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In chronic lymphocytic leukaemia (CLL) patients, treatment with the Bruton tyrosine kinase inhibitor ibrutinib induces a rapid shift of tumour cells from lymph nodes (LN) to peripheral blood (PB). Here, we characterized in depth the dynamics of ibrutinib-induced inflammatory, transcriptional and cellular changes in different compartments immediately after treatment initiation in seven relapsed/refractory CLL patients. Serial PB and LN samples were taken before start and during the first 29 days of treatment. Changes in plasma inflammation-related biomarkers, CLL cell RNA expression, B-cell activation and migration markers expression, and PB mononuclear cell populations were assessed. A significant reduction of 10 plasma inflammation markers, the majority of which were chemokines and not CLL-derived, was observed within hours, and was paralleled by very early increase of CD19(+) circulating cells. At the RNA level, significant and continuous changes in transcription factors and signalling molecules linked to B-cell receptor signalling and CLL biology was observed in both PB and LN CLL cells already after 2 days of treatment. In conclusion, ibrutinib seems to instantly shut off an ongoing inflammatory response and interfere with diverse sensitive pathways in the LN.

Aims and objectives: To explore the experiences of using an app among older people with home-based health care and their nurses. Background: Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Design: Explorative qualitative design. Methods: For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. Results: The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. Conclusions: The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. Implications for practice: The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd

Cells release nano-sized membrane vesicles that are involved in intercellular communication by transferring biological information between cells. It is generally accepted that cells release at least three types of extracellular vesicles (EVs): apoptotic bodies, microvesicles and exosomes. While a wide range of putative biological functions have been attributed to exosomes, they are assumed to represent a homogenous population of EVs. We hypothesized the existence of subpopulations of exosomes with defined molecular compositions and biological properties. Density gradient centrifugation of isolated exosomes revealed the presence of two distinct subpopulations, differing in biophysical properties and their proteomic and RNA repertoires. Interestingly, the subpopulations mediated differential effects on the gene expression programmes in recipient cells. In conclusion, we demonstrate that cells release distinct exosome subpopulations with unique compositions that elicit differential effects on recipient cells. Further dissection of exosome heterogeneity will advance our understanding of exosomal biology in health and disease and accelerate the development of exosome-based diagnostics and therapeutics.

Background: In the front line in cancer care is to systematically integratepatient reported outcomes (PRO) in clinical practice. The development ofthis research program is based on The Participatory Care Model, and buildson how patients can be integrated in their care. The aim is to evaluate the effects of an interactive e-health solution for assessment of symptom burden, generating instant self-care advice and instant access to health care professionals. Methods: The hypothesis is that the intervention promotes safe and participatory care and thereby improves clinical management and health care costs. The experimental multicenter studies incorporate a mixedmethod approach. Ongoing studies include patients with pancreatic and prostate cancer using the mobile phone application in comparison to control groups in standard care. Outcomes are collected before and after treatment by questionnaires concerning capacity to understand, communicate health needs and promote healthy behaviors (health literacy), symptom burden and management and quality of life and from records and registers about disease progress and health care costs. Interviews concern participatory and meaningful care. Studies are ongoing for patients with prostate and pancreatic cancer and elderly populations living at home or in care homes. Results: By using technology patients are able to communicate symptoms and receive instant support while cared for on an outpatient basis and at the same time feel reassured that their condition is monitored by health care professionals facilitating safe and participatory care., Special Session (Mon, 30 Sep, 13:15−14:15)Symptom Management via the Internet:274 Symptom management for cancer patients via mobile phones

The microarray technology is a powerful tool used in many different research areas. The technique has been around for more than a decade and has revolutionized the molecular biology field. In this thesis the Affymetrix GeneChip® arrays were used to study the transcriptomes of Tec family kinase mutant mouse models. Bruton s tyrosine kinase (Btk), IL-2 inducible T-cell kinase (Itk) and Tyrosine kinase expressed in hepatocellular carcinoma (Tec) are protein tyrosine kinases belonging to this Tec kinase family. Mutations in Btk cause a primary immunodeficiency disease called Xlinked agammaglobulinemia (XLA) in humans and X-linked immunodeficiencydisease (Xid) in mice. Gene expression profiling was performed on whole splenic Bcells as well as Transitional 1 (T1) B-cells from Xid, Btk knockout (Btk KO) and control mice. This was done in order to study differences and similarities between Btkdefective mice (Xid and Btk KO together) compared to control. Small differences were distinguished between the Btk-defective mouse strains in the whole splenic B-cell population; only seven genes differed (>2-fold) between the two. A number of potentially interesting genes were found to be differentially expressed in the Btkdefective groups compared to the controls. We also show that the Btk defect is already manifested at the T1 B-cell stage. Itk is important for the T-cell development where it has a role in regulating the conventional versus innate T-cells. Itk-deficient T-cells are of an innate, memory-like type. Tec is poorly expressed in resting T-cells, but is expressed 2-3 days after stimulation. Tec-deficient mice show no phenotypic alterations and the mice develop normally. In Papers III and IV we looked at the transcriptomes of Itk-, Tec- and Itk/Tec-deficient mice by studying unstimulated as well as stimulated CD3+ T-cells. The Itk-deficiency was also studied in CD4+ and CD8+ T-cell subpopulations. The gene expression patterns of Tec-deficient mice compared to control mice s

Nursing today faces numerous challenges. Societal changes lead to reorganization of health care, changing workloads with sicker patients in hospital and home care, and limited economic resources. The increasing and changing nature of knowledge needed for expert care provision challenges nurses to continually update their competencies. These are issues demanding proactive and dynamic changes in the way nurses conceive their mandates and practice. The aim of the action-research project presented here was to foster improved quality of care for patients with advanced cancer through collaborative endeavours integrating cancer nursing clinical practice, research and education in a knowledge exchange programme. The programme was based on input about caregiving needs from multi-professional staff caring for patients with advanced cancer in a variety of healthcare settings. Undergraduate baccalaureate nursing students were then engaged in literature studies to help address these needs. Results of the studies were communicated back to the involved clinicians in a variety of ways. In this paper, we discuss what we have experienced as opportunities and obstacles in conducting the project, based on our reflections and external evaluations. This is linked to a broader discussion of ways of integrating cancer nursing research, education and practice.