Physical Activity Moderates the Association Between Pain and Depressive Symptoms Among Persons with Multiple Sclerosis

OBJECTIVE

The present study examined physical activity as a possible moderator in the relationship between pain and depressive symptoms among persons with multiple sclerosis (PwMS).

METHOD

Fifty-three PwMS completed a comprehensive neuropsychological test battery and psychosocial questionnaires. Pain was operationalized as a composite of measures from the Brief Pain Inventory. Metabolic equivalents (METs) of energy expended during self-reported vigorous activity (VA), moderate activity (MA), and walking, as well as global physical activity which combined the three, were derived from the International Physical Activity Questionnaire-Short Form. Self-reported physical activity was measured using the Cognitive Health Questionnaire Exercise Scale. Regressions on depressive symptoms (Beck Depression Inventory-Fast Screen) examining both conceptualizations of physical activity, pain, and their interactions were explored.

RESULTS

Regression analyses revealed that interactions between pain and each measure of global physical activity were significant (p = .01). Simple effects tests revealed that pain only influenced depressive symptoms in PwMS with low global physical activity METs (p < .001) and low overall self-reported physical activity (p < .001). The separate interactions between pain and METs during self-reported VA, MA, and walking on depressive symptoms were not significant.

CONCLUSION

We found that global physical activity moderated the relationship between pain and depressive symptoms in MS. Specifically, pain influenced depressive symptoms in PwMS who engaged in less overall physical activity. These results highlight the importance of screening PwMS for pain and suggest that behavioral interventions aimed at increasing overall lifestyle physical activity may be useful in improving depressive outcomes in PwMS with pain.

Affective Disturbance and Neurocognitive Variability in College Athletes

OBJECTIVE

Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous research found that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed (A/PS) at baseline compared to healthy controls. However, this work solely examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance.

METHOD

835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into four groups (Healthy Mood [n = 582], Depression Alone [n = 137], Anxiety Alone [n = 54], and Co-Occurring Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined globally and within composites of A/PS and memory via intraindividual standard deviation, with higher scores indicating greater variability.

RESULTS

Linear regression results revealed that the Co-Occurring Depression/Anxiety group exhibited greater variability within the memory composite compared to the Healthy Mood group, as well as the Depression Alone and Anxiety Alone groups. The Depression Alone and Anxiety Alone groups did not differ from the Healthy Mood group on memory IIV. None of the groups differed on A/PS or global IIV.

CONCLUSIONS

Athletes with co-occurring depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that neuropsychological performance is interpreted beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance, as these factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.

Cognitive Reserve Moderates the Effects of Fatigue and Depressive Symptoms in Multiple Sclerosis

To investigate cognitive reserve as a possible moderator in the relationship between fatigue and depressive symptoms in persons with multiple sclerosis (PwMS). Fifty-three PwMS (37 female; mean age, 52.66; mean education, 14.81) completed comprehensive neuropsychological testing and psychosocial questionnaires assessing the perceived effects of fatigue (Fatigue Impact Scale) and depressive symptoms (Beck Depression Inventory-Fast Screen). Cognitive reserve (CR) was operationalized as Fixed CR and Malleable CR. Fixed CR was quantified as the standardized mean of years of education and a vocabulary-based estimate of premorbid intelligence. Malleable CR was quantified as the standardized mean of cognitive exertion, exercise, and socializing items from the Cognitive Health Questionnaire. Regressions on depressive symptoms examining fatigue, both conceptualizations of CR, and their interactions were explored. A Bonferroni correction was used; results were considered significant at an alpha level of p < .01. The interactions between fatigue and both conceptualizations of CR were significant, p = .005 (Fixed CR); p = .004 (Malleable CR). Simple effects tests revealed that fatigue only predicted depressive symptoms in PwMS with low Fixed CR or low Malleable CR (p's < .001), and not in those with high Fixed or high Malleable CR (p > .01). Cognitive reserve moderated the relationship between fatigue and depressive symptoms in PwMS. Specifically, fatigue does not appear to influence depression in PwMS with high cognitive reserve. Having higher cognitive reserve (either Fixed or Malleable) may reduce the likelihood that fatigue will lead to depressive symptoms in MS.

A - 161 Acute Injury Characteristics and Cognitive Post-Concussion Symptom Reporting in Collegiate Athletes with Sports-Related Concussion

OBJECTIVE

Surprisingly little is known about how acute injury characteristics (i.e., loss of consciousness [LOC], retrograde amnesia [RA], and anterograde amnesia [AA]) predict cognitive symptom reporting after sports-related concussion (SRC). This study examined this relationship in collegiate athletes who sustained an SRC. We predicted that athletes who endorsed LOC, RA, and AA would report more cognitive symptoms.

METHOD

141 collegiate athletes who recently sustained an SRC were grouped based on whether they experienced LOC, RA, or AA. Cognitive symptoms were assessed by the cognitive cluster of the Post Concussion Symptoms Scale (PCSS-Cog) both categorically (i.e., presence of symptoms) and continuously (i.e., total score). Chi-square tests investigated group differences on the presence of cognitive symptoms, and independent samples t-tests examined group differences on PCSS-Cog scores.

RESULTS

Athletes who experienced RA were significantly more likely to report cognitive symptoms than those without RA (RA+/PCSS-Cog+ = 62.50%; RA-/PCSS-Cog+ = 40.17%), X2 (1, N = 141) = 4.03, p = 0.045. Similar results were observed for athletes who endorsed AA (AA+/PCSS-Cog+ = 58.82%; AA-/PCSS-Cog+ = 35.56%), X2 (1, N = 141) = 7.15, p = 0.007. There was not a significant relationship between cognitive symptom endorsement and LOC. Athletes who experienced AA had significantly higher PCSS-Cog scores (M = 3.27, SD = 4.60) than those without AA (M = 1.39, SD = 3.04), t(75.22) = 2.62, p = 0.011, 95% CI[0.45, 3.32]. However, there was not a significant relationship between PCSS-Cog scores and LOC or RA.

