High Flow Nasal Cannula in Patients With Cancer at the End of Life.

CONTEXT: High flow nasal cannula (HFNC) is frequently used to manage dyspnea in patients with cancer near the end of life. Because HFNC is restricted to the in-patient setting, patients on HFNC need to be liberated from it to be discharged from the hospital. OBJECTIVES: The purpose of this study is to assess the rate of successful liberation from HFNC in a palliative and supportive care unit (PSCU). METHODS: The study is a retrospective chart review of all 374 adult patients with cancer on HFNC admitted to a palliative and supportive care unit at a tertiary medical center from January 1, 2018 to December 31, 2020. We determined the proportion of patients who were liberated from HFNC (by day three and overall) and the proportion of patients discharged alive. RESULTS: The mean age of the patients was 64, 54% were male and 73% were white. Only 16% (95% CI: 13-20) of the patients were discharged alive. Liberation from HFNC by day three and overall was accomplished in 23% and 25% of the patients respectively. Comparing the patients who could be liberated from HFNC vs. those who could not by day three, 38% vs. 9% were discharged alive respectively; and overall, 62% vs. 1% respectively (P < 0.001 in both cases). CONCLUSION: Only a minority of patients with cancer at the end of life can be liberated from HFNC, and only a minority are discharged alive. This information is important when discussing goals of care with patients and their families before initiating HFNC.

Evaluation of a Daily Nine-Item "Handbook for Self-Care at Work" for Palliative Care Clinicians.

Context: A daily nine-item "Handbook for Self-Care at Work" was created to increase the well-being and satisfaction of the staff at the department of palliative care of a tertiary oncological center in the United States. Objectives: To evaluate the perceived usefulness of and adherence to the Handbook. Design, Setting and Participants: An anonymous survey was conducted among the palliative care staff asking for the frequency of utilization and the perception of usefulness of the Handbook. Additional data collected included demographics, satisfaction with professional life, frequency of burnout, and frequency of callousness toward people. We also compared the use and perception of the Handbook before and during the COVID-19 pandemic. Results: Of 52 palliative care clinicians, 39 (75%) completed the survey. Most participants were women and were <49 years. Most respondents (59%) found the Handbook useful or very useful. Offer help, ask for help, and hydration were perceived as the most useful items. The items most frequently achieved were movement, hydration, and eat light. The least useful perceived item was nap time, which was rarely achieved. During the COVID-19 pandemic, 32 (82%) respondents found the Handbook to be as/somewhat more/much more useful, and 29 (75%) were able to adhere to the items as/somewhat more/much more often than before. Conclusion: Most respondents found the Handbook useful and were able to accomplish the items most of the days. During the COVID-19 pandemic, the staff felt that the Handbook was more useful.

Animal-related motorcycle collisions in North Dakota.

OBJECTIVE: To study the epidemiology and mortality of animal-motorcycle collisions. METHODS: A retrospective study of all motorcycle collisions recorded in the North Dakota Department of Transportation Crash Reporting System from January 2007 to December 2009 was conducted. Mortality was designated as the main outcome measure. RESULTS: Seven hundred sixty-six collisions involving 798 motorcycles were included in this study; 48 of these collisions were with animals (6.3% of all motorcycle collisions). Deer were the most common animal involved (81%). Most animal-motorcycle collisions took place during nighttime with clear weather and on straight rural roads. Drivers were older in animal collisions compared with nonanimal collisions (median of 44 vs 30 years old, respectively, P < .0001). Most drivers were males, whereas most passengers were females. Helmets were worn by only 32% of drivers and 12% of passengers. There were 4 (8%; 95% CI, 3%-20%) fatal animal collisions; 9% of the collisions with large animals were fatal compared with 3% of nonanimal collisions (P = .0411). CONCLUSIONS: Animal-motorcycle collisions are a small subgroup of all motorcycle collisions, but with a high mortality rate. Efforts should be made to increase helmet usage, mitigate these collisions, and increase awareness of this problem among motorcycle riders.

CXCR4 physically associates with the T cell receptor to signal in T cells.

SDF-1alpha (CXCL12) signaling via its receptor, CXCR4, stimulates T cell chemotaxis and gene expression. The ZAP-70 tyrosine kinase critically mediates SDF-1alpha-dependent migration and prolonged ERK mitogen-activated protein (MAP) kinase activation in T cells. However, the molecular mechanism by which CXCR4 or other G protein-coupled receptors activate ZAP-70 has not been characterized. Here we show that SDF-1alpha stimulates the physical association of CXCR4 and the T cell receptor (TCR) and utilizes the ZAP-70 binding ITAM domains of the TCR for signal transduction. This pathway is responsible for several of the effects of SDF-1alpha on T cells, including prolonged ERK MAP kinase activity, increased intracellular calcium ion concentrations, robust AP-1 transcriptional activity, and SDF-1alpha costimulation of cytokine secretion. These results suggest new paradigms for understanding the effects of SDF-1alpha and other chemokines on immunity.

Fundamentals of transcription factors and their impact on pancreatic development and cancer.

Transcription factors are proteins that regulate gene expression by modulating the synthesis of messenger RNA. Since this process, known as gene transcription, is often the dominant control point in the production of many proteins, transcription factors are key regulators of numerous cellular functions, including secretion, proliferation, differentiation, and apoptosis. Most transcription factors are also the final effectors of signaling pathways that transduce signals from the cell membrane to the nucleus. Therefore alterations in the activity or expression of some transcription factors have a significant impact on the biology of human cells and may lead to the development of diseases. In this article we review this field of research with a particular emphasis on the role of transcription factors in pancreatic development and cancer.