Effects of Carbamazepine on Human Chromosomes

The effect of carbamazepine (CBZ) on human chromosomes was studied in an effort to determine its mutagenic potential. Analysis of chromosome breakage, sister chromatid exchanges (SCE), and cell cycle studies were performed in peripheral lymphocyte cultures. The in vivo studies failed to detect any significant increase of chromosome aberrations or SCE or any slowing of the cell cycle. A significant dose-dependent increase in chromosome aberrations but not in SCE was observed in the in vitro analyses. No correlation was observed between chromosome breaks and SCE in either the in vivo or in vitro studies. The negative in vivo results indicate an absence of detectable chromosome-damaging effects of CBZ used in monotherapy in human subjects.     

Trapezial resection arthroplasty for osteoarthritis: use of abductor pollicis longus tendoplasty with interpositional material

In this series, 45 patients had 54 trapezial resection arthroplasties for carpometacarpal osteoarthritis, with nine of the patients having bilateral arthroplasties. A major slip of the abductor pollicis longus tendon was used as a sling, with the underlying flexor carpi radialis tendon as stabilizer. Palmaris longus tendon, when present (42 cases), and absorbable gelatin sponge, when palmaris was absent (12 cases), served as interpositional material. Review was done an average of 4.3 years (range, 1 to 11 years) after the procedure. The average space maintenance of resection site was 4.4 mm. This decreased to an average of 3.5 mm on the key pinch stress maneuver. Subjectively, the patients judged their results to be good to excellent in 49 instances (91%) and fair in 5 (9%).     

Prostate cancer: the influence of stigma on quality of life and relationship satisfaction for survivors and their partners

Objectives: Prostate cancer (PCa) stigma and its relationship to quality of life (QoL) is a relatively new finding. As the experiences of couples facing PCa are shared, the study examined the relationship between of PCa stigma, QoL, and relationship satisfaction of PCa survivors and their spouses.

Design: A correlational design with dyadic data was used.

Sample: Participants (N?=?80 dyads) were PCa survivors and their spouses sampled from an oncology center and PCa support groups.

Methods: Structural equation modeling was used to assess how stigma related to the QoL and relationship satisfaction of participants.

Findings: Stigma had a negative association with QoL, but not relationship satisfaction. There were no significant demographic differences in regards to stigma.

Conclusion: Overall, stigma has a relationship with the experience of couples, but not with every aspect of their experience.

Implications for psychosocial providers: Implications for clinicians in regards to addressing PCa stigma with clients and areas for future research are discussed.     

Top advances of the year: Neuro-oncology

Management of brain tumors has been challenging given the limited therapeutic options and disabling morbidities associated with central nervous system (CNS) dysfunction. This review focuses on recent developments in the field, with an emphasis on clinical management. The growing clinical trials landscape reflects advanced insights into cancer immunology and genomics and the need to address molecular and clinical heterogeneity. Recent phase 3 trials investigating anti–PD-1 immunotherapies, particularly nivolumab, have failed to demonstrate improved survival in glioblastoma, underscoring the need to better understand the complexity of CNS immunologic surveillance. Conversely, targeted therapies have accounted for several US Food and Drug Administration approvals extended to brain tumors, particularly therapies directed to BRAF V600E mutations and TRAK fusions, underscoring a need to routinely screen patients for these rare molecular abnormalities. In primary CNS lymphoma, attention has turned to long-term outcomes of consolidation therapies, and recent studies have highlighted the excellent disease control afforded by high-dose chemotherapy and stem cell transplantation. Meningiomas remain a focus of investigations, with preliminary promising results observed with octreotide combined with mTOR inhibition, and immunotherapy with single-agent pembrolizumab. Finally, proton radiotherapy has emerged as a novel alternative for leptomeningeal metastases from solid tumors, which can now be treated more safely with craniospinal irradiation and monitored by the enumeration of circulating tumor cells in the cerebrospinal fluid as a biomarker. Taken together, these incremental advances have improved outcomes in select brain tumor patient populations, whereas ongoing clinical trials hold the promise of meaningful advances and breakthroughs for larger proportions of patients with brain tumors.     

