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Одним из важных разделов в области охраны здоровья женщин является совершенствование системы скрининга, поскольку рак молоч...
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Одним из важных разделов в области охраны здоровья женщин является совершенствование системы скрининга, поскольку рак молочной железы занимает лидирующие позиции среди злокачественных опухолей у женщин.Ежегодно в мире регистрируется более 1 млн. новых случаев рака молочной железы. При этом заболеваемость в мире постоянно растет на 1-2% в год. В структуре онкологической заболеваемости женщин рак молочной железы занимает первое место. Наиболее высокая заболеваемость наблюдается в США и Западной Европе, составляя 25-30% от всех новых случаев рака у женщин и 18-20% от всех смертей при опухолях у женщин. В России в 2005 г.
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摘要 :
Одним из важных разделов в области охраны здоровья женщин является совершенствование системы скрининга, поскольку рак молоч...
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Одним из важных разделов в области охраны здоровья женщин является совершенствование системы скрининга, поскольку рак молочной железы занимает лидирующие позиции среди злокачественных опухолей у женщин.Ежегодно в мире регистрируется более 1 млн. новых случаев рака молочной железы. При этом заболеваемость в мире постоянно растет на 1-2% в год. В структуре онкологической заболеваемости женщин рак молочной железы занимает первое место. Наиболее высокая заболеваемость наблюдается в США и Западной Европе, составляя 25-30% от всех новых случаев рака у женщин и 18-20% от всех смертей при опухолях у женщин. В России в 2005 г.
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PurposeMeasuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures...
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PurposeMeasuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps.MethodsEnglish-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsyclNFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domajn to select studies throughout the cancer care continuum. We included measures that expressed ? normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure.ResultsA total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remainingarticles, 19 contained nleasures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10- relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific.ConclusionMeasures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.
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Survival gains were achieved in head and neck cancer patients treated with a multidisciplinary approach, including platinum-based concurrent chemoradiation, with a substantial increase in toxicity. The prompt diagnosis and treatme...
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Survival gains were achieved in head and neck cancer patients treated with a multidisciplinary approach, including platinum-based concurrent chemoradiation, with a substantial increase in toxicity. The prompt diagnosis and treatment of these toxicities -the focus of this review - are essential aspects in the daily care of head and neck squamous cell carcinoma patients. Recent findings Low-level laser is a promising therapy for prevention and treatment of mucositis. Amifostine, as an acute and late xerostomia-preventive agent, may be considered in patients undergoing fractionated radiation therapy alone. The incidence of xerostomia was significantly reduced in patients treated with intensity-modulated radiation therapy. Severe cutaneous reactions can occur when epidermal growth factor receptor-targeting agents are administered concurrently to radiation therapy. Erythropoiesis-stimulating agents should not be administered to head and neck cancer patients under radiation therapy or chemotherapy outside of the context of clinical trials. Summary The best outcomes in head and neck squamous cell carcinoma patients treated in the multidisciplinary context can only be achieved with an adequate patient selection, an experienced and motivated team and if the best possible supportive care is offered. Randomized studies on promising supportive therapies must be encouraged.
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Fibrosis is a pathological condition resulting from radiation injury which often limits the prescription of higher (or boost) doses of radiation, risking inadequate tumor control in patients. Recent studies haye documented reducti...
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Fibrosis is a pathological condition resulting from radiation injury which often limits the prescription of higher (or boost) doses of radiation, risking inadequate tumor control in patients. Recent studies haye documented reduction in fibrotic lesions after administration of pentoxyfilline and tocopherol combinations to breast cancer patients receiving adjuvant radiation therapy. Despite the promise of these findings, no techniques or markers are available which can be used to identify the onset or progression of fibrosis in such patients at stages early enough to allow maximum benefit from these types of pharmacological agents. Relative permittivity of skeletal muscle has been investigated in an animal model utilizing high dose rate radiation both at the treatment site as well as on the contralateral site, and was found to be directly related to the formation and progression of fibrotic lesions. A cubic increase in the quantified fibrotic fraction of the tissue (2.7%-13.9% over 11 w post irradiation) was reflected in a linear increase in the tissue's relative permittivity (epsilon_r = 6.3-8.8 over 11 w post irradiation). These findings mandate further investigation of the relationship between tissue's relative permittivity and subcellular injury leading to fibrosis using electrical impedance spectroscopy (EIS).
