What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making

OBJECTIVE

To construct the underlying value structure of shared decision making (SDM) models.

METHOD

We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations.

RESULTS

We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism].

CONCLUSION

SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction.

PRACTICE IMPLICATIONS

This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.

Twelve tips to teach culturally sensitive palliative care

With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.

Impact of sampling origin on molecular detection of high-risk human papillomavirus and oncogene expression

PURPOSE OF INVESTIGATION

The recognition of high-risk human papillomavirus (HR-HPV) as an etiological agent of cervical cancer has increased the importance of testing for HPV, and this might contribute to better risk stratification.

METHODS

Eighty-eight randomly selected cervical cancer specimens including biopsies and their respective smears were used in this study. Control scrapings were obtained from ten healthy women. The presence of HPV16 and HPV18 was investigated using the technique of polymerase chain reaction (PCR) with the specific primers for the L1 region, while mRNA expression of HPV16 E6-E7 was evaluated by a reverse transcription PCR method (RT-PCR).

RESULTS

The positivity for the viral genotype was influenced by the quantity of amplified DNA used. In tumor biopsies the higher positivity for HPV16 (54.5%) and HPV18 (15.9%) was obtained using 687.4 ng of DNA. At smears level solely 31.8% of HPV16 was detected using an average DNA quantity of about 157.2 ng. The revelation of HPV types depends on clinicopathologic data; HPV16 was detected more in advanced stages of squamous carcinoma (SC) samples (20% stage I, 62% Stage II and 80% stage III), while HPV18 and double infection were found exclusively at advanced stages of SC and in adenocarcinoma (AC), respectively (60%, 40% stage III SC and 80%, 20% Stage II A and C). The prevalence of HPV16 E6-E7 transcripts was evaluated at tumor biopsy with frequencies of 50%.

CONCLUSION

Our data provide prospective evidence that HPV16/18L1 revelation at biopsy toward pathological types is efficient and correlates well with oncogenic transcript findings. Subtle changes in viral oncogene dynamics highlight the presence of other regulating proteins serving as additional biomarkers.

Profile of NF-κBp(65/NFκBp50) among prostate specific antigen sera levels in prostatic pathologies

AIM

The aim of this work was to characterise the immunoexpression of NF-κB (p50/p65) in human prostatic pathologies and to study its profiles of activation among sera prostate specific antigen antigen (PSA) according the three groups: 0-4ng/mL, 4-20ng/mL and >20ng/mL.

PATIENTS AND METHODS

Twenty-four men with benign prostate hyperplasia (BPH); 19 men with prostate cancer (PC) and five men with normal prostates (NP). Immunohistochemical and western blot analysis was performed. Serum levels of PSA were assayed by immulite autoanalyser.

RESULTS

In BPH and PC samples, immunoexpressions were observed for NF-κBp65 and NF-κBp50; while in NP samples, only were detected NF-κBp50. PC samples showed immunoreactions to NF-κBp65 and NF-κBp50 more intense (respectively 24.18±0.67 and 28.23±2.01) than that observed in BPH samples (respectively18.46±2.04 and 18.66±1.59) with special localisation in the nucleus. Different profiles of NF-κBp65 immunoexpressions were observed and BPH patients with sera PSA levels between 0-4ng/mL presented a significant weak percentage compared to BPH patients with sera PSA levels between 4-20ng/mL and >20ng/mL. No immunoreactions to NF-κBp65 were observed in PC patients with sera PSA levels between 4-20ng/mL.

CONCLUSION

The sensibility of both NF-κB and PSA to inflammation allowed confirming the relationship between these two molecules and its involvement in prostatic diseases progression (inflammatory and neoplasic).

[IL-2/IL-2R pathway in dendritic cell modulates both their cytokine synthesis profiles and their capacity to activate allogeneic CD4+ T lymphocytes]

The results provide new insights into the role of IL-2/IL-2R pathway in DC. We report that stimulation of human monocyte-derived DC with LPS strongly upregulated CD25 (α chain of the IL-2R) expression. In addition, by using a humanized monoclonal antibody against CD25, we demonstrated that the IL-2 signalling in DC upregulated both IL-12 and γIFN production but decreased IL-10 synthesis. Anti-CD25 treatment reduced the ability of LPS-DC to induce allogeneic CD4(+) T cell proliferation as compared to LPS-matured DC. In addition, LPS-matured DC treated with IL-2 had a higher allostimulatory capacity compared to LPS-DC. We also found that LPS-matured DC produced IL-2. Thus, IL-2 seems to contribute actively to DC activation through an autocrine pathway. Moreover, IL-2 pathway in DC is involved in T helper priming. These findings might be useful for protocols in cellular therapy and a valuable tool to understand graft rejection versus the acquisition of peripheral tolerance.

Serological study in Tunisian cervical cancer patients

OBJECTIVE

The aim of this study is to use a novel ELISA, based on five recombinant HPV-16 and HPV-18 proteins, for detection HPV-specific antibodies in a case-control study.

PATIENTS AND METHODS

L1, E6 and E7 genes have been over expressed in Escherichia coli as double fused proteins. These recombinant proteins were used in a GST-capture ELISA as coating antigens. Human sera were collected from women with cervical cancer. Negative human sera were collected from patients apparently healthy and may be affected by other infectious agents.

