The stromal vascular fraction

The findings emphasize the negative effect of hearing impairment on quality of life.

Histological subtyping of pulmonary adenocarcinoma has recently been updated based on predominant pattern, but data on reproducibility are required for validation. This study first assesses reproducibility in subtyping adenocarcinomas and then assesses further the distinction between invasive and non-invasive (wholly lepidic) pattern of adenocarcinoma, among an international group of pulmonary pathologists. Two ring studies were performed using a micro-photographic image-based method, evaluating selected images of lung adenocarcinoma histologic patterns. In the first study, 26 pathologists reviewed representative images of typical and ‘difficult’ histologic patterns. A total number of scores for the typical patterns combined (n = 94) and the difficult cases (n = 21) were 2444 and 546, respectively. The mean kappa score (± s.d.) for the five typical patterns combined and for difficult cases were 0.77 ± 0.07 and 0.38 ± 0.14, respectively. Although 70% of the observers identified 12–65% of typical images as single pattern, highest for solid and least for micropapillary, recognizing the predominant pattern was achieved in 92–100%, of the images except for micropapillary pattern (62%). For the second study on invasion, identified as a key problem area from the first study, 28 pathologists submitted and reviewed 64 images representing typical as well as ‘difficult’ examples. The kappa for typical and difficult cases was 0.55 ± 0.06 and 0.08 ± 0.02, respectively, with consistent subdivision by the same pathologists into invasive and non-invasive categories, due to differing interpretation of terminology defining invasion. In pulmonary adenocarcinomas with classic morphology, which comprise the majority of cases, there is good reproducibility in identifying a predominant pattern and fair reproducibility distinguishing invasive from in-situ (wholly lepidic) patterns. However, more precise definitions and better education on interpretation of existing terminology are required to improve recognition of purely in-situ disease, this being an area of increasing importance.

To compare the effects of two free radical scavengers, dimethylsulfoxide 50% (DMSO) and N-acetylcysteine (NAC), for treatment of complex regional pain syndrome I (CRPS I), a randomized, double-dummy controlled, double-blind trial was conducted. Two outpatient clinics of two university hospitals in The Netherlands participated in the study and 146 patients, were included over a period of 24 months. Patients were randomized into two treatment groups, one was instructed to apply DMSO 50% five times daily to the affected extremity, the second was treated with NAC 600mg effervescent tablets three times daily, both combined with placebo. Interventions were accompanied by pain medication, occupational therapy for upper extremity CRPS I and physical therapy for lower extremity CRPS I in specific circumstances. Treatment was given for 17 weeks, with a possibility to continue or switch medication after this period, up to 1 year following the onset of treatment. An impairment level sum score was the primary outcome measure. Upper and lower extremity skills and functions, and general health status were also evaluated. Overall, no significant differences were found between NAC and DMSO after 17 and 52 weeks on impairment level and general health status. Significant differences were found for subscores of lower extremity function, in favor of DMSO-treatment. Subgroup analysis showed more favorable results for DMSO for warm CRPS I and significantly better performance of NAC for patients with a cold CRPS I. Results tended to be negatively influenced if the duration of the complaint was longer. Treatment with DMSO and NAC are generally equally effective in treatment of CRPS I. Strong indications exist for differences in effects for subgroups of patients with warm or cold CRPS I: for warm CRPS I, DMSO-treatment appears more favorable, while for cold CRPS I, NAC-treatment appears to be more effective.

We found significant adverse effects of poor hearing on emotional and social loneliness for specific subgroups of older persons. Future research should confirm the subgroup effects and may contribute to the development of tailored prevention and intervention programs.

The main aim of the study is to address the relationship between hearing status and need for recovery. In addition, the role of hearing status in the relationship between psychosocial work characteristics (i.e. job demands and job control) and need for recovery was assessed. The sample comprised 925 normally-hearing and hearing-impaired working adults (aged 18-65 years) participating in the National Longitudinal Study on Hearing. Hearing status was determined using the national hearing (speech-in-noise) test over the internet. Psychosocial work characteristics and need for recovery were assessed using the job content questionnaire and the Dutch questionnaire on the experience and assessment of work. Regression models revealed a significant association between hearing status and need for recovery after work, poorer hearing leading to an increasing need for recovery. Additionally, poorer hearing led to a higher odds for risky levels of need for recovery. Hearing status did not influence the significant relationship between psychosocial work characteristics (i.e. job demand and job control) and need for recovery after work. Implications for clinical practice, such as the necessity of having adequate enablement programs for this specific group of patients, are discussed.

Purpose: Approximately 10 -30% of surgically treated head and neck cancer patients develop local recurrences while the resection margins are histologically tumor free. These recurrences may arise from cancer cells left behind but not detected by the pathologist, or they may develop from precursor lesions adjacent to the tumor that were not completely resected. We have investigated whether TP53-mutated DNA in the surgical margins is suitable to identify patients with head and neck squamous cell carcinoma at risk for local and locoregional recurrence.Experimental Design: In a prospective cohort study of 76 patients with histologically tumor-free margins, the presence of TP53-mutated DNA was determined in the surgical margins using the phage plaque assay and correlated to clinical outcome. Immunostaining of the molecular-positive margins for mutated p53 protein was used to identify whether unresected precursor lesions or residual tumor cells were left behind.Results: The absence of TP53-mutated DNA in surgical margins was significantly associated with remaining free of local and locoregional recurrence (P ‫؍‬ 0.027 and P ‫؍‬ 0.028, respectively). Moreover, the presence of TP53-mutated DNA in the surgical margins was an independent prognosticator for locoregional recurrence (relative risk ‫؍‬ 7.1; P ‫؍‬ 0.021; 95% confidence interval, 0.9 -56). In 20% of the cases, the presence of TP53-mutated DNA in the surgical margins was found to be related to the presence of tumor-related precursor lesions.Conclusions: This study shows the value of TP53-mutated DNA as a molecular marker to predict locally recurrent head and neck squamous cell carcinoma. The observation that all patients who were negative for TP53-mutated DNA in the surgical margins remained free of local recurrence raises hope that molecular analysis of histologically tumor-free surgical margins can be exploited to decide on postoperative radiotherapy. Furthermore, our data provide evidence that local recurrences originate mainly from tumor cells left behind but also originate, in part, from unresected precursor lesions.

BACKGROUND Malnutrition has been recognized as a poor prognostic indicator for cancer treatment–related morbidity and mortality in general, and it is reported to affect 30–50% of all patients with head and neck cancer. In this study, the correlation of nutritional status with 3‐year survival was studied prospectively in 64 patients with T2–T4 carcinomas of the head and neck who were treated surgically with curative intent; the surgery was often followed by radiotherapy. METHODS All patients underwent nutritional screening according to six different parameters on the day prior to surgery. Overall and disease specific survival analyses were performed with a follow‐up period of at least 3 years. Survival analyses were performed with the log rank test and the Cox proportional hazards model. RESULTS Lymph node stage, nonradical resection margins, and occurrence of major postoperative complications were demonstrated to affect disease specific survival for the group as a whole. None of the investigated nutritional parameters were correlated with survival. When men and women were analyzed separately, however, a preoperative weight loss of >5% did have a prognostic value for men. The combination of male gender, preoperative weight loss, and major postoperative complications were related to early death. CONCLUSIONS Apart from the well‐known prognostic parameters lymph node status (T classification) and status of surgical margins, preoperative weight loss and occurrence of major postoperative complications were also found to have a negative effect on the survival of male patients undergoing surgery for advanced head and neck cancer. Cancer 1999;86:519–27. © 1999 American Cancer Society.