Scholar : Journal of Tourism and Cultural Change, Volume 16, Issue 4, September 2018 is now available online on Taylor & Francis Online

The online platform for Taylor & Francis Online content Journal of Tourism and Cultural Change, Volume 16, Issue 4, September 2018 is now available online on Taylor & Francis Online. This new issue contains the following articles: Articles Price, people, location, culture and reputation: determinants of Malaysia as study destination by international hospitality and tourism undergraduates Sanghyeop Lee, Hong Ngoc Nguyen, Kai-Sean Lee, Bee-Lia Chua & Heesup Han Pages: 335-347 | DOI: 10.1080/14766825.2017.1336242 Searching for a lost aura: a Naxi Dongba's spatial practices and space remaking in touristic commoditization Zhaohui Liu Pages: 348-364 | DOI: 10.1080/14766825.2017.1332069 Global scouts: youth engagement with spirituality and wellness through travel, Lake Atitlán, Guatemala Lisa L. Gezon Pages: 365-378 | DOI: 10.1080/14766825.2017.1310217 Knitting at the beach: tourism and the photography of Dutch fabriculture | Remco Ensel Pages: 379-399 | DOI: 10.1080/14766825.2017.1335733 Tourism, territory and cuisine: food consideration and perceptions regarding origin and social changes: the case of Guinea pig José Prada-Trigo Pages: 400-415 | DOI: 10.1080/14766825.2017.1344678 Visitors' diversified motivations and behavior – the case of the pilgrimage center in Krakow (Poland) Justyna Liro, Izabela Sołjan & Elżbieta Bilska-Wodecka Pages: 416-435 | DOI: 10.1080/14766825.2017.1332068 Tourism as a discipline in light of the non-classical sociology of science Leszek Butowski Pages: 436-454 | DOI: 10.1080/14766825.2016.1237959 Book Reviews Political ecology of tourism: community, power and the environment Patrick J. Holladay Pages: 455-456 | DOI: 10.1080/14766825.2017.1364006 Fertility holidays: IVF tourism and the reproduction of whiteness Cristina H. Jönsson Pages: 456-458 | DOI: 10.1080/14766825.2017.1364010 Alternative tourism in Budapest: class, culture and identity in a postsocialist city Emanuela Guano Pages: 458-459 | DOI: 10.1080/14766825.2017.1364001 Creative urbanity: an Italian middle class in the shade of revitalization Noelle Molé Liston Pages: 460-462 | DOI: 10.1080/14766825.2017.1380118 To update which email alerts you receive, manage your alerts within the My Account area. Unsubscribe from new content alerts for this journal (both new issue and latest article notifications) with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

Background: Nipple-sparing mastectomy (NSM) allows for preservation of the entire nipple-areola complex utilizing various incision patterns. Reconstructive trends and overall risk associated with these diverse NSM incisions have yet to be fully elucidated. Methods: All NSMs from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar. Results: A total of 1212 NSMs were performed with 1207 NSMs included for final analysis. Of these, 638 (52.9%) utilized an inframammary fold incision, 294 (24.4%) utilized a lateral radial incision, 161 (13.3%) used a vertical radial incision, 60 (5.0) utilized a Wise pattern incision, 35 (2.9%) used a previous incision, and 19 (1.6%) utilized a periareolar incision. The groups were heterogeneous and differed significantly with regards to various factors including age (p

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Unplanned Emergency Department Visits within 30-Days of Mastectomy and Breast Reconstruction

