Title Complex preoperative brain tumor imaging Abstract The differentiation of glioblastoma, metastases and brain lymphoma using modern diagnostic imaging methods has a major impact on the strategy of further diagnostic examinations and treatment. In a group of 67 patients with glioblastoma and 31 with cerebral metastasis, the ability to differentiate them according to the evaluation of perfusion parameters changes in peritumoral white matter by T1 dynamic post-contrast magnetic resonance imaging was verified, with the positive predictive value in glioblastoma detection up to 91%. In a group of 36 brain lymphoma patients the importance of imaging submodalities and contribution of a complex magnetic resonance imaging protocol to detect lymphoma up to 80% were evaluated. Key words brain, glioblastoma, lymphoma, magnetic resonance imaging, neoplasm metastasis

Bakgrund: Palliativ vård inleds när sjukdom inte är kurativ längre och fokus flyttas tillatt lindra lidande och främja patientens livskvalitet. Cancerrelaterad fatigue[CRF] är ett av de vanligaste symtomen vid cancerbehandling ochcancersjukdom och beskrivs som en oroande, ihållande, subjektiv känsla avtrötthet eller utmattning som inte står i proportion till den senaste tidensaktivitet och stör den vanliga funktionen. För att identifiera CRF beskrivskrävas en ordentlig anamnes, fysisk undersökning, uteslutning av andrabehandlingsbara faktorer och användning av mätverktyg valida förändamålet. I kompetensbeskrivningen för sjuksköterskan inom specialiseradpalliativ vård beskrivs att sjuksköterskan ska kunna uppmärksamma symtomhos patient som baseras på komplexa tillstånd och tidigt kunna identifiera,bedöma, planera och utföra evidensbaserad vård utifrån detta. Syfte: Patienters upplevelser av cancerrelaterad fatigue i ett palliativ skede. Metod: Litteraturöversikt över 13 kvalitativa och 4 kvantitativa artiklar somanalyserades med Whittemore & Knalfs integrativa metod. Resultat: I resultatet framkom det tre olika huvudkategorier som beskrev olikadimensioner av patientens upplevelse av CRF. Fysiska symtom och förlustav kontroll, psykisk och emotionell påverkan och patientens strategier för atthantera CRF. Slutsats: CRF är ett komplext symtom som kräver noggrann utredning. Om symtometinte identifieras kan ett onödigt lidande skapas för patienten. Användning avvalida mätverktyg för att identifiera CRF och skapa möjlighet för patientenatt få samtala och få information gällande CRF ses vara behov patienten harfrån sjuksköterskan, specialistsjuksköterskan och sjukvården. / Background: Palliative care is initiated when illness no longer is curative and the focus isshifted to alleviating suffering and promoting the patient’s quality of life. Cancer-related fatigue [CRF] is one of the most common symptoms of cancer treatment and cancer and is described as a disturbing, persistent, subjective feeling of fatigue or exhaustion that is disproportionate to recentactivity and disrupts normal function. Identifying CRF is described as requiring a thorough medical history, physical examination, exclusion of other treatable factors, and use of measurement tools valid for the purpose. Competence description for the palliative care nurse specialist describes the importance of placing focus on symptoms associated with complex conditions to help identify, assess, plan and perform evidencebased care.  Aim: Patients' experiences of cancer related fatigue in palliative care Method: Literature review of 13 qualitative and 4 quantitative articles analyzed with Whittemore & Knalfs integrative method.    Results: The results of this study revealed three main categories that describeddifferent dimensions of the patients’ experience of CRF. Physical symptoms and loss of control, mental and emotional experiences and the patient's strategies to manage their CRF.   Conclusion: CRF is a complex symptom that requires careful investigation. If the symptom is not identified, the patient can experience unnecessary suffering.The use of valid measurement tools is recommended to help identify CRF and give the patient opportunity to talk about and gain information about CRF from a nurse, specialist nurse or health care professional.

