Determinants of place of death for terminal cancer patients

Approximately two-third of cancer patients, when asked about the preferred place of death, wish to die in their own homes. However, the majority of deaths from cancers in most western countries occur in a hospital. When a person dies from other than sudden or traumatic causes, the death appears to be a function of a complex interplay of personal and cultural values and physical and medical factors, as well as various health care systems forces. This article reviews the determinants of place of death for terminal cancer patients from published studies in hopes of shedding light on the difficulties of dying patients to realize their preferences for place of death. These insights may contribute to modification of hospice care systems so health professionals will be more responsive to the needs of their dying patients to retain control and die with dignity and help health professionals achieve the proposed outcome of hospice care.

Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006

BACKGROUND

Quality of end-of-life care received by cancer patients has never been explored in an entire Asian country for all ages and cancer groups.

PATIENTS AND METHODS

Retrospective cohort study to examine trends in quality of end-of-life care among a cohort of 242 530 Taiwanese cancer patients who died in 2000-2006.

RESULTS

In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%-17.28%), (ii) frequent emergency room visits (15.69%-20.99%) and >14-day hospital stays (41.48%-46.20%), (iii) admissions to intensive care units (10.04%-12.41%), and (iv) hospital deaths (59.11%-65.40%). Use of cardiopulmonary resuscitation (13.09%-8.41%), intubation (26.01%-21.07%), and mechanical ventilation (27.46%-27.05%) decreased, whereas use of hospice services increased considerably (7.34%-16.83%). Among those receiving hospice services, rates of referrals to hospice services in the last 3 days of life decreased from 17.88% to 17.13% but remained steady after adjusting for selected covariates.

CONCLUSIONS

The quality of end-of-life care for Taiwanese cancer decedents was substantially inferior to that previously reported and to that recommended as benchmarks for not providing overly aggressive care near the end of life.

Meanings of dying at home for Chinese patients in Taiwan with terminal cancer: a literature review

To maintain dignity, patients with terminal cancer must be able to do things in their own way, to make their own decisions, and to preside over their own dying. Among the tasks considered essential for patients with terminal cancer is deciding where they prefer to die. The actual place of death has been recognized in hospice care as indicating quality of care. Approximately two-thirds of patients with cancer, when asked about the preferred place of death, say they wish to die in their own homes. Patients with terminal cancer dying at home may find physical and emotional comfort there. Home is a place where people may feel safety and a sense of belonging. In dying at home, patients with terminal cancer also may have a greater chance to control their environment, more autonomy and privacy, and a sense of normality. In this article, special cultural meaning of dying at home for the Chinese patient and the family is reviewed. It is essential for health care professionals to understand Chinese cultural beliefs and values related to dying at home in order to provide culturally sensitive care for Chinese dying patients and their families and to enhance their sense of control over the unknown process of dying.

MHC-I-restricted epitopes conserved among variola and other related orthopoxviruses are recognized by T cells 30 years after vaccination

It is many years since the general population has been vaccinated against smallpox virus. Here, we report that human leukocyte antigen (HLA) class I restricted T cell epitopes can be recognized more than 30 years after vaccination. Using bioinformatic methods, we predicted 177 potential cytotoxic T lymphocyte epitopes. Eight epitopes were confirmed to stimulate IFN-gamma release by T cells in smallpox-vaccinated subjects. The epitopes were restricted by five supertypes (HLA-A1, -A2, -A24 -A26 and -B44). Significant T cell responses were detected against 8 of 45 peptides with an HLA class I affinity of K(D) less than or equal to 5 nM, whereas no T cell responses were detected against 60 peptides with an HLA affinity of K(D) more than 5 nM. All epitopes were fully conserved in seven variola, vaccinia and cowpox strains. Knowledge of the long-term response to smallpox vaccination may lead to a better understanding of poxvirus immunity and may aid in the development of new improved vaccines and diagnostic tools.

