Poor Life Expectancy Research Articles

Cell-Free microRNAs as Potential Oral Cancer Biomarkers: From Diagnosis to Therapy.

Oral cavity cancer is the most frequent malignancy of the head and neck. Unfortunately, despite educational interventions for prevention and early diagnosis, oral cancer patients are often diagnosed in advanced stages associated with poor prognosis and life expectancy. Therefore, there is an urgent need to find noninvasive biomarkers to improve early detection of this tumor. Liquid biopsy has emerged as a valuable tool in medical oncology which provides new horizons for improving clinical decision making. Notably, cell-free microRNAs (miRNAs), a class of short non-coding RNAs, are emerging as novel noninvasive cancer biomarkers. Here, we provide an overview of the potential clinical application of cell-free miRNAs as diagnostic, prognostic, and therapeutic biomarkers in oral cancer.

Patients Turned Down for Non-Emergency Abdominal Aortic Aneurysm (AAA) Surgery: Are We Doing The Right Thing? Factors that Influence Decision Making and the Long-term outcome – A Single Centre Experience

Introduction - Decision to intervene once an AAA has reached the threshold size for repair relies on a careful balancing of risks and benefits. Advances in endovascular treatment have made it possible to intervene in patients that were previously considered unfit for open surgery. Despite this, there will always be patients in whom the survival benefit will not prevail the risks of AAA repair. Our study aims to determine the outcome of AAA patients turned down for non-emergency open and endovascular (including fenestrated or parallel stent graft) treatment as well as the factors involved in the decision-making process. Methods - All patients deemed unfit for open/endovascular AAA repair following multidisciplinary team (MDT) discussion at a tertiary referral hospital from 1st of January to 31st of December 2015 were included. Data was retrospectively analysed from the MDT database and the follow-up period extended until the 1st of June 2017. Reasons for not intervening were recorded using both MDT discussion outcomes and pre-operative assessments. AAAs were stratified according to size at the time of MDT discussion. Cause of death was accepted as “ruptured AAA’’ in those proven on CT scan. Survival was calculated from the date of the MDT discussion and the end point was either death or the close of the study. Results - 118 patients met the study inclusion criteria. 89 (75%) were men and the median age was 77 years. Median survival was 29 months. 77 (65%) patients were dead at the end of the study. Median survival according to AAA sizes were: 36 months (5.5-5.9 cm), 26 months (6.0-6.9 cm). 23 months (7.0-7.9 cm), 8 months (≥ 8.0 cm) (p<0.05, Log Rank test). 16 (14%) patients died of rupture - one patient had open surgery and another one underwent endovascular treatment but unfortunately both died. Cardiopulmonary exercise test (CPEX) was performed in 52% of cases and considered inappropriate in frail patients. Mortality rates were comparable in patients who had (65%) and had not (64%) undergone CPEX (p = 0.94, Chi square test) with a median survival 32 vs 28 months respectively (p = 0.001, Mann-Whitney U test). Median survival was similar for anaerobic threshold: 5-7.9 (32 months) and 8-11(31 months) (p = 0.42 Mann-Whitney U test). The reasons for not intervening included: patient choice (19%), cardiovascular, (67%) respiratory (48%), dementia (14%), malignancy (19%), renal failure (36%), poor CPEX (15%), frailty/not suitable for endovascular intervention (66%). Conclusion - It is reasonable to turn down patients based on their fitness, since they appeared to have a correlated poor life expectancy. 86% of patients turned down for non-emergency AAA repair died of unrelated illness within 2.5 years. 14% of patients during the study period had a documented AAA rupture. None of the patients who underwent emergency repair survived.

PSYCHOLOGICAL WELLBEING INTENDED FOR HEALTHY LONGEVITY

Human body has multidimensional ability to perceive consciousness and has infinite capacity to change, heal and renew by itself which is called rejuvenation. The estimation of Life Expectancy based on data from World Health Organization (WHO) and World Development Indicators (WDI) 2015, ranked 145/187 for India reflects poor life expectancy. Psychological wellbeing and emotional regulations are linked with better health and prevent illness physiologically. The concept of “Kaayakarpam” healthy longevity research from the siddha philosophy counterparts that longevity potential includes observation of certain lifestyle that help to prevent psychosomatic disease as mentioned in “Theraiyar Pini Anugaa Vidhi” as it makes human body resilient naturally.

