Determinants of quality of life from the perspective of the patients: A qualitative analysis of patients with oral cavity cancer

PurposeThe aim of this study was to identify factors from the patient's perspective that influence quality of life and psychological stress after oral cancer, and to find out if these patients would opt for psycho-oncological assistance during further treatment.Materials and methodsStandardized interviews were conducted. All interviews were transcribed and reduced according to previously established rules. Next, the patients' statements were coded, put into one format, and summarized in categories. Each category was described individually so that a rule-based quantitative and qualitative evaluation of the patients’ statements was then possible.Results50 patients were interviewed. 40 of these patients indicated that their own personality and the social support received through friends and family were the most important predictors for quality of life and coping. Therefore, they suggested a focus on these aspects during psycho-oncological treatment. Nearly every patient stated that psycho-oncological assistance should be available for each of them.ConclusionThe results of this study show that patients have clear ideas about the factors that influence their quality of life, and that play a role in coping with disease. Doctors and nursing staff should also understand these factors in order to support patients in the best possible way in the context of psychological first aid.German clinical trials registerDRKS00006263.     

Effect of sacubitril/valsartan on cognitive impairment in colchicine-induced Alzheimer's model in rats

Alzheimer's disease (AD) is a complex neurodegenerative disease. There is epidemiological evidence that heart failure (HF) patients are at higher risk of developing AD, and the impact of sacubitril/valsartan, the first angiotensin receptor-neprilysin inhibitor (ARNI) approved for HF, on cognitive functions is still controversial. To investigate the effect of sacubitril/valsartan on cognitive functions in colchicine-induced AD rat model. Forty adult male Wistar rats were equally allocated into four groups (each of 10 rats): Group I: normal control, Group II: intracerebroventricular injection of colchicine (15 μg/5 μl/bilaterally), Group III: colchicine (15 μg/5 μl/bilaterally, icv) + oral sacubitril/valsartan (100 mg/kg/day) for 25 days, and Group IV: colchicine (15 μg/5 μl/bilaterally, icv) + oral valsartan (50 mg/kg/day) for 25 days. Behavioral assessment was done using Morris water maze and passive avoidance tasks. Biochemically, β-amyloid (1–40 and 1–42) peptides, oxidative stress (malondialdehyde and superoxide dismutase) and inflammatory (tumor necrosis factor-alpha) parameters were measured in hippocampus and prefrontal cortex. Sacubitril/valsartan exaggerated colchicine-induced cognitive impairment in both Morris water maze and passive avoidance tasks and was associated with significant increase in β-amyloid accumulation, oxidative stress, and inflammation versus valsartan. Sacubitril/valsartan caused deleterious effect on cognitive impairment and biochemical alterations in colchicine-induced AD rat model. Hence, special caution should be taken following long-term intake of ARNI on cognitive functions.     

Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases

Aim: The purpose of the study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and osteoarthritis (OA) and correlate them with disease activity parameters. Subjects and methods: This study included 60 patients with various rheumatic diseases (20 with RA, 20 with SLE and 20 with OA), as well as 10 healthy controls. All of them were subjected to complete history‐taking, examination and estimation of disease activity index. The following investigations were done for all subjects: serum and synovial activin A, inhibin A, erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), anti‐dsDNA and complements 3 and 4. Results: Serum levels of activin A were significantly higher in RA, SLE and OA than controls and in RA and SLE versus OA The mean values of serum inhibin A were significantly higher in all studied groups than controls. Synovial activin A and inhibin A were significantly higher in RA than OA. Positive correlations were found between serum activin A and disease activity parameters of RA. In SLE, positive correlations were found between serum activin A and inhibin A with ESR and SLE Disease Activity Index. Conclusions: Serum activin A and inhibin A were significantly higher in RA and SLE. Serum levels correlated positively with disease activity parameters of RA and SLE. However, synovial levels were significantly higher in RA than OA but showed no correlation or negative correlation with disease activity. We recommend further studies to detect the exact role of activin A and inhibin A in these conditions.     

