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Background: Adolescents and young adults (AYAs; ages 15–29 years) diagnosed with cancer are increasingly recognized as an oncology population with distinct psychosocial needs. However, few specialized psychosocial interventions for AYAs currently exist. This study reports on the development of a novel group‐based psychotherapy intervention to address the psychosocial needs of AYAs. The objective was to evaluate the acceptability, feasibility, and preliminary effects of the intervention. Methods: The manualized group psychotherapy program is delivered virtually over an 8‐week period by registered psychologists. Four groups (n = 5–11 AYAs per group) with a total of N = 33 participants (Mage = 20.97 years, SD = 3.68, range = 15–29 years, 76% women) were conducted. Recruitment and retention data assessed intervention feasibility. Patient‐reported psychosocial outcomes were measured at baseline and immediately following the intervention to assess preliminary effects. Acceptability was assessed following the intervention using a self‐report measure of participant satisfaction. Results: Overall, the completion rate of the intervention was 85% (n = 28). All participants "strongly agreed" (88%) or "agreed" (13%) that they were satisfied with the group. Meeting, sharing experiences, and expressing feelings with other AYAs were identified as the most helpful aspects. Participants reported significant improvements in emotional (p < 0.05) and functional (p < 0.01) quality of life from baseline to immediately post‐intervention with medium effect sizes (d = 0.58–0.70). Conclusions: Findings suggest that the intervention is feasible, acceptable, and shows promise for improving psychosocial outcomes for AYAs. Further research will refine the intervention and establish efficacy in a randomized trial. [ABSTRACT FROM AUTHOR]

Objective: Bodily threat monitoring is a core clinical feature of Fear of cancer recurrence (FCR) and is targeted in psycho‐oncology treatments, yet no comprehensive self‐report measure exists. The aim of this study was the theory‐informed development and initial validation of the Bodily Threat Monitoring Scale (BTMS). Methods: Adult survivors of breast and gynaecological cancers (Study 1: N = 306, age = 37–81 years) and childhood cancer survivors (Study 2: N = 126, age = 10–25 years) completed the BTMS, designed to assess how individuals monitor for and interpret uncertain symptoms as indicating that something is wrong with their body. Participants completed measures to assess construct and criterion validity of the BTMS, and childhood cancer survivors (Study 2) completed the BTMS again 2 weeks later to assess test‐retest reliability. Results: The 19‐item BTMS demonstrated excellent internal consistency across adult and childhood cancer samples (α = 0.90–0.96). Factor analyses indicated two subscales capturing 1. Monitoring of bodily sensations and 2. Threatening interpretations of bodily sensations. Two‐week stability estimates were acceptable. For construct validity, the BTMS correlated with body vigilance and anxiety sensitivity. The BTMS also demonstrated criterion validity, yielding significant associations with FCR, intolerance of uncertainty, help‐seeking behaviours, and quality of life. The BTMS was associated with FCR while controlling for body vigilance and anxiety sensitivity, indicating a unique contribution of this theory‐informed measure. Conclusions: The BTMS shows evidence of sound psychometric properties and could be used to elucidate the role of bodily threat monitoring in the maintenance and management of FCR. [ABSTRACT FROM AUTHOR]

Objective: Children with juvenile idiopathic arthritis (JIA) are faced with a complex medical journey requiring consistent adherence to treatments to achieve disease management. Parents are intimately involved in JIA treatments; however, little is known about their experiences in this role. This is relevant as many treatments necessitate procedural pain (e.g., self-injections) or side effects (e.g., nausea), which may impact a parents' ability to follow treatment plans. The objective of this study was to explore the lived experiences of parents who identified challenges with their child's JIA treatments.Methods: Parents of children with JIA who identified challenges with their child's treatments were invited to take part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis.Results: Ten mothers of children with JIA (60% female with a mean age of 11.83 years [range 4-16 years]) participated. Four superordinate themes were present in mothers' experiences: 1) treatments altered mothers' roles within the family, increasing their caregiver burden and advocacy; 2) treatments positively and negatively impacted their relationships (e.g., increased support from others, decreased time with others); 3) treatments elicited various emotional responses (e.g., frustration, grief), which affected their well-being; and 4) treatments were at times a source of internal conflict, affecting mothers' actions and adherence.Conclusion: Mothers' experiences with their child's JIA treatments affects them in various ways that can subsequently impact treatment adherence. Results highlight the value of supporting parents through these complex treatment regimens and incorporating their experiences in treatment decisions to help promote optimal outcomes for children with JIA and their families. [ABSTRACT FROM AUTHOR]