High-affinity human leucocyte antigen class I binding variola-derived peptides induce CD4+ T cell responses more than 30 years post-vaccinia virus vaccination

Interferon-gamma secreting T lymphocytes against pox virus-derived synthetic 9-mer peptides were tested by enzyme-linked immunospot in peripheral blood of individuals vaccinated with vaccinia virus more than 30 years ago. The peptides were characterized biochemically as high-affinity human leucocyte antigen (HLA) class I binders (K(D) <or= 5 nM). However, five of the individuals tested did not show typical CD8(+) T cell-mediated HLA class I-restricted responses. Instead, these donors showed CD4(+) T cell-dependent responses against four of a total of eight antigenic 9-mer peptides discovered recently by our group. These latter responses were blocked specifically in the presence of anti-HLA class II antibody. We conclude that long-lived memory responses against pox virus-derived 9-mer peptides, with high binding affinity for HLA class I molecules, are mediated in some cases by CD4(+) T cells and apparently restricted by HLA class II molecules.

Beneficial effect of HCL-31D in murine models of endotoxaemia

We evaluated the effect of HCL-31D, a novel cAMP-specific phosphodiesterase inhibitor, on the induction of inducible nitric oxide synthase (iNOS) in lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma)-treated rat aortic smooth muscle cells (RASMC) and on survival in a murine model of severe endotoxaemia. Treatment of cultured RASMC with LPS and IFN-gamma resulted in an increase of nitrite, tumour necrosis factor (TNF-alpha) production and induction of iNOS mRNA. However, incubation with HCL-31D (1 approximately 50 microM) for 24 h caused significant attenuation of nitrite and TNF-alpha formation as well as iNOS mRNA induction in a dose-dependent manner but no effect on iNOS activity in RASMC. In addition, administration of HCL-31D (5 mg/kg, i.p.) resulted in that the increase of both plasma nitrate and TNF-alpha levels induced by LPS in vivo was significantly reduced in LPS-treated rats. Treatment of conscious mice with a high dose of LPS (60 mg/kg, i.p.) to ICR mice resulted in a 24-h survival rate of only 10%. However, administration of HCL-31D (5 mg/kg, i.p. at 0 h and 6 h after LPS) improved the 24-h survival to 50%, indicating that HCL-31D has a beneficial effect in murine model endotoxaemia. These effects may be mainly due to inhibition of TNF-alpha formation and of the induction of iNOS. We proposed that the elevation of cAMP levels by HCL-31D may be involved in the prevention of TNF-alpha formation and iNOS induction.

Industrial wideband noise reduction for hearing aids using a headset with adaptive-feedback active noise cancellation

High-intensity noises are a health hazard for industrial workers, and hearing protection is necessary to prevent hearing loss. Passive methods, such as ear muffs, are ineffective against low-frequency noise. Moreover, many hearing-impaired workers must wear hearing aids to enable communication at their workplace, and such aids can amplify ambient noise. To overcome this problem, the present study developed a headset equipped with a digital signal processing system to implement adaptive-feedback active noise cancellation (AFANC) to reduce low-frequency noise. The proposed AFANC headset was effective against wideband industrial noise, with a maximum noise spectrum power reduction of 30 dB. Furthermore, when used with a hearing aid, it improved the speech signal-to-noise ratio by up to 14 dB. These results suggest that a headset with AFANC would be useful for hearing protection in workplaces with high levels of low-frequency industrial noise, especially for hearing-impaired workers.

