The palmitoyl pentapeptide palmitoyl-lysine-threonine-threonine-lysine-serine (pal-KTTKS) is a synthetic material that was designed as a topical agent to stimulate collagen production and thus provide a skin anti-wrinkle benefit. To determine if pal-KTTKS is effective, the clinical study reported here was conducted. Caucasian female subjects (n = 93, aged 35-55) participated in a 12-week, double-blind, placebo-controlled, split-face, left-right randomized clinical study assessing two topical products: moisturizer control product vs. the same moisturizer product containing 3 ppm pal-KTTKS. Pal-KTTKS was well tolerated by the skin and provided significant improvement vs. placebo control for reduction in wrinkles/fine lines by both quantitative technical and expert grader image analysis. In self-assessments, subjects also reported significant fine line/wrinkle improvements and noted directional effects for other facial improvement parameters.

Background Tobacco use is a risk factor for head and neck cancer, but effects on postoperative outcomes are unclear. Methods Head and neck cancer patients (N=89) were recruited before surgery. We assessed self-reported tobacco use status (never, former current) at study entry and recent tobacco exposure via urinary cotinine on surgery day. Outcomes included length of hospital stay (LOS) and complications. Results Most participants reported current (32.6%) or former (52.8%) tobacco use; 43.2% were cotinine positive on surgery day. Complications occurred in 41.6%; mean LOS was 4.0 and 8.8 days in patients who received low and high acuity procedures, respectively. Current and former smokers were over six times more likely to have complications than never smokers (p=.03). For high acuity procedures, LOS was increased in current (by 4.4 days) and former smokers (by 2.3 days, p=0.02). Conclusions Tobacco use status is associated with postoperative complications and may distinguish at risk patients.

Purpose To estimate the hazard for neurologic (central nervous system, CNS) and nonneurologic (non-CNS) death associated with patient, treatment, and systemic disease status in patients receiving stereotactic radiosurgery after whole-brain radiation therapy (WBRT) failure, using a competing risk model. Patients and Methods Of 757 patients, 293 experienced recurrence or new metastasis following WBRT. Univariate Cox proportional hazards regression identified covariates for consideration in the multivariate model. Competing risks multivariable regression was performed to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for both CNS and non-CNS death after adjusting for patient, disease, and treatment factors. The resultant model was converted into an online calculator for ease of clinical use. Results The cumulative incidence of CNS and non-CNS death at 6 and 12 months was 20.6% and 21.6%, and 34.4% and 35%, respectively. Patients with melanoma histology (relative to breast) (aHR 2.7, 95% CI 1.5–5.0), brainstem location (aHR 2.1, 95% CI 1.3–3.5), and number of metastases (aHR 1.09, 95% CI 1.04–1.2) had increased aHR for CNS death. Progressive systemic disease (aHR 0.55, 95% CI 0.4–0.8) and increasing lowest margin dose (aHR 0.97, 95% CI 0.9–0.99) were protective against CNS death. Patients competing risk of death from other causes. with lung histology (aHR 1.3, 95% CI 1.1–1.9) and progressive systemic disease (aHR 2.14, 95% CI 1.5–3.0) had increased aHR for non-CNS death. Conclusion Our nomogram provides individual estimates of neurologic death after salvage stereotactic radiosurgery for patients who have failed prior WBRT, based on histology, neuroanatomical location, age, lowest margin dose, and number of metastases after adjusting for their competing risk of death from other causes.

Purpose This study examined progression and improvement of physical functioning limitations during the mid-life, and whether race/ethnicity, economic strain, or body mass index were associated with these changes. Methods Women from the Study of Women’s Health Across the Nation with ≥1 measure of self-reported physical functioning, categorized as no, some, or substantial limitations, between study visit 4 and 12 were included (n=2497). Results When women were aged 56–66, almost 50% reported limitations in functioning. African American women were more likely to report substantial (OR=1.63; 95% CI: 1.06,2.52) and Chinese women were more likely to report some limitations (OR=2.03; 95% CI: 1.22,3.36) compared to Caucasian women. Economic strain and obesity predicted limitations. The probability of worsening ranged from 6 to 22% and of improving ranged from 11% to 30%. Caucasian and Japanese women had the highest probability of remaining fully functional (80% and 84%, respectively) compared to 71% of African American women. Conclusions Race/ethnicity, obesity, and economic strain were associated with prevalence and onset of physical functioning limitations. Functional improvement is common, even among vulnerable subgroups of women. Future studies should characterize predictors of decline and improvement so that interventions can sustain functioning even in the context of many known immutable risk factors.

The role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) procedures in the management of patients with gastrointestinal stromal tumor (GIST)-induced sarcomatosis that is refractory to tyrosine kinase inhibitors (TKI) is not well defined. A retrospective analysis of a prospective database of 1070 CRS/HIPEC procedures was performed. Demographics, Eastern Cooperative Oncology Group performance status, resection status, morbidity, mortality, perioperative use of targeted therapies, and overall survival were analyzed. Since 1992, 18 CRS/ HIPEC procedures were performed for peritoneal dissemination of GIST. Fifty per cent of these cases were performed before the introduction of TKIs. R0/1 resection was achieved in 72 per cent, whereas 63 per cent of patients were treated with neoadjuvant and/or adjuvant targeted therapy. Thirty-day morbidity and mortality were 33.3 and 5.6 per cent, respectively. Median overall survival after CRS/HIPEC was 3.33 years with 3-year survival of 56 per cent. Median survival in those who did not receive targeted therapy was 1.04 versus 7.9 years for those treated with TKI and cytoreduction. Median postsurgical survival for those treated preoperatively with progression on TKI treatment was 1.35 years versus not reached in those on TKI therapy without progression. Primary therapy for patients with disseminated GIST should be TKI therapy. However, in patients with sarcomatosis from GIST, cytoreduction should be considered before developing TKI resistance. Progression on TKI is associated with poor outcomes even after complete cytoreduction.