Expert Consensus Recommendations for the Suspicion and Diagnosis of Transthyretin Cardiac Amyloidosis.

Cardiomyopathy is a manifestation of transthyretin amyloidosis (ATTR), which is an underrecognized systemic disease whereby the transthyretin protein misfolds to form fibrils that deposit in various tissues and organs. ATTR amyloidosis is debilitating and associated with poor life expectancy, especially in those with cardiac dysfunction, but a variety of treatment options have recently become available. Considered a rare disease, ATTR amyloidosis may be more prevalent than thought, particularly in older persons. Diagnosis is often delayed because of a lack of disease awareness and the heterogeneity of symptoms at presentation. Given the recent availability of effective treatments, early recognition and diagnosis are especially critical because treatment is likely more effective earlier in the disease course. The Amyloidosis Research Consortium recently convened a group of experts in ATTR amyloidosis who, through an iterative process, agreed on best practices for suspicion, diagnosis, and characterization of disease. This review describes these consensus recommendations for ATTR associated with cardiomyopathy as a resource to aid cardiologists and others in the recognition and diagnosis of ATTR associated with cardiomyopathy. Included in this review is an overview of red flag signs and symptoms and a recommended diagnostic approach, including testing for monoclonal protein, scintigraphy, or biopsy and, if ATTR associated with cardiomyopathy is identified, TTR genotyping.

Ethical dilemmas experienced by spouses of a partner with brain tumour.

Caring for a partner with primary malignant brain tumour can be a dramatic life-changing event. Primary malignant brain tumour is known to give poor life expectancy and severe neurological and cognitive symptoms, such as changed behaviour and personality, which demand greater caring responsibilities from spouses. The aim of the study is to explore ethical dilemmas spouses experience in the everyday care of a partner in treatment for primary malignant brain tumour. A phenomenological and hermeneutic qualitative descriptive design was adopted as a method for collecting and analysing data. Ten spouses were interviewed twice using an in-depth, semi-structured interview guide. The interviews took place at the spouses' homes or at the hospital. Ethical matters were considered throughout the research process. Permission from The National Committee on Health Research Ethics and the Danish Data Protection Agency was obtained. The analysis showed that the spouses perceived daily ethical dilemmas in caring for a partner with primary malignant brain tumour. Their life as well as their partner's life had changed considerably. The main theme that emerged therefore was 'oscillating in a changing relationship'. This theme was further elaborated in three subthemes that in more detail demonstrated the dilemmas: 'doing the right thing in unpredictable daily situations'; 'torn between patience and guilt'; and 'living in a time of uncertainty, hope and despair'. Caring for a partner with changed behaviour and personality due to primary malignant brain tumour may involve exhausting ethical caring dilemmas. Spouses' married life may change to a semi-professional asymmetrical relationship, which is challenged by the oscillation between acting responsibly for their partners' well-being and caring dilemmas with no answer for what the right thing to do is. Mixed feelings of right and wrong, patience and guilt, hope and despair seem to be spousal companions through their partners' progressing illness.

Diagnostic value of CD206+CD14+ macrophages in diagnosis of lung cancer originated malignant pleural effusion.

