Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

Purpose The aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL.Patients and methods A total of 413 women with breast cancer from Germany (n=195), Japan (n=112), and Korea (n=106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included.Results The effect of the factor country on physical QOL was seen to be significant, but small (P=0.049, ES=0.018). The scales of General Health (P=0.023), Vitality (P=0.004), and Role Emotional (P=0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients.Conclusions Results from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients’ cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.     

2-DE protein expression in endometrial carcinoma

The objective of this study was to explore the protein expression pattern in normal endometrial mucosa (n = 5) and endometrial carcinoma (n = 15) of low (diploid) and high (aneuploid) malignancy potential by two-dimensional gel electrophoresis (2-DE). The specimens were evaluated for histopathologic subtype, stage and grade in relation to DNA ploidy. A match-set consisting of five samples from normal endometrium, eight diploid and seven aneuploid tumours was created. All the diploid and three of the aneuploid tumours were of endometrioid subtype, while the remaining four were of uterine seropapillary type. There were 192 protein spots differentiating diploid tumours from normal endometrium and 238 protein spots were separating aneuploid tumours from normal endometrium (p < 0.01). A cluster analysis based on 52 significantly deviating protein spots within the groups showed clustering and separation of the normal endometrium, diploid and aneuploid tumours. In conclusion this study showed significant differences in protein expression between normal endometrium and endometrial carcinoma as well as between endometrial carcinoma of low and high malignancy potential. In future studies these results may provide useful in finding new sensitive prognostic markers for endometrial cancer.     

Transgenic flavonoid tomato intake reduces C-reactive protein in human C-reactive protein transgenic mice more than wild-type tomato

The increased consumption of fruits and vegetables is associated with reduced cardiovascular disease. The molecular basis of this health effect is not fully understood, yet dietary flavonoids are thought to play an important role. Genetic engineering has enabled us to overexpress specific flavonoids (flavones and flavonols) in tomato fruit. Human C-reactive protein transgenic (CRPtg) mice express markers of cardiovascular risk that allow us to study of the putative health effects of wild-type tomato (wtTom) and flavonoid-enriched tomato (flTom). In this study, we analyzed whether consumption of wtTom, at a dose achievable with a human diet, has beneficial effects on cardiovascular risk markers and whether flTom may enhance such effects. CRPtg mice were fed a diet containing 4 g/kg wtTom, flTom peel, vehicle, or 1 g/kg fenofibrate, which reportedly reduces cardiovascular risk, for 7 wk. Markers of general health (bodyweight, food intake, and plasma alanine aminotransferase activities) and of cardiovascular risk (plasma CRP, fibrinogen, E-selectin, and cholesterol levels) were analyzed. All groups had comparable food intakes and body-weight gains. Plasma alanine aminotransferase activities increased significantly in vehicle and fenofibrate-treated mice. Compared with baseline, wtTom and flTom significantly reduced basal human CRP concentrations by 43 and 56%, respectively. The CRP-lowering effect of flTom significantly exceeded that of wtTom. The effects of flTom on CRP were reversed within a 2-wk washout period. WtTom and flTom did not affect fibrinogen, but comparably repressed E-selectin expression and upregulated HDL cholesterol. Tomato peel consumption improved cardiovascular risk factors in CRPtg mice, a beneficial effect that was further enhanced by enrichment of the flavonoid content.     

A truncated polycystin-2 protein causes polycystic kidney disease and retinal degeneration in transgenic rats

The cloning of the PKD1 and PKD2 genes has led to promising new insight into the mechanisms that are responsible for cyst development in patients with autosomal dominant polycystic kidney disease. Although the dominant pattern of inheritance would argue for haploinsufficiency, a gain of function, or a dominant negative mechanism, there is good evidence that autosomal dominant polycystic kidney disease behaves like a recessive disease on a cellular level (two-hit mechanism of cystogenesis). For testing of whether other pathomechanisms in addition to the two-hit hypothesis can explain cyst formation, two transgenic rat lines that contain a truncated human polycystin-2 cDNA were generated. The protein product lacks almost the entire COOH-terminus and mimics mutations that frequently are found in patients. The transgene-encoded mRNA could be detected in multiple tissues of both transgenic lines, with the highest expression in the kidney. Both lines present with renal cysts that originate predominantly from the proximal tubule; in the tubular epithelial cells, the epitope-tagged mutant protein was detected in the brush border and in primary cilia. Further evidence of the involvement of primary cilia stems from the finding of retinal degeneration in the transgenic rats and from the fact that stably transfected LLC-PK(1) cells that inducibly produced the truncated polycystin-2 protein elaborated shorter cilia. Other experimental approaches, such as a knock-in strategy, will be necessary to validate these results, but this is the first preliminary evidence that cyst formation is due not only to somatic mutations.     

