Impact of systemic cancer treatment on quality of life and mental well-being: a comparative analysis of patients with localized and advanced cancer.

INTRODUCTION: This study investigated the impact of systemic cancer therapy on the quality of life, mental well-being, and life satisfaction of cancer patients. METHODS: This prospective study was promoted by the Spanish Society of Medical Oncology (SEOM) and enrolled patients with localized, resected, or unresectable advanced cancer from 15 Spanish medical oncology departments. Patients completed surveys on quality of life (EORTC-QoL-QLQ-C30), psychological distress (BSI-18) and life satisfaction (SWLS) before and after systemic cancer treatment. RESULTS: The study involved 1807 patients, 944 (52%) having resected, localized cancer, and 863 with unresectable advanced cancer. The mean age was 60 years, and 53% were female. The most common types of localized cancer were colorectal (43%) and breast (38%), while bronchopulmonary (32%), non-colorectal digestive (23%), and colorectal (15%) were the most frequent among those with advanced cancer. Before systemic treatment, patients with advanced cancer had poorer scores than those with localized cancer on physical, role, emotional, cognitive, social limitations, symptoms, psychological distress, and life satisfaction (all p < 0.001), but there were no differences in financial hardship. Patients with localized cancer had greater life satisfaction and better mental well-being than those with advanced cancer before systemic treatment (p < 0.001). After treatment, patients with localized cancer experienced worsening of all scales, symptoms, and mental well-being (p < 0.001), while patients with advanced disease had a minor decline in quality of life. The impact on quality of life was greater on all dimensions except economic hardship and was independent of age, cancer location, and performance status in participants with resected disease after adjuvant chemotherapy. CONCLUSION: In conclusion, our study highlights that systemic cancer treatment can improve quality of life in patients with advanced cancer, while adjuvant treatments for localized disease may have a negative impact on quality of life and psychological well-being. Therefore, treatment decisions should be carefully evaluated on an individual basis.

Surface ablation outcomes in high myopia with different epithelium removal techniques.

PURPOSE: To study the outcomes of alcohol-assisted photorefractive keratectomy (PRK) when compared with transepithelial PRK (TransPRK) using 2 software programs, with or without SmartPulse Technology (SmartSurfACE), in high myopia. SETTING: Vissum Miranza, University Miguel Hernandez, Alicante, Spain. DESIGN: Retrospective, consecutive, case series. METHODS: High myopic eyes undergoing surface ablation were included. The main inclusion criteria were preoperative spherical equivalent (SE) above -5.50 diopters (D) and no other ocular surgeries. Mitomycin-C was used in all the surgeries. The outcomes were analyzed using the 6-month follow-up visit data. RESULTS: 135 eyes were included. Alcohol-assisted PRK was performed in 65 eyes, transepithelial PRK (TransPRK1) in 32 eyes, and TransPRK2 in 38 eyes. The mean all groups preoperative sphere, cylinder, and SE were -6.00 ± 0.87 D, -1.13 ± 1.03 D, and -6.57 ± 0.69 D, respectively. The mean efficacy index in the alcohol-assisted PRK group was 0.91 ± 0.18 compared with 0.98 ± 0.1 and 0.98 ± 0.12 in the TransPRK1 and TransPRK2, respectively (P = .027). The mean safety index in alcohol-assisted PRK was 0.99 ± 0.05, whereas it was 1 ± 0.06 in the TransPRK1 and 0.99 ± 0.08 in the TransPRK2 (P = .780). A final SE of ± 0.50 D was achieved in 96.9% of eyes in the TransPRK1 group and in 100% eyes in the TransPRK2 group compared with 73.8% in the alcohol-assisted PRK group (P < .001). CONCLUSIONS: Surface ablation with the Amaris 500 excimer laser with flying spot pattern and mitomycin C use showed adequate refractive outcomes in high myopia correction in the 3 groups. TransPRK with or without SmartPulse Technology achieved statistically significant better outcomes than alcohol-assisted PRK in refractive predictability and efficacy.

