An Analysis of Factors Related to Care Engagement along the Cancer Survivorship Care Continuum for Cancer Survivors in Florida

PURPOSE

This study identifies factors associated with care engagement along the cancer survivorship care continuum for Floridians.

METHODS

We identified patients from the OneFlorida Data Trust with a cancer diagnosis at any age and encounters from 2012-2020. Multivariable logistic regression models produced odds ratios (OR) predicting 1) any outpatient non-acute care visit, 2) cancer-related visit with any provider, 3) cancer-related visit with a cancer provider, and 4) survivorship visit with a cancer provider. Encounter-based independent variables were insurance, Social Deprivation Index quartile, and Rural Urban Continuum Area (adjusted for age, sex, race, ethnicity, and treatment).

RESULTS

662,489 survivors were included in the sample. Those with Medicaid and dual eligible status (Medicare and Medicaid) were more likely to have an outpatient visit (Medicaid OR 2.02, 95%CI 1.93-2.12; dual eligible 3.06, 2.91-3.22) or a cancer-related visit with a cancer provider (Medicaid 1.82, 1.77-1.86; dual eligible 1.32, 1.28-1.35), and less likely to have a survivorship visit (Medicaid 0.27, 0.26-0.28; dual eligible 0.20, 0.19-0.21). Uninsured survivors were less likely to have all visit types, while those with Medicare were more likely. Those from the most socially deprived areas were more likely to have an outpatient visit (1.09, 1.03-1.14) and less likely to have a cancer-related visit with any provider (0.90, 0.88-0.92) or a cancer provider (0.93, 0.91-0.95). Survivors from non-metropolitan areas were more likely to have an outpatient visit (1.38, 1.22-1.56), cancer-related visit (1.22, 1.16-1.28), cancer-related visit with a cancer provider (1.45, 1.39-1.52), and a survivorship visit (1.34, 1.22-1.48).

CONCLUSIONS

Survivors who have public insurance are more likely to have outpatient visits, and those with Medicaid or dual eligible status are less likely to have survivorship visits. Uninsured status is consistently associated with lack of engagement across the care continuum. Those from areas with higher social deprivation are more likely to have outpatient visits, but less likely to have a cancer-related visit with or without a cancer provider. Survivors from non-metropolitan areas are more likely to engage in all visit types along the care continuum.

Role of stereotactic body radiation in the enhancement of the quality of life in locally advanced pancreatic adenocarcinoma: a systematic review

INTRODUCTION

Up to 30% of pancreatic cancer patients initially present locally advanced (LAPC). Stereotactic body radiation therapy (SBRT) may be an additional palliative treatment option when curative resection is no longer achievable. Our systematic review aimed to assess the effect of SBRT on the quality of life in LAPC.

METHODS

We searched five databases until June 29th, 2021, for original articles that reported on SBRT for histologically proven LAPC in adults. Data were extracted on study characteristics, SBRT and additional therapy regimen, pain, biliary complications, nutrition, quality of life and other patient-reported outcomes. Statistical analyses were performed for population and survival data.

RESULTS

11 case series studies comprising 292 patients with a median age of 66 (range 34-89) years were included in the final analysis. The weighted average BED2;10 (radiation biologically effective dose, equivalent dose in 2 Gy fractions) was 54 Gy, delivered in 3 to 6 fractions. The individual studies used different scales and endpoints, not allowing a meta-analysis. Pain generally appeared to be improved by SBRT. SBRT significantly reduced jaundice. Local control was achieved in 71.7% of patients. Weight loss and nausea also tended to improve after SBRT.

CONCLUSION

SBRT of locally advanced irresectable pancreatic cancer is a promising approach for achieving local control and improving the quality of life. However, randomized controlled trials with larger cohorts are needed to assess the value of SBRT in pancreatic cancer therapy.

The feasibility of electromagnetic sensing aided post pyloric feeding tube placement (CORTRAK) in patients with thrombocytopenia with or without anticoagulation on the intensive care unit

BACKGROUND

The successful initiation of enteral nutrition is frequently hampered by various complications occurring in patients treated in the intensive care unit (ICU). Successful placement of a nasojejunal tube by CORTRAK enteral access system (CEAS) has been reported to be a simple bedside tool for placing the postpyloric (PP) feeding tube.

METHODS

We evaluated the efficacy and side effects using CEAS to establish EN in patients with critical illness, thrombocytopenia, and/or anticoagulation.

