B7-H4 overexpression impairs the immune response of T cells in human cervical carcinomas

Objective

To investigate B7-H4 expression and its correlation with the number of infiltrating T lymphocytes and cytokine production by those lymphocytes in human cervical cancer and to determine the effect of recombinant B7-H4 on the active peripheral blood T cells of the patients in vitro.

Methods

B7-H4 expression was detected in 67 cases of cervical cancer using immunohistochemical staining. Tumor-infiltrating CD8⁺T, CD4⁺T, and FOXP3⁺ (Forkhead Box P3) T lymphocytes and their levels of IFN-γ and TGF-β₁ production were determined by immunofluorescent double-staining. After the peripheral blood T lymphocytes of patients were co-cultured with B7-H4, proliferation, apoptosis, and cell subtypes were analyzed using flow cytometry. Cytokines in the supernatant were detected by ELISA.

Results

B7-H4 was expressed in 46% (31/67) of the cases of cervical cancer. The number of infiltrating CD8⁺T lymphocytes and their IFN-γ production in positive B7-H4 expression cervical cancers was significantly lower than in negative B7-H4 cases (P < 0.01, P < 0.05), but there was no significant difference between cases positive and negative for B7-H4 with respect to infiltrating FOXP3⁺T and CD4⁺T cells or TGF-β1 production. After co-culture with B7-H4 for 48 h, the patients’ activated T lymphocytes were arrested at G1/G2 phase. The Ki67 positive rates of CD4⁺T and CD8⁺T cells were 2.13 ± 0.13% and 1.03 ± 1.33%, and they were lower than in the blank group. The proportion of CD4⁺T and CD8⁺T cells decreased, but CD4⁺T/CD8⁺T and the proportion of CD4⁺CD25⁺Foxp3⁺T cells increased. In addition, concentrations of IL-10 and TGF-β1 in the supernatant of co-cultured T cells increased significantly (P < 0.05, P < 0.05), but that of IFN-γ decreased. B7-H4 had no significant effect on apoptosis of the T cells.

Conclusion

B7-H4 is overexpressed in human cervical cancers, and it is associated with lower numbers of tumor-infiltrating CD8⁺T lymphocytes and therefore less IFN-γ production. In vitro, B7-H4 inhibits the proliferation of CD4⁺T and CD8⁺T but promotes the proliferation of Tregs and the secretion of IL-10 and TGF-β1. B7-H4 plays an important role in depressing the anti-tumor immunity of CD8⁺T cell in microenvironments of cervical cancer.     

Inflammatory cells in minor salivary glands of patients with chronic hepatitis C: Immunophenotype,pattern of distribution,and comparison with liver samples

Objectives

To characterize the immunophenotype and the distribution of the inflammatory infiltrate (INF) in salivary glands (SG) of patients with chronic hepatitis C, comparing with laboratorial data (genotype, viral load, METAVIR, and HCV RNA in SG), and liver.

Methods

INF was classified as diffuse or focal. Immunohistochemistry for CD3, CD20, CD8, CD4, CD57, CD68, and S100 was performed in 61 SG and 59 livers.

Results

Diffuse INF was more common in SG than in liver. CD3⁺, CD20⁺, and CD8⁺ were the most frequent cells in both tissues, with few CD57⁺, CD68⁺, and S100⁺ cells. CD4⁺ cells were common in liver, but rare in SG. Liver presented higher indexes for all markers, except S100⁺ (p < 0.05). Higher CD3⁺, CD20⁺, and CD8⁺ (p < 0.05) were observed in SG with focal infiltrate than with diffuse infiltrate. In liver, CD20⁺ and CD3⁺ were higher in focal infiltrate, and CD68⁺ in diffuse infiltrate (p < 0.05). Comparisons with laboratorial data did not show statistical significance.

Conclusions

The INF in SG was mainly composed by T and B lymphocytes, mostly cytotoxic T cells. The glandular INF can present differences in composition according to its distribution. A more intense inflammation was observed in liver, but similar cell types were identified in SG, except for CD4⁺.     

Caveolin-1 promotes an invasive phenotype and predicts poor prognosis in large cell lung carcinoma

Purpose

This study investigated the relationships of caveolin-1 expression with clinical pathologic parameters and the prognosis of patients with large cell lung carcinoma. This study also explored the roles of caveolin-1 in cell invasiveness, matrix metalloproteinase (MMP) expression, and non-small cell lung carcinoma activity in vitro.

