Thursday, December 18, 2014

Cells identified that enhance tumor growth and suppress anti-cancer immune attack

Cells identified that enhance tumor growth and suppress anti-cancer immune attack

by Carrie Strehlau

A study led by St. Jude Children's Research Hospital scientists has identified the population of white blood cells that tumors use to enhance growth and suppress the disease-fighting immune system. The results, which appear in the December 18 edition of the scientific journal Immunity, mark a turning point in cancer immunology and provide the foundation for developing more effective immunotherapies.

European Court Rules Obesity Can Be Disability

European Court Rules Obesity Can Be Disability



The European Court of Justice says obesity can be a disability, a ruling that could have consequences for employers across the continent.
The court ruled Thursday in the case of a Danish child-minder who says he was unfairly fired for being fat.
The court said if obesity hinders "full and effective participation in professional life," it could count as a disability. Discrimination on the grounds of disability is illegal under European Union law.

Re: capital in the 21st century

 2014 Dec;65(4):650-66. doi: 10.1111/1468-4446.12111.

Capital in the twenty-first century: a critique.

Author information

  • 1London School of Economics and Political Science.

Abstract

I set out and explain Piketty's model of the dynamics of capitalism based on two equations and the r > g inequality (his central contradiction of capitalism). I then take issue with Piketty's analysis of the rebuilding of inequality from the 1970s to the present on three grounds: First, his model is based on the (neo-classical) assumption that companies are essentially passive actors who invest the amount savers choose to accumulate at equilibrium output - leading to the counterintuitive result that companies respond to the secular fall in growth (and hence their product markets) from the 1970s on by increasing their investment relative to output; this does indeed imply increased inequality on Piketty's β measure, the ratio of capital to output. I suggest a more realistic model in which businesses determine investment growth based on their expectations of output growth, with monetary policy bringing savings into line with business-determined investment; the implication of this model is that β does not change at all. And in fact as other recent empirical work which I reference has noted, β has not changed significantly over these recent decades. Hence Piketty's central analysis of the growth of contemporary inequality requires rethinking. Second, despite many references to the need for political economic analysis, Piketty's analysis of the growth of inequality in the period from the 1970s to the present is almost devoid of it, his explanatory framework being purely mathematical. I sketch what a political economic framework might look like during a period when politics was central to inequality. Third, inequality in fact rose on a variety of dimensions apart from β (including poverty which Piketty virtually makes no reference to in this period), but it is unclear what might explain why inequality rose in these other dimensions.





 2014 Dec;65(4):607-18. doi: 10.1111/1468-4446.12104.

Beyond capital? The challenge for sociology in Britain.

Author information

  • 1School of Sociology, University of Nottingham.

Abstract

This article offers a 'local', British, reading of Piketty's landmark book, Capital in the Twenty-First Century, suggesting that the challenge it offers to sociological approaches to inequality is more fundamental than hitherto recognized. The variations in 'national trajectories' exposed by Piketty reveal Britain to be anomalous in terms of standard approaches to the path dependencies embedded in different welfare regimes. Using the recent work of Monica Prasad on 'settler capitalism' in the USA and the tax and debt-finance regime associated with it, the article suggests that colonialism and empire and its postwar unravelling has had deep consequences for British social stratification, albeit largely neglected by British sociologists. Finally, it points to the fact that the form of tax and debt-finance regime that has become reinforced in Britain is at the heart of recent radical reforms to higher education. These are the currently unexplicated conditions of our future practice as sociologists and, therefore, an obstacle to building a critical sociology on the foundations laid out by Piketty.






 2014 Dec;65(4):678-95. doi: 10.1111/1468-4446.12110.

The politics of Piketty: what political science can learn from, and contribute to, the debate on Capital in the Twenty-First Century.

Author information

  • 1Department of Geography, London School of Economics and Political Science.