Pleural effusions are common complications of various diseases. Patients with malignant pleural effusion (MPE) usually face poor prognosis and short life expectancy. Discriminating between MPE and benign pleural effusion remains to be difficult. The aim of our current study was to evaluate whether CD206+CD14+ macrophages could be a diagnostic biomarker for MPE. The percentages of CD14+, CD86+CD14+ and CD206+CD14+ macrophages in pleural effusions were determined by flow cytometry in 34 patients with MPE and 26 with benign pleural effusion, and their diagnostic performances were evaluated by receiver operating characteristic (ROC) curves. The percentages of CD14+, CD86+CD14+ and CD206+CD14+ macrophages were remarkably higher in MPE than in benign pleural effusion (all P<0.05). With a cutoff value of 39.8%, a high sensitivity of 88.2% and high specificity of 100.0% were found in CD206+CD14+ macrophages to diagnose MPE. The area under the curve, positive predictive value and negative predictive value of CD206+CD14+ macrophages were 0.980 (95% CI, 0.905 to 0.999), 100.0 (88.4 to 100.0) and 86.7 (69.3 to 96.2), respectively. The diagnostic performance of CD206+CD14+ macrophages was more accurate than those of CD14+ and CD86+CD14+ macrophages. CD206+CD14+ macrophages could be used to discriminate MPE from benign pleural effusion.

Nutritional Eating; What Do You Know and When Did You Know It? (P04-098-19)

ObjectivesThe World Health Organization (W.H.O.) projects by 2020 chronic disease will account for 73% of deaths worldwide (W.H.O., 2010). In the United States (U.S.) minorities are high risk for chronic diseases. U.S. census projects by 2050 American minorities as the majority (Census, 2000).Purposes of pilot study 1) identify individual knowledge of chronic diseases; 2) when known (time frame); and 3) knowledge implemented to improve health. Important because if projections are correct health of the majority of people worldwide and U.S. society in particular, (Americas’ minority/majority) forecast as: poor health with short healthy life expectancy.Leading chronic diseases causing mortality in America: heart disease, cancer and lower respiratory diseases (Center for Disease Control, 2016). Hispanics are 16% of U.S. population. Leading cause of mortality: cancer. African Americans are 13.6% of U.S. population. Leading cause of mortality: heart disease. Societal challenge: mitigating health issues of a minority/majority. MethodsA convenience sample adults (N = 15) utilized; most minorities. They completed 32 item questionnaire. Some items were Likert scale 5 strongly agree and 1 strongly disagree. ResultsNinety-nine % have family member(s) with health challenges. More than 50% indicate being, “Healthy”. Half indicate being overweight. The majority response to frequency questions: 2–3 weekly. Example, most consume 9 servings of fruits/vegetables (F/V) 2–3 weekly. USDA recommend 9 servings of F/V daily. Time frame questions: ‘when known’. Example, half indicate meat and dairy as a diet necessity. When known, majority indicate over a year ago. Meat/dairy linked with chronic diseases. Majority misidentifies nutrient dense foods. Example, majority indicate white potatoes and iceberg lettuce as nutrient dense. Nutrient dense foods mitigate chronic diseases. Response to Likert type scale items, example, “I work hard to improve my dietary lifestyle”, most indicate ‘agree’. ConclusionsCurrent nutritional information limited. Outdated nutritional information implemented. Nutrient dense diet lacking. The trajectory forecast of a minority/majority with poor health and short healthy life expectancy is on target. Funding SourcesN/A.

Survival and quality of life after whole brain radiotherapy with 3D conformal boost in the treatment of brain metastases.

