Head and neck squamous cell carcinomas (HNSCCs) most commonly develop in older patients (≥60 years of age) with a history of tobacco and alcohol use. However, young individuals (≤45 years of age) can also develop HNSCC, often without common risk factors. Increasing evidence shows that Human Papillomavirus (HPV) infection is associated with particular HNSCC sites (e.g. oropharynx). We assessed the Roche Linear Array HPV Genotyping Test in several lesions and then examined the prevalence of HPV in HNSCCs from young and older patients. HPV infection was most prevalent in oropharyngeal cancers (16/22, 73%), rarely found in oral cavity cancers (2/53, 4%), and other head and neck sites (1/17, 6%). HPV positive tumors were associated with patients that were >40 and <60 years old (p=0.02). The absence or shortened time of carcinogen exposure from common risk factors and the development of oral squamous cell carcinoma (OSCC) at an early age suggest aberrant genetic events that are different than those in OSSCs from older patients. We used Affymetrix SNP 6.0 arrays to genomically profile oral tumors from young and older patients. Tumors from young patients showed different regions/genes of copy number alterations than those from older patient tumors. An increase of regions of loss of heterozygosity (LOH) in tumors from older patients was observed, and there was a high prevalence of copy number neutral LOH on chromosome 9 in tumors from young and older patients. These data suggest different genetic mechanisms in these patient groups. We have previously shown that HNSCCs from younger patients exhibited a high incidence of microsatellite instability (MSI), a marker of defective mismatch repair (MMR). Deregulated mRNA levels of hPMS1, hPMS2 and hMLH1 were observed and absent/low expression of hPMS1, hPMS2 and hMLH1 protein levels were observed in >50% of OSCCs. No mutations were observed in hPMS1 and hPMS2 and no significant differences of MSI or LOH were observed across genomic loci between tumors of young and older patients. The role of these genetic mechanisms in oral cancer appears complex; studies such as ours should further improve our knowledge of the molecular mechanisms leading to early-onset oral carcinomas.

Head and neck squamous cell carcinomas (HNSCCs) most commonly develop in older patients (≥60 years of age) with a history of tobacco and alcohol use. However, young individuals (≤45 years of age) can also develop HNSCC, often without common risk factors. Increasing evidence shows that Human Papillomavirus (HPV) infection is associated with particular HNSCC sites (e.g. oropharynx). We assessed the Roche Linear Array HPV Genotyping Test in several lesions and then examined the prevalence of HPV in HNSCCs from young and older patients. HPV infection was most prevalent in oropharyngeal cancers (16/22, 73%), rarely found in oral cavity cancers (2/53, 4%), and other head and neck sites (1/17, 6%). HPV positive tumors were associated with patients that were >40 and <60 years old (p=0.02). The absence or shortened time of carcinogen exposure from common risk factors and the development of oral squamous cell carcinoma (OSCC) at an early age suggest aberrant genetic events that are different than those in OSSCs from older patients. We used Affymetrix SNP 6.0 arrays to genomically profile oral tumors from young and older patients. Tumors from young patients showed different regions/genes of copy number alterations than those from older patient tumors. An increase of regions of loss of heterozygosity (LOH) in tumors from older patients was observed, and there was a high prevalence of copy number neutral LOH on chromosome 9 in tumors from young and older patients. These data suggest different genetic mechanisms in these patient groups. We have previously shown that HNSCCs from younger patients exhibited a high incidence of microsatellite instability (MSI), a marker of defective mismatch repair (MMR). Deregulated mRNA levels of hPMS1, hPMS2 and hMLH1 were observed and absent/low expression of hPMS1, hPMS2 and hMLH1 protein levels were observed in >50% of OSCCs. No mutations were observed in hPMS1 and hPMS2 and no significant differences of MSI or LOH were observed across genomic loci between tumors of young and older patients. The role of these genetic mechanisms in oral cancer appears complex; studies such as ours should further improve our knowledge of the molecular mechanisms leading to early-onset oral carcinomas.

Thesis (M.Med. ( Anaesthesiology)) --University of Limpopo (Medunsa Campus), 2011 / Introduction: Multiple studies have described a variable incidence of transient hearing loss (hypoacousis) from 0.4% to 40% after subarachnoid block, especially in the low-frequencies range (125 – 500 Hz) (1, 2). The mechanism of transient hypoacousis is attributed to leakage of cerebrospinal fluid, which leads to a decrease in perilymph pressure within the cochlear. Hypothesis: The study hypothesis was based on an assumption that hearing loss is more frequent in young patients who undergo spinal anaesthesia in comparison with elderly patients. Objective: 1) To determine the incidence of hearing loss after spinal anaesthesia in the young versus elderly patients. Materials and Methods: Ninety-eight male patients (ASA 1 - 11) scheduled for cystoscopy under spinal anaesthesia were recruited for the study. Recruitment of patients for the study was age dependent and was divided into two groups: One group (49 patients) had patients aged between 17 and 44 years (Group Y) and the other group had 49 patients aged between 45 and 77 years made up group two (GROUP E). Subarachnoid injection at L3-4 was performed using a standard 22-gauge Quincke spinal needle with patients in the sitting position and 2,5 ml to 3 ml of 0.5% isobaric bupivacaine was administered. Patients were evaluated on the day before spinal anaesthesia by pure tone audiometry at three different frequency sounds viz. 125 – 500 Hz (Low frequency), 500 – 2000 Hz (Speech frequency) and at 2000 – 4000 Hz (High frequency). This assessment was repeated 48 hours after the spinal block was given Statistical Analysis: Analysis was descriptive providing information on the mean (or median) and standard deviation of the variables for each of the two groups. The results of the audiometry were analyzed using repeated measures analysis of variance and transformation to p-value. Differences in outcomes of the study between the two groups were recorded as being statistically significant if p-value is ≤ 0.05. Results: No patient from the two groups developed hearing loss either at low or high frequencies. However, there was a statistically significant improvement in audiometric results (p-value ranging from 0.0001 and 0.063) 48 hours post-surgery in the elderly group as compared with patients in the younger group. Conclusion: The study revealed no hearing loss post-spinal anaesthesia in both groups. It did, however, show that the elderly group have better hearing acuity at all three frequency levels of sound compared to the younger group after spinal anaesthesia

