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Purpose of Review: This review aims to address the gap in radiation therapy (RT) care for elderly cancer patients. It will discuss the barriers to implementing effective RT in elderly and frail patients with a focus on breast cancer and metastatic settings., Recent Findings: Recent studies indicate that SBRT provides better pain control for bone metastases compared to cEBRT, but elderly patients are underrepresented in these trials. Evidence on the effectiveness of geriatric assessment tools in predicting RT tolerance and toxicity is mixed, with some studies showing a correlation while others do not. Comprehensive geriatric assessments, though promising, are often impractical due to time and resource constraints., Summary: There is a critical need for more inclusive research to better understand the risks and benefits of RT in elderly patients. Developing streamlined geriatric assessment tools and integrating them into clinical practice can enhance treatment personalization. Future studies should prioritize elderly populations to generate robust data, thereby improving RT outcomes and quality of life for this growing patient group., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Two commonly used quality of life (QoL) questionnaires in lung cancer patients are the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Lung Cancer 13 (QLQ-LC13) and the Functional Assessment of Cancer Therapy-Lung (FACT-L). More recently, the EORTC QLQ-LC29 was developed. This systematic review compares the EORTC QLQ-LC29, EORTC QLQ-LC13 and FACT-L in terms of the content, validity and psychometric properties in assessing the QoL of lung cancer patients., Recent Findings: Fourteen studies were included. The EORTC QLQ-LC29 is a 29-item scale that serves as an update of the EORTC QLQ-LC13 to include symptoms from surgery and new targeted therapies. It shows validity, high internal consistency, test-retest reliability, and sensitivity. The FACT-L continues to assess general quality of life and lung cancer-specific symptoms., Summary: The EORTC QLQ-LC29, EORTC QLQ-LC13, and FACT-L were reviewed to assess their validity in measuring QoL of lung cancer patients. All were found to be sufficiently validated, The choice of which to use should depend on the primary goals of the study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

Background: Case-based learning (CBL) is an effective educational method for improving the learning and clinical reasoning skills of students. Advances in e-learning technology have supported the development of the Web-based CBL approach to teaching as an alternative or supplement to the traditional classroom approach., Purpose: This study aims to examine the CBL experience of Hong Kong students using both traditional classroom and Web-based approaches in undergraduate nursing education. This experience is examined in terms of the perceived self-learning ability, clinical reasoning ability, and satisfaction in learning of these students., Methods: A mixture of quantitative and qualitative approaches was adopted. All Year-3 undergraduate nursing students were recruited. CBL was conducted using the traditional classroom approach in Semester 1, and the Web-based approach was conducted in Semester 2. Student evaluations were collected at the end of each semester using a self-report questionnaire. In-depth, focus-group interviews were conducted at the end of Semester 2., Results: One hundred twenty-two students returned their questionnaires. No difference between the face-to-face and Web-based approaches was found in terms of self-learning ability (p = .947), clinical reasoning ability (p = .721), and satisfaction (p = .083). Focus group interview findings complemented survey findings and revealed five themes that reflected the CBL learning experience of Hong Kong students. These themes were (a) the structure of CBL, (b) the learning environment of Web-based CBL, (c) critical thinking and problem solving, (d) cultural influence on CBL learning experience, and (e) student-centered and teacher-centered learning., Conclusions: The Web-based CBL approach was comparable but not superior to the traditional classroom CBL approach. The Web-based CBL experience of these students sheds light on the impact of Chinese culture on student learning behavior and preferences.

