Validity of the Musculoskeletal Tumor Society Score for lower extremity in patients with bone sarcoma or giant cell tumour of bone undergoing bone resection and reconstruction surgery in hip and knee.

BACKGROUND: The Musculoskeletal Tumor Society Score (MSTS) is widely used to evaluate functioning following surgery for bone and soft-tissue sarcoma. However, concerns have been raised about its content validity due to the lack of patient involvement during item development. Additionally, literature reports inconsistent results regarding data quality and structural validity. This study aimed to evaluate content, structural and construct validity of the Danish version of the MSTS for lower extremity (MSTS-LE). METHODS: The study included patients from three complete cohorts (n = 87) with bone sarcoma or giant cell tumour of bone who underwent bone resection and reconstruction surgery in hip and knee. Content validity was evaluated by linking MSTS items to frameworks of functioning, core outcome sets and semi-structured interviews. Data quality, internal consistency and factor analysis were used to assess the underlying structure of the MSTS. Construct validity was based on predefined hypotheses of correlation between the MSTS and concurrent measurements. RESULTS: Content validity analysis revealed concerns regarding the MSTS. The MSTS did not sufficiently cover patient-important functions, the item Emotional acceptance could not be linked to the framework of functioning, the items Pain and Emotional acceptance pertained to domains beyond functioning and items' response options did not match items. A two-factor solution emerged, with the items Pain and Emotional acceptance loading highly on a second factor distinct from functioning. Internal consistency and construct validity showed values below accepted levels. CONCLUSION: The Danish MSTS-LE demonstrated inadequate content validity, internal consistency, and construct validity. In addition, our analyses did not support unidimensionality of the MSTS. Consequently, the MSTS-LE is not a simple reflection of the construct of functioning and the interpretation of a sum score is problematic. Clinicians and researcher should exercise caution when relying solely on MSTS scores for assessing lower extremity function. Alternative outcome measurements of functioning should be considered for the evaluation of postoperative function in this patient group.

A Specific, Measurable, Achievable, Relevant, Timed (SMART) Nursing Project Reduces Anxiety, Depression, and Post-Traumatic Stress Disorder in Parents of Childhood or Adolescent Osteosarcoma Patients.

Specific, measurable, achievable, relevant, timed (SMART) principle improves the nursing utility by setting individual goals for participants and helping them to achieve these goals. Our study intended to investigate the impact of a SMART nursing project on reducing mental stress and post-traumatic stress disorder (PTSD) in parents of childhood or adolescent osteosarcoma patients. In this randomized, controlled study, 66 childhood or adolescent osteosarcoma patients and 126 corresponding parents were enrolled and divided into SMART or normal care (NC) groups at a 1:1 ratio. All parents received a 3-month corresponding intervention and a 6-month interview. Our study revealed that the self-rating anxiety scale score at the 3rd month (M3) (P < 0.05) and the 6th month (M6) (P < 0.01), and anxiety rate at M3 (P < 0.05) and M6 (P < 0.05) were lower in parents in SMART group vs. NC group. The self-rating depression scale score at M3 and M6, and depression rate at M3 and M6 were lower in parents in SMART group vs. NC group (all P < 0.05). Impact of events scale-revised score at the 1st month (M1) (P < 0.05), M3 (P < 0.05), and M6 (P < 0.01) were lower in parents in SMART group vs. NC group. By subgroup analyses, the SMART nursing project showed better impacts on decreasing anxiety, depression, and PTSD in parents with an undergraduate education or above than in those with a high school education or less. Conclusively, SMART nursing project reduces anxiety, depression, and PTSD in parents of childhood or adolescent osteosarcoma patients, which is more effective in those with higher education.

OLIE, ITCC-082: a Phase II trial of lenvatinib plus ifosfamide and etoposide in relapsed/refractory osteosarcoma.

While survival rates for patients with relapsed/refractory osteosarcoma are low, kinase inhibitors have shown efficacy in its treatment. The multikinase inhibitor lenvatinib, plus ifosfamide and etoposide, showed antitumor activity in a Phase II study in patients with relapsed/refractory osteosarcoma. This Phase II randomized controlled trial (OLIE) will assess whether the combination of lenvatinib + ifosfamide + etoposide is superior to ifosfamide + etoposide alone in children, adolescents and young adults with relapsed/refractory osteosarcoma. The primary end point is progression-free survival; secondary and exploratory end points include, but are not limited to, overall survival, objective response rate, safety and tolerability, pharmacokinetic characterization of lenvatinib in the combination treatment, quality of life and quantification of baseline unresectable lesions that are converted to resectable.

