Retrospective single-center study on elderly patients with glioblastoma between 2014 and 2018 evaluating the effect of age and performance status on survival

Background Incidence of glioblastoma (GBM) increases with age and the prognosis is worse among the elderly. This was shown in a Finnish population-based register study evaluating GBM patients diagnosed between 2000 and 2013. The median overall survival (OS) was poor among the elderly (4.5 months), despite the OS increase during that period. We conducted a study to see if the OS has increased in our hospital area with current therapies. Methods One hundred and ninety-eight patients over 65 years at the time of diagnosis, with malignant glioma diagnosed January 1, 2014 to December 31, 2018 at the Helsinki Comprehensive Cancer Center were included. In addition to grade IV gliomas, grade III gliomas with nonmutated R132HIDH1 and only radiographically diagnosed gliomas were included. The demographics and treatment data were collected with performance status evaluated retrospectively. The Kaplan-Meier method and the multivariate Cox proportional hazard model were used for the statistical analysis. Results One hundred and seventy-seven patients with grade IV glioma, 6 with grade III glioma with nonmutated IDH1 and 15 radiologically diagnosed patients were included. One hundred and sixteen patients received chemoradiation, 59 only radiotherapy, 3 only temozolomide, and 27 patients did not receive oncological treatments. In the age group 65-70 years the OS was 9.95 months, 70-75 years 10.12 months, and >75 years 5.54 months. Lower WHO status correlated with longer survival independently of the age of the patient. Also methylated O(6)-methylguanine-DNA-methyltransferase and tumor resection correlated with better survival. Conclusions The performance status of elderly patients is the most important prognostic factor. When choosing treatment protocols for patients in this age group, the performance status not calendar age should be considered.Peer reviewe

Sinisestä biotaloudesta elinvoimaa Koillismaalle -työpaja

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Reduction of FENO by tap water and carbonated water mouthwashes : magnitude and time course

Fractional exhaled nitric oxide (F-ENO) assesses eosinophilic inflammation of the airways, but F-ENO values are also influenced by oral nitric oxide (NO). The aim of this pilot study was to measure F-ENO and compare the effect of two different mouthwashes on F-ENO and analyse the duration of the effect. F-ENO was measured in 12 randomized volunteers (healthy or asthmatic subjects) with a NIOX VERO (R) analyser at an expiratory flow rate of 50mL/s. After a baseline measurement, a mouthwash was performed either with tap water or carbonated water and was measured during 20min in 2min intervals. The procedure was repeated with the other mouthwash. We found that both mouthwashes reduced F-ENO immediately at the beginning compared to the baseline (pPeer reviewe

Work-Related Exposures and Sickness Absence Trajectories: A Nationally Representative Follow-up Study among Finnish Working-Aged People

The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30–59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002–2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43–0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with ≥4 physical workload factors (OR 2.71; 95% CI 1.99–3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors

Traumatic lumbar punctures in diagnostic and intrathecal treatment punctures of pediatric hemato-oncology patients

Successful first diagnostic lumbar puncture (LP) is crucial because intrathecal chemotherapy has not yet protected the central nervous system against cancer cells. If blood contaminates the cerebrospinal fluid (CSF) with blasts, they may enter the central neural system and compromise the patient's health. We retrospectively determined the incidence of traumatic lumbar punctures (TLP) in 2,507 LPs of 250 pediatric hemato-oncology patients aged from one to 18 years, including both diagnostic and intrathecal treatment procedures, and 2,617 LPs of 1,525 other age-matched pediatric patients. We used >= 10 erythrocytes/mu L in the CSF sample as the criterion of TLP. TLPs were less frequent in hemato-oncology patients than in other patients (31.6% vs. 48.5%, p < 0.0001). The incidence of TLP was significantly lower in the first diagnostic LP than in subsequent intrathecal treatment LPs (20.5% vs. 31.6%, p = 0.0046). According to logistic regression analysis, the odds of TLP was 1.6-fold if the LP procedure was not performed in the hemato-oncology department. The odds of the patient's next LP being traumatic were threefold if the previous first LP was traumatic. A week or less time between the first and next LP tripled the odds of TLP as well. The patient's age category was not significantly associated with the incidence of TLP. Given the risks of TLP, hemato-oncology patients' first diagnostic LP should include administration of chemotherapy, as generally recommended, and be performed under general anesthesia or deep sedation by an experienced physician to optimize not only the success of the first LP procedure but also following procedures

Work-Related Exposures and Sickness Absence Trajectories: A Nationally Representative Follow-up Study among Finnish Working-Aged People

The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30–59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002–2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43–0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with ≥4 physical workload factors (OR 2.71; 95% CI 1.99–3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors

Kun aivokasvain on hoidettu - seuranta, kuntoutus, ajo- ja työkykyarvio

Vertaisarvioitu. Teema : aivokasvaimet. English summary.Suomessa ei ole yhtenäistä seurantaohjelmaa aivokasvainten hoidon jälkeen. Sairaanhoitopiirin mukaan päävastuu seurannasta voi olla neurokirurgilla, onkologilla tai neurologilla. Tässä artikkelissa esitämme, kuinka aivokasvaimen hoidon jälkeinen seuranta on järjestetty Helsingin ja Uudenmaan sairaanhoitopiirissä. Tämä seurantamalli on syntynyt Syöpäkeskuksen, neurologian ja neurokirurgian klinikoiden yhteistyön tuloksena, ja on osoittautunut toimivaksi. Seurantaan kuuluvat paitsi aivojen seurantamagneettikuvantamiset tietyin väliajoin, myös oireiden, kuten epilepsian hoito ja seuranta, kuntoutus, työkyky- ja ajokykyarviot. Oleellista seurannan aikana on, että potilaille ja heidän perheilleen järjestyy heidän tarvitsemansa sosiaaliturva ja että he saavat riittävästi myös psykososiaalista tukea.Peer reviewe

