Active Surveillance (AS) for the clinical management of prostate cancer (PC) is a treatment option for men with low-risk PC. Screening procedures have led to the overdetection of PCs that would have never caused problems. Active treatment (e.g., surgery or radiation) for these non-aggressive tumors may not be necessary given the slow-growing nature of PC. AS provides a way to monitor the disease and delay treatment-related compromises on quality of life until clinically indicated (e.g., rising PSA level). However, the intensive monitoring in AS may be a stressful experience and lead to greater anxiety, an emotional state that has been associated with undergoing active treatment despite physician recommendation for AS. The current study aimed to identify psychosocial correlates of anxiety in men undergoing AS. Using Mishel’s Reconceptualized Uncertainty in Illness Model as a framework, the proposed study aimed to examine the relationships between perceived stress management skills, PC psychosocial concerns, and anxiety/arousal. Hierarchical multiple regression analyses were conducted on a sample of 71 men undergoing AS, who were on average 65.40 years old (SD=7.85) and ethnically diverse (52% non-Hispanic White; 31% Hispanic; 17% African American). Results indicated that greater PSMS were significantly associated with less IES-R anxiety (β=-.28, p<.04). PSMS were not significantly associated with PC concerns (β=-.02, p>.05), but greater PC concerns were significantly associated with greater IES-R anxiety (β=.61, p<.01) and PSA anxiety (β=.42, p<.01). These associations held after controlling for relevant covariates. The results suggest a possible role for stress management skills as perceived ability to manage stress was related to less anxiety in the AS experience. Future studies should examine the relationship among these factors in longitudinal designs and whether greater stress is associated with unnecessary active treatment in low-risk PC.

No description available.

No description available.

303 gesunde, deutsche Freiwillige, die in 53 verschiedene Länder (meist nach Asien, Afrika und Südamerika) reisten, wurden in eine prospektive Kohortenstudie aufgenommen. Stuhlproben und Daten über potenzielle reiseassoziierte Risikofaktoren (wie Reisestil, Essgewohnheiten, Auftreten von Gastroenteritis, Hygienemaßnahmen) wurden vor und nach der Reise mittels Fragebogen gesammelt. Mittels Selektivmedien (CHROMagar™ ESBL/KPC-Platten) wurden eine Untersuchung der Stuhlproben auf extended-spectrum beta-lactamase bildende Enterobacteriaceae (ESBL-PE) und Carbapenemase bildende Enterobacteriaceae (CPE) durchgeführt. Isolate mit bestätigtem ESBL-Phänotyp wurden auf das Vorhandensein von blaCTX-M-, blaTEM-, blaSHV-, blaVIM-, blaNDM-, blaKPC- und blaOXA-48-Genen mit Hilfe von PCR-Amplifikation und -Sequenzierung getestet. Bei den Antibiotikaempfindlichkeitstests wurde mit konventioneller Mikrobouillonverdünnung gearbeitet. Die Auswertung von 205 kompletten Teilnahmen zeigte vor Reiseantritt eine ESBL-PE Prävalenzrate von 6,8% (14/205). Unter den 191 Teilnehmern, die vor der Reise ESBL-negativ getestet wurden, waren nach Reiserückkehr 58 (30,4%) mit ESBL-bildenden Escherichia coli kolonisiert und 5 Reisende (8,6%) waren zusätzlich mit ESBL-produzierenden Klebsiella pneumoniae besiedelt. Carbapenem-resistente Enterobacteriaceae wurden nicht nachgewiesen. Die molekulargenetische ESBL-Typisierung zeigte, dass 52/54 (96,6%) der E. coli und 4/4 (100%) der K. pneumoniae-Stämme, die für die Sequenzierung verfügbar waren, CTX-M-Enzyme produzierten, und zwar überwiegend CTX-M-15 (33/56, 58,9%), und 2/54 (3,7%) der E. coli-Stämme SHV-12-Enzyme bildeten. Die Reisenden nach Indien wiesen die höchste Kolonisationsrate mit ESBL-PE (11/15, 73,3%: p=0.015) auf, gefolgt von Reisenden nach Südostasien (22/46, 47,8%; p=0.038). Die Auswertung der reiseassoziierten Risikofaktoren ergab allein für das Auftreten einer Gastroenteritis eine statistische Signifikanz (p=0.011). Strikte Händehygiene und ausschließliches Konsumieren abgepackter Getränke zeigten keinen protektiven Effekt. Die ESBL-PE-Persistenzrate nach 6 Monaten lag bei 8,6% (3/35). Daraus schlossen wir, dass weltweite Anstrengungen notwendig sind, um die weitere Ausbreitung von ESBL-PE in der Bevölkerung anzugehen. Eine aktive Überwachung und Kontaktisolation ist bei Aufnahme in eine medizinische Einrichtung speziell für Patienten, die innerhalb der letzten 6 Monate nach Indien und Südostasien gereist waren, empfehlenswert.

