Overcoming minimal residual disease using intensified conditioning with medium-dose etoposide, cyclophosphamide and total body irradiation in allogeneic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia in adults

BACKGROUND AIMS: An intensified conditioning regimen incorporating medium-dose etoposide (VP16) is an option for patients with acute lymphoblastic leukemia (ALL). However, the prognostic impacts of the addition of VP16 to cyclophosphamide (CY) and total body irradiation (TBI) in patients with Philadelphia chromosome-positive (Ph+) ALL with regard to minimal residual disease (MRD) status have not been elucidated. METHODS: The authors retrospectively compared the outcomes of patients with Ph+ ALL who underwent allogeneic transplantation following VP16/CY/TBI (n = 101) and CY/TBI (n = 563). RESULTS: At 4 years, the VP16/CY/TBI group exhibited significantly better disease-free survival (DFS) (72.6% versus 61.7%, P = 0.027) and relapse rate (11.5% versus 21.1%, P = 0.020) and similar non-relapse mortality (16.0% versus 17.2%, P = 0.70). In subgroup analyses, the beneficial effects of the addition of VP16 on DFS were more evident in patients with positive MRD status (71.2% versus 48.4% at 4 years, P = 0.022) than those with negative MRD status (72.8% versus 66.7% at 4 years, P = 0.24). Although MRD positivity was significantly associated with worse DFS in patients who received CY/TBI (48.4% versus 66.7%, P < 0.001), this was not the case in those who received VP16/CY/TBI (71.2% versus 72.8%, P = 0.86). CONCLUSIONS: This study demonstrated the benefits of the addition of VP16 in Ph+ ALL patients, especially those with positive MRD status. VP16/CY/TBI could be a potential strategy to overcome the survival risk of MRD positivity

Child Abuse and Neglect in USA and Japan : Current Nursing Implications

Child maltreatment is broken down to neglect, physical abuse, sexual abuse, emotional abuse and other types. The reported number of child abuse was over 2 million in a population of 253 million in 1992 in the United States in contrast to 2,000 in 110 million in 1989 in Japan. Although the investigation is not complete in Japan, the rapid life style and culture may be creating more problems concerning violence, substance abuse, and break-down of the family than is actually seen. Unlike the United States, abusers in Japan are reported to be dominantly biological mothers than fathers. Because the risk factors on child abuse are linked to a child's physical and mental conditions, nurses need to recognize and approach effectively the risk factors of both children and abusers

PAEDIATRIC NURSING BY A MALE NURSE : A Case Report of a Sick Child with an Emotional Problem

This case report is focused on development of nursepatient relationship during patient's early days of hospitalisation. Two and a half year-old boy with a chronic pulmonary disease had been impossible to be given cares by nurses, and his mother had done everything for him. His long term illness and parents' divorce may have got him into a bad temper. Judging from his temperament mood he seemed to have emotional problems. One day when a male nurse came, he was accepted by him and almost instantly turned him into a sweet little toddler. The male nurse happened to be a longing father figure of the child and seemed to have fulfilled his emotional need, as the child had not seen his father as often as he wished. From this unexpected case, it was considered that the role of a male nurse especially for a little boy should be stressed more on Paediatric Nursing

Prevalence of Anti-Toxoplasma Antibodies and Hygienic Problems among Unmarried Young Women

We investigated the prevalence of anti-Toxoplasma antibodies in the general population, and among unmarried young women who were freshmen in the College of Medical Care and Technology, Gunma University. The frequency of anti-Toxoplasma antibodies among general population increased gradually from 0.7% in the under 19 year age group to 35% in the 80 to 99 year age group. Up to the age of 29 years (young age group), 2.8% had the antibody, between the age of 30 to 59 years (middle age group) 18.6%, and from the age of 60 and over (old age group) 34.2%. However, the level of titers in the young age group was higher than the others. The finding indicates recent infection of Toxoplasma gondii in the young age group. In the study of the year-to-year changes among freshmen from 1987 to 1992, there has been an obvious decrease in frequency. Nineteen out of 472 subjects (4.0%) had the antibody in 1987, and 12 out of 503 (2.4%) in 1992. The result indicates the risk of primary infection among young people

Effect of Fatty Acids and Prostaglandin on Androgen Receptor Binding in Human Prostatic Cancer Cells

The effect of fatty acids and delta 12 prostaglandin J2 (PGJ) on androgen ([3H]R1881) binding to human prostatic cancer cytosol was investigated with glycerol density gradient analysis and dextran-charcoal assay. The binding of androgen to the prostatic cancer cytosol receptor proteins was not modulated by saturated fatty acids such as palmitic acid (C16:0) or stearic acid (C18:0). Unsaturated fatty acids (UFAs) such as palmitoleic acid (C16:1), linoleic acid (C18:2) and arachidonic acid (C20:4) showed concentration dependent inhibition on androgen binding to the receptor. The inhibitory potency of UFAs did not parallel to the number of cis double bonds and carbon; however, C20:4 had a marked inhibitory effect on the binding. PGJ at a low concentration (9.0nM) stimulated androgen binding to the receptor up to 130% of the control value. At a higher PGJ concentration (30nM), the androgen binding was markedly reduced. The inhibitory effect of PGJ on the androgen binding was more potent than that of UFAs. The results suggest that modulation of steroid hormone action by UFAs is a general characteristic of steroid hormone target cells regardless of species differences or malignant transformation of the cells