Validation of the Chinese Version of Underwood’s Daily Spiritual Experience Scale—Transcending Cultural Boundaries?

Background  Daily spiritual experience (DSE) refers to one’s interaction with the transcendent in day-to-day life. Underwood’s Daily Spiritual Experience Scale mic(DSES) was developed to measure this experiential component of religiousness and spirituality. Addressing ordinary daily experiences rather than particular beliefs, DSES has transcultural applicability potential. Purpose  The current study aimed to develop and evaluate the Chinese version of DSES (DSES-C). Method  The 16-item scale was translated faithfully through standard translation/back-translation procedures. The term “God” required an extended definition embracing both a humanized and a philosophical higher power in Chinese culture. The translated scale plus a battery of validation scales were administered to staff of a large rehabilitation service complex, resulting in 245 completed questionnaires. Results  Exploratory factor analysis revealed a similar factor structure as the original English version and similar problems with items 13 (compassion) and 14 (mercy). After carefully deliberating on the Chinese conceptualization of spirituality and balancing psychometric properties, the one-factor 16-item structure of the English version was supported. DSES-C showed high internal consistency (Cronbach’s alpha = 0.97). Construct validity was supported by correlations with validation scales in expected directions. Conclusion  The psychometric properties of DSES were similar to the English version in factor structure, internal consistency, and convergence/divergence construct validity.     

Physical activity patterns and estimated daily energy expenditures in normal and overweight tunisian schoolchildren

Our aim was to test the normality of physical activity patterns and energy expenditures in normal weight and overweight primary school students. Heart rate estimates of total daily energy expenditure (TEE), active energy expenditure (AEE), and activity patterns were made over 3 consecutive school days in healthy middle-class Tunisian children (46 boys, 44 girls, median age (25^th-75^th) percentile, 9.2 (8.8-9.9) years. Our cross-section included 52 students with a normal body mass index (BMI) and 38 who exceeded age-specific BMI limits. TEE, AEE and overall physical activity level (PAL) were not different between overweight children and those with a normal BMI [median values (25^th-75^th) 9.20 (8.20-9.84) vs. 8.88 (7.42-9.76) MJ/d; 3.56 (2.59-4.22) vs. 3.85 (2.77-4.78) MJ/d and 1.74 (1.54-2.04) vs. 1.89 (1.66-2.15) respectively]. Physical activity intensities (PAI) were expressed as percentages of the individual’s heart rate reserve (%HRR). The median PAI for the entire day (PAI₂₄) and for the waking part of day (PAI_w) were lower in overweight than in normal weight individuals [16.3 (14.2-18.9) vs. 20.6 (17.9-22.3) %HRR, p < 0.001) and 24.8 (21.6-28.9) vs.26.2 (24.5-30.8) %HRR, p < 0.01], respectively. Overweight children allocated more of their day to sedentary pursuits [385 (336-468) vs 297 (235-468) min/d, p < 0.001], and less time to moderate physical activity [381(321-457) vs. 460 (380-534) min/d, p < 0.01]. Nevertheless, because of the greater energy cost of a given task, total and active daily energy expenditure did not differ from those with a normal BMI.

Key points

• The physical activity intensity for the entire day (PAI₂₄) and for the waking part of day (PAI_w) were lower in overweight than in normal weight individuals.
• However, because the energy cost of activity is greater in those who are overweight, they do not differ in total energy expenditure or in active energy expenditure.
• Normal children spend more time in moderate activity and less time in sedentary pursuits than overweight children.

Key words: Heart rate monitoring, activity patterns, energy expenditure, excess weight, obesity.     

Rectal cancer: involved circumferential resection margin – a root cause analysis

Introduction  An involved circumferential resection margin (CRM) following surgery for rectal cancer is the strongest predictor of local recurrence and may represent a failure of the multidisciplinary team (MDT) process.
Aim of study  The study analyses the causes of positive CRM in patients undergoing elective surgery for rectal cancer with respect to the decision-making process of the MDT, preoperative rectal cancer staging and surgical technique.
Method  From March 2002 to September 2005, data were collected prospectively on all patients undergoing elective rectal cancer surgery with curative intent. The data on all patients identified with positive CRM were analysed.
Results  Of 158 patients (male:female = 2.2:1) who underwent potentially curative surgery, 16 (10%) patients had a positive CRM on postoperative histology. Four were due to failure of the pelvic magnetic resonance imaging (MRI) staging scans to predict an involved margin, two with an equivocal CRM on MRI did not have preoperative radiotherapy, one had an inaccurate assessment of the site of primary tumour and in one intra-operative difficulty was encountered. No failure of staging or surgery was identified in the remaining eight of the 16 patients. Abdominoperineal resection (APR) was associated with a 26% positive CRM, compared with 5% for anterior resection.
Conclusion  No single consistent cause was found for a positive CRM. The current MDT process and/or surgical technique may be inadequate for low rectal tumours requiring APR.     

