Stereotactic body radiation therapy of primary lung cancer and metastases

Stereotactic body radiation therapy (SBRT) has been assessed by both retrospective and prospective studies showing excellent treatment outcome with acceptable toxicity and high grade of local control. However, late presenting effects as well as further evaluating toxic effects in relation to dose-volume parameters at high-fraction doses and clinical characteristics is of the utmost importance in order to further develop the clinical application of this method. Study I is a retrospective study of 29 patients (32 lesions) who were treated between 1994 and 2004 with reirradiation with SBRT of a previously treated SBRT-lung target. Reirradiation was defined as >50% overlap of the previously treated target. The primary aim was to evaluate toxicity. Serious toxicity was scored in 11 patients, with the toxic effects being lethal for three patients. Noted risk factors for serious toxicity were central location, large CTV and shorter time between the first treatment and the reirradiation. As concluded from the analysis, reirradiation of a peripherally located lung target is feasible, whereas careful consideration should be taken before reirradiating a centrally located target. In study II, we reported on an extended follow-up of a prospectively collected patient cohort with medically inoperable stage I non-small cell lung cancer (NSCLC) treated curatively with SBRT, 15Gyx3. Between 2003 and 2005, 57 patients were included in this study. Long-term follow-up aimed to evaluate late presenting (def. >36 months) effects and toxicity. Five-yearlocal control and overall survival were 79% and 30% respectively. Three patients had late presenting grade 3 toxicity possibly attributed to their treatment. In conclusion, long-term results of SBRT are excellent and support the further use of SBRT for medically inoperable cases, the shorter survival however, is a limitation, possibly hiding late presenting effects. Study III is a retrospective study of SBRT-treated adrenal metastases, whose objective was an evaluation of local control and toxicity. Fifty-eight patients with 62 adrenal metastases from various origins were treated between 1999 and 2013 and are included in this analysis. The median prescribed BED10 was 80Gy (24-113). Two-year local control rate (based on 60 evaluable tumors) was 87% and grade 3-4 toxicity occurred in 12% of the patients, the majority emanating from gastrointestinal organs. Treating adrenal metastases could render a high grade of local control, which has to be balanced against the risk of toxicity. The clinical challenge is to select the patients truly benefiting from the treatment with disease control and long-term survival. In study IV, 57 patients with 61 SBRT-treated apically located lung tumors, defined as the center of the tumor located above the aortic arch, were retrospectively collected. Here the primary aim was to evaluate radiation induced brachial plexopathy (RIBP). Seven patients presented grade 2-3 RIBP; 3 suffering from sensory/motor deficit and 4 from isolated pain. A normal tissue complication probability (NTCP) model was fitted to the data, the BED3,max NTCP-model did show the best fit. As concluded from this analysis, the brachial plexus has to be considered as a risk organ and a dose-constraint of D-max ≤30Gy to the plexus for a threefraction treatment may be advisable

Characterization of the hupSL promoter activity in Nostoc punctiforme ATCC 29133

<p>Abstract</p> <p>Background</p> <p>In cyanobacteria three enzymes are directly involved in the hydrogen metabolism; a nitrogenase that produces molecular hydrogen, H₂, as a by-product of nitrogen fixation, an uptake hydrogenase that recaptures H₂and oxidize it, and a bidirectional hydrogenase that can both oxidize and produce H₂.<it>Nostoc punctiforme </it>ATCC 29133 is a filamentous dinitrogen fixing cyanobacterium containing a nitrogenase and an uptake hydrogenase but no bidirectional hydrogenase. Generally, little is known about the transcriptional regulation of the cyanobacterial uptake hydrogenases. In this study gel shift assays showed that NtcA has a specific affinity to a region of the <it>hupSL </it>promoter containing a predicted NtcA binding site. The predicted NtcA binding site is centred at 258.5 bp upstream the transcription start point (tsp). To further investigate the <it>hupSL </it>promoter, truncated versions of the <it>hupSL </it>promoter were fused to either <it>gfp </it>or <it>luxAB</it>, encoding the reporter proteins Green Fluorescent Protein and Luciferase, respectively.</p> <p>Results</p> <p>Interestingly, all <it>hupsSL </it>promoter deletion constructs showed heterocyst specific expression. Unexpectedly the shortest promoter fragment, a fragment covering 57 bp upstream and 258 bp downstream the tsp, exhibited the highest promoter activity. Deletion of the NtcA binding site neither affected the expression to any larger extent nor the heterocyst specificity.</p> <p>Conclusion</p> <p>Obtained data suggest that the <it>hupSL </it>promoter in <it>N. punctiforme </it>is not strictly dependent on the upstream NtcA cis element and that the shortest promoter fragment (-57 to tsp) is enough for a high and heterocyst specific expression of <it>hupSL</it>. This is highly interesting because it indicates that the information that determines heterocyst specific gene expression might be confined to this short sequence or in the downstream untranslated leader sequence.</p

