Development of the Chronic Pain Cognition Scale: A Culture-Sensitive Pain Measurement in Chinese.

Purpose: People with pain problems are highly vulnerable to cultural disparities, and it is imperative to reduce these inequalities. This cross-sectional study aimed to develop a culturally sensitive Chronic Pain Cognition Scale (CPCS) for Chinese-/Chinese dialect-speaking populations and investigate its psychometric properties. Patients and Methods: Adult patients with chronic low back pain or chronic neck pain who visited pain clinics at a medical center in northern Taiwan were enrolled. Participants completed the demographic, intensity of pain, and two other related sensations, "Sng ()" and "Ma ()", often reported in Chinese-speaking populations, CPCS, Chronic Pain Acceptance Questionnaire-8, and Pain Self-Efficacy Questionnaire. Results: 200 patients were included. Patients' mean age was 64.84 ± 14.33, 126 (63.0%) were female, and 83 (41.5%) had 13+ years of education. The average duration of pain was 77.25 ± 97.46 months, the intensity of pain was 6.04 ± 2.50, Ma was 3.43 ± 3.24, and Sng was 4.54 ± 3.14. The CPCS comprised four factors: pain impact (how pain impact one's life), losing face (how one being disrespected due to pain), helplessness, and avoidance, with good structural validity and adequate reliability (Cronbach α, 0.60-0.81) and satisfactory criterion-related validity. Moreover, losing face, an essential concept in Chinese relationalism, was significantly related to pain, Sng, and Ma (r = 0.19, 0.15 and 0.16), but not to pain acceptance or self-efficacy, indicating a culturally specific element in pain measurement. Conclusion: The CPCS has good psychometric properties and is suitable for evaluating chronic pain in the clinical setting, and might be generalizable to other Chinese-/Chinese dialect-speaking populations.

Peritoneal effluent MicroRNA profile for detection of encapsulating peritoneal sclerosis.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a catastrophic complication of peritoneal dialysis (PD) with high mortality. Our aim is to develop a novel noninvasive microRNA (miRNA) test for EPS. METHODS: We collected 142 PD effluents (EPS: 62 and non-EPS:80). MiRNA profiles of PD effluents were examined by a high-throughput real-time polymerase chain reaction (PCR) array to first screen. Candidate miRNAs were verified by single real-time PCR. The model for EPS prediction was evaluated by multiple logistic regression and machine learning. RESULTS: Seven candidate miRNAs were identified from the screening of PCR-array of 377 miRNAs. The top five area under the curve (AUC) values with 5 miRNA-ratios were selected using 127 samples (EPS: 56 vs non-EPS: 71) to produce a receiver operating characteristic curve. After considering clinical characteristics and 5 miRNA-ratios, the accuracies of the machine learning model of Random Forest and multiple logistic regression were boosted to AUC 0.97 and 0.99, respectively. Furthermore, the pathway analysis of miRNA associated targeting genes and miRNA-compound interaction network revealed that these five miRNAs played the roles in TGF-ß signaling pathway. CONCLUSION: The model-based miRNA expressions in PD effluents may help determine the probability of EPS and provide further therapeutic opinion for EPS.

The effect of the preoperational psychoeducation program for Taiwanese breast cancer patients: A three-month follow-up study.

Objective: Studies suggest that psychosocial interventions might be more effective during highly stressful periods, such as before surgery. This study aimed to explore the effectiveness of the Preoperational Health Psychology Education program among Taiwanese breast cancer patients. Methods: A total of 137 adult women (1) diagnosed with breast cancer; and (2) admitted to the ward for surgery were recruited to join the program one day before surgery. Emotional distress, worries, and cancer self-efficacy were evaluated at admission, post-program, and 3-month post-surgery. Patients were grouped into high/low distress groups, and mixed-design ANOVA was used to examine the program's effectiveness. Results: The results showed significant interactions of Group × Time in emotional distress (F = 16.15, p = .000) and worry (F = 5.81, p = .005), but not in self-efficacy (F = 2.97, p = .068). The post-hoc tests revealed significant decreases in emotional distress and worry in the high distress group. Conclusion: The program was found helpful in reducing emotional distress and worries. The effect lasting for three-month for those with higher preoperational emotional distresses. Innovation: This psycho-education program with a relatively rare one-session design, targeted at a less-studied pre-surgery period, is helpful to a less-studied population, Asian cancer patients.

