Search

BACKGROUND: The function of the thyroid gland effects on obesity and comorbidities. It has been proven for bariatric surgery to be the most effective in obesity treatment. AIM: to evaluate the dynamics of body weight, thyroid status, leptin and insulin resistance in obese patients after bariatric surgery. MATERIALS AND METHODS: 74 obese patients were observed after bariatric surgery (sleeve gastrectomy 42, gastric bypass - 32); initial body mass index (BMI), thyroid stimulating hormone, free T4, fasting plasma leptin, insulin and glucose were estimated; the insulin resistance index HOMA-IR was calculated. The dynamics of body weight was estimated by BMI and the excess BMI loss (% EBMIL). After 3 years of follow-up, 48 patients were examined. RESULTS: Subclinical hypothyroidism (SH) was detected in 36.5% of patients with high degrees of obesity. A correlation was found between BMI and TSH level (R=0.5; p=0.01). HOMA-IR was increased in most patients with obesity of the II and III degree (4.81.9 ng / ml). In the SH group, the leptin level was significantly higher than in the group with a normal TSH level of 43.07.3 ng / ml and 33.24.6 ng / ml (p=0.004). Among patients with initial SH, spontaneous reduction of TSH levels occurred in 45% patients 3 years after surgery. CONCLUSIONS: Postoperatively, the BMI decrease was associated with the decrease of TSH, leptin and HOMA-IR. The data obtained may reflect the effect of adipose tissue on the functional state of the thyroid gland in patients with high degrees of obesity after bariatric surgery. This seems to be extremely important for maintaining body weight.

Background: Bariatric surgery methods have proven to be most effective in treating obesity. Weight regain (WR) is often found after various types of bariatric surgery. The clinical significance of WR is not clearly defined. Aims: to assess the dynamics of body weight and determine the amount of clinically significant WR based on the study of carbohydrate metabolism and blood pressure in patients with obesity after performing sleeve gastrectomy (SG) and gastric bypass (GB). Materials and methods: 68 patients with obesity after SG (40) and GB (28) were observed for 3 years. Body mass index (BMI), percentage of excess BMI lost (% EBMIL), WR, glycated hemoglobin, blood pressure were evaluated. Results: A comparable efficiency (EBMIL more than 50%) of the SG and the GB was at the nadir point. %EBMIL over 50% was achieved in 78.8% of patients after SG and 80.0% of patients after GB. WR more than 15% was associated with a significant increase in systolic blood pressure. Clinically significant WR in the SG group was detected in 32.5% of patients, in the GB group in 17.2% of patients (p 0.05). Conclusion: WR of more than 15% was associated with a significant increase in systolic blood pressure in patients with obesity after SG and GB, which makes it possible to consider WR of more than 15% clinically significant. A clinically significant WR 36 months after surgery was detected in 32.5% of patients after SG and 17.2% of patients after GB.

Background Current guidelines recommend an early invasive strategy for patients with non-ST segment elevation myocardial infarction (NSTEMI). Purpose To evaluate whether early invasive strategy is associated with better outcome among patients with chronic kidney disease (CKD). Methods Retrospective cohort analysis of consecutive patients with NSTEMI between 2008 and 2021. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation. Invasively treated patients were dichotomized into early ( Results Final study population comprised 7,107 NSTEMI patients, of whom 3,172 (45%) had eGFR Conclusion Among invasively treated NSTEMI patients, the benefit of early invasive strategy is modified by CKD, and limited to those with eGFR ≥45 ml/min/1.73m2. Funding Acknowledgement Type of funding sources: None.

OBJECTIVE. The study assessed an efficacy of laparoscopic gastric bypass (LRGB) in correction of main components of metabolic syndrome (MS). The authors revealed the possible reasons of insufficient efficacy of operation. MATERIAL AND METHODS. Results of LRGB were estimated in 228 patients who underwent operation during 5 years. Index of body mass, % EBMIL, lipid spectrum, level of glycemia, content of leptin and ghrelin were considered. RESULTS. The high efficacy of operation influence on MS was found in young age groups. Other groups had lower efficacy of operation. The reason was in gastrointestinal tract reconstruction that resulted in decrease of body mass, regress of associated diseases, change of key hormones which regulated energy metabolism, homeostasis of glucose and lipids. The ghrelin level didn’t have a determining value and didn’t influence on decrease of MT after operation. CONCLUSIONS. The operation effectively influenced on all possible components of MS, but the ghrelin content wasn’t determinative for long-term regulation of body mass loss and reduced the efficacy of operation.

