Citations

Purpose The sixth edition of American Joint Committee on Cancer (AJCC) Cancer Staging Manual for colon cancer subdivided stage II into IIA (T3N0) and IIB (T4N0) and stage III into IIIA (T1-2N1M0), IIIB (T3-4N1M0), and IIIC (anyTN2M0). Subsequent analyses supported revised substaging of stage III because of improved survival for T1-2N2 versus T3-4N2 and T4N1 survival was more similar to T3-4N2 than to T3N1. The AJCC Hindgut Taskforce sought population-based validation that depth of invasion and nodal status interact to affect survival. Patients and Methods Surveillance, Epidemiology, and End Results (SEER) population-based data from January 1992 to December 2004 for 109,953 colon cancer patients were compared with National Cancer Data Base (NCDB) data on 134,206 patients. T4N0 cancers were stratified by tumors that perforate visceral peritoneum (T4a) versus tumors that invade or are adherent to adjacent organs or structures (T4b). N1 and N2 were stratified by number of involved positive lymph nodes (N+): N1a/N1b (1 v 2-3), N2a/N2b (4 to 6 v ≥ 7). Five-year observed and relative survival data were obtained for each TN category. Results SEER colon cancer analyses confirm that patients with T1-2N0 cancers have better survival than T3N0, T3N0 better than T4N0, T1-2N2 better than T3-4N2, and T4bN1 similar to T4N2. Patients with T4a lesions have better survival than T4b by N category. The number of positive nodes affects survival for each T category. Conclusion This SEER population-based colon cancer analysis is highly consistent with rectal cancer pooled analysis and SEER rectal cancer analyses, supporting the shift of T1-2N2 lesions from IIIC to IIIA/IIIB, shifting T4bN1 from IIIB to IIIC, subdividing T4/N1/N2, and revising substaging of stages II/III. Survival outcomes by TN category for colon and rectal cancer are strikingly similar.

OBJECTIVE. In this study, we investigated the accuracy of measuring walking steps with commercially available pedometers and an accelerometer-based step-counter in normal and overweight children. Our primary hypothesis was that commercially available pedometers are not an accurate measure of walking steps in normal and overweight children while walking. Our secondary hypothesis was that the accelerometer-based step-counter provides an accurate measure of walking steps in normal and overweight children. METHODS. Thirteen boys (11 ± 1 years) and 14 girls (11 ± 1 years) who ranged in BMI from 15 to 27 kg/m2 (16 normal and 11 overweight or obese) were recruited. Each child wore 4 pedometers at the waist and 1 accelerometer-based step-counter on each ankle. Steps were manually counted and energy expenditure was measured while the child walked on the treadmill at 0.5, 1.0, 1.5, and 2.0 mph, each for 5 minutes. The step-counting devices were also validated while children walked on level ground at a self-selected pace. RESULTS. For the commercially available pedometers at the lowest speed of 0.5 mph, the percentage error approximated 100% for both of the pedometers. At the fastest speed of 2.0 mph, the percentage error approximated 60%. Conversely the accelerometer-based step-counter showed a percentage error of 24% ± 22% (mean ± SD) at 0.5 mph; however, as walking speed increased, the error declined to 5% ± 8% at 1.0 mph, 4% ± 5% at 1.5 mph, and 2% ± 2% at 2.0 mph. The relationship between steps counted and walking energy expenditure showed good linear correlation. CONCLUSIONS. Commercially available pedometers are less accurate for measuring walking and require discretion in their use for children. The accuracy of the accelerometer-based step-counter enables it to be used as a tool to assess and potentially promote physical activity in normal and overweight children.

Abstract Microsatellite instability (MSI) occurs in 10% to 20% of colorectal cancers (CRC) and has been attributed to both MLH1 promoter hypermethylation and germline mutation in the mismatch repair (MMR) genes. We present results from a large population- and clinic-based study of MLH1 methylation, immunohistochemistry, and MMR germline mutations that enabled us to (a) estimate the prevalence of MMR germline mutations and MLH1 methylation among MSI-H cases and help us understand if all MSI-H CRC is explained by these mechanisms and (b) estimate the associations between MLH1 methylation and sex, age, and tumor location within the colon. MLH1 methylation was measured in 1,061 population-based and 172 clinic-based cases of CRC. Overall, we observed MLH1 methylation in 60% of population-based MSI-H cases and in 13% of clinic-based MSI-H cases. Within the population-based cases with MMR mutation screening and conclusive immunohistochemistry results, we identified a molecular event in MMR in 91% of MSI-H cases: 54% had MLH1 methylation, 14% had a germline mutation in a MMR gene, and 23% had immunohistochemistry evidence for loss of a MMR protein. We observed a striking age difference, with the prevalence of a MMR germline mutation more than 4-fold lower and the prevalence of MLH1 methylation more than 4-fold higher in cases diagnosed after the age of 50 years than in cases diagnosed before that age. We also determined that female sex is an independent predictor of MLH1 methylation within the MSI-H subgroup. These results reinforce the importance of distinguishing between the underlying causes of MSI in studies of etiology and prognosis. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3208–15)

