Rapid screening of depression and anxiety in cancer patients: Interview validation of emotion thermometers.

BACKGROUND AND OBJECTIVE: This study aimed to determine the degree of depression and anxiety in cancer patients using the Emotion Thermometers (ET) and confirming their clinical usefulness compared to the gold standard interview, as well as determining optimal cut-off values for the appropriate identification of cancer patients' distress. METHODS: We included 238 cancer patients and we used ET (Emotion Thermometers) to screen depression and anxiety and the Beck depression inventory for adults (BDI-II), the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Mini-International Neuropsychiatric Interview (M.I.N.I) was used as the criterial validity standard. RESULTS: The prevalence of anxiety on the M.I.N.I. was 24% and depression was 11%. The optimal value for diagnosis of depression from ET (Dep ET) appears to be > 4.5 (AUC 0.928) against M.I.N.I. Optimal score for anxiety from ET (AnxT ET) compared to GAD according to M.I.N.I. we determined the value of 3.5 (AUC 0.899). To determine the cut off score for distress using from ET (DT), we compared against GAD-7 and BDI-II RS (raw total score) and the most optimal was 4.5 (AUC 0.953). For analysis of the cut off score for quality of life (QoL) against the total sums of all parts of the ET, the value of 14.5 (AUC 0.892) forms the cut off between the negative and the positive clinical finding. CONCLUSIONS: The results of the study support the use of ET as a rapid screening tool for the detection of depression, anxiety and distress in cancer patients.

Walking on a treadmill improves the stride length-cadence relationship in individuals with Parkinson's disease.

BACKGROUND: The gait pattern in Parkinson´s disease (PD) is characterized by a deficit in the internal regulation of stride length (SL), while the control of cadence (Cad) remains intact. The use of the treadmill as a gait rehabilitation tool has provided novel options for treatment of gait impairments in PD. However, it remains unclear whether walking on the treadmill changes the stride length-cadence relationship (SLCrel) in PD. The purpose of the present study was to analyze the SLCrel in PD subjects walking on a treadmill vs. overground, and to further compare the SLCrel to that of age-matched healthy subjects. METHODS: Fifteen PD subjects and fifteen age-matched controls walked overground and on a treadmill at five different self-selected speeds. Gait speed, SL and Cad were recorded at each self-selected speed. A linear regression analysis was conducted to explore the SLCrel and to determine the slope and intercept for each participant. RESULTS: PD subjects showed a lower intercept than control subjects when walking both overground and on a treadmill (F = 8.51, p = 0.007). In comparison with walking overground, walking on a treadmill resulted in a significant increase in the intercept in both PD and control groups (F = 12.17, p = 0.002). There were no significant differences in the slope of the SLCrel. CONCLUSION: PD subjects are able to improve the internal regulation of SL when walking on a treadmill. Our results confirm the potential therapeutic effects of treadmill training for gait rehabilitation in PD and suggest that the mechanisms underlying the positive effects of treadmill training on PD subjects are sustained.

Changes in metabolic and muscle damage indicators following a single bout of jump training on stair versus at level.

UNLABELLED: We hypothesized that stair-jump exercise would induce less muscle damage and greater acute metabolic responses than level-jumps. METHODS: Trained males executed 100 unilateral jumps on stairs with one leg, and at level with the other leg, with two weeks hiatus. Maximal isometric voluntary torque (MVC) and rate of torque development (RTD)in the quadriceps, and unilateral vertical jump height (VJ) were determined in the trained leg at pre-exercise,immediately at post- (IP), 24 h and 48 h after exercise. Serum creatine kinase (CK) level and delayed onset muscle soreness (DOMS) were evaluated at pre-exercise, 24 h and 48 h. Acute lactate and heart rate responses were also measured. RESULTS: Lactate and heart rate at IP increased similarly under the two conditions. CK was elevated and MVC was depressed while RTD and VJ remained unchanged at 24 h in both types of training. MVC recovered at 48 h only after stair-jump exercise. DOMS developed only after level-jumps. Except DOMS, no effects of condition were found in any other variables. CONCLUSIONS: We conclude that vigorous stair-jump exercise highly stresses the aerobic and the anaerobic energy system, and it preserves power and rapid torque generating ability 24 h after exercise. Stair-jump could be one alternative exercise to prevent muscle soreness.

Preoperative radiotherapy of rectal cancer--influence of fractionation and dose.

