The Symptom Experience of Patients With Advanced Pancreatic Cancer: An Integrative Review

Background: Pancreatic cancer is a devastating disease with limited treatment options. More than 80% of pancreatic cancers are diagnosed in advanced stages and often have debilitating symptoms, making symptom management paramount, yet the symptom experience of patients with advanced pancreatic cancer (APC) is not well understood. Objective: The purpose of this integrative review is to synthesize the current evidence regarding the symptom experience of patients with APC. Method: An integrative literature review was conducted to identify the patient symptom experience in studies published from 2005 to 2015. Results: Sixteen studies met the inclusion criteria. All studies used a quantitative approach; 44% were quasi-experimental, 31% were descriptive, and 25% were correlational. Physical symptoms, especially pain, were the primary focus in most studies. Fatigue, loss of appetite, and impaired sense of well-being were prevalent and reported by patients to be of high intensity. Few studies examined psychological symptoms in patients with APC, although anxiety and depression were noted. Conclusion: Findings suggest that physical and psychological symptoms are prevalent, some with high intensity. Preselection of symptom inventories limits our ability to fully understand the symptom experience of patients with APC. Future qualitative work is needed to provide a more in-depth understanding of symptoms, especially symptom quality and distress level, from patients' perspectives. More studies are needed to explore psychological symptoms and the interaction of physical and psychological symptoms. Implications for Practice: Findings help healthcare givers to better understand the symptom experience of their APC patients

PAIN AND ANXIETY AND QUALITY OF LIFE IN BREAST CANCER SURVIVORS

poster abstractBACKGROUND: Pain and anxiety are symptoms that frequently occur as co-related groups termed “clusters.” While it is known that pain may be associated with decreased quality of life (QOL), less is understood about the effects of anxiety on breast cancer survivors (BCS). PURPOSE: The purpose of this study was to: 1) determine levels of pain and anxiety in breast cancer survivors and 2) examine the relationship between anxiety and pain on quality of life in breast cancer survivors (BCS) controlling for age and time post-treatment. THEORETICAL FRAMEWORK: Ferrell’s Quality of Life Model guided this study. METHODS: A cross-sectional, descriptive design was used. BCS enrolled in a longitudinal cognitive behavioral study completed self-report questionnaires including the Medical Outcome Scale-Short Form, Pain Subscale, Spielberger State-Trait Anxiety Instrument (STAI) State Subscale to measure anxiety, and Ferrell’s QOL Instrument which measures Physical, Psychological, Social and Spiritual Well-being (higher scores indicating higher quality of life). Covariates of age and time post-treatment were controlled for. All data were collected at a baseline assessment before randomization in the cognitive intervention study. Data were evaluated using descriptive statistics and general linear regression. RESULTS: 88 female BCS averaging 57 years old (range 40-74; SD=8.54), primarily Caucasian (88.6%), college-educated (88%), approximately 5.3 (SD=4.0) years post-treatment participated. Cancer-related pain (4 lymphedema, 4 neuropathy) was specified by 8 participants. BCS reported low-moderate pain (x= 66.0114; sd = 22.348) and moderate anxiety (x̅=35.0227; sd= 8.7749). Clinically significant levels of anxiety (≥ 39 on the STAI-S where higher scores indicated higher anxiety) were reported in 24% of BCS. Age, anxiety, and pain significantly accounted for 45% of the total variance on QOL in the regression model (R = 0.45, F = 18.61; p = <0.000), controlling for age and time post-treatment. CONCLUSIONS: This study provides support for the fact that both pain and anxiety are negatively associated with QOL. Anxiety is a significant long-term symptom for a sub-set of BCS which negatively impacts all dimensions of BCS quality of life. Findings indicate the need for comprehensive assessment of symptoms of anxiety in long-term BCS and the development of evidenced-based interventions to alleviate anxiety and improve QOL

Clinical significance of serum alanine aminotransferase and lifestyle intervention in children with nonalcoholic fatty liver disease

PurposeThis study aimed to investigate the clinical significance of serum alanine aminotransferase (ALT) levels in children with nonalcoholic fatty liver disease (NAFLD) and the effect of lifestyle intervention on NAFLD.MethodsThe clinical data of 86 children diagnosed with NAFLD were reviewed retrospectively. Forty-six patients belonged to the elevated ALT group and 40 to the normal ALT group. The clinical parameters of patients with NAFLD were also compared based on the status of ALT levels after lifestyle intervention.ResultsPatients with elevated ALT had significantly higher body mass index (BMI) scores than those with normal ALT (P<0.05). Of all the patients with elevated ALT, 89% exhibited moderate or severe degree of fatty change in the liver on ultrasonographic examination, whereas most patients with normal ALT exhibited mild or moderate degree changes. Liver biopsy was performed in 15 children with elevated ALT and all showed mild histological changes. Of all patients with elevated ALT, 49% achieved normal ALT levels after lifestyle intervention. Those with more severe histological changes tended to have continuously increasing ALT levels. There was no correlation between the normalization of posttreatment ALT level and BMI, as well as ultrasonographic findings at diagnosis.ConclusionALT elevation in NAFLD is highly associated with higher BMI scores and more severe degree of fatty changes on ultrasonographic examination. Lifestyle intervention can significantly improve ALT in children with NAFLD. The degree of histologic changes appears to be a predictor of the treatment response to NAFLD

