Chest radiography practice in critically ill patients: a postal survey in the Netherlands

BACKGROUND: To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. METHODS: Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. RESULTS: From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). CONCLUSION: There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

MYC Cooperates with AKT in Prostate Tumorigenesis and Alters Sensitivity to mTOR Inhibitors

MYC and phosphoinositide 3-kinase (PI3K)-pathway deregulation are common in human prostate cancer. Through examination of 194 human prostate tumors, we observed statistically significant co-occurrence of MYC amplification and PI3K-pathway alteration, raising the possibility that these two lesions cooperate in prostate cancer progression. To investigate this, we generated bigenic mice in which both activated human AKT1 and human MYC are expressed in the prostate (MPAKT/Hi-MYC model). In contrast to mice expressing AKT1 alone (MPAKT model) or MYC alone (Hi-MYC model), the bigenic phenotype demonstrates accelerated progression of mouse prostate intraepithelial neoplasia (mPIN) to microinvasive disease with disruption of basement membrane, significant stromal remodeling and infiltration of macrophages, B- and T-lymphocytes, similar to inflammation observed in human prostate tumors. In contrast to the reversibility of mPIN lesions in young MPAKT mice after treatment with mTOR inhibitors, Hi-MYC and bigenic MPAKT/Hi-MYC mice were resistant. Additionally, older MPAKT mice showed reduced sensitivity to mTOR inhibition, suggesting that additional genetic events may dampen mTOR dependence. Since increased MYC expression is an early feature of many human prostate cancers, these data have implications for treatment of human prostate cancers with PI3K-pathway alterations using mTOR inhibitors

Social consequences of a tumor disease - an unexpected problem for relatives

On one hand financial distress is a problem in long-term cancer survivors. On the other hand little is known about theses consequences regarding their family member or relatives. Aim of this study was to look for the incidence of financial distress for family members or relatives due to the cancer diagnosis in the family.27 relatives, who presented themselves in facilities of the "Hessische Krebsgesellschaft", were analyzed by questionnaire consecutively.Regarding our data one third of the relatives who were interviewed reduced their working time and therefore their salary Therefore we think in case of a talk about the financial situation of a cancer patient relatives should be included.Finanzielle und soziale Konsequenzen einer Krebserkrankung bzw. deren Therapie sind ein häufiges und relevantes Problem für Langzeitkrebsüberlebende. Inwieweit eine solche Entwicklung auch Angehörige trifft ist aber vollkommen unklar und bis dato auch nicht untersucht.In der vorliegenden Untersuchung wurden 27 Angehörige, die in einem Zeitraum von 5 Monaten die Beratungsstellen der hessischen Krebsgesellschaften aufsuchten, konsekutiv befragt. Von den Befragten gaben 33% an, dass sie bedingt durch die Tumorerkrankung ihres Angehörigen den zeitlichen Umfang ihrer beruflichen Tätigkeit auf Kosten ihres Einkommens veränderten.Während das Sozialsystem der Bundesrepublik Deutschland erkrankten Patienten in diesen Situationen über das Sozialgesetzbuch IX eine Fülle an Hilfestellungen anbietet, besteht für Angehörige keine Versorgungsstruktur.Aus diesem Grunde sollten unserer Meinung nach bei jeder sozialmedizinischen Beratung von Tumorpatienten, wenn möglich, auch die Angehörigen befragt werden oder, wenn dies nicht möglich ist, deren Situation mit berücksichtigt werden