Psychometric Validation of the Edmonton Symptom Assessment System in Chinese Patients

CONTEXT

The Edmonton Symptom Assessment System is a simple and widely used questionnaire to assess patient symptoms.

OBJECTIVES

We aimed to develop and verify a Chinese version of the Edmonton Symptom Assessment System (C-ESAS) for use with Chinese patients.

METHODS

Two hundred ten patients were surveyed in the Department of Gastroenterology of Xinqiao hospital in southwest China. Patients completed the C-ESAS and the Chinese version of the M. D. Anderson Symptom Inventory to assess internal consistency, test-retest reliability, and concurrent validity of the C-ESAS. The questionnaires were completed again two hours later.

RESULTS

The C-ESAS demonstrated acceptable internal consistency (Cronbach α = 0.72). This indicated that no question had an inappropriate effect on the score. Pearson correlation coefficients for the C-ESAS symptom scores between baseline and after two hours ranged from 0.47 (95% CI, 0.35-0.89) to 0.92 (95% CI, 0.57-0.94), indicating strong test-retest reliability. The corresponding Chinese version of the M. D. Anderson Symptom Inventory symptom scores ranged from 0.66 (95% CI, 0.58-0.95) to 0.96 (95% CI, 0.73-0.97), indicating good concurrent validity. The average time to complete the C-ESAS differed according to patient education level.

CONCLUSION

The C-ESAS is a good tool for measuring multidimensional symptoms in Chinese patients.

Abstract AS20: DNA-PKcs is amplified in high grade serous ovarian cancer (HGSC), correlates with poor outcome and drives resistance to platinum therapy via the AKT signaling pathway

High grade serous ovarian cancer is typified by p53 mutation, high degrees of genomic instability and the development of chemo-resistance. Genomic translocations result from incorrectly repaired DNA double strand breaks (DSBs). DNA-PKcs is a central catalytic component of the error prone non-homologous end joining (NHEJ) DSB repair mechanism. We report here that DNA-PKcs is frequently amplified in copy number in HGSC and that amplification correlates with higher DNA-PKcs gene expression and poorer patient outcome (PFS/OS) using both in-house and publicly available datasets (TCGA). Targeting DNA-PKcs, pharmacologically or by RNAi, enhances apoptosis in response to platinum treatment in platinum resistant cell lines and primary models. Furthermore we report that inhibition of DNA-PK restores response to cisplatin in chemoresistant ovarian cancer cells in vivo. SKOV-3 tumor xenografts were implanted subcutaneously into Balb/c Nu/Nu mice and treated with DNA-PKcs inhibitor NU7441 for 2 weeks alone or in combination with cisplatin. DNA-PK inhibition or cisplatin treatment alone were ineffective however in combination they decreased tumor growth at 14 days by 90%, relative to platinum only treatment. On investigating the mechanism of DNA-PKcs mediated chemoresistance we revealed that, in response to DNA damage, DNA-PKcs phosphorylates AKT on serine residue 473 in the nucleus of platinum resistant ovarian tumor cells, but not sensitive cells from the same patient. Phosphorylation at AKT threonine 308 is unaffected and DNA-PK inhibition does not interfere with insulin-mediated phosphorylation of AKT S473. DNA-PK mediated AKT activation in chemoresistant cells results in inhibitory phosphorylation of the pro-apoptotic protein BAD and stabilisation of the anti-apoptotic Bcl-2 protein resulting in the observed attenuation of apoptotic response to platinum treatment. DNA-PK inhibition is an attractive therapeutic strategy for resensitising resistant tumors to platinum based therapy, directly linking the DNA damage caused by platinum to the pro-survival AKT pathway, without interfering with normal physiological roles of AKT.

Citation Format: Curry E, Cheraghchi-Bashi-Astaneh A, Chen M, Cunnea P, De Sousa C, Maginn E, Dai Y, Liu E, Wasan H, Mills G, Bowtell D, Gabra H & Stronach EA. DNA-PKcs is amplified in high grade serous ovarian cancer (HGSC), correlates with poor outcome and drives resistance to platinum therapy via the AKT signaling pathway [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr AS20.

Patients' and Family Members' Decision-Making and Information Disclosure Preferences in a Single-Center Survey in China: A Pilot Study

BACKGROUND

Understanding the medical decision-making and information disclosure preferences is important for care quality.

OBJECTIVES

To examine the feasibility of using the questionnaires and to identify modifications needed in the following study.

DESIGN

Thirty-three pairs of patients with advanced cancers and their caregivers were asked to complete the questionnaires.

RESULTS

More than 60% of patients and caregivers had an educational level of middle school and below. The active, passive, or shared decision-making preferences for patients were 33.3%, 39.4%, and 27.3%, respectively. Twenty of 33 patients and 24 of 33 caregivers misunderstood the questions.

