Treatment of metastatic cutaneous squamous cell carcinoma in a solid organ transplant recipient with programmed death-1 checkpoint inhibitor therapy.

Limited data exist on the use of immune checkpoint inhibitors (ICI) for the treatment of metastatic cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTR). We report a case of a SOTR who developed metastatic disease following multiple surgeries, three cycles of adjuvant radiotherapy, and minimization of immunosuppression. He was subsequently treated with pembrolizumab and achieved a complete response. However, the patient developed ICI-induced allograft rejection requiring therapy discontinuation. The allograft was salvaged following IVIg and steroids. The patient developed recurrent disease which failed rechallenge with pembrolizumab but achieved a partial response following cemiplimab administration. This case illustrates the potential to treat metastatic CSCC in a SOTR with anti-programmed death-1 therapy and preserve graft function despite allograft rejection.

The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Absentminded lapses during smoking cessation.

Although it is widely believed that drug cravings are responsible for drug use and relapse, S. T. Tiffany (1990) has proposed a cognitive model in which drug use is triggered not by craving but by the cuing of automatized action plans. The purpose of this study was to examine the lapse episodes from an ecological momentary assessment (EMA) study of smokers attempting to quit for evidence of automatic, or absentminded, lapses with slight or no urges to smoke, in keeping with S. T. Tiffany's (1990) model. Qualitative analysis of 270 EMA reports made by 41 smokers during the first 14 days of quitting identified 15 (6%) absentminded lapses. Quantitative urge levels were significantly lower during absentminded lapses compared with nonabsentminded lapses; however, urges were not very low. Results indicate that absentminded lapses may occur but are probably relatively rare.

Coping in real time: using Ecological Momentary Assessment techniques to assess coping with the urge to smoke.

Coping is important for success at smoking cessation, yet little is known about the natural history of coping with urges to smoke during a cessation attempt. In this study, Ecological Momentary Assessment (EMA) methods were used to gather real-time quantitative and qualitative data. For 3 consecutive days during their first 10 days of smoking cessation, 36 participants used tape recorders and palm-top computers to record details of 389 coping episodes, during which they employed 1,047 coping responses. An average of 3.6 coping episodes per day and an average of 2.7 coping responses per episode were reported. Sixty-seven percent of the responses were behavioral and 33% were cognitive. Gender, location of the episode, nicotine dependence, and quitting history were associated with the use of specific strategies. Results indicate that EMA methods and instruments are feasible for measuring coping responses.

In harm's way: childbearing women and nicotine.

In the United States cigarette smoking accounts for 11% of deaths of women. Approximately one of every four women smoke. Among pregnant women, 20-50% smoke, although prevalence rates vary depending upon income, age, and educational level. Spontaneous quit rates are highest among pregnant smokers. Interventions have been used to assist pregnant women to stop smoking, and the use of a combination of methods has yielded the highest quit rates among pregnant women, but postpartum relapse rates provide a glimpse of the short-term benefit of these intense efforts. Smoking cessation interventions for pregnant women must be considered within the larger context of women's lives to promote permanent smoking cessation.

Effects of smoking and telic/paratelic dominance on the contingent negative variation (CNV).

Concepts from reversal theory, a general theory of motivation, emotion and action, have recently been shown to be relevant to smoking behavior and smoking cessation. One relevant concept is that of telic and paratelic dominance. Individuals who are paratelic-dominant are playful, spontaneous, and prefer high arousal seeking. Those who are telic-dominant are serious, tend to plan ahead, and prefer low arousal. This led to the hypothesis that smoking might increase the amplitude of the contingent negative variation (CNV) in paratelic-dominant smokers more than in telic-dominant smokers. CNV was obtained using a Go/NoGo reaction time task with a 2 s S1-S2 interval and variable intertrial intervals. S1 indicated whether the subject was to respond to S2 or not. Errors were punished with a burst of white noise. Subjects performed the CNV task three times: after being deprived of smoking for at least 4 h; after sham smoking; and after smoking a cigarette of their own brand. Telic-dominant subjects differed from paratelic-dominant subjects in the relative amplitude of early (1 s) and late (2 s) components of the CNV. Smoking did not differentially affect the dominance groups unless gender was taken into account, and the most striking interactions between smoking and dominance groups were noted for the NoGo trials. As expected, smoking decreased the amplitude of the early component of the NoGo CNV for telic-dominant women, but increased it for paratelic-dominant women; no significant differences were found for the late component. In men, smoking increased the late CNV more for telics than for paratelics, while smoking did not differentially affect the early component.