Methods

A total of 120 tissue samples were immunohistochemically analyzed for caveolin-1 expression. Cell invasion ability was measured by a Transwell invasion assay. Protein expression was assessed by Western blotting. MMP activity was detected by gelatin zymography.

Results

Caveolin-1 was expressed in 54 of 120 (45.0%) cases of large cell lung carcinoma. Caveolin-1 expression was significantly correlated with node status (N0 vs. N1, N2, and N3; P = 0.005) and advanced pTNM stage (Stages I and II vs. Stage III, P < 0.001). Patients with caveolin-1-positive expression had a poorer prognosis than did those with caveolin-1-negative expression (P < 0.001). The knockdown of caveolin-1 in H460 and 95D cells reduced the invasive ability of the cells and the expression of phosphorylated epidermal growth factor receptor (EGFR), phospho-extracellular signal-regulated kinases 1 and 2, MMP2, and MMP9; the protein level and activity of MMP2 and MMP9 were also decreased by the inhibition of EGFR activity in H460 and 95D cells.

Conclusions

The expression of caveolin-1 was positively correlated with an advanced pathologic stage. Thus, caveolin-1 could act as a predictor of a poor prognosis in patients with large cell lung carcinoma. In addition, the downregulation of caveolin-1 reduced both the invasive ability of tumor cells and the protein and activity levels of MMP2 and MMP9 in vitro, suggesting the involvement of EGFR/MMP signaling in this process.     

The effect of the decoy molecule PA401 on CXCL8 levels in bronchoalveolar lavage fluid of patients with cystic fibrosis

Background

The chemokine interleukin-8 (CXCL8) is a key mediator of inflammation in airways of patients with cystic fibrosis (CF). Glycosaminoglycans (GAGs) possess the ability to influence the chemokine profile of the CF lung by binding CXCL8 and protecting it from proteolytic degradation. CXCL8 is maintained in an active state by this glycan interaction thus increasing infiltration of immune cells such as neutrophils into the lungs. As the CXCL8-based decoy PA401 displays no chemotactic activity, yet demonstrates glycan binding affinity, the aim of this study was to investigate the anti-inflammatory effect of PA401 on CXCL8 levels, and activity, in CF airway samples in vitro.

Methods

Bronchoalveolar lavage fluid (BALF) was collected from patients with CF homozygous for the ΔF508 mutation (n = 13). CXCL8 in CF BALF pre and post exposure to PA401 was quantified by ELISA. Western blot analysis was used to determine PA401 degradation in CF BALF. The ex vivo chemotactic activity of purified neutrophils in response to CF airway secretions was evaluated post exposure to PA401 by use of a Boyden chamber-based motility assay.

Results

Exposure of CF BALF to increasing concentrations of PA401 (50–1000 pg/ml) over a time course of 2–12 h in vitro, significantly reduced the level of detectable CXCL8 (P < 0.05). Interestingly, PA401 engendered release of CXCL8 from GAGs exposing the chemokine susceptible to proteolysis. Subsequently, a loss of PA401 was observed (P < 0.05) due to proteolytic degradation by elastase like proteases. A 25% decrease in neutrophil chemotactic efficiency towards CF BALF samples incubated with PA401 was also observed (P < 0.05).

Conclusion

PA401 can disrupt CXCL8:GAG complexes, rendering the chemokine susceptible to proteolytic degradation. Clinical application of a CXCL8 decoy, such as PA401, may serve to decrease the inflammatory burden in the CF lung in vivo.     

Effects of the glucose-lowering rate on cTnI and hs-CRP serum levels in type 2 diabetics

Objectives

The current objective is to evaluate the effect of intensive glycemic control on serum levels of both Cardiac Troponin I (cTnI) and high sensitivity C-reactive protein (hs-CRP) in subjects with type 2 diabetes. Hence, we are trying to find a reasonable glucose-lowering rate associated with type 2 diabetics with and without coronary heart disease.

Methods

A total of 132 type 2 diabetes mellitus without coronary heart disease (T2DM) cases and 135 type 2 diabetes mellitus with coronary heart disease (T2DM+CHD) cases received intensive glycemic control. Serum cTnI and hs-CRP levels were tested before and after intensive glycemic control.