BackgroundBrain metastases are the most frequent intracranial neoplasms in adults. Although overall survival (OS) is an important endpoint in patients receiving radiotherapy, given their poor life expectancy in general, quality of life is becoming an increasingly useful endpoint. Objectives: to evaluate whole brain radiotherapy (WBRT) with 3D conformal boost in brain metastases patients with regard to OS and quality of life.MethodsDuring April 2015–May 2017, a total of 35 patients with ≤5, previously untreated, inoperable brain metastases were included prospectively. All patients underwent WBRT followed by 3D conformal boost to the metastatic lesions. EORTC quality of life questionnaires QLQ-C30 and QLQ-BN20 were used at baseline and at end of treatment. The mean initial and final scores were compared using Student test. One-year OS with brain metastases was computed with Kaplan Maier method.ResultsMedian survival with brain metastases was 4.43 months (0.73–78.53). The one-year OS for patients with one metastasis was 42% versus 15% for more than one (p<0.04). The presence of extracerebral metastases significantly decreased OS from 39% without extracerebral metastases to 19%. (p<0.05). Quality of life improved significantly in several functional domains: physical (48 vs 60.29), role functioning (28.1 vs 44.7), emotional (47.1 vs 80.2), global health status (40.9 vs 62.3). Symptom scores decreased significantly in most items, corresponding to an improvement in the symptom burden: headache (61.9 vs 0.9), nausea and vomiting (45.7 vs 7.1), visual disorder (26.3 vs 9.2), seizures (30.4 vs 0.9), motor dysfunction (46.6 vs 17.1). Symptom scores for fatigue and drowsiness increased significantly (51.1 vs 74.9, respectively 37.1 vs 70.4), indicating worsening of symptoms.ConclusionsWBRT with 3D conformal boost is a feasible technique which improves quality of life in brain metastases patients. Since survival is limited, the assessment of quality of life is a good indicator of the treatment outcome.

Active Surveillance for Low-risk Prostate Cancer: Are All Criteria Similar?

Active Surveillance (AS) is a therapeutic strategy for early-stage Prostate Cancer (PCa) conceived to balance early detection of aggressive disease and overtreatment of indolent tumor. Several active surveillance protocols have been published over the years, however the risk of misclassification still exist. In this review, we revised the current criteria of AS and evaluated the characteristics of potential risk factors of misclassification or deferred treatment. We did a systematic search of the MEDLINE database, from 1993 to May 2015, according to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines and limited to the English language. The search terms used included "prostate cancer" and "active surveillance" and "criteria. We have excluded from the study reviews and editorial comments as well as multiple papers from the same data sets. Although the follow-up of reported studies was a quite short compared to the duration of the disease, the data are sufficient to conclude that active surveillance should be offered to men with low-risk disease and to men with intermediate risk and poor life expectancy. The present challenge, in fact, is to differentiate the clinically silent disease from the unfavorable course by identifying the right timing for any deferred treatment. This is made particularly difficult by the absence of randomized controlled trials directly comparing different AS monitoring methods. As summarized in this review, it is still difficult to select patients eligible for active surveillance and differentiate them from those that should move to active treatment. From the data, currently available in the literature, however, it is possible to recommend active surveillance to men with low-risk disease and to men with intermediate-risk disease but with short life expectancy.

Transglutaminase is a mesothelioma cancer stem cell survival protein that is required for tumor formation.

Mesothelioma is a rare cancer of the mesothelial cell layer of the pleura, peritoneum, pericardium and tunica vaginalis. It is typically caused by asbestos, notoriously resistant to chemotherapy and generally considered incurable with a poor life expectancy. Transglutaminase 2 (TG2), a GTP binding regulatory protein, is an important cancer stem cell survival and therapy resistance factor. We show that TG2 is highly expressed in human mesothelioma tumors and in mesothelioma cancer stem cells (MCS cells). TG2 knockdown or TG2 inhibitor treatment reduces MCS cell spheroid formation, matrigel invasion, migration and tumor formation. Time to tumor first appearance is doubled in TG2 knockout cells as compared to wild-type. In addition, TG2 loss is associated with reduced expression of stemness, and epithelial mesenchymal transition markers, and enhanced apoptosis. These studies indicate that TG2 is an important MCS cell survival protein and suggest that TG2 may serve as a mesothelioma cancer stem cell therapy target.