RESULTS

Fifty-six mechanically ventilated patients were analyzed. Twenty-four of them underwent prior hematopoietic stem cell transplantation (SCT). Sixteen patients received extracorporeal membrane oxygenation treatment because of acute respiratory distress syndrome. The median platelet count at PP placement was 26 g/L (range, 4-106 g/L); 16 patients received therapeutic anticoagulation (activated partial thromboplastin time, 50-70 s). CEAS-assisted placement of a PP nasojejunal tube was performed successfully in all patients. The most frequent adverse event was epistaxis in 27 patients (48.2%), which was mostly mild (Common Terminology Criteria for Adverse Events grade 1, n = 21 [77.8%], and grade 2, n = 6). A significant association between a low platelet count and bleeding complications was observed (P < 0.001).

CONCLUSION

Performed by an experienced operator, CEAS is a simple, rapidly available, and effective bedside tool for safely placing PP feeding tubes for EN in patients with thrombocytopenia, even when showing an otherwise-caused coagulopathy in the ICU. Higher-grade bleeding complications were not observed despite their obvious correlation to thrombocytopenia. A prospective study is in preparation.

Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

BACKGROUND

Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome.

METHODS

We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0-12 points) and a high (13-24 points) lung ultrasound score group.

RESULTS

The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and p_aO₂ (107 [80-130] vs 80 [66-93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3-25] vs 36.5 [9.8-70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559).

CONCLUSIONS

LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

OP0298 STUDY OF RISK OF VERTEBRAL FRACTURES AFTER THE WITHDRAWAL OF DENOSUMAB TREATMENT

Background:

The discontinuation of treatment with denosumab (Dmab) has been associated with a reactivation effect of bone metabolism that manifests itself with a loss of bone mass and an increased risk of vertebral fractures (VF). The incidence and risk factors that may lead to such loss are not clearly established.

Objectives:

Determine the incidence of VF and bone loss in patients who have withdrawn treatment with Dmab and objectify possible associated risk factors.

Methods:

Retrospective review study of patients treated with Dmab and monitored the last two years in monographic osteoporosis consultations. . We selected patients who withdrew treatment with Dmab and registered demographic characteristics, risk factors for osteoporosis and densitometries prior to treatment and during the period of suspension. We identified patients who presented fractures during treatment withdrawal period, assessing: number of fractures, time from withdrawal to fracture presence, location and if they had received osteoactive treatment in that period.

Results:

Of 415 patients treated with Dmab, 83 discontinued treatment. The average age was 63.91 years, 95.2% of them women. The average duration of treatment prior to withdrawal was 2.73 years. 43.4% of the patients had previous fractures, 47.2% vertebral. The data of the previous bone mineral density and during the follow-up are shown in Table 1. 60 patients presented risk factors for osteoporosis, the most frequent being low calcium intake (36.6%) and 15.6% had disease and osteopenizing treatment. 92.7% of the patients had received prior osteoactive treatment. The most frequent reason for withdrawal of Dmab was for therapeutic vacations (56.6%). 39 patients performed post-withdrawal osteoactive treatment, mostly zoledronate (51.3%). During the two years after the rest, 9 patients had fractures (10.9%), seven of vertebral location (77.7%) and ≥ 2 VF were observed in five of them. 5 patients (71.4%) already had fractures prior to the onset of Dmab. The average time from withdrawal from treatment to fracture presentation was 15 months. None of the fractured patients had received treatment after Dmab withdrawal. Although the mean BMD analyzed by DXA at the end of treatment and that the loss of BMD during rest was higher in patients with fracture compared to those without fracture (-7.8% vs -4.3% in the spine and -8.6% vs -4.4% in total femur), the differences were not significant.

Table 1.

BMD values and percentage of BMD change at the start of treatment with denosumab and during two years of withdrawal.

Previous Stop Dmab(n=83)Stop Dmab(n=54)Break Dmab1(n=28)Break Dmab2(n=20)DMO (mean)(g/cm2)T-score(g/cm2)T-score(g/cm2)T-score(g/cm2)T-score Lumbar spine0,861 ± 0,1-2,610,949 ± 0,1-1,940,965 ± 0,2-1,930,920 ± 0,2-2,22 Femoral neck0,735 ± 1-1,960,774 ± 0,1-1,710,758 ± 0,1-1,840,740 ± 0,1-2,02 Total femur0,784 ± 0,1-1,810,823 ± 0,1-1,480,805± 0,1-1,630,801 ± 0,1-1,68% change DMO Lumbar spine12,2 ± 10,3-5 ± 7,9-5,44 ± 7,9 Femoral neck6 ± 8,5-4,2 ± 3,9-5,35 ± 5,8 Total femur3,9 ± 4,2-5,2 ± 4,9-0,33 ± 19,6

Conclusion:

The incidence of VF in patients who interrupted Dmab was 8.43%. Fractured patients had lower BMD gain despite the treatment than non-fractured patients and also the loss of BMD at rest was greater, without significant differences probably due to low number of patients. Neither the presence of previous fractures nor the duration of treatment could be related to the presence of VF at rest.