<p>Enzootska leukoza goveda je maligna virusna neoplazma retikulohistiocitarnog sistema&nbsp;progresivnog karaktera, koja se karakteri&scaron;e intenzivnim razmnožavanjem limfocita. Ova&nbsp;bolest govedarstvu nanosi velike materijalne &scaron;tete dovodeći do visokog nivoa mortaliteta,&nbsp;pojave učestalijih oportunističkih infekcija, smanjenja produktivnosti i reprodukcije na&nbsp;leukoznim farmama. Imajući u vidu, da govedarstvo predstavlja strate&scaron;ku granu u stočarstvu&nbsp;Srbije i učestvuje u stvaranju znatnog dela nacionalnog dohotka od 1999. godine,&nbsp;preduzimana su sistematska dijagnostička ispitivanja ra&scaron;irenosti ELG na farmama goveda&nbsp;kako u intenzivnoj tako i od 2000. godine i u ekstenzivnoj proizvodnji goveda. Kori&scaron;ćene su&nbsp;savremene metode dijagnostike ELG najpre agargel-imunodifuzioni test (AGID), a potom i&nbsp;indirektna imunoenzimska metoda (ELISA) kao dijagnostički test izbora. Na osnovu&nbsp;dobijenih epizootiolo&scaron;kih podataka sprovo&ntilde;ene su mere za suzbijanje i iskorenjivanje EGL na<br />farmama goveda. U zavisnosti od tehnolo&scaron;kog procesa proizvodnje, kao i od ekonomskih&nbsp;mogućnosti farmi sprovo&ntilde;eni su različiti modeli kontrole i eradikacije.<br />ELG predstavlja veoma ozbiljan zdravstveni i ekonomski problem za govedarsku<br />proizvodnju posebno za zapate mlečnih goveda, a po&scaron;to se i pored sprovo&ntilde;enja mera za&nbsp;eradikaciju, leukoza jo&scaron; uvek zadržala u nekim na&scaron;im stadima i zapatima goveda smatrali smo&nbsp;da bi trebalo preispitati dosada&scaron;nju strategiju kontrole ELG.<br />Razmatrane su pote&scaron;koće u sprovo&ntilde;enju mera za suzbijanje i iskorenjivanje leukoze goveda&nbsp;kao i potreba za izučavanjem epizootiologije, odnosno kontrole kretanja leukoze u&nbsp;trakozvanim leukoznim zapatima koji predstavljaju potencijalne izvore &scaron;irenja leukoze.&nbsp;Imajući u vidu navedeno, cilj ovog ispitivanja je bio ustanoviti stepen ra&scaron;irenosti ELG i&nbsp;ispitaju do sada kori&scaron;ćeni programi kontrole i eradikacije oboljenja. Zadaci ovog istraživanja&nbsp;su bili da se ispitaju pogodnosti pojedinih dijagnostičkih metoda u cilju postavljanja rane&nbsp;dijagnoze oboljenja, istražiti incidenciju i prevalenciju bolesti, proceniti značaj pojedinih&nbsp;puteva preno&scaron;enja u okviru farmi i u regionu, izvr&scaron;iti analizu dosada&scaron;njih rezultata borbe i&nbsp;evaluaciju pojedinih modela, predložiti najpogodnije modele kontrole bolesti u cilju potpune&nbsp;eradikacije bolesti, a tako&ntilde;e razviti i adekvatan model nadzora bolesti kako bi se sprečila&nbsp;njena ponovna pojava i &scaron;irenje. Rezultati serolo&scaron;kih ispitivanja pokazuju da je otkriveno 10.181 pozitivnih životinja, odnosno 8,1% posto životinja u zapatima goveda na velikim farmama. Epizootiolo&scaron;ka situacija na farmama goveda individualnog sektora zahtevala je posebnu pažnju i tu je ispitano 281.369 uzoraka krvi goveda i otkriveno je 567 pozitivnih grla ili 0,4% posto na području 12 op&scaron;tina. Rezultati seroprevalencije predstavljali su ključnu informaciju od značaja za izbor modela kotrole ELG. Odnosno istraživanje efikasnosti pojedinih modela u postizanju rezultata i&nbsp;zadatih ciljeva. Značajnih za izradu komparativne analize kori&scaron;ćenih modela, njihove primene i evaluacije. Epizotiolo&scaron;ki modeli su analizirani, izvr&scaron;ena je njihova evaluacija i preporuka za primenu u epizootiolo&scaron;koj praksi.&nbsp;</p> / <p>Enzootic bovine leucosis is viral malignant neoplasm reticulohistiocytic system and has&nbsp;progressive character, which is characterized by intensive multiplication of lymphocytes.