Bakgrund: Det råder idag en brist på verksamma distriktssköterskor i Sverige samtidigt som befolkningen ökar. Ett resultat av detta är att mer ansvar läggs på de få distriktssköterskor som finns. Ansvaret ökar genom personcentrerad vård samtidigt som mer, mer avancerad medicinsk utrustning skall hanteras och fler barn och unga vuxna vårdas i hemmet. Syfte: Syftet med denna studie var att uppnå en djupare förståelse för de upplevelser distriktssköterskor fått genom att arbeta tillsammans med unga patienter med kärlkateter i patientens hemmiljö för att stärka deras autonomi. Metod: Semistrukturerade intervjuer gjordes med åtta distriktssköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys där meningsenheter skapades vilka sedan kodades, och som skapade underkategori och kategorier. Resultat: Utgjordes av två huvudkategorier med tillhörande underkategorier.Den första huvudkategorin blev- Jag går en bit på vägen med dig handlade om hur distriktssköterskan anpassade sig efter varje patientsituation med tillhörande underkategorier Trygghet i yrkesrollen. Bjuder på sig själv. Varje möte är en utmaning. Patienten och dess familj, medaktörer i vården. Stöd eller inte från verksamheten.Nästa huvudkategori blev - Min roll i vårdandet vilket bestod av hur distriktssköterskornas olika upplevelser av att stärka en patients autonomi påverkade den vårdande relationen, med tillhörande underkategorier: Att anpassa samtalet. Vägen till att stärka patientens autonomi. När vården blir vardag. Slutsats: Mötet med barn och unga vuxna patienter är en professionell utmaning för distriktssköterskan. Distriktssköterskans trygghet i sin yrkesroll möjliggör att goda relationer kan skapas med både patient och familj. Distriktssköterskans upplevelse vid vårdmöten påverkades av distriktssköterskans inre tankar och värderingar. När distriktssköterskan var lyhörd för patientens behov och närståendes önskemål, framträdde ett tydligt personcentrerat förhållningssätt. / Background: There is a shortage of practicing nurses in Sweden while the population is increasing every year. More children and young adults receive care in their own homes.As a result, much more responsibility is being put on the community specialist nurses. For instance, providing person-centered care while simultaneously being able to manage complex medical equipment. The Aim: The aim of this study is to achieve a deeper understanding about the experiences district nurses have while working together with young patients with vascular catheters in their home environments to strengthen their autonomy. Method: Semi-structured interviews with eight district nurses were conducted in this study, and qualitative content analysis were used in this essay, on the grounds that this method seeks to discern the meaning of speech acts, text, gestures, and lived expressions. The result: Two main categories were found in the result, one was I walk with you for a while with following subcategories: The assurance in her professional role. Let them see more than just a health worker.Every meeting is a challenge. The patient and their family are playing a part in the care we provide. The support or not from the workplace.The second main category was My part in the caretaking with following subcategories: Adjust to the conversation. The way to strengthen the patient's autonomy. When caring becomes everyday. Conclusion: Meeting children and young adult patients is a professional challenge for the district nurse. By developing a sense of security in their professional role, it is possible for good relationships to be created with both the patient and their family.It became apparent that the district nurse's attitude at care meetings had a clear effect on the relationship with the patient and the family. By being sensitive to the patient's needs and the wishes of relatives, an approach that focuses on individual patient requirements could clearly emerge.

Univerzita Karlova 1. lékařská fakulta Studijní program: Doktorské studium biomedicíny 1. LF UK Studijní obor: Oborová rada Fyziologie a patofyziologie člověka MUDr. Gabriela Dostálová Disertační práce Vybrané aspekty akutního infarktu myokardu u mladých nemocných Specifics of Acute Myocardial Infarction in Young Adults Školitelé: prof. MUDr. A. Linhart, DrSc., doc. MUDr. D. Karetová, CSc. Praha 2017 Abstract Coronary heart disease is the leading cause of death in adults in the western world. Myocardial infarction can represent the lethal manifestation of coronary heart disease leading to sudden cardiac death. Although myocardial infarction mainly occurs in patients older than 45 years, the young population can be affected as well. Despite the relatively low incidence of myocardial infarction in the young population, the mortality rates and long-term disability make acute myocardial infarction in young patients an important clinical issue. Consequences of myocardial infraction usually have great impact on the young patient's psychology, ability to work and the overall quality of life. The management of young myocardial infarction patients should differ at least slightly from the older ones. Young patients usually have a different risk factor profile, clinical presentation, and prognosis in comparison with...