Objective: Scan‐related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow‐up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real‐world, real‐time capture of scanxiety using patients' personal smartphone. Methods: Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. Results: Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. Conclusions: Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety. [ABSTRACT FROM AUTHOR]

Objective: Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory‐Short Form (FCRI‐SF) for survivors of childhood cancer aged 8–18 years (Fear of Cancer Recurrence Inventory—Child version [FCRI‐C]) and their parents (Fear of Cancer Recurrence Inventory—Parent version [FCRI‐P]) to self‐report on their own FCR and to examine the initial psychometric properties. Methods: The FCRI‐SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI‐C and FCRI‐P were examined in 124 survivors of childhood cancer (43% female; Mage = 14.58 years, SD = 2.90) and 106 parents (90% mothers). Results: All FCRI‐SF items were retained for the FCRI‐C with simplified language. The internal consistencies of the FCRI‐C (α = 0.88) and FCRI‐P (α = 0.83) were good. Exploratory factor analyses yielded one‐factor structures for both measures. Higher scores on the FCRI‐C and FCRI‐P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents. Conclusions: The FCRI‐C and FCRI‐P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI‐C and FCRI‐P to measure FCR in survivors of childhood cancer aged 8–18 years and their parents. [ABSTRACT FROM AUTHOR]

New parents experience significant disruption to their sexual relationships such as lower desire and sexual frequency relative to prepregnancy. Little is known about the sexual distress new parents feel related to these changes, how sexual distress evolves over time, or how coping with stress relates to this distress. New parent couples who engage in more adaptive, joint coping with mutual stressors—common dyadic coping (CDC)—may be better able to manage distress related to their sexuality and thus, experience less sexual distress at 3‐months postpartum and experience more marked improvement over time. In 99 first‐time parent couples, we examined the link between CDC measured at 3‐months postpartum and trajectories of sexual distress across 3‐, 6‐, and 12‐months postpartum. Analyses used dyadic latent growth curve modeling informed by the actor–partner interdependence model. Mothers' sexual distress at 3‐months postpartum was clinically elevated and higher than their partner's. Mothers' sexual distress declined significantly over time, whereas partners' sexual distress remained low and stable. An individual's higher perceptions of CDC was significantly associated with their own (but not their partner's) lower sexual distress at 3‐months postpartum. No significant associations were found between CDC and change in sexual distress over time. How new parents jointly cope with stressors early in the postpartum period may lessen the distress they have about their sexuality at a time when most couples have just resumed sexual activity. Results identify CDC as a possible novel target for interventions aimed at helping couples manage sexual distress during the transition to parenthood. [ABSTRACT FROM AUTHOR]

Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and 4) recommendations for future research. Data sources for the study were articles published from January 1990 to August 2019 identified in the PubMed, PsycINFO, EMBASE, and Web of Science data bases. Eligible studies included: 1) original research, 2) quantitative assessments of pain, 3) articles published in English, 4) cancers diagnosed between birth and age 21 years, 5) survivors at 5 years from diagnosis and/or at 2 years after therapy completion, and 6) a sample size >20. Seventy‐three articles were included in the final review. Risk of bias was considered using the Cochrane risk of bias tool. The quality of evidence was evaluated according to Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Common measures of pain were items created by the authors for the purpose of the study (45.2%) or health‐related quality‐of‐life/health status questionnaires (42.5%). Pain was present in from 4.3% to 75% of survivors across studies. Three studies investigated chronic pain according the definition in the International Classification of Diseases. The findings indicated that survivors of childhood cancer are at higher risk of experiencing pain compared with controls. Fatigue was consistently associated with pain, females reported more pain than males, and other factors related to pain will require stronger evidence. Theoretically grounded, multidimensional measurements of pain are absent from the literature. Survivors of childhood cancer are at higher risk of experiencing pain compared with controls. Future research is urgently needed to discern the true prevalence of pain among this vulnerable population and to develop interventions to enhance the quality of survivorship. [ABSTRACT FROM AUTHOR]

Keywords: adolescent and young adult; cancer survivor; distress screening; fear of cancer recurrence; psycho-oncology; qualitative; semi-structured interview EN adolescent and young adult cancer survivor distress screening fear of cancer recurrence psycho-oncology qualitative semi-structured interview 123 126 4 01/28/21 20210101 NES 210101 BACKGROUND Fear of cancer recurrence (FCR), defined as "fear, worry or concern relating to the possibility that cancer will come back or progress,"1 is emerging as a primary survivorship issue. Qualitative research interviews could be a useful method for conducting FCR research that is both theory-advancing and patient-centered, however given observed individual variability in distress ratings it will be valuable to implement distress screening protocols in such studies going forward. [Extracted from the article]

Aims: Fear of cancer recurrence (FCR) is among the most prevalent and distressing concerns reported by cancer survivors. While younger age is the most consistent predictor of elevated FCR, research to date has focused almost exclusively on adult cancer survivors. This is despite the fact that children with cancer are more likely to survive compared to adults, and will become regular, lifelong users of the medical system to mitigate the effects of toxic treatment. The early experience of cancer yields unique challenges and circumstances that may impact children's capacity for and experience of FCR across the developmental trajectory. The aim of this paper is to present a developmental perspective of FCR from infancy to young adulthood. Methods: Drawing on the developmental science literature and recent theoretical advancements in FCR, we outline cognitive and social factors that may influence children's capacity for and experience of FCR across the developmental trajectory. Results: First, distinct developmental groups that fall under the classification of "childhood cancer survivor," and that all require attention, are summarized. Using the structure of these groupings, we centrally provide a developmental perspective of FCR that offers a useful starting point for research in pediatric populations. Key research gaps, including the need for validated assessment tools to measure FCR in child and adolescent survivors, are highlighted. Conclusions: Consideration of the unique context of childhood is needed to guide the identification of childhood cancer survivors at risk for FCR as well as the development of effective FCR interventions for this population. [ABSTRACT FROM AUTHOR]

Objective: Today, more than 80% of children diagnosed with cancer are expected to survive. Despite the high prevalence of pain associated with the diagnosis and treatment of childhood cancer, there is a limited understanding of how having cancer shapes children's experience and meaning of pain after treatment has ended. This study addresses this gap by exploring childhood cancer survivors' (CCS') experiences of pain from their perspective and the perspective of their parents.Methods: Twenty semi-structured interviews were completed with CCS (50% female; mean age = 13.20 y, range = 8-17 y) and their parents (90% mothers). Data were analyzed using interpretive phenomenological analysis.Results: Analyses revealed three superordinate themes present in the data: (a) pain is a changed experience after childhood cancer; (b) new or ambiguous pains may be interpreted by CCS and parents as a threat of disease recurrence, late effects, or a secondary cancer; and (c) pain interpretation occurs within the broader context of how CCS and parents appraise their cancer experience. Parents generally appraised their child's cancer and pain as more threatening and were influential in guiding their child's interpretations.Conclusions: The cancer experience played an important role in shaping CCS' and their parents' experience and interpretation of pain in survivorship. This study provides novel data to inform the development and refinement of new and existing conceptual models of pain and symptom perception after cancer. The results also point to key areas for future investigation and clinical intervention to address the issue of pain in cancer survivorship. [ABSTRACT FROM AUTHOR]

