Outcomes of adolescents with acute lymphoblastic leukaemia.

INTRODUCTION: Compared with young children who have acute lymphoblastic leukaemia (ALL), adolescents with ALL have unfavourable disease profiles and worse survival. However, limited data are available regarding the characteristics and outcomes of adolescents with ALL who underwent treatment in clinical trials. The aim of this study was to investigate the causes of treatment failure in adolescents with ALL. METHODS: We retrospectively analysed the outcomes of 711 children with ALL, aged 1-18 years, who were enrolled in five clinical trials of paediatric ALL treatment between 1993 and 2015. RESULTS: Among the 711 children with ALL, 530 were young children (1-9 years at diagnosis) and 181 were adolescents (including 136 younger adolescents [10-14 years] and 45 older adolescents [15-18 years]). Compared with young children who had ALL, adolescents with ALL were less likely to have favourable genetic features and more likely to demonstrate poor early response to treatment. The 10-year overall survival and event-free survival rates were significantly lower among adolescents than among young children (77.9% vs 87.6%, P=0.0003; 69.7% vs 76.5%, P=0.0117). There were no significant differences in the 10-year cumulative incidence of relapse, but the 10-year cumulative incidence of treatment-related death (TRD) was significantly greater among adolescents (7.2%) than among young children (2.3%; P=0.002). Multivariable analysis showed that both younger and older adolescents (vs young children) had worse survival and greater incidence of TRD. CONCLUSION: Adolescents with ALL had worse survival because they experienced a greater incidence of TRD. There is a need to investigate optimal treatment adjustments and novel targeted agents to achieve better survival rates (without excessive toxicity) among adolescents with ALL.

Sexual function, self-esteem, and general well-being in Chinese adult survivors of childhood cancers: a cross-sectional survey.

INTRODUCTION: This study was conducted to evaluate sexual function in adult survivors of childhood cancers and investigate possible relationships between sexual function and quality of life, as measured by general well-being, self-esteem, body image, and depressive symptoms. METHODS: This cross-sectional survey was performed in our centre from 14 August 2015 to 8 September 2017. Adult patients who had a history of childhood cancers, and who were disease-free for >3 years, were approached for the study during clinical follow-up. Clinical information was collected from medical records. Self-administered questionnaires regarding quality of life and sexual functioning were given to the patients and resulting data were analysed. RESULTS: Two hundred patients agreed to participate in the study. The overall response rate was 64.8%. Ninety-one (45.5%) patients were women, and the mean age was 25.4 ± 5.57 years. The overall sexual functioning score was 28.3 ± 20.09. Forty-eight (24.0%) patients reported at least one sexual problem. Among patients who reported no sexual problems, more had haematological cancers (P=0.009), fewer underwent surgery (P=0.004), fewer underwent surgery with external effects (P=0.032), and fewer were regular social drinkers (P=0.013); additionally, they had a higher mean Rosenberg self-esteem scale score (P=0.010), lower mean body image scale score (P=0.008), and lower mean Patient Health Questionnaire score (P=0.001). CONCLUSION: Aspects of life beyond disease condition and physical function should be considered in adult survivors of childhood cancers. Appropriate referral and intervention should be initiated for these patients when necessary.

Individual and combined effects of methamphetamine and ketamine on conditioned place preference and NR1 receptor phosphorylation in rats.

Methamphetamine (MA), a commonly abused psychostimulant, induces the drug dependence by enhancing the dopamine-mediated neurotransmission. Ketamine (KET) is a non-competitive N-methyl-D-aspartate receptor antagonist, which can be actually mixed with MA for polydrug abuse. In the present study, the individual and combined effects of KET (10 mg/kg, i.p.) and MA (1 mg/kg, i.p.) on conditioned place preference in rats were investigated. The alterations of serine 897 phosphorylations of NR1 receptors in the striatum and ventral tegmental area of after-conditioning rats were measured immunochemically. The results showed repeated administrations of MA, KET and their combination, at the doses studied, all could induce psychological dependences evaluated by conditioned place preference. KET was not able to suppress the MA-induced place preference. The modulations of NR1 phosphorylations in basal ganglia were partly responsible to place preference. Although the alterations induced by KET were not significant in most areas we studied, MA showed a significant increase in the ventral tegmental area but a marked decrease in caudate putamen and nucleus accumbens. Such alterations were much more significant when KET and MA were combined. These results have important implications for public awareness of harm with combined drug abuse. Further investigations toward the specific interaction of the two drugs are necessary.