Nevoid hyperkeratosis of the nipple and the areola.

A 25-year-old woman presented to our dermatology unit with progressive diffuse thickening of the both areolas. A skin biopsy was taken from the right areola showing irregular filiform acanthosis with elongation and anastomosis of rete ridges, irregular orthokeratotic hyperkeratosis, pseudocyst formation, and hyperpigmentation of the basal layer. The cause of nevoid hyperkeratosis of the nipple and areola is unknown. Eighty percent of cases occur in women and are often manifested during puberty or pregnancy. The disease may also occur in men receiving hormonal therapy. There is no uniformly effective treatment. Dermatologists, gynecologists, and general practitioners have an important part to play in recognizing this condition that may be underdiagnosed because of lack of awareness.

Effects of sound location on visual task performance and electrophysiological measures of distraction.

Novel sounds embedded in a repetitive stream of auditory stimuli impair performance of the visual task at hand. Parmentier et al. suggested that this distraction effect might be because of the shifting cost of moving attention from the task-irrelevant (auditory) to the task-relevant (visual) channel, or from their shifting of spatial locations. Here, the source location of the sounds in an audio-visual distraction paradigm was varied systematically (headphones and 0, -18, -72, 18, and 72 degrees), and the results revealed significant distracting effects of novel sounds occurring in the headphone and the right location conditions. This supports the assumption that in the behavioral cost observed in the audio-visual distraction paradigm a spatial shift of attention is involved.

Reduced novelty-P3 associated with increased behavioral distractibility in schizophrenia.

Behavioral and electrophysiological brain responses were used to examine the relationship between the vulnerability to distraction and the orienting response in schizophrenia. Nineteen schizophrenics and nineteen matched healthy controls were instructed to ignore task-irrelevant auditory stimuli while they classified capital letters and digits. The auditory sequences contained repetitive standard tones occasionally replaced by complex novel sounds. Relative to controls, patients showed an increased behavioral distraction, as indicated by a larger response time increase caused by novel sounds, and a disturbance in the attention orienting toward distracting stimuli, as indicated by a reduced novelty-P3. This behavioral-electrophysiological dissociation may stem from a limited pool of available resources. Thus, the few attentional resources directed toward novel stimuli would be sufficient to cause an important decrease of the similarly reduced amount of resources assigned to task-relevant stimuli, resulting in a striking impairment of the ongoing task performance.

Corneal aberrations and objective visual quality after hyperopic laser in situ keratomileusis using the Esiris excimer laser.

PURPOSE: To evaluate the changes in visual performance and ocular optical quality after hyperopic laser in situ keratomileusis (LASIK) using the Esiris excimer laser (Schwind eye-tech-solutions). SETTING: Vissum-Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: Excimer laser surgery was performed with the Esiris laser in 51 eyes of 29 patients with hyperopia or hyperopic astigmatism. The follow-up was 6 months. Changes in visual acuity, refraction, and corneal and ocular wavefront aberrations (6.0 mm pupil) were recorded and analyzed. RESULTS: The mean preoperative sphere was +4.45 diopters (D)+/-1.08 (SD) (range +2.50 to +7.25 D) and the mean preoperative cylinder, -0.55+/-0.36 D (range 0.00 to 1.00 D). Ten eyes (19.61%) had a LASIK enhancement during the follow-up for the correction of the residual refractive error and were excluded from the refractive analysis. Of the 41 remaining eyes, 95.12% had the same or improved distance best spectacle-corrected visual acuity (BSCVA) 6 months after surgery; 90.25% had no change or a gain of lines of near BSCVA. Moreover, 80.50% of eyes were within +/-0.50 D of emmetropia. Regarding corneal aberrations, statistically significant changes were observed in higher-order aberrations (HOAs), coma-like aberrations, and the primary spherical aberration coefficient Z(4,0), which changed from positive to negative values (all P<.01). Regarding total ocular aberrations, statistically significant changes were observed in total and higher-order root-mean-square values (P<.01). CONCLUSIONS: Hyperopic LASIK using the Esiris excimer laser for the correction of 2nd-order aberrations was safe and effective. Ocular and corneal HOAs increased significantly postoperatively.