Background: Unplanned emergency department (ED) visits are often overlooked as an indicator of care quality. Our objectives were to (1) determine the rate of 30-day ED visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with ED return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, we identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned ED visits. We identified and sorted diagnostic codes to investigate why patients were seeking ED care. Additionally, we performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4,917 (3.1%) experienced an unplanned return to the ED within 30 days of operation. Being younger, having any payer type other than a private payer, or having any number of comorbid conditions resulted in increased odds of revisit to ED. A substantial proportion of those who returned (23%) presented with a pain-related diagnosis. Only 0.9% of cases with a 30-day ED return were readmitted. Conclusions: Numerous patients return to the ED within 30-days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary ED utilization, specifically among younger or publically insured patients. Combining unplanned ED visits with readmission rates as a care quality indicator warrants consideration. Funding: The work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) to Kevin C. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this work was supported by awards from the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161) to Ting-Ting Chung. Corresponding author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive , 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, Phone: 734-936-5885, Fax: 734-763-5354, E-mail: kecchung@med.umich.edu ©2018American Society of Plastic Surgeons

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The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skelton – A Computed Tomography Imaging based Evaluation

Objective: Changes in midfacial skeletal angles and widths have been identified to contribute to the appearance of the aging face. However, information on the onset and gender differences of these changes, as well as a complete understanding of the theory behind this clockwise rotation, remain elusive. Material and Methods: 157 Caucasian individuals (10 males and 10 females of each: 20 – 29yrs, 30 – 39yrs, 40 – 49yrs, 50 – 59yrs, 60 – 69yrs, 70 – 79yrs, 80 – 89yrs & 8 males and 9 females 90 – 98 years) were investigated. Multi-planar computed tomographic scans with standardized angle and distance measurements in all 3 anatomical axes (x, y, z) in alignment to the sella – nasion (horizontal) line were conducted. Results: Both males and females displayed an increase in orbital floor angle (p

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The Stacked Hemi-Abdominal Extended Perforator (SHAEP) flap for autologous breast reconstruction

Background: Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemi-abdominal extended perforator (SHAEP) flap. We described the surgical technique and analyzed our results. Methods: A prospective study was conducted of all SHAEP flap breast reconstructions performed since February 2014. Patient demographics, operative details, complications and flap re-explorations were recorded. The bipedicled hemi-abdominal flap was designed as a combination of the deep inferior epigastric perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels (DCIA/SCIA), the superficial inferior epigastric artery (SIEA), or a lumbar artery or intercostal perforator. Results: A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range 405-797). Median hemi-abdominal flap weight that was used for reconstruction was 598 grams (range 160-1389). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2%), hematoma (3.3%), fat necrosis (2.2%), and wound problems (4.4%). Minor donor-site complications occurred in five patients (10.2%). Most flaps were harvested on a combination of the DIEP and DCIA vessels. Conclusions: This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site. Financial disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Conflicts of interest: None. Funding: None. Trial registration: Not applicable. Acknowledgements: The authors would like to acknowledge Dr. Edward Buchel for his great work on the DCIA flap as a combined flap with the DIEP or SIEA, which was the foundation for the SHAEP flap. Corresponding author: Joshua L. Levine, M.D., Center for Breast Reconstruction, 3 Columbus Circle #1410, New York, NY 10019, United States of America. Phone: 212 – 245 – 8140. Fax: 212 – 245 – 8157. Email: info@joshualevinemd.com ©2018American Society of Plastic Surgeons

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“The Constriction Arm Band Deformity in Brachioplasty Patients: Characterization and Incidence Using a Prospective Registry”

Background: Demand for post-passive weight loss (MWL) brachioplasty in the United States has seen a dramatic increase, from 338 procedures in 2000 to 17,099 in 2015. New challenges are emerging, some without clear solutions. Here we describe our series of arm band deformities not yet been described in the literature. Methods: This is a retrospective review of MWL patients undergoing brachioplasty at our institution (2000-2016). Pre- and post-operative photographs were reviewed to identify the defect. Descriptive statistics and t-test were used. Results: In our cohort of 1,090 MWL patients, 172 patients underwent brachioplasty, 25 patients (15%) were identified with the deformity. Twenty-four (96%) were female (ave 60y [36y,85y], BMI 34 at time of surgery, ave 2y since GBP, mean delta BMI 22). The bands were generally single bands (100%) found bilaterally (68%) in the distal third (74%) of the upper arm and exacerbated (50%) by brachioplasty. The average specimen weighed 1005g. We found arm banding was associated with higher current BMI, but not with maximum BMI or delta BMI. Conclusions: For MWL patients, arm band deformity is a challenging problem which can be exacerbated by brachioplasty and is not currently surgically correctable. It can be identified pre-operatively to aid in counseling. We found patients with higher current BMI to be at a higher risk for the arm band deformity after brachioplasty. Financial Disclosure Statement: The authors have no disclosures. Corresponding Author: J. Peter Rubin, MD, University of Pittsburgh Department of Plastic Surgery, 3550 Terrace Street 6B Scaife Hall, Pittsburgh, PA, 15261, USA. rubipj@upmc.edu ©2018American Society of Plastic Surgeons

