The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff.

The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff.

Cancer Nurs. 2016 Dec 30;

Authors: Nolte L, Kinnane N, Lai-Kwon J, Gates P, Shilkin P, Jefford M

Abstract
BACKGROUND: In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited.
OBJECTIVES: The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation.
METHODS: Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews.
RESULTS: Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers.
CONCLUSION: Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support.
IMPLICATIONS FOR PRACTICE: Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.

PMID: 26720214 [PubMed - as supplied by publisher]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1PAAQTI
via IFTTT

Radiotherapy is Important for Local Control at Primary and Metastatic Sites in Pediatric Rhabdomyosarcoma.

Radiotherapy is Important for Local Control at Primary and Metastatic Sites in Pediatric Rhabdomyosarcoma.

Cureus. 2015;7(11):e388

Authors: Skamene S, Abish S, Mitchell D, Freeman C

Abstract
PURPOSE: The current recommended practice for pediatric patients with metastatic rhabdomyosarcoma includes full-dose radiotherapy to each metastatic site. We wished to question this practice, which can cause side-effects and is often logistically challenging, by studying the pattern of failure in our pediatric and teenage patient population.
METHODS AND MATERIALS: Our institution's cancer registry was queried for patients diagnosed with rhabdomyosarcoma aged 18 or less from January 1990 until January 2014. Twenty-nine patients were found and, of these, six had metastatic disease. Five of the six were treated with standard chemotherapy together with radiotherapy to the primary and metastatic sites with doses and fractionation according to the site. Progression-free survival was calculated from the end of radiotherapy until radiological or pathological evidence of disease progression or death.
RESULTS: Median age was 13 years (range: 12-18). Three were girls. All had alveolar histology and unfavorable primary sites. Twelve metastatic sites were treated with radiotherapy. Doses used were 41.4 - 50.4 Gy in 1.8 Gy fractions for most sites, and 15 Gy in 1.5 Gy fractions for whole lung radiotherapy. The median number of sites treated per patient was two (range: 1 - 6). Median time to progression was 10.1 months (range: 1.9 - 15.7). Local control was 100% for all metastatic sites. Median overall survival (OS) was 31.8 months (range: 20.4 - 95.4 months). Three patients developed progressive disease outside the treated field. One patient died from a secondary hematological malignancy without evidence of disease progression. One patient remains progression-free at 88.6 months post-radiotherapy.
CONCLUSIONS: Radiotherapy to metastatic disease sites prevented in-field progression in all five patients with metastatic alveolar rhabdomyosarcoma. However, failure at sites outside of the radiotherapy volume occurred in three of five of patients and overall survival was very poor despite aggressive treatment to all sites of disease. Radiotherapy has a role in metastatic disease, although future studies evaluating dose and fractionation are needed.

PMID: 26719831 [PubMed]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1PB1byV
via IFTTT

Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: outcomes from a pilot trial.

Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: outcomes from a pilot trial.

BMJ Open Gastroenterol. 2015;2(1):e000052

Authors: Tazzyman S, Richards N, Trueman AR, Evans AL, Grant VA, Garaiova I, Plummer SF, Williams EA, Corfe BM

Abstract
BACKGROUND: Vitamin D deficiency has been associated or implicated with the pathophysiology of the gastrointestinal conditions inflammatory bowel disease and colorectal cancer, as well as with depression. No trials or epidemiology studies to date have investigated a link with irritable bowel syndrome (IBS). A single case report has suggested a benefit in IBS of vitamin D supplementation. We hypothesised that IBS participants with vitamin D insufficiency would benefit from repletion in terms of their IBS symptoms. We undertook a pilot trial to provide data to support a power calculation and to justify a full trial.
METHODS: This was a randomised, double blinded, three-arm parallel design trial of vitamin D, placebo or a combination of vitamin D and probiotics. Participants were further stratified according to whether they were vitamin D replete or insufficient. Vitamin D status was determined by blood test at baseline and exit; IBS symptoms were assessed by validated questionnaire; dietary intakes were assessed by food frequency questionnaire.
RESULTS: A significant proportion of the IBS population were vitamin D deficient, such that the replete stratum could not be adequately recruited. There was a significant association in the baseline data between circulating vitamin D level and quality of life ("How much has IBS affected your life?"). Supplementation significantly improved vitamin D level versus placebo. IBS symptoms were not significantly improved in this pilot, although a power calculation was enabled from the intervention data.
CONCLUSIONS: The IBS population exhibits significant levels of vitamin D insufficiency and would benefit from screening and possible supplementation. The impact of IBS on quality of life may be reduced by vitamin D level. Future trials should have a sample size of over 97.
TRIAL REGISTRATION NUMBER: ICTRN 6116003917.

PMID: 26719813 [PubMed]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1PAATyL
via IFTTT

Detection of Quiescent Infections with Multiple Elephant Endotheliotropic Herpesviruses EEHV2, EEHV3, EEHV6 and EEHV7 within Lymphoid Lung Nodules or Lung and Spleen Tissue Samples from Five Asymptomatic Adult African Elephants.