Bakgrund: Maligna hjärntumörer är aggressiva, med diverse omfattande symtom som beror på graden av malignitet samt tumörens placering. Patienter med malign hjärntumör upplever ofta kognitiva symtom, vilket hotar patientens autonomi och delaktighet i vården. Sjuksköterskor upplever ofta en rädsla kring att möta patientens behov. Sjuksköterskor har även uttryckt en brist på lämpliga verktyg när det gäller att vårda patienter med malign hjärntumör. Patienter beskriver att information de erhållit kring sjukdomen inte är tillräcklig. Syfte: Syftet var att belysa upplevelse av omvårdnad vid diagnostiserad primär malign hjärntumör utifrån sjuksköterske- och patientperspektivet. Metod: Studien genomfördes som en allmän litteraturstudie. Nio resultatartiklar valdes ut från två olika databaser. Resultatartiklarna granskades, bearbetades och sammanställdes till tre huvudkategorier. Resultat: Huvudkategorierna som framkom var: kommunikation mellan sjuksköterska och patient, behov av information och behov av stöd. Resultatet visade hur viktigt kommunikation och information är för både sjuksköterskan och patienten, samt att patienten var i behov av ett känslomässigt och andligt stöd. Konklusion: Ärlig information ger möjlighet till djupa samtal och stöd som rör sjukdomen och döden. Genom att belysa omvårdnaden vid primär malign hjärntumör från både patientens och sjuksköterskans perspektiv ökar kunskapen och möjligheterna till att bedriva personcentrerad omvårdnad. / Background: Malignant brain tumors are aggressive, with various comprehensive symptoms that depend on the degree of malignancy and the location of the tumor. Patients with malignant brain tumors often experience cognitive symptoms, which threaten the patient's autonomy and participation in the care. Nurses often experience a fear of meeting the patient's needs. Nurses have also expressed a lack of appropriate tools when it comes to caring for patients with malignant brain tumors. Patients describe that the information they received about the disease is not sufficient. Aim: The aim was to shed light on the experience of nursing care for diagnosed primary malignant brain tumor from the nurse and patient perspective. Method: The study was conducted as a general literature study. Nine result articles were chosen from two different databases. The resulting articles were reviewed, processed, and compiled into three main themes. Result: The main themes that emerged were communication between nurse and patient, need for information and need for support. The results showed how important communication and information were for the nurse and the patient and that the patient needed emotional and spiritual support. Conclusion: Honest information provides the opportunity for deep conversations and support regarding the illness and death. By highlighting the nursing care for primary malignant brain tumor from both the patient's and the nurse's perspective, the possibilities for person-centered nursing are increasing.

Background: Cancer is today one of the most common public health diseases and the cause of around 9 million deaths each year. Cancer does not only affect the patient with the diagnosis, but also familymembers of the patient due to the occurrence of imbalance within the family system that the diseaseleads to. Family caregivers are thus affected by this imbalance and often take a great deal of responsibility for the care of the cancer patient. Aim: To describe family caregivers’ experiences of giving care to a patient with cancer. Method: General literature review with 10 articles being analyzed using content analysis. Results: Tree main categories emerged. Duty and increased burden, worsening health and need forsupport & information. Results show that family caregivers of cancer patients experience a range of emotional burdens, as well as feelings of inadequacy when caring for a patient with cancer. Conclusion: Family caregivers’ experiences of support and burdens can differ among each other oraffect their quality of life differently. The experiences may vary depending on factors such as type of cancer and stage, support structures, healthcare availability and financial resources within a country. There’s a need for more research on family caregivers’ experiences in relation to differences in those areas. Research in these areas could extend a nurse’s awareness, thus contributing to improved treatment and care.

Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale- II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer. Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach‘s Alpha (a). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatmentrelated variables were examined with ANOVAs. Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with a = 0.93 for the DS-II total scale, a = 0.90 for the Meaning and Purpose subscale, and a = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60). Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24522号 / 医博第4964号 / 新制||医||1065(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 誠司, 教授 萩原 正敏, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

No / Dystroglycan is a ubiquitously expressed cell adhesion molecule frequently found to be altered or reduced in adenocarcinomas, however the mechanisms or consequences of dystroglycan loss have not been studied extensively. We examined the consequence of overexpression or RNAi depletion of dystroglycan on properties of in vitro growth migration and invasion of LNCaP, PC3, and DU145 prostate cancer cell lines. RESULTS: Using LNCaP cells we observed cell density-dependent changes in beta-dystroglycan with the appearance of several lower molecular weight species ranging in size from 43 to 26 kDa. The bands of 31 and 26 kDa were attributed to proteolysis, whereas bands between 43 and 38 kDa were a consequence of mis-glycosylation. The localization of beta-dystroglycan in LNCaP colonies in culture also varied, cells with a mesenchymal appearance at the periphery of the colony had more pronounced membrane localization of dystroglycan. Whereas some cells demonstrated nuclear dystroglycan. Increased dystroglycan levels were inhibitory to growth in soft agar but promoted Matrigel invasion, whereas reduced dystroglycan levels promoted growth in soft agar but inhibited invasion. Similar results were also obtained for PC3 and DU145 cells. This study suggests that changes in beta-dystroglycan distribution within the cell and/or the loss of dystroglycan during tumorigenesis, through a combination of proteolysis and altered glycosylation, leads to an increased ability to grow in an anchorage independent manner, however dystroglycan may need to be re-expressed for cell invasion and metastasis to occur.

