Health-related quality of life, emotional burden, and neurocognitive function in the first generation of metastatic melanoma survivors treated with pembrolizumab: a longitudinal pilot study.

PURPOSE: The aim of this study was to assess the evolution of health-related quality of Life (HRQoL), emotional burden, and neurocognitive function in the first-generation metastatic melanoma survivors treated with pembrolizumab. METHODS: Survivors were defined as patients who achieved a durable remission for at least 6 months after initiating pembrolizumab in a single-center observational study (N = 141). A semi-structured interview was performed at baseline. Neurocognitive computerized testing and patient-reported outcomes were collected at 4 time points to assess HRQoL using the EORTC QLQ-C30 and the HADS to assess anxiety and depression. RESULTS: Out of 35 eligible patients, 25 were recruited and completed baseline assessment (18 female; median age 58 years [range 28-86]; 24 completed the 1-year follow-up phase. Median time since diagnosis was 30 months (range 12-84); median time since initiation of pembrolizumab was 19 months (range 6-42). At all visits, survivors reported a significantly lower global HRQoL, lower physical, emotional, cognitive, role, and social functioning compared with the European Mean of the healthy population. Fifteen patients (64%) had clinical levels of anxiety/depression at one time point during follow-up. The clinical interview revealed that 12 patients (48%) suffered from Cancer-Related-Post-Traumatic-Stress disorder, of whom 7 (28%) developed transient suicidal ideation, 1 patient made a suicide attempt. Neurocognitive testing revealed cognitive impairment in 8 patients (32%). CONCLUSIONS: Metastatic melanoma survivors, treated successfully with pembrolizumab, are at risk for suffering from emotional distress and neurocognitive impairment with a persistent impact on their HRQOL. Timely detection in order to offer tailored care is indicated.

[Perspectives on resilience : trait or aptitude ?] / Considérations sur la résilience : trait ou aptitude ?

In this paper, we discuss various issues related to the concept of resilience, which is conventionally defined as a dynamic process allowing for a positive adaptation in a context of significant adversity. First, we try to draw the reader's attention to the importance of the concept of resilience in terms of public health. Second, we address the difficulty of measuring resilience in a relevant and operational manner. Third, we then address the question of whether resilience can be conceived only in the context of a confrontation with trauma, or whether its application can be relevant to the everyday nontraumatic adversity. In this regard, we introduce and define another coping strategy which is the Sense of Coherence (SOC). Fourth, we discuss the nature of resilience, that is to say, whether it should be considered as a personality trait or as an aptitude. We try to show that this problem arises from the difficulty to specify the emotional processes involved in resilience. Finally, we propose future research perspectives that should allow us to better understand the concept of resilience.

Dans cet article, nous abordons différentes questions relatives au concept de résilience, classiquement définie comme un processus dynamique permettant une adaptation positive dans un contexte d'adversité significative. Premièrement, nous tentons d'attirer l'attention du lecteur sur l'importance du concept de résilience en termes de santé publique. Deuxièmement, nous abordons la question de la difficulté à mesurer la résilience de façon pertinente et opérationnelle. Troisièmement, nous abordons ensuite la question de savoir si la résilience ne peut se concevoir que dans le contexte d'une confrontation à un traumatisme ou si son application peut être pertinente par rapport à l'adversité quotidienne, non traumatique, mais que chacun rencontre au cours de son existence. A ce propos, nous introduisons et définissons une autre stratégie de coping qui est le Sens de la Cohérence (Sense of Coherence/ SOC). Quatrièmement, nous traitons ensuite de la nature-même de la résilience, c'est-à-dire le fait de déterminer si elle doit être considérée soit comme un trait de personnalité, soit comme une aptitude. Nous tentons de montrer que cette problématique provient de la difficulté à préciser les processus émotionnels en jeu dans la résilience. Enfin, nous proposons des perspectives de recherches futures qui devraient permettre d'appréhender de manière plus fine le concept de résilience.

[Brief Therapies : Fundamental concepts]. / Les thérapies brèves : Notions de base.

