Cancer

Hyperthermia is an ancient, but nowadays rapidly developing treatment method in tumor-therapy. Its new paradigm applied in the electro-hyperthermia (oncothermia), which provides energy by means of electric-field and produces non-equilibrium thermal situation in the tissue. The temperature gradients formed in stationer conditions, destroy the membrane of the malignant cells and selectively eliminate the cancer tissue. The characteristic control parameter is the absorbed energy-dose, which is partly used to make the distortions, partly to increase the temperature of the target. This type of technique could be applied for some tumor sites, including brain, soft tissues, liver and abdominal masses, pancreatic cancer, head and neck tumors as well.

Temozolomide (TMZ) is an oral alkylating agent that is regarded as a tolerable and eVective drug. When combined with radiotherapy in patients with newly diagnosed glioblastoma, survival is signiWcantly prolonged. This Wnding has led to widespread use of TMZ for patients with this disease. We summarize developing concerns regarding the use of TMZ, imaging of malignant gliomas, and the pharmacology of TMZ-mechanism of action, scheduling and strategies for overcoming resistance.

This article aims at scientifically investigating the anticipatory grief/mourning phenomenon, which is referred to the psychic processes before the death of a loved one, using the interpretative phenomenological analysis (IPA). The IPA is grounded on a phenomenological hermeneutic: the indepth study of the meaningprocess of a subjective experience by a person. This analysis is applied to the case of a woman caring for her spouse suffering from a cancer, in end-of-life. The findings give an insight of the psychological functioning of a person facing the impending death of a relative, and offer reflection-tools concerning prevention of psychic distress in the bereavement field.

Background: Ascorbic acid (vitamin C, ascorbate) has been shown to protect cells against various types of oxidant injury at physiologically relevant concentrations. Vitamin C has been suggested as having both a preventative and therapeutic role in a number of pathologies when administered at much higher-than-recommended dietary allowance levels. This article reviews the scientific rational for intravenous vitamin C as a potential treatment for cancer.

Caffeic acid phenethyl ester (CAPE) is the major pharmacologically-active component of some propolis types, rich in polyphenols, such as poplar propolis types. CAPE has the potential to be applied as a pharmaceutical as it possesses most of the pharmacological activities of propolis, such as anti-proliferative, antioxidant, immunomodulatory, antidiabetic, anti-inflammatory and antimicrobial. Its advantage is that it lacks some of the downsides of total propolis extracts, such as inability for unified standardization, which is cornerstone for implementing its therapeutic potential as a drug. The current paper provides an overview on the pharmacodynamic principles of CAPE. We present literature search outcomes form ClinicalTrials.gov database and from scientific publications, available on Scopus and Crossref databases. We take a round view of CAPE’s potential therapeutic implications in light of approved drugs with related modes of action.

In the pursuit of sensitive and quantitative methods to detect and diagnose cancer, nanotechnology has been identified as a field of great promise. Semiconductor quantum dots are nanoparticles with intense, stable fluorescence, and could enable the detection of tens to hundreds of cancer biomarkers in blood assays, on cancer tissue biopsies, or as contrast agents for medical imaging. With the emergence of gene and protein profiling and microarray technology, high-throughput screening of biomarkers has generated databases of genomic and expression data for certain cancer types, and has identified new cancer-specific markers. Quantum dots have the potential to expand this in vitro analysis, and extend it to cellular, tissue and whole-body multiplexed cancer biomarker imaging.