RESULTS

Most of the sera showed a positive reactivity to at least one of the HPV-16 or HPV-18 proteins (52/71). A percentage of 39.50% of the sera from HPV-16 infected women and 21.12% of the sera from women infected by HPV-18 genotype recognised at least one of the HPV-16 or HPV-18 proteins. Sera showed different reactivity to L1, E6 and E7 antigens, and only a few serum samples reacted to L1, E6 and E7 HPV-16, E6 and E7 HPV-18 (co-infection). Differences of reactivity between cases and controls were significant (P<0.0001).

CONCLUSION

This novel ELISA, based on recombinant HPV-16 and HPV-18 antigens, is able to detect antibodies in women infected by HPV genotypes. The assay is easy to perform and has low cost, making it suitable for monitoring the natural history of HPV infections as well as for detecting pre-existing HPV antibodies in women who receive vaccination.

Anti-CD25 antibodies affect cytokine synthesis pattern of human dendritic cells and decrease their ability to prime allogeneic CD4+ T cells

Anti-CD25 monoclonal antibodies are widely used in clinical transplantation to prevent acute allograft rejection. Although their effects on T lymphocytes have been extensively studied, their impact on human dendritic cells (DC) has never been reported. Furthermore, the role of the IL-2 in DC functions has not yet been fully elucidated. In this study, we confirm that the stimulation of human monocyte-derived DC with LPS strongly induced the expression of CD25 and that LPS-matured DC also expressed the beta and gamma chain of the IL-2R. We also showed that adding anti-CD25 monoclonal antibodies to LPS induced a decrease in IL-12, IL-1, TNF-alpha, IL-6, and IFN-gamma production and an increase in IL-10 synthesis by DC compared with stimulation with LPS alone. Furthermore, we showed that these modifications diminished the T helper priming ability of DC and polarized the alloimmune response toward TH2. In contrast, humanized anti-CD25 monoclonal antibodies did not affect the up-regulation of CD86, CD80, CD83, HLADR, or CD40 induced upon LPS stimulation. Taken together, this study discloses some previously unrecognized effects of anti-CD25 monoclonal antibodies on DC that may contribute to their clinical efficacy. In addition, this study also shed some light on the role of the IL-2 in human DC activation.

Generation of lymphokine-activated killer cells by adherent LGL phenotype cells and non-adherent T lymphocytes

In this work we separated human blood lymphocytes (PBL) in two populations (A-LAK and NA-LAK cells) by the adherence plastic method. A maximum adherence of cells was obtained after 2 days of PBL incubation in LAK medium containing 500 U/ml rIL-2. The A-LAK cells had LGL phenotype but 40% of them had a macrophage phenotype marker and less than 20% weakly expressed a T-cell marker. This population, when reincubated in culture, produced an increasing titre of interferon. At the same time, a significant NK activity against K562 target cells was measured just after enrichment; these enriched adherent cells also developed an increased LAK activity against DAUDI cell lines, ninefold more at 6 days than when assayed just after enrichment. In contrast, 75% of the NA-LAK enriched cells expressed T-cell marker; these produced two- to threefold less interferon than A-LAK cells at all time-points. The NA-LAK lymphocytes enhanced principally LAK activity measured by 70% lysis against DAUDI target cells tested at 6 days of culture. Further studies are in progress to determine the nature of the effector cells that mediated LAK activity.

Formation and persistence of DNA adducts in epidermal and dermal mouse skin exposed to benzo(a)pyrene in vivo

Tritiated benzo(a)pyrene was applied topically to 35 old male Swiss mice that received 250 nMole (0.63 mCi) per mouse in 150 microliters acetone. At each time point of study, 1, 3 and 7 days, 10 animals were killed, the skin was removed and the susceptible epidermic cells were separated from resistant dermis. The initial level of the total BaP-DNA adduct after 1 day of test was 2 fold higher in epidermic cells; in addition, the concentration of the individual modified deoxyribonucleoside adducts was 4 fold greater in epidermis. However, the nature and the repartition of the modified nucleosides analyzed by high performance liquid chromatography were similar. They were 5 fold more in epidermic cells, except for the (+/-) SynBaP- diolepoxide - deoxyguanosine adduct which was 2 fold more in dermic cells. The major DNA adduct formed in both types of cells was the (+) antiBaP diolepoxide - deoxyguanosine = (+) anti BPDE-dG with 75% of total adduct in epidermic and 55% in dermal cells. The decreased amount of BaP bound to DNA of epidermic and dermic cells may be similar and 90% of (+) anti BPDE-dG was removed after a week of treatment; in addition, a minority that bound with 9OH-BaP was also shown to be persistent. Although the persistence of adduct was 7 fold more important in susceptible epidermal cells than in the resistant dermic population, the nature of adduct repartition and the similar type of excision suggest that other mechanisms are also involved in the biologically different response of epidermis versus dermis to the carcinogenic BaP when it is applied topically.

High interferon titer and defective NK-cell activity in the circulation of nasopharyngeal carcinoma patients

The interferon (IFN) activity of sera from 19 patients with nasopharyngeal carcinoma (NPC) was determined by the plaque-reduction assay with vesicular stomatitis virus (VSV) in HeLa cells and compared to that of sera from matched healthy controls. High titers of interferon were detected in the sera of the NPC patients with a geometric mean titer (GMT) of 43 +/- 25 U/ml. The interferon activity of the patients' sera was acid- and heat-labile (pH = 2 and 56 degrees C for 1 hr) and could be neutralized by a goat antiserum to human IFN-gamma. Interferon titers of the patients, in contrast, to normal controls, were not correlated with natural killer (NK) activity which was abnormally low in the NPC patients. On the other hand, a high percentage of circulating cells co-expressing the LGL marker (HNK-I) and the OKT8 antigen was detected in parallel with high IFN levels in NPC patients.