Adaptation to climate change in Finland : Current state and future prospects

The KOKOSOPU project has aimed at a comprehensive evaluation of the national adaptation policy with particular emphasis on the National Adaptation Plan and international policy development. In addition, future challenges related to societal development have been taken into account. Projections of climate change, Finland’s Climate Act and the strengthened adaptation policy in the EU emphasise the importance of the national adaptation policy. A key objective of the National Adaptation Plan 2014–2022 was to strengthen the adaptive capacity of Finnish society. This objective is still relevant. The conditions for reaching the objective have, however, partly changed. First, cross border consequences of climate change are increasingly emphasised. Second, issues of justice and fairness with respect to the consequences of climate change and adaptation actions are being identified as central. Third, greater weight is given to the overall sustainability of adaptation and climate action. The changing conditions for climate change adaptation should be reflected in the allocation of resources, in improved coordination within the administration and in co-operation between the public and private sector. In addition, knowledge and education should be enhanced, and resources provided for RDI, and for monitoring and evaluation that supports continued improvement of adaptation activities

Adaptation to climate change in Finland : Current state and future prospects

The KOKOSOPU project has aimed at a comprehensive evaluation of the national adaptation policy with particular emphasis on the National Adaptation Plan and international policy development. In addition, future challenges related to societal development have been taken into account. Projections of climate change, Finland’s Climate Act and the strengthened adaptation policy in the EU emphasise the importance of the national adaptation policy. A key objective of the National Adaptation Plan 2014–2022 was to strengthen the adaptive capacity of Finnish society. This objective is still relevant. The conditions for reaching the objective have, however, partly changed. First, cross border consequences of climate change are increasingly emphasised. Second, issues of justice and fairness with respect to the consequences of climate change and adaptation actions are being identified as central. Third, greater weight is given to the overall sustainability of adaptation and climate action. The changing conditions for climate change adaptation should be reflected in the allocation of resources, in improved coordination within the administration and in co-operation between the public and private sector. In addition, knowledge and education should be enhanced, and resources provided for RDI, and for monitoring and evaluation that supports continued improvement of adaptation activities

Effect of Adjuvant Trastuzumab for a Duration of 9 Weeks vs 1 Year With Concomitant Chemotherapy for Early Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer The SOLD Randomized Clinical Trial

IMPORTANCE Trastuzumab plus chemotherapy is the standard adjuvant treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. While the standard duration of trastuzumab treatment is 12 months, the benefits and harms of trastuzumab continued beyond the chemotherapy are unclear. OBJECTIVE To evaluate the efficacy and safety of adjuvant trastuzumab continued beyond chemotherapy in women treated with up-front chemotherapy containing a taxane and trastuzumab. DESIGN, SETTING, AND PARTICIPANTS Open-label, randomized (1: 1) clinical trial including women with HER2-positive breast cancer. Chemotherapy was identical in the 2 groups, consisting of 3 cycles of 3-weekly docetaxel (either 80 or 100 mg/m(2)) plus trastuzumab for 9 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide. Thereafter, no trastuzumab was administered in the 9-week group, whereas controls received trastuzumab to complete 1 year of administration. Disease-free survival (DFS) was compared between the groups using a Cox model and the noninferiority approach. The estimated sample size was 2168 patients (1-sided testing, with a relative noninferiority margin of 1.3). From January 3, 2008, to December 16, 2014, 2176 patients were accrued from 7 countries. INTERVENTION Docetaxel plus trastuzumab for 9 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide in both groups. Controls continued trastuzumab to 1 year. MAIN OUTCOMES AND MEASURES The primary objectivewas DFS; secondary objectives included distant disease-free survival, overall survival, cardiac DFS, and safety. RESULTS In the 2174 women analyzed, median age was 56 (interquartile range [IQR], 48-64) years. The median follow-up was 5.2 (IQR, 3.8-6.7) years. Noninferiority of the 9-week treatment could not be demonstrated for DFS (hazard ratio, 1.39; 2-sided 90% CI, 1.12-1.72). Distant disease-free survival and overall survival did not differ substantially between the groups. Thirty-six (3%) and 21 (2%) patients in the 1-year and the 9-week groups, respectively, had cardiac failure; the left ventricle ejection fraction was better maintained in the 9-week group. An interaction was detected between the docetaxel dose and DFS; patients in the 9-week group treated with 80 mg/m(2) had inferior and those treated with 100 mg/m(2) had similar DFS as patients in the 1-year group. CONCLUSIONS AND RELEVANCE Nine weeks of trastuzumab was not noninferior to 1 year of trastuzumab when given with similar chemotherapy. Cardiac safety was better in the 9-week group. The docetaxel dosing with trastuzumab requires further study.Peer reviewe