Themes and trends in nursing research on cancer patients' families

The purpose of this study was to identify trends in nursing research on cancer patients' families published within the past 12 years (1996-September 2007, present) and examine their research themes. Five core categories were identified: 1) cancer nursing at home, 2) terminal care in a general ward, 3) family's experience in a terminal period and after bereavement, 4) family's experience and care during treatment, and 5) family systems. Findings showed that the following areas of research are being conducted: nursing research on a variety of therapies and care environments, research on nurses' awareness of the families of cancer patients and how this affects treatment, interventional research on how to implement study findings, and research activities based on family nursing.     

Anxiety and associated factors in mothers of twins or triplets as compared with mothers of singleton children

PURPOSE: The purpose of this survey was to study anxiety and associated factors in the mothers of twins or triplets as compared with the mothers of singleton children. METHODS: The subjects were 130 mothers of twins or triplets aged 3 or under and 860 mothers of similarly aged singleton children. The Japanese version of State-Trait Anxiety Inventory (STAI) was used to evaluate their anxiety states. RESULTS: 1. Mothers of twins or triplets showed significantly higher STAI state anxiety scores than those of singleton children. However, there was no significant difference in STAI trait anxiety between mothers with twins or triplets and those with singleton children. 2. Mothers of twins or triplets showed greater anxiety during pregnancy than those of singleton children. There were also higher rates of cases where stress could not be alleviated in mothers of twins or triplets than in those with singleton children. STAI state anxiety of mothers was associated with anxiety during pregnancy, anxiety for future child-rearing, problems with stress alleviation, maternal health conditions, poor sleeping conditions and having siblings. CONCLUSION: This study indicated a tendency for mothers of twins or triplets to show greater anxiety as compared with those having singleton children. It is important to improve the child-rearing environment to reduce anxiety felt by mothers of twins or triplets.     

Development of a new assay for evaluation of l-3,4-dihydroxyphenylalanine cytotoxicity in catalase-mutant Escherichia coli

The present study aimed to assess whether a newly constructed, catalase-deficient Escherichia coli strain that express mammalian catalase gene could be used to identify oxidative stress-generating chemicals. We tested l-3,4-dihydroxyphenylalanine (l-DOPA), a well-known agent that induces reactive oxygen species. We found that l-DOPA exposure reduced the survival of catalase-mutant E. coli in a dose-dependent manner, especially in the strains with lower catalase activities, implying the usefulness of these strains in assessment of oxidative chemicals.     

Macular abnormalities in patients with retinitis pigmentosa: prevalence on OCT examination and outcomes of vitreoretinal surgery

Purpose: To determine the prevalence of macular abnormalities detected by optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP), and to report the results of pars plana vitrectomy (PPV) in five patients with RP. Methods: OCT images of the macula of 622 eyes of 323 patients with RP were evaluated. All patients had a complete clinical examination, and PPV was performed on two RP patients with a macular hole (MH), two patients with vitreomacular traction (VMT) syndrome, and one patient with cystoid macular oedema (CME). Results: A macular lesion was detected by OCT in 46 eyes (7.4%) of 37 patients (11.5%). CME was detected in 34 eyes (5.5%) of 26 patients, an epiretinal membrane in four eyes of four patients, VMT in five eyes of four patients, and full‐thickness MH in three eyes of three patients. PPV was performed on five of these eyes. The MH was closed with vision improvement after a single surgery in one eye, and was closed after repeated PPVs with a decrease of vision in another eye. In both patients with VMT, the visual acuity decreased after the surgery. The macular morphology and visual acuity did not improve postoperatively on the one patient with CME who underwent PPV. Conclusion: When OCT is used, macular abnormalities are present in 7.4% of patients with RP, which is lower than the prevalence reported earlier. Although vitrectomy can improve the macular morphology in some patients with RP, improvement of visual function may be limited most likely because of the long‐standing retinal dysfunction.     

Umbilical cord-blood transplantations from unrelated donors in patients with inherited metabolic diseases: Single-institute experience

Abstract:  We evaluated the feasibility of UCBT from unrelated donors and a myeloablative preparative regimen that did not involve anti-thymocyte globulin in five children with lysosomal and peroxisomal diseases. Patients with MPS II (n = 1), adrenoleukodystrophy (n = 1), metachromatic leukodystrophy (n = 2), and Krabbe disease (n = 1) received UCBT between December 2001 and September 2005. All patients received oral Bu (600 mg/m²), CY (200 mg/kg IV), and fludarabine (180 mg/m² IV). Prophylaxis for GVHD consisted of a combination of tacrolimus and a short methotrexate course. Neutrophil engraftment occurred a median of 24 days (range, 21–25) after transplantation. None had graft rejection. One patient developed grade III acute GVHD and the other four patients had grade I acute GVHD; none had extensive chronic GVHD. One patient developed hemorrhagic cystitis. There were no treatment-related deaths. Although one child with MPS II died of PTLD 10 months after the UCBT, four of the five children are alive 14, 20, 31, and 55 months after transplantation with complete donor chimerism. These results suggest the feasibility of the UCBT with Bu, fludarabine, and CY-preparative regimen for patients with inherited metabolic diseases.     