Disclosure of Interests:

None declared

Cognitive Performance Does not Limit Physical Activity Participation in the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P)

OBJECTIVES

We examined whether multiple domains of baseline cognitive performance were associated with prospective physical activity (PA) adherence in the Lifestyle Interventions and Independence for Elders Pilot study (LIFE-P).

DESIGN, SETTING, PARTICIPANTS

The LIFE-P study was a single-blind, multicenter, randomized controlled trial of a PA intervention compared to a successful aging educational intervention in sedentary, mobility-limited older adults.

INTERVENTION

A 12-month structured, moderate-intensity, multi-modal PA program that included walking, resistance training, and flexibility exercises. For the first 2 months (adoption), 3 center-based exercise sessions (40-60 min) / week were conducted. During the next 4 months (transition), center-based sessions were conducted 2 times / week. The subsequent maintenance phase consisted of optional once-to-twice-per-week center-based sessions and home-based PA.

MEASUREMENTS

Tests of executive and global cognitive functioning, working memory and psychomotor speed were administered at baseline. Median test scores were used to dichotomize participants into low or high cognitive performance groups.

RESULTS

52 mobility-limited older adults (age: 76.9 ±5 yrs) were randomized to the PA arm of LIFE-P. Compared to participants with high cognitive performance, participants with low performance had similar PA adherence rates (all P ≥ 0.34). Furthermore, weak and non-significant univariate relationships were elicited between all measures of cognition and overall PA adherence levels (r values ranged: -0.20 to 0.12, P ≥ 0.12).

CONCLUSION

These data suggest that cognitive performance does not limit long-term PA adherence in mobility-limited older adults. Additional studies in larger cohorts are warranted to verify these findings.

A New Adaptive Home-based Exercise Technology among Older Adults Living in Nursing Home: A Pilot Study on Feasibility, Acceptability and Physical Performance

OBJECTIVES

To explore the feasibility and acceptability of a new home-based exercise technology among older adults and to evaluate its efficacy on physical performance measures.

DESIGN

Longitudinal clinical trial.

SETTING

Oak Hammock at the University of Florida, a nursing home located in Gainesville, Florida.

PARTICIPANTS

Twelve pre-disabled older adults (≥75 years) living in a nursing home with a Short Physical Performance Battery (SPPB) score between 6 and 9 and no diagnosis of dementia.

INTERVENTION

Thirty minutes of light intensity exercise (aerobic, strength and balance) two times per week for four weeks using a home-based physical activity technology called Jintronix.

MEASUREMENTS

Feasibility and acceptability were assessed through a 9-item self-administered questionnaire and by exploring the percentage of quality of movements and time performing exercise which was calculated automatically by Jintronix technology. Physical performance measures were assessed through the SPPB score at baseline, after 4 weeks of intervention and after 3 months from the completion of the intervention.

RESULTS

Twelve older adults (80.5±4.2 years old) performed light intensity exercise with Jintronix for a total of 51.9±7.9 minutes per week. Participants reached 87% score of quality of movements in strength and balance exercises, a global appreciation score of 91.7% and a global difficulty score of 36%. Compared to baseline, there was a significant improvement in SPPB score at the end of the intervention and at 3 months following the completion of the exercise program (0.67±0.98 and 1.08±0.99 respectively, p-value <0.05).

CONCLUSION

Jintronix technology is feasible and acceptable among pre-disabled older adults without dementia living in nursing home and is beneficial in improving their physical performance.

Frailty Clinical Phenotype: A Physical and Cognitive Point of View

Frailty is recognized as a clinical geriatric syndrome used to describe the weakest or most vulnerable older adults. Although the term frailty is commonly used in clinical practice, and the theoretical phenomenon is well accepted, it remains an evolving concept that lacks a universally accepted definition and specific diagnostic criteria. Different perspectives on frailty have led to two distinct viewpoints of this phenomenon in the literature. The first describes the phenomenon based solely on physical attributes and capabilities. In contrast, more recent perspectives describe the phenomenon in broader, multidimensional terms by incorporating the concept of cognitive frailty. In support of this view, there is increasing evidence that consideration of both cognitive and physical factors can better improve the ability to predict adverse health outcomes among frail older adults over physical factors alone. The recent recognition of the importance of cognitive factors has increased the complexity of this phenomenon and difficulty in developing a consensus definition. To add to this challenge, frailty can present in different stages of severity (from mild to severe), and there appears to be a dynamic relationship between these stages. Despite these challenges, a consensus on an international definition of frailty including physical and cognitive criteria is essential in order to advance research and treatment of this condition.