Abstract

Thomas Piketty's imposing volume has brought serious economics firmly into the mainstream of public debate on inequality, yet political science has been mostly absent from this debate. This article argues that political science has an essential contribution to make to this debate, and that Piketty's important and powerful book lacks a clear political theory. It develops this argument by first assessing and critiquing the changing nature of political science and its account of contemporary capitalism, and then suggesting how Piketty's thesis can be complemented, extended and challenged by focusing on the ways in which politics and collective action shape the economy and the distribution of income and wealth. Although Capital's principal message is that 'capital is back' and that without political interventions active political interventions will continue to grow, a political economy perspective would suggest another rather more fundamental critique: the very economic forces Piketty describes are embedded in institutional arrangements which can only be properly understood as political phenomena. In a sense capital itself - the central concept of the book - is almost meaningless without proper consideration of its political foundations. Even if the fact of capital accumulation may respond to an economic logic, the process is embedded in a very political logic. The examples of housing policy and the regulation, and failure to regulate, financial markets are used to illustrate these points.

What is it to do good medical ethics? An orthodox Jewish physician and ethicist's perspective

 2015 Jan;41(1):125-8. doi: 10.1136/medethics-2014-102296.

What is it to do good medical ethics? An orthodox Jewish physician and ethicist's perspective.

Abstract

This article, dedicated to the 40th anniversary of the Journal of Medical Ethics, approaches the question 'what does it mean to do good medical ethics?' first from a general perspective and then from the personal perspective of a Jewish Orthodox physician and ethicist who tries, both at a personal clinical level and in national and sometimes international discussions and debates, to reconcile his own religious ethical values-especially the enormous value given by Jewish ethics to the preservation of human life-with the prima facie 'principlist' moral norms of contemporary secular medical ethics, especially that of respect for patients' autonomy.

Women survivors of intimate partner violence: the difficult transition to independence

 2014 Aug;48(spe):7-15. Epub 2014 Aug 1.

Women survivors of intimate partner violence: the difficult transition to independence.

[Article in English, Portuguese]

Author information

  • 1School of Nursing of Coimbra, Coimbra, Portugal.

Abstract

Objective 
To understand the trajectories that women go through from entering into to leaving relationships involving intimate partner violence (IPV), and identify the stages of the transition process. 
Method 
We utilized a constructivist paradigm based on grounded theory. We ensured that theethical guidelines of the World Health Organization for research on domestic violence were followed. The analysis focused on narratives of 28 women survivors of IPV, obtained from in-depth interviews. 
Results 
The results showed that the trajectories experienced by women were marked by gender issues, (self) silencing, hope and suffering, which continued after the end of the IPV. 
Conclusion 
The transition process consists of four stages: entry - falls in love and becomes trapped; maintenance - silences own self, consents and remains in the relationship; decides to leave - faces the problems and struggles to be rescued; (re) balance - (re) finds herself with a new life. This (long) process was developed by wanting (and being able to have) self-determination.

From U Mass: The Role of the Media in Agenda Setting: The Case of Long-Term Care Rebalancing

 2014 Dec 17. [Epub ahead of print]

The Role of the Media in Agenda Setting: The Case of Long-Term Care Rebalancing.

Author information

  • 1a Gerontology Institute, University of Massachusetts Boston , Boston , Massachusetts , USA.

Abstract

This study investigates the role print media plays in state policy agendas in four states-Connecticut, Minnesota, Oregon, and Utah-in rebalancing long-term care away from institutions toward home- and community-based (HCBS) services. Ordinary least squares regression is used to model states' policy agendas, as measured by the proportion of Medicaid long-term care spending on HCBS expenditures and number of rebalancing bills proposed, from 1999 to 2008. Results reveal a relationship between states' rebalancing agendas and the extent of media coverage, and state economic, political, and programmatic characteristics. Findings suggest that media coverage reflects broader shifts in state-level attitudes toward rebalancing.