The so-called Palo Alto school has produced a fundamental work in the comprehension of human communication. Palo Alto school defined the theoretical concepts of brief therapies and the foundations of systemic therapies. First, this article proposes to specify the sociological context in which systemic theories have emerged by differentiating the paradigms of modern and post-modern societies. Second, it defines some keystone concepts in the field of brief therapies : the homeostasis, the positive and negative feedbacks, the changes of level 1 and 2, the identified patient, the paradoxical injunction and the reframing. Finally, it underlines the risks of a misuse of brief therapies. Indeed, on a superficial level, brief therapies could seem very easy to use. In reality, they are based on great amount of theories and require an important professional experience and an in-depth training.

L'école dite de Palo Alto a produit un travail gigantesque dans le domaine de la compréhension de la communication entre les êtres humains. Elle a jeté les bases de ce qui allait devenir la thérapie systémique. C'est également à partir des travaux de l'école de Palo Alto que sont issus les concepts sous-tendant ce que l'on désigne par le terme de thérapies brèves. Cet article se propose d'abord de repréciser le contexte sociologique au sein duquel les théories systémiques ont vu le jour en différenciant les paradigmes en vigueur dans les sociétés dites modernes et post-modernes. Il présente ensuite les notions de base des thérapies brèves en décrivant différents concepts fondamentaux comme l'homéostasie, les boucles de rétroaction, les changements de niveau 1 et de niveau 2, le patient désigné, l'injonction paradoxale et le recadrage. Enfin, il se termine par une mise en garde contre une utilisation inappropriée des thérapies brèves qui, pouvant apparaître relativement simples en première approche, sont en réalité sous-tendues par un gigantesque corpus théorique et requièrent une grande expérience professionnelle de la part du praticien.

Abatement and degradation pathways of toluene in indoor air by positive corona discharge.

Indoor air concentrations of volatile organic compounds often exceed outdoor levels by a factor of 5. There is much interest in developing new technologies in order to improve indoor air quality. In this work non-thermal plasma (DC positive corona discharge) is explored as an innovative technology for indoor air purification. An inlet gas stream of 10 l min(-1) containing 0.50+/-0.02 ppm toluene was treated by the plasma reactor in atmospheric conditions. Toluene removal proved to be achievable with a characteristic energy density epsilon(0) of 50 J l(-1). Removal efficiencies were higher for 26% relative humidity (epsilon(0)=35 J l(-1)), compared with those at increased humidities (50% relative humidity, epsilon(0)=49 J l(-1)). Reaction products such as formic acid, benzaldehyde, benzyl alcohol, 3-methyl-4-nitrophenol, 4-methyl-2-nitrophenol, 4-methyl-2-propyl furan, 5-methyl-2-nitrophenol, 4-nitrophenol, 2-methyl-4,6-dinitrophenol are identified by means of mass spectrometry. Based on these by-products a toluene degradation mechanism is proposed.

[Place of ivermectin in the treatment of scabies]. / Comment je traite ... la gale par l'ivermectine.

Ivermectin is the first oral treatment available for scabies. It is however not licensed for use in Belgium. In this article, we review its mechanism of action, its preferential indications among which crusted scabies and institutional outbreaks, its contra-indications and its advantages in comparison with topical treatments.

Case-control study to identify melanoma risk factors in the Belgian population: the significance of clinical examination.

BACKGROUND: Although numerous studies have evaluated risk factors associated with cutaneous malignant melanoma (CMM), no such study has been carried out in Belgium. OBJECTIVES: To identify individuals who are at high risk of developing malignant melanoma in Belgium, which could enhance the efficacy of screening interventions and avoid unnecessary skin inspections. STUDY DESIGN/SETTING/SUBJECTS: We prospectively included patients who were diagnosed with invasive malignant melanoma between 1998 and 2001 at the Department of Dermatology in a case-control study. Controls were selected from the outpatient dermatology clinic. Participants were interviewed and clinically examined by a dermatologist. We asked questions concerning most known risk factors associated with malignant melanoma such as phenotypical and skin characteristics, and environmental and lifestyle exposures. To adjust for confounding variables and to estimate odds ratios (ORs) and 95% confidence intervals (CIs), a multivariate model was used. RESULTS: Although sunburn in childhood and substantial occupational solar exposure were modestly, but significantly, associated with malignant melanoma risk, clinical examination yielded several stronger risk factors. In a multivariate model, which adjusted for age, gender and skin phototype, phenotypical characteristics such as skin, hair and eye colour were significantly associated with the development of malignant melanoma. In the multivariate model, people with three or more atypical naevi were at more than 10-fold risk of developing a malignant melanoma (> or = 3 atypical naevi; adjusted OR = 11.40, 95% CI = 4.79-17.53) compared to those without an atypical naevus. The presence of one or more palpable naevi on the upper extremities or having solar lentigines increased the odds of developing malignant melanoma at least twofold. CONCLUSIONS: In Belgium, risk factors associated with malignant melanoma appear to be in accordance with previous studies. To assess peoples' risk profile, clinical skin examination is likely to yield the most important sporadic malignant melanoma risk factors. Therefore, focusing screening campaigns on individuals with predefined findings on skin self-examination may increase its efficacy.