CONCLUSIONS

Low educational levels may be the reason for poor understanding imprecision. It is necessary to use the modification version of the questionnaires in developing countries.

Review of critical incidents in a university department of anaesthesia

In 2011, our hospital started a new system of 100% procedural audit of anaesthesia work, in which we incorporated the reporting of critical incidents. This monitoring of critical incidents has enabled identification of the spectrum of incidents and risk factors and helped in the education of trainees and specialists. In this review, we analyse 379 incidents that had been reported among 44,915 anaesthetics administered in a two-year period. The risk of incidents was higher in patients of lower American Society of Anesthesiologists physical status, anaesthesia of long duration and anaesthesia carried out after-hours. The most common incidents were airway problems and drug administration problems. Fifty-nine percent of incidents were evaluated to be preventable and adverse outcomes occurred in 48% of cases. Human factors were the major contributors to incidents. We suggest that incorporating critical incident reporting as part of a 100% procedural audit facilitated, rather than discouraged, the reporting of critical incidents, even though reporting was not anonymous. The rate of incident reporting increased from 0.37% to 0.84%.

Hepatocyte growth factor (HGF) upregulates heparanase expression via the PI3K/Akt/NF-κB signaling pathway for gastric cancer metastasis

Heparanase (HPA) is an endoglucuronidase that can promote the shedding of associated cytokines in several types of tumors. However, little is known about what controls the expression of HPA or its role in gastric cancer. In this study, we report for the first time that HGF regulates HPA expression to promote gastric cancer metastasis. In this study, HGF and HPA were found to be significantly expressed in 58 gastric cancer patients. High expression of both HGF and HPA was positively associated with TNM stage, invasion depth and poor prognosis. In MKN74 cells, exogenous HGF significantly increased HPA expression at both the mRNA and protein levels. Further study revealed that HGF first activated PI3K/Akt signaling. NF-κB signaling was activated downstream of PI3K/Akt and promoted HPA expression. However, when c-met, PI3K/Akt or NF-κB signal inhibitors were used, HPA expression was significantly decreased. All of these results indicate that HGF regulates HPA expression by PI3K/Akt and downstream NF-κB signaling. Using bioinformatics and the ChIP assay, p65 was observed to bind to the HPA promoter. Furthermore, HGF significantly induced tumor cell migration, whereas treatment with an NF-κB inhibitor decreased migration. Moreover, when HPA was overexpressed in MKN74 cells, migration was significantly enhanced, and the HGF concentration was increased. However, when HPA was down-regulated in MKN45 cells, migration and HGF levels decreased. Together, these results demonstrate that HGF/c-met can activate PI3K/Akt and downstream NF-κB signaling to promote HPA expression and subsequent tumor metastasis.

Low temperature and deformation-free bonding of PMMA microfluidic devices with stable hydrophilicity via oxygen plasma treatment and PVA coating

A deformation-free bonding method with stable hydrophilicity in PMMA devices has been proposed through oxygen plasma treatment and PVA coating.

Copper-catalyzed synthesis of aryldiazo sulfones from arylhydrazines and sulfonyl chlorides under mild conditions

A simple and effective procedure for the preparation of aryldiazo sulfones by Cu-catalyzed sulfonylation/dehydrogenation is presented.

[Stand density estimation based on the measurement of spatial structure]

This study estimated stem density by combining distance sampling with stand spatial structure investigation techniques. We tested the statistical performance of two investigative methods (selecting the fourth- or sixth-nearest tree to the sample location) and three different density estimators (Prodan, Persson and Thompson). Different spatial distribution patterns influenced the performance of these estimators. Prodan's estimator was unbiased for uniform patterns, and it produced increasing bias with increasing spatial clustering. Persson's estimator produced consistent positive bias for uniform and random patterns, with the smallest bias for clustered patterns. Thompson's estimator was robust for random or near-random patterns, and it produced positive and negative bias for uniform and clustered patterns, respectively. No significant performance difference was found between selecting the fourth- and the sixth-nearest trees with the same sample size of 49. Thus, we could combine distance sampling with spatial structure investigation techniques.

Using rifapentine - hen egg lipoprotein conjugate as macrophage-targeted drug delivery carrier against intracellular Staphylococcus aureus

CONTEXT

Hen egg low-density lipoprotein (heLDL), which is present in large quantities in egg yolk, share a high identity with human apolipoprotein B-100 precursor.

OBJECTIVE

This study investigated the use of heLDL as a macrophage-targeted drug delivery carrier against intracellular Staphylococcus aureus.

METHODS

Rifapentine (RPT) was incorporated into heLDL (RPT-heLDL). Staphylococcus aureus ATCC 29740 and human U937 macrophage were used as intracellular infection models.