Detection of Quiescent Infections with Multiple Elephant Endotheliotropic Herpesviruses EEHV2, EEHV3, EEHV6 and EEHV7 within Lymphoid Lung Nodules or Lung and Spleen Tissue Samples from Five Asymptomatic Adult African Elephants.

J Virol. 2015 Dec 30;

Authors: Zong JC, Heaggans SY, Long SY, Latimer EM, Nofs SA, Bronson E, Casares M, Fouraker MD, Pearson VR, Richman LK, Hayward GS

Abstract
More than 80 cases of lethal hemorrhagic disease associated with Elephant Endotheliotropic Herpesviruses (EEHV) have been identified in young Asian elephants worldwide. Diagnostic PCR tests detected six types of EEHV in blood of acute disease cases, although EEHV1A is the predominant pathogenic type. Previously, the presence of herpesvirus virions within benign lung and skin nodules from healthy African elephants led to suggestions that African elephants may be the source of EEHV disease in Asian elephants. Here, we used direct PCR DNA sequencing to detect EEHV genomes in necropsy tissue from five healthy adult African elephants. Two large lung nodules collected from culled wild South African elephants contained high levels of either EEHV3 alone or of both EEHV2 and EEHV3. Similarly, a euthanized USA elephant proved to harbor multiple EEHV types distributed non-uniformly across four small lung nodules, including high levels of EEHV6, lower levels of EEHV3 and EEHV2, and a new GC-rich branch type EEHV7. Several of the same EEHV types were also detected in random lung and spleen samples from two other elephants. Sanger PCR DNA sequence data totaling 100-kb was obtained amongst the total of 15 different strains identified with (except for a few hypervariable genes) the EEHV2, EEHV3, EEHV6 strains all being closely related to known genotypes from acute disease cases, whereas the seven loci (4.0-kb) obtained from EEHV7 averaged 18% divergence from their nearest relative EEHV3. Overall, we conclude that these four EEHV species, but probably not EEHV1, occur commonly as quiescent infections in African elephants.
IMPORTANCE: Acute hemorrhagic disease characterized by high level viremia with members of the Proboscivirus genus threatens the future breeding success of endangered Asian elephants worldwide. Although the genomes of six EEHV types from acute cases have been partially or fully characterized, lethal disease predominantly involves a variety of strains of EEHV1 whose natural host has been unclear. Here we carried out partial PCR sequencing genotype analyses on necropsy tissue from five asymptomatic African elephants and identified multiple simultaneous infections by several different EEHV types, including high concentrations in lymphoid lung nodules. Overall, the results provide strong evidence that EEHV2, EEHV3, EEHV6 and EEHV7 represent natural ubiquitous infections in African elephants, whereas Asian elephants harbor EEHV1A, EEHV1B, EEHV4 and EEHV5. Although a single case of fatal cross-species infection by EEHV3 is known, the results do not support a previous concept that highly pathogenic EEHV1A crossed from African to Asian elephants in zoos.

PMID: 26719245 [PubMed - as supplied by publisher]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1PB1cTK
via IFTTT

Genetic variants in the tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL) do not contribute but Death Receptor (DR4) genes may contribute to susceptibility to head and neck cancer in Pakistani population.

Genetic variants in the tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL) do not contribute but Death Receptor (DR4) genes may contribute to susceptibility to head and neck cancer in Pakistani population.

Cell Mol Biol (Noisy-le-grand). 2015;61(8):53-6

Authors: Sarwar R, Mansoor Q, Farooqi AA, Shahzad S, Fayyaz S, Ismail M

Abstract
TRAIL mediated signaling in cancer cells has emerged as one amongst the most deeply studied molecular phenomenon. Recent breakthroughs have shown that overexpression of anti-apoptotic proteins, inactivation of pro-apoptotic proteins, transcriptional downregulation of TRAIL, DR4/DR5, degradation of DR/DR5 are some of the mechanisms which dramatically abrogate TRAIL induced apoptosis in cancer cells. Data obtained through genetic studies has highlighted highly polymorphic nature of DR4 and in accordance with this concept, we investigated the association between Head and Neck Cancer and polymorphisms in TRAIL (1595 C/T) and DR4 (C626G and A1322G) gene. We selected 100 patients with Head and Neck Cancer and 100 healthy, sex and age matched volunteers randomly. C626G and A1322G in DR4 gene were analyzed using Polymerase Change Reaction (PCR) - Restriction Fragment Length Polymorphism (RFLP) and Amplification Refractory Mutation System (ARMS) techniques respectively. For TRAIL gene 1595 C>T genotypes, there was no statistically significant role of homozygous CC or TT in Head and Neck cancer. CC was 58% in patients and 49% in controls. CT was 30% in patients and 43% in controls. TT was 12% in patients and 8% in controls. Allele frequency for C was noted to be 0.73 (patients) and 0.705 (controls), p-value (1). For T, 0.025 (patients) and 0.001(controls), p-value (0.88). The genotyping for DR4 gene 626 C>G polymorphism was done for 100 head and neck cancer patients and 100 age and sex matched healthy controls. All the genotypes for the polymorphism were in Hardy-Weinberg Equilibrium. For DR4626 C>G genotype, CC was 10% in patients and 2% in controls. GC was 63% in patients and 40% in controls. GG was 27% in patients and 58% in controls. Interestingly, in DR4 genotyping, CC was predisposing factor and GG acted as a protective factor. Allele frequency for C was noted to be 0.41 (patients) and 0.22 (controls), p-value (0.81). For G, 0.585 (patients) and 0.78 (controls), p-value (0.867). For the A1322G polymorphism, TT was 23% in patients and 36% in controls with a p-value 0.09 (table 6). CT was statistically significant in patients (45%) and controls (28%), p-value 0.04. CC was non-significant in patients (32%) and controls (36%), p-value 0.62 (table 6). C allele was 0.45% in patients and 0.5% in controls. T allele was 0.54% in patients and 0.5% in controls. Future studies must converge on somatic mutations, epigenetic mutations and expression analysis of TRAIL and DR4 to get a step closer to individualized medicine.