Obesity has a negative impact on female reproductive health. The review presents literature data on current views on the etiology, pathogenesis of obesity and its impact on the reproductive health of women. Particular attention is paid to problems arising in women of reproductive age who are obese.

OBJECTIVE. The study aimed to improve the results of gastric bypass surgery. MATERIALS AND METHODS. The article analyzed the results of surgical treatment of 342 patients with metabolic syndrome who underwent operation at the period from 2008 to 2016.The patients were divided into 2 groups according to the type of operation. The first group included 224 (65,4 %) patients who underwent standard surgery LGB using Lontron procedure. The second group numbered 118 (34,5 %) patients whom LGB operation with ARC (the original method) were performed. The efficacy of operation was evaluated in different terms (after 3-month, one year and 3 years). The article described in detail and showed the technique of proposed modified operation of gastric bypass surgery. RESULTS. The proposed method of operative treatment was validated by researches performed. There was demonstrated higher efficacy of operations compared with the standard gastric bypass surgery. CONCLUSIONS. The operation of modified laparoscopic gastric bypass with formation of antireflux valve allowed clinicians to improve the results, decrease the number of complications and have a strong influence on main components of metabolic syndrome.

The characteristic feature of molecular medicine as medicine based on molecular structure of human genome data, is its individual character. It is focused on correcting pathological process in specific individual considering unique characteristics of its genome. The other most important feature is its expressed preventive direction. The complete genome information can be obtained well before the onset of disease. The appropriate preventive measures can completely eliminate or significantly prevent development of severe disease. The establishment of gene network of every multi-factorial disease, identification of central genes and genes-modifiers in it, analysis of association of their alleles with disease, development on this basis of set of preventive measures for specific patient constitute conceptual and methodological basis of predictive medicine. As a result of the examination, information can be obtained concerning particular risk of disease development. The physician, considering the results of molecular genetic analysis, elaborates tactics of pathogenetically justified preventive therapy, i.e. corrects congenital metabolic defect.

The article presents the results of treatment of 68 patients who underwent laparoscopic sleeve gastric resection (LSG) and laparoscopic gastric bypass (LGB) at the period from 2014 to 2015. The efficacy of operations on the course of nonalcoholic fatty liver disease (NAFLD) was estimated. There were performed a liver biopsy and histological studies with determination of histological activity index, the rate of severity of fibrosis according R. G. Knodell scale and METAVIR system, nature and degree of manifestation of steatosis of hepatocytes and intrahepatic cholestasis. NAS activity scale was used to evaluate morphological changes. The results of 1,5-year follow-up study were assessed in dynamics. Fibro Test results were in the range from 0 to 1 depending of fibrosis severity using METAVIR system (from F0 to F4), Knodell and Ishak scales. It was stated that there was an improvement of histological and functional findings in cases of hepatic steatosis, inflammation and fibrosis. All the patients (100%) initially had the signs of NAFLD and 12 patients (22,6%) - fibrosis. The complete regression of NAFLD was noted in 43(81,1%) cases and signs of previous fibrosis were smoothed over in 6 patients (41%). Liver function tests have deteriorated at 6-month period, but tests improved to normal rates at the end of 1-year period. The bariatric surgeries are effective methods of NAFLD treatment and Fibro Test is non-invasive and reliable method of liver state assessment.

Obesity has negative impact on female reproductive health. Various medical conservative and surgical interventions have been used to improve the reproductive function in obese women. In this literature review, we featurethe main modern methods of treating obesity in order to restore reproductive function in women.

Laparoscopic sleeve gastrectomy (LSG) was performed in 522 patients at the period from 2007 to 2015. The operation was carried out by different methods. It was stated that «the ideal candidates» for choosing LSG operation were the patients without metabolic syndrome (MS) and body-weight index, which wasn’t higher than 48 kg/m². The operation could be performed on patients younger than 40 years old in order to correct disorders of insulinic and cholesterol metabolism. Patients with MS have limitations for LSG application, because of this reason, the operation is advisable for younger age group without severe accompanying pathology. The operation could be applied in older age group in order to stabilize general condition in case of high risks as the first (sometimes the last) stage of treatment for the patients whom more effective operation couldn’t be recommended.

