Psychological Problems among Head and Neck Cancer Patients in Relation to Utilization of Healthcare and Informal Care and Costs in the First Two Years after Diagnosis

Background: To investigate associations between psychological problems and the use of healthcare and informal care and total costs among head and neck cancer (HNC) patients. Method: Data were used of the NETherlands QUality of Life and Biomedical Cohort study. Anxiety and depression disorder (diagnostic interview), distress, symptoms of anxiety and depression (HADS), and fear of cancer recurrence (FCR) and cancer worry scale (CWS) were measured at baseline and at 12-month follow-up. Care use and costs (questionnaire) were measured at baseline, 3-, 6-, 12-, and 24-month follow-up. Associations between psychological problems and care use/costs were investigated using logistic and multiple regression analyses. Results: Data of 558 patients were used. Distress, symptoms of anxiety or depression, FCR, and/or anxiety disorder at baseline were significantly associated with higher use of primary care, supportive care, and/or informal care (odds ratios (ORs) between 1.55 and 4.76). Symptoms of anxiety, FCR, and/or depression disorder at 12-month follow-up were significantly associated with use of primary care, supportive care, and/or informal care (ORs between 1.74 and 6.42). Distress, symptoms of anxiety, and FCR at baseline were associated with higher total costs. Discussion: HNC patients with psychological problems make more use of healthcare and informal care and have higher costs. This is not the result of worse clinical outcomes.     

解郁丸抗抑郁作用机制的初步研究

目的 :初步探讨解郁丸抗抑郁作用机制。 方法 :采用高剂量阿朴吗啡导致体温下降试验,5-羟色胺酸(5-HTP)诱导甩头行为试验以及高效液相色谱-电化学检测法测定小鼠下丘脑、皮层、海马等脑内单胺类递质及其代谢产物含量。 结果 :解郁丸能显著拮抗高剂量阿朴吗啡所致小鼠体温下降;增加5-HTP诱导甩头行为。解郁丸单次和连续14 d给药,可提高下丘脑中去甲肾上腺素(NE)、多巴胺(DA)与DA的代谢产物3,4-二羟基苯乙二醇(DOPAC)的比值;也可使皮层中5-HT,NE,5-HT的代谢产物5-羟吲哚乙酸(5-HIAA),DOPAC含量升高,降低5-HT与5-HIAA及DA与DOPAC的比值;并可提高海马中5-HT与5-HIAA及DA与DOPAC的比值。解郁丸可使利血平化小鼠下丘脑中NE,5-HIAA,海马中5-HT,5-HIAA,DA与DOPAC的比值明显升高。 结论 :解郁丸抗抑郁作用机制可能与调节不同脑区的5-HT,NE等神经递质有关。单次和连续14 d给药可增加不同脑区5-HT,NE,DA的含量,连续14 d给药对利血平化所致不同脑区单胺类递质含量下降也有不同程度的翻转效应。     

京都酚的致惊作用

京都酚为-中枢神经系统活性二肽,icv可使小鼠出现惊厥。右旋京都酚致惊活性明显强于左旋体。利血平化动物明显增强京都酚的致惊作用,对于京都酚在利血平化小鼠所引起的惊厥,L-Dopa可使之减弱。5-HTP及纳洛酮可使之增强;抗癫痫药中硝基安定、苯妥英钠和丙戊酸钠可明显延长发作潜伏期,缩短持续时间和减少发作率。     

A randomised comparison of vaginoscopic office hysteroscopy and saline infusion sonography: a patient compliance study

Objective  The purpose of this study was to compare patient discomfort during saline infusion sonography (SIS) and office hysteroscopy performed according to a vaginoscopic approach.
Design  Randomised controlled trial.
Setting  University hospital.
Population  Women with an indication for further investigation of the uterine cavity.
Methods  A total of 100 women randomly allocated to either SIS or vaginoscopic office hysteroscopy in an outpatient clinic.
Main outcome measures  Scores on a visual analogue scale (VAS) for pain and a present pain intensity (PPI) scale, conclusiveness and success rate.
Results  The patients' pain scores on both the VAS and the PPI were lower for SIS when compared with office hysteroscopy ( P < 0.05). However, in cases of severe pain (VAS > 7 or PPI > 2), there was no statistically significant difference between both groups. The success rate, defined as adequate inspection of the cervical canal and uterine cavity, was 94% for SIS compared with 92% for office hysteroscopy ( P = 0.633). SIS, multiparity, shorter procedure time and position of the uterus in anteversion decreased pain scores among women studied.
Conclusions  Both SIS and office hysteroscopy are successful procedures and well tolerated by women. SIS induces significantly less discomfort than office hysteroscopy and should therefore be considered the method of choice.     

Efficacy of barriers and hypoxia-inducible factor inhibitors to prevent CO(2) pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model

STUDY OBJECTIVE: To investigate the effects of hypoxia-inducible factor (HIF) inhibitors, flotation agents, barriers, and a surfactant on pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. DESIGN: Prospective randomized trial (Canadian Task Force classification I). SETTING: Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University of Leuven. SUBJECTS: One hundred fourteen female BALB/c mice. INTERVENTIONS: Adhesions were induced during laparoscopy in BALB/c female mice. Pneumoperitoneum was maintained for 60 minutes with humidified CO(2). In 3 experiments the effects of HIF inhibitors such as 17-allylamino 17-demethoxygeldanamycin, radicicol, rapamycin, and wortmanin, flotation agents such as Hyskon and carboxymethylcellulose, barriers such as Hyalobarrier gel and SprayGel, and surfactant such as phospholipids were evaluated. MEASUREMENTS AND MAIN RESULTS: Adhesions were scored after 7 days during laparotomy. Adhesion formation decreased with the administration of wortmannin (p <.01), phospholipids (p <.01), Hyalobarrier Gel (p <.01), and SprayGel (p <.01). CONCLUSIONS: These experiments confirm the efficacy of barriers and phospholipids to separate or lubricate damaged surfaces. They also confirm the role of mesothelial hypoxia in this model by the efficacy of the HIF inhibitor wortmannin.     

洛铂联合5-氟尿嘧啶与亚叶酸钙治疗晚期食管癌的Ⅱ期临床研究

目的：评价洛铂联合5-FU与亚叶酸钙治疗晚期食管癌患者的疗效及安全性。方法：对40例未经化疗的晚期食管癌患者。给予以下方案化疗;洛铂50mg,静脉滴注,2h;亚叶酸钙200mg／m^2,静脉滴注,2h,d1～d3;5-FU400mg／m^2,静脉推注,d1～d3;5-FU600mg／m^2,持续静脉滴注,22h,d1～d3。每21d重复。完成2个周期后行疗效评价。结果：可评价疗效病例37例,其中CR1例,PR16例,SD15例,PD5例,总有效率为45．9％（17／37）（95％CI为30％～63％）,其中初治患者的总体疗效为68．2％（15／22）,复治患者中总体疗效为13．3％（2／15）;中住疾病进展时间为6个月。主要不良反应为骨髓抑制,其中白细胞下降Ⅲ,Ⅳ度为21.1％,血红蛋白下降Ⅲ,Ⅳ度为10．0％,血小板下降Ⅲ度为3．3％,未发现Ⅳ度反应。结论：该联合方案显示明显的抗肿瘤作用,与其他含铂方案相比,洛铂不良反应相对较轻,耐受性好。