The management of stage I--II Hodgkin's disease with irradiation alone or combined modality therapy: the Stanford experience

At Stanford University, between 1968 and 1978, 230 patients with pathologic stage I--II Hodgkin's disease were treated on prospective clinical trials with either irradiation alone or irradiation followed by 6 cycles of adjuvant combination chemotherapy. The actuarial survival at 10 yr was 84% for patients in either treatment group. Freedom from relapse at 10 yr was 77% among patients treated with irradiation alone and 84% after treatment with combined modality therapy [p(Gehan) = 0.09]. Freedom from second relapse at 10 yr was 89% and 94%, respectively [p(Gehan) = 0.56]. Several prognostic factors were evaluated in order to identify patients at high risk for relapse or with poor ultimate survival after initial treatment with irradiation alone. Systemic symptoms, histologic subtype, age, and limited extranodal involvement (E-lesions) did not affect the prognosis of patients and failed to identify patients whose survival could be improved by the routine use of combined modality therapy. Patients with large mediastinal masses (mediastinal mass ratio greater than or equal to 1/3) had a significantly poorer freedom from relapse when treated with irradiation alone than when treated initially with combined modality therapy [45% versus 81% at 10 yr, p(Gehan) = 0.03). The 10-yr survival of these patients, however, was not significantly different (84% versus 74%). The implications of these observations on the management of patient with early stage Hodgkin's disease are discussed.     

Vascular compression of the oculomotor nerve disclosed by thin-slice magnetic resonance imaging

Purpose: To describe the thin-slice magnetic resonance imaging features of vascular compressive oculomotor nerve paresis.Methods: We performed thin-slice (2 mm thick) magnetic resonance imaging of the brainstem in a 74-year-old woman with right partial oculomotor nerve paresis using spoiled gradient recalled acquisition in the steady state.Results: Thin-slice magnetic resonance images disclosed that the right oculomotor nerve was compressed and dislocated superiorly and laterally by the tortuous basilar artery. No other abnormalities were observed.Conclusion: This is the first case report of vascular compressive oculomotor nerve paresis disclosed by thin-slice magnetic resonance imaging.     

Blood preservation. XXXIV. DHA maintains 2,3-DPG and its adverse effect on ATP is reversed with extra phosphate

We have found that the addition of 10 mM inorganic phosphate to DHA in CPD-adenine maintains ATP levels at normal or higher than normal values for six weeks of storage. 2,3-DPG values are slightly lowered by the extra phosphate, but are still maintained at approximately half normal for four weeks by the DHA. The addition of a higher phosphate concentration, 20 mM, to DHA produced lower levels of ATP and 2,3-DPG than those observed with 10 mM phosphate, although both levels were better than in the CPD-adenine control. pH values in this experiment were lowest in the three preservatives containing DHA, probably indicating increased lactate production due to metabolism of this triose sugar, in addition to dextrose present in CPD.     

To Flourish or Not: Positive Mental Health and All-Cause Mortality

Objectives. We investigated whether positive mental health predicts all-cause mortality.Methods. Data were from the Midlife in the United States (MIDUS) study (n = 3032), which at baseline in 1995 measured positive mental health (flourishing and not) and past-year mental illness (major depressive episode, panic attacks, and generalized anxiety disorders), and linked respondents with National Death Index records in a 10-year follow-up ending in 2005. Covariates were age, gender, race, education, any past-year mental illness, smoking, physical inactivity, physical diseases, and physical disease risk factors.Results. A total of 6.3% of participants died during the study period. The final and fully adjusted odds ratio of mortality was 1.62 (95% confidence interval [CI] = 1.00, 2.62; P = .05) for adults who were not flourishing, relative to participants with flourishing mental health. Age, gender, race, education, smoking, physical inactivity, cardiovascular disease, and HIV/AIDS were significant predictors of death during the study period.Conclusions. The absence of positive mental health increased the probability of all-cause mortality for men and women at all ages after adjustment for known causes of death.Historically, mental health has been viewed as the absence of mental disorder, despite conceptions that health in general is something positive and consists of well-being and not merely the absence of illness.1 Mental well-being—i.e., positive mental health—is now a focus of national policy and science. The World Health Organization’s report on mental health defined it as

a state of well–being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.2^(p10)

Mental health has been operationalized under the rubric of subjective well-being, or individuals’ evaluations of the quality of their lives. The nature of subjective well-being has been divided into 2 streams of research. The first approach equates well-being with feeling good and the second with functioning well in life. These 2 streams of subjective well-being research grew from 2 distinct philosophical viewpoints on happiness—one reflecting the hedonic tradition, which champions pleasure (i.e., positive feelings), and the other following the eudaimonic tradition, which emphasizes striving toward excellence or a good life as an individual and a citizen.The hedonic tradition is reflected in research on emotional well-being, where scholars use measures of satisfaction with life and positive affect (e.g., cheerfulness, happiness, and contentment).3 The tradition of eudaimonia is reflected in research on psychological4 and social5 well-being. Here, scholars use multidimensional scales that ask individuals to evaluate how well they see themselves functioning as they strive to achieve sufficient levels of purpose, contribution, integration, autonomy, intimacy, acceptance, and mastery in life. Studies support the tripartite model of emotional, psychological, and social well-being in US adults and youths.6–8Although evidence links subjective well-being to mortality, most research has focused on emotional well-being. Reviews conclude that lower levels of positive emotions such as joy and happiness and lower levels of satisfaction with life are prospectively associated with increased risk of all-cause mortality in healthy populations9–12 and in populations with preexisting physical illnesses.9,11 In their review of 49 longitudinal studies, Howell et al. found an overall effect size of 0.14 for mortality between individuals with high and low emotional well-being (i.e., positive affect or life satisfaction).11A few studies have investigated constructs reflecting psychological or social well-being.13–18 These reports suggest that the dimensions of psychological well-being (e.g., purpose in life) and social well-being (e.g., social coherence—the belief that life makes sense and is predictable—and a sense of contribution to society) are also predictive of mortality. Adults with higher levels of purpose in life13–15; who find life more meaningful, manageable, and predictable16,17; and who feel more useful to other people18 have a lower adjusted risk of all-cause mortality.Published analyses of the Midlife in the United States (MIDUS) data identified an effect of positive mental health—on a continuum from languishing to moderate to flourishing mental health—on future mental illness.19 We used data from the MIDUS cohort study20 to extend the existing literature by investigating the risk of all-cause mortality by each of the components and the algorithm-derived categories of the mental health continuum,21 incorporating measurement of psychological and social well-being in addition to emotional well-being.We examined whether the integration of the 3 types of well-being into the categorization of positive mental health (i.e., flourishing or not flourishing) predicted 10-year all-cause mortality. We also investigated the extent to which 12-month diagnosis of internalizing psychopathology (major depressive episode, panic attacks, and generalized anxiety), education, gender, race, age, risk behaviors (physical inactivity and smoking), and preexisting physical illness confounded or explained the association between positive mental health and mortality.22–27