Clinical research priorities in oncology nursing: An Australian perspective

The aims of this research project were to identify areas for research in oncology nursing that have potential for improvement in patient care and to advise about nursing-research policy and priorities that have relevance to areas of patients'needs. Research participants included 10 Clinical Nurse Consultants (CNC) representing 10 area health authorities in New South Wales, Australia. The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and more than 31 high priorities were identified. Quality of life and symptom management emerged as the top two priority categories in the study. The findings of the study provide direction for clinical nursing research in oncology.     

Steatosis recovery after treatment with a balanced sunflower or olive oil-based diet： Involvement of perisinusoidal stellate cells

AIM: To analyze the relationship between perisinusoidal stellate cell (PSC) activation and the dietary fat quantity and composition in the treatment of hepatic steatosis. METHODS: Using an experimental rat model of steatosis based on the intake of a hyperlipidic diet (14% fat as olive oil or sunflower oil, HL-O and HL-S, respectively), we analyzed the liver's capability of recovery after the treatment with a normal-lipidic diet (5% fat as olive oil or sunflower oil, NL-O and NL-S, respectively) by immu-nocytochemical and Western blot analysis of glial fibril-lary acidic protein (GFAP) expression in PSCs, collagen quantification and serum aminotransferase determination. RESULTS: The fatty infiltration in the steatotic livers decreased after the treatment with both NL diets, indicating liver recovery. This decrease was accompanied with a lower collagen deposition and aminotransferase level as well as changes in the PSC population that increased the GFAP expression. The above-mentioned effects were more pronounced in animals fed on NL-O based diet. CONCLUSION: Treatment with a balanced diet enriched in olive oil contributes to the liver recovery from a steatotic process. The PSC phenotype is a marker of this hepatic-recovery model.     

Serum-free thyroxine and thyrotropin concentrations in euthyroid patients with decompensated congestive heart failure

We realized a prospective study of 106 consecutive patients hospitalized in an Internal Medicine Service with decompensated CHF. Between the 95 patients with normal serum-free thyroxine and thyrotropin concentrations, patients older than 70 years had a significant higher serum free thyroxine concentration (13.1+/-2.6 vs. 10.1+/-1.5 pmol/l, p=0.006) and a lower, but not significant, serum thyrotropin concentration (1.3+/-1.2 vs. 1.7+/-1.1 mU/l, p=0.11). No correlation was found between the functional class, the echocardiographic ejection fraction or the in-hospital stay and the serum free thyroxine and thyrotropin concentrations. The sex, the presence of systolic dysfunction, diastolic dysfunction, atrial fibrillation or comorbidity did not determine significant differences in the serum-free thyroxine and thyrotropin concentrations.     

A psychosocial model of functional disability

With advancing age, many older adults are vulnerable to a decline in physical functioning. Functional disability has been shown to affect the subjective well-being of the individual, and has been associated with increased morbidity and mortality. Social support is commonly assumed to protect people from the experience of psychological distress and enhance well-being. Other studies have demonstrated that satisfaction with social support, rather than the frequency with which support was received, is a powerful predictor of self-reported health status. The present study tests a psychosocial model of functional disability in two elderly populations (61 years of age and older): 178 seniors living in the community (136 females and 42 males) and 168 in-patients in a rehabilitation hospital following total hip and knee arthroplasty (118 females and 50 males). Predictors of functional disability were age, gender, and satisfaction with support. In this model, functional disability, with its related loss of independent functioning, was expected to lead to depression. Results indicated that the two samples differed slightly. Specifically, the elderly in the community sample were significantly older than the rehabilitation patients, whereas the hospital sample reported greater functional disability and were more satisfied with their social relations than the community-residing elderly. Results of path analysis in both samples showed that women reported more functional disability than men and satisfaction with support was associated with lower functional disability. Furthermore, functional disability led directly to depression in both samples. Practical implications for the maintenance and enhancement of daily functioning, as well as well-being in later life are discussed. Her research interests include social functioning among the elderly, organizational issues, stress, and coping. Ms. Fiksenbaum has published papers in these areas and presented research papers at international psychology conferences. Her research interests include gender, job stress, burnout and coping, psychosocial factors and aging, and psychological effects of SARS on nurses. Professor Greenglass serves on numerous academic journal editorial boards and does extensive reviewing for journals, academic conferences, and granting agencies. Sandra R. Marques is currently completing her second year of a Master’s program in Social and Personality Psychology at Queen’s University in Kingston, Ontario, Canada. Her present interests include self-conscious emotions—particularly guilt and shame—and their influence on intentions and condom use. Judy Eaton recently received her Ph.D. from York University, and is currently assistant professor at Wilfrid Laurier University Brantford Campus in Brantford, Ontario, Canada. Her research interests include apology, forgiveness, and interpersonal transgressions.     

