Risk as a pattern over time: Delineation of time-dependent risk factors in biological,psychological, and social variables in cancer patients

Background

Survival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time.

Methods

Patients who attended the authors’ outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model.

Results

The median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0–4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short-term, medium-term, and long-term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time-independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long-term.

Conclusions

The findings of this study allow the development of comprehensive patient-specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care.     

Emotional Reactivity,Emotion Regulation Capacity,and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation

Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma‐related stimuli. Participants were 81 trauma‐exposed refugees (probable PTSD, n = 23; trauma‐exposed controls, n = 58). The experiment comprised three 5‐min phases: a resting phase (baseline); an exposition phase, during which participants were exposed to trauma‐related images (stimulus); and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM‐5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma‐related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma‐related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict samples.     

Extensive cardiac infiltrative melanoma

We report an unusual clinical case of a 66‐year‐old patient with cardiac involvement from a metastatic melanoma, causing the formation of a large right atrial mass with extensive infiltration of the right atrial free wall, the interatrial septum, the coronary sinus, and up to the mitral annulus and posterior wall of the right ventricle, unamendable to complete surgical excision. As secondary cardiac tumors are not part of routine daily clinical practice, we thought that this clinical case would be a good educational opportunity for the practicing clinicians, both specialists and nonspecialists.     

Challenges for Research into Military Investigations

In cases of suspected violations of rules, regulations or the law by armed forces personnel, investigations are invariably mandatory. Military investigations differ from well-researched civilian criminal investigations. Differing from civilian police detectives, most military investigators – as disciplinary supervisors and military police personnel – have a number of tasks to accomplish, which include leading in combat and ensuring military readiness. Military investigations can lead to substantive negative or positive consequences for military readiness, including mental health, unit cohesion and subjective legal certainty. This impact on unit cohesion and mental health is influenced by any prior history of distress or trauma; military investigations are often preceded by contravention of internal disciplinary acts, complaints and traumatic events. This study explores factors in the differing military and legal systems of Germany and the United Kingdom (UK) that might help military personnel to successfully conduct investigations while ensuring deployment readiness and maintaining human rights.     

Loss of programmed cell death 10 activates tumor cells and leads to temozolomide-resistance in glioblastoma

Journal of Neuro-Oncology - Glioblastoma (GBM) is one of the most aggressive and incurable primary brain tumors. Identification of novel therapeutic targets is an urgent priority. Programmed cell...     

Das schwarze Knie – ochronotische Veränderungen im Rahmen einer Alkaptonurie

Die Unfallchirurgie - Der folgende Artikel präsentiert den Fall eines 53-jährigen Patienten, gebürtig in Sri Lanka, der sich zunächst mit dem Verdacht auf ein Kniegelenkempyem...     

German research perspectives on suicidality and the rationale for future multinational suicide prevention projects among military service personnel

Abstract

As a result of scientific publications indicating that the last two decades have seen an increase in the number of suicides in the US Armed Forces, the topic of suicide in the military of other countries, such as Germany, has also received a lot of attention in media and science alike. Risk factors for suicidal behaviour and suicide were identified in several research projects in the US, Canada, the UK, and Germany. Until now, German suicide research among military service personnel has mainly focused on epidemiological aspects of suicides and suicidality, individual risk factors, sub-groups at risk for suicide, suicides and deployment abroad, and associations of suicide and suicide attempts with acute mental disorders. The key findings are summarized in this review article. Efforts should be made to develop and evaluate risk group-focused and occupation-focused prevention and intervention programs. Future multinational studies should address potential differences between risk groups for fatal and non-fatal suicidal behaviour.     

Kinetic Investigations of Quaternization Reactions of Poly[2‐(dimethylamino)ethyl methacrylate] with Diverse Alkyl Halides

Kinetic investigations of the quaternization reactions of poly[2‐(dimethylamino)ethyl methacrylate] (PDMAEMA) with alkyl halides (1‐iodobutane, 1‐iodoheptane, and 1‐iododecane) are carried out at different temperatures. For this purpose, a PDMAEMA (M_n = 17.8 kDa, Ð = 1.35) synthesized via reversible addition fragmentation chain transfer polymerization is utilized. The progress of the quaternization reactions is followed by proton nuclear magnetic resonance. As expected, the rate of quaternization is higher with increasing temperature. The experimental data are used to determine the following kinetic parameters: order of the reaction, Arrhenius' pre‐exponential factor, and activation energy. To the best of knowledge, this is the first contribution that provides detailed kinetic data of the quaternization reactions on PDMAEMA.