scholarly journals Different management of adrenocortical carcinoma in children compared to adults: is it time to share guidelines?

Endocrine ◽  
2021 ◽  
Author(s):  
Salvatore Grisanti ◽  
Deborah Cosentini ◽  
Marta Laganà ◽  
Antonella Turla ◽  
Alfredo Berruti
Keyword(s):  
Adjuvant Therapy ◽  
Adrenocortical Carcinoma ◽  
Palliative Chemotherapy ◽  
Age Groups ◽  
Treatment Strategies ◽  
Point Of View ◽  
Oncology Group ◽  
Adjuvant Therapies ◽  
Adrenocortical Carcinomas ◽  
The Mind

AbstractPediatric and adult adrenocortical carcinomas differ in many respects but treatment is often similar in both age groups. The Journal of Clinical Oncology recently published the results of a risk-stratified single-arm interventional trial conducted by the Children’s Oncology Group in which 77 patients were treated in three different interventional cohorts. In this Point of View paper we comment on the treatment strategies adopted within the ARAR0332 trial in terms of surgery approach, duration of adjuvant therapies, and palliative chemotherapy. We focus on the differences in the treatment of pediatric ACC patients compared to the ESE/ENSAT and ESMO guidelines released in 2018 for adult patients. For example, patients in stratum 3 and 4 received 8 (instead of 6) cycles of EDP chemotherapy but 8 months (instead of 24) of mitotane adjuvant therapy. Bearing clearly in the mind that pediatric and adult ACC patients represent different settings, we wonder whether there could be some areas of intervention overlapping to constitute a continuum of disease across ages. Thus, pediatric and adult cohoperative groups should be encouraged to collaborate in order to reach common guidelines for the treatment of such a rare disease.

Palliative Chemotherapy Near the End of Life in Oncology Patients

2018 ◽  
Vol 35 (9) ◽  
pp. 1215-1220 ◽  
Author(s):  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Age Groups ◽  
Treatment Strategies ◽  
Cancer Center ◽  
Eol Care ◽  
To Receive

Background: Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL. Methods: This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy. Results: Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001). Conclusion: The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.

scholarly journals How is Adrenocortical Cancer being Managed in the UK?

2009 ◽  
Vol 91 (6) ◽  
pp. 489-493 ◽  
Author(s):  
Sebastian R Aspinall ◽  
AH Imisairi ◽  
RD Bliss ◽  
D Scott-Coombes ◽  
BJ Harrison ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adrenocortical Carcinoma ◽  
Case Series ◽  
Cytotoxic Chemotherapy ◽  
Adrenocortical Cancer ◽  
Significant Difference ◽  
Adrenocortical Carcinomas ◽  
The Uk

INTRODUCTION Adrenocortical carcinomas are rare. This case series is reported to give an overview of how adrenocortical carcinoma is currently managed in the UK. PATIENTS AND METHODS A retrospective review was made of case notes from patients with adrenocortical carcinomas presenting to the authors (TWJL, RDB, BJH, and DS-C) over the past 10 years in Newcastle, Sheffield and Cardiff. RESULTS Newcastle treated twelve, Sheffield eleven and Cardiff seven cases. The median follow-up was 25.5 months (range, 1–102 months). All tumours were greater than 5 cm in diameter. The majority presented with symptoms of hormone excess. Adrenalectomy was performed in 83% – this was radical in 30% and followed by excision of recurrence in 13%. Adjuvant mitotane was given in 64% of patients, in combination with cytotoxic chemotherapy in 20%. One-third of patients did not receive any adjuvant therapy. There was no significant difference in survival between the three centres. The majority of patients (57%) died during the period of follow-up of this study. The median survival was 37 months (range, 2–102 months). CONCLUSIONS The size of tumour, stage and mode of presentation, age and overall survival of patients in this study are comparable to published series of adrenocortical carcinomas from major endocrine surgical centres world-wide. Despite controversies about benefits, adjuvant mitotane was used in the majority of cases, whereas cytotoxic chemotherapy was only used in the minority. The exact role of adjuvant therapy in the management of adrenocortical carcinoma is not as well established as for other more common malignancies. Establishing a database for adrenocortical carcinomas in the UK would contribute to our understanding of the management of this disease.