A phase II study of 5-fluorouracil/L-leucovorin/oxaliplatin (mFOLFOX6) in Japanese patients with metastatic or unresectable small bowel adenocarcinoma

Background

Several studies have suggested that chemotherapy prolonged survival in patients with metastatic or recurrent small bowel adenocarcinoma (SBA); however, there is still no standard chemotherapy regimen. Here, we evaluated the efficacy and safety of a 5-fluorouracil (5-FU)/L-leucovorin (l-LV)/oxaliplatin (mFOLFOX6) protocol as a first-line therapy for patients with SBA.

Patients and methods

This was a multicenter, single-arm, open-label phase II study. Eligibility criteria included histologically confirmed adenocarcinoma, age 20–80 years, and an Eastern Cooperative Oncology Group performance status (PS) of 0–2. The primary endpoint was 1-year progression-free survival (PFS). The secondary endpoints included overall response rate (ORR), overall survival (OS), overall PFS, and safety.

Results

Between April 2010 and November 2012, 24 patients were enrolled from 12 institutions. The median age of the patients was 63 years (range 31–79) and there was a male/female ratio of 18/6. The number of PS 0/1 patients was 17/7 and locally advanced/metastatic disease was seen in 2/22 patients, respectively. The primary tumor site was the duodenum in 14 patients (58%) and jejunum in 10 patients (42%). The median follow-up time was 14.7 months (3.7–40.3). The 1-year PFS was 23.3%. The ORR was 9/20 (45%). The median PFS and OS times were 5.9 months (95% confidence interval [CI] 3.0–10.2) and 17.3 months (95% CI 11.7–19.0), respectively. Major grade 3/4 toxicities were neutropenia (38%), anemia/peripheral neuropathy (25%), and stenosis (17%). There were no treatment-related deaths.

Conclusions

Although the primary endpoint was not met, mFOLFOX6 showed effective and good tolerance as a first-line treatment for SBA.

     

The suppressive effect of nucleos(t)ide analogue treatment on the incidence of hepatocellular carcinoma in chronic hepatitis B patients

The development of nucleos(t)ide analogues (NA) has influenced hepatitis B virus management. However, the annual incidence rate during NA treatment has been reported to be 0.3–1.2% in non‐cirrhosis cases and 1.8–6.0% in cirrhosis cases, indicating that the suppressive effect of NA treatment on hepatocellular carcinoma (HCC) would be insufficient. Past studies, including one randomized control trial that compared lamivudine treatment with placebo, have revealed that NA treatment could suppress the incidence of HCC in patients with advanced fibrosis. However, it remains unknown whether NA treatment can suppress the incidence of HCC in chronic hepatitis patients without advanced fibrosis. The HCC incidence in patients treated with entecavir was similar to that of those treated with lamivudine, although entecavir exhibits a stronger viral suppression than lamivudine. The following risk factors related to the incidence of HCC during NA treatment have been identified: older age, male gender, pre‐existing cirrhosis, a family clustering of hepatitis B virus, lower platelet counts, and higher hepatitis B core‐related antigens as baseline factors and higher alpha fetoprotein levels as an on‐treatment factor. Conversely, the loss of the hepatitis B surface antigen (HBsAg) by interferon or NA was correlated with a lower HCC incidence rate. Because interferon treatment has much more effects on reducing HBsAg levels compared with NA treatment, a combination treatment with NA and pegylated interferon can bring additional reduction of HBsAg levels compared with NA monotherapy. Further study is needed to clarify this.     

Necessity of a uniform start for scanning after FDG injection in brain PET study

The authors' goal was to show the importance of starting scanning at a uniform time after F-18 fluorodeoxyglucose injection in positron emission tomography (PET) brain study. METHOD: Fifteen healthy normal subjects underwent FDG-PET to obtain glucose metabolic images starting 60 min and 70 min after FDG injection, respectively. The two sets of images were compared in a voxel-by-voxel analysis. RESULTS: In the bilateral posterior cingulate gyrus, parietal and frontal association cortices, the FDG uptakes were larger on the 70 min scan images than on the 60 min scan images; the 60 min scans resembled Alzheimer's metabolic reduction area. Similarly the FDG uptakes were larger in the pons and vermis on the 60 min scan image than on the 70 min scan image. CONCLUSIONS: Regional FDG uptake is different depending on the time scanning starts after FDG injection, even with a 10 minute difference in start time and different scanning time may lead to misdiagnosis. It is important to standardize the start time of FDG PET after FDG injection in brain PET.