Lay abstract Traditional treatment for osteosarcoma (bone cancer) includes drugs that cause cell damage, such as ifosfamide and etoposide. The study in this article looked at adding lenvatinib, a drug that works to block development of blood vessels, to traditional chemotherapy to see whether it worked better. 'OLIE' is a Phase II clinical study comparing lenvatinib + chemotherapy (ifosfamide + etoposide) to the chemotherapy alone (ifosfamide + etoposide). An earlier study indicated that this drug combination may be successful. The study includes children, adolescents and young adults with osteosarcoma that has come back after, or did not respond to, previous treatment. OLIE will look at the antitumor activity and the side effects of this drug combination. The OLIE study is currently enrolling patients worldwide. Clinical trial registration number: NCT04154189 (ClinicalTrials.gov).

Validation process of Toronto Exremity Salvage Score in Italian: A quality of life measure for patients with extremity bone and soft tissue tumors.

BACKGROUND AND OBJECTIVES: Limb salvage surgery remains the standard treatment in bone and soft tissue tumors. Toronto Extremity Salvage Score (TESS) is the most used quality of life measure. Our objective was to perform cross-cultural adaptation and validation in Italian, testing test-retest reliability, construct validity, and responsiveness. METHODS: We interviewed patients already treated for content validity. A total of 124 patients completed TESS and other questionnaires presurgery, at 3 months, 3 months + 2 weeks, and 6 months follow-up. We calculated intraclass correlation coefficients (ICCs) for reliability, associations with Pearson's r, and change over time with paired T tests. RESULTS: A new item regarding touch-screen devices was added to the upper extremity (UE) questionnaire. ICC resulted of 0.99 for lower extremity (LE) and 0.98 for UE patients, Pearson's r between TESS and Musculoskeletal Tumor Society was .66 and .64, EuroQol-5D-5L r was .62 and .61, and r between TESS and short form-36 physical function subscale was .76 and .71 for LE and UE groups, respectively. Paired T test results were statistically significant to detect change over time (0.03, 0.04, and 0.04 for LE groups and 0.03, 0.01, and 0.04 for UE groups). CONCLUSION: The Italian version of TESS can be used for the bone and soft tissue sarcoma population in clinical trials in Italy and with Italian speaking patients abroad to ensure patients' perspectives for efficacy and efficiency of treatments.

Identifying bone sarcoma survivors facing psychosocial challenges. A study of trajectories following treatment.

OBJECTIVE: Bone sarcoma survivors face a number of physical and psychosocial challenges in relation to the late effects they experience following treatment. The present study aimed to identify and explore the different trajectories that bone sarcoma survivors might navigate during follow-up. METHODS: In-depth and semi-structured interviews were conducted, and an inductive thematic analysis was performed. RESULTS: When they were interviewed three to ten years after the primary diagnosis, the eighteen bone cancer survivors were found to be in three different rehabilitation phases that followed fairly distinct trajectories, namely, back to normal, a new normal and still struggling. Only three participants felt that they had returned to a life that was quite similar to the one they had lived prior to having cancer. Fifteen participants considered their lives and their bodies to be significantly altered. CONCLUSION: Sarcoma survivors who undergo life-changing treatment and return to very different lives than they had before should be identified by healthcare professionals and guided through this demanding phase to better cope with their new living conditions. Information on and tailored guidance related to psychosocial challenges may be of particular importance. Active focus on reorientation, as well as possibilities for growth, seems to be important.

Quality of life after bone sarcoma surgery around the knee: A long-term follow-up study.

It remains unclear if quality of life (QoL) improvements could be expected in young patients after malignant bone tumour surgery after 2 years. To assess the course of QoL over time during a long-term follow-up, malignant bone tumour survivors of a previous short-term study were included. Assessments were done at least 5 years after surgery. QoL was measured with Short-form (SF)-36, TNO-AZL Questionnaire for Adult's Quality of Life (TAAQOL) and Bone tumour (Bt)-DUX. QoL throughout the follow-up was analysed by linear mixed model analysis. From the original cohort of 44 patients; 20 patients were included for this study, 10 males; mean age at surgery 15.1 years and mean follow-up 7.2 years. Twenty-one patients of the initial cohort (47%) deceased. Fifteen patients (75%) underwent limb-salvage and five (25%) ablative surgery. QoL improved significantly during follow-up at Physical Component Summary Scale scale of the SF-36 and TAAQOL and all subscales of the Bt-DUX (p < .01). No significant differences were found between current evaluations and previous evaluations at 2 years after surgery (p = .41-.98). Significant advantages after limb-salvage were seen at the PCS scale of the SF-36 (MD 13.7, p = .05) and the cosmetic scale of the Bt-DUX (MD 17.7, p = .04).

