Radical radiotherapy for nasopharyngeal carcinoma in elderly patients: the importance of co-morbidity assessment

Elderly patients represent a unique challenge for radical treatment in nasopharyngeal carcinoma (NPC) because of age and co-morbid conditions. We sought to evaluate the outcome of this particular group of patients and to identify key factors affecting treatment outcome. From 1998 to 2008, 990 consecutive NPC patients without distant metastasis were treated with radical radiotherapy with planned total dose >66 Gy. Among them, 103 (10.4%) patients were elderly aged >70 (group A). Their clinical characteristics and outcome were compared with those aged <70 (group B). Mortality at 90 days was used as a proxy of early deaths related to treatment. Co-morbidities were measured by the Adult Co-morbidity Evaluation 27 (ACE-27). Group A presented more commonly with poorer performance status. They showed higher rates of acute reaction, radiotherapy incompletion and mortality at 90 days (7.8% vs. 1.2%, p<0.001). The 5-year overall survival rates were 43.9% and 78.1% for groups A and B, respectively (p<0.001). No difference in failure free survival rates was noted. For group A, ACE-27 was the only predicting factor for mortality at 90 days [ACE-27 2-3 vs. 0-1: HR 15.86 (2.68-93.95), p=0.002], and the most important prognostic factors for overall survival included age, presenting stage and ACE-27 (p<0.05). Elderly NPC patients had poorer tolerance to radiotherapy. Early deaths related to treatment were not uncommon. A reasonable disease control can still be attained after radical radiotherapy for those who were able to survive through the peri-radiotherapy period. Patient selection and treatment approach with reference to ACE-27 should be considered.     

Synthesis, antileukemic and antiplatelet activities of 2,3-diaryl-6,7-dihydro-5H-1,4-diazepines

The synthesis, antileukemic and antiplatelet activity evaluation of 2,3-diaryl-6,7-dihydro-5H-1,4-diazepines are described. In general, it was found that compound 17o showed moderate antileukemic activity against MOLT3 human leukemic cancer cell lines. An arachidonic acid induced platelet aggregation effect on washed rat platelets was studied. Compound 17i was found to be the most potent. The antiplatelet properties may be mediated by interference with the arachidonic acid pathway.     

Prospective individual and social predictors of changes in adjustment for patients attending a regional cancer service

Purpose

This study applied the social-cognitive processing (SCP) model to examine whether positive (social support) and negative (social constraints) aspects of the social environment influenced emotional distress, quality of life (QoL), well-being, and benefit finding after cancer.

Methods

Participants were 439 adults at a median of 66 weeks post-diagnosis and 79 % of them had completed cancer treatments. Outcome measures and predictors were assessed twice, 6 months apart, and their relationships were analyzed using hierarchical multiple regressions.

Results

Participants reported improved physical QoL at retest. Correlations showed that better outcomes for depression, anxiety, QoL, and well-being were associated with higher social support and lower social constraints. In addition, benefit finding correlated with social support but not social constraints. After other predictors were taken into account, lower initial social constraints were modestly associated with improved mental QoL at retest. Higher social constraints scores also predicted the development of clinically significant depression and anxiety.

Conclusions

Results provided some support for the SCP model’s prediction that both positive and negative aspects of social environment can contribute to adjustment in people with cancer. Although several findings supported the model, a heterogeneous sample and small effect sizes indicate that replication and further study is needed.     

The Effects of an Antiosteoporosis Herbal Formula Containing Epimedii Herba,Ligustri Lucidi Fructus and Psoraleae Fructus on Density and Structure of Rat Long Bones Under Tail‐Suspension,and its Mechanisms of Action

An innovative anti‐osteoporosis herbal formula containing Epimedii Herba, Ligustri Lucidi Fructus and Psoraleae Fructus (ELP) has been previously shown its bone protecting effects in ovariectomized osteoporotic rats and also in post‐menopausal osteopenic women. This study aimed to investigate the efficacy of ELP against bone loss during physical inactivity or weightlessness. A hindlimb unloading tail‐suspended rat model was used for studying the effects of ELP on bone mineral density (BMD) and bone micro‐architecture. For in vitro mechanistic studies, rat mesenchymal stem cells (MSCs) and mouse macrophage cells (RAW264.7) were used for studying the effects of ELP on osteogenic/adipogenic differentiations and osteoclastogenesis, respectively. Our data illustrated that ELP had a significant preventive effect against bone loss induced by tail‐suspension (TS) at day 28 (p < 0.01) as indicated in the reduction in BMD loss and the preservation of bone micro‐architecture. ELP could significantly promote the osteogenesis and suppress the adipogenesis (p < 0.05) in MSCs. Besides, significant inhibition of osteoclast formation (p < 0.01) was found in ELP‐treated RAW264.7 cells upon receptor activator of nuclear factor kappa‐B ligand induction. Our study presents the first scientific evidence that ELP had a significant preventive effect against bone loss induced by TS through the actions of enhancing osteogenesis, suppressing adipogenesis and osteoclastogenesis. Copyright © 2012 John Wiley & Sons, Ltd.     

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 2: audit of service process

An audit of atopic eczema management, conducted on behalf of the British Association of Dermatologists, examined service structure (phase 1), process (phase 2) and outcome (phase 3). In phase 2, an on-site case-note audit was conducted in 19 hospital dermatology departments randomly selected from the original sample of 187 centres across the U.K. In total, 630 sets of notes were examined for completeness of: (i) information given to general practitioners (GPs) in clinic letters and (ii) facts relevant to the management of atopic eczema recorded in the patients' notes. In general, the information given to GPs in the clinic letters was good, with the recording of diagnosis, treatment and follow-up approaching the 100% working standard. Factual information such as site and severity of eczema (83% and 74%), and presence or absence of asthma (53%) were better recorded than quality of life issues such as sleep loss secondary to itching (21%) and effect on school, work or social life (6%). On average, only 51% of all audit measures were recorded across all centres, with slight variation between centres (41-61%). The centre with the best recording had a purpose-designed data sheet for doctors to complete when seeing new patients with atopic eczema. Such data sheets may help improve case-note recording. Similar data sheets for patients to complete may be more time-efficient.