ON-ICE trial: Investigation of the combined effects of oxytocin and naltrexone on stress-induced and alcohol cue-induced craving in alcohol use disorder-Study protocol of a phase II randomised double-blind placebo-controlled parallel-group trial

INTRODUCTION

Although alcohol dependence (AD) is highly prevalent, only few medications are approved for its treatment. While currently approved medications, such as naltrexone (NTX), reduce craving and relapse risk to a certain extent, new approaches are needed to complement these pharmaca. One potential compound is oxytocin (OXY), which proved beneficial effects on alcohol craving and stress reactivity in preliminary clinical studies and synergism with NTX effects.

METHODS AND ANALYSIS

This clinical phase II trial is a monocentre two-armed, placebo (PLC)-controlled, 1:1 randomised, double-blind, parallel-group study. 62 participants with AD will be randomised to receive either intranasal OXY spray (24 IU) or PLC spray plus oral NTX (50 mg) for 2 days, and alcohol craving will be assessed using a validated combined stress-exposure and cue-exposure experiments and MRI. The primary outcome will be the intensity of alcohol craving, assessed using the Alcohol Urge Questionnaire (AUQ), 60 min after OXY/PLC application, directly after the stress and cue exposures. Secondary outcomes include subjective stress, negative affect, cortisol and OXY plasma levels, and neural response to alcohol and emotional cues and natural rewards. Follow-up drinking data were collected over 90 days. The primary efficacy analysis will test the difference between the verum and the PLC group in the distribution of AUQ craving scores. Appropriate statistical analysis will be used for the evaluation of the secondary outcomes.

ETHICS AND DISSEMINATION

This trial has been approved by the ethics committee of Heidelberg University and competent authority. All participants in the trial will provide written informed consent. The study will be conducted according to the principles of the Declaration of Helsinki and in accordance to the German Medicinal Products act. Results of this study will be disseminated in peer-reviewed scientific journals and deidentified data, and the statistical analysis plan will be made available via open-access online repositories.

TRIAL REGISTRATION NUMBERS

EudraCT 2021-003610-40 and NCT05093296.

Bilateral Implantation of a New Refractive Multi-Segmented Multifocal Intraocular Lens in Cataract or Refractive Lens Exchange Patients

Purpose

To evaluate the safety and efficacy of a new multi-segmented refractive multifocal intraocular lens (IOL) after phacoemulsification and refractive lens exchange (RLE).

Patients and Methods

In this prospective, multicenter clinical trial, 63 presbyopic subjects who had cataract or where RLE candidates were bilaterally implanted with the Precizon Presbyopia IOL (Ophtec BV, Groningen, the Netherlands) after phacoemulsification. The study was conducted at 6 clinical centers in Germany, the Netherlands, Belgium, Turkey and Spain. Subjects were evaluated at baseline and at 1 day, 1 week, 1 and 3 months postoperatively for monocular and binocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), uncorrected (UNVA), corrected (CNVA) and distance-corrected near visual acuity (DCNVA), contrast sensitivity and quality of vision.

Results

Three months postoperatively, binocular UDVA and CDVA of ≥20/40 was achieved in 98.4% (60/61) and 100%, respectively. Binocular UIVA and DCIVA of ≥20/40 was achieved in 96.7% (59/61) and 93.4% (57/61) respectively. Binocular UNVA, CNVA and DCNVA of ≥20/40 was achieved in 93.4% (57/61), 98.4% (60/61) and 95% (57/60) subjects, respectively. Complete spectacle independence was achieved in 80% (49/61) patients; 93% of patients reported that they were quite or very satisfied with the outcomes of the procedure.

Conclusion

Precizon Presbyopia IOL implantation is a safe and effective method to provide good visual acuity at all distances in presbyopic and cataract patients.

Comparison of a new image-guided system versus partial coherence interferometry, Scheimpflug imaging, and optical low-coherence reflectometry devices: Keratometry and repeatability

PURPOSE

To determine the repeatability of keratometry of the Verion image-guided system and to compare the keratometry (K) values with those of established biometric devices.

SETTING

International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

DESIGN

Prospective case series.

METHODS

One randomly chosen eye of volunteers was examined with partial coherence interferometry (PCI) (IOLMaster 500), optical low-coherence reflectometry (OLCR) (Lenstar LS 900), a Scheimpflug device (Pentacam HR), and the new image-guided system by the same examiner. None of the eyes had ocular pathology. Three consecutive measurements were performed with the image-guided system and 1 with the other devices. The flat, steep, and average corneal radii; steep axis; and white-to-white (WTW) distance were analyzed and compared.

RESULTS

One hundred twenty-three eyes of 123 volunteers (mean age 37.9 years ± 16.2 [SD]) had valid measurements for all examinations and were available for analysis. The image-guided system measured statistically significant smaller flat, steep, and average corneal radii than the Scheimpflug device, statistically significant larger flat and average corneal radii than the PCI device, and no statistically significant different values than the OLCR device. The measured steep axis did not differ significantly in any comparison. The WTW measurements were significantly higher than those of all other devices. The analysis of repeatability of the image-guided system showed high intraclass correlation coefficients (range 0.919 to 0.997).