This work analyzed the results of surgical treatment of 380 patients who underwent the laparoscopic adjustable gastric banding (LAGB) at the period from 2004 to 2015. The patients were initially divided into 2 groups with metabolic syndrome (MS) and without MS according to the sex, age (up to 40 years old or older). As the result of performed analysis, there was stated that LAGB operation wasn’t effective and couldn’t be recommended for an application on the patients with MS. The patients have to follow necessary advice for life. Otherwise, the probability of complication development and recurrent operation would be really high and because of this, the more effective surgical treatment should be initially used. LAGB operation didn’t influence on pathogenetic mechanisms of main components of MS and couldn’t be regarded as effective. This LAGB operation is reasonable to apply in women without MS of young age group with initial body mass index lower than 43 kg/m². These women have to be able strictly follow doctor’s advice for life.

The article presents the assessment results of efficacy of modern bariatric laparoscopic operation during 10 years of practice. This work analyzed the treatment results of 1018 operated patients at the period from 2007 to 2014. The laparoscopic regulated gastric bandage operation was performed in 275 (28, 8%) cases. The lapa roscopic longitudinal gastric resection (LLGR) was applied in 411 (43,1%) (231 operation used the developed modification and 180 used standard method). The laparoscopic gastric bypass surgery (LGBS) was carried out in 253 (26,5%) cases (56 used the developed modification and 197 used the Lontron modification). The laparoscopic biliopancreatic bypass surgery (LBBS) was made in 14 (1,4%) cases (11 used Hess Marceau Baltasar modifications and 2 - Fobi modification, 1 - Scopinaro operation). BIB was implanted in 65 (6,3%) cases. The diagnosis of metabolic syndrome had initially been established for 321 (31,5%) patients. The rest of the patients 697 (68,4%) have been operated for obesity of different degree. An initial body mass index (BMI)

Melatonin is neurohormone, which is involved in regulation of many functions of an organism, including the digestive system. Therefore the authors offered to include this hormone as a preconditioner factor in surgical treatment of colon tumors using laparotomy and laparoscopy. Preoperative application of melatonin allowed shortening the terms of postoperative period and hospital stay.

Since the widespread introduction of minimally invasive laparoscopic techniques in abdominal surgery there was a question - what are their physiological differences from operations withapproach by laparotomy. The study of these differences, mechanisms and their correction allows you to bring the results of operations with open approach to the laparoscopic. However, the possibility of an effective systemic exposure, allowing adapting body reaction to surgical procedures remains unresolved. To date, the use of melatonin in surgical practice is based on its functions as a neurotransmitter that can potentiate some natural protective reaction of the body. The paper analyzes the effects of melatonin, you can use as a biological adaptogenic control which generally acts as a trigger to launch a diver-seprocesses, including reparative ones in the body. The use of adaptive mechanisms initiated by melatonin in response to surgical trauma and tumor processes can be successfully applied to improve the results of surgical treatment of patients with surgical diseases operated as open and laparoscopic access.

The research objectives are to determine serum interleukins (IL-2, IL-6) and tumor necrosis factor alpha (TNF - α) and evaluate their interrelation in liver cirrhosis (class A, B, C according to Chad - Pugh). 117 patients were examined and their cytokines levels were determined using enzyme-linked immunosorbent assay.Elevation of cytokine levels IL-2, I-6 and TNF-α within reference values was found in liver cirrhosis cases, expect for level IL-6 in liver cirrhosis cases of class C. In these cases IL-6 level exceeds reference values and is within the limit of 9,94 - 25,21 pg / ml with average concentration of 14,89±4,96 pg / ml. Correlation is found between TNF- α and IL-6 (r = - 0,499) in liver cirrhosis of class A and correlation between TNF- α and IL-2 (r = 0,421) is found in liver cirrhosis of class B.

The World Health Organization (WHO) declared obesity an epidemic of the 21st century. According to WHO, about 30% of the world’s population (more than 2 billion people) are considered overweight [1,2].

It was shown by the authors that changes of the level of cytokines reflected the degree of invasiveness of operative intervention. The endovideosurgical approach was less traumatic and provided a rapid rehabilitation of the patients in postoperative period. It is possible to consider the high levels of IL-10 as a predictor of development of local inflammatory process and as an indicator of probable infectious complications in postoperative period.

