Faculty Bibliography

BACKGROUND AND PURPOSE: This study was designed to determine whether neuropsychological function in HIV-infected persons is correlated with loss of brain volume (as measured by percentage of brain parenchymal volume [PBV]). We hypothesized that whole-brain parenchymal volume might correlate with neuropsychologic performance, even before overt clinical dysfunction is apparent. METHODS: A computer-assisted segmentation technique with thin section MR imaging was used for 15 patients with HIV infection (seven symptomatic, eight asymptomatic) and for five HIV-negative control participants to quantify whole brain and CSF volumes. To determine the degree of brain atrophy, the PBV relative to that of intracranial content was calculated. Neuropsychological performance was assessed by using a standard battery of eight tests (NPZ-8 test battery). RESULTS: HIV-infected patients had significantly lower NPZ-8 scores (t[18] = 2.26, P <.05) and lower PBV (t[18] = 1.79, P <.01) than those of healthy control participants. With the Spearman rank order correlation coefficients, data analyzed for all 20 study participants (15 HIV-infected patients and five noninfected control participants) showed a significant (r = -0.50, P <.05) negative correlation between PBV and NPZ-8 test battery score. In addition, there was a significant negative correlation between subtest score of motor impairment and PBV (r = -0.69, P <.01) and between AIDS dementia complex score (r = -0.64) and PBV (P <.01). CONCLUSION: These correlations suggest that quantitation of PBV may offer an objective, easily acquired surrogate predictor of neuropsychological impairment and clinically apparent cognitive/motor dysfunction among HIV-infected persons

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening

PURPOSE: To determine the effects of cyst diameter and location (intrarenal, exophytic), renal attenuation, section collimation, and computed tomographic (CT) interscanner variability on renal cyst pseudoenhancement in a phantom model. MATERIALS AND METHODS: A customized anthropomorphic phantom was designed to accept 40-, 140-, and 240-HU renal inserts containing intrarenal and exophytic 7-, 10-, and 15-mm cysts. Each phantom and insert were scanned with five different helical CT scanners by using 1.0-1.5-mm, 2.50-3.75-mm, 5.0-mm, 7.0-8.0-mm, and 10.0-mm section collimation. Means and SDs of CT number measurements were obtained for each cyst within each variably 'enhanced' renal insert. Mixed-model analysis of variance accommodating heteroscedasticity of data was used to assess the effect of scanner type, section collimation, and cyst diameter on cyst attenuation. RESULTS: Pseudoenhancement (range, 10.3-28.3 HU), observed by using effective section collimation equal to or less than 50% of cyst diameter, occurred in 34 (38%) of 90 intrarenal cyst measurements. Pseudoenhancement was observed with all five CT scanners, though the magnitude of the effect was nonuniform. Significant interactions were noted between renal cyst diameter, background renal attenuation, and CT scanner type in terms of their effects on cyst attenuation. No appreciable pseudoenhancement was observed with exophytic cysts. CONCLUSION: Pseudoenhancement is maximal when small (< or = 1.5-cm) intrarenal cysts are scanned during maximal levels of renal parenchymal enhancement. The magnitude of this effect varies with scanner type but may be large enough to prevent accurate lesion characterization, despite use of a thin-section helical CT data acquisition technique

Virtually all patients with advanced non-small-cell lung cancer (NSCLC) relapse. Docetaxel has an established, Food and Drug Administration-approved role as salvage therapy in previously treated, platinum-exposed patients. However, the response rate in phase III studies is < 15%, and median survival is only 6-8 months. Temozolomide, a novel triazene derivative with activity in melanoma and anaplastic astrocytoma, has demonstrated activity in C26 adenocarcinoma, Lewis lung cancer, and in phase I studies. A phase II trial was mounted using a unique schedule of oral temozolomide 75 mg/m2 daily for 6 weeks every 8-10 weeks, in patients with previously treated, advanced, incurable NSCLC. Eligibility stipulated an Eastern Cooperative Oncology Group performance status (PS) of 0-2, adequate end organ function, up to 1 prior chemotherapy for advanced (relapsed or metastatic) disease, and up to 1 prior regimen in the context of radiosensitization, adjuvant therapy, or induction. From March 2000 through January 2002, 47 patients (24 male, 23 female) were enrolled. The median age was 67 years. Sixteen patients had a PS of 2, 22 had a PS of 1, and 9 had a PS of 0. It was too early to evaluate 9 patients. Toxicity, with the exception of mild nausea and thrombocytopenia, was negligible. Three patients had a delayed recovery of platelets prompting discontinuation of treatment. Of the 38 evaluable patients, 1 patient had a complete response, 2 patients had a partial response, 12 had stable disease, and 19 had disease progression. Four patients were not evaluable. Six patients died within 30 days of taking temozolomide; 5 of these deaths were not related to treatment upon review by an independent data safety monitoring committee. Temozolomide, using a unique 6-week continuous schedule, has demonstrated activity in the salvage therapy of advanced NSCLC. Toxicity is modest, and accrual to this study continues

We propose two diagnostics for the statistical assessment of Hardy-Weinberg equilibrium. One diagnostic is the posterior probability of the complement of the smallest highest posterior density credible region that includes points in the parameter space consistent with the hypothesis of equilibrium. The null hypothesis of equilibrium is to be rejected if this probability is less than a pre-selected critical level. The second diagnostic is the proportion of the parameter space occupied by the highest posterior density credible region associated with the critical level. These Bayesian diagnostics can be interpreted as analogues of the classical types I and II error probabilities. They are broadly applicable: they can be computed for any hypothesis test, using samples of any size generated according to any distribution

PURPOSE/OBJECTIVES: To examine symptoms and quality of life (QOL) of esophagectomy patients after curative surgery. DESIGN: Longitudinal, descriptive pilot study. SETTING: Comprehensive cancer center in the northeastern United States. SAMPLE: 23 patients were surveyed: 20 men and 3 women. The mean age was 62.3 years. METHODS: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (version 2.0) and the esophageal-specific module were used. Data collection included three or four time points: before neoadjuvant treatment (if administered), before surgery, and three and six months after surgery. MAIN RESEARCH VARIABLES: The effects on symptoms and QOL of curative esophagectomy performed by a thoracic surgical oncologist. FINDINGS: Global QOL declined slightly over time; this change was not statistically significant. A significant inverse relationship was found between symptom intensity and global QOL. The intensity of hoarseness, reflux, and diarrhea increased significantly pre- to postsurgery. The average symptom intensity for the esophageal-specific subset of 24 symptoms increased significantly over time; the greatest intensity was found before surgery. CONCLUSIONS: Over the six-month observation period, the study found little average change in global QOL or functional status. However, symptoms increased significantly during this time period. Increased symptoms were associated with decreased QOL. IMPLICATIONS FOR NURSING: Symptom management should focus on symptoms that interfere with patients' QOL. Further research should target the evaluation of specific interventions for symptoms