&nbsp;This disease is causing a great material damage to cattle farming, leading to high level of&nbsp;mortality, with the emergence of more frequent infections and a reduction in productivity&nbsp;and reproduction in farms in which the leukosis appeared. Having in mind that the cattle&nbsp;farming is a strategic branch of the Serbian livestock and participates in the creation of a&nbsp;significant part of the national income since 1999, systematic diagnostic tests of the&nbsp;prevalence of EBL were undertaken on cattle farms, both in the intensive cattle production&nbsp;and from 2000 extensive production. Modern diagnostics methods of EBL were used,&nbsp;firstly the agargel-immunodiffusion test (AGID), followed by an indirect enzyme&nbsp;immunoassay method (ELISA) as well as a diagnostic test of choice. Based on the&nbsp;obtained epizootic data, the measures for the control and eradication of EBL were carried&nbsp;out on cattle farms. Depending on the technological process of production, as well as the&nbsp;economic farm opportunities, different models of control and eradication were&nbsp;implemented.<br />EBL is a very serious health and economic problem for cattle farming, especially for<br />dairy cattle herds, and despite the implementation of the measures for the eradication of&nbsp;the disease, leucosis is still held in some of our flocks and herds of cattle. Because of that&nbsp;we thought that the current control strategy EBL should be examined.<br />The difficulties in implementing measures to suppress and eradicate bovine leukosis were&nbsp;discuses and the requirement to study the epizootiology , as well as to control the&nbsp;movement of leukosis in so-called leukostic herds, that represent potential source of&nbsp;spreading the leukosis.<br />Taking into account, the purpose of this study was to establish the degree of<br />prevalence of EBL to examine the programs that were used so far to control and eradicate&nbsp;the diseases. The task of this study was to examine the benefits of specific diagnostic methods in order to establish early diagnosis of the diseases, to see into the incidence and prevalence of the leukosis, to estimate the significance of some routes of transmission within the farm and in the region, and to carry out an analysis of recent results in fighting and evaluation of individual models, to suggest the most appropriate models of disease control in order to complete the eradication of leukosis, but also to develop an adequate model of disease control to prevent its re-emergence and spread. The results of serological tests indicate that 10.181 the positive animals were detected, or 8.1 % percent of the animals in cattle herds in large farms. Epizootiological situation in the cattle farms of individual sectors required special attention and 281.369 blood samples of cattle were examined and the 567 positive cases were discovered, or 0.4 % percent in&nbsp;12 communities. Results of seroprevalence were a key information for the choice of models to control ELG, or to investigate the efficiency of some models to achieve results and goals, and important for the production of comparative analysis of models that were used, their implementation and evaluation. Epizootic models were analyzed, their evaluation was made and recommendations for their implementation in the epizootic practice.&nbsp;</p>