Aetiology and outcome of paediatric cardiopulmonary arrest

Cardiopulmonary arrest occurs less commonly in children than in adults, differs in its aetiology and has better outcomes. This article focuses on the causes of cardiac arrest in children, including events occurring under anaesthesia, outcomes and some new developments in management and prevention.     

Circulating Tumor Cells in Patients Undergoing Surgery for Primary Breast Cancer: Preliminary Results of a Pilot Study

Introduction  Circulating tumor cells (CTCs) have recently been shown to be an independent predictor of progression-free and overall survival in patients undergoing treatment for metastatic breast cancer. This study evaluates the presence and significance of CTCs in patient undergoing surgical resection of clinically localized primary breast cancer. Methods  Patients undergoing surgery for clinically localized primary breast cancer were enrolled into a prospective study. Thirty milliliters of blood was drawn and studied using the CellSearch assay. Results  Forty-one patients were enrolled at a single tertiary referral center. Ten patients (24.4%) had detectable CTCs preoperatively (PreOp). Nine (30%) patients were found to have CTCs postoperatively (PostOp). Overall, 16 (39%) were found to have CTCs either PreOp or PostOp. Hormone-negative patients were significantly more likely to have CTCs than hormone-positive patients. No other pathologic factor was predictive of the presence of CTCs. Conclusion  CTCs are detectable and quantifiable in breast surgery patients. CTCs were more likely to be found in hormone receptor negative patients. Further study will allow correlation with other pathological variables and clinical outcome.     

Targeted Disruption of the CXCL12/CXCR4 Axis Inhibits Osteolysis in a Murine Model of Myeloma‐Associated Bone Loss

The plasma cell (PC) malignancy, multiple myeloma (MM), is unique among hematological malignancies in its capacity to cause osteoclast (OC)‐mediated skeletal destruction. We have previously shown that elevated plasma levels of PC‐derived CXCL12 are associated with presence of X‐ray detectable osteolytic lesions in MM patients. To further investigate this relationship, plasma levels of CXCL12 and βCrossLaps, a marker of bone loss, were measured. A strong correlation between levels of CXCL12 and OC‐mediated bone resorption was identified. To confirm the OC‐activating potential of MM PC‐derived CXCL12 in vivo, we established a model of MM‐mediated focal osteolysis, wherein MM PC lines, such as RPMI‐8226, were injected into the tibias of nude mice. Implanting RPMI‐8226 gave rise to osteolytic lesions proximal to the tumor, resulting in a 5% decrease in bone volume (BV) compared with vehicle control. Importantly, bone loss was significantly inhibited with systemic administration of the CXCL12/CXCR4 antagonist T140. Furthermore, implanting CXCL12‐overexpressing RPMI‐8226 cells resulted in a 13% decrease in BV and was associated with increased OC recruitment proximal to the tumor, increased serum matrix metalloproteinase activity, and increased levels of collagen I degradation products. These findings confirm our hypothesis that MM PC‐derived CXCL12 stimulates the recruitment and activity of OC, thereby contributing to the formation of MM osteolytic lesions.     

