The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history.

BACKGROUND: The cortisol awakening response (CAR) has been shown to predict major depressive episodes (MDEs) over a 1-year period. It is unknown whether this effect: (a) is stable over longer periods of time; (b) is independent of prospective stressful life events; and (c) differentially predicts first onsets or recurrences of MDEs. METHOD: A total of 270 older adolescents (mean age 17.06 years at cortisol measurement) from the larger prospective Northwestern-UCLA Youth Emotion Project completed baseline diagnostic and life stress interviews, questionnaires, and a 3-day cortisol sampling protocol measuring the CAR and diurnal rhythm, as well as up to four annual follow-up interviews of diagnoses and life stress. RESULTS: Non-proportional person-month survival analyses revealed that higher levels of the baseline CAR significantly predict MDEs for 2.5 years following cortisol measurement. However, the strength of prediction of depressive episodes significantly decays over time, with the CAR no longer significantly predicting MDEs after 2.5 years. Elevations in the CAR did not significantly increase vulnerability to prospective major stressful life events. They did, however, predict MDE recurrences more strongly than first onsets. CONCLUSIONS: These results suggest that a high CAR represents a time-limited risk factor for onsets of MDEs, which increases risk for depression independently of future major stressful life events. Possible explanations for the stronger effect of the CAR for predicting MDE recurrences than first onsets are discussed.

Creating a career ladder for nursing assistants in long-term care.

This article describes the development, implementation, and evaluation of a career ladder for certified nursing assistants in long-term care. A career ladder is an effective way to maximize the use of unlicensed workers without changing the skill mix (eg, no loss of licensed nursing positions) and allow the licensed nurse more time to perform higher-level clinical tasks, such as assessments, patient education, and documentation. Implementation of an unlicensed worker career ladder also can improve nursing assistant retention.

Administering intraperitoneal chemotherapy using a peritoneal port.

The IP access provided by the relatively closed system using subcutaneous portals linked to the Tenckhoff catheter has revolutionized the clinical approach to intra-abdominal tumors, especially to ovarian cancer. The development of totally implanted peritoneal access ports that diminish the risk of infection and the design of treatment regimens that do not require drainage of the drugs from the peritoneal cavity after instillation have reduced the technical complexity of IP therapy. This treatment approach is safe and can be easily administered by trained oncology nurses and physicians in an outpatient setting. The success of a program for IP chemotherapy depends on a reliable and safe access to the peritoneal cavity, such as the port. Because of the port, during the past 13 years IP chemotherapy has developed into an effective treatment, especially for ovarian cancer patients with small volume disease following laparotomy. Nurses have played a major role in the development of this treatment modality. They have become quite skillful in making assessments and intervening with appropriate nursing measures to ensure that a highly specialized and complex procedure is managed safely. Further clinical nursing research will improve the administration process of IP therapy and ultimately will improve the quality of life for patients.

The port: delivering intraperitoneal chemotherapy in ovarian cancer.

1. Ovarian cancer is rarely diagnosed in the early stages because there are no easily identifiable signs and symptoms. When recognizable signs and symptoms appear, they are commonly unimpressive, elusive, and vague. 2. A significant advantage of intraperitoneal administration of chemotherapy is that high concentrations of drugs can be maintained within the peritoneal cavity with less systemic toxicity than with intravenous administration of similar doses. 3. Surgically implanted ports allow for a completely closed system, eliminating the need for daily care and greatly reducing the potential for infection.

Effective chemotherapy for melanoma after treatment with interleukin-2.

Twenty patients with biopsy-proven metastatic malignant melanoma, previously treated with interleukin-2 (IL-2), received combination chemotherapy for progressive disease. Treatment included carmustine, cisplatin, dacarbazine, and tamoxifen (BCDT). Nausea was the most common toxicity (100%) and usually was mild. Persistent thrombocytopenia was the most frequent toxicity limiting further treatment. Eleven patients (55%) had an objective partial response, three patients (15%) had a minor response, and six patients (30%) had no change or progressive disease in response to this treatment. These results were comparable to the high response rates (21 of 40, 53%) achieved with BCDT in previously untreated patients with melanoma. It was concluded that prior therapy using IL-2 does not significantly alter the response rate of metastatic melanoma to BCDT, thus suggesting that immunomodulators (e.g., IL-2) and chemotherapeutic agents are not cross-resistant treatments.