Wednesday, December 17, 2014

"...the safety, efficacy, and long-term effects of devices are frequently insufficiently known upon device approval."

 2014 Dec 15;39(26):2115-2118.

Scientific Evaluation of Spinal Implants: An Ethical Necessity.

Author information

  • 1*Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands †Department of Neurosurgery, Medical Center Haaglanden, The Hague, the Netherlands ‡Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands §Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands; and ¶Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.

Abstract

The clinical introduction of novel medical devices often occurs without evidence of good methodological quality and with relatively little oversight and regulation. As a consequence, the safety, efficacy, and long-term effects of devices are frequently insufficiently known upon device approval. Recent controversies surrounding the Poly Implant Prothèse (PIP) breast implants, metal-on-metal hip implants, and interspinous implants underscore the need to reconsider how innovation in medical devices can adhere to sound ethical standards without inhibiting surgical research and development. In this article, the introduction of spinal implants is taken as an example to firstly discuss the scientific and ethical challenges of developing, testing, and introducing novel medical devices and to secondly identify avenues for improving the existing regulatory frameworks for such innovation. Two measures for improvement are most feasible in the short term: demanding prospective studies before device introduction and developing registries to monitor and evaluate new medical devices.Level of Evidence: 5.

"Because these expanding moral feelings feel so good to us, we are incapable of perceiving the danger from their ever-expanding focus, in particular from the sincere but increasingly maladaptive collective policies they will engender."

Politics Life Sci. 2014 Spring;33(1):2-32.

No end to caring?

Author information

  • 1Department of Political Science, Idaho State University, Graveley Hall, Pocatello, ID 83209, robishea@isu.edu.

Abstract

Abstract In a recent issue of Politics and the Life Sciences Mark Walker presented a compelling proposition for reducing evil in the world via an interdisciplinary program he calls the "Genetic Virtue Project" (GVP). As Walker explains, the purpose of the GVP is "to discover and enhance human ethics using biotechnology genetic correlates of virtuous behavior." PLS subsequently published several critiques of this proposal. While most of these critiques focused on conventional doubts about the technical feasibility or the ethics of such interventions, the more fundamental concern revealed by both Walker's proposal and its critiques is in the largely unquestioned assumption that more morality is necessarily better. Human history is marked by a gradual if uneven extension of moral concern to increasingly distant others, which many take as evidence of the rationality of morality. There is substantial evidence, though, that this expansion is fundamentally biological in origin and therefore not ultimately limited by rationality. Because these expanding moral feelings feel so good to us, we are incapable of perceiving the danger from their ever-expanding focus, in particular from the sincere but increasingly maladaptive collective policies they will engender. Utilizing the philosophy of Friedrich Nietzsche as a platform, the feasibility of different natural and cultural responses to this impending crisis of caring are examined, none of which are found capable of counteracting this expanding morality. Instead, the best hope for a successful response to this dangerous expansion of caring is actually a sort of reverse GVP, in which the biological mechanisms for this unchecked moral expansion are manipulated via genetic engineering to dial back this expansion. However, the likelihood of actually implementing such an admittedly counterintuitive and controversial program within an increasingly democratized world is doubtful. Ultimately, if we are unable to overcome this betrayal by our best intentions, where does that leave us as a species?

Tuesday, December 16, 2014

Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age

 2014 Dec 10;9(12):e114843. doi: 10.1371/journal.pone.0114843. eCollection 2014.

Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age.

Author information

  • 1Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
  • 2Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • 3Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan; Health Policyand Care Research Center, Taipei Medical University, Taipei, Taiwan.

Abstract

BACKGROUND:

Although a number of studies have investigated correlations of maternal age with birth outcomes, an extensive assessment using age as a continuous variable is lacking. In the current study, we estimated age-specific risks of adverse birth outcomes in childbearing women.

