Is oral chemotherapy prescription safe for patients? A cross-sectional survey

BACKGROUND

Oral chemotherapies are increasingly prescribed. Yet wide variations in prescription practices and in monitoring of toxicity have been underlined despite existing guidelines. There is little recent information available as regard to these practices. We aimed to obtain exhaustive information on oral chemotherapy prescription practices and safety monitoring in French hospitals.

METHODS

A cross-sectional multicentre survey was carried out to collect information on drug prescription, administration and surveillance: prescribing practices, coordination and monitoring of adherence, safety monitoring and side-effects occurrence prevention. Participants were a large sample of the French oncologists prescribing oral chemotherapy (20%).

RESULTS

One hundred and fifty-seven oncologists from 112 hospitals (public, comprehensive cancer centres and private) replied (23.7% of cancer hospitals). The majority (56.1%) of the prescriptions were hand-written on a blank sheet. Eighty-four physicians (53.5%) included dose information and 36 (23%) declared having no monitoring procedures for adherence. Only 84 responders (54%) provided education material at first prescription of oral chemotherapy in way to limit avoidable side-effects. Sixty-one (39%) responders stated that they recalled at least one serious adverse event in the previous year declared in their centre.

CONCLUSIONS

In this 2012 study, the majority of prescribers followed no standards in prescription writing, safety monitoring and toxicity prevention. The implementation of the international recommendations for oral chemotherapy administration should be considered as a top priority-for both prescribers and health authorities-as regards to the dynamic of development of these molecules and their potential side-effects.

Light quality regulates expression of chloroplast genes and assembly of photosynthetic membrane complexes

The concentrations of photosystem I (PSI) and photosystem II (PSII) reaction centers and the level of chloroplast reaction center gene transcripts were determined in pea plants grown under different light-quality regimes. In plants grown in light primarily absorbed by PSI ("red" light), the PSII/PSI reaction center ratio was 2-fold greater than that in plants grown in PSII-sensitizing ("yellow") light. In addition, the ratio of a PSII gene (psbB) transcript to a PSI gene (psaA) transcript was 2.6 times greater in red-grown plants relative to yellow-grown plants. Thus, a differential reaction-center concentration in the thylakoid membrane was accompanied by a differential expression of reaction center genes, suggesting that the synthesis of chloroplast membrane complexes and the assembly of photosystems are regulated by light quality at the transcriptional and/or post-transcriptional level.

Localization of different photosystems in separate regions of chloroplast membranes

The stoichiometric amounts and the photoactivity kinetics of photosystem I (PSI) and of the alpha and beta components of photosystem II (PSII(alpha) and PSII(beta)) were compared in spinach chloroplast membrane (thylakoid) fractions derived from appressed and nonappressed regions. Stroma-exposed thylakoid fractions from the nonappressed regions were isolated by differential centrifugation following a mechanical press treatment of the chloroplasts. Thylakoid vesicles derived mainly from the appressed membranes of grana were isolated by the aqueous polymer two-phase partition method. Stroma-exposed thylakoids were found to have a chlorophyll a/chlorophyll b ratio of 6.0 and a PSII(beta)/PSI reaction center ratio of 0.3. Kinetic analysis of system II photoactivity revealed the absence of PSII(alpha) from stroma-exposed thylakoids. The photoactivity of system I in stroma-exposed thylakoids showed a single kinetic component identical to that of unfractionated chloroplasts, suggesting that PSI does not receive excitation energy from the PSII-chlorophyll ab light-harvesting complex. Thus, stroma-exposed thylakoids are significantly enriched in both PSI and PSII(beta). Inside-out vesicles from the appressed membranes of grana-partition regions had a chlorophyll a/chlorophyll b ratio of 2.0 and a PSII/PSI reaction center ratio of 10.0. The photoactivity of system II showed the membranes of the grana-partition regions to be significantly enriched in PSII(alpha). We conclude that PSII(alpha) is exclusively located in the membranes of the grana partitions while PSII(beta) and PSI are located in stroma-exposed thylakoids. The low PSI reaction center (P700) content of vesicles derived from grana partitions and the kinetic homogeneity of the PSI complex suggest total exclusion of P700 as a functional component in the membrane of the grana-partition region.