This systematic review's goal is to evaluate the efficacy of vitamin D supplementation in helping to manage the nutritional needs of patients diagnosed with prostate cancer. A systematic literature search following the PRISMA guidelines using Scopus, PubMed, and Cochrane databases was conducted to review randomized controlled trials and interventional studies up to 2023. The search strategy targeted randomized controlled trials and intervention studies. The selection process involved screening for study characteristics (study design), participant demographics (prostate cancer patients receiving treatment), intervention details (vitamin D assessment methods, dosages), outcome measures (progression, prognosis, quality of life), and risk estimates (hazard ratios, odds ratios, relative risks) along with covariates adjusted for in the analysis. Data analysis and synthesis included studies assessing vitamin D supplementation's impact on prostate-specific antigen (PSA) levels, tumor progression, osteomalacia, overall survival rates, and quality of life assessments. The literature search yielded a total of 3575 documents. After a preliminary screening of titles and abstracts, 34 full-text studies were examined. In total, nine studies were determined to meet the inclusion criteria. The findings of nine studies suggest a modest but significant association between vitamin D supplementation, reduced PSA levels, slower progression of localized prostate cancer, and improved bone loss. Due to the various treatment options, the overall effects of supplementation on advanced prostate cancer and overall survival were inconclusive. However, this research highlights the potential role of vitamin D in prostate cancer management.