Delays in follow-up after cancer screening contribute to racial/ethnic disparities in cancer outcomes. We evaluated a patient navigator intervention among innercity women with breast abnormalities. A full-time patient navigator supported patients using the care management model. Female patients 18 years and above, referred to an urban, hospital-based, diagnostic breast health practice from January to June 2000 (preintervention) and November 2001 to February 2003 (intervention), were studied. Timely follow-up was defined as arrival to diagnostic evaluation within 120 days from the date the original appointment was scheduled. Data were collected via computerized registration, medical records, and patient interview. Bivariate and multivariate logistic regression analyses were conducted, comparing preintervention and intervention groups, with propensity score analysis and time trend analysis to address the limitations of the pre-post design. 314 patients were scheduled preintervention; 1018, during the intervention. Overall, mean age was 44 years; 40% black, 36% non-Hispanic white, 14%

Evolutionary pressure has selected antibodies as key immune molecules acting against foreign pathogens. The development of monoclonal antibody technology has allowed their widespread use in research, real-time diagnosis and treatment of multiple diseases, including cancer. However, compared with hematologic malignancies, solid tumors have often proven to be relatively resistant to antibody-based therapies. In an attempt to improve the tumor-targeting efficacy of antibodies, new formats with modified, multivalent properties have been generated. Initially, these formats imitated the structure of native IgG, creating mostly monospecific, bivalent antibodies. Recently, novel trivalent antibodies have been developed to maximize tumor targeting capabilities through enhanced biodistribution and functional affinity. We review recent advances in the engineering of multivalent antibodies and further discuss their promise as agents for in vivo diagnostics and therapy.

Objectives: To delineate the influences of the Mediterranean diet (MD) on human mortality and agerelated morbid conditions, principally the metabolic syndrome, hypertension, cardiovascular disease, excess body weight, cancer, poor bone mineralization and rheumatoid arthritis, and neurodegenerative disorders. Method: Citations were selected from a PubMed search according to their clinical and experimental relevance. Results and conclusions: Individuals who adhere to the principles of the traditional MD tend to have a longer life-span. Both men and women who report eating foods closest to the MD are about 10-20% less likely to die over the course of a study of heart disease, cancer or any other cause. The longevity of Mediterranean people has been related to olive oil, and its several microcomponents of antioxidant potential, present in all MD variants. The prevalence of the metabolic syndrome may be reduced by a MD. The MD is significantly inversely associated with both systolic and diastolic blood pressure. It also has benefits in relation to the prevention of cardiovascular events, reduces the risk of mortality after myocardial infarction, and reduces peripheral arterial disease. The risk of obesity decreases with increasing adherence to the traditional MD. The MD also has a preventive effect on cancer, through its antiproliferative and proapoptotic effects, mostly due to the components of virgin olive oil and vegetables. There is some evidence of the benefits of the MD in relation to bone metabolism, rheumatoid arthritis, and neurodegenerative age-related diseases (cognitive deficit, Alzheimer's disease, Parkinson's disease).

Autophagy, a lysosomal degradation pathway for cellular constituents and organelles, is an adaptive and essential process required for cellular homeostasis. Although autophagy functions as a survival mechanism in response to cellular stressors such as nutrient or growth factor deprivation, it can also lead to a non-apoptotic form of programmed cell death (PCD) called autophagyinduced cell death or autophagy-associated cell death (type II PCD). Current evidence suggests that cell death through autophagy can be induced as an alternative to apoptosis (type I PCD), with therapeutic purpose in cancer cells that are resistant to apoptosis. Thus, modulating autophagy is of great interest in cancer research and therapy. Natural polyphenolic compounds that are present in our diet, such as rottlerin, genistein, quercetin, curcumin, and resveratrol, can trigger type II PCD via various mechanisms through the canonical (Beclin-1 dependent) and non-canonical (Beclin-1 independent) routes of autophagy. The capacity of these compounds to provide a means of cancer cell death that enhances the effects of standard therapies should be taken into consideration for designing novel therapeutic strategies. This review focuses on the autophagy-and cell death-inducing effects of these polyphenolic compounds in cancer.