CONCLUSIONS

The new image-guided system had high repeatability for K, steep axis, and WTW measurements. The WTW measurements with the image-guided system were significantly higher than those using the other devices.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

Clinical outcomes after implantation of a toric intraocular lens with a transitional conic toric surface

PURPOSE

To evaluate the postoperative outcomes after implantation of a hydrophilic toric intraocular lens (tIOL) with a transitional conic toric surface in patients with astigmatism undergoing refractive lens exchange (RLE) or cataract surgery.

METHODS

In this monocentric study, clinical outcomes following implantation of the hydrophilic Precizon toric IOL model 565 (Ophtec) were analysed. For intraoperative axis alignment, the Verion Image Guided System was used. Intended versus achieved refraction, IOL position, visual acuity outcomes and power vector analyses were evaluated 3 months postoperatively.

RESULTS

Forty-three eyes of 28 patients (40 eyes cataract, 3 eyes RLE) received a Precizon toric IOL with a cylindrical power between 1.0 and 7.5 D. Target refraction was emmetropia except for four eyes that had a myopic target. The median postoperative IOL rotation at slit lamp was 3° with a range from 0° to 16°. Uncorrected distance visual acuity (UDVA) increased from median 0.5 logMAR preoperatively to median 0.06 logMAR at 3 months postoperatively. Corrected distance visual acuity increased from 0.20 to -0.02 logMAR. Median preoperative subjective cylinder was 1.5 D and 3 months postoperatively 0.25 D.

CONCLUSION

Preoperative diagnostics, IOL selection and correct intraoperative positioning of tIOLs are essential for good outcomes and postoperative spectacle independence following cataract or RLE surgery. Visual acuities and rotational stability of the Precizon toric IOL showed very good outcomes and the subjective postoperative astigmatism could be reduced significantly.

A Supernova at 50 pc: Effects on the Earth's Atmosphere and Biota

Recent 60Fe results have suggested that the estimated distances of supernovae in the last few million years should be reduced from ∼100 to ∼50 pc. Two events or series of events are suggested, one about 2.7 million years to 1.7 million years ago, and another about 6.5-8.7 million years ago. We ask what effects such supernovae are expected to have on the terrestrial atmosphere and biota. Assuming that the Local Bubble was formed before the event being considered, and that the supernova and the Earth were both inside a weak, disordered magnetic field at that time, TeV-PeV cosmic rays (CRs) at Earth will increase by a factor of a few hundred. Tropospheric ionization will increase proportionately, and the overall muon radiation load on terrestrial organisms will increase by a factor of ∼150. All return to pre-burst levels within 10 kyr. In the case of an ordered magnetic field, effects depend strongly on the field orientation. The upper bound in this case is with a largely coherent field aligned along the line of sight to the supernova, in which case, TeV-PeV CR flux increases are ∼104; in the case of a transverse field they are below current levels. We suggest a substantial increase in the extended effects of supernovae on Earth and in the "lethal distance" estimate; though more work is needed. This paper is an explicit follow-up to Thomas et al. We also provide more detail on the computational procedures used in both works.

[Duration of Examination and Patient Comfort with a New Biometric Device, in Comparison to Three Established Devices]

PURPOSE

The aim of this study was to evaluate the duration of the preoperative examination and patient comfort in measurements with an Image Guided System (Verion, Alcon), which is used for the calculation and intraoperative alignment of toric intraocular lenses, in comparison to established keratometry devices.

PATIENTS AND METHODS

In a prospective, monocentric, open, ethics committee controlled study, 150 eyes of 150 ophthalmologically healthy volunteers were examined by a single examiner. Three measurements were performed with the Verion Image Guided System and - for comparison - one measurement each with IOLMaster 500, Lenstar LS900 and Pentacam HR. The measurement time was recorded with a stopwatch. For the analysis, patients were divided into three age groups (young, middle, old). Patient comfort was assessed using a questionnaire, which focussed on grading the whole measurement, as well as brightness of light, head posture and subjective duration.

RESULTS

The mean age of the volunteers was 40.5 years (18-78 years). The mean duration of measurement was as follows: first Verion measurement 54.0 ± 42.7 seconds (n = 149), second Verion measurement 42.0 ± 20.5 s (n = 144), third Verion measurement 44.7 ± 25.2 s (n = 143), IOLMaster 500 46.3 ± 22.4 s (n = 147), Lenstar LS900 46.6 ± 14.4 s (n = 146) and Pentacam HR 46.6 ± 25.5 s (n = 147). Only the first and second Verion measurements were statistically different (p < 0.01). There were no statistical differences between the age groups, with the single exception of young versus old with the Pentacam (p < 0.01). Subjective patient comfort (n = 143) was very high for all devices and rated as "not uncomfortable" or "slightly uncomfortable".

