Background: Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. We investigated the prevalence of pain in cancer patients ...according to the different disease stages and types of cancer. Patients and methods: A systematic review of the literature was conducted. An instrument especially designed for judging prevalence studies on their methodological quality was used. Methodologically acceptable articles were used in the meta-analyses. Results: Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: (i) studies including patients after curative treatment, 33% 95% confidence interval (CI) 21% to 46%; (ii) studies including patients under anticancer treatment: 59% (CI 44% to 73%); (iii) studies including patients characterised as advanced/metastatic/terminal disease, 64% (CI 58% to 69%) and (iii) studies including patients at all disease stages, 53% (CI 43% to 63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was >50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51% to 88%). Conclusion: Despite the clear World Health Organisation recommendations, cancer pain still is a major problem.
The distribution of entangled states across the nodes of a future quantum internet will unlock fundamentally new technologies. Here, we report on the realization of a three-node entanglement-based ...quantum network. We combine remote quantum nodes based on diamond communication qubits into a scalable phase-stabilized architecture, supplemented with a robust memory qubit and local quantum logic. In addition, we achieve real-time communication and feed-forward gate operations across the network. We demonstrate two quantum network protocols without postselection: the distribution of genuine multipartite entangled states across the three nodes and entanglement swapping through an intermediary node. Our work establishes a key platform for exploring, testing, and developing multinode quantum network protocols and a quantum network control stack.
Although a division of the Phanerozoic climatic modes of the Earth into "greenhouse" and "icehouse" phases is widely accepted, whether or not polar ice developed during the relatively warm Jurassic ...and Cretaceous Periods is still under debate. In particular, there is a range of isotopic and biotic evidence that favours the concept of discrete "cold snaps", marked particularly by migration of certain biota towards lower latitudes. Extension of the use of the palaeotemperature proxy TEX86 back to the Middle Jurassic indicates that relatively warm sea-surface conditions (26–30 °C) existed from this interval (∼160 Ma) to the Early Cretaceous (∼115 Ma) in the Southern Ocean, with a general warming trend through the Late Jurassic followed by a general cooling trend through the Early Cretaceous. The lowest sea-surface temperatures are recorded from around the Callovian–Oxfordian boundary, an interval identified in Europe as relatively cool, but do not fall below 25 °C. The early Aptian Oceanic Anoxic Event, identified on the basis of published biostratigraphy, total organic carbon and carbon-isotope stratigraphy, records an interval with the lowest, albeit fluctuating Early Cretaceous palaeotemperatures (∼26 °C), recalling similar phenomena recorded from Europe and the tropical Pacific Ocean. Extant belemnite δ18O data, assuming an isotopic composition of waters inhabited by these fossils of −1‰ SMOW, give palaeotemperatures throughout the Upper Jurassic–Lower Cretaceous interval that are consistently lower by ∼14 °C than does TEX86 and the molluscs likely record conditions below the thermocline. The long-term, warm climatic conditions indicated by the TEX86 data would only be compatible with the existence of continental ice if appreciable areas of high altitude existed on Antarctica, and/or in other polar regions, during the Mesozoic Era.
Summary
In this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical ...density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites.
Introduction
To examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally—in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters.
Methods
Cross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history.
Results
After full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (− 4%) in prediabetes and smaller cross-sectional area of the tibia (− 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (− 5%), cortical thickness (− 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (− 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters.
Conclusions
In this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.
Abstract Background The Surveillance of Rare Cancers in Europe (RARECARE) project aims at increasing knowledge of rare cancers in Europe. This manuscript describes the epidemiology of myeloid ...malignancies (MMs), taking into account the morphological characterisation of these tumours. Methods We used data gathered by RARECARE on cancer patients diagnosed from 1995 to 2002 and archived in 64 European population-based cancer registries, followed up to 31st December 2003 or later. Results The overall annual crude incidence of MMs was 8.6 per 100,000. Acute myeloid leukaemia (AML) and myeloproliferative neoplasms (MPN) were most common, with incidence rates of 3.7 and 3.1 per 100,000 year respectively, followed by 1.8 for myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MD/MPN) and 0.1 for histiocytic and dendritic cell neoplasms (HDCN). The 5-year relative survival rate ranged from 18% for chronic myelomonocytic leukaemia, 19% for AML, 29% for MDS and 44% for chronic myeloid leukaemia to relatively favourable rates for MPN (62%) and HDCN (83%). Total number of new cases of MMs in the EU27 is estimated at 43,000 annually, total number of prevalent cases (1st January 2008) at 189,000 cases. Conclusion MMs form a large variety of rare entities with specific characteristics. Collection of detailed information (immunophenotype, genetic abnormalities, molecular data and clinical data) and an up-to-date classification system is essential for their surveillance, especially now that more and more targeted therapies are being introduced.
In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years ...with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% 95% confidence interval (CI), 21% to 33% in 2000-2007 to 39% 95% CI, 35% to 42% in 2008-2013, P < .001; PFS: 22% 16% to 28% in 2000-2007 to 32% 95% CI, 29% to 36% in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio HR, 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.
•Over the last decade, allogeneic HCT has been increasingly administered in the United States to adults aged 70 and older with hematologic malignancies.•Allogeneic transplant outcomes were reasonable; high comorbidity and ablative conditioning regimens were associated with inferior outcomes.