METHOD:

National population-based data containing maternal and neonatal information were derived from the Health Promotion Administration, Taiwan. A composite adverse birth outcome was defined as at least anyone of stillbirth, preterm birth, low birth weight, macrosomia, neonatal death, congenital anomaly, and small for gestational age (SGA). Singletons were further analyzed for outcomes of live birth in relation to each year of maternal age. A log-binomial model was used to adjust for possible confounders of maternal and neonatal factors.

RESULTS:

In total, 2,123,751 births between 2001 and 2010 were utilized in the analysis. The risk of a composite adverse birth outcome was significantly higher at extreme maternal ages. In specific, risks of stillbirth, neonatal death, preterm birth, congenital anomaly, and low birth weight were higher at the extremes of maternal age. Furthermore, risk of macrosomia rose proportionally with an increasing maternal age. In contrast, risk of SGA declined proportionally with an increasing maternal age. The log-binomial model showed greater risks at the maternal ages of <26 and > 30 years for a composite adverse birth outcome.

CONCLUSIONS:

Infants born to teenagers and women at advanced age possess greater risks for stillbirth, preterm birth, neonatal death, congenital anomaly, and low birth weight. Pregnancies at advanced age carry an additional risk for macrosomia, while teenage pregnancies carry an additional risk for SGA. The data suggest that the optimal maternal ages to minimize adverse birth outcomes are 26∼30 years.

Assessment vs. appraisal of ethical aspects of health technology assessment: can the distinction be upheld?

 2014 Nov 26;10:Doc05. doi: 10.3205/hta000121. eCollection 2014.

Assessment vs. appraisal of ethical aspects of health technology assessment: can the distinction be upheld?

Author information

  • 1University of Borås, Institutionen för vårdvetenskap, Borås, Sweden.
  • 2Swedish Council on HTA (SBU), Stockholm, Sweden.

Abstract

An essential component of health technology assessment (HTA) is the assessment of ethical aspects. In some healthcare contexts, tasks are strictly relegated to different expert groups: the HTA-agencies are limited to assessment of the technology and other actors within the health care sector are responsible for appraisal and recommendations. Ethical aspects of health technologies are considered with reference to values or norms in such a way that may be prescriptive, or offer guidance as to how to act or relate to the issue in question. Given this internal prescriptivity, the distinction between assessment and appraisal seems difficult to uphold, unless the scrutiny stops short of a full ethical analysis of the technology. In the present article we analyse the distinction between assessment and appraisal, using as an example ethical aspects of implementation of GPS-bracelets for people with dementia. It is concluded that for HTA-agencies with a strictly delineated assessment role, the question of how to deal with the internal prescriptivity of ethics may be confusing. A full ethical analysis might result in a definite conclusion as to whether the technology in question is ethically acceptable or not, thereby limiting choices for decision-makers, who are required to uphold certain ethical values and norms. At the same time, depending on the exact nature of such a conclusion, different action strategies can be supported. A positive appraisal within HTA could result in a decision on mandatory implementation, or funding of the technology, thereby making it available to patients, or decisions to allow and even encourage the use of the technology (even if someone else will have to fund it). A neutral appraisal, giving no definite answer as to whether implementation is recommended or not, could result in a laissez-faire attitude towards the technology. A negative appraisal could result in a decision to discourage or even prohibit implementation. This paper presents an overview of the implications of different outcomes of the ethical analysis on appraisal of the technology. It is considered important to uphold the distinction between assessment and appraisal, primarily to avoid the influence of preconceived values and political interests on the assessment. Hence, as long as it is not based on the subjective value judgments of the HTA-agency (or its representative), such an appraising conclusion would not seem to conflict with the rationale for the separation of these tasks. Moreover, it should be noted that if HTA agencies abstain from including full ethical analyses because of the risk of issuing an appraisal, they may fail to provide the best possible basis for decision-makers. Hence, we argue that as long as the ethical analysis and its conclusions are presented transparently, disclosing how well-founded the conclusions are and/or whether there are alternative conclusions, the HTA-agencies should not avoid taking the ethical analysis as close as possible to a definite conclusion.