ALDH2 deficiency induces atrial fibrillation through dysregulated cardiac sodium channel and mitochondrial bioenergetics: A multi-omics analysis.

Point mutation in alcohol dehydrogenase 2 (ALDH2), ALDH2*2 results in decreased catalytic enzyme activity and has been found to be associated with different human pathologies. Whether ALDH2*2 would induce cardiac remodeling and increase the attack of atrial fibrillation (AF) remains poorly understood. The present study evaluated the effect of ALDH2*2 mutation on AF susceptibility and unravelled the underlying mechanisms using a multi-omics approach including whole-genome gene expression and proteomics analysis. The in-vivo electrophysiological study showed an increase in the incidence and reduction in the threshold of AF for the mutant mice heterozygous for ALDH2*2 as compared to the wild type littermates. The microarray analysis revealed a reduction in the retinoic acid signals which was accompanied by a downstream reduction in the expression of voltage-gated Na+ channels (SCN5A). The treatment of an antagonist for retinoic acid receptor resulted in a decrease in SCN5A transcript levels. The integrated analysis of the transcriptome and proteome data showed a dysregulation of fatty acid ß-oxidation, adenosine triphosphate synthesis via electron transport chain, and activated oxidative responses in the mitochondria. Oral administration of Coenzyme Q10, an essential co-factor known to meliorate mitochondrial oxidative stress and preserve bioenergetics, conferred a protection against AF attack in the mutant ALDH2*2 mice. The multi-omics approach showed the unique pathophysiology mechanisms of concurrent dysregulated SCN5A channel and mitochondrial bioenergetics in AF. This inspired the development of a personalized therapeutic agent, Coenzyme Q10, to protect against AF attack in humans characterized by ALDH2*2 genotype.

Risk stratification for lung adenocarcinoma on EGFR and TP53 mutation status, chemotherapy, and PD-L1 immunotherapy.

The overall survival rates for lung cancer remain unsatisfactorily low, even for patients with biomarkers for which target therapies or immunotherapies are recommended. Better identification of at-risk patients is needed to achieve more effective personalized treatment. Here, we derived a risk-stratifying gene signature consisting of five genes that had the greatest differential expression by stage from lung adenocarcinoma (LUAD) transcriptomes. The new gene signature enabled survival prognosis for multiple LUAD datasets from different platforms of transcriptomics and risk stratification for patients with and without a mutation in TP53 or EGFR, with high and low levels of PD-L1, and with and without adjuvant chemotherapy treatment. Using these evaluations, it was also shown to be more robust compared to several other gene signatures. Functional analysis of the five genes and their protein-protein interaction partners indicated that they are functionally enriched in cell cycle, endocytosis, and EGFR regulation, which are biological processes associated with lung cancer and drug resistance. Extensive discussions on related experimental studies suggest that the five genes are novel and sensible targets for developing new drugs and/or tackling drug resistance problems for LUAD.

Validation of the global activity limitation indicator in Taiwan.

