Effects of Ventilation with Large Tidal Volumes or Positive End-Expiratory Pressure on Cardiorespiratory Function in Anesthetized Obese Patients

The cardiorespiratory effects of ventilation with large tidal volumes (LTV) or positive end-expiratory pressure (PEEP) were investigated in 10 extremely obese patients during anesthesia for a jejuno-ileal by-pass operation.
Elevation of the tidal volume by 35% and insertion of a dead space (LTV-group: five patients) or applying a PEEP of 1.0 kPa (PEEP-group: five patients) resulted in significant rises in arterial oxygen tensions (Pa_o2) of 87.4% and 72.4%, respectively. The alveolar-arterial oxygen tension differences (P(a-a)_o2) decreased by 29.2% in the LTV-group and 25.6% in the PEEP-group when compared to control values. No significant differences were found between the groups in Pa_o2 or P(A-a)o₂.
PEEP-ventilation caused a maximal increase in compliance of 42.6%, but there was an increase of only 20.8% in the LTV-group.
Stroke index (the impedance cardiography method) decreased by 19.7% in the PEEP-group, whereas no changes occurred in the LTV-group. The decrease in stroke index was probably due to a reduction in venous return, as reflected in the systolic time intervals. In the PEEP-group a prolongation of the pre-ejection period (PEP) was observed, causing an increase in the PEP/LVET-ratio of 41.2%. A 13.8% increase in PEP/LVET-ratio was found in the LTV-group.
In spite of the increased arterial oxygen contents, no improvements in arterial oxygen delivery were found in either of the groups.     

Hormone-replacement therapy influences gene expression profiles and is associated with breast-cancer prognosis: a cohort study

Background

The aim of the current study was to assess the antidepressant efficacy and safety of Hypericum perforatum (St. John's wort) extract WS^® 5570 at doses of 600 mg/day in a single dose and 1200 mg/day in two doses.

Methods

The participants in this double-blind, randomized, placebo-controlled, multi-center clinical trial were male and female adult out-patients with an episode of mild or moderate major depressive episode (single or recurrent episode, DSM-IV criteria). As specified by the relevant guideline, the study was preceded by a medication-free run-in phase. For the 6-week treatment, 332 patients were randomized: 123 to WS^® 5570 600 mg/day, 127 to WS^® 5570 1200 mg/day, and 82 to placebo. The primary outcome measure was the change in total score on the Hamilton Rating Scale for Depression (HAM-D, 17-item version) between baseline and endpoint. Additional measures included the number of responders, the number of patients in remission, and several other standard rating scales. Efficacy and safety were assessed after 2 and 6 weeks. The design included an interim analysis performed after randomization with the option of early termination.

Results

After 6 weeks of treatment, mean ± standard deviation decreases in HAM-D total scores of 11.6 ± 6.4, 10.8 ± 7.3, and 6.0 ± 8.1 points were observed for the WS^® 5570 600 mg/day, 1200 mg/day and placebo groups, respectively (endpoint analysis). Secondary measures of treatment efficacy also showed that both WS^® 5570 groups were statistically superior to placebo. Significantly more patients in the WS^® 5570 treatment groups than in the placebo group showed treatment response and remission. WS^® 5570 was consistently more effective than placebo in patients with either less severe or more severe baseline impairment. The number of patients who experienced remission was higher in the WS^® 5570 1200 mg/day group than the WS^® 5570 600 mg/day group. The incidence of adverse events was low in all groups. The adverse event profile was consistent with the known profile for Hypericum extract preparations.

Conclusion

Hypericum perforatum extract WS^® 5570 at doses of 600 mg/day (once daily) and 1200 mg/day (600 mg twice daily) were found to be safe and more effective than placebo, with comparable efficacy of the WS^® 5570 groups for the treatment of mild to moderate major depression.     

Psychiatric nursing for promotion of mental health and prevention of depression in the elderly: a case study

The aim of this case study was to describe and analyse the basic pre-conditions for an intervention programme focusing upon mental health promotion and prevention of depression in an elderly community group and to discuss the psychiatric nurse's community-oriented health promotion work. The intervention programme, which was led by a psychiatric nurse, was built on intersectorial co-operation between public and voluntary organizations, development of social networks to promote social support, and target group participation. The nurse's function in the community-oriented work was to act at the individual, group and society level, as well as to mobilize resources among individuals and organizations, in order to create a favourable interaction, resulting in health and empowerment for the individual. Pre-conditions for leading this work were: knowledge of health and mental all health among the elderly, investigation methodology, knowledge about the local society, as well as pedagogical, supervisory and social competence.     

