Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy.

PURPOSE: The aim of the study was to examine anxiety and depression and their effects on the quality of life (QOL) of patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS: A cross-sectional descriptive design was used. Data were collected from a self-report survey derived from the Hospital Anxiety and Depression Scale (HADS)-Cantonese/Chinese version, the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B)-Chinese version, and from demographic and clinical characteristics. Chi-square tests and the General Linear Model (GLM) were used for secondary data analysis. SAMPLE: The study group consisted of 218 women (> or = 18 years old) who were midway through chemotherapy or radiotherapy for stage I-III breast cancer. All subjects were recruited from the outpatient sections of the Departments of Clinical Oncology or Breast Centers of the four Hong Kong public hospitals. RESULTS: The percentage of participants with anxiety (chi2=6.56, p=0.01) or depression (chi2=7.26, p=0.007) was higher in the chemotherapy group. More participants in the chemotherapy group had both anxiety and depression than those in the radiotherapy group, though no statistically significant difference was reported. Anxiety and depression had detrimental effects on the overall and other domains of QOL of these women undergoing adjuvant therapy for breast cancer. CONCLUSION: This study should increase nurses' awareness of the importance of integrating psychological symptom assessment into nursing assessment procedures, and enhance their clinical sensitivity in identifying high-risk groups of patients undergoing specific cancer treatments.

The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study.

PURPOSE/OBJECTIVES: To examine the symptom cluster of fatigue, pain, anxiety, and depression and its effect on the quality of life (QOL) of women receiving chemotherapy or radiotherapy for breast cancer. DESIGN: Descriptive. SETTING: Oncology outpatient sections of four public hospitals in Hong Kong. SAMPLE: 215 ethnic Chinese women who were midway through treatment for breast cancer. METHODS: Chinese versions of the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Brief Pain Inventory, Functional Assessment of Chronic Illness Therapy for Breast Cancer, and Medical Outcomes Study Social Support Survey were used. Spearman rho correlation and structural equation modeling were used to examine the relationships among the study variables. MAIN RESEARCH VARIABLES: Breast cancer, fatigue, pain, anxiety, depression, and QOL. FINDINGS: Most participants reported mild-to-moderate levels of fatigue and pain. Twenty-one percent and 36% of patients might have had an anxiety or depression disorder, respectively. Significant correlations among the four symptoms supported the existence of the symptom cluster. The participants receiving chemotherapy had inadequate social support, experienced higher levels of symptoms, and were more likely to have a poorer QOL. CONCLUSIONS: The findings supported the existence of the symptom cluster that had detrimental effects on QOL. IMPLICATIONS FOR NURSING: This study shed light on a contemporary approach of grouping several related symptoms together. The findings enhance nurses' clinical sensitivity when identifying patients in high-risk groups and provide useful information for designing and prioritizing symptom-management strategies to meet patients' needs.

Neovascularization and bone formation in the condyle during stepwise mandibular advancement.

The aims of this investigation were to identify the temporal expression of vascular endothelial growth factor (VEGF) in the mandibular condyle and to correlate it with the pattern of new bone formation during stepwise mandibular advancement. Two hundred and fifty female, 35-day-old Sprague-Dawley rats were randomly divided into 10 groups, with 10 rats allocated to the single-step bite-jumping subgroup, 10 rats to the stepwise advancement subgroup and five rats to the control subgroup. In the experimental groups, the mandibles were kept in a continuous forward position. The initial stepwise advancement commenced on day 35, whereas the second advancement started on day 65. The rats were sacrificed on experimental days 3, 7, 14, 21, 30, 33, 37, 44, 51 and 60. Sections (7 microm) were cut through the condyle in the parasagittal plane and stained with anti-VEGF antibody. Each section was counter-stained with haematoxylin for observation of the cellular response. The sections were digitized and quantitatively analysed with a computer-assisted image analysing system. The results showed that the initial advancement in the stepwise group led to significantly less expression of VEGF when compared with single advancement. However, the second advancement on day 30 resulted in a significant increase in VEGF expression when compared with the one-step group and the natural growth control group. Thus, it was concluded that changes in the amplitude of mechanical loading, produced by stepwise advancement, have a significant effect on the production of VEGF by the chondrocytes. During the later stages of advancement, more VEGF and more condylar bone was produced.

Myoclonic status epilepticus following repeated oral ingestion of colloidal silver.

The authors report a case of a 71-year-old man who developed myoclonic status epilepticus and coma after daily ingestion of colloidal silver for 4 months resulting in high levels of silver in plasma, erythrocytes, and CSF. Despite plasmapheresis, he remained in a persistent vegetative state until his death 5.5 months later. Silver products can cause irreversible neurologic toxicity associated with poor outcome.