Experience-based modulation of behavioural responses to plant volatiles and other sensory cues in insect herbivores

Plant volatiles are important cues for many herbivorous insects when choosing a suitable host plant and finding a mating partner. An appropriate behavioural response to sensory cues from plants and other insects is crucial for survival and fitness. As the natural environment can show both large spatial and temporal variability, herbivores may need to show behavioural plasticity to the available cues. By using earlier experiences, insects can adapt to local variation of resources. Experience is well known to affect sensory-guided behaviour in parasitoids and social insects, but there is also increasing evidence that it influences host plant choice and the probability of finding a mating partner in herbivorous insects. In this review, we will focus upon behavioural changes in holometabolous insect herbivores during host plant choice and localization of mating partners, modulated by experience to sensory cues. The experience can be acquired during both the larval and the adult stage and can influence later responses to plant volatiles and other sensory cues not only within the developmental stage but also after metamorphosis. Furthermore, we will address the neurophysiological mechanisms underlying the experience-dependent behavioural adaptations and discuss ecological and evolutionary aspects of insect behavioural plasticity based upon experience.

Cloning of an octopamine/tyramine receptor and plasticity of its expression as a function of adult sexual maturation in the male moth Agrotis ipsilon

In the male moth Agrotis ipsilon behavioural response and antennal lobe (AL) neuron sensitivity to the female-produced sex pheromone increase with age and juvenile hormone (JH) level. We recently showed that the neuromodulator, octopamine (OA), interacts with JH in this age-dependent olfactory plasticity. To further elucidate its role, we cloned a full cDNA encoding a protein that presents biochemical features essential to OA/tyramine receptor (AipsOAR/TAR) function. The AipsOAR/TAR transcript was detected predominantly in the antennae, the brain and, more specifically, in ALs where its expression level varied concomitantly with age. This expression plasticity indicates that AipsOAR/TAR might be involved in central processing of the pheromone signal during maturation of sexual behaviour in A. ipsilon.

Central olfactory pathways in mosquitoes and other insects

Studies of CNS processing of olfactory information have contributed significantly to understanding olfactory-guided behaviour in insects. Evidence in moths suggests that each glomerulus in the antennal lobes has a unique property: receptor-axon projections and dendritic arborizations of uniglomerular output neurons can relate to anatomically and functionally distinct glomeruli. Similar correlations are not typical of the concentrically organized locust antennal lobes. Insights about odour processing in the CNS of female mosquitoes should help us to understand how sensory information can lead to host-seeking behaviour. It will be interesting to learn how inputs from CO2 receptors on the maxillary palps and inputs from antennal olfactory receptors that respond to host odours are integrated centrally, so that pharmacological manipulation of olfactory neuron activity might provide a tool for the control of mosquitoes as important vector insects. The antennal lobe of male and female Aedes aegypti contains 20-25 glomeruli. Primary afferent projections from the antennae and maxillary palps target specific glomeruli of the ipsilateral antennal lobe. Maxillary palp projections are restricted to two posteromedial glomeruli, which do not receive antennal afferents. The latter arborize in the remaining glomeruli.

Plant odour processing in the antennal lobe of male and female grapevine moths, Lobesia botrana (Lepidoptera: Tortricidae)

Moths of Lobesia botrana (Lepidoptera: Tortricidae) are confronted with different volatiles emitted from the host plant during the different seasons. To test the hypothesis of plasticity of central plant odour processing in moths of different generations in the future, we first investigated the responses of antennal lobe (AL) interneurons of laboratory-reared virgin and mated males and females. We used intracellular recording and staining techniques while stimulating the antenna with a range of host and non-host plant odours. The AL structure of L. botrana is similar to that found in other Lepidoptera species studied. The most frequent physiological responses for all types of moths were obtained with (E)-2-hexenal, and with thujyl alcohol and beta-thujone, components of tansy, a behaviourally attractive non-host plant. Some broadly responding neurons were capable of distinguishing between different compounds through different response patterns (excitation/inhibition) and/or different dose-response characteristics. Response characteristics (response spectra, threshold and specificity) of neurons were similar, independent of sex or mating status of the moths. Significant differences between the groups were, however, found in the proportion of responding neurons for a few tested components.

The antennal lobe of orthoptera - anatomy and evolution

The first odor-processing neuropils of insects comprise glomeruli, islets of neuropil, that are supplied by olfactory receptor neurons and give rise to efferent axons to higher brain centers. Glomeruli size and organization varies in a taxon-specific manner across the Insecta, suggesting possible correlates between their organization and chemosensory behaviors in different insect groups. Comparative studies of antennal lobe glomeruli within the Orthoptera have been used to infer how the various taxon-specific arrangements of odorant-processing structures (glomeruli) might have evolved. The cellular arrangements in glomeruli have been surveyed using anterograde filling and Golgi impregnation of antennal receptor neurons projecting to the antennal lobe in Stenopelmatidae, Tettigoniidae, Gryllidae, Tetrigidae and Acrididae. These taxa, which represent the two sub-orders of Orthoptera, reveal a high correlation between the neural architecture of the glomeruli and structures within the glomeruli. Using a recent molecular phylogeny of the Orthoptera we have mapped the occurrence of glomerular characteristics to infer the evolution of antennal lobe structures in orthopterans. The functional implications of these results are discussed.