The devastating impact of obesity on global health is without question and it is generally agreed that low levels of physical activity, particularly sitting (i.e., sedentariness), are important in its pathogenesis. Therefore, the measure of physical activity such as walking is vital to its use in the research and clinical milieu. This study investigated three accelerometry parameters (sampling rate, range, and data depth) on ten healthy subjects (BMI 18–31 kg/m 2 ) walking on a calibrated treadmill at eight speeds (0, 0.95, 1.74, 2.48, 3.22, 4.04, 4.83, and 5.70 km/h) while wearing a three-axis accelerometer on the thigh (Crossbow Technology, San Jose, CA) in order to find an optimal system for the determination of walking speed, as well as a new data analysis strategy using a differentiation of the acceleration values (jerk). Twenty-four sampling rates (2–25 Hz in 1-Hz intervals) and seven acceleration ranges (± 1 g – ± 2.5 g at 0.25- g intervals) were used to create a 24 × 7 factorial design. Data was also truncated from two to seven digits in the mantissa. This study found that although there is an improvement in walking speed prediction when sampling rate was set above 4 Hz ( P<0.0002), there was no further improvement when the sampling rate is set higher. This study found that there is an increase in walking speed prediction accuracy when the range of acceleration is limited to ± 1 g ( P<0.0024 for ± 2 g versus ± 1 g). This study found that increasing or decreasing data depth has no impact on walking speed prediction accuracy. Further, this study found that a model based on jerk was accurate at predicting walking speeds ( r 2 0.9 for all comparisons). For measuring walking using a sensor on the thigh, there is no significant improvement gained by large sampling rates, data ranges, or data precision. A model based on the time rate of change of acceleration is a valid analysis tool for measuring walking.

ObjectiveTo identify the presentation of pediatric patients with head and neck manifestations of cat‐scratch disease, one of the most common causes of subacute or chronic lymphadenitis in children, and to determine surgical indications and outcomes.Study DesignCase series.Subjects and MethodsAll pediatric patients from infancy to age 19 years who presented with clinical symptoms of cat‐scratch disease and had an IgG serological test result of more than 1:128 for Bartonella henselae.ResultsNine patients had cat‐scratch disease of the head and neck. Median age at presentation was 4 years; median time from symptom onset to presentation was 20 days. Six (67%) children underwent surgical procedures, and median time from presentation to surgical procedure was 43 days.ConclusionDespite conservative treatment, a minority of pediatric patients with cat‐scratch disease may require surgical drainage of abscess and removal of lymph nodes. Surgical treatment provides tissue for diagnosis, is generally well tolerated, affords improved recovery, and has minimal complications. © 2008 American Academy of Otolaryngology‐Head and Neck Surgery Foundation. All rights reserved.

This article describes research that aims to encourage physical activity through a novel pervasive gaming paradigm. Data from a wearable accelerometer are logged wirelessly to a cell phone and control the animation of an avatar that represents the player in a virtual race game with other players over the cellular network. Winners are declared every day and players with an excess of activity points can spend some to get hints in mental games of the suite, like Sudoku. The racing game runs in the background throughout the day and every little move counts. As the gaming platform is embedded in the daily routine of players, it may act as a strong behavioral modifier and increase everyday physical activity other than volitional sporting exercise. Such physical activity (e.g., taking the stairs), is termed NEAT and was shown to play a major role in obesity prevention and intervention. A pilot experiment demonstrates that players are engaged in NEAT-o-Games and become more physically active while having a good dosage of fun.

AbstractImatinib mesylate (IM, Gleevec) has largely supplanted allogeneic hematopoietic cell transplantation (HCT) as first line therapy for chronic myeloid leukemia (CML). Nevertheless, many people with CML eventually undergo HCT, raising the question of whether prior IM therapy impacts HCT success. Data from the Center for International Blood and Marrow Transplant Research on 409 subjects treated with IM before HCT (IM+) and 900 subjects who did not receive IM before HCT (IM−) were analyzed. Among patients in first chronic phase, IM therapy before HCT was associated with better survival but no statistically significant differences in treatment-related mortality, relapse, and leukemia-free survival. Better HLA-matched donors, use of bone marrow, and transplantation within one year of diagnosis were also associated with better survival. A matched-pairs analysis was performed and confirmed a higher survival rate among first chronic phase patients receiving IM. Among patients transplanted with advanced CML, use of IM before HCT was not associated with treatment-related mortality, relapse, leukemia-free survival, or survival. Acute graft-versus-host disease rates were similar between IM+ and IM− groups regardless of leukemia phase. These results should be reassuring to patients receiving IM before HCT.