BACKGROUNDS/AIMS: We have been focused on patients with preoperative irradiation and compared two modes of radiotherapy, short-term (15 days) and long-term (45 days). METHODOLOGY: Monitored group of 183 patients who had undergone a preoperative irradiation between 01/01/1998 and 12/31/2002 were irradiated in two modes: with a dose of 45Gy applied in 25 fractions/1.8Gy per fraction (CFD45) and a dose of 34.5Gy in 15 fractions/2.3Gy per fraction (CFD34.5). RESULTS: No statistically significant difference in the occurrence of acute and postoperative complications, of locoregional recurrences and secondary dissemination, was mentioned in either group. In patients irradiated with CFD34.5 amputation of the rectum followed in 55%, and unlike the group irradiated with CFD45 the percentage of amputations was significantly lower (42%). We have recorded the average 5-year overall survival (OS) in those irradiated with CFD4.5 in 54% versus 61% in those irradiated with CFD45. More considerable conclusion was made comparing a 5-year disease-specific survival (DSS) versus the mode of irradiation, CFD34.5 57%, versus CFD45 71%. The significance level reached 10% (p = 0.057). CONCLUSIONS: Pre-operative irradiation of the rectal cancer with the dose of 45Gy in 25 fractions/dose of 1.8Gy per fraction is a standard recommended procedure.

Changes of leukocyte adherence ability under the influence of magnetic field in the course of a treatment of patients with laryngeal and pharyngeal carcinoma.

The authors were monitoring adherence ability of T lymphocytes in vitro in patients with laryngeal and pharyngeal carcinoma at the presence of tumor-specific and viral LDH antigen. The results were assessed and expressed in percent of non adherent T lymphocytes (NAL). First, NAL in patients before initiating the treatment was compared with NAL control group (voluntary blood donors). The ability of the adherence in T lymphocytes in the control group is statistically significantly higher. Further on, NAL in the course of a successful oncological treatment was monitored at the interval of 6 months following the treatment, and further on at yearly intervals. NAL level drops statistically significantly within 6 months and then hold on at levels with no statistical difference unlike the control group, however, the ability of T lymphocyte in patients to adhere remains statistically significantly lower. Statistically significantly higher levels of NAL are at the presence of LDH viral antigen. Further on, the authors were following the influence of magnetic sinusoidal field of power frequency (50 Hz) of a low induction (0.5, 0.1, and 0.05 mT) on NAL. NAL values under the influence of an experimental magnetic field before initiating the treatment as well as in the course of a successful oncological treatment are statistically significantly lower. It means that magnetic filed increases the adherence ability of T lymphocytes in patients with laryngeal and pharyngeal cancer in vitro.

[NF-kappaB, colorectal carcinoma and radiotherapy: results of a clinical and experimental study]. / NF-kappaB, kolorektální karcinom a radioterapie: výsledky klinické a experimentální studie.

Resistance to radiotherapy often seen in rectal cancer patients requires intensive study of mechanisms taking part in this process. It seems that nuclear factor-kappaB (NF-kappaB), especially its subunit p65, could play an important role in radioresistance. The aims of this study were: 1. to assess expression of p65 in rectal cancer patients and to evaluate its possible predictive role; 2. to determine in in vitro experiments possibilities of p65 modulation and to evaluate, whether this modulation can result in enhacement of efficiency of radiation therapy. We found that the level of NF-kappaB expression may serve as a predictive marker of overall survival. Further we found that inhibition of NF-kappaB activity caused by radiation improves impact of radiation therapy.

[Chronic post-mastectomy pain]. / Chronická bolest po operaci prsu.

BACKGROUND: Surgery results in chronic pain in 7-80 percent. One of the most studied is chronic post-mastectomy pain. The prevalence was 40-50 percent in studies performed abroad. As this problem has not yet been studied in the Czech Republic, a retrospective prevalence study was performed to asses the extent of the problem and risk factors for development of chronic post-mastectomy pain. METHODS AND RESULTS: After ethic committee approval an anonymous questionnaire was developed and distributed in various oncology department and patients'organisations. Response rate was 100 percent, 330 questionnaires were processed. Chronic post-mastectomy pain (lasting longer than 3 months after surgery) was described by 69 (20.9 per cent) women. The pain was permanent in 17 and transient in 46 cases, not specified in 6 cases. The pain intensity was predominantly mild or moderate. Risk factors were younger age (below 55-60 years, p=0.0098), less extensive surgery (tumourectomy vs. mastectomy, p=0.0017), intensive post operative pain (p=0.0002) and radiotherapy (p=0.0174). Trend in chemotherapy (p=0.0778) was observed. CONCLUSIONS: The prevalence of chronic post-mastectomy pain was lower in our study comparing to studies in other countries. The reason remains obscure in spite of detailed analysis.