An Ultrastructural Study of the Proliferation Patterns of the Reserve Cells of the Human Cervix Uteri

1972 ◽  
Vol 30 ◽  
pp. 80-81
Author(s):  
Takanori Sohda ◽  
Hiroshi Saito ◽  
Goro Asano ◽  
Katsunari Fukushi ◽  
Katsuya Suzuki ◽  
...  
Keyword(s):  
Ultrastructural Study ◽  
Age Groups ◽  
Point Of View ◽  
University Hospital ◽  
Cervix Uteri ◽  
Morphological Aspect ◽  
Functional Aspect ◽  
Pathological Conditions ◽  
Human Cervix ◽  
Morphological Patterns

Recently, the functional aspect as well as morphological aspect of the reserve cells in the cervix uteri drew much attention in view of the carcinogenesis in squamocolumunar junction. In this communication, the authors elucidate the ultrastructural features of the reserve cells in patients of various age groups visiting our university hospital and affiliated hospital.From conventional light microscopic point of view, the reserve cells tend to be pronounced in various pathological conditions, such as the persisting inflammation, proliferative disorders and irritation of hormones. The morphological patterns of the reserve cells from various stage and degree of irritation were observed.

Beérkezett könyvek

2008 ◽  
Vol 63 (4) ◽  
pp. 769-770
Author(s):  
Csaba Pléh
Keyword(s):  
New York ◽  
Point Of View ◽  
Cambridge University ◽  
New Science ◽  
Oxford University ◽  
History Of ◽  
The Mind ◽  
Oxford University Press

Danziger, Kurt: Marking the mind. A history of memory . Cambridge University Press, Cambridge, 2008Farkas, Katalin: The subject’s point of view. Oxford University Press, Oxford, 2008MosoninéFriedJudités TolnaiMárton(szerk.): Tudomány és politika. Typotex, Budapest, 2008Iacobini, Marco: Mirroring people. The new science of how we connect with others. Farrar, Straus and Giroux, New York, 2008Changeux, Jean-Pierre. Du vrai, du beau, du bien.Une nouvelle approche neuronale. Odile Jacob, PárizsGazzaniga_n

scholarly journals An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naureen Keric ◽  
Darius Kalasauskas ◽  
Sophia L. Kreth ◽  
Martin B. Glaser ◽  
Harald Krenzlin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Age Groups ◽  
Treatment Strategies ◽  
The Elderly ◽  
Outcome Analysis ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

scholarly journals The Quality of Life and Satisfaction with Continuous Glucose Monitoring Therapy in Children under 7 Years of Age with T1D Using the rtCGM System Integrated with Insulin Pump—A Caregivers Point of View

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3683
Author(s):  
Ewa Rusak ◽  
Natalia Ogarek ◽  
Karolina Wolicka ◽  
Anna Mrówka ◽  
Sebastian Seget ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Insulin Pump ◽  
Age Groups ◽  
Glucose Monitoring ◽  
Point Of View ◽  
Therapy Assessment ◽  
Monitoring Therapy ◽  
Original Survey

Quality of life (QoL) is an important parameter that affects the choice of therapy. Assessment of QoL and satisfaction with therapy using the rtCGM in children with T1D aged < 7 years was conducted. The study group consisted of 38 children with T1D aged < 7 years (34% aged 2–4, 66% aged 5–7 years), HbA1c: 6.53 ± 0.63%, duration of diabetes: 2.6 ± 1.6 years, treated with an rtCGM-augmented insulin pump for 1.92 ± 1.15 years. Two anonymous surveys were conducted: a. PedsQL3.0 diabetes standardized questionnaire—QoL assessment among age groups: 2–4/5–7 years. b. An original survey assessing the CGM use satisfaction. The mean scores in PedsQL3.0: communication 75%, worries 30%, treatment 70%, and problems associated with diabetes 65%. The QoL scale is: 0–19% very low, 20–39% low, 40–59% moderate, 60–79% high, 80–100% very high. The most frequently reported concerns were long-term diabetes complications and prick pain. Satisfaction with CGM use was high (68% in group aged 5–7 and 92% 2–4 years). Twenty-seven (71%) caregivers confirmed the positive effect of CGM on sleep. During the use of rtCGM a high quality of life was reported, and the quality of sleep in their caregivers was increased.

Are we Ready for a “Microbiome-Guided Behaviour” Approach?

