Lower-Order Pain-Related Constructs Are More Predictive of Cold Pressor Pain Ratings than Higher-Order Personality Traits

Pain is a debilitating condition affecting millions each year, yet what predisposes certain individuals to be more sensitive to pain remains relatively unknown. Several psychological factors have been associated with pain perception, but the structural relations between multiple higher- and lower-order constructs and pain are not well understood. Thus, we aimed to examine the associations between pain perception using the cold pressor task (CPT), higher-order personality traits (neuroticism, negative affectivity, trait anxiety, extraversion, positive affectivity, psychoticism), and lower-order pain-related psychological constructs (pain catastrophizing [pre- and post-], fear of pain, anxiety sensitivity, somatosensory amplification, hypochondriasis) in 66 pain-free adults. Factor analysis revealed 3 latent psychological variables: pain- or body-sensitivity, negative affect/neuroticism, and positive affect/extraversion. Similarly, pain responses factored into 3 domains: intensity, quality, and tolerance. Regression and correlation analyses demonstrated that: 1) all the lower-order pain constructs (fear, catastrophizing, and hypochondriasis) are related through a single underlying latent factor that is partially related to the higher-order negative-valence personality traits; 2) pain- or body-sensitivity was more strongly predictive of pain quality than higher-order traits; and 3) the form of pain assessment is important—only qualitative pain ratings were significantly predicted by the psychological factors.PerspectiveConsistent with the biopsychosocial model, these results suggest multiple pain-related psychological measures likely assess a common underlying factor, which is more predictive of qualitative than intensity pain ratings. This information may be useful for the development and advancement of pain assessments and treatments while considering the multidimensional nature of pain.     

Does Elbow Position Affect Strength and Reproducibility of Power Grip Measurements?

Effects of elbow positioning on grip strength and its between-day reliability of measurement were tested bilaterally in 30 healthy adults. Grip strength was measured twice with a Jamar dynamometer at 0°, 30°, 60°, 90° and 120° of elbow flexion one week apart. Intraclass correlation coefficient model_(1,1) was > 0.987 for each test, and limits of agreement reveal narrow ranges of the 95% confidence intervals for each test, which reflect good between-day reliability for these measurements in both absolute and relative terms. Grip strength at 120° was significantly lower than all other positions on both sides (p < 0.001), whereas the grip strength at 90° was highest among all positions tested. The grip strengths at 0°, 30° and 60° were, in general, 0.5-3% lower than the measurements taken at 90° of elbow flexion, but the differences were not statistically significant. These findings suggest that between-day comparison of grip strength is valid and reproducible in the same testing position, and 120° of elbow flexion is not a desirable position for grip strengthening exercise. The differences in grip strength can be explained by the length-tension relationship and the clinical implications for these findings are discussed.     

我国医疗事故鉴定体制的弊端与改革之管见

我国现行三级医疗事故鉴定体制建立十余年来,弊端已充分显现,严重影响了医疗卫生行业的信誉,阻碍了我国医事法律体系的建设。作者在分析了现行医疗事故鉴定体制的弊端后,提出几点改革思路：医疗人员加强法制观念;逐步建立独立的医疗事故鉴定人名册制度和具体案件的鉴定人三方选制度;调整医疗事故鉴定委员会的结构和职能;;中强我国医事立法;短期内实行多元化的医疗事故鉴定体制,尽可能地增中鉴定结论的可信度。     

Endovascular Treatment of Radiation-Induced Petrous Internal Carotid Artery Aneurysm Presenting with Acute Haemorrhage. A Report of Two Cases

Summary  Haemorrhage from rupture of petrous ICA aneurysm can be life threatening and emergency treatment is required. We report 2 cases of radiation-induced petrous internal carotid artery (ICA) aneurysm presenting with acute haemorrhage (epistaxis and otorrhagia) after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Both patients had a history of RT treatment for NPC. The first patient, a 54-year-old man, presented with sudden severe epistaxis and haemorrhagic shock. The second patient, a 35-year-old man, presented with episodes of severe otorrhagia. The first patient was immediately resuscitated. Obliteration of the aneurysm was performed by endovascular occlusion of the ICA with Guglielmi detachable coils and fibered platinum coils. For the second patient, the aneurysm was treated by deploying a self-expandable stent across the aneurysm neck. In an emergency situation, ruptured petrous ICA aneurysm can be treated with endovascular occlusion of the ICA with microcoils if there is a good collateral blood flow. Alternatively, the aneurysm can be treated by deployment of a stent, which can induce stasis and eventual thrombosis of the aneurysm.     

Analysis of Hurthle cell neoplasms of the thyroid by interphase fluorescence in situ hybridization.

