Posttraumatic growth and demoralization after cancer: The effects of patients' meaning-making.

OBJECTIVE: It is common for patients to experience positive and negative psychological changes (e.g., posttraumatic growth or demoralization) after being diagnosed with cancer. Although demoralization and posttraumatic growth are both related to meaning-making, little attention has been paid to the associations among these concepts. The current study investigated the relationship between demoralization, posttraumatic growth, and meaning-making (focusing on sense-making and benefit-finding during the experience of illness) in cancer patients. METHOD: Some 200 cancer patients (with lung cancer, lymphoma, or leukemia) at the MacKay Memorial Hospital in New Taipei completed the Demoralization Scale-Mandarin Version (DS-MV), the Chinese Posttraumatic Growth Inventory (CPTGI), and a self-designed questionnaire for assessing sense-making and benefit-finding. RESULTS: Demoralization was negatively correlated with posttraumatic growth, sense-making, benefit-finding, and time-since-diagnosis. Multiple regression analysis showed that meaning-making had different effects on demoralization and posttraumatic growth. The interactions of sense-making with either benefit-finding or time-since-diagnosis significantly predicted demoralization. Individuals with relatively higher sense-making and benefit-finding or shorter time-since-diagnosis experienced less demoralization. SIGNIFICANCE OF RESULTS: The suffering of cancer may turn on the psychological process of demoralization, posttraumatic growth, and meaning-making in patients. Cancer patients who evidenced higher posttraumatic growth experienced less demoralization. Trying to identify positive changes in the experience of cancer may be a powerful way to increase posttraumatic growth. As time goes by, patients experienced less demoralization. Facilitating sense-making can have similar effects. Cancer patients with less benefit-finding experience higher demoralization, but sense-making buffers this effect.

A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer.

PURPOSE: This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention. METHODS: Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3. RESULTS: Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77-0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively. CONCLUSIONS: Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.

Arthroscopic treatment of osteoid osteoma in the posterior proximal tibia: A case report and literature review.

BACKGROUND: Osteoid osteoma (OO) is a benign lesion characterized by an increased fibrous component in the bone marrow, presence of bone-like structures within the medullary cavity, and a surrounding sclerotic bone rim. Reports on OO located in the posterior proximal tibia are rare. CASE SUMMARY: Herein, we report the case of an 18-year-old male, admitted for the evaluation of right knee pain. The right knee pain had started 6 months prior without any apparent cause, which was notably severe at night, affecting sleep, and was exacerbated while climbing stairs or bearing weight. The patient also experienced pain on flexion. Three-dimensional computed tomography and magnetic resonance imaging revealed a nodular lesion beneath the cortical bone of the posterior medial plateau of the right tibia and an abnormal signal focus on the posterior lateral aspect of the right tibial plateau associated with extensive bone marrow edema. A small amount of fluid was present in the right knee joint capsule. The patient subsequently underwent arthroscopic excision of the OO. Postoperatively, there was significant relief of pain, and the knee range of motion returned to normal. CONCLUSION: Although OO in the posterior proximal tibia is a rare occurrence, it can be effectively excised through minimally invasive arthroscopic visualization.

Demoralization syndrome among cancer outpatients in Taiwan.

GOALS: This paper aims to explore characteristics of demoralization syndrome as well as the relationship between demoralization syndrome and psychosocial issues as seen through examinations of cancer outpatients in Taiwan. MATERIALS AND METHODS: Outpatients with different cancer types were enrolled in this study. The Demoralization Scale Mandarin Version (DS-MV), Patient Health Questionnaire, Beck Hopelessness Scale, and McGill Quality of Life Questionnaire-Taiwan Version were used as instruments. All data were analyzed using SPSS 18.0. RESULTS: Among the 234 patients studied (97 men and 223 women), the majority had cervical cancer (29.1%), followed by breast cancer (26.5%) and head and neck cancer (24.3%). The mean score of DS-MV was 31.05 (SD 14.87). The results of ANOVA analysis showed a significant effect of occupation F(4.209) = 7.145 (p < 0.001), cancer diagnosis F(7.206) = 3.795 (p < 0.001), and treatment F(8.206) = 3.553 (p < 0.001) on DS-MV. CONCLUSIONS: Demoralization syndrome was found to be related to psychosocial issues, different cancer types, and treatments. Further studies are recommended to better understand causes and impacts of demoralization in the quality of life and care of cancer patients.