Transient post-mating inhibition of behavioural and central nervous responses to sex pheromone in an insect

Mating is costly for both male and female insects and should therefore only occur if it is likely to be successful. Within one scotophase, which is the dark period of the light cycle, male moths can only produce one single spermatophore, which is transferred to the female during mating. Remating within the same scotophase would thus be unsuccessful. We tested the hypothesis that newly mated males of the moth Agrotis ipsilon have developed an energy-saving strategy based on the transient inhibition of their sexual behaviour, thus avoiding unsuccessful remating. Agrotis ipsilon males do not copulate more than once during the same scotophase. Moreover, newly mated males do not respond behaviourally to the female sex pheromone although electroantennograms showed that their peripheral olfactory system is fully functional. However, intracellular recordings of antennal lobe neurons showed that the sensitivity for the synthetic sex pheromone blend decreased as compared with that of unmated males. Both the sexual behaviour and the sensitivity of the antennal lobe neurons were restored when tested during the next scotophase. Our results show a fast, transient neuronal plasticity that 'switches off' the olfactory system, which could prevent males from mating unsuccessfully.

Olfactory protocerebral pathways processing sex pheromone and plant odor information in the male moth Agrotis segetum

We investigated protocerebral processing of behaviorally relevant signals in the turnip moth, Agrotis segetum. Single neurons were studied both physiologically and morphologically using intracellular recording techniques. In moth pheromone communication systems, the presence of the complete, female-produced pheromone blend is necessary for male attraction. We predicted that more protocerebral neurons, compared with AL, would display blend interactions. However, only a few protocerebral neurons responded differently to the blend than could be deduced from the response to single components. The majority of the pheromone-sensitive protocerebral neurons identified in this study responded to the major pheromone component. In coding time, most AL neurons can follow a 5-Hz odor stimulus, whereas most protocerebral neurons failed at higher frequencies than 1 Hz. The majority of neurons that responded to the odorants tested innervated one or both of the protocerebral lateral accessory lobes. If only one of these was innervated, then the innervation always displayed a varicose appearance, suggesting a presynaptic function. Thus, information seems to be transferred from other protocerebral areas to the lateral accessory lobes. Into these, descending neurons sent smooth, postsynaptic branches. A majority of the neurons innervating the superior medial protocerebrum were found to display single-component specificity. Few additional correlations between odor specificity and structural characteristics were apparent.

Juvenile-hormone-mediated plasticity of aggregation behaviour and olfactory processing in adult desert locusts

In desert locusts Schistocerca gregaria, aggregation behaviour is elicited by aggregation pheromones. In this study, we show that the behavioural response to the major and most potent adult aggregation pheromone component, phenylacetonitrile, is age- and juvenile-hormone-dependent. Furthermore, we show that juvenile hormone influences the responsiveness of olfactory interneurons in the antennal lobe to aggregation pheromone, whereas the responsiveness of antennal receptor neurons is not changed. Old locusts and locusts injected with juvenile hormone, in contrast to young locusts and locusts deprived of juvenile hormone through allatectomy, i.e. after surgical removal of the gland producing this hormone, do not display any aggregation behaviour, as indicated by long-term behavioural observations. The lack of positive olfactory-guided behaviour coincides with an impairment of the central olfactory system, which displays a lower number of neurons responding to aggregation pheromone. Indirect and direct actions of juvenile hormone at different levels of the central nervous system may thus contribute to the regulation and modulation of behavioural responsiveness in the locust.

Central processing of sex pheromone stimuli is differentially regulated by juvenile hormone in a male moth

In the male moth, Agrotis ipsilon, the neuronal basis for juvenile hormone (JH)-linked modulation of sex pheromone responsiveness was investigated following stimulation of the antenna with i) an extract of female pheromone gland, ii) the synthetic pheromone blends from A. ipsilon and a closely related species, A. segetum, and iii) single components of the A. ipsilon blend. Response characteristics of olfactory interneurons were studied in the antennal lobe (AL) at different ages and with manipulated JH levels using intracellular recording techniques. Blend-specific, generalist and component-specific neurons were identified and described according to their response pattern. The proportion of low threshold AL interneurons increased significantly with age for all stimuli tested. Changes were, however, less pronounced for the minor single components. The proportion of low threshold AL interneurons in allatectomized (JH-deprived) mature males was significantly lower for all stimuli than in intact mature males. A large proportion of low threshold AL interneurons responding to the pheromone blends, but not as pronounced for single pheromone components, could be restored/induced by injecting JH either into JH-deprived mature males or into young immature males. The specificity for the species-specific blend compared to the A. segetum blend increased with age and JH injections.

