Modifiable and fixed factors predicting quality of life in people with colorectal cancer

Background:

People with colorectal cancer have impaired quality of life (QoL). We investigated what factors were most highly associated with it.

Methods:

Four hundred and ninety-six people with colorectal cancer completed questionnaires about QoL, functioning, symptoms, co-morbidity, cognitions and personal and social factors. Disease, treatment and co-morbidity data were abstracted from case notes. Multiple linear regression identified modifiable and unmodifiable factors independently predictive of global quality of life (EORTC-QLQ-C30).

Results:

Of unmodifiable factors, female sex (P<0.001), more self-reported co-morbidities (P=0.006) and metastases at diagnosis (P=0.036) significantly predicted poorer QoL, but explained little of the variability in the model (R²=0.064). Adding modifiable factors, poorer role (P<0.001) and social functioning (P=0.003), fatigue (P=0.001), dyspnoea (P=0.001), anorexia (P<0.001), depression (P<0.001) and worse perceived consequences (P=0.013) improved the model fit considerably (R²=0.574). Omitting functioning subscales resulted in recent diagnosis (P=0.002), lower perceived personal control (P=0.020) and travel difficulties (P<0.001) becoming significant predictors.

Conclusion:

Most factors affecting QoL are modifiable, especially symptoms (fatigue, anorexia, dyspnoea) and depression. Beliefs about illness are also important. Unmodifiable factors, including metastatic (or unstaged) disease at diagnosis, have less impact. There appears to be potential for interventions to improve QoL in patients with colorectal cancer.

A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer

BACKGROUND

Traditionally, metastatic colorectal cancer (MCRC) has been treated with intravenous (i.v.) 5-fluorouracil/leucovorin (5-FU/LV). The tumour-activated, oral fluoropyrimidine capecitabine demonstrates superior activity and favourable safety compared with the Mayo regimen, while potentially avoiding the complications and inconvenience associated with i.v. regimens.

PATIENTS AND METHODS

Ninety-seven patients with previously untreated advanced/MCRC were randomised to receive capecitabine followed by i.v. 5-FU/LV [Mayo Clinic, in-patient de Gramont (IPdG) or out-patient modified de Gramont (OPdG) regimens], or i.v. 5-FU/LV followed by capecitabine.

RESULTS

Before treatment, of those patients for whom a preference was recorded, almost all (95%) preferred oral treatment (consistent across all treatment groups) and the majority retained this preference after treatment (64% overall; 86%, 63% and 50% in the Mayo, IPdG and OPdG groups, respectively). Following treatment, the principal reasons for oral treatment preference were increased convenience, home-based administration and tablet formulation. Treatment satisfaction was significantly higher with capecitabine compared with Mayo (P<0.05) and with OPdG compared with capecitabine (P<0.05). Quality of life (QoL) was largely constant across the regimens, although it appeared better with OPdG than capecitabine (P<0.05). Grade 3/4 adverse events were uncommon in all arms.

CONCLUSIONS

This study confirmed that the majority of patients with MCRC prefer oral to i.v. therapy, although the OPdG regimen appears to be the most popular i.v. option. Capecitabine clearly represents an effective, well-tolerated oral alternative to i.v. 5-FU/LV.

Isolation and molecular characterization of vancomycin-resistant Enterococcus faecium in Malaysia

Nineteen strains of vancomycin-resistant Enterococcus faecium isolated from 10 of 75 (13.3%) tenderloin beef samples were examined for resistance to selected antibiotics, presence of plasmids, and genetic diversity by random amplification of polymorphic DNA analysis. All strains showed multiple resistant to the antibiotics tested. Multiple antibiotic indexing of the vancomycin-resistant E. faecium strains showed that all (100%) originated from high risk contamination environments where antibiotics were often used. Plasmids ranging in size from 1.5 to 36 megadalton were detected in 15 of 19 (79%) strains. Thus, three plasmid profiles and eight antibiotypes were observed among the E. faecium strains. A high degree of polymorphism was obtained by combining the results of the two primers used; with the 19 E. faecium strains being differentiated into 19 RAPD-types. These preliminary results suggest that RAPD-PCR has application for epidemiologic studies and that resistance patterns and plasmid profiling could be used as an adjunct to RAPD for the typing of E. faecium in the study area.

