Longitudinal quality of life in advanced cancer patients: pilot study results from a VA medical cancer center

To document quality-of-life (QOL), symptom distress and Karnofsky Performance Status (KPS) over time, 67 advanced cancer patients completed the Functional Assessment of Cancer Therapy (FACT-G) and Memorial Symptom Assessment Scale - Short Form (MSAS-SF) from the time of determination of no active anti-cancer treatment to death at 3-6 week intervals. The KPS was determined at each time point. Statistical analyses with mixed effects models were performed to examine the association between changes in QOL, symptom distress and KPS at selected time points in the advanced cancer trajectory. Median survival for the population was 115 days, and a median of 5 interviews was completed per patient. Slow steady changes in KPS, MSAS-SF and FACT-G QOL parameters started 6 months prior to death, with accelerated decline in the last 2 to 3 months and dramatic increase in psychological symptoms during the last month. Different domains changed at different rates at different selected time points. The correlation between changes in KPS, FACT-G parameters and MSAS-SF subscales at enrollment and near death suggests that when patients were stable, changes in KPS correlated significantly with changes in sum FACT-G QOL and physical well being, and with changes in the MSAS-SF subscales. However, when patients were near death, changes in KPS did not correlate with any other changes, and only emotional well being reflected changes in physical and psychological symptom distress. The sequence of changes, and how determinants of symptom distress and QOL change over time, may help clinicians assess the prognosis of terminally ill patients and plan appropriate interventions.     

Elevated Alkaline Phosphatase Prior to Transarterial Chemoembolization for Neuroendocrine Tumors Predicts Worse Outcomes

Introduction

We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases.

Methods

We reviewed all patients who underwent TACE for metastatic NET between 2009 and 2013. Survival was evaluated using preprocedure variables.

Results

One hundred and nine patients underwent 210 TACE procedures. The average age was 57.7 years (range 20–78). Primary sites included pancreas (N?=?20), other gastrointestinal (N?=?52), lung (N?=?9), and unknown (N?=?28). The tumor was grade 1 in 68 (62 %), grade 2 in 21 (19 %), and grade 3 in 3 (3 %). Extrahepatic disease was present in 54 (50 %) and greater than 50 % hepatic tumor burden by imaging in 63 (58 %). Elevated bilirubin occurred in 8 (7 %), elevated AP in 22 (20 %), elevated ALT in 21 (19 %), and elevated AST in 41 (38 %). Univariate predictors included tumor grade (43 vs 27 vs 21 months, p?=?0.015), hepatic tumor burden (59 vs 37 months, p?=?0.009), and elevated AP (59 vs 23 months, p?<?0.001). On multivariate analysis, only elevated AP (p?=?0.001) predicted worse survival.

Conclusions

Elevated AP prior to TACE for metastatic NET portends a worse survival outcome, even more so than tumor grade or extent of hepatic disease.

     

Induction of nitric oxide synthase and activation of signaling proteins in Anopheles mosquitoes by the malaria pigment, hemozoin

Anopheles stephensi, a major vector for malaria parasite transmission, responds to Plasmodium infection by synthesis of inflammatory levels of nitric oxide (NO), which can limit parasite development in the midgut. We have previously shown that Plasmodium falciparum glycosylphosphatidylinositols (PfGPIs) can induce A. stephensi NO synthase (AsNOS) expression in the midgut epithelium in vivo in a manner similar to the manner in which cytokines and NO are induced by PfGPIs in mammalian cells. In mosquito cells, signaling by PfGPIs and P. falciparum merozoites is mediated through Akt/protein kinase B (Akt/PKB), the mitogen-activated protein kinase kinase DSOR1, and extracellular signal-regulated kinase (ERK). In mammalian cells, a second parasite factor, malaria pigment or hemozoin (Hz), signals NOS induction through ERK- and nuclear factor kappa B-dependent pathways and has been demonstrated to be a novel proinflammatory ligand for Toll-like receptor 9. In this study, we demonstrate that Hz can also induce AsNOS gene expression in immortalized A. stephensi and Anopheles gambiae cell lines in vitro and in A. stephensi midgut tissue in vivo. In mosquito cells, Hz signaling is mediated through transforming growth factor beta-associated kinase 1, Akt/PKB, ERK, and atypical protein kinase C zeta/lambda. Our results show that Hz is a prominent parasite-derived signal for Anopheles and that signaling pathways activated by PfGPIs and Hz have both unique and shared components. Together with our previous findings, our data indicate that parasite signaling of innate immunity is conserved in mosquito and mammalian cells.     