CONCLUSION

The duration of the preoperative examination with the Verion Image Guided System is comparable to established keratometry devices. However, IOL calculation with the Verion requires measurement of axial length and anterior chamber depth with another biometric device, which requires additional time. No age dependent differences were found. The examination can be easily integrated into clinical routine and is well tolerated by patients.

TERRESTRIAL EFFECTS OF NEARBY SUPERNOVAE IN THE EARLY PLEISTOCENE

Recent results have strongly confirmed that multiple supernovae happened at distances of ∼100 pc, consisting of two main events: one at 1.7-3.2 million years ago, and the other at 6.5-8.7 million years ago. These events are said to be responsible for excavating the Local Bubble in the interstellar medium and depositing 60Fe on Earth and the Moon. Other events are indicated by effects in the local cosmic ray (CR) spectrum. Given this updated and refined picture, we ask whether such supernovae are expected to have had substantial effects on the terrestrial atmosphere and biota. In a first look at the most probable cases, combining photon and CR effects, we find that a supernova at 100 pc can have only a small effect on terrestrial organisms from visible light and that chemical changes such as ozone depletion are weak. However, tropospheric ionization right down to the ground, due to the penetration of ⩾TeV CRs, will increase by nearly an order of magnitude for thousands of years, and irradiation by muons on the ground and in the upper ocean will increase twentyfold, which will approximately triple the overall radiation load on terrestrial organisms. Such irradiation has been linked to possible changes in climate and increased cancer and mutation rates. This may be related to a minor mass extinction around the Pliocene-Pleistocene boundary, and further research on the effects is needed.

[Influence of corneal pachymetric changes on functional results after cataract surgery]

BACKGROUND

In the early postoperative period following uncomplicated cataract surgery, the correlation of corrected distance visual acuity (CDVA) and the increase in corneal thickness and anterior chamber depth (ACD) are investigated.

PATIENTS AND METHODS

A total of 54 cataract patients with a mean age of 70 ± 8.4 years were included in this prospective study. Surgery was carried out on one eye of each patient according to the study protocol. Refraction, CDVA and ACD were evaluated 1 day and 1 week postoperatively and compared with the pachymetry results measured with the Pentacam.

RESULTS

The mean postoperative CDVA significantly improved from 0.31 ± 0.24 logMAR to 0.18 ± 0.22 logMAR after one day and up to 0.06 ± 0.13 logMAR one week after surgery (p < 0.05). The mean spherical equivalent was - 0.52 ± 0.69 D after one day and - 0.50 ± 0.82 D one week after surgery and showed only minimal differences compared to the mean target refraction of - 0.39 ± 0.70 D. Postoperative corneal thickness showed a significant increase compared to the preoperative results (p < 0.05) on both visits: the mean difference was 33.26 ± 50.20 µm (- 17 to 315 µm) on the first day and 20.22 ± 23.15 µm (- 10 to 99 µm) one week after surgery. Up to 7 days postoperatively the increase in corneal thickness and CDVA showed only moderate or no correlations (r = 0.465 vs. r = 0.072, respectively). Regarding pachymetry and ACD values, no or only low correlations were found.

CONCLUSION

The significant increase in corneal thickness on the first and seventh day shows no to moderate correlation to the CDVA. Nevertheless, a good and early rehabilitation of visual acuity following uncomplicated cataract surgery is possible. Intraocular pressure measurement can lead to false high results due to an increase in corneal thickness.

[Functional results after implantation of an aspheric, aberration-neutral intraocular lens]

PURPOSE

The aim of this study was to perform a clinical evaluation of the functional results and quality of vision after implantation of an aspheric, aberration-neutral, monofocal intraocular lens (IOL).

PATIENTS AND METHODS

47 eyes of 34 patients (median age: 68 years) with cataract were enrolled in this prospective clinical study that had Ethics Committee approval. The C-flex or Superflex aspheric IOL (Rayner, UK) was implanted after phacoemulsification. Follow-up examinations were performed two to four months after surgery including subjective refraction, ETDRS uncorrected (UDVA) and corrected distance visual acuity (CDVA), wavefront analysis, analysis of stray light (C-Quant), contrast sensitivity under different lighting conditions (F. A. C. T.) and a questionnaire.

RESULTS

Two to four months after surgery, median UDVA was 0.08 logMAR (range: 0.64 to - 0.18 logMAR, n = 41). Median CDVA increased from 0.30 logMAR (range: 1.00 to - 0.02 logMAR) preoperatively to - 0.08 logMAR (range: 0.16 to - 0.22 logMAR) postoperatively (n = 47). Median difference between achieved vs. intended (Holladay 1-formula) spherical equivalent was + 0.06 D (range: - 1.06 to + 0.87 D). Median total HOA RMS (6 mm pupil size) was 0.66 µm (range: 0.41 to 1.19 µm). The median spherical aberrations were - 0.36 µm (range: - 0.70 to - 0.17 µm). Analysis of stray light (C-Quant) revealed a median value of 1.21 log(s) (range: 0.79 to 1.57 log[s]).