A novel infusible botanically-derived drug, PG2, for cancer-related fatigue: a phase II double-blind, randomized placebo-controlled study.

PURPOSE: This study investigated the efficacy of the botanical-derived drug, PG2, a partially purified extract of Astragalus membranaceus, as a complementary and palliative medicine for managing cancer-related fatigue (CRF). METHODS: Patients with advanced cancer and moderate to severe CRF were randomized to receive either PG2 or a placebo (normal saline, NS) in the first treatment cycle (four weeks) in a double-blind manner; thereafter, on the next cycle (four weeks), all patients received open-label treatment with PG2. RESULTS: PG2 significantly improved CRF in the NS-primed group. In the first four week cycle, PG2 administration resulted in a greater fatigue-improvement response rate than seen with NS alone. In addition, approximately 82% of patients who reported an improvement of fatigue symptoms following the first cycle of PG2 experienced sustained benefits after administration of the second treatment cycle. Among patients treated with PG2 who did not report an improvement in symptoms throughout the first treatment cycle, approximately 71% showed significant improvement after the second treatment cycle. No major or irreversible toxicities were observed with PG2 treatment. CONCLUSION: PG2 might be an effective and safe treatment for relieving CRF among advanced cancer patients.

The association between skull bone fractures and outcomes in patients with severe traumatic brain injury.

BACKGROUND: In traumatic brain injury (TBI), computed tomography (CT) provides a good assessment of anatomic pathologic findings and the prognostic value of CT characteristics has been well discussed. However, few studies have focused on skull bone fracture and its clinical prognostic importance. Hence, this study aims to evaluate the effects of skull bone fracture on patients with severe TBI admitted to the emergency unit. METHODS: We reviewed the medical records of patients with isolated severe TBI admitted to the emergency unit of a university hospital from July 2003 to June 2008. Patients were divided into two groups based on the presence of skull bone fracture identified by the CT scan while in the emergency unit. Mann-Whitney U test and a Student's t test were used to identify the differences between the two groups, whereas logistic regression was applied to determine any significant differences found in the statistical analysis. RESULTS: A total of 197 patients were signed up in our study. Based on the presence of skull bone fracture on CT scan at emergency department, 92 patients (46.7%) comprised the skull bone fracture group and 59 patients (64.1%) of these died. One hundred five patients (53.3%) comprised the nonskull bone fracture group, of which 33 patients (31.4%) died. There is significant difference between the two groups (p = 0.004). CONCLUSION: This study shows that skull bone fracture is a mortality risk factor for patients with isolated severe blunt TBI.

Indoor air distribution of nitrogen dioxide and ozone in urban hospitals.

Indoor air pollution has recently become a public concern in Taiwan. People recognize that indoor air quality (IAQ) may be more important than outdoor air quality because they spend over 80% of their time indoors. IAQ could affect health and comfort of building occupants. The objectives of this study are (1) to characterize the indoor concentrations of selected air pollutants at two hospitals in Hsinchu, Taiwan, (2) to evaluate the potential indoor sources of pollutants in these selected hospitals and their indoor/outdoor relationships, and (3) to compare pollutant concentrations with values published in other studies. A significant between-hospital difference in average indoor concentration of nitrogen dioxide and 54.14, 32.69 ppb for Hospital A and B, respectively (p < 0.05). Indoor nitrogen dioxide concentration was significantly positively correlated with outdoor nitrogen dioxide concentration, PM(10) concentration, and traffic flow (r = 0.91, 0.65 and 0.72, respectively). The ozone level was also lower in our hospitals than 30 ppb standard.

[Correlation Analysis of Water Quality Between Lake Inflow and Outflow: A Case Study of Poyang Lake].

