The Pain of Ambivalence over Emotional Expression

Purpose

Ambivalence over emotional expression (AEE) is defined as the desire to express emotion but failing to do so. Recent studies have revealed that AEE is associated with more pain. Pain is common among cancer survivors. This cross-sectional study investigated the association between AEE and pain, its underlying mechanism, and cultural relevance among cancer survivors.

Methods

Ninety-six Chinese American breast cancer survivors completed a questionnaire package assessing AEE and pain.

Results

AEE was positively associated with pain severity and pain interference. The association between AEE and pain interference was mediated by intrusive thoughts.

Conclusion

Cancer survivors who are ambivalent over emotional expression may experience high levels of intrusive thoughts, which results in high levels of symptom reports in their pain. The study confirmed the association between AEE and pain and its underlying mechanism among a group whose culture generally encourages emotional suppression. Findings suggest interventions focusing on reducing intrusive thoughts may be effective at reducing pain.

     

Gastrokine 1 mRNA in human sera is not informative biomarker for gastric cancer

Background

We aimed to ascertain if Gastrokine 1 mRNA in the sera of patients with gastric cancer might be an informative biomarker for the disease.

Results

Analysis of GKN1 mRNA in serum samples from healthy individuals (n?=?23) and from patients with diagnosis of gastric cancer (n?=?16), performed by using absolute quantification based on standard curve method, did not show any significative statistical difference between the two unpaired group of individuals.

Conclusions

Our preliminary results did not confirm GKN1 as a potential biomarker for gastric cancer.

     

Der Subtest PSQ-SRBD in einer pädaudiologischen Ambulanz

Background

The sleep related breathing disorder subtest of the pediatric sleep questionnaire (PSQ-SRBD) is widely recommended for the diagnosis of pediatric obstructive sleep apnea (OSA). It consists of 22 items and asks for symptoms in the areas of breathing, daytime sleepiness and behavior.

Objective

The aim of this study was to verify the suitability of the test in a cohort of children mainly suffering from hearing and speech developmental disorders.

Methodology

Retrospectively, the results of the PSQ-SRBD were collected over a period of 3.5 months from all patients above the age of 1 year. The results were evaluated on single item level and in relation to the total score.

Results

Of the 140 questionnaires completed, 12 were not evaluable. The mean age of the children was 5.6 ± 2.9 years and a majority suffered from language impairments, hearing and general developmental disorders. The rate of positive questionnaires with 30.5?% was unexpectedly high. The five most common “yes”- answers came from the behavioral field. Of children with a positive questionnaire, 20.5?% had no “yes” answers in the area of sleep-related respiratory symptoms.

Discussion

In the present cohort an unexpectedly high percentage of questionnaires was positive. A disproportionate number of responses from the behavioral domain are answered with “yes”. It can be assumed that in the above mentioned cohort the prevalence of pediatric SRBD is higher than in the general pediatric population. This could indicate an association between pediatric SRBD and specific language impairments. An alternative explanation would be that the questionnaire is not entirely suitable for this cohort, since it has a high proportion of questions in the behavioral area.

     

Micronized palmitoylethanolamide reduces joint pain and glial cell activation

Objective and design

Temporomandibular disorder (TMD) is a common painful condition in the temporomandibular joint (TMJ). Joint inflammation is believed to be a chief cause of pain in patients with TMD, through the release of pro-inflammatory cytokines that induce peripheral sensitization of nerve terminals followed by microglial stimulation.

Materials and subject

TMJ was induced in rats with the injection of complete Freund’s adjuvant (CFA) emulsion into the left TMJ capsule.

Treatment

The present study would assess the effects of micronized palmitoylethanolamide (m-PEA) on glial activation and trigeminal hypersensitivity.

Methods

Ten mg/kg m-PEA or corresponding vehicle was administered 1 h after CFA and mechanical allodynia and edema were evaluated at 24 and 72 h after CFA injection.

Results

CFA-injected animals showed TMJ edema and ipsilateral mechanical allodynia accompanied by a robust growth in GFAP protein-positive satellite glial cells and activation of resident macrophages in the TG. Moreover, m-PEA administration significantly reduced the degree of TMJ damage and pain, macrophage activation in TG and up-regulation of Iba1.

Conclusions

The results confirm that m-PEA could represent a novel approach for monitoring pain during trigeminal nerve sensitization.