A comparison of the metal content of some benthic species from coastal waters of the Florida panhandle using high-resolution inductively coupled plasma mass spectrometry (ICP-MS) analysis.

Benthic marine invertebrates, sediment, and water from several locations along the Florida panhandle coast from St. Joseph Bay in the west to the mouth of the Wakulla River in the east, including from several river estuaries, were analyzed by double focusing ICP-MS (Finnigan MAT ELEMENT) for Cd, Hg, Pb, Cu, Zn, and As. All were detected in all samples. Sponges generally contained higher levels of Cd than other species. Microciona prolifera sponges from St. Joseph Bay had higher As levels (8.1-13.6 microg/g dry weight) than sponges collected from Dickerson Bay or Appalachee Bay (2.20-9.7) and higher Cd levels (0.43-0.73) than that of a single Microciona specimen collected from Dickerson Bay (0.29). Water content of As was about 20-30x higher in St. Joseph Bay than in any other location, and sediment levels of Cd were about 9x higher. Cu and Zn were higher in organic sediment from St. Joseph Bay than they were in other areas. The Pb content of several sponge species and two of tunicates was considerably higher than in other species. The uptake of most metals in this study (except As) appeared to be affected by the metal, genus, species, and location as much as by levels in either water or sediment. In general, sponges and tunicates seemed to accumulate higher levels than most other species, possibly a function of high filtration rates. The ICP-MS method is useful for environmental studies, but the instrument requires considerable maintenance.

The correlation between neovascularization and bone formation in the condyle during forward mandibular positioning.

The aim of the present study was to investigate the temporal pattern of expression of VEGF (Vascular Endothelial Growth Factor) and new bone formation in the condyle during forward mandibular positioning. The importance of vascularization during endochondral ossification was investigated during natural growth of the condyle and compared to that after forward mandibular positioning. The goal was to further our understanding of the cellular responses during functional appliance therapy with a view to extending the experiment into maturity. One hundred and fifty 35 days old Sprague-Dawley rats, 100 fitted with a bite-jumping appliance and 50 untreated, were divided into 10 groups. One group was sacrificed on each of experimental days 3, 7, 14, 21, 30, 33, 37, 44, 51 and 60 respectively. Sagittal sections were cut and stained with VEGF antibodies and Periodic acid and Schiff's reagent (PAS). Each section was quantitatively analyzed with a computer assisted analyzing program and the temporal sequence of expression of VEGF and new bone formation during natural growth and after mandibular forward positioning was compared. There was significant increase in both vascularization and mandibular bone growth upon forward mandibular positioning and the highest amount of both were expressed in the posterior region of the condyle. The highest acceleration of vascularization preceded that of new bone formation. Thus, forward mandibular positioning was found to solicit a sequence of cellular events leading to increased vascularization and subsequently new bone formation resulting in enhanced condylar growth.

Alcohol and poor compliance as factors in Wernicke's encephalopathy diagnosed 13 years after gastric bypass.

A severely obese man achieved rapid and significant weight loss after Roux-en-Y gastric bypass. Thirteen years later Wernicke's encephalopathy developed as a result of the patient's alcoholism, poor compliance with his micronutrient intake, poor oral intake and the decreased absorptive ability of the small bowel. In selecting any operation to treat morbid obesity the possibility of metabolic problems must be considered as well as the potential for substantial weight loss.

Selenium and zinc levels in surgical patients receiving total parenteral nutrition.

The zinc and selenium levels of 40 surgical patients were monitored pre- and post-TPN. The initial selenium level was low normal, and the initial zinc level was also low. Both selenium and zinc are potent antioxidants involved in cellular defense against free radicals. Surgical patients are at risk for selenium and zinc deficiencies secondary to both increased needs and losses. TPN blood work protocols should include monitoring of selenium and zinc with supplementation of the nutrient solutions, as required.

Determination of silicon in serum and tissue by electrothermal atomic absorption spectrometry.