PMID: 26718429 [PubMed - in process]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1PAATii
via IFTTT

Stimulation of the hypoxia pathway modulates chemotherapy resistance in Hodgkin's lymphoma cells.

Stimulation of the hypoxia pathway modulates chemotherapy resistance in Hodgkin's lymphoma cells.

Tumour Biol. 2015 Dec 30;

Authors: Kewitz S, Kurch L, Volkmer I, Staege MS

Abstract
Hodgkin's lymphoma (HL) is a malignant disease of the lymphatic system. The therapy has been improved during the last decades but there are still patients who cannot be cured, and the therapy is associated with several adverse late effects. Therefore, we asked which genes might be involved in the chemotherapy resistance of HL cells. We observed that HL cells became more resistant against cisplatin after treatment with cobalt chloride. Therefore, we analyzed which genes were differentially expressed between cells incubated in medium with or without cobalt chloride. We found several genes which were up- or downregulated in the presence of cobalt chloride and might be involved in the modulation of chemotherapy resistance. Cobalt chloride is a hypoxia-mimetic agent. Therefore, we tested chemo-resistance and gene expression of HL cells under hypoxic conditions and confirmed the results from the cobalt chloride experiments. Taken together, activation of the hypoxia pathway led to altered gene expression and drug resistance of HL cells. Differentially expressed genes might be interesting targets for the development of future treatment strategies against drug-resistant HL.

PMID: 26718211 [PubMed - as supplied by publisher]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1R1CQpq
via IFTTT

ADSCs in a fibrin matrix enhance nerve regeneration after epineural suturing in a rat model.

ADSCs in a fibrin matrix enhance nerve regeneration after epineural suturing in a rat model.

Microsurgery. 2015 Dec 30;

Authors: Reichenberger MA, Mueller W, Hartmann J, Diehm Y, Lass U, Koellensperger E, Leimer U, Germann G, Fischer S

Abstract
BACKGROUND: Due to their unique properties, adipose derived stem cells (ADSCs) obtain promising potential to enhance nerve regeneration. The aim of this study was to investigate if fibrin-glue embedded ADSCs were a beneficial adjunct to primary coaptation in a rat sciatic nerve model.
MATERIALS AND METHODS: Fifty male Lewis rats underwent sciatic nerve transection and subsequent epineural suture repair. The treatment group received ADSCs re-suspended in fibrin glue, while the control group received fibrin glue only. After 7, 21, 35, and 63 days, analysis involved axon count, myelin sheath thickness as well as N- and G-ratios. Additionally, muscle weight quotient (operated vs. non-operated site of the same animal) was calculated and compared between treatment and control groups. For co-detection of vital ADSCs, vessel walls, and Schwann cells, immunolabeling was performed with CM-DiI, SMA, and S-100 antibodies, respectively.
RESULTS: ADSCs led to a significant increase of myelinization at day 21 (0.508 ± 0.085 μm vs. 0.381 ± 0.044 μm, P = 0.025) and day 35 (0.872 ± 0.09 µm vs. 0.495 ± 0.078 µm; P = 0.01) after surgery. Axon count was significantly increased at day 21 (420 ± 119 vs. 129 ± 63; P = 0.003) and day 63 (284 ± 137 vs. 111 ± 26; P = 0.046) after surgery. N- and G-ratios were significantly different compared with control indicating enhanced nerve regeneration due to ADSC treatment at each time point (P < 0.05). Muscle weight quotient was significantly higher in the treatment group compared with the control at day 21 (44.01% ± 6.16% vs. 35.03% ± 2.61%; P = 0.014) and day 63 (65.49% ± 2.81% vs. 58.79% ± 4.06%; P = 0.009) after surgery. Co-detection of immunolabeled cells showed vital ADSCs at the neuronal repair site and in close proximity to intraneuronal vessels indicating active participation of ADSCs in the process of nerve regeneration and associated angiogenesis.
CONCLUSION: ADSCs embedded in a fibrin matrix can significantly enhance regeneration of peripheral nerve injuries after primary coaptation. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

PMID: 26716599 [PubMed - as supplied by publisher]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RSRTld
via IFTTT