Screening for occult nodal metastasis in squamous cell carcinoma of the vulva.

Metastases to inguinofemoral lymph nodes in patients with carcinoma of the vulva alter the prognosis and treatment of this disease. Our goal was to determine if immunohistochemical staining could reveal occult metastatic nodal disease not detected with routine hematoxylin and eosin staining. We retrospectively examined a total of 110 lymph nodes from 10 patients who had undergone lymph node dissection and found to have all negative nodes. Paraffin embedded lymph nodes were immunostained with a monoclonal antibody directed against multiple low- and high-molecular weight cytokeratins. Micrometastases were not detected in any lymph nodes examined with immunohistochemistry. All positive and negative controls yielded satisfactory results. It is concluded that immunohistochemistry with cytokeratin antibodies does not provide greater sensitivity than routine hematoxylin and eosin staining for the detection of nodal metastases in vulvar carcinoma.

A genetic screen for temperature-sensitive cell-division mutants of Caenorhabditis elegans.

A novel screen to isolate conditional cell-division mutants in Caenorhabditis elegans has been developed. The screen is based on the phenotypes associated with existing cell-division mutations: some disrupt postembryonic divisions and affect formation of the gonad and ventral nerve cord-resulting in sterile, uncoordinated animals-while others affect embryonic divisions and result in lethality. We obtained 19 conditional mutants that displayed these phenotypes when shifted to the restrictive temperature at the appropriate developmental stage. Eighteen of these mutations have been mapped; 17 proved to be single alleles of newly identified genes, while 1 proved to be an allele of a previously identified gene. Genetic tests on the embryonic lethal phenotypes indicated that for 13 genes, embryogenesis required maternal expression, while for 6, zygotic expression could suffice. In all cases, maternal expression of wild-type activity was found to be largely sufficient for embryogenesis. Cytological analysis revealed that 10 mutants possessed embryonic cell-division defects, including failure to properly segregate DNA, failure to assemble a mitotic spindle, late cytokinesis defects, prolonged cell cycles, and improperly oriented mitotic spindles. We conclude that this approach can be used to identify mutations that affect various aspects of the cell-division cycle.

High-power fast-axial-flow CO2 laser with a variable-reflectivity output coupler.

We report what is to our knowledge the first cw, dc-excited, fast-axial-flow CO(2) laser using a variable-reflectivity output coupler. A super-Gaussian reflectivity profile of order 8 with 96% central reflectivity has been achieved by depositing a low-absorption coating onto a ZnSe substrate. The unstable resonator oscillated in the lowest-order mode to produce a diffraction-limited beam of 300 W of power and 0.35-mrad divergence angle (FWHM). The measured near field and far field are in good agreement with the mathematical model. The technique lends itself to extrapolation to the kilowatt level.

Monitoreo clínico neurológico através de escala de Glasgow modificada / Neurologic clinical monitoring by modified glasgow scales

Se presenta por vez primera en nuestro medio la aplicación de una Escala de Monitoreo clinico en el seguimiento del paciente neurológico. Se controlaron 50 pacientes con un protocolo único lo que permitió fijar pautas. Se evaluó la Cuadrícula destacando aspectos positivos y dificuldades halladas en la puesta en práctica. Se mostraron y discutieron casos individuales de sumo interés. Por último se deja abierto el camino para interesantes perspectivas futuras (