CONCLUSIONS

Results suggest that athletes who experience amnesia during SRC are more likely to report cognitive symptoms post-concussion. Moreover, amnesia may be a risk factor for increased self-reported cognitive dysfunction, and athletes who experience RA and especially AA may require more careful SRC management.

Prospective Implications of Insufficient Sleep for Athletes

CONTEXT

Poor sleep is common in collegiate student-athletes and is associated with heterogeneous self-reported complaints at baseline. However, the long-term implications of poor sleep at baseline have been less well studied.

OBJECTIVE

To examine the implications of insufficient sleep at baseline, as well as factors such as symptom reporting and neurocognitive performance at baseline associated with insufficient sleep, for the risk of sport-related concussion (SRC).

DESIGN

Cross-sectional study.

SETTING

Undergraduate institution.

PATIENTS OR OTHER PARTICIPANTS

Student-athletes (N = 614) were divided into 2 groups based on the hours slept the night before baseline testing: sufficient (>7.07 hours) or insufficient (≤5.78 hours) sleepers. Athletes who went on to sustain an SRC during their athletic careers at our university were identified.

MAIN OUTCOME MEASURE(S)

Four symptom clusters (cognitive, physical, affective, and sleep) and headache were examined as self-reported outcomes. Four neurocognitive outcome measures were explored: mean composite of memory, mean composite of attention/processing speed, memory intraindividual variability (IIV), and attention/processing speed IIV.

RESULTS

Insufficient sleepers at baseline were nearly twice as likely (15.69%) as sufficient sleepers (8.79%) to go on to sustain an SRC. Insufficient sleepers at baseline, whether or not they went on to sustain an SRC, reported a higher number of baseline symptoms than did sufficient sleepers. When compared with either insufficient sleepers at baseline who did not go on to incur an SRC or with sufficient sleepers who did go on to sustain an SRC, the insufficient sleep group that went on to incur an SRC performed worse at baseline on mean attention/processing speed.

CONCLUSIONS

The combination of insufficient sleep and worse attention/processing speed performance at baseline may increase the risk of sustaining a future SRC.

Functional Outcomes, Injury Variables, and Athlete Characteristics Associated with Post-Concussion Sleep Disturbance

OBJECTIVE

To examine the relationship between sleep disturbance and functional outcomes following a concussion. Also, to explore athlete and injury-related variables that may be related to risk factors for poor sleep following concussion.

METHOD

124 collegiate athletes completed a neuropsychological evaluation within 14 days of sustaining a sport-related concussion (SRC). Athletes were categorized as sleep disturbed (n = 52) or not sleep disturbed (n = 72). Outcome variables included symptom reports, cognitive performance (mean performance and variability), and mood (depression). Injury characteristics and athlete characteristics explored were loss of consciousness (LOC) associated with the injury, whether the athlete was immediately removed from play, and history of prior concussions.

RESULTS

Sleep disturbed athletes reported more symptoms, F(4, 119) = 7.82, p < 0.001, ƞ2 = 0.21, were more likely to be symptomatic at the time of testing, χ2(1, N = 124) = 19.79, p < 0.001, φ = 0.40, and were marginally more likely to experience clinically significant depression, χ2(1, N = 120) = 3.03, p = 0.08, φ = 0.16, than not sleep disturbed athletes. There were no cognitive differences between the groups, p > 0.05. A greater proportion of sleep disturbed athletes experienced LOC (30%) compared to not sleep disturbed athletes (13%), χ2(1, N = 118) = 4.99, p = 0.03, φ = -0.21.

CONCLUSION

Sleep disturbances following SRC are associated with a broad range of self-reported symptoms. LOC may be associated with an increased risk of developing sleep disturbances; alternatively, sleep disturbances may increase the risk of LOC following concussion.

Subjective Report, Objective Neurocognitive Performance, and "Invisible Symptoms" in Multiple Sclerosis

BACKGROUND

Self- and informant-report measures are often useful in predicting objective cognitive performance; however, the relationship between these reports and mood, anxiety, and fatigue requires further examination. Additionally, it remains unclear as to how these factors might be associated with objective neurocognitive performance.

METHODS

Eighty-six persons with multiple sclerosis (PwMS; F = 65, M = 21) completed a comprehensive neuropsychological battery that included objective neurocognitive measures, subjective reports of neurocognitive function with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) Self-Report (MSNQ-S) and Informant-Report (MSNQ-I), and self-report measures of anxiety, depression, and fatigue. Hierarchical linear regressions were conducted with depression, anxiety, the interaction between depression and anxiety, cognitive fatigue, and physical fatigue as predictors. Outcome variables included the MSNQ-S, MSNQ-I, each of five neurocognitive composites, and global intraindividual variability (IIV).

RESULTS

Although greater cognitive fatigue was associated with greater reported cognitive dysfunction, it was not associated with objective neurocognitive impairment. Greater depression predicted poorer performance on measures of processing speed and verbal memory, though the effects became non-significant once accounting for anxiety. The interaction between depression and anxiety predicted greater neurocognitive IIV; those with high levels of depression and anxiety demonstrated greater dispersion of scores.

CONCLUSIONS

Cognitive fatigue may skew one's perception of their cognition, though it is not associated with objective impairment. However, co-occurring depression and anxiety were associated with greater variability which is a marker of poorer neurocognitive integrity. Our findings highlight the importance of accounting for depression, anxiety, and cognitive fatigue in PwMS, given that they are all potentially modifiable factors.

A-12 Physical Activity Attenuates the Effect of Pain on Depression Symptoms in Multiple Sclerosis

Objective: This study examined physical activity as a potential moderator of the relationship between pain and depression symptoms in persons with multiple sclerosis (PwMS). We hypothesized that pain would predict depression symptoms only in PwMS with low physical activity.

Method: Fifty-four PwMS (38 female) completed a comprehensive neuropsychological test battery and questionnaires. Pain was operationalized as a composite of measures from the Brief Pain Inventory (BPI). The metabolic equivalents (METs) of energy expended during vigorous activity (VA), moderate activity (MA), and walking, as well as global activity which combined the three, were derived from the International Physical Activity Questionnaire-Short Form (IPAQ-SF) based on parameters previously used by Dlugonski et al. (2011). Lower METs suggest less physical activity. The Beck Depression Inventory-Fast Screen (BDI-FS) was used to measure depression symptoms. Linear regressions on depression examining pain, each physical activity index, and their interactions were explored.

