Relationships of emerging biomarkers of cancer cachexia with quality of life, appetite, and cachexia.

PURPOSE: Quality of life (QoL), appetite, cachexia, and biomarkers [albumin, hemoglobin (Hb), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), interleukin 8 (IL-8), C-X-C motif chemokine ligand 5 (CXCL5) and citrullinated histoneH3 (H3Cit)] were compared for 40 cases with advanced cancer and 40 healthy controls. Baseline differences and significant relationships were explored for biomarkers with QoL, appetite, and cachexia. METHODS: In a prospective case-control, age and sex matched study, the European Organisation for the Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC-QLQ-C30) for QoL, the Functional Assessment of Anorexia and Cachexia Therapy assessment (FAACT A/CS-12) for appetite, and a five-factor cachexia assessment tool for cachexia assessment were performed. Routine hematological measurements and blood chemistry analyses together with ELISA procedures and a Multiplex® bead array platform, were used for biomarker analysis. Descriptive statistics and regression analyses were undertaken. P < 0.05 defined statistical significance. RESULTS: Global health status (QL-G), functional scales (QL-FS), and symptom scales (QL-SS) differed for cases and controls (p < 0.01). In cases, differences were observed for QL-G (p < 0.01), QL-FS (p < 0.01), and QL-SS (p = 0.01) compared to standardized references values. FAACT A/CS-12 scores differed significantly between cases and controls (p < 0.01) and 30% of cases scored "poor" appetites. Cachexia was present in 60% of cases. Albumin, lymphocytes, platelets, Hb, platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), CRP, TNFα, all at p < 0.01, neutrophil to lymphocyte ratio (NLR) (p = 0.02), IL-6 (p < 0.04), and IL-8 (p = 0.02) differed significantly between cases and controls. No difference was found for CXCL5 or H3Cit. Albumin NLR, Hb, PLR, SII, TNFα, IL-8, and CRP showed significant relationships with all aspects of QoL. QL-FS was significantly related to CXCL5 (p = 0.04), significant relationships with FAACT A/CS-12 included: NLR (p = 0.002), Hb (p < 0.001), and PLR (p < 0.01). NLR, PLR, SII, TNFα, IL-6, IL-8, and CRP correlated positively to cachexia and albumin while Hb and lymphocyte count correlated negatively to cachexia. CONCLUSION: CXCL5 and H3Cit were not reliable biomarkers for cancer cachexia, nor significantly related to QoL, appetite or cachexia. Albumin, NLR, Hb, PLR, SII, TNFα, IL-8, and CRP were reliable indicators of QoL, appetite, and cachexia. Future research should include other novel biomarkers namely growth differentiation factor-15 (GDF-15), fibroblast growth factor 21 (FGF-21), fractakline, interferon gamma (IFN-y), IL-16, macrophage colony stimulating factor (M-CSF), and macrophage procoagulant-inducing factor (MPIF).

Chloral hydrate side effects in young children: causes and management.

OBJECTIVE: To determine the factors related to undesired effects of chloral hydrate in young children undergoing echocardiogram. Undesired effects studied were reaction to chloral hydrate before to sedation (ataxia, excitement), delayed sedation, light sleep during sedation, and behavioral changes after sedation. DESIGN: Descriptive, correlational design. SETTING: Echocardiography laboratory in a pediatric teaching hospital. SUBJECTS: 140 children aged 0 to 36 months who were undergoing diagnostic echocardiography. Severity of cardiac disease ranged from benign murmur to uncorrectable lesion. Thirty children (21%) had cyanotic cardiac disease. Children were sedated with chloral hydrate per routine (mean dose 87 mg/kg) and observed from time of sedation throughout the examination. Data were collected on child's age, food ingested before sedation, transcutaneous oxygen saturation, and daytime nap schedule. OUTCOME MEASURES: Incidence of paradoxical excitement before sedation, length of time until child reached deep sedation, depth of sleep during the examination, and behavioral changes after sedation. RESULTS: Paradoxical excitement before sedation occurred in 25 children (18%). Length of time until child reached deep sedation averaged 25 minutes. Three children never fell asleep. Proximity of sedation to naptime was positively correlated to the speed of sedation. Deep sedation was achieved in 131 children (94%). Depth of sleep during the examination was related to child's age, proximity of sedation to nap time, and recent food ingestions. Older children, who were due for a nap and who had refrained from eating before the examination were most likely to remain soundly asleep throughout the examination. Children with cyanotic defects were not adversely affected by deep sedation with chloral hydrate. Most children experienced motor and affective changes after sedation. CONCLUSIONS: In this sample, chloral hydrate was an effective and safe sedative. Implications for nursing include changes in scheduling practices, limiting food ingestion before sedation, and information to provide parents about chloral hydrate sedation.

Temperament in infants and toddlers with cardiac disease.

Parental report of temperament in a group of 97 infants and toddlers with cardiac disease revealed differences from healthy children on several temperament dimensions. Increasing disease severity did not correspond with increasingly extreme temperament scores.

The impact of maternal perceptions and medical severity on the adjustment of children with congenital heart disease.

Hypothesized that maternal perceptions would be more significant predictors of emotional adjustment than medical severity. Mothers of 99 children, between the ages 4-10 years, completed the Child Behavior Checklist, Parenting Stress Index, Parental Locus of Control Scale, and a measure of perception of medical severity. Assessed medical severity by number of hospitalizations, operations, catheterizations, hospital days, outpatient visits, and a cardiologist's rating of illness severity. Maternal perceptions were potent predictors of emotional adjustment. Approximately 33% of the variability in adjustment was accounted for by maternal perceptions, while the medical severity accounted for less than 3% of the variability. Severity of illness appears less critical to successful adaptation than the quality of the mother-child relationship.

Brain metastasis: a rare manifestation of adenoid cystic carcinoma of the breast.

Adenoid cystic carcinoma of the breast is a rare neoplasm that usually has a benign biological behavior. A patient who was operated upon for removal of this tumor developed metastases to the lungs and brain 12 years after mastectomy. This is probably the first report in the literature of brain metastasis from adenoid cystic carcinoma of the breast. Radiological and histological evidence of both primary breast tumor and the metastasis to the brain are presented.

Comparative susceptibilities of 40 strains of Pseudomonas aeruginosa to 10 antipseudomonal antimicrobial agents.

The in vitro susceptibility of 40 clinical isolates of Pseudomonas aeruginosa to 10 antipseudomonal antibiotics was determined. Of the strains examined, 100, 90, 85 and 80% were susceptible to netilmicin, amikacin, gentamicin and tobramycin, respectively; 93, 85 and 72% were susceptible to piperacillin, azlocillin and carbenicillin, respectively; and 93, 88 and 84% were susceptible to cefotaxime, moxalactam and cefsulodin, respectively. These data confirm that the newer antipseudomonal antimicrobial agents are more effective against Ps. aeruginosa than the older agents.

Hospital admissions due to adverse drug reactions.

One hundred three (4.1%) of 2,499 patients hospitalized in a general medical ward were admitted because of an adverse drug reaction (ADR). Of 60 drugs involved, the most common were cardiac, antibiotic, and antineoplastic agents. The main reactions included skin rashes, bone marrow depression, arrhythmia, bleeding, and heart failure. Five (4.9%) of the patients died and 11 (10.7%) had life-threatening reactions. Risk factors predisposing to admissions due to ADR were: female sex, decreased renal function, polypragmasia, and the underlying disease. Twenty-seven percent of the admissions could have been avoided by a more careful choice and dosage of drug.