Screening older cancer patients: first evaluation of the G-8 geriatric screening tool

BACKGROUND

Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment (CGA). We develop and evaluate the G-8 screening tool against various reference tests.

PATIENTS AND METHODS

Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospective study. The G-8 consists of seven items from the Mini Nutritional Assessment (MNA) questionnaire and age. Our primary reference test is based on a set of seven CGA scales: Activities Daily Living (ADL), Instrumental ADL, MNA, Mini-Mental State Exam, Geriatric Depression Scale, Cumulative Illness Rating Scale-Geriatrics, and Timed Get Up and Go. We considered the presence of at least one questionnaire with an impaired score as an abnormal reference exam. Additional reference exams are also discussed.

RESULTS

The prevalence of being at risk varied from 60% to 94% according to the various definitions of the reference test. When considering the primary reference test, a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate (85%) without deteriorating the specificity excessively (65%).

CONCLUSION

The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA.

Gamma spectrum unfolding for a NaI monitor of radioactivity in aquatic systems

Spectrum unfolding is a powerful method that can enhance the readability of experimental energy spectra obtained by detectors of poor resolution. It is applied to the NaI-based monitor. The UMG 3.3 package is used for unfolding the experimental spectra with the response matrix obtained by MCNP4c2. The main parameter influencing the quality of the results is the chi(2). The goal of this study is to optimize the choice of this factor. The statistical accuracy of the technique is evaluated.

Neutron-photon discrimination and spectrum unfolding with a stilbene detector

As a first step into the development of a neutron dose monitor, a stilbene detector is used to test a procedure applicable to other organic scintillators allowing for neutron-photon discrimination. The pulses are measured by numerical acquisition and their amplitude and decay time are calculated by software. The discrimination is performed in an amplitude-decay time plot, and separate amplitude spectra are built. These spectra are unfolded MAXED, using the detector response matrices calculated with MCNPX.

[Paranoia and Asperger syndrome]

Paranoia in patients diagnosed with Asperger syndrome in adulthood is discussed and illustrated with the help of a case study. Impaired mentalisation, characteristic for Asperger disorder, influences the way an individual experiences life, making him more vulnerable for the development of delusional beliefs.

Prediction of early death risk in the elderly with cancer: Results of a prospective multicentric study of 364 patients under chemotherapy

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Background: When it is time to decide for or against chemotherapy in elderly patients (pts) with cancer, physicians face the difficult balance of risks and benefits. Too much often, decision is based on empirical feelings rather than reliable and objective factors which are frequently lacking. Yet, elderly pts can benefit from chemotherapy in many situations. Method: To help physicians in the decision process of chemotherapy through identification of factors predicting early death (< 6 months) from the onset of chemotherapy, we performed a prospective accrual of pts older than 70 with various types of cancer treated by 1st line chemotherapy. Baseline geriatric assessment (GA) (MMS, Get up and go, ADL, IADL, MNA, GDS15 , CIRS-G). Treatment was applied by the oncologist according to current standards disregarding GA results. Factors tested were: age, sex, advanced disease, renal and cardiac function, blood counts, performance status (PS), comorbidities and GA data. Results: 364 pts were accrued in 12 centres. Localisations were: lymphomas (110), colon (101), stomach (37), lung (37), pancreas (23), prostate (20), bladder (18), ovary (14) and unknown origin carcinomas (4). Main characteristics: median age (77.5 y. - range: 70- 99), sex ratio H/F (1.43), advanced tumours (66% - metastatic cancer or aaIPI 2–3 for lymphomas), PS>1 (28%), creatinine clearance <50 ml/mn (42%). GA showed 32% of pts ADL-dependent, 70% IADL-dependent, risk of falls in 12.4%, 19.2% MMS<24, 30% GDS15 >6, 63.4% MNA<23.5, 38.2% = 1 CIRS-G gr. 3–4 category. 357 pts have been followed up for more than 6 months and 59 pts died during this period. Only advanced disease (OR: 4.2 - CI95:1.7–10.3) and MNA score (OR: 4.5 - CI95: 1.75–11.6) predicted early death in logistic regression model. In advanced tumours, risk of early death varied from 11% in pts with MNA>23.5 to 40% in pts with MNA<17. Conclusions: In pts older than 70 with cancer, disease extension and MNA could predict for early death. MNA, performed by a trained nurse, should probably be added to routine pre- treatment work-up in these pts to screen for multidisciplinary assessment and management by oncologists and geriatricians. Sponsored by PHRC, sanofi-aventis, Amgen, Pfizer