<p>Karcinomi pluća su najče&scaron;ći uzrok oboljevanja i umiranja od malignih tumora u Svetu. Neodjuvantna terapija kod bolesnika sa lokalno uznapredovalim (IIIA-IIIB) karcinomom pluća i zahvaćenim N2 limfnim čvorovima jedan je od modusa multimodalnog lečenja bolesnika sa nemikrocelularnim karcinomima pluća (NSCLC) u cilju pobolj&scaron;anja ishoda njihovog lečenja. Ovakav pristup podrazumeva prevođenje bolesnika iz vi&scaron;eg u niži stadijum bolesti - &bdquo;downstaging&rdquo;. Do danas nije utvrđena povezanost između pojedinih obrazaca tumorskog odgovora i vrste terapije. S obzirom na značaj kompletnog patolo&scaron;kog odgovora i tumorske regresije u prognozi ishoda lečenja, iznalaženje ove povezanosti je od značaja za dizajniranje budućih neoadjuvantnih trajala. Prilikom utvrđivnja histolo&scaron;ke slike tumorske regresije veoma je važno i merenje areje rezidualnog tumora (ART). Kako je veličina tumora jedan od prognostičkih faktora za bolesnike sa NSCLC koji nisu primali neoadjuvantnu terapiju tako je i merenje ART, za razliku od makroskopske veličine tumora, jedan od prognostičkih faktora za bolesnike sa NSCLC koji su primali neoadjuvantnu terapiju. Krajnji cilj neoadjuvantne terapije trebalo bi da bude resektabilnost i &bdquo;downstaging&rdquo; koji bi mogao da obezbedi u specifičnim kliničkim situacijama i sveukupni onkolo&scaron;ki benefit. Osnovni ciljevi ove doktorske disertacije su bili: da se objektivizira procena veličine ART u tumorskom tkivu pluća i limfnih čvorova; da se proceni povezanost povr&scaron;ine ART sa veličinom tumora na postoperativnom hirur&scaron;kom materijalu posle neoadjuvantne terapije; da se analizira i proceni povezanost histomorfolo&scaron;kih parametara kod tumorske regresije indukovane neoadjuvantnom terapijom i spontane tumorske regresije u tumorima pluća i limfnih čvorova na&nbsp; postoperativnom hirur&scaron;kom materijalu i u zavisnosti od histolo&scaron;kog tipa karcinoma; da se proceni povezanost kliničkog odgovora na neoadjuvantnu terapiju prema kriterijumima Svetske Zdravstvene Organizacije i histolo&scaron;kih parametara u tumorima pluća i limfnim čvorovima na postoperativnom hirur&scaron;kom materijalu nakon neoadjuvantne terapije; da se proceni povezanost patolo&scaron;kog ypTN sa kliničkim ycTN stadijumom bolesti i stepena tumorske regresije indukovane neoadjuvantnom terapijom i patolo&scaron;kog ypTN i da se proceni povezanosti između kliničke i patolo&scaron;ke zahvaćenosti N2 limfnih čvorova posle neoadjuvantne terapije. Merenje ukupne veličine očuvanih ART je najznačajniji objektivni parametar u proceni stepena tumorske regresije. Veličina rezidualnog tumora nije u korelaciji sa veličinom tumora posle neoadjuvantne terapije. Postoji signifikantna razlika u patohistolo&scaron;koj slici tumorske regresije indukovane neoadjuvantnom terapijom i spontane tumorske regresije. Ne postoji signifikantna razlika između histolo&scaron;kog tipa tumora i histolo&scaron;ke slike tumorske regresije. Ne postoji signifikantna povezanost između kliničkog odgovora i stepena tumorske regresije nakon neoadjuvantne terapije. Ne postoji korelacija između kliničkog i patolo&scaron;kog stadijuma bolesti posle neoadjuvantne terapije. Ne postoji korelacija između stepena tumorske regresije indukovane neoadjuvantnom terapijom i ypTN stadijuma bolesti. Ne postoji korelacija između kliničke i patolo&scaron;ke zahvaćenosti N2 limfnih čvorova posle neoadjuvantne terapije. Stepen regresije tumora i merenje ART posle neoadjuvantne terapije određen histopatolo&scaron;kom analizom reseciranog tumora je najobjektivniji kriterijum za procenu hemioterapijskog odgovora i predviđanja ishoda lečenja pacijenata.</p> / <p>Lung cancers are the most common cause of morbidity and mortality from malignant tumors in the World. The neodjuvant therapy in patients with locally advanced (IIIA-IIIB) lung cancer and affected N2 lymph nodes is one of the modes of multimodal treatment of patients with non-small cell lung cancer (NSCLC) in order to improve the outcome of their treatment. This involves converting patients from a higher to a lower stage of the disease - &quot;downstaging&quot;. There has been no significant connection between some forms of tumor response and types of therapy. Given the importance of complete pathological responses and tumor regression in the prediction of treatment outcomes, finding this relationship is of importance for the design of future neoadjuvant trails. In determining the histological tumor regression is very important measurement of area of residual tumor (ART). As the size of the tumor is one of the prognostic factors in patients with NSCLC who did not receive neoadjuvant therapy so the measurement of ART, as opposed to the macroscopic size of the tumor, one of the prognostic factors in patients with NSCLC, who had received neoadjuvant therapy. The ultimate goal of neoadjuvant therapy should be resectability and &quot;downstaging&quot; that could provide overall oncology benefit in specific clinical situations. The main objectives of this thesis were: to objectively estimate the size of ART in tumor tissue of lung and lymph nodes; to estimate the relation between the surface of ART with the size of the tumor on postoperative surgical material after neoadjuvant therapy; to analyze and estimate the relation between histomorphological parameters in tumor regression induced by neoadjuvant therapy and spontaneous tumor regression in tumors of the lung and lymph nodes in the postoperative surgical material and depending on the histological type of cancer; to estimate the relation between clinical response to neoadjuvant therapy according to criteria of the World Health Organization and histological parameters in lung tumors and lymph nodes in the postoperative surgical material after neoadjuvant therapy; to estimate the correlation of the pathological ypTN with clinical ycTN stage of the disease and the degree of tumor&nbsp; regression induced by neoadjuvant therapy and pathological ypTN and estimation of the relation between clinical and pathological involvement of N2 lymph nodes after neoadjuvant therapy. Measurement of the total size of the preserved ART is the most important objective parameter in the assessment of the grade of tumor regression. Size of residual tumor did not correlate with the size of the tumor after neoadjuvant therapy. There was a significant difference in the histological picture of tumor regression induced by neoadjuvant therapy and spontaneous tumor regression. There was no significant difference between the histologic type of tumor and histological tumor regression. There is no significant correlation between clinical response and the grade of tumor regression after neoadjuvant therapy. There is no correlation between clinical and pathological staging of the disease after neoadjuvant therapy. There is no correlation between the grade of tumor regression induced by neoadjuvant therapy and ypTN stage of the disease. There is no correlation between the clinical and the pathological involvement of the N2 lymph nodes to neoadjuvant therapy. The grade of tumor regression and measurement ART after neoadjuvant therapy determined by histopathological analysis of the resected tumor is the most objective criterion for evaluation of chemotherapeutic response and prediction of treatment outcome in patients.</p>