Evaluation of tumor suppressor gene p53, oncogene c-erbB-2 and matrix-metalloproteinase-9 as prognostic and predictive factors in breast carcinoma

Abstract Breast carcinoma is the most common malignancy in females in western countries. Classical prognostic factors such as the size of a primary tumor and the presence or absence of axillary lymph node metastases, malignancy grade and hormone receptor status reflect the subsequent risk of disease recurrence after primary therapy and the need for adjuvant therapies. However, most breast carcinomas are detected in the early stage of the disease and the value of these classical prognostic factors is limited. There is also a great need to find new factors predicting the clinical efficacy of the anticancer drugs available. In this thesis tumor suppressor gene p53, oncogene c-erbB-2 and matrix metalloproteinase-9 were evaluated for their prognostic relevance in breast carcinoma patients treated in Oulu University Hospital, and matrix metalloproteinase-9 was also analyzed in women with premalignant lesions in the breast tissue in order to examine its role in breast carcinogenesis. Histological analyses were carried out from formalin-fixed, paraffin-embedded primary tumor specimens and p53, c-erbB-2 and matrix metalloproteinase-9 (MMP-9) statuses were systematically analyzed by immunohistochemistry. P53 expression correlated with disease-free survival and overall survival in patients with early-stage breast carcinoma, regardless of adjuvant antiestrogen therapy. The co-expression of p53 and c-erbB-2 characterizes a tumor type with a clinically aggressive course of breast carcinoma. The clinical efficacy of anthracyline-based chemotherapy in metastatic carcinoma might be limited in patients with p53 expression in a primary tumor. When postmenopausal patients with lymph node metastases and receiving adjuvant antiestrogen therapy were examined, MMP-9 expression indicated a slightly greater risk of breast carcinoma recurrence in patients with estrogen receptor negative tumors. Hyperplastic breast tissue and invasive breast carcinoma lesions expressed some MMP-9 immunopositivity. However, the strongest positivity was seen in ductal carcinoma in situ samples, suggesting that MMP-9 participates in breast carcinogenesis in the preinvasive phase

Saattohoito terveyskeskuksen vuodeosastolla

Tiivistelmä Nuori lääkäri kohtaa saattohoidossa olevia potilaita terveyskeskuksen vuodeosastolla työskennellessään. Potilaan hoidossa tarvitaan muutakin kuin lääketieteellistä osaamista, mutta se luo perustan onnistuneelle hoidolle. Työuransa aloittelevaa kollegaa tukee paitsi Käypä hoito -ohjeistuksen tuntemus, myös toimiminen osana osaston moniammatillista tiimiä. Hoidon etukäteissuunnittelu tarkistuslistan mukaisesti ja hoidon tarpeiden muuttumiseen varautuminen parantavat hoidon laatua ja oikea-aikaisuutta. Läheisten huomioiminen on tärkeä osa hoitoa. Kuoleman kohtaaminen on osa lääkärin ammatillisen identiteetin rakentumista.Abstract End of life care at primary care ward End of life care is one essential function of primary health care. Medical treatment of physical symptoms follows national guidelines, but patient centered care includes also emotional support and co-operation with family members. Open communication of end of life issues and working as a member of interdisciplinary team are challenging but also rewarding to a young doctor. Consultation of a palliative care specialist physician is recommended in complex cases

Eutanasia

Abstract Relieving patients’ suffering is the foremost duty of doctors. Whether euthanasia is needed to alleviate difficult suffering or not, has been extensively discussed in Finland. As euthanasia should not be considered only as a philosophical question, this article summarizes studies and reports published in jurisdictions where euthanasia and/or assisted suicide have been legalized and aims to provide data for further discussion among doctors. Rising euthanasia rates and signs of extending euthanasia practices from severely ill patients to other conditions — such as patients with psychiatric diagnoses or elderly people with multiple geriatric diseases without evident limited life expectancy — reveal some complexity of the theme. The authors have a critical view on euthanasia legislation, but promote doctors’ education in palliative care and patients’ equal access to specialized palliative care services in Finland.Tiivistelmä Eutanasia tarkoittaa potilaan surmaamista lääkkeillä hänen pyynnöstään kärsimyksen lopettamiseksi. Eduskunnalle jätetty kansalaisaloite viritti maamme historian vilkkaimman eutanasiakeskustelun. Kärsimyksen lievitys on lääkärintyön ydintehtävä, mutta potilaan elämän lopettamista ei voida sellaisena pitää. Silti muutamissa maissa kollegat toteuttavat eutanasiaa, ja lääkärin rooli on keskeinen eutanasiapäätöksessä. Arvioitaessa eutanasialainsäädännön merkitystä on syytä tarkastella näiden maiden käytäntöjä ja kehitystä

Future palliative competence needs:a qualitative study of physicians’ and registered nurses’ views

Abstract Background: Globally, the need for palliative care will increase as a result of the ageing of populations and the rising burden of cancer, non-communicable diseases as well as some communicable diseases. Physicians and registered nurses working in palliative care should have a sufficient level of education and competence in managing the changing needs and requirements of palliative care. There is, however, need for evidence-based palliative care training and education of physicians and registered nurses. The purpose of this study was to describe the views of physicians and registered nurses regarding future competence needs within palliative care. Methods: The study was conducted through use of a cross-sectional qualitative design. A total of 54 physicians and 110 registered nurses completed an open-ended questionnaire about the future competence needs of palliative care. The data were analyzed using inductive content analysis. Results: The results revealed four main competence needs within palliative care for the coming decade: palliative care competence at all levels within healthcare and social welfare services; individualized palliative care competence; person-centered encounters competence; and systematic competence development within palliative care. Conclusions: The results offer cues for education and professional development, which can be used to support physicians and registered nurses when future palliative care competences are included in educational programs. Seamless cooperation between palliative care services and educational institutions is recommended to ensure that undergraduate and postgraduate education is based on a continuous assessment of competence requirements within the field of palliative care. Therefore, online multi-professional simulations, for example, could be used to enhance future competencies within palliative care; undergraduate medical, nursing and allied healthcare students as well as postgraduate palliative care professionals and experts of experience could work together during simulations

Attention and Working Memory in Adolescents with Autism Spectrum Disorder : A Functional MRI Study

The present study examined attention and memory load-dependent differences in the brain activation and deactivation patterns between adolescents with autism spectrum disorders (ASDs) and typically developing (TD) controls using functional magnetic resonance imaging. Attentional (0-back) and working memory (WM; 2-back) processing and load differences (0 vs. 2-back) were analysed. WM-related areas activated and default mode network deactivated normally in ASDs as a function of task load. ASDs performed the attentional 0-back task similarly to TD controls but showed increased deactivation in cerebellum and right temporal cortical areas and weaker activation in other cerebellar areas. Increasing task load resulted in multiple responses in ASDs compared to TD and in inadequate modulation of brain activity in right insula, primary somatosensory, motor and auditory cortices. The changes during attentional task may reflect compensatory mechanisms enabling normal behavioral performance. The inadequate memory load-dependent modulation of activity suggests diminished compensatory potential in ASD.Peer reviewe