Does Subtelomeric Position of COMMD5 Influence Cancer Progression?

The COMMD proteins are a family of ten pleiotropic factors which are widely conserved throughout evolution and are involved in the regulation of many cellular and physiological processes. COMMD proteins are mainly expressed in adult tissue and their downregulation has been correlated with tumor progression and poor prognosis in cancer. Among this family, COMMD5 emerged as a versatile modulator of tumor progression. Its expression can range from being downregulated to highly up regulated in a variety of cancer types. Accordingly, two opposing functions could be proposed for COMMD5 in cancer. Our studies supported a role for COMMD5 in the establishment and maintenance of the epithelial cell phenotype, suggesting a tumor suppressor function. However, genetic alterations leading to amplification of COMMD5 proteins have also been observed in various types of cancer, suggesting an oncogenic function. Interestingly, COMMD5 is the only member of this family that is located at the extreme end of chromosome 8, near its telomere. Here, we review some data concerning expression and role of COMMD5 and propose a novel rationale for the potential link between the subtelomeric position of COMMD5 on chromosome 8 and its contrasting functions in cancer.

HCaRG/COMMD5 inhibits ErbB receptor-driven renal cell carcinoma

Hypertension-related, calcium-regulated gene (HCaRG/COMMD5) is highly expressed in renal proximal tubules, where it contributes to the control of cell proliferation and differentiation. HCaRG accelerates tubular repair by facilitating re-differentiation of injured proximal tubular epithelial cells, thus improving mouse survival after acute kidney injury. Sustained hyper-proliferation and de-differentiation are important hallmarks of tumor progression. Here, we demonstrate that cancer cells overexpressing HCaRG maintain a more differentiated phenotype, while several of them undergo autophagic cell death. Its overexpression in mouse renal cell carcinomas led to smaller tumor size with less tumor vascularization in a homograft tumor model. Mechanistically, HCaRG promotes de-phosphorylation of the proto-oncogene erythroblastosis oncogene B (ErbB)2/HER2 and epigenetic gene silencing of epidermal growth factor receptor and ErbB3 via promoter methylation. Extracellular signal-regulated kinase, AKT and mammalian target of rapamycin which mediate ErbB-dowstream signaling pathways are inactivated by HCaRG expression. In addition, HCaRG is underexpressed in human renal cell carcinomas and more expressed in normal tissue adjacent to renal cell carcinomas of patients with favorable prognosis. Taken together, our data suggest a role for HCaRG in the inhibition of tumor progression as a natural inhibitor of the ErbB signals in cancer and as a potential prognostic marker for renal cell carcinomas.

Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program

OBJECTIVE

The objective of this secondary analysis was to examine the relationships between a reduction in psychological distress and long-term cardiac and psychological outcomes in post-myocardial infarction patients who participated in a randomized trial of home-based psychosocial nursing interventions (the Montreal Heart Attack Readjustment Trial [M-HART]). Gender differences were considered.

METHODS

We studied 433 patients (36.0% women) from the M-HART treatment group who received two home visits after achieving a high psychological distress score (ie, > or =5) on the General Health Questionnaire (GHQ). Short-term GHQ success was determined by a return to a normal GHQ score (<5) or a reduction of > or =50% after the two visits. Patients with short-term successful and unsuccessful GHQ outcomes were compared for mid-term maintenance of success, 1-year death and readmission rates, and 1-year depression and anxiety symptoms.

RESULTS

Patients with short-term GHQ success were more likely to show mid-term GHQ success (p < .001), marginally less likely to die of any causes (p = .087), less likely to die of cardiac causes (p = .043), less likely to be readmitted for any reason (p < .001) and for cardiac reasons (p < .001), and less likely to have high depression (p < .001) and anxiety (p < .001) at 1-year than patients with short-term unsuccessful GHQ outcomes. Results held for men and women and were not altered by controlling for potential confounders. However, the number of deaths prevented analysis with statistical controls.

CONCLUSIONS

Post-myocardial infarction interventions that reduce psychological distress have the potential to improve long-term prognosis and psychological status for both men and women.

Secondary analysis: theoretical, methodological, and practical considerations

Secondary analysis, which involves the use of existing data sets to answer new research questions, is an increasingly popular methodological choice among researchers who wish to investigate particular research questions but lack the resources to undertake primary data collections. Much time loss and considerable frustration may result, however, if researchers begin secondary analyses without an awareness of the distinctive methodological and practical challenges involved. This article highlights difficulties that may arise when researchers use data from previous clinical research projects, including theoretical issues and problems involving sampling, measurement, and external and ecological validity. It also offers practical suggestions for undertaking a secondary analysis and criteria for evaluating secondary analyses.

Informal and formal support for caregivers of a demented relative: do gender and kinship make a difference?

Gender and kinship were examined with regard to caregivers' use of informal and formal support and to two models of support (substitution or supplementation). Three groups of caregivers of a demented relative living at home--husbands, wives, and adult daughters--were compared on measures of both informal and formal support. The gender hypothesis deals with the similarities among caregivers of the same gender with respect to support. The kinship hypothesis refers to the similarities among caregivers having the same kinship with the carereceiver. The gender hypothesis was confirmed for informal informational support while the kinship hypothesis was supported for informal conflictual support. For most of the comparisons, the three groups of caregivers shared more similarities than differences. The interchangeability between informal and formal support seems to fall under the perspective of kinship because the daughter group is the only one where a model of supplementation was observed.