Extrusion-based bioprinting (EBB) is a rapidly growing technology that has made substantial progress during the last decade. It has great versatility in printing various biologics, including cells, tissues, tissue constructs, organ modules and microfluidic devices, in applications from basic research and pharmaceutics to clinics. Despite the great benefits and flexibility in printing a wide range of bioinks, including tissue spheroids, tissue strands, cell pellets, decellularized matrix components, micro-carriers and cellladen hydrogels, the technology currently faces several limitations and challenges. These include impediments to organ fabrication, the limited resolution of printed features, the need for advanced bioprinting solutions to transition the technology bench to bedside, the necessity of new bioink development for rapid, safe and sustainable delivery of cells in a biomimetically organized microenvironment, and regulatory concerns to transform the technology into a product. This paper, presenting a first-time comprehensive review of EBB, discusses the current advancements in EBB technology and highlights future directions to transform the technology to generate viable end products for tissue engineering and regenerative medicine.

A. Pakdaman developed the first process to enrich water with oxygen to 60 mg O 2 /l. In 1988 he introduced oral oxygen therapy into the clinical medicine and nutrition. Pakdaman's process uses an ion physical linkage of molecular O 2 and H 2 O molecules. The O 2 molecules lodge themselves in the "voids" formed between the H 2 O molecules, which are covered with a protective water membrane. Direct contact with mitochondria cell tissues (glands, intestine, liver, kidney, brain, heart, etc) ruptures the sealing membrane and the released oxygen is then readily available to the cell. Oxygen will be mostly absorbed by diffusion and osmosis through cells in the stomach and intestine and will enter the body's blood circulation system through the portal vein. Such additional oxygen can perform all the same functions as the oxygen absorbed through the lungs. Several structures of our organs participate in the absorption and transportation of the oxygen. Among them are the villi and cells containing mitochondrion in the small intestine as well as the lymph system. One of the many pollutants in our ground, surface and drinking water is Nitrate (NO 3). Bacteria in the water will reduce the nitrate to nitrite, which in turn can evolve into e.g. nitrosamines, a known cancer causing substance. Especially vulnerable are small children, who can suffer from hemoglobin blockages. The oxygen in the water can drastically reduce the levels of nitrate and 1992 tests by the Hygiene Institute of the University of Düsseldorf have shown that oxygen enriched water can reduce nitrate by up to 500%. Scientifically confirmed effects of oxygen on the human body (are): • Improved oxygen utilisation disorder and cellular hypoxia (oxygen starvation); • Correction of hypoventilation due to functional weakness of the respiratory tract, by virtue of oxygen transport directly into the blood circulation via the gastrointestinal tract and portal vein; • Correction of disorders of intracellular respiration caused by anemia, enzyme defect, poisoning etc; • Conversion of anaerobic metabolism in cancer cells, inhibiting the growth of malignant cells; • Prophylactic and therapeutic improvement of migraine due to reduction of cerebral hypoxia; • Immune system stimulation and modulation: leucocytes, monocytes, granulocytes, natural killer cells; • Elevation of cellular energy delivery and increases in physical and psychological ability; • Improvements of cell metabolism and biological oxidation through increased availability of oxygen for the mitochondrion and also influencing the regulation of cellular calcium ion concentration; • Acceleration of body detoxification via activation of cytochrome P-450 in the liver; • Improvements of the micro-circulation in the capillary blood vessels; • Improvement of myocardial hypoxia and prevention of heart tissue necrosis insufficiency; • Regulation of blood pressure through effects on chemo-receptors in the carotid and aortic bodies; • Increased number of blood cells; erythrocytes, Hct, Hb and platelets; • Antibacterial and antiviral effect, especially on anaerobic bacteria; • Cytotoxic effect on camphylobactor pylori, plus other gastric and intestinal mucosa improvements; • Neutralization of the stomach acids secreted by the parietal cells and transformation into water; • Acceleration of the wound-healing process (washing and cleansing of open wounds).

