Otitis media with effusion after radiotherapy of the head and neck: a systematic review.

BACKGROUND: Otitis media (OM) and associated hearing problems may be side effects to radiotherapy of the head and neck region and affect patient quality of life. The condition is associated with the tumor location. OBJECTIVE: To perform a systematic review concerning the present knowledge of the risk of OM after radiotherapy of the head and neck. METHODS: A comprehensive search of PubMed and Embase was carried out between 1 October 2015 and 6 February 2017. The search strategy followed the PRISMA guideline for systematic reviews. RESULTS: Of 597 articles 11 fulfilled the inclusion criteria. Seven were retrospective and four prospective. There were no randomized controlled trials. Eight studies concerned nasopharyngeal cancer. One study concerned cancer of the parotid gland and two studies concerned other locations of head and neck cancer. Meta-analysis could not be done due to heterogeneity between the studies. The incidence of OM varied considerably (range 8-29%). CONCLUSIONS: The incidence of OM is high after radiotherapy of cancer of the upper head and neck area and the Eustachian tube (ET) irradiation dosage seems associated with development of OM, but the literature is poor. Research is needed to designate patients at risk of developing OM after radiotherapy. Preferably through analysis of dosage relationships between the ET and middle ear, and development of OM. Reporting of OM should be per ear and follow standardized protocols of middle ear assessment before and after radiotherapy. Furthermore, there is a need to find new ways to prevent and treat radiation-induced OME, preferably through randomized controlled trials.

Perceptions of self, mother and family and behavior of prepubertal depressed children.

PURPOSE: To characterize the perceptions of self, mother and family of prepubertal children and to determine if the perceptions of children with depression and their behavior towards their mothers are different from children with anxiety disorders and nonpsychiatric controls. METHODS: Children (aged 7-13 years) with major depressive disorder (n=30), anxiety disorders (n=37) and nonpsychiatric controls (n=32) underwent structured psychiatric evaluations and completed questionnaires on their perceptions of themselves and their relations with their mothers and families. The child-mother dyad was observed during structured interactions. RESULTS: Self-perceptions of depressed children were significantly more negative than those of children with anxiety and controls. Depression severity negatively correlated with the child's self-perception and positively correlated with perceptions of the mother as being more rejecting, controlling, less accepting and less allowing autonomy, and of the family as being less cohesive. Depression severity was also positively associated with the child's hostile attitude towards the mother during the interactions. CONCLUSION: Our findings of greater negative perceptions of self, mother and family in depressed children compared to children with anxiety disorders and nonpsychiatric children suggest that approaches specifically addressing negative perceptions and targeting familial relationships could be especially effective for treating young children with depression.

Duration and level of transgene expression after gene electrotransfer to skin in mice.

In development of novel vaccines, attention is drawn to DNA vaccinations. They are heat stable and can be easily produced. Gene electrotransfer is a simple and nonviral means of transferring DNA to cells and tissues and is attracting increasing interest. One very interesting perspective with gene electrotransfer is that choice of tissue can determine the duration of transgene expression. With gene electrotransfer to muscle, long-term expression, that is beyond 1 year, can be obtained, whereas gene electrotransfer to skin gives short-term expression, which is desirable in, for example, DNA vaccinations. Level and duration of transgene expression after gene electrotransfer to skin is essential and here we present data from two independent quantitative studies. Using in vivo bioimaging of a far-red fluorescent molecule, Katushka, allowing for continuous monitoring of local gene expression, compared with measurements of a systemic transgene, that is, serum erythropoietin (EPO) after gene electrotransfer with EPO to skin, we found a significant increase in transgene expression (P< 0.01) with a peak 9 days (Katushka) and 14 days (EPO) after transfection. Duration of expression could be 3-4 weeks, which is a suitable time frame for vaccinations and is applicable, for example, in gene therapy for wound healing or treatment of cancer.

Therapeutic levels of erythropoietin (EPO) achieved after gene electrotransfer to skin in mice.

Gene electrotransfer refers to gene transfection by electroporation and is an effective non-viral method for delivering naked DNA into cells and tissues. This study presents data from gene electrotransfer with erythropoietin (EPO) to mouse skin. Nine-week-old female NMRI mice received one, two or three intradermal injections of 50 microg EPO plasmid and were subsequently electroporated. With plate electrodes and 100 microg of EPO, a significant increase in hemoglobin (P<0.01) was observed compared with controls. The level of hemoglobin peaked after 5 weeks but stayed significantly elevated for more than 3 months. Serum EPO was significantly increased (P<0.001) 24 h after the transfection and remained significantly different compared with controls until the maximum level of serum EPO was reached after 2 weeks. Eight weeks after the transfection serum EPO returned to baseline. In this study, we have established that gene electrotransfer to skin of even small amounts of DNA can lead to systemically therapeutic levels of protein. This means that in addition to DNA vaccinations, there is a potential utility for electroporation in alleviating systemic diseases such as cancer and protein deficiency disorders.

Olanzapine, risperidone and haloperidol in the treatment of adolescent patients with schizophrenia.

OBJECTIVES: To evaluate and compare the drug response and side effects of adolescents with schizophrenia treated with olanzapine, risperidone, and haloperidol. METHODS: Forty-three patients were treated with olanzapine (n = 19), risperidone (n = 17) and haloperidol (n = 7) for 8 weeks in an open clinical trial. Clinical improvement was evaluated with the Positive and Negative Syndrome Scale (PANSS), and side effects with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale. RESULTS: Significant clinical improvement was observed by week 4 for all medications. Olanzapine and haloperidol induced fatigability more frequently than risperidone. Haloperidol was associated with a higher frequency of depression and more severe extrapyramidal symptoms. CONCLUSIONS: To the best of our knowledge this is the first study in adolescents to compare the efficacy and side effects of three most commonly prescribed antipsychotic medications. Olanzapine, risperidone and haloperidol appear to be equally effective for the treatment of schizophrenia in adolescent inpatients but have different side effect profiles.

Death concepts in suicidal adolescents.

OBJECTIVE: To investigate the relationship between components of death concept (preoccupation with death, death as a pleasant state, and death as final) and suicidal behavior in adolescents. METHOD: The death concepts of 51 suicidal inpatients, 102 nonsuicidal inpatients, 36 emergency room suicidal subjects, and 81 normal controls were compared using Pfeffer's Child Suicide Potential Scale. In addition, the IQ level as well as emotions that potentially influence the death concept were measured. RESULTS: Both groups of suicidal adolescents evaluated death as more pleasant than the nonsuicidal groups. All the study groups equally perceived death as a final state. Suicidal inpatients were more preoccupied with death than nonsuicidal inpatients, but surprisingly among all study groups, including normal controls, the emergency room suicidal subjects were the least preoccupied with death. Partialing out depression, anxiety, and aggression specifically augmented the association between preoccupation with death and suicidality. Thus the relationship between death concept and suicidality appears to be a direct one. No correlation was found between suicidality and intelligence level. CONCLUSIONS: Elements of death concept distinguish suicidal from nonsuicidal as well as between hospitalized versus nonhospitalized suicidal adolescents. Thus the death concept evaluation is potentially valuable in the assessment of adolescents with a high risk for suicide.