Results: Regression analyses showed that the interaction between pain and global MET significantly predicted depression (p = 0.01). Simple effects tests revealed that pain predicted depression symptoms only in PwMS with low MET scores (p &lt; 0.001). The separate interactions between pain and VA, MA, and walking predicting depression symptoms were not significant.

Conclusion: We found that global physical activity moderated the relationship between pain and depression in MS. Specifically, pain predicted depression symptoms in PwMS who engaged in less physical activity. These results highlight the importance of screening PwMS for pain and suggest that interventions aimed at increasing overall physical activity may be useful in improving depression outcomes in PwMS with pain.

A-38 Sport-related Concussion as a Stressor: Differential Memory for Emotion and Neutral Words

Purpose: To explore if the acute stress associated with sport-related concussion (SRC) leads to differential memory for neutral versus emotion words. Based on a Roozendaal and colleagues’ (2002) model of stress and memory, we hypothesized: Following SRC, athletes will demonstrate better recall for neutral compared to emotion words at immediate recall but demonstrate the reverse pattern on delayed recall, with better recall for emotion compared to neutral words. Methods: 80 (73 Males,7 Females) collegiate athletes completed a neuropsychological evaluation within 14 days of SRC. Two verbal learning and memory tasks were administered: neutral words [Hopkins Verbal Learning Test-Revised (HVLT-R)] and emotion words [Affective Word List (AWL)]. Both tasks had three learning trials and a delayed (20–25 minutes) recall. Paired samples t-tests were conducted to compare memory for emotion words (AWL) and neutral words (HVLT-R): AWL Total Immediate Recall vs. HVLT-R Total Immediate Recall and AWL Delayed Recall vs. HVLT-R Delayed Recall. Results: Following concussion, athletes’ memory for neutral words (M = 94.92, SD = 16.17) did not significantly differ from memory for emotion words (M = 96.83, SD = 18.28) on immediate recall trials, (t(79) = −0.91, p = 0.37, d = 0.11). However, memory for emotion words (M = 96.83, SD = 16.98) was significantly better than memory for neutral words (M = 90.84, SD = 20.58) after a delay, (t(79) = 2.97, p = 0.004, d = −0.33). Conclusions: Our results demonstrate that the stress associated with SRC differentially impacts delayed retrieval of neutral compared to emotion words. Because memory is often impaired following SRC, a more nuanced examination of learning and memory can help clinicians understand neuropsychological deficits associated with SRC, and possibly have implications for addressing memory difficulties.

A-165 Normative Data for the Rivermead Behavioral Memory Test (RBMT) in Collegiate Athletes

Objective

The Rivermead Behavioral Memory Test (RBMT) Story subtest has four alternate forms. While the use of different forms allows for greater test–retest reliability, it is unclear whether these forms are comparable in terms of difficulty and expected performance. Thus, this study aimed to evaluate performance on the different forms of the RBMT in college athletes.

Method

Our sample consisted of 602 (M = 450, F = 152) college athletes tested at baseline. We evaluated performance differences on the four different RBMT forms for immediate and delayed recall.

Results

Independent samples t-tests revealed significant differences between all forms at immediate recall, except when comparing Form A to Form B. There were also significant differences between all forms at delayed recall. Among males, there was a significant difference among most forms at immediate recall, with the exception of Form A compared to Form B. Additionally, among males, there was a significant difference among most forms at delayed recall, with the exception of Form A compared to Form D. Among females, findings indicate that Form A and Form B were comparable and not statistically different at immediate and delayed recall. Additionally, Form C and Form D were comparable and not significantly different at immediate and delayed recall among females.

Conclusions

The significant differences found between many of the RBMT forms at both immediate and delayed recall were further illuminated when accounting for sex differences. Therefore, we recommend using normative data that accounts for form and sex differences when using the RBMT, especially in cases where baseline testing is not available.

A-93 Comorbidity or Concussion: Can we Tell the Difference?

Objective

To evaluate athletes with comorbid mood disturbances at baseline (without recent concussion) compared to those without mood symptoms tested post-concussion. This study is predicated upon previous findings showing that athletes with comorbidity at baseline demonstrate greater neurocognitive impairment, and report greater symptomatology, than healthy controls. It is currently unclear how athletes with comorbidity at baseline compare to athletes post-concussion.

Method

119 college athletes completed objective neurocognitive testing, including measures of depression and anxiety. Athletes were separated into two groups: those with symptoms of comorbid anxiety/depression at baseline (n = 61,M = 35,F = 26) and those without such mood symptoms tested post-concussion (n = 58,M = 52,F = 6). All post-concussion athletes were tested within 14 days of injury. There were no overlapping athletes in these groups. Groups were compared on neurocognitive performance on mean z-score composites of Attention/Processing Speed (A/PS) and Memory.

Results

Regression results revealed that, on the A/PS composite, the Baseline Comorbid group (M = −0.15,SD = 0.64) did not differ significantly from the Post-Concussion Healthy Mood group (M = 0.05,SD = 0.62), t(117) = 1.75,p = 0.08, though there was a small effect size, d = 0.32. Additionally, on the Memory composite, the Baseline Comorbid Group (M = -0.12,SD = 0.69) did not differ from the Post-Concussion Healthy Mood group (M = -0.11,SD = 0.84), t(117) = 0.08,p = 0.94,d = 0.01.

Conclusions

These results suggest that athletes with comorbid anxiety/depression tested at baseline perform similarly to recently concussed athletes without mood disturbance, on objective neurocognitive measures. Thus, despite not experiencing recent injury, athletes with comorbidity present with similar neurocognitive profiles as athletes with recent concussions. These findings highlight the impact of comorbid mood disturbance on cognitive performance and demonstrate the importance of accounting for mood symptomatology when conducting neuropsychological assessments.

A-76 Coping Style Moderates the Effect of Pain on Depression in Multiple Sclerosis

Objective

The present study examined coping style as a possible moderator in the relationship between pain and depression in persons with multiple sclerosis (PwMS).

