Hedonic interactions of medial prefrontal cortex and nucleus reticularis gigantocellularis

It has been shown that 'pure reward' and 'reward-escape' sites in the lateral hypothalamus (LH) of rats respectively ameliorate and exacerbate nucleus reticularis gigantocellularis (NGC) stimulation-induced aversion52. Conversely, the present studies found that 'rewarding' medial prefrontal cortex (MPFC) stimulation increased escape from NGC stimulation regardless of whether the MPFC site tested was 'pure reward' or 'reward-escape' in type. This suggested that a simple algebraic summation model of positive and negative affective processes may not adequately describe the NGC-MPFC interaction. In a subsequent study, rats were observed both to barpress less to obtain, and more to escape from, 'rewarding' MPFC stimulation during continuous NGC stimulation, supporting the hypothesis that the observed MPFC stimulation-mediated increase in NGC stimulation escape reflected an exacerbation of aversion. Finally, NGC stimulation was seen to increase barpressing to obtain 'subreward' MPFC current trains, indicating a potentiation of the reward value of such current. Results of this series of studies suggests a hedonic interaction model of NGC and MPFC characterized by reciprocal neuromodulation. The model is conceptualized as a 'neural opponent process' subserving affective 'balance' and 'feature enhancement', and its possible relevance to the putative role of the MPFC in cocaine use is discussed.     

The use of two measures of health-related quality of life in HIV-infected individuals: a cross-sectional comparison

Two measures of health-related quality of life in 65 HIV-infected individuals were compared in a cross-sectional design. The Quality of Well-Being Scale (QWB) results in a single score ranging from death to perfect health. The MOS-HIV Health Survey (MOS-HIV, 34-item version) gives scores in 11 dimensions. The QWB score distinguished subjects with AIDS from those who were asymptomatic (p=0.027). For the seven multi-item scales of the MOS-HIV, Cronbach's alpha ranged from 0.85–0.95, indicating good internal consistency reliability. Clinical HIV-infection status was significantly associated with the dimensions of Overall Health (p=0.002), Role Function (p=0.022), Social Function (p=0.037), Energy/Fatigue (p=0.027) and Health Distress (p=0.025). All eleven dimensions of the MOS-HIV were significantly correlated with the QWB score (Spearman's coefficient = 0.405–0.670; for all, p<0.01) and the QWB score could be predicted from the MOS-HIV dimension scores using multiple regression. The QWB and the MOS-HIV may be useful in assessing health-related quality of life in patients infected with HIV.Funding support for this study provided by the Center for Pharmaceutical Economics of the University of Arizona.     

Neutral glycolipid composition of primary human brain tumors

Neutral glycolipids (NGL) were isolated and quantitated in 98 primary human brain tumors; 19 low grade astrocytomas (LGA), 12 anaplastic astrocytomas (AA), 37 high grade astrocytomas (HGA), 18 oligodendroglial tumors, and 12 primitive neuroectodermal tumors (PNET). In 38 of these, the nature of the hexose in the cerebroside was determined using immunothin-layer chromatographic techniques. Galactosylceramide (GalCer) was the major ceramide monohexoside (CMH), and glucosylcerebroside never comprised more than 6% of this fraction in any tumor type. Furthermore, there was no correlation between the proportion of glucosylcerebroside and histological diagnosis. AA had the most characteristic neutral glycolipid pattern, with high levels of total lipid, total neutral glycolipid, CMH, and ceramide dihexoside (CDH) but low water contents. Consistent with this glycolipid composition is the finding that AA usually had neither ceramide trihexoside (CTH) nor globoside. Oligodendrogliomas were somewhat similar to AA in having high levels of CMH and infrequently having CTH or globoside. However, oligodendrogliomas had low water and total lipid contents. PNET had low levels of total ipid, total NGL, and CMH, but frequently contained CTH and globoside. LGA had high water contents but low levels of total lipid and CMH. HGA tended to have intermediate levels of almost all constituents analyzed, probably reflecting the pronounced cellular heterogeneity of these tumors. The frequent presence of GalCer in astrocytomas raises the possibility that some of these contain a population of cells that are related to the oligodendroglial lineage. However, the low amounts of GalCer and infrequent presence of sulfatide in PNET is consistent with their lack of differentiation toward oligodendrocytes. It will be of interest to determine if the neutral glycolipid patterns reported here will correlate with patient survival and be of prognostic significance.     