Culturally sensitive active ageing seen through the lens of the welfare theory of health: assistant nurses' views

Assistant nurses caring for older adults with immigrant backgrounds are on the front lines of a practical, theoretical, and policy battlefield. They need to implement culturally sensitive care provision while not overstating the importance of culture, thereby, contributing to a negative picture of older immigrants as especially problematic. One proposed way to strike such a balance is the welfare theory of health (WTH). In this article, we let assistant nurses apply the WTH to a series of questions in four different vignettes representing the life stories of older persons who characterize typical dilemmas described by the theory. The results show that, through the lens of the WTH, assistant nurses looked for individual care preferences rather than stereotypical ideas about cultural characteristics. Further, the assistant nurses expressed a desire to get to know the persons more deeply to better interpret and understand their individual preferences. Thus, the theoretical framework is useful not only for exposing vulnerabilities to which some older adults with immigrant backgrounds may be exposed, but also for finding ways to mitigate the vulnerability by illuminating vital life goals and using them as a framework to organize care. This approach allows for mitigating the gap between the vital life goals and available resources to achieve a holistic state of health

Spotting good ageing: using welfare theory of health to frame the agency of older adults with immigrant backgrounds to attain good ageing

Care providers for older immigrants in Sweden find themselves in a paradox. Individuals and associations call for culturally sensitive elderly care. However, implementing this comes at the risk of over-culturizing needs and behaviours, drawing a negative picture of 'the problem of immigrants' that needs to be solved with special interventions. To find a balance in this paradox, we applied the welfare theory of health to grasp a new understanding of the phenomena and draw a holistic picture of a person's needs and resources available to achieve good ageing, reaching beyond the cultural paradox. Semi-structured qualitative interviews were conducted with older adults with immigrant backgrounds in Sweden. The interviews were analysed using content analysis. Combining welfare theory of health with immaterial capital theories offered a holistic theoretical approach to good ageing. This took its departure from the agency of older adults, mitigating the gap between their vital life goals and available resources to reach these goals. Although informants wanted caring interventions from close family, we identified distinct responses to mitigate the diminished trust older adults had in the capability of welfare institutions to provide adequate elderly care

Investigations of a Possible Chemical Effect of Salvadora persica

Salvadora persica is commonly used chewing sticks in many parts of the world as an oral hygiene tool. This study measured the amount of benzyl isothiocyanate (BITC) released into the mouth and assessed its retention time in saliva. The study also tested if the released amount of BITC could potentially be antibacterial or cytotoxic. Twelve subjects brushed their teeth with fresh Miswak once, twice, and four times. The amount of BITC in the saliva and in the used brushes was quantified using gas chromatography-mass spectrometry. The antibacterial effect of BITC and Miswak essential oil (MEO) was tested against Haemophilus influenzae, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis. The cytotoxic effect on gingival fibroblasts and keratinocytes was tested using MTT. The highest amount of the active compounds was detected in saliva after using the Miswak tip for once and immediately. It significantly decreased when the Miswak tip was used more than once and thus after 10 min. The growth of the tested bacteria was inhibited by MEO and BITC in a dose dependent manner, P. gingivalis being the most sensitive. MTT assay showed that BITC and MEO were cytotoxic towards gingival fibroblasts while oral keratinocytes showed resistance. This study suggests that the Miswak tip should be cut before each use to ensure the maximum effect