CONCLUSION

The C-flex and Superflex aspheric IOLs provide good and predictable functional results. Patients are not negatively influenced by stray light and show slightly negative spherical aberrations.

Identification of pathologically insignificant prostate cancer is not accurate in unscreened men

Background:

Identification of men harbouring insignificant prostate cancer (PC) is important in selecting patients for active surveillance. Tools have been developed in PSA-screened populations to identify such men based on clinical and biopsy parameters.

Methods:

Prospectively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre. Tumour volume was assessed by pathological examination. For each tool, receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared. Comparison of accuracy in screened and unscreened populations was performed.

Results:

Of 848 patients, 415 had Gleason 3+3 disease on biopsy. Of these, 32.0% had extra-prostatic extension and 50.2% were upgraded. One had positive lymph nodes. Two hundred and six (24% of cohort) were D'Amico low risk. Of these, 143 had more than two biopsy cores involved. None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden. Accuracy is low in PSA-screened and -unscreened populations.

Conclusions:

In our unscreened population, tools designed to identify insignificant PC are inaccurate. Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy.

The influence of distress on knowledge transfer for men newly diagnosed with prostate cancer

The purpose of this inquiry was to evaluate the efficacy of prostate cancer education sessions. Implementation of 3-h patient educational sessions was intended to provide men newly diagnosed with localized prostate cancer, who face difficult and complex decisions, information about potential treatment options. Fifty-seven men completed the distress thermometer assessment before the education session to assess baseline levels of distress. Seven of the men were interviewed post-educational session to determine the degree of knowledge transfer from the session. This study explored the efficacy of the patients' learning experience using an interpretive phenomenological research approach. Resulting data revealed that these patients, as adult learners, were distressed and that, despite the availability of pertinent medical content, the subject material was not learned as intended or readily understood. The conclusion drawn from this preliminary applied educational research study was that the education model used was less than efficacious at ensuring that sufficient knowledge transfer was achieved for medical treatment decision-making processes. These findings suggest a need for future research to explore the application of adult learning theories and approaches that may offer enhanced knowledge translation and transfer for prostate cancer education programs.

Ocular outcome and frequency of neurological manifestations in patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

PURPOSE

The purpose of this study was to describe the visual prognosis as well as the frequency and clinical severity of central nervous system involvement in all acute posterior multifocal placoid pigment epitheliopathy (APMPPE) patients of one centre.

METHODS

A retrospective database review of all patients and a prospective clinical, ophthalmological and neurological follow-up, if possible, were conducted.

RESULTS

Eighteen patients with APMPPE were included with a mean follow-up of 17.1 months. Thirteen patients participated in a follow-up exam. Visual acuity improved in 9 of 18 patients to a mean of 0.17 log minimum angle of resolution (MAR) in the worse eye and remained stable in eight patients (mean, 0.03 logMAR). In the majority of patients, the 30° static perimetry improved at follow-up compared to the initial exams. Still, in up to 50 to 60 %, small visual field defects persisted. Overall, 11 patients (61 %) showed neurologic symptoms of varying severity. The most common neurological symptom was headache in nine (50 %) patients. Other symptoms included paraesthesias, psychosis, vertigo, and, as the most severe complication, stroke due to cerebral vasculitis. Fifteen patients were treated with systemic corticosteroids.

CONCLUSIONS

Visual prognosis is good in patients with APMPPE, but visual field defects may remain. Neurological signs and symptoms, especially headaches, are frequent in APMPPE and should be taken seriously. Adequate investigations including MRI and CSF examination should be initiated in these patients.

Screening for distress can predict loss of follow-up and treatment in cancer patients: results of development and validation of the Distress Inventory for Cancer Version 2

INTRODUCTION

The evidence suggests that in most instances distress from cancer goes unrecognised. There has been substantial work in screening for distress leading to development in practice guidelines recommending screening for distress. There is a need to identify distress early in the continuum, where suitable and timely interventions will benefit the patient. The Distress Inventory for Cancer (DIC) was designed for this.

METHODS

The present study reports the improved psychometric properties of the second version of the DIC (DIC 2). A standardisation sample of 520 patients was administered the 73-item draft questionnaire as well as the Functional Assessment of Cancer Therapy-General (FACT-G). Additional 240 patients were administered Hospital Anxiety and Depression Scale (HADS) besides the final DIC 2 and FACT-G. Internal consistency was measured with the Cronbach's alpha. Chi-square, odds ratio, and binary logistic regression were used to compare the results of three tools and to establish validity.

RESULTS

A principal factor analysis of the 73-item draft questionnaire with varimax rotation in a six-factor structure resulted in 33 items. Activity of daily living emerged as a single item domain. The FACT-G scores negatively correlated with DIC 2 scores, while emotional distress of DIC 2 overlapped with anxiety in HADS. DIC 2 significantly predicted patient non-compliance to treatment and follow-up.