OBJECTIVES: To employ an electrothermal atomic absorption spectrometry (ETAAS) method with chemical modifiers for the determination of silicon (Si) in serum and tissues. METHODS: Si was measured in serum of chronic hemodialysis patients, and in fibrous breast capsule tissues following silicone-gel implant removal. Tissue was dried, and digested with concentrated nitric acid prior to analysis. A chemical modifier, which included lanthanum oxide and ammonium phosphate, was used to dilute the serum, and digested tissue samples (1:4) before atomization. Si was determined at 251.6 nm in a graphite fumace using an atomic absorption spectrophotometer. RESULTS: The method was linear (to 1000 micrograms/L), and precise (CV 5.9% at 281 micrograms/L and 8.4% at 73 micrograms/L). Recovery of Si in spiked serum and breast tissue samples was between 97-104%. Reference values for women on a normal diet and no exposure to silicone implants gave serum Si to 30 to 209 micrograms/L (n = 60), and breast tissue levels of 0.25 to 2.4 micrograms/g dry wt (n = 48). Si in breast capsule from women exposed to silicone breast implants varied from 29 to 496 micrograms/g dry wt (n = 10). Serum Si in hemodialysis patients (n = 53) ranged from 900 to 3300 micrograms/L. CONCLUSIONS: We conclude that our chemically modified ETAAS method is suitable for Si determination in normal and elevated human serum and tissue specimens.

Can elevated chromium induce somatopsychic responses?

The possible somatopsychological effects of chromium (Cr) was investigated in a population of patients, from a surgical ward of our hospital, who required total parenteral nutrition (TPN) solutions, and who became exposed to various amounts of this metal from this treatment. The study involved a questionnaire as well as biochemical tests which included serum Cr and other selected trace metals. The renal status for all eligible patients was within normal parameters. The patient population varied in age, pathology, surgical treatment, and duration on TPN. The results showed that every patient who received TPN had an increased serum Cr level; some increases were up to 50-fold above the normal reference level for serum Cr. Although statistical analysis failed to show any significant statistical relationship between an increased serum Cr and the investigated somatopsychological disturbances, this effect cannot be ruled out since one case did show all the dream disturbances. Considering these cases, the action of sedative medications that may suppress the effects of Cr, cannot be ruled out. As Cr(III) may be potentially genotoxic at high concentrations, infusion of this metal over long time periods should be avoided. Supplementation of Cr in TPN solutions appears to be unnecessary for short-term TPN because this metal is a known contaminant of these solutions. Efforts are required to find TPN nutrients with low or no Cr contamination.

Elevated serum chromium in patients on total parenteral nutrition and the ionic species of contaminant chromium.

Chromium (Cr), an essential micronutrient required for glucose metabolism, was found in high concentrations in up to 94% of the patients on short-term total parenteral nutrition. Approximately 50% had serum levels > 10-fold of normal (upper reference value of 3.8 nmol/L), about 18% were > 20-fold, and about 2% were 40-fold higher. The major Cr contaminant was detected in the amino acid constituents, and was found to have the trivalent ionic form. Although trivalent Cr is reported to be less genotoxic, further study is required to determine the effects on cells exposed to high concentrations of this element during parenteral nutrition over an extended period of time.

Trace elements in parenteral micronutrition.

OBJECTIVE: To update some essential trace metals required in total parenteral nutrition. CONCLUSION: Essential trace metals, chromium, copper, manganese, molybdenum, selenium, and zinc are added to parenteral fluids to prevent the development of deficiency syndromes. When possible, these metals should be monitored, even in patients on short-term total parenteral nutrition (TPN) to avoid deficiency or toxicity. Many of the nutrients or additives used in parenteral solutions may be contaminated with metals, such as aluminum or chromium. Such trace-metal monitoring becomes more critical in infants, and those on long-term TPN.

Abnormal trace elements in a patient on total parenteral nutrition with normal renal function.

OBJECTIVE: To describe trace metal changes in a 74-year-old male patient with mesenteric fibrosis and a small bowel fistula who was maintained on total parenteral nutrition in the hospital and at home. METHODS: Trace elements which included chromium and selenium were monitored over a 14-month period as part of his nutrient follow-up. RESULTS: Serum chromium reached levels > 21-fold the upper reference range, and serum selenium, in contrast, was < 0.5 the lower reference range. Plasma aluminum was also measured, and found to be nearly twice the upper reference range, although the patient had normal renal function. We measured the aluminum content of the parenteral nutrients and additives, and found that replacement of calcium gluconate by calcium chloride helped to reduce the aluminum content in the final parenteral solution by 34%. Aluminum and chromium contaminants found in parenteral solutions need to be reduced or removed to avoid toxic accumulation. CONCLUSION: This study illustrates the importance of adequately adjusting essential trace elements, and monitoring contaminants in parenteral fluids in an individual on total parenteral nutrition.

Aluminum determined in plasma and urine by atomic absorption spectroscopy with a transversely heated graphite atomizer furnace.