Justification and implementation of a cancer center pharmacy satellite

The justification, establishment, and evaluation of a full-service cancer center pharmacy satellite for a university hospital are described. Providing efficient and effective pharmaceutical services was difficult because (1) the cancer center is housed in a freestanding building adjacent to the hospital and (2) there are special considerations inherent in the ordering and preparation of antineoplastic medications. Data collected and presented by the pharmacy, along with letters of support from nursing and medical staff, provided justification of the need to establish an oncology satellite pharmacy. The satellite, open 8.0 hours per day Monday through Friday, is primarily responsible for preparing antineoplastic agents and dispensing first doses of other intravenous and oral medications for the cancer center. Satellite staffing consists of 1.2 full-time-equivalent (FTE) pharmacists and 2.0 FTE technicians. A technician works in the satellite the same number of hours as the pharmacist but is also available to prepare antineoplastic drugs in the central pharmacy on weekends. Pharmacist activities also include providing drug and dosing information to the medical and nursing staff, as well as handling investigational drugs. The satellite pharmacy has decreased medication turnaround time by one-half and has improved pharmaceutical services to the nursing staff.     

Quality of life of patients on in-center hemodialysis versus continuous ambulatory peritoneal dialysis.

This study compared chronic hemodialysis and CAPD patients on several quality of life variables: dietary adherence, self-esteem, hope, wellbeing, marital happiness, perceived control over life, marital status, number of emotional support persons, and participation in social, recreational, and work activities. Statistically significant differences in the quality of life variables due to treatment modality or demographic variables were not found. However, CAPD patients did engage in significantly more social and recreational activity, though not more work activity, than did hemodialysis patients. It is noted that 73% of the CAPD patients were Caucasian and that 72% of the hemodialysis patients were of black origin. Similarly skewed racial compositions in preceding research comparing patients on CAPD and hemodialysis suggest that 1. choice of treatment is occurring on the basis of some set of patient characteristics, or 2. systematic assignment is occurring on the basis of race, sex, and/or education. However, given no significant race/demography differences for variables used in this research, it appears that quality of life across racially different groups of hemodialysis and CAPD patients is comparable.     

Nonbiologic factors that impact management in women with urinary incontinence: review of the literature and findings from a National Institute of Diabetes and Digestive and Kidney Diseases workshop

Introduction and hypothesis

Urinary incontinence (UI)—defined as a complaint of involuntary loss of urine—is common in women, with major public health, financial, and quality of life (QoL) implications. Despite the high toll of UI and the availability of effective conservative treatments, many women with UI do not seek care. Those who do often continue to experience symptoms. Improving UI treatment may require a comprehensive approach to urology research, including a broad set of potentially influential factors beyond biologic.

Methods

To explore the effects of nonbiologic factors (NBF) on UI management and treatment response, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop for clinical and psychosocial researchers. Participants proposed a UI treatment pathway: recognizing the problem, willingness to seek treatment, access to care, receiving quality treatment, engaging in self-management, and adhering to chosen treatments; discussed potential NBFs that may affect the pathway; and identified areas for future research. After the meeting, a rapid literature review was conducted to assess the current state of research on NBFs in women with UI.

Results

Participants identified several patient-level NBFs that may influence the UI management pathway, including QoL and perceived bother; stigma, shame, and embarrassment; knowledge and perceptions; social determinants of health; cultural and language characteristics; personal characteristics and skills; and physical abilities. Additionally, participants acknowledged that provider- and system-level factors also play a role and likely interact with patient-level factors.

Conclusions

NBFs that potentially affect the UI management pathway are not well understood, and a comprehensive, interdisciplinary approach to research is needed to understand and appropriately support effective UI treatment.

     

Sporadic unifocal infantile myofibromatosis involving the skull. Case report.

Infantile myofibromatosis involving the skull is a benign disease if there is a solitary lesion. However, the multifocal form with skull involvement may portend a lethal course in the 1st year of life if there is involvement of the heart, lungs, or gastrointestinal tract. The authors report the case of a 3-year-old boy with an enlarging left parietal skull lesion that had been present since infancy. Increasing pain and the need to obtain tissue for diagnosis led to resection of the lesion by means of a small craniectomy. Further evaluation revealed no other lesions. A distinctly rare disease is presented, and the need for staging in children younger than 2 years of age is suggested to rule out cardiac, pulmonary, or gastrointestinal involvement.     

ASO Visual Abstract: No One-Size-Fits-All: Sexual Health Education Preferences in Patients with Breast Cancer

Annals of Surgical Oncology -