Social Discrimination,Concurrent Sexual Partnerships,and HIV Risk Among Men Who have Sex with Men in Shanghai,China

We examined the potential mediating role of sex partner concurrency in explaining associations between experiences of homophobia and financial hardship and HIV risk behavior among a sample of 477 men who have sex with men (MSM) recruited in Shanghai, China from 2004 to 2005. We found significant positive direct associations of experiences of homophobia and financial hardship with having unprotected anal sex with men. These associations were not mediated by male partner concurrency. However, male partner concurrency had a direct effect on having unprotected anal sex with men. Male and female partner concurrency did not mediate the significant association between experiences of homophobia and having unprotected anal/vaginal sex with both men and women, but was positively associated with having unprotected anal/vaginal sex with both men and women. These results suggest that homophobia, financial hardship, and sex partner concurrency should be addressed to help reduce sexual risk for HIV among MSM in China.     

Targeting connexin 43 prevents platelet-derived growth factor-BB-induced phenotypic change in porcine coronary artery smooth muscle cells

We previously reported that reducing the expression of the gap junction protein connexin (Cx)43 in mice restricts intimal thickening formation after acute vascular injury by limiting the inflammatory response and the proliferation and migration of smooth muscle cells (SMCs) toward the damaged site. SMC populations isolated from porcine coronary artery exhibit distinct phenotypes: spindle-shaped (S) and rhomboid (R). S-SMCs are predominant in the normal media, whereas R-SMCs are recovered in higher proportion from stent-induced intimal thickening, suggesting that they participate in the restenotic process. Here, we further investigate the relationship between connexin expression and SMC phenotypes using porcine coronary artery SMCs. Cx40 was highly expressed in normal media of porcine coronary artery in vivo, whereas Cx43 was barely detectable. In contrast, Cx40 was downregulated and Cx43 was markedly upregulated in stent-induced intimal thickening. In vitro, S-SMCs expressed Cx40 and Cx43. In R-SMCs, Cx43 expression was increased and Cx40 was absent. We confirmed that S-SMCs treated with platelet-derived growth factor-BB acquire an R phenotype. This was accompanied by an upregulation of Cx43 and a loss of Cx40. Importantly, platelet-derived growth factor-BB-induced S-to-R phenotypic change was prevented by a reduction of Cx43 expression with antisense, ie, S-SMCs retained their typical elongated appearance and the expression of alpha-smooth muscle actin, a well-known SMC differentiation marker, whereas the expression of S100A4, a typical marker of R-SMCs, was prevented. In conclusion, limiting Cx43 expression in S-SMCs prevents platelet-derived growth factor-BB-induced S-to-R modulation. This suggests that Cx43 may be an additional target for local delivery strategies aimed at reducing restenosis.     

