Treatment of classic Kaposi sarcoma with a nicotine dermal patch: a phase II clinical trial.

BACKGROUND: Kaposi sarcoma (KS), a malignancy of dermal endothelial cells that is caused by human herpesvirus 8 (HHV8) infection, is sensitive to perturbations of immunity. Nicotine might be effective against KS because of its immunologic and vascular effects and because smoking is associated with a low risk of KS. OBJECTIVE AND STUDY DESIGN: We conducted a masked, randomized phase 2 clinical trial of transdermal nicotine and placebo patches to assess the safety and efficacy of nicotine against classic KS (cKS). SUBJECTS AND METHODS: Three cKS lesions, predominantly nodules, in each of 24 non-smoking patients were randomly assigned to 15 weeks continuous treatment with nicotine patch (escalated to 7 mg), identical masked placebo patch or no patch. Changes in lesion area and elevation from baseline through six follow-up visits, by direct measurement and by two independent readers using digital photographs of the lesions, were compared using non-parametric and regression methods. Changes in longitudinal levels of HHV8 antibodies and DNA in blood cells were similarly assessed. RESULTS: There were no systemic or serious adverse events, and compliance was good. One patient resumed smoking and discontinued patches, and two patients withdrew at week 12 for unrelated indications. Six (29%) of the remaining 21 suspended use of patches to relieve local skin irritation; four of these six completed the trial at reduced dose. Treatment assignment was not associated with significant or consistent changes in cKS lesion area or elevation, HHV8 viral load or antibodies. CONCLUSION: Transdermal nicotine and placebo patches caused no serious toxicities but had no demonstrable effect on nodular cKS lesions or HHV8 levels.

Molecular evolution of a Y-chromosomal repetitive sequence family in the genus Mus.

A 522-base-long Y-chromosomal sequence was isolated from a BALB/c genomic library and was designated "BF046." It is repeated about 200 times in the male genome, and a difference was detected between the Mus musculus musculus and the M. m. domesticus type Y chromosomes. BF046-related sequences were present over the entire length of the Y chromosome as visualized by in situ hybridization. Southern blot analysis against DNAs isolated from eight species in the genus Mus showed that BF046-related sequences were amplified in the Y chromosomes of three closely related species: M. musculus, M. spicilegus, and M. spretus. To gain insight into the stability of the BF046 sequence family, we isolated 18 additional clones from these three mouse species and compared their sequences. The M. musculus sequences differed from the M. spicilegus and M. spretus sequences by two indels. The remaining parts of the sequences were very similar, but both parsimony and distance-based analytical methods divided the sequences into the same four subgroups, with each species having its own subgroup(s). Thus, the Y chromosomes of M. musculus, M. spicilegus, and M. spretus can be distinguished from one another.

Molecular characterization of a mouse Y chromosomal repetitive sequence amplified in distantly related species in the genus Mus.

This report describes a 1.1 kb long mouse Y chromosomal sequence designated 142-4. It has a 42% GC content and is rich in short direct and inverted repeats. 142-4 related sequences are repeated about 200 times in the Mus musculus Y chromosome and their distribution was visualized by in situ hybridization. 142-4 detected a restriction fragment length polymorphism that differentiated between the M. m. musculus type and the M. m. domesticus type Y chromosome. Southern blot analysis of DNAs isolated from a panel of mouse species showed that 142-4 related sequences were amplified in the Y chromosomes of M. minutoides, M. musculus, M. saxicola, M. spicilegus, and M. spretus but not in those of M. caroli, M. cookii, and M. pahari. These results suggest that 142-4 related sequences are evolutionarily unstable and their accumulation patterns do not correlate with the known phylogenetic relationships of mouse species in the genus Mus.

Comparison of mouse Y-chromosomal repetitive sequences isolated from Mus musculus, M. spicilegus, and M. spretus.