     

Spirituality,Religiosity, and Health: a Comparison of Physicians’ Attitudes in Brazil,India, and Indonesia

Background

One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice.

Purpose

The present study aims to compare physicians’ perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia.

Method

This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians’ attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians’ responses in each country were examined using chi-squared, ANOVA, and MANCOVA.

Results

A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients’ health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues.

Conclusion

Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.

     

Primary Immunodeficiency Diseases in Aguascalientes,Mexico: Results from an Educational Program

Purpose

Primary immunodeficiencies (PIDs) are a heterogeneous group of disorders characterized mainly by recurrent infections. Late diagnosis remains as one of the main issues to solve. We aimed to increase PID diagnosis in Aguascalientes, a 1.3 million inhabitants state in the center of Mexico, and to describe the clinical features of such patients.

Methods

We developed an educational program for health personnel and general public; patients with possible PID were referred to a State University clinical center from December 2011 to December 2012. The patients were evaluated at the clinic and their definitive diagnosis pursued through laboratory, molecular and genetic assays. We describe the findings of those patients and analyze the impact of the program in terms of number of referrals.

Results

After 41 talks and 12 media appearances 151patients were referred for evaluation. Fifteen (9.9 %) were diagnosed with PID: five (33 %) had antibody deficiencies, seven (47 %) Well-defined syndromes, two (13 %) Severe combined Immunodeficiency (SCID) and one case (7 %) of an innate immune deficiency. All of the 15 PID patients had been referred by physicians, as opposed to the public. We estimated a “number needed to teach” of 75 physicians to get one PID patient referral.

Conclusion

Educational programs are a fundamental part of the global efforts to increase PID diagnosis and care. To be successful, such programs should include public relations, reach for first-contact physicians, and aim to develop an efficient referral network with molecular diagnostic capability. Enhancing medical knowledge on PID is a successful strategy to improve early diagnosis and treatment.

     

Lack of MMP-9 expression is a marker for poor prognosis in Dukes’ B colorectal cancer

Background

Matrix metalloproteinases (MMPs) play a role in cancer progression by degrading extracellular matrix and basement membranes, assisting in tumour neovascularization and in supporting immune response in cancer.

Methods

We studied the prognostic value of immunohistochemical expression of MMP-2, MMP-8, and MMP-9 in a series of 619 colorectal cancer patients using tissue microarray specimens.

Results

Of the samples, 56% were positive for MMP-2, 78% for MMP-8, and 60% for MMP-9. MMP-9 associated with low WHO grade (p?<?0.001). In univariate analysis of Dukes’ B tumours, MMP-9 negativity associated with poor survival (p?=?0.018), and MMP-9 positivity was an independent prognostic marker in multivariate analysis of these tumours (p?=?0.034).

Conclusion

Negative MMP-9 expression can predict poor prognosis in Dukes’ B colorectal tumours and may prove useful for identifying patients, who should be offered adjuvant treatment.

     

The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit

Background

Although many cross-sectional studies have demonstrated the association between cancer pain and psychospiritual distress, the time-dependent relationship has not been fully explored. For that reason, this study aims to investigate the time-dependent relationship between psychospiritual distress and cancer pain management in advanced cancer patients.

Methods

This is a prospective observational study. Two hundred thirty-seven advanced cancer patients were recruited from a palliative care unit in Taiwan. Demographic and clinical data were retrieved at admission. Pain and psychospiritual distress (i.e.: anxiety, depression, anger, level of family and social support, fear of death) were assessed upon admission and one week later, by using a “Symptom Reporting Form”. Patients were divided into two groups according to the pain status one week post-admission (improved versus not improved groups).

Results

One hundred sixty-three (68.8 %) patients were assigned to the improved group, and 74 (31.2 %) patients were assigned to the not improved group. There were no differences in the psychospiritual variables between groups upon admission. In overall patients, all psychospiritual variables improved one week post-admission, but the improvement of depression and family/social support in the not improved group was not significant. Consistent with this, for depression scores, there was a statistically significant pain group x time interaction effect detected, meaning that the pain group effect on depression scores was dependent on time.

Conclusions

We demonstrated a time-dependent relationship between depression and pain management in advanced cancer patients. Our results suggest that poor pain management may be associated with intractable depression. The inclusion of interventions that effectively improve psychospiritual distress may contribute to pain management strategies for advanced cancer patients.