BACKGROUND: The Global Activity Limitation Indicator (GALI) is a single-item measure of functional decline, it is widely used in Europe but it has never been validated in an Asian population. The aim of this study was to validate the GALI in a sample of older Taiwanese people and to explore whether it captured not only physical but also psychological limitations. METHODS: Data for 4961 individuals (mean age, 62.4 ± 9.4 years; 47.2% men) were obtained from a national representative refresh cohort of the 8th wave of the Taiwan Longitudinal Survey on Aging. Logistic regression analysis was used to examine associations among the GALI, activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and to explore whether depressive symptoms (measured by the Center for Epidemiologic Studies Depression Scale, CES-D) could be an indicator of reporting limitations on the GALI. RESULTS: Responding to the GALI, 21.7% of the sample described themselves as 'limited.' In logistic regression, the GALI response was significantly associated with those who reported one or more ADL difficulties (odds ratio [OR] = 35.89, 95% confidence interval [CI] 21.10, 61.03) and IADL difficulties (OR = 13.37, 95%CI 10.09, 17.71), respectively. Furthermore, those with more depressive symptoms were more likely to report they were 'limited' on the GALI. CONCLUSIONS: These findings provided evidence that the GALI is a valid tool to assess general limitations in an Asian population. Furthermore, it captured psychological limitations to some extent. There were variations between Taiwan and European countries (as has been previously reported between European countries). The reporting level in the GALI by the Taiwan population was comparatively lower than that in European countries, highlighting the need to embrace cultural differences and to use caution when comparing GALI results across countries.

Quick screening tool for patients with severe negative emotional reactions to chronic illness: psychometric study of the negative emotions due to chronic illness screening test (NECIS).

Background: Severe negative emotional reactions to chronic illness are maladaptive to patients and they need to be addressed in a primary care setting. Objective: The psychometric properties of a quick screening tool-the Negative Emotions due to Chronic Illness Screening Test (NECIS)-for general emotional problems among patients with chronic illness being treated in a primary care setting was investigated. Method: Three studies including 375 of patients with chronic illness were used to assess and analyze internal consistency, test-retest reliability, criterion-related validity, a cut-off point for distinguishing maladaptive emotions and clinical application validity of NECIS. Self-report questionnaires were used. Results: Internal consistency (Cronbach's α) ranged from 0.78 to 0.82, and the test-retest reliability was 0.71 (P < 0.001). Criterion-related validity was 0.51 (P < 0.001). Based on the 'severe maladaptation' and 'moderate maladaptation' groups defined by using the 'Worsening due to Chronic Illness' index as the analysis reference, the receiver-operating characteristic curve analysis revealed an area under the curve of 0.81 and 0.82 (ps < 0.001), and a cut-off point of 19/20 was the most satisfactory for distinguishing those with overly negative emotions, with a sensitivity and specificity of 83.3 and 69.0%, and 68.5 and 83.0%, respectively. The clinical application validity analysis revealed that low NECIS group showed significantly better adaptation to chronic illness on the scales of subjective health, general satisfaction with life, self-efficacy of self-care for disease, illness perception and stressors in everyday life. Conclusion: The NECIS has satisfactory psychometric properties for use in the primary care setting.

Identification of lncRNA functions in lung cancer based on associated protein-protein interaction modules.

Long non-coding RNAs (lncRNAs) have been found to play important roles in various biological processes; however, many of their functions remain unclear. In this study, we present a novel approach to identify the lncRNA-associated protein-protein interaction (PPI) modules and ascertain their functions in human lung squamous cell carcinoma. We collected lncRNA and mRNA expression profiles of lung squamous cell carcinoma from The Cancer Genome Atlas. To identify the lncRNA-associated PPI modules, lncRNA-mRNA co-expression networks were first constructed based on the mutual ranks of expression correlations. Next, we examined whether the co-expressed mRNAs of a specific lncRNA were closely connected by PPIs. For this, a significantly connected mRNA set was considered to be the lncRNA-associated PPI module. Finally, the prospective functions of a lncRNA was inferred using Gene Ontology enrichment analysis on the associated module. We found that lncRNA-associated PPI modules were subtype-dependent and each subtype had unique molecular mechanisms. In addition, antisense lncRNAs and sense genes tended to be functionally associated. Our results might provide new directions for understanding lncRNA regulations in lung cancer. The analysis pipeline was implemented in a web tool, available at http://lncin.ym.edu.tw/.

The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit.