Combinatorial strategy has been used in therapeutic angiogenesis in animal models of peripheral arterial disease (PAD) and coronary artery disease for decades. Previous studies have shown that basic fibroblast growth factor (FGF-2) and platelet-derived growth factor BB (PDGF-BB) proteins together establish functional and stable vascular networks on mouse corneal and also in animal model of hindlimb ischemia. However, the short half life of protein by single injection is not sufficient to achieve effective dosage, repeated and prolonged injection causes systemic toxicity. Here we study the synergistic effects of FGF-2 and PDGF-BB by intramuscular injection of naked plasmid DNA on therapeutic angiogenesis in rabbit model of hindlimb ischemia. We found that transient delivery of FGF-2 and PDGF-BB naked DNA together resulted in greater increases in capillary growth, collateral formation and popliteal blood flow compared with control and single gene delivery. Our data provided novel evidence of beneficial effects of DNA-based FGF-2 and PDFG-BB on muscle repair after ischemic injury. These findings reveal an alternative therapeutic approach in the treatment of ischemic diseases and even in muscular disorders.

Objectives
This study sought to explore perspectives of trans and gender diverse (TGD) people of ways to alleviate gender dysphoria in service provision and to develop a framework for application in health and other areas that can be used by researchers and service providers to design study protocols, assess organisations and enhance everyday practice in ways that are sensitive to TGD people’s experiences.

Methods
Data from a national Australian survey on TGD people conducted in 2018–2019 (n = 340) were used to develop a framework for alleviating dysphoria. Participants were asked an open-ended question on ways that body discomfort could be minimised in clinical encounters. Inductive thematic analysis was used to develop themes true to participant sentiment, which formed the basis for the development of a framework.

Results
The sample was overall young, with 60.6% aged 18–24, and a strong representation of gender diverse people (42.6%). The most important theme for participants was the context of the experience, which included the subthemes of the interpersonal qualities of service providers, language and pronouns, and practical aspects. Aspects of systems were also important, with education and awareness being particularly emphasised, followed by inclusive environments. Access to gender affirming medical and surgical procedures was rarely mentioned (2.6%). A minority of participants indicated that there was nothing that could be done to alleviate their gender dysphoria (4.4%).

Conclusions
The study proposes a framework that can help facilitate assessment of a service’s current practices, inform a practitioner’s daily practice and be used by researchers to appropriately design studies. The most important areas to address centre on the context of the immediate experience, which may be influenced through systems-level characteristics.

A chronic continuous or intermittent gastrointestinal tract dysfunction, the irritable bowel syndrome (IBS), appears to be due to dysregulation of brain-gut-microbiota communication. Furthermore, the "microbiota" greatly impacts the bi-directional brain-gut axis communication. This article describes IBS in relation to similar diseases, presents the background to osteopathy, and proposes osteopathic manipulative treatment (OMT) to manage IBS. In IBS, OMT focuses on the nervous and circulatory systems, spine, viscera, and thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow, and address somatic dysfunction. Lymphatic and venous congestion are treated by the lymphatic pump techniques and stimulation of Chapman's reflex points. A simple treatment plan designed to lessen chronic pain and inflammation in IBS is presented based on current evidence-based literature. Since food itself, food allergies, and intolerance could contribute to symptom onset or even cause IBS, this article also provides dietary modifications to consider for patients.

Polyphenols are found ubiquitously in plants and their regular consumption has been associated with a reduced risk of a number of chronic diseases, including cancer, cardiovascular disease (CVD) and neurodegenerative disorders. Rather than exerting direct antioxidant effects, the mechanisms by which polyphenols express these beneficial properties appear to involve their interaction with cellular signaling pathways and related machinery that mediate cell function under both normal and pathological conditions. We illustrate that their interactions with two such pathways, the MAP kinase (ERK, JNK, p38) and PI3 kinase/Akt signaling cascades, allow them to impact upon normal and abnormal cell function, thus influencing the cellular processes involved in the initiation and progression of cancer, CVD and neurodegeneration. For example, their ability to activate ERK in neurons leads to a promotion of neuronal survival and cognitive enhancements, both of which influence the progression of Alzheimer's disease, whilst ERK activation by polyphenols in vascular endothelial cells influences nitric oxide production, blood pressure and ultimately CVD risk. The main focus of this review is to provide an overview of the role that polyphenols play in the prevention of cancer, cardiovascular disease and neurodegeneration. We present epidemiological data, human intervention study findings, as well as animal and in vitro studies in support of these actions and in each case we consider how their actions at the cellular level may underpin their physiological effects.

