不同化疗方案治疗晚期胃癌的疗效观察

目的比较FOLFOX、CF、DCFZ种化疗方案治疗晚期胃癌的效果。方法回顾分析173例分别采用FOLFOX、CF及DCF3种治疗方案的初治晚期胃癌患者：其中采用FOLFOX方案治疗71例,CF方案59例,DCF方案43例。每28天为1个疗程,至少完成2个周期的化疗后,评估患者的近期疗效和毒副反应。结果3种方案的近期疗效分别为：FOLFOX方案31．0％,CF方案27．1％,DCF方案55．8％,DCF方案疗效明显高于其他两个方案,差异有统计学意义（P〈0．01）。毒副反应主要为骨髓抑制和消化道反应,DCF方案发生几率较高,但患者均可耐受,差异无统计学意义（P〉0．05）。结论晚期胃癌患者应用DCF方案近期疗效较好,不良反应可以耐受,值得临床推广使用。     

A parallel analysis of individual and ecological data on residential radon and lung cancer in south-west England

Parallel individual and ecological analyses of data on residential radon have been performed using information on cases of lung cancer and population controls from a recent study in south-west England. For the individual analysis the overall results indicated that the relative risk of lung cancer at 100 Bq m⁻³ compared with at 0 Bq m⁻³ was 1.12 (95% confidence interval (0.99, 1.27)) after adjusting for age, sex, smoking, county of residence and social class. In the ecological analysis substantial bias in the estimated effect of radon was present for one of the two counties involved unless an additional variable, urban–rural status, was included in the model, although this variable was not an important confounder in the individual level analysis. Most of the methods that have been recommended for overcoming the limitations of ecological studies would not in practice have proved useful in identifying this variable as an appreciable source of bias.     

Ultraviolet radiation in urban ecosystems with consideration of effects on human health

Excess exposure to ultraviolet radiation (UV) from the sun, particularly the ultraviolet B (UVB), is cited as a cause or contributing factor for deleterious effects on human health, including skin cancers and cataracts. Rates of skin cancer have increased greatly in recent years, and increased UVB caused by reductions in stratospheric ozone may be responsible for some of the increase in rates, though quantified estimates of the effect of the UVB changes on health have low certainty. UVB exposure also affects the function of the immune system, and the potential resulting effects on infectious diseases and immunizations are a concern. Epidemiological considerations suggest that peoples' routine exposure to UV in urban areas can be significant in adverse health effects, particularly for young children. Projected trends of ozone indicate that agreements to limit ozone-depleting substances are slowing the UVB increase, but high levels will continue and apparently impact health to the middle of the current century. Urban trees greatly reduce ultraviolet irradiance in their shade when they obscure both the sun and sky. Where trees or other structures obscure only the sun, leaving much of the sky in view, UVB irradiance will be greater than suggested by the visible shade. Since air pollutants influence the UVB above the canopy, and the overlying atmosphere is usually more polluted in urban than rural areas, additional above-canopy monitoring of UV in urban areas is needed for comparison to existing rural monitoring sites. Such monitoring would facilitate the development of computer models of urban effects on UV, which are needed for epidemiological investigations, public education, and urban planning.     

Bounds in Competing Risks Models and the War on Cancer

In 1971, President Nixon declared war on cancer. Thirty years later, many declared this war a failure: the age‐adjusted mortality rate from cancer in 2000 was essentially the same as in the early 1970s. Meanwhile the age‐adjusted mortality rate from cardiovascular disease fell dramatically. Since the causes that underlie cancer and cardiovascular disease are likely dependent, the decline in mortality rates from cardiovascular disease may partially explain the lack of progress in cancer mortality. Because competing risks models (used to model mortality from multiple causes) are fundamentally unidentified, it is difficult to estimate cancer trends. We derive bounds for aspects of the underlying distributions without assuming that the underlying risks are independent. We then estimate changes in cancer and cardiovascular mortality since 1970. The bounds for the change in duration until death for either cause are fairly tight and suggest much larger improvements in cancer than previously estimated.     

Nurturing Life with Dreams: Therapeutic Dream Work with Cancer Patients

This paper describes the use of dream work as a component of individual counseling for cancer patients. Motivated by the work of experts in the field, who use dream work with their clients facing life-threatening illness and corroborated by a review of the literature, this therapeutic modality was introduced with cancer patients at a social service agency. The clinical work seems to indicate that the use of dreams helps create a safe environment for therapy by encouraging clients to discuss the emotional aspects of their disease and introducing topics, like death and dying, which are normally difficult to discuss.     