CONCLUSION

The results show a suitable internal consistency, construct, and convergent/divergent validity of the global distress measure (DIC 2). The DIC 2 also demonstrates a predictive function for future negative clinical behaviour, the knowledge of which may facilitate better intervention triage.

An intact connexin N-terminus is required for function but not gap junction formation

The cytoplasmic N-termini of connexins have been implicated in protein trafficking, oligomerization and channel gating. To elucidate the role of the N-terminus in connexin37 (CX37), we studied mutant constructs containing partial deletions of its 23 N-terminal amino acids and a construct with a complete N-terminus in which residues 2-8 were replaced with alanines. All mutants containing nine or more N-terminal amino acids form gap junction plaques in transiently transfected HeLa cells, whereas most of the longer deletions do not. Although wild-type CX37 allowed intercellular transfer of microinjected neurobiotin in HeLa cells and formed conducting hemichannels in Xenopus oocytes, none of the mutant constructs tested show evidence of channel function. However, in coexpression experiments, N-terminal mutants that formed gap junction plaques potently inhibit hemichannel conductance of wild-type CX37 suggesting their co-oligomerization. We conclude that as much as half the length of the connexin N-terminus can be deleted without affecting formation of gap junction plaques, but an intact N-terminus is required for hemichannel gating and intercellular communication.

Cataracts are caused by alterations of a critical N-terminal positive charge in connexin50

PURPOSE

To elucidate the basis of the autosomal dominant congenital nuclear cataracts caused by the connexin50 mutant, CX50R23T, by determining its cellular distribution and functional behavior and the consequences of substituting other amino acids for arginine-23.

METHODS

Connexin50 (CX50) mutants were generated by PCR and transfected into HeLa or N2a cells. Expressed CX50 protein was detected by immunoblot analysis and localized by immunofluorescence. Intercellular communication was assessed by microinjection of neurobiotin or by double whole-cell patch-clamp recording.

RESULTS

HeLa cells stably transfected with CX50R23T or wild-type CX50 produced immunoreactive CX50 bands of identical electrophoretic mobility. Whereas HeLa cells stably expressing CX50 contained abundant gap junction plaques, CX50R23T localized predominantly in the cytoplasm. HeLa cells expressing wild-type CX50 showed large gap junctional conductances and extensive transfer of neurobiotin, but those expressing CX50R23T did not show significant intercellular communication by either assay. Moreover, CX50R23T inhibited the function of coexpressed wild-type CX50. Three CX50R23 substitution mutants (CX50R23K, CX50R23L, and CX50R23W) formed gap junction plaques, whereas two mutant substitutions with negatively charged residues (CX50R23D, CX50R23E) did not form detectable plaques. Only the mutant with a positive charge substitution (CX50R23K) allowed neurobiotin transfer at levels similar to those of wild-type CX50; none of the other mutants induced transfer.

CONCLUSIONS

These results suggest that replacement of amino acid 23 in CX50 by any residue that is not positively charged would lead to cataract formation.

Reliability and validity of the Malayalam hospital anxiety and depression scale (HADS) in cancer patients

BACKGROUND & OBJECTIVE

The hospital anxiety and depression scale (HADS) has been widely used on cancer patients as an indicator of psychological morbidity. Though the scale has been used in India, no reports are available on translation of HADS in any Indian language and testing the reliability. The present study describes the translation process of HADS into Malayalam and testing its reliability and validity on psychological morbidity in cancer patients.

METHODS

The English version of the HADS was translated into Malayalam and was used in this study. The questionnaire was administered to 240 cancer patients and statistical analysis was carried out using Chronbach's alpha to test the internal consistency of the HADS scale while confirmatory factor analysis was carried out using principal axis factoring with equimax rotation and Kaiser Normalization to test its construct validity.

RESULTS

The Cronbach's alpha was found to be 0.81 for the HADS anxiety subscale, 0.71 for the HADS depression subscale, and 0.85 for HADS tool. Confirmatory factor analysis (CFA) indicated two depression items (i.e., enjoyment and anhedonia) loading onto the anxiety subscale. Clinical caseness for anxiety was observed in 8 per cent, while 11 per cent of the patients had borderline mood disorder. Clinical caseness for depression was identified in 7.6 and 13 per cent of patients were found to have borderline mood disturbances.

INTERPRETATION & CONCLUSION

This preliminary validation study of the Malayalam version of the HADS showed it as an acceptable, and reliable measure of psychological morbidity among cancer patients. The prevalence of anxiety and depression in Indian population was low and enjoyment and anhedonia might present as anxiety initially.

FACT-G: reliability and validity of the Malayalam translation

BACKGROUND

Emphasis is currently being placed on the need for quality of life in cancer survivors. There is a great need to identify an appropriate tool for quality of life estimation in these linguistically and culturally different settings.

PATIENTS AND METHOD

The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was translated into the Malayalam language complying with the standard cross-cultural translation methodology. The tool was validated and used for estimating quality of life (QOL) of 214 cancer patients undergoing treatment with curative intent.

