Predictive Factors Associated with Declining Psycho-Oncological Support in Patients with Cancer

(1) Background: International cancer treatment guidelines recommend low-threshold psycho-oncological support based on nurses’ routine distress screening (e.g., via the distress thermometer and problem list). This study aims to explore factors which are associated with declining psycho-oncological support in order to increase nurses’ efficiency in screening patients for psycho-oncological support needs. (2) Methods: Using machine learning, routinely recorded clinical data from 4064 patients was analyzed for predictors of patients declining psycho-oncological support. Cross validation and nested resampling were used to guard against model overfitting. (3) Results: The developed model detects patients who decline psycho-oncological support with a sensitivity of 89% (area under the cure of 79%, accuracy of 68.5%). Overall, older patients, patients with a lower score on the distress thermometer, fewer comorbidities, few physical problems, and those who do not feel sad, afraid, or worried refused psycho-oncological support. (4) Conclusions: Thus, current screening procedures seem worthy to be part of daily nursing routines in oncology, but nurses may need more time and training to rule out misconceptions of patients on psycho-oncological support

Injuries in alpine summer sports - types, frequency and prevention: a systematic review.

INTRODUCTION Summer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group. METHOD Literature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed. RESULTS A broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement

Expression of 3q Oncogene SEC62 Predicts Survival in Head and Neck Squamous Cell Carcinoma Patients Treated with Primary Chemoradiation

Primary chemoradiotherapy (CRT) is an established treatment option for locally advanced head and neck squamous cell carcinomas (HNSCC) usually combining intensity modified radiotherapy with concurrent platinum-based chemotherapy. Though the majority of patients can be cured with this regimen, treatment response is highly heterogeneous and can hardly be predicted. SEC62 represents a metastasis stimulating oncogene that is frequently overexpressed in various cancer entities and is associated with poor outcome. Its role in HNSCC patients undergoing CRT has not been investigated so far. A total of 127 HNSCC patients treated with primary CRT were included in this study. The median follow-up was 5.4 years. Pretherapeutic tissue samples of the primary tumors were used for immunohistochemistry targeting SEC62. SEC62 expression, clinical and histopathological parameters, as well as patient outcome, were correlated in univariate and multivariate survival analyses. High SEC62 expression correlated with a significantly shorter overall survival (p = 0.015) and advanced lymph node metastases (p = 0.024). Further significant predictors of poor overall and progression-free survival included response to therapy (RECIST1.1), nodal status, distant metastases, tobacco consumption, recurrence of disease, and UICC stage. In a multivariate Cox hazard proportional regression analysis, only SEC62 expression (p = 0.046) and response to therapy (p < 0.0001) maintained statistical significance as independent predictors of the patients’ overall survival. This study identified SEC62 as an independent prognostic biomarker in HNSCC patients treated with primary CRT. The role of SEC62 as a potential therapeutic target and its interaction with radiation-induced molecular alterations in head and neck cancer cells should further be investigated

Comparison and optimization of sheep in vivo intervertebral disc injury model.

Background The current standard of care for intervertebral disc (IVD) herniation, surgical discectomy, does not repair annulus fibrosus (AF) defects, which is partly due to the lack of effective methods to do so and is why new repair strategies are widely investigated and tested preclinically. There is a need to develop a standardized IVD injury model in large animals to enable comparison and interpretation across preclinical study results. The purpose of this study was to compare in vivo IVD injury models in sheep to determine which annulus fibrosus (AF) defect type combined with partial nucleus pulposus (NP) removal would better mimic degenerative human spinal pathologies. Methods Six skeletally mature sheep were randomly assigned to one of the two observation periods (1 and 3 months) and underwent creation of 3 different AF defect types (slit, cruciate, and box-cut AF defects) in conjunction with 0.1 g NP removal in three lumbar levels using a lateral retroperitoneal surgical approach. The spine was monitored by clinical CT scans pre- and postoperatively, at 2 weeks and euthanasia, and by magnetic resonance imaging (MRI) and histology after euthanasia to determine the severity of degeneration (disc height loss, Pfirrmann grading, semiquantitative histopathology grading). Results All AF defects led to significant degenerative changes detectable on CT and MR images, produced bulging of disc tissue without disc herniation and led to degenerative and inflammatory histopathological changes. However, AF defects were not equal in terms of disc height loss at 3 months postoperatively; the cruciate and box-cut AF defects showed significantly decreased disc height compared to their preoperative height, with the box-cut defect creating the greatest disc height loss, while the slit AF defect showed restoration of normal preoperative disc height. Conclusions The tested IVD injury models do not all generate comparable disc degeneration but can be considered suitable IVD injury models to investigate new treatments. Results of the current study clearly indicate that slit AF defect should be avoided if disc height is used as one of the main outcomes; additional confirmatory studies may be warranted to generalize this finding