Laparoscopic gastrojejunostomy for gastric outlet obstruction: personal serie

Traditionally, benign diseases were responsible for most of the causes of gastric outlet obstruction (GOO), but in recent years, 50-80% could be attributable to malignancy. Malignancy includes distal gastric cancer and hepatobiliary-pancreatic (HBP) neoplasms. In metastatic/unresectable HPB tumors, GOO decrease quality of life and treatment should be necessary. Options are duodenal stent or gastrojejunostomy (GJ), but there is no consensus. In benign diseases, 1-5% of patients with chronic pancreatitis (PC) would develop GOO. We retrospectively review all consecutive patients who underwent laparoscopic GJ for GOO due to CP or advanced HBP cancer at University Hospital of Guadalajara, Spain. We studied 10 patients with laparoscopic GJ. HBP neoplasms: Age: 78,01±6,8 years. Albumin: 28,36 ±2,7. No patient received prior chemo. Tabled 1EP02F-021 TableAge/SexGOOSSClinical successTime to initiate intakeLOS (days)Duration of food intake77/F0Yes412402 (until death)76/M3Yes312228(until death)91/F0Yes15278 (until death)78/F0Yes3107868/M0YesND128276/M0YesND13220 (until death)76/F0YesND5ND Open table in a new tab CP: 3 males. Age: 56,2±3,4. Median albumin: 37,7±6,6. Clinical success: 100%. Median LOS: 6,33±0,6. Previous literature on GOO treatment mixes different causes with different prognosis, so level of evidence is low. In benign diseases, such as CP, data are limited and patients typically requires surgical GJ. In malignancy, literature on GJ showed better long-term relief and lower reintervention rates. In other hand, stents are associated with lower hospital stay, faster initial relief and shorter time to intake, with more recurrent symptoms. Survival is essential for the choice of treatment. In HBP neoplasms, chemotherapy has increased survival. Stent is usually preferred in patients with poor general condition or life expectancy of less than 90 days but more studies are needed to standardize treatment. Laparoscopic GJ is a feasible, safe and efficient technical option.

Staging of Mycosis Fungoides and Sézary Syndrome: Time for an Update?

Mycosis fungoides (MF) is the most common variant of cutaneous T cell lymphoma and frequently presents as early-stage disease with skin patches and plaques with an indolent course, but patients experience significant morbidity from itch and disfigurement. Around 30% of patients with MF present in the advance stages with skin tumours, erythroderma, and extensive nodal or visceral involvement. Sézary syndrome (SS) is the leukaemic cutaneous T cell lymphoma variant. The staging of MF or SS was revised in 2007 to include skin, nodal, visceral, and blood (tumour- node-metastasis-blood classification) to determine nine stages (IA–IVB). While most patients with early disease (Stages IA–IIA) have a good prognosis, 25% progress to advanced disease, with a poor life expectancy of around 3 years; however, some patients do survive for ≥10 years. Accurate staging is crucial since management strategies are stage-based, with skin-directed therapy recommended in early-stage disease and with no curative therapeutic options to improve symptoms and reduce skin tumour burden. In contrast, advanced-stage patients mostly require systemic therapy. Most treatments have only partial response rates, around 40%, and allogeneic bone marrow transplant may provide a more long-lasting therapeutic option for advanced patients. Relevant prognostic factors within the tumour-node-metastasis-blood classification are discussed in this review and their relevance to overall IA–IVB staging and outcomes are debated. Several important prognostic features have been identified that may be used alongside staging to give further prognostic information. These prognostic features include age &gt;60 years at diagnosis, large cell transformation of the skin, and raised serum lactate dehydrogenase levels, which could be developed into a prognostic index to identify patients at risk of progression and requiring more aggressive therapy. The PROCLIPI study, a prospective cutaneous lymphoma international study, has been ongoing since 2015 to collect such data, with the aim of developing a prognostic index for MF and SS.