Results

There was no significant difference in the changing amplitude of cTnI and hs-CRP serum levels variation between four glucose-lowering rates in T2DM group (P > 0.05), while this difference was observed in T2DM+CHD group(P < 0.05). During the follow-up, cTnI and hs-CRP serum levels were lower than those before glycemic control in both T2DM and T2DM+CHD groups (P < 0.05).

Conclusions

The glucose-lowering rate in T2DM+CHD group should be no more than 4 mmol L⁻¹ d⁻¹ and the appropriate glucose-lowering rate in T2DM group is no more than 6 mmol L⁻¹ d⁻¹. Serum levels of cTnI and hs-CRP will be increased if the glucose-lowering rate is over this range, which means that cardiovascular endpoints might be induced.     

Orange juice improved lipid profile and blood lactate of overweight middle-aged women subjected to aerobic training

Objective

This study investigated how consumption of orange juice associated with aerobic training affected serum lipids and physical characteristics of overweight, middle-aged women.

Methods

The experimental group consisted of 13 women who consumed 500 mL/d of orange juice and did 1 h aerobic training 3 times a week for 3 months. The control group consisted of another 13 women who did the same aerobic training program but did not consume orange juice.

Results

At the end of the experiment, the control group lost an average of 15% of fat mass (P < 0.05) and 2.5% of weight (P < 0.05), whereas the experimental group lost 11% of fat mass and 1.2% of weight (P < 0.05). Consumption of orange juice by the experimental group was associated with increased dietary intake of vitamin C and folate by 126% and 61% respectively. Serum LDL-C decreased 15% (P < 0.05) and HDL-C increased 18% (P < 0.05) in the experimental group, but no significant change was observed in the control group. Both groups improved the anaerobic threshold by 20% (P < 0.05), but blood lactate concentration decreased 27% in the experimental group compared to the 17% control group, suggesting that experimental group has less muscle fatigue and better response to training.

Conclusions

The consumption of 500 mL/d of orange juice associated with aerobic training in overweight women decreased cardiovascular disease risk by reducing LDL-C levels and increasing HDL-C levels. This association also decreased blood lactate concentration and increased anaerobic threshold, showing some improvement in the physical performance.     

Shared decision-making to improve attention-deficit hyperactivity disorder care

Objective

To examine the effect of a shared decision-making intervention with parents of children newly diagnosed with attention-deficit/hyperactivity disorder.

Methods

Seven pediatricians participated in a pre/post open trial of decision aids for use before and during the office visit to discuss diagnosis and develop a treatment plan. Encounters pre- (n = 21, control group) and post-intervention implementation (n = 33, intervention group) were compared. We video-recorded encounters and surveyed parents.

Results

Compared to controls, intervention group parents were more involved in shared decision-making (31.2 vs. 43.8 on OPTION score, p < 0.01), more knowledgeable (6.4 vs. 8.1 questions correct, p < 0.01), and less conflicted about treatment options (16.2 vs. 10.7 on decisional conflict total score, p = 0.06). Visit duration was unchanged (41.0 vs. 41.6 min, p = 0.75). There were no significant differences in the median number of follow-up visits (0 vs. 1 visits, p = 0.08), or the proportion of children with medication titration (62% vs. 76%, p = 0.28), or parent-completed behavior rating scale to assess treatment response (24% vs. 39%, p = 0.36).

Conclusions

Our intervention increased shared decision-making with parents. Parents were better informed about treatment options without increasing visit duration.

Practice implications

Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making.     

Expression of carcinoembryonic antigen-related cell adhesion molecule 1(CEACAM1) and its correlation with angiogenesis in gastric cancer

Objective

To examine the expression of carcinoembryonic antigen-related cell adhesion molecule 1(CEACAM1) and CD34 in gastric adenocarcinoma, and to investigate their relations with clinical pathology-related factors.

Methods

Immunohistochemistry (IHC) was used to analyze the expression of CEACAM1 and CD34, and micro-vessel density (MVD) marked by CD34 was calculated in 208 cases of human gastric adenocarcinoma and in 56 cases of normal human gastric tissues.

Results

There was no expression of CEACAM1 in normal gastric mucosa. However, all of the gastric adenocarcinoma tissues expressed CEACAM1 with cytoplasmic and/or membranous staining. CEACAM1 expression was classified as high and low (137/208 vs. 71/208, 65.9% vs. 34.1%), the CD34-MVD value was significantly different between the two groups (P < 0.05). In addition, expressions of CEACAM1 and CD34 were significantly different from gastric adenocarcinoma to normal gastric tissues, respectively (P < 0.05). High CEACAM1 expression and high MVD value were positively associated with lymph nodes metastasis and TNM stage, but negatively related to pathological grade (P < 0.05). But they were irrelevant with tumor size, patients’ age and gender (P > 0.05).