The cell biology of vision

Humans possess the remarkable ability to perceive color, shape, and motion, and to differentiate between light intensities varied by over nine orders of magnitude. Phototransduction—the process in which absorbed photons are converted into electrical responses—is the first stage of visual processing, and occurs in the outer segment, the light-sensing organelle of the photoreceptor cell. Studies of genes linked to human inherited blindness have been crucial to understanding the biogenesis of the outer segment and membrane-trafficking of photoreceptors

Balancing repair and tolerance of DNA damage caused by alkylating agents

Alkylating agents constitute a major class of frontline chemotherapeutic drugs that inflict cytotoxic DNA damage as their main mode of action, in addition to collateral mutagenic damage. Numerous cellular pathways, including direct DNA damage reversal, base excision repair (BER) and mismatch repair (MMR), respond to alkylation damage to defend against alkylation-induced cell death or mutation. However, maintaining a proper balance of activity both within and between these pathways is crucial for a favourable response of an organism to alkylating agents. Furthermore, the response of an individual to alkylating agents can vary considerably from tissue to tissue and from person to person, pointing to genetic and epigenetic mechanisms that modulate alkylating agent toxicity

The impact of vascular lesions in dementia

Vascular dementia (VaD) is a heterogeneous group of brain lesions and vessel disorders. Brain infarcts, microinfarcts, strategic infarcts and white matter lesions have been discussed to play a role. Several different vessels disorders and embolic events can cause these vascular brain lesions. As dementia caused by a single pathology is rarely seen in the elderly brain, vascular lesions are expected to co-occur in cases of neurodegenerative disorders. Therefore, it was necessary to evaluate the impact of vascular lesions in concert with Alzheimer’s Disease (AD)-related pathology in an autopsy study. Here, we studied 212 human autopsy cases for the impact of vascular lesions and underlying vessel disorders in the development of dementing disorders. Macroscopic and microscopic examinations were performed. Clinical data were analyzed to assess the degree of dementia. Types of infarcts and vessel disorders were investigated for its relation with age and prevalences in different age categories. Logistic and linear regression models were applied to clarify the interplay between the pathologies. Atherosclerosis (AS), small vessel disease (SVD), and cerebral amyloid angiopathy (CAA) were shown to be associated with age analyzing distinct prevalences in age categories of this sample. Only the frequency of allocortical microinfarcts increased with age whereas other types of forebrain infarcts showed no significant differences in prevalences of age-related subgroups. AD-related τ- and Aβ-pathology appeared to be the main variables to explain cognitive decline in the elderly. Strategic infarcts/ microinfarcts in the CA1-subiculum region, thereby, contributed significantly in the development of dementia. Gross infarcts and lacunar infarcts had no major impact on the development of dementia, but associations with AS and SVD were shown. The only vessel disorder that had an effect on the dementia-related hippocampal microinfarcts was capillary CAA whereby CAA-affected capillaries were often found outside the infarct presumably exhibiting an important prerequisite for hypoperfusion. Taken together, capillary CAA contributes to the development of dementia probably due to hypoperfusion-induced hippocampal (strategic) microinfarcts. Thus, capillary CAA- and its associated type of Alzheimer’s disease are associated with microinfarcts and hypoperfusion in the hippocampus, which is essential for memory function. Other vessel disorders could not be targeted as major independent contributors to the vascular component of dementia presumably because they spare most frequently the hippocampal formation

Regional determinants of German FDI in the Czech Republic: new evidence on the role of border regions

<p>Regional determinants of German FDI in the Czech Republic: new evidence on the role of border regions. <i>Regional Studies</i>. Using a unique dataset, the regional distribution of German multinationals and their Czech affiliates is analysed. The investigation focuses on locational factors for joint foreign direct investment (FDI) projects that can only be revealed by taking a home-host country perspective. A light is shed on the strong position of the common border region and its asymmetric interconnectedness. While the Czech border region constitutes an attractive target area for investors from all over Germany, multinational firms in the German border region show a significant preference to invest in Czech regions close by, but not so in the non-border regions in the neighbouring country.</p