Protonophores induce plastoquinol oxidation and quench chloroplast fluorescence: Evidence for a cyclic, proton-conducting pathway in oxygenic photosynthesis

The photosynthetic apparatus converts light into chemical energy by a series of reactions that give rise to a coupled flow of electrons and protons that generate reducing power and ATP, respectively. A key intermediate in these reactions is plastoquinone (PQ), the most abundant electron and proton (hydrogen) carrier in photosynthetic membranes (thylakoids). PQ ultimately transfers electrons to a terminal electron acceptor by way of the Rieske Fe-S center of the cytochrome bf complex. In the absence of a terminal acceptor, electrons accumulate in the PQ pool, which is reduced to plastoquinol (PQH(2)), and also on a specialized PQ, Q(A), which is reduced to an unprotonated semiquinone anion (Q(A) (-)). The accumulation of Q(A) (-) is measured by a rise in fluorescence yield and the accumulation of PQH(2) is measured by absorption difference spectrometry. We have found that in the absence of a terminal electron acceptor, two chemically diverse proton-conducting ionophores (protonophores), 2,6-di-t-butyl-4-(2',2'-dicyanovinyl)phenol (SF 6847) and carbonylcyanide p-trifluoromethoxyphenylhydrazone (FCCP), induced oxidation of PQH(2) and quenching of chloroplast fluorescence, signifying oxidation of Q(A) (-). The two protonophores produced the same effects even when the only recognized pathway of PQH(2) oxidation by way of the cytochrome bf complex was inhibited by dibromothymoquinone. Two other uncouplers, gramicidin and nigericin, which are not protonophores but facilitate proton movement across membranes by other mechanisms, were ineffective. These findings are consistent with the operation in the oxygen-generating photosystem (photosystem II) of a cyclic, proton-conducting pathway.

Stoichiometry of system I and system II reaction centers and of plastoquinone in different photosynthetic membranes

The concentrations of photochemical centers and of plastoquinone were measured in several kinds of photosynthetic membranes by optical difference spectroscopy. Photosystem I reaction centers were measured from the light-induced absorbance change at 700 nm (oxidation of the primary electron donor, P700). Photosystem II reaction centers were estimated from the light-induced absorbance change at 325 nm (reduction of the primary electron acceptor, Q). Spinach chloroplasts and membrane fractions obtained by French press treatment, mature and developing pea chloroplasts, and blue-green algal membranes were investigated. No loss of primary photochemical activity occurred during fractionation of the chloroplasts. The results indicated a large variability in the ratio of system II to system I reaction centers (from 0.43 to 3.3) in different photosynthetic membranes. Oxygen-evolving plants may change the ratio of their photosystems in response to environmental light conditions. The amount of photoreducible plastoquinone was also measured at 263 nm. In spinach chloroplasts, seven to eight plastoquinone molecules were found per reaction center of system II. Most of the plastoquinone pool was associated with the grana. However, the ratio of chemically determined plastoquinone to chlorophyll was similar in the grana and stroma thylakoids.

Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

BACKGROUND

Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice.

PURPOSE

To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT.

MATERIAL AND METHODS

The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone.

RESULTS

Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive.

CONCLUSION

CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.

Therapeutic approach to intrusive luxation injuries in primary dentition. A clinical follow-up study

AIM

This paper reports the results of a fifteen-year study carried out at the Dentoalveolar trauma study Centre of the University of Cagliari Dental Department, on treatment modes utilised for the recovery of periodontal injuries in primary dentition.

MATERIALS AND METHODS

The data referred to dental injuries were collected and recorded according to Andreasen's dental trauma classification: clinical signs and symptoms, patient's age and gender, lesion site and extent of the injury, timeframe between trauma and first dental examination. The authors focused their attention on intrusive luxations in primary dentition, which are a very frequent trauma in children between 1 and 4 years of age. It is extremely difficult to treat such injuries and there is an ongoing discussion about the advisability of extracting the intruded teeth, as opposed to wait and assist their natural repositioning using non-invasive techniques aimed at the maintenance of the eruptive space in the dental arch.

RESULTS

This careful conservative approach allowed the repositioning of about 60% of the 85 intruded teeth examined. It substantially reduced the number and severity of undesirable sequelae, both local (enamel-hypoplasia) and occlusal (tooth retention), so that only in about 25% of the followed-up cases damages of the successor tooth were found in the permanent dentition.

CONCLUSION

The authors conclude their study emphasizing that all those involved in paediatric dentistry must be familiar with periodontal injuries and trained in their treatment, particularly as regards intrusive luxations in primary dentition.

Facteurs du choix de la voie d’abord des hystérectomies pour lésions utérines bénignes (prolapsus et indications obstétricales exclus)

OBJECTIVES

We searched for the factors determining the type of hysterectomy (vaginal, laparoscopy or laparotomy) performed in women with supposedly benign uterine disease.