Varje år diagnostiseras 10 000 män med sjukdomen prostatacancer i Sverige. Att drabbas av sjukdomen prostatacancer är emotionellt ansträngande. Väntetiden vad gäller behandling för patienter med prostatacancer är lång. Detta gör att patienter med prostatacancer lever med sjukdomen prostata-cancer och känslorna kopplade till diagnosen prostatacancer under en lång tid. Syftet med den aktuella studien var att beskriva copingprocessen för patienter med prostatacancer innan medicinsk behandling. Metoden som använts till studien var en litteraturstudie baserad på 15 vetenskapliga artiklar. Resultatet visade att den kognitiva bedömningen av sjukdomen prostatacancer präglades av den information som patienter med prostata-cancer fick. Den kognitiva bedömningen av sjukdomen prostatacancer påverkades också av ålder och tid efter diagnos. Copingresurser som hade betydelse för patienter med prostatacancer var socialt stöd, personlighet och psykisk hälsa. De copingstrategier som användes av patienter med prostatacancer var främst emotionellt fokuserade. Patienter med prostatacancer är under stor emotionell belastning. Information och socialt stöd från vårdpersonal hjälper patienter med prostatacancer att hantera den emotionella belastningen. Ytterligare forskning krävs för att identifiera effektiva copingstrategier i ett tidigt stadium av diagnosen prostatacancer. / Every year 10 000 men are diagnosed with prostate cancer in Sweden. Affection of the disease is emotionally strenuous. The wait for treatment among patients diagnosed for prostate cancer is long. This result in patients diagnosed with prostate cancer living with the disease and the emotions associated with the diagnosis of prostate cancer for an extended time. The aim of the current study was to describe the coping process used by patients diagnosed with prostate cancer prior to treatment. The method of the current study was a literature study based on 15 scientific articles. The results indicated that appraisal of prostate cancer was influenced by the information that patients diagnosed with prostate cancer received. Furthermore appraisal of prostate cancer was affected by age and time since diagnosis. Social support, personality and mental health were coping resources that were of significance to patients diagnosed with prostate cancer. Emotion focused coping strategies were primarily used by patients diagnosed with prostate cancer. Patients with prostate cancer are emotionally distressed. Information and social support from healthcare personnel reduces the emotional distress. Further research should investigate what coping strategies are effective in an early stage of prostate cancer diagnosis.

PURPOSE: To determine the accuracy of prostate biopsy Gleason score (GS) compared to prostatectomy GS. To determine whether a biopsy is a satisfactory diagnostic procedure to offer active surveillance for patients with low-grade prostate cancer. METHODS: This study was conducted in Tuft Medical Center as retrospective cohort study over the period from 2007-2010. The study included 83 patients for whom biopsy and prostatectomy GS were available. MEASUREMENTS: Gleason scores of 6, 7, and 8-10 were assigned to low, moderate, and high-grades, respectively. The kappa statistic was calculated to assess the degree of agreement between biopsy and prostatectomy. The ROC curve was used to evaluate the sensitivity and specificity of prostate biopsy for different Gleason grades. Also, compared whether the use of specific criteria for active surveillance (Johns Hopkins and UCSF) may decrease the level of up-grading in patient with low-grade prostate cancer using Chi-square test. RESULTS: The distribution of low, moderate, and high-grade cancer in biopsy (52%, 32%, 16%) and prostatectomy specimen (33%, 55%, 12%) showed fair agreement with weighted kappa 0.35. The prostate biopsy accurately predicted GS in 46%, up-graded in 38%, and down-graded in 16%. The patients with low-grade cancer and potentially eligible for active surveillance showed up-grading in 50% of cases. This up-grading reduced to 40% with the use of Johns Hopkins criteria and to 41% with the use of UCSF criteria. CONCLUSIONS: The accuracy of biopsy GS in predicting prostatectomy GS is severely limited and therefore biopsy is not enough diagnostic procedure to offer active surveillance.