Function and morphology of the antennal lobe: new developments

The antennal lobe of insects has emerged as an excellent model for olfactory processing in the CNS. In the present review we compile data from areas where substantial progress has been made during recent years: structure-function relationships within the glomerular array, integration and blend specificity, time coding and the effects of neuroactive substances and hormones on antennal lobe processing.

The maxillary palp sensory pathway of Orthoptera

Primary sensory projections and arborisations of higher-order neurons associated with the maxillary palps were examined in Tettigoniidae, Gryllidae, Tetrigidae and Acrididae representing the two sub-orders of Orthoptera, Ensifera and Caelifera. Anterograde filling and Golgi impregnation of maxillary receptor neurons revealed two patterns of innervation, the ensiferous and the caeliferous type. In both ensiferans and caeliferans, receptor neurons arborised within the tritocerebrum, the antennal motor- and mechano-sensory centre and the lobus glomerulatus. In ensiferans, additional areas of innervation were found in the lobus glomerulatus and in a previously undescribed neuropil, here referred to as the accessory lobus glomerulatus. In relation to the anatomical data a putative functional segregation of the neuropil into gustatory-, olfactory- and mechano-sensory centres is implied.

Integration of behaviourally relevant odours at the central nervous level in solitary and gregarious third instar locusts, Schistocerca gregaria

Integration of behaviourally relevant odours at the central nervous level of 3rd instar nymphal desert locusts, Schistocerca gregaria, showed phase- and (developmental) stage-dependent characteristics which correlated with differences in the number of olfactory sensilla. Antennal lobe (AL) neurons of gregarious locusts generally responded more frequently and showed a higher sensitivity to the tested stimuli. However, AL neurons of solitary locusts responded significantly more frequently to phenylacetonitril, the major component of the adult aggregation pheromone. Pheromone-specific, plant-specific and pheromone-plant generalist neurons were found in both phases. The response spectra of pheromone-specific neurons correlated with the potential behavioural significance of attractant chemical cues in the environment. Neurons of both phases responded specifically to stage-specific aggregation-pheromone components and to other chemical cues that may be involved in the location of suitable roosting and foraging sites.

Effect of juvenile hormone on the central nervous processing of sex pheromone in an insect

Behavioral sex pheromone responsiveness in the male moth Agrotis ipsilon was previously shown to be controlled by juvenile hormone (JH). However, this morphogenetic hormone did not change the sensitivity of antennae to sex pheromones. To analyze the possible involvement of JH in the central integration of the female-produced sex pheromone, we investigated the pheromone response of olfactory antennal lobe (AL) interneurons in male A. ipsilon as a function of age and JH status by using intracellular recordings. When the antennae were stimulated with the sex pheromone blend, the sensitivity of olfactory AL neurons increased with age, as does the JH-dependent behavioral and physiological development of A. ipsilon males. Furthermore, males surgically deprived of JH showed a significant decrease in the sensitivity of the AL neurons. JH injection in operated or in young males restored or induced, respectively, a high sensitivity of the AL neurons. JH seems likely to be involved in the plasticity of the adult insect brain by modulating the central nervous processing of olfactory information, thus allowing mate recognition and reproduction at the optimal time.

Central processing of aggregation pheromones in solitary and gregarious desert locusts, Schistocerca gregaria

In the desert locust, Schistocerca gregaria, a number of behaviorally active aggregation pheromone components have been identified from adult male S. gregaria, and from third, fourth and fifth instar nymphs. Adult females seem not to produce aggregation pheromones. Adult males and females, but not nymphs respond to the adult male-produced mixture, whereas only nymphs respond to the binary nymph-produced mixture with aggregation behavior. We studied the structure and function of antennal lobe interneurons, responding to single aggregation pheromone components and adult- and nymph-specific mixtures. Neurons in adult males and females and in first instar nymphs of S. gregaria in the solitary and the gregarious phase were investigated. Projection neurons responded with different degrees of specificity to all behaviorally active aggregation pheromone components. Component-specific, blend-specific and generalist neurons were found in adults and first instar nymphs in both phases. Antennal lobe neurons were slightly more sensitive in solitary than in gregarious locusts. In gregarious adult males and females more neurons responded to the adult male mix than to any of the single components. In gregarious first instar nymphs most neurons responded to the adult male mix and the major component but also nymph mix specific neurons were found. The behavior of adults and nymphs is thus partially reflected by the response characteristics of antennal lobe projection neurons.

Migraine therapy: development and testing of a patient preference questionnaire

OBJECTIVES

To develop and test a patient preference questionnaire in migraine.