Method

Fifty-four PwMS (38 female) completed a comprehensive neuropsychological test battery and psychosocial questionnaires. Pain was measured using the Brief Pain Inventory (BPI), and indices of pain severity and pain interference were derived. Active coping and avoidant coping scores were derived from the COPE Questionnaire. The Beck Depression Inventory-Fast Screen (BDI-FS) was used to measure depression.

Results

Regression analyses revealed that the interactions between pain severity and both avoidant (p = 0.005) and active (p = 0.004) coping composites significantly predicted depression. Simple effects tests revealed that pain severity predicted depression in PwMS with low active coping (p &lt; 0.001) and high avoidant coping (p &lt; 0.001), but not high active coping or low avoidant coping. The interactions between pain interference and both avoidant (p = 0.02) and active (p = 0.008) coping composites also significantly predicted depression. Simple effects tests revealed that pain interference predicted depression in PwMS with low active coping (p &lt; 0.001), high active coping, (p = 0.048), and high avoidant coping (p &lt; 0.001), but not low avoidant coping.

Conclusions

We found that coping style moderated the relationship between pain and depression in MS. Pain severity and pain interference predicted depression in PwMS who exhibited less active and more avoidant coping. Interventions that aim to reduce avoidant coping and increase active coping skills may be useful in improving affective outcomes in PwMS.

A-115 Does Cognitive Reserve Moderate Functional Outcomes for Collegiate Athletes with Sports-Related Concussion?

Objective

Studies are lacking that examine whether cognitive reserve (CR) plays a role in differential outcomes for individuals in sports-related concussion (SRC), particularly within the acute phase. This study explored the relationship between CR (WTAR FSIQ), concussion severity (total PCSS score), and three separate outcome measures: cognitive functioning, return-to-play (RTP) time, and depression symptoms.

Method

The total sample included 175 (Males = 131, Females = 44) student-athletes at a Division I University, but only a subset of participants had RTP data available (N = 72; Males = 57, Females = 15). Regression analyses were conducted with CR, PCSS, and their interaction as the main predictor variables for the three separate dependent variables (neurocognitive composite, days to RTP, and BDI-FS total). Sex was found to be significantly related to the neurocognitive variable and the RTP variable and was included in those analyses as a covariate.

Results

For the first regression predicting neurocognitive performance, sex (t = 4.63, p &lt; 0.001) was the only significant predictor. For the second regression predicting depression symptoms, PCSS (t = 4.52, p &lt; 0.001) was the only significant predictor. For the third regression predicting RTP time, sex (t = 3.77, p &lt; 0.001) was the only significant predictor.

Conclusion

Our results did not support a significant moderating effect of CR on the relationship between concussion symptom severity and our three outcome measures (cognitive performance, depression symptoms, RTP time). However, sex appeared to be an important predictor for neurocognitive performance, with females performing significantly higher on average than males, and for RTP times, with females having significantly longer RTP times than males.

A-14 Mechanisms and Neuropsychological Correlates of Sleep Disruption in Concussed College Athletes

Objective

First, to explore demographic/injury characteristics associated with increased sleep disruption post-concussion. Second, to examine the association between sleep disruption post-concussion and symptom reporting and cognitive variability.

Method

124 athletes (M = 103, F = 21) completed neuropsychological testing within 14 days of concussion. Athletes were categorized as sleep-disrupted (n = 52) or not sleep-disrupted (n = 72). Athletes in the sleep-disrupted group endorsed one or more of the following from the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) Post-Concussion Symptom Scale (PCSS): trouble falling asleep, sleeping more than usual, and sleeping less than usual. Loss of consciousness (LOC) and concussion history were explored. Two neurocognitive variability measures were derived from the neuropsychological battery: intraindividual standard deviation (ISD) and maximum discrepancy score (MDS). Variability in memory and attention/processing speed (APS) composites were explored. Total PCSS symptom score, without sleep items, was calculated.

Results

A significantly greater proportion of sleep-disrupted athletes experienced LOC (30%) compared to not sleep-disrupted athletes (13%), χ2(1,N = 118) = 4.99, p &lt; 0.03, φ = 0.21. Sleep-disrupted athletes reported more symptoms, t(122) = −5.42, p &lt; 0.001, d = 0.98, and demonstrated more memory variability (memory ISD, t(122) = −2.22, p = 0.03, d = 0.40, and memory MDS, t(122) = −2.29, p = 0.02, d = 0.41) than not sleep-disrupted athletes. Groups did not differ in APS variability or concussion history.

Conclusions

Given the higher rate of LOC in sleep-disrupted athletes, it is possible that LOC is a mechanism leading to post-concussion sleep difficulties. Furthermore, sleep disruption following concussion results in more variable memory performance and higher symptom reporting. Symptom reporting and/or return to baseline cognitive functioning are often decision-making tools in concussion management. The difficulties experienced by sleep-disrupted athletes may complicate recovery.

GnRH agonist for protection against ovarian toxicity during chemotherapy for early breast cancer: the Anglo Celtic Group OPTION trial

Background

Chemotherapy-induced premature ovarian insufficiency (POI) impacts fertility and other aspects of women's health. The OPTION trial tested whether administration of a gonadotropin-releasing hormone agonist during chemotherapy for early breast cancer reduced the risk of POI.

Patients and methods

This was a prospective, randomized, parallel group study of the gonadotropin-releasing hormone agonist goserelin administered before and during chemotherapy for breast cancer with stage I-IIIB disease. The primary outcome was amenorrhoea between 12 and 24 months after randomization, supported by elevated follicle stimulating hormone concentrations to give an additional analysis as rate of POI.

Results

A total of 227 patients were randomized and the primary analysis was conducted on 202 patients. Goserelin reduced the prevalence of amenorrhoea between 12 and 24 months to 22% versus 38% in the control group (P = 0.015) and the prevalence of POI to 18.5% versus 34.8% in the control group (P = 0.048). Follicle stimulating hormone concentrations were also lower in all women treated with goserelin at both 12 and 24 months (P = 0.027, P = 0.001, respectively). The effect of goserelin was not statistically significant in women >40 years. Assessment of the ovarian reserve using anti-Müllerian hormone showed a marked fall in both groups during treatment to median values of 5% of pretreatment levels in the control group and 7% in the goserelin group, which were not significantly different between groups.