The long-term effects of auricular therapy using magnetic pearls on elderly with insomnia.

OBJECTIVE: To examine the long-term effect of auricular therapy using magnetic pearls administered for the elderly suffering from insomnia. DESIGN: A follow-up study after a randomized controlled trial. SETTINGS: Four hostels for the elderly in Hong Kong. INTERVENTIONS: This paper focuses on reporting the long-term effect of auricular therapy using magnetic pearls in the experimental group of a randomized controlled study. Fifteen volunteer participants were followed up at 1-, 3-, and 6-month intervals after a 3-week treatment course. OUTCOME MEASURES: Objective sleep parameters using actigraphic monitoring were collected at different intervals of time after the therapy. RESULTS: Results of RANOVA demonstrate that there was a significant difference of nocturnal sleep time (F(2.30,29.90)=3.63, P<0.05) and marginally differences of sleep efficiency (F(4,52)=2.52, P=0.05) at baseline, immediately after the therapy, and at the three time intervals at 1, 3 and 6 months. The results illustrate that the mean nocturnal sleep time (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) also remained constant over the 6-month follow up period. The results of least square polynomial regression analysis also illustrate that the mean NST (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) remained constant over the 6-month follow up period. CONCLUSION: The results of this follow up study indicate that auricular therapy using magnetic pearls could have a long-term effect, at least within the observed period of time, on improving the quality as well as the quantity of sleep among the elderly.

Is there a place for auricular therapy in the realm of nursing?

Several theories, such as the 'homuncular reflex theory' 'delta reflex theory', and 'meridian theory' point to the fact that the ear is related to all parts of the human body and internal organs. Being one of the approaches in traditional Chinese medicine, auricular therapy is a therapeutic method by which specific points on the auricle are punctured or pressed. Auricular therapy can activate meridians and collaterals, regulate the Qi and blood, help to achieve the balance between Yin and Yang status of internal organs, and is therefore suitable for treating many disorders of the body. Successful examples of previous studies using this therapy including insomnia, weight reduction, hypertension, treatment of addiction, and pain reduction. However, inconsistency in the treatment protocol among studies, or the use of combined therapies, makes it impossible to draw a strong causal relationship between this therapy and the treatment effect. More appropriate clinical trials are therefore necessary to understand in depth the therapeutic effect of auricular therapy. Ideally, these trials can take place in the context of nursing practice so as to explore the application of this therapy in the realm of nursing, and to enable nurses to make a more effective contribution to primary health care.

Left main coronary artery aneurysm: sealing by stent graft and long-term follow-up.

We describe the implantation of a stent graft to seal off the left main coronary artery aneurysm of a 64-year-old man with guidance by intravascular ultrasound. The aneurysm was successfully sealed off. At 6-month and 1-year follow-up, a small residual aneurysm reappeared, which was treated conservatively. The technical issues in closing this aneurysm and the management of the residual aneurysm are discussed.

Cellular uptake, subcellular localization and photodamaging effect of temoporfin (mTHPC) in nasopharyngeal carcinoma cells: comparison with hematoporphyrin derivative.

Temoporfin (meta-tetra (hydroxyphenyl)chlorin; mTHPC) potentiated a 100-fold higher cytotoxic effect than hematoporphyrin derivative (HPD) on two nasopharyngeal carcinoma cell lines (HK1 and CNE2) in terms of the overall photodynamic therapy (PDT) dose. The cellular uptake, evaluated by flow cytometry and spectrophotometry demonstrated that mTHPC exhibited higher uptake ability than HPD. Confocal laser scanning microscopy detection for both the sensitizer and mitochondria probe on the same cell images revealed that both drugs accumulated diffusely in the cytoplasm and that mitochrondria is a target organelle. Photo-activation ruptured the mitochrondria, with more pronounced mitochondrial damage being observed in mTHPC-PDT course. This correlated well with the cell photokilling efficiency of mTHPC.

Photocytotoxic and DNA damaging effect of temoporfin (mTHPC) and merocyanine 540 (MC540) on nasopharyngeal carcinoma cell.

