Jämförelse av accelerometer och kraftplatta vid mätning av anterio-posteriort och medio-lateralt posturalt svaj

Bakgrund: Fallolyckor har ökat den senaste tiden och orsakar stora kostnader för samhället samt lidande för den drabbade. Det är viktigt att sätta in insatser i fallprevention för att motverka detta. Socialstyrelsen har samordnat en kampanj på uppdrag från regeringskansliet för dessa insatser. I dagsläget används instrument med mått som är ospecifika samt svåra att kvantifiera för att utvärdera fallrisk. Instrumenten som i dagsläget går att kvantifiera är ej mobila. Ett nytt instrument för detta är en bärbar accelerometer som fästes på kroppen och mäter posturalt svaj. Syfte: Undersöka validitet av en accelerometer som fästs på kroppen genom att jämföra dess mätvärden med värden uppmätta på kraftplatta från Good Balance. Studiedesign: Pilotstudie med 23 deltagare, medelålder 26 år rekryterade från Health Science Centre i Lund. Metod: Deltagarna stod på en kraftplatta och hade samtidigt på sig accelerometern. De stod statiskt 30s med öppna ögon (ÖÖ) och 30s med stängda ögon (SÖ) och blev uppmanade att stå så stilla som möjligt. En mall för standardrutiner för kraftplattan följdes. Mätningarna startade samtidigt och resultatet analyserades med deskriptiv statistik och korrelationen undersöktes med Spearman’s korrelationskoefficient (rs). Etik: Deltagandet i denna studie var frivilligt och det gick närsomhelst att avbryta testet utan att specificera varför. Resultat: En mycket hög korrelation såg i riktningen medio-lateral (M-L) både med ÖÖ och SÖ (rs > 0,90). I anterio-posterior (A-P) riktning sågs en hög korrelation i mätningen med ÖÖ (rs = 0,70 ) och en låg korrelation (rs = 0,40 ) med SÖ. Slutsats: Den mobila accelerometern har mycket god validitet vid mätningar i riktning M-L och kan därför ersätta mätning på stationär kraftplatta. Detta ger förutsättningar för att kunna förutse fall i denna riktning. En högre validitet i riktning A-P krävs innan kraftplattan kan ersättas. Studier på personer med hög risk för att falla krävs för att säkerställa validiteten för accelerometern i denna population

Tongue carcinoma in an adult Down's syndrome patient: a case report

<p>Abstract</p> <p>Background</p> <p>Cancer of the oral cavity is rare and unusual in Down's syndrome patient. The over all risk is similar to that in adult population.</p> <p>Case presentation</p> <p>This case report describes a 27 years old male with Down's syndrome, non-smoker, who developed a poorly differentiated squamous cell carcinoma of the tongue. The patient underwent a hemiglossectomy without neck dissection followed by a postoperative locoregional radiation therapy to a total tumor-bed dose of 56 Gy and 45 Gy to the neck. Three months later, the patient presented with local tongue recurrence and was treated by Docetaxel and Carboplatin chemotherapy with no significant response. The patient died one month later, 9 months after his initial diagnosis.</p> <p>Conclusion</p> <p>To our knowledge, this is the first case of tongue carcinoma arising in a patient with Down's syndrome. This unique case might not be sufficient to make a significant conclusion on the prognosis and survival of these patients but will increase the awareness about this possibility and will help in the appropriate management of Down's syndrome patients.</p

Expression of CXCL10 is associated with response to radiotherapy and overall survival in squamous cell carcinoma of the tongue

Five-year survival for patients with oral cancer has been disappointingly stable during the last decades, creating a demand for new biomarkers and treatment targets. Lately, much focus has been set on immunomodulation as a possible treatment or an adjuvant increasing sensitivity to conventional treatments. The objective of this study was to evaluate the prognostic importance of response to radiotherapy in tongue carcinoma patients as well as the expression of the CXC-chemokines in correlation to radiation response in the same group of tumours. Thirty-eight patients with tongue carcinoma that had received radiotherapy followed by surgery were included. The prognostic impact of pathological response to radiotherapy, N-status, T-stage, age and gender was evaluated using Cox's regression models, Kaplan-Meier survival curves and chi-square test. The expression of 23 CXC-chemokine ligands and their receptors were evaluated in all patients using microarray and qPCR and correlated with response to treatment using logistic regression. Pathological response to radiotherapy was independently associated to overall survival with a 2-year survival probability of 81 % for patients showing a complete pathological response, while patients with a non-complete response only had a probability of 42 % to survive for 2 years (p = 0.016). The expression of one CXC-chemokine, CXCL10, was significantly associated with response to radiotherapy and the group of patients with the highest CXCL10 expression responded, especially poorly (p = 0.01). CXCL10 is a potential marker for response to radiotherapy and overall survival in patients with squamous cell carcinoma of the tongue