When loading working memory reduces distraction: behavioral and electrophysiological evidence from an auditory-visual distraction paradigm.

The sensitivity of involuntary attention to top-down modulation was tested using an auditory-visual distraction task and a working memory (WM) load manipulation in subjects performing a simple visual classification task while ignoring contingent auditory stimulation. The sounds were repetitive standard tones (80%) and environmental novel sounds (20%). Distraction caused by the novel sounds was compared across a 1-back WM condition and a no-memory control condition, both involving the comparison of two digits. Event-related brain potentials (ERPs) to the sounds were recorded, and the N1/MMN (mismatch negativity), novelty-P3, and RON components were identified in the novel minus standard difference waveforms. Distraction was reduced in the WM condition, both behaviorally and as indexed by an attenuation of the late phase of the novelty-P3. The transient/change detection mechanism indexed by MMN was not affected by the WM manipulation. Sustained slow frontal and parietal waveforms related to WM processes were found on the standard ERPs. The present results indicate that distraction caused by irrelevant novel sounds is reduced when a WM component is involved in the task, and that this modulation by WM load takes place at a late state of the orienting response, all in all confirming that involuntary attention is under the control of top-down mechanisms. Moreover, as these results contradict predictions of the load theory of selective attention and cognitive control, it is suggested that the WM load effects on distraction depend on the nature of the distractor-target relationships.

Individual differences in sequence learning and auditory pattern sensitivity as revealed with evoked potentials.

Research on motor sequence acquisition has shown significant differences between learners. Learners who develop explicit knowledge respond faster than non-explicit ones and they show larger amplitude in event-related brain potentials to sequence deviants. There is evidence that memory span correlates with the amount of sequence learned, but the specific mechanisms subserving such differences are still unknown. Recently, it has been observed that performance of explicit learners, but not of non-explicit ones, improves when presented with auditory action effects. Accordingly, differences between learners might be related to differences in auditory rhythm perception. To test this hypothesis, the mismatch negativity (MMN)-evoked potential elicited to stimuli violating stimulus alternation (i.e. low pitch, high pitch) was recorded in explicit and non-explicit sequence learners. Results confirmed our prediction: explicit learners showed larger amplitude of the MMN to the violation of the auditory rhythm, suggesting new theoretical implications to account for individual differences in sequential action control.

Abnormal speech sound representation in persistent developmental stuttering.

OBJECTIVES: To determine whether adults with persistent developmental stuttering (PDS) have auditory perceptual deficits. METHODS: The authors compared the mismatch negativity (MMN) event-related brain potential elicited to simple tone (frequency and duration) and phonetic contrasts in a sample of PDS subjects with that recorded in a sample of paired fluent control subjects. RESULTS: Subjects with developmental stuttering had normal MMN to simple tone contrasts but a significant supratemporal left-lateralized enhancement of this electrophysiologic response to phonetic contrasts. In addition, the enhanced MMN correlated positively with speech disfluency as self-rated by the subjects. CONCLUSIONS: Individuals with persistent developmental stuttering have abnormal permanent traces for speech sounds, and their abnormal speech sound representation may underlie their speech disorder. The link between abnormal speech neural traces of the auditory cortex and speech disfluency supports the relevance of speech perception mechanisms to speech production.

Auditory event-related potentials as a function of abstract change magnitude.