Analysis of Clinicopathological Characteristics and Prognosis of Young Patients with Hepatocellular Carcinoma after Hepatectomy

Background and Aims: This study was designed to analyze the effects of age and clinicopathological characteristics on prognosis of Chinese patients with hepatocellular carcinoma (HCC). Methods: The clinical data of 2032 HCC patients who were first diagnosed with HCC and underwent curative hepatectomy in our hospital between January 2006 and January 2011 were retrospectively analyzed. Results: Younger HCC patients (age <40 years, n=465) had a significantly higher hepatitis B infection rate, larger tumors, higher alpha-fetoprotein levels, higher preoperative liver function, and more frequent vascular invasions than older patients. Most younger patients were suitable for anatomical hepatectomy, and their tumors were found to be at a highly advanced stage. The recurrence-free survival and overall survival rates of younger HCC patients were significantly worse than those of older patients but this difference disappeared after propensity score matching. Multivariate analysis of pre-matched samples showed that age ≤40 years was one of the independent risk factors associated with poor overall survival. Conclusions: Younger patients showed different clinicopathological characteristics than older patients, such as higher rates of hepatitis B infection and advanced tumors. The recurrence-free survival and overall survival rates of younger HCC patients after hepatectomy may be similar to those of older patients.

3 x 3 matrix for unitary optical systems

We introduce a 3 x 3 matrix for the study of unitary optical systems. This 3 x 3 matrix is a submatrix of the 4 x 4 Mueller matrix. The elements of this 3 x 3 matrix are real, and thus complex-number calculations can be avoided. The 3 x 3 matrix is useful for illustrating the polarization state of an optical system. One can also use it to derive the conditions for linear and circular polarization output for a general optical system. New characterization methods for unitary optical systems are introduced. It is shown that the trajectory of the Stokes vector on a Poincaré sphere is either a circle or an ellipse as the optical system or input polarizer is rotated. One can use this characteristic circle or ellipse to measure the equivalent optical retardation and rotation of any lossless optical system.

Letter: Hypoglycaemia associated with intrathoracic mesothelioma

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[High performance liquid chromatographic determination of domoic acid in shellfish samples]

Domoic acid in shellfish samples was determined by HPLC with DAD/UV detector at 242 nm. Samples were extracted with methanol-water followed by clean-up of the extracts with strong anion exchange solid phase extraction cartridge(3 mL LC-SAX). Zorbax SB-C18 column, 150 mm x 4.6 mm i.d., and mobile phase of acetonitrile-0.1% aqueous trifluoroacetic acid(13:87, V/V) were used for the assay. The quantitative analysis was performed with external standard. The calibration curve of domoic acid was linear in the range of 1.0 m/L-25.0 mg/L and the detection limit was ca. 0.2 microgram/g.

BEND3 promotes hepatocellular carcinoma progression and metastasis by activating the PI3K/AKT/mTOR pathway and inducing epithelial-mesenchymal transition

OBJECTIVE

This study aimed to investigate the expression of BEND3 in hepatocellular carcinoma (HCC), its correlation with clinical characteristics, and its functional and mechanistic impacts on HCC progression.

METHODS

Bioinformatics analyses identified BEND3 as highly expressed in HCC and associated with poor clinical prognosis, which was further validated using qRT-PCR, western blotting and immunohistochemistry. Stable BEND3-overexpressing and silenced cell lines were constructed to evaluate its functional effects. CCK-8 and colony formation assays assessed its influence on cell proliferation, while wound healing and Transwell assays evaluated its role in migration and invasion. WB and immunofluorescence were employed to analyze the effects of BEND3 on epithelial-mesenchymal transition (EMT) and the PI3K/AKT/mTOR signaling pathway.

RESULTS

Public database analysis, alongside qRT-PCR, western blotting, and immunohistochemical, confirmed that BEND3 expression is significantly elevated in HCC tissues compared to normal liver tissues and is closely associated with poor prognosis. Functional assays demonstrated that BEND3 promotes HCC cell proliferation, migration, and invasion. Mechanistic studies revealed that BEND3 drives HCC progression by inducing EMT and activating the PI3K/AKT/mTOR signaling pathway.

CONCLUSION

BEND3 is highly expressed in HCC and strongly correlates with poor clinical outcomes. Functional and mechanistic analyses indicate that BEND3 enhances HCC progression by promoting proliferation, migration and invasion via EMT induction and PI3K/AKT/mTOR pathway activation.