The experience of pain and anxiety in rectal cancer patients during high-dose-rate brachytherapy.

BACKGROUND: Pain and anxiety have been reported as primary concerns for patients with head-and-neck, gynecologic, and prostate cancers undergoing high dose rate (hdr) brachytherapy. However, almost no research has been published on the degree to which these symptoms are experienced by rectal cancer patients undergoing hdr brachytherapy. We conducted a pilot study examining the experiences of rectal cancer patients during hdr brachytherapy, specifically the intensity and trajectory of their anxiety and pain. METHODS: Rectal cancer patients (n = 25) who received hdr brachytherapy treatment at a hospital in Montreal, Quebec, completed verbal analog scales for pain and anxiety at 4 time points over 4 treatment days. RESULTS: On all 4 days, a subset of patients reported moderate-to-severe anxiety before applicator insertion. Pain increased significantly from the time patients were lying on the table to immediately after insertion of the applicator (p < 0.001). Insertion of the applicator appears to be the most painful part of the procedure, and although anxiety declined to below baseline after applicator removal, pain remained somewhat elevated. Some patients required conscious sedation; however, reports of moderate-to-severe pain were more frequent from patients who received pain medications than from patients who did not receive such medication (p < 0.05). CONCLUSIONS: Most patients with rectal cancer tolerated hdr rectal brachytherapy well, although the procedure is stressful and painful for some. Insertion of the applicator was found to be the point of maximal pain, and medication was not always completely successful at alleviating the pain, suggesting that additional psychosocial interventions might be needed, with particular emphasis on the time of applicator insertion.

Effect of oral rotavirus/iscom vaccines on immune responses in gnotobiotic lambs.

A comparison of the effect on the immune responses in gnotobiotic lambs was made between an iscom vaccine prepared from recombinant rotavirus VP6 protein, an inactivated rotavirus/iscom-matrix vaccine and a vaccine comprising inactivated rotavirus alone. All three vaccines induced immunological priming and some degree of protection was observed after a single oral dose. However, different immune responses were induced in response to a virulent infection. The group vaccinated with the rotavirus/iscom-matrix vaccine showed a Th2-like response characterised by rotavirus-specific antibodies and a down-regulation of IFNgamma in jejunal Peyer's patches. Both Th1-like and Th2-like immune responses were induced in the group receiving the VP6 vaccine as seen by significantly increased expressions of IFNgamma and IL-6 in the jejunal Peyer's patch together with an increased percentage of CD8+ T cells in the intestine and rotavirus-specific antibodies at mucosal surfaces. Iscom vaccines given orally have the ability to induce both Th1-like and Th2-like immune responses in a ruminant model.

Maternal antibodies protect immunoglobulin deficient neonatal mice from mouse hepatitis virus (MHV)-associated wasting syndrome.

PROBLEM: Neonatal mice nursed by dams lacking immunoglobulins (Igs) may often suffer from lethal runting if raised under conventional conditions. The present study was performed in order to clarify a) the cause of the wasting syndrome and b) the protective role of antigen-specific milk antibodies. METHOD: Ig-deficient mouse embryos in a conventional environment were embryo-transferred to specified pathogen free (SPF) dams. Neonatal growth, mortality, and health status of mice from both environments was recorded. Suspected presence of mouse hepatitis virus (MHV) was tested by RT-PCR. Protective effects on neonatal mortality of milk containing different titers of anti-MHV antibodies were investigated in cross-fostering experiments. RESULTS: The SPF colony of Ig-deficient mice exhibited no breeding problems, whereas Ig-deficient neonates in the conventional environment suffered from lethal wasting syndrome. Serological screening of the mice kept in the two environments revealed that mice in the conventional room had high titers of antibodies against mouse hepatitis virus. Presence of MHV in runting neonates was confirmed by pathological examinations and RT-nested-PCR using MHV genome specific primers. Milk containing high titers of anti-MHV antibodies, when provided for 8 days or more, completely prevented Ig-deficient neonates from developing wasting syndrome in the conventional environment. CONCLUSION: These findings show that the neonatal wasting syndrome is associated with the presence of MHV and that neonates are efficiently protected by MHV-specific antibodies in the milk.