Fear of progression in chronic illnesses other than cancer: a systematic review and meta-analysis of a transdiagnostic construct.

Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has rarely been studied outside of the cancer context. This review aimed to: (1) meta-synthesise qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e., seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.

Signatures of a jet cocoon in early spectra of a supernova associated with a γ-ray burst.

Long γ-ray bursts are associated with energetic, broad-lined, stripped-envelope supernovae1,2 and as such mark the death of massive stars. The scarcity of such events nearby and the brightness of the γ-ray burst afterglow, which dominates the emission in the first few days after the burst, have so far prevented the study of the very early evolution of supernovae associated with γ-ray bursts3. In hydrogen-stripped supernovae that are not associated with γ-ray bursts, an excess of high-velocity (roughly 30,000 kilometres per second) material has been interpreted as a signature of a choked jet, which did not emerge from the progenitor star and instead deposited all of its energy in a thermal cocoon4. Here we report multi-epoch spectroscopic observations of the supernova SN 2017iuk, which is associated with the γ-ray burst GRB 171205A. Our spectra display features at extremely high expansion velocities (around 115,000 kilometres per second) within the first day after the burst5,6. Using spectral synthesis models developed for SN 2017iuk, we show that these features are characterized by chemical abundances that differ from those observed in the ejecta of SN 2017iuk at later times. We further show that the high-velocity features originate from the mildly relativistic hot cocoon that is generated by an ultra-relativistic jet within the γ-ray burst expanding and decelerating into the medium that surrounds the progenitor star7,8. This cocoon rapidly becomes transparent9 and is outshone by the supernova emission, which starts to dominate the emission three days after the burst.

Binding site opening by loop C shift and chloride ion-pore interaction in the GABAA receptor model.

GABAA receptors (GABAARs) are crucial in mediating inhibition in the adult mammalian brain. Although the kinetics of this receptor has been extensively studied, the molecular picture of interactions occurring at various channel conformations remains elusive. While electrophysiology combined with mutagenesis sheds light on the role of specific residues, ultrastructural studies reveal static structures which, in the case of GABAARs, are limited to the ß3 homomer. To take advantage of the newest crystal structures of cys-loop receptors, a homology model of α1ß2γ2 GABAAR in the unbound closed state was built using a template of the homomeric glycine receptor in the closed state. The template model contained strychnine molecules at the binding sites which were removed and molecular dynamics was used to study the system relaxation. The modeled GABAAR preserved the closed conformation. Two interfaces forming orthosteric binding sites (ß2/α1) exhibited opening due to the outward shift of loop C. Similar movement, although less pronounced, was observed at the α1/γ2 (modulatory) interface. In contrast, interfaces α1/ß2 and γ2/ß2 remained closed. The former one, due to interactions mediated mainly by loops C and F, affected the neighboring ß2/α1 interface leading to asymmetry between the orthosteric binding sites. Such interactions were not observed at the ß2/α1 interface preceded by a γ2 subunit. As expected, in the channel pore, the conserved leucine gate and selectivity filter were present. However, an additional constriction was found at the top of the pore which differed from a typical hydrophobic channel gate as it consisted of charged residues. Interestingly, this site showed a capacity to trap chloride ions and to undergo conformation transition-like expansion, suggesting an impact on pore properties. In conclusion, our homology model faithfully reproduced major features of heteromeric GABAARs offering insight into the underlying mechanisms of stabilizing the shut conformation and chloride ion interaction with the channel pore.

Importance of early absolute lymphocyte count after allogeneic stem cell transplantation: a retrospective study.

INTRODUCTION: Early lymphocyte recovery after allogeneic hematopoietic stem cell transplantation (HSCT) is related to the prevention of serious infections and the clearing of residual tumor cells. METHODS: We analyzed the absolute lymphocyte count at 20 (D+20) and 30 (D+30) days after HSCT in 100 patients with malignant hematologic diseases and correlated with the risk of transplant-related mortality, overall survival (OS), disease-free survival (DFS), nonrelapsed mortality (NRM), and risk of infection. RESULTS: Patients presenting with lymphocyte counts of <300 × 103/µL on D+30 have a 3.76 times greater risk of death in <100 days. Over a medium follow-up of 20 months OS, DFS, and NRM were similar between the groups. CONCLUSION: In our group of patients delayed lymphocyte recovery after HSCT was a predictor of early death post-HSCT.