The significance of paroxysmal nocturnal haemoglobinuria ( PNHpos) cells and leucocyte subset telomere lengths in paediatric aplastic anaemia ( AA) is unknown. Among 22 children receiving immunosuppressive therapy ( IST) for AA, 73% (16/22) were PNHpos, of whom 94% achieved at least a partial response ( PR) to IST; 11/16 (69%) achieved complete response ( CR). Only 2/6 (33%) PNHneg patients achieved PR. PNHpos patients were less likely to fail IST compared to PNHneg patients (odds ratio 0·033; 95% confidence interval 0·002-0·468; P = 0·012). Children with AA had short granulocyte ( P = 7·8 × 10−9), natural killer cell ( P = 6·0 × 10−4), naïve T lymphocyte ( P = 0·002) and B lymphocyte ( P = 0·005) telomeres compared to age-matched normative data. [ABSTRACT FROM AUTHOR]

Cognitive and functional decline in Alzheimer's disease (AD) may show different, yet correlated, rates of progression. Over a 2-year period we investigated the predictive role of neuropsychological and behavioural variables on the cognitive and functional decline of 43 patients with AD. Slow and fast decliners were defined on the basis of cognitive and functional indexes of disease progression. We found that cognitive decline was predicted by diffuse cognitive impairment and functional progression by visuospatial deficits. Psychotic symptoms predicted faster disease progression in both cognitive and functional dimensions. [ABSTRACT FROM AUTHOR]

Rebound insomnia is a transient intense worsening of sleep usually appearing within 3 days from the abrupt discontinuation of benzodiazepines (mainly short-acting), following long term use and abuse of these hypnotics. Zolpidem is an imidazopyridine, that binds selectively at ω1-receptor subtypes within the GABAA receptor supramolecular complex. It has a rapid onset of action and short-elimination half-life; it reduces the latency of sleep and prolongs the duration of sleep in patients with insomnia, without any major effects on sleep stages and rebound effects upon discontinuation. The present multicentre trial (three Italian centres) was aimed at assessing the symptoms/signs of rebound insomnia after discontinuation of either zolpidem or triazolam. A double-blind, randomized, parallel group trial of 20-day duration was carried out in 22 patients suffering from either transient insomnia, or short-term (situational stress) insomnia, or patients who were poor sleepers. The trial consisted of three periods: a 3-day run-in period with placebo, a 14-day active treatment period (zolpidem 10 mg od or triazolam 0.25 mg od), a 3-day withdrawal period with placebo. There were statistically significant [p=0.0064 for Total Sleep Time (TST) and p=0.0051 for Sleep Efficiency (SE%)] differences between triazolam- and zolpidem-treated patients during the first withdrawal night versus baseline: TST decreased to 34.5 rain after triazolam but increased to 43.8 rain after zolpidvm, and a similar evolution was shown on SE% (a decrease of 6.3 per cent after triazolam and an increase of 9.9 per cent after zolpidem). Also the Wake-time After Sleep Onset (WASO) showed a statistically significantly (p=0.0083) different pattern, during the first withdrawal night, remaining decreased after zolpidem (37.5 min) but suddenly increasing after triazolam (17.3 min). Also the subjective time to fall asleep changed with a statistically significant difference (p=0.042), being increased after triazolam (8.6 min) and decreased after zolpidem (20.8 min). The results of the study demonstrate the presence of clear rebound insomnia after triazolam discontinuation, whereas such a drawback is absent with zolpidem. This allows the abrupt discontinuation of zolpidem without any need for a tapering procedure and without any risk of pharmacological dependence. [ABSTRACT FROM AUTHOR]