SEM evaluation of the apical external root surface of teeth with chronic periapical lesion

The aim is to verify, under scanning electron microscopy, the occurrence of apical root resorption in anterior and posterior teeth with chronic and radiographically visible periapical lesions. Thirty‐two teeth were extracted, the apical thirds (n = 39) were removed, and prepared to analyse the external apical root surface. All specimens presented irregular areas of root resorption with different depths, located mainly around the apical foramen. Teeth with chronic periapical lesions present areas of external apical root resorption with irregular surface and different depths located mainly around the apical foramen. Root resorptions may show different configurations and destroy the apical root structure more or less extensively.     

Evaluation of the centreing ability of the ProTaper Universal™ rotary system in curved roots in comparison to Nitiflex™ files

The aim of the present study was to assess the centreing ability of the ProTaper Universal? rotary system in curved roots in comparison to Nitiflex? files, by means of preoperative and postoperative imaging of a cross‐section of the apical third. Twenty mesiobuccal canals of human first mandibular molars with a degree of curvature ranging from 35° to 60° were divided into two groups of 10 specimens each: group 1, ProTaper Universal? rotary system; group 2 (control), Nitiflex? files. All instruments produced morphological alterations. The Student's t‐test and Kruskal–Wallis test showed that the differences were not statistically significant, except for the specimens instrumented by Nitiflex file #30. The ProTaper Universal? showed the capacity for producing centered preparations in curved and thin root canals with low proportions of apical deviation.     

Adults with intellectual disabilities affected by cancer: critical challenges for the involvement agenda

FORBAT L. & MCCANN L. (2009) European Journal of Cancer Care 19 , 91–97
Adults with intellectual disabilities affected by cancer: critical challenges for the involvement agenda
Cancer incidence and prevalence in people with intellectual disabilities are poorly documented. Changing demographic patterns, however, mirror those in the general population with increased longevity leading to higher numbers of people developing cancer in the future. Little is known about the service and support needs of this group, but there is a precedent to understand their experiences to inform research and service development if appropriately tailored approaches are to be adopted. This article outlines a project that sought to develop an advisory forum of adults with intellectual disabilities affected by cancer, to inform the development of a research agenda. The process of this work is described alongside a critical appraisal of the tensions in involving people with intellectual disabilities as advisors on cancer research and practice. We discuss and challenge the underlying ideologies, which lie in the path of fully engaging with marginalized patients.     

A meta‐analysis on the association of HER‐2 overexpression with prognosis in human osteosarcoma

LI Y.G. & GENG X. (2010) European Journal of Cancer Care 19, 313–316
A meta‐analysis on the association of HER‐2 overexpression with prognosis in human osteosarcoma Various studies examining the relationship between HER‐2 overexpression and clinical outcome in patients with osteosarcoma have yielded inconclusive results. The purpose of the current study was to evaluate the relation of HER‐2 status with clinical outcome in osteosarcoma. We conducted a meta‐analysis of five studies that evaluated the relation between HER‐2 status and 2‐year survival. DerSimonian‐Laird random effects analysis was used to estimate the effects of HER‐2 overexpression on 2‐year survival. The combined relative risk in patients with osteosarcoma for 2‐year survival was 1.26 (95% confidence interval, 0.50–3.14; P = 0.63). HER‐2‐positive status tended to be associated with a worse 2‐year survival, but the overall results were not formally statistically significant. An unfavourable prognostic effect of HER‐2 overexpression in osteosarcoma was evident from the meta‐analysis. However, because several studies were excluded by the current eligibility criteria, caution is needed in interpreting the results.     

Social support and quality of life of prostate cancer patients after radiotherapy treatment

QUEENAN J.A., FELDMAN‐STEWART D., BRUNDAGE M. & GROOME P.A. (2010) European Journal of Cancer Care 19 , 251–259
Social support and quality of life of prostate cancer patients after radiotherapy treatment Research suggests that social support can have an impact on health‐related quality of life (HRQOL). Social support can be structural support (SSS) or functional support (FSS). Our study was designed to clarify the relationships between HRQOL, FSS and SSS. We conducted a cross‐sectional survey and a detailed chart review. The study population was men attending a follow‐up clinic after receiving radiotherapy for prostate cancer. Functional social support was measured by using the MOS Social Support Survey. Structural social support was measured by using questions adapted from the 1994–1995 National Population Health Survey conducted by Statistics Canada. Health‐related quality of life was measured by using the European Organization for Research and Treatment of Cancer's QLQ‐C30. We found a statistically significant positive correlation between FSS and HRQOL but no association between overall SSS and HRQOL. Worsening urinary symptoms were significantly associated with lower levels of FSS and with lower HRQOL. This study underscores that the perception of support (functional) is more important than the amount or size of support (structural). We also identified a subgroup of men who have lower FSS and lower HRQOL that suffer from urinary side effects of their treatment. Further research to clarify the relationship between FSS and urinary symptoms will also clarify how an intervention could improve the HRQOL of these men.