Preliminary information has suggested that megestrol acetate leads to appetite stimulation and nonfluid weight gain in patients with breast cancer, other cancers, and AIDS. Pursuant to this, we developed a randomized, double-blind, placebo-controlled trial of megestrol acetate in patients with cancer-associated anorexia and cachexia. We randomly assigned 133 eligible patients to receive 800 mg of megestrol acetate per day or a placebo. Patients assigned to megestrol acetate more frequently reported improved appetite (P = .003) and food intake (P = .009) when compared with patients receiving the placebo. A weight gain of 15 lb or more over baseline was seen in 11 of 67 (16%) patients receiving megestrol acetate compared with one of 66 (2%) given the placebo (P = .003). Patients receiving megestrol acetate reported significantly less nausea (13% vs. 38%; P = .001) and emesis (8% vs. 25%, P = .009). No clinically or statistically significant toxic reactions were ascribed to megestrol acetate, with the exception of mild edema. This study convincingly demonstrated that megestrol acetate can stimulate appetite and food intake in patients with anorexia and cachexia associated with cancer, leading to significant weight gain in a proportion of such patients.
A topical capsaicin cream decreases postsurgical neuropathic pain and, despite some toxicities, is preferred by patients over a placebo by a three-to-one margin among those expressing a preference.
Pineal serotonin N-acetyltransferase (EC 2.3.1.5) is a neurally regulated enzyme. It is detectable in the rat as early as 4 days prior to birth. A circadian rhythm in enzyme activity appears on the fourth day after birth. It develops most rapidly during the second week and achieves an adult magnitude by the end of the third week at which time nocturnal values are more than 30-fold greater than daytime values. Norepinephrine, which appears to be the neurotransmitter regulating this enzyme, can cause a 2-to 3-fold stimulation of N-acetyltransferase in organ cultures of pineal glands from 4-day-old animals and a 17-fold increase in the activity of glands from 15-day-old animals. Apparently the norepinephrinesensitive system controlling pineal N-acetyltransferase activity also develops most rapidly during the first few weeks of life. The circadian rhythm in the activity of serotonin N-acetyltransferase develops in the pineal glands of both male and female rats at the same rate. A similar rhythm for the enzyme was not observed in twelve other tissues of the rat.
Antiestrogen therapy may offer the possibility of useful and, occasionally, long-term palliation of refractory epithelial ovarian carcinoma, with little toxicity. There may be a trend toward a dose-response effect, which represents a suitable topic for a future prospective trial.
Eine Mo2S3‐Monolage kann auf einer Kupfer(111)‐Oberfläche in Coexistenz mit dreieckigen MoS2‐Inseln und ‐Monolagen gezüchtet werden. Rastertunnelmikroskopie zeigt, dass Anthrachinon bevorzugt auf der Mo2S3‐Monolage adsorbiert und eine komprimierte Adsorbatlage bildet, bevor es andere Oberflächenbereiche, inklusive der reaktiven Randbereiche der MoS2‐Inseln, besetzt.
There are little objective data concerning physician bereavement or other supportive interactions with the families and caregivers of deceased patients. We surveyed the physician staff of a large tertiary rural referral center in central Pennsylvania. We asked about current practices in attending former patients' funerals, family condolence visits, letter or phone contacts, as well as the desire of physicians to participate in these activities. The database consisted of 143 questionnaires that were returned from 286 physicians initially mailed the survey. Only 119 of the 143 had experienced patient deaths in their practices. Most of these 119 physicians did not participate in any type of planned contact with a former patient's family after the patient's death. Phone calls were used 39.6% after an inpatient death, and condolence notes were sent by about 40% of physicians. There was no correlation between these activities and number of deaths in the practice per year or if death occurred as an inpatient or outpatient. Physicians practicing at the medical center more than 10 years were more likely to contact the grieving family or caregivers. There was significant desire by the physicians to have an easy way to identify deceased patients' caregivers or loved ones, to have condolence notes available for the physicians' use, and to have bereavement service information sent to the families or caregivers.
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