Changes in the body image of bone sarcoma survivors following surgical treatment--A qualitative study.

BACKGROUND AND OBJECTIVES: Among several long-term effects, people treated for cancer may experience an altered appearance. Our study aims to identify how visible body changes following surgical treatment affect the life and identity of primary bone sarcoma survivors 3-10 years after diagnosis. A qualitative, phenomenological, and hermeneutic design was applied. METHODS: Sarcoma survivors (n = 18) who were previously treated at Norwegian Radium Hospital, Oslo University Hospital, participated in the study. In-depth and semi-structured interviews were conducted and analyzed using inductive thematic analysis. RESULTS: The main finding of this study concerned how altered appearance after bone cancer treatment in the hip/pelvis or lower extremities affected the participants' self-esteem. Half of the participants expressed concerns about their visible differences, particularly those with functional impairment. They felt that it is important to hide the bodily signs of changes to appear as normal as possible, as well as attractive and healthy. They describe, with specific examples, how these changes influence their self-realization, especially their social life. CONCLUSIONS: Healthcare providers who guide bone sarcoma survivors during follow-up should develop a comprehensive understanding of what it means to cope with a changed and challenging body.

Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur.

BACKGROUND: We tried to compare the functional and psychosocial outcomes after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur. METHODS: We retrospectively reviewed 51 patients who underwent limb-salvage surgery of osteosarcoma in distal femur in our institution, 30 males and 21 females with an average age of 21 years (range 13-51 years). We classified osteosarcoma in distal femur into 3 types, and organized affected limb reconstruction methods after wide resection. MSTS and QOL scores were used to analyze the functional and psychological outcomes. RESULTS: After a mean follow-up of 43 months (12-225 months), there is no difference on functional results and QOL scores among three reconstruction groups (p > 0.05) and among three types groups (p > 0.05). No difference could be noticed on tumor-free survival and total survival among three reconstruction groups (p > 0.05) and three type groups (p > 0.05). In ≤2-year, better functional scores could be found in prosthesis group, rather than the other two inactivated-bone groups (p < 0.05). CONCLUSIONS: Biological reconstruction with alcohol-inactivated autograft replantation could avoid prosthesis related complications and achieved comparable results with prosthesis following resection of osteosarcoma in distal femur. Different reconstruction options could be chosen according to tumor location, such as the distance to Insall line.

[Quality of life in patients with bone tumors, a comparison between different treatments]. / Calidad de vida en pacientes con tumores oseos, una comparacion entre diferentes tratamientos.

INTRODUCTION. Previously, amputation was the only treatment option for patients with malignant bone tumors. Due to technological, medical and surgical advances, the number of survivors and years of survival has been increasing, and thus, the interest in evaluating the impact of this disease on quality of life. OBJECTIVE. To evaluate the health related quality of life reported by patients with bone tumors undergoing different treatments (no surgery/amputation/salvage). MATERIAL AND METHODS. Patients (n = 85) with bone tumors over the age of 18, both sexes, from the Instituto Nacional de Rehabilitación of Mexico City were included, divided into three groups according to type of treatment. The study design was cross-sectional, descriptive of a nonrandom sample. Quality of life was assessed with the Inventory of Quality of Life and Health (InCaViSa). Data were analyzed using descriptive statistics, comparisons between patients with different treatments were evaluated with multivariate analysis of covariance and Sidak post hoc tests. RESULTS. Statistically significant differences were detected in six of the twelve areas of quality of life that are assessed by the scale: physical functioning, isolation, body perception, treatment attitude leisure time and daily life. Health related quality of life in the study group is best for those patients who received amputation compared with the other treatments, while patients limb salvage procedures are those with greater impairment.

Stigma in Pediatric Cancer: An Exploratory Study of Osteosarcoma and Retinoblastoma in Guatemala, Jordan, and Zimbabwe.

