<p dir="ltr">Patients who are aware of their terminal cancer prognosis are more likely to receive end-of-life care consistent with their values. However, prognostic awareness has shown mixed associations with quality of life (QoL) outcomes. Based on theories of acceptance (i.e., Erikson’s stages of life development, Kubler-Ross’s stage model of grief, coping theories) and the Ottawa Decision Support Framework, acceptance of cancer may moderate relationships between prognostic awareness and QoL outcomes and end-of-life treatment preferences. Dyadic coping theories, such as the Systemic Transactional Model and the Dyadic Cancer Outcomes Framework, suggest that patients’ degree of prognostic awareness and acceptance of their illness may also impact their family caregivers’ QoL and end-of-life treatment preferences for the patient. The aim of the present study was to examine the potential moderating role of patient acceptance of cancer in the relationships between patient prognostic awareness and both patient and caregiver QoL and end-of-life treatment preferences. This study was a secondary analysis of cross-sectional data from advanced cancer patients (<i>n</i> = 243) and their caregivers (<i>n</i> = 87) enrolled in the multi-institutional Coping with Cancer-II study. Patient outcomes of physical, psychological, and existential QoL were examined in a moderation path analysis. Caregiver physical and psychological QoL were examined in separate moderation regressions. Patient and caregiver end-of-life treatment preferences were examined in multiple logistic regression moderation models. Results did not support my hypothesis, as patient illness acceptance did not moderate the relationships between patient prognostic awareness and patient and caregiver QoL outcomes and end-of-life treatment preferences. However, there were significant main effects of patient illness acceptance on their own physical, psychological, and existential QoL as well as caregiver psychological QoL. There were also significant main effects of patient prognostic awareness on their own physical QoL and both their own and their caregivers’ end-of-life treatment preferences. Findings suggest that increasing patient’s prognostic awareness and illness acceptance may help improve values-consistent end-of-life care and QoL outcomes in advanced cancer patient-caregiver dyads. Findings support timely conversations to promote advanced cancer patients’ prognostic awareness as well as further research examining the impact of acceptance-based interventions in advanced cancer.</p>

Die ERC ist der diagnostisch Goldstandard bei Patienten mit Klatskintumor und kann auch zur palliativen Stenttherapie eingesetzt werden. Wir konnten die Morbidität und Mortalität der post-ERC-Cholangitis bei Patienten mit Klatskintumor deutlich reduzieren, in dem wir nach MRCP-gestützter Bestimmung des Drainageziels nur eine unilaterale Kontrastierung und Stenteinlage durchführten. Die DNA-Zytometrie war der beste Prognosefaktore für das postoperative Überleben von resezierten Patienten mit Klatskintumor. Im Gegensatz zu diploiden und polyploiden Klatskintumoren hatten Patienten mit aneuploiden Tumoren trotz kurativer Resektion eine sehr schlechte Prognose infolge früher Mikrometastasierung. Bei einigen Patienten mit Klatskintumor liegt eine Billroth II-Gastro-Jejunostomie vor. Trotz der erschwerten Endokoppassage gelang es uns meistens, sowohl die Majorpapille zu erreichen, als auch trotz der inversen Endoskopposition eine sichere Papillotomie durchzuführen. Die perkutane Drainagetherapie mittels PTCD ist eine wertvolle Alternative zur transpapillären Stenttherapie. Als kurative Therapie bei nicht-resezierbaren Cholangiokarzinomen werden Lebertransplantationen durchgeführt. Damit assoziierte biliäre Komplikationen konnten bei uns in den meisten Fällen erfolgreich durch endoskopische Therapie behandelt werden. / ERC is considered as the diagnostic gold standard for patients with Klatskin tumor and can be also used for palliative stenting. We could reduce morbidity as well as mortality due to post-ERC-cholangitis performing MRCP-guided identification of the drainage target and subsequently unilateral contrasting and stenting. DNA-cytomtery was the best prognostic factor predicting the postoperative survival propability of patients with cholangiocarinoma. In contrast to patients resected due to diploid or polyploid Klatskin tumors patients with aneuploid tumors suffered from a bad prognosis due to early micrometastasis. Some patients afflicted from Klatskin tumors have a Billroth II gastro-jejunostomy. In spite of the more difficult endoscopic passage we were mostly able to advance the endoscope to the major papille and to perform a save papillotomy. The percutaneous drainage therapy by means of PTCD is an important alternative to transpapillary stenting. Liver transplantation is performed to cure patients with unresectable Klatskin tumor. Biliary complications which occur after transplantations can be successfully treated in most cases by means of endoscopic therapy.