BACKGROUND: Although many cross-sectional studies have demonstrated the association between cancer pain and psychospiritual distress, the time-dependent relationship has not been fully explored. For that reason, this study aims to investigate the time-dependent relationship between psychospiritual distress and cancer pain management in advanced cancer patients. METHODS: This is a prospective observational study. Two hundred thirty-seven advanced cancer patients were recruited from a palliative care unit in Taiwan. Demographic and clinical data were retrieved at admission. Pain and psychospiritual distress (i.e.: anxiety, depression, anger, level of family and social support, fear of death) were assessed upon admission and one week later, by using a "Symptom Reporting Form". Patients were divided into two groups according to the pain status one week post-admission (improved versus not improved groups). RESULTS: One hundred sixty-three (68.8 %) patients were assigned to the improved group, and 74 (31.2 %) patients were assigned to the not improved group. There were no differences in the psychospiritual variables between groups upon admission. In overall patients, all psychospiritual variables improved one week post-admission, but the improvement of depression and family/social support in the not improved group was not significant. Consistent with this, for depression scores, there was a statistically significant pain group x time interaction effect detected, meaning that the pain group effect on depression scores was dependent on time. CONCLUSIONS: We demonstrated a time-dependent relationship between depression and pain management in advanced cancer patients. Our results suggest that poor pain management may be associated with intractable depression. The inclusion of interventions that effectively improve psychospiritual distress may contribute to pain management strategies for advanced cancer patients.

Consciousness levels one week after admission to a palliative care unit improve survival prediction in advanced cancer patients.

BACKGROUND: Consciousness is an important factor of survival prediction in advanced cancer patients. However, effects on survival of changes over time in consciousness in advanced cancer patients have not been fully explored. OBJECTIVE: This study evaluated changes in consciousness after admission to a palliative care unit and their correlation with prognosis in terminal cancer patients. METHODS: This is a prospective observational study. From a palliative care unit in Taiwan, 531 cancer patients (51.8% male) were recruited. Consciousness status was assessed at admission and one week afterwards and recorded as normal or impaired. RESULTS: The mean age was 65.28±13.59 years, and the average survival time was 23.41±37.69 days. Patients with normal consciousness at admission (n=317) had better survival than those with impaired consciousness at admission (n=214): (17.0 days versus 6.0 days, p<0.001). In the analysis on survival within one week after admission, those with normal consciousness at admission had a higher percentage of survival than the impaired (78.9% versus 44.3%, p<0.001). Patients were further classified into four groups according to consciousness levels: (1) normal at admission and one week afterwards, (2) impaired at admission but normal one week afterwards, (3) normal at admission but impaired one week afterwards, and (4) impaired both at admission and one week afterwards. The former two groups had significantly better survival than the latter two groups: (median survival counted from day 7 after admission), 25.5, 27.0, 7.0, and 7.0 days, respectively. CONCLUSION: Consciousness levels one week after admission should be integrated into survival prediction in advanced cancer patients.

Health issues among nurses in Taiwanese hospitals: National survey.

BACKGROUND: Few, if any, studies have compared the health issues of nurses working in different hospital settings. The objective of this study was to compare the health status and work-related health hazards among nurses working in different hospital units in Taiwan. METHODS: This study was a cross-sectional survey. The study participants were 21,095 full-time employees with a professional background in nursing, working at 100 hospitals across Taiwan. The study participants responded to a structured questionnaire from May to July, 2011. RESULTS: After adjustment for age, sex, educational level, accredited hospital level, and certification as a health promoting hospital, nurses who worked in administration and in outpatient clinics reported better overall health than nurses who worked in operating rooms/delivery rooms, and these nurses reported better overall health than nurses who worked in emergency rooms/intensive care units and general wards. Depressed mood followed the same trend. Nurses who worked in the operating rooms/delivery rooms, wards, and emergency rooms/intensive care units were at higher risk for occupational incidents than nurses who worked in outpatient clinics and administration. The most prevalent health hazards among nurses were low back pain, sprained/strained muscles, cuts, and verbal or sexual harassment/violence. CONCLUSIONS: Nurses who worked in emergency rooms/intensive care units and in wards had worse health and more depressed moods than nurses in other hospital units. Work-related health hazards were common and varied among nurses working in different hospital units. Worksite-based health promotion programs should take these differences into consideration to tailor wellness programs for nurses working in different hospital settings.