Angiopoietin-2 and Survival in Peripheral Artery Disease Patients

Survival of peripheral arterial disease (PAD) patients increased over the last decade due to increased use of secondary preventive medication and rapid revascularization of PAD patients. Angiogenetic markers such as vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2) and its receptor Tie-2 might be useful markers to assess the residual risk for mortality in PAD patients. The aim of this study was to evaluate angiogenetic markers for the prediction of mortality in a PAD cohort. For this purpose, 366 patients (mean age: 69 ± 10 years) with PAD Fontaine stage I or II were included and followed up over a 5-year study period. Serum Ang-2, Tie-2 and VEGF levels were measured by bead-based multiplex assay. All-cause mortality and major cardiovascular events (MACE) including all-cause death, non-fatal stroke and non-fatal myocardial infarction were analysed by Kaplan-Meier and Cox regression analyses after 5 years. Ang-2 was associated with Tie-2 (R = 0.151, p = 0.006) and VEGF levels (R = 0.160, p = 0.002). However, only Ang-2 was linked to all all-cause mortality in PAD patients (hazard ratio [HR]: 1.55 [1.23-2.15], p = 0.008) even after adjustment for age and gender, haemoglobin A1c, low-density lipoprotein cholesterol, systolic blood pressure and glomerular filtration rate (HR: 1.44 [1.03-2.00], p = 0.032). Furthermore, an association of Ang-2 and MACE in PAD patients (HR: 1.36 (1.03-1.78), p = 0.028) was found. This result implies that Ang-2 might be used as an additional marker to stratify PAD patients to predict poor mid-term life expectancy.

Breast cancer among older women: The influence of age and cancer stage on survival

Purpose of studyTo describe the association between increasing age and survival among women aged over 65 years, diagnosed with breast cancer. Materials and methodsA historical prospective cohort study, comparing 3270 breast cancer patients to 13,163 non cancer age matched controls. Baseline characteristics and cancer data gathered from the Israeli Central Bureau of Statistics (1995), the Israel Cancer Registry (2000–2010). Baseline measurements included age, socioeconomic status. Cancer stage at diagnosis was clustered as stage I, stage II–III and metastatic. Cox Proportional Hazards regression models were used to determine Hazards Ratios (HR) for mortality. ResultsBetween ages 65–69 and ≥85, metastatic disease rose from 3.9% to 23.4% and stage I disease declined from 58.6% to 30.1%. At age 80–84, 50% life expectancy among controls, stage I, and stage II–III disease was 95,92 and 90 months respectively, compared to 2 months for metastatic disease. Compared to controls, between the age 65–69 to ≥85, adjusted HR’s progressively decreased among subjects with stage I from HR 0.96 (95% CI 0.69–1.33) to 0.60 (95%CI 0.36–1.01), stage II–III from HR 3.26 (95%CI2.58–4.12) to HR 1.60 (95%CI 1.22–2.09), and metastatic disease from HR 57.40 (95%CI 39.56–83.29) to HR 20.76 (95%CI 14.73–29.24). ConclusionsThis study describes the increasingly poor prognosis and short life expectancy observed among women aged ≥80 diagnosed with metastatic breast. In contrast, our findings confirm the positive prognosis associated with rising age, among older women presenting with stage I breast cancer, among whom survival was similar, if not slightly better, than non-cancer age matched controls.

Correlation Between Baseline Osteoprotegerin Serum Levels and Prognosis of Advanced-Stage Colorectal Cancer Patients

Background/Aims: Osteoprotegerin (OPG) is a soluble receptor of the pro-apoptotic cytokine TRAIL which is thought to contribute to tumour development by inhibiting apoptosis or affecting other aspects of tumour biology, including cell proliferation and immune response. Although immunohistochemical studies suggest that OPG correlates with survival in metastatic colorectal cancer (mCRC), only scarce data are available on serum OPG in CRC patients. Methods: In this pilot study, we assessed the prognostic significance of serum OPG and CEA (Carcinoembryonic antigen) in 81 patients with UICC (Union for International Cancer Control) stage-IV mCRC. OPG was additionally assessed by immunohistochemistry in primary tissue samples from 33 patients of the same cohort. Results: Baseline serum OPG correlated with CEA (r=0.36, p=0.0011), but independently predicted survival of mCRC patients. Life expectancy was poorer in patients with OPG levels above the median concentration of 51ng/ml (median overall survival [95% confidence interval] 1.8 years [1.3-3.0] vs. 1.0 [0.7-1.2] p=0.013). Patients with high levels of both OPG and CEA had an even poorer life expectancy vs. low-OPG/low-CEA patients (0.9 years [0.6-1.5] vs. 3 years [1.2-4.4], p=0.015), indicating that CEA and OPG have additive prognostic significance. Immunohistochemical analysis of OPG failed to show a correlation between OPG staining and survival (p=0.055) or OPG concentration from matched serum samples. Conclusions: This pilot study provides evidence of independent prognostic significance of serum OPG in patients with advanced mCRC and warrants its further prospective validation.