Objective: The primary objective is to describe the practice patterns of nonprocedural propofol use in a single-center referral PICU. The secondary objective is to describe the rate of concordance of propofol use with the PICU local practice of a maximum mean rate of 4 mg/kg/hr and a maximum duration of 24 hours and to assess for signs and symptoms of propofol infusion syndrome., Design: Retrospective descriptive cohort study., Setting: PICU of a tertiary care teaching hospital and referral hospital for the Western Canada., Patients: Children 1 month to 17 years old who received a nonprocedural propofol infusion between January 1, 2009, and December 31, 2009., Interventions: None., Measurements and Main Results: Two hundred twenty-three infusions (representing 210 unique patients) were included in the study. The median average infusion rate (interquartile range) including boluses was 2.7 mg/kg/hr (1.9-3.6 mg/kg/hr), and the mean infusion duration (SD) was 10.3 hours (6.7 hr). Eighty-seven percent and 98% of infusions were concordant with PICU intensivists self-reported practice maximum rate and duration, respectively. No cases of propofol-related infusion syndrome or deaths associated with propofol infusions were identified., Conclusions: The use of propofol infusions was in concordance with PICU local practice, and propofol infusion syndrome did not developed in patients. In agreement with previous recommendations, propofol infusions in the PICU appear to be safe when limiting doses to 4 mg/kg/hr and for less than 24 hours; however, appropriate monitoring of adverse effects is still warranted due to absence of robust evidence.

Background: Liver fibrosis and cirrhosis are well-known risk factors for morbidity after hepatectomy. Liver stiffness measurement (LSM) using transient elastography is a new method for detection of hepatic fibrosis and cirrhosis with high accuracy. Whether LSM can predict posthepatectomy outcomes has not been studied., Methods: This was a prospective cohort study in which consecutive patients underwent hepatectomy for various indications from February 2010 to July 2011. All patients received detailed preoperative assessments including LSM and indocyanine green (ICG) clearance test. The primary outcome was major postoperative complication., Results: One hundred five patients with a mean age of 59 years were included; 75 (71.4%) had chronic viral hepatitis and 76 (72.4%) had hepatocellular carcinoma. Thirty-four patients (32.4%) received major hepatectomy. The median ICG retention rate at 15 minutes was 4.2 (0.1%-32%) and the median LSM was 9.4 (3.3-75 kPa). For posthepatectomy outcomes, only LSM but not ICG showed significant correlation with major postoperative complications on receiver operating characteristic curves, with area under the curve of 0.79 (P < 0.001). Using the calculated cutoff at 12.0 kPa, LSM had sensitivity of 85.7% and specificity of 71.8% in the prediction of major postoperative complications. It was also an independent prognostic factor for major postoperative complications by multivariate analysis. The operative blood loss and transfusion rate were also significantly higher in patients with LSM >12.0 kPa., Conclusions: High LSM (>12.0 kPa) predicted worse posthepatectomy outcomes. Preoperative LSM was better than ICG test in the prediction of major postoperative complications. It was a useful preoperative investigation for risk stratification before hepatectomy.

Aims: Elderly breast cancers are associated with a more favourable biological marker profile and higher proportion of specific subtypes, some of which are of low histological grade. We reviewed the fine needle aspiration cytology (FNAC) to assess the cytological characteristics and any clues to assist in the diagnosis., Methods: The aspirates of 140 cancers of various histological types and grades and 39 benign lesions were evaluated for 13 cytological parameters including cellularity of the direct and cytospin smears, epithelial cell clusters, cellular atypism, cytoplasmic features, vacuoles, mitotic figures, presence of myoepithelial cells, single background epithelial cells, the presence of naked nuclei, stromal fragments and necrosis., Results: We found that the presence of background single epithelial cells, atypism of such cells, absence of benign appearing epithelial fragments, nuclear atypism of the epithelial cells within the fragments, presence of moderate amount of cytoplasm of these cells, absence of myoepithelial cells within the cluster, and absence of bipolar nuclei in the background have a strong association with malignancy. Scoring only the presence of single cells in the background, single cell atypism and the absence of bipolar nuclei in a scoring system can differentiate between benign and malignant aspirates with high (>90%) sensitivity and specificity., Conclusions: Assessing the presence of single cells in the background, single cell atypism and the absence of bipolar nuclei facilitates identification of malignancy in the aspiration of breast lesions from elderly patients.