[Neonatal localized neuroblastoma: 52 cases treated from 1990 to 1999]. / Neuroblastomes localisés du nouveau-né: 52 cas traités de 1990 à 1999.

UNLABELLED: Neuroblastoma is the most frequent tumor observed in the newborn. The aim of this study was to review clinical features, treatment and outcome of newborns diagnosed with a localized neuroblastoma. POPULATION AND METHODS: Data from 52 cases treated according to the NBL 90 and 94 protocols between 1990 and 1999 in 18 French centers of pediatric oncology were analyzed. RESULTS: The median age at diagnosis was 12 days (range 0-28) with antenatal detection in 14 patients (27%). Tumor location was abdominal in 40 patients (adrenal in 20 of the 40), thoracic in eight, pelvic in three, and cervical in one. N-myc amplification was observed in one out of 40 evaluable cases. The size of the primary tumor was less than 5 cm in 25 cases, between 5 and 10 cm in 25 and more than 10 cm in two. Dumbbell tumor was observed in seven, of whom five had neurological deficit. One child died from hemorrhage after fine needle biopsy during diagnostic procedure. Primary surgical resection was attempted in 37 infants, of whom two died of surgery related complications and three had nephrectomy. Tumor was deemed as unresectable in 14 patients, and primary chemotherapy was given followed by surgical excision in 12. One of them died a few days after the beginning of chemotherapy. As a whole, continuous complete remission was achieved in 48 children, four of them after relapse. Overall survival was 92% with a median follow-up of 46 months (0-113 months). CONCLUSION: The excellent prognosis of localized NB in neonates needs very restrictive surgical indications, with well-established anatomic and imaging criteria. Indeed, chemotherapy based on weight and managed by expert teams should allow to perform surgical excision in safer conditions for unresectable tumors.

Emotional and behavioral symptoms in children with acute leukemia.

BACKGROUND AND OBJECTIVES: The diagnosis of leukemia is probably one of the most severe stressors that children can experience and may be associated with emotional and behavioral symptoms indicating comorbidity with mental health disorders. This study aims to evaluate the presence of emotional and behavioral symptoms in children with acute leukemia exposed to chemotherapy from outpatient services at two university hospitals in Brazil. DESIGN AND METHODS: In this cross-sectional study, emotional and behavioral symptoms were assessed using the Children Behavior Checklist (CBCL) in three groups of children aged 5-14 years: a) children with acute leukemia (n = 21); b) children with blood dyscrasias (n = 21); c) children evaluated or treated in a pediatric outpatient service (n = 33). RESULTS: Children with blood dyscrasias had significantly few symptoms of externalization (delinquent and aggressive behavior) than pediatric controls (p< 0.05). Children with leukemia did not differ from the two other groups regarding symptoms of externalization. No significant difference on the scores of the CBCL internalization dimension (anxiety, depression, somatic symptoms and withdrawn) was found among the three groups. INTERPRETATION AND CONCLUSIONS: These findings seem to indicate that children with acute leukemia do not have more emotional or behavioral symptoms than children with benign hematologic or physical diseases suggesting that comorbidity with mental disorders is not higher in children with acute leukemia than in children in the other two groups.

Effect of acute and repeated restraint stress on glucose oxidation to CO2 in hippocampal and cerebral cortex slices.

It has been suggested that glucocorticoids released during stress might impair neuronal function by decreasing glucose uptake by hippocampal neurons. Previous work has demonstrated that glucose uptake is reduced in hippocampal and cerebral cortex slices 24 h after exposure to acute stress, while no effect was observed after repeated stress. Here, we report the effect of acute and repeated restraint stress on glucose oxidation to CO2 in hippocampal and cerebral cortex slices and on plasma glucose and corticosterone levels. Male adult Wistar rats were exposed to restraint 1 h/day for 50 days in the chronic model. In the acute model there was a single exposure. Immediately or 24 h after stress, the animals were sacrificed and the hippocampus and cerebral cortex were dissected, sliced, and incubated with Krebs buffer, pH 7.4, containing 5 mM glucose and 0.2 microCi D-[U-14C] glucose. CO2 production from glucose was estimated. Trunk blood was also collected, and both corticosterone and glucose were measured. The results showed that corticosterone levels after exposure to acute restraint were increased, but the increase was smaller when the animals were submitted to repeated stress. Blood glucose levels increased after both acute and repeated stress. However, glucose utilization, measured as CO2 production in hippocampal and cerebral cortex slices, was the same in stressed and control groups under conditions of both acute and chronic stress. We conclude that, although stress may induce a decrease in glucose uptake, this effect is not sufficient to affect the energy metabolism of these cells.