We compared a stabilized-temperature L'vov platform furnace containing an end-heated graphite atomizer (HGA) and transverse Zeeman background-correction system with a side-heated furnace system (transversely heated graphite atomizer; THGA) containing a longitudinal Zeeman background-correction system for the determination of aluminum in plasma and urine. The regression statistics for the correlation analysis of the two systems (slope coefficient = 0.995, intercept = -1.710, Sy/x = 0.021 micrograms/L) indicate that the systems generate comparable results. The newer technology of the THGA furnace with its more uniform and faster heating cycle allows a lower atomization temperature for aluminum, 2200 degrees C. Analyte carryover was significantly reduced in the THGA furnace system. The THGA system generates results equivalent to HGA in about one-third less time, thus making possible a greater throughput of samples in a busy laboratory.

Reference intervals for blood lead and evaluation of zinc protoporphyrin as a screening test for lead toxicity.

We evaluated, retrospectively, 2921 blood samples for the distribution of blood lead values in children below age 16, and in adult female and male subjects. An upper reference value for children and females at 0.48 mumol/L, and for males at 0.72 mumol/L is used. Over 70% of the adult males and > 80% of the children and adult females were within these reference limits, and considered to be at low risk for lead toxicity. The diagnostic utility of zinc protoporphyrin (ZPP) to screen for a positive blood lead result was evaluated using receiver operating characteristic (ROC) curves and likelihood ratios (LR). These studies confirmed that ZPP was insensitive for the detection of elevated blood lead at the critical thresholds of 0.48-1.21 mumol/L in children and adult females with subclinical lead poisoning. ZPP was more diagnostically useful for screening the higher lead-exposed adult male occupational worker.

Diagnostic evaluation of creatine kinase-2 mass and creatine kinase-3 and -2 isoform ratios in early diagnosis of acute myocardial infarction.

The diagnostic efficacy of creatine kinase (CK) isoforms (CK-3 and CK-2) was compared with measurement of CK-2 mass concentrations for the early diagnosis of myocardial infarction (MI). Serial serum samples drawn from 76 patients with confirmed MI and 55 non-MI patients were used for determining CK-2 mass concentrations and the MM3/MM1 (CK-3 isoforms) and MB2/MB1 (CK-2 isoforms) ratios. We compared the diagnostic utility of each by receiver-operating-characteristic (ROC) curve and likelihood ratio analyses. Our results indicate that all three tests were ineffective within the first 4 h after the onset of chest pain. All three were most effective at 4-18 h after onset, but both CK-3 and CK-2 isoform ratios were less effective than CK-2 mass concentrations in the next 6-h period (18-24 h). In the critical time between 3 and 6 h, the diagnostic performance of all three was comparable.

Relationships among borderline features, body dissatisfaction and bulimic symptoms in nonclinical females.

The present study evaluated the utility of combining measures of body dissatisfaction and borderline personality features in screening high-school girls who may be at risk for bulimia nervosa. Two samples (777 high-school girls and 22 bulimic women in-treatment) completed scales assessing borderline traits, body dissatisfaction, eating symptoms, and associated psychiatric disturbances. Students were divided into four groups, respectively showing: (a) high body dissatisfaction and borderline traits, (b) high body dissatisfaction alone, (c) high borderline traits alone, or (d) neither vulnerability component. Clinical and nonclinical groups were then compared for severity of eating and psychiatric symptoms. Girls displaying the combination of high body dissatisfaction and borderline traits (our presumed "high-risk" group) showed an elevated profile of eating and associated disturbances, highly comparable to the bulimic group. They were also more likely to receive threshold and subthreshold diagnoses of bulimia nervosa (according to simulated diagnoses based on self-report items) than subjects in other high-school groups. Implications of these findings were discussed with reference to the "two-component" model of eating disorders.

Comparison of the diagnostic utility of timed serial (slope) creatine kinase measurements with conventional serum tests in the early diagnosis of myocardial infarction.

We compared the diagnostic utility of recently proposed slope assays for serum creatine kinase and creatine kinase-2 with the optimized decision threshold assays. The former approach has been claimed to be superior to any other single diagnostic technique. We show, by ROC curve and likelihood ratio analyses, that the total creatine kinase slope assay possesses the same diagnostic power, when confidence intervals are used, as the optimized decision threshold assay. Moreover, slope assays of creatine kinase-2 were diagnostically inferior to the optimized decision threshold assays. Indeed, these latter, optimized, assays have the highest likelihood ratios for a positive test result of the available assays, and they should always be used in situations of diagnostic doubt.