Fatigue after breast cancer treatment is a common burden that is challenging to treat. The aim of this study was to explore if such integrated rehabilitation program reduces the prevalence of chronic ...fatigue compared to simple, non-integrated rehabilitation.
The subjects of our prospective study were 600 female breast cancer patients (29-65 mean 52 years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2021 and were monitored for one year. The control group included 301 patients and the intervention group numbered 299 patients. The patients completed three questionnaires (EORTC QLQ-C30, -BR23 and NCCN): before cancer treatment, and then six and twelve months after the beginning of cancer treatment. The control group obtained the standard rehabilitation program, while the intervention group was part of the early, individualized multidisciplinary and integrated approach of rehabilitation. The rehabilitation coordinator referred patients for additional interventions (
, psychologist, gynecologist, pain management team, physiotherapy, clinical nutrition team, kinesiologist-guided online training, vocational rehabilitation, general practitioner). Data on the patients' demographics, disease extent, cancer treatment and complaints reported in questionnaires were collected and analyzed.
There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, or radiotherapy, and also no differences in the fatigue before the beginning of treatment. However, patients from the control group had a greater level of constant fatigue than patients from the intervention group half a year (p = 0.018) and a year (p = 0.001) after the beginning of treatment. Furthermore, a greater proportion of patients from the control group experienced significant interference with their usual activities from fatigue than from the intervention group, half a year (p = 0.042) and a year (p = 0.001) after the beginning of treatment. A multivariate logistic regression showed that one year after the beginning of treatment, the only independent factor correlated to fatigue was inclusion into the intervention group (p = 0.044). Inclusion in the intervention group was beneficial-patients from the control group were 1.5 times more likely to be fatigued.
Early individualized integrated rehabilitation is associated with a lower prevalence of chronic fatigue or fatigue interfering with usual activities in breast cancer patients in comparison to the control group of patients.
Papillary thyroid carcinoma (PTC) arising in pyramidal lobe (PL) is very rare. The aim of this study was to determine the incidence of single PTC focus in PL and its lymphonodal metastases, as well ...as to present a single surgeon experience in management of PL PTC. We performed a retrospective analysis of records of all patients surgically treated for PTC in our institution from year 2003 to 2013. Only patients with single PTC focus in PL were included. Out of total 753 patients, majority (66.52%) had PTC focus in one of the lobes, while only 3 patients (0.4%) had solitary PTC focus in PL. They were all females, aged 36, 41 and 22. During surgery, methylene-blue dye was injected peritumorally. After frozen section analysis of excised PL and isthmus and confirmation of malignancy, we performed total thyroidectomy with central neck dissection, as well as sentinel lymph node biopsy in both jugulo-carotid regions. Pathology showed encapsulated PTC stage T1 and solitary metastasis in Delphian lymph node of the youngest patient. All patients were disease free in the follow-up. PTC single focus in PL is very rare and only individual experiences can be discussed regarding the extent of the surgery.
Background Diabetes mellitus (DM) and DM related comorbidities may initiate difficulties during cancer specific treatment and may have an impact on cancer management and outcome. The aim of our study ...was to find out if DM in patients with advanced colorectal carcinoma (CRC) is associated with cancer-specific or overall survival. Patients and methods This study included 200 consecutive patients (131 males, 69 females, mean age 63 years) with elective CRC surgery at the Institute of Oncology Ljubljana and DM was found in 39 (19.5%) of them. Even 64% of patients had Stage 3 or 4 disease, so neo-adjuvant chemotherapy (CTX) and/or radiotherapy (RT) were carried out in 59% of cases. Data about gender, age, body mass index, presence of DM, American Society of Anesthesiologists (ASA) physical status score, stage of disease and postoperative complications were collected prospectively. Cancer-specific survival and overall survival were compared by log-rank test. Results Patients with DM had a higher ASA score, BMI, the illness marker, rate of massive bleeding, blood transfusion and longer hospital stay than those without DM. The mean follow-up period was 4.75 years. All causes mortality in patients with DM and without DM was 23% and 27%, respectively. Three-year cancer-specific survival in patients with DM and without DM was 85% and 89%, respectively (p = 0.68). Three-year overall survival in patients with DM and without DM was 82% and 84%, respectively (p = 0.63). Conclusions The presence of DM was not associated with tumor stage, disease-specific survival or overall survival in patients with advanced CRC.
