BACKGROUND Conventional measures for assessing arterial stiffness are inherently pressure-dependent. Whereas statistical pressure adjustment is feasible in (larger) populations, it is unsuited for the evaluation of an individual patient. Moreover, statistical “correction” for blood pressure may actually correct for: (1) the acute dependence of arterial stiffness on blood pressure at the time of measurement; and/or (2) the remodelling effect that blood pressure (hypertension) may have on arterial stiffness, but it cannot distinguish between these processes. METHODS We derived — assuming a single-exponential pressure-diameter relationship — three theoretically pressure-independent carotid stiffness measures suited for individual patient evaluation: (1) stiffness index β0, (2) pressure-corrected carotid pulse wave velocity (cPWVcorr), and (3) pressure-corrected Young’s modulus (Ecorr). Using linear regression analysis, we evaluated in a sample of the CATOD study cohort changes in mean arterial pressure (∆MAP) and comparatively the changes in the novel (∆β0, ∆cPWVcorr, ∆Ecorr) as well as conventional (∆cPWV, ∆E) stiffness measures after a 2.9±1.0-year follow-up. RESULTS We found no association between ∆MAP and ∆β0, ∆cPWVcorr, or ∆Ecorr. In contrast, we did find a significant association between ∆MAP and conventional measures ∆cPWV and ∆E. Additional adjustments for biomechanical confounders and traditional risk factors did neither materially change these associations nor the lack thereof. CONCLUSIONS Our newly proposed pressure-independent carotid stiffness measures avoid the need for statistical correction. Hence, these measures (β0, cPWVcorr, Ecorr) can be used in a clinical setting for (1) patient-specific risk assessment and (2) investigation of potential remodelling effects of (changes in) blood pressure on intrinsic arterial stiffness.
We describe a family with translocation (8; 13) (p21;q22), in which both unbalanced products of adjacent-] segregation occurred. Two members of the family have partial trisomy 8p with partial monosomy 13q; two others have partial monosomy 8p with partial trisomy 13q. The latter are both phenotypically normal, which is a highly unusual observation. One of these is, in addition, a carrier of a de novo balanced translocation between chromosomes 2 and 19. The risk for unbalanced progeny is discussed.
Purpose/Objective(s): Multiple large clinical trials have established the equivalence or non-inferiority of hypofractionated radiotherapy compared to conventionally fractionated treatment. The objective of this study is to determine real-world variations in the adoption of hypofractionation across different geographic regions and practice settings for cancers of the breast, prostate, and cervix, and for bone metastases, and barriers and facilitators to such adoption. Materials/Methods: An anonymous, electronic survey was distributed from January to December 2018 in English, Spanish, and Mandarin to radiation oncologists through the ESTRO Global Impact of Radiotherapy in Oncology initiative. There were 2,259 respondents from Europe (56%), Asia Pacific (19%), Middle East (5%), 12% Latin America, (12%), North America (6%), and Africa (2%). This survey assessed preference for hypofractionation and specific fractionation regimens across 4 disease sites (breast, prostate, cervix, and bone metastases) in curative and palliative scenarios. Perceived barriers and facilitators to adoption were evaluated. In regression analyses, hypofractionation preference was defined as use of hypofractionation for >75% of patients within each disease site and in >50% of clinical scenarios overall. Results: Hypofractionation preference was more common in nodenegative than in node-positive breast cancer (83% vs 46%, respectively; p<0.001), in low-and intermediate-vs. high-risk prostate cancer or cases requiring pelvic irradiation (56% vs. 32%, respectively; pZ0.00001); hypofractionation was more common in North America and Europe than other regions. In cervix cancer, hypofractionation was preferred in 30% of locally advanced cervical cancer cases in Africa, but in <10% of cases in other regions. For palliative symptom control, hypofractionation was preferred by 93%, 91%, and 84% of respondents for breast cancer, prostate cancer, and cervix cancer respectively, and in 95% for bone metastases (p<0.001) across geographic regions. Lack of long-term data, inferior local control, toxicity, and inadequate technology were the most commonly cited barriers. In adjusted analyses, hypofractionation preference was associated with age <55 (odds ratio [OR] Z 1.46, 95% CI 1.23 to 1.88), practice in a high-income country (ORZ2.72, 95% CI 2.12 to 3.49), in a university setting (ORZ1.30, 95% CI 1.04 to 1.67), in a center with a catchment area with >1,000,000 population (ORZ1.57, 95% CI 1. to 2.0), and with intensity modulated radiotherapy (ORZ1.70, 95% CI 1.22 to 2.34). Conclusion: Significant variation was observed in preference for hypofractionation across indications and between geographic regions, with greater concordance in preference for palliative indications. Improving the cost-effectiveness of radiotherapy and the quality of care delivered requires greater international attention to continuing medical education and policy reform that aligns evidence-based practice with physician incentives.
Background This study assesses whether 90‐day mortality differs between patients living in rural and urban areas, as lower access to supportive care services in rural areas could result in higher mortality. Methods All patients with head and neck cancer (HNC) treated between 1998 and 2014 with radiotherapy in British Columbia were included. Patients were divided into rurality areas according to the Modified Statistics Canada (mSC) definition, which classifies a population <30 000 as rural and ≥30 000 as urban. Results Five thousand five hundred and fifty‐four patients were included in this study, of which 68% lived in urban centers. The 90‐day mortality for rural versus urban patients were 3.0% and 3.9% (p = 0.09), respectively. Univariate and multivariate analyses showed no association with 90‐day mortality and rurality. Conclusion After controlling for potentially confounding factors, we did not find a significant association between 90‐day mortality and rurality in patients who were treated with radiotherapy for HNC in British Columbia.
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