BACKGROUND: Prostate cancer is by far the most common cancer among Swedish men. Some patients have an aggressive lethal disease, but the majority of affected men have long expected survival. Unfortunately, the diagnostic tools available are insufficient in predicting disease aggressiveness. Novel prognostic markers are therefore urgently needed. Furthermore, metastatic prostate cancer is generally treated with castration, but the long-term effects are insufficient. Additional studies are therefore needed to explore how the effects of this therapy can be enhanced. Prostate growth and regression is beside testosterone controlled by locally produced regulators. Vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) are two of the major regulators in the normal prostate and in prostate tumours. MATERIALS AND METHODS: VEGF and EGFR were explored in the prostate, by treating rats with either anti-VEGF or anti-EGFR treatment during castration and testosterone-stimulated prostate growth. Rats with implanted androgen-independent prostate tumours were treated with an inhibitor of both VEGF receptor-2 (VEGFR-2) and EGFR. Stereological techniques, immunohistochemistry, western blotting and quantitative real-time PCR were used to evaluate these experiments. Furthermore, prostate tissue from untreated prostate cancer patients was used to retrospectively explore the expression of phosphorylated-EGFR (pEGFR) in relation to outcome. RESULTS: Anti-VEGF treatment during testosterone-stimulated prostate growth, inhibited vascular and prostate growth. Anti-EGFR treatment during castration and testosterone-stimulated prostate growth resulted in enhanced castration effects and inhibited prostate growth. Anti-vascular treatment of androgen-independent prostate cancer with an inhibitor of VEGFR-2 and EGFR, that targets the normal and tumour vasculature, enhanced the effects of castration. Low immunoreactivity for pEGFR in prostate epithelial cells, both in the tumour and also in the surrounding non-malignant tissue, was associated with good prognosis. CONCLUSIONS: Anti-vascular treatment, with an inhibitor of VEGFR-2 and EGFR, in combination with castration could be an effective way to treat androgen-insensitive prostate tumours. VEGF and EGFR signalling are necessary components in testosterone-stimulated prostate growth. Phosphorylation of EGFR could be a useful prognostic marker for prostate cancer patients. Tumours may affect the surrounding non-malignant tissue and pEGFR immunoreactivity in the morphologically normal prostate tissue can be used to retrieve prognostic information.