PURPOSE: Stigma is an understudied barrier to health care acceptance in pediatric oncology. We sought to explore the stigma experience, including its impact on cancer treatment decision making, and identify strategies to mitigate stigma for patients with osteosarcoma and retinoblastoma in Guatemala, Jordan, and Zimbabwe. METHODS: Participants included caregivers, adolescent patients (age 12-19 years), and health care clinicians. A semistructured interview guide based on The Health Stigma and Discrimination Framework (HSDF) was adapted for use at each site. Interviews were conducted in English, Spanish, Arabic, or Shona, audio-recorded, translated, and transcribed. Thematic analysis focused on stigma practices, experiences, outcomes, drivers, mitigators, and interventions. RESULTS: We conducted 56 interviews (28 caregivers, 19 health care clinicians, nine patients; 20 in Guatemala, 21 in Jordan, 15 in Zimbabwe). Major themes were organized into categories used to adapt the HSDF to global pediatric cancer care. Themes were described similarly across all sites, ages, and diagnoses, with specific cultural nuances noted. Pediatric cancer stigma was depicted as an isolating and emotional experience beginning at diagnosis and including internalized and associative stigma. Stigma affected decision making and contributed to negative outcomes including delayed diagnosis, treatment abandonment, regret, and psychosocial fragility. Overcoming stigma led to positive outcomes including resilience, treatment adherence, pride, and advocacy. Identified stigma drivers and mitigators were linked to potential interventions. CONCLUSION: Participants describe a shared stigma experience that transcends geography, cultural context, age, and diagnosis. Stigma manifestations have the potential to impact medical decision making and affect long-term psychological outcomes. Stigma assessment tools and interventions aimed at stigma mitigation including educational initiatives and support groups specific to pediatric cancer should be the focus of future research.

Examining the emotional healing process through bibliotherapy in adolescents with cancer: A qualitative descriptive study.

PURPOSE: This study aimed to investigate how interactive bibliotherapy impacted the emotional healing process of adolescents with cancer, drawing upon the three-stage emotional healing process theory-identification, catharsis, and insight. METHOD: A qualitative descriptive study was conducted on data from 14 adolescents, aged 10-19 years, diagnosed with or relapsing from leukemia or osteosarcoma within the past two years. Participants received two interactive bibliotherapy sessions using The Rabbit Listened and You Are Special. Data were collected through semistructured interviews and content analyzed. RESULTS: Analysis identified six themes in The Rabbit Listened and eight in You Are Special. Adolescents primarily engaged in identification, empathizing with protagonists and recalling personal experiences. They underwent catharsis, releasing negative emotions and fostering positivity. Insights emerged on companionship, listening, and others' criticism. CONCLUSIONS: Our study validates the use of the three-stage emotional healing process in interdisciplinary bibliotherapy for understanding emotional changes in adolescents with cancer. It sheds light on their concerns and coping strategies. Healthcare practitioners can utilize interactive bibliotherapy based on this framework to initiate therapeutic communication with adolescent cancer patients and improve interventions and care.

Translation and preliminary validation of the English version of the DUX questionnaire for lower extremity bone tumor patients (Bt-DUX): a disease-specific measure for quality of life.

PURPOSE: To translate the Dutch DUX questionnaire for lower extremity bone tumor patients (Bt-DUX), a disease-specific quality of life (QoL) instrument, into the English (UK) language and preliminary validate the English version in patients who were treated for lower-extremity bone tumors. METHODS: Adaptation and translation process included forward translation, back-translation, and a review of the back-translation by an expert committee. Internal consistency and validity of the translated questionnaire were examined in a sample of adolescents treated for lower extremity osteosarcoma in the United Kingdom. Assessments included the Bt-DUX, the Toronto Extremity Salvage Score (TESS), the Short Form (SF)-36, and the TNO-AZL Questionnaire for Adult's Quality of Life (TAAQOL). RESULTS: Seventeen patients (7 ♂ and 10 ♀), median age 19.9 (range: 16-25) years completed the questionnaires. Mean Bt-DUX score was 38.8 (range: 23-78), with Cronbach's α being 0.95 domain-total correlations ranged between 0.84 and 0.93 (P < 0.01). Spearman's correlation coefficients between the Bt-DUX total and domain scores and corresponding TAAQOL and SF-36 scores were overall moderate to good and reaching statistical significance in a most cases. CONCLUSION: Preliminary evidence suggests that the English Bt-DUX translation is a valid disease-specific instrument for evaluating QoL of adolescents with lower extremity bone cancer.