     

Use of chemotherapy at the end of life in Turkey

Background

An increasing number of patients receive palliative chemotherapy near the end of life. The aim of this study is to evaluate the aggressiveness of chemotherapy in Turkish individuals near the end of life.

Methods

Patients diagnosed with solid tumors and died from 2010 to 2011 in the medical oncology department of Akdeniz University were included in the study. Data about the diagnosis, treatment details and imaging procedures were collected.

Results

Three hundred and seventy-three people with stage IV solid tumors died from 2010 to 2011 in our clinic. Eighty-nine patients (23.9%) patients underwent chemotherapy in the last month of life while 39 patients (10.5%) received chemotherapy in the last 14 days. The probability of undergoing chemotherapy in the last month of life was influenced by: age, ‘newly diagnosed’ patients, and performance status. There was no significant association of chemotherapy in the last month of life with gender and tumor type. Having a PET-CT scan did not alter the chemotherapy decision.

Conclusion

In conclusion, chemotherapy used in the last month of life in a tertiary care center of Turkey is high. Increasing quality of life should be a priority near the end of life and physicians should consider ceasing chemotherapy and direct the patient to early palliative care.

     

Development of a new method for identification and quantification in cerebrospinal fluid of malignant cells from breast carcinoma leptomeningeal metastasis

Background

The diagnosis of leptomeningeal metastasis (LM) in patients with solid tumors remains difficult. The usual diagnostic methods of cytomorphological assessment of cerebro-spinal fluid (CSF) and gadolinium enhanced MRI of the entire neuraxis lack both specificity and sensitivity. The Veridex CellSearch® technology has been designed for the detection of circulating tumor cells (CTC) in blood from cancer patients and validated for the follow-up and prognosis of breast, prostate, colorectal, and lung cancer. Our aim was to adapt this technology for the detection and the enumeration of tumor cells in the CSF of breast cancer patients presenting with LM.

Methods

On the occasion of a randomized phase III study evaluating the role of the intrathecal treatment in LM from breast cancer (DEPOSEIN, EudraCT N°: 2010-023134-23), the CellSearch® technology was adapted to direct enrichment, enumeration and visualization of tumor cells in 5 mL CSF samples, collected on CellSave® Preservative Tubes and analyzed within 3 days after CSF sampling.

Results

Sixteen CSF of 8 patients with primary breast cancer presenting with LM were studied. EpCAM+/cytokeratin + cells with typical morphology could be observed and enumerated sequentially with reproducible results in low or elevated numbers in 8 patients.

Conclusion

This methodology, established on a limited volume of sample and allowing delayed processing, could prove of great interest in the diagnosis and follow-up of cancer patients with LM, especially to appreciate the efficacy of chemotherapy.

     

Recall Bias in Patients with Chronic Low Back Pain: Individual Pain Response Patterns Are More Important Than Pain Itself!

Background

Patients’ cognitive processing of pain-related information as well as their cognitive, affective and behavioral response pattern when experiencing pain in daily life has been shown to be associated with poorer prognosis in low back pain. However, the relationship between specific cognitive processes such as recall of pain-related material and individual pain responses remains unknown.

Purpose

The present study sought to investigate recall bias in patients with chronic low back pain (CLBP) compared to healthy controls. Furthermore, it was aimed to investigate the impact of patients’ individual pain-related responses on recall bias, comparing fear-avoidance response (FAR), endurance response (ER) and adaptive response (AR) patterns.

Method

Thirty-one CLBP patients and 31 controls were tested on a free recall task with three word lists comprising pain words and neutral words. Further, the CLBP group was classified into patients with a FAR, ER and AR pattern, using a short screening including the Avoidance-Endurance Questionnaire (AEQ). Group differences with pain status (CLBP vs. healthy) and AEQ responses (FAR, ER, AR) as between-group factors, word type (pain vs. neutral) as within-group factor and free recall as dependent variable were analysed by means of repeated-measures analysis of (co-) variance.

Results

Results revealed different pain processing of pain words between FAR and ER patterns, whereas CLBP patients as a whole did not differ from the healthy controls. FAR patients displayed significantly less recall than ER patients.

