Pain, depression, asthenia, and insomnia: Prevalence of this symptoms cluster and its impact on health-related quality of life in a cohort of advanced cancers

e20607

Background: Pain (P), depression (D), asthenia (A), and insomnia (I), alone or in combination, are some of the most important and invalidating cancer symptoms. But little is known about the relationship between the symptoms of this cluster, and its impact on health-related quality of life (HRQoL). This analysis has been carried out to better know the prevalence of this symptoms cluster and its impact on HRQoL in cancer patients (pts). Methods: An observational and longitudinal multicentre study was carried out on a sample of cancer pts with breast, lung or colon cancer, any site and period of disease duration, receiving chemotherapy. Data were collected at inclusion and 3 months later. Sociodemographic data, key clinical indicators, as well as P, D, A and I complaints or diagnosis were collected. HRQoL was assessed by means of Nottingham Health Profile (NHP) scale (a generic health measure. Analyses were focused on baseline cross-sectional data). Results: A total of 116 pts were analyzed: 73.3 men, 61 years old (SD=9,1), 2.9 years (SD=2,3) since diagnosis, 16.4 % breast, 54.3% lung, and 29.3% colon cancer; 97.4% with metastasis. At least one symptom cluster under study was presented in 69% of pts: >25% a symptom alone, ≈25% two symptoms, >15% three symptoms, <3% all symptoms in the cluster. Pts could be classified in 13 of the 15 symptoms cluster possible combinations (according to their symptoms complaints/diagnosis) ranging from 0.9% to 12.9%. The two symptoms cluster combinations which did not obtain representation included D + I, while the two symptoms cluster combinations more frequents always included pain. It has been observed that a more quantity of symptoms worst physical and psychological NHP scores. Conclusions: The prevalence of the studied symptoms cluster in cancer pts is high (≈70%) and divers in combinations (13 different symptoms profiles). The quantity of prevalent symptoms cluster is clearly associated with HRQoL.

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No significant financial relationships to disclose.

Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation

BACKGROUND

The pulse pressure variation (PPV) index has been shown to be a reliable predictor of fluid responsiveness (FR) in a variety of clinical settings. However, it has not been formally evaluated in the setting of orthotopic liver transplantation (OLT).

METHODS

Fifteen (n=15) patients undergoing OLT were enrolled in this study. All patients were monitored with a modified pulmonary artery catheter which measured the cardiac output on a semi-continuous basis. A fluid challenge (FC) with 350 ml of colloid was attempted during the following stages of surgery: hepatectomy (TH), anhepatic phase (TA), early post-reperfusion [(TE)--during the first 30 min], late post-reperfusion [(TL)--after hepatic artery anastomosis], and at the beginning of abdominal closure (TC). PPV and stroke volume index (SVI) were recorded at baseline and 5 min after the FC. Each individual FC which raised the SVI more than 10% from baseline was classified as responsive (R); otherwise, it was considered non-responsive (NR).

RESULTS

Forty-one FCs were performed, with 14 (34%) classified as responsive and 27 (66%) as non-responsive. The baseline PPV did not differ significantly between the R and NR groups, showing considerable overlap of its values throughout the procedure [R vs NR; TH: 20% (inter-quartile range 7-32) vs 7% (5-14); TA: 10% (7-14) vs 19% (12-21), and TE+TL: 7% (5-11) vs 9% (7-16)].

CONCLUSIONS

Under the conditions of this study, the PPV index was not shown to be a reliable predictor of FR during OLT. Further studies are warranted to elucidate the role of this and other dynamic indexes in this specific setting.

Temperature-dependent development and potential distribution of Episimus utilis (Lepidoptera: Tortricidae), a candidate biological control agent of Brazilian peppertree (Sapindales: Anacardiaceae) in Florida

The invasive Brazilian peppertree (Schinus terebinthifolius Raddi), native to South America, is widely established throughout central and south Florida. The defoliating leaflet-roller Episimus utilis Zimmerman was selected as potential biocontrol agent of this invasive species. The objectives of this study were to determine development rate and survival of E. utilis at seven constant temperatures (10, 15, 20, 25, 30, 33, and 35 degrees C) and generate prediction maps of the number of generations per year this species may exhibit in the United States. The rate of development of E. utilis as a function of temperature was modeled using linear regression to estimate a lower developmental threshold of 9.6 degrees C and the degree-day requirement of 588. The Logan nonlinear regression model was used to estimate an upper developmental threshold of 33 degrees C. Cold tolerance of E. utilis was examined using all insect stages, and each stage was exposed to three constant temperatures (10, 5, 0 degrees C) for 0.5, 1, 2, 4, and 8 d (or until all insects died). The pupal stage was the most cold tolerant with 100% mortality after 12 d at 0 degrees C. The pupal lethal times at 5 (Ltime50 = 10 d, Ltime90 = 28 d) and 0 degrees C (Ltime50 = 5 d, Ltime90 = 9 d) were used to generate isothermal lines to predict favorable regions for E. utilis establishment. A GIS map was generated to predict the number of generations of E. utilis (range, 0.5-9.8) across all Brazilian peppertree range in the United States. The potential for establishment of E. utilis and its probable distribution in the continental United States was examined.