•The work presents a study of upward lightning initiated by nearby lightning activity.
•Analysis is based on LMA, current and fast antenna measurements.
•Cloud charge structure is presented.
•Leader ...polarity is investigated based on LMA and current measurements.
•The storm LMA activity, measured by the number of located sources, was, on average, almost seven times higher during tower flashes initiated by nearby lightning activity compared to that during the self-triggered tower flashes.
We present in this paper lightning current measurements, LMA (Lightning Mapping Array) data and fast antenna electric fields associated with upward flashes observed at the Säntis Tower during summer of 2017. The LMA network consists of six stations that were installed in the vicinity of the tower at distances ranging from 100 m to 11 km from it. Out of 20 LMA recorded flashes here we analyze in detail three so-called ‘other-triggered flashes’, triggered by preceding activity. Based on the lightning activity derived from the European Lightning Detection Network (EUCLID) in an area within 30 km from the tower and within a 1-s time window before the start of the upward tower flashes, only one out of 20 flashes was classified as ‘other-triggered’(OT). However, the investigations based on the LMA data reveal that 3 more flashes of the 20 analyzed were preceded by nearby activity and should therefore be classified as OT flashes. We analyze conditions conducive to the OT flashes, such as the charge structure of the clouds, polarity of preceding leaders and level of activity of the storm.
The LMA source active time period was on average seven times higher for the OT flashes than that for self-initiated flashes.
Well-differentiated thyroid carcinoma in children and adolescents is rare but demonstrates aggressive behavior. Gross lymph node metastases and distant metastases are common upon first clinical ...presentation. During a 33-year period (1981-2014) at the Institute of Oncology and Radiology of Serbia, 62 children and adolescents underwent surgery due to well-differentiated thyroid carcinoma. Mean age was 16.7 (range 7-21) years. At the time of diagnosis 6% of patients had lung metastases. Total thyroidectomy or completion thyroidectomy was performed for all patients followed by central neck dissection and frozen section examination of jugular-carotid compartments. Median follow-up was 10.9 (range 0.69-33.05) years and median tumor size was 20 (range 2-60) mm. Papillary carcinoma was found in 96%, and follicular and Hürthle cell carcinoma in 2% of patients. Multifocal tumors were found in 50% and capsular invasion in 60% of patients. Lymphonodal metastases in either central or lateral neck compartments were found in 73% of patients. Multifocality and capsular invasion were significantly more frequent in patients less than 16 years of age (both p<0.01). Median disease-free interval had not been reached and overall survival rate was 100%. Well-differentiated thyroid carcinoma in children and adolescents is characterized by a high rate of loco-regional aggressiveness, multifocality, capsular invasion, lymph node metastases and distant metastases at the time of diagnosis. Adequate surgical approaches should be performed for both primary and recurrent disease in young patients with well-differentiated thyroid carcinoma in order to achieve loco-regional disease control and longer disease-free survival.
Preoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or ...molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm.
Altogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma.
Carcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm.
Recurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.
Background. Hürthle cell thyroid carcinoma (HCTC) is a rare type of thyroid carcinoma. In the present study, we investigated whether the expression of miRNAs of interest is associated with the ...occurrence of metastases in patients with HCTC. Materials and Methods. In 39 patients with HCTC (22 with nonmetastatic and 17 with regional or distant metastatic disease), the expression levels of six miRNAs (miR-138, miR-183, miR-221, miR-222, miR-768-3p, and miR-885-5p) and U6 snRNA as endogenous control were determined in FFPE samples of primary tumor and normal thyroid tissue using TaqMan miRNA assays. Results. In patients with HCTC, miR-138 and miR-768-3p were downregulated in tumor samples compared to normal tissue ( p = 0.013 and p = 0.010 , resp.). These two miRNAs were also significantly downregulated in tumor samples of patients with metastatic disease ( p = 0.030 and p = 0.048 , resp.) but not in patients with nonmetastatic disease ( p = 0.249 and p = 0.101 , resp.). In patients with nonmetastatic disease, miR-221 and miR-885-5p were slightly, albeit significantly, upregulated in tumorous compared to normal tissue ( p = 0.042 and p = 0.027 , resp.). Conclusion. Expression of miRNA (miR-183, miR-221, and miR-885-5p) in tumor tissue is associated with the occurrence of distant metastases in patients with HCTC.