Effect of acute and repeated restraint stress on glucose oxidation to CO2 in hippocampal and cerebral cortex slices

It has been suggested that glucocorticoids released during stress might impair neuronal function by decreasing glucose uptake by hippocampal neurons. Previous work has demonstrated that glucose uptake is reduced in hippocampal and cerebral cortex slices 24 h after exposure to acute stress, while no effect was observed after repeated stress. Here, we report the effect of acute and repeated restraint stress on glucose oxidation to CO2 in hippocampal and cerebral cortex slices and on plasma glucose and corticosterone levels. Male adult Wistar rats were exposed to restraint 1 h/day for 50 days in the chronic model. In the acute model there was a single exposure. Immediately or 24 h after stress, the animals were sacrificed and the hippocampus and cerebral cortex were dissected, sliced, and incubated with Krebs buffer, pH 7.4, containing 5 mM glucose and 0.2 æCi D-[U-14C] glucose. CO2 production from glucose was estimated. Trunk blood was also collected, and both corticosterone and glucose were measured. The results showed that corticosterone levels after exposure to acute restraint were increased, but the increase was smaller when the animals were submitted to repeated stress. Blood glucose levels increased after both acute and repeated stress. However, glucose utilization, measured as CO2 production in hippocampal and cerebral cortex slices, was the same in stressed and control groups under conditions of both acute and chronic stress. We conclude that, although stress may induce a decrease in glucose uptake, this effect is not sufficient to affect the energy metabolism of these cells

School dropout and conduct disorder in Brazilian elementary school students.

OBJECTIVES: To evaluate the association between DSM-IV conduct disorder (CD) and school dropout in a sample of students from the third and fourth elementary grades at state schools in the capital of the southernmost state of Brazil. METHODS: In this case-control study, students that dropped out of schools (n = 44) and a control group who continued attending schools (n = 44) were assessed for CD and other prevalent mental disorders, using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiological Version (K-SADS-E). RESULTS: The prevalence of DSM-IV CD was significantly higher in the school-dropout group than in control subjects (P < 0.001), both in the entire sample and in a subsample including only subjects under age 12 years (P = 0.001). Also, the odds ratio (OR) for school dropout was significantly higher in the presence of DSM-IV CD, even after controlling for potential confounding factors (age, estimated IQ, school repetition, family structure, and income) (P < 0.01). CONCLUSION: Our results extend to children and young adolescents previous findings from studies of older adolescents, suggesting an association between school dropout and CD.

Effect of repeated restraint stress on memory in different tasks.

The present study investigated the effect of repeated stress applied to female rats on memory evaluated by three behavioral tasks: two-way shuttle avoidance, inhibitory avoidance and habituation to an open field. Repeated stress had different effects on rat behavior when different tasks were considered. In the two-way active avoidance test the stressed animals presented memory of the task, but their memory scores were impaired when compared to all other groups. In the habituation to the open field, only the control group showed a significant difference in the number of rearings between training and testing sessions, which is interpreted as an adequate memory of the task. In the handled and chronically stressed animals, on the other hand, no memory was observed, suggesting that even a very mild repeated stress would be enough to alter habituation to this task. The performance in the inhibitory avoidance task presented no significant differences between groups. The findings suggest that repeated restraint stress might induce cognitive impairments that are dependent on the task and on stress intensity.