The relationships between inflow and outflow water quality data for Poyang Lake from 1996 to 2016 are discussed and the main influencing factors are identified. TN and TP were the main factors causing a decline in water quality in Poyang Lake during the study period. The water quality of both the inflow and outflow rivers was generally good between 1996 and 2003; however, water quality declined over the study period, which is attributed to an increase in nutrients loads in the watershed. From 2004 to 2011, the water quality of the "Five Rivers" decreased significantly, which caused the water quality of Poyang Lake to decline. Due to the high purification capacity of Poyang Lake, the water quality of the outflow during this period was relatively good. A decline in water quality after this point was affected by pollution loads and hydrological conditions. Specifically, from 2012 to 2016, water quality in Poyang Lake and of the inflow water declined further. This was combined with a decrease in the water-purification capacity of the lake due to changes in the hydrological conditions, resulting in lower water quality at the outflow. Overall, the water quality of the inflow river has been closely related to the water quality in Poyang Lake. The concentrations of TN were significantly higher in the southern and eastern areas of Poyang Lake compared to the western areas. Higher nutrient loading from the Ganjiang River and the Xinjiang River has been an important driver. The concentrations of TP in the southern area of the lake have been significantly higher than in the eastern and western areas. This is attributed to comparatively high TP loads in the Ganjiang River and the Fuhe River. Compared to the changes in hydrological conditions, variations in nutrient loading have had a greater effect on water quality in the lake.

MDM2 SNP 309 and p53 codon 72 polymorphisms are associated with the outcome of oral carcinoma patients receiving postoperative irradiation.

BACKGROUND AND PURPOSE: The p53 tumor suppression pathway is important in effects associated with radiotherapy. The mouse double minute 2 (MDM2) plays a pivotal role in this pathway by down regulating p53. A functional T-to-G polymorphism at nucleotide 309 in MDM2 promoter intron 1 (SNP309) has been identified which influenced transcription activity. A G-to-C SNP at p53 codon 72 results in an Arg/Pro polymorphism, which is associated with apoptosis induction potential and p53 mutation status. MATERIALS AND METHODS: We sequenced both MDM2 SNP309 and p53 codon 72 SNP in patients with oral squamous cell carcinoma (OSCC, n=189), oral submucosal fibrosis (OSF, n=70), and 116 controls. RESULTS: Neither MDM2 SNP309 nor p53 codon 72 SNP was associated with susceptibility to or the age at onset of OSCC or OSF. p53 codon 72 SNP Arg/Arg polymorphism was associated with the progression of OSCC, and the overall (OS) and disease-free survival (DFS) of irradiated patients. The MDM2 SNP309 G/G polymorphism was associated with poor OS in advanced OSCC, and the OS and DSF of irradiated patients. The combination of MDM2 SNP309 G/G and p53 codon 72 Arg/Arg polymorphism is associated with the worst OS and DFS. CONCLUSIONS: Advanced OSCC has high mortality and recurrence. We identified that both MDM2 SNP309 and p53 codon 72 SNP could be useful factors for evaluating the outcome of advanced OSCC treated with adjuvant radiation.

Prevalence, detection and treatment of delirium in terminal cancer inpatients: a prospective survey.