Dose-dependent effect of rosuvastatin on apolipoprotein B-100 kinetics in the metabolic syndrome

In a randomized, double-blind, crossover trial of 5-week treatment period with placebo or rosuvastatin (10 or 40 mg/day) with 2-week placebo wash-outs between treatments, the dose-dependent effect of rosuvastatin on apolipoprotein (apo) B-100 kinetics in metabolic syndrome subjects were studied. Compared with placebo, there was a significant dose-dependent decrease with rosuvastatin in plasma cholesterol, triglycerides, LDL cholesterol, apoB and apoC-III concentrations and in the apoB/apoA-I ratio, lathosterol:cholesterol ratio, HDL cholesterol concentration and campesterol:cholesterol ratio also increased significantly. Rosuvastatin significantly increased the fractional catabolic rates (FCR) of very-low density lipoprotein (VLDL), intermediate density lipoprotein (IDL) and LDL-apoB and decreased the corresponding pool sizes, with evidence of a dose-related effect. LDL apoB production rate (PR) fell significantly with rosuvastatin 40 mg/day with no change in VLDL and IDL-apoB PR. Changes in triglycerides were significantly correlated with changes in VLDL apoB FCR and apoC-III concentration, and changes in lathosterol:cholesterol ratio were correlated with changes in LDL apoB FCR, the associations being more significant with the higher dose of rosuvastatin. In the metabolic syndrome, rosuvastatin decreases the plasma concentration of apoB-containing lipoproteins by a dose-dependent mechanism that increases their rates of catabolism. Higher dose rosuvastatin may also decrease LDL apoB production. The findings provide a dose-related mechanism for the benefits of rosuvastatin on cardiovascular disease in the metabolic syndrome.     

Plant CLE peptides from two distinct functional classes synergistically induce division of vascular cells

The Clavata3 (CLV3)/endosperm surrounding region (CLE) signaling peptides are encoded in large plant gene families. CLV3 and the other A-type CLE peptides promote cell differentiation in root and shoot apical meristems, whereas the B-type peptides (CLE41–CLE44) do not. Instead, CLE41 inhibits the differentiation of Zinnia elegans tracheary elements. To test whether CLE genes might code for antagonistic or synergistic functions, peptides from both types were combined through overexpression within or application onto Arabidopsis thaliana seedlings. The CLE41 peptide (CLE41p) promoted proliferation of vascular cells, although delaying differentiation into phloem and xylem cell lineages. Application of CLE41p or overexpression of CLE41 did not suppress the terminal differentiation of the root and shoot apices triggered by A-type CLE peptides. However, in combination, A-type peptides enhanced all of the phenotypes associated with CLE41 gain-of-function, leading to massive proliferation of vascular cells. This proliferation relied on auxin signaling because it was enhanced by exogenous application of a synthetic auxin, decreased by an auxin polar transport inhibitor, and abolished by a mutation in the Monopteros auxin response factor. These findings highlight that vascular patterning is a process controlled in time and space by different CLE peptides in conjunction with hormonal signaling.     

Quality of life in elderly patients with acute myeloid leukemia: patients may be more accurate than physicians

Background

The aim of this study was to evaluate changes in quality of life scores and their association with therapy and survival in unselected elderly patients with acute myeloid leukemia.

Design and Methods

From February 2003 to February 2007, 113 patients aged more than 60 years with de novo acute myeloid leukemia were enrolled in a prospective observational study. Two different quality of life instruments were employed: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – C30 (EORTC QLQ-C30) and a health-related quality of life questionnaire for patients with hematologic diseases (QOL-E).

Results

Forty-eight patients (42.4%) received intensive chemotherapy and 65 (57.6%) were given palliative treatments. Age greater than 70 years (P=0.007) and concomitant diseases (P=0.019) had a significant impact on treatment allocation. At diagnosis, general quality of life was affected [median QOL-E standardized score 54, interquartile range 46–70; median EORTC global score 50, interquartile range 41–66]. Most patients were given a good ECOG Performance Status (< 2), which did not correlate with the patients’ perception of quality of life. At multivariate analysis, palliative approaches (P=0.016), age more than 70 years (P=0.013) and concomitant diseases (P=0.035) each had an independent negative impact on survival. In a multivariate model corrected for age, concomitant diseases and treatment option, survival was independently predicted by QOL-E functional (P=0.002) and EORTC QLQ-C30 physical function (P=0.030) scores.

Conclusions

Quality of life could have an important role in elderly acute myeloid leukemia patients at diagnosis as a prognostic factor for survival and a potential factor for treatment decisions.