Conclusion

Recall biases in CLBP patients are not only a result of experiencing pain but also effected by patients’ pain response pattern with respect to fear-avoidance versus endurance.

     

Stressful Parental-Bonding Exaggerates the Functional and Emotional Disturbances of Primary Dysmenorrhea

Background

Some evidence suggests that women with primary dysmenorrhea (or painful period) often have traumatic experience with parental attachments, but the exact relationship is still unclear.

Purpose

This study aims to investigate associations between styles of the parental bonding and the detailed aspects of the disorder in Chinese university-student women.

Methods

From university-student women, we have invited 50 primary dysmenorrhea patients and 111 healthy volunteers, to undergo tests of the Functional and Emotional Measure of Dysmenorrhea (FEMD), the Family Relationship Questionnaire (FRQ), and the visual analogue scale for the pain intensity experienced.

Results

Besides the high scores of the FEMD Functional and Emotional scales, the dysmenorrhea patients also scored significantly higher than the healthy controls on the FRQ scales of Paternal Dominance and Maternal Abuse. In patients, the FEMD Emotional scale was negatively predicted by the Paternal Freedom Release scale, and the FEMD Functional scale was positively predicted by the Maternal Dominance scale.

Conclusions

Inappropriate parental bonding or chronic traumatic attachment styles have respective relationships with the functional and emotional disturbances experienced by the primary dysmenorrhea patients.

     

Exploring the Social Needs and Challenges of Chinese American Immigrant Breast Cancer Survivors: a Qualitative Study Using an Expressive Writing Approach

Purpose

Little is known about the psychological well-being and social barriers among immigrant Chinese American breast cancer survivors. The aim of the present study was to explore the social needs and challenges of Chinese American immigrant breast cancer survivors.

Method

This study used the expressive writing approach to explore the experiences among 27 Chinese American breast cancer survivors. The participants were recruited through community-based organizations in Southern California, most of whom were diagnosed at stages I and II (33 and 48%, respectively). Participants, on average, had been living in the USA for 19 years. Participants were asked to write three 20-min essays related to their experience with breast cancer (in 3 weeks). Participants’ writings were coded with line-by-line analysis, and categories and themes were generated.

Results

Emotion suppression, self-stigma, and perceived stigma about being a breast cancer survivor were reflected in the writings. Interpersonally, participants indicated their reluctance to disclose cancer diagnosis to family and friends and concerns about fulfilling multiple roles. Some of them also mentioned barriers of communicating with their husbands. Related to life in the USA, participants felt unfamiliar with the healthcare system and encountered language barriers.

Conclusion

Counseling services addressing concerns about stigma and communication among family members may benefit patients’ adjustments. Tailor-made information in Chinese about diagnosis and treatment for breast cancer and health insurance in the USA may also help patients go through the course of recovery.

     

Hematopoietic Stem Cell Transplantation for XIAP Deficiency in Japan

Background

X-linked inhibitor of apoptosis protein (XIAP) deficiency is a rare immunodeficiency that is characterized by recurrent hemophagocytic lymphohistiocytosis (HLH) and splenomegaly and sometimes associated with refractory inflammatory bowel disease (IBD). Although hematopoietic stem cell transplantation (HSCT) is the only curative therapy, the outcomes of HSCT for XIAP deficiency remain unsatisfactory compared with those for SLAM-associated protein deficiency and familial HLH.

Aim

To investigate the outcomes and adverse events of HSCT for patients with XIAP deficiency, a national survey was conducted.

Methods

A spreadsheet questionnaire was sent to physicians who had provided HSCT treatment for patients with XIAP deficiency in Japan.

Results

Up to the end of September 2016, 10 patients with XIAP deficiency had undergone HSCT in Japan, 9 of whom (90%) had survived. All surviving patients had received a fludarabine-based reduced intensity conditioning (RIC) regimen. Although 5 patients developed post-HSCT HLH, 4 of them survived after etoposide administration. In addition, the IBD associated with XIAP deficiency improved remarkably after HSCT in all affected cases.

Conclusion

The RIC regimen and HLH control might be important factors for successful HSCT outcomes, with improved IBD, in patients with XIAP deficiency.

     

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain

Purpose

This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability.

Method

Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability.

Results

A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability.

Conclusion

Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

     

Klinisch-epidemiologische Krebsregistrierung in Deutschland

Objective

Function and funding of detailed clinical cancer registries (CCRs) is defined by German Social Code Book V (SGB V) and shall be implemented by the end of 2017.