Cirka 300 000 individer drabbas årligen i världen av oral cancer och mer än nittio procent av alla orala cancerformer utgörs av skivepitelcancer. Den femåriga prognosen är generellt 50 % och den 5-åriga relativa överlevnaden har under en tioårsperiod förblivit densamma. Detta motiverar utvecklingen av bättre prognostiska markörer och diagnostiska metoder för att tidigt identifiera de patienter som har risk att utveckla oral skivepitelcancer för att förbättra prognosen och minska lidandet genom tidig insatt behandling. β-catenin är en adhesionsmolekyl som är viktig för bibehållandet av cellulär integration och avvikelser i celladhesionsmolekyler tros spela en central roll när tumörceller invaderar närliggande vävnad det vill säga metastaserar till andra organ.Syftet med studien är att med hjälp av immunohistokemi undersöka om β-catenin kan fungera som en prognostisk markör för utvecklingen av oral skivepitelcancer. Detta görs genom att jämföra förekomsten av β-catenin med hjälp av monoklonala antikroppar i normalt skivepitel, dysplasi och cancer från 18 patienter som har diagnostiserats med oral skivepitelcancer. Infärgningen av Beta catenin jämfördes i normalt oralt skivepitel med cancer och dysplasi för alla biopsier för att undersöka om det förekommer någon skillnad av infärgningen. Förutom detta skedde även en jämförelse av normalt skivepitel med dysplasi och cancer inom varje enskild biopsi.Resultaten visade att det finns en skillnad i uttrycket av β-catenin i normalt skivepitel jämfört med dysplasi och cancer i denna patientgrupp. I denna studie visade mer än 70 % av biopsierna en stark eller måttlig och stark infärgning av β-catenin i normalt skivepitel, mer än 60 % av biopsierna visade en måttlig eller måttlig och svag infärgning av dysplasi och 58,8 % av alla biopsier visade svag infärgning eller ingen och svag infärgning av skivepitelcancer. Då studien visar att mängden av β-catenin är starkast i normalt oralt skivepitel, måttligt i dysplasi och svagast i cancer tyder detta på att β-catenin skulle kunna vara en viktig faktor i utvecklingen av skivepitelcancer i munhålan vilket stämmer väl överens med resultat från andra studier. / Approximately 300,000 individuals are affected every year in the world of oral cancer and more than ninety percent of all oral cancers consists of squamous cell carcinoma. The five-year prognosis is generally 50 % and the 5-year relative survival has over ten years remained the same. This motivates the development of better prognostic markers and diagnostic methods for the early identification of patients at risk of developing oral squamous cell carcinoma to improve prognosis and reduce the suffering of these patients with early treatment.β-catenin is an adhesion molecule that is important for the maintenance of cellular integration and abnormalities of cell adhesion molecules is thought to play a central role in tumorigenesis. The abnormalites is though to enhance tumour cells to break loose from neighbouring cells and invade nearby tissues and organs, however the exact mechanisms are unknown. The purpose of the study is that using immunohistochemistry to examine whether β-catenin may serve as a prognostic marker for the development of oral squamous cell carcinoma. This is done by examining the presence of β-catenin with monoclonal antibodies in 18 biopsies with normal squamous epithelia, dysplasia and cancer from 18 patients diagnosed with oral squamous cell carcinoma from the department of Oral Pathology at Malmö Högskola, Malmö. The staining of beta catenin was compared in normal oral squamous cancer and dysplasia for all biopsies to see whether there is any difference of dyeing. Besides this, there was also a comparison of normal squamous epithelium with dysplasia and cancer in each biopsy.The results showed that there is a difference in the expression of β-catenin in normal squamous epithelium, dysplasia and cancer in this population. In this study, more than 70 % of the biopsies expressed a strong or moderate and strong staining of β -catenin in normal oral squamous epithelium, more than 60 % of the biopsies showed a moderate or moderate and weak staining of dysplasia and 58.8 % of all biopsies showed weak or no staining and weak staining of squamous cell carcinoma.As the study shows that the amount of β -catenin is strongest in normal oral squamous epithelium, moderate in dysplasia and weakest in cancer, this suggests that β -catenin could be an important factor in the development of squamous cell carcinoma of the oral cavity which is in line with results from other studies.

ITC/USA 2010 Conference Proceedings / The Forty-Sixth Annual International Telemetering Conference and Technical Exhibition / October 25-28, 2010 / Town and Country Resort & Convention Center, San Diego, California / Prognostic technology uses a series of algorithms, combined forms a prognostic-based inference engine (PBIE) for the identification of deterministic behavior embedded in completely normal appearing telemetry from fully functional equipment. The algorithms used to define normal behavior in the PBIE from which deterministic behavior is identified can be adapted to quantify normal spacecraft telemetry behavior while in orbit about a moon or planet or during interplanetary travel. Time-series analog engineering data (telemetry) from orbiting satellites and interplanetary spacecraft are defined by harmonic and non-harmonic influences, which shape it behavior. Spectrum analysis can be used to understand and quantify the fundamental behavior of spacecraft analog telemetry and relate the behavior's frequency and phase to its time-series behavior through Fourier analysis.