People abused by angry discipline as children, may tend to abuse or overly punish other people or themselves for perceived wrongs in their adult life. In some individuals, aggressive personality traits may be genetically inherited. The aggressive personality may feel weakened by having guidelines or boundaries for anger. Anger is a normal human emotion, and these guidelines can help express anger in a healthy way.

Tumor microenvironment (TME) is a host for a complex network of heterogeneous stromal cells with overlapping or opposing functions depending on the dominant signals within this milieu. Reciprocal paracrine interactions between cancer cells with cells within the tumor stroma often reshape the TME in favor of the promotion of tumor. These complex interactions require more sophisticated approaches for cancer therapy, and, therefore, advancing knowledge about dominant drivers of cancer within the TME is critical for designing therapeutic schemes. This review will provide knowledge about TME architecture, multiple signaling, and cross communications between cells within this milieu, and its targeting for immunotherapy of cancer.

BACKGROUND: Clinical audit has been increasingly required for the accreditation process in every modern healthcare system. Data collection and analysis are excessively time-consuming in everyday practice. The primary aim of our study was to evaluate the ...

Objectives: To evaluate positron emission tomography-computed tomography (PET-CT) for the preoperative management of early-stage intermediate-and high-risk endometrial cancer (EC). Study design: Data of patients with intermediate-and high-risk early-stage EC were retrieved from a prospectively collected database. Patients with preoperative PET-CT followed by surgical staging including pelvic lymphadenectomy were analyzed. Diagnostic performance for lymph node (LN) metastasis was evaluated. Results: Overall, 45 patients were included: 27 (60%) and 18 (40%) with intermediate-and highrisk EC, respectively. Four patients (8.8%) had LN metastasis, three correctly identified at PET-CT, yielding a sensitivity of 75% (95% CI 21.9-98.7). Among 41 patients (91.2%) without LN metastasis, 38 had negative PET-CT with specificity of 92.7% (95% CI 78.9-98.1). The negative predictive value (NPV) was 97.4% (95% CI 84.9-99.9) and the positive predictive value was 50% (95% CI 13.9-86.1). Conclusions: The utility of PET-CT is limited by the low sensitivity for LN metastasis in intermediate-and high-risk early-stage EC, that may impede to consider PET-CT alone an adequate alternative to surgical retroperitoneal staging by lymphadenectomy or sentinel LN biopsy. However, the high diagnostic accuracy, specificity and NPV might support its adoption to improve the diagnostic accuracy of the sentinel LN algorithm.

PurposeAdjuvant chemotherapy for resected non–small-cell lung cancer (NSCLC) is now accepted on the basis of several randomized clinical trials (RCTs) that demonstrated improved survival. Although there is strong evidence that adjuvant chemotherapy is effective in stages II and IIIA NSCLC, its utility in stage IB disease is unclear. This report provides a mature analysis of Cancer and Leukemia Group B (CALGB) 9633, the only RCT designed specifically for stage IB NSCLC.Patients and MethodsWithin 4 to 8 weeks of resection, patients were randomly assigned to adjuvant chemotherapy or observation. Eligible patients had pathologically confirmed T2N0 NSCLC and had undergone lobectomy or pneumonectomy. Chemotherapy consisted of paclitaxel 200 mg/m2intravenously over 3 hours and carboplatin at an area under the curve dose of 6 mg/mL per minute intravenously over 45 to 60 minutes every 3 weeks for four cycles. The primary end point was overall survival.ResultsThree hundred-forty-four patients...

Pancreatic cancer is a rapidly fatal disease, and there is an urgent need for early detection markers and novel therapeutic targets. The current study has used a proteomic approach of two-dimensional (2D) gel electrophoresis and mass spectrometry (MS) to identify differentially expressed ...

