Array-based comparative genomic hybridization detects copy number variations with prognostic relevance in 80% of ALL with normal karyotype or failed chromosome analysis.

Pretreatment cytogenetics is an important parameter for risk stratification and therapy approach in acute lymphoblastic leukemia (ALL). However, in up to 30% of cases, chromosome banding analysis (CBA) fails or reveals a normal karyotype. To characterize the subset of ALL with normal karyotype or failed CBA, we performed fluorescence in situ hybridization (FISH) or PCR for BCR-ABL1 and MLL rearrangements as well as array comparative genomic hybridization (aCGH) in 186 adult patients. We further carried out FISH for MYC in cases with Burkitt leukemia phenotype. FISH or PCR revealed one of the respective rearrangements in 22% of patients. In 80% of cases, copy number variations (CNV) were identified by aCGH. In 22% of cases, all CNV were below the resolution of CBA. On the basis of results of FISH, RT-PCR and aCGH, patients were categorized into three groups. The novel subset of patients with submicroscopic CNV only showed an overall survival at 3 years of 84% compared with 64% for patients classified as adverse abnormalities and 77% for cases with other aberrations (P=0.046). Thus, ALL with non-informative CBA can be further classified by FISH and aCGH providing prognostic information, which may be useful for a more individualized therapy.

Health-related quality of life in Colombia: reference values of the EORTC QLQ-C30.

There are normative data of the quality of life (QoL) questionnaire EORTC QLQ-C30 (the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) for several European countries and Korea, but not for Latin America. The aim of this study was to provide these normative values for the general population in Colombia and to assess differences in terms of age and sex. For that reason, a sample of 1500 representatively selected individuals of the Colombian population completed the EORTC QLQ-C30 form. Results showed that mean scores of the Colombian population are similar to those obtained in European countries; whereas the mean values from a Korean study were lower (worse QoL). Age and sex differences were found in several scales and symptom items. Linear regression analyses were calculated to help quantify the influence of age and gender on QoL. Men reported better functioning and less symptoms than women on all scales, and older individuals reported worse global scores in terms of functioning and lower QoL than younger ones. In sum, the normative values presented can be used to assess QoL scores of Latin American cancer patients and to compare groups of patients with unequal age and sex distributions.

Response shift in the assessment of anxiety, depression and perceived health in urologic cancer patients: an individual perspective.

The assessment of quality of life in cancer patients is hampered because patients may change their frames of reference during the course of the disease. The aim of this study was to test individual differences in these response shift effects. Urologic cancer patients (n= 275) were examined during the stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). Furthermore, at T3 they were asked to retrospectively assess their situation at T1 (then-test). The difference between this retrospective assessment and the original assessment at T1 was used to determine the response shift effect (recalibration). Anxiety (Generalized Anxiety Disorder Questionnaire-2), depression (Patient Health Questionnaire-2) and health dissatisfaction (Questionnaire on Life Satisfaction) were obtained at all points in time. The effect sizes of the mean response shift effects (recalibration) ranged between 0.26 and 0.48. Nevertheless, a large proportion of the sample showed no response shift (22-38%) or even negative response shift effects (20-30%). There were significant correlations among the response shift measures of the domains (anxiety, depression and health dissatisfaction) with coefficients between 0.29 and 0.51. The results indicate that response shift should not only be assessed on the mean score level, since it is also a dimension of individual difference.

[Medical and psychosocial care needs of cancer patients: a systematic review comparing urban and rural provisions]. / Versorgung und psychosozialer Betreuungsbedarf von Krebspatienten im Stadt-Land-Vergleich - eine Literaturübersicht.

BACKGROUND AND OBJECTIVE: The psychological and oncological care needs of patients with cancer and an adequate structure for their medical care have so far been only marginally considered with regard to disparities in patients' residence (rural or urban). Even though there are thought to be such differences, for example with regard to existing care services and obvious specific care needs for patients in rural areas. This study addresses these issues in a systematic survey of the pertinent literature. METHODS: Publications in the last ten years dealing with identified problems were reviewed. A total of 27 studies met the criteria for analysis. RESULTS: Significant differences between medical care, psychosocial stress and the desired support were reported. Rural patients were more likely to be at a disadvantage compared with their urban counterparts with regard to medical care, being more often burdened cumulatively, and they strongly expressed the wish for psychological and oncological care. But the comparability of these results and transferring these findings to conditions in Germany proved difficult. CONCLUSION: When investigating the demand for psycho-oncological care, one needs to be aware of potential differences between rural and urban areas. Hence, in order to reliably distinguish between rural and urban living areas, a set of concrete criteria which define rural and urban surroundings needs to be established.

Measuring oxygen uptake and carbon dioxide production in critically ill patients using a standard blood gas analyzer.

OBJECTIVE: The measurement of oxygen uptake and CO2 production in critically ill patients requires invasive monitoring or complex analysis equipment. This study investigates the hypothesis that oxygen uptake and CO2 production can be accurately determined by measuring oxygen and CO2 concentrations in samples from inspiratory and expiratory ventilator circuitry, using a standard blood gas analyzer. DESIGN: Prospective comparison of CO2 production and oxygen uptake measurements determined by use of a blood gas analyzer vs. a mass spectrometer. SETTING: University teaching hospital medical and surgical intensive care units (ICUs). PATIENTS: Critically ill patients (n = 46) receiving mechanical ventilation in the ICUs. INTERVENTIONS: PO2 and PCO2 were obtained with two new techniques and compared simultaneously with measurements on a mass spectrometer in critically ill, mechanically ventilated patients. Two methods were evaluated: a) arterial blood gas analyzer measurements of PO2 and PCO2 from fluid collected in traps on the inspiratory and expiratory limbs of the ventilator circuitry; b) PO2 and PCO2 measurements of inspiratory and expiratory gas samples collected in bags and injected directly into an arterial blood gas analyzer. Oxygen consumption and CO2 production were compared, using both methods of gas measurements. MEASUREMENTS AND MAIN RESULTS: Direct injection of gas samples collected in a bag from inspiratory and expiratory limbs of a breathing circuit into the arterial blood gas analyzer correlated very closely with mass spectrometer measurements for all variables (n = 32 sample measurements in 25 patients): fractional oxygen (r2 = .99, slope = 1.02, bias = 0.37%, precision = 0.54), fractional expired CO2 (r2 = .90, slope = 0.86, bias = -0.10%, precision = 0.15), oxygen uptake (r2 = .87, slope = 0.99, bias = 21.6 mL/min, precision = 38.0), and CO2 production (r2 = .98, slope = 0.95, bias = 7.90 mL/min, precision = 15.3). In contrast, although fractional oxygen and CO2 concentrations were approximated by analysis of fluid collected from inspiratory and expiratory traps, the values did not correlate well enough with mass spectrometer values to yield reasonable oxygen uptake or CO2 production results. CONCLUSION: We have demonstrated that direct Fick oxygen uptake and CO2 production can be accurately determined in mechanically ventilated patients, using direct injection of collected gas samples into standard blood gas analyzers. This simple, inexpensive technique can be performed using equipment readily available in any hospital.