Content

Cancer registration according to regionally defined catchment areas, feedback of results and quality assurance are the basis which determines principles of operation and use of data. Each clinical department delivers only its own findings and therapy, while compilation by the clinical cancer registry describes the patients’ way through the regional network of medical care. In this way, oncological centers are not burdened by troublesome documentation of data which originate from other clinics.

Conclusion

After successful implementation of CCRs, interested physicians and clinics are able to spend time for analysis and use of meaningful data with the objective of improving quality of care within the region, implementing innovative therapies and presenting their results, and generating new hypotheses to stimulate research.

     

Multicolor Flow Cytometry for the Diagnosis of Primary Immunodeficiency Diseases

Purpose

Primary immunodeficiency diseases (PIDDs) are rare inherited diseases that impair the human immune system. We established a multicolor flow cytometric assay to comprehensively evaluate the immune status and immunological characteristics of patients with PIDDs.

Methods

Fifty-nine normal controls and 75 patients with PIDDs, including X-linked severe combined immunodeficiency (X-SCID), X-linked agammaglobulinemia (XLA), X-linked hyper IgM syndrome (X-HIGM), ataxia telangiectasia (AT), Wiskott-Aldrich syndrome (WAS), hyper IgE syndrome (HIES), and chronic mucocutaneous candidiasis disease (CMCD), were enrolled in this study. Immunophenotyes were evaluated by multicolor flow cytometry using seven different panels that allowed the detection of major leukocyte populations in peripheral blood.

Results

Multicolor flow cytometry revealed distinct leukocyte populations and immunological features of patients with X-SCID, XLA, X-HIGM, AT, WAS, HIES, and CMCD.

Conclusions

Immunophenotyping by multicolor flow cytometry is useful to evaluate immune status and contributes to the diagnosis and management of patients with PIDDs.

     

Is the content of guidelines/pathways a barrier for the integration of palliative Care in Chronic Heart Failure (CHF) and chronic pulmonary obstructive disease (COPD)? A comparison with the case of cancer in Europe

Background

There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of integration of PC. By cross-examining the levels of PC integration in published guidelines/pathways for CHF/COPD and cancer in Europe, this study examines whether these discrepancies may be attributed to the content of the guidelines.

Design

A quantitative evaluation was made between integrated PC in published guidelines for cancer and CHF/COPD in Europe. The content of integrated PC in guidelines/pathways was measured using an 11 point integrated PC criteria tool (IPC criteria). A statistical analysis was carried out to detect similarities and differences in the level of integrated PC between the two groups.

Results

The levels of integration between CHF/COPD and cancer guidelines/pathways have been shown to be statistically similar. Moreover, the quality of evidence utilized and the date of development of the guidelines/pathways appear not to impact upon the PC integration in the guidelines.

Conclusion

In Europe, the empirically observed imbalance in integration of PC for patients with cancer and CHF/COPD may only partially be attributed to the content of the guidelines/pathways that are utilized for the PC implementation. Given the similarities detected between cancer and CHF/COPD, other barriers appear to play a more prominent role.

     

Psychometric Properties of the Arabic Version of the Drug Use Disorders Identification Test (DUDIT) in Clinical,Prison Inmate,and Student Samples

Purpose

The study aimed to validate the Arabic version of the Drug Use Disorders Identification Test (DUDIT) by (1) assessing its factor structure, (2) determining structural validity, (3) evaluating item-total and inter-item correlation, and (4) assessing its predictive validity.

Method

The study population included 169 prison inmates, 51 patients with clinical diagnosis of substance used disorder, and 53 students (N = 273). All participants completed the self-report version of the Arabic DUDIT. After exploratory factor analysis, internal consistency of the Arabic DUDIT was determined and external validation was performed.

Results

Principal factor analysis showed that Arabic DUDIT exhibited only one factor, which explained 66.9% of the variance. Reliability based on Cronbach’s alpha was .95. When compared to the DSM-IV substance use disorder diagnosis in a clinical sample, DUDIT had an area under the curve (AUC) of .98, with a sensitivity of .98 and a specificity of .90.

Conclusion

The Arabic version of DUDIT is a valid and reliable tool for screening for drug use in Arabic-speaking countries.