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BACKGROUND Although increased height has been associated with osteosarcoma risk in previous epidemiologic studies, to the authors' knowledge the relative contribution of stature during different developmental timepoints remains un...
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BACKGROUND Although increased height has been associated with osteosarcoma risk in previous epidemiologic studies, to the authors' knowledge the relative contribution of stature during different developmental timepoints remains unclear. Furthermore, the question of how genetic determinants of height impact osteosarcoma etiology remains unexplored. Genetic variants associated with stature in previous genome‐wide association studies may be biomarkers of osteosarcoma risk. METHODS The authors tested the associations between osteosarcoma risk and polygenic scores for adult height (416 variants), childhood height (6 variants), and birth length (5 variants) in 864 osteosarcoma cases and 1879 controls of European ancestry. RESULTS Each standard deviation increase in the polygenic score for adult height, corresponding to a 1.7‐cm increase in stature, was found to be associated with a 1.10‐fold increase in the risk of osteosarcoma (95% confidence interval [95% CI], 1.01‐1.19; P = .027). Each standard deviation increase in the polygenic score for childhood height, corresponding to a 0.5‐cm increase in stature, was associated with a 1.10‐fold increase in the risk of osteosarcoma (95% CI, 1.01‐1.20; P = .023). The polygenic score for birth length was not found to be associated with osteosarcoma risk ( P = .11). When adult and childhood height scores were modeled together, they were found to be independently associated with osteosarcoma risk ( P = .037 and P = .043, respectively). An expression quantitative trait locus for cartilage intermediate layer protein 2 ( CILP2 ), rs8103992, was significantly associated with osteosarcoma risk after adjustment for multiple comparisons (odds ratio, 1.35; 95% CI, 1.16‐1.56 [ P = 7.93×10 ‐5 and P adjusted =.034]). CONCLUSIONS A genetic propensity for taller adult and childhood height attainments contributed independently to osteosarcoma risk in the current study data. These results suggest that the biological pathways affecting normal bone growth may be involved in osteosarcoma etiology.
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BACKGROUND Pediatric cancer‐related fatigue is prevalent and significantly impairs health‐related quality of life, yet its patterns and correlates are poorly understood. The objectives of this study were to describe fatigue as p...
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BACKGROUND Pediatric cancer‐related fatigue is prevalent and significantly impairs health‐related quality of life, yet its patterns and correlates are poorly understood. The objectives of this study were to describe fatigue as prospectively reported by children with advanced cancer and to identify the factors associated with fatigue and associated distress. METHODS Children (age ≥2 years) with advanced cancer (N = 104) or their parents at 3 academic hospitals reported symptoms at most weekly over 9 months using the computer‐based Pediatric Quality of Life Evaluation of Symptoms Technology (PediQUEST) system. PediQUEST administered a modified version of the Memorial Symptom Assessment Scale (PQ‐MSAS) as part of a randomized controlled trial. Clinical information was abstracted from medical records. Primary outcomes were: 1) fatigue prevalence (yes/no response to PQ‐MSAS fatigue item) and 2) fatigue distress (composite score of severity, frequency, and bother). Multivariable models were constructed to identify factors independently associated with fatigue prevalence and scores reflecting fatigue distress (ie, burden). RESULTS Of 920 reports, 46% (n = 425) noted fatigue. When reported, fatigue was of high frequency in 41% of respondents (n = 174), severity in 25%of respondents (n = 107), and bother in 34%of respondents (n = 143). Most reports (84%; n = 358) were associated with scores indicating fatigue distress. In multivariable analyses, fatigue was associated with older age, lower hemoglobin, and distress from particular symptoms (anorexia, nausea, sleep disturbance, sadness, and irritability). In contrast, fatigue distress was associated with distress from nausea, cough, and pain. CONCLUSIONS Fatigue is common among children with advanced cancer and is often highly distressing. Interventions focused on uncontrolled symptoms may ease fatigue distress in children with advanced cancer.