Conclusions

The up-regulation of CEACAM1 expression may participate in tumorous angiogenesis, especially high expression of CEACAM1 promoted its capability of invasion and metastasis.     

Self-reported menopausal symptoms in a racially diverse population and soy food consumption

Objectives

Evaluate the association of self-reported vasomotor symptom (VMS) frequency with race/ethnicity among a diverse midlife US population and explore menopause symptom differences by dietary soy isoflavone (genistein + daidzein) consumption.

Study design

Cross-sectional population-based study of peri- and postmenopausal women, ages 45–58.

Outcomes

Recent VMS frequency, VMS ever; recent symptom bother (hot flashes, night sweats, headache and joint-ache).

Results

Of 18,500 potentially eligible women, 9325 returned questionnaires (50.4% response); 3691 were excluded (premenopausal, missing data, taking hormones). Of 5634 remaining women, 82.1% reported hot flashes ever, 73.1% reported night sweats ever; 48.8% and 38.6% reported recent hot flashes or night sweats, respectively. Compared with White women, Chinese, Japanese, Vietnamese, other Asian (each p < 0.001) and Filipino (p < 0.01) women less commonly reported ever having hot flashes; Asian women less commonly reported recent VMS bother (p < 0.001). Black women more commonly reported hot flashes ever (p < 0.05) and recent VMS bother (p < 0.05). Compared with non-Hispanic White women, Hispanic women were less likely to report hot flashes (p < 0.05) or night sweats (p < 0.001) ever. Women were classified by isoflavone consumption: (1) none (n = 1819), (2) 0.01–4.30 mg/day (n = 1931), (3) 4.31–24.99 mg/day (n = 1347) and (4) ≥25 mg/day (n = 537). There were no group differences in recent VMS number/day: (1) 7.0 (95% CI 6.5, 7.5); (2) 6.4 (95% CI 6.0, 7.1); (3) 7.0 (95% CI 6.3, 8.2); and (4) 6.8 (95% CI 6.1, 7.7).

Conclusions

Menopausal symptoms, independent of isoflavone intake, varied considerably by race/ethnicity and were least common among Asian races.     

Neurotransmitter noradrenaline downregulate cytoskeletal protein expression of VSMCs

Objective

This study investigates the effects of noradrenaline (NA) on cytoskeletal protein expression of vascular smooth muscle cells (VSMCs).

Methods

VSMCs were isolated from rat aortic tissue and cultured. The cultured VSMCs were divided into 4 experimental groups: (1) control group, (2) NA treatment group, (3) starvation group, and (4) NA treatment + starvation group. The expression of cytoskeletal protein (smooth muscle α-actin, β-tubulin and desmin) was evaluated by (i) Coomassie blue staining, (ii) immunofluorescent staining, and (iii) RT-PCR and Western Blot.

Results

NA treatment significantly downregulated the expression of SM α-actin, β-tubulin and desmin (P < 0.05). The serum starvation did not affect the expression of cytoskeletal protein (SM α-actin, β-tubulin and desmin), but when the cells were treated with the combination of NA and serum starvation, the expression of SM α-actin, β-tubulin and desmin were down-regulated than those of the serum starvation group (P < 0.05).

Conclusion

These results suggested that NA might play a key role in regulating the cytoskeletal protein expression of VSMCs.     

Teaching nurses how to teach: An evaluation of a workshop on patient education

Objective

To evaluate the effects of a patient education workshop on nurses: (1) communication skills; (2) Knowledge of patient-centered model, patient education process, and sense of preparedness to provide patient education.

Methods

Fourteen nurses attended a 2-day workshop on patient education based on a patient-centered model. Data on communication skills were collected by means of pre-/post-written dialogues and analyzed with the Roter Interaction Analysis System (RIAS). Data of nurses’ knowledge and sense of preparedness were collected through a post questionnaire comprised of 5-point Likert scale items.

Results

Post-dialogues showed an increase in patient talking (P < 0.001) and in patient-centered communication as indicated by the increase in Psychosocial exchanges (P = 0.003) and Process exchanges (P = 0.001). Nurses reported that the workshop increased “very much” their knowledge of the patient-centered model (mean = 4.19) and patient education process (mean = 4.69), and their sense of preparedness to provide patient education (P = 0.001).