METHODS

A user-friendly, self-administered questionnaire was developed to assess the relative importance of aspects of migraine therapy to patients. It was tested in a convenience sample of 66 migraineurs. The questionnaire has five sections: patient preference, migraine history, demographics, usual behavior during an attack, and migraine impact on cognition and functionality. It employs a special reverse-ranking technique to quantify preferences.

RESULTS

Sixty-six migraineurs participated: 86% were women, 53% had not consulted their doctor about migraine in the previous year; and only 51% took prescribed medication, the majority (52%) at the start of a migraine. "A medication that can be taken any time during a migraine attack" was ranked most important by 20% of the migraineurs, one that decreases pain from the unbearable level in 30 minutes by 17%, and one that relieves pain completely within 2 hours by 15%. Not being able to think or concentrate with severe symptoms was reported by 71%. Optional activities were impeded by migraine in 83% of subjects, but required activities in only 60%.

CONCLUSIONS

The patient preference questionnaire is readily completed by subjects and reveals that the dimensions of relief preferred by patients can be addressed by a self-report questionnaire.

[Social phobias]

Social phobia is an anxiety disorder which can be found in general and specific subtype in general population from 2.4 to 16%. People who are suffering from social phobia don't have opportunities for optimal development and their quality of life and work productivity is ruined too. Authors showed definition, diagnosis and differential diagnosis, epidemiology, clinical features, quality of life, work and social disability of people with social phobia. Biology and therapy of social phobia are also presented. This paper is based on findings around the world. Authors recommend more attention to social phobia, its specific type which is very rare, as much as one in comorbidity because this disorder can make big economic costs, especially through work disability, which can be changed by early treatment.

Central nervous processing of sex pheromones in two strains of the European corn borer Ostrinia nubilalis (Lepidoptera: Pyralidae)

Antennal lobe neurones were investigated in the pyralid moth Ostrinia nubilalis using intracellular recording and staining techniques. Response characteristics of antennal lobe neurones from males in the so-called E and Z strains, in F1 hybrids and in parental backcrosses were studied. The antennal lobe of a male O. nubilalis comprises approximately 30 ordinary glomeruli and three enlarged glomeruli making up the macroglomerular complex (MGC). Receptor neurones enter the antennal lobe via the antennal nerve and arborize in single glomeruli. Intracellularly stained, pheromone-responding projection neurones in both parental strains arborized in different glomeruli within the MGC, irrespective of their response characteristics. Neurones were grouped according to their specificity to single pheromone components and to pheromone blends. Component-specific, blend-specific and generalist neurones were found. Specificity only occurred at low stimulus concentrations and disappeared as concentrations increased. Although all neuronal types were present in both pheromone strains and crossings, differences in abundance and sensitivity were found. In the parental strains, neurones responding to the major pheromone component and to the respective strain-specific blend were more abundant than neurones responding to the minor component and the blend produced by the other strain. Neurones investigated in ZxE hybrids responded similarly to those of E-strain males, whereas neurones in EZxZ paternal backcrosses responded similarly to those of Z males. In the hybrids and paternal backcrosses, hybrid-blend-specific neurones were present that were not found in parental-strain males.

Discrimination among pheromone component blends by interneurons in male antennal lobes of two populations of the turnip moth, Agrotis segetum

A difference in female pheromone production and male behavioral response has previously been found in two populations of the turnip moth, Agrotis segetum, originating from Sweden and Zimbabwe, respectively. In this study, we investigated the pheromone response of antennal lobe interneurons of males of the two populations by intracellular recordings, stimulating with single pheromone components and various inter- and intra-populational pheromone blends. Three major physiological types of antennal lobe neurons were established in the two populations according to their responses to different stimuli. One type responded broadly to almost all the stimuli tested. The second type responded selectively to some of the single components and blends. The third type did not respond to any single components but did respond to certain blends. Furthermore, some neurons of the second and third type recognized strain specific differences in ratios between pheromone components. Both projection neurons and local interneurons were found among these three types. Two pheromone responding bilateral projection neurons are reported for the first time in this paper.

Antennal lobe interneurons in the desert locust Schistocerca gregaria (Forskal): processing of aggregation pheromones in adult males and females

Physiological and morphological characteristics of antennal lobe interneurons in male and female Schistocerca gregaria were studied by using intracellular recording and staining techniques. For the first time, the responses of projection neurons to behaviourally active and potential aggregation pheromone compounds and plant odour compounds were recorded in young adult locusts. Excitatory, inhibitory, or combined excitatory/inhibitory responses to the presented odours were detected. The stained neurons had their cell bodies in the frontal cell group, arborized in 10 to 25 glomeruli at equal distances from the central fibre core, and sent their axons to the calyces of the mushroom body and to the lateral protocerebrum. The projection neurons responded to the set of different stimuli with varying specificity. In females, more neurons responded specifically to single plant or aggregation pheromone compounds than in males, where more generalist responses were found. "Blend specialist" neurons, responding only to mixtures of behaviourally active aggregation pheromone compounds, but not to the single compounds, were present in both males and females. Most neurons responded to the behaviourally active aggregation pheromone mixtures and to single compounds present in these mixtures, as well as to plant odours. Fewer neurons responded to the potential aggregation pheromone compounds tested. In several experiments, two spike sizes in the recording were correlated with two stained neurons in the antennal lobe, suggesting electrical coupling of the neurons. No response to any of the stimuli was found in antennal lobe interneurons in old adults. The morphological and physiological features of the projection neurons in S. gregaria are compared with projection neuron characteristics in other insects.

