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Substantial health care resources are used on aggressive end-of-life care, despite an increasing recognition that palliative care improves quality of life and reduces health care costs. We examined the incidence of palliative care encounters in inpatients with incurable head and neck cancer (HNCA) and associations with in-hospital mortality, length of hospitalization, and costs.

Data from the Nationwide Inpatient Sample for 80,514 HNCA patients with distant metastatic disease in 2001-2010 was analyzed using cross-tabulations and multivariate regressions.

Palliative care encounters occurred in 4,029 cases (5%) and were significantly associated with age ≥80 years, female sex, self-pay pay or status, and prior radiation. Palliative care was significantly associated with increased in-hospital mortality and reduced hospital-related costs.

Inpatient palliative care consultation in terminal HNCA is associated with reduced hospital-related costs, but appears to be underutilized and restricted to the elderly, uninsured, and patients with an increased risk of mortality.


palliative care, complications, head and neck neoplasms, costs, Nationwide Inpatient Sample


The Use of Inpatient Palliative Care Services In Patients With Metastatic Incurable Head and Neck Cancer


Carolyn L. Mulvey, B.S.,1 Thomas J. Smith, M.D.,2 and Christine G. Gourin, M.D., M.P.H.1

Publish date

2016 Mar 1.




The reactions of N-heterocyclic carbene CuI and AgI halides with potassium thio- or seleno­cyanate gave unexpected products. The attempted substitution reaction of bromido­(1,3-dibenzyl-4,5-di­phenyl­imidazol-2-yl­idene)silver (NHC*?Ag?Br) with KSCN yielded bis­[bis­(1,3-dibenzyl-4,5-di­phenyl­imidazol-2-yl­idene)silver(I)] tris­(thio­cyanato)­argentate(I) diethyl ether disolvate, [Ag(C29H24N2)2][Ag(NCS)3]·2C4H10O or [NHC*2Ag]2[Ag(SCN)3]·2Et2O, (1), while reaction with KSeCN led to bis­(μ-1,3-dibenzyl-4,5-diphenyl-2-seleno­imidazole-κ2 Se:Se)bis­[bromido­(1,3-dibenzyl-4,5-diphenyl-2-seleno­imid­azole-κSe)silver(I)] di­chloro­methane hexa­solvate, [Ag2Br2(C29H24N2Se)4]·6CH2Cl2 or (NHC*Se)4Ag2Br2·6CH2Cl2, (2), via oxidation of the NHC* fragment to 2-seleno­imidazole. This oxidation was observed again in the reaction of NHC*?Cu?Br with KSeCN, yielding catena-poly[[[(1,3-dibenzyl-4,5-diphenyl-2-seleno­imidazole-κSe)copper(I)]-μ-cyanido-κ2 C:N] aceto­nitrile monosolvate], {[Cu(CN)(C29H24N2Se)]·C2H3N}n or NHC*Se?CuCN·CH3CN, (3). Compound (1) represents an organic/inorganic salt with AgI in a linear coordination in each of the two cations and in a trigonal coordination in the anion, accompanied by diethyl ether solvent mol­ecules. The tri-blade boomerang-shaped complex anion [Ag(SCN)3]2? present in (1) is characterized by X-ray diffraction for the first time. Compound (2) comprises an isolated centrosymmetric mol­ecule with AgI in a distorted tetra­hedral BrSe3 coordination, together with di­chloro­methane solvent mol­ecules. Compound (3) exhibits a linear polymeric 1 ∞[Cu?C≡N?Cu?] chain structure with a seleno­imidazole moiety additionally coordinating to each CuI atom, and completed by aceto­nitrile solvent mol­ecules. Electron densities associated with an additional ether solvent mol­ecule in (1) and two additional di­chloro­methane solvent mol­ecules in (2) were removed with the SQUEEZE procedure [Spek (2015 ?). Acta Cryst. C71, 9-18] in PLATON.


N-Heterocyclic carbene, copper(I), silver(I), thio­cyanate, seleno­cyanate, d10 electron configuration, crystal structure


Unexpected reactions of NHC*?CuI and ?AgI bromides with potassium thio- or seleno­cyanate


Matthias Tacke,a Daniel Marhofer,a Hessah Althani,a and Helge Muller-Bunza,*

Publish date

2019 Nov 1;




Despite its efficacy, the use of morphine for the treatment of chronic pain remains limited because of the rapid development of tolerance, dependence and ultimately addiction. These undesired effects are thought to be because of alterations in synaptic transmission and neuroplasticity within the reward circuitry including the striatum. In this study we used subcellular fractionation and quantitative proteomics combined with computational approaches to investigate the morphine-induced protein profile changes at the striatal postsynaptic density. Over 2,600 proteins were identified by mass spectrometry analysis of subcellular fractions enriched in postsynaptic density associated proteins from saline or morphine-treated striata. Among these, the levels of 34 proteins were differentially altered in response to morphine. These include proteins involved in G-protein coupled receptor signaling, regulation of transcription and translation, chaperones, and protein degradation pathways. The altered expression levels of several of these proteins was validated by Western blotting analysis. Using Genes2Fans software suite we connected the differentially expressed proteins with proteins identified within the known background protein-protein interaction network. This led to the generation of a network consisting of 116 proteins with 40 significant intermediates. To validate this, we confirmed the presence of three proteins predicted to be significant intermediates: caspase-3, receptor-interacting serine/threonine protein kinase 3 and NEDD4 (an E3-ubiquitin ligase identified as a neural precursor cell expressed developmentally down-regulated protein 4). Because this morphine-regulated network predicted alterations in proteasomal degradation, we examined the global ubiquitination state of postsynaptic density proteins and found it to be substantially altered. Together, these findings suggest a role for protein degradation and for the ubiquitin/proteasomal system in the etiology of opiate dependence and addiction.


Morphine Regulated Synaptic Networks Revealed by Integrated Proteomics and Network Analysis*


Steven D. Stockton, Jr.,‡§ Ivone Gomes,‡ Tong Liu,¶ Chandrakala Moraje,‡ Lucia Hipolito,? Matthew R. Jones,‡ Avi Ma'ayan,‡ Jose A. Moron,? Hong Li,¶ and Lakshmi A. Devi‡§**

Publish date

2015 Oct;