MATERIAL AND METHOD

We conducted a retrospective study of 101 consecutive hysterectomies performed on voluminous uteruses, prolapsus and obstetrical indications excluded. The following factors likely to have influenced the decisions were examined: patient age, nulliparity, menopausal status, history of laparotomy, uterus weight, narrow vagina, nature of uterus lesions, associated unilateral or bilateral annexectomy, complications.

RESULTS

The frequencies were: vaginal route 58.4% (average uterine weight 249.4 g, range 93-1149 g), laparoscopic preparation 37.6% (average uterine weight 348 g, range 92-818 g), and laparotomy 4% (average uterine weight 586.2 g, range 112-1216 g). Factors determining type of hysterectomy were uterine weight (and therefore volume) (p < 0.05), nulliparity (p < 0.04), narrow vagina probed by compulsory Schuchardt incision (p < 0.02), associated annexectomy (p < 0.01). No other factors were significantly determinant. The vaginal route appears to be highly preferred.

CONCLUSION

Vaginal hysterectomy is clearly the most preferred and practiced. Laparoscopy may be helpful for vaginal hysterectomy and laparotomy is exceptional.

Sequence learning and sequential effects

In a serial reaction time (RT) task with a probabilistic stimulus sequence, the length of the response-to-stimulus interval (RSI) and the sequence complexity was manipulated to investigate the relationship between sequence learning and sequential effects in serial RT tasks. Sequential effects refer to the influence of previous stimulus presentations on the RT to the current stimulus. Sequence learning is stimulus-transition specific and is demonstrated as the difference between practiced and unpracticed sequences within an interpolated random block of trials. There is a clear parallel between sequence learning and specific changes in sequential effect in the short RSI conditions, suggesting that a common mechanism may lie at the basis of sequence learning and automatic facilitation, which is responsible for sequential effects at short RSI. Importantly, the changes in sequential effects accompanying sequence learning are the same as those observed with practice in random serial RT tasks, indicating that the learning process underlying sequence learning is the same as in random tasks.

Factors influencing hospital infection control policies in Italian hospitals

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

Photosystem II damage and repair cycle in the green alga Dunaliella salina: involvement of a chloroplast-localized HSP70

The involvement of HSP70B in the photosystem II damage and repair process in Dunaliella salina was investigated. A full-length cDNA of the D. salina hsp70B gene was cloned and sequenced. Expression patterns of the hsp70B gene were investigated upon shifting a D. salina culture from low-light to high-light growth conditions, designed to significantly accelerate the rate of PSII photodamage. Northern blot analyses and nuclear run-on transcription assays revealed a significant but transient induction of hsp70B gene transcription, followed by a subsequent increase in HSP70B protein synthesis and accumulation. Mild detergent solubilization of photoinhibited thylakoid membranes, in which photodamaged PSII centers had accumulated, followed by native gel electrophoresis revealed the formation of a 320 kDa protein complex that contained, in addition to the HSP70B, the photodamaged but as yet undegraded D1 protein as well as D2 and CP47. Evidence suggested that the 320 kDa complex is a transiently forming PSII repair intermediate. Denaturing solubilization of the 320 kDa PSII repair intermediate by SDS-urea resulted in cross-linking of its polypeptide constituents, yielding a 160 kDa protein complex. The role of the HSP70B in the repair of photodamaged PSII centers, e.g. in stabilizing the disassembled PSII-core complex and in facilitating the D1 degradation and replacement process, is discussed.

Sequential analysis of a Simon task--evidence for an attention-shift account

We investigated the attention-shift hypothesis of the Simon effect by analysing the effect of repeating relevant colour or irrelevant location of the stimulus in four serial reaction time tasks. In Experiment 1 with short response-stimulus intervals (RSI), we assume that there is no time to engage attention at the fixation cross before the onset of a new stimulus. In agreement with the hypothesis, Experiment 1 reveals no Simon effect when the stimulus location is repeated. In Experiment 2 with long RSI, we observe a Simon effect for location repetitions and alternations. In Experiment 3 with long RSI, we hinder the disengagement of attention by displaying the stimulus after response execution. As expected, the Simon effect is reduced for location repetitions. In Experiment 4 with stimuli additionally presented at the fixation cross, responses are faster if the attention shift towards the centrally presented stimulus corresponds with the location of the required response. Additionally, we argue that binding of the stimulus features into an object or event file better explains the so-called blocking of the automatic response-priming route after a noncorresponding trial.