Effect of repeated restraint stress on memory in different tasks

The present study investigated the effect of repeated stress applied to female rats on memory evaluated by three behavioral tasks: two-way shuttle avoidance, inhibitory avoidance and habituation to an open field. Repeated stress had different effects on rat behavior when different tasks were considered. In the two-way active avoidance test the stressed animals presented memory of the task, but their memory scores were impaired when compared to all other groups. In the habituation to the open field, only the control group showed a significant difference in the number of rearings between training and testing sessions, which is interpreted as an adequate memory of the task. In the handled and chronically stressed animals, on the other hand, no memory was observed, suggesting that even a very mild repeated stress would be enough to alter habituation to this task. The performance in the inhibitory avoidance task presented no significant differences between groups. The findings suggest that repeated restraint stress might induce cognitive impairments that are dependent on the task and on stress intensity

Epinephrine effects on memory are not dependent on hepatic glucose release.

Epinephrine released or administered soon after a given training task modulates memory processes. Since epinephrine does not readily cross the blood-brain barrier, studies have suggested that some of the central effects of epinephrine might be mediated by peripheral release of glucose. These experiments examined the involvement of blood glucose levels in the posttraining effects of peripherally administered epinephrine. The effects of the administration of epinephrine (25 and 625 microg/kg) [corrected] on memory of an inhibitory avoidance task were evaluated in fed and fasted rats (depleted glycogen stores in liver). Blood glucose levels after the task in each group were also measured. Female Wistar rats were divided in two groups. Fed and 48-h-fasted animals were submitted to the inhibitory avoidance task and received i.p. epinephrine or saline immediately after training. The test session was carried out 48 h after training. Epinephrine (25 or 625 microg/kg) [corrected] caused an increased glycemia in fed rats, but no effect was observed in fasted animals. Administration of epinephrine 25 microg/kg [corrected] induced a facilitation of memory, while epinephrine 625 microg/kg [corrected] impaired retention (either in fasted or in fed animals). There was no relation between increased glycemia induced by epinephrine and its effects on memory, since this drug presented its classical effects independently of the previous state of the animal (fed or fasted). The results of the present study suggest that the effects of systemic released or administered epinephrine on memory processes are not dependent on hepatic glucose release.

Effect of restraint stress on feeding behavior of rats.

The expression of appetite reflects the complex functioning of a psychobiological system organized in different levels closely related to each other, in which emotional changes can influence feeding behavior. Benzodiazepines are widely used as anxiolytics and can change behaviors caused by stress. The aim of the present study was to verify the feeding behavior of rats, submitted or not to fasting, after acute and chronic restraint stress. We also evaluated the response to the ingestion of sweet food of chronically restrained animals after the administration of diazepam. Male adult Wistar rats were exposed to restraint 1 h/day for 50 days in the chronic model. In the acute model, there was a single exposure. Four hours after the stress, the animals were placed in a lightened area in the presence of 10 pellets of sweet food (Froot Loops). The number of ingested Froot Loops was measured during a period of 3 min in the presence or absence of fasting. The groups acutely stressed showed ingestion similar to that of the control group, whether they had been fasted or not. The chronically stressed animals showed increased ingestion of sweet food. Diazepam given 60 min before the test session of the stressed rats reduced the ingestion of these animals to control levels. Thus, the chronic stress increases appetite for sweet food, independently of hunger, and diazepam is able to reverse this behavior.

A contribution of the Asian female immigrants into the Canadian population.

"In Canada, the proportion of women among immigrants fluctuates around 50 percent, with a slight increase in recent years. Another important characteristic of immigration...is a radical change in the composition of origin of flows in the past three decades--European-dominated streams have been replaced by those originating mostly in Asia. This paper focuses on female Asian immigrants in Canada.... Major Asian source countries of female immigrants (Hong Kong, Philippines, India, China, Sri Lanka, Taiwan, Lebanon and Iran) give evidence to the growing importance of political push factors and sending countries' policies-facilitation factors as crucial determinants of international migration."

The elderly and international migration in Canada: 1971-1986.