Cohabitation of alert residents with cognitively impaired peers in nursing homes: the nursing staff's point of view

The nursing staff's point of view has rarely been examined in regard to the difficulties of cohabitation of alert residents with those who are cognitively impaired. The aims of this study were to assess the nursing staff's preference for mixed or segregated care settings and to identify the factors related to this preference. A systematic sample of 349 nursing staff members working in mixed care settings in 19 nursing homes in Montreal (Canada) completed a questionnaire. There were as many staff members who favored mixed care settings as there were those who preferred segregated settings. A stepwise regression analysis revealed that 46% of the variance is explained by the model, and factors related to staff concerns about residents accounted for 42% of that variance. Notably, staff members who gave a lower rating to the disadvantages for lucid residents living on mixed care units or those who reported more benefits for nonlucid residents living on mixed care units were more in favor of cohabitation. Factors related to staff members' personal concerns explain 3% of the variance. In-service educational strategies are discussed.

Why alert residents are more or less willing to cohabit with cognitively impaired peers: an exploratory model

This study tested a model of the willingness of alert residents to cohabit with cognitively impaired peers in nursing homes. A systematic sample of 435 alert residents living on mixed care units selected in 19 nursing homes were interviewed. Four factors were of particular influence on the willingness to cohabit: alert residents' negative emotional reactions to living with the cognitively impaired, their knowledge of confusion, disturbance generated by dysfunctional behaviors, and benefits of cohabitation for the cognitively impaired as perceived by alert residents.

Caregiving tasks as predictors of mental health of wife caregivers of men with chronic obstructive pulmonary disease

The type, number, and amount of disturbance generated by caregiving tasks as well as the adequacy of informal social support were examined as predictors of the mental health of 89 wife caregivers of men with chronic obstructive pulmonary disease (COPD). The number of supervision tasks performed was predictive of all the mental health outcomes except one. When disturbance level was examined, giving emotional support in difficult situations was the task category that predicted five of the eight outcomes. Support variables accounted for small amounts of variance of most outcomes. However, caregivers who received respite support when they needed it were actually three times more likely to take psychotropic drugs than those not receiving support.

[Cohabitation of lucid and non-lucid residents]

The primary goal of this study was to confirm the appropriateness of an experimental model that studied the emotions of a rational client toward living with cognitively impaired clients. The second goal was to identify factors linking the feelings of health caregivers toward the cohabitation or segregation of rational and cognitively impaired couples. The research took place in 19 Montreal senior citizen homes with 75 beds or more. The senior citizen homes, the rational clients and the health caregivers were selected using specific criteria and systematic sample selection. Individual interviews with 435 rational clients living in cohabitation units were undertaken. In addition, 349 health caregivers (nurses, practical nurses and attendants) responded to a questionnaire relating to the cohabitation of these couples. It was found that the rational clients adjusted well to the model. Four variables reflecting the emotions of 33 per cent of the rational partners include: The frequency of uncomfortable feelings related to living with the cognitively impaired; their knowledge level about cognitive impairment; their distress level relating to the confused/irrational behavior of the cognitively impaired; and their perception of the advantages of living with the cognitively impaired. The rational clients who had the least understanding of cognitive impairment identified that they were more upset by the confused client's behavior. They demonstrated uncomfortable feelings toward living with confused/irrational clients more frequently, and perceived less advantages relating to cohabitating with these clients. Consequently, the rational clients were less amenable to cohabitation. The percentage of cognitively impaired clients living on the same floor was not identified as a variable.(ABSTRACT TRUNCATED AT 250 WORDS)

{Critical review of studies on social support and its relation to the well-being of people suffering from dementia}

Many people suffering from dementia live at home, in spite of the demands that such a situation puts on those who care for them. The role of helper is usually assumed by a particular family member who is therefore more likely to feel the impact of the caregiving responsibility. Researchers are concerned with the relationship between the well-being of these helpers and their informal social support. This article presents a critical review of 21 studies of that relationship. The various dimensions of social support considered in the studies are analyzed, as are the methodological limits. A discussion of findings about the relationships between social support and well-being completes the analysis. It appears that researchers have a limited conception of social support and assess only a few of its many dimensions in a variety of ways. Very few authors explicitly specify underlying assumptions or a theory relevant to their conceptualization of social support. The weakness and the diversity of this conceptualization are reflected in the measurement tools which consist of a few ad hoc questions on social support in nearly 50% of the studies. Few studies consider the support availability, duration, conflict, and reciprocity. The buffering effect model of support is examined in one study. Inadequate sample size, unrepresentative samples, and lack of control in regard to confounding variables are among the methodological problems identified. When researchers use an evaluative approach to measure social support, the relationships between support and well-being are more often significant than when a descriptive approach is used. In future studies, researchers should be careful to better articulate the theoretical notions proposed in studies on caring for a family member with dementia at home with those coming from studies on social support in general. It is important for researchers to strengthen their study design and to carry out longitudinal studies; they must also try to understand how the influence of society works. From this perspective, one avenue for the future might involve studying the sequence of relationships between stress, support, coping strategies, and well-being. This is all the more important because at the present time certain studies on the caring of persons with dementia are based on a conceptual framework of stress. Such a framework considers support as a mediating factor.