Central processing of sex pheromone, host odour, and oviposition deterrent information by interneurons in the antennal lobe of female Spodoptera littoralis (Lepidoptera: Noctuidae)

Physiological and anatomical characteristics of antennal lobe interneurons in female Spodoptera littoralis (Boisd.) were investigated using intracellular recording and staining techniques. Responses of local interneurons and projection neurons to female sex pheromone components, host plant odours, and behaviourally active oviposition deterrents were recorded. We found local interneurons and projection neurons that responded specifically to only one or two of the tested odours, but we also found less specific cells, and neurons that responded to most of the tested odourants. These findings show that there are not only specific olfactory pathways in female moths up to the protocerebral level, but also that integration can begin in the antennal lobe. No correlation was found between the degree of specificity of either local interneurons or projection neurons and their respective morphological characteristics. Specialized and unspecialized local interneurons arborized throughout the antennal lobe. Specialized and unspecialized projection neurons had uniglomerular arborizations in the antennal lobe and sent their axons to the calyces of the mushroom body, and to the lateral horn of the protocerebrum. One specific projection neuron had multiglomerular arborizations and projected only to the lateral horn of the protocerebrum. Projection neurons arborizing in the glomeruli closest to the entrance of the antennal nerve always responded to pheromone components. No other correlations were found between the arborization pattern of projection neurons in the antennal lobe or in the protocerebrum and their response characteristics. The sensitivity of local interneurons and projection neurons was in the same range as that of receptor neurons in olfactory sensilla on the antennae, suggesting a much lower convergence in the central nervous system in females than in the pheromone-processing pathway in males.

[Inpatient and partial hospitalization facilities for child and adolescent psychiatry in the unified Germany, 1991]

First results of the project "Surveys regarding the structure of psychiatric institutions for children and adolescents in the Federal Republic of Germany" are described. On July 1, 1991 there were 111 in-patient institutions with a total capacity for 6363 children and youths. The contributing shares of each state (Bundesland) vary enormously. The number of accommodations per 100,000 residents is between 2.1 and 19. One reason for this discrepancy lies in the fact that the services of the institutions are called upon without regard to the state borders. More important though is the fact that in the new states the psychiatric institutions for children and youths also treat young patients who are psychologically or mentally handicapped with neuropsychiatric complications to a greater extent than comparable institutions in the old states.

Reading twisted text: implications for the role of saccades

These experiments investigated how the quality of saccadic skill limits the acquisition of visual information during a reading task. Subjects read text in which the spatial pattern of saccades was varied by reversing the order of words in a line, the order of letters in a word, or both. Some of these transformations drastically altered the customary visual appearance of words. To distinguish visual from oculomotor influences on reading, letters, in some conditions, were rotated 180 deg to produce text in which the customary visual appearance of words was destroyed while the order of words and letters remained unchanged. We found that the directional pattern of saccades had relatively modest effects on reading speed under the instruction to read accurately. The size of saccades had large effects on reading speed. Text in which familiar patterns of letters were destroyed, either by changing letter-order or letter-orientation, was read by sequences of small (less than 30') saccades made to look at every letter, or every alternate letter. Separate tests of letter recognition showed that these small saccades were necessary because recognition of letters drops sharply as a function of eccentricity in the absence of familiar letter patterns. Frequent small saccades slowed reading in that durations of the pauses before saccades increased when saccade size fell below 30-60'. We found a similar pattern of increased saccadic latency with decreasing saccade size when subjects used saccades to track a point whose motion mimicked their own reading eye movement patterns. The long latencies before small saccades in the point-tracking task showed that saccadic programming difficulties contributed to the long pause durations before small saccades during reading. The observed difficulty in programming small saccades means that valid inferences about the duration of visual or cognitive processes cannot be drawn from the temporal pattern of saccades unless the relative difficulty and time required to program different spatial patterns of saccades is taken into account.

Brain serotonin concentration: elevation following intraperitoneal administration of melatonin

The intraperitoneal administration of melatonin to rats caused an increase in brain serotonin concentration, especially in the midbrain. This effect could be demonstrated within 20 minutes of melatonin administration and was not associated with changes in norepinephrine concentration.