Conclusions

Data suggest the efficacy of the workshop in developing patient-centered communication skills and improving nurses’ knowledge and preparedness to deliver patient education.

Practice implications

Trainings based on a patient-centered model and interactive learning methods should be implemented for nurses to improve their ability to deliver effective patient education.     

Correlation between infiltration of FOXP3 regulatory T cells and expression of B7-H1 in the tumor tissues of gastric cancer

Background

Substantial evidence suggests that the expansion of regulatory T cells (T_regs) plays a pivotal role in immunological evasion of tumors. Recent studies have demonstrated that a majority of tumor cells overexpress B7-H1, and this overexpression is associated with poor disease prognosis. Although an increase of T_regs and B7-H1 has been revealed in several malignancies, their correlation in gastric cancer has not been studied.

Methods

Tumor sections from 111 gastric cancer patients were stained for FOXP3 and B7-H1 by immunohistochemistry. The expression levels of these two molecules were statistically associated with various factors involved in disease progression and prognosis. The correlation between their expression levels was analyzed.

Results

The infiltration of FOXP3⁺ Tregs and expression of B7-H1 were observed in gastric cancer tissues, and there was a highly significant correlation between these two molecules (P < 0.01). The expression of FOXP3⁺ Tregs and B7-H1 was associated with lymph node metastasis and the clinicopathological stage and prognosis of gastric cancer patients. The expression levels of these two determinants in patients with lymph node metastasis and an advanced clinicopathological stage were distinctly higher (P < 0.05). The patients with enhanced expression of FOXP3⁺ Tregs and B7-H1 exhibited a lower overall survival rate and a worse prognosis (P < 0.05).

Conclusions

Increased expression of FOXP3⁺ Tregs and B7-H1 was observed in gastric cancer tissues; the two molecules were closely correlated with each other, suggesting that they might be used as new biomarkers to predict the disease progression and prognosis. Combinatorial immunotherapeutic approaches based on depleting the T_regs and blocking B7-H1 might improve therapeutic efficacy in gastric cancer.     

A clinicopathological and immunohistochemical study of minimal deviation adenocarcinoma of the uterine cervix

Objective

To investigate the clinical, pathological and immunohistochemical features of minimal deviation adenocarcinoma (MDA) of the uterine cervix by conducting a retrospective study of 25 cases consecutively treated in three institutes over a 10 years period.

Methods

Of 25 cases with MDA, clinical features were retrospectively reviewed, gross and micro appearances of surgical specimens of 17 operative cases were observed. Ki67, SMA, p53, PCNA, Vimentin, CEA, ER, CA125 and PR were detected on tissues from MDA and 50 cases common adenocarcinomas of the uterine cervix (AUCs) (differentiation rank: high 16, moderate 20, low 14). Their expressions were assessed in paraffin sections using the immunohistochemistry method.

Results

MDA accounted for only 1.2% of adenocarcinomas of the uterine cervix. The main clinical manifestations were vaginal profuse, watery or mucoid discharge and irregular bleeding. Signs were cervical hypertrophy or thickening. The gross appearance showed many similarities with common AUCs. Immunohistochemical results: the positive rates for p53 and Ki67 in >50% of the cell nuclei (Ki67/50⁺) were 88% and 64% in MDA respectively, significantly higher than common AUCs (38%, 18%, P < 0.01), CA 125 was 18% in MDA, clearly lower than common AUCs (58%, P < 0.01). There was no difference between MDA and common AUCs for CEA, PR, Vimentin, ER, PCNA and SMA (P > 0.05). No significant difference was noticed among the high, moderate and low differentiation groups in common AUCs (P > 0.05).

Conclusions

For early stage diagnoses, MDA should be considered when cervical hypertrophy is present in patients complaining of a vaginal profuse watery or mucoid discharge and irregular bleeding. Positive immunohistochemical staining for p53, Ki67/50⁺ and negative for CA125 can assist diagnosis and discrimination.     

Morphological modification of female bladder after prolonged use of soy-based diets

Objectives

The aim of this study was to compare the effects of a prolonged use of organic and transgenic soy upon the lipid profile and the collagen/muscle ratio of the detrusor muscle of the bladder.

