0.002). Conclusion: Among the various findings, the presence of syringohydromyelia is the main factor distinguishing ependymoma from astrocytoma. [ABSTRACT FROM AUTHOR]

Background: Breast magnetic resonance imaging (MRI) has been introduced in the preoperative management of invasive lobular breast cancer (ILC). We analysed if MRI leads to adequate changes in surgical management.Patients and methods: We carried out a single-centre retrospective confirmatory analysis of 92 patients with ILC and a preoperative breast MRI. By applying a blinded tumour board method, we analysed if surgical procedures were altered due to breast MRI. In case of alteration, we analysed whether the change was adequate according to the postoperative pathology findings. We considered an adequate rate of change >5% to be a clinically relevant benefit.Results: A change in surgical therapy due to the MRI findings occurred in 23 of 92 patients (25%). According to the postoperative pathology findings, this change was adequate for 20 of these patients (22%; 95% confidence interval [CI] 14%–31%, P < 0.0001). An overtreatment occurred for three patients (3%; 95% CI 0%–6%) who underwent a mastectomy following the results of breast MRI. Patients with larger tumours did likely benefit more from preoperative breast MRI.Conclusions: Patients with ILC might benefit from a preoperative breast MRI. Possible harm from overtreatment should be minimised by diligent use of preoperative histological clarification. [ABSTRACT FROM AUTHOR]

Background: A single-nucleotide polymorphism (SNP) in the FGFR4 gene is associated with poor prognosis in solid tumors. A recent study presented the first evidence that FGFR4 Arg388 could predict resistance to adjuvant chemotherapy in breast cancer. The present study evaluates the potential of this SNP to predict response to neoadjuvant chemotherapy (NCT) for primary breast cancer (PBC). [ABSTRACT FROM PUBLISHER]

Expression of the Bcl-2 protein confers resistance to chemotherapy-mediated apoptotic signals in patients with breast cancer. We investigated effects of Bcl-2 down-regulation by the Bcl-2 antisense oligodeoxynucleotide oblimersen in breast tumor biopsies. Oblimersen targets Bcl-2 messenger RNA (mRNA), down-regulates Bcl-2 protein translation and enhances antitumor effects of subtherapeutic chemotherapy doses. Within a phase I trial, we administered escalating doses of oblimersen (3, 5 or 7 mg/kg/day) as continuous infusion on days 1–7 in combination with standard-dose docetaxel (Taxotere), Adriamycin and cyclophosphamide (TAC) on day 5 as preoperative chemotherapy in 28 patients with T2–4 tumors. Effects of oblimersen were evaluated in tumor biopsies and peripheral blood mononuclear cells (PBMCs) 4 days after start of oblimersen and before TAC treatment by quantitative microfluidic real-time PCR. Read-outs consisted in measurement of Bcl-2 mRNA modulations and of 18 putative predictive markers. Two of 13 patients showed a diminution of Bcl-2 transcripts after 4 days of treatment with oblimersen 5 mg/kg/day. PBMCs could not be evaluated as a surrogate tissue because no qualified RNA could be isolated. Nevertheless, we demonstrated feasibility to process clinical samples and to obtain good quality RNA from tumor biopsies and indicated the potential of oblimersen to lower Bcl-2 mRNA in breast cancer. [ABSTRACT FROM PUBLISHER]

Purpose/objective(s): We recently published 2-year results of the prospective, randomized IMRT-MC2 trial, showing non-inferior local control and cosmesis in breast cancer patients after conventionally fractionated intensity-modulated radiotherapy with simultaneously integrated boost (IMRT-SIB), compared to 3D-conformal radiotherapy with sequential boost (3D-CRT-seqB). The present study reports on 2-year quality of life results.Materials/methods: Five hundred two patients were enrolled to analyze non-inferiority of IMRT-SIB (50.4 Gy in 1.8 Gy fractions with a 64.4 Gy SIB to the tumor bed in 2.3 Gy fractions) to 3D-CRT-seqB (50.4 Gy in 1.8 Gy fractions, followed by a sequential boost of 16 Gy in 2 Gy fractions). For quality of life (QoL) assessment, patients completed the QLQ-C30 (15 items) and QLQ-BR23 (8 items) questionnaires at baseline and 6 weeks and 2 years after radiotherapy. Comparisons between treatment groups were made at 6 weeks and 2 years after radiotherapy, using Mann-Whitney U-test. The Friedmann test was used to compare QoL at different time points during follow-up (baseline, 6 weeks and 2 years after radiotherapy) and to detect significant changes of QoL over all time points.Results: After six weeks and two years, 237 and 212 QoL questionnaires (94 % and 84 %) were available in the IMRT group, 231 and 210 (93 % and 84 %) in the control group, respectively. The only significant difference of QoL scores between the IMRT-SIB and the 3-D-CRT-seqB group was seen 6 weeks after radiotherapy for pain (22.3 points for IMRT vs. 27.0 points for 3D-CRT-seqB; P = 0.033; r = 0.102) and for arm symptoms (18.1 points for IMRT vs. 23.6 points for 3D-CRT-seqB; P = 0.013; r = 0.118), both favoring IMRT. Looking at changes after two years compared to baseline, both arms showed significant improvement in global score (IMRT: P = 0.009, r = 0.021; 3D-CRT: P = 0.001, r = 0.028) with slight deterioration on the role (IMRT: P = 0.008, r = 0.021; 3-D-CRT: P = 0.001, r = 0.038) and social functioning (IMRT: P = 0.013, r = 0.021; 3D-CRT: P = 0.001, r = 0.033) as well as the future perspectives scale (IMRT: P = 0.003, r = 0.026; 3D-CRT: P = 0.0034, r = 0.020).Conclusion: This is the first randomized phase III trial demonstrating that simultaneously integrated boost irradiation was associated with slightly superior quality of life compared to conventional sequential boost irradiation. These findings further support the widely clinical implementation of SIB in adjuvant breast cancer treatment. NCT01322854. [ABSTRACT FROM AUTHOR]