Background: Current theories assume that retrograde memory deficits for semantic information in amnestic mild cognitive impairment (aMCI) are temporally graded and partially sparing most remote memories. Moreover, these models assume a prevalent role of the hippocampus in early phases of memory consolidation and of the prefrontal mesial neocortical areas in permanent consolidation of traces., Purpose: To explore the relationship between hippocampus and memory accuracy for the most recent public events and between the ventro-medial prefrontal cortex (vmPFC) and memory accuracy irrespective of the memory age, we investigated in aMCI patients the retrograde memory for public events and its relationship with grey matter volume reductions in the hippocampus and vmPFC., Methods: 18 aMCI patients and 13 healthy subjects (HS) underwent a modified version of the Famous Events questionnaire (FEq) to assess their memory performance for public events. Patients underwent 3T-MRI scanning to assess correlations between FEq's scores and grey matter volumes., Results: aMCI showed significantly reduced performances on FEq compared to HS in the recollection of most recent events, while no significant difference was observed for more remote memories, thus demonstrating a temporal gradient. Moreover, hippocampal volumes predicted accuracy scores for most recent, but not older, public events. Finally, an area in the subcallosal portion of the vmPFC, corresponding to BA32, predicted accuracy scores on FEq irrespective of the period examined., Conclusions: Pathological changes in a neural circuit linking hippocampal to medial prefrontal cortical regions are responsible for impaired recollection of retrograde memories in aMCI., (© 2021 The British Psychological Society.)

Objectives: Working memory (WM) for verbal and visual material may be affected early in individuals with mild cognitive impairment (MCI). Verbal and visuospatial span tasks, that is neuropsychological procedures commonly used for the clinical assessment of WM, have been scarcely investigated in these patients. Therefore, this study was aimed at evaluating whether performance on tests of verbal and visual-spatial span (which rely to different extents on distinct components of the WM system) is differently sensitive to the presence of MCI and, in particular, of a preclinical AD condition in patients with MCI., Materials & Methods: 99 patients with amnesic MCI were given the Digit Span Forward (DSF) and Digit Span Backward (DSB) tests and the Corsi span task (CS) at baseline and were followed up for two years. 32 MCI patients converted to Alzheimer's disease (MCIc), but 67 patients did not deteriorate to meet the criteria for AD (MCIs)., Results: Results showed that although performance on DSF did not differ between groups, performance on DSB and CS and ratio indexes indicative of a performance decline passing from DSF to DSB and from DSF to CS significantly discriminated between a group of matched healthy controls and the overall group of MCI patients. Moreover, the ratio indexes significantly discriminated between MCIc and MCIs individuals., Conclusions: These data are consistent with the hypothesis that individuals with MCI, particularly those destined to convert to AD, are affected by reduced central executive resources even though the phonological loop is still functioning normally., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The role of the hippocampus and neocortical areas in the retrieval of past memories in pre-dementia Alzheimer's disease (AD) patients was investigated. The aim was to assess whether the hippocampus has a temporary role in memory trace formation, according to the Cortical Reallocation Theory (CRT), or whether it continuously updates and enriches memories, according to the Multiple Trace Theory. According to the former theory, hippocampal damage should affect more recent memories, whereas the association cortex is expected to affect memories of the entire lifespan. In the second case, damage to either the hippocampus or the association cortices should affect memories of the entire lifespan. Seventeen patients with amnestic Mild Cognitive Impairment due to AD were submitted to autobiographical (i.e., episodic and semantic personal) memory assessment. Patients underwent MRI for the acquisition of T1-weighted brain volumes. Voxel-based morphometry was used to assess correlations between grey matter (GM) volumes and autobiographical memory. Correlation analyses revealed a strict association between GM volumes in the hippocampus and patients' ability to retrieve the most recent but not the oldest autobiographical memories in both aspects, episodic and semantic. Moreover, patients' GM volumes in the pre-frontal and temporal polar areas were associated with recollection of episodic and semantic events, respectively. Finally, GM volumes in the precuneus and occipital cortex were associated with retrieval of the most recent episodic events. These findings indicate that the hippocampus has a specific time-dependent role; thus, they support the CRT., (© 2018 The British Psychological Society.)