2019 ◽  
Vol 28 (04) ◽  
pp. 708-724
Author(s):  
ANDREA LAVAZZA ◽  
VITTORIO A. SIRONI
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Negative Attitude ◽  
Well Being ◽  
Fecal Microbiota ◽  
Point Of View ◽  
Brain Functioning ◽  
The Central Nervous System ◽  
The Individual ◽  
The Right ◽  
The Mind

Abstract:The microbiome is proving to be increasingly important for human brain functioning. A series of recent studies have shown that the microbiome influences the central nervous system in various ways, and consequently acts on the psychological well-being of the individual by mediating, among others, the reactions of stress and anxiety. From a specifically neuroethical point of view, according to some scholars, the particular composition of the microbiome—qua microbial community—can have consequences on the traditional idea of human individuality. Another neuroethical aspect concerns the reception of this new knowledge in relation to clinical applications. In fact, attention to the balance of the microbiome—which includes eating behavior, the use of psychobiotics and, in the treatment of certain diseases, the use of fecal microbiota transplantation—may be limited or even prevented by a biased negative attitude. This attitude derives from a prejudice related to everything that has to do with the organic processing of food and, in general, with the human stomach and intestine: the latter have traditionally been regarded as low, dirty, contaminated and opposed to what belongs to the mind and the brain. This biased attitude can lead one to fail to adequately consider the new anthropological conceptions related to the microbiome, resulting in a state of health, both physical and psychological, inferior to what one might have by paying the right attention to the knowledge available today. Shifting from the ubiquitous high-low metaphor (which is synonymous with superior-inferior) to an inside-outside metaphor can thus be a neuroethical strategy to achieve a new and unbiased reception of the discoveries related to the microbiome.

Jules Verne’s ‘Around the World in 80 Days’: Multilingualism, Multiculturalism and Symbols

2021 ◽  
Vol 2021 ii (15) ◽  
pp. 146-182
Author(s):  
Haroula Hatzimihail ◽  
Ioannis Pantelidis
Keyword(s):  
Key Words ◽  
Age Groups ◽  
Literary Work ◽  
Point Of View ◽  
Social Classes ◽  
Jules Verne ◽  
The World ◽  
Semiotic Systems ◽  
Points Of View ◽  
Different Cultures

In this announcement, the various –linguistic and non-linguistic- symbols used in the literary work 'Around the world in 80 days', written by Jules Verne, are examined from an intertemporal and contemporary point of view. The references through these points of view, in matters of multiculturalism and multilingualism, are becoming classical in nature: they concern the necessity of the applied ability to communicate between individuals who belong to different social classes and age groups, speak the same or different languages, come from different cultures, with rights and obligations in their various areas of life, etc. Key-words: linguistics, multilingualism, multiculturalism, semiotics, semiotic systems, symbols

Еnactivist Criticism of the Neurobiological Theory of Consciousness

2021 ◽  
pp. 76-80
Author(s):  
Anastasia O. Shabalina ◽  
Keyword(s):  
Philosophy Of Mind ◽  
Point Of View ◽  
Science Methods ◽  
Neural Processes ◽  
Neural Substrate ◽  
Critical Revision ◽  
Concept Of Information ◽  
The Mind ◽  
The Brain ◽  
Person Experience

The article considers the main arguments against the neurobiological theory of consciousness from the point of view of the enactivist approach within the philosophy of mind. The neurobiological theory of consciousness, which reduces consciousness to neural activity, is currently the dominant approach to the mind-body problem. The neurobiological theory emerged as a result of advances in research on the phenomena of consciousness and through the development of technologies for visualizing the internal processes of mind. However, at the very heart of this theory, there is a number of logical contradictions. The non-reductive enactivist approach to consciousness, introduced in this article, contributes to the existing argumentation against the reduction of consciousness to neural processes with remonstrations that take into account the modern neuroscientific data. The article analyzes the argumentation of the sensorimotor enactivism developed by A. Noe and offers the account of the teleosemantic approach to the concept of information provided by R. Cao. The key problems of the neurobiological theory of consciousness are highlighted, and the objections emerging within the framework of the enactivist approach are analyzed. Since the main concepts on which the neural theory is based are the concepts of neural substrate, cognition as representation, and information as a unit of cognition, the author of the article presents three key enactivist ideas that oppose them. First, the enactivist concept of cognition as action allows us to consider the first-person experience as a mode of action, and not as a state of the brain substrate. Second, the article deals with the “explanatory externalism” argument proposed by Noe, who refutes the image of cognition as a representation in the brain. Finally, in order to critically revise the concept of information as a unit of cognition, the author analyzes Cao’s idea, which represents a teleosemantic approach, but is in line with the general enactivist argumentation. Cao shows that the application of the concept “information” to neural processes is problematic: no naturalized information is found in the brain as a physical substrate. A critical revision of beliefs associated with the neural theory of consciousness leads us to recognize that there are not enough grounds for reducing consciousness to processes that take place in the brain. That is why Noe calls expectations that the visualization of processes taking place in the brain with the help of the modern equipment will be able to depict the experience of consciousness the “new phrenology”, thus indicating the naive character of neural reduction. The article concludes that natural science methods are insufficient for the study of consciousness.

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