Unplanned reoperations for infection complications: a survey for quality control

BACKGROUND: Unplanned reoperation is perceived as a quality indicator for surgical procedures. However, there is a lack of data regarding the extent to which infections add to the reoperation rate. We studied the role of infection as an indication for unplanned reoperation. METHODS: The setting was a surgical department at an academic teaching hospital performing a spectrum of general, vascular, thoracic (lung), and transplant (kidney) procedures. Between January, 2003 and September, 2004, data on operations, unplanned reoperations, and complications were documented prospectively. Unplanned reoperation was defined as unexpected reoperation within 30 days of the primary procedure. Endpoints were the number of unplanned reoperations attributable to infection, the site of the infection, the type of the primary operation, and deaths. RESULTS: A total of 6,287 operations were performed during the study period. The rate of unplanned reoperations was 1.34% (84/6287), and 15 (17.9%) of these 84 patients had to undergo reoperation because of an infection. The primary operations in these cases were general surgical procedures in 11 patients, kidney transplant in two patients, and vascular surgery and lung resection in one patient each. Leakage of a gastrointestinal anastomosis was the predominant cause in the general surgical group (8/11). The most frequent initial procedure was colon resection (n = 4) followed by ileostomy closure (n = 2) and kidney transplant (n = 2). One unplanned reoperation had to be done after esophagectomy, pancreatoduodenectomy, pneumonectomy, incisional hernia repair, appendectomy, femoro-femoral bypass, and resection of a soft tissue tumor. The mortality rate after unplanned reoperation for infection was 20% (3/15), a significantly higher rate than in patients not having reoperation (p < 0.00001). Subgroup analysis did not show any significant difference in mortality according to whether the unplanned reoperation was indicated by infection, bleeding, or other reason (p = 0.28). Patients who required operation because of an infection stayed significantly longer in the intensive care unit (p = 0.018) and underwent more reoperations (p = 0.003) than those with other indications for reoperation. CONCLUSION: Infections add considerably to the rate of unplanned reoperation. The mortality rate is high, but not significantly different from that in patients having reoperation for other indications. A longer stay in the intensive care unit and a higher number of reoperations indicate a greater use of resources by these patients.     

Anastomotic obstruction after magnetic vascular coupling after minimally invasive direct coronary artery bypass grafting

We report a 61-year-old man who required reoperation 8 months after minimally invasive direct coronary artery bypass grafting after magnetic vascular coupling due to a symptomatic subtotal obstruction at the anastomotic site. It was also determined that the patient had been noncompliant in following the prescribed postoperative antiplatelet therapy.     

Intrathecal and systemic concentration of NT-proBNP in patients with severe traumatic brain injury

Outcome of patients suffering from traumatic brain injury (TBI) depends on the development of secondary brain damage. In this context, recent studies underlined the role of the natriuretic peptides- atrial natriuretic peptide and brain natriuretic peptide (BNP)-in aneurysmatic subarachnoidal hemorrhage (SAH). Especially BNP correlates with intracranial pressure and clinical outcome after SAH. Since its role in TBI remains unclear, the intracranial and systemic concentrations of N-terminal (NT)-proBNP were analyzed in patients suffering from severe TBI. We measured NT-proBNP levels in cerebrospinal fluid (CSF) and serum of 14 patients suffering from severe TBI (GCS15 mm Hg (n=6), the serum (800+/-150 pg/mL) and CSF levels (55+/-9 pg/mL) of NT-proBNP were significantly increased after 24 h, as compared to patients with ICP15 mm Hg. Further studies are currently performed to elucidate the physiologic role of NT-proBNP in TBI.     

Prediction of glomerular filtration rate in renal transplant recipients: cystatin C or Modification of Diet in Renal Disease equation?

BACKGROUND: To overcome disadvantages of serum creatinine two strategies have been suggested to identify patients with reduced glomerular filtration rate (GFR). On the one hand, the Modification of Diet in Renal Disease (MDRD) equation is now recommended to classify the stage of chronic kidney disease. On the other hand, cystatin C (Cys C) has been investigated in numerous studies, finding a higher sensitivity than creatinine in detecting diminished GFR. To date, no comparison of both strategies in patients after renal transplantation has been performed. METHODS: One hundred and five consecutive renal transplant recipients underwent (99m)Tc-DTPA-- clearance measurement. Simultaneously, MDRD estimates were calculated and Cys C serum levels were determined. ROC analyses were performed at different decision points from 20 to 70 mL/min/1.73 m(2). RESULTS: Although the area under the curve did not differ significantly between MDRD and Cys C within the tested GFR range, the AUC for Cys C tended to be higher when GFR exceeded 55 mL/min/1.73 m(2). A significantly higher diagnostic accuracy for Cys C compared with MDRD (p = 0.045 at 65 mL/min/1.73 m(2)) was found when investigating the subgroup of patients with well-functioning grafts (GFR>40 mL/min/1.73 m(2)). CONCLUSION: MDRD equation is equivalent to Cys C measurement in renal transplant recipients. As availability of MDRD is superior to Cys C, we recommend GFR estimation using the MDRD equation. Nevertheless, Cys C may serve as a confirmation test of high MDRD estimates in patients with well-functioning grafts because of superior accuracy in these patients.