Angiotensin-converting-Enzym-Hemmer (ACEI) und Angiotensin-Rezeptor-Blocker (ARB) sind häug verwendete Antihypertensiva. Weil Eekte auf aber-rante Gefäßbildung und veränderte Immunantwort beschrieben wurden, wurde geprüft, ob sie mit einem besseren Ansprechen auf die neoadjuvante Strahlentherapie des Rektumkarzinoms assoziiert sind. D azu werteten die Forscher retrospek-tiv zum einen die Daten von 115 Pa-tienten aus, die zwischen 1999 und 2012 an der Universität von Wisconsin wegen eines Rektumkarzinoms mit oder ohne begleitende Chemotherapie neoadjuvant bestrahlt worden waren, um eine kurati-ve Resektion zu ermöglichen. 25 von ih-nen (21,7 %) nahmen zum Zeitpunkt der Strahlentherapie ACEI oder ARB ein. Unabhängig davon wurden die Daten ei-ner Kohorte von 186 Patienten analysiert, die ebenfalls wegen eines Rektumkarzi-noms zwischen 1995 und 2010 an der Universität von Hawaii neoadjuvant be-strahlt worden waren, wobei 49 von ih-nen (26,3 %) ACEI/ARB einnahmen. Den Wisconsin-Daten zufolge war die Einnahme von ACE/ARB mit einer Ver-dreifachung der pathologischen Kom-plettremissionen (pCR) assoziiert (52 vs. 17 %; p = 0,001). In der 2. Kohorte zeigte sich eine signikante Verdoppelung der pCR-Rate bei ACEI/ARB-Einnahme (24 vs. 12 %, p = 0,03). Signikante Unter-schiede bezüglich Patientencharakteris-tika oder Art, Dauer und Intensität der onkologischen erapie bestanden zwi-schen den Gruppen mit und ohne Ein-nahme von Antihypertensiva nicht. Auch zeigten sich keine Assoziationen zwischen pCR-Rate und der Einnahme von anderen Medikamenten. In der mul-tivariaten Analyse aller Daten zusam-men war die Einnahme von ACEI/ARB ein starker Prädiktor für eine pCR (Odds Ratio 4,02; p < 0,001). Damit war die ACEI/ARB-Einnahme sogar ein stärkerer Prädiktor für pCR als klini-sches Stadium oder Grading in der Bi-opsie. Ein Eekt auf das lokalrezidiv-, metastasenfreie oder Gesamtüberleben ließ sich nicht zeigen. Das führen die Forscher auf die zu geringe Zahl der Pa-tienten und die zu kurze Dauer der Be-obachtung (4,1 bzw. 5,3 Jahre) zurück. Fazit: Bei Patienten mit Rektumkarzi-nom war die Einnahme von ACEI/ARB in 2 unabhängigen Kohorten mit einer signikanten Steigerung der pCR-Rate nach der neoadjuvanten erapie asso-ziiert. Morris ZS et al. Increased tumor response to neoadjuvant therapy among rectal cancer patients taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Cancer. 2016;122(16):2487-95. Intensivierung der neoadjuvanten Therapie beim lokal fortgeschrittenen Rektumkarzinom Standard beim lokal fortgeschrittenen Rektumkarzinom ist die totale meso-rektale Exzision mit einer Fluoruracil(FU)-basierten Radiochemotherapie vor und einer adjuvanten Chemotherapie nach der Operation. Ein deutlicher Überlebensvorteil gegenüber einer Operation alleine oder mit adjuvanter Chemotherapie konnte damit aber bisher nicht gezeigt werden. D eshalb wurde in einer Phase-III-Stu-die das Überleben nach modizier-ten multimodalen erapien untersucht. 495 erwachsene chinesische Patienten mit lokal fortgeschrittenem Rektumkar-...
The majority of work-family research has focused on negative spillover between demands and outcomes and between the work and family domains (e.g., work-family conflict; see review by Eby, Casper, Lockwood, Bordeaux, & Brinley, 2005). The theory that guided this research was in most cases role stress theory (Greenhaus & Beutell, 1985) or the role scarcity hypothesis (Edwards & Rothbard, 2000). However, according to spillover theory, work-related activities and satisfaction also affect non-work performance, and vice versa. Recently, in line with the positive psychology movement (Seligman & Csikszentmihalyi, 2000), work-family interaction research has also included concepts of positive spillover (Bakker & Schaufeli, 2008; Grzywacz & Marks, 2000). This emerging focus supplements the dominant conflict perspective by identifying new ways of cultivating human resource strength. Greenhaus and Powell (2006) suggested that work-family enrichment best captured the mechanism of the positive work-family interface, and conceptualized work-family enrichment as "the extent to which experiences in one role improve the quality of life in the other role" (p. 73). Carlson, Kacmar, Wayne, and Grzywacz (2006) described the bi-directional and multidimensional concept of work-to-family enrichment (WFE) as how family roles benefit from work roles through developmental resources, positive affect and psychosocial capital derived from involvement in work. Similarly, family-to-work enrichment (FWE) is defined as how work roles benefit from family roles through developmental resources, positive affect and gains in efficiency derived from involvement in family. As the concept and measure of work-family enrichment has been specified and validated, the identification of factors that enable this positive side of work-family interface has become possible. Published theory testing research has demonstrated that the enrichment and conflict components of work-family interface are distinct,
PURPOSE In the multicenter, open-label, phase III FOWARC trial, modified infusional fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus radiotherapy resulted in a higher pathologic complete response rate than fluorouracil plus radiotherapy in Chinese patients with locally advanced rectal cancer. Here, we report the final results. METHODS Adults ages 18 to 75 years with stage II/III rectal cancer were randomly assigned (1:1:1) to five cycles of infusional fluorouracil (leucovorin 400 mg/m2, fluorouracil 400 mg/m2, and fluorouracil 2.4 g/m2 over 48 hours) plus radiotherapy (46.0 to 50.4 Gy delivered in 23 to 25 fractions during cycles 2 to 4) followed by surgery and seven cycles of infusional fluorouracil, the same treatment plus intravenous oxaliplatin 85 mg/m2 on day 1 of each cycle (mFOLFOX6), or four to six cycles of mFOLFOX6 followed by surgery and six to eight cycles of mFOLFOX6. The primary end point was 3-year disease-free survival (DFS). RESULTS In total, 495 patients were randomly assigned to treatment. After a median follow-up of 45.2 months, DFS events were reported in 46, 39, and 46 patients in the fluorouracil plus radiotherapy, mFOLFOX6 plus radiotherapy, and mFOLFOX6 arms. In each arm, the probability of 3-year DFS was 72.9%, 77.2%, and 73.5% ( P = .709 by the log-rank test), the 3-year probability of local recurrence after R0/1 resection was 8.0%, 7.0%, and 8.3% ( P = .873 by the log-rank test), and the 3-year overall survival rate was 91.3%, 89.1%, and 90.7% ( P = .971 by log-rank test), respectively. CONCLUSION mFOLFOX6, with or without radiation, did not significantly improve 3-year DFS versus fluorouracil with radiation in patients with locally advanced rectal cancer. No significant difference in outcomes was found between mFOLFOX6 without radiotherapy and fluorouracil with radiotherapy, which requires additional investigation of the role of radiotherapy in these regimens.
Background: Despite the use of a series of preventive measures, a high incidence of severe acute respiratory syndrome (SARS) was observed among health care workers (HCWs) during the SARS epidemic. This study aimed to determine which preventive measures may have been effective in protecting HCWs from infection, and which were not effective.
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