[Progress in surgical treatment may improve the quality of life in patients with breast surgery for malignant tumors]. / Pokroky v chirurgické lécbe mohou zlepsovat kvalitu zivota pacientek po operaci prsu pro zhoubný nádor.

Breast cancer surgery (BCS) is a common procedure performed in women. Chronic postmastectomy pain (PMP) has been reported in as many as 22-72 percent of patients. There are no published reports in Czech Republic. This study was performed to evaluate the prevalence and risk factors of PMP. An anonymous questionnaire was given to women after attending oncology departments in various hospitals during 3-month period. All 176 questionnaires have returned. The average age was 63.6 (SD 11.2) years, BMI 26.3 (SD 4.0). There was 23.6% of PMP prevalence in our group. The risk factors were younger age (below 60, p < 0.001, below 65, p < 0.01 resp.) and type of surgery (total mastectomy vs. tumour removal, p < 0.01). The prevalence of PMP in our study was significantly lower than in other studies. The age of our group was higher, than in other studies, but it does not explain the difference. We can hypothesise the reason is improved surgical technique.

Kinetics of mixed lymphocyte reaction after blood transfusions.

The kinetics of mixed lymphocyte reaction (MLR) was studied in an unrelated pair of potential kidney graft donor and recipient. The recipient immunological reactivity to donor cells was specifically modulated by donor blood transfusions. Prior to transfusions, recipient MLR to donor lymphocytes expressed as per cent of the relative response (% RR) was 85.73. It dropped to 43.75 on the 21st posttransfusion day, and was as low as 19.16 on the 151st day (5th month). Next, a gradual increase in MLR occurred. The % RR increased to 46.15 in the 9th month and returned close to the pretransfusion level, to 78.30, in the 12th month. Transplantation of the kidney from the potential donor was not performed.

Cryoglobulinaemia and cryofibrinogenaemia in IgA nephropathy: a follow-up study.

Sera and plasmas from 50 patients with IgA nephropathy (IgA-NP) have been investigated for the presence of cryoglobulin (CG) and cryofibrinogen (CF), respectively, 2-5 cryoprotein determinations being made for each patient. CG was transiently found in 20 of 50 patients (40%), but in none of 20 healthy blood donors, whereas CF was found in 37 of 50 patients (74%) and in 4 of 20 healthy blood donors. The cryoprecipitates were of single and mixed component types. All but 2 of the patients with CF had haematuria. Nearly all of them had histories of long exposure to the cold as manual workers at the onset or recognition of their disease. There was no clinical remission during a 2-to-5-year follow-up if cryoproteinaemia persisted. A certain correlation was detected between the composition of the CP and the renal immunohistological findings. It is suggested that renal deposition of circulating CF or local formation of CF might be responsible for the tubulo-interstitial fibrocellular changes, which are of prognostic importance.

Circulating immune complexes in patients with IgA glomerulonephritis.

Fourty-four patients with IgA-glomerulonephritis (IgA GN) were studied for circulating immune complexes (IC) repeatedly in the course of disease on the evidence of four different methods suited for the detection of IC, viz. complement consumption assay, Clq-solubility test and two tests based on PEG-precipitation, and of indirect signs pointing to the presence of IC. Joint assessment of the direct and indirect signs (positivity of a minimum of 2 indirect signs or any of the direct signs) permitted to ascertain the presence of circulating IC in 72 per cent of the patients and in 63.3 per cent of the examined sera. There was no close relationship between the presence of IC and the clinical activity. On the other hand, in 16 patients positive for the rheumatoid factor (RF) the renal biopsy material revealed extensive vascular lesions. The findings suggest that the circulating IC, some of which contain RF, play a part in the pathomechanism of IgA GN and are involved in the production of the vascular abnormalities in this disease.

Double labelled T suppressor lymphocytes in the thymus of a patient with myasthenia gravis: morphological and immunological characteristics.

Double labelled lymphocytes were prevalent in the thymus of a 32-year-old woman with myasthenia gravis. The simultaneous presence of both E and C3b surface receptors was demonstrated. Focal paranuclear acid phosphatase activity of the cells supported their T cell origin. Histological analysis revealed a hyperplastic thymus with germinal centres in one lobe and an unusual transition to "thymoma-like" diffuse sheets of thymocytes and large thymic epithelial cells in the other lobe. Immunological studies of isolated cells from the "thymoma-like" region revealed a high percentage of E rosettes (96%), EAC rosettes (87%) and IgG-EA rosettes (60%). The large number of "active" rosettes (94%) indicated high avidity of receptors for sheep red blood cells. The postoperative accumulation of acid phosphatase positive T cells with C3b surface receptors in the peripheral blood was striking. These characteristics suggest that this cell population represents an activated T subset (TG) with a certain degree of immaturity similar to a particular stage of foetal T cell development (prothymocytes).

