Behandling och överlevnad i Merkelcellskarcinom vid Helsingfors Universitets Centralsjukhus 2010 - 2018 : specifik betoning på adjuvant strålbehandling

Background: Merkel Cell Carcinoma (MCC) is a very rare but lethal skin cancer, most commonly presenting in elderly individuals with fair skin. UV-exposure or infection with the Merkel Cell Polyomavirus are crucial for the MCC pathogenesis. MCC most commonly presents as a local red-pink nodule, usually on UV-exposed skin areas of the head and neck or the extremities. The recommended treatment consists of a surgical tumour resection, a sentinel lymph node biopsy and adjuvant radiation therapy (RT), in metastatic MCC chemotherapy or immunotherapies can be added. Five-year survival is 40 - 70%. The aims for this study was to analyse MCC patients regarding patient and disease characteristics and administered treatments and the effects they pose on disease prognosis, with a special emphasis on radiation therapy. Methods: Data regarding patient and disease characteristics, treatments, disease progression and survival was collected from patient databases regarding all patients diagnosed with MCC at HUH in the period 2010-2018. Statistical analyses were made regarding independent variable effect on survival, with more thorough calulations regarding the effect on adjuvant radiotherapy. Results: 47 patients were included in this study. The mean age was 79 years, 59.6% were female, the primary tumour most commonly in the head and neck area and most patients presented with a local disease. 43 patients had a surgical re-excision, 28 patients received adjuvant RT, one patient was treated with chemotherapy and one with the immunotherapy avelumab. A small tumour size, low stage, lower patient age and treatment with adjuvant RT correlated with improved survival. Two-year survival was 57.1%. The disease specific survival for patients treated with RT was 74.0%, and 51.8% for patients who did not receive RT. Conclusion: The patient cohort was similar to those presented in previous studies. A small primary tumour, local disease, lower age at time of diagnosis and treatment with adjuvant RT was beneficial for survival. MCC is still an aggressive cancer with high mortality, and the administered treatments vary between patients at HUH.Bakgrund: Merkelcellkarcinom (MCC) är en mycket ovanlig men väldigt dödlig hudcancer som främst förekommer hos äldre individer med ljus hudton. Exponering för UV-strålning eller infektion med Merkelcell polyomavirus är centralt för patogenesen. MCC kommer oftast till uttryck som en rosa-röd lokal nodul på UV-exponerade hudområden i hals- och huvudområdet eller extremiteterna. Den rekommenderade behandlingen utgörs av en kirurgisk tumörresektion, portvaktskörtelbiopsi och adjuvant strålbehandling, vid metastaserad sjukdom även av cytostatikabehandling eller immunterapi. Femårsöverlevnaden är 40 - 70%. Studiens syfte var att analysera MCC-patienter gällande patient- och sjukdomskarakteristika och behandlingar samt inverkan de har på sjukdomsprognosen med en specifik betoning på adjuvant strålbehandling. Metoder: Data gällande patient- och sjukdomskarakteristika, behandlingar, sjukdomsprogression och överlevnad samlades in ur patientjournaler gällande alla patienter diagnostiserade med MCC inom HUCS-området 2010-2018. Statiska analyser gjordes gällande oberoende variablers inverkan på överlevnaden, med grundligare kalkyleringar gällande inverkan av adjuvant strålbehandling. Resultat: 47 patienter inkluderades i studien. Medelåldern bland patienterna var 79 år, 59,6% var kvinnor, primärtumören var oftast i huvud-halsområdet och sjukdomen lokal vid diagnostidpunkten. 43 patienter genomgick en kirurgisk tumörresektion, 28 patienter fick adjuvant strålbehandling, en patient behandlades med cytostatika, och en med immunoterapi. En liten tumörstorlek, låg tumörklass, lägre ålder vid diagnostidpunkten och behandling med adjuvant strålbehandling var fördelaktiga för överlevnaden. 2-årsöverlevnaden var 57,1%. Den sjukdomsspecifika 3-årsöverlevnaden för patienter som behandlades med strålbehandling var 74,0%, och för de som inte behandlades med strålbehandling 51,8%. Slutsats: Patientgruppen motsvarade till sina egenskaper det som beskrivits i tidigare litteratur. En liten primärtumör, lokal sjukdom vid diagnos, lägre ålder vid insjuknande samt behandling med adjuvant strålbehandling var fördelaktigt för prognosen. MCC är fortfarande en aggressiv cancer med hög mortalitet och behandlingarna varierar märkbart mellan patienter inom HUCS-området

