Risk factors and survival outcomes in patients with brain metastases from breast cancer.

Development of central nervous system (CNS) metastases in breast cancer (BC) is associated with poor prognosis. The incidence of CNS metastases in metastatic BC is reported to be about 10-16 %, but different subtypes of BC are associated with different risk of developing CNS metastases. We retrospectively analysed the risk of CNS metastases and the outcome in a cohort of 473 patients with metastatic BC. CNS metastases were diagnosed in 15.6 % of patients and median survival from diagnosis of CNS metastases was 7.53 (25th-75th 2.8-18.9) months. The risk of developing CNS metastases was higher in patients with grade 3, hormone receptor negative, HER2-positive, high Ki-67 BC. When compared to luminal A subtype, only HER2-positive BC was associated with increased risk of CNS metastases. Survival from diagnosis of CNS metastases was longer in patients with HER2-positive BC, while it was shorter in patients that did not receive any locoregional treatment, or with extra-CNS disease, or with more than 3 CNS lesions.

Erectile dysfunction after prostate three-dimensional conformal radiation therapy. Correlation with the dose to the penile bulb.

PURPOSE: Erectile dysfunction is associated with all the common treatment options for prostate cancer. The aim of this research was to evaluate the relationship between erectile function and radiation dose to the penile bulb (PB) and other proximal penile structures in men receiving conformal radiotherapy (CRT) without hormonal therapy (HT) for prostate cancer, whose sexual function was known before treatment. PATIENTS AND METHODS: The study included 19 patients treated with 3D-CRT for localized prostate cancer at our department, who were self-reported to be potent before treatment, had not received HT, and had complete follow-up data available. Our evaluation was based on the International Index of Erectile Function (IIEF-5). Dose-volume histograms (DVHs) were used to evaluate the dose to the PB. Statistical analysis was performed with an unconditional logistic regression model. RESULTS: All patients reported change in potency after radiation. Eight patients (42%) remained potent but showed a decrease of 1 or 2 levels of potency, as defined by the IIEF-5 questionnaire (reduced potency group), while 11 patients (58%) reported a change of higher levels and revealed a severe erectile dysfunction after 2 years (impotence group). Multivariate analysis of morphological and dosimetric variables yielded significance for the mean dose (p = 0.05 with an odds ratio of 1.14 and 95% CI 1-1.30). Patients receiving a mean dose of less than 50 Gy to the PB appear to have a much greater likelihood of maintaining potency. CONCLUSION: Our data suggest a possible existence of a dose-volume correlation between the dose applied to the PB and radiation-induced impotence.

Effect of biostimulation on uterine involution, early ovarian activity and first postpartum estrous cycle in beef cows.

The objective was to determine the effect of biostimulation (bull-exposure) on uterine involution (UI), plasma progesterone concentration (P4), size of largest follicle (LF), number of follicles larger than 5 mm ( F > or = 5 ), presence of fluid in uterine lumen (PF), presence of luteal tissue (LT), and length of the first estrous cycle postpartum (LEC). Ninety Angus cows with calves were allocated by parity and body frame into three groups (30 per group) 1 week postpartum. Two groups were exposed to bulls (BE) and one non-exposed group (NE) served as a control. Data were collected during weekly sessions of palpation per rectum, ultrasonography and bleeding on a subgroup of 30 cows (10 cows per group) for 6 weeks, and permanent surveillance of estrus with HeatWatch on all 90 cows. There were no significant differences between BE and NE cows for UI ( 17.1+/-1.1 days versus 20.1+/-1.6 days), LF ( 9.5+/-1.7 mm versus 11.0+/-2.4 mm), F > or = 5 ( 1.20+/-0.3 versus 1.47+/-0.09 ), and PF. However, LT was detected in more BE than NE cows (13 versus 2; P<0.001 ). Overall differences in P4 were found between BE and NE cows with detected LT ( 2.00+/-0.3 ng/ml versus 1.05+/-0.4 ng/ml, respectively; P<0.05 ). More BE cows resumed reproductive cyclicity with estrous cycles normal in length compared with NE cows (16/30, 53%; 16/30, 53%; and 8/30, 26.6%, for the two BE groups and the NE group, respectively; P<0.01 ). In conclusion, BE hastened luteal function but did not affect uterine involution.

Interactions among program, placement, and services in educational planning for students with disabilities.

Although IDEA and its corresponding federal regulations provide an underlying philosophy and procedures to help design education for students with disabilities, the law remains open to widely varying interpretations. One aspect of IDEA, namely, the relationship among the program, placement, and services for a student with disabilities when planning an appropriate education is discussed here. An analysis of how these three interrelated components can be applied in different sequences highlights drawbacks to some sequence variations. A conceptualization of how program, placement, and services can be approached in an interactive manner, rather than a strict linear one, is offered within a framework that is consistent with IDEA, its corresponding regulations, and educational logic.