Serologic studies of hepatitis viruses for their aetiologic role in chronic liver disease.

Serum samples from 130 patients with chronic (persistent or active) hepatitis, including cirrhosis, and 70 patients with chronic alcoholic disease, all confirmed by biopsy, were examined by counter electrophoresis (CEP) for HBsAg. The patients were residents in the South-Transdanubian region of Hungary. Of the former 25%, of the latter 3%, proved positive. In 138 of the cases, 4 different tests were performed, viz. CEP, complement fixation, reverse passive haemagglutination (RPH) and radioimmunoassay (RIA). The results were positive in 24, 36, 43 and 60%, respectively, in chronic hepatitis and in 4, 6, 8 and 14%, respectively, in cases of alcoholic origin. Serum samples from the same patients were tested for anti-HBs and anti-HBc. Positive anti-HBs was found in 24% of the patients with chronic hepatitis and in 26% of those with alcoholic liver disease. The presence of anti-HBc was demonstrated in 42% and 38%, respectively. Joint evaluation of RPH-positive and anti-HBc positive cases on the one hand and of RIA-positive and anti-HBc positive cases on the other resulted in 68% and 71% HB virus-related positivity, respectively. The present study failed to furnish evidence in support of the presence of hepatitis A virus of its involvement in the aetiology of chronic liver disease.

HLA antigens in chronic active hepatitis.

Seventy-five patients (28 HBsAg-positive and 28 HBsAg-negative) with chronic active hepatitis (CAH) were studied for HLA antigens. In the whole material, the HLA antigens were distributed as in the controls, with the only exception of the HLA-A9 antigen, the frequency of which, as compared with the controls, was moderately increased (37.4% against 22.7%). It was mainly the HBsAg-negative group which showed a significant increase in the frequency of the HLA-A9 antigen (42.9%). In the HBsAg-negative group, as compared with the HBsAg-positive group, where the frequency of HLA-A2 was 53.2%--and as compared with the controls, too--it was relatively low 29.3%. The frequency of HLA-A1 and HLA-B8 was not increased in any type of chronic active hepatitis. HLA-B8 was less frequent in the HBsAg-positive than in the HBsAg-negative group (10.6% against 21.4%).

Levamisole treatment of acute viral hepatitis and HBsAG-positive chronic active hepatitis.

A fundamental role is attributed to the pathological immune response in the development of chronic hepatitis B. By virtue of its non-specific immune modulatory effect, levamisole is capable of improving impaired T-cell function. Hence, studies with treated and control groups were performed in determine the effect of levamisole in acute viral hepatitis and chronic active hepatitis B. In acute hepatitis B, levamisole promoted the normalization of GPT, the elimination of HBsAg; this improvement was preceded by higher GPT values and increased titres of IgG, IgA, and of anti-HBcore. In chronic active hepatitis in the first few months of treatment a moderate increase of the GPT and HBsAg levels occurred, followed later by a decrease of these values. At the same time the phytohaemagglutinin reactivity of lymphocytes increased, and so did the ratio of circulating active T-cells.

The role of hepatitis B surface antigen in the pathogenesis of glomerulopathies.

The frequency of hepatitis B surface antigen (HBsAg) has been studied in the sera and renal biopsies of 276 patients with various forms of glomerulonephritis (GN), the nephrotic syndrome and other nephropathies. Using a modified Hepanosticon method, HBs antigenemia was detected in 32 of 196 patients (16.3%) with immune complex (IC) GN and the nephrotic syndrome. Indirect immunofluorescence revealed HBsAg in 33 renal biopsy tissue specimens (16.8%). HBsAg was found in the sera of four of the 80 remaining patients with other renal diseases (5%), and in the renal biopsy tissues of another four (5%). Antibody against HBsAg could only be demonstrated in the serum of one glomerulonephritic patient. The sera of 18,799 normal blood donors were used as controls; of these 186 (0.99%) had positive tests for HBsAg. It is concluded that, in some patients with GN and the nephrotic syndrome, HBsAg-containing IC may be implicated in the development and/or progression of the disease.