Photodynamic therapy (PDT) is a new approach to cancer treatment for a variety of malignant tumors. In this study, two clinical photosensitizers, Temoporfin (meta-tetra-hydroxyl-phenyl-chlorin; mTHPC) and merocyanine 540 (MC540), were selected to explore for their photocytotoxic and genotoxic effects on nasopharyngeal carcinoma cells (NPC/HK1 and CNE2). Results of tetrazolium reduction assay showed that 80% cell killing were achieved for both cell lines at 0.4 microg/ml mTHPC for 24 h incubation and then with 40 kJ/m2 light irradiation, whereas 40 microg/ml MC540 with 50 kJ/m2 light dosage was required to attain the same level of phototoxicity for NPC/HK1. On the contrary, NPC/CNE2 was quite resistant to MC540. Hence, mTHPC-mediated PDT exerted a more potent effect than MC540-mediated PDT, even though the molar extinction coefficient of the main absorption peak for MC540 is much higher than that of mTHPC. Dark cytotoxicity remained negligible for both sensitizers. Comet assay was used to evaluate the DNA strand break and potential genotoxic effect induced by mTHPC and MC540 on the NPC cells. No DNA strand break was detected in the absence of light, and under sublethal treatment (LD25) for either sensitizer-loaded cells. Confocal laser scanning microscopy showed that mTHPC and MC540 localized in the cytoplasm but not in the nucleus of the tumor cells, which provided evidence for undetectable DNA damage under dark and low photodynamic dose.

Anxiety in ethnic minority youth. Methodological and conceptual issues and review of the literature.

Although current research has documented a relatively high prevalence of anxiety disorders in American youth, this research has been conducted mainly with nonminority samples. Fair treatment and increasing numbers of ethnic minority persons in the United States require that more should be known about minority youth. However, research with majority youth cannot be safely generalized to minority youth for several reasons, such as potential differences in the manifestation of anxiety, differences in style of response to assessment devices, and different life circumstances. This review is presented in two major sections. First, the authors address definition of terms and fully examine the significance of studying anxiety in ethnic minority youth. Also considered are methodological issues such as sampling and participation biases. Second, the authors review anxiety in ethnic minority children and adolescents in the United States including studies addressing fears, worries, trait anxiety, test anxiety, and anxiety disorders.

A prospective study of elective stenting in unprotected left main coronary disease.

The standard treatment of left main coronary artery (LMCA) disease has been bypass surgery (CABG). Recent reports suggested that stenting of LMCA disease might be feasible. From January 1995 to April 1998, we carried out a prospective study of elective stenting of unprotected LMCA disease to evaluate its immediate and long-term results. Of 61 consecutive patients with unprotected LMCA disease, 6 were excluded. Acute procedural success was 100% for the remaining 55 patients, without any complications such as stent thrombosis, myocardial infarction, CABG, or death. During a mean follow-up of 16.1+/-9.6 months, 11 patients (20%) had symptomatic recurrence, between 2 to 6 months after their procedure. Seven patients underwent CABG, two had repeat intervention, one continued with medical therapy, and one died before planned angiography. There was no late sudden death. Forty-four patients (80%) remained asymptomatic. We conclude that elective stenting may be a safe alternative to CABG in unprotected LMCA disease.

Homework compliance, perceptions of control, and outcome of cognitive-behavioral treatment of social phobia.

This study examined the relationship of compliance with homework assignments and posttreatment anxiety in patients who received cognitive-behavioral group therapy (CBGT) for social phobia. Greater homework compliance measured in the first and latter periods of CBGT was associated with lower levels of social interactional anxiety after treatment. Surprisingly, homework compliance during the middle sessions of CBGT was positively related to posttreatment fears of scrutiny and criticism. Perceptions of control in social phobia and their potential effect on homework compliance and the homework compliance/treatment outcome relationship were also examined using the Levenson (Journal of Consulting and Clinical Psychology, 41, 397-404, 1973) Locus of Control Scale. Social phobics were less likely to believe in their own control over events than a comparison sample of community subjects but attributed greater control over events to other powerful persons. Among patients, higher Internality and lower Powerful Others subscale scores were associated with higher levels of pretreatment anxiety. However, neither subscale was significantly related to measures of homework compliance. Furthermore, when included in multiple regression analyses, neither subscale or its interaction with homework compliance added to the prediction of posttreatment anxiety. Limitations of this study and future research to improve assessment of homework compliance and perceptions of control among social phobic patients are discussed.

Social anxiety and perception of early parenting among American, Chinese American, and social phobic samples.