Methods

Wistar rats were fed three different diets from weaning until sacrifice (15 months old): control group (CG) casein-based diet; organic soy group (OSG) organic soy-based diet; genetically modified soy group (GMSG) transgenic soy-based diet.

Results

There was no difference in the food consumption or in the diet isoflavone components among the groups. Comparing to CG, both OSG and GMSG groups presented a significant (p < 0.05) reduction in the body weight, triglycerides, cholesterol and the smooth muscle of the detrusor and a significant (p < 0.05) increase of collagen fibers number of the detrusor muscle.

Conclusions

These findings call into question that, the prolonged use of soy-based diets can be deleterious to the bladder by altering the collagen/muscle ratio what can cause bladder dysfunctions similar with that occurring during menopause.     

Elevated circulating miR-150 and miR-342-3p in patients with irritable bowel syndrome

Background and aims

MicroRNAs (miRNAs) are small non-coding RNAs, which regulate gene expression and are thus of interest as diagnostic markers, and as clues to etiology and targets of intervention. This pilot study examined whether circulating miRNAs are differentially expressed in patients with IBS.

Methods

miRNA microarrays (NanoString) were run on the whole blood of 43 participants.

Results

hsa-miR-150 and hsa-miR-342-3p were found to be significantly elevated (FDR adjusted p ≤ 0.05, ≥ 1.6 fold change) in IBS patients compared to healthy controls. Neither of these miRNAs showed any relationship to race or sex. hsa-miR-150 is associated with inflammatory bowel disorders and pain, and interacts with a protein kinase (AKT2) through which it may affect inflammatory pathways. hsa-miR-342-3p is predicted to interact with mRNAs involved in pain signaling, colonic motility, and smooth muscle function.

Conclusions

This preliminary study reports the association of two miRNAs, detected in whole blood, with IBS. These miRNAs link to pain and inflammatory pathways both of which are thought to be dysregulated in IBS. Larger sample sizes are needed to confirm their importance and potential as biomarkers.     

Inter-relation of Th1, Th2, Th17 and Treg cytokines in oral cancer patients and their clinical significance

Background

Altered cytokine production can lead to immune dysfunction in cancer patients. Hence, we investigated the cytokine balance in oral squamous cell carcinoma (OSCC) patients and their significance in providing new therapeutic insights.

Methods

We quantified Th17 (IL17A), Treg (TGFβ1), Th1 (IL2, IFNγ) and Th2 (IL4, IL10) like cytokines in the sera of 78 cases and 39 controls by ELISA. The intracellular expression of these cytokines was analyzed in 10 subjects from each group by flow cytometry.

Results

Serum levels of IL17A, TGFβ1, IL4 and IL10 were significantly higher while IL2 and IFNγ were relatively lower in patients as compared to controls. TGFβ1 (r = 0.55), IL4 (r = 0.75) and IL10 (r = 0.80) significantly (P < 0.0001) correlated with disease progression and their elevated levels showed increased odd ratios of approximately 18, 14 and 37, respectively. IL17A appeared as a risk factor (OR = 2.21, 95% CI = 0.89–5.42) although statistically insignificant. The levels neither correlated with disease progression nor with TGFβ1, IL4 and IL10 but showed positive association with IL2 (r = 0.51, P < 0.0001) and IFNγ (r = 0.24). Flow cytometry data also showed similar trend.

Conclusions

We reported a distinct TGFβ1 and Th2 (IL4, IL10) polarization with a borderline elevation of IL17A while, a suppression of Th1 (IL2, IFNγ) cytokines in OSCC patients.     

The effect of short-term aerobic training on coagulation and fibrinolytic factors in sedentary healthy postmenopausal women

Objective

The purpose of this study was to assess the effect of short-term aerobic training on the fibrinolytic and coagulative factors in postmenopausal women.

Study design

Twenty volunteer sedentary healthy postmenopausal women (48–53 years), who entered the menopause naturally, were divided randomly into two groups: training (n = 10) and control (n = 10).

Methods and main outcome measures

Training consisted of 10 sessions of submaximal aerobic cycling, 35 min for each session (5 min warm-up, 25 min aerobic training with 70% HRmax, 5 min active and 15 min passive recovery), 3 times a week. Coagulation and fibrinolytic factors were assessed both before and after aerobic program in both groups.