Obesity is a well recognized risk factor for several types of cancers, many of which occur solely or disproportionately in women. Adipose tissue is a rich source of adipose-derived stem cells (ASC), which have received attention for their role in cancer behavior. The purpose of this systematic review is to present the existing literature on the role of ASCs in the growth, development, progression, and metastasis of cancer, with an emphasis on malignancies that primarily affect women. To accomplish this goal, the bibliographic database PubMed was systematically searched for articles published between 2001 and 2014 that address ASCs' relationship to human cancer. Thirty-seven articles on ASCs' role in human cancer were reviewed. Literature suggests that ASCs exhibit cancer-promoting properties, influence/are influenced by the tumor microenvironment, promote angiogenesis, and may be associated with pathogenic processes through a variety of mechanisms, such as playing a role in ...

Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m 2) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease.

We studied the activity of 14 compounds, all of which have been shown to interfere in plant cell division, in two animal tumor cell cultures, EL-4 and L1210. Four compounds [propham, chlorpropham, bensulide S-(O,O-diisopropylphosphorodithioate) ester of A/-(2-mercaptoethyl)benzenesulfonamide), and siduron] had a 50% inhibitory dose less than 10~4 M; six [2,3,5-triiodobenzoic acid, (2,4-dichlorophenoxy)acetic acid, bromacil, (2,4,5-trichlorophenoxy)acetic acid, naptalam, and (4-chloro-2-methylphenoxy)acetic acid] had a 50% inhibitory dose between 10~" and 10~3 M, and the remaining four 2,3: 4,6-di-O-isopropylidene-2-keto-L-gulonate, eptam, maleic hydrazide, and 4-(methylsulfonyl)-2,6-dinitro-/\/,N,-dipropylaniline] had a 50% inhibitory dose at higher than 10~3 M. There was a significant correlation between the effect on the two cell lines as well as between the inhibition of cell proliferation and that of thymidine and leucine uptake. More detailed study of cell proliferation and leucine and thymidine uptake for bensu lide and 2,3,5-triiodobenzoic acid revealed a dose-response pattern of inhibition starting shortly after exposure of the cells to the compounds. These results indicate that some inhibitors of plant cell division are capable of inhibiting the proliferation of animal tumor cells.

he fossils described elsewhere in this issue probably left no descendants, are not very old, and were found on a remote island. Despite this, they are among the most outstanding discoveries in palaeoanthropology for half a century. The two papers concerned-by Brown et al. 1 and Morwood et al. 2-appear on pages 1055 and 1087 of this issue, and respectively describe the fossils and their archaeological context. The find is startling.It is of a pygmysized, small-brained hominin, which lived as recently as 18,000 years ago, and which was found on the island of Flores together with stone tools, dwarf elephants and Komodo dragons. Discoveries don't get better than that. The Flores fossils add a new and surprising twig to the hominin family tree, which diverged from the chimpanzee lineage about 7 million years ago. The first African hominins existed 7-1.2 million years ago, were 1-1.5 metres tall, walked upright on two legs (that is, were bipedal), and had chimpanzee-size brains. These early forms comprised as many as six genera and fourteen species, of which the australopithecines are the best known. By 2.5 million years ago, our own genus, Homo, had emerged, with its different body shape, slower growth, greater reliance on meat in the diet, and 'encephalization'-larger brains than expected for body size. These were the first hominins to make stone tools systematically and to colonize Eurasia. They include the familiar names of H. habilis, H. erectus, H. neanderthalensis and, finally, H. sapiens, which put in an appearance about 160,000 years ago. The new fossil is part of this Homo group (Fig. 1). Flores lies to the east of Java, and was probably never connected to the mainland. The presence of 800,000-year-old simple stone tools first attracted attention in 1998 (ref. 3), raising the controversial possibility that H. erectus had produced them and had crossed major sea barriers to reach Flores. Now we have the announcement of the discovery of an 18,000-year-old hominin skeleton from a cave, Liang Bua, on Flores. Although this date is more than 140,000 years after modern humans evolved in Africa, more than 25,000 years after H. sapiens reached Australia, and about 10,000 years after the last known Neanderthal, the