Urine Microscopy Is Associated with Severity and Worsening of Acute Kidney Injury in Hospitalized Patients

Background and objectives: Serum creatinine concentration at the time of nephrology consultation is not necessarily indicative of the severity of acute kidney injury (AKI). Although urine microscopy is useful to differentiate AKI, its role in predicting adverse clinical outcomes has not been well described.Design, setting, participants, & measurements: The relationship between urine microscopy findings at the time of nephrology consultation for AKI and clinical outcomes was evaluated prospectively. A urinary sediment scoring system was created on the basis of the number of renal tubular epithelial cells and granular casts. The primary outcome was worsening of AKI (progressing to higher AKI Network stage, dialysis, or death) during hospitalization.Results: Of 249 patients consulted for AKI, 197 had acute tubular necrosis or prerenal AKI and were included in the analysis. At consultation, 80 (40%) had stage 1, 53 (27%) had stage 2, and 66 (33%) had stage 3 AKI. The urinary sediment combined scores were lowest in those with stage 1 and highest in stage 3 AKI. Seventy-nine patients (40%) experienced worsening of AKI from the time of consultation. The urinary scoring system was significantly associated with increased risk of worsening AKI (adjusted relative risk: 7.3; 95% confidence interval: 4.5 to 9.7 for worsening with score of ≥3 versus score of 0) and was more predictive than AKI Network stage at the time of consultation.Conclusions: The urinary sediment score may be a useful tool to predict worsening of AKI due to either acute tubular necrosis or prerenal AKI during hospitalization.Currently, diagnosis of acute kidney injury (AKI) is based on serum creatinine concentration and urine output. The Acute Kidney Injury Network (AKIN) definition is based on these two parameters and uses various cutoffs to define three distinct AKI stages (1). Urine microscopy and biochemistry are complementary to these diagnostic parameters and provide information that facilitates the differentiation of AKI into traditional categories, including prerenal AKI and acute tubular necrosis (ATN), the most common causes of hospital-acquired AKI (2–4). Urinary microscopy in patients with ATN classically is described as containing renal tubular epithelial (RTE) cells, RTE cell casts, granular casts, or mixed cellular casts, whereas sediment in patients with prerenal AKI usually is bland or contains occasional hyaline casts (5–9). In fact, we recently demonstrated that urine microscopy at the time of nephrology consultation, on the basis of the number of RTE cells and granular casts (10). We believe this is important because both prognosis and therapies for prerenal AKI and ATN differ substantially, making early clinical differentiation fundamental to AKI management.

Table 1.

Scoring system based on number of granular casts and RTE cells

Disruptions in Functional Network Connectivity During Alcohol Intoxicated Driving

Background: Driving while under the influence of alcohol is a major public health problem whose neural basis is not well understood. In a recently published functional magnetic resonance imaging (fMRI) study ( Meda et al., 2009 ), our group identified 5, independent critical driving‐associated brain circuits whose inter‐regional connectivity was disrupted by alcohol intoxication. However, the functional connectivity between these circuits has not yet been explored in order to determine how these networks communicate with each other during sober and alcohol‐intoxicated states. Methods: In the current study, we explored such differences in connections between the above brain circuits and driving behavior, under the influence of alcohol versus placebo. Forty social drinkers who drove regularly underwent fMRI scans during virtual reality driving simulations following 2 alcohol doses, placebo and an individualized dose producing blood alcohol concentrations (BACs) of 0.10%. Results: At the active dose, we found specific disruptions of functional network connectivity between the frontal‐temporal‐basal ganglia and the cerebellar circuits. The temporal connectivity between these 2 circuits was found to be less correlated (p < 0.05) when driving under the influence of alcohol. This disconnection was also associated with an abnormal driving behavior (unstable motor vehicle steering). Conclusions: Connections between frontal‐temporal‐basal ganglia and cerebellum have recently been explored; these may be responsible in part for maintaining normal motor behavior by integrating their overlapping motor control functions. These connections appear to be disrupted by alcohol intoxication, in turn associated with an explicit type of impaired driving behavior.