Aim. To study an interrelation of anxiety and depression with arterial hypertension (HT) of various degrees taking into account gender distinctions.Material and methods. One-stage (cardiology and psychometric screening) epidemiology study was carried out in 1% sample of the Novgorod Region adult population. The program of screening included the standard epidemiological record of HT detection and psychometric testing in 1607 respondents with the Hospital anxiety and depression scale (HADS). Risk calculation was performed by logistical regress model using disagreement criterion (odds ratio).Results. HT prevalence rate was 52.1% among men and 49.8% among women of Novgorod Region. The highest prevalence rate of HT was observed at the age ≥70 years: 88.9% among women and 83.6% among men. Relationship between subclinical and clinical types of the anxiety, depression and HT degrees 2-3 was revealed with some gender peculiar properties. Patients with isolated systolic HT had high association with anxiety and depression irrespective of gender.Conclusion. Revealed relationship between anxiety, depression and HT, especially in patients with HT degree 3, required an interdisciplinary approach to the therapy of this group of patients.

We conducted a translational genomic pilot study to evaluate the impact of genomic information related to colorectal cancer (CRC) risk on psychosocial, behavioral and communication outcomes. In 47 primary care participants, 96% opted for testing of three single nucleotide polymorphisms (SNPs) related to CRC risk. Participants averaged 2.5 of 6 possible SNP risk alleles (10% lifetime risk). At 3-months, participants did not report significant increases in cancer worry/distress; over half reported physical activity and dietary changes. SNP risk scores were unrelated to behavior change at 3-months. Many participants (64%) shared their SNP results, including 28% who shared results with a physician. In this pilot, genomic risk education, including discussion of other risk factors, appeared to impact patients' health behaviors, regardless of the level of SNP risk. Future work can compare risk education with and without SNP results to evaluate if SNP information adds value to existing approaches.

Aim. To study the effect of the antidepressant paroxetine on the compliance to antihypertensive therapy in patients with arterial hypertension (HT) and post-stroke depression.Material and methods. Patients (n=24) aged 55-73 with controlled HT (blood pressure, BP140/80 mmHg after 16 weeks was found in 10 (41.6%) patients. Clinical post-stroke depression was found in 7 (30.4%) patients, 5 (41.6%) of them were from group 2 (OR=0.35, 95% CI 0.12-0.78). High treatment compliance was in 15 (65.2%) patients, and 9 (81.8%) of them were from group 1. Nine (39.1%) patients did not receive an adequate antihypertensive therapy, 5 (41.6%) of them were from group 2 and could not explain their refusal from medication. General index of intellectual function was higher in patients of group 1 (p=0.034) than this in group 2; index of motor function did not change significantly (p>0.05).Conclusion. Reduction of compliance to antihypertensive therapy and rehabilitation in hypertensive patients after stroke is associated with unmotivated refusal from treatment because of clinical post-stroke depression.

Carriers for chronic granulomatous disease (CGD) and patients with lupus erythematosus (LE) share several characteristics: They are mostly females, they reduce nitroblue tetra-zolium (NBT) poorly in their neutrophils, and, in some cases, they have similar skin lesions. We thus investigated 19 female LE patients for the presence of laboratory findings characteristic of the carrier state for CGD. None of these patients turned out to have the combined abnormality of neutrophil bactericidal activity and neutrophil NBT-reduction that is diagnostic of CGD carrier state in the X-linked form. An increased frequency of CGD carriers among female LE patients thus appears to be unlikely. Why some CGD carriers develop skin lesions typical of LE remains unexplained.

This article describes the increasing use of the courts and the jails as “institutions of last resort” for multi-problem clients suffering the effects of mental retardation combined with other life challenges, such as mental illness, substance abuse, homelessness, and a history of physical and/or sexual abuse. The authors label these individuals as suffering from “Horrible Life Disorder” (HLD), and characterize them, for the most part, as lacking the comprehension necessary to navigate through the complexities of the court and probation systems. The article describes and evaluates the development of a program, within the Office of the Defender General of the State of Vermont, to (a) identify and accommodate such mentally retarded, HLD clients in the criminal justice system and (b) train public defense attorneys, judges, police, and probation officers to respond more effectively to the special issues of these citizens.