Dysregulation of heat shock protein 27 expression in oral tongue squamous cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Recent proteomic studies identified Hsp27 as a highly over-expressed protein in oral squamous cell carcinoma (OSCC). Clinical studies that attempted to evaluate the prognostic values of Hsp27 yielded inconsistent results, which may be due to inclusion of OSCC cases from multiple anatomic sites. In this study, to determine the utility of Hsp27 for prognosis, we focused on oral tongue SCC (OTSCC), one of the most aggressive forms of OSCC.</p> <p>Methods</p> <p>Archival clinical samples of 15 normal oral tongue mucosa, 31 dysplastic lesions, 80 primary OTSCC, and 32 lymph node metastases were examined for Hsp27 expression by immunohistochemistry (IHC). Statistical analyses were carried out to assess the prognostic value of Hsp27 expression for patients with this disease.</p> <p>Results</p> <p>Dysregulation of Hsp27 expression was observed in dysplastic lesions, primary OTSCC, and lymph node metastases, and appears to be associated with disease progression. Statistical analysis revealed that the reduced Hsp27 expression in primary tumor tissue was associated with poor differentiation. Furthermore, the higher expression of Hsp27 was correlated with better overall survival.</p> <p>Conclusion</p> <p>Our study confirmed that the dysregulation of Hsp27 expression is a frequent event during the progression of OTSCC. The expression of Hsp27 appears to be an independent prognostic marker for patients with this disease.</p

Ki-67 expression predicts locoregional recurrence in stage I oral tongue carcinoma

Oral tongue squamous cell carcinoma (OTSCC) is an aggressive cancer associated with poor prognosis. Methods for determining the aggressiveness of OTSCC from analysis of the primary tumour specimen are thus highly desirable. We investigated whether genomic instability and proliferative activity (by means of Ki-67 activity) could be of clinical use for prediction of locoregional recurrence in 76 pretreatment OTSCC paraffin samples (stage I, n=22; stage II, n=33; stage III, n=8; stage IV, n=13). Eleven surgical tumour specimens were also analysed for remnants of proliferative activity after preoperative radiotherapy. Ninety-seven percent of cases (n=72) were characterised as being aneuploid as measured by means of image cytometry. Preoperative radiotherapy (50–68 Gy) resulted in significant reduction of proliferative activity in all patients for which post-treatment biopsies were available (P-value=0.001). Proliferative activity was not associated with response to radiation in stage II patients. However, we report a significant correlation between high proliferation rates and locoregional recurrences in stage I OTSCC patients (P-value=0.028). High-proliferative activity is thus related to an elevated risk of recurrence after surgery alone. We therefore conclude that Ki-67 expression level is a potentially useful clinical marker for predicting recurrence in surgically treated stage I OTSCC

The proportion of cancer-related entries in PubMed has increased considerably; is cancer truly "The Emperor of All Maladies"?

In this work, the public database of biomedical literature PubMed was mined using queries with combinations of keywords and year restrictions. It was found that the proportion of Cancer-related entries per year in PubMed has risen from around 6% in 1950 to more than 16% in 2016. This increase is not shared by other conditions such as AIDS, Malaria, Tuberculosis, Diabetes, Cardiovascular, Stroke and Infection some of which have, on the contrary, decreased as a proportion of the total entries per year. Organ-related queries were performed to analyse the variation of some specific cancers. A series of queries related to incidence, funding, and relationship with DNA, Computing and Mathematics, were performed to test correlation between the keywords, with the hope of elucidating the cause behind the rise of Cancer in PubMed. Interestingly, the proportion of Cancer-related entries that contain "DNA", "Computational" or "Mathematical" have increased, which suggests that the impact of these scientific advances on Cancer has been stronger than in other conditions. It is important to highlight that the results obtained with the data mining approach here presented are limited to the presence or absence of the keywords on a single, yet extensive, database. Therefore, results should be observed with caution. All the data used for this work is publicly available through PubMed and the UK's Office for National Statistics. All queries and figures were generated with the software platform Matlab and the files are available as supplementary material

