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1دورية أكاديمية
المؤلفون: Rietman, Andre B., van Helden, Hanneke, Both, Pauline H., Taal, Walter, Legerstee, Jeroen S., van Staa, AnneLoes, Moll, Henriette A., Oostenbrink, Rianne, van Eeghen, Agnies M.
المصدر: American Journal of Medical Genetics Part A ; volume 176, issue 5, page 1150-1160 ; ISSN 1552-4825 1552-4833
الوصف: Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder associated with lifelong tumor growth propensity and neurocognitive impairments. Although follow‐up of adults with NF1 often focuses on tumor growth, follow‐up of cognitive or social problems and other NF1‐related comorbidity is often not a part of standardized care. In order to provide optimal care services for these patients, we explored the care needs of adults with NF1. A qualitative study was performed using semi‐structured group interviews, exploring worries and care needs in medical, psychological, and socioeconomic domains, also focusing on the transition from pediatric to adult care. Four focus groups were conducted, including young adult patients, patients over age 30, and parents of young adult patients. In total, 30 patients and 12 parents participated. Data were transcribed verbatim and analyzed by computerized thematic analysis. Themes were organized using the World Health Organization International classification of functioning, disability, and health (ICF). Results indicated many and diverse worries and care needs both during the transitional period and in adulthood in medical, mental health, and socioeconomic domains. Worries could be categorized into 13 themes. Parents reported high stress levels and difficulties with their parental role. Participants expressed the need for more information, access to NF1 experts, daily living support, care for mental health and socioeconomic participation, and closer communication between health‐care providers. In conclusion, worries and needs of patients and parents underline the importance of multidisciplinary follow‐up and continuity of care during and after the transitional period. Additionally, parental stress requires more attention from care providers.
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2دورية أكاديمية
المؤلفون: Taal, Walter, Brandsma, Dieta, de Bruin, Hein G., Bromberg, Jacoline E., Swaak‐Kragten, Annemarie T., Sillevis Smitt, Peter A. E., van Es, Corine A., van den Bent, Martin J.
المصدر: Cancer ; volume 113, issue 2, page 405-410 ; ISSN 0008-543X 1097-0142
الوصف: BACKGROUND. Radiotherapy (RT) plus concomitant and adjuvant temozolomide (TMZ) is now the standard of care for patients with newly diagnosed glioblastoma. The occurrence of pseudo‐progression directly after RT is a recognized phenomenon, but to the authors' knowledge its incidence after combined RT/TMZ is unknown. The occurrence of early pseudo‐progression was retrospectively assessed in a cohort of malignant glioma patients treated with RT/TMZ. METHODS. The pre‐RT and post‐RT brain scans from patients treated with RT/TMZ for a malignant glioma were reviewed. Scans were made before the start of RT, 4 weeks after the end of RT, and every 3 months thereafter. In addition, information was collected regarding clinical signs and symptoms, dexamethasone dose, histology, and survival. RESULTS. Eighty‐five patients were identified. In 36 patients (42%) the first follow‐up scan 4 weeks after the end of RT indicated disease progression. Of these 36 patients, 18 (50%) were diagnosed with pseudo‐progression. None of the patients received additional treatment other than TMZ. Six of 18 patients with pseudo‐progression and 12 of the 18 patients with real tumor progression developed new clinical signs and symptoms during RT or in the first 4 weeks thereafter. CONCLUSIONS. Up to 50% of malignant glioma patients treated with RT/TMZ and progression immediately after RT develop pseudo‐progression. The current study data support the idea to continue TMZ in the case of progressive lesions immediately after RT/TMZ. Surgery should be considered in symptomatic cases. The inclusion of patients with progressive lesions developing directly after chemoradiation in studies regarding recurrent gliomas will lead to an overestimation of the results. Cancer 2008. © 2008 American Cancer Society.
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3دورية أكاديمية
المصدر: Psychophysiology ; volume 41, issue 2, page 254-258 ; ISSN 0048-5772 1469-8986
الوصف: We compared the effects of laughter and several respiratory movements on spinal motor excitability to unravel their respective influences. We measured H‐reflexes in 13 healthy volunteers during 10 different tasks (including laughter, simulated laughter, and various respiratory movements). We compared the percentage that remained of the initial H‐reflex during each task with that during a neutral task. H‐reflex percentage differed between the neutral task (79.4±16.1%), true laughter (43.7±17.9%), and simulated laughter (66.6±24.3%), and between the two latter tasks. Coughing also resulted in H‐reflex suppression, but not as deeply as true laughter. During the other respiratory maneuvers, the H‐reflex increased compared to the neutral task. Our finding that true laughter evoked more H‐reflex depression than simulated laughter suggests that mirth on its own depresses the H‐reflex. This mechanism may also be involved in the pathophysiology of cataplexy, the main symptom of narcolepsy.