Hairy cell leukemia. Current management.

The long-term outlook for patients with HCL has brightened over the last 5 years with the development of two highly effective systemic therapies, pentostatin and alpha-interferon. Pentostatin can induce complete responses in over 75 per cent of patients and may offer cure in this disease. Splenectomy continues to have a role as first-line therapy in selected patients in whom it may offer a median remission duration of over 5 years. Alpha-interferon is the treatment of choice for patients requiring initial systemic therapy and can be used intermittently to re-induce remission in patients with disease progression off therapy. Outside of clinical trials pentostatin should be utilized only in appropriately selected patients refractory to interferon therapy.

The t(2;5)(p23;q35): a recurring chromosomal abnormality in Ki-1-positive anaplastic large cell lymphoma.

In lymphoid neoplasms, nonrandom cytogenetic abnormalities correlate with clinical, morphologic and immunophenotypic features. A subtype of non-Hodgkin's lymphoma, which expresses the Ki-1 antigen (CD30) and has distinct morphologic and clinical features, has recently been described. We now report the association of a reciprocal translocation involving the short arm of chromosome 2 (band p23) and the long arm of chromosome 5 (band q35), t(2;5)(p23;q35), with Ki-1 positive anaplastic large cell lymphoma. Rearrangement of the genes that are located at the breakpoints on chromosomes 2 and 5 may be a critical step in the pathogenesis of this lymphoma.

Enhanced in vitro bone marrow cell migration and T-lymphocyte responses in aged mice given subcutaneous thymic epithelial cell grafts.

Thymic epithelial cell cultures from newborn CBA/J mice were developed and grown on collagen-coated dextran beads. These thymic epithelial cells were transplanted subcutaneously into aged syngeneic mice. After several weeks, enhanced in vitro migration of host bone marrow cells occurred to supernatants prepared from neonatal thymus cultures in thymic epithelial cell grafted mice compared to control aged mice. Percent migration equaled that of migration from control young adult mice. In addition, enhanced T-lymphocyte responses were observed in aged mice given thymic epithelial cell grafts as compared to aged controls.

Augmentation of pre- and post-thymic T-lymphocyte responses in thymic epithelial cell grafted nude mice.

Thymic epithelial (T-E) cell cultures from newborn mice, grown on dextran beads coated with denatured collagen, were injected subcutaneously into athymic "nude" mice. After 8 weeks, enhanced in vitro migration of T-E cell grafted nude mouse bone marrow cells occurred to thymus supernatants prepared from neonatal thymus cultures. Percent migration was equal to the migration of control AKR bone marrow. In vivo T-lymphocyte responses were also significantly enhanced in T-E cell grafted nude mice as compared to controls.

DNA-stimulated ATPase activity on the lon (CapR) protein.

The gene product of the pleiotropic lon (also called capR) locus in Escherichia coli, the CapR protein, is an ATP hydrolysis-dependent protease and a nonspecific nucleic acid-binding protein. We demonstrated that it is also a DNA-stimulated adenosine triphosphatase (ATPase). This new activity is distinct from the protease-associated ATPase activity and occurs in the absence of proteolytic substrate. The reaction requires the presence of a divalent cation and has a pH optimum of 8.0. The products of the reaction are ADP and inorganic phosphate. No adenylation or phosphorylation of the DNA or proteins was detected. The maximum rate of ATP hydrolysis occurs in the presence of supercoiled (form I) DNA. Relaxed circles (form II), double-stranded DNA, and single-stranded DNA are less effective in promoting ATPase activity, whereas RNA is inactive. The DNA-stimulated ATPase activity is inhibited by a mutationally altered form of the CapR protein called the CapR9 protein. The interaction of the CapR and CapR9 subunits suggests that this enzymatic activity of the CapR protein is oligomeric in the presence of DNA. Our in vitro experiments indicate a possible role for nucleic acids in the regulation of all lon (capR) activity.