RESULTS

Cronbach's alpha for the Malayalam version of the FACT-G was 0.8, and for the subscales it ranged from 0.64 to 0.83, compared to source tool alpha of 0.89, with the subscale's ranging from 0.63 to 0.89. The mean overall FACT-G score was 79.8 (standard deviation [SD] = 18.7). Socio-economic factors such as education, education of the spouse, occupation of the spouse, and family income were found to influence FACT-G scores.

CONCLUSION

Despite cultural variations, the local Malayalam language version of the FACT-G scale was found to be reliable like the source scale and sensitive cross-culturally. The instrument makes it possible to identify domains influencing QOL and thereby may help direct interventions to them.

Psychological distress in cancer patients: hypothesis of a distress model

A substantial body of research suggests links between stress, coping and cancer. Research also implicates the immune system as a link between stressful events and cancer. The current trend in research in the area of psycho-oncology attempts to define the types of stress and coping mechanisms being used in order to identify predictors of psychological distress. Based on the available review of literature, the impact of distress does seem to play a prominent role in the transition from a state of health to that of ill-health or even a terminal event. In the light of these studies, a distress model for the cancer patient has been hypothesized here.

Quality of life in breast cancer patients: validation of a FACT-B Malayalam version

BACKGROUND

Recent advances in diagnosis and treatment of cancer have led to an increase in cancer survival, and hence, there is a greater emphasis on quality beside quantity of survival. Developing countries too have begun to recognize the need for monitoring quality of life (QOL). However, in most of the developing countries, a validated and reliable tool for the purpose is yet to be realized.

MATERIAL AND METHOD

The functional assessment of chronic illness therapy (FACIT) system is a collection of QOL questionnaires targeted to measure QOL in chronic illness. The functional assessment of cancer therapy for breast cancer (FACT-B) was translated into the local language (Malayalam) and tested for validity and reliability.

RESULTS

The tool thus developed showed substantial sensitivity, as does the source tool. The Cronbach's alpha for the total FACT-B was 0.87, which is similar to the alpha of 0.9 observed in the FACT-B English version. The mean FACT-B score was 94.3 compared to 112.8 for the source tool.

CONCLUSION

The Malayalam translation of the FACT-B questionnaire was developed, tested and validated, and was found satisfactory in comparison to the source tool.

Development of a distress inventory for cancer: preliminary results

CONTEXT

Advances in cancer treatment have led to cure and prolongation of patients' lives; however associated psychosocial problems, including distress, can detrimentally affect patients' compliance with treatment and ultimately, their outcome. Symptom distress has been well addressed in many studies; however, psychological distress has only been quantified by using depression or anxiety scales/checklists or quality of life scales containing a distress sub scale/component or by the use of scales that are not psychological distress-specific.

AIMS

The present study is an attempt to construct a psychological distress inventory for specific use with cancer patients.

SETTINGS AND DESIGN

The standardisation sample consisted of 63 randomly selected patients with head and neck cancer who had undergone/ were undergoing curative treatment at the Regional Cancer Centre, Trivandrum.

PATIENTS AND METHODS

The Distress Inventory for Cancer contained 57 positively and negatively toned items. An item analysis was conducted, followed by a factor analysis, thereby identifying the domains influencing distress.

RESULTS

The final questionnaire contained 26 items subdivided into four domains viz. the personal, spiritual, physical, and the family domains, with each domain providing a sub score. The reliability coefficient (Cronbach's alpha) of the scale was found to be 0.85.

CONCLUSIONS

These are the preliminary results of an ongoing study on global distress and tool development process. Reported here is the first step towards development of such tool.

Rehabilitation of cancer patients

With the developments in cancer treatment, more and more patients are surviving their disease. However, very little emphasis is being placed to rehabilitate these cancer survivors. Ignorance, social structure, stigma attached in seeking psychological help, and poor communication skills of oncology staff all contribute to poor rehabilitative efforts. The priority of governmental agencies and health efforts to fight rampant communicable diseases, malnutrition, maternal health, and the frequent natural calamities, puts rehabilitation movements in the back seat. Treatment and prevention of disability and its rehabilitation requires comprehensive and multidisciplinary approach. There is an urgent need to promote physical and psychological rehabilitation.

