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BACKGROUND: Despite recognition of the high prevalence of alcoholism among patients with head and neck cancer, the prognostic importance of alcoholism has not been evaluated adequately. Previous investigators have speculated that alcoholic patients may have a poorer prognosis than nonalcoholic patients because of more advanced stage of cancer, the immunosuppressive effects of alcohol, and an increased rate of death due to other alcohol-related diseases. PURPOSE: The goal of this population-based study was to identify the features of alcoholism that are associated with survival for patients with head and neck cancer and to develop an alcoholic severity staging system from a composite of the independent features of alcoholism. METHODS: This prospective study included 649 patients who were diagnosed with cancer of the oral cavity, oropharynx, hypopharynx, or larynx during the period from September 1, 1983, through February 28, 1987, in a three-county area of western Washington state that participates in the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute. Details on lifetime alcohol consumption, treatment for alcoholism, abstinence from alcohol prior to the diagnosis of cancer, and alcohol-related health problems were ascertained through in-person interviews near the time of diagnosis. Patients were classified as either nonalcoholics or alcoholics according to their responses to questions from the Michigan Alcoholism Screening Test. The measures of alcohol consumption and abuse that were found to be independently associated with 5-year survival by logistic regression analysis were combined using conjunctive consolidation to create a final composite variable, called an alcoholic severity stage. Cox proportional hazards regression analysis was done to estimate the relative risk (R) of death within 5 years due to specific causes of death for each of the alcoholic severity stages. RESULTS: Alcoholism (RR = 2.06; 95% confidence interval [CI] = 1.43-2.98) and a history of alcohol-related systemic health problems (i.e., liver disease, pancreatitis, delirium tremens, or seizures) (RR = 2.76; 95% CI = 1.69-4.49) were associated with an increased risk of death, whereas abstinence (i.e., the consumption of fewer than one drink per week at 1 year prior to the diagnosis of cancer) (RR = 0.62; 95% CI = 0.39-0.97) was associated with a decreased risk of death. These associations were independent of age, site of cancer, anatomical stage, histopathologic grade, smoking, and type of antineoplastic treatment. Patients in the two worst alcoholic severity stages had an increased risk of dying not only of head and neck cancer but also of cardiovascular disease, pulmonary disease, and other alcohol-related causes. CONCLUSIONS: Alcohol abuse, measured by alcohol consumption, functional impairment, a history of alcohol-related health problems, or abstinence, can provide important prognostic information for patients with head and neck cancer. Our results suggest that sobriety among alcoholic patients can lead to prolonged survival. 相似文献
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This paper describes the application of an expert system for the evaluation of the short-term thermal rating and temperature rise of overhead conductors. The expert system has been developed using a database and Leonardo expert system shell which is gaining popularity among commercial tools for developing expert system applications. The expert system has been found to compare well when evaluated against site tests. A practical application is given to demonstrate the usefulness of the expert system developed 相似文献
66.
This second article deals with using the Comsis software for a particular application. Simulation is used to determine the maximum channel density in presence of crosstalk. In a first part, the modelling of the system is described. The simulation parameters of different optical elements are given. The results show that in the case of channels modulated at 500 Mbitls using fsk modulation format, and a direct detection operation at 1,5 μm, a minimum spacing of 6 GHz can be obtained with a 2 dB penalty. Thus if only the bandwidth of the erbium doped fibre amplifier is taken into account, the maximum number of channels which can be used is 250. However if the fsr (free spectral range) of optical filter is taken into account, the maximun number of channels is limited to 30. 相似文献
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Activation of macrophages by T cells is considered an initiating event in glomerular crescent formation. Since interferon-gamma (INF gamma) is a key mediator in T-cell-mediated activation of macrophages, we decided to test its role in a model of crescentic glomerulonephritis. An anti-glomerular basement membrane (GBM) serum was injected intravenously in presensitized wild-type or IFN gamma receptor deficient (IFN gamma(R)-/-) mice. Glomerulonephritis with glomerular crescents and tubulointerstitial inflammation developed in both strains, even though most evaluated morphological parameters and proteinuria indicated a less severe pathology in the mutant mice compared to the wild type. Thus, IFN gamma is not essential either for glomerular crescent formation or for tubulointerstitial involvement in anti-GBM glomerulonephritis in mice. In conclusion, the role of macrophages in this model might have been overestimated, or other cytokines may compensate for deficient IFN gamma signaling in the activation of macrophages. 相似文献
68.
The network interconnection and its regulation consist in solving the following dilemma: increase competition and preserve the universal service through access charges, which symbolizes today institutional organization within the telecommunication industry. This paper presents some of the economic and social factors that drive the interconnection policies namely ona (open network architecture) in the United States, or onp (open network provision) in Europe. In the first section, we list some social and economical issues related to open network policies. In the second section, we study the different answers brought up by the regulator through alternative interconnection price formulas. In conclusion, we discuss the stakes and risks of interconnection, while the technological evolution of network introduces intelligent software in switching équipement and implements the tremendous abilities of the digital broadband networks. 相似文献
69.
PURPOSE: To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS: 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS: In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION: Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used. 相似文献
70.
TL Holyoake MG Freshney L McNair AN Parker PJ McKay WP Steward E Fitzsimons GJ Graham IB Pragnell 《Canadian Metallurgical Quarterly》1996,87(11):4589-4595
The characterization of many cytokines involved in the control of hematopoiesis has led to intense investigation into their potential use in ex vivo culture to expand progenitor numbers. We have established the optimum ex vivo culture conditions that allow substantial amplification of transient engrafting murine stem cells and which, simultaneously, augment the ability to sustain serial bone marrow transplantation (BMT). Short-term incubation of unfractionated BM cells in liquid culture with stem cell factor (SCF) and interleukin-11 (IL-11) produced a 50-fold amplification of clonogenic multipotential progenitors (CFU-A). Following such ex vivo expansion, substantially fewer cells were required to rescue lethally irradiated mice. When transplanted in cell doses above threshold for engraftment, BM cells expanded ex vivo resulted in significantly more rapid hematopoietic recovery. In a serial transplantation model, unmanipulated BM was only able to consistently sustain secondary BMT recipients, but BM expanded ex vivo has sustained quaternary BMT recipients that remain alive and well more than 140 days after 4th degree BMT. These results show augmentation of both short-term recovery posttransplant and the ability to serially transplant marrow by preincubation in culture with SCF and IL-11. 相似文献