Physical and psychological symptoms of quality of life in the CHART randomized trial in head and neck cancer: short-term and long-term patient reported symptoms

The randomized multicentre trial of continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in patients with advanced head and neck cancer showed no good evidence of a difference in any of the major clinical outcomes of survival, freedom from metastases, loco-regional control and disease-free survival. Therefore an assessment of the effect of treatment on physical and psychological symptoms is vital to balance the costs and benefits of the two treatments. A total of 615 patients were asked to complete a Rotterdam Symptom Checklist and the Hospital Anxiety and Depression Scale, which cover a variety of physical and psychological symptoms, at a total of ten time points. The data consisted of short-term data (the initial 3 months) and long-term data (1 and 2 years). The short-term data was split into an exploratory data set and a confirmatory data set, and analysed using subject-specific and group-based methods. Differences were only claimed if hypotheses generated in the exploratory data set were confirmed in the confirmatory data set. The long-term data was not split into two data sets and was analysed using a group-based approach. There was evidence of significantly worse symptoms of pain at day 21 in those treated with CHART and significantly worse symptoms of cough and hoarseness at 6 weeks in those treated conventionally. There was also evidence to suggest a higher degree of decreased sexual interest at 1 year and sore muscles at 2 years in those treated with conventional radiotherapy. There is no clear indication that one regimen is superior to the other in terms of ‘quality of life’, generally the initially more severe reaction in the CHART group being offset by the longer duration of symptoms in the conventionally treated group. © 1999 Cancer Research Campaig

Sunitinib induced pyoderma gangrenosum-like ulcerations

Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PDGF-α - and -β-, VEGF-1-3-, KIT-, FLT3-, CSF-1- and RET-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment

Localized Surface Plasmon Resonance Biosensing with Large Area of Gold Nanoholes Fabricated by Nanosphere Lithography

Localized surface plasmon resonance (LSPR) has been extensively studied as potential chemical and biological sensing platform due to its high sensitivity to local refractive index change induced by molecule adsorbate. Previous experiments have demonstrated the LSPR generated by gold nanoholes and its biosensing. Here, we realize large uniform area of nanoholes on scale of cm2 on glass substrate by nanosphere lithography which is essential for mass production. The morphology of the nanoholes is characterized using scanning electron microscope and atomic force microscope. The LSPR sensitivity of the nanoholes to local refractive index is measured to be 36 nm/RIU. However, the chip has demonstrated high sensitivity and specificity in biosensing: bovine serum albumin adsorption is detected with LSPR peak redshift of 27 nm, and biotin-streptavidin immunoassay renders a LSPR redshift of 11 nm. This work forms a foundation toward the cost-effective, high-throughput, reliable and robust chip-based LSPR biosensor

IT controls in the public cloud : success factors for allocation of roles and responsibilities

The rapid adoption of cloud computing by organizations has resulted in the transformation of the roles and responsibilities of staff in managing the information technology (IT) resources (via IT governance controls) that have migrated to the cloud. Hence, the objective of this research is to provide a set of success factors that can assist IT managers to allocate the roles and responsibilities of IT controls appropriately to staff to manage the migrated IT resources. Accordingly, we generated a set of success factors from behavioral and information systems (IS) literature. These success factors were verified using in-depth interviews of executives from the United Arab Emirates (UAE). The empirical intervention suggests that the role allocation is driven predominantly by people’s skills, competencies, organizational strategy, structures, and policies. In addition, the research made clear that the most significant competency and skill for a person allocated to IT controls is to be able to evaluate and manage a cloud service provider, especially in terms of risks, compliance, and security issues related to public cloud technology. The findings of this study not only offer new insights for scholars and practitioners involved in assigning responsibilities but also provide extensions for IT governance framework authorities to align their guidelines to the emerging cloud technology

GPs’ Interactional Styles in Consultations with Dutch and Ethnic Minority Patients

The aim of this study was to examine interactional styles of general practitioners (GPs) in consultations with Dutch patients as compared to ethnic minority patients, from the perspective of level of mutual understanding between patient and GP. Data of 103 transcripts of video-registered medical interviews were analyzed to assess GPs’ communication styles in terms of involvement, detachment, shared decision-making and patient-centeredness. Surveys were used to collect data on patients’ characteristics and mutual understanding. Results show that overall, GPs communicate less adequately with ethnic minority patients than with Dutch patients; they involve them less in decision-making and check their understanding of what has been discussed less often. Intercultural consultations are thus markedly distinguishable from intracultural consultations by a lack of adequate communicative behavior by GPs. As every patient has a moral and legal right to make informed decisions, it is concluded that GPs should check more often whether their ethnic minority patients have understood what has been said during the medical consultation

Assessing the reliability of retrospective reports of adverse childhood experiences among adolescents with documented childhood maltreatment

The literature suggests that childhood maltreatment is related to a higher probability of developing psychopathology and disease in adulthood. However, some authors have questioned the reliability of self-reports of maltreatment, suggesting that psychopathology at the time of evaluation affects self-reports. We evaluated the reliability of the self-reports of 79 young adults who were identified in childhood by Child Protective Services by comparing two moments of evaluation. Psychological and physical symptoms were tested to evaluate their interference with the reports. We found good to excellent agreement, with no significant correlation between the changes in self-reported experiences and the changes in physical and psychological symptoms, suggesting that the reliability of reports is not related to the health state at the time of the report

Host-microbe-drug-nutrient screen identifies bacterial effectors of metformin therapy

Metformin is the first-line therapy for treating type-2 diabetes and a promising anti-aging drug. We set out to address the fundamental question of how gut microbes and nutrition, key regulators of host physiology, impact the effects of metformin. Combining two tractable genetic models, the bacterium E. coli and the nematode C. elegans, we developed a high-throughput four-way screen to define the underlying host-microbe-drug-nutrient interactions. We show that microbes integrate cues from metformin and the diet through the phosphotransferase signalling pathway that converges on the transcriptional regulator Crp. A detailed experimental characterization of metformin effects downstream of Crp in combination with metabolic modelling of the microbiota in metformin-treated type-2 diabetic patients predicts the production of microbial agmatine, a regulator of metformin effects on host lipid metabolism and lifespan. Our high-throughput screening platform paves the way for identifying exploitable drug-nutrient-microbiome interactions to improve host health and longevity through targeted microbiome therapie