Conclusion

This study shows that goserelin reduced the risk of POI in women treated with chemotherapy for early breast cancer, with particular efficacy in women aged ≤40 years old. The degree of ovarian protection also seems limited and the clinical significance for fertility and longer term prevention of estrogen deficiency-related outcomes needs to be determined.

Investigating photoreceptor densities, potential visual acuity, and cone mosaics of shallow water, temperate fish species

The eye is an important sense organ for teleost species but can vary greatly depending on the adaption to the habitat, environment during ontogeny and developmental stage of the fish. The eye and retinal morphology of eight commonly caught trawl bycatch species were described: Lepidotrigla mulhalli; Lophonectes gallus; Platycephalus bassensis; Sillago flindersi; Neoplatycephalus richardsoni; Thamnaconus degeni; Parequula melbournensis; and Trachurus declivis. The cone densities ranged from 38 cones per 0.01 mm(2) for S. flindersi to 235 cones per 0.01 mm(2) for P. melbournensis. The rod densities ranged from 22800 cells per 0.01 mm(2) for L. mulhalli to 76634 cells per 0.01 mm(2) for T. declivis and potential visual acuity (based on anatomical measures) ranged from 0.08 in L. gallus to 0.31 in P. melbournensis. Higher rod densities were correlated with maximum habitat depths. Six species had the regular pattern of four double cones arranged around a single cone in the photoreceptor mosaic, while T. declivis had only rows of double cones. P. melbournensis had the greatest potential ability for detecting fine detail based on eye anatomy. The potential visual acuity estimates and rod densities can be applied to suggest the relative detection ability of different species in a commercial fishing context, since vision is a critical sense in an illuminated environment for perceiving an oncoming trawl.

The Chernobyl Tissue Bank: integrating research on radiation-induced thyroid cancer

The only unequivocal radiological effect of the Chernobyl accident on human health is the increase in thyroid cancer in those exposed in childhood or early adolescence. Cancer is a complicated disease and it is unclear whether the mechanism by which radiation gives rise to cancer differs from that involved in the generation of cancers of the same type by other environmental stimuli. The Chernobyl Tissue Bank was established in response to the scientific interest in studying the molecular biology of thyroid cancer after Chernobyl to address this question. The project is supported by the governments of Ukraine and Russia, and financially supported (in total around US$3 million) by the European Commission, the National Cancer Institute of the USA and the Sasakawa Memorial Health Foundation of Japan. The project began collecting a variety of biological samples from patients on 1 October 1988, and has supplied material to 23 research projects in Japan, the USA and Europe. The establishment of the Chernobyl Tissue Bank has facilitated co-operation between these research projects and the combination of clinical and research data provides a paradigm for cancer research in the molecular biological age.

Integrating research on thyroid cancer after Chernobyl--the Chernobyl Tissue Bank

The only unequivocal radiological effect of the Chernobyl accident on human health is the increase in thyroid cancer in those exposed in childhood or early adolescence. In response to the scientific interest in studying the molecular biology of thyroid cancer after Chernobyl, the Chernobyl Tissue Bank was established. The project is supported by the governments of Ukraine and Russia, and financially supported (in total around US$3 million) by the European Commission, the National Cancer Institute of the USA and the Sasakawa Memorial Health Foundation of Japan. The project began collecting a variety of biological samples from patients on 1 October 1988, and has supplied material to 21 research projects in Japan, the USA and Europe. The establishment of the Chernobyl Tissue Bank has facilitated co-operation between these research projects and the combination of clinical and research data provides a paradigm for cancer research in the molecular biological age.

Metallothionein crypt-restricted immunopositivity indices (MTCRII) correlate with aberrant crypt foci (ACF) in mouse colon

Metallothionein (MT) crypt-restricted immunopositivity indices (MTCRII) are colonic crypt stem cell mutation markers that may be induced early and in abundance after mutagen treatment. Metallothionein is the endogenous reporter gene for MTCRII, but is not typically implicated in the classical pathway of colorectal tumorigenesis. Hence, the oncological relevance of MTCRII is unclear. This study tests the hypothesis that MTCRII induced by N-methyl-N-nitrosourea (MNU) and lambda carrageenan (lambdaCgN) associate with aberrant crypt foci (ACF) in mouse colon. Undegraded lambdaCgN and MNU were tested alone and in combination against MTCRII and ACF in Balb/c mice, at 20 weeks after the start of treatment. MTCRII were unaffected by lambdaCgN alone. Combined lambdaCgN/MNU treatments induced greater MTCRII (P < 0.01) as well as greater number (P < 0.001) and crypt multiplicity (P < 0.01) of ACF than MNU alone. MTCRII were approximately 10-fold more numerous than ACF, although linear correlations were observed between these parameters (r = 0.732; P < 0.01). MTCRII are induced by lambdaCgN/MNU interactions in sufficient numbers to provide statistical power from relatively small sample sizes and correlate with ACF formation. MTCRII could thus provide the basis for a novel medium-term murine bioassay relevant to early-stage colorectal tumorigenesis.

Nicotine: therapeutic potential for the treatment of ulcerative colitis

Ulcerative colitis (UC) is predominantly a disease of non-smokers, and nicotine may be the agent responsible for this association. Transdermal nicotine has been shown to improve disease activity and sigmoidoscopic appearance in the active disease but in one study had no effect on maintenance of remission. Since side-effects with nicotine patches occur in up to two thirds of patients, attempts to reduce systemic levels and improve drug tolerance have been developed with colonic delivery systems of nicotine. Preliminary observations with nicotine enemas in UC have shown clinical benefit, but controlled trials are needed. Mechanisms responsible for the association of smoking with colitis and for the therapeutic effect of nicotine remain an enigma; possibilities include: modulation of the immune response, alterations of colonic mucus and eicosanoid production, changes in rectal blood flow, decreased intestinal permeability and the release of endogenous glucocorticoids. With current treatment for UC limited to corticosteroids and formulations of 5-aminosalicylic acid, alternative treatments are required and nicotine may fulfil this role.

