Long-term survivors of glioblastoma: Tumor molecular, clinical, and imaging findings.

Background: Glioblastoma (GBM) is the most aggressive primary brain malignancy with <45% living a year beyond diagnosis. Previously published investigations of long-term survivors (LTS) provided clinical data but rarely incorporated a comprehensive clinical and molecular analysis. Herein, we identify clinical, imaging, molecular, and outcome features for 23 GBM-LTS patients and compare them with a matched cohort of short-term survivors (STS). Methods: Molecularly confirmed Isocitrate Dehydrogenase (IDH) wildtype GBM patients living ≥3 years post-diagnosis (NLTS = 23) or <3 years (NSTS = 75) were identified from our Natural History study. Clinical and demographic characteristics were compared. Tumor tissue was analyzed with targeted next generation sequencing (NGS) (NLTS = 23; NSTS = 74) and methylation analysis (NLTS = 18; NSTS = 28). Pre-surgical MRI scans for a subset of LTS (N = 14) and STS control (N = 28) matched on sex, age, and extent of resection were analyzed. Results: LTS tended to be younger. Diagnostic MRIs showed more LTS with T1 tumor hypointensity. LTS tumors were enriched for MGMTp methylation and tumor protein 53 (TP53) mutation. Three patients with classic GBM histology were reclassified based on NGS and methylation testing. Additionally, there were LTS with typical poor prognostic molecular markers. Conclusions: Our findings emphasize that generalized predictions of prognosis are inaccurate for individual patients and underscore the need for complete clinical evaluation including molecular work-up to confirm the diagnosis. Continued accrual of patients to LTS registries that containcomprehensive clinical, imaging, tumor molecular data, and outcomes measures may pro\vide important insights about individual patient prognosis.

Manejo odontológico del paciente con EPOC / Dental management of the patient with COPD

El objetivo de este trabajo es revisar la literatura científica disponible sobre las consideraciones odotológicas y las manifestaciones orales que pueden presentar los pacientes con EPOC. Para ello se revisaron los artículos disponibles en Pubmed. De los resultados destacamos que los principales factores de riesgo de la EPOC son el tabaco y la edad. En España se prevé un aumento de pacientes con EPOC debido al envejecimiento paulatino de la población. En la práctica odontológica hay un promedio de 130 pacientes con EPOC de cada 2.000 pacientes que acuden a la consulta. El dentista debe llevar a cabo el tratamiento odontológico siguiendo las consideraciones pre, intra y postoperatorias propuestas para los pacientes con EPOC, e identificar aquellos que son inestables para posponer la cita o considerar su hospitalización. Las lesiones orales más frecuentes son la enfermedad periodontal, xerostomía, caries, y erosiones del esmalte. Conclusiones: Dada la alta prevalencia de la EPOC es necesario tener en cuenta ciertas precauciones a la hora de realizar el tratamiento dental y las contraindicaciones farmacológicas en estos pacientes. El dentista debe estar familiarizado con esta enfermedad y promover la salud oral en estos pacientes

The aim purpose of this work was to review the available scientific literature on the odontologic considerations and oral lesions that can present a patient with COPD. In order to do so, the available articles were checked in Pubmed. The principal risk factors for COPD include smoking and age. In Spain, an increase in the number of patients with COPD is expected due to the gradual aging of the population. In dental practice there is an average of 130 patients with COPD out of every 2000 patients who come to the dental clinic. The dentist must carry out the dental treatment following the considerations proposed for patients with COPD and identify the unstable patients to postpone the dental appointment or consider their hospitalization. The most frequent oral lesions are periodontal disease, xerostomia, caries and enamel erosions. Conclusions: Given the high prevalence of COPD, it is necessary to take into account certain precautions when performing dental treatment and pharmacological contraindications in these patients. The dentist should be familiar with this illness and promote the oral health in these patients

Manejo y consideraciones clínicas de los pacientes asmáticos en la consulta dental / Management and clinical considerations of the asthmatic patients in the dental practice

El objetivo de este trabajo es revisar la literatura científica disponible sobre las consideraciones odontológicas y las manifestaciones orales que pueden presentar los pacientes asmáticos. Se han revisado 34 artículos publicados entre los años 2001 y 2018. En función de su fisiopatología hay 5 tipos de asma, y clínicamente se clasifica en leve, moderada y grave. Entre los factores de riesgo destacan el tabaco, obesidad, genética, factores socioeconómicos y exposición a ciertas sustancias. El tratamiento de elección se basa en los broncodilatadores y glucocorticoides inhalados. Esta medicación disminuye la cantidad de flujo y el pH salival. Por este motivo la cavidad oral es más susceptible de desarrollar patologías como caries, enfermedad periodontal y candidiasis oral. Concluimos que, dada la alta prevalencia del asma, es necesario que el odontólogo tenga en cuenta las consideraciones pre, intra y postoperatorias propuestas para los pacientes asmáticos, y evite los fármacos que puedan precipitar un ataque. El dentista debe estar familiarizado con esta enfermedad, y promover la salud oral en estos pacientes

The purpose of this work is to review the available scientific literature on the dental considerations and the oral manifestations that may present asthmatic patients. 34 articles published between 2001 and 2018 were reviewed. According to its pathophysiology, there are 5 types of asthma, and clinically, the asthma severity classification is divided into mild, moderate and severe. The principal risk factors for asthma include tobacco, obesity, genetics, socioeconomic factors and exposure to substances. The treatment of choice is based on inhaled bronchodilators and glucocorticoids. This medication decreases the amount of flow and salivary pH. For this reason, the oral cavity is more susceptible to developing pathologies such as caries, periodontal disease and oral candidiasis. Conclusions. Given the high prevalence of asthma, the dentist must carry out the dental treatment following the considerations proposed for patients with asthma and should know the pharmacological contraindications in these patients. The dentist should be familiar with this illness and promote the oral health in these patients

Life on the Edge: Immigrants Confront the American Health System.