Note: characterization of Vibrio cholerae O139 Bengal isolated from water in Malaysia

Four Vibrio cholerae O139 Bengal strains isolated from surface water were characterized by antibiotic resistance, plasmid profile, presence of cholera toxin gene and random amplification of polymorphic DNA (RAPD) analysis. All four strains exhibit multiple resistance towards the antibiotics tested with a multiple antibiotic resistance index of 0.5-0.66, and harboured a 2.0 MDa non-conjugative plasmid. The Vibrio cholerae O139 Bengal were positive for the cholera toxin gene. Antibiotyping and random amplification of polymorphic DNA analysis with four primers proved to be useful in discriminating the isolates. RAPD proved to be more sensitive. These results reveal that there is significant genetic diversity among the Vibrio cholerae O139 Bengal strains studied.

A randomized controlled trial of the effect of third-trimester calcium supplementation on maternal hemodynamic function

OBJECTIVE

To determine the effect of third-trimester calcium supplementation on maternal hemodynamic function.

METHODS

Pregnant women were randomized to receive either 1.5 g of elemental calcium or placebo for 6 weeks during the third trimester. Using Doppler technique, maternal hemodynamic characteristics were measured at baseline, at 2 hours after the first dose of study drug, and at the completion of 6 weeks. Serum, dietary, and urinary calcium levels were also assessed. Power calculation indicated the need to study ten subjects in each group to detect a 1.2 L (20%) difference in cardiac output between groups, assuming a mean of 6.2 +/- 1.0 L/minute. Data were analyzed by analysis of variance for repeated measures, Student t test, Mann-Whitney U test, and Fisher exact test.

RESULTS

Twenty-three women enrolled, and 18 completed the study. There were no statistically significant differences in demographic characteristics or in serum, dietary, or urinary calcium levels between the two groups. There were also no statistically significant differences in hemodynamic function over time within the calcium supplementation or placebo group (P > .05; analysis of variance for repeated measures). After 6 weeks, there were no significant differences between the calcium- and placebo-treated subjects in any hemodynamic measurement. Specifically, there was not a statistically significant difference in cardiac output (7.3 +/- 1.2 L/minute versus 8.0 +/- 0.9 L/minute; P = .09) between the calcium- and placebo-treated groups.

CONCLUSION

These findings suggest that third-trimester calcium supplementation does not significantly alter cardiac output. The mechanism by which calcium supplementation lowers blood pressure remains to be elucidated.

Optimization of ETV-ICP-MS conditions for the determination of multi-elements in semiconductor grade acids

The performance of an electro thermal vaporization (ETV) unit as a sample introduction device for an inductively coupled plasma mass spectrometer (quadrupole-ICP-MS) was evaluated. The technique was found to have several advantages over the conventional nebulization method. Some features of ETV-ICP-MS for single element determination have been investigated. Attempts were made to optimize the experimental parameters such as vaporization temperature, vaporization interval and carrier gas flow rate. The study highlights on the determination of Cr, Mn, Al and Na. A compromise condition for multi-element determination was suggested and tested from single-element optimum conditions obtained. 25 microL solution was used for the analysis. Results obtained for the analysis of conc. HCl samples are also reported.

Relationships of plasma lipoprotein concentrations to unbound, albumin-bound and sex hormone-binding globulin-bound fractions of gonadal steroids in men

Most epidemiologic studies of plasma lipoproteins and gonadal steroids have measured total hormone concentrations only. Gonadal steroids are transported in plasma in unbound, albumin-bound and sex hormone-binding globulin (SHBG)-bound forms, only the first two of which are biologically active. In the present study the associations of plasma lipoproteins with the different fractions of testosterone, oestradiol and 5 alpha-dihydrotestosterone (5 alpha DHT) were explored by multiple regression in 70 men aged 52-67 years (mean, 59 years). The principal finding was that the distribution of cholesterol between the two major subclasses of high density lipoprotein (HDL) was correlated with the concentrations of unbound and albumin-bound oestradiol, but not with SHBG-bound oestradiol or any fraction of testosterone or 5 alpha DHT. These associations were independent of plasma triglyceride. Apoproteins A-I and A-II were not correlated with any hormone fraction. Thus, in middle-aged/elderly men HDL subclasses appear to be influenced by circulating estrogenic activity, but not by androgenic activity, through a mechanism that is unrelated to triglyceride transport or HDL apoprotein metabolism.

