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Objectives There is a paucity of research on the impact of cancer treatment on the health-related quality of life (HRQOL) of adolescent and young adult (AYA) patients with cancer. Patient-reported outcomes (PROs) are self-report measures used to assess HRQOL and symptom burden. The extent to which PROs have been included in trials that include common AYA cancer types has not been previously assessed. Methods Therapeutic phase 3 trials among common AYA cancer types (Hodgkin lymphoma, non-Hodgkin lymphoma, acute lymphoblastic leukemia, sarcomas, and germ cell tumors) initiated between 2007 and 2020 were identified on ClinicalTrials.gov . The proportions and characteristics of trials including a PRO endpoint were assessed. For comparison with an older population, the proportion of breast and colorectal therapeutic phase 3 trials including PRO endpoints were assessed. Results Eighty-seven studies met the inclusion criteria. Overall, 20.7% of therapeutic phase 3 AYA trials included a PRO endpoint, and only one trial published PRO data. Germ cell tumors (42.9%) and non-Hodgkin lymphoma (40%) trials had the highest proportions of PRO inclusion. The European Organization for Research and Treatment of Cancer generic, cancer-specific quality of life questionnaire was the most commonly used PRO measure; nevertheless, the measures used varied within and between cancer types. The proportion of trials including a PRO endpoint did not change significantly between 2007 to 2013 and 2014 to 2020 (18.6% vs 22.7%, P=.79). Conclusions Few therapeutic phase 3 AYA cancer trials include PRO endpoints, fewer publish PRO data, and there is no homogeneity in the measures administered. Therapeutic trials represent an underused opportunity to capture PRO data in the AYA population with the goal of improving HRQOL outcomes.

Conducting palliative care research can be personally and professionally challenging. Although limitations in funding and training opportunities are well described, a less recognized barrier to successful palliative care research is creating a sustainable and resilient team. In this special report, we describe the experience and lessons learned in a single palliative care research laboratory. In the first few years of the program, 75% of staff quit, citing burnout and the emotional tolls of their work. To address our sustainability, we translated resilience theory to practice. First, we identified and operationalized shared mission and values. Next, we conducted a resilience resource needs assessment for both individual team members and the larger team as a whole and created a workshop-based curriculum to address unmet personal and professional support needs. Finally, we changed our leadership approach to foster psychological safety and shared mission. Since then, no team member has left, and the program has thrived. As the demand for rigorous palliative care research grows, we hope this report will provide perspective and ideas to other established and emerging palliative care research programs.

Context Supporting patients' spiritual needs is central to palliative care. Adolescents and young adults (AYAs) may be developing their spiritual identities; it is unclear how to navigate conversations concerning their spiritual needs. Objectives To 1) describe spiritual narratives among AYAs based on their self-identification as religious, spiritual, both, or neither and 2) identify language to support AYAs' spiritual needs in keeping with their self-identities. Methods In this mixed-methods, prospective, longitudinal cohort study, AYAs (14–25 years old) with newly diagnosed cancer self-reported their "religiousness" and "spirituality." One-on-one, semistructured interviews were conducted at three time points (within 60 days of diagnosis, six to 12 months, and 12–18 months later) and included queries about spirituality, God/prayer, meaning from illness, and evolving self-identity. Post hoc directed content analysis informed a framework for approaching religious/spiritual discussions. Results Seventeen AYAs (mean age 17.1 years, SD = 2.7, 47% male) participated in 44 interviews. Of n = 16 with concurrent survey responses, five (31%) self-identified as both "religious and spiritual," five (31%) as "spiritual, not religious," one (6%) as "religious, not spiritual," and five (31%) as neither. Those who endorsed religiousness tended to cite faith as a source of strength, whereas many who declined this self-identity explicitly questioned their preexisting beliefs. Regardless of self-identified "religiousness" or "spirituality," most participants endorsed quests for meaning, purpose, and/or legacy, and all included constructs of hope in their narratives. Conclusion AYA self-identities evolve during the illness experience. When words such as "religion" and "spirituality" do not fit, explicitly exploring hopes, worries, meaning, and changing life perspectives may be a promising alternative.