Syringomatous adenoma of the nipple: report of a case

Syringomatous adenoma of the nipple is a rarely encountered neoplasm of the breast with histological features similar to eccrine syringoma of the skin. This tumour which is locally invasive with high potential for recurrence if incompletely excised is considered benign and a complete excision is sufficient. Hence it deserves recognition by pathologists and surgeons for appropriate management. We report a case of syringomatous adenoma of the nipple in a postmenopausal diabetic woman who was incidentally found to have a subareolar mass in her right breast. Clinical examination and mammographic findings indicated malignancy. Histopathological examination showed features of syringomatous adenoma of the nipple. A clinicopathological study and histological differential diagnosis of this unusual tumour is described.     

Relationships in early childhood education – beyond the professional into the personal within the teacher–child dyad: relationships ‘that ripple in the pond’

The dyadic nature of the teacher–child relationship is recognized as a significant factor in young children’s learning experiences. However understandings about how teachers’ own personal and professional identities and experiences influence their construction of teacher–child relationships are under researched. This article extends upon earlier research by exploring the concept of a networked dimension of teachers’ personal relationships and how they inform their perceptions of their relationships with children within a dynamic system. Through the interpretation of four teachers’ life history narratives and utilizing the lens of development systems theory, we present original insights regarding how they understand their personal and professional relationships with children. We illuminate how teachers’ lives are open, networked and overlapping in nature and that there are implications for teachers’ initial education and professional development.     

Patterns of lumbar region movement during trunk lateral bending in 2 subgroups of people with low back pain

BACKGROUND AND PURPOSE: The movement system impairment (MSI) system is one proposed system for classifying low back pain (LBP) problems. Prior clinical data and observations for the MSI system suggest that different LBP subgroups demonstrate different patterns of movement during clinical tests, such as trunk lateral bending (TLB). The purpose of this study, therefore, was to examine the validity of the observation that lumbar region (LR) movement patterns during TLB are different between 2 subgroups of people with LBP: lumbar rotation with extension (Rotation With Extension) and lumbar rotation (Rotation). SUBJECTS: Participants were 44 people (28 men and 16 women; age [X+/-SD], 28.5+/-8.4 years) with chronic or recurrent LBP. METHODS: Each participant's LBP problem was classified with the MSI system. Kinematic variables were measured, and LBP symptoms were recorded during the TLB test. RESULTS: People in the 2 LBP subgroups demonstrated different patterns of LR movement during TLB. People in the Rotation With Extension subgroup displayed an asymmetric (right versus left) pattern of LR movement across the TLB movement, whereas people in the Rotation subgroup displayed a symmetric pattern of LR movement. Equal proportions of people in the 2 subgroups reported an increase in symptoms with the TLB test. DISCUSSION AND CONCLUSION: The patterns of LR movement across the TLB movement were different in 2 subgroups of people with LBP. The difference in the LR movement patterns between subgroups may be an important factor to consider in specifying the details of the interventions for these 2 LBP problems.     

The role of dental hygienists, assistants, and office staff in CAMBRA

The role of the dental team in caries management by risk assessment is critical to successful patient outcomes. Positive patient interactions and communication, proper appointment scheduling, diagnostics and data gathering, as well as implementation of noninvasive or minimally invasive procedures can be the responsibility of all members of the dental team. This article will evaluate the role of the clinical and administrative staff in maintaining a practice with a focus on disease prevention and management..     

Assessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential home

The effects of yoga and ayurveda on geriatric depression were evaluated in 69 persons older than 60 who were living in a residential home. Participants were stratified by age and gender and randomly allocated to three groups: Yoga, Ayurveda, or Wait-list Control. The 15-item Geriatric Depression Scale was used to assess depressive symptoms prior to the intervention, and after 3 months and 6 months post-intervention. Participation in one of the three groups lasted 24 weeks. The yoga program (7 hours 30 minutes per week) included physical postures, relaxation techniques, regulated breathing, devotional songs, and lectures. The Ayurveda Group received an herbal preparation twice daily for the whole period. The depression symptom scores of the Yoga Group at both 3 and 6 months decreased significantly, from a group average baseline of 10.6 to 8.1 and 6.7, respectively (p < .001, paired t-test). The other groups showed no change. Hence, an integrated approach of yoga including the mental and philosophical aspects in addition to the physical practices was useful for institutionalized older persons.