The Use of Dietary Supplements to Alleviate Androgen Deprivation Therapy Side Effects during Prostate Cancer Treatment

Prostate cancer (PCa), the most commonly diagnosed cancer and second leading cause of male cancer death in Western societies, is typically androgen-dependent, a characteristic that underlies the rationale of androgen deprivation therapy (ADT). Approximately 90% of patients initially respond to ADT strategies, however many experience side effects including hot flashes, cardiotoxicity, metabolic and musculoskeletal alterations. This review summarizes pre-clinical and clinical studies investigating the ability of dietary supplements to alleviate adverse effects arising from ADT. In particular, we focus on herbal compounds, phytoestrogens, selenium (Se), fatty acids (FA), calcium, and Vitamins D and E. Indeed, there is some evidence that calcium and Vitamin D can prevent the development of osteoporosis during ADT. On the other hand, caution should be taken with the antioxidants Se and Vitamin E until the basis underlying their respective association with type 2 diabetes mellitus and PCa tumor development has been clarified. However, many other promising supplements have not yet been subjected large-scale clinical trials making it difficult to assess their efficacy. Given the demographic trend of increased PCa diagnoses and dependence on ADT as a major therapeutic strategy, further studies are required to objectively evaluate these supplements as adjuvant for PCa patients receiving ADT.     

Deleterious Effects of a Low Amount of Ethanol on LTP-Like Plasticity in Human Cortex

Ingesting ethanol (EtOH) at low doses during social drinking is a common human behavior for its facilitating effects on social interactions. However, low-dose EtOH may have also detrimental effects that so far are underexplored. Here we sought to test the effects of low-dose EtOH on long-term potentiation (LTP)-like plasticity in human motor cortex. Previous cellular experiments showed that low-dose EtOH potentiates extrasynaptic GABAAR and reduces NMDAR-mediated currents, processes that would limit the expression of LTP. Paired associative transcranial magnetic stimulation (PAS_LTP) was employed in nine healthy subjects for induction of LTP-like plasticity, indexed by a long-term increase in motor-evoked potential input–output curves. Synaptic α1-GABAAR function was measured by saccadic peak velocity (SPV). Very low doses of EtOH (resulting in blood concentrations of <5 mM) suppressed LTP-like plasticity but did not affect SPV when compared with a placebo condition. In contrast, 1 mg of alprazolam, a classical benzodiazepine, or 10 mg of zolpidem, a non-benzodiazepine hypnotic, decreased SPV but did not significantly affect LTP-like plasticity when compared with placebo. This double dissociation of low-dose EtOH vs alprazolam/zolpidem effects is best explained by the putatively high affinity of EtOH but not alprazolam/zolpidem to extrasynaptic GABAARs and to NMDARs. Findings suggest that enhancement of extrasynaptic GABAAR-mediated tonic inhibition and/or reduction of NMDAR-mediated neurotransmission by EtOH blocks LTP-like plasticity in human cortex at very low doses that are easily reached during social drinking. Therefore, low-dose EtOH may jeopardize LTP-dependent processes, such as learning and memory formation.     

Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations

A fundamental skill of the anesthesiologist is airway management. We validated a simple endotracheal intubation algorithm with a large proportion of fiberoptic tracheal intubations used for years in daily practice. Over 2 yr, 13,248 intubations (>90% of all intubations, including obstetrics and ear, nose, and throat patients) in a heterogeneous patient population at our acute care hospital were evaluated prospectively. About 80 physician and nurse anesthetists were involved. Once the indication for intubation (oral or nasal) was established, the first step was to choose between the primary conventional technique (laryngoscope with Macintosh blades) and the primary fiberoptic technique. For the conventional technique, a well defined procedure had to be followed (maximum of two attempts at intubation; if unsuccessful, switch to secondary oral fiberoptic intubation). For the primary fiberoptic technique, the anesthesiologist had to decide between nasotracheal intubation in awake patients and oral intubation in anesthetized patients. Fiberoptics were used for 13.5% of the intubations. By following our algorithm, intubation failed in 6 out of 13,248 cases (0.045%; 95% confidence interval 0.02%-0.11%). We demonstrate that a simple algorithm for endotracheal intubation, basically limited to fiberoptics as the only aid, is successful in daily practice. Only methods that are practiced daily can be used successfully in emergencies.     

Patient satisfaction with anesthesia care: information alone does not lead to improvement

PURPOSE: To evaluate if information campaigns and introduction of information leaflets lead to an improvement in patient satisfaction with anesthesia care. METHODS: In 2000, we carried out an assessment of patient satisfaction with anesthesia care. "Information/involvement in decision making" was identified as the worst problem area. The three hospitals involved in this study introduced strategies to improve this dimension of patient satisfaction by launching information campaigns, producing or improving information brochures (particularly in hospitals A and C), and by expanding the preanesthetic care unit (hospital B). In 2002, a second survey was carried out. Each of the hospitals sent questionnaires to 600 elective surgery patients after discharge. We compared the total problem scores (the percentage of patients who responded that a problem was present) and the problem scores for the dimension 'information/involvement in decision making' between 2000 and 2002. RESULTS: The total problem score (mean in %, 95% confidence interval) for all three hospitals together remained unchanged [19% (1)], as well as the problem scores for each hospital [hospital A 16% (1), hospital B 21% (1), hospital C 20% (1)]. The problem score for 'information/involvement in decision making' remained unchanged also: 31% (29-33) in 2000 compared to 28% (26-30) in 2002. CONCLUSION: Information campaigns and the introduction of information leaflets alone do not improve patient satisfaction with anesthesia care.     

Alpha synchronization during auditory spatial short-term memory

Recent studies have suggested an active role of cortical alpha oscillations for cognitive functions including short-term memory. We used magnetoencephalography to assess alpha activity during an auditory spatial delayed matching-to-sample task compared with a nonmemory control condition. In the memory task, participants had to memorize the lateralization angle of a noise stimulus S1 and compare it with another lateralized sound S2 presented after an 800-ms delay phase. Whereas alpha desynchronization following S1 was observed over superior temporal areas under both conditions, only the memory task was accompanied by posterior parietal alpha synchronization during the subsequent delay period. The findings are consistent with the notion of alpha activity reflecting active inhibition of interfering processes during memory maintenance of spatial sounds.