Parameterization and inference for nonparametric regression problems

We consider local likelihood or local estimating equations, in which a multivariate function () is estimated but a derived function () of () is of interest. In many applications, when most naturally formulated the derived function is a non-linear function of (). In trying to understand whether the derived non-linear function is constant or linear, a problem arises with this approach: when the function is actually constant or linear, the expectation of the function estimate need not be constant or linear, at least to second order. In such circumstances, the simplest standard methods in nonparametric regression for testing whether a function is constant or linear cannot be applied. We develop a simple general solution which is applicable to nonparametric regression, varying-coefficient models, nonparametric generalized linear models, etc. We show that, in local linear kernel regression, inference about the derived function () is facilitated without a loss of power by reparameterization so that () is itself a component of (). Our approach is in contrast with the standard practice of choosing () for convenience and allowing ()> to be a non-linear function of (). The methods are applied to an important data set in nutritional epidemiology.     

Prediction of tumour pathological subtype from genomic profile using sparse logistic regression with random effects

The purpose of this study is to highlight the application of sparse logistic regression models in dealing with prediction of tumour pathological subtypes based on lung cancer patients'' genomic information. We consider sparse logistic regression models to deal with the high dimensionality and correlation between genomic regions. In a hierarchical likelihood (HL) method, it is assumed that the random effects follow a normal distribution and its variance is assumed to follow a gamma distribution. This formulation considers ridge and lasso penalties as special cases. We extend the HL penalty to include a ridge penalty (called ‘HLnet’) in a similar principle of the elastic net penalty, which is constructed from lasso penalty. The results indicate that the HL penalty creates more sparse estimates than lasso penalty with comparable prediction performance, while HLnet and elastic net penalties have the best prediction performance in real data. We illustrate the methods in a lung cancer study.     

Agency and fatalism in older Appalachian women’s information seeking about gynecological cancer

Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women’s agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment. Fatalism was not understood apart from placing trust in medical expertise. We implore researchers to further explore rural expressions of agency.     

Unifying CRM and EWOC designs for phase I cancer clinical trials

The main goal of phase I cancer clinical trials is to determine the highest dose of a new therapy associated with an acceptable level of toxicity for the use in a subsequent phase II trial. The continual reassessment method (CRM) [O’Quigley, J., Pepe, M., Fisher, L., 1990. Continual reassessment method: a practical design for phase I clinical trials in cancer. Biometrics 46, 33–48] and escalation with overdose control (EWOC) [Babb, J., Rogatko, A., Zacks, S., 1998. Cancer phase I clinical trials: efficient dose escalation with overdose control. Statist. Med. 17 (10), 1103–1120] are two model-based designs used for phase I cancer clinical trials. A few modifications of the (original) CRM and EWOC have been made by many authors. In this paper, we show how CRM and EWOC can be unified and present a hybrid design. We study the characteristics of the approach of the hybrid design. The comparisons of the three designs (CRM, EWOC, and the hybrid design) are presented by convergence rates and overdose proportions. The simulation results show that the hybrid design generally has faster convergence rates than EWOC and smaller overdose proportions than CRM, especially when the true maximum tolerated dose (MTD) is above the mid-level of the dose range considered. The performance of these three designs is also evaluated in terms of sensitivity to outliers.     

Adherence to Mediterranean diet and risk of prostate cancer

In Europe, countries following the traditional Mediterranean Diet (MeDi), particularly Southern European countries, have lower prostate cancer (PCa) incidence and mortality compared to other European regions. In the present study, we investigated the association between the MeDi and the relative risk of PCa and tumor aggressiveness in a Spanish population. Among individual score components, it has been found that subjects with PCa were less likely to consume olive oil as the main culinary fat, vegetables, fruits and fish than those without. However, these differences were not statistically significative. A high intake of fruit, vegetables and cooked tomato sauce Mediterranean style (sofrito) was related to less PCa aggressiveness. Results showed that there are no differences in the score of adherence to the Mediterranean dietary patterns between cases and controls, with mean values of 8.37?±?1.80 and 8.25?±?2.48, respectively. However, MeDi was associated with lower PCa agressiveness according to Gleason score. Hence, relations between Mediterranean dietary patterns and PCa are still inconclusive and merit further investigations. Further large-scale studies are required to clarify the effect of MeDi on prostate health, in order to establish the role of this diet in the prevention of PCa.