Akrasia, health behavior, relapse, and reversal theory.

Philosophical explanations of the phenomenon of akrasia have been used in this article to characterize some of the difficulties involved in successful behavior change. The theory of psychological reversals provides a framework for understanding various types of akratic behavior. In addition, empirical research on the temptations of persons trying to quit smoking has supported hypotheses generated by the theory. The theory suggests that resisting the temptation to engage in akratic behavior is a complex phenomenon. Different strategies are needed in different types of metamotivational states. Reversal theory provides a coherent system for understanding and predicting akratic behavior. It suggests possible interventions that would improve the probability of circumventing akrasia and that would improve behavior change efforts of nurses engaged in health-promotion and disease-prevention activities.

Reversal theory constructs and cigarette availability predict lapse early in smoking cessation.

The purpose of this study was to investigate the contribution of reversal theory constructs (i.e., metamotivational states) to understanding the outcome of tempting situations that occur in the first 6 weeks of smoking cessation. Cessation program participants (n = 68) were interviewed about tempting situations in which they either smoked or maintained abstinence. Both independent groups and repeated measures analyses indicated that metamotivational state (serious and goal-directed vs. playful and spontaneous) and cigarette availability significantly predicted outcome. Reversal theory constructs correctly predicted outcome of the tempting episode for 70% of the subjects, while cigarette availability was an accurate predictor for 74%. Metamotivational state and cigarette availability together predicted the outcome for 89% of the subjects.

Smoking and EEG power spectra: effects of differences in arousal seeking.

Reversal theory, a general theory of motivation, emotion and action, has recently been shown to predict lapses in smoking cessation. Individuals are less likely to lapse if they are in the telic (serious-minded, arousal avoidant, goal-oriented) state than when they are in the paratelic (playful, arousal seeking, spontaneous) state. The literature indicates that people can smoke in such a way as to either increase or decrease central nervous system arousal; smoking in the telic and paratelic states might therefore differentially affect the resting electroencephalograph, as quantified by Fast Fourier Transform analysis. The basic hypothesis was supported. Theta power was decreased when subjects in the telic state smoked, while beta 2 power was increased when subjects in the paratelic state smoked; the latter finding was, however, true only for men. The results have important implications for research on changing health behaviors and for smoking cessation programs.

Reversal theory's mastery and sympathy states in smoking cessation.

Relapse is the most frequent outcome of smoking cessation attempts. This study tests the usefulness of the mastery and sympathy concepts of Apter's reversal theory to explain whether subjects lapse or abstain during highly tempting situations. Descriptions of the highly tempting situations of 57 individuals who were attempting to quit smoking were assigned to mastery or sympathy categories. Situations were also coded for availability of cigarettes. Logit modeling revealed that both the mastery/sympathy variable and the availability of cigarettes were necessary to fit the data. Being in the mastery state and having to exert effort to get cigarettes were significantly related to resisting the urge to smoke. The smoking status of 36% of the subjects was correctly classified using both variables. The usefulness of mastery/sympathy states in explaining relapses in behavior change is discussed.

Cloned spindle and epithelioid cells from murine Kaposi's sarcoma-like tumors are of endothelial origin.

Kaposi's sarcoma (KS) is a complex neoplasm comprising spindle cells, vascular structures, erythrocytes, and an inflammatory infiltrate. The pathogenesis of this disorder is not yet understood, which is a major impediment to the design of safe and effective new therapies. We previously reported a murine model in which simian virus 40 (SV40) T-antigen-transformed murine endothelial cells induce lesions with the histopathologic features of KS. We have now cloned by limiting dilution seven morphologically distinct tumor-derived lines, all of which express the SV40 T antigen. Because SV40 is non-permissive in mouse cells, the presence of this viral marker permits definitive identification of cellular origin. We report here that both spindle cell and epithelioid cell clones from these KS-like tumors are derived from endothelial cells.