Does exposure to stressors predict changes in physiological dysregulation?

BACKGROUND: The allostatic load framework implies that cumulative exposure to stressors results in multi-system physiological dysregulation. PURPOSE: The purpose of this study was to investigate the effect of stress burden on subsequent changes (2000-2006) in physiological dysregulation. METHODS: Data came from a population-based cohort study in Taiwan (n = 521, aged 54+ in 2000, re-examined in 2006). Measures of stressful events and chronic strain were based on questions asked in 1996, 1999, and 2000. A measure of trauma was based on exposure to the 1999 earthquake. Dysregulation was based on 17 biomarkers (e.g., metabolic, inflammatory, neuroendocrine). RESULTS: There were some small effects among men: chronic strain was associated with subsequent increases in dysregulation (standardized ß = 0.08, 95 % CI = 0.01 to 0.20), particularly inflammation; life events were also associated with increased inflammation (ß = 0.10, CI = 0.01 to 0.26). There were no significant effects in women. CONCLUSIONS: We found weak evidence that stress burden is associated with changes in dysregulation.

Plasma adiponectin levels correlate positively with an increasing number of components of frailty in male elders.

OBJECTIVE: Frailty is an important geriatric syndrome. Adiponectin is an important adipokine that regulates energy homeostasis. The aim of this study is to investigate the relationship between plasma adiponectin levels and frailty in elders. METHODS: The demographic data, body weight, metabolic and inflammatory parameters, including plasma glucose, total cholesterol, triglyceride, tumor necrosis factor alpha (TNF-α), c-reactive protein (CRP) and adiponectin levels, were assessed. The frailty score was assessed using the Fried Frailty Index (FFI). RESULTS: The mean (SD) age of the 168 participants [83 (49.4%) men and 85 (50.6%) women] was 76.86 (6.10) years. Judged by the FFI score, 42 (25%) elders were robust, 92 (54.7%) were pre-frail, and 34 (20.3%) were frail. The mean body mass index was 25.19 (3.42) kg/m(2). The log-transformed mean (SD) plasma adiponectin (µg/mL) level was 1.00 (0.26). The log-transformed mean plasma adiponectin (µg/mL) levels were 0.93 (0.23) in the robust elders, 1.00 (0.27) in the pre-frail elders, and 1.10 (0.22) in the frail elders, and the differences between these values were statistically significant (p  = 0.012). Further analysis showed that plasma adiponectin levels rose progressively with an increasing number of components of frailty in all participants as a whole (p for trend  = 0.024) and males (p for trend  = 0.037), but not in females (p for trend  = 0.223). CONCLUSION: Plasma adiponectin levels correlate positively with an increasing number of components of frailty in male elders. The difference between the sexes suggests that certain sex-specific mechanisms may exist to affect the association between adiponectin levels and frailty.

Correlates of fatigue phenomenon in palliative care patients with advance cancers in Taiwan.

BACKGROUND: Fatigue is a multidimensional phenomenon that has different meanings according to different societal and cultural settings. This study aims to decipher fatigue in Taiwanese patients with cancer. METHODS: We recruited 440 patients with advanced cancer admitted consecutively to the palliative care unit of a major medical center in Taiwan. The data were collected at admission, 1 and 2 weeks after admission, and 2 days before death. RESULTS: The subject group consisted of 51.8% males and 48.2% females with a median age of 67 years (ranging from 27 to 93 years). The leading primary tumor sites among these patients were lung (20.2%), liver (18.0%), and colon-rectum (10.7%), and the median survival was 15 days, with a range of 1 to 418 days. All symptoms improved 1 week after admission, but most of them significantly worsened 2 days before death. In general, the physical signs manifested variation patterns similar to those of symptoms. The severity of psychosocial distress and death fear was lower after admission and retained the same level at 2 days before death, defying the consistent patterns found in other symptoms and signs. In the correlation analysis, most symptoms were correlated with fatigue during admission, with weakness being the most significant one. Although self-efficacy and emotion were correlated with fatigue both on admission and 1 week after admission, social support and death fear were not correlated with fatigue at all times. CONCLUSION: The meaning of fatigue is mainly associated with physical factors among these patients. Education of complexities in fatigue in tandem with psychosocial and spiritual care may help alleviate this symptom, and promote quality of life.