With broadening indications, more options for hematopoietic cell transplantation (HCT) and improvement in survival, the number of long-term HCT survivors is expected to increase steadily. Infertility ...is a frequent problem that long-term HCT survivors and their partners face and it can negatively impact on the quality of life. The most optimal time to address fertility issues is before the onset of therapy for the underlying disease; however, fertility preservation should also be addressed before HCT in all children and patients of reproductive age, with referral to a reproductive specialist for patients interested in fertility preservation. In vitro fertilization (IVF) and embryo cryopreservation, oocyte cryopreservation and ovarian tissue banking are acceptable methods for fertility preservation in adult women/pubertal females. Sperm banking is the preferred method for adult men/pubertal males. Frequent barriers to fertility preservation in HCT recipients may include the perception of lack of time to preserve fertility given an urgency to move ahead with transplant, lack of patient-physician discussion because of several factors (for example, time constraints, lack of knowledge), inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation. There is a need to raise awareness in the medical community about fertility preservation in HCT recipients.
Autologous haematopoietic SCT with PBSCs is regularly used to restore BM function in patients with multiple myeloma or lymphoma after myeloablative chemotherapy. Twenty-eight experts from the ...European Group for Blood and Marrow Transplantation developed a position statement on the best approaches to mobilising PBSCs and on possibilities of optimising graft yields in patients who mobilise poorly. Choosing the appropriate mobilisation regimen, based on patients' disease stage and condition, and optimising the apheresis protocol can improve mobilisation outcomes. Several factors may influence mobilisation outcomes, including older age, a more advanced disease stage, the type of prior chemotherapy (e.g., fludarabine or melphalan), prior irradiation or a higher number of prior treatment lines. The most robust predictive factor for poor PBSC collection is the CD34(+) cell count in PB before apheresis. Determination of the CD34(+) cell count in PB before apheresis helps to identify patients at risk of poor PBSC collection and allows pre-emptive intervention to rescue mobilisation in these patients. Such a proactive approach might help to overcome deficiencies in stem cell mobilisation and offers a rationale for the use of novel mobilisation agents.
Several studies have been conducted to reconstruct temperature variations across the Aptian Stage, particularly during early Aptian Oceanic Anoxic Event (OAE) 1a. There is a general consensus that a ...major warming characterized OAE 1a, although some studies have provided evidence for transient "cold snaps" or cooler intervals during the event. The climatic conditions for the middle–late Aptian are less constrained, and a complete record through the Aptian is not available. Here we present a reconstruction of surface-water palaeotemperature and fertility based on calcareous nannofossil records from the Cismon and Piobbico cores (Tethys) and DSDP Site 463 (Pacific Ocean). The data, integrated with oxygen-isotope and TEX86 records, provide a detailed picture of climatic and ocean fertility changes during the Aptian Stage, which are discussed in relation to the direct/indirect role of volcanism. Warm temperatures characterized the pre-OAE 1a interval, followed by a maximum warming (of ~ 1.5–2 °C) during the early phase of anoxia under intense volcanic activity of the Ontong Java Plateau (OJP). A short-lived cooling episode interrupted the major warming, following a rapid increase in weathering rates. Nannofossils indicate that mesotrophic conditions were reached when temperatures were at their highest and OJP volcanism most intense, thus suggesting that continental runoff, together with increased input of hydrothermal metals, increased nutrient supply to the oceans. The latter part of OAE 1a was characterized by cooling events, probably promoted by CO2 sequestration during burial of organic matter. In this phase, high productivity was probably maintained by N2-fixing cyanobacteria, while nannofossil taxa indicating higher fertility were rare. The end of anoxia coincided with the cessation of volcanism and a pronounced cooling. The mid-Aptian was characterized by highest surface-water fertility and progressively decreasing temperatures, probably resulting from intense continental weathering drawing down pCO2. The lowest temperatures, combined with low fertility, were reached in the middle–late Aptian across the interval characterized by blooming of Nannoconus truittii. The prolonged cooling was followed by significant warming across the Aptian–Albian boundary. The data presented suggest that OJP activity played a direct role in inducing global warming during the early Aptian, whereas other mechanisms (weathering, deposition of organic matter) acted as feedback processes, favouring temporary cooler interludes.
The formation of oceanic detachment faults is well established from inactive, corrugated fault planes exposed on sea floor formed along ridges spreading at less than 80 km Myr-1 (refs 1-4). These ...faults can accommodate extension for up to 1-3 Myr (ref. 5), and are associated with one of the two contrasting modes of accretion operating along the northern Mid-Atlantic Ridge. The first mode is asymmetrical accretion involving an active detachment fault along one ridge flank. The second mode is the well-known symmetrical accretion, dominated by magmatic processes with subsidiary high-angle faulting and the formation of abyssal hills on both flanks. Here we present an examination of ∼2,500 km of the Mid-Atlantic Ridge between 12.5 and 35° N, which reveals asymmetrical accretion along almost half of the ridge. Hydrothermal activity identified so far in the study region is closely associated with asymmetrical accretion, which also shows high levels of near-continuous hydroacoustically and teleseismically recorded seismicity. Increased seismicity is probably generated along detachment faults that accommodate a sizeable proportion of the total plate separation. In contrast, symmetrical segments have lower levels of seismicity, which occurs primarily at segment ends. Basalts erupted along asymmetrical segments have compositions that are consistent with crystallization at higher pressures than basalts from symmetrical segments, and with lower extents of partial melting of the mantle. Both seismic evidence and geochemical evidence indicate that the axial lithosphere is thicker and colder at asymmetrical sections of the ridge, either because associated hydrothermal circulation efficiently penetrates to greater depths or because the rising mantle is cooler. We suggest that much of the variability in sea-floor morphology, seismicity and basalt chemistry found along slow-spreading ridges can be thus attributed to the frequent involvement of detachment faults in oceanic lithospheric accretion.
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