Experiments with semantic priming (SP) paradigms have documented early hypopriming in patients with AD when concepts are used as primes and attribute concept features as targets, suggesting that concept attributes are vulnerable to damage very early in the disease course. The aims of this study were to confirm early priming reduction in the attribute condition in patients with AD and to determine which of several semantic indexes (such as the level of distinctiveness, correlation or feature dominance of concept features) best predicts the priming effect size in AD. We administered an SP attribute condition paradigm to 20 mildly demented patients with AD and to 10 NCs. We used concept-attribute pairs for which normative data of semantic indexes relative to both concept primes (i.e., number, type, mean level of dominance, distinctiveness and correlation of features constituting the concepts) and target features (i.e., level of feature dominance, correlation and distinctiveness) were available. Results showed that compared to NCs, the AD group obtained very reduced priming facilitation. Furthermore, the item regression analyses showed that the priming decrement in the AD group was predicted by the feature dominance of the target in the related pairs; that is, the lower the target feature dominance, the lower the priming effect elicited. These results confirmed hypopriming in the attribute condition from the very early phase of AD and support the view that attributes which are more salient for the identification of a given concept are also those most resistant to semantic memory degradation in AD pathology., (© 2018 The British Psychological Society.)

Introduction: Patients with amnestic mild cognitive impairment (a-MCI) are deficient in storing memory traces relative to recollective forms of declarative memory. Controversial data have, instead, been reported concerning the storage of new memory traces relative to familiarity, with some studies reporting impairment and others sparing of the storage of this form of memory. No data have been reported concerning the consolidation of recollection and familiarity memory traces subsequent to their storage., Methods: To investigate consolidation deficits resulting in accelerated forgetting of the memory trace, we submitted 16 patients with a-MCI and 19 age-matched normal controls (NC) to a verbal version of the experimental paradigm devised by Huppert and Piercy (1977, Neuropsychologia, 15, 643; 1978, Nature, 275, 317), which we modified to obtain a subjective judgement of the memory process (i.e., recollection or familiarity) for each remembered word that had prompted the 'old' response. The y/n recognition tests with a remember/know paradigm were given 10 min, 1 hr, and 24 hr after the study phase., Results: Data demonstrated that patients with a-MCI forgot the memory traces relative to both the recollection and the familiarity components of recognition at the same rate as NC., Conclusions: Evidence was particularly strong for the familiarity component (where a-MCI patients scored the same as NC at all three delay intervals), but was less robust for the recollection data (where an equivalent forgetting rate across the three delay intervals could be demonstrated only for subgroups of a-MCI patients and NC who obtained comparable scores on the 10-min test)., (© 2016 The British Psychological Society.)

Introduction: In a door-to-door two-phase survey of common neurologic diseases conducted in two Sicilian municipalities, we investigated the incidence and the lifetime prevalence of Bell's palsy (BP)., Material & Methods: During phase I, we administered a screening instrument for facial palsy to 11,901 adult persons. During phase 2, study neurologists using specified diagnostic criteria evaluated those subjects who screened positive., Results: We found 73 subjects who had experienced BP during their life. The lifetime prevalence as of November 1, 1987, was 642.8 cases per 100,000 population age 15 years and above. The prevalence increased with age and was similar in men and women. Eighteen episodes of BP occurred in the three years preceding the prevalence day. The average annual incidence rate was 52.8 new episodes per 100,000 population age 15 years and above. Incidence increased with age., Conclusion: Comparison with other incidence studies suggests some geographic variability.