Emotionally distant and controlling child-rearing attitudes have been reported to characterize the parents of American or western European social phobics in previous research. However, the notion that these parental attitudes may be associated with social anxiety only in some cultures has not been investigated. The present study examined social anxiety among American social phobics and American and Chinese/Chinese American volunteer samples and how it may relate to their parents' child-rearing attitudes. Multivariate analyses of variance revealed overall group differences. Both volunteer samples reported lower levels of anxiety than social phobics. Parents of Chinese/Chinese Americans and social phobics were reported to be similar in their (1) isolation of children from social activities; (2) over-emphasis of others' opinions; and (3) use of shame tactics for discipline (more so than American volunteers' parents). However, parents of nonsocial phobics were more likely to attend family social activities than social phobics' parents. Overall, the association between a reported parenting style emphasizing others' opinions and shame tactics and social anxiety in their adult children was more evident in both American samples than among Chinese/Chinese Americans.

Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease.

The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and often clinically undetectable lesions. 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%). US correctly detected iliopsoas pathology in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection. A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.

Primary bone tumors. MR morphologic appearance correlated with pathologic examinations.

Eighty-three MR studies for primary bone tumors, performed with both spin echo and short time inversion recovery (STIR) sequences, were reviewed. Twenty-six patients underwent surgery within 10 days after MR imaging. Specimens were cut and directly compared with MR images. In the remainder, pathologic slides were compared in order to obtain a better understanding of MR pattern. All MR images were examined with a traditional morphologic approach and, upon comparison with surgical macroslides and with pathology samples, some MR distinctive patterns were identified: the bulky appearance of osteosarcoma surrounded by muscle edema, the multilobular high signal intensity (SI) chondroid lesions, the subtle infiltration of Ewing's sarcoma, rarely accompanied by muscle edema and prone to MR underestimation, the well defined "multiple shells" pattern of giant cell tumor, and the ill defined "storiform" appearance of malignant fibrous histocytoma are all typical MR features strictly corresponding to pathologic findings. The chondroid origin tumors may be identified based on the lobular high SI pattern whereas a benign fibrous lesion was the only one in this series to be distinguished relying on the SI. Peritumoral soft tissue edema was found by the STIR sequence only in malignant tumors (69%) of this series, and particularly in osteosarcoma (96%), chondrosarcoma (83%), and giant cell tumor (100%): this associate finding may further contribute to the diagnosis.

Reduction of cellular damage induced by cerebral ischemia in rats.

A model of incomplete cerebral ischemia involving bilateral ligation of the common carotid arteries in rats, was used to examine the potential of a Chinese herbal preparation and of nifedipine to reduce cell damage following cerebral ischemia. The herbal preparation contained ginsengosides and extracts of Panax notoginseng, Ligusticum chuanxiong Hort., Carthamus tinctorius L. and Salvia militorrhiza Bge. Histological evidence of cell damage and the formation of peroxidation products were both reduced in rats pretreated with the herbal preparation or with nifedipine. It has been suggested that the free radical reaction is involved in tissue damage, particularly in the pathological neurocyte injury of cerebral ischemia. The results show that in this model of incomplete cerebral ischemia, the degree of lipid peroxidation can be lowered by the pretreatment with Chinese herbs containing ginsengosides or with nifedipine. These drugs maybe beneficial in the treatment of cerebral ischemia in humans.

MRI in primary bone tumors: therapeutic implications.

The accuracy of preoperative MRI in detecting tumor extent has been evaluated in 35 patients with primary bone neoplasms; intra-osseous extent was measured on MR images and compared with macroslides of surgical specimens in 26 cases. An almost completely accurate prediction of tumor size was obtained with the combined employment of Spin-Echo (SE) and Short Inversion Time Inversion Recovery (STIR) sequences in the various tumors, with the exception of two Ewing's sarcomas. Changes in Signal Intensity (SI) and tumor morphology were identified in those cases which had undergone presurgical chemotherapy; the reduction in SI and in tumor size or the appearance of a more homogeneous signal was correlated with a positive response to cytotoxic therapy. MR imaging fully satisfies surgeon's preoperative requirements in the assessment of therapy-responding neoplasms as well as in local tumor staging in all types of neoplasms, with the exception of Ewing's sarcoma.

Cystic dysplasia in ectopic kidney associated with absent vas deferens and congenital inguinal hernia.

We report a case of congenital cystic dysplasia of a kidney associated with an absent vas deferens and congenital inguinal hernia on the same side. The findings are explained in embryologic terms. Congenital abnormalities of the kidney are often associated with other abnormalities of the urogenital system and should be looked for when managing children with this condition.