On the basis of a study of forty health care delivery institutions in Florida, California, and New Jersey, this paper examines the interaction the immigration and health systems in the USA. We investigate barriers to care encountered by the foreign-born, especially unauthorized immigrants, and the systemic contradictions between demand for their labor and the absence of an effective immigration policy. Lack of access and high costs have forced the uninsured poor into a series of coping strategies, which we describe in relation to commercial medicine. We highlight regional differences and the importance of local politics and history in shaping health care alternatives for the foreign-born.

The Unequal Structure of the German Education System: Structural Reasons for Educational Failures of Turkish Youth in Germany.

The paper examines the educational experiences of Turkish youth in Germany with special references to the statistical data of Educational Report, PISA surveys. The results of the educational statistics of Germany show that more than group characteristics like social and cultural capital, structural and institutional factors (multi-track system with its selective mechanism, education policy, context of negative reception of Germany, institutional discrimination, and lack of intercultural curriculum) could have a decisive role in hampering the educational and labor market integration and social mobility of Turkish youth. This can be explained by a mix of factors: the education system which does not foster the educational progress of children from disadvantaged families; the high importance of school degrees for accessing to the vocational training system and the labor market; and direct and indirect institutional discrimination in educational area in Germany. Thus, this work suggests that the nature of the education system in Germany remains deeply "unequal," "hierarchical" and "exclusive." This study also demonstrates maintaining the marginalized position of Turkish children in Germany means that the country of origin or the immigrants' background is still a barrier to having access to education and the labor market of Germany.

The U.S. Health System and Immigration: An Institutional Interpretation.

We examine the institutions that comprise the U.S. health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States are used as an empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed.

The Adaptation of the Immigrant Second Generation in America: Theoretical Overview and Recent Evidence.

This paper summarises a research program on the new immigrant second generation initiated in the early 1990s and completed in 2006. The four field waves of the Children of Immigrants Longitudinal Study (CILS) are described and the main theoretical models emerging from it are presented and graphically summarised. After considering critical views of this theory, we present the most recent results from this longitudinal research program in the forum of quantitative models predicting downward assimilation in early adulthood and qualitative interviews identifying ways to escape it by disadvantaged children of immigrants. Quantitative results strongly support the predicted effects of exogenous variables identified by segmented assimilation theory and identify the intervening factors during adolescence that mediate their influence on adult outcomes. Qualitative evidence gathered during the last stage of the study points to three factors that can lead to exceptional educational achievement among disadvantaged youths. All three indicate the positive influence of selective acculturation. Implications of these findings for theory and policy are discussed.

The Back Pocket Map: Social Class and Cultural Capital as Transferable Assets in the Advancement of Second-Generation Immigrants.

In this paper I move beyond current understandings of family- and school-related dynamics that explain the educational and occupational success of low-income immigrant children to investigate the role of cultural capital acquired in the country of origin. Class-related forms of knowledge acquired prior to migration can become invaluable assets in areas of destination through the realization of what Pierre Boutdieu calls habitus, that is, a series of embodied predispositions deployed by individuals in their pursuit of set objectives. Although the concept has attracted prolonged attention, the mechanisms by which the habitus is fulfilled remain unspecified. Here, I propose and examine three of those mechanisms: (a) cognitive correspondence, (b) positive emulation, and (c) active recollection. My study shows that class-related resources, like education, self definition, and remembrance of nation and ancestry play an important function, shaping youthful expectations and behaviors, and protecting the children of low-income immigrants from downward mobility.

Empirically selected instruments for measuring quality-of-life dimensions in culturally diverse populations.

We describe a process for developing and testing the cultural equivalence of quality-of-life (QOL) instruments that may be used across culturally diverse populations. QOL instruments dealing with satisfaction with various life domains, psychological distress, and physical health and functioning were reviewed by African-American and Hispanic community advisory boards, translated into Spanish and back-translated to ensure translation adequacy, administered to samples of 100 patients from each of the ethnic minority populations by indigenous nurse interviewers, and examined for psychometric adequacy. Ten QOL measures showed adequate reliability and validity for further use in the assessment of QOL with African-American and Hispanic patients. Three other measures failed to meet the defined standards. A dimension shown to be particularly difficult to address across culturally diverse groups is family functioning. Procedures for achieving cultural equivalence of QOL measures have been shown to be practical and productive. Measures are identified that may be used with some confidence to assess varied dimensions of QOL with culturally diverse groups.