© 2014 Elsevier Inc.. The present study examined the direct and indirect relations of family contextual factors, effortful control (EC), and the early math and English literacy skills of first and second-generation Chinese American immigrant children in early elementary school. Using a socioeconomically diverse sample of 258 Chinese American children (53% receiving free- or reduced-price school lunch), we assessed EC with a combination of parent and teacher reports, computerized neuropsychological tests, and a behavioral frustration task. Children's math calculation and English literacy skills were assessed with standardized achievement tests. Results of structural equation modeling suggested that: (a) EC was positively associated with both math and English literacy skills; (b) parents' enculturation was marginally and positively associated with children's EC, and EC mediated the link between parent's enculturation and children's achievement, (c) authoritarian parenting was marginally and negatively associated with children's EC, and EC mediated the link between authoritarian parenting and children's achievement; (d) parents' enculturation had a direct and negative link to children's English literacy skills; and (e) no evidence of an EC. ×. SES interaction was found. The findings highlight the need to consider joint influences of socioeconomic, interpersonal, and cultural factors on children's academic development in immigrant families; and provide support for promoting children's effortful control as an intermediate target of intervention.

Ethnopharmacological relevance Hepatitis C is a major public health problem internationally. Many patients cannot benefit from the current treatment regimen (interferon/ribavirin combinations) due to its side effects or ineffectiveness. Xiao-Chai-Hu-Tang or Sho-sai-ko-to (SST), a compound of seven botanical extracts used for liver diseases traditionally in East Asia, was shown to reduce transaminases and the incidence of hepatocellular carcinoma in hepatitis B patients. We conducted a phase II trial of SST in hepatitis C patients who were not candidates for interferon-based therapy to determine whether this agent is worthy of further study. Materials and Methods Twenty four chronic hepatitis C patients received SST at 2.5 g per os (p.o.) three times daily (t.i.d.) for 12 months. Liver function, hepatitis C virus (HCV) viral load and liver biopsy histology were assessed before and after the intervention. Results Improvement of aspartate aminotransferase (AST) was observed in 16 (67%) of study participants. Improvement of alanine aminotransferase (ALT) was seen in 18 (75%) patients. Viral load response was mixed, with 7 patients showing reductions, 10 increases and 7 indeterminate due to assay limitations. Among the 9 (38%) subjects who showed improvement per Knodell's histology activity index (HAI) scores in paired comparison of pre- and post-treatment liver biopsy (the primary endpoints of the study), 5 (21%) showed an improvement of 2 points or greater, meeting the pre-defined criteria for “response. Conclusions Sho-sai-ko-to (SST or Xiao Chai Hu Tang) may improve liver pathology in selected hepatitis C patients who are not candidates for interferon based treatment. Larger, controlled studies of this botanical formulation may be warranted.

Summary Hepatic amyloid deposition in the form of globular inclusions is a rare occurrence. Only 24 such cases have been reported to date. Its clinical and pathological significance are undefined. Unawareness of such a pattern can cause diagnostic confusion. We herein describe a case of globular hepatic amyloid in a patient with a B-cell lymphoma and chronic hepatitis C. The findings in our case support the literature data in that (1) it is often an incidental finding during workup for other coexisting conditions and (2) its morphology is peculiar but can be recognized with ease if one is aware of its existence. Our case also provides new insights into this condition. First, it represents the first nonautopsy case to demonstrate that globular hepatic amyloid is an indication of systemic amyloidosis, thus emphasizing the clinical importance of the recognition of this condition. Second, in our case, there was a coexisting B-cell lymphoma, the constituent cells of which showed immunoglobulin λ light chain restriction, and patient's serum λ light chain was elevated. However, light chain restriction was not demonstrated in the globular inclusions, and there was no evidence of monoclonal gammopathy by serum electrophoresis. Whether immunoglobulin light-chain abnormality played a causal role in this condition is to be determined.