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Development of the BODY-Q Chest Module Evaluating Outcomes Following Chest Contouring Surgery

Background: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome (PRO) instrument designed for weight loss and/or body contouring. In this paper, we describe the development of a new module for masculinizing chest contouring surgery. Methods: Qualitative methods were used to develop and refine the content of the BODY-Q Chest Module, which was subsequently field-tested in Canada, USA, Netherlands and Denmark between June 2016 and June 2017. Participants were men and trans men aged 16 years or older and seen for gynecomastia, weight loss or trans men chest surgery. Data were collected using either a web-based application or paper questionnaire. Rasch Measurement Theory (RMT) analysis was performed. Results: The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, 341 gender confirming). RMT analysis refined a 10-item chest and 5-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability, i.e., Person Separation Index and Cronbach's alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale). Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean score for the chest and nipples scales was significantly higher (p

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“Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized Cross-over, Single-Center Clinical Trial”

Background: By age 60, 30% of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetics dictating foot type, multiple forefoot steroid injections, surgery and foot trauma. Methods: We present data from a two-year, prospective, randomized cross-over study performed to assess pain and disability indexes, fat pad thickness, forces and pressures of stance and gait. Group 1 underwent fat grafting with two years of follow-up, while Group 2 underwent conservative management for 1 year, then received fat grafting with 1 year of follow-up. Results: 18 subjects (14 female, 4 male) comprised Group 1. 13 subjects (9 female, 4 male) comprised Group 2. Group 1 reported the worst pain at baseline, Group 2 experienced the worst pain at 6, 12-month Standard of Care (SOC) visits; pain for both groups immediately improved following fat grafting and lasted through study follow up (p

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Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases

Background: Sterile, ready-to-use acellular dermal matrix (RTU ADM), introduced as an alternative to aseptic, freeze-dried acellular dermal matrix (FD ADM) for implant-based breast reconstruction (IBR), has been investigated in a limited number of studies. The purpose of this study was to compare outcomes in IBR with RTU ADM and FD ADM. Methods: We analyzed patients undergoing IBR with either FD ADM or RTU ADM, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of ADM on outcomes while controlling for potential confounders. Results: 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions comprised the population: 612 (n=910 breasts) with FD ADM and 673 (n=1129 breasts) with RTU ADM. The FD ADM cohort had a significantly higher rate of explantation compared to RTU ADM cohort (18.0% versus 12.0%, p = 0.0036), but surgical site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients having reconstruction with FD ADM, compared to RTU ADM, did not have higher odds of experiencing surgical site infections (OR 1.064, p = 0.7455), but did have higher odds of explantation (OR 1.570, p = 0.0161). Tobacco use (OR 2.809, p = 0.0002) and BMI (OR 1.054, p

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Dominant men are faster in decision-making situations and exhibit a distinct neural signal for promptness

Abstract

Social dominance, the main organizing principle of social hierarchies, facilitates priority access to resources by dominant individuals. Throughout taxa, individuals are more likely to become dominant if they act first in social situations and acting fast may provide evolutionary advantage; yet whether fast decision-making is a behavioral predisposition of dominant persons outside of social contexts is not known. Following characterization of participants for social dominance motivation, we found that, indeed, men high in social dominance respond faster–without loss of accuracy–than those low in dominance across a variety of decision-making tasks. Both groups did not differ in a simple reaction task. Then, we selected a decision-making task and applied high-density electroencephalography (EEG) to assess temporal dynamics of brain activation through event related potentials. We found that promptness to respond in the choice task in dominant individuals is related to a strikingly amplified brain signal at approximately 240 ms post-stimulus presentation. Source imaging analyses identified higher activity in the left insula and in the cingulate, right inferior temporal and right angular gyri in high than in low dominance participants. Our findings suggest that promptness to respond in choice situations, regardless of social context, is a biomarker for social disposition.