RESULTS AND CONCLUSION

The loading efficiency of RPT into the heLDL was 66.10 ± 2.28 μg RPT/mg heLDL. Fluorescence microscopy and oil red O staining results indicated RPT-heLDL can be taken up by U937 macrophages. The cell viability (MTT assay) was increased when the concentration of heLDL was <150 μg/mL. Unloaded heLDL (100 μg/mL) can inhibit the growth of intracellular S. aureus compared with the untreated control group after 18 h incubation. RPT-heLDL (6.6 μg/mL RPT, 100 μg/mL heLDL) eliminated 94% of intracellular S. aureus, whereas the corresponding dose of free RPT (6.6 μg/mL) induced an 87% reduction. The in vitro results of the current study indicated that heLDL might be used as a suitable drug carrier for targeting human macrophages.

Clinical study of treatment switching from premixed insulin to basal insulin combined with oral hypoglycemic drugs in patients with type 2 diabetes

AIM

Premixed insulin regimens are commonly used for the treatment of patients with type-2 diabetes mellitus (T2DM). However, limited data are available regarding next-step therapy options in cases where premixed insulin fails to provide adequate glycemic control. This 20-week observational study of everyday clinical practice evaluated the efficacy, safety and treatment satisfaction of insulin glargine plus oral anti-diabetic drugs (OADs) in T2DM patients previously treated with premixed insulin.

METHODS

In this open-label, single-arm, 20-week study, 70 subjects with T2DM inadequately controlled with premixed insulin were switched to insulin glargine plus OADs. Changes in glycaemic control, incidence of hypoglycaemia, treatment satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ), serum superoxide dismutase (SOD), and serum 8-iso-prostaglandin (8-iso-PG) were evaluated at the start and the end of the study.

RESULTS

Over the 20 week treatment period, mean (±SD) HbA1c levels decreased from 8.28 ± 1.24% to 6.83 ± 1.09%, mean (±SD) FBG levels decreased from 7.64 ± 1.36 mmol/L to 5.57 ± 1.21 mmol/L, and 2 h PBG levels decreased from 12.07 ± 1.17 mmol/L to 8.94 ± 1.56 mmol/L, all P < 0.001. A total of 3 symptomatic hypoglycemic episodes were reported. No significant reductions in body weight were observed. The mean daily dose of insulin decreased by 14 U between week 0 (30.20 ± 9.93 U) and week 20 (16.38 ± 5.15 U). The total treatment satisfaction score showed a significant increase from study baseline to end point. Significant increases in SOD(90.00 ± 16.62 to 108.81 ± 27.02 u/ml, P < 0.01) and reductions in 8-iso-PG(2.15 ± 0.61 to 1.64 ± 0.42 pg/ml, P < 0.05) were observed between the start and end of the observation period. There were significant differences in baseline HbA1c, duration of diabetes, and baseline postprandial C-peptide between the A1c ≤ 6.5% group and the A1c > 7.0% group [HbA1c: 7.25% ± 1.02% vs. 9.32% ± 1.23%; duration: 7.84 ± 1.02 vs. 13.96 ± 1.35 years; postprandial C-peptide: 4.83 ± 2.11 vs 2.54 ± 0.87 nmol/L, all P < 0.05].

CONCLUSIONS

The observational study shows that, in T2DM patients inadequately controlled with premixed insulin, switching therapy to glargine plus OADs is associated with significant improvements in glycaemic control and treatment satisfaction, and is with low incidence of hypoglycemia. Baseline postprandial C-peptide, HbA1c, and duration of diabetes are the key factors closely related to efficacy of this treatment regimen.

Association between illness progression measures and total cost in Alzheimer's disease

OBJECTIVE

To compare the associations between dependence and clinical measures of cognition, function and behaviour and total care cost using data from a longitudinal study in Alzheimer's disease (AD).

DESIGN

Longitudinal, observational study.

SETTING

Community-dwelling subjects.

PARTICIPANTS

Male and female subjects between 50 and 85 years of age with mild to moderate AD.

INTERVENTION

None.

MEASUREMENTS

Subject dependence was assessed using the Dependence Scale (DS), cognition (ADAS-Cog, MMSE), function (DAD), behaviour (NPI) and resource utilization with the Resource Utilization in Dementia Questionnaire.

RESULTS

The repeated measures models confirmed a significant association between the DS and total care cost indicating an increase in cost with increasing dependence. A 1-unit increase in DS score was associated with a 28.60% increase in total care cost. Model 2 indicated that a one point change in MMSE, DAD and NPI is associated with 5.29%, 2.32% and 1.71% increase in total cost, respectively. Model 3 indicated that a one point change in ADAS-Cog, DAD and NPI is associated with a 1.74%, 2.42%and 1.62% increase in total cost, respectively.

CONCLUSION

Strategies which prevent deterioration in clinical measures or delay dependence should result in total cost savings. The quantitative relationships observed should assist in the economic assessment of interventions which effect cognition, function, behaviour and dependence.