Cirrhosis resulting from hepatitis C virus is presently the most common indication for liver transplantation (OLT) in the United States. A number of U.S. transplant centers require cirrhotics who are using methadone to discontinue it before proceeding with OLT. We sought to examine the outcomes of those patients who had undergone OLT at the Mount Sinai Medical Center. A retrospective chart review of 36 subjects on methadone maintenance treatment (MMT), and off heroin, at the time of OLT was performed. The median daily methadone dose pre-OLT was 50 mg. Post-OLT, there was an increase in methadone dose in 15 subjects, a decrease in four subjects, and no dose change in 17 subjects. Four subjects had documented single episodes of intravenous drug use post-OLT; only one subject had a dose change after the event. Patient and graft survival rates were comparable to the national average. There was no significant difference in post-OLT outcome in patients on MMT when compared with the general population. The few episodes of drug relapse were not related to changes in the methadone dose. Efforts should be made to allow methadone-using cirrhotics better access to OLT without regard to methadone dosage.

A capacitively coupled microwave plasma atomic emission spectrometer (CMP-AES) has been evaluated as a means for the direct analysis of several of the primary and trace elements in whole blood. A tungsten filament spiral electrode was used with the CMP, and whole blood samples were deposited on the electrode and subsequently dried, ashed, and atomized. The emission was measured with a spectrometer and a charge-coupled-device detector. A sample size of only 2 μl was required and the time for each sample run was under 4 min. This method has a wide dynamic range, allowing the determination of both the primary elements in blood and elements present in trace quantities. Potassium, sodium, lithium, magnesium, manganese, and zinc were studied. Good linearity was observed and the concentration levels obtained for these elements were consistent with literature values. The primary advantages of this method are that no sample pretreatment or dilution is required, the instrument cost is low, and the method is capable of simultaneous multielement analysis on small, discrete samples.

Background: Mixed cryogiobulinemia (MC) Is a complication of chronic hepatitis C virus (HCV) infection (detectable in 50% of patients) and may predispose to lymphoproliferative disSrders. Entry of HCV into hepatocytes and B lymphocytes may result from binding to CD81, a nonglycosylated tetraspanin protein that is widely expressed and involved in immune regulation, B cell stimulation, cell to cell interaction, and neuro-slgnaling. Hypothesis: Polymorphisms in the CD81 coding region may predispose patients with HCV to the development of MC. Methods: Forty-three patients with HCV were selected for invesngation. Patients with HCV +/laboratory and clinical ewdence of MC were examined as well as 16 HCV-ve healthy controls (HC). A retrospective chart review assessed patient demographics, manifestations of MC, cryocrit, liver histology, genotype and viral load when available. Lymphocytes were collected from fresh blood samples and RNA was isolated. RT-PCR was used to create a cDNA library for each patient and the CD81 coding region was amplified by PCR, inserted into the pCR | 2.1 TOPO' vector and transformed into competent 1-shot E. coil bacteria. Four clones from each patient were selected for CD81 sequencing and reproducible mutations were identified. Results: Sequence analysis was completed for 59 individuals, 16 HC, 9 HCV+/MCand 34 HCV+/MC+, 22 (64.7%) of whom were symptomatic. Nucleotide aberrancies were found in 5 pts, 4 HCV + / + MC ( 12 %), 0 HCV +/MC (0%) and 1 HC (6%). Manifestations of MC included 1 skin, 1 renal, 1 skin/neuropathy, 1 skin/renal and 1 skin/renal/arthntis. No patient had overt lymphoma. Of the 5 patients with a CD81 polymorphism, 4 had changes in the coding sequence for the second extracellular region of the protein, to which HCV is reported to bind. However, of those 5 patients, 3 had DNA changes that did not correspond with a change in amino acid coding. Conclusions: Polymorphisms of CDB1 may predispose to the development of MC in patients infected with HCV. As 3 out of 5 polymorphisms did not result in amino acid substitution, the question of a plausible mechanism underlying this association arises. The identified polymorphisms cannot explain why some individuals with HCV develop MC and others do not.