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Nimotuzumab for Recurrent Nasopharyngeal Carcinoma

Condition:   Recurrent Nasopharyngeal Carcinoma
Intervention:   Drug: Nimotuzumab
Sponsors:   Fujian Cancer Hospital;   Sun Yat-sen University;   Jiangxi Provincial Cancer Hospital;   Zhejiang Cancer Hospital;   Fujian Medical University Union Hospital
Recruiting

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A First-in-human Study of ILDR2 (Immunoglobulin-like Domain Containing Receptor 2) Function-blocking Antibody BAY1905254

Condition:   Advanced Solid Tumor
Intervention:   Drug: BAY1905254
Sponsor:   Bayer
Not yet recruiting

https://ift.tt/2x1G9rJ

Immunotherapy +/- EGFR Inhibitor In Advanced/Metastatic cSCC: Tackling Primary And Secondary Resistance

Condition:   Skin Neoplasm
Interventions:   Drug: Pembrolizumab;   Drug: Cetuximab
Sponsors:   Fondazione IRCCS Istituto Nazionale dei Tumori, Milano;   Merck Sharp & Dohme Corp.
Not yet recruiting

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Pathophysiological Mechanism Behind Prolonged Whiplash Associated Disorders

Condition:   Whiplash Injuries
Intervention:   Other: Exercises
Sponsor:   Linkoeping University
Not yet recruiting

https://ift.tt/2x0J6sA

A Safety and Tolerability Study of NC318 in Subjects With Advanced or Metastatic Solid Tumors

Conditions:   Advanced or Metastatic Solid Tumors;   Head and Neck Squamous Cell Carcinoma;   Non-Small Cell Lung Cancer;   Ovarian Cancer
Intervention:   Drug: NC318
Sponsor:   NextCure, Inc.
Not yet recruiting

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Scholar : Research in Drama Education: The Journal of Applied Theatre and Performance, Volume 23, Issue 4, November 2018 is now available online on Taylor & Francis Online

The online platform for Taylor & Francis Online content Research in Drama Education: The Journal of Applied Theatre and Performance, Volume 23, Issue 4, November 2018 is now available online on Taylor & Francis Online. This new issue contains the following articles: Editorial Lost lists: time for reading, writing, thinking Helen Nicholson Pages: 479-482 | DOI: 10.1080/13569783.2018.1513898 Research Articles A theatrical critique of humanitarian civility in the ICRC Museum John Yves Pinder Pages: 483-498 | DOI: 10.1080/13569783.2018.1494558 Intergenerational performance ecology: a practice-based approach Sarah Hopfinger Pages: 499-516 | DOI: 10.1080/13569783.2018.1508990 Points and Practices Fools rush in … and succeed: how an outsider's naivety effected an arts and reconciliation initiative in Indonesia's Sulawesi Catherine Diamond Pages: 517-522 | DOI: 10.1080/13569783.2018.1494560 Research Article We might play different parts: theatrical improvisation and anti-racist pedagogy Samuel Jaye Tanner, Erin T. Miller & Shannon Montgomery Pages: 523-538 | DOI: 10.1080/13569783.2018.1494557 Points and Practices Did that really happen? The marginalising of fiction in the prison education classroom John G. Parkinson Pages: 539-547 | DOI: 10.1080/13569783.2018.1494563 Research Articles Actor, character, and the political in Nola Chilton's documentary theatre Shulamith Lev-Aladgem Pages: 548-562 | DOI: 10.1080/13569783.2018.1494559 Co-emergence: an art-full dance of inquiry into artists' experiences of making art Gail J. Mitchell, Carla Rice & Victoria Pileggi Pages: 563-581 | DOI: 10.1080/13569783.2018.1507730 Understanding spaces of potentiality in applied theatre Cathy Sloan Pages: 582-597 | DOI: 10.1080/13569783.2018.1508991 The integrated spectator: theatre audiences and pedagogy David Allen & Eero Laine Pages: 598-612 | DOI: 10.1080/13569783.2018.1494556 Points and Practices A teacher's response to '"Where the wild things are" – an insider's experience of the contemporary classroom' Laura Hennessy Pages: 613-616 | DOI: 10.1080/13569783.2018.1494561 To update which email alerts you receive, manage your alerts within the My Account area. Unsubscribe from new content alerts for this journal (both new issue and latest article notifications) with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Uptake effects of toxic heavy metals from growth soils into jujube and persimmon of China