Functional neuroimaging has revealed several brain regions that are selective for the visual appearance of others, in particular the face. More recent evidence points to a lateral temporal region that responds to the visual appearance of the human body (extrastriate body area or EBA). We tested whether this region distinguishes between egocentric and allocentric views of the self and other people. EBA activity increased significantly for allocentric relative to egocentric views in the right hemisphere, but was not influenced by identity. Whole-brain analyses revealed several regions that were influenced by viewpoint or identity. Modulation of EBA activity by viewpoint was modest relative to modulation by stimulus class. We propose that the EBA plays a relatively early role in social vision.

Background: Premature neonates with short bowel syndrome often have diverting enterostomies and distal mucous fistulae. The authors reviewed their experience in 12 premature neonates in whom proximal bowel contents were re-fed into the mucous fistula., Methods: We reviewed the records of 12 premature neonates who presented with acute abdomen and who underwent intestinal resection with formation of diverting enterostomy and mucous fistula between July 1999 and December 2002. All received parenteral nutrition. Refeeding of enterostomy contents into the distal mucous fistula was commenced after patency of the distal intestine was confirmed by radiologic examination. Demographic data, body weight and clinical outcomes were recorded., Results: Median gestational age was 31 weeks and mean birth weight was 1.59 kg. Diagnoses included necrotizing enterocolitis (n = 6), meconium ileus-like conditions (n = 2), ileal atresia (n = 2), malrotation with volvulus (n = 1) and focal intestinal perforation (n = 1). Refeeding was successfully established in all patients with no complications. The mean duration of refeeding was 63.5 days. All patients achieved good weight gain after refeeding (18.9 +/- 2.9 g/d) with a reduction of parenteral nutrition requirements. All enterostomies were subsequently closed. Four patients died of unrelated causes after reanastomosis and the remaining eight were discharged., Conclusions: Mucous fistula refeeding is safe in premature neonates with enterostomies. It can prevent disuse atrophy in the distal loop and facilitate subsequent reanastomosis. Furthermore, the increased absorptive function provided by the small bowel incorporated in the mucous fistula can reduce the requirement for total parenteral nutrition.

The role of cocaine in cardiac ischemia and subsequent reversible and irreversible pathologic changes is well established. Nevertheless, the mechanisms leading to cardiac injury and irreversible cellular changes remain elusive. Reactive oxygen species (ROSs) are the critical mediators of cellular damage during ischemia-reperfusion. To explore the response of cardiac oxidative stress parameters to intravenous (i.v.) And intraperitoneal (i.p.) cocaine exposure, cardiac total glutathione (GSH, GSSG), malonaldialdehyde (MDA), Mn-superoxide dismutase (Mn-SOD), catalase (CAT), GSH-peroxidase (GSH-px), and GSH s-transferase (GST) were measured, along with biochemical and histologic markers indicative of cardiac injury. Repeated i.p. cocaine exposure produced significant impairment in cardiac integrity, demonstrated by increased circulating lactate (2.4-fold; p < 0.0001), creatine kinase (2.2-fold; p < 0.0001), and creatinine levels (1.7-fold; p < 0.0001). Infiltration of neutrophils into myocardial cavities also was evident. These changes paralleled increases in cardiac MDA (25%; p < 0.04), GSSG (55%; p < 0.001), protein carbonyls (23%; p < 0.05), and Mn-SOD (23%; p < 0.05) levels, indicative of oxidative stress, decreases in GSH (35%; p < 0.01), adenosine triphosphate (ATP; 26%; p < 0.04), GSH-px (28%; p < 0.03), CAT (32%; p < 0.01), and GST (50%; p < 0.001) levels. Intravenous cocaine administration also had similar effects on cardiac oxidative stress measures. In conclusion, our data indicate that cocaine administration compromised the heart's antioxidant defense system.