Relationship of high density lipoprotein composition to plasma lecithin:cholesterol acyltransferase concentration in men

The epidemiological associations between the plasma concentrations of several components of high density lipoprotein (HDL) and plasma lecithin:cholesterol acyltransferase (LCAT) concentration have been studied in 101 men aged 52-67 years. Subjects were apparently healthy, and had been selected to provide a wide range of HDL-cholesterol levels. A weak positive correlation was observed between plasma total HDL-cholesterol concentration and LCAT concentration (r = 0.24, P less than 0.02). This reflected an association between HDL3-cholesterol (measured by precipitation) and enzyme concentration (r = 0.21, P less than 0.05). Apoprotein (apo) A-II concentration was also positively correlated with LCAT (r = 0.27, P less than 0.01). HDL2-cholesterol and apo A-I concentration were unrelated to LCAT concentration, as also were the HDL2/HDL3 and HDL-cholesterol/apo A-I ratios. The associations of HDL3 cholesterol and apo A-II with LCAT were strengthened when allowance was made by multiple regression for the effect of log plasma triglyceride; under these circumstances variation in LCAT explained statistically 8% of the variance in HDL3-cholesterol, and 10% of that in apo A-II.

The production and use of monoclonal antibodies to measure apolipoprotein B by a competitive enzyme-linked immunoassay

The production of monoclonal antibodies to human lipoproteins is described. One of these antibodies, which was shown to be specific to apolipoprotein B, was used to develop a competitive enzyme-linked immunoassay for apolipoprotein B in serum samples. The antibody selected recognises apolipoprotein B in both low density and very low density lipoprotein particles, but there is no cross-reactivity with high density lipoprotein. There is no requirement for labelling of antigen or antibody used in the assay, and results obtained correlate well (r = 0.88) with measurements on serum samples using a radial immunodiffusion assay for apolipoprotein B.

Resistive NMR of intracranial hematomas

Comparison between computed tomography and nuclear magnetic resonance imaging in 17 patients with intracranial hematomas indicates a distinct role for NMR in evaluating the stable patient with hematoma. NMR is useful for delineating the extent of the hematoma, the relationship of the hematoma to brain anatomy, and the presence of hematoma at a time when the hematoma is isodense on CT.

Resistive NMR of brain stem gliomas

The NMR and CT findings in 22 patients with primary brain stem tumors were compared to determine the value of each study in identifying, and delineating the extent and relationships of the tumor to brain anatomy. NMR was found to be distinctly superior to CT in showing involvement of the medulla and upper cervical cord. NMR eliminates the need for intrathecal enhanced metrizamide CT, and in the future should be the only initial diagnostic test needed for the evaluation of intrinsic brain stem tumors.

Comparison of digital subtraction arteriography and conventional film screen subtraction arteriography for neuroradiology

Sixty-nine patients with 91 separate abnormal findings were studied by both intra-arterial digital subtraction arteriography (ADSA) and conventional film screen subtraction arteriography (CFSA) in the same projection, with the same magnification. Digital subtraction arteriography has distinct advantages over CFSA in the form of reduced contrast utilization, better patient tolerance of arteriography because of reduced contrast concentration, superior contrast resolution, and rapid, on-line visualization of the abnormalities. Digital subtraction arteriography is limited by its availability in only a single plane, by decreased spatial resolution which affected the image quality for intracranial blood vessels at an image intensifier (I.I.) field of 12 inches, and by relatively limited field of view both intracranially and extracranially for I.I. fields of 6 and 9 inches.

CT metrizamide myelography in multiple bilateral intrathoracic meningoceles

An intrathoracic meningocele is a protrusion of spinal meninges through an intervertebral foramen into the thoracic cavity. The majority occur in association with neurofibromatosis, and bilateral or multiple lesions are rarely seen. In conventional radiography, small meningoceles may be hidden behind other mediastinal structures. To investigate paraspinal masses, computed tomography (CT) with intrathecal contrast material is likely to result in more frequent detection of unsuspected lateral meningoceles. This report details our experience with CT metrizamide myelography in a case of multiple bilateral intrathoracic meningoceles.

Interaction between ceruloplasmin and Sendai virus envelope components. Note VI. Effect of ceruloplasmin on the antigenicity of Sendai virus and subviral fractions

The results obtained by immunization of rabbits with different Sendai virus antigens (whole virus, envelope fragments and partially purified nucleoprotein) previously incubated with homologous ceruloplasmin confirm the hypothesis of a common protein support for both hemagglutinin and neuraminidase activities, demonstrate the participation of ceruloplasmin in the immune mechanism and reveal the role of the carbohydrate moiety of the glycoprotein in immune response. The probable mechanism of interaction between ceruloplasmin and Sendai virus envelope glycoprotein is discussed.