BACKGROUND: Delirium is a common syndrome in terminal cancer patients. However, its detection and treatment by palliative care teams are not well documented. This survey aimed to determine the prevalence, detection and treatment of delirium in terminal cancer inpatients. METHODS: The survey was conducted in Mackay Hospice and Palliative Care Center, Taiwan, from August 2006 to January 2007. All terminal cancer inpatients were invited to participate. The Delirium Rating Scale-Chinese Version was used by a research assistant as the screening instrument. Patients detected by screening were reviewed by psychiatrists to verify the diagnosis and determine the sub-type of delirium. The palliative care team members were asked to evaluate all the participants weekly. The medications used for delirium were obtained by a medical chart review. Result Two hundred and twenty eight participants (49.9%) among 457 inpatients were screened. The prevalence of delirium was 46.9% (n = 107). Of these, the most common subtype was hypoactive (68.2%, 95% confidence interval (CI): 59.4-77.0%). The mortality rate of inpatients with delirium (77.6%, 95% CI: 69.7-85.5%) was higher (P < 0.0001) than those without delirium (50.9%, 95% CI: 44.4-57.4%). The overall detection rate by any member of the palliative team was 44.9% (n = 48) (95% CI: 35.5-54.3%). The detection rate of the hypoactive subtype was only 20.5% (95% CI: 11.2-29.8%), which was significantly lower than that of the hyperactive/mixed subtypes (P < 0.0001). Therapy for delirium was prescribed in 42.1% (n = 45) (95% CI: 32.7-51.5%) with haloperidol being the most common medication. CONCLUSION: The prevalence of delirium was high, but the rates of detection and treatment were low. Interventions are recommended to improve the diagnosis and treatment of delirium in palliative care units.

Determination of 1-hydroxypyrene in human urine by acid hydrolysis coupled to solid-phase microextraction and semi-microcolumn liquid chromatography.

This study developed an acid hydrolysis coupled to a solid-phase microextraction method employing a semi-microcolumn liquid chromatography system, instead of enzyme hydrolysis with solid-phase extraction for the pretreatment of human urine samples, to detect urinary 1-hydroxypyrene (1-OHP). The complete separation and detection of urinary 1-hydroxyprene was performed using a high-performance liquid-chromatography fluorescence detection system with an analytical C(18) semi-microcolumn, 60% (v/v) aqueous acetonitrile elution, and a lambda(ex/em) = 348/388 nm pair detection wavelength. Calibration graphs were linear with very good correlation coefficients (r = 0.9997), and the detection limit was 1.0 ng/L. These important parameters for acid hydrolysis and solid-phase microextraction were investigated. The total recovery was above 83% in acid hydrolysis with solid-phase microextraction. The proposed method provided a relatively simple, convenient, and practical procedure to determine the level of urinary 1-hydroxypyrene in biological samples, and was successfully applied to detect the urine of students.

Post-operative concurrent chemoradiation therapy using oral uracil-tegafur versus weekly intravenous fluorouracil for locally advanced rectal cancer.

BACKGROUND: This prospective, nonrandomized study was conducted to compare the efficacy and toxicity of post-operative concurrent chemoradiation therapy (CCRT) using daily oral uracil-tegafur plus leucovorin (UFUR/LV) vs. weekly intravenous fluorouracil plus leucovorin (5-FU/LV) in patients with locally advanced rectal cancer. MATERIALS AND METHODS: From November 1996 through December 2004, 30 patients with stage II or III rectal cancer were enrolled. Either 5-FU (400 to 450 mg/m2) plus LV (80 to 100 mg/m2) weekly or oral UFUR (250 to 300 mg/m2/d) plus oral LV (30 to 45 mg/m2/d) were given during radiotherapy. Radiation (50.4 to 60.4 Gy) was delivered to the tumor bed in 28-33 fractions. RESULTS: The mean survival, 2-year overall survival and disease-free survival were 36 months vs. 30 months, 68% vs. 66% and 55% vs. 50%, (p > 0.05), in the UFUR/LV and 5-FU/LV groups, respectively. There were no treatment-related deaths or grade 4 toxicity in either group. Grade 3 dermatitis, gastrointestinal and hematologic toxicity were noted in the 5-FU/LV group. CONCLUSION: Because of a similar survival rate and lower toxicity, oral UFUR/LV is suggested as an alternative regimen to intravenous 5-FU/LV in post-operative CCRT of locally advanced rectal cancer.

Tunable tapered waveguide for efficient compression of light to graphene surface plasmons.

