Highlights d HCC and iCCA have a varying degree of transcriptomic diversity d Tumor transcriptomic diversity is associated with patient outcomes d Tumor-derived VEGF drives microenvironmental reprogramming d T cells derived from higher heterogeneous tumors showed lower cytolytic activities

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Summary:outcome. 7 QOL is a multidimensional phenomenon consisting of physical, psychological, and social dimensions, 7 following BMT, an individual's QOL may be affected by As more women are treated with bone marrow transplantation (BMT) for breast cancer, there is growing difficulties in any or all of these areas. QOL following BMT has been examined in several surinterest in quality of life (QOL) following treatment. Although there have been some clinical studies of QOL vey studies. 7,8 However, in some of these studies, QOL was assessed using methods of questionable reliability and valfollowing BMT, this area has received little systematic attention. In particular, it is unclear how QOL for idity, such as open-ended questionnaires, 9 patient interviews, 10 or non-validated QOL instruments developed by women treated with BMT for breast cancer differs from that which might be expected for 'healthy' women of the study authors. 11 In this introduction, only studies which employed standard, validated questionnaires to assess QOL about the same age. To address this issue, we compared QOL reported by women treated with autologous BMT following BMT are briefly reviewed. In a study conducted by Andrykowski and colleagues, 1 for breast cancer with that of a group of women of similar age with no history of cancer. In addition, we exam-QOL was assessed in individuals who were an average of 26 months post-BMT using the Functional Living Indexined the relationship of demographic factors, medical factors, and self-reported symptom prevalence, severity, Cancer (FLIC). 12 Based on mean FLIC scores, the QOL of the BMT survivors was similar to that of a normative samand distress to QOL in post-BMT patients. All participants completed the SF-36 Health Survey developed ple of cancer patients in active chemotherapy treatment. Poorer QOL in BMT survivors was associated with being from the Medical Outcomes Study (SF-36). Post-BMT patients also completed the ECOG Performance Status older (ie above age 30) at the time of BMT. The QOL of 135 individuals who were an average of 47 Rating Scale (PSR) and the Memorial Symptom Assessment Scale (MSAS). Results indicated that, compared months post-BMT was assessed by Baker and colleagues 3 using a measure of life satisfaction (Satisfaction with Life to the women with no cancer history, post-BMT patients reported significantly impaired physical functioning, Domains Scale; SLDS) 13 and a measure of emotional wellbeing (Profile of Mood States; POMS). 14 Based on physical role functioning, general health, vitality, social functioning, and emotional role functioning. Impaired responses to the SLDS, the authors indicated that the BMT survivors reported an 'above average level of satisfaction' QOL following BMT was significantly associated with lower income, a longer time to engraftment, longer hoswith most areas of life but reported some dissatisfaction with physical strength and sexual relations. In addition, the pital stay, poor performance status, and greater symptom prevalence, severity, and d...

A multicenter survey of 11 cancer centers was performed to determine the rate of hospital-onset Clostridium difficile infection (HO-CDI) and surveillance practices. Pooled rates of HO-CDI in patients with cancer were twice the rates reported for all US patients (15.8 vs 7.4 per 10,000 patient-days). Rates were elevated regardless of diagnostic test used.In 2011, an estimated 1.6 million people underwent treatment for cancer. 1 Clostridium difficile is the most common bacterial cause of healthcare-associated diarrhea in persons receiving chemotherapy for cancer. Several risk factors in this population raise the risk of C. difficile infection (CDI). 2,3 In the last decade, with the emergence of BI/NAP1 strain the incidence and severity of CDI increased across North America and Europe, and the need for widespread surveillance became more important than ever. With the advent of public reporting for CDI, comparison of rates across centers will occur and may not take into account differences in patient populations. Therefore, we sought to determine the rate of hospital-onset (HO)-CDI and surveillance practices in a population of HSCT recipients and patients with cancer. Establishment of a benchmark for this large but unique patient group will assist both infection control practitioners and concerned consumers as they compare rates across states and hospitals. METHODS RESULTSA total of 11 centers participated in the survey. Hospital characteristics are shown in Table 2. Among the centers, the number of oncology beds ranged from 22 to 600 (median, 100 beds); HSCT beds, 6-80 (median, 26 beds). PCR was the most common detection method (6), followed by EIA (4) and CTA (1). Six centers are located in states where C. difficile is a reportable healthcare-associated infection (HAI). Rates of HO-CDIA case of HO-CDI was defined as a positive result of a laboratory assay for C. difficile toxin A and/or B following in-patient admission. The cutoff used was >48 hours at 5 centers and >72 hours at 6 centers.Centers using PCR as detection method had a higher median HO-CDI rate (1.72 per 1,000 patient-days) compared to EIA (0.9 per 1,000 patient-days; Figure 1). Among the centers that use PCR, the median HO-CDI rate was highest when the 48-hour cutoff from admission was used to define an HO-CDI case: 2.2 per 1,000 patient-days (more than 48 hours) and 1.57 per 1,000 patient-days (more than 72 hours). Relapse versus second new infectionMost centers followed the ad hoc C. difficile surveillance working group's criteria for recurrent infection. 6 In total, 7 of 9 centers that track recurrent cases consider an episode occurring more than 8 weeks after the index episode as a second new infection. One center uses 12 weeks as the interval and another center only considers a recurrent episode occurring at least 6 months after the index episode as second new infection. Duration of isolationIsolation practice for C. difficile varied widely across all centers. Two of 11 centers isolated patients with CDI for the entire duration of hos...