Abstract

Compared with other agricultural plants, information about uptake effects of toxic heavy metals from growth soils into persimmon and jujube are scarce. In this study, the single and comprehensive uptake effects of five toxic heavy metals (Pb, As, Cd, Cr, and Hg) between the two fruits and their growth soils were investigated. The results showed that the average concentrations of heavy metals in the two fruits were found to be 30 (Pb), 6.6 (As), 2.3 (Cd), 38 (Cr), and 0.33 (Hg) μg/kg, respectively. The average concentrations of heavy metals in their growth soils were 26.31 (Pb), 9.63 (As), 0.12 (Cd), 57.6 (Cr), and 0.049 (Hg) mg/kg, respectively. An uptake effect was observed for the two fruits. The values of Nemerow pollution index (NPI) in the two fruits and their growth soils were 0.10 and 0.55, respectively. The average bioconcentration factor (BCF) values of Pb, As, Cd, Cr, and Hg in the two fruits were 0.0012, 0.00075, 0.021, 0.00077, and 0.012, respectively. Based on the residue levels of toxic heavy metals in the growth soils and soil parameters, the prediction models for NPI and BCF were established, with the adjusted regression coefficients of 0.65 (NPI) and 0.81 (BCF). The contribution rates of different soil parameters to NPI were 21.7% (OC), 16.1% (Pb), 17.1% (Cr), 19.8% (Cd), and 25.4% (As), respectively. The contribution rates of different soil parameters to BCF were 10.2% (OC), 9.4% (Cr), and 80.4% (Cd), respectively.

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Role of sorption energy and chemisorption in batch methylene blue and Cu 2+ adsorption by novel thuja cone carbon in binary component system: linear and nonlinear modeling

Abstract

Functionalized thuja cone carbon (FTCC) was synthesized thermochemically. It was carried out by carbonization (250 °C) and activation (320 °C), followed by surface functionalization in 0.5 M HAN (HNO and HCl₃) mixture and subsequent heating in H₂SO₄ (95%) at 90 °C. This was used for methylene blue (MB) adsorption in single component system (SCS) and binary component system (BCS) with Cu²⁺. Maximum adsorption capacity of MB (83.4 mg/g) was achieved at pH 10 at 100 mg/L of adsorbate solution. MB and Cu²⁺ adsorption onto FTCC obeyed pseudo-second-order model kinetics. Spontaneous and endothermic MB adsorption was noticed with negative Gibbs free energy change (− 6.34, − 9.20, and − 13.78 kJ/mol) and positive enthalpy change (133.91 kJ/mol). At low concentrations, Cu²⁺ adsorption increased by 14 mg/g with least reduction of MB adsorption (< 4 mg/g) in BCS. Isotherm models (Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich) support the increase in Cu²⁺ adsorption in BCS. The sorption heat of MB shifted from 165.16 kJ/mol (SCS) to 150.85 kJ/mol in BCS (Temkin) and from 57.74 kJ/mol (SCS) to 50.50 kJ/mol in BCS (D-R), which supports the lower MB uptake in BCS due to decrease in sorption energy. The sorption heat of Cu²⁺ is increased (148.43 kJ/mol) in the BCS than SCS (155.36 kJ/mol), which makes the equal distribution of increased bonding energies; therefore, FTCC surface sites increased the Cu²⁺ uptake in the BCS. Desorption studies concluded the reusability of FTCC by 75% and 79% for MB and Cu²⁺ adsorption respectively. This study recommends to determine the best fit of isotherm and kinetic models to adsorption data by linear as well as nonlinear regression fit.