The Time for Design-Based Research is Right and Right Now

The science-to-service problem continues to taunt the field of education (Fixsen, Blasé, Naoom, & Wallace, 2009). As an academic discipline, the field requires knowledge generation that adds to or deepens theoretical understandings. As a profession, knowledge generation that solves local problems and supports continuous improvement is necessary. Using design-based research (DBR) provides a means of serving theoretical and practical needs in education, addressing the complexity of education by informing immediate practice while simultaneously contributing to theoretical understandings in the field of education. Using Stokes’ (1977) model of scientific research and knowledge generation, we situate DBR within Pasteur’s quadrant, describe how to increase its use, and recommend a new means for dissemination

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

Merkel cell carcinoma (MCC) is a rare cutaneous carcinoma that has gained enormous interest since the discovery of Merkel cell polyoma virus, which is a causative oncogenic agent in the majority of MCC tumours. Increased research has focused on effective treatment options with immuno-oncology. In this study, we reviewed the real-world data on different treatments given to MCC patients in Finland in 1986–2016. We used the Finnish Cancer Registry database to find MCC patients and the Hospital Discharge Register and the Cause-of-Death Register to obtain treatment data. We identified 376 MCC patients and 33 different treatment entities and/or combinations of treatment. An increase was noted in the incidence of MCC since 2005. Therefore, the cohort was divided into two groups: the “early“ group with time of diagnosis between years 1986 and 2004 and the “late” group with time of diagnosis between 2005 and 2016. The multitude of different treatment combinations is a relatively new phenomenon; before the year 2005, only 11 treatments or treatment combinations were used for MCC patients. Our data show that combining radiation therapy with simple excision provided a survival advantage, which was, however, lost after adjustment for stage or age. Our registry study serves as a baseline treatment efficacy comparison as we move into the age of immunotherapy in MCC. Standardizing the treatment of MCC patients in Finland requires more work on awareness and multidisciplinary co-operation

Moose Distribution And Age And Sex Ratios In Northwest Montana As Reported By Hunters At Check Stations

We sought to better document moose (Alces alces) distribution and age and sex ratios in northwest Montana by asking hunters. During the 2010 hunting season we asked all hunters stopping at six check stations if they had seen moose, and if so, where, how many, and if they saw bulls, cows or calves. During the 13 days that check stations were open 17,564 hunters reported 490 sightings totaling 749 moose (313 bulls, 320 cows, 95 calves and 21 unknown) for an average of 1.5 moose per sighting (range 1 - 5). Across all check stations there was an average of 2.8 sightings and 4.3 moose seen per 100 hunters, but this varied from 0.9 sightings and 1.2 moose per 100 hunters at the Swan Check Station to 6.9 sightings and 10.4 moose per 100 hunters at Canoe Gulch. The bulls per 100 cows ratio averaged 98:100 across all check stations but varied from 67:100 at Canoe Gulch to 225:100 at the Swan. Likewise,the calves per 100 cows ratio averaged 30:100 but varied from 8:100 at the Swan to 54:100 at Thompson Falls. Hunter-reported sex and age ratios at the North Fork Check Station agreed with those observed during a post-season helicopter survey in the same area (?2 p = 0.83), but hunter-reported ratios at Olney were significantly higher than those observed by helicopter (?2 p = 0.01). We discuss the difficulty of monitoring moose populations and the pros and cons of helicopter surveys and hunter-reported moose sightings

Morphological Heterogeneity of the Endoplasmic Reticulum within Neurons and Its Implications in Neurodegeneration

The endoplasmic reticulum (ER) is a multipurpose organelle comprising dynamic structural subdomains, such as ER sheets and tubules, serving to maintain protein, calcium, and lipid homeostasis. In neurons, the single ER is compartmentalized with a careful segregation of the structural subdomains in somatic and neurite (axodendritic) regions. The distribution and arrangement of these ER subdomains varies between different neuronal types. Mutations in ER membrane shaping proteins and morphological changes in the ER are associated with various neurodegenerative diseases implying significance of ER morphology in maintaining neuronal integrity. Specific neurons, such as the highly arborized dopaminergic neurons, are prone to stress and neurodegeneration. Differences in morphology and functionality of ER between the neurons may account for their varied sensitivity to stress and neurodegenerative changes. In this review, we explore the neuronal ER and discuss its distinct morphological attributes and specific functions. We hypothesize that morphological heterogeneity of the ER in neurons is an important factor that accounts for their selective susceptibility to neurodegeneration.Peer reviewe

Kinetics of exciton photoluminescence in type-II semiconductor superlattices

The exciton decay rate at a rough interface in type-II semiconductor superlattices is investigated. It is shown that the possibility of recombination of indirect excitons at a plane interface essentially affects kinetics of the exciton photoluminescence at a rough interface. This happens because of strong correlation between the exciton recombination at the plane interface and at the roughness. Expressions that relate the parameters of the luminescence kinetics with statistical characteristics of the rough interface are obtained. The mean height and length of roughnesses in GaAs/AlAs superlattices are estimated from the experimental data.Comment: 3 PostScript figure