The correlation between dose of folinic acid and neurotoxicity in children and adolescents treated for osteosarcoma with high-dose methotrexate (HDMTX): a neuropsychological and psychosocial study.

BACKGROUND: This study has been performed to examine the currently used doses of folinic acid (FA) and to determine the importance of the dose of FA in preventing subtle neurotoxicity. Thirty osteosarcoma patients were an appropriate population studied as they have no intrinsic neurological involvement. The neuropsychological and psychosocial status was tested in 2 groups of patients treated with similar protocols containing repeated doses of high-dose methotrexate, but different doses of FA. The patients received 300 to 600 mg/m or 120 to 250 mg/m FA in their protocols. METHODS: Eighteen tests or subtests of neuropsychological assessment were tested. RESULTS: Eleven of 18 tests were significant at the P=0.025 level favoring the group treated with high dose of FA. There were no clear results in the psychosocial measures with only a single measure of self-esteem (understanding) being significantly higher (P=0.024) in the group treated with high dose of FA, other measures had no statistical significance. CONCLUSIONS: A correlation between a higher dose of FA after high-dose methotrexate and a better neuropsychological status was clearly shown. The doses of FA used in the low FA group, 120 to 250 mg/m, were similar to those used by several groups treating children with leukemia; some have used even lower doses and report gross neurotoxicity.

Validation of the Brazilian version of the musculoskeletal tumor society rating scale for lower extremity bone sarcoma.

BACKGROUND: The Musculoskeletal Tumor Society (MSTS) rating scale is an English-language instrument used worldwide to assess functional evaluation of patients with musculoskeletal cancer. Despite its use in several studies in English-speaking countries, its validity for assessing patients in other languages is unknown. The translation and validation of widely used scales can facilitate the comparison across international patient samples. OBJECTIVES/PURPOSES: The objectives of this study were (1) to translate and culturally adapt the MSTS rating scale for functional evaluation in patients with lower extremity bone sarcomas to Brazilian Portuguese; (2) analyze its factor structure; and (3) test the reliability and (4) validity of this instrument. METHOD: The MSTS rating scale for lower limbs was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and reviewed by a multidisciplinary committee for further implementation. The questionnaire was administered to 67 patients treated for malignant lower extremity bone tumors who were submitted to limb salvage surgery or amputation. They also completed a Brazilian version of the Toronto Extremity Salvage Score (TESS). Psychometric properties were analyzed including factor structure analysis, internal consistency, interobserver reliability, test-retest reliability, and construct validity (by comparing the adapted MSTS with TESS and discriminant validity). RESULTS: The MSTS rating scale for lower limbs was translated and culturally adapted to Brazilian Portuguese. The MSTS-BR proved to be adequate with only one latent dimension. The scale was also found to be reliable in a population that speaks Brazilian Portuguese showing good internal consistency (Cronbach's alpha = 0.84) and reliability (test-retest reliability and interobserver agreement of 0.92 and 0.98, respectively). Validity of the Brazilian MSTS rating scale was proved by moderate with TESS and good discriminant validity. CONCLUSIONS: The Brazilian version of the MSTS rating scale was translated and validated. It is a reliable tool to assess functional outcome in patients with lower extremity bone sarcomas. It can be used for functional evaluation of Brazilian patients and crosscultural comparisons.

Living with rotationplasty--quality of life in rotationplasty patients from childhood to adulthood.

BACKGROUND: Knowledge about the long-term sequelae of rotationplasty, in adults treated surgically in childhood for Osteosarcoma in the lower limb, mainly concerns function and performance; the aim of this study is to explore the experience and the Quality of Life (QoL) of the patients who underwent Rotationplasty from 1986 to 2006 in Italy. METHODS: Quantitative test: Administration SF-36 questionnaire to 20 subjects aged ≥16 years. Qualitative test: Semi-structured interview recorded in 10 of these subjects. RESULTS: Greater well-being was found in the Mental Component Summary (MCS) scale of subjects aged over 24 years, with a score mean of 54.2 (±4.8), compared with that of those aged up to 24 years, with a mean score of 48.0 (±6.6), P = 0.04. Relational and emotional difficulty in adolescence, which had been partially overcome in adulthood, was revealed. CONCLUSIONS: The assessment of QoL by the SF-36 questionnaire was effective, and a correspondence was found between what emerged from the quantitative study and the contents of the interview. Knowing the strengths and weaknesses that were highlighted is indispensable for parents and operators when choosing among the various surgical options and to facilitate coming to terms with the injury and the "scars".