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Nuclear particles containing RNA polymerase III complexes associated with the junctional plaque protein plakophilin 2

Plakophilin 2, a member of the arm-repeat protein family, is a dual location protein that occurs both in the cytoplasmic plaques of desmosomes as an architectural component and in an extractable form in the nucleoplasm. Here we report the existence of two nuclear particles containing plakophilin 2 and the largest subunit of RNA polymerase (pol) III (RPC155), both of which colocalize and are coimmunoselected with other pol III subunits and with the transcription factor TFIIIB. We also show that plakophilin 2 is present in the pol III holoenzyme, but not the core complex, and that it binds specifically to RPC155 in vitro. We propose the existence of diverse nuclear particles in which proteins known as plaque proteins of intercellular junctions are complexed with specific nuclear proteins.

Comparison of the aggregation properties, secondary structure and apoptotic effects of wild-type, Flemish and Dutch N-terminally truncated amyloid beta peptides

The Dutch (E22Q) and Flemish (A21G) mutations in the betaAPP region of the amyloid precursor protein (APP) are associated with familial forms of Alzheimer dementia. However, patients with these mutations express substantially different clinical phenotypes. Therefore, secondary structure and cytotoxic effects of the three Abeta(12-42) variants [wild-type (WT), Dutch and Flemish] were tested. At a concentration of 5 microM the aggregation of these peptides followed the order: Abeta(1-42) WT > Abeta(12-42) WT > Abeta(12-42) Flemish > Abeta(12-42) Dutch. The stability of the secondary structure of these peptides upon decreasing the trifluoroethanol (TFE) concentration in the buffer was followed by circular dichroism measurements. WT peptides progressively lost their alpha-helical structure; this change occurred faster for both the Flemish and Dutch peptides, and at higher percentages of TFE in the buffer, and was accompanied by an increase in beta-sheet and random coil content. Apoptosis was induced in neuronal cells by the Abeta(12-42) WT and Flemish peptides at concentrations as low as 1-5 microM, as evidenced by propidium iodide (PI) staining, DNA laddering and caspase-3 activity measurements. Even when longer incubation times and higher peptide concentrations were applied the N-truncated Dutch peptide did not induce apoptosis. Apoptosis induced by the full length Abeta(1-42) peptide was weaker than that induced by its N-truncated variant. These data suggest that N-truncation enhanced the cytotoxic effects of Abeta WT and Flemish peptides, which may play a role in the accelerated progression of dementia.

[A comprehensive form for the standardized characterization of transgenic rodents: genotype, phenotype, welfare assessment, recommendations for refinement]

When "creating" transgenic mouse strains it is not possible to predict their phenotype with certainty, particularly not with respect to welfare. The generation of models for (human) diseases deliberately implies a compromised health ranging from minor (clinically inapparent) to lethal. To ensure animal welfare requirements and apply the criteria of the 3R, a careful phenotype characterisation and welfare assessment has to be done routinely for each newly produced strain, at individual and strain level, starting by the standardised monitoring of founders and their consequent generations. A comprehensive form has been developed for a standardised characterisation of transgenic mouse strains. It is subdivided into basic and detail information. It can be kept up to date continuously in the form of a computerised database, incorporating growing knowledge and experience of the strain. Basic information mainly serves the requirements of housing and breeding facilities as well as the authorities in view of animal welfare measures, detail information mainly serves the interests of research and efficiency.