A ‘MicroSociety w ’ School includes time during all or most days for students to take on roles in developing and operating a miniature society, including, for example, such ‘institutions’ as businesses, consumers, elected officials, a money system, a tax collection system, police and courts. This case study, conducted by the first author, looks in detail at Mesquite, a school with a highly effective MicroSociety program, to discover the organizational factors and processes that appear to account for its success. This case is part of a larger, formative evaluation project, sponsored by MICROSOCIETY, Inc., the national organization that provides support for individual MicroSociety programs. The case took place in the context of the first author’s multiyear relationship as a type of ‘developmental evaluator’ for MICROSOCIETY, Inc., combining both evaluation and organizational consultation functions. The findings of the case study and the potentials and challenges of the author’s developmental evaluation role are described and discussed. q 2004 Elsevier Ltd. All rights reserved.

In the introduction to this Special Section, we proposed “the creation of a database of systematic, pragmatically focused case studies in program planning and evaluation [that] will be useful to both theorist and practitioner.” Six case studies have been presented to ‘pilot test’ the value and feasibility of this proposal. This concluding statement offers lessons learned from these case studies that argue for the database proposal's viability and that point to its future prospects.

The present Special Issue proposes that the creation of a database of systematic, pragmatically focused case studies in program planning and evaluation will be useful to both theorist and practitioner. This knowledge-base can (a) facilitate cross-case comparisons for inductively deriving generalizations of best practice; (b) allow practitioners to use the experience of past cases to guide their practice in present cases; and (c) further explore the foundational nature of evaluation as a discipline. This introduction first explores why there are so few published evaluation case studies. It then describes the development of a pragmatic paradigm, including a common analytic framework for facilitating the conduct, documentation, and discussion of individual case studies and for organizing them into a database. The introduction concludes with a cross-case summary comparison of the three cases in this first part of the Special Issue. In the next issue of this journal, a second part of the Special Issue will be presented. This will include three additional case studies and an analysis of all six of the case studies in terms of what we have learned about the theoretical and practical values—as well as the challenges—of creating a database of systematic, pragmatic case studies in evaluation.

Is there a therapy research paradigm that is suited to the models of clinicians who do not use a CBT approach? This article says yes, and describes that alternative: the collection into an organised database of systematic, 'pragmatic case studies' conducted by individual therapists. A review of this paradigm reveals that it can also serve the needs of CBT clinicians and researchers who, it turns out, are actually closet case-study advocates. (author abstract)

Aim. To study extra- and intracranial hemodynamics in patients with chronic hepatitis of different activity.Material and methods. Ultrasonography of the cerebral blood flow was performed in 576 patients with chronic hepatitis.Results. Contralateral hemyspherical asymmetry (more than 30 %) of the maximum linear rate of blood flow in the medium cerebral arteries and decrease in resistance index (0,55±0,09) and pulsativity index (1,34±0,66) were found in 33,8 % of patients with chronic hepatitis of high activity. Collateral blood flow reduction through connecting arteries of Willis circle was revealed in 13,8 % of patients. The tortuosity of arteries and thickening of intima-media complex was found in patients with chronic hepatitis (mainly of high activity). It leads to decline of cerebral blood flow.Conclusion. Symptomatic and asymptomatic cerebral blood flow disturbances were observed in 23,2% and 38,8% of patients with active chronic hepatitis respectively.

Importance The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions. Objective To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions. Design, Setting, and Participants A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures. Intervention Random assignment to print-based decision aid (n = 628), web-based interactive decision aid (n = 625), or usual care (UC) (n = 626). Main outcomes and measures Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening. Results Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P d ) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC ( d = 0.33) and print vs UC ( d = 0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P = .009) and significantly more web ( P = .001) and print ( P = .03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P = .06) and web participants (50.4%; P = .10) were not significant. Screening rates at 13 months did not differ significantly among groups. Conclusions and Relevance Both decision aids improved participants’ informed decision making about PCa screening up to 13 months later but did not affect actual screening rates. Dissemination of these decision aids may be a valuable public health tool. Trial Registration clinicaltrials.gov Identifier:NCT00196807