The mouse Y chromosome is rich in repetitive sequences. We describe a new highly male-specific BALB/c mouse sequence named 142-5. The distribution of 142-5 related sequences, which appeared to be repeated at least 100 times in the male genome of Mus musculus, was visualized on the Y chromosome by in situ hybridization. Their accumulation patterns in the genus Mus showed that the sequences evolved quickly and suggested that they might prove useful for detecting genetic differences between closely related species. To test this hypothesis, we isolated 20 additional sequences from three mouse species (M. musculus, M. spicilegus, and M. spretus) and compared their nucleotide sequences using three different computer programs. It was found that the sequences were remarkably similar but could be divided into four subgroups, and that each species had a distinct set or sets of sequences that were amplified in the Y chromosome.

Evaluation of therapeutic factors in group psychotherapy for 'non-sensical' shop-lifters: a preliminary report.

There is a growing emphasis upon psychiatric involvement in management of 'non-sensical' shop-lifters, those who steal items they neither want nor need. However there is very little description of, or research into, psychological treatment approaches for this group of clients. We report a preliminary study of the process of therapy in two out-patient psychotherapy groups for female 'non-sensical' shop-lifters. Therapeutic factors in the group psychotherapy were evaluated using the method of Bloch et al. (1979) to assess the most important event in therapy. Results from nine subjects indicate that universality (realizing that one's problems are not unique) was rated as the most important aspect of therapy, with self-understanding the second most important. The implications of these findings for future provision and facilitation of therapy for this group of clients are discussed.

The Separation-Individuation Inventory. Association with borderline phenomena.

The Separation Individuation Inventory (SII; Christenson and Wilson, J. Nerv. Ment. Dis., 173:561-565, 1985) was designed to assess adult psychopathology construed in terms of the concepts of separation and individuation (Mahler, Pine, and Bergman, The Psychological Birth of the Human Infant: Symbiosis and Individuation, 1975). Its reported use is confined to the original authors' paper, which compared scores of 20 subjects with borderline personality disorder with the scores of staff control subjects. We report the association of the SII with two self-report measures of borderline personality diagnosis and phenomenology. Our British samples, from the staff and residents in a therapeutic community for severely personality-disordered clients, thus complement the original American work. The SII was found to have good internal consistency, respectable screening parameters, and high correlations with indications of trait psychopathology. We suggest a slight modification to the scoring of the inventory and two main areas for additional research.

Dealing with verbal abuse: evaluation of the efficacy of a workshop for student nurses.

Verbal abuse is a problem that can confront all health care professionals in their day to day practice. Studies into abuse of professionals have emphasised the stressful effects of non-physical violence and have shown that it is often the most inexperienced members of various professions who are in the 'front line' of such attacks. The group of staff particularly at risk are student nurses (HSC 1987). This paper presents an evaluative study of a workshop devised to help student nurses to deal with verbal abuse (Wondrak 1989). Psychiatric nursing students were studied from two intakes into a training course. A simulated situation of an interview with a verbally abusive patient was video taped and assessment was made by independent raters of each subjects ability to deal with the situation. 14 of the subjects then attended a verbal abuse workshop and when re-tested, their ability to deal with abuse was compared with those 15 student nurses who did not attend a workshop. The findings are encouraging, indicating that there is a significant change in the experimental group on a number of variables, related to both practical and emotional aspects of dealing with abuse. Thus the efficacy of the short workshop in improving ability to deal with verbal abuse was demonstrated.

Therapeutic community treatment for personality disordered adults: changes in neurotic symptomatology on follow-up.

Personality disordered patients are important as they place high continuing demands on services and are often refractory to traditional treatments. Often personality disorders may co-exist with neurotic symptomatology, worsening prognosis of the latter. This paper reports change in neurotic symptomatology following intensive, long term, therapeutic community treatment for such patients. Sixty two subjects with personality disorder were followed up for eight months after discharge (response rate 65%). Results showed a highly significant reduction in symptomatic distress as measured by the SCL-90R questionnaire. Investigation of the reliability and clinical importance of the change in individual subjects demonstrated that 55% of subjects had improved reliably, and in 32% this change was also clinically significant, whilst only 6.5% of subjects had deteriorated reliably.