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Volumetric and texture analysis of pretherapeutic 18 F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib

Abstract

Purpose

The metabolically most active lesion in 2-deoxy-2-(¹⁸F)fluoro-D-glucose (¹⁸F-FDG) PET/CT can predict progression-free survival (PFS) in patients with medullary thyroid carcinoma (MTC) starting treatment with the tyrosine kinase inhibitor (TKI) vandetanib. However, this metric failed in overall survival (OS) prediction. In the present proof of concept study, we aimed to explore the prognostic value of intratumoral textural features (TF) as well as volumetric parameters (total lesion glycolysis, TLG) derived by pre-therapeutic ¹⁸F-FDG PET.

Methods

Eighteen patients with progressive MTC underwent baseline ¹⁸F-FDG PET/CT prior to and 3 months after vandetanib initiation. By manual segmentation of the tumor burden at baseline and follow-up PET, intratumoral TF and TLG were computed. The ability of TLG, imaging-based TF, and clinical parameters (including age, tumor marker doubling times, prior therapies and RET (rearranged during transfection) mutational status) for prediction of both PFS and OS were evaluated.

Results

The TF Complexity and the volumetric parameter TLG obtained at baseline prior to TKI initiation successfully differentiated between low- and high-risk patients. Complexity allocated 10/18 patients to the high-risk group with an OS of 3.3 y (vs. low-risk group, OS = 5.3 y, 8/18, AUC = 0.78, P = 0.03). Baseline TLG designated 11/18 patients to the high-risk group (OS = 3.5 y vs. low-risk group, OS = 5 y, 7/18, AUC = 0.83, P = 0.005). The Hazard Ratio for cancer-related death was 6.1 for Complexity (TLG, 9.5). Among investigated clinical parameters, the age at initiation of TKI treatment reached significance for PFS prediction (P = 0.02, OS, n.s.).

Conclusions

The TF Complexity and the volumetric parameter TLG are both independent parameters for OS prediction.

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Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: a prospective study with 1 year follow-up

Abstract

Objective

To assess prospectively the prevalence of impulse control disorders (ICD), psychiatric symptoms, and their clinical correlates in patients with prolactinoma receiving dopamine agonists (DA) in comparison to those with non-functioning pituitary adenomas (NFA) and healthy controls (HC).

Methods

A total of 25 patients with prolactinoma, 31 with NFA, and 32 HCs were included in the study. All patients and controls were screened for the presence of ICDs and other psychiatric disorders using revised version of Minnesota Impulsive Disorders Interview (MIDI-R), Barratt Impulsiveness Scale (BIS-11), Symptom Check List (SCL-90-R) questionnaire and Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).

Results

We detected two new cases (8%) of ICD associated with DAs. Both cases presented with hypersexuality, which reversed totally or decreased upon discontinuation of the drug. The re-challenge of the DA in a smaller dose has led to either no symptoms or weaker symptoms than before. There was an increase in the number of patients who screened positive on obsession, interpersonal sensitivity, paranoid ideation, and additional items subscales of SCL-90-R in comparison to HCs at the end of the study period (p < 0.05 for all). Likewise, cumulative DA dose was positively correlated to obsession, interpersonal sensitivity, paranoid ideation, hostility, phobic anxiety subscales, and GSI scores of SCL-90-R (p < 0.05 for all).

Conclusions

DAs are associated with a small but substantial short-term risk of ICD development and a broad range of psychiatric symptoms in patients with prolactinoma receiving DAs.

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