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Currently, many patients with early-stage localized prostate cancer (PrCa) (D’Amico: low risk or low-intermediate risk) do not receive immediate therapy but are monitored within systematic AS programs. Prospective trials showed rates of stage reclassification and progression to the treatment of 20–40% over 2–5 years. However, in certain patients, PrCa progresses rapidly to an advanced stage that requires combined modality therapies, which carry increased risk for toxicity and poor outcomes. There is a need to identify biomarkers that can predict the risk for disease progression in this population. Research showed that dysregulation of metabolism is an important hallmark of cancer progression. Here, we pursued a pilot investigation of enzymes of de novo lipogenesis [ATP-citrate lyase (ACLY), Acetyl-CoA Carboxylase (ACC)], lipid oxidation [a-Methylacyl-CoA Racemase (AMACR)], glucose uptake [facilitative glucose transporter 1 (GLUT1)], and folate – glutamate metabolism (PSMA: prostate-specific membrane antigen) as potential biomarkers of PrCa progression in AS patients. With ethics approval from the Hamilton Integrated Research Ethics Board (HiREB), 40 AS patients were accrued prospectively from the Niagara Health System PrCa diagnostic program clinics and were asked to donate their biopsy tissue. 28 patients progressed on repeat biopsies at 12 or 24 months after initial diagnosis and were included in the “Progressed” group, and 12 did not who were included in the “Non-Progressed” group. Baseline diagnostic prostate core biopsy tissues of both groups were evaluated with H&E and immunohistochemistry (IHC) staining for ACLY, ACC, GLUT1, AMACR and PSMA expression (quantified by H-score). H-scores were evaluated in benign and malignant components (epithelial cells) and were compared between the two groups of patients. We observed statistically significant increased GLUT1 expression in malignant epithelial cells of the progressed group compared to the non-progressed group. Also, we found statistically significant increased PSMA expression in the benign epithelial cells of the progressed group compared to the non-progressed group. Further, our results demonstrated a statistically significant increase in ACLY and ACC expression in malignant epithelial cells compared to benign epithelial cells in the progressed group, while AMACR was detected solely in the malignant component. Overall, the results of this pilot study are consistent with the notion of induction of glycolytic metabolism, de novo lipogenesis and increased PSMA expression associated with the risk for PrCa progression. The levels of expression of PSMA within benign epithelial cells and GLUT1 within malignant epithelial cells may have value as predictive markers of risk for PrCa progression in AS patients. Future studies should investigate this concept systematically in larger AS cohorts. / Thesis / Master of Science (MSc) / Currently, many patients with localized prostate cancer do not receive immediate therapy and are monitored within systematic active surveillance (AS) programs. The main aim of AS management is to prevent overtreatment and treatment-related complications in patients who would otherwise have a good quality of life despite dealing with prostate cancer. However, many of these patients, especially those with low intermediate-risk prostate cancer have a significant risk for disease progression and metastasis. Additionally, there is a lack of promising tissue biomarkers to predict the risk for progression in AS patients at the time of initial diagnosis. Research showed that metabolism dysregulation is an essential hallmark of cancer progression, including prostate cancer. In this pilot study, we examined whether the expression of enzymes involved in lipid, glucose and protein metabolism could have value as biomarkers of risk for prostate cancer progression in patients managed with AS. The expression of five metabolic enzymes (ACLY, ACC, GLUT1, AMACR and PSMA) was examined in tumor and benign regions of diagnostic biopsies of the prostate obtained from men managed with AS. Our early results suggest that the expression of enzymes of protein (PSMA) and glucose (GLUT1) metabolism may have value as biomarkers of risk for prostate cancer progression and should be investigated further in systematic studies.