The impact of CNS-directed treatment on quality of life in childhood cancer survivors

Purpose

Pediatric cancer survivors may have lower quality of life (QoL), but most research has assessed outcomes either in treatment or long-term survivorship. We focused on early survivorship (i.e., 3 and 5 years post-diagnosis), examining the impact of CNS-directed treatment on child QoL, as well as sex and age at diagnosis as potential moderators.

Methods

Families of children with cancer (ages 5–17) were recruited at diagnosis or relapse (N?=?336). Survivors completed the PedsQL at 3 (n?=?96) and 5 years (n?=?108), along with mothers (101 and 105, respectively) and fathers (45 and 53, respectively). The impact of CNS treatment, sex, and age at diagnosis on child QoL was examined over both time since diagnosis and time since last treatment using mixed model analyses.

Results

Parent-report of the child’s total QoL was in the normative range and stable between 3 and 5 years when examining time since diagnosis, while child reported QoL improved over time (p?=?0.04). In terms of time since last treatment, mother and child both reported the child’s QoL improved over time (p?=?0.0002 and p?=?0.0006, respectively). Based on parent-report, males with CNS-directed treatment had lower total QoL than females and males who did not receive CNS-directed treatment. Age at diagnosis did not moderate the impact of treatment type on total QoL.

Conclusions

Quality of life (QoL) in early survivorship may be low among males who received CNS-directed treatment. However, this was only evident on parent-report. Interventions to improve child QoL should focus on male survivors who received CNS-directed treatment, as well as females regardless of treatment type.

     

西印度醋栗对四氯化碳引起的大鼠和小鼠急性过氧化肝损伤的保护作用

目的：证实西印度醋栗（Phyllanthus acidus（L.）Skeels）的果实在传统医学中作为保肝药使用的药用用途。方法：连续5d分别给予各组大鼠西印度醋栗果实的70%乙醇提取物（100,200和400mg/kg口服）及对照药水飞蓟素（100mg/kg口服）并于第2天及第3天皮下注射四氯化碳（2mL/kg）。测定血清天冬氨酸氨基转移酶（aspartate transaminase,AST）、丙氨酸氨基转移酶（alanine transaminase,ALT）、碱性磷酸酶（alkaline phosphatase,ALP）、总胆红素以及总蛋白并进行肝脏组织病理学检测。检测大鼠肝组织匀浆中的氧化应激标记物如脂质过氧化反应（lipid peroxidation,LPO）、还原型谷胱甘肽（reduced glutathione,GSH）、超氧化物歧化酶（superoxide dismutase,SOD）、过氧化氢酶（catalase,CAT）以及谷胱甘肽过氧化物酶（glutathione peroxidase,GPx）以衡量西印度醋栗的体外抗氧化作用。此外,本实验还记录了伊维巴诱导的给药后小鼠睡眠时间,使用2,2-二苯基-1-苦基肼（2,2-diphenyl-1-picrylhydrazil,DPPH）法测定小鼠服药后的自由基清除率。结果：与对照组相比,西印度醋栗果实的乙醇提取物及水飞蓟素均显著降低了模型大鼠血清AST、ALT和ALP水平及LPO并升高了TP、GSH、SOD、CAT和GPx的水平（P〈0.01或P〈0.05）。大鼠肝脏组织的组织病理学切片结果也证实了以上实验结果。在小鼠实验中,与对照组相比,西印度醋栗果实的乙醇提取物显著缩短了伊维巴诱导的小鼠睡眠时间（P〈0.01）,并具有较高的DPPH清除率。结论：本研究的实验结果证实了西印度醋栗果实对四氯化碳引起的大鼠急性过氧化肝损伤的保护作用,机制可能与其抗氧化作用及自由基清除功能有关     

Ganoderma lucidum is an inhibitor of testosterone-induced prostatic hyperplasia in rats