Dielectric-graphene-dielectric (DGD) structure has been widely used to construct optical devices at infrared region with features of small footprint and low-energy dissipation. The optical properties of graphene can be manipulated by changing its chemical potential by applying a biased voltage onto graphene. However, the excitation efficiency of surface wave on graphene by end-fire method is very low because of large wavevector mismatch between infrared light and surface wave. In this paper, a dielectric-semiconductor-dielectric (DSD) tapered waveguide with magnetic tunability for efficient excitation of surface waves on DGD at infrared region is proposed and analyzed. Efficient excitation of surface waves on DGD with various chemical potentials in graphene layer and incident frequencies can be attained by merely changing the external magnetic field applied onto the DSD tapered waveguide. The electromagnetic simulations verify the design of the proposed structure. More importantly, the constituent materials used in the proposed structure are available in nature. This work opens the door toward various applications in the field of using surface waves.

Magnetically controlled planar hyperbolic metamaterials for subwavelength resolution.

Breaking diffraction limitation is one of the most important issues and still remains to be solved for the demand of high-density optoelectronic components, especially for the photolithography industry. Since the scattered signals of fine feature (i.e. the size is smaller than half of the illuminating wavelength λ) are evanescent, these signals cannot be captured by using conventional glass- or plastic-based optical lens. Hence the corresponding fine feature is lost. In this work, we propose and analyze a magnetically controlled InSb-dielectric multi-layered structure with ability of subwavelength resolution at THz region. This layered structure can resolve subwavelength structures at different frequencies merely changing the magnitude of external magnetic field. Furthermore, the resolving power for a fixed incident frequency can be increased by only increasing the magnitude of applied external magnetic field. By using transfer matrix method and effective medium approach, the mechanism of achieving super resolution is elucidated. The electromagnetic numerical simulation results also prove the rationality and feasibility of the proposed design. Because the proposed device can be dynamically reconfigured by simply changing the magnitude of external magnetic field, it would provide a practical route for multi-functional material, real-time super-resolution imaging, and photolithography.

Guideline and preliminary clinical practice results for dose specification and target delineation for postoperative radiotherapy for oral cavity cancer.

BACKGROUND: Surgery followed by radiotherapy (RT) is indicated for patients with high-risk oral cavity cancer (OCC). Based on multi-institutional reports, we developed a guideline for postoperative RT for patients with OCC. METHODS: A multidisciplinary OCC team was recruited to develop a questionnaire concerning details of risk-factor categorization, target delineation, and dose specification. Thirty-one radiation oncologists from 18 institutions completed the questionnaire, and data were subjected to extensive review to establish the guideline by expert meeting. In this study, we also report the results for patients treated in accordance with the guideline at our institution between 2007 and 2011. RESULTS: Forty-one patients received RT compatible with this guideline with a median 26.8-month follow-up. Thirty-two patients (78%) remained disease-free, 6 (15%) developed locoregional recurrence (4 in-field, 1 marginal, and 1 out-field) and 4 (10%) developed distant metastasis. The overall 2-year survival rate was 86.7%. CONCLUSION: This guideline is promising and should be validated and refined in further clinical practice.

Determination of 1-hydroxypyrene in children urine using column-switching liquid chromatography and fluorescence detection.

This study developed an acid hydrolysis method instead of using enzyme extraction, equipped with column-switching system for the pretreatment of samples, in the determination of 1-hydroxypyrene in the urine from children and pyrene in airborne particulates. We collected both types of samples from areas near a petrochemical industry and rural areas as reference. Samples were first treated with acid hydrolysis and followed by solvent extraction prior to being injected into the separation system for the determination with high performance liquid chromatography and fluorescence. A column-switching system was on-line with a C18 separation column to remove matrix interference and obtain a stable baseline of the chromatogram. The eluent used to separate the 1-hydroxypyrene was 60% (v/v) aqueous acetonitrile solution. A fluorescence detector was used to monitor 1-hydroxypyrene at lambdaex = 348 nm and lambdaem = 388 nm, and pyrene at lambdaex = 331 nm and lambdaem = 390 nm. Both calibration graphs were linear with very good correlation coefficients (r > 0.999) and the detection limits were ca. 2pg (5ng/l). Results showed that there was a significant association between 1-hydroxypyrene levels in urine specimens and pyrene levels in airborne particulate samples (r = 0.68, P < 0.05). The average levels of pyrene in the particulates (0.18 versus 0.09ng/m3) and of 1-hydroxypyrene in urine specimens (155.9 versus 110.2ng/g creatinine) were higher for the petrochemical area than for the rural area. This method is stable and sensitive for measuring polycyclic aromatic hydrocarbons in environmental samples.