Hurthle cells of the thyroid gland are very rich in mitochondria and oxidative enzymes. As a high level oxidative metabolism may lead to higher level of oxidative stress and can be associated with an ...increased risk for cancer, we investigated whether common functional polymorphisms in antioxidant genes (SOD2, CAT, GPX, GSTP1, GSTM1 and GSTT1) are associated with the development or clinical course of Hurthle cell thyroid carcinoma (HCTC).
A retrospective study was performed in 139 patients treated by thyroid surgery for a Hurthle cell neoplasm. HCTC, Hurthle cell thyroid adenoma (HCTA) or Hurthle cell thyroid nodule (HCTN) were diagnosed by pathomorphology. DNA was extracted from cores of histologically confirmed normal tissue obtained from formalin-fixed paraffin-embedded specimens and genotyped for investigated polymorphisms. Logistic regression was used to compare genotype distributions between patient groups.
HCTC, HCTA and HCTN were diagnosed in 53, 47 and 21 patients, respectively. Metastatic disease and recurrence of HCTC were diagnosed in 20 and 16 HCTC patients, respectively. Genotypes and allele frequencies of investigated polymorphisms did not deviate from Hardy-Weinberg equilibrium in patients with HCTC, HCTA and HCTN. Under the dominant genetic model we observed no differences in the genotype frequency distribution of the investigated polymorphisms when the HCTA and HCTN group was compared to the HCTC group for diagnosis of HCTC or for the presence of metastatic disease. However, GPX1 polymorphism was associated with the occurrence of recurrent disease (p = 0.040).
GPX1 polymorphism may influence the risk for recurrent disease in HCTC.
Interest in exploring the meteorological conditions favoring upward lightning from tall man‐made structures has grown in recent years, largely due to the worldwide expansion of wind energy. To this ...end, instrumented towers existing around the world are the most suitable places to study upward lightning. In this context, an LMA network was deployed around the Säntis Mountain (northeast Switzerland) during the summer of 2017, in order to complement the long‐term measurements currently held at the Säntis telecommunications tower, a lightning hot spot in central Europe. This campaign allowed, for the first time, to gather a comprehensive set of observations of self‐initiated upward lightning emerging from the Tower. With the help of C‐band dual‐polarimetric radar data, the present work focuses on the meteorological conditions conductive to self‐initiated upward lightning from the Säntis. The analysis revealed that the upward propagating positively charged leaders spread mostly horizontal above the melting level, after an initial short vertical path from the tower tip. After this initial stage, the majority of upward leaders were followed by a sequence of negative return strokes. The inception upward lightning under a stratiform cloud shield would be favored by the low height of the charge structure. From the obtained results, it turns out that a key feature favoring self‐initiated upward lightning would be the proximity of the tower tip to the melting level.
Plain Language Summary
In this paper, we present a multisensor analysis of upward lightning emerging from the Säntis tower, in Switzerland. This telecommunications tower is a lightning “hot spot” in central Europe, with a hundred of lightning striking the tower every year. For this reason, the tower has been instrumented, to study the current associated to the lightning discharges that hit the tower. To complement the current measurements, a Lightning Mapping Array network was deployed around the Säntis Mountain, during the summer of 2017. This campaign allowed, for the first time in Europe, to study the three‐dimensional structure of the upward leaders that initiate the process of the upward lightning from the tower. Moreover, with the help of dual‐polarimetric radar data from MeteoSwiss (Switzerland Federal Office for Meteorology), the present work analyzes the meteorological conditions that favor the triggering of upward lightning from the Säntis tower.
Key Points
After a short vertical path, upward positive leaders turned horizontal to spread above the melting level
Self‐initiated upward lightning occurred under stratiform precipitation, once the convective region of the system has passed away
A key feature favoring self‐initiated upward lightning is the proximity of the tower tip to the melting level
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