Event-related potentials were recorded in healthy volunteers to test the accuracy of the human brain to extract, preattentively, auditory abstract rules. The abstract rule was determined by the frequency relationship between two pure tones forming a pair. The standard pairs had identical tone frequency, whereas the deviant pairs had the second tone two, four, six or eight musical steps higher or lower in frequency than the first one. All abstract changes elicited mismatch negativity, which was not affected by the magnitude of change. However, the subsequent P3a increased as a function of the magnitude of the abstract change. These results suggest that mismatch negativity detects violations of abstract rules, and the amount of violation is analyzed in subsequent stages of auditory processing.

Attention capture by auditory significant stimuli: semantic analysis follows attention switching.

Event-related potentials (ERPs) were recorded from the scalp to investigate a long-standing controversy in auditory attention research, namely when the 'breakthrough of the unattended' takes place in the human brain. Nine subjects classified visual stimuli appearing 300 ms after task-irrelevant standard tones (80%, i.e. P = 0.8) or novel sounds (20%, i.e. P = 0.2) into odd/even categories. After the recording session, subjects scored the novel sounds as to whether they had any particular meaning (identifiable) or were perceived as a burst of noise (non-identifiable), and performance and ERPs were analysed according to this classification. A control condition, in which the visual stimuli were presented with no sounds, showed that subjects covertly monitored the task-irrelevant sounds during visual task-performance, and a further condition, in which the auditory and visual stimuli appeared regardless of each other, made it possible to trace the processing of the distracters during allocation of attention outside the auditory environment. Results yielded identical N1-enhancement for the two types of novel sounds, indicating similar attention switching triggered to these two types of unexpected sounds. However, there was a stronger orientating of attention towards identifiable novel sounds, as indicated both by behavioural distraction and by larger novelty-P3. Furthermore, this stronger orientating of attention was due to the sounds being contingent on the visual stimuli, as no increase in novelty-P3 to identifiable novel sounds was observed in the control condition, in which the sounds occurred outside the attentional set. Therefore, provided that the N1-enhancement reflects a call for focal attention, and novelty-P3 the effective orientating of attention towards the eliciting sounds, the present results suggest that semantic analysis of significant sounds occurs after a transitory switch of attention towards the eliciting stimuli. Moreover, as the novelty-P3 increase in amplitude was observed only when subjects covertly monitored the sounds, the present data suggest that semantic analysis of irrelevant sounds depends on the top-down cognitive influences of the attentional set.

An electrophysiological and behavioral investigation of involuntary attention towards auditory frequency, duration and intensity changes.

We measured behavior and event-related brain potentials (ERPs) in 12 subjects performing on an audio-visual distraction paradigm to investigate the cerebral mechanisms of involuntary attention towards stimulus changes in the acoustic environment. Subjects classified odd/even numbers presented on a computer screen 300 ms after the occurrence of a task-irrelevant auditory stimulus, by pressing the corresponding response button. Auditory stimuli were standard tones (600 Hz, 200 ms, 85 dB; P=0.8) or deviant tones (P=0.2), these differing from the standard either in frequency (700 Hz), duration (50 ms) or intensity (79 dB), in separate blocks. In comparison to performance to visual stimuli following the standard tones, reaction time increased by 24 ms (F(1,11)=10.91, P<0.01) and hit rate decreased by 4.6% (F(1,11)=35.47, P<0.001) to visual stimuli following the deviant tones, indicating behavioral distraction. ERPs revealed the mismatch negativity (MMN) elicited to deviant tones, which was larger for the duration deviant than for the frequency and intensity deviants (F(2,22)=19.43, P<0.001, epsilon =0.83), and which had different scalp distribution for all three deviant conditions (F(16,176)=2.40, P<0.05, epsilon =0.12). As the shorter duration and softer intensity deviant tones were unlikely to engage fresh neurons responding to their specific physical features, the present results indicate that a genuine change detection mechanism is involved in triggering attention switching towards sound changes, and suggest a largely distributed neural network of the auditory cortex underlying such involuntary attention switching.