Patterns Of Modalities Research Articles

Patterns of Relapse and Modalities of Treatment of Breast Cancer: The ‘IRIS’ Project, a Multicenter Observational Study

Objectives: The aim of this study was to describe the patterns of breast cancer relapse and the factors influencing therapeutic choices in an unselected postmenopausal population. Methods: Five hundred and thirty-nine patients were enrolled between October 1999 and March 2001. The majority (92.6%) underwent surgery for the primary tumor: there was no difference between general and university hospitals in terms of the type of mastectomy, but a slight difference was found between Southern and Northern Centers. Results: At the time of first relapse, 61.6% of the patients had a good Karnofsky performance status. The median disease-free interval (DFI) was 34 months. More than half of the patients (62.3%) presented a single metastasis. Metastatic disease was treated with chemotherapy in 64.8% of cases (alone in 44.1%, and in combination with hormone therapy in 20.1%), hormone therapy alone was given in 30.8% of cases. The main reasons for choosing chemotherapy were age (31%), standard guidelines (19.4%) and the site of metastatic disease (14.3%), and those for selecting hormone therapy were age (26.6%), site of relapse (19.3%), standard guidelines (19.2%), biological tumor characteristics (14.3%) and the DFI (11.1%). Taxane-containing treatments accounted for 46.1% of the chemotherapies, whereas letrozole was the preferred hormone (41.2%). Conclusion: The first relapse of breast cancer is often single, at bone or viscera, and mainly diagnosed by instrumental screening examinations. The preferred chemo- and hormone therapies are taxane-containing regimens and letrozole, respectively.

Primary malignant melanoma of esophagus: Report of four cases and review of the literatures

Objective: To investigate the clinical features and prognosis of the primary malignant melanoma of esophagus, to try to find out a rational therapy and to evaluate the value of surgical resection. Methods: Retrospective study was conducted for four cases with Primary malignant melanoma of esophagus hospitalized from May 1975 to April 1999. The relevant literatures of primary malignant melanoma of esophagus in recent years were also reviewed. Results: Four patients received multimodality therapy including surgical resection. The survival time is 16 years, 53 months, 5 months and 6 months, respectively. Conclusion: Primary malignant melanoma of the esophagus has a poor prognosis. Surgical resection plays an important role and is indispensable. The patterns of combination treatment modality need further investigation. Preoperative therapy combined with surgical resection and post-operative therapy may be a better management.

Hacia una reformulación del nexo entre investigación y docencia.

En este artículo, se aborda el tema de la relación entre docencia e investigación desde la perspectiva de la diversidad. El punto de partida es la constatación del surgimiento de muy diversas variedades de universidad, como consecuencia de las distintas formas en que esta institución se adapta e innova frente a los cambios de la modernidad. Además, se exploran los patrones de las modalidades de docencia, que obedecen a los cambios en los perfiles y en las demandas de profesionales. El proceso de diversificación ha hecho surgir las así llamadas “universidades docentes”, en las cuales se opta por relegar las actividades de investigación a un segundo plano en las misiones institucionales explícitas de estas instituciones. En el artículo, se propone que la misma lógica de la diversidad debiera aplicarse a las tareas de investigación, pues en verdad no existe un solo modelo de investigación, si es que estamos dispuestos a pensar más allá del modelo clásico de investigación de las ciencias experimentales. Ahora bien, desde el momento en que se admite que hay diversidad en las formas de investigación, es posible replantear la relación de las universidades docentes con esta actividad tan crucial para el desarrollo de las universidades En definitiva, se trata de admitir que la diversidad ha llegado también a tocar la puerta de la investigación, como ya ocurrió con la docencia.

Conceptual database modeling for understanding and developing information management applications.

In response to rising health care costs and changing expectations concerning the quality of health care, information management is becoming increasingly important in the practice of medicine; more specifically, it is beginning to effect significant changes in radiology practice and patient care. Radiologic applications of information management include reporting diagnostic information generated from film interpretation as well as tracking utilization patterns of different imaging modalities and the variability of clinical outcomes, documenting the type of information sought by and provided to clinicians, and evaluating departmental quality standards and performance goals. Conceptual database modeling enables radiologists to understand and participate in the development of information systems, thereby improving the likelihood of successful results. In object-role modeling, groups of relevant objects and roles are identified and used to create elementary facts that form the "building blocks" for information models. The resultant models can easily be communicated, reviewed, and revised, allowing decreased development time and optimizing inclusion of relevant features in the target relational database. Increasing the amount of clinical and management input in the development process may help information systems better meet user needs, become accepted and more often used, and ultimately succeed.