The aim of the present study was to find out whether Ganoderma lucidum (GL) can be used as a clinically effective medicine for the management of prostatic hyperplasia. In vitro studies were conducted to assess the 5α-reductase inhibitory potential of GL. A biochemical marker viz. β-sitosterol was identified and characterised in the extracts utilising high-performance thin-layer chromatography. Testosterone (3 mg kg(-1) s.c.) was administered to the rats along with the test extracts (10, 20 and 50 mg kg(-1) p.o.) and β-sitosterol (10 and 20 mg kg(-1) p.o.) for a period of 28 days. Finasteride was used as a positive control (1 mg kg(-1) p.o.). GL extracts attenuated the increase in the prostate/body weight ratio induced by testosterone. Petroleum ether extract exhibiting the best activity. Ethanolic extract also exhibited significant activity. The urine output also improved significantly, which emphasise the clinical implications of the study. Testosterone levels measured weekly and prostate-specific antigen (PSA) levels measured at the end of the study also support our claims. The PSA levels decreased in the extract-treated groups, indicating their usefulness in the treatment of benign prostatic hyperplasia. Histological studies have shown a considerable improvement in the prostatic histoarchitecture in the extract-treated groups when compared to the testosterone-treated group.     

Pattern of drug usage in bronchiolitis

Bronchiolitis is a common viral respiratory infection in infants and young children. The objective of this study was to assess the pattern of drug usage in paediatric patients with bronchiolitis. One hundred patients (aged 2 weeks to 22 months) were evaluated. Of these, 64% had a respiratory syncytial virus infection. The drug therapy included albuterol in 99%, corticosteroids in 36%, aminophylline in 12% and ribavirin in 2% of the patients. The drug doses and frequencies, and durations of therapy varied substantially among patients. This emphasizes the need for well-designed research to develop optimal dosage regimens in paediatric patients with bronchiolitis.     

Frequency and preventability of adverse drug reactions in paediatric patients.

PURPOSE: To evaluate the frequency, severity and preventability of adverse drug reactions (ADRs) in paediatric patients during the 6-year period from 1 January 1994 to 31 December 1999. METHODS : Data on patient demographics, documented allergies, suspected drug, American Hospital Formulary Service drug classification and dosage regimen were collected retrospectively from ADRs reported to a hospital surveillance programme. ADRs were categorised by severity, preventability and causality. Analysis was conducted by Chi-square and Wilcoxon rank sum (Mann-Whitney) tests. RESULTS: During the 6-year period, 565 ADRs were reported at a rate of 0.85 ADRs per 100 admissions. The mean patient age was 9.6 years. No history of allergies was documented in 87.4% of the cases, although 2.8% of patients had a documented allergy to the suspected medication. Opioids (narcotics) [n = 65, 11.5%], anticonvulsants (n = 67, 11.9%) and antibiotics (n = 149, 26.4%) were the most frequently implicated drug classes. Over 50% of the reported ADRs resulted in treatment intervention and/or temporary patient harm and of these, 73% required drug therapy. Causality was classified as 'definite' (44.1%), 'probable' (49.9%) or 'possible' (6.0%). Of the reported ADRs, 20.7% were preventable. CONCLUSIONS: ADRs resulted in treatment intervention or temporary patient discomfort in >50% of patients. The incidence of preventable ADRs is similar to that found in adult literature. No single drug caused >5% of reported ADRs. Opioids, anticonvulsants and antibiotics were the most common drug classes associated with ADRs. Thus, strategies targeting these drug classes and interventions during the medication ordering and administration processes may reduce the number of ADRs and possibly the associated costs. Even though preventable ADRs may not be entirely eliminated, the goal should be to increase ADR awareness and encourage early detection and intervention to minimise patient discomfort.     

Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility‐related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their “top 3” life goals. Only 40% reported fertility‐related discussions with their health care providers in survivorship. Given the importance of biological children among this cohort, future guidelines should encourage a more proactive approach to providing fertility counseling and offering testing, to mitigate distress and prevent unplanned pregnancies.