Supportive management of patients with brain tumors

Management issues for patients with brain tumors include peritumoral edema, symptomatic seizures, venous thromboembolism, headache, pain, fatigue and neuropsychological complaints. Vasogenic edema is typically ameliorated with the lowest dose possible of corticosteroid. Seizures are managed with attention to additional or complicated side effects of antiepileptic drugs and their interactions with chemotherapy, and primary prevention with antiepileptic medications is not recommended. Appropriate treatments for headache, pain, fatigue and neuropsychological complaints are important, but are not yet well standardized. Above all, patients' personal goals regarding their priorities at the end of life have the most importance.     

Prognostic value of plasma soluble urokinase plasminogen activator receptor (suPAR) in Danish patients with recurrent epithelial ovarian cancer (REOC)

The level of the soluble urokinase plasminogen activator receptor (suPAR) is elevated in tumour tissue from several types of cancer. This is the first study aiming to predict the prognosis for survival by the use of a pre-chemotherapeutic plasma suPAR value in 71 patients with recurrent epithelial ovarian cancer (REOC). For determination of suPAR, pre-chemotherapeutic blood samples from the patients with REOC were processed into plasma (EDTA) within one working day from venipuncture. The plasma suPAR level is not correlated with performance status (p=0.41), FIGO stage (p=0.09), treatment-free interval (TFI) of 12 months (p=0.26), site of recurrence (peritoneum, p=0.50 or pelvis, p=0.44), age (p=0.43), or serum CA125 (p=0.09). Univariate as well as multivariate analyses cannot demonstrate that high pre-chemotherapeutic levels of plasma suPAR (p=0.22, p=0.80) are associated with shorter survival of REOC patients. Multivariate analysis showed that only TFI of 12 months (p=0.001) and performance score status of 2 (p=0.02) were independent prognostic factors. Our study indicates that pre-chemotherapeutic measurement of plasma suPAR level in REOC patients may not be useful to identify a subgroup of patients with poor prognosis.     

What do you think of your dentist? A dental practice assessment questionnaire

Background In order to comply with clinical governance requirements and receive payments under the Qualities and Outcomes Framework, GPs are required to undertake an annual survey of patient experience using a validated assessment tool. Dentists, in contrast, have embryonic clinical governance structures. The provision of quality dental services was identified in NHS Dentistry: Options for Change as a priority for the future. In anticipation of the PCT role in commissioning quality NHS dental care, Croydon PCT has developed an instrument to examine various aspects of the patient experience. Methods A review of existing literature identified five generic dimensions of patient satisfaction with dental care: technical competence, interpersonal factors, convenience, costs and facilities. The dental practice assessment questionnaire was developed to cover all of these dimensions using a number of validated measures and modified questions. A small scale pilot was undertaken before the questionnaire was sent to a 10% random stratified sample of the PCT population. Results Validation analyses were undertaken in conjunction with the GKT Dental Institute. Cronbach's alpha demonstrated very high levels of internal consistency, and factor analysis and correlation coefficients demonstrated high levels of factorial and concurrent validity respectively. Subgroup analysis revealed differences in reported satisfaction by age and ethnic group, and that those who attend because of pain or a dental emergency are generally less satisfied with the care they receive. These results are consistent with previous research findings. Conclusion The dental practice assessment questionnaire is a valid and consistent measurement tool. Its use could be extended across the NHS without difficulty.     

Activity dynamics and behavioral correlates of CA3 and CA1 hippocampal pyramidal neurons

The CA3 and CA1 pyramidal neurons are the major principal cell types of the hippocampus proper. The strongly recurrent collateral system of CA3 cells and the largely parallel‐organized CA1 neurons suggest that these regions perform distinct computations. However, a comprehensive comparison between CA1 and CA3 pyramidal cells in terms of firing properties, network dynamics, and behavioral correlations is sparse in the intact animal. We performed large‐scale recordings in the dorsal hippocampus of rats to quantify the similarities and differences between CA1 (n > 3,600) and CA3 (n > 2,200) pyramidal cells during sleep and exploration in multiple environments. CA1 and CA3 neurons differed significantly in firing rates, spike burst propensity, spike entrainment by the theta rhythm, and other aspects of spiking dynamics in a brain state‐dependent manner. A smaller proportion of CA3 than CA1 cells displayed prominent place fields, but place fields of CA3 neurons were more compact, more stable, and carried more spatial information per spike than those of CA1 pyramidal cells. Several other features of the two cell types were specific to the testing environment. CA3 neurons showed less pronounced phase precession and a weaker position versus spike‐phase relationship than CA1 cells. Our findings suggest that these distinct activity dynamics of CA1 and CA3 pyramidal cells support their distinct computational roles. © 2012 Wiley Periodicals, Inc.     

Seeking common pathophysiology in asthma, atopy and sinusitis

Asthma and chronic sinusitis are inexplicably common airway diseases that are linked to atopy and allergic inflammation. T helper type 2 (Th2) cells and the associated cytokines are believed to play crucial pathogenic roles in asthma, but the environmental factors that instigate allergic airway disease remain poorly understood. Environmental proteinases are highly allergenic and are candidate inducers of airway Th2 responses. Determining the proteinases and their sources that are relevant to airway disease, however, remains challenging. In this Opinion, we summarize the evidence that implicates fungi as both a relevant source of allergenic proteinases and a potential cause of asthma, atopy and chronic sinusitis through airway infection. Clarification of the extrinsic causes of these processes will markedly improve diagnosis, prognosis and therapy.