Posttraumatic stress symptom (PTSS) and posttraumatic growth (PTG) in parents of childhood, adolescent and young adult patients with high-grade osteosarcoma.

BACKGROUND: Posttraumatic stress symptom (PTSS) and posttraumatic growth (PTG) were surveyed in parents of childhood, adolescent and young adult patients with high-grade osteosarcoma. METHODS: A questionnaire survey was performed in parents of patients with osteosarcoma (51 families). The Impact of Event Scale-Revised (IES-R) and posttraumatic growth inventory (PTGI) were employed for the evaluation of PTSS and PTG, respectively. The mean scores were compared with those in preceding studies employing the same scales. In addition, the correlation between the IES-R and PTGI scores was investigated in the parents. RESULTS: Fifty-eight subjects of 34 families (30 fathers and 28 mothers) replied to the questionnaire. The mean IES-R score in the parents was 18.5, which was higher than that in patients with osteosarcoma (9.7) in our previous study. The mean PTGI score in the parents was 44.9, which was higher than that in university students (33.9) reported by Taku et al. A positive correlation was noted between the IES-R and PTGI scores in the parents. CONCLUSIONS: The PTSS level tended to be higher in the parents rather than in patients with osteosarcoma. The PTG level increased as the PTSS level rose in the parents.

[Effect of shentong zhuyu decoction on pain behavior and spinal cord astrocytes model of osteocarcinoma pain].

OBJECTIVE: To study the analgesic effect of shentong zhuyu decoction (SZD) and its effect on the expression of the spinal cord glial fibrillary acidic protein (GFAP). METHODS: One hundred C3H/HeNCrlVr male mice were randomly divided into the normal group (n=8), the sham operation group (n=30), the model group (n=30), the Chinese medicine (CM) group 1 (n=8), the CM group 2 (n=8), the CM group 3 (n=8), and the vehicle group (n=8). 0.1 g crude drug of SZD/0.4 mL, 0.3 g crude drug of SZD/0.4 mL, 0.9 g crude drug of SZD/0.4 mL, and 0.4 mL normal saline were respectively given by gastrogavage to mice in CM 1, 2, 3 groups and the vehicle group, once daily for seven days starting from Day 14. The paw withdrawal thermal latency (PWTL), as the behavior indicator, was assessed in mice using radiant thermal stimulator. The lumbar enlargement of the spinal cord was taken after the behavioral test on Day 21. GFAP mRNA and protein expressions were detected using real-time quantitative RT-PCR and Western blot. RESULTS: Compared with the normal group (Day 0) (PWTL: 15.91 +/- 1.65 s) and the sham operation group (PWTL: Day 4: 13.33 +/- 1.44 s; Day 7: 11.28 +/- 0.61 s; Day 10: 15.47 +/- 2.46 s; Day 14: 15.69 +/- 1.98 s; Day 21: 15.69 +/- 1.68 s), the PWTL value in the model group (Day 4: 13.24 +/- 1.02 s; Day 7: 11.30 +/- 1.09 s; Day 10: 9.12 +/- 0.54 s; Day 14: 7.79 +/- 0.77 s; Day 21: 6.36 +/- 0.59 s) progressively decreased (P < 0.05) as time went by, while the spinal cord GFAP mRNA and protein expressions gradually increased. Compared with the normal group (Day 0) and the sham operation group (Day 14), the PWTL value in the CM groups and the vehicle group obviously decreased on Day 14 (P < 0.05). The PWTL value was not significantly different among the model group, CM groups, and the vehicle group on Day 14 (P > 0.05). On Day 21 the PWTL value of CM group 2 and 3 increased and the spinal cord GFAP mRNA and protein expression levels decreased when compared with the model group and the vehicle group (P < 0.05). But no significant difference in the PWTL value or GFAP expression levels was shown among the CM 1 group, the vehicle group, and the model group (P > 0.05). CONCLUSION: SZD had analgesic effect. Inhibition of the proliferation and activation of the spinal cord astrocytes might be one of its mechanisms.

[Teaching a teenager approaching the end of life]. / Enseigner auprès de l'adolescent en fin de vie.

When a teenager is diagnosed with a life-threatening condition, priority is given to the provision of care, but the continuation of the adolescent's education is also encouraged, through the hospital school. Thereby, like all children of his age, Issem, suffering from an osteosarcoma, will sit his secondary school exams and will be supported to the end by his teachers. Personal accounts.