Investigation of loss of heterozygosity and SNP frequencies in the RET gene in papillary thyroid carcinoma

In both medullary carcinoma and papillary carcinoma of the thyroid, altered expression of the RET gene is implicated in tumorigenesis. Recent studies suggest that loss of heterozygosity (LOH) at the G691S SNP may be associated with tumors from patients with a history of radiation exposure. We investigated LOH for three RET SNPs (G691S, S904S, and L769L) in tumor and normal tissue from 46 patients from Ukraine and Belarus who were exposed to radioactive fallout following the Chernobyl nuclear accident and were operated for papillary thyroid carcinoma between 1995 and 2000. Normal tissue from 28 patients was heterozygous for at least one SNP; DNA from the corresponding tumor samples was also heterozygous, indicating that no LOH had taken place. To assess SNP frequencies in a radiation-associated thyroid cancer cohort, we investigated a further 68 unpaired post-Chernobyl samples. For G691S, there was considerable deviation from Hardy-Weinberg equilibrium; more detailed analysis showed that this was linked to age at onset of disease. Among younger patients, the distribution of genotypes conformed to Hardy-Weinberg equilibrium; among older patients, we observed marked deviation (p = 0.0072), with significant over-representation of the rare S allele relative to the younger groups (Fisher's exact, p = 0.0233). This suggests that SNPs in the RET oncogene may play a role in sporadic papillary thyroid carcinoma.

Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness

The large numbers of papillary thyroid carcinomas that have occurred in those exposed to high levels of short-lived isotopes in fallout after Chernobyl provide a unique opportunity to correlate latency and tumour biology. We show that short latency is associated with tumours with a phenotype that is significantly less structurally differentiated, shows significantly less peritumour fibrosis, and significantly more invasive spread when compared to tumours with a longer latent period. In contrast, the type of differentiation (papillary or follicular architecture) is associated with age at exposure. These findings suggest that the initial mutation at the time of exposure played a major role in tumour latency and aggressiveness. We and others have shown that RET-PTC3 rearrangements are associated with the solid morphology seen in these short latency tumours, while classical papillary carcinomas more often show RET-PTC1 rearrangements. Studies in transgenic mice show similar findings, and in vitro studies show that RET-PTC3 induces more rapid growth than RET-PTC1. We therefore suggest that the solid morphology, high frequency of RET-PTC3 rearrangements and aggressive behaviour noted in early investigations of post-Chernobyl tumours were characteristic of short latency rather than the nature of the mutagen, and that successive overlapping waves of papillary carcinoma with differing latency, differing patterns of mutations and differing clinical behaviour are occurring in those exposed to Chernobyl fallout.

Analysis of the Ki-67 antigen at the invasive tumour front of human oral squamous cell carcinoma

BACKGROUND

It is hypothesised that cell proliferation, as measured by the Ki-67 labelling index (LI) at the invasive tumour front (ITF) was directly related to the histological grade in human oral squamous cell carcinomas (SCCs).

METHODS

Tissues from 42 human oral SCCs were collected and stained with an antibody directed against the Ki-67 antigen using an advanced polymer staining system. Quantitation of the immunopositive cells was performed on two parallel sections at the invasive tumour front (ITF), using an image analyser. The Ki-67 LI was expressed as the number of positive nuclei/mm2 of epithelium. The control tissue used was normal epithelium at the excision margin.

RESULTS

The mean Ki-67 LI for oral SCCs at the ITF was significantly greater than that for the excision margin tissue (P < 0.0001). There was a positive association between increasing Ki-67 LI and increasing Broders' grade (P < 0.05), with a well-differentiated tumour having the lowest mean Ki-67 LI (1549 +/- 806) and a poorly differentiated tumour having the highest value (2232 +/- 771). A similar trend was observed between the mean Ki-67 LI and Bryne's multifactorial grading system.

CONCLUSIONS

It was concluded from this study that cell proliferation (as measured by the Ki-67 antigen) at the ITF had a strong positive relationship with histological grading in human oral SCC.

Enteric-release glyceryl trinitrate in active Crohn's disease: a randomized, double-blind, placebo-controlled trial

BACKGROUND

Mucosal ischaemia may contribute to the pathogenesis of Crohn's disease. Microvascular abnormalities have been found in colonic resection specimens, and mucosal levels of constitutive nitric oxide synthase are reduced.

AIM

To assess the efficacy of a novel, enteric-release formulation of the nitric oxide donor, glyceryl trinitrate, aimed at increasing the mucosal circulation and relaxing smooth muscle in the affected bowel.

METHODS

The trial was randomized, double-blind and placebo-controlled. Baseline disease activity was assessed by a structured symptom diary, with blood tests and a quality of life assessment. Patients with a Crohn's disease activity index of > or = 150 and < 450 were randomized to receive 12 weeks of either glyceryl trinitrate (initially 6 mg twice daily, increasing to 9 mg twice daily after 6 weeks) or an identical placebo. Assessments were repeated at 6 and 12 weeks.

RESULTS

Seventy patients (22 male) entered the study; 34 were given glyceryl trinitrate and 36 placebo. At 12 weeks, there were no differences between the treatment groups in terms of Crohn's disease activity index, pain, stool frequency, inflammatory markers or quality of life scores.

CONCLUSIONS

Enteric-release glyceryl trinitrate did not benefit patients with mild to moderately active Crohn's disease. Whilst ischaemia may contribute to the pathogenesis of Crohn's disease, our results fail to provide supportive evidence for this hypothesis.

Non-hepatic hyperammonaemia: an important, potentially reversible cause of encephalopathy

The clinical syndrome of encephalopathy is most often encountered in the context of decompensated liver disease and the diagnosis is usually clear cut. Non-hepatic causes of encephalopathy are rarer and tend to present to a wide range of medical specialties with variable and episodic symptoms. Delay can result in the development of potentially life threatening complications, such as seizures and coma. Early recognition is vital. A history of similar episodes or clinical risk factors and early assessment of blood ammonia levels help establish the diagnosis. In addition to adequate supportive care, investigation of the underlying cause of the hyperammonaemia is essential and its reversal, where possible, will often result in complete recovery. Detection of an unborn error of metabolism should lead to the initiation of appropriate maintenance therapy and genetic counselling.

