Sixty-eight lymphomas induced by eight different avian leukosis viruses have been analyzed on Southern blots for virus-induced mutations in the chicken c-myc gene. Sixty-six of the lymphomas exhibited a proviral insertion in c-myc, whereas one exhibited a new transduction of c-myc. Sixty-four of the proviral insertions were in the same transcriptional orientation as c-myc. Two were in the opposite transcriptional orientation. All of the insertions were upstream of the protein-coding sequences of c-myc, with most residing in the first exon or the first intron of c-myc. All of the lymphoma-inducing proviruses had deletions that included either sequences near the 5' long terminal repeat (LTR) or an LTR. The most frequent lymphoma-inducing provirus appeared to have retained both of its LTRs, but had lost sequences near its 5' LTR. The second and third most frequent lymphoma-inducing proviruses consisted of solo LTRs or of proviruses that had lost the 5' LTR as well as some internal sequences. Twenty-four insertions were mapped in c-myc. Each of these mapped to within 150 base pairs of one of the five DNase I-hypersensitive sites that occur in a 3-kilobase region immediately 5' to the protein-coding sequences of c-myc. One lymphoma contained a new c-myc transducing virus. This virus, MYC-3475, caused rapid-onset myelocytomatosis. * Corresponding author. different recombinants between RAV-1 or RAV-2 and endogenous ALVs (26). Fujinami-associated virus was isolated from a stock of Fujinami sarcoma virus provided by H. Hanafusa. This isolate of Fujinami-associated virus has an EcoRI site in its LTR. Nontransforming subgroup E virus strain 2 is a recombinant of the Prague strain of Rous sarcoma virus type B and RAV-0 (35). It was obtained from J. Coffin,

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Children without a clear diagnosis are relatively common in pediatric palliative care and have-like all other patients-the right to receive optimized and symptom-adapted palliative care. Parents are less likely to choose treatment limitation for children who lack a definitive diagnosis. What is Known: • A clear diagnosis is usually considered important for best-practice pediatric palliative care (PPC) including advanced care planning (ACP). • Timely initiation of pediatric palliative care (PPC) is highly recommended in children with life-limiting conditions. What is New: • SWAN (syndrome without a name) children show similar signs and symptoms (mostly neurological) and have similar supportive needs as brain-injured children. • Defining treatment limitations in advance care planning is more difficult for parents of SWAN compared to brain-injured children.

Pediatric advance care planning seeks to ensure end-of-life care conforming to the patients/their families’ preferences. To expand our knowledge of advance care planning and “medical orders for life-sustaining treatment” (MOLST) in pediatric palliative home care, we determined the number of patients with MOLST, compared MOLST between the four “Together for Short Lives” (TfSL) groups and analyzed, whether there was a relationship between the content of the MOLST and the patients’ places of death.The study was conducted as a single-center retrospective analysis of all patients of a large specialized pediatric palliative home care team (01/2013-09/2016). MOLST were available in 179/198 children (90.4%). Most parents decided fast on MOLST, 99 (55.3%) at initiation of pediatric palliative home care, 150 (83.4%) within the first 100 days. MOLST were only changed in 7.8%. Eighty/179 (44.7%) patients decided on a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) order, 58 (32.4%) on treatment limitations of some kind and 41 (22.9%) wished for the entire spectrum of life-sustaining measures (Full Code). Most TfSL group 1 families wanted DNACPR and most TfSL group 3/4 parents Full Code. The majority (84.9%) of all DNACPR patients died at home/hospice. Conversely, all Full Code patients died in hospital (80% in an intensive care setting).The circumstances of the childrens’ deaths can therefore be predicted considering the content of the MOLST. Regular advance care planning discussions are thus a very important aspect of pediatric palliative home care.