ITC/USA 2009 Conference Proceedings / The Forty-Fifth Annual International Telemetering Conference and Technical Exhibition / October 26-29, 2009 / Riviera Hotel & Convention Center, Las Vegas, Nevada / Prognostic technology uses a series of algorithms, combined forms a prognostic-based inference engine (PBIE) for the identification of deterministic behavior embedded in completely normal appearing telemetry from fully functional equipment. The algorithms used to define normal behavior in the PBIE from which deterministic behavior is identified can be adapted to quantify normal spacecraft telemetry behavior while in orbit about a moon or planet or during interplanetary travel. Time-series analog engineering data (telemetry) from orbiting satellites and interplanetary spacecraft are defined by harmonic and non-harmonic influences which shape it behavior. Spectrum analysis can be used to understand and quantify the fundamental behavior of spacecraft analog telemetry and relate the behavior's frequency and phase to its time-series behavior through Fourier analysis.

ITC/USA 2011 Conference Proceedings / The Forty-Seventh Annual International Telemetering Conference and Technical Exhibition / October 24-27, 2011 / Bally's Las Vegas, Las Vegas, Nevada / Prognostic technology uses a series of algorithms, combined forms a prognostic-based inference engine (PBIE) for the identification of deterministic behavior embedded in completely normal appearing telemetry from fully functional equipment. The algorithms used to define normal behavior in the PBIE from which deterministic behavior is identified can be adapted to quantify normal spacecraft telemetry behavior while in orbit about a moon or planet or during interplanetary travel. Time-series analog engineering data (telemetry) from orbiting satellites and interplanetary spacecraft are defined by harmonic and non-harmonic influences, which shape it behavior. Spectrum analysis can be used to understand and quantify the fundamental behavior of spacecraft analog telemetry and relate the behavior's frequency and phase to its time-series behavior through Fourier analysis.

Hintergrund: Leptin ist ein unabhängiger kardiovaskulärer Risikofaktor und scheint prothrombotische Effekte zu besitzten. Adiponectin hingegen scheint vor Thrombosen zu schützen. Wir untersuchten deswegen die Bedeutung dieser beiden Adipozytokine bei Patienten mit einer akuten Lungenembolie. Durchführung: Im Rahmen einer prospektiven Fall-Kontroll-Studie schlossen wir zwischen 2003 und 2006 97 Patienten mit gesichterter Lungenembolie und 40 Patienten mit dem Ausschluß einer Lungenembolie ein. Die Lungenembolie-Patienten wurden bezüglich eines komplizierten Verlaufs innerhalb der ersten 30 Tage nach dem Ereignis (Tod, Katecholaminebedarf, Reanimation, Intubation, Hypotonie) sowie bezüglich des Langzeit-Überlebens beobachtet. Ergebnisse: Bei Patienten mit Lungenembolie ist ein höherer Leptinspiegel ein prognostischer Parameter für eine niedrigere 30-Tages-Komplikationsrate und ein besseres Langzeit-Überleben. Patienten mit einer Lungenembolie weisen signifikant höhere Adiponectinwerte als Patienten ohne Lungenembolie auf. Eine prognostische Bedeutung hat Adiponectin bei Patienten mit einer Lungenembolie nicht. Schlußfolgerung: Niedrige Leptinspiegel sind bei Patienten mit einer akuten Lungenembolie ein unabhängiger prognostischer Parameter für einen komplizierten 30-Tages-Verlauf und eine erhöhte Mortalität im Langzeit-Verlauf. Lungenembolie-Patienten weisen eine Hyperoadiponectinämie auf, dies könnten Ausdruck einer kardialen Sekretion und Wirkung des Asiponectins infolge der Lungenembolie sein.