Despite significant progress in genomics research over the past decade, we remain years away from the integration of genomics into routine clinical care. As an initial step toward the implementation of genomic-based medicine, we explored primary care patients’ ideas about genomic testing for common complex diseases to help develop future patient education materials and interventions to communicate genomic risk information. We conducted a mixed-methods study with participants from a large primary care clinic. Within four focus groups, we used a semi-structured discussion guide and administered brief pre- and post- discussion quantitative surveys to assess participants’ interest, attitudes, and preferences related to testing and receipt of test results. Prior to the discussion, moderators presented a plain-language explanation of DNA and genetics, defined “SNP”, and highlighted what is known and unknown about the risks associated with testing for SNPs related to colorectal cancer risk. We used the NVIVO 8 software package to analyze the transcripts from the focus group discussions. The majority of participants (75 %) were “very” or “somewhat interested” in receiving information from a colon cancer SNP test, even after learning about and discussing the small and still clinically uncertain change in risk conferred by SNPs. Reported interest in testing was related to degree of risk conferred, personal risk factors, family history, possible implications for managing health /disease prevention and curiosity about genetic results. Most people (85 %) preferred that genetic information be delivered in person by a healthcare or genetics professional rather than through print materials or a computer. These findings suggest that patients may look to genetic counselors, physicians or other healthcare professionals as gatekeepers of predictive genomic risk information.

The U.S. Department of Energy's Biomass Program has begun an initiative to obtain consistent quantitative metrics for algal biofuel production to establish an 'integrated baseline' by harmonizing and combining the Program's national resource assessment (RA), techno-economic analysis (TEA), and life-cycle analysis (LCA) models. The baseline attempts to represent a plausible near-term production scenario with freshwater microalgae growth, extraction of lipids, and conversion via hydroprocessing to produce a renewable diesel (RD) blendstock. Differences in the prior TEA and LCA models were reconciled (harmonized) and the RA model was used to prioritize and select the most favorable consortium of sites that supports production of 5 billion gallons per year of RD. Aligning the TEA and LCA models produced slightly higher costs and emissions compared to the pre-harmonized results. However, after then applying the productivities predicted by the RA model (13 g/m2/d on annual average vs. 25 g/m2/d in the original models), the integrated baseline resulted in markedly higher costs and emissions. The relationship between performance (cost and emissions) and either productivity or lipid fraction was found to be non-linear, and important implications on the TEA and LCA results were observed after introducing seasonal variability from the RA model. Increasing productivity and lipidmore » fraction alone was insufficient to achieve cost and emission targets; however, combined with lower energy, less expensive alternative technology scenarios, emissions and costs were substantially reduced.« less

Most medical organizations recommend informed decision making before undergoing prostate cancer screening. The authors conducted a detailed evaluation of men's use of an interactive, Web-based prostate cancer screening decision aid. Participants (N = 531) were 57 years old (SD = 6.8), 37% were African American, and 92% had Internet access. Men completed 2 telephone interviews, pre- and 1-month post-Web site availability. Half of the sample (n = 256) accessed the Web site. Multivariate analysis revealed that users were more likely than nonusers to be White (OR = 2.37, CI 1.6-3.6), previously screened (OR = 2.13, CI 1.07-4.26), have Internet access (OR = 3.66, CI 1.15-11.58), and to report daily Internet use (OR = 2.58, CI 1.47-4.55). Agreement between self-reported and actual Web site use was moderate (κ = .67). Tracking software revealed a mean of 1.3 (SD = 0.5) log-ons and a median of 38 min per log-on. Of participants, 84% used the values clarification tool, and more than 50% viewed each video testimonial. Baseline screening preference was associated with values clarification tool responses and Web site feedback. This study revealed that, beyond the digital divide, Web site use depended on more than Internet access. Further, electronic tracking of Web site use demonstrated overestimation of self-reported use, high use of interactive features, and effect of baseline screening preference on men's response to the Web site.

To cope with the current diversity and centrifugal trends in our field, the National Conference on Graduate Education in Psychology recently proposed that each department and school of psychology conduct a self-study to clarify its goals, values, and curricular emphases. This article provides a blueprint to enable programs in any area of applied or professional psychology to engage in such a process of intensive self-scrutiny. The model adopted is based chiefly on four features of organizational development: open systems theory, the distinction between process and task emphases, democratic values, and action research. A case example is provided to illustrate how application of the model helps to insure the active collaboration of faculty, students, and alumni, resulting in a ready acceptance and implementation of recommended curricular changes.

This paper focuses on state level program evaluation: What are the conditions that influence its conduct and impact? A model is offered as a guide for assessing the conditions under which an evaluation is conducted, as well as its potential impact. The utility of the model is demonstrated by a case study that contrasts how two states approached the same issue, using similar data collection and analyses. The issue addressed by each state was the “Institute for Mental Disease” problem raised by the Federal Health Care Financing Agency.