From U Chicago: How to Achieve Health Equity

N Engl J Med. 2014 Dec 11;371(24):2331-2332.

How to Achieve Health Equity.

Author information

  • 1From the Section of General Internal Medicine, the Department of Medicine, Chicago Center for Diabetes Translation Research, the MacLean Center for Clinical Medical Ethics, the Robert Wood Johnson Foundation (RWJF) Finding Answers: Disparities Research for Change, and the RWJF Reducing Health Care Disparities through Payment and Delivery System Reform, University of Chicago, Chicago.

Abstract

Two studies in this issue of the Journal indicate that differences in how we deliver care to patients in various racial or ethnic groups have narrowed nationally, but health outcomes remain worse for blacks than for whites. Trivedi et al.1 studied hospitalizations of patients for acute myocardial infarction, heart failure, and pneumonia from 2005 through 2010. They found that racial or ethnic differences decreased for processes of care (i.e., what clinicians do for patients), such as evidence-based prescribing of medications and the administration of flu shots. In contrast, Ayanian et al.2discovered that black enrollees in Medicare Advantage health plans . . .

Betty Chung: Next Generation Sequencing and Personalized Genomic Patient Care (via labmedicineblog.com)

Next Generation Sequencing and Personalized Genomic Patient Care

(Scroll down, 2nd post down)

Monday, December 15, 2014

Ebola virus disease: essential public health principles for clinicians

 2014 Nov;15(7):728-31. doi: 10.5811/westjem.2014.9.24011. Epub 2014 Sep 26.

Ebola virus disease: essential public health principles for clinicians.

Author information

  • 1University of California at Irvine, Center for Disaster Medical Sciences and Department of Emergency Medicine, Orange, California.
  • 2University of California at Irvine, Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Orange, California.

Abstract

Ebola Virus Disease (EVD) has become a public health emergency of international concern. The World Health Organization and Centers for Disease Control and Prevention have developed guidance to educate and inform healthcare workers and travelers worldwide. Symptoms of EVD include abrupt onset of fever, myalgias, and headache in the early phase, followed by vomiting, diarrhea and possible progression to hemorrhagic rash, life-threatening bleeding, and multi-organ failure in the later phase. The disease is not transmitted via airborne spread like influenza, but rather from person-to-person, or animal to person, via direct contact with bodily fluids or blood. It is crucial that emergency physicians be educated on disease presentation and how to generate a timely and accurate differential diagnosis that includes exotic diseases in the appropriate patient population. A patient should be evaluated for EVD when both suggestive symptoms, including unexplained hemorrhage, AND risk factors within 3 weeks prior, such as travel to an endemic area, direct handling of animals from outbreak areas, or ingestion of fruit or other uncooked foods contaminated with bat feces containing the virus are present. There are experimental therapies for treatment of EVD virus; however the mainstay of therapy is supportive care. Emergency department personnel on the frontlines must be prepared to rapidly identify and isolate febrile travelers if indicated. All healthcare workers involved in care of EVD patients should wear personal protective equipment. Despite the intense media focus on EVD rather than other threats, emergency physicians must master and follow essential public health principles for management of all infectious diseases. This includes not only identification and treatment of individuals, but also protection of healthcare workers and prevention of spread, keeping in mind the possibility of other more common disease processes.

Establishing components of high-quality injury care: Focus groups with patients and patient families

 2014 Nov;77(5):749-756.

Establishing components of high-quality injury care: Focus groups with patients and patient families.

Author information

  • 1From the University Health Network (A.R.G.); and Sunnybrook Health Sciences Centre (A.N.), Toronto, Ontario; Department of Community Health Sciences (J.M.B., H.T.S.), and Institute for Public Health (H.T.S.), University of Calgary; and Departments of Medicine (H.T.S.), and Critical Care Medicine (H.T.S.), University of Calgary and Alberta Health Services, Calgary Zone, Calgary, Alberta; Vancouver General Hospital (D.E.), Vancouver; and Interior Health Authority (L.G.), Kelowna, British Columbia, Canada.