Risk factors associated with moderate and serious injuries attributable to the 1994 Northridge Earthquake, Los Angeles, California.

PURPOSE: The purpose of this study was to use emergency department data to estimate levels of morbidity and risk factors due to earthquake-related mechanisms of injury subsequent to an urban night-time earthquake. METHODS: Data were abstracted from 4190 medical records for the month of January, 1994. Injuries attributable to the earthquake were identified through emergency department and medical records. These injuries were: (a) categorized by mechanism of injury; (b) assigned an injury severity score; and (c) linked to structural and geologic data. Proportional polytomous and dichotomous logistic regression were used to estimate risk of more severe injury associated with demographic characteristics, injury characteristics, structural characteristics, and geologic factors. RESULTS: More severe earthquake-related injuries (serious versus moderate and moderate versus minor) were statistically significantly associated with patient age (> or = 60 years old), upper extremities, falling, multi-family structures, pre-1960 housing, and the 50th percentile of Peak Ground Acceleration, after adjusting for all other available demographic, injury, structural, and geologic characteristics. CONCLUSIONS: The current recommendation of 'duck, cover, and hold' might not be optimal during a nighttime earthquake, particularly if individuals are in the padded environment of the bed. Actions such as reaching for or catching objects, bracing, or holding onto perceived stable objects may increase risk for more serious injury. Alternate responses include assuming a tucked position (as in airline crashes) or staying in bed for non-ambulating people. Structural damage and structure size were not associated with more serious injuries, but structure use and age were, leading the authors to suspect that unmeasured socioeconomic factors might impact risk factors. The importance of including population demographic characteristics in hazard modeling is emphasized.

Assessment of estrus detection by visual observation and electronic detection methods and characterization of factors associated with estrus and pregnancy in beef heifers.

One hundred and sixty-four beef heifers representing Angus, Brahman and their crosses were subjected to estrus synchronization treatment following evaluation of weight, body condition score and reproductive tract. Heifers were assigned to 1 of 2 methods of estrus detection, either visual observation for signs of standing estrus or a rump-mounted pressure-sensitive detection device. All heifers were artificially inseminated during a 25d insemination period and then bred by a bull. The effectiveness of estrus detection and timely insemination were evaluated by the type of detection method, breed and breeding event resulting in a pregnancy. Although there was not a significant difference in first service conception for method of detection, at the end of a 25-d insemination period, 60.5% of the visually observed heifers were pregnant, while only 45.8% of the heifers detected by the mount detection device were pregnant (P = 0.05). The reduced 25-d conception rate in the pressure-sensitive detection group suggested that insemination of detected heifers may not have been optimal for pregnancy. The mean time to estrus after implant removal and the time of insemination were evaluated. Heifers pregnant at the first service had a shorter time to estrus (32.11 +/- 1.6 h, P=0.13), a longer mean interval from the start of estrus to insemination (12.10 +/- 1.2 h, P = 0.16) and a positive mean interval between the end of standing estrus and the time of insemination (3.17 +/-1.7 h, P=0.19) than heifers not conceiving at the synchronized estrus (38.5 +/- 2.1, 7.42 +/- 1.9 h and -2.04 +/- 2.1 h, respectively). Breed differences were observed in estrus durations (Angus 8.52 +/- 1.2 h, Brahman 6.65 +/- 1.2 h, crossbred 11.90 +/- 1.2 h; P = 0.03), number of mounts (19 +/- 3.6, 25 +/- 5.4, 37 +/- 5.5, respectively; P=0.02) and gestation length (281 +/- 1.2, 291 +/- 1.8, 286 +/- 1.1 d, respectively; P = 0.001).

Quality of life as context for planning and evaluation of services for people with disabilities.

Quality of life has become a dominant theme in planning and evaluating services for people with disabilities. This article reviews definitions of quality of life, explores the concept from the perspective of the optimal theory of personal well-being, and surveys the research on the concept and its implications for planning and evaluating services. This article explores the subjective nature of life quality, particularly for people with disabilities, and relates the concept to both cultural norms and universal human values and needs. Each person experiences life, and disability, in unique ways. Practitioners need to consider quality-of-life issues as a context in planning and evaluating quality services.

"I've counted Jon": transformational experiences of teachers educating students with disabilities.

The purpose of this study was to describe the experiences of general education teachers who have had a student with severe disabilities in their class. Interviews of 19 general education teachers, kindergarten through Grade 9, as well as questionnaires completed by 18 teachers, were analyzed using categorical coding procedures to identify themes related to the teachers' experiences. Results showed that despite teachers' initial negative reactions to the placement of a child with severe disabilities in their classrooms, 17 teachers described transforming experiences of a more positive nature and related many benefits to the students with disabilities, their classmates, and the teachers themselves. Respondents also characterized what support services they found helpful and not helpful.