Determination of polycyclic aromatic hydrocarbons in water by solid-phase microextraction and liquid chromatography.

This study describes the determination of polycyclic aromatic hydrocarbons (PAHs) in water using high-performance liquid chromatography (HPLC) coupled with fluorescence detection (FLD). Because individual PAHs are generally present in water only at trace levels, a sensitive and accurate determination technique is essential. The separation and detection of five PAHs were run completely within 25 min by the HPLC/FLD system with an analytical C18 column, a fluorescence detection, and acetonitrile-water gradient elution. Calibration graphs were linear with very good correlation coefficients (r > 0.9998), and the detection limits were in the range of 2-6 ng/l for five PAHs. Solid phase microextraction (SPME) was performed for sample pretreatment prior to HPLC-FLD determination, and the governing parameters were investigated. Compared to conventional methods, SPME has high recovery, saves considerable time, and reduces solvents waste. The extraction efficiencies of five PAHs were above 88% and the extraction times were 35 min in one pretreatment procedure. One particular discovery is that 1.5 M sodium monochloroactate (ClCH2COONa) can improve the extraction yield of PAH compounds more than other inorganic salts. The SPME-HPLC-FLD technique provides a relatively simple, convenient, practical procedure, which was here successfully applied to determine five PAHs in water from authentic water samples.

[The application and programming of digital potentiometers in medical instruments].

Digital potentiometers have been used in medical instruments. This paper describes the structure and principle of a digital potentiometer, especially its interfacing with a single chip processor and its programming.

Acute effects of three club drugs on the striatum of rats: evaluation by quantitative autoradiography with [18F]FDOPA.

In this work, we used quantitative autoradiography to study the acute effect of cocaine, methamphetamine, and ketamine on the uptake of [(18)F]FDOPA in the striatum of rats. Drugs were treated 0.5 h before (pre-treated), and 1.5 h after (post-treated) [(18)F]FDOPA injections, rats were then sacrificed at 2 h post [(18)F]FDOPA injections to determine the striatum/frontal cortex binding ratios in the striatum. The ratios were lower in the post-treated groups than those of the pre-treated groups, suggesting a net effect of inhibition of trapping of the tracer. The order of uptake inhibition is: ketamine>methamphetamine>cocaine.

Simultaneous imaging of temporal changes of NF-κB activity and viable tumor cells in Huh7/NF-κB-tk-luc2/rfp tumor-bearing mice.

Few studies have reported that the effect of sorafenib on advanced human hepatocellular carcinoma (HCC) is taking place via the inhibition of NF-κB signal transduction. Here we constructed a human HCC Huh7 stable clone with NF-κB-responsive element to drive dual reporter genes, herpes simplex virus thymidine kinase (tk) and firefly luciferase (luc2), and co-transfected with a third red fluorescent protein (rfp) gene, renamed as Huh7/NF-κB-tk-luc2/rfp cells, and combined with bioluminescent imaging (BLI) and red fluorescent protein imaging (RFPI) to monitor the effect of sorafenib on NF-κB activation and tumor inhibition. The results show that sorafenib could suppress the NF-κB-DNA binding activity, and the expression of downstream effector proteins. Notably, the relative photon fluxes obtained from RFPI and BLI, which represent the viable tumor cells and cells with NF-κB activation, decreased after sorafenib treatment by 50 to 65%, and 87.5 to >90%, respectively, suggesting that NF-κB activation is suppressed in viable HCC cells by sorafenib. Simultaneous molecular imaging of the temporal change of NF-κB activity and of viable cells in the same Huh7/NF-κB-tk-luc2/rfp tumors of the animal may reflect the real status of NF-κB activity and the viable tumor cells at the time of imaging.