Nucleotide sequence analysis of a mouse Y chromosomal DNA fragment containing Bkm and LINE elements.

The strong suppression of crossing-over between the X and Y chromosomes permits rapid accumulation of repetitive sequences in the Y chromosome. To gain insight into the mechanism responsible for the sequence amplification, it is essential to characterize Y chromosomal repetitive sequences at the molecular level. Here, we report the entire nucleotide sequence (3,902bp) of AC11, a mouse sequence that is repeated 300 times in the Y chromosome. AC11 is AT rich (32.8% GC), and contains many short poly(A) sequences. In addition, it has Bkm and LINE sequences as well as a Y chromosome-specific sequence. The Bkm sequence consists of typical (GATA) and (GACA) repeating units, whereas the LINE sequence deviates considerably from other mouse LINE sequences (71-76% identity) and may be considered atypical. The Y chromosome-specific region seems to be unique and does not identify similar sequences in the GenBank library. The information obtained from the nucleotide sequence should form the foundation to study the evolutionary processes through which AC11-related sequences have accumulated in the mouse Y chromosome.

Cultural factors in the eating disorders: a study of body shape preferences of Arab students.

A replication of an American study of body shape preference was conducted in a group of 218 Arab students attending the American University in Cairo, Egypt. Arab female students felt their ideal shape to be significantly thinner than their current shape, while male students did not. Hence the appraisal of body shape shows gender differences in Egypt consistent with the American study. The Arab women reported a current shape similar to American women but had a smaller discrepancy between ratings of their ideal and current body shape. There was no difference for either Arab women or men between the shape thought most attractive to the opposite sex and that which the other gender actually reported as most attractive. The study shows a clear preference for thinness in the Arabic culture, inferences are made to its role in predisposing to eating disorders.

Family composition and social class in bulimia. A catchment area study of a clinical and a comparison group.

Many theories of the etiology of eating disorders focus on the role of the family. However, these theories are based on clinical experience and uncontrolled clinical case series. We report a study comparing 50 bulimic women with 40 non-eating-disordered women all from the same clinical catchment area. This study revealed no significant differences in social class, family size, birth position, or sibling sex ratio between the two groups. However, the parents of bulimic women were found to have been significantly older than those of the control group at the time of birth of their daughter. These findings are discussed with reference to previous family studies of eating disorders.

Bulimia in British blacks and Asians. A catchment area study.

This paper describes the demographic and clinical features of five non-white, normal body weight bulimics, all from the same catchment area. Comparisons with white bulimic referrals from the same area showed clinical similarities, but the non-white bulimics gave an account of gross emotional deprivation: all came from broken homes; four had been separated for long periods from their mothers; two had been subjected to incestuous abuse; and four had been cared for by white women. Response to treatment was poor. The ratio of non-white referral to white was at most one tenth of the ratio of non-white to white women in the catchment area.

Body image distortion in non-eating disordered women and men.

This study of body image perception in 100 non-eating disordered women and men demonstrates that overperception of body widths, whilst accurately perceiving a neutral object, is not restricted to populations with eating disorders, nor is it peculiar to women. Men consistently overestimated body widths to the same extent as female subjects. Overall, 84% of women and 52% of men wished to weigh less. Considering those subjects within the 10% range of Mean Matched Population Weight (MMPW), men wished to be 0.75 kg heavier, whilst women at MMPW wished to weigh 3.25 kg less. For women, the subjects who were most satisfied with their actual weight were those who were well below MMPW. There is a tendancy that the greater the deviation of weight from normal, in either direction, the greater the degree of body width overestimation. These results suggest that the overperception of body width is more related to current weight than to concern about weight and shape, or to the presence or absence of an eating disorder. They question the use of empirical body size estimation measurement in eating disordered populations.