Mobbning och social stöd från lärare och klasskamrater: En longitudinell studie av barns erfarenheter av mobbning

Syftet med studien är att undersöka elevers utvecklingsvägar när det gäller upplevd utsatthet för mobbning samt att undersöka hur dessa olika utvecklingsvägar är relaterade till elevers upplevda sociala stöd från lärare och klasskamrater. En longitudinell design tillämpades där 3349 svenska elever i årskursena fyra till nio, besvarade en enkät vid två olika tillfällen, separerat med ett år. Fyra olika grupper kunde identifieras inom datamaterialet (1) ej utsatta elever, elever som inte var utsatta för mobbning vid något av mättillfällena, (2) undkomna offer, elever vars situation förändrades till det bättre, (3) nya offer, elever vars situation försämrades samt (4) fortsatt utsatta elever, elever som var utsatta för mobbning under hela mätperioden. Barn som aldrig varit utsatta för mobbning rapporterade de högsta nivåerna av upplevt socialt stöd från lärare såväl som klasskamrater vid mätning två. Gällande socialt stöd från klasskamrater hade undkomna offer högre nivåer än såväl nya som fortsatt utsatta elever. De nådde dock inte upp till samma nivå som de elever som aldrig varit utsatta för mobbning under mät­perioden. När det gäller lärarstöd fanns dock inga signifikanta skillnader mellan de elever som undkommit mobbning, nya offer eller fortsatt utsatta elever

A Model System for In Vitro Studies of Bank Vole Borne Viruses

The bank vole (Myodes glareolus) is a common small mammal in Europe and a natural host for several important emerging zoonotic viruses, e.g. Puumala hantavirus (PUUV) that causes hemorrhagic fever with renal syndrome (HFRS). Hantaviruses are known to interfere with several signaling pathways in infected human cells, and HFRS is considered an immune-mediated disease. There is no in vitro-model available for infectious experiments in bank vole cells, nor tools for analyses of bank vole immune activation and responses. Consequently, it is not known if there are any differences in the regulation of virus induced responses in humans compared to natural hosts during infection. We here present an in vitro-model for studies of bank vole borne viruses and their interactions with natural host cell innate immune responses. Bank vole embryonic fibroblasts (VEFs) were isolated and shown to be susceptible for PUUV-infection, including a wild-type PUUV strain (only passaged in bank voles). The significance of VEFs as a model system for bank vole associated viruses was further established by infection studies showing that these cells are also susceptible to tick borne encephalitis, cowpox and Ljungan virus. The genes encoding bank vole IFN-β and Mx2 were partially sequenced and protocols for semi-quantitative RT-PCR were developed. Interestingly, PUUV did not induce an increased IFN-β or Mx2 mRNA expression. Corresponding infections with CPXV and LV induced IFN-β but not Mx2, while TBEV induced both IFN-β and Mx2

Culturally sensitive active ageing seen through the lens of the welfare theory of health: assistant nurses’ views

Assistant nurses caring for older adults with immigrant backgrounds are on the front lines of a practical, theoretical, and policy battlefield. They need to implement culturally sensitive care provision while not overstating the importance of culture, thereby, contributing to a negative picture of older immigrants as especially problematic. One proposed way to strike such a balance is the welfare theory of health (WTH). In this article, we let assistant nurses apply the WTH to a series of questions in four different vignettes representing the life stories of older persons who characterize typical dilemmas described by the theory. The results show that, through the lens of the WTH, assistant nurses looked for individual care preferences rather than stereotypical ideas about cultural characteristics. Further, the assistant nurses expressed a desire to get to know the persons more deeply to better interpret and understand their individual preferences. Thus, the theoretical framework is useful not only for exposing vulnerabilities to which some older adults with immigrant backgrounds may be exposed, but also for finding ways to mitigate the vulnerability by illuminating vital life goals and using them as a framework to organize care. This approach allows for mitigating the gap between the vital life goals and available resources to achieve a holistic state of health

Ett miljöanpassat informationssamhälle 2020

Rapport från regeringens IT-politiska strategigrupp