ONYX-015 is an E1B-55kDa gene-deleted adenovirus engineered to selectively replicate in and lyse p53-deficient cancer cells. To evaluate the selectivity of ONYX-015 replication and cytopathic effects for the first time in humans, we carried out a Phase II clinical testing of intratumoral and peritumoral ONYX-015 injection in 37 patients with recurrent head and neck carcinoma. Patients received ONYX-015 at a daily dose of 1 ؋ 10 10 plaque-forming units (pfu) via intratumoral injection for 5 days during week 1 of each 3-week cycle (n ‫؍‬ 30; cohort A), or 1 ؋ 10 10 pfu twice a day for 10 days during weeks 1 and 2 of each 3-week cycle. Posttreatment biopsies documented selective ONYX-015 presence and/or replication in the tumor tissue of 7 of 11 patients biopsied on days 5-14, but not in immediately adjacent normal tissue (0 of 11 patients; P ‫؍‬ 0.01). Tissue destruction was also highly selective; significant tumor regression (>50%) occurred in 21% of evaluable patients, whereas no toxicity to injected normal peritumoral tissues was demonstrated. p53 mutant tumors were significantly more likely to undergo ONYX-015-induced necrosis (7 of 12) than were p53 wild-type tumors (0 of 7; P ‫؍‬ 0.017). High neutralizing antibody titers did not prevent infection and/or replication within tumors. ONYX-015 is the first genetically engineered replicationcompetent virus to demonstrate selective intratumoral replication and necrosis in patients. This agent demonstrates the promise of replicationselective viruses as a novel therapeutic platform against cancer.

The case of a 33-year-old woman with primary carcinoid of the uterine cervix is reported. Primary carcinoid tumor is well known to occur in organs such as the gastrointestinal tract, lung and gonads. However, its occurrence in the uterine cervix is rare. To our knowledge, primary carcinoid of the uterine cervix has not been reported from the United States, although it has been well documented by non-American authors. Light microscopically, the tumor was characterized by formation of solid nests, trabeculae and glands. The cells therein showed argyrophil granules but were negative for argentaffin reaction. Electron microscopy revealed the presence of numerous neurosecretory granules and microfilaments. On the basis of light microscopic ultrastructural and cytochemical properties, the tumor is believed to arise from the normal argyrophil cell of the cervix and is regarded as an endocrine tumor, a member of the group of neoplasms called apudomas. Cancer 43:535-538, 1979. ARCINOID OF THE UTERINE CERVIX became C a convincingly established a n d accepted entity only in the recent past. It was first described by Albores-Saavedra' in 1972. Thereafter, Tateishi et U L .~~ published their observations of 5 such cases a n d coined the term "argyrophil cell carcinoma" for the specific type of cervical carcinoma derived from the argyrophil cells, normally found in the cervical epithelium. More recently, Albores-Saavedra' reported additional observations o n 12 cases of carcinoid tumors of the uterine cervix. Since then, occasional case reports have been cited in literature by European (English6 and Czech-o~lovakian'~) authors. An apparent lack of familiarity and adequate documentation in the American literature prompts this report.

Medical and nursing staff in oncology for older cancer patients are confronted with a range of problems including co-morbidity, poly-pharmacy, cognitive impairments, emotional problems, functional limitations, sensory impairment and a lack of social support. Comprehensive geriatric assessment identifies many of the existing problems and can be used to estimate life expectancy and tolerance of treatment. However, health care providers have to interpret and apply the medical and nursing information and must deal with specific problems and care needs throughout the continuum of cancer care. Imperfect interdisciplinary communication, cooperation and patient-provider communication may further complicate the care actually delivered. A clinical care pathway aims to improve continuity, increase multidisciplinary tuning and deliver appropriate patient education, treatment and care for vulnerable older cancer patients. This paper gives an overview of common problems in older cancer patients and addresses communication barriers through the development of clinical care pathways in geriatric oncology.