Global health inequalities and the need for solidarity: a view from the Global South.

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times.

Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty.

Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.

Surgical and endovascular venous arterialization for treatment of critical limb ischaemia.

Patients with critical limb ischaemia have a poor life expectancy. Aggressive revascularization is accepted in order to preserve their independence in the final phase of their lives. Bypass surgery and more recently endovascular interventions with angioplasty and stenting have become the treatment of choice to prevent amputation and to resolve pain. However, as many as 20 % of patients with critical limb ischaemia are unsuitable candidates for a vascular intervention because of extensive occlusions of outflow in the crural and pedal vessels. Such "no-option critical limb ischaemia" may be treated with venous arterialization. In the present review, we discuss the history of the venous arterialization procedure, the mechanisms, the different techniques, and complications of venous arterialization.

Embedded Palliative Care Provider in Pulmonary Practice; Discussion of the Structure, Process, and Outcomes

Abstract Patients with severe Chronic Obstructive Pulmonary Disease (COPD) have a poor quality of life and limited life expectancy. PalliativeCare (PC) providers are well versed to provide care for these chronically ill patients with COPD. The objective of this paper is to describe the process taken by a health system inpatient palliative care team and pulmonary providers to embed palliative services within a specialty office-based practice. We considered the impact of integrating PC services on the structure, process, and outcomes of patients, health system, and office practice. Specific attention was placed on the effect of an embedded PC provider on workload of the office practice. Six months after initiating the PC provider into the pulmonary practice, we reviewed the impact on the patients and practice. A total of 63 patient visits were completed during 112 hours of embedded PC services.Twenty-three patients enrolled with hospice, between their first and third appointments with PC provider. We found a reduction in Emergency Department (ED) visits and hospitalization, 52% and 33% respectively. We also noted a reduction in pulmonary office appointments and incoming triage calls, 77% and 43%, respectively. Finding from the inquiry of the impact of an embedded PC clinic did not demonstrate increased workload, rather a decreased demand on the health system and pulmonary office staff. Keywords: Embedded Palliative Care; Palliative Care; Pulmonary Practice

Management of Multiply Relapsed Aggressive Non-Hodgkin Lymphoma: New Perspectives

Patients with refractory/relapsed (R/R) non-Hodgkin lymphoma (NHL) make up a very heterogeneous population with a poor life expectancy. The objective of this symposium was to provide an overview of the current treatment landscape for aggressive NHL, as well as the future research on new treatments. Transplant-eligible patients receive salvage chemotherapy, followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). Patients who fail transplant or are transplant-ineligible generally receive palliative treatment or enter clinical trials; there is no standard of care and thus there is a high unmet clinical need. Pixantrone is currently indicated for adult patients with multiply R/R aggressive B-cell NHL, thereby filling the unmet clinical need in this field. The symposium started with a brief overview of the meeting objectives. This was followed by an overview of the current and future treatment landscape for aggressive NHL, including a case study of a patient with diffuse large B-cell lymphoma (DLBCL) with multiple relapses receiving pixantrone as monotherapy. The results and post hoc analysis of the CORAL and the SCHOLAR1 studies were reviewed, including the relative merits of combination therapy versus monotherapy for patients with relapsed DLBCL who had failed second-line salvage therapy. The symposium ended with an outline of the profile and mechanism of action of pixantrone, and evidence from the PIX301 study that provided the basis for regulatory approval for the use of pixantrone in third and fourth-line treatment of R/R aggressive B-cell NHL. The clinical efficacy and safety of pixantrone were reviewed, together with a future perspective on the ongoing PIX306 trial. The symposium concluded with the presentation of two clinical cases of patients treated with pixantrone, a ‘Question and Answer’ session, and a panel discussion.