"This paper addresses issues of elderly immigrants in Canada within two areas: their characteristics as immigrants and their contribution to the social phenomenon of the aging of the Canadian population. The patterns of net immigration of persons aged 60 years and over are identified according to sex, age and place of origin of immigrants.... Emigration of this group is studied separately. The results of the analysis demonstrate that the elderly immigrant population displays migration patterns significantly different from that of the total immigrant population. Older immigrants participate even more extensively than their younger counterparts in the process of remigration or return migration. As a consequence, an increase of the proportion of older immigrants...does not necessarily accelerate the aging of the Canadian population." (SUMMARY IN ITA)

Foreign-born Canadian emigrants and their characteristics (1981-1986).

"This article provides estimates of levels and structures of recent return migration from Canada. Estimates are distinguished according to sex, period of immigration and place of birth of foreign-born emigrants. Special attention is paid to propensity to return. The impact of return migration on change of foreign-born populations is also evaluated." This is a revised version of a paper originally presented at the 1989 Annual Meeting of the Population Association of America (see Population Index, Vol. 55, No. 3, Fall 1989, p. 426).

Mortality differentials among immigrant populations in Canada.

PIP: Mortality among different groups of migrants to Canada is compared with that of native-born Canadians and with trends in the migrants' countries of origin, using data for the period 1981-1985. Results show that life expectancy at birth among migrants in Canada is generally higher than that of the populations at place of origin and destination. (SUMMARY IN FRE AND SPA)^ieng

Two neglected categories of immigrants to Canada: temporary immigrants and returning Canadians.

Results are presented from an attempt to improve Canadian statistics on international migration so as to comply with U.N. guidelines by including data on long-term residents with temporary status and Canadian citizens and permanent residents returning from abroad. "The estimation procedures involve extensive operations on three Canadian administrative data systems: the Visitors Immigration Data System of Employment and Immigration Canada; the Family Allowances Files of Health and Welfare Canada; and the Customs and Excise Files of Revenue Canada. These data are used to produce the number of immigrants in both of the neglected categories, as well as to calculate the geographic (origin and destination) and demographic (sex, age, marital status) structures of these groups. Results of the analysis of estimates for the period 1982-1988 show that, due to their size and characteristics, both of these neglected categories of immigrants constitute a significant part of immigration to Canada, and their importance has and will continue to increase over time."

Adjustment of immigrants in Canada: methodological possibilities and its implications.

PIP: Progress in research on the adaptation of immigrants depends on the resolution of both its methodological and empirical aspects. Adaptation can be defined in operational terms as "partaking in the life of the country productively and to one's advantage." The society to which immigrants need to adapt is usually highly developed. Factors that influence immigrants' adaptation are 1) demographic factors, 2) economic factors, 3) social factors, 4) the immigration policy of the country of destination, and 5) the motives for immigration combined with information on the country of destination. 3 models analyze the socioeconomic adaption of immigrants: 1) the assimilation model (the period of immigration is the most important determinant of immigrants' adjustment); 2) the ethnic stratification model (status at entry to the receiving country differs for different ethnic groups); 3) the structural differences model (demographic, economic, and social characteristics of immigrants interact and may influence the adaptation process). The author examines the adjustment process of immigrants to Canada on the assumption that the age of immigrants at the moment of arrival in Canada plays the most important role in adaptation. The following are factors in the adaptation process in order of importance: 1) person's age at the moment of arrival (PAMA) in Canada, 2) duration of residence in Canada, and 3) membership in an ethnic group. The immigrant population is stratified by cohorts defined according to these factors. The author divides nonimmigrant cohorts into 4 stages: 1) exploration (age 24 and under), 2) stabilization (age 25-44), 3) mature (45-59), and 4) reconciliation stage (age 60 and over). He further defines 6 cohorts of immigrants: 1) preschool and school population (early exploration stage, 0-16); 2) vocational training, university, and 1st stage of family formation (terminal period of exploration stage, age 17-24); 3) prime family formation period and 1st stage of work experience (1st period of professional stabilization stage, age 25-34); 4) terminal period of family and household formation and prime period of professional stabilization (2nd period of professional stabilization stage, age 35-44); 5) older worker population (mature stage, age 45-59); 6) workers before retirement and elderly population (reconciliation stage in professional life, age 60 and over). By defining immigrant subpopulations using both the PAMA and "ethnicity" factors as the criteria, one can examine the roots of the observed variation across subpopulations from both structural and cultural points of view.^ieng