Evidence for an RNA-based catalytic mechanism in eukaryotic nuclear ribonuclease P

Ribonuclease P is the enzyme responsible for removing the 5'-leader segment of precursor transfer RNAs in all organisms. All eukaryotic nuclear RNase Ps are ribonucleoproteins in which multiple protein components and a single RNA species are required for activity in vitro as well as in vivo. It is not known, however, which subunits participate directly in phosphodiester-bond hydrolysis. The RNA subunit of nuclear RNase P is evolutionarily related to its catalytically active bacterial counterpart, prompting speculation that in eukaryotes the RNA may be the catalytic component. In the bacterial RNase P reaction, Mg(II) is required to coordinate the nonbridging phosphodiester oxygen(s) of the scissile bond. As a consequence, bacterial RNase P cannot cleave pre-tRNA in which the pro-Rp nonbridging oxygen of the scissile bond is replaced by sulfur. In contrast, the RNase P reaction in plant chloroplasts is catalyzed by a protein enzyme whose mechanism does not involve Mg(II) coordinated by the pro-Rp oxygen. To determine whether the mechanism of nuclear RNase P resembles more closely an RNA- or a protein-catalyzed reaction, we analyzed the ability of Saccharomyces cerevisiae nuclear RNase P to cleave pre-tRNA containing a sulfur substitution of the pro-Rp oxygen at the cleavage site. Sulfur substitution at this position prohibits correct cleavage of pre-tRNA. Cleavage by eukaryotic RNase P thus depends on the presence of a thio-sensitive ligand to the pro-Rp oxygen of the scissile bond, and is consistent with a common, RNA-based mechanism for the bacterial and eukaryal enzymes.

Chloroplast ribonuclease P does not utilize the ribozyme-type pre-tRNA cleavage mechanism

The transfer RNA 5' maturation enzyme RNase P has been characterized in Bacteria, Archaea, and Eukarya. The purified enzyme from all three kingdoms is a ribonucleoprotein containing an essential RNA subunit; indeed, the RNA subunit of bacterial RNase P RNA is the sole catalytic component. In contrast, the RNase P activity isolated from spinach chloroplasts lacks an RNA component and appears to function as a catalytic protein. Nonetheless, the chloroplast enzyme recognizes a pre-tRNA substrate for E. coli RNase P and cleaves it as efficiently and precisely as does the bacterial enzyme. To ascertain whether there are differences in catalytic mechanism between an all-RNA and an all-protein RNase P, we took advantage of the fact that phosphodiester bond selection and hydrolysis by the E. coli RNase P ribozyme is directed by a Mg2+ ion coordinated to the nonbridging pro-Rp oxygen of the scissile bond, and is blocked by sulfur replacement of this oxygen. We therefore tested the ability of the chloroplast enzyme to process a precursor tRNA containing this sulfur substitution. Partially purified RNase P from spinach chloroplasts can accurately and efficiently process phosphorothioate-substituted pre-tRNAs; cleavage occurs exclusively at the thio-containing scissile bond. The enzymatic throughput is fivefold slower, consistent with a general chemical effect of the phosphorothioate substitution rather than with a metal coordination deficiency. The chloroplast RNase P reaction mechanism therefore does not involve a catalytic Mg2+ bonded to the pro-Rp phosphate oxygen, and hence is distinct from the mechanism of the bacterial ribozyme RNase P.

A subunit interaction in chloroplast ATP synthase determined by genetic complementation between chloroplast and bacterial ATP synthase genes

F1F0-ATP synthases utilize protein conformational changes induced by a transmembrane proton gradient to synthesize ATP. The allosteric cooperativity of these multisubunit enzymes presumably requires numerous protein-protein interactions within the enzyme complex. To correlate known in vitro changes in subunit structure with in vivo allosteric interactions, we introduced the beta subunit of spinach chloroplast coupling factor 1 ATP into a bacterial F1 ATP synthase. A cloned atpB gene, encoding the complete chloroplast beta subunit, complemented a chromosomal deletion of the cognate uncD gene in Escherichia coli and was incorporated into a functional hybrid F1 ATP synthase. The cysteine residue at position 63 in chloroplast beta is known to be located at the interface between alpha and beta subunits and to be conformationally coupled, in vitro, to the nucleotide binding site > 40 A away. Enlarging the side chain of chloroplast coupling factor 1 beta residue 63 from Cys to Trp blocked ATP synthesis in vivo without significantly impairing ATPase activity or ADP binding in vitro. The in vivo coupling of nucleotide binding at catalytic sites to transmembrane proton movement may thus involve an interaction, via conformational changes, between the amino-terminal domains of the alpha and beta subunits.

Impaired growth in children with asthma during treatment with conventional doses of inhaled corticosteroids

We describe 6 (4F, 2M) prepubertal children with moderate asthma diagnosed at a mean age of 2.8 years. All patients were treated with inhaled corticosteroids in a dose of between 300 and 800 mcg of beclomethasone dipropionate (becotide) daily, given either as an aerosol or rotahaler. Mean height velocity SDS decreased from -0.8 (range +0.5 to -2.0) to -3.2 (range -1.3 to -4.8) when the dose was increased. Alternatively, when the dose was reduced or stopped, mean height velocity SDS increased from -3.2 (range -2.0 to -4.8) to +0.8 (range -1.2 to +2.7). Careful assessment of height velocity is indicated in all children receiving treatment with inhaled corticosteroids.