Management of furcation‐involved teeth

In the present study, data from more than 550 periodontally diseased patients with more than 1100 furcation invasions were retrospectively analysed. There were apparent differences in the distribution of different furcation degrees in patient populations treated by 2 differently experienced operators. However, treatment modality patterns were rather similar. Scaling during periodontal flap surgery was the most often performed treatment procedure in degree I (97-98%) and II (75-83%) involvements. About 44% of degree III involved teeth were extracted. In order to determine the influence of degree of furcation involvement, tooth type and operator variability on treatment modality, logistic regression analysis was applied. Degree of furcation involvement was an important indicator variable in all models. Scaling as a sole measure was mainly performed in relation to degree I of furcation involvement. With every increase in degree, the odds of scaling decreased by factor 12.7. The odds of root resection was upper 1st molars 46 x higher than in wisdom teeth or lower 2nd molars with the same degree of involvement, but only 3.3 x higher than in lower 1st molars. Tunnel preparation as well as regenerative procedures were mainly confirmed to lower molars. Operator variability was only introduced as a covariate in the extraction model. hence, despite of different operator skill and severity of periodontal disease in treated populations, decision for one or the other treatment modality seems to depend essentially on degree of furcation involvement as well as tooth type.

Theoretical habitat templets, species traits, and species richness: floodplain vegetation in the Upper Rhône River

SUMMARY The floodplain vegetation at approximately 100 sites located in nine different habitat types of the Upper Rhône River, France, was surveyed three times over the past 27 years. Information on species traits of the higher plants comprising the Rhône floodplain vegetation was based on studies conducted between Geneva, Switzerland, and Lyon, France. These data were structured using a ‘fuzzy coding’ technique and then examined using ordination analyses to investigate: (i) relationships among species traits; (ii) habitat utilization; (iii) the relationship between species traits and habitat utilization; and (iv) trends of species traits and species richness in the framework of spatial–temporal habitat variability to test predictions of the river habitat templet and the patch dynamics concept. Size, number of descendants per reproductive cycle, number of reproductive cycles per individual, and the regeneration potential of an individual were positively related with each other, whereas the degree of attachment to the soil decreased, and the reproductive period shifted from autumn/late summer towards early summer/spring, as size increased. The habitat utilization by the higher plants of the floodplain revealed a double lateral gradient: the first was from the banks of the temporary waters to terrestrial flats; the second from aggrading pebble to aggrading silt habitats. These gradients were related to gradients in water saturation, oxygen conditions, nutrient loading, and nutrient retention of the soils. A significant relationship between species traits and habitat utilization was observed for the floodplain vegetation, i.e. plant communities used particular habitat types with a particular set of species trait modalities (= categories). Patterns of species trait modalities were significantly related to temporal and spatial habitat variability but only modalities of the trait ‘parental care’ conformed to trends predicted from theory. No trends were observed when species richness of different habitat types was considered in the framework of spatial–temporal habitat variability. Although the habitats of the Upper Rhône clearly act as a templet for the species traits of the floodplain vegetation, the lack of agreement between observations and predictions on trends in species traits and richness in terms of habitat variability suggest that important elements of theory should be rejected. However, human‐induced changes in these habitats are too recent when compared with the longer time periods required for floodplain vegetation to respond to such changes.

Visual projections induced into the auditory pathway of ferrets: II. Corticocortical connections of primary auditory cortex

Although the development of corticocortical projections has been well studied, less is known about the role of sensory inputs in the specification of these connections. As part of an ongoing series of studies in our laboratory, we have examined the role of thalamic input modality in the development of corticocortical connections. These studies involve making unilateral lesions and inducing retinal inputs into the auditory thalamus (MGN) during early development in ferrets, thereby conferring visual responsiveness on primary auditory cortex (AI). In this way we can examine the role of input identity in cortical specification in general, and connectivity patterns specifically. A previous paper (Pallas et al. [1990] J. Comp. Neurol. 298:50-68) described the pattern of thalamocortical and corticothalamic connections of auditory cortex in normal and lesioned animals. This study compares the pattern of auditory corticocortical connections in normal and lesioned animals. We injected neuroanatomical tracers into AI and mapped out the distribution of retrogradely labelled cells in the cortex. We report that the cortical inputs to ferret AI resembled those in cats, and that the pattern of ipsi- and contralateral corticocortical connections of ferret AI with visual input was similar to the normal pattern. Auditory cortex with visual input did not make ectopic connections with visual cortex, but maintained its connections with other auditory cortical areas. These results suggest that the overall corticocortical connections of an area are not influenced by the modality or activity pattern of its inputs. In particular, altering the input activity to a cortical area does not seem to promote the formation of entirely new connections, although small changes in the strength of existing connections are possible (Sur et al. [1990] Trends Neurosci. 13:227-233).