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Background Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide thes...
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Background Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide these discussions. Methods The authors reviewed studies published between 2013 and 2017 that reported direct health care costs and indirect (productivity losses) costs. The annual mean total and net costs of cancer were summarized for all payers and for survivors only by age (ages 18‐64 and ≥65 years), by phase of care (initial [ie, 12 months from diagnosis], continuing, and end‐of‐life [ie, 12 months before death]), or for recently diagnosed (within 1‐2 years of diagnosis) and longer term survivors. Results For all payers combined, costs for cancers like breast, prostate, colorectal, and lung cancers were $20,000 to $100,000 in the initial phase, $1000 to $30,000 annually in the continuing phase, and ≥$60,000 in the end‐of‐life phase. Annual out‐of‐pocket costs to recently diagnosed survivors were >$1000 for medical care and time costs, approximately $2000 for productivity losses, and from $2500 to >$4000 for employment disability, depending on age. For longer term survivors, the cost of medical care was approximately $1500 for older survivors and $747 for younger survivors, time costs were $831 to $955 for older survivors and $459 to $630 for younger survivors, and productivity losses were approximately $800. Disability among long‐term survivors was similar to that among short‐term survivors. Limitations of the reviewed studies included older data and under‐representation of higher cost cancers. Conclusions Frequently updated cost information for all cancer types is needed to guide discussions of anticipated short‐term and long‐term cancer‐related costs with survivors. Cancer 2018;000:000‐000 . ? 2018 American Cancer Society .
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Manganese superoxide dismutase (SOD2) is a nuclear encoded and mitochondria localized antioxidant enzyme that converts mitochondria derived superoxide to hydrogen peroxide. This study investigates the hypothesis that mitochondria ...
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Manganese superoxide dismutase (SOD2) is a nuclear encoded and mitochondria localized antioxidant enzyme that converts mitochondria derived superoxide to hydrogen peroxide. This study investigates the hypothesis that mitochondria derived reactive oxygen species (ROS) regulate ionizing radiation (IR) induced transformation in normal cells. Mouse embryonic fibroblasts (MEFs) with wild type SOD2 (+/+), heterozygous SOD2 (+/-), and homozygous SOD2 (-/-) genotypes were irradiated with equitoxic doses of IR, and assayed for transformation frequency, cellular redox environment, DNA damage, and cell cycle checkpoint activation.Transformation frequency increased (~5-fold) in SOD2 (-/-) compared to SOD2 (+/+) MEFs. Cellular redox environment (GSH, GSSG, DHE and DCFH-oxidation) did not show any significant change within 24 h post-IR. However, a significant increase in cellular ROS levels was observed at 72 h post-IR in SOD2 (-/-) compared to SOD2 (+/+) MEFs, which was consistent with an increase in GSSG in SOD2 (-/-) MEFs. Late ROS accumulation was associated with an increase in micronuclei frequency in SOD2 (-/-) MEFs. Exit from G2 was accelerated in irradiated SOD2 (+/-) and SOD2 (-/-) compared to SOD2 (+/+) MEFs.These results support the hypothesis that SOD2 activity and mitochondria generated ROS regulate IR induced transformation in mouse embryonic fibroblasts.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) clearly reduce the risk of human colorectal neoplasia in epidemiological and prospective randomized clinical studies of aspirin and nonaspirin NSAIDs, including selective cyclooxygenas...
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Nonsteroidal anti-inflammatory drugs (NSAIDs) clearly reduce the risk of human colorectal neoplasia in epidemiological and prospective randomized clinical studies of aspirin and nonaspirin NSAIDs, including selective cyclooxygenase-2 (COX-2) inhibitors, or coxibs (1-3). In contrast, the epidemiological and clinical data on NSAIDs in reducing breast cancer risk are not consistent. This inconsistency is likely attributable to contrasting expression patterns of COX-2, a key target of NSAIDs, in breast and colon neoplasia (4,5), and to differing activities of individual NSAIDs (which have varying selectivity for COX-2 vs COX-1), including a potentially selective impact of certain NSAIDs on hormone receptor-positive breast tumors.
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