Enfriamiento artificial y tasa de concepción de vaquillas holstein con estrés térmico

Las altas temperaturas afectan la reproducción del ganado bovino reduciendo la intensidad del estro y la fertilidad. Basado en lo anterior el objetivo del estudio fue evaluar los efectos de la inseminación artificial (IA) a tiempo fijo más un período corto de enfriamiento ambiental sobre la tasa de concepción y respuesta fisiológica de vaquillas bajo estrés calórico. Noventa vaquillas Holstein fueron distribuidas aleatoriamente en uno de los siguientes tratamientos: Un tratamiento testigo (T1) con detección visual de estro e IA mañana-tarde (n= 30); un segundo tratamiento (T2) bajo un protocolo de IA a tiempo fijo (n= 30) y un tercer tratamiento (T3) con el mismo protocolo de IA de T2 más un período de enfriamiento ambiental (ventilación y aspersión) de las vaquillas 11 d antes y 21 d después de la IA (n= 30). El experimento se dividió en dos períodos: el primero del 25 de junio al 26 de julio; el segundo del 15 de agosto al 16 de septiembre. En el primer periodo las vaquillas en T3 tuvieron una temperatura rectal (39,35oC) más baja (p

Secondhand smoke exposure in Mexican discotheques

This study describes the impact of exposure to secondhand smoke for subjects who spend time in a discotheque, by comparing within-subject baseline and postexposure urinary cotinine levels. A total of 100 nonsmoking volunteers from a central region of Mexico provided a urine sample before entering a discotheque and another sample an average of 6 hr after the end of exposure. Concentrations of cotinine and its metabolite, trans-3'-hydroxycotinine, were measured in the urine by liquid chromatography-mass spectrometry. In females the average preexposure level of urinary cotinine was 2.2 ng/ml, and the average postexposure level was significantly higher, at 15.7 ng/ml. In males the average preexposure level of cotinine was 3.7 ng/ml, compared with 49.1 ng/ml in the postexposure assessment. The highest postexposure values were found in men younger than 22 years old with a value of 469.5 ng/ml. Exposure to secondhand smoke is a serious health risk. Our findings are important given that many of our subjects were exposed to substantial amounts of secondhand smoke in discotheques, as evidenced by the high urinary cotinine and 3'-hydroxycotinine concentrations. These findings support the need to prohibit smoking in discotheques to protect nonsmokers' health.

Neoadjuvant and combined chemoradiotherapy followed by surgery in locally advanced esophageal cancer: A single-centre experience

15086

Background: Concomitant chemoradiotherapy (CT-RT) with CDDP-5FU CT is a standard treatment in locally advanced esophageal cancer (EC). Long-term results are poor. The role of neoadjuvant CT (nCT) and of radical surgery after CT-RT is unclear. Methods: Single-institution, prospective trial in pts with stage II-IVA EC (TNM). PS 0–1. Staging: CT scan, barium x-ray, esophagoscopy and endoscopic ultrasound. Treatment schema: 1 cycle of neoadjuvant CT (CDDP 100 mg/m2 d1 and 5-FU 1,000 mg/m2/24 h d1–5); after 21 days, 50 Gy of RT (1.8 cGy/day, M to F) and 2 cycles of reduced-dose CT (CDDP 15 mg/m2 d1–5 and 5-FU 800 mg/m2/24 h d1–5, q21 days). In pts deemed resectable, surgery was done after 4–6 weeks. In the remainder, a 10 Gy boost was given with 1 cycle of modified CT. Primary endpoint: clinical and pathological response rate (RR) after 1st phase. Secondary endpoints: OS and toxicity rates. Results: 71 pts accrued between 1998 and 2006. Median age 61 yrs (r 44–80). 96% males. 85% squamous cell carcinomas. Middle third: 51%; upper third: 27%; lower third 22%. Gastric involvement: 11%. cT3: 46%, cT4: 28%. cN positive: 48%. Grade 3–4 toxicity with nCT and CT-RT: mucositis (9 and 19.5%), emesis (9 and 9%) and infection (6 and 9%). Full dose CT-RT: 87%. Clinical RR after 1st phase: CR 50%, PR 25%, SD 9%, PD 7%. Confirmation (CT- biopsy): 69%. Surgery: 30%. Reasons for no surgery: comorbidity (11%) and age (10%). Pathologic RR: CR 39%, microscopic rest 39% and macroscopic rest 22%. Downstaging 50%. No pN positive. 3 pts had unresectable disease. 62% received 2nd phase RT boost, 31% with CT. Clinical RR: CR 69%, PR 6%, PD 25%. Median follow-up 50 m (r 6–129 m). Median OS 10.5 m (r 7.4–12.8 m). 4-year OS of 18%. 47% deaths due to progression, 5% treatment-related deaths and 10% in the postoperative period. Only a clinical CR after 1st phase was found to improve OS (13.5 vs 7 m, p 0.0141). Conclusions: This regimen is well tolerated and offers a high response rate. Clinical response evaluation overestimates the pathologic response rate. In our series, the possible survival benefit of surgery is offset by the postoperative death rate.