Training and learning in Emergo Train System®

Emergo Train System® är ett simuleringsverktyg som används för övningar i katastrofmedicin och krisberedskap. Syftet med denna studie är att undersöka hur bekväma instruktörer i Emergo Train System känner sig med att hålla i ETS-övningar efter sin utbildning, och att undersöka vad deltagare i instruktörernas övningar tycker om verktyget och övningarna. Datainsamlingen skedde i form av enkäter och två semistrukturerade intervjuer. Resultaten visade att instruktörer är nöjda med sin utbildning, och att de upplever att de efter utbildningen hade fått tillräcklig kunskap för att sätta upp egna övningar. En stor trygghet för instruktörerna låg även i att kunna vända sig till varandra för stöd och problemlösning. Deltagarna i övningarna upplevde att träning med ETS var lärorikt och relevant för deras arbete. Den här studien har gett en utgångspunkt till att få förståelse för hur instruktörer och deltagare i ETS-övningar upplever sin beredskap efter att ha övat med Emergo Train System. Det är däremot relevant att utföra vidare studier om ämnet, med fler deltagare, för att få en tydligare uppfattning om hur det ser ut ute på sjukhusen.

Training and learning in Emergo Train System®

Emergo Train System® är ett simuleringsverktyg som används för övningar i katastrofmedicin och krisberedskap. Syftet med denna studie är att undersöka hur bekväma instruktörer i Emergo Train System känner sig med att hålla i ETS-övningar efter sin utbildning, och att undersöka vad deltagare i instruktörernas övningar tycker om verktyget och övningarna. Datainsamlingen skedde i form av enkäter och två semistrukturerade intervjuer. Resultaten visade att instruktörer är nöjda med sin utbildning, och att de upplever att de efter utbildningen hade fått tillräcklig kunskap för att sätta upp egna övningar. En stor trygghet för instruktörerna låg även i att kunna vända sig till varandra för stöd och problemlösning. Deltagarna i övningarna upplevde att träning med ETS var lärorikt och relevant för deras arbete. Den här studien har gett en utgångspunkt till att få förståelse för hur instruktörer och deltagare i ETS-övningar upplever sin beredskap efter att ha övat med Emergo Train System. Det är däremot relevant att utföra vidare studier om ämnet, med fler deltagare, för att få en tydligare uppfattning om hur det ser ut ute på sjukhusen.

Oral and Oropharyngeal Cancer - Aspects on Epidemiology and Prognostic Markers

Head and neck cancer is a heterogeneous group of tumours, although histopathologically, >95% are squamous cell carcinomas (SCC). Some tumours respond better to therapy than others. Not enough is known to predict the outcome and tailor individualised treatment. Although one of the main risk factors, smoking, has decreased over the last decades, some head and neck cancer groups show increasing incidence. Oral and oropharyngeal SCC (OOPHSCC) are amongst them. High risk human papillomavirus (HPV) has been reported to be found in a high proportion of OOPHSCC, especially in oropharyngeal cancers. It is presumed to be the reason for the incidence increase of oropharyngeal SCC, but not for oral SCC. Many studies, but not all, show better survival for patients with HPV positive tumours. Different methods for HPV detection are being used, making it difficult to compare results. Alpha B-crystallin, a small heat-shock protein, has in a previous study been found to be an independent prognostic marker for poor outcome in head and neck SCC. This thesis aimed to investigate the epidemiological changes for tongue cancer in the Nordic countries and to compare some possible predictive factors for OOPHSCC. During the period 1960-1994, an incidence increase in SCC of the mobile tongue in all ages, except for women aged 65-79, was observed. Data including site and histology was obtained from the national cancer registries. The increase was most pronounced in young adults (20-39 years), with a five-fold increase in men and a six-fold increase in women. Young adults had a significantly better crude, as well as relative, survival compared to older patients. In a follow-up study, the incidence trends were studied, extending the study period by 14 years, extracting data from the NORDCAN registry. The incidence increase continued for all ages, except for in young adult men. In a consecutive series of 128 OOPHSCC, no difference in five year survival was found between patients with HPV positive and HPV negative tumours. Sample collection method was by cotton tipped swab and mouth wash (SMC). When 91 patients from the same study population were analysed, instead using formalin fixed paraffin embedded tissue from their diagnostic biopsies (FFPE), again no survival difference was found. The rate of inconsistent results between SMC and FFPE was 27%. In a set of 55 OOPHSCC, alpha B-crystallin was found to be a strong independent prognostic marker for poor prognosis in oral SCC, but not in oropharyngeal SCC. The findings highlight the fact that more and more differences between oral and oropharyngeal SCC are being revealed