Planning oral rehabilitation: case-based computer assisted learning in clinical dentistry

The partially edentulous adult offers a unique and problem-rich resource as a basis for a case-based learning scenario in clinical dentistry in the field of planning oral rehabilitation. However, there is little resource material available to help students negotiate the territory between diagnosis and treatment options of discrete conditions and treatment sequencing once decisions have been made. To address the educational void surrounding the teaching and learning of oral rehabilitation strategies, the authors have developed a CD-ROM 'Interactive Learning in Dentistry: Decision making in the oral rehabilitation of the partially edentulous adult'. The disc emphasises the distinction between 'doing' and 'planning to do' in the decision-making process. After using the disc the students should be able to apply a generic framework to formulate a custom oral rehabilitation plan for their own patient. The disc was evaluated by final-year students from the Faculty of Dentistry, University of Sydney. Response to the program was essentially positive and comments from students have impacted on further development.

Megacystis-microcolon-intestinal hypoperistalsis syndrome and the absence of the alpha3 nicotinic acetylcholine receptor subunit

BACKGROUND & AIMS

The megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a rare disease of childhood that presents early with intestinal hypoperistalsis, hydronephrosis, and hydroureters. Transgenic mice that lack the alpha3 subunit containing nicotinic acetylcholine (nAChR) have a phenotype similar to that of MMIHS.

METHODS

We examined the expression of this subunit in control and MMIHS tissue derived from patients using in situ hybridization (ISH) and immunocytochemistry (ICC).

RESULTS

In controls, both techniques showed a wide distribution of alpha3 nAChRs present in ganglion cells, muscle, and epithelium. By contrast, most MMIHS tissue gave negative staining with ISH and variable results with ICC.

CONCLUSIONS

These observations are consistent with a lack of alpha3 nAChRs contributing to the pathogenesis of MMIHS.

Capillary electrophoresis-based heteroduplex analysis with a universal heteroduplex generator for detection of point mutations associated with rifampin resistance in tuberculosis

BACKGROUND

Slab gel heteroduplex analysis (HDA), a popular scanning method for genetic mutations, uses DNA fragments typically generated by PCR to create homo- and heteroduplex molecules with conformational differences and sequence-dependent electrophoretic profiles. Use of a universal heteroduplex generator (UHG) enhances the subtle variations caused by single-base substitutions.

METHODS

The HDA-UHG slab gel format was modified for an efficient capillary-based method. The effect of staining dyes TOPRO5 and YOPRO1 on the analysis of heteroduplexes was studied, as well as ultraviolet absorbance and laser-induced fluorescence (LIF) detection methods. In addition, the entangled polymers hydroxyethyl cellulose, methyl cellulose, and linear polyacrylamide were evaluated as separation matrices.

RESULTS

This assay was able to detect the presence of Mycobacterium tuberculosis and its rifampin susceptibility directly from clinical specimens in dramatically reduced analysis time (30 min vs 2.5 h). Optimized conditions included 0.3% methyl cellulose as the separation matrix, on-line staining using 1 micromol/L YOPRO1, and LIF detection for quantitative and reproducible analysis of single-base substitutions in the rifampin resistance-determining region of rpoB that give rise to the rifampin-resistant phenotype of M. tuberculosis. We generated 95% confidence limits using the wild-type sequence and used these limits to determine rifampin susceptibility in samples.

CONCLUSIONS

Capillary electrophoresis, combined with the HDA-UHG technique, may be of value for rapid and efficient clinical diagnosis of rifampin-resistant tuberculosis strains.

DNA replication licensing and human cell proliferation

The convergence point of growth regulatory pathways that control cell proliferation is the initiation of genome replication, the core of which is the assembly of pre-replicative complexes resulting in chromatin being ‘licensed’ for DNA replication in the subsequent S phase. We have analysed regulation of the pre-replicative complex proteins ORC, Cdc6, and MCM in cycling and non-proliferating quiescent, differentiated and replicative senescent human cells. Moreover, a human cell-free DNA replication system has been exploited to study the replicative capacity of nuclei and cytosolic extracts prepared from these cells. These studies demonstrate that downregulation of the Cdc6 and MCM constituents of the replication initiation pathway is a common downstream mechanism for loss of proliferative capacity in human cells. Furthermore, analysis of MCM protein expression in self-renewing, stable and permanent human tissues shows that the three classes of tissue have developed very different growth control strategies with respect to replication licensing. Notably, in breast tissue we found striking differences between the proportion of mammary acinar cells that express MCM proteins and those labelled with conventional proliferation markers, raising the intriguing possibility that progenitor cells of some tissues are held in a prolonged G1 phase or ‘in-cycle arrest’. We conclude that biomarkers for replication-licensed cells detect, in addition to actively proliferating cells, cells with growth potential, a concept that has major implications for developmental and cancer biology.

Fluorescence, reflectance, and light-scattering spectroscopy for evaluating dysplasia in patients with Barrett's esophagus

BACKGROUND & AIMS

The aim of this study was to assess the potential of 3 spectroscopic techniques (fluorescence, reflectance, and light-scattering spectroscopy) individually and in combination, for evaluating low- and high-grade dysplasia in patients with Barrett's esophagus (BE).

METHODS

Fluorescence spectra at 11 excitation wavelengths and a reflectance spectrum were acquired in approximately 1 second from each site before biopsy using an optical fiber probe. The measured fluorescence spectra were combined with the reflectance spectra to extract the intrinsic tissue fluorescence. The reflectance spectra provided morphologic information about the bulk tissue, whereas light-scattering spectroscopy was used to determine cell nuclear crowding and enlargement in Barrett's epithelium.

RESULTS

Significant differences were observed between dysplastic and nondysplastic BE in terms of intrinsic fluorescence, bulk scattering properties, and levels of epithelial cell nuclear crowding and enlargement. The combination of all 3 techniques resulted in superior sensitivity and specificity for separating high-grade from non-high-grade and dysplastic from nondysplastic epithelium.