Objectives: As part of a door-to-door survey of neurologic diseases, we investigated the prevalence of lumbosacral radiculopathy (LR) in two Sicilian municipalities (N = 14,540, as of November 1, 1987)., Material & Methods: During phase 1, we administered a brief screening instrument to subjects in the study population. In phase 2, study neurologists using specified diagnostic criteria investigated those subjects who screened positive. Our case finding was restricted to subjects who manifested symptoms of LR in the six months preceding the prevalence day., Results: We found 143 subjects affected by LR (112 definite, 31 possible) yielding a crude prevalence of 9.8 cases per 1,000 population. Age-specific prevalence was generally higher in men; it increased to a peak at age 50-59 years and decreased steadily thereafter. At the peak, prevalence was higher in factory workers, housewives, and clerks compared to workers in other occupations., Conclusions: LR is a common neurologic disease in the general population.

Introduction: Because of the limited information on cervical spondylotic radiculopathy, we conducted a door-to-door two-phase survey in a Sicilian municipality., Material and Methods: We first screened for cervical spondylotic radiculopathy among the inhabitants of the municipality: (N = 7653, as of the prevalence day, November 1, 1987). Study neurologists then investigated those subjects suspected to have had a cervical spondylotic radiculopathy. Diagnoses were bases on specified criteria., Results: We found 27 subjects affected by CSR (17 definite, 10 possible). Prevalence (cases per 1000 population) was 3.5 in the total population; it increased to a peak at age 50-59 years, and decreased thereafter. The age-specific prevalence was consistently higher in women., Conclusions: Comparison with other prevalence studies shows similar age-specific patterns, but different magnitudes, which may partly reflect methodologic differences across studies.

The effects of Viloxazine (VLX, 100 mg b.i.d. for 10 days) on the steady-state plasma concentrations of Oxcarbazepine (OXC), its active metabolite 10, 11-dihydro-10-hydroxy-carbazepine (MHD) and the corresponding diol (DHD) were studied in a randomized, double-blind cross-over placebo-controlled trial in 6 epileptic patients stabilized on a fixed dosage of OXC. Administration of VLX resulted in an 11% increase in the plasma concentration of MHD (p = 0.003) associated with a 31% fall in DHD levels (p = 0.0001). Plasma concentrations of unchanged OXC were unaffected by VLX. No changes in seizure frequency nor signs of drug toxicity were observed during the study. Although VLX may inhibit the conversion of MHD to the inactive diol, the interaction is unlikely to be of clinical significance.

Significant alterations in T cell subpopulations and function occur in chronic lymphocytic leukemia (CLL) patients. We studied whether abnormalities in peripheral blood T cell parameters were present in 15 untreated early stage CLL patients (ie, Rai stage 0, 1, 2). Seven of the nine patients showed decreased T helper support as compared to control T cells for pokeweed mitogen (PWM)-induced control B cell proliferation (ie, patient 6,063 +/- 1,434 cpm vs control 14,894 +/- 121 cpm). All stage 0 and 1 patients showed a marked impairment of T helper activity for control B cell proliferation (patient T = 7,752 +/- 1,137 cpm vs control T = 14,894 +/- 121 cpm). In a separate assay system, six of nine CLL patients showed T suppressor activity for control B cell proliferation greater than control T cell suppressor activity. Four patients were stage 0 and 1. CLL patients demonstrated markedly impaired T cell support for control B cell immunoglobulin synthesis compared to control T cells (188 +/- 28 vs 869 +/- 56 hemolytic plaque-forming cells (HePFC)/culture, respectively). Control T cells showed increasing support for control B cell immunoglobulin synthesis with increasing T:B cell ratios (869 +/- 56 vs 1,265 +/- 48 HePFC/culture, at 1:1 and 2:1 T:B cell ratios, respectively). In contrast, five of eight CLL patients' T cells showed no improvement in control B cell immunoglobulin synthesis with increasing T:B cell ratios (795 +/- 56 vs 569 +/- 48 HePFC/culture, at 1:1 and 2:1 T:B cell ratios, respectively). There was no direct correlation with CLL T cell-mediated suppression of B cell proliferation and suppression of B cell immunoglobulin synthesis. These studies suggest there is a complex array of abnormal immunoregulatory T cell function in early stage CLL. These include a prominent T helper dysfunction and more variable excessive suppressor activity. The relationship of these findings to the basic disease process remains to be elucidated.