Involvement of zeaxanthin and of the Cbr protein in the repair of photosystem II from photoinhibition in the green alga Dunaliella salina

A light-sensitive and chlorophyll (Chl)-deficient mutant of the green alga Dunaliella salina (dcd1) showed an amplified response to irradiance stress compared to the wild-type. The mutant was yellow-green under low light (100 micromol photons m(-2) s(-1)) and yellow under high irradiance (2000 micromol photons m(-2) s(-1)). The mutant had lower levels of Chl, lower levels of light harvesting complex II, and a smaller Chl antenna size. The mutant contained proportionately greater amounts of photodamaged photosystem (PS) II reaction centers in its thylakoid membranes, suggesting a greater susceptibility to photoinhibition. This phenotype was more pronounced under high than low irradiance. The Cbr protein, known to accumulate when D. salina is exposed to irradiance stress, was pronouncedly expressed in the mutant even under low irradiance. This positively correlated with a higher zeaxanthin content in the mutant. Cbr protein accumulation, xanthophyll cycle de-epoxidation state, and fraction of photodamaged PSII reaction centers in the thylakoid membrane showed a linear dependence on the chloroplast 'photoinhibition index', suggesting a cause-and-effect relationship between photoinhibition, Cbr protein accumulation and xanthophyll cycle de-epoxidation state. These results raised the possibility of zeaxanthin and Cbr involvement in the PSII repair process through photoprotection of the partially disassembled, and presumably vulnerable, PSII core complexes from potentially irreversible photooxidative bleaching.

Hydrogen production. Green algae as a source of energy

Hydrogen gas is thought to be the ideal fuel for a world in which air pollution has been alleviated, global warming has been arrested, and the environment has been protected in an economically sustainable manner. Hydrogen and electricity could team to provide attractive options in transportation and power generation. Interconversion between these two forms of energy suggests on-site utilization of hydrogen to generate electricity, with the electrical power grid serving in energy transportation, distribution utilization, and hydrogen regeneration as needed. A challenging problem in establishing H(2) as a source of energy for the future is the renewable and environmentally friendly generation of large quantities of H(2) gas. Thus, processes that are presently conceptual in nature, or at a developmental stage in the laboratory, need to be encouraged, tested for feasibility, and otherwise applied toward commercialization.

Hydrogen production. Green algae as a source of energy

Hydrogen gas is thought to be the ideal fuel for a world in which air pollution has been alleviated, global warming has been arrested, and the environment has been protected in an economically sustainable manner. Hydrogen and electricity could team to provide attractive options in transportation and power generation. Interconversion between these two forms of energy suggests on-site utilization of hydrogen to generate electricity, with the electrical power grid serving in energy transportation, distribution utilization, and hydrogen regeneration as needed. A challenging problem in establishing H(2) as a source of energy for the future is the renewable and environmentally friendly generation of large quantities of H(2) gas. Thus, processes that are presently conceptual in nature, or at a developmental stage in the laboratory, need to be encouraged, tested for feasibility, and otherwise applied toward commercialization.

Absence of lutein, violaxanthin and neoxanthin affects the functional chlorophyll antenna size of photosystem-II but not that of photosystem-I in the green alga Chlamydomonas reinhardtii

Chlamydomonas reinhardtii double mutant npq2 lor1 lacks the beta, epsilon-carotenoids lutein and loroxanthin as well as all beta,beta-epoxycarotenoids derived from zeaxanthin (e.g. violaxanthin and neoxanthin). Thus, the only carotenoids present in the thylakoid membranes of the npq2 lor1 cells are beta-carotene and zeaxanthin. The effect of these mutations on the photochemical apparatus assembly and function was investigated. In cells of the mutant strain, the content of photosystem-II (PSII) and photosystem-I (PSI) was similar to that of the wild type, but npq2 lor1 had a significantly smaller PSII light-harvesting Chl antenna size. In contrast, the Chl antenna size of PSI was not truncated in the mutant. SDS-PAGE and Western blot analysis qualitatively revealed the presence of all LHCII and LHCI apoproteins in the thylakoid membrane of the mutant. The results showed that some of the LHCII and most of the LHCI were assembled and functionally connected with PSII and PSI, respectively. Photon conversion efficiency measurements, based on the initial slope of the light-saturation curve of photosynthesis and on the yield of Chl a fluorescence in vivo, showed similar efficiencies. However, a significantly greater light intensity was required for the saturation of photosynthesis in the mutant than in the wild type. It is concluded that zeaxanthin can successfully replace lutein and violaxanthin in most of the functional light-harvesting antenna of the npq2 lor1 mutant.