Abstract

BACKGROUND:

Each year, injuries affect 700 million people worldwide, more than 5 million people die of injuries, and 68,000 survivors remain permanently impaired. Half of all critically injured patients do not receive recommended care, and medical errors are common. Little is known about the aspects of injury care that are important to patients and their families. The purpose of this study was to explore the views of patients and families affected by injury on desired components of injury care in the hospital setting.

METHODS:

With the use of a grounded theory approach, this qualitative study involved focus groups with injured patients, family members of survivors, and bereaved family members from four Canadian trauma (injury care) centers.

RESULTS:

Thirty-eight participants included injured patients (n = 16), family members of survivors (n = 13), and bereaved family members (n = 9) across four trauma (injury care) centers in different jurisdictions. Participants articulated numerous themes reflecting important components of injury care organized across three domains as follows: clinical care (staff availability, professionalism, physical comfort, adverse events), holistic care (patient wellness, respect for patient and family, family access to patient, family wellness, hospital facilities, supportive care), and communication and information (among staff, with or from staff, content, delivery, and timing). Bereaved family members commented on decision making and end-of-life processes. Subthemes were revealed in most of these themes. Trends by site or type of participant were not identified.

CONCLUSION:

The framework of patient- and family-derived components of quality injury care could be used by health care managers and policymakers to guide quality improvement efforts. Further research is needed to extend and validate these components among injured patients and families elsewhere. Translating these components into quality indicators and blending those with measures that reflect a provider perspective may offer a comprehensive means of assessing injury care.

The neural bases for valuing social equality

 2014 Nov 18. pii: S0168-0102(14)00290-9. doi: 10.1016/j.neures.2014.10.020. [Epub ahead of print]

The neural bases for valuing social equality.

Author information

  • 1Tamagawa University Brain Science Institute, 6-1-1, Tamagawa-gakuen, Machida, Tokyo 194-8610, Japan; Japan Society for the Promotion of Science, 5-3-1, Koji-machi, Chiyoda-ku, Tokyo 102-8471, Japan; Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, United States. Electronic address: qqqqaokiq@yahoo.co.jp.
  • 2Tamagawa University Brain Science Institute, 6-1-1, Tamagawa-gakuen, Machida, Tokyo 194-8610, Japan.

Abstract

The neural basis of how humans value and pursue social equality has become a major topic in social neuroscience research. Although recent studies have identified a set of brain regions and possible mechanisms that are involved in the neural processing of equality of outcome between individuals, how the human brain processes equality of opportunity remains unknown. In this review article, first we describe the importance of the distinction between equality of outcome and equality of opportunity, which has been emphasized in philosophy and economics. Next, we discuss possible approaches for empirical characterization of human valuation of equality of opportunity vs. equality of outcome. Understanding how these two concepts are distinct and interact with each other may provide a better explanation of complex human behaviors concerning fairness and social equality.

The good, the bad, and the timely: how temporal order and moral judgment influence causal selection

 2014 Nov 18;5:1336. doi: 10.3389/fpsyg.2014.01336. eCollection 2014.

The good, the bad, and the timely: how temporal order and moral judgment influence causal selection.

Author information

  • 1Department of Philosophy, Institute of Philosophy II, Ruhr University Bochum Bochum, Germany.
  • 2Department of Philosophy, King's College London London, UK.
  • 3Faculty of Humanities, Institute for Philosophy, University of Duisburg-Essen Essen, Germany.
  • 4Department of Philosophy, University of Sheffield Sheffield, UK.