Large granular lymphocytes (LGL) may exert regulatory influences on B cell immunoglobulin synthesis. We, therefore, investigated the influence of LGL from controls and B cell chronic lymphocytic leukemia patients (B-CLL) on control B cell proliferation to costimulation with the F(ab')2 fragment of goat antihuman mu and B cell growth factor (BCGF). Purified LGL (greater than 90% by morphology) from control and B-CLL peripheral blood were added in various concentrations to purified control B cells and incubated with anti-mu and BCGF for 3 days. [3H]-thymidine uptake of B cells was then measured. There was no proliferation of control or CLL LGL alone to the costimulatory signals of the F(ab')2 fragments of goat antihuman mu chain and BCGF. Addition of control LGL to equal numbers of control B cells did not blunt control B cell responsiveness to BCGF (with control LGL 8,649 +/- 298 cpm vs. control B cells alone 8,336 +/- 556 cpm, mean +/- SEM). When control LGL were increased to 10:1 LGL:B cell ratio, the maximal inhibition by control LGL of control B cell proliferative response to BCGF was 23%. In contrast, addition of CLL LGL at a 1:1 LGL:B cell ratio resulted in marked impairment of the control B cell proliferative response to BCGF (with CLL LGL 3,586 +/- 954 cpm vs. control B cells alone 8,649 +/- 298 cpm). Inhibition by CLL LGL occurred in a cell-concentration-dependent manner. No difference in CLL LGL's inhibitory effect on either resting or activated control B cell responsiveness to BCGF was noted. Inhibition of de novo protein synthesis (by cycloheximide inhibition) of CLL LGL did impair CLL LGL's inhibitory capacity for BCGF-induced B cell proliferation. A possible explanation for these findings includes the possibility that a subgroup of LGL with B cell suppressive activity may have expanded as a host response to the B cell leukemia or as part of the disordered cell regulation in B-CLL.

Low-dose Ara-C (10 mg/m2 subcutaneously bid) has been used as an alternative therapy for acute nonlymphocytic leukemia (ANLL) and myelodysplastic syndromes. We sought to define its therapeutic mechanism by assessing clinical and cytogenetic responses to treatment in conjunction with careful in vitro study of both morphologic and functional characteristics of bone marrow cells cultured with Ara-C. Sixteen patients (12 ANLL, four myelodysplastic syndrome) were treated. All developed pancytopenia and 11 of 12 had bone marrow hypoplasia during treatment. Four had a meaningful clinical response while five more showed in vivo leukemic cell sensitivity to low-dose Ara-C. Seven showed no response. Cells with cytogenetic abnormalities were either decreased in number or eradicated during clinical improvement. Liquid culture of marrow mononuclear cells with Ara-C (.033-.333 micrograms/ml X 7 days) produced little evidence of morphologic or functional differentiation (ten of 11 studied). No functional maturation was observed in cells from clinically responding patients. We conclude that low-dose Ara-C is modestly effective for some patients with ANLL or myelodysplasia. However, no evidence for in vivo leukemic differentiation is suggested by either in vitro culture studies or cytogenetic correlates of clinical response. In vitro marrow culture studies failed to predict clinical response to Ara-C.

Nine patients with acute myelogenous leukaemia were treated with low-dose ARA-C (10 mg/m2, q 12h) for a planned 21 d. Complete remission was attained in only one patient (11.1%). Definite cytoreductive effect was seen in four additional patients. There was one treatment-related death. Haematologic toxicity occurred in all nine patients with sever thrombocytopenia most prominent. Severe hepatotoxicity precluded further ARA-C treatment in one patient. Because of toxicity only two patients were able to complete their scheduled 3 week courses of low-dose ARA-C. No evidence of ARA-C induced differentiation of leukaemic cells was noted on follow-up bone marrow examination during or shortly after the treatment course. The utility and indication for low-dose ARA-C therapy of AML remains to be determined.