CONCLUSIONS

Intrinsic fluorescence, reflectance, and light-scattering spectroscopies provide complementary information about biochemical and morphologic changes that occur during the development of dysplasia. The combination of these techniques (Tri-Modal Spectroscopy) can serve as an excellent tool for the evaluation of dysplasia in BE.

Effect of an enteric-release formulation of naloxone on intestinal transit in volunteers taking codeine

INTRODUCTION

Constipation is a common side-effect of opioid therapy; in addition to their analgesic effect, opioids reduce intestinal secretion and motility with an increase in whole-gut transit time. Naloxone, a specific opioid antagonist, reverses these effects but may also cause symptoms of opioid withdrawal in patients on long-term therapy.

AIM

To use an enteric-release formulation, designed to produce a topical effect in the gut, with minimum systemic effects.

METHODS

Naloxone 10 mg b.d. and codeine 30 mg b.d. were used with identical placebo capsules in four sets of studies; 12 male volunteers were given the drugs alone and in combination, with a control study involving double placebo, during each of four study periods. Whole-gut transit time was calculated and compared for each treatment period.

RESULTS

Naloxone, both alone and with codeine, significantly shortened the mean whole-gut transit time compared with the control period, respectively, from 53.1 to 42.1 h (P=0.005) and to 40.7 h (P=0.024). Urgency to defecate was reported by two volunteers on naloxone alone and by three on combination therapy.

CONCLUSIONS

The results show that the naloxone formulation counteracts the effect of codeine on intestinal transit, suggesting that it may have useful clinical applications.

Membranous nephropathy associated with chronic immune thrombocytopenic purpura in childhood

Membranous nephropathy has been associated with many autoimmune diseases. We describe a child with membranous nephropathy associated with chronic immune thrombocytopenic purpura (ITP) and Coombs'-positive hemolytic anemia. After 3 years of ITP, the patient developed nephrotic syndrome during a flare of ITP. A biopsy specimen showed membranous nephropathy. Treatment with corticosteroids led to improvement of the thrombocytopenia and resolution of the proteinuria. Two years later, the patient again developed thrombocytopenia and proteinuria. Both conditions resolved after treatment with corticosteroids. This case suggests that ITP can cause membranous nephropathy.

Differences in susceptibility to colonic stem cell somatic mutation in three strains of mice

Different species and different strains of animals commonly show very different sensitivities to carcinogenic regimes, which are often unexplained. A major possible contributory factor is variation in susceptibility to mutation, but this has not been directly demonstrated. This study therefore quantified the colonic stem cell mutation frequency in three strains of mice using two carcinogens. Stem cell mutations were identified using loss of function of glucose 6-phosphate dehydrogenase (G6PD) in individual crypts, a technique validated by several previous studies. The carcinogens dimethylhydrazine (DMH) and ethyl nitrosurea (ENU) were given to Balb/C, C57BL/6J, and C3H mice. In response to DMH, Balb/C mice were most susceptible, with approximately double the stem cell mutation frequency found in C3H and more than ten-fold that found in C57BL/6J (3.3+/-0.71 vs. 1.5+/-0.52 vs. 0.28+/-0.8x10(-4)). In response to ENU, Balb/C mice and C3H mice were equally susceptible, showing a stem cell mutation frequency approximately twice that of C57BL/6J (3.1+/-0.4 vs. 3.1+/-0.65 vs. 1.63+/-0.28x10(-4)). The observed differences among the strains with respect to somatic mutation following DMH treatment are likely to be due to the previously documented differences in metabolic conversion to the active metabolite. However, as ENU is a directly acting, rapidly inactivated mutagen, strain differences in response to ENU are unlikely to be due to strain-dependent metabolism of the mutagen and are likely to reflect differences in DNA repair efficiency, or possibly in stem cell kinetics among the strains studied. Susceptibility to the induction of colonic stem cell mutation is an important factor in susceptibility to carcinogens, whether due to differences in DNA repair or to other factors. Direct quantification of stem cell mutation frequency allows the separate identification of this component of the carcinogenic cascade and shows that it can make a major contribution to the differing susceptibility of different mouse strains.

Combretastatin-A4 disrupts neovascular development in non-neoplastic tissue

Combretastatin-A4 phosphate (cis-CA-4) is a tubulin-binding agent currently undergoing clinical trials as an anti-tumour drug. We have investigated whether CA-4 functions as a tumour-specific anti-vascular agent using the hyperplastic thyroid as a novel in vivo model of neovascularization. CA-4 elicited pathological changes in normal tissue, manifested as the induction of multiple, discrete intravascular thrombi. These vascular-damaging effects indicate that CA-4P does not function as a tumour-specific agent but targets neovasculature irrespective of the primary angiogenic stimulus.

Nuclear localization of epidermal growth factor and epidermal growth factor receptors in human thyroid tissues

Epidermal growth factor (EGF) has widespread growth effects, and in some tissues proliferation is associated with the nuclear localization of EGF and epidermal growth factor receptor (EGFR). In the thyroid, EGF promotes growth but differs from thyrotropin (TSH) in inhibiting rather than stimulating functional parameters. We have therefore studied the occurrence and cellular distribution of EGF and EGFR in normal thyroid, in Graves' disease, where growth is mediated through the thyrotropin receptor (TSHR), and in a variety of human thyroid tumors. In the normal gland the staining was variable, but largely cytoplasmic, for both EGF and EGFR. In Graves' disease there was strong cytoplasmic staining for both EGF and EGFR, with frequent positive nuclei. Nuclear positivity for EGF and particularly for EGFR was also a feature of both follicular adenomas and follicular carcinomas. Interestingly, nuclear staining was almost absent in papillary carcinomas. These findings document for the first time the presence of nuclear EGF and EGFR in thyroid. Their predominant occurrence in tissues with increased growth (Graves' disease, follicular adenoma, and carcinoma) may indicate that nuclear EGF and EGFR play a role in growth regulation in these conditions. The absence of nuclear EGF and EGFR in papillary carcinomas would suggest that the role played by EGF in growth control differs between papillary carcinoma and follicular adenomas/carcinomas of the thyroid.