Retinal ganglion cells exhibit a loss of normal gene expression as an early (pre-BAX involvement) part of their apoptotic program during glaucomatous degeneration. This process can be ameliorated, but not completely blocked, using HDAC inhibitors. Epigenetic changes to active chromatin, such as deacetylation, may be mediated by HDAC3 in dying neurons.

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BackgroundPsychological distress is a common problem that occurs in advanced cancer patients; however, the concept has not been sufficiently specified or clearly described.ObjectiveTo develop succinct understanding of psychological distress among advanced cancer patients.MethodsA literature search was conducted using the CINAHL, PubMed, and MEDLINE databases from 1988 to 2018. The analysis used the 8 steps of concept analysis developed by Walker and Avant. The final articles selected focused on definitions, predictors, determinant factors, and measurements of psychological distress in advanced cancer.ResultsAnalysis identified that psychological distress in terms of advanced cancer has 5 defining attributes: (1) anxiety, (2) depression, (3) death anxiety, (4) demoralization, and (5) a perceived inability to cope effectively. The primary antecedent is treatment complexity. The consequences are acceptance and living in the present positively, lower performance status, poor quality of life, suicide, and hastened death.ConclusionsThis concept analysis clarifies the meaning of the concept and differentiates the concept of psychological distress from other emotional symptoms that advanced cancer patients commonly experience. It provides clarity in meaning by examining various ways the concept is used in the area of nursing.Implications for PracticeThe identified attributes of psychological distress play vital roles in nursing assessments and should be used as guidance for nurses to provide appropriate nursing care for advanced cancer patients. Interventions should address antecedents and consequences of the concept and consider individuals as persons with unique characteristics.