Well-being at the end of life: Part 1. A research agenda for psychosocial and spiritual aspects of care from the patient's perspective.

This article reviews the scientific literature concerning psychosocial and spiritual aspects of palliative care for the patient with cancer. It discusses 4 separate areas: the continuum of care, communication, spiritual and psychological issues, and psychotherapeutic and behavioural management of physical symptoms. Most of the research could be classified as fundamental according to the Cancer Control Framework of the National Cancer Institute of Canada. In some areas, even fundamental research was lacking. There is a need for clearer and more relevant definitions of the desired outcomes of interventions and also for the development of appropriate quantitative and qualitative methods. We must determine which interventions can be initiated earlier in the disease trajectory and can provide benefit at the palliative phase. Given the burden of suffering that palliative care aims to address, relatively little research in this area has been conducted.

Evidence that cytochrome b559 protects photosystem II against photoinhibition.

Light that exceeds the photosynthetic capacity of a plant can impair the ability of photosystem II to oxidize water. The light-induced inhibition is initiated by inopportune electron transport reactions that create damaging redox states. There is evidence that secondary electron transport pathways within the photosystem II reaction center can protect against potentially damaging redox states. Experiments using thylakoid membranes poised at different ambient redox potentials demonstrate that light-induced damage to photosystem II can be controlled by a redox component within the reaction center [Nedbal, L., et al. (1992) Proc. Natl. Acad. Sci. U.S.A. 89, 7929-7933]. The rate of photoinhibition is slow when the redox component is oxidized, but increases by more than 10-fold when the redox component is reduced. Here, using spinach thylakoid membranes, we provide evidence that the redox component is cytochrome b559, an intrinsic heme protein of the photosystem II reaction center. The results support a model in which the low-potential (LP) form of cytochrome b559 protects photosystem II by deactivating a rarely formed, but hazardous redox state of photosystem II, namely, P680/Pheo-/ QA-. Cytochrome b559LP is proposed to deactivate this potentially lethal redox state by accepting electrons from reduced pheophytin. The key observations supporting this proposal are as follows: (1) The oxidation-reduction potential of cytochrome b559LP is in the range predicted by redox titrations of photoinhibition. (2) If cytochrome b559LP is reduced prior to illumination, the rate of photoinhibition is fast, whereas if the cytochrome is oxidized prior to illumination, the rate of photoinhibition is slow.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial insemination: a comparison of pregnancy rates with intrauterine versus cervical insemination and washed sperm versus serum swim-up sperm preparations.

A four-cycle artificial insemination protocol was undertaken, with luteinizing hormone (LH) timing, to compare washed sperm and serum swim-up sperm preparations and cervical and intrauterine insemination. Of the 75 patients entered into the protocol series, 63 finished all 4 cycles. During the treatment period, 24 patients became pregnant, 20 of whom were donor (AID) pregnancies (out of 52 patients) and 4 were husband (AIH) pregnancies (out of 11 patients). Seventy-five percent of the pregnancies were intrauterine, whereas only 25% were from cervical inseminations. Sixty-two percent of the pregnancies were due to serum swim-up sperm preparations, and 38% were due to washed sperm preparations. The data indicate substantially higher pregnancy rates can be obtained with intrauterine insemination and suggest that additional studies are necessary to determine if the method of sperm preparation significantly influences pregnancy rates.

Infertility in patients with hyperprolactinemia from a pituitary adenoma. Effect of transsphenoidal pituitary adenectomy.

Four patients with infertility caused by a prolactin-secreting pituitary adenoma underwent transsphenoidal pituitary adenectomy. Preoperatively, in three patients prolactin level was elevated and gonadotropin levels were depressed. In one patient, prolactin level was elevated, and gonadotropin levels were normal, although no rise in gonadotropin levels was noted after clomiphene citrate therapy. In another patient growth hormone level was elevated. Pituitary function was otherwise normal in all patients. The patients underwent transsphenoidal pituitary adenectomy and postoperatively the first three showed normal prolactin and growth hormone levels. The fourth has not yet been reevaluated. Spontaneous pregnancy occurred in all four patients without manipulation shortly after surgery. We suggest that transsphenoidal pituitary adenectomy is a successful and low-risk approach to infertility secondary to prolactin-secreting pituitary adenomata.