Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression

OBJECTIVE

Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders.

METHOD

Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility.

RESULTS

Vignettes were assessed by 280 clinicians; 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization.

CONCLUSION

Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.

Kiyoteru Tokuyasu: a pioneer of cryo-ultramicrotomy

In July 2015 Professor K.T. Tokuyasu passed away in San Diego giving us the opportunity to reflect on the contribution this electron microscopist made to the field of immunocytochemistry. His work provided a sensitive, minimally invasive approach to producing thin sections of biological material for labeling with antibodies. His approach has been applied to a wide range of biological applications and provided important information on cellular processes.

Abstract B33: CRLX101, an investigational nanoparticle-drug conjugate, localizes in human tumors and not in adjacent healthy tissue after intravenous dosing

Background: Nanoparticle-based therapeutics are thought to rely on the enhanced permeability and retention effect to preferentially localize in solid tumors and not healthy tissue. These phenomena are rationalized primarily from animal models of the human disease. There is a need to obtain analogous information from humans in order to better understand how nanoparticle-based therapeutics perform in humans. CRLX101 is an investigational nanoparticle drug conjugate (NDC) consisting of a cyclodextrin-containing polymer (CDP) conjugate of the payload camptothecin (CPT). The individual polymer strands self-assemble into nanoparticles (ca. five strands) of approximately 10 to 40 nm diameter and 10 wt% CPT by multiple, interstrand, inclusion complex formation between the cyclodextrin and the CPT molecules. CRLX101 is currently being investigated in phase II trials in patients with renal, ovarian and rectal cancer.

Methods: A phase I clinical trial was performed with CRLX101 at the City of Hope, in patients with advanced or metastatic stomach, gastroesophageal or esophageal cancer. This study was sponsored by City of Hope Medical Center, and funding and CRLX101 was provided by Cerulean Pharma Inc. (ClinicalTrials.gov identifier: NCT01612546). The goal of this study was to test the hypothesis that intact CRLX101 nanoparticles deposit in human tumors and not in normal adjacent tissue after intravenous administration. Tumor and adjacent healthy tissue biopsies were obtained through endoscopic capture from patients who received CRLX101, and analyzed via a number of methodologies.

Results: Both the pre- and post-dosing, healthy tissue samples adjacent to tumors show no evidence of either the NDC or the payload (CPT) contained within the NDC. Similar results are obtained from the pre-dosing tumor samples. However, in 8 of 9 patients that were evaluated, CPT is detected in the tumor tissue by fluorescent microscopy examination of fixed sections. For 3 of these patients, proof of intact CRLX101 NDC is obtained from tissue sections by colocalized, fluorescence from the CPT and a secondary antibody used to stain a PEG specific antibody (binds to the PEG in CRLX101). Following fluorescence imaging, remaining tissues from 3 patients were homogenized and measured for free and CDP conjugated CPT using HPLC. CPT was present in the post-treatment tumor tissue of all 3 patient samples with an average of 96.2±13.1% in the conjugated form, indicating that CRLX101 NDCs are localized in these samples.

Conclusions: Tumor and adjacent healthy tissue biopsies obtained from cancer patients who have received CRLX101show that these NDCs do localize in human tumors and not in adjacent tissues.

Citation Format: Andrew Clark, Devin T. Wiley, Jonathan E. Zuckerman, Paul Webster, Joseph Chao, James Lin, Yun Yen, Mark E. Davis, Scott Eliasof. CRLX101, an investigational nanoparticle-drug conjugate, localizes in human tumors and not in adjacent healthy tissue after intravenous dosing. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr B33.

Oxytocin is unequally distributed in a bag of normal saline--true or false?

Oxytocin infusion used in labour can sometimes be left hung on the stand for many hours. There has been no study to determine if oxytocin is equally distributed throughout the infusion bag and if the distribution stays the same with time. We postulated that there may be settling of the molecules such that oxytocin concentrates at the bottom of the infusion bag. Eight infusion bags were prepared by mixing 10 IU of oxytocin in 1 litre of normal saline. The infusion bags were hung on infusion stands for 8 hours after which 10 samples of 100 mls of the solution from each bag were taken in different containers and the concentration of oxytocin calculated using oxytocin specific Enzyme Immunoassay (EIA) in the different samples. No statistically significant correlation between the oxytocin concentration and the sample number was observed (p-value = 0.738). There was no obvious relationship between oxytocin concentration and the sample number in each bag. There was no evidence to suggest that a linear oxytocin concentration gradient develops in a bag of normal saline over an 8-hour period. In fact the distribution appears to be random and unequal.