Abstract

Causal selection is the cognitive process through which one or more elements in a complex causal structure are singled out as actual causes of a certain effect. In this paper, we report on an experiment in which we investigated the role of moral and temporal factors in causal selection. Our results are as follows. First, when presented with a temporal chain in which two human agents perform the same action one after the other, subjects tend to judge the later agent to be the actual cause. Second, the impact of temporal location on causal selection is almost canceled out if the later agent did not violate a norm while the former did. We argue that this is due to the impact that judgments of norm violation have on causal selection-even if the violated norm has nothing to do with the obtaining effect. Third, moral judgments about the effect influence causal selection even in the case in which agents could not have foreseen the effect and did not intend to bring it about. We discuss our findings in connection to recent theories of the role of moral judgment in causal reasoning, on the one hand, and to probabilistic models of temporal location, on the other.

Wonder and the Patient

 2014 Dec 9. [Epub ahead of print]

Wonder and the Patient.

Author information

  • 1Centre for Medical Humanities, Durham University, Durham, UK, h.m.evans@durham.ac.uk.

Abstract

Is it possible to distinguish, as sociologist Arthur Frank proposes, an 'ideal of wonder' within which ill persons could recover some of their former sense of life and flourishing, even within the constraints of ill-health? Beyond this, are there more general benefits in terms of health and well-being that could accrue from cultivating an openness to wonder? In this paper I will first outline and defend a notion of wonder that gives philosophical support to Frank's proposal, noting why thinking about medical treatment may readily provoke a sense of wonder. Second I will however limit the normative force of such an 'ideal of wonder' noting its demands and some of the challenges facing it. The paper goes on, third, to conjecture wider benefits within and beyond the clinical encounter arising from being mindful of the wonder of embodied human agency. Fourth the paper will consider alignments between the foregoing analysis and some theoretical commitments in recent work in health geography. Finally I will briefly reconsider the notion of the body-as-territory, and the role of the imagination in bringing it under wonder's gaze.

The Long-Term Outcomes of Induction Chemoradiotherapy Followed by Surgery for Locally Advanced Non-Small Cell Lung Cancer

 2014 Oct 23;7(3):700-710. eCollection 2014.

The Long-Term Outcomes of Induction Chemoradiotherapy Followed by Surgery for Locally Advanced Non-Small Cell Lung Cancer.

Author information

  • 1Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Hidaka, Japan.
  • 2Division of Thoracic Oncology, Saitama Cancer Center, Saitama, Hidaka, Japan.
  • 3Department of Pathology, Saitama Cancer Center, Saitama, Hidaka, Japan.
  • 4Department of Radiation Oncology, Saitama Cancer Center, Saitama, Hidaka, Japan.
  • 5Department of Respiratory Medicine, Saitama International Medical Center, Hidaka, Japan.

Abstract

BACKGROUND:

Although the concept of induction therapy followed by surgical resection for locally advanced non-small cell lung cancer (LA-NSCLC) has found general acceptance, the appropriate indications and the strategy for this treatment are still controversial.

METHODS:

From 2000 through 2008, 36 patients received concurrent chemoradiotherapy followed by surgery. We retrospectively reviewed these cases, analyzed the outcomes and examined the prognosis.

RESULTS:

The median radiation dose given was 60 Gy. Chemotherapy included a platinum agent in all cases; cisplatin-based chemotherapy was administered to 9 cases, and a carboplatin-based chemotherapy regimen was administered to 27. A complete resection was performed in 94% of the patients. Seventeen (47.2%) patients exhibited a complete pathological response, and downstaging was induced in 26 (72%) cases. The morbidity and 30-day mortality rates were 11.1 and 0%, respectively. The 5-year overall survival rate in the patients with complete resection (n = 33) was 83.3%.

CONCLUSIONS:

Induction chemoradiotherapy followed by surgery for LA-NSCLC provided a favorable prognosis for selected patients. A complete pathological response was found in about half of cases. This strategy is feasible and was associated with low morbidity and high resectability rates, suggesting that it contributed to improving the treatment results.