Effect of Hydraulic Activity on Crystallization of Precipitated Calcium Carbonate (PCC) for Eco-Friendly Paper

Wt% of aragonite, a CaCO3 polymorph, increased with higher hydraulic activity (°C) of limestone in precipitated calcium carbonate (PCC) from the lime-soda process (Ca(OH)2-NaOH-Na2CO3). Only calcite, the most stable polymorph, was crystallized at hydraulic activity under 10 °C, whereas aragonite also started to crystallize over 10 °C. The crystallization of PCC is more dependent on the hydraulic activity of limestone than CaO content, a factor commonly used to classify limestone ores according to quality. The results could be effectively applied to the determination of polymorphs in synthetic PCC for eco-friendly paper manufacture

Enhanced cytotoxic effect of radiation and temozolomide in malignant glioma cells: targeting PI3K-AKT-mTOR signaling, HSP90 and histone deacetylases

BACKGROUND: Despite aggressive treatment with radiation therapy and concurrent adjuvant temozolomide (TMZ), glioblastoma multiform (GBM) still has a dismal prognosis. We aimed to identify strategies to improve the therapeutic outcome of combined radiotherapy and TMZ in GBM by targeting pro-survival signaling from the epidermal growth factor receptor (EGFR). METHODS: Glioma cell lines U251, T98G were used. Colony formation, DNA damage repair, mode of cell death, invasion, migration and vasculogenic mimicry as well as protein expression were determined. RESULTS: U251 cells showing a low level of methyl guanine transferase (MGMT) were highly responsive to the radiosensitizing effect of TMZ compared to T98G cells having a high level of MGMT. Treatment with a dual inhibitor of Class I PI3K/mTOR, PI103; a HSP90 inhibitor, 17-DMAG; or a HDAC inhibitor, LBH589, further increased the cytotoxic effect of radiation therapy plus TMZ in U251 cells than in T98G cells. However, treatment with a mTOR inhibitor, rapamycin, did not discernibly potentiate the radiosensitizing effect of TMZ in either cell line. The mechanism of enhanced radiosensitizing effects of TMZ was multifactorial, involving impaired DNA damage repair, induction of autophagy or apoptosis, and reversion of EMT (epithelial-mesenchymal transition). CONCLUSIONS: Our results suggest possible strategies for counteracting the pro-survival signaling from EGFR to improve the therapeutic outcome of combined radiotherapy and TMZ for high-grade gliomas

Dominant 1/3-filling Correlated Insulator States and Orbital Geometric Frustration in Twisted Bilayer Graphene

Geometric frustration is a phenomenon in a lattice system where not all interactions can be satisfied, the simplest example being antiferromagnetically coupled spins on a triangular lattice. Frustrated systems are characterized by their many nearly degenerate ground states, leading to non-trivial phases such as spin ice and spin liquids. To date most studies are on geometric frustration of spins; much less explored is orbital geometric frustration. For electrons in twisted bilayer graphene (tBLG) at denominator 3 fractional filling, Coulomb interactions and the Wannier orbital shapes are predicted to strongly constrain spatial charge ordering, leading to geometrically frustrated ground states that produce a new class of correlated insulators (CIs). Here we report the observation of dominant denominator 3 fractional filling insulating states in large angle tBLG; these states persist in magnetic fields and display magnetic ordering signatures and tripled unit cell reconstruction. These results are in agreement with a strong-coupling theory of symmetry-breaking of geometrically frustrated fractional states

Data migration on parallel disks

Abstract. Our work is motivated by the problem of managing data on storage devices, typically a set of disks. Such storage servers are used as web servers or multimedia servers, for handling high demand for data. As the system is running, it needs to dynamically respond to changes in demand for different data items. There are known algorithms for mapping demand to a layout. When the demand changes, a new layout is computed. In this work we study the data migration problem, which arises when we need to quickly change one layout to another. This problem has been studied earlier when for each disk the new layout has been prescribed. However, to apply these algorithms effectively, we identify another problem that we refer to as the correspondence problem, whose solution has a significant impact on the solution for the data migration problem. We study algorithms for the data migration problem in more detail and identify variations of the basic algorithm that seem to improve performance in practice, even though some of the variations have poor worst case behavior

Data Migration on Parallel Disks

Our work is motivated by the problem of managing data on storage devices, typically a set of disks. Such high demand storage servers are used as web servers or multimedia servers, for handling high demand for data. As the system is running, it needs to dynamically respond to changes in demand for different data items. There are known algorithms for mapping demand to a layout. When the demand changes, a new layout is computed. In this work we study the data migration problem, which arises when we need to quickly change one layout to another. This problem has been studied earlier when for each disk the new layout has been prescribed. However, lack of such information leads to an interesting problem that we call the correspondence problem, whose solution has a significant impact on the solution for the data migration problem. We examine algorithms for the data migration problem in more detail and identify variations of the basic algorithm that seem to improve performance in practice, even though some of the variations have poor worst case behavior. UMIACS-TR-2003-11