Growth following single fraction and fractionated total body irradiation for bone marrow transplantation

Total body irradiation (TBI) is used as preparative regimen prior to bone marrow transplantation (BMT). Since there are more long-term survivors, follow up studies are important. We have performed a retrospective analysis of growth for 49 children, who had undergone treatment with cyclophosphamide and TBI before BMT. Of these patients 26 received single fraction (SF) TBI as a dose of 900-1000 cGy, whereas 23 received fractionated (FF) TBI as a total dose of either 1200 cGy divided in six fractions or 1440 cGy divided in eight fractions over 3 days. Half of the patients in the SF-TBI group, and 9 in the FF-TBI group had received low-dose cranial irradiation prior to TBI. In all groups a decrease in height SDS was observed. By evaluating the major factors leading to growth impairment the influence of cranial irradiation, which was demonstrable in the 1st year after TBI, could not be shown after 3 years. At this time growth was significantly more impaired in the SF group with a mean height SDS of -0.9 (+/- SD 0.9) compared to a mean height SDS -0.22 (1.02) in the FF group (P < 0.05). Measurement of segmental proportions showed a significant difference in SDS for sitting height in comparison to SDS for subischial leg length, irrespective of the TBI regimen. This was already evident 1 year after TBI and decreased during the following years. Twenty four of the patients (17 in the single fraction and 7 in the fractionated TBI group) were treated with growth hormone, but demonstrated an inappropriate response with absent catch-up growth in their legs.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term treatment with growth hormone in Noonan's syndrome

Five children (four boys, one girl) with Noonan's syndrome were treated with growth hormone for a mean of 2.9 (range 1.8 to 4.6) years. Treatment was commenced at a mean age of 3.9 (range 2.5 to 6.0) years. After one year of treatment, height velocity SDS increased from a mean of -2.1 (range -4.1 to -0.3) to a mean of +3.1 (range +2.0 to +3.5). Subsequently, height SDS increased significantly from -3.3 (range -4.2 to -2.2) to -2.4 (range -3.3 to -1.6). Although in all patients a marked decrease in height velocity was observed in the following years of treatment, compared to the first year, height SDS continued to improve in comparison to pretreatment (mean height SDS in the third year for four patients was -2.1) (range -3.1 to -1.4). In the four patients who had completed their second year of treatment, height SDS for bone age had increased from -1.8 (range -2.8 to -0.9) to -1.2 (range -1.6 to -0.6).

Endocrine function following single fraction and fractionated total body irradiation for bone marrow transplantation in childhood

Forty-nine children who had undergone treatment with cyclophosphamide and total body irradiation before bone marrow transplantation were investigated for impaired endocrine function. Twenty-six patients received single fraction total body irradiation as a dose of 9-10 Gy, whereas 23 patients received fractionated total body irradiation as a total dose of either 12 Gy divided into six fractions or 14.4 Gy divided into eight fractions, administered over 3 or 4 days. Half of the patients in the single fraction group and nine in the fractionated group had received cranial irradiation prior to total body irradiation. Pathological changes in thyroid function were observed in 19 patients (73%) of the single fraction group (elevated thyrotrophin (58%) and decreased thyroxine levels (15%)), whereas in the fractionated group only six patients (25%) developed transient raised thyrotrophin levels: the mean observation period was 3.2 years in the single fraction group and 2.7 years in the fractionated group. The stimulated growth hormone peak concentration was influenced significantly by previous cranial irradiation and was independent of the type of total body irradiation administered. In the patients who had received cranial irradiation, the mean growth hormone peak levels were 8.4 mU/l (single fraction group) and 13.9 mU/l (fractionated group), whereas in those who received only total body irradiation they were 24.9 mU/l(single fraction group) and 28.1 mU/l (fractionated group). The basal gonadotrophin concentration in children older than 9 years showed elevated levels in nine patients (50%) of the single fraction group and in only three patients (30%) of the fractionated group.(ABSTRACT TRUNCATED AT 250 WORDS)

Gonadotropin releasing hormone analogue and growth hormone therapy in precocious and premature puberty following cranial irradiation for acute lymphoblastic leukaemia

Ten girls with early puberty secondary to cranial irradiation as a part of the treatment for acute lymphoblastic leukaemia (ALL) were treated with either gonadotropin-releasing hormone analogue (GnRHa) and human growth hormone (GH) (8 girls) or with GnRHa alone (2 girls). After 4 years of treatment, height SDS for bone age was improved in the group who received combined treatment (from -0.97 to +0.07, p < 0.001), in contrast to the 2 patients who received GnRHa alone in whom height standard deviation scores for bone age decreased (from -1.10 to -1.33). Sitting height in all patients was relatively shorter than leg length, and there was no significant alteration during the 4 years of treatment.

The maturing teenage mother

The public consciousness about teenage childbearing and its associated hazards has been raised through widespread documentation of the phenomenon. This study was conducted to obtain information from maturing teenage mothers about their lifestyles, health habits and attitudes towards family planning. Results showed some definite trends with age maturity. Recommendations include the development of services for males, programs for parents, increased use of media and existing community resources, expansion of clinic services to be more amenable to teenagers and increased education about nonprescription methods of family planning.