Can a good death and quality of life be achieved for patients with terminal cancer in a palliative care unit?

BACKGROUND: Lack of evidence supporting the claim that palliative care can improve quality of life and promote good death in patients with terminal cancer. OBJECTIVES: This study was designed to evaluate the change of quality of life and quality of death over time and between patients of long and short survival in a palliative care unit. METHODS: Patient demography, cancer sites, Eastern Cooperative Oncology Group (ECOG) status were collected at admission. Quality of life, including physical and psychological symptoms, social support, and spirituality was assessed daily after admission. Quality of death was assessed by a Good Death Scale (GDS) at admission and retrospectively for 2 days before death. RESULTS: A total of 281 patients (52% women) were admitted and died in the study period. One hundred forty-five patients (51.6%) died within 3 weeks. Although those with short survival (<3 weeks) had more physical symptoms during the first week, there was no difference in quality of life dimensions at admission, at 1 week, and at 2 days before death between survival groups. Physical conditions deteriorated with time but other dimensions continued to improve until death. GDS and subdimensions continued to improve until death. Although those with long survival (≥3 weeks) have better scores for awareness, acceptance, timeliness, comfort, and GDS at admission, there was no difference between the two groups at 2 days before death. CONCLUSION: Under comprehensive palliative care, patients with terminal cancer can have good quality of life and experience a good death even with short survival.

Significance of symptom clustering in palliative care of advanced cancer patients.

Patients with advanced cancer often experience multiple concurrent symptoms. To explore this symptom clustering and its associated parameters, we prospectively surveyed 427 consecutive patients on admission to the Palliative Care Unit. There were 222 males (52.0%) and 205 females (48.0%), with a median age of 66 years (range: 27-93 years). The main tumor sites were lung (19.9%), liver (18.0%), and colorectum (11.0%). The median survival was 13 days (1-418 days). Symptoms were assessed using a face-valid Symptom Reporting Form. We identified five symptom clusters by exploratory factor analysis. Clusters were named "loss of energy," "poor intake," "autonomic dysfunction," "aerodigestive impairment," and "pain complex." We used nonhierarchical cluster analysis to divide the 394 patients with complete data into six groups. Each group was characterized by a particular pattern that was composed of different symptom clusters. Survival, functional performance, bone metastasis, and fluid accumulation were significantly associated with symptom clustering in six groups of patients. The severity of psychological distress also related to their physical deterioration. These data suggest that different underlying mechanisms associate with symptom clustering. Further elucidation of these processes may assist in symptom management.

Diabetes mellitus and functional impairment in Taiwanese older men and women.

Type 2 diabetes mellitus is strongly related to many kinds of functional impairment, even after adjusting for demographic and comorbid conditions. The current study examined sex differences in the relationships between Type 2 diabetes mellitus and functional impairment in an Asian population sample. Data were obtained from a national survey, the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. A total of 652 older adults aged > or =65 years were included in the study. Pearson's chi(2)-test and multiple logistic regression analysis were used to examine the relationships between diabetes and functional impairments in older men and women. The reported numbers of impairments were significantly higher in women, in those aged > or =75 years, and in those with diabetes. There were sex and age differences in the relationships between diabetes and functional difficulties. Even after adjustment for age, education, and co-morbid conditions, men with diabetes were about four times more likely to have difficulties related to self-care, and women with diabetes were about two to three times more likely to have difficulties related to higher functioning than their non-diabetic counterparts. Sex differences should be considered when understanding the relationships between diabetes and functional impairments in older adults.

Social relations and PTSD symptoms: a prospective study on earthquake-impacted adolescents in Taiwan.