No significant financial relationships to disclose.

Treatment of hirudin overdosage in a dialysis patient with heparin-induced thrombocytopenia with mixed hemodialysis and hemofiltration treatment

We report a patient who developed type II heparin-induced thrombocytopenia (HIT) and accidentally received a recombinant hirudin (r-hirudin) overdosage. Treatment with hemodialysis (HD) using high-flux polysulfone dialyzer and hemofiltration was performed. Length of treatment was adjusted, monitoring activated partial thromboplastin time (aPTT) to 1.5-2.5 times the mean of the normal range. She developed deep venous thrombosis and occlusion of vascular access. Only after cessation of heparin lock catheter, platelet count began to increase. After one year of treatment with acenocoumarol and additional low-dose r-hirudin, neither bleeding nor thrombotic episodes have been reported.

Effect of primer selection on estimates of GB virus C (GBV-C) prevalence and response to antiretroviral therapy for optimal testing for GBV-C viremia

GB virus C (GBV-C; also called hepatitis G virus) is a common cause of infection associated with prolonged survival among HIV-infected individuals. The prevalences of GBV-C viremia vary widely in different studies, and there has been poor agreement among different laboratories performing GBV-C RNA detection in quality control studies. To determine the optimal method of measuring GBV-C RNA in clinical samples, samples obtained from 939 HIV-infected subjects were studied using reverse transcription (RT)-PCR methods amplifying four separate regions of the GBV-C genome. Primers amplifying the E2 coding region were 100% specific; however, their sensitivity was only 76.6%. In contrast, primers amplifying three additional conserved regions of the GBV-C genome (the 5' nontranslated region and the nonstructural protein-coding regions 3 and 5A) were more sensitive but produced higher rates of false-positive results. Using low-specificity primer sets influenced the significance of association between GBV-C viremia and response to antiretroviral therapy. Using a quantitative GBV-C RNA method, the GBV-C RNA concentration did not correlate with baseline or set point HIV RNA levels; however, a correlation between negative, low, and high GBV-C RNA levels and increasing reduction in HIV RNA following antiretroviral therapy was observed. Subjects with both GBV-C E2 antibody and viremia had significantly lower GBV-C RNA levels than did viremic subjects without E2 antibody. These studies demonstrate that accurate detection of GBV-C RNA by nested RT-PCR requires the use of primers representing multiple genome regions. Analyses based on testing with single primers do not lead to reliable conclusions about the association between GBV-C infection and clinical outcomes.

Rationale and design of ACTIVE: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events

BACKGROUND

Atrial fibrillation (AF) is the most frequently occurring cardiac arrhythmia with often serious clinical consequences. Many patients have contraindications to anticoagulation, and it is often underused in clinical practice. The addition of clopidogrel to aspirin (ASA) has been shown to reduce vascular events in a number of high-risk populations. Irbesartan is an angiotensin receptor-blocking agent that reduces blood pressure and has other vascular protective effects.

METHODS AND RESULTS

ACTIVE W is a noninferiority trial of clopidogrel plus ASA versus oral anticoagulation in patients with AF and at least 1 risk factor for stroke. ACTIVE A is a double-blind, placebo-controlled trial of clopidogrel in patients with AF and with at least 1 risk factor for stroke who receive ASA because they have a contraindication for oral anticoagulation or because they are unwilling to take an oral anticoagulant. ACTIVE I is a partial factorial, double-blind, placebo-controlled trial of irbesartan in patients participating in ACTIVE A or ACTIVE W. The primary outcomes of these studies are composites of vascular events. A total of 14000 patients will be enrolled in these trials.

CONCLUSIONS

ACTIVE is the largest trial yet conducted in AF. Its results will lead to a new understanding of the role of combined antiplatelet therapy and the role of blood pressure lowering with an angiotensin II receptor blocker in patients with AF.

Life-cycle assessment of municipal solid wastes: development of the WASTED model

This paper describes the development of the Waste Analysis Software Tool for Environmental Decisions (WASTED) model. This model provides a comprehensive view of the environmental impacts of municipal solid waste management systems. The model consists of a number of separate submodels that describe a typical waste management process: waste collection, material recovery, composting, energy recovery from waste and landfilling. These submodels are combined to represent a complete waste management system. WASTED uses compensatory systems to account for the avoided environmental impacts derived from energy recovery and material recycling. The model is designed to provide solid waste decision-makers and environmental researchers with a tool to evaluate waste management plans and to improve the environmental performance of solid waste management strategies. The model is user-friendly and compares favourably with other earlier models.