No description available.

Malgré une amélioration de la prise en charge thérapeutique au cours des dernières années, les leucémies aiguës myéloïdes (LAM) pédiatriques sont des hémopathies graves, avec des taux de rechute pouvant atteindre 30% et des taux de survie inférieurs à 75%. Une meilleure description des anomalies moléculaires chez les enfants atteints de LAM est nécessaire pour affiner le pronostic de ces patients. En utilisant le séquençage haut débit ciblé sur 36 gènes et la technique de LD (ligation-dependent) RT-PCR, ce travail décrit le profil moléculaire ainsi que sa signification pronostique chez 385 enfants atteints de LAM de novo inclus dans l’essai clinique prospectif ELAM02. 76 % des patients présentent au moins une mutation parmi les gènes étudiés. Les mutations les plus fréquentes concernent les gènes contrôlant les voies de signalisation des tyrosine kinases (61 %), suivis par les facteurs de transcription (16 %), les suppresseurs de tumeurs (14 %), les modificateurs de la chromatine (9 %), la méthylation de l'ADN (8 %), la cohésine (5 %) et le spliceosome (3 %). De plus, un transcrit de fusion est détecté dans près de la moitié des cas. Au final, les réarrangements impliquant le CBF, les mutations de NPM1 et double-mutations de CEBPA (CEBPA-dm) représentent 37% de la cohorte et définissent un sous-groupe moléculaire au pronostic favorable (survie globale à 3 ans: 92,1%) alors que les fusions impliquant NUP98, les mutations WT1, RUNX1 et PHF6 (15% de la cohorte) constituent un sous-groupe moléculaire au pronostic péjoratif (survie globale à 3 ans: 46,1%). Les réarrangements de KMT2A (21 % de la cohorte) sont associés à un risque intermédiaire. Malgré quelques similitudes, le profil moléculaire et sa signification pronostique diffèrent entre les LAM de l’enfant et de l’adulte. Ces résultats contribuent à affiner la stratification du risque pronostique des LAM pédiatriques et ainsi améliorer leur prise en charge thérapeutique. Cette classification moléculaire reste à valider dans d’autres cohortes pédiatriques indépendantes. / Despite major treatment improvements over the past decades, pediatric acute myeloid leukemia (AML) is still a life-threatening malignancy with relapse rates up to 30% and survival rates below 75%. A better description of the pattern of molecular aberrations in childhood AML is needed to refine prognostication in such patients. We report here the comprehensive molecular landscape using both high-throughput sequencing focused on 36 genes and ligation-dependent RT-PCR in 385 children with de novo AML enrolled in the prospective ELAM02 trial and we evaluated their prognostic significance. 76% of patients had at least one mutation among the genes we screened. The most common class of mutations involved genes that control kinase signaling (61%) followed by transcription factors (16%), tumor suppressors (14%), chromatin modifiers (9%), DNA methylation controllers (8%), cohesin genes (5%) and spliceosome (3%). Moreover, a recurrent transcript fusion was detected in about a half of pediatric patients. Overall, CBF rearrangements, NPM1 and double CEBPA mutations represented 37% of the cohort and defined a favorable molecular subgroup (3-years overall survival: 92.1%) while NUP98 fusions, WT1, RUNX1 and PHF6 mutations (15% of the cohort) segregated into a poor molecular subgroup (3-years overall survival: 46.1%). KMT2A-rearrangements (21% of the cohort) were associated with an intermediate risk. Despite some overlaps, the spectrum of molecular aberrations and their prognostic significance differ between childhood and adult AML. These data have important implications to contribute in refining risk stratification of pediatric AML and show the need for further validations in independent pediatric cohorts.