This prospective longitudinal study examined two competing models, a traditional social support model and a supportive and detrimental social relations model, to clarify the association of PTSD symptoms with supportive and detrimental social relations. Seven-hundred five adolescents living near the epicenter of the Taiwan Chi-Chi Earthquake participated in the study. The models were evaluated and cross-validated using structural equation modeling. The supportive and detrimental social relations model appeared to be a better fit. After further evaluation of three nested versions of the supportive and detrimental social relations model, detrimental social relations was found to partially mediate the relationship between PTSD symptoms 1 and 2 years following the earthquake. The findings suggest that helping adolescents deal with detrimental social relations can contribute to postdisaster adjustment.

Semantic memory deficits in low-educated patients with Alzheimer's disease.

BACKGROUND/PURPOSE: Although a deficit of semantic memory is evident in the dementia of the Alzheimer's type (DAT), the underlying neuropsychologic mechanism remains controversial. Breakdown of the semantic network during the course of DAT and an inability to access semantic information have been postulated as possible explanations, but supporting data are limited, particularly in low-educated patients. This study examined semantic memory in low-educated patients with different degrees of dementia severity. METHODS: In total, 197 adult subjects were recruited, including 165 DAT patients and 32 normal controls. Subjects were divided into four subgroups according to their dementia severity. All subjects completed an episodic memory task, the Six-Object Memory Test, and semantic memory tasks including the Object Naming Test, the Remote Memory Test and the Semantic Association of Verbal Fluency Test. One-way ANOVA and ANCOVA with a post hoc Scheffe's procedure were used to evaluate differences between groups. RESULTS: All patients, irrespective of the degree of dementia, showed impaired performance on the Six-Object Memory Test [F (4, 163) = 69.95, p < 0.0001 for immediate recall; F (4, 163) = 41.34, p < 0.0001 for delayed recall]. On the semantic memory tasks, patients with moderate to severe dementia showed impaired performances on the Object Naming Test [F (4, 180) = 28.25, p < 0.0001] and the Remote Memory Test [F (4, 167) = 26.22, p < 0.0001 for recall; F (4, 167) = 34.80, p < 0.0001 for recognition], while all patients performed defectively on the Semantic Association of Verbal Fluency Test [F (4, 194) = 70.43, p < 0.0001]. CONCLUSION: Our results thus partially support the hypotheses that a loss of semantic structure and an inability to access semantic knowledge occur in the pathogenesis of DAT.

Symptom patterns of advanced cancer patients in a palliative care unit.

This study involved longitudinal evaluations of symptom severity and describes the symptom patterns of 77 terminal cancer patients (median age: 62 years; 61% female), selected from 537 consecutive patients admitted to the Palliative Care Unit of the National Taiwan University Hospital. The most common primary cancer sites in these patients were lung (23.4%), liver (15.6%), and stomach (13%). Nineteen physical and psychological symptoms were assessed using different scales. The median number of symptoms was 11 (range: 1-18) on admission, among which weakness, fatigue, anorexia, pain, and depression were the most common. A comparison of the initial symptom severity scores with those at one week after admission and two days before death suggested six symptom change patterns: A: continuous static (restless/heat, abdominal fullness, constipation, dizziness, and insomnia); B: static-increase (fatigue, weakness, nausea/vomiting, taste alteration, dysphagia, diarrhea, dry mouth, and night sweats); C: decrease-static (pain and depression); D: decrease-increase (anorexia and dyspnea); E: static-decrease (aggression); and F: gradually decrease (anxiety). These six symptom patterns can be divided into two categories on the basis of the relative severity of symptoms between one week after admission and two days before death. The first category included patterns A, C, E and F, and the symptoms improved with palliative care. However, the symptoms in the second category (patterns B and D), which were associated with the anorexia-cachexia syndrome and dyspnea, did not show improvement. As symptom management is an essential component of palliative care, holistic care, which encompasses physical, psychosocial and spiritual aspects, represents a rational approach for the relief of these incurable symptoms at the end stage of life for these patients.