SESSION TYPE: Miscellaneous Case Report Posters IPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Uterine artery Embolization (UAE) is a minimally invasive treatment for uterine fibroids and is an alternative to hysterectomy. Particles of polyvinyl alcohol are injected under fluoroscopy into the uterine artery to block vascularization to the fibroids. Common adverse effects include fever, nausea, cramping abdominal pain, and vaginal discharge of necrotic tissue and blood. Other complications such as uterine injury, infection and even sepsis are rare. Several case reports described patients developing pulmonary emboli following this procedure including 2 fatalities. We report a patient with a benign course of multiple leiomyomata in the lungs discovered 8 years after UAE.CASE PRESENTATION: 44 year old female with history of uterine fibroids status post UAE 8 years ago presented with symptoms of productive cough and shortness of breath. Chest X-ray showed multiple well circumscribed bilateral pulmonary nodules. On tomography (CT) scan the largest nodule was 2.8 x 2.6 cm. There was also some airspace disease noted in the right upper lobe. Patient was treated with antibiotics for community acquired pneumonia and her symptoms resolved. She underwent bronchoscopy with transbronchial biopsy which was non-diagnostic. Percutaneous CT guided biopsy of one of the peripheral nodules showed smooth muscle cells of uterine origin. Cells appeared to be well differentiated which is consistent with leiomyoma. Patient was monitored with biannual CT scans and the nodules remained stable on two follow-up scans. She remains asymptomatic. Patient was encouraged to undergo hysterectomy to prevent any further leiomyomatous metastases.DISCUSSION: UAE remains a popular and minimally invasive alternative to hysterectomy. Leiomyomatous tissue can be dislodged during this procedure and embolize in the pulmonary vasculature. Implantation into the parenchyma can lead to subsequent nodule formation. Benign metastasizing leiomyoma has been described after uterine manipulation. We report a patient who developed benign metastasizing leiomyoma discovered 8 years after UAE. Our patient has had a benign course and the pulmonary nodules have been stable in size for over one year.CONCLUSIONS: Benign metastasizing leiomyoma may occur after UAE. It appears to have a benign course and patients may not be symptomatic. Consideration of imaging after this procedure may be appropriate.1) Hamoda H, Tait P, Edmonds DK. Fatal Pulmonary Embolus After Uterine Artery Fibroid Embolisation. Cardiovasc Intervent Radiol 2009; 32:1080-1082.2) Poujade O, Genin AS, Dhouha M, Luton D. A Benign Metastasizing Leiomyoma Involving a Nodule in the Pulmonary Artery: Case and Literature Review. Eur J of Gynaecol Oncol 2010; 31:329-32.DISCLOSURE: Eric Anderson: Consultant fee, speaker bureau, advisory committee, etc.: Honoraria for educational lectures from superDimensionThe following authors have nothing to disclose: Dmitriy Kogan, Cristina Reichner, Mary Fishman, Gloria Bowles-JohnsonNo Product/Research Disclosure InformationGeorgetown University, Washington, DC.

Background Little is known about using the Objective Structured Clinical Examination (OSCE) in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course. Methods Cross-sectional study at Harvard Medical School, 1997–1999, for 489 second-year students. Results Average total OSCE score was 57% (range 39–75%). Among clinical skills, students scored highest on patient interaction (72%), followed by examination technique (65%), abnormality identification (62%), history-taking (60%), patient presentation (60%), physical examination knowledge (47%), and differential diagnosis (40%) (p < .0001). Among 16 OSCE stations, scores ranged from 70% for arthritis to 29% for calf pain (p < .0001). Teaching sites accounted for larger adjusted differences in station scores, up to 28%, than in skill scores (9%) (p < .0001). Conclusions Students scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching.

Pressure on the outer can thus of the eye can change the oculomotor innervation, and thus the corollary discharge, while a subject maintains monocular fixation on a visual target. We tested the possibility that sensory and motor effects of pressing an eye were due to a shift in the subjective straight-ahead direction. Subjects set an auditory source to straight ahead with and without a structured visual field and with and without eyepress. We also measured matching of auditory and visual targets under the same four conditions. Eyepress biased audio-visual matching with and without a structured field, but did not induce a straight-ahead shift. The deviation of the occluded eye was correlated with the amount of perceptual shift in audio-visual matching (r= .83). We conclude that perceptual offsets during eyepress are caused by a bias in extraretinal signals, and not by a cognitive straight-ahead shift.