Recent studies have indicated that numerical chromosomal abnormalities including changes in p53 and cyclin D1 may be involved in Hurthle cell tumorigenesis. We analyzed a series of Hurthle cell neoplasms of the thyroid to evaluate the diagnostic and prognostic utility of numerical anomalies by DNA fluorescent probes for cyclin D1 and p53 gene loci and chromosomes 5, 7, 11, 12, 17, and 22. Interphase fluorescence in situ hybridization (FISH) analysis was performed on paraffin-embedded tissue sections from 10 Hurthle cell adenomas, 19 Hurthle cell carcinomas, and 7 normal thyroid tissues used as controls. Directly labeled fluorescent DNA probes for the centromere region of chromosomes 7, 11, 12, and 17 and locus-specific probes for chromosomes 5 and 22, cyclin D1, and p53 were utilized for dual-probe hybridizations. Sixty percent (6 of 10) Hurthle cell adenomas and 63% (12 of 19) Hurthle cell carcinomas showed chromosome gains. Twenty percent (2 of 10) Hurthle cell adenomas and 26% (5 of 19) Hurthle cell carcinomas showed chromosome losses. Normal thyroid tissues used as controls showed no chromosomal abnormalities. Among Hurthle cell tumors with chromosomal abnormalities, adenomas averaged 2.7 gains and 0.3 losses per case, and carcinomas averaged 3.3 gains and 0.6 losses per case. The two adenomas with chromosome losses each showed loss of one chromosome, whereas the five carcinomas with losses averaged 1.8 losses per case. Chromosome 22 was the most common loss identified, occurring in three of the 11 patients who died of disease. These results indicate that chromosomal imbalances as gains are common in both benign and malignant Hurthle cell neoplasms, but Hurthle cell carcinomas tend to have more chromosome losses than adenomas. Among Hurthle cell carcinomas in this study, chromosome losses were identified only from patients who died of disease. The loss of chromosome 22 may have prognostic value in Hurthle cell carcinoma of the thyroid.     

Two-field dissection is enough for esophageal cancer.

Three-field lymphadenectomy for esophageal cancer remains controversial. The high prevalence of cervical lymph node involvement is the basis of cervical lymphadenectomy. Studies of recurrence patterns after esophagectomy, however, indicate that clinically relevant cervical nodal recurrence is uncommon, and that the incidence of such recurrence is similar to that of two-field lymphadenectomy. Moreover, a convincing survival benefit cannot be proven for the more extended lymphadenectomy. The emphasis of three-field lymphadenectomy has shifted to lymphadenectomy of the superior mediastinum and along the recurrent laryngeal nerve chains. Radical dissection of these areas may improve local disease control; the price to pay is increased postoperative morbidity and impaired long-term quality of life. Furthermore, the selection of appropriate patients for extended lymphadenectomy is difficult. Formal three-field lymphadenectomy seems unnecessary, but the controversy of the optimal extent of lymphadenectomy and its impact on survival remains unanswered.     

Measuring social relational quality in colorectal cancer: the Social Relational Quality Scale (SRQS)

Objectives: Social relationships are central in Asian communities. Despite colorectal cancer (CRC) incidence increasing in Asian populations the roles of social activity in facilitating adjustment and optimizing coping resources in Asian peoples remains largely unknown. We derived and validated among Chinese CRC patients, an instrument assessing social relational quality to enable study of these social processes. Methods: Qualitative interviews (n=16) generated 22‐items subsequently administered to 166 Chinese CRC survivors. Principal components analyses identified underlying constructs. The draft instrument, plus measures of optimism, affect, physical symptoms, and perceived social support were administered to a second cohort of 234 newly diagnosed Chinese CRC patients. Results: Three factors were extracted (54.44% of the total variance): Family Intimacy(7 items, 33.08%), Family Commitment (5 items, 14.17%), and Friendships (5 items, 7.19%). All subscales were internally consistent (α=0.75–0.82), exhibiting concurrent validity in negative correlations with anxiety and depression and positive correlations with physical and psychological well‐being. Convergent validity was indicated by significant positive correlations with optimism, and divergent validity by insignificant inverse correlations with physical symptoms and moderate correlations with perceived social support. Hierarchical regressions revealed positive correlations of the three subscales with psychological well‐being, controlling for perceived social support (β=0.13–0.28). Good criterion validity was indicated. Conclusion: The Social Relational Quality Scale is a psychometrically sound self‐report measure of social relational quality among Chinese CRC patients and needs further validation among other Asian groups. Copyright © 2008 John Wiley & Sons, Ltd.     

Clinical evaluation of continuous daily dosing of sunitinib malate in patients with advanced gastrointestinal stromal tumour after imatinib failure

AimsTo assess the antitumour activity, safety, pharmacokinetics and pharmacodynamics of continuous daily sunitinib dosing in patients with imatinib-resistant/intolerant gastrointestinal stromal tumour (GIST) and to assess morning dosing versus evening dosing.Patients and methodsIn this open-label phase II study, patients were randomised to receive morning or evening dosing of sunitinib 37.5 mg/day. The primary end-point was clinical benefit rate (CBR; percent complete responses + partial responses [PRs] + stable disease [SD] ?24 weeks). Secondary end-points included progression-free survival (PFS), overall survival (OS), safety, pharmacokinetic parameters and plasma biomarker levels.ResultsSixty of 61 planned patients received treatment (30 per dosing group); 26 completed the study. Overall, the CBR was 53% (95% exact CI, 40–66): eight patients (13%) achieved objective PRs; 24 (40%) achieved SD ?24 weeks. Median PFS was 34 weeks (95% CI, 24–49); median OS was 107 weeks (95% CI, 72 – not yet calculable). Most adverse events (AEs) were of grade 1 or 2 in severity, and were manageable through dose modification or standard interventions. No new AEs were apparent compared with the approved intermittent dosing schedule. Antitumour activity and safety were generally similar with morning and evening dosing. Continuous daily sunitinib dosing achieved and sustained effective drug concentrations without additional accumulation across cycles. Decreases from baseline in plasma levels of soluble KIT after 20 and 24 weeks of dosing correlated with longer OS.ConclusionFor patients with imatinib-resistant/intolerant GIST, continuous daily sunitinib dosing appears to be an active alternative dosing strategy with acceptable safety.