Results

Fibrinogen, von Willbrand factor (vWF-Ag) antigen, plasminogen activator inhibitor-1 activity (PAI-1:Ac) and antigen (PAI-1:Ag) showed significant reduction after 10 sessions in the training group (P < 0.05). Also after training, prothrombin time (PT), partial thromboplastin time (PTT), tissue plasminogen activator activity (tPA:Ac) and antigen (tPA:Ag) increased (P < 0.05).

Conclusion

It was concluded that fibrinolytic activity on postmenopausal women could be improved by a 3-week regular submaximal training program. These changes on the hemostatic factors suggest that short-term aerobic training may prevent the decline in fibrinolytic function observed in sedentary postmenopausal women.     

Pooled analysis of sustained response rates for extended release quetiapine fumarate as monotherapy or adjunct to antidepressant therapy in patients with major depressive disorder

Background

Clinical trials are not generally powered to analyze outcomes such as sustained response. We evaluated sustained response rates for patients with major depressive disorder receiving quetiapine XR as monotherapy or adjunct therapy.

Method

Post hoc analyses of pooled data from four previously reported randomized, placebo-controlled studies of quetiapine XR 150 and 300 mg/day as monotherapy or adjunct therapy to ongoing antidepressant. Sustained response rates (≥50% reduction in MADRS total score at specific timepoint and each subsequent visit until Week 6) were calculated at Weeks 1, 2, and 4; rates were compared using a Cochran–Mantel–Haenszel analysis.

Results

In the monotherapy studies, the proportion of patients experiencing sustained response was greater with quetiapine XR 150 mg/day versus placebo at Week 2 (20.0% vs. 13.3%; p<0.05) and Week 4 (33.3% vs. 23.3%; p<0.01) (observed cases [OC]). The corresponding sustained response rates for quetiapine XR 300 mg/day were 18.0% (p=0.104) and 29.7% (p=0.063), respectively (OC).The proportion of patients experiencing sustained response was greater in the adjunct studies versus placebo at Weeks 2 and 4 for quetiapine XR 150 (Week 2, 30.1% vs. 15.2%, p<0.001; Week 4, 40.1% vs. 32.0%, p<0.05) and 300 mg/day (Week 2, 29.0% vs. 15.2%, p<0.001; Week 4, 42.0% vs. 32.0%, p<0.05) (OC).

Limitations

Post hoc analyses, acute treatment period; no active comparator.

Conclusions

Quetiapine XR as monotherapy (150 mg/day at Weeks 2 and 4) or adjunct to ongoing antidepressant therapy (150 and 300 mg/day at Weeks 2 and 4) increased sustained response rates versus placebo.     

Communication matters: The impact of communication and participation in decision making on breast cancer patients’ depression and quality of life

Objective

This study explored the impact of breast cancer patients’ experiences of physician–patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment.

Methods

Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later.

Results

Patients who rated their level of information at baseline as high were less depressed after three (p = .010) and six months (p < .001) and experienced higher quality of life after three (p < .001) and six months (p = .049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p < .001) and had lower depression scores three months later (p = .005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact.

Conclusion

The findings reveal the significance of physician–patient communication and stress the meaning of baseline depression for later adjustment.

Practice implications

A high level of information and tailoring the involvement in decision making to patients’ desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.     

Communicating global cardiovascular risk: Are icon arrays better than numerical estimates in improving understanding,recall and perception of risk?

Objective

Experts recommend that adults have their global cardiovascular risk assessed. We investigated whether icon arrays increase understanding, recall, perception of CVR, and behavioral intent as compared with numerical information.

Methods

Male outpatient veterans, at an intermediate to high cardiovascular risk participated in a randomized controlled trial of a computer tutorial presenting individualized risk. Message format was presented in 3 formats: percentages, frequencies, and frequencies with icon arrays. We assessed understanding immediately (T1) and recall at 20 min (T2) and 2 weeks (T3) after the intervention. We assessed perceptions of importance/seriousness, intent to adhere, and self-efficacy at T1. Self-reported adherence was assessed at T3.

Results

One-hundred and twenty male veterans participated. Age, education, race, health literacy and numeracy were comparable at baseline. There were no differences in understanding at T1 [p = .31] and recall at T3 [p = .10]. Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [p ≤ .001]. There were no differences in perception of seriousness and importance for heart disease, behavioral intent, self-efficacy, actual adherence and satisfaction.

Conclusion

Icon arrays may impair short-term recall of CVR.

Practice implications

Icon arrays will not necessarily result in better understanding and recall of medical risk in all patients.