Management of juvenile angiofibromata.

Twenty-eight angiofibromata, treated between 1971 and 1988, were reviewed according to their patterns of invasion, blood supply, treatment modality, and clinical course. All patients were males, and two patients were black. The average age was 14.8 years. Nasopharyngeal masses, epistaxis, and facial asymmetry were the most common presenting symptoms. Tumors extended along predetermined pathways following the vascularity of the external carotid system. CNS extension arose via the superior orbital fissure or direct extension from the sphenoid sinus. Angiography described the neoplastic vascularity, CT with contrast demonstrated tumor location and extracranial extension, and MRI best demonstrated CNS invasion. All lesions were reclassified according to the American Joint Committee staging system. Twenty-seven patients were operated upon; four with cryotherapy and 23 following embolization. Two tumors recurred and needed additional surgery. One patient with CNS invasion was treated with estrogen and radiotherapy for cure. Tumor staging is not particularly helpful in decision making, because surgery must be individualized according to tumor location and extent. Surgical approaches for specific tumor locations are discussed.

Selective averaging of argon laser induced pre-pain and pain related cortical responses

The argon laser was found to be suitable for pre-pain and pain stimulation. The visible (488 and 515 nm) argon laser light penetrates the skin and is absorbed by melanin and haemoglobin. Argon laser stimuli of different intensities were perceived differently, and could be classified into 3 pre-pain and 3 pain classes. The pre-pain sensations were either perceived as warmth, weak pin prick, or weak pin prick followed by warmth. The pain sensations were perceived as painful pin pricks of different intensities. Single cortical responses to argon laser stimuli were averaged selectively, according to this perceptual classification, and characteristic pre-pain and pain related cortical responses were recorded. The sensation of warmth was related to a late cortical deflection, 700–800 ms after stimulus onset, whereas the pin prick related response appeared with a latency of 300–400 ms. Pre-pain related responses were only recorded when selective averaging according to perception was used. The amplitude of the selectively averaged pain related cortical responses correlated with the subjective sensation of pain. Selective averaging of pre-pain and pain related single responses may prove useful in studying the cortical projection of different perceptions or modality patterns, and to investigate the function of the thermal and nociceptive pathways and their interactions.

Predicting alcoholism manpower needs.

In response to the needs both to develop new, nonduplicative alcoholism services and to contain cost, and in order to plan for the labor-intensive alcoholism treatment system, planning techniques are needed to assist in the rational planning for and allocation of manpower. Using data from the 1980 National Drug and Alcoholism Treatment Utilization Survey, it is possible to analyze the staffing patterns of various modalities of alcoholism treatment. Two regression equations were developed to identify key variables for predicting manpower needs in various facilities. Budget, service type, and treatment capacity were statistically significant predictions of direct-care FTE staff in inpatient/residential units. The best predictive ability for direct-care FTE staff in detoxification and longer-term residential facilities was obtained with a general regression model which was based on all types of services (e.g., detoxification, longer-term residential, and outpatient). For outpatient settings, however, direct-care FTE staff was best predicted by considering budgets and treatment capacities within outpatient settings only. Based on this study, a planner can predict, with reasonable confidence, FTE direct-care staff by varying the values of the independent variables in the regression equation to reflect the various characteristics of the services being planned.

Nepal: The Politics of Referendum

THE 1980 REFERENDUM in Nepal was a critical landmark in the country's continuing quest since the 1950s for a national consensus regarding the nature of its political system. In contrast to the neighbouring South Asian states of Pakistan and Bangladesh, however, where referenda have tended to be instruments used by political incumbents to legitimize a fait accompli, the Nepalese referendum aimed at ascertaining the people's preferences regarding two political frameworks-the existing Panchayat system with suitable reforms, or its replacement by a multi-party system. The Panchayat system was a legacy which King Birendra had inherited as early as 1972. What factors and forces impelled him to seek the country's verdict on its suitability seven years after he ascended the throne? How did the governing and oppositional elites react to the announcement? What were the patterns of alignment and modalities of campaigning in the period preceding the referendum, from May 1979 to May 1980? What are the implications-long-term as well as short-term-of the referendum results for the political system of Nepal? To answer these questions, it is necessary to probe into the nature and character of the power structure in the land-locked kingdom as it evolved under the Panchayat system, the political as well as socioeconomic pressures and pulls leading to the referendum-announcement, the strategies and tactics of the governing and non-governing elites to seize upon the key issues, the regional and ethnic dimensions of the referendum results and, finally, the implication of the verdict for the processes of stateand nation-building in Nepal.