中国大陆地区妇女骨质疏松筛选工具探讨

目的建立适用于中国大陆地区40岁及以上妇女的骨质疏松（osteoporosis，OP）筛选工具。方法以20～39岁妇女腰椎骨密度的均数和标准差作为参考值计算T—score。以双能X线骨密度仪（dual—energy X—ray absorptiometry，DxA）的测量结果作为金标准，采用二分类的Bayes判别分析，建立判别函数。结果我国大陆地区40岁及以上妇女OP筛选工具（osteoporosis screening tool for Chinese，OSTC）为：体重-2×年龄＋50。判别准则为OSTC〉0为无OP危险性，OSTC≤0为有OP危险性。OSTC的正判率为75．78％，灵敏度为76．8％，特异度为75．1％，Kappa值为0．51（P=0．000），说明OSTC与DXA的判定结果一致性尚可。结论OSTC是一个简便的OP筛选工具。根据年龄、体重两个变量的简单计算，即可对我国大陆地区40岁及以上的妇女进行OP危险性的筛选。但OSTC没有得到外部数据的验证，其优劣还有待进一步评价。     

Codeine and aspirin analgesia in postpartum uterine cramps: qualitative aspects of quantitative assessments

The analgesic response to codeine of patients with postpartum uterine-cramp pain has recently met with controversy. To readdress this question, we conducted a new study comparing codeine sulfate, 60 mg (N = 32) and 120 mg (N = 31), with aspirin, 650 mg (N = 34), and placebo (N = 32) in hospitalized women with moderate or severe postpartum uterine cramps treated with single oral doses in a parallel, stratified, randomized, double-blind trial. Subjective reports were used as indices of response, and patients rated pain intensity, pain relief, and side effects at periodic, uniformly conducted interviews for 6 hr. Most measures of analgesia exhibited important differences among the treatments. In patients with undifferentiated pain (N = 129) and in a subset of patients with pure uterine cramps (N = 56; i.e., no concomitant episiotomy), aspirin showed the greatest response, whereas codeine responses were equivocal with no evidence of a positive dose response. In contrast, in a subset of patients with mixed episiotomy-uterine pain (N = 73), 120 mg codeine showed good separation from placebo and compared favorably with aspirin. Codeine, 60 mg, showed a similar trend, and there was a strong suggestion of dose-dependent analgesia. Side effects were not remarkable except for dizziness and drowsiness after 120 mg codeine in all sets and subsets of patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pain and analgesic response after third molar extraction and other postsurgical pain

There is uncertainty over whether the patient group in which acute pain studies are conducted (pain model) has any influence on the estimate of analgesic efficacy. Data from four recently updated systematic reviews of aspirin 600/650 mg, paracetamol 600/650 mg, paracetamol 1000 mg and ibuprofen 400 mg were used to investigate the influence of pain model. Area under the pain relief versus time curve equivalent to at least 50% maximum pain relief over 6 h was used as the outcome measure. Event rates with treatment and placebo, and relative benefit (RB) and number needed to treat (NNT) were used as outputs from the meta-analyses. The event rate with placebo was systematically statistically lower for dental than postsurgical pain for all four treatments. Event rates with analgesics, RB and NNT were infrequently different between the pain models. Systematic difference in the estimate of analgesic efficacy between dental and postsurgical pain models remains unproven, and, on balance, no major difference is likely.     

Stimulation of prostaglandin accumulation in the rat anterior pituitary gland by luteinizing hormone releasing hormone in vitro.

The addition of luteinizing hormone releasing hormone releasing hormone (LH-RH) to cultures of monolayers of rat anterior pituitary cells was shown to increase both the concentrations of prostaglandins E1 and E2 (PGE) in the cells and the release of LH over similar ranges of concentrations of LH-RH (10(-6) to 10(-10) mol/l). The peak concentration of PGE was observed after 2.5 h. The stimulation of the level of PGE in the cells by LH-RH was completely inhibited by two inhibitors of prostaglandin synthetase, which only partially inhibited the stimulation of LH release. Therefore the increased concentration of PGE was not obligatory for the effect of LH-RH on LH release. It was also shown that monobutyryl cyclic AMP stimulated the intracellular concentration of PGE and it is suggested that the stimulation of PGE levels may be mediated by increased levels of cyclic AMP in the cells after the addition of LH-RH.