Genetic Variation in Sex Hormone Genes Influences Heel Ultrasound Parameters in Middle‐Aged and Elderly Men: Results From the European Male Aging Study (EMAS)

Genes involved in sex hormone pathways are candidates for influencing bone strength. Polymorphisms in these genes were tested for association with heel quantitative ultrasound (QUS) parameters in middle‐aged and elderly European men. Men 40–79 yr of age were recruited from population registers in eight European centers for the European Male Aging Study (EMAS). Polymorphisms were genotyped in AR, ESR1, ESR2, CYP19A1, CYP17A1, SHBG, SRD5A2, LHB, and LHCGR. QUS parameters broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the heel and used to derive BMD. The relationships between QUS parameters and polymorphisms were assessed using linear regression adjusting for age and center. A total of 2693 men, with a mean age of 60.1 ± 11.1 (SD) yr were included in the analysis. Their mean BUA was 80.0 ± 18.9 dB/Mhz, SOS was 1550.2 ± 34.1 m/s, and BMD was 0.542 ± 0.141 g/cm². Significant associations were observed between multiple SNPs in a linkage disequilibrium (LD) block within CYP19A1, peaking at the TCT indel with the deletion allele associating with reduced ultrasound BMD in heterozygotes (β =?0.016, p = ?0.005) and homozygotes (β = ?0.029, p = 0.001). The results for BUA and SOS were similar. Significant associations with QUS parameters were also observed for the CAG repeat in AR and SNPs in CYP17A1, LHCGR, and ESR1. Our data confirm evidence of association between bone QUS parameters and polymorphisms in CYP19A1, as well as modest associations with polymorphisms in CYP17A1, ESR1, LHCGR, and AR in a population sample of European men; this supports a role for genetically determined sex hormone actions in influencing male bone health.     

Severity of anxiety and work‐related outcomes of patients with anxiety disorders

Background: This study examined associations between anxiety and work‐related outcomes in an anxiety disorders clinic population, examining both pretreatment links and the impact of anxiety change over 12 weeks of treatment on work outcomes. Four validated instruments were used to also allow examination of their psychometric properties, with the goal of improving measurement of work‐related quality of life in this population. Methods: Newly enrolled adult patients seeking treatment in a university‐based anxiety clinic were administered four work performance measures: Work Limitations Questionnaire (WLQ), Work Productivity and Activity Impairment Questionnaire (WPAI), Endicott Work Productivity Scale (EWPS), and Functional Status Questionnaire Work Performance Scale (WPS). Anxiety severity was determined using the Beck Anxiety Inventory (BAI). The Clinical Global Impressions, Global Improvement Scale (CGI‐I) was completed by patients to evaluate symptom change at a 12‐week follow‐up. Two severity groups (minimal/mild vs. moderate/severe, based on baseline BAI score) were compared to each other on work measures. Results: Eighty‐one patients provided complete baseline data. Anxiety severity groups did not differ in job type, time on job, job satisfaction, or job choice. Patients with greater anxiety generally showed lower work performance on all instruments. Job advancement was impaired for the moderate/severe group. The multi‐item performance scales demonstrated better validity and internal consistency. The WLQ and the WPAI detected change with symptom improvement. Conclusion: Level of work performance was generally associated with severity of anxiety. Of the instruments tested, the WLQ and the WPAI questionnaire demonstrated acceptable validity and internal reliability. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Impact of PercuSurge GuardWire device on prevention and reduction of recovery time from complete heart block in patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention

Second-degree heart block or complete heart block (CHB) is a relatively frequent complication of acute inferior wall myocardial infarction (AIWMI). This study investigated whether the PercuSurge device can prevent procedure-related CHB or can shorten CHB recovery time in patients with AIWMI undergoing primary percutaneous coronary intervention (PCI). Between May 2002 and April 2005, a PercuSurge device was utilized in 113 patients (study population, group 1) with AIWMI due to obstruction of the right coronary artery (RCA) with a reference lumen diameter (RLD) > or = 3.5 mm. The control subjects (group 2) consisted of 119 patients who experienced AIWMI due to RCA obstruction with a RLD > or = 3.5 mm from May 2000 to April 2002. The combined incidence of new onset of CHB following the interventional procedure was significantly higher in group 2 than in group 1. Additionally, recovery time from CHB to first-degree heart block or normal sinus rhythm was remarkably longer in group 2 than in group 1. Furthermore, the duration of hospitalization in group 2 was significantly longer than in group 1. Multiple stepwise analyses demonstrated that the PercuSurge device was the only independent predictor of preventing new onset of CHB during the procedure. Additionally, this mechanical device along with final TIMI-3 flow and final myocardial blush grade > or = 2 was independently associated with reducing recovery time from CHB. In conclusion, the PercuSurge device can prevent procedure-related CHB and shorten the recovery time for CHB in patients with AIWMI undergoing primary PCI.