Thirty chronic bronchitis and emphysema patients were assessed both upon entry into a comprehensive care program and after one year on the program. The following were evaluated: (a) objective signs of ventilation impairment (e.g. MVV and PaCO2); (b) symptoms of airway obstruction (e.g. experienced difficulty breathing) and (c) psychological adjustment, including affective distress, dependency behavior and selected types of psychopathology. In a comparison between the clinical status of the study group upon entering the care program and 1 yr later, the group showed some absolute improvement in objective signs and affective distress; some relative improvement in symptoms; and no changes in dependency behavior or psychopathology. In an analysis of relationships among patient changes on the different variables over the first year of the program, it was found that from both the patients' and the staff's point of view, improvement in objective signs, symptoms and psychological adjustment were all positively associated.

1. 1. One hundred ninety-six patients were treated with various types of fibrinolytic enzyme preparations. 2. 2. Of 538 intravenous and/or intra-arterial infusions, hemorrhage occurred in twelve cases, and pulmonary embolism in two. 3. 3. Pyrogenic side effects were seen commonly with earlier preparations but only four times in 385 treatments with newer, more purified preparations. 4. 4. With four- to eight-hour infusions, decrease of factors of the blood clotting system was never of sufficient magnitude to be of clinical significance. Rapid intravenous injection resulted in more pronounced changes. Factors most often affected were prothrombin, factor V, factor VII and fibrinogen. 5. 5. Retreatment with streptokinase or streptokinase-activated plasmin three weeks after an initial course of therapy resulted in anaphylactoid reactions in two of three cases. Retreatment with urokinase-activated plasmin caused no side effects and did not result in decreased therapeutic activity in twelve cases. 6. 6. In cases of thrombophlebitis or thrombosis of the large veins (chiefly complications of neoplastic diseases in elderly patients) of less than five days' standing when treatment was initiated, of sixty-two patients treated with streptokinase, urokinase- or chloroform-activated plasmin, streptokinase or urokinase, alone or in combination with anticoagulants, twenty-eight (45 per cent) returned to normal and twenty (32 per cent) improved in less than five days, six (10 per cent) did not improve and one died of pulmonary embolism. All preparations used appeared to be therapeutically active. The objectives and methods of this study precluded the use of a matched control group of patients on a randomized double-blind basis. Nevertheless, therapeutic results in the groups of patients treated with fibrinolysin were superior to those in the untreated group or groups treated with anticoagulants.

Methods for the purification and isolation of plasminogen, plasmin and the SK-plasminogen activator are reviewed. In addition, a new method is presented for the isolation of highly purified plasmin, and preliminary data are presented concerning attempts to isolate the SK-plasminogen activator in purer form than has hitherto been possible.

Prior to taste aversion conditioning with morphine, diazepam or delta 9-tetrahydrocannabinol (delta 9-THC), rats received pre-exposures to the vehicle or one of the three drugs. Morphine pre-exposures blocked the aversion normally induced by morphine, but not by delta 9-THC or diazepam. Diazepam pre-exposures attenuated both the morphine- and diazepam-induced taste aversions to a significantly greater degree than the taste aversion induced by delta 9-THC. As a result of delta 9-THC pre-exposures, the aversions induced by diazepam and delta 9-THC were attenuated as well as the morphine-induced aversion, which was the most greatly attenuated. These results demonstrate that pre-exposure effects are not necessarily bi-directional and, moreover, they are inconsistent with current hypotheses which attempt to account for the attenuating effect of drug pre-exposures on taste-aversion conditioning.

There has been an explosion in the understanding of the malignant nature of the cutaneous T cell lymphomas (CTCL) including mycosis fungoides and the Sezary syndrome during the past 15 years. Crossen et al. demonstrated that the malignant cells were lymphocytes and Brouet and co-workers and Zucker-Franklin and co-workers demonstrated that the malignant lymphocytes had T-lymphocyte membrane properties [3, 4, 12]. The cytologic and ultrastructural features of the cells with highly convoluted nuclei were described by Lutzner et al. [23]. Both Lutzner and Crossen found cytogenetic abnormalities in the malignant cells and this observation has subsequently been confirmed and extended [12, 23, 30]. Finally, it has recently been shown that the malignant cells are usually derived from the helper/inducer subset of T-lymphocytes [1, 2, 18, 21].